Elif Horozoğlu

Smoking TobaccoSmoking Tobacco

Health consequences of tobacco useHealth consequences of tobacco usePassive smokingPassive smokingInterventions for reducing smoking ratesInterventions for reducing smoking ratesEffects of quittingEffects of quitting

Health consequences of tobacco useHealth consequences of tobacco usethe number one preventable cause of death the number one preventable cause of death and disability in U.S.and disability in U.S.more than 440.000 deaths a year, mostly more than 440.000 deaths a year, mostly from cancer, cardiovascular disease, and from cancer, cardiovascular disease, and chronic obstructive pulmonary diseasechronic obstructive pulmonary diseaseUntil the mid-1990s, CVD is the first leading Until the mid-1990s, CVD is the first leading smoking-related cause of death. Smoking-smoking-related cause of death. Smoking-related cancer deaths now exceed smoking-related cancer deaths now exceed smoking-related CVDrelated CVDChronic obstructive pulmonary disease is the Chronic obstructive pulmonary disease is the third leading cause of death.third leading cause of death.

What is the evidence?What is the evidence?

Although experimental studies are lacking, Although experimental studies are lacking, descriptive researches have firmly established descriptive researches have firmly established a a cause and effect relationshipcause and effect relationship between between cigarette smoking and lung cancer, heart cigarette smoking and lung cancer, heart disease, and chronic obstructive pulmonary disease, and chronic obstructive pulmonary disease.disease.

Smoking and cancerSmoking and cancerplays a role in the development of several cancers, plays a role in the development of several cancers, especially lung cancer.especially lung cancer.80% of smoking-related cancer deaths are from lung 80% of smoking-related cancer deaths are from lung cancer.cancer.Smoking may be responsible for lip, pharynx, pancreas, Smoking may be responsible for lip, pharynx, pancreas, esophagus, larynx, trachea, urinary bladder, and kidney esophagus, larynx, trachea, urinary bladder, and kidney cancer.cancer.Relative risk for lung cancer among cigarette smokers is Relative risk for lung cancer among cigarette smokers is 9.0.(the strongest link between any behavior and a major 9.0.(the strongest link between any behavior and a major cause of death).cause of death).During the mid 1960s, cigarette consumption began to During the mid 1960s, cigarette consumption began to drop sharply, and then about 25 to 30 years later, lung drop sharply, and then about 25 to 30 years later, lung cancer deaths among men began to decline.cancer deaths among men began to decline.

Smoking and cardiovascular Smoking and cardiovascular diseasedisease

the leading cause of death in the US and the second the leading cause of death in the US and the second largest cause of tobacco-related deathslargest cause of tobacco-related deathsRelative risk for CVD among smokers is about 2.0.Relative risk for CVD among smokers is about 2.0.Smoking increases the progression of atherosclerosis by Smoking increases the progression of atherosclerosis by as much as 50% during a 3- year period, speeding the as much as 50% during a 3- year period, speeding the plaque formation within the arteries.plaque formation within the arteries.Nicotine increases heart rate, blood pressure, and Nicotine increases heart rate, blood pressure, and cardiac output.cardiac output.plaque formation + nicotine stimulation increase plaque formation + nicotine stimulation increase smokers’ risk of CVD. smokers’ risk of CVD.

Smoking and chronic obstructive Smoking and chronic obstructive pulmonary disease pulmonary disease

the third leading cause of death in US, and the the third leading cause of death in US, and the third leading cause of tobacco-related deathsthird leading cause of tobacco-related deathsChronic bronchitis and emphysema are the two Chronic bronchitis and emphysema are the two most deadly COPDs.most deadly COPDs.Since 1950s, mortality rates from COPD have Since 1950s, mortality rates from COPD have increased faster than any other major cause of increased faster than any other major cause of death except HIV infection.death except HIV infection.COPD is relatively rare among nonsmokers. COPD is relatively rare among nonsmokers. Only 4% of male nonsmokers and 5% of female Only 4% of male nonsmokers and 5% of female nonsmokers receive diagnosis of COPD.nonsmokers receive diagnosis of COPD.

Other effects of smokingOther effects of smoking

Smoking has an interactive effect with depression;that is Smoking has an interactive effect with depression;that is smokers tend to have more depressive symptoms and smokers tend to have more depressive symptoms and depressed people tend to smoke more.depressed people tend to smoke more.periodontal disease, multiple sclerosisperiodontal disease, multiple sclerosisCompared to non-smoker, smokers more likely toCompared to non-smoker, smokers more likely to

commit suicidecommit suicide develop common colddevelop common cold have problem with cognitive functioninghave problem with cognitive functioning experience accelerated facial wrinklingexperience accelerated facial wrinkling hearing losshearing loss macular degeneration( a serious visual impairment)macular degeneration( a serious visual impairment)

Other effects of smokingOther effects of smoking

Female smokers double their chances of developing Female smokers double their chances of developing ovarian cysts, and women smoking at least one pack of ovarian cysts, and women smoking at least one pack of cigarettes a daycigarettes a day, , increases their risk of bone fractures.increases their risk of bone fractures.

Smoking makes males older, less attractive in Smoking makes males older, less attractive in appearance, and increases their chances of becoming appearance, and increases their chances of becoming sexually impotent.sexually impotent.

Cigar and pipe smokingCigar and pipe smoking

Cigar and pipe smoking may be less dangerous than Cigar and pipe smoking may be less dangerous than cigarettes, but they are not safe.cigarettes, but they are not safe.People who smoked only cigars had a risk of 2.9, and People who smoked only cigars had a risk of 2.9, and those who smoked only pipes had a 2.5 increase in their those who smoked only pipes had a 2.5 increase in their risk for lung cancer.risk for lung cancer.However, the combination of cigars or pipes with However, the combination of cigars or pipes with cigarettes dramatically increased the relative risk for lung cigarettes dramatically increased the relative risk for lung cancer.cancer.The relative risk for the combination of cigars and The relative risk for the combination of cigars and cigarettes is 6.9,whereas the combination of pipes and cigarettes is 6.9,whereas the combination of pipes and cigarettes is 8.1! cigarettes is 8.1!

Passive smokingPassive smoking

Environmental tobacco smoke (ETS) or second hand Environmental tobacco smoke (ETS) or second hand smokesmoke

Lung cancer, breast cancer, heart disease, and a variety Lung cancer, breast cancer, heart disease, and a variety of respiratory problems in childrenof respiratory problems in children

Passive smoking and lung cancerPassive smoking and lung cancer

In general, the more smoke people are exposed to and In general, the more smoke people are exposed to and the longer the exposure, the higher the risk for lung the longer the exposure, the higher the risk for lung cancer.cancer.Exposure from a spouse or from coworkers creates a Exposure from a spouse or from coworkers creates a slightly elevated risk.slightly elevated risk.People exposed to environmental smoke during People exposed to environmental smoke during childhood have no elevated risk for lung cancer, and childhood have no elevated risk for lung cancer, and those exposed to their spouse’s smoke have only a those exposed to their spouse’s smoke have only a slight increase.slight increase.

Passive smoking and breast cancerPassive smoking and breast cancer

Although some early research showed that passive Although some early research showed that passive smoking was a risk factor for breast cancer, more recent smoking was a risk factor for breast cancer, more recent and better research indicated women are not under the and better research indicated women are not under the elevated risk from their smoking husbands.elevated risk from their smoking husbands.

Regarding of the husband’s level of smoking, the death Regarding of the husband’s level of smoking, the death rate of women married to smokers for 30 years or more rate of women married to smokers for 30 years or more was not more than the death rate of women married to was not more than the death rate of women married to nonsmokers.nonsmokers.

Passive smoking and CVDPassive smoking and CVD

A meta-analysis of researches indicated that the excess A meta-analysis of researches indicated that the excess risk of heart disease for passive smokers is about 25%.risk of heart disease for passive smokers is about 25%.

Although passive smoking kills thousands of people each Although passive smoking kills thousands of people each year, the risk from passive smoking is only aboutyear, the risk from passive smoking is only about

1/10 the risk from active smoking.1/10 the risk from active smoking.

Passive smoking and the health of Passive smoking and the health of childrenchildren

Infants whose mother smoke have an increased risk for Infants whose mother smoke have an increased risk for dying sudden infant death syndrome (SIDS), and the dying sudden infant death syndrome (SIDS), and the more cigarettes mothers smoke, the greater their infants’ more cigarettes mothers smoke, the greater their infants’ risk for SIDS.risk for SIDS.

increased risk of bronchitis, pneumonia, asthma, lower increased risk of bronchitis, pneumonia, asthma, lower respiratory tract illnesses, low birth weight and childhood respiratory tract illnesses, low birth weight and childhood cancercancer

Smokeless tobaccoSmokeless tobacco

Snuffing or chewing tobaccoSnuffing or chewing tobaccoAlthough the risk of smokeless tobacco Although the risk of smokeless tobacco isis not as great as not as great as cigarette smoking,cigarette smoking, smokeless tobacco has significant smokeless tobacco has significant health hazards.health hazards.

Increased rate of cancer of the oral cavity,Increased rate of cancer of the oral cavity, periodontal periodontal disease and heart diseasedisease and heart disease

People who use smokeless tobacco have a twofold risk People who use smokeless tobacco have a twofold risk for high cholesterol.for high cholesterol.

Interventions for reducing smoking Interventions for reducing smoking ratesrates

Deterring smoking Deterring smoking

Quitting smokingQuitting smoking

Deterring smokingDeterring smokingInformation alone is not an effective way to change Information alone is not an effective way to change behavior.behavior.Smoking prevention programs that use lectures, posters, Smoking prevention programs that use lectures, posters, pamphlets, articles in school newspapers etc. are almost pamphlets, articles in school newspapers etc. are almost universally ineffective in preventing young people from universally ineffective in preventing young people from starting to smoke.starting to smoke.Inoculation programs aimed at buffering young Inoculation programs aimed at buffering young adolescents against the social pressures to smoke have adolescents against the social pressures to smoke have been more effective than educational programs.been more effective than educational programs.buffering techniques + communitywide antismoking buffering techniques + communitywide antismoking campaign long-term positive resultscampaign long-term positive results

Quitting smokingQuitting smoking

The decline in smoking rates is not due to fewer people The decline in smoking rates is not due to fewer people starting to smoke but in large part to increased cessation starting to smoke but in large part to increased cessation rates.rates.Long-term smokers refuse to believe reports of negative Long-term smokers refuse to believe reports of negative effects of smoking.effects of smoking.Optimistic bias and high self-esteem may contribute to Optimistic bias and high self-esteem may contribute to the difficulty of quitting smoking.the difficulty of quitting smoking.Addictive qualities of smoking Addictive qualities of smoking

people seeking treatment for alcohol or drugpeople seeking treatment for alcohol or drug dependependendence who also smoked reported that cice who also smoked reported that cigarettes garettes would be the most difficult to quit.would be the most difficult to quit.

Quitting smokingQuitting smoking

Quitting without therapyQuitting without therapyUsing nicotine replacement therapyUsing nicotine replacement therapyReceiving psychological intervention Receiving psychological intervention Participating in a community campaignParticipating in a community campaign

Quitting without therapy Quitting without therapy

Schacter (1987) found that nearly a third of the heavy Schacter (1987) found that nearly a third of the heavy smokers who quit said they had no problems in quitting.smokers who quit said they had no problems in quitting.

Schacter’s research suggest that people who quit Schacter’s research suggest that people who quit smoking on their own largely succeed and never attend smoking on their own largely succeed and never attend a clinic.a clinic.People who attend clinics are atypical group and their People who attend clinics are atypical group and their failure rates are too high.failure rates are too high.

Using nicotine replacement therapy Using nicotine replacement therapy

Nicotine patch and nicotine gum are the two most Nicotine patch and nicotine gum are the two most common nicotine replacement therapies.common nicotine replacement therapies.The nicotine patch maintained 22% success versus 9% The nicotine patch maintained 22% success versus 9% for a placebo patch.for a placebo patch.Nicotine gum produced 17-18% success versus 11% for Nicotine gum produced 17-18% success versus 11% for a placebo.a placebo.The effectiveness of both nicotine patch and nicotine The effectiveness of both nicotine patch and nicotine gum is increased when combined with psychological gum is increased when combined with psychological interventions.interventions.Nicotine patch may cause skin reaction and nicotine gum Nicotine patch may cause skin reaction and nicotine gum may cause mouth soreness, hiccups, and jaw ache.may cause mouth soreness, hiccups, and jaw ache.Nausea, light headedness, and sleep disturbances are Nausea, light headedness, and sleep disturbances are other possible side effects.other possible side effects.

Receiving a psychological interventionReceiving a psychological intervention

Behavior moditification, cognitive behavioral approaches, Behavior moditification, cognitive behavioral approaches, contracts made by smoker and a therapist in which the contracts made by smoker and a therapist in which the smoker agrees to stop smoking, group therapy, social smoker agrees to stop smoking, group therapy, social support, relaxation training, stress management, booster support, relaxation training, stress management, booster sessions to prevent relapse are psychological sessions to prevent relapse are psychological approaches aimed at smoking cessation.approaches aimed at smoking cessation.

The stages of change model of James ProchaskaThe stages of change model of James ProchaskaPrecontemplation stage: no intention to quitPrecontemplation stage: no intention to quitContemplation stage: aware of the problem-consider Contemplation stage: aware of the problem-consider quitting sometime in the future.quitting sometime in the future.

Receiving a psychological Receiving a psychological intervention intervention

Going from precontemplation to preparation for quitting is Going from precontemplation to preparation for quitting is more effective than moving only to next step.more effective than moving only to next step.Supportive practitioners increase smokers’ self-efficacy.Supportive practitioners increase smokers’ self-efficacy.Verbal persuasion is one of the method for enhancing a Verbal persuasion is one of the method for enhancing a smoker’s self-efficacy. It has only limited influence.smoker’s self-efficacy. It has only limited influence.Previous successful performance the strongest source Previous successful performance the strongest source of self-efficacyof self-efficacySmokers who trained stress-coping skills are more likely to Smokers who trained stress-coping skills are more likely to quit than those who have not learned these techniques.quit than those who have not learned these techniques.CounselingCounseling ++ nicotine replacement therapy nicotine replacement therapy

the most effectivethe most effective

Participating a community Participating a community campaigncampaign

The percentage of people who quit smoking as a result The percentage of people who quit smoking as a result of health campaign is usually quite small, however if their of health campaign is usually quite small, however if their messages reaches people, then thousands of lives may messages reaches people, then thousands of lives may be saved.be saved.

Monetary incentives along with telephone counseling to Monetary incentives along with telephone counseling to smokers are not effective.smokers are not effective.

Who Quits and Who Does Not?Who Quits and Who Does Not?

GenderGenderMen have had higher quit rates than women over the Men have had higher quit rates than women over the past 40 years.past 40 years.Do women have more difficulty quitting than men?Do women have more difficulty quitting than men?NO! Because women who try to quit have more NO! Because women who try to quit have more obstacles to overcome.obstacles to overcome.Women more participate quitting programs voluntarily.Women more participate quitting programs voluntarily.When women decide to quit, they are as likely as men to When women decide to quit, they are as likely as men to quit.quit.Women have more difficulty during the first 24 hours, but Women have more difficulty during the first 24 hours, but after that they are equal to men.after that they are equal to men.

Who quits and who does not?Who quits and who does not?

AgeAgeYounger smokers who smoke at high level are less likely to quit Younger smokers who smoke at high level are less likely to quit than older smokers who smoke at a low level.than older smokers who smoke at a low level.

Educational levelEducational levelBecause smokers with lower levels of education Because smokers with lower levels of education

1)1) Begin smoking earlierBegin smoking earlier2)2) Have higher scores on neuroticismHave higher scores on neuroticism3)3) Have lower scores on emotional supportHave lower scores on emotional support4)4) Have low levels of perceived personal controlHave low levels of perceived personal control

Lower educational level is related to higher smoking rates. Lower educational level is related to higher smoking rates.

Who quits and who does not?Who quits and who does not?

A supportive social network may also help people quit A supportive social network may also help people quit smoking.smoking.Moreover, some researches suggests that problem Moreover, some researches suggests that problem drinkers who able to stop drinking are also able to quit drinkers who able to stop drinking are also able to quit smoking.smoking.Many people quit both simultaneously.Many people quit both simultaneously.

Relapse preventionRelapse prevention

Abstinence violation effectAbstinence violation effect one cigarette one cigarette createscreates a full relapse, complete with feelings of total a full relapse, complete with feelings of total failure.failure.1/4 of successful self-quitters slip at one time or another.1/4 of successful self-quitters slip at one time or another.Thus, a single slip shouldn’t discourage people from Thus, a single slip shouldn’t discourage people from continuing their effort to quitting!continuing their effort to quitting!2/3 of self-quitters relapsed after only 2 days and 92% 2/3 of self-quitters relapsed after only 2 days and 92% had resumed smoking after 6 months.had resumed smoking after 6 months.Formal smoking cessation programs’ relapse rate is Formal smoking cessation programs’ relapse rate is about 70 to 80%.about 70 to 80%.

Quitting and Weight GainQuitting and Weight Gain

Middle-aged people will gain weight whether they are Middle-aged people will gain weight whether they are smokers, have quit, or have never smoked.smokers, have quit, or have never smoked.The average weight gain for most men and women is The average weight gain for most men and women is relatively modest- about 9 to 11 pounds.relatively modest- about 9 to 11 pounds.However, some people gain large amounts of weight.However, some people gain large amounts of weight.Women are more concerned about weight gain than are Women are more concerned about weight gain than are men, but their total weight gain after quitting is about the men, but their total weight gain after quitting is about the same as that of men. Their percentage of weight gain is same as that of men. Their percentage of weight gain is more than men because men are heavier than women at more than men because men are heavier than women at baseline.baseline.

Quitting and weight gainQuitting and weight gain

Exercise can prevent weight gain in both women and Exercise can prevent weight gain in both women and men.men.

Quitting smoking is much more beneficial to health than Quitting smoking is much more beneficial to health than maintaining lower weight...maintaining lower weight...

Health benefits of quittingHealth benefits of quitting

After both female and male smokers have quit smoking After both female and male smokers have quit smoking for 16 years, they had about the same rate of mortality for 16 years, they had about the same rate of mortality as people who have never smoked.as people who have never smoked.

Smokers who quit can eventually reduce their risk of Smokers who quit can eventually reduce their risk of CVD to that of a nonsmokers, BUT their risk of lung CVD to that of a nonsmokers, BUT their risk of lung cancer does not change.cancer does not change.