Smoking

AdditivesCigarettes are more than just tobacco leaves

rolled in paper.

Cigarettes have approximately 597 other ingredients in them.

AdditivesSome additives are used to improve the flavor

(i.e. to decreases the bitterness of the tobacco).

Most additives are used to increase the tobacco’s potency resulting in increased addictiveness.

When burnt, the mix results in over 4,000 chemicals, including over 40 known carcinogenic compounds and 400 other toxins.

Smoke Constituents (according to Phillip Morris)Tobacco smoke contains thousands of different

chemicals, including tar, nicotine and carbon monoxide (CO).

In addition to tar, nicotine, and CO, nearly 5,000 chemicals have been identified in tobacco smoke to date.

Public health authorities have classified between 45 and 70 of those chemicals, including carcinogens, irritants and other toxins, as potentially causing the harmful effects of tobacco use.

Some of the Harmful Chemicals in Cigarettes Cyanide

Benzene

Formaldehyde

Methanol (wood alcohol)

Acetylene (the fuel used in welding torches)

ammonia

Poisonous Gases Nitrogen oxide Carbon monoxide

Surgeon General’s Report on Smoking (2004)Smoking causes diseases in nearly every organ

of the body.

“The toxins from cigarette smoke go everywhere the blood flows.” – Dr. Carmona

Smoking kills an estimated 440,000 Americans each year.

On average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years.

Surgeon General’s Report on Smoking (2004)The economic tolls exceeds $157 billion each

year in the United States - - $75 billion in direct medical costs and $82 billion in lost productivity.

Statistics indicate that more than 12 million Americans have died from smoking since the 1964 report of the surgeon general, and another 25 million Americans alive today will most likely die of a smoking-related illness.

Smoking the low-tar or low-nicotine cigarettes does NOT offer a health benefit over smoking regular or “full-flavor” cigarettes.

Surgeon General’s Report on Smoking (2004)Quitting smoking has immediate and long-term

health benefits, reducing risks for diseases caused by smoking and improving health in general.

“Within minutes and hours after smokers inhale their last cigarette, their bodies begin a series of changes that continue for years,” Dr. Carmona said.

Quitting smoking at age 65 or older reduces by nearly 50% a person’s risk of dying of a smoking-related disease.

Diseases Linked To Smoking Lung cancer

Larynx cancer

Chronic bronchitis

Bladder cancer

Esophageal cancer

Mouth cancer

Throat cancer

Cardiovascular disease

Reproductive effects

Cataracts

Pneumonia

Acute myeloid leukemia

Diseases Linked To Smoking Abdominal aortic

aneurysm

Stomach cancer

Pancreatic cancer

Cervical cancer

Periodontitis

Cigarette Smoking and CancerCigarette smoking causes 87 percent of lung

cancer deaths and is responsible for most cancers of the larynx, oral cavity, pharynx, esophagus, and bladder.

Secondhand smoke is responsible for an estimated 3,000 deaths among U.S. nonsmokers each year.

Cigarette Smoking and CancerTobacco smoke contains thousands of chemical

agents, including over 60 substances that are known to cause cancer.

The risk of developing smoking-related cancers, as well as noncancerous diseases, increases with total lifetime exposure to cigarette smoke.

Smoking cessation has major and immediate health benefits, including decreasing the risk of lung and other cancers, heart attack, and chronic lung disease.

Chronic BronchitisChronic bronchitis is a disease where the

airways produce too much mucus, forcing the smoker to cough it out.

The lungs start to produce large amounts of mucus and do it more often.

The airways become inflamed and the cough becomes chronic.

Airways get blocked by scars and mucus.

Serious infections can result.

EmphysemaCigarette smoking is the major cause of

emphysema.

The disease slowly destroys a persons ability to breathe.

Oxygen gets into the blood by moving across a large surface area in the lungs.

EmphysemaNormally, thousands of tiny sacs make up this

surface area.

In emphysema, the walls between the sacs break down making larger, but fewer sacs.

This decreases the surface area, which lowers the amount of oxygen reaching the blood.

Overtime, the surface area can become so small that the person must gasp for breath.

Emphysema (Early Signs)Shortness of breath (especially when lying

down).

A mild cough that doesn’t go away (often dismissed as “smoker’s cough”).

Feeling tired.

Sometimes weight loss.

Emphysema (Later stages)Patients can only breathe comfortably with the

help of an oxygen tube under the nose.

More susceptible to other problems linked to weak lung function, including pneumonia.

Emphysema cannot be reversed, but it can be slowed – especially if the person stops smoking.

Chronic Obstructive Pulmonary DiseaseMore than 7 million current and former

smokers suffer from chronic and obstructive pulmonary disease (COPD).

Bronchitis and emphysema are types of COPD.

COPD is the fourth leading cause of death in America.

Chronic Obstructive Pulmonary DiseaseSmoking is the main risk factor for COPD.

The late stage of chronic lung disease is one of the most miserable of all medical problems.

It creates a feeling of gasping for breath all the time – much like the feeling of drowning.

Smoker’s CoughChemicals and heat from the smoke destroy

cilia.

Cilia are tiny hairlike formations that beat outward and sweep harmful material out of the lungs.

Cigarette smoke slows the sweeping action.

Some of the poisons in the smoke stay in the lungs and the mucus stays in the airways.

Smoker’s CoughWhile a smoker sleeps, some of the cilia

recover and begin working again.

After waking up, the smoker coughs because the lungs are trying to clear away the irritants that built up the day before.

The cilia will completely stop working after they have been exposed to smoke for a long period of time.

This makes the smoker’s lungs even more exposed and prone to infection and irritation.

Smoking and Heart DiseaseSmoking increases the risk of heart disease,

which is the number one cause of death in the United States.

Smoking, high blood pressure, high cholesterol, physical inactivity, obesity, and diabetes are all risk factors for heart disease, but cigarette smoking is the biggest risk factor for sudden death from a heart attack.

A smoker who has a heart attack is more likely to die within an hour of the heart attack than a non-smoker.

Smoking and PregnancySmoking during pregnancy is linked with a

greater chance of miscarriage, premature delivery, stillbirth, infant death, low birth-weight, and sudden infant death syndrome (SIDS).

Up to 5% of infant deaths could be prevented if pregnant women did not smoke.

Secondhand SmokeSecondhand smoke is also known as

environmental tobacco smoke (ETS).

ETS is a combination of the smoke coming from the lit end of a cigarettes plus the smoke exhaled by a person smoking.

Secondhand SmokePublic health officials have concluded that

secondhand smoke from cigarettes causes disease, including lung cancer and heart disease, in non-smoking adults, as well as causing conditions in children such as asthma, respiratory infections, cough, wheeze, otitis media (middle ear infection) and Sudden Infant Death Syndrome.

Secondhand smoke can exacerbate adult asthma and cause eye, throat and nasal irritation.

Helping Smokers QuitA guide for Clinicians from the U.S. Department

of Health & Human Services

“Even brief tobacco dependence treatment is effective and should be offered to every patient who uses tobacco.” - Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update

Helping Smokers QuitAsk

Advise

Assess

Assist

Arrange

AskAsk about tobacco frequency at every visit.

Implement a system in your clinic that ensures that tobacco-use status is obtained and recorded at every patient visit.

AdviseAdvise all tobacco users to quit.

Use clear, strong, and personalized language. For example:

“Quitting tobacco is the most important thing you can do to protect your health.

AssessAssess readiness to quit.

Ask every tobacco user if he/she is willing to quit at this time. If willing to quit, provide resources and assistance. If unwilling to quit at this time, help to motivate

the patient: Identify reasons to quit in a supportive manner. Build patient’s confidence about quitting.

AssistAssist tobacco users with a quit plan.

Assist the smoker to: Set a quit date, ideally within 2 weeks. Remove tobacco products from their environment. Get support from family, friends, and coworkers. Review past quit attempts – what helped, what led

to relapse. Anticipate challenges, particularly during the critical

first few weeks, including nicotine withdrawal. Identify reasons for quitting and benefits of quitting.

AssistGive advice on successful quitting:

Total abstinence is essential – not even a single puff.

Drinking alcohol is strongly associated with relapse.

Allowing others to smoke in the household hinders successful quitting.

AssistEncourage use of medication:

Recommend use of over-the-counter nicotine patrch, gum, or lozenge; or give prescription for varenicline, bupropion, SR, nicotine inhaler, or nasal spray, unless contraindicated.

Provide resources: Recommend the toll free 1-800-QUIT NOW (784-

8669), the national access number to State-based quitline services.

AssistRefer to Web Sites for free materials:

Agency for Healthcare Research and Quality: www.ahrq.gov/path/tobacco.htm

U.S. Department of Health and Human Services: www.smokefree.gov

ArrangeArrange followup visits.

Schedule followup visits to review progress toward quitting.

If a relapse occurs, encourage repeat quit attempt. Review circumstances that caused relapse. Use

relapse as a learning experience. Review medication use and problems. Refer to 1-800-UIT NOW (784-8669).

Help for Smokers and Other Tobacco UsersQuit Smoking

You can quit. Quitting is hard. Many people try several times before they quit for good, but they do succeed.

Good Reasons for QuttingYou will feel better.

You will have more energy and breathe easier. Your chances of getting sick will go down.

Smoking is dangerous. More than 435,000 Americans die each year from

smoking.

More Good Reasons for Quitting If you are pregnant, your baby will be healthier.

Your baby will get more oxygen.

The people around you, especially your children, will be healthier. Breathing in other people’s smoke can cause

asthma and other health problems.

You will have more money. If you smoke one pack per day, quitting smoking could save you up to $150 a month.

Savings Per MonthIf you smoke(packs per day)

You pay(per day)

Quitting saves(per month)

1 $5.00 $150

2 $10.00 $300

3 $15.00 $450

There Has Never Been a Better Time to QuitA combination works best.

Set a quit date. Get support. Take medicine.

Get Ready + Get Help + Get Medicine = Stay Quit!

Get ReadySet a quit date.

No smoking after: ____________________

Change the things around you. Get rid of all cigarettes in your home, car, and

place of work. Do not let people smoke in your home.

After you quit, don’t smoke – not even a puff! Don’t use any tobacco!

Get MedicineYou can buy nicotine gum, the nicotine patch,

or the nicotine lozenge at a drug store.

You can ask your pharmacist for more information.

Get MedicineAsk your doctor about other medicines that can

help you. Nicotine nasal spray. Nicotine inhaler. Bupropion SR (pill) Vaerenicine (pill)

Most health insurance companies will pay for these medicines.

Get HelpTell your family, friends, and people you work

with that you are going to quit. Ask for their support.

Talk to your doctor, nurse, or other health care worker. They can help you quit.

Call 1-800-QUIT NOW (784-8669) to be connected to the quitline in your State.

It’s free. They will set up a quit plan with you.

Stay Quit If you “slip” and smoke or chew tobacco, don’t

give up. Try again soon. Set a new quit date and get back on track.

Avoid alcohol.

Avoid being around smoking.

Eat healthy food and get exercise.

Keep a positive attitude. You can do it!

You Can QuitMost people try several times before they quit

for good.

Quitting is hard, but – You Can Quit!

Quitting During a Hospital StayYou hospital visit is a great time to quit

smoking.

Why should I quit now? Smoking may slow your recovery from surgery and

illness. It may also slow bone and wound healing. All hospitals in the United States are smoke free. You will be told NOT to smoke during your hospital

stay – now is a great time to quit.

Quitting During a Hospital StayHow do I quit in the hospital?

Talk to your doctor or other hospital staff about a plan for quitting.

Ask for help right away. Your doctor may give you medicine to help you

handle withdrawal while in the hospital and beyond.

Quitting During a Hospital StayHelpful hints to stay quit.

Ask your friends and family for support Continue your quit plan after your hospital stay. Make sure you leave the hospital with the right

medicines or prescriptions. If you “slip” and smoke, don’t give up. Set a new

date and get back on track. For help in quitting, call the National Quitline toll

free: 1-800-QUIT NOW.

Effects of Quitting20 minutes after quitting

Your heart rate and blood pressure drop

12 hours after quitting The carbon monoxide level in your blood drops to

normal

2 weeks to 3 months after quitting Your circulation improves and your lung function

increases

Effects of Quitting1 to 9 months after quitting

Coughing and shortness of breath decrease; cilia (tiny hairlike structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.

1 year after quitting The excess risk of coronary heart disease is half

that of a smoker’s.

Effects of Quitting5 years after quitting

Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.

10 years after quitting The lung cancer death rate is about half that of a

person who is still smoking. The risk of cancer of the throat, esophagus, bladder, cervix, and pancreas decreases.

15 years after quitting The risk of coronary heart disease is that of a non-

smoker’s.

Benefits That Will Be Seen Right AwayFood will taste better.

Your sense of smell returns to normal.

Your breath, hair, and clothes smell better.

Your teeth and fingernails stop yellowing.

Ordinary activities leave you less out of breath (i.e. climbing a flight of stairs or housework).

Stops premature aging of skin and gum disease from smoking.

Organizations That Can HelpAmerican Cancer SocietyToll-free number: 1-

800-ACS-2345 (1-800-227-2345)Web site: www.cancer.org

American Heart Association Toll-free number: 1-800-AHA-USA-1 (1-800-242-8721) Web site: www.americanheart.org

American Lung Association Toll-free number: 1-800-LUNG-USA (1-800-548-8252) Web site: www.lungusa.org

Organizations That Can HelpNational Cancer Institute Toll-free number: 1-

877-448-7848 (smoking cessation help) 1-800-4-CANCER (1-800-422-6237) for cancer informationWeb site: www.cancer.gov

Centers for Disease Control and PreventionToll-free number: 1-800-CDC-INFO (1-800-232-4636) Web site: www.cdc.gov/tobacco/quit_smoking/index.htm

Organizations That Can HelpSmokefree.gov (Info on state phone-based

quitting programs) Toll-free number: 1-800-QUITNOW (1-800-784-8669) Web site: www.smokefree.gov