Tobacco Use: Health Problems, Treatment, and Prevention
Health Problems of Tobacco Use, Options for Treatment of Nicotinism, WHO Preventing Activities for Tobacco Use
Background:
– Tobacco is an agricultural product processed from the leaves of plants and is used mainly for recreational purposes.
– Worldwide, 48 million people die every year as a consequence of smoking.
– 1 in every 4 citizens die from tobacco-related diseases (cancer, cardiovascular, non-neoplastic respiratory diseases, etc.)
– In the Czech Republic, there are 2.3 million smokers (250,000 <18y).
– Associated conditions: 20% of male ED.
– Each cigarette shortens life by 5 minutes; 15 years over a lifetime.
– If a smoker stops smoking, the risk of AMI decreases:
- By 30% in a matter of hours.
- By 50% in years.
Forms of Smoking:
– Active smoking – cigarette, cigar, pipe.
– Passive smoking – second-hand smoking.
– Special – water pipe (worse than smoking cigarettes).
– Smokeless tobacco:
- Oral – chewed (banned in Europe – except for Sweden).
Classification of Smokers:
– Occasional.
– Addicting (situational) – psychological dependence.
– Mental addiction – those whose motivation is relaxation, calming, and removing a feeling of emptiness.
– Mental and physical dependence – palpitations, sweating, flushing, tremors, and restlessness in the absence of smoking.
Smoking Prevention, Education
– “Help for life without tobacco” is the new EU’s antismoking campaign directed at young people, non-smokers, and people who would like to quit smoking.
The 3 priorities of the “help” campaign are:
- Smoking prevention.
- Giving up smoking.
- The dangers of passive smoking.
– For youth tobacco prevention, educational resources and materials such as videos, posters with celebrities, and tobacco-free sports initiatives are preferred.
– One of the most important education acts occurred when smoking was banned in public places, which is an acknowledgment that significant numbers of people smoke and put co-workers at risk.
– For years, many public health researchers believed that smoking prevention programs should be aimed at teenagers because they are the years when smokers take up the habit that remains with them up until adulthood. However, it has been proved that smoking prevention is more complicated than previously believed.
WHO Preventing Activities of Tobacco Use:
– In June 2002, the WHO ‘Tobacco Free Initiative’ organized a meeting to develop ‘Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence’ for governments, non-governmental organizations, and health professionals interested in making public health gains in the short and medium term.
The policy recommendations were published in June 2003.
– A smoking cessation policy should be part of any comprehensive tobacco-control policy if smoking cessation efforts are to be effective and sustainable.
– A supportive environment, including a decrease in the accessibility of tobacco products, a reduction in social acceptance of tobacco consumption, and an increase in information, will improve the likelihood of smokers quitting.
– All tobacco-users should be offered effective treatment for tobacco dependence.
– Member States should develop evidence-based national policy guidelines for the treatment of tobacco dependence.
– Awareness should be increased among health-care professionals, administrators, and policy-makers of both the benefits and cost-effectiveness of smoking cessation interventions relative to other health-care interventions.
– Training should be provided to all health-care providers at primary care, community and national levels to enable them to deliver smoking cessation interventions effectively.
– New partnerships are needed to increase commitment and the pool of financial and technical support for implementing evidence-based treatment.
Legislation:
– Increase taxes on smoking.
– Establish non-smoking public areas.
– Ban tobacco advertising.
– Stop sponsorships by tobacco companies.
– Stronger health warnings.
Prevention in Families:
Parents should not smoke at home.
Smoking Cessation
– It is essential that the patient voluntarily agrees to quit smoking.
– Testing:
- Basic anthropometric parameters, BP, HR, etc…
- Content of CO in exhaled air.
- >7 ppm in active smokers (lethal dose = 60 ppm).
- Specific metabolite measures.
- One question is enough to test the dependence level – “would it be difficult for you to go one day without smoking?”
- If the answer is yes, then the patient is addicted.
– Interview:
- Information about smoking habits and history; previous attempts at quitting.
- Explanation of the problem of addiction.
- Educate the patient.
- Problems associated with quitting.
- What to do with their hands.
- What to do when they crave a cigarette.
- How to avoid risky areas.
- About the D day.
- About assistance pharmacotherapy.
- Arrange another consult in 2 weeks.
- Homework:
- Write down the pros and cons of smoking and the benefits of non-smoking.
- Calculate how much money is spent on tobacco each month.
- Set the best pharmacotherapy.
- Explain that they must stop at once, not in little bits.
– Tricks to help:
- Keeping the hands busy – intelligent plasticine, power-ball, toys.
- Avoiding the taste – replace the need for tobacco with something good.
- Chewing gum, tangerine, orange (peeling takes time), chocolate.
- After eating – instead of smoking, brush teeth.
- Prepare sentences to say in situations where the pressure to smoke is high.
- Avoid inappropriate compensations – e.g. alcohol.
Drug Assistance:
– Nicotine replacement therapy.
- Non-prescription:
- Chewing gum – 2-4mg of nicotine; one gum corresponds to about 1 cigarette; effects last about 30 minutes.
- Patch – 16-24h (the 16h patch may cause night-time withdrawal). Local erythematous reactions are normal due to the addition of vasodilators. Used for at least 3 months.
- Inhaler.
- Can be used by pregnant women, children, and people with CVD.
- Side effects – allergy or physiological reaction to vaso-relaxing substances.
- Non-prescription:
– Bupropion – antidepressant.
- The exact mechanism is unknown.
- For heavy smokers, it can be combined with NRT, but only from D day.
- 1-2 weeks before D-Day.
- Relative contraindications include – pregnancy, seizures, epilepsy, active or history of bulimia or anorexia, concomitant use of MAO inhibitors.
– Varenicline – partial agonist of the nicotinic AChRs.
- No drug interactions.
- Increases dopamine in the CNS and has an antagonistic effect to nicotine because the nicotine receptor is occupied – the patient smokes but derives no pleasure from it.
- Side effects – nausea, unusual dreams, morning sickness.
- Changes in the schedule can help.
- Indicated for smokers who – are addicted, never stopped smoking, or who unsuccessfully tried to quit.
– Self-help groups e.g. Nicotine Anonymous.
– Self-help books.
– “Faux” cigarette can be used as an alternative to smoking as well as cessation.
– Biochemical feedback methods can allow tobacco-users to be identified and assessed, and the use of monitoring throughout an effort to quit can increase motivation to quit.
– Alternatives such as acupuncture, herbs, hypnosis.