Tobacco Use: Health Problems, Treatment, and Prevention
Tobacco Use: Health Problems, Treatment, and Prevention
Background
Tobacco, an agricultural product processed from plant leaves, is primarily used for recreational purposes.
Smoking causes 48 million deaths worldwide annually.
Tobacco-related diseases (cancer, cardiovascular disease, non-neoplastic respiratory diseases, etc.) are responsible for 1 in 4 deaths.
The Czech Republic has 2.3 million smokers, including 250,000 individuals under 18 years old.
Associated conditions include a 20% prevalence of erectile dysfunction in males.
Each cigarette reduces lifespan by 5 minutes, totaling 15 years over a lifetime.
Quitting smoking significantly reduces the risk of acute myocardial infarction:
- By 30% within hours
- By 50% within years
Forms of Smoking
Active smoking: Cigarette, cigar, pipe
Passive smoking: Second-hand smoking
Special: Water pipe (more harmful than cigarettes)
Smokeless tobacco:
- Oral: Chewed (banned in Europe, except Sweden)
Classification of Smokers
Occasional
Addicting (situational): Psychological dependence
Mentally addicted: Seek relaxation, calmness, and relief from emptiness
Mentally and physically dependent: Experience palpitations, sweating, flushing, tremors, and restlessness without smoking
Smoking Prevention and Education
The EU’s new antismoking campaign, “Help for Life Without Tobacco,” targets young people, non-smokers, and individuals who want to quit. The campaign prioritizes:
Smoking prevention
Smoking cessation
Dangers of passive smoking
Youth tobacco prevention utilizes educational resources like videos, posters featuring celebrities, and tobacco-free sports initiatives.
Banning smoking in public places acknowledges the health risks posed to non-smokers and is a crucial educational measure.
While initially believed to be most effective during teenage years, smoking prevention requires a more comprehensive approach.
WHO Tobacco Control Activities
In June 2002, the WHO Tobacco Free Initiative developed “Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence” for governments, NGOs, and health professionals.
Published in June 2003, the recommendations emphasize the importance of integrating smoking cessation policies into comprehensive tobacco control strategies.
Creating a supportive environment involves reducing tobacco accessibility, decreasing social acceptance of smoking, and increasing awareness to support smokers in quitting.
Effective treatment for tobacco dependence should be offered to all tobacco users.
Evidence-based national policy guidelines for treating tobacco dependence are crucial.
Health-care professionals, administrators, and policymakers need greater awareness of the benefits and cost-effectiveness of smoking cessation interventions.
Training for healthcare providers at all levels is essential for effective delivery of smoking cessation interventions.
New partnerships are needed to secure financial and technical support for implementing evidence-based treatment.
Legislation
Increase taxes on tobacco
Establish smoke-free public areas
Ban tobacco advertising
Prohibit tobacco company sponsorships
Implement stronger health warnings
Prevention in Families
Parents should maintain a smoke-free home.
Smoking Cessation
Voluntary commitment from the patient is essential.
Testing:
- Basic anthropometric parameters (BP, HR, etc.)
- Exhaled carbon monoxide (CO) levels: >7 ppm in active smokers (lethal dose = 60 ppm)
- Specific metabolite measurements
- Dependence level assessment: “Would you find it difficult to go a day without smoking?” (Yes indicates addiction)
Interview:
- Gather information on smoking habits, history, and previous quit attempts.
- Explain addiction and its implications.
- Educate the patient about:
- Challenges associated with quitting
- Coping mechanisms for cravings and hand habits
- Avoiding high-risk situations
- Setting a quit date (D-Day)
- Pharmacotherapy options
- Schedule a follow-up consultation in 2 weeks.
Homework:
- List the pros and cons of smoking and the benefits of quitting.
- Calculate monthly tobacco expenses.
Treatment plan:
- Determine the most appropriate pharmacotherapy.
- Emphasize the importance of quitting abruptly, not gradually.
Helpful Tips
Keep hands occupied with activities like using intelligent plasticine, power balls, or toys.
Replace tobacco cravings with healthier alternatives like chewing gum, tangerines, oranges, or chocolate.
Brush teeth after meals instead of smoking.
Prepare responses for situations with high smoking pressure.
Avoid unhealthy coping mechanisms like alcohol.
Drug Assistance
:– Nicotine replacement therapy
o 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
o Can be used by pregnant women, children and people with CVD
o Side effects – allergy or physiological reaction to vaso-relaxing substances – Bupropion – antidepressant
o The exact mechanism is unknown
o For heavy smokers, it can be combined with NRT, but only from D day
o 1-2 weeks before D-Day
o Relative contraindications include – pregnancy, seizures, epilepsy, active or history of bulimia or anorexia, concomitant use of
MAO inhibitors
– Vareniklin – partial agonist of the nicotinic AChRs
o No drug interactions
o 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
o Side effects – nausea, unusual dreams, morning sickness
Changes in the schedule can help
o 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.