Tobacco Use: Health Risks, Cessation, and WHO Prevention

Posted on Sep 4, 2024 in Medicine & Health

Tobacco Use: Health Risks, Cessation, and WHO Prevention

Background

  • – Tobacco, derived from plant leaves and primarily used recreationally, poses significant health risks.

  • – Globally, smoking causes 48 million deaths annually, accounting for 1 in 4 deaths from diseases like cancer, cardiovascular disease, and respiratory illnesses.

  • – In the Czech Republic alone, there are 2.3 million smokers, including 250,000 individuals under 18 years old.

  • – Smoking is linked to various health issues, including a 20% prevalence of erectile dysfunction in males.

  • – Each cigarette reduces lifespan by 5 minutes, accumulating to 15 years over a lifetime.

  • – Quitting smoking significantly reduces the risk of acute myocardial infarction (AMI):

    • By 30% within hours
    • By 50% within years

Forms of Smoking

  • – Active smoking: Cigarettes, cigars, pipes

  • – Passive smoking: Second-hand smoke exposure

  • – Water pipe smoking: Poses even greater health risks than cigarettes

  • – Smokeless tobacco:

    • Oral tobacco (chewing), banned in most of Europe except Sweden

Classification of Smokers

  • – Occasional smokers

  • – Addicted (situational) smokers: Psychological dependence

  • – Mentally addicted smokers: Seek relaxation, stress relief, and emotional comfort

  • – Physically and mentally addicted smokers: Experience withdrawal symptoms like palpitations, sweating, flushing, tremors, and restlessness

Smoking Prevention and Education

– The EU’s “Help for Life Without Tobacco” campaign targets youth, non-smokers, and individuals aiming to quit, focusing on:

  • Smoking prevention
  • Smoking cessation support
  • Raising awareness about the dangers of passive smoking

  • – Youth-focused prevention strategies utilize educational resources, celebrity endorsements, and tobacco-free sports initiatives.

  • – Public smoking bans acknowledge the widespread impact of smoking and protect non-smokers from second-hand smoke.

  • – While initially believed to be most effective during teenage years, research indicates that smoking prevention requires a more comprehensive approach across different age groups.

WHO Preventing Activities of Tobacco Use

– In 2002, the WHO’s “Tobacco Free Initiative” convened a meeting to formulate policy recommendations for smoking cessation and treatment, targeting governments, NGOs, and healthcare professionals.

  • – Published in 2003, these recommendations emphasized the integration of smoking cessation policies into comprehensive tobacco control programs.

  • – Creating a supportive environment entails reducing tobacco accessibility, challenging social acceptance of smoking, and disseminating information to empower smokers to quit.

  • – Offering effective treatment for tobacco dependence to all users is crucial.

  • – Developing evidence-based national guidelines for tobacco dependence treatment is essential.

  • – Raising awareness among healthcare providers, administrators, and policymakers about the benefits and cost-effectiveness of cessation interventions is vital.

  • – Training healthcare providers at all levels to deliver effective cessation interventions is paramount.

– Fostering new partnerships is essential to secure financial and technical support for implementing evidence-based treatment approaches.

Legislation

  • – Increasing tobacco taxes

  • – Establishing smoke-free public spaces

  • – Enacting comprehensive bans on tobacco advertising and sponsorships

  • – Implementing stronger health warnings on tobacco products

Prevention in Families

– Parents should refrain from smoking at home to protect children from second-hand smoke exposure.

Smoking Cessation

  • – Voluntary commitment from the patient is crucial for successful cessation.

  • – Testing:

    • Basic anthropometric measurements (e.g., height, weight), blood pressure, heart rate
    • Exhaled carbon monoxide (CO) levels: >7 ppm indicates active smoking (lethal dose = 60 ppm)
    • Specific metabolite measurements
    • Dependence level assessment: A single question, “Would it be difficult for you to go one day without smoking?” can determine addiction (yes = addicted)

– Interview:

  • Gather information about smoking habits, history, and previous quit attempts.
  • Explain the concept of addiction and its implications.
  • Educate the patient about:
    • Challenges associated with quitting
    • Coping mechanisms for cravings and triggers
    • Strategies for avoiding high-risk situations
    • Information about the designated quit day (D-Day)
    • Available pharmacotherapy options
  • Schedule a follow-up consultation within two weeks.

– Homework:

  • List the pros and cons of smoking and the benefits of quitting.
  • Calculate monthly tobacco expenditure.
  • Determine the most suitable pharmacotherapy.
  • Emphasize the importance of quitting abruptly rather than gradually.

Tricks to Aid Cessation

  • – Keep hands occupied with fidget toys, stress balls, or puzzles.

  • – Substitute tobacco cravings with healthier alternatives like chewing gum, fruits (e.g., tangerines, oranges), or dark chocolate.

  • – Brush teeth after meals instead of smoking.

  • – Prepare assertive statements to decline cigarettes in tempting situations.

  • – Avoid unhealthy coping mechanisms like alcohol consumption.

Drug Assistance

Nicotine Replacement Therapy (NRT)

  • – Non-prescription options:

    • Chewing gum (2-4mg nicotine per piece, equivalent to approximately one cigarette, effects lasting around 30 minutes)
    • Patches (16-24 hours of nicotine delivery; 16-hour patches may lead to nighttime withdrawal symptoms; local skin reactions are common due to vasodilators; use for a minimum of 3 months)
    • Inhalers

  • – Safe for pregnant women, children, and individuals with cardiovascular disease.

  • – Potential side effects include allergies or reactions to vasodilating agents.

Bupropion (Antidepressant)

  • – Mechanism of action in smoking cessation remains unclear.

  • – Can be combined with NRT for heavy smokers, starting from D-Day.

  • – Initiate 1-2 weeks before D-Day.

  • – Relative contraindications: Pregnancy, seizure disorders, history of bulimia or anorexia, concurrent use of MAO inhibitors.

Varenicline (Nicotinic Acetylcholine Receptor Partial Agonist)

  • – Minimal drug interactions.

  • – Increases dopamine levels in the central nervous system and occupies nicotine receptors, reducing smoking pleasure.

  • – Side effects: Nausea, vivid dreams, morning sickness (adjusting the dosing schedule can alleviate these effects).

  • – Indicated for highly addicted smokers, those who have never successfully quit, or individuals with multiple failed quit attempts.

Other Support Systems

  • – Self-help groups (e.g., Nicotine Anonymous)

  • – Self-help books

  • – Nicotine-free alternatives like e-cigarettes

  • – Biochemical feedback methods for monitoring progress and enhancing motivation

  • – Complementary therapies: Acupuncture, herbal remedies, hypnosis