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Smoking Cessation Training

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					Smoking Cessation Training

        “Commit to Quit”
    The University of Texas Medical Branch
                   Galveston

           Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   1
Annual Number of Deaths: U.S.
               Alcohol
                                                            AIDS
                                                                          Tobacco
                                                                          Smoke
                                                                          Alcohol
                                                                          Cocaine
Secondhand Smoke
                                                                          Heroin
                                                                          Homicide
                                                                          Suicide
                                                                          Cars
                                                                          Fires
                                                                          AIDS

                                    Tobacco


                    Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132              2
Lung Cancer Death Rates
(British Physicians, 1951-1961, per 100,000)


                     3.5
                       3
       Death Rates




                     2.5
                       2
                     1.5
                       1
                     0.5
                       0
                           0    5       10       15       20       25       30       35   40
                               Average # of Cigarettes Smoked / Day

                               Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132             3
Cigarette Smoking and Lung Cancer




          Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   4
Risk Factors for Heart Disease




         Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   5
Most Common Cancers
          Men                                               Women
 Incidence     Mortality Incidence         Mortality
 1. Prostate 1. Lung       1. Breast      1. Lung
 2. Lung       2. Prostate 2. Lung         2. Breast
       3. Colorectal              3. Colorectal




            Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132     6
Smoking Risks and Pregnancy
      SIDS                                         1.25
                                              1

                                                                        1.98
    Low Wt
                                              1

                                                                1.7            Smokers
    Preterm
                                              1
                                                                               Nonsmokers
                                                      1.36
   SpnAbort
                                              1

              0           0.5             1            1.5              2
                                Relative Risk

                  Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                       7
Smoking Cessation Reduces Risk
  CORONARY                                      CANCERS
  HEART DISEASE                                   Lung
  STROKE                                         Head & Neck
  COLD / Enphasema                               Stomach
  LOW BIRTH WT.                                  Pancreatic
  Preterm Births, SIDS,                           Kidney
  ENT Infections
                                                  Bladder
  OSTEOPOROSIS
                                                  Cervical
  FIRE DEATHS

             Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   8
Life Expectancy:
Smokers vs. Nonsmokers

                  100

                  80
    % Surviving




                  60                                                               Smokers
                  40                                                               NonSmokers

                  20

                   0
                        0   35        45        55        65        75        85
                                               Age


                            Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                 9
How Smoking Causes Disease




        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   10
Dose Response
           Mortality Ratios by # Cigarettes Smoked

    40+/day                                                          2.36

   21-39/day                                                  2.03

   10-20/day                                          1.67

    <10/day                                   1.29

  Nonsmoker                              1

               0          0.5        1        1.5         2          2.5



                   Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132      11
Carcinogens in Cigarette Smoke
   Benz(a)anthracene                          Dibenzo(a,j)pyrene
   Benzo(b)fluoranthene                       Dibenzo(a,I)pyrene
   Cadmium/compounds                          Indeno(1,2,3cd)pyrene
   Dibenz(a,h)acridine                        2-Naththylamine
   Dibenz(a,h)anthracene                      N-Nitrosodiethylamine
   7HDibenzo(c,g)                                  – sonornicotine,
      – carbazole                                   – sopiperidine,etc.
   Dibenz(a,j)acridine                           2,3,7,8Tetrachloro-
                                                   dibenzo-p-dioxin
              Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132         12
Ciliotoxins in Cigarette Smoke
  Hydrocyanic                  acid
  Acrolein
  Ammonia
  Formaldehyde
  Acetaldehyde


         Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   13
Nicotine Levels in Smokers
            Blood Nicotine Concentrations
                       (ng/m l)


 30
 25                          26             26 27
                        24        23 24
 20             20 20
                                                       18 17
 15
           12                                                     12 13
 10
  5
  0
      8:        H       4:        8:          M         4:         8:
      00        N       00        00          N         00         00
      A                 P         P                     A          A
      M                 M         M                     M          M
                        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   14
Carbon Monoxide in Smokers
                   Carboxyhemoglobin (%)

  10

  8
  6

  4
  2

  0
   8am 10   HN    2       4       6       8      10     MN         2   4   6   8am



             Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                 15
Nonsmoker’s Exposures to ETS
                   Respirable Suspended Particulates
                                589
             600
             500                              417
                    351
   (UG/M3)




             400
             300                                           202              187
             200
             100
               0
                   Party        Bar         Bingo Bowling Public
                                                           Area



                      Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132         16
Nonsmoker’s Absorption of Nicotine
                             Urinary Cotinine Excretion

                1.5
   (ug/mg Cr)




                 1

                0.5

                 0
                      None           Work              Both
                                     only



                       Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   17
Who Smokes




       Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   18
Cigarette Smoking in the U.S.


               50

               40
Prevalence %




               30                                                                          Men
               20                                                                          Women

               10

               0
                1970   1975     1980        1985        1990         1995           2000

                              Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                  19
Educational Status and Smoking
                  40
                  35                                                             High School
                  30                                                             Dropout
   Prevalence %




                  25                                                             High School
                                                                                 Graduate
                  20
                                                                                 Some College
                  15
                  10                                                             College Graduate
                  5
                  0
                   1975   1980     1985      1990       1995       2000



                           Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                  20
Smoking Among Young People
     Compared to teens that don’t smoke,
             teens who smoke are:
   3 times more likely to use alcohol;
   8 times more likely to use pot; and
   22 times more likely to use cocaine!




          Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   21
Cigarette Smoking in the U.S.

                     Surgeon
               60    General’s
                    Report 1964            Cigarette Tax Doubles
                                                   1983
               50                                                          Tobacco
Prevalence %




                           Broadcast Ads                                Companies Law
               40            Ban 1973                                     Suits 1995
                                                                                                Men
               30
                                                          Tax Doubles
                                                                                                Women
               20                                         Again 1989
                                                                            Tobacco Free
                                                                            Schools 1997
               10
               0
                1965     1970     1975      1980       1985        1990    1995          2000

                                   Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132                  22
Why People Smoke




        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   23
Model Nonsmoking Behavior
  Out of 1,000 kids who smoke,
    750 come from families
   where one or both parents
             smoke!


        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   24
Factors in Smoking
  Psychosocial Factors
   Social Acceptability
   Feelings of Well-being
  Physiological Factors
   Nicotine Addiction
   Secondary Gains



           Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   25
Kicking the Habit
  Smoking Triggers
   Stressful life situations
   Other habits - coffee, alcohol, eating, sex
   Cues - others smoking, weight gain, etc...
  Cessation Triggers
   Encouragement from significant others
   New Coping Skills

           Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   26
Readiness to Change
   Precontemplation
   Contemplation
   Preparation
   Action
   Maintenance




             Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   27
Persistence Pays
                            1,000 smokers trying to quit

                  400
                                                                              1st try
   # Successful




                  300
                                                                              2nd try
                  200                                                         3rd try
                                                                              4-6th try
                  100
                                                                              7th try
                   0




                        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132           28
Commit to Quit




        Billy U. Philips, Jr., Ph.D., M.P.H. (409) 772-9132   29
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