] Medical training on tobacco

Royal College of Physicians of London Tobacco Advisory Group Medical training on tobacco Contents Section 1 – Active smoking Section 2 – Passive smoking Section 3 – Nicotine addiction Section 4 – Health Inequalities Section 5 – Policies to reduce smoking Section 6 – Smoking cessation Section 7 – Delivering cessation advice Section 8 – Questions that smokers ask Royal College of Physicians of London Tobacco Advisory Group 1. Active smoking King James I counterblaste • ...a custome lothesome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black and stinking fume thereof, nearest resembling the horrible stygian smoke of the pit that is bottomless (1604) What is smoking? • Chronic relapsing dependence syndrome • Smoking is use of the addictive drug nicotine • Delivered to the brain by tobacco smoke via lungs and blood • Reinforced by sensory, behavioural and social conditioning • Entrenched by powerful withdrawal syndrome • Great harm caused by toxins in the smoke • Promoted commercially • Regulated to some extent Who are the smokers (UK)? • 13 million adults (16+) – 26% women – 28% men • Sharp socio-economic gradient – 16% managerial / professional – 33% routine or manual – Up to 80% in the most deprived groups • 400,000 teenagers (11-15) – 11% girls – 9% boys Trends in UK adult smoking 60 50 40 Men Women % 30 20 10 0 1974 1978 1982 1986 1990 1994 1998 2002 Office of National Statistics, 2000 Trends in UK underage smoking (11-15 years) 16 14 12 10 % 8 6 4 2 0 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 19 99 20 00 20 01 20 02 Boys Office of National Statistics, 2000 Girls Why do people smoke? “The first cigarette is a noxious experience to the noviate.…that the beginning smoker will tolerate the unpleasantness we must invoke a psychological motive. Smoking a cigarette for the beginner is a symbolic act. I am no longer my mother’s child, I’m tough, I am an adventurer, I’m not square….the act of smoking remains a symbolic declaration of personal identity…. …As the force from the psychological symbolism subsides, the pharmacological effect takes over to sustain the habit.” (Philip Morris, 1969) Cause of harm •Tobacco smoke contains over 4,000 identified compounds, including: • • • • • • • • • • • • • • 2-nitropropane Acetaldehyde Acrolein Acrylonitrile Ammonia Aromatic amines Arsenic Aza-arenes Benzo (a) pyrenes Carbon monoxide Carboxylic acids Dimethylnitrosamine Formaldehyde Hydrazine • • • • • • • • • • • • • • Hydrogen cyanide Insecticide residues Isoprenoids Napthalenes Nickel Nicotine Nitrogen oxides Non-volatile nitrosamines Phenols Polonium-210 Polynuclear aromatic hydrocarbons Pyridine Urethane Vinyl chloride Largest single public health problem • 1 in 5 UK deaths caused by smoking • Largest avoidable cause of premature death • 2,300 killed every week All deaths Smoking statistics: Illness and deaths. ASH 2001 Smoking Other Life years lost to common risks The contribution of the main known, quantifiable risk factors to NHS preventable life years lost 4% 6% 13% 6% 2% 27% Drugs Atrial fibrillation Smoking Diet Cholesterol 13% 15% 14% Blood pressure Physical inactivity Obesity Alcohol Deaths attributable to smoking (1997) Main causes of death attributable to smoking (UK) Cancer Heart, stroke, circulation Lung diseases, COPD Digestive diseases, ulcers 45,100 37,900 34,100 1,900 119,000 RCP Nicotine Addiction in Britain, 2000 Smoking mortality figures • Richard Doll’s 40-year study of 40,000 British doctors • Numerous smaller studies • Established positive significant association with 24 causes of death • Other studies have proved associations with 50 diseases Overall risk to smokers and never smokers 100 Never smoked regularly 80 80 % Alive 60 40 Current cigarette smokers 59 7.5 years 33 20 12 0 40 Doll et al, BMJ 1994; 309:901-911 55 70 85 100 Age Life years lost due to smoking 25 Avge loss of life (yrs) 20 15 10 5 0 All Proportion of life-long smokers 1 smoker in 2 dies 15 years early 25 Avge loss of life (yrs) 20 15 10 5 0 Half Half Proportion of life-long smokers 1 smoker in 4 dies 23 years early 25 Avge loss of life (yrs) 20 15 10 5 0 Half 25% >70 Proportion of life-long smokers 25% <70 119,000 deaths from smoking-related diseases 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Men Women Others Respiratory disease Heart & circulatory disease All cancers 34,100 deaths from respiratory diseases 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Men Women Pneumonia Brochitis & Emphysema Other smoking deaths 37,900 deaths from heart and circulatory disease 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Men Women Aortic aneurysm Myocardial degeneration Atherosclerosis Stroke Ischaemic heart disease Other smoking deaths 45,100 deaths from smoking related cancers 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Men Women Cancers Other smoking deaths Smoking related cancers - breakdown Leukaemia 35,000 Pancreas 30,000 Bladder 25,000 20,000 15,000 10,000 5,000 0 Men Women Throat & Mouth Kidney Stomach Unspecified Oesophagus Lung Trends in UK smoking and lung cancer deaths Smoking prevalence Peto et al, BMJ 2000;321:323-329 Trends in UK smoking and lung cancer deaths Smoking prevalence Lung cancer deaths Peto et al, BMJ 2000;321:323-329 Other conditions associated with smoking • • • • • • • • • • • • • Angina risk 20 x risk Buerger’s disease Cataracts 2 x risk Crohn’s disease Depression Duodenal ulcers Chronic rhinitis Fertility 30% lower Graves’ disease Hearing loss Immune system impaired Decreased lung function Ocular Histoplasmosis • • • • • • • • • • • • • Optic neuropathy 16 x risk Menopause 2 years early Sudden Infant Death syndrome Osteoporosis Peripheral vascular disease Psoriasis 2 x risk Rheumatoid arthritis Reduced sperm count Tuberculosis Macular degeneration 2 x risk Low child birth weight 4 x risk Vocal chord polyps Increased sperm abnormalities Who smokes – worldwide 800 700 600 Smokers (millions) 60 50 40 Percentage 500 400 300 200 100 0 Developed Less Developed Countries 30 20 10 0 Developed Less Developed Countries Smoking related deaths - worldwide millions Now: • 4.9 million deaths per year • 40% in developing countries 10 8 6 4 2 0 Developing World Developed world Now Smoking related deaths - worldwide millions 10 By 2025: • 10 million deaths per year • 70% in developing countries Developing World 8 6 4 2 0 Developed world Now 2025