SMOKING IN PERSPECTIVE SMOKING IN PERSPECTIVE Approaching the Patient Approaching the Patient Who Smokes: Who Smokes: • Kills more than 480,000 Americans per year The Family Physician's Role in Successful The Family Physician's Role in Successful • Causes 1 in every 5 deaths in U.S. Smoking Cessation and Relapse Prevention Smoking Cessation and Relapse Prevention • Causes lung and other cancers, COPD, stroke, and heart disease • Contributes to complications of pregnancy ALAN BLUM, MD ALAN BLUM, MD • Adversely affects fetal and child health Gerald Leon Wallace, MD Endowed Chair in Family Medicine Gerald Leon Wallace, MD Endowed Chair in Family Medicine Director, The Center for the Study of Tobacco and Society Director, The Center for the Study of Tobacco and Society • Causes addiction that warrants treatment University of Alabama School of Medicine University of Alabama School of Medicine • Adds billions of dollars to health costs Academic Afternoon September 10, 2019 Academic Afternoon September 10, 2019 1
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SHIFTING THE FOCUS SHIFTING THE FOCUS Substance Product Effects Promotion User Pusher 5
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DEATHS FROM CIGARETTE DEATHS FROM CIGARETTE SMOKING IN U.S. SINCE 1964 SMOKING IN U.S. SINCE 1964 20,000,000 ADULT CIGARETTE SMOKING ADULT CIGARETTE SMOKING SMOKING DEATHS, 2016 SMOKING DEATHS, 2016 PREVALENCE, 2017 PREVALENCE, 2017 United States: 14.0% United States: 480,317 Alabama: 20.9% Alabama: 8,600 10
“TOBACCO CONTROL” “TOBACCO CONTROL” MOTOR VEHICLE DEATHS, 2017 MOTOR VEHICLE DEATHS, 2017 • Increase taxes • Raise purchasing age • Ban indoor smoking United States: 37,133 • Ban ads Alabama: 948 • Anti-smoking ads • Quitlines • Lawsuits • FDA regulation SMOKING CESSATION SMOKING CESSATION MARKERS OF ADDICTION • 37.8 million smoke • >20 cigarettes /day • 77% want to stop • Smoke upon awakening • 40% try each year • Psychiatric condition • 5% succeed • Alcohol dependence 11
REASONS PHYSICIANS DON’T REASONS PHYSICIANS DON’T ADVISE PATIENTS ON SMOKING ADVISE PATIENTS ON SMOKING PATIENTS WHO SMOKE PATIENTS WHO SMOKE CESSATION CESSATION • Patient sensitivity • No advice from MD: 50% • Time constraints • Tobacco-related deaths: 50% • Little or no reimbursement • Lack of self-efficacy • A role for ancillary personnel CONSUMER ADVOCATE CONSUMER ADVOCATE MEDICAL APPROACH MEDICAL APPROACH APPROACH APPROACH • “What brand do you buy?” • “How much do you smoke?” • “How much do you spend?” • “How long have you smoked?” KEYS TO SMOKING KEYS TO SMOKING SMOKING’S MYTHS SMOKING’S MYTHS CESSATION CESSATION • Relieves stress • Individualize • Keeps weight down • Personalize • Low-tar, filters, are safer • Demythologize • Contextualize 12
THE PRODUCT THE PRODUCT MOTIVATORS MOTIVATORS • Filter • Fear • Low tar • Humor • Lights • Anger • Menthol 13
SMOKING AND CANCER SMOKING AND CANCER • Mouth and pharynx • Larynx and lung • Esophagus, stomach, and colon • Pancreas and liver • Kidney and bladder COPD • 5% of US population • 80% caused by smoking • 4 th leading cause of death 14
MARLBORO’S MARLBORO’S CAMEL’S CORONARY CAMEL’S CORONARY MYOCARDIAL MAYHEM MYOCARDIAL MAYHEM CONSEQUENCES CONSEQUENCES • ↑ oxygen demand • Adverse lipid profile • ↓ angina threshold • Altered hematologic factors • ↓ exercise performance • Direct arterial wall effects • ↑ recurrent infarction • Elevated blood pressure DIABETES DIABETES SMOKING + DIABETES SMOKING + DIABETES 11x Cardiovascular Mortality 3x Cardiovascular Mortality SMOKING WORSENS… SMOKING WORSENS… • Asthma • Buerger’s disease • Macular degeneration • Periodontal disease • Peptic ulcer disease • Osteoprosis • Degenerative disc disease 15
POSTOPERATIVE POSTOPERATIVE EFFECTS ON FERTILITY OUTCOMES OUTCOMES Gonadotropins Sperm Motility/morphology • ↑ wound healing Androgen/Estrogens Ovulatory Cyclicity Spermato/Oogenesis Fertilization • ↓ cardiac morbidity Embryogenesis Implantation • ↓ respiratory morbidity BENEFITS OF STOPPING BENEFITS OF STOPPING COSMETIC BENEFITS COSMETIC BENEFITS • 1 day: ↓ Myocardial infarction risk • Fresher breath, clothing • 1 year: ↓ Stroke risk 50% • Whiter teeth, nails • 10 years: Stroke risk of non-smoker • Endurance • 15 years: CHD risk of non-smoker MONEY WASTED MONEY WASTED HITS TO THE HEART HITS TO THE HEART Number of packs/day Number of cigarettes/day x cost/pack x 10 inhalations/cigarette x 365 days/year x 365 days/year x number of years smoking = x number of years smoking = Total hits to the heart and lungs Total cash lost (plus interest) 16
METHODS FOR STOPPING METHODS FOR STOPPING BEHAVIOR MODIFICATION BEHAVIOR MODIFICATION • Avoid situations • Cold turkey • Use oral substitutes • Medication • Do Relaxation Response: • Counseling, quitlines, classes • Postpone • Hypnosis, acupuncture, herbs • Inhale • Reconsider RELAPSE PREVENTION RELAPSE PREVENTION ADJUNCTIVE THERAPY ADJUNCTIVE THERAPY • Gum (Nicorette) • Family and friends • Patch (Nicoderm) • Physician, dentist, nurse • Verenicline (Chantix) • Follow-up phone calls • Bupropion (Zyban) • www.WhyQuit.com • E-cigarettes TOP CAUSES OF DEATH TOP CAUSES OF DEATH 1. Heart disease 2. Cancer 3. Stroke 4. COPD 5. Accidents 6. Diabetes 17
LOW BIRTHWEIGHT LOW BIRTHWEIGHT • Smoking mothers: 12.40% • Non-smoking mothers: 7.66% SMOKING IN PREGNANCY SMOKING IN PREGNANCY EFFECTS IN CHILDREN EFFECTS IN CHILDREN • Low birthweight • SIDS • Preterm labor • Asthma • Spontaneous abortion • Bronchitis, pneumonia • Abruptio placenta • Otitis media • Placenta praevia • School performance • Premature rupture of membranes 18
SECONDHAND SMOKE SECONDHAND SMOKE • Lung cancer: 3,000 deaths/year • Heart disease: 40,000 deaths/year • Asthma: 2 million ER visits/year INFLUENCES INFLUENCES • Peers • Parents • Propaganda 19
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Alan Blum, M.D. Professor and Gerald Leon Wallace, MD Endowed Chair in Family Medicine Director, The University of Alabama Center for the Study of Tobacco and Society ablum@ua.edu 27
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