About 4.9 million die each year WW. By 2020 – 10 million

2. About 4.9 million die each year WW. By 2020 – 10 million Annually, smoking kills more people than a combined mortality from AIDS, alcohol, drug abuse, car crashes, murders, suicides, and fires

3. SMOKING FACT SHEET • Globally, 1 person dies every 6 seconds from smoking related diseases • A smoker loses an average of 13.8 years of life • One out of every five deaths is caused by tobacco

4. Tobacco use costs the United States billions of dollars each year. • Cigarette smoking costs more than $193 billion (i.e., $97 billion in lost productivity plus $96 billion in health care expenditures).1 • Secondhand smoke costs more than $10 billion (i.e., health care expenditures, morbidity, and mortality).

5. Thousands of young people begin smoking every day • Each day, more than 3,800 persons younger than 18 years of age smoke their first cigarette. • Each day, about 1,000 persons younger than 18 years of age begin smoking on a daily basis.

6. Many adult smokers want to quit smoking • Approximately 69% of smokers want to quit completely. • Approximately 52% of smokers attempted to quit in 2010.

7. Types of Tobacco – Smokeless Tobacco Smokeless tobacco snuff: Nicotine + Carcinogens + other toxins Gutkha is basically a sweetened mixture of tobacco, betel, lime and catechu chewed together. 7

8. Types of Tobacco – Smokeless Tobacco • Khaini: is basically a preparation made from tobacco leaves when they are mixed with lime and ready to be chewed. • Zarda: Chewing tobacco mostly added to betel leaves 8

9. Types of Tobacco Smoking 9

10. CIGARETTES: 20th Century phenomenon – Epidemic after 2nd world war CIGARS:A cigar is a tightly rolled bundle of dried and fermented tobacco. The wrapper determines much of the cigar's character and flavor. 6

11. Types of Tobacco Smoking - Pipes A "Bulldog" style pipe made of Briar wood Meerschaum (hydrated magnesium silicate), a mineral found mainly in central Turkey CALABASH GOURDS (usually with meerschaum or porcelain bowls set inside them) are quite expensive. “CORNCOB" pipes made from maize cobs are cheap

12. Types of Tobacco Smoking Egyptians call it Shisha, Lebanese refer to it as Nargile, in English, it is Hookah or hubble-bubble

13. Types of Tobacco Smoking - BIDIS • Bidis – common in south asia • Concentrations of nicotine, tar and other toxic agents in the smoke are much higher for bidi than for cigarettes. • Since bidi is hand-rolled, workers employed in bidi factories are at risk of developing cancerous conditions due to exposure to tobacco dust and flakes

14. Types of Tobacco Smoking Kreteks:are cigarettes made with a complex blend of tobacco, cloves and a flavoring 'sauce'. Kreteks are by far the most widely-smoked form of cigarettes in Indonesia.

15. Passive Smoking • Passive or involuntary smoking occurs when the exhaled and ambient smoke from one person's cigarette is inhaled by other people. • Passive smoking involves inhaling carcinogens, as well as other toxic components, that are present in secondhand tobacco smoke.

17. How Many Cigarettes Have You Smoked Without Knowing It? If you have been. . . it’s like you’ve smoked. . • In a smoky bar for 2 hrs = • In a nonsmoking section for 2 hrs = • In a car with someone, windows closed for 1 hr = source: breathe easy Springfield, www.breatheeasymo.org 17

18. Passive Smoking • Exposure to secondhand smoke occurs anywhere smoking is permitted: homes, workplaces, and other public places. • According to the WHO, some 200,000 workers die each year due to exposure to smoke at work, •  About 700 million children, around half the world's total, breathe air polluted by tobacco smoke, particularly in the home • Based on the evidence of three recent comprehensive reports on May 29, 2007, the WHO called for a global ban on smoking at work and in enclosed public places.

19. Passive Smoking • Secondhand smoke is known to harm children, infants and reproductive health • Acute lower respiratory tract illness, • Asthma induction and exacerbation, • Chronic respiratory symptoms, • Middle ear infection, • Lower birth weight babies, • Sudden Infant Death Syndrome, or SIDS. • Low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease,

20. What is third-hand smoke, and why is it a concern? Definition: A term used to describe the gases and small particles in cigarette smoke that are deposited on every surface they come in contact with. From the smoker's hair and clothing, to the environment the cigarette was smoked in, these toxic particles remain long after the cigarette has been put out and any secondhand smoke has been removed from the area.

21. What is third-hand smoke, and why is it a concern? • Residual nicotine and other toxic chemicals - indoor surfaces • Potential health hazard to nonsmokers (especially children.) • Third-hand smoke clings to hair, skin, clothes, furniture, drapes, walls, bedding, carpets, dust, vehicles and other surfaces, even long after smoking has stopped • Third-hand smoke residue builds up on surfaces over time and resists normal cleaning. • Can't be eliminated by airing out rooms, opening windows, using fans or air conditioners, or confining smoking to only certain areas of a home. • Third-hand smoke remains long after smoking has stopped

22. Tobacco Addiction • Motivated by the desire for nicotine. • Smokers regulate their nicotine intake and blood levels by adjusting the frequency and intensity of their smoking both to obtain psychoactive effects and avoid withdrawal. • Smokeless tobacco contains nicotine, carcinogens and other toxins capable of causing gum and oral disease mainly. • When tobacco is burned resultant smoke contains Nicotine, CO + 4000 other toxic compounds.

23. Effects of Smoking on Health • Nicotine is absorbed into pulmonary circulation, brain nicotinic cholinergic receptors • Smokeless tobacco is absorbed more slowly and results in less intense pharmacologic effects. • With long term use of tobacco, physical dependence develops as a result of an increased number of nicotinic cholinergic receptors in the brain.

24. Effects of Smoking on Health • The acidic pH of smoke generated by cigarettes dramatically reduces nicotine absorption in oral mucosa, necessitating inhalation of smoke deep into lungs. • Alkaline pH of smoke from tobacco utilized in cigars, pipes and smokeless tobacco allows absorption from oral mucosa to satisfy the smokers need for this drug.

25. Effects of Smoking on Health ORAL • Staining and shifting of teeth • Oral cancers • Mouth sores • Root caries (cavities) • Sinusitis • Hairy tongue • Smoker’s lip • Leukoplakia • Snuff Dipper’s lesions • Smoker’ palate • Periodontal diseases which includes bone and tooth loss, if unchecked, it can lead to complete destruction of the tooth’s supporting tissues, abscesses and, ultimately, loss of the tooth. • Dangerous gum diseases • Loss of taste sensation • Halitosis (Bad breath)

26. Effects of Smoking on Health NON MALIGNANT Gastrointestinal Respiratory Cardiovascular Ocular Sexual Dysfunction & Infertility Pregnancy related Skin wrinkling Osteoporosis

27. SMOKING HAZARDS – PEPTIC ULCER

28. SMOKING HAZARDS - COPD Increased incidence of Asthma Chronic obstructive pulmonary disease (COPD) is a permanent, incurable reduction of pulmonary capacity characterized by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis

29. SMOKER’S LUNG

30. SMOKING HAZARDS - LARYNX Larynx – SupraglotticSquamous Cell carcinoma Anterior Left Vocal Cord Polyp

31. SMOKING HAZARDS - VASCULAR • CVA • CARDIAC - CAD & MI • OCULAR • HYPERTENSION • THROMBOANGITIS OBLITERENS (BURGER’S DISEASE)

32. SMOKING HAZARDS - VASCULAR

33. SMOKING HAZARDS - EYE • Smoking doubles the risk of nuclear cataract. cataracts are more serious in heavy smokers than in light smokers. • Age related macular degeneration (AMD) risk among smokers is 2 to 3 times higher. • Smoking may accelerate the development of, or worsen diabetic retinopathy,

34. Anterior ischaemic optic neuropathy is an eye disease that results in a sudden, painless loss of vision, often leading to permanent blindness. Smokers are at a 16-fold increased risk

35. SMOKING HAZARDS - SEXUAL • Smoking increases the risk of erectile dysfunction because blood flow into the penis is blocked by atherosclerosis. • Smoking also causes • Abnormal sperm shape, • Impaired sperm motility • Damaged sperms, • Oligospermia • Reduced ejaculate volume

36. Smoking and Pregnancy • Smoking causes delivery complications, (Fetal tobacco syndrome) • Increases risk of pre-term delivery (premature rupture of membrane) • Abortions : 2 - 3 times • Abruptioplacentae & Placenta previa • Giving birth to low-birth weight baby : 4 times • Slows fetal growth • Smoking also increases risk of serious health problems to the newborn such as:  • Cerebral palsy • Mental retardation : 1.5 times • Learning disabilities  • Sudden Infant Death Syndrome (SIDS)

37. Smoking and Oral Hygiene After: After quitting and a thorough cleaning, this smoker's teeth were restored to their originalwhiteness. Failure to remain tobacco-free will cause the staining to recur in weeks • Before: 37-year-old heavy smoker with a heavy build up of dental calculus, stains, and severely offensive tobacco breath.

38. Smoking and Oral Hygiene Smokers can develop a condition called black hairy tongue

39. Smoking and Periodontitis Roughly half of periodontitis cases are attributed to current or former smoking. Smokers experience widespread periodontal destruction and have significantly greater loss of bone height

40. Smoker’s Palate Relatively common tobacco related white lesion seen in the palate of a pipe, cigar or a cigarette smoker. Unless the habit is particularly intense or the patient is a reverse smoker, risk for malignancy is quite low. The combination of tobacco smoke and heat combustion is believed to be important for this tissue change.

41. Smoker’s Melanosis Cigarette smoking in particular may lead to melanin pigmentation of the gums and other mucosal sites in the oral cavity. The process is reversible and improves when the patient quits smoking. It is a harmless condition but needs to be separated from other more serious pigmental disorders

42. Smoking Stains Smoking wrinkles “For smokers, middle-age starts in their early 30’s as the tell-tale wrinkles around the mouth and eyes begin to appear. Young female smokers are likely to be wasting their money on anti-aging face creams if they continue to smoke.”

43. SMOKING & ORAL CANCER A large cancer (Squamous CC) is shown growing out of neck of this patient’s neck. The cancer was due to smoking and started in patient’s mouth. The cancer eventually eroded into Carotid Artery causing massive bleeding & death.

44. Snuff Dipper’s lesions A white or discolored lesion of the oral mucosa occurring at the site at which the powdered tobacco is retained. Malignant transformations are not common but do occur, usually as low-grade VERRUCOUS CARCINOMAS.

45. New developments Global Treaty 2004 WHO Framework Convention for Tobacco Control (FCTC) • Need now to legislate and fund campaigns in accordance with it • The Convention entered into force on 27 February 2005 -- 90 days after it had been acceded to, ratified, accepted, or approved by 40 States. ( now 172 countries have ratified – covering 87% world population)

46. Non Party States Countries those have signed but not yet ratified U.S.A Argentina,  Cuba,  Czech Republic,  El Salvador,   Ethiopia,  Haiti, Morocco,  Mozambique,  Switzerland Countries that have not signed Andorra Dominican Republic,  Eritrea,  Indonesia,  Liechtenstein*,  Malawi,  Monaco,  Somalia, Tajikistan,  Uzbekistan,  Zimbabwe

47. Monitor tobacco use and prevention polices. Protect people from tobacco smoke.Offer help to quit tobacco useWarn about the dangers of tobacco.Enforce bans on tobacco advertising, promotion and sponsorship.Raise taxes on tobacco.

48. When it comes to stemming the flow of death and destruction that tobacco use leaves in its wake, it takes a village to effect change -- a global village. If adopted by governments around the world, these simple, yet powerful MPOWER policies could be a life preserver that will save millions and millions of lives.

49. From WHO: "To sell a product that kills up to half of all its users requires some extraordinary marketing savvy."

50. Quitting Smoking • How to stop smoking … for good!