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Tobacco Use and Lessons Learned as an RT Delegate to China

Tobacco Use and Lessons Learned as an RT Delegate to China

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Tobacco Use and Lessons Learned as an RT Delegate to China

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  1. Tobacco Use and Lessons Learned as an RT Delegate to China Gaylene Lee, M.Ed, RRT-NPS, TTS RT Program Director, SJVC Gaylene.Lee@sjvc.edu 559-790-8795

  2. One World One Dream 08/08/08 at 8:08p.m.

  3. Year of the Pig • Chinese Zodiac

  4. Global Tobacco Use and Mortality • Tobacco use:1.3 Billion Smokers (CDC) • Mortality: Five (5) million/year (National Cancer Institute) • Expected to increase to 10 million/year by 2025 • 20th century – 100 million deaths • 21st century – Expected to be one (1) Billion • Global leading cancer (American Cancer Society) • Lung Cancer: 1.35 million new cases and 1.18 million deaths each year • 600,000 die in China and over 160,000 in the U.S.

  5. Global Population • March 2008 • 6.60 billion • China • 1.30 billion • World’s largest and most populated • United States • 3.04 million

  6. United States versus China Tobacco Use • United States • 21.65% or 52 million (US Census Bureau of International Database) • China • 30.45% or 320.2 million (US Census Bureau of International Database) • 27% of total worldwide smokers (CDC) • 60% men (defined as15 or >) • < 5% women

  7. First Day in China

  8. Physicians and Teachers Tobacco Use in China • Physicians (WHO) • 68% • Teachers (WHO) • 65% I hope they don’t see the cigarette behind my back

  9. Tobacco Use Mortality Rate in China • Annually • One (1.0) million individuals due to tobacco use • 600,000 due to lung cancer (Ministry of Health and Anti-Cancer Association) • Will increase to 2.2 million by 2020, if nothing done • 100,000 due to second-hand smoke (Ministry of Health)

  10. Male and Female Guardian Lions (Foo Dogs)

  11. Tobacco Production in China • China National Tobacco Company (Largest Tobacco Company in the World) • Chinese government owned • Formed 1982 • Under the State Tobacco Monopoly Administration (STMA) also formed in 1982 • Objectives • Modernize • Reduce number of factories to fewer than 100

  12. Tobacco Production in China cont. • STMA sales to 350 million smokers • China National Tobacco Company responsible for: • Marketing • Production • Distributing • Sales

  13. Tobacco Production in China cont. • 12 provinces produce tobacco • Hunan is the largest with 70% of taxes from tobacco (Hometown province for Chinese Tobacco) • 900 Brands of Tobacco in China • Greater than 1.2 trillion cigarettes consumed • 30% of total world consumption • 1,400 cigarettes for every Chinese man, woman, and child

  14. Chinese Culture and Smoking • Business Men • “Giving Face” • Goodwill Gesture • “Losing Face” • Wedding Ceremonies

  15. Beijing Respiratory Disease Research Institute

  16. Dr. Xiao Dan WHO Collaborating Center for Tobacco or HealthDirector of Epidemiological

  17. The Beginning of Respiratory Care in China

  18. Luo Zujin, RT (AARC Fellow)Janet Boehm, AARC Past President, Leader of Delegation

  19. Beijing #6 Hospital

  20. The Neurochemistry of Tobacco Addiction

  21. Points to Cover • Two forms of nicotine • Definition of addiction • Neurochemistry of tobacco addiction • Nicotine withdrawal symptoms • Discussion of database of U.S. medications used for tobacco dependency treatment • Core competencies for tobacco treatment specialist

  22. Two Forms of Nicotine • Bound (tobacco leaf) • Free (altered by pH) • Results when ammonia is added • Immediate impact • More satisfaction http://tobaccodocuments.org/product_design/00044522-4523.html • pH • Cigarette: 5.5 – 6.0 • Spit: up to 8.3 (Source: CDC) • Cigar: 6.2 – 8.2 http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

  23. Absorption of Nicotine • Rate of Absorption • Cigarette : fastest route • Cigar : slower than cigarettes • Spit : slowest rate http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

  24. Is it Addiction? Three or more of the following: • Preoccupation with getting tobacco • Compulsive use • Difficulty with controlling intake • Persistent, even with health problems • Relapse • Tolerance • Withdrawal Source: World Health Organization Diagnostic and Statistical Manual - IV (DSM-IV) How long does it take to become dependent? • Can be after the first cigarette! http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF

  25. Count Down from Ten Short-Term Memory • Dopamine • Acetylcholine • Serotonin • Endorphins Medial Forebrain Bundle “Reward Pathway” Reinforcement Ventral Tegmental Area

  26. Withdrawal Symptoms • Cravings • Irritability • Hostility • Anxiety • Depressed mood • Difficulty concentrating • Decreased heart rate • Sleep disturbance • Sweating • Increased hand tremor Half-Life of Nicotine • Two hours, but will be increase up to 8 hours

  27. We Must Break The Cycle Not a

  28. Quitting and Reducing Tobacco Use Inventory of Products Database • https://secure.tobaccofreekids.org/Cessation/ • Database of products being used for cessation • Included: • product name • manufacturer’s name • manufacturer’s address • product website address • directions for use • warnings and disclaimers • ingredients (active and inactive) • claims

  29. The Association for the Treatment of Tobacco Use and Dependence (ATTUD) • What standards should be followed when developing a tobacco treatment specialist training program? • Core competencies, for training, and for credentialing of tobacco treatment providers. • http://www.attud.org/docs/Standards.pdf

  30. AARC Tobacco Resource Page • http://www.aarc.org/resources/tobacco/index.asp