1 / 41

How to Fight the Tobacco Epidemic

How to Fight the Tobacco Epidemic. Presentation to Portfolio Committee on the Tobacco Products Control Amendment Bill, 23 January 2007 C T Bolliger. History of Tobacco. A.D. 600: Maya stone carvings 1492: Columbus tobacco to Europe

kacia
Download Presentation

How to Fight the Tobacco Epidemic

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. How to Fight the Tobacco Epidemic Presentation to Portfolio Committee on the Tobacco Products Control Amendment Bill, 23 January 2007 C T Bolliger

  2. History of Tobacco • A.D. 600: Maya stone carvings • 1492: Columbus tobacco to Europe • 16th cty: Sultan Constantinople: smokers to be quartered, or at least beheaded • 1604: James I: “A Counterblaste to Tobacco” AND big revenue by tax !!! • 1798: Benjamin Rush, colonial physician: condemns tobacco • 19th cty: moderate consumption - pipe, cigars, chew, sniffing • 1881: cigarette-rolling machine - safety matches

  3. History of Tobacco • 1906: “The Dukes” investing up to 80% of profit into advertising • 20th cty: smoking epidemic • 1945: cigarette dominant • 1964: Luther Terry, First Surgeon General’s report • 1998: EC advertising ban voted • 2003: FCTC (signed by > 100 countries by June 2004, !!!  ratified)

  4. Prevalence Sources: WHO, National Centre for Health Statistics, Japan Tobacco Inc., Comité Français d’Éducation pour la Santé, Serbian Ministry of Health, The World Bank, SADHS,

  5. Advertising banned in SA since 2001 • Switzerland (15-74yrs): 33% latest (2002): 30.5% 15-24 yo.: 37.4% • South Africa (>18yrs, SADHS 98) : 24% latest (2004): 22%

  6. Cigarette prices and consumption (S.A.) C van Waalbeek

  7. Composition of the retail price of cigarettes (S.A.) C van Walbeek

  8. S.A.government‘s achievements Advertising ban Price increase Restaurants

  9. Projected annual tobacco-related deaths Year Total 1.World3.World 1950 300.000 300.000 - 1965 1.000.000 900.000 100.000 1975 1.500.000 1.300.000 200.000 1995 3.000.000 2.000.000 1.000.000 2000 3.500.000 2.400.000 1.100.000 2025 10.000.000 3.000.000 7.000.000 Mackay JL. Tuber Lung Dis 1994;75:8-24

  10. Perceived risks of CAD and Cancer in Smokers MI Cancer Current smokers 29% 40%  40 cig/day 39% 49% Ayanian JZ. JAMA 1999;281:1019-21

  11. Never smokedregularly 100 80 60 40 20 0 Current ciga-rette smokers 80% 59% 7.5 years % Alive 33% 12% 40 55 70 85 100 Age (Doll R., BMJ 1994; 309:901-11. 35 539 doctors x 40 years)

  12. Never smoked regularly Former smokers Continuing cigarette smokers 100 80 60 40 20 0 % Alive Former smokers stopped 35 - 44 Former smokers stopped 45 - 54 100 80 60 40 20 0 % Alive Former smokers stoped 55 - 64 Former smokers stopped > 65 40 55 70 85 100 40 55 70 85 100 Age Age

  13. 50% of long-term smokers die from their habit Doll R. BMJ 1994

  14. Risk factors for MI Yusuf S, Lancet 2004;364:937-52

  15. Smoking is the most important preventable cause of disease

  16. Law MR. BMB 1996;52:22

  17. Effect of number of cigarettes smoked at home Risk factor 1 1 - 10 11 - 20 > 20

  18. Milk CausesCancer ! Milk CausesCancer !

  19. Desired nicotine actions • Arousal • Relaxation (in stress) • Improved mood • Increased concentration • Increased vigilance • Shorter reaction time • Weight control • Regular bowel movements

  20. Effects of Nicotine on the BrainImproves mood and influences Memory Frontal brain: steers behaviour, remembers after years that nicotine triggers feeling of well-beingt. Nucleus Accumbens: responsible for feeling of well-being. Nerve cells secret mainly dopamine Hippocampus: stores memories in cooperation with frontal brain. Amygdala: Emotions are processed.

  21. Nicotine withdrawal symptoms (DSM-III) • Craving for tobacco • Irritability • Anxiety • Difficulty concentrating • Restlessness • Headaches • Drowsiness • GI tract disturbances

  22. How to quit? Most smokers need professional help National Quitline: 011 720 3145 GP Smoking cessation specialist Smoking cessation Clinic Faculty of Health Sciences,U.S.: 021 938 9423

  23. The 5 A’s • Ask Smoker? • Advise Quit! • Assess Willing? • Assist Aid! • Arrange Follow-up!

  24. Practical smoking cessation • Screening visit: phone, computer? (motivation?!) • Initial interview GP/ nurse (day 0; 40’ - 1 h): • Info about withdrawal symptoms • Coping strategies • Change of life style • Pharmaceutical Aids? (+ 3/12) • Nonsmoker at once • Intensive follow-up (p.e. weeks 1, 2, 4, 8, 12, 16, 20, 26, 52) • Occasionally intensive group therapy

  25. ~ Nicotine replacement therapy • Patch (15 - 25 mg; 16h or 24 h) • Chewing gum (2 or 4 mg) • Mouth spray (1mg/actuation) • Nasal spray (0.5 mg / puff) • Inhaler (13 mg / puffs; 80 puffs 1 mg = 1 Cig.) • Lozenges (1mg) • Sublingual tablets (2 mg)

  26. TØnnesen NEJM 1991, 325:311 100 80 60 40 20 0 Active Placebo Abstainers (%) N = 145 n = 144 0 1 3 6 12 26 52 30 20 10 Patch size cm2 Weeks

  27. Continuous Abstinence during Follow-Up  * **  p=<0.001, OR 2.24, 95% CI 1.45, 3.56 P=<0.001; OR 2.34; 95% Cl 1.43, 3.98 * P=0.002; OR 2.19; 95% Cl 1.29, 3.86 **

  28. Take home message: For the doctor • Smoking is highly addictive (Nicotine) • Smokers underestimate health risk: 50% will be killed long-term • Smokers need professional help to quit • Pharmaceutical aids double success rate For the politician • S.A.: so far very good job with legislation • Tabacco companies not to be underestimated • Tobacco Products Control Amendment Bill needs endorsement to achieve further reduction in tobacco consumption

More Related