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How to Fight the Tobacco Epidemic

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How to Fight the Tobacco Epidemic

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  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