Medical training on tobacco

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Medical training on tobacco

• Royal College of Physicians of London
• Tobacco Advisory Group

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Contents

• Section 1 Active smoking
• Section 2 Passive smoking
• Section 3 Nicotine addiction
• Section 4 Health Inequalities
• Section 5 Policies to reduce smoking
• Section 6 Smoking cessation
• Section 7 Delivering cessation advice
• Section 8 Questions that smokers ask

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Royal College of Physicians of London Tobacco
Advisory Group
1. Active smoking
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King James I counterblaste

• ...a custome lothesome to the eye, hateful to the
  nose, harmful to the brain, dangerous to the
  lungs, and in the black and stinking fume
  thereof, nearest resembling the horrible stygian
  smoke of the pit that is bottomless (1604)

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What is smoking?

• Chronic relapsing dependence syndrome
• Smoking is use of the addictive drug nicotine
• Delivered to the brain by tobacco smoke via lungs
  and blood
• Reinforced by sensory, behavioural and social
  conditioning
• Entrenched by powerful withdrawal syndrome
• Great harm caused by toxins in the smoke
• Promoted commercially
• Regulated to some extent

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Who are the smokers (UK)?

• 13 million adults (16)
• 26 women
• 28 men
• Sharp socio-economic gradient
• 16 managerial / professional
• 33 routine or manual
• Up to 80 in the most deprived groups
• 400,000 teenagers (11-15)
• 11 girls
• 9 boys

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Trends in UK adult smoking

Office of National Statistics, 2000
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Trends in UK underage smoking (11-15 years)

Office of National Statistics, 2000
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Why do people smoke?

• The first cigarette is a noxious experience to
  the noviate.that the beginning smoker will
  tolerate the unpleasantness we must invoke a
  psychological motive.
• Smoking a cigarette for the beginner is a
  symbolic act. I am no longer my mothers child,
  Im tough, I am an adventurer, Im not
  square.the act of smoking remains a symbolic
  declaration of personal identity.
• As the force from the psychological symbolism
  subsides, the pharmacological effect takes over
  to sustain the habit.
• (Philip Morris, 1969)

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Cause of harm

• Tobacco smoke contains over 4,000 identified
  compounds, including

• 2-nitropropane
• Acetaldehyde
• Acrolein
• Acrylonitrile
• Ammonia
• Aromatic amines
• Arsenic
• Aza-arenes
• Benzo (a) pyrenes
• Carbon monoxide
• Carboxylic acids
• Dimethylnitrosamine
• Formaldehyde
• Hydrazine

• Hydrogen cyanide
• Insecticide residues
• Isoprenoids
• Napthalenes
• Nickel
• Nicotine
• Nitrogen oxides
• Non-volatile nitrosamines
• Phenols
• Polonium-210
• Polynuclear aromatic hydrocarbons
• Pyridine
• Urethane
• Vinyl chloride

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Largest single public health problem

• 1 in 5 UK deaths caused by smoking
• Largest avoidable cause of premature death
• 2,300 killed every week

Smoking statistics Illness and deaths. ASH 2001
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Life years lost to common risks
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Deaths attributable to smoking (1997)

• Main causes of death attributable to smoking (UK)

RCP Nicotine Addiction in Britain, 2000
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Smoking mortality figures

• Richard Dolls 40-year study of 40,000 British
  doctors
• Numerous smaller studies
• Established positive significant association with
  24 causes of death
• Other studies have proved associations with 50
  diseases

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Overall risk to smokers and never smokers
Never smoked
100
regularly
80
80
Current cigarette
smokers
60
59
7.5 years
Alive
40
33
20
12
0
40
55
70
85
100
Age
Doll et al, BMJ 1994 309901-911
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Life years lost due to smoking
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1 smoker in 2 dies 15 years early
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1 smoker in 4 dies 23 years early
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119,000 deaths from smoking-related diseases
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34,100 deaths from respiratory diseases
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37,900 deaths from heart and circulatory disease
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45,100 deaths from smoking related cancers
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Smoking related cancers - breakdown
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Trends in UK smoking and lung cancer deaths
Smoking prevalence
Peto et al, BMJ 2000321323-329
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Trends in UK smoking and lung cancer deaths
Lung cancer deaths
Smoking prevalence
Peto et al, BMJ 2000321323-329
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Other conditions associated with smoking

• Angina risk 20 x risk
• Buergers disease
• Cataracts 2 x risk
• Crohns disease
• Depression
• Duodenal ulcers
• Chronic rhinitis
• Fertility 30 lower
• Graves disease
• Hearing loss
• Immune system impaired
• Decreased lung function
• Ocular Histoplasmosis

• Optic neuropathy 16 x risk
• Menopause 2 years early
• Sudden Infant Death syndrome
• Osteoporosis
• Peripheral vascular disease
• Psoriasis 2 x risk
• Rheumatoid arthritis
• Reduced sperm count
• Tuberculosis
• Macular degeneration 2 x risk
• Low child birth weight 4 x risk
• Vocal chord polyps
• Increased sperm abnormalities

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Who smokes worldwide
Smokers (millions)
Percentage
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Smoking related deaths - worldwide

• Now
• 4.9 million deaths per year
• 40 in developing countries

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Smoking related deaths - worldwide

• By 2025
• 10 million deaths per year
• 70 in developing countries