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Last updated February 2011 Demographics and Health Effects Revised 05/06.

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Presentation on theme: "Last updated February 2011 Demographics and Health Effects Revised 05/06."— Presentation transcript:

1 Last updated February 2011 Demographics and Health Effects Revised 05/06

2 Last updated February 2011 Demographics and Health Effects Section Revised 05/06 ChairAnn Malarcher Centers for Disease Control and Prevention, Atlanta, USA Peter AndersonIndept. Consultant in Public Health, Spain Mary-Jane AshleyUniversity of Toronto, Canada Shanta R Dube Centers for Disease Control and Prevention, Atlanta, USA Linda Pederson Centers for Disease Control and Prevention, Atlanta, USA Jonathan SametJohns Hopkins University, School of Hygiene and Public Health, Baltimore, USA Michael ThunAmerican Cancer Society, Atlanta, USA

3 Last updated February 2011 Health and Economic Costs of Tobacco Use

4 Last updated February 2011 Estimates are based on data and information from the World Health Organization * Childhood and maternal under nutrition includes: vitamin A Deficiency, zinc, iron; under weight 1 Years of life lost Global burden of disease and injury attributable to selected risk factors, 2000 (Total in thousands) Risk Factor Deaths (thousands) % of total deaths YLLs 1 (thousands) As % of total YLLs 1 Childhood and maternal under nutrition* 6, , Tobacco4, , Blood Pressure7, , Physical Inactivity1, , Occupation , Unsafe sex2, , Alcohol1, , Unsafe water, sanitation and hygiene 1, , Illicit drugs204.44,819.5 Urban air pollution ,404.7

5 Last updated February 2011 AFROAfrican Region AMERORegion of the Americas EMROEastern Mediterranean Region EUROEuropean Region SEAROSouth-East Asia Region WPROWestern Pacific Region

6 Last updated February 2011 Projected global burden of lung cancer in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, : data sources, methods and results. World Health Organization Region Total deaths (thousands) MaleFemale AFRO39318 AMRO EMRO EURO SEARO WPRO WORLD2,2161,522694

7 Last updated February 2011 Projected global burden of ischemic heart disease in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, : data sources, methods and results. World Health Organization Region Total deaths (thousands) MaleFemale AFRO AMRO1, EMRO1, EURO2, ,241 SEARO3,1871,6271,559 WPRO1, WORLD9,7374,7025,034

8 Last updated February 2011 Projected global burden of COPD in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, : data sources, methods and results. World Health Organization Region Total deaths (thousands) MaleFemale AFRO AMRO EMRO EURO SEARO1, WPRO3,1481,4251,723 WORLD5,8962,9812,915

9 Last updated February 2011 Projected global burden of cerebrovascular disease in 2030 Mathers, C., & Loncar, D. (2005). Updated projections of global mortality and burden of disease, : data sources, methods and results. World Health Organization Region Total deaths (thousands) MaleFemale AFRO AMRO EMRO EURO1, SEARO1, ,009 WPRO2,6791,1891,491 WORLD7,6773,2604,417

10 Last updated February 2011 Burden of disease and injury attributable to tobacco use, 2000 Estimates are based on data and information from the World Health Organization 1 Years of life lost Region Deaths (thousands) As % of total deaths YLLs 1 (thousands) As % of total YLLs 1 AFRO ,002.7 AMRO , EMRO , EURO1, , SEARO1, , WPRO , WORLD4, ,6225.0

11 Last updated February 2011 *Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, Lung Colon & rectum Stomach Rate Per 100,000 Prostate Pancreas LiverLeukemia Cancer Death Rates*, for Men, US,

12 Last updated February 2011 Lung Colon & rectum Uterus Stomach Breast Ovary Pancreas Cancer Death Rates*, for Women, US, *Age-adjusted to the 2000 US standard population. US Mortality Public Use Data Tapes , US Mortality Volumes , National Center for Health Statistics, Centers for Disease Control and Prevention, Rate Per 100,000

13 Last updated February 2011 Smoking-Attributable Mortality Fractions Among Males in the United States, 2001 CDC, Adult SAMMEC, Percentage

14 Last updated February 2011 Smoking-Attributable Mortality Fractions Among Females in the United States, 2001 CDC, Adult SAMMEC, Percentage

15 Last updated February 2011 CDC. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, MMWR 2005;54(25): Nearly 440,000 Average Annual Deaths Attributable to Cigarette Smoking – United States, Ischemic Heart Disease; 86,801

16 Last updated February 2011 National Center for Health Statistics, Deaths: Final Deaths National Vital Statistics Report, 2006; 54(13); Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses- United States, ; MMWR. 2005:54(25): Number of death (thousands) Annual Deaths from Smoking Compared with Selected Other Causes in the United States

17 Last updated February 2011 One out of two lifelong adult smokers will die from a smoking related disease. CDC. Projected smoking-related deaths among youth – United States. MMWR 1996;45(44):

18 Last updated February 2011 Smoking and Health Among Adolescents Rapid addiction to nicotine from early smoking More likely to use other drugs (alcohol, marijuana, & cocaine) More likely to be involved in other risky behaviors Poorer overall health Increased resting heart rates USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday, DR, et al. Cigarette smoking and self-reported health problems among US high school seniors, Am J of Health Promotion 1995;10(2):

19 Last updated February 2011 Smoking and Health Among Adolescents Increased effects on the respiratory system Increased wheezing, gasping and shortness of breath Increased coughing and phlegm production Decreased physical performance Decreased endurance Reduced lung function Slowed growth of lung function USDHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General, 1994; Arday et al. Cigarette smoking and self-reported health problems among US high school seniors, Am J Health Promot 1995;10:

20 Last updated February 2011 Effects of Smoking and Pregnancy/Reproduction Reduced Fertility Reduced risk for preclampsia Fetal growth restriction Increased risk of premature rupture of the membranes, placenta previa, & placental abruption Increased risk of preterm delivery & shortened gestation USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, 2004.

21 Last updated February 2011 Increased risk of low birth weight Increased risk of perinatal mortality (stillbirth & neonatal deaths) Increased risk of reduction of lung function in infants Increased risk of sudden infant death syndrome (SIDS) USDHHS. The Health Consequences of Smoking: A Report of the Surgeon General, Effects of Smoking and Pregnancy/Reproduction

22 Last updated February 2011 Health Effects of Secondhand Smoke

23 Last updated February 2011 Contents of Secondhand Smoke (SHS) Cigarette smoke contains more than 7000 chemical compounds Sixty nine chemicals in tobacco smoke are known or probable carcinogens SHS is a known human carcinogen USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

24 Last updated February 2011 An hour a day in a room with smoke is nearly a hundred times more likely to cause lung cancer in a non-smoker than 20 years spent in a building containing asbestos. -Sir Richard Doll, 1985

25 Last updated February 2011 Health Effects of Secondhand Smoke - Adults SHS exposure causes lung cancer among lifetime nonsmokers SHS exposure associated with living with a smoker increases risk of lung cancer by 20%-30%. SHS exposure causes coronary heart disease morbidity and mortality SHS exposure increases risk of heart disease by 25%- 30% SHS exposure causes increased respiratory symptoms of odor annoyance & nasal irritation USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

26 Last updated February 2011 Health Effects of Secondhand Smoke -Children SHS exposure causes sudden infant death syndrome (SIDS) Maternal exposure to SHS during pregnancy causes a small reduction in birth weight SHS exposure after birth causes a lower level of lung function SHS exposure from parental smoking causes lower respiratory illness in infants and children USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006.

27 Last updated February 2011 SHS from parental smoking causes cough, phlegm, wheeze and breathlessness in school age children SHS from parental smoking causes exacerbations of asthma SHS exposure from parental smoking causes the onset of wheeze illness in early childhood SHS exposure from parental smoking causes middle ear disease (acute and recurrent otitis media, chronic middle ear effusion) USDHHS. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, Health Effects of Secondhand Smoke -Children

28 Last updated February 2011 Approximately, 5 million people will die from tobacco related illness this year. By 2030, 10 million people will die each year. World Health Organization. The Tobacco Atlas (2002). Ezzati & Lopez. Estimates of Global Mortality Attributable to Smoking in Lancet 2003; 362:

29 Last updated February 2011 Benefits of Cessation

30 Last updated February 2011 Benefits of Cessation Overall Former smokers live longer compared with continuing smokers Smoking cessation reduces risk of premature death Risk of death decrease shortly after quitting Smoking cessation benefits almost every part of the body USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

31 Last updated February 2011 Smoking Cessation and Lungs Lung function starts to improve 2-3 months after quitting Smoking cessation reduces risk of lung cancer, 10 years after quitting, the risk of lung cancer decreases to % that of a continuing smoker USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

32 Last updated February 2011 Smoking Cessation and the Respiratory System Risk of death from Chronic Obstructive Pulmonary Disease is decreased after quitting Risk of upper and lower respiratory illness such as colds, flu, bronchitis and pneumonia is lowered Coughing, sinus congestion, fatigue and shortness of breath decrease 2-3 months after quitting Smoking cessation lowers risk of larynx cancer USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

33 Last updated February 2011 Smoking Cessation and the Heart Smoking cessation reduces the excess risk of dying from abdominal aortic aneurysm by 50% among former smokers Risk of coronary heart disease decreases by half 1-2 years after quitting After 15 years of quitting, coronary heart disease risk is nearly that of a non-smoker Among persons diagnosed with cardiovascular heart disease, smoking cessation reduces risk of recurrent infarction and cardiovascular death After quitting peripheral artery disease decreases USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

34 Last updated February 2011 Smoking Cessation and Other Parts of the Body Stroke risk is reduced to that of a never smoker after 5 to 15 years of cessation Risk of mouth, throat, and esophagus cancers are halved five years after quitting Bladder cancer risk is halved a few years after quitting Smoking cessation lowers the risk of kidney, stomach, pancreatic and cervical cancer Smoking cessation lowers risk of peptic ulcers USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

35 Last updated February 2011 Smoking Cessation and Pregnancy Quitting smoking before or early during pregnancy lowers risk of miscarriage, low birth weight of baby and SIDS Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

36 Last updated February 2011 Summary: Health Benefits of Smoking Cessation Smoking cessation has major and immediate health benefits for men and women of all ages Benefits apply to persons with and without smoking- related diseases Former smokers live longer than continuing smokers Smoking cessation decreases the risk of lung and other cancers, heart attack, stroke, and chronic lung disease Smoking cessation improves reproductive outcomes USDHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General, 1990

37 Last updated February 2011 Tobacco Dependence

38 Last updated February 2011 "In a sense, the tobacco industry may be thought of as being a specialized, highly ritualized, and stylized segment of the pharmaceutical industry. Tobacco products uniquely contain and deliver nicotine, a potent drug with a variety of physiological effects." Claude Teague memo "RJR Confidential Research Planning Memorandum on the Nature of the Tobacco Business and the Crucial Role of Nicotine Therein

39 Last updated February 2011 Frequency of Cigarette Use, 2004 SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health Percentage

40 Last updated February 2011 Tobacco Dependence in the United States, million Americans 12 years or older met the criteria for nicotine dependence in the past month based on their cigarette use 1.1 million youth 12 to 17 years old are nicotine dependent cigarette smokers The rate of dependence is higher for those who start smoking at an earlier age than for those who initiate cigarette use later in life SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health

41 Last updated February 2011 Nicotine Dependence among Past Month Smokers, by age, 2004 SAMHSA (2005), Results from the 2004 National Survey on Drug Use & Health

42 Last updated February 2011 Relapse Rate Over Time Heroin Smoking Alcohol Time (Months) 2 Weeks Abstainers (%) USDHHS. The Health and Consequences of Tobacco: Nicotine Addiction. A Report of the Surgeon General, 1988.

43 Last updated February ,000 to 100,000 young people around the world become addicted to tobacco, everyday. World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control (Washington: World Bank, 1999).

44 Last updated February 2011 Effective Treatment Interventions

45 Last updated February 2011 Effective Treatment Interventions Brief advice to quit from doctors, nurses and other healthcare providers Group counseling Individual counseling Telephone counseling Pharmacotherapy Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

46 Last updated February 2011 Identification and Assessment of Tobacco Use Assisting the patient in quitting (5As) –Ask – Systematically identify all tobacco users at every visit –Advise – Strongly urge all tobacco users to quit –Assess – Determine willingness to make a quit attempt –Assist – Aid the patient in quitting –Arrange – Schedule follow-up contact Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

47 Last updated February 2011 Effective counseling treatment for tobacco use and dependence Practical counseling (problem solving/skills training) Intra-treatment social support Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

48 Last updated February 2011 Elements of counseling Practical Counseling –Recognize danger situations –Develop coping skills –Provide basic information Supportive Counseling –Encourage the patient in the quit attempt –Communicate caring and concern –Encourage the patient to talk about the quitting process Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

49 Last updated February 2011 Effective pharmacotherapy for smoking cessation Pharmacotherapy that reliably increase long term smoking abstinence rates Bupropion Nicotine gum, inhaler, nasal spray, lozenge and patch Varenicline Clonidine and Nortriptyline can be used if other pharmacotherapy is not effective

50 Last updated February 2011 Motivational intervention for those unwilling to quit consist of the 5 Rs Relevance – Encourage patient to identify why quitting is relevant Risks – Ask patient to identify potential negative consequences of tobacco use Rewards – Ask patient to identify potential benefits of quitting Roadblocks – Ask patient to identify barriers to quitting Repetition – Repeat motivational intervention every time unmotivated patient enters a clinical setting Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

51 Last updated February 2011 Increase the unit price for tobacco products Mass media education campaigns combined with other interventions to inform and motivate tobacco users to quit Provider reminder systems that identify patients who use tobacco products and prompt providers to discuss cessation with their client or advise client to quit at every encounter Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to Community Preventative Services. Oxford University Press. New York, New York, Recommendations for increasing tobacco cessation

52 Last updated February 2011 Provider reminder plus provider education, with or without client education Reduction of out-of pocket costs for effective cessation therapies Multi-component interventions that include client telephone support Task Force on Community Preventative Services. Zaza S, Briss PA, Harris, KW (eds). The Guide to Community Preventative Services. Oxford University Press. New York, New York, Recommendations for increasing tobacco cessation

53 Last updated February 2011 Standardization of care for routine, effective treatment of tobacco use needs Continuous screening of tobacco use among those who enter the health care system Availability of effective intensive treatments that includes counseling and pharmacotherapy Recommendations for increasing tobacco cessation

54 Last updated February 2011 Recommendations for increasing tobacco cessation Treatment that emphasizes problem-solving and within- treatment social support Extended or augmented psychosocial interventions beyond minimal advice to quit for pregnant smokers Institutionalize system changes that are essential to ensure that clinical interventions occur


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