1. Fellowship in Head and Neck Surgery (USA) Fellowship in Neurotology & Skull Base Surgery (USA) Senior Consultant in ENT-Head and Neck and Neurotology Apollo Hospitals, Bangalore

2. In India It is estimated that around 40% of the men and 15% of the women use tobacco on a regular basis. However, in certain areas of the country regular use increases to over 85% in men and over 65% in women (including smoking and chewing).

3. Facts and Figures Most prevalent age - 25-44 years Average age to start smoking is 14.6 years Tobacco is the most preventable cause of head and neck cancer deaths. Use of tobacco (cigarettes, paan, chewing tobacco or snuff) is closely linked with cancers of the mouth, throat, voice box and tongue. There are 4,000 substances found in cigarettes and 43 of them are known to cause cancer.

4. Ingredients in cigarettes Polonium210 (nuclear waste) Acetaldehyde (irritant) Lead (nerve poison) Formaldehyde (embalming fluid) Cadmium (found in batteries) N-Nitrosamines (known carcinogen) Benzopyrene (known carcinogen) Uranium 235 (nuclear waste) Nicotine (addictive substance)

5. Health Consequences of Nicotine Exposure Accelerated coronary and peripheral vascular disease Increase in heart rate (30% higher) Stroke Hypertension Smokeless tobacco users had 2.5 times increase in cholesterol

6. Effect of Tobacco on Pregnancy/Birth Hypoxemia of fetus Spontaneous abortion Placental disruption Preterm delivery Decreased milk production Birth defects (cleft lip or palate) low birth weight.

7. If you smoke or are around second-hand smoke while you are pregnant, you are more likely to: deliver early experience problems during labour if you’re breast-feeding -> some chemicals are passed directly from breast milk to the baby. baby has higher risk of dying during childbirth or dying of SIDS (sudden infant death syndrome).

8. What is second-hand smoke? Second-hand smoke is the smoke from a burning cigarette, pipe or cigar. Also known as environmental tobacco smoke ETS contaminates the air and is retained in clothing, curtains and furniture. Cigarettes produce about 12 minutes of smoke, yet the smoker may inhale only 30 seconds of smoke from their cigarette. The rest of the smoke lingers in the air for non-smokers to breathe. When someone smokes inside a home or car, everyone inside breathes second-hand smoke.

9. Effects of ETS It is unpleasant, annoying, and irritating to the eyes and nose headaches, coughing and wheezing, nausea and dizziness. colds, bronchitis and pneumonia. Long term exposure  heart problems, breathing problems and lung cancer.

10. Effect of ETS on Children coughing and wheezing asthma and other breathing problems bronchitis and pneumonia higher risk of heart disease

11. increases both the number and the duration of ear infections - the most common cause of children's hearing loss take up smoking themselves. impairment in school performance and intellectual achievement has also been demonstrated.

12. World Health Organization’s International Agency for Research on Cancer (IARC) have all classified secondhand smoke as a known human carcinogen—a category reserved for agents for which there is sufficient scientific evidence that they cause cancer

13. the risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year!

14. Facts about Smokeless Tobacco: A Dangerous Alternative Smokeless tobacco is highly addictive It is the leading cause of oral cancer It kills at a younger age than cigarettes It has 100 times higher concentration of cancer- causing agents than cigarettes Most commonly used by 18-25 age 28 substances in this are known to cause cancer

15. Statistics show that every year 8,00,000 new cancer cases are registered 3,20,000 of which are suffering from Head and Neck cancers largely attributed to tobacco habits. While, tobacco claims about 4.9 million deaths annually globally, an alarming 1 million of them are from India.

16. Head and neck cancers are common in India and account for about 30% of cancers in males and about 13% in females. In the Western world in general, it accounts for less than 10% of all cancers The primary reason for this unusually high incidence is the indiscriminate use of tobacco in its various forms

17. The overall survival rate for head and neck cancer in the general population is only 52%, a rate which is worse than uterine, breast, cervical and colon cancers With early detection and treatment, the 5- year survival rate can increase up to 85%.

18. Warning Signs A sore on the lip or in the mouth that does not heal A lump on the lip or in the mouth or throat A white (leukoplakia) or red patch on the gums, tongue or lining of the mouth Unusual bleeding, pain or numbness in the mouth A sore throat or a feeling that something is caught in the throat Difficulty or pain with chewing or swallowing Swelling of the jaw that causes dentures to fit poorly or become uncomfortable

19. A change in the voice or hoarseness Pain in the ear without evidence of local ear problems Slurred speech Loose teeth not associated with any gum problems Swelling, numbness, paralysis of the muscles in the face Chronic sinus infections that do not respond to treatment with antibiotics Bleeding through the nose, frequent headaches, swelling or other trouble with the eyes.

20. Tips to quit tobacco Remember, most people don’t start on their own, so don’t try quitting on your own. Ask for help and positive reinforcement from your friends, parents, coaches, teachers, whomever...

21. Tips to quit tobacco Think of reasons why you want to quit. Pick a quit date and throw out all your tobacco and ashtray. Tell yourself out loud every day that you’re going to quit. Find alternatives to tobacco. A few good examples are sugarless gum, fruits, raisins or dried fruit. Notice when and where you use tobacco. Plan other things to do at those times. Delay the act, count till 100 Substitute stimulus associated with tobacco i.e. tea can be replaced by milk or juice.

22. Tips to quit tobacco Find activities to keep your mind off tobacco. You could ride a bike, talk or write a letter to a friend, work on a hobby, or listen to music. Do something else when you feel the urge to smoke/ chew tobacco. This will help you keep your mind off tobacco. Exercise can help relieve tension caused by quitting. Set realistic goals and achieve them. Don't give in to cravings. These usually last for only 3-5 minutes.

23. Tips to quit tobacco Deep breathing: When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Increase your water intake. Take small sips of water when the urge to smoke/chew is high. Reward yourself. You could save the money that would have been spent on tobacco products and buy something nice for yourself.

24. Motivating Patients to Quit Improved health Food tastes better Improved sense of smell Save money Feel better about yourself Home, car, breath will smell better Can stop worrying about quitting Set a good example for children Healthier babies and children Not worry about exposing others to smoke Feel better physically Freedom from addiction Perform better in sports

25. Nicotine Withdrawal Symptoms Withdrawal peaks in 2 days and lasts up to 1-2 weeks (on average) Depressed mood, sadness Insomnia Irritability, frustration, anger Anxiety Impaired concentration Restlessness Increased appetite

27. Once You Quit: Learn to say no to tobacco offers from others. Don’t take even one puff. Try to remain in smoke free areas. Avoid company of smokers and chewers. Make a group of people who have quit tobacco. Try alternative ways to deal with stresses — Relaxation, deep breathing, listening to music, exercises, taking a walk, talking to someone over telephone etc Even if you fail in your attempt- Try again

28. Are you ready to Quit?