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1、Rx for CHANGE,Clinician-Assisted Tobacco Cessation for Patients with Cancer,is the chief, single, avoidable cause of death in our society and the most important public health issue of our time.”,C. Everett Koop, M.D., former U.S. Surgeon General,“CIGARETTE SMOKING,TRENDS in ADULT SMOKING, by SEXU.S.
2、, 19552006,Trends in cigarette current smoking among persons aged 18 or older,Graph provided by the Centers for Disease Control and Prevention. 1955 Current Population Survey; 19652005 NHIS. Estimates since 1992 include some-day smoking.,Percent,70% want to quit,Male,Female,23.9%,18.0%,20.8% of adul
3、ts are current smokers,Year,2004 REPORT of the SURGEON GENERAL: HEALTH CONSEQUENCES OF SMOKING,Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general. Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases
4、caused by smoking and improving health in general. Smoking cigarettes with lower machine-measured yields of tar and nicotine provides no clear benefit to health. The list of diseases caused by smoking has been expanded.,U.S. Department of Health and Human Services. (2004). The Health Consequences of
5、 Smoking: A Report of the Surgeon General.,FOUR MAJOR CONCLUSIONS:,HEALTH CONSEQUENCES of SMOKING,Cancers Acute myeloid leukemia Bladder and kidney Cervical Esophageal Gastric Laryngeal Lung Oral cavity and pharyngeal Pancreatic Pulmonary diseases Acute (e.g., pneumonia) Chronic (e.g., COPD),Cardiov
6、ascular diseases Abdominal aortic aneurysm Coronary heart disease Cerebrovascular disease Peripheral arterial disease Reproductive effects Reduced fertility in women Poor pregnancy outcomes (e.g., low birth weight, preterm delivery) Infant mortality Other effects: cataract, osteoporosis, periodontit
7、is, poor surgical outcomes,U.S. Department of Health and Human Services. (2004). The Health Consequences of Smoking: A Report of the Surgeon General.,HEALTH CONSEQUENCES of SMOKELESS TOBACCO USE,Periodontal effects Gingival recession Bone attachment loss Dental cariesOral leukoplakiaCancer Oral canc
8、er Pharyngeal cancer,Oral Leukoplakia Image courtesy of Dr. Sol Silverman - University of California San Francisco,Use of alcohol in combination with moist snuff increases the risk of oral cancers.,ANNUAL U.S. DEATHS ATTRIBUTABLE to SMOKING, 19972001,Centers for Disease Control and Prevention. (2005
9、). MMWR 54:625628.,32%,28%,23%,9%,8%,1%,TOTAL: 437,902 deaths annually,Percentage of all smoking-attributable deaths*,* In 2005, it was estimated that nearly 50,000 persons died due to second-hand smoke exposure.,NICOTINE DISTRIBUTION,Henningfield et al. (1993). Drug Alcohol Depend 33:2329.,Arterial
10、,Venous,Nicotine reaches the brain within 11 seconds.,Nicotine enters brain,Stimulation of nicotine receptors,Dopamine release,DOPAMINE REWARD PATHWAY,Prefrontal cortex,Nucleus accumbens,Ventral tegmental area,Irritability/frustration/anger Anxiety Difficulty concentrating Restlessness/impatience De
11、pressed mood/depression Insomnia Impaired performance Increased appetite/weight gain Cravings,NICOTINE PHARMACODYNAMICS: WITHDRAWAL EFFECTS,Hughes. (2007). Nicotine Tob Res 9:315327.,Most symptoms manifest within the first 12 days, peak within the first week, and subside within 24 weeks.,HANDOUT,QUI
12、TTING: HEALTH BENEFITS,Lung cilia regain normal function Ability to clear lungs of mucus increases Coughing, fatigue, shortness of breath decrease,Excess risk of CHD decreases to half that of a continuing smoker,Risk of stroke is reduced to that of people who have never smoked,Lung cancer death rate
13、 drops to half that of a continuing smoker Risk of cancer of mouth, throat, esophagus, bladder, kidney, pancreas decrease,Risk of CHD is similar to that of people who have never smoked,2 weeks to 3 months,1 to 9 months,1 year,5 years,10 years,after 15 years,Time Since Quit Date,Circulation improves,
14、 walking becomes easierLung function increases up to 30%,Years of life gained,Age at cessation (years),Prospective study of 34,439 male British doctors Mortality was monitored for 50 years (19512001),On average, cigarette smokers die approximately 10 years younger than do nonsmokers.,Among those who
15、 continue smoking, at least half will die due to a tobacco-related disease.,SMOKING CESSATION: REDUCED RISK of DEATH,Doll et al. (2004). BMJ 328(7455):15191527.,TOBACCO USE and the DEVELOPMENT of CANCER,TOBACCO: CANCERS CAUSED by TOBACCO,Lung Larynx Oral cavity and pharynx Esophagus Pancreas,Bladder
16、 and kidney Cervix Stomach Bone marrow (acute myeloid leukemia),USDHHS. (2004). The Health Consequences of Smoking: A Report of the Surgeon General.,Sufficient evidence exists to infer a CAUSAL relationship between tobacco use and these cancers.,TOBACCO and CANCER: CARCINOGENS in TOBACCO PRODUCTS,Polycyclic aromatic hydrocarbons (PAHs) Benzopyrene Benzanthracene Tobacco-specific nitrosamines (TSNAs) Aromatic amines Formaldehyde Benzene Vinyl chloride Cadmium Radioactive polonium-210,
