_____ people die prematurely each year in the USA from tobacco related deaths
480,000 people (18% of US deaths)
How many tobacco related deaths globally each year?
How many smokers will be killed by their habit?
Premature mortality of smokers is ____ times higher than non-smokers
____ million americans have chronic disease related to tobacco use
What is the relationship between psychiatric illness and cigarette use?
7.1% of US population has psychiatric illness; however, this population consumes over 44.2% of all cigarettes.
True or False: Health costs and productivity loss due to tobacco in the USA costs more than 280 billion dollars per year
What groups does tobacco-related morbidity and mortality affect most?
Lower SES, mental illness, substance abuse, people with limited access to information about health risks and cessation services
Which race/ethnicity has the highest % of smokers?
American Indians (40%)
True or False: higher educated people tend to smoke less
True or False: poorer people smoke more than people more financially well off
True or False: Incarcerated people smoke more than the general US population
True or False: HIV infected persons smoke more than general USA population
True (42% vs 21%)
True or False: around 900 toxins have been identified in cigarette smoke.
False. more than 4,000
True or False: people who smoke or who are exposed to second-hand smoke have increased risk of disease in almost every body system
True or False: No amount of tobacco use is safe
What are the top 3 diseases caused by tobacco use?
Chronic Obstructive Pulmonary Disease
Tobacco accounts for about ____ % of all cancers
Tobacco smoking is the most important risk factor for which cancers?
Most important risk factor for:
- Lung (87%)
- Oral cavity, larynx, and pharynx (90%)
- Esophagus (86%)
- Bladder (60%)
Significant risk factor for:
Kidney, stomach, uterus, cervix, colon, pancreas, leukemia
Smokers have a ____ fold risk for cancer compared to non-smokers
True or False: For lung cancer, amount of smoking does have an effect on cancer risk.
Smokers who use greater than 40 cigarettes per day have double the risk of developing lung cancer when compared to smokers using less than 20 cigarettes per day.
True or False: for COPD, smoking cessation is the only intervention that can slow down or stop the decline in pulmonary function
In addition to coronary disease, tobacco is a major cause of which other vascular diseases? (5)
2. peripheral vascular disease
3. abdominal aortic aneurysm
4. venous thromboembolism
5. sudden cardiac death.
What are some heath consequences of smoking and pregnancy? (7)
- Sudden Infant Death Syndrome (SIDS)
- Prenatal deaths
- Low-birth weight infants
- Pre-term deliveries
True or False: health consequences for second-hand smoke are the same as smoking
Childhood exposure to second-hand smoke increases rate of what issues?
- Pulmonary infections
- Ear infections
- Suddent Infant Death Syndrome (SIDS)
What group of the population has the lowest decline in smoking prevalence?
88% of adults who smoke started before the age of ___ and 99% before the age of ____
What is the greatest risk factor for teens to start smoking?
Exposure to second-hand smoke or a smoker in the household
How do taxes on tobacco help the issue?
Higher prices have been shown to decrease smoking rates. 50% increase in price reduces overall cigarette consumption by 20%. Revenue from taxes can be used to support cessation services
True or False: Smoking bans (at work and public places) has helped in the fight against tobacco smoking
Why is nicotine highly addictive?
Nicotine binds to receptors in the CNS that increase dopamine and norepinephrine causing euphoria and relaxation.
What are the withdrawal symptoms of smoking and how long do symptoms last?
Withdrawal symptoms are strongest during the first 72 hours of cessation but can persist for 6-8 weeks (or perhaps longer)
True or False: Smoking can be difficult to quit because of social and behavioral reasons too
True or False: It is never too late to quit smoking
Quitting before age 40 reduces risk by 90% of tobacco related death.
Quitting before age 65 reduces risk by 65%.
True or False: Smoking cessation services are covered by insurance
True. Mandated by ACA
True or False: Health benefits for quitting smoking are effective quite immediately.
What are the 5 A's for helping smokers?
Ask (routine question at check-in for every visit)
Advise (clear, strong, personalized)
Assess (assess willingness)
Assist (counseling (self-help, individual, group, phone, etc), pharmacotherapy)
Arrange (following up within 2 weeks after quit date)
Pharmacotherapy is shown to have effectiveness in helping with smoking cessation. Name 3 therapies that can help:
1. Nicotine replacement therapy
2. Bupropion (Zyban, Wellbutrin)
3. Varenicline (Chantix)
True or False: not many smokers are using pharmacotherapy for smoking cessation.
True. Only 17%
Nicotine replacement therapy comes in many forms. Name 5
- Lozenge (tablet)
- Nasal spray
What does nicotine replacement do?
Alleviates symptoms of withdrawal
Does nicotine replacement actually help?
Yes, it increases quit rate 1.5-2 x at 6 months
True or False: Combining multiple forms of nicotine replacement may be more effective
True. (e.g. long-acting form plus something in-pocket to take if symptoms spike)
Is long-term treatment with nicotine replacement therapy safe?
Yes. Patients don't ever need to come off their nicotine replacement if they don't feel like they are ready
What are safety concerns for E-cigs and vaping?
- Added toxins in propellants (carcinogens, solvents)
- inconsistent delivery
- inconsistent regulation
- more cases of accidental nicotine poisoning (ingestion of concentrate)
- risk of 2nd hand vapor
True or False: E-cigarettes have been shown to help with smoking cessation
True or False: E-cigarettes are a gateway to nicotine addiction
What is bupropion (zyban or wellbutrin SR) and how does it help with smoking cessation? (2)
Bupropion is an anti-depressent that inhibits the reuptake of dopamine and norepinephrine (which helps with cravings and withdrawal symptoms).
It can also prevent the weight gain associated to smoking cessation.
What are contraindications for bupropion (zyban or wellbutrin SR)? (2)
Bupropion lowers the threshold for seizure so patients with seizure disorders shouldn't take this.
Also, since Bupropion is an anti-depressant, patients with stable regimens for their depression shouldn't add this to a regimen that's already working for them.
How effective is Bupropion (zyban or wellbutrin SR) compared to nicotine replacement therapy?
Slighlty more effective (but in same ballpark)
How does Varenicline (Chantix) help for smoking cessation? (2)
It acts as a partial agonist at the nicotine receptor which releases dopamine (to decrease cravings and withdrawal symptoms).
It also acts as an antagonist by blocking the binding of exogenous nicotine (which decreases the reward from smoking).
What are side effects of Varenicline (Chantix)? (4)
1. Nausea (in up to 40%)
How effective is Varenicline (Chantix) for smoking cessation compared to nicotine replacement therapy or Bupropion?
2.88 overall odds ratio (compared to 1.8 for NRT and Bupropion)
True or False: Smoking rates in mentally ill have declined minimally compared to the general population
True or False: Varenicline and Bupropion are not safe to use in patients with well-controlled mental illness
False. They are safe to use in patients with well-controlled mental illness. It was once thought that these therapies might increase suicidality but this has been debunked.
True or False: All smokers for whom pharmacotherapy is not contra-indicated should receive it
Relapse is very common for smoking cessation. About how many times do people quit before long-term success?