With special thanks to Dr. Ron LaporteWith special thanks to Dr. Ron Laporte
at University of Pittsburgh for emailingat Un...
There are almost 10-15 millionThere are almost 10-15 million
established smokers in Pakistanestablished smokers in Pakista...
Drug AddictsDrug Addicts Non Drug AddictsNon Drug Addicts
EstablishedEstablished
SmokersSmokers
257257 6262
Non-SmokersNon...
Have you ever smoked a whole cigarette?
Ever tried – even a few puffs?
No – Never SmokerNever Smoker Yes
YesNo – TrierTrie...
Smoking by Age andSmoking by Age and
Stage of Onset*Stage of Onset*
AGE
*Source: The MACC Study
Tobacco Dependence as aTobacco Dependence as a
Chronic DiseaseChronic Disease
 Tobacco dependence demonstratesTobacco dep...
Smoking in PerspectiveSmoking in Perspective
Kills more than 440,000 Americans each yearKills more than 440,000 Americans ...
Environmental Tobacco SmokeEnvironmental Tobacco Smoke
Kills one person prematurely, for every 8 people killed byKills one...
Perceived Health Risks
Among Cigarette Smokers
Heart attack Cancer
All smokers 29% 40%
Heavy smokers 39% 49%
Ayanian & Cle...
Predictive Factors of YouthPredictive Factors of Youth
Smoking OnsetSmoking Onset
EnvironmentalEnvironmental
Access to cig...
Exposure to advertising, adult/sibling role modelsExposure to advertising, adult/sibling role models
who smoke cigarettes,...
It is essential that clinicians andIt is essential that clinicians and
health care delivery systemshealth care delivery sy...
Brief tobacco dependenceBrief tobacco dependence
treatment is effective, andtreatment is effective, and
every patient who ...
Assessment of Tobacco UseAssessment of Tobacco Use
Does Patient Now Use
Tobacco?
Did Patient
Once Use?
Tobacco?
Prevent
Re...
Two Questions, Three MinutesTwo Questions, Three Minutes
Very Brief CounselingVery Brief Counseling
 Do you smoke?Do you ...
PharmacotherapiesPharmacotherapies
Numerous effective pharmacotherapies forNumerous effective pharmacotherapies for
smokin...
The “5 R’s” to EnhanceThe “5 R’s” to Enhance
Motivation for Patients UnwillingMotivation for Patients Unwilling
To QuitTo ...
Types of Prevention ProgramsTypes of Prevention Programs
for Youthfor Youth
School-based curriculaSchool-based curricula
S...
Sources of MOST RECENT Cigarette:Sources of MOST RECENT Cigarette:
Past Month Smokers, Grades 8-10Past Month Smokers, Grad...
Mass Media StrategiesMass Media Strategies
Aimed at YouthAimed at Youth
Pros Cons
Reach large numbersReach large numbers
o...
Tobacco Advertising ContinuesTobacco Advertising Continues
in Youth-Oriented Magazinesin Youth-Oriented Magazines
Thank you forThank you for
NOT SmokingNOT Smoking
Tobacco smoking control 3
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  • This slide clearly demonstrates that smoking onset occurs rapidly in early adolescence. These are the same stages with same definitions as shown in the previous slide.
  • These factors are reviewed in detail in the 1994 Surgeon General’s Report on Preventing Tobacco Use among Young People. This slide shows the factors that have been shown to be predictive of smoking in research studies and their inter-relationships, based on social cognitive theory.
  • Most of the predictive factors are applicable to multiple stages of smoking onset (as defined in slide #2). But changes from never smoker to experimental are more associated with the social environment. Changes to regular and established smoking are more associated with amount, opportunities, and access to tobacco.
  • There are eight major types of prevention programs for youth. These will each be reviewed in the following slides.
  • Forster JL, Chen CHV, Blaine TM, Perry CL, Toomey T. Social Exchange of Cigarettes by Youth. Under Review
    Most cigarettes are obtained from other teens, including friends. Adults provide only a small proportion of cigarettes to teens, and a slightly larger proportion come directly from businesses.
  • These are the pro’s and con’s of mass media approaches to smoking prevention with youth.
  • Citation: National Center for Tobacco-Free Kids, 2002; www.tobaccofreekids.org/reports/addicting/
  • Tobacco smoking control 3

    1. 1. With special thanks to Dr. Ron LaporteWith special thanks to Dr. Ron Laporte at University of Pittsburgh for emailingat University of Pittsburgh for emailing and providing me with valuableand providing me with valuable material and data to be used in thismaterial and data to be used in this presentation……….presentation……….Nayyar R. KazmiNayyar R. Kazmi
    2. 2. There are almost 10-15 millionThere are almost 10-15 million established smokers in Pakistanestablished smokers in Pakistan Common in labourer class,Common in labourer class, transport drivers, other lower socio-transport drivers, other lower socio- economic groups as well as uppereconomic groups as well as upper stratum of the societystratum of the society
    3. 3. Drug AddictsDrug Addicts Non Drug AddictsNon Drug Addicts EstablishedEstablished SmokersSmokers 257257 6262 Non-SmokersNon-Smokers 3939 134134 Kazmi NR, et al. Regular smoking as a risk factor in drug addicts- A case control study in Peshawar- Int Journal of Epidemiology: 2000. Vol.XXI, No.IV: 1554 Odds Ratio 14.24
    4. 4. Have you ever smoked a whole cigarette? Ever tried – even a few puffs? No – Never SmokerNever Smoker Yes YesNo – TrierTrier Smoked > 1 whole cigarette? No – TrierTrier Yes On how many of last 30 days did you smoke? None – < Monthly smoker< Monthly smoker < 20 days > 20 days – Established smokerEstablished smoker On how many of last 7 days did you smoke? None – Experimental SmokerExperimental Smoker At least one – Regular SmokerRegular Smoker 11 22 22 33 44 55 Stage Model of Smoking AcquisitionStage Model of Smoking Acquisition 66
    5. 5. Smoking by Age andSmoking by Age and Stage of Onset*Stage of Onset* AGE *Source: The MACC Study
    6. 6. Tobacco Dependence as aTobacco Dependence as a Chronic DiseaseChronic Disease  Tobacco dependence demonstratesTobacco dependence demonstrates features of a chronic disease:features of a chronic disease:  Long-term disorderLong-term disorder  Periods of relapse and remissionPeriods of relapse and remission  Requires ongoing rather than acute careRequires ongoing rather than acute care
    7. 7. Smoking in PerspectiveSmoking in Perspective Kills more than 440,000 Americans each yearKills more than 440,000 Americans each year 23% of adult Americans smoke23% of adult Americans smoke 3,000 children and adolescents become regular3,000 children and adolescents become regular tobacco users every daytobacco users every day Causes cancer, heart disease, stroke,Causes cancer, heart disease, stroke, pulmonary disease, and adverse pregnancypulmonary disease, and adverse pregnancy outcomes- shortens life expectancy 14 yearsoutcomes- shortens life expectancy 14 years Adds $157 billion in costs per yearAdds $157 billion in costs per year One-third of all tobacco users in U.S. will dieOne-third of all tobacco users in U.S. will die prematurelyprematurely
    8. 8. Environmental Tobacco SmokeEnvironmental Tobacco Smoke Kills one person prematurely, for every 8 people killed byKills one person prematurely, for every 8 people killed by primary smokingprimary smoking 50,000 premature deaths each year50,000 premature deaths each year 1 million ER visits for asthma each year1 million ER visits for asthma each year Causes all diseases primary smokeCauses all diseases primary smoke 60 carcinogens-formaldehyde, benzo[a]pyrene60 carcinogens-formaldehyde, benzo[a]pyrene 6 developmental toxicants, nicotine, CO6 developmental toxicants, nicotine, CO The tobacco industry spends billions arguing the pointThe tobacco industry spends billions arguing the point
    9. 9. Perceived Health Risks Among Cigarette Smokers Heart attack Cancer All smokers 29% 40% Heavy smokers 39% 49% Ayanian & Cleary JAMA 1999;281:1091-1021
    10. 10. Predictive Factors of YouthPredictive Factors of Youth Smoking OnsetSmoking Onset EnvironmentalEnvironmental Access to cigarettesAccess to cigarettes Exposure to marketingExposure to marketing Peer use and supportPeer use and support Sibling use and supportSibling use and support Parental supportParental support Normative expectationsNormative expectations BehavioralBehavioral Academic achievementAcademic achievement Behavioral skillsBehavioral skills Prior use of tobaccoPrior use of tobacco Other problem behaviorsOther problem behaviors Socio-DemographicSocio-Demographic Low SESLow SES Developmental stageDevelopmental stage Intra-PersonalIntra-Personal Functional meaningsFunctional meanings of smokingof smoking Low self-imageLow self-image Self-efficacy to refuseSelf-efficacy to refuse offersoffers Personality factorsPersonality factors
    11. 11. Exposure to advertising, adult/sibling role modelsExposure to advertising, adult/sibling role models who smoke cigarettes, and low academicwho smoke cigarettes, and low academic achievementachievement Peer influences to smoke, the perception thatPeer influences to smoke, the perception that smoking is normative and functional, and socialsmoking is normative and functional, and social access to cigarettes.access to cigarettes. Social situations and peers that support smoking,Social situations and peers that support smoking, low self-efficacy and skills to refuse offers tolow self-efficacy and skills to refuse offers to smoke, and social/commercial access to cigarettes.smoke, and social/commercial access to cigarettes. Peers who smoke, the perception that smoking hasPeers who smoke, the perception that smoking has personal utility, social and commercial access topersonal utility, social and commercial access to cigarettes, and few restrictions on smoking in thecigarettes, and few restrictions on smoking in the home, school, and community settings.home, school, and community settings. Number of cigarettes smoked, frequency ofNumber of cigarettes smoked, frequency of smoking, self-efficacy to refuse offers, peersmoking, self-efficacy to refuse offers, peer support for smoking, and other problem behaviors.support for smoking, and other problem behaviors. Stages of Smoking Onset andStages of Smoking Onset and Predictive Factors among YouthPredictive Factors among Youth
    12. 12. It is essential that clinicians andIt is essential that clinicians and health care delivery systemshealth care delivery systems (including administrators,(including administrators, insurers, and purchasers)insurers, and purchasers) institutionalize the consistentinstitutionalize the consistent identification, documentation,identification, documentation, and treatment of every tobaccoand treatment of every tobacco user seen in a health careuser seen in a health care setting.setting.
    13. 13. Brief tobacco dependenceBrief tobacco dependence treatment is effective, andtreatment is effective, and every patient who usesevery patient who uses tobacco should be offeredtobacco should be offered at least brief treatment.at least brief treatment.
    14. 14. Assessment of Tobacco UseAssessment of Tobacco Use Does Patient Now Use Tobacco? Did Patient Once Use? Tobacco? Prevent Relapse Promote Motivation To Quit Provide Appropriate Treatments Is Patient Now Willing To Quit? Encourage Continued Abstinence YES NO YES NO YES NO Patient Presents to a Health Care Setting
    15. 15. Two Questions, Three MinutesTwo Questions, Three Minutes Very Brief CounselingVery Brief Counseling  Do you smoke?Do you smoke?  Do you want to quit?Do you want to quit?  If yes-If yes-  provide adviceprovide advice  set quit dateset quit date  prescribe medsprescribe meds  set follow-upset follow-up  If no-provide advice and move onIf no-provide advice and move on
    16. 16. PharmacotherapiesPharmacotherapies Numerous effective pharmacotherapies forNumerous effective pharmacotherapies for smoking cessation now exist. Except insmoking cessation now exist. Except in the presence of contraindications, thesethe presence of contraindications, these should be used with all patientsshould be used with all patients attempting to quit smoking.attempting to quit smoking. SixSix first-linefirst-line pharmacotherapies werepharmacotherapies were identified that reliably increase long-termidentified that reliably increase long-term smoking abstinence rates:smoking abstinence rates: Bupropion SRBupropion SR • Nicotine Nasal Spray• Nicotine Nasal Spray Nicotine GumNicotine Gum • Nicotine Patch• Nicotine Patch Nicotine InhalerNicotine Inhaler Nicotine LozengeNicotine Lozenge
    17. 17. The “5 R’s” to EnhanceThe “5 R’s” to Enhance Motivation for Patients UnwillingMotivation for Patients Unwilling To QuitTo Quit  RELEVANCERELEVANCE: Tailor advice and discussion to: Tailor advice and discussion to each patienteach patient  RISKSRISKS: Discuss risks of continued smoking: Discuss risks of continued smoking  REWARDSREWARDS: Discuss benefits of quitting: Discuss benefits of quitting  ROADBLOCKSROADBLOCKS: Identify barriers to quitting: Identify barriers to quitting  REPETITIONREPETITION: Reinforce the motivational: Reinforce the motivational message at every visitmessage at every visit
    18. 18. Types of Prevention ProgramsTypes of Prevention Programs for Youthfor Youth School-based curriculaSchool-based curricula School environmental changesSchool environmental changes Parental involvementParental involvement Teen cessation programsTeen cessation programs Social and commercial access strategiesSocial and commercial access strategies Mass media campaignsMass media campaigns Cigarette advertising and promotional bansCigarette advertising and promotional bans Price increasesPrice increases
    19. 19. Sources of MOST RECENT Cigarette:Sources of MOST RECENT Cigarette: Past Month Smokers, Grades 8-10Past Month Smokers, Grades 8-10 N = 3991N = 3991Source: Forster et al, under review.
    20. 20. Mass Media StrategiesMass Media Strategies Aimed at YouthAimed at Youth Pros Cons Reach large numbersReach large numbers of teensof teens Can change socialCan change social normsnorms Can be linked to moreCan be linked to more intensive interventionsintensive interventions Message may not beMessage may not be relevantrelevant Superficial preventionSuperficial prevention messagemessage Expensive on primaryExpensive on primary networksnetworks Needs frequent updatingNeeds frequent updating Types:Types: Television counter-advertising, radio ads,Television counter-advertising, radio ads, print media, internetprint media, internet
    21. 21. Tobacco Advertising ContinuesTobacco Advertising Continues in Youth-Oriented Magazinesin Youth-Oriented Magazines
    22. 22. Thank you forThank you for NOT SmokingNOT Smoking

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