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  • 1931
  • 2007
  • July 30, 2008 SF Chron
  • Marin Independent Journal 3 July 2002
  • NYT 11/12/99

Generic pharmacy talk Generic pharmacy talk Presentation Transcript

  • The Pharmacist’s Role in Ending the Tobacco Pandemic
    Alan Blum, MD
    Auburn University
    Harrison School of Pharmacy
    February 18, 2011
  • DEATHS FROM CIGARETTE SMOKING IN US SINCE 1964
    12,000,000
  • Smoking Prevalence
  • CAUSES OF DEATH
    Heart disease
    Cancer
    Stroke
    COPD
    Accidents
    Diabetes
  • MARLBORO’S MYOCARDIAL MAYHEM
    ↑ oxygen demand
    ↓ angina threshold
    ↓ exercise performance
    ↑ recurrent infarction
  • CAMEL’S CORONARY CONSEQUENCES
    Adverse lipid profile
    Altered hematologic factors
    Direct arterial wall effects
    Elevated blood pressure
  • Cancer Death Rates for Men, US, 1930-2005
  • Cancer Death Rates for Women, US, 1930-2005
  • COPD
    5% of US population
    80% caused by smoking
    4th leading cause of death
  • DIABETES:
    3x Cardiovascular Mortality
  • SMOKING + DIABETES:
    11x Cardiovascular
    Mortality
  • OTHER TOBACCOGENIC PROBLEMS
    Osteoporosis
    Hip fractures
    Early menopause
    Macular degeneration
    Peptic ulcer disease
  • SECONDHAND SMOKE
    Lung cancer: 3,000 deaths/year
    Heart disease: 40,000 deaths/year
    Asthma: 2 million visits/year
  • SMOKING IN PREGNANCY
    Low birthweight
    Preterm labor
    Spontaneous abortion
    Abruptio placenta
    Placenta praevia
    Premature rupture of membranes
  • EFFECTS ON CHILDREN
    SIDS
    Asthma
    Bronchitis
    Otitis media
    Pneumonia
  • INFLUENCES
    Peers
    Parents
    Propaganda
  • SMOKING CESSATION
    44.5 million smoke
    77% want to stop
    40% try each year
    5% succeed
  • MARKERS OF ADDICTION
    >20 Cigarettes /day
    Smoke upon awakening
    Psychiatric condition
    Alcohol dependence
  • BEHAVIOR MODIFICATION
    Identify situations
    Choose oral substitutes
    Do five-minute plan:
    Postpone
    Inhale
    Reconsider
  • SMOKING’S MYTHS
    Relieves stress
    Keeps weight down
    Low-tar, filters, are safer
  • THE PRODUCT
    Filter
    Low tar
    Lights
    Menthol
  • MONEY LOST
    Number of packs/day
    x Cost/pack
    x 365 days/year
    X Number of years smoking
    Total cash lost (plus interest)
  • INHALATION COUNT
    Number of cigarettes/day
    x 10 inhalations/cigarette
    x 365 days/year
    x Number of years smoking
    Total inhalations
  • BENEFITS OF STOPPING
    1 day: ↓ MI risk
    1 year: ↓ Stroke risk 50%
    10 years: Stroke risk of non-smoker
    15 years: CHD risk of non-smoker
  • COSMETIC BENEFITS
    Fresher breath, clothing
    Whiter teeth, nails
    Endurance
  • NICOTINE REPLACEMENT THERAPY
    Gum (Nicorette)
    Transdermal patch (Nicoderm)
    Inhaler (Nicotrol)
    Lozenge (Commit)
    Electronic cigarette?
  • ADJUNCTIVE PHARMACOTHERAPY
    Bupropion
    Clonidine
    Nortriptyline
    Verenicline
    Rimonabant
  • SMOKING PREVENTION
    Increase cigarette taxes
    Restrict teen access
    Clean indoor air laws
    Ban advertising
    Educate on TV, radio, internet
  • SHIFTING THE FOCUS
    Substance -> Product
    Effects -> Promotion
    User -> Pusher
  • AMERICAN TOBACCO COMPANIES
    Philip Morris USA
    Reynolds-American Inc.
    Lorillard Inc.
    United States Smokeless Tobacco
    Liggett Vector Brands Inc.
    Swedish Match
    Imperial Tobacco
  • CANCER’S 7 WARNING SIGNS
    Philip Morris USA
    Reynolds American Inc
    Lorillard Inc.
    United States Smokeless Tobacco
    Liggett Vector Brands Inc.
    Swedish Match
    Imperial Tobacco
  • Alan Blum, M.D.
    Professor and Gerald Leon Wallace Endowed Chair in Family Medicine, College of Community Health Sciences, School of Medicine, The University of Alabama
    Director, The University of Alabama Center for the Study of Tobacco and Society
    ablum@cchs.ua.edu
  • STRATEGIC WEAPONS
    Map
    Calendar
    Camera
  • Alan Blum, M.D.
    Professor and Endowed Chair in Family Medicine, The University of Alabama
    Director, The University of Alabama Center for the Study of Tobacco and Society
    ablum@cchs.ua.edu