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EVY R. SARMIENTO,
MD.
DOH CHD Bicol Legazpi City
In the 20th century, the tobacco
epidemic killed 100 million people
worldwide.
•During the 21st century, it could kill one billion.
SMOKING: A Serious Problem
I in 10 deaths are from tobacco use
Tobacco use killed 6 million people in 2010*
1 billion deaths are forecast over the 21st
century (100 m died from tobacco smoking
in the 20th
century)
About 15 years of life are lost on average by
smoking
Tobacco use costs a nation 3.6% of its GDP
www.deathsfromsmoking.net *American Cancer Society 2009
TOBACCO WILL KILL OVER 175 MILLION PEOPLE
WORLDWIDE BETWEEN NOW AND THE YEAR 2030
Number of disease-related deaths worldwide per day
HIV/AIDS
8,500
TUBERCULOSIS
5,000
MALARIA
3,000
TOBACCO
13,500
Source: WHO/IUATLD
Global Burden of Tobacco
1 B smokers / 200
M female
Adults: 40% male;
9% female
Adolescents: 151
countries surveyed
– roughly equal in
number
Smoking Prevalence Among Women
Philippine Data: 2009 GATS
 17.3 M (28.3%) aged 15 years and over – 80%
current smokers
o 14.6 M (47.7%) men; 2.8 M (9%) women
 Daily cigarette smokers:
o 98% men; 83% women
o men: 11.3 sticks; women: 7 sticks
REPLACEMENT SMOKERS
15
Today’s teenager is
tomorrow’s potential
regular customer.
Philip Morris Memo, 1981
Prevalence of Tobacco Use
Among Youth
Prevalence of Tobacco Use and Susceptibility
to Tobacco Use
By Sex, PHL Global Youth Tobacco Survey 2007
POOR MAN’S
FIX
1.3%
1.6%
13.1%
2.6%
6.3%
8.2%
3.3%
2.6%
61.1%
Food
Clothing
Housing
Health
Education
Utilities
Transport &
Communication
Tobacco
Other expenses
Source: Tobacco and Poverty Study in the Philippines, May 2006; Basic Data: FIES, 2003
60%
14.4%1.7%
2.9%
7.5%
9.3%
0.6%
1.6%
2.0%
 20,000 Filipinos die20,000 Filipinos die
everyevery
year due to tobacco-year due to tobacco-
related diseaserelated disease
THAT’S 2 OR 3 EVERY HOUR
ACTIVE SMOKING:
Refers to directly
smoking from a
LIGHTED
Cigarette or other
tobacco products.
These persons are
referred to as
SMOKERS
MAINSTREAM SMOKE
PASSIVE SMOKING:
Also called
Involuntary or
Second-Hand
smoking.
It occurs when non-
smokers are exposed
to second-hand
smoke from
smokers
SIDE STREAM SMOKE
Tobacco can
kill you!
Each time
you smoke a
cigarette it
takes away 5
to 20
minutes of
your life.
Fatal and disabling diseasesFatal and disabling diseases
 Cancers of the lungs and otherCancers of the lungs and other
organsorgans
 Ischemic Heart DiseaseIschemic Heart Disease
 StrokesStrokes
 Respiratory diseasesRespiratory diseases
What Are You Smoking?
Acetanisole, Acetic Acid, Acetoin, Acetophenone, 6-Acetoxydihydrotheaspirane, 2-Acetyl-3- Ethylpyrazine, 2-Acetyl-5-
Methylfuran, Acetylpyrazine, 2-Acetylpyridine, 3-Acetylpyridine, 2-Acetylthiazole, Aconitic Acid, dl-Alanine, Alfalfa Extract,
Allspice Extract, Oleoresin, And Oil, Allyl Hexanoate, Allyl Ionone, Almond Bitter Oil, Ambergris Tincture, Ammonia,
Ammonium Bicarbonate, Ammonium Hydroxide, Ammonium Phosphate Dibasic, Ammonium Sulfide, Amyl Alcohol, Amyl
Butyrate, Amyl Formate, Amyl Octanoate, alpha-Amylcinnamaldehyde, Amyris Oil, trans-Anethole, Angelica Root Extract, Oil
and Seed Oil, Anise, Anise Star, Extract and Oils, Anisyl Acetate, Anisyl Alcohol, Anisyl Formate, Anisyl Phenylacetate, Apple
Juice Concentrate, Extract, and Skins, Apricot Extract and Juice Concentrate, 1-Arginine, Asafetida Fluid Extract And Oil,
Ascorbic Acid, 1-Asparagine Monohydrate, 1-Aspartic Acid, Balsam Peru and Oil, Basil Oil, Bay Leaf, Oil and Sweet Oil,
Beeswax White, Beet Juice Concentrate, Benzaldehyde,Benzaldehyde Glyceryl Acetal, Benzoic Acid, Benzoin, Benzoin Resin,
Benzophenone, Benzyl Alcohol, Benzyl Benzoate, Benzyl Butyrate, Benzyl Cinnamate, Benzyl Propionate, Benzyl Salicylate,
Bergamot Oil, Bisabolene, Black Currant Buds Absolute, Borneol, Bornyl Acetate, Buchu Leaf Oil, 1,3-Butanediol, 2,3-
Butanedione, 1-Butanol, 2-Butanone, 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One, Butter, Butter Esters, and
Butter Oil, Butyl Acetate, Butyl Butyrate, Butyl Butyryl Lactate, Butyl Isovalerate, Butyl Phenylacetate, Butyl Undecylenate, 3-
Butylidenephthalide, Butyric Acid, Cadinene, Caffeine, Calcium Carbonate, Camphene, Cananga Oil, Capsicum Oleoresin,
Caramel Color, Caraway Oil, Carbon Dioxide, Cardamom Oleoresin, Extract, Seed Oil, and Powder, Carob Bean and Extract,
beta-Carotene, Carrot Oil, Carvacrol, 4-Carvomenthenol, 1-Carvone, beta-Caryophyllene, beta-Caryophyllene Oxide, Cascarilla
Oil and Bark Extract, Cassia Bark Oil, Cassie Absolute and Oil, Castoreum Extract,Tincture and Absolute,Cedar Leaf Oil,
Cedarwood Oil Terpenes and Virginiana, Cedrol, Celery Seed Extract, Solid, Oil, And Oleoresin, Cellulose Fiber, Chamomile
Flower Oil And Extract, Chicory Extract, Chocolate, Cinnamaldehyde, Cinnamic Acid, Cinnamon Leaf Oil, Bark Oil, and Extract,
Cinnamyl Acetate, Cinnamyl Alcohol, Cinnamyl Cinnamate, Cinnamyl Isovalerate, Cinnamyl Propionate, Citral, Citric Acid,
Citronella Oil, dl-Citronellol, Citronellyl Butyrate, Citronellyl Isobutyrate, Civet Absolute, Clary Oil, Clover Tops, Red Solid
Extract, Cocoa, Cocoa Shells, Extract, Distillate And Powder, Coconut Oil, Coffee, Cognac White and Green Oil, Copaiba Oil,
Coriander Extract and Oil, Corn Oil, Corn Silk, Costus Root Oil, Cubeb Oil, Cuminaldehyde, para-Cymene, 1-Cysteine, Dandelion
Root Solid Extract, Davana Oil, 2-trans, 4-trans-Decadienal, delta-Decalactone, gamma-Decalactone, Decanal, Decanoic Acid,
1-Decanol, 2-Decenal, Dehydromenthofurolactone, Diethyl Malonate, Diethyl Sebacate, 2,3-Diethylpyrazine,Dihydro Anethole,
5,7-Dihydro-2-Methylthieno(3,4-D) Pyrimidine, Dill Seed Oil and Extract, meta-Dimethoxybenzene, para-Dimethoxybenzene,
2,6-Dimethoxyphenol, Dimethyl Succinate, 3,4-Dimethyl-1,2-Cyclopentanedione, 3,5- Dimethyl-1,2-Cyclopentanedione, 3,7-
Dimethyl-1,3,6-Octatriene, 4,5-Dimethyl-3-Hydroxy-2,5-Dihydrofuran-2-One, 6,10-Dimethyl-5,9-Undecadien-2-One, 3,7-
Dimethyl-6-Octenoic Acid, 2,4-Dimethylacetophenone, alpha,para-Dimethylbenzyl Alcohol, alpha,alpha-Dimethylphenethyl
Acetate, alpha,alpha Dimethylphenethyl Butyrate, 2,3-Dimethylpyrazine,2,5-Dimethylpyrazine, 2,6-Dimethylpyrazine,
Dimethyltetrahydrobenzofuranone, delta-Dodecalactone, gamma-Dodecalactone, para-Ethoxybenzaldehyde, Ethyl 10-
Undecenoate, Ethyl 2-Methylbutyrate, Ethyl Acetate, Ethyl Acetoacetate, Ethyl Alcohol, Ethyl Benzoate, Ethyl Butyrate, Ethyl
Cinnamate, Ethyl Decanoate, Ethyl Fenchol, Ethyl Furoate, Ethyl Heptanoate, Ethyl Hexanoate, Ethyl Isovalerate, Ethyl
Lactate, Ethyl Laurate, Ethyl Levulinate, Ethyl Maltol,Ethyl Methyl Phenylglycidate, Ethyl Myristate, Ethyl Nonanoate, Ethyl
Octadecanoate, Ethyl Octanoate, Ethyl Oleate, Ethyl Palmitate, Ethyl Phenylacetate, Ethyl Propionate, Ethyl Salicylate, Ethyl
trans-2-Butenoate, Ethyl Valerate, Ethyl Vanillin, 2-Ethyl (or Methyl)-(3,5 and 6)-Methoxypyrazine, 2-Ethyl-1-Hexanol, 3-
Ethyl -2 -Hydroxy-2-Cyclopenten-1-One, 2-Ethyl-3, (5 or 6)-Dimethylpyrazine, 5-Ethyl-3-Hydroxy-4-Methyl-2(5H)-Furanone,
2-Ethyl-3-Methylpyrazine, 4-Ethylbenzaldehyde, 4-Ethylguaiacol, para-Ethylphenol, 3-Ethylpyridine, Eucalyptol, Farnesol, D-
Fenchone,
POISONS in Cigarette
Fennel Sweet Oil, Fenugreek, Extract, Resin, and Absolute, Fig Juice Concentrate, Food Starch Modified, Furfuryl Mercaptan, 4-(2-Furyl)-3-Buten-2-One,
Galbanum Oil, Genet Absolute, Gentian Root Extract, Geraniol, Geranium Rose Oil, Geranyl Acetate, Geranyl Butyrate, Geranyl Formate, Geranyl
Isovalerate, Geranyl Phenylacetate, Ginger Oil and Oleoresin, 1-Glutamic Acid, 1-Glutamine, Glycerol, Glycyrrhizin Ammoniated, Grape Juice
Concentrate,Guaiac Wood Oil, Guaiacol, Guar Gum, 2,4-Heptadienal, gamma-Heptalactone, Heptanoic Acid, 2-Heptanone, 3-Hepten-2-One, 2-Hepten-4-
One, 4-Heptenal, trans -2-Heptenal, Heptyl Acetate, omega-6-Hexadecenlactone, gamma-Hexalactone, Hexanal, Hexanoic Acid, 2-Hexen-1-Ol, 3-Hexen-1-
Ol, cis-3-Hexen-1-Yl Acetate, 2-Hexenal, 3-Hexenoic Acid, trans-2-Hexenoic Acid, cis-3-Hexenyl Formate, Hexyl 2-Methylbutyrate, Hexyl Acetate, Hexyl
Alcohol, Hexyl Phenylacetate, 1-Histidine, Honey, Hops Oil, Hydrolyzed Milk Solids, Hydrolyzed Plant Proteins, 5-Hydroxy-2,4-Decadienoic Acid delta-
Lactone, 4-Hydroxy-2,5-Dimethyl-3(2H)-Furanone, 2-Hydroxy-3,5,5-Trimethyl-2-Cyclohexen-1-One, 4-Hydroxy -3-Pentenoic Acid Lactone, 2-Hydroxy-4-
Methylbenzaldehyde, 4-Hydroxybutanoic Acid Lactone, Hydroxycitronellal, 6-Hydroxydihydrotheaspirane, 4-(para-Hydroxyphenyl)-2-Butanone, Hyssop
Oil, Immortelle Absolute and Extract, alpha-Ionone, beta-Ionone, alpha-Irone, Isoamyl Acetate, Isoamyl Benzoate, Isoamyl Butyrate, Isoamyl
Cinnamate,Isoamyl Formate, Isoamyl Hexanoate, Isoamyl Isovalerate, Isoamyl Octanoate, Isoamyl Phenylacetate, Isobornyl Acetate, Isobutyl Acetate,
Isobutyl Alcohol, Isobutyl Cinnamate, Isobutyl Phenylacetate, Isobutyl Salicylate, 2-Isobutyl-3-Methoxypyrazine, alpha-Isobutylphenethyl Alcohol,
Isobutyraldehyde, Isobutyric Acid, d,l-Isoleucine, alpha-Isomethylionone, 2-Isopropylphenol, Isovaleric Acid, Jasmine Absolute, Concrete and Oil, Kola
Nut Extract, Labdanum Absolute and Oleoresin, Lactic Acid, Lauric Acid, Lauric Aldehyde, Lavandin Oil, Lavender Oil, Lemon Oil and Extract, Lemongrass
Oil, 1-Leucine, Levulinic Acid, Licorice Root, Fluid, Extract and Powder, Lime Oil, Linalool, Linalool Oxide, Linalyl Acetate, Linden Flowers, Lovage Oil And
Extract, 1-Lysine, Mace Powder, Extract and Oil, Magnesium Carbonate, Malic Acid, Malt and Malt Extract, Maltodextrin, Maltol, Maltyl Isobutyrate,
Mandarin Oil, Maple Syrup and Concentrate, Mate Leaf, Absolute and Oil, para-Mentha-8-Thiol-3-One, Menthol, Menthone,Menthyl Acetate, dl-Methionine,
Methoprene, 2-Methoxy-4-Methylphenol, 2-Methoxy-4-Vinylphenol, para-Methoxybenzaldehyde, 1-(para-Methoxyphenyl)-1-Penten-3-One, 4-(para-
Methoxyphenyl)-2-Butanone, 1-(para-Methoxyphenyl)-2-Propanone, Methoxypyrazine, Methyl 2-Furoate, Methyl 2-Octynoate, Methyl 2-Pyrrolyl Ketone,
Methyl Anisate, Methyl Anthranilate, Methyl Benzoate, Methyl Cinnamate, Methyl Dihydrojasmonate, Methyl Ester of Rosin, Partially Hydrogenated, Methyl
Isovalerate, Methyl Linoleate (48%), Methyl Linolenate (52%) Mixture, Methyl Naphthyl Ketone, Methyl Nicotinate, Methyl Phenylacetate, Methyl
Salicylate, Methyl Sulfide, 3-Methyl-1-Cyclopentadecanone, 4-Methyl-1-Phenyl-2-Pentanone, 5-Methyl-2-Phenyl-2-Hexenal, 5-Methyl-2-
Thiophenecarboxaldehyde, 6-Methyl-3,-5-Heptadien-2-One, 2-Methyl-3-(para-Isopropylphenyl) Propionaldehyde, 5-Methyl-3-Hexen-2-One, 1-Methyl-
3Methoxy-4-Isopropylbenzene, 4-Methyl-3-Pentene-2-One, 2-Methyl-4-Phenylbutyraldehyde, 6-Methyl-5-Hepten-2-One, 4-Methyl-5-Thiazoleethanol,4-
Methyl-5-Vinylthiazole, Methyl-alpha-Ionone, Methyl-trans-2-Butenoic Acid, 4-Methylacetophenone, para-Methylanisole, alpha-Methylbenzyl Acetate,
alpha-Methylbenzyl Alcohol, 2-Methylbutyraldehyde, 3-Methylbutyraldehyde, 2-Methylbutyric Acid, alpha-Methylcinnamaldehyde, Methylcyclopentenolone,
2-Methylheptanoic Acid, 2-Methylhexanoic Acid, 3-Methylpentanoic Acid, 4-Methylpentanoic Acid, 2-Methylpyrazine, 5-Methylquinoxaline, 2-
Methyltetrahydrofuran-3-One, (Methylthio)Methylpyrazine (Mixture Of Isomers), 3-Methylthiopropionaldehyde, Methyl 3-Methylthiopropionate, 2-
Methylvaleric Acid, Mimosa Absolute and Extract, Molasses Extract and Tincture, Mountain Maple Solid Extract, Mullein Flowers, Myristaldehyde, Myristic
Acid, Myrrh Oil, beta-Napthyl Ethyl Ether, Nerol, Neroli Bigarde Oil, Nerolidol, Nona-2-trans,6-cis-Dienal, 2,6-Nonadien-1-Ol, gamma-Nonalactone,
Nonanal, Nonanoic Acid, Nonanone, trans-2-Nonen-1-Ol, 2-Nonenal, Nonyl Acetate, Nutmeg Powder and Oil, Oak Chips Extract and Oil,Oak Moss Absolute,
9,12-Octadecadienoic Acid (48%) And 9,12,15-Octadecatrienoic Acid (52%), delta-Octalactone, gamma-Octalactone, Octanal, Octanoic Acid, 1-Octanol, 2-
Octanone, 3-Octen-2-One, 1-Octen-3-Ol, 1-Octen-3-Yl Acetate, 2-Octenal, Octyl Isobutyrate, Oleic Acid , Olibanum Oil, Opoponax Oil And Gum, Orange
Blossoms Water, Absolute, and Leaf Absolute, Orange Oil and Extract, Origanum Oil, Orris Concrete Oil and Root Extract, Palmarosa Oil, Palmitic Acid,
Parsley Seed Oil, Patchouli Oil, omega-Pentadecalactone, 2,3-Pentanedione, 2-Pentanone, 4-Pentenoic Acid, 2-Pentylpyridine, Pepper Oil, Black And
White, Peppermint Oil, Peruvian (Bois De Rose) Oil, Petitgrain Absolute, Mandarin Oil and Terpeneless Oil, alpha-Phellandrene, 2-Phenenthyl Acetate,
Phenenthyl Alcohol, Phenethyl Butyrate, Phenethyl Cinnamate, Phenethyl Isobutyrate, Phenethyl Isovalerate, Phenethyl Phenylacetate, Phenethyl
Salicylate, 1-Phenyl-1-Propanol, 3-Phenyl-1-Propanol, 2-Phenyl-2-Butenal, 4-Phenyl-3-Buten-2-Ol,4-Phenyl-3-Buten-2-One, Phenylacetaldehyde,
Phenylacetic Acid, 1-Phenylalanine, 3-Phenylpropionaldehyde, 3-Phenylpropionic Acid, 3-Phenylpropyl Acetate, 3-Phenylpropyl Cinnamate, 2-(3-
Phenylpropyl)Tetrahydrofuran, Phosphoric Acid, Pimenta Leaf Oil, Pine Needle Oil, Pine Oil, Scotch, Pineapple Juice Concentrate, alpha-Pinene, beta-
Pinene, D-Piperitone, Piperonal, Pipsissewa Leaf Extract, Plum Juice, Potassium Sorbate, 1-Proline, Propenylguaethol, Propionic Acid, Propyl Acetate,
Propyl para-Hydroxybenzoate, Propylene Glycol, 3-Propylidenephthalide, Prune Juice and Concentrate, Pyridine, Pyroligneous Acid And Extract, Pyrrole,
Pyruvic Acid, Raisin Juice Concentrate, Rhodinol, Rose Absolute and Oil, Rosemary Oil, Rum, Rum Ether, Rye Extract, Sage, Sage Oil, and Sage Oleoresin,
Salicylaldehyde, Sandalwood Oil, Yellow, Sclareolide, Skatole, Smoke Flavor, Snakeroot Oil, Sodium Acetate, Sodium Benzoate, Sodium Bicarbonate,
Sodium Carbonate, Sodium Chloride, Sodium Citrate, Sodium Hydroxide, Solanone, Spearmint Oil, Styrax Extract, Gum and Oil, Sucrose Octaacetate, Sugar
Alcohols, Sugars, Tagetes Oil, Tannic Acid, Tartaric Acid, Tea Leaf and Absolute, alpha-Terpineol, Terpinolene, Terpinyl Acetate, 5,6,7,8-
Tetrahydroquinoxaline, 1,5,5,9-Tetramethyl-13-Oxatricyclo(8.3.0.0(4,9))Tridecane, 2,3,4,5, and 3,4,5,6-Tetramethylethyl-Cyclohexanone, 2,3,5,6-
Tetramethylpyrazine, Thiamine Hydrochloride, Thiazole, 1-Threonine, Thyme Oil, White and Red, Thymol, Tobacco Extracts, Tochopherols (mixed), Tolu
Balsam Gum and Extract, Tolualdehydes, para-Tolyl 3-Methylbutyrate, para-Tolyl Acetaldehyde, para-Tolyl Acetate, para-Tolyl Isobutyrate, para-Tolyl
Phenylacetate, Triacetin, 2-Tridecanone, 2-Tridecenal, Triethyl Citrate, 3,5,5-Trimethyl -1-Hexanol, para,alpha,alpha-Trimethylbenzyl Alcohol, 4-(2,6,6-
Trimethylcyclohex-1-Enyl)But-2-En-4-One, 2,6,6-Trimethylcyclohex-2-Ene-1,4-Dione, 2,6,6-Trimethylcyclohexa-1,3-Dienyl Methan, 4-(2,6,6-
Trimethylcyclohexa-1,3-Dienyl)But-2-En-4-One,2,2,6-Trimethylcyclohexanone, 2,3,5-Trimethylpyrazine, 1-Tyrosine, delta-Undercalactone, gamma-
Undecalactone, Undecanal, 2-Undecanone, 10-Undecenal, Urea, Valencene, Valeraldehyde, Valerian Root Extract, Oil and Powder, Valeric Acid, gamma-
Valerolactone, Valine, Vanilla Extract And Oleoresin, Vanillin, Veratraldehyde, Vetiver Oil, Vinegar, Violet Leaf Absolute, Walnut Hull Extract, Water, Wheat
Extract And Flour, Wild Cherry Bark Extract, Wine and Wine Sherry, Xanthan Gum, 3,4-Xylenol, Yeast
POISONS in Cigarette
ACETONE- nail polish remover
ACETIC ACID- vinegar additive
AMMONIA-toilet cleaner
ARSENIC-rat poison
BUTANE- cigarette lighter
• CADMIUM- batteries
DDT- insecticides
• ETHANOL- alcohol
FORMALDEHYDE- preservatives
• CYANIDE- gas chamber
METHANE- use like gasoline
• NAPHTHALENE- moth balls
NITROBENZENE- gasoline
• NITROUS OXIDE- disinfectant
Number of Cigarette Smoked- The more cigarette smoked,
the greater the risk.
Duration of Smoking- The longer you smoke, the greater the
risk
Age Started Smoking- The younger you started, the greater
your risk
Pattern of Inhaling- The deeper you inhale, the greater your
risk
The more chemicals and toxins inhaled,
the greater the risk
Burden of Smoking
 Cardiovascular
Diseases
 Cerebrovascular
Diseases
 Cancers
 Lung Diseases
 Other Harmful Effects
Larynx: 1980
Esophagus: 1982
Kidney: 1982
Nasal & Oral
pharynx: 1982
Coronary heart
disease: 1979
Stomach: 2002
Cervix: 2002
Liver: 2002
Stroke: 1983
Aortic aneurysm:
1983
Atherosclerotic
peripheral vascular
disease: 1983
Lung: 1964
Chronic obstructive
pulmonary disease
(COPD): 1964
Bladder: 1990
Pancreas: 1990
Leukemia: 2002
Ureter: 1990
http://www.cdc.gov/tobacco/sgr/sgr_2004
Cataract: 2004
Diminished Health: 2004
GANGRENE
Nov 2009
Effects of Smoking Among Women
Although most
women believe that
they are not
vulnerable to lung
cancer, they are
definitely wrong.
Both men and women
are vulnerable to all
the effects that
smoking has to
offer.
SMOKING and CERVICAL CANCER
 Female smokers are 3x more likely to develop
CERVICAL CANCER
• Women who smoke
may also experience
some birth defects to
their unborn babies.
• When a women is
pregnant she is not
only responsible for
herself, but for the
unborn child inside
her.
Whatever she does to
harm her health is
also
harming the
health of her
unborn
Pregnancy and Smoking
Prenatal/Neonatal Outcomes
 20-30% low birth wt. infants
 Fetal growth retardation
 Spontaneous abortion &
Pre-term deliveries
 Stillbirth
 Ectopic pregnancies
 Placenta previa and
placental abruption
 Lower APGAR
 Ear infections
 Tooth decay
 More likely to become
smokers
 Higher incidence of
negative behavior
 Cognitive & behavioral
development
 Attention Deficit
Hyperactivity Disorder (ADHD)
Diseases and Adverse Health Effects Caused by Secondhand
Smoke
Children
SIDS
Exacerbation of
Asthma
Chronic
Respiratory Illness
Reduced Lung
Function Growth
Middle Ear Disease
Acute Respiratory
Illness
Adults
Lung Cancer
Heart Disease
 Cigarettes and lighters themselves also cause injury
and even death. Children have been accidentally
burnt by other people's cigarettes, and lighters and
lighter fluid are also a cause of burns.
Other Effects of Smoking that some
People might not be Aware of like:
Other Effects of Smoking: SMOKING and FERTILITY
 Female
smokers are
2-3x more
likely to be
INFERTILE
and delays in
conceiving
• Male
smokers
are 5-6x
more
likely to
be
IMPOTE
NT
STAINED and DECAYED
TEETH
Other Effects of Smoking:
STAINED and DECAYED
TEETH
Other Effects of Smoking:
breath is offensive
Slow Descent into Hell…
Other Effects of Smoking:
Tobacco is toxic
to your body.
Tobacco is
addictive. Once
you start using it
your body starts
needing it.
AddictionAddiction
The addictive properties of nicotineThe addictive properties of nicotine
are well documented but oftenare well documented but often
underestimated by the consumerunderestimated by the consumer
Pleasure, appetite
suppression
Arousal, appetite suppression
Arousal, cognitive
enhancement
Memory improvement
Mood modulation, appetite
suppression
Reduction of anxiety and
tension
Inhaled
smoke
Smoke production
by pyrolysis
(1600–1800° F)
1. Cigarette
constituents
• Organic matter
• Nicotine
alkaloids*
• Additives
Inhaled to lungs, where
absorption occurs
Absorption factors:
• Inhalation amount
• Inhalation depth
• Inhalation duration
• pH of smoke
• Absorption characteristics
of individual constituents
Air dilution
and cooling via
porous paper
Sidestream smoke
Mainstream
smoke
Filter traps
some
particulates
2. Pyrolysis
products
• CO2
• CO
• Tar
Tobacco
Total addiction potentials:
Function of nicotine dosing capacity
Speed it can deliver nicotine
Palatability and sensory characteristics
of the system
Ease which nicotine can be extracted
*Nicotine is distilled
from burning tobacco
and is carried into
the lung on particles
in the smoke”
JE Henningfield, 1984
 Nicotine binds preferentially to nicotinic acetylcholinergic (nACh) receptors in
the central nervous system; the primary is the α4β2 nicotinic receptor in the
Ventral Tegmental Area (VTA)
 After nicotine binds to the α4β2 nicotinic receptor in the VTA, it results in a
release of dopamine in the Nucleus Accumbens (nAcc) which is believed to be
linked to reward
α4 β2
β2β2
α4
α4β2
Nicotinic
Receptor
Time
Peak is due to rapid delivery from smoke into arterial blood,
Related to psychoactive effect* and addiction potential
Cigarette Smoked Cigarette Smoked Cigarette Smoked
Nicotinebloodµg/ml)
Initial fall in blood level
Due to redistribution
Fall in blood
Level due to
metabolism
Threshold level
for
withdrawal
symptoms
J Respir Dis 1998
*Means to control mood, appetite, body weight
sustain cognitive performance on which smokers rely
Hungry nicotine receptors
YOU CAN
STILL
SMOKE….
Just
NOT HERE
 FCTC is the world’s first public health
treaty, which is designed to reduce
tobacco-related deaths and disease
around the world
 FCTC Ratification. Philippines signed
the FCTC on September 2003 and
became a Full Party after the Senate
ratified the treaty on April 2005.
 The Convention contains provision on
tobacco control measures which aim to
reduce supply or demand for tobacco.
1. Framework Convention on Tobacco
Control
(FCTC)
2. RA 9211 – Tobacco Comprehensive Act of
2003
3. CSC MC 2009-17 - 100% Smoke-free
Environment
4. CSC DOH 2010-01-Joint MC Protection of
the Bureaucracy Against Tobacco
Interference
LEGAL MANDATES:
 seeks to do the following:
a) Prohibition of smoking in public places
b) Public information on health risks of tobacco use
c) Regulation and subsequent ban on tobacco advertisements
and sponsorships
d) Labelling of tobacco products
e) Prohibition on sale of tobacco products to minors
f) Assistance to tobacco farmers for alternative agricultural
crops
The world is accustomed
to thinking of the law as
an instrument of justice,
but not as an instrument
of health... it is time
that the tools of law be
harnessed in the service
of global health and
global justice.
WHO’s report Towards health with justice,
2002
Only a full smoking ban in
all enclosed workplaces,
including catering and
drinking
establishments, and all
public
buildings and transport
can
protect the health of
employees
and non-smokers.
Report approved by 561 of 660
Members of the European
Parliament (2007)
71
Pull together for smoke-free legislation
Raise children in SMOKE-
FREE ENVIRONMENT
DOH Presentation - Smoking

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DOH Presentation - Smoking

  • 1. EVY R. SARMIENTO, MD. DOH CHD Bicol Legazpi City
  • 2.
  • 3.
  • 4.
  • 5. In the 20th century, the tobacco epidemic killed 100 million people worldwide. •During the 21st century, it could kill one billion. SMOKING: A Serious Problem
  • 6. I in 10 deaths are from tobacco use Tobacco use killed 6 million people in 2010* 1 billion deaths are forecast over the 21st century (100 m died from tobacco smoking in the 20th century) About 15 years of life are lost on average by smoking Tobacco use costs a nation 3.6% of its GDP www.deathsfromsmoking.net *American Cancer Society 2009
  • 7. TOBACCO WILL KILL OVER 175 MILLION PEOPLE WORLDWIDE BETWEEN NOW AND THE YEAR 2030
  • 8. Number of disease-related deaths worldwide per day HIV/AIDS 8,500 TUBERCULOSIS 5,000 MALARIA 3,000 TOBACCO 13,500
  • 10.
  • 11.
  • 12. Global Burden of Tobacco 1 B smokers / 200 M female Adults: 40% male; 9% female Adolescents: 151 countries surveyed – roughly equal in number
  • 13. Smoking Prevalence Among Women Philippine Data: 2009 GATS  17.3 M (28.3%) aged 15 years and over – 80% current smokers o 14.6 M (47.7%) men; 2.8 M (9%) women  Daily cigarette smokers: o 98% men; 83% women o men: 11.3 sticks; women: 7 sticks
  • 15. 15 Today’s teenager is tomorrow’s potential regular customer. Philip Morris Memo, 1981 Prevalence of Tobacco Use Among Youth
  • 16. Prevalence of Tobacco Use and Susceptibility to Tobacco Use By Sex, PHL Global Youth Tobacco Survey 2007
  • 17.
  • 19. 1.3% 1.6% 13.1% 2.6% 6.3% 8.2% 3.3% 2.6% 61.1% Food Clothing Housing Health Education Utilities Transport & Communication Tobacco Other expenses Source: Tobacco and Poverty Study in the Philippines, May 2006; Basic Data: FIES, 2003 60% 14.4%1.7% 2.9% 7.5% 9.3% 0.6% 1.6% 2.0%
  • 20.  20,000 Filipinos die20,000 Filipinos die everyevery year due to tobacco-year due to tobacco- related diseaserelated disease THAT’S 2 OR 3 EVERY HOUR
  • 21. ACTIVE SMOKING: Refers to directly smoking from a LIGHTED Cigarette or other tobacco products. These persons are referred to as SMOKERS MAINSTREAM SMOKE
  • 22. PASSIVE SMOKING: Also called Involuntary or Second-Hand smoking. It occurs when non- smokers are exposed to second-hand smoke from smokers SIDE STREAM SMOKE
  • 23. Tobacco can kill you! Each time you smoke a cigarette it takes away 5 to 20 minutes of your life.
  • 24. Fatal and disabling diseasesFatal and disabling diseases  Cancers of the lungs and otherCancers of the lungs and other organsorgans  Ischemic Heart DiseaseIschemic Heart Disease  StrokesStrokes  Respiratory diseasesRespiratory diseases
  • 25. What Are You Smoking?
  • 26.
  • 27. Acetanisole, Acetic Acid, Acetoin, Acetophenone, 6-Acetoxydihydrotheaspirane, 2-Acetyl-3- Ethylpyrazine, 2-Acetyl-5- Methylfuran, Acetylpyrazine, 2-Acetylpyridine, 3-Acetylpyridine, 2-Acetylthiazole, Aconitic Acid, dl-Alanine, Alfalfa Extract, Allspice Extract, Oleoresin, And Oil, Allyl Hexanoate, Allyl Ionone, Almond Bitter Oil, Ambergris Tincture, Ammonia, Ammonium Bicarbonate, Ammonium Hydroxide, Ammonium Phosphate Dibasic, Ammonium Sulfide, Amyl Alcohol, Amyl Butyrate, Amyl Formate, Amyl Octanoate, alpha-Amylcinnamaldehyde, Amyris Oil, trans-Anethole, Angelica Root Extract, Oil and Seed Oil, Anise, Anise Star, Extract and Oils, Anisyl Acetate, Anisyl Alcohol, Anisyl Formate, Anisyl Phenylacetate, Apple Juice Concentrate, Extract, and Skins, Apricot Extract and Juice Concentrate, 1-Arginine, Asafetida Fluid Extract And Oil, Ascorbic Acid, 1-Asparagine Monohydrate, 1-Aspartic Acid, Balsam Peru and Oil, Basil Oil, Bay Leaf, Oil and Sweet Oil, Beeswax White, Beet Juice Concentrate, Benzaldehyde,Benzaldehyde Glyceryl Acetal, Benzoic Acid, Benzoin, Benzoin Resin, Benzophenone, Benzyl Alcohol, Benzyl Benzoate, Benzyl Butyrate, Benzyl Cinnamate, Benzyl Propionate, Benzyl Salicylate, Bergamot Oil, Bisabolene, Black Currant Buds Absolute, Borneol, Bornyl Acetate, Buchu Leaf Oil, 1,3-Butanediol, 2,3- Butanedione, 1-Butanol, 2-Butanone, 4(2-Butenylidene)-3,5,5-Trimethyl-2-Cyclohexen-1-One, Butter, Butter Esters, and Butter Oil, Butyl Acetate, Butyl Butyrate, Butyl Butyryl Lactate, Butyl Isovalerate, Butyl Phenylacetate, Butyl Undecylenate, 3- Butylidenephthalide, Butyric Acid, Cadinene, Caffeine, Calcium Carbonate, Camphene, Cananga Oil, Capsicum Oleoresin, Caramel Color, Caraway Oil, Carbon Dioxide, Cardamom Oleoresin, Extract, Seed Oil, and Powder, Carob Bean and Extract, beta-Carotene, Carrot Oil, Carvacrol, 4-Carvomenthenol, 1-Carvone, beta-Caryophyllene, beta-Caryophyllene Oxide, Cascarilla Oil and Bark Extract, Cassia Bark Oil, Cassie Absolute and Oil, Castoreum Extract,Tincture and Absolute,Cedar Leaf Oil, Cedarwood Oil Terpenes and Virginiana, Cedrol, Celery Seed Extract, Solid, Oil, And Oleoresin, Cellulose Fiber, Chamomile Flower Oil And Extract, Chicory Extract, Chocolate, Cinnamaldehyde, Cinnamic Acid, Cinnamon Leaf Oil, Bark Oil, and Extract, Cinnamyl Acetate, Cinnamyl Alcohol, Cinnamyl Cinnamate, Cinnamyl Isovalerate, Cinnamyl Propionate, Citral, Citric Acid, Citronella Oil, dl-Citronellol, Citronellyl Butyrate, Citronellyl Isobutyrate, Civet Absolute, Clary Oil, Clover Tops, Red Solid Extract, Cocoa, Cocoa Shells, Extract, Distillate And Powder, Coconut Oil, Coffee, Cognac White and Green Oil, Copaiba Oil, Coriander Extract and Oil, Corn Oil, Corn Silk, Costus Root Oil, Cubeb Oil, Cuminaldehyde, para-Cymene, 1-Cysteine, Dandelion Root Solid Extract, Davana Oil, 2-trans, 4-trans-Decadienal, delta-Decalactone, gamma-Decalactone, Decanal, Decanoic Acid, 1-Decanol, 2-Decenal, Dehydromenthofurolactone, Diethyl Malonate, Diethyl Sebacate, 2,3-Diethylpyrazine,Dihydro Anethole, 5,7-Dihydro-2-Methylthieno(3,4-D) Pyrimidine, Dill Seed Oil and Extract, meta-Dimethoxybenzene, para-Dimethoxybenzene, 2,6-Dimethoxyphenol, Dimethyl Succinate, 3,4-Dimethyl-1,2-Cyclopentanedione, 3,5- Dimethyl-1,2-Cyclopentanedione, 3,7- Dimethyl-1,3,6-Octatriene, 4,5-Dimethyl-3-Hydroxy-2,5-Dihydrofuran-2-One, 6,10-Dimethyl-5,9-Undecadien-2-One, 3,7- Dimethyl-6-Octenoic Acid, 2,4-Dimethylacetophenone, alpha,para-Dimethylbenzyl Alcohol, alpha,alpha-Dimethylphenethyl Acetate, alpha,alpha Dimethylphenethyl Butyrate, 2,3-Dimethylpyrazine,2,5-Dimethylpyrazine, 2,6-Dimethylpyrazine, Dimethyltetrahydrobenzofuranone, delta-Dodecalactone, gamma-Dodecalactone, para-Ethoxybenzaldehyde, Ethyl 10- Undecenoate, Ethyl 2-Methylbutyrate, Ethyl Acetate, Ethyl Acetoacetate, Ethyl Alcohol, Ethyl Benzoate, Ethyl Butyrate, Ethyl Cinnamate, Ethyl Decanoate, Ethyl Fenchol, Ethyl Furoate, Ethyl Heptanoate, Ethyl Hexanoate, Ethyl Isovalerate, Ethyl Lactate, Ethyl Laurate, Ethyl Levulinate, Ethyl Maltol,Ethyl Methyl Phenylglycidate, Ethyl Myristate, Ethyl Nonanoate, Ethyl Octadecanoate, Ethyl Octanoate, Ethyl Oleate, Ethyl Palmitate, Ethyl Phenylacetate, Ethyl Propionate, Ethyl Salicylate, Ethyl trans-2-Butenoate, Ethyl Valerate, Ethyl Vanillin, 2-Ethyl (or Methyl)-(3,5 and 6)-Methoxypyrazine, 2-Ethyl-1-Hexanol, 3- Ethyl -2 -Hydroxy-2-Cyclopenten-1-One, 2-Ethyl-3, (5 or 6)-Dimethylpyrazine, 5-Ethyl-3-Hydroxy-4-Methyl-2(5H)-Furanone, 2-Ethyl-3-Methylpyrazine, 4-Ethylbenzaldehyde, 4-Ethylguaiacol, para-Ethylphenol, 3-Ethylpyridine, Eucalyptol, Farnesol, D- Fenchone, POISONS in Cigarette
  • 28. Fennel Sweet Oil, Fenugreek, Extract, Resin, and Absolute, Fig Juice Concentrate, Food Starch Modified, Furfuryl Mercaptan, 4-(2-Furyl)-3-Buten-2-One, Galbanum Oil, Genet Absolute, Gentian Root Extract, Geraniol, Geranium Rose Oil, Geranyl Acetate, Geranyl Butyrate, Geranyl Formate, Geranyl Isovalerate, Geranyl Phenylacetate, Ginger Oil and Oleoresin, 1-Glutamic Acid, 1-Glutamine, Glycerol, Glycyrrhizin Ammoniated, Grape Juice Concentrate,Guaiac Wood Oil, Guaiacol, Guar Gum, 2,4-Heptadienal, gamma-Heptalactone, Heptanoic Acid, 2-Heptanone, 3-Hepten-2-One, 2-Hepten-4- One, 4-Heptenal, trans -2-Heptenal, Heptyl Acetate, omega-6-Hexadecenlactone, gamma-Hexalactone, Hexanal, Hexanoic Acid, 2-Hexen-1-Ol, 3-Hexen-1- Ol, cis-3-Hexen-1-Yl Acetate, 2-Hexenal, 3-Hexenoic Acid, trans-2-Hexenoic Acid, cis-3-Hexenyl Formate, Hexyl 2-Methylbutyrate, Hexyl Acetate, Hexyl Alcohol, Hexyl Phenylacetate, 1-Histidine, Honey, Hops Oil, Hydrolyzed Milk Solids, Hydrolyzed Plant Proteins, 5-Hydroxy-2,4-Decadienoic Acid delta- Lactone, 4-Hydroxy-2,5-Dimethyl-3(2H)-Furanone, 2-Hydroxy-3,5,5-Trimethyl-2-Cyclohexen-1-One, 4-Hydroxy -3-Pentenoic Acid Lactone, 2-Hydroxy-4- Methylbenzaldehyde, 4-Hydroxybutanoic Acid Lactone, Hydroxycitronellal, 6-Hydroxydihydrotheaspirane, 4-(para-Hydroxyphenyl)-2-Butanone, Hyssop Oil, Immortelle Absolute and Extract, alpha-Ionone, beta-Ionone, alpha-Irone, Isoamyl Acetate, Isoamyl Benzoate, Isoamyl Butyrate, Isoamyl Cinnamate,Isoamyl Formate, Isoamyl Hexanoate, Isoamyl Isovalerate, Isoamyl Octanoate, Isoamyl Phenylacetate, Isobornyl Acetate, Isobutyl Acetate, Isobutyl Alcohol, Isobutyl Cinnamate, Isobutyl Phenylacetate, Isobutyl Salicylate, 2-Isobutyl-3-Methoxypyrazine, alpha-Isobutylphenethyl Alcohol, Isobutyraldehyde, Isobutyric Acid, d,l-Isoleucine, alpha-Isomethylionone, 2-Isopropylphenol, Isovaleric Acid, Jasmine Absolute, Concrete and Oil, Kola Nut Extract, Labdanum Absolute and Oleoresin, Lactic Acid, Lauric Acid, Lauric Aldehyde, Lavandin Oil, Lavender Oil, Lemon Oil and Extract, Lemongrass Oil, 1-Leucine, Levulinic Acid, Licorice Root, Fluid, Extract and Powder, Lime Oil, Linalool, Linalool Oxide, Linalyl Acetate, Linden Flowers, Lovage Oil And Extract, 1-Lysine, Mace Powder, Extract and Oil, Magnesium Carbonate, Malic Acid, Malt and Malt Extract, Maltodextrin, Maltol, Maltyl Isobutyrate, Mandarin Oil, Maple Syrup and Concentrate, Mate Leaf, Absolute and Oil, para-Mentha-8-Thiol-3-One, Menthol, Menthone,Menthyl Acetate, dl-Methionine, Methoprene, 2-Methoxy-4-Methylphenol, 2-Methoxy-4-Vinylphenol, para-Methoxybenzaldehyde, 1-(para-Methoxyphenyl)-1-Penten-3-One, 4-(para- Methoxyphenyl)-2-Butanone, 1-(para-Methoxyphenyl)-2-Propanone, Methoxypyrazine, Methyl 2-Furoate, Methyl 2-Octynoate, Methyl 2-Pyrrolyl Ketone, Methyl Anisate, Methyl Anthranilate, Methyl Benzoate, Methyl Cinnamate, Methyl Dihydrojasmonate, Methyl Ester of Rosin, Partially Hydrogenated, Methyl Isovalerate, Methyl Linoleate (48%), Methyl Linolenate (52%) Mixture, Methyl Naphthyl Ketone, Methyl Nicotinate, Methyl Phenylacetate, Methyl Salicylate, Methyl Sulfide, 3-Methyl-1-Cyclopentadecanone, 4-Methyl-1-Phenyl-2-Pentanone, 5-Methyl-2-Phenyl-2-Hexenal, 5-Methyl-2- Thiophenecarboxaldehyde, 6-Methyl-3,-5-Heptadien-2-One, 2-Methyl-3-(para-Isopropylphenyl) Propionaldehyde, 5-Methyl-3-Hexen-2-One, 1-Methyl- 3Methoxy-4-Isopropylbenzene, 4-Methyl-3-Pentene-2-One, 2-Methyl-4-Phenylbutyraldehyde, 6-Methyl-5-Hepten-2-One, 4-Methyl-5-Thiazoleethanol,4- Methyl-5-Vinylthiazole, Methyl-alpha-Ionone, Methyl-trans-2-Butenoic Acid, 4-Methylacetophenone, para-Methylanisole, alpha-Methylbenzyl Acetate, alpha-Methylbenzyl Alcohol, 2-Methylbutyraldehyde, 3-Methylbutyraldehyde, 2-Methylbutyric Acid, alpha-Methylcinnamaldehyde, Methylcyclopentenolone, 2-Methylheptanoic Acid, 2-Methylhexanoic Acid, 3-Methylpentanoic Acid, 4-Methylpentanoic Acid, 2-Methylpyrazine, 5-Methylquinoxaline, 2- Methyltetrahydrofuran-3-One, (Methylthio)Methylpyrazine (Mixture Of Isomers), 3-Methylthiopropionaldehyde, Methyl 3-Methylthiopropionate, 2- Methylvaleric Acid, Mimosa Absolute and Extract, Molasses Extract and Tincture, Mountain Maple Solid Extract, Mullein Flowers, Myristaldehyde, Myristic Acid, Myrrh Oil, beta-Napthyl Ethyl Ether, Nerol, Neroli Bigarde Oil, Nerolidol, Nona-2-trans,6-cis-Dienal, 2,6-Nonadien-1-Ol, gamma-Nonalactone, Nonanal, Nonanoic Acid, Nonanone, trans-2-Nonen-1-Ol, 2-Nonenal, Nonyl Acetate, Nutmeg Powder and Oil, Oak Chips Extract and Oil,Oak Moss Absolute, 9,12-Octadecadienoic Acid (48%) And 9,12,15-Octadecatrienoic Acid (52%), delta-Octalactone, gamma-Octalactone, Octanal, Octanoic Acid, 1-Octanol, 2- Octanone, 3-Octen-2-One, 1-Octen-3-Ol, 1-Octen-3-Yl Acetate, 2-Octenal, Octyl Isobutyrate, Oleic Acid , Olibanum Oil, Opoponax Oil And Gum, Orange Blossoms Water, Absolute, and Leaf Absolute, Orange Oil and Extract, Origanum Oil, Orris Concrete Oil and Root Extract, Palmarosa Oil, Palmitic Acid, Parsley Seed Oil, Patchouli Oil, omega-Pentadecalactone, 2,3-Pentanedione, 2-Pentanone, 4-Pentenoic Acid, 2-Pentylpyridine, Pepper Oil, Black And White, Peppermint Oil, Peruvian (Bois De Rose) Oil, Petitgrain Absolute, Mandarin Oil and Terpeneless Oil, alpha-Phellandrene, 2-Phenenthyl Acetate, Phenenthyl Alcohol, Phenethyl Butyrate, Phenethyl Cinnamate, Phenethyl Isobutyrate, Phenethyl Isovalerate, Phenethyl Phenylacetate, Phenethyl Salicylate, 1-Phenyl-1-Propanol, 3-Phenyl-1-Propanol, 2-Phenyl-2-Butenal, 4-Phenyl-3-Buten-2-Ol,4-Phenyl-3-Buten-2-One, Phenylacetaldehyde, Phenylacetic Acid, 1-Phenylalanine, 3-Phenylpropionaldehyde, 3-Phenylpropionic Acid, 3-Phenylpropyl Acetate, 3-Phenylpropyl Cinnamate, 2-(3- Phenylpropyl)Tetrahydrofuran, Phosphoric Acid, Pimenta Leaf Oil, Pine Needle Oil, Pine Oil, Scotch, Pineapple Juice Concentrate, alpha-Pinene, beta- Pinene, D-Piperitone, Piperonal, Pipsissewa Leaf Extract, Plum Juice, Potassium Sorbate, 1-Proline, Propenylguaethol, Propionic Acid, Propyl Acetate, Propyl para-Hydroxybenzoate, Propylene Glycol, 3-Propylidenephthalide, Prune Juice and Concentrate, Pyridine, Pyroligneous Acid And Extract, Pyrrole, Pyruvic Acid, Raisin Juice Concentrate, Rhodinol, Rose Absolute and Oil, Rosemary Oil, Rum, Rum Ether, Rye Extract, Sage, Sage Oil, and Sage Oleoresin, Salicylaldehyde, Sandalwood Oil, Yellow, Sclareolide, Skatole, Smoke Flavor, Snakeroot Oil, Sodium Acetate, Sodium Benzoate, Sodium Bicarbonate, Sodium Carbonate, Sodium Chloride, Sodium Citrate, Sodium Hydroxide, Solanone, Spearmint Oil, Styrax Extract, Gum and Oil, Sucrose Octaacetate, Sugar Alcohols, Sugars, Tagetes Oil, Tannic Acid, Tartaric Acid, Tea Leaf and Absolute, alpha-Terpineol, Terpinolene, Terpinyl Acetate, 5,6,7,8- Tetrahydroquinoxaline, 1,5,5,9-Tetramethyl-13-Oxatricyclo(8.3.0.0(4,9))Tridecane, 2,3,4,5, and 3,4,5,6-Tetramethylethyl-Cyclohexanone, 2,3,5,6- Tetramethylpyrazine, Thiamine Hydrochloride, Thiazole, 1-Threonine, Thyme Oil, White and Red, Thymol, Tobacco Extracts, Tochopherols (mixed), Tolu Balsam Gum and Extract, Tolualdehydes, para-Tolyl 3-Methylbutyrate, para-Tolyl Acetaldehyde, para-Tolyl Acetate, para-Tolyl Isobutyrate, para-Tolyl Phenylacetate, Triacetin, 2-Tridecanone, 2-Tridecenal, Triethyl Citrate, 3,5,5-Trimethyl -1-Hexanol, para,alpha,alpha-Trimethylbenzyl Alcohol, 4-(2,6,6- Trimethylcyclohex-1-Enyl)But-2-En-4-One, 2,6,6-Trimethylcyclohex-2-Ene-1,4-Dione, 2,6,6-Trimethylcyclohexa-1,3-Dienyl Methan, 4-(2,6,6- Trimethylcyclohexa-1,3-Dienyl)But-2-En-4-One,2,2,6-Trimethylcyclohexanone, 2,3,5-Trimethylpyrazine, 1-Tyrosine, delta-Undercalactone, gamma- Undecalactone, Undecanal, 2-Undecanone, 10-Undecenal, Urea, Valencene, Valeraldehyde, Valerian Root Extract, Oil and Powder, Valeric Acid, gamma- Valerolactone, Valine, Vanilla Extract And Oleoresin, Vanillin, Veratraldehyde, Vetiver Oil, Vinegar, Violet Leaf Absolute, Walnut Hull Extract, Water, Wheat Extract And Flour, Wild Cherry Bark Extract, Wine and Wine Sherry, Xanthan Gum, 3,4-Xylenol, Yeast POISONS in Cigarette
  • 33. BUTANE- cigarette lighter • CADMIUM- batteries
  • 36. METHANE- use like gasoline • NAPHTHALENE- moth balls
  • 38. Number of Cigarette Smoked- The more cigarette smoked, the greater the risk. Duration of Smoking- The longer you smoke, the greater the risk Age Started Smoking- The younger you started, the greater your risk Pattern of Inhaling- The deeper you inhale, the greater your risk The more chemicals and toxins inhaled, the greater the risk
  • 40.  Cardiovascular Diseases  Cerebrovascular Diseases  Cancers  Lung Diseases  Other Harmful Effects
  • 41. Larynx: 1980 Esophagus: 1982 Kidney: 1982 Nasal & Oral pharynx: 1982 Coronary heart disease: 1979 Stomach: 2002 Cervix: 2002 Liver: 2002 Stroke: 1983 Aortic aneurysm: 1983 Atherosclerotic peripheral vascular disease: 1983 Lung: 1964 Chronic obstructive pulmonary disease (COPD): 1964 Bladder: 1990 Pancreas: 1990 Leukemia: 2002 Ureter: 1990 http://www.cdc.gov/tobacco/sgr/sgr_2004 Cataract: 2004 Diminished Health: 2004
  • 44. Effects of Smoking Among Women
  • 45. Although most women believe that they are not vulnerable to lung cancer, they are definitely wrong. Both men and women are vulnerable to all the effects that smoking has to offer.
  • 46. SMOKING and CERVICAL CANCER  Female smokers are 3x more likely to develop CERVICAL CANCER
  • 47. • Women who smoke may also experience some birth defects to their unborn babies. • When a women is pregnant she is not only responsible for herself, but for the unborn child inside her. Whatever she does to harm her health is also harming the health of her unborn Pregnancy and Smoking
  • 48.
  • 49.
  • 50. Prenatal/Neonatal Outcomes  20-30% low birth wt. infants  Fetal growth retardation  Spontaneous abortion & Pre-term deliveries  Stillbirth  Ectopic pregnancies  Placenta previa and placental abruption  Lower APGAR
  • 51.  Ear infections  Tooth decay  More likely to become smokers  Higher incidence of negative behavior  Cognitive & behavioral development  Attention Deficit Hyperactivity Disorder (ADHD)
  • 52. Diseases and Adverse Health Effects Caused by Secondhand Smoke Children SIDS Exacerbation of Asthma Chronic Respiratory Illness Reduced Lung Function Growth Middle Ear Disease Acute Respiratory Illness Adults Lung Cancer Heart Disease
  • 53.  Cigarettes and lighters themselves also cause injury and even death. Children have been accidentally burnt by other people's cigarettes, and lighters and lighter fluid are also a cause of burns. Other Effects of Smoking that some People might not be Aware of like:
  • 54. Other Effects of Smoking: SMOKING and FERTILITY  Female smokers are 2-3x more likely to be INFERTILE and delays in conceiving • Male smokers are 5-6x more likely to be IMPOTE NT
  • 55. STAINED and DECAYED TEETH Other Effects of Smoking:
  • 56. STAINED and DECAYED TEETH Other Effects of Smoking: breath is offensive
  • 57. Slow Descent into Hell… Other Effects of Smoking:
  • 58. Tobacco is toxic to your body. Tobacco is addictive. Once you start using it your body starts needing it.
  • 59. AddictionAddiction The addictive properties of nicotineThe addictive properties of nicotine are well documented but oftenare well documented but often underestimated by the consumerunderestimated by the consumer
  • 60. Pleasure, appetite suppression Arousal, appetite suppression Arousal, cognitive enhancement Memory improvement Mood modulation, appetite suppression Reduction of anxiety and tension Inhaled smoke
  • 61. Smoke production by pyrolysis (1600–1800° F) 1. Cigarette constituents • Organic matter • Nicotine alkaloids* • Additives Inhaled to lungs, where absorption occurs Absorption factors: • Inhalation amount • Inhalation depth • Inhalation duration • pH of smoke • Absorption characteristics of individual constituents Air dilution and cooling via porous paper Sidestream smoke Mainstream smoke Filter traps some particulates 2. Pyrolysis products • CO2 • CO • Tar Tobacco Total addiction potentials: Function of nicotine dosing capacity Speed it can deliver nicotine Palatability and sensory characteristics of the system Ease which nicotine can be extracted *Nicotine is distilled from burning tobacco and is carried into the lung on particles in the smoke” JE Henningfield, 1984
  • 62.  Nicotine binds preferentially to nicotinic acetylcholinergic (nACh) receptors in the central nervous system; the primary is the α4β2 nicotinic receptor in the Ventral Tegmental Area (VTA)  After nicotine binds to the α4β2 nicotinic receptor in the VTA, it results in a release of dopamine in the Nucleus Accumbens (nAcc) which is believed to be linked to reward α4 β2 β2β2 α4 α4β2 Nicotinic Receptor
  • 63. Time Peak is due to rapid delivery from smoke into arterial blood, Related to psychoactive effect* and addiction potential Cigarette Smoked Cigarette Smoked Cigarette Smoked Nicotinebloodµg/ml) Initial fall in blood level Due to redistribution Fall in blood Level due to metabolism Threshold level for withdrawal symptoms J Respir Dis 1998 *Means to control mood, appetite, body weight sustain cognitive performance on which smokers rely Hungry nicotine receptors
  • 65.
  • 66.  FCTC is the world’s first public health treaty, which is designed to reduce tobacco-related deaths and disease around the world  FCTC Ratification. Philippines signed the FCTC on September 2003 and became a Full Party after the Senate ratified the treaty on April 2005.  The Convention contains provision on tobacco control measures which aim to reduce supply or demand for tobacco.
  • 67. 1. Framework Convention on Tobacco Control (FCTC) 2. RA 9211 – Tobacco Comprehensive Act of 2003 3. CSC MC 2009-17 - 100% Smoke-free Environment 4. CSC DOH 2010-01-Joint MC Protection of the Bureaucracy Against Tobacco Interference LEGAL MANDATES:
  • 68.  seeks to do the following: a) Prohibition of smoking in public places b) Public information on health risks of tobacco use c) Regulation and subsequent ban on tobacco advertisements and sponsorships d) Labelling of tobacco products e) Prohibition on sale of tobacco products to minors f) Assistance to tobacco farmers for alternative agricultural crops
  • 69. The world is accustomed to thinking of the law as an instrument of justice, but not as an instrument of health... it is time that the tools of law be harnessed in the service of global health and global justice. WHO’s report Towards health with justice, 2002
  • 70. Only a full smoking ban in all enclosed workplaces, including catering and drinking establishments, and all public buildings and transport can protect the health of employees and non-smokers. Report approved by 561 of 660 Members of the European Parliament (2007)
  • 71. 71
  • 72. Pull together for smoke-free legislation
  • 73. Raise children in SMOKE- FREE ENVIRONMENT

Editor's Notes

  1. We hold in our hands the solution to the global tobacco epidemic that threatens the lives of 1B men, women and children during this century. Tobacco use can kill in so many ways that it is a risk factor for 6-8 leading causes of death in the world. The cure is not on the hands or dependent not on medicines or vaccines, but on the concerted efforts / actions of government and civil society.
  2. Tobacco use is established as a major risk factor for six of the leading causes of death in the world. Hatched areas indicate proportions of deaths that are related to tobacco use. If we sum up all those due to tobacco use alone, it overtakes all other leading causes.
  3. Annual deaths from smoking Smoking kills about 1.9 million people a year. [CLICK] About 1 million die in middle age from smoking [CLICK] Many of those killed in middle age … Of course, some of those killed by smoking in middle age might have died soon anyway from another cause, but some would have lived on for 10, 20, 30 or more good years. [CLICK] About 22 years of life are lost … Those who are killed while still in middle age lose, on average, about 22 years. (Of course, this is not the same as saying that all smokers lose 22 years of life expectancy. This applies only to the smokers who are killed in middle age by the habit.)
  4. If control measures instituted do not produce impact, it is estimated that in 20 to 30 years from now, the cumulative tobacco-related deaths are steepedly increased over 100 million deaths especially in developing countries.
  5. Cigarette consumption worldwide had rose from 10’s in the 1800’s to billion of sticks in the 21st century.
  6. Household expenditure on tobacco in 2006 is more than their expenses for health and education
  7. Nicotine and the byproducts of smoking are thought to increase a woman’s relative risk for cervical cancer by concentrating in the cervical mucus and decreasing the immune capability of Langerhan’s cells to protect cervical tissue from invading oncogenic factors, such as HPV infection (Ylitalo et al. 1999).
  8. Nicotine in tobacco smoke reaches the human brain about 10 seconds after the smoker inhales a puff. Nicotine binds stereoselectively to nicotinic receptors located in the brain, autonomic ganglia, the medulla, and neuromuscular junctions. Most relevant to nicotine addiction are the neuronal nicotinic cholinergic receptors.1 These are located throughout the brain but are concentrated in the mesolimbic dopaminergic pathway, or ‘pleasure-reward pathway’, and in the locus ceruleus, a noradrenergic center in the brain. The locus ceruleus plays a critical role in cognitive processes and memory.2 Nicotine in tobacco smoke increases the number of nicotine receptor sites in the brain by two-to three-fold, and this nicotine receptor proliferation may not be reversible in humans. Nicotine receptor activation facilitates the release of neurotransmitters. The release of specific neurotransmitters has been speculatively linked to the reported, reinforcing effects of nicotine (see diagram).1 Acute nicotine administration results in increased dopamine release from the CNS, activating the mesolimbic dopaminergic system and producing perceptions of pleasure and happiness, increased energy and motivation, increased alertness, increased feeling of vigor, increased cognitive arousal and increased alertness, similar to that produced by other addictive drugs like heroin or cocaine. Nicotine is also a powerful activator of the locus ceruleus, causing norepinephrine release that leads to generalized brain activation and arousal, increased alertness, concentration, intellectual skill, enhanced memory, and improved problem-solving behavior. In addition, norepinephrine reduces appetite, contributing to smokers’ lower weight compared to non-smokers.2 References: 1. Benowitz NL. Nicotine addiction. Primary Care 1999; 26:611–631. 2. Sachs DPL. Tobacco dependence: pathophysiology and treatment. In Pulmonary Rehabilitation: Guidelines For Success. 4th edn 2000. Edited by JE Hodgkin, GL Connors & BR Celli. Lippincott Williams and Wilkins. Graph source: Benowitz NL. Nicotine addiction. Primary Care 1999; 26:611–631.
  9. This figure shows that the concentration of tobacco smoke entering the lung can be altered by many variables. The number of puffs, the frequency of puffs, the depth of inhalations, the pH of the smoke, and dilution with air can all modify the intake of tobacco smoke.1 For this reason, the dose of nicotine to a smoker cannot be predicted from the nicotine content of the tobacco and needs to be measured in the blood.2 In a study conducted among 22 smokers, researchers found that the average intake of nicotine per cigarette was 1 mg (0.3–2 mg) and that this did not correlate with a machine-determined yield.3 References: 1. Henningfield JE. Behavioral pharmacology of cigarette smoking. In Advances in Behavioral Pharmacology, vol. 4 1984; pp 131–210. Edited by T Thompson, PB Dews, JE Barrett. Orlando: Academic Press. 2. Benowitz NL Nicotine addiction. Primary Care 1999; 26:611–631. 3. Benowitz NL and Jacob P 3rd. Daily intake of nicotine during cigarette smoking. Clinical Pharmacology and Therapeutics 1984; 35:499–504. Figure Source: Henningfield JE. Behavioral pharmacology of cigarette smoking. In Advances in Behavioral Pharmacology, vol. 4 1984; pp 131–210. Edited by T Thompson, PB Dews & JE Barrett. Orlando: Academic Press.
  10. Key Point Nicotine stimulates dopamine release in areas of the brain which is believed to result in the reward and satisfaction effect associated with smoking. Background After inhalation, nicotine preferentially binds to nicotinic acetylcholinergic (nACh) receptors located in the mesolimbic-dopamine system of the brain within a matter of seconds. Nicotine specifically activates 4β2 nicotinic receptors in the Ventral Tegmental Area (VTA) causing an immediate dopamine release at the Nucleus Accumbens (nAcc).1 The dopamine release is believed to be a key component of the reward circuitry associated with cigarette smoking.1 Reference 1. Picciotto MR, Zoli M, Changeux J. Use of knock-out mice to determine the molecular basis for the actions of nicotine. Nicotine Tob Res. 1999; Suppl 2:S121-125.