This document discusses the harms of cigarette smoking and the pharmacist's role in addressing the tobacco epidemic. It notes that smoking has caused over 12 million deaths in the US since 1964 and is a leading cause of heart disease, cancer, stroke, COPD and other illnesses. Smoking also increases health risks and mortality for conditions like diabetes. In addition, secondhand smoke exposure harms non-smokers. The document outlines strategies for smoking cessation like nicotine replacement therapy and counseling. It argues pharmacists should educate the public about smoking health risks and promotion by tobacco companies to help reduce smoking prevalence.

1. The Pharmacist’s Role in Ending the Tobacco PandemicAlan Blum, MDAuburn University Harrison School of Pharmacy February 18, 2011

3. DEATHS FROM CIGARETTE SMOKING IN US SINCE 196412,000,000

6. Smoking Prevalence

7. CAUSES OF DEATHHeart diseaseCancerStrokeCOPDAccidentsDiabetes

8. MARLBORO’S MYOCARDIAL MAYHEM↑ oxygen demand↓ angina threshold↓ exercise performance↑ recurrent infarction

9. CAMEL’S CORONARY CONSEQUENCESAdverse lipid profileAltered hematologic factorsDirect arterial wall effectsElevated blood pressure

12. Cancer Death Rates for Men, US, 1930-2005

13. Cancer Death Rates for Women, US, 1930-2005

15. COPD5% of US population80% caused by smoking4th leading cause of death

16. DIABETES:3x Cardiovascular Mortality

17. SMOKING + DIABETES:11x Cardiovascular Mortality

18. OTHER TOBACCOGENIC PROBLEMSOsteoporosisHip fracturesEarly menopauseMacular degenerationPeptic ulcer disease

20. SECONDHAND SMOKELung cancer: 3,000 deaths/yearHeart disease: 40,000 deaths/yearAsthma: 2 million visits/year

21. SMOKING IN PREGNANCYLow birthweightPreterm laborSpontaneous abortionAbruptio placentaPlacenta praeviaPremature rupture of membranes

22. EFFECTS ON CHILDRENSIDSAsthmaBronchitisOtitis mediaPneumonia

26. INFLUENCESPeersParentsPropaganda

45. SMOKING CESSATION44.5 million smoke77% want to stop40% try each year5% succeed

46. MARKERS OF ADDICTION>20 Cigarettes /daySmoke upon awakeningPsychiatric conditionAlcohol dependence

47. BEHAVIOR MODIFICATIONIdentify situationsChoose oral substitutesDo five-minute plan: Postpone Inhale Reconsider

48. SMOKING’S MYTHSRelieves stressKeeps weight downLow-tar, filters, are safer

49. THE PRODUCTFilterLow tarLightsMenthol

50. MONEY LOSTNumber of packs/dayx Cost/packx 365 days/yearX Number of years smokingTotal cash lost (plus interest)

51. INHALATION COUNTNumber of cigarettes/dayx 10 inhalations/cigarettex 365 days/yearx Number of years smokingTotal inhalations

52. BENEFITS OF STOPPING1 day: ↓ MI risk1 year: ↓ Stroke risk 50%10 years: Stroke risk of non-smoker15 years: CHD risk of non-smoker

53. COSMETIC BENEFITSFresher breath, clothingWhiter teeth, nailsEndurance

54. NICOTINE REPLACEMENT THERAPYGum (Nicorette)Transdermal patch (Nicoderm)Inhaler (Nicotrol)Lozenge (Commit)Electronic cigarette?

55. ADJUNCTIVE PHARMACOTHERAPYBupropionClonidineNortriptylineVereniclineRimonabant

57. SMOKING PREVENTIONIncrease cigarette taxesRestrict teen accessClean indoor air lawsBan advertisingEducate on TV, radio, internet

59. SHIFTING THE FOCUSSubstance -> ProductEffects -> PromotionUser -> Pusher

60. AMERICAN TOBACCO COMPANIESPhilip Morris USAReynolds-American Inc.Lorillard Inc.United States Smokeless TobaccoLiggett Vector Brands Inc.Swedish MatchImperial Tobacco

61. CANCER’S 7 WARNING SIGNSPhilip Morris USAReynolds American IncLorillard Inc.United States Smokeless TobaccoLiggett Vector Brands Inc.Swedish MatchImperial Tobacco

74. 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 AlabamaDirector, The University of Alabama Center for the Study of Tobacco and Societyablum@cchs.ua.edu

112. STRATEGIC WEAPONSMapCalendarCamera

136. Alan Blum, M.D.Professor and Endowed Chair in Family Medicine, The University of AlabamaDirector, The University of Alabama Center for the Study of Tobacco and Societyablum@cchs.ua.edu