3. • Formerly regarded solely as a “lifestyle choice.”
• Smoking is now recognized as a chronic, relapsing
disorder caused because of addiction.
• It has become the leading preventable cause of
mortality and morbidity over the years.
Am J Med (2008)121 (4A), S1–S2Am J Med (2008)121 (4A), S1–S2
Smoking – An epidemic
4. Tobacco
TRADITIONAL COMMERCIAL
Smoked in a pipe for
ceremonial purposes
Used as an offering to a
healer, elder or other person
as a sign of respect or thanks
Medicinal tobacco was often
used as a painkiller
Deliberate targeting of
specific consumer groups
Premeditated and conscious
addition of chemicals that
lead to addiction
Scarcely contains actual
tobacco
4
7. Approx 50 LAKHS people die from tobacco use every
year
(1 death every 6 seconds)
Tobacco kills up to half of its users.
WHO report, 2011
8. • India has about 12 crore smokers & it is ever increasing
• 32.7% of adult males and 1.4% of adult females
• 17% of males and 9% of females in 13-15 yrs age group use
tobacco.
• Smoking currently causes approx 8-10 lakh deaths per year in
India.
WHO report on the global tobacco epidemic, 2008
N Engl J Med 2008;358:1137-47.
How big is the problem of
smoking in India
15. Smokeless Tobacco in India
• Only 20% of the total tobacco consumed in India is in
the form of cigarettes
• About 40% consume bidis and the remaining 40%
chew tobacco, pan masala, snuff, gutkha, masheri
and tobacco toothpaste.
• These products contain putrefied tobacco, paraffin,
areca nut, lime, catechu, and 230 permitted additives
and flavours including known carcinogens.
• India has one of the highest rates of oral cancer in the
world
• Leading cause of oral cancer, oral mucosal fibrosis,
periodontal disease, abrasion of teeth & bad
breath.
1) http://www.cpaaindia.org/activities/projects.
2) WHO
3) Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:857-864)
16.
17.
18. Can smoking affect vision?
• Smoking is as bad for your eyes as it is for
the rest of your body. Research has linked
smoking to an increased risk of
developing age-related macular
degeneration, cataract, and optic nerve
damage, all of which can lead to
blindness.
19. How does smoking affect bones?
• Recent studies show a direct relationship between tobacco use and decreased bone
density.
• Smoking is one of many factors—including weight, alcohol consumption, and activity
level—that increase your risk for osteoporosis
• Significant bone loss has been found in older women and men who smoke. Quitting
smoking appears to reduce the risk for low bone mass and fractures.
• In addition, smoking from an early age puts women at even higher risk for
osteoporosis. Smoking lowers the level of the hormone estrogen in your body, which
can cause menopause earlier, boosting the risk for osteoporosis.
20. How does smoking affect heart
and blood vessels?
• The chemicals in tobacco smoke harm your blood cells and damage the function of
your heart. This damage increases your risk for:
• Atherosclerosis,
• Aneurysms
• Cardiovascular disease (CVD), which includes:
– Coronary heart disease (CHD), narrow or blocked arteries around the heart
– Heart attack and damage to your arteries
– Heart-related chest pain
– High blood pressure
• Peripheral arterial disease (PAD)
• Stroke, which is sudden death of brain cells caused by blood clots or bleeding
21. How does smoking affect lungs
and breathing?
Smoking causes:
•Chronic obstructive pulmonary disease (COPD)
•Emphysema
•Chronic bronchitis
•Pneumonia
•Asthma
•Tuberculosis
22. Exposing an infant to
second-hand smoke
greatly increases the
child’s risk of:
• asthma
• pneumonia
• bronchitis
• fluid in the
middle ear
23. Each year, second-hand tobacco smoke is
responsible for thousands of:
• deaths from heart disease in adults
• deaths from lung cancer in adults
• deaths from other cancers in adults
• cases of lung infections, such as pneumonia
and bronchitis, in infants and young children
• Infertility, spontaneous abortion, and low birth
weight babies
Second-hand Tobacco Smoke
24. The Consequences of Second-hand
Tobacco Smoke on Health
Effects Causally Associated with Second-hand Smoke Exposure
Developmental Effects
Foetal growth: low birth weight or small for gestational age
Sudden infant death syndrome (SIDS)
Respiratory Effects
Acute lower respiratory tract infections in children (bronchitis,
pneumonia)
Asthma induction and exacerbation in children
Chronic respiratory symptoms in children
Eye and nasal irritation in adults
Middle ear infections in children
25. The Consequences of Second-hand
Tobacco Smoke on Health
Effects Causally Associated with Second-hand Smoke
Exposure (cont.)
Carcinogenic Effects
Lung cancer
Nasal sinus cancer
Cardiovascular Effects
Heart disease mortality
Acute and chronic coronary heart disease morbidity
26. The Consequences of Second-hand
Tobacco Smoke on Health
Effects With Suggestive Evidence of a
Causal Association With Second-hand Smoke Exposure
Developmental Effects
Spontaneous abortion
Adverse impact on cognition and behavior
Respiratory Effects
Exacerbation of cystic fibrosis
Decreased pulmonary function
Carcinogenic Effects
Cervical cancer
30. Risks from Environmental
Tobacco Smoke (ETS)
– Mainstream—smoke drawn through tobacco while
inhaling
– Sidestream—smoke from the burning end of a
cigarette or smoke exhaled by a smoker
– Contains 2 times more tar and nicotine, 5 times
more carbon monoxide, and 50 times more
ammonia than mainstream smoke
– Causes more deaths a year than any other
environmental pollutant
32. A smoker’s risk of
heart attack is more
than twice that of
nonsmokers.
Cigarette smoking is
the biggest risk factor
for sudden cardiac
death.
33. Smoking and Strokes
• Cigarette smoking doubles the risk of a stroke.
• Smoking damages the cardiovascular system.
• Cigarette smoke makes clotting more likely.
• Smoking cessation today would significantly cut
risk of stroke within two years.
34. Smoking & Reproduction
• Women smokers have greater risks of:
– Primary and secondary infertility
– Miscarriage and premature delivery
– Stillbirth, neonatal deaths, and sudden infant death
syndrome (SIDS)
– Danger to the mother, eg, bleeding
– Menstrual problems
– Premature menopause + osteoporosis
35.
36. Women who plan to have children need
to know that smoking is associated with:
• Reduced fertility
• Early menopause
• Increased likelihood of delayed pregnancy
• Complications of pregnancy
• Reduced oxygen to placenta
37. Women
who take
birth
control pills
and smoke
are:
39 times more
likely to have a
heart attack
22 times more
likely to suffer
from certain
forms of stroke
38.
39.
40.
41.
42.
43.
44.
45. EFFECTS OF TOBACCO ON HEALTH
Tobacco affects all parts of the body from head to toe
Skin Premature aging
Skin creasing and
Skin cancers
Teeth Staining
Wearing off of teeth
Receding gum line
Mouth Oral cancer
Submucosal fobrosis
Vocal cords Cancer
Eyes Visual problems – cataracts, premature
blindness
Brain Addiction
Strokes
Brain hemorrhage
Heart Heart attacks
Aneurysms
Sudden death
46. Blood vessels Hardening and bloackage
leading to gangrene
Lungs Chronic bronchitis
Emphysema
Infections
Chronic obstructive lung
disease
Cancer
Bladder/ Kidney Cancer
Male impotence
Esophagus/ stomach/ pancreas Cancer
Reproductive system Male impotence
Female infertility
Abortions
Premature birth
Osteoporosis
Bones Thining and risk of fractures
47. Is smoking a risk factor for
autoimmune diseases?
• Smoking compromises the immune system, making smokers more likely to have
respiratory infections.
• Smoking also causes several autoimmune diseases, including Crohn’s disease and
rheumatoid arthritis.
• It may also play a role in periodic flare-ups of signs and symptoms of autoimmune
diseases.
• Smoking doubles your risk of developing rheumatoid arthritis.
• Smoking has recently been linked to type 2 diabetes, also known as adult-onset
diabetes. Smokers are 30% to 40% more likely to develop type 2 diabetes than
nonsmokers.
•Tobacco contains nicotine, which is highly addictive.
•When a smoker takes a puff, it takes only 10-19 seconds for the effects of the nicotine to reach the brain – that’s faster than that uptake of heroin or cocaine. In fact, many drug addicts say they would rather give up heroin or cocaine than cigarettes.
Source: American Academy of Pediatrics 1997; Smoking Cessation: Clinical Practice Guideline Number 18. Agency for Health Care Policy and Research, Centers for Disease Control and Prevention, April 1996.
This list of health risks is compiled from data from the World Health Organization, American Cancer Society, the American Lung Association, the National Cancer Institute, The Heart Association, the US Centers for Disease Control and Prevention, and from various studies undertaken in Asia.
This list of health risks is compiled from data from the World Health Organization, American Cancer Society, the American Lung Association, the National Cancer Institute, The Heart Association, the US Centers for Disease Control and Prevention, and from various studies undertaken in Asia.
Sources:
International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. WHO/NCD/TFI//99.10. World health Organization, Geneva, Switzerland, 11-14 January 1999.
Things You Should Know About ETS, American Academy of Pediatrics, 1997; CDC Office on Smoking and Health 1999.
International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. WHO/NCD/TFI//99.10. World health Organization, Geneva, Switzerland, 11‑14 January 1999.
Source: National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 99-4645, 1999.
International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. WHO/NCD/TFI//99.10. World health Organization, Geneva, Switzerland, 11‑14 January 1999.
Source: National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 99-4645, 1999.
International Consultation on Environmental Tobacco Smoke (ETS) and Child Health. WHO/NCD/TFI//99.10. World health Organization, Geneva, Switzerland, 11‑14 January 1999.
Source: National Cancer Institute. Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD. U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub. No. 99-4645, 1999.
•The Association of Reproductive Health Professionals issued guidelines for prescribing oral contraceptives to smokers. They suggest that the choice of oral contraceptives should be tailored to a woman’s age and how much she smokes. Women over 35 years of age who smoke heavily (15 or more cigarettes a day) should be categorically denied oral contraceptives unless they quit, because of the risks involved.
Castelli WP. Reducing risk in OC users who smoke. Contemp Ob Gyn 1996; 41:118-126.