SMOKING HAZARDS AMONG YOUGSTERS AND ADULTS

HAZARDS AND PREVENTION OF SMOKING AMONG YOUNGSTERS AND ADULTS EMPHASIZED BY WHO IN CONNECTION WITH NO TOBACCODAY OF THIS YEAR.

1. World No Tobacco Day 2024 -MAY 31 DR D RAJAN HOD, AZEEZIZA MEDICAL COLLEGE, KOLLAM

2. The theme for this year’s  World No Tobacco Day, "Protecting Children from Tobacco Industry Interference ”  underscores the critical need to prevent future generations from falling prey to the harmful impact of tobacco use.

3. INCIDENCE About 8 million people die each year worldwide. The industry’ targeting of youth through appealing packaging, flavors, and advertising is designed to entice new, younger users. These practices, part of the “economics of deception and manipulation” -book by Nobel Prize in Economics laureates, George Akerlof and Robert J. Shiller, youngsters susceptible to addiction and the long-term ill health consequences of tobacco use.

4. Death statitics - Tobacco use in India 35% of population using in India 1.2 million deaths- Smoking 1 million deaths Passive smoking -2.4 lakhs deaths Chewing cause 35000 deaths. 20% of CAD -3.5 Lakhs 47%-4.25 Lakhs of copd death by tobacco use 14% about 1 lakh of Stroke by tobaccouse

5. The significance of protecting youth for human capital development Protecting children from tobacco use is vital for human capital development. By keeping away young people from the influence of tobacco, - less likely to develop tobacco-attributable-diseases that hinder their educational attainment and professional achievements. Healthy, tobacco-free youth are more likely to perform better academically and are capable workforce in the future. This fosters innovation, economic growth, and societal progress, as individuals can fully realize their lifetime potential These efforts also contribute to reduce healthcare costs associated with treating tobacco-attributable diseases, such as cancer, cardiovascular diseases, and respiratory illnesses. This improves individual quality of life and reduces the strain on healthcare systems.

6. Tobacco taxation is a highly effective measure to control tobacco use One effective strategy in protecting children from tobacco is higher taxes on tobacco products to increase their prices and lower their affordability. Research has shown that young people are - price-sensitive than adults, significantly reduce their purchasing these products. Regulatory policies can also play an important role in protecting children and adolescents from relentless advertising and promotion by the tobacco industry. Comprehensive bans on tobacco advertising, promotion, and sponsorship, as well as plain packaging laws, can reduce the social acceptability of tobacco use. By creating environments where tobacco use is less visible and less glamorized, we can prevent youth from starting to use tobacco in the first place.

7. Despite the potential of tobacco taxes, they remain an underused policy Taxing tobacco is a highly effective but underused policy to control tobacco use. The 2024 Tobacconomics Cigarette Tax Scorecard reveals that governments worldwide have made insufficient progress in leveraging tobacco taxation to combat tobacco use as one of the leading causes of preventable death. Despite the potential of tobacco taxes to both save lives and increase government revenues, most countries have not effectively utilized this policy tool. The Scorecard finds that the global average cigarette tax score dropped down to 1.99 out of 5.00 points in 2022 following a modest increase from 1.89 in 2014 to 2.25 in 2020. Overall scores improved in only 31 countries from 2020 to 2022, while scores worsened in 76 countries and stayed the same in 55 countries. Only 68 countries of the 170 for which data are available scored 2.50 or higher. As a result, cigarettes are affordable in most countries and becoming more affordable in too many.

8. Advancing the tobacco taxation agenda A World Bank Group suggested tobacco taxation, leaders need to adopt bold and decisive strategies. One critical step is to implement substantial and successful tax strategy to reduce tobacco product affordability. Combining large initial tax and hikes with recurrent increases can reduce consumption. Governments must convey that tax hikes are sustained effort to keep tobacco prices increasing to motivate current smokers to quit and deter young people from starting. Regional collaboration can prevent in minimizing cross-border smuggling and fostering shared goals among countries.

9. There is no time to waste The COVID-19 pandemic exposed the potential devastating impact of unattended public health, social, and environmental risks and their spillover effects in a fast-changing, crowded, and interconnected world. Tobacco use is a decades-old pandemic that needs to end once and for all, across the world, as an imperative to sustainable development.

10. Health Effects of Cigarette Smoking

11. Diseases caused by smoking include: Cancer Heart disease stroke Lung diseases Type 2 Diabetes Chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis

12. Cigarette smoking harms nearly every organ of the body. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system, including rheumatoid arthritis. Secondhand smoke exposure contributes to over 40,000 deaths among nonsmoking adults and 400 deaths in infants each year. In adults, secondhand smoke causes: Coronary heart disease Stroke Lung cancer Children exposed to secondhand smoke are at increased risk for: Sudden infant death syndrome Acute respiratory infections Middle ear disease More severe asthma Respiratory symptoms Slowed lung growth

13. Benefits of Quitting Smoking Quitting smoking has health benefits at any age, no matter how long or how much you have smoked.

14. PSYCHOSOCIAL THERAPY Psychological therapies for tobacco dependence include behavior therapy and hypnosis. Behavior therapy involves skills training, relapse prevention, stimulus control, and aversive therapy to help smokers cope with high-risk situations, eliminate smoking cues in their environment, and associate smoking with unpleasant sensations. Hypnosis may also be beneficial for some patients, using suggestions about the benefits of quitting and posthypnotic suggestions to make cigarettes taste unpleasant or produce nausea.

15. Psychopharmacological Therapies Product Route of Administration Usual Dose Nicotine Replacement Medications NicoDerm, Habitrol , Generic versions Patch Varies by product and amount a person has smoked. Nicorette, Commit, Generic versions Oral (Gum, Lozenge) Nicotrol Inhaled (Nasal Spray, Inhaler) Non-Nicotine Medications Bupropion Pill Starting: 150 mg × 3 days After 3 days increase to 150 twice a day Begin 1 wk before quitting Varenicline Tartrate Pill Days 1–3: 0.5 mg once daily Days 4–7: 0.5 mg twice Daily Day 8–End of treatment: 1 mg twice daily

16. Nicotine Replacement Therapies All nicotine replacement therapies can double cessation rates by reducing nicotine withdrawal. Replacement therapies use a short period of maintenance followed by a gradual reduction period. Nicotine polacrilex gum is an OTC product that releases nicotine via chewing and buccal absorption. Nicotine lozenges offer the highest level of nicotine of all nicotine replacement products. Nicotine patches are available in a 16-hour, notaper preparation and a 24- or 16-hour tapering preparation. Nicotine nasal spray produces nicotine concentrations in the blood that are more similar to those from smoking a cigarette. The nicotine inhaler delivers 4 mg per cartridge and provides a behavioral substitute for smoking. These devices require frequent puffing and have minor adverse effects.

17. Non-Nicotine Medications Bupropion is an antidepressant medication that can be used as a non-nicotine therapy for smoking cessation. Bupropion SR (sustained release) is started at a dose of 150 mg/day and increased to 150 mg twice a day for 6 to 12 weeks. Daily dosages of 300 mg of bupropion can double quit rates in smokers with and without a history of depression. A combination of bupropion and nicotine patch had higher quit rates than either therapy alone. Adverse effects of bupropion can include insomnia and nausea, but these are rarely significant. Contraindications to using bupropion include a seizure disorder, current/past bulimia or anorexia nervosa, rennet/concurrent MAOI, or other bupropion use. Varenicline is a partial agonist at the α4β2 neuronal nicotinic acetylcholine receptor that both relieves craving and withdrawal and reduces the reinforcing effects of nicotine. Varenicline was associated with neuropsychiatric adverse events, but the FDA has since removed the black box warning associated with these events. Clinicians should monitor for symptoms related to mental status and cardiac status in patients taking varenicline.

18. Quitting smoking Improves health status and enhances quality of life. Reduces the risk of premature death - 10 years to life expectancy. Reduces the risk for cardiovascular diseases, chronic obstructive pulmonary disease (COPD), cancer, and poor reproductive health outcomes. Benefits people with diagnosed with coronary heart disease or COPD. Benefits the health of pregnant women and their fetuses and babies. Reduces the financial burden. While quitting earlier in life yields greater health benefits, quitting smoking is beneficial to health at any age. Even people who have smoked for many years or have smoked heavily will benefit from quitting. Quitting smoking is the single best way to protect family members, coworkers, friends, and others from the health risks associated with breathing secondhand smoke

19. Cardiovascular health benefits of quitting smoking Reduces the risk of disease and death from cardiovascular disease. Reduces markers of inflammation and hypercoagulability. Leads to rapid improvement in high-density lipoprotein cholesterol (HDL-C) levels. Reduces the development of subclinical atherosclerosis and slows its progression over time. Reduces the risk of coronary heart disease with risk falling sharply 1-2 years after cessation and then declining more slowly over the longer term. Reduces the risk of disease and death from stroke, with risk approaching that of never smokers after cessation. Reduces the risk of abdominal aortic aneurysm, with risk reduction increasing with time since cessation. May reduce the risk of atrial fibrillation, sudden cardiac death, heart failure, venous thromboembolism, and peripheral arterial disease (PAD). People already diagnosed with coronary heart disease also benefit from quitting smoking. Quitting smoking after a diagnosis of coronary heart disease Reduces the risk of premature death. Reduces the risk of death from heart disease. Reduces the risk of having a first heart attack or another heart attack.

20. Respiratory health benefits of quitting smoking Reduces the risk of developing COPD. Among those with COPD, slows the progression of COPD and reduces the loss of lung function over time. Reduces respiratory symptoms, such as cough, sputum production, wheezing. Reduces respiratory infections, such as bronchitis, pneumonia. May improve lung function, reduce symptoms, and improve treatment outcomes in people with asthma.

21. Cancer-related health benefits of quitting smoking

22. Quitting smoking reduces the risk of 12 Different Cancers Acute myeloid leukemia , Bladder, Cervix, lung, Colon and rectum Esophagus Kidney Liver Mouth and throat (oral cavity and pharynx) Pancreas Stomach Voice box (larynx) For cancer survivors, quitting smoking may improve prognosis and reduce risk of premature death.

23. Reproductive health benefits of quitting smoking Quitting smoking is one of the most important actions women who smoke can take for a healthy pregnancy and a healthy baby. The best time for women to quit smoking is before they try to get pregnant. But quitting at any time during pregnancy can benefit the health of both mother and baby. Before pregnancy or early in pregnancy reduces the risk for a small-for-gestational-age baby. During pregnancy reduces the risk of delivering a low birth weight baby. Early in pregnancy eliminates the adverse effects of smoking on fetal growth. Before pregnancy or early in pregnancy may reduce the risk of preterm delivery.

24. Health benefits of quitting smoking over time Length of time after quitting Benefit Minutes Heart rate drops. 24 hours nicotine level in the blood drops to zero. Several days Carbon monoxide level in the blood drops to level of someone who does not smoke. 12 months Coughing and shortness of breath decrease. 1 to 2 years Risk of heart attack drops sharply. 3 to 6 years Added risk of coronary heart disease drops by half. 5 to 10 years Added risk of cancers of the mouth, throat, and voice box drops by half. Risk of stroke decreases. 10 years Added risk of lung cancer drops by half after 10 to 15 years. Risk of cancers of the bladder, esophagus, and kidney decreases. 15 year Risk of coronary heart disease drops to close to that of someone who does not smoke. 20 years Risk of cancers of the mouth, throat, and voice box drops to close to that of someone who does not smoke. Risk of pancreatic cancer drops to close to that of someone who does not smoke. Added risk of cervical cancer drops by about half

25. Secondhand smoke is harmful Commercial tobacco smoke contains hundreds of harmful chemicals. A There are more than 7,000 chemicals in commercial tobacco smoke, including hundreds of chemicals that are toxic and 70 that can cause cancer There is no safe level of exposure to secondhand smoke. Even brief exposure can cause serious health problems. Secondhand smoke can cause coronary heart disease, stroke, and lung cancer in adults who do not smoke.14 Infants and young children are especially impacted by health problems caused by secondhand smoke because their bodies are still growing. Children exposed to secondhand smoke are at an increased risk for Sudden infant death syndrome (SIDS) Acute respiratory infections, such as pneumonia and bronchitis Middle ear disease More frequent and severe asthma Respiratory symptoms Slowed lung growth

26. Protecting people from secondhand smoke exposure The harm caused by secondhand smoke is preventable. Stop smoking to prevent secondhand smoke exposure. Comprehensive smokefree laws and policies that prohibit smoking in all areas of indoor spaces Comprehensive smokefree laws and policies can also help people quit smoking and can help keep young people from starting to smoke. These laws and policies must be applied equitably to ensure that all people have a fair and just opportunity to breathe smokefree air and be as healthy as possible. Most comprehensive smokefree laws and policies also prohibit the use of e-cigarettes. Including e-cigarettes in smokefree or tobacco-free policies can protect people who do not use e-cigarettes from exposure to e-cigarette emissions.

27. You can quit smoking: here's how Quitting smoking is one of the most important steps you can take to improve your health. This is true no matter how old you are or how long you have smoked. The good news is there are proven treatments that can help you quit. Many people who smoke become addicted to nicotine, a drug that is found naturally in tobacco. This can make it hard to quit smoking. But the good news is there are proven treatments that can help you quit.

28. 5 Major Steps to Intervention Ask: Identify and document tobacco use Advise: Clear, Strong and Personalized manner urge every tobacco user to quit. Assess: Willingness to quit Assist: Patient to quit use Counselling Pharmacotherapy Arrange: Schedule follow up ,contact in person or by telephone.

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