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Dr. Rasha Salama PhD Community Medicine Suez Canal University Egypt
Facts (cont.)
Smoking, especially current smoking, is a crucial and extremely modifiable independent determinant of stroke. Second-hand smoke (also called environmental tobacco smoke) is a Class A carcinogen and contains approximately 4,000 chemicals. Exposure of children to second-hand smoke:
can cause middle ear effusion increases the risk of croup, pneumonia and bronchiolitis by 60 percent in the first 18 months of life increases the frequency and severity of asthma episodes is a risk factor for induction of asthma in asymptomatic children.
Excess risk of heart disease is reduced by half after one years abstinence. The risk of a major coronary event reduces to the level of a never smoker within five years. In those with existing heart disease, cessation reduces the risk of recurrent infarction or death by half. Former smokers live longer: after 10 to 15 years abstinence, the risk of dying almost returns to that of people who never smoked. Smoking cessation at all ages, including in older people, reduces risk of premature death. Men who smoke are 17 times more likely than non-smokers to develop lung cancer. After 10 years abstinence, former smokers risk is only 30 to 50 percent that of continuing smokers, and continues to decline.
Women who stop smoking before or during the first trimester of pregnancy reduce risks to their baby to a level comparable to that of women who have never smoked. Around one in four low birth weight infants could be prevented by eliminating smoking during pregnancy. The average weight gain of three kg and the adverse temporary psychological effects of quitting are far outweighed by the health benefits.
ESSENTIAL COMPONENTS
The following elements must all be included to maximize the success of any program to reduce tobacco use. Conducted in isolation, each of these elements can reduce tobacco use, but done together they have a much more powerful impact: Public Education Efforts Community-Based Programs Helping Smokers Quit (Cessation) School-Based Programs Enforcement Monitoring and Evaluation Related Policy Efforts
Community-Based Programs:
Because community involvement is essential to reducing tobacco use, a portion of the tobacco control funding should be provided to local government entities, community organizations, local businesses, and other community partners.
School-Based Programs:
School-based programs offer a useful way to prevent and reduce tobacco use among kids, especially when based on the CDCs Guidelines for School Health Programs to Prevent Tobacco Use and Addiction. To operate most effectively, school-based programs must include curricula that have been shown to be effective, as well as tobacco-free policies, training for teachers, programs for parents, and cessation services.
Enforcement:
Rigorously enforcing laws prohibiting tobacco sales to youth and limiting exposure to secondhand smoke is an essential element of creating an environment conducive to reducing tobacco use. These enforcement efforts should include penalties for violators, and compliance enhancing education.
Enforcement (cont.):
To increase tobacco control enforcement, funds must be provided to enforcement agencies to make sure other enforcement efforts are not compromised. Other agencies and organizations should also be supported to provide related educational efforts to raise awareness of the laws and their enforcement and to promote compliance.
GUIDING PRINCIPLES
Past experience with tobacco control efforts indicates that five principles should guide the development of a successful state program to prevent and reduce tobacco use: 1. It must be comprehensive. Stopgap or partial measures will meet with only partial success. Elements work most effectively when they are combined in complementary fashion.
Introduction
There is good evidence that even brief advice from health professionals has a significant effect on smoking cessation rates. A supportive, ongoing relationship with a health professional is often an essential precursor to successful quitting. Success in quitting smoking depends less on any specific type of intervention than on delivering personalized empathic smoking cessation advice to smokers, and repeating it in different forms from several sources over a long period. Smoking cessation is a dynamic process that occurs over time rather than a single event. Smokers cycle through the stages of contemplation, quitting and relapse an average of three to four times before achieving permanent success.
Tobacco dependence is a chronic condition that often requires repeated intervention. However, effective treatments exist that can produce long-term abstinence. These guidelines are designed for smoking cessation providers to assist all clients with smoking cessation.
ASK
ASSESS
ADVISE
ASSIST
ARRANGE
There are several versions of the Fagerstrm test. The one we will use has 6 multiple-choice questions. Each of the multiple-choice responses has a point score. After the person has answered all the questions, you need to add all points from the individual questions; this should give an integer between 0 and 10. The person is then probably strongly addicted if the total score is 8 or more; addicted if the score is 6 or 7; mildly addicted if the score is 3, 4, or 5; and not addicted if the score is 2 or less.
Q1: When do you smoke your first cigarette of the day? Allowed responses: within 5 minutes (3 pt), 6-30 minutes (2 pt); 31-60 minutes (1 pt); more than 60 minutes after waking up (0 pt) Q2: Do you find it hard not to smoke in places where it is forbidden, such as in a cinema? Allowed responses: yes (1 pt), no (0 pt) Q3: Which cigarette would you most hate to give up? Allowed responses: the first one in morning (1 pt); any other one (0 pt) Q4: How many cigarettes do you smoke in a day? Allowed responses: 10 or less (0 pt); 11-20 (1 pt); 21-30 (2 pt); 31 or more (3 pt) Q5: Do you smoke more after waking up than during the rest of the day? Allowed responses: yes (1 pt), no (0 pt) Q6: Do you still smoke if you are so sick that you're in bed most of the day? Allowed responses: yes (1 pt), no (0 pt)
Thank you