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- 2. INTRODUCTION Tobacco useis the leading preventable cause of death. The practice of burning tobacco and inhaling the smoke, is known as Smoking. There are about 1.3 billion cigarette smokers worldwide and this number is still increasing. About 1 in 5 adults smoke. 4 out of 10 nonsmokers (40%) are exposed to secondhand smoke. More than 1 out of 2 kids (aged 3–11 years) are exposed to secondhand smoke. More men (nearly 24%) than women (about 18%) smoke. Smoking rates are higher among people with a lower education level.
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- 4. TOXIC COMPONENTS OF TOBACCOSMOKE Tobacco smoke contains chemicals that are harmful to both smokers and nonsmokers. Breathing even a little tobacco smoke can be harmful. Tobacco smoke contains about 4800 compounds. Tobacco smoke consists of two phases: The vapor (or gaseous) phase and Particulate phase
- 5. TOXIC COMPONENTS OFVAPOR PHASE Carbon monoxide Carbon dioxide Carbonyl sulfide Benzene Toluene Formaldehyde Acrolein Acetone Pyridine 3-Methylpyridine 3-Vinylpyridine Hydrogen cyanide Ammonia Methylamine Dimethylamine Nitrogen oxides Formic acid Acetic acid Methyl chloride
- 6. TOXIC COMPONENTS OF PARTICULATEPHASE Nicotine Anabatine Phenol Catechol Hydroquinone Cholesterol γ-Butyrolacetone Quinoline Harman Benzoic acid Lactic acid Glycolic acid Succinic acid
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- 8. TOXIC COMPONENTS OF TOBACCOSMOKE The majority of compounds are found in the particulate phase. Nicotine is the major component of the particulate phase. Nicotine comprises 1.5% of the total weight of a commercial cigarette and is the primary alkaloid found in tobacco. The carcinogens are also found in the particulate matter. About 69 carcinogens are identified in tobacco smoke. Among them, 11 are known human carcinogens and 7 are probably carcinogenic in humans.
- 9. NICOTINE Nicotine isa stimulant and is one of the main factors leading to continued tobacco smoking. According to studies by Henningfield and Benowitz, nicotine is more addictive than cannabis, caffeine, ethanol, cocaine, and heroin when considering both somatic and psychological dependence. Smoking Nicotine Facilitates dopamine release in the nucleus accumbens Pleasurable effect Triggers positive reinforcement Nicotine addiction various nicotine delivery systems, such as the nicotine patch or nicotine gum, that can satisfy the addictive craving by delivering nicotine without the harmful combustion by-products. This can help the heavily dependent smoker to quit gradually, while discontinuing further damage to health.
- 10. CHEMICAL CARCINOGENS Tobacco smoke Carcinogenicpyrolytic products, Polycyclic aromatic hydrocarbon (Benzopyrene) and Acrolein Formation of epoxides Irreversibly attaches to a cell's nuclear DNA Genetic mutation Cancer cell About 69 carcinogens are identified in tobacco smoke. Among them, 11 are known human carcinogens and 7 are probably carcinogenic in humans.
- 11. RADIOACTIVE CARCINOGENS Tobaccosmoke contain small amounts of lead-210(210Pb) and polonium-210 (210Po) both of which are radioactive carcinogens. Research by NCAR radiochemist Ed Martell suggested that radioactive compounds in cigarette smoke are deposited in "hot spots" where bronchial tubes branch. Smoking an average of 1.5 packs per day gives a radiation dose of 60-160 mSv/year, compared with living near a nuclear power station (0.0001 mSv/year) or the 3.0 mSv/year average dose for Americans. The radioactive smoke is deposited in lungs and releases radiation even if a smoker quits the habit. If the smoker also breathes in the asbestos fibers which commonly occur in urban and industrial environments, the risk of cancer is greatly increased.
- 12. HEALTH RISKS OFSMOKING
- 13. HEALTH RISKS OFSMOKING Atherosclerotic diseases of the heart and blood vessels: Cardiovascular disease (including myocardial infarction and sudden death) Cerebrovascular disease (Stroke) Peripheral vascular disease (Claudication, etc) Noncancerous lung diseases: Chronic obstructive pulmonary disease Asthma Cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix. Toxicity to the human reproductive system Reduced Fertility
- 14. CARDIOVASCULAR DISEASES Cigarettesmokers are more likely than nonsmokers to develop both large-vessel atherosclerosis and small-vessel disease. Approximately 20–30% of coronary artery disease is caused by cigarette smoking. According to a study by an international team of researchers, people under 40 are five times more likely to have a heart attack if they smoke. Smoking Promotes Atherosclerosis, platelet aggregation and vascular occlusion Increases the likelihood of myocardial infarction and sudden cardiac death Cessation of cigarette smoking reduces the risk of a second coronary event within 6–12 months. After 15 years of abstinence from smoking, the risk of a new myocardial infarction or death from coronary heart disease in former smokers is similar to that for those who have never smoked.
- 15. CEREBROVASCULAR DISEASE 10%of occlusive cerebrovascular disease are caused by cigarette smoking. Smoking Atherosclerosis of cerebral blood vessels Narrowing of arteries Cerebral Ischemia Stroke
- 16. PERIPHERAL VASCULAR DISEASE Approximately 90% of peripheral vascular disease in the nondiabetic population can be attributed to cigarette smoking. Smoking Atherosclerosis of peripheral blood vessels Narrowing of arteries Claudication Gangrene
- 17. CANCER Cigarette smokingaccounts for at least 30% of all cancer deaths. It is linked with increased risk of cancers such as: Lung Larynx (voice box) Oral cavity (mouth, tongue, and lips) Nose and sinuses Pharynx (throat) Esophagus (tube connecting the throat to the stomach) Stomach Pancreas Cervix Kidney Bladder Ovary (a type called mucinous ovarian cancer) Colorectum (the colon and/or the rectum) Acute myeloid leukemia Smoking accounts for 87% of lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat. The risks of cancer increase with the increasing number of cigarettes smoked per day and with increasing duration of smoking.
- 18. RESPIRATORY DISEASE Cigarettesmoking is responsible for 90% of chronic obstructive pulmonary disease. Chronic mucous hyperplasia of the larger airways results in a chronic productive cough in as many as 80% of smokers >60 years. Chronic obstructive pulmonary disease (COPD) caused by smoking, is a permanent, incurable (often terminal) reduction of pulmonary capacity characterised by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis. The carcinogen acrolein and its derivatives also contribute to the chronic inflammation present in COPD. Smoking Long term exposure to Carbon monoxide and Cyanide Chronic inflammation and narrowing of the small airways Pulmonary damage and loss of elasticity in the alveoli Emphysema and COPD Reduced expiratory airflow Changes in the small airways of young smokers will reverse after 1–2 years of cessation.
- 19. ERECTILE DYSFUNCTION Incidenceof impotence is approximately 85 percent higher in male smokers compared to non-smokers, and it is a key cause of erectile dysfunction (ED). The British Medical Association estimates that up to 120,000 men have ED because of smoking. Smoking increases the risk of erectile dysfunction (ED) by about 50 per cent, in men aged 30-40. Smoking Narrowing of arteries supplied to penis Reduced blood supply Erectile dysfunction
- 20. FEMALE INFERTILITY Smokingis harmful to the ovaries, potentially causing female infertility. Smoking Nicotine and other harmful chemicals Interfere with the body’s ability to create estrogen Affects folliculogenesis and ovulation Female Infertility Cigarette smoking also interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium. Some damage is irreversible, but stopping smoking can prevent further damage. Smokers are 60% more likely to be infertile than non-smokers.
- 21. PREGNANCY COMPLICATIONS Smoking Intrauterine growthretardation (IUGR) Low birth weight (<2500 g) smoking in pregnancy also increases the risk of preterm delivery. Other adverse pregnancy outcomes linked to smoking are miscarriage (spontaneous abortion) and stillbirth. Smoking during pregnancy affects children even after birth. Sudden infant death syndrome is two to four times more common in infants born to mothers who smoked during pregnancy. Cognitive deficits and developmental problems in childhood are also linked to maternal smoking during pregnancy.
- 22. INFECTION Tobacco isalso linked to susceptibility to infectious diseases, particularly in the lungs. Smoking more than 20 cigarettes a day increases the risk of tuberculosis by two to four times. Being a current smoker has been linked to a fourfold increase in the risk of invasive pneumococcal disease. The usage of tobacco also increases rates of infection: common cold and bronchitis, chronic obstructive pulmonary disease, emphysema and chronic bronchitis in particular. Smoking Nicotine Increase in CD4+ cell production Affects immune system Increased risk of pulmonary and respiratory tract infections
- 23. STRESS Smokers reporthigher levels of everyday stress. Several studies have monitored feelings of stress over time and found reduced stress after quitting. Recent studies have shown a positive relationship between psychological distress and salivary cotinine levels in smoking and non- smoking adults, indicating that both firsthand and secondhand smoke exposure may lead to higher levels of mental stress. Medical researchers have found that smoking is a predictor of divorce. Smokers have a 53% greater chance of divorce than nonsmokers.
- 24. OTHER RISKS Smokersare at a significantly increased risk for chronic kidney disease than non-smokers. A history of smoking encourages the progression of diabetic nephropathy. Cigarette smoking also increases a woman's risk of postmenopausal osteoporosis and fracture. Smokers have higher rates of peptic ulcer disease, and sensorineural hearing loss than nonsmokers. The blood vessels in the eye are sensitive and can be easily damaged by smoke, causing a bloodshot appearance and itchiness. Heavy smokers are twice as likely to get macular degeneration, resulting in the gradual loss of eyesight. Smokers run an increased risk of cataracts. Smokers have more prominent skin wrinkling than nonsmokers, independent of sun exposure.
- 25. OTHER RISKS Smokingstains teeth and gums. Smoking increases risk of periodontal disease, which causes swollen gums, bad breath and teeth to fall out. Smoking causes an acid taste in the mouth and contributes to the development of ulcers. Smoking Reduces the blood supply to the skin and lowers levels of vitamin A Paler skin and more wrinkles Affects personal looks Smokers are 4 times more likely to have gray hair and increased hair loss. The majority of residential fire deaths are caused by smoking.
- 26. OTHER RISKS Smokinginterferes with the healing of bone and muscle injuries, and they lead to higher rates of complications after surgery. 50% more likely than nonsmokers to injure themselves with sprains and fractures. Smokers are more vulnerable to headaches. People who smoke are more likely to have sinusitis. Long-time smokers may face an increased risk of multiple sclerosis. smoking impedes the blood supply to the lower spine, it is also linked to chronic low back pain and degenerative disk disease.
- 27. SECOND HAND SMOKE Nonsmokers are harmed by chronic exposure to environmental tobacco smoke (ETS). The children of parents who smoke have more serious respiratory infections during infancy and childhood, more respiratory symptoms, and a higher rate of chronic otitis media and asthma than the children of nonsmokers. Secondhand smoke exposure increases a nonsmoker's risk of lung cancer and coronary heart disease.
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- 29. REFERENCES Behavioral Medicine:A Guide for Clinical Practice,3e Mitchell D. Feldman, John F. Christensen The MD Anderson Manual of Medical Oncology, 2e Hagop M. Kantarjian, Robert A. Wolff, Charles A Koller Hurst's The Heart, 13e Valentin Fuster, Richard A. Walsh, Robert A. Harrington Harrison's Online Featuring the complete contents of Harrison's Principles of Internal Medicine, 18e
- 30. REFERENCES CURRENT Diagnosis& Treatment: Psychiatry, 2e Michael H. Ebert, Peter T. Loosen, Barry Nurcombe, James F. Leckman Principles and Practice of Hospital Medicine Sylvia C. McKean, John J. Ross, Daniel D. Dressler, Daniel J. Brotman, Jeffrey S. Ginsberg Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e Laurence L. Brunton, Bruce A. Chabner, Björn C. Knollmann CURRENT Medical Diagnosis & Treatment 2013 Maxine A. Papadakis, Stephen J. McPhee, Eds. Michael W. Rabow, Associate Ed.
- 31. REFERENCES http://www.who.int/tobacco/research/youth/he alth_effects/en/index.html http://www.cdc.gov/tobacco/data_statistics/fac t_sheets/health_effects/effects_cig_smoking/ http://www.cancer.gov/cancertopics/factsheet/ Tobacco/cessation http://www.nhs.uk/chq/pages/2344.aspx? categoryid=53&subcategoryid=536