Smoking

Why Drink and Drive?? When you

can Smoke n Fly Dont hate Smoker
every cigarette might be their last
Behind the scene
 Bangladesh Fact sheet

Every year more than 92,100 people in

Bangladesh are killed by tobacco-caused
disease
More than 164,000 children and more than 25
million adults continue to use tobacco each
 Global scenario
About 5.8 trillion (5,800,000,000,000) cigarettes were smoked
worldwide in 2014, cigarette consumption is still on the rise.
The WHO Eastern Mediterranean Region (EMRO) now has the
highest growth rate in the cigarette market, with more than a
one-third increase in cigarette consumption since 2000.
Patterns of cigarette consumption vary widely within
countries. Cigarette consumption displays large disparities
and is associated with lower socioeconomic status, even in
low- and middle-income countries.
China and Eastern and Southern Europe consume the most
cigarettes per person. This is not only because of the high
smoking prevalence but also high smoking intensity the
large number of cigarettes smoked by average smoker per
day.
Presentation on Epidemiology

Determinants of smoking
behavior and cessation
strategy
Presentation Prepared for:

Dr. Shafiqul Islam

Professor
Dept. of Public Health
State University of Bangladesh
 Introduction
Tobacco use is the leading cause of
preventable deaths in the world.
Affect both users and those exposed to
tobacco smoke.
Currently around 6 million tobacco users and
600,000 nonusers die each year due to
tobacco use and exposure to second-hand
smoke.
170,000 of the victims were children.
Around one billion smokers worldwide, with
1. World Health Organization, Tobacco. Fact Sheet No. 339
80% of them living in low and middle income
Updated July 2015.
2. countries [1,2].
M. Oberg et.al. Worldwide burden of disease from
exposure to second-hand smoke: a retrospective analysis of
 Scenario
1980* 2012* 2015**

Men 41.2% 31.1% 25.0%

If present patterns of use persist,
Wome
tobacco10.6%
use could 6.2%
cause as 5.4%
many
n as 1 billion premature deaths
globally during the 21st
Daily Tobacco use century*
*http://jamanetwork.com/pdfaccess.ashx?url=/data/journals/jama/929635/
on 04/03/2017
**http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30819-X.pdf
 Determinants of
smoking behaviour
 Smoking ??
Cigarettesmokingrefers to
activesmokingof manufactured or
hand rolled tobacco cigarettes, from
purchased or home grown tobacco

The termsmokingrefers to activesmoking

behaviour, that is, the intentional inhalation
of tobaccosmoke
 Determinants
Include factors that influence health:
biological, chemical, physical, social,
cultural, economic, genetic and behavioural.
Tobacco industrymarketing; easy access
totobaccoproducts; low prices;peer
pressure;tobacco useand approval of use by
peers, parents and siblings; and the
misperceptionthat smoking enhances
socialpopularityare among the factors that
increasesmoking initiationamong boys and
girls.

Shafey O, Eriksen M, Ross H, Mackay J. The Tobacco Atlas. American

 Cont
Among men, tobacco use significantly associated
with increased age
Lower education is associated for both male and
female
Significant inverse relationship between tobacco
use and wealth index
Burden of tobacco use is greatest in high income
countries (18% of deaths are attributable to
tobacco use)*
Weak enforcement in prohibition of tobacco
advertisements, promotion and sponsorship;
*Tobacco use in 3 billion individuals from 16 countries: an
exposure of children, youth and adults to tobacco
analysis of nationally representative cross-sectional household
advertisements
surveys (Lancet) through all forms of media**
** COUNTRY PROFILES WHO Framework Convention on Tobacco
Control in WHO South-East Asia Region
 Cont
Hand-rolled bidi low price which manufacture by
small local companies and as a cottage industry
Impose lower taxes on tobacco products
Relative deprivation and societal deprivations are
strongly associated
Tobacco is cultivated in many countries of the
region
Smokers are much more likely to be alcohol
drinkers and that drinkers are much more likely
to be smokers***

What Are the Major Determinants in the Success of Smoking

Cessation: Results from the Health Examinees Study
 Family Smoking
Family smoking and role models are
significant factors in influencing young
children to smoke.
Children often see smoking as grown-
up behavior, which further encourages
them to smoke.
Children from families where smoking
is prevalent tend to develop the habit
and are less likely to quit later in life.
http://www.livestrong.com/article/96478-causes-smoking-
among-teens/
 Peer pressure
A significant factor for many people who
start to smoke.

Economic status, educational level and

family history are significant factors that
determine the level of peer pressure
and the consequences of such
pressures.
 Advertising and Media
As with any other type of advertising,
advertising by tobacco companies
hopes to influence people to smoke.
Although the ways in which tobacco
companies can reach the public have
been curtailed by legislation, the
effects can still be seen by marketing
campaigns using cartoon characters,
giveaways and free samples.
 Social factors
Relatively low socioeconomic status
Relatively high accessibility and availability of
tobacco products
Perceptions by adolescents that tobacco use is
normative, usual or acceptable behavior
Use of tobacco by significant others and approval
of tobacco use among those persons,
Lack of parental support
Low levels of academic achievement and school
involvement
Lack of skills required to resist influences to use
tobacco
Belief that tobacco use is functional or serves a
purpose etc.
https://www.ncbi.nlm.nih.gov/books/
Social influences are the most important
NBK99236/
 Psychological factors
Relatively low self-efficacy for refusal
Relatively low self-image
The number of smoking parents
The number of friends trying smoking
Family conflict
Refusal of affair/ job etc.
Alcohol use
Smokers are more likely to suffer from depression,
anxiety disorders, substance abuse, conduct
disorder, and schizophrenia.
Approximately 23 percent of the United States
population smoke regularly, whereas as many as 90
percent of schizophrenics are heavy smokers.
Psychology and Smoking Behavior Tobacco in History and
Culture: An Encyclopedia
 Cultural factors
Culture have an important influence on
adolescents' beliefs, values, and smoking
prevalence patterns.
The initiation of smoking in western societies
usually occurs during adolescence, and the
patterns of adolescent smoking are strongly
associated with cultural dimensions
These cultural values shape how adolescents think
and feel, their conceptualisations relating to
smoking, their decisions to experiment with
tobacco, and their attitudes towards tobacco.
Afro-American teens reported later onset of daily
smoking compared with non-Afro-American youth-
ethnic
Cultural differences
Factors inSmoking
Affecting meanings and beliefs
Intentions in Sri Lankan
Immigrant Adolescents:
concerning smoking An and
Exploratory Study
tobacco-related cultural
Socio-Economic Differences
Low socioeconomic status is associated with high rates of
cigarette smoking
These socioeconomic differences tend to emerge during
young adulthood

Young adults who have not attended or are not enrolled in

college smoke at twice the rate (30%) of their college-
educated counterparts (14%).

Food insecurity or the lack of physical and economic access to

adequate and appropriate foods contributes to smoking-
higher smoking prevalence among members of low-income
families with past-year food insecurity (44%) than their food-
secure counterparts (32%)

https://www.cdc.gov/pcd/issues/2016/pdf/
15_0458.pdf
Cessation
 Cessation
Raising cigarette price through
increased taxation can lead to a
win-win-win situation in
Bangladeshit will reduce
cigarette consumption, increase
tobacco tax revenue and
potentially decrease socio-
Bangladesh: economic
Evidence from theinequities.
The Price Sensitivity of Cigarette Consumption in
International Tobacco
Control (ITC) Bangladesh Wave 1 (2009) and Wave 2 (2010)
Surveys https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090419/
 Tobacco Cessation
Tobacco cessation(quitting smoking) is the process of
discontinuing tobacco smoking. Tobacco contains
nicotine which makes the process of quitting often very
prolonged and difficult.
Quitting smoking significantly reduces the risk of dying
from tobacco-related diseases such as heart disease and
lung cancer.
Seventy percent of smokers would like to quit smoking,
and 50 percent report attempting to quit within the past
year.
Many different strategies can be used for smoking
cessation, including quitting without assistance
medications such as nicotine replacement therapy,
cytisine or varenicline, and behavioral counseling.
The majority of smokers who try to quit do so without
assistance, though only 3% to 6% of quit attempts
without assistance are successful.
 The role of health professionals
Health professionals play an important role in educating and
motivating smokers as well as assessing their dependence on
nicotine and providing assistance to quit.
All health professionals should systematically identify
smokers, assess their smoking status and offer them advice
and cessation treatment at every opportunity.
Brief interventions for smoking cessation involve
opportunistic advice, encouragement and referral.
Interventions should include one or more of the following:
brief advice to stop smoking
an assessment of the smokers interest in quitting
an offer of pharmacotherapy where appropriate
providing self-help material
offering counseling within the practice or referral to
external support such as Quilting an accredited tobacco
treatment specialist or other local programs in your area.
 Nicotine Replacement Therapy
Nicotine has both stimulant and depressant actions.
Research showed using Nicotine Replacement Therapy
(NRT) can reduce number of cigarettes smoked and cut
down the amount of dangerous inhaled smoke which
contains harmful Polycyclic aromatic hydrocarbons
(PAHs) responsible for most of harmful health effects.
Patients should be counseled to stop smoking
completely prior to initiating NRT to avoid the potential
risk of nicotine overdose.
Using two forms of nicotine replace (e.g. patch plus
resin) results in higher quit rates and should be
recommended if other forms of nicotine replacement
are not effective alone.
Use of NRT is recommended for a minimum of 6-8
weeks.
Quit rates with use of NRT range between 20% and
 Behavioral and Advice Based support for tobacco
cessation
Smoking reduction rather than smoking cessation
Some smokers are unable or unwilling to completely quit smoking. It has been
proposed that reducing the number of cigarettes smoked per day has long-term
benefits.

However, it is not clear whether this strategy decreases the risk for tobacco-related
diseases.

Research has shown that smoking reduction by 50% modestly reduces the risk of lung
cancer in heavy smokers (15 or more cigarettes each day). There is insufficient
evidence about long-term benefit to support the use of interventions intended to help
smokers reduce, but not quit, smoking.

Some people who do not wish to quit can be helped to cut down the number of
cigarettes smoked by using nicotine gum or nicotine inhaler.

Because the long-term health benefit of a reduction in smoking rate is unclear, this
use of NRT is more appropriate before quitting.

Smokers who use NRT for smoking reduction are approximately twice as likely to
progress to quitting than those who do not.
 Relapse
For any individual attempt to quit , failure to quit is more likely than
successful cessation.
Most smokers make repeated quit attempts before finally achieving
long-term abstinence.
Relapse in the first weeks of a quit attempt is common.
Relapse is associated with the severity of withdrawal symptoms and
other factors, such as stress and weight gain, may be more important.
There is no intervention that is proven to prevent relapse, but advice
and pharmacotherapy are recommended to treat symptoms of
withdrawal, stress and weight gain.
Thank You