Tobacco and Nicotine Quiz

Tobacco Types

• Two main types: combustible (smoking) and smokeless (spit)
• Combustible types include: cigarettes, cigars, pipes, bidis, kreteks, hookah
• Cigarettes are the most common smoking tobacco.
• Hookah is a water pipe used for smoking tobacco, often thought of as safer but has health risks associated with longer use, and sharing.

Combustible Tobacco

• Cigarettes are the most common form.
• Cigars also exist.
• Pipe tobacco is another option.
• Bidis and Kreteks are other forms with higher concentrations of nicotine, tar, and carbon monoxide than conventional US cigarettes. The FDA banned the manufacturing and sale of bidis and kreteks in the U.S.

Smokeless Tobacco

• Plugs, wads, twist, loose leaf
• Snuff (dry or moist)
• Snus (comes in small cylinder cans, heat and clean)
• Smokeless tobacco does not produce smoke, but generates saliva, which can be a trigger of health issues

Electronic Nicotine Delivery Systems (ENDS)

• E-cigarettes, vape pens, e-cigs
• Have evolved significantly in recent years.
• Disposable varieties are more commonly used.
• Improper disposal of batteries and chemical products is a danger to the environment.
• Heat not Burn tobacco types like IQOS and Eclipse exist.

What's Burning?

• Cigarette smoke contains over 7000 chemicals and gasses.
• Components include tar, carbon monoxide, hydrogen cyanide, heavy metals (lead, arsenic), formaldehyde, acetone, and pesticides.

Nicotine Addiction

• Nicotine addiction is a complex process involving psychological and social factors.
• The "chain of nicotine reaction" involves 3 factors: Psychological dependence, nicotine addiction, and socioeconomic factors.
• The brain absorbs nicotine rapidly, impacting the brain within 8 seconds, and stimulating the release of dopamine.
• Nicotine alters the brain by upregulating nicotine receptors, leading to cravings.
• Withdrawal symptoms may include anger, anxiety, cravings, depression, difficulty concentrating, fatigue, and nausea.
• Nicotine receptors in brain cells of smokers are different from those in nonsmokers.

Oral Nicotine Products

• Synthetic nicotine, a non-tobacco product that contains nicotine, is addictive.
• The nicotine levels vary in different brands, however most are addictive.
• The products contain carcinogens, including ammonia, chromium, formaldehyde, nickel, and nicotine salt.
• Long-term use is associated with increased risks of heart disease, vascular disease, and other health problems.

Cardiovascular and Respiratory Effects

• Smoking can cause coronary heart disease and stroke, peripheral vascular disease and abdominal aortic aneurysm.
• Smoking can lead to lung cancer and respiratory conditions such as emphysema and chronic bronchitis.

Smoking & Cancer

• Smoking is linked to numerous types of cancer, affecting different parts of the body.

Endocrine and Gastrointestinal Systems

• Smoking is a risk factor for type 2 diabetes mellitus.
• Smoking worsens other complications of diabetes including cardiovascular and other diseases.
• Smoking can affect thyroid function, pituitary and adrenal gland hormones, and parathyroid hormone.
• GI diseases such as ulcers and Crohn's disease are also risk factors.

Smoking Effects: Skin & Hair

• Poor wound healing, premature wrinkling, smoker's face, brittle/dry hair, hair loss, benign skin lesions, and cancerous skin lesions are possible consequences of smoking

Women & Tobacco

• Women find quitting more difficult than men.
• Postmenopausal women who smoke have lower bone density.
• Women smokers have an increased cancer risk compared to men smokers.
• Smoking affects fertility (including miscarriage, premature, and low birth weight babies).
• Smoking increases the risk of nicotine addiction in children, and risk of cleft lip/palate, and sudden infant death syndrome (SIDS).

Health effects of Vaping

• Evidence on vaping devices is limited.
• Nicotine in e-cigarettes can cause poisoning and addiction in non-smokers.
• Malfunctioning devices can cause oral injury, and lung injury.
• Reduced exposure to toxins compared to traditional smoking products may be one positive.
• Cellular cytotoxic effects are a potential concern.

Smokeless: Not Harmless

• Smoking affects the heart, damage to DNA and key enzymes.
• Smoking can lead to damage to oral health.

Adverse Oral Health Effects

• Stained teeth, reduced taste/smell, halitosis, hairy tongue, Smoker's Melanosis, Nicotine Stomatitis, Candidiasis, Leukoplakia, Carcinomas, Periodontal disease or dental cares are oral health effects from smoking.
• Increased surgical risks, poor wound healing, increased risk of implant failure are potential risks due to smoking

Environmental Tobacco Smoke (ETS)

• Secondhand smoke is the smoke exhaled by smokers
• Mainstream smoke is what is directly produced by burning tobacco.
• Sidestream smoke is what is directly emitted during burning of tobacco products.
• Thirdhand smoke refers to the cigarette by-products found on surfaces even after the smoke is gone

Clinical Practice Guideline: Treating Tobacco Use and Dependence

• Pharmacotherapy – includes medication for smoking cessation. Many medications can double quitting rates compared to a placebo. Some examples include Bupropin and Varenicline.
• Practical counseling – in-person, group, and phone counseling can help patients to quit.
• Motivational interviewing (MI) – Effective motivational approaches can be effective in helping support the unwiling to quit.
• Medication combined with counseling – Most effective treatment option.

Quitting Success

• Help from a clinician practically doubles quit opportunities from 5+ months compared with no clinician support.
• Clinicians are obligated to address tobacco use and help in establishing quit plans.
• Quitting is a decision for the individual.

Pharmacotherapy

• All FDA-approved therapies increase long-term smoking cessation
• Nicotine Replacement Therapy (NRT) including patches, gum, lozenges, inhalers, and nasal sprays are first-line therapies

Nicotine Replacement Therapy (NRT)

• Products aid in reducing nicotine withdrawal symptoms, including those affected by quitting.

Common Elements of Practical Counseling

• Provide basic information on addiction, withdrawal symptoms, relationship of lapse to relapse, and coping mechanisms.
• Help clients recognize triggers and develop coping skills to prevent lapses during their quitting journey.
• Help clients to anticipate and avoid triggers that may cause a relapse

Guideline Recommendations

• Tobacco use is considered a chronic disease.
• Clinicians should document tobacco use by patients.
• Treatment should be effective and cost-effective, advising all users to QUIT.
• Brief intervention, medications (7 first-line drugs), individual, group, and phone counseling are effective.
• Combination approaches work even better than individual approaches and/or brief intervention

Tapering (Cut Down to Quit)

• Tapering is gradually reducing cigarettes, rather than quitting immediately.
• Cold turkey (immediate cessation) vs. tapering.
• Ways to taper include reducing the # cigarettes smoked, and lengthening the space/time between cigarettes smoked.

ENDS/Vaping Devices

• Recommend evidence-based cessation aids for patients interested in quitting.
• Include behavioral counseling and pharmacotherapy.
• Support the attempt to quit e-cigs and vaping, while encouraging quitting all traditional tobacco.
• Emphasize the lack of evidence for safety and efficacy of e-cigarettes and vaping.
• Urge a quit date for vaping

Great American Smoke Out

• Public health campaign encouraging people to quit smoking.