Tobacco Use: Destructive Behavior - UDST Lecture - 27 November 2024 PDF

20/11/2024 Tobacco Control & Prevention in Qatar Ms. Noor El Nakib, MPH Healthcare Services Administrator University of Doha for Science and Technology 27 November 2024 1...

20/11/2024 Tobacco Control & Prevention in Qatar Ms. Noor El Nakib, MPH Healthcare Services Administrator University of Doha for Science and Technology 27 November 2024 1 Outline ✓ HMC Tobacco Control Center - WHO CC ✓ Global and National Tobacco Use Epidemics ✓ Types of Tobacco and Nicotine Products ✓ Tobacco Addiction ✓ Harmful Health Effects of Tobacco ✓ Cost on the Environment ✓ Second-Hand Smoking ✓ Benefits of Quitting Smoking ✓ Road Map to Quit ✓ Treatment 2 2 1  20/11/2024 Did you know that there is a Tobacco Control Center that helps and supports people to quit smoking in Qatar? 3 3 HMC Tobacco Control Center’s 2021 Journey Re-designation as WHO Collaborating Center 4 4 2  20/11/2024 TCC Main Pillars Cessation ~ 14,000 patients/year Quitting rate: 35% Clinics Outreach & Research Training Activities Activities WHO Collaboration (The Center was re-designated as a WHO Collaborating Center until August 2025) 5 5 Self-Destructive Behaviors Behaviors that are bound to harm us physically or mentally. This may be UNintentionally OR we know EXACTLY what we are doing - but the urge is too strong to control. Some of those self-destructive behaviors warrant preventive action: such as tobacco use. 6 6 3  20/11/2024 "I smoke because I'm self- destructive!" 7 7 Tobacco Epidemic Worldwide Statistic There are still 1.25 billion people who use 1 tobacco; 80% of those live in low- and middle- income countries Tobacco kills more than 8 million people 2 per year ✓ 7 million of overall deaths are the result of direct tobacco use 3 ✓ 1.2 million are non-smokers who were exposed to second-hand smoke Over 60% of the world’s 1.25 billion 4 adult tobacco users want to quit. Around 70% of world’s tobacco users have no access 5 to comprehensive tobacco cessation 8 8 services 8 4  20/11/2024 Tobacco: A Global Killer The number of people who die from smoking is more than who die from AIDs, car accidents, drug use and suicide altogether 9 9 Although global smoking prevalence has declined (from 22.7% in 2007 to 19.6% in 2019), the total number of smokers remains high due to population growth. 7th Edition 1 0 10 5  20/11/2024 7th Edition 1 1 11 Surveillance of e-cigarettes use among adult population ranges between 0.2 – 10.5 %. Surveillance of e-cigarettes use among youth population ranges between 0.7 – 29.9 %. It is worthy to mention that the surveillance of e-cigarette use among both populations need improvement in most countries. 1 7th Edition 2 12 6  20/11/2024 13 Ref.: Reitsma MB, et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990–2019. Lancet Public Health 2021 13 Prevalence of Tobacco Use in Qatar Population Author, Year Total (%) Men (%) Women (%) Al-Mulla, A. M. , & Bener, A. 36.5 42.1 6.9 Adults >=15 years old (2003). Adults >=18 years old Al-Mulla, A., Mamtani, R., et al. 25.2 36.6 9.2 (2021) Al-Mulla, et al (2008) 16.6 21.1 12.7 Youth 13-15 years old GYTS WHO (2013) 15.7 22.8 8.8 GYTS WHO (2018) 12.1 15.7 8.7 14 14 7  20/11/2024 Magnitude of the Problem in Qatar Prevalence of tobacco use among adult population: 25.2 % % of Tobacco Use by Nationality Qatari 20.6 Non-Qatari 29.3 % of Tobacco Use by Gender Males 36.6 Females 9.2 Source: Al-Mulla, A., Mamtani, R., et al. (2021) 1 5 15 Magnitude of the Problem in Qatar (cnt’d) Percentage of types of current tobacco use Tobacco Product Usage Percentage (%) Cigarette 42.8 Shisha 20.9 Medwakh 3.2 Electronic cigarette 2 Chewable tobacco 1.9 (sweika, tanbak) Heated tobacco 0.3 Source: Al-Mulla, A., Mamtani, R., et al. (2021) 1 6 16 8  20/11/2024 Tobacco Addiction A plant dried and prepared for Tobacco smoking or chewing 70 cancerous chemicals Toxic liquid Highly addictive Nicotine Decreases metabolic activity Leads to harder time to focus Leads to impairments in memory Is an urge to do something that is hard to control or stop. Addiction A primary, treatable, chronic disease involving brain reward, motivation, memory and related circuitry. 60% of smokers wish they could quit 17 17 Tobacco Products in Qatar Novel Nicotine or Tobacco Products Illegal in Qatar; for personal use only ▪ Electronic Nicotine and Non- nicotine Delivery Systems (such as E-Cigarettes and E- These products Hookah) are marketed as safe and of “reduced harm” ▪ Heat Not Burn Tobacco that can help (such as IQOS) people quit conventional tobacco use. ▪ Nicotine Pouches (such as Lyft and Fox) 1 18 8 NO SAFE TOBACCO or NICOTINE Product 18 9  20/11/2024 Law # 10 of 2016 on the control of Tobacco and its Derivatives Article 7: Importing, circulating, displaying, selling, distributing or manufacturing ✓ Chewing tobacco (in any form and under any name) ✓ Electronic cigarette, shisha or simulators of smoking tools ✓ Sweika, in any form or under any name shall be prohibited. 19 19 Electronic Cigarettes Do not contain tobacco but in most cases contain nicotine. They are harmful to your health and are not safe. Are electronic battery-powered devices that vaporize liquid nicotine or “juice” – Nicotine in e-cigs is very addictive, just like cigarettes – The liquid has dangerous, cancer-causing chemicals also found in cigarettes An aerosol is created from the addictive liquid They come in many shapes, sizes and colors. They were originally designed to resemble combustible cigarettes, but EC technology has rapidly evolved. 20 20 10  20/11/2024 Electronic Cigarettes (cnt’d) The nicotine content of ENDS can range from 0 to › 66 mg/ml or more (at least twice the nicotine content of a standard cigarette) (Source: WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC 2021) They can cause many problems, including: ✓ Lung damage, making it harder to breathe ✓ Nicotine addiction ✓ Unintended injuries (fires and explosions; poisoning – toxic nicotine exposure) Young people who use e-cigarettes may be more likely to smoke cigarettes in the future 21 21 Electronic Cigarettes (cnt’d) What is in an E-cigarette’s Aerosol? 22 22 11  20/11/2024 Electronic Cigarettes (cnt’d) What are the negative effects of E-cigarettes? Lung Diseases Nicotine Addiction Harmful Substances Harm brain Liquid nicotine Unintended injuries development poisoning 23 23 Heated Tobacco Products (HTP)s HTPs are not e-cigarettes. HTPs heat tobacco to generate nicotine. E-cigarettes heat e-liquid, which may or may not contain nicotine. The use of any tobacco product— including heated tobacco products—is expose users to toxic emissions harmful heat actual tobacco leaf HTPs are tobacco products that produce aerosols containing nicotine and other chemicals, which are inhaled by users, through the mouth. They also contain non-tobacco additives and are often flavored. 24 24 12  20/11/2024 Novel Nicotine Products: FOX or LYFT – Nicotine Pouches Moist and smokeless tobacco-free products packed in pouches (like a small teabag) that contain nicotine with added flavourings. They may contain cancer-causing chemicals and several other chemicals such as: ammonia, chromium, formaldehyde, nickel, pH adjusters, and nicotine salt. It is placed between the gum and the upper lip Nicotine in the products is absorbed through the tissues of the mouth Marketed as being of reduced harm compared to other tobacco products (Misconception) Research on these new products should be studied more. What we know so far is that: these products contain nicotine that harms your health. 25 25 Tobacco Products in Qatar Traditional Tobacco Products Novel Nicotine or Tobacco Products Illegal in Qatar; for personal use only ▪ Cigarettes ▪ Electronic Nicotine and Non-nicotine ▪ Shisha Delivery Systems (such as E-Cigarettes and E- Hookah) ▪ Cigar ▪ Sabeel, Medwakh ▪ Heat Not Burn Tobacco (such as IQOS) ▪ Smokeless tobacco (Sweika, Sohatt, Ban) ▪ Nicotine Pouches (such as Lyft and Fox) 2 26 6 NO SAFE TOBACCO or NICOTINE Product 26 13  20/11/2024 Chemical Constituents of Cigarettes Tobacco is inherently toxic and contains carcinogens even in its natural form. ⚫ At least 250 of which are known to be harmful ⚫ At least 70 of which are known to cause cancer Nicotine is a culturally and socially acceptable dangerous, addictive drug. 27 27 Water-Pipe (Shisha) Tobacco in shisha contains a higher percentage of nicotine compared to cigarettes Amount of nicotine in one tip of unflavored shisha tobacco is approx. equal to 70 cigarettes Short-term health effects: increased heart rate and blood pressure, decreased lung function, and CO poisoning The long-term health effects: poor lung function, Chronic Obstructive Pulmonary Disease (COPD) and esophageal and stomach cancer Increased risk of infectious diseases spread due to shisha sharing even if the mouthpiece was changed Misconception: "Smoking a water-pipe is less harmful than a cigarette” 2 8 28 14  20/11/2024 Toxin Comparison Content between of Smoke smoking a single Shisha session vs. a single cigarette 29 29 Medwakh Dukha is a mixture of tobacco leaves with herbs, spices and dried flowers or dried fruits that are smoked in a pipe called "medwakh“ Amount of nicotine can reach more than 5 times of that of a cigarette Leads to the entry of a large amount of nicotine into the body within a short period of time causing danger to the brain, heart and blood vessels Health consequences*: Significant acute effect on systolic blood pressure, heart rate and respiratory rate *Shaikh RB, et al. Acute effects of dokha smoking on the cardiovascular and respiratory systems among UAE male university students. Asian Pac J Cancer Prev. 2012;13(5):1819-22. doi: 3 10.7314/apjcp.2012.13.5.1819. PMID: 22901128. 0 30 15  20/11/2024 Smokeless Tobacco Type of tobacco products that does not require to be heated or burnt (non-combustible form). Chewing tobacco is placed between the inner lip and gum. Health Effects of Smokeless Tobacco: ✓ Nicotine addiction (similar to cigarettes) ✓ Increased risk of infections in the mouth such as weakness in the teeth cavities, gum bleeding, etc.. ✓ Increase risk of cancer of the mouth, gum, tongue or lips 3 1 31 Harmful Effects of Tobacco Use 32 Around 25% of all heart disease deaths & 90% of lung cancer deaths are directly attributed to smoking 32 16  20/11/2024 Health Effects of Smoking (cnt’d) Main Toxic Elements Nicotine Carbon Monoxide Tar Atherosclerosis, coronary Inhibit function of RBCs Chronic Obstructive heart disease Pulmonary Disease Physical Addition Insufficient Oxygen Supply Cancer Increase blood Poor Heart Attack Stroke Bronchitis pressure performance 33 33 World No Tobacco Day 2022 Tobacco: Threat to Our Environment 3 4 34 17  20/11/2024 35 35 The industry’s carbon footprint from production, processing and transporting tobacco is equivalent to one- fifth of the CO2 produced by the commercial airline industry each year, further contributing to global warming. (Source: WHO) 36 36 18  20/11/2024 37 37 Second-Hand Smoking Toxins in SHS Definition include Health impacts Pregnant women Cardiovascular When pregnant Also known as Ammonia disease women are exposed Passive smoking, is Arsenic Lung problems to smoke they the accidental Benzene (COPD) transmit the inhalation of smoke, Carbon monoxide Increased risk of lung poisonous chemicals called second-hand Formaldehyde cancer to the fetus which smoke or Frequent coughing leads to SIDS – Hydrogen cyanide environmental sudden infant death Lead and Shortness of tobacco smoke, by syndrome Chromium VI breath individuals other than the intended Ear infections "active" smoker Frequent asthma attacks Eye irritation There is no risk-free level of secondhand smoke exposure; even brief exposure can be harmful to health 38 38 19  20/11/2024 Second-Hand Smoking (cont’d) 3 Source: WHO Report on the Global Tobacco Epidemic 2008. 9 39 Second-Hand Smoking (cont’d) 4 0 40 20  20/11/2024 Third-Hand Smoking Thirdhand smoke is made up of the pollutants that settle indoors when tobacco is smoked (becomes embedded in most soft surfaces such as clothing, furniture, drapes, bedding and carpets). Chemicals in thirdhand smoke include nicotine and cancer- causing substances (such as formaldehyde, naphthalene and others) Infants and young children are at greater risk for exposure to thirdhand smoke due to activities such as crawling and putting non-food items in their mouths. 4 1 41 Immediate Benefits of Quitting Smoking Heart rate and blood pressure will drop within 20 mins. Carbon monoxide level will drop, and oxygen levels will increase within 12 hours. Food tastes better. Your breath, clothes and hair won’t smell like smoke. Overall energy improves. You are saving money. You are now more in control of your life and actions now that you are no longer addicted to a tobacco product. 4 2 42 21  20/11/2024 Health Benefits of Quitting Smoking 43 43 Stages of Change Research has shown that individuals will go through predictable stages of change when they attempt to break a self-destructive behavior pattern — such as heavy alcohol or drug use, cigarette smoking or binge eating The stages of change are: precontemplation, contemplation, preparation, action, maintenance and relapse. 4 4 44 22  20/11/2024 Stages of Change (cnt’d) 4 5 45 46 46 23  20/11/2024 Tools for Motivating Tobacco Users ⚫ Visual motivational tools: – Carbon Monoxide Monitor – Pulmonary Function Testing (Spirometry) – "Lung Age" Indicator 47 47 Treatment Methods at TCC Health Education and Psychological Counseling Counseling and behavior modification play an important role in a quitter’s journey. Using Medication As much as counseling is important, medication is as essential and using them together can more than double the chances of quitting. Nicotine Replacement Therapy (NRT) NRT gives you nicotine (in the form of lozenges, patches, sprays, inhalers, or gum) but not the other harmful chemicals in tobacco. Laser Treatment Therapy A painless innovative technique, based on stimulation of specific points in the body to release endorphins, used to help tobacco users quit. 48 48 24  20/11/2024 Referral System For further information: Self 4025 4857 - 5080 0959 Referral For booking an appointment: 4025 4981 - 16060 Healthcare Hamad Medical Corporation providers Primary Healthcare Centers referral Others (private, MOI clinic, MOD clinic) 49 49 Locations of Tobacco Cessation Clinics at HMC Expansion of service provision was implemented to ensure its availability and accessibility to all citizens and residents across the state of Qatar. Free and accessible tobacco cessation services are being provided based on global evidence-based guidelines and protocols across all clinics under TCC. The clinics are located at: Current: ❖ Tobacco Control Center ❖ Hamad General Hospital ❖ Al Wakra Hospital ❖ Hazm Mebaireek General Hospital ❖ Al Khor Hospital 50 50 25  20/11/2024 It’s never TOO LATE to quit smoking or any type of tobacco product We are here to help! For further information: 4025 4857 5080 0959 For booking an appointment: 4025 4981 16060 Hamad Bin Khalifa Medical City Building 311, 3rd floor 51 Tobacco Related Questions 5 2 52 26  20/11/2024 1- Addiction to nicotine is the same as addiction to cocaine or heroin. a) True b) False 5 3 53 2- The prevalence of tobacco use among the adult population in Qatar is: a- 10 % b- 15 % c- 25 % d- 30 % 5 4 54 27  20/11/2024 3- Other healthy habits, such as proper nutrition and lots of exercise, may make up for smoking. a) True b) False 5 5 55 4- Shisha smoking is less harmful than smoking cigarettes. a) True b) False 5 6 56 28  20/11/2024 5- Tobacco chewing results in: a) Mouth cancer b) Lung cancer c) Bone cancer d) Leukemia 5 7 57 6- Addiction of Tobacco is due to a) Histamine b) Nicotine c) Tar d) Carbon Monoxide 5 8 58 29  20/11/2024 7- Number of annual global deaths due to tobacco is: a) 10 million b) More than 8 million c) Less than 7 million d) 1.3 million 5 9 59 8- Toxic component of tobacco smoke that impairs O2 transport is: a) Nicotine b) Benzopyrene c) Tar d) Carbon monoxide 6 0 60 30  20/11/2024 9- E-juice contains: a) Propylene glycol + flavoring + water b) Tobacco + flavoring + nicotine c) Propylene glycol + flavoring + nicotine d) Corn syrup + flavoring + water 6 1 61 10- What are the negative health effects of e-cigarettes? a) The long-term health effects of e- cigarettes are not yet known. b) Tooth decay c) Eye and throat irritation d) Answers a & c 6 2 62 31  20/11/2024 11- When people try e-cigarettes to quit smoking, they often: a) Quit smoking b) Switch completely from cigarettes to e- cigarettes c) Use both e-cigarettes and cigarettes d) Switch to nicotine replacement therapy 6 3 63 12- Vaping or using any type of the novel nicotine or tobacco products is one of the approved methods of quitting. a) True b) False 6 4 64 32  20/11/2024 13- Which has less nicotine than cigarettes? a- Tobacco dip b- Snuff c- Both d- Neither 6 5 65 14- The safest tobacco/ nicotine product is: a- Traditional cigarette b- Electronic cigarette c- Shisha d- Heat No Burn Products e- There is no safe tobacco/nicotine product. 6 6 66 33  20/11/2024 15- What is approximately the percentage of attempts to quit smoking without assistance that are successful? a- 1%–10% b- 30%–40% c- 50% d- More than 50% 6 7 67 Tobacco Cessation Resources Source Name Description Link Ministry of Public Access to the full national clinical https://www.moph.gov.qa/english Health – Qatar guidelines for the management of /OurServices/eservices/Pages/Clin tobacco dependency. ical-Guidelines.aspx#T American Lung Useful information on cancer, https://www.lung.org/ Association tobacco, and tobacco-related health issues. American Cancer Useful information on cancer, https://www.cancer.org/cancer/ca Society tobacco, and tobacco-related health ncer-causes/tobacco-and- issues. cancer.html CDC The Centers for Disease Control and https://www.cdc.gov/tobacco/ Prevention provide useful information on smoking and tobacco use. SmokeFree A National Cancer Institute website https://smokefree.gov/ dedicated to help smokers quit. World Health The World Health Organization https://www.who.int/health- Organization provide updated information on topics/tobacco#tab=tab_1 6 tobacco use and its prevention and 8 control. 68 34  20/11/2024 Thank you! 69 35