Description

• Tobacco use is the leading cause of preventable morbidity and mortality worldwide:
  • 443,000 deaths annually in the US
  • 4.2 million premature deaths/year worldwide
  • Major risk factor for:
    • Atherosclerotic cardiovascular disease
    • Lung cancer
    • Chronic obstructive pulmonary disease (COPD)
• Nicotine is highly addictive.
• Smoking damages nearly every organ in the human body.
• 2nd-hand exposure to cigarette smoke is associated with a 20% greater risk of lung cancer and coronary heart disease.
• Quitting smoking has both immediate and long-term health benefits.

Epidemiology

• 2.4 million new smokers annually in the US (2.6% initiation rate)
• 58.8% of new smokers are <18 years of age (5.8% initiation rate for teens).

• 69.6 million Americans (27.4%) currently use tobacco (2010 data).
• Highest among those aged 18–25 (40.8%)
• Race: Highest among American Indians/Alaskan Natives (35.8%), lowest among Asians (12.5%)
• Gender: Male > Female (33.7 vs. 21.5%)
• Inversely proportional to education level

Risk Factors

• Presence of a smoker in the household
• Easy access to cigarettes
• Perceived parental approval of smoking
• Comorbid stress and psychiatric disorders
• Low self-esteem and self-worth
• Poor academic performance
• Boys: High levels of aggression and rebelliousness
• Girls: Preoccupation with weight and body image

General Prevention

• Most 1st-time tobacco use occurs before high school graduation, so educational interventions should target students in grade school and middle school and must address both the health consequences and psychosocial aspects of smoking (1)[A].
• The American Academy of Family Physicians’ Tar Wars program has targeted 4th and 5th graders successfully.
• Other helpful measures include:
  • Smoking bans in public areas and workplaces
  • Restriction of minors’ access to tobacco
  • Restrictions on tobacco advertisements
  • Raising prices through taxation
  • Media literacy education
  • Tobacco-free sports initiatives

Pathophysiology

• Addiction due to nicotine’s rapid stimulation of the brain’s dopamine system (teenage brain especially susceptible)
• Atherosclerotic risk due to adrenergic stimulation, endothelial damage, carbon monoxide, and adverse effects on lipids
• Direct airway damage from cigarette tar
• Carcinogens in all tobacco products

Commonly Associated Conditions

• Coronary artery disease
• Cerebrovascular disease
• Peripheral vascular disease
• Abdominal aortic aneurysm (AAA)
• COPD
• Cancer of the lip, oral cavity, pharynx, larynx, lung, esophagus, stomach, pancreas, kidney, bladder, cervix, and blood
• Pneumonia
• Osteoporosis
• Periodontitis
• Alcohol use
• Depression and anxiety
• Reduced fertility

• 16.3% of pregnant women smoke.
• Women who smoke or who are exposed to 2nd-hand smoke during pregnancy have increased risks of miscarriage, placenta previa, placental abruption, premature rupture of membranes, preterm delivery, low-birth-weight infants, and stillbirth.

• 2nd-hand smoke increases the risk of the following in infants and children (2)[A]:
  • Sudden infant death syndrome
  • Acute upper and lower respiratory tract infections
  • More frequent and more severe exacerbations of asthma
  • Otitis media and need for tympanostomies
• Nicotine passes through breast milk, and its effects on the growth and development of nursing infants are unknown.