Tobacco Contains Nicotine

Tobacco contains nicotine, a powerful neurotoxin that is particularly harmful to insects. All means of consuming tobacco result in the absorption of nicotine in varying amounts into the user's bloodstream, and over time the development of tolerance and dependence

How Smoking Affects The Environment • Each cigarette manufacturing machines uses 4 miles of paper per hour which could be used • • • • • • •

instead for many other important things. Tobacco is the most widely grown non-food crop in 120 countries therefore less land is available for food crop. Between 10 to 20 million people could be fed if food crop was grown in its place. Burning tobacco is the main source of indoor pollution in the developed world as it contains over 4,000 dangerous chemicals. One whole tree is needed to cure the tobacco for 300 cigarettes . Cigarette smoke generates contains two of the main gases related to the greenhouse effect they are carbon dioxide and methane. If you smoked a packet of cigarettes a day, your habit would cost around $1800 per year. Wouldn't you rather do something fun with that money, like a trip to Disneyland? A broken leg of a smoker takes 80% longer to heal than a nonsmoker (276 days compared to 146) Secondhand smoke causes 3,000 cases of lung cancer in nonsmokers each year

Why do People Start To Smoke ? • The main reasons why the youth begins to start smoking are : • Peer group pressure, feeling left out while friends smoke and trying to fit in with the crowd. • Stress at home, work, school or in general by getting fed up with things. • Trying to attract attention, act cool or become popular. • Calm down nerves Health Hazards of Smoking

Introduction High Blood Pressure Heart Disease Pulmonary Disease Vascular Diseases Stroke Laryngeal Polyps Impotence Wrinkling of Skin Mouth Disease Respiratory Infections Smoking and Ulcer Smoking and Pregnancy Effects of Smoking

• Health Hazards of Smoking Introduction Smoking is associated with significant morbidity and mortality. Smoking still remains one of the leading cause of preventable death. Smoking has the dubious distinction of affecting all the systems from head to foot. High Blood Pressure Nicotine in the cigarette causes constriction of blood vessels which increases blood pressure resulting in hypertension. Smoking causes an acute increase plasma ACTH, cortisol, aldosterone, and catecholamine levels which can in turn lead to indirect elevation of blood pressure. Each time a cigarette is smoked there is an acute rise in blood pressure. Further more studies have shown that smoking interferes with the metabolism of multiple anti-hypertensive medications. Heart Diseases and smoking Smoking is one of the major risk factor in the development of cardiovascular disease by the action on the blood vessels; by increasing the work load of the heart; by decreasing exercise tolerance. Coronary artery disease (CAD) Cerebrovascular disease Abdominal aortic aneurysm

Peripheral vascular disease are some of the diseases caused by smoking. Cigarette smoking increases the duration of ischemia in patients with Coronary heart diseases and also the number of times a patient gets ischemic attacks. Smoking decreases HDL (good) cholesterol. Chronic Obstructive Pulmonary Diseases Cigarette smoke also contains substances that directly damage the lung tissue thereby , reducing their capacity to absorb oxygen. Substances released by the immune system in response to cigarette smoke also destroy the lung cells. Smoking irritates the bronchial tree in the lungs, which in turn results in the production of more mucus causing the typical smokers' cough. Bronchitis and emphysema aPeripheral vascular diseases Smoking by its action on blood vessels causes vasoconstriction and is the also the risk factor for the development of large vessel peripheral vascular disease and inflammation of a vein. This is mediated through smoking induced atherosclerosis and vasoconstriction. These conditions are exacerbated by diseases such as diabetesre some of the cPeripheral vascular diseases Peripheral vascular diseases Smoking by its action on blood vessels causes vasoconstriction and is the also the risk factor for the development of large vessel peripheral vascular disease and inflammation of a vein. This is mediated through smoking induced atherosclerosis and vasoconstriction. These conditions are exacerbated by diseases such as diabetes. Health Hazards of Smoking – Stroke Smoking causes deposition of fatty deposits in the blood vessels which is called atherosclerosis. Slowing of blood flow also occurs which in turn can lead to thrombus formation. This can result in stroke. The risk of stroke due to cigarette smoking is dose related i.e. the more number of cigarettes one smokes, greater is the risk of stroke

Chronic Hoarseness and Laryngeal Polyps Chronic smokers often develop a persistent hoarse voice and sometimes a soft, benign growth in the voice cords called vocal cord polyps which might need surgical removal Health Hazards of Smoking - Impotence Smoking increases the risk of erectile dysfunction because blood flow into the penis is blocked by atherosclerosis. Smoking causes abnormal sperm shape,

impaired sperm motility damage, reduced number of sperms and reduced volume of ejaculate

Premature Wrinkling of Skin Tobacco use causes thickening and fragmentation of the elastic fibers of skin and decreases the formation of collagen that maintains a healthy and supple skin. Oxygen supply and the water content of skin is also reduced by reducing .circulation Gum, Dental and Mouth Disease Tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease which results in poor mouth hygiene and .bad breath Upper Respiratory Infections Smoking irritates the lining of the nose and causes increased nasal secretions and .swelling Smoking and Ulcer Studies have shown that smoking increases acid secretion, and decreases mucosal blood flow resulting in acid peptic ulcer and also delays the healing of .gastric and duodenal ulcers Smoking and Pregnancy Smoking causes delivery complications, Increases risk of pre-term delivery Giving birth to low-birth weight baby Slows fetal growth :Smoking also increases risk of serious health problems to the newborn such as cerebral palsy mental retardation learning disabilities More harmful effects of smoking Several studies have also shown that smoking leads to less stamina Interferes with the functions of thyroid Causes bone loss leading to bone fractures Accelerates the development of the macular degeneration Increases the chances of developing multiple sclerosis Predisposes to cervical dysplasia

Smoking And Cancer

What does cigarette smoke contain?

Cigarette smoke contains about 4,000 chemical agents, including over 60 carcinogens including substances, such as carbon monoxide, tar, arsenic, cyanide, .benzene, formaldehyde, methanol, acetylene, ammonia, lead

What is the association between smoking and cancer? The chances of smokers becoming afflicted with cancer is very high. Several studies have shown that the various carcinogens in the cigarette smoke cause cancer formation. Cancers are most likely to occur in organs like lungs, oral cavity which come into direct contact with smoke. When the substances delivered in cigarette smoke are absorbed and spread through the human body, smoking .causes cancer at various distant sites The risk of developing cancer is related to the Number of cigarette packs .1 Duration of smoking .2 Age at which smoking is started .3 The type of cigarettes smoked .4

What are the organs that can be affected by smoking Cigarette smoking increases the risk of the cancer in the following organs Lungs Cancer .1 Larynx Cancer .2 Oesophageal Cancer .3 Mouth or oral Cancer .4 Stomach cancer .5 Pancreas Cancer .6 Colorectal Cancer .7 Liver Cancer .8 Bladder Cancer .9 Kidney Cancer .10 Cervix Cancer .11 Breast cancer .12 Non Hodgkin's Tumours .13 Blood cancers like .14

)Acute Myelogenous Leukemia (AML )Acute Lymphocytic Leukemia (ALL -

Types of cigarette smoking Current smoker is a person who has smoked 100 cigarettes in a lifetime and .now smokes every day or some days A former smoker is a person who has smoked 100 cigarettes in a lifetime and .now does not smoke at all A never smoker is a person who has never smoked a cigarette or has never .smoked 100 cigarettes in a lifetime Light smoker is one who smokes 5 or fewer cigarettes per day and occasional .smokers .Moderate smoker is one who smokes 6 to 21 cigarettes a day .Heavy smoker is one who smokes more than 21 cigarettes a day

What is active smoking? .Active smoking is the intentional inhalation of smoke using cigarettes and cigars What is passive smoking? A non smoker who breathes other people's smoke is called passive smoking. It is .also called as involuntary or secondhand smoking

What happens in passive smoking In passive smoking, both the smoke from the burning tip of the cigarette and smoke that has been exhaled by the smoker is breathed in by the passive smoker. The various chemicals and carcinogens in the cigarette smoke can cause .smoking related diseases similar to ones acquired by actual smoking

What are the effects of passive smoking? Effects of passive smoking depend on the exposure levels and duration of .exposures. It can be immediate or late effects The chemicals in the cigarette smoke can cause irritation of the eyes, headache, cough, sore throat, and nausea. Studies have shown that in patients with asthma exposure to smoke can reduce the lung function significantly and new cases of .asthma can be induced in children who are exposed to cigarette smoke A major review by the Government-appointed Scientific Committee on Tobacco and Health (SCOTH) stated that passive smoking is a cause of lung cancer and ischemic heart disease in adult non-smokers, and a cause of respiratory disease, .cot death, middle ear disease and asthmatic attacks in children

Passive smoking increases the risk of getting frequent lower respiratory tract infections in children. Passive smoking during childhood predisposes children to .develop cancer as adults Exposure to passive smoking during pregnancy can lead to the birth of low birth .weight babies

Contents of a cigarette The smoke from a cigarette contains more than 4000 chemicals, which could have various toxic, mutagenic and carcinogenic effects. The content and concentration of chemical ingredients can vary widely from one brand or type of cigarette to the next. Below is a list of few of the chemicals and their harmful effects . Acetone Cyanide Aluminum DDT/Dieldrin Ammonia Ethenol Arsenic Formaldehyde Benzene Hydrogen cyanide Butane Lead Cadmium Methanol Carbon monoxide Nicotine Carbon dioxide Tar Chloroform Vinyl Chloride Chemicals and their harmful effects Acetone : Acetone is a colorless mobile flammable liquid )1 Use : It is most commonly used at home as an active ingredient in nail polish .removers. It is also used to make plastic, fibers, drugs, and other chemicals Health risk : Swallowing high levels of acetone can result in unconsciousness and .damage to the skin in the mouth Aluminum : Aluminum is a soft and lightweight metal )2 Use : Aluminum alloys are a vital element in the manufacture of aircrafts, rockets, automobiles , trucks, railroad cars etc . It is also used for packaging cans and foil. .Powdered aluminum is commonly used for silvering in paint Health risk: Aluminum is found to cause contact dematitis and also evidence of some degree of toxicity is seen if consumed in excessive amounts Smoking cessation

The Easy Way to Stop Smoking by Allen Carr, a famous book teaching smoking cessation Many of tobacco's health effects can be minimised through smoking cessation. The British doctors study[79] showed that those who stopped smoking before they reached 30 years of age lived almost

as long as those who never smoked. It is also possible to reduce the risks by reducing the frequency of smoking and by proper diet and exercise. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants. Smokers wanting to quit or to temporarily abstain from smoking can use a variety of nicotine-containing tobacco substitutes, or nicotine replacement therapy (NRT) products to temporarily lessen the physical withdrawal symptoms, the most popular being nicotine gum and lozenges. Nicotine patches are also used for smoking cessation. Medications that do not contain nicotine can also be used, such as bupropion (Zyban or Wellbutrin) and varenicline (Chantix).

Smoking cessation

A 'No Smoking' sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. Nicotine is a psychologically and physically addictive substance, and quitting smoking is commonly considered to be difficult. Psychological and pharmacological aids are available to help people quit smoking, although success rates are relatively low. As part of the wider tobacco control movement, there have been numerous advertising campaigns, smoking restriction policies, tobacco taxes, and other strategies to encourage people to quit smoking. Tobacco use is a major cause of death worldwide, according to the World Health Organization

Nicotine replacement therapy Nicotine replacement therapy (NRT) is the use of various forms of nicotine delivery methods intended to replace nicotine obtained from smoking or other tobacco usage. These products are intended for use in smoking cessation efforts to help deal with withdrawal

symptoms and cravings caused by the loss of nicotine from cigarettes. Several forms of NRT have been marketed, including the nicotine patch, inhaler, nasal spray, gum, sublingual tablet, and lozenge. NRT is thought to be useful and beneficial for tobacco users who want to quit their addiction and is for most people perfectly safe. Cigarettes on the other hand cause the early deaths of about 5 million people each year[1]. These people are not killed by the nicotine in the cigarette, but by other constituents of tobacco smoke such as Carbon Monoxide and tars. It is the nicotine that keeps the smoker addicted. Cigarettes can be viewed as a "dirty" and dangerous method of delivering nicotine, while NRT is a "clean" and safe method. NRT delivers nicotine to the smokers brain in a much slower way than cigarettes do. It helps to damp down the urges to smoke that most smokers have in the early days and weeks after quitting, rather than remove them totally. It gives the smoker the chance to break smoking cues in their daily lives, and might provide a more comfortable exit from the smoking habit. NRT however is best used with some form of support, ideally from someone who knows something about smoking cessation. A small number of people who use NRT, especially Nasal Spray and Nicotine Gum, will go on to use it on a longer term basis. These are usually highly nicotine dependent smokers who would not have been able to quit without the help of such medication. There is currently no evidence that such long term usage is harmful to health, especially when compared to smoking. Findings from a recent Cochrane review of controlled trials testing NRT products indicated that smokers using NRT were 1.5 to 2 times more likely to be abstinent from smoking at followup than those in the placebo or control treatment condition. Types • • • • • •

Nicotine patch Nicotine gum Nicotine lozenge Nicotine inhaler Nicotine spray Nicotine sublingual tablet

Nicotine patch A nicotine patch is a transdermal patch that releases nicotine into the body through the skin. It is usually used as a method to quit smoking.

Nicotine patches come in several steps so that users can phase out nicotine use; for example, 21, 14, and 7 mg. A cigarette delivers roughly 1 mg of nicotine, so someone who used to smoke a pack (20 cigarettes) per day or more could start with the "step 1" 21mg patch, while someone who smoked less could start with "step 2." After several weeks (6 is recommended) at step 1, new non-smokers move on to step 2 (usually 2 weeks) and step 3 (2 weeks). For most users, there are few or no short-term health problems associated with using the patch, so users should not rush themselves through the steps; rather, users can phase out nicotine use on their own schedules. The nicotine patch was invented by UCLA addiction researchers Dr. Murray E. Jarvik and Dr. Jed Rose; their patent was licensed by CibaGeigy, later merged with Novartis. It provides the basis for most generic nicotine patches on the market as of this date (November 2006).

Efficacy There have been some doubts expressed as to the efficacy of Nicotine Patches, in trials, the success rates of the control groups was significantly lower than would be expected, the presumption being that the low dose control patches made it harder to quit than normal. Nicotine replacement products (including patches) result in 7% of quitters quitting for at least six months. Alternative such as High intensity counselling increase quitting rates 300% to 22% (see Table 12)

Side Effects Death There are a few recorded cases in which nicotine addicts, died from heart failure after applying multiple patches and then smoking and consuming alcohol at the same time, against doctor's orders.[citation needed] Lawsuits by survivors of such descendants against the descendant's physician and the manufacturers of nicotine patches, cigarettes, and alcohol have all been generally unsuccessful. Nightmares Patches are intended to be worn for twenty-four hours at a time, and then be replaced at the same time every day. However, some individuals wearing the patch while they sleep experience abnormally vivid and possibly violent dreams or nightmares. Within this group, some people become acclimated and are not bothered;

others find them completely intolerable. Other people actually enjoy the intense vivid dreaming, experiencing no nightmares or unpleasant dreams, just pleasant dreams of unusual intensity. For some smokers the solution is simply to wear the patch for approximately seventeen hours only, and remove it before bed. There are also several brands which offer sixteen hour patches. However, because the patches take between 2 and 4 hours to achieve peak concentration in the body, this can leave the wearer vulnerable to cravings in the morning, particularly if they don't put on the patch immediately when they wake up. For heavier smokers, or smokers whose prior smoking habits included a smoke first thing in the morning or when getting home from work, the twenty-four hour patches can help avoid times of the day where the patch is not delivering enough nicotine and cravings start. Itching The nicotine and the adhesive can cause swelling, itching and discomfort in the area covered by the patch. Instructions for using the patch indicate it should be placed at a different location every day. Usually the feeling of itching and mild burning subsides in 3060 minutes, and is only slightly uncomfortable.

Nicoderm Functioning

Unlike adhesive bandages, topical patches generally use a solid plastic backing, occasionally with a fabric covering on the outside to look like an adhesive bandage. Topical patches also use a much stronger adhesive, allowing them to maintain their hold without having to wrap around to themselves, be covered or taped. Like any other topical patch currently available on the market right now, NicoDerm's adhesive also mediates the release of the medication through the skin. NicoDerm comes in 3 different variations ranging from 7 mg to 21 mg. The main difference between each level is not the amount of nicotine placed between the backing and the adhesive, but the size of the patch. This is due to the nature of the adhesive. For the adhesive to maintain its hold properly, the consistency of it must remain the same, thereby allowing only a specific amount of nicotine through.

Nicotine gum

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A man about to use a piece of nicotine gum. Nicotine gum is a type of chewing gum that delivers nicotine to the body. It is used as an aid in smoking cessation and in quitting smokeless tobacco. The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth. It is currently available over-the-counter in the US. The pieces are usually available in individual foil packages and come in various flavors including orange, and mint. Each piece typically contains 2 or 4 mg of nicotine, with the appropriate dosage depending on the smoking habits of the user. Popular brands include Nicorette and Nicotinell in the UK. Alternative nicotine replacement products include the nicotine patch

.Clinical efficacy of bupropion in the management of smoking cessation

Nicotine addiction is a chronic relapsing condition that can be difficult to treat. Until recently, pharmacological options for the treatment of tobacco dependence were primarily limited to nicotine replacement therapy (NRT). Sustained-release bupropion (bupropion SR) is the first non-nicotine pharmacological treatment approved for smoking cessation. Bupropion SR is recommended for first-line pharmacotherapy alongside NRT in the updated US Clinical Practice Guidelines and the UK Health Education Authority Guidelines. The UK National Institute of Clinical Excellence recommends NRT and bupropion SR for smokers who have expressed a desire to quit smoking. This review presents evidence that bupropion SR is an effective first-line therapy for smoking cessation in a wide range of patient populations. It is associated with significantly higher smoking cessation rates compared with placebo in patients with or without a history of prior bupropion SR or NRT use, and its effect is independent of gender. Bupropion SR treatment is effective in the prevention of relapse to smoking in those patients who have successfully quit, and re-treatment is effective in smokers who recommence smoking after a previous course of bupropion SR. Bupropion SR treatment relieves the symptoms of craving and nicotine withdrawal, and attenuates

the weight gain that often occurs after smoking cessation. Data collected from motivational support programmes and employer-based studies provide strong evidence of the effectiveness of bupropion SR as an aid to smoking cessation in 'real life' situations, and confirm the efficacy seen in clinical trials. Management of Smoking in People With Psychiatric Disorders

Management of Tobacco Addiction The management of tobacco addiction in individuals with psychiatric disorders must consider both clinical interventions and also system and program approaches. Clinical interventions focusing on specific assessment and treatment techniques will be reviewed after considering what changes must occur in both mental health and addiction settings to address tobacco.

System and Program Approaches Better addressing tobacco in mental health and addiction treatment settings will require program changes and other broader system changes to change the treatment culture so that appropriate tobacco dependence assessment and treatment approaches can be implemented in these settings. Who should manage smoking for individuals with psychiatric disorders? Much of the tobacco dependence treatment staff training has focused on primary care physicians. This effort has helped in reducing smoking in the general population; however, not among smokers with psychiatric disorders. A recent review of physicians' practice from the National Ambulatory Medical Care Survey[51] found that smokers with psychiatric disorders are treated infrequently, and that primary care physicians counsel these smokers more often than psychiatrists. Unfortunately, few primary care physicians get trained in the clinical issues pertinent to smokers with psychiatric disorders, such as the risk that bupropion can induce mania in some individuals with untreated bipolar disorders, tobacco use decreases psychiatric medication blood levels, and tobacco abstinence increases medication blood levels and the related side-effects such as extrapyramidal symptoms, seizures, or sedation. A brief and practical treatment guideline for treating smokers with schizophrenia has been published in Australia to help educate practitioners about ways to intervene.[52] The steps suggested by these authors include identifying smokers, assessing their readiness to quit, monitoring for symptom changes, creating treatment plans, using medications, and providing behavioral treatment. We believe that mental health and addiction specialists are well suited to treat tobacco dependence, and that addressing tobacco should be integrated into the routine work of mental health and addiction treatment settings

Medications for nicotine dependence treatment. Six medications have received FDA approval for nicotine dependence treatment, and the practice guidelines recognize these medications as first line treatments.[10] These treatments are effective for approximately 2530% of smokers in the general population at any one attempt, and this rate increases with combined psychosocial treatment.[59, 60] Some research has been performed using some of these medications with smokers with psychiatric disorders; however, such studies continue to have relatively small sample sizes. Bupropion and NRT patch and gum were effective with the subtypes of psychiatric disorders studied (schizophrenia and depression). Consideration should be given to the effect of quitting smoking on psychiatric medication blood levels, sideeffects and symptoms. The five types of NRTs are administered in a variety of ways: nicotine polacrilex (gum), nicotine transdermal patch, nicotine inhaler, nicotine nasal spray, and the newly approved nicotine lozenge. These medications are similar in how they reduce nicotine withdrawal and

the urge to smoke, improve abstinence rates and patient satisfaction, and have low abuse liability (JR Hughes, JL Pillitteri, PW Callas, et al., 2003, personal communication).[61, 62] The nicotine lozenge was approved by the FDA in October 2002. Its dosing is based not on the number of cigarettes smoked but on the time to the first cigarette, an important determinant of the severity of nicotine dependence.[63] The only FDA approved non-nicotine treatment is bupropion SR marketed as Zyban SR for tobacco addiction and Wellbutrin SR for depression treatment. Bupropion's effect on tobacco dependence, however, is independent of depression status. Bupropion SR has proved effective in patients with or without past depression medication treatment.[23, 64] The mechanism by which bupropion works is unclear, but is most likely secondary to dopamine and norepinephrine blockade.[10, 65] Bupropion SR treatment is effective in reducing craving, preventing relapse, and re-treatment is effective in smokers with a previous unsuccessful course of bupropion.[66, 67] A recent study[68] found that nortriptyline (an older tricyclic antidepressant) was effective like bupropion compared with placebo, and reduced the negative effect related to quitting at dosages similar to the treatment for depression. Most smokers with psychiatric disorders are heavy smokers. Heavy smokers usually have higher carbon monoxide and cotinine levels, higher Fagerstrom nicotine dependence scores, more nicotine withdrawal symptoms, and experience mood difficulties during withdrawal. There is some evidence to suggest titrating the dosage of NRT to the cotinine levels of the smoker. Heavy smokers may have improved outcomes with higher NRT dosages (multiple NRTs simultaneously, multiple NRT patches), adding bupropion SR, and integrating behavioral therapies. One pilot study of schizophrenic smokers[69**] reported that high-dose patch treatment resulted in 40% fewer withdrawal symptoms, a 2.5 times greater reduction in craving and was well tolerated, although larger trials are needed. Psychosocial treatments. The previously mentioned treatment guidelines[10, 70] are excellent sources of information on evidence-based psychosocial treatments, including motivational enhancement therapy, cognitive behavioral therapy (CBT; relapse prevention), and other behavioral therapies. Combined structured interventions (such as the American Lung Association's Freedom from Smoking) can also be effective. These approaches have been tested with smokers with psychiatric disorders, although in small sample size studies and only with certain disorders. These interventions are effective in this population, but most studies report tinkering with the standard approaches to adapt to the specific issues of the particular psychiatric disorder. As it becomes more common to address tobacco among smokers with psychiatric disorders, it will be important to learn how best to motivate this population to seek treatment for tobacco dependence. Steinberg et al.[71] found that one motivational enhancement therapy session helped approximately a third of smokers with psychiatric disorders to increase their motivation to seek tobacco dependence treatment within one month, compared with none receiving just a psychoeducational session or very brief advice.