: -, , 10 2012

5 -

:

:

:

:

: , ,

% of adultsNYC NYS Free patch 3 3- 3- - - 35% 2002NYS NYS

Chart1

21.6

21.6

21.6

21.5

21.5

21.5

21.7

21.7

21.7

21.5

19.2

18.3

18.9

17.5

16.9

15.8

15.8

14

NYC

21.6%

21.5%

21.7%

21.5%

19.2%

18.3%

18.9%

17.5%

16.9%

15.8%

15.8%

14.0%

Sheet1

199319941995199619971998199920002001200220032004200520062007200820092010

NYC21.621.621.621.521.521.521.721.721.721.519.218.318.917.516.915.815.814

, , , , , , , 443,000 /1$96 2$97 21 . : . http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/healthprofessional2 (CDC). , 2004-2010. MMWR 2010;60(38):1305-1309

-~ 850.000 - (14,0%) - , 17.200 - , 2 14 32 (NYC DOHMH), . 2009. http://www.nyc.gov/html/doh/downloads/pdf/vs/2009sum.pdf12004 . , , , , 2004.

3 (CDC). , - , 1995-1999. MMWR 2002;51(14):300-303

, U.S. Department of Health and Human Services. The Health Consequences of Smoking: what it means to you. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.

, (COPD), (. )

Cigarette smoking is a cause of several groups of diseases: cancers of a number of organs, cardiovascular disease, chronic lung diseases, and peptic ulcer disease.1 These diseases occur not only at the sites contacted directly by tobacco smoke, the mouth, throat and lungs, but also at sites reached by tobacco smoke components and metabolites, such as the heart, blood vessels, kidney and bladder. These diseases reflect carcinogenesis, atherogenesis, and chronic lung inflammation, the latter probably arises through unfavorable balances of oxidants versus antioxidants and proteolytic versus anti-proteolytic factors. Many of the diseases causally linked to smoking are shown in the figure. The following table gives key conclusions of reports of the US Surgeon General, and the International Agency for Research on Cancer (IARC).24 Additionally, smoking during pregnancy has adverse effects on pregnancy outcome.3

References:1. Baron JA & Rohan TE. Tobacco. In Cancer Epidemiology and Prevention. 2nd edn 1996; pp. 269289. Edited by D Schottenfeld & JF Fraumeni Jr. New York: Oxford University Press. 2. US Department of Health, Education and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: US Government Printing Office; 1964. 3. US Department of Health and Human Services. Reducing the health consequences of smoking. 25 years of progress. A Report of the Surgeon General. Washington, DC: US Government Printing Office; 1989.4. International Agency for Research on Cancer. Tobacco Smoking, vol. 38 of IARC monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. World Health Organization; 1986.

*

http://ibgwww.colorado.edu/cadd/a_drug/essays/essay4.htm

/

?

?

?

50.000 3.500 46.000 http://www.cancer.gov/newscenter/entertainment/tipsheet/secondhand-smoke

, (), , : 34% 24% 25% 40-60%1-4, , , 74% , 5

1 The health consequences of involuntary exposure to tobacco smoke : a report of the Surgeon General. [Atlanta, Ga.] : U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, [2006]2 Law MR et al. Br Med Bull 1996;52:22-34; Law MR et al. BMJ 1997;315:973-80. 3 Coultas DB. Thorax 1998;53:381-7.4 Otsuka R et al. JAMA 2001;286:436-41.5 Farkas, A. J., E. A. Gilpin, et al. (2000). "Association between household and workplace smoking restrictions and adolescent smoking. " JAMA 284(6): 717-22.

13% 1

, , ,

1 Trends in smoking before, during, and after pregnancyPregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 20002005.

12: (~2x) (~2x) (~2x) (30% ) (SIDS) (1.4-3x) () 1 http://www.cdc.gov/reproductivehealth/tobaccoUsePregnancy/index.htm2 http://www.marchofdimes.com/pregnancy/alcohol_smoking.htmlJennifer E. Bruin, Herzel C. Gerstein, and Allison C. Holloway. Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicological Sciences. 2010.116(2) 364-374

1&2:

()1 http://www.cdc.gov/reproductivehealth/tobaccoUsePregnancy/index.htm2 http://www.marchofdimes.com/pregnancy/alcohol_smoking.html

()

: ( ), , 2 ,

1 http://www.cdc.gov/reproductivehealth/tobaccoUsePregnancy/index.htm2 http://www.marchofdimes.com/Pregnancy/alcohol_smoking.htmlJennifer E. Bruin, Herzel C. Gerstein, and Allison C. Holloway. Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicological Sciences. 2010.116(2) 364-374

- ,

( )

,

- :

? 1-9 (NYS NRT*, HHC - ) 10-20 (1/2 - 1 ) 21-40+ ( 1 ) ? 5 6-30 31-60 60+ ?

-

*NRT = -

- (NRT) ( )

SR ( Zyban) ( )

(Chantix) ( )

NRT ,

NRT

?

, / ()

,

, NYC (New York City) www.nyc.gov/nycquits311ESCAPE NYS NYS BigAppleRx DOHMH

NYS NYS 311 1-866-NYQUITS (697-8487) NRT 2- NRT, 18

nysmokefree.com 2- ( )

NYS: 90- / = 30- + 2 ( , .e., ) NRT (, , , ) (- , Chantix varenicline) Medicaid

BigAppleRx NYC 46% 27% NRT50% Bupropion17% Chantix , NYC, , , . :www.bigapplerx.comcall 311

(NPGP)

NYC DOHMH

(www.nycquits.org) 311

4- NRT , NRT

DOHMH Publications

www.nyc.gov/nycquits

CRAVINGS LOGQUIT DIARY

*Hi, Good Morning:

My name is Magda Desdunes from the NYC Department of Health of Mental Hygiene. I am the Director of Community Outreach Initiatives for the Bureau of Chronic Disease Prevention & Tobacco Control*We will discuss the following today:Read the list from the slide

*NYC has a 5-Point Action plan for tobacco control which includes the following: Read the list from the slide.

We also, now have smoke-free parks and beaches.

Essentially we try to make it harder to smoke and easier to quit

Does anyone know how much a pack of cigarette costs? Average cost is $10.50 11. 50. (at Grand Central station a pack can cost $15)

*So far since 2002, adult smoking is down 35% through our 5-point plan (including taxation, legal action and cessation).

The areas with the dark orange (East Harlem, South Bronx and Central Brooklyn) have higher smoking prevalence. These are also neighborhoods where you work.

**Read the slide., then ask?

What about productivity? Many employees have: time-off from work disability claims submitted (disability insurance)People are more sick

Who is going to take care of these sick individuals? So the responsibility lies on the caregiver.

**There are about 850,000 adult smokers in NYC, which is 14% of the adult population.

Almost half of them will die of smoking-related illnesses.

Furthermore, 7,200 New Yorkers die from a smoking-related illness annually.

Did you know that smokers lose an average of 14 years of life. Who wants to die early?Those who die early, what will they miss? WHAT IS IN YOUR CIGARETTE?

There are 7,000 toxins and 50 cancer-causing chemicals in tobacco smoke including:

Acetone, an eyes, nose, and throat irritant, which can cause liver and kidney damage;*What other product contains acetone? Nail polish removerCadmium, used in batteries, can cause liver and kidney damage;Formaldehyde, can cause nasal cancer, can damage the lungs, skin and digestive system;Hydrogen cyanide, used in gas chambers, causes nausea, headaches and fatigue; andCarbon monoxide, dangerous to heart and muscle function, causes breathing problems.

**Here are some of the diseases smoking causes:

Cancers (Stomach, Cervical)Chronic Diseases (Stroke, Blindness, Heart Disease, Atherosclerotic peripheral vascular disease (MARIE), Infertility).

Atherosclerotic peripheral vascular disease is when the arteries that supply blood become completely or partially blocked (as a result of atherosclerosis). So complication from this is open sores, ulcers, gangrene and in extreme cases-amputation.

Smokers know the consequences of smoking, but cant stop. Why?*Nicotine is not what causes disease, it is the smoking.

Nicotine = one of the most addictive substances known. It keeps people smoking.

Nicotine is found primarily in tobacco.

Nicotine works on the rewards pathway, which is in the deep part of the brain (Red area on the slide)

Travels to the brain in 10 seconds from cigarette smoke, binds to the receptor and releases dopamine.

dopamine levels in the brain, creating feelings of pleasure and relaxation

Effects last 5 minutes to 2 hours

Also, appetite and metabolism (WEIGHT LOSS)

*Many smokers have to smoke first thing in the morning, before doing anything else.

*Smokers feel withdrawal experience withdrawal when they cant have a cigarette, when they wake up or when trying to quit.

They feel anxious, stressed, or depressed when their nicotine levels drop and so they will use tobacco to relieve withdrawal symptoms

That is why it is so difficult to quit and easy to relapse and start smoking again. *How does smoking hook people in the following aspects?

Biological: Feels good (We just talked about it, what about the brain?) and fear of gaining weight.

Social: Peer pressure, drinking, hanging out with friends /family that smoke, boredom, holidays, associations (people, place, things)

Psychological: stress, coping mechanism, habit, and self-medication.

Are there any other ways people are hooked? Driving, Coffee

*Benefit is that they are NOT burning $, but saving it.

Because your taste buds improve, food tastes better.

You can get gum disease and stained teeth from smoking. If you quit smoking, the disease would not be as pronounced.

It also stains your nails and causes your skin to wrinkle.

Smoking cigarettes causes you to age faster, you will look older. **What is secondhand smoke? Secondhand smoke is the smoke from the end of the cigarette that is inhaled. Who is exposed to it? People around the smoker.It causes about 50,000 additional deaths per year in NON-smokers.They die from lung cancer or heart disease. Remember there is NO safe level of SHS exposure according to the Surgeon General.

**SHS usually occurs in the home. In buildings, SHS enters neighboring apartments and stays there.

About 40 60% of non-smokers exposed to SHS have a higher risk of asthma.

Have you heard of thirdhand smoke? Thirdhand smoke is smoke/toxins left behind on objects (such as stuffed animals or curtains or bed covers) that remain after cigarettes are put out. Unclear what health effects are yetEven after 2 months of vacancy and professional cleaning, new non-smoking tenants showed higher finger nicotine levels than new tenants of non-smoking apartments.4 (4 Matt, G. E., P. J. Quintana, et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tob Control. 2010)

Even after 2 months an apartment was vacant and cleaned by a professional cleaning company, the new non-smoking tenants showed higher finger nicotine levels than new tenants of non-smoking apartments.

*First bullet is according to the 2008 Pregnancy Risk Assessment and Monitoring System (PRAMS) data from 29 states, Also, of women who smoked 3 months before pregnancy, 45% quit during pregnancy. Among women who quit smoking during pregnancy, 50% relapsed within 6 months after delivery.

In NYC, 9% of women reported smoking during that last three months of pregnancy. (2010 NYC PRAMS data).

Nicotine and tobacco toxins cross the placenta and is detectable in breast milk.

Remember that timing plays a major role, and your visit takes place during the period when most relapse occur. Try not to miss the opportunity to help!

As for demographic groups, in 2008, the prevalence of smoking during the last 3 months of pregnancy was highest among women who were between 2024 years of age (19.3%), were Alaska Native (30.4%), had less than 12 years of education (22.5%), or were Medicaid insured during prenatal care (22.1%).*Women who smoke during pregnancy experience spontaneous abortion, still birth, low birth weight and are two times more likely to experience placenta previa (placenta partially obstructs the cervix/a low-lying placenta that covers part or all of the opening of the uterus preterm birth or maternal/fetal death) and placental abruption (placenta detaches from the uterus prematurely preterm delivery and maternal/fetal death).

Tobacco smoke also constricts blood vesssels (produces antimetabolic effects) and can interfere with fetal growth.

http://www.cdc.gov/reproductivehealth/tobaccoUsePregnancy/index.htmhttp://www.marchofdimes.com/Pregnancy/alcohol_smoking.html*Pregnant women who are exposed to SHS, may experience delivering a low birth weight baby.

Babies exposed to SHS, have greater chances of asthma and bronchitis. *The long term effects of nicotine exposure to the fetus and infant causes increased risk for type 2 diabetes, and asthma in early years and adulthood. **Most smokers want to quit (60 70%) and most have tried to quit before.

It takes most smokers an average of 7 times to successfully quit. *Clarified heavy*NRT is nicotine-containing medications used for smoking cessation. Buproprian SR is a non-nicotine prescription medication used for both smoking cessation (Zyban) and for treating depression (Wellbutrin). It changes the brain chemistry. Varenicline also a non-nicotine prescripton medication used for smoking cessation. It works on the lock and key mechanism by binding to the receptor and basically blocks or covers over the lock. So when nicotine enters , it has nowhere to go. Nicotine is in your system, but doesnt create any symptoms and there is no response from the brain or body. Therefore, the smoker has no reason to keep smoking.No feeling of pleasure and relaxation; the smoker does not get the high. **NRT and meds are not recommended for pregnant women.**Why use the medications?It helps people not experience (feel) withdrawal symptoms. It makes quitting easier. It increases ones chance of quitting successfully. **NRT is the safest form of Nicotine by far! It also doesnt have all the toxins and cancer causing agents.***Actually, NRT doubles the rate of quitting successfully.*These therapies work by releasing low levels of nicotine. How to Use the Patch: 24-hour patch provided in various doses 7, 14, or 21 mg One patch per day worn (changed when client wakes up) Can be worn while showering or bathing and reinforced with surgical tapeHow to Use the Gum: Chew and Park methodPossible side effects: (Rare, but Occur)Skin irritation if mild, try cortisone cream / if severe, discontinueSleep disruption (vivid dreams) try peeling off patch before going to sleepToo much nicotine:Palpitations (fast heartbeat), headache, upset stomach, feel dizzy or nauseousToo little nicotine: Anxious, irritable, have difficulty concentrating, feel strong cravings for cigarettes.*If the NRT does not work, there is also Zyban and Chantix by prescription only. *Can you name a few triggers? ****ESCAPE- Smoking Cessation Program for NYC Government Employees and their families. Dept of Education, DSNY, NYPD.Call 212-676-2393 for an appointment

For more information visit nyc.gov/nycquits or call 311If smoker enrolls online, counseling is still provided. A Quitline counselor will call the enrollee afterwards. *This benefit makes medication very affordable! Co-pays are 50 to $6.00. If you can afford to smoke, you can definitely afford to quit. *Do you know about Big Apple Rx?

BigAppleRx is the City's official prescription discount card program developed to help NYC consumers save on their medication costs . It provides discounts averaging 46%; 18% average on brand-name drugs, and 63% on generic drugs.Specifically for the quit-smoking meds (READ from 3rd Bullet)The card is free and available to everyone living, working, or visiting the City, regardless of age, income, citizenship or health insurance status. No personal information or enrollment is required to use the card. For more information, you can visit the website at www.bigapplerx.com or by calling 311.Provides discounts for a broad range of medicationsIn order to receive a discount, you must have a valid prescription. Tobacco control can send you flyers on the card for health fairs.*This year the program was March 1-16, 2012.

Did anyone enroll this year? If so, what was your experience?*Pregnancy Coaching Guide: Provides steps and strategies to assist pregnant women with quitting.

Medicaid Fact Card: Provides information about what smoking cessation benefits are offered through Medicaid.

Quit to Save: This brochure focuses on the financial benefits of quitting by visually displaying how the money that is burnt can be spent elsewhere.

Guide to Smoking Cessation Services- provides a listing of services (individual or group counseling, support groups and medication) available in NYC to assist with quitting smoking.

Still Smoking health bulletin: Give reasons to quit, way to make quitting easier and provides encouragement.

How to Make Your Home Smoke-free: Highlights the benefits to a smoke-free home, consequences of secondhand smoke and how to make your home smoke-free.

**Our smoking cessation website. You can use the cravings log to track your urge to smoke. Helps you see when and why your smoke.

Quitting isnt easy, but definitely possible. So the quit diary can be used to write down what you are going through, good and bad.

We are also sharing tips that users have submitted to us by posting them on the site for others as new suggestions or tips. Smoking is expensive, so use the quit calculator to see how much you will save or have saved.

Your clients can get extra support from thousands of other quitters by joining the Health Departments Facebook community I Quit Because. (www.facebook.com/nycquits ) Your clients can also sign up to receive supportive text messages from SmokefreeTXT. Please make sure that the patient is aware that although the service is free, the text messages are not. (smokefree.gov/smokefreetxt/)

*So, basically there are many quit-smoking resources available.

You can be champions by encouraging your clients to quit.

The take home message for your clients is:If you are a smoker, quitting is the most important thing you can do for your health!*