L52: Tobacco And Health

Question 1

Non-communicable disease

Answer 1

• 63% people die from NCD
• 4 NCDs
  —> CVD
  —> cancers
  —> chronic respiratory disease
  —> diabetes
• 4 risk factors
  —> tobacco
  —> diet
  —> lack physical activity
  —> alcohol

Question 2

Smoking risk

Answer 2

• 50% will be killed
• 2/3 will be killed if start smoking at teenage
• kill 16 people each day in HK
• quit before 40 can avoid excess risk
• Group 1 carcinogen (same as Alcohol)
• not known to increase risk for breast, nasal pharyngeal cancer

Disease:

• liver
• erectile dysfunction (50% risk increase, reduced volume, sperm count, abnormal sperm shape, motility)
• colorectal
• diabetes

Question 3

2nd hand and 3rd hand smoke

Answer 3

2nd hand:

• Main stream smoke (15%, exhaled smoke)
• Side stream smoke (85%, smoke from lit cigarette, higher conc of carcinogens and toxic agents than MSS)

3rd hand:
- smoke residue on surface react with other chemicals

Question 4

Short term effects and Health consequence of 2nd hand smoke

Answer 4

Short term effects:

1. Irritation of mucous membrane (eye, nose)
2. Headache
3. Nausea

Health consequence:

1. Stroke
2. Lung cancer
3. Respiratory symptoms in children (asthma, hospitalisation)
4. Tuberculosis
5. Coronary heart disease

Question 5

Involuntary smoking

Answer 5

• excess risk from spouse exposure
• excess risk from workplace exposure
• no risk free level of exposure (separate smokers, cleaning air, ventilated buildings cannot eliminate exposure)

Question 6

Health warnings on cigarette packs

Answer 6

• 12 types of pictorial warnings
• at least 85% covering of main surface
• misleading description is restricted
• Health warning messages
  —> Quit Smoking for future generations
  —> Quitline 1833 183

Future:
- Plain packaging

Question 7

Youth-targeting smoking prevention

Answer 7

NOT effective since adults can induce young people to smoke

Question 8

***WHO report on Global Tobacco Epidemic

Answer 8

6 policies: MPOWER

• Monitor: tobacco use and prevention policy
• Protect: people from tobacco smoke
• Offer: help to quit smoking
• Warn: risk of smoking
• Enforce: bans on ads, promotion by tobacco companies
• Raise: tobacco tax (Most effective)

Question 9

Medical students as advocates

Answer 9

• public health advocacy
• lobbying
• research
• educational session
• Youth Quitline

Question 10

Tobacco addiction

Answer 10

• Physiological (nicotine)

- Social / Psychological

Question 11

Health benefits of smoking cessation

Answer 11

• CHD risks ↓ by 50% after 1 year, similar to non-smoker after 15 years
• Lung cancer risks ↓ to 50% of smokers after 10 years
• other cancer risks ↓
• Quit before 40 ↓ loss by 90%

Question 12

NRT

Answer 12

• 2x cessation rate
• minimal side effects
• 1st line treatment
• low adherence
• appropriate counselling needed

Drugs:

• Bupropion (less effective than Varenicline)
• Varenicline

Question 13

Tobacco control problems in HK

Answer 13

1. No penalty for owners not taking actions to stop smoking in smoke-free place
2. Smoking at bus stops
3. Displays of cigarettes
4. Price too low
5. 3rd hand smoke

Question 14

***Minimal approach as doctors

Answer 14

AWARD

• Ask
• Warn
• Advice
• Refer
• Do it again

Question 15

3 components of E-cigarette

Answer 15

• Battey
• Atomizer (heating device)
• Cartridge

Question 16

***E-cigarette vs HNB tobacco

Answer 16

E-cigarette:

• do not burn/use tobacco leaves (NO tobacco)
• have/no nicotine
• vaporize a solution containing nicotine
• unknown harms
• appealing to youth: flavours —> Diacetyl (bronchiolitis obliterans)
• harmful ingredients: polycyclic aromatic hydrocarbon (PAH), formaldehyde, glycerin
• cause pro-inflammatory response —> ↑ respiratory resistance (asthma, COPD)
• sympathetic predominance, ↑ oxidative stress —> CVD risk
• damage DNA —> cancer
• heavy metals —> brain damage, cancer
• NOT an aid to quit smoking —> more likely to smoke / nicotine addiction

Heat-not-burn tobacco:

• heat up tobacco stick / capsule using heat (350oC) rather than combustion
• contain nicotine
• main ingredient: tobacco —> nicotine
• harmful ingredient: nicotine, VOC, CO, PAH
• may have higher content of nicotine + tar than traditional cigarette

Question 17

Amendment bill to Smoking Ordinance

Answer 17

• prohibit alternative smoking products (e-cigarette, HNB tobacco product)
• import, manufacture, sale, distribution and advertisement are banned