Use and misuse of tobacco

Question 1

What has been the general trend of smoking in Canada over time?

Answer 1

Since the 1980s there has been a gradual decline in tobacco use from 45% –> 20% in 2004 (age 15-19)

Question 2

What has been the general trend of smoking in Aboriginals in Canada over time?

Answer 2

The prevalence of smoking has gradually decreased, but remains high with rates as high as 59% which are 3 x higher than non-aboriginal Canadians
There are studies that show prevalence as high as 82%

Question 3

What are the health implications of smoking?

Answer 3

Myocardial disease
Vascular disease
Chronic lung disease
Cancer
T2DM

Question 4

What are the consequences of smoking in pregnancy?

Answer 4

Perinatal deaths
Placental problems
prematurity
congenital abnormalities - gastroschesis
SIDS
learning disabilities
miscarriages
small size
Neonatal withdrawal
ADHD

Question 5

What are the risks of postnatal exposure to second hand smoke?

Answer 5

LRTI
decreased lung growth
AOM
SIDS
asthma

Question 6

What are the effects of nicotine?

Answer 6

Positive effect on mood and performance - more efficient processing f information
Small doses: increased alertness and arousal
Large doses: sedation and reduced anxiety
Addiction

Question 7

How long does it take for addiction to occur?

Answer 7

It was previously thought that it takes months for addiction to occur, but small use of a short period of time can be addictive

Question 8

What factors affect risk of addiction?

Answer 8

Age of onset
Maternal smoking in pregnancy
Easy access
Reduced sensitivity to the tastes
Genetic factors: nicotinic acetylcholine receptor, dopamine transporter gene, cytochrome P450 2A6
NB there are no genetic factors relating to nicotine metabolism

Question 9

Does taxing cigarettes decrease use?

Answer 9

Yes
a 10% increase in cost was associated with a 14% decrease in use.
Access to tax-free tobacco on reserves undermines this

Question 10

What are some factors influencing smoking rates that are unique to aboriginal people?

Answer 10

Tobacco use in ceremonies and medicinal purposes. IN the traditional sense, the most powerful way to communicate with the spirits is to smoke a sacred pipe
Tax-free
Poverty, social determinants of health

Elders maintain that recreational use of tobacco with high nicotine content is disrespectful to traditions

Question 11

What are some examples of strategies to improve the tobacco scene?

Answer 11

Smoke free public and work places
Taxing
Age limits - need to be standardised
Banning tobacco advertising
Keep products out of sight
Health warnings

Question 12

What’s the name of the medication to help with nicotine addiction?

Answer 12

Bupropion

Question 13

How can you help a patient who is smoking?

Answer 13

ASK about tobacco use
ADVISE urge to quit
ASSSESS willingness to attempt to quit
ASSIST counselling and pharmacological therapy
ARRANGE follow up