The Immediate and Long-Term Impact of Smoking on Health

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1 The Immediate and Long-Term Impact of Smoking on Health February 17, 2016

2 Agenda Opening Remarks Housekeeping Polling Questions Presentation Q&A Closing Remarks 2

3 Introduction to the atom Alliance Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies. 3

4 Objectives During this Webinar you will learn how to : Describe both the immediate and long term impact of smoking on heart health Access available resources on smoking cessation for patient use 4

Housekeeping Items To ensure maximum sound quality, participant lines have been muted; however we welcome ALL questions and comments via the chat board on the

5 Housekeeping Items To ensure maximum sound quality, participant lines have been muted; however we welcome ALL questions and comments via the chat board on the right hand side of your screen To submit questions or comments: Use WebEx chat send messages to the panelists or all participants using the chat feature drop down menu 5

These questions will come up on the right side of your screen.

6 Housekeeping Items During today s presentations, you may be asked to participate in some polling questions. These questions will come up on the right side of your screen. When you answer a polling question, be sure to hit the submit button so we can capture your answer. 6

7 Polling Question #1 Which State are you from? The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Alabama Indiana Mississippi The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Kentucky Tennessee Other: 7

8 Polling Question #2 Does your State have a QuitLine? Yes No I don t know 8

9 The Effect of Smoking on Your Patients Heart Health February 17, 2016 Elizabeth Anderson- Hoagland, MPH Policy Analyst Kentucky Tobacco Prevention and Cessation Program

10 Agenda Prevalence of tobacco use Overview of health effects of smoking Secondhand smoke Thirdhand smoke Smokeless tobacco Financial Impact of smoking Heart Disease Electronic Cigarettes Smoking and Medications Cessation Resources

Surgeon General s Report U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: 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, 2014.

11 Surgeon General s Report U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: 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, Printed with corrections, January 2014.

12 Smoking is the leading cause of preventable disease and death in the U.S. 42 million American adults and about 3 million middle and high school students smoke. 480,000 Americans die prematurely from smoking each year. 16 million+ Americans suffer from a disease caused by smoking. Smokers suffer more health problems and disability due to their smoking and on average lose more than a decade of life.

13 Evidence has linked smoking to diseases of nearly all organs of the body

14 90% of smokers start before the age of % % 11.1% % 13.8% % 15.4% % No Data Percentage of High School Students Who Currently Smoked Cigare9es *On at least 1 day during the 30 days before the survey. State Youth Risk Behavior Surveys, 2013

Youth Face Immediate Consequences from Tobacco Use Reduce maximum lung function Cough and phlegm production Increased number and severity of respiratory infections

15 Youth Face Immediate Consequences from Tobacco Use Reduce maximum lung function Cough and phlegm production Increased number and severity of respiratory infections Decreased physical fitness Atherosclerosis (Plaque on arteries) Increased resting heart rate High LDL (bad) cholesterol levels Glucose intolerance Depression Academic difficulties

16 Adult smoking data

17 Nicotine Nicotine is the primary addicting drug in cigarettes. At high doses, nicotine has acute toxicity. Nicotine activates biological pathways through which smoking increases the risk for disease. Nicotine patches, gum, and lozenges are safe when used as directed.

18 Smokeless Tobacco Potential issues for blood pressure Nicotine Sodium Licorice

19 Constituents of Smoke Contributors to cardiovascular disease Oxidizing chemicals Carbon monoxide Acrolein 1,3- butadiene Particulates Polycystic aromatic hydrocarbons Metals such as cadmium Nicotine

20 Lung Cancer Lung cancer is the #1 cause of cancer death for men and women. Today s smokers are more likely to develop lung cancer than smokers 50 years ago. 87% of lung cancer deaths are caused by smoking

Reproductive health More than 400,000 U.S. babies are exposed to chemicals in cigarette smoke before birth. Babies of smoking mothers have higher risk of SIDS.

21 Reproductive health More than 400,000 U.S. babies are exposed to chemicals in cigarette smoke before birth. Babies of smoking mothers have higher risk of SIDS. Mothers who smoke in early pregnancy are more likely to have babies with cleft lip or cleft palate. Pregnant women should not use bupropion (Zyban) or varenciline (Chantix). Nicotine Replacement Therapy (NRT) should only be considered if behavioral therapy is not sufficient. The long term health impact of NRT on the fetus and child is unknown.

22 Chronic Obstructive Pulmonary Disease (COPD) 79% of all cases of COPD are caused by smoking Mortality from COPD has increased since 1964 Men tend to have more emphysema Women may be at greater risk for early onset COPD and the mortality rate for women has risen faster than for men.

Diabetes Diabetes is the 7th leading cause of death in the U.S. Smoking causes type 2 diabetes. Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.

23 Diabetes Diabetes is the 7th leading cause of death in the U.S. Smoking causes type 2 diabetes. Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers. Diabetic smokers: Have difficulty regulating insulin levels. Have higher risk of heart disease, blindness, kidney failure, and nerve and blood vessel damage to feet and legs.

24 Eye- Disease Smoking causes serious eye disease, including: Age- related macular degeneration (AMD) Cataracts These diseases are the most common causes of blindness.

25 The Immune System Smoking harms the immune system and causes autoimmune disorders. Smoking is a cause of rheumatoid arthritis (RA). RA treatment can be less effective for smokers.

26 Smokers are sicker More than 16 million Americans suffer from at least one disease caused by smoking. Smokers have more lung infections than nonsmokers. Smokers are admitted to hospitals more often than nonsmokers. Smokers miss more work than nonsmokers.

27 Heart Disease Cardiovascular disease is the biggest killer in the U.S. Smoking causes 32 percent of coronary heart disease deaths It causes more than 800,000 deaths every year. Smoking is a major cause of cardiovascular disease. Secondhand smoke increases the risk for heart attack or stroke, even for nonsmokers.

28 Smoking causes cells lining veins and arteries to swell. Narrower arteries mean reduced blood flow to the heart, brain, and organs. Clots can block narrowed arteries, causing heart attack, stroke, and even sudden death. Even occasional smoking damages blood vessels.

29 Interactions between medications and smoking Smoking induces drug metabolizing enzymes in the liver. Smokers have higher clearance of certain drugs and may require higher doses to achieve clinical response. When smokers quit, their medication may need to be lowered to prevent toxicity. Example: smoking increases caffeine clearance by 50%, one reason coffee and cigarettes seem to go together. Potential drug interactions with smoking and quitting available at: health- drug- coverage/pharmacare/sc- interact.pdf

30 Secondhand Smoke

31 Thirdhand Smoke The smoke residue that can stick to furniture, carpeting, car seats, hair, or clothes Contains 250 chemicals, including cancer- causing nitrosamines Babies and young children are particularly at risk

The Economic Cost The estimated economic costs attributable to smok- ing and exposure to tobacco smoke continue to increase and now approach $300 billion

32 The Economic Cost The estimated economic costs attributable to smok- ing and exposure to tobacco smoke continue to increase and now approach $300 billion annually, with direct medical costs of at least $130 billion and productivity losses of more than $150 billion a year. 1 $956 taxpayer burden per household. 2

33 About electronic cigarettes

34 How many people use e- cigarettes? Adults: 3.7% every day or some days 1 5.1% year olds High school students: 13.4% current users 2 2 million high school students and 450,000 middle school students currently use e- cigarettes

35 Conventional vs. E- Cigarettes E- Cigs Particulate matter Tar Carbon monoxide Tobacco- specific Nitrosamines Formaldehyde Nicotine Short Term Health Effects Long Term Health Effects? Legend More than cigarettes Less than cigarettes Depends upon product

Flavorings Diacetyl bronchiolitis obliterans popcorn lung 75% of e- cigarettes tested Aldehydes respiratory irritation, airway constriction Dark chocolate and wild cherry flavors

36 Flavorings Diacetyl bronchiolitis obliterans popcorn lung 75% of e- cigarettes tested Aldehydes respiratory irritation, airway constriction Dark chocolate and wild cherry flavors Twice the recommended workpalce safety limit for aldehydes vanillin and benzaldehyde Cinnamaldehyde toxic to human lung cells in lab, swollen throats, mouth sores Cinnamon flavors

Dual Use From 2010-2011, 72.0 percent of people who recently used e- cigarettes also currently smoked conventional cigarettes.

37 Dual Use From , 72.0 percent of people who recently used e- cigarettes also currently smoked conventional cigarettes. That number rose to 76.8 percent during Cutting down is not enough! Any benefit would only be realized by completely quitting combustible cigarettes. 2, 3

38 Do E- Cigarettes Help People Quit Smoking? U.S. Preventive Services Task Force Draft Recommendation released June 1, 2015 found no evidence that e- cigarettes helped with smoking cessation

39 So How Do You Help Patients Quit?

40 Ask, Advise, Refer Ask: Do you use any form of tobacco? Advise: Quitting tobacco is one of the best things you can do for your health. I strongly encourage you to quit. Are you interested in quitting? Refer: This is a resource I recommend for helping quit. It will provide support, help you create a plan, and talk to you about how to overcome urges.

41 The 5As Ask about tobacco use: Do you use any form of tobacco? Advise the patient to quit tobacco Assess readiness to quit: Are you interested in quitting tobacco? Assist the patient in quitting: Provide brief counseling and medication if appropriate Arrange for follow- up

1-800- Quit Now Most smokers want to quit and half already have Cessation therapies improve your chances of quitting successfully Call 1-800- QUIT- NOW

42 Quit Now Most smokers want to quit and half already have Cessation therapies improve your chances of quitting successfully Call QUIT- NOW for free help Dejelo- Ya Spanish language portal CDC Tips From a Former Smoker tips/partners/health/hcp/index.html

43 Contact Information Elizabeth Anderson- Hoagland Youth Policy Analyst Tobacco Prevention and Cessation Program Kentucky Department for Public Health 275 E. Main St. HS1 E- E Frankfort, KY (502) ext ElizabethA.Hoagland@ky.gov

44 Polling Question #3 What Topics Would You Be Interested in Learning More About in Future Events? Physician Quality Reporting System (PQRS) Welcome to Medicare Visit reimbursement Meaningful Use of Electronic Health Records Depression and Chronic Disease Use of Patient Portals Cardiac Registry for Home Health Agencies Care Coordination Patient and Family Engagement Other 1

45 Thank you for joining us! Please complete the survey that will come up as you exit the webinar we value your feedback in developing future events! Always feel free to contact us at 2

Chapter 11 Tobacco Section 1: Tobacco Use

Chapter 11 Tobacco Section 1: T obacco Use Do Now 1. Read the article The facts behind e-cigarettes and their health risks 2. Annotate 3. Summary Key Terms Ø Nicotine Ø Carcinogen Ø Tar Ø Carbon monoxide