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<ul><li><p>SMOKING BURDEN <br />SMOKING CESSATION</p><p>dr.Slamet Hariadi Sp.P (K)</p><p>LAB/SMF FK UNAIR/RSUD DR SOETOMO</p><p>SURABAYA</p></li><li><p>Indonesia 2006</p></li><li><p>3G</p>Good careGeneticGod</li><li><p>Burden of Disease</p>Smoking is highly prevalent worldwide Smoking increases morbidity and mortalityThe benefits of quitting have been demonstrated<p>*</p><p>*</p><p>*</p><p>*</p></li><li>More than 10 million cigarettes are smoked every minute of every day around the world by1:1 billion men1250 million women1China, USA, Russia, Japan and Indonesia consume more than 50% of the worlds cigarettes1If current trends continue, smokers will consume 9 trillion cigarettes annually by 20251<p>1. The Tobacco Atlas. Second edition. Published by American Cancer Society, 2006.</p><p>Global Epidemic of Smoking</p><p>*</p><p>Data Indonesia : jumlah konsumsi tembakau dan perokok </p></li><li><p>Gender-Specific Smoking Prevalence Across the World</p><p>1. Mackay J, et al. The Tobacco Atlas. Second Ed. American Cancer Society Myriad Editions Limited, Atlanta, Georgia, 2006. Also available online at:</p><p>US</p><p>24%</p><p>19%</p><p>Men</p><p>Women</p><p>Australia</p><p>19%</p><p>16%</p><p>Belarus</p><p>53%</p><p>7%</p><p>Brazil</p><p>22%</p><p>14%</p><p>Canada</p><p>22%</p><p>17%</p><p>Chile</p><p>48%</p><p>37%</p><p>China</p><p>67%</p><p>2%</p><p>Egypt</p><p>45%</p><p>12%</p><p>France</p><p>30%</p><p>21%</p><p>Iceland</p><p>25%</p><p>20%</p><p>Mexico</p><p>13%</p><p>5%</p><p>Iran</p><p>22% </p><p>2%</p><p>Kenya</p><p>21%</p><p>1%</p><p>Sweden</p><p>17%</p><p>18%</p><p>Philippines</p><p>41%</p><p>8%</p><p>Portugal</p><p>33%</p><p>10%</p><p>South Africa</p><p>23%</p><p>8%</p><p>India</p><p>47%</p><p>17%</p><p>Russian Fed</p><p>60%</p><p>16%</p><p>Italy</p><p>33%</p><p>17%</p><p>Spain</p><p>39%</p><p>25%</p><p>Germany</p><p>37%</p><p>28%</p><p>*</p><p>*</p><p>*</p><p>*</p><p>Key Point</p><p>Gender-specific smoking prevalence varies across the world.</p><p>Background</p><p>Worldwide, there are marked differences in smoking prevalence rates between men and women from country to country. For example, in South Africa, the Philippines, China, Iran, and Portugal, smoking prevalence is much lower in women than in men. In contrast, in the United States, Canada, Australia, and Iceland, the prevalence of smoking in men is only slightly higher than that in women.1 </p><p>Overall, the prevalence of smoking in men is declining. However, although smoking prevalence in women is declining in some countries, such as the United States, the United Kingdom, Australia, and Canada, in several southern, central, and eastern European countries, the rate of smoking in women is not in decline or is still increasing.1</p><p>Reference</p><p>1. Mackay J, Eriksen M, Shafey O. The Tobacco Atlas. Second Ed. American Cancer Society Myriad Editions Limited. Atlanta, Georgia, 2006. Also available online at:</p><p>1/Mackay/pp. 98-104, <br />Table A</p><p>1/Mackay/pp. 98-104, <br />Table A</p><p>1/Mackay/ <br />pp 98-105 </p></li><li><p>Smoking Prevalence in Asia</p><p>29.4%</p><p>51.6%</p><p>671,017,000</p><p>India</p><p>39.3%</p><p>48.5%</p><p>46,063,000</p><p>Thailand</p><p>69.0%</p><p>49.9%</p><p>146,860,000</p><p>Indonesia</p><p>53.4%</p><p>51.1%</p><p>958,295,000</p><p>China</p><p>% Men Smoker</p><p>(Source: WHO)</p><p>% Men</p><p>(Source: WHO)</p><p>Population</p><p>(Source: WHO)</p><p>Country</p></li><li>According to the WHO, every 8 seconds a person dies of a smoking-related disease2 Smoking causes premature death in 1 in 2 smokers3Smoking causes over 50 health disorders Smoking causes more than 20 fatal conditions4 <p>2. World Health Organization (2000). Tobacco Kills dont be duped. World No Tobacco Day 31 May 2000. Campaign brochure.</p><p> Last accessed January 2007.</p><p>3. Royal College of Physicians of London. Medical Training on Tobacco. Available online at URL:</p><p> Last accessed February 2007.</p><p>4. Action on Smoking and Health UK. Factsheet no:2. August 2005. Last</p><p>accessed January 2007.</p><p>Consequences</p><p>*</p></li><li><p>Annual Deaths Attributable to Tobacco: Worldwide Estimates</p><p>Canada</p><p>&gt;25%<br /></p><p>Australia</p><p>20%-24%</p><p>UK</p><p>&gt;25% <br /></p><p>Germany<br /> &gt;25%</p><p>China &amp; Taiwan</p><p>10%-14%<br /></p><p>Brazil </p><p>15%-19%<br /></p><p>% of Total Deaths Attributable to Tobacco*</p><p>*Regional estimates in 2000 in men aged &gt;35 years.</p><p>1. Mackay J, Eriksen M. The Tobacco Atlas. Second Ed. World Health Organization; 2006.</p><p>US </p><p>&gt;25%<br /></p><p>Mexico </p><p>15%-19%<br /></p><p>Argentina </p><p>15%-19%<br /></p><p>Spain</p><p>&gt;25%<br /></p><p>Russian Federation</p><p>&gt;25%<br /></p><p>Sweden </p><p>&gt;25%<br /></p><p>Turkey</p><p>&gt;25%<br /></p><p>*</p><p>*</p><p>*</p><p>*</p><p>Key Point</p><p>In some countries, deaths attributable to tobacco account for &gt;25% of total deaths in men aged &gt; 35 years.</p><p>Background</p><p>The World Health Organization estimates that in the year 2000, 25% of total deaths in men aged &gt;35 years in most countries in the Northern Hemisphere (including the United States, Canada, Cuba, Israel, Russia and all European nations) were tobacco related. In these countries, &gt;25% of all men died from tobacco-related disorders. Twenty to 25% of women over the age of 35 died from tobacco-related disorders in the United States, Canada, and Cuba.</p><p>Reference</p><p>1. Mackay J, Eriksen M. The Tobacco Atlas. Second Ed. Geneva, Switzerland: World Health Organization; 2006.</p><p>2/Mackay/ <br />pp 42, 43. </p><p>1/Mackay/ <br />p 36/Figure at bottom; p.37/Figure; <br />p. 40-41/Globe figure</p><p>2/Mackay/ <br />pp 42, 43. </p><p>1/Mackay/ <br />p 36/Figure at bottom; p.37/Figure; <br />p. 40-41/<br />Globe figure</p><p>2/Mackay/ <br />pp 98-105 </p></li><li><p>So Why Do People Keep Smoking?</p><p>Nicotine used to<br />self-medicate<br />withdrawal symptoms5</p><p>5. Adapted from: American Cancer Society. ACS Guide to Quitting Smoking, October 2006. Last accessed February 2007.</p><p>Nicotine used for pleasure, enhanced performance,</p><p>mood regulation5</p><p>Tolerance and physical dependence (cravings) 5</p><p>Abstinence produces withdrawal symptoms5</p><p>*</p><p>5. American Cancer Society. ACS Guide to Quitting Smoking, October 2006. Available online at URL: Last accessed February 2007.</p></li><li><p>Top 10 Reasons For Quitting</p><p>Not Sure and Decline to answer responses not shown and range from less than one-half percent to 1 percent.</p><p>Bottom nine answer choices are not shown and range from 0 to 7 percent</p> Among Asian smokers who have tried to quit, the primary motivation is to improve their own health.<p>Q655: Which of the following describes why youve tried to quit smoking cigarettes?</p><p>Base: Have tried to quit smoking (n=352)</p></li><li><p>Reasons for Being Unable to Quit Smoking</p> The top reason for failing to quit successfully is addiction. <p>Q665: Why do you feel you have been unable to completely quit smoking?</p><p>Base: Have tried to quit (n=352)</p><p>Not Sure and Decline to answer responses not shown and range from 0 percent to 2 percent.</p></li><li><p>Percent Think Only Willpower is Needed</p><p>Not Sure and Decline to answer responses not shown and range from 0 percent to 1 percent.</p> A large majority of Asian smokers think willpower is all that they need to to quit smoking.<p>Base: All respondents (n=500)</p><p>Q761: How strongly do you agree or disagree with the following statements?</p><p>All I need to quit smoking is willpower.</p><p>Agree</p><p>89%</p><p>Disagree</p><p>10%</p></li><li>Quitting smoking is believed to be extremely importantQuitting smoking is believed to be extremely difficult<p>STOP and SUPPORT:<br />Key Finding 1</p></li><li><p>Recording Smoking Habits</p><p>Far fewer smokers who have talked to their doctor about smoking say their doctor records their smoking habits than doctors claim</p></li><li><p>Apa hambatan utama yang dirasakan dokter dalam menolong pasien berhenti merokok?</p><p>3 hambatan utama dalam menghentikan rokok:</p>kurangnya keinginan/kesadaran pasienAdiksipengaruh lingkungan<p>Pfizer Inc. STOP (Smoking:The Opinion of Physicians). 2006</p></li><li><p>Apa yang diperlukan para dokter untuk dapat membantu pasien berhenti merokok lebih baik??</p><p>Menurut mereka, kehadiran suatu obat yang lebih efektif daripada obat-obat yang telah tersedia saat ini akan sangat membantu mereka dalam menolong pasien untuk berhenti merokok</p><p>Pfizer Inc. STOP (Smoking:The Opinion of Physicians). 2006</p></li><li>I have been on Chantix for 2 months! I have slipped a couple times but the cigs tasted terrible! I'm finally learning to cope with out cigs in my life. There are so many other good things to turn to other than nicotine. Chantix has been a miracle for me." ~JJ~ </li><li>"Day 1 thru 7, I said this is NOT going to work. On day 8, I didn't want to smoke. Wow, I could not believe I wasn't screaming at everyone.I have been smoke free for 3 weeks now and am so excited about this medication." ~Rena~<br /></li><li><p>Smoking cessation</p></li><li><p>STRATEGI UNTUK MEMBANTU BERHENTI MEROKOK </p> TINDAKAN 1.ASK : tanyakan penggunaan tembakau dalam setiap kedatangan.Catat semuanya.STRATEGI Hubungkan pemakaian tembakau dengangejala/ penderita. </li><li><p>STRATEGI UNTUK MEMBANTU BERHENTI MEROKOK</p>2.ADVISE: semua perokok harus berhenti Nasehat harus: Jelas : Berhenti merokok kita bantu Berhenti merokok anda lebih sehat Tegas: Berhenti merokok melindungi kesehatan anda di masa depan Personal : Merokok bisa membuat anak anda ikut merokok.</li><li><p>STRATEGI UNTUK MEMBANTU BERHENTI MEROKOK</p>3.ASSESS: perjelas kapan berhenti merokok. Paling lambat 30 hari, Paling baik berhenti sekarang. Bantu diaKalau perlu lakukan intensive intervensi.Lakukan motivasi berulang bila perlu. Bila termasuk kelompok tertentu misal geriatrik/gra-vida, lakukan informasi tambahan</li><li><p>STRATEGI UNTUK MEMBANTU BERHENTI MEROKOK</p>4.ASSIST:Bantu dalam membuat rencana Persiapan berhenti (STAR):Set atur waktuTell beri tahu keluarga/teman/teman kerja.Anticipate dalam masa krisis timbulnya gejala .Remove buang tembakau dari lingkungan.</li><li><p>assist</p> Konseling Jangan merokok meski satu hisapan Faktor apa yang menyebabkan relaps? Antisipasi terhadap triger . Harus lolos. Alkohol hindari. Perokok lain di lingkungan?</li><li><p>assist</p>Petugas membantu semua petugas Lingkungan partner,teman ,teman kerja dan team kesehatan. Penggunaan obat . bupropion ,nicotine gum. nicotin inhalermnasal spay Nicotin patch.Chantix Faktor lain pemerintah .LSM dan klinik siap membantu.</li><li><p>STRATEGI UNTUK MEMBANTU BERHENTI MEROKOK</p>5.ARRANGE : Rancangan untuk follow up baik lewat tilpun atau tatap muka. Waktu : pada minggu pertama, bulan pertama &amp; sesudahnya harus tetap diatur.Tindakan : pujian bila berhasil bila gagal motivasi ulang.(Anderson 2000)</li><li><p>MOTIVASI UNTUK BERHENTI MEROKOK: 5 Rs<br /></p></li><li><p>RE SMOKING </p></li><li><p>OBAT ???</p>SIAPA YANG PERLU ? SEMUA KECUALI PEROKOK &lt; 10 HAMIL ADOLESCENTOBAT LINI PERTAMA? BUPROPION SR, NICOTIN GUM/ NASAL SPRAY/ PATCH. chantixPEMILIHAN OBAT ? BANYAK FAKTOR HARUS DIPERHATIKAN.PEROKOK RINGAN ? PENGGANTI NIKOTEN </li><li><p>STOP and SUPPORT: <br />Summary </p>Smokers and doctors agree that quitting smoking is important but toughEnormous communications gap between doctors and smokersPrevents smokers receiving optimal smoking cessation supportDoctors want improved training as well as better tools and resources to help smokers quit</li><li><p>Summary</p>Smoking prevalence and attributable deaths are enormous and in some areas increasing Smoking is leading preventable cause of disease and premature deathQuitting improves health outcomes and can reverse disease progression<p>*</p><p>*</p><p>*</p><p>*</p></li><li><p>62</p><p>24</p><p>18</p><p>18</p><p>16</p><p>16</p><p>8</p><p>7</p><p>7</p><p>17</p><p>020406080100</p><p>Concern it would negatively affect long term health</p><p>I was diagnosed with a health problem.</p><p>Concern about affecting others' health</p><p>I felt pressure from family and friends.</p><p>It became too expensive.</p><p>I was making a life change.</p><p>It negatively affected my appearance.</p><p>It was too difficult to find places that allowed</p><p>smoking</p><p>It negatively affected my image</p><p>Other</p><p>% of respondents</p><p>36</p><p>24</p><p>20</p><p>18</p><p>11</p><p>7</p><p>5</p><p>5</p><p>5</p><p>5</p><p>4</p><p>3</p><p>3</p><p>3</p><p>2</p><p>1</p><p>39</p><p>020406080100</p><p>Cravings too strong.</p><p>Withdrawal symptoms too problematic.</p><p>Don't think my smoking is a problem.</p><p>Enjoy smoking too much.</p><p>Not happy with side effects.</p><p>Don't know which treatment would work best.</p><p>Treatment I tried didn't work.</p><p>Doctor has never raised the issue.</p><p>Don't have enough family/friends support.</p><p>Feel pressure to continue smoking from family/friends.</p><p>Feel pressure to continue smoking from co-workers.</p><p>Don't know where to turn for help.</p><p>Don't have enough support from doctor.</p><p>Feel pressure to continue smoking from employer.</p><p>Don't have enough support from co-workers.</p><p>Don't have enough support from employer.</p><p>Other</p><p>% of respondents</p><p>7</p><p>3</p><p>16</p><p>73</p><p>0%</p><p>20%</p><p>40%</p><p>60%</p><p>80%</p><p>100%</p><p>Strongly DisagreeSomewhat DisagreeSomewhat AgreeStrongly Agree</p><p>26</p><p>0</p><p>10</p><p>20</p><p>30</p><p>40</p><p>50</p><p>60</p><p>70</p><p>80</p><p>90</p><p>100</p><p>"My doctor records my smoking habits"</p><p>percent agree with statement</p><p>71</p><p>0</p><p>10</p><p>20</p><p>30</p><p>40</p><p>50</p><p>60</p><p>70</p><p>80</p><p>90</p><p>100</p><p>"I record my patients' smoking habits"</p><p>percent agree with statement</p></li></ul>