1. The Pharmacist’s Role in Ending the Tobacco Pandemic Alan Blum, MD Auburn University Harrison School of Pharmacy February 18, 2011

3. DEATHS FROM CIGARETTE SMOKING IN US SINCE 1964 12,000,000

6. Smoking Prevalence

7. CAUSES OF DEATH Heart disease Cancer Stroke COPD Accidents Diabetes

8. MARLBORO’S MYOCARDIAL MAYHEM ↑ oxygen demand ↓ angina threshold ↓ exercise performance ↑ recurrent infarction

9. CAMEL’S CORONARY CONSEQUENCES Adverse lipid profile Altered hematologic factors Direct arterial wall effects Elevated blood pressure

12. Cancer Death Rates for Men, US, 1930-2005

13. Cancer Death Rates for Women, US, 1930-2005

15. COPD 5% of US population 80% caused by smoking 4th leading cause of death

16. DIABETES: 3x Cardiovascular Mortality

17. SMOKING + DIABETES: 11x Cardiovascular Mortality

18. OTHER TOBACCOGENIC PROBLEMS Osteoporosis Hip fractures Early menopause Macular degeneration Peptic ulcer disease

20. SECONDHAND SMOKE Lung cancer: 3,000 deaths/year Heart disease: 40,000 deaths/year Asthma: 2 million visits/year

21. SMOKING IN PREGNANCY Low birthweight Preterm labor Spontaneous abortion Abruptio placenta Placenta praevia Premature rupture of membranes

22. EFFECTS ON CHILDREN SIDS Asthma Bronchitis Otitis media Pneumonia

26. INFLUENCES Peers Parents Propaganda

45. SMOKING CESSATION 44.5 million smoke 77% want to stop 40% try each year 5% succeed

46. MARKERS OF ADDICTION >20 Cigarettes /day Smoke upon awakening Psychiatric condition Alcohol dependence

47. BEHAVIOR MODIFICATION Identify situations Choose oral substitutes Do five-minute plan: Postpone Inhale Reconsider

48. SMOKING’S MYTHS Relieves stress Keeps weight down Low-tar, filters, are safer

49. THE PRODUCT Filter Low tar Lights Menthol

50. MONEY LOST Number of packs/day x Cost/pack x 365 days/year X Number of years smoking Total cash lost (plus interest)

51. INHALATION COUNT Number of cigarettes/day x 10 inhalations/cigarette x 365 days/year x Number of years smoking Total inhalations

52. BENEFITS OF STOPPING 1 day: ↓ MI risk 1 year: ↓ Stroke risk 50% 10 years: Stroke risk of non-smoker 15 years: CHD risk of non-smoker

53. COSMETIC BENEFITS Fresher breath, clothing Whiter teeth, nails Endurance

54. NICOTINE REPLACEMENT THERAPY Gum (Nicorette) Transdermal patch (Nicoderm) Inhaler (Nicotrol) Lozenge (Commit) Electronic cigarette?

55. ADJUNCTIVE PHARMACOTHERAPY Bupropion Clonidine Nortriptyline Verenicline Rimonabant

57. SMOKING PREVENTION Increase cigarette taxes Restrict teen access Clean indoor air laws Ban advertising Educate on TV, radio, internet

59. SHIFTING THE FOCUS Substance -> Product Effects -> Promotion User -> Pusher

60. AMERICAN TOBACCO COMPANIES Philip Morris USA Reynolds-American Inc. Lorillard Inc. United States Smokeless Tobacco Liggett Vector Brands Inc. Swedish Match Imperial Tobacco

61. CANCER’S 7 WARNING SIGNS Philip Morris USA Reynolds American Inc Lorillard Inc. United States Smokeless Tobacco Liggett Vector Brands Inc. Swedish Match Imperial Tobacco

74. Alan Blum, M.D. Professor and Gerald Leon Wallace Endowed Chair in Family Medicine, College of Community Health Sciences, School of Medicine, The University of Alabama Director, The University of Alabama Center for the Study of Tobacco and Society ablum@cchs.ua.edu

112. STRATEGIC WEAPONS Map Calendar Camera

136. Alan Blum, M.D. Professor and Endowed Chair in Family Medicine, The University of Alabama Director, The University of Alabama Center for the Study of Tobacco and Society ablum@cchs.ua.edu