HEALTH PROMOTION AND EDUCATION

What is health?

First proposed by WHO in 1946:

Health is a state of complete physical, mental,

and social well-being, and not simply the absence
of disease or infirmity

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Health Promotion:
the science and art of
helping people have
more control over
factors that affect their
health so that they can
move towards a state
of optimal health

- includes a balance of
physical, social,
intellectual, emotional,
occupational, and
spiritual health.

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- Mid-19th century - largest cause of death = tuberculosis
- Dietary diseases: beri-beri
- Infectious diseases: smallpox, diphtheria, yellow fever

- Airborne infectious diseases: pertusis, measles

- Via food & water: cholera, dysentery
- 20th century:
→  life expectancy
1850 : Man = 40, women = 42
1984 : Man = 72, women = 78

- About 2/3 of death in the US:

1. Heart disease
2. Cancer
3. Stroke
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- Many diseases are caused by behaviour
that is entirely voluntary
- Factors predisposing to CHD:
1. Smoking
2. High plasma cholesterol
3. High-fat diet
4. High-sugar content

- Others:
1. Obesity
2. High salt intake
3. Excessive alcohol consumption
4. Lack of ex.

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Health Practices

1. Sleeping > 8 hours/ day.

2. Eating breakfast almost everyday.

3. Never or only occasionally eating between meals.

4. Being at/near the appropriate weight for their height.

5. Never smoke cigarettes.

6. Never/ moderately drinking alcohol.

7. Regular physical activity.

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Why don’t people do what’s good for them?

1. Less healthful behaviour often brings immediate pleasure.

2. Long-range -ve consequences
seem remote, both in time
and in likelihood.
3. Social pressure
4. Some behaviour can become very strong habits:
physical addiction/ psychological dependence.
5. Unaware of the danger.
6. Unaware of how to change their behaviour.

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PREVENTION IS BETTER THAN CURE

Primary Prevention
 stop people from developing ill-health or a disease.

Secondary Prevention
 identify & treat an illness/ injury early with the aim of
stopping or reversing the problem.
 prevent subsequent recurrences/ relapses.

Tertiary Prevention
 after disease has occurred, advice offered to influence
patient’s lifestyle & progression of the condition, &
on appropriate use of their medicines.
 try to contain/retard the damage
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Factors Which Influence The Effectiveness of
Health Education:

1. Unwillingness to understand/ recognise the risks

of some of the activities.
2. Social and peer pressure.
3. Advertising.
4. Fatalism
 “It won’t happen to me”
5. Little or no immediate
effect.
6. Age: People < 40,
little interest in their own health.
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METHODS OF DISSEMINATING HEALTH
EDUCATION:

1. TV/ Radio
2. Books/ magazines
3. Health talks and seminars
4. Small group discussion
5. Discussion between health
educators & clients
6. Pharmacists
7. Internet
8. Handphones
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Weight Management

Requirements

-Good understanding of obesity

-Dieting
-Exercise
-Behaviour modifications
-Pharmacotherpay
-Evidence-based natural therapy
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What can be done:

-BMI
-Waist circumference measurements
-Total body fats/ visceral fats
-Explain risk of obesity/overweight
-Recommend a weight reduction programme
-Follow-up and monitoring

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 SMOKING TOBACCO

 Largest preventable cause

of dis. & premature death.
 Originally promoted as a
recreational habit

 A form of drug dependence

- hazardous to health & anti-social.
 UK annual cost of smoking to health service, > £500m
 90% of death: bronchitis, chronic obstructive airway
diseases, and related illness.
 90% of deaths caused by lung cancer.
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 Smoking is a Disease
• Tobacco smoking - classified as a Mental and
Behavioral Disorder under the WHO’s
International Classification of Diseases (ICD-
10) coded as F17.2

• Other ICD-10 coding: Z50+, Z70+, Z80+

•  contacts with health services, passive smoking and
hazards related to family history

• Tobacco users are nicotine addicts

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TOBACCO
- > 7000 cpds in tobacco smoke, 70 carcinogens:
(1) gaseous phase
(2) particulate phase

- Conc. of constituents inhaled

by smokers from a
cig. depends on:

(1) brand
(2) cigarette length
(3) filter characteristics
(4) paper characteristics
(5) smoking behaviour
(6) temp.
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- Two types of smoke generated:
(1) Mainstream smoke
 usually filtered & lungs retain 85 -99% of the
particulate matter and about 55% of CO.

(2) Sidestream smoke

 environmental tobacco smoke
 diluted by air but unfiltered &
contain much higher conc. of
all constituents.

- Most important constituents:

(1) Tar
(2) Carbon monoxide
(3) Nicotine
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NICOTINE
 major constituent of the particulate phase.
 produces rapid & powerful physiological effects
which probably leads to dependence.
 activate both CNS & symp. nervous system.
  HR & BP  stimulates the body
 crosses placenta & low conc. in breast milk.
 damage bld. vessels, ↓ prostacyclin conc. →
vasoconstriction &  platelet aggregation.

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- Cigar & pipes?

- Conc. of nicotine can be altered by:

(1) conc. of smoke/ air
(2) inhalation depth
(3) no. of cigarettes smoked
(4) puffing intensity
(5) puffing rate
(6) vol. of inhaled smoke

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Nicotine Regulation
- Main metabolites: cotinine & nicotine-N-oxide
- Cotinine used as a marker to determine nicotine intake
- can be measured in saliva, urine & bld., also in cervical
mucous secretions, long t ½ (10 - 20H).

Relationship of smoking to lung cancer appeared

related to:
1. Duration of smoking
2. Depth of inhalation
3. No. of cigarettes smoked daily
4. No. of puffs
5. Starting age of smoker.

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Obstetric Disorders:
- Lower birth weight
- ↑ perinatal mortality
- Pre-term delivery
- Spontaneous abortion ( risk 2X that of non-smokers)
- Placental malfunction -  incidence of antepartum
haemorrhage & premature mem. rupture.
- Postnatal development -  rate of intellectual development
- Higher tendency to discontinue breast feeding
- Infantile colic.

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WHO SMOKES?
1. Age: highest bet. 20 - 45
2. Gender: “Virginia Slims”
3. Sociocultural factors:
- family & work place
- % of people who smoke generally  with 
in edn. , income, & job prestige.

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 in smoking tended to occur if :

1. Role model - at least one parent smoked

2. Rebelliousness - perceived their
parents as unconcerned / even
encouraging about their smoking
3. Has siblings/ friends who
smoked
4. Socialised with friends very
often
5. Peer pressure to smoke
6. Smoker’s image –
held +ve attitude about smoking
7. Did not believe smoking would
harm their health.
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Why continue to smoke?
1. +ve effect
2. reduce -ve effect
3. a habitual/ automatic behaviour
4. may develop a psychological dependence
5. biological factors - genetic

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PASSIVE SMOKING/ Second Hand Smoke

Smoke that comes from the burning end of a cigarette

(side-stream smoke)
+
Smoke that is exhaled by smoker while smoking
(main stream smoke)

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Extent of passive smoking depends on:
1. Distance from the smokers
2. Duration of exposure
3. Number of cigarettes
4. Size of the room
5. Ventilation efficiency

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Secondhand Smoke → Serious Health Risks

- children are still developing

physically, - higher breathing
rates than adults, lungs are still
developing

- little control over their indoor

environments.

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 Health Effects of second hand smoke on
Children
BRAIN
• Possible assn. with brain tumors & long term mental effects
EARS
• Chronic otitis media
RESPIRATION AND LUNGS
• Respiratory infections (bronchitis / pneumonia)
• Asthma induction / exacerbations
• Chronic respiratory symptoms (wheezing / cough / breathlessness)
• Decreased lung function

HEART
• Deleterious effects on oxygen, arteries

BLOOD
• Possible association with lymphoma
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 Harm Caused by Second Hand Smoke
Health Effects On Adult

HAIR
BRAIN AND MENTAL EFFECTS • Smell
• Strokes
EYES
NOSE • Sting, water and blink more
• Irritation

HEART RESPIRATION AND LUNGS

• Harms, clogs, weakens arteries • Lung cancer
• Heart attack, angina • Worsening of pre-
existing chest
problems (asthma/
UTERUS COPD/emphysema)
• Low birth weight / small
for gestational age
BURNS
• From fires caused by tobacco

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Effects of passive smoking on health:

1. Irritation of eyes & nose

2. Chest tightness
3. Coughing
4. Headache
5. Nausea
6. Wheezing

- Chronic effects: ↑ risk of heart disease, resp.tract infections,

asthma, & emphysema.

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Measures to eliminate passive smoking:

1. No-smoking policies at work & in public places.

2. ↑ public awareness of the health risks.

3. Legislation.
4. Recognition by smokers of the risk of passive
smoking.
5. Social unacceptability.

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Strategies to reduce tobacco smoking

Primary prevention
1. Health education/ campaign
2. Cigarette modification
3. Tobacco taxation
4. Legislation to restrict
smoking in public places
5. Ban tobacco advertising
6. Ban sales to young people
7. Promote no-smoking as attractive
8. School-based activities
9. Non-smokers clubs
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10. Health warnings on tobacco packs
Secondary Prevention

- Encourage smokers to quit - prevent smoking-related dis.

- Focused on immediate effect: cost, health problems
- Ask past quit experience
- Set a quit date : 2 -4 weeks ( a signt. date)
- Tell family, friends, etc.
- Alcohol can cause smoking relapse

- Basic principles for changing own behaviour

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Discuss withdrawal symptoms:

1. Cough – drink plenty of fluids

2. Giddy – for short period
3. Headache – for short period
4. Numbness/muscle pain → exercise
5. Constipation, nausea, flatulence – for short period
→ increase dietary fibre
6. Lack of conc., sleeplessness, restlessness
– for short period

Fagerstrom score > 4 or smoking > 20 sticks/day

→ use NRT unless CI

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 Fagerström’s Test For Nicotine Addiction
Test Questions Answers Points
1. How soon after you wake up do you smoke your Within 5 minutes 3
first cigarette? 6 – 30 minutes 2
31 – 60 minutes 1
After 60 minutes 0

2. Do you find it difficult to refrain from smoking in Yes 1

places where it is forbidden e.g. workplace, No 0
restaurants, public transport?

3. Which cigarette would you most hate to give The first one in the morning 1
up? All others 0

4. How many cigarettes a day do you smoke? 10 or less 0

11 – 20 1
21 – 30 2
31 or more 3

5. Do you smoke more frequently during the first Yes 1

hours after waking than during the rest of the No 0
day?

6. Do you smoke if you are so ill that you are in Yes 1

bed most of the day? No 0

Total Score : 1 – 3 = minimal dependence

4 – 7 = moderate dependence
8 –10 = high dependence
 Din’s Quick Test for Nicotine Addiction

1. Do you smoke more than 20 cigarettes per day?

2. Do you smoke your first cigarette within 20 mins

of waking?

Both answers “No”  Low dependence

One “Yes” and the other “No”  Moderate dependence
Both answers “Yes”  High dependence
Quitting

- 60% success rate

- (1) “Cold turkey”
(2) Oral substitutes
(3) Alone/ buddy system
(4) Commit themselves
(5) Provide material rewards/ punishment

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Non-Pharmacological Methods to
overcome Nicotine withdrawal:

- Delay
- Take deep breath
- Drink water
- Do something
- Take some food
- Take bath or wash hands
- Do light exercise

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Treatment to stop smoking

1. BEHAVIOURAL METHODS
(a) Aversion strategies
electric shock
imagined negative scenes
cigarette smoke itself:
(a) Smoke holding
(b) Focused smoking
(c) Satiation
(d) Rapid smoking

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(b) Self-management strategies

(c) Group therapy

2. OTHER METHODS
- Hypnosis
- Systematic desensitization
- Restricted Environmental Stimulation Therapy
(REST)

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Higher success rate if include:

1. Biochemical analysis
2. Daily telephone call
3. Recommended by the physician

Smoking Relapse

1. Stress
2. Social support
3. Beliefs and attributions about themselves
4. Weight gain

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Treatment to stop smoking

- DRUGS

- Nicotine replacement - chewing gum 2mg & 4mg

- Bupropion
- Varenicline

- for those smoking > 20 cigarettes/day and no CI

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 Bupropion 150mg (Zyban®)
• An antidepressant
• Mode of action not clear
– may involve an effect on NA
& dopamine neurotransimission
• Start for 1-2 weeks before quit date to reach a high
enough level in the blood.
• Dosing: Begin with 150 mg am x 6/7, then 150 mg BD.
Max per dose 150mg, per day 300mg, 8H
• Period of tx = 7-9 weeks
• C/I: Hist. of seizures, eating disorders, CNS tumours,
acute symptoms of alcohol/BDZ withdrawal
• D/I: Antipsychotics, quinolones, sedating AHs,
systemic steroids, theophylline, tramadol. 53
 Varenicline (Champix®)
• A selective nicotine receptor partial agonist
• Varenicline has 2 strengths:
– 0.5 mg (a white tablet )
– 1.0 mg (a blue tablet)

• Start tx 1-2 weeks prior to a quit attempt or stop date.

– Take after meals with a full glass of water to reduce
associated nausea.
• 12-week course recommended, another 12/52 to
ensure long-term abstinence.

• Normally as an adjunct and as part of a prog. of

behavioural support
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ROLE OF THE PHARMACIST

1. Identify smokers
2. Distribute health education materials
3. Develop no-smoking attitude
4. Participate in National No-smoking Days
5. Advise by example
6. Should not sell tobacco/tobacco products
7. Knowledgeable
8. Emphasize all the benefits
of not smoking
9. Provide appropriate advice

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CSCSP
Certified
Smoking
Cessation Service
Provider

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Vaping : E-cigarette
e-cigarette market - estimated that there are between
400,000 and 1.25 million vapers in Malaysia out of a
smoking pop. of about 5 millions.

Contains a mix of liquid nicotine with propylene glycol or

vegetable glycerine, and flavoring. Also called vape juice, e-
juice and e-liquid, heats up inside the cartridge to produce
vapour.

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