BAHAYA ROKOK

Permasalahan Rokok di Dunia

Merupakan penyebab kematian terbesar di dunia yang dapat dicegah4.9 juta orang meninggal akibat rokok di th 2000 (50% di negara berkembang); dan akan meningkat 2 x lipat di th 2020 (70% di negara berkembang)Di seluruh dunia terdapat kurang lebih 1.25 miliar perokok, 800 juta ada di negara berkembang(Bettcher, FCTC WHO, Dec 2003)

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Data Rokok di IndonesiaHampir 70% pria Indonesia merokok1Total perokok di Indonesia berjumlah 62.800.0002 70% perokok mulai merokok sebelum usia 19 tahun3,412,77 % sudah merokok sejak SD3,4*2. http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=476&Itemid=23. http://www.pdpersi.co.id/?show=detailnews&kode=957&tbl=artikel4. http://www.tempointeraktif.com/hg/nasional/2007/05/30/brk,20070530-100967,id.html

1. WHO 2002

RokokTembakau yang dihisap: 4000 zat kimia, 250 racun atau bersifat karsinogenik1

1. National Toxicology Program. 11th Report on Carcinogens; 2005. Available at: http://ntp-server.niehs.nih.gov. 2. Mackay J, Eriksen M. The Tobacco Atlas. World Health Organization; 2006. 3. Harvard Health Letter. May 2005.

Zat kimia pada tembakau2Juga ditemukan diHidrogen SianidaGas BeracunAcetoneCatButaneBahan bakar pemantikArsenicRacunCadmiumAki mobilCarbon monoxideAsap knalpotAmoniaPembersih lantaiDDTInsektisidaMetanolBensin roketNaftalenKamperVinil KloridaPlastikToluenePelarut industri

Kandungan UtamaNikotin zat yang menyebabkan ketagihan

Tar tidak banyak berbeda dengan kandungan tar jalan raya

Karbon monoksida asap yang keluar dari knalpot mobil, mengurangi kandungan oksigen yang diambil

Bahan karsinogenik lebih 30 bahan telah dikenal pasti menyebabkan kanker

Dampak Jangka Pendek MerokokDenyut nadi dan tekanan darah meningkatPeristaltik usus meningkatNafsu makan menurunSirkulasi darah kurang baik (efek vasokonstriksi)Suhu ujung-ujung jari (tangan dan kaki) menurun Berkurangnya rasa mengecap dan membauMewarnai gigi dan jari (kuning sampai hitam)

*Dampak Jangka Panjang RokokKankerParu LaringMulut/faring UsusGinjal Mulut rahimLeukemia(AML, ALL, CLL)2-4EsofagusPankreasKandung kemihPenyakit LainLuka lama sembuhFraktur pinggulDensitas tulang yang rendahKatarakUlkus peptikKardiovaskulerPenyakit Jantung Iskemik Stroke-demensia vaskuler5 Penyakit pembuluh darah tepi6Aneurisma Aorta AbdominalSaluran PernapasanPPOKPneumoniaAsthma yang tidak terkontrolAlat ReproduksiBerat Badan Lahir RendahKomplikasi kehamilanInfertilitas ImpotensiKematian Janin MendadakDampak Jangka Panjang RokokIn patients who are Helicobacter pylori positive. AML = Acute myeloid leukemia; ALL = acute lymphocytic leukemia; CLL = chronic lymphocytic leukemia; COPD = chronic obstructive pulmonary disease. 1. Surgeon Generals Report. The Health Consequences of Smoking. 2004; 2. Sandler DP et al. J Natl Cancer Inst. 1993;85:1994-2003; 3. Crane MM et al. Cancer Epidemiol Biomarkers Prev. 1996;5:639-644; 4. Miligi L et al. Am J Ind Med. 1999;36(1):60-69; 5. Roman GC. Cerebrovasc Dis. 2005;20(Suppl 2):91-100; 6. Willigendael EM et al. J Vasc Surg. 2004;40:1158-1165.

Perbedaan Paru-paruPerokok vs Non-perokokGambar Paru PerokokGambar Paru Bukan Perokok

Gambar Paru Perokok

Kematian Pada Perokok.70% akibat penyakit paru kronik, bronkhitis kronik, dan emfisema40% akibat stroke90% akibat kanker paruData WHO 2004 :Kematian akibat merokok sudah mendekati 5 juta kasus per tahun

Resiko bagi Perokok PasifAsap Samping (asap dari pembakaran ujung rokok)

Perokok pasif Resiko terkena kanker paru dan penyakit jantung bertambah 20-30%Ibu hamil Resiko mengalami proses kelahiran yang bermasalah (bayi lahir dengan berat badan rendah, lahir mati dan cacat lahir)Anak anak Lebih mudah terkena infeksi saluran pernafasan

Efek Rokok Pada Perokok PasifAsap yang dihirup 2 kali lebih banyakKadar bahan berbahaya yang dihisap, lebih tinggi :> CO, 2-4 kali lebih tinggi> Nikotin, 2-3 kali lebih tinggi> Nitrosamin, 50 kali lebih tinggiKemungkinan terkena kanker paru 30% lebih tinggiKanker paru pada istri perokok 20-50% lebih tinggiKematian istri perokok akibat penyakit jantung koroner lebih tinggiBatuk pilek pada anak perokok 20-80% lebih seringBronkhitis pada anak perokok 2 kali lebih sering

Bahaya Asap Rokok Terhadap anak-anakMerokok berdekatan dengan kanak-kanak meningkatkan risiko anak-anak mengalami: Asma Sering pilek Radang telinga Bronkitis Kerap Ke Klinik Menjadi perokok

Efek Rokok Pada WanitaEfek Kosmetika : Kulit keriput, rambut kaku, mata merah, bau tidak sedap, gigi berwarna kuning, suara serak.

Kesuburan berkurang, menopause dini, kalsium tulang menurun menyebabkan tulang keropos dan mudah patah

Merokok pada kehamilan : menyebabkan keguguran, bayi lahir mati atau lahir cacat.

Dampak Asap Rokok bagi Orang Lain

84% perokok dewasa merokok di rumah (2004) Dari 48.9% penduduk semua umur yang terpapar asap rokok orang lain di rumah (Susenas 2001): 66% (65 juta) PEREMPUAN 70% populasi (43 juta) ANAK-ANAK 0-14 th

81% remaja 13-15 th terpapar di tempat2 umum 64% di dalam rumah (GYTS, 2006)

Perbandingan Bahan dalam Asap Aliran Utama dan Asap Aliran SampinganNikotinAsetonTarHidrogen sianidKarbon monoksidaToluenBenzenAnilinNitrosamin (bahan karsinogen) 2 kali ganda2-5 kali ganda3 kali ganda4-6 kali ganda5 kali ganda6-8 kali ganda10 kali ganda30 kali ganda50 kali gandaAsap Aliran Utama vs Asap Aliran Sampingan

Kanker Bibir

4000 bahan kimia beracun, 69 penyebab kanker PADAT: NIKOTIN (ZAT ADIKTIF) TAR(kumpulan partikel pdt penyebab kanker) GAS: CO (mengikat sel darah merah mengganti O2) Gas-gas berbahaya lainKandungan Asap Rokok

*Sulit Berhenti Merokok : Karena Ketergantungan Nikotin

Bagaimana Nikotin Bekerja di Otak?

Efek Yang DitimbulkanPenggunaan tembakau yang berlangsung lama dapat mengakibatkan paru-paru, jantung dan pembuluh darah menjadi rusak, dan kanker. Penyakit-penyakit yang ditimbulkan dari merokok seperti kanker paru-paru, emphysema (penyakit bengkak pada paru-paru karena pembuluh darah yang kemasukan udara), serangan jantung, stroke. Karena pengaruh nicotine di keseimbangan sistem syaraf, merokok atau mengunyah tembakau mengecilkan pembuluh darah, menaikkan detak jantung dan tekanan darah, menurunkan nafsu makan, meningkatkan kewaspadaan, menghasilkan euphoria yang sangat ringan, setengah mengurangi indera perasa dan penciuman, dan mengganggu paru-paru.

Akibat Nikotin

* 25% kematian akibat jantung koroner* Serangan jantung 3 kali lebih sering* Serangan jantung di usia < 50 tahun

Dysphoric / mood yang jelekInsomniaFrustasiMudah Marah & CemasSulit BerkonsentrasiKurang SabarTidak TenangDenyut nadi meningkatNafsu makan/ berat badan yang bertambahBerhenti merokok itu sulitGejala Putus Nikotin biasa disertai dengan 4 atau lebih tanda-tanda seperti:

70 % perokok ingin berhenti merokok tetapi.

Hughes JR. New treatments for smoking cessation. CA Cancer J Clin. 2000;50:143-151FoulisJ, Burke M, Steinberg M, William JM, Ziedonis DM. Advances in pharmacotherapy for tobacco dependence. Expert Opin Emerg Drugs. 2004;9:39-53Department of Health. Smoking kills: a White Paper on Tobacco. London, England: Stationery Office; 1998

HANYA 5%-10% yang dapat melakukannya tanpa bantuanFaktanya

Gejala-gejala yang mungkin muncul bila seseorang berhenti merokok1,21. Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006: Available at http://psychiatryonline.com. Accessed November 7, 2006. 2. West RW, et al. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited. 2004.Sulitnya berhenti merokok tanpa bantuan

Sekarang ada terobosan TERBARU, solusi berhenti merokok PERTAMA di Indonesia: Varenicline Tartrate*

**Mari Hidup Sehat Tanpa Rokok!TERIMA KASIH

******Key PointTobacco smoke exposes the body to 250 toxic or carcinogenic chemicals.Vinil klorida plastik

BackgroundTobacco and tobacco smoke are known to be carcinogenic in humans.Tobacco smoke contains at least 4000 chemicals, at least 250 of which are toxic or carcinogenic.1 For example, tobacco smoke contains irritants, such as acetone, ammonia, and toluene, found in paint stripper, cleaners, and solvents respectively; toxic heavy metals, such as cadmium, used in car batteries, and arsenic, used in poisons; and carbon monoxide, which is a hazardous component of exhaust fumes.2 Although it is addictive, the nicotine found in tobacco is not a known carcinogen.3 All cigarettes are toxic: the US Surgeon Generals report noted that smoking cigarettes with lower yields of tar and nicotine provides no health benefit.4

References1. National Toxicology Program. 11th Report on Carcinogens; 2005. Available at: www.cdc.gov/tobacco/ets. 2. Mackay J, Eriksen M. The Tobacco Atlas. Second Ed. Geneva, Switzerland: World Health Organization; 2006.3. Harvard Health Letter. May 2005. 4. US Department of Health and Human Services. The Health Consequences of Smoking. A Report of the Surgeon General. Atlanta, Georgia: 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; 2004. 4/SGR/p. 25/col2/21/NTP/p. 1/col2/4,52/Mackay/p34/Deadly Chemicals3/Harvard/p.2/3/figure1/NTP/p. 1/col 2/4,5; p. 3/col 1/3; p. 4/col 2/2; p. 5/col 2/42/Mackay/ p. 34/ Deadly Chemicals4/SGR /p. 25/ col2/23/Harvard/ p.2/3/ figure**Cigarette smoke is an aerosol composed of volatile agents in the vapor (gas) phase and of semi-volatiles and non-volatiles in the particulate (solid) phase. The volatile phase accounts for about 95% of the weight of the cigarette smoke and contains some 400500 gaseous compounds, including nitrogen, CO, CO2, ammonia, hydrogen cyanide and benzene. There are about 3,500 compounds in the particulate phase a major component is the alkaloid nicotine. The particulate matter without the alkaloids and the water is called tar. Cigarette tar contains polynuclear aromatic hydrocarbons, N-nitrosamines and aromatic amines, which have been identified as carcinogens.1,2Many approaches can be used to reduce the concentrations of certain cigarette smoke constituents. These include filters, changes in paper porosity, and using different tobacco blends of reconstituted tobacco or expanded tobacco. Also, nicotine, tar and CO yields depend extensively on the way the smoker smokes, in particular, the volume of each puff and the interval between puffs. Yields of other smoke chemicals may also be influenced by smoking patterns.3

References:1. Hoffmann D, Hoffmann I. The changing cigarette, 19501995. Journal of Toxicology and Environmental Health 1997; 50:307364. 2. Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. 2000; pp. 2766.3. Hoffmann D, Djordjevic MV & Brunnemann KD. Changes in cigarette design and composition over time and how they influence the yields of smoke constituents. In Monograph 7. The FTC cigarette test method for determining tar, nicotine, and carbon monoxide yields of US cigarettes. Report of the NCI Expert Committee 1996. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health.

*************Women may have greater withdrawal symptoms.More than 90% of young people who use tobacco daily experience at least one symptom of withdrawal. Smoking cessation (nicotine cessation) produces a well-defined withdrawal syndrome characterized by four or more of the following signs: dysphoric or depressed mood insomnia irritability, frustration, or anger anxiety difficulty concentrating restlessness or impatience decreased heart rate increased appetite or weight gain

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)TM. 4th ed. 1994.

**Key PointNicotine withdrawal syndrome is characterized by a combination of physical and psychological conditions, which make smoking difficult to treat.

BackgroundRecognizing that nicotine withdrawal results in clinically significant impairment in a persons ability to function, the American Psychiatric Associations Diagnostic and Statistical Manual (DSM) classifies these symptoms as a distinct condition: nicotine withdrawal syndrome. The symptoms of nicotine withdrawal syndrome can develop rapidly after a smoker tries to quit, and characteristics include the psychological symptoms of dysphoric or depressed mood; anxiety; irritability, frustration, or anger; and restlessness or impatience and the physical symptoms of insomnia, increased appetite/weight gain, and difficulty concentrating. Although present in those who use other nicotine-containing products, the manifestations of nicotine withdrawal syndrome are more intense in individuals who smoke compared with those who use other forms of tobacco. The rapidity of onset and intensity of withdrawal syndrome in smokers may suggest a greater dependence on tobacco.1

The typical duration of most of these symptoms is 10 weeks. Although anxiety is listed as a classic symptom of nicotine withdrawal in the DSM, additional information is available about the relationship between anxiety and smoking. Some evidence suggests that while smokers increase their smoking when stressed, smoking does not help relieve the stress. As smokers stop smoking, levels of stress and anxiety actually decrease.2

References1. Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006: Available at http://psychiatryonline.com. Accessed November 7, 2006.2. West R, Shiffman S. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited. 2004.1/DSM IV-TR p 1 of printout, table 292.0

2/West/ p 37/Table;p. 39, 21/DSM IV-TR p 1 of printout, table 292.0,

2/West/ p 37/Table3p. 39, 2

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