Tütün ile İlişkili Bozukluklar
Özet
Tütün kullanımı, dünya genelinde kafeinden sonra en yaygın ikinci psikoaktif madde kullanımı olup önlenebilir morbidite ve mortalitenin en önemli belirleyicilerinden biridir. Sigara dumanında bağımlılığa yol açan temel bileşen nikotin olsa da dumanın içinde psikoaktif ve kanserojen özelliklere sahip 7.000’den fazla farklı bileşik yer almaktadır. Küresel verilere göre bir milyardan fazla insan sigara içmekte ve bu bireylerin en az yarısının tütün ilişkili komplikasyonlar nedeniyle erken yaşta hayatını kaybetmesi beklenmektedir. Türkiye’de ise yetişkin nüfusun %31,6’sı (yaklaşık 19,2 milyon kişi) tütün ürünü kullanmaktadır. Tütün bağımlılığı, genetik yatkınlıklar (~%70 oranında kalıtımsallık), nikotin metabolizma hızı, çevresel faktörler ve psikiyatrik komorbiditelerle şekillenen karmaşık bir klinik tablodur. Klinik tanılamada DSM-5 ve ICD-10 kriterlerinin yanı sıra Fagerström Nikotin Bağımlılık Testi gibi ölçeklerden yararlanılmaktadır. Bağımlılığın tedavisinde, FDA onaylı birinci basamak farmakoterapiler (nikotin replasman tedavileri, vareniklin, bupropion) ve davranışsal danışmanlık kombinasyonları bırakma başarısını 2-3 kat artırmaktadır. Ayrıca pasif ve üçüncü el sigara dumanına maruz kalma riskini azaltmaya yönelik toplumsal vergilendirme, dumansız hava sahası yasaları ve reklam yasakları gibi kapsamlı tütün kontrol politikaları da hayati önem taşımaktadır.
Tobacco use is the second most common psychoactive substance use worldwide after caffeine and stands as a major determinant of preventable morbidity and mortality. Although nicotine is the primary component responsible for dependence, tobacco smoke contains more than 7,000 different compounds, some of which are psychoactive and carcinogenic. Globally, over one billion people smoke, and at least half of them are expected to die prematurely from tobacco-related complications. In Turkey, 31.6% of the adult population (approximately 19.2 million people) currently use tobacco products. Nicotine dependence is a complex clinical condition shaped by genetic predispositions (~70% heritability), nicotine metabolism rate, environmental factors, and psychiatric comorbidities. Clinical assessment utilizes DSM-5 and ICD-10 criteria alongside scales such as the Fagerström Test for Nicotine Dependence. In terms of treatment, combining FDA-approved first-line pharmacotherapies (nicotine replacement therapies, varenicline, bupropion) with behavioral counseling increases cessation rates by 2 to 3 times. Furthermore, comprehensive tobacco control policies including heavy taxation, smoke-free zone laws, and advertising bans are critical to mitigating the risks of secondhand and thirdhand smoke exposure.
Referanslar
Gubner N.R., Benowitz N.L. (2021). Neurobiology of Nicotine and Tobacco. In K.T. Brady, F.R. Levin, M. Galanter & H.D. Kleber (Eds.), Textbook of Substance Use Disorder Treatment (6 th ed., pp. 265-278). Washington: American Psychiatric Association Publishing
Bilir, N. (2017). Türkiye’de tütün kontrolünün etkisi. Ankara: Ankara Ofset Basım Matbaacılık
Le Foll B, Piper ME, Fowler CD, et al. Tobacco and nicotine use. Nat Rev Dis Primers. 2022;8(1):19. Doi: 10.1038/s41572-022-00346-w.
Fagerström KO, Bridgman K. Tobacco harm reduction: the need for new products that can compete with cigarettes. Addict Behav. 2014;39(3):507-511. Doi:10.1016/j.addbeh.2013.11.002
Hartmann-Boyce J, McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;9(9):CD010216. Doi:10.1002/14651858.CD010216.pub3
Demirel, ÖF.,Tosun, M. (2018) Tütün ile İlişkili Bozukluklar. Oğuz Karamustafalıoğlu (Ed.), Temel ve Klinik Psikiyatri içinde (s.591-598). Ankara: Güneş Tıp Kitabevi
GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet 2021;397:2337–2360. Doi:10.1016/S0140-6736(21)01169-7
Evans-Polce RJ, Kcomt L, Veliz PT, et al. Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates. Am J Psychiatry. 2020;177(11):1073-1081. Doi:10.1176/appi.ajp.2020.20010005
Öntaş E, Aslan D. Küresel Yetişkin Tütün Araştırması Türkiye 2016- HÜTF Halk Sağlığı AD Toplum İçin Bilgilendirme Serisi-(2018/2019-63) (10.07.2022 tarihinde http://www.halksagligi.hacettepe.edu.tr/ adresinden ulaşılmıştır).
TÜİK (2020). Türkiye Sağlık Araştırması 2019. (10.07.2022 tarihinde https://data.tuik.gov.tr/Bulten/Index?p=Turkiye-Saglik-Arastirmasi-2019-33661 adresinden ulaşılmıştır).
Küresel Gençlik Tütün Araştırması KGTA- 2017. (10.07.2022 tarihinde https://hsgm.saglik.gov.tr/depo/birimler/tutun-mucadele-bagimlilik-db/duyurular/KGTA-2017_pdf.pdf adresinden ulaşılmıştır).
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US).
Oberg M, Jaakkola MS, Woodward A, et al. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet 2011; 377: 139–46. Doi: 10.1016/S0140-6736(10)61388-8.
Groner JA, Huang H, Joshi MS, et al. Secondhand smoke exposure and preclinical markers of cardiovascular risk in toddlers. J Pediatr 2017; 189: 155–61. Doi: 10.1016/j.jpeds.2017.06.032
Ma C, Heiland EG, Li Z, et al. Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12-16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys. Lancet Glob Health. 2021;9(12):e1667-e1678. Doi:10.1016/S2214-109X(21)00365-X
Argüder E, Abuzaina O, Bakır H, ve ark. Hasta ve Yakınlarının Pasif Sigara İçiminin Oluşturduğu Sağlık Sorunları Hakkındaki Farkındalığı. Ankara Med J. 2019;(1):213-225. Doi:10.17098.amj.576890
WHO (2016). WHO global report on trends in tobacco smoking 2000-2005. (20.07.2022 tarihinde https://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/en/index4.html adresinden ulaşılmıştır).
WHO 2021. Tobacco fact sheet. (25. 07.2022 tarihinde https://www.who.int/news-room/fact-sheets/detail/tobacco adresinden ulaşılmıştır).
Acuff L, Fristoe K, Hamblen J, et al. Third-Hand Smoke: Old Smoke, New Concerns. J Community Health. 2016;41(3):680-687. Doi:10.1007/s10900-015-0114-1
Hatsukami DK, Stead LF, Gupta PC. Tobacco addiction. Lancet. 2008;371(9629):2027-2038. Doi:10.1016/S0140-6736(08)60871-5
Benowitz NL. Nicotine addiction. Prim Care. 1999;26(3):611-631. Doi:10.1016/s0095-4543(05)70120-2
Zevin S, Gourlay SG, Benowitz NL. Clinical pharmacology of nicotine. Clin Dermatol. 1998;16(5):557-564. Doi:10.1016/s0738-081x(98)00038-8
Hukkanen J, Jacob P 3rd, Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacol Rev. 2005;57(1):79-115. Doi:10.1124/pr.57.1.3
Gotti C, Zoli M, Clementi F. Brain nicotinic acetylcholine receptors: native subtypes and their relevance. Trends Pharmacol Sci. 2006;27(9):482-491. Doi:10.1016/j.tips.2006.07.004
Caggiula AR, Donny EC, White AR, et al. Cue dependency of nicotine self-administration and smoking. Pharmacol Biochem Behav. 2001;70(4):515-530. Doi:10.1016/s0091-3057(01)00676-1
Caggiula AR, Donny EC, White AR, et al. Environmental stimuli promote the acquisition of nicotine self-administration in rats. Psychopharmacology (Berl). 2002;163(2):230-237. Doi:10.1007/s00213-002-1156-5
Fowler CD, Turner JR, Imad Damaj M. Molecular Mechanisms Associated with Nicotine Pharmacology and Dependence. Handb Exp Pharmacol. 2020;258:373-393. Doi:10.1007/164_2019_252
Li MD, Cheng R, Ma JZ, et al. A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins. Addiction. 2003;98(1):23-31. Doi:10.1046/j.1360-0443.2003.00295.x
Sullivan PF, Kendler KS. The genetic epidemiology of smoking. Nicotine Tob Res. 1999;1 Suppl 2:51-70. Doi:10.1080/14622299050011811
Broms U, Silventoinen K, Madden PAF, et al. Genetic architecture of smoking behavior: a study of Finnish adult twins. Twin Res Hum Genet. 2006;9:64–72.
Kendler KS, Thornton LM, Pedersen NL. Tobacco consumption in Swedish twins reared apart and reared together. Arch Gen Psychiatry 2000;57:886–892.
Li MD, Cheng R, Ma JZ, et al. A meta-analysis of estimated genetic and environmental effects on smoking behavior in male and female adult twins. Addiction. 2003;98:23–31.
Xian H, Scherrer JF, Madden PAF, et al. The heritability of failed smoking cessation and nicotine withdrawal in twins who smoked and attempted to quit. Nicotine Tob Res. 2003;5:245–254.
Chaudhri N, Caggiula AR, Donny EC, et al. Complex interactions between nicotine and nonpharmacological stimuli reveal multiple roles for nicotine in reinforcement. Psychopharmacology (Berl). 2006;184(3-4):353-366. Doi:10.1007/s00213-005-0178-1
Benowitz NL, Hukkanen J, Jacob P 3rd. Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol. 2009;(192):29-60. Doi:10.1007/978-3-540-69248-5_2
Lerman C, Schnoll RA, Hawk LW Jr, et al. Use of the nicotine metabolite ratio as a genetically informed biomarker of response to nicotine patch or varenicline for smoking cessation: a randomised, double-blind placebo-controlled trial. Lancet Respir Med. 2015;3(2):131-138. Doi:10.1016/S2213-2600(14)70294-2
Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annu Rev Public Health. 2017;38:165-185. Doi:10.1146/annurev-publhealth-031816-044618
Chen J, Bacanu SA, Yu H, et al. Genetic relationship between schizophrenia and nicotine dependence. Sci Rep 2016;6:25671. Doi: 10.1038/srep25671
Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35(2):158-176. Doi:10.1016/j.amepre.2008.04.009
Kasza, KA, Ambrose BK, Conway KP, et al. Tobacco-product use by adults and youths in the United States in 2013 and 2014. N. Engl. J. Med. 2017; 376: 342–353. Doi: 10.1056/NEJMsa1607538
Richardson A, Xiao H, Vallone DM. Primary and dual users of cigars and cigarettes: profiles, tobacco use patterns and relevance to policy. Nicotine Tob Res. 2012;14(8):927-932. Doi:10.1093/ntr/ntr306
American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders, Fifth edition. American Psychiatric Association. Arlington, VA, 2013.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva, 1992.
Heatherton TF, Kozlowski LT, Frecker RC, et al. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991;86(9):1119-1127. Doi:10.1111/j.1360-0443.1991.tb01879.x
Heatherton TF, Kozlowski LT, Frecker RC, et al. Measuring the heaviness of smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict. 1989;84(7):791-799. Doi:10.1111/j.1360-0443.1989.tb03059.x
WHO 2021. Tobacco control to improve child health and development: thematic brief (20.07.2022 tarihinde https://www.who.int/publications/i/item/9789240022218-Downloads/9789240022218-eng.pdf adresinden ulaşılmıştır).
Leão T, Kunst AE, Perelman J. Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review. Eur J Public Health. 2018;28: 39–43. Doi:10.1093/eurpub/ckx215
Royal College of Physicians (RCP) 2021. Smoking and health 2021: a coming of age for tobacco control? (25.07.2022 tarihinde https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-2021-coming-age-tobacco-control adresinden ulaşılmıştır).
U.S. Department of Health and Human Services. Smoking Cessation. 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, 2020.
Ziedonis D, Das S, Larkin C. Tobacco use disorder and treatment: new challenges and opportunities. Dialogues Clin Neurosci. 2017;19(3):271-280. Doi:10.31887/DCNS.2017.19.3/dziedonis
UpToDate (2022). Pharmacotherapy for smoking cessation in adults. (02/07/2022 tarihinde https://www.uptodate.com/contents/pharmacotherapy-for-smoking-cessation-in-adults?search=psychotherapy%20in%20nicotine%20dependency%20&topicRef=6920&source=see_linkadresinden ulaşılmıştır).
Lindson N, Chepkin SC, Ye W, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019;4(4):CD013308. Doi:10.1002/14651858.CD013308
US Preventive Services Task Force, Krist AH, Davidson KW, et al. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(3):265-279. Doi:10.1001/jama.2020.25019
FDA 2018. FDA Drug Safety Communication: FDA revises description of mental health side effects of the stop-smoking medicines Chantix (varenicline) and Zyban (bupropion) to reflect clinical trial findings. (20.07.2022 tarihinde https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-revises-description-mental-health-side-effects-stop-smoking adresinden ulaşılmıştır).
Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387(10037):2507-2520. Doi:10.1016/S0140-6736(16)30272-0
