Smoking Cessation

views updated Jun 08 2018

Smoking Cessation

Definition
Purpose
Description
Even a new heart can’t break a bad habit

Definition

Smoking cessation means “quitting smoking,” or “withdrawal from nicotine.” Tobacco is highly addictive, therefore, quitting the habit often involves irritability, headache, mood swings, and cravings associated with the sudden cessation or reduction of tobacco use by a nicotine-dependent individual.

Purpose

There are many good reasons to stop smoking; one of them is that smoking cessation may speed post-surgery recovery. Smoking cessation helps a person heal and recover faster, especially in the incision area, or if the surgery involved any bones. Research shows that patients who underwent hip and knee replacements, or surgery on other bone joints, healed better and recovered more quickly if they had quit or cut down their tobacco intake several weeks before the operation. Smoking weakens the bone mineral that keeps the skeleton strong and undermines tissue and vessel health. One study suggested that even quitting tobacco for a few days could improve tissue blood flow and oxygenation, and might have a positive effect on wound healing. If a patient has had a history of heart problems, his chances of having a second heart attack will be lowered. Quitting may also reduce wound complications, and lower the risk of cardiovascular trouble after surgery. If surgery was performed to remove cancerous tumors, quitting will reduce the

KEY TERMS

Addiction— Compulsive, overwhelming involvement with a specific activity. The activity may be smoking, gambling, alcohol, or may involve the use of almost any substance, such as a drug.

Appetite suppressant— To decrease the appetite.

Constrict— To squeeze tightly, compress, draw together.

Convulsion— To shake or effect with spasms; to agitate or disturb violently.

Depressant— A drug or other substance that soothes or lessens tension of the muscles or nerves.

Detoxification— To remove a poison or toxin or the effect of such a harmful substance; to free from an intoxicating or addictive substance in the body or from dependence on or addiction to a harmful substance.

Endorphins— Any of a group of proteins with analgesic properties that occur naturally in the brain.

Gestational age— The length of time of growth and development of the young in the mother’s womb.

Metabolism— The sum of all the chemical processes that occur in living organisms; the rate at which the body consumes energy.

Nicotine— A poisonous, oily alkaloid in tobacco.

Oxygenation— To supply with oxygen.

Paraphernalia— Articles of equipment or accessory items.

Premature— Happening early or occurring before the usual time.

Psychoactive— Affecting the mind or behavior.

Respiratory infections— Infections that relate to or affect respiration or breathing.

Smoking cessation— The act of quitting smoking or withdrawal from nicotine.

Stimulant— A drug or other substance that increases the rate of activity of a body system.

Tremor— A trembling, quivering, or shaking.

Withdrawal— Stopping of administration or use of a drug; the syndrome of sometimes painful physical and psychological symptoms that follow the discontinuance.

risk of a second tumor, especially if cancer in the lung, head, or neck has been successfully treated.

Description

Quitting smoking is one of the best things a person can do to increase their life expectancy. On average, male smokers who quit at 35 years old can be expected to live to be 76 years old instead of 69 years if they were still smoking. Women who quit would live to be 80 years old instead of 74 years.

Effects of smoking on the body

Nicotine acts as both a stimulant and a depressant on the body. Saliva and bronchial secretions increase along with bowel tone. Some inexperienced smokers may experience tremors or even convulsions with high doses of nicotine because of the stimulation of the central nervous system. The respiratory muscles are then depressed following stimulation.

Nicotine causes arousal as well as relaxation from stressful situations. Tobacco use increases the heart rate about 10-20 beats per minute; and because it constricts the blood vessels, it increases the blood pressure reading by 5-10 mm Hg.

Sweating, nausea, and diarrhea may also increase because of the effects of nicotine upon the central nervous system. Hormonal activities of the body are also affected. Nicotine elevates the blood glucose levels and increases insulin production; it can also lead to blood clots. Smoking does have some positive effects on the body by stimulating memory and alertness, and enhancing cognitive skills that require speed, reaction time, vigilance, and work performance. Smoking tends to alleviate boredom and reduce stress as well as reduce aggressive responses to stressful events because of its mood-altering ability. It also acts as an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. The fear of weight gain prevents some people from quitting smoking. The addictive effects of tobacco have been well documented. It is considered mood- and behavior-altering, psychoactive, and prone to abuse. Tobacco’s addictive potential is believed to be comparable to the addictive potentials of alcohol, cocaine, and morphine.

Health problems associated with smoking

In general, chronic use of nicotine may cause an acceleration of coronary artery disease, hypertension, reproductive disturbances, esophageal reflux, pepticulcer disease, fetal illnesses and death, and delayed wound healing. The smoker is at greater risk of developing cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix); heart attacks and strokes; and chronic lung disease. Using tobacco during pregnancy increases the risk of miscarriage, intrauterine growth retardation (resulting in the birth of an infant small for gestational age), and the infant’s risk for sudden infant death syndrome.

The specific health risks of tobacco use include: nicotine addiction, lung disease, lung cancer, emphysema, chronic bronchitis, coronary artery disease and angina, heart attack, atherosclerotic and peripheral vascular disease, aneurysms, hypertension, blood clots, strokes, oral/tooth/gum diseases including oral cancer, and cancer in the kidney, bladder, and pancreas. Nicotine is also associated with decreased senses of taste and smell. During pregnancy, nicotine may cause increased fetal death, premature labor, low birth weight infants, and sudden infant death syndrome.

Smoking is also increasingly harmful to a person’s social acceptability. According to the National Institute on Drug Abuse (NIDA), students at the high school and college levels in the early twenty-first century are increasingly disapproving of smoking. In just one year, disapproval of smoking among high school seniors increased from 76.2% in 2004 to 79.8% in 2005. For young adults, smoking complicates finding housing, as many landlords will not rent to smokers and many potential roommates do not want to share their apartment with a smoker.

Nonsmokers who are regularly exposed to secondhand smoke also may experience specific health risks including:

Increased risk of lung cancer.
An increased frequency of respiratory infections in infants and children (e.g. bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature.
Acute, sudden, and occasionally severe reactions including eye, nose, throat, and lower respiratory tract symptoms.

The specific health risks for smokeless tobacco users include many of the diseases of smokers, as well as a 50-fold greater risk for oral cancer with long-term or regular use.

In diabetics taking medication for high blood pressure, it has been reported that smoking may increase the risk of kidney disease and/or kidney failure.

Making a plan to quit

Long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking, but only the smoker has the power to stop smoking. Before a smoker decides to quit, he should make sure he wants to quit smoking for himself, and not for other people. The following are some suggestions the smoker may want to consider:

The first step is to set a quit date. Women should set their quit date to begin at the end of their period for best results.
Make a written list of why you want to quit smoking.
Consider using an aid to help you quit, which can be the patch, nicotine gum, Zyban, nicotine spray, soft laser therapy, nasal inhaler, or some other method. If you plan to use Zyban, set your quit date for one week after you begin to use it.
Smoke only in certain places, preferably outdoors.
Switch to a brand of cigarettes that you don’t like.
Buy a piggy bank or an attractive box or jar and put the money in it that you would ordinarily spend on cigarettes. At an average cost of $5 per pack, the money in your savings bank will quickly add up.
Do not buy cigarettes by the carton.
Cut coffee consumption in half. You will not need to give it up.
Practice putting off lighting up when the urge strikes.
Go for a walk every day or begin an exercise program.
Stock up on non-fattening safe snacks to help with weight control after quitting.
Enlist the support of family and friends.
Clean and put away all ashtrays the day before quitting.

Smokers who are trying to quit should remind themselves that they are doing the smartest thing they have ever done. Because of the preparation for smoking cessation, the smoker won’t be surprised by or fearful of quitting. The quitter will be willing to do what’s necessary, even though it won’t be easy. Remember, this will likely add years to the lifespan. The quitting smoker should be prepared to spend more time with nonsmoking friends, if other smokers don’t support the attempt to quit.

Since hospitals are smoke-free environments, if a smoking patient is in the hospital for elective surgery, it may be a good opportunity to quit smoking. It might be best to set the quit date around the time of the surgery and let the attending doctor know. As the smoker takes the first step, professional hospital staff will be there to give the support and help needed. Medical staff can start the patient on nicotine replacement therapy to help control the cravings and increase the chances of quitting permanently.

Methods of quitting

Cold turkey, or an abrupt cessation of nicotine, is one way to stop smoking. Cold turkey can provide cost savings because paraphernalia and smoking cessation aids are not required; however, not everyone can stop this way as tremendous willpower is needed.

Laser therapy is an entirely safe and pain free form of acupuncture that has been in use since the 1980s. Using a painless soft laser beam instead of needles the laser beam is applied to specific energy points on the body, stimulating production of endorphins. These natural body chemicals produce a calming, relaxing effect. It is the sudden drop in endorphin levels that leads to withdrawal symptoms and physical cravings when a person stops smoking. Laser treatment not only helps relieve these cravings, but helps with stress reduction and lung detoxification. Some studies indicate that laser therapy is the most effective method of smoking cessation, with an extraordinarily high success rate.

Acupuncture—small needles or springs are inserted into the skin—is another aid in smoking cessation. The needles or springs are sometimes left in the ears and touched lightly by the patient between visits.

Some smokers find hypnosis particularly useful, especially if there is any kind of mental conflict, such as phobias, panic attacks, or weight control. As a smoker struggles to stop smoking, the conscious mind, deciding to quit, battles the inner mind, which is governed by habit and body chemistry. Hypnosis, by talking directly to the inner mind, can help to resolve that inner battle.

Some people are helped to quit smoking by psychotherapy. As of 2007, cognitive behavioral therapy, or CBT, is considered the most effective form of psychotherapy for smoking cessation. A research team at Yale University reported in the fall of 2007 that CBT was more effective than brief behavioral interventions in helping adolescent smokers stay in a smoking cessation program as well as actually quitting smoking.

Aversion techniques attempt to make smoking seem unpleasant. This technique reminds the person of the distasteful aspects of smoking, such as the smell, dirty ashtrays, coughing, the high cost, and health issues. The most common technique prescribed by psychologists for “thought stopping”—stopping unwanted thoughts—is to wear a rubber band around the wrist. Every time there is an unwanted thought (a craving to smoke) the band is supposed to be pulled so that it hurts. The thought then becomes associated with pain and gradually neutralized.

Rapid smoking is a technique in which smoking times are strictly scheduled once a day for the first three days after quitting. Phrases are repeated such as “smoking irritates my throat” or “smoking burns mylips and tongue.” This technique causes over-smoking in a way that makes the taste and sensations associated with smoking very unpleasant.

There are special mouthwashes available, which, when used before smoking, alter the taste, giving cigarettes a very unpleasant taste. The intention is to create a link in the smoker’s mind between cigarettes and a bad taste in the mouth.

Smoking cessation aids wean a person off nicotine slowly, and the nicotine can be delivered where it does the least bodily harm. Unlike cigarettes, these aids do not introduce other harmful poisons to the body. They can be used for a short period of time; however, nicotine from any source (smoking, nicotine gum, or the nicotine patch) can make some health problems worse. These include heart or circulation problems, irregular heartbeat, chest pain, high blood pressure, overactive thyroid, stomach ulcers, or diabetes.

The four main brands of the patch are Nicotrol, Nicoderm, Prostep, and Habitrol. All four transmit low doses of nicotine to the body throughout the day. The patch comes in varying strengths ranging from 7 mg to 21 mg. The patch must be prescribed and used under a physician’s care. Package instructions must be followed carefully. Other smoking cessation programs or materials should be used while using the patch.

Nicorette gum allows the nicotine to be absorbed through the membrane of the mouth between the cheek and gums. Past smoking habits determine the right strength to choose. The gum should be chewed slowly.

The nicotine nasal spray reduces cravings and withdrawal symptoms, allowing smokers to cut back slowly. The nasal spray acts quickly to stop the cravings, as it is rapidly absorbed through the nasal membranes. One of the drawbacks is a risk of addiction to the spray.

The nicotine inhaler uses a plastic mouthpiece with a nicotine plug, delivering nicotine to the mucous membranes of the mouth. It provides nicotine at about one-third the nicotine level of cigarettes.

Bupropion hydrochloride, sold under the trade name Zyban, is an oral medication that is making an impact in the fight to help smokers quit. It is a treatment for nicotine dependence. Another new medication, approved by the Food and Drug Administration (FDA) in 2006, is varenicline tartrate, sold under the trade name Chantix. Chantix is thought to work by affecting parts of the brain affected by nicotine in two ways: by providing some nicotine effects to ease withdrawal symptoms and by blocking the effects of nicotine from cigarettes if the patient resumes smoking. In November 2007, however, the FDA issued a warning regarding mood changes reported in persons taking Chantix. The drug is still considered safe, but anyone taking it in order to stop smoking should contact their doctor at once if they feel depressed or notice other sudden mood changes.

The nicotine lozenge is another smoking cessation aid recently added to the growing list of tools to combat nicotine withdrawal.

As of 2007, scientists are researching the possibility of developing medications that inhibit the function of CYP2A6, an enzyme that makes people more susceptible to nicotine addiction. Some people have a genetic variant that decreases the amount of CYP2A6 in the body, which is thought to protect these individuals against nicotine addiction. Thus medications that lower the amount of this enzyme might offer a new approach to smoking cessation.

Withdrawal symptoms

Generally, the longer one has smoked and the greater the number of cigarettes (and nicotine) consumed, the more likely it is that withdrawal symptoms will occur and the more severe they are likely to be. When a smoker switches from regular to low-nicotine cigarettes or significantly cuts back smoking, a milder form of nicotine withdrawal involving some or all of these symptoms can occur.

These are some of the withdrawal symptoms that most former smokers experience in the beginning of their new smoke-free life:

dry mouth;
mood swings;
irritability;
feelings of depression;
gas in the digestive tract;
tension;
sleeplessness or sleeping too much;
difficulty in concentration;
intense cravings for a cigarette;
increased appetite and weight gain; and
headaches.

These side effects are all temporary conditions that will probably subside in a short time for most people. These symptoms can last from one to three weeks and are strongest during the first week after quitting. Drinking plenty of water during the first week can help detoxify the body and shorten the duration of the withdrawal symptoms. A positive attitude, drive, commitment, and a willingness to get help from health care professionals and support groups will help a smoker kick the habit.

Researchers from the University of California San Diego strongly suggest that any of the above cessation aids should be used in combination with other types of smoking cessation help, such as counseling and/or support programs. These products are not designed to help with the behavioral aspects of smoking, but only the cravings associated with them. Counseling and support groups can offer tips on coping with difficult situations that can trigger the urge to smoke.

Even a new heart can’t break a bad habit

Why do some people who have heart transplants continue to smoke? In a three-year study at the University of Pittsburgh of 202 heart transplant recipients, 71% of the recipients were smokers before surgery. The overall rate of post-transplant smoking was 27%. All but one of the smokers resumed the smoking habit they had before the transplant. The biggest reason for resuming smoking was addiction to nicotine. Smoking is a complex behavior, involving social interactions, visual cues, and other factors. Those who smoked until less than six months before the transplant were much more likely to resume smoking early and to smoke more. One of the major causes of early relapse was because of depression and anxiety within two months after the transplant. Another strong predictor of relapse was having a caretaker who smoked. The knowledge of these risk factors could help develop strategies for identifying those in greatest need of early intervention. According to European studies, the five-year survival rate for post-transplant smokers is 37%, compared to 80% for nonsmoking recipients. Smokers can develop inoperable lung cancers within five years after a transplant, thus resulting in a shorter survival rate. There is an alarming incidence of head and neck cancers in transplant recipients who resume smoking.

Overall, there is a 90% relapse rate in the general population; however, the more times a smoker tries to quit, the greater the chance of success with each new try.

Resources

BOOKS

Abrams, David B., et al. The Tobacco Dependence Treatment Handbook: A Guide to Best Practices. New York: Guilford Press, 2003.

American Cancer Society. Kicking Butts: Quit Smoking and Take Charge of Your Health. Atlanta, GA: American Cancer Society, 2002.

Britton, John, ed. ABC of Smoking Cessation. Malden, MA: BMJ Books, 2004.

Dodds, Bill. 1440 Reasons to Quit Smoking: 1 For Every Minute of the Day. Minnetonka, MN: Meadowbrook Press, 2000.

Mannoia, Richard J. NBAC Program: Never Buy Another Cigarette: A Cigarette Smoking Cessation Program. Paradise Publications, 2003.

National Institutes of Health. Clearing the Air: Quit Smoking Today. Bethesda, MD: National Institutes of Health, 2003.

Shipley, Robert H. Quit Smart: Stop Smoking Guide With the Quitsmart System, It’s Easier Than You Think! Quitsmart, 2002.

PERIODICALS

Cavallo, D. A., J. L. Cooney, A. M. Duhig, et al. “Combining Cognitive Behavioral Therapy with Contingency Management for Smoking Cessation in Adolescent Smokers: A Preliminary Comparison of Two Different CBT Formats.”American Journal on Addictions 16, no. 6 (November 2007): 468–474.

Lancaster, T., L. Stead, and K. Cahill. “An Update on Therapeutics for Tobacco Dependence.” Expert Opinion on Pharmacotherapy 9, no. 1 (January 2008): 15–22.

Landman, Anne, Pamela M. Ling, and Stanton A. Glantz. “Tobacco Industry Youth Smoking Prevention Programs: Protecting the Industry and Hurting Tobacco Control.” American Journal of Public Health 92, no. 6 (June 2002): 917–30.

Le Foll, B., and T. P. George. “Treatment of Tobacco Dependence: Integrating Recent Progress into Practice.” Canadian Medical Association Journal 177, no. 11 (November 20, 2007): 1373–1380.

Mwenifumbo, J. C., and R. F. Tyndale. “Genetic Variability in CYP2A6 and the Pharmacokinetics of Nicotine.” Pharmacogenomics 8, no. 10 (October 2007): 1385–1402.

Taylor, D. H., Jr., V. Hasselblad, S. J. Henley, M. J. Thun, and F. A. Sloan. “Research and Practice: Benefits of Smoking Cessation for Longevity.” American Journal of Public Health 92, no. 6 (June 2002): 990–996.

OTHER

Illig, David. Stop Smoking. Audio CD. Seattle: WA: Successworld, 2001.

Mesmer. Stop Smoking With America’s Foremost Hypnotist. Audio CD. Victoria, BC: Ace Mirage Entertainment, 2000.

“NIDA InfoFacts: Cigarettes and Other Tobacco Products.” National Institute on Drug Abuse. July 2007. http://www.nida.nih.gov/infofacts/tobacco.html (April 7, 2008).

“Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use,” patient version. National Cancer Institute. 2008. http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/Patient (April 7, 2008).

ORGANIZATIONS

Action on Smoking and Health, 2013 H Street, NW, Washington, DC, 20006, (202) 659-4310, http://ash.org.

American Cancer Society, 1875 Connecticut Avenue, NW, Suite 730, Washington, DC, 20009, (800) ACS-2345, http://www.cancer.org.

Centers for Disease Control and Prevention, Mail Stop K50, 4770 Buford Highway, NE, Atlanta, GA, 30341, (800) 232-4636, http://www.cdc.gov/tobacco/osh/index.htm.

Crystal H. Kaczkowski, M.Sc.

Rebecca Frey, Ph.D.

The Gale Encyclopedia of Surgery and Medical Tests

Smoking Cessation

views updated Jun 08 2018

Smoking cessation

Definition

Smoking cessation means “quitting smoking,” or “withdrawal from nicotine.” Because smoking tobacco is highly addictive, quitting the habit often involves irritability, headache, mood swings, and cravings associated with the sudden cessation or reduction of tobacco use by a nicotine-dependent individual.

Purpose

There are many good reasons to stop smoking; one of them is that smoking cessation may speed post-surgery recovery. Smoking cessation helps a person heal and recover faster, especially in the incision area, or if the surgery involved any bones. Research shows that patients who underwent hip and knee replacements, or surgery on other bone joints, healed better and recovered more quickly if they had quit or cut down their tobacco intake several weeks before the operation. Smoking weakens the bone mineral that keeps the skeleton strong and undermines tissue and vessel health. One study suggested that even quitting tobacco for a few days could improve tissue blood flow and oxygenation, and might have a positive effect on wound healing. If a patient has had a history of heart problems, his chances of having a second heart attack will be lowered. Quitting may also reduce wound complications, and lower the risk of cardiovascular trouble after surgery. If surgery was performed to remove cancerous tumors, quitting will reduce the risk of a second tumor, especially if cancer in the lung, head, or neck has been successfully treated.

Description

Quitting smoking is one of the best things a person can do to increase their life expectancy. On average, male smokers who quit at 35 years old can be expected to live to be 76 years old instead of 69 years if they were still smoking. Women who quit would live to be 80 years old instead of 74 years.

Effects of smoking on the body

Nicotine acts as both a stimulant and a depressant on the body. Saliva and bronchial secretions increase along with bowel tone. Some inexperienced smokers may experience tremors or even convulsions with high doses of nicotine because of the stimulation of the central nervous system. The respiratory muscles are then depressed following stimulation.

Nicotine causes arousal as well as relaxation from stressful situations. Tobacco use increases the heart rate about 10–20 beats per minute; and because it constricts the blood vessels, it increases the blood pressure reading by 5–10 mm Hg.

Sweating, nausea, and diarrhea may also increase because of the effects of nicotine upon the central nervous system. Hormonal activities of the body are also affected. Nicotine elevates the blood glucose levels and increases insulin production; it can also lead to blood clots . Smoking does have some positive effects on the body by stimulating memory and alertness, and enhancing cognitive skills that require speed, reaction time, vigilance, and work performance. Smoking tends to alleviate boredom and reduce stress as well as reduce aggressive responses to stressful events because of its mood-altering ability. It also acts as an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. The fear of weight gain prevents some people from quitting smoking. The addictive effects of tobacco have been well documented. It is considered mood- and behavior-altering, psychoactive, and abusable. Tobacco's addictive potential is believed to be comparable to alcohol, cocaine, and morphine.

**Cigarette smoking status of adults in the United States age 45 and over, by sex and age group, 2006**
Sex and age group	All current smokers	Every day smokers	Some day smokers	Former smokers	Non- smokers
source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey
(Illustration by GGS Information Services. Cengage Learning, Gale)
Percent
Both sexes	20.8%	16.7%	4.2%	21.0%	58.2%
Men
45–64	24.5%	21.1%	3.5%	32.1%	43.4%
65 and over	12.6%	10.4%	2.2%	51.1%	36.2%
Women
45–64	19.3%	16.5%	2.8%	22.0%	58.7%
65 and over	8.3%	7.0%	1.3%	27.9%	63.8%

Health problems associated with smoking

In general, chronic use of nicotine may cause an acceleration of coronary artery disease, hypertension , reproductive disturbances, esophageal reflux, peptic ulcer disease, fetal illnesses and death , and delayed wound healing. The smoker is at greater risk of developing cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix); heart attacks and strokes; and chronic lung disease. Using tobacco during pregnancy increases the risk of miscarriage, intrauterine growth retardation (resulting in the birth of an infant small for gestational age), and the infant's risk for sudden infant death syndrome.

The specific health risks of tobacco use include: nicotine addiction, lung disease, lung cancer , emphysema , chronic bronchitis , coronary artery disease and angina , heart attack, atherosclerotic and peripheral vascular disease , aneurysms, hypertension, blood clots, strokes, oral/tooth/gum diseases including oral cancer , and cancer in the kidney, bladder, and pancreas. Nicotine is also associated with decreased senses of taste and smell. During pregnancy, nicotine may cause increased fetal death, premature labor, low birth weight infants, and sudden infant death syndrome.

Nonsmokers who are regularly exposed to second hand smoke also may experience specific health risks including:

Increased risk of lung cancer.
An increased frequency of respiratory infections in infants and children (e.g. bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature.
Acute, sudden, and occasionally severe reactions including eye, nose, throat, and lower respiratory tract symptoms.

The specific health risks for smokeless tobacco users include many of the diseases of smokers, as well as a 50-fold greater risk for oral cancer with long-term or regular use.

In diabetics taking medication for high blood pressure, it has been reported that smoking may increase the risk of kidney disease and/or kidney failure.

Making a plan to quit

Long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking, but only the smoker has the power to stop smoking. Before a smoker decides to quit, he should make sure he wants to quit smoking for himself, and not for other people. The following are some suggestions the smoker may want to consider:

Women should set their quit date to begin at the end of their period for best results. The first step is to set a quit date.
Make a written list of why you want to quit smoking.
Consider using an aid to help you quit, which can be the patch, nicotine gum, Zyban, nicotine spray, soft laser therapy, nasal inhaler, or some other method. If you plan to use Zyban, set your quit date for one week after you begin to use it.
Smoke only in certain places, preferably outdoors.
Switch to a brand of cigarettes that you don't like.
Do not buy cigarettes by the carton.
Cut coffee consumption in half. You will not need to give it up.
Practice putting off lighting up when the urge strikes.
Go for a walk every day or begin an exercise program.
Stock up on non-fattening safe snacks to help with weight control after quitting.
Enlist the support of family and friends.
Clean and put away all ashtrays the day before quitting.

KEY TERMS

Addiction —Compulsive, overwhelming involvement with a specific activity. The activity may be smoking, gambling, alcohol, or may involve the use of almost any substance, such as a drug.

Appetite suppressant —To decrease the appetite.

Constrict —To squeeze tightly, compress, draw together.

Convulsion —To shake or effect with spasms; to agitate or disturb violently.

Depressant —A drug or other substance that soothes or lessens tension of the muscles or nerves.

Detoxification —To remove a poison or toxin or the effect of such a harmful substance; to free from an intoxicating or addictive substance in the body or from dependence on or addiction to a harmful substance.

Endorphins —Any of a group of proteins with analgesic properties that occur naturally in the brain.

Gestational age —The length of time of growth and development of the young in the mother's womb.

Metabolism —The sum of all the chemical processes that occur in living organisms; the rate at which the body consumes energy.

Nicotine —A poisonous, oily alkaloid in tobacco.

Oxygenation —To supply with oxygen.

Paraphernalia —Articles of equipment or accessory items.

Premature —Happening early or occurring before the usual time.

Psychoactive —Affecting the mind or behavior.

Respiratory infections —Infections that relate to or affect respiration or breathing.

Smoking cessation —To quit smoking or withdrawal from nicotine.

Stimulant —A drug or other substance that increases the rate of activity of a body system.

Tremor —A trembling, quivering, or shaking.

Withdrawal —Stopping of administration or use of a drug; the syndrome of sometimes painful physical and psychological symptoms that follow the discontinuance.

Smokers who are trying to quit should remind themselves that they are doing the smartest thing they have ever done. Because of the preparation for smoking cessation, the smoker won't be surprised or fearful about quitting. The quitter will be willing to do what's necessary, even though it won't be easy. Remember, this will likely add years to the lifespan. The quitting smoker should be prepared to spend more time with nonsmoking friends, if other smokers don't support the attempt to quit.

Since hospitals are smoke-free environments, if a smoking patient is in the hospital for elective surgery, it may be a good opportunity to quit smoking. It might be best to set the quit date around the time of the surgery and let the attending doctor know. As the smoker takes the first step, professional hospital staff will be there to give the support and help needed. Medical staff can start the patient on nicotine replacement therapy to help control the cravings and increase the chances of quitting permanently.

Methods of quitting

Cold turkey, or an abrupt cessation of nicotine, is one way to stop smoking. Cold turkey can provide cost savings because paraphernalia and smoking cessation aids are not required, however, not everyone can stop this way as tremendous willpower is needed.

Laser therapy is an entirely safe and pain free form of acupuncture that has been in use since the 1980s. Using a painless soft laser beam instead of needles the laser beam is applied to specific energy points on the body, stimulating production of endorphins. These natural body chemicals produce a calming, relaxing effect. It is the sudden drop in endorphin levels that leads to withdrawal symptoms and physical cravings when a person stops smoking. Laser treatment not only helps relieve these cravings, but helps with stress reduction and lung detoxification. Some studies indicate that laser therapy is the most effective method of smoking cessation, with an extraordinarily high success rate.

Acupuncture—small needles or springs are inserted into the skin—is another aid in smoking cessation. The needles or springs are sometimes left in the ears and touched lightly by the patient between visits.

Some smokers find hypnosis particularly useful, especially if there is any kind of mental conflict, such as phobias, panic attacks, or weight control. As a smoker struggles to stop smoking, the conscious mind, deciding to quit, battles the inner mind, which is governed by habit and body chemistry. Hypnosis, by talking directly to the inner mind, can help to resolve that inner battle.

Aversion techniques attempt to make smoking seem unpleasant. This technique reminds the person of the distasteful aspects of smoking, such as the smell, dirty ashtrays, coughing, the high cost, and health issues. The most common technique prescribed by psychologists for “thought stopping”—stopping unwanted thoughts—is to wear a rubber band around the wrist. Every time there is an unwanted thought (a craving to smoke) the band is supposed to be pulled so that it hurts. The thought then becomes associated with pain and gradually neutralized.

Rapid smoking is a technique in which smoking times are strictly scheduled once a day for the first three days after quitting. Phrases are repeated such as “smoking irritates my throat” or “smoking burns my lips and tongue.” This causes over-smoking in a way that makes the taste and sensations very unpleasant.

There are special mouthwashes available, which, when used before smoking, alter the taste, making cigarettes taste awful. The aim is for smoking to eventually become associated with this very unpleasant taste.

Smoking cessation aids wean a person off nicotine slowly, and the nicotine can be delivered where it does the least bodily harm. Unlike cigarettes, they do not introduce other harmful poisons to the body. They can be used for a short period of time. However, it should be noted that nicotine from any source (smoking, nicotine gum, or the nicotine patch) can make some health problems worse. These include heart or circulation problems, irregular heartbeat, chest pain, high blood pressure, overactive thyroid, stomach ulcers, or diabetes.

The four main brands of the patch are Nicotrol, Nicoderm, Prostep, and Habitrol. All four transmit low doses of nicotine to the body throughout the day. The patch comes in varying strengths ranging from 7 mg to 21 mg. The patch must be prescribed and used under a physician's care. Package instructions must be followed carefully. Other smoking cessation programs or materials should be used while using the patch.

Nicorette gum allows the nicotine to be absorbed through the membrane of the mouth between the cheek and gums. Past smoking habits determine the right strength to choose. The gum should be chewed slowly.

The nicotine nasal spray reduces cravings and withdrawal symptoms, allowing smokers to cut back slowly. The nasal spray acts quickly to stop the cravings, as it is rapidly absorbed through the nasal membranes. One of the drawbacks is a risk of addiction to the spray.

The nicotine inhaler uses a plastic mouthpiece with a nicotine plug, delivering nicotine to the mucous membranes of the mouth. It provides nicotine at about one-third the nicotine level of cigarettes.

Zyban is an oral medication that is making an impact in the fight to help smokers quit. It is a treatment for nicotine dependence.

The nicotine lozenge is another smoking cessation aid recently added to the growing list of tools to combat nicotine withdrawal.

Withdrawal symptoms

Generally, the longer one has smoked and the greater the number of cigarettes (and nicotine) consumed, the more likely it is that withdrawal symptoms will occur and the more severe they are likely to be. When a smoker switches from regular to low-nicotine cigarettes or significantly cuts back smoking, a milder form of nicotine withdrawal involving some or all of these symptoms can occur.

These are some of the withdrawal symptoms that most ex-smokers experience in the beginning of their new smoke-free life:

dry mouth
mood swings
irritability
feelings of depression
gas
tension
sleeplessness or sleeping too much
difficulty in concentration
intense cravings for a cigarette
increased appetite and weight gain
headaches

These side effects are all temporary conditions that will probably subside in a short time for most people. These symptoms can last from one to three weeks and are strongest during the first week after quitting. Drinking plenty of water during the first week can help detoxify the body and shorten the duration of the withdrawal symptoms. A positive attitude, drive, commitment, and a willingness to get help from health care professionals and support groups will help a smoker kick the habit.

Researchers from the University of California San Diego strongly suggest that any of the above cessation aids should be used in combination with other types of smoking cessation help, such as behavioral counseling and/or support programs. These products are not designed to help with the behavioral aspects of smoking, but only the cravings associated with them. Counseling and support groups can offer tips on coping with difficult situations that can trigger the urge to smoke.

Even a new heart can't break a bad habit

Why do some people who have heart transplants continue to smoke? In a three-year study at the University of Pittsburgh of 202 heart transplant recipients, 71% of the recipients were smokers before surgery. The overall rate of post-transplant smoking was 27%. All but one of the smokers resumed the smoking habit they had before the transplant. The biggest reason for resuming smoking was addiction to nicotine. Smoking is a complex behavior, involving social interactions, visual cues, and other factors. Those who smoked until less than six months before the transplant were much more likely to resume smoking early and to smoke more. One of the major causes of early relapse was because of depression and anxiety within two months after the transplant. Another strong predictor of relapse was having a caretaker who smoked. The knowledge of these risk factors could help develop strategies for identifying those in greatest need of early intervention. According to European studies, the five-year survival rate for post-transplant smokers is 37%, compared to 80% for nonsmoking recipients. Smokers can develop inoperable lung cancers within five years after a transplant, thus resulting in a shorter survival rate. There is an alarming incidence of head and neck cancers in transplant recipients who resume smoking.

Overall, there is a 90% relapse rate in the general population but, the more times a smoker tries to quit, the greater the chance of success with each new try.

Resources

BOOKS

Dodds, Bill. 1440 Reasons to Quit Smoking: 1 For Every Minute of the Day. Minnetonka, MN: Meadowbrook Press, 2000.

Jones, David C. and Derick D. Schermerhorn, eds. Yes You Can Stop Smoking: Even if You Don't Want To. Dolphin Pub., 2001.

Kleinman, Lowell, Deborah Messina-Kleinman, and Mitchell Nides. Complete Idiot's Guide to Quitting Smoking. London, UK: Alpha Books, 2000.

Mannoia, Richard J. NBAC Program: Never Buy Another Cigarette: A Cigarette Smoking Cessation Program. Paradise Publications, 2003.

Shipley, Robert H. Quit Smart: Stop Smoking Guide With the Quitsmart System, It's Easier Than You Think! Quitsmart, 2002.

PERIODICALS

Landman, Anne, Pamela M. Ling, and Stanton A. Glantz. “Tobacco Industry Youth Smoking Prevention Programs: Protecting the Industry and Hurting Tobacco Control.” American Journal of Public Health 92, no. 6 (June 2002): 917–30.

Ling, Pamela M. and Stanton A. Glantz, “Forum on Youth Smoking, Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence From Industry Documents.” American Journal of Public Health 92, no. 6 (June 2002): 908–16.

Taylor, Donald H., Jr., Vic Hasselblad, S. Jane Henley, Michael J. Thun, and Frank A. Sloan. “Research and Practice, Benefits of Smoking Cessation for Longevity.” American Journal of Public Health 92, no. 6 (June 2002): 990–6.

ORGANIZATIONS

Action on Smoking and Health. 2013 H Street, NW, Washington, DC 20006. (202) 659-4310. http://ash.org.

The American Lung Association. 61 Broadway, 6th Floor, New York, NY. 10006. (800) 586-4872. http://www.lungusa.org.

OTHER

Illig, David. Stop Smoking. Audio CD. Seattle: WA: Successworld, 2001.

Mesmer. Stop Smoking With America's Foremost Hypnotist. Audio CD. Victoria, BC: Ace Mirage Entertainment, 2000.

Crystal H. Kaczkowski M.Sc.

The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers

Smoking Cessation

views updated May 21 2018

SMOKING CESSATION

Smoking prevalence has been declining in countries such as the United States, Australia, Canada, and the United Kingdom, but these declines are matched by increasing rates in most other countries. The Healthy People 2010 goal in the United States is to decrease prevalence from 24 percent to 12 percent by the year 2010. This goal can only be achieved by helping current smokers to quit. Increasing the incidence of quitting is achieved through medications, counseling strategies, and public health approaches.

IMPACT OF SMOKING

In the United States smoking became increasingly popular from the early 1900s through the mid-1960s, but it then declined substantially. During the 1950s, the link between smoking and respiratory diseases and cancer became known. In 1964, the first Surgeon General's Report on smoking noted the substantial health hazards associated with smoking. Cigarette smoke contains more than 4,000 chemicals, of which forty-three are known to cause cancer. Among the more toxic chemicals in tobacco are ammonia, arsenic, carbon monoxide, and benzene. Cigarette smoking is now known to cause chronic obstructive pulmonary disease (COPD), heart disease, stroke, multiple cancers (including lung cancer), and adverse reproductive outcomes. Smoking causes about 21 percent of all deaths from heart disease, 86 percent of deaths from lung cancer, and 81 percent of all deaths from chronic lung disease.

Nicotine is highly addictive and causes persistent and compulsive smoking behavior. Most users make four to six quit attempts before they are able to remain nicotine-free. Smoking cessation produces major and immediate health benefits by reducing mortality and morbidity from heart disease, stroke, cancer, and various lung diseases.

SECONDHAND SMOKE

Secondhand smoke, or environmental tobacco smoke (ETS), causes lung cancer and cardiovascular disease in nonsmoking adults. About 43 percent of U.S. children are exposed to cigarette smoke by household members. Childhood exposure to ETS has been shown to cause asthma and to increase the number of episodes and severity of the disease. ETS exposure of very young children is also causally associated with an increased risk of bronchitis, pneumonia, and ear infections. For these reasons, the importance of smoking cessation extends beyond the health benefit of the smokers themselves.

EFFECTIVE INTERVENTIONS

In general, clinical interventions to treat tobacco use double unassisted quit rates. Effective interventions include the provision of advice to quit by a health care provider, the provision of behavioral counseling, and medications. Since the 1980s, efforts to reduce tobacco use have shifted away from an exclusive focus on clinical interventions to include a broader public health approach. This broader approach increases quitting by changing societal norms around tobacco use and increasing the motivation and support for people to attempt to quit.

CLINICAL INTERVENTIONS

Tobacco dependence is a chronic relapsing condition that often requires repeated intervention. The U.S. Public Health Service's "Treating Tobacco Use and Dependence" Clinical Practice Guideline describes the strong science base behind current treatment recommendations. Guidelines from Canada and the United Kingdom provide similar recommendations.

Brief advice to quit smoking from a health care provider increases quit rates by 30 percent. Every person who uses tobacco should be offered at least brief advice to quit smoking because failure to do so becomes a reason for smokers to assume their doctor does not consider it important to their health. More intensive counseling (individual, group, and telephone counseling) and medications are even more effective and should be provided to all tobacco users willing to use them.

Counseling. All patients should be asked at every visit to their physician whether they smoke, and this information should be recorded in the patient chart. Providers are encouraged to incorporate the five As: Ask, Advise, Assess, Assist, and Arrange into their treatment strategy. Asking if a person smokes prompts the provider to give advice to quit. The assessment process determines whether the person is ready to quit in the near future; the clinician's message can then be tailored either to provide advice about quitting or to a motivational message to increase interest in quitting. Assistance is given by reviewing information on the quitting process, providing more intensive counseling and by encouraging the use of medications. Arranging means following up with the patient to determine the effectiveness of treatment.

Medication. Five medications have been approved by the U.S. Food and Drug Administration for treating nicotine dependence. All produce approximately a doubling of quit rates. Bupropion SR works on the nicotine receptors in the brain and seems to curb the craving for nicotine. Nicotine replacement therapy (NRT) products are produced in four forms in the United States: gum, patch, nasal spray, and inhaler. Nicotine tablets are also available in Europe. These products provide nicotine without the toxic chemicals that one inhales with smoke or absorbs through the mouth with chew or spit tobacco. Currently, the patch and gum are available in over-the-counter form; the nasal spray and inhaler are available by prescription.

HEALTH CARE SYSTEM SUPPORT FOR TREATMENT OF TOBACCO-USE

Several guidelines recommend that health care systems institutionalize the consistent identification, documentation, and treatment of every tobacco users. Another recommendation is to provide full insurance coverage for medication and counseling related to tobacco use. Data show that reducing cost barriers not only increases the use of more effective treatments but also increases the number of people who successfully quit.

Tobacco-dependence treatments are both clinically effective and highly cost-effective relative to other medical and disease prevention interventions. Treatment of tobacco use costs $2,600 per year of life saved compared with $62,000 for mammograms and $23,000 for the treatment of hypertension.

Model Clinical Treatment Programs. Group Health Cooperative (GHC) of Puget Sound, a Seattle-based managed care organization, provides comprehensive coverage for smoking cessation. Treatment includes telephone or group behavioral counseling and medications to support the quit process. This program enrolls 8 percent of all smokers in GHC into the treatment program each year and has a 30 percent long-term quit rate. Smoking has declined at a faster rate among GHC enrollees than among the general population of Washington State. It is estimated that this program paid for itself within four years.

SPECIAL POPULATIONS

Pregnant Women. If a woman is pregnant or nursing it is especially important for her to quit smoking—to protect her own health and the health of the baby. Counseling is the primary treatment recommended for pregnant women. A pregnant woman who is a heavy smoker and unable to quit should consult her physician about the possible use of medication.

Young People. Since most tobacco use begins during adolescence, it is important to prevent onset of tobacco use and to encourage cessation at a young age. Half of adolescent smokers say they want to stop smoking cigarettes completely and about six of ten report that they seriously tried to quit in the past year. Unfortunately, adolescent tobacco users can become addicted to nicotine within the first weeks of use, and most adolescents experience symptoms of nicotine withdrawal when they try to quit. Therefore, adolescents are as likely to relapse as adults are. It is unclear which interventions will help adolescents quit. However, some adolescent prevention and cessation programs show promise in increasing quit rates.

POPULATION APPROACHES TO CESSATION

The Community Preventive Services Task Force reviewed the effect on cessation of population approaches, including media campaigns, cigarette tax increases, and clean indoor air laws, and found that media campaigns and price increases promoted cessation. Clean indoor air policies decrease the number of cigarettes smoked per day; though the impact on cessation is less clear.

CESSATION ACTIVITIES IN THE UNITED STATES

California and Massachusetts have developed comprehensive programs that include media campaigns, community interventions, and state-sponsored telephone quit lines. These programs have been successful in increasing smoking cessation. Oregon has collaborated with managed care organizations to improve treatment and also provides telephone counseling and medication to Medicaid clients. Florida has developed a very successful media campaign and community intervention that reduced smoking by young people.

Comprehensive programs directed at both young people and adults that focus on decreasing initiation, increasing cessation, and decreasing exposure to ETS have proven effective. In California, comprehensive tobacco-control programs and policies have been associated with accelerated declines in cardiovascular disease and deaths from lung cancer compared to the rest of the nation.

State Roles. The Center for Disease Control and Prevention's 1999 Best Practices for Comprehensive Tobacco Control Programs suggests that comprehensive state programs include the following (1999):

Community programs to reduce tobacco use.
Chronic disease programs to reduce the burden of tobacco related disease.
School programs to reduce tobacco use by young people.
Enforcement of clean indoor air and minors' access laws.
Statewide programs.
Counter-marketing campaigns.
Cessation programs.
Surveillance and evaluation.
Administration and management.

Combining individual, systems, and population-based approaches that increase cessation offers the best opportunity to reduce morbidity and mortality from tobacco use, which is the leading preventable cause of death in the United States. The clinician's role is to assess every patient's tobacco use and interest in quitting, advise those who smoke to stop, offer individual, group, or telephone counseling, and encourage patients to use effective medications. The role of the health care system is to implement system changes to support routine tobacco treatment by clinicians and to monitor the effect of treatment through quality performance measures.

Employers also play a role, which consists of providing insurance coverage for cessation services, providing treatment services at the worksite, and establishing smoke-free buildings or campuses. Finally the role of the government is to increase the price of tobacco products, implement media campaigns, enact clean indoor air policies and laws, regulate tobacco products, and ensure insurance coverage of tobacco use treatment.

Corinne G. Husten

Abby C. Rosenthal

Micah H. Milton

(see also: Addicition and Habituation; Adolescent Smoking; Advertising of Unhealthy Products; Media Advocacy; Office on Smoking and Health; Tobacco Control )

Bibliography

Canadian Task Force on the Periodic Health Examination (1994). Canadian Guide to Clinical Prevention Health Care, 2nd edition. Ottawa: Canada Communication Group.

Centers for Disease Control and Prevention (1999). Best Practices for Comprehensive Tobacco Control Programs—August 1999. Atlanta, GA: Author.

Corrao, M. A.; Guindon, G. E.; Sharma, N.; and Shokoohi, D. F., eds. (2000). Tobacco Control: Country Profiles. Atlanta, GA: American Cancer Society.

Cromwell, J.; Bartosch, W. J.; Fiore, M. C.; Hasselblad, V.; and Baker, T. (1997). "Cost-Effectiveness of the Clinical Practice Recommendation in the AHCPR Guideline for Smoking Cessation." Journal of the American Medical Association 278(21):1759–1766.

DiFranza, J. R.; Rigotti, N. A.; McNeill, A. D.; Ockene, J. K.; Savageau, J. A.; St. Cyr, D.; and Coleman, M. (2000). "Initial Symptoms of Nicotine Dependence in Adolescents." Tobacco Control 9:313–319.

Fichtenberg, C. M., and Glanz, S. A. (2000). "Association of the California Tobacco Control Program with Declines in Cigarette Consumption and Mortality from Heart Disease." New England Journal of Medicine 343:1772–1777.

Fiore, M. C.; Bailey, W. C.; Cohen, S. J. et al. (2000). Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Public Health Service.

McAffee, T.; Wilson, J.; Dacey, S.; Sofian, N.; Curry, S.; and Wagener, B. (1995). "Awakening the Sleeping Giant: Mainstreaming Efforts to Decrease Tobacco Use in an HMO." HMO Practice 9(3):138–142.

National Cancer Institute (1999). Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency. Smoking and Tobacco Control Monograph No. 10. Bethesda, MD: Author.

Raw, M.; McNeill, A.; and West, R. (1998). "Smoking Cessation Guidelines for Health Professionals. A Guide to Effective Smoking Cessation Interventions for the Health Care System." Thorax 53(1):S1–S19.

Silagy, C., and Ketteridge, S. (1998). "The Effectiveness of Physician Advice to Aid Smoking Cessation. Database of Abstracts of Reviews of Effectiveness." In The Cochrane Library, Issue 2. Oxford: Update Software.

Task Force on Community Preventive Services (2001). "Recommendations Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke." American Journal of Preventive Medicine 20(2S).

U.S. Department of Health and Human Services (1989). Reducing the Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Atlanta, GA: CDC, Office on Smoking and Health.

—— (1990). The Health Benefits of Smoking Cessation: A Report of the Surgeon General. Atlanta, GA: CDC, Office on Smoking and Health.

—— (1994). Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: CDC, Office on Smoking and Health.

—— (2000). Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: CDC, Office on Smoking and Health.

U.S. Department of Health, Education, and Welfare (1964). Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: U.S. Public Health Service, Centers for Disease Control and Prevention.

Wagner, E. H.; Curry, S. J.; Grothaus, L.; Saunders, K. W.; and McBride, C. M. (1995). "The Impact of Smoking and Quitting on Health Care Use." Archives of Internal Medicine 155:1789–1795.

Encyclopedia of Public Health Husten, Corinne G.; Rosenthal, Abby C.; Milton, Micah H.

Smoking Cessation

views updated May 17 2018

Smoking cessation

Definition

Smoking cessation means "to quit smoking," or "withdrawal from nicotine." Because smoking is highly addictive, quitting the habit often involves irritability, headache, mood swings, and cravings associated with the sudden cessation or reduction of tobacco use by a nicotine-dependent individual.

Purpose

There are many good reasons to stop smoking; not the least is that smoking cessation may speed post-surgery recovery. Smoking cessation helps a person heal and recover faster, especially in the incision area, or if the surgery involved any bones. Research shows that patients who underwent hip and knee replacements, or surgery on other bone joints, healed better and recovered more quickly if they had quit or cut down their tobacco intake several weeks before the operation. Smoking weakens the bone mineral that keeps the skeleton strong and undermines tissue and vessel health. One study suggested that even quitting tobacco for a few days could improve tissue blood flow and oxygenation, and might have a positive effect on wound healing. If a patient has had a history of heart problems, his chances of having a second heart attack will be lowered. Quitting may also reduce wound complications, and lower the risk of cardiovascular trouble after surgery. If surgery was performed to remove cancerous tumors, quitting will reduce the risk of a second tumor, especially if cancer in the lung, head, or neck has been successfully treated.

Description

Quitting smoking is one of the best things a person can do to increase their life expectancy. On average, male smokers who quit at 35 years old can be expected to live to be 76 years old instead of 69 years if they were still smoking. Women who quit would live to be 80 years old instead of 74 years.

Effects of smoking on the body

Nicotine acts as both a stimulant and a depressant on the body. Saliva and bronchial secretions increase along with bowel tone. Some inexperienced smokers may experience tremors or even convulsions with high doses of nicotine because of the stimulation of the central nervous system. The respiratory muscles are then depressed following stimulation.

Nicotine causes arousal as well as relaxation from stressful situations. Tobacco use increases the heart rate about 10–20 beats per minute; and because it constricts the blood vessels, it increases the blood pressure reading by 5–10 mm Hg.

Sweating, nausea, and diarrhea may also increase because of the effects of nicotine upon the central nervous system. Hormonal activities of the body are also affected. Nicotine elevates the blood glucose levels and increases insulin production; it can also lead to blood clots. Smoking does have some positive effects on the body by stimulating memory and alertness, and enhancing cognitive skills that require speed, reaction time, vigilance, and work performance. Smoking tends to alleviate boredom and reduce stress as well as reduce aggressive responses to stressful events because of its mood-altering ability. It also acts as an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. The fear of weight gain prevents some people from quitting smoking. The addictive effects of tobacco have been well documented. It is considered mood-and behavior-altering, psychoactive, and abusable. Tobacco's addictive potential is believed to be comparable to alcohol, cocaine, and morphine.

Health problems associated with smoking

In general, chronic use of nicotine may cause an acceleration of coronary artery disease, hypertension, reproductive disturbances, esophageal reflux, peptic ulcer disease, fetal illnesses and death, and delayed wound healing. The smoker is at greater risk of developing cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix); heart attacks and strokes; and chronic lung disease. Using tobacco during pregnancy increases the risk of miscarriage, intrauterine growth retardation (resulting in the birth of an infant small for gestational age), and the infant's risk for sudden infant death syndrome.

The specific health risks of tobacco use include: nicotine addiction, lung disease, lung cancer, emphysema, chronic bronchitis, coronary artery disease and angina, heart attack, atherosclerotic and peripheral vascular disease, aneurysms, hypertension, blood clots, strokes, oral/tooth/gum diseases including oral cancer, and cancer in the kidney, bladder, and pancreas. Nicotine is also associated with decreased senses of taste and smell. During pregnancy, nicotine may cause increased fetal death, premature labor, low birth weight infants, and sudden infant death syndrome.

Nonsmokers who are regularly exposed to second hand smoke also may experience specific health risks including:

Increased risk of lung cancer.
An increased frequency of respiratory infections in infants and children (e.g. bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature.
Acute, sudden, and occasionally severe reactions including eye, nose, throat, and lower respiratory tract symptoms.

The specific health risks for smokeless tobacco users include many of the diseases of smokers, as well as a 50-fold greater risk for oral cancer with long-term or regular use.

In diabetics taking medication for high blood pressure, it has been reported that smoking may increase the risk of kidney disease and/or kidney failure.

Making a plan to quit

Long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking, but only the smoker has the power to stop smoking. Before a smoker decides to quit, he should make sure he wants to quit smoking for himself, and not for other people. The following are some questions as well as some suggestions the smoker may want to consider:

When is the best time to quit smoking? The answer may be different for women and men. Women should set their quit date to begin at the end of their period for best results. The first step is to set a quit date.
Make a written list of why you want to quit smoking.
Will you use an aid to help you quit? Will it be the patch, nicotine gum, Zyban, nicotine spray, soft laser therapy, nasal inhaler, or some other method? If you plan to use Zyban, set your quit date for one week after you begin to use it.
smoke only in certain places, preferably outdoors
switch to a brand of cigarettes that you don't like
do not buy cigarettes by the carton
cut coffee consumption in half (You will not need to give it up.)
practice putting off lighting up when the urge strikes
go for a walk every day or begin an exercise program
stock up on non-fattening safe snacks to help with weight control after quitting
enlist the support of family and friends
clean and put away all ashtrays the day before quitting

Smokers who are trying to quit should remind themselves that they are doing the smartest thing they have ever done. Because of the preparation for smoking cessation, the smoker won't be surprised or fearful about quitting. The quitter will be willing to do what's necessary, even though it won't be easy. Remember, this will likely add years to the lifespan. The quitting smoker should be prepared to spend more time with nonsmoking friends, if other smokers don't support the attempt to quit.

Since hospitals are smoke-free environments, if a smoking patient is in the hospital for elective surgery , it may be a good opportunity to quit smoking. It might be best to set the quit date around the time of the surgery and let the attending doctor know. As the smoker takes the first step, professional hospital staff will be there to give the support and help needed. Medical staff can start the patient on nicotine replacement therapy to help control the cravings and increase the chances of quitting permanently.

Methods of quitting

Cold turkey, or an abrupt cessation of nicotine, is one way to stop smoking. Cold turkey can provide cost savings because paraphernalia and smoking cessation aids are not required; however, not everyone can stop this way as tremendous willpower is needed.

Laser therapy is an entirely safe and pain-free form of acupuncture that has been in use since the 1980s. Using a painless soft laser beam instead of needles the laser beam is applied to specific energy points on the body, stimulating production of endorphins. These natural body chemicals produce a calming, relaxing effect. It is the sudden drop in endorphin levels that leads to withdrawal symptoms and physical cravings when a person stops smoking. Laser treatment not only helps relieve these cravings, but helps with stress reduction and lung detoxification. Some studies indicate that laser therapy is the most effective method of smoking cessation, with an extraordinarily high success rate.

Acupuncture—small needles or springs are inserted into the skin—is another aid in smoking cessation. The needles or springs are sometimes left in the ears and touched lightly by the patient between visits.

Some smokers find hypnosis particularly useful, especially if there is any kind of mental conflict, such as phobias, panic attacks, or weight control. As a smoker struggles to stop smoking, the conscious mind, deciding to quit, battles the inner mind, which is governed by habit and body chemistry. Hypnosis, by talking directly to the inner mind, can help to resolve that inner battle.

Aversion techniques attempt to make smoking seem unpleasant. This technique reminds the person of the distasteful aspects of smoking, such as the smell, dirty ashtrays, coughing, the high cost, and health issues. The most common technique prescribed by psychologists for "thought stopping"—stopping unwanted thoughts—is to wear a rubber band around the wrist. Every time there is an unwanted thought (a craving to smoke) the band is supposed to be pulled so that it hurts. The thought then becomes associated with pain and gradually neutralized.

Rapid smoking is a technique in which smoking times are strictly scheduled once a day for the first three days after quitting. Phrases are repeated such as "smoking irritates my throat" or "smoking burns my lips and tongue." This causes over-smoking in a way that makes the taste and sensations very unpleasant.