The depth of the problem: According to the US Centers for Disease
Control and Prevention (CDC), approximately 18 percent of adults in the United
States (42.1 million people) were smokers in 2012. The use of tobacco products
varies with gender, age, and ethnic background. Worldwide in 2012, the prevalence
of daily tobacco smoking in persons over the age of fifteen years was 31.1 percent
for men and from 6.2 percent for women.
According to the CDC, smoking is responsible for an estimated 480,000 deaths per
year in the United States and an additional 41,000 thousand deaths due to exposure
to secondhand
smoke. Smoking causes cancer, heart disease, stroke, and lung
diseases such as emphysema and chronic bronchitis. Cancer was among the first
diseases causally linked to smoking, and cigarette smoking is the leading
preventable cause of death in the United States. Smoking is the leading risk
factor for lung
cancer and is responsible for about 90 percent of all lung
cancer deaths. Smoking is estimated to increase the risk of coronary heart disease
by two to four times, of stroke by two to four times, and of lung cancer by
twenty-five times. Smoking causes damage to nearly every organ of the body.
Quitting smoking can add years to a person's life.
Smoking cessation is a difficult challenge that involves overcoming both physical
and psychological dependence. Most smokers are addicted to nicotine, a
psychoactive drug naturally found in tobacco products that produces dependence and
makes quitting difficult. In addition, smoking becomes a routine or habit that can
be hard to break, especially when it is as a coping mechanism for stress or
anxiety. Cessation is difficult and often requires multiple attempts. Users
commonly relapse because of withdrawal symptoms and mental
dependence. Cigarette cravings are usually the worst during the first two to three
days of smoking cessation; the physical symptoms of nicotine
addiction last for about three weeks after quitting smoking,
although the mental addiction to smoking typically lasts longer.
Quit and relapse rates: Approximately 70 percent of US adult smokers
reported in 2011 that they would like to quit, according to the CDC. In 2011, an
estimated 42.7 percent of adult smokers in the United States had attempted to quit
smoking during the preceding twelve months.
However, not all smokers are successful in their attempts to stop smoking, and
many try several times before they are able to quit. Less than 10 percent of
smokers who attempt to quit on their own have long-term success. The majority of
smokers cite symptoms of withdrawal and cravings as the main reasons for smoking
relapse. Most relapses occur within three months of quitting. However, the use of
effective treatments can double to triple the rates of successful smoking
cessation.
Health benefits of cessation: Smoking cessation leads to almost
immediate health benefits for people with and without smoking-related diseases.
For example, almost immediately after quitting, people experience improved
circulation, decreased blood pressure and pulse rates, and increased body
temperature in the hands and feet. In addition, cessation also leads to an almost
immediate improvement in such respiratory symptoms as coughing, wheezing, and
shortness of breath. Carbon monoxide and nicotine levels in the body rapidly
decrease.
In the long term, the health benefits of smoking cessation can be substantial.
Smoking cessation greatly reduces the risk of premature death by reducing the risk
of smoking-related diseases. Former smokers live longer than those who continue to
smoke; former smokers who quit by age thirty can have their health become as good
as a nonsmoker's. The risk of having a heart attack drops significantly within
one year after quitting smoking, and the chance of stroke can
fall to about that of a nonsmoker after two to five years. Smoking cessation
lowers the risk of developing and dying from lung cancer, other types of cancer,
and other diseases (such as heart disease, stroke, chronic
bronchitis, and emphysema). The risk of developing
cancer declines with the number of years of smoking cessation. For example, about
ten years after quitting, a former smoker’s risk of dying from lung cancer is 50
percent less than the risk faced by those who continued to smoke. After five years
of quitting, the risk of cancers of the mouth, throat, esophagus, and bladder is
cut in half. Additional benefits include an improved sense of taste and smell and
increased lung function. Furthermore, smoking decreases fertility in both men and
women. Women who stop smoking before or during pregnancy reduce their risk of
having miscarriages and having babies with low birth weights.
Smoking increases the risk of premature delivery, stillbirth,
and sudden infant
death syndrome (SIDS).
Although cessation is beneficial at all ages, the earlier a person stops smoking,
the greater the health benefits.
Smoking cessation methods: Smoking cessation is a two-step process
that includes overcoming the physical dependence on nicotine and breaking the
smoking habit. Methods used to increase smoking cessation rates include
medications, counseling, support groups, behavioral therapies, and alternative
therapies such as hypnotism and acupuncture.
Medications that have proven to be effective in treating tobacco dependence
include nicotine
replacement therapies (NRTs) and non-nicotine treatments,
such as bupropion and varenicline. NRTs are designed to provide
users with small amounts of nicotine that help reduce the craving for cigarettes
and relieve the withdrawal symptoms associated with smoking cessation, making it
easier to quit. Some are available over the counter without a doctor’s
prescription. Although they contain some nicotine, NRTs are not as bad as smoking
because they do not contain the toxins and carcinogens found in tobacco products.
Types of NRTs include gums, inhalers, nasal sprays, lozenges, and patches.
Although these treatments have been shown to be safe and effective when used as
directed, smokers should talk with their health care providers before beginning
any smoking cessation medication.
Nicotine gum (such as Nicorette), approved in 1984, was the first pharmacologic
smoking cessation aid approved by the US Food and Drug Association (FDA). The
recommended treatment is typically at least nine pieces of gum per day for the
first six weeks followed by a gradual reduction.
Available only by prescription, the nicotine inhaler (Nicotrol) is a plastic
cylinder that looks like a cigarette and has a cartridge that delivers nicotine.
After using nicotine inhalation for twelve weeks, your doctor may begin to
decrease your dose gradually. Side effects of nicotine inhalation include mouth
and throat irritation.
Nicotine nasal sprays are dispensed from pumps. The nicotine is rapidly absorbed
through the nasal membranes and quickly reaches the bloodstream. A usual dose is
one to two sprays following a craving to smoke. Side effects include nose and
throat irritation.
Nicotine patches (such as Nicoderm) release a constant amount of nicotine into the
body throughout the day. Most patches are replaced daily, and treatment periods
typically range from six to ten weeks. They come in different shapes and sizes.
Side effects of nicotine patches include skin irritation, dizziness, headache, and
nausea and vomiting. Some studies have suggested that the patch is less effective
than inhalers or gum because the continuous release of nicotine does not allow for
the individual to overcome periodic cravings.
In 2002, the first and only over-the-counter nicotine lozenge was introduced to
the market. It comes in the form of a hard candy and slowly releases nicotine as
it dissolves in the mouth. The most common side effects are sore teeth and gums,
indigestion, and throat irritation.
Available only by prescription, bupropion was approved by the FDA as a smoking
cessation aid in 1997. Unlike with NRTs, treatment with bupropion begins while the
user is still smoking, typically one week before the quit date, and continues for
seven to twelve weeks. Length of treatment is individualized. Common side effects
include insomnia, dry mouth, and dizziness.
The prescription drug varenicline was approved in 2006 for smoking cessation.
Typically, this nicotine-free tablet is taken twice daily for twelve weeks. Common
side effects include headache, nausea and vomiting, gas, insomnia, and change in
taste perception. Possible serious adverse effects include changes in behavior,
agitation, depressed mood, and suicide ideation. Individuals should discontinue
varenicline and immediately contact their doctor if such serious psychiatric
adverse effects occur.
All doctors should provide routine smoking cessation interventions to patients who
smoke, offering advice and support on how to quit. A combination of counseling and
medication is more effective than either alone, and both should be offered by
clinicians to aid in smoking cessation. Phone counseling (including quitlines),
group counseling, and individual counseling have all been shown to improve rates
of smoking cessation.
Symptoms of smoking withdrawal: Smokers who try to quit may face
physical and psychological symptoms of withdrawal. Physically, the body reacts to
the absence of nicotine. Symptoms of withdrawal include dizziness, depression,
irritability, anxiety, sleep disturbances, headaches, difficulty concentrating,
drowsiness, and increased appetite. They typically start within a few hours of the
last cigarette and peak about two to three days later. Mentally, the smoker must
break the habit of coping with stress by smoking.
Aldrich, Matthew.
Stop Smoking. Chicago: Contemporary Books, 2006.
Print.
Centers for Disease
Control and Prevention. Targeting Tobacco Use: The Nation’s Leading
Cause of Death, 2005. Bethesda: Author, 2005. Print.
DeNelsky, Garland Y.
Stop Smoking Now! The Rewarding Journey to a Smoke-Free
Life. Cleveland: Cleveland Clinic, 2007. Print.
Grana, Rachel A., Lucy Popova, and Pamela M.
Ling. "A Longitudinal Analysis of Electronic Cigarette Use and Smoking
Cessation." JAMA Internal Medicine 174.5 (2014): 812–13.
Web 13 Nov. 2014.
Koskinen, Charles J., ed. Handbook
of Smoking and Health. New York: Nova, 2011. Print.
LaTorre, Giuseppe. Smoking
Prevention and Cessation. New York: Springer, 2013.
Print.
Ng, Marie, et al. "Smoking Prevalence and
Cigarette Consumption in 187 Countries, 1980–2012." JAMA
311.2 (2014): 183–92. Web. 13 Nov. 2014.
Perkins, Kenneth A.,
Cynthia A. Conklin, and Michele D. Levine. Cognitive-Behavioral
Therapy for Smoking Cessation: A Practical Guidebook to the Most
Effective Treatments. New York: Routledge, 2008.
Print.
US Dept. of Health and Human Services.
A Report of the Surgeon General: How Tobacco Smoke Causes
Disease. Atlanta: Centers for Disease Control and Prevention,
2010. PDF file.
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