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What problems are caused by smoking?
By smoking, you can cause health problems not only for
yourself but also for those around you.
 Hurting
Yourself
Smoking is an addiction. You see, tobacco contains nicotine,
a drug that is addictive. The nicotine, therefore, makes it
very difficult (although not impossible) to quit. In fact,
since the U.S. Surgeon General's 1964 report on the dangers
of smoking, millions of Americans have quit.
Still, more than 400,000 deaths occur in the U.S. each year
from smoking-related illnesses. The reason for these deaths
is that smoking greatly increases the risk of getting lung
cancer, heart attack, chronic lung diseases, stroke, and many
other cancers. Moreover, smoking is perhaps the most
preventable cause of breathing (respiratory) diseases within
the USA
Hurting Others
Smoking harms not just the smoker, but also family members,
coworkers, and others who breathe the smoker's cigarette
smoke, called secondhand smoke. Among infants up to 18 months
of age, secondhand smoke is associated with as many as
300,000 cases of bronchitis and pneumonia each year. In
addition, secondhand smoke from a parent's cigarette
increases a child's chances for middle ear problems, causes
coughing and wheezing, and worsens asthma.
If both parents smoke, a teenager is more than twice as
likely to smoke than a teenager whose parents are both
nonsmokers. Even in households where only one parent smokes,
young people are also more likely to start smoking. Pregnant
women who smoke are more likely to deliver babies whose
weights are too low for the babies' good health. In fact, it
has been estimated that if all women quit smoking during
pregnancy, about 4,000 new babies would not die each year.
What is addictive disease and why is smoking considered an
addictive disease?
The term addictive disease or addiction describes a
persistent habit that is harmful to the person. Thus,
addiction is a chronic (long duration) disease with
progressive reliance on the substance causing the addiction.
The addictive substance also causes the accompanying
deterioration of a person's physical and psychological
health.
Psychologically, an individual's behavior pattern establishes
how the addictive substance is used. One type of behavior is
compulsive behavior, which is an overwhelming and
irresistible interest in use of the substance. For example,
the compulsive addict makes sure that the substance is always
available. Another type of behavior is habitual behavior,
which is using the substance regularly or occasionally for
the desirable effects. Physically, continuous use of the
substance leads to dependence on the drug by the body. This
dependence means that when the drug is discontinued, symptoms
of withdrawal or distress occur.
Nicotine is the component of cigarettes that addicts. Almost
immediately upon inhalation, the body responds to the
nicotine. An individual feels relaxed, calmer, and happier
than before the inhalation. These pleasant feelings reflect
the physical side of addiction. But then, doing without
cigarettes causes craving for more cigarettes, irritability,
impatience, anxiety, and other unpleasant symptoms. Indeed,
these symptoms are the symptoms of withdrawal from
cigarettes. What's more, over time, more and more nicotine is
desired to produce the favorable effects and to avoid the
symptoms of withdrawal.
What are the signs of cigarette addiction?
The signs of addiction to cigarettes include:
Smoking more than seven cigarettes per day
Inhaling deeply and frequently
Smoking cigarettes containing nicotine levels more than 0.9mg
Smoking within 30 minutes of awakening in the morning
Finding it difficult to eliminate the first cigarette in the
morning
Smoking frequently during the morning
Finding it difficult to avoid smoking in smoking- restricted
areas
Needing to smoke even if sick and in bed
Why should someone quit smoking?
Quitting smoking makes a difference right away in the way you
feel. You can taste and smell food better. Your breath smells
better. Your cough goes away. These benefits happen for men
and women of all ages, even those who are older. They happen
for healthy people as well as those who already have a
disease or condition caused by smoking.
Even more importantly, in the long run, quitting smoking cuts
the risk of lung cancer, many other cancers, heart disease,
stroke, and other lung or breathing (respiratory) diseases
(e.g., bronchitis, pneumonia, and emphysema). Moreover,
ex-smokers have better health than current smokers. For
example, ex-smokers have fewer days of illness, fewer health
complaints, and less bronchitis and pneumonia than current
smokers.
Finally, quitting smoking saves money. A pack-a-day smoker
who pays $4.00 per pack can expect to save more than $1,408
per year! What's more, it appears that the price of
cigarettes will continue to rise in coming years, as will the
financial rewards of quitting.
What are the steps in quitting?
First, one can do certain things to get ready to quit. Then,
there are other things to do on the day of quitting. Finally,
we can do things to help us stay quit (this is the hardest
part).
Getting Ready to Quit
Set a date for quitting. If possible, plan to have a friend
quit smoking with you.
Notice when and why you smoke. Try to find the things in your
daily life that you often do while smoking (such as drinking
your morning cup of coffee or driving a car).
Change your smoking routines: Keep your cigarettes in a
different place. Smoke with your other hand. Don't do
anything else when you are smoking. Think about how you feel
when you smoke.
Smoke only in certain places, such as outdoors.
When you want a cigarette, wait a few minutes. Try to think
of something to do instead of smoking. For example, you might
chew gum or drink a glass of water.
Buy one pack of cigarettes at a time. Switch to a brand of
cigarettes that you don't like.
On the Day You Quit
Get rid of all your cigarettes. Put away your ashtrays.
Change your morning routine. When you eat breakfast, don't
sit in the same place at the kitchen table. Stay busy.
When you get the urge to smoke, do something else instead.
Carry other things to put in your mouth, such as gum, hard
candy, or a toothpick.
Reward yourself at the end of the day for not smoking. See a
movie or go out and enjoy your favorite meal.
Staying Quit
The expected consequences of quitting are irritability,
difficulty concentrating, increased appetite, and of course,
urges to smoke. So, if you feel more short-tempered or
distracted or sleepier than usual, don't worry because these
feelings will pass.
Try to exercise. For example, take walks or ride a bike.
Consider the positive things about quitting. For example,
think about how much you like yourself as a non-smoker, the
health benefits for you and your family, and the example you
set for others around you. A positive attitude will help you
through the tough times.
When you feel tense, try to keep busy and think about ways to
ease the tenseness. Tell yourself that smoking won't make it
any better, and go do something else.
Eat regular meals because feeling hungry is sometimes
mistaken for the desire to smoke.
Start a money jar with the money you save by not buying
cigarettes.
Let others know that you have quit smoking. You will find
that most people will support you. Many of your smoking
friends may want to know how you quit. It's good to talk to
others about your quitting. In fact, people who stay off
smoking for at least one year often have had very strong
support from a companion or coworker.
If you slip and smoke, don't be discouraged. Many former
smokers tried to stop several times before they finally
succeeded.
What methods can help a person quit smoking?
Several methods are available to assist those who decide to
quit smoking. The three main categories of methods are:
Changing the behavior that is associated with smoking
Self-help literature
Nicotine replacement therapy.
Each method actually offers several different options.
Moreover, combinations of the methods usually are necessary,
and no one combination will work for everyone. In fact, it
may be necessary to try several different methods or
combinations of methods before success is achieved.
Behavioral modification and self-help literature
Due to the addictive nature of nicotine, some form of
behavioral modification is often necessary for successful
cessation of smoking. Educational programs, hypnosis, and
aversion therapy (learning how to avoid cigarettes) are a few
options. Patients may be counseled to avoid specific triggers
or situations that lead to smoking. For example, instead of
awakening and grabbing a cigarette at the bedside or smoking
immediately after a meal, people may be encouraged to replace
the urge to smoke with another activity, such as, taking a
walk or reading a book.
Numerous associations and societies, for example, the
American Cancer Society, American Heart Association, and the
American Lung Association, have developed brochures to help
smokers quit smoking.
Nicotine Replacement Therapy
Nicotine replacement therapy (NRT) became available over the
counter (OTC) in the 1990's. The purpose of NRT is to
substitute another source of nicotine while cigarettes are
discontinued. By this means, the habit of smoking is
eliminated, even though the addiction to nicotine remains
intact. But at the same time, NRT eliminates the symptoms of
withdrawal that can trigger more smoking. In addition,
behavioral counseling to change smoking-related behavior
usually is necessary. Once cigarettes have been replaced
during NRT, the amount of nicotine is then gradually reduced.
Currently, there are two forms of NRT available over-the-
counter; nicotine transdermal systems or patches (Nicoderm CQ
and Nicotrol) and nicotine polacrilex resin or gum (Nicorette).
The patch contains nicotine that is stored within a specially
designed support or matrix. Once applied, the nicotine
transdermal systems steadily release nicotine that is
absorbed across the skin and into the blood stream. The gum
contains nicotine that is released slowly upon chewing and
"parking". Parking refers to the action of shifting the gum
to one side of the cheek after chewing in order to speed the
absorption of nicotine. A program for slowly weaning users
from patches or gum is provided by each product's
manufacturer.
Nicoderm CQ is available in three strengths; 21mg, 14mg, and
7mg. People are advised to begin with the 21mg patch if they
smoke more than 10 cigarettes per day or the 14mg patch if
they smoke less than 10 cigarettes per day. After six weeks
of wearing the initial patch strength, the next lowest patch
is worn for two weeks. If therapy was started with the 21mg
patch, an additional two weeks is required for the 7mg patch.
A maximum of eight or 10 weeks, depending upon the strength
of the first patch used, is recommended for a successful
quitting program. The Nicoderm CQ patch can be worn for 16
hours (from awakening until bedtime) or 24 hours if the urge
to smoke is great upon awakening.
Nicotrol is available as a 15mg patch, and should be worn no
more than 16 hours per day. Nicotrol may be worn for up to
six weeks.
The side effects commonly seen with patches are burning,
itching, or redness at the site of the patch, headache,
insomnia, nervousness, dizziness, cough, rash, joint aches,
painful menstruation, and changes in taste.
Nicorette is available in 2 strengths; 4mg and 2mg. Patients
are advised to begin with the 4mg piece of gum if they smoke
more than 25 cigarettes per day or the 2mg piece if they
smoke fewer than 7 cigarettes per day. No more than 20 pieces
of the 4mg strength or 30 pieces of the 2mg strength should
be chewed in one day. Initial weaning from treatment should
begin after 2 to 3 months and be completed by 4 to 6 months.
The most common side effects with Nicorette are aching jaws
or soreness of the gums, changes in taste, abdominal
(gastrointestinal) discomfort, hiccups, nausea, vomiting, and
belching.
How effective is NRT? Approximately 25% of patients
successfully stop smoking with nicotine patch therapy. The
success rate with nicotine gum is similar. When intensive
behavioral counseling is added, the rate of success for NRT
increases to 35-40%.
What prescription products are available for smoking
cessation?
The following products for cessation of smoking are available
by prescription only. Nicotine for NRT is available by
prescription as an inhaler or nasal spray (Nicotrol Inhaler
and Nicotrol NS). These other forms of delivery of nicotine
seem to work as well as the nicotine patches or gum.
Bupropion hydrochloride (Zyban, Wellbutrin) is a medication
that is used primarily for treating depression. This drug,
however, also has been found to be effective in helping
people to quit smoking.
Other agents that have been tried for cessation of smoking
include serotonin reuptake antagonists (drugs also used for
depression) and the anti-hypertensive drugs clonidine (Catapres)
and calcium channel blockers. Although these agents appear to
be less effective than NRT, they may be promising for some
patients.
How are nicotine-containing products used safely?
Users of nicotine-containing products should understand that
all of these products have side effects as well as effects on
other underlying medical conditions such as diabetes
mellitus, high blood pressure, asthma, and heart disease.
Furthermore, these products can have interactions with other
prescribed medications such as pain relievers, blood
thinners, and high blood pressure medications. And finally,
they do have their limitations. The following guidelines are
to help you safely use these products to achieve your goal of
quitting smoking.
Always read the labels and know the ingredients in the
products. Never take more than the recommended dose without
checking with your doctor first.
If you are pregnant or nursing a baby, seek the advice of a
health professional before using any nicotine-containing
product.
Do not use a nicotine-containing product if you continue to
smoke, chew tobacco, use snuff, or other nicotine-containing
products.
Consult a physician before using nicotine-containing products
if you:
Are under 18 years of age
Have heart disease, an irregular heartbeat, or have had a
recent heart attack (Nicotine can increase your heart rate.)
Have high blood pressure that is not controlled with
medication (Nicotine can increase your blood pressure.)
Have a history of, or currently have, inflammation of the
esophagus (esophagitis) or ulcers of the stomach or duodenum
(peptic ulcer disease)
Take insulin for diabetes.
Take any prescription medications (Nicotine interacts with
some medications, such as aspirin, some medications for the
heart, and female hormones to decrease their levels in the
blood.)
Have a skin disorder, such as dermatitis, which may increase
the likelihood of skin reactions by the skin to the patch
People should stop using nicotine- containing products and
see their physician if they have or develop:
Mouth, tooth, or jaw problems (applies to Nicorette gum)
Irregular heartbeats or palpitations
Symptoms of nicotine overdose, such as nausea, vomiting,
dizziness, weakness, and rapid heartbeat
Severe rash, redness, swelling, burning, or itching at the
site of the patch
What is in the future for smoking?
Health care workers have become extremely active in
publicizing the negative effects of smoking. In fact, health
care workers have been instrumental in passing various
legislations to limit smoking in public. As a result, the
proportion of people in the US who smoke has dropped from
40.4% in1965 to 22.7% in 2000 (data from the US department of
Health).
This reduction in the percent of people who smoke, however,
has been significantly less in women than in men. That is,
from 1965 to 2000, smoking among men dropped from 50.2% to
24.1% while during the same period, smoking among women
dropped from 31.9% to 21.4%. So, in the future, efforts need
to be made to understand and eliminate this difference
between the genders. Moreover, with the passage of even
stricter legislation, the percent of people who smoke should
(hopefully) fall to single digits by the year 2010.
Investigators have recently focused on the impact of passive
(second hand) smoking on coronary artery disease. The latest
data reveal that a small but significant increase in the risk
of heart disease exists among the individuals who are exposed
to second hand smoke. Given the fact that millions of people
are exposed to second hand smoke, the public health
consequences of this finding are potentially of enormous
significance. We will need to find ways to deal with the
problem of second hand smoke.
The hottest area of the current research on smoking is the
study of the population distribution of the genes for smoking
(genetic epidemiology). (Genes determine an individual's
inherited characteristics.) Only a small fraction of
individuals who start smoking as an adolescent will actually
become nicotine dependent. So, what determines which
individuals will become nicotine-dependent? Investigators
have found that smoking initiation (the obligatory first
step) and the development of nicotine dependence are both
influenced by genetic factors. The genetic factors appear to
play a larger role in nicotine dependence than in smoking
initiation. The next step will be to identify these genes and
learn how they work. The ultimate goal would be to favorably
manipulate these genes.
Smoking and Quitting Smoking At A Glance
Although smoking is an addiction, people can quit smoking.
Secondhand smoke is harmful to the health of children, family
members, and coworkers
Quitting smoking cuts the risk of lung cancer, heart disease,
stroke, and respiratory diseases
The steps in quitting, each of which requires special
attention and efforts by the smoker, are getting ready to
quit, quitting, and staying quit
A number of techniques are available to assist people who
want to quit, including nicotine replacement therapy (NRT),
behavioral modification, and self-help literature
In nicotine replacement therapy, which is the cornerstone of
most smoking cessation programs, another source of nicotine
is substituted while the cigarettes are stopped (The idea of
NRT is to eliminate both the smoking habit - although the
addiction remains - and the symptoms of withdrawal. Then, the
replacement nicotine is gradually stopped.)
Currently, two forms of NRT are available over the counter,
nicotine patches and nicotine gum, and two forms are
available by prescription, an inhaler and a nasal spray
NRT has about a 25% success rate, which increases to 35 or
40% when NRT is combined with intensive behavioral counseling
Nicotine containing substances have side effects,
interactions with other medications, effects on other medical
conditions, and limitations in their use
A prescription drug called bupropion (Zyban, Wellbutrin) has
been found to be effective in helping people to stop smoking
For more information about quitting, call:
1-800-4-CANCER, the National Cancer Institute's toll-free
Cancer Information Service, or 1-800-ACS-2345, the American
Cancer Society's Cancer Response System, or look in your
local phone directory for smoking cessation resources that
may be available in your area, such as local chapters of the
American Cancer Society, American Lung Association, American
Heart Association, or state and local health departments.
Portions of the preceding information was provided with the
kind permission of U.S. National Institutes of Health.
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