Category: Nicotine Alternatives

Nicotine addiction is a preventable illness, and, with training, RTs can help their patients kick the habit. By Roberta B. Hollander, PhD, MPH, and Donna Oliver-Freeman, MS , RRT In 1979, the Surgeon General declared cigarette smoking the nation’s key cause of preventable illness and premature death.1 It is a leading risk factor for cardiovascular disease; chronic obstructive pulmonary disease; lung, throat, mouth, kidney, pancreatic, bladder, and stomach cancers; and a growing list of other serious health problems. It accounts for 90% of all lung cancer deaths. Pregnant women who smoke raise their risk of low birth weight babies, preterm deliveries, and infant deaths.5 SUBSCRIBE TO DAILY RT NEWS In addition, secondhand smoke exposure has been linked to sudden infant death syndrome, asthma and other respiratory and ear infections in children, and cardiovascular disease and cancers in family members, leading the Environmental Protection Agency to label it a Group A carcinogen.3,5,6 Overall, smoking rates for US adults are gradually trending downward, but smoking and its adverse health effects continue to impact some racial/ethnic, income, educational, and age groups disproportionately. Women now pay the price of lung cancer cases and deaths from decades of increased smoking. Also, because 28% of high school students use tobacco (22.3% use cigarettes), 90% of smokers start before age 21, and smokers who begin early are less likely to quit, tobacco companies aggressively target youth (and other special populations) in advertising, sponsorship of events, and product offers.5,7,8 As well, the decline in smoking is not occurring quickly enough. The Centers for Disease Control and Prevention warn that at the present pace, the national health objective to reduce adult cigarette smoking prevalence to 12% by 2010 will not be achieved. Accordingly, we need more and better tailored programs to help people quit or keep them from starting altogether. These should include evidence-based strategies such as waging new antismoking media campaigns, raising the price of tobacco products, and reducing the ability of minors to access products.9,10 Benefits of Quitting Smokers who quit reap immediate health benefits. In the long term, risks of heart disease, lung and other cancers, and stroke are lowered.3 For some conditions, such as peripheral artery occlusive disease, stroke, and duodenal and gastric ulcers, ex-smokers reduce their risks to those of nonsmokers; for others, the risks are cut substantially. The bottom line is that quitting increases the potential for longer and healthier lives.7 (See Table 1). Table 1. Health benefits of quitting.Short-Term:• Blood pressure and circulation improve.• Carbon monoxide levels drop.• Coronary heart disease risk begins to decrease.• Lung function begins to improve.• Senses of smell and taste begin to improve.Long-Term:• Heart disease risk is reduced by half after 1 year of abstinence.• The risk of stroke is decreased.• Lung cancer risk is decreased by 30%–50% after 10 years.• After 5 years, risk of oral, esophageal, bladder, and cervical cancer is half that of smokers.• Respiratory problems decrease.• There is overall improvement in health and quality of life; less shortness of breath, fatigue, etc; and if the individual quits before age 50, the risk of dying in the subsequent 15 years is half that of smokers.Special Benefits for Pregnant Women:• Risk of low birth weight baby is decreased.• Risk of miscarriage is decreased.• Risk of stillbirth is decreased. [3,7,11] Why Is It So Difficult to Quit? Given these significant health benefits, why don’t more smokers quit? Nicotine addiction is the key. Terms like habituating, substance abuse, dependency, and powerfully addictive have been used by the US Surgeon General since the 1960s to describe how nicotine affects smokers. In 1988, nicotine was recognized as the principal pharmacological agent in tobacco, and nicotine dependence and nicotine addiction became scientifically equivalent.7 Just 10 to 20 seconds after inhaling a puff, nicotine reaches the brain; binds with the nicotinic receptor, autonomic ganglia, medulla, and neuromuscular junctions7,12; and increases nicotine receptor sites twofold to threefold. Receptor activation facilitates release of neurotransmitters. Acute nicotine administration results in increased dopamine and norepinephrine release from the central nervous system, producing the pleasurable effects that make nicotine so addictive and quitting so hard.12 Guideline for Treating Tobacco Dependence Faced with the enormous public health burden of smoking, in 2000 the US Public Health Service, in partnership with nonprofit organizations, developed the Clinical Practice Guideline for Treating Tobacco Use and Dependence.13 The expert panel used published evidence-based research as the basis for their recommendations. Since the clinical practice guideline was issued, researchers have examined various behavioral, pharmacologic, and alternative smoking-cessation interventions; and have assessed the level of research evidence for their effectiveness (see Table 2 and Smoking Cessation Resources sidebar for other evidence-based programs and materials). Many authors14,15 have observed that tailoring cessation interventions by combining types (such as behavioral interventions of counseling or self-help with pharmacological interventions like nicotine-replacement therapy) yields higher quit rates. Table 2 Behavioral, pharmacologic, and alternative interventions.14-16 Evidence A* Interventionbrief and low-intensity Descriptionintervention lasting 3-5 minutes A group counseling/individualcounseling/intensive sessions two or more sessions lasting longer than 10 minutes A telephone counseling proactive telephone calls A self-help written materials, audio or video tapes, computer programs A nicotine replacement therapy (NRT) available as gum, transdermal patches, intranasal spray, inhaler devices, sublingual tablets A bupropion anxiolytic and antidepressant B** clonidine antihypertensive, may reduce withdrawal symptoms (has significant side effects) B mecamylamine nicotine antagonist, may reduce desire to smoke B nortriptyline tricyclic antidepressant B fluoxetine, sertraline, paroxetine, naltrexone selective serotonin reuptake inhibitors C*** alternative interventions aversion therapy, hypnotherapy, acupuncture, acupressure, electroacupressure, exercise A*—Multiple, well-designed randomized clinical trials, directly relevant to the recommendation, that yield a consistent pattern of findings. B**—Some evidence from randomized clinical trials supports the recommendation, but scientific support is not optimal (such as too few trials, inconsistent trials, trials not directly relevant). C***—Studies have mixed results; some show significant improvement in cessation rates, and others show no evidence of improvement.14-16 Other Factors in Smoking and Quitting A majority of smokers want to quit, but few plan to do so within the following 6 months; and only 20% to 25% of smokers who attempt to quit remain smoke-free at the end of 1 year.17 Thompson et al18 conducted interviews with heavy smokers (smoked 25 or more cigarettes daily) to understand the psychosocial issues related to smoking and quitting. They found that heavy smokers were least likely to stop and more likely to seek smoking-cessation assistance. They also discovered factors that influenced or promoted smoking, factors that influenced quitting, perceptions of quitting, and explanations of failure (see Table 3). Smokers were highly addicted to nicotine; were physically, emotionally, and socially dependent on cigarettes; and used smoking to cope and comfort themselves because they felt their lives were conflicted and they had few personal resources to deal with their conflicts. The few successful quitters said that there was no single factor that accounted for their success; rather, they just knew “it was time to quit.” The researchers felt that the significant difference between being a smoker and an ex-smoker was a change in self-perception from being a smoker to being a former smoker. Quitting occurred when all internal and external influences merged with the desire, motivation, and commitment to quit smoking.18 Table 3 Factors that promote smoking and influence quitting.Factors that promote smoking:• physical addiction• smell and taste of tobacco• psychological habit• drinking and stress relief• social pressure from tobacco companies• family members and smoking buddies Factors that influence quitting:• encouraging environment that included family and friends and a work site that supported cessation• fear of weight gain• loss of smoking friends• felt it was impossible to quit• fear of failure• too many triggers for cessation to be easily achieved12,18 TTM Clearly, for many smokers and some clinicians, changing smoking behavior seems like a daunting, even impossible task. Over the past two decades, Prochaska and colleagues have developed their Transtheoretical Model (TTM) to explain how people change smoking and other health behaviors.19-21 TTM has been applied to numerous smoking interventions and has resulted in cessation rates double those of standard efforts.12 TTM conceptualizes an individual’s change process using stages of change: Precontemplation: Smoker does not intend to take action in the foreseeable future.Contemplation: Smoker intends to change in the next 6 months.Preparation: Smoker intends to take action soon, usually within the next month.Action: Smoker made changes in lifestyle within the past 6 months.Maintenance: Smoker has engaged in new behavior for 6 months or more without relapse.Termination: Smoker does not give in to temptation and has complete self-efficacy.22 TTM also includes the measurable concepts of decisional balance and self-efficacy. For smoking cessation, self-efficacy is the belief in one’s capability to organize and execute specific actions...

Category: Nicotine Alternatives

Nicotine Alternatives

FDA Allows Smokeless Tobacco Products to Be Advertised As Less Harmful Than Cigarettes

Youth with Nicotine Use Disorder Go Untreated

Juul Warned Over Claims E-Cigarette Safer Than Smoking

Can E-cigarettes Really be a Smoking Cessation Aid?

Snus Use Tied to Higher Risk of Prostate Cancer Mortality

The Rise of E-cigarettes: Harmful or Harm-Reducing?

Are Cigarette Substitutes a Safe Alternative? It Depends on User Habits

Smokers Consume Same Amount of Cigarettes Regardless of Nicotine Levels

Nicotine Alternatives

Combo Nicotine Replacement Therapy Boosts Quit Rate for Smokers

One in Five US Adults Use Tobacco Products

Nicotine in E-cigarettes Labeled Carcinogenic

‘Cool’ Factor Separates E-cigarettes from Nicotine Inhalers

E-cigarettes ‘Not A Healthy Alternative To Smoking’

E-Cigarettes Not Linked to Smoking Cessation

Nicotine Addiction: Why Don’t Smokers Just Quit?

Nicotine Alternatives

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