Nicotine

A potent and toxic stimulant causing 1 out of 5 deaths in US each year (~434,000 per year)

Risk: Cardiovascular Disease

n Risk of coronary heart disease doubles (quadruples in heavy smokers)

n Nicotine increases HR & BP

n At the same time there is less blood getting to the heart, a greater risk of clotting, and an increase in serum cholesterol and fatty deposits

Risk: Respiratory Disease

n Lung Cancer

n Chronic Obstructive Lung Diseases like emphysema & bronchitis

n Increased respiratory infections

Myth of the Safer Cigarette

n To maintain customer satisfaction, filtered cigarettes have to use a high T/N tobacco, counteracting the benefit of the filter and raising the toxicity of sidestream smoke.

Myth of the Safer Cigarette

n “Low T/N” figures are based on smoke drawn by smoking machine. Holes in sides of filter allowing air to be drawn in with smoke, diluting it. Smokers block those holes with fingers or lips so get a higher proportion of smoke, decreasing or eliminating the benefits of low T/N.

Myth of the Safer Cigarette

n Smokers unconsciously adjust their pattern of smoking to maintain certain levels of nicotine despite the content in a particular cigarette (e.g. smoke more cigarettes, more puffs per cigarette, smoke further down on the butt).

Fetal Tobacco Syndrome

n Smoking during pregnancy produces a dose-dependent decrease in oxygen to the baby, resulting in:

– shorter, lighter babies with smaller heads

– dose-related risk of miscarriage, placental problems, bleeding, stillbirth, prematurity, neonatal death

– some studies show small but consistent increases in learning difficulties and hyperactivity in those kids; increased SIDS

Why People Smoke

n For stimulating effect

n For relaxing effects

n For positive mood change

n In response to situational and social cues

n Nervous habit, occupy hands/mouth

n A smoking ritual

n Consider these when trying to quit

Withdrawal Symptoms

n Drowsy, depressed, decreased concentration, brain less aroused

n Restlessness, anxiety, irritability

n Headache, sweating, decreased HR & metabolism, GI complaints, sleep disturbances

n Craving

n Behavioral habits may be even more important than withdrawal

Pharmacological Approaches

n Nicotine substitutes

– Nicorette chewing gum

– Nicotine patch

– Nicotine inhaler

– Nicotine nasal spray

n Avoid withdrawal symptoms while breaking behavioral habit

n Easier way to “taper off” for some

Nicotrol Inhaler

Nicotrol Nasal Spray

Nicotrol Inhaler

Non-Nicotine Inhaler

Zyban

n Antidepressant buproprion (same as Wellbutrin) seems to relieve the mood changes of withdrawal and reduce craving, leading to increases in both short term and long-term smoking cessation.

Tips For Quitting on Your Own

n Learn why you smoke – write down when & where you smoke and what you’re feeling on an index card you keep in your smokes for 2 weeks

n Cutback by about one-half. Smoke those cigarettes at pre-arranged times.

n Then go cold turkey. Avoid smoking situations. Choose as unstressful a time as you can. Hang around non-smokers.

n Consider relapses part of the process and immediately return to your “program”.

Tips if You Can’t Quit

n Smoke fewer cigarettes

n Inhale less; take fewer puffs

n Only smoke 1/3 down cigarette

n Don’t cover filter holes

Some Behavioral Approaches

n Stimulus control (of situations and access)

n Visualizing smoking consequences

n Relaxation training, other “substitutes”

n Contingency contracting

n Social support (buddy system; groups)

n Aversion therapy