**Adverse effects: [[Nausea and vomiting|Nausea]], [[Sleeping difficulty|trouble sleeping]], vivid/strange dreams and [[depressed mood]]
**Adverse effects: [[Nausea and vomiting|Nausea]], [[Sleeping difficulty|trouble sleeping]], vivid/strange dreams and [[depressed mood]]
===Modalities===
[[Image:Nicoderm.JPG||thumb|right|A 21mg dose [[Nicoderm]] CQ patch applied to the left arm]]
Techniques which can increase smokers' chances of successfully quitting are:
*Quitting "[[cold turkey]]": abrupt cessation of all nicotine use as opposed to tapering or gradual stepped-down nicotine weaning. It is the quitting method used by 80<ref>Doran CM, Valenti L, Robinson M, Britt H, Mattick RP. Smoking status of Australian general practice patients and their attempts to quit. Addict Behav. 2006 May;31(5):758-66. PMID 16137834</ref> to 90%<ref>{{cite web| title=Cancer Facts & Figures 2003 | author=American Cancer Society | url=http://www.cancer.org/downloads/STT/CAFF2003PWSecured.pdf}}</ref> of all long-term successful quitters.
*Smoking-cessation support and counseling is often offered over the internet, over the phone [[quitline]]s (e.g. 1-800-QUIT-NOW), or in person. One effective way to assist smokers who want to quit is through a telephone [[quitline]] which is easily available to all. Professionally run quitlines may help less dependent smokers, but those people who are more heavily dependent on nicotine should seek local smoking cessation services, where they exist, or assistance from a knowledgeable health professional, where they do not. Some evidence suggests that better results are achieved when counseling support and medication are used simultaneously. Quitting with a group of other people who want to quit is also a proven method of getting support, available through many organizations.
*[[Nicotine replacement therapy]], NRT: pharmacological aids that are clinically proven to help with withdrawal symptoms, cravings, and urges (for example, transdermal [[nicotine patch]]es, [[nicotine gum|gum]], lozenges, sprays, and [[inhaler]]s)
*The antidepressant [[bupropion]], marketed under the brand name Zyban®, helps with withdrawal symptoms, cravings, and urges.
Bupropion is contraindicated in [[epilepsy]], seizure disorder; anorexia/bulimia (eating disorders), patients use of psychosis drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium)<ref>Charles F. Lacy et al, ''LEXI-COMP'S Drug Information Handbook 12th edition''. Ohio, USA,2004</ref>
*Nicotinic receptor antagonist [[varenicline]] (Chantix®) (Champix® in the UK)
*Recently, a shot given multiple times over the course of several months, which primes the immune to produce antibodies which attach to nicotine and prevent it from reaching the brain, has shown promise in helping smokers quit. However, this approach is still in the experimental stages. [http://news.wired.com/dynamic/stories/T/TOBACCO_VACCINE?SITE=WIRE&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2007-11-07-23-20-38]
===Alternative techniques===
Some 'alternative' techniques which have been used for smoking cessation are:
*[[Hypnosis]] clinical trials studying hypnosis as a method for smoking cessation have been inconclusive. (The Cochrane Database of Systematic Reviews 2006, Issue 3.)
*[[Herbalism|Herbal preparations]] such as [[Kava]] and [[German_Chamomile | Chamomile]]
*[[Acupuncture]] clinical trials have shown that acupuncture's effect on smoking cessation is equal to that of sham/placebo acupuncture. (See Cochrane Review)
*Attending a self-help group such as [[List of Twelve-Step groups|Nicotine Anonymous]][http://www.nicotine-anonymous.org/] and electronic self-help groups such as Stomp It Out[http://www.experienceproject.com/mk/smokefree/index.php]
*Laser therapy based on [[acupuncture]] principles but without the needles.
*Quit meters: Small computer programs that keep track of quit statistics such as amount of "quit-time", cigarettes not smoked, and money saved.
*[[Self-help|Self-help books]] ([[Allen Carr]], FreshStartMethod etc.) Some of these claim very high success rates but little externally verified evidence of this success exists.
*[[Spirituality]] Spiritual beliefs and practices may help smokers quit.[http://www.sciencedaily.com/releases/2007/05/070507154054.htm]
*[[Smokeless tobacco]]: [[Snus]] is widely used in Sweden, and although it is much healthier than smoking, something which is reflected in the low cancer rates for Swedish men, there are still some concerns about its health impact. [http://www.snus.cc/snuff-health.aspx]
* Herbal and aromatherapy "natural" program formulations.
*[[Smoking reduction utensil]] ([[minitoke]])<ref>{{cite web | title="Smoking reduction may lead to unexpected quitting" | Author=Hughes et al. | accessdate=2007-12-27 |url=http://www.medicalnewstoday.com/articles/58430.php}}</ref>
*Smoking herb substitutions (non-tobacco)[[http://en.wikiversity.org/wiki/Smoking_Cessation]]
==Information for healthcare professionals==
[[Clinical practice guideline]]s by the United States Preventive Service Task Force ([[USPSTF]]) in 2009 stated<ref name="pmid19380855">{{cite journal| author=U.S. Preventive Services Task Force| title=Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. | journal=Ann Intern Med | year= 2009 | volume= 150 | issue= 8 | pages= 551-5 | pmid=19380855 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19380855 }} </ref>:
* “The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products.” (Grade A recommendation)
The USPSTF has provided good evidence that demonstrates a clear benefit in both successful smoking cessation and greater than 1 year abstinence when clinicians provide smoking cessation interventions to adult patients. These interventions include behavioral counseling (<10 minutes) and pharmacotherapy. Brief smoking cessation counseling (3 minutes) though less effective, was found to increase quit rates.
A [[systematic review]] by the [[Cochrane Collaboration]] defined brief advice from a single verbal “stop smoking” statement to counseling up to 20 minutes and cited evidence that demonstrated when “assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%.<ref name="pmid23728631">{{cite journal| author=Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T| title=Physician advice for smoking cessation. | journal=Cochrane Database Syst Rev | year= 2013 | volume= 5 | issue= | pages= CD000165 | pmid=23728631 | doi=10.1002/14651858.CD000165.pub4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23728631 }} </ref>
Regarding individual studies, several have found that smoking cessation advice is not always given in primary care in patients aged 65 and older<ref>Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing. 2000 May;29(3):264-6. PMID 10855911</ref><ref>Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J. Smokers ages 50+: who gets physician advice to quit? Prev Med. 2000 Oct;31(4):364-9. PMID 11006061</ref>, despite the significant health benefits which can ensue in the older population<ref>Ferguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction. 2005 Apr;100 Suppl 2:59-69. PMID 15755262</ref>.
[[Health professional]]s may follow the "five As" with every smoking patient they come in contact with:<ref>{{cite journal |journal=CMAJ |date=2007 |volume=177 |issue=11 |pages=1373–80 |title= Treatment of tobacco dependence: integrating recent progress into practice |author= Le Foll B, George TP |doi=10.1503/cmaj.070627 |pmid=18025429 |url=http://www.cmaj.ca/cgi/content/full/177/11/1373}}</ref>
#Ask about smoking
#Advise quitting
#Assess current willingness to quit
#Assist in the quit attempt
#Arrange timely follow-up
==See also==
==See also==
Line 141:
Line 97:
*[[Tobacco and health]]
*[[Tobacco and health]]
==Notes==
==References==
{{reflist|2}}
{{reflist|2}}
==References==
* Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. Bmj 2004;328(7455):1519.
* [[Helgason AR]], Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H. Factors related to abstinence in a telephone helpline for smoking cessation. European J Public Health 2004: 14;306-310.
* {{cite journal | author = Henningfield J, Fant R, Buchhalter A, Stitzer M | title = Pharmacotherapy for nicotine dependence. | journal = CA Cancer J Clin | volume = 55 | issue = 5 | pages = 281-99; quiz 322-3, 325 | year = | id = PMID 16166074}} ''[http://caonline.amcancersoc.org/cgi/content/full/55/5/281 Full text]''
* Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99(1):29-38.
* Hutter H.P. et al. Smoking Cessation at the Workplace:1 year success of short seminars. International Archives of Occupational & Environmental Health. 2006;79:42-48.
* Marks, D.F. The QUIT FOR LIFE Programme:An Easier Way To Quit Smoking and Not Start Again. Leicester: British Psychological Society. 1993.
* Marks, D.F. & Sykes, C. M. Randomized controlled trial of cognitive behavioural therapy for smokers living in a deprived area of London: outcome at one-year follow-up
Psychology, Health & Medicine. 2005;7:17-24.
* Marks, D.F. ''Overcoming Your Smoking Habit''. London: Robinson.2005.
* Peters MJ, Morgan LC. ''The pharmacotherapy of smoking cessation''. Med J Aust 2002;176:486-490. [http://www.mja.com.au/public/issues/176_10_200502/pet10850_fm.html Fulltext]. PMID 12065013.
* USDHHS. Treating Tobacco Use and Dependence. Rockville, MD: Agency for Healthcare Research Quality; 2000.
* West R. Tobacco control: present and future. Br Med Bull 2006;77-78:123-36.
* Williamson, DF, Madans, J, Anda, RF, Kleinman, JC, Giovino, GA, Byers, T '''Smoking cessation and severity of weight gain in a national cohort''' N Engl J Med 1991 324: 739-745
* [http://www.who.int/tobacco/en/index.html World Health Organization, Tobacco Free Initiative]
* [[Zhu S-H]], Anderson CM, Tedeschi GJ, et al. Evidene of real-world effectiveness of a telephone quitline$for smokers. N Engl J Med 2002;347(14):1087-93.
==External links==
* [http://www.helpguide.org/mental/quit_smoking_cessation.htm Helpguide.org - How to Quit Smoking]
* [http://www.cancer.org/docroot/PED/ped_10.asp?sitearea=PED American Cancer Society Quit Tobacco Resources]
* [http://www.smokefree.gov/ National Cancer Institution Online guide to quitting]
* [http://whyquit.com WhyQuit.com]
* [http://www.ctri.wisc.edu/Smokers/smokers_Quit.Tips.htm University of Wisconsin Center for Tobacco Research and Intervention]
* [http://cpmcnet.columbia.edu/dept/nursing/clin_resources/mods-apn/ebp_pt_resources/SmCessationResources.htm Columbia University School of Nursing Smoking Cessation Portal]
* [http://www.lifesolved.com/story.php?title=Canrsquot_Quit_Smoking_Try_Calendar_Technique-1 Technique to Quit Smoking]
* [http://www.stop-tabac.ch Stop-tabac.ch: smoking cessation website in 5 languages]
* [http://www.smokefreeme.com SmokeFreeMe is an online guide to quit smoking]
Tobacco use is the leading cause of preventable disease, disability, and death in the United States. Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke and 16 million live with a serious illness caused by smoking. Smoking can cause repairable damage to various organs including the heart, lungs, kidneys, stomach and intestines. Smoking is associated with the causation of various cancers in the humans. Quitting smoking cuts cardiovascular risks, reduces risk for stroke to about half that of a nonsmoker’s, reduces risks for cancers of the mouth, throat, esophagus, and bladder by half within 5 years and ten years after quitting smoking, the risk for lung cancer drops by half. Smoking cessation can be achieved by some general, non-pharmacological and pharmacological strategies.
Smoking and Health
The impact of smoking on the health can be summarized as follows:[1][2][3]
Effect of Smoking Cessation on various Risks
Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.
Within 2 to 5 years after quitting smoking, your risk for stroke may reduce to about that of a nonsmoker’s.
If you quit smoking, your risks for cancers of the mouth, throat, esophagus, and bladder drop by half within 5 years.
Ten years after you quit smoking, your risk for lung cancer drops by half.
Smoking cessation
General Principles
The 5As are an evidence-based framework for structuring smoking cessation in health care settings. The 5As include: Ask, Assess, Advise, Assist and Arrange follow-up.
The 5As
Technique
Ask
Identify and document tobacco use status for every patient at every visit
Advise
In a clear, strong, and personalized manner, urge every tobacco user to quit.
Advices should be:
Clear:
I think it is important for you to quit smoking now and I can help you. Cutting down while you are ill is not enough.
Strong:
As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. The clinic staff and I will help you.
Personalized:
Tie tobacco use to current health, and its social and economic costs, motivation level to quit, and the impact of tobacco use on children and others in the household.
Assess
Assess willingness to make a quit attempt.
Is the tobacco user willing to make a quit attempt within the next 30 days?
Assist
For the patient willing to make a quit attempt, offer medication and provide or refer for counseling or additional treatment to help the patient quit.
For patients unwilling to quit at the time, provide interventions designed to increase future quit attempts.
Arrange follow-up
For the patient willing to make a quit attempt, arrange for followup contacts, beginning within the first week after the quit date.
For patients unwilling to make a quit attempt at the time, address tobacco dependence and willingness to quit at next clinic visit.
Pharmacological
First-line pharmacotherapy includes the multiple forms of nicotine replacement therapy (patch, nasal spray, losenge, gum, inhaler), sustained- release bupropion hydrochloride, and varenicline. Second line therapy includes clonidine and nortriptyline and have been found to be efficacious.[4] The following is a description of the various treatment modalities available:[5]
