17.3 Million Filipino Adults Are Current Tobacco Smokers

Twenty-eight percent or 17.3 million Filipino adults age 15 years and older are current tobacco smokers, according to the results of the 2009 Global Adult Tobacco Survey (GATS). Almost half (48 percent or 14.6 million) of adult males and 9 percent (2.8 million) of adult females are current smokers. Moreover, 23 percent of Filipino adults are daily tobacco smokers: 38 percent for males and 7 percent for females.

Filipinos mainly smoke cigarettes, which include manufactured cigarettes and hand-rolled cigarettes. Cigarettes are smoked by 47 percent of men and by 9 percent of women. On the average, male daily smokers consume 11 cigarettes per day while female daily smokers consume 7 cigarettes per day.

Among adults who smoked 12 months before the survey, 48 percent made a quit attempt, while only 5 percent made a quit attempt and successfully quit smoking.

More than one-third (37 percent) of adults who worked indoors or outdoors with an enclosed area at their workplace were exposed to tobacco smoke. Among adults who used public transportation a month prior to the survey, more than half (55 percent) were exposed to second-hand smoke, while among those who visited government buildings or offices, more than one-third (37 percent) were exposed to second-hand smoke. .

The Philippines 2009 GATS is a nationally representative household survey of the population 15 years of age and older. It was designed to collect information on respondents' background characteristics; patterns of tobacco use; former/past tobacco consumption; age of initiation of daily smoking; consumption of different tobacco products (cigarettes, pipes, cigars and other smoked tobacco); nicotine dependence; frequency of quit attempts; exposure to second-hand smoke; and knowledge about health effects of smoking among others. Survey data were collected electronically during personal interviews conducted from September 10 to October 12, 2009.

Funding for the GATS was provided by the Bloomberg Initiative to Reduce Tobacco Use. Data collection was implemented by the NSO. Other GATS partners include the World Health Organization, Centers for Disease Control and Prevention (CDC), CDC Foundation, the Johns Hopkins Bloomberg School of Public Health, RTI International, Department of Health, and the National Institutes of Health.

Source: National Statistics Office Manila, Philippines- See more at: http://web0.psa.gov.ph/article/173-million-filipino-adults-are-current-tobacco-smokers#sthash.mOJoUC9P.dpuf- See more at: http://web0.psa.gov.ph/article/173-million-filipino-adults-are-current-tobacco-smokers#sthash.mOJoUC9P.dpuf

Department of Health revs up smoking cessation program

By Sheila Crisostomo | Updated August 28, 2011 - 12:00amhttp://www.philstar.com:8080/metro/720779/department-health-revs-smoking-cessation-program

MANILA, Philippines - The Department of Health (DOH) is beefing up its smoking cessation program, an official said yesterday.

Precy Cuevas, chief health information officer at the DOHs Dangerous Disease Office, said the DOH had long ago set up smoking cessation clinics in state-run hospitals and regional medical centers but smokers going there for help were few and far between.

The environment is not supportive for them to quit. Unlike now there are many policies and ordinances that say you cannot smoke here and there, she said.

The DOH is coordinating with local government units for the establishment of smoking cessation clinics in strategic localities across the country. The idea is to have one clinic in each city or town.

What we wanted to do is for all our health workers to (dispense) brief advice (about the menace of smoking) In barangay health stations, it is routine (practice) for them to make risk assessment of people and we want tobacco use to be included in it, Cuevas said.

Those who need more intensive support to be able to quit will be referred to the smoking cessation clinics, she added.

Citing the 2009 Philippines Global Adult Tobacco Survey, Cuevas said there are around 17.3 million Filipinos aged 15 years old and above who smoke, and 60 percent of them are interested in giving up the habit.

Cuevas added that since the nicotine content of cigarettes is addictive, many smokers might need professional help to be able to quit.

Nicotine affects the blood pressure and oxygen level in the body, causing the release of dopamine in the brain. Dopamine is a chemical that gives pleasurable feelings and since it is triggered by nicotine, it relies on this toxic substance to achieve the desired sensation, thus, the addiction, she said.

Aside from nicotine, there are other toxic chemicals in cigarettes, Cuevas said. These include butane (found in lighters); cadmium (batteries); stearic acid (candle wax); toluene (industrial solvents); ammonia (toilet cleaners); paint; methanol (rocket fuel); carbon monoxide; arsenic (a poison); methane (sewer gas); acetic acid (vinegar) and hexamine (barbeque lighter).

The Potential Effectiveness of Stop Smoking Interventions in the Philippinesby: Jenni Greaves Acta Medica Philippina:The National Health Science Journalhttp://actamedicaphilippina.com.ph/content/potential-effectiveness-stop-smoking-interventions-philippines

A survey of smoking habits in the Philippines1, the results of which were published in this journal in 2013, revealed that 31% of the population smokes. While smoking rates remain far lower among women the study showed that more than four times as many men as women smoke rates are still high among women over the age of 70, while men in their twenties smoke in greatest numbers. This highlights the need for smoking cessation interventions in the Philippines across the age range, targeting both men and women.

Health impacts of smokingA recent piece of research published in The Lancet2, considering the cases of lung cancer attributable to smoking, provides further evidence for the need to both prevent people taking up smoking and to help those already smoking to quit. The research into lung cancer cases associated with smoking indicated that of the 10,871 cases of lung cancer diagnosed in 2008, 62% of these cases were attributable to smoking. What is more, there was the loss of 64,913 disability adjusted life years as a consequence of smoking, with 99% of these related to loss of life as a result of early mortality. With smoking contributing significantly to cases of oral cancers, circulatory disease and COPD, the impact of smoking on health outcomes is serious.

Efforts to reduce smoking levelsThe World Health Organization advises that there are four key areas to prevent smoking uptake and aid smoking cessation3. Firstly, it is essential that current smokers receive help, both in terms of counselling and stop smoking medication to support their quit attempts. Hard-hitting images of the damage caused by smoking also serve as a helpful deterrent and it is crucial to ban all cigarette advertising. Finally, the World Health Organization also highlights the positive impact that higher taxes have on smoking rates.

Help to quitSmoking cessation counseling forms part of the quit smoking program offered by the Department of Health in the Philippines4, helping smokers to identify triggers, cope with withdrawal symptoms and manage cravings. Although limited information is available about the effectiveness of this smoking cessation counseling, data from the Global Adults Tobacco Survey in the Philippines indicated that of those who smoked in the last 12 months, 12.3% reported receiving counselling, though only 4.5% managed to quit. However, in addition to counselling, the Department of Health also advocates nicotine replacement therapy. While this form of therapy can help with nicotine cravings, a more successful approach is using the stop smoking medication varenicline, sold under the brand names of Champix and Chantix. In a study published in the International Journal of Clinical Practice5, looking at the success of smoking cessation drugs in Asia, of smokers from the Philippines who took varenicline for 12 weeks, 51% successfully quit. This piece of research also found the drug was safe, though as reported by KwikMed6, nausea was a common side effect; others include headaches, low mood and sleep disturbances. Where appropriate, smokers should have access to varenicline.

Pictorial warningsAlthough there are a variety of ways to get anti-smoking messages across to people, pictorial warnings are most effective. This was demonstrated in a piece of work published in Social Science and Medicine7, which investigated the impact of anti-smoking adverts in countries with low and middle-income, including the Philippines. Adverts illustrating the health effects of smoking had greatest impact and their influence was most consistent across the countries and different sectors of the population within countries. However, other forms of advertising that emphasise the negative health impacts of smoking were also shown to be effective, though to a lesser degree. Pictorial warnings should therefore feature on tobacco products and be used alongside messages to dissuade smoking.

Advertising bansAccording to Tobacco Control Laws, advertising tobacco products through media sources is now banned in the Philippines8. However, tobacco companies may still advertise where their products are sold and offer promotions. Research shows though that young people in the Philippines are still being exposed to other forms of advertising; the results of a survey published in Tobacco Induced Diseases9, show 91% reported exposure through television programmes and 79% through outdoor community events. Further work is therefore needed to reduce indirect advertising of tobacco products.Higher taxesAs reported in the New England Journal of Medicine, a 50% rise in the cost of tobacco products reduces their consumption by around 20%10. Higher taxes are therefore an effective means to cut tobacco use. While cigarettes are not uniformly taxed in the Philippines at present, according to an article in the Philippine Star, unitary taxation of tobacco will take effect in 201711. One of the hoped effects of this is reduced usage of tobacco products.Although interventions are in place in the Philippines to reduce tobacco consumption, further efforts are needed to cut smoking rates, benefiting the health of both smokers and those exposed to their second-hand smoke. Research looking at the effectiveness of stop smoking interventions for people in the Philippines will help to guide the help offered to smokers.

References:1. Punzalan FER et al (2013) Smoking burden in the Philippines. Acta Medica Philippina. 47(3): 28-312. Bilano VLF (2013) Smoking attributable burden of lung cancer in the Philippines: a comparative risk assessment. The Lancet. 381: S153. World Health Organization (2013) Tobacco4. Department of Health (no date) Smoking cessation program5. Wang C et al (2013) Effectiveness and safety of varenicline as an aid to smoking cessation: results of an inter-Asian observational study in real world clinical practice. The International Journal of Clinical Practice. 67(5): 469-766. KwikMed (no date) What to expect while on chantix7. Durkin S et al (2013) Potential effectiveness of anti-smoking advertisement types in ten low and middle-income countries: Do demographics, smoking characteristics and cultural differences matter? Social Science and Medicine. 98: 204-138. Tobacco Control Laws (2013) Country details for Philippines9. Agaku IT et al (2013) A cross-country comparison of the prevalence to exposure of tobacco advertisements among adolescents aged 13-15 in 20 low and middle-income countries. Tobacco Induced Diseases. 11: 1110. Jha P & Peto R (2014) Global effects of smoking, of quitting and, of taxing tobacco. New England Journal of Medicine. 370: 360-6811. Dela Pena ZB (2013) Cigarette, alcohol taxes up 81.5%. The Philippine Star, 21 December

ENDING TOBACCO PROBLEM: Resources for Local ActionInstitute of Medicine of the National Academicshttp://sites.nationalacademies.org/tobacco/smokingcessation/tobacco_051286Copyright 2015. National Academy of Sciences.

Smoking Cessation Programs

Research shows that the best way for people to quit smoking is through evidence-based smoking cessation technologies and programs. Such services include, among others, prescription drugs, insurance programs, nicotine over-the-counter products, and quit lines. Smokers who take part in cessation programs are more likely to successfully quit smokingdefined as abstinence for six months or morethan those who attempt quitting on their own.However, less than 50 percent of the 44.5 million current smokers make an attempt to quit annually. Seventy percent of smokers who attempt to quit do so without the use of evidence-based programs, and, of those, 90 percent will relapse. Cessation programs are available to smokers, yet they are underutilized, frequently because smokers are unaware of them.In order to expand cessation program use and ultimately increase cessation rates, smokers must know that safe, effective, and accessible cessation programs are available.

To reach out to those smokers who want to quit and to ensure maximum use of cessation programs, federal and state health agencies need to establish an integrated, multi-level approach. Nearly 90 percent of smokers surveyed in 2004 wanted to know how to quit smoking and wanted additional information on where to get help. State tobacco control agencies, in collaboration with health care partners, can provide smokers with the much needed program assistance they seek. In addition, volunteer organizations such as the American Cancer Society can play a critical role in providing smokers with cessation services and programs.Health practitioners also can be strong advocates, encouraging smokers to quit and directing them to the proven cessation programs to assist with the process.A Promising Approach: Quit Lines

One type of cessation program that has been found to be effective is the telephone quit line. For many years, state and local telephone quit lines have helped people who have called for assistance in their efforts to quit smoking. In particular, national quit line networks have been found to be effective; they have shown a higher rate of smoking abstinence by as much as 30 to 50 percent more than the rate achieved under control conditions [1]. Providing smokers with a national quit line can potentially reach an additional five million quitters per year, saving three million lives within two decades [2].

As of February 2004, approximately 31 states had smoking quit lines, but no national network existed and there was no coordination between states. An Intergovernmental Agency on Smoking Cessation convened in 2004 recommended the creation of a national smoking quit line to address this fragmented solution.The Secretary of Health and Human Services called on the NCI and CDC to implement the recommendation.

The NCI and CDC held five regional meetings to meet with representatives from each state to implement the plan. While representatives were wary at first, all fifty states had established smoking quit lines by June 2006.Twenty states used the national number, 1-800-QUITNOW, and the remaining thirty states connected their state number to the national number [3].Each state quit line provides different services. Some refer callers to local cessation programs, while counselors may answer the phone in other states, offering advice to callers.In some states, the quit line is part of the states tobacco control program, while in other states it might simply be affiliated or partnered with the states efforts.

Funding for state quit lines comes from a variety of sources including federal funds, state funds, Master Settlement Agreement funds, and tobacco tax revenues, as well as private sources such as foundations and grants.The CDC provides some of this funding through the National Tobacco Control Programs Funding Opportunity Announcement (FOA). Each state can submit funding requests and the CDC will evaluate that states application and budget against the FOAs criteria and then award the money accordingly. Many states received funding from the CDC to set up their quit lines, and many still receive funding to keep them going.However, none of these sources provides a stable, constant flow of funds.State and federal budgets differ each year and quit line funding often is cut when other issues take higher priority. When budgets are tight, states have seen their funding for quit lines reduced, and some are in danger of being shut down altogether.Further Information

One way to increase the overall impact of cessation within the population is to increase the reach of current interventions using social marketing to enhance smokers motivation and interest in cessation.The Internet is proving to be a cost-effective vehicle for reaching smokers, but few programs have been thoroughly evaluated.

Every level of the health care system must be supportive of smoking cessation efforts through policies and incentives.Public and private health care systems should organize and provide smokers with comprehensive cessation programs by demonstrating an assortment of successful cessation methods and management models.Although the initial financial investment for institutions to provide comprehensive cessation programs may be high, they will receive a significant return in their investment within a few short years [4].Quitters gained an average of 7.1 years of life, with an average cost of $3,417 for each year of life saved.With the costs of health care expenditures for smokers and productivity losses from smoking estimated to be more than $167 billion per year [5],the expected savings from the implementation of effective cessation programs could be substantial.

Cessation from smoking is a long and arduous journey for many smokers, even though for a majority of the time the smoker is not actively attempting to quit.Thus, there are multiple opportunities to enhance cessation success rates at many points of the smokers journey.However, there is substantial room to improve the overall cessation outcome rate through strengthening and developing policies that support a comprehensive smoking cessation care management system that addresses each and every step in the process from current smoker to abstinence.

[1] Fiore, M.C., Bailey, W.C., Cohen, S.J. (2000). Treating Tobacco Use and Dependence (Clinical Practice Guideline). Rockville, MD: U.S. Department of Health Human Services. Public Health Service.[2] Fiore, M.C., Croyle, R.T., Curry, S.J., Cutler, C.M., Davis, R.M., Gordon, C., Healton, C., Koh, H.K., Orleans, C.T., Richling, D., Satcher, D., Seffrin, J., Williams, C., Williams, L.N., Keller, P.A., Baker, T.B. (2004). Preventing 3 million premature deaths and helping 5 million smokers quit: a national action plan for tobacco cessation. American Journal of Public Health, 94(2):205-310.[3] 1-800-QUIT-NOW is a free smoking cessation service for the general public.[4] AHIP (Americas Health Insurance Plans). 2004. Making the Business Case for Smoking Cessation.[5] CDC. 2005. Annual smoking-attributable mortality, years of potential life lost, and productivity lossesUnited States, 19972001. MMWR (Morbidity and Mortality Weekly Report) 54(25):625-628.

Motivating and Helping Smokers to Stop Smoking

John R Hughes, MD1 Copyright2003 by the Society of General Internal Medicine Journal List J Gen Intern Med v.18(12); 2003 Dec PMC1494968Smokers try to quit only once every 2 to 3 years and most do not use proven treatments. Repeated, brief, diplomatic advice increases quit rates. Such advice should include a clear request to quit, reinforcing personal risks of smoking and their reversibility, offering solutions to barriers to quitting, and offering treatment. All smokers should be encouraged to use both medications and counseling. Scientifically proven, first-line medications are nicotine gum, inhaler, lozenge, and patch plus the nonnicotine medication bupropion. Proven second-line medications are clonidine, nicotine nasal spray, and nortriptyline. These medications are equally effective and safe and the incidence of dependence is very small. The proven psychosocial therapies are behavioral and supportive therapies. These are as effective as medications and are effective via individual counseling, group, and telephone formats.

EPIDEMIOLOGY OF SMOKING CESSATIONAbout 40% of current smokers attempt to quit each year1and 4% to 6% are successful2; thus each year about 2% of smokers quit for good.1Most smokers make multiple attempts, such that half eventually quit smoking.1Beginning in the 1990s, rates of cessation began to stall1due to both no increase in the frequency of quit attempts and no increase in the success of a given quit attempt.3Some, but not all, believe this is because those who have quit thus far have been the easy quitters leaving the more dependent, less psychologically stable, and less advantaged smokers who want to quit but are unable.3Two-thirds of self-quitters relapse within 2 days4; thus, the major focus of smoking cessation interventions must be in the first few days.

Go to:MISPERCEPTIONS ABOUT SMOKING CESSATIONOne misperception by clinicians, smokers, and nonsmokers is all smokers can quit smoking, if they are just motivated enough. This statement is similar to statements made about alcohol and depression problems in the early 1900s. We now know that many persons with these problems are able to self-cure, but also that many are unable to improve without treatment. The same is true for tobacco use.5A related statement is that 95% of all smokers who quit do so on their own. In fact, with all the new treatments, one-third of smokers who quit now do so via treatment,6a rate of treatment use greater than that for alcoholism or obesity.7Some clinicians do not believe brief advice is effective; however, many randomized trials indicate that even brief advice increases quit rates.8,9Some clinicians do not believe they have the time to provide advice; however, the major role clinicians play is to motivate smokers to quit, which can take as little as 3 minutes (Table 1).8Some clinicians fear they may embarrass their patients by discussing the topic; however, exit polls suggest that most smokers state doctors who do not ask about their smoking habits are less competent doctors.SPECIFIC ISSUES IN SMOKING CESSATIONAlthough many experts recommend abrupt cessation methods, gradual reduction is as effective.8However, all experts believe setting a firm date by which one is to become tobacco free is important.Smoking decreases blood levels of a number of medications; thus, stopping smoking substantially increases these blood levels, i.e., often by 20% to 50%.23Patients often need to have their dosage of these medications monitored and adjusted when they stop smoking.Smokers weigh less than nonsmokers because nicotine suppresses appetite and increases energy expenditure.25Smokers gain an average of 4 kg when they stop smoking.25Studies of teaching smokers to diet to keep off weight gain to increase quit rates found just the opposite dieting caused more relapse.25Early studies suggest postcessation exercise not only prevents weight gain but also aids cessation.23Also, both NRT and bupropion prevent weight gain while they are used.8Thus, one option is to encourage exercise and to use a medication initially. Dieting (if necessary) could then be postponed until abstinence is well established and medication is decreased.25The little research that has been done on treatment for those with psychiatric disorders,26adolescents,27or smokeless tobacco users8suggests these groups should be treated similarly to adult cigarette users until special programs for these groups are validated.8Go to:

CONCLUDING REMARKSThe most important aspect to smoking cessation is maintaining the motivation to make multiple attempts. Thus, quit attempts should be thought of like practice sessions in learning a new skillat some point one hopes to get it right, but one should not put undue hope on any single given quit attempt, and take solace in knowing the probability of success increases with each try.Given that 1) stopping smoking is the single most important thing one can do to improve their health; 2) smoking cessation treatment doubles or triples quit rates; and 3) smoking treatment is the gold standard of cost-effective treatments,28smoking cessation is not the time to try to reduce costs by allocating treatments only to those with special difficulties. All smokers should be encouraged to access a treatment. Typically, state health departments are the best source of information on local cessation resources. In addition, since the efficacy of brief advice, pharmacotherapies, and psychological therapies all are dose relatedthe more intense the treatment, the greater the success rate8smokers should be encouraged to participate in as intensive therapies as possible.Go to:

REFERENCES1.Center for Disease Control and Prevention. Cigarette smoking among adultsUnited States, 1998.Morb Mortal Wkly Rep.2000;49:8814.[PubMed]2.Cohen S, Lichtenstein E, Prochaska JO, et al. Debunking myths about self-quitting.Am Psychol.1989;44:135565.[PubMed]3.Hughes JR.The evidence for hardeningIs the target hardening? NCI Smoking and Tobacco Control Monograph.Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2001.4.Hughes JR, Gulliver SB, Fenwick JW, et al. Smoking cessation among self-quitters.Health Psychol.1992;11:3314.[PubMed]5.Hughes JR. Four beliefs that may impede progress in the treatment of smoking.Tob Control.1999;8:3236.[PMC free article][PubMed]6.Hughes JR, Burns DM.Population Based Smoking Cessation.Bethesda, MD: National Cancer Institute;; 2001. Impact of medications on smoking cessation; pp. 15564. Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control, Monograph No. 12.7.Klingemann H, Sobell L, Barker J, et al.Promoting Self-Change from Problem Substance Use: Practical Implications for Policy, Prevention and Treatment.Dordrecht, The Netherlands: Kluwer Academic Publications; 2001.8.Fiore MC, Bailey WC, Cohen SJ, et al.Treating Tobacco Use and DependenceClinical Practice Guideline.Rockville, MD: Public Health Service; 2000.9.Silagy C, Ketteridge S. Physician Advice for Smoking Cessation. 1999. The Cochrane Library, Issue 4 Updated Software;10.Etter JF, Perneger TV, Ronchi A. Distributions of smokers by stage: international comparison and association with smoking prevalence.Prev Med.1997;26:5805.[PubMed]11.Emmons KM, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations.Am J Prev Med.2001;20:6874.[PubMed]12.Prochaska JO, Goldstein MG. Process of smoking cessation: implications for clinicians.Clin Chest Med.1991;12:72735.[PubMed]13.Burns DM, Anderson C, Major J, Vaughn J, Shanks T.Population Impact of Smoking Cessation.Bethesda, MD: National Cancer Institute; 2000. Cessation and cessation measures among adult daily smokers: national and state-specific data; pp. 2598. Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control, Monograph No. 12.14.Hughes JR. Harm reduction approaches to smoking: the need for data.Am J Prev Med.1998;15:789.[PubMed]15.Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking.JAMA.1999;281:726.[PubMed]16.Benowitz NL.Nicotine Safety and Toxicity.New York: Oxford University Press; 1998.17.Shiffman S, Dresler CA, Hajek P, Gilburt SJA, Targett DA, Strahs KR. Efficacy of a nicotine lozenge for smoking cessation.Arch Intern Med.2002;162:126776.[PubMed]18.Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation.N Engl J Med.1999;340:68591.[PubMed]19.Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.J Am Coll Cardiol.1997;29:142231.[PubMed]20.Hughes JR. Behavioral support programs for smoking cessation.Mod Med.1994;62:227.21.Lancaster T, Stead LF. Individual Behavioural Counselling for Smoking Cessation. 2002. The Cochrane Library, Issue 3, Updated Software;[PubMed]22.Stead LF, Lancaster T. Group Behaviour Therapy Programmes for Smoking Cessation. 2002. The Cochrane Library, Issue 3, Updated Software;[PubMed]23.Lancaster T, Stead LF. Self-help Interventions for Smoking Cessation. 2002. The Cochrane Library, Issue 3, Updated Software;[PubMed]24.Lichtenstein E, Glasgow RE, Lando HA, Ossip-Klein DJ. Telephone counseling for smoking cessation: rationales and review of evidence.Hlth Educ Res.1996;11:24357.[PubMed]25.Perkins KA. Weight gain following smoking cessation.J Consult Clin Psychol.1993;61:76877.[PubMed]26.Hughes JR, Zarin DA, Pincus HA. Treating nicotine dependence in mental health settings.J Prac Psych Behav Hlth.1997:2504.27.Sussman S. Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting.Tob Induced Dis.2002;1:3581.[PMC free article][PubMed]28.Warner KE, Luce BR.Cost-Benefit and Cost-Effectiveness Analyses in Health Care: Principles, Practice, and Potential.Ann Arbor, MI: Health Administration Press; 1983.

Articles fromJournal of General Internal Medicineare provided here courtesy ofSociety of General Internal Medicine

SMOKING CESSATIONSmoking cessation(colloquiallyquitting smoking) is the process of discontinuingtobacco smoking. Tobacco containsnicotine, which isaddictive,[1]making the process of quitting often very prolonged and difficult.Smoking is the leading preventable cause of death worldwide, and quitting smoking significantly reduces the risk of dying from tobacco-related diseases such as heart disease and lung cancer.[2]Seventy percent of smokers would like to quit smoking, and 50 percent report attempting to quit within the past year.[3]Many different strategies can be used for smoking cessation, including quitting without assistance ("cold turkey" or cut down then quit), medications such asnicotine replacement therapy(NRT) orvarenicline, and behavioral counseling. The majority of smokers who try to quit do so without assistance, though only 3 to 6% of quit attempts without assistance are successful.[4]Use of medications and behavioral counseling both increase success rates, and a combination of both medication and behavioral interventions has been shown to be even more effective.[5]Because nicotine is addictive, quitting smoking leads to symptoms of nicotine withdrawal such as craving, anxiety and irritability, depression, and weight gain..[6]:2298Professional smoking cessation support methods generally endeavor to address both nicotine addiction and nicotine withdrawal symptoms.

Comparison of success rates across interventions can be difficult because of different definitions of "success" across studies.[13]Robert West and Saul Shiffman, authorities in this field recognised by government health departments in a number of countries,[109]:73,76,80have concluded that, used together, "behavioural support" and "medication" can quadruple the chances that a quit attempt will be successful.A 2008 systematic review in theEuropean Journal of Cancer Preventionfound that group behavioural therapy was the most effective intervention strategy for smoking cessation, followed bybupropion, intensive physician advice, nicotine replacement therapy, individual counselling, telephone counselling, nursing interventions, and tailored self-help interventions; the study did not discussvarenicline.[33]

Factors affecting success[edit]Quitting can be harder for individuals with dark pigmented skin compared to individuals with pale skin since nicotine has an affinity formelanin-containing tissues. Studies suggest this can cause the phenomenon of increasednicotine dependenceand lower smoking cessation rate in darker pigmented individuals.[112]There is an important social component to smoking. A 2008 study of a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%.[113]Nevertheless, aCochranereview determined that interventions to increase social support for a smoker's cessation attempt did not increase long-term quit rates.[114]Smokers who are trying to quit are faced with social influences that may persuade them to conform and continue smoking. Cravings are easier to detain when one's environment does not provoke the habit. If a person who stopped smoking has close relationships with active smokers they are often put into situations that make the urge to conform more tempting. However, in a small group with at least one other not smoking, the likelihood of conformity decreases. The social influence to smoke cigarettes has been proven to rely on simple variables. One researched variable depends on whether the influence is from a friend or non-friend.[115]the research shows that individuals are 77% more likely to conform to non-friends, while close friendships decrease conformity. Therefore, if an acquaintance offers a cigarette as a polite gesture, the person who has stopped smoking will be more likely to break his commitment than if a friend had offered.Smokers withmajor depressive disordermay be less successful at quitting smoking than non-depressed smokers.[8]:81[116]Relapse (resuming smoking after quitting) has been related to psychological issues such as lowself-efficacy[117]or non-optimal coping responses;[118]however, psychological approaches to prevent relapse have not been proven to be successful.[119]In contrast, varenicline may help some relapsed smokers.[119]

Wiki Smoking Cessation Bibliography[edit]1. Jump up^"Guide to quitting smoking".American Cancer Society. 2011-01-31. Retrieved2011-02-15.2. Jump up^World Health Organization. WHO Report on the Global Health Epidemic, 2011: Warning about the dangers of tobacco.http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf.3. Jump up^"Quitting smoking among adults--United States, 2001-2010".MMWR. Morbidity and mortality weekly report60(44): 15131519. Nov 11, 2011.ISSN1545-861X.PMID22071589. Retrieved2015-05-09.4. Jump up^Rigotti, Nancy A. (Oct 17, 2012)."Strategies to help a smoker who is struggling to quit".JAMA308(15): 15731580.doi:10.1001/jama.2012.13043.ISSN1538-3598.PMID23073954. Retrieved2015-05-09.5. Jump up^Stead, Lindsay F.; Lancaster, Tim (2012)."Combined pharmacotherapy and behavioural interventions for smoking cessation".The Cochrane Database of Systematic Reviews10: CD008286.doi:10.1002/14651858.CD008286.pub2.ISSN1469-493X.PMID23076944. Retrieved2015-05-09.6. Jump up^Benowitz NL; Benowitz, Neal L. (2010)."Nicotine addiction".N Engl J Med362(24): 2295303.doi:10.1056/NEJMra0809890.PMC2928221.PMID20554984.7. ^Jump up to:abCochrane Tobacco Addiction Group (2010-03-02)."Welcome". Retrieved2011-02-17.8. ^Jump up to:abcdefghijklmnopqrstuvwxyzaaabFiore MC, Jan CR, Baker TB et al. (2008).Clinical practice guideline: treating tobacco use and dependence: 2008 update(PDF). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service. Retrieved2011-02-16.9. Jump up^Fiore MC, Bailey WC, Cohen SJ et al. (1996).Smoking cessation. Clinical practice guideline no. 18. AHCPR publication no. 96-0692. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research.10. Jump up^Fiore MC, Bailey WC, Cohen SJ et al. (2000).Clinical practice guideline: treating tobacco use and dependence(PDF). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service. 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