Smoke Less America

Current Research Findings and Information

Smoking Hurts Your Health

The best-known effect of smoking is that it causes cancer. Smoking can also aggravate many problems that people with diabetes already face, such as heart and blood vessel disease.

1.      Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack, stroke, miscarriage, or stillbirth.

2.      Smoking increases your cholesterol levels and the levels of some other fats in your blood, raising your risk of a heart attack.

3.      Smoking damages and constricts the blood vessels. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections.

4.      Smokers with diabetes are more likely to get nerve damage and kidney disease.

5.      Smokers get colds and respiratory infections easier.

6.      Smoking increases your risk for limited joint mobility.

7.      Smoking can cause cancer of the mouth, throat, lung, and bladder.

8.      People with diabetes who smoke are three times as likely to die of cardiovascular disease as are other people with diabetes.

9.      Smoking increases your blood pressure.

10. Smoking raises your blood sugar level, making it harder to control your diabetes.

11. Smoking can cause impotence.

Vitamin C for Smokers - A Long Shot

A study showing that injecting chronic smokers with vitamin C helped their arteries widen made headlines when it was published in the July 1 Circulation. But smokers shouldn't think they can pop pills to avoid heart disease.

Cigarette smoke contains chemicals called free radicals, which initiate a chain of artery- damaging events. They make LDL ("bad" cholesterol) stickier and more likely to cause atherosclerosis (clogged arteries). Vitamin C is an antioxidant—a substance that mops up free radicals before they wreak havoc.

In this small all-male study, 10 nonsmokers and 10 long-time smokers (a pack a day for more than 20 years) were first given shots of a chemical that relaxes the lining of the arteries. The result in nonsmokers was wider arteries, but as expected, the smokers' arteries didn't respond well. Then all the men were injected with vitamin C. When researchers tried the chemical again, the smokers' arteries widened much more. But is this a "cure" for smoking-induced atherosclerosis?

"Not by a long shot," says HealthNews associate editor Harry Greene, MD. About one gram of vitamin C was injected directly into the men's arteries; you'd have to swallow a lot of pills to get this amount into your bloodstream, and daily injections aren't very appealing. Also, the widening effect was probably temporary, according to the researchers. And the study only looked at the arm arteries; coronary arteries might react differently.

Increasing your vitamin C intake probably won't help. A large study published in 1993 by Eric Rimm, an assistant professor of epidemiology at the Harvard School of Public Health, found no evidence that high intakes of vitamin C, from pills or food, could reduce smokers' risk of heart disease. His advice: "The best thing for smokers to do is quit."

Courtesy of HealthNews from the Publishers of the New England Journal of Medicine

Just Trying to Quit Smoking can Add Years to Life

SOURCE: Annals of Internal Medicine, 2005;142:233-239


Smokers assigned to a quit-smoking program, regardless of whether or not

they actually quit, had lower death rates than those assigned to usual care,

according to a new study.


Researchers for the Lung Health Study evaluated 5,887 middle-aged smokers

with mild lung disease who were randomly assigned to either a quit-smoking

program (behavior modification and nicotine gum) or usual care. Study

participants were followed an average of 14.5 years.


Results show while only 21.7 percent of those in the quit-smoking program

had actually quit smoking after five years (compared with 5.7 percent who

received the usual care), even the non-quitters in the quit-smoking program

had a 15-percent lower death rate than smokers who received usual care.


So why did those in the quit-smoking program who remained smokers still reap

some health benefits?


Study author John E. Connett, Ph.D., professor of biostatistcs at the

University of Minnesota School of Public Health in Minneapolis, says,

"People quit, restarted, and quit again. However, quitting had such a

statistically large impact on the overall population that even though many

people quit and started smoking again, as long as they were smoke free for

periods of time, they had better outcomes than those who continued to



As expected, those who had quit smoking altogether during the study had

death rates that were 46-percent lower than those who continued to smoke.


Smoking Makes Root Canals Likelier

People Who Smoke at Least 12 Years Most Vulnerable

Courtesy of Miranda Hitti

New research shows that smokers are more likely than nonsmokers to get root canals.

Root canals are done when a tooth's dental pulp -- which includes nerves, blood vessels, and connective tissue -- becomes infected and inflamed. The infected tissue is removed, and then the hollow area is cleansed and filled to prevent the infection's return.

Elizabeth Krall Kaye, PhD, MPH, and colleagues reported their findings in New York, at a media teleconference organized by the American Medical Association and American Dental Association.

"Our study has shown that men have almost twice the risk of having root canal treatments if they smoke cigarettes, compared to men who never smoke," Kaye said, in the teleconference.

Kaye is a professor in the department of health policy and health services research at Boston University's Goldman School of Dental Medicine.

About the Study

Kaye's team got data from a study of 811 men who were followed for up to 28 years. The study started in the late 1960s and early 1970s. Back then, the men were about 48 years old, on average. The men were mostly middle-class whites.

Every three years, the men got their teeth examined and had dental X-rays taken at the study site. The men also reported their smoking habits.

A total of 230 men had never smoked. Another 440 men were former smokers. Most of the smokers smoked cigarettes. Few smoked pipes or cigars.

The researchers checked the X-rays to see if root canals had been done. They spotted 998 teeth that had root canals done on them. Those teeth belonged to 385 men, so many men got more than one root canal.

Reduce the Odds of Root Canal

Among current smokers, those who had smoked for more than 12 years were most likely to have a root canal. Current smokers who had smoked for fewer years had a lower risk, but they were still more likely than nonsmokers to have root canals.

Pipes and cigars weren't linked to high odds of getting root canals. But there wasn't much data on those smokers, Kaye's team notes.

Quitting cigarettes -- and staying smoke-free -- helped, the study shows.

"There is good news from this study for people who do smoke, and that is that if you quit, your risk of root canal treatment will go down," Kaye says. She notes that men who quit cigarettes for nine or more years were about as likely as lifelong nonsmokers to get root canals.

Dentists' Role

All dentists should ask their patients if they smoke and want to quit, Kaye notes.

"Dentists can provide the nicotine patch and other types of cessation products, and they can refer them to smoking cessation clinics and programs," she says. "I think it should be a part of every dentist's program."

The X-rays don't show why cigarette smokers were more likely than nonsmokers to get root canals. "We couldn't in this study determine what the biological mechanisms might be," Kaye says.

She and her colleagues describe several possibilities in their report:

    Smoking makes it harder to fend off infections.

    Smoking increases inflammation.

    Smoking damages the circulation system and lowers oxygen levels.

Kaye also points out that the "dose-response" findings of this study strengthen the case that smoking is a cause of dental disease. The men who smoked the most had the highest number of root canals, and the nonsmokers and those that had quit the longest had the least.

The findings probably apply to women, Kaye says. "Perhaps it might be harder to detect, because at least historically, women haven't smoked as long or as much per day as men have, but I think the risk would still be there."


Lose Weight and Quit Smoking With New Drug

Rimonabant Fights Munchies, Urge to Smoke

Lose weight and quit smoking? A new drug promises to help people do just that.

The drug is called rimonabant. And no, you can't get it -- yet. But early data from advanced clinical trials may indicate you may see it before too long. Its planned brand name -- pending FDA approval -- is Acomplia.

It's already picked up a nickname: the munchies drug. That's because rimonabant acts like marijuana in reverse, cutting appetite and curbing the craving for nicotine. In two large-scale clinical trials, the drug has helped people with weight loss and smoking cessation.

Researchers and officials from drug maker Sanofi-Synthelabo today held a press conference to discuss the findings.

"Those who stay on drug for a year show remarkable weight loss: 17 pounds," said Jean Pierre Despres, PhD, professor of food and nutrition sciences at Laval University, in Montreal. "And we saw a remarkable reduction in waist circumference of 8 centimeters or [3 inches]."

"Rimonabant ... roughly doubled the odds of quitting smoking," said Robert Anthenelli, MD, associate professor of psychiatry at the University of Cincinnati College of Medicine. "We also found remarkably reduced postcessation weight gain: a 77% reduction versus placebo. ... These dual effects on smoking cessation and reduced weight gain make rimonabant a promising agent for treating tobacco dependence."

Weight Loss Where It Counts

The weight-loss study enrolled more than 1,000 moderately obese men and women whose cholesterol and blood-fat levels put them at high risk of diabetes. Half of them had what is known as the metabolic syndrome, a combination of abdominal fat, high blood pressure, high blood-fat levels, low levels of "good" HDL cholesterol, and high blood-sugar levels.

After a year on a diet that restricted daily calories by 600, more than one in four study participants who got inactive placebo pills lost more than 5% of their body weight. Only one in 10 lost more than 10% of their body weight. But nearly three of four participants who got 20 mg doses of Acomplia lost at least 5% of their body weight -- and nearly half lost more than 10%.

That's impressive weight loss for any clinical trial. But Despres says that people who took Acomplia lost the most dangerous pounds -- abdominal fat. Half of those who had metabolic syndrome no longer had the condition after treatment with the 20-milligram dose of Acomplia.

"I am very impressed in the increase in [good] HDL cholesterol generated by this one-year rimonabant therapy," Despres said. "The 20-milligram dose was able to generate a 20% increase in HDL, accompanied by more than a 10% decrease in triglycerides [blood fats]. Those who completed the full study had even more spectacular results: a 25% increase in HDL."

Quit Smoking, Gain Less Weight

A different clinical trial tested whether rimonabant can help people quit smoking. The 10-week trial enrolled nearly 800 men and women. Before starting the study, they smoked an average 23 cigarettes a day. Their goal: to quit smoking for at least four weeks straight.

Among those who completed the study, one in five people managed to quit smoking even though they got only inactive placebo pills. But more than one in three people (36.2%) who got 20-milligram doses of rimonabant were able to quit.

None of these smokers was obese. But those who quit smoking while taking placebo pills gained 6.6 pounds. Those who got 20 milligrams of rimonabant gained only 1.5 pounds.

A one-year continuation of the trial is underway in the U.S. and Europe.


It's not totally misleading to call rimonabant anti-marijuana. The medical name for marijuana is cannabis. And scientists have recently discovered that the human body makes marijuana-like molecules called cannabinoids. These molecules regulate how the body uses and stores energy, as well as immune function. To do this, they plug into receptor molecules on the outside of nerve cells, fat cells, and immune cells.

Rimonabant is the first of what promises to be a slew of new drugs that take advantage of these findings. There are two kinds of cannabinoid receptors, known as CB-1 and CB-2. The CB-1 receptors are found on nerve and fat cells. Rimonabant blocks these CB-1 receptors.

Douglas A. Greene, MD, Sanofi-Synthelabo vice president for regulatory affairs, says that obese people and people with a craving for nicotine have an overactive cannabinoid system. By partially blocking this system, rimonabant helps people lose weight and quit smoking.

A Heart Drug

So is rimonabant a weight-loss drug or a smoking-cessation drug? Greene says it's both and neither. He prefers to think of it as a heart-health drug.

"This compound is completely novel," he says. "It is the first in a class of new medications that has effects on two major cardiovascular risk factors. These are probably the two major preventable risk factors for heart disease: smoking and obesity. This represents a major medical advance for patients at risk of heart disease. This is an important medical therapy that will have a major public health impact."

Stay tuned. More detailed results from these and other studies will be announced next month at a major medical meeting.

Courtesy of Daniel DeNoon.


Women quitting smoking faster than men


Latest statistics compiled by the US's Centers for Disease Control and Prevention have found that women are quitting smoking in greater numbers as compared to men.


Data collected by the centre has revealed that the percentage of women who smoke has dropped down below 20 percent. While in 2003, the number of women who smoked was a mere 19.2 percent, the numbers of male smokers stood at 24.1 percent.


Experts however believe that despite the dip in the national average from 22.5 percent in 2002 to 21.6 percent in 2003, the rate is not fast enough to reach the magic figure of 12 percent by 2010.


"It's wonderful that it's trending down. But we still need to fight and keep our guard up about very innovative and clever marketing by the tobacco industry," The New York Daily News quoted Dr. Avi Barbasch, an oncologist on board the directors of the American Cancer Society as saying.


The study further revealed that Native American male population had 42 percent smokers, the Hispanic and the Asian women had only 10 and seven percent smokers respectively.



"Passive" tobacco inhalation increases risk by 30%

Courtesy of Richard N. Fogoros, M.D., a former professor of medicine, and a longtime practitioner, researcher and author in the fields of cardiology and cardiac electrophysiology.


In a study published in Circulation on May 23, investigators report that the cardiovascular system of nonsmokers is extremely sensitive to tobacco toxins inhaled during passive smoking. They reached this conclusion by analyzing 29 studies that measured the risk of heart disease in people who never smoked tobacco, but who were exposed to secondhand smoke.


While secondhand smokers only inhale about 1/100th the dose of smoke inhaled by the smokers themselves, the effect of that secondhand smoke is large. Secondhand smokers have a risk of coronary heart disease that is 30% higher than for nonsmokers who are not exposed to secondhand smoke. In contrast, the risk for actual smokers is increased by 80%. So, while the dose of smoke inhaled by passive smoking is 100 times smaller than for smokers, the increase in risk to the nonsmokers is much, much greater than that.


Indeed, their excess risk is almost 40% as high as the excess risk to the smokers themselves.


The investigators further listed the effects that secondhand smoke have been shown to have on the cardiovascular system that can lead to an increase in cardiac disease. These include: making platelets stickier, causing inflammation, reducing HDL cholesterol levels, increasing LDL cholesterol levels, and increasing insulin resistance. Some of these effects can be measured after just a few minutes of exposure to secondhand smoke.


The accumulating and disturbing evidence against secondhand smoke is enough to make even DrRich, an ardent supporter of individual freedoms, hope for even more restrictions on smoking in public places.


Taking a Look Inside


They say a picture is worth a thousand words and when it comes to quitting smoking, a thousand words doesn’t seem like enough to describe what’s happening to you body. Take a look:



These photographs are courtesy of Frederic W. Grannis Jr. M.D
Thanks for allowing them to be used to help people
see the long term effects of smoking.



Withdrawal - Physical And Psychological Symptoms


What Are the Physical Symptoms of Nicotine Withdrawal?


The physical symptoms of nicotine withdrawal vary from person to person, but may include any of the following:


  • Increased appetite, especially for carbohydrates and sweets
  • Increased coughing and sputum production
  • Sweating
  • Fatigue
  • Muscle aches and cramps
  • Constipation or diarrhea
  • Headache
  • Hypersensitivity to stimuli
  • Sleep disturbances
  • Weight gain
  • Nausea


What Are The Psychological Symptoms of Nicotine Withdrawal?


Since tobacco users have a habit of obtaining increased concentration and alertness from tobacco, they sometimes experience feeling foggy, unfocused, unmotivated and forgetful for a short time after they reduce or quit. Fortunately, these psychological symptoms also pass their peak by the second or third day, then drop rapidly. The psychological symptoms of nicotine withdrawal vary from person to person, but may include any of the following:


  • Irritability
  • Restlessness
  • Anxiety
  • Increased aggressive thoughts and behavior
  • Depression
  • Decreased ability to tolerate stress or disruption
  • Decreased sexual drive
  • Impaired work performance


Intense tobacco cravings Positive Physical, Psychological and Environmental Symptoms of Nicotine Withdrawal?


Happily, there are many positive psychological symptoms and physical effects to counterbalance the negative effects of nicotine withdrawal. They include:


  • Happiness about getting free from tobacco
  • Happiness about being free of the self-nagging and guilt about using tobacco products Improved abilities to smell and taste
  • Clothes, home, and car smell better every day
  • None of the mess and dirt associated with tobacco use
  • Lowered blood pressure
  • Lowered heart rate
  • Improved circulation in the hands and feet
  • Decreases in the carbon monoxide levels
  • More oxygen to your brain and body


Generally feel better than when you used tobacco products In addition, the natural cleansing systems in your lungs begin to operate more effectively, and you experience a higher level of health and well-being.


Quit Smoking and Save Your Skin!

Research from Nagoya City University in Japan highlights the fact that smoking damages the skin's ability to renew itself, diminishing collagen production by up to 40%. Collagen is the skin's scaffolding, and without it the skin loses its elasticity and starts to sag.


Professor Harryono Judodihardjo, a leading cosmetic dermatologist and medical director of the Cellite Clinic in Cardiff, said, "Smoking adds years to your appearance. In order to remain young-looking, the skin has to maintain its ability to create replacement tissue.


"Cigarette smoke inhibits this process as it contains more than 4,000 toxins. The smoke constricts the blood vessels thereby reducing the amount of oxygen the skin receives."


The term "smoker's face" entered the medical lexicon with an article written by Dr Douglas Model for the British Medical Journal, in which he coined the expression.


The symptoms of "smoker's face" include a number of distinct characteristics:


Prominent lines;


A gaunt appearance - sunken cheeks;


Tough, dry, leathery skin;


A mottled, reddish; complexion caused by inadequate oxygenation of the blood and, in some cases, a grey pallor due to atrophy of the skin.


A study conducted by the Twin Research Unit at St Thomas' Hospital, looked at 50 sets of identical twins. These individuals were divided into non-smokers and long-term smokers. The smokers were found to have 25% thinner skin than their smoke-free siblings.


Scientists also believe that smoking may impact adversely on DNA.


Professor Judodihardjo said, "Evidence suggests that smoking may have a deleterious effect on DNA. Damaged DNA in skin tissue can result in abnormal cell growth which make be a factor in certain types of skin cancer.


"Smoking affects the skin's ability to heal too. For this reason I don't offer certain treatments to heavy smokers."


Smoking also adversely affects the endocrinal system - the glands that secrete hormones - with the potential for increasing the waist to hip ratio.


"Smokers may weigh less than non-smokers, but the weight is distributed unevenly, which is why many smokers have pot bellies and spindly legs," Professor Judodihardjo said.


The effects of smoking are cumulative, so it's never too late to reap the benefits of quitting.


"My wholehearted advice to smokers is to prevent further damage occurring to their skin, or any other part of the body, by giving up tobacco immediately," Professor Judodihardjo added.


"The sooner you quit, the sooner the body can start to repair itself."


Urging Doctors to Do More to Stop Smoking...

A national smoking opponent urged doctors to do more to help smoking patients quit and stressed that workplaces need to be smoke-free for the health of employees.

Dr. Michael Fiore founder and director of the University of Wisconsin Center for Tobacco Research and Intervention since 1992, said one of his studies showed doctors discussed tobacco use in only 21 percent of visits at 36 primary care practices in Wisconsin.

Doctors said in the study they didn't have enough time to discuss tobacco use, patients didn't want to hear about it and they felt they couldn't help their patients stop smoking.

"Even a brief encounter can make a difference," Fiore said. "A physician discussing tobacco use for three minutes can increase abstinence rates."

Fiore spent the day in
La Crosse as part of the Healthy Living Together project sponsored by the La Crosse Tribune and WXOW-TV 19. He spoke to leaders of Teens Against Tobacco Use and La Crosse area health-care professionals at Gundersen Lutheran Medical Center and then held a panel discussion with business leaders later in the day.

Another study showed that smoking patients were more satisfied with their health care when doctors asked about their smoking addiction, Fiore said. "It's just the opposite of what physicians think," he said. "Smokers expect us to bring up the topic."

Doctors are successful when they ask smokers about their tobacco use, advise them to quit, assess their willingness to quit, assist them in quitting and arrange follow-up, he said. Doctors helping patients can increase their quit rates from 5 percent on their own to 15 to 30 percent.

Fiore said smoking workplaces hurt business and employees. He said customers expect a smoke-free business today, and smoke-free workplaces increase quit rates among smoking employees.

Smoking employees cost businesses more in lost productivity, sick days and health-care costs, he said.

"Going smoke-free doesn't hurt business," Fiore said. "Smoking hurts business."

Business leaders, including Dr. Robert Nesse of Franciscan Skemp Healthcare, and Peter Hughes of Gundersen Lutheran, talked about making hospitals and clinics smoke-free in the past several years and offering help for smoking employees.

Nesse said he tells business leaders that smoking is related to
6 to 8 percent of health-care costs.

Mayor John Medinger said the smoke-free restaurant ordinance was a struggle but turned out to be a success. Art Lotz, owner of Mr. D's Restaurant and Bakery, said his business went smoke-free 10 months before the ordinance went into effect because more people wanted a smoke-free dining experience.

"I wanted to eliminate the hassles," Lotz said. "It has been a positive experience, and our business has held up. Smokers came back, and we gained new customers. The ordinance has increased the dining experience as a whole in
La Crosse."

Fiore urged business leaders to support making all public places and workplaces, including bars, smoke-free. Medinger said that would be highly controversial, and the public would have to demand it. Fiore said
Wisconsin will make all public places smoke-free, including bars, after Minnesota and Iowa pass state laws similar to six other states.

"People need to realize the sky does not fall when you can't smoke in a restaurant or bar, or at work," Fiore said. "You're protecting the public as well as employees."

Smoking Habits May be Genetic

Whether a person starts smoking and how many cigarettes they smoke a day may be largely determined by their genes, according to a new study.

Researchers found that having family members that smoke not only increases the chance that young people will start smoking cigarettes, but it also influences how many cigarettes they smoke per day and how addicted they become to nicotine.

The large study of Dutch twins suggests that a combination of shared genetics and environmental factors plays a major role in determining a person's cigarette smoking habits.

But researchers say having a genetic predisposition for nicotine addiction doesn't mean that someone will become addicted to tobacco or unable to quit. They say smokers with a genetic predisposition can still quit smoking, but they may find it harder to quit smoking than others.

The news comes as millions of Americans are trying to quit smoking for at least one day as a part of today's annual Great American Smokeout, sponsored by the American Cancer Society.


Hard to Quit Smoking? Blame Your Genes (Not Entirely)

In the study, published in The Pharmacogenomics Journal, researchers looked into the link between genetics and smoking habits of 3,657 Dutch twin pairs. About half of the twins had never smoked.

They found both smoking initiation and number of cigarettes smoked per day were strongly influenced by environmental and genetic factors.

For example, the study showed genetic factors explained 36% of the variability in whether twins started smoking or not. Shared environmental factors, such as exposure to smokers at school or in the neighborhood, explained 56%.

In addition, researchers found shared genetic factors explained 51% of the differences in how many cigarettes the participants smoked, while shared environmental factors explained 30% of this difference.

Researchers say genes located on chromosomes 6 and 14 appear to be involved in whether or not a person starts smoking, and a region on chromosome 3 affects how many cigarettes are smoked a day.

But they say further research is needed to confirm these results as well as determine whether genes might help explain why some people have a harder time quitting smoking than others.

SOURCES: Vink, J. The Pharmacogenomics Journal; vol 4: pp 274-282. News release, Netherlands Organization for Scientific Research. News release, American Cancer Society.


Can lung cancer be prevented?

Retinoid May Help Prevent Lung Cancer - Vitamin A Derivative May Lower Risk Among Former Smokers


Quitting smoking is the single biggest thing a person can do to reduce their risk of lung cancer, but now researchers may have finally found a way to lower the risk for people who have already quit their cigarette habit. A new study shows that daily treatment with a retinoid drug may prevent lung cancer in former smokers.

Retinoids are natural and synthetic compounds related to vitamin A (retinol) and retinoic acid (RA). Although they have been found to help prevent head and neck cancers, until now retinoids have not been shown to be effective in preventing lung cancer.

In fact, researchers say some studies have shown that retinoids are of no benefit in reducing the risk of lung cancer in current smokers. But this may be the first study that has shown a benefit in targeting former smokers and reversing signs of precancerous lesions in lung tissue.

Lung cancer is the leading cause of cancer death in the U.S., and researchers say about 90% of all lung cancers occur in people who smoke, which has made smoking cessation efforts a major focus of lung cancer prevention efforts.

Although the risk of lung cancer decreases in people who quit smoking, the risk still remains about twice as high as those who have never smoked, for about 20 years after they quit. The risk after 20 years lowers some but continues to remain high.

In the study, published in the Feb. 5 issue of the Journal of the National Cancer Institute, researchers looked at the effects of two different types of retinoids on restoring the presence of a substance called retinoic acid receptor beta (RAR-beta) in lung tissue from a group of 226 former smokers. Loss of RAR-beta is considered a sign of pre-cancerous tumors.

Researcher Jonathan M. Kurie, MD, of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues found a loss of RAR-beta in nearly 60% of the participants at the start of the study.

But after three months of twice-daily treatment with the retinoid known as 9-cisRA, there was a significant increase in the presence of RAR-beta among those who received the retinoid compared with the placebo. No benefit was found for the second type of retinoid tested.

Researchers say the study shows that the benefits of retinoid treatment may differ among current vs. former smokers.

In an editorial that accompanies the study, Jason S. Vourlekis, MD, and Eva Szabo, MD, of the National Cancer Institute, say it remains to be seen how restoration of RAR-beta might correlate to a reduction in risk of lung cancer, and more studies will be needed to examine that issue.

SOURCE: Journal of the National Cancer Institute Jennifer Warner WebMD Medical News


When will the cravings end?

Nicotine leaves the body, on the average, in 3-7 days (you can speed up that process by drinking lots of water or fruit juice and by exercising--with a doctor's supervision, ideally). That should take care of most of the PHYSICAL cravings, which are generally the worst; but then there are MENTAL/ EMOTIONAL/ BEHAVIORAL 'cravings' that you may have to deal with as well. These urges to smoke can appear, occasionally and unexpectedly. The good news is that, depending on how much work you're willing to do, or on how strong your support network is, these unannounced cravings can usually be dismissed quite easily and quickly. Many ex-smokers never again experience the urge to smoke. The longer you have been quit the less frequent and less intense these cravings are! It DOES get better with each and every passing day!

Information About Lung Cancer


Cigarette smoking is the single most important preventable cause of lung cancer, accounting for 85% of all new cases of lung cancer in Canada and the United States. Lung cancer is the leading cause of cancer deaths.


What is cancer?


Cancer is the development of abnormal cells that grow out of control and form lumps called tumors. There are two types of tumors - benign and malignant. Malignant tumors are the most harmful and are often fatal. Benign tumors are more easily managed and controlled through surgery and other therapies.


How does cancer attack the lungs?


Cigarette smoke damages the lungs in two ways:


Cigarette smoke inhibits and damages the normal cleaning process by which the lungs get rid of foreign and harmful particles. Smoke destroys an important cleansing layer in the lungs, which in turn causes a build-up of mucus. The result is "smokers' cough," an alternative method that the lungs take in attempting to clean themselves.


The harmful cancer-producing particles in cigarette smoke are able to remain lodged in the mucus and develop into cancer tumors.



Lung cancer will continue as the leading cause of cancer death among Canadian women with an estimated 7,000 deaths in the year 2000. The number of new cases of women diagnosed with lung cancer will increase to 8,400.8

The estimates for Canadian men who will die of lung cancer in the year 2000 have risen to 10,700. The incidence of new cases of lung cancer is estimated at 12,200.


In 1998, an estimated 17,100 Canadians died due to smoking-related lung cancer. Of the deaths caused by smoking-related disease, lung cancer accounted for 31% of male deaths and 28% of female deaths.


The risk of lung cancer increases sharply the more you smoke and the longer you smoke.


Second-hand smoke is the primary risk factor for contracting lung cancer among non-smokers. In Canada, about 300 non-smokers die annually from exposure to second-hand tobacco smoke.


Screening and treatment for lung cancer


There are no tests or techniques currently available that are effective in the early detection of lung cancer. Routine screening for lung cancer is not recommended by any medical organization. Treatment of non-small-cell lung cancer consists of various combinations of surgical resection, chemotherapy and radiotherapy.


Currently, no single chemotherapy regimen is recommended for routine use, although systemic chemotherapy can produce partial responses and aid symptoms for short durations.


Reducing the risk of contracting lung cancer


People who quit smoking greatly reduce their risk of developing lung cancer compared with those who continue to smoke.

In general, the longer you don't smoke the greater the reduction in risk. The risk levels among long-term (10+ years) ex-smokers approaches those of non-smokers.



The Truth About "Light" Cigarettes: Questions and Answers

Many smokers choose "low-tar," "mild," or "light" cigarettes because they think that light cigarettes may be less harmful to their health than "regular" or "full-flavor" cigarettes.

After all, the smoke from light cigarettes feels smoother and lighter on the throat and chest - so lights must be healthier than regulars, right? Wrong.

The truth is that light cigarettes do not reduce the health risks of smoking. The only way to reduce your risk, and the risk to others around you, is to stop smoking completely.

What about the lower tar and nicotine numbers on light cigarette packs and in ads for lights?

  • These numbers come from smoking machines that "smoke" every brand of cigarettes exactly the same way.
  • These numbers do not really tell how much tar and nicotine a particular smoker may get because people do not smoke cigarettes the same way the machines do. And no two people smoke the same way.

How do light cigarettes trick the smoking machines?

  • Tobacco companies designed light cigarettes with tiny pinholes on the filters. These "filter vents" dilute cigarette smoke with air when light cigarettes are "puffed" on by smoking machines, causing the machines to measure artificially low tar and nicotine levels.
  • Many smokers do not know that their cigarette filters have vent holes. The filter vents are uncovered when cigarettes are smoked on smoking machines. However, without realizing it and because they cannot avoid it, many smokers block the tiny vent holes with their fingers or lips -which basically turns the light cigarette into a regular cigarette.
  • Because people, unlike machines, crave nicotine, they may inhale more deeply; take larger, more rapid, or more frequent puffs; or smoke a few extra cigarettes each day to get enough nicotine to satisfy their craving. This is called "compensating," and it means that smokers end up inhaling more tar, nicotine, and other harmful chemicals than the machine-based numbers suggest.
  • Cigarette makers can also make the paper wrapped around the tobacco of light cigarettes burn faster so that the smoking machines get in fewer puffs before the cigarettes burn down. The result is that the machine measures less tar and nicotine in the smoke of the cigarette.

What is the scientific evidence about the health effects of light cigarettes?

  • The Federal Government's National Cancer Institute (NCI) recently concluded that light cigarettes provide no benefit to smokers' health.


  • According to the NCI report, people who switch to light cigarettes from regular cigarettes are likely to inhale the same amount of hazardous chemicals, and they remain at high risk for developing smoking-related cancers and other diseases.


  • There is also no evidence that switching to light or ultra-light cigarettes actually helps smokers quit.

What do tobacco companies say about the health effects of light cigarettes?

  • The tobacco industry's own documents show that companies were well aware that smokers of light cigarettes compensate by taking bigger puffs.
  • Industry documents also show that the companies were aware early on of the difference between machine-measured yields of tar and nicotine and what the smoker actually inhales.
  • The NCI report concluded that strategies used by the tobacco industry to advertise and promote light cigarettes were intended to reassure smokers and to prevent them from quitting, and to lead consumers to perceive filtered and light cigarettes as safer alternatives to regular cigarettes.

What is the bottom line for smokers who want to protect their health?

  • There is no such thing as a safe cigarette. The only proven way to reduce your risk of smoking-related disease is to quit smoking completely.
  • Here's good news: Smokers who quit before age 50 cut their risk of dying in half over the next 15 years compared with people who keep smoking.

        Quitting also decreases your risk of lung cancer, heart attacks, stroke, and chronic lung disease.

Courtesy of the National Cancer Institute

Secondhand Smoke Can Hide in Your Home

Secondhand tobacco smoke contaminants lurking in household dust and on furniture and other surfaces can expose children to levels that are equivalent to several hours of active smoking, says a study in the current issue of Tobacco Control.

The study also says that making adults smoke outside doesn't fully protect children from the harmful effects of tobacco smoke.

Researchers compared 49 homes that included children between 2 and 12 months old. Nonsmokers lived in 15 of the homes. Of the remaining 34 homes, 17 were occupied by smokers who tried to protect their children by smoking outdoors. The other 17 homes were occupied by smokers who made no attempt to protect their children from secondhand smoke.

Dust and surface wipe samples were collected from the living room and the child's bedroom in each of the homes. Urine and hair samples were taken from the children. Nicotine monitors were placed in the living room and the child's bedroom of each home.

Levels of tobacco contaminants in the dust, air and surface samples of homes where adults smoked outdoors were up to seven times higher than in homes of nonsmokers. Tobacco contaminant levels in the homes of indoor smokers were up to eight times higher than in the homes where adults went outside to smoke.

Infants are particularly at risk from these indoor tobacco contaminants because they spend most of their time indoors and are close to contaminated sources, the study authors say.

Courtesy of HealthDayNews

Smoking Damages Reproductive Health

Report finds pervasive effects on men, women and babies

A new British report says cigarette smoking causes damage throughout a person's reproductive years and reduces the chance of having healthy children.

The report advises anyone planning to have kids to stamp out that cigarette butt once and for all.

The report, a comprehensive look at more than two decades of studies on smoking and reproduction, concludes that the damaging effects of smoking occur throughout a person's reproductive life, from puberty to young adulthood and into middle age. This was true of both men and women.

"There are so many aspects where smoking impacts our health -- 50 or 60 damaging aspects, of which there are many that can kill," says report author Dr. Sinead Jones, director of the British Medical Association's Tobacco Control Resource Centre. "So the evidence of fertility and conception -- for example, both male and female fertility -- was important for us to highlight."

It finds women who smoke take longer to conceive, and also will find their chances of conception reduced by up to 40 percent per cycle.

Also, both men and women may have less response to fertility treatments when they smoke, thereby jeopardizing the possibility of having a family.

"Men are twice as likely to be infertile and to have damaged DNA in their sperm," Jones says. "And with women, we found higher incidences of miscarriages."

The report says that between 3,000 and 5,000 miscarriages per year in the United Kingdom can be directly linked to smoking.

It also found that 120,000 men in England between the ages of 30 and 50 are impotent due to smoking. Moreover, every year smoking is implicated in around 1,200 cases of malignant cervical cancer in women.

According to the report, there is conclusive evidence that women smokers face a variety of ailments: a higher risk of heart disease when taking contraceptive pills; early menopause; and cervical cancer. The danger is passed on to the child, too: placental complications; premature membrane rupture; premature and low birth weight babies; and perinatal death.

Babies whose mothers smoked had a higher risk of SIDS, middle-ear disease, respiratory illnesses, developing asthma in those previously unaffected, and suffering asthma attacks in those already affected.

The more tobacco the person consumed the greater the adverse effect, the report notes, and stopping smoking dramatically reduced the effects.

"This report clearly shows the devastating impact of smoking on generations to come," says Deborah Arnott, director of the British anti-smoking organization Action on Smoking and Health. "Stopping smoking should be the number one priority for anyone who wants to have children."

"This is important not just to increase the chances of conception but also to give your child the best start in life," she continues. "More than 17,000 children are hospitalized every year [in the U.K.] because of respiratory problems caused by their exposure to parents' smoke. By stopping smoking, parents will not only improve their own health but will lessen the chances of their children developing illnesses such as asthma and pneumonia."

But the report finds good news in the growing trends towards eliminating tobacco advertising and promoting smoke-free legislation in many areas, such as in the United States and in many European cities.

"Our government has a long way to go," Jones says. "We find that they are very complacent on the issue."

Courtesy Andrew Conaway HealthDay Reporter

Black Youths Likelier to Quit Smoking

Study cites parental disapproval, less exposure to peers who smoke

Most black teens try smoking cigarettes, but they're much less likely than whites and Hispanics to become regular smokers as adolescents and young adults, new research finds.

The Rand Corp. study, published in the February issue of the American Journal of Public Health, found 62 percent of black youths had lit up by age 13, compared with 69 percent of Hispanics, 52 percent of whites and 36 percent of Asian-Americans.

But by age 15, just 7 percent of blacks in the study had become regular smokers, compared with 20 percent of whites and Hispanics and 8 percent of Asian-Americans.

Rand researchers attribute the drop-off in smoking among blacks to factors including parental disapproval, communication with parents about personal problems, having fewer friends who smoke, and receiving fewer offers of cigarettes from peers.

"What we find really intriguing is that this parental disapproval of smoking really seems to have an impact that African-American kids really pay attention to," says study author Phyllis L. Ellickson.

Ellickson, director of the Rand Center for Research on Maternal, Child and Adolescent Health, says the results suggest steps such as getting parents to talk to their children about smoking, improving family bonds and dampening peer pressure to smoke might help keep youths from becoming regular smokers.

For the study, researchers tracked more than 6,000 blacks, whites, Hispanics and Asian-Americans for 10 years, from ages 13 to 23. Rand recruited the study participants from 30 California and Oregon middle schools for a study on substance abuse.

Students completed surveys about substance abuse, smoking and psychological, social and behavioral factors.

By age 23, the survey showed, 19 percent of blacks smoked regularly, compared with 32 percent of whites, 29 percent of Hispanics and 16 percent of Asian-Americans.

Along with influence of peers and parents, researchers looked at risk factors that could be related to decisions on whether to smoke, such as school grades and "problem behavior" such as rebelliousness and marijuana or alcohol use.

Asian-Americans did well in school and were less likely than others to drink alcohol, smoke marijuana, or be exposed to "pro-smoking influences," Ellickson says.

Blacks, by contrast, had significantly worse grades than whites throughout middle school and high school. "But," Ellickson adds, "it appears to be counteracted by positive influence from parents and less exposure to smoking."

For example, the proportion of black youths with a best friend who smokes dropped after age 13 or 14, the study says.

Edwin Fisher, a professor of psychology, medicine and pediatrics at Washington University in St. Louis, says parents play a crucial role in keeping kids from becoming smokers.

"An overlooked aspect of preventing smoking in adolescents is parental involvement and parental wisdom in treating smoking as a health problem, not a discipline problem," says Fisher, a spokesman for the American Lung Association.

"So it's not a matter of simply saying, 'You don't smoke because you're my child and it's my house.' It's a matter of explaining to young people why smoking is so dangerous, and providing them opportunities for showing independence in doing things their own way in healthy ways without needing to show their independence by doing things like smoking."

Preventing smoking during the teen years is critical. Tobacco use typically begins by age 16, and the first smoke almost always occurs before high school graduation, the American Lung Association says. At least 4.5 million American adolescents smoke, and each day 6,000 U.S. children under 18 smoke their first cigarette, the association says. Moreover, smoking-related diseases kill about 430,700 Americans each year.

Adolescent smoking has been linked not only to significant health problems, but also involvement in fights, carrying weapons, engaging in high-risk sexual behavior and using alcohol and other drugs.

Four decades after the landmark Surgeon General's Report on Smoking and Health provided the first official U.S. recognition that smoking causes cancer and other serious diseases, other new studies also have looked at the demographics of those who smoke.

The Dana-Farber Cancer Institute, a teaching affiliate of Harvard Medical School, found that occupation is a significant factor in determining which adults smoke. People in working-class, non-supervisory positions, including blue-collar and service jobs, had the highest smoking rates. The study also showed those with less education and lower income smoked more than others.

The findings appear in the same issue of the American Journal of Public Health, along with results of a separate Dana-Farber study on one of the first workplace programs to successfully reduce smoking rates among blue-collar workers. The study concluded that smoking cessation combined with broader occupational safety and health worked much better than smoking cessation offered alone.

Researchers tested the two approaches at 15 Massachusetts manufacturing firms for two years. Smoking quit rates for those who had smoking cessation as part of the broader health-promotion efforts were more than twice that of those who underwent only smoking cessation.

In an analysis of national survey data from 1999 to 2001, the U.S. Centers for Disease Control and Prevention found 8.2 percent of blacks aged 12 to 17 had smoked during the preceding month. That compares with 29.5 percent of American Indians and Alaska natives, 14.9 percent of white youths, 11.4 percent of Hispanics and 8.8 percent of those from Asian ethnic groups, according to the survey, which appears in the Jan. 30 issue of the CDC publication Morbidity and Mortality Weekly Report.

By Gary Gately (HealthDay Reporter)

Genes May Help You Quit Smoking

Those with two in particular have an easier time

Did you ever wonder why some people stop smoking cold turkey and never look back, while others struggle to quit again and again?

Researchers from the Tobacco Use Research Center at the University of Pennsylvania may have found at least part of the answer -- genetics.

Two genes in particular seem to help smokers quit successfully, and this same combination of genes also makes them less likely to start smoking again, report the researchers in the October issue of Health Psychology.

"This study provides the first evidence that genes that alter dopamine function may influence smoking cessation and relapse during treatment," study author Caryn Lerman, associate director for Cancer Control and Population Science at the University of Pennsylvania, says in a press release.

Dopamine is a neurotransmitter that acts as a messenger between nerve cells in the brain.

Lerman and her colleagues studied 418 people who were enrolled in a clinical trial to test the effectiveness of the antidepressant bupropion for smoking cessation. The study participants either received a placebo or bupropion for 10 weeks and behavioral counseling.

Blood samples were taken from all of the participants for genetic analysis. Smoking status was assessed at the end of the 10 weeks and then again after six months.

People who had particular variants of a dopamine transporter gene (SLC6A3) and a dopamine receptor gene (DRD2) were more successful at staying off cigarettes and avoiding relapse than people who didn't have those variants.

"One of the great mysteries in smoking cessation is why some people find it so easy and why it's so hard for others," says Robert Baker, director of the Ochsner Center for the Elimination of Smoking in New Orleans. "I hear about people who have smoked for 40 years and then just put them down one day. Others haven't smoked as long and seem to have a much harder time. I think genetic factors do play a role."

Dr. Marc K. Siegel, an internist at New York University Medical Center, agrees. "It's not surprising to hear that someone's genetic makeup influences their response to quitting smoking. Some patients respond to Zyban [a form of bupropion], some to the patch [nicotine replacement therapy]." Often, people who want to quit are encouraged by doctors to use Zyban and a patch.

What's exciting about this research, Siegel says, is the possibility that one day doctors could specifically target smoking cessation treatment to each patient based on their genetic makeup. But such a therapy is likely a long time away. "If you're waiting for a cure before you quit smoking," advises Baker, "you may not live that long."

Despite some compelling reasons to quit -- including an increased risk of many cancers, heart disease and a one in five chance of developing emphysema or chronic bronchitis, according to the American Cancer Society -- many people still smoke.

About 25 percent of all men and 21 percent of women in the United States are currently smokers, according to the U.S. Centers for Disease Control and Prevention.

The good news is that plenty of people -- with and without these genes -- have quit smoking. The American Cancer Society says that more than 44 million Americans have stopped smoking.

"You may have a more difficult time if you don't have these genes," says Baker, "but you can still get off cigarettes. I'm sure there are thousands upon thousands who have done just that."

By Serena Gordon HealthDay Reporter

Decades After Landmark Smoking Report, Some Issues Remain Clouded

Research finds misuse of tobacco funds 40 years later

Forty years to the day that a landmark Surgeon General's report found the health hazards of smoking warranted "appropriate remedial action," a new study says there is still a long way to go.

A series of public health measures large and small have been taken since the 1964 report declared that cigarette smoking causes cancer and other diseases. Perhaps the single largest came in 1998, when the Master Settlement Agreement (MSA) required four U.S. major U.S. tobacco companies to give $209 billion to 46 states in return for dropping lawsuits.

The original lawsuit, brought by state attorney generals, aimed to get funds for Medicaid to recover the cost of treating tobacco-related illness. The settlement, however, allowed the states to use the windfall primarily at their own discretion.

And while many states said that they planned to use the funds to defray Medicaid costs, few have actually done so, according to new research being released Sunday from the Jan. 15 issue of the New England Journal of Medicine.

The journal chose this date because of Jan. 11, 1964, when Surgeon General Dr. Luther Terry released his historic report linking smoking to health hazards. That report help jump-start the antismoking movement in this country.

For the most part, the researchers say, states have not used the funds to cover Medicaid costs or for tobacco control and education projects. Instead, they have been used to address budget deficits and ensure "no new taxes."

"We missed a big opportunity, and we certainly could have done a lot more and we didn't do it. That's a shame," says Dr. Steven A. Schroeder, author of the new study and a professor of health and health care at the University of California, San Francisco. "State politicians chose not to use [master settlement funds] for the intended purposes."

"[The tobacco industry] got out of it easy," adds Dr. Robert Giusti, chief of pediatric pulmonology and assistant chair of pediatrics at Long Island College Hospital in Brooklyn, N.Y. "It became apparent quite a while ago that this was not going to have an impact on changing smoking habits. It has been a frustration."

According to the New England Journal article, in fiscal year 2003, 47 percent of the MSA payments were funneled into state budgets, up from 29 percent the year before and from 16 percent in the three preceding fiscal years.

Perhaps most troubling, many states are mortgaging future MSA payments through bond issues. This gives states a direct and strong interest in keeping the tobacco companies afloat so they will continue to pay.

In addition, certain stipulations in the original settlement, such as stronger warnings on tobacco packages, have been abandoned.

Most of the funding for the American Legacy Foundation disappears after five years because the money depends on the tobacco companies' maintaining a 99.05 percent or greater share of the U.S. cigarette market.

The new findings coincide with the Jan. 6 release of the American Lung Association State of Tobacco Control: 2003, which concludes that most states are not doing what it takes to protect citizens from tobacco smoke. The report card gave an "F" to 38 states and the District of Columbia for funding tobacco prevention and control programs and an "F" to 35 states and D.C. for smoke-free air laws. Three states flunked in tobacco taxes while 23 states failed in laws limiting youth access to tobacco.

There have been some forward movement, however.

The article quotes Matt Myers, director of the Campaign for Tobacco-Free Kids, saying that MSA was responsible for "the most significant increase in spending on tobacco prevention and cessation in history. These funds have forever changed the debate about the appropriate level of funding for tobacco control."

The MSA-funded American Legacy Foundation, Schroeder writes, is "the most important national counter-marketing effort in 30 years."

And to pay for all this, tobacco companies had to raise the price of cigarettes, an action which in itself resulted in fewer smokers.

The innovation from here on, Schroeder says, "is going to have to be on the ground and a little bit at a time, and it's too bad."

Still, there are hopeful signs. The telephone "quit lines," for instance, have been "fantastic," Schroeder says. They just haven't been marketed very well. Fuel for the anti-tobacco movement is also coming from raising cigarette taxes, counter-marketing (such as the American Legacy Foundation), and the clean indoor air movement.

Meanwhile, Guisti, adds, getting people to quit smoking is still the primary responsibility of physicians.

"I think there are reasons for optimism," Schroeder says. "Smoking rates are going down and smoking is becoming less socially acceptable. Those are two wonderful trends, [but] the problem is a lot of people think the battle is over -- but it's not."

His argument is bolstered by another new body of research, released in Saturday's British Medical Journal, that found low-tar cigarettes are no less damaging to health than any other form of filtered cigarettes.

The American Cancer Society estimates that before the 1964 Surgeon General's report, about half of all American adults smoked; today, the organization says, it's down to about 22 percent.

Smoking kills 440,000 American men and women each year, which is almost one person a minute, the ACS says. And cigarette smoking causes approximately 30 percent of all cancer deaths in the country, it adds.

(Courtesy of Amanda Gardner, HealthDay Reporter)

Smokers: Consider Your Legs

Blocked arteries can lead to amputation

If you're a smoker, you should worry about your legs, the Society of Interventional Radiology warns.

What with lung cancer, heart attack, stroke and the like, smokers have plenty to worry about, the society acknowledges. But legs -- specifically, blood vessels in legs -- often get ignored.

Just as smoking accelerates the buildup of the fatty deposits in heart and brain arteries that result in heart attacks and strokes, it has the same effect in legs. The result is a condition called peripheral vascular disease (PVD), which can lead to gangrene or amputation.

And it's not only smokers who are at risk, says Dr. Ziv J. Haskal, a professor of radiology and surgery at Columbia University and a spokesman for the Society of Interventional Radiology. Other risk factors for PVD are identical to those for heart attack and stroke -- diabetes, high blood pressure, high cholesterol, obesity and lack of exercise.

"It is an accepted belief that PVD is vastly under-diagnosed," Haskal says. "It affects perhaps 10 million Americans. But it is often mistaken for other conditions, such as arthritis."

The classic symptom of PVD is intermittent claudication, leg pain that occurs when walking or exercising and disappears when the activity stops. But many people with PVD have other symptoms, such as numbness and tingling of the legs and feet, ulcers or sores that don't heal, or coldness of the legs or feet.

Such symptoms should send a person to a radiologist for a simple screening test called an ankle brachial index, which compares blood pressure in the leg with blood pressure in the arm, Haskal says. It is "an excellent diagnostic test," he adds.

"Detecting PVD doesn't mean that you can reverse it," Haskal says. "But its progression can be stopped by a supervised exercise program and medication. Such a program has been shown to improve walking distance."

For severe cases, he says, an interventional radiologist can apply the same techniques used for heart artery blockage -- angioplasty to widen the blood vessel followed by implantation of a stent, a flexible tube, to prevent it from closing.

And, of course, a smoker should stop smoking if possible, Haskal says, because "there are a thousand other reasons why someone should stop smoking."

(Courtesy of Ed Edelson, HealthDay Reporter)

Heart Patients Gain by Quitting Smoking

Study finds it's never too late to break habit

You have heart disease and chest pain -- a heart attack waiting to happen. Quitting smoking is the least of your worries, right?

Think again. Heart disease patients who quit smoking can reduce their risk of premature death by about 36 percent, regardless the severity of their illness or their age, says a new study by British researchers.

"It seems that it's always worth quitting," says study leader Julia Critchley, an epidemiologist at the Liverpool School of Tropical Medicine in England. The only time it's ever too late is, well, when it's too late.

Critchley and a colleague, Simon Capewell of the University of Liverpool, reviewed 20 previous studies of smoking cessation among heart patients. Of those, six were considered "higher quality," being relatively free of errors in methodology and other potential hitches that might skew the results.

The 20 studies included more than 12,000 people, of whom nearly 5,700 were smokers. Taken together, they showed that people who stopped smoking reduced their risk of death by 36 percent compared with those who continued lighting up. The so-called "relative risk" of suffering non-deadly heart attacks was also lower, by 32 percent, in the groups that quit smoking. Follow-up periods in the studies ranged from two years to 26 years. However, the risk of death didn't fall with time, suggesting that most of the drop in risk associated with quitting smoking occurs within two years or so of cessation.

A report on the new study appears in the latest issue of the Cochrane Library, an international medical publication.

Dr. Richard Stein, a cardiologist at Beth Israel Medical Center in New York City and a spokesman for the American Heart Association, says people who quit smoking often take up other heart-friendly behaviors, too. They're more likely to exercise, use medications to lower their cholesterol and blood pressure, and eat a low-fat diet high in fruits and vegetables. As a result, it's often difficult for researchers to tease out the precise impact of smoking cessation on reducing the risk of future heart problems.

Still, Stein adds, the latest study sounds "reasonable" given what researchers have found previously. The link, he says, is probably related to the way tobacco smoke exacerbates trouble spots, or plaques, in narrowed blood vessels. Smoking damages the cells that line vessel walls. When these cells are the only thing keeping a "vulnerable" plaque from breaking loose into the bloodstream, the added weakening can be devastating.

When people stop smoking, they snuff out a major source of instability for their vulnerable plaques -- and thus avoid future heart attacks and strokes, Stein says.

If you do quit smoking, ask for a raise. Michigan researchers have found that employees who quit smoking save their company money by boosting their productivity and reducing their medical expenses. However, the expenses for workers with chronic ailments such as arthritis, back pain or allergies take twice as long -- 10 years versus five -- to reach the level of employees who never smoked. That study appears in the latest issue of the American Journal of Health Promotion.

Courtesy of Adam Marcus (HealthDay Reporter )

Smoking and Bladder Cancer in Women

A new study shows smoking puts women at significantly higher risk for urinary bladder cancer.

University of Minnesota investigators report up to 25 percent of bladder cancer cases seen in their analysis of postmenopausal women could be attributed to smoking.

Bladder cancer strikes nearly 55,000 people in the United States every year. Men are more affected than women, and most studies gauging bladder cancer risks have been conducted among men. These researchers evaluated a large population of women past menopause to assess risk factors for this group.

The study involved more than 27,000 women who were participating in the Iowa Women's Health Study. All completed a study questionnaire on various health-related factors in 1988 and then were followed for the next 13 years to assess for bladder cancer incidence.

Results show current smokers had about a 5.5-fold higher risk of developing bladder cancer than nonsmokers. After adjusting for other factors that could increase the risk, smokers still had about a 4.25-increased risk. Quitting smoking helped. Women who had kicked the habit for longer than 15 years had a relative risk approaching that of nonsmokers.

The study also linked bladder cancer in women to several other risk factors, including diabetes, lack of physical activity, being unmarried, and having a smaller body mass index. However, these risks were not as significant as the smoking risk.

SOURCE: Cancer, 2002;95:2316-2323

Courtesy of Ivanhoe Newswire

Smokers Raise Risk of MS

Study finds they're twice as likely to develop disease

Smokers face twice the risk of developing multiple sclerosis (MS), a crippling disease that destroys the lining of nerve cells, new research shows.

Norwegian and American scientists have found people smoked -- including those who've quit the habit -- have nearly double the risk of MS as those who never used tobacco. The effect wasn't quite as great as the long-established impact of smoking on the risk of cardiovascular trouble, such as heart attacks and chest pain, but it was larger than the increased risk of asthma associated with tobacco use.

"We found this rather strong relationship between smoking and MS. It's almost comparable with cardiovascular disease" and smoking, says study leader Trond Riise, an epidemiologist at the University of Bergen in Norway.

Multiple sclerosis involves the destruction of a protein called myelin that covers nerve fibers -- probably by the body's own immune system. Myelin both protects nerves and lets them function properly. People with MS suffer a wide range of symptoms with varying severity. These include difficulty walking and swallowing, fatigue and vision problems. The disease, which affects 400,000 Americans, usually sets in between the 20s and 50s.

Scientists aren't sure why smoking might heighten the risk of developing MS. One explanation, Riise says, is that smoking saps the immune system and makes people vulnerable to infections, particularly of the throat, that trigger the nervous system disease. "We believe that it's most likely that the factor that initiates this disease is an infection," Riise says, though he admits that the mechanism remains "speculation." A report on the findings appears in the Oct. 28 issue of Neurology.

A 2001 study by Harvard University study turned up a similar link between smoking and MS in female nurses. That study, reported in the American Journal of Epidemiology in 2001, found the risk of MS diminished, though not entirely, in people who'd quit smoking compared with those who still smoked. However, the risk increased the longer a woman smoked.

Riise's group looked at the risk of MS and smoking in 22,240 Norwegian men and women living in Hordaland County in 1997. Of those, 8,239 never smoked, while 7,892 smoked and 6,109 had given up the habit.

The researchers identified 86 cases of MS. The risk of developing the disease was 80 percent greater among smokers or former smokers than among people who'd never smoked.

The association between smoking and the nerve disorder was greater for men than women. It didn't appear to wane significantly in former smokers, although most people had quit relatively recently before being diagnosed with MS, Riise says. The average duration of smoking before diagnosis was about 15 years.

In addition to raising the odds of developing MS and perhaps other autoimmune diseases, previous research suggests smoking also appears to worsen flare-ups of symptoms.

However, Stephen Reingold, vice president of research programs at the National Multiple Sclerosis Society, says the newest findings don't address that effect. "It does not tell us anything about the impact of smoking for people who have MS," he says.

Reingold says smoking, infections and other environmental exposures or behaviors probably interact with a genetic susceptibility to MS.

Courtesy of By Adam Marcus (HealthDay Reporter)

Smokers: Beware Bad Air

Pollution can triple heart attack risk, study finds

If you're unwise enough to smoke, you'd better keep a close eye on local air pollution levels, a French study indicates.

"We clearly showed that the heart attack rate was increased by 161 percent when the ambient air pollution index was high," says Dr. Yves Cottin, a professor of cardiology at the University Hospital of Dijon, who presented the findings Nov. 9 at the American Heart Association's annual conference in Orlando, Fla. "Smokers are particularly sensitive to air pollution, since we found a threefold increase risk in heart attack in the smoking population when the pollution is high."

The risk is closely associated with levels of fine particles, which mainly are generated by diesel engines, the study finds.

Cottin and his colleagues collected data on 322 Dijon area residents hospitalized for heart attacks in 2001 and 2002, looking at the relationship between incidence and levels of air pollution summarized in the ATMO index, which rates pollution on a scale of 1 to 10.

The pollution level rose to 6 or higher only 18 days of each year, but those days had the greatest incidence of heart attacks, especially for smokers, Cottin says.

Smokers "should reduce or stop cigarette smoking during poor air quality days," he says. "Smokers are also recommended to stay at home during those days."

And high pollution levels also call for special attention to the symptoms of a heart attack on high-pollution days, in case immediate emergency care is needed, Cottin says.

The French report is the latest addition to "a host of short-term and epidemiological studies that show an association between cardiovascular events and air pollution," says Dr. Robert D. Brook, an assistant professor of medicine at the University of Michigan and a member of an expert panel that is writing a position paper on the subject for the American Heart Association.

"Certain individuals are at especially high risk," Brook says. "They include smokers, the elderly, people with diabetes and children, in relation to asthma. This finding has been replicated all over the world, and an association has also been found with the risk of stroke."

Cottin says his group is studying the mechanism by which air pollution causes heart attacks and other cardiovascular problems. There is evidence that pollutants can contribute to an inflammatory process that leads to rupture of fatty deposits called plaques, releasing clots that block blood vessels, he says.

Some newspapers publish information on local air pollution levels on a regular basis, Brook says. Air pollution readings for communities across the country also are available daily on the Web site of the U.S. Environmental Protection Agency.

Courtesty of Ed Edelson (HealthDay Reporter)

COPD: The Unnoticed Epidemic

Jump in cases fueled by women getting lung disease

Most people have never heard of it, and have no idea what the acronym means. But it's the fourth leading cause of death in the United States and the sixth in the world, and it costs $32 billion a year in this country alone.

COPD, short for chronic obstructive pulmonary disease, is essentially an umbrella term that refers to irreversible airflow obstructing and which includes chronic bronchitis and emphysema. Patients often say that they feel "hungry for air." The disease has no cure.

While death rates for other diseases include stroke and heart disease were decreasing, the mortality for COPD jumped 163 percent from 1968 to 1998. By 2020, experts say, it will be the third biggest killer in the world.

"It's a common disease that has reached epidemic proportions," says Dr. Richard S. Irwin, president of the American College of Chest Physicians, who moderated an American Medical Association panel on COPD Thursday.

Women are driving that trend, adds Dr. A. Sonia Buist, a professor of medicine at Oregon Health & Science University in Portland. In 2000, for the first time, deaths among women were higher than those among men from COPD.

About 24 million Americans are estimated to suffer from COPD, only 10 million of whom are diagnosed and only 6 million of whom are being treated. Those numbers help explain why November has been designated COPD Awareness Month, and why medical professionals are pushing for doctors and patients alike to recognize the disease in its own right.

Why the increase? Buist attributed it mostly to increases in smoking and in exposures to other risk factors, especially in developing countries, as well as to the changing age structure of the population. "More people are living into the COPD years," she says.

Smoking is, in fact, the number one cause of COPD, in the United States accounting for some 80 percent to 90 percent of cases. That number is probably less in developing countries where other exposures (for example, certain cooking fuels) are more common.

Why are women increasingly affected? Because they started smoking and joining the workforce in the 1940s and are now seeing the result of those exposures.

The disease is grossly under diagnosed, even though diagnosis can be as simple as spirometry, a classic breathing test that some argue should become the fifth vital sign. "Only 15 percent of people with COPD in the U.S. have had a breathing test," Buist says. Half of COPD patients are being treated by family doctors without spirometry.

One of the problems is that we all lose lung function as we get older, and the symptoms of COPD too often are confused with those of normal aging. Those symptoms include shortness of breath, increased effort to breathe, chronic cough, increased mucus production and frequently clearing of the throat.

Once lung damage has happened, it can't be reversed. The best you can do is to stop the damage in its tracks, and the best way to do that is to (you guessed it) stop smoking. In fact, the only two things that have been shown to improve mortality are oxygen supplementation in people with low blood oxygen and quitting smoking.

Drugs such as bronchodilators and inhaled steroids can control various symptoms but right now, that's it as far as pharmacotherapies go. "The prospect of something novel soon is not particularly good," says Dr. Alan R. Leff, a professor of medicine, pediatrics, anesthesia and critical care and the University of Chicago.

Exercise, however, does have benefits. It "doesn't change the lung but it allows you to do more with the lungs you have," says Dr. Mark J. Rosen, a professor of medicine at Albert Einstein College of Medicine in New York City.

Courtesy of Amanda Gardner HealthDay Reporter

Vitamin C May Ward Off Stroke
A study finds an added benefit for smokers.

People who eat a diet rich in vitamin C may be at lower risk of suffering strokes, and smokers who do so may benefit the most.

A new Dutch study finds people with the lowest amount of vitamin C in their diets were 30 percent more likely to have a stroke than people with the highest amount of it.

People with the highest amount of vitamin C in their diets consumed more than 133 milligrams of vitamin C per day. People with the lowest amount in their diets got less than 95 milligrams per day. The recommended daily amount is 60 milligrams a day.

Smokers with diets high in vitamin C were more than 70 percent less likely to have a stroke than smokers with diets low in vitamin C.

Antioxidants such as vitamin C may protect cells from oxidative stress, which plays a role in stroke, the researchers say.

"The lower third will have a higher risk of stroke and those with higher intake will be at lower risk," says study author Dr. Monique Breteler of Erasmus Medical Center in Rotterdam. "Vitamins don't react so differently within populations -- so this fits for general populations."

The research "confirms that the healthy diet is good for you, one that is rich in antioxidants and vegetables, as we have seen over the last several years," she adds.

Researchers studied 5,197 people aged 55 and older living in Rotterdam, all of the whom had no cognitive problems, were living independently, and had never had a stroke.

Participants were then tracked for an average of 6.4 years, and during that time, 253 of them suffered strokes.

The study also found smokers benefited from high levels of vitamin E in their diets. They were more than 20 percent less likely to have a stroke than those with diets low in vitamin E. Ironically, nonsmokers with high vitamin E levels didn't enjoy similar protection.

"This is not an excuse to continue smoking. There is more than enough medical evidence to show that smoking is extremely bad for you," Breteler cautions. "The effects of anti-oxidation are more than outweighed by other factors."

"But we looked at that because smoking causes damage due to increased oxidative stress. Then vitamin C has anti-oxidative properties, so we looked at [that] connection and saw that it was indeed the case," she says.

However, the use of dietary supplements containing vitamins C and E and other antioxidants didn't seem lower the risk of stroke more, but Breteler says this finding doesn't mean supplements have no potential benefit.

"I think it's important for the public to keep hearing the message about our diet and reducing stroke risk, and this study shows this quite very nicely," says Dr. Philip B. Gorelick, head of the cerebrovascular disease and neurological critical care department at Rush University Medical Center in Chicago.

The results appear in the Nov. 11 issue of Neurology.

This seems to confirm similar findings from a 2002 Finnish study, which showed a relationship between low vitamin C levels and an increased risk of stroke. The study of 2,419 men between the ages of 42 and 60 also showed a relationship between high levels of vitamin C and reduced stroke risk, especially in overweight and hypertensive men.

One possible explanation is that vitamin C enhances endothelial function, which inhibits artery clogging and lowers blood pressure. But the link could also simply be that people who take vitamin supplements or eat vitamin-rich fruits and vegetables may be more health-conscious than those who don't.

So the study cautions that vitamin C alone may not be responsible for the results of the study.

Rich sources of vitamin C include oranges and other citrus fruits, strawberries, red and green peppers, broccoli, and brussels sprouts. Good sources of vitamin E are vegetable oils such as sunflower seed, cottonseed, safflower, palm and wheat germ oils, margarine and nuts.

Vitamin C has had a much heralded history, ever since the 18th century British explorer James Cook was credited with being the first captain to use diet as a cure for scurvy, the disease caused by lack of ascorbic acids. After making his crew eat cress, sauerkraut and an orange extract, he lost no men to the ailment on several months-long voyages.

It has, it also seems, even reached a sort of cult status. One such example is the efforts of the former Nobel-prize winner Linus Pauling, who advocated, against medical evidence some say, megadoses of vitamin C to protect against cancer and many other ailments. Pauling died in 1994 at age 93.

But studies have shown that, since vitamin C passes out of the body via urine, amounts in excess of what the body can use are simply eliminated.

Courtesty of Drew Conaway HealthDay Reporter

What's in Cigarette Smoke?

Cigarette smoke contains over 4,000 chemicals, including 43 known cancer-causing (carcinogenic) compounds and 400 other toxins. These include nicotine, tar, and carbon monoxide, as well as formaldehyde, ammonia, hydrogen cyanide, arsenic, and DDT.

Nicotine is highly addictive. Smoke containing nicotine is inhaled into the lungs, and the nicotine reaches your brain in just six seconds.

Nicotine in small doses acts as a stimulant to the brain. In large doses, it's a depressant, inhibiting the flow of signals between nerve cells. In even larger doses, it's a lethal poison, affecting the heart, blood vessels, and hormones. Nicotine in the bloodstream acts to make the smoker feel calm.

As a cigarette is smoked, the amount of tar inhaled into the lungs increases, and the last puff contains more than twice as much tar as the first puff. Carbon monoxide makes it harder for red blood cells to carry oxygen throughout the body. Tar is a mixture of substances that together form a sticky mass in the lungs.

Most of the chemicals inhaled in cigarette smoke stay in the lungs. The more you inhale, the better it feels—and the greater the damage to your lungs.

Listed here are 109 of the more toxic chemicals. Those proven to cause cancer are in boldface type.

Acetic Acid
Carbon Monoxide
Carbon Sulfide


Formic Acid
Hydrogen cyanide
Hydrogen sulfide
Linoleic Acid
Linolenic Acid
Methyl formate
n-Nitrosoethyl methylamine

Nitric Oxide
Nitrous oxide phenols
Palmitic acid
Propionic acid
Stearic acid



Vinyl Chloride


*Courtesy of


Smoking Rate Dips Among U.S. Adults - CDC Study


The percentage of American adults who regularly smoke cigarettes fell slightly in 2001, according to a federal study. The numbers cast doubt on the nation's ability to meet a targeted reduction of the habit by 2010.

About 440,000 Americans die each year from lung cancer and other diseases related to tobacco use, making smoking the leading preventable cause of death in the United States, according to the federal government.


In 2001, an estimated 46.2 million adults, or 22.8 percent of those 18 years and over, reported that they were current smokers, according to an annual survey published on Thursday by the Centers for Disease Control and Prevention.


That compared to an estimated 23.3 percent of adults who smoked the previous year and 25 percent who did in 1993. Blacks in particular registered sharp declines in smoking in 2001, according to the survey.


CDC officials welcomed the findings, attributing them in part to the impact of anti-tobacco control programs at the state level, but they also warned that not enough money was being invested in such efforts.


Tobacco companies agreed in 1997 and 1998 to pay $206 billion as part of a landmark legal settlement with a number of states that had sued the industry to recoup the health-care costs of treating sick smokers.


"The states were starting to fund some comprehensive tobacco-prevention and control programs, but unfortunately with the budget crises those funds are being lost and put into general revenues," said Dr. Corinne Husten, medical officer in the CDC's office of smoking and health.




"We do have a lot of concern that we may not be able to maintain these (smoking) declines," said Husten, who added that the United States was unlikely to meet a federal goal of reducing the adult smoking rate to 12 percent or less by 2010.


To hit that target, adult smoking would have to fall more than four times the rate of decline between 1994 and 2001.


The CDC is advocating that states increase the funding and implementation of comprehensive anti-tobacco programs that target different ethnic communities, adolescents and rich and poor Americans alike.


Anti-tobacco activists contend that the human and economic costs of smoking could be dramatically reduced if authorities at both the state and federal levels clamped down on tobacco advertising and raised taxes on cigarettes to make them less affordable, particularly to teenagers and young people.


In the past two years about half the state governments in the nation have increased excise taxes on cigarettes and other tobacco products. A number of others have passed legislation further restricting smoking in restaurants and public areas.


Earlier this year, an advisory committee to the U.S. Department of Health and Human Services recommended increasing the federal cigarette tax by $2 a pack and using at least half the revenue to help people kick the habit.


The Bush administration rejected the idea.


"We urge the White House to reconsider its position in light of the clear need for bold and aggressive efforts at all levels," Matthew Myers, president of the Campaign for Tobacco-Free Kids, a Washington-based anti-tobacco group, said on Thursday.


SOURCE: Morbidity and Mortality Weekly Report October 10, 2003


Magnetic Field May Help Smokers to Quit

Smokers exposed to repeated pulses of magnetic energy via a coil-shaped stimulator placed on the head apparently smoke less afterwards, German doctors report. This technique, called high-frequency repetitive transcranial magnetic stimulation (TMS) may eventually be used to reduce cigarette smoking among individuals who want to quit.


Repetitive TMS, sometimes used to treat depression, "is a novel approach that has never been tried before" for smoking cessation, lead author Dr. Peter Eichhammer told Reuters Health. Drugs, such as bupropion or nicotine replacement, are commonly prescribed for patients when they decide to stop smoking. Eichhammer explained that his team studied TMS because it specifically "targets areas related to the brain's reward system." Hence, TMS avoids side effects caused by drugs that affect other areas of the brain not involved in cravings.


The research team at the University of Regensburg, Germany, conducted a trial in a group of 14 smokers who wished to stop smoking. According to their report in the Journal of Clinical Psychiatry, each subject underwent two trials of active stimulation and two trials of "sham" stimulation on 4 consecutive days, without knowing which was which.


On average, the subjects smoked significantly fewer cigarettes during the 6-hour period immediately following active treatment compared with placebo treatment. No adverse effects other than two cases of mild headache after active stimulation were reported.


The German research team has initiated a larger trial of repetitive TMS as treatment for smoking cessation. In addition, Eichhammer said, "We want to optimize high-frequency repetitive TMS as an effective method for treating other addictions as alternatives to conventional drug-related treatment approaches."


SOURCE: Journal of Clinical Psychiatry, August 2003.

Smoking and Litter

A frequently overlooked aspect of smoking is the ever-growing problem of litter. The following is an excerpt from a non-profit organization dedicated to reducing cigarette-related litter. Please check out their site and you might find out some new information about the multiple dangers of the use of tobacco products!


There is a lot of misinformation out there regarding cigarette butt litter. The biggest myth is that cigarette filters are biodegradable. In fact, cigarette butts are not biodegradable in the sense that most people think of the word. The acetate (plastic) filters can take many years to decompose. Smokers may not realize that their actions have such a lasting, negative impact on the environment.

This myth has been perpetuated not just by the wishful thinking of many smokers, but also by the cigarette companies, who have taken great pains to keep their customers in the dark on this issue. It is very common for highly littered items such as soda cans, snack wrappers, and fast food containers to have a simple "Please Don't Litter" message. You won't find such a message on cigarette packs. Although our contacts in the industry are at a loss as to why they can't take this simple step, our best guess is that they would prefer to leave their customers blissfully ignorant. Maybe they think that people will smoke fewer cigarettes if they have to be responsible for disposing of them. We think they ought to give their customers the benefit of the doubt. Smoking and littering do not have to be synonymous, as many smokers have proven by example.

What happens after that butt gets casually flicked onto the street, nature trail, or beach? Typically wind and rain carry the cigarette into the water supply, where the toxic chemicals the cigarette filter was designed to trap leak out into aquatic ecosystems, threatening the quality of the water and many aquatic lifeforms. Cigarette butts may seem small, but with several trillion butts littered every year, the toxic chemicals add up!


Study Affirms Safety of The Pill


But news isn't so good for smokers who took the early versions of oral contraceptive

There's good news for women who were early users of birth control pills in the 1970s and 1980s as well as for women now taking newer versions of oral contraceptives.

A large, decades-long study confirms that nonsmoking women on the pill do not have higher overall death rates. Although mortality rates from cervical cancer were higher, these were balanced out by decreased death rates from ovarian and other uterine cancers.

Smokers have a much more grim prognosis, however. The study, appearing in the July 19 issue of The Lancet, found that overall death rates were more than twice as high for women who took the pill and who smoked at least 15 cigarettes a day as compared to nonsmokers.

Two other large studies had already published similar results. "This is a pretty solid finding with these big studies in agreement," says Dr. Martin Vessey, lead author of the latest study. "The sound statistical conclusion is that there is no harmful effect to taking oral contraceptives. That's a very important result." Vessey, an emeritus professor of public health at the University of Oxford in Britain, has been involved in the study since it began 35 years ago.

The study started by recruiting 17,032 British women between 1968 and 1974. At the time, the women were aged 25 to 39 and were white and married. All used oral contraceptives, a contraceptive diaphragm, or an intrauterine device (IUD). Many of the women ended up being on the pill for at least eight years, Vessey says.

"In common with a number of studies, we did find an increase in deaths from cancer of the cervix in pill users," Vessey says. "That was compensated for by fewer deaths from cancers of the other parts of the uterus and from cancers of the ovary. If you put those three reproductive cancers together, the net effects of the pill on the three is beneficial."

"Their findings are consistent with previous studies, and that is a slight increase in cervical cancer and a decrease in particular in ovarian cancer. We've pretty much known this for many years now," adds Dr. Sanjay Agarwal, director of the Center for Reproductive Medicine at Cedars-Sinai Medical Center in Los Angeles.

Heavy smokers, however, had more than double the death risk, largely from heart disease and stroke.

"The key to this study is the breakdown effect of smoking. It really does underline the significant detrimental effects of smoking even in young ages," Agarwal. "This study just highlights very strongly that smoking really does increase the risk of heart attacks and hemorrhagic stroke in women taking birth control pills."

So what does it mean to today's pill users? "This study mainly concerns the pills used in the '70s and '80s, and in Britain those pills were mostly pills containing 50 micrograms of estrogen. They were sort of medium dose," Vessey says. "Nowadays the pills used have lower doses of estrogen and hormones generally."

For middle-age and early elderly women who were on the pill during this time period, the results should be very reassuring -- as long as they're not smokers.

"I think you could definitely regard these findings as also being reassuring in terms of modern pills, although obviously there is a bit of extrapolation there," Vessey says.

"We would assume that lower doses equate with more safety, so I think this is encouraging," Agarwal adds. "I think the main areas where oral contraceptives are likely to be safer are with stroke and heart attacks."

Another study is looking at this very thing. And, meanwhile, the current researchers will continue to collect data from this study.


Courtesy of Amanda Gardner

SOURCES: Martin Vessey, M.D., emeritus professor of public health, University of Oxford, Oxford, U.K.; Sanjay Agarwal, M.D., acting director, division of reproductive endocrinology, and director, Center for Reproductive Medicine, Cedars-Sinai Medical Center, Los Angeles; July 19, 2003, The Lancet.

Smoke Screen

Study: Tobacco use in movies spurs teens to smoke

Smoking on the silver screen strongly encourages adolescents to start puffing themselves, new research says.

The study finds that adolescents exposed to more smoke-filled films are far more likely to take up smoking over the next two years than their peers who don't watch such movies.

"Smoking in the movies is associated with about 125,000 children a year dying prematurely," says Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

Making smoking on screen a trigger for an "R" rating would cut that 125,000 figure in half, says Glantz, author of an editorial accompanying the journal article. "The question is, does the Motion Picture Association of America [MPAA] want to save 63,000 lives a year with appropriate ratings?" he says.

Many previous studies have suggested that depictions of smoking on screen encourage teens to smoke. Indeed, the World Health Organization declared "tobacco-free films" a theme of this year's World No Tobacco Day.

Harder to prove, however, is a direct connection between a teen seeing smoking in a movie and his or her decision to pick up the habit. The latest study sought to determine how often that happened.

A research team led by Madeline Dalton, a professor of pediatrics at Dartmouth Medical School, followed 2,603 boys and girls, ages 10 to 14, who said at the beginning of the study that they'd never smoked. They were asked if they'd seen any of 50 popular films -- out of a possible 601 -- with varying amounts of smoking. Titles ranged from action blockbusters like Die Hard and True Lies to children's movies, including 101 Dalmatians (the live-action version), Free Willy, and The Little Mermaid.

"We picked them based on box office receipts, not on whether they had smoking," Dalton says.

Over the next 13 to 26 months, 259 (about 10 percent) of the boys and girls reported smoking at least once. But while 17 percent of those in the group that saw the most movies with smoking tried tobacco, only 3 percent in the group that saw the fewest such films did so.

Risk-seeking behavior, rebelliousness, self-esteem, parental history of smoking, and other personality and parenting factors affected the chances that a child would start smoking. After weighing these factors, the researchers determined that seeing smoky movies still nearly tripled the odds a youth would experiment with tobacco -- a greater effect even than cigarette advertising, Glantz says.

"We found that of the children who tried smoking, half of them did so based on what they saw in the movies," Dalton says.

Dalton, like Glantz, believes the film rating system needs to start considering smoking. "The current intent of the ratings system is to notify parents of content that is thought to be inappropriate for children," she says. "Now we have evidence that smoking in movies is inappropriate for children and the message needs to be put out there."

Since smoking is rarely integral to movie plots, Glantz says, people should wonder why characters are often lighting up. "Sex and violence sell tickets. Smoking doesn't. Why are [movie studios] clinging to it?"

The MPAA did not return calls seeking comment.

Tobacco industry documents reveal that cigarette makers in the past have forged deals with Hollywood studios to feature certain brands in films -- despite denials by both sides. And while scripts may not call for a character to smoke, actors and directors often decide a scene calls for cigarettes anyway.

Kimberly Thompson, a Harvard epidemiologist who has studied tobacco use and movies, calls the new study "important" because it's the first thorough attempt to put a time-frame around youth smoking and exposure to the habit on film. However, she says, the researchers fall short of sealing their case.

"A strong correlation still doesn't get you to causation. This is good and strong evidence, but it's still a correlation," Thompson says.

By Adam Marcus
HealthDay Reporter

Studies Rap Philip Morris on Gay Marketing

In two new reports, researchers claim the Philip Morris tobacco company tried to extend its advertising reach into the gay community in the early 1990s while denying it was targeting any specific group.

"They were trying to have it both ways. They want the market, they want the business, but they want to buy our silence and distance themselves when homophobes object to their involvement," says Naphtali Offen, co-author of one of the studies and a research associate at the LGBT (Lesbian, Gay, Bisexual & Transgender) Tobacco Project at the University of California at San Francisco (UCSF).

Philip Morris also turned a boycott led by gays into a public relations opportunity by boosting its funding for AIDS organizations, the researchers say.

But a spokesman for Philip Morris defends the company, saying it markets its product -- which he acknowledges is "addictive" and "causes serious disease" -- to all kinds of groups and has advertised for years in gay-oriented magazines. In regard to the boycott issue, spokesman Brendan McCormick says the company has a history of supporting charitable organizations, including those that fight AIDS.

Today, tobacco companies actively pitch their products to gays through advertising in magazines and newspapers, and the market seems to be receptive. Studies have shown gays and lesbians are more likely to be smokers than heterosexuals.

But tobacco companies weren't always interested in advertising directly to gays. In 1992, Philip Morris became the first tobacco company to buy ads in a gay-oriented magazine.

But the groundbreaking ads in a magazine called Genre, geared toward gay men, created a stir. Philip Morris responded to media requests by saying it didn't target "specific groups in society," researchers report in the June issue of the American Journal of Public Health.

That, the researchers charge, was disingenuous. An examination of internal tobacco company documents found that a marketing consultant in early 1992 urged the company to advertise its Benson & Hedges cigarette brand in gay publications.

The documents were released in 1998 as part of a settlement between the attorneys general of several states and the tobacco industry.

The consultant wrote that the company could target the gay community and that "you can own this market." The company agreed to do so, "but when they got called on it, they said they really didn't even see [Genre] as a gay magazine," says study co-author Elizabeth A. Smith, a research associate at UCSF's LGBT Tobacco Project.

Philip Morris continued to advertise in gay publications throughout the 1990s. "Our marketing efforts are designed to appeal to diverse people of both genders and all ethnic groups and sexual preferences," McCormick says.

In another report, in the June issue of Tobacco Control, researchers at the University of California at San Francisco claim a 1990 gay boycott against Philip Morris backfired.

The boycott was launched by the Washington, D.C., chapter of the ACT-UP organization, which used a blend of public theater and shock tactics to draw attention to the AIDS epidemic. The chapter was angry about the tobacco company's support of then Senator Jesse Helms, R-N.C., an opponent of AIDS funding and gay rights.

The boycott, against Marlboro cigarettes, had no major effect on the earnings of Philip Morris, the researchers say. But the company did respond by boosting its funding of AIDS organizations and the chapter ended its boycott efforts, even though Philip Morris still supported Helms.

"The boycott that was initially against the industry ended up being an opportunity for [Philip Morris] to make friends by settling the boycott," Smith says.

McCormick, however, says Philip Morris has long supported charities, including those involved in health efforts. In fact, he says, the tobacco company even supports efforts to educate people about the risks of smoking.

"We manufacture a product that causes serious disease in smokers and is addictive," he says. "The safest thing for people to do is not for smoke at all."

However, he adds, 45 million Americans haven't made that choice.

Meanwhile, the company went a step further Tuesday toward accepting more government regulation. Mike Szymanczyk, chief executive of Philip Morris, told a Congressional panel that oversight from the U.S. Food and Drug Administration (FDA) would let the company sell two products that are less harmful than cigarettes, according to an Associated Press report.

The company had long opposed any government regulation over tobacco, but changed course in 2000, saying it would be amenable to some oversight. However, the U.S. Supreme Court ruled that year that the FDA had no authority.

SOURCES: Naphtali Offen and Elizabeth A. Smith, Ph.D., research associates, LGBT Tobacco Project, University of California at San Francisco; Brendan McCormick, spokesman, Philip Morris, New York City; June 2003 American Journal of Public Health; June 2003 Tobacco Control

Courtesy: By Randy Dotinga HealthDayNews Reporter

Smoking Increases Panic Attack Risk

Studies in the past suggested an association between smoking and mental disorders. Now, new research finds a unique connection between smoking and the risk of a panic attack.

For the research, authors used data from the Early Developmental Stages of Psychopathology Study. The study included adolescents and young adults in Munich, Germany. Researchers assessed number of cigarettes smoked, nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders. Study participants were followed for four years.

At the start of the study researchers note a clear association between panic attacks and disorders and regular smoking and nicotine dependence. After analyzing the data, researchers say they also found an increased risk for the onset of a panic attack in those who smoked regularly and were nicotine dependent. Prior nicotine dependence also increased a person's risk for the onset of a panic disorder, whereas those who had panic problems did not show a tendency to turn to smoking.

Researchers say this study shows a rather unique and specific relationship between smoking and the increased risk for a panic attack or panic disorder. They say their results suggest smoking and nicotine dependence increase the risk for panic attacks and disorder but not for most other anxiety disorders. Furthermore, prior smoking increases the risk for a panic problem, but there is no higher incidence of smoking among cases with an anxiety disorder.

SOURCE: Archives of General Psychiatry, 2003;60:692-700

Smoking on the Big Screen

Now researchers in New Hampshire say parental guidance can impact what movies kids see, and, in turn, their exposure to harmful habits. It's clear the presence of smoking by celebrities in movies influences adolescent attitudes and behavior.

Movies traditionally glamorize smoking, associating it with character traits such as toughness, rebelliousness, and sexiness, the research explains. Past research has shown adolescents are responsive to actions, including smoking and drinking, portrayed on screen. The influence of the media in this situation, finds research, can be very powerful. James D. Sargent, M.D., and his team of researchers at Dartmouth-Hitchcock Medical Center, sought to determine what factors could modify adolescent exposure to smoking in movies.

Nearly 5,000 junior high school students participated in the study. The students reported which of the 50 randomly chosen movies they had seen. The researchers then analyzed the occurrence of smoking in these films. In general, the students who had the most exposure to smoking in movies had the least amount of parental restriction and the greatest access to movies, including movie channels available at home. Dr. Sargent concludes, "Exposure to movie smoking is reduced when parents limit movie access" and monitor the films they allow their child to view.

Dr. Sargent proposes that a new approach to the exposure of movie smoking "may be to limit access of young adolescents to movies," because adolescents who saw fewer smoking depictions also saw fewer movies in general.

SOURCE: Archives of Pediatric & Adolescent Medicine 2003;157:643-648

Banning Smoking in the Home Helps Infants

Banning smoking in the home limits infants' exposure to tobacco smoke. Infant exposure to environmental tobacco smoke increases the risk of sudden infant death syndrome, asthma, and other respiratory conditions.

A recent study analyzed the urinary cotinine levels, a byproduct of nicotine, of 314 infants living in smoking households. Participating infants were between 4 weeks and 24 weeks old. Researchers from the University of Warwick, United Kingdom, found banning smoking in the home was associated with a small but significant reduction in cotinine levels. Other methods to reduce tobacco smoke in the home, such as no smoking while the infant sleeps or limiting the number of cigarettes, produced no reduction in the cotinine levels and had no effect on exposure of infants.

More than 80 percent of participating parents thought environmental tobacco smoke was harmful and 90 percent believed that their children could be protected from smoke exposure in the home. At least half of the parents reported using more than one measure to reduce infant tobacco smoke exposure in the home. Further research is needed to determine if measures less strict than banning smoking, like opening windows and using fans while smoking will have any effect on infant cotinine levels.

SOURCE: British Medical Journal, 2003;327:257-260

Courtesy of (Ivanhoe Newswire)

Smoking and Oral Contraceptives: A Deadly Combination

A new study shows oral contraceptives are safe for non-smokers but can be deadly for women who smoke. The study began 35 years ago and included 17,000 women.

Oral contraceptives were widely used in the 1970s and 1980s. There has long been a question of whether being on the birth control pill could increase your chance for cancer or other fatal diseases. As part of the Oxford Family Planning Association study, researchers from the Institute of Health Sciences in England looked at the deaths associated with oral contraceptives use and cigarette smoking.

The women in the study were between 25 and 39 years old. They either used oral contraceptives, a contraceptive diaphragm or an intrauterine device. Follow-up information was available on the women up until 2000. By that time, researchers report 889 of the 17,000 women had died. Researchers looked at the cause of death and which contraceptive they used.

The study reports there was no increased risk of death among the women who used the birth control pill compared to the women who never used oral contraceptives. In fact, the numbers suggest the death rate was lower among those who were on birth control pills. However, there was an increased risk of death from heart disease in women who used the oral contraceptive and smoked. Specifically, there was a 25-percent increased risk of death for light smokers. The study also found women who smoked more than 15 cigarettes a day and were taking oral contraceptives were twice as likely to die than non-smokers.

Researchers say this study confirms what three other studies have found in that there is no adverse effect from oral contraceptive use in non-smokers. Study authors say this should be a reassuring finding for many older women today. However, the study also confirms that smoking and oral contraceptive use can be a deadly combination.

This article was reported by, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to:

SOURCE: The Lancet, 2003;362:185-191


Teaching Blue-Collar Workers to Kick Butts

Blue-collar workers have traditionally had the hardest time trying to kick the smoking habit. But researchers have found a new method that doubles the success rate for those who want to quit.

The study, published in the August issue of the journal Cancer Causes and Control, found that blue-collar workers are more willing to quit when they're taught about the risks of combining smoking with other common workplace hazards.

"We're trying to catch their attention," says the study's lead author, Glorian Sorensen, a Harvard University professor and director of the Dana-Farber Cancer Institute's Center for Community-Based Research.

"Blue-collar workers have a harder time quitting. And more traditional workplace programs haven't been as successful with blue-collar workers," she says.

There's a pressing need for a successful cessation program because blue-collar workers smoke far more than other workers. A 1997 study found that 37 percent of male blue-collar workers and 33 percent of female workers smoked. For white-collar workers, just 21 percent of men and 20 percent of women smoked, Sorensen says. Moreover, white-collar workers are quitting at a faster rate, she says.

But the risks of smoking on the job aren't just limited to cigarettes for blue-collar workers. Those workers are often exposed to chemicals that can become deadlier when combined with smoking. For example, asbestos workers who smoke dramatically increase their chances of dying of lung cancer, the American Lung Association says.

Even without smoking, American workplaces can be dangerous. An estimated 60,000 people die of occupational diseases every year; of those, more than 17,000 die of lung cancer because of inhaling cancer-causing agents, the American Lung Association says.

Those factors increase the urgency of persuading blue-collar workers to quit, Sorensen says.

In prior studies, she found that blue-collar workers get less support in their efforts to quit than white-collar workers, even though they're often very willing to try.

"Blue-collar workers attempt to quit at the same rate as white-collar workers, but they're much less successful. Maybe there is more peer pressure in these workplaces," adds Greg DeLaurier, a consultant with the University of Massachusetts in Lowell, who works with labor unions around the country to establish smoking-cessation programs.

For the Dana-Farber study, researchers randomly selected 15 large manufacturing companies around the Boston area. Then they divided the workers into two groups. One group went through a general health program, which included information about the risks of smoking. The other group focused on specific occupational hazards within the workplace, and how smoking makes them worse.

Twice as many workers in the latter group quit smoking over the 16-month study, Sorensen found. And because they were already careful about workplace hazards, they were much more willing to support their co-workers' efforts to quit smoking.

DeLaurier has had the same experience in working with blue-collar smokers.

"What doesn't work very well is if you just offer a generic smoking program," he says. "But if you tie it into the specifics of the workplace, smoking is no longer just an abstraction. It puts it in a context the worker will listen to."

The study also supports the idea that the work environment is an ideal place to tackle health issues, Sorensen says.

"The large majority of adults spend their time in a work setting. It's a place that shapes our behavior through social norms and the support you get from your co-workers," she says. "As we think about health, whether smoking or anything else, we need to think about how those individual factors are situated in the broad fabric of a person's life."

What To Do

To learn more about occupational hazards and their long-term effects, visit the American Lung Association. For information about smoking on the job, visit this site. To read one of the first federal reports about the risks of smoking in blue-collar work sites, try the Centers for Disease Control and Prevention.

SOURCES: Glorian Sorensen, Ph.D., professor of health and social behavior, department of health and social behavior, Harvard School of Public Health, and director, Dana-Farber Institute's Center for Community-Based Research, Boston; Greg DeLaurier, labor consultant with the University of Massachusetts, Lowell; August 2002 Cancer Causes and Control. By Ross Grant HealthScoutNews Reporter


Smoking Cessation and Its Benefits

Quitting smoking can have a profound, positive impact on a person's quality of life.

Data from large prospective studies have shown that cigarette-smoking men have a 70 percent higher overall death rate than nonsmokers. The excess mortality of female smokers has been somewhat less than that of male smokers, but is increasing.

A strong dose-response relationship exists between cigarette smoking and excess mortality, as measured by the age at onset of smoking, the number of cigarettes smoked, the number of years smoking, and the depth of inhalation. Cessation of smoking is associated with a decrease in excess mortality.

Speak with your physician about quitting smoking. He or she will help you through the process, answer your questions, and give you support.

Nicotine replacement therapy is available (nicotine patch, nicotine gun, and nicotine nasal spray) after you have quit.

Other medications may be helpful as well.

Questions To Ask Your Doctor
Are there tests that will show the status of my lungs?

Will there be weight gain if smoking is stopped?

Are there any medications to help a person stop smoking?

What are their side effects?

Is nicotine addicting?

Will there be increased nervousness when a person stops smoking?

Does genetics have anything to do with smoking?

Does smoking cause permanent staining of the teeth?

What are the pros and cons of the nicotine patch, nicotine gum, and nicotine nasal spray?


Passive Smoke Tied to Dental Woes in Kids

Study finds link, but expert sees no association

Parents have yet another reason to quit smoking: Passive smoke from their puffing could be ruining their children's baby teeth.

That's what researchers from the University of Rochester Medical Center in New York conclude in a new study, although at least one dental expert isn't convinced this study proves such a link.

In the March 12 issue of the Journal of the American Medical Association, the Rochester researchers report that children who are exposed to environmental tobacco smoke have almost twice the risk of cavities that youngsters in smoke-free homes do.

"This is just one more piece of evidence that passive smoke harms children," says study author Dr. C. Andrew Aligne, who was with the University of Rochester Medical Center at the start of the study but finished it after founding a company called Pediathink.

Aligne says further research needs to be done to corroborate their findings, but adds, "if this relationship is causal, one quarter of children with cavities in their baby teeth would be cavity-free if tobacco smoke exposure could be eliminated."

However, Dr. Manuel Cordero, a New Jersey dentist and a spokesman for the Academy of General Dentistry, isn't convinced. "There may be a connection [between passive smoking and children's cavities], but it has not been proven by this study," he says.

Despite advances in dental care, tooth decay remains a common childhood disease, costing the U.S. more than $4 billion a year, according to the study. Tooth decay causes pain, poor appearance and possible problems with speech development.

The researchers gathered data on 3,531 children between the ages of 4 and 11 for this study from the Third National Health and Nutrition Examination Survey. All of the children had a complete dental examination and blood tests that measured their cotinine levels. Cotinine is a byproduct of nicotine that is present in the blood of people who are exposed to smoke, either directly or indirectly.

Fifty-three percent of the children had cotinine levels high enough to indicate passive smoke exposure, according to the study. Nearly half of all the children had at least one decayed or already filled baby tooth, while 26 percent already had a cavity in one of their permanent teeth.

Children exposed to passive smoke had almost twice the risk of having a cavity in their baby teeth, according to Aligne. However, there was no statistically significant relationship between cavities in permanent teeth and passive smoke. While the researchers weren't able to address the reason why with the data available, Aligne believes that as with other health risks, younger children and their developing bodies are simply more susceptible.

Cordero points out the researchers found that cavities in baby teeth were nearly three times as common in kids whose parents had less than a high school education compared to those with more than a high school education. This factor, he says, is probably more of an influence on cavity development than passive smoking.

Aligne, however, says he and his colleagues tried to control the data for other potential risk factors -- such as poverty, race, sugar intake and family income -- and that they still found an association between passive smoke and cavities in baby teeth after doing so.

In the study, the researchers explain it may not necessarily be the smoke exposure, but that parents who smoke may also have other unhealthy behaviors, such as not brushing teeth regularly or eating too much candy, which could be causing the cavities.

Cordero believes these explanations are much more likely. "Parents who smoke are teaching poor overall health habits," he says.

Whether the connection between passive smoke and cavities holds up in future studies or not, Aligne says, "Dental cavities and passive smoking are still very big public health problems and we need to do more to prevent them."

Source: By Serena Gordon, HealthScoutNews Reporter


Temporary Symptoms May Cause Some to Relapse

Smokers are likely to develop mouth ulcers and cold symptoms for up to two weeks after quitting. This problem, which researchers say is temporary, may be one reason so many succumb to nicotine's urges.

But if smokers trying to quit can hang on, all symptoms seem to be gone after six weeks, according to new research. The study is published in the February issue of Tobacco Control.

Researchers followed the progress of 174 smokers wanting to quit. The smokers went through a seven-week smoking cessation program combining behavior support with nicotine patches.

After weeks one and two, there were significant increases in mouth ulcers and cold symptoms, such as coughing, sneezing, and sore throats. It was during this time, according to researchers, that people were more likely to have setbacks. Slightly less than half the participants managed to resist temptation for the entire six weeks of the study.

The researchers say that mouth ulcers may be caused by the loss of antibacterial properties of smoking while an increase in cold symptoms may be due to a loss of natural antibodies in the saliva.

Michael Ussher, MD, and colleagues, conclude that more research is needed to determine if cold symptoms and mouth ulcers persist beyond two weeks after quitting.

Being psychologically prepared for these effects may improve smokers' odds of quitting, they say.

SOURCE: Fern Garber - WebMD News Tobacco Control, February 2003.

Can Lung Cancer Be Prevented?

Retinoid May Help Prevent Lung Cancer - Vitamin A Derivative May Lower Risk Among Former Smokers

by Jennifer Warner (WebMD Medical News )

Quitting smoking is the single biggest thing a person can do to reduce their risk of lung cancer, but now researchers may have finally found a way to lower the risk for people who have already quit their cigarette habit. A new study shows that daily treatment with a retinoid drug may prevent lung cancer in former smokers.

Retinoids are natural and synthetic compounds related to vitamin A (retinol) and retinoic acid (RA). Although they have been found to help prevent head and neck cancers, until now retinoids have not been shown to be effective in preventing lung cancer.

In fact, researchers say some studies have shown that retinoids are of no benefit in reducing the risk of lung cancer in current smokers. But this may be the first study that has shown a benefit in targeting former smokers and reversing signs of precancerous lesions in lung tissue.

Lung cancer is the leading cause of cancer death in the U.S., and researchers say about 90% of all lung cancers occur in people who smoke, which has made smoking cessation efforts a major focus of lung cancer prevention efforts.

Although the risk of lung cancer decreases in people who quit smoking, the risk still remains about twice as high as those who have never smoked, for about 20 years after they quit. The risk after 20 years lowers some but continues to remain high.

In the study, published in the Feb. 5 issue of the Journal of the National Cancer Institute, researchers looked at the effects of two different types of retinoids on restoring the presence of a substance called retinoic acid receptor beta (RAR-beta) in lung tissue from a group of 226 former smokers. Loss of RAR-beta is considered a sign of pre-cancerous tumors.

Researcher Jonathan M. Kurie, MD, of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues found a loss of RAR-beta in nearly 60% of the participants at the start of the study.

But after three months of twice-daily treatment with the retinoid known as 9-cisRA, there was a significant increase in the presence of RAR-beta among those who received the retinoid compared with the placebo. No benefit was found for the second type of retinoid tested.

Researchers say the study shows that the benefits of retinoid treatment may differ among current vs. former smokers.

In an editorial that accompanies the study, Jason S. Vourlekis, MD, and Eva Szabo, MD, of the National Cancer Institute, say it remains to be seen how restoration of RAR-beta might correlate to a reduction in risk of lung cancer, and more studies will be needed to examine that issue.

SOURCE: Journal of the National Cancer Institute, Feb. 5, 2003.

Smokers have more aches and pains!

As if lung cancer, heart disease, and emphysema weren't enough, researchers now say smoking may be to blame for some common aches and pains, too. A new study shows smokers are more likely to complain about pain in their back, neck, arms, and legs than non-smokers.

The report, published in the January issue of the Annals of Rheumatic Diseases, shows smokers as well as ex-smokers are at higher risk for aches and pains -- especially those that lead to chronic disabilities and interfere with daily activities.

Researchers surveyed nearly 13,000 adults across Great Britain and asked them about whether they suffered pain in the low back, neck, upper and lower limbs in the last 12 months. They also asked questions about their smoking habits, physical activities at work, headaches, tiredness, and stress.

They found the percentage of people who reported pain in the past year was consistently higher among smokers and ex-smokers for all the parts of the body examined by the study.

Smokers and ex-smokers were at especially high risk for pain that prevented them from performing daily tasks.

Researcher K. T. Palmer, MD, of the Southampton General Hospital, and colleagues say some of their findings may be muddled by the fact that current and ex-smokers were more likely to have a physically demanding job. This group also reported feelings of frequent tiredness, stress, and headaches, which could indicate a lower overall threshold for pain.

But researchers say the pattern persisted even when they adjusted for these factors and when they looked at pain reported among only white-collar workers.

Even so, they say it's unclear whether tobacco affects the body's pain sensors, or whether people with a low tolerance for reporting pain and disability are more likely to take up and keep smoking.

"If taking up smoking increases pain susceptibility, then this provides another reason to avoid the habit," according to the researchers, "but if the type of people who smoke report pain more readily, a search should next be made for the underlying mechanisms...."

~Jennifer Warner

Nicotine Replacement Backed Despite Cancer Study

Researchers say they're still much safer than smoking

By Randy Dotinga

Nicotine replacement products are much safer than smoking despite a new study suggesting that nicotine could play a role in lung cancer.

That assurance comes from a leading maker of these products as well as researchers who reported last week that nicotine appears to give a helping hand to cancer cells in the lungs.

"Our study is probably the first to show that nicotine can act similarly to a carcinogen," says Kip A. West, a researcher with the National Cancer Institute.

However, the study is based on findings in the laboratory, and researchers haven't tested their theories on animals or humans. And the scientists aren't suggesting that smokers give up trying to quit with the aid of nicotine replacement products, which now include lozenges in addition to the ubiquitous patches and gum.

To make the point even clearer, GlaxoSmithKline issued a statement saying the risks of using nicotine-based smoking cessation products "are extremely small compared to the known deadly risks of smoking." The pharmaceutical company makes NicoDerm CQ nicotine patches, Nicorette gum and Commit lozenges, which let smokers slowly wean themselves off their addiction by getting doses of nicotine without having to light up.

According to the American Cancer Society, the nicotine replacement products deliver lower doses of the chemical than tobacco. They also let smokers focus more on the psychological difficulties of quitting than the physical addiction.

While nicotine is considered to be largely responsible for turning smokers into addicts, scientists have not considered it to be a cause of cancer. Instead, researchers blame hundreds of other poisonous chemicals in cigarettes, pipes and cigars.

Federal researchers, however, wondered whether nicotine could play a role in the development of cancer. They set up experiments involving lung cells in a laboratory and report their findings in a recent issue of the Journal of Clinical Investigation.

In a healthy body, cancer-infected cells will automatically activate a kind of suicide program: The cells will kill themselves before they can wreak havoc on the body. However, when researchers hit human lung cells with cancer-causing chemicals, the levels of nicotine normally experienced by smokers appeared to prevent the cells from switching on the suicide protocol.

"It has a protective effect," West says. The survival of the cells, in turn, "allows them to accumulate mutations that would enable them to become tumor cells."

The researchers found that nicotine and a related chemical in tobacco known as NNK appear to affect the cells by influencing pathways where command signals travel.

What does this mean for nicotine products that are geared to help people stop smoking? West says the research does raise concerns if people use the products for a long time. "Prolonged use could be a bad thing," he says.

GlaxoSmithKline says its products are designed to be used over 10 to 12 weeks as a "step-down therapy" that more than doubles the chances of successfully quitting over the "cold turkey" approach.

However, the company suggested that long-term use might not be a problem. It cited a 1997 federally funded study that found people could safely take nicotine gum for five years.

What To Do

For a fact sheet on nicotine replacement products, go to the American Lung Association or the American Cancer Society.

SOURCES: Kip A. West, Ph.D., postdoctoral fellow and researcher, Cancer Therapeutics Branch, National Cancer Institute, Bethesda, Md.; statement from GlaxoSmithKline; Jan. 1, 2003, Journal of Clinical Investigation

Copyright 2003 ScoutNews, LLC. All rights reserved.


Study: 'Safer' Cigarettes May Be All Smoke

Two studies find targeted brands may lead to increased addiction

By Jennifer Thomas
HealthScoutNews Reporter

They're sold by big tobacco companies and go by names like Advance, Eclipse and Accord.

They're marketed as safer cigarettes that can lessen the risks of smoking by releasing fewer cancer-causing substances.

But two new studies show these so-called safer cigarettes may not be safer at all -- and may even lead to increased addiction.

In the first study, researchers invited 20 smokers in the lab and, over three days, had them puff on their own brand of cigarettes, then an Advance cigarette, now sold by Brown & Williamson Tobacco Corp., and also an unlit cigarette for comparison.

Advance cigarettes are marketed as a safer cigarette because they supposedly contain less of a type of cancer-causing substance called nitrosamines, said Thomas Eissenberg, an associate professor of psychology at Virginia Commonwealth University and lead author of both studies.

The Advance study, which did not look at nitrosamine levels, found the cigarette produced 11 percent less carbon monoxide. Carbon monoxide has been linked to cardiovascular disease in smokers, Eissenberg said.

But Advance also delivered 25 percent more nicotine into the blood than the smokers' own brands. Nicotine is the addictive substance in cigarettes.

"We don't know for sure if it causes increased dependence, but certainly many smokers would like to know if they're being exposed to more nicotine," Eissenberg said.

A spokesman for Brown & Williamson responded that the researchers had looked at an early version of Advance cigarette made by a different company.

"The nicotine levels they are reporting are not correct," spokesman Marc Smith said. "They are looking at a product that is not on the market today. The product being sold today has much lower nicotine levels ..." He did not say what the nicotine levels were.

The study appears in the December issue of the journal Tobacco Control.

In a second study, published in the December issue of Harm Reduction, Eissenberg and his colleagues conducted a similar experiment with Accord cigarettes, made by Philip Morris Co. Inc., and Eclipse, made by R.J. Reynolds Tobacco Co..

Both cigarettes heat rather than burn tobacco, presumably reducing carcinogen levels.

Researchers didn't look at carcinogen levels, but they did look at nicotine, carbon monoxide and the effects on smokers' heart rate.

On the plus side, they found Accord delivered significantly less nicotine and boosted smokers' heart rate and carbon monoxide levels less than traditional cigarettes.

But Accord didn't do as well as traditional cigarettes in suppressing cravings or reducing such withdrawal symptoms as anxiety, restlessness and irritability, they found.

If Accord fails to give smokers the same satisfaction they get from smoking their regular brand, they may simply smoke more, which would defeat the purpose of safer cigarettes, Eissenberg said.

Eclipse, on the other hand, increased heart rate and suppressed withdrawal symptoms about as well as conventional cigarettes. However, Eclipse delivered about 30 percent more carbon monoxide than regular cigarettes, Eissenberg said.

"Based on our evaluation, all three alternative cigarettes appear to reduce some toxins that are associated with smoking-related diseases," Eissenberg said. "But our testing also revealed that Eclipse and Advance may increase levels of dangerous substances produced by these cigarettes that smokers should be aware of."

A spokeswoman for R.J. Reynolds said the 30 percent increase in carbon monoxide (CO) cited in the study is not correct.

"The CO claim mentioned in the study is contrary to what we have found during our extensive investigations. Under FTC machine-smoking puffing conditions, the 'tar' and nicotine yields for Eclipse are in the range of ultra-low-'tar' cigarettes, while the CO yield is in the low-'tar' range," said Carole Crosslin.

The company's extensive studies, she added, "have found that, on average, there is about a 10 percent increase in COhB in smokers switching to Eclipse from their usual brand."

However, Patrick Reynolds, founder of the Foundation for a Smokefree America, called the research an important step in debunking claims of safe cigarettes.

"There is an array of tobacco products on the market all claiming to varying degrees to be safer," said Reynolds, the grandson of R.J. Reynolds and the son of a man who died of smoking-related disease. "It will be decades before we have the medical data and studies in about whether these products are substantially safer."

Even if a product delivers less carbon monoxide or carcinogens, he added, it is still unknown what amount causes an individual smoker to get cancer or heart disease.

"Whether the products are one percent safer or 15 percent safer, we really don't have any clue," Reynolds said. "The big danger is that many smokers may believes these products are far safer than they really are and will justify their continued smoking based on that."


Hiking Cigarette Tax Could Save Millions Of Lives

Raising price seen as most effective way to cut smoking-related deaths

By Jennifer Thomas
HealthScoutNews Reporter

What's the single most effective way of preventing deaths from smoking?

Hike the price of cigarettes, new research says.

Raising the tax on cigarettes could avert between 5 million and 16 million tobacco-related deaths worldwide in the coming years, according to a study in the September issue of Nicotine & Tobacco Research.

Researchers evaluated the effectiveness of several types of tobacco control: tax increases; nicotine replacement; and a package of interventions, including bans on advertising and promotion of tobacco products, anti-smoking education and smoking restrictions in public places or work places.

They then used economic models and the results of previous smoking cessation studies to estimate the number of deaths that could be avoided by using the three methods around the world. These results were applied to a global model of smokers in 1995.

Raising the price of cigarettes by 10 percent worldwide would prevent between 5 million and 16 million deaths, they found. People in low- to mid-income countries and people between the ages of 15 and 29 would be the most impacted by the price increases, according to the study.

"In general, price increases are the most cost-effective, anti-smoking intervention," writes lead author Dr. M. Kent Ranson, of the London School of Hygiene and Tropical Medicine in England.

John Banzhaf, executive director Action on Smoking and Health, says the study is consistent with previous research.

"There are many studies which show that increasing taxes on cigarettes is a very effective way to decrease consumption," Banzhaf says. "And it's no surprise that they are most effective with kids and with people who are in the lower socioeconomic classes."

Nicotine replacement includes products such as chewing gum, skin patches, nasal sprays, inhalers and lozenges. Liberalizing access to nicotine replacement could avoid 1 million to 5 million smoking-related deaths, the study found. It would have the greatest impact on people between 30 to 59 years old.

Bans on advertising, prohibition of smoking in public places and anti-smoking educational programs would probaably reduce smoking worldwide by about 2 percent, meaning another 5 million lives would be saved.

In the United States, about 23.3 percent of adults smoke, according to the Centers for Disease Control and Prevention (CDC). And 70 percent of them want to quit, reports the 2000 National Health Interview Survey.

Peter Jacobson, an associate professor of health law at the University of Michigan in Ann Arbor, says the new study is logical based on previous research findings.

However, Jacobson adds, the study underestimates the power and importance of education programs that "de-normalize" smoking, making it a habit that is socially unacceptable.

This change in attitude toward smoking is largely a result of ceaseless efforts by educators and public health experts to spread the message about the dangers of tobacco, says Jacobson, lead author of Combating Teen Smoking: Research and Policy Strategies.

"One might get the false impression from this study that the only thing that's needed is to raise taxes," Jacobson says. "What's missing, and what many tobacco control researchers are starting to look at, are more comprehensive programs."

Raising taxes is but one, albeit important, weapon in the arsenal against tobacco.

He points out that smoking rates are higher in European countries than in the United States, even though Europe has higher taxes on cigarettes. In countries such as Denmark and Portugal, taxes account for more than 70 percent of the price of a pack of cigarettes. In the United States, Massachusetts has the highest tax rate at 38 percent, he notes.

What about smokers' rights?

Banzhaf puts little stock in their arguments that they're being overtaxed. He cites a CDC study that found each pack of cigarettes will mean subsequent health-care costs of about $12.85. Much of that cost is paid for by non-smokers in the form of taxes and higher health-care costs, Banzhaf says.

In the state of New York, for example, smokers pay $1.50 tax on each pack of cigarettes -- far less than the $12.85 it will eventually cost in health-care expenses, he adds.

"It's a small step in the right direction to make them pay their fair share of these huge costs," he says.

What To Do

For more information on the legal battle against tobacco, upcoming anti-smoking legislation and the latest tobacco research, visit Action on Smoking and Health.

The Centers for Disease Control and Prevention has tips on quitting smoking.

SOURCES: John Banzhaf, executive director, Action on Smoking and Health, Washington, D.C.; Peter Jacobson, J.D., M.P.H., associate professor, health law, University of Michigan, Ann Arbor; September 2002 Nicotine & Tobacco Research

Copyright 2002 ScoutNews, LLC. All rights reserved.


All it takes is one cigarette !

Up to now, it was thought it took a few years for smokers to become addicted, but the latest research shows addiction takes place in days

LONDON -- Scientists have confirmed a suspicion held by some smokers but never proven: it could take just one cigarette to become addicted.

Experts have tried for years to determine how long people have to smoke before becoming addicted, said Dr Richard Hurt, director of the Nicotine Dependency Unit at the Mayo Clinic in the United States.

"The best answer to date has been one to two years," said Dr Hurt, who was not involved with the latest research. "There's been a suspicion that many people become addicted very quickly, but this is really the first hard evidence that we've had that this occurs."

Research reported in the British Medical Association journal, Tobacco Control, found that several 12- and 13-year-olds showed evidence of addiction within a few days of their first cigarette.

Dr Hurt said the findings would help scientists better understand the biology of nicotine addiction and lend more plausibility to the idea that some people may be more susceptible genetically to it than others.

The study was conducted by scientists at the University of Massachusetts in 1998. The experts followed 681 teenagers aged 12 and 13 from seven schools in central Massachusetts for a year and tracked their smoking habits.

The researchers did not label any of them as addicted because the standard definition of nicotine dependence assumes that addiction cannot happen without prolonged heavy smoking.

The scientists simply recorded symptoms that indicate addiction. Symptoms include cravings, needing to smoke more to get the same buzz, withdrawal symptoms when not smoking, feeling addicted to tobacco and loss of control over the number of cigarettes smoked or the duration of smoking.

A total of 95 teens said they had started smoking occasionally - at least one cigarette a month - during the study.

The scientists found that 63 per cent of them had one or more symptoms of addiction.

A quarter of those with symptoms got them within two weeks of starting to smoke and several said their symptoms began within a few days.

Sixty-two per cent said they had their first symptom before they began smoking every day, or that the symptoms had made them start smoking daily.

"The really important implication of this study is that we have to warn kids that you can't just fool around with cigarettes or experiment with them for a few weeks and then give them up," said Dr Joseph DiFranza, who led the research team.

"If you fool around with cigarettes for a few weeks, you may be addicted for life." - AP.

*courtesy of QuitSmoking.Com


Turns Out Secondhand Smoke, Not Curiosity, Can Kill a Cat
Study underscores the threat to humans, especially children

WEDNESDAY, July 31 (HealthScoutNews) -- Even having nine lives is no protection against secondhand smoke.

Cats who live with people who smoke are more than twice as likely as other cats to develop a deadly form of cancer called feline lymphoma, says a study by scientists at Tufts University School of Veterinary Medicine and the University of Massachusetts.

The study appears in tomorrow's issue of the American Journal of Epidemiology.

The finding provides compelling evidence of the need for further study of the link between secondhand smoke and non-Hodgkin's lymphoma in humans, which is similar to lymphoma in cats, the study authors say.

"We believe the feline exposure patterns to environmental tobacco smoke may mimic those of young children living in households where adults smoke and where the children inhale tobacco smoke or ingest particulate matter by mouthing contaminated objects," says lead author Elizabeth R. Bertone, an epidemiologist at the University of Massachusetts at Amherst.

The study looked at 180 cats treated at Tufts Veterinary School's Foster Hospital for Small Animals between 1993 and 2000. Eighty of the cats were treated for lymphoma; the rest were treated for renal failure.

The authors adjusted for age and other factors and concluded that cats exposed to any household environmental tobacco smoke had 2.4 times greater risk of lymphoma than cats who lived with non-smokers.

The risk increased with longer exposure. Cats subjected to at least five years of secondhand smoke were 3.2 times more at risk for lymphoma than other cats.

The number of smokers in a house also made a difference. One smoker in a home increased a cat's risk by 1.9 times, while two or more smokers made a cat 4.1 times more likely to develop lymphoma.

Cats living in homes where people smoked a pack or more of cigarettes a day were 3.3 times more at risk than cats in smoke-free homes.

New Link Between Smoking & Cancer Found
By Richard Woodman

LONDON (Reuters) - British researchers said on Tuesday they had identified a possible new mechanism that might explain how smoking can cause breast and bowel cancer as well as lung cancer. The team, at the
Christie Hospital, Manchester, UK, said they had found that smokers have significantly higher levels of insulin-like growth factor (IGF) in their blood than non-smokers.

"We are excited about the findings of this research as they indicate a possible new mechanism to explain the development of some cancers," said research leader Dr. Andrew Renehan.

"This has potential implications for cancer risk assessment and cancer prevention strategies in the future," he added in a statement.

The findings were presented at the British Endocrine Societies' meeting in
Harrogate, YorkshireEurope's largest annual meeting of hormone specialists. Renehan said that other research had recently established that IGF is linked to breast and colorectal cancer. This had prompted his team to examine associations between smoking and IGF.

The team looked at cigarette smoking histories in over 400 individuals, aged 55 to 65, attending a bowel cancer screening trial in
Manchester. The investigators found that long-term smoking significantly affected levels of IGF and that this was related to length of use and number of cigarettes smoked.

"The findings were dose-related and were statistically significant," he added in a telephone interview. "There was a 20% to 25% difference in IGF levels between the heaviest smokers and the non-smokers."

Asked about the likely biological mechanism, he said it was known that growth factors could encourage cancer cell growth and protect abnormal cells against natural death caused by apoptosis, the "cell suicide" mechanism.

However, he said that a much larger study would be needed to prove that smoking, IGF levels and cancer risk are all linked.

Three studies released last year by British and American researchers suggest that common processes involving insulin signaling control the ageing process in organisms ranging from yeast to quite possibly humans.

Nicotine Patches, Gums May Pose Health Risk : Nicotine By-Product Could Cause Problems
By Jennifer Warner

Nicotine patches and gums have helped millions of people improve their health by allowing them to quit smoking. But a new study shows that these products may create other problems for their users.

The study, published in the Journal of the American Chemical Society, shows that nornicotine, a product created by the breakdown of nicotine, may interfere with a variety of chemical reactions in the body. These reactions may, in turn, trigger a range of negative health affects.

Researchers stress that their findings are preliminary and have only been demonstrated in the lab, not in humans. The study suggests that those who take medications or smoke while using nicotine products may be at a greater risk for adverse drug reactions because nornicotine may alter the effects and potency of other drugs.

While the addictive effects of nicotine is well known, the authors say their study shows another by-product of tobacco also plays a role. Nornicotine can prompt reactions that change the ways chemicals are processed and circulate in the body, although nicotine has no effect on these reactions.

In fact, researchers say it's the first time this type of compound has been shown to trigger these chemical reactions.

Some medications, such as steroids and antibiotics, may be more likely to interact with nornicotine, according to researchers. Tests are now underway to determine exactly which drugs may put smokers and users of other nicotine products at risk.

Experts say love of nicotine is all in mind
By Ronald Kotulak, Tribune science reporter

Working to unravel a long-standing puzzle of cigarette addiction,
University of Chicago researchers have discovered why smoking is uniquely pleasurable and why nicotine has such ferociously addictive powers.

Published Thursday in the scientific journal Neuron, the research shows that nicotine not only stimulates pleasure in the brain's reward center but has the unique ability to neutralize the "off-switch" that usually throttles down good feelings quickly.

The finding provides major clues to understanding the complex process by which the brain becomes addicted to nicotine and opens new approaches to developing drugs to block nicotine's power to hijack the brain.

For the 2,000 teenagers a day who become smokers, the new evidence helps to explain how a single cigarette quickly teaches the brain cells of a first-time smoker to crave nicotine.

And for the more than 30 million American smokers who try to quit smoking each year and fail, the finding shows why breaking the habit is so hard.

U. of C.'s Daniel S. McGehee and his colleagues showed how nicotine from a cigarette produces a high that can last up to an hour.

It does so first by quickly turning on the pleasure chemical dopamine in the brain's reward center, something scientists have known for several years. But the dopamine surge ends quickly, and researchers couldn't figure out what caused nicotine's long-lasting high and its ability to induce addiction.

McGehee's finding shows for the first time that nicotine also acts on a group of regulatory cells whose job is to stop the dopamine high. With this control mechanism temporarily disabled, the reward system continues to operate long after it should have been shut down.

The result is a runaway feel-good sensation that the brain commits to its memory bank as something it wants more of.

"This gives an explanation for why the long high happens," said Dr. Glen Hanson, acting director of the National Institute on Drug Abuse. "It's a combination of tolerance happening to several systems at the same time. When you sum everything up, you get an enhancement of the dopamine pleasure pathway."

McGehee's detailed studies of rat brains revealed the step-by-step process by which nicotine takes over the brain's reward system. Neuronal pathways in that system were examined cell by cell to determine how they responded or failed to respond to individual neurotransmitters.

Drug companies have been hampered in their efforts to develop anti-addiction medicines because they didn't know how the brain became addicted, said John Dani, a Baylor College of Medicine neuroscientist who was one of the first to show nicotine's effect on dopamine.

"Dan's work will allow both academic and pharmaceutical researchers to focus on the mechanisms of addiction with a greater understanding of how they work," Dani said.

The brain's reward system, scientists believe, is basically designed to help a person learn what is good for his survival and what is not.

It provides a wide range of sensations from euphoria to just plain feeling good. Experiences such as falling in love, getting a big promotion, coloring between the lines for the first time, seeing your baby's smile and winning the lottery promote some of the biggest dopamine jolts. Eating a good meal, making a new friend, taking a walk on the first morning of spring, working a crossword puzzle and other less intense learning experiences get less of the pleasure chemical.

"These really important events in our lives have a different quality to them that is imparted by the reward system," McGehee said. "What the drugs of abuse are doing is usurping that reward system."

Dopamine is carefully dispensed. A jolt makes a person feel good and helps lay down a memory of a new experience or reinforce an old one.

But dopamine is soon cut off, reducing the pleasurable effect to baseline levels. If it weren't turned down, dopamine would cause a constant feeling of being high, which would impede new learning and reduce the chance of survival.

"Nicotine acts as if it's reinforcing a behavior that should be rewarded," Dani said. "The brain is fooled into thinking that nicotine is a proper participant in life."

An estimated 57 million Americans smoke, which is linked to more than 400,000 deaths annually from cancer, heart attacks, strokes and emphysema. It is the nation's most preventable cause of death.

A cigarette contains about 10 milligrams of nicotine. About 1 to 2 milligrams get into the blood stream and hit the brain's reward center within 10 seconds after inhalation.

An average smoker takes 10 puffs per cigarette over a five-minute period. For a person who smokes 1 1/2 packs daily, his brain gets 300 hits of nicotine.

That nicotine plugs into receptor ports on brain cells stimulating the production of dopamine. Dopamine then turns the brain's pleasure center on.

At the same time, nicotine molecules plug into another set of inhibitory neurons, jamming their ability to turn off the pleasure center. The subsequent high lasts about an hour, the time it takes for nicotine in the blood to subside to the point where the inhibitory system can be reactivated.

"There's no other outcome than excitation when you've got nicotine in the system," he added. "It would be hard to design a drug that acts on the reward center that would be more effective than nicotine."

Copyright 2002, Chicago Tribune

Smokers Disillusioned With Their Habit

If They Could Start Over, Most Say They Would Never Start By Jennifer Warner

WebMD Medical News

March 8, 2002 -- Given the chance, most smokers say they would have never started smoking in the first place, according to a new survey of British smokers. Many may also overestimate their plans to quit.

When asked: "If you had your time again, would you start smoking?" 83% of current smokers said they would not. Older adults seemed the most disenchanted with their habit, with 90% of smokers aged 45 to 64 saying they would not smoke if they could start over.

Researchers say that sense of regret may come with age because many of the smoking-related health problems such as emphysema begin to surface later in life.

The national survey of 893 smokers also revealed that most smokers aren't realistic when it comes to thinking about quitting. Nearly 60% said they planned to quit within two years, but recent history shows only about 6% actually manage to do so.

Young smokers were especially optimistic about quitting. Eighty percent of smokers under the age of 40 said they believed they would stop smoking within 20 years. On average, they thought they would quit within 2 years.

But those hopes may not be realistic, judging from previous research. In 1998, 65% of people that had ever been a smoker were still smoking at age 40 and 45% at age 60.

The survey is published in this week's British Medical Journal.

How common is it?

  • SMOKING has been identified as the single most preventable cause of death and disease in the United States.
  • Approximately 50 million Americans smoke
  • There are over 1.1 billion smokers worldwide!
  • They consume about 540 billion cigarettes each year
  • 1.1 trillion cigarettes are smoked every year worldwide!
  • Approximately 400,000 people die each year in the U.S. from smoking-related causes.
  • About 3 million people die worldwide each year, with about one-third of them in developing countries.
  • Tobacco use rings up $50 billion each year in health care costs in the U.S.!
  • Cigarettes currently cause approximately 20% of all deaths in U.S.

By Age

  • In General the earlier someone starts smoking, the less likely that he/she will quit
  • Smoking among high schoolers is increasing with more whites than blacks picking up the habit among juveniles
  • 23.4% of people between 18 and 24 years of age smoke
  • 25.9% of people between 25 and 44 years of age- the highest over all
  • 23.4% of people 65 years or older smoke

For Teenagers

  • Out of all the people who smoke, 80% started before the age of 21. This means that, you are more likely to start smoking as a teeenager than at any other age.
  • Smoking in the teenage population starts usually around grade 6 and almost about 75% of teenagers who smoke now started around grade 9, according to a study done in 1986.
  • Those teenagers who started smoking are at a much higher risk for drug abuse including cocaine and marijuana, than those who didn't start smoking.

By Sex

For Men

  • If you are over 35 and smoke, you are 10 TIMES MORE likely to get Chronic Obstructive Pulmonary Disease (COPD) and 22 TIMES MORE likely to die from Lung Cancer than those who do not smoke.
  • Smoking is on the rise in young men, unfortunately.
  • Men (23.9%) smoke more than women (21%)

For Women

  • Deaths due to Lung Cancer have become higher than Breast Cancer since 1987.
  • If you are 35 or over and smoke, you are 10.5 TIME MORE likely to get Emphysema or Chronic Bronchitis than nonsmoking females
  • Those females who are starting to smoke are doing so at an earlier age than before.
  • Babies are more likely to have birth complications if born to a woman who smoked during pregnancy than those who didn't.
  • The number of women who smoke is increasing in many countries.

By Race

Blacks over 18 years of age have the highest amount of smokers

  • Whites 22.9%
  • Blacks 25.1%
  • Hispanic 21.2%
  • Asian 14.4%

By Education

  • People with less formal education tend to smoke more
  • Less than 12 years 29.1%
  • More than 12 years 18%

By Location

  • Nevada has the highest number of adult smokers (30.3%)
  • Utah has the lowest number of adult smokers (15.1%)
  • States with the highest cigarette taxes, such as Washington State, Washington D.C., Hawaii, Arizona, Massachusetts Connecticut and Minnesota, have lower rates of adult smokers!
  • States with the lowest cigarette taxes, such as Virginia, Kentucky, N. Carolina, S. Carolina, Wyoming, Tennessee, Indiana and W. Virginia, have higher rates of adult smokers!
  • In developed countries, 41% of men and 21% of women regularly smoke cigarettes.
  • In developing countries, 50% of men smoke, and 8% of women.

SOURCE: The Ashtray: Smoking and Tobacco Abuse

Fighting Smoke With Smoke

No-Nicotine Cigarettes -- Quitting Tool or Trap for Fools?
By Daniel DeNoon

Coming soon to a store near you: nicotine-free cigarettes. Smoking them is supposed to help you quit smoking.

This isn't the first time that the tobacco industry has come up with this idea. The soon-to-be-renamed Philip Morris Co. Inc. couldn't sell cigarettes made from tobacco treated to remove nicotine. Vector Tobacco Inc. recently began selling the "reduced carcinogen" Omni cigarettes. Now Vector has a new almost-no-nicotine product made from genetically engineered tobacco plants. It's slated for release some time this year.

Why would anybody smoke this high-tar, no-nicotine product -- even if, as advertised, they taste like full-nicotine cigarettes? The idea is that these "no-nics" might satisfy the urge to smoke while at the same time weaning a person from nicotine. Can it work?

That depends on whom you ask. So far, the only researcher to look at how the new tobacco product might help people quit smoking is Jed E. Rose, PhD, a neuroscientist at
Duke University in Durham, N.C. Rose has some pretty good credentials -- he's the inventor of the nicotine patch.

"I think it is a very seriously promising approach that needs to be explored," Rose tells WebMD. "A lot of people jump to conclusions based on the presumed motives of the tobacco companies. Whether it works is a scientific issue, not a political one. There is widespread acceptance of the theory that people smoke because they are dependent on nicotine. So if you remove nicotine, it might possibly be a step toward quitting. It needs to be tested and it may or may not work."

Other observers are far less impressed with the idea. One of them is Jeff Wigand, PhD, the former cigarette company executive who blew the whistle on his former employers.

"The way to help smokers to quit is to help them get over their nicotine addiction -- and this is best done with help from people who have the person's heath as their first interest, not a tobacco company," Wigand tells WebMD. "When has a single tobacco company got into the smoking-cessation business? Now we are going to give out cigarettes as a quitting strategy? If smokers need something to hold in their hands, give them a pencil."

Randolph D. Smoak Jr., MD, immediate past president of the American Medical Association, says nicotine-free and reduced-carcinogen cigarettes are just marketing gimmicks.

"A cigarette is nothing but a delivery device for premature death," Smoak says. "No matter how you dress it up or dress it down, it is the same product. If you take away the nicotine, then people are not going to smoke it, because they do not get the nicotine kick. If people are still smoking cigarettes without nicotine -- if they will -- they still are exposed to the carcinogens. To say we will take away the addictive portion is no salvation. To diminish the nicotine is just a false sense of security and hope for people who are addicted and are exposed to carcinogens."

In a study being presented to the
Feb. 20-23, 2002, annual meeting of the Society for Research on Nicotine in Tobacco, Rose looked at what happens when smokers use no-nic cigarettes.

Smokers who use low-tar, low-nicotine cigarettes puff harder to get a satisfactory smoke. But Rose found that these same smokers take normal puffs of high-tar, no-nicotine cigarettes. And the no-nics satisfied smokers' craving for cigarettes -- although it didn't keep them from getting the bad mood that's part of nicotine withdrawal.

Rose says that cigarettes give a smoker a quick nicotine "spike." This acts as a reward and makes a smoker want another cigarette. Rose says that no-nic cigarettes don't have that reward -- so smoking them might eventually break the vicious smoking-reward circle.

"Whether those internal cues to keep smoking extinguish over time, that is the big unknown," Rose says. "If it turns out to be a period of weeks, that would be great. If it took years [of smoking no-nic cigarettes], it would not be so great. We just don't know the answer to that question yet."

Rose's study was partially funded by an unrestricted gift to
Duke University by Vector. Rose says he's free to use the funds any way he likes, has no limits on what he's able to say about the work, and has no financial interest in Vector.

'Light' Cigarettes - Not Better
Smoking "light" cigarettes may seem like a healthier alternative to regular cigarettes, but according to a recent US government report, it's not. "Low-tar" and "light" are descriptions that cigarette companies are allowed to advertise if the level of nicotine and other toxic chemicals are below certain government standards. The study reports that death rates for smokers who smoked "light" cigarettes were similar to those who smoked regular cigarettes. Reason: researchers believe that "light" cigarette smokers may take extra and deeper puffs, thereby inhaling the same amount of nicotine and tar as found in regular cigarettes. So what is the best type of cigarette to smoke? No cigarette!

The Facts in General

  • About 400,000 Americans die every year because of health problems due to smoking
  • 1 out of every 6 deaths each year are due to smoking.
  • Every year, 1.5 million people quit smoking but 50 MILLION KEEP ON GOING!!
  • Tobacco companies spend $5,000 every minute to advertise their products
  • Smoking has caused the health care costs to rise dramatically to $65 billion per year.
  • Smoking CAUSES Emphysema, Lung Cancer, and Chronic Bronchitis

Warning Labels

OTTAWA, Canada (CNN) -- Graphic warning labels on cigarette packages in Canada have been effective in discouraging smoking, according to a study by the Canadian Cancer Society.

Fifty-eight percent of smokers interviewed in the study said full-color pictures of how cancer affects the mouth, lungs, heart and brain had made them think more about the health effects of smoking.

The warnings were so effective that 44 percent of the smokers polled said the new warnings increased their motivation to quit smoking. And 38 percent of smokers who attempted to quit in 2001 said the new warnings were a factor in motivating them to try to quit.

The full-color, picture-based warnings cover half of the front and back of each package of cigarettes. They include pictures of a diseased mouth, a lung tumor, a brain after a stroke, a damaged heart, and a limp cigarette that warns of impotence. Warnings inside each package offer tips on quitting.

The warnings were launched about a year ago and replaced black-and-white text messages that covered about 35 percent of each package, similar to cigarette package warnings in the United States.

The study also found that:

-- 43 percent of smokers and 40 percent of nonsmokers said they are more concerned about the health effects of smoking because of the new warnings;

-- 21 percent of smokers said they have been tempted on one or more occasions to have a cigarette but decided not to because of the new warnings;

-- 27 percent of smokers said they smoke less inside their home because of the new warnings;

-- 35 percent of smokers and 34 percent of nonsmokers said they know more about the health effects of smoking than they did before the new warnings;

-- 48 percent of nonsmokers said the new warnings made them feel better about being a nonsmoker;

--17 percent of smokers said they have put their cigarette pack away at least once because they did not want others to see the warning, and 24 percent of smokers said they have at least once put a cardboard sleeve over their pack or transferred cigarettes to another container;

--18 percent of smokers said they have on at least one occasion asked for a different package of cigarettes when purchasing them because they did not like the warning on the package first offered.

In addition, smokers and nonsmokers identified the warning depicting a diseased mouth and the picture of a lung tumor as most effective at discouraging smoking.

The health warnings on cigarette packages are required under the Tobacco Products Information Regulations. The rules, which set a precedent at the time, were adopted under the Tobacco Act that the Canadian Parliament passed in 1997.

In January 2000, similar bills were proposed in the United States. However, the leading advocate, U.S. Sen. Frank Lautenberg, D-New Jersey, retired, and the proposal has not come before Congress under the Bush administration.

However, Reps. James V. Hansen, R-Utah, and Marty Meehan D-Massachusetts said Wednesday that they will introduce legislation to require larger, picture-based health warnings on U.S. tobacco products following the release of the Canadian study.

According to the Canadian Cancer Society, Brazil will require picture-based warnings as of January 31, and a European Community directive gives member countries the option of using pictures. The World Health Organization is examining picture-based warnings as a possible worldwide requirement through an international treaty.

The study, in which 2,000 Canadian adults were interviewed -- 633 of them smokers -- was funded by the Institute of Cancer Research of the Canadian Institutes of Health Research.

Is smokeless tobacco safer than cigarettes?


It's true that many people think smokeless tobacco (also known as chewing or spit tobacco, or snuff) isn't as bad as cigarettes. One study quoted in the Surgeon General's Report (SGR) said that 77 percent of kids thought cigarette smoking was very harmful, but only 40 percent thought smokeless tobacco was very harmful. Very wrong! The truth is that smokeless tobacco use is connected with all sorts of problems.


Smokeless tobacco can cause bleeding gums and sores of the mouth that never heal. Eventually you might end up with cancer.


Tobacco is tobacco: it all contains nicotine, and nicotine is addictive!


It stains your teeth a yellowish-brown color. It gives you bad breath. It can make you dizzy, give you the hiccups, even make you throw up. (Definitely NOT cool!)

Finally, one more fact to chew on -- according to the SGR, kids who use smokeless tobacco are more likely to start using cigarettes, too. That's a double whammy that no healthy body can survive! So spit it out; say no to smokeless tobacco.

Cigarettes and the Digestive System

Cigarette smoking causes a variety of life-threatening diseases, including lung cancer, emphysema, and heart disease. An estimated 400,000 deaths each year are caused directly by cigarette smoking. Smoking is responsible for changes in all parts of the body, including the digestive system. This fact can have serious consequences because it is the digestive system that converts foods into the nutrients the body needs to live.

Current estimates indicate that about one-third of all adults smoke. And, while adult men seem to be smoking less, women and teenagers of both sexes seem to be smoking more. How does smoking affect the digestive system of all these people?

Harmful Effects

Smoking has been shown to have harmful effects on all parts of the digestive system, contributing to such common disorders as heartburn and peptic ulcers. It also increases the risk of Crohn's disease and possibly gallstones. Smoking seems to affect the liver, too, by changing the way it handles drugs and alcohol. In fact, there seems to be enough evidence to stop smoking solely on the basis of digestive distress.


Heartburn is common among Americans. More than 60 million Americans have heartburn at least once a month, and about 15 million have it daily.
Heartburn happens when acidic juices from the stomach splash into the esophagus. Normally, a muscular valve at the lower end of the esophagus, the lower esophageal sphincter (LES), keeps the acid solution in the stomach and out of the esophagus. Smoking decreases the strength of the esophageal valve, thereby allowing stomach juice to reflux, or flow backward into the esophagus. Smoking also seems to promote the movement of bile salts from the intestine to the stomach, which makes the stomach juice more harmful. Finally, smoking may directly injure the esophagus, making it less able to resist further damage from refluxed material.


Ulcer A peptic ulcer is an open sore in the lining of the stomach or duodenum, the first part of the small intestine. The exact cause of ulcers is not known. A relationship between smoking cigarettes and ulcers, especially duodenal ulcers, does exist. The 1989 Surgeon General's report stated that ulcers are more likely to occur, less likely to heal, and more likely to cause death in smokers than in nonsmokers.
Why is this so? Doctors are not really sure, but smoking does seem to be one of several factors that work together to promote the formation of ulcers.

For example, some research suggests that smoking might increase a person's risk of infection with the bacterium Helicobacter pylori (H. pylori). Most peptic ulcers are caused by this bacterium.

Stomach acid is also important in producing ulcers. Normally, most of this acid is buffered by the food we eat. Most of the unbuffered acid that enters the duodenum is quickly neutralized by sodium bicarbonate, a naturally occurring alkali produced by the pancreas. Some studies show that smoking reduces the bicarbonate produced by the pancreas, interfering with the neutralization of acid in the duodenum. Other studies suggest that chronic cigarette smoking may increase the amount of acid secreted by the stomach.

Whatever causes the link between smoking and ulcers, two points have been repeatedly demonstrated: People who smoke are more likely to develop an ulcer, especially a duodenal ulcer, and ulcers are less likely to heal quickly among smokers in response to otherwise effective treatment. This research tracing the relationship between smoking and ulcers strongly suggests that a person with an ulcer should stop smoking.

Liver Disease

The liver is an important organ that has many tasks. Among other things, the liver is responsible for processing drugs, alcohol, and other toxins to remove them from the body. There is evidence that smoking alters the ability of the liver to handle these substances. In some cases, this may influence the dose of medication necessary to treat an illness. Some research also suggests that smoking can aggravate the course of liver disease caused by excessive alcohol intake.

Crohn's Disease Crohn's disease causes inflammation deep in the lining of the intestine. The disease, which causes pain and diarrhea, usually affects the small intestine, but it can occur anywhere in the digestive tract. Research shows that current and former smokers have a higher risk of developing Crohn's disease than nonsmokers do. Among people with the disease, smoking is associated with a higher rate of relapse, repeat surgery, and immunosuppressive treatment. In all areas, the risk for women, whether current or former smokers, is slightly higher than for men. Why smoking increases the risk of Crohn's disease is unknown, but some theories suggest that smoking might lower the intestine's defenses, decrease blood flow to the intestines, or cause immune system changes that result in inflammation.
Gallstones Several studies suggest that smoking may increase the risk of developing gallstones and that the risk may be higher for women. However, research results on this topic are not consistent, and more study is needed.

Can the Damage be Reversed?

Some of the effects of smoking on the digestive system appear to be of short duration. For example, the effect of smoking on bicarbonate production by the pancreas does not appear to last. Within a half-hour after smoking, the production of bicarbonate returns to normal. The effects of smoking on how the liver handles drugs also disappear when a person stops smoking. However, people who no longer smoke still remain at risk for Crohn's disease. Clearly, this question needs more study.

Tobacco related diseases claim approximately 419,000 American lives each year.

Some of the adverse health effects include:

  • Cigarettes contain at least 43 individual cancer-causing chemicals and smoking is directly responsible for almost 90% of all lung cancers.
  • Smoking causes most of the cases of emphysema and chronic bronchitis.
  • Smoking during pregnancy accounts for 20 - 30% of low birthweight infants and up to 14% of preterm births. Approximately 10% of all infant deaths are attributable to smoking.
  • Apparently healthy, full-term infants of smokers have been found to be born with narrowed airways and impaired lung function.
  • Smoking by parents (second hand smoke) is associated with adverse effects in their children such as exacerbations of asthma, increased upper respiratory infections (colds, ear infections, etc.) and SIDS (sudden infant death syndrome). Children under 18 months of age are very susceptible to secondhand smoke causing lower respiratory tract infections.
  • Secondhand smoke is responsible for 3,000 lung cancer deaths annually in U.S. nonsmokers.
  • Nicotine is a very addictive substance. It reaches the brain faster than drugs that are used intravenously. Users of nicotine become physically, as well as, psychologically addicted. Because nicotine is used socially, this makes it an even more difficult habit to break.

Questions and Answers About Cigar Smoking and Cancer

What are the health risks associated with cigar smoking?

Scientific evidence has shown that cancers of the oral cavity (lip, tongue, mouth, and throat), larynx, lung, and esophagus are associated with cigar smoking. Furthermore, evidence strongly suggests a link between cigar smoking and cancer of the pancreas. In addition, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart and lung disease.

Like cigarette smoking, the risks from cigar smoking increase with increased exposure. For example, compared with someone who has never smoked, smoking only one to two cigars per day doubles the risk for oral and esophageal cancers. Smoking three to four cigars daily can increase the risk of oral cancers to more than eight times the risk for a nonsmoker, while the chance of esophageal cancer is increased to four times the risk for someone who has never smoked. Both cigar and cigarette smokers have similar levels of risk for oral, throat, and esophageal cancers.

The health risks associated with occasional cigar smoking (less than daily) are not known. About three-quarters of cigar smokers are occasional smokers.

What is the effect of inhalation on disease risk?

One of the major differences between cigar and cigarette smoking is the degree of inhalation. Almost all cigarette smokers report inhaling while the majority of cigar smokers do not because cigar smoke is generally more irritating. However, cigar smokers who have a history of cigarette smoking are more likely to inhale cigar smoke. Cigar smokers experience higher rates of lung cancer, coronary heart disease, and chronic obstructive lung disease than nonsmokers, but not as high as the rates for cigarette smokers. These lower rates for cigar smokers are probably related to reduced inhalation.

How are cigars and cigarettes different?

Cigars and cigarettes differ in both size and the type of tobacco used. Cigarettes are generally more uniform in size and contain less than 1 gram of tobacco each. Cigars, on the other hand, can vary in size and shape and can measure more than 7 inches in length. Large cigars typically contain between 5 and 17 grams of tobacco. It is not unusual for some premium cigars to contain the tobacco equivalent of an entire pack of cigarettes. U.S. cigarettes are made from different blends of tobaccos, whereas most cigars are composed primarily of a single type of tobacco (air-cured or dried burley tobacco). Large cigars can take between 1 and 2 hours to smoke, whereas most cigarettes on the U.S. market take less than 10 minutes to smoke.

How are the health risks associated with cigar smoking different from those associated with smoking cigarettes?

Health risks associated with both cigars and cigarettes are strongly linked to the degree of smoke exposure. Since smoke from cigars and cigarettes are composed of many of the same toxic and carcinogenic (cancer causing) compounds, the differences in health risks appear to be related to differences in daily use and level of inhalation.

Most cigarette smokers smoke every day and inhale. In contrast, as many as three-quarters of cigar smokers smoke only occasionally, and the majority do not inhale.

All cigar and cigarette smokers, whether or not they inhale, directly expose the lips, mouth, tongue, throat, and larynx to smoke and its carcinogens. Holding an unlit cigar between the lips also exposes these areas to carcinogens. In addition, when saliva containing smoke constituents is swallowed, the esophagus is exposed to carcinogens. These exposures probably account for the fact that oral and esophageal cancer risks are similar among cigar smokers and cigarette smokers.

Cancer of the larynx occurs at lower rates among cigar smokers who do not inhale than among cigarette smokers. Lung cancer risk among daily cigar smokers who do not inhale is double that of nonsmokers, but significantly less than the risk for cigarette smokers. However, the lung cancer risk from moderately inhaling smoke from five cigars a day is comparable to the risk from smoking up to one pack of cigarettes a day.

What are the hazards for nonsmokers exposed to cigar smoke?

Environmental tobacco smoke (ETS), also known as secondhand or passive smoke, is the smoke released from a lit cigar or cigarette. The ETS from cigars and cigarettes contains many of the same toxins and irritants (such as carbon monoxide, nicotine, hydrogen cyanide, and ammonia), as well as a number of known carcinogens (such as benzene, nitrosamines, vinyl chloride, arsenic, and hydrocarbons). Because cigars contain greater amounts of tobacco than cigarettes, they produce greater amounts of ETS.

There are, however, some differences between cigar and cigarette smoke due to the different ways cigars and cigarettes are made. Cigars go through a long aging and fermentation process. During the fermentation process, high concentrations of carcinogenic compounds are produced. These compounds are released when a cigar is smoked. Also, cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than cigarette tobacco. As a result, compared with cigarette smoke, the concentrations of toxins and irritants are higher in cigar smoke.

In addition, the larger size of most cigars (more tobacco) and longer smoking time produces higher exposures to nonsmokers of many toxic compounds (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances) than a cigarette. For example, measurements of the carbon monoxide (CO) concentration at a cigar party and a cigar banquet in a restaurant showed indoor CO levels comparable to those measured on a crowded California freeway. Such exposures could place nonsmoking workers attending such events at significantly increased risk for cancer as well as heart and lung diseases.

Are cigars addictive?

Nicotine is the agent in tobacco that is capable of causing addiction or dependence. Cigarettes have an average total nicotine content of about 8.4 milligrams, while many popular brands of cigars will contain between 100 and 200 milligrams, or as many as 444 milligrams of nicotine.

As with cigarette smoking, when cigar smokers inhale, nicotine is absorbed rapidly. However, because of the composition of cigar smoke and the tendency of cigar smokers not to inhale, the nicotine is absorbed predominantly through the lining of the mouth rather than in the lung. It is important to note that nicotine absorbed through the lining of the mouth is capable of forming a powerful addiction, as demonstrated by the large number of people addicted to smokeless tobacco. Both inhaled and noninhaled nicotine can be addictive. The infrequent use by the average cigar smoker, low number of cigars smoked per day, and lower rates of inhalation compared with cigarette smokers have led some to suggest that cigar smokers may be less likely to be dependent than cigarette smokers.

Addiction studies of cigarettes and spit tobacco show that addiction to nicotine occurs almost exclusively during adolescence and young adulthood when young people begin using these tobacco products. Also, several studies raise the concern that use of cigars may predispose individuals to the use of cigarettes. A recent survey showed that the relapse rate of former cigarette smokers who smoked cigars was twice as great as the relapse rate of former cigarette smokers who did not smoke cigars. The study also observed that cigar smokers were more than twice as likely to take up cigarette smoking for the first time than people who never smoked cigars.

What are the benefits of quitting?

There are many health benefits to quitting cigar smoking. The likelihood of developing cancer decreases. Also, when someone quits, an improvement in health is seen almost immediately. For example, blood pressure, pulse rate, and breathing patterns start returning to normal soon after quitting. People who quit will also see an improvement in their overall quality of life. People who decide to quit have many options available to them. Some people choose to quit all at once. Other options gaining popularity in this country are nicotine replacement products, such as patches, gum, and nasal sprays. If considering quitting, ask your doctor to recommend a plan that could best suit you and your lifestyle.

What are the current trends in cigar smoking?

Although cigar smoking occurs primarily among males between the ages of 35 and 64 who have higher educational backgrounds and incomes, recent studies suggest new trends. Most new cigar users today are teenagers and young adult males (ages 18 to 24) who smoke occasionally (less than daily). According to two large statewide studies conducted among California adults in 1990 and 1996, cigar use has increased nearly five times among women and appears to be increasing among adolescent females as well. Furthermore, a number of studies have reported high rates of use among not only teens but preteens. Cigar use among older males (age 65 and older), however, has continued to decline since 1992.

How are current trends in cigar smoking different from past decades?

Total cigar consumption declined by about 66 percent from 1973 until 1993. Cigar use has increased more than 50 percent since 1993. The increase in cigar use in the early 1990s coincided with an increase in promotional media activities for cigars.

What additional information is available about the effects of cigar smoking?

The 1998 NCI monograph Cigars: Health Effects and Trends can be ordered from the Cancer Information Service (see below). U.S. residents can order the monograph online at on the Internet. (The monograph can also be viewed and downloaded from this Web site.)

Additional information on the health effects of tobacco is available from the CDC's Tobacco Information and Prevention Source (TIPS) at on the Internet. This program collects and distributes reports and news about tobacco, lists services available for people trying to quit using tobacco products, and produces publications about tobacco and the dangers of its use.

Antidepressants Help Smokers' Hearts

Some antidepressants may do double duty for people who smoke. A study published in the American Heart Association journal Circulation finds that selective serotonin reuptake inhibitors may significantly cut smokers' risk for heart attacks. Researchers from the University of Pennsylvania looked at looked at 3,643 smokers in the Philadelphia area over a two-year period. The subjects were ages 30 to 65. Those who were taking SSRIs including Prozac, Zoloft, Paxil or Luvox had a 65 percent lower risk of having a heart attack compared to the smokers who weren't taking SSRIs, The Associated Press reports. The researchers theorize that SSRIs might act as blood thinners and reduce formation of heart attack-causing blood clots, the AP says. They say the lower risk could also come simply from treating the symptoms of depression -- a condition that is a known risk factor for heart attacks. They say more study is needed to see whether SSRIs help protect non-smokers from heart attacks.

Why Do Smokers Fail to Quit?

Although over a quarter of American adults continue to smoke, about 70% of them want to quit. Unfortunately, in one study of women smokers who said they wanted to stop smoking, 80% of them were unable to. Withdrawal is a difficult process. Even after years of not smoking, about 20% of ex-smokers still have occasional cravings for cigarettes. People who keep trying, however, have a fifty-fifty chance of finally quitting. In any case, the attempts to quit are never a waste of time, since the amount of smoking is reduced during these periods. The smoker is up against an army of obstacles to quitting.

Individual Risk Factors for Failure

Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:

  • Being female
  • Being a heavy smoker
  • Inhaling deeply
  • Being a long term smoker
  • Severe withdrawal symptoms

Among many studies, however, only one found a single consistent factor for failure to quit:

Cheating during the first two weeks of withdrawal, even with the patch, nearly guarantees smoking again in six months. (In one study, nearly half of the people who did not cheat during the first two weeks were still not smoking after six months.)
Addictive Aspects of Nicotine

Nicotine is a psychoactive drug, and some researchers feel it is as addictive as heroin. In fact, nicotine has actions similar to cocaine and heroin in the same area of the brain.

Depending on the amount taken in, nicotine can act as either a stimulant or a sedative. Cigarette smoking (either the nicotine or the oral process of smoking itself) has definite immediate positive effects:

  • It relieves minor depression.
  • It helps suppress little fits of anger.
  • It enhances concentration and short-term memory.
  • It produces a modest sense of well-being.

The addictive process of smoking has a specific daily cycle:

Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Nicotine, particularly taken in first few cigarettes of the day, increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations, a feeling similar to achieving a reward.

During the day, however, the nerve cells become desensitized to nicotine; smoking becomes less pleasurable, and smokers may be likely to increase their intake to get their "reward." A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.
Withdrawal in the First Two Weeks

Because the first two weeks are so critical in determining quitting failure rates, smokers should not be shy about seeking all the help they can during this period.

Withdrawal symptoms begin as soon as four hours after the last cigarette, generally peak in intensity at three to five days, and disappear after two weeks. They include both physical and mental symptoms.

Physical Symptoms. During the quitting process people should consider the following physical symptoms of withdrawal as they were recuperating from a disease and treat them accordingly as they would any physical symptoms:

  • Tingling in the hands and feet
  • Sweating
  • Intestinal disorders (cramps, nausea)
  • Headache
  • Cold symptoms as the lungs begin to clear (sore throats, coughing, and other signs of colds and respiratory problem)
  • Mental and Emotional Symptoms.

Tension and craving build up during periods of withdrawal, sometimes to a nearly intolerable point. One European study found that the incidence of workplace accidents increases on No Smoking Day, a day in which up to 2 million smokers either reduce the amount they smoke or abstain altogether.

Nearly every moderate to heavy smoker experiences more than one of the following strong emotional and mental responses to withdrawal.

  • Feelings of being an infant: temper tantrums, intense needs, feelings of dependency, a state of near paralysis.
  • Insomnia
  • Mental confusion
  • Vagueness
  • Irritability
  • Anxiety
  • Depression is common in the short and long term. In the short term it may mimic the feelings of grief felt when a loved one is lost. As foolish as it sounds, a smoker should plan on a period of actual mourning in order to get through the early withdrawal depression.
  • Long-Term Depression

There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of triggering depression when they quit smoking. And, depressed smokers have a very low level of success; only about 6% remain smoke-free after a year. There are strong reasons for this:

Smoking may be masking major depression, which can become severe even after the early stages of withdrawal have passed.
For some smokers, the future physical damage incurred by smoking is an abstraction, which fails to motivate quitting when measured up against the very real emotional pain triggered by nicotine withdrawal.

Not only does the smoker suffer, but the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.

People who suffer from depression associated with quitting might do better using a combination of emotionally supportive therapy (as opposed to behavioral therapy), nicotine replacements, and temporary use of antidepressants, such as bupropion (Zyban). If severe depression lasts beyond withdrawal, professional help should be sought as soon as possible.

Advertising as Reinforcement

Advertising reinforces the addiction by presenting smokers as ideal adults, people who have outgoing cheerful attitudes, are able to work and play exuberantly, are often risk-takers, and enjoy the present moment. This insidious message is doubly attractive to a smoker who is trying to quit; the withdrawal state puts one in an emotionally infantile state. The ads remind the smoker that, with the purchase of a pack of cigarettes, it's very easy to become a grown-up again. (And, even worse, these same ads are telling children that smoking is a short cut to adulthood.)

Weight Gain

The emphasis on weight loss in our society has given many people an excuse to start or continue smoking.

Effects of Smoking on Calories. Smoking does indeed use up calories, about 200 a day according to one study. A 1999 study reported that smoking increases energy expenditure in men by 3.6% at rest and by 6.3% during physical activity. (Actually, the higher level during exercise was only because the men inhaled more deeply during that time.)

Reasons for Weight Gain after Quitting. Quitting can add five or more pounds, due to the following reasons:

  • Obviously, the body is working better. After quitting, the body's metabolism slows down, and food is digested more efficiently.
  • Insulin levels increase, enabling the body to process more sugar for energy.
  • People snack as an oral substitution.
  • Long-Term Effects of Abstinence on Weight. One 1998 study reported that people who quit smoking put on more weight than expected, and although they gained most of the weight in the first year, they kept adding weight over a period of five years. This contradicts other studies that ex-smokers lost their extra weight over a year or two and that the longer they abstained from smoking the more weight they lost. Indeed, an encouraging 1999 study reported that weight gain tends to peak between two and four years after quitting and then declines to the same rate as those who never smoked.

Keeping the Weight Off. It should be noted that to use up the 200 calories gained from quitting smoking, one need only take an extra 15-minute daily walk and eliminate 100 calories a day from meals. Even a moderate increase in physical activity among middle-aged women who have quit smoking can help keep weight gain to a minimum. (Using Zyban also appears to help protect against weight gain.)


Development of major depression after treatment for smoking cessation. Am J Psychiatry. 2000 Mar;157(3):368-74.


Well-Connected reports are written and updated by experienced medical writers and reviewed and edited by the in-house editors and a board of physicians, including faculty at Harvard Medical School and Massachusetts General Hospital. The reports are distinguished from other information sources available to patients and health care consumers by their quality, detail of information, and currency. These reports are not intended as a substitute for medical professional help or advice but are to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition.

This report may not be copied, displayed on Internet web sites, or otherwise distributed without the express permission of the

'Light' Cigarettes Burned by Tobacco Control Advocates

No Evidence to Indicate the Risk Is Lower

By Sean Martin
WebMD Washington Correspondent

Reviewed by Dr. Jacqueline Brooks

"Light" or "mild" cigarettes provide little real health benefits over regular brands, tobacco control advocates maintained Monday at the 11th World Conference on Tobacco OR Health.

"Low-yield" brands with reduced nicotine and tar levels have grown in popularity since the late 1960s to take up about two-thirds of the U.S. cigarette market. This growth has been spurred by increasing health concerns over cigarettes. But anti-tobacco leaders worry that these brands give smokers a false impression of being less harmful.

William Farone, an industry "whistleblower" as former director of applied research at Philip Morris, tells WebMD, "I don't think people generally understand that smoking a low-cigarette isn't safer."

In a presentation Monday, David Burns, MD, of the University of California at San Diego School of Medicine, said, "The evidence does not suggest that a meaningful reduction in risk has been produced by shifting to low-yield cigarettes."

Gregory Connolly, director of the Massachusetts Tobacco Control Program, tells WebMD, "The evidence would show, in fact, that they are as harmful as conventional cigarettes." According to Ann McNeill, PhD, a public health consultant, low-yield cigarettes have brought "little, if any, benefit" to public health and possible health harm to the degree that they have kept smokers from quitting altogether.

Lung cancer is still the leading cancer among U.S. men, and in 1987 it began outpacing breast cancer among American women.

Farone noted that internal documents have revealed that the tobacco industry has long been aware that people who smoke lighter cigarettes often compensate for lower nicotine levels by smoking more cigarettes. In addition, he said, these smokers might draw smoke more deeply into their lungs, triggering different types of lung cancer.

According to Farone, a lighter cigarette "still has all the [cancer-causing agents], and maybe even more." Regardless of its nicotine and tar levels, tobacco smoke contains carbon monoxide and cancer-causing nitrosamines. Moreover, tobacco firms use a large list of additives in cigarettes that have unknown health effects.

European Union health ministers have approved guidelines that outlaw brands being marketed as light or mild. Peter Boyle, a researcher from Italy's European Institute of Oncology, reported results that found a ninefold difference among 29 countries in nitrosamine levels in cigarettes. He and many other tobacco control advocates believe that cigarettes should be regulated for levels of the cancer-causing compound.

That may be a long time coming in the U.S., where cigarettes and their component ingredients are not strictly controlled, and the Supreme Court ruled earlier this year that the FDA lacks the authority to regulate cigarettes.

Clifford Douglas, a tobacco control consultant, tells WebMD, "That [government] oversight is essential. Otherwise, we've got an industry self-regulating under a very imperfect system of public pressure and individual states." Congress may take action next year to regulate tobacco in some way, but the tobacco industry holds impressive clout with many lawmakers.

Meanwhile, Connolly is trying to get Massachusetts to set state regulatory standards for cigarettes based on their toxicity and addictiveness.

He tells WebMD, "If Jesse Helms wants kids smoking Marlboro Light 100s in North Carolina, that's fine with us." He notes that before his state can act, however, "We still have four active lawsuits against us."

As for the industry, RJ Reynolds is test-marketing the Eclipse cigarette, which heats tobacco rather than burns it and may reduce some of a cigarette's toxicity.

Tobacco industry representatives have not been invited to this meeting, but organizers said that they were free to register and have attended past meetings.


(A consumer guide from the U.S. Department of Health and Human Services Public Health Services)


If you have tried to quit smoking, you know how hard it can be. It is hard because nicotine is a very addictive drug. For some people, it can be as addictive as heroin or cocaine.

Quitting is hard. Usually people make 2 or 3 tries, or more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts.


This booklet tells about ways you can get help to quit smoking. It explains the best ways for you to quit, and quit for good. All the information in this booklet is based on scientific research about what will give you the best chances of quitting. The booklet also lists names and addresses of organizations that can offer help and more information.



Quitting smoking is one of the most important things you will ever do:

You will live longer and live better. Quitting will lower your chance of having a heart attack, stroke, or cancer. If you are pregnant, quitting smoking will improve your chances of having a healthy baby. The people you live with, especially your children, will be healthier. You will have extra money to spend on things other than cigarettes.


Studies have shown that these five steps will help you quit and quit

for good. You have the best chances of quitting if you use them

1. Get ready.

2. Get support.

3. Learn new skills and behaviors.

4. Get medication and use it correctly.

5. Be prepared for relapse or difficult situations.


Set a quit date.
Change your environment.
— Get rid of ALL cigarettes and ashtrays in your home, car, and place of work.
— Don’t let people smoke in your home.
Review your past attempts to quit. Think about what worked and what did not.
Once you quit, don’t smoke—NOT EVEN A PUFF!


Studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:

Tell your family, friends, and coworkers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.
Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).
Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area.


Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task.
When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place.
Do something to reduce your stress. Take a hot bath, exercise, or read a book.
Plan something enjoyable to do every day.
Drink a lot of water and other fluids.


Medications can help you stop smoking and lessen the urge to smoke.

The U.S. Food and Drug Administration (FDA) has approved five medications to help you quit smoking:
— Bupropion SR - available by prescription
— Nicotine gum - available over-the-counter
— Nicotine inhaler - available by prescription
— Nicotine nasal spray - available by prescription

Nicotine patch - available by prescription and over-the-counter
Ask your health care provider for advice and carefully read the information on the package.
All of these medications will more or less double your chances of quitting and quitting for good.
Everyone who is trying to quit may benefit from using a medication. If you are pregnant or trying to become pregnant, nursing, under age 18, smoking fewer than 10 cigarettes per day, or have a medical condition, talk to your doctor or other health care provider before taking medications.


Most relapses occur within the first 3 months after quitting. Don’t be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for.

Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
Other smokers. Being around smoking can make you want to smoke.
Weight gain. Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don’t let weight gain distract you from your main goal—quitting smoking. Some quit-smoking medications may help delay weight gain.
Bad mood or depression. There are a lot of ways to improve your mood other than smoking.

If you are having problems with any of these situations, talk to your doctor or other health care provider.


Studies suggest that everyone can quit smoking. Your situation or condition can give you a special reason to quit.

Pregnant women/new mothers: By quitting, you protect your baby’s health and your own.
Hospitalized patients: By quitting, you reduce health problems and help healing.
Heart attack patients: By quitting, you reduce your risk of a second heart attack.
Lung, head, and neck cancer patients: By quitting, you reduce your chance of a second cancer.
Parents of children and adolescents: By quitting, you protect your children and adolescents from illnesses caused by second-hand smoke.


Think about the following questions before you try to stop smoking. You may want to talk about your answers with your health care provider.

Why do you want to quit?
When you tried to quit in the past, what helped and what didn’t?
What will be the most difficult situations for you after you quit? How will you plan to handle them?
Who can help you through the tough times? Your family? Friends? Health care provider?
What pleasures do you get from smoking? What ways can you still get pleasure if you quit?
Here are some questions to ask your health care provider.

How can you help me to be successful at quitting?
What medication do you think would be best for me and how should I take it?
What should I do if I need more help?
What is smoking withdrawal like? How can I get information on withdrawal?

For information about the guideline or to get more copies of this booklet, call toll free: 800-358-9295, or write:

Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907


Tobacco Regulations Clouded

The Supreme Court has to consider both historical precedent and the balance of power among government agencies.
By Randy Wilson , JD

The Supreme Court has to consider both historical precedent and the balance of power among government agencies. Earlier this month, the court heard arguments from both government and tobacco attorneys regarding whether the FDA had the authority to regulate cigarettes. A lower court, the 4th U.S. Circuit Court of Appeals, ruled last year that the FDA cannot regulate cigarettes. Supreme Court justices, in early review, appear to be leaning toward upholding that lower-court ruling.

How can that be? Scientific evidence continues to mount that cigarette smoking is the greatest public health hazard facing the United States. Popular opinion strongly favors bans against smoking in public places. Cities such as San Francisco have banned smoking in restaurants and bars. Why is the Supreme Court looking at bucking this trend?

Mainly because the FDA's origins lie in regulating medicines, and historically tobacco has not been included under the agency's purview. The FDA's power to regulate drugs originated with the Food, Drug, and Cosmetic Act passed by Congress in 1938. For years, the FDA claimed it did not have the power to regulate cigarettes -- limiting its mission to ensuring that medical devices, including drugs, are safe and effective.

In an abrupt turn in 1996 based on new medical evidence that showed the highly addictive qualities of nicotine, the FDA decided that it should regulate tobacco. The agency argued that if it had the ability to regulate NoDoz stay-awake stimulants, for one example, it should have the same right to regulate nicotine.

However, tobacco lawyers claim there is a big difference between NoDoz, which is a drug intended to keep people awake, and the nicotine in tobacco, which has no medical benefit. Tobacco lawyers, calling the government's bluff in a sense, have also argued that if cigarettes are so dangerous, they should be banned rather than regulated.

In my opinion, the Supreme Court will have a tough time ruling against the tobacco industry. If the FDA is allowed to expand its reach in regulating cigarettes without an act of Congress, it will open the door to allowing other government agencies to stretch their authority as well. This would be a dangerous precedent, possibly undermining the checks and balances built into our system of government.

That said, this case provides the Supreme Court with an opportunity to force Congress to face a glaring public-policy conflict. Congress has subsidized the tobacco industry, encouraging the production of a deadly consumer product, while at the same time attempting to curtail the sale of that product. If the Supreme Court rules against the FDA, Congress and the nation will have to debate how to handle the production and sale of cigarettes in the United States.

2000 Healtheon/WebMD. All rights reserved.

Fighting Against a Mass Murderer

Lung cancer is America's leading cancer killer. Women who smoke seem especially resistant to the message. By Beatrice Motamedi

WebMD Medical News

Reviewed by Dr. Craig H. Kliger

Feb. 26, 2001 -- Michelle Globerson started smoking when she was just 15 years old. Now 45, she's quit smoking four times, each time cold turkey, but never for good.

Recently, she's been seeing more and more public service announcements on TV, including one spot that calls smoking "puking (and) disgusting." She agrees. But she's still not ready to give up her pack-a-day habit.

"I know it's wrong -- I'm hurting myself," says Globerson, a supervisor for a pool building company in Mesa, Ariz. "Something is going to make me want to quit. I just don't know what it will be."

She has plenty of company. Despite a decline in U.S. smoking rates since the mid-1960s, tobacco use among women remains stubbornly high.

At first glance, the nationwide numbers seem to favor females. Just 20.9% of adult women smoke, compared with 24.2% of men, according to the latest CDC data. But the data mask a remarkable drop of nearly 47% in male smoking rates between 1965 and 1995, compared to a more modest decline of 35% for women.

More worrisome is the increase in lung cancer cases. Among women, they've more than doubled since 1973, according to the American Lung Association. Lung cancer mortality fell by 3.2% for men between 1992 and 1997, but among women the rate was essentially unchanged.

There's also concern about teens. While youth smoking rates appear to have steadied after years of increases, an important new study raises serious questions about the effectiveness of school-based programs, a mainstay of teen education efforts.

The study, by researchers at the Fred Hutchinson Cancer Research Center in Seattle, appeared in the December 2000 issue of the Journal of the National Cancer Institute. It surveyed smoking rates among 8,400 students in Washington state, half of whom had been exposed to an intensive, grade 3-to-12 program.

The program was based on the popular "social influences" approach, which teaches kids how to resist TV ads and peer pressure through media literacy classes, role-playing, and other behavioral exercises.

The results were surprising: Researchers found "no significant difference" in tobacco use between students who had gone through the program and those who hadn't; the smoking rate among 12th grade girls who took antismoking classes, for example, was 24.4%, compared with 24.7% for those who didn't.

"It was disappointing, because the social influences approach has been such an attractive one," says Arthur V. Peterson Jr., PhD, a Hutchinson researcher and professor of biostatistics at the University of Washington. "We had high hopes."

A leading cause of cancer deaths

Lung cancer is America's No. 1 cancer killer, claiming more lives than any other type. The CDC estimates that 164,100 new cases were diagnosed last year; each year, more than 156,900 men and women die from lung cancer, representing nearly 28% of all cancer deaths.

Perhaps the only good thing about lung cancer is that the usual cause is easy to identify: cigarette smoking, which causes up to 90% of all such cases, according to the National Cancer Institute (NCI).

Increasingly, states such as Arizona, California, Oregon, Massachusetts, and Florida have turned to public service ads, clean air laws, and taxes on cigarettes, in their bids to drive down smoking and cancer rates. Last year saw the debut of more statewide tobacco control laws than ever before, according to the American Lung Association, including 113 new laws in 43 states.

Controversial and costly as they may be, evidence indicates that tobacco control programs work, particularly for women. California, which launched its program in 1988, saw smoking drop from 22.4% to 18% between 1988 and 1997, according to a December report by the CDC. Lung cancer cases plunged by 14%, compared to a decline of 2.7% in a sample that included five states and three cities. Among women, the impact was even more striking: A 4.8% drop in lung cancer incidence within California, compared with an increase of 13.2% elsewhere.

Critics point out that smoking rates were already on their way down by the time California took aim at tobacco. "But the rate of decline has accelerated -- it's two to three times as rapid as the declines around the country," says Terry Pechacek, PhD, associate director for science in the CDC's Office of Smoking and Health.

And while it will take 10 to 15 years to see the full effect of lower smoking on lung cancer, heart disease is another story: "More than half [of the risk] is gone within one or two years of quitting," Pechacek says. Heart disease is the leading cause of death among women; lung cancer is second.

TV, taxes and treatment

Experts agree that what makes the California model work is that it's comprehensive and doesn't rely on any one approach, a lesson hammered home in the Hutchinson study.

Creative as it was -- 10th graders even re-enacted testimony given by tobacco executives before Congress, just to get a sense of the issues -- the Hutchinson program provided kids with a total of just 46.75 hours of instruction over nine years of schooling. Compare that, Peterson says, to the estimated $7 billion spent each year by tobacco companies on advertising and marketing.

"It's like a raft on a raging sea," Peterson says, of school-based education. "From the results of this study, we would conclude that this raft has no chance. So more and different things must be done."

What should they be? Increasingly, states are turning to a triad of TV ads, taxes, and treatment.

In California, Arizona, Florida, and Massachusetts, aggressive TV and print campaigns portray smoking not only as unhealthy but uncool. In Florida, TV spots crafted with the help of teens hit hard at tobacco companies, with ads that featured images of corrupt executives and corpses in body bags. Edgy and sometimes gritty, the ad campaign, called "Truth," is credited with a 40% reduction in teen smoking between 1998 and 2000.

Taxes on tobacco are another strategy: Over the past decade, all 50 states have adopted them, from a high of $1 per pack in Alaska to 35 cents in Nevada. Some suggest they could be raised even more.

Youth smokers "are somewhere between two and four times as responsive" to price hikes as adults, says David Levy, PhD, senior scientist at the Pacific Institute for Research and Evaluation in Rockville, Md., and a professor of economics at the University of Baltimore. African-American adolescents are particularly sensitive to price swings, he says.

That fact alone could be a powerful weapon: A study in the December 2000 issue of the Journal of the National Medical Association reported that black teenagers who smoke are more likely to develop lung cancer and other long-term problems, even though black teens as a group smoke less than their white peers. Researchers believe racial differences in the way nicotine is metabolized could make tobacco more lethal for blacks.

"You could say it's regressive," says Levy, of taxes that disproportionately affect black youth. "But death is regressive."

Improving treatment options is the third approach. For many smokers, the worst thing about quitting is that it's expensive; the CDC estimates that it can cost as much as $400 for a three-month "quit attempt" using the nicotine patch. Unfortunately, insurance rarely pays.

Some states may force the issue. In Maryland, a coalition of state officials and advocacy groups intends to introduce what would be the nation's first law requiring private insurers to pay for prescription antismoking drugs. "This is a hard sell, believe me," says Joan Stine, director of Maryland's Office of Health Promotion, adding that an earlier version of the bill was torpedoed last year by the state's HMOs.

"In the long run, you save money on these folks if they stop smoking," Stine says. "But [HMOs] don't operate in the long run."

Not quitting, but still watching

One reason for the focus on smoking is that unlike breast or prostate cancer, there is no widely available, effective screening test for early stage lung cancer.

Currently, the NCI is in the midst of a yearlong study of 3,000 patients, to determine whether low-dose CT (computed tomography) scans are safer and more effective than chest X-rays. Indeed, a review article in the Nov. 30, 2000, issue of The New England Journal of Medicine cautions against "compromise or shortcuts in the rigorous scientific process required to determine whether this practice is justified," finding from their review of literature to date, "there does not appear to be a dramatic impact on survival." They further note: "Too often, presumed solutions prematurely become standard medical care before the appropriate studies have been completed."

So prevention remains key. For Globerson, that probably means more TV ads. Some of them make her flinch, but she forces herself to watch.

"Because it does make me think," she says. "Maybe the next time I see the commercial, that will be the time I stop."

Beatrice Motamedi is a health and medical writer based in Oakland, Calif., who has written for Hippocrates, Newsweek, Wired, and many other national publications.

Why Cigarettes are a Woman's Worst Enemy

Sure, cigarettes can harm anybody, men and women alike. But some of smoking's ill effects, from ectopic pregnancy to premature menopause, are reserved for women only. This November 19 is the American Cancer Society's 22nd Great American Smokeout. If you haven’t decided to give up smoking yet, here are some compelling reasons to quit now.
By Peg Rosen

Sure, cigarettes can harm anybody, men and women alike. But some of smoking's ill effects, from ectopic pregnancy to premature menopause, are reserved for women only. This November 19 is the American Cancer Society's 22nd Great American Smokeout. If you haven’t decided to give up smoking yet, here are some compelling reasons to quit now.

Smoking Increases Your Risk of Cervical and Rectal Cancer

Not only can smoking cause a variety of cancers in both men and women, it puts women at higher risk of cervical cancer, according to the American College of Obstetricians and Gynecologists (ACOG). A Danish study published in the April 21, 1999 issue of the Journal of the National Cancer finds that premenopausal women who smoke are six times more likely to develop rectal cancer than those who don't. Smoking Worsens Your Period According to the ACOG, women who smoke experience more severe premenstrual symptoms and have a 50 percent increase in cramps lasting two or more days.

Smoking Damages Your Fertility

Smoking affects practically every phase of conception, according to Vicki Seltzer, M.D., vice president for women’s health services at North Shore-Long Island Jewish Health System in New York. "Smokers have a greater risk of not ovulating, and it is also less likely that a fertilized egg will implant in the uterus. Smokers who receive in vitro fertilization are less likely to be successful." Seltzer also notes that nicotine interferes with the function of the fallopian tube and can hinder an egg from traveling normally to the uterus, which can lead to an ectopic or tubal pregnancy -- potentially life-threatening conditions.

Smoking Hurts Your Unborn Baby

"When you smoke during pregnancy, you poison the fetus," says Benjamin Sachs, professor of obstetrics and gynecology at Harvard Medical School. "Carbon monoxide has a greater affinity for fetal tissue than for adult tissue, and when nicotine crosses the placenta it speeds up the [baby’s] heart rate."
According to the ACOG, smoking increases a pregnant woman's risk of miscarrying by 39 percent and heightens the chances of other serious complications, including placental abruption (when the placenta separates from the uterine wall), placenta previa (when the placenta covers the opening of the uterus) and stillbirth.

Many studies have pointed to maternal smoking as the most preventable cause of low birth weight. The breast milk of smokers can carry nicotine to a suckling baby. And a 1995 report in the Journal of Pediatrics found that infants exposed to tobacco smoke are nearly three times more likely to die from sudden infant death syndrome.

Smoking Ages You

You've probably noticed that smokers develop wrinkles earlier than nonsmokers. What often goes unnoticed is that smoking hastens menopause by one to two years. "Nicotine interferes with the blood supply to the ovary, and if you decrease blood supply to any organ, you decrease its function," says Sandra Carson, M.D., professor of obstetrics and gynecology at Baylor College of Medicine in Houston. Estrogen is produced in the ovaries, which "could explain why smoking brings on earlier menopause," Carson says. Cigarettes can lead to early osteoporosis, too, adds Carson: many studies have shown smoking significantly reduces bone mineral density.

Cigarettes Go to Your Heart

A woman who smokes is two to six times more likely to have a heart attack than one who doesn't, according to the National Institutes of Health. One to four cigarettes a day is enough to double your risk of heart disease, says the ACOG. And a Finnish study published in the July 1998 British Medical Journal found that female smokers are twice as likely to have a heart attack after age 65 as male smokers. Researchers believe estrogen -- which smoking apparently inhibits -- helps protect women against heart disease.

And remember that your behavior sets an example for your daughter or any girl in your life. "The rate of high school girls who are smoking is now on par with that of boys," says Wanda Jones, a spokeswoman for the National Women’s Health Information Center. "This is not the kind of equality for women our mothers and grandmothers envisioned."

Limits on Teen Cigar Sales: Just Blowing Smoke?

Study Shows Minors Can Make Purchases on the Internet

By Gay Frankenfield, RN
WebMD Medical News

The sale of tobacco products to minors is illegal in the U.S., but that doesn't mean it doesn't happen. Age disclosure is often not required to purchase cigars on the Internet, according to a report in the May issue of the American Journal of Public Health.

"The findings are concerning in light of a 1997 study that showed 22% of high school students smoked a cigar in the previous month," says study author Ruth Malone, RN, PhD, an assistant professor of nursing and health policy at the University of California at San Francisco.

As if looking to purchase cigars, Malone searched the web for cigar links and visited 140 sites in 1998. Each site was then analyzed for legal and health warnings, payment terms, and promotional strategies. To assess recent trends, a second search for cigar links was conducted in 1999, Malone says.

Only 25% of the sites included a statement prohibiting tobacco sales to minors and just 10 sites required age disclosure prior to purchase. In addition to credit cards, a third of the sites accepted cash on delivery, money orders, and personal checks. Also, one in three sites used promotional cartoons, which may appeal to a young audience. Only five sites provided health warnings.

Just one year later, there was a threefold increase in the number of links to cigar sites. Malone tells WebMD that the increase shows that Internet cigar sales are likely to continue to grow. "The number of minors on the net is also expected to increase from 10 to 45 million over the next two years."

Others claim that cigarettes are a much bigger problem among minors. "It's been shown that 60% of all teen-agers have tried a cigar, but less than 5% smoked a second cigar," says Marc Schneiderman, MD, president of the Allegheny Chapter of the Pennsylvania Academy of Family

Physicians. "But there are 3,000 new cigarette smokers every day, most of which are teen-agers."

Schneiderman, who smokes two cigars a day, conducted a review of cigar research since 1950. "Inhalation habits and alcohol abuse both appear to play an important role in the development of tobacco-related diseases," says Schneiderman. "But many of the studies have methodological flaws that limit the findings."

Still, the researchers say more efforts are needed to enforce the law. The Synar Amendment encourages restriction of tobacco sales to minors by limiting federal monies to states that are not in compliance. "Teen-age sting operations are used to test compliance," says Malone, "and it may be a good strategy for the Internet as well."

Referring to a 1998 joint statement on electronic commerce, Malone adds that the U.S. and Australia agreed to limit children's access to unsuitable Internet content with filtering and blocking systems. At present, the Clinton administration continues to look for ways to keep tobacco out of the hands of children, according to Mark Kitchens, a White House spokesman.

The study was supported with a grant from the National Cancer Institute.

Vital Information:

  • Age disclosure is often not required to buy cigars on the Internet, and health warnings are rare.
  • Most sites don't issue a statement prohibiting tobacco sales to minors, and many accept forms of payment other than credit cards.
  • Public health experts call for strict enforcement of existing laws, including the Synar Amendment that limits federal monies to states that are not in compliance.

Glamorous Image Lights Fire Under Cigar Sales

Public Health Officials Try to Snuff Out Demand

By Jeff Levine
WebMD Washington Bureau Chief

Whether it's a movie star puffing contentedly on a panatela or teen idols brandishing their stogies in menacing defiance of societal norms, cigars have come to be increasingly important status symbols for smokers and a growing concern to public health officials.

Ironically, during a time when doctors and regulators have put extraordinary efforts into sending out messages about the dangers of cigarettes and chewing tobacco, cigar sales are smoking. Researchers say premium cigar sales have increased from 90,000 in 1986 to 274,000 in 1996. That trend has generated a wave of studies that were presented at the American Public Health Association's 127th annual meeting here this week.

Not surprisingly, a study of cigar advertising over the last decade shows that it targets men and promotes the power of cigars to attract women and wealth. Elisabeth Gruskin, DrPH, of the Institute for Health Policy Studies at the University of California, San Francisco (UCSF), says that the 92 ads she looked at generally depicted men luxuriating with their cigars in upscale environments; women were generally portrayed as sexual conquests.

In one example, the message of an advertisement with a woman draped languorously over a smiling, male cigar smoker makes the point, "When you only have time for a quickie."

A study done by the Office of Inspector General at the Department of Health and Human Services suggests the proliferation of pro-cigar messages is getting through to children. Recent research involving 230 teens was aimed at gaining an understanding of how children feel about cigar use and its health consequences.

The information was gathered from junior high school, high school, and college focus groups. Among the findings, says lead researcher Elise Stein, MPH, are that about three-fourths of teens report widespread cigar use and experimentation among their peers. Manufactured cigars, rather than premium smokes, are most popular. 'Blunting' -- the practice of removing tobacco from a cigar and spiking it with marijuana -- is said to be widespread.

Stein says her analysis shows that teens believe cigars are more socially desirable than cigarettes and that they are easy to purchase. Among the issues to be studied, she says, is the loophole in federal regulations for cigars. They are exempt from current FDA rules that control tobacco sales because of subtle technical questions about their addictive properties. In addition, cigars don't face the same advertising disclosure rules as cigarettes.

Lynn Wenger, MPH, also of the Institute for Health Policy Studies at UCSF, collected some 600 articles about cigars between 1992 and 1998; they were more or less evenly divided between general interest and specialty cigar magazines. The approach varied from the elite Cigar Aficionado to the lower-end, more youthful Smoke.

But whether the cover featured actor Tom Selleck or rock group Red Hot Chili Peppers, the message inside was generally uncritical. Wenger says that only 1% of the articles in cigar magazines focused on health issues related to the product. Just 3% of cigar-oriented pieces in the other magazines discussed health matters; most of the pieces discussed cigars as a business.

Both cigar and non-cigar magazines leaned heavily on celebrities in their product-related pieces.

"The use of cigars is rationalized [as] a fad or a trend," says Wenger who feels that their needs to be more anti-cigar advocacy in the media.

Still Smoking in 2000? Professional Advice on Medications That Work

Author Linda Hyder Ferry, M.D., M.P.H., discusses how medical assistance can help you quit smoking.
By Linda Hyder-Ferry , MD, MPH

Moderator: Welcome to WebMD. Today we will be discussing Still Smoking in 2000? Professional Advice on Medications That Work with Linda Hyder Ferry, M.D., M.P.H.

Dr. Linda Hyder Ferry is the co-author of the How To Quit Smoking and Not Gain Weight Cookbook. She is the founder of F.I.N.D. (the Foundation for Innovations in Nicotine Dependence), an associate professor at the Loma Linda University School of Medicine, and a leading nicotine-dependence researcher who first studied the use of bupropion (Zyban) as a nicotine-free treatment for smoking cessation. She teaches medical students and physicians how to help smokers optimize their smoke-free futures.

Do smokers really need professional medical assistance to quit smoking? Most ex-smokers have done it on their own (cold turkey), right?

Dr. Ferry: There are 50 million people who used to smoke in the U.S. When you ask them how they quit smoking, a significant number will say they did it on their own. Does that mean it's the best way? Absolutely not. Most people trying to quit on their own will have to try 5 to 7 times, whereas with professional medical support, you only need to try once to be successful. What does that mean? Professional medical assistance? It means someone helps you assess why you smoke, determines if you have any underlying medical conditions that make you dependent upon nicotine, and can help you select the correct medications to help reduce your nicotine withdrawal symptoms and prevent relapse. Quit rates on your own amount to 5% success rate at the end of the year. However, professional assisted quit rates are from 40 to 60% at the end of the year. If you had cancer, would you try to cure it on your own with a 5% quit rate, or would you rather go for professional help from someone who knows how to cure cancer? Very very few people who stay abstinent for one year relapse the second year; 75% of the relapse occurs in the first three, four months. It drops down to a 10 to 15% quit rate, and then after six months, goes down to 5%. The majority of the relapse happens very early.

Moderator: What about the over-the-counter herbal stop-smoking agents that are promoted? Are they proven to work?

Dr. Ferry: Herbal products and non-prescription or over-the-counter products to stop smoking do not require any trials to prove their effectiveness prior to marketing.I would encourage caution for any product that says "guaranteed to work or money back". $29.95. Those are usually money making scams, and you don't get your money back.Are there no benefits from herbal products? That can't be stated for sure. Herbal products that change the chemistry in the brain affecting moods and feelings, may well work similarly to nicotine in the brain, as it is an "herbal product" from the tobacco plant. However, it's one manipulated by the tobacco manufacturers. To date, we have no clinical trials showing that herbal products improve the quit rates compared to placebo.

Moderator: How does Bupropion Hydrochloride (Zyban) work?

Dr. Ferry: There are two FDA approved medications to control nicotine withdrawal symptoms during the attempts to quit smoking. Nicotine replacement therapy (NRT) replaces nicotine in your brain, to keep the smoker from having nicotine withdrawal symptoms. The non-addicting and nicotine free product approved in 1997, named buproprian (Zyban), is not a replacement for nicotine. It is a mood stabilizing modifier of the brain's neurochemistry called an amino-ketone class.It stabilizes the dopamine and norepinephrine in the brain that are responsible for the nicotine withdrawal symptoms when someone stops using tobacco. Those symptoms are irritability, frustration, insomnia, anxiety, difficulty concentrating, restlessness, increased appetite, and depressed mood. Zyban is believed to control these symptoms by keeping the levels of norepinephrine and dopamine stable in someone's brain, instead of having them bottom out when you quit smoking.

It may have other functions of which we are unaware, but the response of patients using Zyban in the 1 to 2 weeks before they give up tobacco, and quit smoking, follows the following pattern. #1, I no longer am enjoying the pleasure or taste of smoking. #2, I am much calmer now that I am cutting back on tobacco or have quit. #3, I am no longer experiencing the severe cravings, and can go for hours without even needing to think to smoke. #4, I am not as sad, or blue, or bored, or lonely feeling as I usually am when I try to go for long periods without nicotine. Those responses indicate to me that at least in the effects of tobacco on these neurotransmitters in a smoker's brain, Zyban is assisting the smoker to avoid the ups and downs of nicotine withdrawal symptoms, by some mechanism.

Moderator: How are sugar and insulin involved when a smoker quits?

Dr. Ferry: Nicotine stimulates a variety of neurotransmitters that affect appetite.

Dr. Ferry: One of them is seretonin.

Dr. Ferry: Seretonin is also known to be related to a carbohydrate binge that sets off appetite, increasing the desire for sugar or starch. People who crave carbohydrates may have low seretonin levels, so when you quit smoking, and you no longer are stimulating your seretonin, you feel anxious and irritable and you crave sweets.

Dr. Ferry: ... Except for tryptophan, which remains in the blood at high levels

Dr. Ferry: Tryptophan is the building block to create seretonin. Seretonin increases calmness and increases sugar cravings, so that's why you crave sugar.

BarbChizmas_WebMD: What about weight gain? Do you gain more or less when taking Zyban?

Dr. Ferry: Two large trials done from '95 to '98 have shown that during a 7 to 9 week period after quitting smoking, people on Zyban gain less weight than people who are on placebo. When you quit using Zyban, the effect on the supposed appetite-center disappears in a matter of days, and craving or increased appetite that remains after the disappearing of nicotine can lead to excessive eating. People concerned about controlling their urges to eat and cravings for sweets, may want to stay on Zyban for longer periods of time than these two clinical trials were designed to demonstrate. This medication has been used as an indication for depression, safely up to several years. So there's no reason to be afraid to use it for a longer period of time than just controlling the cravings for nicotine. Remember that nicotine suppresses a normal appetite, therefore, most smokers but not all, have not dealt with a healthy, normal adult appetite since they were adolescents. And learning to handle and cope with that may exceed their coping strategies when food smells better and tastes better after quitting smoking. The average weight gain when people are not prepared for the increased appetite and craving is 5 to 7 pounds. But it is avoidable if someone understands the reasons why they smoke and the 5 causes of weight gain after quitting.

In my book, How to Quit Smoking and Not Gain Weight, Mary Donkersloot and I give a scientific basis for avoiding weight gain after discontinuing tobacco. People gain weight for the following reasons. First, instead of the cigarette in their fingers, and the hand to mouth action of smoking, they replace that with food and eat in excess of 500 to 800 calories a day. #2, nicotine withdrawal symptoms, as I explained earlier, can stimulate cravings for sweets or food. #3, the nerve that creates the sense of smell in your nose, the olfactory nerve, returns to normal functioning within 3 to 5 days after discontinuing tobacco. The wonderful smell and taste of food can make otherwise normal food seem more appealing to the recent ex-smoker and lead to overeating. #4, smoking that delivers nicotine to the brain speeds up the body's metabolism rate and burns calories faster. Quitting tobacco slows down the metabolic rate. #5, smokers are often more sedentary than non-smokers and, therefore, do not metabolize and utilize the normal calories eaten each day, and are therefore more likely to gain weight after quitting smoking as adults. Nicotine does suppress the normal appetite, which comes back to life within the first 1 to 2 weeks after discontinuing all nicotine products. This is a good thing and should be celebrated when your appetite no longer is controlled under the addicting influence of nicotine; just don't let it run away with you and learn to control it.

Moderator: Are there no side effects to Zyban?

Dr. Ferry: Zyban is a medication that changes the chemistry in the human brain. Anything that will change brain chemistry has its beneficial effects and its potential detrimental effects. The side effects of Zyban are that a third of people will also have chemical effects relating to two common symptoms. #1, dry mouth in up to 38% of people. #2, difficulty sleeping. This is more common in people who've used Zyban than in people who've quit smoking cold turkey. Other uncommon symptoms of using Zyban are increase in headaches if people have regular headaches prior to quitting smoking, upset stomach which can be controlled by taking the medication with meals, constipation which can be controlled by increasing the fiber in your diet and drinking 10 glasses or more of water a day along with regular exercise. Feeling irritable or stimulated as if drinking too much coffee; all of these side effects can be managed by altering the dose of the medication or the timing of the medication. The dry mouth and other symptoms may not change until your brain chemistry adjusts to the effect of Zyban, about 2 to 3 weeks later. Very few of these side effects are severe enough to discontinue the medication, as there are seldom deaths due to dry mouth or insomnia but 400,000 people die every year because they don't have the courage to stop smoking.

The one serious side-effect doctors should screen for is increased risk for seizures; the 3 indicators to put someone at high risk, is having a family history of seizures, a severe injury to your brain (gun shot wound, or skull fracture), another concern is people who have a history of stroke, and those who are currently abusing alcohol or other stimulant drugs. If those conditions do not apply to the smoker, there is an extremely low rate of the risk of seizures approximating less than 1 in 10,000 people. And we know 1 in 2 people who continue to smoke will die of a tobacco related disease prematurely. So the risk and benefit is entirely on the side of getting professional help to determine the benefit of Zyban in your effort to quit smoking.

Moderator: What is "the patch" and how does it work?

Dr. Ferry: When someone says they've used the patch to quit smoking, what they've done is delivered nicotine through something that looks like a large circle or square band aid, in which nicotine is embedded in the adhesive. Nicotine goes through the skin into the blood, travels back to the blood through the lungs, and then to the brain. The smoker can't tell whether the nicotine came from a lit cigarette or from the patch. The brain just recognizes that nicotine is circulating and decreases nicotine withdrawal symptoms. Using NRT, or gun, or nasal spray, or the oral inhaler of delivering nicotine into the blood... that quit rate can be doubled to 10% and maybe 15% of all people. This is according to large clinical trials. However, comparing that between men versus women, there's a significant difference in most large studies showing that men respond more favorably to the NRT, than women do. The evidence isn't clear as to why men have a better respond to NRT. There is the suggestion that men and women often smoke for different reasons; because of the woman's hormonal makeup, estrogen and progesterone cycling every month, they may absorb nicotine differently than men. This seems to be evident by that women use a less number of cigarettes a day than men do, and nicotine levels in blood are lower. That means a woman's brain gets the same effect with a lower dosage of nicotine. Another concern is that men seem to smoke for reasons of aggression, and to control nicotine withdrawal symptoms and anger, whereas women appear to use tobacco to control their moods and emotions and stress. We know that twice as many women are depressed over a lifetime, and we also know that the use of tobacco changes the chemistry in a smoker's brain to decrease symptoms of depression. Therefore, a lot of research is going on now to understand if women are self-medicating undiagnosed depressive disorders, and when you just give NRT, you don't really give what a woman wants from smoking. However, very interesting news is that in the large trials done on Zyban, there's no difference between the effectiveness on men versus women. Women quit at an equally high rate than men do using this medicine. I believe we need to look more closely into the question of whether Zyban is satisfying a primary reason why a woman smokes compared to a man; that is, helping them deal with depressed mood disorders so that they no longer need nicotine or tobacco to do that.

Moderator: How effective are some of these medications when taken in combination?

Dr. Ferry: A large study of 900 patients compared Zyban and NRT alone and in combination; the patients who quit smoking on Zyban alone were 36% at the end of treatment, compared to NRT which was 23%. When you combined both together, it was 39%. Looking at those results at 1 year, the Zyban therapy was 30%. NRT alone was 15%. When used in combination 35.5%. There are some people that may benefit from using both together; its not clear exactly who those people might be. Not everybody has a significant jump in success rates by combining NRT with Zyban. But it is clear from this one study that Zyban is more effective in the general smoking population than NRT alone. In fact, at 1 year, there was no difference from the placebo patients (who had received no medication) and the NRT subjects, whereas, the Zyban patients had a significantly higher, nearly double, the quit rate. I believe that patients with the following conditions should talk to their physicians about combined therapy: those who are very heavy smokers (2 to 3 packs a day), smokers with a previous history of other chemical dependencies, and those with a previous history of depression or other psychiatric illnesses. However, that's based on 10 years of clinical experience and not on clinical trials, as there have never been any studies of the use of Zyban in patients with psychiatric illness.

Paninas_WebMD: Is there something, in addition to Zyban, that will curb craving?

Dr. Ferry: There are several reasons for craving when someone is abstaining from the use of tobacco; in order to extinguish all sources of craving, you would have to live in an entirely sterile environment that would have no cues or reminders of smoking behaviors. Therefore, its impossible for an ex-smoker to say "Oh, I've never even had one craving." For example, visual cues when someone isn't thinking of smoking can stimulate the brain's chemistry, making someone desire tobacco. Visual cues are the most difficult to distinguish. The smell of tobacco products again, even when you're not thinking of smoking, can set off the trigger to desire use of tobacco and set off cravings. #3, familiar environments where one naturally would reach for a cigarette, or stressful situations like working on the computer or having an argument with a boss or friend, or even if your brain wasn't prepared to have a nicotine craving, can set off that chemical reaction. #4, the final method for nicotine craving is the actual chemistry of the reward center in your brain; this is the only source of craving that is modified by medications. Therefore, medications will never eliminate all cues and triggers to smoke. Most of the tips helping people to prepare to quit distinguishes the behaviors, thought patterns, attitudes, and environments that help to eliminate a lot of the unnecessary stimuli to crave tobacco. These are all essential to change prior to someone quitting. Finally, understanding why you smoke by taking the quiz "Why Do You Smoke?" can help you identify what your reasons are for needing to smoke. If you can understand what your reasons are and meet those needs by something other than tobacco that's satisfying, then you'll have less craving and desire to smoke. The easy answer you may have been looking for isn't some "natural" way to avoid craving besides taking NRT or Zyban. We don't know of any other product that actually satisfies that part of the brain and extinguishes that every 20 to 40 minute cycle that the brain chemistry goes through needing another hit of tobacco, except that those medications that work in the way nicotine does. There are many claims for herbal products, but look carefully at their ingredients. They either have caffeine or other stimulant products that work similarly to nicotine, but they've never been proven to be effective... so it's probably not a good value for dollar on your investment.

Moderator: How important is it to maintain a daily routine after quitting smoking?

Dr. Ferry: My motto is that "preparation is everything". Quitting is the simple part; people can quit a thousand times, but if you aren't prepared to stay quit, it's a waste of effort. In order to prepare to quit smoking, I recommend you establish an entirely new routine for your life in the 1 to 4 weeks before your quit date, bringing into your rituals and routines things that aren't associated with smoking. If you always sit down with the same coffee mug in the same chair where you always smoke, what do you expect your brain to do except to want to light up? My recommendation is that you totally disrupt your comfortable, pleasant environment and situations that you smoke prior to your quit date, and establish new habits and routines. Drink milk instead of coffee. Drink tea or water. But don't go back to that familiar coffee mug; throw it out and get a new one that won't be associated with the visual cues to smoke. Buy a coffee mug that tells you not to smoke, and create new rituals and patterns. If one of your patterns is coping styles to deal with stress, then practice coping styles now for 5 to 10 minutes. And practice this new behavior, so that it's comfortable and familiar when you finally do give up your tobacco. A very important pattern to support a successful quit attempt is regular meals, healthy snacking, daily exercise for the 2 weeks after you quit smoking, and going to bed earlier than you normally would because nicotine withdrawal sets up changes in your metabolic rates and sleep patterns in your brain. You need that extra hour or two of sleep and exercise to re-establish the brain chemistry that you want to be stabilized at after you quit using nicotine. Another tip is to drink plenty of water; 6 to 8 glasses might be adequate for someone small in stature, 8 to 10 glasses for someone who is large frame or very tall. Nicotine is water-soluble; after your quit date, drinking water eliminates nicotine quickly from your system, and the very active drinking water stimulates dopamine release in your brain, stabilizing that chemistry that creates the sense of pleasure and satisfaction. So yes, routines are important to establish with new environments, not smoking in your car, and establishing regular routines of not smoking to change your attitude prior to your quit date. And that makes the transition much easier.

Moderator: What kinds of diets should someone that is quitting smoking use, and which kinds should they stay away from?

Dr. Ferry: Because of the unstable chemical reactions that go on when you're trying to get your brain off nicotine, it would not be in one's best interest to also have highs and then lows from high sugar content which create additional irritability, compounding nicotine withdrawal. My co-author, Mary Donkersloot RD, and I believe that diets are counter-productive. Healthy balanced nutrition is really the key to good health after quitting smoking. In our book, we recommend a specific calorie amount and balance of carbohydrates, proteins and fats for those first 24 hours after you quit smoking, and a guideline for the whole first week after you quit smoking. The key is, when you need something to replace the pleasure... use a fruit that you enjoy in the most natural state as possible. Eat the whole apple with peel rather than drink apple juice. Don't overdo it on high fat, high salt, or high sugar snack foods. And be moderate in your portion sizes. Our book actually has in the second half, a wide range of very healthy recipes for smokers to practice prior to their quit date and to put into their regular routines, which gives high fiber, reasonable protein levels, and complex carbohydrate balanced meals and recipes. If you just eat every three to five hours with a small portion of a balanced protein, carbohydrate and fat snack, rather than overeating because you are depriving yourself and then get overly hungry, then you''ll find much more stability in your eating patterns, your cravings, and weight gain. A variety of examples are included in our book.

You see a cover of our book and the link to order it on my website -- The Foundation For Innovations In Nicotine Dependence ( Or the book can be ordered under the health and smoking cessations sections of bookstores -- the authors are Mary Donkersloot and Linda Hyder-Ferry. The title is How To Quit Smoking And Not Gain Weight Cookbook by Random House Publishers.

Moderator: Are there future drugs or treatments for quitting smoking and what research is there?

Dr. Ferry: Some researchers are looking at the effectiveness of giving a vaccine that blocks the transmission of nicotine from the blood to brain. And we're not sure you could just overcome it by smoking more and longer. Other medications similar to Zyban are being studied now that may work more effectively on certain centers of the brain to target the pleasure and reward centers with even less side effects than Zyban has. An important thing to remember is that if you have an underlying depression or anxiety, ask your doctor to screen you for those symptoms and to treat you prior to quitting smoking. Many physicians don't realize that those underlying mood disorders can sabotage a person's efforts to quit smoking, even when they're serious and trying very hard to quit. Please don't be discouraged if you've tried to quit and it failed; understand why you smoke and take that quiz on my website -- Find alternative methods to meet your needs that don't require tobacco, and move on to your smoke-free future.

Moderator: Is it helpful to quit smoking with a friend?

Dr. Ferry: We know that social support and befriending is important in a variety of treatments for mental illness and addictive disorders. The most successful method to quit the use of alcohol is Alcoholics Anonymous by providing a social support system where people used to resort to alcohol. If you are planning to quit smoking, you don't have to do it at the same time as someone else, but you can get the support of someone who's also quitting and can understand what you're going through and will be there for you. So buddy up and let people know you're quitting, tell them your date, and make yourself accountable to someone who loves you enough and helps you to quit. Checking in with them on a daily basis is an excellent insurance policy for relapse prevention.

Moderator: Thank you very much for joining us, Dr. Ferry. Please join us every Wednesday at 9 pm EST here in the Mind and Body Auditorium for our live weekly event. Next week we will be discussing The Psychological Impact of Cancer and Its Treatments, with Dr. Anne Coscarelli.

Cigars: A Dangerous Habit

By Carlos Iribarren , MD, MPH, PhD

A lot of people think cigar smoking isn't dangerous because most cigar smokers don't inhale. In fact, surveys suggest that about 10% of cigar aficionados do inhale. But even those who don't purposely inhale still breathe in plenty of second-hand smoke from a burning cigar -- and so do the people around them.

What's more, cigar smokers can't help swallowing some of the toxic substances in cigar smoke, which contains greater concentrations of nicotine, benzene, lead nitrogen oxides, and other nasty chemicals than does the smoke from cigarettes. You should also know that cigar smoke generally has a higher pH (a measure of acidity) than cigarette smoke. The higher pH facilitates the absorption of nicotine through the lining of your mouth and nose, according to research published in the Journal of the American Medical Association on December 18, 1996.

Cigars may seem to carry less risk because most cigar smokers don't smoke as often or as much as cigarette smokers. Yet in a study I recently co-authored with several colleagues comparing cigar smokers with nonsmokers (The New England Journal of Medicine, June 10, 1999), we found higher risks of heart disease, chronic obstructive pulmonary disease, and cancers of the mouth, esophagus, and lungs among men who puffed fewer than five cigars a day. As for people who smoked more than five cigars a day, the risks went straight through the roof -- tripling in the case of lung cancer. Interestingly, we also found that the combination of drinking alcohol and smoking cigars raised the danger even higher.

Our study was published at a time when sales of cigars had surged 50% in a period of just five years, according to statistics from the U.S. Department of Agriculture. Luckily, their popularity now appears to be leveling off and perhaps even declining.

Don't fool yourself into thinking that it's safe to jump from that window on the fourth floor. It's still a long way down. You'll do yourself a big favor by jumping on another trend instead: kicking the cigar habit for good.

Want Better Sex?

Then put out that cigarette. Researchers are finding that smoking decreases both desire and performance.
By Glenn Gordon

Mark Jordan, a 22-year-old substitute teacher in Phoenix, Ariz., had been smoking for a year when the fire seemed to go out of his love life. "Sex was suddenly getting boring," he says. "I didn't want to have it. I would get out of breath so easily and I simply felt gross." While he averaged only half a pack a day, on a weekend night he might smoke much more.

"I remember having sex in the shower and feeling like I was going to pass out," he says. That was a turning point. He stopped smoking, started exercising and eating right, and now says he has a much greater interest in sex and enjoys it more than ever.

Watching Sharon Stone puff away in the film Basic Instinct may be stimulating for some men, but smoking can be a major drag in a real-life bedroom (or shower, as Jordan found). "Smoking has a direct, negative effect on the sexuality of a man on every level," says Panayiotis M. Zavos, PhD, director of the Andrology Institute of America and professor of reproductive physiology and andrology at the University of Kentucky in Lexington.

Zavos and his fellow researchers studied 290 couples undergoing evaluation for infertility and reported their results at the joint annual meeting the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society last September. As part of the study, couples completed a questionnaire detailing their smoking and sexual habits. None of the women were currently smoking, but 158 of the men, all between the ages of 26 and 35, smoked an average of 30 cigarettes a day and had been smokers for an average of more than seven years.

Lighting Up May Not Light Your Fire

Zavos' findings confirmed that men's smoking had a significant and negative effect on a couples' ability to conceive. But they also turned up a surprise: Smoking significantly diminished a man's sexual desire and satisfaction -- even for young men in their 20s and 30s.

The smokers reported having sex less than six times a month whereas the nonsmoking men were having sex nearly twice as often. This difference is especially significant considering that these couples were actively trying to conceive. "In current research, we are trying to identify how and why tobacco use negatively impacts men's sexual performance. In my clinical experience, it does decrease performance. Sexual performance is more than just erectile function, it involves many of the systems of the body," says Zavos. "But when a man's ability to have sex decreases, his appetite for sex will generally follow."

Zavos found that when diminished desire is combined with impaired performance, overall satisfaction is likely to suffer. When asked to rate their satisfaction with the sex they were having on a scale of 1 to 10, nonsmoking couples averaged 8.7, while couples with male smokers fared far worse with an average of only 5.2. "There's no doubt in my mind," says Zavos, "that nearly any man's sexual satisfaction and frequency [of having sex] would increase if he stopped smoking."

Other experts agree that smoking can impair sexual performance. "Smoking causes damage to smooth muscle inside the penis that interferes with erectile functioning," says Richard Milsten, MD, co-author of The Sexual Male and a urologist for more than 30 years in Woodbury, N.J. "So if men can't perform as well, it would make sense that their libidos would suffer." However, Milsten cautions against simple explanations for sexual behavior. "There are so many factors in sexuality. Smoking is just one. Still, I don't think it's outlandish to say that refraining from smoking will benefit your sex life."

For Some Men, Cigarettes Still Seem Sexy

Larry Bullock, 36, an actor and model living in New York, has recently considered breaking the habit. Bullock started smoking at 14 because it seemed "masculine, adult, and cool." He says he has always enjoyed a very high libido and never noticed any negative effects from smoking -- until recently. "In fact, I loved smoking before and after sex," says Bullock. "They were the best cigarettes of the day."

But lately, says Bullock, who will appear on the cover of an upcoming fitness magazine, he began to notice that he was "feeling a bit winded" during sex. "I get so out of breath and wheezy sometimes, that I've had to ask my partner to refrain from asking me if I'm OK after orgasm."

What if you smoke fewer cigarettes or have been smoking for fewer years than Bullock or the men in the survey? While Zavos admits to not having all the answers, he speculates that whether or not you notice anything now, "you're on a dangerous path."

Not everyone is convinced that smoke-free living will give them a new lease on their sex life, however. "I quit for a few months," says Mathew Lenning, a 25-year-old graphic designer in New York, who's been smoking since high school, "but the only change I noticed about sex was that I really missed having a cigarette afterwards."

Glenn Michael Gordon is a senior producer at He has written for YM, Twist, Child, and Time Out New York magazines.

Panic Attacks More Common in Smokers

Mental Disorder Linked to Cigarettes
By Daniel J. DeNoon and Liz Meszaros
WebMD Medical News

If you think smoking calms you down, think again. A study of thousands of smokers shows that they are three times more likely than nonsmokers to have panic attacks and panic disorder.

"We know already a whole lot about the effects of smoking on just physical health, and now we are also starting to see the adverse effects in new research on mental illness," study co-author Naomi Breslau, PhD, tells WebMD. "This is one example."

A panic attack can have all sorts of symptoms: shortness of breath, dizziness, heart palpitations, trembling, sweating, choking, nausea, numbness, flushes or chills, loss of one's sense of reality, chest pain, fear of dying, and/or fear of going crazy. People who have frequent panic attacks (more than four in a month) or have persistent fear of having another attack for a month after an attack suffer from panic disorder.

Breslau says, "It's not simply that the two things go together, but it's suggesting that smoking is playing a causal role." According to Breslau, smoking increases a person's lifetime risk of a panic attack by three to four times.

The risk of a first-time panic attack goes down in people who have quit smoking, although the studies do not show whether quitting will eliminate all risk in people who have smoked. But people who smoke should quit now, advises Breslau, who is director of research in the psychiatry department of the Henry Ford Health System. She and Donald F. Klein, MD, of the New York State Psychiatric Institute published their findings in the December issue of the journal Archives of General Psychiatry.

She suggested that tobacco smoke may induce panic attacks in susceptible individuals. "There can be other mechanisms by which smoking induces panic: the effect of nicotine for example," Breslau says. Nicotine has a stimulating effect on the brain. It does all sorts of things."

Panic attacks may be a false alarm in which a person's body mistakenly thinks it is suffocating, Klein previously has written. Based on this theory, Breslau and Klein suggest in their article that carbon monoxide in cigarette smoke may set off panic attacks in people predisposed to overreact.

In an interview seeking objective comment, clinical psychologist Benjamin Fialkoff, PhD, tells WebMD that the study findings appear to be in line with his experience in treating patients with panic disorder.

"It doesn't surprise me in view of the findings that smoking increases stress," he said. "What we have in a panic response is the body's stress response going full out. ... In general, you don't feel a soothing, calming feeling after you have a cigarette."

Fialkoff says he prefers a combination treatment for patients with panic disorder. He refers those patients willing to take medications to a physician for a mild tranquilizer and an antidepressant. He then teaches patients ways to reduce their anxiety symptoms, usually with breathing or relaxation techniques but sometimes with self-hypnosis. When a specific irrational fear (phobia) is involved, Fialkoff helps patients confront these fears in small, incremental steps. Last but not least, he says he helps patients restructure their fearful thoughts so that they do not lead to full-blown panic.

Vital Information:

  • Smokers are three times more likely to have panic attacks -- and panic disorder -- than nonsmokers.
  • In addition to harming a person's physical health, smoking can harm a person's mental health.
  • Risk of panic attack gets smaller in people who quit smoking, but it is not clear how long it takes for the risk to go down.

Cigarette Makers Beat Back Secondhand Smoke Claim

By Michael Connor MIAMI (Reuters) - U.S. cigarette makers defeated the first of about 3,200 individual secondhand smoke claims on Thursday, when a Miami jury ruled the companies had no liability for the lung ailments of a former flight attendant.

The six-person jury spent less than a day deciding against Marie Fontana, 59, a former TWA flight attendant who relies on portable oxygen tanks and blamed her sarcoidosis on passengers smoking on planes. "There is no liability for the defendants," a Miami court official said. Philip Morris and other cigarette makers paid $349 million in 1997 to settle a class-action suit on behalf of flight attendants claiming injuries from secondhand smoke on U.S. airliners. Smoking on U.S. domestic routes was banned in 1990.

But no plaintiff has yet received any cash, with $300 million set aside for a health foundation and $49 million for plaintiffs' lawyers. The 1997 deal called for follow-up trials on individual claims filed by last autumn. About 3,200 such claims are now in the pipeline, and Fontana's was the first to come to trial.

Lawyers for the nonsmoking Fontana argued during a nearly three-week trial that her sarcoidosis, a steadily worsening condition, and other lung ailments were caused by passenger smoking on planes in the 1970s and 1980s.

Defense lawyers disputed that the secondhand smoke caused Fontana's sarcoidosis and denied she had emphysema and chronic bronchitis as her lawyers said.

Fontana's lawyers, in asking for cash awards to cover lost wages and health care costs, said she needs both of her lungs replaced and will require medical care for the rest of her life. Lawyers said the Fontana case may prove crucial, possibly affecting other anti-tobacco lawsuits throughout the United States. The tobacco industry has been under courtroom and regulatory siege in the United States since the mid 1990s.

Sanford C. Bernstein analyst Bill Pecoriello said in a research note issued before the jury's decision that a favorable verdict for the defendants, such as Philip Morris, the maker of Marlboros, and R.J. Reynolds Tobacco, would bode well for the industry in the other flight attendants' cases awaiting trial.

Brown & Williamson, a unit of British American Tobacco Plc, and Lorillard, a unit of Loews Corp, were also defendants in the Fontana suit.

Minutes After Smoking Cessation

Did you know that your body starts to show signs of being
healthier only 20 minutes after your last cigarette? By
that time, your blood pressure, pulse rate, and body
temperature all return to baseline levels. Of course, the
longer you stay tobacco-free, the healthier your body

Quitting Smoking and Self-Efficacy

The role self-efficacy plays in behavior has been a considered to be an important variable for many years. Recently, Jean-Francois Bergman Etter, Max Humair Manfred and Thomas Jean-Paul Perneger examined the predictive utility of self-efficacy and quitting smoking cigarettes. Specifically, the authors created and tested an assessment instrument designed to measure smoker's belief in their own ability to quit smoking, called the Smoking Self-Efficacy Questionnaire (SEQ-12), a 12-items scale. The results of their empirical study involving 644 participants suggests the instrument can be broken down into two subscales, feeling depressed and external stimuli. The SEQ-12 appears to have excellent psychometeric properties ( internal consistency coefficients were .95 and .94 for each scale and test-retest reliability coefficients were .95 and .93). At the 16 month follow-up, score on the SEQ-12 predicted smoking cessation status for current smokers. In other words, folks who scores high on the SEQ-12 (i.e. people who believed that they were able to quit smoking, had lower levels of depression and were willing and able to avoid associating with other smokers) were more likely to be ex-smokers 16 months later. The authors recommend the use of the instrument in both research and clinical settings. For more details, see the original article in the journal Addiction (vol 95), June 2000, page 901-913.

Smoking Increases Skin Cancer Risk

We are already aware of many of the deleterious effects of smoking on the body. Here is another one to add to the
list. A study published in the January 2001 issue of the Journal of Clinical Oncology reported that the more
cigarettes an individual smokes, the greater the chance that he or she will develop squamous cell carcinoma, a type
of skin cancer. See your doctor to discuss ways that you can quit smoking.

- M. Ellman

Bromocripting and Cigarette Smoking

In a recent article in the research journal Addiction, authors Murry Jarvik, Nicholas Caskey, William Wirshing, Damian Madsen, Paula Iwamoto-Schaap, Julie Elins, Naomi Eisenberger, and Richard Olmstead investigated the role bromocriptine can play in the treatment of cigarette smoking. In an empirical study, the authors compared 20 heavy smokers aged 18 to 58 years old. Half of the participants received 1 of 2 doses of bromocriptine (2.50 mg, 3.75 mg) over 3 sessions. The other half of the participants received a placebo. The smoking behaviors of all subjects were monitored and recorded for 5 hours after treatment. The experimental group (the group which received the bromocriptine treatment) was significantly different from the control group. Specifically, the people who received the bromocriptine treatment smoked fewer numbers of cigarettes and took fewer puffs off of each cigarette. In addition, the experimental group also had significantly lower levels of plasma nicotine and cotinine, which in turn is interpreted to mean that they not only craved cigarettes less than the control group, they also experienced less reinforcement from the nicotine. Finally, the researchers also found significantly lower levels of depression and decreased vigor than the control group. This is good news for individuals interested in augmenting their smoking cessation program with pharmaceutical interventions. The original article by the authors is in volume 95(8) of the journal Addiction (2000) pages 1173 to 1183.

Although bromocriptine appears to be beneficial for quitting smoking cigarettes, don't mistake it for a wonder drug. Like all medications, it does have its share of side-effects. Some serious side effects have occurred have included strokes, seizures (convulsions), and heart attacks. Some deaths have also occurred. You should discuss with your doctor the good that this medicine will do as well as the risks of using it. In addition, medical journals recommend against consuming any alcohol while on bromocriptine.

The following link provides some information from Excite's medical information page regarding bromocriptine.

Couple Approaches to Smoking Cessation

Carleton Palmer, Donald Baucom, and Colleen McBride have recently written an interesting chapter in the book The Psychology of Couples and Illness: Theory, Research and Practice (2000) in which they discuss, as the title would suggest, a couples-based approach to quitting smoking. Specifically, the authors look at the impact of a partner on a smoking person's behavior and habit and generate several useful suggestions to maximize the likelihood of successful cessation. The authors begin their chapter with a review of the literature regarding two person groups and quitting smoking, stating that having a partner who continues to smoke is a significant threat to continued abstinence once a person has quit smoking. This is actually congruent with addiction literature with other substances. Alcohol, cocaine and marijuana research as well as most 12-step programs emphasize the need to discontinue relationships with using friends and associations. Cigarette smoking, however, introduces a unique twist on this time tested and honored recommendation of breaking off relations with individuals who continue to use substances. Specifically, imagine someone entering an alcohol rehabilitation program. Let's say that after years of struggling and multiple loses, a husband begins treatment and experiences success in the initial stages, but his wife states that she intends to continue drinking alcohol, having alcohol in the house and inviting / encouraging visiting friends to have a drink as well. Your average person would understand that this situation is likely to be problematic and may, in fact, result in the marital discord and possibly divorce. Alcoholism is frequently viewed as a serious condition that frequently requires changes in the family unit during the course of treatment. Now take the same scenario and replace alcohol with cigarettes. The idea that someone might end a long-term monogamous relationship simply because one of the partners refuses to quit smoking can seem more trivial and less understandable. Although may would argue that the principal is the same and therefore termination the relationship may become necessary, the authors of Couple Approaches to Smoking Cessation emphasize attempting to work within the relationship to aid in quitting. They recommend both partners examine their reasons to continue to smoke and to quit, including looking at the costs and benefits of each choice. Even if both partners don't decide to quit (or don't decide to quit at the same time), the authors make recommendations regarding how the individuals interact.
For example, they recommend avoiding negative-coercive behaviors (i.e. nagging at or punishing each other, or using 'reverse-psychology' by making statements like "I knew you couldn't do it.") and instead emphasize supportive behaviors, targeting high-risk couple routines and couples therapy to reduce relationship stress and conflict. I felt the authors emphasis on improving couple relations and encouraging couple-based interventions is an interesting and timely suggestion that anyone who is quitting smoking and has a partner who smokes (and is planning to quit or keep smoking) is recommended to review.

Book Title:
The Psychology of Couples and Illness: Theory, Research and Practice (2000), American Psychological Association, Washington DC


Know that most relapses occur in the first week after quitting, when
withdrawal symptoms are strongest and your body is still dependent on
nicotine. Be aware that this will be your hardest time, and use all your
personal resources; willpower, family, friends, and the tips in this
booklet- to get you through this critical period successfully.

Know that most other relapses occur in the first week after quitting, when
situational triggers, such as a particularly stressful event, occur
unexpectedly. These are the times when people reach for cigarettes
automatically, because they associate smoking with relaxing. This is the
kind of situation that's hard to prepare yourself for until it happens, so
it's especially important to recognize it if it does happen. Remember that
smoking is a habit, but a habit you can break.

Realize that most successful ex-smokers quit for good only after several
attempts. You may be one of those who can quit on your first try. But if
you're not, don't give up. Try again.

Reframing Health Behavior Change with Behavioral Economics

Warren K. Bickel, Ed., and Rudy E. Vuchinich, Ed., have written an in-depth examination of factors influencing the wide spread use of tobacco and the difficulties of quitting smoking. Their work is presented in one section of the book, Behavioral Economics of Tobacco Smoking (published by Lawrence Erlbaum Associates, Inc., 2000) gives an overview of basic concepts of behavioral economics of tobacco smoking. Their work suggests that several elements negatively impact an individual's attempt at quitting smoking. Specifically, they report that the low social, behavioral and economic cost required to obtain nicotine reinforcement from smoking is the primary factor promoting smoking. Bickel and Vuchinish suggest that, since there continues to be minimal negative social consequences for tobacco use, the relatively low cost of tobacco and the ease at which cigarettes can be obtained, quitting smoking is an enormously difficult task beyond the pure addictive properties of nicotine.

Anti-smoking program didn't have an impact

WASHINGTON (AP) -- It was to be a showcase, world class demonstration of how to persuade school children not to smoke.
The $15 million program used the latest smoking prevention theories from the best social scientists. From the third grade on, children attended special classes and were meticulously instructed by trained teachers how to resist tobacco use.
But after 14 years, experts declared Tuesday that the project failed. More than a fourth of the former Washington state school children in the study are now regular smokers, about the same rate as those who didn't receive the special classes, according to a report in the Journal of the National Cancer Institute.
"It simply didn't work," said Arthur V. Peterson Jr., the project's lead researcher. "It was a surprise. It was a disappointment."
Peterson, who heads a cancer prevention program at Fred Hutchinson Cancer Research Center in Seattle, said researchers are now scrambling to find new approaches for controlling tobacco use among the young.
"It is time for researchers to go back to the drawing board," said Peterson.
He said techniques that have worked in some areas include denying youthful access to tobacco by raising taxes and controlling sales, and by countering tobacco company advertising with a heavy, youth-oriented media blitz.
The Fred Hutchinson Cancer Research Center study, involving 8,388 school children and 640 teachers in 40 school districts, was based on what is called a "social influences" approach.
The experiment included classes designed to arm children with the skills to ignore social pressures to smoke, to teach them about the dangers of smoking and to provide a motivation to remain smoke-free throughout life. The students were taught to resist advertising, peer persuasion and influences at home.
Children were targeted during the critical tobacco decision years -- the time in life when smoking habits that may last a lifetime are adopted.
The study started in September 1984 and continued until September 1999, with researchers following the progress of the test children as they grew older.
"This study was carefully conceived and meticulously performed, and it achieved a new standard of scientific rigor for prevention research," said Richard Clayton, a University of Kentucky researcher.
Yet it failed.
Surveys of the students in the study found that 24.4 percent of the girls and 26.3 percent of the boys were daily smokers by the 12th grade. That rate of smoking is almost identical to that among students who did not participate in the study, researchers found.

Study Links Smoking, Colon Cancer

By PAUL RECER, AP Science Writer

WASHINGTON (AP) - Smoking cigarettes for 20 years or more can increase by more than 40 percent the risk of dying of colorectal cancer, according to a study that blames tobacco use for nearly one in eight such deaths in the United States. A team of American Cancer Society researchers report Wednesday in the Journal of the National Cancer Institute that a study of 781,351 people over 14 years showed a strong statistical linkage between cigarettes and death from colon or rectal cancer.

"It is clear that cigarette smoking is associated with colorectal cancer mortality for both men and women," Ann Chao, a researcher with the American Cancer Society and first author of the study, said Tuesday. Chao said earlier lab studies showed that carcinogens in cigarette smoke may cause tumors in the colon and rectum and may damage the DNA in cells. The new study is the first to link cigarettes and colorectal cancer death among such a large number people followed for such a long period of time, she said.

Based on the study, Chao concluded that of the approximately 56,000 Americans who die annually of colorectal cancer, about 6,800 of the deaths, some 12 percent, are associated with cigarette smoking. Colorectal cancer is diagnosed in more than 780,000 people worldwide annually, according to the World Health Organization. There about 129,400 cases of colorectal cancer identified in the U.S. annually, according to 1999 figures from the American Cancer Society.

Cigarette smoking is identified by the Centers for Disease Control and Prevention as the cause of 160,000 deaths from eight kinds of cancer, but colorectal cancer is not included on that list as a disease linked to tobacco use, said Chao. Chao and her co-authors suggest in the study that colorectal cancer now should be classified as a "smoking-related cancer." Dr. Bernard Levin of the University of Texas M.D. Anderson Cancer Center in Houston said the study gives strong support for classifying colorectal cancer as a smoking-related illness.

"This study and others show that there is a high risk (of colorectal cancer) after 20 years or more of exposure (smoking)," he said.
Levin, the vice president for cancer prevention at M.D. Anderson, said the new study shows a clear dose-related effect from smoking: The more one smokes, the greater the risk of cancer. Smoking also has been linked to death from heart and pulmonary disease. The CDC estimates that cigarette smoking causes more than 400,000 premature deaths annually. In the research, Chao and her colleagues found that 4,432 people in the study group died of colon or rectal cancer over the 14-year period.

An analysis of the smoking habits of the 781,351 people in the study, said Chao, showed the risk of colorectal cancer death increased steeply among 20-year smokers. The risk of death from the disease, she said, was directly linked to the number of cigarettes smoked and to the number of years that a person smoked. For instance, people in the study who smoked more than 40 cigarettes a day were 54 percent more likely to die of the cancer than were those who never smoked. Smokers who have puffed for more than 60 years were 48 percent more likely to die of colorectal cancer than those who never smoked.

The age when smoking started also played a role, said Chao. People who started the habit before the age of 15 had a 47 percent greater risk of dying from colorectal cancer than did those who never smoked. Quitting cigarettes lowered the risk, but not until 20 years after quitting, when the risk became similar to that of those who never smoked.

Losing Your Voice

Back in 1968, Virginia Slims cigarettes capitalized on the burgeoning women's movement with its "You've Come a Long Way, Baby" ads, linking smoking with freedom and independence. Not only did the slogan become a popular catch-phrase, it helped boost cigarette sales-and paved the way for other cigarette companies to market directly to women. Within six years after the ads first appeared, the number of 12-year-old girls who smoked increased 110 percent, according to research published in the Journal of the American Medical Association. Virginia Slims (which is owned by Philip Morris U.S.A.) must have been hoping for a similar success in the fall of 1999 when the brand launched a $40 million advertising campaign using the language of personal empowerment. Headlined "Find Your Voice," the campaign showcased artfully photographed women of various ethnic groups, with text that included such phrases as "In silence I see. With wisdom I speak." But "Find Your Voice" found nothing but trouble.
When the ads, featuring black, white, Asian, and Hispanic models, started appearing in women's magazines, anti-smoking advocacy groups went on the offensive. "It was outrageous how they targeted young minority women, who traditionally haven't smoked as much as white women," says Matthew Myers, president of the Campaign for Tobacco-Free Kids. "Philip Morris saw a new market and went after this community with the focus of a laser beam."
Soon, the National Coalition for Women Against Tobacco, an 11 -million-member collective founded by the American Medical Women's Association, and other groups had mobilized a counter campaign. Enlisting former tobacco model and current cancer sufferer Janet Sachman as a spokeswoman, the National Coalition demanded an immediate end to what it saw as the tobacco industry's "newest attempt at recruitment." This past summer, Philip Morris's CEO told a Florida jury looking to award punitive damages in a class-action lawsuit brought against the nation's four biggest tobacco companies that the "Find Your Voice" line was "a mistake." (The admission came following the CEO's deposition, when a lawyer asked if "Find Your Voice" might be offensive to ex-smokers who were now victims of throat cancer.) Explaining that it doesn't "want people to look at our advertising and say that we're trying to do something wrong," Philip Morris edited out the offensive phrase-and then decided to shelve the entire campaign.
-Kathleen Renda

No More Free Smokes

Phoenix (AP) -- R.J. Reynolds has agreed to stop mailing cigarette samples to nonsmokers nationwide. Arizona Attorney General Janet Napolitano had demanded since November that the Winston-Salem, N.C.,-based tobacco manufacturer stop the practice.

R.J. Reynolds has maintained it did nothing wrong because the samples were sent only to people were sent only to people who signed up for assorted promotions and had certified that they were over age 21.

But in a letter Thursday to Napolitano from Reynolds vice president and deputy general counsel Guy M. Blynn, the manufacturer acknowledged that its mailing system for dealing with adult smokers is "flawed" because it allows unsolicited mail to be sent.

Effective immediately, the company said it would stop sending product samples nationwide to people in the current program, but the company will allow those on the mailing list to choose whether to stay on the list or be removed.

Nicotine Patch

Nicotine patches were introduced in 1992 amid much fanfare. Millions of dollars have been spent advertising the merits of this smoking-cessation method. Newspapers and magazines are sprinkled with ads promoting the patch. Fortunately, this is a case in which the product will likely live up to its billing!


Most nicotine patches look like large round Band-Aids. They contain a small amount of nicotine embedded in a special material. This material is kept in close contact with the skin by an adhesive.

How It Works

The patch releases nicotine, which is absorbed by the skin. The nicotine then enters the bloodstream. The amount of nicotine absorbed from the patch is lower than that provided by smoking a cigarette.

It has been known for a while that nicotine can penetrate intact skin. Over the last decade, a few investigators have studied nicotine patches and found that skin absorption of nicotine could decrease cigarette cravings. Soon thereafter a patch was developed that could release small amounts of nicotine over a twenty-four-hour period.


There are many reports that the nicotine patch reduces cigarette cravings, and recent findings have demonstrated that it can improve success rates among smokers who want to quit.

A recent report in The New England Journal of Medicine studied the safety and effectiveness of nicotine skin patches designed to release nicotine into the smoker's body over a sixteen-hour period. Subjects were given patches that were to be placed on the skin in the morning and taken off at night. Some were given patches that did not contain nicotine. No special counseling program accompanied this intervention.

The researchers found that the subjects given the real nicotine patches were more successful in quitting. The success rate at six weeks was 53 percent in the nicotine-patch group and 17 percent in the other. At the end of a year, the success rate was 17 percent in the nicotine-patch group and 4 percent in the other group. Symptoms of nicotine withdrawal tended to be less in the nicotine-patch group.

Another study involved nine medical centers and 935 patients. At the six-month mark, 1 in 4 subjects treated with the nicotine patch remained a nonsmoker as compared with 1 in 9 subjects treated with a patch that contained no nicotine.

These studies provide compelling scientific evidence that the patch is an effective aid for smoking cessation. There are few other methods that have undergone such screening by the medical community and have been found to be beneficial.

How to Use the Patch

The patches come in various strengths including 22, 21,15,14,11,10, 7, and 5 milligrams, depending on the manufacturer. The size of the patch is proportional to the amount of nicotine in it. Therefore, the 21-milligram patch is the largest and the 5-milligram patch is the smallest.

The patches may be used in a variety of different programs. One approach is to use a larger patch for six weeks and then move to smaller patches for two weeks each. Some people use the larger patch for a longer time. There is no magic way to tell when you are ready to switch to a smaller patch.

It is usually recommended that at six weeks you give a smaller patch a try. If you have trouble with symptoms when you switch, then you can always return to the larger patch. As with the nicotine gum, you should not use the patch unless you have stopped smoking.

The importance of this warning is highlighted by the recent reports of heart attacks in people who were wearing a patch and smoking. Although the contribution of the double dose of nicotine to the heart attack cannot be proven, there is concern among some physicians that the added nicotine played a role.

How to Place the Patch

The patch is designed to be placed on any non-hairy, clean, dry area of the body. The exact location of the patch does not matter. You should avoid areas that are oily, dirty, hairy, or irritated in any way. Open the storage packet and remove the patch. Place the patch on your skin and bold it there for about ten seconds, until you are sure that it sticks well. The entire patch, including the edges, should be firmly attached. Once you have placed the patch, you should wash your hands, since if you get nicotine in your eyes or nose, it could cause burning, stinging, or redness. The patch should remain in place for twenty-four hours and then be discarded. (Discard the patches in a place that is safe from children and pets.) If you leave the patch on for longer than twenty-four hours, it can irritate your skin. The next patch should be placed in a different location. You should not use one particular skin location more than once a week.

Side Effects

In recent large studies of the nicotine patch, there have been very few reported side effects. The most common complaint has been mild itchiness that lasted for fifteen to thirty minutes after placing the patch on the skin.

Does it matter at what time of day you apply the patch?

The time of day is not important. The patch can be put on at any time of the day or night, and this time can vary. All that you need to do is take off the old one and put on the new one.

What if you leave the patch on for longer than twenty-four hours?

Don't worry. The recommendation that the patch not be worn for longer than twenty-four hours is based on the observation that it may cause skin irritation. There should not be any other ill effects. Just remove the patch when you can.

Can you take a shower if you're wearing the patch?

The patch was designed to get wet without losing adhesiveness or effectiveness. You can bathe, swim, or shower while wearing it.

What if the patch falls off?

The patch is designed to stick well. If it does fall off, however, simply replace it. It is a good idea to carry an extra patch with you just in case you need it.

Which patch should you use?

Four nicotine-releasing adhesive patches for the skin - Nicoderm, Habitrol, Prostep, and Nicotrol - have been approved for the relief of nicotine withdrawal symptoms. They are all excellent products. Nicoderm and Habitrol are available in strengths of 7, 14, and 21 milligrams per day. Prostep is available in 11 and 22 milligrams per day, and Nicotrol is available in 5, 10, and 15 milligrams per day.

Nicotrol is designed to be worn only during waking hours, while the other patches should be worn for twenty-four hours. Nicotrol claims this is an advantage, but there is no evidence that indicates this patch is better than the others. In fact, there are no published comparisons of these patches in any clinical trials. Nevertheless, there are claims by the pharmaceutical companies that there are important differences in these patches relating to blood levels of nicotine, rate of allergic reactions, and ease of opening the package. At this time, all of the patches should be considered equally effective. The prices are similar; they average three dollars a day. The bottom line is that they are all excellent products and there is currently no clear advantage' to using one over the others.

Which dose should you use?

Patches should usually be started at the strongest strength. For Nicoderm and Habitrol, you should start with 21 milligrams per day; for Prostep, the 22-milligram strength; and for Nicotrol, 15 milligrams. For smokers who weigh less than 100 pounds, smoke less than half a pack of cigarettes per day, or who have cardiovascular disease, it may be preferable to start with a lower dose.

Physicians and Nicotine Replacement

Physicians may not always be the best source of information about nicotine replacement. A recent survey of California physicians practicing general medicine revealed that many were misinformed about the use of nicotine gum, even though almost 90 percent had prescribed it within the last year. Almost half of these physicians believed that, even if their patients did not stop smoking, they should use the gum to cut down on cigarettes. In addition, contrary to recommendations from authorities on smoking cessation, one in four of the doctors thought that the gum should not be used for more than one month.

The message is that not all doctors are informed (or even interested) in smoking cessation. It is your responsibility to educate yourself. If you are ready to quit, find a physician who knows about the gum or is familiar with the patch and has experience prescribing it.

Source: Krumholz, H. M. & Phillips, R.H. (1993) No If's, And's or Butts; the Smoker's Guide to Quitting , New York, Avery Publishing Group Inc.

Good News for Women: Stop Smoking, Not Eating

Ruth Kava
American Council on Science and Health

Smokers who quit smoking typically gain a modest amount of weight. This
weight gain seems to deter many women from attempting to quit, even though
the health benefits of smoking cessation far outweigh any negative health
effects of weight gain. "Fear of weight gain is particularly cited by
female smokers," notes Dr. Nancy Rigotti of the Harvard Medical School in
an editorial, "some of whom, it seems, would prefer to be slender young
corpses rather than plump women with long lives."

But one hypothesis suggests that those who exercise regularly while they
are quitting smoking may substantially diminish associated weight gain as
well as improve their chances of quitting. A study by Dr. B. H. Marcus and
coworkers published in the latest (June 14) issue of the Archives of
Internal Medicine, assessed whether exercise does indeed enhance the
ability to quit smoking and to maintain an ex-smoker status, while
reducing the tendency toward weight gain.

A total of 281 healthy but inactive young to middle-aged women took part
in the study. On average, the participants had smoked more than one pack
of cigarettes per day for over 20 years. The women participated in either
a behavioral smoking-cessation program alone (the control group), or in
the same program with the addition of three supervised sessions of
vigorous aerobic exercise per week (the exercise group). All participants
stopped smoking after the fifth week of the 12-week-long program.

Compared with the control group, the exercisers were significantly more
successful at maintaining their abstinence from smoking both 3 and 12
months after the formal program ended. At the same time, exercisers were
in better physical condition and had gained significantly less weight than
the sedentary quitters (6.7 versus 11.8 pounds).

Most of the effect of exercise on weight control was seen during the
period in which the subjects participated in the exercise intervention,
and the authors noted that weight gain was delayed but not completely
prevented in this trial. They suggested that this was due to some
subjects' stopping regular exercise once the 12 week treatment program
ended, and to others' possibly reducing their exercise frequency or
intensity once exercise sessions were no longer supervised.

Beyond the direct effects of exercise on increasing metabolic rate and
calorie expenditure, Marcus and colleagues state that "exercise may also
have advantages that complement existing treatments," "is effective in
modulating depression," and "is a beneficial strategy for managing
stress." Women smokers should take heart from these results -- they can
both quit smoking and eat at least some cake-as long as they keep moving!

American Council on Science and Health

Nicotine: Is It Addictive?

The answer to that question is an undeniable and resounding YES. Former U.S. Surgeon General C. Everett Koop compares nicotine's grip on its users to that of heroin. According to a study performed at the Henry Ford Health Sciences Center in Detroit, about 90 percent of smokers are persistent daily users and 10 percent are occasional users. That's almost the exact, reverse of another bad habit, excessive drinking. Only 10 to 15 percent of people who drink become dependent, problem drinkers, while most people use alcohol on an occasional basis.

What makes nicotine so addictive? Just 11 seconds after you take a puff of a cigarette--within five heartbeats--nicotine reaches the brain, where it attaches itself to certain receptors in a part of the brain called the limbic system. This action releases chemicals called neurotransmitters that affect cognition and alertness, as well as feelings of pleasure and satisfaction. Nicotine also increases the brain's uptake of glucose, an energy nutrient. Finally, nicotine slows down communication between certain parts of the brain, which causes you to feel more relaxed. Nicotine also causes your heart rate and blood pressure to rise, giving you a sense of stimulation and increased energy.

Now you can see why you crave nicotine: It helps you think faster, calm down, and feel pleasure--all within 11 seconds. If you smoke a pack a day and take 10 puffs from each cigarette, you stimulate your brain with nicotine 200 times a day. Unfortunately, though, you'll probably need more and more nicotine to get the same effect because most people develop a nicotine tolerance.

And those are just the purely physiological aspects of cigarette addiction. There's more, much more, to this habit than meets the lungs and brain.

So If I Quit Now, Will I Live Longer?

Did you know that people who quit smoking live longer than people who continue to smoke? After fifteen years off cigarettes, the risk of death for ex-smokers returns to nearly the level of people who have never smoked. Male smokers who quit between ages 35to 39 add an average of five years to their lives. Female quitters in this age group add three years to their lives. These are averages - for some people, it's a lot more years.

If you're thinking that the earlier facts (see previous updates to the web page below) about lung disease don't apply to you, as your family has no history of lung cancers, it's important to consider the following: it's a surprisingly overlooked fact that even more people die from heart disease associated with smoking than from smoking-related cancers. Inpatients with diabetes, a condition which often leads to heart disease, smoking further increases heart and stroke risks.

Tobacco use is also associated with other diabetic complications, including nervous system damage (neuropathy) and blindness caused by damage to the retinas of the eyes (retinopathy). Blindness due to age-related macular degerations is also more common among diabetics and nondiabetics who smoke. So, if either heart disease or diabetes is part of your family's medical history, the facts about the dangers of smoking are just as applicable to you.

What If You're Already Sick?

What if you already have a smoking-related illness? You'll be glad to know that the benefits of quitting smoking also apply to people who are currently sick:

For people with...

Quitting smoking...

Heart Disease

Reduces the risk of repeat heart attacks and death from heart disease by 50 percent or more.

Peripheral Artery Disease

(poor circulation to the legs)

Improves ability to exercise and increases overall survival.


Reduces the risk of recurrence and improves short-term healing.

Lung Cancer

Favorably improves response to many types of anticancer treatments and reduce3s risk of recurrence of cancer.

Source: Fisher, E. B. (1998). 7 Steps to a Smoke-Free Life. John Wiley & Sons, Inc. New York.

Smoking Facts:

  • 70% of all smokers want to quit
  • 419,000 Americans die from diseases caused by smoking every year
  • $65,000,000,000 cost to U.S. in healthcare and lost productivity
  • 34% of smokers attempt to quit each year
  • Cigarette smoking can cause impotency
  • Quitting cigarettes can be harder than quitting heroin or cocaine
  • Women who smoke have a 50% higher risk of having a heart attack than male smokers
  • Women smokers are twice as likely as male smokers to get lung cancer
  • Lung cancer has surpassed breast cancer as leading killer of American women
  • Cigarettes are the leading cause of fire fatalities
  • 1 pack per day puts 1 quart of tobacco tar in lungs each year
  • Lung cancer is the leading cause of all cancer deaths
  • Smoking is the single largest cause of preventable sickness and death in the United States.
  • Approximately 40 million Americans smoke cigarettes...25% of the adult population.
  • 17% of teenagers smoke.
  • 3,000 teens start smoking every day.
  • Parents who smoke are much more likely to have children who smoke.
  • Half of all people who have ever smoked have now quit.
  • The prevalence of smoking is highest among adults aged 25-40 (30%) and lowest among those 65+ (13%).
  • The state with the highest percentage of smokers is Nevada (30.5%), followed by Alaska (28.0%) and Kentucky (27.9%).
  • The state with the lowest percentage of smokers is Utah (15.6%), followed by Nebraska (17.4%) and Montana (18.0%).
  • Smoking accounts for at least 7% of all health care costs in the US, an estimated $50 billion dollars in 1993.
  • The federal government and state governments pay for more than 43% of all smoking-related medical expenses.
  • Tobacco kills more Americans (450,000) each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fire and
  • AIDS combined.

IRS rewards those who quit smoking


Smokers trying to kick the habit can claim some costs as medical expenses on income tax returns under a decision by the Internal Revenue Service that reverses a 20-year-old agency position. Doctors involved in smoking cessation programs said the IRS ruling could have broader ramifications by persuading providers of health benefits packages to include such treatment in their coverage. "It's about time," said Dr. Mike Eriksen, director of smoking and health at the federal Centers for Disease Control in Atlanta. "There is no better preventative program than stopping someone from smoking."
Citing Surgeon General reports since 1988 that nicotine is addictive and smoking harms health, the IRS concluded that programs and prescription drugs that help someone quit smoking are no different from efforts to treat alcoholism or drug addiction -- both of which are tax deductible.
"What the research of the last decade has documented is that this is one of the most powerful addictions that a person can succumb to," said Dr. Michael Fiore, director of the Center for Tobacco Research and Prevention at the University of Wisconsin. "It's not just some bad habit. It's a dangerous, chronic disease." In revoking its 1979 position against the deduction, the IRS agreed.
"A strong causal link exists between smoking and several diseases," the agency said in its announcement. "Nicotine, a substance common to all forms of tobacco, is a powerfully addictive drug." Not every expense can be deducted. The law does not permit a taxpayer to claim such non-prescription medications as nicotine patches or gum. Also, the total in medical expenses -- smoking-related or otherwise -- must reach 7.5 percent of a taxpayer's adjusted gross income in order to qualify as an itemized deduction. But prescriptions, doctor bills or cessation programs offered by hospitals or other treatment facilities could be deducted, so long as they are not reimbursed by an employer or by insurance.
Eriksen said there are an increasing number of intensive programs available, including some at drug treatment centers that have added nicotine addiction. There are also more and more pharmaceutical options, he said.
"It's the right thing to do in terms of the dollar invested and the dollar saved," he said.
Taxpayers who paid for a smoking cessation program in recent years could file an amended return to claim those costs, particularly if they already had enough medical expenses to qualify.
Other taxpayers should check past returns to figure if the smoking expenses reached the 7.5 percent of adjusted gross income threshold.
Taxpayers can generally file an amended return for three years after the due date of the original return using IRS Form 1040X.

Exercise Helps Smokers Quit

SOURCE: Chicago (AP)

Women who exercise vigorously while trying to quit smoking are twice as likely to kick the habit than ex-smokers who don't work out regularly, a new study finds. The report also offers good news to female smokers who fear that giving up tobacco and nicotine will lead to weight gain. Researchers found that women who worked out as they tried to quit gained only about haft the weight of those who did not.

"I can't say that definitively this will help all people, but given all of the other health benefits associated with regular exercise I would certainly encourage people trying to quit smoking to talk to their physicians about starting a program," said Bess Marcus, an associate professor of psychiatry and human behavior at Brown University and the study's lead author.

The findings appear in the Archives of Internal Medicine. Researchers at The Miriam Hospital in Providence, R.I., followed 281 healthy but sedentary female smokers who attended a 2-week program to stop smoking. Haft of the women participated in supervised workouts three times a week during the program While the others did not.

Of the 134 women in the group who exercised regularly, 19.4 percent kicked the habit for at least two months after their program ended while 10.2 percent of the 147 non-exercisers did the same. Three months ~later, the comparison of those still smoke-free was 16.4 percent to 8.2 percent, respectively, and 11.9 percent vs. 5.4 percent a year later. The women ranged between ages 18 and 65 and had smoked routinely for at least a year.

"There seems to be a new drug every day to help you quit smoking," Marcus said in a telephone interview Sunday. "But this study suggests that there's a drug-free alternative to quitting smoking if that's what you prefer."

SOURCE: American Cancer Society

Many changes occur in the body after quitting smoking. The following list represents some of the common positive benefits that take place after you stop smoking:

  • In 20 minutes: blood pressure falls and the pulse rate returns to normal.
  • In 24 hours: chance of a heart attack decreases.
  • In 48 hours: taste and smell are enhanced.
  • In 2 weeks to 3 months: blood circulation improves and lung function increases up to 30 percent.
  • In one month to nine months: coughing, sinus congestion, fatigue an shortness of breath decrease. Lunch function continues to improve and overall energy increases.
  • In one year: excess risk of heart disease is half that of a smoker.
  • In five years: rate of lung cancer drops by almost half.
  • 5 to 15 years: risk of stroke is reduced to that of a nonsmoker. Risk of cancer of the mouth and throat is half that of a smoker.
  • 10 years: Rate of lung cancer is similar to non-smokers.
  • 15 years: Risk of heat disease is the same as for a non-smoker.

The benefits of quitting for your health and well-being are numerous and significant. It's never to late to stop smoking!

SOURCE: No If's And's or Butts: The Smoker's Guide to Quitting by Harlan Krumholz, MD and Robert Phillips, PhD

What Exactly Happens During Nicotine Withdrawal?

Nicotine is a syndrome resulting from the abrupt cessation or reduction of the use of nicotine-containing substances that have been employed for a least a moderate duration and in moderate amounts (approximately at least 5 weeks).

Symptoms of nicotine withdrawal include: heart rate may slow, blood pressure may rise and other physiological and psychological reactions. In order to be medically diagnoses with nicotine withdrawal you must meet the following criteria:

  • Daily use of nicotine for at least several weeks
  • Abrupt cessation or reduction of nicotine followed within twenty-four hours by at least four of the following symptoms:
    • craving for nicotine
    • irritability, frustration or anger
    • anxiety
    • difficulty concentrating
    • restlessness
    • decreased heart rate
    • increased appetite or weight gain

Commonly reported symptoms also include: depression, disrupted sleep, impatience, impaired work performance and increase enjoyment of sweets. Cigarette craving is the most commonly experience symptoms.

BUT REMEMBER, these symptoms don't last forever!

SOURCE: Good Housekeeping, May 1998:

Smokers have many options available to them to aid in quitting smoking with the use of pharmaceutical interventions. The following table presents findings regarding effectiveness, side effects and costs for 5 commonly used medications.

Drug Name:

Bupropion Hydrochloride (Zyban)

How it Works

Smokers start taking the drug about 2 weeks before they plan to quit and for 7 to 12 weeks afterward. The drug eases withdrawal symptoms by acting on the same brain receptors affected by nicotine.


After 1 month, 49 percent of users still aren't smoking. A preliminary study found that after 1 year, 23 percent of users had kicked the habit.

Side Effects

Dry mouth, constipation and insomnia. Smokers who are taking other antidepressants and those who have kidney problems, epilepsy, alcoholism or eating disorders should not use.


About $270 for a 12-week supply (insurance may cover).

Best For

Smokers who don't want to use nicotine methods, or those who become depressed after quitting.

Drug Name:

Nicotine Inhaler (Nicotrol Inhaler)

How it Works

Smokers suck in nicotine vapor, satisfying the familiar hand-to-mouth ritual. The chemical even delivers the sensation smokers get in the back of their throat. The during is absorbed within 15 to 30 minutes.


After a year, 10 to 20 percent of users still aren't smoking.

Side Effects

Mild irritation of the throat or mouth; coughing. Smokers with a asthma, allergies and sinus conditions should check with their doctors before using.


About $180 to $360 for a 2 month supply (insurance may cover).

Best For

Smokers who miss the hand-to-mouth ritual of the habit.

Drug Name:

Nicotine nasal spray (Nicotrol NS)

How it Works

The smoker squirts it into her nostrils whenever she feels the urge to light up. The drug is absorbed within 5 minutes.


After a year, 10 to 20 percent of users still aren't smoking.

Side Effects

Nose and throat irritation; upset stomach. Smokers with asthma and allergies should check with their doctors before using.


About $280 for a 2 month supply (insurance may cover)

Best For

Pack-a-day smokers who need to satisfy their nicotine cravings quickly.

Drug Name:

Nicotine patch (NicoDermCQ, Nicotrol; Habitrol and Prostep by prescription only).

How it Works

Placed on the arm, the patch delivers nicotine into the blood stream over a 24-hour period.


After a year, 10 to 20 percent of users still aren't smoking.

Side Effects

Reports of nausea and light-headedness in those who smoke while wearing the patch. Also, sleep disturbances and skin irritation.


About $240 to $300 for a 2-month supply (insurance may cover).

Best For

Smokers who prefer a low-maintenance product.

Drug Name:

Nicotine Gum (Nicorette)

How it Works

The smoker chews until she feels a slight tingling or peppery taste. Then she places the product between her cheek and gum until the sensation is gone. Nicotine is released into the bloodstream within 20 to 40 minutes.


After a year, 10 to 30 percent of users still aren't smoking.

Side Effects

Some complaints of unpleasant taste. Smokers with dental problems, such as denture or temporomandibular joint dysfunction can't use.


About $240 for a 2-month supply (insurance probably won't cover).

Best For

Smokers who need to satisfy an oral fix, but don't want to use the inhaler).

It is important to remember that smoking has many behavioral components. Without addressing these components (i.e. counseling, group therapy, work-shops, self-help treatment plans, etc.) it is likely that medications alone with fail.

The patch/nicotine-blocker (a substance that inhibits the pleasurable effects of nicotine) is in the final testing phase at the FDA and may be on the market as soon as next year.