Tuesday, July 1, 2008

Want to Quit Smoking?

Technology is helping to make winners of quitters.
The internet has long been rife with self-help sites for those who wish to give up smoking, but new technologies are emerging to give smokers a leg up in their struggle.
There are websites that offer interactive resources to motivate quitters and keep them on track, mini-computers that can help you track your progress, and software for hand-helds that makes it easier for doctors to pitch in.
"These technologies offer a lot of promise -- they are very intriguing," said Scott Strayer, a physician who developed software called the Handheld Computer Smoking Intervention Tool for the National Cancer Institute.

The software allows clinicians to access data about smoking cessation, drug interactions, addiction evaluations and other information to use in interviews as people begin the effort to quit.
The role of computers is evolving, said Strayer, a family practice physician who teaches at the University of Virginia. He hopes the next generation of hand-held medical devices will be able to track smokers' progress and link their quitting regime with their health records, to give doctors a portable and unobtrusive profile of their patients' efforts.
Though there has been little clinical research, Strayer said websites with interactive capabilities like social networking also can improve the chances of kicking the habit for good.
A study published last month in the New England Journal of Medicine found smokers tend to quit in groups and that real-life social networks add to the pressure to quit.
Researchers at the University of California-San Diego said they looked at 12,000 socially interconnected people over 32 years. They did not examine online communities, but some researchers believe that what works in the real world also would work online.
One of the best online communities is at a site run by a suburban Boston woman, Terry Miller (quitsmoking.about.com). It offers an environment of mutual encouragement and support among its thousands of members, who gather dots, stars, keys and wings as they progress.
Miller, a 51-year-old mother of two, logged on to the site after smoking for 26 years. That was six years ago and Miller now operates the site, which she says has helped thousands of people quit.
Miller says the online community actually may work better than a real-life social circle at helping people. For example, the support community online is far bigger, it's made up entirely of individuals on a shared journey, and it's available to quitters round-the-clock.
"In all of the years I've been participating at the ... forum, the idea of stepping outside of oneself to help another has been the foundation of the community. It's contagious and self-sustaining," Miller said. Though she has no firm evidence, Miller believes the success rate for people who join the site is much higher than the 7 percent who succeed in the general population.
Beth Bock, a professor in the Department of Psychiatry and Human Behavior at Brown University Medical School, has been studying online resources for aspiring quitters for years. Her latest research, due to be published shortly in the Journal of Medical Internet Research, found that while web-based resources are plentiful, it may be difficult to locate the best sites.
An analysis of the top results for search terms like "quit smoking" or "smoking cessation" found three of every four sites offering little or no quality resources; many merely sold smoking-cessation products or listing articles.
The best sites followed U.S. Public Health Service guidelines, which include assessing how ready smokers are to quit, assisting them with plans, providing practical counseling tips and suggestions, offering social support, recommending mediation and arranging follow-up.
Interaction is crucial, Bock said, and while some sites provide ways for smokers to interact with each other, they could be doing much more.
The QuitKey mini computer helps quitters keep track of their progress.

Then there are devices like the QuitKey, a computer small enough to carry on your key chain, and which can prod you, step by step, along the path to nicotine freedom.
In step one, you smoke normally but press a button, to allow the device to track your tobacco habits. The little computer creates a profile of your addiction. Then, in stage two, it prompts you when to smoke, gradually reducing the number of cigarettes per day until it reaches zero.
If all else fails, there is a South American website called Build Your Own Death Project (irreal.cl/byodp) that offers a novel way of reminding smokers of the deadly consequences their habits can have.
The site allows smokers to download, print and assemble cigarette packaging with skeletons, ghosts and other ghoulish graphics on them and names like "Cancers," "Muerte" and "Suicide."

Quit smoking with a proven approach

I read with interest the open letter from Dr. Brad Rodu to Sen. Obama in the June 22 Perspective section ("Quitting ins't that easy"). In this open letter, Dr.Rodu advocated the use of smokeless and spit tobacco (which I will refer to only as spit tobacco) to reduce the cravings of nicotine addiction and reduce the harm from cigarettes. He minimized the risk from spit tobacco in his comments.

As a physician who has spent my professional career helping those with nicotine addiction, I would like to offer an alternative view. Using spit tobacco for smoking cessation is an area of controversy among anti-tobacco advocates. Many of us who have cared for patients with their tongues or half their jaws removed because of spit tobacco would not advocate its use. Moreover, UST, Philip Morris, RJ Reynolds and other producers of spit and smokeless tobacco are marketing flavored packets designed to attract and addict young people. And many spit tobacco products deliver more nicotine than cigarettes.

While I support using a variety of techniques for smoking cessation for my patients, I would suggest that a safer method than spit tobacco is using approved nicotine replacement such as patches, gum and lozenges. In fact, the most recent update of the CDC Guidelines for Smoking Cessation doesn't recommend use of spit tobacco but does recommend the use of combinations of nicotine replacements, such as patches plus gum, finding that the results were as good as using other pharmacologic therapy. And the cost is comparable to using spit tobacco. Moreover, all smokers have access to the national quit line (1-800-QUITNOW) and many states provide nicotine replacement therapy for those who can't afford it or whose insurance doesn't cover it.

I would urge all smokers trying to quit to use a proven approach which is safer than spit tobacco.


Quick, what's the greatest threat to a smoker's health? Lung cancer is a good guess, and a wrong answer. Cigarettes cause 124,000 lung-cancer deaths in America each year, but they kill even more people (138,000) via heart disease. Smokers suffer heart attacks at twice the rate of nonsmokers--and they're less likely to survive them. Fortunately, these effects are reversible. Quit smoking, and your risk of a heart attack drops almost immediately, returning to that of a never-smoker within five to 15 years. Breaking the addiction isn't easy--some 40 percent of smokers try each year, and most of them fail. But a failed attempt is not a final defeat. What distinguishes successful quitters is their willingness to keep trying. Smoking cessation is a marathon, not a 50-yard dash, and winning takes practice. Here are some strategies for reaching the finish line.

Think ahead. It often helps to set a date to quit and to spend some time preparing yourself for the challenges you'll encounter. The first ones are physiological. Tobacco smoke delivers nicotine, a powerful psychoactive drug, to the nervous system. Most smokers become irritable, restless, anxious or depressed when they try to go without it, and many have trouble concentrating and sleeping. Fortunately, these withdrawal symptoms are transient. They usually peak within two to three days and then wane steadily. So think beyond the discomfort of the moment. If you can make it to day four, life will get easier.

Use crutches. Medical treatment makes the transition easier. Nicotine administered through patches, gums, lozenges, inhalers or nasal sprays can alleviate withdrawal symptoms, and the prescription drug Zyban (bupropion) can help reduce craving. Studies suggest that quitters who use any of these aids double the chances of success. For best results, you should continue using them for two to three months.

Change your routine. Nicotine isn't the only reason quitting smoking is hard. Cigarettes become a part of a smoker's everyday routine. If you're accustomed to lighting up whenever you have a cup of coffee, finish a meal or encounter a stressful situation, you may need to recondition yourself. Simple tricks can help you sidestep temptation. Some people try switching from coffee to tea for a while, or using a toothpick as an after-dinner pacifier. New rituals are easy to adopt, and they quickly become old ones.

Seek support. Quitting is easier if you have people to lean on, so don't go it alone. Friends, co-workers and family members can provide much-needed moral support, especially if they've been through the process themselves. Physicians and psychotherapists can offer valuable counseling. And though smoking-cessation programs can't guarantee results, they can increase your chances of success. Free information and counseling are now available nationwide at 800-QUIT-NOW or through Web sites such as smokefree. gov, cdc.gov/tobacco and quitnet.com.

Smoking is a powerful addiction, but it can be beat. Former smokers now outnumber current ones in this country, and indoor-smoking bans are giving people new incentives to quit. Medicines now in development could soon make smoking cessation easier, but no one should wait for them. Today's treatments are effective, and too few smokers are benefiting from them.