Smoking and Health

Question 1

History of Smoking

Answer 1

• In 1826, the pure form of nicotine is finally discovered and scientists find that it is dangerous
• in 1847, Phillip Morris is established

Question 2

Smoking is directly related to ___% of lung deaths and ___-___% of Chronic Obstructive Pulmonary Disease deaths?

Answer 2

90% and 80-90%

Question 3

Hazards of Smoking?

Answer 3

Causes cancer, heart disease, stroke, lung diseases, diabetes and COPD

Question 4

How can smoking cause lung cancer?

Answer 4

• smoking damages your lungs natural cleaning and repair system and traps cancer-causing chemicals in your lungs
• chemicals mix and form sticky tar that lines your lungs
  the cilia that lung your lungs help clean dirt
• if cilia are covered in tar, they cant clean properly and germs, chemicals, and dirt stay in lungs and cause disease-cancer

Question 5

How can smoking cause COPD?

Answer 5

• as you breathe in, your alveoli help you absorb oxygen into your body, and as you breathe out, alveoli help you get rid of the waste gas-carbon dioxide.
• smoking damages the structure of the alveoli by making it less stretchy-harder for lungs to take in oxygen and get rid of carbon dioxide
• leads to shortness of breath and feeling tired
• the heart has to work hard to give body oxygen it needs
• over time, this damage leads to COPD

Question 6

How many Canadians and Americans does smoking kill a year?

Answer 6

• 37000 Canadians and 480000 Americans a year

Question 7

Economic Costs of a Smoke vs. Non-Smoker

Answer 7

• healthcare for smokers are higher

- overall, smokers cost healthcare systems less because they die younger

Question 8

Benefits of Quitting Smoking

Answer 8

• After 20 minutes your blood pressure and pulse
  return to normal
• After 12 hours the carbon monoxide level in your blood drops to normal
• After 24 hours your lungs start to clear
• After two days your body is nicotine-free and your sense of taste and smell improve
• After three days you can breathe more easily, and your energy increases
• After two to 12 weeks, your circulation improves.
• After three to nine months coughs, wheezing and breathing improves
• After one year your heart attack risk is half that of a smoker
• After 10 years your lung cancer risk is half that of a smoker
• After 15 years the risk of coronary heart disease is that of a non-smoker

Question 9

Health Consequences of Smoking Cessation

Answer 9

• Smoking cessation results in many positive
  health consequences; most immediately and
  substantially cessation reduces the risk for
  coronary heart disease and other
  cardiovascular diseases

Question 10

High Recidivism Rates

Answer 10

• Failure rates amongst self-quitters have
  consistently been shown to be as high as 95-98%
  after 1 year
• Relapse after quitting is fast and common
• (nearly half relapse within 2 weeks)
• Up to 70% of current smokers wish to quit or have made at least 1 quit attempt (Graul et al., 2005; Maurer et al., 2006)

Question 11

Why is Quitting hard?

Answer 11

• Weight Managment: nicotine regulates metabolism
• Psychological: helps control mood and stress
• Habit and Sensory (reinforcing cues): risky situations that trigger the urge to smoke
• Risk factors: depression, history of alcohol or drug abuse, low SES, co-morbidity

Question 12

Nicotine- How it works

Answer 12

• within several seconds, about 1/4 of the nicotine has gone through the bloodstream straight to the brain

Question 13

Nicotine Metabolism

Answer 13

• nicotine is metabolized to cotinine, and cotinine is metabolized to 3-hydroxycotinine by the liver enzyme cytochrome P450 2A6
• the rate of nicotine metabolism has been found to predict smoking behaviour

Question 14

Cutting back vs. Quitting

Answer 14

• health benefits only seen for quitting
• cutting back may been effective first step to ultimately quitting
• approved method of quitting in Europe but not US

Question 15

Why could exercise help?

Answer 15

Exercise has positive effects on mood
- elevated mood/reduced anxiety
- reduced drug cravings
- withdrawl relief
Exercise increases self-efficacy/coping
- increased likelihood of quitting
Exercise may be a competitive behaviour to smoking and hence incompatible
Promotes healthy weight and may reduce post cessation weight concerns
Exercise has favourable effect on CUD risk profile

Question 16

Study: Effect of Exercise on cigarette cravings and ad libitum smoking following concurrent stressors
By: Fong, jesus, bray, prap

Answer 16

• Exercise significantly decreased cravings following concurrent stressors
• Exercise had no effect on ad lib smoking

Question 17

Nicotine Replacement Theory

Answer 17

Reward Pathway: Nicotine stimulates nicotonic acetylcholine receptors located in the ventral tegmental area –> leads to the release of copamine in the nucleus accumbens
- all of the NRT products rely on systemic aterial delivery as cigarettes

Question 18

Study: The effect of acute exercise on cigarette cravings while using a nicotine lozenge
by: tritter, fitzgeorge, prap

Answer 18

Method: Measures

1. Cigarette Cravings
   - desire to smoke
   - single-utem statement
   - 7-point Likert Scale
2. Withdrawal Symptoms
   - Mood and Physical Symptoms Scale
   - 5 single-items that are believed to be part of the nicotine withdrawal syndrome including: depressed mood, irritability, restlessness, hunger, poor concentration
   - 5-point scale

Conclusion:

• engaging in an acute bout of moderate-intensity exercise while consuming a nicotine lozenge yields additive cigarette craving relief for recently quit smokers
• means that when feasible, one should utilize both treatments simutaneously to maximise relief

Question 19

Psychological Mechanisms

Answer 19

• Exercise, Expectancy Effect: expentancy beliefs towards exercise are un-related to reductions in cravings
  Exercise serves as a distraction
• idea that if a smoker redirects their attention toward something else, urge will pass
• possible that it may play a small role early on in the exercise bout, but it is unlikely to have any effects once the exercise stops
  Alleviates affect/mood disturbances
• some evidence that exercise can reduce negative affect (i.e. depressed mood, irritability) which in turn can reduce cravings
• some evidence that exercise can reduce negative mood and enhance positive mood which in turn can reduce cravings

Question 20

Study: Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation
by: daniel, cropley, fife-schaw

Answer 20

results:

• no significant group main effects were found for desire to smoke
• in other words, all groups showed a similar reduction in desire to smoke during and following exercise

Question 21

Cortisol

Answer 21

• has been shown to drop during the first 2 weeks of abstinence and low cortisol on the first day of abstinence has been associated with increased tobacco cravings and withdrawal symptoms
• one plausible explanation for this counterintuitive finding is that there is an increase in nicotine receptor sensitivity associated with a reduction in cortisol leading to an intensification of tobacco craving and withdrawal symptoms
• acute exercise in humans has been shown to elevate cortisol levels. Through extension, exercise may help buffer both the desire to smoke and withdrawal symptoms by raising cortisol levels back to normal, thus regulating the body’s cortisol response in the absence of nicotine

Question 22

Study: Seminal work by Marcus and Colleagues Design

Answer 22

Design
- half the group attended a cessation program with a 3x a week wellness program, and the other half attended a cessation program with supervised vigorous exercise 3x a week
- participants were asked to stop smoking at the end of week 4
- abstinence from smoking was based on continine and CO cut-off points
- abstinence was measured 1 week after quit day, end of treatment and 3 and 12 months later
Results
- quitters gained significantly more weight than non-quitters
- among quitters, exercise subjects gained significantly less weight than control subjects at the end of treatment
Conclusions:
- These results are encouraging..suggest the adding exercise to a CBT cessation program has value
- the marginal benefits of adding pharmacological agents, such as nicotine replacement therapy, deserves exploration