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A \'No Smoking\' sign
Smoking cessation is the effort to stop smoking tobacco products. Nicotine is an addictive substance, especially when taken in by inhaling tobacco smoke, probably because of the rapid absorption through the lungs. Tobacco use is one of the major causes of death worldwide, according to the World Health Organization. World Health Organization, Tobacco Free Initiative .Contents |
Research in western countries has found that approximately 3-5% of quit attempts succeed using willpower alone (Hughes et al, 2004) and clinical trials have shown that Nicotine Replacement Therapy (NRT) (see below) can double this rate to approximately 6-10% (Silagy et al, 2004). This is a small effect but is considered very worthwhile. Multi-session psychological support from a trained counselor, either individually or in groups has been shown in clinical trials to have an effect similar to that for NRT. The best chances of success can be obtained by combining medication and psychological support (see below) (USDHHS, 2000). Apart from NRT, medication that have been shown to be effective in clinical trials are: the tricyclic anti-depressant nortriptyline, bupropion (Zyban,or Quomem in some countries) and the nicotinic partial agonist, varenicline (Chantix in the US and Champix elsewhere). Thorough reviews of the evidence for all these methods of stopping are available via the Cochrane Library website Cochrane Library
There are many people and organizations touting what are claimed to be effective methods of helping smokers to stop. Any smoker thinking of paying money for such help would be well advised to ask whether the claims of success are backed up by indepedent comparative clinical trials, how the success rates have been calculated and what numbers of smokers have been included in the figures. It is very easy to make misleading claims of success rates which are not adequately supported by evidence.
A range of population level strategies such as advertising campaigns, smoking restriction policies, and tobacco taxes have been used to promote smoking cessation. Of these, raising the cost of smoking is the one that has the strongest evidence (West, 2006).
Smoking cessation will almost always lead to a longer and healthier life. Stopping in early adulthood can add up to 10 years of healthy life and stopping in one\'s 60s can still add 3 years of healthy life (Doll et al, 2004). Stopping smoking is also associated with better mental health and spending less of one\'s life with diseases of old age.
The most common short-term effects of stopping smoking are: increased irritability, depression, anxiety, restlessness, difficulty concentrating, increased appetite, constipation, mouth ulcers and increased susceptibility to upper respiratory tract infections. These mostly last for up to 4 weeks, though increased appetite typically lasts for more than 3 months. The most obvious long-term effect is weight gain (Hughes, 2007).
Smoking cessation services, which offer group or individual therapy can help people who want to quit. Some smoking cessation programs employ a combination of coaching, motivational interviewing, cognitive behavioral therapy, and pharmacological counseling.
Trials have shown that an effective method for quitting smoking is cognitive behaviour therapy or CBT. For example, the QUIT FOR LIFE Programme (David Marks, 1993, 2005) has produced quit rates that are 5-6 times higher than quitting by willpower alone (Marks & Sykes, 2002).
While some smokers are successful with their first attempt, many people fail several times. Many smokers find it difficult to quit, even in the face of serious smoking-related disease in themselves or close family members or friends. A serious commitment to arresting dependency upon nicotine is essential.
Some studies have concluded that those who do successfully quit smoking can gain weight. "Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit." (Williamson, Madans et al, 1991) Therefore, drug companies researching smoking-cessation medication often measure the weight of the participants in the study.
Tobacco smoking has a laxative effect, smoking cessation may lead to constipation, however this is by no means inevitable and is easily treated. Nicotine withdrawal symptoms:Constipation. helpwithsmoking.com (2005). Retrieved on 2007-06-29.
Major depression may challenge smoking cessation success in women. Quitting smoking is especially difficult during certain phases of the reproductive cycle, phases that have also been associated with greater levels of dysphoria, and subgroups of women who have a high risk of continuing to smoke also have a high risk of developing depression. Since many women who are depressed may be less likely to seek formal cessation treatment, practitioners have a unique opportunity to persuade their patients to quit. The impact of depression on smoking cessation in women.
A 21mg dose Nicoderm CQ patch applied to the left arm
Techniques which can increase smokers\' chances of successfully quitting are:
Bupropion is contraindicated in epilepsy, seizure disorder; anorexia/bulimia (eating disorders), patients use of psychosis drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium)Charles F. Lacy et al, LEXI-COMP\'S Drug Information Handbook 12th edition. Ohio, USA,2004
Some \'alternative\' techniques which have been used for smoking cessation are:
Several studies have found that smoking cessation advice is not always given in primary care in patients aged 65 and olderMaguire CP, Ryan J, Kelly A, O\'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing. 2000 May;29(3):264-6. PMID 10855911Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J. Smokers ages 50+: who gets physician advice to quit? Prev Med. 2000 Oct;31(4):364-9. PMID 11006061, despite the significant health benefits which can ensue in the older populationFerguson J, Bauld L, Chesterman J, Judge K. The English smoking treatment services: one-year outcomes. Addiction. 2005 Apr;100 Suppl 2:59-69. PMID 15755262.
One effective[citation needed] way to assist smokers who want to quit is through a telephone quitline which is easily available to all. Professionally run quitlines may help less dependent smokers, but those people who are more heavily dependent on nicotine should seek local smoking cessation services, where they exist, or assistance from a knowledgeable health professional, where they do not. Some evidence suggests that better results are achieved when counselling support and medication are used simultaneously[citation needed]. Quitting with a group of other people who want to quit is also a proven[citation needed] method of getting support, available through many organizations.
Health professionals may follow the "five As" with every smoking patient they come in contact with:Le Foll B, George TP (2007). "Treatment of tobacco dependence: integrating recent progress into practice". CMAJ 177 (11): 1373–80. doi:10.1503/cmaj.070627. PMID 18025429.
Information for Healthcare providers may be found in the official site of the Israeli College of Physicians for Smoking Prevention and Cessation.
Psychology, Health & Medicine. 2005;7:17-24.
Stop-tabac.ch: smoking cessation website in 5 languages
This article is licensed under the GNU Free Documentation License. It uses material from Wikipedia