Smoking cessation

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Smoking cessation (also known as stop smoking or just stop ) is the process of cessation of tobacco smoking. Tobacco smoke contains nicotine, which is addictive. Nicotine withdrawal makes the stopping process often very long and difficult.

Seventy percent of smokers want to quit smoking, and 50 percent report trying to quit in the past year. Smoking is a preventable cause of death worldwide. Tobacco cessation significantly reduces the risk of death from tobacco-related illnesses such as coronary heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer. Because of its association with many chronic diseases, smoking has been restricted in many public places.

Many different strategies can be used to quit smoking, including stopping unaided ("cold turkey" or cutting and stopping), behavioral counseling, and drugs such as bupropion, cytisine, nicotine replacement therapy, or varenicline. Most smokers who try to quit do so without help, even though only 3% to 6% of unsuccessful stops are successful. Behavioral and behavioral counseling each increases the success rate of quitting smoking, and the combination of behavioral counseling with drugs such as bupropion is more effective than intervention alone.

Because nicotine is addictive, quitting smoking causes nicotine withdrawal symptoms such as nicotine cravings, anxiety, irritability, depression, and weight gain. Professional cessation support methods generally try to overcome nicotine withdrawal symptoms to help clients break free of nicotine addiction.

Video Smoking cessation

Method

A major review of the scientific literature on smoking cessation includes:

• Systematic review of Cochrane Tobacco Addiction Group from Cochrane Collaboration. In 2016, this independent, international, not-for-profit organization has published more than 91 systematic reviews "on interventions to prevent and treat tobacco addiction" to be referred to as "Cochrane review" in this article.
• Clinical Practice Guidelines: Treat Tobacco Use and Dependence: Update 2008 from the US Department of Health and Human Services, which will be referred to as "2008 Guidelines". These guidelines were originally published in 1996 and revised in 2000. For Guidelines 2008, experts screened over 8,700 research articles published between 1975 and 2007. Over 300 studies were used in meta-analyzes of relevant treatments; an additional 600 reports were not included in the meta-analysis, but helped formulate recommendations. Limitations of the 2008 Guidelines include not evaluating the study of the "cold turkey" method ("unsuccessful stops") and focusing on studies that follow up on the subject only about 6 months after the "stop date" to capture the largest number of studies for analysis. Most relapses occur early in an attempt to quit, although some recurrences may occur - even years later.

No help

It is common for former smokers to make a number of attempts (often using different approaches at every opportunity) to stop smoking before achieving long-term abstinence. According to a recent UNC survey, more than 74.7% of smokers seek to quit without assistance, otherwise known as "Cold Turkey", or with home remedies. A recent study estimates that former smokers make between 6 and 30 trials before successfully stopping. Identifying which approach or technique is most successful is ultimately difficult; it has been estimated, for example, that only about 4% to 7% of people can quit smoking in any given business without drugs or other assistance. A recent review of unsuccessful stopping in 9 countries found that most efforts to quit are still without help, although the trend seems to shift. In the US, for example, the rate of non-smoking smoking stopped from 91.8% in 1986 to 52.1% during 2006 to 2009. The most common method of unplanned assistance is "cold turkey", a term that has been used to mean quitting without help or suddenly stop and "gradually reduce the number" of cigarettes, or "cigarette reduction".

Cold turkey

"Cold turkey" is an everyday term that shows a sudden withdrawal of an addictive drug, and in this context shows a complete and complete cessation of all nicotine. In three studies, it is a quit method cited by 76%, 85%, or 88% of successful quitters in the long run. In a major UK study of former smokers in the 1980s, before the advent of pharmacotherapy, 53% of former smokers said it was "not at all difficult" to stop, 27% said "quite difficult", and the remaining 20% ​​found it very difficult. Research has found that two thirds of people who just quit smoking are reported to use cold turkey method and find it useful.

Drugs

The American Cancer Society notes that "Studies in medical journals have reported that about 25% of smokers who use drugs can remain smoke-free for more than 6 months." Single drugs include:

• Nicotine replacement therapy (NRT): Five drugs have been approved by the US Food and Drug Administration (FDA) deliver nicotine in a form that does not involve the risk of smoking: transdermal nicotine, nicotine gum, nicotine lozenges, nicotine spray, and nicotine inhalers. NRT is intended to be used for a short time and should be reduced to a low dose before stopping. NRT increases the chances of quitting smoking by 50 to 70% compared with placebo or without treatment.

Increased success opportunities are found when a combination of nicotine patches and faster acting forms are used. One study found that 93 percent of over-the-counter NRT users relapsed and resumed smoking within six months.

There is weak evidence that adding mecamylamine to nicotine is more effective than nicotine alone.

• Antidepressants: Bupropion antidepressants are considered first-line drugs to quit smoking and have been shown in many studies to improve long-term success rates. People taking bupropion should be monitored for unusual mood swings; bupropion also increases the risk of seizures and should not be used in people with seizure disorders. Nortriptyline has also been shown to increase the success rate of quitting smoking. In recent Cochrane updates, Nortriptyline did not result in a significant abstinence rate compared with placebo, or evidence of additional benefit when combined with NRT, although only four trials were included in the analysis.
• Other antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and St. John's wort has not been consistently proven effective for quitting smoking.
• Varenicline lowered the desire to smoke and reduced withdrawal symptoms and is therefore considered the first-line drug to quit smoking. A Cochrane review of 27 studies in 2007 also found that the number of people who quit smoking with varenicline was higher than that of bupropion or NRT. Varenicline is more than twice as likely to stop compared with placebo, and is also as effective as combining two types of NRT. 2 mg/day varenicline has been found to lead to the highest abstinence rate (33.2%) of any single therapy, while 1 mg/day leads to a 25.4% abstinence rate. A 2011 review of double-blind studies found that varenicline has increased the risk of serious serious cardiovascular events compared with placebo. It is not currently clear whether varenicline causes cardiovascular events or if it makes them worse. Concerns arise that varenicline can cause neuropsychiatric side effects, including suicidal thoughts and behavior. However, recent studies have shown less serious neuropsychiatric side effects. For example, a 2016 study involving 8,144 patients treated in 140 centers in 16 countries "did not show a significant increase in neuropsychiatric side-effects caused by varenicline or bupropion relative to nicotine or placebo patches". The 2016 Cochrane Review concludes that recent evidence does not indicate that there is a relationship between depression, agitation or suicidal thoughts in smokers using varenicline to reduce the urge to smoke. For people who have pre-existing mental health problems, varenicline may slightly increase the risk of having these neuropsychiatric side-effects.
• Clonidine may reduce withdrawal symptoms and "approximately double abstinence rates when compared with placebo," but side effects include dry mouth and sedation, and abruptly discontinuing medications can cause high blood pressure and other side effects.
• Anxiolytics may have some helpful effects but more research is still needed.
• Previously, rimonabant which is a cannabinoid type 1 receptor antagonist is used to help stop and moderate the expected weight gain. But it is important to know that rimonabant and taranabant production was stopped by the manufacturer in 2008 due to serious side effects.

The 2008 US Guidelines determined that three effective drug combinations:

• Long-term nicotine and ad libitum NRT rubber or spray
• Nicotine patch and nicotine inhaler
• Nicotine and bupropion patches (the only US FDA approved combination to quit smoking)

Reduce to stop

Gradual reduction involves slowly reducing a person's daily nicotine intake. This can theoretically be achieved through repeated changes in cigarettes with lower nicotine levels, by gradually reducing the number of cigarettes smoked daily, or by smoking only a small percentage of cigarettes at every opportunity. A systematic review of 2009 by researchers at the University of Birmingham found that nicotine replacement therapy gradually can be effective in quitting smoking. There was no significant difference in the rates of smoking cessation among smokers who quit due to gradual reduction or sudden cessation as measured by the abstinence of smoking at least six months from stopping days, suggesting that people who want to quit can choose between these two methods.

Set a Stop Plan and Exit Date

Most sources of smoking cessation such as CDC and Mayo Clinic encourage smokers to make stop plans, including setting a stop date, which helps them anticipate and plan ahead for a smoking challenge. A stop plan may increase a smoker's chances of stopping successfully because it can set Monday as a stop date, since research has shown that Monday more than any other day is when smokers look for online information to quit smoking and call the country's stop line.

Community intervention

A Cochrane review found evidence that community intervention using "multiple channels to provide reinforcement, support and norms for not smoking" impacted smoking cessation outcomes among adults. Specific methods used in society to encourage smoking cessation among adults include:

• Policies make work and public places smoke-free. It is estimated that a "clean comprehensive indoor law" can increase smoking cessation rates by 12% -38%. In 2008, New York State Alcoholism and Substance Abuse Services were banned by smoking patients, staff and volunteers in 1,300 addiction treatment centers.
• The voluntary rules make the home smoke-free, which is suspected of promoting smoking cessation.
• Initiatives to educate the public about the health effects of passive smoking, including significant harm from passive smokers to multi-unit housing residents.
• Increase the price of tobacco products, for example by taxation. The US Task Force on Community Prevention Services finds "strong scientific evidence" that it is effective in increasing tobacco use cessation It is estimated that a 10% price increase will increase the smoking withdrawal rates by 3-5%.
• Mass media campaigns. The US Task Force on Community Prevention Services states that "solid scientific evidence" exists for this when "combined with other interventions", but Cochrane's review concludes that "it is difficult to assign their independent roles and values".
• Institutional smoking ban. A Cochrane Review recently found evidence that enforcing institutional bans (ie hospitals and jails) reduced smoking and second exposure, although the evidence base was rated as poor quality.

Psychosocial approach

• Great American Smokeout is an annual event that invites smokers to stop for a day, hoping they will be able to extend this forever.
• World No Tobacco Day The World Health Organization is held on 31 May each year.
• Smoking cessation support is often offered through phone outlets (for example, US 1-800-QUIT-NOW-free toll numbers), or directly. Three meta-analyzes have concluded that effective telephone cessation support when compared with minimal or none-time self-help or self-help, and that drug-stopping support is more effective than treatment alone, and intensive individual counseling is more effective than brief individual counseling interventions. There are approximately 10% to 25% increased chance of successful cessation of smoking with behavioral support given directly or over the phone when used in addition to pharmacotherapy.
• An online social networking network is attempting to replicate an offline group stop model using custom-made web apps. They are designed to promote online social support and encouragement for current smokers (usually automatically calculated) achievements achieved. Initial studies have shown social cessation to be very effective with smokers aged 19-29 years.
• Psychological support groups or individuals can help people who want to quit. More recently, group therapy has been found to be more useful than self-help and some other individual interventions. The form of psychological counseling support can be effective on its own; combine them with drugs more effectively, and the number of support sessions with the drug correlates with effectiveness. Counseling styles that have been effective in quitting smoking include motivational interviews, cognitive behavioral therapy and Acceptance and Commitment Therapy.
• The Freedom From Smoking group clinic covers eight sessions and features step-by-step plans to quit smoking. Each session is designed to help smokers control their behavior. The clinical format encourages participants to work on the processes and problems of stopping both individually and as part of a group.
• Some formats of psychosocial intervention increase the stopping ratio: 10.8% without intervention, 15.1% for one format, 18.5% for 2 formats, and 23.2% for three or four formats.
• The Transtheoretical model including "change stages" has been used in adjusting the smoking cessation method to individuals. However, the 2010 Cochrane review concludes that "stage-based self-help interventions (expert systems and/or customized materials) and individual counseling are no more or less effective than their non-stage based equivalents."

Self-help

A Cochrane review in 2005 found that self-help materials could only produce a slight increase at the stop level. In the 2008 Guidelines, "weak self-help effects," and the number of self-help types do not result in higher levels of abstinence. However, self-help modalities for quitting smoking include:

• Private self-help groups like Nicotine Anonymous, or web-based terminating sources like Smokefree.gov, which offer a variety of help including self-help materials.
• WebMD: resources that provide health information, tools for managing health, and support.
• A web-based and self-contained interactive program and an online community that helps participants stop. For example, "stop meter" keeps track of statistics like how long a person keeps fasting. In the 2008 US Guidelines, there is no meta-analysis of computerized intervention, but they are described as "very promising." A meta-analysis published in 2009, the Cochrane review was updated in 2013, and a systematic review of 2011 found the evidence base for such weak interventions, although interactive and customized interventions show some promise.
• Mobile-based interventions: Updated review of Cochrane 2016 states that "current evidence supports the beneficial impact of mobile-based termination interventions on six month discontinuation results." A randomized 2011 randomized trial of mobile-based stop-smoking support found in the UK that the Txt2Stop termination program significantly increases the shutdown rate in 6 months.A meta-analysis 2013 also notes the "modest benefits" of mobile health interventions.In addition, machine learning combined with smartphones can be very helpful.
• An interactive web-based program combined with mobile phones: Two RCTs documented the effects of long-term treatment (abstinence rate: 20-22%) of the intervention.
• Self-help books like Allen Carr Easy Way to Stop Smoking .
• Spirituality: In one survey of adult smokers, 88% reported a history of spiritual practice or belief, and of those over three quarters thought that using spiritual resources could help them quit smoking.
• The review of awareness training as a treatment for addiction shows a reduction in desire and smoking after training.
• Physical activity helps in the maintenance of quitting smoking even if there is no conclusive proof of the intensity of the most appropriate exercise.

Biochemical feedback

Various methods exist that allow smokers to see the impact of their tobacco use, and the immediate effects of quitting smoking. Using biochemical feedback methods can allow tobacco users to be identified and assessed, and use of monitoring during efforts to quit may increase the motivation to quit. A recent Cochrane Review found "little evidence of the effects of most types of biomedical tests for risk assessment on quitting smoking,".

• Carbon monoxide (CO) monitoring: Since carbon monoxide is a significant component of cigarette smoke, carbon monoxide monitors can be used to detect recent cigarette usage. Carbon monoxide concentration in breath has been shown to directly correlate with blood CO concentrations, known as carboxyhemoglobin percent. The value of demonstrating blood CO concentrations to smokers through non-invasive breath samples is that it connects smoking habits with physiological disorders associated with smoking. Within hours of stopping, CO concentrations show a marked decline, and this can be encouraging for someone who works to quit. Respiratory CO monitoring has been used in smoking cessation as a tool to provide patients with biomarker feedback, similar to the way in which other diagnostic tools such as stethoscope, blood pressure cuff, and cholesterol tests have been used by medical experts in medicine.
• Cotinine: Nicotine metabolism, cotinine present in smokers. Like carbon monoxide, the cotinine test can serve as a reliable biomarker to determine smoking status. The levels of casinine can be tested through urine, saliva, blood, or hair samples, with one of the main concerns of the cotinine test being an invasive typical sampling method.

Although both of these measures offer high sensitivity and specificity, they differ in usage and cost methods. For example, breathing CO monitoring is non-invasive, while cotinine tests depend on body fluids. Both of these methods can be used alone or together, for example, in situations where verification abstinence requires additional confirmation.

Competitions and incentives

Financial incentives or materials to persuade people to stop smoking increase smoking cessation while incentives are available. Competitions that require participants to save their own money, "betting" that they will succeed in their efforts to quit smoking, seem to be an effective incentive. However, in direct comparison with other incentive models such as giving NRT participants or placing them in a more distinctive gift program, it is more difficult to recruit participants for this type of contest. There is evidence that incentive programs may be effective for pregnant women who smoke.

A separate 2008 Cochrane review found that one type of competition, "Stop and Win," increased the stop level among the participants.

Health system

Methods used with children and adolescents include:

• Increased motivation
• Psychological support
• Youth anti-tobacco activities, such as sports involvement
• School-based curriculum, such as life skills training
• School-based nurse counseling sessions
• Reduce access to tobacco
• Anti-tobacco media,
• Family communication

A Cochrane review, especially from studies that combine increased motivation and psychological support, concludes that the "complex approach" to quitting smoking among young people shows promise. The 2008 US Guidelines recommend counseling style support for adult smokers based on a meta-analysis of seven studies. Both Cochrane and Guideline 2008 reviews recommend drugs for teenagers who smoke.

Pregnant women

Smoking during pregnancy can cause adverse health effects on females and fetuses. The 2008 US Guidelines stipulate that "people-to-person psychosocial interventions" (usually including "intensive counseling") increase the rate of abstinence of pregnant women who smoke up to 13.3%, compared with 7.6% in usual care. Mothers who smoke during pregnancy have a greater tendency toward premature birth. Their babies are often underdeveloped, have smaller organs, and weigh much less than normal babies. In addition, these babies have a weaker immune system, making them more susceptible to many diseases such as middle ear inflammation and asthma bronchitis, which can bring significant morbidity. It is also possible that the child will become a smoker in adulthood. Systematic reviews suggest that psychosocial interventions help women quit smoking at the end of pregnancy and may reduce the incidence of low birth weight babies.

It is a myth that a female smoker can cause harm to the fetus by quitting immediately after finding her pregnant. This idea is not based on medical studies or facts.

Worker

A 2008 Cochrane review of smoking cessation at work concluded that "interventions targeting individual smokers increase the likelihood of quitting smoking,". A systematic review of 2010 provides that incentives and competition at work need to be combined with additional interventions to produce a significant increase in smoking cessation rates.

Inpatient smokers

Smokers hospitalized may be highly motivated to quit smoking. A review of Cochrane 2012 found that interventions initiated during hospital stay and continued for a month or more after being discharged were effective in producing abstinence.

Patients undergoing elective surgery may benefit from preoperative stop smoking interventions, when starting 4-8 weeks before surgery with weekly counseling interventions for behavioral support and use of nicotine replacement therapy. It was found to reduce the complications and the amount of postoperative morbidity.

Mood disorder

People who have mood disorder or attention deficit hyperactivity disorder have a greater chance to start smoking and lower the chance to quit smoking.

Homeless and poor population

Homeless people multiply the possibility of someone currently being a smoker. It does not depend on other socioeconomic factors and health conditions of behavior. The homeless have the same level of desire to quit smoking but are less likely than the general population to succeed in their attempts to quit smoking.

In the United States, 60-80% of homeless adults are current smokers. This figure is much higher than the general adult population of 19%. Many current smokers who become homeless report smoking as a way of addressing "all the stresses of being homeless." The perception that homeless people who smoke "socially acceptable" can also reinforce this trend.

Americans under the poverty line have higher rates of smokers and lower rates of stopping than those living above the poverty line. It has been shown that while the homeless population as a whole is concerned about the short-term effects of smoking such as recurrent bronchitis, which is less concerned with long-term consequences. Homeless populations have unique barriers to quitting smoking such as unstructured days, work-seeking stress, and immediate survival needs that replace the desire to quit smoking.

These unique barriers can be fought thus: pharmacotherapy and behavioral counseling for high nicotine dependence rates, immediate financial benefit emphasis for those short-term long-term occupants, partnering with shelters to reduce the social acceptance of smoking in this population, tax increases not just on cigarettes but also on alternative tobacco products, to make addiction more difficult to fund.

Maps Smoking cessation

Comparison of success rate

Comparison of success rates between interventions can be difficult because of the different definitions of "success" throughout the study. Robert West and Saul Shiffman, the authorities in this field recognized by government health departments in a number of countries, have concluded that, jointly used, "behavioral support" and "drugs" can double the chances that stopping efforts will succeed.

A systematic review of 2008 in the European Journal of Cancer Prevention found that group behavioral therapy was the most effective intervention strategy for quitting smoking, followed by bupropion, intensive doctoral advice, nicotine replacement therapy, individual counseling, counseling through telephone. , nursing orders, and tailored self-help interventions; this study does not discuss varenicline.

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Factors affecting success

Quitting smoking can be more difficult for individuals with dark pigmented skin compared to individuals with pale skin because nicotine has affinity for tissues containing melanin. Studies show this may lead to nicotine dependence-enhancing phenomena and lower rates of smoking stops in darker pigmented individuals.

There are important social components for smoking. A 2008 study of highly connected networks with more than 12,000 people found that quitting smoking by certain individuals reduced the chances of others around them illuminating by the following amounts: a 67% pairs, 25% siblings, a friend by 36%. %, and co-workers by 34%. Nevertheless, Cochrane's review determined that interventions to increase social support for smoking cessation did not increase long-term stops.

Smokers who try to stop are confronted with social influences that can persuade them to adjust and continue smoking. Cravings are more easily retained when a person's environment does not provoke a habit. If a person who stops smoking has a close relationship with an active smoker, he is often put into situations that make the drive to adjust more seductively. However, in small groups with at least one other not smoking, the chances of decreasing conformity. The social effect of smoking has been shown to depend on simple variables. One variable under study depends on whether the effect is from a friend or not a friend. Research shows that individuals are 77% more likely to adjust to non-peers, while close friendships reduce conformity. Therefore, if an acquaintance offers cigarettes as a polite gesture, the person who has quit smoking will be more likely to break his commitment than if a friend offers it. Recent research from the International Tobacco Surveillance Survey (ITC) survey of more than 6,000 smokers found that smokers with fewer smoking friends were more likely to stop and succeed in quitting.

Expectations and attitudes are important factors. A self-perpetuating cycle occurs when a person feels bad about smoking but smokes to reduce bad feelings. Deciding that cycle can be the key to changing the attitude of sabotage.

Smokers with major depressive disorders may be less successful in quitting smoking than non-depressed smokers.

Relapse (continued smoking after quitting) has been associated with psychological problems such as low self-efficacy, or non-optimal coping responses; However, the psychological approach to prevent recurrence has not proved successful. In contrast, varenicline may help some smokers who relapse.

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Side effects

Symptoms

In a 2007 review of the abstinence effects of tobacco, Hughes concluded that "anger, anxiety, depression, difficulty concentrating, impatience, insomnia, and anxiety are valid withdrawal symptoms that peak within the first week and last 2-4 weeks." In contrast, "constipation, coughing, dizziness, increased dreams, and mouth ulcers" may or may not be a symptom of breaking up, while drowsiness, fatigue, and certain physical symptoms ("dry mouth, flu symptoms, headache, palpitations, skin rashes, sweating, tremors ") are not withdrawal symptoms.

Weight

Quitting smoking was associated with an average 4-5 kilogram (8.8-11.0 pound) weight gain after 12 months, mostly in the first three months of quitting.

Possible causes of weight gain include:

• Excessive smoking expresses the AZGP1 gene that stimulates lipolysis, so quitting smoking can lower lipolysis.
Smoking suppresses appetite, which may be caused by the effects of nicotine on central autonomic neurons (eg, through the regulation of melanin that concentrates hormone neurons in the hypothalamus).
• Heavy smokers are reportedly burning 200 calories per day more than non-smokers who eat the same foods. Possible reasons for this phenomenon include the ability of nicotine to increase energy metabolism or the effects of nicotine on peripheral neurons.

The 2008 guidelines show that bupropion, nicely released nicotine gum, and nicotine gum are used "to delay weight gain after stopping." The Cochrane Review 2012 concludes that there is not enough evidence to recommend a particular program to prevent weight gain.

Depression

As with other physically addictive drugs, nicotine addiction leads to a decrease in regulation of dopamine production and other stimulant neurotransmitters as the brain attempts to compensate artificial stimulation caused by smoking. Therefore, when people stop smoking, depressive symptoms such as suicidal tendencies or actual depression can occur, although recent international studies compare smokers who have quit for 3 months with smokers who constantly find that quitting smoking does not seem to improve anxiety or depression. Side effects of quitting smoking may be very common in women, as depression is more common in women than men.

Anxiety

A recent study by The British Journal of Psychiatry has found that successful smokers quit feeling less anxious afterwards with a greater effect among those who have mood and anxiety disorders than those who smoke for pleasure.

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Health benefits

Many adverse health effects of tobacco can be reduced or largely removed through smoking cessation. The health benefits of smoking cessation include:

• Within 20 minutes of stopping, blood pressure and heart rate decreased
• In 12 hours, the levels of carbon monoxide in the blood decreased to normal
• Within 48 hours, the nerve endings and sense of smell and taste both begin to recover
• Within 3 months, the circulation and lung function improved
• Within 9 months, there was a decrease in cough and shortness of breath
• In 1 year, the risk of coronary heart disease is reduced by half
• In 5 years, the risk of stroke falls with nonsmokers, and the risk of many cancers (mouth, throat, esophagus, bladder, cervix) decreases significantly
• In 10 years, the risk of dying from lung cancer decreases by half, and the risk of cancer of the larynx and pancreas decreases
• In 15 years, the risk of coronary heart disease drops to a non-smoker level; lowers the risk of developing COPD (chronic obstructive pulmonary disease)

The British Doctors Study shows that those who quit smoking before they reach 30 years of age live almost as long as those who never smoked. Stop in your sixties can still add three years of healthy life. A randomized trial of the US and Canada showed that a 10-week stop smoking program reduced the death rate from all causes for the next 14 years. A recent article on mortality in a cohort of 8,645 smokers followed up after 43 years determined that "current and lifelong smoking cigarettes are constantly associated with an increased risk of all causes, CVD [cardiovascular disease], COPD [chronic obstructive pulmonary disease], and cancer, and lung cancer deaths.

Another published study, "Smoking Cessation Reduced Postoperative Complications: A Systematic Review and Meta-analysis," examined six randomized trials and 15 observational studies to see the effects of preoperative stop smoking on postoperative complications. The findings are: 1) taken together, the study showed a decrease in the possibility of postoperative complications in patients who quit smoking prior to surgery; 2) overall, each week of pre-operation termination increases the effect magnitude by 19%. Significant positive effects were recorded in trials where smoking cessation occurred at least four weeks before surgery; 3) For six randomized trials, they showed a relative 41% relative risk reduction for postoperative complications.

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Cost effectiveness

The cost-effectiveness analysis of smoking cessation activities has shown that they improve QALY-compliant life-years at a cost comparable to other types of interventions to treat and prevent disease. Studies on the effectiveness of smoking cessation costs include:

• In the 1997 US analysis, cost estimates per QALY varied by type of termination approach, ranging from group intensive counseling without nicotine replacement at $ 1108 per QALY to minimal counseling with nicotine candy at $ 4542 per QALY.
• A study from Erasmus University Rotterdam is limited to people with chronic obstructive pulmonary disease finding that the cost-effectiveness of minimal counseling, intensive counseling, and drug therapy is EUR16,900, EUR8,200, and EUR2,400 per QALY obtained each..
• Among the clients of the National Health Service's stop smoking in Glasgow, the cost of one-to-one pharmacy counseling Ã, Â £ 2,600 per QALY earned and group support fees Ã, Â £ 4,800 per QALY earned.

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Statistical trends

The frequency of smoking cessation among smokers varies across countries. Smoking cessation increased in Spain between 1965 and 2000, in Scotland between 1998 and 2007, and in Italy after 2000. In contrast, in the US the "stable (or slightly varying)" stoppage rate between 1998 and 2008, and in China smoking dropping rates declined between 1998 and 2003.

Source of the article : Wikipedia