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New Method to Quit Smoking

New Method to Quit Smoking. Speaker: Mr. William Chui Education Director, Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong 23th Oct 2006. LEGCO approved to ban smoking in restaurants S mokers are more determined to quit.

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New Method to Quit Smoking

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  1. NewMethod toQuit Smoking Speaker: Mr. William Chui Education Director, Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong 23th Oct 2006

  2. LEGCO approved to ban smoking in restaurantsSmokers are more determined to quit • LEGCO approved the Smoking (Public Health) (Amendment) Bill 2005, which is recommended to be effective from Jan, 2007. • Non-smoking areas will be expanded in Hong Kong: smoking will be strictly prohibited in enclosed public places like restaurants, indoor workplaces and karaokes. • Also, government will enforce more restrictions on the packaging, labeling and promotions of cigarettes. Survey reveals that the restriction of smoking in restaurant urges more than half of the smokers to quit.

  3. How to quit smoking effectively?

  4. Smokers in Hong Kong • Accounts for 1 in 5 adults • Approx. 800,000 smokes in HK • Male : Female = 86% : 14% • Female smokers aged 30-49 increased 15% in the past 3 years • 7,000 people die prematurely from smoking-related diseases each year • About 60% smokers have never thought of quitting or unwilling to quit shortly, and they are not going to join any smoking cessation program

  5. Smoking as an addiction • Physically: • Nicotine dependence • Abrupt stop or reduction of nicotine in-take may lead to withdrawal cravings, nervousness, anxiety, over-eating and weight gain etc. • Psychological and social factors: • In addition to physical addiction, stress and social activities also contribute to a smoker’s dependence on cigarette

  6. Common ways to quit smoking Non-medical treatments: • Stop smoking immediately by willpower • Switch to light cigarette with less nicotine • Snacking instead of smoking • Alternative methods like hypnotherapy, acupuncture etc Medical treatments : • Use Nicotine Replacement Therapy (NRT) abruptly(e.g. patch, gum or inhalator) to manage withdrawal cravings • Seek advice from medical professionals and use medicine (non NRT treatment like Bupropion )to reduce the desire of smoking

  7. The efficacy

  8. Quit smoking without using any kind of treatment90% will relapse • The lack of willpowerand perseverance might finally lead to relapse • Overseas clinical study reveals that: • 90% will relapse within 12 monthsif not using any kind of treatment to quit smoking, most of them will smoke again within one week. 1 1. Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

  9. The myth of “light” or “ultra light”(Cigarettes with less tar and nicotine)Toxins are even more harmful • May lead to compensatory smoking • There are 4,000 toxins from light cigarettes that are more harmful than nicotine. Among them, 40 toxins is proven carcinogenic Shiffman et al. J Consult Clin Psychol, 1996; Henningfield et al. Tob Control, 1998 Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

  10. Snacks as a replacement of cigarettes: Lead to weight gain, not long lasting

  11. No scientific prooffor alternative smoking cessationmethods • Hypnotic therapy& acupuncture etc

  12. Determination + cut down cigarette consumption + NRT Increase the chance of successful quitting • Most of the smokers not yet know about NRT

  13. Seek medical professionals’ advice and use appropriate medications:Highly effective yet seldom used Shiffman et al. J Consult Clin Psychol, 1996; Henningfield et al. Tob Control, 1998 Henningfield et al. Tob Control, 1998; Ussher, West. Hum Psychopharmacol, 2003

  14. “NRT – Cut down then Stop”More effective than no treatment • Study indicates that “Cut down and Stop” can increase the success rate of smokers who are not ready or unable to quit smoking, and prepare for a complete cessation. The more you cut down, the higher chance of successful cessation. • Likelihood of successful cessation increases dramatically if daily consumption of cigarette can be reduced by more than 50%. • Heavy smokers need to reduce nicotine levels in order to achieve successful cessation. For those who want to quit smoking but not ready or unable to stop abruptly, an effective, safe and convenient approach to cut down smoking might lead to a higher chance for successful quitting.

  15. Latest cessation strategy “NRT – Cut down then Stop” approach • Targets smokers who want to stop but not yet ready or unable to stop abruptly. • A first step to help increase confidence, motivation and compliance to stop completely. • Cutting down gradually may reduce withdrawal symptoms when cessation is attempted. • Achieve the ultimate goal of complete smoking cessation after reduction.

  16. “NRT – Cut down then Stop”Help 40% of smokers who are not ready or unable to stop smokingto quit successfully 6 months test results for 616 smokers who are not interested (or unable) to quit smoking 43% 43% quit successfully in 6 months (% ) 16% Carpenter M, Hughes J, Solomon L, Callas P. Both smoking reduction with nicotine replacement therapy and motivational advice increase future cessation among smokers unmotivated to quit. J Consult Clin Psychol 2004; 72: 371-381

  17. “NRT – Cut down then Stop”Double the chance of complete cessation NRT group Placebo group 成功戒煙機會 增加1.875倍 23% Increase the chance of success by 1.875times 6.3% Participants% 8% 0.5% Month 12 Month 4 Source: Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up. 2003 Society for the Study of Addiction to Alcohol and Other Drugs.

  18. How to choose the method for smoking cessation? Can you stop smoking right away? Yes No Can you reduce your daily consumption of cigarette from now on, then stop completely in the near future? Can you stop smoking from next month (with help)? Yes No Yes No Use NRT to reduce cigarette consumption, then stop smoking completely Use NRT to quit smoking within a short time Seek pharmacists or medical professionals’ advice

  19. “NRT – Cut down then Stop”4 Steps Approach Nicotine Nicotine Nicotine Nicotine Nicotine Nicotine Nicotine

  20. “NRT – Cut down then Stop”4 Steps Approach Using nicotine replacement products Nicotine Nicotine Nicotine Nicotine Nicotine Nicotine Nicotine Nicotine

  21. Summary • Legislative Council has just passed the “Smoking (Public Health) (Amendment) Bill 2005” which further expands indoor statutory non-smoking area such as restaurants or bars etc. There is an urgency for smokers to quit smoking. • Study reveals that success rate will increase significantly if daily consumption of cigarette can be reduced. • The latest strategy : “NRT – Cut down then Stop” is appealing to smokers who are not yet ready to quite • Double the chance of complete cessation as compared with the placebo group. • Smokers who are not ready or unable to quit smoking should seek advice from pharmacists, medical professionals or smoking cessation groups, to tailor-made a quit smoking plan and to use NRT products to achieve complete cessation. • Determination is the key to successful quitting. Falba et al. Addiction,2004; Fagersrom et al.Tobacco Control, 1997; Bolliger et al. Br Med J, 2000

  22. Thank You

  23. Background information

  24. Health Hazards of Smoking • 80% of lung cancer deaths.* • 20% of deaths from coronary heart disease.* • Increase the risk of heart attack. • For those women using oral contraceptives, it will further increases the risk of heart attack, stroke or other cardiovascular diseases. • Increase the chance of spontaneous abortion, premature birth, lower birth weight babies. • Increase sperm abnormalities and impotence in men. WHO website, WHO policy recommendations on smoking cessation and treatment of tobacco dependence, 2003

  25. Hazards of Secondhand Smoke • Mainstream smoke: directly inhaled by smokers, comprise 15% of all secondhand smoke. • Sidestream smoke: smoke emitted from the burning of cigarette in the air which comprise 85% of all second-hand smoke. As it has not been filtered, it contains more toxic chemicals, more than 3 times of tar and 6 times of nicotine than mainstream smoke. • Secondhand smoke: mixture of smoke emitted during cigarette burning and exhaled smoke of smokers during smoking. • Secondhand smoke contains more than 4,000 particles and gases, Many potentially toxic gases are present in higher concentrations in sidestream smoke than in mainstream smoke. • Inhaling secondhand smoke may cause: • Sore throat, eye irritation, cough, headache, etc. • Serious diseases, e.g. cancer, heart attack, asthma, etc. 參考資料: 香港吸煙與健康委員會網頁

  26. “NRT – Cut down then Stop”is less addictive than cigarette Arterial Cigarette = highly addictive NRT = low potential of abuse Venous Adapted fromHenningfield, N Engl J Med, 1995;333:1196-1203

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