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6. Smoking cessation. Royal College of Physicians of London Tobacco Advisory Group. Smokers’ attitudes. Reluctant and disillusioned 83% say they would not smoke if they had their time again 71% want to quit Reasons 61% Health 43% Expense 20% Addiction 17% Disgust 5% Social stigma.

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6 smoking cessation l.jpg

6. Smoking cessation

Royal College of Physicians of London

Tobacco Advisory Group


Smokers attitudes l.jpg
Smokers’ attitudes

  • Reluctant and disillusioned

    • 83% say they would not smoke if they had their time again

    • 71% want to quit

  • Reasons

    • 61% Health

    • 43% Expense

    • 20% Addiction

    • 17% Disgust

    • 5% Social stigma




The delusion gap l.jpg
The delusion gap

Jarvis et al, BMJ 2002;324:608


Relapse after quitting percent staying abstinent from cigarettes over time l.jpg
Relapse after quitting: Percent staying abstinent from cigarettes over time

Stapleton, Statistical Methods in Medical Research 1998;7:187-203


The case for smoking cessation l.jpg
The case for smoking cessation cigarettes over time

  • Excellent ‘holistic’ health intervention

    • Treat up to 50 diseases before they can arise…

  • Low unaided success rate (1-3%) among smokers

    • Small increases in success rate accumulate over time

  • Extremely cost effective

    • £800 per life year saved

    • Compares to up to £30,000 per life year for new health technologies approved by NICE

  • Saves burdens on NHS over time

    • Can reduce prescribing costs for patients at risk of heart disease episodes

    • Protection of children from passive smoking


Health benefits of smoking cessation l.jpg
Health benefits of smoking cessation cigarettes over time

  • Increased life expectancy

  • Halving of risk of lung cancer risk after ten years

  • Heart disease risk declines towards non-smoker level over 10 years

  • Accelerated decline in lung function reduced

  • Improved reproductive health

  • Improved recovery from surgery


Effects of quitting l.jpg

After 20mins: cigarettes over time

After 8 hrs:

After 24 hrs:

After 48 hrs:

After 72 hrs:

blood pressure and pulse rate return to normal

blood nicotine & CO halved, oxygen back to normal

CO eliminated; lungs start to clear mucus etc.

nicotine eliminated; senses of taste & smell much improved.

breathing easier; bronchial tubes begin to relax; energy levels increase

Effects of quitting


Effects of quitting10 l.jpg

2 to 12 weeks: cigarettes over time

3 to 9 months:

1 year:

10 years:

15 years

circulation improves

coughs, wheezing and breathing problems improve

risk of heart attack halved

risk of lung cancer halved

risk of heart attack equal to

never-smoker’s

Effects of quitting


Slide11 l.jpg

Smoking, quitting smoking, and life expectancy cigarettes over time

Taylor et al 2002


Slide12 l.jpg

20.0 cigarettes over time

17.9

16.0

45-54

13.2

12.0

55-64

Rate per 1000 person years

9.2

65-74

8.0

7.1

7.0

75-84

4.5

3.9

4.0

2.7

1.7

1.1

0.6

0.6

0.6

0.3

0.1

0.0

0.0

Nonsmokers

1-14 cigs

15-24

25 +

Halpern,MT et al

JNCI 1993 85:457-64

Smoking habit

Lung cancer risk by age and smoking habit


Lung cancer risk by age of quitting l.jpg

Current cigarettes over time

smokers

quit 30-39

Never

1500

smokers

1000

quit 40-49

Lung cancer deaths per 100,000

quit 50-54

500

quit 55-59

0

quit 60-64

40

50

60

70

80

Age

Halpern,MT et al JNCI 1993 85: 457-64

Lung cancer risk by age of quitting


Smoking policies smoking cessation l.jpg
Smoking policies – smoking cessation cigarettes over time

Doll et al, BMJ 1994;309:901-11


Smoking cessation and chd l.jpg

“Healthy” smokers cigarettes over time

Mortality risk after cessation reaches that of non-smoker in 10 years;

Acute myocardial infarction (heart attack) risk declines by 50% after 1 year

Smokers with CHD

Cessation halves risk during 1-13 years of follow-up (Eur Heart J 1999;20:1773)

One of every five smokers that quits avoids CHD event during 10 years

Smoking cessation and CHD


Blood pressure stroke renal function l.jpg
Blood pressure, stroke, renal function cigarettes over time

  • 24-hour BP monitoring showed daytime lowering of BP after 1 week of cessation (Hypertension 1999;33:586)

  • Former smokers have decreased carotid artery stenosis compared to current smokers

  • Cessation reduces risk of stroke to non-smoker level after 5 years

  • Drug treatment of hypertension is less effective in smokers

  • Former smokers have less renal function abnormalities than continuing smokers


Slide17 l.jpg

2.9 cigarettes over time

2.8

Sustained quitters

2.7

Continuing smokers

Postbronchodilator FEV1

2.6

2.5

2.4

5

Screen

1

2

3

4

Years of follow-up

Anthonisen et al, JAMA 1994;272(19):1497-505

depqumch.tc

Change in FEV1 by smoking status


The case for smoking cessation18 l.jpg
The case for smoking cessation cigarettes over time


The case for smoking cessation19 l.jpg
The case for smoking cessation cigarettes over time


Cost effectiveness l.jpg
Cost effectiveness cigarettes over time


Cost effectiveness of other common therapies in medicine l.jpg
Cost-effectiveness of other common therapies cigarettes over timein medicine

Intervention Discounted cost (£) per year of life saved

Pravastatin in primary prevention of CVD 20,375

(Caro, BMJ 1997;315:1577)

Simvastatin after myocardial infarction 5,502

(Jonsson, Eur Heart J 1996;17:1001)

Aspirin in secondary prevention of CHD 7,750

(Gaspoz, NEJM 2002;346:1800)


Modelling impact of smoking cessation on rates of hospitalisation for acute mi and stroke l.jpg
Modelling impact of smoking cessation cigarettes over timeon rates of hospitalisation for acute MI and stroke

  • Current policy would result in 347 AMI and 214 stroke hospitalisations avoided in the year 2000, and by 2010 this would be 6386 AMI and 4964 strokes avoided. Californian programme in the UK:

    • 739 AMI and 455 stroke avoided in 2000

    • 14 554 AMI and 11 304 strokes avoided by 2010.


Smoking cessation infant health l.jpg
Smoking cessation: infant health cigarettes over time

Value of cessation: Lightwood et al.

  • Measured excess direct medical costs of low birth weight due to smoking

  • Cost per birth - $511

  • Equivalent to $263m in USA


Success of cessation services england april december 2002 l.jpg
Success of cessation services cigarettes over timeEngland, April-December 2002

  • 154,880 people set quit date

  • At 4 week follow up: 79,646 had quit: 51% of those setting a quit date (self report)

  • 53,770 confirmed as not smoking by CO validation

    Source: Department of Health, 2003.


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