Smoking Cessation Strategies

The journey to quit smoking is a significant decision often accompanied by questions and contemplations. SIMEDHealth Primary Care physician, Dr. Jenny Chen, examines smoking cessation strategies, the short and long-term health risks of not quitting, and assessing nicotine replacement therapy, medications, and counseling effectiveness. She also addresses potential treatment side effects, offering guidance for those with past struggles in quitting smoking. To schedule an appointment with a SIMEDHealth Primary Care Provider, click here.



1. What is the impact of smoking on health?

The consequences of smoking are far-reaching and serious. The statistics are staggering, with an estimated over 900 million people world-wide engaged in this habit. It's not just a major cause of disease; it's the leading preventable cause of death globally. The impact of smoking is comprehensive, affecting the respiratory system, circulatory system, skin, dentition and significantly escalating the risk of various types of cancer.


2. What are the health risks or complications associated with long-term smoking?

Over the long term, the consequences are dire, with chronic obstructive pulmonary disease, and emphysema being common outcomes. These chronic lung conditions do not just affect health but also reduce a person's ability to lead a productive life, diminishing both the quality of life and life expectancy. Smoking even a few cigarettes a day dramatically increases the risk of myocardial infarction, or heart attack. Women smokers face a six-fold increase in this risk, while men face a three-fold increase compared to those who have never smoked. This heightened risk is attributed to the free radicals present in cigarette smoke, which contribute to the formation of proatherogenic particles. These particles are a key factor in the development of obstructing plaque in arteries, which is a precursor to various vascular and heart conditions. Beyond heart diseases, smoking is also a leading contributor of several types of cancer, including but not limited to lung, breast, cervical, and colon cancer.


3. How does smoking cessation impact a person's health in both the short term and the long term

The benefits of quitting smoking are significant and well-substantiated. One of the most compelling pieces of evidence comes from studies on the effects of smoking bans in public areas. These studies have shown a correlation between such bans and a considerable decrease in the incidence of acute myocardial infarctions in the community. Quitting smoking also has immediate benefits for lung health, with a noticeable decrease in lung-related symptoms such as decreased cough shortly after quitting. The risk of developing lung cancer also decreases within five years of stopping smoking, although it's important to note that former smokers still maintain a higher risk than those who have never smoked.


4. Are there differences in the effectiveness of nicotine replacement therapy, prescription medications and behavioral counseling in aiding smoking cessation?

When considering quitting smoking, setting a quit date can be an effective strategy to bolster motivation. Understanding and acknowledging the barriers to quitting, such as nicotine withdrawal symptoms and the various triggers that induce the urge to smoke, is also crucial. Nicotine withdrawal can manifest in various forms, including increased appetite and weight gain, mood changes such as depression, insomnia, irritability, anxiety, and restlessness. Fortunately, these symptoms can be mitigated with the help of first-line smoking cessation medications, including nicotine replacement therapies, varenicline, or the antidepressant bupropion. Moreover, behavioral approaches play a crucial role in the cessation process. Avoiding situations that trigger the urge to smoke, engaging in distracting activities, and employing strategies to deal with oral fixation, such as chewing gum or healthy snacking, can be highly effective. Hypnotherapy is another option that has shown potential small benefits, although it's less accessible due to the limited availability of providers.

5. Are there potential side effects of these cessation treatment options that individuals should consider?

For those who have tried and failed to quit smoking in the past, it's crucial to remember that seeking professional help can significantly increase the likelihood of success. It's also important to recognize that for most people, multiple attempts may be necessary before successfully quitting. The combination of behavioral therapy and pharmacotherapy has been shown to be the most effective approach to smoking cessation. Depending on the chosen medication, treatment typically begins on or before the set quit date. With the optimal treatment combination, the success rate for quitting for at least six months can be as high as 25 to 35 percent. In contrast, only about 3 to 6 percent of smokers who attempt to quit on their own are successful for a year or longer. Common potential side effects of cessation medications like varenicline include gastrointestinal and neurological symptoms, such as nausea, vomiting, abnormal dreams, headaches, insomnia, and irritability. Bupropion, another common medication used, can potentially cause side effects including faster heart rate, sweating, constipation, and weight loss. However, its potential for causing weight loss can be advantageous, as weight gain is a common concern among those attempting to quit smoking. Bupropion should be used with caution due to its potential to lower seizure thresholds and, like other antidepressants, to possibly trigger manic episodes in patients with bipolar disorder. It’s also associated with a slight increase in the risk of suicidal ideation in young adults prone to depression, making it potentially more suitable for use in patients older than 24 years of age. Nicotine replacement therapy, available in forms like nasal sprays, chewing gum, and transdermal patches, is another effective option to help reduce nicotine cravings. However, users should be aware of potential side effects such as increased blood pressure, palpitations, and skin reactions, including redness and itching from the patch.

6. For someone who has unsuccessfully tried to quit before, what advice or alternative approaches might you recommend to increase their chances of success in quitting smoking?

The journey to quit smoking is challenging yet immensely rewarding. Understanding the risks associated with smoking and the various methods available to quit is crucial for anyone looking to embark on this path. I encourage individuals who are ready to quit smoking to seek comprehensive support, encompassing both behavioral counseling and pharmacologic treatments, for the best chance at a healthier, smoke-free life.