Academic Achievement and Smoking Initiation

This particular topic has been studied before and even commented on by me. But it bears repeating, especially when a great study comes out and tells us something we all suspected in the first place. The question is this, if people who have greater college education smoke less, then how far back can we trace this phenomona? In other words, do lower achievers in say, high school, middle school or even elementary school, have a greater propensity to end up a smoker?

I love the journal Addiction. They publish some really unique studies on nicotine addiction. The researchers here have really hit a home run, or at least I think so. They evaluated 741 kids with absolutely no history of smoking in the 7th grade, this is in Canada. They followed these kids for 4 years up through grade 10. Here's what they found.

Based on the grade point average (GPA) of the students, three academic achievement levels or what they call trajectories were identified: high achievers (HA), average achievers (AA) and unstable low achievers (ULA). ULA made up about 12% of the total studied population. Within these three groups were identified different rates of smoking initiation.

HA   - 7.1% initiation
AA   - 15.1% initiation
ULA - 49.1% initiation

Lets see if we can identify a trend. Hum, it's on the tip of my tongue. Pretty startling isn't it. In addition, they found that ULA students who had involved and educated parents were less likely to initiate smoking.

It looks as if apathy is the largest contributor to smoking initiation. Here comes my sweeping, broad stroked statement - kids who aren't taught to care about their education by their parents seem doomed to repeat their parents' mistakes. Now granted, some of these kids have very difficult family situations, but I'm sure those exist in all the populations studied.

The point is this, education seems to matter, especially when it comes to smoking. The less educated smoke more. Those identified early in adolescence as low achievers will end up smoking more. This is great to know because that means we can intervene in this time of their life and potentially break the cycle of addiction before it starts. Nicotine and the brain do not mix, especially at such a young age. But it seems we can do something about it. So talk to your kids before he/she gets to 7th grade about how smoking is stupid and how it kills people. We do it here all the time and my kids are totally grossed out by smoking and think it's the worst thing ever.

Is Nicotine Bad

I was searching on the internet the other day and came across this question that someone asked, "is nicotine bad for you". I thought about this for a while and didn't really know how to answer the question because I thought the wrong question was being asked. Seriously, should we be asking if nicotine is bad when there are a host of other cancer causing agents in tobacco. I mean, is someone going to quit smoking because the idea of smoking causing lung cancer just isn't scary enough, they also need to know that nicotine makes your ears ring before they'll quit.

I talk a little more about this question on my website. But I just wanted to drop in for a second and publish this thought before I forgot about it.

Nicotine Replacement Therapy as a Quitting Tool

Nicotine replacement therapy (NRT) has been around a long time, with varying degrees of success. Most agree that NRT will double a person's chance of quitting over going cold turkey alone. But the outcomes, defined as smoking cessation, are still pretty small.

A recent study looked at the affect NRT had on smoking reduction and temporary abstinence in England. The researchers wanted to see if NRT use could predict smoking cessation attempts. I'm not really sure why they were asking this question and the end result of the study is not what I find important.

Rather, the scientists state that NRT was associated with an overall smoking reduction of about two cigarettes per day. They also found that people who used NRT were more likely to try to quit smoking that someone who did not use it - which I think is a patently obvious observation that didn't require a study. But that's just my two cents.

Anyway, I wanted to focus on this 2 cigarette per day reduction. Is it just me or does that seem kind of small? Yeah, that's what I thought. But I think I know why it is so small.

Since most NRT is available without a prescription, most people who want to quit can just go online or to a local store and buy nicotine gum or whatever. Lets say a guy wants to quit, but he's not completely sure about how to go through it. More than likely, he's heard about NRT and will probably "try" some nicotine gum or the patch. Hey, you don't need a script and nobody needs to know what you're doing. It's kind of a covert quit attempt. No real planning, no thinking about it, just try and see what happens.

In this scenario, smoking cessation success may be difficult to achieve. The biggest mistake people make is failing to plan a quit attempt. When you approach a serious addiction, which lets face it, nicotine is, you must be serious in your desire to quit. Testing the waters and trying things out are, in the end, not worth the trouble.

I've heard some people using nicotine gum for over a year. Now I don't know if they were addicted to nicotine gum or just felt the need to keep trying, but planning is the answer. So I believe these people in the study were not serious about quitting, rather they were just experimenting with NRT to see if it would magically take their nicotine addiction away. Obviously, it doesn't seem to work that way.

Smokeless Tobacco Is Not a Stop Smoking Aid

I had a friend who did quit smoking. He did so by using smokeless tobacco. He thought the risk trade-off was a good one. However, there is evidence which states this may not be the case as smokeless tobacco (ST) can lead to a whole host of medical problems in and of itself, such as: pancreatic cancer, fatal myocardial infarction (heart attack) and stroke.

Smokeless tobacco delivers a high concentration of nicotine directly into the bloodstream, making it extremely addicting. In fact, nicotine replacement therapy is only useful for cessation cravings for the short term, and have not been proven to maintain cessation over extended periods of time.

So now my friend no longer smells like cigarette smoke, but his smokeless tobacco habit is about twice as bad as his cigarette habit ever was. If you're going to quit, just quit, don't substitute.

Stopped Smoking

So you finally stopped smoking! Congratulations. The question now becomes, will you stay stopped? Are you ready for the sneaky cravings? Have you prepared yourself for the gentle smoking cues that come with familiar behavior, like having the first cup of coffee in the morning?

I know you've stopped smoking, but you need to treat nicotine addiction as an alcoholic treats his/her alcohol addiction - that is a lifelong battle. Once an addict, always an addict; even if it's "only nicotine". The physiological addictive properties of nicotine rivals opiates and cocaine, so don't underestimate it's power.

It's like Darth Vader telling Luke not to underestimate the power of the dark side. It can hold devastating power over you even after you've stopped smoking. So be a good scout and always be prepared for those cravings. They can derail your plans quicker than you'd imagine.

Does Anxiety or Depression Impact Nicotine Addiciton

Quite awhile ago now, bupropion (Welbutrin) was first used on people who suffered from depression. Researchers were surprised to discover a mis-intended, but beneficial side effect, that being smoking cessation. There is strong long-standing evidence that links depression with smoking behavior and nicotine addiction. I remember there were lots of patients in the 'psych ward' at our hospital that would go outside for their smoke break. I don't mean that to be a mischaracterization, but rather just an anecdotal observation from my hospital days.

Now there are questions as to whether a tendency to anxiety and depressive reactions is some how involved in the clinical presentation of someone with a nicotine addiction. Researchers in Polan sought to answer this question in a study titled, "Anxiety, depression and methods of stress coping in patients with nicotine dependence syndrome". It was published in the Medical Science Monitor: international medical journal of experimental and clinical research - [2011 May 2;12(5):CR272-276] by Pietras, T and others.

Here they compared two groups: smokers with no serious systemic co-morbidities and healthy subjects. Each individual was assessed in the same manner using the same behavioral tools for measuring anxiety, depression and coping abilities. Their results show the average intensity of anxiety as a trait and anxiety as a state were different in these two groups. Depression was also demonstrated to be more intensive in the nicotine addiction group. Finally, those with the nicotine addiction used more emotion-based coping behavior than did the healthy control group subjects.

They concluded that anxiety and depression, along with differences in coping, distinguished those who were addicted to nicotine from their non-smoking, healthy counterparts. So, which came first, the chicken or the egg?

Do people smoke because they're depressed or are they depressed, therefore, they smoke? I don't believe this study answers that rather complex question. Rather, it simply delineates the differences between these two groups. I'm sure bother ends of the argument are true. It is interesting to note, however, that there is a linking between a person's sense of well-being with oneself and his/her environment, with their nicotine addiction.

This fact tells us there is more to smoking cessation than simply quitting cold turkey. Although, for some it is that easy. For many others, it is seemingly complex weave of behavior, genetic predisposition, culture and brain chemistry. This isn't surprising, since most addictions are viewed in those terms already.

Weight Gain After Smoking Cessation in First 30 Days

I have spoken to lots of people who tried to quit smoking. Those who really didn't try that hard always had this fall back excuse, "I didn't want to gain all that weight". Let's see, if I had to choose between the mortality and morbidity associated with smoking and smoking related diseases, and compare them to a 10-15 pound weight gain...I think I'd take the weight gain. Now granted for many, 10 or 15 extra pounds does seem like a lot. But I think the benefits outweighs the harm, pardon the pun.

Well, a new study looks at the use of nicotine gum in the first 30 days of a quit program. The researchers wanted to see if (and how much) nicotine gum helped keep the dreaded smoking cessation weight gain from materializing. Their work can be seen in the journal Addiction entitled, "Effect of compliance with nicotine gum dosing on weight gained during a quit attempt".

They utilized a randomized, double-blinded, placebo controlled trial. They only enrolled 103 participants, but that's not too bad. They found that when smokers were quitting, those who used more pieces of nicotine gum (> 9 pieces per day), had less weight gain in the first 30 days of the quit attempt. They saw a similar effect among participants with regard to the dosing of nicotine gum (2 mg vs. 4 mg dose).

Interestingly, the placebo group experienced an average of 1.6 kg of weight during the first 30 days. That's only 3.5 pounds of weight gain. So even if someone does gain weight when quitting, it's not a horrible amount, just a couple of pounds. Heck, I put on 5 pounds just this last Thanksgiving holiday.

So there you go. If you're a little hesitant to stop smoking , then just try using nicotine gum. But make sure you use it the correct way. Chew it until it softens, then park it between your cheek and gum. Continuous chewing will only cause you to ingest the nicotine by swallowing. That will cause gastric upset and will waste the nicotine. It is supposed to be absorbed in the mouth. Always read the stop smoking aid packaging to ensure you are using it the correct way.

If you are still concerned about gaining weight, then map out a set of new habits to replace the old ones. Try a new exercise program ir start munching on crunchy vegetables like carrot sticks or celery. These are not only great ways to lose weight, but will also help with your cravings. Good luck.

Cigarette Cravings - Where Do They Come From?

If you read this blog frequently, then you know I always talk about the two parts of the nicotine addiction. First there's the physiological addiction of nicotine and then there's the behavioral component of the addiction. Both are equally powerful and make it difficult for smokers to quit smoking.

Researchers at Duke University recently published that some smokers are genetically pre-disposed to the physical addiction found in nicotine. They characterized smokers their genome. So if your DNA code looks like this, you'll struggle with quitting; but if it looks like that, you may have no trouble quitting.

Well now, Mahler and de Wit have published a fascinating article in PloS One, that looks at the second part of the addiction, but from the same genetic standpoint. Let me explain this behavioral or classic conditioning before I get too far ahead.

Classical or Pavlovian conditioning is characterized by the association of a response with a neutral stimulus. The association develops because it is paired with a significant stimulus that does bring about a specific response. For example, his dogs began to salivate when given food. He then introduced the neutral stimulus which was the bell. The bell and food became paired to the salivating response. Hence, the conditioned stimulus (bell) brought about a conditioned response (salivation).

So with a smoker, lets say he smokes a cigarette with coffee in the morning and then again after dinner. The coffee-drinking by itself does not trigger the smoker to want a cigarette at first. But the coffee drinking eventually becomes paired with smoking. Now the smoker drinks a cup of coffee while at work and suddenly finds himself craving a cigarette. He now has a new conditioned stimulus (coffee) the triggers a conditioned response (cigarette craving).

These researchers actually found what they call a "cue-reactive phenotype" among smokers who are more sensitive to conditioned stimuli than others. This means, they are more likely to develop classic conditioning cues to neutral stimuli. As a side note, they also point out that the subjects who rated as having stronger behavioral triggers for smoking, also had stronger triggers for food craving too.

This isn't necessarily earth shattering news, but it does help us realize the importance of conditioning on smoking cessation (and diet too, I suppose). It cannot be overlooked when developing a method to stop smoking. Many would-be ex-smokers relapse because they underestimate, or never consider, the environmental cues that often trigger the smoking response.

It's a Head Scratcher!

The government seems to be wanting to make inroads with the American smoking public. "How so?", you may ask? Well, they've changed their stance on what they will pay for in regards to smoking cessation. They have always paid for smoking cessation medications and now it looks like they are willing to pay for smoking cessation counseling as well.

Now we haven't talked too much about counseling, but here's the upshot. It works! Think of the success rates for nicotine replacement therapy and Zyban - only in the 6 to 10% range, depending on which article you read. Chantix boasts around a 20% success rate. So how does counseling fit it with all these magic pills? Well, add a simple smoking cessation counseling program to your method of choice and you increase the success rate to the twenties. That is astounding! Basically 4-5 times more successful than quitting cold turkey.

In the past, Medicare would only pay for counseling if you already had contracted a smoking related illness. Now they have removed that condition. This makes perfect sense, since most people have a smoking related illness in the pipeline when they reach Medicare age.

This is a move that shows how the government is hoping to move us from a treatment based healthcare system to a prevention based model. So congratulations to the US Federal Government on this one. I know, I can't believe I said it either.