Tobacco and Health Flashcards
health hazards of smoking
- smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
- smoking is directly related for approximately 90% of lung deaths and approximately 80-90% of Chronic Obstructive Pulmonary Disease-COPD (emphysema and bronchitis) deaths
smoking and lung cancer
smoking damages your lungs’ natural cleaning and repair system and traps cancer-causing chemicals in your lungs
- smoking chemicals mix together to form a sticky tar that lines the inside of your lungs
- the cilia (tiny hairs) that line the inside of your lungs help to clean out dirt and germs from your lungs
- If the cilia are covered in tar, they can’t do their job properly, and germs, chemicals and dirt can stay in your lungs and cause disease-cancer
smoking and chronic obstructive pulmonary disease (COPD)
- Smoking permanently damages the alveoli (air sacks) in the lungs, making it harder to breathe
- The alveoli are built like tiny, stretchy balloons. As you breathe in, your alveoli help you absorb oxygen into your body, and as you breath out, alveoli help you get rid of the waste gas-carbon dioxide
- Smoking damages the structure of the alveoli by making it less stretchy-harder for lungs to take in oxygen and get rid of carbon dioxide
- Leads to shortness of breath and feeling tired
- Heart has to work harder to give your body the oxygen it needs
- Over time this damage leads to COPD
smoking and death
risk factor leading to death of smoking is the highest
tobacco kills about 37,000 Canadians a year
tobacco kills about 480,000 Americans a year
smoking prevalence in Canada
smokers declined over the years
smokers are more prevalent to lower income than higher, because income is tied with education
there are people that smoke more that have labour intensive jobs compared to managerial jobs
cancer prevention
modifiable factors:
- tobacco use
- physical inactivity
- unhealthy diet
- excess body weight
- alcohol
- environment
health consequences of smoking cessation
smoking cessation results in many positive health consequences; most immediately and substantially cessation reduces the risk for coronary heart disease and other cardiovascular diseases (CVD)
treatment after CHD: reduction of the mortality risk
high recidivism rates
- failure rates amongst self-quitter have consistently been shown to be as high as 95-98% after 1 year
- relapse after quitting is fast and common (nearly half relapse within 2 weeks)
- up to 70% of current smokers wish to quit or have made at least 1 attempt
how nicotine works
nicotine dependence
- self-administration
- withdrawal symptoms
how it works
- within several seconds, about 1/4 of the nicotine has gone through the bloodstream straight to the brain
- causes a rise in heart rate and in the rate of breathing
- nicotice stimulates nicotine acetylcholine receptors located in the ventral tegmental area
- leads to the release of dopamine in the nucleus accumbens [plays an important role in processing rewarding and reinforcing stimuli (addictive drugs, sex and exercise)]
- nicotine increases activity in the brain stem - enhances cognitive functions
other reasons quitting smoking is hard
weight management: nicotine regulates metabolism
psychological: helps control mood and stress
habit and sensory (reinforcing cues): risking situations that trigger the urge to smoke
risk factors: depression, history of alcohol or drug abuse, low socioeconomic status, co-morbidity (presence of 2 or more diseases)
nicotine is highly addictive and quitting requires much more than will power
nicotine metabolism
nicotine is metabolized to cotinine which is metabolized to 3-hydroxycotinine by the liver enzyme cyctochrome P450 2A6. the rate of nicotine metabolism has been found to predict smoking behavior
cutting back vs quitting
- health benefits only seen for quitting
- cutting back may be an effective first step to ultimately quitting
- approved method of quitting in Europe but not the US
- Hughes (2006) has shown that smoking reduction leads to more cessation (16 of 19 studies reviewed)
clinical guidelines for treating tobacco dependance
why exercise could help with smoking
exercise has positive effects on mood
- elevated mood/reduced anxiety
- reduced drug cravings => withdrawal relief
exercise increases self-efficacy/coping
=> increased likelihood of quitting
exercise may be a competitive behavior to smoking and hence incompatible
promotes healthy weight and may reduce post cessation weight concerns
exercise has a favorable effect on CVD risk profile
the effects of acute exercise on tobacco cravings and withdrawal symptoms in temporary abstinent
the acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review and meta-analysis
by Robers, Maddison, Simpson, Bullen and Prapavessis
findings: majority of studies favoring exercise to reduce cigarette cravings
limitation with acute exercise and temporary cessation paradigm: lab scenarios deal with single instead of multiple stressors
a more realistic situation for a smoking attempting to quit: stressors are presented concurrently
- temporary abstinence
- demanding cognitive tasks and/or cue-elicited smoking stimuli
its unknown how exercise will affect cravings and time to first cigarette in this situation
effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors
by Fong, Prapavessis
design:
baseline assessment -> follow up assessment then randomized into -> exercise or sitting group
and participant reported time of first cigarette
findings:
strength of desire to smoke during exercise dropped and a slight increase in craving after done
sitting group had a consistent high craving of a cigarette
the time for the first cigarette had no difference between the groups
- first study to examine the effects of acute exercise following concurrent stressors
- reflects a more ecologically valid scenario when a smoker is attempting to quit
- exercise significantly decreased cravings following concurrent stressors
- exercise had no effect on ad lib smoking
limitations with acute exercise and temporary smoking abstinent paradigm
- studies include temporarily abstinent smokers rather than quitters
- severity of desire (cravings) symptoms may not correspond entirely with those felt when an individual is fully invested in a quit attempt
- the effect of acute exercise on cravings and withdrawal during a pharmacological based products is unknown
nicotine replacement therapy
reward pathway: nicotine stimulates nicotinic acetylcholine receptors in the ventral tegmental area -> leads to the release of dopamine in the nucleus accumbens [plays important role in processing rewarding and reinforcing stimuli]
* all of the NRT products rely on systemic venous absorption and therefore, do not achieve the rapid systemic arterial delivery as cigarettes
the effect of acute exercise on cigarette cravings while using a nicotine lozenge
by Tritter, Prapavessis
measures:
1. cigarette cravings: desire to smoke, single-item statement, 7-point Likert scale
2. withdrawal symptoms
method: sample is categorized into lozenge + exercise or lozenge + passive sitting
findings: exercise + lozenge had reduced desire to smoke compared to sitting + lozenge
- engaging in acute moderate-intensity exercise while consuming a nicotine lozenge yields cigarette craving relief for recenty quit smokers
- should utilize both treatments together to maximize relief
acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation
by daniel, cropley
to find if exercise to reduce cravings was because of expentancy of it to work
findings
no significant group main effects were found for desire to smoke
all groups showed a similar reduction in desire to smoke during and following exercise
cortisol in smokers
cortisol has been shown to drop during the first 2 weeks of abstinence and low cortisol on the first day of abstinence has been associated with increased tobacco cravings and withdrawal symptoms
one explanation for this counterintuitive finding is that there is an increase in nicotine receptor sensitivity associated with a reduction in cortisol leading to an intensification of tobacco craving and withdrawal symptoms
acute exercise in humans has been shown to elevate cortisol levels. exercise may help buffer both the desire to smoke and withdrawal symptoms by raising cortisol levels back to normal, thus regulating the body’s cortisol response in the absence of nicotine
exercise on cortisol and cravings
light, moderate and vigorous exercise groups
the harder the exercise the more plasma cortisol
the more cortisol the less cravings for nicotine
summary
acute exercise reduces craving temporarily for abstinent smokers
why exercise works is not well understood
long-term abstinence
by marcus et al.
half the group attended a cessation program combined with a three-times-a-week wellness program
the other half attended to a cessation program with supervised vigorous exercise three-times-a-week program
- participants were asked to stop smoking at the end of week 4
findings
exercise group has more participants that continued abstinence than the control group
VO2 Peak was higher at the end of the treatment (oxygen consumption)
mean weight gain for quitters was substantially greater than non-quitters
but exercise group that quit gained more weight than control group that quit
conclusions
suggest that adding exercise to a CBT cessation program works
- the marginal benefits of adding pharmacological agents, such as nicotine replacement therapy, deserves exploration
smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention
by de jesus, prapavessis
female smokers - one year exercise (pre-quit period) + nicoderm quit smoking program to prevent smoking relapse and to maintain exercise
cigarette consumption - # of cigarettes an individual smokes
smoking topography - a thorough representation of the physical characteristics of smoking behaviour, # of puffs, puff volume, flow rate, puff duration, time between puffs
findings after 3 weeks
cigarettes per day - decrease
carbon monoxide - decrease
puffs (volume/flow) - no significant difference
puff (duration/interval) - no significant difference
smoking satisfaction, psychological reward, enjoyment of respiratory tract sensations and craving reduction - decrease
- the pre-quit period of the exercise-based quit smoking program had a beneficial impact on: # of cigarettes smoked, smoking topography and smoking sensations
conclusion: first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm with cigarettes
female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation
