Tobacco and Health

Question 1

health hazards of smoking

Answer 1

• 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

Question 2

smoking and lung cancer

Answer 2

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

Question 3

smoking and chronic obstructive pulmonary disease (COPD)

Answer 3

• 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

Question 4

smoking and death

Answer 4

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

Question 5

smoking prevalence in Canada

Answer 5

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

Question 6

cancer prevention

Answer 6

modifiable factors:

• tobacco use
• physical inactivity
• unhealthy diet
• excess body weight
• alcohol
• environment

Question 7

health consequences of smoking cessation

Answer 7

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)

Question 8

treatment after CHD: reduction of the mortality risk

Answer 8

Question 9

high recidivism rates

Answer 9

• 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

Question 10

how nicotine works

Answer 10

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

Question 11

other reasons quitting smoking is hard

Answer 11

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

Question 12

nicotine metabolism

Answer 12

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

Question 13

cutting back vs quitting

Answer 13

• 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)

Question 14

clinical guidelines for treating tobacco dependance

Answer 14

Question 15

why exercise could help with smoking

Answer 15

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

Question 16

the effects of acute exercise on tobacco cravings and withdrawal symptoms in temporary abstinent

Answer 16

Question 17

the acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review and meta-analysis

Answer 17

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

1. temporary abstinence
2. demanding cognitive tasks and/or cue-elicited smoking stimuli

its unknown how exercise will affect cravings and time to first cigarette in this situation

Question 18

effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors

Answer 18

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

Question 19

limitations with acute exercise and temporary smoking abstinent paradigm

Answer 19

• 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

Question 20

nicotine replacement therapy

Answer 20

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

Question 21

the effect of acute exercise on cigarette cravings while using a nicotine lozenge

Answer 21

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

Question 22

acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation

Answer 22

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

Question 23

cortisol in smokers

Answer 23

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

Question 24

exercise on cortisol and cravings

Answer 24

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

Question 25

long-term abstinence

Answer 25

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

Question 26

smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention

Answer 26

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