Nicotine Replacement May Help Smokers Quit Gradually

(HealthDay News) -- For smokers who want to cut down on the number of cigarettes they smoke, using nicotine replacement therapy not only helps them smoke less but makes it twice as likely that they will quit altogether, British researchers report.

Although using nicotine replacement therapy -- such as gum, inhalers, patches and lozenges -- as a way to reduce smoking is approved in Britain and other countries, it remains unapproved and controversial in the United States. Some think it sends the wrong message -- that cutting down on smoking is OK. Others think that because tobacco companies make other nicotine delivery devices, this approach is merely a boon to the tobacco industry.

"We looked at papers that took people who said, 'I don't want to stop smoking, but I am prepared to reduce my smoking,' " said lead researcher Dr. Paul Aveyard, from the School of Health and Population Sciences at the University of Birmingham. They were given either a nicotine replacement product or a placebo, "and twice as many in the active treatment groups quit smoking compared with the placebo side," he said.

The results are similar to studies on the use of nicotine replacement therapy among people who said they wanted to quit.

In addition, Aveyard said, there were no serious adverse effects from the use of nicotine replacement while people continued to smoke.

The findings were published online April 3 in BMJ.

For the study, Aveyard's team reviewed seven studies that compared the use of nicotine gum or inhalators with placebos to see which was more effective in gradually getting smokers to quit. The studies included a total of 2,767 people.

Over six to 18 months, 6.75 percent of those using nicotine replacement stopped smoking for six months -- double the proportion of those using placebos. The researchers said it meant that 3 percent of smokers quit who otherwise would not have.

Participants in the studies who used nicotine replacement also received regular behavioral support and monitoring, and the researchers said that this support may have been as important as the nicotine replacement itself.

Aveyard said that use of nicotine replacement would allow treatment of many more smokers than the small number who say they want to quit. "It potentially opens the door to treat almost all smokers with treatments that were formally reserved for people who are wanting to quit right now," he said.

Because most nicotine replacement drugs are available over-the-counter but are not approved in the United States for smoking reduction, Aveyard suggests that people who want to try this approach should first consult with their doctor.

Dr. Norman H. Edelman, chief medical officer of the American Lung Association, predicted that the topic is going to be widely discussed in the United States.

"In Britain, they are a little bit ahead of us," Edelman said. "Right now, the FDA approval for nicotine replacement therapy is as an aid to cessation. The next issue is whether we should use nicotine therapy to reduce smoking without worrying about whether people quit or not."

The American Lung Association says that it should be used to help people quit smoking, but the group has "not adopted the idea of using nicotine replacement therapy for risk reduction," Edelman said.

And whether the Food and Drug Administration will approve its use to cut down on smoking is unclear, he said.

"It's a hot potato topic," Edelman said. "Cigarette companies are manufacturing nicotine delivery devices of all kinds, and there is a tendency to be negative about that. Nobody feels kindly disposed to letting tobacco companies make nicotine delivery devices."

And using nicotine replacement to reduce smoking sends the message that you can benefit by just smoking less, and "the American Lung Association is very opposed to that," Edelman said. "We do not support risk reduction by just smoking fewer cigarettes."

In a related article in the Journal of Thoracic Oncology, researchers reported that programs to help people quit smoking are cost-effective even for people with lung cancer.

A research team led by Dr. Christopher Slatore, from the University of Washington in Seattle, found that a smoking cessation program started before lung resection surgery was cost-effective both one and five years after surgery. They based their analysis on length of survival and improvement in the person's quality of life.

Although the results of the study apply only to people eligible for resection, all lung cancer patients should take part in smoking cessation programs, the researchers concluded.

More information
The American Lung Association has more on quitting smoking.

Newly Pregnant Smokers Have a 15-Week Window to Quit

(HealthDay News) -- Pregnant women who quit smoking before the 15th week of pregnancy reduce their risk of premature birth and having small babies to that of nonsmoking women, a new study finds.

It's known that smoking during pregnancy increases the risk of miscarriage, ectopic pregnancy, premature birth, small babies, stillbirth and neonatal death, but no study until now has determined whether stopping smoking in early pregnancy reduces the risks of small babies and premature births, the study authors said.

"Pregnant women who smoke should be encouraged and assisted to become smoke-free early in pregnancy," said lead researcher Dr. Lesley McCowan, an associate professor of obstetrics and gynecology at the University of Auckland in New Zealand.

Women who don't quit smoking by 15 weeks are three times more likely to give birth prematurely and twice as likely to have smaller babies, compared to women who stopped smoking, McCowan said.

The findings were published in the March 27 online issue of BMJ.

For the study, McCowan's team collected data on 2,504 pregnant women. Eighty percent did not smoke, 10 percent had quit smoking and 10 percent were current smokers.

There was no difference in the rate of spontaneous premature birth between women who did not smoke and those who had stopped by week 15 (4 percent vs. 4 percent). The same was true for having smaller babies (10 percent vs. 10 percent), the researchers found.

However, women who continued to smoke had higher rates of spontaneous preterm birth than woman who quit (10 percent vs. 4 percent) and higher rates of smaller babies (17 percent vs. 10 percent).

The study also found that women who stopped smoking weren't more stressed than women who continued to smoke, McCowan noted.

"Health professionals who care for pregnant women need to ask about smoking, advise about the importance of stopping, and, where possible, refer for extra support early in pregnancy to assist women to become smoke-free," she advised.

Dr. Richard Frieder, an associate clinical professor of obstetrics and gynecology at the University of California, Los Angeles David Geffen School of Medicine, said the study authors didn't explain whether this difference in low birth weight and gestational age at delivery actually translates into a measurable difference in newborn health.

"We assume this to be true, but there was only about a half pound difference in birth weight and six days difference in gestational age. These numbers are not very impressive that one would think a big difference in neonatal health would be achieved. Still, we should assume that a half pound and six days more of gestation is better and that we should strive to help women stop smoking," he said.

There are other big issues at play when it comes to babies, women and cigarette smoke, Frieder added.

"Babies that live in 'smoking homes' have a much higher risk of respiratory ailments, such as asthma and pneumonia and SIDS. In addition, women are more susceptible to the cancer-causing effects of cigarette smoke than men. The tobacco industry specifically targets women, despite this well-known fact," he said.

More information
For more on smoking and pregnancy, visit the American Lung Association.

Study Probes Why Smokers Find It Hard to Quit

(HealthDay News) -- If you're not craving a hit of nicotine the moment you declare you are quitting smoking, your battle just got a little tougher, say researchers at the University of Pittsburgh and Carnegie Mellon University.

"We have observed previously that the idea of smoking a cigarette becomes increasingly attractive to smokers while they are craving," lead investigator Michael Sayette, a University of Pittsburgh professor of psychology, said in a university news release. "This study suggests that when smokers are not craving, they fail to appreciate just how powerful their cravings will be. This lack of insight while not craving may lead them to make decisions -- such as choosing to attend a party where there will be lots of smoking -- that they may come to regret."

The study, published in the September issue of Psychological Science, examines the "cold-to-hot empathy gap" -- that is, the tendency for people in a "cold" state (one not influenced by visceral factors such as hunger or fatigue) to improperly predict their own behavior when in a "hot" state (hungry, fatigued). This is, in part, because those in the cold state can't recall the intensity of their past cravings.

The researchers gathered 98 smokers for two experimental sessions. Those put in a "hot" state were asked to not smoke for 12 hours prior to the first session, then were induced to crave a cigarette by holding but not smoking a lit one. Those in a "cold" state smoked up until the first session but did not hold a lit cigarette. A comparison group skipped the first session completely.

During the first session, "hot" and "cold" participants were asked how much money they would need to delay smoking for five minutes in the second session, a time when all participants would be in a "hot" state. Smokers in all three groups had to abstain from smoking for 12 hours before the second session started, and were asked to hold -- but not smoke -- a lit cigarette during the session.

When asked the money question in the second session, the "cold" smokers from the first session asked for significantly more money to delay smoking for just five minutes while those originally in a "hot" state did not request an increase.

Those from the "cold" group were also much less likely to accurately predict how much money they would need to delay lighting up. Almost half of the "cold" smokers requested more money than what they had initially predicted, while only 25 percent of the "hot" group did the same.

"These findings suggest that smokers are likely to underpredict their own future desire to smoke when they're not craving a cigarette," study co-author George Loewenstein, the Herbert A. Simon Professor of Economics and Psychology at Carnegie Mellon, said in the news release. "The research not only has implications for helping smokers quit, but it also enlightens us on how nonsmokers may pick up the habit. If smokers can't appreciate the intensity of their need to smoke when they aren't currently craving, what's the likelihood that people who have never smoked can do so?"

More information
The American Cancer Society has more about how to quit smoking.