Longtime Smokers Can See Instant Health Benefits When They Quit

New therapies can help you break the smoking habit and immediately reduce health risks.

The costs of smoking reveal themselves most brutally in midlife or later: increased risks of 15 types of cancer, heart disease, lung disease, stroke, diabetes, even osteoporosis.

“Tobacco is the only product that hurts us when used as intended, killing half of all users,” Otis Brawley, MD, chief medical officer of the American Cancer Society, tells Next Avenue.

But there’s no reason you should resign yourself to this fate. Despite the widespread assumption that after age 50 it’s too late — that longtime smokers won’t see substantial benefits if they kick the habit  — recent analysis of data from 13 studies shows otherwise. When a smoker quits, even after many years of tobacco use, the risks of heart attack, stroke, chronic obstructive pulmonary disease (COPD) and other lung diseases quickly decline. So, too, the risk of other cancers, including esophgus, mouth, larynx and acute myeloid leukemia. 

“The risks of cardiovascular disease deaths drops almost immediately,” Dr. Brawley says, noting that whenever new laws are established to prohibit smoking in restaurants and other public places, "within six months, those cities see the number of heart attacks going down among smokers and those exposed to second-hand smoke.” A 2009 study in Arizona suggests such bans also reduce the number of secondhand smoke-related strokes. 

When hypertension patients give up cigarettes, their systolic blood pressure drops within three weeks, according to Dr. Brawley. And there are other benefits over time for any smoker who quits: After 10 years — and perhaps as few as five — cancer risks also will have declined significantly, although they’ll never return to pre-smoking levels, Dr. Brawley says.

“The benefits are greater the earlier in life one quits, but there are significant benefits even for people in their 80s,” he says.

Are you Teaching Your Grandkids to Smoke?
Parents who smoke are more likely to influence their own children to become smokers when they become young adults, studies show. But nobody talks about the grandparents. Research shows that when a grandparent smokes, it too dramatically increases the likelihood that his or her grandchild will take up the habit. For grandparents who smoke, there’s a double incentive to quit.
“The influence of grandparents is overwhelming,” says Marie Leiner, a researcher at Texas Tech University Health Sciences in El Paso, Tex. Leiner has found that children whose grandparents are hooked on nicotine are 70 percent more likely to become smokers themselves than kids whose grandparents are nonsmokers.

Research indicates that quitting for the sake of loved ones may help smokers rid themselves of the habit more successfully. Parents who are motivated by a desire to protect their children, for example, are more likely to give up cigarettes for good, according to a recent analysis of data from 18 studies. 

Dr. Brawley emphasizes the importance of encouraging young people not to start smoking. “Ninety-six percent of smokers over age 40 began before they were 17 years old,” he says, adding, “We know that’s when the tobacco industry wants to handcuff them.”

Nicotine is more addictive than cocaine, Dr. Brawley says, which means giving up cigarettes is a challenge at any age. But research indicates that it’s no harder in midlife than in youth. What makes it most difficult is not how many years you’ve smoked but the extent of your daily habit.

“People who smoke two packs a day are more addicted than one-pack-a-day smokers,” Dr. Brawley explains. For this reason, light smokers — those who go through less than a pack a day — tend to be much more successful in their attempts to quit.

Still, even heavy smokers can kick the habit — despite tobacco companies’ desire to hang on to their customers, which is reflected in efforts ranging from direct mail to their infamously misleading  “low tar” and “mild” marketing campaigns.

New (and Sometimes Dubious) Quitting Strategies

Quitting is a complex process, and there is no simple key to success for every smoker.

What appears to be the most effective strategy involves a combination of drug therapy and counseling, according to Dr. Brawley. “Counseling can be done one on one, with a doctor, social worker, psychology,” he says. “There’s even some data showing calls to a telephonic quit-tobacco help-line can work.”

There are no shortage of smartpone apps for quitting smoking available on the Internet. There’s even a free one developed by MMG for the Tobacco Control Research Branch of the National Cancer Institute.  

If nicotine replacement therapy — patches or gum — does not work, there are other options. Combining bupropion with nicotine replacement slightly improves success rates (by 9 percent) over nicotine patches or gum alone, according to a recent study. 
Of course, any use of prescription drugs should be discussed with a physician, since most of these drugs present risks and side effects of their own. Varenicline (Chantix), for example, may triple the odds that you will successfully give up tobacco, but it carries potentially serious risks to some patients’ cardiovascular health, and possible psychiatric risks as well. 
Diazepam (Valium) is frequently prescribed to help patients manage the anxiety associated with nicotine withdrawal. So far there’s no evidence, however, that it improves success rates among smokers trying to stop. And like many prescription medications, it is potentially habit-forming.

Unproven and “snake oil” products that promise to help smokers quit are ubiquitous, Dr. Brawley cautions. Moreover, the notion that chewing tobacco is a less-dangerous alternative to cigarettes is completely wrongheaded, he says.

“But I keep an open mind,” Dr. Brawley adds. “There are nontraditional things that appear beneficial. Some hypnosis approaches seem to work.”
Studies have also begun to suggest that acupuncture and acupressure may be effective. Although large trials have not been done to confirm this, at least these techniques are safe.
“One product we don’t have data on, but that people are selling already, are e-cigarettes,” Dr. Brawley says, referring to electronic, cigarette-shaped tobacco nebulizers that allow smokers to inhale a vapor that contains nicotine without lighting up. It may be that nicotine replacement sidesteps the toxic cocktail of chemicals in cigarette smoke.  “Five years from now, we might see that as a good thing," says Dr. Brawley, "but the science hasn’t been done yet — and they’re being sold as if the science has been done.”

Nor has Nicobrevin, an over-the-counter herbal supplement that comes in capsule form (it’s a mixture of quinine, camphor and eucalyptus oil) been fully tested. Two clincal trials suggerst that Mecamylamine, a blood pressure medication, shows some promise when used in combination with nicotine replacement, because it binds to and blocks nicotine receptors. But clinical trials have not yet confirmed that preliminary finding, and used alone, it does not appear to be a useful anti-smoking medication.

No matter which approach to quitting you choose, support is essential. Smokers whose partners, friends and family encourge their effort to quit are more likely to be successful, research shows. And group therapy roughly doubles a smoker’s chances of giving up the habit

Mental Health Factors Related to Quitting and How to Manage Them

Guilt and self-blame are counterproductive and “a documented barrier to cessation” that reduce the chances a smoker will successfully quit, according to Jane Cataldo, a geriatric nursing researcher at UC San Francisco. The tobacco industry maintains that addicted smokers are solely responsible for their behavior, and this contributes to self-blame, she notes.

Language can have a strong impact, either negative or positive. One pilot study, published in March 2012 in the journal Family Process, reports that couples, by speaking of smoking as “our” problem rather than “my” or “your” problem, can improve quit rates and reduce the chance of relapse.
Depression, particularly among postmenopausal women, appears to be a significant factor in smoking behavior, including relapse. Some prescription antidepressants — such as bupropion (Zyban) and nortriptyline (Aventyl) — can do double-duty, helping to counter depression and significantly improving the odds that the smoker will successfully quit.

These drugs don’t just alleviate the smoker’s depression; they also affect the brain in ways similar to nicotine-replacement therapy, research suggests. Other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and fluoxetine (Prozac), do not have that effect and, as a result, appear to be less useful in helping people stop smoking.

Weight Gain Can Be an Unhealthy Side Effect 

Kicking tobacco typically leads to weight gain, particularly in postmenopausal women. Quitters tend to accumulate fat, but also healthy muscle mass. One way to address this is through exercise and diet, but there have not yet been enough studies to determine what kind of regimen is best. Studies show, however, that naltrexone (Revia) and bupropion can help reduce weight increases associated with quitting tobacco. 

Bryant Furlow is a medical journalist and investigative reporter who lives in Albuquerque, N.M.

Bryant Furlow
By Bryant Furlow
Bryant Furlow is an investigative reporter and medical writer who lives in Albuquerque.

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