The Medical Minute: The Great American Smokeout

American Cancer Society

By John Messmer

Since 1976, the American Cancer Society has sponsored the Great American Smokeout in an effort to focus attention on the health dangers of smoking and the importance of quitting. Americans are increasingly aware that smoking is highly addictive and destructive, and today there are more former smokers than ever. Yet, despite the generally accepted (even by tobacco companies) knowledge that smoking is addictive and that it causes many harmful health effects, about one in five adults and one in four teens smoke.

An estimated 438,000 people die annually as a result of cigarette smoking or secondhand smoke according to the Surgeon General’s 2006 report. Fortunately, the percentage of Americans with cotinine, the byproduct of nicotine exposure, has fallen by 70 percent in the last decade, but even so, about 40 percent of us continue to have measurable cotinine levels, indicating regular exposure to second hand smoke. Babies whose mothers smoke while pregnant and afterwards have increased risks for sudden infant death syndrome, asthma, pneumonia and ear infections.

Nov. 20, this year’s date for the Great American Smokeout, is a good time to try quitting, even if it’s just for one day. To avoid withdrawing, there are many nicotine substitutes available with and without prescription, from nicotine gum to lozenges, sprays and patches. While these do not treat the addiction, at least nicotine replacement products eliminate the other toxic products delivered by tobacco. Nicotine replacement products help the tobacco user to unlearn the habit of dealing with cigarettes, pipes, cigars and chewing tobacco and puts that person in a good position gradually to use less nicotine and to quit eventually.

Prescription medications can help reduce the craving that comes from quitting. Nicotine causes addiction by increasing the amount of dopamine in the “pleasure center” of the brain. As nicotine is metabolized, the pleasure center loses this stimulation and demands more, leading to continued use of nicotine. Bupropion (Zyban, Welbutrin) has been available for some time to help treat nicotine withdrawal. It increases the amount of dopamine in parts of the brain. A newer medication, varenicline (Chantix) takes a different approach. This medication acts like nicotine to a small degree, fooling the pleasure center into thinking it’s being stimulated while simultaneously blocking nicotine from attaching to the nicotine receptors in the brain, negating its effects. Thus, smoking itself is not as pleasurable. Over time, the pleasure center stops demanding nicotine as strongly, increasing the person’s ability to resist the desire to smoke.

Even with medications, many smokers will benefit from support in their quitting. The National Cancer Institute sponsors a toll-free number (800)-QUIT-NOW (800-784-8669; TTY 800-332-8615) and Web site http://1800quitnow.cancer.gov/ to meet that need. The American Cancer Society Quit line is similar at (800) 227-2345. The Pennsylvania Quit Line is (877) 724-1090. There is information on just about every aspect of tobacco addiction and quitting smoking at the Centers for Disease Control and Prevention (CDC) Web site: www.cdc.gov/tobacco.

Once a smoker has quit, it is vitally important never to have anything to do with tobacco again. The nicotine receptors in the brain will always be ready to respond to nicotine. Even a brief exposure to nicotine can stimulate the desire to smoke again – this is why former smokers who “have just one” typically resume smoking.

It’s never too late to quit. Much of the increased disease risk returns to normal after time. There has never been more help to quit. For anyone who has ever considered quitting, now is the time.

John Messmer is associate professor of family and community medicine at Penn State College of Medicine and a staff physician at Penn State Hershey Medical Center.