SMOKING

 

Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects. It is considered an addictive substance because it contains the chemical, nicotine.

HISTORY AND INCIDENCE:

The tobacco plant is believed to have originated in the Western Hemisphere. The cultivated species most often grown for North American and European tobacco products is Nicotiana tabacum. The leaves of the plant are prepared for smoking, chewing, or sniffing. In addition, nicotine tobacco contains over 19 known carcinogens (most collectively known as "tar"), and more than 2,000 chemicals.

Prior to European influence in the Americas, tobacco was used by the Indians of Mexico and Peru, for ceremonies, medicinal purposes, and to alleviate hunger pangs during famines. Columbus is credited with introducing tobacco into Europe. Tobacco use became widely accepted by the Portuguese, Spanish, French, British, and Scandinavians. Explorers and sailors who became dependent upon tobacco, began planting seeds at their ports of call, thus introducing the product into other parts of Europe and Asia.

The colonists introduced tobacco on the American continent in the early 1600s. It became a major crop and trading commodity of the Jamestown colony. Over the years, tobacco has been claimed as a cure for a wide range of ailments with varying forms of administration. (For example, used in poultices, pastes, smoked, chewed, sniffed, or placed in any body cavity). Its social importance also grew over the years, even to the point of denoting the "modern or liberated woman" during the first part of the twentieth century.

It was not until the 1960s, with the introduction of medical research related to cigarette smoking, that the adverse health effects of tobacco became widely publicized. Unfortunately, most of the health hazards were associated only with cigarette smoking. While the number of cigarette smokers in the United States has continually decreased over recent years, the number of smokeless tobacco users has steadily increased. Since the 1970s, a 15-fold increase in smokeless tobacco has been noted in adolescents 17 - 19 years old. This has most likely been related to the emphasis on smokefree environments; availability; increased advertising of smokeless products; macho, athletic role models who use and advertise for smokeless products; and the false belief that smokeless tobacco is a safe alternative for those convinced they should stop smoking, but who still want (are addicted to) the nicotine effects of tobacco.

Although over 38 million people in the United States have quit smoking, about 50 million continue to smoke (about 25.7% of the adult population). Each year, approximately 1.3 million Americans quit smoking. In addition, about two thirds of current smokers state that they would like to quit, and only 19% of the current U.S. smokers report they have never tried to quit. About 30% - 40% of those who have not tried to quit, say they do not believe that the health risks of smoking are real, or they do not believe that quitting smoking will ultimately decrease their risks for disease.

It is estimated that about 5.5 million people use smokeless tobacco daily and another 6 million use it at least weekly. Young men are at highest risk for using tobacco products, but the incidence in women is increasing. Smokeless tobacco use is highest in the Southeast region, followed by the Central Plains and Western States. Its use is lowest in the Northeast region of the United States. Smokeless tobacco use patterns, are higher within the following occupations: athletes, ranchers, farmers, fishermen, lumberjacks, and industrial workers who have repetitive jobs requiring hand freedom.

EFFECTS:

Nicotine has both stimulant and depressant effects upon the body. Bowel tone and activity increases along with saliva and bronchial secretions. Stimulation of the central nervous system may cause tremors in the inexperienced user, or even convulsions with high doses. Stimulation is followed with a phase that depresses the respiratory muscles. As a euphoric agent, nicotine causes arousal as well as relaxation from stressful situations. On the average, tobacco use increases the heart rate 10 - 20 beats per minute, and it increases the blood pressure reading by 5 - 10 millimeters of mercury (because it constricts the blood vessels). Nicotine may also increase diaphoresis (sweating), nausea, and diarrhea, because of its effects upon the central nervous system. Nicotine's effects upon hormonal activities of the body, is also evident. It elevates the blood level of glucose and increases insulin production. Nicotine also tends to enhance platelet aggregation, which may lead to thrombotic (blood clot) events.

The "positive" effects of nicotine upon the body, may also be noted. It stimulates memory and alertness, enhancing cognitive skills that require speed, reaction time, vigilance and work performance.
As a mood altering agent, it tends to alleviate boredom and reduce stress and reduces aggressive responses to stressful events. It also tends to be an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets), and inhibiting the efficiency with which food is metabolized. Peoples who use tobacco products frequently, depend upon it providing these side effects to help them accomplish certain tasks, at specific levels of performance.

The addictive effects of tobacco, have been well documented. It is considered mood and behavior altering, psychoactive, and abuseable. As a multisystem pharmacological agent that is voluntarily administered, tobacco is believed to have an addictive potential comparable to alcohol, cocaine, and morphine.

ASSOCIATED HEALTH RISKS:

In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux, hypertension, fetal illnesses and death, and delayed wound healing. Tobacco, the vehicle of nicotine delivery, contains tar (numerous chemicals that cause a thick, sticky substance when smoked) and about 2,000 chemicals total. Tobacco and its various components, have been associated with an increased risk for cancer of various body organs.

Some Of The Chemicals Identified In The Gas Phase Of Tobacco Smoke Include:

Acetone - A colorless, flammable liquid which is used as a solvent (it is most familiar as the solvent in nail polish remover). The simplest ketone, it mixes with water, ethyl alcohol, and most oils. It melts at -95.4° C. and boils at 56.2° C. It is naturally found in very tiny quantities in the body fluids and tissues of healthy people, and in somewhat larger amounts in people suffering from diabetes or starvation.

Acetonitrile - Colorless liquid with an ether-like odor. Symptom: Asphyxia, nausea, vomiting, chest pain, weakness, stupor, convulsions, and eye irritation.

Acetylene - Acid comes from the French 'acide' from the Latin 'acidus,' from 'acere', meaning to be sour. Other related words: acerbate, acerbic, acetone, acetylene, and 'Acer'; the genus name for maple trees. But watch out on organic chemistry tests; acetic acid and acetylene have two carbons but acetone has three.

Ammonia - The common name for NH3, a strongly basic, irritating, colorless gas which is lighter than air and readily soluble in water. It is formed in nature as a by-product of protein metabolism in animals. Industrially, it is used in explosives, fertilizer, refrigerants, household cleaning solutions, etc.

Ammonium hydroxide (NH4+) -  A solution of ammonia gas in water.

Carbon Dioxide - A metabolic byproduct of carbohydrate metabolism. Carbon Dioxide collects in the tissues, is cleared by the blood (via the veins) and removed from the body via the lungs when we exhale air.

Carbon Monoxide - An organic byproduct of combustion, tasteless, odorless gas that competes with oxygen binding sites on the hemoglobin molecule. Early symptoms of carbon monoxide exposure, include headache and nausea. Advanced exposure results in coma, cardiovascular collapse and death.

Dimethylinitrosamine - A chemical identified in the gas phase of tobacco smoke.

Hydrogen Cyanide - At room temperature, hydrogen cyanide is a colorless liquid which boils at 26° C. The most important route of poisoning is through inhalation. Both gaseous and liquid hydrogen cyanide, as well as cyanide salts in solution, can also be taken up through the skin. Colorless or pale blue liquid or gas bp 26° C, mp -13° C. Bitter almond odor detectable at 1 to 5 ppm; however, 20 to 60% of the population are reported to be unable to detect the odor of HCN.  The acute toxicity of hydrogen cyanide is high, and exposure by inhalation, ingestion, or eye or skin contact can be rapidly fatal. Symptoms observed at low levels of exposure (e.g., inhalation of 18 - 36 ppm for several hours) include weakness, headache, confusion, nausea, and vomiting. Inhalation of 270 ppm can cause immediate death, and 100 to 200 ppm can be fatal in 30 to 60 min. Aqueous solutions of HCN are readily absorbed through the skin and eyes, and absorption of 50 mg can be fatal. In humans, ingestion of 50 - 100 mg of HCN can be fatal. Because there is wide variation in the ability of different individuals to detect the odor of HCN, this substance is regarded as having poor warning properties.
Effects of chronic exposure to hydrogen cyanide are nonspecific and rare. Last, but not least, gas chamber poisoning.

Methane - Methane (CH4) is a hydrocarbon and a principal component of natural gas. Methane is also a "greenhouse gas," meaning that its presence in the atmosphere affects the earth's temperature and climate system. Like carbon dioxide (CO2) and nitrous oxide (N2O), methane is a radiatively and chemically active "trace gas." Methane is considered a trace gas because it is a minor atmospheric constituent (1.72 parts per million by volume, ppmv, in 1990) compared to other gases such as nitrogen and oxygen (78% and 21% by volume, respectively). Methane's radioactive activity refers to properties that cause it to trap infrared radiation (IR), or heat, enhancing the greenhouse effect.

Propane Propene - A heavy gaseous hydrocarbon, C3H8, of the paraffin series, occurring naturally dissolved in crude petroleum, and also made artificially. A colorless gaseous hydrocarbon (C3H6) of the ethylene series, having a garlic odor. It occurs in coal gas, and is produced artificially in various ways.

Pyridine - A nitrogenous base, C5H5N, obtained from the distillation of bone oil or coal tar, and by the decomposition of certain alkaloids, as a colorless liquid with a peculiar pungent odor. It is the nucleus of a large number of organic substances, among which several vegetable alkaloids, as nicotine and certain of the ptomaine's, may be mentioned.

Methyl chloride - A colorless, flammable, liquified gas with a sweet-like odor. Highly Toxic. Attacks central nervous system, odor does not give adequate warning of presence. Methyl Chloride - CH3Cl - is used as a refrigerant, as a catalyst solvent in Butyl rubber, as a reagent in silicone production, in organic synthesis, in the manufacture of tetramethyllead, as a solvent, and as a starting material in the manufacture of such chemicals as methyl mercaptan, methylene chloride, chloroform, carbon tetrafluoride. It is used in the manufacture of silicone polymers, tetramethyllead (an antiknock agent for gasoline), and methylcellulose (a textile-sizing agent) and as a solvent in the production of butyl rubber. It has also been used as a refrigerant, but less toxic and less flammable compounds have largely replaced it. Methyl chloride was first prepared about 1835 from methanol, sulfuric acid, and common salt. The oldest commercial process was the thermal decomposition of betaine, a waste product of the beet-sugar industry; later methods depend on the reaction of methanol with hydrogen chloride or of methane with chlorine. The compound is ordinarily stored and shipped as the liquid, which boils at -24° C (-11° F) at atmospheric pressure. Health Factors: SYMPTOM: Dizziness, nausea, vomiting, visual disturbance, staggering, slurredspeech, convulsions, coma, liver, kidney damage, frostbite, damage frostbite.

Methylfuran - A chemical identified in the gas phase of tobacco smoke.

Nitrogen Oxides - Nitrogen oxides (NOx) such as nitrogen dioxide are the products generated by combination of the nitrogen and oxide in fuel or air upon combustion of substances. Nitrogen dioxide is known to affect the throat and the lung. The main effects are emphysema and cellular damage which reduce the efficiency of breathing. In levels encountered in polluted air, people with respiratory problems, particularly infants, may be affected.

Nitrospyrrolidine - A chemical identified in the gas phase of tobacco smoke.

Propionaldehyde - Propionaldehyde is a colorless liquid with a suffocating fruity odor. The odor threshold for propionaldehyde is 1 ppm. The chemical formula for propionaldehyde is C3H6O, and the molecular weight is 58.08 g/mol. The vapor pressure for propionaldehyde is 317 mm Hg at 25° C.
Propionaldehyde is used in the manufacture of plastics, in the synthesis of rubber chemicals, and as a disinfectant and preservative.

2-Butane - An inflammable gaseous hydrocarbon, C4H10, of the marsh gas, or paraffin, series.

3-Picoline - Any one of three isometric bases (C6H7N) related to pyridine, and obtained from bone oil, acrolein ammonia, and coal-tar naphtha, as colorless mobile liquids of strong odor.

3-Vinylpyridine - A chemical identified in the gas phase of tobacco smoke, plus toxic and tumorigenic agents in undiluted cigarette sidestream smoke.
Some Of The Chemicals In The Particulate Phase:
Aniline - An organic base belonging to the phenyl amines. It may be regarded as ammonia in which one hydrogen atom has been replaced by the radical phenyl. It is a colorless, oily liquid, originally obtained from indigo by distillation, but now largely manufactured from coal tar or nitrobenzene as a base from which many brilliant dyes are made.

Benzopyrene - Poly cyclic aromatic compound. Potent mutagen and carcinogen.

Catechole - A colorless crystal (C6H6O2), soluble in water, alcohol, ether, benzene, and alkalis. An alkaline solution gives a coloration with ferric chloride, which turns brown on standing in air. It can be obtained fromCATECHU , a natural dye, or prepared by fusing orthobenzenedisulfonic acid with caustic soda. Catechol is the principal constituent of the condensed (catechol) tannins.

Hydrazine - Hydrazine is a colorless, mobile liquid which is used as missile fuel. It is also used to remove oxygen from boiler water to prevent corrosion and as a building block for agricultural chemicals.

Naphthalene - Naphthalene, C10 H8 ,is a poly aromatic hydrocarbon with two ortho condensed benzene rings. It is a white crystalline solid with a strong odor of moth balls. Its principal use is in the production of pthalic anhydride, insecticides, plasticizes, pharmaceuticals and lubricants. Naphthalene is a major component of coal tar (5% - 11%) and enters the environment mainly from industrial or municipal waste treatment plant discharges or spills. Canadian coking operations produce a significant amount of coal tar (50 litres/metric ton of coke).It is also a component of crude oil and therefore can be used as an indicator of pollution by the same.

Methylnapthalene - One of the chemicals in the particulate phase.

Methylquinolines - A bacterial culture.

Nicotine - A plant alkaloid from tobacco, blocks transmission at nicotinic synapses.

N'-Nitrosonornicotine - Is a yellow oil that solidifies on standing in the cold. It is soluble in water. N-Nitroso compounds are readily degraded in the presence of ultra-violet or visible light. When heated to decomposition, it emits toxic fumes of nitrogen oxides (NOx) N-Nitrosamines are frequently produced during rubber processing and may be present as contaminants in the final rubber products. Potential exposure depends on the ability of the nitrosamines to migrate from the product and enter the body. Significant levels of N-nitroso compounds have been identified in a number of materials including pesticides, cosmetics, cutting fluids, and fire resistant hydraulic fluids. The N-nitroso compounds found in these products were apparently formed in situ during storage or handling as the result of a reaction between amines present in the mixture and inorganic nitrite, which may have been added as a corrosion inhibitor.

NNK - NNK is a light yellow crystalline solid with a melting point of 63°-65°C. The abbreviation NNK was selected to emphasize the relationship of this compound to nicotine and stands for nicotine-derived nitrosamino ketone. NNK has no known use other than as a laboratory chemical. NNK is not produced commercially. It is an oxidation and nitrosation reaction product of nicotine.NNK is formed during the curing, aging, and processing and smoking of tobacco. It has been detected in tobacco at 0.1-35 mg/kg, in snuff products at 0.2-8.3 mg/kg, and in cigarette smoke at 0.1-0.5 µg/cigarette. It may also form in the mouth during tobacco chewing or oral snuff use. NNK has also been detected in the sidestream smoke of cigarettes. Potential exposure to NNK is widespread among tobacco product users and those exposed to sidestream smoke.

Phenol - A white or pinkish crystalline substance, C6H5OH, produced by the destructive distillation of many organic bodies, as wood, coal, etc., and obtained from the heavy oil from coal tar. It has a peculiar odor, somewhat resembling creosote, which is a complex mixture of phenol derivatives. It is of the type of alcohol's, and is called also phenyl alcohol, but has acid properties, and hence is popularly called carbolic acid, and was formerly called phenic acid. It is a powerful caustic poison, and in dilute solution has been used as an antiseptic.
2. Any one of the series of hydroxyl derivatives of which phenol proper is the type. Glacial phenol, any one of a series of compounds having both phenol and aldehyde properties. Phenol phthalein.

Pyrene - The 'stone' (endocarp plus seed) of a succulent fruit.

Quinoline - A nitrogenous base, C9H7N obtained as a pungent colorless liquid by the distillation of alkaloids, bones, coal tar, etc. It the nucleus of many organic bodies, especially of certain alkaloids and related substances; hence, by extension, any one of the series of alkaloidal bases of which quinoline proper is the type.

Stigma sterol - One of several ingredients, used in an acne remover.

Toluene - A hydrocarbon, C6H5.CH3, of the aromatic series, homologous with benzene, and obtained as a light mobile colorless liquid, by distilling tolu balsam, coal tar, etc.

Tar - A thick, black, viscous liquid obtained by the distillation of wood, coal, etc., and having a varied composition according to the temperature and material employed in obtaining it. Coal tar. Mineral tar, a kind of soft native bitumen. Tar board, a strong quality of mill board made from junk and old tarred rope. Tar water. A cold infusion of tar in water, used as a medicine. The ammonia cal water of gas works. Wood tar, tar obtained from wood. It is usually obtained by the distillation of the wood of the pine, spruce, or fir, and is used in varnishes, cements, and to render ropes, oakum, etc., impervious to water.

Water -The fluid which descends from the clouds in rain, and which forms rivers, lakes, seas, etc. Pure water consists of hydrogen and oxygen, H2O, and is a colorless, odorless, tasteless, transparent liquid, which is very slightly compressible. At its maximum density, 39° F. or 4° C., it is the standard for specific gratuities, one cubic centimeter weighing one gram. It freezes at 32° F. or 0° C. and boils at 212 degrees F. or 100° C. It is the most important natural solvent, and is frequently impregnated with foreign matter which is mostly removed bydistillation; hence, rain water is nearly pure. It is an important ingredient in the tissue of animals and plants, the human body containing about two thirds its weight of water.

2-Naphthylamine - An industrial chemical, is now used for research purposes only. Previously, 2-naphthylamine was used mainly as an intermediate in the manufacture of dyes and as an antioxidant in the rubber industry, but in recent years, manufacturers have substituted other chemicals for 2-naphthylamine.  It is not produced for commercial use in the United States.
The primary routes of potential human exposure to 2- naphthylamine are inhalation, ingestion, and dermal contact. Prior to termination of its domestic production and use in the dye and rubber industries, an estimated 1,000 workers were possibly exposed to 2-naphthylamine. The National Occupational Exposure Survey (1981-1983) indicated that 275 total workers, including 265 women, potentially were exposed to 2-naphthylamine in the work place. Investigators have reported its presence in coal tar and cigarette smoke (0.02 µg/cigarette). The compound also occurs as an impurity in commercial 1- naphthylamine (0.5% or less). Laboratory technicians and scientists who use the compound in research may constitute the group with the greatest risk of potential exposure.

4-Aminopiphyenyl - One of the chemicals in the particulate phase.


For Smokers,
The Specific Health Risks Of Tobacco Use Include:
Nicotine addiction - Nicotine addiction is when a person psychologically, physically, and/or socially has a compulsive need for nicotine. There is a persistent craving for the nicotine product. The amount and frequency with which a nicotine product is used continually increases (for example, a person now feels the need to smoke 2 packs a day instead of 1 pack a day). A lot of valuable time is spent trying to get some nicotine. Things that used to be important to a person, such as activities or personal relationships, have been pushed aside or given up completely for the opportunity to get a nicotine fix. Nicotine use continues even though the dangerous health risks are known. Claims of being unable to quit due to sickness, weight gain, and/or cravings for nicotine, when there is no usage. This often means nicotine is being used to avoid the withdrawal syndrome. There have been repeated unsuccessful attempts to quit.

Decreased senses of taste and smell - Foods tastes differently to smokers. Sense of smell is not as strong, as a non-smoker.

Increased fetal death and diseases - A miscarriage; the spontaneous termination of a pregnancy before fetal development adequate for survival (usually about 20 weeks). A natural event, not an elective or therapeutic abortion procedure.

LUNG DISEASE:
Emphysema - A lung disease involving damage to the air sacs (alveoli). The lungs become less able to expand and contract (loss of elasticity). The air sacs are unable to completely deflate (over inflation) and are therefore unable to fill with fresh air for adequate ventilation.

Chronic Bronchitis - An inflammation of the bronchi, the main air passages to the lungs, that occurs over a long period and recurs over several years.

Lung Cancer - A cancerous growth in lung tissue. Lung cancer may be metastatic from another source (colon) or may be primary (tumor is of lung cell origin). Classification is based on the type of cell the lung cancer originates from (adenocarcinoma, alveolar cell carcinoma, squamous cell carcinoma, large cell and small cell carcinomas).

CORONARY ARTERY DISEASE:
Angina - A dull, crampy centralized abdominal pain that occurs 15-30 minutes after a meal. Associated with ischaemic bowel disease. Evaluated with mesenteric arteriography.

Heart Attacks -  A blockage in the heart's arteries may reduce or completely cut off the blood supply to a portion of the heart. This can cause a blood clot to form and totally stop blood flow in a coronary artery, resulting in a heart attack also called an acute myocardial infarction (MI). Irreversible injury to the heart muscle usually occurs if medical help is not received promptly. Unfortunately, it is common for people to dismiss heart attack symptoms.

ATHEROSCLEROTIC AND PERIPHERAL VASCULAR DISEASE:
Aneurysms - A sac formed by the dilatation of the wall of an artery, a vein or the heart. The physical signs of arterial aneurysm are the formation of a pulsating tumor and often a bruit (aneurysmal bruit) heard over the swelling. Sometimes there are symptoms from pressure on contiguous parts.

Hypertension - Persistently high arterial blood pressure. Hypertension may have no known cause (essential or idiopathic hypertension) or be associated with other primary diseases (secondary hypertension). This condition is considered a risk factor for the development of heart disease, peripheral vascular disease, stroke and kidney disease.

Blood clots - The conversion of blood from a liquid form to solid through the process of coagulation. A thrombus is a clot which forms inside of a blood vessel. If that clot moves inside the vessel it is referred to as an embolus (embolism). The presence of atherosclerotic plaque lining blood vessel walls is a significant stimulus for clot formation.

Strokes - A condition due to the lack of oxygen to the brain which may lead to reversible or irreversible paralysis. The damage to a group of nerve cells in the brain is often due to interrupted blood flow, caused by a blood clot or blood vessel bursting. Depending on the area of the brain that is damaged, a stroke can cause coma, paralysis, speech problems and dementia.

ORAL/TOOTH/GUM DISEASE:
Includes Oral Cancer - Most oral cancers are squamous cell ("scale like" cell type) carcinomas, which are malignant and tend to spread rapidly.A disorder involving abnormal, malignant tissue growth in the mouth. Oral or mouth cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, or in the salivary glands, cheek lining, gingival (gums), or palate (roof of the mouth).


For Nonsmokers,
Exposed Regularly To Second Hand Smoke, The Specific Health Risks Include:
Increased risk of Lung Cancer over those not exposed to smoke.
In infants and children- an increased frequency of respiratory infections (such as Bronchitis and Pneumonia), Asthma, and decreases in lung function as the lungs mature.
May experience (upon exposure to smoke) acute, sudden, and occasionally severe, reactions including eye, nose, throat, and lower respiratory tract symptoms.


For Smokeless Tobacco Users,

The Specific Health Risks Include:

Nicotine Addiction - Same as above. Plus, increased infant death and diseases (if mothers to be, chew).

Decreased senses of taste and smell - Kills the real taste of food. Can dull the sense of smell.

ORAL/TOOTH/GUM DISEASES:
Including a 50 times greater risk for oral cancer with long term or regular use. (See above)

CORONARY ARTERY DISEASE:
Angina - Same as above.
Heart attacks - Same as above.

ATHEROSCLEROTIC AND PERIPHERAL VASCULAR DISEASE:
Aneurysms - Same as above.
Hypertension - Same as above.
Blood clots - Same as above.
Strokes - Same as above.


STOPPING SMOKING
A wide range of methods exist for quitting smoking. Family members, friends, and work associates may be supportive or encouraging, but the desire and commitment to quit must be a personal decision. It may prove helpful to write up a specific list of the reasons why one wants to quit. A 1990 Gallup poll of smokers revealed, that two thirds of smokers state they would like to quit.

Past attempts to quit tobacco use, should be viewed as learning experiences, not failures. Information from people who have been able to successfully quit smoking, shows that 70% had made 1 - 2 previously unsuccessful attempts; 20% had made 3 - 5 previously unsuccessful attempts; and 9% had made 6 or more previously unsuccessful attempts before actually quitting.

Like other addictive behaviors, tobacco use is difficult to stop and maintain, particularly if acting totally alone. The best success in quitting has been noted with comprehensive programs that may combine various strategies, over time (usually 4 - 8 weeks, with 1 or 2 hours of support per week) including education, peer support, behavior recognition, behavior modification methods, recognition of potential relapse situations, and strategies for confronting such situations. Medications that are nicotine substitutes, such as transdermal nicotine or nicotine gum, may be used temporarily in conjunction with such programs. Some medications require a prescription, therefore seek the support and cooperation of the primary care provider for their use.

Comprehensive programs for quitting smoking, have a successful rate of about 20% - 40% of participants. In contrast, 2.5% of people who choose to quit smoking spontaneously, without help, achieve success. Once a person has chosen to quit using tobacco products, it may prove beneficial to elicit a broad range of collaborative methods and support persons to enhance optimal success. If success is not reached initially, simply look at what occurred or what didn't work, develop new strategies, and try again. Multiple attempts are frequently necessary to "beat the habit."


BENEFITS OF QUITTING
WITHIN 20 MINUTES OF QUITTING:
Blood pressure and pulse rate drop to normal.
Body temperature of extremities (hands and feet) increases to normal.

WITHIN 8 HOURS OF QUITTING:
Carbon Monoxide level in blood, drops to normal.
Oxygen level in blood increases to normal.

WITHIN 24 HOURS OF QUITTING:
Risk of sudden heart attack decreases.

WITHIN 48 HOURS OF QUITTING:
Nerve endings begin to regenerate senses of smell, and taste begins to return to normal.

WITHIN 2 WEEKS - 3 MONTHS OF QUITTING:
Circulation improves, walking becomes easier, lung function increases up to 30%.

WITHIN 1- 9 MONTHS OF QUITTING:
Overall energy, typically increases. Symptoms associated with chronic use, decrease. (Such as coughing, nasal congestion, fatigue, and shortness of breath).

Cilia - (Fine, hair like projections lining lower respiratory tract): function begins to return to normal, which increases the body's ability to handle mucus, clean the respiratory tract, and reduce respiratory infections.

WITHIN 1 YEAR OF QUITTING:
Excess risk of Coronary Heart Disease, is half that of a tobacco user.

WITHIN 5 YEARS OF QUITTING:
Lung Cancer death rate (for average 1 pack a day former smoker), decreases by nearly 50%.
Risk of cancer of the mouth, is half that of a tobacco user.

WITHIN 10 YEARS OF QUITTING:
Lung Cancer death rate, becomes similar to that of a non tobacco user. Precancerous cells are replaced with normal cell growth.
Risk of stroke is typically lowered, possibly to that of a non tobacco user.
Risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases.

WITHIN 15 YEARS OF QUITTING:
Risk of Coronary Heart Disease, is that of a nonsmoker.


CALL YOUR HEALTH
CARE PROVIDER IF:
You are a current tobacco user interested in an individual health risk profile, methods to stop tobacco use, help and support for ceasing tobacco use, more information regarding tobacco related health risks (or second-hand smoke) and benefits of quitting tobacco use.
You are a woman using tobacco products who is currently pregnant or planning a pregnancy in the future.
You are experiencing signs or symptoms of specific diseases associated with tobacco use (even if you are a nonsmoker exposed regularly to second-hand smoke).

OTHER RESOURCES INCLUDE:
Local chapters of the American Lung Association and The American Cancer Association. Both organizations have a wide range of resource materials and formalized, comprehensive smoking cessation programs.
NOTICE: The information provided herein, should not be used for diagnosis or treatment of any medical condition. A licensed physician, should be consulted for diagnosis and treatment of any and all medical conditions.



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