Age, gender and social advantage affect success in quitting smoking

The study, commissioned by the National Institute for Health and Clinical Excellence (NICE) and undertaken by the UK Centre for Tobacco Control Studies (UKCTCS), reviewed published studies from between 1990 and 2007 to establish success rates for the NHS smoking cessation services. It found that older smokers are more likely than young smokers to successfully quit, some men appear to be more successful at quitting than women despite the fact that more women attend the smoking cessation services, and more disadvantaged groups face greater challenges when giving up smoking.

30 may 2011--The findings support other international research that also suggests that while women are highly motivated to quit smoking, men may be more likely to succeed when they access services to help them stop. Several factors seem to explain the lower success rates of women, such as less confidence in quitting, the inter-relationship between gender and deprivation and differences in the meaning and role of tobacco in men and women's lives.

Pregnant women and more disadvantaged groups face particular challenges in quitting. Pregnant smokers who enrol in smoking cessation programmes may just suspend their smoking for the duration of their pregnancy as opposed to quitting altogether. These smokers are more likely to be shift and manual workers and may experience multiple barriers that make it harder to stop smoking in the long-term.

There are similar difficulties for smokers from more deprived areas where smoking is more prevalent. In such areas, smoking is often perceived as the norm which makes quitting harder.

While cessation rates for smokers accessing NHS stop smoking services were lower in disadvantaged areas (52.6 per cent) than elsewhere (57.9 per cent) the proportion of smokers being treated by the services was higher (16.7 per cent compared with 13.4 per cent). The net effect with the additional treatment meant that a higher proportion of smokers in the most disadvantaged areas reported success (8.8 per cent) than in more advantaged areas (7.8 per cent).

The UK remains the only country in the world to have a comprehensive, free-at-the-point-of-use cessation services and the study suggests that these services do provide effective support for smokers who want to quit. However, a number of important research questions remain regarding the effectiveness of different forms of intervention offered by the services.

For example, because gender, ethnicity, class, age and level of dependency affect success in giving up smoking, tailored interventions may help to improve cessation rates. In the case of pregnant women, two reviews of NHS smoking cessation services provide evidence that the most effective treatment for pregnant smokers includes elements such as systematic training of midwives in how to refer pregnant smokers, flexible home visits, and providing intensive multi-session treatments delivered by a small number of dedicated staff.

The research team concluded that NHS stop smoking services have made a contribution to reducing inequalities in smoking prevalence. To achieve government targets will require both the development of more innovative cessation interventions for some specific groups of smokers and recognition that tobacco control policy will need to take account of the unique challenges these groups face when trying to quit smoking.

Provided by Economic & Social Research Council

First brain study reveals benefits of exercise on quitting smoking

11 feb 2009--Research from the University of Exeter reveals for the first time, that changes in brain activity, triggered by physical exercise, may help reduce cigarette cravings. Published in the journal Psychopharmacology, the study shows how exercise changes the way the brain processes information among smokers, thereby reducing their cravings for nicotine. For the first time, researchers used functional Magnetic Resonance Imaging (fMRI) to investigate how the brain processes images of cigarettes after exercise.

The study adds weight to a growing body of evidence that exercise can help manage addiction to nicotine and other substances. It backs up previous studies, which have shown that just one short burst of moderate exercise can significantly reduce smokers' nicotine cravings.

Ten regular smokers were asked to cycle at a moderate pace for ten minutes, after 15 hours of abstinence from nicotine. They were then given an fMRI scan while they viewed a series of 60 images. Some visuals featured cigarettes and would normally induce cravings in a smoker. On a second occasion, the same group was given an fMRI scan and shown the same series of images without having undertaken exercise. They were also asked to report on their cravings for nicotine during both phases of the study.

The brain images captured by the fMRI show a difference between the two conditions. After no exercise the smokers showed heightened activity in response to the images in areas of the brain associated with reward-processing and visual attention. After exercise the same areas of activation were not observed, which reflected a kind of 'default mode' in the brain. The smokers also reported lower cravings for cigarettes after exercise compared with when they had been inactive.

The researchers do not know exactly what caused the difference in brain activity following exercise. One suggestion is that completing exercise raises mood (possibly through increases in dopamine) which reduces the salience or importance of wanting a cigarette. Another possibility is that exercise causes a shift in blood flow to areas of the brain less involved in anticipation of reward and pleasure generated by smoking images.

Previous research by the University of Exeter has suggested that exercise can reduce nicotine cravings. Results from a series of studies show that smokers report reduced cigarette cravings after exercising. This study showed that exercise can reduce cravings when smokers are faced with images that have been previously shown to cause lapses in smokers trying to quit. This is the first time that anyone has investigated brain activity during this process.

Kate Janse Van Rensburg, a PhD student at the University of Exeter, lead author on the paper, said: "Our findings add to a growing body of evidence suggesting that exercise can help people give up smoking. This strengthens the argument that moderate exercise could be a viable alternative to many of the pharmaceutical products, such as nicotine patches, for people who want to give up smoking. A ten or fifteen minute walk, jog or cycle when times get tough could help a smoker kick the habit. There are of course many other benefits from a more active lifestyle including better fitness, weight loss and improved mood."

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Kate Janse Van Rensburg carried out this study as part of her PhD with the University of Exeter's School of Sport and Health Sciences and School of Psychology.

Doctors refuse to fix builder's broken ankle unless he quits smoking

By CHRIS BROOKE

A man with a broken ankle is facing a lifetime of pain because a Health Service hospital has refused to treat him unless he gives up smoking.
John Nuttall, 57, needs surgery to set the ankle which he broke in three places two years ago because it did not mend naturally with a plaster cast.
Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.
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They have told him they will treat him only if he gives up smoking. But the former builder has been unable to break his habit and is now resigned to coping with the injury as he cannot afford private treatment.
He is in constant pain from the grating of the broken bones against each other and has been prescribed daily doses of morphine.
Mr Nuttall, of Newlyn, Cornwall, broke the ankle in a fall in 2005. Initially he refused surgery because he had caught MRSA at a different hospital four years earlier, and was terrified of history repeating itself.
He hoped the fractured bones would knit together with a standard plaster cast to immobilise his ankle.
But six months and three plaster casts later, it became clear that an operation to pin the bones was the only solution.
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However, the hospital told Mr Nuttall, who no longer works because of smoking-related chest problems, that he would have to give up smoking before an operation could be carried out.
Mr Nuttall said: '"I am in agony. I have begged them to operate but they won't. I have tried my hardestto give up smoking but I can't. I got down to ten a week at one point but they said that was not good enough.
"I spent 12 months trying to give up and used patches and everything, but nothing works.
"I have smoked for over 40 years and it's not going to happen.
"We were brought up at a time when cigarette advertisements were everywhere and there were no warnings.
"I want to warn other smokers that they could be denied medical treatment and there is nothing we can do about it.
"I have paid my dues as a taxpayer-and now the NHS won't treat me."
Mr Nuttall, who is single, uses a walking stick to get around and fears his bones will now be so 'calcified' that an operation would not work even if he were allowed to have it.
"It is very painful," he said. "If I walk more than a few steps I can feel it grinding."
A spokesman for the hospital trust said: "Smoking has a very big influence on the outcome of this type of surgery, and the healing process would be hindered significantly."

New study shows benefits of quitting smoking

Giving up smoking can reduce the risk of dying from the disease by up to 70 percent, new research published in the American Journal of Epidemiology this week shows.
The research by the Asia Pacific Studies Collaboration (APCSC) confirms that cigarette smoking substantially increases the risk of dying from lung cancer in both Australia/New Zealand (ANZ) and Asia, and importantly highlights the continuing popularity of cigarette smoking across large parts of Asia, including China, where the harmful effects of smoking are still not widely appreciated.
The study of 500,000 adults also shows that the risks of dying from lung cancer were about 20 times higher among women who smoke compared with male smokers, a worrying finding given the increasing trend for women to take up the habit in many countries.
One of the paper's authors is Professor Konrad Jamrozik, from UQ's School of Population Health.