1. Why people smoke

2.  Clinicians are more likely to succeed in helping people to quit smoking if they have some understanding and empathy for why people start smoking and continue to smoke.

3.  This presentation looks at some of the commonly perceived “benefits” of smoking, along with some of the more significant barriers to quitting.

4. Why do people start smoking?  Most smokers begin as children (~ 30% by 11 years olds)  There is no single reason why young people begin to smoke.  Predisposing factors include –low socioeconomic status –adverse childhood experiences –mental illness are generally not easily changed.  Influencing factors –Friends and the presence of people around them who smoke  Nicotine addiction can occur rapidly. (~10% within 2 days, ~25% within a month)

5. Why do people keep smoking?  Nicotine addiction  Behavioral rewards  Stress relief  Avoid weight gain

6. Nicotine addiction  Nicotine reaches the brain in 10 to 16 seconds (faster than if it was delivered intravenously), and lasts about two hours.  Nicotine induces the release of dopamine, in a similar way to amphetamines and cocaine.  Has a biphasic effect, it can both invigorate and relax  Nicotine improves reaction time in new users, but not in chronic users.  Nicotine withdrawal starts within hours and peaking within the first week.

7. Symptoms of nicotine withdrawal  Lightheadedness  Sleep disturbance  Poor concentration  Craving for nicotine  Irritability or aggression  Depression  Restlessness  Increased appetite

8. Behavioural rewards of smoking  The sight, smell and sensations of smoking have a behavioural conditioning effect – which NRT does not address.  Smoking can elicit Pavlovian response – eg. having a cup of coffee, concluding a meal, seeing or smelling smoke. Considered a reason why light smokers, continue to smoke.  Social norms play a role – whether smoker is discouraged (smoke free messages) or encouraged (high prevalence/social norm)

9. Smoking to deal with stress  Many smokers report they feel calmer and have improved concentration after a cigarette – although more likely the cigarette has alleviated the symptoms of withdrawal.  Smoking is similar to some relaxation techniques: –going outside to smoke – leaving the stressful situation behind –smoke is inhaled and exhaled in a slow and often deliberate manner – similar to relaxation breathing techniques.  These are useful methods in their own right for dealing with stress, so remind people they probably already have the skills to manage stress, even if they don’t realise it.

10. Smoking to avoid weight gain  Weight gain occurs in approximately 75% of people following smoking cessation  Probably due to  in metabolic rate  Health risks of smoking considered worse than health risks of extra weight

11. Barriers to quitting smoking  Enjoy smoking  Craving  Stress relief  Withdrawal symptoms  Weight gain  Fear of failure  Cost of meds  Discouragement  Cost of classes  Timing of classes  Disrupt social relations

12. The lifetime benefits of quitting  Many of the major risks associated with smoking decrease within two to five years of quitting smoking. For some conditions a residual risk remains and may never return to the level of a non-smoker

13. The social responsibility of smokers  It is important smokers minimise the risk of their smoking for those around them – especially babies and children

14. The social responsibility of smokers Non-smokers can be exposed to smoke by two recognised ways:  “Second hand smoke”, which is exposure to cigarette smoke from someone smoking nearby, often described as “the exposure that occurs as an unavoidable consequence of breathing in a smoke-filled environment”.  “Third hand smoke” – which is residual tobacco smoke and particles remaining after the cigarette is extinguished.

15. Second hand smoke  Also known as environmental tobacco smoke  ~ 85% “sidestream smoke” – smoke emitted from the burning end of the cigarette, and ~15% “mainstream smoke” – smoke exhaled by smokers.  Sidestream smoke poses the greatest risk because it has not been filtered.

16. Second hand smoke – at home and work  Approximately 10% of NZers are exposed to second hand smoke in their homes  Māori most likely to be exposed

17. The effects of second hand smoke  There is no safe level of second hand smoke exposure.  Contributes to ~ 350 deaths per year.  People have an increased risk of lung cancer, coronary heart disease, stroke and sudden infant death syndrome.  It has been estimated that in New Zealand, second hand smoke exposure in the home will contribute to approximately: –15,000 episodes of childhood asthma annually, –> 27,000 child respiratory problems –1500 operations for glue ear

18. Third hand smoke  The particles and gases that linger in a room, remain in the clothing, hair or possessions after someone has smoked.  It is difficult to quantify the extent of the risk.  Children are generally considered more susceptible to the effects of third hand smoke because they may touch, mouth, play and crawl on contaminated surfaces.

19. Keeping others safe  While people continue to smoke, it is important they consider the risks to those around them.  Smokefree Homes campaign (2004) adopted the message “taking the smoke outside”.  Smoke Free Cars campaign (2006) encouraged to not smoke in the car, even when alone. “…the poisons linger long after the smoke has disappeared...”