Lung Cancer

November is lung cancer awareness month – aiming to increase awareness of lung cancer, and its causes and to stimulate activities aimed at preventing and treating lung cancer.

Most people are aware that by far the biggest cause of lung cancer is tobacco smoke, whether it be via active smoking of cigarettes or cigars, or exposure to environmental tobacco smoke pollution (secondhand smoke). Many people are still surprised to learn that lung cancer kills more women than breast cancer. The risks of lung cancer increase dramatically with age and years of tobacco smoking. Men who continue to smoke are over 20 times more likely to die of lung cancer compared with men who have never smoked. At age 75, never smokers have a cumulative risk of lung cancer of less than one percent. Those who smoked but quit at age 50 have a cumulative risk of lung cancer by age 75 of 6%. Those who continue smoking have a cumulative risk of lung cancer by age 75 of over 16%. So it is clear that quitting smoking reduces the risks of lung cancer, even if you have smoked for decades. However, the risks do not return to those of a never smoker and it takes about 15 years without smoking for the increased risks to be cut in half.

Environmental tobacco smoke pollution also causes lung cancer. This cause accounts for a significant proportion of the never smokers who get lung cancer. So living with someone who smokes in the home, or working in an environment where people smoke (e.g. a bar, restaurant or casino) will significantly increase your lung cancer risks even if you never smoked yourself. This is part of the reason why many countries and states have passed laws to prevent smoking in workplaces (and remember, bars, restaurants and casinos are workplaces too). Its also part of the reason that many homes have also become smoke-free – requiring family, friends and guests who smoke to take it outside rather than pollute the air inside the home with carcinogens.

Unfortunately the 5-year survival rate for lung cancer remains very low – around 15%, and so far there has not been very convincing evidence that going for CT scans is particularly effective in detecting curable lung tumors at an early stage (without giving false-positives causing unnecessary treatment).

On the positive side, lung cancer is largely preventable on an individual level by not smoking and by avoiding smoky places. On a national level too, we know how to prevent most lung cancer, by implementing comprehensive tobacco control policies including smoke-free workplace legislation, increasing cigarette taxes, hard-hitting mass media educational campaigns, and providing effective smoking cessation treatments. For reasons not entirely unrelated to political campaign contributions from tobacco companies, successive governments have chosen not to adequately fund these effective lung cancer prevention efforts – even though they happen to prevent heart disease, respiratory disease and numerous other illnesses at the same time.

At this moment the President of the United States has promised to veto legislation that has been approved by both the Senate and Congress to increase cigarette taxes to pay for health insurance for poor families. Protecting the tobacco industry in this way leads directly to many more cases of lung cancer.

The symbol for lung cancer awareness is a clear ribbon – symbolic of the “invisible cancer” that receives far fewer dollars for prevention and treatment or public attention than other types of cancer.

For those wishing to learn more about the ways that tobacco harms health, some colleagues and I have just published a fairly detailed review of the health effects of tobacco as a chapter in a new book . You can access the pdf of this chapter via the following link:
http://www.tobaccoprogram.org/staffarticles.htm

Labels: lung cancer, Smoking

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Smoking, smokeless tobacco and cancer (2)

My previous post discussed toxin delivery from different tobacco products. Now what is the evidence relating use of these products to health problems? Unfortunately most studies don’t collect data on different brands or even categories of smokeless tobacco being used, and few compare directly the risks from smokeless with those from smoking. However, we can get a sense of the risks by examining studies based in different parts of the world where different types of tobacco are used. When we look at it this way we can find very clear evidence that the types of smokeless tobacco used in Sudan and India increase the risk of oral cancer. There is also toxicological evidence showing that Sudanese smokeless tobacco has very high concentrations of TSNAs (carcinogenic toxins), as do some forms of smokeless tobacco used in India. In Asia the picture is complicated by the tradition of adding other ingredients, especially areca nut which is highly carcinogenic on its own.

Then when we look at studies of smokeless tobacco use from the U.S. we see mixed results. One particular study published in the 1980s found very high risks of oral cancer. That study by Professor Deborah Winn and colleagues focused on women in southern United States and found that white never-smoking women (who tend to use oral dry snuff powder) had a relative risk of over 4.2 (2.6-6.7), for developing oral and pharyngeal cancer. Women who had used smokeless tobacco for 50 years had a 50-fold increase in risk for some oral cancers. It should be noted that only a tiny minority of smokeless users use the type of dry snuff tobacco that is commonly used by women in these rural parts of North Carolina. It should also be noted that the type of smokeless tobacco with the extremely high concentration of toxins mentioned in my previous post was also a type of dry snuff. So it begins to look like it’s the smokeless tobacco with very high toxin levels that has evidence of a causal effect on oral cancer. In fact, one of the largest studies on the effects of smokeless tobacco use in the United States (by the American Cancer Society) found no significant increase in the risk for oral cancer among smokeless tobacco users. One of these studies examined a population of 2488 smokeless tobacco users with a median age of 57 at enrolment (i.e. they'd used smokeless for decades) and followed them up 18 years later (i.e. mean age 75). This study found only one death from oral cancer in exclusive smokeless tobacco users, and none in former users, which was a slightly lower rate than occurred in people who had never used any tobacco in their life. These findings from the American Cancer Society suggest that any effect of commonly used brands of smokeless tobacco in the United States on oral cancer, if present, is relatively small.

Finally, we can examine the studies conducted in Sweden where the use of a form of low-toxin moist snuff (called snus) is more common than smoking in men. These studies consistently find no increased risk of oral cancer for snus users. One of the best of these studies was published in the Lancet recently and found that snus users have no increased risk of oral or lung cancer, but they have twice the risk of pancreatic cancer of never tobacco users. That same study found higher risks of all these cancers in smokers (e.g. smokers were about 10 times more likely to get lung cancer than either snus users or never tobacco users, who both had similar risks).

So now lets come back the recent report by Hecht and colleagues. It found similar concentrations of a specific carcinogen in smokeless users and smokers. But we have excellent data showing that smokers have much higher risks of lung cancer than smokeless users, and also higher risks of oral cancer than users of some forms of smokeless tobacco. The lung cancer pattern suggests that deposition of carcinogens directly into the lungs is relevant to the causal mechanism as smokeless tobacco has generally not been found to cause lung cancer in humans. But then we also have a higher risk of oral cancer for smokers. This causes one to consider whether the biomarker being measured in the urine in Hecht and colleague's study is very closely linked to the mechanism wherbye tobacco causes cancer in humans. Perhaps there are other toxins (e.g. benzo(a)pyrene) that are important in triggering cancer in smokers, but are found in lower levels in smokeless users? Whatever, the explanation, it seems that urine NNAL levels do not relate very closely to cancer risks in tobacco users.

But when discussing health risks from tobacco we need to be clear that these involve much more than lung or oral cancer, but also other cancers, and also other serious respiratory and cardiovascular diseases. For most of these, the health risks from smoking greatly outweigh the risks from smokeless tobacco. Chronic respiratory diseases are extremely common among smokers but there is neither good evidence nor a plausible rationale linking use of smokeless tobacco to these respiratory diseases.

So although it is clear that smokeless tobacco contains carcinogens and is not harmless, it is significantly less harmful than smoking cigarettes. I agree with Hecht and colleagues that we should not encourage anyone to use smokeless tobacco, when we have safe and effective medicines to help them quit smoking. However, I think we need to be able to give an honest answer to the question, “Are there forms of smokeless tobacco that are much less likely to kill me than smoking cigarettes?”. The honest answer is,”yes”. Similarly, of we are asked whether some types of smokeless tobacco may be less harmful than others, it seems prudent to suggest that some types of tobacco that have higher concentrations of toxins than others, and that the type of smokeless tobacco used in Sweden (snus) appears to be lower in toxins and health risks than much of the tobacco used in the rest of the world. It is far from risk-free (as are many things that people choose to do on a regular basis, like driving a car, eating donuts, drinking beer, mountain-climbing, or having sex), but experts agree that it is about 90% less harmful than smoking:
http://cebp.aacrjournals.org/cgi/content/full/13/12/2035
Similarly, given the relationship between toxin delivery and health effects from smokeless tobacco, it would seem to be sensible to regulate tobacco products in a manner that requires manufacturers to minimize the concentrations of toxins delivered as much as is technically possible.

In the mean time (and also after regulation is in place), manufacturers who produce and market products containing and delivering unnecessarily high quantities of toxins should be legally liable for the effects of their defective products.

Labels: cancer, smokeless, Smoking, tobacco

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Chantix and mental illness - what are the facts?

The August issue of the American Journal of Psychiatry included two letters reporting single cases of worsening of symptoms of schizophrenia and mania, while they were taking the new smoking cessation medication, Chantix (varenicline). Links to those case reports can be found below. It was also noticeable that some readers of my previous article on Chantix who were also taking medications for psychiatric problems wrote online comments about unpleasant side effects.
http://www.healthline.com/blogs/smoking_cessation/2007/04/chantix-how-does-this-new-quit-smoking.html

People suffering from major mental illnesses were excluded from the initial placebo-controlled trials of varenicline (Chantix), which showed that it is both safe and effective in helping smokers to quit. It is normal practice to exclude certain categories of patient from trials of new medicines, prior to the drug being approved for sale to the public. Often the reason is that patients with certain diagnoses are more likely to be taking medications that may affect the condition being treated (e.g. antidepressants could theoretically affect smoking cessation, as at least 2 antidepressants are effective for smoking cessation). Sometimes it is partly to protect those considered “at risk”, from taking an unlicensed experimental medicine. What we end up with is that many new medicines have mainly been studied in people who are relatively healthy, apart from having the condition the new medicine is designed to treat. Chantix is like many new drugs in this respect. It is also very common, especially for new medicines that are very widely used, for reports to appear of unusual side-effects occurring in some patients. I’ve published a few such reports myself.

However, it is not until fairly thorough additional placebo-controlled studies have been published in more patient groups, that we can tell with any confidence whether the new drug really does cause problematic side effects in certain patient groups or not. Sometimes such studies are never carried out and in that case we need to rely on the reported experiences of clinicians treating those patient groups over a period of time.

One thing we have to bear in mind is that when a person starts using Chantix, that’s not the only thing that’s changing. That person will also be trying to quit smoking. Quitting smoking itself causes a number of changes, including the increases in nicotine withdrawal symptoms I’ve talked about before (see link below), and also a slowing in metabolism of some medications, that could cause an increase in the blood levels of the drugs contained in those medicines (I’ll discuss this in a future post). So some symptoms may be related to quitting smoking, rather than Chantix per se.

So if I had a relative who smoked and suffered from a mental illness (like schizophrenia, bipolar disorder or depression) and was taking medicine for that illness but wanted help to quit smoking, what would I suggest?

As with all the people I see who want to quit smoking, I’d describe all the available forms of help, including counseling, internet support and medicines. I’d recommend that they use these. With regards to medicines, I’d point out one advantage of nicotine replacement therapy, which is that it does not involve taking a “new” drug, - as they have been taking nicotine in a much more harmful form every day, for years. When discussing Chantix I’d point out that it had not been studied in many people with a serious mental health problem, and so it would be particularly important to discuss that option with their doctor and to allow the doctor to monitor their progress on that medicine fairly closely if the doctor decided to prescribe it. But if my family member had already tried nicotine replacement therapy and wanted to try something different, I wouldn’t discourage it. I’ve heard from many clinicians who have treated patients with mental health problems successfully with Chantix, and so I am not convinced yet that there is a markedly increased risk of adverse events caused by Chantix in such patients.

It would be helpful to hear peoples’ experiences of using Chantix, particularly if you have also had a mental health problem. If you feel that any medicine has caused a harmful effect, then you should tell your doctor, and particularly in the case of a new medicine, it may be appropriate to report this to the FDA. For further information on that procedure, visit: http://www.fda.gov/medwatch/

Here are the links to the recent case reports:
http://ajp.psychiatryonline.org/cgi/content/full/164/8/1269
http://ajp.psychiatryonline.org/cgi/content/full/164/8/1269-a

Here is the link to my previous article on nicotine withdrawal:http://www.healthline.com/blogs/smoking_cessation/2007/03/what-is-nicotine-withdrawal-syndrome.html

Labels: Chantix, mental illness, quit smoking cessation tobacco advice cigarettes, Smoking, tobacco, varenicline

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Sidestream cigarette smoke more toxic than mainstream smoke

In my last post about tobacco smoke pollution I mentioned the puzzling fact that although exposure to tobacco smoke pollution (TSP or ETS or SHS) gives about 1-5% of the smoke dose of active smoking, it gives a proportionately bigger increase in some disease risks. This fact has caused some to be rather skeptical about the evidence on tobacco smoke pollution and health. But just this month a new paper has been published by Drs Suzaynn Schick and Stan Glanz at University of California at San Francisco, that sheds some new light on this.

One of the main carcinogens in cigarette smoke is known as NNK (as its long chemical name is almost unpronounceable!). Previous studies have shown that there is a 3-4 times higher concentration of NNK in sidestream smoke (the smoke released from a burning cigarette into the air between puffs) than in mainstream smoke (the smoke inhaled by the smoker). But the new paper by Drs Schick and Glanz went further. They analyzed tobacco industry documents dating back to the 1980s that showed that Philip Morris tobacco company (which was, at that time, denying the harmfulness of exposure to environmental tobacco smoke) had conducted studies that not only measured these effects, but uncovered the mechanism behind it (continued reaction of nicotine, nitrogen oxides and other smoke chemicals). These studies also showed that while the smoke ages as it hangs in the air in a room where someone has smoked, the concentration of NNK actually increases another 2-4 times! So the net effect is that the concentration of NNK per unit of sidestream smoke hanging around in the air in a room hours after the smoker has left, may be 10 times greater than the concentration per unit of smoke the smoker inhaled directly from the cigarette. This type of finding may be a part of the explanation of why exposure to tobacco smoke pollution is more harmful than we might expect from the simple amount of smoke being inhaled.

Of course the tobacco company that discovered these results (Philip Morris, makers of Marlboro) did not expend much effort to share them with the public. Rather, it has taken painstaking research by public health scientists to piece together the evidence from tobacco industry documents and publish them in a peer-reviewed journal.

This gives yet more reason to ensure that people (and pets) in public spaces should not be exposed to tobacco smoke pollution, and to make sure your home environment is smoke-free.

This link takes you to the original journal report:
http://cebp.aacrjournals.org/cgi/content/abstract/16/8/1547

Labels: ETS, pollution, SHS, Smoking, tobaco

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How many medical doctors smoke?

In many countries medical doctors have been at the forefront of attempts to reduce the number of people who smoke. The medical doctor is one of the most highly respected professionals and patients place a large amount of faith in their doctor’s advice. However, concerns have been expressed about the willingness of doctors who smoke themselves to advise their patients to quit, and about the likelihood of patients taking such advice seriously if they are aware that the doctor is a smoker him/herself. So what proportion of medical doctors smoke?

In the past month Drs Derek Smith and Peter Leggat published a comprehensive international review of tobacco smoking in the medical profession from 1974-2004. The study showed that in countries like the United States, UK, Canada, Australia and New Zealand, smoking rates have dropped dramatically among doctors, from 15-20% in the 1970’s to around 5% at the end of the 20th century. However, such low smoking rates are not uniform among doctors across the world. In China, 32% of male doctors smoke (but 0% of females doctors smoke), in Italy 28% of doctors smoke (32% among men), and in Turkey or Bosnia & Herzegovina around 40% of doctors smoke.

Some may be surprised to hear that as many as 5% of US doctors smoke. But remember that doctors are human beings like the rest of us, and not immune to either infections or addictions. Many smoking doctors report that they (like most smokers) started in their teen years and so were likely addicted even prior to the decision to study medicine at college. I prefer to look at the low (and still falling) smoking rates among doctors in some countries as a very positive sign. It provides an indication of how low it is possible for smoking prevalence to go in a population that is well informed of the health risks, has relatively good access to treatment, and generally works in a smoke-free environment where smoking is not considered to be socially acceptable. It suggests that 5% may be a reasonable target for the rest of the population as well.

The full report on smoking among doctors can be found at:
http://www.biomedcentral.com/1471-2458/7/115

Labels: doctors, medical, profession, Smoking, tobacco

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Wearing the patch prior to quitting may help

If you buy a box of nicotine patches, you will notice that the instructions for use and warnings advise against wearing the patch while taking nicotine from any other source. Many smokers interpret this as implying that something terrible will happen if they kept the patch on while smoking, and consequently when they have a lapse cigarette then often decide to take the patch off (and so obey the instructions on the box).

However, numerous studies have shown that nothing terrible happens when you smoke while wearing the patch. 15 years ago I published a study in which 30 smokers smoked normally for 2 weeks, and wore full strength nicotine patches for one of those weeks and placebo patches for the other. The smokers generally couldn’t tell which week was the week with the nicotine patches and the single participant who vomited did so while wearing placebo patches! So it appears to be very unlikely for smokers to experience adverse events caused by wearing the patch while smoking.

However, some recent studies have actually suggested that wearing the patch for a few weeks prior to the target quit date may actually increase the chances of a successful quit. One such study was carried out by Dr Schuurmans and colleagues in South Africa. They found that people who wore nicotine patches for two weeks prior to their quit day had better long term quit rates than smokers who wore placebo patches for two weeks prior to their quit date (22% vs 12% quit, 6 months later).

Interestingly, studies of the use of other forms of nicotine replacement therapy by smokers not intending to quit have also found that not only does the NRT help them to reduce their cigarette consumption, but that a significant proportion of them go on and quit completely. One such study was carried out by Dr Batra and colleagues in Germany. They recruited over 300 smokers who were interested in cutting down but not quitting. They were provided with either 4mg nicotine gum or placebo gum for a year. As well as helping with smoking reduction, the group receiving the nicotine gum had significantly more people who were quit 13 months later (12% versus 5%).

We are not clear on the mechanism whereby combining NRT with smoking prior to quitting may help subsequent cessation. It may simply be that it loosens the associations between smoking and reinforcement (by providing nicotine separately from smoking). Just to be clear, the use of NRT prior to the quit date is not yet normal practice, and may never become so. My current practice is to advise patients using the patch to put their first patch on the morning of their quit day and not before (as suggested on the box). However, as more evidence is gathered on the safety and effectiveness of NRT pre-treatment, I may have to reconsider.

Labels: cessation, nicotine, pre-treatment, replacement, Smoking

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Reductions in teen smoking.

One of the most fascinating and unexplained changes in smoking habits that has taken place in the United States was the dramatic reduction of cigarette smoking among African American youth since the 1970s. The “Monitoring the Future” study has documented clearly that in 1975, smoking prevalence was very similar across ethnic/racial groups of teenagers, with 38% of white teens smoking, 37% of African American teens smoking and 36% of Latino youth smoking cigarettes in 1977. However, by 1985, smoking prevalence had halved among African American teens (18%) but remained high in whites (31%) and Latino youth (26%). By 1992 the differences had become even more marked, with only 9% of African American youth smoking, compared with 32% of white youth and 25% of Latino youth. Although smoking declined in young people of all backgrounds since 1998, these ethnic/racial differences largely persist. So the proportion of African American teens who smoke was cut by more than three quarters over 15 years, and yet no-one appears to know how it happened. Suggestions have ranged from increased price-responsiveness among African American teens (during a period involving increases in price of cigarettes), the possibility that African American youth could be using other substances instead. However, this last idea is based more on stereotypes than data: illegal drug use has also fallen in African American youth over the same time frame, and in 2006 a smaller proportion of African American high school seniors had used an illicit substance in the past year, as compared with whites or Latinos.

So this rather dramatic reduction in smoking by African American youth occurred prior to the major funded campaigns that followed the master Settlement Agreement in 1998, and is largely unexplained. If you think you have an explanation, please tell me!

Labels: ethnicity, nicotine addiction cigarette, race, Smoking, teen, tobacco, youth

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Which nicotine replacement therapy?

Nicotine replacement therapy (NRT) is the name given to FDA-approved medicines containing nicotine that are used to reduce nicotine withdrawal symptoms and cravings and to help smokers quit. Currently there are 5 main types: patch, gum, lozenge, nasal spray and inhaler. These latter two (nasal spray and inhaler) are only available via prescription in the United States, although they are available over-the-counter in many other countries (e.g. UK).

Each type of NRT has its own advantages and disadvantages. The patch is by far the most commonly used NRT, largely because it is the easiest to use, requiring only a single patch application per day. Another advantage of the patch is that its side effects are usually mild – primarily mild skin irritation and itching. The main disadvantage is that there is nothing one can do with the patch to increase the dose when you feel the need for more nicotine.

The gum and the lozenge are broadly similar in terms of dose (each available in 2mg and 4mg formats) and route of administration. The main challenge facing the gum chewer is to adopt a “chew and park” style, such that you chew the gum a few times to release a peppery taste (nicotine) and then park it in the side of your mouth for a few minutes before chewing again. The labeling on the gum suggests that people who smoke less than 25 cigarettes per day should use 2mg (rather than 4mg) and the labeling on the lozenge states that those who don’t smoke within 30 minutes of waking in the morning should use the 2mg lozenge. In practice many clinicians have learned that this labeling (especially the gum) is a recipe for under-dosing and advise all but the lightest smokers to use the 4mg formulation of each product. To get a real benefit from these products you need to use enough. Most users only take 3 or 4 per day in response to cravings. You can get a far greater benefit by taking one per hour (to prevent cravings and withdrawal symptoms) plus another whenever you have a breakthrough craving.

I described the nicotine nasal spray in some detail a few days ago. It appears to be particularly helpful for heavy addicted smokers who are willing to persevere despite the initial nasal irritation. Make sure you have some Kleenex handy when you first try the spray. The initial doses sting and will make you sneeze. But, just as with smoking, you will get used to it within a few days, and within a week will probably like it!

The inhaler‘s main advantage is that it enables the smoker to continue with a similar hand/mouth habit, but it helps to gradually wean them off nicotine. The main thing to note is that one puff on a cigarette delivers a similar amount of nicotine to ten puffs on the inhaler. This means that in order to obtain a therapeutic dose, the ex-smoker has to be puffing on the nicotine inhaler almost all the time. We recommend puffing on the inhaler for 20 minutes out of ever waking hour. Again, people who get into that regular use habit early on tend to do very well with the inhaler.

Some years ago Professor Peter Hajek and colleagues at the University of London conducted a randomized trial comparing the nicotine patch, gum, nasal spray and inhaler. In practice they all had similar quit rates (around 20-25% complete abstinence 3 months later), although women did better on the inhaler than the gum and men were the opposite. Prior to their quit attempt, participants were shown videos describing each NRT and were then allowed to rate their preferences. They were each then randomly allocated to one product. This meant that some people were allocated the product that was their first preference, whereas most were not. However, at the end of the study the smoking cessation outcomes were similar for those receiving their preferred NRT versus those being randomly allocated to a less preferred NRT. Also, people came to prefer the product they were given after they had used it for a week.

One final thing to consider is that the products differ in the risk of inducing dependence. It is extremely rare for someone to have any difficulty coming off the patch (which typically have a built-in reduction plan, involving using smaller sized patches over 4 weeks). However, some people (about 5-10%) find themselves using the gum, inhaler or lozenge long term (i.e. over 3 months and possibly continuing for years). The nicotine nasal spray has the highest dependence potential, with around 10-15% of those who use it continuing use after 3 months. The risk of becoming dependent is related to the speed of nicotine delivery from the product (spray fastest, but still slower and lower dose than a cigarette, whereas the patch delivers nicotine very slowly). It also seems to be related to how addicted the person was to their cigarettes. Thus people who smoked over a pack a day and smoke within 30 minutes of waking in the morning (or wake at night to smoke) are more likely to become a long term user of their NRT product. However, in the placebo-controlled trials these were precisely the people who were much less likely to succeed in quitting if they received the placebo. The thing to remember here is that it is much better to be a long term user of an NRT product delivering only nicotine, than a continuing user of a product that delivers a higher dose of nicotine plus 4000 other toxic chemicals (i.e. a cigarette).

Recently a group of experts in the treatment of tobacco addiction got together to produce a consensus statement guiding consumers on the most effective ways to use NRT to help them quit smoking. You can find a copy of the paper and the summary (in both English and Spanish) at: http://proyectovidanofume.org/publication.htm

Labels: addiction, cigarette, nicotine, NRT, replacement, Smoking, therapy, tobacco

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Can Smoking Cessation Internet Sites Help You Quit?

Many smokers use the internet to seek help in stopping smoking. Thousands of websites (including this one) provide basic information and advice on stopping smoking, and over 30 focus on providing direct smoking cessation assistance (e.g. a tailored quit plan) rather than just information and advice. So do these smoking cessation websites actually help smokers to quit?

When one considers some of the advantages of the internet (easy access, anonymity, lack of face-to-face contact etc), one can immediately also see some of the challenges in evaluating smoking cessation websites. For example, how do you follow-up on people who visited a website anonymously, in order to find out if they quit smoking? Research on this topic has only recently started, but there are already some promising studies suggesting that some smoking cessation websites boost the smokers’ chances of quitting. A recent study by Dr Lynn Swartz at the Oregon Center for Applied Science compared one particular internet site with no intervention. They found that smokers given access to the smoking cessation internet site were roughly twice as likely to have quit smoking three months later. Another recent study by Dr Joanne Pike at University of Texas Health Science Center compared utilization and quit rates at 5 interactive websites and one static website, all of which aimed to help smokers quit. They found that some of the interactive websites had much higher participation rates than others, and that this was associated with the amount of interactivity available on the site. Sites containing a lot of interactive functions also tended to have more participants succeed in quitting smoking.

Many of the websites offer the chance to view some of the basic information pages immediately but require visitors to complete an online registration process (and possibly pay a fee) before being given full access to the more useful interactive features on the site. One of the top smoking cessation websites can be found at: www.quitnet.com . This site offers a range of interactive features including “chat rooms”, and “ask-the-expert” functions, as well as online “wizards” that automatically calculate how much money you have saved since you quit smoking. This site is widely used around the world, so that at any given moment there will be hundreds or thousands of people visiting the site for help to quit.

The advantages of these interactive smoking cessation websites are that they are available 24/7, from the comfort of your own home, are generally free or low cost, and can put you in touch with a whole community of people going through the same process. Website assistance can also be used in addition to other methods (e.g. counseling and/or medication). Generally the more help and support you can get, the more likely you are to succeed in quitting. If you found any websites particularly helpful (or unhelpful), let me know, so I can pass it on to others. Best of luck.

Labels: cessation, online, Smoking, website

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