Risk Factor Guidelines: Smoking

1. What can parents do to prevent their kids from smoking?

• Despite the impact of movies, music, and TV, parents can be the GREATEST INFLUENCE in their kids' lives.
• Talk directly to children about the risks of tobacco use; if friends or relatives died from tobacco-related illnesses, let your kids know.
• If you use tobacco, you can still make a difference. Your best move, of course, is to try to quit. Meanwhile, don't use tobacco in your children's presence, don't offer it to them, and don't leave it where they can easily get it.
• Start the dialog about tobacco use at age 5 or 6 and continue through their high school years. Many kids start using tobacco by age 11, and many are addicted by age 14.
• Know if your kids' friends use tobacco. Talk about ways to refuse tobacco.
• Discuss with kids the false glamorization of tobacco on billboards, and other media, such as movies, TV, and magazines.

2. How is second-hand smoke bad?

• Secondhand smoke is associated with an increased risk for lung cancer and coronary heart disease in nonsmoking adults. Secondhand smoke is a known human carcinogen (cancer-causing agent).
• Young children are particularly susceptible to secondhand smoke because their lungs are not fully developed,. Exposure to secondhand smoke is associated with an increased risk for sudden infant death syndrome (SIDS), asthma, bronchitis, and pneumonia in young children.

3. What are bidis and kreteks?

Bidis (pronounced "bee-dees") are small, thin hand-rolled cigarettes imported to the United States primarily from India and other Southeast Asian countries. They consist of tobacco wrapped in a tendu or temburni leaf (plants native to Asia), and may be secured with a colorful string at one or both ends. Bidis can be flavored (e.g., chocolate, cherry, and mango) or unflavored. They have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States.

Kreteks (pronounced "cree-techs") are sometimes referred to as clove cigarettes. Imported from Indonesia, kreteks typically contain a mixture consisting of tobacco, cloves, and other additives. As with bidis, standardized machine-smoking analyses indicate that kreteks deliver more nicotine, carbon monoxide, and tar than conventional cigarettes. There is no evidence to indicate that bidis or kreteks are safe alternatives to conventional cigarettes.

4. What kind of bad things are in cigarettes?

• Cigarettes contain formaldehyde-the same stuff used to preserve dead frogs.
• The same cyanide found in rat poison is in cigarette smoke.
• Nicotine is an addictive compound in cigarettes, but nicotine is also a potent insecticide found in bug spray.

5. Can smoking change how I look?

Yes! And not for the better.

• Tobacco smoke can make hair and clothes stink.
• Tobacco stains teeth and causes bad breath.
• Short-term use of spit tobacco can cause cracked lips, white spots, sores, and bleeding in the mouth.
• Surgery to remove oral cancers caused by tobacco use can lead to serious changes in the face. Sean Marcee, a high school star athlete who used spit tobacco, died of oral cancer when he was 19 years old.

6. Are low-tar cigarettes better than regular cigarettes?

No. The risk for lung cancer is only slightly lower with low tar cigarettes. Reduced tar levels have little, if any, effect on other lung diseases or heart disease. Existing research does not support recommending that smokers switch to low-yield cigarette brands. There is no convincing evidence that changes in cigarette design have resulted in an important decrease in the diseases caused by cigarettes. The best thing you can do for your health is to quit now.

7. What about clove cigarettes (kreteks), bidis or cigars? Are they any safer than regular cigarettes?

There is no evidence to indicate that clove cigarettes, bidis or cigars are safe alternatives to conventional cigarettes.

8. Is smokeless tobacco or chew bad for your health?

Smokeless tobacco is a significant health risk and is not a safe substitute for smoking cigarettes.

• Smokeless tobacco contains 28 cancer-causing agents (carcinogens). It is a known cause of human cancer, as it increases the risk of developing cancer of the oral cavity. Oral health problems strongly associated with smokeless tobacco use are leukoplakia (a lesion of the soft tissue that consists of a white patch or plaque that cannot be scraped off) and recession of the gums.
• Smokeless tobacco use can lead to nicotine addiction and dependence.
• Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

9. Can smoking affect my ability to play sports?

Yes, smoking really hurts athletic performance. Here's how.

• Nicotine in cigarettes, cigars, and spit tobacco is addictive.
• Nicotine narrows your blood vessels and puts added strain on your heart.
• Smoking can wreck lungs and reduce oxygen available for muscles used during sports.
• Smokers suffer shortness of breath (gasp!) almost 3 times more often than nonsmokers.
• Smokers run slower and can't run as far, affecting overall athletic performance.
• Cigars and spit tobacco are NOT safe alternatives.

10. Why is it so hard to quit smoking?

Nicotine is the psychoactive drug in tobacco products that produces dependence. Most smokers are dependent on nicotine, and smokeless tobacco use can also lead to nicotine dependence. Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol. Examples of nicotine withdrawal symptoms include irritability, anxiety, difficulty concentrating, and increased appetite. Quitting tobacco use is difficult and may require multiple attempts, as users often relapse because of withdrawal symptoms. Tobacco dependence is a chronic condition that often requires repeated intervention.

11. What are some ways to quit smoking?

• Brief clinical interventions by a physician or nurse can increase the chances of successful quitting. Also behavioral therapy with a psychologist, social worker or psychiatrist can be helpful in quitting.
• Treatments with more person-to-person contact and intensity (e.g., more time with therapist) are more effective.
• Individual, group, or telephone counseling are all effective.
• Prescription and non-prescription medications can be effective in treating tobacco dependence. These include nicotine replacement products (e.g., gum, inhaler, patch) and non-nicotine medications, such as Bupropion SR ® (Zyban).
• Hypnosis and acupuncture are reported by some people to be helpful. Ask your doctor for a referral.

12. Can free telephone counseling be effective?

People who use telephone counseling are twice as likely to quit as people who don't get any counseling. Telephone counselors are trained to help quitters avoid common mistakes that might lead to relapse. Also most states offer some kind of free telephone counseling or a "Quitline" for people seeking to quit smoking. To find a Quitline in your area, call the American Cancer Society at 1-800-ACS-2345.

13. What kinds of in-person counseling are effective for adolescents?

A recent comprehensive review of adolescent smoking cessation programs indicated that classroom programs had the highest cessation rates (17%), followed by computer-based programs (13%) and school-based clinics (12%).

Brief office based interventions, such as videos, in-person counseling, referrals to quitting support and diligent follow-up, can also boost an adolescents chances of quitting.

14. Does medication increase success in quitting?

Yes. Medication almost doubles a person's chances of quitting and quitting for good.

15. What are the first-choice medications?

All five of the FDA-approved medications for smoking cessation are recommended including bupropion SR, nicotine gum, nicotine inhaler, nicotine nasal spray, and the nicotine patch.

But because of the lack of sufficient data to rank-order these five medications, choice of a specific first-line medication must be guided by factors such as clinician familiarity with the medications, contraindications for selected patients, patient preference, previous patient experience with a specific pharmacotherapy (positive or negative), and patient characteristics (e.g., history of depression, concerns about weight gain).

Special consideration should be given before using medication with selected populations: those with medical contraindications, those smoking less than 10 cigarettes/day, pregnant, and adolescent smokers.

16. Are medications appropriate for lighter smokers (e.g., 10-15 cigarettes/day)?

If medication is used with lighter smokers, clinicians should consider reducing the dose of first-line medications.

17. What second-choice medications are recommended

Clonidine and nortriptyline. Consider prescribing these second-choice agents for patients unable to use first-choice medications because of contraindications or for patients for whom first- choice medications are not helpful. Monitor patients for the known side effects of second- choice agents.

18. Which medications should be considered with patients particularly concerned about weight gain?

Bupropion SR and nicotine replacement therapies (NRTs), in particular nicotine gum, have been shown to delay, but not prevent, weight gain.

19. Which medications should be considered with patients with a history of depression?

Bupropion SR and nortriptyline appear to be effective with this population.

20. May tobacco dependence medications be used long-term (e.g., 6 months or more)?

Yes. This approach may be helpful with smokers who report persistent withdrawal symptoms during the course of pharmacotherapy or who desire long-term therapy. A minority of individuals who successfully quit smoking use over-the-counter nicotine replacement medications (gum, nasal spray, inhaler) long-term. The use of these medications long-term does not present a known health risk. Additionally, the FDA has approved the use of bupropion SR for a long-term maintenance indication.

21. Is combining nicotine replacement medications okay and does it increase rates of success?

Yes. There is evidence that combining the nicotine patch with either nicotine gum or nicotine nasal spray increases long-term abstinence rates over those produced by a single form of NRT.

Health Effects of Smoking Among Young People

Tips for Quitting Smoking

Benefits of quitting

What happens to your body when you quit smoking