Correcting the misperceptions about nicotine and NRT

Nicotine replacement therapy is one of the most accessible proven treatments for quitting smoking. But despite widespread marketing of these products, many smokers, and even healthcare providers, have misperceptions about them.

Because of these unfounded fears, many smokers are reluctant to use nicotine replacement products to help them quit. Several studies have documented wide misconceptions about the safety and efficacy of NRT, especially among smokers with the least education (Cummings & Hyland, 2005). For example:

• In one survey of current smokers, only one-third correctly reported that nicotine patches were less likely to cause a heart attack than smoking cigarettes and two-thirds incorrectly believed that nicotine causes cancer.
• Some 41% of smokers said they heard of safety concerns about using NRT products, including fear that smoking while using the patch caused adverse reactions and chewing nicotine gum lead to mouth ulcers.
• Fewer than half reported that nicotine gum and patches were less addictive than cigarettes (Cummings et al, 2004; Bansal et al, 2004).
• In estimates from another survey, 36% of US adults falsely believe that stop smoking medications might actually harm their health (Giovino, 2005).

These misperceptions about nicotine negatively affect the demand for and use of NRTs. Correcting these misperceptions with smokers and health care providers may lead to more smokers confidently using these products and increasing their chances for quitting.

Surprisingly, the way nicotine is discussed in many cessation materials may contribute to these misperceptions. For example, some cessation materials reviewed by NTCC did not clearly distinguish between the components of cigarettes and cigarette smoke that cause cancer, and the component that is addictive (nicotine). They way the information was presented on the "harms of smoking" left the reader with the impression that nicotine was one of the cancerous components.

Considerable misinformation on nicotine and NRT can also be found on the internet. There are a number of websites that promote their non-evidence based cessation products and methods as more effective and even safer than products containing nicotine. For example:

• One website for a non-NRT product states that "pharmaceutical companies have created both nicotine replacement and prescription medications. [but] nicotine is still toxic to the body whether it comes from a patch or a cigarette." (http://www.cig-arette.com/)
• Other sites for herbal cessation products states that their products satisfy the body's craving for nicotine "without all the negative side effects of patches containing the actual drug" or "eliminates, rather than replenishes, the level of nicotine in your body, helping you break the habit." (http://www. stopsmokingresolution.com; http://getzeronicotine.com/)
• One site for a nicotine-free formula actually compares the use of NRT by a smoker to giving an alcoholic more alcohol to help him quit. (http://www.nicocure.com/).
• A website endorsing the "cold turkey" method of quitting calls NRT products "crutches" and the use of them "will be tragic" for smokers. It states that "while the [nicotine] gum may reduce the severity of initial withdrawal.the cost for this easing of initial symptoms is a prolonged chronic withdrawal followed by.the same withdrawal [the smoker] would have originally encountered as when quitting cigarettes when giving up the gum." (http://www.whyquit.com)

How you can help

To help a broad spectrum of health professionals and organizations communicate more effectively about the role of nicotine and NRT, NTCC has created a fact sheet that contains key points on nicotine and its role in quitting. There are many ways you can help in the effort to dispel the myths about nicotine and NRT:

1. Place the fact sheet on your website and disseminate it to your partners. This fact sheet is public domain, and NTCC has created a version in MS Word so that you can put your organization's logo on it and treat it as one of your own products if you wish.
2. Encourage your partners to use the fact sheet to review their cessation materials to ensure that the information about nicotine and NRT is accurate.
3. Review your own cessation materials using the fact sheet.

By correcting misperceptions that may exist about nicotine and NRT, NTCC and its partners can help smokers make accurate and informed choices about which cessation aids to use and increase their chances of quitting.

For more information on this fact sheet, or to obtain a copy, please contact Jessica Nadeau at jnadeau@aed.org or visit http://www.tobacco-cessation.org.

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Public Perceptions about the Effectiveness of Tobacco Cessation Products and Services

In a survey conducted in the spring of 2006 by the Harvard School of Public Health and RWJF, researchers polled a sample of 1,076 adults to gauge the perceived effectiveness of several tobacco cessation treatments and methods. The results support existing evidence that there is a disconnect between the perceived effectiveness and the actual effectiveness of tobacco cessation treatments. Evidence-based smoking cessation methods perceived as most effective by both smokers and nonsmokers included: help from a doctor (77%), help from clinics or support groups (73%) and using a nicotine patch (58%). Less than half of respondents perceived that some evidence-based treatments were effective, including nicotine tablets, lozenges or inhalers (37%), prescription medication (47%), nicotine gum (45%) and telephone quit lines (24%). In fact, methods without evidence like acupuncture, hypnosis, self-aids and quit smoking programs offered by tobacco companies were perceived as more effective than telephone quit lines. Many consumers continue to underestimate the benefit of cessation treatments that have evidence supporting their effectiveness. Therefore, attitudes about cessation treatments remain a significant barrier to utilization.

For more information, see external PDF:
Robert Wood Johnson Foundation Research Highlight Number 20, January 2007

Drugs Help Smokers Quit, Even if Not First Time

Smokers who use smoking cessation pharmaceuticals to try to kick the habit should keep trying, even if the drugs do not work at first. It can take several weeks for many people to fully wean themselves off tobacco according to David Gonzales, director of the Oregon Health & Science University smoking cessation center. Researchers found that 24 percent of those taking Chantix were able to quit right away, versus 18 percent taking Zyban and just 10 percent given a placebo. But an additional 20 percent of those taking Chantix and 11 percent taking Zyban were able to quit if they kept trying through three months. "Our recent analysis shows smokers and clinicians should not be discouraged when total abstinence is not achieved in the first weeks of treatment with smoking cessation medications," said Gonzales.

For more information, see web link:
Reuters, February 24, 2007

Smokers Who Switch to Oral Tobacco Still at Risk

An American Cancer Society study of more than 116,000 men finds that cigarette smokers who switched to spit tobacco products had a higher risk of dying prematurely from tobacco-related diseases than former smokers who stopped using all forms of tobacco. The study's principal finding was that the men who switched from smoking cigarettes to using spit tobacco had higher death rates from lung cancer, stroke, heart disease and all causes combined than men who quit using tobacco entirely. Switchers also had more than twice the death rate from cancers of the mouth and throat. "Smokers who switched to snuff or chewing tobacco had considerably worse health outcomes than those who quit entirely," said Michael Thun, MD, vice president of Epidemiology and Surveillance Research, American Cancer Society. "Any smoker who is trying to quit should use proven methods such as nicotine replacement, antidepressants, and behavioral counseling rather than other tobacco products if they do not succeed in quitting without assistance. There is currently no reliable evidence to support the promotion of alternative tobacco products for smoking cessation."

For more information, see web link:
Henley, S. (2007) Tobacco Control, 16:22-28

Intensive Smoking Cessation Intervention Reduces Mortality in High-Risk Smokers with Cardiovascular Disease

Hospitalized patients who undergo structured treatment to quit smoking are significantly more likely to remain smoke-free, according to a new study. New research published in the February issue of Chest suggests that high-risk smokers with acute cardiovascular disease are three to four times more likely to quit smoking when treated with an intensive smoking cessation program. All patients received 30 minutes of counseling prior to hospital discharge, plus self-help materials. Those in the intensive therapy group received a minimum of 12 weeks behavior modification counseling, plus individualized anti-smoking medication. The smoking cessation therapy was continued on discharge from hospital. After two years of follow up, 39% of those in the intensive smoking cessation therapy group were still abstaining from tobacco, compared to only 9% in the usual care group. Their risk of hospitalization was also cut by half. Those in the usual care group had four times the death rate compared to those in the intensive smoking cessation therapy group.

For more information, see web link:
Mohiuddin, SM et al, (2007) Chest, 131:446-452

Study Finds Exercise Helps Curb Nicotine Cravings

In a review that appears in the journal Addiction, reviewers examined 12 different studies on cigarette cravings and exercise that each required different amounts and types of exercise. Most included smokers who don't exercise regularly. In most studies, the smokers were asked not to smoke for a certain amount of time, ranging from half an hour to about 17 hours, on average. In some studies, they were put in tempting situations, such as being in a room with a lit cigarette. Overall, the studies show that exercise reduces smokers' cigarette cravings and prolongs the amount of time before smokers light up a cigarette. The reduction in smokers' cigarette cravings after exercise was described as "encouraging." The review doesn't show exactly how exercise cut cigarette cravings, but the reviewers argue that exercise does more than merely distract people from the urge to smoke. Further studies are needed, but the researchers point out that exercise curbs stress, improves mood, and spurs the release of brain chemicals that may override nicotine cravings.

For more information, see web link:
Taylor, AH et al (2007) Addiction, 102(4) 534-543.

Long-term Smoking Cessation May Reverse Artery Stiffness

Ex-smokers achieved non-smokers' level of arterial stiffness after a decade of smoking cessation, in a cross-sectional study reported in Hypertension: Journal of the American Heart Association. The researchers studied 554 people who had high blood pressure but had never been treated for it. Researchers divided the subjects into: current smokers, ex-smokers and never-smokers. Researchers found that current and ex-smokers of only one year had significantly higher stiffness measurements compared with non-smokers. In ex-smokers, duration of smoking cessation was directly related to improvement in arterial stiffness. They found some improvement after one to 10 years, but arterial stiffness parameters only reached normal levels after more than a decade of smoking cessation.

For more information, see web link:
Long-term smoking cessation may reverse artery stiffness

California Anti-Smoking Laws Save Thousands of Lives, New Study Finds

According to a new study, more than 50,000 lives will have been saved by the year 2010 in California because of statewide tobacco control policies. The study also estimates smoking rates among Californians dropped by 25 percent due to higher cigarette prices, ramped up media campaigns, clean air laws and reducing youth access to cigarettes. "As the first state to successfully initiate a comprehensive plan to 'denormalize' tobacco, California serves as a benchmark for other states" said study author David Levy, Ph.D., a senior research scientist at PIRE Public Services Research Institute. The study estimates the change in adult smoking rates and smoking-related deaths with these new policies in place individually and as a group after controlling for other trends. The research is based on SimSmoke, a computer simulation of tobacco control policy effects developed by Dr. Levy that can be programmed for use in countries and states. SimSmoke projects smoking trends over time, and traces the impact of tobacco control policies and smoking habits on death rates.

For more information, see web link:
PRNewswire, March 1, 2007

Black Children Especially Vulnerable to Second-Hand Tobacco Smoke

Black children may be far more susceptible to secondhand tobacco smoke than white kids according to researchers. In a study published in the March issue of the journal Chest, 220 children with asthma, black children exposed to at least five cigarettes a day had significantly higher toxin levels in their hair and blood than white children exposed to the same amount of smoke. The study may shed light on why black children are more susceptible to tobacco-related disorders, like asthma, sudden-infant death syndrome and low birth weight.

For more information, see web link:
Wilson, SE, et al (2007) Chest, 131:856-862

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New Online Tobacco Treatment Training Program Announced

The American Society of Addiction Medicine (ASAM) and Clinical Tools, Inc., recently launched a new Internet-based training program to educate healthcare providers about tobacco prevention and cessation. The training program prepares physicians and other health professionals to provide clinical tobacco interventions for prevention and cessation. The Tobacco Treatment Training Program is available on the Internet 24 hours a day, 7 days a week and can be completed at the convenience of the learner. No special software is needed with this browser-based program. The new Tobacco Treatment Training Program is available online at http://www.TobaccoTreatmentTraining.com. The training program was developed with funding from the National Cancer Institute and the National Heart, Lung, and Blood Institute. Health professionals can complete the program all at once or over multiple sessions. Healthcare providers who complete the training program will earn continuing medical education credits. Training in smoking cessation has been shown to increase the rate of tobacco interventions that are conducted by health professionals. Furthermore, comprehensive training, such as what the Tobacco Treatment Training Program offers, results in increased cessation rates among patients.

For more information, see external PDF:
ASAM News Release, February 22, 2007

Fight Against Tobacco Addiction Reached Tipping Point In The US

Last year marked the tipping point in the fight against tobacco addiction according to Free & Clear®, a national leader in coaching-based tobacco dependence treatment. The United States now has more former smokers than current smokers. Further, over half of Americans now live in a city or state that is smoke-free. In 2006, seven states and 116 cities, including Washington, DC, enacted local smoke-free laws, bringing the total up to 22 states and 577 municipalities. With these new policies in place, employers and health plans have begun joining state agencies in assisting tobacco users to quit. Free & Clear has helped these agencies and organizations implement their programs and services. In 2006, Free & Clear signed contracts with over 40 large employers, health plans, and government organizations and is now the official tobacco cessation program for sixteen states and over 100 employers and health plans. "Over 10% of the Fortune 100 has partnered with Free & Clear to lower health care costs and increase employee productivity by helping their people quit using tobacco," said Tim Kilgallon, chief executive officer and president. "In 2006, we registered over 115,000 people into Free & Clear tobacco cessation programs and completed nearly 700,000 intervention calls."

For more information, see external PDF:
Free & Clear News Release, February 12, 2007

Campaign Launches Online Component to Target Teenage Chewing Tobacco Users

To combat chewing tobacco use among teens, the Pennsylvania Department of Health has launched an aggressive media and online campaign -- including a MySpace profile and Youtube videos. The campaign's target age group is teenagers ages 14 to 17 and began last fall with television and radio advertisements. Expanding the campaign to the Internet will help reach more teens, said Yasmin Coleman, Pennsylvania Department of Health director of marketing. "The motivation is to reach teens where they live and play today, which is online," said Coleman. The campaign will have an account on MySpace.com and launch videos on the popular video-sharing site, Youtube.com. It also hosts its own independent Web site, whereispete.org, which targets teens with photos and interactive games. Coleman said the campaign's primary purpose is to raise awareness throughout Pennsylvania, but to motivate people to visit the Web site, whereispete.org, and to call the free quit line, 1-800-QUIT-NOW.

For more information, see web link:
Campaign to target teenage tobacco users

Battle Heats Up Over Nicotine Therapy-Anti-Smoking Experts Plan Push to Ease Warnings on Use

Some critics claim that nicotine replacement products are producing only limited gains in smoking cessation. But some high-profile public-health experts say the problem isn't the effectiveness of the product, but may be over-regulation. They say that federal law requires nicotine gums, patches, lozenges and other products to carry so many warnings that smokers are reluctant to use them. So tobacco researchers and policy makers are starting to argue that the federal Food and Drug Administration should tone down the warnings on pharmaceutical nicotine. At a day-long summit in February in Austin, Texas, entitled "The Case for More Flexible Regulatory Policy," public-health experts discussed a number of changes they may seek to current regulations. Among other possibilities, they say they may recommend relaxing the health cautions for pregnant women and eliminating the requirement that teenagers refrain from using over-the-counter nicotine products without the approval of a physician.

For more information, see web link:
Helliker, K Battle Heats Up Over Nicotine Therapy. (2007, February 27). Wall Street Journal.

Where Tobacco Ruled, Smoking Ban Gains Ground

Smoking in most workplaces could soon be banned in Tennessee, a state with a long history of producing tobacco, the New York Times reported on March 12. Tennessee Gov. Phil Bredesen has proposed the indoor-smoking ban as well as tripling the current cigarette tax to help pay for smoking-prevention programs. The smoking ban has won support from the Tennessee House speaker and the Senate president, as well as the Tennessee Chamber of Commerce. Mr. Bredesen said he proposed the ban because he felt the time was right. The harmful effects of smoking are well documented, he said, and tobacco's declining clout in the state has now made it possible. "What's exciting here is that we're seeing more activity in what is traditionally tobacco country," said Annie Tegen of Americans for Nonsmokers' Rights. "Times are definitely changing, and just because they grow tobacco there does not mean that they're not going to take public health seriously."

For more information, see web link:
Emery, T Where Tobacco Ruled, Smoking Ban Gains Ground. (2007, March 12). New York Times.

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