An essential health resource for current and former smokers - An essential health resource for current and former smokers

E-cigarette Poisoning

The jury is still out as to what role (if any) e-cigarettes have in smoking cessation. However, it’s clear that their use has skyrocketed in the past few years. With the increased use, a new problem has surfaced – nicotine poisoning.

E-cigarettes contain liquid nicotine, which can be ingested. (Of course inhalation can also result in poisoning.) In 2010 it was rare to have a case of nicotine poisoning from e-cigarettes. Most cases were from accidental ingestion of cigarettes by children. Today, over 40% of the cases are caused by e-cigarettes with more than half the cases occurring in children under 5. Since e-cigarettes come in different shapes and colors, they can often seem appealing to little kids.

Symptoms of nicotine poisoning include nausea, vomiting, malaise, headache, rapid heart rate, elevated blood pressure, and sweats, but in severe cases can result in seizures and even death.

So if you’re currently using e-cigarettes, especially if you have children, keep them in a secure location. Better yet, quit altogether. There’s still no good evidence that they help people quit smoking.

- Tamir


Are e-cigarettes encouraging teenagers to smoke?

As many of you are aware, e-cigarettes are becoming more and more popular. Celebrities have been seen smoking them, and they’re touted as a cool and safe alternative to regular cigarettes.

e-cigarette image

Almost everyone would agree that if it came down to smoking a regular cigarette or an e-cigarette, the e-cigarette would probably be safer. The big controversy exists due to the idea that e-cigarettes encourage teens and young adults who never would have smoked to start using them. Once hooked on the nicotine from the e-cigarettes, many go on to smoke regular cigarettes. This is especially true since there’s an eerie similarity between how cigarettes were marketed back in the 1950s and 1960s to how companies heavily market e-cigarettes today to the young population. E-cigarettes come in different flavors, shapes, styles, etc.

A new study from JAMA Pediatrics seems to confirm the fears that e-cigarettes are acting as a bridge to regular cigarettes.

The study surveyed around 40,000 teens in 2011 and 2012, and found many disconcerting results. First of all, amongst teens who were experimental smokers, those who had ever used e-cigarettes were roughly 6 times more likely to have ever been smokers (defined as smoking >100 cigarettes) as well as over 6 times as likely to be current smokers compared to those who had not used e-cigarettes. Amongst current e-cigarette users, the rates were even higher – 7.4 times the risk of ever having smoked regular cigarettes, and close to 8 times the risk of currently smoking cigarettes. Finally, for those who were current smokers, current or past e-cigarette use made it much less likely that they would abstain from smoking over the next 30 days, 6 months, and a year (up to 90% less likely!).

The only possible positive spin was that current smokers who had ever used e-cigarettes were about 50% more likely to intend to quit over the next year. However, as the above data shows, most were unable to quit.

The bottom line is that e-cigarettes seem more and more to be a wolf in sheep’s clothing. Although “fun” and “safe” on the surface, it seems that the sum of the evidence is that they are getting young people addicted to nicotine and down the line to regular cigarettes.

- Tamir


Another reason to quit smoking: Your kids’ carotids

Secondhand smoke exposure is a controversial subject. On the one hand, there are those who make it out to be almost as bad as smoking (I’ve even heard people who claim that it’s worse than smoking!). On the other hand, there are those, mostly from pro-smoking groups, who completely minimize any possible danger from secondhand smoke.

The truth is somewhere in between. There’s no doubt that secondhand smoke is nowhere near as harmful to one’s health as actual smoking. However, there are studies that link it to several adverse health outcomes.

A recent study published in the European Heart Journal checked the thickness of the carotid arteries (the main blood vessel supplying blood to the brain) in over 2,000 people. Thicker vessels mean that they’re more diseased with unhealthy plaque that’s clogging them; it’s also a marker for blood vessel health in the rest of the body, including the vessels that supply blood to the heart.

On average, people whose parents both smoked when they were children had blood vessels that were over 3 years older than their peers who grew up in nonsmoking homes. In homes with one parent smoker, the study authors were unable to discern a difference. Perhaps when only one parent is smoking, he or she goes outside or away from others who don’t enjoy the smoke; in contrast, when both parents are smoking they’re likely to both be sitting around the house, such that the children are inhaling more smoke.

Again, if you have children and smoke around them, you’re causing serious harm to their health. It’s already known that children of smokers suffer more asthma, respiratory and ear infections, and are at increased risk of Sudden Infant Death Syndrome. This study adds further damning evidence. So if you’re cool with what cigarettes are doing to you, then fine, continue to smoke. But at least do it in a way that isn’t harming your kids. Then again, even if you smoke away from your young ones, but end up dying at a young age because you smoked, that would devastate your family as well.

- Tamir


Even one a day is bad

As we’ve discussed in our book and blog, there’s a misconception that light smoking (smoking a few cigarettes a day) isn’t too bad. After all, many other unhealthy things we do in moderation are probably not too bad. For instance, if someone who has an otherwise healthy diet and is physically active indulges their sweet tooth a little with a cookie or a candy bar here and there, for the most part, it probably won’t affect their health too much.

Woman smoking

Not so with smoking. I’m not going to suggest that smoking 1 or 2 cigarettes a day is as bad as smoking 2 packs, but its harmful effects are proportionally much worse than almost any other unhealthy habit. New research from University College London shows that people who smoke as little as 1-4 cigarettes daily TRIPLE their risk of having a heart attack.

Only 1 in 7 light smokers felt that they were addicted, but only a quarter believed that light smoking significantly impacts one’s health.

So, if you’re a social smoker, or like to have one in the evening with a beer (or one in the morning with your coffee), then at the very least know that it’s harming your body much more than you may realize. Maybe this will spur you to quit completely. Because you smoke so little right now, it will probably be much easier to quit than if you were puffing away on one or two packs a day. Furthermore, many light smokers only do it for social reasons, such as when they go out with friends. Otherwise, smoking isn’t a part of their daily routine. If this describes you, then by tweaking your social life a bit (e.g. hanging out in smoke-free areas), quitting should really be no big deal.

- Tamir

(Image links to source: Wikimedia Commons.)


CVS stops selling cigarettes: Will this help people who want to quit?

Let me preface this post by stating that I don’t have any commercial, personal, financial, or any other ties to CVS.

As most of you who’ve entered the major pharmacy chains such as CVS, Walgreen’s, and Rite Aid know, right behind the counter is a very large wall of cigarettes. All different brands. Different deals (buy 2 packs, get a third free). Stores are known to stock products that people will buy on a whim by the check-out counter. That’s why you’ll also notice gum, candy, popular magazines, and other miscellaneous items in the front too. People who smoke, or even used to smoke, have the unfortunate experience of being seduced by the cigarettes while waiting to pay for other items. “Hey, Marlboro is on sale this week. Let me get a carton or two!” “I haven’t smoked in a few weeks, but I’m under a crazy amount of stress. Discounted cigarettes! What the heck – I’ll get a pack or two . . . .”

Many people over the years have challenged pharmacies, claiming that they have some chutzpah selling cigarettes. After all, most of us use pharmacies to purchase products pertaining to our health such as medications, skin care products, first aid items, etc. It’s almost as if having cigarettes in the same vicinity somewhat makes them okay or not so bad.

Most pharmacies will state that they also sell nicotine replacement products and other smoking cessation products. Indeed, pharmacists are a great resource for people trying to quit. Nevertheless, the idea of pharmacies selling cigarettes leaves a bad taste in our mouths. In a way, it’s analogous to seeing a cigarette machine in the waiting room of your doctor’s office.

CVS recently decided to stop selling cigarettes by October of this year. This unexpected decision, which is going to cost them $2 billion in annual revenue (according to one article I saw) has been lauded by doctors, medical associations, and politicians.

Yes, I’m sure it’s true that there’s a financial motive as well. Maybe they want to rebrand themselves as the pharmacy that cares about people’s health in the hopes that this will attract a certain type of consumer. It’s still a pretty bold move. With the popularity of smoking decreasing overall, maybe other large retail pharmacies will follow suit.

Almost all of us visit retail pharmacies, at least from time to time. Limiting tobacco purchases to tobacco stores and other less accessible areas may end up helping people quit and help those who quit stay tobacco free.

- Tamir


Quitting smoking when you have mental health issues: New research

As we discuss in our book and blog, there’s a widespread misconception that smoking helps people deal with mental health problems such as anxiety. In many cases, smokers who have psychiatric/psychological illnesses or problems with drug or alcohol abuse are treated for the disorder or substance abuse, but the doctor will often hold off on smoking cessation due to the mistaken notion that patients need to deal with their more serious issues first.


Well, a new study published in Psychological Medicine adds more evidence that not only is it not necessary to hold off on smoking cessation, but continuing to smoke actually makes people more likely to continue suffering from mental health problems as well as drug or alcohol abuse.

The authors of the study analyzed data from over 4,800 smokers who participated in 2 surveys spaced 3 years apart. They found that those who initially reported mood/anxiety disorders, or drug or alcohol abuse in the first survey were much less likely to report those problems in the second survey if they quit in the interim. The numbers were quite impressive.

64% of the people in the initial survey reported mood/anxiety disorders, 33% had problems with alcohol, and 23% with drugs. At the follow up survey, those who had quit smoking were 40% less likely to suffer from anxiety, 30% less likely to have a problem with alcohol, and 70% less likely to have issues with drug abuse!

Although this study doesn’t definitively prove that smoking cessation improve mental health, the drastic results are quite suggestive. The take home message is that if you currently smoke and suffer from mood/anxiety disorders, alcohol abuse, and or drug abuse, it seems that by quitting, you could increase your chances of successful outcomes with your other problems. Don’t buy into the assumption that cigarettes will help you deal with stress or anxiety.

- Tamir


Visualization Techniques for Quitting Smoking: Don’t Hold Back

In our book and blog, we discuss several techniques you can use when trying to quit smoking. Visualization is one of them. It basically works as follows. When you have an urge to smoke, close your eyes and vividly imagine something horrible that smoking could do to you.

I apologize ahead of time if these seem a bit over the top, but it’s important that you choose to visualize scenarios that will affect you strongly – enough to resist the temptation of a cigarette.

  1. Imagine sitting in a doctor’s office after coming in short of breath with a bad cough. The doctor enters the room with the results of your tests, looking stern and solemn. “I’m afraid you have lung cancer,” you’re told. “Unfortunately, it’s spread to your spine and brain. You only have 3 months left to live, and there isn’t much we can do for you…”
  2. Imagine visiting your own funeral. In great detail, picture your spouse, children, parents, relatives and friends absolutely devastated from your untimely death from a heart attack or cancer. Carefully look at your young children crying bitterly at having to grow up without you. Imagine your spouse, all alone, having to raise the children without a partner, having to worry about paying the bills without any financial support. Imagine your own parents going through the pain of losing a child.
  3. Imagine lying sick in a hospital bed with pancreatic cancer that has spread everywhere. You’re in constant agonizing pain, nauseous, jaundiced, and gasping for breath. Your hair is gone from chemotherapy. You look gaunt and ashen. Your friends and loved ones are anguished.
  4. Make up your own scenario – whatever it takes to scare you enough not to smoke. To help you, look up images of smokers dying of different smoking related illnesses. Imagine yourself in those pictures.

Is this a bit morbid? Yes. But it can be effective.

Visualization can also work when trying to change other lifestyle habits. Let’s say you want to adopt a healthier diet. When you have a craving for some junky food, picture your arteries clogging up as the food enters your body. Picture yourself getting fatter and fatter, popping out of your clothes, splitting them down the middle as you bend forward.

So next time you feel like having that smoke (or ordering extra large fries), close your eyes, and let your imagination run wild.

- Tamir


Update on Smoking Cessation Medications

Quitting, maybe with the help of smoking cessation medications

As discussed in our book, there are three main medications to help people quit: varenicline (Chantix), bupropion (Zyban), and various nicotine replacement treatments (NRT’s) (patches, inhalers, lozenges, gum). A recent study published in JAMA discusses how effective the different treatments are compared to using nothing and vis a vis each other. The study was a review of 12 large review studies looking at at over 20 years of data in over 100,000 people.

Smoking Cessation Medication Results

Using any of the above medications was associated with a significantly higher rate of smoking cessation than using nothing. People were 84% more likely to quit when using NRTs, 82% with bupropion, and 188% with varenicline! Among the various NRTs, the gum was the least effective. Using a combination of NRTs (e.g. patch with inhaler or lozenge) was more effective than using a single product. This makes sense, as it more closely replicates what happens when people smoke. The patch provides a baseline level of nicotine replacement, while the inhaler or lozenges are used for breakthrough cravings.

Varenicline was close to 60% more effective than either bupropion or single NRTs, but wasn’t more effective than combination NRTs. Bupropion and single NRTs had similar efficacy rates. Absolute smoking cessation rates were 31.5% for combination NRTs, 27.6% for verenicline, 19.1% for bupropion, and 17.6% for single NRTs. Of note, only 10.6% of people who used nothing quit.

All treatments were considered quite safe. Although there had been some worries regarding a possible increased risk of heart attacks in those using varenicline, and a possible increased risk of suicidality in both varenicline and bupropion users, this was not borne out by the study.

The bottom line is that if you are trying to quit, then using medication greatly increases your chances of being successful. Using a combination of NRTs seems to be the most effective and is probably the safest way to go, so it may be what most people should start off with.

Lastly, I know that more and more people are using electronic cigarettes (e-cigarettes) in order to quit. Although it’s possible that they do have a role in smoking cessation, as of this writing, there are no good studies to support this notion; furthermore, their safety at this time is unknown as well. For now, it’s probably best to start with the modalities mentioned in this post, as these do have evidence to back them up.

- Tamir


Great American Smokeout 2013: Ready to Quit?

It’s that time of year again: Tomorrow (11/21) is the Great American Smokeout. For those of you who aren’t familiar with it, the Smokeout, which falls on the third Thursday in November every year, encourages smokers to quit. Maybe you’ll manage to quit for only that one day, but hopefully the change will be permanent.

Great American Smokeout 2013 sign

People often like specific days dedicated to improving their health. For example, we make New Year’s resolutions to lose weight or quit smoking. We may start a diet or quit smoking on our birthday. The Smokeout adds yet another day to the calendar that a smoker can use as a springboard to quit.

What if you aren’t ready to quit?

If you’re planning to quit – then by all means, quit tomorrow. Plan ahead, and recruit friends and loved ones to help you stay smoke-free. If you aren’t yet ready to quit, then let me make a suggestion. Quit for just one day. Don’t smoke a single cigarette tomorrow. You may be thinking, “What’s the point? Not smoking for one day probably won’t have much of an impact on my health, so why bother?” The point is that if you see that you can otherwise enjoy life without reaching for a cigarette, then maybe you’ll consider quitting long-term. In order to make this “Smokeout experiment” more successful, try to have an enjoyable day. Treat yourself to a nice meal at a fancy restaurant. Buy yourself a nice outfit. Hang out with friends or family. Anything except having a cigarette.

Hopefully, you’ll come to realize that you don’t really need that cigarette. Even if quitting completely is not on the table right now, maybe it will convince you that down the line, when you do choose to quit, you’ll be able to do it and still have fun and pleasure in life.

What do you experience after quitting?

The American Cancer Society has more information about the Great American Smokeout, along with some interesting tidbits about how the body recovers from the harmful effects of smoking.

Within 20 minutes of quitting, your heart rate and blood pressure drop. Within 12 hours, the levels of carbon monoxide in your blood normalize. Within 2-12 weeks, your circulation and lung function improve. Within 1-9 months, many of the chronic respiratory symptoms such as coughing, shortness of breath, and frequent infections improve. With a year, your risk of a heart attack is half of what it would have been had you continued to smoke. Within 5 years your risk of oral, esophageal and bladder cancer drops by half. The risk of cervical cancer returns to that of a nonsmoker. By 2-5 years, the risk of a stroke is down to the level of a non-smoker. By 10 years, the risk of lung cancer drops by half the risk of a current smoker, and the risk of pancreatic and voice box cancer is reduced as well. By 15 years after quitting, your risk of heart disease is back down to that of a non-smoker. Of course, all of these numbers are averages, and both the duration as well as the amount of cigarettes smoked makes a difference; nevertheless, it gives you a decent idea of what to expect.

Happy Quitting!

- Tamir

(Image links to source: Wikimedia Commons.)


The effects of peer pressure on food choices

Often, the people around us make the difference between our ability to stick to a healthy lifestyle vs. do things that damage our bodies. Peer pressure is why many of us started smoking in the first place. Peer pressure is often why we make poor choices, such as binge drinking. And peer pressure is often why we relapse and start smoking again.

What the people around you eat will affect you

It’s well known that if you’ve just quit smoking – but family members and friends are still puffing away around you – it’s going to be difficult to continue abstaining. The constant exposure to the sight of someone taking a drag and the smell of smoke are all too tempting.

Peer pressure and dieting

Same thing goes for dieting. If you’re sitting at the dinner table munching on some greens and boiled chicken while your family is indulging in deep dish pizza, bread sticks, soda, and dessert, you’re probably not going to last long.

A recent study presented at the Agricultural and Applied Economics Association’s annual meeting in Washington DC shows just how much peer pressure affects our food choices, both healthy and unhealthy.

In this well-done study, the author followed over 1500 patrons at a restaurant over a 19 week period, and analyzed their ordering patterns based on receipts. She discovered that when people ate in groups, they tended to order similar types of food, for better or worse. Those in groups where unhealthy fare was ordered were more likely to follow suit, while in groups where healthy dishes such as salads were ordered, others in the group were also more likely to order a healthier meal. This was even true if initially the person was more inclined to be dissatisfied with the healthy choice.

What should you do?

What does this mean for us? Whether you are trying to quit smoking or improve your eating habits, planning ahead is essential to ensure success. If you’re trying to quit smoking, try to have your friends or loved ones quit with you – perhaps with a friendly wager. If you’re trying to follow a healthy diet, then make it a family affair. Even thin people shouldn’t be constantly indulging in junk food. When at work, a business meeting, or simply hanging out with friends, it can become a bit trickier. Perhaps you can have peer pressure work towards your favor by ordering first, which, as the above study suggests, may “force” others to follow suit. In addition, it doesn’t have to be black and white. If your friends are all ordering double cheese burgers, fries, and sodas, and you’re too shy to order the dietetic special on the menu, then perhaps order a single burger with no cheese and a side salad or a soup instead of fries.

Ultimately, if you’re constantly surrounded by friends with poor habits, then it may be a good idea to hang out more with health-conscious people. I’m not suggesting that you dump all of your long-time buddies, only that you be mindful about the influence they have on your lifestyle choices. As the years roll on, you have to think about your own health and well-being.

- Tamir

(Image links to source: Daily Mail.)