Don’t Smoke? You Could Still Get Lung Cancer .

If you think you’re safe from lung cancer because you’ve never smoked, think again. Being a non-smoker doesn’t mean you cannot get lung cancer.

While cigarette smoking is the No. 1 cause of lung cancer, you also can get it from breathing secondhand smoke, being exposed to asbestos or radon, or having a family history of lung cancer.

Many people think lung cancer always is the result of a personal choice to smoke cigarettes, and so don’t see lung cancer patients in the same light as, say, a breast cancer patient. However, the vast majority of people who die from lung cancer quit smoking long before they received a lung cancer diagnosis.

“There’s a huge stigma associated with lung cancer because the majority of people who die from it are either smokers or former smokers,” says oncologist Nathan Pennell, MD, PhD.

“But the fact is that anyone who has lungs can be exposed to toxins and develop lung cancer, so this is a disease that should concern everyone,” Dr. Pennell says.

Why people who don’t smoke should be concerned about #lungcancer
One of the first questions people usually ask when they find out someone has lung cancer is, “Was he (or she) a smoker?”

“Tobacco smoke is one of the most addictive substances known to man, and addiction is a disease,” Dr. Pennell says. “Many people who smoke become addicted as teenagers. Whether you’re a smoker or not, nobody deserves to die from lung cancer.”

An under-funded area of research

More people in the United States die from lung cancer than any other type of cancer, according to the Centers for Disease Control and Prevention (CDC). This is true for men and women.

But because of the stigma associated with lung cancer, it is difficult for researchers to get funding to try to find a cure.

“Public funding has a lot to do with politics, and public opinion doesn’t support lung cancer as it does the so-called ‘blameless cancers’ like breast cancer or prostate cancer,” Dr. Pennell says. “Those types of cancers also have a lot more survivors who can advocate for funding.”

There are not enough lung cancer survivors to demand change, Dr. Pennell says. “Those who do survive often blame themselves, so there is a smaller percentage of survivors who are willing to tell their stories,” he says.

New breakthroughs in lung cancer treatments

Despite funding difficulties, medicine has made progress in lung cancer diagnosis and treatments over the last several years. Genetic testing is one example.

“There are many different types of lung cancer. Genetic testing has helped researchers to develop therapies that target specific types of cancer cells,” Dr. Pennell says.

Immune-based therapies, in which the immune system is primed to attack tumors, also are showing potential for treating lung cancer, Dr. Pennell says. These therapies already have been approved for treating skin cancer.

Development of screening tools such as CT scans help with early identification of lung cancer, too, which Dr. Pennell says “could save tens of thousands of lives.”

“Unfortunately, we’re not getting much support from insurers to pay for them,” he says.

What you can do to help

Lung cancer research needs financial support, Dr. Pennell says. Advocating for support for lung cancer research could be the key to funding the research that discovers a cure.

“I would encourage survivors, especially those who never smoked, to advocate for lung cancer research and to let people know that progress is being made,” Dr. Pennell says. “We need to get the word out about how important this is to everyone, not just to those who smoke.”


E-Cigs: No Help in Quitting, Smoking Less.

Electronic cigarettes didn’t help smokers quit or even smoke less, according to a longitudinal study that may quash some public health hopes for the nicotine-delivery devices.

Smokers who also reported any e-cigarette use at baseline in the web-based study weren’t significantly more likely to have quit tobacco 1 year later (odds ratio 0.71, P=0.35), said Pamela Ling, MD, MPH, of the University of California San Francisco.

The same was true for prior 30-day e-cigarette use after accounting for baseline intent to quit, cigarette consumption, and dependence (OR 0.76, P=0.46), the group reported in a research letter online in JAMA Internal Medicine.

Among people who didn’t quit, “vaping” wasn’t associated with smoking fewer cigarettes over time either (P=0.25).

These findings from analysis of 949 smokers in a nationally representative panel followed from 2011 through 2012 by web-based market research firm Knowledge Networks (now GfK) add to similar findings from population-based and Quitline studies.

“Although electronic cigarettes are aggressively promoted as smoking cessation aids, studies of their effectiveness for cessation have been unconvincing,” Ling’s group wrote.

For example, one placebo-controlled but underpowered trial suggested e-cigarettes were at least as good as nicotine patches in helping smokers quit, but quit rates were dismal either way at 6% to 7%.

“Regulations should prohibit advertising claiming or suggesting that e-cigarettes are effective smoking cessation devices until claims are supported by scientific evidence,” Ling’s group argued.

The top reason for regular e-cigarette use cited in surveys has been kicking the tobacco habit, and some public health experts have been cautiously supporting that harm-reduction strategy.

“As a harm reduction proponent, I would be willing to put aside the fact that any product with the name ‘cigarette’ (e- or otherwise) causes me reflex tachycardia and support electronic cigarettes … if there were good data indicating that they helped smokers to stop,” JAMA Internal Medicine editor Mitchell Katz, MD, wrote in a note accompanying Ling’s letter.

However, he agreed with their conclusion and further advocated FDA regulation as drug-delivery devices.

While the U.S. Supreme court struck down FDA attempts to regulate e-cigarettes as drugs or devices in 2010, the agency has regulations in the works that are expected to generally bring the same kind of restrictions to e-cigarettes as to other tobacco products.

“The bottom line is e-cigarettes are not a good way to quit,” commented Brian Tiep, MD, director of smoking cessation at City of Hope in Duarte, Calif.

The devices may not have all the carcinogenic compounds found in burning tobacco, but that doesn’t mean they’re entirely safe, he told MedPage Today, pointing to FDA analyses finding carcinogenic nitrosamines and the antifreeze component diethylene glycol in e-cigarette nicotine solutions.

However, he noted that Ling’s study population wasn’t actively trying to quit and that an adequately-powered study is still needed to assess e-cigarettes’ performance in a smoking cessation program.

Ling’s group also cautioned about limited statistical power, as smoking cessation was self-reported and included only nine of the 88 e-cigarette users.

Their study lacked data on how frequently the population used e-cigarettes and motivation for use as well.

The data came from a study funded by the National Cancer Institute.


Action Points

  • Electronic cigarettes didn’t help smokers quit or even smoke less, according to a longitudinal study that may quash some public health hopes for the nicotine-delivery devices.
  • Note that while the U.S. Supreme court struck down FDA attempts to regulate e-cigarettes as drugs or devices in 2010, the agency has pending regulations that are expected to generally bring the same kind of restrictions to e-cigarettes as to other tobacco products.

Most recent data from UK points to substantial public health benefits of electronic cigarettes.

While most anti-smoking organizations continue to oppose electronic cigarettes (e-cigarretes), warning of the hypothetical risks of these products, new data from the UK suggest that in real life, e-cigarettes are producing substantial public health benefits.

Recent data (monthly tracking of key performance indicators; e-cigarettes in England – latest trends) from the Smoking Toolkit Study (Cancer Research UK, UK Centre for Tobacco Control Studies) reveal the following critical points:

The use of e-cigarettes has increased dramatically, ever since the fourth quarter of 2011.
Precisely coincident with the rise in e-cigarette use in the UK has been a significant increase in quit smoking attempts.
E-cigarettes have surpassed nicotine replacement therapy (NRT) and other drugs as the most commonly used smoking cessation method.
Overall motivation to quit has increased since the dramatic rise in e-cigarette use.
The majority of dual users (e-cigarettes and cigarettes) are using e-cigarettes every day, and half are using at least two cartridges/disposables per day.
Very few non-smokers or long-term ex-smokers are using e-cigarettes.
Report STS140122 (Electronic cigarettes in England – latest trends) draws the following conclusions:

The increase in e-cigarette use prevalence may have stalled;
There is no evidence that e-cigarettes are undermining motivation to quit or reduction in smoking prevalence; and
Use of e-cigarettes by never smokers or long-term ex-smokers is extremely rare.
The rest of the story
Based on these most recent data from the UK, it appears that there just is not evidence to support the wild contentions that anti-smoking groups, advocates, and health agencies like the Centers for Disease Control (CDC) and WHO are disseminating to the public. Contrary to what Stan Glantz [Professor, Department of Medicine, and Director, Center for Tobacco Control Research and Education, University of California San Francisco, US] is telling the press, there simply is no evidence that the use of e-cigarettes is undermining smoking cessation or impeding the decline in smoking prevalence. Nor is there evidence that e-cigarettes are causing non-smokers or ex-smokers to return to cigarette smoking. Moreover, there is no evidence that dual use is decreasing the motivation of smokers to quit or precluding these smokers from reaping any health benefits.

In contrast, however, to the lack of evidence that e-cigarettes are having any negative public health effects, there is strong evidence to suggest that these products are having a substantial positive public health impact. In particular, there is evidence that not only do these products help many smokers quit smoking, but more generally, they increase population interest in smoking cessation, enhance levels of motivation to quit smoking, and lead to increased quit attempts among current smokers.

The only bad news coming out of the actual data is that the efforts of anti-smoking groups and advocates appear to be working: they are being successful in discouraging smokers from trying to quit smoking using e-cigarettes. Ironically, the results of public health efforts have been to impede smoking cessation, lower the overall motivation of smokers to quit, and decreasing the number of quit attempts among current smokers.

In other words, the anti-smoking movement is violating the first principle of public health practice by doing public health harm.

While it is difficult for me to have to criticize anti-smoking groups because these are groups with which I have had a career-long collegial relationship, it appears that these groups are substantially harming the health of the public by impeding smoking cessation. Sadly, this means that their efforts are going to result in a significant amount of unnecessary disease and death.

This is not the way public health is supposed to be. But this is what happens when an abstinence-only mentality takes over in any area of public health, whether it be nicotine addiction or heroin addiction.


8 Natural Ways to Quit Smoking Cigarettes.

Compelling reasons to stop smoking far outnumber effective ways to do so. Even with recent revelations that tobacco is contaminated with the highly carcinogenic radioisotope polonium-210, the addictive hold it maintains on millions of smokers worldwide who already know it causes premature death and cancer is far more powerful than the desire for self-preservation, it would seem.

This is why effective, natural interventions for smoking cessation are so needed today and why we are excited to report on a new study involving a solution that can be found not at your local pharmacy, but at your local grocer’s fruit stand.

In a new study published in the Journal of the Medical Association of Thailand titled, “Efficacy of fresh lime for smoking cessation,“[i] researchers from the Department of Medicine, Srinakharinwirot University, Thailand tested the effectiveness of fresh lime as a smoking cessation aid compared with nicotine gum.

100 regular smokers aged 18 or older who were willing to quit were entered into a six-month long randomized, controlled trial, receiving either fresh lime (47) or nicotine gum (53) over the course of the study. Smoking reduction was confirmed through measuring exhaled carbon monoxide (CO), with measurements at weeks 9-12 being the primary outcome. Severity of craving was also measured using a visual analogue scale.

The results of the trial showed that there was no significant difference in abstinence rates between the groups during weeks 9-12, although they did observe that “7-day point prevalence abstinence at week 4 of the fresh lime users was statistically significant lower than those using nicotine gum (38.3% vs. 58.5%; p = 0.04). They also found fresh lime users tended to report more intense cravings than the nicotine gum group, but the number of cravings were found not to differ significantly between the groups.

The report concluded, “Fresh lime can be used effectively as a smoking cessation aid, although not as good as nicotine gum in reducing cravings.”‘


Lime, of course, is an easily accessible and non-toxic alternative to nicotine gum, and physiologically has a number of ‘side benefits,’ including alkalinizing the tissues, which are normally more acidic in tobacco users to begin with.  It is also an anti-infective agent, having been demonstrated to have significant antimicrobial activity against multiple strains of drug resistant E. coli,[ii] and inhibiting the survival of Vibrio cholera, the pathogen that contributes to cholera, in foods;[iii] another nice ‘side benefit’ considering smokers often have compromised immunity.

Additional evidence-based natural aids for smoking cessation include:

Acupunture: Acupuncture treatment ameliorated the smoking withdrawal symptoms as well as the selective attention to smoking-related visual cues in smokers. [iv]

Exercise: Five minutes of moderate intensity exercise is associated with a short-term reduction in desire to smoke and tobacco withdrawal symptoms.[v] [vi]

Hypnosis: Hypnosis combined with nicotine patches compares favorably to standard behavioral counseling for smoking cessation.[vii] In a meta-analysis of 59 studies hypnosis was judged to be partially efficacious in the treatment of smoking cessation.[viii]

Black Pepper: Inhalation of vapor from black pepper reduces smoking withdrawal symptoms.[ix]

Mindfulness: Mindfulness-based interventions reduce the urge to smoke in college student smokers.[x]

Self-Massage: Smoking cravings are reduced by self-massage.[xi]

Rhodiola rosea: Rhodiola rosea has a therapeutic effect in the treatment of smoking cessation.[xii]

St. John’s Wort: There is preclinical evidence that St. John’s wort is therapeutic in nicotine addiction.[xiii] [xiv]  [Note: St. John’s wort can interact with a wide range of medications, and should be used under the guidance of a licensed health professional]

Source and citations:

If you think the timing is wrong for quitting cigarettes, you are wrong – Now is the time.

I bet you didn’t know that nicotine in commercial cigarettes is up to 35 times stronger than it was in the 1950’s and early 1960’s, before Big Tobacco (Marlboro and Kool) started using ammonia to free-base it. That is the number one reason why 95% of smokers who try to quit without help will return to smoking within 6 months. Nicotine is artificial chemical control of your emotions. Some people are switching to e-cigs (electronic cigarettes), so they can keep their nicotine addiction going strong while eliminating “some” of the chemicals found in the commercial cancer sticks. Other people quit cold turkey, usually after finding out they have cancer, or after a close friend or relative winds up six feet under from the nicotine nightmare. Talk about bad timing.


Quitting “cold turkey” is very difficult. Most people who quit smoking “cave in” and start back up again within half a year, but why? That’s because most programs give little to zero advice about nutrition and building back up the nutrients and the gut “flora” (good bacteria), which is destroyed by the 4,000 chemicals in every cigarette. Also, behavior rituals like breathing patterns and hand to mouth habits must be replaced with positive ones, or they will be missed and might cause a relapse. (

Plus, on top of everything else that sends smokers back to the well, toxic food and high blood acidity can cause nicotine withdrawal symptoms to flare up and the “urge to smoke” seem more “necessary,” leading to temporary relief from cravings and stressful moments, only to drag the person back into the undertow of chemical addiction and artificial emotion control. (

On top of the big “hooks” that keep smokers addicted, the cigarette industry spends about $23,000,000 a day on advertising and promotions. The statistics are all consuming, and cigarettes cause about 5 million deaths annually worldwide. Still, people smoke and wonder why they don’t quit. Want to know why? They can’t quit because they don’t know how. Even though “Big Tobacco” got busted for fraud and settled in the billions, they’re still up to no good, free-basing nicotine and brainwashing people into the habit from which they just can’t seem to “escape.”

23 million smokers in U.S. wish they could QUIT today

There are 46,000,000 smokers in the U.S. alone and half want to quit, but only 5% will succeed. Scary ads don’t work, and commercial cigarettes are STILL JUICED UP WITH AMMONIA, despite settling with Blue Cross Blue Shield to the tune of $6.5 billion in the 1990’s for doing just that and also marketing to children and teens. “More than 15 years has passed since the conclusion of the Minnesota tobacco trial and the signing of the Master Settlement Agreement (MSA) by 46 U.S. State Attorney Generals and the US tobacco industry. The Minnesota settlement exposed the tobacco industry’s long history of deceptive marketing, advertising, and research and ultimately forced the industry to change its business practices. It has also been more than 15 years since the tobacco industry’s individual settlements with the states of Mississippi (1997), Florida (1997), and Texas (1998) … These agreements are the 5 largest settlements in the history of litigation.” (

The CDC scary advertising campaign is also a dismal failure, only helping about 4% of the people who see it quit smoking, half of whom go back to smoking within 6 months, so what’s the use? Although the CDC brags that 1.6 million people TRIED to quit thanks to their scary ad campaign, how many really did quit? You can’t just scare people out of the third strongest addictive drug on the planet (nicotine); people need guidance and nutritional help.

The Number One Excuse is “Bad Timing”

The single most popular excuse that people use for not quitting is that the timing is wrong. They will say that times are TOO stressful, so they’ll have to wait, but the last thing the body needs while it’s under stress is ammonia, bleach, pesticide and plastic fumes entering the lungs, attached to chemical tar and glass fibers that cut the epithelial tissue. This breaks down the person’s immunity and makes them more susceptible to common colds, flu, viruses, bacterial infections, nasal congestion, allergies, sinus infections, bronchial infections, bladder infections, depression, sleep disorders and more. So go figure. Who needs all of that when times are stressful? Some people turn to electronic cigarettes to filter out some of the chemicals contained in commercial cigarettes (except for diethylene glycol – antifreeze – which causes leukemia!), but many of those people learn a hard lesson: nicotine damages the central cleansing organs and causes a host of its own problems, short term and long term, so bragging rights there are few and far between. (

One way out of the nicotine “prison” is to combine chemical knowledge with behavior modification and nutritional guidance. These three factors and skill bases, when taught and used correctly, have the highest success rate for helping smokers quit and stay smoke-free for life. There is a natural method that incorporates all three of these phases and is receiving excellent reviews. Studies show that smokers who seek help and follow the “yellow brick road” to a smoke-free life have an easier time “sticking to their guns.” The 14AndOut one hour program (video of the class) teaches smokers how to wean themselves off commercial cigarettes in 14 days or less and is recommended by Mike Adams, the Health Ranger and Editor of Natural News. The program has been a sensation for the past two years and there is nothing else like it on the market right now. Give 14AndOut a try and share the natural method with your friends, co-workers, relatives and/or neighbors who smoke cigarettes and speak of quitting. Stop smoking before 2014 and bring in the New Year with style and good health. Where there is a will, there is a way!

New non-smokers may gain weight because of gut changes, not food.

Eighty percent of people who quit smoking put on an average of 15 pounds, studies have shown, and those pounds are usually attributed to a person trading lighting up for pigging out. But according to the researchers at the Zurich University Hospital, the weight gain may not have to anything to do with an increase in calories. Rather, the weight might be a result of changes in the composition of a person’s intestinal flora after they quit. The study found that when a person stops smoking, the bacteria in their intestinal flora shifts to a type which burns energy more efficiently and breaks down more of what is ingested, thus creating more fat and less waste. The 20 study participants insisted their calorie intake stayed the same or fell after they quit smoking.



The Regulatory Challenge of Electronic Cigarettes.

Electronic cigarettes (e-cigarettes or electronic nicotine delivery systems) heat a nicotine solution to generate vapor that is inhaled, without the combustion of tobacco and its toxic constituents. Use of e-cigarettes is increasing in the United States and around the world. Current smokers in the United States report an 11.4% prevalence of ever use of e-cigarettes and 4.1% use in past 30 days.1 They likely pose less direct hazard to the individual smoker than tobacco cigarettes and might help smokers quit smoking or reduce harm by smoking fewer tobacco cigarettes. On the other hand, there are potential harms, including promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors. The Food and Drug Administration (FDA) is authorized to regulate tobacco products, and in 2011 the agency announced plans to regulate e-cigarettes as tobacco products.2 The FDA will need to make a number of regulatory decisions about product safety that could have major effects on public health and will face many challenges.


The delivery of nicotine to the lungs via inhalation, with rapid absorption into the circulation, is critical to the addictiveness of cigarette smoking.3 The adverse health consequences of cigarette smoking are caused primarily by inhalation of toxic tobacco constituents and organic combustion products. Nicotine per se contributes to some smoking-related diseases, but its contribution is considered to be much smaller than that of combustion products.3 The provision of clean nicotine (without combustion products or other tobacco plant toxins) in the form of nicotine replacement therapies (NRTs) has been in use for nearly 30 years and has proven to be a safe way to facilitate smoking cessation. Currently available NRT products are not as satisfying and are less acceptable to smokers compared with inhaling and absorbing nicotine from cigarette smoke. The possibility of an inhaled clean nicotine device has been discussed by health researchers for many years as a potentially more effective way to promote smoking cessation. Although not yet proven safe or effective for smoking cessation, the e-cigarette has been positioned as such an inhaled nicotine delivery device and has gained popularity through this perception.4


More than 250 e-cigarette brands are on the market currently, and products have evolved rapidly in recent years. Different e-cigarette brands are engineered differently, affecting the character and potential toxicity of the vapor. Thus, it is difficult to generalize about e-cigarettes as a single device. The FDA will need to consider the engineering of e-cigarettes with respect to different types of nicotine solutions, the capacity of the cartridges containing the solution, the nature of the heating element and battery, the types of additives and flavorings, and the potential toxicants released in the vapor.


Liquids used in e-cigarettes vary with respect to concentrations of toxicants, and the quality control in e-cigarette manufacturing is questionable.5 Although a number of toxicants have been identified in e-cigarette vapors, the levels of these toxicants are orders of magnitude lower than those found in cigarette smoke, although higher than those found in NRT.6 Although it cannot be said that currently marketed e-cigarettes are safe, e-cigarette vapor is likely to be much less toxic than cigarette smoke. Among the questions that should be considered by the FDA are (1) Do low levels of contaminants in e-cigarette vapor pose a health risk? (2) What are the thresholds for toxicity of contaminants in vapor? (3) What should be the basis for product standards for e-cigarettes? (4) Could the risks be ameliorated by changes in engineering?


Testimonials, surveys, and one uncontrolled clinical trial report that e-cigarettes facilitate the quitting of cigarette smoking and allow smokers to smoke fewer cigarettes per day if they continue to smoke.7– 8However, longitudinal analysis using population-level data found no difference in quit rates between e-cigarette users and nonusers.9 Controlled clinical trials and population-level observational cohort studies are needed to establish the utility of these cigarettes to facilitate smoking cessation. Research is also needed regarding the role of e-cigarettes in harm reduction, including reduced cigarette smoking and associated reduction of tobacco toxicant exposure. The FDA will need to determine the magnitude of potential health benefits from e-cigarettes for individual smokers.


Several potential sources of population harm require research and subsequent weighing of individual benefit vs population risk. These include uptake of e-cigarette use by nonsmokers, who may later become cigarette smokers or long-term nicotine addicts; promotion of dual use of e-cigarettes and regular cigarettes, such that use of e-cigarettes undermines quitting cigarette smoking; undermining the denormalization of cigarette smoking, because e-cigarettes look like regular cigarettes and their use in public would give the appearance that cigarette smoking behavior is more acceptable; and exposure to a new source of air pollution in places covered by smoke-free policies.


Advertising and marketing can be considered in the context of both manufacturer and consumer. Industry has been aggressively marketing e-cigarettes with claims of health benefit compared with smoking tobacco cigarettes, for reducing and quitting smoking, for smoking without generating irritating and harmful secondhand smoke, and for using when a person cannot smoke cigarettes.10 Marketing also uses young models and celebrities to convey images of the product as glamorous and modern. The net result of industry marketing and consumer advocacy has been a substantial increase in the use of the product. Effective promotion of e-cigarettes could be advantageous if it was determined there was individual health benefit and a low level of total population harm—for example, if e-cigarette use was found to facilitate smoking cessation and not encourage dual use or appeal to youth as a novel nicotine product.

The FDA needs to decide how marketing should be regulated in the context of potential benefits and population risks. This includes deciding the legal age at which minors can purchase the products and other possible access restrictions, as well as evaluating the appeal of the marketing to youth. Determining the effect of e-cigarettes on the entire population will be challenging.


Assuming that e-cigarettes of high quality could be safe and could offer net public health benefit (including high consumer acceptability, more effective nicotine delivery, low levels of contaminants, not undermining existing tobacco control efforts), and that product improvement is occurring in an environment of marketplace competition, a critical question is when the FDA should begin to require product licensing. A disadvantage of requiring licensing is that regulatory requirements are likely to slow product innovation. The advantage of licensing would be to ensure the quality and consistency of products.

Medications to promote smoking cessation are regulated by the FDA Center for Drug Evaluation and Research (CDER). Tobacco products are regulated by the FDA Center for Tobacco Products (CTP). According to current FDA regulations, in the event that e-cigarettes are found to be helpful in facilitating smoking cessation, the same product could be regulated simultaneously, both by CDER as a medication and by CTP as a tobacco product. This makes little practical sense. A comprehensive regulatory approach to nicotine-containing products is needed. Regulation needs to include the full spectrum of products, from the most hazardous to the least hazardous, with consideration of the potential of less harmful products to reduce exposure to the most harmful combustion products from smoked tobacco, while simultaneously evaluating the total public health effects of the policies.

Source: JAMA

Should Smokers Quit Abruptly or Gradually?.

Quit rates are roughly the same, and relatively poor, with both approaches.
The main approaches to quitting smoking are abrupt cessation (sometimes called “cold turkey”) and gradual reduction of smoking before quitting. U.S. clinical practice guidelines, as well as pharmaceutical labels required by the U.S. FDA, strongly imply that smokers should try to quit smoking abruptly as part of various quit regimens. However, some smokers prefer to gradually decrease their nicotine intake. In a Cochrane review of 10 randomized controlled trials conducted in various clinical settings in several countries, researchers assessed quit rates at least 6 months postintervention (gradual reduction or abrupt cessation) in 3760 smokers who wanted to quit smoking. Smoking status was verified biologically in 7 studies.

Quit rates were 14% to 15%, regardless of cessation approach. The success of either approach did not differ in studies that incorporated nicotine replacement, self-help methods, or behavioral support.


In this meta-analysis, quit rates were similar for abrupt cessation and gradual reduction of smoking before quitting. These results suggest that clinicians can work with patients who want to quit smoking to identify which approach they prefer, as part of a comprehensive smoking cessation program. Clinical practice guidelines in the U.S. favor abrupt cessation, but those in the U.K. and Australia already incorporate this flexibility.

Source: NEJM

Pharmacological interventions for smoking cessation: an overview and network meta-analysis.



Smoking is the leading preventable cause of illness and premature death worldwide. Some medications have been proven to help people to quit, with three licensed for this purpose in Europe and the USA: nicotine replacement therapy (NRT), bupropion, and varenicline. Cytisine (a treatment pharmacologically similar to varenicline) is also licensed for use in Russia and some of the former socialist economy countries. Other therapies, including nortriptyline, have also been tested for effectiveness.


How do NRT, bupropion and varenicline compare with placebo and with each other in achieving long-term abstinence (six months or longer)?
How do the remaining treatments compare with placebo in achieving long-term abstinence?
How do the risks of adverse and serious adverse events (SAEs) compare between the treatments, and are there instances where the harms may outweigh the benefits?


The overview is restricted to Cochrane reviews, all of which include randomised trials. Participants are usually adult smokers, but we exclude reviews of smoking cessation for pregnant women and in particular disease groups or specific settings. We cover nicotine replacement therapy (NRT), antidepressants (bupropion and nortriptyline), nicotine receptor partial agonists (varenicline and cytisine), anxiolytics, selective type 1 cannabinoid receptor antagonists (rimonabant), clonidine, lobeline, dianicline, mecamylamine, Nicobrevin, opioid antagonists, nicotine vaccines, and silver acetate. Our outcome for benefit is continuous or prolonged abstinence at least six months from the start of treatment. Our outcome for harms is the incidence of serious adverse events associated with each of the treatments.
We searched the Cochrane Database of Systematic Reviews (CDSR) in The Cochrane Library, for any reviews with ‘smoking’ in the title, abstract or keyword fields. The last search was conducted in November 2012. We assessed methodological quality using a revised version of the AMSTAR scale. For NRT, bupropion and varenicline we conducted network meta-analyses, comparing each with the others and with placebo for benefit, and varenicline and bupropion for risks of serious adverse events.

Main results

We identified 12 treatment-specific reviews. The analyses covered 267 studies, involving 101,804 participants. Both NRT and bupropion were superior to placebo (odds ratios (OR) 1.84; 95% credible interval (CredI) 1.71 to 1.99, and 1.82; 95% CredI 1.60 to 2.06 respectively). Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head-to-head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96).
Varenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than ‘other’ NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from ‘other’ NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46).
Cytisine (a nicotine receptor partial agonist) returned positive findings (risk ratio (RR) 3.98; 95% CI 2.01 to 7.87), without significant adverse events or SAEs.
Across the 82 included and excluded bupropion trials, our estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. SAE meta-analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta-analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56).
Nortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose-dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin’s UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments.

Authors’ conclusions

NRT, bupropion, varenicline and cytisine have been shown to improve the chances of quitting. Combination NRT and varenicline are equally effective as quitting aids. Nortriptyline also improves the chances of quitting. On current evidence, none of the treatments appear to have an incidence of adverse events that would mitigate their use.
Further research is warranted into the safety of varenicline and into cytisine’s potential as an effective and affordable treatment, but not into the efficacy and safety of NRT.

Source: Cochrane Library

Daily Walk Can Help Teenagers Quit Smoking.


According to a study published online in the Journal of Adolescent Health, teen smokers who increased the days on which they got just 20 minutes of exercise were able to cut down on their smoking habit.

“This study adds to evidence suggesting that exercise can help teenagers who are trying to quit smoking,” explained lead author Dr Kimberly Horn from the George Washington University School of Public Health and Health Services.

“Teens who boosted the number of days on which they engaged in at least 20 minutes of exercise, equivalent to a short walk, were more likely than their peers to resist lighting up a cigarette.”

Dr Horn’s team tracked 233 teenagers from 19 high schools in West Virginia. The participants were daily smokers with other risky behaviors.

“It is not unusual for teenage smokers to engage in other unhealthy habits,” Dr Horn said. “Smoking and physical inactivity often go hand in hand.”

The average teenager in the study smoked a half a pack on weekdays and a whopping pack a day on the weekends.

A previous study of the same group compared 3 types of programs aimed at getting the participants to stop or cut down on smoking. That study found that an intensive smoking cessation intervention combined with a fitness program was the most successful way to help teenagers quit.

In the current study, Dr Horn’s team looked to see if an increase in physical activity would help teens quit regardless of the type of intervention. Some teenagers went through an intensive anti-smoking program combined with a fitness intervention while others just got the smoking cessation program and still others listened to a short anti-smoking lecture.

The researchers found that all of the teens increased their exercise activity to some degree – just by virtue of being in the study. However, teens who reported increasing the number of days in which they got just 20 minutes a day of exercise were able to significantly cut back on the cigarettes they smoked.

“Certainly, the study has limitations,” Dr Horn said. “We don’t fully understand the clinical relevance of ramping up daily activity to 20 or 30 minutes a day with these teens. But we do know that even modest improvements in exercise may have health benefits. Our study supports the idea that encouraging one healthy behavior can serve to promote another, and it shows that teens, often viewed as resistant to behavior change, can tackle two health behaviors at once.”

“Additional research must confirm the key findings and prove that they apply to all teen smokers and not just those in West Virginia,” Dr Horn said.

Source: /