A Banner Publication
November 2, 2006 – No. 3
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The deadliest of habits:

Despite decades of warnings, smokers still lighting up

The good news is that there is now some help for smokers.

A new prescription medication, Chantix, promises to help curb the addiction to nicotine. Chantix, manufactured by Pfizer Inc., received U.S. Food and Drug Administration approval in May, and is now available through many health plans, including MassHealth.

In two recent studies published in the Journal of the American Medical Association, Chantix proved to be more effective in smoking cessation than a placebo or Zyban, one of the first-line drugs currently available on the market. During three test periods in one study, Chantix proved to be more than twice as effective as the placebo and roughly 50 percent more effective than Zyban in curbing smoking.

Chantix has proven to be a safe and well-tolerated medication and promises effective management of smoking cessation.

One of the studies was conducted by Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital.

Smoking is now still a major health problem across the globe and will be for the foreseeable future. By 2010, the World Health Organization predicts the annual global cost of tobacco-related illness will be about $500 billion.

In this country alone, more than 434,000 people die each year from smoking-related diseases.

But more startling is that of the estimated 44 million Americans who smoke, about 70 percent claim they would like to quit, and another 40 percent actually try. But in a given year, federal officials said, fewer than five percent are successful.

By now, most smokers know the risks. Lung cancer is the second most common cancer in both men and women, but the deadliest cancer in both sexes. Overall, more people die of lung cancer than colon, breast, and prostate cancers combined, and more women die of lung cancer than breast, ovarian, and cervical cancers combined.

And for those still in denial about the harmful effects of smoking, cigarette smoking accounts for 87 percent of lung cancer deaths and roughly one-third of all cancer deaths.

The reason is pretty obvious. Cigarettes contain more than 60 carcinogens, or cancer-causing agents, as well as 4,000 substances, some of which are poisonous to the body.

One of the ingredients, tar, which includes the majority of the cancer-causing chemicals in tobacco smoke, is particularly evil, and so-called “low-tar” cigarettes provide no protection against lung cancer. The carcinogens attack the rectangular-shaped cells that line the airways of the lungs, causing them to reproduce uncontrollably. The lungs’ healthy cells try to fight back, but over time, cancer cells often win the battle. Worse, those cancer cells can and do spread — usually to the brain or bones.

Another active ingredient in tobacco is the addictive drug nicotine. With each cigarette the typical smoker inhales as much as two milligrams of nicotine. It’s that drug that spreads through the blood stream to the part of the brain that triggers feelings of pleasure. The immediate physiological response is an increase in blood pressure, respiration, heart rate, and blood glucose level.

Similar to other drugs, like heroin and cocaine, these feelings of pleasure dissipate quickly, leaving cravings for more nicotine. As the body adapts to the nicotine, smokers often increase the number of cigarettes to continue to get a “kick” from the drug.

In recent years, nicotine levels in cigarette smoke have increased. A recent report by the Massachusetts Department of Public Health indicated that the nicotine yield — the amount of nicotine in inhaled smoke — has risen roughly ten percent in U.S. cigarettes between 1998 and 2004. One of the greatest percentage increase was found in Kool menthol cigarettes, a very popular brand smoked by blacks.

It’s not surprising then, given the higher levels of nicotine yield found in Kool and other menthol cigarettes, that blacks die from lung cancer at higher rates than whites, even though more whites than blacks smoke in the United States. According to the National Cancer Institute, the death rate for black men was 32 percent higher than that for white men between 2000 and 2003.

In Boston, black men have a slightly higher death rate from lung cancer than white men, while the rate in black women trails behind that of white women.

A recent study published in the New England Journal of Medicine offers a partial explanation for the disparities. Among light to moderate smokers, African Americans and Native Hawaiians had significantly higher risks for lung cancer than whites, Japanese Americans, and Latinos. But for all heavy smokers, the risks of cancer are similar. The authors of the study suggest differences in the metabolism of nicotine as one possible explanation, as well as the depth and frequency of inhalation as another.

While further research is required, one thing is clear. Smoking is among the deadliest of addictions, regardless of race or gender.

It increases the risk of 15 other cancers, cardiovascular disorders, and chronic obstructive pulmonary disease, or COPD. The fourth leading cause of death in this country, COPD is a term referring to two diseases — emphysema and chronic bronchitis. In both diseases, the flow of air into and out of the lungs is obstructed. The symptoms of both are cough and shortness of breath, while sufferers of chronic bronchitis also produce increased mucus.

While blacks in Massachusetts are half as likely to die of COPD than whites, living with the disease severely reduces the quality of life. Sufferers may require supplemental oxygen in order to breathe more easily, and the complications of the disease can impair social activities, physical exertion, and the ability to work.

Being a non-smoker does not make a person immune from lung cancer. Secondhand smoke contains the same chemicals and carcinogens contained in active cigarette smoke, and are emitted by not only a burning cigarette but also the exhaled smoke.

A U.S. Surgeon General report determined that there are substantial health risks from second hand smoke. Children who are exposed to second hand smoke are at increased risk for complications of asthma, sudden infant death syndrome (SIDS), and severe respiratory illnesses. It is estimated that a non-smoking woman has a 24 percent increased risk of lung cancer from living with a smoker and a 16 percent increased risk from workplace smoking. Roughly, 38,000 people die each year from lung cancer and heart disease because of second hand smoke.

A vaccine, NicVax, which hopes to block the ability of nicotine to enter the brain, thus eliminating the pleasure associated with smoking, is under investigation. According to National Institute on Drug Abuse Director Dr. Alan I. Leshner, “If people found tobacco less rewarding, they would be less likely to continue using it. Ultimately, however, our best treatment for nicotine addiction is prevention.”

And getting smokers to quit.


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