SMOKING I. Reflection of smoking When your parents were young, people could buy cigarettes and smoke pretty much anywhere — even in hospitals! Ads for cigarettes were all over the place. Today we're more aware about how bad smoking is for our health. Smoking is restricted or banned in almost all public places and cigarette companies are no longer allowed to advertise on TV, radio, and in many magazines. Almost everyone knows that smoking causes cancer, emphysema, and heart disease; that it can shorten your life by 10 years or more; and that the habit can cost a smoker thousands of dollars a year. So how come people are still lighting up? The answer, in a word, is addiction. Once You Start, It's Hard to Stop Smoking is a hard habit to break because tobacco contains nicotine, which is highly addictive. Like heroin or other addictive drugs, the body and mind quickly become so used to the nicotine in cigarettes that a person needs to have it just to feel normal. People start smoking for a variety of different reasons. Some think it looks cool. Others start because their family members or friends smoke. Statistics show that about 9 out of 10 tobacco users start before they're 18 years old. Most adults who started smoking in their teens never expected to become addicted. That's why people say it's just so much easier to not start smoking at all. II. Major diseases caused by smoking A. Cardiovascular disease Cardiovascular disease is the main cause of death due to smoking. Hardening of the arteries is a process that develops over years, when cholesterol and other fats deposit in the arteries, leaving them narrow, blocked or rigid. When the arteries narrow (atherosclerosis), blood clots are likely to form. Smoking accelerates the hardening and narrowing process in your arteries: it starts earlier and blood clots are two to four times more likely. Cardiovasular disease can take many forms depending on which blood vessels are involved, and all of them are more common in people who smoke. A fatal disease Blood clots in the heart and brain are the most common causes of sudden death. Coronary thrombosis: a blood clot in the arteries supplying the heart, which can lead to a heart attack. Around 30 per cent are caused by smoking. Cerebral thrombosis: the vessels to the brain can become blocked, which can lead to collapse, stroke and paralysis. If the kidney arteries are affected, then high blood pressure or kidney failure results. Blockage to the vascular supply to the legs may lead to gangrene and amputation. Smokers tend to develop coronary thrombosis 10 years earlier than non-smokers, and make up 9 out of 10 heart bypass patients. B. Cancer Smokers are more likely to get cancer than non-smokers. This is particularly true of lung cancer, throat cancer and mouth cancer, which hardly ever affect non-smokers. The link between smoking and lung cancer is clear. Ninety percent of lung cancer cases are due to smoking. If no-one smoked, lung cancer would be a rare diagnosis - only 0.5 per cent of people who've never touched a cigarette develop lung cancer. One in ten moderate smokers and almost one in five heavy smokers (more than 15 cigarettes a day) will die of lung cancer. The more cigarettes you smoke in a day, and the longer you've smoked, the higher your risk of lung cancer. Similarly, the risk rises the deeper you inhale and the earlier in life you started smoking. For ex-smokers, it takes approximately 15 years before the risk of lung cancer drops to the same as that of a non-smoker. If you smoke, the risk of contracting mouth cancer is four times higher than for a non-smoker. Cancer can start in many areas of the mouth, with the most common being on or underneath the tongue, or on the lips. Other types of cancer that are more common in smokers are: bladder cancer cancer of the oesophagus cancer of the kidneys cancer of the pancreas cervical cancer C. COPD Chronic obstructive pulmonary disease (COPD) is a collective term for a group of conditions that block airflow and make breathing more difficult, such as: Term watch Chronic means long term, not severe. emphysema - breathlessness caused by damage to the air sacs (alveoli) chronic bronchitis - coughing with a lot of mucus that continues for at least three months. Smoking is the most common cause of COPD and is responsible for 80 per cent of cases. It's estimated that 94 per cent of 20-a-day smokers have some emphysema when the lungs are examined after death, while more than 90 per cent of non-smokers have little or none. COPD typically starts between the ages of 35 and 45 when lung function starts to decline anyway. . Other risks caused by smoking Did you know? A single cigarette can reduce the blood supply to your skin for over an hour. Smoking raises blood pressure, which can cause hypertension (high blood pressure) - a risk factor for heart attacks and stroke. Couples who smoke are more likely to have fertility problems than couples who are non-smokers. Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to ease. The blood vessels in the eye are sensitive and can be easily damaged by smoke, causing a bloodshot appearance and itchiness. Heavy smokers are twice as likely to get macular degeneration, resulting in the gradual loss of eyesight. Smokers run an increased risk of cataracts. Smokers take 25 per cent more sick days year than non-smokers. Smoking stains your teeth and gums. Smoking increases your risk of periodontal disease, which causes swollen gums, bad breath and teeth to fall out. Smoking causes an acid taste in the mouth and contributes to the development of ulcers. Smoking also affects your looks: smokers have paler skin and more wrinkles. This is because smoking reduces the blood supply to the skin and lowers levels of vitamin A. III. Smoking and others There are many health-related reasons to give up cigarettes - not just for smokers, but to protect those around you. Babies born to mothers who smoke during pregnancy are twice as likely to be born prematurely and with a low birth weight. Passive smoking The 'side-stream' smoke that comes off a cigarette between puffs carries a higher risk than directly inhaled smoke. Children who grow up in a home where one or both of their parents smoke have twice the risk of getting asthma and asthmatic bronchitis. They also have a higher risk of developing allergies. Infants under two years old are more prone to severe respiratory infections and cot death. For adults, passive smoking seems to increase the risk of lung cancer, but the evidence for an increased risk of heart disease is not yet conclusive. Let's take a look at how cigarette smoke affects our bodies, from head to toe. You may be surprised at some of the ways smoking has a negative impact on our health. Hair: Smell and staining Brain and Mental Effects: Stroke Addiction/nicotine withdrawal Altered brain chemistry Anxiety about harm caused by smoking Eyes: Eyes that sting, water and blink more Macular degeneration Cataracts Nose: Less sense of smell Thyroid Graves Disease Thyroid Disease Skin: Wrinkles Premature aging Teeth: Discoloration and stains Plaque Loose teeth Gum disease (gingivitis) Mouth and Throat: Cancers of the lips, mouth, throat and larynx Cancer of the esophagus Sore throat Reduced sense of taste Breath smells of smoke Hands: Poor circulation(cold fingers) Peripheral vascular disease Tar stained fingers Respiration and Lungs: Lung Cancer COPD (includes chronic bronchitis and emphysema) Cough and sputum Shortness of breath Colds and flu Pneumonia Asthma Complicates Tuberculosis Heart: Harms, blocks and weakens arteries of the heart Heart attack Liver: Cancer Abdomen: Stomach and duodenal ulcers Cancer of stomach, pancreas and colon Aortic aneurysm Kidneys and bladder: Kidney cancer Bladder cancer Bones: Osteoporosis Spine and hip fractures Spine: Degenerative Disc Disease Male reproduction: Sperm: deformity, loss of motility, reduced number Infertility Impotence Female reproduction: Period pains Earlier menopause Cancer of cervix Infertility and delay in conception Blood: Leukemia Legs and Feet: Gangrene Peripheral vascular disease Beurger Disease Immune System: Weakened immune system The effects of smoking hold additional risks for women. Those who smoke throughout their pregnancies increase the risk of: Spontaneous abortion/miscarriage Ectopic pregnancy Abruptio placentae Placenta previa Premature rupture of the membranes Premature birth Risks to the fetus include: Smaller infant(for gestational age) Stillborn infant Birth defects, e.g. congenital limb reduction Increased nicotine receptors in baby's brain Increased likelihood of child smoking as a teenager Possible predisposition to adult anxiety disorders As long as this list of diseases known to be associated with smoking is, it is incomplete. We don't yet fully understand all of the dangers that cigarette smoke presents, but research continues, bringing us new discoveries seemingly by the day. SOLUTION We all know there are at least a hundred good reasons to quit and we’ve all heard them over and over again. Well. Here they are again…at least some of them. Hopefully there’s something in here that you haven’t heard before. This is just a few of the obvious, and more vain reasons: saving money, lowering anxiety (from constantly wondering when you’ll get your next smoke), less coughing and shortness of breath, increasing your senses of smell and taste, whiter teeth, not having your breath and clothing smell like a smoking tree, fewer wrinkles, better skin and avoiding smoker’s voice. These are the ways to stop smoking and they might be efficient: 1. Nicotine replacement therapy (NRT) According to Prof Bolliger, any form of NRT increases the success rate of a smoking cessation programme. All the different types of NRT have been shown to be effective, with little or no side-effects. NRT can be regarded as a temporary solution that helps smokers get past the first hurdle on their journey to long-term smoking cessation. A tip: always carry a batch of gum or another type of NRT with you while you travel. "The urge could come at any time," says Bolliger. 2. Zyban alone The antidepressant Zyban (bupropion) seems to increase levels of dopamine and norepinephrine in the brain, leading to an enhanced feeling of pleasure. Buproprion seems also to prevent relapse, according to researchers from the Mayo Clinic Nicotine Dependence Center. The relapse-free period did not, however, persist: at the end of the first year, 55% of the Zyban group in the Mayo Clinic study were still smoke-free, but two years later, similar numbers of the Zyban and non- Zyban groups had relapsed. Longer-term treatment of bupropion may prevent relapse, but more research on the long-term benefits of Zyban is necessary before definite conclusions can be drawn. Zyban should not be used by: people with seizure disorders such as epilepsy, those who have shown an allergic response to bupropion, people with a current or prior diagnosis of bulimia, anorexia nervosa or bipolar disorder, people with a liver disorder, kidney problems, heart problems, hypertension, head injury, a brain or spinal column tumour, diabetes, or people using alcohol or benzodiazipine sleeping tablets. Zyban is only available on prescription. 3. Combination therapy Combination therapy, which involves counselling, the simultaneous administration of NRT (patches and/or gum) and/or the drug Zyban, seems to be an effective solution for many smokers. Preliminary research results indicate a 50 percent six-month success rate for combination therapy. The dosage and usage of NRT and/or Zyban vary according to the individual. The usual recommendation is to take NRT and/or Zyban for three months – then you either make it or you don't. If you don't make it, it's not useful to try again immediately. Accept it and have another go in six months' time, is Bolliger’s advice. Counselling forms an integral part of the Stop Project, a smoking cessation programme that is run at the University of Stellenbosch Faculty of Health Sciences. 4. Smokenders’ behavioural changes Some experts do not regard NRT alone as a long-term solution, but as a temporary replacement. This replacement method doesn't address the core psychological factors involved in smoking addiction. According to Mercia Axon, managing director of Smokenders, nicotine addiction, though real, has been blown out of proportion. The focus for long-term smoking cessation should be on behavioural changes. "Most smokers will recognise that the emotional bond with their cigarettes is the biggest issue. Our programme gives people a stress management tool and helps them to reconstruct their emotional support system," says Axon. The international Smokenders group specifically deals with the emotional and psychological aspects involved in smoking. These factors are addressed during seven group sessions. Long-term success is linked to appropriate ways of managing emotions and stress – without cigarettes. The first six months is the most difficult period for many smokers. Clients who feel the urge to light up during this period should contact their counsellors immediately, Axon advises. The group claims it has a 92% success rate after a one-year period and a 70% to 75% success rate after a period of five years. Bolliger, however, queries the high success rates of some smoking cessation programmes. He speculates that inaccurate feedback from clients may be boosting the figures. 5. Kicking the habit on your own Quitting all by yourself is not easy, but not impossible. The biggest reason for relapse, in general, is that the quitter feels anxious about being without his cigarettes. Other reasons include missing the pleasure of smoking, feeling pressurised by family members or friends who smoke, or feeling addicted. The Boston research found certain lifestyle habits to be an indicator of likelihood of relapse: more than five alcoholic drinks or more than six cups of coffee daily. Research suggests that stress management techniques, like exercise or yoga, can play an important role in long-term success, whether you want to stop by yourself or join a programme. People who are committed to stop smoking should make it easier for themselves by monitoring their diets to prevent weight gain and cutting back on excess alcohol and caffeine intake to limit the risk of relapse. "Whatever works, is fine," Bolliger says. "In the end, most people stop by themselves."
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