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Smoking Cessation

Cigarette smoking is the single most important cause of disease and premature death in the United States. Health Effects of Smoking. Heart diseaseLung disease

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Smoking Cessation

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    1. Smoking Cessation Kevin Scott Ferentz, MD Associate Professor Department of Family Medicine Univ. of Maryland School of Medicine

    3. Health Effects of Smoking Heart disease Lung disease – COPD, asthma Cancer Lung, ENT, pancreas Cervix, colorectal Skin (squamous cell) Vascular disease - impotence Stroke Cataracts Gum disease Dementia Early menopause Osteoporosis Wound healing Anxiety Miscarriage SIDS Hearing loss Rheumatoid arthritis Macular degeneration Tooth decay Depression Multiple sclerosis

    4. Smoking in the U.S. 25% of adults men = women rate hasn’t dropped in 1990’s 1.3 million quit each year 3,000 teens start each day adolescent smoking increasing more ex-smokers than current smokers

    6. Smoking kills more people each year than alcohol cocaine crack heroin homicide suicide car accidents fires AIDS

    7. What’s in a cigarette? 4,000 chemicals tar carbon monoxide nicotine

    9. Health benefits after quitting cough, DOE resolve in weeks exercise tolerance improves rapidly bladder cancer: 50% reduction in 5 years lung cancer: 50% reduction in 10 years heart disease: 50% reduction in 1 year! No excess risk of heart disease by 10-15 years vascular disease: 50% reduction in 5 years mortality - same as never smokers by 10-15 yrs

    10. Non-health reasons for quitting COST!!! inconvenience self-esteem role model

    11. Common concerns Withdrawal short lived Cravings last 3-5 minutes, diminish rapidly Tension validate, normalize find other ways to cope Weight gain - not inevitable! 1/3 gain: 5-8 lbs.

    12. Three Aspects of Addiction Physical Psychological Behavioral

    13. Behavior modification review reasons for quitting (index card) identify triggers (4 day diary) plans to avoid or cope with each trigger change habit: packs only, different brands develop support system (tell everyone) self rewards (day, week, month, year) written commitment to quit day

    14. Pharmacological treatment nicotine replacement - “methadone for the smoker” gum patches nasal spray inhaler bupropion all decrease cravings, withdrawal 20-25% quit rates at 1 year

    15. Nicotine replacement and buproprion should always be used in conjunction with behavior modification

    16. Conclusions We haven’t started winning the war All smoking patients should be counseled Always use pharmacological interventions Be public health advocates

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