There are an increasing number of options available for the treatment of nicotine dependence. As noted above, nicotine dependence is a chronic, relapsing disorder, and treatment should be approached from this perspective. The U. S. Public Health Service’s Clinical Practice Guideline on Treating Tobacco Use and Dependence is a comprehensive review of smoking cessation research, with recommendations based on numerous meta-analyses. It is the best resource for evaluating currently available treatments, and therefore it is the basis for most of the conclusions that we present here. Pharmacotherapies To date, there are seven FDA-approved medications that reliably increase long-term abstinence rates. These includefive nicotine replacement therapies (NRT) (gum, transdermal patch, inhaler, nasal spray, and lozenge), and two non- nicotine medications (bupropion SR, and varenicline). NRTs are designed to wean smokers gradually off nicotine in a manner that reduces the severity of withdrawal symptoms and cravings to smoke. They are typically used during the first 8–12 weeks of tobacco abstinence. Although the products vary in their routes of nicotine delivery (with the patch providing the most consistent delivery and stable Read more […]
Archive for category Tobacco'
Epidemiology of Tobacco Use in Pregnancy According to the latest estimates, approximately 27 to 33 percent of women of childbearing age are smokers. Although increasing pressure is being placed on those who smoke to cease during pregnancy, the majority of expecting mothers fail to do so. The Centers for Disease Control (CDC) reports that 20 to 25 percent of expectant mothers continue their tobacco use during gestation. In the National Health Interview Survey, only 27 percent of women were able to immediately quit use when told that they were pregnant and an additional 12 percent were able to quit by the third trimester of pregnancy. Growth Effects Tobacco use by pregnant women raises concerns about potential teratogenic effects. Nicotine and its by-product, cotinine, are found in fetal serum and amniotic fluid at 15 percent higher concentrations than in maternal blood and last for 15 to 20 hours. Large amounts of nicotine and cotinine can be ingested by nursing infants of women who smoke. It has been well documented for many years that tobacco exposure affects fetal growth even after controlling for pertinent demographic and confounding variables. The earliest reported study on human infants who were prenatally exposed Read more […]
Although speculation regarding the effects of smoking dates back to the sixteenth century, when tobacco was introduced to the Old World, clinical and epidemiological investigation has positively linked smoking with specific illness and death only within this century. The economic effects of smoking have been relatively neglected, however. This report is intended to shed additional light on them. The calculation of the costs of smoking is most important, not only because of the nation’s present preoccupation with health care costs in general but also because of political decisions that are being made daily in both public and private sectors concerning the allocation of resources, including specifically government regulation, health education, and the role of health prevention. Anti-Smoking advertising, for example, can be justified only by assuming that the benefits of the campaign outweigh the costs of the operation. But decisions can be made more rationally if we know (1) the actual costs of smoking, and (2) both the costs and the effectiveness of different methods of intervention. Cost of disease considerations Both direct and indirect health care costs are included in the economic impact of smoking. Direct Read more […]