Should smokers be advised to cut down as well as quit?
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2787 (Published 19 May 2014) Cite this as: BMJ 2014;348:g2787
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Dear Editors,
Patients don't need to take lifelong nicotine replacement therapy.
Varenicline treatments induce definitive smoking cessation in two months.
Brief hypnotherapeutic interventions and specific ear acupuncture sessions have been proven effective, in similar time frames.
If someone argues against definitive smoking cessation for not favouring the Pharmaceutical Industry, I would respond saying that this way the Tobacco Industry is favoured!
References
http://www.ncbi.nlm.nih.gov/pubmed/24522334
http://www.ncbi.nlm.nih.gov/pubmed/24559809
http://www.ncbi.nlm.nih.gov/pubmed/22502956
Competing interests: No competing interests
It could be a waste of valuable time to encourage smoking reduction rather than quitting.1 It is not just smokers but also children who benefit from a smoke-free environment, even before conception.
It is a bit late to advise stopping smoking during pregnancy. The production of healthy sperm need at least 3-4 months smoke-free before conception and women need to be healthy at conception. Couples with histories of headache, migraine, or “unexplained” infertility and/or recurrent miscarriage benefit from stopping smoking and alcohol drinking immediately and following a low allergy diet.2-4
It is impossible to carry out a meaningful food exclusion and reintroduction diet if patients continue to smoke. It is helpful to supply addicts with the biochemical evidence of harm such as high cadmium levels and essential nutrient deficiencies – especially of zinc which is displaced by cadmium, and essential polyunsaturated fatty acids.
Within a year of smoke-free legislation taking effect in the US and Europe, rates of pre-term births and paediatric hospital admissions for asthma fell by 10%. There was also a significant 5% decline in children being born very small for their gestational age.5
1 Aveyard P, Lindson-Hawley N, Hastings G, de Andrade M. Should mokers be advised to cut down as well as quit? BMJ 2014;348:g2787
2 Grant ECG. Oral contraceptives, smoking, migraine and food allergies.Lancet 1978;2:581-4
3 Grant ECG. Food allergies and migraine. Lancet 1979;1:966-69
4 Grant ECG. The harmful effects of common social habits, especially smoking and using oral contraceptive steroids, on pregnancy. Int J Environ Studies 1981;17:57-66.
5 Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Lancet.2014 May 3;383(9928):1549-60.
Competing interests: No competing interests
This article provides a useful insight into some of the current debate in the public health research community regarding tobacco harm reduction and also e-cigarettes/vapourisers. I commend all the authors, who are all close colleagues and members of the UK Center for Tobacco and Alcohol Studies (www.ukctas.ac.uk) . I think an important, if partial, footnote has been provided today by another UKCTAS colleage and his team, Professor Robert West from University College London. As West et al's latest paper shows: http://eu.wiley.com.ezproxy.stir.ac.uk/WileyCDA/PressRelease/pressReleas...
Smokers who try to stop are more likely to be successful with e-cigarettes than willpower alone or over the counter nicotine replacement therapy. This latest paper is another very useful piece in the current jigsaw of evidence on electronic cigarettes.
The public health community needs to keep an open mind and respond to research as it emerges. What we should avoid is reactive scare-mongering and I fear some of the content of this article encourages that. In fact, his 'head to head' depicts this issue as a polarised debate, but that is too simplistic. We may currently disagree, but I think the authors would all concede that we need to listen to everyone's views but keep in mind the goal of reducing the heavy toll of disease and early death from tobacco, particularly in our most disadvantaged communities. It is clear now that tobacco harm reduction and e-cigarettes have an important part to play in that, and we should not be trying to turn the clock back to a time when the only message the medical or research community could provide was 'quit or die'. Times have changed. Some of us need to wake up to that fact.
Competing interests: Linda Bauld chaired the NICE programme development group on tobacco harm reduction from 2011-2013. She is also current Director of the Institute of Social Marketing at the University of Stirling where two of the authors of the article are based.
Our choice to engage in risky behaviours such as cigarette smoking is influenced by how we feel about the behaviour itself. If we find smoking pleasurable, our interpretation of the ‘riskiness’ of engaging in the behaviour will be influenced to underestimate the risk (Affect heuristic) [1]. Likewise, if we are exposed to other smokers who have not had lung cancer, we will underestimate the prevalence of the consequence in society, thus reducing our perception of risk (availability bias) [2].
It is striking that cigarette smoking was promoted as healthy 70 years ago and is likely that adverse health effects of e-cigarettes may come to light in the next decade. Swapping a known risk for an unknown risk is analogous to crossing a busy road with a blindfold instead of running directly into the traffic.
Cutting down on smoking may create a false impression of risk reduction. The only way to prevent ongoing effects from smoking is to stop completely. Where patients find this difficult or are resistant to smoking cessation the emphasis should shift to focus on other health promoting behaviour and risk factor modification. This could include focusing on a healthy diet, regular exercise and reduction of alcohol. Once the patient has begun to adopt a healthy lifestyle and to reap its benefits, the natural progression will be smoking cessation. This will now be the individual’s decision and not something they are reluctantly pressurized into doing. By its nature this will be more sustainable, as opposed to a false impression of risk reduction through reducing cigarette frequency. Whilst shown effective at increasing quit rate in those that do manage to successfully cut down Aveyard and Linson-Hawley themselves accept that attempts to cut down are poorly maintained [3].
[1] Slovic, P. Finucane, M. L. Peters, E. and Mcgregor, D.G. (2004) Risk as Analysis and Risk as Feelings: Some thoughs about affect, reason and rationality. Risk analysis vol 24 no.2
[2] Kahneman, D. Tversky, A. (1982). "The psychology of preferences". Scientific American 246: 160–173. doi:10.1038/scientificamerican0182-160
[3] Aveyard, P. Lindon-Hawley, N. Hastings, G. and de Andrade, M. (2014) BMJ 348:g2787
Competing interests: No competing interests
Re: Should smokers be advised to cut down as well as quit?
In the Uk we have been pussy-footing for scores of years. It suits the exchequer, it suits the Media, it suits the advertising firms.
In the tribal area of Nagaland, a village has decided to become smoke-free. Try Google and you will find it.
Although I like UKIP in many ways, II disdain the pictures of its Leader with Sir Walter Raleigh billowing out of his mouth.
Will some parish in England care to follow the Nagas?
Remember, shall we, that within living memory, Welshmen had to cross the border in to England for a tipple on a Sunday.
Any parishes in England prepared to UDI for banning smoking , except in private houses? I mean no smoking in pubs, clubs, the village green, on the pavements, on the roads, in cars, on bikes, on tractors, on horse-back?
Competing interests: Non-smoker