The New Your Times: Lung screening lowers the smoker’s motivation to quit smoking

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The results of a new study on smoking cessation published in New York Times suggest that the billions of dollars insurers spend on screening smokers for lung cancer could be better spent on helping them quit and keeping others from starting.

Although screening is initially seen as the first step of the whole cessation process, the new study indicates that more often smokers’ believe that they had dodged a bullet and could safely continue to smoke. Even when nodules that suggested cancer-in-the-making were found, most participants remain smokers because they believe screening could catch cancer early before it would threaten their lives.

The study was conducted by  Dr. Zeliadt, a health economist at the V.A. Puget Sound Health Care System and the University of Washington in Seattle, and seven of his colleagues and enrolled 37 current smokers who were offered lung cancer screening.

After being screened and told the results, the participants were interviewed in-depth about their smoking-related health beliefs. For about half of those in whom cancer was not found, “screening lowered their motivation for cessation”. A commonly expressed opinion was that the screening provided the same health benefits as stopping smoking, even when precancerous lung nodules were detected.

“They compared how hard it was to quit smoking with how easy it was to be screened,” said Steven B. Zeliadt, the lead author of the study. “They engaged in magical thinking that now there’s this wonderful painless external test that can save lives.” But, Dr. Zeliadt added, “If we want to save lives from smoking, we should take all this money being spent on screening and double down on smoking cessation efforts.”

The study findings shed light on a common psychological problem called cognitive dissonance – a conflict between people’s beliefs and their behaviors that typically prompts them to adjust their attitudes and beliefs to make them consistent with their behavior, rather than change their behavior, which is more challenging.

“Smoking is a classic example,” Omid Fotuhi, a social and health psychologist at Stanford University, said. “Smokers think, ‘I know smoking is unhealthy for me, but I can’t change my behavior because I’m addicted.’ So they follow the path of least resistance and keep smoking.”

Dr. Fotuhi said that counseling for smokers should target the rationalizations they use to reduce cognitive dissonance. For example, a smoker who claims that smoking helps them cope with stress should be told that the effect is only temporary and that much of the stress they experience is the result of nicotine withdrawal, which prompts them to smoke another cigarette and perpetuate the cycle. Once their system is cleared of nicotine, that stress will likely dissipate. “We need to keep our eyes focused on the prize,” he said.“On how to reduce smoking-related deaths from lung cancer and other conditions, not on how many people we can get screened.”

You can see the publication with all the information on the study here.

12 advices on how to not get cancer

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Cancer experts at the World Health Organisation (WHO) have published a 12-point code aimed at preventing cancer, the Independent reported.

Dr Joachim Schuez, who led the research, explained “these are all recommendations where you can change your behaviour as an individual”. These are their guidelines:

  1. Do not smoke. Do not use any form of tobacco.

  2. Make your home smoke-free. Support smoke-free policies in your workplace.

  3. Take action to be a healthy body weight.

  4. Be physically active in everyday life. Limit the time you spend sitting.

  5. Have a healthy diet:

  • Eat plenty of whole grains, pulses, vegetables and fruits.
  • Limit high-calorie foods (foods high in sugar or fat) and avoid sugary drinks.
  • Avoid processed meat; limit red meat and foods high in salt.
  1. If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.

  2. Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.

  3. In the workplace, protect yourself against cancer-causing substances by following health and safety instructions.

  4. Find out if you are exposed to radiation from naturally high radon levels in your home. Take action to reduce high radon levels.

  5. Breastfeeding reduces the mother’s cancer risk.

If you can, breastfeed your baby. Hormone replacement therapy (HRT) increases the risk of certain cancers. Limit use HRT.

  1. Ensure your children take part in vaccination programmes for:
  • Hepatitis B (for newborns)
  • Human papillomavirus (HPV) (for girls).
  1. Take part in organized cancer screening programmes for:
  • Bowel cancer (men and women)
  • Breast cancer (women)
  • Cervical cancer (women)

Find out more about the European Code Against Cancer at:

58% of the Americans want smoking to be illegal in all public places

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A majority of Americans continue to believe that smoking should be made illegal in all public places (58%), as they have since 2011. 41% are opposed to a total ban in public places.

The latest results come from Gallup’s July 8-12 Consumption Habits survey, in which 19% of all Americans report having smoked cigarettes in the past week.


In a separate question, Gallup finds much less support for an outright ban on smoking. About one in four Americans (24%) say smoking should be made completely illegal. That is twice the level in 2007 and the highest ever found in Gallup surveys. Still, a large majority of Americans (76%) say smoking should not be made illegal, perhaps reflecting Americans’ instincts against making behaviors totally illegal, or reflecting their doubts that such a ban would work in practical terms.


Women are a good deal more likely than men to say that smoking should be banned in public places or made illegal entirely. Among age groups, the older an American is, the more likely he or she is to support a ban on smoking in public places. But Americans of all ages are about equally as likely to support an outright ban.

Read the original article on Gollup.

Researchers give 6 solutions that will help the entire world quit smoking

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new study published in the journal Addiction suggests countries have no excuse for not helping their citizens quit smoking, Business Insider reported.

With tobacco still the leading cause of preventable death worldwide, killing some 5 million people annually, even the poorest countries can do their part.

The international team of researchers behind the study offer up six methods that are globally affordable and shown to work.

1. Healthcare advice

Simple one-on-one discussions between a doctor and patient can be enormously effective in getting people to see firsthand — on a personal, not statistical, level — how tobacco use can harm their health.

Even five-minute chats, which require only a small investment of time, were found to raise quitting rates by 2 percentage points.

2. Self-help materials

People who want to quit smoking can expect modest support if they use leaflets and books offering advice, support, and, in some cases, information regarding medication use.

Researchers saw an increase in cessation by 2 percentage points when people used printed materials instead of white-knuckling the quitting process.

3. Telephone helplines

Encouraging people to sign up for so-called proactive hotlines, in which a trained counselor initiates the call to tobacco users, can raise cessation rates by up to 3 percentage points, provided the support is offered on a regular, ongoing basis.

Meanwhile, hotlines that require callers to dial in themselves — known as “reactive” hotlines — haven’t conclusively been shown to help people quit, the researchers explain.

4. Automated text messaging

Even in low-income countries, text messages can serve as helpful reminders to smokers looking to quit.

Functioning similar to face-to-face healthcare advice, texts can deliver motivational messages and offer behavioral distractions when needed, the report explains. Quitting rates bumped up 4 percentage points over no intervention.

5. Cytisine

Cytisine is a cheap plant extract that binds with nicotine receptors to make smoking less satisfying. It also alleviates the withdrawal symptoms that make quitting so hard.

Cytisine has been in use under the Bulgarian brand Tabex for decades, but, regretfully, has yet to win over scientists in the Western world. According to the new model, cytisine could help people from all income levels quit smoking at a low cost. When used by people who smoke at least 15 cigarettes a day, cytisine has shown bumps to cessation rates of 6 percentage points.

6. Nortriptyline

A kind of antidepressant, nortriptyline requires consistent monitoring from a healthcare professional, the researchers write.

Typically combined with behavioral support, as the drug comes with some mild adverse side effects, a 12-14-week regimen can result in a gain of 10 percentage points in quitting rates compared to a placebo.

“One of the barriers to countries doing more to offer support has been concern about cost,” says Martin Raw, the  co-author of the study and director of the International Center for Tobacco Cessation.

He and his colleagues used four countries of varying income levels to represent cost-effectiveness: Nepal for low-income countries, India for middle-low-income countries, China for upper-middle-income countries, and the United Kingdom for high-income countries.

“Affordable” treatments were those whose cost to save a year of life fell below the average economic output of people in that country, otherwise known as the per capita GDP. Treatments were deemed effective if they helped people quit smoking for 6-12 continuous months.

The beauty of these six solutions, says lead author of the study Robert West, is that countries can essentially mix and match them according to their resources.

“Our report shows that every country in the world could be doing something,” West explained. “The more a country does, the more of their citizens’ lives they will protect.”

Read the original article on BI’s Tech Insider.

Good News: Mortality And Heart Failure Risks Decrease With Time For Ex-Smokers

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After 15 years of no smoking the risks of heart failure (HF) and death amongst former light and moderate smokers is getting reduced slowly, but firmly. This is what a new study based on the daily use of cigarettes amongst smokers shows. According to researchers, the more years go by, the more ex-smokers can see the health benefit of quitting the habit, Healio reported.

In the prospective Cardiovascular Health Study of Cardiovascular risks were enrolled near 4 500 community-dwelling adults, in the age 65 and older in the United States. More than half of the participants (57 %) declared never smoking, 29% quitted more than 15 years prior and 14% were current smokers.

Researchers involved in the study divided former smokers in three groups by pre-cessation smoking intensity – light, mild and heavy smokers. The results were a very good news for everyone, that stopped using tobacco in any form long ago – the risks of incident HFs, all-cause and cardiovascular mortality for ex-smokers were similar to the one for the people. that have never smoked a cigarette in their lives. Although the heart failure, cariovascular, non-cardiovascular and myocardial infarction risks were high amongst heavy smokers, the risk for all-cause mortality has considerably decreased.

Most of the smokers can’t find a reason to stop smoking, because they see themselves “infected” for live, but the study findings show that, with time, the biggest health concerns for light and moderate smokers fade away. Also, these these health concerns did not differ from the ones that non smokers have, and get lower even for heavy smokers. The trick is to stop here and now and go from there.

Dr. Frank Bures: Does Europe have a smoking-cessation secret?

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“Cytisine has been available in the former socialist economy countries of eastern Europe since 1964. Made by the Bulgarian drug company Sopharma AD and sold as Tabex, it has never been available to most of the rest of the world. A new study from New Zealand reported in the Dec. 18 New England Journal of Medicine compared the cessation results of cytisine to varenicline.”

Tobacco is likely the most addictive chemical we humans encounter (except maybe for Oreo cookies. Yes, someone studied them and found an addictive result). The search continues for aids to help people quit tobacco use.

Nicotine gum, lozenges, patches, (all called nicotine replacement therapy), some drugs first intended for psychiatric disease treatments, counseling, hypnosis, etc. have all been tried. Currently the favorite in the United States is a drug called varenicline — brand-name Chantix.

Varenicline was derived from a drug called cytisine. The plant Cytisus laborinium (Golden Rain acacia) first was used as a smoking substitute during World War II. This led to it being used as a smoking-cessation aid, with the extraction of the chemical cytosine coming later. The drug company Pfizer created different forms of it, called analogs, leading to varenicline’s formulation and its fast-track approval by the Federal Drug Administration and introduction in 2006 to the United States.

Cytisine and varenicline both bind to the cell receptors for nicotine, of which there are many. The one they have the most affinity for is nicotinic acetylcholine receptor apha4beta2, the cell receptor that appears to mediate nicotine dependence. They only bind partially to give less kick than nicotine itself, but still decrease cravings.

Cytisine has been available in the former socialist economy countries of eastern Europe since 1964. Made by the Bulgarian drug company Sopharma AD and sold as Tabex, it has never been available to most of the rest of the world. A new study from New Zealand reported in the Dec. 18 New England Journal of Medicine compared the cessation results of cytisine to varenicline.

It pointed out right away that the cost of cytisine was far less than all others. The authors listed 25 days of cytisine cost $20 to $30, nicotine replacement therapy for 8 to 10 weeks cost $112 to $685 and varenicline cost $474 to $501 for 12 weeks.

This was the first study to compare the two drugs directly. The subjects were culled from New Zealand’s national smoking quit line. They collected 1,310 people, divided them between the drugs, and used a phone self-reporting system for results and side effects. Any time this format is used, criticisms abound. But the results were still valuable.

The reported percentages of abstinence for cytisine vs. varenicline were 60 percent vs. 46 percent at one week, 40 percent vs. 31 percent at one month, 31 percent vs. 22 percent at two months, and 22 percent vs. 15 percent at six months.

Past studies of cytisine are few. One in 2011 from Poland and England compared it to placebo. At 12 months, 8.4 percent of the cytisine group were abstinent vs. 2.4 percent in the placebo crowd. Here, both groups took pills for 25 days without knowing which was which, so-called double blinded.

Adverse reactions were mostly nausea, vomiting and sleep disorders for both drugs. In other reports, varenicline has engendered occasional suicidal thoughts and behaviors, while cytisine has not. Interestingly, plants that contain cytisine, including common broom and mescalbean, have been used as recreational drugs. However, too much cytisine can cause convulsions, heart pain, headache, respiratory failure and death. Oops. No reference was made about the derivation of the dosing schedule of Tabex.

The doctor who wrote an editorial pointed out that tobacco is now the leading cause of preventable death worldwide, and China now uses and manufactures the most tobacco of any country. Both the article and editorial agree that cytisine is at least as good as varenicline — and considerably cheaper.

Of course, more studies are needed for approval in the Unite States. That is the stumbling block here and in Western Europe. The stumbling block to many people wanting to quit now is the cost of what’s available. Cytisine would make it affordable almost everywhere.

Perhaps some highly motivated politico can become the standard bearer for getting it approved on a fast track, especially with 50 years’ experience other countries. And maybe not.

As Milton Berle, the comedian, said, “You can a lead man to Congress, but you can’t make him think.”


Ex Smoker: Mladen Borisov, Sofia, Bulgaria

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If we say that Mladen is a gamechanger, we won’t be wrong. He is among the young Bulgarian entrepreneurs and we are pretty sure that his latest project is about to change the way we study in digital environment.
Mladen is an ex smoker and he was kind enough to tell us about his experience with cigarettes and quitting.

Why did you start smoking?
Because it was cool, you know. Chicks like it and it makes you look more mature and at some point it became a habit to smoke cigarette after cigarette.

For how long did you smoke before you quit?
I was a smoker for 10 years before I quit.

How many times did you try to quit?
I tried 3 or 4 times before I really succeeded.

What made you start smoking again?
Smoking made me look cool, helped me socialize more with people that way.

How did you manage to quit eventually?
I was scared of the side effects and what really got to me eventually was the possibility of getting cancer and inevitably dying.

What did the process of quitting look like?
You can say that I did it cold turkey. One day I just stopped.

What were the things that challenged you, while quitting?
I guess I was just really scared of the change.

In what way did your life change after quitting?
I could breathe more easily, my teeth got whiter and my breath fresher. I stopped snoring and even felt more powerful and energized.

Were there any side effects caused by this process?
I can’t really remember any.

Who supported you in the process? What helped you?
No one actually. I knew it was good for my health to stop smoking. And I did it.

A lot of people don’t take that in mind, but how hard is it to quit smoking and what was the emotional cost you had to pay while doing it?
The only cost is that you can’t enjoy drinking beer as much as when you are out with friends. Also the whole going outside -talking to chicks part – is not so fun anymore.

What would you advise people who would want to quit smoking?
You just need to stop! Cigarettes will destroy your body. And the risk of being found death at 40 is bigger for you than for the non-smokers.

Looking back, what were the biggest harms the smoking did to you and your family?
Bad breath, I guess.

What makes you happy?
The little things.