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Problem statement
Smoking has been a health problem all over the world due to its negative health effects. The allure of smoking is great particularly for teenagers but the resultant addiction makes smoking a dangerous health risk. In this light, several alternatives have been advanced to assist addicts quit smoking.
Background
According to modern research, obtaining the numbers of dead people is the initial step in improving the health of the people of that nation. A recent study conducted in India indicated that there were a million deaths caused by tobacco related diseases. This had alarming reactions from people all over the world. However, these results were not new. According to statistics, smoking can be attributed of the more than 438,000 annual deaths in the US. This leads to a loss of more than 92 million dollars due to deceased human resources (Homish et al 2011). Such statistics qualify smoking as critical risk factor for numerous diseases. Initially it was perceived as an analgesic and used to treat disorders such as intestinal complications and rheumatism. Presently, cigarette smoking is known to be responsible for more than 30% cancer deaths (lung cancer) in the US. Other diseases caused by smoking include chronic bronchitis, aneurysms, neonatal death, heart attack and stroke. Moreover, further studies have shown that more eighty thousand children worldwide begin the habit of smoking every year. This implies the number of addicts is also growing at the same rate.
Originally, it was assumed that the effects of smoking were less in India than in the USA. The smoking of bidis, a cigarette with a lesser content of tobacco than the ordinary cigarette was taken as the main reason. In addition, the uptake age of the smoking habit in India was much more advanced compared to that of the US citizens. In the US, there were more teenagers getting trapped into the smoking addiction mainly due to peer pressure. The number of cigarettes consumed by each smoker was more for the US citizens than it was for the Indians. Despite this statistics, the risk factor in smoking remains relatively the same for the two countries. Bidis is said to reduce the lifespan of a man by five years and that of women by three extra years. The ordinary cigarette, on other hand, cuts down a mans life span by more than ten years. How tobacco smoke manages to achieve such alarming results becomes the vital question.
Cigarette smoke is made up of over four thousand varied chemicals. Of these, four hundred are known carcinogens. Other vital components of cigarette smoke are oxidants such as oxygen-less radicals and volatile aldeydes. Several researchers have found cigarette smoke to contain different amounts of toxic-ants. Hoffiman and Hecht identified forty-six toxicants while the US Environmental Protection Agency (EPA) came up with a list of 82 toxicants. Moreover, numerous randomized epidemiological studies attribute cigarette smoke to numerous heart complications and chronic pulmonary disorders.
Tobacco companies have come up with ways to reduce the toxic levels in cigarettes. However, complete cessation is the only sure way to reduce the risk of exposure to different diseases by helping the smokers to quit. Many smokers are more than willing to quit and a study on the effectiveness of the quitting options available would come in handy. It will help them evaluate the easiest and most effective option available. Taking actions that prevent the teenagers from starting may be important but it will only curb the number of deaths by the year 2050.
Landscape Identification
In studying the smoking problem, several stakeholders and factors must be put into consideration. The stakeholders in the smoking problem can be divided into two major categories: smokers and tobacco companies. The smokers are the divided into two categories: active smokers and passive smokers. Active smokers are the smokers who actually smoke while the passive smokers are those who inhale the cigarettes smoke by being situated next to smoker. These include the smokers friends, co-workers and relatives. The different factors that affect smoking are:
Social factors
Social facts play the greatest of role in determining the level of tobacco consumption. First, the smoking habit of the smoker was most probably initiated by social habits. The social theory identifies smoking as one of the habits acquired by example. Parents, siblings or successful actors and musicians play a vital role in influences young peoples actions (Kong et al 2011). Smokers may have adopted the smoking habit since a close relative to whom they look up to was a smoker. Moreover, music videos and movies portray smoking as a prestigious habit which greatly influences the potential smokers to start smoking. In other instances, smoking can be used to initiate and perpetuate friendships. Requesting a stranger for a match box can at time act as an icebreaker in a conversation. The smoking zones in the working areas and in streets in certain countries also create opportunities for bonding for the smokers. These social factors may act as hindrances to the quitting process particularly if the friendship bond has its roots in the smoking habit. Attempts to quit may be viewed as criticism of the habit which may eventually break up the friendship bond.
Tobacco companies are aware of the potential of the social habits and continue to sponsor sporting activities that are appealing to the young generation. This makes the smoking appealing and therefore increasing the likelihood of future smoking by these youngsters (Fichera & Sutton 2011). For instance, tobacco companies pump in millions into the motor industry. According to recent studies, young people that are great fans of the motor sport exhibit a greater likelihood of smoking than those who are not. However, these companies ensure they do not portray the negative aspects of smoking such as the discolored fingers, bad mouth odor and increased risk of disease contraction. In addition, critical health complications may result in the death of the smoker. This becomes a loss to all the beneficiaries of the smoker particularly the nuclear family. Emotional suffering due to parental loss could lead the children to develop a smoking habit as a way to relieving themselves off the stress (Laura 2011).
Political
Tobacco companies ensure their products reach their customers through sales by middlemen. In any given country, there are rules that govern the sales and smoking of tobacco products. Such legislations include the government imposition of exorbitant taxes on the numerous tobacco products in an attempt to limit the number of smokers. The government is concerned with the health of its citizens and is well aware of the negative effects of tobacco smoking. The tobacco companies are well aware of this and go as far as bribing the law makers for them to formulate laws in their favor. Tobacco lobbies spend up to $100000 daily on politicians to prevent deregulation of tobacco. Lawsuits filed against tobacco companies end up closed through punitive damages to the plaintiffs or rulings in favor of tobacco companies. In other instances, politicians use smoking as an image of identification. It portrays them as care-free thus endearing them to the people (Anonymous 2011). Promises to amend laws related to smoking could also be used to woo voters into voting in favor of the politician.
Economics
The economics of tobacco industry can be analyzed on the basis of elasticity of its demand and prices and the implications on the market under reference. Economic forces can be modeled in such a way that they contribute to the reduction of the death toll due to consumption of tobacco. Since excise tax makes up a section of the price of a commodity, numerous countries including the United States of America (USA) use taxation as a key strategy to cut down the rate of tobacco consumption. Tobaccos response to demand is similar to that of other commodities. Economists definition of price is not only monetary but it also includes other factors such as time and cost relating to the product. The restrictions and setting aside of smoking zones imposes additional costs on the smokers. Fines imposed on those who break this law also serve as additional costs. In addition, limiting youths accessibility to tobacco may help determine the first age of tobacco consumption as well as evade the additional costs. Other factors that influence the demand of cigarettes are income of the smokers, advertising and other promotional activities by the tobacco companies and taste differences.
In industrialized nations, the relationship between the smokers income and the rate of cigarettes smoking is reversed. Unlike earlier, cigarettes are now classified as inferior goods. This implies an increase in the income of the smokers is followed by a subsequent decline in the rate of cigarette smoking. Wealthy people have a greater access to information on the negative effects of smoking and therefore tend to abstain from smoking. In developing countries, the increase in the price of cigarettes results in a subsequent decrease in the rate of tobacco consumption by the smokers. Despite the legal restrictions on the advertisement of tobacco, tobacco companies spend millions on the adverts to ensure they reach as many potential customers as possible. They do these based on studying the economics of tobacco products.
Legal factors
There are numerous laws that govern the sales of tobacco products in all countries. For instance, there is an age limit below which minors should not smoke. Parents and law enforcers ensure minors do not smoke tobacco before their right age. This helps limit the number of smokers in the country (Frank 2011). Moreover, there are laws that limit public smoking to certain zones provided by the municipalities. This is intended to reduce the level of pollution. Laws have also been put in place to determine the time during which the smoking advertisements are aired. This is intended to reduce the number of minors with accessibility to the television from starting the smoking habit. Lastly, some countries demand that every cigarette packet be accompanied by a warning on the negative health effects of cigarette smoking. All the laws are backed by penalties should they not be followed or broken.
Tobacco companies are affected negatively by these laws as they are bent on decreasing their sales. However, the health of the people comes before the monetary returns. Therefore, tobacco companies have no choice but to comply. The age limit law is the most observed as the minors have parents who limit their freedom and thus control the age at which they begin to smoke. The health warnings on the cigarette packets are mostly ignored by the smokers. A majority of them are addicted and quitting is not an easy option.
Alternative options
Majority of the smokers depend on a combination of counseling, medications and family support in order to quit smoking. The interventions that help one quit smoking are referred to as smoking cessation. There are health insurance policies that cover smoking cessation particularly counseling and medication. Under counseling, all the plan participants are entitled to telephone-based counseling. The health plan should cover all medical alternatives below. While some of the medications need a prescription, others are sold over the counter. Doctors are usually in the best position to advise their clients on the best method or combination of methods to help treat their cigarette addiction. Nicotine in the cigarette is not responsible for the cancer in a smokers body. Therefore, nicotine replacements are in certain cases used in medication. The quitting process requires persistence as a single attempt may not work the magic. Successful attempts require up to eight or ten times according to current statistics (Malarcher et al 2011). The alternative treatment options are as below.
Self-Help
This refers to a smoking cessation method in which experienced or educated groups or individuals write out materials such as pamphlets, booklets, mailings accompanied by videotapes and audiotapes to help the smoker in the quitting process. These methods become necessary since physicians and therapist-facilitated interventions can only reach a small group of people. The main intention of this method is to avail behavioral interventions and alleviate the need for treatment attendance. The self -help materials can be disseminated and applied as smoking cessation interventions on a wider scale than other therapist-delivered interventions. The self- help methods are either tailored for an individual or non-tailored.
Advantages
This method can reach a greater number of people at the same time since the information can be shared. A single self-help material can be used by different people at different times with no need for additional costs to be incurred. Moreover, its documentation allows future reference with no additional costs where necessary. The information in the material remains unchanged for long periods of time making it more reliable. It does not depend on the physicians ability to communicate the intended message effectively. In addition, the cost of purchasing the self-help materials is relatively low. Pamphlets can go for less than $100 while videos and audio tapes cost much less. This makes them affordable to the smokers. Lastly, the smoker can easily determine the schedule for the quitting process depending on the supposed treatment process.
Disadvantages
Self-help methods depend on the smokers ability to comprehend the instructions given in the pamphlet, audio tape or video. The smoker may wrongly interpret them and in the process fail to achieve the intended purpose. Use of written pamphlets may not effectively convey the message intended and therefore complicate the whole quitting process. Making the process difficult has the effect of discouraging the smoker as the process is not particularly easy. Moreover, the process is demanding and may require a lot of follow up by a second party. Having self-help materials does not avail the appropriate follow up pressure required and could cause the smoker to quit midway. The method may therefore demand the services of a third party which may not be available. In addition, certain self-help materials may be expensive for the smokers making the quitting process expensive. Efficiency of this method is therefore not reliable.
Counseling
Successful quitting results from two forms of counseling and behavioral therapies. First is ensuring the smokers acquire practical counseling in which they acquire problem solving skills. Secondly, making sure the smokers get the support and encouragement in the process of treatment (Steinberg et al 2011). These are sometimes incorporated within other smoking cessation interventions. The telephone quit lines such as the American 1-800-QUIT-NOW ensure call-back counseling is available for all those who are willing. The cost of this method can be analyzed based on the organization offering it and on the smoker intending to quit. A recent study shows that the wages of the counselors handling about 1440 smokers could go up to $27.3 million but would result in a gain of over thirsty thousand lives. A normal counseling program can cost the smokers averagely $540 when only the intervention costs are considered. The organization from which the smoker seeks help must be registered within the laws of the country concerned.
Advantages
Smokers receive counseling from professional physicians or therapists. Such professionals are properly trained on the most appropriate ways to successfully help the smokers quit the smoking habit. They administer the required amount of follow up and are available should anything be difficult or beyond the patients understanding. The telephone quit lines are operational twenty four hours in a day thus making them convenient for the smokers to reach.
Disadvantages
Counseling requires set up of particular schedules with the counselor which could conflict with the smokers working schedule and therefore complicate the quitting process. This method can be expensive particularly for the group or organization offering it. Compared to the self-help materials, the intervention is more expensive particularly if follow up telephone calls are provided. In addition, the attitude and personality of the therapist can determine the effectiveness and the time taken before the intended goals are met.
Bupropion SR
Following approval by FDA in 1997, Bupropion SR became the first non-nicotine medication identified to give successful smoking cessation results. It achieves these results by acting on the chemicals associated with nicotine craving. Usage can be done alone or in conjunction with nicotine replacements. Patients with seizure disorders, any previous or present identification of bulimia or anorexia nervosa, a two week period usage of Monoamine oxidase (MAO) inhibitor, or present intake of any form of medicated drug containing bupropion should use this method. Prescription is mandatory for this form of medication. According to studies conducted by the British National Coordination Center, the application of bupropion is relatively affordable as compared to the NRT method discussed below. The cost is approximated to be $700 for the complete intervention process. In the application of this method, the motivational support should be accompanied by the prescription (Planer et al 2011).
Advantages
This method is considered much cheaper than all the other the NRT options. The period required for the quitting process is relatively reduced and therefore chances of the smoker being persistent are very high. Cigarette smoking introduces nicotine into the body system of the smoker and causes an unending craving for nicotine. It is a non-nicotine method and therefore does not cause any harm to the smokers body. Studies have indicated that nicotine based methods could cause effects of nicotine similar to those caused by smoking-related nicotine.
Disadvantages
Unlike the other forms of medication, it requires prescription. Bupropion SR demands seeking services in certain locations that might involve additional travel costs. Absence of the designated personnel could cause the delays in the medication process as the drugs cannot be purchased over the counter. It has side effects such as rash, insomnia, headache and tremor. These may result from withdrawal from application of the treatment. Its most distinguished side effect is seizure (Andrea 2011).
Nicotine Replacement Therapy
This refers to the application of Nicotine Replacement Therapy (NRT) bent on replacing the nicotine from cigarettes and subsequently curbing symptoms of nicotine withdrawal. Application of different types of NRTs, for instance, gum and patch and combination with Bupropion SR is possible under this form of medication. However, pregnant women who smoke are usually advised against using NRT. Nicotine gum has been proved as a reliable smoking cessation treatment option. Usually, the recommended dosage for the highly dependent smokers is 4mg compared to the 2mg for lighter smokers. The smoker is required to chew the gum thus quickly delivering nicotine to the brain and the blood. If done for two or more weeks, likelihood of the smoker quitting is doubled. Another effective smoking cessation treatment is the nicotine inhaler. This refers to a plastic tube containing a nicotine cartridge. A nicotine vapor is released when the inhaler is puffed on. The quit rate with this method is relatively higher as it closely resembles that of smoking a cigarette. It is about twenty five percent. Nicotine lozenge is a tablet that emits nicotine into the smokers body by dissolving in the mouth. It requires o prescription and is available over the counter. It demonstrates a quit rate of about twenty four percent. The working of the Nicotine nasal spray is similar to that of the inhalers but has a higher quit rate of about twenty seven percent. Lastly, there is the Nicotine patch that delivers successful results by being smeared on the smokers skin. The dosage is reduced gradually in the course of a few weeks. The usual dosage is 25ml but can be increased with the anticipation of a higher likelihood of quitting. Patches can be prescribed by a medical professional or purchased over the counter.
According to studies conducted recently, the success of the NRT intervention is not dependent on the form of NRT used. All the forms lead to relatively similar results. Moreover, provision of additional support to the individual does not necessarily increase the chances of quitting. The recommended time period is eight weeks and any extension does not necessarily guarantee different results.
Advantages
This method reduces the urge to smoke and down cuts the symptoms associated with attempts to quit smoking. The different forms of NRT allow the smoker to identify the most appropriate form for their condition. Its ability to deliver excellent results without the need for counseling or any motivational support makes the process cost-effective. Moreover, the period of use of the NRT is rather short (Vidrine & Vidrine 2011).
Disadvantages
All forms of NRT have certain side effects associated with them. For instance, gums and tablets can cause irritation to the mouth. Patches also cause irritation to the skin. Since, they only replace the smoking-related nicotine with another form of nicotine; the initial effects of the nicotine may still be experienced. However, studies into this matter have shown that NRT do not cause heart attack as initially believed. Moreover, the method is limited to certain smokers only; it is not universal. Its costs are relatively higher as compared to the other forms of medication already discussed.
Varenicline
This is usually sold as Chantix in the US and as Champix in foreign nations. It was recently approved for the smoking cessation treatment. It is an agonist of nicotinic acetylcholine receptors and utilizes its lower binding affinity with other alpha-seven receptors to alter the reinforcing effect of nicotine in the smokers body. The rewarding and reinforcing effects of smoking are achieved by inhibiting the binding of nicotine to alpha-four-beta-two receptors. Usually, it is available in packs of fifty six 0.5mg or 1mg tablets. This pack costs $54.60 while a twelve-week course treatment costs three times the same amount. When its effects are accessed retrospectively or prospectively, varenicline is used to lower the smoking urge. However, these results are particularly limited to men as women take longer to respond. The results are also dependent on the smokers interest to quit. The higher the interest of the smokers causes faster effects of varenicline. It is normally prescribed as a part of behavioral support (Yeomans et al 2011). Smokers intending to quit are required to set the date of quitting and start application of varenicline about fourteen days before. Just as the bupropion SR and NRT, use of varenicline causes nausea and gastrointestinal disorders (Kathleen 2011).
Advantages
Varenicline is cheap and affordable to many smokers. It is requires a short period of use before the supposed quitting date. Moreover, since tablets are taken, it does not interfere with the working schedule of the smoker and is therefore is more flexible to apply (Erin 2011).
Disadvantages
Usage of varenicline results in side effects such as vomiting that may discourage the smoker. In critical cases, this form of medication works better when combined with motivational support. This in turn increases its cost.
Comparison table
Recommendation
Among the five smoking cessation treatment alternatives, the most efficient is varenicline. This method is better than self-help material and counseling as it works to limit the smoking rewards of nicotine which forms the root of the addiction. It allows a flexible quitting process as the tablet can be taken at ones convenience. In comparison to the other medications it is relatively cheaper with a short duration of use. Recent studies indicate varenicline demonstrates significantly greater quit rate than bupropion SR: odds ratio 1.93(ninety five percent confidence interval of 1.40-2.68). The study further proves varenicline to be superior to bupropion SR and NRT, both in the short-term and long-term. According to a study in the manufacturers submission, varenicline sustained its domination over bupropion and NRT- both in cost and efficiency- for twenty years and over. Moreover, varenicline achieves continuous abstinence better than other forms of medication (Karam-Hage et al 2011). The documented success rate (70%) distinguishes it from all the other smoking cessation intervention especially because multiple quit attempts are required by many smokers. According to the extrapolated results, varenicline can save up to more than eighty thousand lives in a period of less than three months. Smokers willing to quit can apply this medication combined with a little motivational support for better and more satisfactory results. However, it is important to note that the quitting process demands persistence and perseverance before any results can be observed. The smoker should also maintain a positive mental attitude throughout the whole process.
References
Andrea L. (2011). W.Va.s Smoking Problems Can Be Solved With the Right Programs. The State Journal, 27(37), 16.
Anonymous. (2011). Smoking Cessation Resources for Patients. The Journal of Cardiovascular Nursing, 26(6), 431.
Erin, J. (2011). Tool kits join the war on smoking. The Centralian Advocate, 17.
Fichera, E., & Sutton, M.. (2011). State and self-investments in health. Journal of Health Economics, 30(6), 1164.
Frank, B. (2011). Roundup: Tobacco giant launches High Court challenge to Australias plain cigarette law. Xinhua News Agency CEIS.
Homish, G., Eiden, R., Leonard, K., & Kozlowski, L. (2011). Social-environmental factors related to prenatal smoking. Addictive Behaviors, 37(1), 73.
Karam-Hage, M., Strobbe, S., Robinson, J., & Brower, K. (2011). Bupropion-SR for Smoking Cessation in Early Recovery from Alcohol Dependence: A Placebo-Controlled, Double-Blind Pilot Study. The American Journal of Drug and Alcohol Abuse, 37(6), 487.
Kathleen S. (2011). Snuffing out youth smoking. The Washington Post, p. A.17.
Kong, G., Camenga, D., & Krishnan-Sarin, S. (2011). Parental influence on adolescent smoking cessation: Is there a gender difference? Addictive Behaviors, 37(2), 211.
Laura, B. (2011). Smoking rate at all-time low; Teen smokers slide to 12%. The Ottawa Citizen, C.11. Retrieved December 24, 2011, from ProQuest Newsstand.
Malarcher, A., Dube, S., Shaw, L., Babb, S., & Kaufmann, R. (2011). Quitting Smoking Among Adults United States, 2001-2010. MMWR. Morbidity and Mortality Weekly Report, 60(44), 1513-1519.
Planer, D., Lev, I., Elitzur, Y., Sharon, N., Ouzan, E., Pugatsch, T., Chasid, M., Rom, M., & Lotan, C. (2011). Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome. Archives of Internal Medicine, 171(12), 1055.
Steinberg, M., Randall, J., Greenhaus, S., Schmelzer, A., Richardson, D., & Carson, J. (2011). Tobacco dependence treatment for hospitalized smokers: A randomized, controlled, pilot trial using varenicline. Addictive Behaviors, 36(12), 1127.
Vidrine, D., & Vidrine, J. (2011). Active vs. Passive Recruitment to Quitline Studies: Public Health Implications. Journal of the National Cancer Institute, 103(12), 909.
Yeomans, K., Payne, K., Marton, J., Merikle, E., Proskorovsky, I., Zou, K., Li, Q., & Willke, R.. (2011). Smoking, smoking cessation and smoking relapse patterns: a web-based survey of current and former smokers in the US. International Journal of Clinical Practice, 65(10), 1043-1054.
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