Smoking and quitting - what's new?

Almost one in five of UK and US adults smoke, and of them, 70% want to quit - so it's hardly surprising there's a lot of research into what works. Several smoking stories have been in the media this week, each offering a different take on our battle with the Evil Weed.

The first headline screamed 'Going cold turkey is the best way to quit'. But this wasn't about whether or not you get support in your efforts, or whether you use smoking cessation aids like nicotine replacement therapy (NRT). The study involved offered everyone support and NRT - the same services everyone in the UK can access free on the NHS. The difference was between cutting down gradually or choosing a 'quit date' and stopping straight away their definition of cold turkey. At the end of the six-month study, 22% of those who stopped straight off were still smoke-free, compared to 15% of those who cut down gradually.

So from the NHS's perspective, this isn't really news at all - although it does make sense. If you manage to stop smoking completely for 28 days, you're five times more likely to quit for good (1). If you go 'cold turkey with no support, you have only a 3% chance of being smoke-free at a year (2), and you have only a one in six chance of lasting 28 days. By contrast, more than 70% of people manage to stay off cigarettes for 28 days with a combination of support from a healthcare professional and smoking cessation aids.

Of course some people will relapse - smoking is highly addictive, which is why we need all the support we can get. So while a figure of 22% may not sound that impressive, it's a great deal better than the alternative.

The second story relates to pregnant women and what happens to their willpower after they have their babies. Every woman should know the dangers of smoking for their unborn child, and many of them try to clean up their act - 13% of women enrolling in smoking cessation programmes are pregnant. But 43% of them start smoking again within six months of delivery - despite all the risks to children's lungs from passive smoking, and the link with Sudden Infant Death Syndrome (cot death). While there is some good news - 11% of women smoke throughout pregnancy, compared to 17% of women overall. But we clearly need to do more to support them, and their babies.

Finally, e-cigarettes are in the news again, with the announcement that the Welsh Assembly has passed a law banning their use in some public places. They take a different stance from Public Health England (PHE), who published a report last year (3), stating that e-cigarettes are 95% less harmful than 'normal' cigarettes. They're positively keen on them, describing them as a 'game changer' in terms of getting people to quit. Scotland has taken a middle ground, forbidding the use of e-cigarettes in most hospital grounds.

PHE does concede that there are no studies on possible long-term effects from e-cigarettes. But they release very little nicotine into the surrounding air for others to breathe in, and contain fifty times less damaging formaldehyde than traditional cigarettes.

The Welsh Assembly's arguments have been well rehearsed. They're concerned that they may act as a 'gateway drug', tempting non-smokers into nicotine addiction (0.2% of e-cigarette users are never-smokers). They're concerned about lack of regulation of e-cigarettes, meaning huge differences in amounts of nicotine and toxins they contain. This is likely to be less of an issue from this year with the advent of the EU Tobacco Products Directive.

But finally, the Welsh Assembly talks about 'normalising' smoking again - and this does have me worried. Most of us have long forgotten the days when the bloke on the table next to you in the restaurant lit up after his main course and blew smoke straight at you - and most of us are only too happy to forget. 'Pro-vapers' would argue that e-cigarettes are completely different - but some of them are specifically designed to look like normal cigarettes. I'm delighted my kids have grown up thinking smoking is uncool - and I don't want that to change.


1) Eur Respir Rev 2008; 17: 110, 199-204

2) Action on Smoking and Health UK (ASH). ASH Essential Information on Nicotine and Addiction. February 2009

3) PHE report:

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