| Prevalence |
- Although tobacco smoking is decreasing in NZ approximately 18% of adults smoke, 17% smoking daily[1]
- Highest levels are those under 34 yrs at 24% - particularly amongst 18-24 yrs: men 24%, women 30% - and 25-34 yrs: men 30%, women 24% [1]
- Maori, especially females, smoking is highest at 41% followed by Pacific peoples at 26% [1]
- Those in poorer areas appear to smoke more (28%) [1]
- More common amongst those with other addictions and/or mental health issues
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| Health costs |
- Contains 4,000 chemicals, at least 60 of which are carcinogenic
- Approximately 5,000 [2] New Zealanders die each year from smoking related diseases (350-500 [2] from passive smoking)
- 80% of lung cancer caused by smoking
- Smoking linked to many cancers
- Major cause of heart attacks, heart disease, strokes
- Major cause of respiratory illnesses such as emphysema, chronic bronchitis
- Can cause blindness, infertility, impotence
- WHO estimate by 2020, tobacco smoking will kill more than any other disease.
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| Why smoke |
- Influenced to start by peer groups, family, lack of knowledge about costs to health, disregard of costs (especially the young who may not relate to mortality risk), lack of knowledge about addictive qualities of nicotine, desire to reduce weight.
- Some hereditary risk (possibly 60%) attributable to becoming dependent.
- Once started may become important as central nervous system adapts to its effects, and gradually may become dependent on its use.
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| What happens |
- Nicotine is the main addictive ingredient, with each cigarette having about 10mg – 1mg approx is taken in by the smoker, and over 90% of this is absorbed by the lungs. Travels rapidly by blood to the central nervous system (CNS), affects the CNS, then breaks down within a few minutes. This rapid effect and short lasting process can lead to habit/addiction.
- Effects in the CNS are euphoria, ability to address stress, social ease when dealing with others, memory enhancement, and reduction in appetite. Increases, then stabilises the heart rate. These rewarding effects become a powerful reinforcer for continued smoking.
- Like many other addictive drugs, nicotine increases a neurotransmitter dopamine that signals reward to the CNS
- As the smoker finds the levels of rewarding feelings can be increased through smoking, the sense of control and the CNS adaptation to these higher levels of dopamine mean smoking becomes a more important way to feel good.
- Unfortunately, the CNS adapts by producing less ability to use dopamine when higher levels commonly exist (homeostasis) as well as a tolerance (more nicotine needed for the same effect) and the CNS may need the prompt from the nicotine to feel the rewarding effects.
- Without the nicotine there can develop a psychological and physical craving for the nicotine, depressed mood, irritability, anxiety, restlessness, concentration difficulties, and increased appetite. Withdrawal commences after a few hours of last smoking, peaks after a few days, and gradually subsides over weeks. Relapse is common.
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| How to stop |
- Can be through a self-awareness of costs and decision to stop as well as inability to access tobacco (usually financial costs – but can be prioritised over food etc)
- Motivation to try to stop is important in attempting to stop or reduce, maintaining abstinence (or reduced use), and re-attempting cessation following relapses
- Motivating can enhance decisions to quit, rather than using threats of costs which can be regarded as non-applicable to them (e.g. ‘My grandmother lived to 98 and smoked every day’; ‘Young people don’t die of smoking’).
- Support can be the smoking Quitline (ph. 0800 778 778), encouragement to reduce smoking, stopping, trying again, and by avoiding other smokers
- Addressing weight gain with other strategies
- Nicotine is not carcinogenic and can be administered in pure form, gradually reducing as withdrawal urges reduce. This can be through nicotine replacement therapy (gum, patches, nasal spray and inhaler), pills that reduce the withdrawal effects or control dopamine surges through their anti-depressant ability (e.g. bupropion or Zyban, and nortriptyline) some of which is subsidised by the government (contact the Quitline for more information). On average these medications can increase the ability to stop smoking by between 1.5 and 2 times, increasing the likelihood of succeeding.
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| Not smoking at all |
- Prevention information may reduce desire to start smoking, a highly desirable outcome, as there is no minimum safe level of smoking. Smoking at a younger age (as with many addictions) is more likely to increase likelihood of addiction.
- Smoking is highly addictive, and difficult to stop once it has become part of someone’s behaviour.
- Within a year of stopping, many of the biological costs can be reversed.
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| References and Links |
- The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey Ministry of Health 2012
- Tobacco Facts: May 2001 Ministry of Health 2001
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