|Commissioned Corps E-Bulletin|
|Tobacco Smoking Cessation|
|Submitted by CAPT Bernard Parker
As officers of the Commissioned Corps of the U.S. Public Health Service (Corps), whose mission is to promote healthy lifestyles (and as our formal training and continuing education instructs us), a most challenging (and individually embarrassing) task is for each of us to “practice what we preach”. For most of us, we desire and strive for “perfection” but each of us can individually recognize an area (or “vice” or two) where we can improve ourselves.
When we look beyond our roles as Corps officers with a health mission, and instead examine our individual selves, we acknowledge that we can be our worst patients, and also acknowledge that each of us share the same physical and psychological pathways which lead to bad habits as our patients or clients. Many of us have internalized what our parents would remind (or nag) us, “you know better than that” which can enforce a “guilt trip.” Finally, it is painful for each of us to recommend to a client or patient to adopt a healthy lifestyle, when sometimes the client or patient sees (or “catches”) us not “practicing what we preach.” Thus, as individual, to paraphrase the recently deceased health-guru Jack LaLanne, we might hate adopting some of our lifestyle modifications, but we love the results of those modifications!
It is with this setting that we discuss tobacco smoking cessation. As officers who are appointed to set the example for public health, and being trained as professionals within individual disciplines of science pertaining to public health care, we understand (or should understand) that tobacco smoking – whether active (primary) or passive (second-hand) exposure – predisposes us to various medical condition including cancer, cardiovascular disease, and pulmonary disease. Each cigarette has a mixture of carcinogens, such as polycyclic aromatic hydrocarbons and nitrosamines, with the addicting substance nicotine (itself not considered carcinogenic). Additionally, although much literature focuses on cigarette smoking, cigar smoking has the health risks similar to cigarette smoking, particularly with regards to oropharyngeal cancers. Finally, smokeless tobacco (chewing tobacco) also represents a serious health risk, being linked to dental caries, gingivitis, oral leukoplakia, and oral cancer.
The focus of smoking cessation is breaking the nicotine addiction. Nicotine (like other highly substances) acts on the dopaminergic-mesolimbic pathway, which is the brain’s “incentive pathway” that controls motivated behaviors. The use of nicotine is self-reinforcing, leading to compulsive use, particularly to individuals who are genetically predisposed to this. Hence the use of nicotine replacement therapies in smoking cessation programs (i.e. nicotine patches and nicotine gum), as well as drugs such as bupropion (which inhibit re-uptake of dopamine into neurons) and the new partial nicotine receptor agonist varenicline (approved by the Food and Drug Administration in May 2006).
There are smoking cessation programs that Corps officers may enter at Military Treatment Facilities (MTFs) as well as private facilities which may be covered through TRICARE. Officers may contact the Medical Affairs Branch if they require additional guidance.
Also, the Surgeon General’s 2008 Guidelines are available at http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf .
The 2008 update to the Surgeon General’s 2008 Guidelines is located at the Agency for Healthcare Research and Quality website, http://www.ahrq.gov/clinic/tobacco/tobaqrg.pdf .
Finally, the guidelines are also located within the following Centers for Disease Control and Prevention website, http://www.cdc.gov/tobacco/quit_smoking/cessation/index.htm .
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