HealthReach Community Education

• We provide tactical information and practical skills to achieve and maintain a healthier, smoke free lifestyle through a supportive, nonjudgmental approach.
• Exeter Hospital affiliated health care professionals teach a series of 3 classes held every month. The classes cover:
• "Healthful Eating Strategies"
• "Healthful Exercise Strategies"
• "The Mind-Body Connection: Stress Management Strategies"
  
• The Program Coordinator assists you with developing your personalized quit plan.
  
• Rolling enrollment allows you to start when you are ready; no waiting for the next monthly session to start.
  
• You can enroll yourself, or talk to your healthcare provider about referring you to the program.
  
• If you choose self-enrollment, we will send your provider a referral form so he or she can help support you and be consulted by the Program Coordinator, if necessary, for recommendations on an appropriate smoking cessation aid for you.
  
• When you complete the program, your support does not end there. We will call you at 1, 3, 6 and 12 months after the program ends to check in with you, celebrate with you if you are still smoke-free, and provide additional counseling, support, and information if needed.
  
• Anthem of NH currently provides reimbursement for the program. Contact your insurance provider to determine specific coverage criteria you may have.
  

For more information or to register, call Exeter Hospital's HealthReach Information Center at 603-580-6668. For class descriptions and schedule, click the Calendar link at the top of the page

According to the Centers for Disease Control, in the U.S. about 443,000 deaths each year are attributable to cigarette smoking, making it the number 1 cause of preventable death. Since 1964, when the first Surgeon General's report on the health effects of smoking was published, the evidence has continued to mount that tobacco use harms nearly every organ in the body.

Cardiovascular diseases (e.g. heart attacks, stroke, peripheral arterial disease), lung diseases, multiple cancers (not just lung cancer, but including and not limited to colorectal, bladder, and cervical), osteoporosis, complications in pregnancy, fetal development and birth, increased risk of SIDS and development of early childhood asthma are just some examples of the health consequences of smoking.

And cigarette smoking is not the only culprit. Cigars and smokeless tobacco products have similar as well as their own consequences. Finally, even if you have avoided tobacco use or have quit, exposure to secondhand smoke puts you at risk for the same health issues as current smokers.

For more information on specific health effects, click the links below.

CDC: Basic Information on Health Effects and Resources
The Health Consequences of Smoking, a Report of the Surgeon General, May 27, 2004

Now for the good news! The health benefits of quitting begin within the first 20 minutes after your last cigarette, and continue for weeks, months and years thereafter. Below is a partial list of the benefits one can look forward to when the commitment is made to quit. You will see that, first and foremost, it is never too late to quit!

• People who stop smoking greatly reduce their risk of dying prematurely. Benefits are greater for people who stop at earlier ages, but cessation is beneficial at all ages.(The Health Benefits of Smoking Cessation, A Report of the Surgeon General, 1990; Women and Smoking, A Report of the Surgeon General, 2001)
• Women who stop smoking before or during pregnancy reduce their risk for adverse reproductive outcomes such as infertility or having a low-birth-weight baby. (Women and Smoking, A Report of the Surgeon General, 2001)
• 20 minutes after quitting: Your heart rate and blood pressure drop. (Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification, Mahmud, A, Feely, J. 2003. Hypertension: 41:183.)
• 12 hours after quitting: The carbon monoxide level in your blood drops to normal. (US Surgeon General's Report, 1988, p. 202)
• 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. (US Surgeon General's Report, 1990, pp.193, 194,196, 285, 323)
• 1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. (US Surgeon General's Report, 1990, pp. 285-287, 304)
• 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's. (US Surgeon General's Report, 1990, p. vi)
• 5 years after quitting: Your stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting. (US Surgeon General's Report, 1990, p. vi)
• 10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease, too. (US Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)
• 15 years after quitting: The risk of coronary heart disease is the same as a non-smoker's. (US Surgeon General's Report, 1990, p. vi)
  

Source: American Cancer Society; Centers for Disease Control; U.S. Surgeon General

There is no question that nicotine is the addictive substance in tobacco that makes quitting so difficult. In summarizing the vast body of evidence on nicotine addiction, the Centers for Disease Control makes the following statement:

"Nicotine is the psychoactive drug in tobacco products that produces dependence. Most smokers are dependent on nicotine, and smokeless tobacco use can also lead to nicotine dependence. Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol. Examples of nicotine withdrawal symptoms include irritability, anxiety, difficulty concentrating, and increased appetite.^"

Nicotine addiction has both biological and behavioral components that work together to make it difficult to overcome:

1. Biological: Very simply stated, nicotine is rapidly absorbed into the bloodstream and quickly travels to the brain, where it binds with receptors throughout the brain, leading to the release of a brain chemical called dopamine.
• Dopamine stimulates sensations of pleasure, motivation and reward. The sensations can be both relaxing and stimulating.
• Nicotine levels drop relatively quickly, causing a sense of craving which, if not alleviated by more nicotine, can lead to symptoms of withdrawal.
• The more the brain is exposed to nicotine, the higher the number of receptors and the amount of dopamine released, creating a cycle of increasing need for more nicotine.
2. Behavioral: Working hand in hand with the biological aspect of addiction, smoking develops very strong associations with other daily behaviors.
• These triggering behaviors, or antecedents, can be different for each individual and include things like having a cup of coffee, after a meal, driving in the car, talking on the phone, drinking an alcoholic beverage, even simply getting out of bed in the morning.
• Stress, or emotional responses to stress, is a common triggering behavior for many smokers.
• The trigger, or antecedent, leads to the act, or behavior, of smoking in a predictable and often unconscious cycle.

Smoking Cessation Medications:

There are 2 general categories of smoking cessation medications, nicotine replacement therapy (NRT) and oral medications. Some NRTs are available over the counter, while others, as well as the oral medications, are available by prescription only. The following are FDA approved, first-line smoking cessation medications:

Non-prescription (over the counter) NRT:

• Nicotine gum (available in generic and brand name)
• Nicotine patch (available in generic and brand name)
• Nicotine lozenge

Prescription-only aids

• Nicotine inhaler
• Nicotine nasal spray
• Bupropion SR (Zyban): oral medication
• Varenicline (Chantix): oral medication

Smoking cessation aids are covered by most health insurance. Co-payments are often applicable. Insurance companies can provide information on their coverage of smoking cessation aids.

Although the available aids have been determined to be both safe and effective, it is important for smokers to consult their healthcare providers, even before using over the counter NRT, to help determine the best smoking cessation aid for their individual needs and medical histories.

Smoking Cessation Medication Guide

Identifying and Managing Triggers:
Identifying what triggers the urge to smoke is a big step in the direction of taking control and managing the behavior of smoking. Becoming conscious of the triggers is important because the antecedent-behavior cycle can often become automatic. Since most triggers are not likely to go away and are accompanied by cravings, learning to manage them with other, specific behavioral strategies is essential.

• Keeping a journal of smoking behavior can help identify and track details like time of day, activities, thoughts, and feelings prior to and while smoking
• Talk to family and friends and see if they have noticed particular details about behaviors or moods leading up to smoking
• Once triggers are identified, think about which one(s) represent the greatest challenge
• Plan a strategy of alternative behaviors to use when triggers occur, particularly for those that are most challenging.
• Regular exercise, deep breathing and other relaxation techniques can not only manage stress that triggers the urge to smoke, but also the stress associated with quitting and with nicotine withdrawal.

Breathe NH

NH Tobacco Cessation and Control Program

U.S. Surgeon General

Smokefree.gov

Centers for Disease Control

American Cancer Society

American Lung Association

American Heart Association

Campaign for Tobacco Free Kids