Hypnosis Acupuncture ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

point.฀Acupuncture฀appeared฀to฀be฀superior฀to฀no฀intervention฀in฀terms฀of฀early฀results฀ OR฀=฀5.88;฀CI:฀2.66–13.01,฀but฀this฀effect฀could฀not฀be฀conirmed฀after฀6-months฀OR฀=฀0.99;฀ CI:฀ 0.30–3.24฀ Table฀ 10.2 ฀ [106] .฀ Differences฀ in฀ acupuncture฀ technique฀ auricular฀ vs.฀ other฀body฀location฀also฀had฀no฀effect฀on฀success฀rates.฀It฀remains฀to฀be฀seen฀whether฀ acupuncture฀is฀useful฀during฀the฀acute฀withdrawal฀phase฀ [104] .

10.11 Reduced Smoking

Gradual฀ reduction฀ of฀ the฀ nicotine฀ dose฀ administered฀ in฀ cigarettes฀ has฀ been฀ tested฀ as฀ a฀ method฀of฀promoting฀smoking฀cessation.฀These฀studies฀were฀designed฀to฀investigate฀the฀ following: 1.฀ Different฀ilter฀sizes฀to฀reduce฀the฀absorbed฀nicotine฀dose 2.฀ Cigarettes฀with฀differing฀nicotine฀yields 3.฀ Gradual฀daily฀reduction฀in฀cigarette฀consumption฀ [100,฀107–109] The฀ statistically฀ non-signiicant฀ success฀ rate฀ associated฀ with฀ this฀ technique฀ was฀ 5฀ 2–11฀on฀average.฀Methods฀based฀on฀smokers’฀intentions฀to฀quit฀smoking฀by฀a฀gradual฀ reduction฀ in฀ consumption฀ or฀ other฀ related฀ techniques฀ e.g.฀ using฀ ilter฀ tips฀ of฀ differing฀ lengths฀are฀unusable฀and฀should฀be฀discarded.

10.12 Pregnancy

As฀is฀evident฀from฀the฀data฀reviewed฀in฀ Chap.฀9 ,฀pregnant฀women฀who฀smoke฀run฀a฀con- siderable฀risk฀for฀their฀children฀–฀and฀this฀risk฀increases฀as฀a฀function฀of฀the฀number฀of฀ cigarettes฀smoked฀daily.฀Since฀women฀ideally฀should฀not฀receive฀any฀medication฀during฀ pregnancy,฀numerous฀smoking฀cessation฀programmes฀have฀been฀designed,฀based฀solely฀on฀ the฀provision฀of฀counselling฀to฀women.฀Data฀obtained฀in฀37฀trials฀including฀16,916฀women฀ offer฀grounds฀for฀optimism:฀a฀signiicant฀reduction฀in฀smoking฀smoking฀cessation฀was฀ achieved฀by฀medical฀counselling฀in฀34฀studies฀OR฀=฀0.53;฀CI:฀0.47–0.60฀and฀the฀percent- age฀of฀women฀continuing฀to฀smoke฀was฀lowered฀by฀6.4฀ [105] .฀In฀8฀studies฀with฀validated฀ smoking฀cessation,฀high-intensity฀counselling฀and฀very฀stringent฀assessment฀criteria,฀the฀ percentage฀of฀women฀continuing฀to฀smoke฀fell฀by฀8.1฀OR฀=฀0.53;฀CI:฀0.44–0.63฀ [105] .฀ The฀subset฀of฀trials฀with฀information฀on฀fetal฀outcome฀revealed฀reductions฀in฀low฀birth฀ weight฀OR฀=฀0.80;฀CI:฀0.67–0.95฀and฀preterm฀births฀OR฀=฀0.83;฀CI:฀0.69–0.99฀and฀an฀ increase฀in฀mean฀birth฀weight฀of฀28฀g฀9–49฀g.฀Ultimately,฀therefore,฀these฀techniques฀may฀ be฀regarded฀as฀useful฀for฀reducing฀perinatal฀mortality฀ [110] . Counselling฀ guidelines฀ for฀ use฀ in฀ gynaecological฀ practice฀ have฀ been฀ published฀ in฀ Germany,฀providing฀advice฀to฀pregnant฀women฀and฀indicating฀where฀additional฀information฀ can฀be฀purchased฀ [23] .

10.13 E-Learning, Email and Internet for Smoking Cessation

In฀the฀past฀few฀years,฀internet฀or฀email-driven฀programmes฀for฀smoking฀cessation฀were฀ established฀ [111] .฀A฀study฀by฀Riley฀et฀al.฀sought฀to฀test฀the฀feasibility฀of฀two฀self-help฀ behavioural฀interventions฀to฀reduce฀and฀maintain฀a฀50฀reduction฀in฀smoking฀among฀ those฀unable฀or฀unwilling฀to฀quit,฀and฀to฀evaluate฀the฀impact฀of฀smoking฀reduction฀on฀ subsequent฀quit฀attempts฀ [112] .฀Ninety-three฀smokers฀who฀desired฀to฀reduce฀rather฀than฀ quit฀smoking฀were฀entered฀in฀the฀study฀and฀randomly฀assigned฀to฀either฀computerized฀ scheduled฀gradual฀reduction฀CSGR฀or฀a฀manual-based฀selective฀elimination฀reduction฀ SER.฀Both฀groups฀produced฀signiicant฀reductions฀in฀smoking฀approximately฀10฀ciga- rettesday,฀during฀the฀7-week฀treatment฀phase,฀which฀were฀maintained฀over฀1฀year.฀The฀ CSGR฀group฀reported฀greater฀mean฀percent฀reductions฀in฀smoking฀from฀pre-฀to฀post- treatment฀37฀for฀CSGR,฀20฀for฀SER฀and฀a฀greater฀percentage฀of฀subjects฀meeting฀ the฀50฀reduction฀goal฀30฀for฀CSGR,฀16฀for฀SER฀compared฀with฀the฀SER฀group.฀ The฀groups฀were฀comparable,฀however,฀on฀all฀other฀outcome฀measures฀at฀post-treatment฀ and฀at฀6-฀and฀12-month฀follow-up.฀Although฀subjects฀with฀a฀current฀desire฀for฀smoking฀ cessation฀were฀excluded฀from฀this฀study,฀one-third฀of฀the฀subjects฀reported฀a฀24-h฀quit฀ attempt฀in฀the฀year฀following฀study฀initiation,฀and฀8.6฀of฀the฀subjects฀met฀7-day฀point- prevalence฀criteria฀for฀abstinence฀CO฀validated฀at฀the฀12-month฀follow-up.฀The฀results฀ of฀this฀study฀lend฀support฀to฀the฀feasibility฀of฀self-help฀behavioural฀interventions฀to฀pro- duce฀sustained฀reductions฀in฀smoking฀rates฀without฀apparent฀negative฀impact฀on฀subse- quent฀quit฀attempts฀ [112] .

10.14 Concluding Remarks

• ฀ The฀counselling฀of฀smokers฀by฀a฀physician฀or฀other฀trained฀health฀care฀professionals฀is฀ an฀essential฀component฀of฀smoking฀cessation. • ฀ Behavioural฀therapy฀programmes฀have฀proved฀effective฀in฀terms฀of฀non-pharmacolog- ical฀counselling฀and฀treatment,฀and฀these฀should฀also฀be฀used฀in฀pregnant฀women. • ฀ Mass฀media฀campaigns฀reach฀larger฀segments฀of฀the฀population,฀but฀differ฀widely฀in฀ terms฀of฀their฀effectiveness,฀and฀the฀inancial฀cost฀of฀the฀media฀spend฀can฀be฀consider- able.฀Projects฀of฀this฀kind฀should,฀therefore,฀be฀discussed฀on฀a฀case-to-case฀basis฀before฀ the฀decision฀is฀taken฀to฀implement฀them. • ฀ Like฀many฀other฀interventions,฀hypnotherapy฀and฀acupuncture฀may฀be฀effective฀in฀indi- vidual฀smokers.฀Overall,฀however,฀the฀results฀of฀treatment฀in฀the฀published฀literature฀do฀ not฀satisfy฀the฀efficacy฀criteria฀of฀evidence-based฀medicine.