INTRODUCTION:

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly the substance is the dried leaves of the tobacco plant which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette. Smoking generally has negative health effects, because smoke inhalation inherently poses challenges to various physiologic processes such as respiration. Diseases related to tobacco smoking have been shown to kill approximately half of long term smokers when compared to average mortality rates faced by non-smokers.

A 2007 report states that, each year, about 4.9 million people worldwide die as a result of smoking.^[1]

If you smoke, giving up is probably the greatest single step you can take to improve your health. Seven out of ten smokers say that they want to stop, but most believe they can't. However, half of all smokers eventually manage to stop smoking.^[2]

Contents of tobacco smoke:

· Cigarette smoke contains over 4,800 chemicals, 69 of which are known to cause cancer.

· Carbon monoxide is a poisonous gas linked with heart disease, stroke and other circulation problems.^[3]

· Tar is deposited in the lungs with every breath of cigarette smoke taken. Tar causes cancer and damages your lungs.^[4]

· Benzene is a solvent and is a known cause of cancer and is associated with leukemia.^[5]

· Formaldehyde is a poison used to preserve dead bodies. It is known to cause cancer, respiratory, skin and gastrointestinal problems.

· Ammonia - it is also found in cleaning fluids in toilet cleaner

· Cadmium is a poisonous metal, used in batteries. It causes liver, kidney and brain damage.

· Butane used in lighter fluid

· Stearic acid used to prepare candle wax

· Xexamine used in barbecue lighter

· Taluene used as an industrial solvent

· Nicotine used as an insecticide

· Methanol used in rocket fuel

· Arsenic- its known dangerous poison

· Acetic acid used in vinegar

· Cyan hydric acid used in gas chamber

· Polonium 210 is a radioactive element

· DDT it’s an insecticide

· Vinyl Chloride used in plastic materials

· Naphthalene used as a moth repellent

· Acetone is a solvent.^[6]

Danger:

· Smoking is directly responsible for approximately 90 percent of lung cancer deaths and approximately 80-90 percent of COPD deaths.^[7]

· The list of diseases caused by smoking includes chronic obstructive pulmonary disease coronary heart disease, stroke, abdominal aortic aneurysm, acute myeloid leukemia, cataract, pneumonia, periodontitis, and bladder, esophageal, laryngeal, lung, oral, throat, cervical, kidney, stomach, and pancreatic cancers. Smoking is also a major factor in a variety of other conditions and disorders, including slowed healing of wounds, infertility, and peptic ulcer disease.^[8]

Recommendations/strategies:

Preparing to stop:

It is important to stop smoking because person want to write down your reasons, and keep the list to hand over the next few months. Think of the benefits: less coughing, cleaner clothes, better breathing, more money, and a lower risk of developing smoking-related illnesses.

When person have decided to stop, make a plan:

· choose a day to quit; ask family and friends for their support

· plan a reward for the end of your first day, and the end of the first week, and the first month

· and the day before, get rid of cigarettes, ashtrays and lighters.^[9]

Stopping:

Your goal is to get through the first day without smoking. If you need to put something in your mouth chew sugar-free gum or something healthy and non-fattening. Drink juice and eat fruit. If you feel a strong craving, try taking some deep breaths and delay giving in to the urge. It will usually pass in a couple of minutes. If you need to do something with your hands, find something to fiddle with - a pencil, a coin, anything but a cigarette.^[9]

Staying stopped:

Take it one day at a time. Each day congratulate yourself on having made it so far. Keep reminding yourself of your reasons for giving up, and what you are gaining by not smoking. Think positively, remain determined and reward yourself. At the beginning it may help to change your normal routine, to avoid situations that would normally encourage you to smoke such as going to the pub, party, and outing with smokers.^[9]

After the first weeks, especially if it was easy, people may stop encouraging you, and even forget you're stopping. This period is crucial. Try not to be complacent. Don't allow yourself to be tempted. Don't be tempted to smoke one cigarette. This can easily lead to two or three cigarettes and you risk becoming a smoker again.^[9]

Save the cigarette money. For an average smoker it could be over 1500 Rs a month. Six months without smoking could save 9000 Rs and one year could save 18000 Rs by this you could buy a new bike for enjoyment or else 4 Hercules bicycle for enjoyment or for exercise.^[9]

Withdrawal symptoms:

Nicotine affects the brain with seconds of inhaling cigarette smoke. It increases the heart rate and blood pressure, constricts the small blood vessels under your skin, causes changes in blood composition and metabolism, and increases the production of hormones. Nicotine can also affect your mood and behaviour.^[10]

Withdrawal from nicotine can cause:

· depressed mood

· difficulty in sleeping

· irritability

· frustration or anger

· anxiety

· difficulty with concentration

· restlessness

· decreased heart rate

· dizziness

· increased appetite

· Slower pulse

· Drop in blood pressure

· Occasional constipation

· Occasional drop in the ability to perform difficult tasks and loss of concentration and/or patience.

· Tingling in the arms and legs

· Coughing

· Feelings of craving

· Tension^[11]

Benefits from Quitting Smoking:

· After 20 minutes, blood pressure drops to normal.

· After 8 hours, the carbon monoxide level in the blood drops to normal.

· After 48 hours, nerve endings start re-growing and the senses of smell and taste are enhanced.

· Your sense of taste and smell will improve (within a couple of days)

· Your circulation will improve (within a few weeks).

· In one to nine months, coughing, sinus congestion, fatigue, and shortness of breath decrease and cilia (tiny, hair like cells that move continually to clean air that is breathed in) re-grow in the lungs.

· After five years, the chance of dying from lung cancer decreases by almost half.

· After 15 years, the risk of heart disease is equal to that of a nonsmoker, and the risk of dying from lung cancer is only slightly higher than that of a non-smoker.

· Smoking takes an average of at least seven years off every smoker's life, which works out to five and a half minutes per cigarette.

· The risk of lung cancer drops considerably after five years of not smoking.

· People with emphysema who have smoked still lose some of their breathing capacity but the rate of loss goes way down once they've stopped smoking.

· Even People in their 60s who have lots of smoking related problems live longer if they stop smoking.

· Quitting smoking substantially lowers the chance of esophagus, mouth, pancreas, bladder, and cervix cancer.

· If you quit, you've got a lot less chance of getting some other major disease, including coronary heart disease and cardiovascular disease.^[12]

Nursing Consideration:

Nurses have a key role to play in influencing the health of patients. Whether working in a hospital or the community, nurses are ideally placed to encourage smokers to give up. Even the most basic intervention by a health professional can have a profound effect on encouraging a smoker to stop or to seek help in stopping.^[13]

· Deep Breathing:

Deep breathing is a very useful tool to quit smoking. You can use deep breathing as a coping skill. The benefits are helps cravings pass, promotes relaxation, relieves feelings of tension, anxiety, and nervousness, increases oxygen and blood flow to the brain improves memory, alertness, problem solving, and decision-making skills.^[14]

· Nicotine Gum:

Nicotine is the addictive chemical in tobacco. Nicotine gum can help people quit smoking, especially when it is used with a program to change behavior. Nicotine gum helps to control withdrawal symptoms and cravings. It can double the rate of quitting.^[14]

· Nicotine Patches:

A nicotine patch gives you a small amount of nicotine; much less than you get when you smoke. It helps to reduce craving and urges to smoke. You can get it without a prescription.^[14]

· Education:

· Educate the smoker related to harmful content of tobacco smoke, harmful effects of smoke on each body organs

· Discuss about benefits of quit smoking

· Enumerate diseases concerned to smoking with smoker

· Show the pictures of cancer related to tobacco smoke

· Conduct role play/drama regarding tobacco and its health effects in community setting to make aware of people

REFERENCE:

1. A review available from: https://en.wikipedia.org/wiki/Smoking

2. A review available from: http://www.employeewellnessprogram.org/Program/factsheets/SMOKING WHY_STOP_SMOKING.pdf

3. Christian Nordqvist. Mon 13 July 2015, available from: http://www.medicalnewstoday.com/articles/215420.php

4. A review available from: http://www.getselfhelp.co.uk/hyp/stopsmoking2.htm

5. Agency for Toxic Substances and Disease Registry. 2013: Accessed at www.atsdr.cdc.gov/toxfaqs/tf.asp?id=38&tid=14 on October 15, 2015. available from: http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/benzene

6. Tobacco Fact Sheet: Cigarette Content & Design. 11th World Conference on Tobacco OR Health. available from: http://scottsevinsky.com/pt/presentations/inservice_smoking.pdf

7. A review available from: http://uncw.edu/tobacco/health_effects.html

8. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 5.

9. NHS informs. 07 November 2013. A review available from: http://www.nhsinform.com/health-library/articles/s/smoking-quitting/making-changes/

10. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 09/14/2016. available from: https://www.psychologytoday.com/conditions/nicotine

11. Darla Burke. Timothy J. Legg, Ph.D., CARN-AP on November 11, 2015. available from: http://www.healthline.com/health/smoking/nicotine-withdrawal#Overview1

12. John R. Polito. May 14, 2016. A review available from: http://whyquit.com/whyquit/A_Benefits_Time_Table.html

13. Ben Youdan. Nurses' role in promoting and supporting smoking cessation. Vol: 101, issue: 10, page no: 26

14. A review available from: http://www.upmc.com/patients-visitors/education/smoking/Pages/default.aspx

Received on 03.11.2016 Modified on 20.02.2017

Asian J. Nur. Edu. and Research.2017; 7(3): 441-446.