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Race, Weight Play Role in Battle to Quit Smoking

Whites fare better on the patch, but blacks, obese do well with nasal spray

SUNDAY, Aug. 8, 2004 (HealthDayNews) -- Determined to quit smoking?

Your weight and ethnicity may be key when choosing the nicotine-replacement therapy that'll give you the best chance of kicking the habit for good.

Researchers now find that while the Nicoderm patch was especially effective in helping thinner, white smokers quit, it was less successful for heavier individuals and blacks, who fared better using the Nicotrol nasal spray.

"Different smokers have different levels of effectiveness with the patch versus the nicotine spray," concluded lead researcher Caryn Lerman, a professor of psychiatry at the University of Pennsylvania's Abramson Cancer Center.

By now nearly all Americans understand there are clear links between smoking and increased risks for cancer and heart disease, the nation's two biggest killers. Yet about a quarter of the population still puff away, addicted to the powerful nicotine rush that cigarettes provide.

Over the past several decades, commercial nicotine-replacement products have given smokers bent on quitting a chance to ease off nicotine gradually, instead of going cold turkey. While the overall success rate of quitting smoking with these products remains low -- just 10 percent to 15 percent of users will stay tobacco-free for more than six months -- patches, gums and sprays double a smoker's chance of quitting for good, experts say.

But are all nicotine-replacement aids created equal? In their study, Lerman's team assigned 300 long-term smokers intent on quitting either the Nicoderm patch or Nicotrol nasal spray.

The spray works by delivering a quick shot of nicotine to the system via the nasal passages, whereas the patch delivers a steady, more gradual supply of the chemical through the skin.

Publishing the results in a recent issue of Annals of Internal Medicine, Lerman's team reported that six-month quit rates were similar for both groups -- about 12 percent for those using the spray and 15 percent among those on the patch. These percentages are in keeping with findings from previous research into the effectiveness of nicotine-replacement products.

But real differences emerged when the researchers broke the results down in terms of the participants' race and physical characteristics.

Lerman said white smokers, smokers with relatively low levels of nicotine dependence, and the non-obese (a body mass index below 30) "respond better to the nicotine patch than the nicotine spray."

On the other hand, black smokers, the obese and smokers who rated their dependence on nicotine as "high," achieved long-term smoking cessation more frequently with the spray.

According to Lerman, social and physiologic characteristics common to specific types of smokers may explain these results. In the case of the Nicotrol spray, "it may be that there are certain types of people that derive more benefit from the positive reinforcing effects of the nasal spray," she said. For example, research has shown that black smokers are more likely than whites to inhale more deeply when smoking, ingesting more nicotine per puff than white smokers.

"We also know that African-Americans are more likely to smoke menthol cigarettes than regular cigarettes," Lerman said. "They may find the sensory aspect of the nasal spray more enjoyable, because menthol cigarettes provide sensory [stimulation] as well. Maybe the spray has some of those sensory features that are rewarding," she speculated.

And because people who consider themselves highly addicted may experience especially overwhelming nicotine cravings when they try and quit, the quick nicotine "jolt" that the spray provides may help them get through these tough moments, she said.

On the other hand, the patch may work better in those with milder cravings because they require only a continuous, steady suppression of the nicotine urge.

Dr. Michael Thun is head of epidemiological research at the American Cancer Society. He said the study findings should help smokers make more informed choices about the product that's best for them.

But he also noted that "sales in nicotine replacement therapy have been falling" as tobacco companies introduce so-called "alternative" cigarette products that imply a reduction in health risk to users.

"Unfortunately, these products -- such as the (now discontinued) Eclipse 'smokeless' cigarette -- do not do what they promised," Thun said.

It's no secret that quitting smoking is hard -- really hard, Lerman said.

"The brain becomes very adapted to having nicotine on board," she said. "The brain has adjusted to a certain state and if you take that chemical away and don't replace it or treat it somehow, there's very significant withdrawal symptoms. And some people are so uncomfortable with those symptoms that they prefer to smoke, rather than to feel awful."

But smokers can and should turn to those who love them for valuable support during their battle against nicotine, Lerman advised.

"Studies show that social support and encouragement is very important to the quitting process. Specific things, like having a partner choose a specific 'quit date' and coming up with strategies and rewarding activities as a replacement for smoking. The more things they can get their partner to do and do together to replace some of the reward from smoking -- that could really help the process," she said.

More information

Need help quitting? Visit the American Cancer Society.

SOURCES: Caryn Lerman, Ph.D., professor, department of psychiatry, Abramson Cancer Center, University of Pennsylvania, Philadelphia; Michael Thun, M.D., head, epidemiological research, American Cancer Society, Atlanta; March 15, 2004, Annals of Internal Medicine
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