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89-438: Nicotine replacement therapy ( NRT ) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco . It is used to help with quitting smoking or stopping chewing tobacco . It increases the chance of quitting tobacco smoking by about 55%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis . Types of NRT include

178-497: A 12-month period." The Cigarette Dependence Scale was developed "to index dependence outcomes and not dependence mechanisms". The Nicotine Dependence Syndrome Scale, "a 19-item self-report measure, was developed as a multidimensional scale to assess nicotine dependence". The Wisconsin Inventory of Smoking Dependence Motives "is a 68-item measure developed to assess dependence as a motivational state". Traditional cigarettes are

267-630: A 1999 meta-analysis published in the American Journal of Preventive Medicine , smoking prior to pregnancy is strongly related to an increased risk of developing an ectopic pregnancy . According to a study conducted in 2008 by the Pregnancy Risk Assessment Monitoring System (PRAMS) that interviewed people in 26 states in the United States, approximately 13% of women reported smoking during

356-475: A child with cleft palate . Smoking during pregnancy can result in lower birth weight as well as deformities in the fetus. Smoking nearly doubles the risk of low birthweight babies. In 2004, 11.9% of babies born to smokers had low birthweight as compared to only 7.2% of babies born to nonsmokers. More specifically, infants born to smokers weigh on average 200 grams less than infants born to people who do not smoke. The nicotine in cigarette smoke constricts

445-422: A cough, runny nose, or headaches. Serious risks include nicotine poisoning and continued addiction . They do not appear to increase the risk of heart attacks . There are possible harms to the baby if used during pregnancy . Nicotine replacement therapy works by reducing cravings caused by nicotine addiction . They were first approved for use in 1984, in the United States. Nicotine replacement products are on

534-581: A cough, runny nose, or headaches. To minimize local skin reactions from the patch, the application site should be moved daily. The nicotine patch can also cause strange dreams if worn while asleep. Nasal sprays commonly cause nasal irritation, watering eyes, and coughing. Serious risks include nicotine poisoning , which includes symptoms like visual disturbances, hyper-salivation, nausea, and vomiting; and continued addiction to nicotine products. Avoiding smoking and other products with nicotine are recommended since it may lead to nicotine overdose. Although overdose

623-404: A dependence about 32% of the time. There are approximately 976 million smokers in the world. Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used. Recent data suggest that, in the United States, the rates of daily smoking and

712-467: A dramatic decrease between 4-weeks and one year. A quit rate of 53% at four weeks fell to only 15% at one year. Younger smokers, females, pregnant smokers and more deprived smokers had lower quit rates than other groups. The efficacy for each of the formulations alone (lozenges, nasal spray, gum, and transdermal patch) to aid in smoking cessation is equal. Efficacy increases 15% to 36% with combining treatments such as gum and lozenges. Higher doses increase

801-402: A healthy, normal weight. As a result of this alteration to brain function, teenage obesity can in turn lead to a variety of health problems including diabetes (a condition in which the affected individual's blood glucose level is too high and the body is unable to regulate it), hypertension (high blood pressure), and cardiovascular disease (any condition related to the heart but most commonly

890-414: A low birth weight (less than 2.5 kilograms or 5.5 pounds), making it more likely the baby will become ill or die. Premature and low birth weight babies face an increased risk of serious health problems as newborns have chronic lifelong disabilities such as cerebral palsy (a set of motor conditions causing physical disabilities), intellectual disabilities and learning problems. If you are smoking during

979-594: A method to treat tobacco dependence through priming the body to mount an immune response against nicotine. Tobacco use disorder According to the World Health Organization , "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day." The WHO estimates that there were 1.24 billion tobacco users globally in 2022 , with

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1068-478: A more positive outcome for women who cease smoking for the remainder of their pregnancy relative to women who continue to smoke. There are many resources to help pregnant women quit smoking such as counseling and drug therapies. For non-pregnant smokers, an often-recommended aid to quitting smoking is through the use of nicotine replacement therapy (NRT) in the form of patches, gum, inhalers, lozenges, sprays or sublingual tablets . NRT, however, delivers nicotine to

1157-419: A nicotine dependence diagnosis which was defines as "...a cluster of cognitive, behavioral, and physiological symptoms..." In the updated DSM-5 there is no nicotine dependence diagnosis, but rather Tobacco Use Disorder, which is defined as, "A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least 2 of the following [11 symptoms], occurring within

1246-403: A nicotine patch. NRT products were first approved for use in the United States in 1984. Nicotine replacement products are on the World Health Organization's List of Essential Medicines .. They are available as generic medication . The nicotine patch is a once-daily, longer-acting form of NRT. An advantage of the nicotine patch is its simple compliance; it does not require active use throughout

1335-522: A number of other threats to the health of the foetus. Because of the associated risks, people are advised not to smoke before, during or after pregnancy. If this is not possible, however, reducing the daily number of cigarettes smoked can minimize the risks for both the mother and child. This is especially true for people in developing countries, where breastfeeding is essential for the child's overall nutritional status. Women who are pregnant or planning to become pregnant are advised to stop smoking. It

1424-633: A person continues to use nicotine . Teenagers do not have to be daily or long-term smokers to show withdrawal symptoms . Relapse should not frustrate the nicotine user from trying to quit again. A 2015 review found "Avoiding withdrawal symptoms is one of the causes of continued smoking or relapses during attempts at cessation, and the severity and duration of nicotine withdrawal symptoms predict relapse." Symptoms of nicotine dependence include irritability, anger, impatience, and problems in concentrating. There are different ways of measuring nicotine dependence. The five common dependence assessment scales are

1513-834: A physician before initiating NRT. Smoking is known to cause cardiovascular diseases such as coronary heart disease, hypertension, heart attack, stroke, and peripheral artery disease. Cigarette smoking is the cause of 20% of all cardiovascular deaths in the United States, which is the leading cause of mortality. Nicotine replacement therapies should be used cautiously in individuals with the following conditions: severe reactive airway diseases (for nasal spray), chronic nasal disorders such as sinusitis, polyps, rhinitis, or allergy (for nasal spray), diabetes (insulin-dependent), gastrointestinal diseases such as esophagitis, active gastric or peptic ulcer disease, liver problems, hyperthyroidism,pheochromocytoma, phenylketonuria (for lozenges), renal problems, and skin conditions such as psoriasis or dermatitis (for

1602-410: A plan to quit and utilizing quit programs, a quit phone line, or app that provides tips and inspiration to help quit. Using nicotine replacement therapy to quit smoking should be considered for people who are severely dependent on nicotine. People who are severely dependent include those who smoke: more than one pack per day, within five minutes of awakening, while ill, when they wake up in the middle of

1691-433: A plethora of health risks and damage to both the mother and the fetus. Women who smoke during pregnancy are about twice as likely to experience the following pregnancy complications : According to a 1999 meta-analysis published in the American Journal of Preventive Medicine , smoking during pregnancy is related to a reduced risk of developing pre-eclampsia . Some studies show that the probability of premature birth

1780-424: A smoker is—people who smoke more cigarettes or who smoke earlier in the morning use higher doses of nicotine replacement treatments. There is no consensus for remedies for tobacco use disorder among pregnant smokers who also use alcohol and stimulants. TA-NIC is a proprietary vaccine in development similar to TA-CD but being used to create human anti-nicotine antibodies in a person to destroy nicotine in

1869-481: A smoker’s chances of successfully quitting . Nicotine dependence is defined as a neurobiological adaptation to repeated drug exposure that is manifested by highly controlled or compulsive use, the development of tolerance, experiencing withdrawal symptoms upon cessation including cravings, and an inability to quit despite harmful effects. Nicotine dependence has also been conceptualized as a chronic, relapsing disease. A 1988 Surgeon General report states, "Tolerance"

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1958-502: A smoking cessation service based on pharmacotherapy in combination with counseling support. An Action on Smoking and Health (UK) (ASH) report claims that the average cost per life-year gained for every smoker successfully treated by these services is less than £1,000 (below the NICE guidelines of £20,000 per QALY (quality-adjusted life year). However, the investment in NHS stop smoking services

2047-527: A tobacco-free variant of snus. They are pre-portioned and are held in the user's lip or cheek allowing for sublingual or buccal delivery of flavors and high doses of nicotine. The small pouches are not like chewing tobacco , as the user does not need to spit since the contents of the pouches stay inside during use. Swedish pouches have been available on the American consumer market since at least 2016 but their popularity and controversy surged in 2019 and 2020. In

2136-502: A total nicotine delivery that is comparable to that of nicotine gum. Nicotine toothpicks generally are infused with food-grade flavorings and 1–3 mg of nicotine, which is similar to that of other oral-delivery nicotine products and some cigarettes. In spite of these similarities, as of 2018 they have been a subject of controversy. Online retailers have been under scrutiny for allowing their products to be too easily purchased by youth. Various news outlets and school districts have expressed

2225-517: A true pulmonary inhaler, and nicotine vaccines . Nicotine preloading, otherwise known as pre-cessation or pre-quitting NRT, has found that using the patch for a few weeks before the quit date produces significantly higher quit rates than if it was started on the quit day. The true pulmonary inhaler would deliver nicotine to the lungs in a manner that more resembles cigarette smoking, which would provide better relief of background cravings as well as acute cravings. Nicotine vaccines are under investigation as

2314-593: Is a link between chronic tic disorders, which include Tourette syndrome and other disorders like ADHD and OCD. According to a study published in 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry, there is an especially high risk for children to be born with a chronic tic disorder if their mother is a heavy smoker. Heavy smoking can be defined as ten or more cigarettes each day. With this heavy smoking, researchers have found that there

2403-614: Is a relationship between CHRNA5 - CHRNA3 - CHRNB4 nicotinic acetylcholine receptors and complete smoking cessation. Increasing evidence indicates that the genetic variant CHRNA5 predicts the response to smoking cessation medicine. In addition to the specific neurological changes in nicotinic receptors, there are other changes that occur as dependence develops. Through various conditioning mechanisms ( operant and cue/classical ), smoking comes to be associated with different mood and cognitive states as well as external contexts and cues. There are treatments for nicotine dependence, although

2492-681: Is a serious public health concern due to it being one of the leading causes of avoidable deaths worldwide. The medical community is concerned that e-cigarettes may escalate global nicotine dependence, particularly among adolescents who are attracted to many of the flavored e-cigarettes. There is strong evidence that vaping induces symptoms of dependence in users. Many organizations such the World Health Organization, American Lung Association , and Australian Medical Association do not approve of vaping for quitting smoking in youth, making reference to concerns about their safety and

2581-445: Is an increase in risk as high as 66% for the child to have a chronic tic disorder. Maternal smoking during pregnancy is also associated with psychiatric disorders such as ADHD. Concerning the increase risk for Tourette syndrome, there is an increased risk when two or more psychiatric disorders are also existent as maternal smoking leads to a higher chance of having a psychiatric disorder. Pregnant women who smoke may be at risk of having

2670-447: Is an increased frequency of nicotine dependence in people with anxiety disorders. 6% of smokers who want to quit smoking each year are successful at quitting. Nicotine withdrawal is the main factor hindering smoking cessation. A 2010 World Health Organization report states, "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking

2759-542: Is another aspect of drug addiction [dependence] whereby a given dose of a drug produces less effect or increasing doses are required to achieve a specified intensity of response. Physical dependence on the drug can also occur, and is characterized by a withdrawal syndrome that usually accompanies drug abstinence. After cessation of drug use, there is a strong tendency to relapse." Nicotine dependence leads to heavy smoking and causes severe withdrawal symptoms and relapse back to smoking. Nicotine dependence develops over time as

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2848-416: Is considered less safe for the fetus because it delivers continuous nicotine exposure, as opposed to the gum or lozenge, which delivers intermittent and thus lower nicotine exposure. Strong evidence suggests that nicotine cannot be regarded as a safe substance of cigarette use. Nicotine itself could be at least partly responsible for many of the adverse after birth health results related to cigarette use while

2937-492: Is generally based on if the user is considered a heavy, average, or light smoker. A cigarette delivers an average of 1 mg to 3 mg of the nicotine contained in it. NRT products typically aim to parallel this, but the amount of nicotine absorbed by the user is less than the original dose. Nicotine nasal sprays are formulated in doses of lowest strength, available in 0.5 mg and 1 mg strengths. Nicotine lozenges deliver doses as low as 1 mg up to 4 mg. It

3026-403: Is important to examine these effects because smoking before, during and after pregnancy is not an unusual behavior among the general population and can have detrimental health impacts, especially among both mother and child, as a result. In 2011, approximately 10% of pregnant women in data collected from 24 U.S. states reported smoking during the last three months of their pregnancy. According to

3115-715: Is not chewed as the gum would be, and dissolves in approximately 30 minutes. This formulation may be preferred by those individuals who do not find gum chewing to be acceptable. Nicotine gum is available in doses of 2 mg and 4 mg. Using 4 mg nicotine gum versus 2 mg gum increases the likelihood of successful smoking cessation. When using the gum, acidic beverages like soda, coffee, or beer should be avoided fifteen minutes prior and during use because they can impede proper absorption of nicotine. Nicotine inhalers come in 10 mg and 15 mg cartridge strengths and typically deliver around 4 mg in one dose. The inhaler may be preferred in individuals who want to satisfy

3204-450: Is rare, it can be problematic, especially in children and pets. The symptoms of nicotine overdose include headache, pale skin and mouth, belly pain, weakness, diarrhea, tremors or seizures, agitation, confusion, restlessness, high or low blood pressure, fast or irregular heartbeat, fast breathing, and cold sweats. Limited evidence exists regarding long-term NRT use. Nicotine is not safe to use in any amount during pregnancy. Nicotine crosses

3293-490: Is relatively low. A comparison with treatment costs for illicit drug users shows that £585 million is committed for 350,000 problem drug users compared to £56 million for 9 million users of tobacco. This is £6.20 for each smoker, compared to £1,670 per illegal drug user. The claims for high efficacy and cost-effectiveness of NRT have not been substantiated in real-world effectiveness studies. Pierce and Gilpin (2002) stated their conclusion as follows: "Since becoming available over

3382-545: Is revealed by the occurrence of signs of physiological dysfunction when the drug is withdrawn; further, this dysfunction can be reversed by the administration of drug". The long use of Fagerström Test for Nicotine Dependence is supported by the existence of significant preexisting research, and its conciseness. The 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) had

3471-409: Is roughly 50% higher for women who smoke during pregnancy, going from around 8% to 11%. Smoking can also impair the general development of the placenta, which is problematic because it reduces blood flow to the fetus. When the placenta does not develop fully, the umbilical cord which transfers oxygen and nutrients from the mother's blood to the placenta, cannot transfer enough oxygen and nutrients to

3560-435: Is still more beneficial to breastfeed than to completely avoid this practice altogether. There is evidence that breastfeeding offers protection against many infectious diseases , especially diarrhea. Even in babies exposed to the harmful effects of nicotine through breast milk, the likelihood of acute respiratory illness is significantly diminished when compared to infants whose mothers smoked but were formula fed. Regardless,

3649-551: Is that UK smokers are trying to quit with e-cigarettes rather than NRT methods. E-cigarettes are often, although not always, designed to look and feel like cigarettes. They have been marketed as less harmful alternatives to cigarettes, but very few are as yet approved as NRTs in any jurisdiction . Some electronic cigarettes have coarsely adjustable nicotine levels. Some healthcare groups have hesitated to recommend e-cigarettes for quitting smoking , because of limited evidence of effectiveness and safety. However, more recent review show

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3738-411: Is unclear whether adolescents gain benefit from cognitive-behavioral therapy or smoking cessation over the long-term as of 2017. Most tobacco users are under-eighteens when they start, and almost no-one over the age of 25 starts using. While there is no evidence that NRT can increase the risk of heart attacks, individuals with pre-existing cardiovascular conditions or recent heart attacks should consult

3827-810: The Fagerström Test for Nicotine Dependence , the Diagnostic and Statistical Manual of Mental Disorders criteria, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives. Nicotine is a parasympathomimetic stimulant that binds to nicotinic acetylcholine receptors in the brain. Neuroplasticity within the brain's reward system , including an increase in

3916-404: The Fagerström Test for Nicotine Dependence , the Diagnostic and Statistical Manual of Mental Disorders , the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives. The Fagerström Test for Nicotine Dependence focuses on measuring physical dependence which is defined "as a state produced by chronic drug administration, which

4005-494: The United States Public Health Service listed seven agents for the stopping of tobacco, which included five nicotine replacement treatments (nicotine patches, gum, lozenges, inhalers, and nasal sprays) and two oral medications ( bupropion and varenicline ). Other NRT options are available, including nicotine mouth sprays and sublingual tablets. The dose of nicotine replacement therapy products

4094-597: The World Health Organization's List of Essential Medicines . They are available as generic medications . Nicotine replacement therapy, in the form of gum, patches, nasal spray, inhaler and lozenges all improve the ability of people trying to quit tobacco products. Nicotine replacement therapy is as effective as medications, such as bupropion , in helping people quit smoking for at least six months. All forms of nicotine replacement therapy, including nicotine gum, patches, nasal spray, inhalers, and lozenges, have similar success rates in terms of helping people stop smoking. However,

4183-411: The adhesive patch , chewing gum , lozenges , nose spray , and inhaler . The use of multiple types of NRT at a time may increase effectiveness. Common side effects depend on the formulation of nicotine. Common side effects with the gum include nausea, hiccups , and irritation of the mouth. Common side effects with the patch include skin irritation and a dry mouth while the inhaler commonly results in

4272-402: The adrenal medulla , resulting in increased levels of adrenaline and beta-endorphin . Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the central and peripheral nervous systems . Chronic nicotinic acetylcholine receptor activation from repeated nicotine exposure can induce strong effects on the brain, including changes in

4361-484: The first trimester (organogenesis stage); the period where the organs and system of the baby as developing will be affected. There is 50 – 80% chance of having a congenital defect to your unborn child Sudden infant death syndrome (SIDS) is the sudden death of an infant that is unexplainable by the infant's history. The death also remains unexplainable upon autopsy. Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of SIDS due to

4450-425: The placenta and is found in the breast milk of mothers who smoke as well as mothers who inhale passive smoke . There are possible harms to the baby if NRT is used during pregnancy . Thus, pregnant women and those who are breastfeeding should also consult a physician before initiating NRT. The gum, lozenge, and nasal spray are pregnancy category C. The transdermal patch is pregnancy category D. The transdermal patch

4539-473: The US and UK concerns have been raised that nicotine pouches are seemingly too similar to banned snus products, is aimed at teenagers, further complicating the youth vaping trend, falling into the hands of adolescents easily, and are discrete enough to easily pass for regular gums or lozenges. Nicotine infused toothpicks are another product that has been available in the United States since at least 2013. They can have

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4628-470: The US), nicotine gum , nicotine inhaler , nicotine lozenge/mini-lozenge , nicotine nasal spray , nicotine patch , and varenicline . These medications have been shown to significantly improve long-term (i.e., 6-months post-quit day) abstinence rates, especially when used in combination with psychosocial treatment. The nicotine replacement treatments (i.e., patch, lozenge, gum) are dosed based on how dependent

4717-596: The United States stopped smoking, there would be an estimated 11% reduction in stillbirths and a 5% reduction in newborn deaths. A recent study has proposed that maternal smoking during pregnancy can lead to future teenage obesity . While no significant differences could be found between young teenagers with smoking mothers as compared to young teenagers with nonsmoking mothers, older teenagers with smoking mothers were found to have on average 26% more body fat and 33% more abdominal fat than similar aged teenagers with non-smoking mothers. This increase in body fat may result from

4806-595: The arterial system. Nicotine replacement products vary in the time it takes for the nicotine to enter the body and the total time nicotine stays in the body. The more quickly a dose of nicotine is delivered and absorbed, the higher the addiction risk. It is possible to become dependent on some NRTs. Nicotine patches are applied to the skin and continuously administer a stable dose of nicotine slowly over 16–24 hours. Nicotine gum , nicotine sprays, nicotine toothpicks, nicotine sublingual tablets, and nicotine lozenges administer nicotine orally with quicker nicotine uptake into

4895-555: The benefits of breastfeeding outweigh the risks of nicotine exposure. Passive smoking is associated with many risks to children, including, sudden infant death syndrome (SIDS), asthma , lung infections, impaired respiratory function and slowed lung growth, Crohn's disease , learning difficulties and neurobehavioral effects, an increase in tooth decay , and an increased risk of middle ear infections. A grandmother who smokes during her daughter's pregnancy transmits an increased risk of asthma to her grandchildren, even if

4984-422: The blood vessels in the placenta and carbon monoxide, which is poisonous, enters the fetus' bloodstream, replacing some of the valuable oxygen molecules carried by hemoglobin in the red blood cells. Moreover, because the fetus cannot breathe the smoke out, it has to wait for the placenta to clear it. These effects account for the fact that, on average, babies born to smoking mothers are usually born too early and have

5073-415: The body but lasting a shorter amount of time. Nicotine inhalers are metered-dose inhalers that administer nicotine through the lungs and mucous membranes of the throat quickly, lasting for a short amount of time. For example, blood nicotine levels are the highest 5–10 minutes after using the nicotine nasal spray , 20 minutes after using a nicotine inhaler or chewing nicotine gum, and 2–4 hours after using

5162-526: The brain's physiology, that result from the stimulation of regions of the brain associated with reward, pleasure, and anxiety. These complex effects of nicotine on the brain are still not well understood. When these receptors are not occupied by nicotine, they are believed to produce withdrawal symptoms. These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating. Neuroplasticity within

5251-425: The brain's reward system occurs as a result of long-term nicotine use, leading to nicotine dependence. There are genetic risk factors for developing dependence. For instance, genetic markers for a specific type of nicotinic receptor (the α5-α3-β4 nicotine receptors) have been linked to increased risk for dependence. The most well-known hereditary influence related to nicotine dependence is a mutation at rs16969968 in

5340-462: The brain, which subsequently causes the release of dopamine and other neurotransmitters , such as norepinephrine , acetylcholine , serotonin , gamma-aminobutyric acid , glutamate , endorphins , and several neuropeptides . Repeated exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor desensitization and subsequent receptor upregulation . This upregulation or increase in

5429-408: The chance of stopping smoking for a period of six months and more. For patches, the most efficient doses were 25 mg worn over 16 hours or 21 mg worn over 24 hours. The evidence suggests that 4 mg nicotine gum leads to higher quit rates compared with 2 mg in heavy smokers. N -Nitrosonornicotine , a strong carcinogen present in unburned tobacco and cigarette smoke, has been found in

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5518-407: The child. It also puts the child at increased risk for nicotine addiction in the future. Pregnant women should consider behavioral therapy before NRT is considered. In people under the age of eighteen, a physician is often consulted before starting NRT. The evidence suggests that exposure to nicotine between the ages of 10 and 25 years causes lasting harm to the brain and cognitive ability. Evidence

5607-408: The concern that these products have a high appeal to minors wanting to experiment with nicotine due to; the multitude of sweet flavors offered, ease & speed of use, seeming innocuous, and having a discreet nature. In 2015, NRT sales fell for the first time since 2008 while sales for e-cigarettes or electronic nicotine delivery systems (ENDS) continued to increase at a substantial rate. The evidence

5696-432: The counter, NRT appears no longer effective in increasing long-term successful cessation" (p. 1260). Efficacy studies, which are conducted using randomized controlled trials, do not transfer very well to real-world effectiveness. Bauld, Bell, McCullough, Richardson and Greaves (2009) reviewed 20 studies on the effectiveness of intensive NHS treatments for smoking cessation published between 1990 and 2007. Quit rates showed

5785-401: The day. The gum, lozenge, sublingual tablet, oral inhaler, oral spray, and nasal spray are acutely dosed products, providing the user with the benefit and ability of self-titrating based on cravings. Brand names include Commit Lozenge, Nicoderm, Nicogum, Nicorette , Nicotex, Nicotinell, and Thrive. NRT products contain similar pharmaceutical grade nicotine as is used in e-cigarettes. In 2015,

5874-400: The effects of smoking during pregnancy, which is thought to impact fetal genetic programming in relation to obesity. While the exact mechanism for this difference is currently unknown, studies conducted on animals have indicated that nicotine may affect brain functions that deal with eating impulses and energy metabolism. These differences appear to have a significant effect on the maintenance of

5963-668: The expectant mother's child in utero . For some pregnant smokers, NRT might still be the most beneficial and helpful solution to quit smoking. Research in the UK has also shown that e-cigarettes could be more effective than nicotine patches, and because of this, could lead to better pregnancy outcomes. It is important that smokers talk to doctor to determine the best course of action on an individual basis. Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of sudden infant death syndrome (SIDS). If one does continue to smoke after giving birth, however, it

6052-543: The fetus, which will not be able to fully grow and develop. These conditions can result in heavy bleeding during delivery that can endanger mother and baby, although cesarean delivery can prevent most deaths. There is limited evidence that smoking reduces the incidence of pregnancy-induced hypertension , but not when the pregnancy is with multiple babies (i.e. it has no effect on twins, triplets, etc.). Other effects of maternal smoking during pregnancy include an increased risk for Tourette syndrome and tic disorders . There

6141-516: The first cigarette earlier in the day and smoking more cigarettes per day." E-cigarettes may result in starting nicotine dependence again. Greater nicotine dependence may result from dual use of traditional cigarettes and e-cigarettes. Like tobacco companies did in the last century, there is a possibility that e-cigarettes could result in a new form of dependency on nicotine across the world. Nicotine dependence results in substantial mortality, morbidity, and socio-economic impacts. Nicotine dependence

6230-411: The first trimester increase the risk that their child will develop birth defects, particularly congenital heart defects than expectant mothers who have never smoked. The study found that the risk posed to the expectant mother's child increases both with the quantity of cigarettes smoked, as well as the length of time during pregnancy during which the mother continues to smoke. This, per the study, renders

6319-696: The hand-to-mouth ritual that smoking provides. Transdermal patches deliver between 5 mg and 52.5 mg of nicotine, which results in plasma levels similar to that of heavy smokers. Combining nicotine patch treatment with a faster nicotine-delivery means, like nicotine gum or spray, improves the likelihood of successful treatment. Some smokeless consumer products available can function as alternative nicotine delivery systems (ANDS) but they have not received FDA approval as smoking-cessation therapy aids that are safe and effective. Snus and nasal snuff also allow for nicotine administration outside of tobacco smoking. Nicotine pouches are described as similar to or

6408-625: The human body so that it is no longer effective. Psychosocial interventions delivered in-person (individually or in a group) or over the phone (including mobile phone interventions) have been shown to effectively treat nicotine dependence. These interventions focus on providing support for quitting and helping with smokers with problem-solving and developing healthy responses for coping with cravings, negative moods, and other situations that typically lead to relapse. The combination of pharmacotherapy and psychosocial interventions has been shown to be especially effective. First-time nicotine users develop

6497-475: The increased levels of nicotine often found in SIDS cases. Infants exposed to smoke during pregnancy are up to three times more likely to die of SIDS than children born to non-smoking mothers. Smoking can also cause other birth defects, reduced head circumference, altered brainstem development, altered lung structure, and cerebral palsy. Recently the U.S. Public Health Service reported that if all pregnant women in

6586-457: The last three months of pregnancy. Of women who smoked during the last three months of pregnancy, 52% reported smoking five or fewer cigarettes per day, 27% reported smoking six to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per day. In the United States, women whose pregnancies were unintended are 30% more likely to smoke during pregnancy than those whose pregnancies were intended. Smoking during pregnancy can lead to

6675-448: The likelihood that someone will stick to a certain treatment varies, with compliance being the highest with nicotine patches, followed by nicotine gum, inhalers, and nasal sprays. Using a few different nicotine replacement methods in combination may improve success rates in stopping tobacco use. Additionally, using nicotine replacement with counseling has been proven to improve tobacco abstinence rates. These other strategies include: creating

6764-433: The majority of the evidence focuses on treatments for cigarette smokers rather than people who use other forms of tobacco (e.g., chew , snus , pipes , hookah , e-cigarettes). Evidence-based medicine can double or triple a smoker's chances of quitting successfully. There are eight major evidence-based medications for treating nicotine dependence: bupropion , cytisine (not approved for use in some countries, including

6853-496: The most common delivery device for nicotine. However, electronic cigarettes are becoming more popular. Nicotine can also be delivered via other tobacco products such as chewing tobacco, snus, pipe tobacco, hookah, all of which can produce nicotine dependence. Pre-existing cognitive and mood disorders may influence the development and maintenance of nicotine dependence. Nicotine is a parasympathomimetic stimulant that binds to and activates nicotinic acetylcholine receptors in

6942-560: The mother was pregnant. There is evidence that nicotine negatively affects fetal brain development and pregnancy outcomes. There is also risk of stillbirth and pre-term birth. Nicotine use will probably harm fetal neurological development . Risks to the child later in life from nicotine exposure during pregnancy include type 2 diabetes , obesity, hypertension, neurobehavioral defects, respiratory dysfunction, and infertility. Nicotine exposure during pregnancy can result in attention deficit hyperactivity disorder (ADHD) and learning disabilities in

7031-524: The nicotinic acetylcholine receptor CHRNA5 , resulting in an amino acid alteration from aspartic acid to asparagine. The single-nucleotide polymorphisms (SNPs) rs6474413 and rs10958726 in CHRNB3 are highly correlated with nicotine dependence. Many other known variants within the CHRNB3–CHRNA6 nicotinic acetylcholine receptors are also correlated with nicotine dependence in certain ethnic groups. There

7120-504: The night, to ease withdrawal signs and symptoms. Nicotine replacement products are most beneficial for heavy smokers who smoke more than 15 cigarettes per day. There are not enough studies to show whether NRT helps those who smoke fewer than 10 cigarettes per day. Evaluation of NRT in real-world studies produces more modest outcomes than efficacy studies conducted by industry-funded trials. The National Health Service (NHS) in England has

7209-646: The number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers. However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness. There is also evidence that among smokers, some subgroups may be more dependent than other groups. Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in quitting , suggesting that women may be more dependent by that criterion. There

7298-641: The number of nicotine receptors, occurs as a result of long-term nicotine use and leads to nicotine dependence. In contrast, the effect of nicotine on human brain structure (e.g., gray matter and white matter ) is less clear. Genetic risk factors contribute to the development of dependence. For instance, genetic markers for specific types of nicotinic receptors (the α5–α3–β4 nicotinic receptors) have been linked to an increased risk of dependence. Evidence-based treatments—including medications such as nicotine replacement therapy , bupropion , varenicline , or cytisine , and behavioral counseling —can double or triple

7387-408: The number of nicotinic receptors significantly alters the functioning of the brain reward system . With constant use of nicotine, tolerance occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain. After several months of nicotine abstinence, the number of receptors go back to normal. Nicotine also stimulates nicotinic acetylcholine receptors in

7476-478: The number projected to decline to 1.20 billion in 2025. Of the 34 million smokers in the United States in 2018, 74.6% smoked every day, indicating the potential for some level of nicotine dependence. There is an increased incidence of nicotine dependence in individuals with psychiatric disorders , such as anxiety disorders and substance use disorders . Various methods exist for measuring nicotine dependence. Common assessment scales for cigarette smokers include

7565-510: The opposite, possibly because of newer types of e‐cigarettes have better nicotine delivery than older one. The U.S. Food and Drug Administration (FDA) has a list of additional tobacco products they are seeking to regulate, including electronic cigarettes. Most approved NRT products have been approved for over 20 years, however the FDA has also approved nicotine inhalers as a form of NRT. Future approaches of NRT could include nicotine preloading,

7654-432: The potential that experimenting with vaping may result in nicotine dependence and later tobacco use. Smoking and pregnancy Tobacco smoking during pregnancy causes many detrimental effects on health and reproduction, in addition to the general health effects of tobacco . A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to

7743-514: The thickening of arteries due to excess fat build-up). According to a 2010 study published in the European Journal of Pediatrics , the cessation of maternal smoking during any point during pregnancy reduces the risk of negative pregnancy outcomes when compared to smoking throughout the entire nine months of pregnancy, especially if it is done within the first trimester . The study found that expectant mothers who smoke at any time during

7832-549: The transdermal patch). Nicotine replacement therapy works by reducing cravings due to nicotine addiction . Smoking cigarettes releases high doses of nicotine to the brain in a matter of seconds as opposed to low doses released over a period of minutes to hours by the various forms of nicotine replacement therapy. Nicotine from NRT does not reach as high a concentration in the blood as does nicotine from smoke inhalation due to different absorption methods. NRT relies on systemic venous absorption, whereas nicotine from cigarettes reaches

7921-430: The urine of some users of oral NRT products. Nicotine patches is an alternative. Some side effects are caused by the nicotine, and are common to NRT products. Other common side effects depend on the formulation of nicotine. Common side effects with the gum include nausea, hiccups , and irritation of the mouth. Common side effects with the patch include skin irritation and a dry mouth while the inhaler commonly results in

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