Smoking, Fuel Use in China Projected to Cause Millions of Deaths

If current levels of smoking and biomass and coal fuel use in homes continues, between 2003 and 2033 there will be an estimated 65 million deaths from chronic obstructive pulmonary disease (COPD) and 18 million deaths from lung cancer in China, accounting for 19 percent and 5 percent of all deaths in that country during this period.

Researchers at the Harvard School of Public Health (HSPH) predict that the combined effects of these two major factors alone will be responsible for more than 80% of COPD deaths and 75 percent of lung cancer deaths in China over a 30-year period. But interventions to reduce smoking and household use of biomass fuels and coal for cooking and heating could significantly reduce the number of deaths.

The findings are from a study that will appear online on October 4 and in the October 25 print issue of The Lancet. It is the first quantitative analysis to look at the combined effects of smoking and household fuel use on COPD, lung cancer and tuberculosis (TB).

Respiratory diseases are among the 10 leading causes of deaths in China. About half of Chinese men smoke and in more than 70 percent of homes in China residents cook and heat their homes with wood, coal and crop residues. Smoking and pollution from indoor burning of these fuels are major risk factors for COPD and lung cancer and have been linked with tuberculosis (TB). Globally, more than 900 million of the world's 1.1 billion smokers currently live in low-income and middle-income countries and about one half of the world's population uses biomass fuels and coal for household energy.

Using data on smoking, fuel use and current as well as projected levels of COPD, lung cancer and TB, the authors set out to estimate the effects of modifying smoking and fuel use on future COPD and lung cancer deaths and TB incidence. They grouped the results into scenarios based on whether interventions involved moderate control of smoking and fuel use, aggressive control or a complete cessation of exposures to the pollutants.

They found that reducing those two risk factors would significantly decrease deaths from COPD and lung cancer. If smoking and biomass and coal use were to be eliminated gradually over the next 30 years, an estimated 26 million COPD deaths (40 percent of projected COPD deaths) and 6 million lung cancer deaths (34 percent of projected lung cancer deaths) would be avoided. For moderate and aggressive control scenarios, deaths from these diseases could be reduced by an estimated 17 percent to 34 percent among men and 18 percent to 29 percent among women. There will also be major benefits for TB, above and beyond those that can be achieved through treatment.

Hsien-Ho Lin, a graduate student in the department of epidemiology at HSPH and the lead author of the study, says "this analysis shows that smoking and fuel use, which affects hundreds of millions of people in China, will be a defining feature of future health in that country."

Policy responses and specific interventions could help reduce the enormous disease burden from smoking and household fuel use. In the article, the authors suggest that at the national level, for example, authorities could create regulatory and economic policies that reduce smoking and promote clean household fuels. At the individual level, TB patients could be offered tobacco cessation programs.

"There are proven ways to reduce tobacco smoking and to provide homes with clean-burning energy alternatives. China can save millions of premature deaths from respiratory diseases in the next few decades if it leverages its effective policy system to implement these interventions," says Majid Ezzati, associate professor of international health at HSPH and senior author of the study.

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Smokers Might Benefit From Earlier Colon Cancer Screening

New evidence suggests screening for colorectal cancer, which is now recommended to begin at age 50 for most people, should start five to 10 years earlier for individuals with a significant lifetime exposure to tobacco smoke, a University of Rochester Medical Center study said.

An examination of 3,450 cases found that current smokers were diagnosed with colon cancer approximately seven years earlier than people who never smoked. The study is also one of the first to link exposure to second-hand smoke, especially early in life, with a younger age for colon cancer onset.

The article appears online in the Journal of Cancer Research and Clinical Oncology.

“The message for physicians and patients is clear: When making decisions about colon cancer screening you should take into account smoking history as well as family history of disease and age,” said lead author Luke J. Peppone, Ph.D., research assistant professor of Radiation Oncology at the James P. Wilmot Cancer Center at the University of Rochester.

Peppone’s group examined data from patients diagnosed with colorectal cancer between 1957 and 1997 at Roswell Park Cancer Institute in Buffalo. (Peppone joined the University of Rochester in 2007, coming from RPCI. Co-authors are from RPCI.)

Over the 40-year period smoking habits changed, with a decrease in the percentage of current or active smokers and an increase in the percentage of former smokers. Still, the age at colon cancer diagnosis was 6.8 years younger among current smokers and 4.3 years younger for former smokers who quit less than five years ago, the results showed. People who quit more than five years ago had no significant increased risk.

However, people who reported they began smoking as young teens (before age 17) or who smoked heavily (1 pack a day or more) were the most likely to be diagnosed with cancer much younger than their never-smoking counterparts. Past exposure to second-hand-smoke was an additional, significant risk factor, compared to never smoking. In fact, when active smokers and passive smoking were combined into one subgroup, the age at cancer diagnosis was nearly 10 years earlier, Peppone said.

Although smoking is a well-known risk factor for many cancers, only recent studies have suggested that cigarettes may cause colon cancer.

The biological reasons for the cigarette smoke-colon cancer risk are unclear. However, researchers believe that cigarette smoke reduces the body’s resistance to malignancies, just as smoking can depress immune function in general, impairing the ability to fight off infections and viruses. Carcinogens from smoke reach the bowel through direct circulation or by swallowing smoke and passing it through the intestines.

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Number of Russian Women Smokers Has Doubled Since Soviet Collapse

The number of Russian women who smoke has more than doubled since the collapse of the Soviet Union, according to new research.

In 1992, seven per cent of women smoked, compared to almost 15 per cent by 2003. In the same period, the number of men who smoke has risen from 57 per cent to 63 per cent.

The researchers behind the study, published in the journal Tobacco Control, blame the privatisation of the previously state owned tobacco industry and the behaviour of the transnational tobacco companies (TTCs) for what they describe as a “very worrying increase.”

Between 1992 and 2000, TTCs such as Philip Morris, British American Tobacco and Japan Tobacco International invested approximately $1.7 billion to gain a 60 percent share of the privatized Russian tobacco market.

Tobacco advertising had simply not existed in the Soviet era. Yet as soon as the TTCs were there, it was rampant, say researchers. By the mid 1990s it was estimated that half of all billboards in Moscow and three quarters of plastic bags in Russia carried tobacco advertising.

“There can be no doubt that the marketing tactics of Philip Morris, British American Tobacco and the like directly underpin this massive increase in smoking that spells disaster for health in Russia,” says Dr Anna Gilmore from the School for Health at the University of Bath, who carried out the study with academics from the London School of Hygiene & Tropical Medicine and University College London, and has been researching tobacco control in the region for over seven years.

“Following privatisation of the tobacco industry, TTCs invested heavily in developing the market, promoting smoking as part of the new ‘western lifestyle’,” Gilmore says.

“They aggressively targeted women, young people and those living in cities with their marketing and distribution strategies. This is now directly reflected in the smoking patterns we are seeing. Until this point women in Russia had simply not smoked,” she adds.

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Life's Tough on North American Smokers

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Cigarette Smoke And Alcohol Damage Hearts Worse As Combo

Tobacco smoke-filled air is bad for cardiovascular health, and drinking alcohol at the same time only makes it worse, according to researchers at the University of Alabama at Birmingham (UAB).

Testing the theory that moderate alcohol consumption provides some heart-protection benefits, the UAB team said it wanted to take the idea further and look at the effects of smoking and breathing second-hand smoke along with drinking.

They reported that mice exposed to smoky air in a laboratory enclosure and fed a liquid diet containing ethanol, the intoxicating ingredient in alcohol, had a 4.7-fold increase in artery lesions. That compares to mice who breathed filtered air and ate a normal solid diet.

Artery lesions are a common problem in heavy smokers and a key sign of advancing
cardiovascular disease. The results are published in the journal Free Radical Biology & Medicine.
The researchers reported mice solely exposed to the smoky air had a 2.3-fold increase in artery lesions when compared to mice who breathed filtered air. Mice solely fed a liquid diet containing ethanol had a 3.5-fold increase in artery lesions when compared to mice fed a normal diet.
The study points to a greater need to understand the negative biological impact of single or multiple risky behaviors, and the compounding effect of environmental hazards such as second-hand smoke, says Scott Ballinger, an associate professor in the UAB Department of Pathology and lead author on the study.

“Our study shows that exposure to cigarette smoke when combined with alcohol consumption caused the greatest degree of cardiovascular disease development compared to either action or exposure alone,” Ballinger says.

“Because moderate alcohol consumption is commonly thought to be cardioprotective, these findings are important for smokers and non-smokers alike in terms of what you should and should not do to protect their health,” says Shannon Bailey, an associate professor in the UAB Department of Environmental Health Sciences and a co-investigator on the study.

The mice experiments were performed over a five-week period. Blood-alcohol concentrations reached the equivalent of a 150-pound adult consuming 2 drinks per hour. Cigarette smoke exposure was similar to being in an automobile with a chain smoker with the windows closed.
In addition to measuring artery lesions in the study mice, the UAB team looked at other signs of advancing cardiovascular disease like DNA damage and oxidative stress in key heart tissues.

Like the artery lesions, these added measurements showed that taking in both smoky air and ethanol had the effect of basically nullifying any potential heart benefit from drinking alcohol by itself.

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Is Fear of Weight Gain Keeping Many Women From Trying to Quit Smoking?

Is a fear of getting fatter partly to blame for the fact that nearly one in five American women still smokes, and many don’t try to quit?

Although there are many possible reasons for the stubborn persistence of smoking, fear of weight gain is high on the list for many women, says a University of Michigan Health System researcher who has devoted much of her career to studying this issue.

Several years ago, she and her team reported that 75 percent of all women smokers say they would be unwilling to gain more than five pounds if they were to quit smoking, and nearly half said they would not tolerate any weight gain. In fact, many women started smoking in the first place because they thought it might help them stay slim.

Now, new U-M research findings published in the October issue of Addictive Behaviors show that women who smoke tend to be further from their ideal body image, and more prone to dieting and bingeing, than those who don’t smoke.

Cigarettes are well known to suppress appetite and weight, says Cindy Pomerleau, director of the U-M Nicotine Research Laboratory. “So it’s hardly surprising that women who have trouble managing their weight or are dissatisfied with their bodies are drawn to smoking,” she says.

In another recent study, published in August, the U-M team found that overweight women smokers who were overweight as children were far more likely to have started smoking in their early teens than women whose weight problems started later in life. They also had worse withdrawal symptoms when they tried to quit.

Once they make a serious attempt to quit, evidence suggests that most weight-concerned smokers can be just as successful in kicking the habit as others.

“The problem here is getting women who are concerned about their weight to be willing to try to make a quit attempt,” says Pomerleau, “and then helping them gain a sense of control over their weight.”

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Girls Who Begin Dieting Twice as Likely to Start Smoking

Starting to diet seems to double the odds a teenage girl will begin smoking, a University of Florida study has found.

UF researchers, who analyzed the dieting and smoking practices of 8,000 adolescents, did not find the same link in boys, who were also less likely than girls to diet, according to findings released Friday in the American Journal of Health Promotion.

“Dieting was a significant predictor of initiation of regular smoking among females,” says Mildred Maldonado-Molina, a UF assistant professor of epidemiology and health policy research and lead author of the study. “We were expecting that this relationship was going to be stronger among females. That has been well-documented, especially because (nicotine) can suppress your appetite.

“In boys we found something we don’t understand yet,” she says. “We found that those who were inactive dieters, those who first started dieting and then stopped, were more likely to engage in smoking behaviors.”

The researchers derived their findings from the answers of 7,795 adolescents who were surveyed during the first two waves of the National Longitudinal Study of Adolescent Health, completed in 1994 and 1996. The teens were in seventh, eighth and ninth grade when surveyed.
UF researchers included the answers of adolescents who said they were trying to lose weight and divided the group into four units: non-dieters, new dieters, former dieters and consistent dieters, who said they were dieting both times they were surveyed. They excluded teens who were already smokers and those who admitted to taking diet pills, vomiting and using other unhealthy weight-loss tactics.

“That group (of teens who were beginning to diet) was the one we were most interested in, seeing how the start of one behavior related to initiation of smoking,” Maldonado-Molina says.
Researchers also found that girls who consistently dieted were more likely to smoke.

Still, the number of children smoking in the United States has dropped in the 10 years since the first two waves of the survey were completed. In 1995, about 35 percent of high school students smoked regularly, according to the Centers for Disease Control and Prevention. Now about 23 percent of high-school age children reportedly smoke and 8 percent of middle school students do. The percentage of girls who smoke is slightly higher in both age groups, according to a 2006 CDC report on tobacco use among youth.

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Inhaling From Just 1 Cigarette Can Lead To Nicotine Addiction

A new study published in the Archives of Pediatric and Adolescent Medicine shows that 10 percent of youth who become hooked on cigarettes are addicted within two days of first inhaling from a cigarette, and 25 percent are addicted within a month. The study found that adolescents who smoke even just a few cigarettes per month suffer withdrawal symptoms when deprived of nicotine, a startling finding that is contrary to long-held beliefs that only people with established smoking habits of at least five cigarettes per day experience such symptoms.

The study monitored 1,246 sixth-grade students in six Massachusetts communities over four years. Students were interviewed frequently about smoking and symptoms of addiction, such as difficulty quitting, strong urges to smoke, or nicotine withdrawal symptoms such as cravings, restlessness, irritability, and trouble concentrating. Of those who were hooked, half were already addicted by the time they were smoking seven cigarettes per month. As amazing as it may seem, some youth find they are unable to quit smoking after just a few cigarettes. This confirms an earlier study by the same researchers.

Recent research has revealed that the nicotine from one cigarette is enough to saturate the nicotine receptors in the human brain. “Laboratory experiments confirm that nicotine alters the structure and function of the brain within a day of the very first dose. In humans, nicotine-induced alterations in the brain can trigger addiction with the first cigarette,” comments

Joseph R. DiFranza, MD, professor of family medicine & community health at the University of Massachusetts Medical School and leader of the UMMS research team. “Nobody expects to get addicted from smoking one cigarette.” Many smokers struggle for a lifetime trying to overcome nicotine addiction. The National Institutes of Health estimates that as many as 6.4 million children who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence.

“While smoking one cigarette will keep withdrawal symptoms away for less than an hour in long-time smokers, novice smokers find that one cigarette suppresses withdrawal for weeks at a time,” explains Dr. DiFranza. “One dose of nicotine affects brain function long after the nicotine is gone from the body. The important lesson here is that youth have all the same symptoms of nicotine addiction as adults do, even though they may be smoking only a few cigarettes per

month.”

Symptoms of nicotine addiction can appear when youth are smoking as little as one cigarette per month. At first, one cigarette will relieve the craving produced by nicotine withdrawal for weeks, but as tolerance to nicotine builds, the smoker finds that he or she must smoke ever more frequently to cope with withdrawal.

According to DiFranza, the addiction-related changes in the brain caused by nicotine are permanent and remain years after a smoker has quit. This explains why one cigarette can trigger an immediate relapse in an ex-smoker. It also explains why an ex-smoker who relapses after many years of abstinence cannot keep the craving away by smoking one cigarette per month. Unlike the newly addicted novice smoker, a newly relapsed smoker must smoke several cigarettes each day to cope with the craving.

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Spiritual Beliefs, Practices May Help Smokers Quit

Unlike many traditional alcohol and drug dependence treatment programs, mainstream smoking cessation programs generally exclude spiritual practice and beliefs from the treatment process. But a study by Oregon Health & Science University Smoking Cessation Center researchers reveals many smokers are receptive to and may benefit from their own spiritual resources, when attempting to quit.

The study, believed to be the first to look at the potential use of spiritual resources for quitting in adult smokers, recently was published in Nicotine & Tobacco Research.

For decades, the OHSU research team encountered some patients in clinical practice who reported that in addition to the treatments provided by the team, they used personal spiritual beliefs and practices in their quit attempts. This led the team to question why spiritual resources were not part of mainstream tobacco dependence treatment programs.

"We theorized the absence of spiritual resources in smoking cessation programs may be due to perceived resistance from smokers or, until recently, the social acceptance of smoking, which may have prevented patients and providers from considering the health effects of tobacco dependence as life-threatening," says David Gonzales, principal investigator of the study, and co-director, OHSU Smoking Cessation Center, OHSU School of Medicine. "We know that smoking cessation medications coupled with behavioral interventions increase quit rates, but quitting is still difficult and some smokers need more support in order to quit successfully. We may be missing opportunities to assist these smokers."

Gonzales and colleagues discovered that women were more likely to report a spiritual practice or belief compared with men, but smokers of both sexes who smoked more than 15 cigarettes per day were more likely to be open to having their health care provider encourage them to use their own (the patient's) spiritual practice to assist in a quit attempt.

"Our findings suggest that although not all clinicians want to talk about spirituality with their patients, those who do feel comfortable doing so will likely find most patients who smoke are receptive. Asking smoking patients if they have a spiritual practice or belief may be important to their care," Gonzales explains.

Patient spirituality is becoming more mainstream in medicine and is accepted as integral to the treatment of many medical conditions, especially cancer, Gonzales says. Surveys show patients would like their providers to discuss spirituality related to their health care. Along with this opportunity there is a challenge for health care providers to respect spiritual beliefs and practices that may be different from their own. Further investigation and program development on how to include spirituality in mainstream tobacco dependence treatment is warranted, he and his team concluded.

To conduct this research, Gonzales and colleagues surveyed 104 current smokers, aged 18 or older and not attempting to quit, in smoking areas outside building on the OHSU Marquam Hill Campus. Study participants were equally male and female, on average 38 years old, and had smoked about 17 cigarettes a day for approximately 21 years. The anonymous surveys included questions about smoking behaviors, and spiritual practices and beliefs.

Of the 104 participants, 92 had some history of using spiritual resources, and of those, 78 percent believed that using those resources when making a quit attempt could be helpful.

Seventy-seven percent believed having treatment staff encourage the use of spiritual resources to help them quit could be beneficial.

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Study Shows Smoking Common During Pregnancy

While pregnancy may be considered an effective motivator for smoking cessation, results of a new study by researchers at the Mailman School of Public Health indicate that pregnant U.S. women commonly smoke, placing themselves and their unborn children at risk for health and developmental complications. The research also finds a significant association between cigarette use, nicotine dependence, and the presence of mental disorders among pregnant women.

The data show that almost 22 percent of these women smoked cigarettes and more than 10 percent were nicotine dependent. The results also indicate that approximately 30 percent of pregnant women who used cigarettes had a mental disorder, with personality disorders, major depressive disorder, and specific phobia among the most common psychological ailments.

Mental disorders were even more common among pregnant women with nicotine dependence, affecting more than 57 percent. In terms of specific disorders, the strongest associations with nicotine dependence were seen for prolonged depression, panic disorder, and major depressive disorder.

"Our research shows that prenatal smoking appears to be more common in pregnant women who are already vulnerable—those who are unmarried, have less than high school education, and have lower personal incomes," says Renee Goodwin, assistant professor of Epidemiology at the Mailman School, and lead scientist. "They also are likely to have limited access to health care services, which may contribute to a lower likelihood of some women quitting smoking upon becoming pregnant."

The study included 1,516 pregnant women at least 18 years old who took part in the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative survey of more than 43,000 U.S. adults administered by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Mental disorders and nicotine dependence were diagnosed through use of the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV.

The findings were published in the April issue of Obstetrics and Gynecology. The study was supported in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

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Teen Risk-Taking May Be Biologically Driven and Inevitable, Research Says

While the government spends billions of dollars on educational and prevention programs to persuade teens not to do things like smoke, drink or do drugs, a Temple University psychologist suggests that competing systems within the brain make adolescents more susceptible to engaging in risky or dangerous behavior, and that educational interventions alone are unlikely to be effective.

Laurence Steinberg, distinguished university professor and the Laura H. Carnell professor of psychology at Temple, outlines his argument in, “Risk Taking in Adolescence: New Perspectives from Brain and Behavioral Science,” in the April issue of the journal, Current Directions in Psychological Science.

“While it is probably not fair to say that none of the programs we have developed works, most of the educational efforts to persuade kids to not smoke or to not use drugs or alcohol, to engage in safe sex or to drive more safely have not been effective,” says Steinberg, director of the John D. and Catherine T. MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice. “There is a program here or there that works, but, by and large, we have spent billions of dollars on initiatives that have not really had much of an impact.”



Steinberg says that over the past 10 years there has been a great deal of new research on adolescent brain development that he believes sheds light on why kids engage in risky and dangerous behavior, and why the educational programs or interventions that have been developed have not been especially effective.



According to Steinberg, heightened risk taking in adolescence is the result of competition between two very different brain systems, the socioemotional and cognitive-control networks, that are undergoing maturation during adolescence, but along very different timetables. During the adolescence, the socioemotional system becomes more assertive during puberty, while the cognitive-control system gains strength only gradually and over a longer period of time.
The socioemotional system, which processes social and emotional information, becomes very active during puberty allowing adolescents to become more easily aroused and experience more intense emotion, and to become more sensitive to social influence.



Conversely, says Steinberg, the cognitive-control system is the part of the brain that regulates behavior and makes the ultimate decisions, but is still maturing during adolescence and into a person’s mid-20s at least.



In the article, Steinberg says that the socioemotional network is not in a state of constantly high activation during adolescence. When the socioemotional network is not highly activated -- for example, when individuals are not emotionally excited or are alone -- the cognitive-control network is strong enough to impose regulatory control over impulsive and risky behavior, even in early adolescence.



In the presence of peers, however, or in situations where emotions run high, the socioemotional network becomes sufficiently activated to diminish the regulatory effectiveness of the cognitive-control network.


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Studies Identify DNA Regions Linked to Nicotine Dependence

Americans are bombarded with antismoking messages, yet at least 65 million continue to light up. Genetic factors play an important role in this continuing addiction to cigarettes, suggest scientists at Washington University School of Medicine in St. Louis.

In two studies in the January 2007 issue of Human Molecular Genetics, the scientists show that certain genetic variations can influence smoking behaviors and contribute to a person's risk for nicotine dependence.

The smoking-related genes identified normally facilitate communication between nerve cells in the brain. One gene in particular, the alpha-5 nicotinic cholinergic receptor (CHRNA5) gene, was a very strong indicator of risk for nicotine dependence. Individuals with a specific variation in the gene seemed to have a two-fold increase of developing nicotine dependence once exposed to cigarette smoking. CHRNA5 is from a class of receptors that plays a role in dopamine pathways in the brain, which are linked to a person's experience of pleasure.

The researchers also identified genes related to gamma aminobutyric acid (GABA) receptors, another set of proteins vital to nerve cell function. Both GABA and nicotinic receptors had been suspected of involvement in nicotine addiction, but these findings strengthen those suspicions.

The studies also identified a gene not previously known to be involved with nicotine dependence. Called the Neurexin 1 (NRXN1) gene, it helps regulate the balance between excitatory mechanisms — those that increase communication between nerve cells — and inhibitory mechanisms — those that slow firing between nerve cells.

"An imbalance between excitatory and inhibitory activity in the brain may predispose people to addiction, such as alcoholism, drug dependence or nicotine dependence," says Laura Jean Bierut, M.D., associate professor of psychiatry and principal investigator of both studies. "The Neurexin gene we've identified is really a key factor in the balance between inhibition and excitatory activity in neurons."

Bierut suspects a large number of genes are involved in nicotine dependence, and she says understanding how they work may make it possible to develop new treatments for smoking cessation.

The research team analyzed data from almost 2,000 participants in two ongoing studies. One, called the Collaborative Genetic Study of Nicotine Dependence, is a U.S.-based sample that includes both addicted smokers and "social" smokers from St. Louis, Minneapolis and Detroit. The other is an Australian study of smokers of European ancestry called the Nicotine Addiction Genetics study.

The scientists combined two approaches for analyzing genetic information. One approach scanned the entire human genome for suspicious areas of DNA while the second approach closely examined specific target genes.

"The combination of these two approaches represents the most powerful and extensive study on nicotine dependence to date and is an important step in a large-scale, genetic examination of nicotine dependence," says Elias A. Zerhouni, M.D., the director of the National Institutes of Health, which funded the studies. "As more genomic variations are discovered that are associated with substance abuse, we can better understand addictive disorders."

The researchers identified an area of DNA variation that seems to alter the function of a nicotinic receptor protein. That small variation makes a big difference in risk for nicotine dependence.

Current drug treatments for nicotine dependence continue to be only marginally successful, and Bierut believes using information about genetic traits to tailor medications to individuals could make them significantly more effective. "The type of variant you have at this particular receptor — the alpha-5 nicotinic receptor — may actually predict whether or not you will do well on nicotine replacement therapy," she says.

<---Anyone who's been or is a smoker, knows how hard it is to quit cigarettes. Even after we hear again and agian the risk of lung cancer for some reason we pick up a cigarette, ignoring the cancer statistics. Smokefree seems far away. But eventually, there is a point when quitting smoking makes the most sense.The effect of smoking takes too much of a toll.--->

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