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The moment you think about leaving smoking, is the moment you should leave it. Smoking is one of the leading causes of preventable deaths worldwide.

You possibly started smoking because of various reasons; peer pressure, social norms, stress, parental behaviour, advertising, misinformation; this list is endless. You probably started smoking as a way of experimentation, as nobody starts smoking wanting to smoke for the rest of their life. You have probably realized slowly and steadily that you are now a regular smoker. You know the adverse effects of smoking on health. It is likely that you know that smoking is one of the leading causes of cancer and heart disease, and innumerable other diseases. Your smoking not only affects you, but those around you. If you have children, they are more likely to have respiratory and ear infections when compared to children of individuals who do not.smoke.

You almost certainly have, at some time or the other in your life, thought about giving up smoking. However, you may have also realized that giving up smoking is a lot more difficult than making the decision to quit. You possibly have demonstrated immense willpower and resolve in other areas of your personal and work life, but have found giving up smoking very difficult.

What does our tobacco cessation clinic have to offer?

You deserve to be able to stop smoking comfortably, and not endure suffering while doing so. Giving up smoking is scary, the fear of symptoms of withdrawal are genuine, and the chances of one resuming smoking are high when one experiences discomfort.

The principle of the smoking cessation clinic is to treat smoking like any other ailment; with medications to prevent cravings, strategies to deal with situations in which the urge to smoke is high, and nicotine replacement therapy to counter and tide over instances in which the desire to smoke makes one overwhelmingly uncomfortable. The clinic comprises a trained respirologist with the knowledge and skills to assess the level of dependence, and to suggest appropriate pharmacotherapy, and a trained psychologist to help with the anxiety and apprehensions that are inevitable with such a major life-altering decision.

We would like to address some of the myths associated with smoking, in order to equip you with the knowledge to make an informed decision to quit smoking.

Tobacco Cessation Clinic details:

Every Saturday between 2 pm to 5 pm,
3^rd Floor Wing 3,
Room no.: 3307

Consultant Doctor:

Dr. Lancelot Pinto

Myth 1: My other healthy habits may make up for my smoking.

Truth: Individuals who smoke sometimes justify their habit by insisting that proper nutrition and lots of exercise are enough to keep them healthy. Not so! Research shows that eating a healthy diet and exercising do not reduce the health risks associated with smoking. Smoking affects every organ system in the body and thinking that you're going to find the perfect lifestyle to counteract the effects of smoking is not realistic.

Myth 2: I've smoked for so long; the damage is already done.

Truth: Quitting smoking at any age is a good idea for your health. The damage caused by smoking is cumulative, and the longer a person smokes, the greater his/her risk for life-threatening ailments. Smoking can cut about 14 years off of the life span of both men and women. If you quit smoking at age 35 you will live about five to ten years longer and decrease the risk of developing cancer and heart diseases. But quitting smoking at any age results in health benefits. Smokers who quit before age 35 prevent 90% of the risk of health problems attributable to smoking. A smoker who quits before age 50 reduces his/her risk of dying by 50 percent within the next 15 years as compared to someone who continues to smoke. So, it doesn't matter at what stage of life are you, you could stop the danger that smoking has been causing to your body.

Myth 3: If I stop smoking, I will gain weight.

Truth: If you substitute eating for the oral gratification that smoking gives you, you will possibly gain weight. If, however, you eat healthy and exercise you will not gain weight. Education and counselling can establish a program for you that may help you lose 5 to 10 pounds and increase your stamina, lung capacity and stabilize your weight.

Myth 4: Smoking will make me look cool and good in front of others.

Truth: Smoking stains your teeth, causes facial wrinkles, depletes energy, burns holes in clothes, and causes bad breath and a general bad aroma in both men and women. People who smoke are more likely to have high blood pressure are more likely to become impotent than non-smokers.

Myth 5: Cutting back on smoking is good enough.

Truth: Cutting down on the number of cigarettes is not an effective strategy. Smokers who cut back draw more deeply and smoke more of each cigarette. So even though they smoke fewer cigarettes, they get the same dose of toxic smoke. Studies also suggest that the only smoking cessation strategy that works consistently is getting to the point of not even a single puff.

Myth 6: Infrequent and social smoking is harmless.

Truth: Any pattern of smoking, including social smoking, is dangerous. Science has not identified a safe level of smoking, and even a few cigarettes can maintain the addiction. Lot of people claim to be just "social smokers", but the odds are that they're actually fooling themselves.

Myth 7: Cigars and hookahs are safe alternatives.

Truth: All tobacco products, including cigars and hookahs, have nicotine, that's a highly addictive substance. The tobacco industry comes up with these new products to recruit new, younger smokers. And, they advertise them as less harmful than conventional cigarettes. But once a young person gets acquainted with nicotine, it's more likely he or she will try other tobacco products. Cigar smokers have higher death rates from chronic obstructive pulmonary disease and are 4 to 10 times more likely to die from cancers of the throat, mouth, lips, larynx and oesophagus than non-smokers. People who chew tobacco are more likely to develop oral cancers which affect the tongue, lips, cheeks and gums.

Myth 8: Switching to 'light'/menthol/low-tar cigarettes will cut my risk.

Truth: Smokers who switch to brands labelled "light" or "mild" inevitably compensate for the lower levels of tar and nicotine by inhaling smoke more deeply or by smoking more of each cigarette. Most people who smoke them wind up getting the same amount of the dangerous components in tobacco smoke. People who smoke light cigarettes are dying of lung cancer, stroke, heart attack, and emphysema every day.
Similarly, cigarettes labelled "natural" or "organic" are no safer than ordinary cigarettes.

Myth 9: Myth: Quitting "cold turkey" is the only way to go.

Truth: Some smokers think that quitting abruptly is the best approach and that willpower is the only effective tool for curbing tobacco cravings. They're partly right: Commitment is essential. Of 100 individuals who try to quit cold turkey, only 3 continue to be smoke-free at the end of a year. Smokers are more likely to succeed at quitting if they take advantage of counselling and smoking cessation medications, including nicotine (gum, patches, lozenges, inhaler, or nasal spray)

Myth 10: Smoking doesn't hurt anybody but me!

Truth: There is no risk-free level of exposure to second-hand smoke. Even brief second-hand smoke exposure can cause harm. Exposure to second hand smoke at home or work increases a person's risk of heart disease by 25 to 30% and lung cancer by 20 to 30%. That's because the amount of cancer-causing chemicals is higher in second-hand smoke than in the smoke inhaled by smokers. According to the National Cancer Institute, USA, second hand smoke makes those exposed more susceptible to asthma attacks, ear infections and other respiratory problems. Second hand smoke kills an estimated 35,000 to 65,000 non-smokers each year. Up to 62,000 will die from heart disease and 3,000 will die from lung cancer. Children of those who smoke are more likely to have respiratory tract and ear infections when compared to those who do not.

Myth 11: I tried quitting once and failed, so it's no use trying again

Truth: Most smokers try several times before quitting for good. So if you've failed previously, don't let that deter you from trying again.

However,
"If you keep on doing what you've always done, you'll keep on getting what you've always got."

According to you what are the serious health implications of tobacco consumption in Mumbai? Respiratory disease, cardiovascular disease, lung cancer, reproductive health – which of these have the highest percentage?

Scientifically, tobacco has serious implications on all of the above diseases, but in India, smoking majorly leads to cardiovascular disease, COPD, and lung cancer. The burden of respiratory diseases is high in India. One of the major reasons being that Indians are born with 33% lower lung functionality as compared to Caucasians. And smoking makes situations worse, This is well-captured in a global study called 'Pure study'. Dr. Pinto to share the study details

What are the barriers to quitting tobacco?

Smoking and tobacco consumption is a disease rather than a habit. Treatment needs to be meted out in addition to advising precautions just like any other disease. Cigarettes and tobacco contain nicotine which is a very powerfully addictive, much more addictive than drugs such as Heroine.

Would be able to share any city specific statistics/study/survey on smoking habits, demographics, age groups and attempts for smoking cessation?

• COPD Assessment Test - Abstract and 'Quality of Life Questionnaire' of (200 participants). It was observed that smokers seem to have a poor quality of life as compared to non-smokers.
• Study – COPD to be the next epidemic. (30%) 1/3rd of world's COPD deaths will be in India by 2030. COPD kills half a million people in India every year, more than those who die due to tuberculosis, malaria or HIV-AIDS. These numbers are expected to grow by 160% over the next 2 decades, in contrast to the decline in the number of deaths anticipated due to malaria, Tb or HIV-AIDS.
• Study – Only 3 in 100 people are successful in trying to quit smoking by themselves without any external treatment or medical support. Dr. Pinto feels that with the help of drugs and medical support, this number can rise to 25 – 30 %.
• COPD Data on the correlation between Pneumonia, TB and smoking and also between smoking parent and respiratory problems in child
• Interesting TIME Magazine quote on how difficult it is to quit smoking.

What is Tobacco cessation treatment? How does it benefit chronic tobacco users

• Tobacco cessation is the process of helping people quit tobacco (smoking and smokeless tobacco) comfortably with the help of Varenicline, Buproprion and/or Nicotine Replacement Therapy (NRT) and Cognitive Behavioral Therapy (CBT)
• Nicotine is simply addictive. It is not a disease causing enemy as it is made to be in media. The nicotine in cigarettes is not as harmful as its other components such as tar, a mixture of dangerous chemicals, formaldehyde, arsenic, carbon monoxide which are proved carcinogens responsible for lung cancer. Hence, through NRT, nicotine is provide to the body by safer means with an intent of delivering the same high as nicotine does
• NRT to a great extent helps decrease withdrawal symptoms triggered by stopping smoking or chewing tobacco
• The combined treatment benefits chronic smokers greatly making them strong enough to prevent withdrawal side effects

When was the Tobacco cessation clinic launched at Hinduja Hospitals? Is it the first of its kind? (First in India, State, City, Unique Treatment Approach) / What is the USP of the Clinic?

• Tobacco Cessation Clinic at P.D. Hinduja Hospital and Medical Research Centre was launched at Hinduja Hospital in December 2014 for tobacco smokers (cigarettes) as well as smokeless tobacco (gutkha)
• To their mind, not aware of any Tobacco cessation clinics in Mumbai as of yet (MSL to check and reconfirm)
• USP of the Clinic and Treatment – The treatment offered is simplistic but scientific with a customized approach based on the patient's behavioral pattern and psyche to help them quit tobacco consumption. People are not judged or scared here, counselling is provided in a supportive way and with an action plan model, there is no shock value, there are no gory images.

What is the major reason for smokers to opt for this treatment? (Family pressure, Health reasons, etc.) What are the demographics?

• Major reason being health scares such as a heart attack, pneumonia, coughing up blood.
• Other major reasons being family pressure, decision to have a child
• 98% men opt for the treatment

What is the duration of the treatment?

Duration of the treatment is usually 3 months but may be extended up to 6 month. The timeline for doctor counselling is 1st week, after 3 weeks, 2 months and 3 months.

Are there any basic requisites for the treatment? Eg. Need to stay, need a family member to closely monitor?

The patient needs to be ready mentally and physically. They need to regularly attend the clinic per the timelines set for them. The clinic does not follow a policy of convincing people to quit smoking. They instead believe in helping people who want to quit smoking.

What are various components of Tobacco cessation treatment offered at Hinduja Hospitals? (Medication, Counseling, Rehabilitation, etc.)

• Medications based on estimating the dose of nicotine consumed through tobacco, and the degree of addiction
• Champix, the most successful smoking cessation drug worldwide is used which stimulates the nicotine receptor, providing the nicotine high, yet at the same time blocking the receptor, thereby preventing the high obtained from tobacco
• Buproprion – it is an antidepressant that has met with success in curbing the addiction
• Nicotine gum and patch treatment - People don't get addicted to the nicotine in gum or patch. The gum should not be consumed like a chewing gum as it leads to nausea and vomiting. The correct technique to consume should be followed from the instructions on the manual
• Cognitive Behavioral Therapy (CBT)
• Screening for depression followed by psychiatric counselling for different cases such as suicidal feelings, angina, etc.

What are the withdrawal symptoms and how well are they managed by the clinic?

• Based on the behavioral analysis, a situation based action plan is charted and shared with the patient to train him how to deal with situations wherein he/she would have to urge to start consuming tobacco again. The plan helps in cases of couple of lapses.
• A relapse plan is discussed between the 2^nd and 3^rd counselling session to make the patient aware of the implications of total defaults

What is the success rate of the treatment? Can we have patient testimonials. Is there any research study to support it?

• Dr. Pinto shared a very interesting patient case study of Mrs. Mistry, a 75 year old lady who smoked a pack of cigarettes per day for about 40 years. Since she started her treatment at Hinduja Hospital's Tobacco cessation clinic under Dr. Pinto, she has successfully quit smoking since 6 months
• Mrs. Mistry is ready to share her testimonial with media and she can be reached out in the future

Post the treatment, does the clinic enlist recommend a daily routine practice for the individual to curb the temptation

• The clinic provides an extended Action Plan for patients to prevent them to resort to smoking again. Brochures are shared with family /close members to educate them for helping the patient in the process of rehabilitation. The plan also includes the steps to be taken in case of relapse
• In case of total relapse, the patient is recommended to retake the treatment which is customized keeping the relapse in mind

Do you support the government's current initiative to discourage smoking - Increase tax on cigarette packets and Increase size of the warning image. Do you think this is suffice and effective in curbing the number of smokers? And why?

• Yes, but these initiatives are not suffice since they have not helped in bringing down the percentage of tobacco consumers in India.
• Scare tactics on the packaging does not help. Most people continue tobacco consumption despite being well-educated and well aware of the ill-effects.
• Increasing the price and taxes on the cigarettes packets helps to an extent, but things get back to where it was, when manufacturing firms come up with other feasible alternatives for their consumers.

What are the measures you would like to suggest to the government in this regard? Would you want the government to support smoking cessation clinics?

• Since most tobacco consumption activities happen during work hours owing to stress, there is a dire need for employers to initiate anti-tobacco activities such as stress dealing situations, providing financial incentives to employees who quit smoking,
• Government needs to do an analysis of the money invested in tobacco cessation vs tobacco/cigarette manufacturing in India
• Targeting chronic smokers is much more difficult than targeting smoking initiation in teens and youngsters. Government needs to do something to prevent smoking initiation at an early age to altogether reduce the rate of tobacco consumption in India