Factors Affecting Quitting Smoking

Quitting smoking can be very daunting, and people thinking of quitting need to go through several stages of contemplation before they are ready to face the associated physical and psychological challenges. It is estimated that up to 90% of smokers think they should quit, but only 20% are committed to quitting at any one time.

The factors associated with the decision to quit and the difficulty of continuing to not smoke depend upon your personal situation, experience, personality and support network.

For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking.

Psychologists believe there are five main stages of the quitting process:

Precontemplation: Precontemplation is when the initial thought about quitting comes to mind. You will usually set yourself a quit time within the next 6 months;Contemplation: Contemplation is when you are seriously thinking about quitting in the next 6 months;Preparation: Preparation is when you actually prepare for your quit attempt, which is planned to start within the month;Action: Action is when a quit attempt is made ands lasts at least 24 hours;Maintenance: Maintenance is when you are smoke-free for at least 6 months. This is the hardest step of quitting as you are most vulnerable to relapse.

The level of nicotine dependence is determined by a combination of many different factors that can vary between individuals. Dependence on nicotine (and any other addictive drug) is made up of psychological dependence, physical dependence and tolerance. This means that people become dependent (or 'addicted') to the psychological effects of nicotine (e.g. stress relief) and the body becomes physically dependent on nicotine, such that without it the body experiences withdrawal symptoms. Tolerance is the process whereby smokers become used to nicotine. As they continue smoking, they need more and more nicotine to satisfy the same psychological and physical effects of the drug.

The level of dependence on nicotine is the largest factor determining successful quit attempts. The higher the level of dependence, the harder it will be to quit.

A high level of physical dependence on nicotine is associated with:

A greater exposure to nicotine, which results in further changes to the brain. This is called neuroadaptation. The more nicotine that the brain is exposed to, the more changes the brain will make to its structure and function in order to adapt to the extra nicotine. Once the brain has adapted to high levels of nicotine, it becomes dependent on having nicotine supplied;A greater natural need for nicotine. For example, some people may have a greater natural tendency to develop addictive behaviour, which is defined by their genetic predisposition; andMore severe withdrawal symptoms.

A high level of psychological dependence on nicotine is associated with:

A physical or social environment with strong cues and associations. Many people associate smoking with certain cues. For example, if?you have a cigarette every time you?have a coffee, the coffee becomes a cue. When you go to have a coffee, you will automatically associate this with also?having a cigarette;An environment that has more opportunities to smoke. For example, if you work outside where you can smoke more often than somebody who works in an office, or if you live in a house with other smokers who don't mind smoke in the house; andBeing a learned habit. For many people, smoking is a learned behaviour that comes just as naturally as turning on a light when you walk into a dark room.

Motivation is often thought of as the main reason behind quitting. If someone successfully quits smoking, they are thought to be highly motivated. While motivation is a very important part of quitting, it is not the sole predictor of outcome. If you fail a quit attempt, it does not mean you are not as motivated as somebody who successfully quits –?it means that you have a higher level of nicotine dependence and you may need to try a few more times before you are successful. That said, motivation does play a crucial factor in the quitting process, especially in making the initial decision to quit.

It is hard to define what motivates someone to quit smoking and maintain cessation. The motivation for each person will be brought on by different factors. Some may want to improve fitness and sporting performance, some may be thinking of starting a family, some may want to save money ... the list is endless!

Practise actively thinking about your reason to quit so you remember it every time you feel like a cigarette; it may help you to maintain smoking cessation.

Before you quit, you must believe that you are capable of doing so. This is a concept called self-efficacy. People who are self-efficacious will be more successful in quitting. If you have the motivation, the knowledge and an?understanding of the challenges associated with quitting, you already have the tools you need in order to make a quit attempt. The more faith you have in yourself, then the easier it will be to quit. Remember, in Australia there are more people who have successfully quit smoking than people who still smoke.?If 4.3 million other Aussies can quit smoking, so can you!

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

The physical symptoms of nicotine withdrawal are often associated with relapsing during a quit attempt. Withdrawal symptoms are most intense in the first week of smoking cessation, and last for 2–4 weeks.

Common withdrawal symptoms include:

Mood changes, including agitation, aggression, depression and anxiety;Restlessness;Poor concentration;Increased appetite;Disturbed sleep;Decreased heart rate; andDecreased levels of adrenaline.

Keep in mind that these withdrawal symptoms will not last forever. If you make it past the first week, you are past the worst of it and the?withdrawal symptoms will become less intense!

Whether you are only just thinking about quitting or at the stage where you are completely adamant and prepared to quit, the best place to start is with your doctor. They will be able to provide you with some basic information about quitting and advise you on the best course of action.

Zwar N, Richmond R, Borland R, et al (eds). Smoking cessation guidelines for Australian general practice [online]. Fairbairn, ACT: quitnow, Australian Government Department of Health and Ageing; 2004 [cited 8 September 2010]. Available from: URL link?Ellerman A, Ford C, Stillman S.?Smoking cessation: 7.7 Personal factors associated with quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkBenowitz NL. Clinical pharmacology of nicotine: Implications for understanding, preventing, and treating tobacco addiction. Clin Pharmacol Ther. 2008;83(4):531-41. [Abstract]Winstanley M. Addiction: 6.9 Nicotine withdrawal syndrome. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL linkEllerman A, Ford C, Stillman S.?Smoking cessation: 7.3 The process of quitting. In: Scollo M, Winstanley M (eds). Tobacco in Australia: Facts and?Issues (3rd edition)?[online].?Carlton, VIC:?Cancer Council Victoria; 2008 [cited 15 June 2010]. Available from: URL link?

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Effect of Environmental Factors on Sperm Health

Humans are constantly exposed to a range of chemicals and toxins in their environment which can affect their health, including their reproductive health. For men, a range of environmental exposures are associated with reduced sperm concentration and quality. Men whose sperm is sub-optimal in either quantity or quality are less likely to conceive, and will, on average, take longer to do so, should they manage to successfully conceive.

While environmental chemicals and toxins are found in many environments, they are most commonly found at dangerous concentrations in occupational environments, such as chemicals used in agricultural and manufacturing sector workplaces. There are also many more environmental exposures which potentially increase the risk of male infertility but have not yet been studied (e.g. hundreds of chemicals are now used in manufacturing and other industries, and all are likely to have different health effects, but the effects on male infertility have been studied for only a few). The environmental factors which have evidence of an association with male infertility, include heat, radiation, chemicals and trauma.

Sperm production in humans and other mammals is dependent on the temperature of the testicles. Sperm is optimally produced when the testicles are 2-4oC below body temperature. The temperature of the testes is regulated by the scrotum (which expands and contracts to facilitate heat transfer) and heat exchange between blood flowing into the testes via the arteries in the spermatic cord, and that flowing out of the testes via the veins in the spermatic cord. This results in the pre-cooling of blood entering the testes, although the pre-cooling mechanism can only regulate testicular temperature to an extent.

In situations of extreme heat, the scrotum's natural cooling mechanisms may be insufficient to prevent a rise in testicular temperature. The increased testicular temperature may affect both the quality and quantity of sperm produced.

Some men expose themselves to extremely high temperatures in their day to day life, for example by taking hot baths. However, the majority of unsafe heat exposure occurs in occupational situations. A number of studies have demonstrated an association between sperm quality and heat exposure. A large case control study found that men exposed to heat because of their occupation were 1.8 times more likely to have morphologically abnormal sperm. They were also 1.8 times more likely to have been trying unsuccessfully to conceive for more than one year, than men who had not been occupationally exposed to heat.

Studies have also demonstrated that the following occupational groups have a higher risk of infertility, which is thought to be related (at least in part) to testicular heat exposure.

Occupational drivers

One study at an infertility clinic found that occupational drivers accounted for 9.4% of patients but only 3.8% of the general population. Drivers are thought to be at greater risk of infertility because long periods of sitting can increase testicular heat, as the testicles are insulated by the thighs whilst a man is seated.

Ceramic oven operators

One study comparing oven operators to other, non-heat exposed workers in a ceramic factory reported that significantly greater proportions of oven operators were childless (7.6% of oven operators compared to 1.1% who don't work in that industry) and reported difficulty conceiving (23% of oven operators compared to 12% of men not in that industry). The semen of the oven operators contained significantly less motile sperm (7% motile) than that of the other workers in the ceramic factory (who had 28% motile sperm).

Bakers

One study reported that a significantly lower proportion of men in the baking profession conceived within three (14%) or six months (29%) than men working in non-heat exposed professions (55% at three months, 74% at six months).

Radiation and other toxic substances found in war environments negatively affect sperm quality. Compared to other body organs the testes are very sensitive to radiation. Radiation exposure affects spermatogenesis (the production of sperm).

A French study found that men who had worked on a nuclear submarine were 2.9 times more likely to be infertile than men who had not. It is most likely that this decreased fertility was related to suboptimal sperm production. Other studies have demonstrated that radiation exposure affects testicular function and spermatogenesis (as opposed to other male infertility factors like sperm transport and sexual function).

Another study of gulf war veterans reported that returned servicemen who participated in the 1990-1991 Gulf war were 41% more likely to be infertile than servicemen who were not deployed to the Gulf region during that war. Similarly Gulf war veterans were 18% more likely than non-deployed servicemen to take more than one year to conceive. The authors of this study believed that sub-fertility in Gulf War veterans was caused by impaired spermatogenesis, caused by toxic exposure during the war.

Exposure to radiation during radiotherapy for cancer treatment is also a known risk factor for testicular failure in men. Impairment of sperm production is dose dependent. This means that the higher the dose or longer the direction of radiotherapy, the more likely sperm production is to be impaired. Recovery of testicular function following radiotherapy typically takes more than five years.

Men who are regularly exposed to some chemical substances are more likely to be infertile than men who are not. For example, a longitudinal study, which compared the semen samples of men with varying exposures to organophosphorous pesticides found that men with the highest exposure to these pesticides had the poorest sperm quality.

Another study of men attending an Argentinean infertility clinic found a link between pesticide exposure and sperm concentration, output and motility less than would be expected. The greater an individual's exposure to pesticides, the more likely their sperm concentration, output, motility and proportion of morphologically normal sperm would be reduced. Exposure to glycol ether has also been shown to increase the risk of suboptimal sperm production. There are numerous pesticides which have not been studied in relation to male fertility and further research regarding these is necessary.

Chemotherapy medications used to treat cancer often cause infertility and the extent to which a man's fertility is affected by chemotherapy depends on the type of chemotherapy drug used, the dose, duration of treatment and the man's age when he is treated. Typically patients who are younger and taking lower medication doses are less likely to experience impaired fertility than older patients and those taking higher medication doses, however some chemotherapy medications are more likely to result in infertility than others.

Male subfertility or infertility following chemotherapy most commonly occurs as a result of damage to the germinal epithelium lining the tubules of the testis. This is the section of the testis where the germ cells from which sperm are produced reside.

A patient's libido is often also affected by chemotherapy. This can be as a direct result of the medications or their side effects or because of the psychosocial effects of the treatment which may negatively affect a men's ability to conceive.

The likelihood of a man developing impaired spermatogenesis also depends on the type of cancer. Amongst men with acute leukaemias, it is estimated that at least 21% experience some degree of subfertility following treatment. For other cancers such as tumours of Hodgkin's disease and testicular cancers, the proportion of men experiencing impaired fertility is much higher (65-75%). In cases of testicular carcinoma or Hodgkin's disease fertility is partially impaired as a result of the disease itself (i.e. impaired fertility is common even prior to chemotherapy). Fertility often recovers following chemotherapy, however typically not for many years.

Testicular trauma can negatively affect spermatogenesis, however scientists do not yet fully understand why.

Men who wish to protect the health of their sperm can do so by avoiding a range of environmental exposures. They should:

Avoid occupations which involve exposure to extreme heat (e.g. baking, ceramics) or extreme testicular heat (e.g. driving, which requires long periods of sitting in a position in which the testicles are insulated);Avoid hot baths;Wear boxer shorts instead of tight underwear;Avoid occupations which involve high levels of exposure to radiation (e.g. military), and toxic chemicals (e.g. agriculture);Cryopreserve sperm for future use in assisted reproduction cycles if they are to undergo radiation therapy or chemotherapy.Evidence from laboratory studies of rats suggests that hormone treatment prior to chemotherapy help protect fertility, however further studies on humans are necessary to confirm this result;Evidence suggests that following testicular trauma, testicular repair is more effective than removal of the injured testicle in protecting fertility.

For?more information on sperm health and male fertility, see Sperm Heal

For more information on workplace health including office ergonomics series, useful tips on avoiding injuries in the workplace and costs on the workforce, see Workplace Health.

Oliva, A. Spira, A. Multigner, L. Contribution of environmental factors to the risk of male infertility. Human Reprod. 2001;16(8):1768-76.Royal College of Obstetricians and Gynaecologists. Fertility: Assessment and treatment for people with fertility problems - Clinical Guideline [online]. Royal College of Obstetricians and Gynaecologists. 2004 [cited 30 October 2008]. Available from URL: http://www.rcog.org.uk/index.asp?PageID=696McLachlan, R.I. de Krester, D.M. Male Infertility: The Case for Continued Research. MJA. 2001;174:116-7.Thonneua, P. Bujan, L. Multigner, L. Mieusett, R. Occupational Heat Exposure and Male Fertility: A Review. Human Reprod, 1998;13(8):2122-5.de la Calle, F.P. Rachou, E. le Martelot, M, et al Male Infertility Risk Factors in a French military population. Human Reprod, 2001;16(3):481-6.Alvarez, J.G. Nurture vs Nature: how can we optimise sperm quality. J Andrology, 2003;24(5):640-8.Maconochie, N. Doyle, P. Carson, C. Infertility among male UK veterans of the 1990-01 Gulf war: reproductive cohort study. BMJ, 2004;329(7459):323.Juhler, R.K. Larsen, S.B. Meyer, O. Human semen quality in relation to dietary pesticide exposure and organic diet Arch Environ Contam Toxicol, 1999;37(3):415-23.Cherry, N. Moore, H. McNamee, R. et al. Occupation and male infertility: glycol ethers and other exposures. Occup Environ Med. 2008;65:708-14.Lenz, K.I. Valley, A.W. Review: Infertility after chemotherapy: a review of the risks and strategies for prevention. J Oncol Pharm Pract. 1996;2:75-100.Shaul, D. Xie, H. Diaz, J. et al. Surgical treatment of testicular trauma: effects on fertility and testicular histology. J Pediat Surg. 1997;32(1):84-7.Hirsch, A. Male Subfertility [Clinical Review]. BMJ. 2003;327:669-72.Meistrich, M.L. Wilson, G. Ye, W.S. et al. Relationship among hormonal treatments, suppression of spermatogenesis, and testicular protection from chemotherapy-induced damage. J Clin Oncol. 1997;15:3488-95.Delic, J.I. Protection of spermatogenesis during cancer chemotherapy. Sys Biol Reprod Med. 1987;18(3):211-3.Lin, W. Kim, E. Quesada, L. et al. Unilateral testicular injury from external trauma: evaluation of semen quality and endocrine parameters. J Urol. 1998;159(3):841-3.

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