Research Takes On Post-Smoking Health Issues
The challenge of quitting smoking doesn't end with the last puff. Not gaining weight can be an additional hurdle. And it's an especially important one for former smokers who have high blood pressure or are at risk for it.
University of Iowa experts, along with investigators at Mayo Clinic and the University of Tennessee, are trying to find the best ways to help people with these conditions be successful at quitting smoking, as well as controlling their blood pressure and preventing weight gain.
"There is a well-known relationship between quitting smoking and weight gain,” said Mark Vander Weg, Ph.D., the study's principal investigator for the UI site and associate professor of internal medicine at the UI Roy J. and Lucille A. Carver College of Medicine.
"It's a significant challenge for people to 'stay quit'. Trying to combine quitting smoking and keeping weight off at the same time can be a lot of behavioral change to try to manage at once for many people," said Vander Weg, who also is a researcher with the Center for Research in the Implementation of Innovative Strategies in Practice at the Iowa City Veterans Affairs Medical Center.
"For some people who have just quit smoking, it's appropriate to have them accept initial weight gain and instead help them not gain too much weight. But for people who have high blood pressure, gaining even 10 to 15 pounds may be problematic for their health after they quit smoking," he said.
To assist this particular group, Vander Weg and colleagues at the UI Preventive Intervention Center in the UI College of Public Health embarked on the study, which is funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health. The UI is one of three sites nationwide participating in the investigation. The study aims to enroll 2,320 people, including an expected 912 at the UI.
Of course, the first step in the study is to help participants quit smoking. Smoking rates have declined significantly since the 1960s, when nearly half the adult population over age 18 smoked. However, from 2004 to 2006, the percentage of adult smokers in the U.S. remained steady at 21 percent, according to a Centers for Disease Control report.
"People know that smoking is unhealthy but choosing not to is a different thing. We try to take away the reasons people have not to quit," said Bill Barker, recruitment coordinator with the Preventive Intervention Center.
"There are many important behavioral and psychological factors involved in smoking and thus in quitting smoking and staying off tobacco products," Vander Weg said. "For many people it's not only nicotine dependency but also a learned association that involves what has essentially become an automatic behavior. Many people also smoke in response to negative mood and stress."
While there are many types of quit aids, the center is using a patch for the study because it is among the safest and most effective of nicotine replacement products as well as being available over-the-counter, Barker said.
Once study participants quit smoking they are randomly assigned to one of three treatment approaches: a 17-session program to manage weight, a 17-session program to control blood pressure, or use of self-help materials designed to help manage body weight and blood pressure. Study involvement lasts about 14 months and includes eight to 25 visits.
Vander Weg emphasized the study focuses on preventing weight gain, not on weight loss. "People tend to eat an extra 300 to 400 calories a day after they quit smoking. At the same time, a person's metabolism changes since with smoking an extra 100 to 150 calories are typically burned each day. Together, these two things contribute to weight gain. People are always better off quitting smoking, but we want to find the best way to help people maintain their weight and blood pressure while maintaining their status as non-smokers."
While the current study focuses on people with high blood pressure, Vander Weg also is interested in how best to help people with psychiatric conditions quit and not develop additional health or other problems.
"People with psychiatric disorders often smoke at higher rates, yet their success at quitting tends to be lower than other groups," he said.