Many smokers think that nicotine causes cancer, and they are therefore very reluctant to use nicotine replacement in the form of patches or gum to help them quit smoking, according to surprise findings of a survey reported here at the annual meeting of the American College of Chest Physicians.

The survey consisted of 1,139 people -- 482 men and 657 women -- enrolled in a smoking cessation program at North Shore-Long Island Jewish Health System in Great Neck, New York. The participants were questioned about the their beliefs regarding smoking and the risk of developing cancer, and nicotine's part in that cancer risk.

Lead investigator Dr. Virginia Reichert said that the majority of smokers -- 72 percent of women and 59 percent of men -- believed that nicotine causes cancer. In addition, 72 percent of women and 63 percent of men smoked "light" cigarettes, thinking this would lower their intake of nicotine and thus lower their risk of cancer.

"Just the opposite is true," Reichert stated. "Nicotine does not cause cancer, but that is why patients are reluctant to use patches to help them quit ... It's the cigarette smoke that contains carcinogens, neurotoxins and other toxins."

More women expressed fear, guilt and worry about the risks they were taking with smoking (77 percent versus 62 percent of men), and they were also more afraid of failure in their attempts to quit than men (17 percent versus 11 percent). However, quit rates at 30 days were essentially the same for women and men -- 59 percent versus 55 percent.

"Nicotine is the drug that smokers crave. That's why the patches are a good alternative for those who want to quit," Reichert said.

"Smokers need a comprehensive care program that includes (drug therapy) using nicotine patches," she added. "The programs are very much the same as other addiction treatment programs, but they need to go a step further," she said.

Complete abstinence is not used, because going "cold turkey" has a very high failure rate, Reichert said. "A program that involves behavior modification, guided imagery and support systems are helpful," she concluded, "and patches are a very useful tool in the program."