PATIENT HEALTH GUIDE Hooked? Heres help! 32% to 28%. The number of high school seniors A guide to smoking who smoke dropped from 29% in 1976 to 21% in 1983. cessation This article explores the options available to smokers and offers helpful smoking cessation tips. If you have attempted and failed to quit smoking Kathleen Kuk once before, try again. The benefits are almost Senior Staff Editor immediate. Within 2 years of quitting, an ex- smoker has half the risk of heart disease as a Smoking stinks. It is hard to ignore the message. person who continues to smoke. Within 10 years of Family, friends, physicians, the media, even a quitting, the risk of developing and dying from package of cigarettes themselves carry the news— smoking-related cancer approaches that of some- "Warning: The Surgeon General has determined one who has never smoked. that cigarette smoking is dangerous to your health." Kicking the nicotine habit How dangerous? Smoking, the most preventable More than 56 million Americans are hooked on cause of death in the U.S., is responsible for cigarettes. Nicotine, a natural component of the 320,000 deaths annually. It is a major cause of tobacco plant, is responsible for this dependency. emphysema, chronic bronchitis, heart disease, and The powerful drug is 6 to 8 times more addictive cancer of the lung, throat, mouth, and esophagus. than alcohol! With every puff of a cigarette, a burst It contributes to cancer of the bladder, kidney, and of nicotine to the brain creates an immediate pancreas. It causes, in fact, far more cancer deaths feeling of satisfaction. The euphoria is short lived, than all other causes of cancer combined. The however, and the smoker must light up again to bottom line is that pack-a-day smokers shave 5 recreate the sensation. Nicotine also induces a years off their life expectancy, while people who wide range of physical changes. The heart rate smoke 2 or more packs a day cut their life speeds up, blood pressure rises, and blood vessels expectancy by 8 years. constrict. The major role of nicotine, however, is to Smoking also poses a health hazard to innocent strengthen and reinforce the desire to smoke. bystanders. Smoking during pregnancy increases Abruptly cutting off the supply of nicotine throws the risk of miscarriage, birth defects, prematurity, the body into a state of temporary disarray. This and lower birth weight. Young children with adjustment period is known as withdrawal. Phys- smoking parents are twice as likely to suffer from ical withdrawal symptoms include decreased bronchitis, pneumonia, and other respiratory infec- heartbeat and blood pressure, light-headedness, tions. And nonsmoking wives of smoking husbands occasional headaches, lack of energy, insomnia, have an increased risk of heart disease and lung sore throat, cough, and stomach upset. This cancer. physical disorientation usually disappears within But enough of the lecture. If you belong to the one week. majority of smokers, you are well aware of the The psychologic response to quitting take much health hazards. Ninety percent of smokers have longer to overcome—anywhere from a few weeks admitted that they want to quit. Recent statistics to years. Recent quitters experience an overpower- reflect this desire. From 1976 to 1985, adult male ing desire to smoke. Later, this craving manifests smoking dropped from 42% of the population to itself as a pleasant recollection of the joys of 33%, while adult female smoking decreased from smoking. Almost 90% of all smokers experience 289/118 March 1987/Journal of AOA/vol. 87/no. 3 PATIENT HEALTH GUIDE craving, and 50% of quitters who relapse cite this Going it alone as a major factor. Despite the proliferation of "stop smoking" clinics And what about that old bugaboo, weight gain? and seminars, most smokers who quit do so on This overrated side effect serves as a handy excuse their own. Often, the decision is made to quit for not giving up smoking. In one study, more than "cold turkey." Studies have shown that withdrawal half of all quitters gained less than 5 lbs., stayed symptoms subside more quickly this way. The body the same, or actually lost weight! Even if someone rids itself of nicotine within 48 hours, and the does gain weight, he or she would have to put on smoker needs only to ride out the discomfort, more than 75 pounds to offset the health benefits rather than prolonging the agony with renewed, of not smoking. albeit small and less frequent, bursts of nicotine. Weight gain, unlike other mental and physical Still, a slow and steady approach to smoking side effects of nicotine withdrawal, is entirely cessation does have its advantages. Gradual re- preventable. Some quitters nurse their symptoms of ducers have time to mentally prepare themselves withdrawal by snacking; if you wish to do so, for the challenge ahead. Many smokers "step nibble on low-calorie foods, such as fruit, raw down" to brands of cigarettes with lower tar and vegetables, sunflower seeds, pickles, crackers, or nicotine content, so that the final absence of pretzels. Other folks "reward" themselves with rich nicotine is less traumatic. Other smokers increase desserts; instead, select a nonfattening treat such as the time interval between smoked cigarettes until a new outfit, record album, or trip to the movies. the point is reached that they can stop smoking Some ex-smokers need oral stimulation; substitute altogether. Another trick is to stub out the cigarette a cigarette with a carrot or celery stick, sugar-free after taking fewer and fewer puffs. gum, toothpick, or drinking straw. A final guaran- Whichever method is chosen—gradual or sud- tee against weight gain is to incorporate an den—there are numerous aids to help you toward exercise program into your new, nonsmoking your goal. Many nonprofit organizations offer self- lifestyle. An ideal time for a brisk walk is right after help booklets chock full of advice. The American dinner—at the time when you would usually settle Lung Association, for example, offers a do-it- down for an after-dinner smoke. yourself program called Freedom from smoking in 20 days. (See page 273/122 for where to write for Picking a program these and other brochures.) A sampling of stop- There comes a day when a smoker declares, smoking tips culled from the American Heart "Today is the day I am going to quit!" Fortunately, Association, American Cancer Society, American there are several paths he or she may follow to Lung Association, and National Cancer Institute achieve the goal of quitting. The important thing to appears on page 272/121. remember is that no one method is right for everyone. If you dont succeed with one approach, Over-the-counter aids try another. Aficionados of late-night television or readers who Most smoking programs have end-of-treatment peruse mail-order ads in the backs of magazines success rates of 40% to 90%. However, many may be familiar with those "amazing" cures for the quitters relapse into their old, bad habit before the smoking habit. If some of these products sound too span of a year. What distinguishes a wistful smoker good to be true, they probably are. from a successful ex-smoker? The key to success is Progressive cigarette filters are marketed as a motivation. If you do not truly want to quit, you successful smoking deterrent. The idea is to filter probably wont. out ever-increasing amounts of tar and nicotine Patient Health Guide 270/119 PATIENT HEALTH GUIDE until the smoker kicks the habit. The filters do at greater risk than people who abstain from all indeed eliminate tar and nicotine, but studies show forms of tobacco. few smokers reach the ultimate goal. Various tablets and remedies are heralded as safe Group sessions substitutes for tobacco and nicotine. Most have Commiserating with fellow quitters under the been repudiated by the Food and Drug Administra- guidance of a professional counselor is a popular tion. One formulation is still available over the approach to smoking cessation. A quick peek counter. These tablets contain a traditional Indian under "Smokers information and treatment cen- herb, lobeline. However, 10 of 11 studies con- ters" in the Yellow Pages will reveal a multitude of ducted have shown that lobeline is no more local sources. Some clinics are sponsored by effective at stopping smoking than placebo pills. nonprofit organizations, such as the American An astringent mouthwash is designed to leave a Lung Association, The Seventh-Day Adventist sweetish, metallic taste that can last up to 4 hours. Church, or local hospitals; other treatment centers After swishing with the silver acetate concoction, are run by for-profit corporations (SmokEnders and smokers supposedly lose the desire for another Smoke Watchers, for example). The fee require- cigarette. Three studies on the product have been ment to join some of these clinics may serve as that inconclusive; the Food and Drug Administration is extra incentive to stick with the program and conducting further tests. succeed. Nicotine gum is the most successful drugstore Each program tackles an identical problem in a deterrent. Surprisingly, nicotine that is chewed and slightly different fashion. As mentioned earlier, no absorbed through the blood-rich tissues of the one program can be deemed better than the others. cheek carries few of the hazards of nicotine that is Shop around and select the program that best smoked. Therefore, chomping on the gum allows matches your personality and needs. See page the smoker to break the habitual and psychologic 273/122 for where to write for more information. addiction to smoking, without having to suffer A common thread in most of these programs is physical withdrawal.