Facts you should know about smoking and quitting smoking
There are many techniques to help people quit smoking.
- Although smoking is an addiction, people can quit smoking.
- Secondhand smoke is harmful to the health of children, unborn children, family members, and coworkers.
- Quitting smoking cuts the risk of lung cancer, heart disease, stroke, and respiratory diseases.
- The steps in quitting, each of which requires special attention and efforts by the smoker, are getting ready to quit, quitting, and staying quit.
- A number of techniques are available to assist people who want to quit, including nicotine replacement therapy (NRT), behavioral modification, self-help literature, and prescription medications.
- In nicotine replacement therapy, which is the cornerstone of most smoking cessation programs, another source of nicotine is substituted while the cigarettes are stopped. (The idea of nicotine replacement therapy is to eliminate both the smoking habit – although the addiction remains – and the symptoms of withdrawal. Then, the replacement nicotine is gradually stopped.)
- Currently, three forms of nicotine replacement therapy are available over the counter: nicotine patches, nicotine gum, and nicotine lozenges, while two forms are available by prescription, an inhaler and a nasal spray.
- Nicotine replacement therapy has about a 25% success rate, which increases to 35% or 40% when nicotine replacement therapy is combined with intensive behavioral counseling.
- Nicotine-containing substances have side effects, interactions with other medications, effects on other medical conditions, and limitations in their use.
- Varenicline (Chantix) is a prescription drug that can help adults quit smoking. It is believed to act on the same receptors (the sites where nicotine acts to produce its effects) in the brain as nicotine, resulting in activation (stimulation) of these receptors and blocking the ability of nicotine to attach to these receptors.
- A prescription drug called bupropion (Zyban, Wellbutrin) has also been found to be effective in helping people to stop smoking.
- e-cigarettes are smokable, refillable or replaceable cartridges or cartridges that hold liquid that contains nicotine, solvents, and flavors.
- The safety of e-cigarettes is not known at this time.
10 Ways to Resist Tobacco Cravings
For most tobacco users, tobacco cravings can be overpowering, but it is important not to succumb to these cravings. Although the cravings can feel intense and cause anxiety, they are temporary. With appropriate measures and a support system, with time, it is possible to permanently overcome the cravings and quit tobacco smoking or chewing.
Get tips on how to resist tobacco cravings »
What problems does smoking cause?
By smoking, you can cause health problems not only for yourself but also for those around you.
Smoking is an addiction. Tobacco contains nicotine, a drug that is addictive. The nicotine, therefore, makes it very difficult (although not impossible) to quit. In fact, since the U.S. Surgeon General's 1964 report on the dangers of smoking, millions of Americans have quit. Still, approximately 484,000 deaths occur in the U.S. each year from smoking-related illnesses. This represents almost 1 out of every 5 deaths. The reason for these deaths is that smoking greatly increases the risk of getting lung cancer, heart attack, chronic lung disease, stroke, and many other cancers. Smokers die an average of 10 years earlier than nonsmokers. Smoking is the most preventable cause of death. In addition, smoking is perhaps the most preventable cause of breathing (respiratory) diseases within the USA.
Smoking harms not just the smoker, but also family members, coworkers, and others who breathe the smoker's cigarette smoke, called secondhand smoke or passive smoke. Among infants up to 18 months of age, secondhand smoke is associated with as many as 300,000 cases of chronic bronchitis and pneumonia each year. In addition, secondhand smoke from a parent's cigarette increases a child's chances for middle ear problems, causes coughing and wheezing, worsens asthma, and increases an infant's risk of dying from sudden infant death syndrome (SIDS).
Smoking is also harmful to the unborn fetus. If a pregnant woman smokes, her fetus is at an increased risk of miscarriage, early delivery (prematurity), stillbirth, infant death, and low birth weight. In fact, it has been estimated that if all women quit smoking during pregnancy, about 4,000 new babies would not die each year.
Exposure to passive smoke can also cause cancer. Research has shown that non-smokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other non-smokers. An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking, and an estimated 49,000 deaths each year in total from all smoking-related conditions occur as a result of secondhand smoke. Secondhand smoke also increases the risk of stroke and heart disease. If both parents smoke, a teenager is more than twice as likely to smoke as a teenager whose parents are both nonsmokers. Even in households where only one parent smokes, young people are more likely to start smoking.
What is addictive disease and why is smoking considered an addictive disease?
The term addictive disease or addiction describes a persistent habit that is harmful to the person. Thus, addiction is a chronic (long duration) disease with reliance on the substance causing the addiction. The addictive substance also causes the accompanying deterioration of a person's physical and psychological health.
Psychologically, an individual's behavior pattern establishes how the addictive substance is used. One type of behavior is compulsive behavior, which is an overwhelming and irresistible interest in use of the substance. For example, the compulsive addict makes sure that the substance is always available. Another type of behavior is habitual behavior, which is using the substance regularly or occasionally for the desirable effects. Physically, continuous use of the substance leads to dependence on the drug by the body. This dependence means that when the drug is discontinued, symptoms of withdrawal or distress occur.
Nicotine is the component of cigarettes that addicts. Almost immediately upon inhalation, the body responds to the nicotine. An individual feels relaxed, calmer, and happier than before the inhalation. These pleasant feelings reflect the physical side of addiction, but then, not smoking cigarettes causes a craving for more cigarettes, irritability, impatience, anxiety, and other unpleasant symptoms. Indeed, these symptoms are the symptoms of withdrawal from cigarettes. Moreover, with time, more and more nicotine is desired to produce the favorable effects and to avoid the symptoms of withdrawal.
What are the symptoms and signs of cigarette addiction?
The signs of addiction to cigarettes include:
- Smoking more than seven cigarettes per day
- Inhaling deeply and
Smoking cigarettes containing nicotine levels more
- Smoking within 30 minutes of awakening in the morning
- Finding it difficult to eliminate the first cigarette in the morning
- Smoking frequently during the morning
- Finding it difficult to avoid
smoking in smoking-restricted areas
- Needing to smoke even if sick
and in bed
Why should someone quit smoking?
Quitting smoking makes a difference right away in the way you feel. You can taste and smell food better. Your breath smells better. Your cough goes away. These benefits happen for men and women of all ages, even those who are older. They happen for healthy people as well as those who already have a disease or condition caused by smoking.
Even more importantly, in the long run, quitting smoking cuts the risk of lung cancer, many other cancers (including laryngeal, oral cavity, stomach, esophageal, cervical, kidney, bladder, and colon cancers), heart disease, stroke, and other lung or breathing (respiratory) diseases (for example, chronic bronchitis, pneumonia, and emphysema). Smoking also increases the risk of peripheral vascular disease and abdominal aortic aneurysms. Moreover, ex-smokers have better health than current smokers. For example, ex-smokers have fewer days of illness, fewer health complaints, and less frequent bouts with chronic bronchitis and pneumonia than current smokers. People who quit smoking can actually reduce their risk of developing lung cancer or other smoking-related diseases.
Finally, quitting smoking saves money. The average cost of a pack of cigarettes is approximately $6.28 a pack (depending on where you live). A smoker with a pack a day habit spends approximately $44.00 per week ($2,288 per year).
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What are the steps in quitting?
First, one can do certain things to get ready to quit. Then, there are other
things to do on the day of quitting. Finally, one can do things to help oneself
to remain abstinent. (This is the hardest part.)
Getting ready to quit smoking
- Set a date for quitting. If possible, plan to have a
friend quit smoking with you.
It's best to pick a day within the next month. A date too far off in the future
will give you a chance to procrastinate and postpone, while a date too soon may
not allow you to make a plan for medications or support systems.
- Notice when and why you smoke. Try to find the things
in your daily life that you often do while smoking (such as drinking your
morning cup of coffee or driving a car).
- Change your smoking routines: Keep your cigarettes in
a different place. Smoke with your other hand. Don’t do anything else when you
are smoking. Think about how you feel when you smoke.
- Smoke only in certain places, such as outdoors.
- When you want a cigarette, wait a few minutes. Try to
think of something to do instead of smoking. For example, you might chew gum
or drink a glass of water.
- Buy one pack of cigarettes at a time. Switch to a
brand of cigarettes that you don’t like.
On the day you quit smoking
- Get rid of all your cigarettes. Put away your
- Change your morning routine. When you eat breakfast,
don’t sit in the same place at the kitchen table. Stay busy.
- When you get the urge to smoke, do something else
- Carry other things to put in your mouth, such as gum,
hard candy, or a toothpick.
- Reward yourself at the end of the day for not
smoking. See a movie or go out and enjoy your favorite meal.
- Tell your friends and family members about your decision to quit
smoking, and ask for their support.
What is the average weight gain for those who quit smoking?
- The expected consequences of quitting are
irritability, difficulty concentrating, increased appetite, and of course,
urges to smoke. So, if you feel more short-tempered or distracted or sleepier
than usual, don’t worry because these feelings will pass.
- Try to exercise. For example,
go for a walk,
bike, if you have access to a pool
swim, take a
- Consider the positive things about quitting. For
example, think about how much you like yourself as a non-smoker, the health
benefits for you and your family, and the example you set for others around
you. A positive attitude will help you through the tough times.
- When you feel tense, try to keep busy and think about
ways to ease the tenseness. Tell yourself that smoking won’t make it any
better, and go do something else.
- Eat regular meals because feeling hungry is sometimes
mistaken for the desire to smoke.
- Start putting the money you save by not
buying cigarettes in a "money jar."
- Let others know that you have quit smoking. You will
find that most people will support you. Many of your smoking friends may want
to know how you quit. It’s good to talk to others about your quitting. In
fact, people who stay off smoking for at least one year often have had very
strong support from a companion or co-worker.
- If you slip-up and smoke, don’t be discouraged or give up and return to
your smoking habit. Many
former smokers have tried to quit several times before they finally
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What methods can help a person quit smoking?
Several methods are available to assist those who decide to quit smoking. The
main categories of methods are:
- Behavior modification and self help-literature to quit smoking
- Nicotine replacement therapy
- Prescription smoking cessation aids
actually offers several different options. Moreover, combinations of the methods
usually are necessary, and no one combination will work for everyone. In fact,
it may be necessary to try several different methods or combinations of methods
before success is achieved.
Behavioral modification and self-help literature to quit
Due to the addictive nature of nicotine, some form of behavioral modification
is often necessary for successful cessation of smoking. Educational programs,
hypnosis, and aversion therapy (learning how to avoid cigarettes) are a few
options. Smokers may be counseled to avoid specific triggers or situations that
lead to smoking. For example, instead of awakening and grabbing a cigarette at
the bedside or smoking immediately after a meal, people may be encouraged to
replace the urge to smoke with another activity, such as, taking a walk or
reading a book.
Numerous medical associations and societies, for example, the American Cancer
Society, American Heart Association, and the American Lung Association, have
developed brochures to help smokers quit smoking.
Nicotine replacement therapy to quit smoking
Nicotine replacement therapy (NRT) became available over
the counter in the 1990’s. The purpose of nicotine replacement therapy is to substitute another source of
nicotine while cigarettes are discontinued. By this means, the habit of smoking
is eliminated, even though the addiction to nicotine remains intact. But at the
same time, nicotine replacement therapy eliminates the symptoms of withdrawal that can trigger more smoking. In
addition, behavioral counseling to change smoking-related behavior usually is
necessary. Once cigarettes have been replaced during nicotine replacement
therapy, the amount of nicotine
is then gradually reduced.
Currently, there are different forms of nicotine replacement therapy available over-the-counter
- nicotine transdermal systems or patches (Nicoderm CQ and Nicotrol),
polacrilex resin or gum (Nicorette), and
- nicotine lozenges (Commit).
The nicotine patch (Nicoderm CQ and
contains nicotine that is stored within a specially designed support or matrix.
Once applied, the nicotine transdermal system steadily releases nicotine that is
absorbed across the skin and into the blood stream. The gum contains nicotine
that is released slowly upon chewing and “parking”. Parking refers to the action
of shifting the gum to one side of the cheek after chewing in order to speed the
absorption of nicotine. Nicotine lozenges contain
nicotine within a hard candy that allows for slow release of nicotine as the
candy dissolves in the mouth. A program for slowly weaning users from nicotine
replacement products is provided by each product’s manufacturer.
patch, Nicoderm CQ, is available in three strengths; 21, 14, and 7 mg. People
are advised to begin with the 21 mg patch if they smoke more than 10 cigarettes
per day or the 14 mg patch if they smoke less than 10 cigarettes per day. After
six weeks of wearing the initial patch strength, the next lowest patch strength
is worn for two weeks. If therapy was started with the 21 mg patch, an
additional two weeks is required for the 7mg patch. A maximum of eight or 10
weeks, depending upon the strength of the first patch used, is recommended for a
successful quitting program. The Nicoderm CQ patch can be worn for 16 hours
(from awakening until bedtime) or 24 hours if the urge to smoke is great upon
Nicotrol is available as a 15 mg patch, and should be worn no more
than 16 hours per day. Nicotrol may be worn for up to six weeks.
effects commonly seen with patches are:
itching, or redness at
the site of the patch,
- changes in taste.
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The gum, Nicorette, is
available in a variety of flavors in 2 strengths; 4 and 2 mg. Patients are advised to begin with the 4
mg piece of gum if they smoke more than 25 cigarettes per day or the 2 mg piece
if they smoke fewer than 7 cigarettes per day. No more than 20 pieces of the 4
mg strength or 30 pieces of the 2 mg strength should be chewed in one day.
Initial weaning from treatment should begin after 2 to 3 months and be completed
by 4 to 6 months. The most common side effects with Nicorette gum are:
- aching jaws or soreness of the gums,
- changes in taste,
- vomiting, and
Commit nicotine lozenges are available
in 2 or 4 mg doses. One dose consists of one lozenge, and no more than 20 doses
should be consumed in one day. The manufacturers of Commit recommend choosing
the proper dosage based upon when you usually have the first cigarette of your
day. According to the manufacturer’s instructions, if you smoke within 30
minutes of getting up in the morning, you should use the stronger 4 mg dose. If
not, you should use the 2 mg lozenges.
Biting or chewing nicotine lozenges
instead of allowing them to dissolve can lead to indigestion or
heartburn. You should
not eat or drink anything while the lozenge is in your mouth. The lozenges will
last for about 20-30 minutes when allowed to dissolve in the mouth. The most
commonly reported side effects with nicotine lozenges are:
- soreness of the teeth or gums,
- headache, and
How effective is nicotine replacement therapy?
Approximately 25% of patients successfully stop smoking with nicotine patch
therapy. The success rate with nicotine gum is similar. There have not yet been
studies to compare the effectiveness of nicotine lozenges to the patch or gum.
The rate of success for nicotine replacement therapy increases 35% to 40% when intensive behavioral counseling is added.
prescription products are available for smoking cessation?
There are products for cessation of smoking that are
available by prescription only. Nicotine for nicotine replacement therapy is available by prescription as
an inhaler or nasal spray (Nicotrol Inhaler and Nicotrol NS).These other forms of delivery of nicotine
seem to work as well as the nicotine patches or gum. Prescription nicotine
replacement products are more expensive than
Varenicline (Chantix) is a prescription drug approved by the U.S. FDA to help adults quit smoking. Chantix does not contain nicotine, but is believed to act on the same receptors (the sites where nicotine acts to produce its effects) in the brain as nicotine, resulting in activation (stimulation) of these receptors and blocking the ability of nicotine to attach to these receptors. Chantix should be taken seven days prior to the date an individual desires to quit smoking, and most people will keep taking Chantix for up to 12 weeks.
Side effects of the Chantix may include:
- constipation, and
- changes in dreaming.
Chantix is not appropriate for use by pregnant and breast-feeding women and people with certain chronic medical conditions.
Bupropion (Zyban) is a
medication that is used primarily for treating depression. This drug, however, also has been found to be effective in helping
people to quit smoking, and has been approved by the U.S. FDA for use in smoking
cessation in adults.
Other agents that have been tried for cessation of
smoking include serotonin reuptake antagonists (drugs also used for depression)
and the anti-hypertensive drugs clonidine (Catapres) and
blockers. Although these agents appear to be less effective than nicotine
replacement therapy, they may
be effective for some people.
How can nicotine-containing products be used safely?
Users of nicotine-containing products should understand
that all of these products have side effects as well as effects on other
underlying medical conditions such as
diabetes, high blood pressure,
asthma, and heart disease. Furthermore, these products can have interactions
with other prescribed medications such as pain relievers, blood thinners, and
high blood pressure
medications. And finally, they do have their limitations. The following
guidelines are to help you safely use these products to achieve your goal of
- Always read the labels and know the ingredients in
the products. Never take more than the recommended dose without checking with
your doctor first.
- If you are pregnant or
nursing a baby, seek the
advice of a health professional before using any nicotine-containing product.
- Do not use a nicotine-containing product if you
continue to smoke, chew tobacco, use snuff, or other nicotine-containing
- Consult a physician before using nicotine-containing products if you are under 18 years of age
- Have heart disease, an irregular heartbeat, or have
had a recent heart attack (Nicotine can
increase your heart rate.)
- Have high blood pressure that is not controlled
with medication (Nicotine can increase your blood pressure.)
- Have a history of, or currently have, inflammation
of the esophagus (esophagitis) or ulcers of the stomach or duodenum (peptic ulcer
insulin for diabetes.
- Take any prescription medications (Nicotine
interacts with some medications, such as
aspirin, some medications for the
heart, and female hormones to decrease their levels in the blood.)
- Have a skin disorder, such as
may increase the likelihood of skin reactions by the skin to the patch
should stop using nicotine-containing products and see their physician if they
have or develop:
- Mouth, tooth, or jaw problems (applies to Nicorette
- Irregular heartbeats or palpitations
- Symptoms of nicotine overdose, such as nausea,
vomiting, dizziness, weakness, and rapid heartbeat
- Severe rash,
redness, swelling, burning, or itching at the site of the patch
What are e-cigarettes?
e-Cigarettes are smokable, refillable containers or cartridges that contain fluid consisting of solvents, flavors, and varying amounts of nicotine. Inhaling from the devices is known as “vaping.” Negative pressure on the cartridge created by inhaling triggers a battery-powered heating and vaporization of the solution. The composition of the fluid in e-cigarettes varies depending upon the manufacturer.
Is an e-cigarette harmful?
There is little scientific information that determines how safe or unsafe e-cigarettes may be. Nicotine in any form is known to be addictive, and nicotine addiction can develop from using e-cigarettes. Nicotine has been shown to cause adverse health effects including:
- abdominal pain, and
- eye irritation.
More serious effects can occur with high doses of nicotine, such as:
- increased heart rate,
- high blood pressure,
- coma, and
- even death.
The US Food and Drug Administration has reported that cancer-causing nitrosamines have been detected in some e-cigarettes. Further, poison centers have reported numerous cases of poisonings of small children from consuming the liquid in the cartridges of e-cigarettes.
Is secondhand smoke from e-cigarettes harmful?
e-Cigarettes expel vapors that contain nicotine, which is known to be addictive. Depending on the composition of the fluid in the cartridge, nitrosamines or other dangerous chemicals may also be expelled. It is not known at this time how significant the risk is to the health of those who breathe secondhand vapors from e-cigarettes.
Are e-cigarettes safe to use during pregnancy?
Little is known about the long-term health effects of e-cigarettes, but nicotine has been shown to be harmful to the developing fetus. Nicotine narrows blood vessels and interferes with circulation of blood to the fetus. It can interfere with development of the fetal brain and may harm fetal lung function. It also increases the risk for sudden infant death syndrome (SIDS). Doctors recommend that pregnant women abstain from both smoking and e-cigarette use.
What is the latest research on smoking?
Health care workers have become extremely active in publicizing the negative effects of smoking. In fact, health care workers have been instrumental in passing various legislation to limit smoking in public. As a result, the proportion of people in the US who smoke has dropped from 40.4% in 1965 to around 17% in 2013 (data from the US Department of Health).
This reduction in the percent of people who smoke has been significantly less in women than in men. From 1965 to 2010, smoking among men dropped from 50.2% to 20.5% while during the same period, smoking among women dropped from 31.9% to 15.3%. So, in the future, efforts need to be made to understand and eliminate this difference between the genders.
One interesting area of the current research on smoking is the study of the population distribution of the genes for smoking (genetic epidemiology). (Genes determine an individual's inherited characteristics.) Only a small fraction of individuals who start smoking as an adolescent will actually become nicotine dependent. So, what determines which individuals will become nicotine-dependent? Investigators have found that smoking initiation (the obligatory first step) and the development of nicotine dependence are both influenced by genetic factors. The genetic factors appear to play a larger role in nicotine dependence than in smoking initiation. The next step will be to identify these genes and learn how they work in order to facilitate the development of effective prevention and treatment strategies for tobacco addiction.
Teen smoking rates remain of concern. In 2011 19% of high school girls and 28% of boys had used some form of tobacco in the prior month.. According to the American Cancer Society, the majority of cigarette use- in almost 90% of people who smoke- begins before a person reaches 18 years of age. Very few people start smoking after age 25. Statistics show that 99% of adult smokers had started by age 26. Education of the at-risk teen population is therefore critical for prevention of tobacco use. Various celebrities and activist groups actively promote campaigns aimed at a teen audience that educate about the consequences of smoking and offer advice on smoking cessation and prevention. While teen smoking rates increased during the 1990s (36% of teens smoked in 1997), prevention and education campaigns have brought about a decrease in teen smoking in recent years.