Check Your Smoking

Quit Smoking Successfully

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Ifs,

Ands

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WHY QUIT SMOKING?

For your health, loved ones, finances, community, popularity, vitality, environment, and safety.

If you are like a great many smokers, you probably want to quit. Most smokers say they would tike to stop and would do so if there were some easy and different ways to do so. Each year, about one-third of all smokers make an earnest attempt to kick the habit. True, there are many failures. Most smokers make more than one attempt at quitting before they are successful. It took a long time for you to "learn" the cigarette habit. It can't be unlearned overnight. Quitting is tough, but not impossible. More than 3 million Americans quit every year.

Understand that withdrawal symptoms are temporary. They usually last only 1-2 weeks. Know that most relapses happen in the first week after quitting, when withdrawal symptoms are strongest and your body is still dependent on nicotine. Be aware that this will be your hardest time and use all your personal resources-willpower, family and friends-to get you through this critical time successful.

Many smokers have successfully given up cigarettes by replacing them with new habits, without quitting "cold turkey,' planning a special program, or seeking professional help. There are many tricks to help you give up smoking. Remember that successful methods are as different as the people who use them. What may seem silly to others may be just what you need to quit-so don't be embarrassed to try something new. Pick a method that makes sense to you; then follow through--you'll have a better chance of success.

Facts on File

Smoking is the single most important preventable cause of death in our society.
Smoking is responsible for more than 1 out of 6 deaths in the nation.
Among women, smoking accounted for 30,000 deaths in 1965 & 106,000 deaths in 1985 from ten causes: heart disease, stroke chronic obstructive pulmonary disease and cancer of the mouth, esophagus, larynx, pancreas, bladder & kidney.
Attention women: Smoking has become an "equal opportunity" disease
By the year 2000, it is anticipated that a larger proportion of women than men will be smokers.

SMOKING: IT'S NEVER TOO LATE TO STOP

Smoking, high blood pressure, and high blood cholesterol (a fatty substance in the blood) are major factors that contribute to coronary heart disease. A person with high blood pressure or high cholesterol who also smokes has a much greater risk of heart attack than a person who has only one of these risk factors.

When a person stops smoking the benefits to the heart and circulatory system begin right away. The risk of heart attack, stroke, and other circulatory diseases drops. Circulation of blood to the hands and feet improves. Although quitting smoking won't reverse chronic lung damage, it may slow the disease and help retain existing lung function.

Smoking also causes several types of cancer, including those of the lungs, mouth, larynx and esophagus. It plays a role in cancers of the pancreas, kidney, and bladder. A smoker's risk of cancer depends in part on the number of cigarettes smoked, the number of years of smoking, and how deeply the smoke is inhaled. After a smoker quits, the risk of cancer or heart disease begins to decline, and within a decade the risk is reduced to that of a non-smoker. It's never too late to quit!

Check Your Smoking		An Important Quiz for Older Smokers
I.Q.		If you or someone you know is an older smoker, you may think there is no point in quitting now. Think again. By quitting smoking now, you will feel more in control and have fewer coughs and colds. On the other hand, with every cigarette you smoke, you increase your chances of having a heart attack, a stroke or cancer. Need to think about this more? Take this older smokers’ I.Q. quiz. Just answer "true" or "false" to each statement below.

		T	F
1	If you have smoked for most of your life, it’s not worth stopping now.	o	o
2	Older smokers who try to quit are more likely to stay off cigarettes.	o	o
3	Smokers get tired and short of breath more easily than smokers of the same age do.	o	o
4	Smoking is a major risk for heart attack and stroke among adults 60 years of age or older	o	o
5	Quitting smoking can help those who have already had a heart attack.	o	o
6	Most older smokers don’t want to stop smoking.	o	o
7	An older smoker is more likely to smoke MORE cigarettes than a younger smoker is.	o	o
8	Someone who has smoked 30 or 40 years probably won’t be able to quit smoking.	o	o
9	Very few older adults smoke cigarettes.	o	o
10	Lifelong smokers are more likely to die of disease like emphysema and bronchitis than non-smokers are. Prepared by the National Heart, Lung and Blood Institute Smoking Education Program	o	o

How can I quit smoking?

You learned to be a smoker. Now you can learn to be a nonsmoker.

How? You practice. Practice going without cigarettes. Keep practicing.

Learning anything new is tough at first. It does get easier, after the first few weeks.

Work with a buddy and quit together.
Start a no-smoking group at work.
Attend a smoking cessation program.
You can do it with a friend...or without.

Smokers who stay smokers

Cigarettes do a lot for me.
They’re kind of a friend (or a crutch)
Always there when I need them
Quitting deprives me
I resent being deprived

Smokers who quit smoking

Cigarettes make me cough, feel breathless, trigger heart trouble, cause lung cancer, chronic bronchitis and emphysema.
Cigarettes deprive me of life--health
Quitting has tremendous advantages for me.

There are two ways to quit.

Cold Turkey. This works best for those who are really hooked. Difficult at first, but very rewarding.

Tapering off.

Sometimes it helps to think of quitting one day at a time--instead of from here to eternity.

Tell yourself you won’t smoke today, and then don’t.

Even one nonsmoking day is a break for your heart and lungs.

Remember that practice makes perfect. You can do it.

PREPARE YOURSELF TO QUIT SMOKING

Decide positively that you want to quit. Try to avoid negative thoughts about how difficult it might be. List all the reasons you want to quit. Every night before going to bed, repeat one of the reasons 10 times.
Develop strong personal reasons in addition to your health and obligations to others. For example, think of all the time you waste taking cigarette breaks, rushing out to buy a pack, hunting for a light, etc.
Begin to condition yourself physically. Start a modest exercise program, drink more fluids, get plenty of rest, and avoid fatigue.
Set a target date for quitting-perhaps a special day such as your birthday, your anniversary, or the Great American Smokeout. If you smoke heavily at work quit during your vacation so that you're already committed to quitting when you return. Make the date sacred, and don't let anything change it. This will make it easy for you to keep track of the day you became a non-smoker and to celebrate that date every year.
Bet a friend you can quit on your target date. Put your cigarette money aside for every day and forfeit it if you smoke. (But if you do smoke, don't give up. Simply strengthen your resolve and try again.)
Ask your spouse or a friend to quit with you. Tell your family and friends that you're quitting. They can be an important source of support-both before and after you quit.

When smokers quit

Within 20 Minutes

Blood pressure drops to normal

Pulse rate drops to normal

Temperature of hands and feet increase to normal

Within 8 Hours

Smoker’s breath disappears

Carbon monoxide level in blood drops to normal

Oxygen level in blood increases to normal

Within 24 Hours

Chance of heart attack decreases

Within 3 days

Breathing is easier

Within 2 to 3 Months

Circulation improves

Walking becomes easier

Lung function increases up to 30 percent

Within 1-9 Months

Coughing, sinus congestion, fatigue, shortness of breath decrease

Cilia that sweep debris from your lungs grows back increasing your ability to handle mucus, clean the lungs, reduce infection

Energy increases

Within 1 Year

Risk of coronary heart disease is half that of a smoker

Within 2 Years

Heart attack risk drops to near normal

Within 5 Years

Lung cancer death rate for average pack-a-day smoker decreases by almost half

Stroke risk is reduced

Risk of mouth, throat and esophageal cancer is half that of a smoker.

Within 10 Years

Lung cancer death rate is similar to than of a person who does not smoke.

The pre-cancerous cells are replaced

Within 15 years

Risk of coronary heart disease is the same as a person who has never smoked

Information Source: American Cancer Society

WAYS TO QUIT SMOKING

SWITCH BRANDS	Switch to a brand you find distasteful. Change to a brand that that is low In tar and nicotine a couple of weeks before your quit date. This will help change your smoking behavior. However, do not smoke more cigarettes, inhale them more often or more deeply, or place your fingertips over the holes in the filters.
CUT DOWN THE NUMBER OF CIGARETTES YOU SMOKE	Smoke only half of each cigarette. Each day, postpone lighting your first cigarette one hour. Smoke on odd or even hours of day. Decide how many you will smoke during the day. For each additional cigarette, give a dollar to your favorite charity. Change your eating habits to help you cut down. For example, drink milk, which many people consider incompatible with smoking. End meals or snacks with something that won't lead to a cigarette Reach for a glass of juice instead of a cigarette for a "pick-me-up."
DON'T SMOKE "AUTOMATICALLY"	Smoke only those cigarettes you really want. Catch yourself before you light up a cigarette out of pure habit. Don't empty your ashtrays. This will remind you of how many cigarettes you have smoked each day. Make yourself aware of each cigarette by using the opposite hand or putting cigarettes in an unfamiliar location or a different pocket to break the automatic reach.
MAKE SMOKING INCONVENIENT	Stop buying cigarettes by the carton. Don't carry cigarettes with you at home and at work. Make them difficult to get
MAKE SMOKING UNPLEASANT	Smoke only under circumstances that are not especially pleasurable for you. If you like to smoke with others, smoke alone. Turn your chair toward an empty comer and focus only on the cigarette you are smoking and 'its many negative effects. Collect all your cigarette butts in one large glass container as a visual reminder of the filth smoking represents.

COMMON EXCUSES FOR SMOKING

I'M UNDER A LOT OF STRESS, AND SMOKING RELAXES ME	Your body is used to Nicotine, so you naturally feel more relaxed when you give it a substance it has come to depend on. But nicotine is a stimulant-it raises your heart rate, blood pressure, and breathing rate. Most ex-smokers feel much less nervous just one to two weeks after quitting.
SMOKING MAKES ME MORE EFFECTIVE IN MY WORK	Trouble concentrating con be short-term symptom of quitting, but smoking actually deprives your brain of oxygen
I'VE ALREADY CUT DOWN TO A SAFE LEVEL	Cutting down is a good first step, but there is a big difference in the benefits to you between smoking a little and not smoking at all. Besides, smokers who cut back often inhale more often and more deeply-thus canceling the benefits of cutting back. After you have cut back to about seven cigarettes a day, pick a quitting date within 1-2 weeks.
I SMOKE ONLY SAFE, LOW TAR, LOW- NICOTINE CIGARETTES.	These cigarettes still contain harmful substances, and many smokers who use them inhale more often and more deeply to maintain their nicotine intake Also, carbon monoxide intake often increases with a switch to low-tar cigarettes.
IT'S TOO HARD TO QUIT. I DON'T HAVE THE WILLPOWER	Quitting and staying away from cigarettes is hard, but it's not impossible More than 3 million Americans quit every year It's important for you to remember that many people have had to try more than once, and try more than one method, before they become ex-smokers, but they have done it and so can you.
SOMETIMES I HAVE AN IRRESISTIBLE URGE TO HAVE A CIGARETTE	This is a common feeling, especially within the first 1-3 weeks. The longer you are off cigarettes, the more your urges will come at times when you smoked before, such as When you're drinking coffee or alcohol or you are at a cocktail where other people are smoking. If you can't avoid these high- risk situations, you can try to visualize how you will handle the desire for a cigarette if these occasions happen.
I BLEW IT. I SMOKED CIGARETTE	Smoking one or even a few cigarettes doesn't mean you have "blown it". It does mean that you have to strengthen your will to quit and try again. Don't forget that you got through several days-perhaps even weeks or months-without a cigarette. This shows that you don't need cigarettes and that you can be a successful quitter.

WHAT HAPPENS AFTER YOU QUIT SMOKING...

Immediately after quitting, many ex-smokers experience "symptoms of recovery" such as temporary weight gain caused by fluid retention, irregularity, and dry, sore gums or tongue. You may feel edgy, hungry, tired, short tempered and have trouble sleeping. You may notice that you're coughing a lot. These symptoms are the result of your body clearing itself of nicotine, a powerful addictive chemical. Most nicotine is gone from the body in 2-3 days.
Within 12 hours after you have your last cigarette; your body will begin to heal itself. The levels of carbon monoxide and nicotine in your system will decline rapidly, and your heart and lungs will begin to repair the damage caused by cigarette smoke.
Within a few days, you'll probably begin to notice some remarkable changes to your body. Your sense of smell and taste may improve. Although you'll breathe easier and your smoker's hack will begin to disappear, you may notice that you still cough for awhile, and you'll be free from the mess, smell, inconvenience, and expense.
The after-effects of quitting are only temporary. After you quit, you will begin adding a number of healthy productive days to each year of your life. Most important, you've greatly improved your chances for a longer life. You've significantly reduced your risk of death from heart disease, stroke, chronic bronchitis, emphysema, and several kinds of cancer.

YOU DON'T HAVE TO GAIN WEIGHT WHEN YOU STOP SMOKING

Weight gain is one of the greatest fears of smokers who want to quit and that fear can become a "convenient" excuse for continuing to smoke. Actually, only 25% of people who quit gain weight There are two important reasons why some people gain weight when they stop smoking: 1) since smoking is an oral habit (like eating), it Is easy to grab something to eat every time you want a cigarette, and 2) your body's metabolism burns calories at a slower rate when the stimulating chemicals found in cigarettes are no longer present. You can give up tobacco and not gain weight. Here are some helpful hints:

Stock low-calorie snacks (celery, carrots, sugarless gum, and mints) at home and at work.
Avoid soft drinks, coffee or tea. Caffeine is associated with smoking.
It may be easier to quit smoking if you give up alcohol for a while.
Don't let "cigarette" breaks become eating breaks. Go for quiet walk or make a couple of trips up and down the stairs.
Satisfy your cravings with good tasting, low-calorie foods.

SMOKY AIR

Every time a cigarette is lit, smoke enters the air from "mainstream" and "mainstream" sources. Mainstream smoke is pulled through the cigarette and is exhaled by the smoker. Sidestream smoke comes from the burning end of the cigarette.

A smoker inhales and exhales mainstream smoke eight or nine times with each cigarette for a total of about 24 seconds, but the cigarette itself burns for 12 minutes and pollutes the air continuously with sidestream smoke.

Non-smokers are exposed to mainstream smoke after the smoker exhales it, but even more harmful for non-smokers is the sidestream smoke, which goes directly into the air from the burning cigarette. Sidestream smoke has higher concentrations of poisons than smoke inhaled by the smoker. Some studies show there is twice as much tar and nicotine in sidestream smoke compared to mainstream. Nearly 85% of the smoke in a room comes from sidestream smoke. There are no safe levels of tobacco smoke.

CIGARETTE SMOKING AND CARDIOVASCULAR DISEASES

AHA Scientific/Medical Position

Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for about 417,000 of the more than 2 million annual deaths. Cigarette smokers have a greater risk of developing chronic disorders such as atherosclerosis, several types of cancer and chronic obstructive pulmonary disease. Atherosclerotic cardiovascular disease (clogged arteries) is the chief contributor to the excess deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease (heart attack).

Risk factors

Cigarette/tobacco smoke, high blood cholesterol, high blood pressure and physical inactivity are the four major independent and modifiable risk factors for coronary heart disease. Cigarette smoking is so widespread and significant as a risk factor that the Surgeon General has called it "the most important of the known modifiable risk factors for coronary heart disease in the United States."

A relationship exists between cigarette smoking and the risk of coronary heart disease. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. Cigarette smoking is the most important risk factor for both young men and women. It produces a greater relative risk in persons under 50 years of age than in those over 50 years old.

Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease compared with women who neither smoke nor use oral contraceptives.

The ratio of high-density lipoprotein cholesterol to low-density lipoprotein cholesterol is lower in cigarette smokers than in non-smokers. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk.

The AHA also believes more study is needed of the effects of passive smoking (also called secondhand smoke and environmental tobacco smoke) on heart and blood vessel disease in non-smokers. Several studies already document the health hazards posed by passive smoking. It’s estimated that from 37,000 to 40,000 people die from heart and blood vessel disease caused by other people’s smoke each year.

1996 American Heart Association ENVIRONMENTAL TOBACCO SMOKE

In January 1993 the Environmental Protection Agency (EPA) officially declared Environmental Tobacco Smoke (ETS) a known human carcinogen, classifying it as an environmental toxin equivalent to asbestos and other hazardous substances. The EPA’s report "Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders," calls ETS a serious and substantial health risk for nonsmokers, particularly children.

AHA Scientific/Medical Position

In 1992 the AHA’s Council on Cardiopulmonary and Critical Care concluded that environmental tobacco smoke (ETS) is a major preventable cause of cardiovascular disease and death. The statement urges that environmental smoke be treated as an environmental toxin, and that ways be found to protect workers and the public from this health hazard.

Interesting?

ETS contains more than 4,000 chemicals and at least 40 known carcinogens. Nicotine, the addictive drug contained in tobacco, leads to acute increases in heart rate and blood pressure. Cigarette smoking also increases platelet aggregation, or blood clotting. It also damages the endothelium, the layer of cells that line all blood vessels, including the coronary arteries. In addition, nonsmokers who have high blood pressure or high blood cholesterol are at even greater risk of developing heart diseases from ETS exposure.

The 1986 Report of the Surgeon General, as well as studies by the National Academy of Sciences (NAS), thoroughly document the health hazards posed by passive smoking. Evidence of the hazards of involuntary tobacco smoking continues to mount. A January 1991 report published in Circulation, an AHA scientific journal, cited a set of epidemiological studies linking heart disease with passive exposure to tobacco smoke. The report concluded that exposure to environmental tobacco smoking causes about 10 times as many deaths from heart and blood vessel diseases as it does from cancer. The best method for controlling worker exposure is to eliminate tobacco use from the workplace and to implement a smoking cessation program.

CIGARETTE SMOKING STATISTICS

Current estimates for the United States are that 25.1 million men (27.5 percent) and 22.5 million women (22.7 percent) are smokers, putting them at increased risk of heart attack. In addition, an estimated 2.1 million teenagers aged 12 through 17 years are smokers. The latest estimates show that:

•27.0 percent of white males and 23.7 percent of white females are smokers. Among blacks the figures are 33.2 percent for males and 19.8 percent for females.

• Among Asians/Pacific Islanders, 19.4 percent of males and 9.7 percent of females smoke. Among American Indians/Alaskan Natives, 39.9 percent of males and 28.7 percent of females are smokers.

• Studies show that smoking prevalence is several times higher among those with less than 12 years of education compared to those with more than 16 years of education.

• In the United States studies show that smoking has declined by 40 percent since 1965. However, recent data show that the downward trend may have leveled off.

Smoker's Face

Another Reason to Quit the Habit

The doctor could tell the patient had once been an attractive woman.

But now, though only in her 50s, her face was etched with wrinkles, her features gaunt-looking with prominent underlying bones and her skin shriveled and gray with purplish blotches.

Diagnosis: smoker's face.

Dr. Douglas Model of Eastbourne, England, added this condition to the medical lexicon in 1985 after surveying 116 patients and correctly identifying roughly half of current smokers by their facial features alone.

The distinctive characteristics of smoker's face, which makes people look far older than their years, were present in 19 (46 percent) current smokers, 3 (8 percent) former smokers and no nonsmokers, irrespective of their age, social class, recent weight fluctuations and exposure to sunlight.

It is hoped that the all-too-visible and often discomforting damage to skin induced by smoking will encourage more people to quit, "especially those who may be more concerned about their outward appearance than the potential internal damage associated with smoking."

Smoking damages cells and tissues in so many ways that it can have myriad effects on the body. Among them are these:

WRINKLES: "For some patients the threat of wrinkles may be a more powerful motivator to help them stop smoking than the more deadly consequences of smoking," Smith wrote. He explained that, as with skin that is overexposed to sunlight, smoking causes thickening and fragmentation of elastin, the elastic fibers that are long and smooth in healthy skin.

CIRCULATION: Smoking also depletes the skin's oxygen supply by reducing circulation. It decreases the formation of collagen, the skin's main structural component, and may reduce the water content of the skin, all of which increase wrinkling. Smoking also interferes with the skin's ability to protect itself against damage by free radicals, highly reactive substances that are omnipresent in tobacco smoke. In women, smoking diminishes the level of circulating estrogen, which in turn fosters dryness and disintegration of skin tissues.

SKIN CANCERS: Two kinds of skin cancers, the more curable squamous cell carcinomas and the often lethal melanomas, are influenced by smoking. Smith said that although smoking did not cause melanoma, smokers with melanoma were more likely to die of their disease. They are twice as likely to have advanced disease at the time of diagnosis and are more likely to have their cancers spread within two years of diagnosis, probably because smoking impairs the immune system.

As for squamous cell carcinoma, even when exposure to sunlight was taken into account, smokers were found to be at greater risk of developing this cancer. In a study of more than 107,000 nurses, for example, the risk of developing squamous cell carcinoma was 50 percent greater in smokers than in those who had never smoked. Smokers also tend to get particularly "large, bad" skin cancers, Smith said.

OTHER CANCERS: Cancers of the lip, mouth, penis, anus and vulva are also more common in smokers than nonsmokers. For example, in one study of 903 female cancer patients, 60 percent of those with vulvar and anal cancers and 42 percent of those with cervical and vaginal cancers were smokers as against only 27 percent of comparable women without cancer. Smoking more than 10 cigarettes a day more than doubles a man's risk of developing penile cancer.

DELAYED WOUND HEALING: The problem of slow or incomplete healing of wounds associated with exposure to cigarette smoke was clearly demonstrated in laboratory animals in the 1970s. Then surgeons began reporting on similar problems in patients who smoked: larger scars in women undergoing exploratory abdominal surgery, more complications and skin sloughing after face lifts and a much higher failure rate of skin grafts, for example. The more and the longer patients had smoked, the greater the likelihood of impaired wound healing. Even resuming smoking during an uneventful recovery could lead to adverse effects.

Smith linked the slow healing of wounds to known effects of cigarette smoking, which constricts surface blood vessels, reduces the oxygen level in the blood, thickens the blood and impedes the laying down of collagen needed for healing.

PSORIASIS AND RELATED DISEASE: Studies of both men and women with this unsightly and discomforting skin condition have shown that smokers are about two to three times as likely to develop it as nonsmokers. And the morecigarettes smoked, the greater the risk.

Palmoplantar pustulosis,a difficult-to-treat skin condition that resembles psoriasis, occurs only on the palms of the hands and soles of the feet. The skin blisters, then forms a scaly rash. It occurs almost exclusively in smokers, and it does not necessarily go away when the patient quits smoking, Smith said. The condition involves white blood cells called neutrophils. Smoking causes an increase in neutrophils and also induces changes in their function and shape.

ORAL LESIONS: In addition to smoker's face, there is also smoker's palate and smoker's tongue. The tars and heat of tobacco smoke can cause tiny red pimples in the mouth that result from an inflammation of the openings of salivary glands. Smokers also often develop depressions on the surface of the tongue. Potentially more serious, however, are lesions called leukoplakia, which are about six times more common in smokers than in nonsmokers. Although benign, these white patches in the mouth can become cancerous.

BUERGER'S DISEASE: This blood vessel disease results in poor circulation in the lower legs, causing skin problems like burning, tingling and ulcerations. "It usually occurs in young men who smoke, men in their 30s," Smith said. "But now that women are smoking a lot more, we're seeing it in women too."

OTHER SKIN CONDITIONS: Many skin diseases are associated with diabetes, which impairs circulation to the outer reaches of the body. A study of more than 112,000 female nurses followed for 12 years showed that current smokers faced an increased risk of developing noninsulin-dependent diabetes, and that the risk rose with the number of cigarettes smoked each day. Another study of nearly 43,000 male health professionals showed that smoking 25 or more cigarettes a day doubled a man's risk of developing diabetes.

People who smoke are much more likely to develop the bowel disorder Crohn's disease, which can cause "big, ugly-looking ulcerations, most often on the legs, and painful red nodules, usually on the lower legs," Smith said.

Another condition more common in smokers is systemic lupus erythematosus, an autoimmune disease that can cause rashes on the face, scalp, hands and elsewhere, ulcerations in the mouth and hair loss. Studies show that the more cigarettes smoked, the greater the risk of developing lupus.

EXCERPT. Jane Brody, 1996 The New York Times