Date:  Jan 02 2000 11:27:33 EST  
From:  QuitSmokingTips <bwprice@quitsmokingsupport.com>  
Subject:  QuitSmokingTips - Volume 2 Number 1  

QuitSmokingTips is now into its 2nd year and I want to welcome the 276 new
members who have signed up in the past 2 weeks. 

I hope everyone had a Merry Christmas and a Happy and Safe New Year!

The following is courtesy of the American Cancer Society:


QUITTING SMOKING: 
 
Over 40 million people in the United States have made the decision
sometime in their lives to quit smoking. According to the US Surgeon
General, "Smoking cessation (stopping smoking) represents the single most
important step that smokers can take to enhance the length and quality of
their lives."

WHY IS IT SO HARD TO QUIT?

Mark Twain said, "quitting smoking is easy; I've done it a thousand
times." Maybe you've tried to quit too. Why is quitting, and staying quit,
hard for so many people? The answer is nicotine. 

Nicotine

Nicotine is a drug found naturally in tobacco. It is highly addictive, as
addictive as heroin and cocaine. The body becomes physically and
psychologically dependent on nicotine, and studies have shown that smokers
must overcome both of these to be successful at quitting and staying quit.

When smoke is inhaled, nicotine is carried deep into the lungs where it is
absorbed quickly into the bloodstream and carried to the heart and brain.
Nicotine affects many parts of the body, including the heart and blood
vessels, the hormonal system, body metabolism, and the brain. Nicotine
produces pleasurable feelings that make the smoker want to smoke more and
also acts as a depressant by interfering with the flow of information
between nerve cells. As the nervous system adapts to nicotine, smokers
tend to increase the number of cigarettes they smoke, and hence the amount
of nicotine in their blood. After a while, the smoker develops a tolerance
to the drug, which leads to an increase in smoking over time. Eventually,
the smoker reaches a certain nicotine level and then smokes to maintain
this level of nicotine. 

Nicotine Withdrawal

When smokers try to cut back or quit, the absence of nicotine leads to
withdrawal. Withdrawal is both physical and psychological. Physically, the
body is reacting to the absence of the drug nicotine. Psychologically, the
smoker is faced with giving up a habit. Both must be dealt with if
quitting is to be successful. 

Withdrawal symptoms can include any of the following: depression, feelings
of frustration and anger, irritability, trouble sleeping, difficulty
concentrating, restlessness, headache, tiredness, and increased appetite.
These uncomfortable symptoms lead the smoker to again start smoking
cigarettes enough to boost blood levels of nicotine back to the level at
which no symptoms occur.

If a person has smoked regularly for a few weeks or longer and abruptly
stops using tobacco or significantly reduces the amount smoked, withdrawal
symptoms will occur, usually within a few hours of the last cigarette and
peak about 48 to 72 hours later. Withdrawal symptoms can last for a few
days to several weeks. How to cope with withdrawal is covered in the
section on how to quit.

There are many reasons, however, to face the discomfort of withdrawal and
quit smoking for good.

WHY QUIT?

Your Health

Health reasons usually top the list of reasons people give for quitting
smoking. Nearly everyone knows that smoking can cause lung cancer, but few
people realize it is also a risk factor for many other kinds of cancer as
well, including cancer of the mouth, voice box (larynx), bladder, kidney,
pancreas and cervix. Cigarette smoking and cancer are covered in a
separate essay. 

Smoking increases the risk of respiratory diseases such as emphysema,
chronic bronchitis and chronic obstructive pulmonary disease (COPD).
Smokers have twice the risk of dying of heart attacks, as do non-smokers.
And smoking is a major risk factor for peripheral vascular disease, a
narrowing of the blood vessels that carry blood to the leg and arm
muscles. 

Smoking also causes premature wrinkling of the skin, bad breath, clothes
and hair to smell bad, and nails to turn yellow. 

For women, there are unique risks. Women over 35 who smoke and use "the
pill" (oral contraceptives) are in a high-risk group for heart attack,
stroke, and blood clots of the legs. They are more likely to have a
miscarriage or a lower birth-weight baby. 

For decades the Surgeon General has reported the health risks associated
with smoking. But there are benefits for smokers of all ages. Benefits
apply to healthy people and to those who might already have
smoking-related diseases. Your reasons for quittting might include some of
the following benefits:

People who quit smoking live longer than those who continue to smoke. 
After 15 years off cigarettes, the risk of death for ex-smokers returns to
nearly the level of persons who have never smoked.
 
Quitting smoking decreases the risk of lung cancers, heart disease,
stroke, chronic lung diseases, and respiratory illnesses.
 
Ex-smokers have fewer health complaints, better self-reported health
status, and reduced rates of bronchitis and pneumonia.
 
For women who stop smoking before becoming pregnant or during the first
trimester of pregnancy, they reduce their risk of having a low birthweight
baby to that of women who have never smoked reduce their risk of
miscarriage.

Cost:

The prospect of better health is a major reason for quitting, but there
are others as well. Smoking is expensive. It's not hard to figure out how
much you spend on cigarettes: multiply the number of packs you smoke per
day (be honest) by the cost per pack. Then multiply by 365 days per year.
The number may surprise you. Now multiply that by the number of years you
have been smoking and the number will probably astound you. 

Multiply the cost per year by 10 (for the upcoming ten years of smoking)
and ask yourself what you would rather do with that much money. Do you
really want to continue burning up your money with nothing to show for it
except possible health problems? 

Social Acceptance

Smoking is less socially acceptable now than it was in the past. Most
workplaces have some type of smoking restrictions, and some employers
prefer to hire non-smokers. Landlords, also, may choose not to rent to
smokers.

Friends may ask you not to smoke in their houses or in their cars. Public
buildings, concerts, even sporting events are largely smoke-free. Like it
or not, finding a place to smoke can be a hassle. 

Health of Others

Smoking not only harms your health but the health of those around you.
Exposure to environmental tobacco smoke (also called passive smoking or
second hand smoke includes exhaled smoke as well as smoke from burning
cigarettes. Studies have shown that environmental tobacco smoke can cause
lung cancer in healthy non-smokers. It is also associated with sudden
infant death syndrome (SIDS), and low-birth weight infants. Babies and
children raised in a household where there is smoking have more ear
infections, colds, bronchitis, and other respiratory problems than
children from non-smoking families do. Environmental smoke can also cause
eye irritation, headaches, nausea, and dizziness.

Setting an Example

If you have children, you want to set a good example for them. When asked,
nearly all smokers say they don't want their children to smoke, but
children whose parents smoke are more likely to start smoking themselves.
You can become a good role model for them by quitting now.

HOW TO QUIT

Smokers often say, "Don't tell me why to quit, tell me how." There is no
one right way to quit, but there are some key elements in quitting smoking
successfully. These four factors are crucial:


Making the decision to quit 
Setting a quit date and choosing a quit plan 
Dealing with withdrawal 
Maintenance or staying quit 
Making the Decision to Quit

The decision to quit smoking is one that only you can make. Others may
want you to quit, but the real commitment must come from you.

Researchers have looked into how and why people stop smoking. They have
some ideas, or models, of how this happens.

The Health Belief Model says that you will be more likely to stop smoking
if you:

believe that you could get a smoking-related disease and this worries you 

believe that you can make an honest attempt at quitting smoking
 
believe that the benefits of quitting outweigh the benefits of continuing
to smoke
 
know of someone who has had health problems as a result of their smoking

Do any of these apply to you?

The Stages of Change Model identifies the stages that a person goes
through in making a change in behavior. Here are the stages as they apply
to quitting smoking:

Pre-contemplator. This is the smoker who is not thinking seriously about
quitting right now.
 
Contemplator. This is the smoker who is actively thinking about quitting
but is not quite ready to make a serious attempt yet. This person may say,
"Yes, I'm ready to quit, but the stress at work is too much, or I don't
want to gain weight, or I'm not sure if I can do it."
 
Preparation. Smokers in the preparation stage seriously intend to quit in
the next month and often have tried to quit in the past 12 months. They
usually have a plan. 
Action. This is the first 6 months when the smoker is actively quitting. 
Maintenance. This is the period of 6 months to five years after quitting
when the ex-smoker is aware of the danger of relapse and take steps to
avoid it.
Where do you fit in this model? If you are thinking about quitting,
setting a date and deciding on a plan will move you into the preparation
stage, the best place to start.

Setting a quit date and deciding on a plan

Once you've made a decision to quit, you're ready to pick a quit date.
This is a very important step. Pick a specific day within the next month
as your Quit Day. Picking a date too far in the future allows you time to
rationalize and change your mind. But do give yourself enough time to
prepare and come up with a plan. You might choose a date with a special
meaning like a birthday or anniversary, or simply pick a date. Circle the
date on your calendar. Make a strong, personal commitment to quit on that
day.

There is no one right way to quit. Most smokers prefer to quit "cold
turkey," that is abruptly and totally. They smoke until their Quit Day and
then stop all at once, or they may smoke fewer cigarettes for a week or
two before their Quit Day. Another way involves cutting down on the number
of cigarettes smoked each day. With this method, you gradually reduce the
amount of nicotine in your body. You might cut out cigarettes smoked with
a cup of coffee, or you might decide to smoke only at certain times of the
day. While it sounds logical to cut down in order to quit gradually, in
practice this method usually is not effective. 

Quitting smoking is a lot like losing weight; it takes a strong commitment
over a long period of time. Smokers wish there were a magic bullet-- a
pill or method that would make quitting painless and easy. But that is not
the case. Nicotine substitutes can help reduce withdrawal, but they are
most effective when used as part of a stop smoking plan that addresses
both the physical and psychological component of quitting smoking. 

Here are some steps to help you prepare for your Quit Day:

Pick the date and mark it on your calendar. 
Tell friends and family of your quit day. 
Stock up on sugarless gum, cinnamon sticks, carrot sticks, hard candy. 
Decide on a plan. Will you use nicotine replacement therapy (the patch or
gum)? Will you attend a smoking cessation class? If so, sign up now. 
Practice saying, "No thank you, I don't smoke." 
Set up a support system. This could be a group class, Nicotine Anonymous,
or a friend who has successfully quit and is willing to help you.
Successful quitting is a matter of planning and commitment, not luck.
Decide now on your own plan. Some possibilities include using the nicotine
patch or gum, joining a stop smoking class, going to Nicotine Anonymous
meetings, or using self-help materials such as books and pamphlets. Your
plan should include one or more of these options.

On your Quit Day, follow these suggestions:

Do not smoke 
Get rid of all cigarettes, lighters, ashtrays, etc. 
Keep active -- try walking, exercising, or doing other activities or
hobbies 
Drink lots of water and juices 
Begin using the patch or gum if that is your choice 
Attend stop smoking class or follow a self-help plan 
Avoid high-risk situations where the urge to smoke is strong 
Reduce or avoid alcohol 
Use the four "A's" (avoid, alter, alternatives, activities) to deal with
tough situations (described in more detail later)
Dealing With Withdrawal

Withdrawal from nicotine has two parts, the physical and the
psychological. The physical symptoms, while annoying, are not life
threatening. Nicotine replacement (the patch or gum) can help reduce many
of these physical symptoms. But most smokers find that the bigger
challenge is the psychological part of quitting. 

If you have been smoking for any length of time, smoking has become linked
with nearly everything you do -- waking up in the morning, eating,
reading, watching TV, drinking coffee, etc. It will take time to "un-link"
smoking from these activities. That is why, even if you are using the
patch or gum, you may still have strong urges to smoke. 

One way to overcome these urges or cravings is to identify
rationalizations as they come up. A rationalization is a mistaken belief
that seems to make sense at the time but is not based on facts. If you
have tried to quit before, you will probably recognize many of these
common rationalizations.

I'll just have one to get through this rough spot . (Does a smoker ever
stop with just one?) 
Today is not a good day; I'll quit tomorrow. (We've heard that one
before.) 
It's my only vice. 
How bad is smoking, really? Uncle Harry smoked all his life and he lived
to be over 90. Air pollution is probably just as bad. 
You've got to die of something. 
Life is no fun without smoking.
You probably can add more to the list. As you go through the first few
days without smoking, write down any rationalizations as they come up and
recognize them for what they are: messages that can trap you into going
back to smoking. Use the ideas below to help you keep your commitment to
quitting.

Avoid. People and places where you are tempted to smoke. Later on you will
be able to handle these with more confidence. 
Alter. For example, switch to soft drinks or water instead of alcohol or
coffee. Take a different route to work; take a brisk walk instead of a
coffee break. 
Alternatives: Use oral substitutions such as sugarless gum or hard candy,
raw vegetables such as carrot sticks, or sunflower seeds. 
Activities. Exercise or hobbies that keep your hands busy (needlework,
woodworking, etc.) can help distract you from the urge to smoke.
Deep breathing and delay are two other useful tactics. When you were
smoking, you breathed deeply as you inhaled the smoke. When the urge
strikes now, breathe deeply and picture your lungs filling with fresh,
clean air. Remind yourself of your reasons for quitting and the benefits
you'll gain as an ex-smoker.

If you feel that you are about to light up, delay. Tell yourself you must
wait at least 10 minutes. Often this simple trick will allow you to move
beyond the acute urge to smoke. 

What you're doing is not easy, so you deserve a reward. Put the money you
would have spent on tobacco in a jar every day and then buy yourself a
weekly treat. Buy a magazine, go out to eat, call a friend long-distance.
Or save the money for a major purchase. You can also reward yourself in
ways that don't cost money: take time out to read, work on a hobby, or
take a relaxing bath. 

Staying Quit (Maintenance)

Remember the quotation by Mark Twain? Maybe you, too, have quit many times
before. So you know that staying quit is the final, and most important,
stage of the process. You can use the same methods to stay quit as you did
to help you through withdrawal. Think ahead to those times when you may be
tempted to smoke and plan on how you will use alternatives and activities
to cope with these situations.

More dangerous, perhaps, are the unexpected strong desires to smoke that
occur, sometimes months (or even years) after you've quit. To get through
these without relapse, try the following: 

First, review your reasons for quitting and think of all the benefits to
your health, your finances and your family. 
Second, remind yourself that there is no such thing as just one cigarette
-- or even one puff. Ride out the desire to smoke. It will go away, but do
not fool yourself into thinking you can have just one.
What if you do smoke? The difference between a slip and a relapse is
within your control. You can use the slip as an excuse to go back to
smoking, or you can look at what went wrong and renew your commitment to
staying off smoking for good.

When smokers quit - the benefits over time


20 minutes after quitting: blood pressure drops to a level close to that
before the last cigarette. Temperature of hands and feet increases to
normal. 
8 hours after quitting: carbon monoxide level in the blood drops to
normal. 
24 hours after quitting: chance of heart attack decreases. 
2 weeks to 3 months after quitting: circulation improves; lung function
increases up to 30%. 
1 to 9 months after quitting: coughing, sinus congestion, fatigue, and
shortness of breath decrease; cilia regain normal function in the lungs,
increasing the ability to handle mucus, clean the lungs, and reduce
infection. 
1 year after quitting: excess risk of coronary heart disease is half that
of a smoker's. 
5 years after quitting: stroke risk is reduced to that of a nonsmoker 5-15
years after quitting. 
10 years after quitting: lung cancer death rate about half that of a
continuing smoker's; risk of cancer of the mouth, throat, esophagus,
bladder, kidney, and pancreas decrease. 
15 years after quitting: risk of coronary heart disease is that of a
nonsmoker's.


QUESTIONS ABOUT SMOKING AND HEALTH

Is there a safe way to smoke?
No. All cigarettes can cause damage to the human body and even a small
amount is dangerous. Cigarettes are perhaps the only legal product whose
advertised and intended use smoking is harmful to the body and is a proven
cause of cancer. 

Although some people try to make their smoking habit safer by smoking
fewer cigarettes, most smokers find that difficult. Some people think that
switching from high tar and nicotine cigarettes to those with low tar and
nicotine content makes smoking safer, but this is not always true. When
people switch to lower tar and nicotine brands, they often smoke more
cigarettes or more of each cigarette to get the same nicotine dose as
before. A low-tar cigarette can be just as harmful as a high-tar cigarette
when a person takes deeper puffs, puffs more frequently, or smokes
cigarettes to a lower butt length. Even if smokers who switch to lower tar
brands do not make these changes to compensate, the health benefits are
insignificant when compared to the benefits of quitting completely.

Is cigarette smoking really addictive?
Yes. The nicotine in cigarette smoke is what causes an addiction to
smoking. Nicotine is a drug which is addicting just like heroin and
cocaine for three main reasons. First, when taken in small amounts,
nicotine produces pleasurable feelings that make the smoker want to smoke
more. Second, smokers usually become dependent on nicotine and suffer both
physical and psychological withdrawal symptoms when they stop smoking.
These symptoms include nervousness, headaches, irritability, and
difficulty in sleeping. Third, because nicotine affects the chemistry of
the brain and central nervous system, it can affect the mood and
temperament of the smoker. 


Who is most likely to become addicted?

Anyone who starts smoking is at risk of becoming addicted to nicotine.
Studies show that among addictive behaviors such as the use of alcohol and
other drugs, cigarette smoking is most likely to become an established
habit during adolescence. Therefore, when young people become cigarette
smokers they are more likely to become addicted and more likely to suffer
from the variety of health problems caused by cigarette smoking.

What does nicotine do?
Nicotine is a poison and taken in large doses could kill a person by
paralyzing breathing muscles. Smokers usually take it in small amounts
that the body can quickly break down and get rid of, which is why the
nicotine does not kill instantly. The first dose of nicotine causes a
person to feel awake and alert, while later doses result in a calm,
relaxed feeling. Nicotine can make new smokers, and regular smokers who
get too much of it, feel dizzy or nauseous. The resting heart rate for
young smokers increases 2 to 3 beats per minute. It also lowers skin
temperature and reduces blood flow in the legs and feet. Evidence shows
that nicotine plays an important role in increasing smokers' risk of heart
disease and stroke.


Does smoking cause cancer?

Yes. Tobacco smoke contains at least 43 carcinogenic (cancer-causing)
substances. Smoking causes many kinds of cancer, not just lung cancer.
Tobacco use accounts for 30%, or one in three, of all cancer deaths in the
United States. Smoking is responsible for almost 90% of lung cancers among
men and more than 70% among women, about 83% overall. Cancer of the mouth,
larynx, pharynx, esophagus, kidney, bladder, pancreas, and uterine cervix
also have in common cigarette smoking as a major cause.


How does cigarette smoke affect the lungs?

Cigarette smoking causes several lung diseases that can be just as
dangerous as lung cancer. Chronic bronchitis - a disease where the airways
produce excess mucus, which forces the smoker to cough frequently - is a
common ailment for smokers. Cigarette smoking is also the major cause of
emphysema - a disease that slowly destroys a person's ability to breathe. 

In order for oxygen to reach the blood, it must move across large surfaces
in the lungs. Normally, thousands of tiny sacs make up about 100 square
yards of surface area in the lungs. When emphysema occurs, the walls
between the sacs break down and create larger but fewer sacs,
significantly decreasing the amount of oxygen reaching the blood.
Eventually, the lung surface area can become so small that a person with
emphysema has to spend most of the time gasping for breath, with an oxygen
bottle near by or with oxygen tubes inserted into the nasal cavity.

Chronic obstructive pulmonary disease (COPD), which includes chronic
bronchitis and emphysema, kills about 81,000 people each year; cigarette
smoking is responsible for more than 65,000 of these deaths.

What in cigarette smoke is harmful?

Cigarette smoke is a complex mixture of organic and inorganic compounds
generated by the combustion (burning) of tobacco and additives. Cigarette
smoke contains tar, which is made up of over 4,000 chemicals, including
the 43 known to cause cancer. Some of these substances cause heart and
respiratory diseases, all of which are disabling and can cause death. You
might be surprised to know some of the chemicals found in cigarette smoke.
They include: cyanide, benzene, formaldehyde, methanol (wood alcohol),
acetylene (the fuel used in torches), and ammonia. It also contains the
poisonous gases nitrogen oxide and carbon monoxide. Its main active
ingredient is nicotine, an addictive drug.


Does cigarette smoking affect the heart?

Yes. Smoking cigarettes increases the risk of heart disease, which is
America's number one killer. Almost 180,000 Americans die each year from
cardiovascular disease caused by smoking. Smoking, high blood pressure,
high blood cholesterol, and lack of exercise are all risk factors for
heart disease, but smoking alone doubles the risk of heart disease. Also,
for smokers and non-smokers who have had a heart attack, smokers are more
likely to have another.


How does smoking affect pregnant women and their babies?

Pregnant women who smoke endanger the health and lives of their unborn
babies. Babies of smoking women average 6 ounces less at birth than babies
of nonsmoking women. When a pregnant woman smokes, she really is smoking
for two because the nicotine, carbon monoxide, and other dangerous
chemicals in smoke enter her bloodstream and pass directly into the baby's
body. Statistics show a direct relation between smoking during pregnancy
and spontaneous abortions, stillbirths, death among newborns, and sudden
infant death syndrome (SIDS). Research shows that the risk of SIDS triples
for babies of mothers who smoke during pregnancy; two-thirds of SIDS
deaths among babies of women who smoked during pregnancy can be attributed
to smoking.


What are some of the short- and long-term effects of smoking cigarettes?

Smoking causes cancer, which may not develop for years. Regardless of how
many smokers are lucky enough to escape cancer, the truth is inescapable:
cigarette smokers die younger than nonsmokers. In fact, smoking decreases
a person's life expectancy by 10 - 12 years. Smokers between the ages of
35 and 70 have death rates three times higher than those who have never
smoked. 

There are many more short-term effects of smoking. A major consequence of
smoking is decreased lung function which is why smokers often suffer from
shortness of breath, nagging coughing, or tiring easily during strenuous
physical activity. Smoking also diminishes the ability to smell and taste
and causes premature aging of skin.

What are the dangers of environmental tobacco smoke (ETS)?

ETS, also known as passive smoking, occurs when nonsmokers inhale the
tobacco smoke of others. This includes mainstream smoke, smoke that is
drawn through the mouthpiece of a cigarette that is then exhaled into the
air by smokers, and side stream smoke, the smoke that comes from the
burning tobacco in cigarettes. ETS contains the same harmful chemicals as
the smoke that smokers inhale. In fact, because side stream smoke is
formed at lower temperatures, it gives off even larger amounts of
cancer-causing substances. 

ETS causes lung cancer in healthy nonsmokers. A nonsmoker who is married
to a smoker has a 30% greater risk of developing lung cancer than a
nonsmoker living with a nonsmoker. Children whose parents smoke are more
likely to suffer from pneumonia or bronchitis in the first two years of
life than children who live in smoke-free households. Several studies have
also established a link between parental smoking and the occurrence of
sudden infant death syndrome (SIDS). Children of parents who smoke have a
twofold increased risk of dying of SIDS.

ETS can also affect nonsmokers by causing eye irritation, headaches,
nausea, and dizziness.

Is smoking common among young people?

Yes. Tobacco use, including smoking cigarettes, chewing tobacco, and
dipping snuff, remains common among American youth. Each day,
approximately 6,000 young persons try a cigarette and approximately 3,000
become daily smokers. If current patterns of smoking behavior persist, an
estimated 5 million US persons who were aged 0-17 years in 1995 could die
prematurely from smoking-related illnesses. These projected patterns of
smoking and smoking-related deaths could result in an estimated $200
billion (in 1993 dollars) in future health-care costs and approximately 64
million years of potential life lost.

Overall, about one-third of adolescents in the United States smoke or use
smokeless tobacco. The highest rate of smokeless tobacco use is found
among white young adults, and the lowest rate among young adult African
Americans. Twenty percent of male high-school students between the ages of
12 and 17 have used some form of smokeless tobacco.

Statistics also show that students who use other drugs, get in fights,
carry weapons, attempt suicide, and engage in high-risk sexual behaviors
are more likely to smoke.

What are the chances that smoking will kill you?

Three million people die worldwide each year as a result of smoking. In
the United States, tobacco use is responsible for nearly one in five
deaths, killing more than 400,000 Americans each year. This is more than
the number of people who would die every year if three jumbo jets crashed
each day with no survivors. Smoking is the single most preventable cause
of death in our society. Statistically, smokers die 10 - 12 years younger
than non-smokers. 

How many people smoke cigarettes?

In 1965, more than 42% of adults 18 years of age and older smoked
cigarettes. In 1995, 24.7% of adults--about 47 million people smoked
cigarettes. Approximately 28% of men and 23% of women are smokers. Blacks
smoke about the same as whites, 26% and 25%, respectively. Education level
seems to affect smoking rates as shown by a consistent decrease in the
smoking rate in groups with a higher level of education.

Why do people begin to smoke?

Most people begin smoking between the ages of 10 and 18. Peer pressure and
curiosity are the major influences that encourage them to experiment with
smoking. Also, people with parents who smoke are more likely to begin
smoking than those who have nonsmoking parents. Those who begin to smoke
at a younger age are more likely than late starters to develop long-term
nicotine addiction.

Another prevalent influence in our society is the tobacco industry's
advertisements for its products. The tobacco industry spends nearly $6
billion annually to develop and market ads that depict smoking as an
exciting, glamorous, healthy adult activity.

Can quitting really help a lifelong smoker?

Yes. It is never too late to quit. The sooner smokers quit, the more they
can reduce their chances of getting cancer and other diseases. Within 20
minutes of smoking the last cigarette, the body begins a series of
regenerating changes. After 20 minutes, blood pressure drops to normal.
After 8 hours, the carbon monoxide level in the blood drops to normal.
After 24 hours, the chance of heart attack decreases. After one year, the
risk of coronary heart disease is half that of a smoker. In 1 to 9 months,
coughing, sinus congestion, fatigue, and shortness of breath decrease and
cilia regrow in the lungs. After 10 years, the lung cancer death rate
decreases by almost half. After 15 years, the risk of coronary heart
disease is that of a non-smoker. It is important to note that the extent
to which these risks fall depends on the total amount the person smoked,
the age the person started smoking, and the amount of inhalation.

If you smoke but don't inhale, is there any danger?

Yes. Wherever smoke touches living cells, it does harm. Even if smokers
don't inhale - including pipe and cigar smokers - they are at an increased
risk for lip, mouth, and tongue cancers. Because it is virtually
impossible to avoid inhaling smoke totally, these smokers are also
increasing their risk of getting lung cancer.

Suppose I smoke for a while and then quit?

Smoking begins to cause damage right away and is highly addictive. Several
studies have found nicotine to be as addictive as heroin, cocaine, or
alcohol; it is the most common form of drug addiction in the United
States. Therefore, it is obviously better never to start smoking
cigarettes and become addicted to nicotine than it is to smoke with the
intention of quitting later. And like alcohol, heroin, and cocaine,
nicotine creates a permanent tolerance in the body. When an ex-smoker
smokes a cigarette, even years after quitting, the nicotine reaction may
be triggered, quickly hooking the person on the old habit.

How do people successfully quit?

Each year about 17 million people try to quit for at least a day during
the American Cancer Society's Great American Smoke out. Of these quitters,
more than 4 million still aren't smoking after three months. About 90% of
those who have tried to quit have done so on their own by either stopping
"cold turkey" or using other methods. Cigarette smoking in adults dropped
from 42% in 1965 to 25% in 1995.

There is no one right way to quit. Successful cessation may include one or
a combination of methods including using step-by-step manuals, attending
self- help classes or counseling, or using a nicotine replacement therapy
(nicotine patch or nicotine gum). Anything that is legal, ethical, and
effective is worth trying; this could include chewing sugarless gum,
eating carrot sticks, hiding ashtrays, taking long walks, asking others
not to smoke around you, and spending time in places where smoking is
prohibited.

According to the Surgeon General, decisions to quit or not to start in
1985 will have postponed or prevented an additional 2 million
smoking-related deaths between 1986 and the year 2000. 

What is nicotine replacement therapy?

Nicotine replacement therapies are medications that provide nicotine
without the other harmful components of cigarette smoke. To be most
effective, nicotine replacement therapy should be used with a cessation
program that addresses a person's psychological dependence on smoking. By
chewing gum containing nicotine or wearing a transdermal patch from which
the skin absorbs nicotine, a smoker's withdrawal symptoms are
significantly decreased or eliminated. 

Not everyone can use nicotine replacement therapy. People with certain
medical conditions and pregnant women should not use it. When using the
patch, it is very important that users do not smoke cigarettes or use
tobacco in any form.

Why do smokers have "smoker's cough"?

Cigarette smoke contains chemicals that irritate the air passages and
lungs. When a smoker inhales these substances, the body tries to protect
itself by coughing. The well-known "early morning" cough of smokers
happens for a different reason. Normally, cilia (tiny hairlike formations
lining the airways) beat outward and sweep harmful material out of the
lungs. Cigarette smoke, however, decreases the sweeping action, so some of
the poisons in the smoke remain in the lungs. When a smoker sleeps, some
cilia recover and begin working again. After waking up, the smoker coughs
because the lungs are trying to clear away the poisons that built up the
previous day. Unfortunately, prolonged exposure to smoke completely
destroys the cilia's ability to function. Then the smoker's lungs are even
more exposed and susceptible than before, especially to bacteria and
viruses in the air.


Are chewing tobacco and snuff safe alternatives to cigarette smoking?
No. Smokeless tobacco contains nicotine, the same addictive drug found in
cigarettes. Snuff dippers consume on average more than 10 times the amount
of cancer-causing substances (nitrosamines) than cigarette smokers. In
fact, some brands of smokeless tobacco contain as much as 20,000 times the
legal limit of nitrosamines permitted in certain foods and consumer
products, such as beer, bacon, and baby bottle nipples.

The juice from the smokeless tobacco is absorbed directly through the
lining of the mouth. This creates sores and white patches which often lead
to cancer of the mouth. Smokeless tobacco users greatly increase their
risk of other cancers including gum, pharynx, larynx, and esophagus. Other
consequences of smokeless tobacco use include halitosis (chronic bad
breath), discoloration of teeth and fillings, gum disease, and tooth loss.

Since nearly 25% of adult smokeless tobacco users also smoke cigarettes,
their risks of developing cancer is higher.

What are the health risks of smoking pipes or cigars?

Smoking cigars or pipes alone is not a healthy alternative to smoking
cigarettes. The risk for lung cancer is higher among smokers who smoke
cigarettes and cigars or pipes, and for smokers who switch to cigars or
pipes after years of cigarette smoking.

Overall cancer deaths among men who smoke cigars are 34% higher than among
nonsmokers. Cigars and pipes also release ETS, which is harmful to anyone
who breathes it.

What is being done to protect people from the hazards of smoking?

Both the public and private sectors have taken action to help decrease the
number of smoking-related deaths and illnesses in this country. Since
1966, Surgeon General's health warnings have been required on all
cigarette packages and, since 1987, on all smokeless tobacco products.
Congress banned television and radio advertising of cigarettes in 1971 and
of smokeless tobacco products in 1987.

Today, laws in 49 states and the District of Columbia restrict or prohibit
smoking in public places. Many federal work sites, including the White
House, are smoke-free. In addition, Congress has banned smoking on all
domestic airplane flights of six hours or less.

Forty-nine states and the District of Columbia have passed laws
prohibiting the sale and distribution of tobacco products to children
under the age of 18 (Virginia restrictions apply only to the sale of
tobacco products). But many (if not most) of these are ineffective because
of the difficulties in enforcing these laws. Public opinion for the
restriction of tobacco use is also evident in new cigarette tax
legislation around the country. 

How does tobacco use affect the economy?

The tobacco industry is one of the most profitable businesses in the
country; in 1991 tobacco manufacturers' revenue was $32 billion.
Nevertheless, the costs of smoking are far higher than the income from
cigarette sales. Health care costs caused directly by smoking total more
than $50 billion each year. Lost economic productivity caused by smoking
also costs the US economy more than $50 billion each year. This totals
more than $100 billion lost each year to health care costs and lost
productivity due to smoking.

Of course these numbers represent only the financial costs. No statistic
can express the devastation of pain and suffering caused by cigarette
smoking.

ARE MENTHOL CIGARETTES SAFER THAN OTHER BRANDS?

Menthol cigarettes are not safer than other brands and may even be more
dangerous. About 28% of all cigarettes sold in the United States are
menthol. About 76% of African American cigarette smokers smoke menthol
cigarettes as compared to 23% of whites. These brands contain enough
menthol to produce a cool sensation in the throat when smoke is inhaled.
People who smoke menthol cigarettes can inhale more deeply or hold the
smoke inside longer than smokers of non-menthol cigarettes. This may
explain why African Americans, who statistically smoke fewer cigarettes a
day (but more menthol cigarettes), are more likely than whites to die from
smoking-related diseases like lung cancer, heart disease, and stroke.

WHERE CAN I GO FOR ADDITIONAL HELP?

It is hard to fight any addiction, and smoking is no different. But you
can quit! More than 40 million Americans have successfully quit smoking.
Call the human resources office where you work; many companies have
information about employee cessation programs. A variety of organizations
offer information on how to quit and where to go for help.

If you want to quit smoking and need help, talk with your health care
provider and contact one of the following organizations. They can provide
you with current information, advice, and suggestions for beginning the
end of your tobacco use.

American Cancer Society
Telephone: 1-800-ACS-2345
Internet: www.cancer.org

Agency for Health Care Policy and Research
Internet Address: www.ahcpr.gov

American Academy of Medical Acupuncture
Telephone: 800-521-2262 (Patient Referral Line) 

American College of Obstetricians & Gynecologists
Telephone: 202-638-5577
Internet Address: www.acog.org

American Heart Association
Telephone Number: 800-242-1793 (call center) or 800-242-1793 or
214-373-6300 (administrative offices)
Internet Address: www.amhrt.org 

American Lung Association
Telephone: (800) 586-4872 or 212-315-8700 
Internet Address: www.lungusa.org

National Cancer Institute 
Cancer Information Service
Telephone: 800-4-CANCER or 800-422-6237
Internet Address: www.nci.nih.gov

National Women's Health Information Center (NWHIC)
Telephone: 800-994-WOMAN or 800-994-9662
Internet Address: www.4woman.org

Nicotine Anonymous
Telephone: 415-750-0328
Internet Address: www.nicotine-anonymous.org

Office on Smoking & Health
National Center for Disease Prevention and Health
Telephone: 770-448-5705
Internet Address: www.cdc.gov/tobacco

Tobacco-Free America Legislative Clearinghouse
Telephone: 202-452-1184

REFERENCES

Agency for Health Care Policy and Research, U.S. Department of Health and
Human Services
Centers for Disease Control and Prevention.

Fiore MC, Smith SS, Jorenby DE, Baker TB. The effectiveness of the
nicotine patch for smoking cessation. A meta-analysis. Journal American
Medical Association. 1995; Jan 18: 273 (3): 181.

Hurt RD, Sachs DPL, Glover ED et al. A comparison of sustained-release
bupropion and placebo for smoking cessation, New England Journal of
Medicine, October 23, 1997; 337: 17.

Nicotine Nasal Spray Aims to Halt Smoking. New York Times, March 26, 1996,
C7.

Stapleton JA, Russell MA, Feyerabend C. et al. Dose effects and predictors
of outcome in a randomized trial of transdermal nicotine patches in
general practice. Addiction, Jan. 1995; 90 (1): 31-42.

The Health Benefits of Smoking Cessation. Centers for Disease Control and
Prevention. DDHS Publication No. (CDC) 90-8416, 1990. 

Glantz, Stanton. Tobacco Biology and Politics, Health Edco, 1994, 8-11. 

Tonnesen P, Norregaard J, Simonsen K, Sawe U. A double-blind trial of a
16-hour transdermal nicotine patch in smoking cessation. New England
Journal of Medicine. August 1, 1991; 325: 5: 311-315. 

Tonnesen P et al. Two and four mg nicotine chewing gum and group
counseling in smoking cessation: an open, randomized, controlled trial
with a 22 month follow-up. Addictive Behaviors. 1988; 13 (1): 17-27. 

Transdermal Nicotine Study Group. Transdermal nicotine for smoking
cessation. Six-month results from two multicenter controlled clinical
trials. Journal American Medical Association. Dec 11, 1991; 266 (22):
3133-3138. 

US Dept of Health & Human Services. Reducing the Health Consequences of
Smoking: 25 years of Progress. A Report of the Surgeon General. USD HHS,
PHS-CDCP, CCD PHP Office of Smoking & Health. DHHS Publ # (CDC) 89-8411
1989. 

US Department of Health and Human Services. The Health Consequences of
Smoking: Nicotine Addiction: A Report of the Surgeon General, US DHHS,
PHS, CDC. Office on Smoking and Health. DHHS Publ# (CDC) 88-8406. 

REVISED 8/21/99