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WHAT IS IT?
People who quit smoking usually don’t decide to quit because of all the bad news about it. They already know it’s bad for them. Often, experts say, smokers quit because they simply get fed up with being controlled by the habit.

Still, the facts about smoking are as true as ever. It kills more Americans than auto and airplane accidents, AIDS, cocaine and heroin overdoses, and murder combined. Smoking tobacco, in fact, kills about 400,000 men and women each year, which makes it the leading cause of preventable death in the United States. One in every five deaths is smoking-related, and, on average, smokers die seven years earlier than nonsmokers.

Smoking results in many kinds of cancers, above all lung cancer. It’s also a major cause of heart disease, stroke, and a host of other health problems, including emphysema and bronchitis.

And it hurts more than just the smoker. Secondhand smoke (other people’s tobacco smoke) kills as many as 68,000 Americans each year. It is especially hard on children: Adults who smoke around kids put them at high risk for a number of problems, including colds, ear infections, asthma, and even sudden infant death syndrome-when a healthy baby dies during sleep.

Many people have trouble kicking the habit because tobacco contains a highly addictive substance: nicotine. It provides a “fix” every time you light up. But you can quit. There are many things you can do to ease your cravings for tobacco and kick the habit. Your doctor can also help.
WHAT IS HAPPENING?
With every puff of tobacco smoke you inhale, nicotine passes through your lungs into your bloodstream. Your blood pumps nicotine right to your brain, which absorbs it in seconds and releases chemicals that make your heart beat faster, raise your blood pressure, and boost your spirits.

It doesn’t take long before you start to depend on this boost to feel normal. When nicotine levels in your blood fall too low, you have symptoms of withdrawal-headaches, fatigue, and bad moods.

Nicotine isn’t the only thing in tobacco that causes problems. Carbon monoxide, a deadly gas, steals oxygen from your red blood cells and impairs eyesight, hearing, and judgment. It also raises your risk of stroke and heart attack.

The tar in tobacco smoke lodges in your lungs. Some of the chemicals in this tar can cause cancer by changing normal cells into cancer cells.

The tar and gas also damage your lungs in other ways. They raise your risk of bronchitis and emphysema, a sometimes deadly illness that keeps you from getting enough air.
WHAT CAUSES IT?
No one can say exactly why one person gets hooked on smoking and another doesn’t, or why some people are more likely to get a serious illness from smoking. But researchers have found certain factors that increase a person’s risk of starting and staying with the habit, and then falling ill from it.

Peer pressure
Young people often start smoking and keep it up to appear cool. Ads on billboards and elsewhere portray smoking as sexy and fun; they pass over the fact that it can make you sick and spoil your looks.

Social habits
People often smoke to calm down, ease fear, or enhance pleasure. They find it’s soothing to go through the ritual of lighting a cigarette and even holding or gesturing with one. Some smokers also become used to having tobacco at certain times: when they’re with other smokers, after eating, while working, or after sex.

Living with a smoker
Studies show that children who live with adults who smoke are more likely than other kids to take up the habit themselves. As adults, if they have children and continue to smoke, their own kids are also more likely to smoke, passing the deadly habit from generation to generation. Even if they themselves never smoke, though, people who live around smokers have a much higher risk of lung cancer and heart disease.

Heavy smoking
While there’s no safe level of smoking, heavy smokers-those who smoke more than a pack of cigarettes a day-have a much higher risk of getting tobacco-related diseases than lighter smokers.

Years of smoking
Longtime smokers have a much higher risk of illness than those who quit early.
WHAT YOU CAN DO FOR YOURSELF
Of course the best way to avoid the dangers of smoking is not to start. But if you do smoke, then do what you can to quit. Lots of things will help.

Keep a journal
Record your smoking habits for a while before you quit. Note when you smoke each cigarette. Do you have one with every cup of coffee or after each meal? Do you smoke when you’re anxious or bored? Think about your smoking habits so you know what makes you reach for tobacco. When you’re aware of your triggers, it’s easier to resist them once you quit smoking.

Plan your quitting
Pick a day to quit. Circle it on your calendar. It helps to choose a day when your routine is changing anyway, such as the day you leave for vacation or go on a family outing. It also helps to make a specific plan ahead of time for dealing with temptations-identify a few coping strategies that will work for you (such as taking a walk or calling a friend). Keep very busy the first day. Tell as many people as you can that you’re quitting. When you tell others, quitting then becomes a matter of pride. That will help you avoid a relapse.

Take the pleasure out of it
Make smoking as unpleasant as you can. Put all your stale butts in an open jar where you can see and smell them, or stop emptying your ashtrays. Switch to a brand of cigarettes you don’t like. Smoke only in a small closed room. Or sit in a chair facing a wall when you smoke. While you smoke, think about the cigarette and its dangers. You might even try looking at yourself in a mirror each time you put a match to your cigarette-what you see may help convince you that you don’t need it.

Watch the clock
Count the number of cigarettes you smoke in a day, and schedule them by the clock. Space your smokes evenly throughout the day. The next week, cut the number of cigarettes by a third and space them farther apart. The week after that, cut back another third, until you cut back to nothing. One study showed that this tactic had a 44 percent success rate-much higher than quitting “cold turkey” or even using nicotine gum or patches. You could also cut down on the number of cigarettes you smoke by smoking only half of each cigarette, smoking only during odd or even hours of the day, or deciding beforehand how many cigarettes you’ll smoke during the course of a day.

Schedule your smoking only for certain times of the day-for instance, after a meal or during your morning work break. Try not to reach for tobacco at any other time.

Rid your home of smoking gear
Along with all your cigarettes, cigars, and tobacco, throw out all the things that remind you of smoking-above all ashtrays and lighters. Stop carrying cigarettes with you and make them difficult to get to.

Try nicotine patches and gum
Nicotine patches and gum used to be available only with a doctor’s prescription. Now drugstores can sell them over the counter. Patches leak nicotine into the bloodstream through your skin in smaller and smaller amounts over weeks or months. The gum releases the substance as you chew, and each day your goal is to chew fewer sticks. Either may help you wean yourself slowly from nicotine without getting the harmful tars and gases of cigarettes. You can work on changing your habits and behavior without having to go through tough withdrawal symptoms.

If you use gum, though, stay away from coffee and colas-the acids in these drinks block the nicotine from getting into your bloodstream (absorption of nicotine from the patch is not affected by food or drink).

Be prepared for cravings
You may have some difficult moments when you feel the urge to smoke. If that happens, try a low-calorie snack instead of lighting up. Keep crunchy vegetables such as carrots and celery handy, or things like sugarless candy, gum, sunflower seeds, raisins, or apples. They’re all good oral substitutes. Many people find that after eight weeks or so of not smoking, they can return to their old eating habits.

A shower or a bath might also help when the cravings hit. Or try lighting a candle or a stick of incense, or striking a match and putting it out as if it were a cigarette.

Reward yourself
Mark your progress toward freedom from smoking with frequent rewards. After each small milestone, such as your first smokeless weekend, treat yourself-to a bubble bath, a new tie, a matinee at the movies, or a day at the beach.

Ease stress
Many people smoke to relieve tension. While you’re trying to kick the habit-and after you quit-you’ll need to relieve stress in other ways.

First, make time for pursuits you enjoy, such as gardening, going to a movie, or having a picnic with friends. To calm the jitters, exercise instead of reaching for a cigarette. Exercise relieves tension and provides the same sense of well-being as smoking. Try walking briskly, swimming, or jogging for 20 to 30 minutes at least every other day, or whenever you feel an urge to light up. Pick an activity you enjoy-that way you’re more likely to stick with it.

Get plenty of rest. Try to take three to four

10-minute breaks during busy days. While you’re relaxing, take deep breaths from your stomach. Studies show deep breathing relieves feelings of anxiety. So does meditation. Try this: Sit comfortably in a chair in a quiet place, with your feet flat on the floor and your hands in your lap. Close your eyes and after a minute or so let your mind begin to say a simple phrase or word-your mantra. Researchers often suggest the word one. When thoughts come to mind, let them pass and keep returning to your chosen word. Don’t feel you have to repeat the mantra all the time; let it come and go. Make it the center of your energy, but try not to focus too hard. After 20 minutes (it’s okay to open your eyes to check the time), stop saying the mantra and sit quietly with your eyes closed for a couple more minutes.

Get support
Tell your friends if you’re having trouble quitting. They may be able to offer encouragement or helpful advice. Some people trying to quit get help from support groups such as those run by the American Cancer Society. There you’ll meet others who know what you’re going through. You can share the hard times and triumphs of kicking the habit, plus any tips for quitting you’ve learned along the way. And you’re likely to find some new friends.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you are having trouble with withdrawal symptoms, your doctor can help

Nicotine nasal spray
Nasal spray with nicotine is a new form of nicotine therapy, available only by prescription. Nicotine in the spray is absorbed through the mucous membrane of your nose in five or ten minutes-more rapidly than nicotine from gums or patches. The spray is especially helpful for very dependent smokers because it delivers more nicotine more rapidly. The most common side effects include nasal irritation, sore throat, coughing, and watery eyes. There’s a higher risk of becoming dependent on the spray than on gum or patches.

Non-nicotine drug help
Bupropion, a drug used to treat depression, has now

become the first non-nicotine medicine prescribed for smokers trying to quit. The drug is used to treat depression under the name Wellbutrin, and for smoking under the name Zyban. (Researchers are now looking at other antidepressants to learn if they also can help smokers quit; none have been approved by the FDA for that purpose, however.) Bupropion’s benefits were discovered when doctors prescribing it to treat depression noticed that patients who took it also lost their desire to smoke. The drug appears to reduce the craving for tobacco, though researchers aren’t sure how it works. Bupropion also seems to ease symptoms of withdrawal.

Users begin taking the drug before they quit smoking, which seems to help them cope with the emotional stress of quitting. Side effects of Zyban may include trouble sleeping, unusual weight loss, and dry mouth.

Hypnosis
Hypnosis can help calm cravings and boost your desire to quit. How well it works depends on how easy you are to hypnotize, though. During hypnosis, the hypnotist asks you to relax and focus on thoughts of your own good health and stopping smoking. You go under hypnosis for one to five sessions. You’ll also learn how to hypnotize yourself at home by relaxing and focusing on certain thoughts.