Download Printable PDF of this Newsletter

HealthHints

Tobacco Cessation:
Best practices & programs for quitting tobacco

October 2008 – Vol. 12, No. 10

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

There are about 47 million smokers in the United States (about ¼ of the population) – most say they would like to quit, but only about 5 percent manage to do so each year.¹

Quitting smoking, chewing tobacco, snuff, or any other type of tobacco product is hard. That’s because nicotine (a drug found naturally in tobacco products) is highly addictive – as addictive as heroin or cocaine.²

“Smoking is the nation’s leading preventable cause of death. It significantly increases the risk for coronary heart disease, stroke, and peripheral vascular disease. In fact, more than half of all smoking-related deaths in America each year are from heart disease, stroke, or other cardiovascular diseases.”³

“Smoking-related diseases claim an estimated 430,700 American lives each year. Smoking costs the United States approximately $97.2 billion each year in health-care costs and lost productivity. It is directly responsible for 87 percent of lung cancer cases and causes more cases of emphysema and chronic bronchitis.”⁴

The reality is, we could dedicate an entire book to talking about the statistics – the negative health consequences related to tobacco use and those exposed to it, as well as the financial consequences for the individual and the nation. Some of these reasons might even convince some to consider quitting, but most people who smoke will make the decision to quit for their own reasons – be it their own health, the health of a loved one, or some other circumstances, such as no smoking policies at work, in the community, etc.

Although talking about these elements may provide a bit of insight or motivation, for the most part, we don’t want or need to be told why to quit, we want and need to know how.

Key Factors for How to Quit: Beginning the fight for freedom from tobacco

The problem with describing how to quit tobacco is that there isn’t one right way or one magic pill that works for all tobacco users. In fact, what works for one may not work for another. And, what works for someone who smokes may or may not work as well for someone who chews tobacco. Still, there seem to be some key factors that help most people quit, so let’s start with these key factors for quitting and staying quit:

Make the decision to quit, and keep all of your reasons for wanting to quit visible.
Set a quit date, and mark it on your calendar.
Get ready by planning how you will deal with obstacles to quitting and choosing the method by which you will quit.
Get support through friends, family, one-on-one support, group support, support from a former smoker, and/or telephone help lines.
Get medication (if needed), and use it correctly.
Stay quit by deciding now how you will deal with relapse and maintaining your quit status.^2,5

For a quick-start guide, see Steps for Quitting Tobacco (PDF).

Deciding to Quit: Are you ready?

Research says that you will be more likely to quit smoking if you:

believe you could get a tobacco-related disease, and that worries you.
believe that you can make an honest attempt at quitting.
believe that the benefits of quitting outweigh the benefits of continuing tobacco use.
know someone who has had health problems as a result of their tobacco use.²

You may go through stages of contemplation about quitting. First, you may not be thinking seriously about quitting. Then you’re thinking about it, but you’re concerned that the stress at work is too much, you’ll gain weight (PDF), you’ll be anxious all the time, or you’re just not sure you can do it. Finally, you will be prepared and ready to quit.

It is normal to go through these thoughts. If you are stuck thinking about quitting but not moving on to prepare to quit, read on about how to deal with some of the elements that might be holding you back. Perhaps you have even tried to quit before but aren’t sure how to go about it again. If you didn’t make a plan for quitting before – try it this time (we’ll show you how). Many people try quitting at least two to three times before they are successful. Some people try five to seven times or more before they reach the goal. Others can go “cold turkey” and quit the first time. Don’t be discouraged. Not quitting the first time is NOT failing. Look at your attempt as a positive experience – progress toward quitting for good – you are trying and learning what triggers your tobacco use along the way. Don’t give up; get ready for your next attempt to quit for good.

Find reasons to quit that are important to you. Try to think of more than just health reasons. Consider the following ideas:⁶

the amount of money you’ll save by not buying tobacco;
the time you’ll have for yourself instead of taking cigarette breaks, rushing out to buy tobacco, or searching for a light;
not being short of breath, coughing as much, or fighting sores in your mouth; and
setting a better example for your children, grandchildren, or others.⁶

Write down all of your reasons for wanting to quit. Ask former smokers their reasons for quitting. Keep the entire list, or at least the top five on your list,⁷ where you will see them often, such as: where you keep your cigarettes or other tobacco products, in your wallet or purse, in the kitchen, in the bathroom, in your car, attached to the TV remote, or beside your bed.⁶

Setting Your Quit Date: Making your mark

You’ve decided to quit tobacco. Unless there is a critical health reason that causes you to need to quit immediately, give yourself time to make some important changes and make a plan. The first thing you need to do is to set a quit date. When choosing a quit date, try these recommendations:

Choose a date 2–4 weeks away (within the next month) to give yourself time to prepare but not so long that you lose your drive to quit.
Choose a date that is special to you (e.g., birthday, anniversary, holiday, New Years Day, Independence Day, World No Tobacco Day [May 31], or the date of the Great American Smokeout [3rd Thursday in November each year]). Choosing a random date is fine, too.
If you use tobacco at work, choose a quit date on the weekend or a day off. That way you’ll already be tobacco-free when you return.
Mark the date on your calendar.
Make a strong personal commitment to quit that day, and stick with it.^2,5,6

Get Ready to Quit: Environment, tobacco triggers, & quit methods

Getting ready to quit involves:

considering your environment,
discovering your tobacco triggers, and
deciding the best quit method for you.

Considering Your Environment

Make a clean getaway! Make some special plans for your quit date. Plan to make a clean break with tobacco on the date your quit. Change your usual routine and environment to increase your chances for success by following these suggestions:

Remove all tobacco products from your home, car, and work. Throw away all your cigarettes, snuff, chew, cigars, etc. Throw away or give away your matches, lighters, and ashtrays (if an item has sentimental value, ask a friend to store it for you). Don’t forget the ones in your makeup bag, junk drawer, tackle box, golf bag, or other places outside the home.
Do NOT save just one pack of cigarettes or chew, one cigar, or one can of snuff. Some smokers like to do this “just in case” or to “prove” they have the willpower not to use tobacco. Don’t! Saving just one pack of tobacco makes it easier to start again.
Schedule an appointment on your quit date to have your dentist clean your teeth to get rid of tobacco stains. See how great they look, and try to keep them that way.
Make things clean and fresh at home, work, and in your car. Clean your drapes and clothes. Wash your car – inside and out. Buy flowers for your home and/or workplace – you’ll enjoy their scent as your normal sense of smell returns.
Don’t let people smoke in your home. Ask other members of your household who smoke to quit with you. If they won’t quit, ask them if they would be willing to smoke outside or at least not to smoke around you.
Change your normal routine. If you normally have a cigarette with your coffee in the morning, try juice or a bowl of cereal instead. Avoid places or change routines where you normally drink alcohol – alcohol and tobacco use typically go hand-in-hand. If you smoke when you take a bath, try a shower instead. If you always take a tobacco break at the same time and place each day at work, change the time and place you take your break, and replace tobacco with a walk around the grounds or hallway, or spend the time getting a healthy snack. If you always smoke in the car, try riding with a friend who doesn’t smoke, or place gum, toothpicks, etc. in your car to chew on instead.^5,6,8,9

Discovering Your Tobacco Triggers

Certain things trigger, or turn on, our need to use tobacco. These things can be moods, feelings, places, or things we do. Examples include: feeling stressed, feeling down, talking on the phone, drinking alcohol, watching TV, driving your car, finishing a meal, playing cards, taking a work break, being with other smokers, drinking coffee, seeing someone else smoke, cooling off after an argument, and feeling lonely.⁶

Know your pattern for tobacco use, such as, which triggers are the strongest; which cigarettes are the “must haves”; and where, when, or with whom you’re most likely to use tobacco. It can help you begin to break the pattern.¹⁰

Before you quit tobacco, make a sincere effort at keeping a written record (PDF) of each time you use tobacco and under what circumstances. Try to do this for at least three days; if possible, keep recording your tobacco use for a couple of weeks. This record will be extremely useful in uncovering what triggers your use of tobacco most often. Many people find that they use tobacco without even thinking about it when they see it written down. Most importantly, this record will help you prepare how best to fight the urge to use tobacco when you quit.

Once you know what triggers you to use tobacco, you can start preparing how you will handle these circumstances when you quit. See Quitting Tobacco Tips (PDF) for ideas on how to cope with your tobacco-use triggers.

Deciding the Best Quit Method

Some people may argue that quitting “cold turkey” – abruptly and totally – is the only way to quit tobacco. That just happens to be the way most people who use tobacco prefer to quit.² They use tobacco until their quit date and then stop all at once. The truth is, there is no one right way to quit for everyone. So, if you are concerned about quitting abruptly on your quit date, you might want to try nicotine fading or tapering off (PDF) for a few weeks prior to your quit date.

Smokeless Tobacco…Unique Aspects of Quitting

Like cigarettes, smokeless tobacco is addictive. When we try to quit smokeless tobacco, we will deal with withdrawal symptoms and cravings just as a smoker does. That’s because smokeless tobacco delivers high doses of nicotine to the body. An average dose of snuff is 3.6 mg, and an average dose of chew is 4.6 mg – compared to 1.8 mg nicotine for a cigarette.

A Swedish study on quitting smokeless tobacco reported participants having as much trouble quitting smokeless tobacco as smokers had quitting cigarettes. In fact, evidence also suggested that regular snuff users would smoke cigarettes to satisfy their need for nicotine.

Thus, we know that quitting smokeless tobacco is challenging. The psychological and physical challenges are there to be met head on. And, though many of the methods for handling these challenges are the same as for a smoker, there are two unique aspects to quitting for the smokeless tobacco user:

There is often a stronger need for oral substitutes to take the place of chew or snuff.
The disappearance of mouth sores and gum problems caused by smokeless tobacco provides a readily visible benefit.¹¹

Get Support: Increase Your Chance for Success

Studies have shown that you have a better chance of quitting tobacco if you have some help in the form of support people.⁵ Support can come in many forms: individuals, family, friends, former smokers, one-on-one programs, group programs, health care providers, smoking counselors, or telephone quitlines. You may have some ideas of your own about who can best help you. Try seeking support through some or all of the following avenues:

Tell your family, friends, and co-workers that you are going to quit and would like their support. Ask them not to smoke around you, or ask them to consider quitting with you.
Seek out individual, group, or telephone counseling. “The more counseling you have, the better your chances of quitting.”⁵ Check with your employer, health insurance company, or local hospital for help finding support groups. Try a smoking cessation group program, or check out a quitline for support and resources.
Talk with your health care providers. These can include doctors, dentists, nurses, pharmacists, psychologists, nutritionists/dieticians, and smoking counselors. All of these people can be a great source of information and support.

Try these resources to find support:

If you are trying to give support to someone who is trying to quit tobacco, see Being a True Support: How Do I Support Someone Trying to Quit? (PDF).

Self-Help Materials: Finding what works for you

Did you know that you don’t have to leave the comforts of your own home to participate in some programs? There are many excellent self-led programs and self-help materials (PDF) available either on-line, through the mail, and even at local libraries and bookstores. These programs offer flexibility and privacy, and many are free. You can use these materials to learn how to prepare for your quit attempt, deal with withdrawal symptoms, develop strategies to help with cravings, and prevent relapse once you’ve quit. See our Resource Guide (PDF) for more information on programs and resources that can help you quit.

What about Medications? Double your chances for quitting

Do you use tobacco within 30 minutes of waking up in the morning? Do you smoke 20 cigarettes (one pack) or more each day? At times when you can’t use tobacco or don’t have any, do you feel a craving for it? Is it tough for you to keep from using tobacco for more than a few hours? When you are sick enough to stay in bed, do you still use tobacco?¹²

If you answered yes to two or more of the questions above, you may be at a level of nicotine addiction that warrants the use of medication as part of your quit smoking plan.¹³ In fact, “research has shown that using a quit-smoking medicine, such as bupropion (Zyban®), varenicline (Chantix®), or the nicotine patch, gum, nasal spray, inhaler, or lozenge, can double your chances of successfully quitting.”¹⁴

The U.S. Food and Drug Administration has currently approved seven medications to help you quit, some which are available over-the-counter and some by prescription. To learn more about these medications, see A Quick Reference to Quit Tobacco Medications (PDF) and Tobacco Cessation Medications – The Right Choice for You? (PDF).^5,15

Stay Quit: Withdrawal, cravings, & relapse

Dealing with withdrawal, cravings, and relapse when trying to quit tobacco – simply put – is hard to do. We’ve put together a list of Quitting Tobacco Tips (PDF) that includes ideas pulled from many reputable resources that have helped others when trying to quit tobacco – and it may help you, too.

See our Resource Guide (PDF) for information that is designed to help you through the quit process. It contains information on quit tobacco contact numbers and websites; books and audio books; face-to-face programs and support; prenatal, infant, and child resources, quitline resources; tools for teens; web-based programs and support; and worksite and community events and materials.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

Landers, SJ. (2003). Kicking butt: Primary care physicians can help smokers quit. Retrieved March 7, 2005. From http://www.ama-assn.org/amednews/2003/12/15/hlsa1215.htm.
American Cancer Society (2005). Quitting smoking. Retrieved March 3, 2005. From http://www.cancer.org/docroot/PED/content/PED_10_
13X_Guide_for_Quitting_Smoking.asp?sitearea=PED.
American Heart Association (2005). Smoking cessation guidelines. Retrieved March 4, 2005. From http://www.americanheart.org/presenter.jhtml?identifier=4735.
American Lung Association (2004). Quit smoking. Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33484.
United States Department of Health and Human Services (2000). You can quit smoking consumer guide. Retrieved March 9, 2005. From http://www.cdc.gov/tobacco/quit/canquit.htm.
National Cancer Institute & United States Department of Health and Human Services (2005). Clearing the air: Quit smoking today. Retrieved March 9, 2005. From http://www.smokefree.gov/pubs/clearing_the-air.pdf.
American Lung Association (2004). Building motivation to quit. Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39201.
American Lung Association (2004). Planning ahead. Retrieved March 28, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39206.
American Lung Association (2004). Alternatives. Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39204.
American Lung Association (2004). Triggers. Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39197.
American Cancer Society (2005). Quitting smokeless tobacco. Retrieved March 3, 2005. From http://www.cancer.org/docroot/PED/content/PED_10_
13X_Quitting_Smokeless_Tobacco.asp?sitearea=PED.
American Lung Association (2004). Are you addicted to cigarettes? Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=40382.
American Lung Association (2004). Nicotine addiction. Retrieved March 11, 2005. From http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39198.
American Cancer Society (2007). Double your chances of quitting smoking. Retrieved September 24, 2008. From http://www.cancer.org/docroot/PED/content/PED_10_
3x_Double_Your_Chances.asp?sitearea=PED.
University of Wisconsin Medical School: Center for Tobacco Research and Intervention (2008). FDA-approved medications to help patients quit smoking. Retrieved September 24, 2008. From http://www.ctri.wisc.edu/Smokers/smokers_
FDA.Approved.Medications.htm.

Tobacco Cessation: Best practices & programs for quitting tobacco