Secondhand Smoke

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People regularly exposed to secondhand smoke may have increased risks of dying from various causes, a long-term study from China suggests.

Researchers found that compared with adults who lived and worked in smoke-free environs, those exposed to secondhand smoke were more likely to die of heart disease or lung cancer over 17 years.

And they were also more likely to die of stroke or the lung disease emphysema -- two diseases that have had relatively weaker links to secondhand smoke.

The findings, which appear in the medical journal Chest, cannot definitively prove that secondhand smoke is the culprit. But the researchers were able to account for some other key factors, like a person's age, education, job, and blood pressure and cholesterol levels.

And the links between secondhand smoke and mortality remained, say the researchers, led by Dr. Yao He of Chinese PLA General Hospital in Beijing.

"This is exactly the type of study design you want to see," said Joanna Cohen, director of the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health in Baltimore.

Cohen, who was not involved in the research, pointed out that the study followed people over many years, and it found evidence of a "dose-response" relationship -- meaning people's risks climbed as their secondhand smoke exposure increased.

Those things are considered key in building the case for a cause-and-effect relationship.

A number of studies have found that non-smokers who regularly breathe in other people's tobacco smoke have an increased risk of developing heart disease or certain cancers, including lung tumors.

In the U.S., the most recent Surgeon General's report said there was "suggestive" evidence that secondhand smoke might boost people's risk of stroke and emphysema, also known as chronic obstructive pulmonary disease or COPD.

But the evidence was considered insufficient to say there was a "causal relationship," Cohen noted.

"This type of study," she said, "is important for adding to evidence of a causal relationship."

Cohen also said it was "huge" that the information was coming from China. "It's the country with the most number of smokers," she pointed out. And, she said, it is trailing other nations in anti-smoking education and tobacco control.
The current findings are based on 910 adults who were followed over almost two decades.

At the start, 44 percent said they lived with a smoker, while 53 percent said they inhaled secondhand smoke at work.

Over the following years, 249 study participants died. And the risks of death from heart disease, stroke, lung cancer and emphysema were all two to three times higher among people exposed to secondhand smoke.

Among men, for example, 11 percent of the 271 men exposed to secondhand smoke died of stroke. That compared with 6.5 percent of the 168 men who lived and worked in smoke-free surroundings.

The numbers of people who died of each specific cause were fairly small, which is a limitation.

"When numbers get small," Cohen said, "it makes it more difficult to get a precise estimate" of risks.

But she said the results do support evidence that secondhand smoke may boost the risks of not only heart disease and certain cancers, but stroke and emphysema as well.

The Easy Way to Stop Smoking

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Just suppose there was the easy way to stop smoking method which could enable any smoker to quit – immediately, permanently, and without willpower, no torturous withdrawal or weight gain, no shock tactics, pills, patches or other gimmicks. Furthermore, not only could you find it easy to quit, but you can actually enjoy the process from the moment you extinguish the last cigarette and never again feel that you miss cigarettes or smoking. This stop smoking method exists and is called Allen Carr’s Easyway. Contact your nearest Allen Carr’s Easyway centre for help to stop smoking or visit Allen Carr’s Easyway Worldwide.

About Allen Carr’s Easyway

Allen Carr’s Easyway’s approach concentrates on the removal of fear. The method eliminates the phobias and anxieties which prevent people from being able to enjoy life to the full, and has been applied successfully to a number of issues – smoking cessation , weight loss , alcohol and all other drug problems , preventing children from smoking, fear of flying , freedom from debt .
Allen Carr’s hundred-cigarettes-a-day addiction was driving him to despair until, in 1983, after countless failed attempts to quit smoking, he finally discovered what the world had been waiting for: an Easy Way to Stop Smoking . He went on to build a global publishing programme and a worldwide network of quit smoking clinics that span the globe and have a phenomenal reputation for success in offering stop smoking help . His stop smoking books have been published in over 38 different languages in over 57 countries and DVD, audio, CD-ROM, video game and webcast versions of his quit smoking method are also available. Allen Carr’s Easyway’s work continues under the stewardship of Allen’s appointed successor, Managing Director Robin Hayley and Worldwide Director John Dicey. Everyone at Allen Carr’s Easyway is working tirelessly to ensure that Allen’s legacy achieves its full potential.
Hundreds of thousands of people have attended Allen Carr’s Easyway To Stop Smoking clinics where they guarantee that you will find it easy to quit smoking or your money back . Should you require advice on quitting, help to give up smoking or stop smoking support you will find our stop smoking therapists understanding and sympathetic about any concerns you may have about stopping smoking. They are expert in Allen Carr’s Easyway method.
Weight control and alcohol sessions are offered at a selection of these clinics. A full corporate stop smoking service is also available enabling companies to implement stop smoking programmes in the workplace simply and effectively.

What people say about Allen Carr’s Easyway –
“I would definitely recommend this course…if I’d known it was going to be this easy – I would have quit ages ago” Daily Mail
“An intelligent and original method” Evening Standard
“A different approach. A stunning success” The Sun
“Some friends of mine who had stopped using Allen Carr’s method suggested I tried it. I did. It was such a revelation that instantly I was freed from my addiction. Like those friends of mine, I found it not only easy but unbelievably enjoyable to stay stopped.” Sir Anthony Hopkins
“Nobody has TOLD me I have to say great things about this, no one has PAID me to say great things about this but I will say on the third day of stopping, when I should be climbing the walls…I genuinely believe that I will never smoke again” Daily Record
“Normally when we have health or fitness gurus of any sort on this show they are greeted with great scepticism, but I have to say our switchboard is jammed and every single caller is positive about Allen Carr. It is quite amazing” BBC Radio 5
“Allen Carr explodes the myth that giving up smoking is difficult” The Times
“If you are one of those folk single-handedly keeping your local tobacconist in business, but want to ditch the demon weed, this is for you” OK Magazine
“This is the no-willpower method. You don’t suffer any kind of tug-of-war with yourself because the cravings are totally removed” Tatler

Celebrity clients include –
Sir Richard Branson, Sir Anthony Hopkins, Hrithik Roshan, Ellen DeGeneres, Ashton Kutcher, Stefano Gabbana, Michael McIntyre, Michael Ball, Anjelica Huston, Bruce Oldfield, Neve Campbell, Ruby Wax, Lou Reed, Jason Mraz, Gianluca Vialli, David Blaine, Arlene Phillips, Ferzan Ozpetek, Ronnie O’Sullivan, Bruce Oldfield, Alberto Vázquez, Martin Clunes…and many others who wish to remain anonymous.

Smoking Cessation

Smoking cessation (colloquially quitting smoking) is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the development of strong physical substance dependence or psychological dependence (in more common parlance, addiction).

Smoking cessation can be achieved with or without assistance from healthcare professionals or the use of medications.[2] Methods that have been found to be effective include interventions directed at or via health care providers and health care systems; medications including nicotine replacement therapy (NRT) and varenicline; individual and group counselling; and Web-based or stand-alone and computer programs. Although stopping smoking can cause short-term side effects such as reversible weight gain, smoking cessation services and activities are cost-effective because of the positive health benefits.

In a growing number of countries, there are more ex-smokers than smokers.
Early "failure" is a normal part of trying to stop, and more than one attempt at stopping smoking prior to longer-term success is common.

NRT, other prescribed pharmaceuticals, and professional counselling or support also help many smokers.
However, up to three-quarters of ex-smokers report having quit without assistance ("cold turkey" or cut down then quit), and cessation without professional support or medication may be the most common method used by ex-smokers.

Nicotine addiction

Tobacco contains the chemical nicotine. Smoking cigarettes can lead to nicotine addiction.:2300–2301 The addiction begins when nicotine acts on nicotinic acetylcholine receptors to release neurotransmitters such as dopamine, glutamate, and gamma-aminobutyric acid.:2296 Cessation of smoking leads to symptoms of nicotine withdrawal such as anxiety and irritability.:2298 Professional smoking cessation support methods generally endeavour to address both nicotine addiction and nicotine withdrawal symptoms.
Studies have shown that it takes between 6 to 12 weeks post quitting before the amount of nicotinic receptors in the brain return to the level that of a non smoker.

Methods of smoking cessation

Major reviews of the scientific literature on smoking cessation include:
Systematic reviews of the Cochrane Tobacco Addiction Group of the Cochrane Collaboration. As of 2012, this independent, international, not-for-profit organization has published over 60 systematic reviews "on interventions to prevent and treat tobacco addiction" which will be referred to as "Cochrane reviews."

Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update of the United States Department of Health and Human Services, which will be referred to as the "2008 Guideline." The Guideline was originally published in 1996 and revised in 2000. For the 2008 Guideline, experts screened over 8700 research articles published between 1975 and 2007.:13–14 More than 300 studies were used in meta-analyses of relevant treatments; an additional 600 reports were not included in meta-analyses, but helped formulate the recommendations.[6]:22 Limitations of the 2008 Guideline include its not evaluating studies of "cold turkey" methods ("unaided quit attempts") and its focus on studies that followed up subjects only to about 6 months after the "quit date" (even though almost one-third of former smokers who relapse before one year will do so 7–12 months after the "quit date").

Unassisted methods
As it is common for ex-smokers to have made a number of attempts (often using different approaches on each occasion) to stop smoking before achieving long-term abstinence, identifying which approach or technique is eventually most successful is difficult; it has been estimated, for example, that "only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help."[11]. However, in analysing a 1986 U.S. survey, Fiore et al. (1990) found that 95% of former smokers who had been abstinent for 1–10 years had made an unassisted last quit attempt. The most frequent unassisted methods were "cold turkey" and "gradually decreased number" of cigarettes. A 1995 meta-analysis estimated that the quit rate from unaided methods was 7.3% after an average of 10 months of follow-up.

Cold turkey
"Cold turkey" is a colloquial term indicating abrupt withdrawal from an addictive drug, and in this context indicates sudden and complete cessation of all nicotine use. In three studies, it was the quitting method cited by 76%, 85%, or 88% of long-term successful quitters. In a large British study of ex-smokers in the 1980s, before the advent of pharmacotherapy, 53% of the ex-smokers said that it was "not at all difficult" to stop, 27% said it was "fairly difficult", and the remaining 20% found it very difficult.[2] Cold turkey methods have been advanced by J. Wayne McFarland and Elman J. Folkenburg; Joel Spitzer and John R. Polito; and Allen Carr.

Healthcare provider and system interventions
Interventions delivered via healthcare providers and healthcare systems have been shown to improve smoking cessation among people who visit those providers.

A clinic screening system (e.g., computer prompts) to identify whether or not a person smokes doubled abstinence rates, from 3.1% to 6.4%.78–79 Similarly, the Task Force on Community Preventive Services determined that provider reminders alone or with provider education are effective in promoting smoking cessation.

A 2008 Guideline meta-analysis estimated that physician advice to quit smoking led to a quit rate of 10.2%, as opposed to a quit rate of 7.9% among patients who did not receive physician advice to quit smoking.:82–83 A Cochrane review found that even brief advice from physicians had "a small effect on cessation rates."[21] However, one study from Ireland involving vignettes found that physicians' probability of giving smoking cessation advice declines with the patient's age,[22] and another study from the U.S. found that only 81% of smokers age 50 or greater received advice on quitting from their physicians in the preceding year.

For one-to-one or person-to-person counselling sessions, the duration of each session, the total amount of contact time, and the number of sessions all correlated with the effectiveness of smoking cessation. For example, "Higher intensity" interventions (>10 minutes) produced a quit rate of 22.1% as opposed to 10.9% for "no contact"; over 300 minutes of contact time produced a quit rate of 25.5% as opposed to 11.0% for "no minutes"; and more than 8 sessions produced a quit rate of 24.7% as opposed to 12.4% for 0–1 sessions.[6]:83–86

Both physicians and non-physicians increased abstinence rates compared with self-help or no clinicians.:87–88 For example, a Cochrane review of 31 studies found that nursing interventions increased the likelihood of quitting by 28%.

According to the 2008 Guideline, based on two studies the training of clinicians in smoking cessation methods may increase abstinence rates:130; however, a Cochrane review found "a measurable effect" that such training decreased smoking in patients.

Reducing or eliminating the costs of cessation therapies for smokers increased quit rates in three meta-analyses.139–140:38–40

In one systematic review and meta-analysis, multi-component interventions increased quit rates in primary care settings. "Multi-component" interventions were defined as those that combined two or more of the following strategies known as the "5 A's"[6]:38–43:

Ask — Systematically identify all tobacco users at every visit
Advise — Strongly urge all tobacco users to quit
Assess — Determine willingness to make a quit attempt
Assist — Aid the patient in quitting (provide counselling-style support and medication)
Arrange — Ensure followup contact

Biochemical feedback

Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with its corresponding percent concentration of carboxyhemoglobin.
Various methods exist which allow a smoker to see the impact of their tobacco use, and the immediate effects of quitting. Using biochemical feedback methods can allow tobacco-users to be identified and assessed, and the use of monitoring throughout an effort to quit can increase motivation to quit.

Breath carbon monoxide (CO) monitoring: Because carbon monoxide is a significant component of cigarette smoke, a breath carbon monoxide monitor can be used to detect recent cigarette use. Carbon monoxide concentration in breath has been shown to be directly correlated with the CO concentration in blood, known as percent carboxyhemoglobin. The value of demonstrating blood CO concentration to a smoker through a non-invasive breath sample is that it links the smoking habit with the physiological harm associated with smoking. Within hours of quitting, CO concentrations show a noticeable decrease, and this can be encouraging for someone working to quit. Breath CO monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback, similar to the way in which other diagnostic tools such as the stethoscope, the blood pressure cuff, and the cholesterol test have been used by treatment professionals in medicine.

Cotinine: A metabolite of nicotine, cotinine is present in smokers. Like carbon monoxide, a cotinine test can serve as a reliable biomarker to determine smoking status.[31] Cotinine levels can be tested through urine, saliva, blood, or hair samples, with one of the main concerns of cotinine testing being the invasiveness of typical sampling methods.

While both measures offer high sensitivity and specificity, they differ in usage method and cost. As an example, breath CO monitoring is non-invasive, while cotinine testing relies on a bodily fluid. These two methods can be used either alone or together, for example, in a situation where abstinence verification needs additional confirmation.

Single medications
The American Cancer Society estimates that "between about 25% and 33% of smokers who use medicines can stay smoke-free for over 6 months." Single medications include:

A 21mg dose Nicoderm CQ patch applied to the left arm.
Nicotine replacement therapy (NRT): Five medications approved by the U.S. Food and Drug Administration (FDA) deliver nicotine in a form that does not involve the risks of smoking. The five NRT medications, which in a Cochrane review increased the chances of stopping smoking by 50 to 70% compared to placebo or to no treatment, are:
transdermal nicotine patches deliver doses of the addictive chemical nicotine, thus reducing the unpleasant effects of nicotine withdrawal. These patches can give smaller and smaller doses of nicotine, slowly reducing dependence upon nicotine and thus tobacco. A Cochrane review found further increased chance of success in a combination of the nicotine patch and a faster acting form. Also, this method becomes most effective when combined with other medication and psychological support.
gum
lozenges
sprays
inhalers.

A study found that 93 percent of over-the-counter NRT users relapse and return to smoking within six months.
Antidepressant: Bupropion is FDA-approved and is marketed under the brand name Zyban. Bupropion is contraindicated in epilepsy, seizure disorder; anorexia/bulimia (eating disorders), patients' use of antidepressant drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium).

Nicotinic receptor partial agonists:
Cytisine (Tabex) is a plant extract that has been in use since the 1960s in former Soviet-bloc countries.[38] It was the first medication approved as an aid to smoking cessation, and has very few side effects in small doses.

Varenicline tartrate is a prescription drug marketed by Pfizer as Chantix in the U.S. (under FDA approval) and as Champix outside the U.S. Synthesized as an improvement upon cytisine, varenicline decreases the urge to smoke and reduces withdrawal symptoms. Two systematic reviews and meta-analyses supported by unrestricted funding from Pfizer, one in 2006 and one in 2009, found varenicline more effective than NRT or bupropion. A table in the 2008 Guideline indicates that 2 mg/day of varenicline leads to the highest abstinence rate (33.2%) of any single therapy, while 1 mg/day leads to an abstinence rate of 25.4%.[6]:109 A 2011 Cochrane review of 15 studies (13 of which had been sponsored by Pfizer) found that varenicline was significantly superior to bupropion at one year but that varenicline and nicotine patches produced the same level of abstinence at 24 weeks.[4

A 2011 review of double-blind studies found that varenicline has increased risk of serious adverse cardiovascular events compared with placebo. Varenicline may cause neuropsychiatric side effects; for example, in 2008 the U.K. Medicines and Healthcare products Regulatory Agency issued a warning about possible suicidal thoughts and suicidal behavior associated with varenicline.

Moclobemide has been tested in heavy dependent smokers against placebo based on the theory that tobacco smoking could be a form of self medicating of major depression,[49] and moclobemide could therefore help increase abstinence rates due to moclobemide mimicking the MAO-A inhibiting effects of tobacco smoke. Moclobemide was administered for 3 months and then stopped; at 6 months follow-up it was found those who had taken moclobemide for 3 months had a much higher successful quit rate than those in the placebo group. However, at 12 month follow-up the difference between the placebo group and the moclobemide group was no longer significant.

Two other medications have been used in trials for smoking cessation, although they are not approved by the FDA for this purpose. They may be used under careful physician supervision if the first line medications are contraindicated for the patient.
Clonidine may reduce withdrawal symptoms and "approximately doubles abstinence rates when compared to a placebo," but its side effects include dry mouth and sedation, and abruptly stopping the drug can cause high blood pressure and other side effects.

Nortriptyline, another antidepressant, has similar success rates to bupropion but has side effects including dry mouth and sedation.

Combinations of medications
The 2008 US Guideline specifies that three combinations of medications are effective:118–120:
Long-term nicotine patch and ad libitum NRT gum or spray
Nicotine patch and nicotine inhaler
Nicotine patch and bupropion (the only combination that the US FDA has approved for smoking cessation)

Cut down to quit
Gradual reduction involves slowly reducing one's daily intake of nicotine. This can theoretically be accomplished through repeated changes to cigarettes with lower levels of nicotine, by gradually reducing the number of cigarettes smoked each day, or by smoking only a fraction of a cigarette on each occasion. A 2009 systematic review by researchers at the University of Birmingham found that gradual nicotine replacement therapy could be effective in smoking cessation. A 2010 Cochrane review found that abrupt cessation and gradual reduction with pre-quit NRT produced similar quit rates whether or not pharmacotherapy or psychological support was used.

Stop Smoking Aids

Quitting smoking is never easy - but a growing number of stop smoking aids make it easier than ever for smokers to break their addiction to nicotine.

Research suggests that medications and nicotine replacement therapies can double and sometimes even triple the chances that a smoker will successfully quit. Some of these treatments also help to minimize weight gain while quitting -- an important plus for many smokers who want to kick the habit.

Your Quit-Smoking Fears Debunked
You know you should quit smoking for your health's sake. So what's holding you back? Maybe you’re afraid of the weight gain, that it will wreck your mood, or that it won't work. But what if that wasn't necessarily so? It's time to lay your quit-smoking fears to rest once and for all. Here's what experts want you to know about why some of those fears aren't what they're cracked up to be, and why none of them should keep you from quitting.
Read the Your Quit-Smoking Fears Debunked article > >
With a growing number of options available, doctors are now able to create personalized treatment plans tailored to an individual smoker’s needs and preferences.

What’s right for you? Here are stop-smoking aids and drugs to consider:

Nicotine Replacement Therapies

The idea is simple. To help smokers manage nicotine withdrawal, nicotine replacement therapies deliver the potent drug in ways that are far healthier and safer than cigarettes. Ideally, ex-smokers can gradually reduce the amount of nicotine or stop nicotine replacement therapy all at once after they’ve broken the habit of smoking. Even when used for long periods of time, nicotine replacement therapies are far safer than smoking. Quit rates range from 19% to 26%.

Is it right for you? If you’ve tried to quit before and failed because the craving for nicotine was too strong, nicotine replacement therapies may help. Gum, lozenges, and patches are available over-the-counter. Nasal sprays and inhalers require a prescription. Gums and lozenges are handy to use and offer something for smokers to put in their mouths instead of a cigarette. Some smokers prefer inhalers because the process of inhaling mimics smoking a cigarette. All of these forms are about equally effective and they can be used in combination. Indeed, evidence suggests that combining patches with inhalers, gum, or nasal sprays improves long-term quit rates. But you cannot continue to smoke while using nicotine replacement therapy. You must quit tobacco before you take alternate forms of nicotine.

Expert advice: “Don’t be in too much of a hurry to go off nicotine replacement,” says Scott McIntosh, PhD, associate professor of community and preventive medicine at the University of Rochester in New York and director of the Greater Rochester Area Tobacco Cessation Center. “One common problem we see is people stopping too early and then experiencing cravings that they can’t resist.” McIntosh recommends using nicotine replacement therapies for two to three months. And after you’ve stopped using them, he recommends keeping some gum or lozenges handy just in case you suddenly experience an intense craving.

Chantix (Varenicline)

Varenicline, the latest antismoking drug to win FDA approval, works by blocking nicotine receptors in the brain. It is sold under the trade name Chantix in the U.S. and Champix in other parts of the world. Chantix is usually prescribed for a 12-week period, with the option of another 12-week maintenance course. About 33% of smokers who use the drug successfully quit.

Is it right for you? Chantix is effective in lessening nicotine cravings and has helped many smokers successfully quit. Unlike Zyban, it should not be used in combination with nicotine replacement therapies (unless under a doctor’s supervision.) Chantix was approved in 2006. Side effects include nausea, vomiting,abnormal dreams, constipation, and flatulence. In 2009, the FDA required Chantix to have a boxed warning about serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Some serious side effect symptoms may be related to nicotine withdrawal.

Expert advice: “If you and your doctor decide to try Chantix, it’s important to monitor your moods and alert your doctor immediately if you notice any change,” says Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco. Some of the less serious but still unpleasant side effects of the drug, such as nausea, often go away over time.

Zyban (Bupropion SR)

Approved in 1997, Zyban acts on chemicals in the brain to ease nicotine withdrawal symptoms, making it easier for smokers to resist the craving to light up. The pills are usually taken twice a day for a period of seven to 12 weeks. Some ex-smokers may need to remain on Zyban for longer periods. About 24% of smokers who use Zyban successfully quit.

Is it right for you? Zyban is especially helpful for people with intense nicotine withdrawal symptoms. It can be used alone or in combination with nicotine replacement therapies such as patches or gum. The FDA has required Zyban to have a boxed warning for serious neuropsychiatric events, including depression, suicidal thoughts, suicidal behavior, agitation, and hostility. Some serious side effect symptoms may be related to nicotine withdrawal. The drug is not recommended for people with seizure disorders, bulimia, anorexia, or patients who are abruptly stopping use of alcohol or sedatives, or are using a monoamine oxidase (MAO) inhibitor. The most common side effects are dry mouth and insomnia.

Expert advice: Zyban should be started a week or two before your quit date to tame nicotine withdrawal symptoms. Like all drugs, it should be taken as recommended. Contact a health care provider right away if agitation, hostility, depressed mood, suicidal thoughts/behavior, or other changes in thinking or behavior develop.

Counseling and Support

Counseling and support groups have been shown to improve a smoker’s odds of successfully quitting. Counseling takes many forms, from a doctor’s advice to a formal smoking cessation program such as those offered by medical centers and community health organizations. Online support in the form of quitlines has also proved very helpful. Counseling typically includes advice on how to recognize smoking triggers, strategies to resist cravings, how to prepare for your quit day, ongoing support during the first few months of quitting, and other assistance. Counseling can be combined with all forms of smoking-cessation aids.

Is it right for you? Counseling and support is invaluable for almost all smokers who want to quit. Personal preference is the most important criteria, so choose the kind of program that feels right for you. If you thrive in the company of other people, look for a smoking-cessation program that meets in your community. If you want to go it alone, check out the growing number of online support groups and quitlines. Good places to start include the National Cancer Institute’s web site on smoking cessation or the North American Quitline Consortium. You can also call the federal government’s quitline at 800-QUITNOW.

Expert advice: The more support and counseling you receive, research suggests, the better your odds of success.

Stop Smoking With a Combination of Aids

The best combination of approaches is the one that feels right to you. Experts say a few guidelines can help you and your doctor choose the most effective strategies.

If you’ve tried and failed to quit using one particular smoking cessation aid, such as nicotine replacement patches, for example, it’s wise to try another on your next attempt.
If previous attempts have ended because you gave into intense cravings, talk to your doctor about combining therapies such as nicotine replacement inhalers with drugs that will minimize those cravings.
If you’re reluctant to quit because you’re worried about weight gain, talk to your doctor about treatments that can minimize weight gain, and check out support groups that will encourage you to become more active.
Whatever combination of approaches you choose, make sure that you begin with a positive mental attitude. “Optimism and the belief that you can do it is one of the most powerful indicators for success,” says Bruce S. Rabin, MD, PhD, medical director of the University of Pittsburgh Medical Center Healthy Lifestyle Program.

Quit Smoking Tips

For all the intense efforts to quit smoking in America over the past two decades, the progress has not been stellar. Today one in four men and one in five women still smoke.

For those who never smoked, this is a befuddling fact. Don’t smokers understand that cigarettes are the number one killer in America, that they dramatically increase risk for heart disease, stroke, cancer, high blood pressure, and almost every other health concern, small or large? How could any habit be worth this?


Truth is, most smokers do understand. They also understand the huge financial toll of smoking, with a pack of 20 cigarettes costing $10 in some areas (imagine: $3,650 spent a year on cigarettes by pack-a-day smokers — often people of only modest resources).
Then why do millions still smoke? In good part, because the nicotine in cigarettes is highly addictive. In good part, because smoking provides psychological comfort to some people. Perhaps most of all, because quitting smoking is so hard.

Researchers and businesses have responded strongly to the last point. Never have there been so many tools, systems, and programs available for quitting smoking. And with every month that passes, there is more research showing the benefits of quitting, and the drawbacks of not quitting.

So if you smoke, consider again whether it is time, finally, to quit. If yes, you’ll need to think through the best approach, perhaps working with your doctor or an expert. But the following 25 tips will help you succeed.

1. Make an honest list of all the things you like about smoking. Draw a line down the center of a piece of paper and write them on one side; on the other side make a list of all the things you dislike, such as how it can interfere with your health, work, family, etc., suggests Daniel Z. Lieberman, M.D., director of the Clinical Psychiatric Research Center at George Washington University Medical Center in Washington, D.C. Think about the list over time, and make changes. If you are brave enough, get feedback from family and friends about things they don’t like about your use of cigarettes. When the negative side outweighs the positive side, you are ready to quit.

2. Then make another list of why quitting won’t be easy. Be thorough, even if the list gets long and discouraging. Here’s the important part: Next to each entry, list one or more options for overcoming that challenge. For instance, one item might be: “Nicotine is an addictive drug.” Your option might be: “Try a nicotine replacement alternative.” Another reason might be: “Smoking helps me deal with stress.” Your option might be: “Take five-minute walks instead.” The more you anticipate the challenges to quitting, and their solutions, the better your chance of success.

3. Set a quit date and write a “quit date contract” that includes your signature and that of a supportive witness.

4. Write all your reasons for quitting on an index card and keep it near you at all times. Here are some to get you started: “My daughter, my granddaughter, my husband, my wife…”
You get the idea.

5. As you’re getting ready to quit, stop buying cartons of cigarettes. Instead, only buy a pack at a time, and only carry two or three with you at a time (try putting them in an Altoids tin). Eventually you’ll find that when you want a smoke, you won’t have any immediately available. That will slowly wean you down to fewer cigarettes.

6. Keep a list of when you smoke, what you’re doing at the time, and how bad the craving is for a week before quitting to see if specific times of the day or activities increase your cravings, suggests Gaylene Mooney, chair of the American Association for Respiratory Care’s Subcommittee on Smoking and Tobacco-Related Issues. Then arrange fun, unique things to do during those times, like some of the ones we recommend here.

7. Prepare a list of things to do when a craving hits. Suggestions include: take a walk, drink a glass of water, kiss your partner or child, throw the ball for the dog, wash the car, clean out a cupboard or closet, have sex, chew a piece of gum, wash your face, brush your teeth, take a nap, get a cup of coffee or tea, practice your deep breathing, light a candle. Make copies of the list and keep one with you at all times so when the craving hits, you can whip out the list and quickly do something from it.

8. When your quit date arrives, throw out anything that reminds you of smoking. That includes all smoking paraphernalia — leftover cigarettes, matches, lighters, ashtrays, cigarette holders, even the lighter in your car.

9. Instead of a cigarette break at work, play a game of solitaire on your computer. It takes about the same time and is much more fun (although, like cigarettes, it can get addictive). If your company prohibits games like that, find another five-minute diversion: a phone call, a stroll, or eating a piece of fruit outdoors (but not where smokers congregate).

10. Switch to a cup of herbal tea whenever you usually have a cigarette. That might be at breakfast, midmorning, or after meals. The act of brewing the tea and slowly sipping it as it cools will provide the same stress relief as a hit of nicotine.

11. Switch your cigarette habit for a nut habit — four nuts in their shell for every cigarette you want to smoke. This way, you’re using your hands and your mouth, getting the same physical and oral sensations you get from smoking.

12. Carry some cinnamon-flavored toothpicks with you. Suck on one whenever a cig craving hits.

13. Make an appointment with an acupuncturist. There’s some evidence that auricular acupuncture (i.e., needles in the ears) curbs cigarette cravings quite successfully, says Ather Ali, N.D., a naturopathic physician completing a National Institutes of Health-sponsored postdoctoral research fellowship at the Yale-Griffin Prevention Research Center in Derby, Connecticut. You can even do it yourself by taping “seeds” (small beads) onto the acupuncture points and squeezing them whenever cravings arise.

14. Swing by the health food store for some Avena sativa (oat) extract. One study found that, taken at 1 milliliters four times daily, it helped habitual tobacco smokers significantly decrease the number of cigarettes they smoked.

15. Think of difficult things you have done in the past. Ask people who know you well to remind you of challenges you have successfully overcome, says Dr. Lieberman. This will give you the necessary self-confidence to stick with your pledge not to smoke.

16. To minimize cravings, change your routine. Sit in a different chair at breakfast or take a different route to work. If you usually have a drink and cigarette after work, change that to a walk. If you’re used to a smoke with your morning coffee, switch to tea, or stop at Starbucks for a cup of java — the chain is smoke-free.

17. Tell your friends, coworkers, boss, partner, kids, etc., how you feel about situations instead of bottling up your emotions. If something makes you angry, express it instead of smothering it with cigarette smoke. If you’re bored, admit to yourself that you’re bored and find something energetic to do instead of lighting up.

18. If you relapse, just start again. You haven’t failed. Some people have to quit as many as eight times before they are successful.

19. Put all the money you’re saving on cigarettes in a large glass jar. You want to physically see how much you’ve been spending. Earmark that money for something you’ve always dreamed of doing, but never thought you could afford, be it a cruise to Alaska or a first-class ticket to visit an old college friend.

20. Switch to decaf until you’ve been cigarette-free for two months. Too much caffeine while quitting can cause the jitters.

21. Create a smoke-free zone. Don’t allow anyone to use tobacco in your home, car, or even while sitting next to you in a restaurant. Make actual “No Smoking” signs and hang them around your house and in your car.

22. Find a healthy snack food you can keep with you and use in place of cigarettes to quench that urge for oral gratification. For instance, try pistachio nuts, sunflower seeds, sugarless lollipops or gum, carrot or celery sticks. The last ones are best if you are concerned about weight gain.

23. Picture yourself playing tennis. Or go play tennis. British researchers found volunteers trying to quit smoking were better able to ignore their urges to smoke when they were told to visualize a tennis match.

24. Quit when you’re in a good mood. Studies find that you’re less likely to be a successful quitter if you quit when you’re depressed or under a great deal of stress.

25. Post this list in a visible location in your house. Whenever you’re tempted to light up, take a look at all the ways smoking can damage your health:

Increases risk of lung, bladder, pancreatic, mouth, esophageal, and other cancers, including leukemia
Reduces fertility
Contributes to thin bones
Affects mental capacity and memory
Reduces levels of folate, low levels of which can increase the risk of heart disease, depression, and Alzheimer’s disease
Increases likelihood of impotence
Affects ability to smell and taste
Results in low-birth-weight, premature babies
Increases risk of depression in adolescents
Increases risk of heart disease, stroke, high blood pressure
Increases risk of diabetes
Increases your child’s risk of obesity and diabetes later in life if you smoked while pregnant

Stop Smoking Naturally

STOP SMOKING NATURALLY AND LIVE THROUGH IT

What Stop Smoking Naturally Isn’t

There are lots of ways to quit smoking. There are few ways to stop smoking naturally. And there are lots of unnatural ways to quit. They can range from taking a mind altering drug to nicotine gum or to just grunting it out cold turkey. We can be hypnotized or we can put herbal drops under our tongue or patches on our arms.

Those methods have all worked to some degree of success. However they all have one downfall. All of those methods do have one thing in common! They are not ways to stop smoking naturally. The Websters Dictionary says naturally means:

1 : by natural character or ability
2 : according to the usual course of things
3 a : without artificial aid b : in a simple and sincere manner
4 : in a lifelike manner

If we are looking for a way to stop smoking naturally it should fit within that definition.

It needs to get rid of more than just the the physical habit. And not use nicotine replacement methods. Nicotine replacement therapies only treat the physical habit.

If you are a smoker you know its not that simple. Left untreated the mental habit will likely come back and wipe out any progress you may have made. The saddest thing in the world to hear is someone who has quit for any length of time (two weeks or more) and still says they have cigarette cravings. It’s sadder yet when they fall back into their old habit.

That is the downfall. Those methods never deal with the mental habit of smoking.

What Is Stop Smoking Naturally

There are ways to stop smoking naturally. By saying quit smoking naturally I mean quit smoking exactly the same way you started . You didn’t jump to a pack a day in the first day. Is it quit smoking naturally to jump down to zero from a pack a day. No it’s not.

The only truly successful way to stop smoking for good and not fall back is to stop smoking naturally. That would be the reverse of how you started. That makes sense doesn’t it. You have heard of many ways to stop smoking that aren’t close to being natural. I have even written some articles here on some of them.

I don’t have space here to explain exactly what I mean to stop smoking naturally by doing the reverse of how you started. So read the paragraph below and take me up on something that will change your life.

I want to give you a way to quit once and for all. I have made a 35 minute webinar on how to stop smoking naturally and not suffer. I will even give you a remarkable tool that will help you. In this webinar I will show you how to create a plan to stop smoking naturally.

These are some simple, common sense ways to stop smoking naturally just the opposite way you started.

These methods work to quit once and for all. Thousands have used to quit without suffering. Get this 35 minute webinar that has helped so many. Just take the survey on the left side of the page. I will send you the webinar at the end of the survey.

STOP SMOKING COLD TURKEY

The term cold turkey leads an image of the pale, cold, bumpy skin of a turkey with no feathers. That looks similar to the skin of a drug addict in withdrawals. When you stop smoking cold turkey there may more withdrawal symptoms than trying to get off drugs. To go cold turkey is to stop smoking suddenly and completely.

Many smokers are taking in as much as 20 mg of nicotine or more every day. The brains receptors will create a sense of comfort or pleasure when they receive nicotine inhaled through the smoke. When you stop smoking cold turkey your daily nicotine intake goes from 20 mg or more to nothing, the first day.

There will be issues, your body won’t be happy with your decision. Those pleasure receptors will be looking for nicotine. This method takes strong discipline and lots of will power to succeed. Unfortunately there is much more to deal with when you stop smoking cold turkey than just physical symptoms.

Stop Smoking Cold Turkey How Its Done

Usually people just decide to stop smoking cold turkey, it’s an emotional decision. They may be upset at a cost increase in cigarettes or frustrated with being stuck in a habit they don’t want. Either way its not complicated at first. You just throw away your cigarettes and don’t smoke.

Many people will go through bags of hard candy, or chew mountains of gum just to try to satisfy their nicotine cravings . The nicotine will be out of their systems and physical cravings in less than a week. That’s when the interesting aspect of the mental habit comes into play.

The cigarette has been such a important coping method for a very long time. The ex smoker may loose their identity when stop smoking cold turkey and have difficulty coping with daily tasks that were previously done with a cigarette to keep them company.

Stop Smoking Cold Turkey What I like

Well the concept of being just done appeals to me. To walk away from your habit and never look back would be great. To be finished in one quick decision… perfect. Instant freedom is what I want.

However the habit is so extensive and far reaching that to stop smoking cold turkey just won’t get it done. The habit hangs on. The smoking habit is complex.

Stop Smoking Cold Turkey What I don’t like

The biggest thing I dislike is there is an ridiculous failure rate. Less than 10% will succeed. The so called experts like to say you can fail at quitting up to 7 times before you succeed. The problem with that is that every time we try and fail we inoculate ourselves like a flue shot but against quitting.

When we fail and expect we will fail again we might never try again. This is the worst and most painful way to stop. Sadly to stop smoking cold turkey is the most popular way people try to quit.

Stop Smoking Cold Turkey Overall Thoughts

There is no cost, at least in money when you quit this way. However your chance of succeeding is not great. Smoking is a costly habit . You may have to pay a bit of money to find a good quality method to quit.

You need to find a method that addresses all the aspects of smoking. There is a plan I can recommend and it costs less than you spend on a carton of cigarettes now. It’s The Quit Smoking Plan, it has a money back guarantee but so does stop smoking cold turkey.

Stop Smoking Aid Chantix Safety Concerns

Evidence is accumulating that the stop smoking aid drug Chantix is linked with unprovoked acts and thoughts of aggression and violence, according to a new report.

The drug is so potentially dangerous that its use should be restricted to exclude police, military, and similar occupations in which workers carry weapons, says Thomas J. Moore, senior scientist for drug safety and policy at the Institute for Safe Medication Practices in Horsham, Pa. Moore is one of three co-authors of the new report on the drug, published in the Annals of Pharmacotherapy.

"My colleagues and I have been concerned about the safety profile of [Chantix] since our first report [warning of adverse events] in 2008," Moore tells WebMD.

But others, including a smoking cessation researcher and a spokesperson for Pfizer, which makes Chantix, disagreed strongly. They point out that the number of adverse events is far outweighed by the benefits of the drug, which has helped countless people give up cigarettes and the health risks associated with tobacco use.

One co-author of the report, Joseph Glenmullen, MD, of Harvard Medical School, has been retained as a potential consultant in legal cases involving Chantix. He often provides expert testimony on the side effects of psychiatric medications.

About Chantix

Chantix was approved by the FDA in May 2006 as a smoking cessation treatment. It targets nicotine receptors in the brain, blocking nicotine from getting to them.

Smokers begin at a low dose and then increase it, continuing to smoke until the eighth day, when they are instructed to quit. They continue the drug for 12 weeks and in some cases an additional 12.

In late 2007, concern surfaced after an episode in which a Dallas musician taking the drug displayed aggressive, abusive behavior and was shot dead while trying to kick in the door of a girlfriend's neighbor, the researchers write.

Since the drug came on the market, the FDA has received adverse event reports and then issued communication about the possible risks, and required a medication guide be given to each patient and with each refill. On the package insert, a boxed warning says that some people have had changes in behavior as well as hostility, agitation, suicidal thoughts, and other problems. Patients are advised to stop the drug and get medical help if that happens.

Chantix: A Closer Look

Moore and his colleagues gathered information on 78 adverse event reports received by the FDA as well as four other cases reported in clinical trials and three others from published literature. Moore suspects that the 78 cases are just a fraction of existing reports and that some adverse events are unreported.

The researchers used assessment tools to home in on 26 of the cases to look at more closely. Of these 26:

10 involved assault
9 involved homicidal thoughts
7 cases included other thoughts or acts of aggression or violence
In a sampling of the cases, the researchers reported that:

A 24-year-old woman on the drug woke up her boyfriend and started beating him, then attempted to kill herself.
A 21-year-old woman threatened her mother with a shotgun.
A 46-year-old man reported he had ''crazy thoughts'' of killing himself and his parents.
A 42-year-old man punched a stranger while at a bowling alley.
The symptoms typically began soon after starting the drug, Moore and his colleagues say, occurring a median of two days after starting.

They found that when the drug was stopped, the symptoms and other adverse effects resolved in most all cases.

Moore and his colleague note that nearly 40% of patients on Chantix were also on tranquilizers, antidepressants, or antipsychotic drugs, according to the FDA. The adverse events, the researchers write, may be more or less likely when another medication is also being taken.

The acts are not likely part of nicotine withdrawal, the researchers say, as they say the effects aren't noticed in other smoking cessation products. The problems may be confined to a small, susceptible group, they say.

The new report shouldn't turn people automatically against the drug, says Serena Tonstad, MD, PhD, a professor of health promotion and education at the Loma Linda University School of Public Health in Loma Linda, Calif., who reviewed the report for WebMD.

She has served on the advisory board and has been a consultant for Pfizer.

''I wouldn't advise people not to try it [Chantix] based on this report," she says. "The benefit of quitting smoking is most important.'' And, she says, the drug has proven effective in helping people to quit.

She does agree that people on the drug need to be monitored, and people with bipolar disorder should be especially closely monitored, she says. In her experience, they seem to be more at risk for difficulties than people with other psychiatric problems. ''With depressed people, I like their depression to be controlled before putting them on smoking cessation," she says.

MacKay Jimeson, a spokesman for Pfizer, issued this statement: “Pfizer takes the safety of all of its medicines seriously. All post-marketing reports of adverse events are reviewed by Pfizer, and reported to regulators, including FDA. The currently approved Chantix label contains a boxed warning regarding reports of serious neuropsychiatric events reported in some patients. If these neuropsychiatric symptoms are observed by the physician, patient or caregiver, patients should stop taking Chantix and notify their healthcare provider immediately. There is no reliable scientific evidence demonstrating that Chantix causes these events."

Clinical studies are under way, he says, "to help us further characterize the benefit risk profile of Chantix in different smokers. As studies complete, the results will be published.”

From May, 2006 until late last year, Jimeson says, more than 12 million prescriptions for Chantix had been written worldwide. More than 6 million in the U.S. have been prescribed the drug, according to the drug's web site.