*Rates are adjusted to the 1970 census population.
Source: American Cancer Society.
Even before the first Surgeon General's report on smoking related illnesses (1964) was released, the number of male smokers in the U.S. was already decreasing. In the mid 1950s, close to 55% of the male population smoked; by 1993 it was 32%. On the other hand, in the mid 1950s, 25% of women smoked. The incidence actually increased to 35% in the early 1960s and then started a slow downturn, eventually paralleling males in the early 1980s (Fig. 2).
*Estimates since 1992 incorporate some-day smoking.
Source: Current Population Survey, 1995; National Health Interview Surveys, 1965-1993.
There are a few hopeful signs among young people. As opposed to the trend in the 1930s, college-bound young people are less likely to smoke. It is also true that the smoking incidence is lower in adults with the most years of formal education (Fig. 3).
*Estimates since 1992 incorporate some-day smoking.
Source: National Health Interview Surveys, 1965-1993
Another trend is a sharp decrease in smoking by young African-American women (Fig. 4.
*Smoking one or more cigarettes per day during the previous 30 days. Estimates are based on two-year floating averages.
Source: Institute for Social Research, University of Michigan, Monitoring the Future Project.
There are now four types of Nicotine Replacement Therapy (NRT) and one antidepressant approved for smoking cessation. These treatments have different characteristics that can translate into specific advantages for individual smokers.
Several of the drugs are available over the counter (OTC). Though you can buy these drugs and use them on your own, I advise you to find (if possible) a helpful and sympathetic doctor who can counsel you and prescribe treatment if you need it to help you. Smoking is not a sin or a moral weakness. It is an addiction, a chronic disease that needs treatment before it kills you or spoils you life with a lot of illnesses. Enlist your doctor's help. Show the doctor this article and advise him/her to read the professional version. Help your doctor help a lot of people like you.
The cigarette habit isn't just about tobacco and inhaling smoke. It consists of dozens of unconsidered impulses which are reinforced hundreds or even thousands of times a day with every puff you take. Let's be honest. Nicotine is a wonderful drug. It calms you down and peps you up at the same time. What else does that? You will need preventive strategies to keep from smoking. You need to understand the urge, figure out why you liked smoking, recognize the "danger situations" and find substitute actions to take at those moments when the urge becomes nearly irresistible.
First, "clock" your habit. Write down every cigarette you smoke during the day and how important it was to smoke it. You need to know which are those "necessary" cigarettes, when the urge to smoke is the strongest. Then you think of other things you could do instead of smoking. Remember, the urge to smoke will go away whether you smoke or not. Identify "triggers," those situations or activities that are strongly associated with smoking. Finishing a meal, getting into your car, getting out of the subway station, picking up the telephone or going to a bar with friends, are some examples. Think of ways to avoid these trigger situation or an alternative activity or another "hand activity" to take the place of smoking.
Every smoker is unique. That is why you have to look at your own situation and work out solutions. There is one problem that is very common -- alcohol.
Every smoker is unique. That is why you have to look at your own situation and work out solutions. There is one problem that is very common -- alcohol. If you want to quit smoking, alcohol is your Health Enemy Number One. Hang out with teetotalers (and non-smokers) and stay out of bars, especially in those first few months of quitting. Most people can't have JUST ONE. You are physically and pyschologically addicted.
Why am I telling you all this? Because the problem with the smoking habit is that it is not just nicotine. It is a ritual, a habit, a reflex. It has to be unlearned. You need to build up alternative habits and reflexes, which, as time goes on, become automatic and unconsidered, just like smoking was. It takes about three weeks to break a habit and three months of successful abstinence to strengthen these new habits to the point where relapse into smoking again is less likely.
NRT eases nicotine withdrawal WHILE you are working on getting through urges, avoiding triggers and building up alternative ways of dealing with stress, tension, anger, etc.
With all forms of NRT, smoking must cease completely when using the NRT. Setting a quit date is key. You have to QUIT. This helps you do it. There must be absolutely no smoking when taking any form of nicotine replacement therapy. Some people who have cheated have experienced a severe sudden rise of their blood pressure and heart attacks.
- Nicoderm® 21mg, 14mg, 7mg, 24 hr patch — OTC
- Nicotrol® 15mg, 16 hr patch — OTC
- Habitrol® 21mg, 14mg, 7mg, 24 hr patch — prescription
- ProStep® 22mg, 11mg, 24 hr patch — prescription
The nicotine patch contains a nicotine compound that is absorbed into the body through the skin. It is applied in the morning and removed the following morning or before bedtime.
Some quitters complain of vivid dreams while wearing the patch at night. So removing it at bedtime is recommended, even with the so-called 24-hour patch. The other side effect is skin rash at the site of application. Moving the patch to a different area every day of the week may solve this problem.
Most patch-users are pleased with the effect of the patch. Many tell me that they applied it and simply forgot about it and also forgot to smoke. "If I'd known it would be so easy, I would have done it years ago," is a common comment.
Some patch types come in three strengths (Nicoderm® and Habitrol®). Smoking a pack or more a day requires the top strength. Stay on that one as long as you need it (say, six weeks) to be thoroughly out of the habit. Then work out a taper schedule. Don't get cocky. Take your time. It usually takes about three months. The Nicotrol® patch is meant to be used 16 hrs and taken off at bedtime. It is now recommended for six weeks. Six weeks without smoking is very good, but remember you are not "home free," especially during the first three months. You can use other NRT products or lower strength patches to keep you on track.
Chewing the gum at regular intervals results in a low steady level of nicotine in the blood. I find the gum particularly useful for people who are worried about weight gain because the gum occupies the mouth with a calorie-free substance. The gum is also useful for episodic smokers, who just need something to help them get over the urge.
- the patch: automatic pilot
- the gum: mouth is busy, no calories
- the nasal spray: a quick hit for an urge
- the inhaler: something to handle
Can these forms of NRT be used in combination? Yes. You could wear the patch and add any of the other three to help with your particular problem:
- a piece of gum to keep from reaching for a piece of candy
- a nasal spray to get over an urge
- an inhaler to keep your hands busy
There are a few circumstances when nicotine replacement could be harmful. If you have just had a heart attack or have a life threatening cardiac arrhythmia, NRT is not recommended. There is also a concern about NRT in pregnancy. It is hard to imagine anything worse for a developing fetus than tobacco smoke with its carbon monoxide and noxious chemicals. It is certainly harmful. Women who smoke throughout pregnancy run a higher risk of having a low birth weight or premature baby. The baby is also at higher risk for Sudden Infant Death Syndrome (SIDS). If, even with this information, a woman is having great difficulty quitting, I personally would have little hesitation about using NRT to help her quit.
If you have just had a heart attack or have a life threatening cardiac arrhythmia, NRT is not recommended.
The standard recommendation is to start with one Zyban® a day for three days, then add a second dose eight or more hours later. The main side effects of Zyban® are dry mouth, tremor (shakiness) and insomnia (difficulty sleeping). As the TV commercials warn, you should not take Zyban® if you have a seizure disorder or a risk of seizure. This includes known seizure patients on medication, those people with a history of head injury and people who drink three or more alcoholic beverages a day. People who have an eating disorder, anorexia nervosa or bulimia, were noted to have a higher risk or seizures when placed on bupropion, and, therefore, should not take Zyban®.
Some notes about the side effects of Zyban®: If you are small and skinny, you may need only one pill a day. If you have problems with insomnia, take the second dose earlier in the day. Be sure the second dose is at least eight hours after the first dose. The risk of seizure is related to dose. The formula of Zyban® is meant to last eight hours. If you take your second dose less than eight hours after the first dose, you run the risk of having too high a blood level. Zyban® is Wellbutrin® is bupropion. If you are taking Wellbutrin®, you cannot add Zyban®. You are already on it!!
- It may take several tries before you succeed in quitting. Prepare yourself and look at each quit as a learning experience. Quit again as fast as you can. You have a better chance of succeeding.
- Every smoker is unique and needs different solutions. Examine your own habit closely and put together your own program.
- There are many techniques and medications to help you. You have the information. Pick out what appeals to you and try it.
- Millions of women and men have quit smoking. You can too!!