Smoking and Tobacco

The Facts about Smoking 
Medication/Nicotine Replacement Therapy
How to Quit Smoking
Dealing with Withdrawal
What Happens when you Quit?
Staying Quit 

The Facts about Smoking 

    Smoking is an addiction. Over 4000 chemicals are found in cigarette smoke, many of which are know carcinogens to both humans and other animals. Nicotine, a drug found naturally in tobacco, is highly addictive and makes it very hard for a person to quit smoking once they have begun the habit.

    The Center for Disease Control and Prevention has reported that tobacco use remains the leading preventable cause of death in the United States, causing more than 440,000 deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs. Nationally, smoking results in more than 5.6 million years of potential life lost each year. Approximately 80% of adult smokers started smoking before the age of 18. Every day, nearly 4000 young people under the age of 18 try their first cigarette. More than 6.4 million children living today will die prematurely because of a decision they will make as adolescents - the decision to smoke cigarettes.

    Cigarette smoking affects almost every part of the human body:

    Heart

    When you smoke, your pulse quickens, causing your heart to beat an extra 10 - 25 times per minute... or as many as 36,000 additional times a day. This forces the heart to work harder and can contribute to the risk of a heart attack. Cigarette smoking is directly responsible for at least 20% of all deaths from heart disease; it lowers "good" cholesterol levels, causes deterioration of elastic properties in the aorta and increases the risk for blood clots.

    smoker's lungLungs
    Cigarette smoke attacks the lungs' natural defenses and can completely paralyze the natural cleansing process. Excess mucus in the lungs will make you more susceptible to colds, flu, bronchitis, and other respiratory infections. Continued exposure can lead to lung cancer and lung diseases, including pneumonia and emphysema.

    Cancer
    Lung cancer is just one of the serious health risks caused by smoking. Smokers are also susceptible to cancers of the larynx, mouth, esophagus, bladder, pancreas, kidney and stomach.

    Eyes
    Smokers have a much higher risk of developing two major sight-threatening conditions. Macular degeneration can occur when the macula, the central part of the retina at the back of your eye, becomes scarred, robbing the person of central vision. Research also has shown that smokers are about 3 times more likely to develop cataracts, a gradual thickening that develops in the lens of the eye. Smoke can also cause serious irritation for those who wear soft contact lenses.

    Nose & Throat
    Irritating gases in cigarette smoke, such as formaldehyde, ammonia, hydrogen sulfide and others, can cause serious irritation to the sensitive membranes in the nose and throat. The results: a runny nose and the proverbial smoker's cough. Continued exposure can produce abnormal thickening in the throat lining, a condition, when accompanied with cellular changes, has been linked to throat cancer.

    Mouth
    Stained yellow teeth, bad breath and an acute loss in your sense of taste are just some of the less serious consequences of smoking. Smoking as well as the use of spit tobacco or "chew" can also contribute to cancer of the lips, gums and throat.

    Skin
    Smoker's have what is called a "smoker's face." Characterized by a grayish appearance of the skin and deep lines around the corners of the eyes and mouth, smoker's face is caused by a lack of oxygen to the skin. These conditions occur because smoking constricts the blood vessels in the skin, making it more susceptible to wrinkling.

    Male Reproductive System
    The negative effects of smoking on the blood vessels leading to the male reproductive organs may mean men can experience erectile dysfunction or even impotency. Smoking can also affect fertility by decreasing sperm count and mobility.

    Female Reproductive System
    Smoking can result in fewer reproductive years and a sharp decline in fertility for women. Female smokers are three times more likely to be infertile and reach menopause one and three-quarter years earlier than nonsmokers.

    Breast
    Research is finding a connection between the risk of developing breast cancer and smoking.

    Bones
    Smokers have a higher risk of developing osteoporosis, a condition that involves bone thinning. The loss of bone tissue, more prevalent among women, can result in an increase of bone fractures.

    Blood
    The carbon monoxide inhaled with each drag on a cigarette can stay in the bloodstream for up to six hours. Once in the bloodstream, it begins attacking the red blood cells, virtually replacing the oxygen your body needs to function. The process means less oxygen reaches the brain and other vital organs.

    Digestive System
    Smokers are at greater risk of developing peptic ulcers, Crohn's disease and gallstones and can experience chronic heartburn. Smoking also affects the way the liver operates, particularly in terms of how it processes alcohol.

    Secondhand Smoke

    • Secondhand smoke is a mixture of the smoke given off by the burning end of a cigarette, pipe, or cigar, and the smoke exhaled from the lungs of smokers. The mixture contains more than 4000 substances, some of which are known to cause cancer.

    • Secondhand smoke has been classified by the U.S. Environmental Protection Agency (EPA) as a know cause of lung cancer in humans (Group A Carcinogen).

    • Secondhand smoke is known to cause lung cancer deaths in nonsmokers.

    • Being around secondhand smoke causes irritation of the eyes, nose, and throat.

    • Secondhand smoke also irritates the lungs. This can lead to coughing, excess phlegm, chest discomfort, and difficulty in breathing.

    • Those most affected by secondhand smoke are children because their bodies are still developing. Exposure to the posons in secondhand smoke puts children in danger of severe respiratory diseases and can hinder the growth of their lungs. The effects can last a lifetime.

    • Ventilation systems in homes cannot filter and circulate air well enough to eliminate secondhand smoke. Blowing smoke away from children, going into another room to smoke, or opening a window may help reduce children's exposure but will not protect them from the dangers of secondhand smoke.

    Nicotine
    Nicotine is a drug found naturally in tobacco. It is highly addictive, as addictive as other drugs, such as heroin and cocaine. Over the course of a smoker's life, their body becomes physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these dependencies in order to quit and stay quit.

    When smoke is inhaled into the body, nicotine is carried deep into the lungs where it is absorbed quickly into the bloodstream and carried to the heart, brain, liver, and spleen. Nicotine also affects many other parts of the body, including the heart and blood vessels, the hormonal system and the body's metabolism. Nicotine can be found in breast milk and in cervix mucous secretions of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in the amniotic fluid and the umbilical cord blood of newborn infants. Mainly the liver and lungs metabolize nicotine, but a small amount is excreted by the kidneys. Nicotine is broken down by the body in to the by-products cotinine and nicotine-N'-oxide. In general, a regular smoker will have nicotine or cotinine present in the body for about three to four days.

    Nicotine produces pleasurable feelings that make the smoker want to smoke more and also acts as a depressant by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, smokers tend to increase the number of cigarettes they smoke, and hence the amount of nicotine in their blood. After a while, the smoker develops a tolerance to the drug, which leads to an increase in smoking over time. Eventually, the smoker reaches a certain nicotine level and then smokes to maintain this level of nicotine.

    The longer someone smokes, the higher the dependency on nicotine, and the more difficult it becomes for the smoker to quit. When smokers first attempt to cut back the amount of cigarettes they are smoking, the initial absence of nicotine in their bloodstream leads to withdrawal symptoms that often kick the smoker back to smoking.

    In large amounts, nicotine acts like a poison. Nicotine has been used to kill insects. Nicotine makes the heart beat faster, thus increasing the breathing rate and causing the body to use more oxygen. Nicotine causes other changes in the circulatory system too. Blood vessels narrow and the blood travels through them more slowly, which causes hypertension for many smokers. Nicotine also appears to increase the tendency of the blood to clot and has been linked to diseases of the blood vessels and heart. 

    Medication/Nicotine Replacement Therapy      

    For many smokers, an effective quit method will include a combination of emotional support from others, a change in daily habits, and a form of therapy through the use of nicotine substitutes. When smokers try to cut back or quit, the absence of in their body leads to withdrawal symptoms. Nicotine substitutes treat the very difficult withdrawal symptoms that almost 90% of all smokers say is the reason they cannot quit smoking. These substitutes reduce the symptoms of nicotine withdrawal during the quit process, allowing the smoker to concentrate on the psychological aspects of quitting smoking.

     Nicotine replacement therapy offers several advantages for those trying to quit: 

    • Nicotine replacement is a cleaner form of nicotine.  It avoids the thousands of poisons and tar that are found in cigarette smoke.
    • Nicotine replacement delivers a smaller dose of nicotine into the body.
    • Nicotine replacement therapy has been proven to double your chances of quitting smoking for good.

      There is also another quit medication call bupropion which is available by prescription. Make sure to discuss with your health care provider which medication best suits your needs. Consider all the options, such as how much you smoke, whether you need oral or hand stimulation, cost, and the overall speed and effectiveness of each method. You may also want to check to see if your insurance company covers any of the cost of these medications. 

      Bupropion 

      Bupropion hydrochloride or Zyban™, is a pill that is available with a prescription. The pill does not contain nicotine and helps to decrease nicotine cravings and withdrawal symptoms by stimulating the chemicals in the brain affected by nicotine. Bupropion also is known as the antidepressant Wellbutrin™. You do not have to stop smoking when you first start taking Bupropion, but it is recommended that you set your quit date for 2 weeks after beginning Bupropion. Once you stop smoking, you will continue to take the pills for 7-12 weeks, as prescribed by your health care provider.  

      Although easy to use, users of Bupropion may experience some side effects. The most common side effects include dry mouth, trouble sleeping and nervousness.  You should not take Bupropion if you have seizures, have or had an eating disorder, are taking Wellbutrin™ or another medication containing bupropion hydrochloride or are taking or have taken a monoamine oxides inhibitor (MAO). In addition, you should discuss the following with your health care provider to see if Bupropion is still right for you: alcohol use, being or planning to be pregnant and breastfeeding. 

      Nicotine Inhaler or Puffer 

      Known as Nicotrol™, the inhaler is available only with a prescription and gives the user a dose of nicotine that is absorbed through the lining of the mouth. The inhaler is hollow and about the size of a cigarette; a nicotine-filled cartridge is placed inside the inhaler. One advantage to the inhaler is that it may help with the physical craving for nicotine and the psychological need to have something in your hand that is associated with smoking. To use the inhaler, you place a nicotine cartridge in the inhaler and then "puff" to get the nicotine into your mouth. The dosage will vary by person but it can take around 80 "puffs" to get the amount of nicotine that is in one cigarette. The inhaler may need to be used frequently, about 6 cartridges a day, particularly at the beginning of the quitting process.  Some people may dislike the frequent use of the inhaler, and it may cause mouth and/or throat irritation. 

      Nicotine Spray

      The nasal spray, known as Nicotrol NS™, is available only with a prescription and delivers nicotine through the nasal membranes of the nose. This method of nicotine delivery is quicker than that experienced with the nicotine gum or inhaler. A single spray into each nostril will deliver one dose. Although the actual dosage and frequency will be determined by your health care provider, it can vary from 8 - 40 doses a day. Users may experience mouth, nose, sinus, and/or throat irritation with the use of the nicotine spray.  If you have allergies or asthma, you may not be able to use NicotrolNS™. 

      Nicotine Patch

      There are two types of nicotine patches. Habitrol™ or Prostep™ require a prescription and Nicotrol™ and Nicoderm CQ™ do not. Nicotine is delivered in a steady amount throughout the day through the skin and therefore is slower in its release than other medications. The patch is used by applying it to a different part of the upper body every day; the less hairy, unshaven areas of skin often are better.

      Although some patches are available without a prescription, it is recommended that you talk with your health care provider to start at the right dosage for you and then decrease to smaller dosages. The length of usage will vary by person and can continue from 4 weeks to 3 months. The patch is available in 16-hour and 24-hour increments. Individuals may experience skin irritation from use of the patch. It is important not to use any other forms of tobacco or nicotine when using the patch in order to avoid overdose. Nicotine will continue to be in your system for several hours after you take off the patch. Individuals who have had allergic reactions to adhesive tape or other patches should not use the patch. Be sure to speak with your health care provider about any of the follow, even if they occurred in the past, if you are thinking about using the patch: ulcers; kidney, liver or skin disease; overactive thyroid; high blood pressure; heart attack, irregular heartbeat or chest pain from a heart condition; diabetes needing insulin injections; or any other serious illness. In addition, other drugs, even over-the-counter products such as headache or pain medications, can affect the effect of nicotine patches for you. Make sure you properly dispose of the patch once you have used it by putting it in foil or back in its own wrapper and throwing it in a garbage can that cannot be accessed by pets or children.

      Nicotine Gum

      Nicotine gum, or Nicorette™ offers another form for delivering nicotine that is available without a prescription and is absorbed through the lining of the mouth. To use the gum, you will need to chew it briefly and then place in between the inside of your cheek and gum line. The nicotine is inside the gum, and after the quick chew, it is released into the lining of the mouth to be absorbed. Your stomach cannot absorb the nicotine so if you continue to chew it and swallow the saliva, you may become nauseated. You will know to stop chewing when you have a peppery taste or feel a slight tingling sensation in your mouth. When that taste or feeling disappears, you will need to chew the gum briefly again.  The gum is available in different dosage levels and it takes approximately 30 minutes for the nicotine to be absorbed completely from the gum. You cannot drink, eat, or chew anything else 15 minutes before you use the gum or while it is in your mouth. You should not be using any other form of tobacco or nicotine while using the gum. It is recommended that you speak with your health care provider while using the gum so that you do not overuse it or become addicted. You will need to decrease the frequency of use as your cravings for nicotine decrease. Also talk with your health care provider about your medical history as well as using the gum with other drugs, even caffeine or over-the-counter headache or pain medication. You will want to speak with your dentist before using Nicorette™ if you have any dental or jaw problems.  Side effects of using Nicorette™ may include bleeding gums, indigestion, nausea, sore throat, slight swelling of the mouth or hiccups. Be sure to continue to talk with your health care provider about any side effects you experience as these can differ by person or become more severe. Addiction to and overdose of nicotine gum is possible and symptoms may include the following: dizziness, fast and irregular pulse, vomiting, exhaustion, shakes, vomiting, fainting, and headaches.

      Nicotine Lozenge

      After several years of testing, the FDA recently approved the first over-the-counter nicotine-containing lozenge that benefits a smoker trying to quit by providing constant oral stimulation in an easy-to-control dose. The lozenge comes in the form of a hard candy, and releases nicotine as it slowly dissolves in the mouth. Studies show that the nicotine lozenge is as effective as other nicotine replacement therapies when used as directed. Like the nicotine gum, the nicotine lozenge delivers nicotine to the brain more quickly than the patch, making it easier to tailor dosage according to need. One lozenge is a "dose." Simply place the lozenge in your mouth and let it dissolve, moving it back and forth from time to time. Each lozenge will last about 20-30 minutes, and nicotine will continue to leach through the lining of the mouth for a short time after the lozenge has disappeared.

      The manufacturer recommends you use at least 9 lozenges per day for the first 6 weeks, and that you not use the lozenge for more than 12 weeks in allTake care not to eat or drink 15 minutes before using the lozenge or while it is in your mouth. The most common side effects of lozenge use are soreness of the teeth and gums, indigestion, and irritated throat. Do not bite into or chew the lozenge, as this will cause more nicotine to be swallowed quickly and result in indigestion and/or heartburn.

      Comparison of Nicotine Replacement Products

       

      NRT Form

      Availability

      Flexible Dosing

      Min/Max Dose

      Time To Onset

      Oral Delivery

      Primary Side Effects

      Generic Form Available

      Nicotine

      Patch

      Over-the-Counter

      No

      1 daily

      1-3 hours

      No

      Topical skin rash

      Yes

      Nicotine Gum

      Over-the-Counter

      Yes

      9-20 daily

      7-10 mins

      Yes

      mouth/throat soreness

      No

      Nicotine Lozenge

      Over-the-Counter

      Yes

      9-20 daily

      7-10 mins

      Yes

      hiccups; heartburn

      No

      Nicotine Inhaler

      Prescription

      Yes

      6-16 daily

      5 mins

      Yes

      cough; throat irritation

      No

      Nasal Spray

      Prescription

      Yes

      13-20 daily

      10-15

      mins

      No

      nose/throat irritation; runny nose

      No

       

      (Adapted from Schmitz J., Henningfield J, Jarvik M, "Pharmacologic Therapies for Nicotine Dependence." In Principles for Addiction Medicine, 2nd ed., 1998).

      How to Quit Smoking      

      If you have decided to stop smoking and you don't know what to do, where to go, or who to ask for help, this information provides a guide that can help you quit smoking for good. There is no one right way to stop smoking, but there are smoke key elements that can help kick the habit successfully.

      Making the Decision to Quit

      Go through the self-assessment sections and the benefits of quitting.  Determine where you are and what you need to do next.  If you decide you are ready to stop, go to the next step.

      Setting the Date and Deciding on a Plan

      Once you've decided to stop smoking, it's time to pick the "quit date". Make sure that is within the next month. Choosing a date too far in the future will make it easier to rationalize a way out of it. However, there also needs to be enough time to become prepared. Once prepared, it is then time to come up with a solid plan. Here are some step to help you prepare for your "quit date".

      • Pick the date. Mark it clearly on the calendar.
      • Tell friends and family of the "quit date" and ask for their support
      • Get rid of all cigarettes, lighters, ashtrays, etc. And stock up on sugarless gum, cinnamon sticks, carrot sticks, and hard candy.
      • Decide on a plan. What option do you have for cessation?  Are there community, campus, or on-line resources that best match your personal needs. (Call the CSB/SJU Health Promotion Office at 2587 for information about what is available on campus)
      • Consider nicotine replacement therapy. Medications have been proven to increase the success of quitting. Investigate your options and think about what will work best for you. If you are interested in using a medication, talk with your health care provider. You may need to start using it before you "quit date."
      • Call a quit line or check out a web site designed to help you stay smoke- free, or contact your health care provider or the health promotion office (2587) for support and encouragement.
      • Practice saying, "No thank you. I don't smoke."
      • Enlist the help of your support system. Tell others of you plan and ask for their support. Ask a friend to quit smoking with you. You can also join Nicotine Anonymous or talk with a friend who has successfully quit and is willing to help.
      • Identify your trigger, those things that tempt you to light up a cigarette. Think about the times or rituals during the day when you normally smoke, such as with a cup of coffee in the morning, between classes, while studying, or at a bar. Figure out what you will do instead of smoking, such as skipping the coffee, going for a walk, chomping on carrot sticks or lollipops, or even avoiding large social gatherings such as those at a bar. These temptations will become less and less strong the longer you are smoke-free.
      • Speak with your health care provider if you are concerned about weight gain, depression, or other common side effects of nicotine withdrawal. Remember that exercise can decrease your chances of gaining weight while you quit smoking and can make quitting much easier, so start a workout routine before your "quit date" so that you can continue it throughout the quitting process.

      What to Do When the Quit Date Comes

      The "quit date" has arrived, and even though you may be completely prepared, you are still stressed and need some guidance on what you should do. Here are some suggestions to help make your "quit date" much easier: 

      • Do not smoke. Stop smoking the night before. When you wake up in the morning, you will have an eight-hour head start to being smoke-free.
      • Keep active - try walking exercising, or doing other activities or hobbies.
      • Drink lots of water and fruit juices.
      • Start nicotine replacement therapy if you choose to do so.
      • Continue following a self-help plan, using computer resources, talking with your health care provider, etc. Call your support system or a quit line when you are tempted to light up.
      • Avoid high-risk situations where the urge to smoke is strong.
      • Reduce or avoid alcohol and/or caffeine. Alcohol clouds judgment and can make it easier for you to slip up and smoke. Plus, alcohol and caffeine may be linked to smoking for some people. It is important to break this connection.

      Use the 4 A's 

      1. Avoid. Certain people and places can tempt you to smoke. Stay away for now. Later on, you'll be able to cope.
      2. Alter. Switch to soft drinks or water instead of alcohol or coffee. Take a different rout to classes or work. Take a walk when you used to take a smoke break.
      3. Alternatives. Use oral substitutes like sugarless gum, hard candy, or sunflower seeds.
      4. Activities. Exercise or do hobbies that keep your hands busy (video games, needles work, woodworking, etc.) can help distract the urge to smoke.

      To Deal with the Urges

      Use the 5 D's 

      1. Delay a minute or two and the urge will pass.
      2. Drink water to fight off cravings.
      3. Do something else to distract yourself - walk, call a friend, clean a closet, etc.
      4. Deep Breathe - it will relax you. Close your eyes and take ten slow deep breaths.
      5. Discuss your thoughts and feelings with someone close to you.

       Getting Support 

      Now that the quit process has begun, times are going to be tough and temptation will be running high. Support is readily available for people trying to quit smoking, and there are many resources that can be used to help make stopping more feasible and less stressful. 

      • Family and Friends: Many former smokers say that the key to their support network was their family and friends in their community. Find people that you can confide in, those who want you to quit and will be there for you when the times are tough. If some of these people are smokers, make sure that they know that they cannot smoke around you.
      • Your Health Care Provider: Talk to your health care provider about your plan to quit smoking. Make an appointment and bring a list of all of your questions. Do not be afraid of asking anything. Your health care provider wants to help you quit smoking.

      Some questions you could ask may include:

      1. How can you help me be successful at quitting?
      2. What medication do you think would be best for me and how should I take it?
      3. What should I do if I need more help?
      4. What is smoking withdrawal like? How can I get information on withdrawal?

      Be prepared for your provider to ask you questions, as well. Make sure you are completely honest, and don't be afraid because the process will help you in the long run. It may help you to fill out the Tobacco Use History in the self-assessment section, and bring it with you to your appointment. This might help your provider support you better.

      • Quit Lines: Quit lines are telephone-based supports to help stop smoking.
      • Web Sites: There are web sites designed to help people who are trying to quit. You may want to check www.Gottaquit.com orwww.quitnet.com.
      • Quit Programs: Stop-smoking programs are designed to help smokers recognize and cope with the common problems that arise during quitting and provide support and encouragement in the fight to stay smoke-free Studies show that the most effective quit programs include either individual or group counseling. There is a strong relationship between the intensity of the counseling and the success rate. In general, the more intense the program, the more likely it will be successful in helping people quit smoking for good. Intensity can be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. Call the health promotion office at 2587 to find out what's available on campus.

      Dealing with Withdrawal      

      Withdrawal from nicotine typically includes physical and psychological symptoms. The physical symptoms, although annoying, are NOT life threatening. Nicotine replacement therapy can reduce these symptoms. The psychological part of quitting is often the greater challenge. If you have been a smoker for any extended period of time, it has become linked to everything you do - from waking up in the morning, to eating, to watching TV, to socializing - everything. Naturally, it will take time to "un-link" smoking from your daily life. Most people who are trying to stop smoking have some withdrawal symptoms, but usually not all of those that are listed. If any of the symptoms become too hard to bear, contact your health care provider for further assessment.

      •  Irritability/Anxiety 

        • The body's craving for nicotine causes irritability after stopping smoking.
        • Irritability from stopping smoking will lessen over time, typically over a span of two to four weeks.
        • Using different forms of nicotine replacement therapy should help to ease these symptoms.
        • Inform your family and friends that this it going to be a tough time for you and remind them that these symptoms, although frustrating, are temporary, and are a result of you trying to do something great for yourself. 

        Craving a Cigarette 

        • Cravings for cigarettes happen most often during the first few days of the smoke-free process. These cravings are short-lived, so just bear with them and the time can pass.
        • Cravings lessen over time. Most ex-smokers say that they only have an occasional urge to smoke about two to three weeks after they have quit.
        • Distract yourself. Walk, talking with friends and loved ones, picking up a new hobby, reading a book, or exercising are all examples of doing something more constructive with your time.

         Coughing/Clearing Your Throat/Dry Throat/Post-Nasal Drip 

        • A smoker's body created extra mucous to help rid the body naturally of the harmful chemicals in cigarettes. Once smoking is stopped, the body no longer produces this extra mucous. Coughing and clearing of the throat are natural reactions to this adjustment.
        • Coughing and other similar symptoms are simply signs of the body healing itself.
        • These symptoms usually go away within a few days after you stop smoking.
        • Drinking water or having a hard candy are ways to ease the coughing.

         Sleepless Nights (Insomnia) 

        • Nicotine can affect how deeply you sleep. Once you stop smoking, your body no longer has its "fix" of nicotine. This symptom should go away within a few days. Note: Dreaming about smoking is also a very common occurrence.
        • Ways in which you can battle insomnia in a calm manner include deep breathing, a hot bath before going to bed, and drinking decaffeinated tea or warm milk.

        Lightheaded (Dizziness) 

        • Dizziness seems to happen because the body is now getting normal amounts of oxygen that it otherwise did not get when you smoked. This is a sign of your body repairing itself and returning back to normal health.
        • This is a very common symptom and should only last a few days.

         Concentration Problems 

        • Smokers rely on nicotine to help them concentrate. Most ex-smokers say that their concentration returns to normal with one or two weeks after stopping smoking.
        • Choosing a weekend or vacation are often good times to plan on stopping smoking.

         Feeling Tired 

        • Nicotine is a stimulant, which means that your body speeds up. Feeling tired is the body's reaction to not having the nicotine. Energy levels will increase as the body gets more used to the effects of not smoking.
        • Tiredness typically happens in the afternoon. Try to plan activities that help keep energy levels running high, like a mid-afternoon workout with a friend.
        • Healthy eating habits and avoiding foods high in sugar can help reduce the effects of feeling tired.
        • Use of the nicotine patch or gum can help lessen this problem.

         Hunger 

        • Sometimes, cigarette cravings are mistaken for hunger.
        • Try not to replace cigarettes with food. Use the 5 D's instead
          1. Delay
          2. Drink water
          3. Do something else
          4. Deep breathe
          5. Discuss with a friend

         Depression 

        • Some ex-smokers say that stopping smoking is like losing a friend. It is not uncommon to feel a bit depressed during the quit process.
        • Remind yourself that stopping smoking will have amazing long-term positive effects and that the negative feelings and withdrawal will pass in a short period of time.
        • Physical activity often reduces the negative feelings.
        • These feelings will pass. Remind yourself over and over again that the progress you have made so far is something to be tremendously proud of. Starting to smoke again often increases the depression due to the guild of having returned to smoking.
        • Discuss your feelings with others.
        • Use oral medications (Zyban™) as antidepressants will assist you in maintaining a positive outlook on the process. If you have severe symptoms of depression, contact you health care provider immediately.

         Constipation 

        • Constipation may occur for a brief period after stopping smoking. It will typically go away within a week or two.
        • Eat more whole grains, fruits, and vegetables.
        • Drink plenty of water.
        • Physical activity will help to reduce constipation

         Chest Tightness 

        • Your body craving nicotine often causes tightness in the chest.
        • This usually passes within a few days of having stopped smoking.
        • Speak with your health care provider if you are concerned.

      What Happens when you Quit?      

      Many smokers have heard the negative effects of smoking and know that quitting can lower chances of getting related cancers. However, the benefits of quitting begin with the first 20 minutes and can continue as long as one stays quit.

      After smoking the last cigarette:

      20 Minutes
      • Blood pressure and pulse drop to normal
      • Body temperature of hands and feet increases to normal

      8 Hours

      • Carbon monoxide levels in blood drop to normal
      • Oxygen levels in blood increase to normal
      24 Hours
      • Chance of heart attack decreases
      48 Hours
      • Nerve endings start to re-grow
      • Smell and taste abilities are enhanced

      2 Weeks to 3 Months

      • Circulation improves
      • Walking becomes easier
      • Lung function increases by up to 30%
      1 to 9 Months
      • Coughing, fatigue, shortness of breath and sinus congestion decrease
      • Cilia re-grow in lungs, increasing the lungs' ability to clean itself, handle mucus and reduce infection

      1 Year

      • Excess risk of coronary heart disease is half that of a smoker
      5 Years
      • Lung cancer death rate decreases by almost half, for average (1 pack a day) former smoker
      • Stroke risk reduced to that of a non-smoker
      • Risk of cancer of the mouth, throat and esophagus is half that of a smoker
      10 Years
      • Lung cancer death is similar to that of a non-smoker
      • Precancerous cells are replaced
      • Risk of cancer of mouth, throat, esophagus, bladder, kidney, cervix and pancreas decreases
      15 Years
      • Risk of coronary heart disease is that of a non-smoker

      (Source: American Cancer Society)

      In addition to the health benefits, overall appearance will also improve by eliminating the yellow teeth, stale breath and smell of cigarette smoke on hair and clothes. Confidence will grow because quitting and leading a smoke-free lifestyle can give someone a strong sense of satisfaction and the feeling that they can accomplish anything.

      And quitters may have more money! Those who smoked 20 cigarettes a day will save themselves about $900 a year. Non-smokers also pay less for life insurance premiums.

      Staying Quit

      Staying quit is the final step in the process, and you can use the same methods to stay quit as those that helped you through the initial withdrawal. Think ahead to the times where you think you are going to smoke and plan on how you will use alternatives and activities to cope with these difficult situations.

      • Remember to use the 5 D's when you get the urge to smoke (Delay, Drink water, Do something else, Deep breathe, Discuss with a friend)]

      • Never forget why you stopped smoking!
      • Never take even a puff of another cigarette.
      • Avoid high risk situations like boredom, stress, alcohol, etc., that are often associated with smoking.
      • Don't rationalize and think you can have just one cigarette.
      • Reward yourself!
      • Be proud of trying to stop smoking
      • Begin to think of yourself as a nonsmoker
      • Make some specific plans for handling difficult situations.
      • Remember that many people do sleep and have a cigarette, so don't be too hard on yourself.
      • If you need to, get yourself "back on track" and use it as a learning experience.

      There are several specific concerns that arise after your stop smoking that make staying quit more difficult. However, you can prepare yourself for each of these before your initial "quit date" by educating yourself on the proper techniques to deal with them.

       Another Smoker in the Household
      Seeing a person in your home light a cigarette will more often than not trigger the impulse to smoke, even if you had not been thinking of smoking until then. It is important that you plan for these situations.

      • Ask for cooperation from the smokers in your home.
      • Ask family and friends to respect your decision to stop smoking.
      • Ask if they will agree to stop smoking around you.
      • Ask others to be mindful of their cigarettes by not leaving open packs lying around, emptying ashtrays regularly, and taking their cigarettes with them when they leave.
      • Suggest they contain their smoking to the outside or, at least, to a designated area in the home.
      • Be aware: it may take a significant degree of assertiveness to gain complete cooperation, but it is worth it.

      Social Situations

      In a social situation where cigarettes are readily available, a person in the quit process needs to approach all temptations in a confident manner. Below are some tips to help you stay a nonsmoker in social situations.

      • Remember your reasons for stopping smoking; those reasons remain valid, even though you will be in this situation.
      • Visualize yourself as a nonsmoker before you are in the situation.
      • Decide what to say if offered a cigarette. "No thanks.  I've stopped smoking," is usually effective.
      • Limit yourself in regards to the smoking of others. This is particularly important when the social occasion is happening in your own living space. Think about how you can tell others your limits; practice by saying it out loud into a mirror until you believe yourself.
      • Take note of what other nonsmokers are doing in the same situation.
      • Avoid alcohol as much as possible. The effect of alcohol will make you more likely to rationalize smoking, or even forget your reasons for quitting smoking in the first place.
      • Bring a "prop" or something to keep your mouth and/or hands occupied.
      • Try to have a support person with you at the party that can keep you on track when the times get tough.

      Weight Gain

      Studies have shown that 75% of people who stop smoking do not gain weight, and those that do gain weight gain between five and seven pounds. Most weight gain occurs in the first few weeks after stopping smoking. Some people actually lose weight when they stop smoking. You may begin to feel more energetic, especially if you are exercising during the stop smoking process. People gain weight after stopping smoking because of the loss of nicotine in their body. Nicotine is a stimulant that speeds up the basal metabolic rate in the human body. When a person stops smoking, their basal metabolic rate slows down, and if their activity rate does not increase and/or their food intake does increase, some weight gain may occur. Sometimes the craving for a cigarette is confused with a hunger pain, so people trying to stop may eat to satisfy this craving for a cigarette. Gaining a few pounds is not nearly as dangerous as smoking. To be at the same risk of early death associated with smoking one pack of cigarettes a day, a person would need to be about 100 pounds above their ideal weight.