Smoking Cessation

After 20 minutes: Blood pressure and pulse decrease
After 24 hours: Risk of heart attack decreases
After 48 hours: Nerve endings start growing; smell and taste return
After 2 weeks: Lung function improves
After 1 year: Risk of heart disease drops to half of that of a smoker
After 5 years: Risk of stroke is equal to that of someone who never smoked
After 10 years: Risk of lung cancer is half that of a smoker
After 15 years: Risk of heart disease is similar to that of someone who never smoked.
Fewer wrinkles: If you smoke more than 50 packs per year, you have almost 5 times the risk of wrinkles than nonsmokers.
Brighter skin: The yellowish appearance of your skin associated with smoking will disappear shortly after quitting.
Nicer nails: Smoking cessation can improve circulation in your fingers and promote longer and healthier nails.
Bad breath and stained teeth are improved after smoking cessation.

How to Quit:
In order to quite, you may need at least two weeks of preparation before you are ready to throw away your cigarettes forever, according to University of Pittsburgh clinical psychologist Saul Shiffman, Ph.D., who has conducted studies on the subject.

Here's his 14-day countdown plan for preparing yourself to quit-and then finally doing it once and for all.

Day 14. Set your quit date.
Simply pick a date that's two weeks away.

Day 13. Choose the method that will work best for you.
Two of the most common ways to quit are on your own or withthe help of a Nicotine Replacement Therapy (NRT). When you quit on your own, you're relying on the strength of your willpoweralone. With NRT, however, you use a nonprescription nicotine patch (such as NicoDerm® CQ®) or nicotine gum (such as Nicorette®) that can provide you with gradually decreasing doses of nicotine until your desire for it disappears. NRT has two major advantages over quitting on your own:

1.You don't have to rely on willpower alone to succeed, and
2.NRT can satisfy your cravings for nicotine-without further exposure to the harmful components of cigarettes, such as carbon monoxide and tar.

85% of smokers have attempted to quit by going "cold turkey," according to a recent survey of more than 1,000 smokers conducted by the Gallup Organization for Porter Novelli and SmithKline Beecham. But simply tossing the cigarettes and relying on willpower alone doesn't seem to work for most people. The typical former smoker attempted to quit nearly 5 times before succeeding; smokers with a two-pack-a-day habit have tried to quit just under nine times. No wonder, then, that 86% of the smokers in the survey, along with a whopping 89% of the successful quitters, believe clinically proven smoking cessation treatments should be as widely available as cigarettes.

Day 12. List the reasons you want to quit.
Scare yourself. Smoking has been shown to cause cancer, heart disease and stroke. And secondhand smoke harms others, especially kids. Write down your personal reasons on a wallet-size card and carry it with you.

Day 11. List the reasons you're afraid to quit.
Maybe you think you'll pack on the pounds, lose focus or become irritable. But most quitters find weight gain usually minimal, and irritability a passing symptom. In fact, most people who use NRT report feeling less severe withdrawal symptoms soon after they start.

Day 10. Devise a game plan.
Keep a log of each time you reach for a cigarette and then decide what you'll do instead. If you always smoke after dinner, take a walk. Stock up on sugar-free lollipops for oral gratification. Or try carrying a rubber ball to keep your hands occupied.

Day 9. Find a support group.
A support group increases your chances of quitting successfully. To find one, call the American Cancer Society at 1-800-ACS-2345.

Day 8. Go public.
Let family and friends know about your commitment and ask for their encouragement.

Day 7. Make a contract with yourself.
Put your intentions to quit on paper and sign it.

Day 6. Buy some "no smoking" signs.
Place them throughout your house, on your desk and in your car.

Day 5. Plan to reward yourself.
Think of several little treats to give yourself for getting past the first day, the first week and other quitting milestones.

Day 4. Have your carpets and drapes cleaned.

Day 3. Have your clothes cleaned.

Day 2. Get your quit kit ready.
Make sure you have everything you need to help you get through those first few weeks without cigarettes: sugar-free hard candy, a rubber ball and, if you are using help, a NicoDerm CQ Patch or Nicorette Gum Starter Kit.

Quit Day. Have a smokeout ceremony.
In sight of friends and family, get rid of your cigarettes and state your commitment to quit. Read aloud the list of your reasons to stop smoking. And why not propose a toast to the future, which now promises to be a healthier one!

Other tips to help quit smoking:

1. You've heard it a million times: Drink eight glasses of water a day for good health. But did you know that finally taking that advice could also make quitting cigarettes a whole lot easier? The reason: "Dehydration aggravates nicotine-withdrawal symptoms," says Felicia Busch, R.D., a spokesperson for the American Dietetic Association. In fact, in order to help keep withdrawal symptoms at bay, Busch recommends drinking even a little more-10 eight-ounce glasses of water each day. If that seems like a lot, keep in mind that you can also fulfill your fluid requirement with soups, juices, even such juicy fruits as oranges, pineapples and grapes.

2. Less Stress = More Succes
Having a hard time kicking the habit? Maybe you're just too stressed. Renowned physician Dean Ornish, M.D., believes that the first step to successful quitting involves balancing your life and the stressors in it. "Everyone knows smoking is bad for your health" says Dr. Ornish. "But that isn't enough for some people to quit. You have to address your underlying stress, anxiety and loneliness." Try his tension-taming techniques:

Bend an ear: "When we perceive ourselves as isolated and alone, we are likely to feel chronically stressed," says Dr. Ornish. Simply discussing your problems, fears and concerns with a friend or family member can lower your stress level.

Take a breather: Sign up for yoga or do the breathing, stretching and visuali- zation techniques outlined in Dr. Ornish's book Love and Survival. Yoga not only helps you manage stress, but, Dr. Ornish says, "These techniques were designed for something much greater-as tools for transformation."

Reconnect with nature: Try one of Dr. Ornish's suggestions-lie down and look at the sky, turn on some music or spend time in nature listening to the sounds.

Nicotine Substitutes:
The best way to quit for most people is a combination of factors, such as medications, changing habits and emotional support. The best-known medicines are probably nicotine substitutes such as the patch, gum, nasal spray, inhalers, and lozenges, which are known as nicotine replacement therapy (NRT).

The reason for the effectiveness of NRT is that it can ease the withdraw symptoms associated with the absence of nicotine. The following list of symptoms can often lead a person to resume smoking to achieve adequate nicotine levels.

Withdrawal symptoms that can occur within a few hours and can peak within 2-3 days after abruptly stopping can include any of the following:

• Depression
• Feelings of frustration and anger
• Irritability
• Trouble sleeping
• Difficulty concentrating
• Restlessness
• Headache
• Tiredness
• Increased appetite

Smoking delivers nicotine to the bloodstream very quickly, while NRT generally work more slowly. However, NRT offers several advantages for people trying to quit:

• Nicotine replacement is a cleaner form of nicotine. It avoids the thousands of poisons and tar that are found in burning tobacco.
• Nicotine replacement delivers a lower dose of nicotine.
• Nicotine replacement reduces withdrawal symptoms, allowing the smoker to focus on the psychological aspects of quitting.

Side effects of nicotine replacement:

• Skin irritation—redness and itching
• Dizziness
• Racing heart beat
• Sleep problems
• Headache
• Nausea
• Vomiting
• Muscle aches and stiffness

Types of Nicotine Substitutes
Nicotine patches provide a measured dose of nicotine through the skin. As the nicotine doses are lowered over the course of treatment, a patient is weaned away from nicotine. Patches are available without a prescription. Several types and different strengths are available. Package inserts describe how to use the product as well as special considerations and possible side effects.

Side effects are related to:

• The dose of nicotine
• The brand of patch
• Individual skin characteristics
• How long the patch is used
• How it is applied

Nicotine gum: (nicotine polacrilex) is a fast-acting form of replacement in which nicotine is absorbed through the tissues of the mouth. It can be bought without a prescription.

According to directions, chew the gum slowly until you note a peppery taste. Then, "park" it against the cheek, chewing it and parking it off and on for about 20-30 minutes. Food and drink can affect how well the nicotine is absorbed. You should avoid acidic foods and drinks such as coffee, juices, and soft drinks for at least 15 minutes before and during gum use.

Some side effects of nicotine gum:

• Bad taste
• Throat irritation
• Mouth ulcers
• Hiccups
• Nausea
• Jaw discomfort
• Racing heartbeat

Long-term use of the gum is one disadvantage of nicotine gum. In fact, research has shown that 15%-20% of gum users who successfully quit smoking continue using the gum for a year or longer. Although the maximum recommended length of use is 6 months, continuing to use the gum is likely to be safer than going back to smoking. But since there is little research on the health effects of long-term nicotine gum use, most health care providers still recommend limiting its use to 6 months.

Nicotine nasal spray: Delivers nicotine quickly to the bloodstream as it is absorbed through the nose and is available by prescription only.

Nasal spray gives immediate relief of withdrawal symptoms and offers you a sense of control over nicotine cravings. The Food and Drug Administration cautions that since this product contains nicotine, it can be addictive. It recommends the spray be prescribed for three month periods and should not be used for longer than 6 months.

The most common side effects last about 1 to 2 weeks and can include the following:

• Nasal irritation
• Runny nose
• Watery eyes
• Sneezing
• Throat irritation
• Coughing

There is also the danger of using more than is needed. If you have asthma, allergies, nasal polyps, or sinus problems, your doctor may suggest another form of nicotine replacement.

Nicotine inhalers: Introduced in 1998 and are available only by prescription. The nicotine inhaler is a plastic tube with a nicotine cartridge inside. When you puff on the inhaler, the cartridge provides a nicotine vapor. Unlike other inhalers, which deliver most of the medication to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth. Common side effects are coughing and throat irritation. With the nicotine inhaler, a smoker may feel like they are substituting some of the behavioral aspects of smoking.

Nicotine lozenges: The FDA recently approved the first nicotine-containing lozenge as an over-the-counter aid in smoking cessation. Smokers determine which dose is appropriate based on how long after waking up they normally have their first cigarette. The lozenge manufacturer recommends using it as part of a 12-week program.

Bupropion: (Zyban) is a prescription antidepressant medication in an extended-release form that reduces the frustrating symptoms of nicotine withdrawal. Although this drug contains no nicotine, it affects chemicals in the brain that are related to nicotine craving. Zyban can be used alone or together with nicotine replacement. In one study, Zyban helped 49% of smokers quit for at least a month. In the same study, 36% of nicotine patch users were able to quit for a month. When both methods were used, 58% of smokers were able to remain smoke free for over a month. This medication should not be taken if you have a history of seizures, anorexia, heavy alcohol use, or head trauma.

Several medical journals have reported that between one-fourth and one-third of smokers who use nicotine replacement or bupropion (Zyban) can remain smoke-free for over 6 months.

Hypnosis and Accupuncture have been advocated by many as an alternative to traditional therapies for smoking cessation. Although not as well studied as other treatment options, they can work as an adjunct with traditional therapies. In fact, a number of people have utilized these non-conventional therapies alone with significant success.

If you want to quit smoking and need help, talk with your health care provider and contact one of the following organizations. They can provide you with current information, advice, and suggestions for beginning the end of your tobacco use.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.

American Cancer Society
Telephone: 1-800-ACS-2345
Internet: www.cancer.org

American Heart Association
Telephone Number: 800-242-8721 (administrative offices)
Internet Address: www.americanheart.org

American Lung Association
Telephone: 800-586-4872 or 212-315-8700
Internet Address: www.lungusa.org

References
American Cancer Society. Cancer Facts and Figures 2003. Atlanta, GA.