Experts say it takes a plan and support for those who want to succeed at quitting smoking. / Pedro Verde
With the new year just days away, many smokers are resolving to kick the habit.
New Year's Day is the single most popular quit date of the year, says Thomas Glynn, director of cancer science and trends at the American Cancer Society. Many others pick days with special significance to them, such as an anniversary or a child's birthday.
While giving up smoking is a notoriously difficult challenge, doctors say they know more than ever about what works and what doesn't. And people have more choices today than ever about how to develop a "quit plan" that works, Glynn says. Developing a plan is essential, he says, given the strength of nicotine addiction.
Some choices are easy.
Strategies to skip include acupuncture and hypnosis, which have never been shown to help people quit smoking, Glynn says.
Another bad idea? Trying to quit on your own, without a plan, support, counseling or medication, says Bill Blatt, director of tobacco programs at the American Lung Association.
Only about 5% of people who take this approach manage to quit long-term, staying smoke-free at least six months, Blatt says.
People can boost their odds of success by writing down their reasons for quitting, telling their friends and families about their plans, talking to their doctors and by thinking of ways to change daily routines that revolve around smoking, he says. People who normally smoke first thing in the morning, for example, may want to break the habit by jumping in the shower as soon as they wake up instead. Those accustomed to smoking after dinner may want to talk a walk outside.
Telling friends and families about a quit date helps people to enlist support â?? and patience. That can be key, given that a common side effect of nicotine withdrawal is irritability, Glynn says. "A lot of psychological research shows that when you make a public commitment, you are more likely to do it," Glynn says.
The lung association's "Quitter in You" program offers guidance both for smokers and those who want to help a loved one quit: http://www.quitterinyou.org/
Taking a Food and Drug Administration-approved medication can boost the odds of quitting to 20%, Blatt said. FDA-approved smoking cessation drugs include several available without a prescription. Among them: nicotine-replacement gum, lozenges and patches. Other products, such as faster-acting nasal sprays and inhalers, require a prescription. So do two drugs that help to reduce nicotine's effects on the brain â?? varenicline, sold as Chantix, and bupropion, sold as Zyban â?? which can help reduce cravings and withdrawal symptoms.
But the people most likely to quit smoking â?? and stay smoke-free long-term â?? are those who combine medications with counseling, Blatt says. These folks have a 40% to 50% chance of successfully quitting.
Smokers who get counseling, even by telephone, are more likely to quit.
Counseling can come in many forms, Blatt says.
In general, the more intensive the counseling, the better it works, says Blatt, although he notes that it's possible that people who sign up for such counseling â?? provided in face-to-face meetings â?? may also be more committed than others. Telephone counseling is also effective, however, and people can access this help easily by calling 1-800-QUIT-NOW.
Several groups provide online quitting help. Others even send text messages, offering support or helping work toward a quit date, Blatt says. Some services allow users to reply to the messages, to ask questions or get support. People can sign up for a "SmokefreeTXT," for example, at smokefree.gov, from the Department of Health and Human Services.
People can chat live online at livehelp.cancer.gov, run by the National Cancer Institute, which is available 8 a.m. to 11 p.m. ET Monday through Friday.
A review by the Cochrane Database, which evaluates medical evidence, last year found that these text messages increase quit rates.
Hundreds of smartphone apps also offer to help smokers quit.
Reviews haven't been glowing.
Few of these apps include proven quitting strategies, such as those endorsed by the U.S. Public Health Service, according to a study in the December issue of the American Journal of Preventive Medicine. Only a handful of apps suggest medication. And none suggest calling a quit line.
Perhaps the most controversial quitting strategy involves electronic cigarettes, or e-cigarettes. These are battery-powered devices shaped like cigarettes, but containing no tobacco. Instead, they use a heating element to vaporize a liquid that contains nicotine, and sometimes other flavors. Advocates of e-cigarettes say they're safer than tobacco. Critics note that FDA tests have found that some e-cigarettes contain carcinogens and other toxic chemicals.
Studies about using e-cigarettes to quit have produced mixed results.
In a December editorial in The New England Journal of Medicine, doctors from the Columbia University Mailman School of Public Health in New York note that "some studies suggest that the majority of e-cigarette users treat them as cessation aidsand report that they've been key to quitting smoking."
Stanton Glantz, a professor at the University of California-San Francisco, says that evidence suggests e-cigarettes act more like a "bridge," allowing people to light up in restaurants and other places where tobacco isn't allowed.
Glantz notes that several population-based studies of e-cigarettes have found that adults and kids who try e-cigarettes are less likely to quit than others.
A September study in The Lancet, however, found that e-cigarettes were about as effective as nicotine patches when smokers tried to quit. About 4% to 7% of smokers quit smoking, whether they were assigned to use e-cigarettes, nicotine patches or placebo e-cigarettes.
And while many public health officials stand firmly against e-cigarettes, Richard Carmona, the former U.S. Surgeon General, joined the board of an e-cigarette company because he predicts that e-cigarettes will help reduce tobacco use.
"I think they are probably going to be somewhat useful," Glynn says. "They will probably help some people stop."
Others strongly disagree.
Given that e-cigarettes have no advantages over FDA-approved nicotine-replacement products, there's no reason for smokers to use them while trying to quit, says Erika Sward, the lung association's assistant vice president for national advocacy.
Although the FDA has announced its intention to regulate them, the e-cigarette business today is akin to the Wild West, and users don't really know what they're inhaling, she says. Ingredients or contaminants could vary from one e-cigarette to another.
"We don't know what's in e-cigarettes," Sward says. "We don't know what the long-term health consequences are."
Tobacco experts agree on one essential point about quitting: the importance of persistence.
Few people quit smoking on the first try. In fact, the average smoker makes seven to nine attempts before quitting for good, Blatt says. Instead of blaming themselves for a slip, he says, people should analyze what made them want to smoke, then try to avoid these triggers.
About 70% of smokers want to quit. And 50 million Americans already have. In fact, former smokers now outnumber the country's 44 million smokers, Glynn says. If people slip up, they should try to get back to their plan as soon as possible, rather than give up.
Glynn says he advises people to "start thinking of yourself as a non-smoker who is on the journey of a lifetime."
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