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Health Hazard: Smoking Tobacco

We've all heard of someone who smoked two packs a day throughout her life until she died peacefully in her sleep when she was eighty-eight. But that's playing Russian roulette with one bullet in five chambers, since 20 percent or more of the people who smoke will die from it. Despite all the warnings, one woman in six smokes, and over 150,000 women die from tobacco-related causes every year. Even if it doesn't kill you, smoking weakens your immune system, and it contributes to diseases of the heart and lungs, stroke, osteoporosis, and early menopause. It also harms children. A baby whose mother smokes is twice as likely to die of SIDS, and her older children are more likely to have asthma, pneumonia, and bronchitis; secondhand smoke causes 150,000 to 300,000 lower respiratory tract infections annually in American infants and toddlers.

If you smoke, you already know you should quit, and if you've tried to do so, you know how hard it can be. Thankfully, there has been tremendous research on changing the habits that aren't good for your health. Let's go through the keys to success.

Change the thinking. In a sense, the part of your mind that wants to smoke tricks you into doing it in three ways. First, it makes you overestimate the immediate pleasure; for example, your mind says that a cigarette would be good right now, but in reality, by the fifth puff your mouth is already starting to taste bad once again. Second, it underestimates the future costs: who wants to think about cancer when she has a cigarette after lunch? Third, it downplays the rewards of doing something that's healthier, like breathing regular air instead of tobacco smoke.

Once you understand these tricks, the solution is straightforward. First, notice how unpleasurable most of the moments spent smoking actually are, maybe even writing a note to yourself about them. Then, the next time there's the impulse to smoke, really remember what it's going to be like, seeing it clearly, without any rosy-smoke-colored glasses. Second, before lighting up, look squarely at the horrible risks of smoking. If you really want to stop, you could make yourself imagine the moment when the doctor says you've got lung cancer, the chemotherapy, your hair falling out, having to tell the kids about your disease, getting weaker and weaker, going to the hospital for the last time, saying good-bye to your children . . . we're sorry, but you only help yourself if you, frankly, twist the blade. If that's just too intense, remember how your mouth feels after you finish a cigarette, the wheezing as you go up a flight of stairs, the extra coughing by your children. If your partner doesn't smoke, consider what it's like for him to kiss you: Like licking an ashtray, a famous actress once said, after filming her love scenes with a leading man who smoked. Third, imagine how good it will feel to do something healthier, such as going for a walk in the fresh air to get an energy boost instead of using nicotine. Perhaps write yourself a note describing how you'll feel after a month without tobacco, or glue a picture of a vibrantly healthy woman to your pack of cigarettes. Think about the nice things you could have with the money saved by not buying cigarettes.

Change the context. Smoking, or any bad habit, occurs in a context; change that, and you disrupt the habit. For example, if you normally smoke in the house, go outside, preferably to an unpleasant place like the garage or tool shed. If you normally have a cigarette with your morning coffee, try having a cup of black tea. Spend time with friend's who don't smoke, and stay out of bars or other places people smoke. Instead of having your lunch outside, eat inside a restaurant where no-smoking rules apply. Put your cigarettes in a different, out-of-the-way place where you have to think twice before getting one.

Since the context of smoking includes the routine physical behaviors of lighting up, holding the cigarette, and so on, try varying those, too - even if it seems a little silly, like smoking with gloves on. Or try this: the next time you feel like smoking, take a few big breaths and hold the inhalation on each, then light a match, blow it out slowly, and crush the match in an ashtray while imagining it's a cigarette. Take advantage of disruptions in your routine: if you can't smoke while visiting the relatives, do you really need to start up again when you get home? At the end of a long plane flight, you could capitalize on the fact that you're already six hours into quitting smoking. Sometimes the disruption is dramatic. Jan's mother, Dorothy, had a very serious stroke, and when she was leaving the hospital (happily, after a remarkable recovery), she asked her doctor if she could still smoke. Sure, he said, and paused for effect: If you want another stroke. Dorothy chose right then and there to stop cold turkey, and she said later. It was the easiest decision I ever made.

Replace the pleasure of the bad habit with one that's more positive. If you smoke for a jump start, make sure you're eating well (especially protein), try a cup of coffee or tea, splash cold water on your face, or get some exercise. Many people smoke to manage their nervous energy; instead, get up and move around, take big breaths, or use another relaxation method. If cigarettes provide oral stimulation, you could chew gum, munch popcorn, or press a knuckle against your lips.

Get support. It's much easier to quit smoking, or any risky behavior, when someone who cares about you is on your side. You could tell your husband or a friend that you're trying to - going to! - stop smoking, perhaps by naming a "last day" and going public with your intentions. Look into Nicotine Anonymous (NA) and see if that twelve-step approach speaks to you; NA and its close cousin, Alcoholics Anonymous (AA), have been profoundly helpful for millions of people. You can find local meetings by calling NA or AA in your phone book. (There are other support groups, like Rational Recovery, that take a generally similar approach, but without referring to a "higher power.") Your doctor may be able to help you quit through a combination of a nicotine patch and a low dose of an antidepressant.

Be good to yourself. Besides the psychological stress of changing a familiar habit, there could be symptoms of physical withdrawal such as craving tobacco, feeling jittery, or feeling fatigued. So try to be nice to yourself during the withdrawal phase. Eat extra well, especially fresh fruit and leafy green vegetables. Get lots of sleep. Dial back your commitments at work and try to minimize stressful activities at home: it's probably not the moment to reorganize the garage. Try to do more pleasurable activities than usual, especially those that preclude smoking, like going to lots of movies.

Avoid relapses. Most smokers "quit" several times before they finally, truly do so. To make this time the last one, look back on any previous attempts at quitting and study the reasons why they failed - and then target those factors to stop them from controlling you and undermining your health.

You can ask people not to smoke around you, or stay away from the places you used to smoke in (other than, obviously, your own home), until it doesn't affect you. Notice that if you let yourself really feel the craving to smoke, without trying to suppress or resist it, it always passes within a few minutes. Watch out for those tricky little voices in your mind: There's nothing wrong with just one. I'll only take a puff. No one will know. If you feel like you're getting close to smoking again, tell someone who cares about you and ask for his or her support; maybe go to more NA meetings. If you slip and have a cigarette, you don't have to assume it means you're smoking again: tell yourself that cigarette was just part of quitting and get right back onto your program. Every day, remind yourself of the many benefits of not smoking: from being able to taste food fully to living to see your grandchildren. Acknowledge yourself for succeeding at one of the hardest things a person will ever do.



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