Prior to the first Surgeon General's Report on Cigarette Smoking in 1964, about half of all American adults lit up. That number has declined over the last 30 years, but about one in four adults still smoke. Many of them would like to quit, so the American Lung Association and a Washington University in St. Louis researcher have written a book to help them.
Called "7 Steps to a Smoke-Free Life," the book, published in May 1998, is based on the American Lung Association's award-winning "Freedom from Smoking" program. Both the book and the program are designed to help smokers better understand their addiction and prepare to quit.
"The more you identify the reasons why you smoke and the reasons you want to quit, the more likely you'll be successful," says Washington University's Edwin B. Fisher Jr., Ph.D. Fisher is a professor of psychology in Arts and Sciences and of medicine and pediatrics and director of the university's School of Medicine's Division of Health Behavior Research.
Most Fail At First
According to the Lung Association, an estimated 46 million Americans smoke cigarettes and more than two thirds -- 32 million -- would like to stop. Each year, 34 percent of smokers actually try to quit. Most fail, at least at first. In the book, Fisher draws on his own experience as a smoker who once faced the prospect of attempting to quit. As a former nicotine addict, he can empathize with those trying to quit now.
"It's a bit like learning to ride a bike. Falling and skinning your knees is often part of the process. When working with smokers, I never say 'it's just a matter of making up your mind to quit,'" he says. "I know that quitting smoking is very hard. It took me 10 or 12 attempts before I succeeded."
Although much new research has been published since Fisher gave up smoking 20 years ago, he says he used many of the strategies outlined in the new book. It's very important, he says, to set a quit date, identify the environmental cues that make you want to smoke, tell friends that it's time to quit and stay upbeat even if the first few attempts fail.
The seven steps form a road map for smokers who want to quit, but not every cessation technique fits every would-be nonsmoker. Fisher says nicotine patches, inhalers, books, videos and group meetings can be helpful, but tools must be tailored to individual needs. These tools fit into the broader framework described by the seven steps:
- Recognize your habit and your addiction -- Every smoker has two basic reasons for smoking: nicotine addiction and pleasure. And after smoking has become a habit, it becomes automatic. Simply paying more attention to when you smoke and what makes you light up can teach you a good deal about why you smoke and help you develop strategies for quitting.
- Build your motivation to quit -- List the pros and cons of smoking and quitting, thinking about health concerns, social pressures to quit and life events that will encourage you to stop. Then write down your top five reasons for quitting.
- Develop a quitting plan -- Would you rather go it alone or with a group? Would quitting cold turkey be preferable to gradually reducing your nicotine intake? Do you want to use medications to boost your efforts?
- Set a quit date -- This gives you time to circle a date on the calendar, plan to avoid certain smoking cues and enlist the support of family and friends.
- Quit -- Get rid of all of the cigarettes, ashtrays, matches and lighters in the house. Keep your top five quitting reasons with you and refer to it when you crave a cigarette.
- Maintain your program for the first two weeks -- The cravings will subside, and you will begin to feel better in a few days, though irritability, nervousness, sleep problems, difficulty concentrating and coughing may last for a few weeks.
- Survive the first six months -- The physical addiction subsides after a week or two, but psychological cues can still give you the urge to light up.
"The first six months after quitting smoking are the most difficult," Fisher says. "A person not only has to contend with constant urges to smoke, but also with stressors like putting on weight or bad moods and frustrations that can prompt a relapse. But the person can focus on the tremendous health benefits of not smoking. They'll feel better, have more energy and live longer. And they can always lose the pounds they gain and learn better ways of preventing and dealing with bad moods than puffing on cigarettes."
Why People Smoke
The book lists several mind-numbing statistics about smoking that many people don't consider when they light up. For example, smoking is the greatest source of preventable death in our society.
Smokers die an average of six to eight years earlier than nonsmokers. Eighty-seven percent of all lung cancers are caused by smoking. Every year, more Americans die from smoking-related diseases than from AIDS, drug abuse, car accidents and homicide -- combined.
Payoffs Within Hours Of Quitting
But many who quit simply for the health benefits become discouraged if they don't see the advantages of not smoking in their daily lives. Fisher therefore offers suggestions on how to find the payoffs of smoking cessation within hours of quitting.
Though smokers are at very high risk for cancer, heart disease and emphysema, the risks for heart disease decline within hours of the last cigarette. When smokers quit, their blood can carry more oxygen to the rest of the body, so the heart doesn't have to work as hard. That is significant because smoking kills more people from heart disease than from cancer. And the further away people get from that last cigarette, the nearer their other risks return to those of nonsmokers -- after 10 years, the lung cancer risk for ex-smokers is as low as that for those who never smoked.
Other health benefits allow former smokers to exercise harder and for longer periods of time just a few days or weeks after quitting. And there are obvious economic benefits. At a couple of dollars a pack, smokers can save hundreds of dollars annually by quitting. Plus, with smoking limited in most public buildings, smokers can use the regulations to help them quit.
"The funny thing about quitting," Fisher adds, "is that if you really know why you want to quit, then the rules and regulations that used to bug you will become your assistants. Rather than feeling hassled to do something you know you should do, you'll realize that the rules and regulations support what you have chosen to do for yourself."
Note: For more information, see Fisher, E.B., with Goldfarb, T.L, 7 Steps to a Smoke-Free Life, Jon Wiley and Sons, May 1998.