I am thinking about stopping smoking

This brochure is designed for those who can seriously see quitting smoking,
but who are not quite ready to stop yet.

Print this brochure, rather than read it on the screen

Congratulations on your intention to quit smoking! You have already made an important step many smokers never make. This brochure was created to help you get to the day you will be ready to actually try to stop smoking. It includes brief self-evaluation questionnaires. Take the time to respond to them, as they will help you to think carefully about your smoking habit.

You can do it too!

Like many smokers, you probably think it is difficult or impossible to stop smoking. However, there are currently 36 million ex-smokers in the USA. If millions of people have succeeded, you are capable of doing it as well! Most of these ex-smokers (more than 90%) stopped smoking by themselves by using the techniques and ideas presented in this series of brochures.

The advantages of life without tobacco

Begin by making a list of the advantages of stopping smoking:

___________________   ___________________   ___________________

Here is what some ex-smokers told us about their experience of quitting. Imagine the day when you can express the same point of view!

• "I am very proud of having quit. It proved that I have the willpower to deal with major difficulty. For 18 years, I believed it was impossible."
• "I am more sure of myself and of my ability to change my own habits."
• "I have lost a feeling of guilt I had been turning on myself."
• "I always get up fresh in the morning. No sore throat, no nothing."
• "I save 25 dollars per week (a fill-up at the gas station)".
• "My family thinks quite a bit more of me".

And more

• In the days after quitting smoking, you will rediscover your complete sense of taste and smell. You will enjoy perfumes and smells fully, and you will be able to taste the things you eat.
• In the weeks after quitting smoking, physical performance improves and the cough disappears.
• No matter how old you are, or how many years you have smoked, stopping smoking has a beneficial effect on your health, even if you are already sick from a tobacco-related disease. It is NEVER TO LATE to stop smoking.

The advantages and the drawbacks of cigarettes

• Before quitting smoking, ex-smokers had profoundly modified their opinions on the drawbacks and the advantages of cigarettes.
• Respond to the questions below. This will help you think about this subject.

Total Drawbacks______________

Total Advantages ______________

Calculate the difference between the two totals:

Drawbacks - Advantages = ____ - ____ = ____.

If the difference between the drawbacks and the advantages is:

Cigarettes or health

You risk becoming seriously ill if you continue to smoke. Stopping smoking is the most important thing you can do to protect your health, whatever your age and the number of years you have smoked.

Did you know?

• In the USA, in the UK, and in most developed countries, smoking is the leading preventable cause of death and disease.
• In the USA, 530,000 people die each year from diseases caused by smoking. This is equivalent to 1,325 crashes of a Boeing 747 (more than 3 crashes per day)! It is more than the TOTALITY of deaths due to road accidents, illegal drugs, AIDS, alcoholic cirrhosis, homicides and suicides. In the UK, smoking is responsible for 121,000 deaths per year.
• Smoking does not only kill old people. In the USA, 36% of deaths occurring in men aged 35 to 69 are due to smoking; and 31% for women of the same age. For the UK, the corresponding figures are 31% for men and 25% for women. (The mortality is lower for women because, in the past, women were less likely to smoke than men).
• 90% of all lung cancer is attributable to tobacco smoking.
• Only 13% of the people who have been diagnosed with lung cancer today will still be alive in 5 years.
• One smoker out of 2 will die of a disease caused by his or her smoking. On average, smokers die 8 years before non-smokers. By stopping smoking, you add several years to your life expectancy and increase your chances of seeing your grandchildren grow up.
• Usually, smoking-related deaths are preceded by long and painful diseases and medical or surgical treatments.

Did you also know that...?

• Smokers get colds more often and recover more slowly than nonsmokers do.
• Smoking damages the skin and increases facial wrinkles.
• Gum diseases are more common in smokers than non-smokers.
• For men, smoking can cause impotence.
• In smoking, you put the health of others in danger. For nonsmokers living with a smoker, the risk of cancer is increased by 26%, and the risk of heart attack by 23%, as compared to nonsmokers who live with nonsmokers.
• Smokers cause 33% of all fires (cigarettes thrown in the trash, etc.).
• Many road accidents are caused by smokers, due to their inattention either while lighting cigarettes or searching for cigarettes that have fallen on the floor.

While smoking, you absorb:

• About 4,000 substances naturally present in the tobacco, including nicotine (which causes addiction), carbon monoxide (dangerous because it hinders oxygen from binding to the blood), arsenic and cyanide.
• Tar, which deposits in the bronchi and lungs and can cause cancer.
• Additives: carbonic, acetic, formic, and benzoic acids; titanium dioxide; ash-bleaching products; combustion accelerators, etc.
• Ammonia, which cigarette manufacturers add to the tobacco to facilitate the absorption of nicotine and maintain the dependence of smokers.
• Many of these substances and additives are extremely toxic. Do you really want to absorb this daily?

Women gain a lot by quitting smoking

• Smoking reduces fertility. Women smokers who hope to become pregnant have to wait longer than women who do not smoke. Women who quit smoking before trying to become pregnant increase their chances of becoming pregnant to equal those who do not smoke.
• For women who take the contraceptive pill, smoking increases the risk for vascular problems. Women who take the pill should not smoke.
• The birth weight of newborns whose mothers smoke is less than that of newborns whose mothers mother do not smoke (Low birth weight represents a serious risk for newborns).
• Nicotine crosses the placenta as well as passes through mother's milk. It acts on the nervous system of both the fetus and the nursing infant.

In stopping smoking, you also protect your children

• Children of smokers are twice as likely to become smokers themselves as children of nonsmokers.
• Children of smokers have more respiratory problems (particularly asthma and respiratory infections) than the children of nonsmokers.
• The risk of sudden infant death (SIDS) is higher for infants whose parents smoke.

Why do you continue to smoke?

Take a few minutes to ask yourself what keeps you from quitting smoking.

What keeps me from stopping smoking?

a)____________________________________________________________________

b)____________________________________________________________________

c)____________________________________________________________________

Here is what smokers who participated in our surveys told us about their reasons to smoke, and the answers that we can give them:

"I like to smoke."

Stopping smoking can also make you feel good. You will rediscover perfumes and odors, your taste will improve, you will be in better shape. You will have better breath and you will not smell like smoke anymore. Your friends and family will stop criticizing you about your smoking.

"Smoking relaxes me."

There are other ways to relax: breathing deeply several times, taking a walk, doing more sports, practicing a relaxation technique, getting enough sleep, taking a nap, etc.

The pleasure and feelings of relaxation after you smoke a cigarette are linked mostly to dependence on nicotine. They are the consequence of the elimination of disagradable nicotine withdrawal signs (anxiety, restlessness, irritability, etc.). Non-smokers neither feel pleasure nor relaxed when they absorb nicotine. If you stop smoking, you will realize that you do not need cigarettes to be relaxed. Smokers have forgotten what it is like to be completely relaxed, as they are always afraid of having a nicotine withdrawal.

"A cigarette helps me in difficult times."

Ask yourself truly, do cigarettes really help you deal with your problems? Lighting a cigarette when a problem appears can prevent you from clearly discerning it and from searching for a solution.

"Smoking helps me concentrate and work better."

Nicotine facilitates concentration mostly because it reduces withdrawal symptoms (which include restlessness and anxiety); using nicotine just allows you to focus on something else than these symptoms. In reality, cigarettes reduce intellectual performance, because of diminished flow of oxygen to the brain.

"I have no willpower."

Many people think that willpower is enough to stop smoking. We think that this is not entirely true. We believe that stopping smoking requires specific knowledge and expertise. Anyone can quit smoking, if done correctly. This series of brochures presents strategies and techniques that have allowed smokers to stop smoking. Remind yourself that you have no less willpower than other people who -around you -have successfully stopped. You must convince yourself that you are stronger than cigarettes.

"I am addicted to nicotine."

Nicotine is a substance that causes a strong physical addiction. Nicotine dependence is the main reason why smokers continue to smoke. With each cigarette, you strengthen and reinforce this dependence. However, in only three weeks of not smoking you will get rid of the dependence. Quitting smoking is the door to the prison of dependence. Many ex-smokers told us that freeing themselves of this dependency was less difficult than they thought, and that they would have stopped earlier, had they known how easy it was.

"I am afraid of the withdrawal effects of quitting."

These symptoms generally disappear within 2 to 3 weeks. The nicotine-containing "patch," chewing gums and nasal spray reduce or eliminate these symptoms. By using these products from the first day after you stop smoking, you increase by 2 to 3 times your chances of successfully quitting.

To learn how to cope with nicotine withdrawal, you can hold off from smoking for a few hours. Then, try it for a half-day. Then, try it for an entire day. Just like in other domains, practice makes perfect. These brief periods without cigarettes can prepare you to definitively stop smoking and increase your confidence in your capacity to resist cigarettes.

"I will become irritable or depressed if I stop."

It is true that some people become irritable or depressed after they quit smoking. These are typical nicotine withdrawal symptoms, ones that are reduced by using nicotine-containing products. With or without these products, most of the withdrawal symptoms disappear in 2 to 3 weeks. If the depression persists for longer than this, take it seriously and see a doctor. If you already had a serious episode of depression, your doctor may give you anti-depressant drugs before you attempt to quit smoking, to prevent a new episode of depression.  

"I smoke very few cigarettes; it isn't dangerous."

This is bad logic. Many scientific studies agree that even smokers of few cigarettes run serious risks. For example, smokers of 1 to 10 cigarettes a day have 10 times the risk of getting lung cancer as nonsmokers.

"I smoke light cigarettes; I run only small risk."

The term "light cigarettes" was invented by the tobacco industry to lead smokers into believing that they are less toxic. This is false. First, there are no agreed-upon criteria to define "light" cigarettes. Second, machines establish the level of nicotine and tar written on the cigarette packets, but people do not smoke like machines! Smokers of light cigarettes do not smoke the same way that smokers of "regular" cigarettes do. They inhale the smoke more deeply, take longer and more frequent drags, make shorter butts and block ventilation holes around the filter to avoid diluting the smoke with air. Consequently, the level of nicotine and other toxic substances in the blood is not much different for smokers of light cigarettes and for smokers of regular cigarettes.

"Most of the people around me smoke."

In the U.S., about 28% of adults smoke. Thus, the majority does not smoke. In our brochure entitled "I just quit smoking", you will find advice on how to resist the influence of smokers who encourage you to smoke.

"I have too many problems right now," or "I'll wait until New Year's Eve, when I will have found a job, etc."

Since you intend to stop smoking, why wait more? It will not be easier to quit later than it will be right now. Smoking is an addiction: over time, you will become more addicted, not less. Don't waiting until you become ill of a tobacco-caused disease. Take a firm decision right now to stop smoking. Many ex-smokers have said that this firm engagement with themselves was decisive for successful quitting. Several events can make you think about quitting smoking: flu, bronchitis, pregnancy, smoking-related diseases among those around you, etc. If these events occur, tell yourself that this is the right moment to seize for stopping smoking.

"I dread gaining weight if I stop smoking."

It is true that many people gain weight after they stop smoking. This is not the case for everyone, and the weight gain is generally moderate (8 to 10 pounds, or 3 to 4 kilos on average) If this happens, solve one problem at a time. Deal with smoking first, then with losing weight. Tell yourself that if you can stop smoking, you are just as capable of losing weight. Many techniques allow you lose the weight : ask for the advice of a dietician, doctor, or consult a good bookstore (addresses on page 19). In anticipation of the eventual gain of weight, you could lose a few pounds or one or two kilos now. To fight the weight gain, eat less fat and do more sports or exercise. In addition, using nicotine-containing products (chewing gum, patch) or the drug bupropion from your first day as an ex-smokers can limit or at least delay the weight gain.

"If I try to stop, I'm afraid I will just start again."

Relapsing is a normal phenomenon, a part of the quitting process. On average, ex-smokers make 4 serious attempts to quit before they quit for good . Relapsing is not something to be ashamed of. You must try and try again. It is not a shame if you are not successful the first time you try around. Every attempt increases your chances of success.

How to progress?

What activities and thoughts could you use to make progress towards stopping smoking?

Use the space below to make a list.

________________________     ____________________________

Research conducted among people who, like you, intended to quit smoking and finally succeeded enables us to suggest to you the following advice:

Inform yourself

• Start by adjusting your opinion about smoking and inform yourself well.
• Read documents on the drawbacks of smoking. You will find at the end of this booklet a list of web sites that you may visit.
• Inform yourself about:
  • the help available to quit smoking,
  • products that contain nicotine (chewing gum, patch, nasal spray, inhaler, tablet),
  • the drug bupropion, which is quite effective in helping smokers quit smoking.
• Talk about your smoking habit with your doctor, your dentist, your pharmacist or other health professionals. They can provide you with you personalized information.
• Talk with ex-smokers. The can help you as they understand the best what it takes to stop smoking Ask them what caused them to stop smoking, what advantages they had from it and how they got there.

Keep asking yourself why you smoke

Before stopping smoking, ex-smokers have passed through a phase of profound questioning. Ask yourself why you smoke, what the benefits of smoking are and in what ways cigarettes harm you. Imagine yourself as an ex-smoker and think of the pride that those who have succeeded feel after having stopped smoking.

Accept that society changes

You have certainly noticed that in the past few years, the attitude of many people towards smokers has changed. Instead of being hostile to these changes, try to see them as something that might help you. Notice that there are more and more places reserved for non-smokers: these places will make life a lot easier when you are striving to not touch cigarettes. Choose restaurants that provide a non-smoking section and ask for a table in this area.

Turn to family, friends and colleagues for support

• Many ex-smokers said that the help of the people around them has been an essential element of their success.
• Talk to people you trust about your intention to stop smoking and ask your friends and family to encourage your intents, and to avoid criticizing your smoking habit.
• Expect little (if any) help on the part of smokers. Instead, look to the support of non-smokers and ex-smokers.
• If your partner is a smoker, try to convince him or her to quit as well.

Call on the help of a professional

Many doctors and psychologists are specialized in helping people quit smoking. Their help can increase your chances of success. You can also participate in a group method (e.g., the 5-Day Plan).

Use nicotine replacement products

If you try stopping smoking, you should use pharmaceutical products that contain nicotine (patch, chewing gum, nasal spray, inhaler, sublingual tablet). These products reduce or even eliminate withdrawal symptoms. People who use these products are 2 to 3 times more likely to succeed at quitting than those who do not. Ask your doctor, your dentist or your pharmacist for advice. These products are not dangerous to your health. In particular, the risk of cardiovascular accident is not increased for people who use these products. This also applies to patients with heart disease.

If you failed with nicotine replacement products, use the drug bupropion

Bupropion is anti-depressant drug that is very effective in helping non-depressed smokers quit smoking. The side-effects of bupropion are more important than those of nicotine-containing products. Therefore, you should use bupropion only if you have failed in a serious quit attempt while using nicotine-containing products (patch, gum, etc.).

Think carefully about the advantages of a life without cigarettes

• Make a list of the benefits of quitting smoking. Post this list in a visible place.
• Say to yourself, for example "In stopping smoking, I am taking things in my own hands and I am improving my life," or "If I stop smoking, I will save 1,000 Dollars per year."

Consider the image you project of yourself

Today, it is considered worse and worse to smoke. Consider the negative image you give of yourself to your family, children, work colleagues and bosses. In quitting smoking, you will project an image of a strong and responsible person, capable of willpower, conscious of your health and that of others. In addition, adults who smoke share part of the responsibility when kids imitate their behavior. Remind yourself that by stopping smoking, you set a positive role model for kids.

Ask yourself if you want to continue to support the tobacco industry

Have you considered that in buying cigarettes, you are supporting an industry that targets children, manipulates the composition of the tobacco to make it more addictive, and has lied for many years, because, despite what they said repeatedly, they knew that nicotine is addictive?

Calculate the costs of smoking

How much do you spend each day on your cigarettes? _____ $ / day.

Multiply this figure by 365 to obtain your spending per year: _____ $ / year.

Multiply this figure by 10 to find your spending over ten years: _____ $ / 10 years.

Write what you can buy with these amounts:

________________________         _________________________

Keep a smoker's journal

Self-observation by taking written notes is an effective method for stopping smoking. Many ex-smokers have found that while smoking, keeping a journal has allowed them to better control their smoking habit and their reflexes. They have said that this has "opened their eyes" about a habit that they thought they understood. Why not do the following experiment during a couple of days:

• Keep in your pack of cigarettes a copy of the "smoker's journal" at the end of this booklet.
• Before lighting each cigarette, write down the date, the hour, the situation and the mood you were in, the strength of your urge to smoke, as well as a way to resist the urge to smoke in this situation.
• Each night, re-read your journal and think about it carefully.

For those who have started smoking again after they tried to quit

You are not the only one who has tried unsuccessfully to stop smoking. On average, ex-smokers make 4 attempts to quit before they actually come to stop smoking altogether. Hence, it is entirely normal to re-start several times. Consider the fact that having re-started smoking is not like a failure, but instead like a learning experience. Learn from this experience. Like in other domains, mastery comes through practice.

The fact that you have returned to smoking does not mean that you are incapable of stopping smoking, but rather that you were not able to control a particular situation. Try to remember the circumstances under which you started to smoke again and prepare a strategy to resist smoking in similar situations. The following questionnaire can help you think about your relapse:

1. Under what circumstances did you start smoking again (place, with whom, what activity, your mood state at the time)?

_____________________________________________________________________

2. What triggered the urge to smoke?

_____________________________________________________________________

3. In the future, how will you resist cigarettes in similar situations or how can you avoid these situations?

_____________________________________________________________________

Remind yourself that your next attempt to quit will be different than the previous one, as you will be better prepared, having the benefits of the advice that can be found in this series of brochures. Try and try again, and you finally will succeed!

Read our brochure entitled "I started smoking again"

It contains information and advice that will help you to overcome the negative feelings that follow a relapse, then try again.

And now?

We know that it is not easy to quit smoking. Nevertheless, for the quality of your life, for your health, for the health of those around you, you should make a commitment to yourself to stop smoking. Since you have already decided to quit smoking, what are you waiting for? The best is to prepare your attempt to quit right now, before becoming sick from a tobacco-related disease, and before making those around you sick. Think about the positive image you will project of yourself by stopping smoking.

We can help you!

We offer individualized advice to help you stop smoking. For this, you must respond to a questionnaire, then send it to us. In return, you will receive an evaluation of your own personal characteristics. If you wish, you may choose to receive a series of evaluations, updated from time to time. You can obtain this personal evaluation directly on this web site, by answering our questionnaire on the screen. We have also created a series of brochures that can be useful to you. You can order these materials from the address found on the first page.

To everyone, good luck!

Smoker's Journal

Photocopy and cut out this journal. Over a few days, fill it out before lighting each cigarette. At night, go over it and think about it.

Smoker's Journal

Review of the day of (date): _______________

The situations where the urge to smoke was strongest: ________________________________

The most effective strategies to resist in these situations: _______________________________

* Mood: neutral, worried, stressed, angry, depressed, content, relaxed, tired, bored.

** Intensity of the urge to smoke: none=0, very weak=1, moderate=2, strong=3, extreme=4.

Where to find help and information about quitting smoking?

Internet

• Individualized advice given by a system-expert: http://www.stop-tabac.ch.
• The Center for Disease Control's Tobacco Information and Source Page is put out by the Office on Smoking and Health.
• The QuitNet is an online resource and support center for smokers struggling to quit and for those ex-smokers working to stay quit. http://www.quitnet.org/
• Nicotine Anonymous offers meeting information, a twelve step program, and motivational slogans. A great thing is that there are no fees for joining. http://rampages.onramp.net/~nica/

Additional Internet Links

GENERAL LINKS

• Tobacco BBS
• Smoking From All Sides
• NicNet: Nicotine and Tobacco Network
• A Capsule History of Tobacco

HEALTH-RELATED LINKS

• The Centers for Disease Control and Prevention
• CDC Tobacco Use and Prevention Information
• Food and Drug Administration
• American Cancer Society
• American Lung Association
• American Lung Association: Smoking and Tobacco Control

DOCUMENTS AND LITIGATION

• CourtTV Tobacco Cases
• Tobacco Control Archives - The Brown & Williamson Collection
• Tobacco Litigation (The Wilmington Institute)
• Andrews' Publications: Tobacco Industry Litigation Reporter
• Tobacco on Trial: The Newsletter of the Tobacco Control Movement

ANTI-SMOKING SITES

• The Master Anti-Smoking Page
• The Foundation for a Smoke-free America
• Nicotine Anonymous
• Americans for Nonsmokers' Rights
• ASH - Action on Smoking and Health
• National Center for Tobacco Free Kids

NEWSGROUPS

• alt.smokers
• alt.support.stop-smoking
• alt.support.non-smokers
• alt.support.non-smokers.moderated

Articles and Publications

• Major Depression Linked To Stages Of Smoking - MHN Reading Room
• Psychiatrists use Antidepressants to Treat Smoking Addiction - MHN Reading Room
• Smoking As Drug Dependence - The Harvard Medical School Mental Health Letter
• Smoking Contributes to Mental Decline in Elderly - MHN Reading Room
• Smoking Found to Increase Sight Risk - USA Today

Products For Sale

• LifeSign - Smoking cessation program.
• The Quit Smoking Company
• Quit'em - Stop smoking focus cards

Software

• Smoke Free Stats - Free software to help you quit cigarettes.

Treatment & Support Services

• Addiction Alternatives - Dr. Marc Kern
• Neighborhood Tobacco Recovery Network - Calgary, Alberta, Canada

Video

• Message to Youth - A NEW VIDEO
• Straight Talk About Tobacco, a live talk by Patrick Reynolds, was recently made available on video. Filmed before 2,000 middle and high school students, this powerful, multimedia presentation helps motivate youth to stay tobacco free, and to resist the onslaught of tobacco advertising and peer pressure.

The stages of change

• Most smokers pass through 5 steps (or stages) before they become confirmed ex-smokers.
• We have designed a brochure for each of these 5 stages, as well as a brochure for those who have restarted smoking after trying to quit (relapse).
• These brochures can be ordered from the address located on the first page.
• If you are in the Contemplation stage (you are seriously considering stopping smoking within the next 6 months), this is the brochure you should read first.
• You get the most out of these brochures if you make notes on them, if you underline the important passages and if you take note of the main points.

This brochure was created at the Institute of Social and Preventative Medicine of the University of Geneva, with the support of the Swiss Cancer League, the Swiss National Science Foundation, the Swiss-Romande Lottery, the Geneva Department of Social Action and Health, the Swiss Federal Office of Public Health, The Swiss Foundation for Health Promotion, Pharmacia & Upjohn, the Swiss Pulmonary League, the Cipret-Genève and the Jura Canton Health Service. We thank the Swiss Association for Smoking Prevention (at) for it help and support.

Copyright (c) Jean-François Etter 1999. All rights reserved.

Author: Jean-François Etter

Translated from French into English 1 March, 1999 by MCART.org

Your donations will allow us to distribute these brochures and to pursue our prevention programs and our research on smoking prevention. Send donations to the Postal Account CCP 12-7003-9, Faculté de médecine, CH-1211 Geneva 4, Switzerland. Do not forget to indicate: "Fonds 2428 - IMSP."

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