Can't stop smoking? Don't give up

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— If you've tried several times to quit smoking and failed, you may think it's time to give up.

Not true.

Most Americans make four to eight tries in a five-year period before they finally succeed.

With knowledge of the health risks associated with tobacco, the prevalence of smoking declined steadily among nearly all age groups and income levels during the second half of the last century. From 1993 to present, however, the number of smokers has remained fairly constant at about 25 percent of the population - suggesting that those who found it relatively easy to quit may have already done so.

Both a stimulant and a sedative, nicotine is one of the most addictive of all substances of abuse. Of the remaining smokers, about 70 percent said they would like to quit, and there are tools available to help.

Reasons to quit: Whether it's your first or your fifth try, a basic initial step is to make a list of your reasons to quit.

There's no question that you'll be healthier. Smoking is a major factor in about 25 percent of all fatal heart attacks and 33 percent of cancer deaths. Hat "smoker's cough" you have every morning is not normal, of course, but a symptom of chronic lung and breathing problems that will only get worse with continued smoking.

Emphysema, a smoker's disease, is the fourth leading cause of death. Within 15 years of quitting, on the other hand, your risk of dying will be about the same as that of a person who has never smoked.

Think of your personal reasons as well.

Your family will thank you for quitting. Not only will you be extending your years with them, but those years will be more satisfying. No more trips outside in the middle of winter. No more smelly clothes and breath. Smoking is an expensive habit. Plan the things you will be able to do with the money you save.

Make your list as specific as possible and put it on the refrigerator door or bathroom mirror so you'll be able to remind yourself every day.

Have a plan: There's never a perfect time to quit smoking, but it's best to avoid periods when you know you're going to be under pressure at home or work.

Some choose their birthday or wedding anniversary as a start date. New Year's Day has symbolic implications. The Thursday before Thanksgiving is Great American Smoke-Out Day, when thousands of Americans will start their battle together.

Leave yourself at least two weeks to prepare for this date. Choose a method, plan your strategy and put together a group of family and friends willing to offer support when it's needed. Have your carpets, drapes and clothes cleaned to get rid of the smoke smell, and dispose of all tobacco products, ashtrays and lighters. In their place, gather together what some call a "quit kit" - items like hard candy and stress-busting gadgets to get your through the initial cravings.

For many individuals, worry about increased appetite and weight gain is an important consideration. As a result, the two-week period before your start date is a good time to start a new exercise program or expand one you already have.

In addition to helping control appetite and weight, exercise can reduce stress, build self confidence and improve mood. One study of 281 women enrolled in a smoking cessation program found those who took part in three vigorous workouts a week were twice as likely as other subjects to remain smoke free. They also gained less weight.

Choose a method: You may know someone who just quit smoking without any formalized plan. That's great if you can do it. If you've tried and failed, you know, at least for you, it's not just a matter of will power. And it need not be - there are many effective methods available and your doctor may be able to find one that's right for you.

Studies have confirmed the effectiveness of individual counseling and group therapy smoking cessation clinics, either on their own or in combination with nicotine replacement.

Nicotine replacement therapy is available through a number of products. The idea is to reduce the withdrawal symptoms and craving by delivering a controlled dose of nicotine. A Cochrane Review of more than 90 studies found that nicotine replacement - regardless of the method - nearly doubled a person's chances of quitting successfully. The quit rate was even higher when nicotine replacement was combined with counseling or therapy.

Nicotine chewing gum and skin patches can be purchased over the counter. Inhalers and nasal sprays, which may give quicker action, require a prescription.

The only other approved medication for smoking cessation is sustained release buproprion (Zyban), an atypical antidepressant. Nortriptyline, another antidepressant and the hypertension medication clonidine have also been used as stop smoking aids.

Self-help materials such as leaflets, manuals, audio and videotapes and computer programs are less expensive, but studies have found them effective primarily when materials are tailored specifically to the individual and combined with follow-up phone calls.

A number of Web sites offer advice, encouragement, support and, in some cases, a personalized self-guided quit course. The Boston University School of Public Health produces www.quitnet.org., which offers a series of tips delivered to your e-mail daily, starting two weeks before and lasting two weeks after your quit day.

Australia's National Tobacco Campaign offers www.quitnow.info.au. Teen smokers are the primary target of the United Kingdom's cartoon-based site, www.iquitonline.com.

The Internet approach is free - other methods are clearly more expensive. What's important, of course, is finding one that's effective. If you're spending $60 to $100 on cigarettes, you undoubtedly will be spending multiples of those amounts on medical care in the future. Whatever it costs to break the habit, it's a good investment.

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