Alberta Daniels, 45, Chicago

A 30-year smoker, Alberta Daniels didn’t want to quit her pack-a-day habit but knew she had to. “I’m coughing more and my chest is starting to hurt,” she told us.

She’d tried kicking butts four times previously, using a nicotine patch and lozenges. Once she quit for four months but relapsed and smoked a whole pack in a night.

Daniels told us she puffed to deal with job stress; she took several smoke breaks during the workday to ease her tension. At night, she’d shut herself in her bedroom and smoke to unwind.

The expert: Carol Southard, RN, a tobacco treatment specialist at Northwestern Memorial Hospital in Chicago

Her give-it-up guide: Southard says it’s a myth that smokers have to want to quit in order to succeed. “We do them a huge disservice by telling them to wait until they’re ready. It’s more important that they decide to quit and learn how to do it.”

To give Daniels the best shot at kicking the habit, Southard enrolled her in a smoking cessation support group and prescribed nicotine patches and Chantix, a drug that shuts down the brain’s nicotine receptors. Based on her experience, Southard felt the combination would give Daniels a significant chance of ditching cigarettes for good. “Smokers who try to quit without group support or medication have only a 3 to 5 percent chance of succeeding,” she says.

How it worked: “I confess I didn’t quit 100 percent at first,” says Daniels. “I’d sneak two or three cigarettes a day. Carol said that allowing myself to smoke at all was a slippery slope. It was just so hard! I needed to smoke to deal with the work and financial drama in my life, but Carol called me out on my excuses. ‘Having a cigarette isn’t going to solve your problems,’ she’d tell me.

“She suggested I alter my routine to avoid situations that made me want to light up. So instead of smoking in my bedroom when I got home from work, I sat outside and talked to my sister, who lives upstairs. Later, when I’d normally make coffee — which always triggers a cigarette craving — I hung out in the living room with my daughters. I’d never expose anyone to secondhand smoke so it helped to avoid being alone.

“Initially, I didn’t tell my daughters and my 4-year-old grandson, Trevone, that I was quitting because I didn’t want them to bug me. When I finally did, they were thrilled, especially Trevone. He’d learned about the dangers of smoking at preschool and had been begging me to stop.

“The withdrawal was rough, even with the patch. (I stopped taking Chantix after I broke out in a rash; I learned later that it was due to anxiety, not the drug.) I yelled at people, my concentration was off, and I was making mistakes at work. Going to the support group meetings helped because I saw that other people were struggling, too.

“Eight weeks into the program, I noticed I felt a lot better. One day I had to run a half block and up a flight of stairs to catch the train, and I wasn’t winded. That was incredible. My sense of smell and taste improved too. When I stood next to a smoker, I’d think, Damn, that’s what I used to smell like? I can’t believe nobody told me!

“Today, I still want to smoke but I just don’t. I wear the patch faithfully, and I even went back on Chantix because I want to kill the cravings for good. Now that I feel so much healthier, I’ve started kickboxing. I love it! It’s another incentive to stay off cigarettes: If I smoke, I won’t be able to kickbox.

“When I’d relapse during my past attempts to stop smoking, I’d think: Forget it. So what if I don’t quit? But this time I didn’t want to let Carol down — or my family. When Trevone said, ‘I’m glad you don’t smoke those cigarettes anymore, Grandma,’ it was a really proud moment.”

http://www.lhj.com/health/stress/mood-boosters/break-your-worst-habits/?page=2

Smokers planning to kick the habit may have more success if they begin using a cessation medication several weeks before they actually try to quit. Those are the results of a clinical trial conducted by researchers at the University at Buffalo Roswell Park Cancer Institute (RPCI) and other institutions published recently in Clinical Pharmacology and Therapeutics. The study focused on 35 women and 25 men, all smokers from Western New York who were on average 48 years old and smoked a pack of cigarettes per day. Participants who were randomized to take the smoking cessation medication varenicline (marketed as Chantix) for four weeks prior to trying to quit smoking were more likely to successfully quit smoking than those who took varenicline for just one week before quitting, which is the current standard therapy for the drug. Everyone took the medication for an additional 11 weeks after the quit day.

For More Information:
http://www.buffalo.edu/news/13103

Researchers in Greece saw changes in the lung function of healthy smokers who puffed on an e-cigarette for just five minutes — although it’s not clear what the long-term result of those responses might be in regular e-cigarette users, the team reports in the journal Chest.

“E-cigarettes” are battery-powered devices that allow users to inhale a vaporized liquid nicotine solution instead of tobacco smoke. They were designed as a way for smokers to get their nicotine fix without exposing themselves, or other people, to the toxins in tobacco smoke.

But some scientists, including officials at the U.S. Food and Drug Administration (FDA), warn that too many questions remain about the safety of these products.

“This is the first evidence that just one (e-cigarette) use can have acute physiologic effects,” said lead researcher Constantine I. Vardavas, of the Center for Global Tobacco Control at the Harvard School of Public Health.

For the new study, Vardavas and colleagues in Athens had 30 healthy smokers puff on an e-cigarette to see how it affected their airways.

The researchers found that after five minutes, users showed signs of airway constriction — as measured by several types of breathing tests — and of inflammation.

It is not known whether that short-term response could translate into health effects in the long run, including lung diseases like emphysema.

“More studies on the long-term effects are needed,” Vardavas told Reuters Health.

But, he noted, if e-cigarettes trigger airway effects after just a few minutes, that raises concerns about repeated use of the products over time.

“There are claims that e-cigarettes have no health effects,” Vardavas said. “But that’s not correct.”

An industry spokesperson defended the products.

“This is a product that eliminates second-hand and third-hand smoke,” said Ray Story, CEO of the Tobacco Vapor Electronic Cigarette Association.

Third-hand smoke refers to the toxic particles that remain on smokers’ clothes, furniture and other surfaces long after second-hand smoke has cleared.

“We already know e-cigarettes are much safer than the conventional cigarette,” Story said, “because you’re not burning it, and you don’t have the five or six thousand ingredients in cigarettes, which are mostly dangerous chemicals.”

Story said that e-cigarettes contain only five main ingredients: nicotine, water, propylene glycol, glycerol and flavoring.

“These ingredients are all FDA-approved,” Story said.

But the FDA says on its website that “e-cigarettes may contain ingredients that are known to be toxic to humans, and may contain other ingredients that may not be safe.”

Indeed, the FDA and the e-cigarette industry have had a rocky relationship.

In 2010, the agency sent warnings to five makers of e-cigarettes for marketing them illegally as stop-smoking aids. The FDA also tried to regulate e-cigarettes as drugs — and thereby block their importation into the U.S. — but a U.S. court ruled that the FDA could only regulate the devices as tobacco products.

Vardavas said it’s not clear why e-cigarettes increased airway constriction in this study. But when they had 10 of the study participants use “control” devices — e-cigarettes that had the cartridges removed — they did not see the same airway effects.

So one or more ingredients in the e-cigarette may be responsible, but it’s not known which they are, Vardavas said.

The study was partly funded by the Hellenic Cancer Society in Greece. The researchers report no financial conflicts of interest.

It’s possible, according to Vardavas, that if people used e-cigarettes as a temporary “bridge” to quitting smoking, any short-term effects of the products would be outweighed by the long-term health benefits.

But no one knows if e-cigarettes actually do help smokers kick the habit.

“If you’re trying to quit,” Vardavas advised, “stick to the methods that are known to work.”

Those, he noted, include nicotine patches and gum, prescription medications like bupropion (Zyban) and varenicline (Chantix), and counseling.

SOURCE: http://bit.ly/xwYmwQ Chest, online December 22, 2011.

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_120507.html (* this news item will not be available after 04/04/2012)

February 8, 2012

A new study in Biological Psychiatry this month now suggests that low dopamine levels that occur as a result of withdrawal from smoking actually promote the relapse to smoking. Dopamine is a brain chemical messenger that is critically important in reward and motivation. Some research suggests that one of its central roles is to send a signal to the brain to ‘seek something enjoyable’. Indeed, dopamine is released during many rewarding experiences, including taking drugs, smoking, having sex, and eating food.This signal seems to depend on the dopamine which is released in response to environmental cues, called phasic release, as opposed to the tonic seepage of small amounts of dopamine from nerve cells. The tonic release of dopamine is implicated in helping the dopamine system set the level of its reactivity to inputs.Since dopamine is released by smoking, it makes sense that dopamine levels become abnormal when a smoker chooses to stop smoking. Researchers from Baylor College of Medicine in Texas undertook their study to characterize these changes.They studied mice that were administered nicotine, the active constituent of cigarettes, for several weeks. The researchers then withheld the nicotine and measured the subsequent alterations in dopamine signaling during the withdrawal period.They reported that withdrawal from nicotine produced a deficit in dopamine in which the basal dopamine concentration and tonic dopamine signals were disproportionately lower than the phasic dopamine signals. Re-exposure to nicotine reversed the hypodopaminergic state.”This study is an elegant example of yet another way that addiction ‘hijacks’ the reward system. The phasic release of dopamine triggers us to seek things that, in theory, help us to adapt to our environment,” commented Dr. John Krystal, editor of Biological Psychiatry. “However, in addiction the phasic release of dopamine is heightened and it triggers the pursuit of abused substances. This disturbance of dopamine function would, conceivably, make it that much harder to avoid seeking drugs of abuse.”According to the authors, these findings indicate that medications which could help elevate tonic dopamine levels during withdrawal may be successful treatment strategies for nicotine-dependent individuals attempting to quit smoking. Theoretically, such a treatment could help normalize any fluctuating dopamine levels from the sudden lack of nicotine, and also lessen the dopamine-influenced urges to seek out the nicotine, leading to relapse. More information: The article is “Withdrawal from Chronic Nicotine Exposure Alters Dopamine Signaling Dynamics in the Nucleus Accumbens” by Lifen Zhang, Yu Dong, William M. Doyon, and John A. Dani (doi:10.1016/j.biopsych.2011.07.024). The article appears in Biological Psychiatry, Volume 71, Issue 3 (February 1, 2012)

Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence

1. Stuart G. Ferguson PhD1,*,
2. Joseph G. Gitchell BA2,
3. Saul Shiffman PhD3,4
© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction Issue Aims: Smokers who lapse during a cessation attempt are at particularly high risk of relapse, so interventions to help smokers recover from lapses are urgently needed. Two recent studies have suggested continuing to use nicotine patches following a lapse may be a beneficial relapse prevention strategy. However, to date no study that uses approved doses of nicotine patches under real-world conditions has tested this hypothesis.
Design & Setting: Clinical trial conducted across eight US study sites. Participants & Measurements: Using data from 509 subjects (240 active; 269 placebo) who lapsed during weeks 3-5 of treatment in a randomized, double blind placebo controlled trial of 21-mg nicotine patches, we examined whether active nicotine patch use improved the chances of recovering abstinence (7-day point-prevalence) at weeks 6 and 10. Findings: Active patch use (versus placebo) increased the likelihood of recovery from a lapse both at 6 weeks (8.3% vs 0.8%; Relative Risk [RR]=11.0, p<.001) and at 10 weeks (9.6% vs 2.6%; RR=3.7, p<.001). Conclusions: Continuing treatment to aid smoking cessation with active patches promotes recovery from lapses. Smokers should be encouraged to persist with patch treatment if they lapse to smoking.

People who smoke only at weekends cause as much damage to their memory as those who smoke on a daily basis, according to research from Northumbria University.

Academics from the Collaboration for Drug and Alcohol Research Group in Northumbria’s School of Life Sciences tested 28 social smokers – those who smoke around 20 cigarettes once or twice a week, typically when out at the weekend – 28 people who smoke 10-15 cigarettes daily and 28 people who had never smoked on a video-based prospective memory test.

Participants were asked to remember a series of pre-determined actions at specific locations when viewing a short clip of a busy high street. For example, they were asked to remember to text a friend when passing a particular store.

In the first study of its kind, researchers found that both groups of smokers performed worse than those who had never smoked, with no difference according to the pattern of smoking.

Dr Tom Heffernan, Senior Lecturer in Psychology, who conducted the research with Dr Terence O’Neill, said: “Smoking-related memory decline in general has been linked with increases in accelerated cerebral degeneration such as brain shrinkage.

“This new research suggests that restricting smoking to weekends makes no difference – smoking damages your memory.”

Source:

A Comparison of Social (Weekend) Smokers, Regular (Daily) Smokers and a Never-Smoked Group Upon Everyday Prospective Memory

The Open Addiction Journal, 2011, Volume 4, Pp 72-75

Tom Heffernan and Terence O’Neill

http://www.benthamscience.com/open/toaddj/articles/V004/72TOADDJ.htm
http://www.benthamscience.com/open/toaddj/articles/V004/72TOADDJ.pdf

In the nearly half-century since the U.S. surgeon general proclaimed that smoking cigarettes will lead to cancer and early death, our view of smoking has been steadily spiraling downward.

Smokers have fallen from the heights of ultra-cool (think Humphrey Bogart or James Dean) and into the depths of foolish (consider 5 million tobacco-related deaths).

So today, on the 35th Great American Smokeout, some health officials might hope we’re nearing the end of our longtime affair with smoking, pointing to a steadily declining line on a graph as proof.

The fact is, about a third fewer Americans smoke today, about 21 percent, than in the late 1970s (34 percent), according to the U.S. Centers for Disease Control and Prevention.

In other words, we’ve come a long way.

Maybe.

Certainly, tobacco use is far from over. Some studies figure that there are still some 1.2 billion smokers throughout the world — one-third of which are in China.

However, these days, few question that cigarettes kill. Nearly one of every five deaths in the United States is related to smoking, theAmerican Cancer Society says. They kill more Americans than alcohol, car accidents, suicide, AIDS, homicide and illegal drugs combined.

The Smokeout, sponsored by the Cancer Society since 1976, is the annual event in which health officials and cancer-prevention groups encourage smokers to quit for at least one day, hoping that it might challenge them to stop permanently.

“The single most important thing you can do to reduce your risk of cancer — by 33 percent — is to stop smoking,” said Alexandra Vukoder of the Cancer Society’s office in Cleveland. “We are all hoping for the day, even if it seems far off, when smoking is no longer an issue.”

Clearly, we’re no longer the nation where not so long ago there were cigarette lighters in every car, ashtrays on every restaurant table and where smokers were expected — welcomed, even — on airplanes, in hospitals and in schools.

No, we’re now almost completely a culture where cigarette, cigar and pipe smokers are just no longer accepted. There’s actually a Facebook page titled “I hold my breath when I see a smoker come near me.”More than 30,000 people have clicked on the “like” button.

And frankly, the smokers among us aren’t really even among us — at least not publicly. They’re on the fringes in Ohio and many other states.

This, not even a half-century from the time when cigarette smoke hung in the air inside any office building or business. And no wonder: Cigarettes were cheap at 46 cents a pack.

Ask anyone of the smoking generations about their first job and they’ll often as not tell you stories of how workers smoked at their desks in the early days of haze. Or watch an old movie. Heck, even Santa Claus turns in for the night in a smoke-filled room in the original “Miracle on 34th Street.”

Now, smokers have to pay more than 10 times what their parents paid for the same pack of cigarettes. They’re left to cluster in their own hazy, leperlike colonies several hundred feet from the door of most buildings.

“There’s no doubt that there’s a lot of stigma attached to using tobacco products now,” Vukoder said. “Even so, the smoking rate in Ohio is still 23 percent, and we’d be satisfied for the Great American Smokeout if we can get a few of those to commit to give up smoking.”

Vukoder’s modest expectations for incremental gain in the long-running war against a product some 5,000 years old shouldn’t be surprising.

“I call the Great American Smokeout a ‘rehearsal,’ ” said Iyaad M. Hasan, a certified nurse practitioner and director of the Tobacco Treatment Center at the Cleveland Clinic Wellness Institute. “It’s not easy to quit, but if we can get people to look at their life without tobacco for one day, maybe we can help them.”

The worst thing to happen to smokers might seem like exile as communities and companies consider even more-restrictive rules for tobacco users. The Cleveland Clinic’s recent decision to rescind job offers for applicants who test positive for nicotine is an example.

But the best thing to happen in the last decade or so is that real help is available, Hasan said. That’s the real difference today, not that smokers are isolated.

“The culture change came first, but when the Smokeout began 35 years ago, smokers didn’t have the choices for cessation treatment they have today,” Hasan said. “It’s no longer just ‘cold turkey and good luck.’ There’s even the chance of a vaccine down the road.”

A vaccine? Certainly that could be the most deadly development yet for tobacco — ashes to ashes, in the end?

Not likely.

“We’ve seen a lot of attempts through the years to stop people from doing something that they enjoy doing, but as long as there is a market for something, someone is going to produce it,” Roger Quarles, president of the International Tobacco Growers Association, said by telephone Wednesday.

Quarles was in Uruguay to meet with officials from the World Health Organization about proposed restrictions on tobacco additives for flavored cigarettes and cigars.

“I think even health folks realize that even though they’ve put smokers outside and they’re going to put more graphic warnings on the labels, that people will do what they want to do in free countries,” Quarles said.

He said that even though U.S. percentages have dropped from 34 percent to 21 percent since 1978, population growth has meant that there are just as many smokers as ever.

“They’ve made smoking more inconvenient for people, but I don’t see smoking going anywhere.”

Of course, no one would be surprised to hear a leading tobacco advocate say that.

But Hasan and Vukoder also cautiously admit they face a still-strong opponent that may never be eliminated — even with the declining percentages and the clear changes toward an anti-smoking culture 3 1/2 decades since the first Smokeout.

“Tobacco is hooked up to so many mental, habitual and emotional links that it’s very hard for people to see there’s hope to get past it,” Hasan said. “We know there is, but they can’t always see they’re being controlled by it.”

Vukoder agreed and said that as long as smoking is still cool for teens (and until recently as long as tobacco companies could market mint chocolate chip flavored cigarettes and the like) and legal, people will still choose to smoke.

“Here’s the bottom line, though: We care about smokers or we wouldn’t do these things,” she said. “The world has changed a lot over the last 35 years and it may seem like smokers are the enemy, but they’re not.

“We’re the ones trying to help smokers — and everyone around them — from the effects of the smoke that can kill them.”

Computer-assisted reporting editor Rich Exner contributed to this story.

Recent studies have consistently found that racial/ethnic minority smokers of menthol cigarettes have a lower quit rate than comparable smokers of regular cigarettes, particularly among younger smokers.

One possible reason suggested in the report is that the menthol effect is influenced by economic factors — less affluent smokers are more affected by price increases, forcing them to consume fewer cigarettes per day.

“This pattern of results is consistent with an effect that relies on menthol to facilitate increased nicotine intake from fewer cigarettes where economic pressures restrict the number of cigarettes smokers can afford to purchase,” said Jonathan Foulds, Ph.D., professor, Public Health Sciences, Penn State College of Medicine, and an author of the report.

Menthol is a compound extracted from mint oils or produced synthetically that activates cold-sensitive neurons in the nervous system. Menthol cigarettes make up about 25 percent of the market but are preferred by certain subgroups of smokers, including about half of teenage smokers and 80 percent of African-American smokers.

Research has shown that menthol cigarettes may provide higher levels of carbon monoxide, nicotine and cotinine per cigarette smoked than regular cigarettes.

“Menthol stimulates cold receptors, so it produces a cooling sensation,” Foulds said. “This effect may help smokers inhale more nicotine per cigarette and so become more addicted. In effect it helps the poison go down easier.

“The smoker who has reduced their cigarette consumption typically compensates by increasing inhalation per cigarette. Menthol in cigarettes makes the smoke less harsh, enabling these smokers to obtain a larger and more reinforcing nicotine hit.”

The researchers, who published their results in a special issue of the journal Nicotine and Tobacco Research, reviewed the evidence from 10 published studies that compared smoking cessation rates or proportions between mentholated and regular cigarette smokers.

Not all of the studies included in the report found an effect of menthol on quitting, and no studies to date have been specifically designed to look at menthol and cessation, but the effects of menthol on quitting were larger in more recent studies, in younger smokers and largely restricted to African-American and Latino smokers.

Other members of the research team are Monica Webb Hooper, Ph.D., Department of Psychology and Biobehavioral Oncology, University of Miami; Mark J. Pletcher, M.D., M.P.H., Department of Epidemiology and Biostatistics, University of California at San Francisco; and Kolawole S. Okuyemi, M.D., M.P.H., Program in Health Disparities Research, University of Minnesota Medical School.

Lead researcher Dennis Trinidad of Claremont Graduate University’s School of Community and Global Health, and colleagues at University of California at San Francisco, University of California at San Diego and the University of Illinois at Chicago, based their findings on data from the U.S. Census Bureau.

The census. in partnership with the National Cancer Institute, surveyed residents on their smoking habits.

“Our understanding of how to get people to quit smoking has been based on those who were the heaviest smokers, that is, those who smoked a pack a day or more,” Trinidad said in a statement. “Now, as the smoking population shifts to include more light smokers, we may need to look for better ways to help them stop.”

The study, published in the April issue of the American Journal of Public Health, showed racial and ethnic minorities are generally more likely than non-Hispanic whites to be light smokers, but smokers in that group who tried to quit did no better, and in some cases fared worse, than among non-Hispanic whites.

Researchers compared the association between three different definitions of social smoking – a common pattern among young adults – and cessation indicators. The three different definitions of social smoking they used included: (1) self-identified; (2) smoking mainly with others; or (3) smoking only with others. They used a Web-enabled, cross-sectional national survey of 1,528 young adults between the ages of 18 and 25 from a panel maintained by the research group.

The total sample was ethnically diverse, with 61 percent identifying themselves as White American, 13.9 percent as African American, 18.3 percent as Hispanic American, 3.9 percent as other non-Hispanic and 3 percent as biracial Hispanic. The sample was equally distributed between men and women. Researchers found that self-identified social smokers were less likely to have cessation intentions; whereas behavior social smokers (mainly or only smoked with others) were more likely than self-identified social smokers to have cessation intentions or attempts.

The study’s authors suggest, “Smoking cessation in young adults – particularly among social smokers – is both a challenge and an opportunity. …Clinicians and researchers need to address the differences between self-identification and behavior as a social smoker to develop more effective smoking cessation strategies tailored to these two distinct groups.”

“Social Smoking among Young Adults: Investigation of Intentions and Attempts to Quit.”
Anna V. Song, PhD
American Journal of Public Health

You already know smoking is harmful to your body.  Even so, lots of people keep smoking.  So why should you quit?  The logic is simple: You’ll improve the quality and length of your life and the lives of the people around you.  Even so, quitting is very difficult. One way to prepare to successfully launch your smoke-free life is to understand why you smoke and what happens when you stop.

Why is it so hard to quit?

• It’s hard to tackle the physical addiction to nicotine. Cigarettes contain nicotine, a highly addictive substance found naturally in tobacco.  It travels quickly to the brain when it is inhaled and can cause a feeling of temporary relaxation and/or stress relief. Nicotine can also elevate your mood and your heart rate. But this feeling is only temporary. After your body rids itself of the drug, you start to crave another cigarette. The surgeon general’s study on nicotine concluded that  “behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin andcocaine.”
  Nicotine Addiction

  What causes nicotine addiction?

   

  Nicotine is an addictive drug. It causes changes in the brain that make people want to use it more and more. In addition, addictive drugs cause unpleasant withdrawal symptoms. The good feelings that result when an addictive drug is present — and the bad feelings when it’s absent — make breaking any addiction very difficult. Nicotine addiction has historically been one of the hardest addictions to break.

  The 1988 Surgeon General’s Report, “Nicotine Addiction,” concluded that:

  • Cigarettes and other forms of tobacco are addicting.
  • Nicotine is the drug that causes addiction.
  • Pharmacologic and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.

   

  What else does nicotine do to the body?

  How does nicotine in cigarettes increase the risk of heart attack?

  What are the symptoms of nicotine withdrawal?

  How long does nicotine stay in the body?

  Shortly after you finish smoking a cigarette, your body starts to show signs of withdrawal. You start to crave another cigarette to overcome these symptoms, starting a vicious cycle of dependency.

• It may seem challenging to find new ways to handle your stress. Do you grab a cigarette when you feel stressed or anxious?  Stress, whether it’s from your job, relationships, caregiving burdens or just plain fast-paced living, can cause you to look for fast and easy relief.

But in the long run, smoking will only add to your stress by taking away your good health. To successfully quit smoking, you may need to think through your stress-management options before you quit.

Consider these tips:

1. Stop and take a deep breath. Taking five to 10 deep breaths is a good start to stress relief. You also get the benefit of inhaling clean air into your lungs without those harmful chemicals!
2. Go for a walk. Physical activity can release a chemical in your body that improves your mood and relieves stress. Walking for 30 minutes a day can be a healthy distraction, burn extra calories and help your heart.
3. Try to relax. Stress can make your muscles tense. Relax them by stretching, deep breathing, doing yoga, getting a message or even closing your eyes and visualizing yourself in a peaceful place.
4. Call a friend. Talking through your highs and lows with family, friends or even a support group can give you comfort and positive reinforcement.
5. Cut back on caffeine. Caffeine is a stimulant that will increase your heart rate and your anxiety.  When you’re trying to decrease your stress, caffeine makes you tense, keeps you up at night and may even cause you to want to smoke.
6. Take care of your body. Drink lots of water, eat healthy and get extra sleep. You’ll feel more energized and ready to handle stress.

• It requires an open mind to discover new options — and new benefits. Here are some comments from people who claim they smoke just because they enjoy it:
  • “I just like smoking.”
  • “Most of us are hungry for rewards. We want to be patted on the back. A cigarette is a reward that we can give ourselves as often as we want.”
  • “My smoke break is my favorite time of the day because that’s when I hang out with my friends.”
  • Sound familiar? Try to remember that whatever satisfaction comes from smoking will be short-lived – literally – because cigarettes can shorten your life.

Here are some other questions to consider as you plan your smoke-free life.

Does smoking:

• Provide a way to meet people or hang out with a group?
• Distract you when you feel lonely?
• Help you control your weight?
• Boost your confidence?
• Provide an oral fixation or give you something to do with your hands?
• Serve as a companion to coffee or alcohol or seem like the thing to do after a meal?
• Calm you while you are driving?

Here are some great alternatives:

• Rethink your social breaks. If you smoke with friends to be social or with co-workers on your lunch break, it is important to tell them that you are trying to quit — and invite them to join you. According to a Preventive Medicine study, 68 percent of smokers want to quit, and social support can be vital. But if you’re not ready, and if it becomes too difficult to spend time in these places where you normally smoke, think about changing your schedule or taking your breaks with nonsmokers.
• Keep yourself busy. Go for walks, read a book or listen to music.
• Keep your hands and your mouth busy. Chew gum, eat a healthy snack, squeeze a stress ball or play with putty.
• After a meal, get up immediately from the table and engage in a pleasurable activity.
• If coffee is your trigger, change something about the way you drink it. Change the mug you drink from or when and where you indulge. Start a new habit!
• If you smoke in your car, remove your ashtray and replace it with potpourri or notes to remind you why you want to quit smoking.
• At parties, try to stay away from smoking areas. Stay indoors or distance yourself from people who are smoking. This might be hard, but stay with it!
  You might also need to cut back on alcohol. It’s hard to have will power and stay focused on your commitment when you’ve had too much to drink.

Knowing  yourself and discovering why you smoke will help you make a plan to quit. Your heart will thank you for years to come!