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Today's Health - Wellness / Exercise / Reflections:Your No-Fail Guide to Stop SmokingLet's face it: It's hard to quit smoking. You've tried and failed several times. This time, though, you have lots of help -- from support groups, new therapies and drugs to smart phone apps. Check out these 15 tips to kick the stinky habit for good…
You know smoking is bad for you. It's the leading cause of chronic obstructive pulmonary disease (COPD). It also causes cancer, heart disease and stroke. It kills 440,000 people a year. And we're not even counting its hit on your pocketbook and social life.
But you just keep coming back for more. Many others -- about 23 million women smokers, according to the American Heart Association -- feel your pain.
In fact, smoking among adults rose for the first time in 15 years, according to statistics released this month by the Centers of Disease Control and Prevention.
In a phone survey of 22,000 adults, about 20.6% said they smoked in 2008, an increase from 19.8% in 2007.
But there's good news: If you want to quit, it's easier than ever before thanks to a host of new tools and techniques.
Medications, a promising new vaccine, nicotine replacement therapies, counseling services, telephone support lines, smart phone apps and social media tools like Twitter and Facebook can help even longtime smokers free themselves from tobacco's iron grip.
So stub out that smoke and throw away that pack. Here are 15 tips to get cigarettes out of your life for good – no ifs, ands or butts.
1. Don't be discouraged by past failures.
You've tried to quit and failed. Are you thinking: There's no way I can ever succeed?
Don't let past failures derail your healthy future. Instead, start thinking of quitting as a journey that stops and starts. If you slip, just begin again.
Smokers learn from each slip, so build on that knowledge, says Thomas Glynn, director of international cancer control for the American Cancer Society.
People rarely succeed on the first try, he says. "It usually takes five to seven serious attempts before they finally quit."
2. Figure out why you want to quit.
Quitting is like giving up a best friend. It's not a decision to make lightly, Glynn says.
So take a deep breath and consider your motivation for quitting. Do you want to watch your children or grandchildren grow up? Walk up a flight of stairs without wheezing? Save money?
Whatever your reason, write it down on a paper and laminate it. Carry it with you at all times. When the urge to smoke overwhelms you, read it.
"You need to remind yourself of that motivation," Glynn says:3. Don't go cold turkey.
Everyone seems to know the person who decided to quit, tossed the packs and never picked up a cigarette again. Beware: Those people are rare.
Going cold turkey may be the most popular quit-smoking method, but it's "a fairly spectacularly, ineffective way," says Douglas E. Jorenby, professor of medicine and director of clinical services at the Center for Tobacco Research and Intervention at the University of Wisconsin.
About 95% of quitters who go cold turkey relapse within a year, he says.
The most successful quitting programs had three components: counseling, social support and medication, according to the U.S. Public Health Service's 2008 analysis of 30 years of smoking-cessation research. Your plan should incorporate all three.
"Quitting smoking is hard enough, why not … help that process?" asks Erik Augustson, clinical psychologist and behavioral scientist with the tobacco control research branch of the National Cancer Institute.
4. Call-in tech support.
Quality counseling is as close as your cell phone or iPhone app.
Call a quit line or text a friend if the urge to smoke gets too strong.
Look for communities on the Web, such as on Facebook and a Twitter feed.
You can even download applications, some free, to your iPhone to track your smoking and set goals for cutting back. Check out My Quit Line (search on your iPhone or iTunes or tobacco-cessation.org) or Smokeless (iphonehealthapps.net/).
All 50 states have free quit-smoking telephone lines, usually staffed with well-trained counselors to help devise a plan and give you medical advice, Jorenby says.
The national access number to state-based quit services is (800) QUIT NOW (784-8669), usually open during business hours.
Surprisingly, only 1%-4% of smokers use them.
5. Try nicotine replacement therapy (NRT).
The Food and Drug Administration (FDA) has approved five forms of over-the-counter NRTs: gum, patch, lozenge, nasal spray and inhaler.
Talk to your doctor or pharmacist to see which might be best for you and check your health insurance policy to see which might be covered.Also, before you choose a method, think about your smoking habits. Do you need something to do with your hands? The inhaler or nasal spray might be best.
Do you need an oral fix? Try gum.
Would you prefer to not think about it at all? Slap on a patch in the morning and forget about it.
6. Consider prescription drugs.
The FDA has approved two prescription medications to help smokers quit. Both act on the brain, where nicotine stimulates the pleasure centers.
One is the antidepressant bupropion (brand name Zyban), because smokers typically suffer from depression more than non-smokers do, Glynn says.
In a study of 707 smokers comparing bupropion to a placebo, researchers found that the drug relieved depression and helped them drop the habit. After a year, 21% of the bupropion users had stayed away from cigarettes; only 11% of the placebo group did, according to the findings published in 2003 in the Journal of Internal Medicine.
The second medication, Varenicline (brand name Chantix), reduces cravings by blocking the brain from getting pleasure from nicotine. For it to be effective, however, smokers must stick with the prescribed 12-week regimen, Glynn cautions.
"On average, medication can double your chances of successfully quitting, and if you can combine the medication with [counseling] you can triple your chances," he says.
More promising is a vaccine that will prevent nicotine from arousing the brain's pleasure sensors.
The National Institute on Drug Abuse, a division of the National Institutes of Health, gave Nabi BioPharmaceuticals a $10-million grant to take its anti-nicotine vaccine, NicVAX, to Phase III clinical trials.
Any public release is years away, but "it holds a lot of potential," says the NCI's Augustson. "I don't think there's going to be a magic bullet. Smokers may still have to do work."
7. Don't limit yourself to one method.
Smoking is such a pernicious addiction that no one treatment has produced a quit rate of more than 30%, Augustson says.
But combining NRTs or medications may help overcome the odds, studies show.Jorenby, for example, was one of the lead researchers on a clinical trial that compared several smoking-cessation therapies. The results, published this year in the Archives of General Psychiatry, found that combining the patch and lozenge was the most effective method.
The study's 1,504 smokers were randomly assigned to one of six treatment groups: nicotine lozenge alone, nicotine patch alone, bupropion alone, patch plus nicotine lozenge, bupropion plus nicotine lozenge or placebo. They also received counseling.
After six months, those using the patch and lozenge had a 40% quit rate. (That percentage, however, was expected to decline over time, researchers said.) This may be due to the steady nicotine supply from the patch and periodic boosts from lozenges, according to the scientists.
8. Set a Quit Day.
Saying "I'll quit tomorrow" without planning is a surefire way to fail.
Set a Quit Day several weeks ahead so you begin to picture yourself as a nonsmoker, Glynn says.
That way you can start to make small changes to smoking behavior. For example, don't have that cigarette with your first cup of coffee.
9. Clean house.
Before Quit Day, ransack your house and toss all stashes of cigarettes.
Get that pack out of the sock drawer and the car's glove compartment. Clean up ashtrays and butts that you've flicked into the bushes around your house.
It may seem revolting to think of smoking used butts, but what seems "absolutely disgusting today may not be three or four days after your quit date," Jorenby says.
10. Get your friends and family on board.
Before Quit Day, warn your family that you'll be grouchy or nervous. Tell your friends not to let you bum cigarettes, no matter how much you plead. Recruit a buddy to help talk you through bad moments - even when 2 a.m. cravings hit.
"Social support tends to be important ," Augustson says.
"Define what kind of help you want," Augustson advises.Women are also more likely than men to seek formal treatment from counselors, support groups or smoking clinics; guys often try to tough it out, experts say.
11. Avoid triggers.
Stay away from situations that trigger a craving for a smoke. If you once smoked with buddies outside the office lobby, avoid it.
"Most people who smoke are very good at being able to anticipate [triggers] because their smoking is so regular," Jorenby says.
Alcohol can set off potent cravings because a smoke and drink often go together. So stay away from martinis or beer for several months or go to a smoke-free bar.
Cut back on coffee too. Because nicotine helps to metabolize caffeine in the body, you may find that you're bouncing off the walls with your normal consumption.
Of course, some situations just can't be avoided, so you'll just have to stay strong.
"I've had people tell me with a straight face, `Doc, my car won't start unless I have a cigarette in my hand,'" Jorenby says.
12. You can beat that craving.
A craving is like a wave that peaks and falls away.
"No matter how intense the craving is, it will fade on its own," Augustson says.
So how do you get through those times when you think you'll explode without a cigarette?
First, try a chewing nicotine gum or popping a lozenge. If that doesn't help, distract yourself. Take a walk or hot bath – or call a friend. The desire will eventually fade.
13. Get real about weight gain.
Let's face facts: Most quitters gain 5-10 pounds during the process.
More women than men fear losing the battle of the bulge after quitting, though guys admit they worry about it too, Jorenby says.
But concentrate on the big picture here: The health problems from smoking far outweigh those from a slight weight gain. You'd have to put on 100 pounds to equal the damage of smoking, Glynn says.
Remember: Quitters often get more active and feel better about walking, running and exercising.
And keep healthy munchies --- carrot and celery sticks or fruit --- on hand to help get your oral fix or curb the craving to eat.14. Reward yourself.
Don't think of quitting as denying yourself. Instead, reward your progress and efforts with treats one week, two weeks and three weeks after Quit Day.
But to avoid weight gain, don't reward yourself with food. Get a massage, a new exercise outfit or spend a day at a spa.
"People who feel they've lost a best friend need positive reinforcement and something to look forward to during what feels like self-deprivation," Jorenby says.
15. Avoid smoking scams.
Don't invest in stop-smoking devices that seem to be too good to be true. They probably are.
There's no data proving the effectiveness of replacement electronic cigarettes or e-cigarettes --- battery-powered devices in which you inhale nicotine vapor, but take in none of the other harmful chemicals found in tobacco smoke, Glynn says.
"You have to question whether you want to be a guinea pig," he says.
What about hypnosis or acupuncture? All three experts agree that clinical trials haven't proven that these methods work.
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Long Beach, CA - Gay Pride; May 16, 2010
Montreal Gay Pride; Aug 15, 2010
Wall Street Journal / Dec 20, 2010 / By GEOFFREY A. FOWLER, VALERIE BAUERLEINGay and lesbian advocates heralded the end of "Don't Ask, Don't Tell" as an historical milestone --- but battles remain for gay-rights proponents, particularly on the hot-button issue of same-sex marriage.
The repeal of the law that forbade gay and lesbian soldiers from being open about their sexuality was the first time Congress has voted in support of a bill ending a form of discrimination based on sexual orientation.
The repeal signals a "sea change," in the status of gay and lesbian people in the broader society, said Kate Kendell, the Executive Director of the National Center for Lesbian Rights in San Francisco. The battle for gay and lesbian rights "isn't the same as the fight for racial equality," said Ms. Kendell, "but surely when the government gets out of the business of sponsoring discrimination, the attitudes and opinions of the wider culture move to embrace greater inclusion and acceptance."
Yet the gulf on gay rights remains deep when it comes to other issues. Congress never passed the so-called Employment Non-Discrimination Act, which would prohibit workplace discrimination based on sexual orientation, and it remains legal in 29 states to fire people based on sexual orientation. In American business, offering domestic partnership benefits and protection from discrimination has become increasingly common. According to the Human Rights Campaign, a gay-rights organization, some 89% of Fortune 500 companies prohibit discrimination on the basis of sexual orientation, and 57% provide domestic partner health insurance benefits to employees.
Gay marriage remains a battleground. A recent survey by the Associated Press found that 52% of Americans support the federal government giving legal recognition to marriages between couples of the same sex, while 46% do not. Currently five states and the District of Columbia permit gay marriage, while 38 states have either laws or amendments against same-sex marriage.
Sen. Richard Burr of North Carolina was among the eight Republicans who voted in favor of the repeal, and the only Southerner. He said the timing of the change was wrong, but the repeal was the right thing to do. "Given the generational transition that has taken place in our nation, I feel that this policy is outdated and repeal is inevitable," Sen. Burr said in a statement.
In 1993, when the policy was introduced by President Bill Clinton, NBC News/Wall Street Journal polls found no more than 43% of Americans supported lifting restrictions on gays in the military. This May, a CNN poll found that 78% supported the idea.
Some conservative groups lined up against the repeal. "The rush to repeal DADT...is a slap in the face of the American people who are tired of bully politics," read a letter to Congress signed by 90 members of the Freedom Federation, a coalition of conservative groups.
In the South, the reactionwas mixed, particularly in areas with large military populations such as the Carolinas.
Ilario Pantano, a Marine Corps veteran and former GOP congressional nominee, criticized the repeal effort on his radio show, which airs in southeastern North Carolina. Mr. Pantano said Republicans and conservative Christians who didn't speak out against "are taking a cowardly position on an issue that's Biblically wrong," as well as militarily wrong.
In the last decade, gay-rights advocates have changed their message to focus less on the right to be different and more on the desire to join in the rights of mainstream society. That has come about, in part, as more gay Americans have come out to friends and family. Today, about 4% of Americans identify as gay or lesbian, said Gary Gates, a demographer at the Williams Institute, at the University of California at Los Angeles Law School, which studies sexual orientation in the law and public policy. Data from the Census Bureau in 2009 said there about 581,000 cohabitating same-sex couples in the U.S.
"For the first time, we're talking about how [gay] people aren't just victims, they can be heroes," said Mark Kleinschmidt, the gay mayor of Chapel Hill, N.C. and the son of a military officer, who watched the "Don't Ask" coverage on CSPAN. "That's transformative."
Mr. Kleinschmidt, 40, said he would likely have gone into the military himself, but "that decision was made for me," he said. "It had nothing to do with my ability, just something about me that they didn't want. That wasn't going to be true for another generation."
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