Q AND A

Everything you always wanted to ask about smoking-and quitting

You've probably thought about quitting smoking at one time or another, but you may have fears or questions that are holding you back. These frequently asked questions-and answers-can help you make the decision.

Q: Won't I gain weight if I stop smoking?

A: Some people gain weight and some don't. Those who do usually gain only a few pounds (5 to 10, on average). You can minimize the gain by getting regular exercise and relying on low-calorie snacks like fruit and raw vegetables. Dieting is not a good idea while you're in the early stages of quitting; save it for later, when you're a confirmed nonsmoker. Remember, a small weight gain will make very little difference to the way you look, but continuing to smoke creates serious risks to your health.

Q: What if I don't have the willpower?

A: You don't have to have super willpower-just as much as the 3 million other Americans who quit every year. They don't all succeed on the first attempt, either, but after several tries they manage it. Talk to your doctor about your concerns. Giving up smoking isn't easy, but the support of your physician will increase your chances of success.

Q: If I only smoke low-tar, low-nicotine cigarettes, do I still need to quit?

A: There's no such thing as a "safe" cigarette. Besides, if you are like most smokers of these brands, you probably inhale the smoke more often or more deeply in order to get as much nicotine as you would with other brands.

Q: Is it better to quit cold turkey or to taper off over a long period of time?

A: There is no best way, but tapering off is more difficult than you may think. Cold turkey works best for most people.

Q: Some of my friends say giving up smoking makes you feel terrible. Are they right?

A: Maybe, maybe not. The nicotine in cigarettes is an addictive drug, so some smokers have withdrawal symptoms when they quit. And some don't. Withdrawal symptoms can include sleep difficulties, restlessness, difficulty concentrating, anxiety, irritability, headache, and constipation-though very few people experience all of them. Symptoms are worst in the first three days after quitting and usually disappear completely after a few weeks. Some people who quit also find they cough more than they did while they were smoking. This is temporary, a sign that your lungs are recovering their ability to get rid of phlegm.

Q: Some people say the patch can relieve these symptoms and turn off the cravings for a cigarette. Does it really work?

A: Yes. Many smokers have found that the patch, which releases controlled amounts of nicotine through the skin, is very helpful in relieving withdrawal symptoms and calming the craving for a smoke. Nicotine replacement is also available as chewing gum and nasal spray. The patch and gum are available in drugstores without prescription, but these are real medications and you should discuss them with your doctor before you try them. You need a prescription for the nasal spray. An antidepressant medication called bupropion (Wellbutrin, Zyban) is also available by prescription, and many have found it helpful in dealing with withdrawal symptoms and cigarette cravings.

Q: If I give up cigarettes, will my body recover from the effects of smoking?

A: Yes. Much of the damage is reversible, especially in young people like you. You'll notice that you have more stamina for sports or dancing within a month after you quit.

Q: Are there support groups for people who are trying to stop smoking?

A: Yes. You can find one by calling the county health department, the local chapter of the American Cancer Society or the American Lung Association, your community hospital, the National Cancer Institute (call 800-4-CANCER), or Nicotine Anonymous (415-995-1938).

Q: Once I've quit, can I have a cigarette now and then, on special occasions?

A: It's not a good idea. Nicotine addiction is easily retriggered in former smokers, and you'd be taking a real risk of getting hooked again.

The Q and A on smoking cessation may be photocopied and distributed to families in your practice without permission of the publisher.

GUIDE FOR PATIENTS

How to stop smoking

Quitting smoking isn't easy, but millions of people have done it and so can you. These tips will help.

Getting ready to quit

Set a date for quitting. Try to convince a friend to quit with you, so you'll have mutual support.
Notice when, where, and how you smoke. List the times when you usually light up-with morning coffee, after a meal, while driving, or whatever your usual smoking occasions are.
Change your smoking routines. Keep your cigarettes in a different place, don't hold your cigarette in the hand you're used to using, switch brands, and don't carry on any other activity-like reading, driving, talking on the phone, or watching TV-while you smoke.
Designate one place to smoke-like the back porch-and don't smoke anywhere else.
When you want a cigarette, wait a few minutes before you light up. Try doing something else, like chewing gum or drinking a glass of water, and see if the urge passes.
Buy only one pack of cigarettes at a time.
Ask your doctor about medications that ease withdrawal symptoms and reduce cigarette cravings. You may want to have nicotine patches or gum on hand, ready for quit day.

On quitting day

Get rid of all your cigarettes and put away your ashtrays.
Change your morning routines, especially where and when you eat breakfast. Try sitting somewhere else, or going out to eat.
When you get the urge to smoke, do something else instead.
Carry substitutes to put in your mouth, such as chewing gum, hard candy, or toothpicks.
Reward yourself at the end of the day. See a movie, or eat a favorite treat.

Staying smoke-free

Don't be upset if you feel sleepy or short-tempered. These are symptoms of nicotine withdrawal, and they will go away in a few days.
Exercise regularly. Go for walks, ride a bike, or take part in sports you enjoy.
Think about the positive aspects of not smoking: your self-image as someone who's kicked the habit, the health benefits you and your family get from living in a smoke-free environment, the example you set for others.
When you feel tense, think about the problem that's creating those feelings and try to solve it. Tell yourself that smoking won't make it better.
Eat regular meals, so you don't have times when you feel hungry and confuse that feeling with the desire to smoke.
Put the money you would have spent on cigarettes in a money jar every day, and watch it mount up. Plan to buy something special for yourself.
Let other people know you have stopped smoking. Your friends who still smoke may want to know how you did it.
If you break down and smoke a cigarette, don't give up. Many former smokers made several attempts to stop before they succeeded. Quit again.

The patient guide on how to quit smoking may be photocopied and distributed to families in your practice without permission of the publisher.

Where to turn: Resources for patient education

Pediatricians, parents, and patients can access a wide range of resources to assist their smoking cessation efforts. Here is a partial listing of sources providing educational materials and self-help guidelines. The web sites often include hypertext links to additional resources.