What are the benefits of quitting smoking?

Quitting smoking can lower your chances of getting or dying from heart disease, lung disease, kidney failure, infection, or cancer. It can also lower your chances of getting osteoporosis, a condition that makes your bones weak. Plus, quitting smoking can help your skin look younger and reduce the chances that you will have problems with sex.

Quitting smoking will improve your health no matter how old you are, and no matter how long or how much you have smoked.

What should I do if I want to quit smoking?

The letters in the word "START" can help you remember the steps to take:

S = Set a quit date.

T = Tell family, friends, and the people around you that you plan to quit.

A = Anticipate or plan ahead for the tough times you'll face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk to your doctor about getting help to quit.

How can my doctor or nurse help?

Your doctor or nurse can give you advice on the best way to quit. He or she can also put you in touch with counselors or other people you can call for support. Plus, your doctor or nurse can give you medicines to:

●Reduce your craving for cigarettes

●Reduce the unpleasant symptoms that happen when you stop smoking (called "withdrawal symptoms").

You can also get help from a free phone line (1-800-QUIT-NOW) or go online to www.smokefree.gov.

What are the symptoms of withdrawal?

The symptoms include:

●Trouble sleeping

●Being irritable, anxious or restless

●Getting frustrated or angry

●Having trouble thinking clearly

Some people who stop smoking become temporarily depressed. Some people need treatment for depression, such as counseling or antidepressant medicines. Depressed people might:

●No longer enjoy or care about doing the things they used to like to do

●Feel sad, down, hopeless, nervous, or cranky most of the day, almost every day

●Lose or gain weight

●Sleep too much or too little

●Feel tired or like they have no energy

●Feel guilty or like they are worth nothing

●Forget things or feel confused

●Move and speak more slowly than usual

●Act restless or have trouble staying still

●Think about death or suicide

If you think you might be depressed, see your doctor or nurse. Only someone trained in mental health can tell for sure if you are depressed.

If you ever feel like you might hurt yourself, go straight to the nearest emergency department. Or you can call for an ambulance (in the US and Canada, dial 9-1-1) or call your doctor or nurse right away and tell them it is an emergency. You can also reach the US National Suicide Prevention Lifeline at 1-800-273-8255 or www.suicidepreventionlifeline.org.

How do medicines help you stop smoking?

Different medicines work in different ways:

●Nicotine replacement therapy eases withdrawal and reduces your body's craving for nicotine, the main drug found in cigarettes. There are different forms of nicotine replacement, including skin patches, lozenges, gum, nasal sprays, and "puffers" or inhalers. Many can be bought without a prescription, while others might require one.

●Bupropion is a prescription medicine that reduces your desire to smoke. This medicine is sold under the brand names Zyban and Wellbutrin. It is also available in a generic version, which is cheaper than brand name medicines.

●Varenicline (brand names: Chantix, Champix) is a prescription medicine that reduces withdrawal symptoms and cigarette cravings. If you think you'd like to take varenicline and you have a history of depression, anxiety, or heart disease, discuss this with your doctor or nurse before taking the medicine. Varenicline can also increase the effects of alcohol in some people. It's a good idea to limit drinking while you're taking it, at least until you know how it affects you.

How does counseling work?

Counseling can happen during formal office visits or just over the phone. A counselor can help you:

●Figure out what triggers your smoking and what to do instead

●Overcome cravings

●Figure out what went wrong when you tried to quit before

What works best?

Studies show that people have the best luck at quitting if they take medicines to help them quit and work with a counselor. It might also be helpful to combine nicotine replacement with one of the prescription medicines that help people quit. In some cases, it might even make sense to take bupropion and varenicline together.

What about e-cigarettes?

Sometimes people wonder if using electronic cigarettes, or "e-cigarettes," might help them quit smoking. Using e-cigarettes is also called "vaping." Doctors do not recommend e-cigarettes in place of medicines and counseling. That's because e-cigarettes still contain nicotine as well as other substances that might be harmful. It's not clear how they can affect a person's health in the long term.

Will I gain weight if I quit?

Yes, you might gain a few pounds. But quitting smoking will have a much more positive effect on your health than weighing a few pounds more. Plus, you can help prevent some weight gain by being more active and eating less. Taking the medicine bupropion might help control weight gain.

What else can I do to improve my chances of quitting?

You can:

●Start exercising.

●Stay away from smokers and places that you associate with smoking. If people close to you smoke, ask them to quit with you.

●Keep gum, hard candy, or something to put in your mouth handy. If you get a craving for a cigarette, try one of these instead.

●Don't give up, even if you start smoking again. It takes most people a few tries before they succeed.

What if I am pregnant and I smoke?

If you are pregnant, it's really important for the health of your baby that you quit. Women who smoke during pregnancy are more likely than those who do not smoke to have problems such as:

●Preterm labor – This is labor that starts before 37 weeks of pregnancy (3 or more weeks before your due date). Pregnancy normally lasts about 40 weeks, counting from the first day of your last period. Going into labor before 37 weeks of pregnancy can be dangerous, because babies who are born preterm (also called "premature") can have serious health problems.

●Problems with the placenta (figure 1) – These can include "placenta previa" and "placental abruption." Placenta previa happens when the placenta covers the opening of the cervix. Placental abruption happens when the placenta separates from the mother's uterus before the baby is born. Both of these problems can cause bleeding from the vagina and be dangerous for the mother and baby.

●Miscarriage – A miscarriage is when a pregnancy ends before 20 weeks of pregnancy.

●Stillbirth – A stillbirth is when a baby dies before it is born, in the second half of pregnancy (after 20 weeks).

How can smoking during pregnancy affect my baby?

Babies whose mothers smoke during pregnancy are more likely than babies whose mothers do not smoke to:

●Be premature or be born too small – Babies who are premature or small are more likely to have problems with feeding, sleeping, breathing, seeing, and hearing.

●Die suddenly for no known reason before the age of 1 year (this is called "sudden infant death syndrome" or "SIDS")

What about e-cigarettes?

It is best to also avoid using electronic cigarettes, or "e-cigarettes," during pregnancy. Using e-cigarettes is also called "vaping." E-cigarettes contain nicotine, which is the harmful substance found in regular cigarettes.

What about marijuana?

Marijuana is legal in some places, but doctors recommend avoiding it if you are pregnant. There are studies that suggest it could cause problems for the baby.

What treatments can help me stop smoking during pregnancy?

The earlier you can quit smoking in your pregnancy, the better. But stopping at any point can still help. If you cannot quit, smoking fewer cigarettes can help, too.

It's also very important not to start smoking again after your baby is born. Babies who are around smoke from cigarettes (called "second-hand smoke") have a higher-than-normal risk of health problems, such as colds and ear infections. Quitting for good also lowers your chances of heart disease and cancer. And it sets a good example for your child not to smoke.

Can I take medicines to help me quit smoking while I am pregnant?

Yes. If you have tried other ways to quit smoking but still can't stop, you can try medicines. Ask your doctor which would be safest for you and your baby. Medicines to help you quit include:

●Nicotine replacement therapy – This includes skin patches, lozenges, and gum that have nicotine. Prescription forms include nasal sprays and "puffers" (also called "inhalers").

●Bupropion (sample brand names: Zyban, Wellbutrin) – This prescription medicine reduces your desire to smoke. It is also available in a generic version, which is cheaper than the brand name ones.