Smoking Cessation
What are the health risks of smoking tobacco?
Quitting smoking is important for your health. Besides being the leading cause of cancer in the United States, smoking tobacco harms most organs of your body and causes many other health problems.
Tobacco smoke contains many chemicals and can even be harmful even if you don’t smoke. Exposure to secondhand smoke can increase the risk of cancer and other diseases. If you’re pregnant, it can harm your fetus.
It can be difficult to quit smoking. That’s because smoking also causes addiction to nicotine, a stimulant drug in tobacco. Nicotine addiction makes it harder to stop, but quitting smoking can improve the quality and length of your life.
What are the benefits of quitting smoking?
Tobacco use is the most common preventable cause of death. The more years you smoke and the more cigarettes you smoke each day, the higher your risk. Quitting smoking can help reduce your risk of health problems as well as improve the quality of your life.
Some initial benefits of quitting include:
- Lower heart rate and blood pressure
- Less carbon monoxide in the blood (carbon monoxide reduces the blood’s ability to carry oxygen)
- Better circulation
- Less coughing and wheezing
- Sense of smell and taste return
In the long term, quitting tobacco can help you live a longer life. Your risk of getting cancer decreases with each year you stay smoke-free.
How can I quit smoking?
There are many ways to quit smoking. Common methods used to help quit smoking include:
- Counseling with a health care provider about your smoking habits, readiness to quit, and setting a quit date.
- Smoking aids such as nicotine replacement products or medicines to help reduce nicotine addiction. These may not be right for you if you are pregnant, breastfeeding, a teenager, or if you have certain medical issues or take certain medicines.
- Smoking reduction by slowly reducing the number of cigarettes per day, or stopping smoking altogether, often called “cold turkey.”
You may need to try different things, but a mixture of counseling and quit-smoking medicine has been shown to be the best method.
Some people think that switching to e-cigarettes can help to quit smoking, but that has not been proven. These battery-operated smoking devices look like cigarettes but work differently. Using an e-cigarette is called vaping. Researchers still have a lot to learn about the health effects of using e-cigarettes.
When you stop or cut back on smoking, you may have short-term effects such as irritability, anxiety, moodiness, weight gain, or trouble sleeping. These are called withdrawal symptoms. You can work with your provider to help reduce these symptoms and find the best way for you to quit.
If you smoke, you should quit. But quitting can be hard. Most people who have quit smoking have tried at least once, and often several times, without long-term success in the past. View any past attempts to quit as a learning experience, not a failure.
There are many reasons to quit using tobacco. Long-term use of tobacco can increase your risk of many serious health problems.
THE BENEFITS OF QUITTING
You may enjoy the following when you quit smoking.
- Your breath, clothes, and hair will smell better.
- Your sense of smell will return. Food will taste better.
- Your fingers and fingernails will slowly appear less yellow.
- Your stained teeth may slowly become whiter.
- Your children will be healthier and will be less likely to start smoking.
- It will be easier and cheaper to find an apartment or hotel room.
- You may have an easier time getting a job.
- Friends may be more willing to be in your car or home.
- It may be easier to socialize. Many people do not smoke and do not like to be around people who smoke.
- You will save money. If you smoke a pack a day, you spend about $2000 a year on cigarettes.
HEALTH BENEFITS
Some health benefits begin almost immediately. Every week, month, and year without tobacco further improves your health.
- Within 20 minutes of quitting: Your blood pressure and heart rate drop to normal.
- Within 12 hours of quitting: Your blood carbon monoxide level drops to normal.
- Within 2 weeks to 3 months of quitting: Your circulation improves and your lung function increases.
- Within 1 to 9 months of quitting: Coughing and shortness of breath decrease. Your lungs and airways are more able to handle mucus, clean the lungs, and reduce the risk of infection.
- Within 1 year of quitting: Your risk of coronary heart disease is half that of someone still using tobacco. Your heart attack risk drops dramatically.
- Within 5 years of quitting: Your risk of mouth, throat, esophagus, and bladder cancers are reduced by half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker after 2 to 5 years.
- Within 10 years of quitting: Your risk of dying from lung cancer is about one half that of a person who still smokes.
- Within 15 years of quitting: Your risk of coronary heart disease is the same as that of a non-smoker.
Other health benefits of quitting smoking include:
- Lower chance of blood clots in the legs, which may travel to the lungs
- Lower risk of erectile dysfunction
- Fewer problems during pregnancy, such as babies born at low birth weight, premature labor, miscarriage, and cleft lip
- Lower risk of infertility due to damaged sperm
- Healthier teeth, gums, and skin
Infants and children who you live with will have:
- Asthma that is easier to control
- Fewer visits to the emergency room
- Fewer colds, ear infections, and pneumonia episodes
- Reduced risk of sudden infant death syndrome (SIDS)
MAKING THE DECISION
Like any addiction, quitting tobacco is difficult, especially if you do it alone. There are a lot of ways to quit smoking and many resources to help you. Talk to your health care provider about nicotine replacement therapy and smoking cessation medicines.
If you join smoking cessation programs, you have a much better chance of success. Such programs are offered by hospitals, health departments, community centers, and work sites.
Alternative Names
Secondhand smoke; Cigarette smoking – quitting; Tobacco cessation; Smoking and smokeless tobacco – quitting; Why you should quit smoking
References
American Cancer Society website. Health benefits of quitting smoking over time. www.cancer.org/cancer/risk-prevention/tobacco/benefits-of-quitting-smoking-over-time.html. Updated November 10, 2020. Accessed November 30, 2023.
Brunetta PG, Kroon L. Smoking cessation. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 66.
Centers for Disease Control and Prevention website. Smoking cessation: fast facts. www.cdc.gov/tobacco/php/data-statistics/smoking-cessation/. Updated September 17, 2024. Accessed September 26, 2024.
George TP. Nicotine and tobacco. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 363.
Gotts JE, Benowitz NL. Smoking hazards: cigarettes, vaping, marijuana. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 65.
Patnode CD, O’Connor E, Whitlock EP, Perdue LA, Soh C, Hollis J. Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med. 2013;158(4):253-260. PMID: 23229625 pubmed.ncbi.nlm.nih.gov/23229625/.
Prescott E. Lifestyle interventions. In: de Lemos JA, Omland T, eds. Chronic Coronary Artery Disease: A Companion to Braunwald’s Heart Disease. Philadelphia, PA: Elsevier; 2018:chap 18.
How to stop smoking: Dealing with a slip up
As you learn how to live without cigarettes, you may slip up after you quit smoking. A slip is different than a total relapse. A slip occurs when you smoke one or more cigarettes, but then go back to not smoking. By acting right away, you can get back on track after a slip.
Tips if you Slip
These tips can help you stop a slip from becoming a relapse to full-time smoking.
Stop smoking again right away. If you bought a pack of cigarettes, destroy the rest of the pack. If you bummed a cigarette from a friend, ask that friend not to give you any more cigarettes.
Do not beat yourself up. Many people quit smoking several times before they quit for good. If you get too stressed after a slip, it could make you want to smoke even more.
Get back to basics. Remind yourself why you want to quit. Post the top 3 reasons by your computer, in your car, on the refrigerator, or someplace else you will see it throughout the day.
Learn from it. Look at what made you slip, then take steps to avoid that situation in the future. Triggers for a slip can include:
- Old habits like smoking in the car or after a meal
- Being around people who smoke
- Drinking alcohol
- Smoking first thing in the morning
Adopt new habits. Once you figure out what made you slip, plan new ways of resisting the urge to smoke. For instance:
- Give your car a complete cleaning and make it a smoke-free zone.
- Brush your teeth right after every meal.
- If your friends light up, excuse yourself so you do not have to watch them smoke.
- Limit how much you drink. You might need to avoid alcohol for a while after you quit.
- Set a new morning or evening routine that does not include cigarettes.
Build coping skills. You might have slipped in response to a stressful day or strong emotions. Develop new ways to deal with stress so you can get through tough times without cigarettes.
- Learn how to deal with cravings
- Read up on stress management and practice the techniques
- Join a support group or program to help you quit
- Talk to a friend or family member you trust
Continue nicotine replacement therapy. You may have heard that you cannot smoke and use nicotine replacement therapy (NRT) at the same time. While this is true, a temporary slip does not mean you have to stop NRT. If you are using nicotine gum or other form of NRT, keep it up. It might help you resist the next cigarette.
Keep a slip in perspective. If you smoke a cigarette, look at it as a one-time mistake. A slip does not mean you failed. You can still quit for good.
References
American Cancer Society website. How to quit tobacco: help for cravings and tough situations while you are quitting tobacco. www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/quitting-smoking-help-for-cravings-and-tough-situations.html. Updated October 10, 2020. Accessed September 23, 2024.
Centers for Disease Control and Prevention website. Tips from former smokers. www.cdc.gov/tobacco/campaign/tips/index.html. Updated February 5, 2024. Accessed September 23, 2024.
George TP. Nicotine and tobacco. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 363.
Ussher MH, Faulkner GEJ, Angus K, Hartmann-Boyce J, Taylor AH. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2019;(10):CD002295. PMID: 31684691 pubmed.ncbi.nlm.nih.gov/31684691/.
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A craving is a strong, distracting urge to smoke. Cravings are strongest when you first quit.
What Causes Cravings
When you first quit smoking, your body will go through nicotine withdrawal. You may feel tired, moody, and have headaches. In the past, you may have coped with these feelings by smoking a cigarette.
Places and activities can trigger cravings. If you used to smoke after meals or when you talked on the phone, these things might make you crave a cigarette.
How to Manage Cravings
You can expect to have cravings for a few weeks after you quit. The first 3 days will probably be the worst. As more time passes, your cravings should get less intense.
PLAN AHEAD
Thinking about how to resist cravings ahead of time can help you overcome them.
Make a list. Write down the reasons you are quitting. Post the list someplace visible so you can remind yourself of the good things about quitting. Your list might include things like:
- I will have more energy.
- I will not wake up coughing.
- My clothes and breath will smell better.
- The longer I do not smoke, the less I will crave cigarettes.
Make rules. You might find yourself thinking you can just smoke 1 cigarette. Any cigarette you smoke will tempt you to smoke more. Rules provide structure to help you keep saying no. Your rules might include:
- When I have a craving, I will wait at least 10 minutes to see if it passes.
- When I have a craving, I will walk up and down the stairs 5 times.
- When I have a craving, I will eat a carrot or celery stick.
Set up rewards. Plan rewards for each stage of quitting you get through. The longer you go without smoking, the bigger the reward. For instance:
- After 1 day of not smoking, reward yourself with a new book, DVD, or album.
- After 1 week, visit a place you have wanted to go for a long time like a park or museum.
- After 2 weeks, treat yourself to a new pair of shoes or tickets to a game.
Talk back to yourself. There might be times you think you have to have a cigarette to get through a stressful day. Give yourself a pep talk:
- Cravings are part of quitting, but I can get through it.
- Every day I go without smoking, quitting will get easier.
- I have done hard things before; I can do this.
AVOID TEMPTATION
Think about all the situations that make you want to smoke. When possible, avoid these situations. For example, you might need to avoid spending time with friends who smoke, going to bars, or attending parties for a while. Spend time in public places where smoking is not allowed. Try to do things you enjoy like going to a movie, shopping, or hanging out with non-smoking friends. This way you can start to associate not smoking with having fun.
DISTRACT YOURSELF
Keep your hands and mouth busy as you get used to not handling cigarettes. You can:
- Hold a pen, stress ball, or rubber band
- Chop vegetables for snacking
- Knit or do a jigsaw puzzle
- Chew sugar-free gum
- Hold a straw or stir stick in your mouth
- Eat carrots, celery, or apple slices
PRACTICE NEW WAYS TO RELAX
Many people use smoking to relieve stress. Try new relaxation techniques to help calm yourself:
- Take a deep breath in through your nose, hold it for 5 seconds, exhale slowly through your mouth. Try this a few times until you feel yourself relax.
- Listen to music.
- Read a book or listen to an audiobook.
- Try yoga, tai chi, or visualization.
EXERCISE
Exercise has many benefits. Moving your body may help reduce cravings. It can also give you a feeling of wellbeing and calm.
If you only have only a little time, take a short break and walk up and down the stairs, jog in place, or do squats. If you have more time, go to the gym, take a walk, bike ride, or do something else active for 30 minutes or more.
When to Call the Doctor
If you do not think you can quit on your own, contact your health care provider. Nicotine replacement therapy may help you stave off cravings through the first and hardest stage of quitting.
References
American Cancer Society website. How to quit tobacco: help for cravings and tough situations while you are quitting tobacco. www.cancer.org/cancer/risk-prevention/tobacco/guide-quitting-smoking/quitting-smoking-help-for-cravings-and-tough-situations.html. Updated October 10, 2020. Accessed September 26, 2024.
Centers for Disease Control and Prevention website. Tips from former smokers. www.cdc.gov/tobacco/campaign/tips/index.html. Updated February 5, 2024. Accessed September 26, 2024.
George TP. Nicotine and tobacco. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 363.
Ussher MH, Faulkner GEJ, Angus K, Hartmann-Boyce J, Taylor AH. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2019;(10):CD002295. PMID: 31684691 pubmed.ncbi.nlm.nih.gov/31684691/.