Kicking butt

Only six days ago, she’d been a smoker. But today, Susan Lavigne* is making a determined second attempt at kicking the habit. She confesses quitting is like having PMS. “It does something weird to your moods. You feel angry, depressed, less tolerant.” Even so, she says wryly, “I haven’t killed anyone yet.”

The first time around, Lavigne quit to avoid triggering a friend’s asthma. A year later, driven by stress, she turned once again to cigarettes. She hadn’t really believed smoking had affected her health but after starting again, she noticed her chest felt tight after climbing a flight of stairs and her usually brisk cycling pace had clearly slowed.

“The important thing is not to do it because it’s the right thing for somebody else. You have to do it for yourself,” Lavigne says. “You have to firmly believe that you want to be a non-smoker.”

Paul McDonald, a professor of health studies and gerontology at the University of Waterloo, is one of Canada’s top authorities on smoking cessation. He says for many smokers, reality kicks in as they age. They’re confronted with warnings such as shortness of breath or circulatory problems and increasingly find other 50-plusmokers suffering similar — or worse — changes in health.

All of us can play a role
“Smoking is far and away the biggest threat to public health in this country,” he asserts. “Somewhere between 15 and 20 per cent of all deaths are related to tobacco use.”

That realization triggered his interest in researching how to help people quit smoking. He sees smokers as more than tobacco abusers.

“I help smokers because they are our parents, our children, our neighbours, our teachers. They’re community leaders, the people who volunteer. They’re the people who make our lives worthwhile. They deserve support.”

The complexity of smoking cessation intrigues him. “It’s not a question of just will power,” he notes. Social and physical environments, biological variables and smokers’ emotional and cognitive responses all affect the quitting process.

It turns out all of us can play a role in ending smoking. “Doing what we can to create supportive environments will help people quit and stay smoke-free. People who live in smoke-free homes are 65 per cent more likely to remain smoke-free than those who continue to permit smoking in their homes,” he notes. “And the odds of quitting go up 20 per cent for people working where smoking is prohibited.”

Scolding, shaming and making smokers feel bad won’t work. It’s better to tell someone like Lavigne she’ll still have support and respect, even if she struggles. “Make it clear you’ll be there for the long term,” he says.

Next page: Develop a strategy for success

Develop a strategy for success
There are certain things smokers who want to quit should do, McDonald says. First, they must understand why they smoke. Is it a stress reliever or a way to control emotions? Is it a no-longer-needed show of rebellion? Is it associated with certain situations, such as drinking coffee or an alcoholic beverage, sitting in the car or at a computer, making a phone call or taking a break? Armed with this knowledge, it’s possible to develop tactics for dealing with the desire to smoke. 

Although some worry about putting on weight if they quit, an average gain of about five pounds is relatively insignificant. “It’s a whole lot less risk than continuing to smoke,” McDonald says.

Having small successes develops the self-confidence needed to accomplish the goal of becoming a non-smoker. Before the planned quit date, McDonald suggests practising by delaying the first cigarette of the day or smoking only half a cigarette. Then, he says, the smoker must commit to quitting on a specific day. “Don’t keep putting it off or, pretty soon, 20 years go by.”

McDonald’s research has shown that smokers’ dependence on nicotine ranges from full-blown addiction to little or no dependency. Administering nicotine by a patch or in gum form may be helpful. Zyban, a non-nicotine, antidepressant medication available only by prescription has helped some kick the smoking habit, but it must be started a week before the quitting date. He observes that people who experience withdrawal and cravings are more successful if they use these [pharmacological treatments] along with counselling or self-help material. Counselling is a toll-free phone call away in most provinces.

Susan Lavigne has given herself an incentive for staying tobacco-free: she plans to reward herself with a sleek new bike – purchased with the money she’ll save. The smoking calculator on the SilkQuit website is helping her track the dollars.

* Not her real name

Not just blowing smoke
• Roughly 5.4 million Canadians, or 21 per cent of those 15 and older, smoke. Average number of cigarettes smoked per day? 16. Those least likely to be considering quitting? People widowed or over 65. (Canadian Tobacco Use Monitoring Survey 2002) 
• Canada has 45,000 smoking-related deaths a year – five times those caused by car accidents, suicides, drug abuse, murder and AIDS combined. (Physicians for a Smoke-Free Canada)
• Our government “spends $200 million on tobacco control and $2.5 billion treating tobacco-related disease.” (Canadian Council for Tobacco Control)
• Smoking causes 25 life-threatening diseases, including heart disease, stroke, lung cancer and respiratory disease. (Smoking Cessation in Ontario 1998/99)
• Lung function of both sexes improves after prolonged smoking cessation. Women’s improvement is generally more than twice that of men’s in the first year of quitting. (Lung Health Study, American Journal of Epidemiology)
• Ticked off because you can’t smoke indoors anymore? Pat yourself on the back for doing a community service. When smoking was banned for six months in public places in Helena, Mont., the heart attack rate fell by nearly half.
• Second-hand smoke is the greatest risk factor for lung cancer among non-smokers. (Canadian Cancer Society)
• Cats living with smokers develop the most common feline tumour at more than twice the rate of those living with non-smokers.
• Faith and begorra. On March 29, 2004, the Irish will ban smoking in pubs.
• Pennsylvania State University researchers found that time seems to pass 50 per cent slower for people in the process of quitting smoking.

Tips for butting out forever
When the craving for a smoke hits, think of these four Ds offered by the Ontario Lung Association.
1. Drink water. Soothe the oral need with
a straw as wide as a cigarette.
2. Deep breathing. Ten deep breaths calm the jitters and help lung capacity.
3. Delay. Putting off having a smoke proves you are the one in control.
4. Do something different. Change habits associated with having a cigarette.

From the U.S. Surgeon General
• Smoking cessation is the most important step smokers can take to enhance the length and quality of their lives.
• There’s always a benefit to your health when you quit even when there is already smoke-related illness.
• Smoking is a major risk factor for six of the leading 14 causes of death among those 60 and older and is a complicating factor for three others.
• People who quit smoking after diagnosis of cancer had a reduced risk of acquiring a second primary cancer compared with those who kept on smoking.
• Smoking increases the risk of respiratory infections such as pneumonia, which often cause death in patients with underlying chronic disease.
• Nicotine withdrawal peaks in the first one to two days following cessation.
• Smoking is the most extensively documented cause of disease investigated in the history of biomedical research. •

Useful resources:
Health Canada –
Canadian Cancer Society – (click on tobacco pages)

Newfoundland: 1-800-363-5864
New Brunswick, Nova Scotia, Ontario, Manitoba, Saskatchewan: 1-877-513-5333
Prince Edward Island: 1-888-818-6300
Quebec: 1-888-853-6666
Alberta: 1-866-332-2322
British Columbia: 1-877-455-2233