At a recent art opening near New York's High Line, the air was practically opaque on the sidewalk, thanks to an assemblage of gallery sylphs, cigarettes dangling from their manicured fingers. At another event, at the Lever House on Park Avenue, it seemed like half the stylish crowd was huddled outside by the entrance, puffing away as they teetered on their stilettos. Didn't these people read the headline-making study in the New England Journal of Medicine? Earlier this year, it reported a steep increase in tobacco-related ailments among female smokers, who are now more likely to die of lung cancer than men who smoke. Equally bleak news came from a separate study published in the same issue of the NEJM: It found that women who smoke die, on average, a full decade sooner than nonsmokers.
Yet despite the warnings, one in five Americans still lights up. Fortunately, the same NEJM study found that kicking the habit at any age dramatically lengthens your life expectancy. In fact, those who quit by the age of 34 regained the entire ten years. (Smokers who kicked the habit between 35 and 44, meanwhile, reclaimed nine.) But quitting is a grueling process (natural childbirth was less painful, a friend told me) with an average of seven attempts before success. Women in particular fear putting on the pounds once they stop (smoking experts are now crafting cessation programs to address these concerns).
Kicking the habit delivers gratifying results, and quickly: Twenty minutes after you stub out your last cigarette, your blood pressure goes almost completely back to normal; within 24 hours, your chance of a heart attack decreases. And now there are more ways to stop than ever. Here are the latest.
Call the Doctor
It turns out that the most dreaded method of quitting-going cold turkey-is actually one of the least effective, with a dismal success rate of less than 5 percent. Experts now say the best way to quit is under a doctor's care, using a combination of meds such as Chantix or Zyban, nicotine-replacement therapy (nasal sprays, patches, gum), and counseling. "Cigarette smoking is a chronic disease," says Michael C. Fiore, M.D., professor of medicine at the University of Wisconsin and director of its Center for Tobacco Research and Intervention. "I'd never tell a diabetic patient, 'Use your willpower exclusively to control your blood sugar.' " The American Lung Association offers a Freedom from Smoking program, consisting of eight weekly small-group sessions, at hospitals nationwide; more than a third of participants are smoke-free six months later. For a more stubborn habit, the Mayo Clinic and the St. Helena Center for Health, which has the added bonus of a view of Napa vineyards, offer inpatient treatments that last a week or more. The programs are intense but effective: The Mayo Clinic's success rate is more than 52 percent.
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One of the most popular tools is the electronic cigarette, which satisfyingly mimics the experience of smoking (some brands even have an LED at the tip that lights when you take a drag). Instead of tobacco, the rechargeable device converts liquid nicotine into a vapor that people inhale, sans toxic tars and carbon monoxide. Health organizations, including the FDA, remain leery: Not only have there been no major studies showing that they're effective but most brands are made in China, without quality control or standardization. Still, legions of aspiring ex-smokers swear by them (annual U.S. sales are now inching upward of $500 million). As a bonus, e-cigarettes skirt many public smoking regulations, so people can re-create the Eisenhower era and freely puff away in the workplace. In the world of nicotine-replacement aids, meanwhile, the latest development is the mini lozenge, which dissolves at lightning speed in a smoker's mouth. "It takes the edge off very quickly," Fiore says.
Hit the Gym
Several studies, including a major one presented at the World Congress of Cardiology last year, have found that exercise reduces both urges to smoke and withdrawal symptoms. "Just 30 minutes of moderate exercise, five days a week, will help," says Richard D. Hurt, M.D., professor of medicine and director of Mayo Clinic's Nicotine Dependence Center. So does loading up on produce, according to researchers at the University at Buffalo. They found that smokers who ate the most fruits and vegetables over a fourteen-month period were three times more likely to have quit than those who didn't eat as much produce. One theory is that cravings for food and cigarettes are linked, so high-fiber foods create satiety and ward off the desire to light up. Not only that, but a Duke University study discovered-for reasons still not understood-that eating fruits and vegetables actually makes cigarettes taste worse.
The evidence is growing that social media, from Twitter accounts to Facebook and texting, is a powerful tool in helping smokers put down the pack. "The more contact time there is with others, the better the outcome," says Hurt. A review of studies published last year by the Cochrane Collaboration found that with help from strategic text messages, smokers were able to double their chance of success. On Facebook, a new science-backed app ten years in the making called UbiQUITous has smokers set a quit date and post their progress while receiving encouragement from friends online. And on Becomeanex.org, a site with 450,000 members, smokers vent and exchange been-there-done-that-advice like "Don't keep an emergency pack."
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There's no way around it: Most people put on an average of four to ten pounds after they quit. Not only does smoking burn an extra 100 to 200 calories a day by elevating your heart rate and increasing metabolism, but those who are trying to break the habit often swap cigarettes for food. Most weight is gained within the first three months of quitting and then sharply decelerates, according to an analysis of 62 studies published last year in the British Medical Journal. To help people get through that vulnerable period, a drug called naltrexone has been shown in studies to significantly reduce weight gain for up to one year in female smokers. And Fiore says there is evidence that nicotine gum and lozenges help curb appetite, while Hurt recommends the smoking-cessation med bupropion. Once people get their addiction under control, then they can focus on their diet: According to the BMJ study, nearly 20 percent of former smokers lost weight after one year of abstaining.
Clearing the Air
Secondhand smoke is more than a nuisance-it's a serious health issue. Nonsmokers who are regularly exposed to cigarette smoke increase their heart-disease risk by 25 to 30 percent and their lung cancer risk by 20 to 30 percent, according to the Centers for Disease Control and Prevention. And it is now solidly proven that public-smoking bans have resounding health benefits-not just for smokers but for everyone. New research from the Mayo Clinic in Rochester, Minnesota, found an astonishing 33 percent drop in heart-attack rates in one local county after public smoking bans were enacted. "If you could invent a pill that reduces heart attacks by 33 percent," says the Mayo Clinic's Richard D. Hurt, M.D., who led the study, "that would earn a Nobel Prize." And a recent citywide ban on public smoking in Pueblo, Colorado, led to a significant decrease in preterm births. Now that smoking is forbidden in most workplaces, the next wave is to prohibit the actual smokers themselves. Some employers have put out the word that smokers need not apply. Apartment buildings are also following the trend. Michael C. Fiore, M.D., says that smoke-free residences "without question" will become the norm by the end of the decade. A bill introduced in February by a California assemblyman would prohibit smoking in all multi-unit homes in the state. "With tobacco smoke, unlike other environmental toxins, there's no lower level of exposure that's safe," says Hurt. "As little as five minutes of exposure causes the aorta to malfunction. Thirty minutes of exposure causes the coronary arteries to malfunction." Smokers may complain that they are being increasingly marginalized, but even they benefit: Research shows that the more smoke-free places there are, the easier it is to resist the urge to light up.
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