- INSIDER polled 1,102 people about their New Year’s resolutions, and 80 said they want to quit smoking in 2019.
- The top five methods involve gradually reducing cigarette use, quitting cold turkey, switching to e-cigarettes, nicotine patches, and prescription medications.
- INSIDER asked three experts about these choices, and they said a combination of medication and counseling gives smokers a better chance of quitting.
- Though e-cigs were a popular choice on the poll, right now there’s no data on their long-term safety and effectiveness as a quitting tool.
Each year in the US, smoking causes more deaths than HIV, illegal drug use, alcohol use, motor vehicle accidents, and firearm-related incidents combined, according to the Centres for Disease Control and Prevention (CDC). So it’s not too surprising that, even though US smoking rates have reached a historic low, some people choose to quit smoking as a New Year’s resolution.
INSIDER recently polled 1,102 people about their 2019 resolutions, and 80 respondents said they wanted to kick a smoking habit. When asked which quitting strategy they planned to adopt in the new year, the top five answers were gradually reducing cigarette use, going cold turkey, using e-cigarettes, using nicotine patches, and taking prescription medication like Chantix.
INSIDER spoke with three experts in the smoking cessation field to ask whether these top choices can really help smokers quit in 2019.
The first and most important thing to know is that no single quitting plan will work for all people, Dr. Steve Schroeder, distinguished professor of health and healthcare and director of the Smoking Cessation Leadership Center at the University of California San Francisco, told INSIDER.
“There’s no magic bullet,” he said. “There’s no one size fits all. So every person should feel free to design and experiment.”
Second, don’t get discouraged if it takes multiple tries to quit for good.
“Recent data show that it often takes up to 30 quit attempts before someone finally stops,” Schroeder said. “[But] there are now more ex-smokers than current smokers in the United States. So the messages is, if you don’t succeed, don’t feel like it’s all over. Keep trying.”
And, whether 2019 marks your first or 12th or 30th attempt to quit, there are some strategies (and combinations of strategies) that are proven to be more effective than others. Here’s what the experts had to say about the top responses in INSIDER’s poll.
1. Gradually reducing cigarette use
Gradually reducing cigarette use can work as a strategy to quit, Dr. Michael Fiore of the Center for Tobacco Research and Intervention at the University of Wisconsin told INSIDER.
“There’s some science behind that approach,” he said. “Gradually reducing cigarettes has been tested in a number of scientific studies and has been shown to be one of the effective ways to quit smoking.”
But he added that combing this approach with nicotine replacement therapy – like nicotine patches and lozenges – will “markedly enhance” success. (More on those products later.)
Fiore said his clinical recommendation is to use nicotine replacement therapy, cut the number of cigarettes you smoke in half, and gradually decrease from there over the next two to four weeks.
That said, some people who try this approach may reduce their smoking but never fully quit, according to Jennifer Hobbs Folkenroth, national senior director of tobacco control at the American Lung Association (ALA).
“Many people just switch their mindset from a full-time smoke to an occasional smoker and justify in their mind as being ok,” she told INSIDER.
The problem is that, while smoking fewer cigarettes does reduce your risk for lung diseases, it won’t help your heart health, Schroeder explained.
“Smoking a small number of cigarettes is almost as harmful to your cardiovascular health as smoking a large number,” he said. “For heart disease and stroke, even if you’re smoking only one or two cigarettes per day, the changes to the inside of the arteries and the platelets are sufficient that your risk stays up.”
“If you reduce on the way to quitting, that’s great,” he added. “But going from a pack a day to 10 cigarettes a day is not as helpful as you might think.”
Fiore also noted that cutting down on the number of cigarettes smoked makes people smoke them more efficiently. That means they take more and longer drags and them in their lungs longer.
“So, in essence, you’re delivering higher levels of toxins than you would if you smoked more cigarettes per day,” he said. “That’s a really important reason why you want to get to zero.”
2. Quitting cold turkey
Quitting cold turkey – meaning trying to quit smoking with no assistance whatsoever – is only successful about 3% to 5% per cent of the time, Hobbs Folkenroth said.
But it’s not realistic to expect that willpower alone is enough to quit. Most smokers become addicted to the nicotine in tobacco, and some research suggests it may be as addictive as heroin or cocaine, according to the CDC.
Fiore said quitting cold turkey can be a reasonable strategy only if smokers use two other forms of assistance in their attempt: First, some form of counseling, and second, a smoking cessation medicine that’s been approved by the US Food and Drug Administration (FDA).
“Unfortunately there’s a lot of misconceptions about [quitting] and one is if that you are strong enough person you would do it on your own without any help, without any medicine,” Fiore said. “I tell patients that you’re smart and you’re strong if you use the treatments that boost your success rates. You’re not weak.”
3. E-cigarettes or vaping
Fiore and Schroeder both said that, for adults, e-cigarettes are less harmful than smoking traditional cigarettes. But simply being less harmful than cigarettes doesn’t make e-cigs 100% safe, Fiore added. And right now, there’s just not enough research to know whether they’re safe in the long term or effective as quitting aids.
So far, scientific evidence has identified some concerning possible risks with e-cig use. An investigative report published this month in JAMA found that e-cigs and cigarettes both contain high amounts of toxins like lead, cadmium, and pyrene. Another 2018 study suggested daily vape use is linked to a higher risk of heart attack.
But if a smoker still wants to try e-cigarettes as part of a quitting plan, Fiore recommended switching to exclusive e-cig use (rather than a combination of e-cigs and traditional smoking) and using e-cigs for a finite period of time.
Schroeder agreed with the latter point.
“If you switch to an e-cigarette then you need to try to get off of that, too,” he said. “That contains the same nicotine that kept you hooked to regular cigarettes.”
Hobbs Folkenroth said that, because the FDA hasn’t yet ruled that any e-cigarette is safe and effective for quitting, the ALA doesn’t currently support them as a smoking cessation tool.
4. Nicotine patches
Nicotine patches are one type of nicotine replacement therapy, or NRT. These types of products are FDA-approved for quitting smoking and work by supplying the body with small doses of nicotine, satisfying cravings and reducing urges to smoke. They also address symptoms of nicotine withdrawal, like feeling sad or irritable and having trouble sleeping.
There are five total options. Nicotine patches, gum, and lozenges can be purchased over the counter, while nicotine nasal spray and nicotine inhalers are available by prescription.
All the experts INSIDER interviewed recommended combining the long-acting patch, which is worn all day, with a short-acting product like gum or lozenges.
“You get that relief all day [from the patch] but for those really strong breakthrough cravings, those are the ones where you can pop a lozenge or a piece of gum and really get that extra boost needed to get you through,” Hobbs Folkenroth said.
She added that many individuals will stop NRT early due to the products’ cost, but added that insurance plans may cover over-the-counter NRT products if they’re prescribed by a doctor. It’s worth asking your doctor and contacting your insurance company to see if your plan includes this type of benefit.
5. Prescription medication
There are two other medicines that are FDA-approved to help smokers quit. One is bupropion (brand name: Zyban) and the other is varenicline (brand name: Chantix), both of which are available by prescription only.
Varenicline is the more popular of the two drugs and is shown to be more effective, Fiore said. It works in the areas of the brain affected by nicotine, reducing the drug’s rewarding effects.
Both medications can have side effects and risks, so a conversation with your personal doctor is the best way to determine whether one or the other is a good option for you. One other consideration: For the best results, Hobbs Folkenroth said smokers need to start taking varenicline or bupropion before they actually start quitting, so some forward planning is required.
Counseling is another important tool
It didn’t appear in the top five responses for INSIDER’s poll, but each of the experts who spoke with INSIDER said some form of counseling increases the odds of a successful quit attempt. Counseling and medication are both shown to be effective in helping people quit, but when combined, they’re even more effective than using either one on its own, according to the CDC.
Counseling involves communicating with a trained professional who can offer guidance on a quit attempt. But it doesn’t have to be an in-person affair. Some services offer counseling over the phone, text messages, or through mobile apps, and many are free.
“People can do [counseling sessions] from the comfort of their home, so they don’t have to worry about getting childcare or parking or having to miss work,” Schroeder said. “So they’re very convenient.”
Each US state has a quitline with counselors who are trained to help smokers quit (You can call 800-QUIT-NOW to connect to your state’s quitline). Other counseling programs include SmokeFreeTXT, Quit for Life, Become an Ex, and the American Lung Association’s Freedom from Smoking.
“Many [counseling programs] are free, but sometimes a smoker prefers to try to quit alone or privately because that way, if they fail, they’re not going to upset anyone or disappoint their family members or friends,” Hobbs Folkenroth said. “However, no one should ever have to quit alone, and we know that every smoker can quit. It’s absolutely possible.”
SurveyMonkey Audience polls from a national sample balanced by census data of age and gender. Respondents are incentivized to complete surveys through charitable contributions. Generally speaking, digital polling tends to skew toward people with access to the internet. SurveyMonkey Audience doesn’t try to weight its sample based on race or income. Total 1,037 respondents, margin of error plus or minus +/- 3.15 percentage points with 95% confidence level.
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- There’s even more evidence that e-cigarettes can expose you to dangerous toxins
- The government wants to crack down on cigarettes with menthol, a flavour that’s wildly popular and may make quitting even harder
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