Quitting Smoking Let Us Help If you’re reading this, you’ve already taken the first step, the single most important step that you can make to extend your life. Good for You! You don’t have to be one of the half of all smokers who keep smoking who will end up dying from a smoking-related illness. Smoking or use of tobacco products (cigarette, cigar, pipe, snuff, chewing, hookah pipes & even e-cigarettes) are not healthy behaviors and contribute negatively to your overall health. E-cigarettes are becoming more and more popular. Although they are less harmful

than traditional cigarettes, they do contain nicotine and their long-term effects are unknown. In fact, they are not regulated which means there are no safety or quality checks. According to the FDA, e-cigarettes are not always safe and in an analysis of 18 samples of cartridges from 2 leading e-cigarette brands, cancer-causing substances were found in half the samples. There were other impurities noted as well. For example, diethylene glycol, a toxic ingredient found in antifreeze, was found in one sample. Testing also found small amounts of nicotine in most of the cartridges labeled nicotine-free. Oral tobacco products contain human carcinogens. These products cause mouth cancer and gum disease. They also destroy the bone sockets around teeth and can cause teeth to fall out. There are studies showing potential harmful effects on the heart and circulation, as well as increased risks of other cancers. (American Cancer Society) Cigars have a higher level of carcinogens, toxins, and tar than cigarettes. Many

people view cigar smoking as less dangerous than cigarette smoking. Yet one large cigar can contain as much tobacco as an entire pack of cigarettes. Cigar smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the esophagus is exposed to carcinogens. 1



Cigar smoke has: • A higher level of cancer-causing substances: During the fermentation

nitrosamines are produced. These compounds are released when a cigar is smoked. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke. • More tar: For every gram of tobacco smoked, there is more cancer- causing tar in cigars than in cigarettes. • A higher level of toxins: Cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than the burning of cigarette tobacco. As a result, cigar smoke has higher concentrations of toxins than cigarette smoke. (National Cancer Institute). Pipe: Research shows that pipe smoking is every bit as dangerous as cigarette

smoking, and possibly even more dangerous. (WebMD)

Hookah Pipe: When using a hookah pipe, you’re likely to inhale more smoke than

you would from a cigarette. Hookah smoke has many toxic compounds and exposes you to more carbon monoxide than cigarettes do. Hookahs also produce more secondhand smoke. Hookah smoking is usually a social event in which smokers talk as they pass the pipe around. It’s thought of as a safer alternative to cigarettes because the percentage of tobacco in the product smoked is low and people think the water filters out the toxins. This is false. The water does not filter out many of the toxins. In fact, hookah smoke contains more toxins such as nicotine, carbon monoxide, tar, heavy metals, and other hazardous substances, than cigarette smoke. And users breathe in secondhand smoke, as well as toxins released from the heat sources used to burn hookah tobacco. It has been suggested that in a typical 1-hour hookah smoking session, users may breathe in 100 to 200 times the amount of smoke, 9 times the amount of carbon dioxide, and nearly twice the amount of nicotine they would get from one cigarette. Several types of cancer have been linked to hookah smoking, including lung, mouth, and bladder cancer. Hookah use is also linked to other unique risks not found with cigarette smoking. For example, infectious diseases can be spread by sharing the pipe or through the way the tobacco is prepared. (National Cancer Center) Clove cigarettes: Also called kreteks (kree-teks), originated in Indonesia and other

Southeast Asian countries. They contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. The chemicals in cloves have been linked to asthma and other lung diseases. Users often have the mistaken notion that smoking clove cigarettes is safer than smoking regular cigarettes. However, this is a tobacco product with the same health risks as cigarettes. In fact, clove cigarettes have been shown to deliver more nicotine, carbon monoxide, and tar than regular cigarettes. (National Cancer Center) 2

Nicotine is the chemical component in tobacco (the substance associated with psychoactive reinforcing properties) that establishes nicotine dependence and the nicotine withdrawal syndrome. Nicotine dependence develops fairly rapidly— often within six months of regular use. Addiction to nicotine is a chronic health issue. According to the Mayo Clinic, “Drug addiction, also called substance use disorder, is a dependence on a legal or illegal drug or medication. Keep in mind that alcohol and nicotine are legal substances, but are also considered drugs. When you’re addicted, you’re not able to control your drug use and you may continue using the drug despite the harm it causes. Drug addiction can cause an intense craving for the drug. You may want to quit, but most people find they can’t do it on their own. Drug addiction can cause serious, long-term consequences, including problems with physical and mental health, relationships, employment, and the law.” According to the U.S. Surgeon General, “smoking causes a host of cancers and other illnesses and is still the leading preventable cause of death in the United States, killing 480,000 people each year.

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How many cigarettes do you smoke per day?


Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.

Mark Twain When do you smoke your first cigarette (time from waking)? People who smoke more than 20 cigarettes per day and have their first cigarette within 30 minutes of waking have a high nicotine dependence. The severity of the dependence depends more on difficulty quitting and remaining smoke-free than on the amount and pattern of smoking. (1) What Kind of Smoker Are You? (Adapted from Do You Smoke? Medical Society of Nova Scotia, 2000) 1. I’m Not Interested in Quitting • While you might not be ready to quit, think about the impact smoking has on your life, especially any illnesses related to your smoking, and your family’s life. • Even if you do continue to smoke, it is important to smoke outdoors so that your second-hand smoke doesn’t harm anyone else. • Remember, according to the Cleveland Clinic, the risk for those with a first- degree relative who smokes is three times that of those in a family of nonsmokers. 2. I’m Interested and Thinking About Quitting • Think about the pros and cons of smoking and the pros and cons of quitting. If the pros of quitting outweigh the cons, it is clear you are worried about smoking and want to do something about it. See the section on how to quit. • Even cutting down on daily usage is a good start! 3. I’m Interested and Ready to Quit • Preparing to quit takes commitment, but you can do it! See the section on How to Quit. 4. Now That I Have Quit • CONGRATULATIONS! Welcome to a smoke-free life. Use your plan to cope with triggers. 4

OK, Let’s Learn About the Benefits of Quitting Smoking Physical Benefits • 20 minutes after you quit, your heart rate and blood pressure drop (2) • 2 hours after you quit, the amount of nicotine in your bloodstream will drop by half
 • 8 hours after quitting, there will be more oxygen in your blood • 12 hours after quitting the carbon monoxide level in your blood drops to normal (3) • 72 hours your breathing becomes easier. Your bronchial tubes begin to relax

• 20 minutes after you quit, your heart rate and blood pressure drop (2) • 2 hours after you quit, the amount of nicotine in your bloodstream will drop by half
 • 8 hours after quitting, there will be more oxygen in your blood • 12 hours after quitting the carbon monoxide level in your blood drops to normal (3) • 72 hours your breathing becomes easier. Your bronchial tubes begin to relax

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• 2 weeks – 12 weeks your circulation improves and your lung function increases

 (4) • 1 to 9 months after quitting 
coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection 
(5)

Active pack a day smoker’s lung

Smoker’s lung just 90 days after quitting

• 1 year after quitting 
the excess risk of coronary heart disease is half that of a continuing smoker’s 
(6) • 5 years after quitting the risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years (7) • 10 years after quitting the risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases (8) • 15 years after quitting the risk of coronary heart disease is that of a non-smoker’s (9) • You will be protecting your family from the dangers of second-hand smoke and setting a good example for your children

• There is an increased risk of the baby developing asthma if the mother smokes and with secondhand smoke



• Babies and children have more ear infections, colds, bronchitis, and problems with breathing than children in non-smoking families



• Secondhand smoke is linked to sudden infant death syndrome (SIDS) and slow lung growth in children (American Cancer Society)



• Breathing the smoke from the tip of your cigarette and the smoke you exhale increases your family’s risk of lung cancer by between 20 and 30 per cent and their risk of heart disease by nearly a quarter (10) 6



• Pollution from tobacco smoke can cling
 to carpets, furnishings and walls. These materials absorb the toxins found in tobacco smoke and gradually release them back into the air, posing an additional risk of exposure. Second-hand smoke can remain in contaminated dust and surfaces, even
if smoking took place days, weeks or months earlier (11)



• Remember, there is no safe way to smoke in a car. In a small confined space of a car, smoke density can build up very quickly to hazardous levels. Smoking in a car exposes occupants to harmful chemicals in greater concentrations than in any other environment (12)



• In most countries, smoking in a car with children under the age of 18 is illegal

• If you are pregnant, you will help prevent complications such as miscarriage, premature delivery, cleft lip, cleft Giving up smoking palate and your baby will more likely have a normal birth is the easiest thing weight. (During pregnancy, nicotine crosses the placenta and has been found in amniotic fluid and the in the world. I know umbilical cord blood of newborn infants) (13) because I’ve done it thousands of times. • Food will taste better and your sense of smell will improve. • Your breath, hair, clothes and car will smell better • Your fingers, fingernails and teeth will be less stained 


Mark Twain

• You will have more energy. Physical activities will be easier and more enjoyable

Other Benefits • You will overcome a strong addiction and be in control of your life • Your self-confidence will improve • You will be providing a good role model for your children
 • Your life insurance premiums will go down • You will save money. If you smoke 1 pack/day, in 10 years you will have spent $18,250.00. Ask yourself, how would you rather use that money? • Everyday activities (such as climbing stairs or light housework) will no longer leave you out of breath • You can be in a smoke-free building

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How to Quit! According to the Center for Disease Control, smokers can and do quit smoking. In fact, today there are more former smokers than current smokers

1. Congratulate yourself on this first step.



2. Set a date in the near future and stick to it.



3. Prepare for your Quit Day. Will you quit cold turkey, taper down before the day, start with nicotine replacement therapy?



4. Get rid of all ashtrays and cigarettes in your house, car and at work.



5. Only 3% of smokers succeed by willpower alone. (14) Stopping smoking works best when you are part of a program.

6. Develop a personalized quit program. This may include help from a doctor, support groups, telephone counseling, behavioral therapy, individual counseling sessions, exercise and hypnosis. According to the American Cancer Society, there is little or no evidence that acupuncture, magnet therapy or low-level laser therapy is effective.



7. Establish a self-reward program (stickers, small gifts or treat).



8. Use positive self –talk; “I know I can do it”, “ This is hard but I’m strong”, “ I can’t wait to feel better”. Practice saying, “No thank you, I don’t smoke J”.



9. Tell your family and friends about your plan to quit. Set up a support system of people you can call on. (see resources for support groups)

10. Discuss use of stop-smoking medications with your health care provider. Nicotine Replacement Therapy (NRT) and other medicines have been proven to double your chances of quitting (15). These come in gum, patches, lozenges, pills, inhalers and nasal sprays. They are lower concentrations of nicotine and may not have the other 7000 chemicals and chemical compounds found in cigarettes. Of the 7000, hundreds are harmful and at least 70 can cause cancer.



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11. According to the American Cancer Society, filters that reduce tar and nicotine do not work. In fact, studies have shown that smokers who use filters tend to smoke more.

12. Develop strategies to deal with the side effects of cessation.



• Nicotine is an appetite suppressant & can boost metabolism. Therefore, your weight may fluctuate



• Exercise will help not only with the possibility of weight gain, but will also reduce your craving for cigarettes (16)



• Avoid triggers; people, places and things that remind you of smoking. Ex) if you always had a cigarette with your morning coffee, try sitting in a different room, using a different mug and reading a magazine (keeps your hands busy)



• Stay strong – the beginning is the most difficult, but the cravings will pass



• Avoid alcohol. Drinking lowers your chance of success

13. Develop a plan to handle any slips. Don’t despair if you have a cigarette. It can take a few attempts to succeed. 14. Share your success with us! [email protected].

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Resources For Quitting Contact Information: • American Cancer Society: www.cancer.org 1-800-227-2345 • American Heart Association: Toll-free number: 1-800-242-8721 (1-800-AHA-USA-1) Website: www.americanheart.org • American Lung Association Toll-free number: 1-800-548-8252 Website: www.lungusa.org • BC Doctors’ Stop Smoking Program 115-1665 West Broadway
Vancouver, BC
V6J 5A4
Tel: 1-800-665-2262 or 604-736-3987 Website: http://www.bcdssp.com • Centers for Disease Control & Prevention
Office on Smoking & Health
 Free quit support line: 1-800-784-8669 (1-800-QUIT-NOW) TTY: 1-800-332-8615
Website: www.cdc.gov/tobacco • Everyday Choices: Quitting tips and advice can be found at www.everydaychoices.org or by calling 1-866-399-6789 • National Cancer Institute: 
Free tobacco line: 1-877-448-7848 (1-877-44U-QUIT) (also in Spanish) Direct tobacco website: www.smokefree.gov Quitting information, quit-smoking guide, and counseling are offered, as well as referral to state telephone-based quit programs (if needed for special services) • Nicotine Anonymous: Toll-free number: 1-877-879-6422 (1-877-TRY- NICA) Website: www.nicotine-anonymous.org • You can also enroll in a NHS stop-smoking program • QUITLINE: In the U.K. call QUITLINE 0800 00 22 00 or email [email protected] • www.smokefree.gov • Check your workplace, hospital, and local wellness centers. They often have stop-smoking programs, groups, or classes.

Mobile Phone Apps*: • Smoke Free • Kwit • Livestrong My Quit Coach • Quit it Lite • Quit Smoking: Cessation Nation • Quit Smoking with Andrew Johnson (hypnotherapy) • Craving to Quit

*International Bipolar Foundation (IBPF) does not endorse any of these applications. These apps have not been evaluated for medical accuracy by IBPF. The U.S. Food & Drug Administration has not approved them unless otherwise indicated.

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References 1. Rosser, W et al. Department of Family and Community Medicine University of Toronto, Toronto, ON. Smoking Cessation Guidelines 
 2. Effect of smoking on arterial stiffness and pulse pressure amplification, Mahmud 
A, Feely J. Hypertension. 2003:41:183 3. US Surgeon General’ s Report, 1988, p. 202
 4. US Surgeon General’ s Report, 1990, pp.193, 194,196, 285, 323 
 5. US Surgeon General’ s Report, 1990, pp. 285-287, 304 
 6. US Surgeon General’ s Report, 2010, p. 359 7. A Report of the Surgeon General: How Tobacco Smoke Causes Disease - The Biology and Behavioral Basis for Smoking-Attributable Disease Fact Sheet, 2010; and Tobacco Control: Reversal of Risk After Quitting Smoking. IARC Handbooks of Cancer Prevention, Vol. 11. 2007, p 341 8. A Report of the Surgeon General: How Tobacco Smoke Causes Disease - The Biology and Behavioral Basis for Smoking-Attributable Disease Fact Sheet, 2010; and US Surgeon General’ s Report, 1990, pp. vi, 155, 165 9. Tobacco Control: Reversal of Risk After Quitting Smoking. IARC Handbooks of Cancer Prevention, Vol. 11. 2007. p 11 10. World Health Organisation: www.who.int.tobacco/en/atlas10/pdf 11. Effect of sorption on exposures to organic gases from environmental tobacco smoke http://eetd.lbl.gov/node/49332 12. Ott W, langan l, Switzer P. A time series model for cigarette smoking activity patterns: model validation for carbon monoxide and respirable particles in a chamber and an automobile. Journal of Exposure Analysis and Environmental Epidemiology, 1992; 2 (Suppl 2):175-200. 13. http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_ smoking_508.pdf 14. http://www.nhs.uk/livewell/smoking/Pages/Copingwithcravings 15. http://www.netdoctor.co.uk/smoking/medicines_000500.htm#ixzz3x9 16. http://www.nhs.uk/livewell/smoking/Pages/weightgain.aspx Copyright 2015

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