Cigarette Smoking

Cigarette smoking is a leading contributor to death and illness among Americans.

Significantly fewer than half of all American adults smoke. Slightly more men smoke than women.
Hispanics and Asian Americans smoke less than whites or African Americans. Fewer than one third of
people ages 25 to 44 are current smokers.
Since 1964, when the Surgeon General issued the first report outlining the health dangers of smoking, the
prevalence of smoking has dropped among adults. The incidence of lung cancer, chronic bronchitis,
and emphysema would become significantly less common if people would stop smoking.
Compared to a nonsmoker, a smoker faces these risks:

fourteen times greater risk of dying from cancer of the lung, throat, or mouth;

four times greater risk of dying from cancer of the esophagus;

two times greater risk of dying from a heart attack;

and

two times greater risk of dying from cancer of the bladder.

Use of other tobacco products such as pipes, cigars, and snuff is less common; however, the health
effects of these products are similar to those of cigarettes - particularly their association with cancers of
the mouth, throat, and esophagus.
Increasing attention has been devoted to publicizing the dangers of second-hand (environmental) smoke,
the association between tobacco marketing and initiation of smoking among youth, and the development
of strategies and medications to help smokers quit. According to the CDC, about 126 million non-smoking
Americans are exposed to secondhand smoke and put at risk for tobacco-related problems such as lung
cancer, heart disease and respiratory infections. In addition, a new problem termed "third-hand smoke"
has been recently investigated. Cigarette smoke generated carcinogens lodge in clothing, carpets, drapes
and other materials and can be absorbed through human skin, especially that of children and infants.
These carcinogens can also be ingested and inhaled in dust.
Cigarette smoking has been linked strongly to the following illnesses:

heart disease

stroke

hypertension (high blood pressure)

other diseases of blood vessels (such as poor circulation in the legs) and aortic aneurysms
(potentially life-threatening disruptions in the wall of the aorta)

respiratory illness, including the following:

o

lung cancer

emphysema

bronchitis

pneumonia

cancers, including:
o

lip or mouth

pharynx or larynx (voice box)

esophagus (food pipe)

stomach

pancreas

kidney

urinary bladder

o
cervix
Ban on cigarette displays at cashiers among anti-smoking measures in the pipeline

The Health Ministry is looking to end point of display of tobacco products, and ban emerging tobacco
products. It will also conduct a public consultation exercise on plain packaging for tobacco products.
SINGAPORE: The Health Ministry is looking at various new initiatives to control smoking, including the
banning of point of display of tobacco products, according to Associate Professor Muhammad Faishal
Ibrahim, Parliamentary Secretary for Health, in Parliament on Thursday (Mar 12).
Tobacco control is an "important" issue, he said. "We all know that smoking can seriously harm our
health. In Singapore, it is the second-most important cause of premature deaths and ill health," Prof
Faishal said during the Committee of Supply debate.
As such, in terms of controlling smoking, the Health Ministry is looking to reduce the advertising effect
of point-of-sale displays, particularly on the youth. It will be banning such displays through an amendment
of the Tobacco (Control of Advertisements and Sale) Act this year, he said.
"When tobacco products are no longer prominently displayed near the cashiers, it could decrease
impulse purchases and help smokers trying to quit," he said. "There will be a 12-month grace period to
provide retailers enough time to comply."

EMERGING TOBACCO PRODUCTS

The Parliamentary Secretary also noted that while Singapore is doing well compared to Organisation
for Economic Co-operation and Development (OECD) countries, there are worries that smoking rates are
high among younger men.
"Tobacco companies have been coming out with new tobacco products that appeal to the youth. We
are concerned about the health risks of such products, and have been studying ways to address this
growing trend," Prof Faishal said.
Pointing to the shisha ban introduced last November, he said that similar bans on other products may
be introduced later this year. Compliance to the shisha ban "has been good" and the ministry will assess
the full effect of the ban after the transitional period ends on Jul 31, 2016.

WANTED: VIEWS ON PLAIN PACKAGING LAWS

Prof Faishal added that the ministry is also looking into plain packaging - a move implemented by
Australia and is the first in the world. This requires tobacco products to be sold in plain boxes, with
graphic health warnings, the brand name in standardised typeface, and minus all corporate logos and
trademarks.
"We will be conducting a public consultation on requiring the packaging of tobacco products to be
standardised in Singapore, towards the end of this year. I would like very much to hear your views," he
said.

I QUIT CAMPAIGN HAS BEEN "EFFECTIVE"

To get more people to quit the smoking habit, the I Quit campaign - which adopts a community-based
yet personalised approach to build a network of support - was set up in 2011.
This movement has reached 13,000 smokers through various platforms at the workplaces, hospitals,
uniform groups and in the community, Prof Faishal said.
"It has proved effective simply because it involves not just the smoker who wants to quit, but also
support from his family and friends. In many cases, it has helped to bring the family closer together," he
said.

The Effects of Smoking on the Body

Tobacco smoke is enormously harmful to your health. Theres no safe way to smoke. Replacing your
cigarette with a cigar, pipe, or hookah wont help you avoid the health risks associated with tobacco
products.
Cigarettes contain about 600 ingredients. When they burn, they generate more than 7,000 chemicals,
according to the American Lung Association. Many of those chemicals are poisonous and at least 69 of

them can cause cancer. Many of the same ingredients are found in cigars and in tobacco used in pipes
and hookahs. According to the National Cancer Institute, cigars have a higher level of carcinogens, toxins,
and tar than cigarettes.
When using a hookah pipe, youre 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.
In the United States, the mortality rate for smokers is three times that of people who never smoked,
according to the Centers for Disease Control and Prevention. Its one of the leading causes of
preventable death.
Central Nervous System
One of the ingredients in tobacco is a mood-altering drug called nicotine. Nicotine reaches your brain in
mere seconds. Its a central nervous system stimulant, so it makes you feel more energized for a little
while. As that effect subsides, you feel tired and crave more. Nicotine is habit forming.
Smoking increases risk of macular degeneration, cataracts, and poor eyesight. It can also weaken your
sense of taste and sense of smell, so food may become less enjoyable.
Your body has a stress hormone called corticosterone, which lowers the effects of nicotine. If youre under
a lot of stress, youll need more nicotine to get the same effect.
Physical withdrawal from smoking can impair your cognitive functioning and make you feel anxious,
irritated, and depressed. Withdrawal can also cause headaches and sleep problems.

Respiratory System
When you inhale smoke, youre taking in substances that can damage your lungs. Over time, your lungs
lose their ability to filter harmful chemicals. Coughing cant clear out the toxins sufficiently, so these toxins
get trapped in the lungs. Smokers have a higher risk of respiratory infections, colds, and flu.
In a condition called emphysema, the air sacs in your lungs are destroyed. In chronic bronchitis, the lining
of the tubes of the lungs becomes inflamed. Over time, smokers are at increased risk of developing these
forms of chronic obstructive pulmonary disease (COPD). Long-term smokers are also at increased risk of
lung cancer.
Withdrawal from tobacco products can cause temporary congestion and respiratory pain as your lungs
begin to clear out.
Children whose parents smoke are more prone to coughing, wheezing, and asthma attacks than children
whose parents dont. They also tend to have more ear infections. Children of smokers have higher rates
of pneumonia and bronchitis.

Cardiovascular System
Smoking damages your entire cardiovascular system. When nicotine hits your body, it gives your blood
sugar a boost. After a short time, youre left feeling tired and craving more. Nicotine causes blood vessels
to tighten, which restricts the flow of blood (peripheral artery disease). Smoking lowers good cholesterol
levels and raises blood pressure, which can result in stretching of the arteries and a buildup of bad
cholesterol (atherosclerosis). Smoking raises the risk of forming blood clots.
Blood clots and weakened blood vessels in the brain increase a smokers risk of stroke. Smokers who
have heart bypass surgery are at increased risk of recurrent coronary heart disease. In the long term,
smokers are at greater risk of blood cancer (leukemia).
Theres a risk to nonsmokers, too. Breathing secondhand smoke has an immediate effect on the
cardiovascular system. Exposure to secondhand smoke increases your risk of stroke, heart attack, and
coronary heart disease.
Skin, Hair, and Nails (Integumentary System)
Some of the more obvious signs of smoking involve the skin. The substances in tobacco smoke actually
change the structure of your skin. Smoking causes skin discoloration, wrinkles, and premature aging.
Your fingernails and the skin on your fingers may have yellow staining from holding cigarettes. Smokers
usually develop yellow or brown stains on their teeth. Hair holds on to the smell of tobacco long after you
put your cigarette out. It even clings to nonsmokers.

Digestive System
Smokers are at great risk of developing oral problems. Tobacco use can cause gum inflammation
(gingivitis) or infection (periodontitis). These problems can lead to tooth decay, tooth loss, and bad breath.
Smoking also increases risk of cancer of the mouth, throat, larynx, and esophagus. Smokers have higher
rates of kidney cancer and pancreatic cancer. Even cigar smokers who dont inhale are at increased risk
of mouth cancer.
Smoking also has an effect on insulin, making it more likely that youll develop insulin resistance. That
puts you at increased risk of type 2 diabetes. When it comes to diabetes, smokers tend to develop
complications at a faster rate than nonsmokers.
Smoking also depresses appetite, so you may not be getting all the nutrients your body needs.
Withdrawal from tobacco products can cause nausea.

Sexuality and Reproductive System

Restricted blood flow can affect a mans ability to get an erection. Both men and women who smoke may
have difficulty achieving orgasm and are at higher risk of infertility. Women who smoke may experience

menopause at an earlier age than nonsmoking women. Smoking increases a womans risk of cervical
cancer.
Smokers experience more complications of pregnancy, including miscarriage, problems with the placenta,
and premature delivery.
Pregnant mothers who are exposed to secondhand smoke are also more likely to have a baby with low
birth weight. Babies born to mothers who smoke while pregnant are at greater risk of low birth weight,
birth defects, and sudden infant death syndrome (SIDS). Newborns who breathe secondhand smoke
suffer more ear infections and asthma attacks.

Is Smoking Dragging You Down?

By Lisa Zamosky
If you smoke, you've likely heard the pleas from friends and family to quit. You probably know that
smoking makes heart disease, stroke, cancer, emphysema, chronic bronchitis, and other killers more

likely. You might even know that smoking is the No. 1 cause of preventable death in the U.S. and
worldwide.
But knowing about long-term risks may not be enough to nudge you to quit, especially if you're young. It
can be hard to feel truly frightened by illnesses that may strike decades later. And quitting smoking is
hard. As many as 75%-80% of smokers say they'd like to quit. But it takes the average smoker five to 10
attempts before successfully quitting.
For some smokers, it's the little things that motivate quitting. Things like the smell it leaves on your
clothes, the way people react when they find out you're a smoker, the stains it leaves on your teeth -everyday aggravations that can add up to a tipping point to kick the habit.
Here are 10 common daily side effects of smoking that often create the incentive to quit.
1. Smelling like smoke
There's no mistaking the smell of cigarette smoke, and it's not one many people describe favorably.
Steven Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of
California at San Francisco, says that smokers are commonly self-conscious about the smell of smoke on
their clothes and in their hair. And the smell of their breath is one of particular sensitivity to most smokers.
"Some of the media campaigns have compared kissing a smoker to licking an ashtray," Schroeder says.
Enough said.
2. Sense of smell and taste
Smelling like an ashtray isn't the only impact smoking has on the nose. Smokers also experience a dulling
of their senses; smell and taste in particular take a hit when you smoke.
Smokers can't appreciate the taste of many foods as intensely as they did before smoking, but it's really
the loss of the sense of smell that diminishes the ability to taste, notes Andrew Spielman, DMD, PhD,
associate dean for academic affairs and professor of basic science and craniofacial biology at the NYU
School of Dentistry. Breathing in the hot fumes of cigarette smoke is toxic to the senses.

Some smokers realize that foods don't taste the way they used to, but the process can be quite gradual,
making it difficult to detect. Quitting brings a swift return of the senses.
"I can't tell you how many smokers who have successfully quit come back to the clinic and say eating is a
totally different experience," says Michael Fiore, MD, MPH, founder and director of the University of
Wisconsin Center for Tobacco Research and Intervention. "The pleasure of eating is dramatically
enhanced when smokers quit. And it happens within a few days but can continue for up to three to six
months."
3. Premature aging
"One of the chief and significant causes of premature aging of the face is smoking," Fiore says. Skin
changes, like leathery skin and deep wrinkling, are more likely in people who are regular smokers.
According to the American Academy of Dermatology, smoking leads to biochemical changes in the body
that speed the aging process. For example, smoking deprives the living skin tissue of oxygen by causing
constriction of the blood vessels. As a result, blood doesn't get to your organs as easily, and that includes
the skin.
Another classic smoker giveaway is tar staining of the hands and skin from holding cigarettes. "Burning
cigarette smoke is most apparent around the face and I think that what we sometimes see is staining of
the skin from the tars and other deadly toxins in tobacco smoke," Fiore says.
Fiore also points out that the muscle actions required to inhale lead to the classic smoker's wrinkles
around the mouth.
4. Social pressures
Schroeder cites a study published in The New England Journal of Medicine in 2008, which looked at the
dynamics of smoking in large social networks as a part of the Framingham Heart Study. The study, which
took place during the period between 1971 and 2003, examined smoking behavior and the extent to
which groups of widely connected people have an affect on quitting. One of the findings was that smokers
have increasingly moved to the fringes of social networks. "Smokers have become marginalized,"
Schroeder says.
Joyce Wilde, a small business owner and former smoker in Pittsburgh, remembers feeling marginalized
when she smoked heavily. "Smoking really messed with my self-concept," Wilde tells WebMD. "I usually
hid somewhere and smoked so no one would see me. The experience of smoking embarrassed me and I
felt weakened by it, both physically and emotionally."

The reasons for the increasing unpopularity of smoking and diminished social standing of those who
continue to light up likely has roots in our increased understanding of the health implications of smoking,
not just for the smoker, but for those breathing in secondhand smoke as well.
"The reason for [clean indoor air] ordinances is to protect the healthy nonsmoker from the known danger
of toxins of secondhand smoke," Fiore says. "It's not just the inconvenience of it makes my clothes smell
bad when I go to get a drink, it's that risk from the carcinogens and side stream smoke, some of which are
at higher concentrations than direct smoke."
5. Finding a mate
Anyone who has perused the dating advertisements in papers, magazines or online, has seen more than
his or her fair share of the phrase, "No smokers, please."
Long after quitting smoking on a daily basis, Wilde found herself once again reaching for cigarettes during
the stressful time of her divorce. She was a decade older than when she last smoked and at the time,
living in Southern California where she felt the competition in the singles market was stiff. Smoking, she
says, only added to the challenge of finding a new mate after her marriage ended.
"After I crossed 40, the dating scene became harder because my peers were looking at people much
younger, so if you add smoking into that, it's even harder," Wilde says.
That's not surprising to Fiore. "There is a general sense that I'd rather be with someone who did not smell
like a dirty ashtray," he says.
6. Impotence
If smoking generally adds a hurdle to finding a new partner, impotence sure doesn't help. Yet smoking
increases the chances of impotence dramatically for men by affecting blood vessels, including those that
must dilate in order for an erection to occur.
"It's been said in the scientific literature that one of the most powerful messages to teenage boys is that
not only does it make you smell like an ashtray and no one wants to kiss a smoker, but it can cause
impotence or impact your erections. It's a message that is frequently used to motivate adolescent boys to
step away from cigarettes," Fiore says.

7. Increased infections
You may know about the long-term health risks associated with smoking, but did you realize that smoking
also makes you more susceptible to seasonal flus and colds? "People don't realize how much more
frequently smokers get viral, bacterial and other infections," Fiore says.
Tiny hairs called cilia that line the respiratory tract, including the trachea and bronchial tubes, are
designed to protect us from infection. "Cilia are constantly waving in a way that grabs bacteria and viruses
that get into the trachea and pushes them up and out so we cough them out and swallow them and
destroy them with our stomach acids," Fiore explains.
One of the toxic effects of cigarette smoke is that it paralyzes the cilia, thereby destroying this core
protective mechanism. That's why smokers have so many more infections. Within a month of quitting,
however, your cilia start performing their protective role once again.
8. You're a danger to others
Secondhand smoke is estimated to cause 50,000 deaths every year. It's no wonder: More than 4,500
separate chemicals are found in a puff of tobacco smoke, and more than 40 of those are known
carcinogens.
"It takes very little secondhand smoke to trigger a heart attack or stroke in someone who is predisposed
to that condition," Schroeder says. The ingredients in smoke cause platelets, the material in our blood that
helps it clot, become sticky. This increases the risk of heart attacks.
"There have been a number of studies to show that when a community goes smoke-free the proportion of
heart attacks seen at the hospitals goes down by 20% or 30%," Schroeder says.

9. Impact on physical activity

Many smokers report a diminished ability over time to comfortably do things as simple as climbing a set of
stairs or enjoying sports activities they once easily took part in such as volleyball or jogging.
According to Schroeder, even young athletes in otherwise top physical condition don't perform as well if
they smoke because over time, smoking causes the lungs and heart to work harder.

10. Cost
If you're a smoker, it's no surprise that smoking is downright expensive. The price of a pack of cigarettes
varies greatly by location, but Fiore says the average cost is about $5 per pack, and in some states it can
be as high as $10 per pack, including federal and state taxes.
"Who today has [that kind of money] that they can put aside this way?" Fiore asks. "If you're in a place
where it costs $7 for a pack [of cigarettes], you're approaching $3,000 a year. That's putting aside the fact
that the average smoker has three extra sick days a year, is 8% less productive, and has $1,600 in extra
health care costs per year," he says. "The annual economic costs [of smoking] are over $200 billion
nationally."
PREVENTING SMOKING

Did you know that the average age that people take up smoking in New Zealand is 14.6 years?
If we can prevent young people from taking up smoking they will not get addicted, suffer the effects of
smoking, and won't have to go through the quitting process. Nearly three-quarters (72%) of 15 to 19-yearold smokers say they wish they'd never started to smoke.
The Reducing Smoking Initiation Framework 2005 provides an outline of why young people start smoking,
a guide to how our work can be more effective, and interventions that work.
The literature review for this document can be found here.
HOW DO WE PREVENT PEOPLE FROM SMOKING?
There are a range of complex factors involved in why young people take up smoking. These include:

family smoking
access to tobacco products
tobacco promotion
peer bonding
perceptions of friends' smoking
parental rules, cessation, and comments
social norms
smokefree environments
school factors
connectedness - family, school, community.

No one factor is responsible by itself, but a combination of factors are involved. This is why multicomponent projects are often talked about, as they try to address more than one factor. They are also
shown to work better i.e, have more positive outcomes. From the above list you can see how projects
aimed at reducing second-hand smoke exposure and quitting might also have an impact on young people
taking up smoking.
The Ottawa Charter is useful to use when thinking about prevention strategies. Another tool is
the Spectrum of Prevention.
Smoking may well be the norm within the communities you are working with and needs to be challenged.
The ability to gain knowledge of those communities, how they work, and who key people are is a real
strength of local providers.

WHAT YOU CAN DO

Create smokefree places where kids are. This helps denormalise smoking and normalise
smokefree.

Make submissions when you can. This helps influence policy development e.g. Mori Affairs
Select Committee Inquiry, Proposal to Ban Tobacco Displays.

Inform your local smokefree enforcement agency if you know of any retailers selling tobacco to
minors or if you think what they are doing could be 'wrong'.

Advocate for the removal of tobacco displays. Research shows that the more that young people
are exposed to tobacco displays the more likely they are to smoke.

Promote and support quitting, especially among parents and caregivers.

Promote smokefree cars and homes.

Decrease access to tobacco by young people. e.g. making parents aware of where they leave
their tobacco in the house.

Support parents to deliver anti-tobacco messages to kids.

Connect with other providers and organisations.

Support the community to be involved with smokefree/auahi kore

Teen smoking: 10 ways to keep teens smoke-free

Want to prevent teen smoking? Understand why teens smoke and how to talk to your teen about
cigarettes.By Mayo Clinic Staff
Teen smoking might begin innocently, but it can become a long-term problem. In fact, most adult smokers
begin smoking as teenagers. Your best bet? Help your teen avoid taking that first puff. Follow these tips to
help prevent teen smoking.
1. Set a good example
Teen smoking is more common among teens whose parents smoke. If you don't smoke, keep it up. If you
do smoke, quit now. The earlier you stop smoking, the less likely your teen is to become a smoker. Ask
your doctor about ways to stop smoking.
In the meantime, don't smoke in the house, in the car or in front of your teen, and don't leave cigarettes
where your teen might find them. Explain to your teen how unhappy you are with your smoking, how
difficult it is to quit and that you'll keep trying until you stop smoking for good.

2. Understand the attraction

Teen smoking can be a form of rebellion or a way to fit in with a particular group of friends. Some teens
begin smoking to control their weight. Others smoke to feel cool or independent.
Ask your teen how he or she feels about smoking and if any of your teen's friends smoke. Applaud your
teen's good choices, and talk about the consequences of bad choices. You might also talk with your teen
about how tobacco companies try to influence ideas about smoking such as through advertisements or
product placement in the movies that create the perception that smoking is glamorous and more prevalent
than it really is.
3. Say no to teen smoking
You might feel as if your teen doesn't hear a word you say, but say it anyway. Tell your teen that smoking
isn't allowed. Your disapproval will have more impact than you think. Teens whose parents set the firmest
smoking restrictions tend to smoke less than do teens whose parents don't set smoking limits. The same
goes for teens who feel close to their parents.
4. Appeal to your teen's vanity
Smoking isn't glamorous. Remind your teen that smoking is dirty and smelly. Smoking gives you bad
breath and wrinkles. Smoking makes your clothes and hair smell, and it turns your teeth yellow. Smoking
can leave you with a chronic cough and less energy for sports and other enjoyable activities.
5. Do the math
Smoking is expensive. Help your teen calculate the weekly, monthly or yearly cost of smoking a pack a
day. You might compare the cost of smoking with that of electronic devices, clothes or other teen
essentials.
6. Expect peer pressure
Friends who smoke can be convincing, but you can give your teen the tools he or she needs to refuse
cigarettes. Rehearse how to handle tough social situations. It might be as simple as saying, "No thanks, I
don't smoke." The more your teen practices this basic refusal, the more likely he or she will say no at the
moment of truth.

7. Take addiction seriously

Most teens believe occasional smoking won't cause them to become addicted and that, if they become
regular smokers, they can stop smoking anytime they want. Teens, however, can become addicted with
intermittent and relatively low levels of smoking. Remind your teen that most adult smokers start as teens.
Once you're hooked, it's tough to quit.
8. Predict the future
Teens tend to assume that bad things happen only to other people. Most teens think cancer, heart attacks
and strokes occur only in the abstract. Use loved ones, friends, neighbors or celebrities who've been ill as
real-life examples.
9. Think beyond cigarettes
Smokeless tobacco, clove cigarettes (kreteks) and candy-flavored cigarettes (bidis) are sometimes
mistaken as less harmful or addictive than are traditional cigarettes. Teens also often think that water pipe
(hookah) smoking is safe. Nothing could be further from the truth. Kreteks, bidis and hookahs all carry
health risks. Don't let your teen be fooled.
10. Get involved
Take an active stance against teen smoking. Participate in local and school-sponsored smoking
prevention campaigns. Support efforts to make public places smoke-free and increase taxes on tobacco
products. Your actions can help reduce the odds that your teen will become a smoker.
If your teen has already started smoking, avoid threats and ultimatums. Instead, find out why your teen is
smoking and discuss ways to help your teen quit. Avoiding or stopping smoking is one of the best
things your teen can do for a lifetime of good health.

Avoiding the Most Common Smoking Triggers

Susan Pike
NYS Smokers Quitline
A piece of quit-smoking advice I offered in the Top Tips To Quit Smoking post at the end of last year was
to identify the triggers, or those people, places, things or situations that may entice you to smoke. Now

that youve identified your personal triggers, what steps can you take to mitigate their influence? Here are
some ways to help control some of the most common smoking triggers.
Alcohol
Drinking alcohol often triggers the urge to smoke, especially during parties and situations when you are
around other smokers. Try staying inside with the nonsmokers when the smokers go out to smoke. Also
pace your alcohol consumption if you find the more you drink, the harder it is to resist lighting up. By
having a nonalcoholic beverage after each alcoholic one, you will drink less and not have as many
cigarette urges.
Stress
Dealing with stress can be a trigger to smoke. There are many different ways you can alleviate stress
without lighting up. Try exercising, even a quick 15-minute walk to clear your mind. Learning relaxation
techniques such as deep breathing or meditation may also help dealing with stress. Find a stress-reliever
that works for you.
Driving
Many smokers smoke while driving. There are a couple of ways to help alleviate this trigger. You might
want to have some sugar-free hard candy in the car, or carry a toothpick in the hand that you would have
otherwise held the cigarette. Try playing some music while you are driving. Listening to something you
enjoy and that engages your mind will help take your thoughts away from cigarettes.
Coffee
Drinking coffee often triggers the urge to smoke. Because these two go hand-in-hand for many smokers,
it may seem very difficult to do one without the other. You may not have to give up your love for coffee just
yet. One thing that may help is making sure you are not sitting in the same seat or the same room where
you used to sit when you were smoking, or try having your coffee on the go instead of sitting and drinking
it. Also try holding the cup in the hand that used to hold the cigarette.
Boredom
During the quitting process it is very important to keep busy and distract yourself during the first couple of
days. Keep a to-do list at hand and start crossing things off the list rather than looking for a cigarette

Smoking Prevention Strategies for Urban and Minority Youth

Smoking is declining among many teenagers,but one-third of high schoolers still use tobacco. This article
explores the risks of smoking and campaigns to prevent it.
ERIC Clearinghouse on Urban Education
by Wendy Schwartz
Overall, the number of adolescents who smoke and use smokeless tobacco is decreasing, and the
decrease is sharpest among minority youth. Still, about one-third of high school students use tobacco
products. Adolescents living in disadvantaged urban areas suffer from many of the stresses shown to
increase tobacco use. In addition to experiencing the health problems associated with tobacco use, young
smokers are at greater risk for trying alcohol and other drugs (Kaufman, Jason, Sawlski, & Halpert,
1994; Preventing, 1994; Trends, 1995).
The decline in the number of adolescent smokers is largely the result of intensive multi-pronged antitobacco campaigns. These strategies have been most effective with white, middle-class adolescents, the
result of the failure to create campaigns convincing to the African American, Latino, and urban youth who
still might be inclined to smoke (Cella, Tulsky, Sarafian, Thomas, & Thomas, 1992). New Federal
regulations governing cigarette sales and advertising to youth are being phased in, and they are expected
to steepen the decline in youth tobacco use. Currently, urban areas are the site of many new prevention
strategies targeted to special populations. This digest provides an overview of these initiatives.
Risk Factors for Youth Smoking: Personal
Adolescents smoke for many of the same reasons that they use alcohol and other drugs. Urban
community disorganization, crime, violence, poverty, and inadequate schools can lead to a variety of
problems for youth, smoking included. Personal factors that put youth at risk for smoking addiction include
the following (Gardner, Green, & Marcus, 1994; Preventing, 1994; Lerner, 1997):

Inadequate life skills; victimization; emotional and psychological problems; and lack of selfcontrol, assertiveness, and peer refusal skills.

Lack of school involvement, academic failure, and dropping out.

Antisocial conduct, such as gang participation; rejection of commonly held values; and
association with others who exert a negative influence.

Premature pregnancy and parenthood.

Family homelessness, poverty, stress, lack of cohesion and supervision, conflict, and violence.

Parental and sibling use of cigarettes, alcohol, and other drugs; and inadequate disapproval of
substance use.

Tobacco Company Advertising

Tobacco companies assert publicly that minors should not smoke. However, to offset the overall decline in
smoking, companies have stepped up their efforts to "influence kids who are 14" and at a susceptible time
in their lives, as acknowledged by one advertising executive. Advertisements feature young, attractive,
and successful people, and companies sponsor youth sporting and rock music events (Preventing,
1994; Carol, 1988). African Americans are specially targeted, with black magazines receiving
disproportionately more revenues from cigarette advertising than other consumer magazines. Billboards

advertising tobacco products are seen four to five times more frequently in communities of color than in
white areas (African Americans, 1992).
Federal regulations will ban tobacco marketing targeted to youth by mid-1998, but general tobacco
campaigns will still reach adolescents, particularly in communities of color where advertising is heaviest.
Effective Anti-Smoking Education
Several essential components of tobacco prevention education have been identified. They cover the
following points (Carol, 1988; Flynn et al., 1992;California, 1993; Lerner, 1997):
Smoking is not personally or socially desirable. Dispel the myths that tobacco is functional for stress
reduction, weight maintenance, and social enhancement. Point out that the places where smoking is
acceptable are decreasing. Many adolescents, unwilling to risk the health hazards from second-hand
smoke, do not want to be near smokers.
Smoking takes away a smoker's free choice. Since adolescents especially desire autonomy over all areas
of their lives, demonstrate how tobacco addiction takes away free will, particularly the ability to stop
smoking.
Smoking is not an adult habit or an effective act of rebellion. Point out that only 27 percent of adults
smoke-evidence that smoking is not a prevalent sign of maturity. Adolescents who want to rebel against
those seeking to control them should resist the lure of tobacco companies and their advertising agencies,
not non-smoking adults.
Smoking destroys good health. Show the probable physical effects of smoking in full detail.
Most teenagers do not smoke and it is okay to refuse to smoke. Point out that fewer than 20 percent of
teenagers smoke regularly, and in California only 5 percent do so. Youth who begin to smoke because
their peers do are really succumbing to perceived pressures from a minority. Help teenagers develop
"refusal skills" to give them the courage to refuse to engage in behaviors they may not choose.
Anti-Smoking Policies, Programs, and Practices
An anti-tobacco education is best presented through a variety of strategies. Ideally, it begins early in
children's lives, because on average youth smoke their first cigarette at age 13 (Lerner, 1997).
Anti-smoking initiatives that are created by, or at least involve, youth are most effective. These are a few
examples of programs that have captured urban youth's attention (Cella et al., 1992; Gardner et al.,
1994; Rainwater & De Caprio, 1994;Beales, 1997):

The American Lung Association's anti-smoking, parent participation curriculum, with a

multicultural video.

The Detroit Urban League's "Male Responsibility: Lifepower" program, a rites of passage program
for African American youth.

California's "Richmond Quits Smoking Project," a rap video using multicultural models that
teaches refusal skills.

The "take back the community" project, an action to whitewash billboards with cigarette ads in
Harlem, New York.

The Boston Young Latinas Substance Abuse Prevention Project, which helps girls age 10-14
develop good health habits and positive social skills.

California's Project Able, which provides information about smoking and other dangers through
short plays written in street language and performed for high-risk youth.

As the Federal restrictions on the sale and marketing of tobacco to youth are being phased in, similar-and
even more stringent-steps to deter youth can be taken locally. Initiatives include the following (Flynn et al.,
1992; California, 1993;Rainwater & De Caprio, 1994; Gardner et al., 1994; Preventing, 1994; Kaufman et
al., 1994):
School

Designate schools as smoke-free places, and prevent the nearby sale and use of cigarettes.

Infuse an anti-tobacco message into many courses, not just health education.

Create, publicize, and uniformly enforce clear rules regarding student substance use.

Provide intensive staff training in anti-smoking education.

Community

Develop an anti-tobacco advertising campaign and request free print placement and air time. Use
models and premises that appeal to youth and reflect their cultures.

Incorporate anti-tobacco education into all youth programs.

Incorporate anti-smoking strategies to use with children into all types of parent programs.

Provide anti-smoking education along with other services in adolescent clinics.

Provide addiction recovery services to adolescent smokers.

Prevent the sale of cigarettes to youth and the display of tobacco promotions.

Develop leaders and promote community bonding, cultural pride, and bicultural competence by
youth.

Family

Establish homes as smoke-free places. Do not smoke, if possible, or at least provide an antismoking education.

Provide children with good supervision and support.

Remind older children that they are role models for younger family members, and that many
youth begin to smoke because their older siblings do.

Take a parenting skills course to learn how to provide an anti-smoking and refusal skills education
at home.

Conclusion
Although tobacco use by adolescents has been decreasing, there is some evidence that youth are getting
caught up in the current cigar-smoking fad, created by celebrities and fueled by positive media stories. In
addition, smoking promotions are prevalent on the Internet. Thus, anti-smoking initiatives must be
maintained, updated, and perhaps even intensified. The most effective interventions for urban youth
provide an anti-tobacco education continuously and consistently from grade school to high school
graduation.

Role of the physician in smoking prevention

OBJECTIVES
The objectives of this statement are:

to review the scope of the problem of smoking among children and youth;

to review the factors that cause children and youth to start smoking; and

to examine the role of the physician in the prevention of smoking among children and youth.
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SCOPE OF THE PROBLEM

Smoking has been called the chief, single, avoidable cause of death in our society and the most
important public health issue of our time (1). According to Health Canada (2), as many as 45,000 deaths
annually are attributable to tobacco use. Direct health care costs related to tobacco use were

approximately $3 billion in 1993. The death rate from lung cancer is increasing more quickly than rates for
any other type of cancer among Canadian women. Between 1960 and 1987, 765,000 Canadians died of
smoking-related illnesses.
Although the smoking rate declined during the 1970s and the 1980s, it stabilized in the mid-1990s.
Smoking actually increased among some population groups, including youth, women, Aboriginals and low
income earners. The 1994 Survey on Smoking in Canada (Cycle 1) (3) showed a smoking rate of 31% for
those aged 15 years and older, and 27% among youths aged 15 to 19 years. While the overall smoking
rate did not change from 1991 to 1994, smoking among youth aged 15 to 19 years increased from 23% in
1991 to 27% in 1994 (3). Results from Cycle 2 of the Survey on Smoking in Canada (3) have confirmed
this trend.
Over the past two decades, the average age at which youths start to smoke has dropped from 16 years to
12 years. Data from the National Clearinghouse on Tobacco and Health show that by age 12 years, half
of Canadas schoolchildren experiment with tobacco (4). In a recent survey among Nova Scotia
adolescents (5), the rate of cigarette smoking increased by about 34% from 1991 to 1996. Hamburg et al
(6) and Kandel (7) showed that smoking can be associated with the consumption of beer, wine, hard
liquor, and cannabis and other illicit drugs. During the 12 months before the 1996 Nova Scotia survey (5)
was conducted, as many as one-fifth of the students surveyed reported not only using tobacco but also
using alcohol and cannabis; 27.1% of the students had experienced at least one alcohol-related problem
and 6% had experienced at least one drug-related problem (5).
There is a well known association between maternal smoking during pregnancy and low birth weight (8).
Maternal smoking has been associated with successive preterm deliveries (9). Children of mothers who
smoked during pregnancy have been shown to be at an increased risk of asthma and impaired lung
function in the first decade of life (10), an increased risk of atopic dermatitis and exacerbation of
respiratory allergies, increased hospitalization rates for respiratory problems, and an increased risk of
middle ear disease in preschool children (11). Sudden infant death syndrome was shown to be associated
with parental smoking (12).
The use of smokeless tobacco is also rising. In Quebec, the consumption rate of smokeless tobacco is
1%, and it is quite popular among Aboriginals. Using smokeless tobacco causes oral leucoplastic lesions,
as well as gingivitis and periodontitis. Nicotine and other chemical products from tobacco are absorbed in
blood at rates similar to that of cigarette smoking.
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FACTORS THAT INFLUENCE SMOKING AMONG CHILDREN AND YOUTH

Environmental factors
The influence of parental cigarette use and attitudes begins early in a childs life (13,14). The child learns
that cigarette smoking is acceptable and that it is a way to deal with stress or boredom.
Peer influence is the most potent proximal causal factor for the onset of smoking (13,14) because it helps
to create a social environment where smoking is acceptable.
Mass media contribute to the acceptance of a smoking environment by portraying smokers as attractive,
outgoing, popular and sexy. Some children and youth see athletes who chew tobacco, and movie stars
and musicians who smoke as attractive role models. Although cigarettes are not advertised on television
in Canada, viewers are still exposed to cigarette company logos on billboards and banners in televised
sports events. Print advertising campaigns also contribute to a pervasive acceptance of cigarettes (15).
Policy interventions, such as increases in cigarette excise taxes, have been shown to reduce youth
tobacco consumption at least as much as adult consumption (16).
Personality factors
Knowledge, attitudes and beliefs: It has been shown that adolescents who smoke are less knowledgeable
about the negative consequences of smoking, and hold more favourable attitudes and beliefs toward
smoking than nonsmoking adolescents (14,15). The type of smoking that is perceived as being harmful to
a youths health seems to be unrelated to his or her own smoking habits. Some adolescents with attention
deficit/hyperactivity disorder see smoking as a form of self-treatment. Others are swayed by the
misguided belief that smoking helps to lose weight (17).
Transition-prone, unconventional or problem-prone personality characteristics:Smoking can be a way to
express personality traits such as wanting to act more mature or more grown-up, being tough or cool,
rebelliousness or having sensation-seeking tendencies (18,19).
Behavioural factors
Smoking can be a manifestation of a behaviour that departs from the norm. Children who display
antisocial behaviour at a young age have been shown to be the adolescents who are at risk for problem
behaviour, including cigarette smoking (6).
High risk situations
Situations that place children and youth at high risk for smoking consist of having parents and siblings
who smoke and have positive attitudes toward smoking; peer pressure and a high degree of involvement
in social activities; positive attitudes toward smoking; and negative attitudes toward school.

Go to:
THE PHYSICIANS ROLE IN PREVENTING SMOKING AMONG CHILDREN AND YOUTH
The physician is generally perceived by children and youth as being a highly credible source of
information and is, therefore, in an advantageous position to help prevent smoking. The Canadian Task
Force on the Periodic Health Examination (in its 1985 update on the periodic health examination [20] and
in the Canadian Guide to Clinical Preventive Health Care [21]) and the United States Guide to Clinical
Preventive Services(22) assign clinical intervention in tobacco use an A rating, meaning that the
intervention is supported by first-class or the highest level of evidence. Smoking prevention and cessation
efforts are also recommended as a part of routine preventive care for youth (23,24).
In the United States, the National Cancer Institute Prevention and Cessation Division (25) has developed
a curriculum for smoking prevention and cessation that is based on four As: Ask, Advise, Assist and
Arrange. A fifth A, Anticipate, has been added to this statement for paediatric practice. The
recommendations listed below (and summarized in Table 1) vary according to the age of the targeted
population, and have been assigned evidence ratings according to the Clinical Practice Guideline of the
Agency for Health Care Policy and Research on Smoking Cessation (26).
Clinical interventions of the physician to prevent smoking among children and youth
Early childhood (birth to five years)
Early childhood is the time to target parents and other adults about information on smoking prevention
and cessation. See Table 2 for secondary effects of passive smoking.
Secondary effects of passive smoking on children
Anticipate

Ask about the smoking habits of parents and other caregivers (Evidence A).

Provide advice to those exposed to smoke or family members who smoke (Evidence A).

Identify families with adult smokers (Evidence B).

Inquire about all possible sources of smoke exposure, including child care settings and cars

Ask

(Evidence A).

Advise

Focus on a parents own health risk and the health effects of passive smoke (Evidence C).

Discuss the importance of parents as role models for the smoking habits that their children
develop later in life (Evidence C).

Assist

Provide smoking cessation advice and information about second-hand smoking issues (Evidence
A) (Table 2).

Provide self-help materials to all parents who smoke and who would like to stop (Evidence B).

Arrange

Arrange and/or initiate prescribing pharmacological cessation aids (Table 3) (27) to parents who
want to quit smoking (Evidence A).

During follow-up visits, ask and monitor the progress of parents and others who attempted to quit
but may still be smoking (Evidence C).

School-aged children (ages five to 12 years)

The ages five to 12 years are considered to be the time of social inoculation (28). Further research is
needed in this age group about effective smoking prevention and cessation strategies. As a result, all
activities described below, except one, are assigned a C rating at the present time.
Anticipate

Emphasize to children the adverse health effects of tobacco, including cigarette use, using snuff
and chewing tobacco.

Include children in discussions about smoking and tobacco use, when possible.

Inform parents that the peak age for the onset of smoking and use of smokeless tobacco is 11 to
13 years.

Ask

Use a questionnaire in the waiting room to inquire about smoking and attitudes toward smoking.
Sample questions may include the following:

Do you think it is harmful to try smoking?

Will you smoke when youre an adult?

Have you tried smoking?

Do you smoke?

Do you know anyone who smokes? What do you think about that?

Is smoking discussed in school? If yes, during which class?

Advise

Focus on the following short term effects of smoking.

Cigarettes smell bad.

Cigarettes stain teeth, clothes and fingers.

Cigarettes decrease athletic performance.

Nicotine is addictive.

Advise children who have or are experimenting with smoking to stop.

Praise children who have not yet smoked, and advise them to be prepared to refuse offers to
smoke.

Emphasize the responsibility of parents to serve as role models, and counsel parents about the
effects of passive smoke and how smoking is portrayed as being socially acceptable through
advertising or smoking-related play (eg, candy cigarettes).

Assist

Praise and reinforce the healthy behaviours of children at lower risk for becoming tobacco users
and those who have never experimented with tobacco.

Point out the false portrayals of glamour, sex and athletic prowess in tobacco advertising.

Help children to develop specific refusal skills, learning to say no while maintaining their selfesteem with peers.

Encourage participation in programs that promote the development of skills to solve problems, set
goals, make decisions and counter negative peer pressure.

Give assistance in smoking cessation to parents who smoke (Evidence A).

Arrange

Identify children at high risk for smoking based on their attitudes, behaviours, or lack of motivation
or confidence in their ability to resist.

Plan more intensive follow-up and reinforcement of antismoking messages for those children.

Monitor the progress of parents who try to quit smoking.

Adolescents and young adults (ages 13 to 20 years)

Adolescence is the time for prevention and cessation as short term goals (28). A variety of approaches
should be used together, from the brief intervention at the office visit to school programs and interventions
in community group settings (29). In a recent study of 101 adolescent smokers, nicotine patch therapy
combined with brief individual counselling was not effective (30). Further research on the effectiveness of
prevention and smoking strategies is needed in this age group, and, therefore, the activities described
below are currently assigned a C rating.
Anticipate

Discuss smoking experimentation and behaviours with youth in a confidential setting.

Offer advice to parents about the importance of stating clear expectations and the effect that their
own behaviour has in role modelling.

Adolescent females are vulnerable to unrealistic portrayals of the female body and to cigarette
advertisements that imply that smoking keeps weight down.

Ask

Ask about attitudes or beliefs about smoking in a confidential manner and include specific
questions about smokeless tobacco.

Ask about the smoking habits of parents, friends and siblings.

Ask whether parents purchase or give cigarettes to their children.

Ask about knowledge of or participation in smoking prevention programs in the school or

community.

Ask about participation in sports or extracurricular activities where tobacco use may compromise
performance.

Advise

Emphasize the immediate and short term effects of smoking and smokeless tobacco on health
and athletic performance.

Discuss the short term benefits of not smoking.

Review several tobacco advertisements with adolescents and point out that the advertisements
falsely glamourize tobacco use.

Offer a cessation plan to all adolescents who smoke.

Praise adolescents who do not smoke.

Assist

Encourage activities that are incompatible with tobacco use.

Counsel nonsmoking adolescents or those who experiment with smoking to enhance their skills
to counter peer pressure, and help them to say no.

For youth who are motivated to quit smoking, give self-help materials, set a quit date, help them
enlist social support and strengthen their coping responses.

For youth who are not motivated to quit smoking, talk about knowledge and changes in attitude.

Arrange

Schedule a follow-up visit one to two weeks after the quit date and another visit six to eight weeks
later to discuss progress and problems.

Encourage another attempt for those who were unable to quit.

Help identify high-risk relapse situations and how to avoid them.

STRUCTURING THE OFFICE ENVIRONMENT

Physicians offices should have a nonsmoking policy for staff, adolescents and parents. No smoking
signs should be posted in the waiting room. Magazines with tobacco advertisements should be removed
because explicitly countering tobacco advertising helps sensitize parents and their families to the
insidious nature of these messages. Nurses and other office staff can be involved in counselling smokers.
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ADVOCACY FOR SCHOOL HEALTH EDUCATION
Physicians should actively promote school-based tobacco prevention programs, either as a separate
program or as part of a comprehensive health education curriculum. According to Epps et al (31), a
minimum of five sessions per year for at least two years is necessary for sustained results. Generally,
programs are given from grade 6 to grade 9. Content should include information about the social
influences of tobacco, the short and long term effects, and training in refusal skills based on social
inoculation that help youth rehearse cigarette refusal skills through role play.
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POLICY ADVOCACY
There are many opportunities to influence governing bodies in policy decisions. Physicians should
become active in supporting initiatives to encourage antismoking legislation, such as:

banning smoking in and around schools;

banning all cigarette advertising, including all passive advertising (eg, banners, logos) during
sponsored sports events and other events;

enforcing existing regulations involving the sale of tobacco to minors;

supporting existing bans on cigarette vending machines and self-service displays;

limiting the number of outlets where tobacco products can be purchased; and

enforcement of financial disincentives.

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SUMMARY AND RECOMMENDATIONS

Tobacco use is a major public health problem that begins during childhood and adolescence.

More girls than ever are smoking, and they are quite vulnerable to the subtle messages in
cigarette advertising.

Smoking is a child health problem that physicians need to address, beginning in the prenatal
period and continuing through adulthood.

In daily clinical practice, physicians intervention should include: anticipatory guidance; asking
about knowledge, behaviour and attitudes; providing advice; assisting with efforts to quit smoking;
and arranging follow-up visits.

Parents should be encouraged to stop smoking, and to create and maintain a nonsmoking
environment at home for their child.

Children should receive messages that emphasize the negative health effects of smoking.

Adolescents should be encouraged to remain nonsmokers in an environment where there is

social pressure to smoke.

Physicians should actively promote school-based prevention programs and be actively involved in
policy interventions related to smoking.

Youth Smoking Prevention

Smoking is a pleasure that entails risks. Therefore, we strongly believe that smoking is only for informed
adults who are aware of these risks.
We fully support laws and regulations prohibiting the sale of tobacco products to anyone under the legal minimum
age. We also believe that enforcement and penalties for breaking such laws must be tough enough to discourage
anybody from selling to minors.
We also know how important it is that our marketing practices are aligned with efforts to combat underage smoking.
That is why we abide by British American Tobaccos strict International Marketing Standards, which are globally
consistent and demonstrate our commitment to marketing appropriately and only to informed adult tobacco
consumers.
British American Tobacco Caribbean & Central America (BATCCA) works with retailers - a group of key importance in
the battle against underage smoking - in order to contribute towards youth smoking prevention.
However, in a few countries, with the support of interested parties, we are also involved in educational and
advertising-based efforts to help discourage youth smoking.

Our approach
Our Youth Smoking Prevention campaign (YSP) has two main objectives: to prevent underage access to tobacco
products, and to discourage smoking among this sector of the population. Our efforts are centred around three basic
approaches:

Retail access prevention These programmes aim to block sales to the under age at the point of sale. They
include proof-of-age schemes and retailer motivation on the importance of not selling cigarettes to minors.

Activities outside the point-of-sale Our markets also implement awareness campaigns for the general
population, as well as educational campaigns directed at parents.

Stakeholder engagement We seek the support of stakeholders such as business associations, national
and local governments, and non-governmental organisations, among others, to work together towards the
prevention of underage smoking.

Our activities
The companys policy is NOT to market its products to minors. Therefore, as of 2002, BATCCA has implemented
different campaigns at regional level, directed at retailers, to prevent underage cigarette sales.
The initiative is the companys specific response to the concerns of different sectors of society, and its purpose is to
create awareness among retailers and consumers about the need to prevent underage smoking and adhere to
legislation prohibiting tobacco sales to adolescents. We believe that youth smoking prevention is the responsibility of
society as a whole, including the tobacco industry.
Nonetheless, it is important to highlight that underage smoking is a complex problem and there is no simple solution.
However, by taking advantage of the experience and knowledge of all interested parties, including government,
retailers, parents, teachers and youth themselves, we hope YSP programmes are accepted and successful.

Previous campaigns
Adolescents DONT smoke campaign
British American Tobacco Central America, as part of the tobacco industry, sponsored this Youth Smoking Prevention
campaign that was made up of shorts aired on Central Americas main TV channels and cinema chains.
This campaign involved adolescents who through their own behaviour and using simple language shared by their
peers created awareness on the fact that success in life does not depend on smoking. The campaign slogan was:
"They enjoy life, they hang out with friends of the same age, they're like many other adolescents, and they don't
smoke."
The audiovisual messages depicted age-appropriate behaviours and entertainment, such as sports, music, and
fashion; this was done to avoid the patronizing tone commonly rejected by adolescents.
I dont sell cigarettes to minors campaign
In 2005, with the slogan I dont sell cigarettes to minors, the Central American tobacco industry, led by British
American Tobacco Caribbean & Central America (BATCCA), joined efforts with other stakeholders to plan and
implement this underage tobacco sales campaign, with active retailer participation as well as the participation of
some government institutions.
The initiative, clearly in line with the concerns of different sectors of society, intended to create retailer and consumer
awareness about the need to prevent underage smoking and adhere to legislation prohibiting the sale of tobacco
products to this sector of the population.
BATCCA believes that youth smoking prevention is the responsibility of society as a whole, including the tobacco
industry. We have always said that cigarettes, because of the risks they entail, are for informed adult consumers only.
In this manner, with trade support, we are able to reinforce awareness among parents, teachers, and health
authorities, among other stakeholders.
The campaign used visually appealing and easy-to-understand printed materials placed visibly in commercial outlets.
Simulating a traffic sign, they made a clear reference to the law in each Central American country prohibiting cigarette
sales to minors, and placing special emphasis on the fact that this is the responsibility of society as a whole. It is
worth highlighting that our sales representatives were in charge of campaign material placement prior outlet
authorisation.
Im responsible campaign
In 2008, BATCCA together with all the British American Tobacco Group companies in America launched the Im
responsible campaign. The purpose of this initiative was to create awareness among retailers and society with the
hope to discourage underage cigarette consumption through product access restrictions.
The campaign was supported by renowned groups and associations and was implemented in more than 124,000
points-of-sale in the Caribbean and Central America.
The campaign began by creating awareness among the companys sales force on their key role in communicating
with retailers and the importance of preventing underage smoking. The campaign used different communication
pieces to call upon the responsibility of retailers, consumers, and parents in the prevention underage smoking. Letter
and brochures were distributed among retailers.

What are we doing today?

British American Tobacco is currently implementing a new global youth smoking prevention campaign. Its aim is to
stress that tobacco products must be marketed responsibly and that retailers must NOT sell tobacco products to
anyone under 18.
The point-of-sale is where consumers purchase tobacco products. Therefore, BATCCA is focusing its greatest efforts
here in order to prevent underage access to these products. At the beginning of 2010, the company began changing
the communications material in more than 124,000 points-of-sale in Central America and the Caribbean.

How to Quit Smoking

A Guide to Kicking the Habit for Good

Whether youre a teen smoker or a lifetime packaday smoker, quitting can be tough. But the
more you learn about your options and prepare for quitting, the easier the process will be. With
the right game plan tailored to your needs, you can break the addiction, manage your cravings,
and join the millions of people who have kicked the habit for good.

Why quitting smoking can seem so hard

Smoking tobacco is both a physical addiction and a psychological habit. The nicotine from
cigarettes provides a temporary, and addictive, high. Eliminating that regular fix of nicotine will
cause your body to experience physical withdrawal symptoms and cravings. Because of
nicotines feel good effect on the brain, you may also have become accustomed to smoking as
a way of coping with stress, depression, anxiety, or even boredom.
At the same time, the act of smoking is ingrained as a daily ritual. It may be an automatic
response for you to smoke a cigarette with your morning coffee, while taking a break from work
or school, or during your commute home at the end of a long day. Perhaps friends, family
members, and colleagues smoke, and it has become part of the way you relate with them.
To successfully quit smoking, youll need to address both the addiction and the habits and
routines that go along with it.

Your personal stop smoking plan

While some smokers successfully quit by going cold turkey, most people do better with a plan to
keep themselves on track. A good plan addresses both the shortterm challenge of quitting
smoking and the longterm challenge of preventing relapse. It should also be tailored to your
specific needs and smoking habits.
Questions to ask yourself

Take the time to think of what kind of smoker you are, which moments of your life call for a
cigarette, and why. This will help you to identify which tips, techniques or therapies may be most
beneficial for you.

Do you feel the need to smoke at every meal?

Are you more of a social smoker?

Is it a very bad addiction (more than a pack a day)? Or would a simple

nicotine patch do the job?

Do you reach for cigarettes when you're feeling stressed or down?

Are there certain activities, places, or people you associate with smoking?

Is your cigarette smoking linked to other addictions, such as alcohol or

gambling?

Are you open to hypnotherapy and/or acupuncture?

Are you someone who is open to talking about your addiction with a therapist
or counselor?

Are you interested in getting into a fitness program?

Start your stop smoking plan with START

S = Set a quit date.
Choose a date within the next 2 weeks, so you have enough time to prepare without losing your motivation to quit. If you mainly
smoke at work, quit on the weekend, so you have a few days to adjust to the change.
T = Tell family, friends, and co-workers that you plan to quit.
Let your friends and family in on your plan to quit smoking and tell them you need their support and encouragement to stop.
Look for a quit buddy who wants to stop smoking as well. You can help each other get through the rough times.
A = Anticipate and plan for the challenges you'll face while quitting.
Most people who begin smoking again do so within the first 3 months. You can help yourself make it through by preparing ahead
for common challenges, such as nicotine withdrawal and cigarette cravings.

R = Remove cigarettes and other tobacco products from your home, car, and work.
Throw away all of your cigarettes (no emergency pack!), lighters, ashtrays, and matches. Wash your clothes and freshen up
anything that smells like smoke. Shampoo your car, clean your drapes and carpet, and steam your furniture.
T = Talk to your doctor about getting help to quit.
Your doctor can prescribe medication to help with withdrawal and suggest other alternatives. If you can't see a doctor, you can get
many products over the counter at your local pharmacy or grocery store, including the nicotine patch, nicotine lozenges, and
nicotine gum.

How to quit smoking: Identify your smoking triggers

One of the best things you can do to help yourself quit is to identify the things that make you
want to smoke, including specific situations, activities, feelings, and people.
Keep a craving journal

A craving journal can help you zero in on your patterns and triggers. For a week or so leading up
to your quit date, keep a log of your smoking. Note the moments in each day when you crave a
cigarette:

What time was it?

How intense was the craving (on a scale of 1-10)?

What were you doing?

Who were you with?

How were you feeling?

How did you feel after smoking?

Do you smoke to relieve unpleasant or overwhelming feelings?

Managing unpleasant feelings such as stress, depression, loneliness, fear, and anxiety are some of
the most common reasons why adults smoke. When you have a bad day, it can seem like
cigarettes are your only friend. As much comfort as cigarettes provide, though, it's important to
remember that there are healthier (and more effective) ways to keep unpleasant feelings in check.
These may include exercising, meditating, using sensory relaxation strategies, and practicing
simple breathing exercises.
For many people, an important aspect of quitting smoking is to find alternate ways to handle these difficult
feelings without smoking. Even when cigarettes are no longer a part of your life, the painful and
unpleasant feelings that may have prompted you to smoke in the past will still remain. So, it's

worth spending some time thinking about the different ways you intend to deal with stressful
situations and the daily irritations that would normally have you reaching for a cigarette.
Tips for avoiding common smoking triggers

Alcohol.

Other smokers.

End of a meal.

Many people have a habit of smoking when they drink. TIP: switch to
non-alcoholic drinks or drink only in places where smoking inside is
prohibited. Alternatively, try snacking on nuts and chips, or chewing on a
straw or cocktail stick.
When friends, family, and co-workers smoke around you, it is
doubly difficult to quit or avoid relapse. TIP: Your social circles need to know
that you are changing your habits so talk about your decision to quit. Let
them know they won't be able to smoke when you're in the car with them or
taking a coffee break together. In your workplace, don't take all your coffee
breaks with smokers only, do something else instead, or find non-smokers to
have your breaks with.
For some smokers, ending a meal means lighting up, and the
prospect of giving that up may appear daunting. TIP: replace that moment
after a meal with something such as a piece of fruit, a (healthy) dessert, a
square of chocolate, or a stick of gum.

How to quit smoking: Coping with nicotine withdrawal symptoms

Once you stop smoking, you will experience a number of physical symptoms as your body
withdraws from nicotine. Nicotine withdrawal begins quickly, usually starting within thirty
minutes to an hour of the last cigarette and peaking about 2 to 3 days later. Withdrawal
symptoms can last for a few days to several weeks and differ from person to person.
Common nicotine withdrawal symptoms include:

Cigarette cravings

Insomnia

Irritability, frustration, or anger

Tremors

Anxiety or nervousness

Increased coughing

Difficulty concentrating

Fatigue

Restlessness

Constipation or upset stomach

Increased appetite

Depression

Headaches

Decreased heart rate

Unpleasant as these withdrawal symptoms may be, they are only temporary. They will get better
in a few weeks as the toxins are flushed from your body. In the meantime, let your friends and
family know that you won't be your usual self and ask for their understanding.
Coping with Nicotine Withdrawal Symptoms
Symptom
Craving for cigarette

Duration
Relief
Most intense during first week but can linger Wait out the urge; distract yourself; take a brisk
for months
walk.

Irritability, impatience

Two to four weeks

Exercise; take hot baths; use relaxation techniques;

avoid caffeine.

Insomnia

Two to four weeks

Avoid caffeine after 6 p.m.; use relaxation

techniques; exercise; plan activities (such as
reading) when sleep is difficult.

Fatigue

Two to four weeks

Take naps; do not push yourself.

Lack of concentration

A few weeks

Reduce workload; avoid stress.

Hunger

Several weeks or longer

Drink water or low-calorie drinks; eat low-calorie

snacks.

Coughing, dry throat, nasal drip Several weeks

Drink plenty of fluids; use cough drops.

Constipation, gas

Drink plenty of fluids; add fiber to diet; exercise.

One to two weeks

Adapted with permission from Overcoming Addiction: Paths Toward Recovery, a

special health report from Harvard Health Publications.

How to quit smoking: Manage cigarette cravings

Avoiding smoking triggers will help reduce the urge to smoke, but you can't avoid cravings
entirely. But cigarette cravings don't last long, so if you're tempted to light up, remember that the
craving will pass and try to wait it out. It also helps to be prepared in advance. Having a plan to
cope with cravings will help keep you from giving in.
Do the dishes, turn on the TV, take a shower, or call a friend.
The activity doesn't matter as long as it gets your mind off of smoking.

Distract yourself.

Remind yourself why you quit.

Focus on your reasons for quitting, including the

health benefits, improved appearance, money you're saving, and enhanced
self-esteem.

Where you are or what you're doing may be

triggering the craving. If so, a change of scenery can make all the difference.

Get out of a tempting situation.

Reward yourself.

Reinforce your victories. Whenever you triumph over a

craving, give yourself a reward to keep yourself motivated.
Coping with Cigarette Cravings in the Moment

Find an oral

Keep other things around to pop in your mouth when cravings hit. Good

substitute

choices include mints, hard candy, carrot or celery sticks, gum, and sunflower
seeds.

Keep your

Read a book or magazine, listen to some music you love, do a crossword or

mind busy

Sudoku puzzle, or play an online game.

Keep your

Squeeze balls, pencils, or paper clips are good substitutes to satisfy that need

hands busy

for tactile stimulation.

Brush your

The just-brushed, clean feeling can help get rid of cigarette cravings.

teeth

Drink water

Slowly drink a large, cold glass of water. Not only will it help the craving pass,
but staying hydrated helps minimize the symptoms of nicotine withdrawal.

Light

Instead of lighting a cigarette, light a candle or some incense.

something else

Get active

Go for a walk, do some jumping jacks or pushups, try some yoga stretches, or
run around the block.

Try to relax

Do something that calms you down, such as taking a warm bath, meditating,
reading a book, or practicing deep breathing exercises.

Preventing weight gain after youve stopped smoking

Weight gain is a common concern when quitting smoking. Some people even use it as a reason
not to quit. While it's true that many smokers put on weight within six months of stopping
smoking, the gain is usually smallabout 5 pounds on averageand that initial gain decreases

over time. Its also important to remember that carrying a few extra pounds for a few months
wont hurt your heart as much as smoking will. Of course, gaining weight is NOT inevitable
when you quit smoking.
Smoking acts as an appetite suppressant. It also dampens your sense of smell and taste. So after
you quit, your appetite will likely increase and food will seem more appealing. Weight gain can
also happen if you replace the oral gratification of smoking with eating, especially if you turn to
unhealthy comfort foods. So it's important to find other, healthy ways to deal with stress and
other unpleasant feelings rather than mindless, emotional eating.
Instead of turning to cigarettes or food when you feel
stressed, anxious, or depressed, learn new ways to soothe yourself.

Nurture yourself.

Eat healthy, varied meals.

Drink lots of water.

Take a walk.

Snack on low-calorie or calorie-free foods.

Eat plenty of fruits and vegetables and limit your fat

intake. Seek out low-fat options that look appetizing to you and you will
actually eat. Avoid alcohol, sugary sodas, and other high-calorie drinks.
Drinking lots of waterat least six to eight 8 oz. glasses
will help you feel full and keep you from eating when you're not hungry. Water
will also help flush toxins from your body.
Walking is a great form of exercise. Not only will it help you burn
calories and keep the weight off, but it will also help alleviate feelings of
stress and frustration that accompany smoking withdrawal.
Good choices include sugar-free gum,
carrot and celery sticks, sliced bell peppers or jicama, or sugar-free hard
candies.

Medication and therapy to help you quit smoking

There are many different methods that have successfully helped people to quit smoking,
including:

Quitting smoking cold turkey.

Systematically decreasing the number of cigarettes you smoke.

Reducing your intake of nicotine gradually over time.

Using nicotine replacement therapy or non-nicotine medications to reduce

withdrawal symptoms.

Utilizing nicotine support groups.

Trying hypnosis, acupuncture, or counseling using cognitive behavioral

techniques.

You may be successful with the first method you try. More likely, youll have to try a number of
different methods or a combination of treatments to find the ones that work best for you.
Medications to help you stop smoking

Smoking cessation medications can ease withdrawal symptoms and reduce cravings, and are
most effective when used as part of a comprehensive stop smoking program monitored by your
physician. Talk to your doctor about your options and whether an anti-smoking medication is
right for you. U.S. Food and Drug Administration (FDA) approved options are:
Nicotine replacement therapy involves "replacing" cigarettes with other
nicotine substitutes, such as nicotine gum or a nicotine patch. It works by delivering small and
steady doses of nicotine into the body to relieve some of the withdrawal symptoms without the
tars and poisonous gases found in cigarettes. This type of treatment helps smokers focus on
breaking their psychological addiction and makes it easier to concentrate on learning new
behaviors and coping skills.
Non-nicotine medication. These medications help you stop smoking by reducing cravings and
withdrawal symptoms without the use of nicotine. Medications such as bupropion (Zyban) and
varenicline (Chantix) are intended for short-term use only.
Nicotine replacement therapy.

Alternative therapies to help you stop smoking

There are several things you can do to stop smoking that dont involve nicotine replacement
therapy or prescription medications: Ask your doctor for a referral or see Resources and
References below for help finding qualified professionals in each area.
A popular option that has produced good results. Forget anything
you may have seen from stage hypnotists, hypnosis works by getting you into
a deeply relaxed state where you are open to suggestions that strengthen
your resolve to quit smoking and increase your negative feelings toward
cigarettes.

Hypnosis

Acupuncture

Behavioral Therapy

One of the oldest known medical techniques, acupuncture is

believed to work by triggering the release of endorphins (natural pain
relievers) that allow the body to relax. As a smoking cessation aid,
acupuncture can be helpful in managing smoking withdrawal symptoms.
Nicotine addiction is related to the habitual behaviors
(the rituals) involved in smoking. Behavior therapy focuses on learning new
coping skills and breaking those habits.

Self-help books and websites can provide a number of

ways to motivate yourself to quit smoking. One well known example is
calculating the monetary savings. Some people have been able to find the
motivation to quit just by calculating how much money they will save. It may
be enough to pay for a summer vacation.
Motivational Therapies