attachment 6a

National Cancer Institute

Q U I T S M O K I N G

T O D AY

U.S. DEPARTMENT
OF HEALTH AND
HUMAN SERVICES
National Institutes
of Health

Table of Contents

Introduction...........................................................................................1

Before you START a Smoke-Free Life ...............................................2

Quitting.is.Hard......................................................................................2

Preparing.to.Quit.....................................................................................3

Now Let’s START................................................................................12

Set.a.Quit.Date......................................................................................12.

Tell.your.Family,.Friends,.and.Coworkers.You.Plan.to.Quit...................13

Anticipate.and.Plan.for.the.Challenges.You.Will..

....Face.While.Quitting...........................................................................14

Remove.Cigarettes.and.Other.Tobacco.Products.from..

....Your.Home,.Car,.and.Workplace........................................................16

Talk.to.Your.Doctor.about.Getting.Help.to.Quit...................................17

My.Quitting.Worksheet.........................................................................19

Today’s the Big Day – Your Quit Date. .............................................21

Keep.Busy.and.Find.New.Things.to.Do.................................................21

Stay.Away.From.What.Tempts.You.........................................................23

Plan.to.Reward.Yourself..........................................................................25

Quitting for Good – You Can Do It!...................................................27

Keep.Your.Guard.Up..............................................................................27

Don’t.Get.Discouraged.if.You.Slip..........................................................28

Stay.Upbeat............................................................................................29

Focus.on.a.New,.Healthier.Lifestyle........................................................30

Remember the Long-Term Rewards. ...............................................32

For More Information.........................................................................34

National.Cancer.Institute.......................................................................34

American.Cancer.Society........................................................................35

American.Heart.Association...................................................................35

American.Legacy.Foundation.................................................................35

American.Lung.Association....................................................................36

Centers.for.Disease.Control.and.Prevention...........................................36





Introduction

From those of us at the National Cancer Institute:
Congratulations! You are taking the first step to
quitting cigarette smoking.
We wrote this booklet with the help of ex-smokers
and experts. It can help you prepare to quit and
support you in the days and weeks after you quit.
It also describes problems to expect when you
quit. Being prepared can help you through the
hard times.
Many tips are offered in this booklet—choose
what works best for you. You can quit for good,
even if you’ve tried before. In fact, most smokers
try to quit many times before they succeed.
Stay upbeat. Keep trying. Use what you learn each
step of the way until you quit for good. Soon, you
too will be an ex-smoker.

The National Cancer Institute (NCI) is part of the National Institutes of
Health, one of  agencies in the U.S. Department of Health and Human
Services. NCI is the U.S. Government’s principal agency for cancer research
and training.



Before you

S

TART a Smoke-Free Life

Quitting is hard

Many.ex-smokers.say.quitting.was.the.hardest.thing.they.ever.did..
Do.you.feel.hooked?.You’re.probably.addicted.to.nicotine..Nicotine.is.in.
all.tobacco.products..It.makes.you.feel.calm.and.satisfied,.yet.also.alert.
and.focused..But.the.more.you.smoke,.the.more.nicotine.you.need.to..
feel.good..Soon,.you.don’t.feel.“normal”.without.nicotine..This.is..
nicotine.addiction.
It.takes.time.to.break.free.from.nicotine.addiction..It.may.take.more..
than.one.try.to.quit.for.good..So.don’t.give.up.too.soon..You.will.feel.
good.again..
Quitting.is.also.hard.because.smoking.is.a.big.part.of.your.life..You.may.
enjoy.holding.a.cigarette.and.puffing.on.it..You.may.smoke.when.you.
are.stressed,.bored,.or.angry..You.may.light.up.when.you.drink.coffee.or.
alcohol,.talk.on.the.phone,.drive,.or.are.with.other.smokers..After.months.
and.years,.smoking.has.become.part.of.your.daily.routine..You.may.light.
up.without.even.thinking.about.it..
Quitting.isn’t.easy..Just.reading.this.booklet.won’t.do.it..You.may.try.to.
quit.several.times.before.you’re.finally.done.with.cigarettes..But.you.will.
learn.something.each.time.you.try..It.takes.willpower.and.strength.to.beat.
your.addiction.to.nicotine..Remember.that.millions.of.people.have.quit.
smoking.for.good..You.can.be.one.of.them..
Just.thinking.about.quitting.may.make.you.anxious..But.your.chances.
will.be.better.if.you.get.ready.first..Quitting.works.best.when.you’re..
prepared..



KEEP IN MIND

Preparing to quit
Think about why you want to quit
Decide.for.sure.that.you.want.to.quit,.and.then..
promise.yourself.you’ll.do.it..It’s.okay.to.have.mixed.
feelings..Don’t.let.that.stop.you..There.will.be.times.
every.day.that.you.don’t.feel.like.quitting..You.will..
have.to.stick.with.it.anyway..Find.reasons.that.are.
important.to.you..
Think.of.health.reasons,.such.as:
◆

My.body.will.start.healing.right.away.

◆

I.will.have.more.energy.and.focus.

◆

I.will.feel.more.physically.fit..

◆

I.will.have.whiter.teeth.and.healthier.gums.

◆

I.will.cough.less.and.breathe.easier..

◆

◆

◆

I.will.lower.my.risk.of.cancer,.heart.attack,.stroke,.
emphysema,.chronic.bronchitis,.and.cataracts..
I.will.reduce.the.risk.of.fertility.problems,..
premature.births,.and.lower.birthweight.babies..
I.will.no.longer.expose.my.family.and.friends.to..
secondhand.smoke..

Your body gets more
than nicotine when
you smoke.
Cigarette smoke
contains more than
4,000 chemicals. Some
of these chemicals are
also found in wood
varnish, the
insecticide DDT,
rat poison, and nail
polish remover.
The ashes, tar, gases,
and other poisons—
such as arsenic—in
cigarettes harm your
body over time. They
damage your heart
and lungs. They also
make it harder for
you to taste and smell
things and to fight
infection.
Source: U.S. Department of
Health and Human Services.
Reducing Tobacco Use:
A Report of the Surgeon
General. Atlanta, GA: U.S.
Department of Health and
Human Services, Centers
for Disease Control and
Prevention, National
Center for Chronic Disease
Prevention and Health
Promotion, Office on
Smoking and Health, 000.



KEEP IN MIND
Even a little secondhand smoke is dangerous.
Secondhand smoke—also called environmental tobacco
smoke—comes from a burning tobacco product and from the
smoke exhaled by smokers. Inhaling secondhand smoke is
called involuntary or passive smoking.
Nonsmokers who breathe secondhand smoke may:
◆

develop cancer or heart disease

◆

have breathing problems

◆

get colds and the flu more easily

◆

die younger than people who don’t breathe
secondhand smoke

Pregnant women who breathe secondhand smoke may:
◆
◆

give birth to low-weight babies
have babies who are more likely to die of sudden infant
death syndrome (SIDS)

Children who breathe secondhand smoke may:
◆

have breathing problems, such as asthma

◆

get more ear infections

◆

develop more lung infections, such as pneumonia

Source: U.S. Department of Health and Human Services. The Health
Consequences of Involuntary Exposure to Tobacco Smoke: A Report of
the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, Coordinating Center
for Health Promotion, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health, 006.

4

Think.of.some.other.reasons.to.quit,.such.as:
◆
◆

◆

I.will.be.proud.of.myself.
I.will.make.my.family,.friends,.and.coworkers..
proud.of.me.
I.will.be.a.better.role.model.for.others,.especially..
my.kids.

◆

I.will.feel.more.in.control.of.my.life.

◆

I.will.have.more.money.to.spend..

◆

I.will.save.time.by.not.taking.cigarette.breaks,..
buying.cigarettes,.or.searching.for.a.light..

Write down why you want to quit
Write.down.all.the.reasons.you.want.to.quit...
Keep.your.list.where.you’ll.see.it.often..Good.places..
for.your.list.are:
◆

where.you.keep.your.cigarettes

◆

in.your.wallet.or.purse.

◆

in.your.kitchen.

◆

in.your.car

When.you.reach.for.a.cigarette,.find.your.list.of..
reasons.for.quitting..It.will.remind.you.why..
you.want.to.stop..
My reasons to quit are

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________


KEEP IN MIND
Pregnancy and smoking are not a good mix.
If you are pregnant or thinking about having a baby, there’s
no better time to quit smoking than now. Women who smoke
have a harder time getting pregnant. If they do get pregnant,
they risk losing the baby or having a stillborn baby. And
babies born to mothers who smoke:
◆
◆

may be smaller than normal at birth
are more likely to die of sudden infant death
syndrome (SIDS)

◆

may be cranky, restless, and get sick more often

◆

are more likely to have learning problems as they develop

The good news is that quitting can help you have a healthy
baby. It helps to quit any time during your pregnancy,
but it’s even better to quit before you become pregnant.
Information to help you stop smoking is available in English
and Spanish at www.smokefree.gov/resources.html.
Source: U.S. Department of Health and Human Services. Women and
Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion,
Office on Smoking and Health, 00.

6

Learn how much you depend on nicotine
Knowing.how.addicted.you.are.to.nicotine.can.help.
you.quit..It.can.help.you.decide.if.you.need.extra..
support,.such.as.joining.a.quit-smoking.program.or.
taking.medication.to.help.you.quit..
Answer.the.six.simple.questions.in.this.nicotine..
addiction.test..Your.score.will.help.you.figure.out..
how.much.you.depend.on.nicotine..

Nicotine Addiction Test

. .....
. How soon after you wake up do you
smoke your first cigarette?

. Do you smoke more frequently in the
hours after waking than during the
rest of the day?
. Do you find it difficult not to smoke?
4. Which cigarettes would you most
hate to give up?
. How many cigarettes do you
smoke a day?

6. Do you smoke when you’re so sick
that you’re home in bed?

..
Less than
 minutes
6–0 minutes
–60 minutes
After  hour
Yes
No
Yes
No
The first one in
the morning
Any other
0 or less

Points Your
Points



0

0

0

0
0

–0

–0

 or more

Yes

No
0
Your Score

Understand what your score means
If.you.scored.even.a.single.point,.you.may.be.dependent..
on.nicotine..The.higher.your.score,.the.more.dependent..
you.are..Remember—no.matter.what.your.score,.you’ll..
have.to.work.hard.to.quit....
Source: Heatherton, TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The
Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom
Tolerance Questionnaire. British Journal of Addictions. 99; 86:9–7.

7

Understand what makes you want to smoke
Wanting.to.smoke.is.not.just.an.unhealthy.habit...
You.want.to.smoke.because.your.body.now.relies.on.
nicotine..When.the.amount.of.nicotine.in.your.body.
runs.low,.it.triggers.a.craving—a.strong,.almost..
uncontrollable.urge—for.another.cigarette..You.may.
feel.jittery,.short-tempered,.or.anxious.when.you.
haven’t.smoked..Your.body.wants.nicotine.
Triggers—people,.places,.activities,.and.feelings.you..
associate.with.smoking—also.make.you.want.to.
smoke..Your.triggers.might.be.hearing.the.sounds.of..
a.party,.finishing.a.task,.or.smelling.coffee..Whatever.
your.triggers,.they.can.make.you.crave.a.cigarette..

Know your triggers
If.you.know.your.triggers,.you.have.a.head.start.on.
avoiding.situations.that.tempt.you.to.smoke..
Think.about.what.might.tempt.you.to.smoke..Put.a.
check.next.to.the.triggers.on.page.9.that.apply.to.you..
Many.smokers.find.that.all.these.triggers.make.them.
want.to.smoke..You.may.only.check.a.few..The.point.is.
to.recognize.all.the.situations.that.trigger.your.craving.
for.a.cigarette..

8

❑ Waking.in.the.morning

❑ Driving.my.car

❑ Drinking.coffee,.tea,.or..
alcohol

❑ Being.a.passenger

❑ Smelling.a.cigarette

❑ After.having.sex

❑ Being.with.other.smokers
❑ Seeing.someone.smoke
❑ Taking.a.break
❑ Talking.on.the.phone
❑ Checking.email
❑ Surfing.the.Internet
❑ Watching.TV

❑ After.eating
❑ After.completing.a.task
❑ Feeling.stressed
❑ Feeling.lonely.or.depressed
❑ Being.or.feeling.less.tolerant
❑ Feeling.bored
❑ Feeling.angry,.irritable,..
or.impatient

Meet your triggers head on
You.can.get.prepared.to.quit.smoking.by.thinking.of.ways.to.avoid.some.
triggers.and.creating.alternatives.for.others..You’ll.find.that.the.urge.to.
smoke.only.lasts.a.few.minutes..Even.if.it.lasts.longer,.it.will.go.away,.
whether.or.not.you.smoke..Fighting.the.urge.to.smoke.is.easier.if.you:
◆

take.a.deep.breath

◆

keep.your.hands.busy—write,.doodle,.or.hold.a.coin.or.pencil

◆

◆

put.something.else.in.your.mouth,.such.as.a.toothpick,..
sugar-free.lollipop,.or.celery.stick
go.places.where.smoking.isn’t.allowed,.such.as.a.library.or..
nonsmoking.restaurant.

◆

hang.out.with.people.who.don’t.smoke

◆

avoid.or.reduce.alcoholic.drinks;.try.to.drink.water.or.juice.instead

I will deal with my triggers by

____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
9

Know your options for quitting smoking
Quitting.is.hard..Success.partly.depends.on.how.much.you.depend.on.
nicotine..With.many.quit.methods.to.choose.from,.be.aware.that.no.
single.approach.works.best.for.everyone..And.you.may.need.to.try.more.
than.one.method.before.you.quit.for.good.
Some.quit.methods.require.a.doctor’s.prescription..While.others.do.not,.
it’s.always.a.good.idea.to.discuss.your.plan.to.quit.smoking.with.your.
doctor..Check.the.box.of.the.options.you.want.to.talk.about.with..
your.doctor.

❑ Cold turkey

For.some.smokers,.“going.cold.turkey”.seems.like.the.easiest.way.to.quit:.
Just.stop.smoking.and.tell.yourself.you’ll.never.light.up.again..This..
works.for.some.smokers—usually.those.with.the.lowest.level.of.nicotine..
dependence—but.not.many..Fewer.than.5.percent.of.smokers.can..
quit.this.way..Most.people.aren’t.prepared.when.smoking.habits.and..
withdrawal.symptoms.trigger.an.intense.urge.to.smoke..Research.shows.
that.most.smokers.have.more.success.with.one.of.the.assisted.quit..
methods.discussed.below..These.methods.have.been.tested.and.all.of..
them.are.included.in.the.U.S..Public.Health.Service.guidelines.for..
treating.tobacco.use.and.dependence.

❑ Over-the-counter medications

You.don’t.need.a.prescription.to.buy.certain.medications.that.can..
improve.your.success.with.quitting..Nicotine.replacement.therapy.(NRT)..
products—lozenges,.gum,.or.a.patch—provide.nicotine.to.help.reduce.
your.craving.for.nicotine.and.withdrawal.symptoms,.if.any..This.allows.
you.to.focus.on.changing.the.behavior.and.habits.that.trigger.your.urge.to.
smoke..To.read.more.about.NRT,.see.page.18.
0

KEEP IN MIND

❑ Prescription medications

Your.doctor.can.prescribe.medications.to.help.you.quit.
smoking..Some—inhalers.and.nasal.sprays—act.much.
like.nonprescription.nicotine.replacement.therapy...
Other.medications.do.not.contain.nicotine.and.work.
in.different.ways.to.help.reduce.your.urge.to.smoke..To.
read.more.about.prescription.medications,.see.page.18.

❑ Counseling and group support

Many.smokers.quit.with.support.provided.by.individual.
counseling.or.group.treatment..You.can.combine..
these.therapies.with.over-the-counter.or.prescription.
medications..Counseling.can.help.you.identify.and..
overcome.situations.that.trigger.the.urge.to.smoke...
Research.shows.that.success.rates.for.all.quit.methods.
are.higher.when.they.are.combined.with.a.support..
program.that.provides.encouragement.through.regularly.
scheduled.one-on-one.or.group.meetings,.or.quitlines..

❑ Quitlines

Quitlines.are.free,.telephone-based.counseling.programs.
that.are.available.nationwide..When.you.call.a.quitline,.
you.are.teamed.with.a.trained.counselor.who.can.help.
you.develop.a.strategy.for.quitting.or.help.you.stay.
on.the.program.you.have.chosen..The.counselor.often.
provides.material.that.can.improve.your.chances.of.
quitting..You.can.call.the.National.Cancer.Institute’s.
Smoking.Quitline.at.1–877–44U–Quit.(1–877–448–
7848).or.the.National.Quitline.at.1–800–QUITNOW.
(1–800–784–8669)..These.are.national.quitlines.that.
can.help.you.anywhere.in.the.United.States..

Not everyone has
feelings of withdrawal,
but many smokers do.
You may experience
one or many
symptoms of
withdrawal and they
may last for different
periods of time.
Common feelings of
smoking withdrawal
include:
◆

◆

◆

◆

◆

◆

feeling down, blue,
or depressed
feeling anxious,
nervous, or
restless
having trouble
thinking clearly
being unable
to sleep
feeling tired or
run down
feeling hungry or
gaining weight



S

Now Let’s

TART

START

et a quit date

Finding.a.time.to.quit.isn’t.easy..Any.time.can.be.a.good.
time.to.quit.when.you.are.ready.to.try..Some.smokers.
like.to.pick.a.day.that.is.meaningful.to.them,.such.as:

KEEP IN MIND
Some smokers find
it difficult to quit at
certain times—
after a bad day or
personal loss,
during a crisis, or
at a stressful time,
such as a divorce.
Examine how you
view such times in
your life. Can you
afford to wait before
setting your quit
date?

◆

a.birthday.or.wedding.anniversary

◆

the.first.day.of.vacation

◆

New.Year’s.Day.(January.1)

◆

Independence.Day.(July.4)

◆

World.No.Tobacco.Day.(May.31)

◆

The.Great.American.Smokeout..
(the.third.Thursday.of.each.November)

It.doesn’t.have.to.be.a.special.day.to.quit..For.many.
people,.today.is.the.day..You.can.choose.any.day.to.be.
your.quit.day..When.you.are.ready.to.take.the.first.step.
toward.quitting,.take.it..
START: Five important steps toward quitting for good

S Set a quit date
T Tell family, friends, and coworkers you plan to quit
A Anticipate and plan for the challenges you will
face while quitting

My quit date is.

.______________


R

Remove cigarettes and other tobacco products
from your home, car, and workplace

T

Talk to your doctor about getting help to quit

S

TART

ell your family, friends, and coworkers you plan to quit

Quitting.smoking.is.easier.with.the.support.of.others..
Tell.your.family,.friends,.and.coworkers.you.plan.to.
quit.and.how.they.can.help.you..
Some.people.like.to.have.others.ask.them.how.things.
are.going,.while.some.find.it.annoying..Tell.the.people.
you.care.about.exactly.how.they.can.help.you..Here.
are.some.ideas:
◆

◆

◆

◆

Ask.everyone.to.understand.if.you.have.a.change.in.
mood;.assure.them.it.won’t.last.long.
Ask.smokers.who.are.close.to.you.to.quit.with.you.
or.at.least.not.smoke.around.you..

__________________

__________________

__________________

Tell.yourself.and.others:.“The.longer.I.go.without.
cigarettes,.the.sooner.I’ll.feel.better.”

__________________

Tell.yourself.and.others:.“The.worst.withdrawal.
symptoms.from.smoking—irritability.and.trouble.
sleeping—may.be.over.within.2.weeks.”

__________________

In.addition.to.the.support.of.family,.friends,.and..
coworkers,.you.can.get.support.if.you:
talk.one-on-one.or.in.a.group.with.others..
who.are.quitting
◆ text-message.experts.on.LiveHelp.at..
www.smokefree.gov..
◆ call.the.National.Cancer.Institute.Quitline.at.
1–877–44U–QUIT.(1–877–448–7848).
◆ contact.the.National.Quitline.at..
1–800–QUITNOW.(1–800–784–8669)
◆

The family, friends,
and coworkers
I want to tell are

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________

__________________


ART

ST

nticipate and plan for the challenges
you will face while quitting

Expecting.challenges.is.an.important.part.of.getting.ready.to.quit...
Quitting.presents.both.short-.and.long-term.challenges..You.may.need..
different.strategies.for.handling.each..

Short-term challenges
Most.people.who.have.a.hard.time.quitting.and.resume.smoking.do.so.in.
the.first.3.months.after.trying.to.quit..Difficulty.quitting.is.often.caused.by.
withdrawal.symptoms—the.physical.discomfort.smokers.feel.when.they..
give.up.nicotine..It.is.your.body’s.way.of.telling.you.it.is.learning.to.be..
nicotine-free..These.feelings.will.go.away.in.time..

Long-term challenges
Even.as.your.physical.withdrawal.is.decreasing,.you.may.still.be.tempted.
to.smoke.when.you.feel.stressed.or.down..Although.it’s.a.challenge.to.be.
ready.for.these.times,.knowing.that.certain.feelings.can.trigger.a.craving..
to.smoke.will.help.you.handle.the.tough.times.

Smoking journal
To.understand.your.short-.and.long-term.challenges,.start.by.examining.your.
smoking.habits..Keeping.a.smoking.journal.can.help.you.track.how.many.
cigarettes.you.smoke.a.day.and.what.you.are.doing.when.you.light.up..
Check.for.patterns.in.your.smoking..You.may.find.triggers.you.aren’t.even.
aware.of..Perhaps.cigarettes.you.smoke.at.certain.times.or.circumstances.
mean.different.things.to.you..Some.may.be.more.important.than.others..
Understanding.what.tempts.you.to.smoke.in.the.short.and.long.term.will.
help.you.control.the.urge.to.smoke.before.it.hits..
4

You.can.copy.the.journal.in.this.booklet.or.make.your.
own..Keep.your.journal.with.you.so.you.can.easily.use.
it..Be.sure.to.record.the.time.you.smoke,.where.you.
are,.what.you.are.doing,.and.what.you.are.thinking.or..
feeling..Rate.how.much.you.want.the.cigarette.each..
time.you.smoke.
Try.this.activity.for.at.least.a.few.days,.making.sure.
to.record.1.day.during.the.week.and.1.day.on.the.
weekend..You.may.even.find.that.the.time.you.take.to.
complete.the.journal.helps.you.smoke.less..

0

None



Just a little



Some



A lot

My Smoking Journal
Cigarette Time Craving
Number of Day Level

Activity

Who I Was
With

Mood

Example

At work

Alone

Stressed

0:4






4

6
7
8
9
0



4

6
7
8
9
.

0



STA

RT

emove cigarettes and other tobacco products
from your home, car, and workplace
Getting.rid.of.things.that.remind.you.of.smoking.also.
will.help.you.get.ready.to.quit..You.should:
◆

KEEP IN MIND
All forms of tobacco
are harmful.
Tobacco products
and delivery methods
come in many forms.
However tobacco
is packaged or
delivered, it causes
disease and
addiction. Light or
low-tar cigarettes
are just as harmful as
regular cigarettes.
Clear your home, car,
and workplace of all
forms of tobacco.

◆

◆

Throw.away.all.your.tobacco.supplies.(cigarettes,.
lighters,.matches,.and.ashtrays)..Don’t.forget.to.
check.your.drawers,.coats,.and.bags..
Make.things.clean.and.fresh.in.your.home.and..
car.and.at.work;.for.instance,.clean.your.drapes,..
carpets,.and.clothes..
Have.your.teeth.cleaned.and.remove.those..
nicotine.stains.

Don’t.save.the.“just.in.case”.pack.of.cigarettes!..
Saving.one.pack.just.makes.it.easier.to.start..
smoking.again..
I can remove reminders of smoking by

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

6

T

STAR

alk to your doctor about getting
help to quit

It.is.important.to.tell.your.doctor.when.you.are.ready.
to.quit—especially.if.you.are.pregnant,.thinking.of..
becoming.pregnant,.or.have.a.serious.medical..
condition..Your.doctor.can.help.you.connect.with.the.
right.resources.to.make.your.quit.attempt.successful..
Remember—quitting.“cold.turkey”.isn’t.your.only.
choice.
Make.sure.to.let.your.doctor.or.pharmacist.know..
what.medications.you.are.taking..Nicotine.changes.
how.some.drugs.work..Your.doctor.may.need.to..
adjust.some.of.your.medications.after.you.quit..
You.can.learn.more.about.medications.before.you..
see.your.doctor.from.the.summaries.below.and.the..
up-to-date.medication.guide.at www.smokefree.gov/
quit-smoking/medicationguide...

Medications to help you quit
The.Food.and.Drug.Administration.(FDA).has..
approved.nicotine.and.non-nicotine.cessation..
products.to.reduce.withdrawal.symptoms.and.the..
urge.to.smoke..Studies.show.that.these.medications,.
compared.with.trying.to.quit.without.them,.can.
double.or.triple.your.chances.of.quitting.for.good..You.
will.get.the.most.benefit.from.these.medications.when.
you.follow.the.instructions.completely..You.should.not.
use.any.product.that.has.not.been.tested.and.approved.
by.the.FDA.

7

Nicotine cessation products

KEEP IN MIND
Medications alone
can’t do all the work.
They can help with
cravings and
withdrawal, but they
won’t completely
prevent withdrawal
symptoms. Even if
you use medication
to help you stop
smoking, quitting may
still be hard at times.
Many people find
it helps to combine
medication with
behavior strategies.
For example, you
can keep healthy
snacks handy to beat
cravings, limit time
with smokers, and
enroll in a smoking
cessation program.

8

Nicotine.cessation.products—also.called.nicotine.
replacement.therapy.(NRT)—contain.small.amounts.
of.nicotine.but.not.the.hundreds.of.other.harmful.
chemicals.found.in.cigarettes..NRT.helps.you.handle.
the.physical.symptoms.of.quitting.by.providing..
nicotine.at.much.lower.levels.than.found.in.cigarettes..
This.satisfies.your.nicotine.craving.and.lessens.your.
urge.to.smoke..Over-the-counter.NRT.options..
include.a.patch,.gum,.or.lozenges.that.contain..
nicotine..Nicotine.inhalers.and.nasal.sprays.are..
available.only.by.prescription..

Non-nicotine cessation products
Some.products.that.help.withdrawal.symptoms.and.
nicotine.cravings.don’t.contain.nicotine..They.help.by.
reducing.symptoms.and.smoking.urges..A.prescription.
is.needed.for.these.medications..See.your.physician.to.
discuss.the.details.of.your.medication.plan.and.to.get.a.
prescription.

My next doctor’s appointment is
Date________________________Time_________________

My Quitting Worksheet
Review what you have done so far to prepare yourself to quit smoking
successfully.
My reasons to quit are

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
My nicotine addiction test score is _______________________________

My triggers
❑ Waking in the morning

❑ Driving my car

❑ Drinking coffee, tea, or
alcohol

❑ Being a passenger

❑ Smelling a cigarette

❑ After having sex

❑ Being with other smokers

❑ After completing a task

❑ Seeing someone smoke

❑ Feeling stressed

❑ Taking a break

❑ Feeling lonely or depressed

❑ Talking on the phone

❑ Being or feeling less tolerant

❑ Checking email

❑ Feeling bored

❑ Surfing the Internet

❑ Feeling angry, irritable,
or impatient.

❑ Watching TV

❑ After eating

I will deal with my triggers by

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
9

My Quitting Worksheet
The quit method I’m interested in
❑ Cold turkey
❑ Over-the-counter medication (gum, patch, lozenges)
❑ Prescription medication (inhaler, nasal spray)
❑ Counseling and group support
❑ Quitlines.

.

My quit date is._______________________________________________

The family, friends, and coworkers I want to tell are

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
I can remove reminders of smoking by

_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

My next doctor’s appointment is
Date____________________________Time__________________________

0

B

Today’s the

ig Day–Your Quit Date

So.today.is.the.big.day—your.quit.date..Quitting.is.not.
easy,.so.to.help.you.get.through.your.first.smoke-free.
days,.we.suggest.that.you:.
◆

keep.busy.and.find.new.things.to.do

◆

stay.away.from.what.tempts.you

◆

plan.to.reward.yourself.

Keep busy and find new things to do
Keep.busy.today,.spending.as.much.time.as.you.can.in.
nonsmoking.places..Create.some.new.habits.and.mix.
up.your.daily.routine..Today.and.the.days.ahead.will.
be.easier.if.you.avoid.things.that.remind.you.of..
smoking..Remember—it’s.harder.to.smoke.if.you.are.
keeping.yourself.busy.and.finding.new.things.to.do..
Here.are.some.examples.to.get.you.started.
Go to nonsmoking places

Be active

◆

gyms

◆

walk.or.run.

◆

libraries

◆

take.a.bike.ride

◆

malls

◆

go.for.a.swim

◆

museums

◆

shoot.hoops

◆

places.of.worship

◆

try.a.yoga.class

◆

smoke-free.restaurants.



Distract your hands
◆

hold.something—a.
tennis.ball,.pen,.or.coin

◆

squeeze.Silly.Putty®

◆

knit.or.crochet

◆

write.a.letter

Drink the right stuff
◆
◆

◆

avoid.alcoholic.drinks.
drink.a.lot.of.water.and.
low-sugar.fruit.juice
replace.coffee.or.tea.with..
a.new.healthy.beverage

Distract your mind
◆

do.a.crossword.puzzle

◆

read.a.book

◆

play.cards

Fool your mouth
◆

try.a.toothpick.or.straw

◆

eat.a.lollipop.

◆

chew.sugar-free.gum

◆

eat.carrot.or.celery.sticks

◆

brush.your.teeth.often.
and.use.mouthwash.

You.may.have.a.hard.time.concentrating.in.your.early.
days.as.a.nonsmoker..Mental.activities,.such.as.doing.
crossword.puzzles.or.even.reading.a.book.or.magazine,.
may.be.more.challenging..Recognize.that.it.may.be.
difficult.to.stay.mentally.focused.in.the.early.stages..
of.quitting..Remember—your.skill.in.these.activities.
will.return..



Stay away from what tempts you
You.now.understand.that.certain.things.trigger.your.
urge.to.smoke..Today.and.as.you’re.trying.to.quit,.
review.your.list.of.triggers..Then.think.of.how.you.can.
avoid.them..Other.helpful.tips.to.avoid.triggers.are.
noted.below.

Change your routine
Changes.in.your.routine.help.you.avoid.times.and.
places.that.trigger.the.urge.to.smoke..Do.things.and.
go.places.where.smoking.is.not.allowed..Keep.this.up.
until.you.feel.more.relaxed.and.confident.about.being.
smoke-free.
Instead of smoking…

Try…

after meals

getting up from the table, brushing and
flossing your teeth, and taking a walk.

while driving

listening to a new radio station, trying a
different route, or taking a train, carpool, or
bus, if possible.

while drinking coffee

switching to water, juice, or tea. Or, change
the time you drink your coffee.

at a party

standing with nonsmokers and keeping your
hands busy.



When you really crave a cigarette
Remember—the.urge.to.smoke.usually.lasts.only.a.few.minutes..Try.to.
wait.it.out..One.reason.it’s.important.to.get.rid.of.all.your.cigarettes.is.to.
give.yourself.the.time.you.need.for.these.cravings.to.fade..Drink.water.or.
do.something.else.until.the.urge.passes..Look.at.the.plan.you.made.when.
you.were.getting.ready.to.quit..You.wrote.down.steps.to.take.at.a.time.like.
this..Try.them!.You.also.can.use.any.of.the.tips.below.
Tips

Examples

Pick up something
other than a cigarette.

Try carrot or celery sticks, pickles, popsicles,
sunflower seeds, apples, raisins, or pretzels.

Have a list of things you
can do at a moment’s notice.

Organize your computer files, delete messages
from your cell phone, or call a friend to chat.

Take a deep breath.

Take 0 slow, deep breaths and hold the
last one. Then breathe out slowly. Relax.

Clean something.

Wash your hands or the dishes, vacuum,
or clean out your car.

Make a move.

Go outside or to a different room, or change
what you are doing or who you are with.

.
No.matter.what,.don’t.think,.“Just.one.won’t.hurt.”.It.will.hurt..It.will.
slow.your.progress.toward.your.goal.of.being.smoke-free..Remember—
trying.something.to.beat.the.urge.is.always.better.than.trying.nothing..
The.craving.will.go.away,.whether.you.smoke.a.cigarette.or.not..

4

KEEP IN MIND

Plan to reward yourself
Don’t.think.of.it.as.stopping.smoking..Think.of.it.as.
starting.a.new,.healthier.life.style..Staying.smoke-free.is.
challenging..It.takes.some.time..Be.patient..You.will..
begin.to.feel.better..Set.up.rewards.to.remind.yourself..
how.hard.you’re.working..For.example,.you.could:
◆

buy.yourself.something.special.to.celebrate.quitting.

◆

splurge.on.a.massage.or.dinner.at.a.new.restaurant

◆

see.a.movie.or.sporting.event.

◆

start.a.new.hobby

◆

begin.exercising..

You have to be
careful with food
rewards.
It’s a great idea to go
out to dinner or have
a scoop of ice cream.
Just be reasonable.
Treat yourself without
overeating. Make
sure you are really
hungry and not just
searching for a
substitute for a
cigarette craving.

My list of rewards
Make.your.own.list.of.rewards..If.they.require.a..
purchase,.figure.out.the.cost..Then.plan.for.rewards..
that.equal.the.amount.of.time.you’ve.succeeded.in.
quitting.(1.day,.1.week,.1.month,.and.so.on)..Put.aside.
cigarette.money.to.save.for.or.buy.some.of.them..You’ll.
be.amazed.at.how.fast.the.money.you.used.to.spend.on.
cigarettes.adds.up.and.how.soon.you’ll.be.able.to.buy.
your.rewards..
I would like to reward myself by

_________________________________________________________
_________________________________________________________
_________________________________________________________


Now.that.you.aren’t.buying.cigarettes,.you.probably..
have.more.spending.money..For.example,.if.you.smoke.
one.pack.a.day:*
After…
 day

…You’ve Saved
$.00

 week

$.00

 month

$0.00

 year

$,8.00

0 years

$8,0.00

0 years

$6,00.00

*Prices are based on an average of $.00 per pack of cigarettes. The cost of
a pack may differ, depending on where they are bought.

6

G

Quitting for

ood–You Can Do It!

Beating.an.addiction.to.nicotine.takes.a.lot.more.than.just.willpower.and.
determination..You.should.feel.great.about.yourself.for.making.it.this.far..
Now’s.the.time.to.focus.on.sticking.with.it..To.continue.your.success,.
make.sure.you:
◆

keep.your.guard.up

◆

don’t.get.discouraged.if.you.slip

◆

stay.upbeat

◆

focus.on.a.new,.healthier.lifestyle

Keep your guard up
Your.brain.has.learned.to.crave.nicotine..Although.you.have.quit,.the.urge.
to.smoke.often.hits.at.the.same.time.as.when.you.smoked..For.a.long.
time,.you.have.connected.certain.people,.places,.activities,.and.feelings.
with.smoking.a.cigarette..Although.you.have.quit,.triggers.such.as..
drinking.coffee.or.using.your.cell.phone.don’t.just.disappear..These..
triggers.may.cause.you.to.smoke.again.
Be.cautious.and.understand.that.most.of.the.cravings.connected.to.your.
triggers.should.disappear.within.a.few.months..But.others.may.last.longer..
That’s.why.you.should.never.take.a.puff.again,.no.matter.how.long.it’s.
been.since.you.quit.
Continue.to.review.your.smoking.journal.to.see.when.you.might.be.
tempted..Then.use.the.skills.you’ve.learned.to.continue.to.get.through.
your.urges.without.smoking..

7

Don’t get discouraged if you slip
Don’t.be.discouraged.if.you.slip.and.smoke.one.or.two.
cigarettes..It’s.not.a.lost.cause..One.cigarette.is.better.
than.an.empty.pack..But.that.doesn’t.mean.you.can.
safely.smoke.every.now.and.then,.no.matter.how.long.
ago.you.quit..One.cigarette.may.seem.harmless,.but.it.
can.quickly.lead.back.to.your.old.smoking.habits..
Many.ex-smokers.tried.stopping.many.times.before.
finally.succeeding..When.people.slip,.it’s.usually.within.
the.first.few.months.after.quitting,.when.resisting.the.
urge.to.smoke.can.be.especially.challenging..If.you.do.
slip,.here.are.some.strategies.that.can.help.you.get.back.
on.track.

Realize you slipped
Acknowledge.that.you.slipped..You’ve.had.a.small..
setback..This.doesn’t.make.you.a.smoker.again..Feel.
good.about.all.the.time.you.went.without.smoking..
Focus.on.strengthening.your.coping.skills..

Don’t be too hard on yourself
One.slip.doesn’t.make.you.a.failure..It.doesn’t.mean..
you.can’t.quit.for.good..But.don’t.be.too.easy.on..
yourself,.either..If.you.slip,.don’t.say,.“Well,.I’ve.blown.
it..I.might.as.well.smoke.the.rest.of.this.pack.”.It’s.
important.to.get.back.on.the.nonsmoking.track.right.
away..Remember,.your.goal.is.no.cigarettes—not.even.
one.puff..
8

Understand why you slipped
Find.the.trigger..Exactly.what.was.it.that.made.you.
smoke?.Be.aware.of.that.trigger..If.you.are.using..
medication.to.help.you.quit,.don’t.assume.that.it..
isn’t.working.if.you.slip.and.have.a.cigarette.or.two...
Stay.with.it..It.will.help.you.get.back.on.track..

Learn from your experience
What.has.helped.you.the.most.to.keep.from.smoking?.
Make.sure.to.do.that.on.your.next.try..If.you.need.to.
visit.your.doctor.or.other.health.professional.again,..
do.so..He.or.she.can.help.motivate.you.to.continue.
your.effort.to.quit..Talk.to.your.family.and.friends...
It’s.okay.to.ask.for.support..
Know.and.use.the.tips.in.this.booklet..People..
with.even.one.coping.skill.are.more.likely.to.stay..
ex-smokers.than.those.who.don’t.know.any...
START.to.stop.again!.It’s.never.too.late.to.try.

Stay upbeat
As.you.go.through.the.first.days.and.weeks.without.
smoking,.stay.positive..Don’t.blame.yourself.if.you..
slip.and.smoke.a.cigarette..Don’t.think.of.smoking.as..
“all.or.nothing.”.Take.it.one.day.at.a.time..
Remember—you.didn’t.learn.to.smoke.overnight...
You.may.have.taken.months.or.even.longer.to..
adjust.your.routines.to.smoking..Quitting.is.a.learning.
process,.too..Staying.positive.will.help.you.choose..
new.activities.and.patterns.to.replace.old.habits.

9

Focus on a new, healthier lifestyle
Watch your weight
Many.ex-smokers.gain.some.weight.because.food.tastes.and.smells.better.
after.quitting..You.may.notice.that.you.snack.more.as.a.way.to.cope.with.
the.stress.of.quitting..Because.your.body.uses.food.more.slowly.when.you.
first.stop.smoking,.you.may.gain.weight..
If.you’re.worried.about.gaining.weight,.remember.that.the.benefits.from.
quitting.far.outweigh.the.initial.possibility.of.a.few.extra.pounds..And..
by.being.aware.of.possible.weight.gain,.you.can.do.something.about.it...
Get.in.shape.and.eat.regular,.nutritious.meals.to.prevent.unhealthy.weight.
gain..Talk.to.your.doctor.or.a.nutritionist.about.meals.and.snacks.with.
healthy.amounts.of.protein,.fruits,.and.vegetables..Also,.check.the..
suggestions.below..

Get in shape
Exercise.is.a.great.distraction.from.smoking..It.lowers.the.stress.and..
reduces.the.cravings.that.make.you.want.a.cigarette..Try.to.make.time..
to.be.physically.active.every.day..Experts.recommend:
◆

◆

30.minutes.a.day.of.moderate.physical.activity.for.at.least.5.days..
a.week,.or.
at.least.20.minutes.of.vigorous.physical.activity.at.least.3.days.a.week.

Keep.in.mind.most.physical.activities.will.help.you.burn.calories.and..
control.weight.gain..When.you.talk.to.your.doctor.about.quitting,.ask.
about.exercises.or.activities.that.can.get.you.back.on.the.road.to.being.fit..
Find.activities.you.like.to.do.and.that.will.fit.into.your.schedule..You.can.
also.add.activity.to.your.day.by.walking.during.lunch,.taking.the.stairs,.
0

parking.farther.away.from.your.destination,.or..
stretching.during.breaks..Possible.activities.include:.
◆

walking.or.running

◆

tennis

◆

dancing

◆

basketball

◆

martial.arts

◆

aerobics

◆

yoga

◆

cycling.

Eat healthy foods
Don’t.stress.over.your.eating.patterns..Just.try.to.make.healthy.food.
choices.as.you.begin.to.increase.your.exercise..Any.small.changes.will.
help..Here.are.some.tips.to.get.you.started.today:
◆

◆
◆

◆

◆

.replace.high-calorie.foods.with.healthy,.low-calorie.ones,.such.as.fresh.
fruits,.vegetables,.juices,.yogurt,.or.air-popped.popcorn.without.butter
eat.sugar-free.candy.or.juice.pops,.or.chew.sugar-free.gum.
choose.foods.that.take.longer.to.eat.and.keep.your.hands.busy,.such.as.
oranges.or.sunflower.seeds
try.crunchy.foods,.such.as.pretzels.and.rice.cakes,.so.your.mouth..
has.to.work
drink.water.before.and.between.meals..

If.you.need.to.have.something.sweet.on.occasion,.choose.foods.that.taste.
sweet.but.have.reduced.fat.and.sugar,.such.as.low-fat.frozen.yogurt.
For.more.information.on.how.to.eat.healthy.foods,.talk.to.your.doctor.or.
nutritionist..Remember.to.be.patient..It.takes.time.to.get.good.at.eating.
healthily.and.staying.smoke-free!


Remember

T

he Long-Term Rewards

Tobacco.use.in.the.United.States.causes.more.than.440,000.deaths.each.
year..Of.those.deaths,.170,000.are.from.cancer..
Once.you.quit.smoking,.you.will.add.healthy.days.and.years.to.your.life..
And.you.will.significantly.lower.your.risk.of.death.from.lung.cancer.and.
other.diseases,.including:
◆

heart.disease

◆

stomach.cancer

◆

stroke

◆

bladder.cancer

◆

emphysema

◆

esophageal.cancer

◆

cervical.cancer

◆

laryngeal.cancer

◆

kidney.cancer

◆

oral.cancer

◆

acute.myeloid.leukemia

◆

throat.cancer

◆

pancreatic.cancer

The.health.of.your.loved.ones.also.will.benefit.from.your.quitting—.
they’ll.no.longer.be.exposed.to.dangerous.secondhand.smoke..Finally,.by.
quitting.smoking,.you’re.setting.a.good.example..You’re.showing.others,.
especially.young.people,.that.a.life.without.cigarettes.is.a.longer,.healthier,.
happier.life...
Within.20.minutes.of.smoking.that.last.cigarette,.your.body.starts.making.
healthy.changes.that.will.continue.for.years..You.can.look.forward.to.the.
following.dramatic.changes.the.moment.you.become.an.ex-smoker..



12 hours after quitting
The.carbon.monoxide.level.in.your.blood.drops..
to.normal..
2 weeks to 3 months after quitting
Your.heart.attack.risk.begins.to.drop..Your.lung..
function.begins.to.improve..
1 to 9 months after quitting
Your.coughing.and.shortness.of.breath.decrease..
1 year after quitting
Your.added.risk.of.coronary.heart.disease.is.half.that..
of.a.smoker’s..
5 years after quitting
Your.stroke.risk.is.reduced.to.that.of.a.nonsmoker’s..
5–15.years.after.quitting..
10 years after quitting
Your.lung.cancer.death.rate.is.about.half.that.of..
a.smoker’s..
15 years after quitting
Your.risk.of.coronary.heart.disease.is.back.to.that.of..
a.nonsmoker’s.

Congratulations!

20 minutes after quitting
Your.heart.rate.drops.

Source: U.S. Department of Health and Human Services. The Health
Consequences of Smoking: What It Means to You. Atlanta, GA: U.S.
Department of Health and Human Services, Centers for Disease Control
and Prevention, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health, 004.



For More

I

nformation

National Cancer Institute
◆

www.cancer.gov

The.National.Cancer.Institute.(NCI).website.provides.two.key.tools.to.
help.you.quit.smoking:.LiveHelp,.an.online.text.messaging.service,.and.
the.toll-free.number.to.NCI’s.Smoking.Quitline..LiveHelp.offers.you.live,.
online.assistance.from.information.specialists.who.provide.cancer..
information.and.can.help.you.navigate.the.NCI.website..Click.on.the.
LiveHelp.link,.Monday.through.Friday..
NCI’s.Smoking.Quitline.also.is.staffed.by.specialists.who.can.help.you.
quit.smoking..Call.1–877–44U–Quit.(1–877–448–7848),..
Monday.through.Friday.

Cancer Information Service
◆ http://cis.nci.nih.gov
NCI’s.Cancer.Information.Service.provides.accurate,.up-to-date..
information.on.cancer..Information.specialists.can.help.you.quit.smoking.
and.explain.the.latest.cancer.information.in.easy-to-understand.English..
or.Spanish..Call.1–800–4–CANCER.(1–800–422–6237);.TTY,..
1–800–332–8615.

4

American Cancer Society
◆

www.cancer.org

The.American.Cancer.Society.(ACS).has.volunteers.and.offices.all.over..
the.country..ACS.can.help.you.learn.about.the.health.hazards.of.smoking.
and.how.to.become.an.ex-smoker..Its.programs.include.the.Great.American.
Smokeout.each.November..ACS.also.has.many.booklets.and.other..
information.to.help.you.quit..Check.online.or.call.1–800–ACS–2345.
(1–800–227–2345).to.find.your.local.office.or.for.more.information..

American Heart Association
◆

www.americanheart.org

The.American.Heart.Association.(AHA).has.thousands.of.volunteers..
and.130,000.members—doctors,.scientists,.and.others—in.55.state.and..
regional.groups..AHA.offers.books,.tapes,.and.videos.on.how.smoking..
affects.the.heart..It.also.has.a.guidebook.on.weight.control.in.quit-smoking.
programs..Check.online.or.call.1–800–AHA–USA1.(1–800–242–8721)..
to.find.your.local.office.or.for.more.information.

American Legacy Foundation
◆

www.americanlegacy.org

The.American.Legacy.Foundation®.develops.programs.that.address.the.
health.effects.of.tobacco.use..Through.grants,.training,.partnerships,.and.
grassroots.marketing,.the.Foundation.aims.to.help.young.people.reject.
tobacco.and.give.everyone.access.to.tobacco.prevention.and.cessation.
services..Vulnerable.populations.are.a.key.focus..Check.online.for.more.
information.


.American
◆

Lung Association

www.lungusa.org

The.American.Lung.Association.(ALA).helps.smokers.
who.want.to.quit.through.its.Freedom.From.Smoking®.
self-help.quit-smoking.program..ALA.actively.supports.
laws.and.information.campaigns.for.nonsmokers’.
rights..It.also.provides.public.information.programs.
on.the.health.effects.of.smoking..Check.online.or.call.
1–800–LUNG–USA.(1–800–586–4872).to.find.your.
local.office.or.for.more.information.

Centers for Disease Control
and Prevention
◆

www.cdc.gov/tobacco/osh/.

The.Office.on.Smoking.and.Health,.a.program..
office.within.the.Centers.for.Disease.Control.and.
Prevention.(CDC),.funds.booklets.on.smoking.topics.
such.as.relapse,.helping.a.friend.or.family.member.
quit.smoking,.the.health.hazards.of.smoking,.and.the.
effects.of.parental.smoking.on.teenagers..Check.online.
or.call.1–800–CDC–INFO.(1–800–232–4636).for.
more.information.

6

My Notes

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My Notes

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NIH Publication No. 08-1647

Printed October 2008