Better ways to call it quits

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You likely know the reasons why you should quit smoking.

If you didn’t, here’s a fact sheet from the World Health Organization. You’re probably aware that stopping smoking reduces your risk of lung cancer, heart disease, and chronic obstructive pulmonary disease more commonly referred to as COPD (more facts here). A recent study has further shown that long-term smoking causes your brain’s cortex to thin. The good news is that stopping smoking will restore part of your cortex.

You probably also know that you can receive support from the Health Promotion Board on the Quit Smoking Helpline (1800 438 2000) and the I Quit mobile app. But you may not be aware that some ways to quit are better than others. Here’s what the experts say:

1. Cut back on nicotine slowly
A 2015 study shows that brain oxygen uptake and blood flow decreases up to 17% just 12 hours after people stop smoking. This nauseatingly unpleasant sensation is a likely obstacle for many aiming to stop smoking entirely. So actually, it seems that quitting gradually may be better in the long run than going cold turkey.

2. E-cigarettes are one way to quit smoking
recent study found that as many as a fifth of participants had quit smoking and were smoke-free 8 months after a 2-month study, during which they could use e-cigarettes. In another recent study involving randomized trials, more participants were smoke-free by the end of the year with e-cigarettes (9% quit smoking) than a placebo (4% quit smoking). It also turns out that the kind of e-cigarette you use and how often you use them may be more important than you thought. Recent reports suggest that e-cigarettes are effective if used regularly and if you use the refillable tank versions. The jury’s still out though, according to a 2015 meta-analysis of research: This analysis says that on the whole, e-cigarettes helped people stay smoke-free for a month but not 3 or 6 months after quitting.

3. Use concrete rewards
Give yourself an incentive to stop smoking. Don’t laugh. It works. Participants who earned a $20 gift card on their quit date and additional $5 each week for the following 12 weeks after the quit date, were much more likely to stay smoke-free than those who didn’t have a financial incentive to do so. In this 2014 study, about half were smoke-free a month after their quit date, and a third remained smoke-free 2 months after they stopped receiving any financial incentive.

A 2015 study found that adding a financial disincentive further improved quit rates. More people stayed smoke-free for 6 months if they received US$800 than if they had counselling or nicotine-replacement therapy (gum, medication, patches). But even more people stayed smoke-free if they not only received US$650 but also had to forfeit a US$150 deposit for not staying smoke-free 6 months after the quit date. So here’s a way for your supporters to do something concrete to up your chance of success. It’s better, of course, if your friends and family have deep pockets.

4. Consider coaching and counselling options
Getting help and support from an stop smoking specialist advisor has been shown to be one of the most effective strategies for helping smokers stay smoke-free. But not everyone wants or has time for one-to-one sessions. A 2014 study found that providing smokers with support through a virtual stop-smoking advisor via the interactive “StopAdvisor” website doubled quit rates among those from lower income groups. Unfortunately, that’s not an option here.

You can however receive support from smoking cessation programmes at the polyclinics — both the National Healthcare Group and SingHealth polyclinics offer them. Smoking cessation advisors can also help at the Department of Pharmacy at Changi General Hospital, Khoo Teck Puat Hospital, and National University Hospital, as well as at Singapore General Hospital (Department of Respiratory & Critical Care Medicine), Tan Tock Seng Hospital (Clinic 4A), and the National Skin Centre.

And everyone can get involved. Family and friends can getting involved too. Anyone can learn the basics of smoking cessation counselling — HPB provides Level 1 and Level 2 training, and continuing education Level 3 workshops.

There may also be a smoking cessation programme at your workplace: Check with your HR to find out more. And if there isn’t, consider seeking support from a professional counsellor — the Employee Assistance Programme or EAP at your workplace may be a good place to start.

5. Watch out for your cravings
A 2015 study found that brain areas associated with smoking cravings were much less activated for women during the ovulation period than a later part of the menstrual cycle. Even if you’re not planning to time your exit from nicotine, you could be mentally more prepared to do battle with your cravings before you get to that time of the month.

You can have all resources about how to best quit, but it’s the emotional support that’s most crucial to staying smoke-free. Just remember, there’s no one-size-fits-all solution to quitting. Have a happy smoke-free No Tobacco Day!

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When is it a good time to talk about smoking?

Smoking begins early. A survey in 2000 found that a quarter of teenagers had smoked before, and more than 1 in 10 had smoked in the past month. Telling your children not to smoke doesn’t work. So what does?

Prisoner Holding Cigarette Between Bars

Talk to your kids about the health risks of nicotine before addictions take over!

1. Talk to your kids before they are teenagers!
It turns out that if you haven’t already started smoking by age 18, you’re not really going to start. Smokers tend to start young, so it’s important to get them to hear the message early. So talk to your kids about the effects of smoking before they are teenagers!

2. Nagging is not a communication strategy
Parent-child talks are more effective when you invite your children to participate in a two-way conversation and when you use a tone that shows that you care.

3. Speak the same language as your kids
Not every teenager cares about the long-term effects of smoking (lung cancer, head and neck cancer, heart attacks, stroke). They may not care about the effects of secondhand smoke.

Such facts don’t work as well as telling teenagers about wrinkly skin and yellow teeth, which result from tobacco use. Here’s a fact sheet that’s been designed for teens.

4. Be supportive
Teenage brains are more susceptible to becoming dependent on nicotine than those of adults. You can have a more meaningful conversation with your teenager if you can stay away from sounding judgemental, accusatory, or condescending. 

5. Using peer pressure to your advantage
A recent study found peer pressure works both ways. But it’s more common for smoking teenagers to introduce their non-smoking peers to tobacco than the other way around. Non-smoking teenagers are relatively less successful at dissuading peers from smoking. 

It might be because teenagers lack knowledge about the more effective ways to quit tobacco. Do you have The Knowledge? (Here are more resources for teenagers).

6. How to be cool (but not smoke)
Or it may be that peer pressure works because smoking is seen as being cool. Consumer research show that being cool is about breaking rules which are seen as unfair or unnecessary, while not breaking legitimate rules.

So that means campaigns will be effective if they educate teenagers that they can choose to stop smoking. And that’s what the research says: A 1999 study showed that teenagers, who made an independent decision not to smoke, reduced their smoking in subsequent months.

7. Beware the effect film noir has on your kids
Movies which glamourize smoking may have an unintended effect on you and your family.

In a recent study, young adults were more likely to endorse alcohol use after watching movie clips where alcohol was portrayed in a good rather than bad light, even though alcohol consumption was not the main theme of any of the movies watched. This likely applies to tobacco as well.

No one makes movies like they used to. But you might want to talk to your kids about the reality behind Hollywood’s golden age after you and the kids watch To Have and Have Not.

8. Children who stay in school longer are less likely to smoke
It’s been known for a while that there are fewer smokers among those with more years of education. A 2014 study found that those who smoked at age 16 were more likely to be smokers as adults and less likely to have a university degree.

But having better problem-solving abilities does not explain this trend. Rather, family factors are likely to be responsible. Teenagers who feel connected to their parents and are monitored by their parents are less likely to smoke.

9. Do what you preach
Children learn by example. Those with parents who smoke are 3 times more likely to smoke. A 2006 study conducted in New Zealand found that parental smoking was responsible for an estimated 40% of teenagers who smoked.