NATIONAL INSTITUTES OF HEALTH

National Heart, Lung, and Blood Institute

Nurses: Help Your Patients Stop Smoking

Nurses Can Help Smokers Quit

Most Smokers Are Ready to Hear from You

How You Can Help

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

National Heart, Lung, and Blood Institute
Smoking Education Program
P.O. Box 30105
Bethesda, Maryland 20824-0105
Y
ou can help your patients This guide contains: Begin to use this teaching guide
stop smoking. How? Talk Information you can use to this week or, better yet, today.
to patients about their confidently talk about Role-play the steps of the
smoking, provide some simple quitting smoking smoking intervention with a
but effective quit smoking friend or colleague before
advice, and ask other health A quick and easy-to-use
teaching guide: “Steps for talking with patients.
professionals to do the same.
This concise guide will help you Nurses’ Smoking Take every opportunity to
do this successfully. Intervention” practice and make it part of
A pocket summary of the your routine.
Smoking is a proven health teaching guide If you smoke, use this
hazard, and there are clear Five handouts that can be booklet to help yourself quit.
benefits to quitting. There is no copied and given to
safe cigarette and no safe level patients.
of smoking. Nurses have a
responsibility, as health
professionals, to talk to all their
patients who think about
quitting. This is true whether
you work in a hospital, health
department, worksite, school,
physician’s office, patient’s home,
or any other setting.

Nurses Can Help Smokers Quit

Most Smokers Are Ready to Hear from You

How You Can Help

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacemeat Therapy

Steps for Nurses' Smoking Intervention

T
hree out of four Smokers expect to hear concern One Nurse’s Experience
smokers say they want about their smoking in health
“When I first started talking to
to quit. settings. When you use the
patients about their smoking, I
Steps for Nurses’ Smoking
was hesitant. I thought patients
Most smokers know that smoking Intervention listed later, you will
would think their smoking was
causes lung cancer, not be seen as nagging or
none of my business. I found just
emphysema, and heart disease. preaching. Your advice will be
the opposite. Many patients were
seen as good nursing practice.
willing to talk about their
Seven out of ten smokers have
smoking and plans to stop. Some
tried to quit smoking.
tried to quit, and a smaller group
did so. I feel good knowing I am
Ninety percent of former
making a difference in the
smokers quit on their own
health of my patients.”
without participation in formal
programs. Smokers can quit with
your advice.

Most Smokers Are Ready to Hear from You

How You Can Help

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

Four Stages of Quitting Ask Other Health Professionals
Smoking to Help Smokers Quit
You will see smokers at each of In addition to talking to patients
the four stages of quitting yourself, remind other members
smoking. With the Steps for of the health team to do the
Nurses’ Smoking Intervention, same. When you learn that a
you can help smokers through patient smokes, ask the
these stages of breaking the physician to talk to him or her
habit: about quitting.
Stage 1. Not seriously
thinking about Encourage other nurses,
quitting respiratory care practitioners,
(Precontemplation) dietitians, physician assistants,
and other health care providers
Stage 2. Thinking about the to talk to smokers, also.
pros and cons of Repetition of the same no-
quitting smoking message by several
(Contemplation) sources will encourage smokers
Most smokers will be in the first
Stage 3. Intending to quit two stages, not quite ready to to think more seriously about
and taking actions quit. They often need an outside quitting smoking.
to do so (Action) prompt to start them thinking
Stage 4. Remaining off seriously about quitting. Use Document on the patient record
smoking or every clinical opportunity, such or chart the person’s smoking
returning to it as a patient’s persistent cough or history, desire to quit, and quit
(Maintenance or recent illness, to personalize the date. Use notes in the planning
relapse). need to stop smoking. Your portion of the record to prompt
advice can encourage them to others to discuss stopping
You are successful when you think more seriously about smoking with the patient.
help smokers move closer to quitting (stage 2) or to set a
taking action and stopping quit date (stage 3). See the
smoking. Even if they don’t quit, Challenges to Quitting section
they are further on their way to for ways to help those in stages 3
quitting-because of you. and 4.

How You Can Help

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replesement Therapy

Steps for Nurses' Smoking Intervention

W
hat would happen if two More Risk Factors, More Risk Pregnant women who smoke
fully loaded jumbo jets Patients with diabetes, high increase their chances of having
crashed every day with blood cholesterol, or high blood low birth weight infants by 50
no survivors? What if a new pressure at least double their percent. Also, smoking increases
virus killed 1,000 Americans already increased risk for heart the risk of miscarriage,
every day? You’d see fast action disease by smoking. Other premature birth, and stillbirth.
to stop this loss of life. problems are also more prone to Children regularly exposed to
occur. For example, diabetics the cigarette smoke of others
Cigarette smoking now causes who smoke greatly increase- the (passive smoking) have more
1,000 Americans to die each day. risk of poor circulation to their upper respiratory and inner ear
hands and feet. This condition infections. Women who smoke
Cigarette smoking is the single can lead to gangrene. and take birth control pills
most important preventable increase their risk of a heart
cause of death in the United attack 10 times. Their risk of a
States. One of every six deaths in stroke also increases.
the United States is related to
smoking. As of 1990, 25.5 percent
of (or about 45.8 million) How Much Greater Is Smokers' Risk of Dying from Major
Americans smoked cigarettes. Diseases?*
Many of these people are your
patients.
Stroke
2 times risk
Smokers increase their risk of
death from many major diseases
because they smoke. The table Mouth Cancer
on this page shows, for example, 6 times risk
that smokers have double the Larynx Cancer
risk of dying from coronary heart 10 times risk
disease as do those who never
Chronic Obstructive
smoked. Pulmonary Disease
10 times risk
They also greatly increase their
risk of lung cancer and several Lung Cancer
other cancers-mouth, throat, 12 times risk
bladder, pancreas, and kidneys.
Stomach and duodenal ulcers
are more likely to occur, less Coronary Heart Disease
likely to heal, and more likely to 2 times risk
cause death in smokers than
nonsmokers. The risk of *Estimated increased risks for male and female smokers age 35 or older. Adapted from:
developing occupational lung US. Department of Health and Human Services, Reducing the Health Consequences of
Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville, Office of
diseases is also increased in Smoking and Health, 1989.
smokers.

The Facts: Smoking Causes Death, Disease, and Disability

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

 Help Your Patients Reduce
What to Say to Smokers About the Benefits of Quitting Their Risk and Get These
Ask patients what they think their benefits of quitting would be. Benefits
Share some of the benefits listed below. When you see a smoker, think of
patients who have heart disease,
cancer, stroke, or emphysema.
Some Reasons Smokers Give for and lower respiratory tract You don’t want this smoker, your
Quitting infections as do infants with current patient, to develop one of
Reduced risk of heart attack, mothers who smoke. these diseases. You will save
cancer, and stroke Spouses of nonsmokers some of your smokers from these
have half the lung cancer problems by talking to them
Feeling more in control of about quitting.
life risk of spouses living with
smokers.
Better smelling hair, breath,
clothes, house, and car Benefits of Quitting Start
More stamina when Within Days
walking or exercising As the carbon monoxide
Less coughing, colds, and level in the blood decreases,
flu the oxygen level increases
to normal.
Benefits to People Around The heartbeat slows to
Smokers Who Quit normal.
Infants with mothers who The lungs begin to clear
do not smoke have half the and repair themselves.
bronchitis, pneumonia, ear
Long-Term Benefits of Quitting
After 1-2 years of not
smoking, the ex-smoker’s
risk of a heart attack drops
sharply and gradually
returns to normal after
about 10 years.
After quitting smoking, the
risk of lung, bladder,
laryngeal, oral, and
esophageal cancer is
gradually reduced when
compared with continued
smoking. However,
cessation may not reduce
the former smoker’s risk
level to that of an individual
who never smoked.

Benefits of Quitting

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

I
f smokers want to quit, why To help smokers quit and The key to quitting for smokers is
don’t they? Here are a few remain off smoking (stages 3 not gritting their teeth to resist
reasons or challenges and 4), discuss the following the urge to smoke. That doesn’t
smokers must overcome to quit. three points: work. The key is to be active in
Addiction: Ask about specific distracting themselves from
Most smokers are addicted to tempting situations. Ask thinking about smoking using
nicotine and will crave current smokers about times the techniques listed in the first
cigarettes. when they smoke. Ask column. You don’t need to
recent ex-smokers about provide “answers” to each
Habit: smoking situation. Ask the
Smokers smoke automatically in when they feel the urge to
smoke. smoker to think of activities that
specific situations every day. they think will work.
Reward: Discuss ways to avoid
Some smokers relax or obtain these situations. Can they Address any concerns about
pleasure from smoking. avoid the location (e.g., weight gain. Tell smokers that
bars) or friends who smoke many gain weight after
Stimulant: for a few weeks? (See the
Some smoke when they are tired quitting, although some do not.
patient handout.) The average weight gain for ex-
and want to feel more energetic.
Help them find something smokers found in most studies is
Weight gain: else to do instead of about 5-10 pounds. Some gain
Many smokers gain weight after smoking in each situation. more, some less, and some do
quitting. Suggest sipping water, not gain any weight. Suggest
Social: breathing deeply, moving that patients focus on quitting
Most smokers have friends or around, and keeping their smoking now and then tackle
relatives who smoke. hands busy. Remind them any weight gain later. Tell them
Time filler: that the urge will soon fade. they can help prevent weight
Many smokers smoke when they gain or keep it small by eating
are bored or have nothing to do. low-fat foods and exercising.
Coping: Remember that many smokers
Most smokers smoke when they will hesitate and want to put off
feel worried, upset, sad, or mad. quitting. And, many of those who
try will not quit for good with this
Smoking is a part of the smoker’s attempt. Encourage those who
life. To stop smoking, smokers return to smoking to learn from
must first decide to quit. To the attempt and try again. Refer
remain smoke-free, smokers may to the patient handout on this
use two techniques: 1) avoid point. Never give up on a
tempting situations and 2) do patient. Nearly half of all adults
something else when the urge who ever smoked have quit for
to smoke arises. life. Often it takes a few attempts
before smokers quit for life.

Challenges to Quitting

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

 What to Say to Smokers About Withdrawal Symptoms
There will be withdrawal symptoms after quitting. Give
examples such as lack of concentration, feeling tired, or being
restless.
The withdrawal symptoms may come and go, get stronger or
weaker, or remain the same. Tell the smoker to be prepared
for these changes.
The withdrawal symptoms should last 2 to 4 weeks.

Withdrawal symptoms usually last much longer. All smokers do

occur within 24 hours of stopping not experience the same
smoking or reducing the number withdrawal symptoms.
of cigarettes smoked per day.
These symptoms are signs that Below is a list of withdrawal
the body is recovering form symptoms and tips to help you
smoking. Tell smokers this fact. answer many of the questions
smokers may ask you. If patients
Most symptoms end within 2 to have trouble with these
4 weeks. Some symptoms symptoms, refer them to a
decrease sharply after the first physician.
few days. The urge to smoke will

Ways to Cope with Withdrawal Symptoms

Withdrawal Symptom Things You Might Do
Craving for cigarettes Do something else; take slow deep breaths; tell
yourself, "don't do it."
Anxiety Take slow deep breaths; don't drink caffeine drinks; do
other things.
Irritability Walk; take slow deep breaths; do other things.
Trouble sleeping Don't drink caffeine drinks in the evening; don't take naps during
the day; imagine something relaxing like a favorite sport.
Lack of concentration do something else; take a walk.
Tiredness Exercise; get plenty of rest.
Dizziness sit or lie down when needed; know it will pass.
Headaches Relax; take mild pain medication as needed.
Coughing Sip water.
Tightness in chest Know it will pass.
Constipation Drink lots of water; eat high-fiber foods like vegetables and fruits.
Hunger Eat well-balanced meals; eat low-calorie snacks; drink cold water.

Withdrawal Symptoms

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

How Nicotine Replacement
Therapy Can Help What to Say to Smokers About Nicotine Replacement
Nicotine replacement therapy
Therapy
may help smokers stay off
smoking by reducing their Nicotine gum or the nicotine patch may be useful—check with the
withdrawal symptoms so the doctor or dentist. If either one is to be used, help the patient get a
patient can concentrate more prescription and teach the patient how to use the gum or the
fully on the behavioral aspects of patch correctly.
smoking cessation. Nicotine from
any source is addictive. nicotine gum or the nicotine Specific information on how
Therefore, nicotine replacement patch correctly, Some important much to use is provided in the
should be used carefully. It is not information about nicotine gum package insert. If nicotine gum is
designed to be used and the nicotine patch is prescribed for the hospitalized
alone. It should be used with presented below. Complete patient, make the gum easily
other smoking cessation information about nicotine gum available to the patient as
programs and materials. or a particular nicotine patch is ordered. You may wish to keep a
provided in the package insert. limited supply of nicotine gum at
Two nicotine replacement the bedside for easy patient
therapy options are available. Nicotine Gum access.
They are nicotine gum (nicotine
How It Works
polacrilex medication) and the
Nicotine gum contains nicotine Warnings/Precautions
nicotine patch (transdermal
in a gum base. When chewed PATIENTS SHOULD NOT
nicotine). Both nicotine gum and
briefly until softened, and then SMOKE WHILE USING
the nicotine patch replace the
placed between the cheek and NICOTINE GUM!! Smoking
nicotine from cigarettes with a
gum, the nicotine from the gum while using nicotine gum
lower, more even dose. Thus,
nicotine replacement therapy is is absorbed into the blood could result in an overdose of
through the lining of the mouth. nicotine.
only used when all smoking has
Once in the bloodstream,
stopped—on quit day and
nicotine travels to the brain Children, pregnant women, or
beyond. Anyone interested in
where it binds to nicotinic lactating women should not
making nicotine replacement
therapy a part of their smoking receptors to gradually reduce use nicotine gum.
cessation process should discuss withdrawal symptoms.
with their physician which Nicotine gum should not be
option is best for them—the gum How It Is Used used by patients who have
The amount of nicotine gum life-threatening cardiac
or the patch.
each patient uses will vary. arrhythmias, severe angina, or
Encourage patients to discuss who have had a recent
When used with a stop smoking
with their physician the myocardial infarction.
program, nicotine replacement
following information:
therapy may help smokers
remain off cigarettes. These stop —how many pieces per day they Patients with medical con-
smoking programs include should use, ditions such as hypertension,
group sessions, individual —when they should use the gum cardiac arrhythmias, oral/
instruction, and self-help during the day, and pharyngeal inflammation,
—when they should be weaned history of esophagitis, peptic
booklets that teach habit-
breaking techniques. off the gum. ulcer disease, hyper-
thyroidism, insulin-dependent
Nicotine gum and the nicotine diabetes, or cardiovascular
patch may be most helpful to disease, should consult their
smokers who smoke more than physician before using
one pack a day. Lighter smokers nicotine gum.
may find them helpful, too. Both
are available only with a
prescription.

Health professionals should

teach patients how to use

Nicotine Replacement Therapy

Steps for Nurses' Smoking Intervention

 Patients should consult with Each brand allows gradual Patients with medical
their physician or dentist if decreases in the amount of conditions such as
they have dentures, bridges, nicotine delivered by providing hypertension, renal or hepatic
or dental problems before smaller patches over time until insufficiency, cardiac
using nicotine gum. Patients the patient has no need for arrhythmias, active peptic
with active temporo- nicotine replacement. Specific ulcer disease, hyper-
mandibular joint disease information on each brand is thyroidism, insulin-dependent
should not use nicotine gum. provided in the package insert. diabetes, peripheral vascular
Patients should consult with their disease, or cardiovascular
Side Effects physician to determine which disease should consult their
Side effects may include a sore brand is best for them. physician before using the
jaw, a sore mouth, excessive nicotine patch.
salivation, dyspepsia, nausea,
and/or hiccups. Patients with atopic or
eczematous dermatitis should
consult with their physician
Nicotine Patch before using the nicotine
patch.
How It Works
The nicotine patch delivers a Side Effects
steady dose of nicotine through Side effects may include skin
the skin of the person wearing irritation, sweating, abnormal
the patch. Once absorbed dreams, insomnia, nervousness,
through the skin, the nicotine is diarrhea, dyspepsia, dry mouth,
delivered to the bloodstream arthralgia, and/or myalgia.
within a few hours of
application, where it travels to
the brain. In the brain, the
nicotine binds to nicotinic
receptors to reduce withdrawal
symptoms.

How It Is Used Warnings/Precautions

The nicotine patch is applied PATIENTS SHOULD NOT
each day on the upper arm, SMOKE WHILE USING THE
back, or chest and is used for NICOTINE PATCH!! Smoking
several weeks at a time. The while using the nicotine patch
amount of nicotine in each patch could result in an overdose of
and the dose delivered over a 24 nicotine.
hour period vary with each
brand of transdermal nicotine. Pregnant women or lactating
The physical size and women should consult with
appearance and the length of their physician before using Instructions for patients using
time the patch should be worn the nicotine patch. nicotine gum and the nicotine
vary among brands as well. patch are provided on the
Encourage patients to discuss Children should not use the patient education handout at
with their physician the nicotine patch; women in the end of this guide. If
following information: labor or delivery should not nicotine replacement therapy
—When to put the patch on use the nicotine patch. is indicated for a particular
(usually first thing in the patient, give them the handout
morning), The nicotine patch should not on nicotine gum or the
—What dose or size of patch to be used by patients with life nicotine patch provided in this
use, threatening cardiac arrhyth- guide. Complete information
—How long to keep it on each mias, severe or worsening on nicotine gum or a
day, angina, or a recent myo- particular nicotine patch is
—How many weeks to use the cardial infarction. provided in the package
patch, insert.
—How to wean off the patch.
Y
ou can make a difference 3. Prepare Your Smokers To
with your smoking
patients in just a short Ask the patient to set a
time. Here are some important target quit date within 1 to
tips: 3 weeks from now. If that
Start today. To start, just ask time frame doesn’t work,
patients about their smoking explore what time frame
and advise them to quit. might be better. Ask patients
Within a week or so, add the who are not ready to quit to
“prepare” and “followup” think seriously next week
steps. If time is short, simply about the reasons for
do the “ask” and “advise” quitting.
steps. Soon, this smoking Have the patient write
intervention will be a his/her quit date on the
Give a firm, simple no-
flexible part of your nursing attached patient handout.
smoking message such as,
routine. This contract can be made
“I am concerned about
Keep your objectives in your smoking. I must between the patient and
mind. Patients will: highly recommend that you you or a friend or relative.
—Set a quit date and begin quit.” Ask them to complete the
to prepare to quit, rewards part later. Stress
Repeat your recommenda-
—Or think more during the the need to reward them-
tion when smokers give
next week about the selves.
excuses for not quitting. For
reasons for quitting and Mention the three main tips
example, say “I can see you
the possibility of doing so in “Breaking the Habit” in
have concerns, but I still
in the next year. the enclosed patient
must recommend that you
Convey warmth, under- quit. Smoking is a major handout. Show this to them.
standing, acceptance, and health threat for you.” Never These three tips are 1) do
respect for patients. argue about the excuses or something else instead of
Express concern about their accept the excuses. Always smoking, 2) avoid tempting
smoking. end with your patients situations, and 3) stick with
knowing you think they your effort to stop smoking.
1. Ask All Patients if They should quit. Express confidence that
Smoke they can and will quit.
For smokers, ask how much
they smoke.
Congratulate smokers who
have quit.
Document patients’ smoking
or nonsmoking status in
your notes or other forms.

2. Advise All Smokers To

Quit
Ask the patients what they
think the benefits of their
quitting would be.
Show the patient the
handout and review a few
benefits you feel would be Followup
meaningful.
Prepare
Advise
Ask

Steps for Nurses' Smoking Intervention

Tell patients they will Tell all patients you are 4. Followup: Let Your
experience withdrawal very interested in hearing Patients Know You Care
symptoms for about 2 to 4 how they do. If you plan to Talk with all patients
weeks after quitting. Show followup, tell them you will. briefly about their smoking
them the handout on this. If you cannot followup with the next time you see
Offer them information on them, tell them you will be t h e m—the next
how to obtain a prescription thinking of them on their appointment, home visit,
for nicotine gum or the quit day. If you can handle wherever. Ask them if they
nicotine patch, if calls, ask them to call you smoke and for their
appropriate and not with their progress. thoughts on what you said
contraindicated. about smoking. As time
Offer information on local permits, talk to them about
smoking cessation their progress, problems,
programs. Write the phone and plans.
numbers on the patient’s Give new ex-smokers a “pat
handout. You could also on the back” each time you
give patients one of the self- see them.
help booklets listed on the
“Breaking the Habit” patient Send cards or call patients
handout. at home a day or so before
their quit day and/or soon
after their visit, when you
can. This is a very helpful
way to show you care. It
also reminds them of their
commitment to quit.
Work with health
professionals in other
settings to stay in contact
with patients and reinforce
no-smoking messages.
Selected References For technical questions, contact:
U.S. Department of Health and
Human Services. Reducing the Office on Smoking and Health
Health Consequences of Center for Chronic Disease
Smoking: 25 Years of Progress. A Prevention and Health
Report of the Surgeon General. Promotion
Office on Smoking and Health, Mail Stop K-50
Rockville, MD: 1989, DHHS 89- Centers for Disease Control
8411. 1600 Clifton Road, N.E.
Altanta, Georgia 30333
U.S. Department of Health and (404) 488-5708
Human Services. How You Can
Help Patients Stop Smoking: Acknowledgments
Opportunities for Respiratory Developed by:
Care Practitioners. National
Heart, Lung, and Blood Institute, National Heart, Lung, and Blood
Bethesda, MD: 1989, NIH Institute
Publication No. 89-2961. Smoking Education Program
P.O. Box 30105
Schneider, Nina. How to Use Bethesda, Maryland 20824-0105
Nicotine Gum and Other
Strategies to Quit Smoking. New Contributing Authors:
York: Pocket Books, 1988. Joan E. Blair, R.N., M.P.H.
National Heart, Lung, and Blood
U.S. Department of Health and Institute
Human Services. Clinical Bethesda, Maryland
Opportunities for Smoking Ted Buxton, M.P.H.
Intervention: A Guide for the University Research Corporation
Busy Physician. National Heart, Bethesda, Maryland
Lung, and Blood Institute,
Bethesda, MD: 1992, NIH Illustrations and Publication
Publication No. 92-2178. Design By:
Jeanne Kelly
U.S. Department of Health and Aardvark Design Associates
Human Services. How to Help Leesburg, Virginia
Your Patients Stop Smoking: A
National Cancer Institute
Manual for Physicians. National
Cancer Institute, Bethesda, MD:
1989, NIH Publication No. 89-
3064.

American Lung Association.

Freedom From Smoking in 20
Days. New York: American Lung
Association, 1981, Item No. 0034.

American Lung Association. A

Lifetime of Freedom From
Smoking. American Lung
Association, New York: 1981, Item
No. 0026.
Quit and Be Free
What Will It Take For You By Quitting Smoking, I Will Get These Benefits...
To Quit Smoking?
Many smokers have quit I will greatly lessen my chances of getting cancer or having a
smoking because of the many heart attack.
benefits of being smoke-free. I will have fewer colds or flu each year.
Some waited until they had I will have better smelling clothes, hair, breath, home, and
symptoms like a cough or car.
breathing problems. And others I will climb stairs and walk without losing my breath.
waited until they were told they I will have more money to spend on other things.
had cancer or a heart problem. I will reduce the number of coughs, colds, and earaches my
What will it take for you to stop young child will have.
smoking? I will have fewer wrinkles.
I will be free of my morning cough
Think About Your Reasons I will increase my sense of control over my life.
for Quitting Each Day I will
What do you want to gain from
I Lose These Benefits Each Day That I Do Not Quit Smoking
quitting? Check your reasons in
the list below, then write them
down. Pick a few times during Tell them your reasons for
the day to read and review your Think of When You Will
Quit wanting to quit. Ask for their
list. Tape the list on your support.
refrigerator or bathroom mirror Choose a quit date and promise
where you will see it. yourself not to smoke. Write the
date on the contract below and
Prepare, Take Charge and
Think of your reasons to quit have someone sign it with you. Quit
each time you reach for your List how you’ll reward yourself, The methods listed on the
pack of cigarettes. By repeating too. handout, “Breaking the Habit,”
your reasons often, your drive to have helped thousands of former
quit smoking will grow stronger. Tell your friends, family, and smokers to break the habit. Ask
Try it. coworkers about your quit date. your nurse for this handout, and
begin to practice these methods
now. You will quit smoking.

I will quit smoking on . I will reward myself

(date)
for not smoking as follows:

First day of not smoking

(reward)

Each week of not smoking

(reward)

(signed)

(cosigned)
Breaking the Habit
Do Something Else Move. Get up and Avoid people who smoke in
Instead of Smoking walk. front of you.
Think of some common times Call or see a helpful Avoid those places where
when you smoke. For instance, friend. you smoked, when you can.
you might smoke after meals, Yawn, sigh, or breathe Do not drink alcohol for at
while driving, or when you are deeply. least the first 2 weeks of not
bored. For each of these times, smoking.
find something else to do in Starting today, practice Stop Ask family members and
place of smoking. This will Think-Act when you want to friends not to offer you
distract you from your urge to smoke. Right now, do Stop- cigarettes or leave them
smoke. And before you know it, Think-Act. Use it to postpone laying around.
the urge to smoke will fade. smoking a few cigarettes each
Here’s what you should do. day for 10 minutes. When your
quit day comes, you’ll be in Stick With Your Effort to
Each time you feel an urge to control. Practice makes Stop Smoking
smoke, do the following quickly: nonsmokers. If you do smoke a cigarette,
regain control:
Stop Say, “Stop!” to Avoid Tempting
yourself, even out 1. Stop smoking and get rid of
Situations any cigarettes you might have.
loud.
Destroy all cigarettes the 2.Forget about feeling guilty.
night before quit day. Also, You were in a tough situation.
Think Repeat the reasons
why you are quitting. throw away all ashtrays, Learn from it and then just
matches, and lighters. forget it.
Tell yourself that you
can wait out the urge. 3. Plan and practice what you
will do next time in that
Act Put something in your situation. Talk to a friend
mouth. about it. Take charge and you
Sip water, chew ice or will quit smoking.
sugarless gum, eat fruit
or a low-calorie snack, Nicotine gum or the nicotine
or use a toothpick. patch may also help you quit
Keep your hands busy. smoking. It will reduce your
Try beads, paper clips, withdrawal symptoms. Your
doodling, crossword doctor or dentist must write a
puzzles, or handling a prescription for you to get the
coin. gum or the patch. Ask them
about it.

Call For More Information. Call

the National Cancer Institute
(1-800-4-CANCER) to order the
booklet, Quit for Good. The
Office on Smoking and Health
(404-488-5708) offers Clearing the
Air. Call the local chapters of the
American Heart Association,
American Cancer Society, and
American Lung Association to
obtain other materials and
schedules of group programs.
Ask your nurse for these phone
numbers or look in your phone
book.
Being in Control of Withdrawal Symptoms

T
here will be withdrawal 2 to 4 weeks. Your knowing this It is helpful to remind yourself
symptoms after you quit. will help you stay in control and that these symptoms will be over
These symptoms are not smoke. soon. You will not smoke in
good signs that your body is spite of these symptoms like
recovering from smoking. The When symptoms occur, you can millions of other former
symptoms may come and go, get distract yourself from them or smokers.
stronger or weaker, or stay the reduce them. The table below
same. Most symptoms end within tells you some things you can do.

Withdrawal Symptom Things You Might Do

Craving for cigarettes Do something else; take slow deep breaths; tell yourself, “Don’t do
it.”

Anxiety Take slow deep breaths; don’t drink caffeine drinks; do other things.

Irritability Walk; take slow deep breaths; do other things.

Trouble sleeping Don't drink caffeine drinks in evening; don’t take naps during the
day; imagine something relaxing like a favorite spot.

Lack of concentration Do something else; take a walk.

Tiredness Exercise; get plenty of rest.

Dizziness Sit or lie down when needed; know it will pass.

Headaches Relax; take mild pain medication as needed.

Coughing Sip water.

Tightness in chest Know it will pass.

Constipation Drink lots of water; eat high-fiber foods like vegetables and fruits.

Hunger Eat well-balanced meals; eat low-calorie snacks; drink cold water.
Nicotine Gum

N
icotine gum may help How It Works Not Drink Liquids
you stay off smoking by When you chew nicotine gum, Around the Time You Use
reducing your the nicotine from the gum is the Gum
withdrawal symptoms. Some absorbed through the lining of —Wait at least 15 minutes
examples of withdrawal your mouth. Next, the nicotine after drinking acidic
symptoms are dizziness, travels through your blood to beverages such as coffee,
headaches, and lack of your brain to help replace the tea, milk, fruit juice, or soft
concentration. The gum gives nicotine your body got used to drinks before using the
you nicotine at a lower, more when you smoked. This will help gum. If you do not wait 15
even dose than your cigarettes you feel fewer withdrawal minutes, you will lose
do. Nicotine gum is used only symptoms. Talk to your doctor or much of the effect of the
when all smoking has nurse and read the instructions gum.
stopped—on quit day and that come with the gum to learn
how to use it. —Do not drink any liquids
beyond. Do NOT smoke and use
the gum!! while the gum is in your
Some Important Things to mouth.
When used with a stop smoking Remember Prevent the Side Effects
program, nicotine gum may Talk to Your Doctor About from the Gum: Chew Slowly
help you quit for life. These stop How Much To Use —Most side effects can be
smoking programs include prevented by chewing the
group sessions and self-help —Start using the gum upon
waking on quit day gum more slowly. Tell
booklets. These will help you your doctor if you have
cope with your cravings to —Your doctor will tell you: any side effects such as a
smoke. The gum does little to • how many pieces per sore jaw, a sore mouth,
reduce your cravings to smoke. day you can use, extra saliva, heartburn,
• when you should use feeling sick to your
The gum is most helpful to the gum during the day, stomach, or hiccups.
smokers who are addicted to and
nicotine. Each piece of gum • when you can begin to Stop Using the Gum When
contains 2 mg of nicotine. The wean off the gum. You Are Ready
general plan is to switch to Chew the Gum, Then Put It
nicotine gum, stabilize on it until —As the urge to smoke
into Your Cheek, Then comes less often, slowly
you are accustomed to being a Repeat This.
nonsmoker, and then taper off reduce the number of
and be off in 3 to 6 months. —Put the gum in your pieces of gum used each
Nicotine gum is not for everyone. mouth and chew it slowly day.
Check with your doctor to see if it until you taste it. —Most people are off the
is best for you. You can only get —Then place the nicotine gum in 3 to 6 months, but
the gum with a prescription. gum between your cheek some may need it longer.
and your gum. Hold it
Nicotine gum does not contain there.
any sugar. —After the flavor goes
away, bite or chew slowly
until you taste the gum
again. Then put the gum
back in your cheek. This
should happen once
every minute or so.
—Use each piece of gum for
20 to 30 minutes and then
throw it away.

(continued on next page)

Nicotine Gum (continued)

Make Special Note of dentures, bridges, or

These Things When Using other dental conditions.
the Gum —Nicotine gum is not for
—Nicotine from any source everyone.
(smoking, nicotine gum, —Be sure to tell your doctor:
or the nicotine patch) can • If any of the above
make some health prob- situations exist,
lems worse. For example, • If you have any side
heart or circulation prob- effects from nicotine
lems (such as an gum,
irregular heartbeat, • What medications you
chest pain, or a heart are on, and
attack), high blood • If you are not ready to
pressure, stomach ulcers, quit smoking.
overactive thyroid, and
diabetes that needs
insulin.
—Nicotine gum should not
be used by patients who
have life-threatening
cardiac arrhythmias,
severe angina, or who
have had a recent
myocardial infarction.
—Nicotine gum can also
cause problems with
pregnancy and a baby
being nursed.
—Chewing nicotine gum
may make jaw joint
(temporomandibular
joint) disease worse.
The gum may also
cause problems with
The Nicotine Patch

T
he nicotine patch may How to Use the Nicotine Patch The nicotine patch should
help you stay off smoking Talk to your doctor or nurse and not be used by patients with
by reducing your read the instructions that come life-threatening cardiac
withdrawal symptoms. Some with the patch to learn how to arrhythmias, severe or
examples of withdrawal use it. Your doctor will tell you: worsening angina, or a
symptoms are dizziness, recent myocardial
—When to put the patch on
irritability, headaches, and lack infarction.
(usually first thing in the
of concentration. The patch gives morning), The nicotine patch can also
you nicotine at a lower, more —What dose or size of patch to cause problems with
even dose than your cigarettes use, pregnancy and a baby
do. The nicotine patch should —How long to keep it on each being nursed.
only be used when all smoking day, The nicotine patch may not
has stopped—on quit day and —How many weeks you should work as well if you have
beyond. Do NOT smoke and use use the patch, skin problems or if your skin
the patch!! —How you should wean yourself is irritated. In some users,
off the patch. (Tell your doctor the patch may cause
When used with a stop smoking if you think you need to use the normal skin to become red
program, the nicotine patch patch for a shorter or longer or swollen.
may help you quit for life. These period of time.)
stop smoking programs include The nicotine patch is not for
group sessions and self-help everyone.
Make Special Note of These
booklets. The patch is most Things When Using the Nicotine Be sure to tell your doctor:
helpful to smokers who are Patch —If any of the above
addicted to nicotine. The general Nicotine from any source situations exist,
plan is to switch to the nicotine (smoking, nicotine gum, or —If you have side effects
patch, stabilize on it until you the nicotine patch) can from the nicotine patch,
are accustomed to being a non- make some health problems such as: red or swollen
smoker, and then taper off with worse. For example, heart skin, abnormal dreams,
smaller patches and be off in or circulation problems sweating, insomnia, or
several months. The nicotine (such as an irregular heart diarrhea
patch is not for everyone. Check beat, chest pain, or a heart —What medications you
with your doctor to see if it is best attack), high blood pressure, are on, and
for you. You can only get the stomach ulcers, overactive —If you are not ready to
patch with a prescription. thyroid, or diabetes that quit smoking.
needs insulin.
How It Works
When you wear the nicotine
patch, it delivers a steady dose of Some Important Things to Remember
nicotine through your skin into Don't use the patch if you are still smoking. You will get too
your bloodstream. The nicotine much nicotine in your body.
travels to your brain to help Don't put the patch on skin that is irritated, burned, or hurt in
replace the nicotine your body any way.
got used to when you smoked. Don't put the patch on the same place on your skin for al least
This will help you feel fewer a week.
withdrawal symptoms. Don't use more than one patch at a time.
Don't let children or pets touch the patch.
You can swim, exercise, take a bath or shower, and go inside
a sauna while you are wearing a nicotine patch.
If the patch falls off, throw it away and put on a new one in a
different place that is clean and dry.
Keep the patch inside its envelope until you are ready to use it.
Put a new patch on and take the old patch off at the same
time each day, or as directed by your doctor.
Use other smoking cessation programs or material while you
are using the patch.
Pocket Guide to Nurses'
Smoking Intervention
1. Ask
Ask patients if they smoke and
how much.
Congratulate ex-smokers.
Record their smoking status.

2. Advise
ask patients about the
benefits of quitting smoking.
Express concern and
recommend that patients quit.

3. Prepare
Set a quit date.
Review tips for quitting on
handout.
Tell patients you will followup
or you will think of them on
quit day.

4. Followup
Ask patients if they smoke.
give ex-smokers a "pat on the
back."
Send cards or call patients
soon after their visit and/or
just before quit day.
Discrimination Prohibited: Under provisions of applicable public laws enacted by Congress
Since 1964, no person in the United States shall, on the grounds of race, color, national origin,
Handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected
To discrimination under any program or activity (or, on the basis of sex, with respect to any
Education program or activity) receiving Federal financial assistance. In addition, Executive
Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in
The performance of Federal contracts, and Executive Order 11246 states the no federally
Funded contractor may discriminate against any employee or applicant for employment
Because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung,
and Blood Institute must be operated in compliance with these laws and Executive Orders.
 U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Public Health Service
National Institutes of Health
National Heart, Lung, and Blood Institute
NIH Publication No. 92-2962
January 1993