2. How does smoking affect your health?

Health concerns usually top the list of reasons people give for quitting smoking. This is a very real concern: smoking harms nearly every organ of the body. Half of all smokers who keep smoking will end up dying from a smoking-related illness.

CancerNearly everyone knows that smoking can cause lung cancer, but few people realize it is also linked to a higher risk for many other kinds of cancer too, including cancer of the mouth, nose, sinuses, lip, voice box (larynx), throat (pharynx), esophagus, bladder, liver, kidney, pancreas, ovary, cervix, stomach, colon, rectum, and acute myeloid leukemia.Lung diseasesSmoking greatly increases your risk of getting long-term lung diseases like emphysema and chronic bronchitis. These diseases make it harder to breathe, and are grouped together under the name chronic obstructive pulmonary disease (COPD). COPD causes chronic illness and disability, and gets worse over time – sometimes becoming fatal. Emphysema and chronic bronchitis can be found in people as young as 40, but are usually found later in life, when the symptoms become much worse. Long-term smokers have the highest risk of developing severe COPD. Pneumonia and tuberculosis are also included in the list of diseases caused or made worse by smoking.Heart attacks, strokes, and blood vessel diseasesSmokers are twice as likely to die from heart attacks as non-smokers. Smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles. Smoking also affects the walls of the vessels that carry blood to the brain (carotid arteries), which can cause strokes. Smoking can cause abdominal aortic aneurysm, in which the layered walls of the body’s main artery (the aorta) weaken and separate, often causing sudden death. And men who smoke are more likely to develop erectile dysfunction (impotence) because of blood vessel disease.

3. Why is it so hard to quit smoking?

Thanks to the anti-smoking propaganda over the past decades, people now are quite aware of the health risk associated with smoking, and more than 70% of adult cigarette smokers had made at least one serious attempt to quit during their smoking careers. But the result is not as promising as it sounds. Among smokers that choose to quit, only 4% to 7% can succeed by themselves. So why is it so hard to quit smoking?

Smoking tobacco is both a physical addiction and a psychological habit. The nicotine from cigarettes provides a temporary—and addictive—high. Eliminating that regular fix of nicotine will cause your body to experience physical withdrawal symptoms and cravings. Because of nicotine’s “feel good” effect on the brain, you may also have become accustomed to smoking as a way of coping with stress, depression, anxiety, or even boredom.
At the same time, the act of smoking is ingrained as a daily ritual. It may be an automatic response for you to smoke a cigarette with your morning coffee, while taking a break from work or school, or during your commute home at the end of a long day. Perhaps friends, family members, and colleagues smoke, and it has become part of the way you relate with them. To successfully quit smoking, you’ll need to address both the addiction and the habits and routines that go along with it.
Whether you’re a teen smoker or a lifetime pack-a-day smoker, quitting can be tough. But the more you learn about your options and prepare for quitting, the easier the process will be. With the right game plan tailored to your needs, you can break the addiction, manage your cravings, and join the millions of people who have kicked the habit for good.

4. What are cravings or urges?

There are at least three kinds of cigarette urges that ex-smokers have:

  1. nicotine withdrawal urges
  2. habit urges
  3. memories of smoking


Over your years of smoking, your body got used to nicotine. Many of your organs made changes to get used to the effects of nicotine. These include your brain and your heart. These changes let you smoke without feeling all the effects of nicotine that you felt when you first started smoking. For example, after years of smoking you probably did not feel light-headed after a cigarette. Your pulse no longer raced as fast. But, when you quit smoking your body adjusted again. This time it adjusted to not getting nicotine. Your brain, heart, and other organs now had to get used to you not smoking! This change can be unpleasant and is called nicotine withdrawal. The symptoms of nicotine withdrawal include:

  • lightheadedness (feeling dizzy)
  • sleep problems
  • decreased heart rate
  • craving for cigarettes
  • increased appetite
  • poor attention or concentration
  • headache
  • nausea (sick to your stomach)
  • depression (feeling sad)
  • irritability (feeling grouchy)
  • anxiety (feeling tense)
  • constipation

Most people do not have all of these symptoms, but they do have some. Nicotine withdrawal begins about 20 minutes after your last cigarette. If you do not smoke, it lasts between one and two weeks. There are three ways to stop these unpleasant symptoms.


Habit urges occur when an ex-smoker is in a situation that is tied to smoking for that person. Here are some examples of habit urges:

  1. Tom always smoked while talking on the telephone. Whenever the phone rang, he would reach for his pack and light a cigarette. Now he has quit smoking for three weeks. But whenever he hears the telephone ring he still wants a smoke.
  2. Patty had been smoke-free during her pregnancy and for three months since giving birth, and she was proud of it. Last week, while driving her daughter to day care, she was rear-ended by another driver. She was not hurt, but her baby was bruised on her forehead. One person at the scene of the accident was smoking, and Patty felt that she too needed a cigarette to deal with the stress.

Here is a list of some common triggers for habit urges:

  • talking on the phone
  • driving a car
  • seeing cigarettes or smelling smoke
  • drinking coffee
  • drinking alcohol
  • feeling bored
  • sitting outside
  • feeling STRESSED
  • being with someone who is smoking (like a girlfriend, husband, or coworker)
  • having a fight with family
  • anxiety (feeling tense)
  • finishing a job
  • eating
  • celebrating
  • returning to the workplace
  • trying to solve a problem
  • feeling lonely
  • feeling angry, sad, or nervous
  • social events(with smokers or nonsmokers)


You may have been a smoker for many years. You may have lived much of your life as a smoker. If you smoked a pack per day, you took about 70,000 puffs on cigarettes each year. There are few things that you have done as many times, besides breathing. Thus, you will have memories of smoking. You may see someone smoking and recall that you used to do that. Other things may trigger memories of when you were a smoker - an old song, a certain food, old friends, etc.

5. Breath Carbon Monoxide Test

What does a carbon monoxide breath test show?
Key Terms:

  • PPM (Parts Per Million) – Unit of measure. As it relates to this test, the reading means one part CO in one million parts of air (breath).
  • %COHB (Carboxyhemoglobin) – COHB reading shows the percentage of vital oxygen that has been replaced in the bloodstream by CO.

A CO breath test shows the amount of carbon monoxide in the breath (ppm), which is an indirect, non-invasive measure of blood Carboxyhemoglobin (%COHb), which is the level of CO in the blood.

The percentage of COHb is the proportion of red blood cells carrying CO instead of oxygen. So if your CO reading is 5% (about 30 ppm) it means 5% of your red blood cells are carrying CO instead of oxygen. This creates a shortage of oxygen, and the body needs oxygen to live.

The CO reading is going to be highest later in the day, when the smoker has smoked most or all of their daily ration of cigarettes and have built up a high CO level. CO leaves the body rapidly and the half-life is about 5 hours. Within 24 to 48 hours of not smoking, smokers will be at non-smoker levels – which means the CO reading doesn’t tell you exactly how many cigarettes have been smoked; rather it is an indicator of how much smoke a smoker is inhaling and how much of the cigarette they are smoking, which is why experts believe that the CO breath test is a good indicator of a smoker’s dependence to nicotine.

Resources and references

  1. Tobacco in Australia – A comprehensive online resource of national tobacco control program.
  2. World Health Organization. "WHO report on the global tobacco epidemic, 2008: the MPOWER package." (2008).
  3. Shahab, Lion. "Why use CO-verified 4-week quit rates as the primary measure of stop smoking service success?." (2014).
  4. Hughes, John R. "Motivating and helping smokers to stop smoking." Journal of general internal medicine 18.12 (2003): 1053-1057.
  5. Guide to Quitting Smoking – Ways to improve your chances of quitting smoking and dealing with both mental and physical addiction. (American Cancer Society)
  6. Covita – The Smokerlyzer® monitors instantly and non-invasively measure the amount of CO on a smoker’s breath
  7. Tobacco Research and Intervention Program at the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida

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