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Are you finally ready to give up years of cigarette smoking? Quitting cold turkey doesn�t work for everyone. So what�s the best smoking cessation program for you? Combine counseling and medication for best results, a top tobacco addiction expert says. Learn more here. Plus, take our smoking quiz to find out if you�re really ready to quit� More American women are making healthier choices when it comes to eating, exercising and watching their weight. So why are so many � 18%, according to the Centers for Disease Control and Prevention � still smoking? Perhaps they don�t know that 64% of women smokers will die from a smoking-related illness, such as cancer, stroke or heart attack, according to a 2008 study published in the Journal of the American Medical Association. And that 50% of women smokers will die 10-15 years earlier if they don�t stop. Or, more likely, they�re not sure which are the best ways to quit smoking. To find out how to get started on a successful smoking cessation program, we talked to a nationally recognized expert on tobacco addiction and treatment: Michael Fiore, M.D., founder and director of the Center for Tobacco Research and Intervention and a professor of medicine at the University of Wisconsin-Madison School of Medicine and Public Health. �Quitting is hard work, but it�s achievable,� he says. �In America today, more than 50 million people have successfully quit.� Fiore chaired the panel that developed the U.S. Public Health Service (PHS) Clinical Practice Guideline: �Treating Tobacco Use and Dependence,� 2008, the gold standard on smoking cessation for health-care providers. What�s the first thing you tell a woman who decides to quit smoking? The first thing I say is, �Congratulations, you�ve made the most important decision possible to protect your present and future health.� For women and their families, there�s nothing that hurts health more than tobacco use. But smoking�s dangers are long-term. Why should a woman start a smoking cessation program now? Tobacco use is also a core cause of acute illness, including upper and lower respiratory tract infections, exacerbations of asthma and exposing children to secondhand smoke. By quitting, you�re not only preserving your health for the future, but also your family�s health today. How should a woman begin a smoking cessation program? There�s no one-size-fits-all approach, but one key step is to talk to a physician, nurse practitioner or physician�s assistant, because they can provide information and smoking cessation medication. Also, call the National Quit Line, 1-800-QUIT-NOW, where counselors will work with you through the entire quitting process. Third, check out the National Cancer Institute�s website. How important is attitude in a successful smoking cessation program? As with all addictions, the desire to quit must come from the individual. As much as we want a loved one to stop smoking, if that individual isn�t ready, it�s not going to happen. Should those starting a smoking cessation program be prepared for failure at first? The average person takes 3-5 attempts before quitting for good. But every time we try we�re smarter, stronger and have learned new strategies. The key is to stay at it. The message I want to leave folks with is, �You can successfully quit.� Should smoking be treated as a chronic disease? Without question. But because our society often frames smoking as just a bad habit, people think they�re weak-willed if they haven�t broken free. I often tell smokers that, just as with hypertension and diabetes, smoking is not a weakness on your part. As with other chronic diseases, quitting often requires treatment over time, with periods of relapse and remission. Don�t beat yourself up. Focus instead on what mix of treatments you can use to successfully quit. We have many more tools in the toolbox to help people quit than we did 10 years ago. Is it harder for women to quit smoking than men? National data suggests quitting rates are similar between women and men. But when we see women in clinics, they report greater difficulty quitting. To boost the likelihood of success, both men and women should use a combination of counseling and one of the seven medications approved by the Food and Drug Administration (FDA). Is nicotine replacement therapy (NRT) typically the first step in smoking cessation medication? Does it work? Of the seven FDA-approved medicines, five contain nicotine (the patch, gum, inhaler, lozenge and nasal spray). The patch is used around the clock. The rest are used as need arises. They�re often combined, with regular use of the patch, and lozenges or gum just for urges. What smoking cessation treatment is the most successful? Two medications were shown to be more effective than all the others, according to the 2008 guidelines. They are a combination NRT (the patch with gum or lozenges) or varenicline (brand name Chantix), a pill that�s also very effective. Varenicline is equal to the combination NRT and more effective than the patch or the other NRT options used alone. Varenicline doesn�t have nicotine. How does it work? It was designed to treat tobacco dependence. It binds to the same brain receptors as nicotine and does two things: It causes a release of dopamine, which is the common neurotransmitter for pleasure, thereby blunting the urge to smoke; and second, blocks nicotine�s pleasurable effects. Varenicline simulates the effects of nicotine while blocking the reinforcing effects of nicotine. So when you take a drag of smoke, you aren�t getting any [pleasure] out of it. What�s the other major drug used in a smoking cessation program? Bupropion, an antidepressant (also prescribed under the brand name Wellbutrin), is the other FDA-approved drug and also effective as a smoking cessation aid. It�s less effective for most people than varenicline. Bupropion is particularly effective in people who get depression when they quit smoking. What are the side effects of these smoking cessation medications? Both varenicline and bupropion have an FDA black-box warning [the federal agency�s strongest] on the packaging, so discuss this with your doctor. There have been [some] people who have gotten depressed using these medications, particularly if they have a history of depression. Their biggest side effects are sleep disruption and some nausea, but most people tolerate it better over time. It�s not common for people to stop it because of these side effects. Nausea can also be a side effect of NRT � think back to sneaking your first cigarette and how you probably were nauseous. If the patient experiences nausea we would decrease the dose of nicotine in the treatment. What withdrawal symptoms can women expect when in a smoking cessation program? Quitting smoking results in a myriad of withdrawal symptoms, including irritability, difficulty concentrating, disturbed sleep, urges to smoke, increased appetite, and, for some people, depressed mood. There is probably a degree of self-medication in smoking because it releases dopamine. Thus, when you quit smoking, and you�re not stimulating dopamine release, there�s an adjustment period. But we can offer patients an incredibly powerful bridge from using deadly cigarettes to being an ex-smoker � through the use of medicine for 8-12 weeks on average together with counseling. How important is counseling? Like medication, it�s one of the two scientific research-supported treatments that boost quitting success rates. Counseling and medication combined is the best prescription. But counseling alone also has been proven to be effective, including for pregnant women (the FDA-approved drugs aren't approved for pregnant women). Counseling is readily available. And you can take advantage of online and phone-based counseling to supplement counseling from your physician. Ideally, taking advantage of all three is the best way to go for many women. It�s about upping your odds. But any will help those odds. What about alternatives such as hypnotism, acupuncture or herbal remedies? Hypnosis, acupuncture and herbs have not been shown, scientifically, to be effective. If you don�t want to use medication, I would advise counseling as a non-medicine treatment that has science behind it. Is it important to have a structured action plan to quit smoking? Definitely. It really helps because so many people are on the fence. They know they need to quit and setting up a quit smoking plan is a way to get off the fence. It�s important to have a date to go totally smoke-free and prepare for it. Get counseling. Get on one of the medications to help blunt the withdrawal symptoms. These are ways to maximize your likelihood of success. Should a woman involve her partner in her smoking cessation program? Yes. Couples develop routines and patterns around smoking, and you will need your spouse�s support. Often, the significant other doesn�t want to quit smoking at the same time, so it�s important to have a discussion. Try to get your spouse to support you even if he continues to smoke. You might ask that he not smoke in the house or in front of you, or not leave ashtrays and cigarettes out. And you should request that he try to support you as much as he can and not say things like, �If you�re going to be this crabby, I�d rather have you smoking.� What about other smoking triggers? Think about your alcohol intake. Half of people who try to quit smoking tell us that they relapsed when they drank. Alcohol relaxes us and lowers inhibition, and smoking and alcohol are intimately linked. For a month after quitting smoking, you may want to abstain from alcohol or limit yourself to one or two measured drinks per day, because it�s really hard to stay smoke-free if you�re intoxicated. Should women be prepared for weight gain when they quit smoking? On average, women gain between 5-10 pounds. We don�t have a way to prevent that. But we know that if you integrate exercise into your quit smoking plan, you can blunt that weight gain and/or prevent it. Healthy eating is important too. A lot of people have strong urges to eat when quitting and you have to be aware of it and manage it. Do you recommend exercise? Endorphins (brain signals) produced by exercise such as running or walking can help women trying to quit smoking because they elevate mood and reduce stress. Talk to your doctor before starting an exercise program, particularly if you�re over 50. The great news is, within a couple of days of quitting, most people report they have more breathing capacity. And within a month nearly everybody feels they can exercise more because the body has more oxygen than carbon monoxide and all the toxins from cigarettes. Virtually all smokers will say, �Boy, do I feel better." How can people can distract themselves in the early days of a smoking cessation program? Smoking urges come in waves, so [consider] delaying strategies that will get you through the worst of the urge � whether it�s getting up and moving, deep breathing, a glass of water, munching on a carrot stick or looking at your watch and saying, �I�m not going to take any action for an hour.� With tobacco � and virtually any drug addiction � urges come to a peak, and if you can get through that without having a smoke, it gets better. What new smoking cessation treatments are on the horizon? There�s a vaccine being tested that would prevent nicotine from reaching your brain by developing antibodies � but that�s many years off. The National Cancer Institute is doing a lot of research on developing future treatments, but you have access to effective treatments now. I wouldn�t wait. I�d quit smoking now.