The nicotine left in your body after smoking also can aggravate stress. Worse, roughly half a million North Americans die of smoking-related illnesses each year. That’s 20 percent of all deaths from all causes. We already know that smoking causes lung cancer. But did you know that smokers are also twice as likely to develop heart disease? A single cigarette affects your body within seconds, increasing heart rate, blood pressure, and the demand for oxygen (because of constricted blood vessels and carbon monoxide, a byproduct of cigarettes). The greater the demand for oxygen, the greater the risk of heart disease.

Lesser-known long-term effects of smoking include a lowering of HDL, or good cholesterol, and damage to the lining of blood vessel walls, which paves the way for arterial plaque formation. In addition to increasing your risk for lung cancer and heart disease, smoking can lead to stroke, peripheral vascular disease, and a host of other cancers. Just take a look at some of the things you’ll gain by quitting this habit:

• Decreased risk of heart disease

• Decreased risk of cancer of the lung, esophagus, mouth, throat, pancreas, kidney, bladder, and cervix

• Lower heart rate and blood pressure

• Decreased risk of lung disease (bronchitis, emphysema)

• Relaxation of blood vessels

• Improved sense of smell and taste

• Healthier teeth

• Fewer wrinkles

Not everyone can quit smoking cold turkey, although it’s a strategy that many have used successfully. (Some coldturkey quitters report that keeping one package of cigarettes within reach lessens anxiety.) The symptoms of nicotine withdrawal begin within a few hours and peak at twenty-four to forty-eight hours after quitting. You may experience anxiety, irritability, hostility, restlessness, insomnia, and anger. For these reasons, many smokers turn to smoking cessation programs, which can include some of the following:

Behavioral counseling. Group or individual counseling can raise the rate of abstinence 20 to 25 percent. This approach to smoking cessation aims to change the mental processes of smoking, reinforce the benefits of nonsmoking, and teach skills to help the smoker avoid the urge to smoke.

Nicotine gum. Nicotine gum (Nicorette) is now available over the counter. It works as an aid to help you quit smoking by reducing nicotine cravings and withdrawal symptoms. Nicotine gum helps you wean yourself from nicotine by allowing you to gradually decrease the dosage until you stop using it altogether, a process that usually takes about twelve weeks. The only disadvantage of this method is that it caters to the oral and addictive aspects of smoking (rewarding the urge to smoke with a dose of nicotine).

Nicotine patch. Transdermal nicotine, known as the patch (Habitrol, Nicoderm, Nicotrol), doubles abstinence rates in former smokers. Most brands are now available over the counter. Each morning, you apply a new patch to a different area of dry, clean, hairless skin and leave it on for the day. Some patches are designed to be worn a full twentyfour hours. However, the constant supply of nicotine to the bloodstream sometimes causes vivid or disturbing dreams. You can also expect to feel a mild itching, burning, or tingling at the site of the patch when it is first applied. The nicotine patch works best when it is worn for at least seven to twelve weeks, with a gradual decrease in strength (nicotine dosage). Many smokers find it effective because it allows them to tackle the psychological addiction to smoking before they deal with physical symptoms of withdrawal.

Nicotine inhaler. The nicotine inhaler (Nicotrol inhaler) delivers nicotine orally via inhalation from a plastic tube. Its success rate is about 28 percent, similar to that of nicotine gum. It’s available only by prescription in the United States and has yet to make its debut in Canada. Like nicotine gum, the inhaler mimics smoking behavior by responding to each craving or urge to smoke, a feature that has both advantages and disadvantages to the smoker who wants to get over the physical symptoms of withdrawal. The nicotine inhaler should be used for a period of twelve weeks.

Nicotine nasal spray. Like nicotine gum and the nicotine patch, the nasal spray reduces craving and withdrawal symptoms, allowing smokers to cut back gradually. One squirt delivers about one milligram of nicotine. In three clinical trials involving 730 patients, 31 to 35 percent were not smoking at six months. This compares to an average of 12 to 15 percent of smokers who were able to quit unaided. The nasal spray has a couple of advantages over the gum and the patch. First, nicotine is rapidly absorbed across the nasal membranes, providing a kick that is more like the real thing. Also, the prompt onset of action plus a f lexible dosing schedule benefits heavier smokers. Because the nicotine reaches your bloodstream so quickly, nasal sprays have a greater potential for addiction than do the slower-acting gum and patch.

Alternative therapies. Hypnosis, meditation, and acupuncture have helped some smokers quit. In the case of hypnosis and meditation, sessions may be private or part of a group smoking cessation program.