TO: STATE Health Reporters
FR: YOUR ORGANIZATION’S NAME AND CONTACT STAFF AND NUMBER
DATE : March XX, 2009
RE: Resources to help smokers quit as federal cigarette tax increase goes into effect
On April 1st, the federal tax on cigarettes will increase by 62 cents per pack. That means a
pack-a-day smoker will spend more than $X,XXX on cigarettes in a year; a 2-pack-a-day
smoker will spend almost $X,XXX. (See attached table for state-specific data to fill in blanks). As a result, many of our [INSERT STATE] smokers will be motivated to quit smoking and seek
out services to help them.
But quitting smoking is not easy. A whopping 97 percent of those who try to quit “cold turkey” 1usually relapse. But it can be done, and the benefits to smokers who quit and their friends and
loved ones are enormous. That’s why it’s critical for your readers to be well informed about the
counseling, medication and other services available to help smokers quit. Accessing accurate
information and the right resources can often mean the difference between success and failure.
As smokers adjust to higher cigarette prices, we encourage you not only to report on the tax
increase itself, but also help ensure that those smokers who now want to quit are armed with
the information they need to achieve success.
For your consideration, we’ve included some materials that you may find helpful as you decide
how to inform your readers about how they might quit and what resources are available locally:
(1) potential “quit smoking” story ideas; (2) a smoking cessation overview and (3) a list of
national and local smoking cessation resources. If you have questions, or are interested in
speaking with a local stop smoking expert, please call XXXXX.
1. Potential “Quit Smoking” Story Ideas
? “Quit Now...and How” – Provide smokers who want to quit with information about the
health, financial and social benefits of quitting. Include quitting tips and a list of local and
national resources that can help smokers successfully quit (see section 7 of this memo).
? “Diary of a Quitter” – Identify a local smoker who wants to quit. Chronicle his or her
quit attempt from day one, including insights into why the smoker decided to quit,
method the smoker is using to quit and the challenges/triumphs the smoker encounters
(e.g., fears, frustrations, accomplishments, advice), and views from friends, spouses, or
relatives of the smoker trying to quit.
? “Non-Smoker’s Guide to Quitting Smoking” – Offer tips to non-smokers on the “do’s
and don’ts” of talking to a loved one about quitting, and suggest ways they can help a
smoker quit successfully.
? “Helping Pregnant Smokers Quit” – Smoking during pregnancy puts mothers and
babies at risk for complications such as premature birth, low birth weight, or miscarriage.
Research suggests that women are much more likely to give up smoking when they are
pregnant than at any other time. Develop an article about the health risks associated
with smoking during pregnancy and the resources available to help pregnant smokers
quit for good. (The National Partnership for Smoke-Free Families has extensive
information and links to other resources at www.smokefreefamilies.tobacco-
2. Why Quit? The Benefits of Quitting Smoking
2Smoking remains the leading cause of preventable death in the United States, accounting for 3more than 400,000 deaths in the United States each year. Smokers who quit can live longer and healthier lives, and reduce their chances of having a heart
attack, stroke, cancer and other tobacco-caused diseases. Pregnant women who stop smoking
can increase their chances of giving birth to healthy babies. Smokers who quit improve the
health of those around them by reducing their exposure to secondhand smoke. Parents who 4quit significantly reduce the chances that their children will smoke. Smokers who quit also
have extra money to spend on things other than cigarettes.
Quitting also produces fast, major health benefits, some within minutes from smoking that last
cigarette. Examples include:
? At 20 minutes after last cigarette: blood pressure decreases, pulse rate drops, and
body temperature of hands and feet increases.
? At 8 hours after quitting: carbon monoxide level in blood drops to normal, and oxygen
level in blood increases to normal.
? At 24 hours after quitting: chance of a heart attack decreases.
? At 48 hours after quitting: nerve endings start regrowing, and ability to smell and taste is
? After 2 weeks to 3 months: circulation improves; walking becomes easier, lung function
? After 1 to 9 months: coughing, sinus congestion, fatigue, shortness of breath decreases.
? After 1 year: excess risk of coronary heart disease is decreased to half that of a smoker.
? After 5 to 15 years: stroke risk is reduced to that of people who have never smoked.
? After 10 years: risk of lung cancer drops to as little as one-half that of continuing
smokers; risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas
decreases; and risk of ulcer decreases.
? After 15 years: risk of coronary heart disease is similar to that of people who never 5smoked; and risk of death returns to nearly the level of people who never smoked.
3. The Three Elements of Tobacco Addiction
Quitting smoking is difficult because nicotine is a highly addictive drug. People usually try two
or three times, often more, before finally succeeding in quitting. Fortunately, scientific studies
have identified steps smokers can take that can help them quit and quit for good, as well as
effective counseling and medication that can help them.
To maximize chances of quitting, smokers need to approach their attempt from three angles:
Mind: For many smokers, cigarettes can provide a false sense of comfort when their
emotions get the best of them.
Body: The nicotine in cigarettes causes a physical addiction.
Habit: Smokers often have a routine of having a cigarette in specific situations – with a
cup of coffee, after a meal or on the phone.
Following are tips for fighting each of these elements of tobacco addiction:
4. For Your Mind: Quitting with Support
Studies have shown that smokers have a better chance at quitting successfully if they have help.
Following are several ways a smoker can get that support:
Talk to Family and Friends Tell family, friends and co-workers that you are going to quit and you want their support. Ask
them not to smoke or leave cigarettes out.
Seek Advice from a Health Care Provider
In 2008, the U.S. Public Health Service (PHS) updated its Clinical Practice Guideline for
physicians, Treating Tobacco Use and Dependence. The PHS Guideline emphasized that the
more frequently a tobacco user interacts with the health care professional guiding his/her quit
attempt (e.g., doctor, dentist, pharmacist, nurse, psychologist, smoking cessation counselor),
the greater the chances the tobacco user has of successfully quitting and remaining abstinent.
Smokers should talk to their health care provider about quitting.
Take Advantage of Counseling Get individual, group or telephone counseling. The more counseling you have, the better your
chances are of quitting. Programs are given at local hospitals and health centers. Call your
local health department for information about programs in your area.
Every state in the U.S. offers some type of telephone-based cessation counseling service.
Research now exists that demonstrates the effectiveness of quitlines. The U.S. Public Health
Service found that quitline counseling can more than double a smoker’s chances of quitting and quitline counseling combined with medication (such as nicotine replacement therapy) can more
than triple the chances of quitting.
Quitlines reach two to three percent of smokers each year. With ongoing support (e.g.,
promotion, outreach and health system integration), quitlines have the potential to reach seven
to ten percent of smokers each year, a marked improvement over regular counseling programs,
which only reach less than one percent of smokers per year.
What’s more, quitlines have the potential to reach large numbers of tobacco users, including low
income, rural, elderly, uninsured and racial/ethnic populations who may not otherwise have
access to cessation services.
In [STATE], smokers can reach the [STATE] Quitline by calling 1-866-XXX-XXXX. The
[STATE] Quitline is a free service that offers information about tobacco use cessation,
telephone counseling sessions, and referrals to local quit smoking programs, as well as follow-
up and support.
5. For Your Body: How Medication Can Help
In addition to counseling and other support, the PHS Guideline strongly recommends the use of
drug treatment that is approved by the U.S. Food and Drug Administration (FDA) to increase the
likelihood of a successful quit attempt.
Nicotine replacement therapies (NRTs) help reduce craving and nicotine withdrawal symptoms
by providing a temporary alternative source of nicotine, without exposing the quitter to the
harmful tars and carbon monoxide from cigarette smoke. The FDA-approved NRT treatments
? Nicotine Gum (e.g., Nicorette or also available in generic or store-branded nicotine
polacrilex gum): proven safe and effective and increases long-term quit rates (over
placebo – no drug treatment) by 30 to 80 percent. Available only as an over-the-
? Nicotine Patch (e.g., NicoDerm CQ, Clear NicoDerm CQ): proven safe and effective
and approximately doubles long-term quit rates (over placebo – no drug treatment).
Available both over-the-counter and as a prescription medication.
? Nicotine Lozenge (i.e., Commit): approved by the FDA in October 2003 as a safe and
effective treatment for quitting smoking. One study demonstrated the lozenge can 7double a smoker’s chances of quitting. Available only as over-the-counter product.
? Nicotine Inhaler (e.g., Nicotrol Inhaler): proven safe and effective and more than
doubles long-term quit rates (over placebo – no drug treatment). Available only as a
? Nicotine Nasal Spray (e.g., Nicotrol NS): proven safe and effective and more than
doubles long-term quit rates (over placebo – no drug treatment). Available only as a
The recommended FDA-approved non-nicotine medication is:
? Bupropion SR (i.e., Zyban) has an established record of clinical efficacy and
approximately doubles long-term abstinence rates (over placebo – no drug treatment).
This is a non-nicotine medication and is available only in prescription as either a
smoking cessation product (Zyban) or an anti-depressant (Wellbutrin).
? Varenicline (i.e., Chantix) is the most recent non-nicotine medication to be approved
by the FDA. It is available only as a prescription medication.
Combining medications such as these with behavioral support will give smokers their best
chance of quitting, but either approach alone still provides significant benefits over quitting
6. For Your Habit: Changing Your Ways
Smokers trying to quit need to learn new skills and behaviors to distract themselves from the
urge to smoke in situations where they used to do so. Some tips for getting through these
? Talking to someone, going for a walk or getting busy with a task.
? Change routine. Use a different route to work. Drink something non-
caffeinated instead of coffee. Eat breakfast in a different place.
? Do something to reduce stress, like take a bath, exercise, or read a book.
? Drink a lot of water and other fluids.
7. National and Local Smoking Cessation Resources:
? www.smokefree.gov – This site was created by the National Cancer Institute (NCI) in
conjunction with the Centers for Disease Control and Prevention (CDC) and the American
Cancer Society. It includes an online step-by-step cessation guide, a list of local and state
telephone quitlines, information about NCI’s national telephone quitline (1-877-44U-QUIT or
1-877-448-7848) and downloadable publications on quitting smoking.
? Office of the Surgeon General’s resources on tobacco cessation –
? Quit.com – www.quit.com – Features smoking cessation tips and a “Frequently Asked
Questions” section. Visitors can fill out a “personal quit profile” to find out which section of
the site will be most helpful to them.
? American Lung Association, 800-LUNG-USA (1-800-586-4872) – www.lungusa.org:
Features smoking statistics and “Freedom from Smoking,” a free 24-hour smoking
cessation support program on the Internet.
? American Cancer Society, 1-800-ACS-2345 – www.cancer.org ? American Legacy Foundation – www.americanlegacy.org
? American Heart Association – www.americanheart.org
? CDC Office on Smoking & Health –www.cdc.gov/tobacco/quit_smoking/index.htm ? National Partnership for Smoke-Free Families –
State and Local Resources [List your state and local resources here]
A list of more resources is available at www.tobaccofreekids.org/research/factsheets/pdf/0247.pdf
1 Hughes JR, Gulliver SB, Fenwick JW, Valliere WA, Cruser K, Pepper S, Shea P, Solomon LJ, Flynn BS.
Smoking cessation among self-quitters. Health Psychol. 1992;11(5):331-4. 2 Ali H. Mokdad, James S. Marks, Donna F. Stroup, and Julie L. Gerberding Actual Causes of Death in
the United States, 2000 JAMA, Mar 2004; 291: 1238 - 1245. 3 CDC, "Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --
United States 2000-2004," MMWR 57(45), November 14, 2008
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm. 4 Bricker JB, Leroux BG, Peterson AV Jr, Kealey KA, Sarason IG, Andersen MR, Marek PM. Nine-year
prospective relationship between parental smoking cessation and children's daily smoking. Addiction.
2003 May; 98(5):585-93.
Chassin L, Presson C, Rose J, Sherman SJ, Prost J. Parental smoking cessation and adolescent
smoking. J Pediatr Psychol. 2002 Sep;27(6):485-96. 5 When Smokers Quit – The Health Benefits of Quitting. American Cancer Society,
http://www.cancer.org/docroot/SPC/content/SPC_1_When_Smokers_Quit.asp. The Health Benefits of Smoking Cessation: A Report of the Surgeon General (1990). U.S. Department of Health and Human
Services. Public Health Service. Center for Disease Control. Office on Smoking and Health. DHHS
Publication No. (CDC) YO-K-116. 1990, http://sgreports.nlm.nih.gov/NN/B/B/C/T/; The Health Consequences Of Smoking – Nicotine Addiction: A Report of the Surgeon General (1988), U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control. Center
for Health Promotion and Education. Office on Smoking and Health. Rockville, Maryland 20857,
http://www.cdc.gov/tobacco/sgr_1988.htm. 6 All information in this section taken from the Tobacco Use Quitelines fact sheet, prepared by the Office
on Smoking and Health, CDC and American Legacy Foundation, February 2003,
http://www.ctcinfo.org/upload/quitl_factsheet.pdf. 7 Shiffman S, Dresler CM, Hijak P, Gilburt S, Targett D, Strahs KR. Efficacy of a Lozenge for Smoking
Cessation. Arch Intern Med 2002; 162: 1267-1276