The Smoker Aid Program

UNIVERSITY OF GENEVA
Institute of Social and Preventive Medicine
CMU. CP. CH-1211 Geneva 4. Switzerland. Fax: +41.22.379.59.12. E-mail:

Your personal evaluation

Mr Master

Sep 12, 2002.

Dear Mr Master,

This evaluation is based on your responses to our questionnaire. It includes advice and information that indicate how you can progress in this program for yourself. This program includes a series of reports, of which this is the first. After some time, complete our questionnaire again. We will send you a new evaluation that will take into consideration possible changes made over time.

PRINT this document, save it and re-read to it from time to time. You will get the most out of it if you take notes. Underline the important passages and take note of the main points.

Your current situation

People become ex-smokers smoking by passing through a succession of steps, or "stages." You are currently in the stage known as "Preparation." In other words, you have decided to attempt to stop smoking in the next 30 days.

This is an excellent stage to begin this program. In this evaluation and in our brochures, you will find advice and information on how to properly prepare your attempt to quit smoking.

Your attitude towards smoking

People who quit smoking – and then, avoid relapsing – have undergone profound changes in what they think about the pros and cons of cigarettes. The following paragraphs are based on your responses to questions about the drawbacks of smoking.

Your responses indicate that you are aware of the drawbacks of smoking. This is a very good result. Smokers who are well aware of the drawbacks of cigarettes have greater chances of successfully quitting smoking.

By stopping smoking, you also protect your children

Children of smokers are about 2 times more likely to start smoking than are children of non-smokers. By stopping smoking, you reduce the risk of your children themselves starting to smoke.

Children of smokers are more at risk of respiratory infections, asthma and chronic bronchitis than are children of non-smokers. "Parents smoke, children choke."

The risk of sudden infant death (SIDS) is much higher when the parents smoke than if they are non-smokers.

This is what smoking costs you

Based on your responses, we have calculated that you currently spend 1,095 dollars per year for your cigarettes, or 12,931.95 dollars for 10 years including 3% interest.

Write below what can buy with this money:

- each year: _______________________________

- or after 10 years: _______________________________

Smoking less means risking less

Based on your responses, we have calculated that you currently smoke 10,950 cigarettes per year. Maybe you could smoke only half this number of cigarettes, keeping only the cigarettes that you really like and dropping those that you light automatically.

It is better to quit smoking, but if you cut by half your consumption of cigarettes:

you decrease your risk of getting ill, in particular your risk of cancer.
you spare money.
you increase your chances of progressing in this programme, because the less you smoke the more likely you are to be able to quit smoking.

Number of cigarettes smoked per day by participants in this survey.

Consumption for jim murray
30 cigarettes per day.

PS: On average, participants in this survey smoke 20 cigarettes per day.

How smoking shortens your life

On average, smokers loose 11 minutes of life for every cigarette they smoke. Your answers on your cigarette consumption enable us to compute that each and every day, your smoking habit reduces your life expectancy by 5.4 hours. Each year, your smoking habit reduces your life expectancy by 167.2 days. These figures are not exaggerated, they are estimated from very sound epidemiologic studies that compared the life expectancy of smokers and non-smokers, and that concluded that on average, smokers live many years less than non-smokers. These figures really represent the number of life years that your smoking habit takes away from you.

High-risk situations and ways to deal with them

In order to stop smoking and then to avoid a relapse, it is important to know how to resist the urge to smoke when it comes. This section holds a report of your responses concerning your capacity to refrain from smoking in risky situations.

Your responses indicate that you should improve your mastery of the situations that give you the urge to smoke. For this:

Reduce the number of cigarettes you smoke each day. By absorbing less nicotine, you reduce your physical dependence –-and hence–- your urge to smoke.
Also, ask yourself under which circumstances the urge to smoke creeps up on you and how to go about resisting it.
In the course of each day, do the following experiment: keep a copy of the "Smoking Journal" that can be found on page 15 of our brochure "It is final, I am quitting smoking" in your pack of cigarettes. Fill it out before lighting each cigarette. Many smokers have said that journal has "opened their eyes" about a habit that they thought they understood.
Train yourself. Just like for everything else in life, practice makes perfect. Practice not smoking after a meal. From time to time, drink your coffee without lighting a cigarette. Space out the cigarettes. Little victories like this can help you to make progress.
Inform yourself at this time about the substitution products that contain nicotine (patch, chewing gum and nasal spray). By reducing the urge to smoke, these products multiply the chances of your successfully attempting to stop smoking by 2 to 3 times.

High risk situations for you:

Your responses indicate that to progress in this program, you should improve your ability to refrain from smoking when you feel poorly, e.g., nervous, angry or demoralized. Like millions of other ex-smokers, you are perfectly capable of facing your problems without resorting to cigarettes. To get there more easily, follow the advice given in this program:

Take a few minutes now to ask yourself if cigarettes really help you to deal with your problems, and how you could manage without resorting to a cigarette.
Why not do the following experiment for a few days: keep a copy of the "Smoking Journal" in your pack of cigarettes that can be found on page 1 de our brochure "It is final, I am quitting smoking" and fill it out before lighting each cigarette. Many smokers have said that the journal has "opened their eyes" about a habit that they thought they understood.
A good way of progressing in this program would be to practice from time to time dealing with these negative feelings without smoking. In this field, just as in others, practice makes perfect: "You become a gymnast by doing gymnastics" and it is by practicing not smoking in these situations that make you want to smoke that will lead you to become an ex-smoker. Little successes like this increase your confidence in yourself and allow you to progress in this program.

Strategies to progress in this program

In this section, we inform you of strategies that you can use by yourself to stop smoking. These strategies have been used successfully by smokers who were, like you, in the "Preparation" stage and subsequently stopped smoking. You need to know that stopping smoking is not just a question of willpower. It is also a matter of expertise and technique. This knowledge and technique is the subject of the following paragraphs.

Distract yourself

This strategy consists of using thoughts and activities that distract you to resist the urge to smoke.

Your responses indicate that you will need to use distracting thoughts and activities more often. Whenever the urge to smoke comes, instead of taking a cigarette, you could:

Do something else,
Breathe several times slowly and deeply,
Focus yourself on your work or on a detail-rich task,
Wait 5 minutes so the urge to smoke passes,
Tell yourself: "Do I really need a cigarette right now?,"
Drink some water,
Eat some fruit,
Chew some sugarless chewing gum,
Occupy your hands (manipulate a pencil etc.),
Leave where you are,
Go for a walk.

By using these techniques, you will show yourself how relatively easy it is to skip some cigarettes. This is a good way to prepare your attempt to stop.

Inform yourself and think carefully about the consequences of smoking

This strategy consists of informing yourself about the consequences of smoking and to admit that smoking is dangerous to you personally.

Your responses indicate that you are aware of the consequences of smoking for your health. This is an excellent result. People like you – who understand and admit that smoking is extremely dangerous to the health – have greater chances of stopping successfully.

Ask for the support of those around you

This strategy consists of looking to your friends, colleagues and family for support and encouragement for your efforts to stop smoking.

Your responses suggest that you are using this strategy. This is a very good result. Your attempt to stop smoking will have more chances of being successful if those around you support you. Also, look to professionals for help. Inform yourself about the specialized assistance that is available on withdrawal from nicotine (addresses in our brochures).

Seize control

This strategy consists of actively taking control of your smoking habit.

Your results indicate that you need to make an extra effort to control your smoking. In the field of smoking cessation, just as in other fields, practice makes perfect. To best prepare your attempt to stop, from time to time, try:

Delaying the first cigarette of the day for as long as possible
Avoiding smoking after meals
Taking your coffee without a cigarette
Placing yourself in the non-smoking areas in public places
Avoiding smoking in the presence of children as well as in your car, etc.
Spending a whole evening without smoking
Spending 24 hours without smoking (you will see how to deal with all the situations of daily life without smoking)
Smoking only half of your cigarettes (the last half of cigarettes is more toxic than the first half).
Waiting 5 minutes for the urge to smoke to pass

Little successes like this increase your confidence in your capacity to control your smoking habit. Self-confidence is an essential element of successfully stopping smoking.

Reconfirm your motivation to stop smoking

This strategy consists of thinking more carefully about the advantages of stopping smoking and setting a concrete date to attempt to stop.

Your responses indicate that you are using this strategy. This is a very good result. Go ahead and:

Make an absolute decision to stop smoking. Many ex-smokers have told us that the key to their success was this firm self-commitment
If you have not already done it, fix the date of your attempt to quit –- right now (in the next 30 days) and hold yourself to this date.
Read our brochures "It is final, I am quitting smoking" and "I just quit smoking". In them, you will find the necessary advice to succeed at your attempt.

Smoking cessation and weight gain

You said that you fear to gain weight, if you quit smoking. Here is some information on this topic:

Nicotine modifies the metabolism of fat (lipids) and increases the expenditure of energy. This is why male smokers weigh on average 3 kilograms less than male nonsmokers, even though they eat the same amount of food. Thus the body weight of smokers is lower than the normal weight of men of the same age, this under-weight can be dangerous for heath.
After quitting smoking, ex-smokers catch up with this weight deficit. The weight gain which follows smoking cessation is moderate (3 kilograms on average in men), and more than half male ex-smokers (55%) gain less that 3 kilograms after quitting smoking.
This weight gain is caused by nicotine withdrawal, and can be delayed if you use nicotine replacement products (nicotine patch, gum, nasal spray, inhalator or tablet).
Instead of worrying so much about gaining weight that you drop the idea of quitting smoking, you had better modify your attitude towards your body image. By quitting smoking, you will catch up with the normal weight of non-smokers of your age. On average you will not exceed this weight. Smoking is an unhealthy way of controlling one's weight.
Do one thing at a time: quit smoking first, then manage a possible weight gain. Do not go on a too strict diet, since this will represent too many difficulties at the same time.
Ex-smokers tend to eat more sugar, which is a food high in calories. To avoid gaining weight, avoid sugar and fat (lipids).
Do more sports, be physically active, it is an effective way of avoiding to gain weight. It also increases your chances of quitting smoking successfully.
To delay the weight gain, see a dietitian or take a medication which decreases appetite.
If you quit smoking, your hair and clothes will not smell like smoke anymore, and you will have a better breath. Thus your appearance may improve, even if you gain weight.

Nicotine-containing products

Your responses indicate that you do not intend to use a nicotine-containing product the next time you attempt to quit smoking. However, considering your level of addiction to nicotine, these products could increase your chances of quitting successfully.

Nicotine is a drug that causes a physical dependence and unpleasant withdrawal symptoms when you stop absorbing it. Among those who smoke daily, 9 out of 10 are dependent on nicotine and will feel these symptoms when they quit smoking. These symptoms may include:

Irresistible urge to smoke,
Anxiety,
Irritability, impatience, nervousness,
Headaches, insomnia,
Low feelings or depression,
Difficulty in concentrating.

By reducing withdrawal symptoms, or even by eliminating them altogether, nicotine-containing products increase your chances of successfully quitting by 2 to 3 times. Many scientific studies have demonstrated the effectiveness of these products. We strongly recommend that you use them. They will render your attempt to quit much more comfortable.

These products exist in 5 different forms. Depending on the country where you live, all forms are not available and some forms are available only with a prescription from a doctor.

The patch diffuses nicotine slowly through the skin all day long. Use it for the entire time recommended, between 6 and 12 weeks.
Chewing gums are effective if you follow the instructions strictly (chew with the specified technique, take the number of pieces specified, use for the entire time recommended).
Nasal sprays immediately relieve withdrawal symptoms and make the need to smoke disappear.
Inhaler, replaces the gestures of smoking and relieves withdrawal symptoms.
Sublingual tablets melt slowly under the tongue.

Here are the reasons given by participants of our survey as to why they prefer not to use these products, as well as responses that we gave to them:

"I do not like the idea of using a medication to help me quit smoking."

It is not shameful to use a medication to free yourself from a drug – like nicotine – that causes physical dependence.

"These products do not work."

Though many scientific studies have shown these products are effective, they do not guarantee success. The use of these products does not free you from the efforts of changing your habits.

"I can stop smoking just fine without these products. Willpower is enough."

A poorly placed sense of pride can lead you to a relapse. These products can double to triple your chances of success. Have as many winning cards on your side as possible!

"These products cost too much."

It is true that these products are expensive (The patch costs 120 US dollars per month). It is, however, much less than you spend each year to smoke.

"I’m afraid of the side effects of these products."

These products have very few side effects, and the effects are banal. The patch can trigger itching or temporary, localized reddening of the skin. The spray can cause temporary irritation of the nasal membranes. It is important to know that the nicotine patch, nasal spray, inhaler, sublingual tablet and chewing gum are not dangerous to your health. In particular, the risk of cardiovascular accident is not increased for people who use these products. This also applies to patients with heart disease.

"I’m not dependent on the nicotine."

These products increase your chances of success even if you smoke only 10 cigarettes per day. Start by accepting the idea that if you smoke more than 5-10 cigarettes per day, you will be dependent on the nicotine. A good way to see if you are dependent is to stop smoking for 24 hours. People who feel absolutely no withdrawal symptoms in the course of these 24 hours are probably not very dependent. Others will benefit a lot from using nicotine-containing product.

"My problem is not the physical dependence, but getting rid of an old habit."

It will be easier for you to attack the other aspects of your smoking habit if the problem of physical dependence is resolved by using products that contain nicotine.

Print and read our brochures: they are an important part of this program
You will find many useful suggestions in our brochure "It is final, I am quitting smoking", designed for smokers, who –like you– have found themselves in the Preparation stage. We recommend that you print this brochure, as well as the brochure entitled "I just quit smoking." You can also order printed and illustrated versions of these brochures. We are happy to send you these brochures by mail (Address: Library. IMSP. CMU. Case postale. CH-1211 Geneva 4. Switzerland).

Save your personal code
This program is most effective if you do it over time. After a while, fill out our questionnaire again. You will receive a new evaluation that includes a report of the changes in the intervening time. So that we can find your previous responses, it is VERY IMPORTANT that you save your personal code and indicate it to us in the next questionnaire. (This code appears on the first page of this document, after you name, for example: abcde).

Now, act!

From all of the activities suggested in this evaluation, choose 5 the activities that you will do now to make progress in this program:

The 5 activities that I will do from now on:

1

2

3

4

5

We wish you the best of luck and send you our warmest wishes.

Jean-François Etter, PhD. In charge of the "stop-tabac.ch" web site.

This program was created by the Institute of Social and Preventative Medicine of the University of Geneva, with the support of the Swiss League against Cancer (Ligue suisse contre le cancer), the Swiss National Fund for Scientific Research (Fonds national suisse de la recherche scientifique), the Swiss-Romande Lottery (la Loterie de la Suisse Romande), the Department of Social Action (Département de l'Action sociale), the Geneva Department of Public Health (la santé du canton de Genève, Direction de la santé publique), the Federal Office of Public Health (Office fédéral de la santé publique), The Swiss Foundation for the Promotion of Health (Fondation suisse pour la promotion de la santé), Pharmacia & Upjohn, the Swiss Pulmonary League (Ligue pulmonaire suisse) and the Jura Canton Health Service (Service de la santé du canton du Jura). The computer system that produced this personalized evaluation was created in Geneva by ABC Network (www.abc.ch) and is currently developed and maintained by the Health on the Net Foundation (HON) (www.hon.ch). We thank the Swiss Association for the Prevention of Smoking (Association suisse pour la prévention du tabagisme (AT) and the Cipret-Genève for their help and advice. The evaluation paragraphs were translated from French into English by www.mcart.org

This program was created by, and is run under the direction of Jean-François Etter, PhD ( ).

If you have an Internet site, we appreciate your linking to the site http://www.stop-tabac.ch.

Your opinion on this personalized evaluation:

We would like to know what you think of this document. Thank you for sending this document annotated with your comments and suggestions at the following address: "Smoker Aid Program" IMSP. CMU. CP. CH-1211 Geneva 4. Switzerland. Fax: +41.22.379.59.12. E-mail:

Opinion form