As it is Great American Smokeout Day, it is important to raise awareness that people trying to quit smoking often feel a lot of shame around failed attempts.  Reframing multiple quit attempts as practice for eventual success instead of submission to multiple failures can have an enlightening effect on someone trying to quit.  Understanding these challenges and some tobacco myths and half-truths can help people get closer to quitting smoking for good.

After working for years helping people make better educated and more health supportive food and activity choices, I expanded my counseling about a decade ago to include tobacco cessation.  Tobacco is a major cause of CVD and when I looked at the data I saw that there was probably no greater single lifestyle change to lower risk of heart disease than quitting smoking for a tobacco user.1  I thought my skills as a nutrition educator would crossover well.  After all, once people learned the risks of eating too much fat or sugar and learning how to buy and prepare healthier foods, many people are able to make small but effective dietary changes that help reduce their disease risk.

I soon realized that quitting tobacco has its own distinct challenges.  To better equip myself to help tobacco users, I became a Certified Tobacco Cessation Counselor through the program at the Mayo Clinic Nicotine Dependence Center which covers everything from medications used to help people quit, brain chemistry and the neurology of nicotine addiction, and various styles of counseling that are believed to be most effective. 

Through my work helping people quit, I realized that while everyone knows today that tobacco is bad for their health, there remain myths and half-truths around tobacco use.  For example, nicotine itself while highly addictive is not harmful to health.  It is actually the hundreds of other chemicals in tobacco, some added by tobacco companies, that cause harm.  Understanding this helps many people consider nicotine replacement therapy (patches, gums, etc.) to help them quit. 

Some facts about tobacco and quitting:

  • Tobacco/nicotine dependence is a condition that can require multiple quit attempts and multimodal support . There are many evidence-based and helpful treatments and resources for quitting.
  • Tobacco users can and do quit smoking. In fact, today there are more former smokers than current smokers.
  • Tobacco use, regardless of whether it is smoked or smokeless increases the risk of heart disease (heart attacks and strokes) and cancer. The chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis. Smoking also increases the risk of lung disease (emphysema, also called chronic obstructive pulmonary disease and lung cancer).
  • Effective ways to quit smoking include: Discussion with healthcare providers, individual, group, or telephone counseling, programs delivered through mobile phones, or a combination of several of these.
  • Medications can help you quit including Nicotine Replacement Therapy (patches, gums, and lozenges) which you can get without a prescription, or prescription medications including bupropion SR (Zyban) and varenicline tartrate (Chantix). Many states have no-fee quit lines that are staffed with experienced counselors to support quit attempts at no charge.
  • While there is no one correct way to quit, research shows counseling and medication are both effective for treating tobacco dependence and using them together is even more effective than using either one alone.2-4

As a counselor, I found many people underestimate the power of their environment.  For example, people who quit and then go back into environments where they used to smoke found them to be very strong triggers for picking up tobacco again.  This can be difficult because we can’t completely rearrange our work or social environments to be free of triggers, but there are some places and circumstances that can be permanently or at least temporarily sidestepped (i.e. nightlife environments like pubs or bars where smokers collect, “smoking buddies” who share butt breaks together, etc.). 

Tobacco counselors can help their clients identify those difficult environments and situations and help reroute life when possible to avoid them or develop strategies to manage them when they can’t be avoided. Likewise there are people that can be very supportive of smokers trying to quit, and those who might not be so helpful.  Helping a client identify one from the other can help people trying to quit  to navigate these relationships. 

Telling your friends, family, and other people to whome you’re close that you’re trying to quit is a great way to reach out for support. They can encourage you to keep going, especially when you’re tempted to light up.  The financial expense is also motivating for many (though not all).  Clients often collect the money they would be spending on cigarettes, dip, or snuff and save it to buy something nice and rewarding for their efforts. Tobacco users who quit also often find they increase their activity and eat better, probably the additive effect of prioritizing self-care.

The most important guidance I continue to share as a tobacco cessation counselor is it can take multiple tries to quit tobacco for good.  Rather than thinking about these as failures, just like training for a marathon, it takes practice to cross that final mile.  Each quit attempt is perfect practice for the day a tobacco user puts it down for good.



  2. Huxley R, Woodward M. Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet. 2011;378(9799): 1297–1300.
  3. Vollset SE, Tverdal A, Gjessing HK. Smoking and deaths between 40 and 70 years of age in women and men. Ann Intern Med. 2006;144(6):381–389.
  4. Centers for Disease Control and Prevention (CDC), 2010. Smoking & tobacco use – Health effects of cigarette smoking. [Online]. Available