If at first you don't succeed, quit again

When you're a smoker, very few sweet voices greet you throughout your day.

Most people just want to get away from you.

There's no smoking indoors in public places or outside in parks or playgrounds.

So maybe there's no time like the present to quit.

And if you do try, as thousands of Americans will Thursday during the Great American Smokeout, you will hear one friendly voice on the other end of the line at 1-800-QUIT-NOW.

If you're lucky you might reach Loraine, a former smoker whose mission is to help others quit. She sweetly asks her clients the tough questions, such as how many cigarettes they smoke per day and how smoking makes them feel.

She then walks them through the ways in which they can break the habit, either cold turkey or by using non-smoking aids.

"We want you to be as comfortable as possible when you do this," she says, as she coaches a client into a nonsmoking plan.

At the end of a 30-minute conversation, Loraine sends her client a certificate and promises to call on their quit date. A week or two after the quit date, Loraine will call again.

There is no magic bullet to quit smoking, no miracle cure that will take away cravings or erase smoking behavior, no matter what new drug comes out.

"As Yoda would say, the magic bullet resides within you," says Dr. Steven Schroeder, director of the Smoking Cessation Leadership Center at the University of California, San Francisco.

Despite an occasional "Star Wars" quote, Schroeder minces no words when he talks about the grasp the habit has on smokers.

"Nicotine is more addictive than heroin or crack cocaine," he says.

The good news is, the number of smokers in the United States is decreasing. For the first time, there are more former smokers than current smokers out there.

Set a date to quit

Schroeder has been working with smokers for about 15 years and writes papers on the subject of quitting.

He says first smokers need to want to quit. They then need to find the right time to do it and set a quit date. Next, smokers need to bolster the reasons why they want to quit and figure out the temptation triggers and try to erase them.

Then, he says, smokers should decide which cessation aids are right for them.

There are a variety of such products on the market, from over-the-counter nicotine replacement therapy (NRT) aids such as nicotine gum and the nicotine skin patch to prescription NRTs and non-nicotine prescription medications like bupropion and the newer medication Chantix.

The bad news is that none of these aids is 100 percent effective. In fact, none is 50 percent effective. Drug company Pfizer's own studies on Chantix say it's 44 percent successful, the highest of all.

"We think it is the best drug so far," says Dr. Kolawole Okuyemi of the University of Minnesota Medical School, who wrote a paper on the subject of quitting aids titled "Interventions to Facilitate Smoking Cessation" and studies multi-ethnic populations and their smoking habits.

Other drugs, like nicotine gum and the patch, have success rates of about 20 percent. Between 2.5 and 5 percent of smokers are successful at quitting without any aids.

Drugs act differently on people of different races, depending on the type of cigarette used, such as mentholated vs. non-mentholated, Okuyemi says, so it is not easy to predict what will work on whom.

It takes a combination of products and counseling to really help people quit, says Dr. Jodi Prochaska, clinical psychologist and assistant professor at the University of California, San Francisco.

While alternative therapies are sometimes touted as a cure to help people quit, Prochaska says there is no good evidence that acupuncture helps smokers quit. There is some evidence that hypnosis can be helpful.

Kaiser Permanente of Northern California takes a proactive stance with smokers, says Jeanne Reisman, chief of health education for Kaiser's Oakland Medical Center and an anti-tobacco champion.

Kaiser physicians identify smokers during visits and encourage them to quit. The company offers smoking cessation classes to its patients and offers discounts on stop smoking aids.

Reisman and other experts we interviewed say most people fail the first time, but the likelihood of being successful gets higher after several tries.

Quitting smoking, they say, is the best single thing anyone can do for their health. Smoking causes lung cancer, heart disease, respiratory problems and can harm others who are exposed to the smoke.

The first step is up to you.