Please find below the responses to February's question. There were some cross-cultural themes (e.g. quitting "cold turkey," providing positive social support, implementing no-smoking policies, and emphasizing the impacts of smoking on family members) as well as some more novel ideas. Our favorite is the Czech taxi driver's solution!

ALGERIA – Kamel Bereksi, sous-secteur Jean Kraft
The best method to stop smoking is to simply not smoke. However, an alternative [less recommended] solution is to go ahead and smoke away, eventually succumbing to bronchitis, emphysema, or a fullblown case of lung cancer. Becoming one of the 3 million people who die each year from tobacco – that’s the radical way to quit!

ARGENTINA – Diane Scheines, Asociacion Argentina de Educacion y Prevencion del Cancer
Dr. Eduardo Laura, President of the Scientific Commission of AAPEC, is working with the sychologist Claudia Cerella in "Helping Groups for Smokers." They meet twice a week in the Hospital Library. Each group has several meetings. In the first and the last one Dr. Laura does a demonstration of how carbon monoxide decreases when someone stops smoking. It is a very cheap way to help people to stop smoking. Afterwards, those we stop smoking start working in the Association to help other people quit. We are also starting a new Program for Health Professionals that is called "Advice to the Smoker Patient." The people who want to quit smoking and that is working with us say that they do it: 1. Because they feel the damage in their organism like a: persistent cough, agitation, little capicity to make phisical excersises and low resistance, bad blood circulation, reiterate lung problems, throat pain, etc. 2. Because they begin to think about their families, the need to enjoy more time with them and the desire to be an example for their children. 3. Because the Doctor or their family ask them to quit smoking. The Dr. advice achieves a higher percentage of people who quit smoking and afterwards help others to do it. 4. Because they want to take out of their body, their hair, their home, etc. the smell to tobacco. 5. There is a very little percentage of people who want to quit smoking due to the economic factor or bacause they fear cancer.

CZECH REPUBLIC – Jiri Kozak, Czech Committee of EMASH
There are more than 70 Smoking Cessation Clinics in the Czech Republic. All therapists are educated in NRT and in behavioral treatment and counseling. Allow me to offer one story of an ex-smoker that we heard at a counseling session 6 months after he stopped smoking: "As a cab-driver I used the car all the day and when I was a smoker, I smoked during every drive. When I started up I had to take a cigarette. Now I am an ex-smoker, so I established a handle from a flush toilet at the ceiling of my car and when the urge for a cigarette comes, I grasp for the handle with my right hand and it is impossible for me to hold onto something else. The urge for cigarette disappears in a moment."

ROMANIA – Florin Mihaltan, Romanian Society of Pneumology
I think for Romania the most important step for effectively helping peoples would be to increase the number of trainers and smoking cessation opportunities (consultation, education, medicine).

USA – Ted Collins, Private Social Work Practice/Red Ribbon Coalition (KS)
It is a very personal issue, cold turkey and chewing on sweet cheroots (small, ugly, sweet cigars), not lighting them, worked for me. I chewed on the cheroots for about 10 days. Group stuff didn't work and I tried many times before succeeding. Stop date was my anniversary, March 18, 1980. I am still addicted and cannot take one puff.

USA – Doris Hundley, North Central District Health Department (KY)
In response to your question about smoking cessation techniques. I work with teenagers who cannot use patches etc. The best thing is to let me plan their own alternative to smoking that is healthy. Carrot sticks, gum, exercise. But mainly they respond to warmth and kindness. If you just encourage them and keep their spirits up, that is the most helpful thing. Although people say that discussing health effects is no helpful, a good video that shows physical consequences of tobacco gets them primed for the actual "quit day".

USA – Barbara Patterson, Northwest Oklahoma Tobacco Free Coalition
I wish I had a good answer for treating nicotine addiction, as quitting is so difficult for many. The few people that we have worked with have reported that they decided to quit because there are just fewer and fewer (public) places for them to smoke. Our communities should not pit smokers against non-smokers, but, instead, approach the issue with an attitude that being tobacco free will improve our community's health.

USA – Jerry Gabay, Nuestra Comunidad Sana (OR)
There is a study (about 3-4 years old) out of USF that indicates that the most effective way to get Hispanics/Latinos to modify their smoking habits is to have them understand the impacts of second-hand smoke on their families. In contrast, the most effective means for Anglos was stated to be getting them to understand the effects on their own health. There is no surprise here. A number of surveys and/or studies around the country, including one we did here for the Oregon Health Division 3 years ago, indicate that smoking amongst Hispanics/Latinos is highly social. As such, one of the things we emphasize in our workshops is to recruit non-smoking friends of the smoker to help him/her stay away from places/people who will encourage smoking.

USA – Bill Smith, Tualitin Valley Centers (OR)
I've created a youth (10-18) free interactive website for tobacco prevention and cessation for my organization: www.Zapbac.com. It has lots of stuff; the cessation portion, "Ceasefire" contains the elements of most of the good curricula out there on this subject. It's working to some degree. What we have learned: kids will not "register" even with an alias or zipcode -- there's a paranoia for lots of kids and adults about putting anything on the internet or a website that could identify them. Also, incentive gifts for kids to quit or to go thru a program seem relatively ineffective. Good creative interactive elements do work. We all know that helping kids to quit is even harder than adults and success rates are low for both. One-on-one can work beautifully, but it's obviously time-comsuming and expensive. Parent example is very important. Refusal skills are also of paramount importance, so that kids can withstand peer pressure. American Lung Association's newest youth curriculum on this subject is "NOT" -- "Not on Tobacco." It is gender specific and early results are promising.

VIETNAM – Hoang Van Kinh, Vietnam Committee on Smoking and Health, MOH Vietnam
We are applying prevention in a village in the Mountain area. The Leader of the commune had smoked for about 30 years, but when the program came to his village he committed to quit smoking. His method? Eating watermelon seeds whenever he felt the urge to smoke. Now he has overcome his addiction.

VIETNAM – Le Thi Thu, PATH Canada
According to the findings of the survey on tobacco smoking prevalence and related decease in Vietnam in 1997, the following are some main factors that encourage people to quit smoking in Vietnam:
* Workplace smoking bans. Many government ministries have implemented such bans (Defense, Health etc). As a result, there are higher than average quitting success rates among soldiers, police and health officers.
* Family encouragement, e.g. wife, children etc.
* The desire to be an example to one’s family, particularly children.
* Interest in joining others who have quit smoking
* Understanding how much a tobacco habit wastes
* Improved knowledge of the health hazards associated with tobacco
* Information about the effects of secondhand smoke
In addition to these finding, our observations indicate smoking cessation is also strongly related to the following factors:
* Individual/groups/organization establishing non-smoking place/community
* Increasing tax on tobacco
* Serious illness
* Economics status
The number one reason people gave (over 70.4%) for wanting to quit was the health hazards.
Establishing no-smoking areas helps many smokers to quit -- for it is no longer convenient to continue their habit.

YUGOSLAVIA (Serbia and Montenegro) – Andjelka Dzeletovic, Institute of Public Health of Serbia
The cheapest way to quit smoking is will power! I actually know a few people who have succeeded to quit smoking in that way and they haven't started smoking for years now. We have observed that heavy smokers who have started their quitting by detoxification by drinking larger amounts of water (in the morning) have been more successful in tobacco cessation.

For more examples see February's Question or contact:
Anna White
Global Partnerships for Tobacco Control
Essential Action
P.O. Box 19405
Washington, DC 20036
Tel: +1 202-387-8030
Fax: +1 202-234-5176
Email: [email protected]