Millions of Lives Going Up in Smoke

IT IS one of the best-​selling consumer products in the world. It commands armies of loyal buyers and enjoys a rapidly expanding market. Its delighted companies boast impressive profits, political clout, and prestige. The only problem is, its best customers keep dying off!

The Economist observes: “Cigarettes are among the world’s most profitable consumer products. They are also the only (legal) ones which, used as intended, turn most of their users into addicts and often kill them.” This means big profits for the tobacco companies but huge losses for their customers. According to the U.S. Centers for Disease Control and Prevention, some five million years of life are sliced off the lives of American smokers each year, roughly a minute for each minute spent smoking. “Smoking kills 420,000 Americans a year,” reports Newsweek magazine. “That’s 50 times as many as illegal drugs.”

Around the world, three million people a year​—six every minute—​die from smoking, according to the book Mortality From Smoking in Developed Countries 1950-2000, published by Britain’s Imperial Cancer Research Fund, WHO (World Health Organization), and the American Cancer Society. This analysis of world smoking trends, the most comprehensive to date, covers 45 countries. “In most countries,” warns Richard Peto of the Imperial Cancer Research Fund, “the worst is yet to come. If current smoking patterns persist, then by the time the young smokers of today reach middle or old age, there will be about 10 million deaths a year from tobacco​—one death every three seconds.”

“Smoking is like no other hazard,” says Dr. Alan Lopez of WHO. “It will kill one in two smokers eventually.” Martin Vessey of the Department of Public Health at Oxford University says similarly: “These findings over 40 years lead to the horrible conclusion that one-​half of all smokers will eventually be killed by their habit​—a truly terrifying thought.” Since the 1950’s, 60 million people have died from smoking.

It is also a truly terrifying thought to the tobacco companies. If three million people each year around the world are now dying from smoking-​related causes, and many others quit smoking, then more than three million new users must be found annually.

One source has emerged because of what tobacco companies hail as the liberation of women. Smoking by women has been an accomplished fact for some years in Western lands and is now moving into places where it used to be viewed as a stigma. Tobacco companies intend to change all of that. They want to help women celebrate their newfound affluence and liberation. Special cigarette brands claiming lower tar and nicotine contents lure women who smoke and who find such smoke less harsh. Other cigarettes are perfumed or have a long, slender design​—the look that women may hope to achieve by smoking. Tobacco advertisements in Asia feature young, chic Asian models dressed seductively in Western elegance.

Smoking-​related death rates, however, are keeping pace with the “liberation” of women. The number of lung cancer victims among women has doubled in the last 20 years in Britain, Japan, Norway, Poland, and Sweden. In the United States and Canada, rates have increased 300 percent. “You’ve come a long way, baby!” proclaims one cigarette advertisement.

Some tobacco concerns have their own strategy. One Philippine company in that predominantly Catholic country distributed free calendars bearing a portrait of the Virgin Mary and their cigarette brand logos placed brazenly below the icon. “I had never seen anything like it before,” said Dr. Rosmarie Erben, Asian health adviser for WHO. “They were trying to link the icon motif to tobacco, to make Philippine women comfortable with the idea of smoking.”

In China an estimated 61 percent of the adult men smoke, whereas only 7 percent of the women do. Western tobacco companies have their eyes on the “liberation” of these lovely Oriental ladies, millions of whom were so long denied the “pleasures” of their glamorous Western sisters. One large fly in the ointment, though: The government-​owned tobacco company supplies most of the smokes.

Western companies, however, are gradually prying open the door. With limited advertising opportunities, some cigarette companies look to groom their future customers in a stealthy way. China imports movies from Hong Kong, and in many of them, the actors are paid to smoke​—a soft sell!

With hostility growing on the home front, the prosperous American tobacco companies are extending their tentacles to embrace new victims. The facts show that they have taken deadly aim at the developing nations.

Health officials worldwide sound the warning. The headlines declare: “Africa Battles a New Plague​—Cigarette Smoking.” “Smoke Turns to Fire in Asia as the Cigarette Market Soars.” “Asian Smoking Rates Will Lead to Cancer Epidemic.” “The New Third World Fight Is Over Tobacco.”

The continent of Africa has been battered by drought, civil war, and the AIDS epidemic. Yet, says Dr. Keith Ball, British cardiologist, “Short of nuclear war or famine, cigarette smoking is the greatest single threat to the future health of Africa.”

Multinational giants hire local farmers to grow tobacco. The farmers cut down trees sorely needed for cooking, heating, and housing and use them as fuel to cure tobacco. They grow lucrative tobacco crops instead of less profitable food crops. Impoverished Africans commonly spend a large proportion of their scanty income on cigarettes. So African families wither from malnutrition while the coffers of Western tobacco companies grow fat from the profits.

Africa, Eastern Europe, and Latin America are all targeted by Western tobacco companies, who see the developing world as one gigantic business opportunity. But teeming Asia is by far the biggest gold mine of them all. China alone presently has more smokers than the entire population of the United States​—300 million. They smoke a staggering 1.6 trillion cigarettes a year, one third of the total consumed in the world!

“Physicians say the health implications of the tobacco boom in Asia are nothing less than terrifying,” reports The New York Times. Richard Peto estimates that of the ten million anticipated smoking-​related deaths each year in the next two or three decades, two million will be in China alone. Fifty million Chinese children alive today may die from smoking-​related diseases, Peto says.

Dr. Nigel Gray summed it up this way: “The history of smoking over the past five decades in China and Eastern Europe condemns those countries to a major tobacco disease epidemic.”

“How can a product which is the cause of 400,000 premature deaths each year in the US, a product which the US Government is trying hard to help its citizens to quit, suddenly become different beyond American borders?” asked Dr. Prakit Vateesatokit of the Anti-​Smoking Campaign of Thailand. “Does health become irrelevant when the same product is exported to other countries?”

The developing tobacco interests have a powerful ally in the U.S. government. Together they have fought to gain footholds abroad, particularly in Asian markets. For years American cigarettes were locked out of Japan, Taiwan, Thailand, and other countries, some of whose governments had their own monopolies on tobacco products. Antismoking groups protested imports, but the U.S. administration brandished a persuasive weapon​—punitive tariffs.

From 1985 on, under intense pressure from the U.S. government, many Asian countries have opened their gates, and American cigarettes have been flooding in. U.S. cigarette exports to Asia jumped by 75 percent in 1988.

Perhaps the most tragic victims of the tobacco wars are the children. A study reported in The Journal of the American Medical Association says that “children and teenagers constitute 90% of all new smokers.”

An article in U.S.News & World Report estimates the number of teen smokers in the United States at 3.1 million. Every day 3,000 new recruits start smoking​—1,000,000 a year.

One cigarette advertisement features a fun-​loving, pleasure-​seeking cartoon camel, often with a cigarette dangling from his lips. This cigarette advertisement is charged with luring youngsters into nicotine slavery before they comprehend the health risks. Within three years of running this advertisement, the cigarette company enjoyed a 64-​percent increase in sales to adolescents. A study at The Medical College of Georgia (U.S.A.) found that 91 percent of six-​year-​olds surveyed recognized this smoking cartoon character.

Another popular cigarette icon is the free-​wheeling macho cowboy whose message is, according to one teen, “When you’re smoking, you’re unstoppable.” It is said that the biggest-​selling consumer product in the world is a cigarette that corners 69 percent of the market among teen smokers and is the most advertised brand. As an added incentive, coupons come with each pack, to be redeemed for jeans, hats, and sportswear popular with youths.

Recognizing the tremendous power of advertising, antismoking groups have succeeded in having tobacco advertisements banned from television and radio in many countries. One way the savvy tobacco advertisers circumvent the system, however, is by strategically placing billboards at sports events. Therefore, a telecast game, with a vast young audience, may show their favorite player poised for action in the foreground and a towering cigarette billboard lurking in the background.

At downtown locations or in front of schools, cleverly costumed women in miniskirts or in cowboy or safari outfits hand out free cigarettes to eager or curious teens. At video arcades, discos, and rock concerts, samples are passed around freely. One company marketing plan leaked to the press showed that a particular brand in Canada targeted French-​speaking males from 12 to 17 years of age.

The glaring message is that smoking brings pleasure, fitness, virility, and popularity. “Where I worked,” said one advertising consultant, “we were trying very hard to influence kids who were 14 to start to smoke.” Advertisements in Asia depict healthy, young Western athletic types romping on beaches and ball fields​—while smoking, of course. “Western models and life-​styles create glamorous standards to emulate,” remarked a marketing trade journal, “and Asian smokers can’t get enough.”

After spending billions of advertising dollars, the tobacco marketers have scored huge successes. A Reader’s Digest special report showed that the rise in the number of young smokers is alarming. “In the Philippines,” says the report, “22.7 percent of people under 18 now smoke. In some Latin American cities, the teen-​age rate is an astonishing 50 percent. In Hong Kong, children as young as seven are smoking.”

However, even as tobacco celebrates its conquests abroad, cigarette companies are painfully aware of gathering storm clouds at home. What are tobacco’s chances of weathering the storm?

[Blurb on page 3]

Its best customers keep dying off

[Blurb on page 5]

Asia, tobacco’s newest killing fields

[Blurb on page 6]

90 percent of all new smokers​—children and teenagers!

[Box on page 4]

The Deadly Recipe​—What’s in a Smoke?

Up to 700 different chemical additives may be used by cigarette manufacturers, but the law allows the companies to keep their lists secret. On the lists, though, are heavy metals, pesticides, and insecticides. Some ingredients are so toxic that it is illegal to dump them in a landfill. That graceful swirl of cigarette smoke carries with it some 4,000 substances, including acetone, arsenic, butane, carbon monoxide, and cyanide. The lungs of smokers and of people nearby are exposed to at least 43 known cancer-​causing agents.

[Box on page 5]

Nonsmokers at Risk

Do you live, work, or travel with heavy smokers? If so, you may be at increased risk for lung cancer and heart disease. A 1993 study by the U.S. Environmental Protection Agency (EPA) concluded that environmental tobacco smoke (ETS) is a Group A carcinogen, the most dangerous. The massive report analyzed the results of 30 studies implicating the spiraling smoke from the end of cigarettes as well as exhaled smoke.

The EPA blames passive smoke for 3,000 lung-​cancer deaths each year in the United States. The American Medical Association in June 1994 corroborated the conclusions with a study it published showing that women who never smoked but were exposed to ETS have a 30 percent greater risk of developing lung cancer than other lifetime nonsmokers.

For young children, exposure to smoke results in 150,000 to 300,000 cases of bronchitis and pneumonia annually. Smoke aggravates asthma symptoms for 200,000 to 1,000,000 children each year in the United States.

The American Heart Association estimates that as many as 40,000 deaths a year occur from heart and blood vessel diseases precipitated by ETS.

[Pictures on page 7]

A glamorous Asian model and the targets

Tobacco’s Defenders Launch Their Hot-​Air Balloons

IN THE 1940’s, London was a city under siege. German fighter planes and flying bombs rained down terror and destruction. But if the situation hadn’t been so dire, the inhabitants might have been amused by a bizarre sight.

Tethered by long cables, thousands of large balloons floated overhead. Their purpose was to discourage low-​level air raids and hopefully snag a few flying bombs in midair. The balloon barrage, ingenious as it was, met with minimal success.

Cigarette companies have likewise found themselves under siege. The sprawling tobacco empires, once impregnable bastions of political and economic might, are being attacked at every turn.

The medical community churns out page after page of incriminating studies. Crusading health officials maneuver for advantage. Outraged parents charge that their children are being victimized. Determined legislators have chased cigarette smoke out of office buildings, restaurants, military installations, and airplanes. In many countries, tobacco advertisements have been banned from television and radio. In the United States, entire states are suing for millions in health-​care costs. Even lawyers are joining the fight.

So in an attempt to fend off their attackers, the tobacco companies have launched some defensive balloons of their own. However, they appear to be filled with a lot of hot air.

The U.S. public has, this past year, had a front-​row seat as indignant legislators and government health officials mounted a vigorous offensive against the tobacco industry. In hearings before a U.S. congressional panel in April 1994, tobacco executives of seven large American companies were confronted with the incriminating statistics: more than 400,000 Americans dead each year and millions more sick, dying, and addicted.

What did they have to say for themselves? The embattled executives offered some interesting statements in their defense: “Smoking . . . has yet to be proven to have a causal role in the development of diseases,” asserted a Tobacco Institute spokesman. What is more, the smoking habit was portrayed as being as harmless as any other enjoyable activity, such as eating sweets or drinking coffee. “The presence of nicotine does not make cigarettes a drug, or smoking an addiction,” said one tobacco company chief executive officer. “The premise that nicotine in cigarettes is addictive at any level is incorrect,” asserted a tobacco company scientist.

If cigarettes are not addictive, countered the committee, why have tobacco companies tried to manipulate the nicotine levels in their products? “Taste,” explained another tobacco company executive. Is there nothing worse than a tasteless cigarette? When shown stacks of research from his own company’s files suggesting nicotine’s addictiveness, he clung to his story.

Apparently, he and others will cling to that opinion no matter how much the cemeteries fill up with tobacco victims. Early in 1993, Dr. Lonnie Bristow, chairman of the American Medical Association Board of Trustees issued an interesting challenge. The Journal of the American Medical Association reports: “He invited executives of the major US tobacco companies to walk with him through hospital wards to see one of the results of smoking​—lung cancer patients and other pulmonary cripples. There were no takers.”

The tobacco industry boasts that it provides good jobs in a world economy of burgeoning unemployment. In Argentina, for example, one million jobs are created by the industry, with four million more jobs indirectly related. Massive tax revenues have earned tobacco companies the good graces of many governments.

One tobacco concern has specifically favored minority groups with generous donations​—a seeming manifestation of civic-​mindedness. Internal company documents, however, revealed the true motive of this “constituency development budget”​—to create goodwill among potential voters.

This same tobacco company has also made friends among the arts with large contributions to museums, schools, dance academies, and music institutions. Officials of art organizations brace themselves to accept the badly needed tobacco money. Recently, members of the art community of New York City faced an awkward dilemma as this same tobacco company called on them to lend their voice to lobbying efforts against antismoking legislation.

And, of course, the wealthy tobacco giants are not timid about scattering money around to politicians, who can use their influence against any proposals unfriendly to tobacco interests. Government officials in high places have championed the cause of the tobacco companies. Some have financial ties to the industry or feel pressure to repay them for the generous campaign support from tobacco money.

One U.S. congressman reportedly received over $21,000 in donations from cigarette companies and subsequently cast his vote against a number of antitobacco issues.

A former well-​paid tobacco lobbyist, at one time a state senator and a heavy smoker, recently discovered that he has throat, lung, and liver cancer. Now he has keen regrets and laments that “lying there with something you caused yourself” makes a person feel like a fool.

With all the power that advertising dollars can buy, the tobacco giants are vigorously attacking the opposition. One advertisement waves the freedom flag, solemnly warning, “Today It’s Cigarettes. Tomorrow?” It implies that caffeine, alcohol, and hamburgers will be the next victims of supposedly fanatic prohibitionists.

Newspaper advertisements have sought to discredit a widely quoted U.S. Environmental Protection Agency study that classified passive smoke as carcinogenic. The tobacco industry announced plans to do legal battle. A television program accused one company of toying with nicotine levels to encourage addiction. The network airing the show was promptly presented with a $10 billion lawsuit.

The tobacco companies have battled mightily, but the air is becoming still thicker with accusations. Some 50,000 studies have been conducted during the last four decades, resulting in an ever-​growing mountain of evidence on the hazards of tobacco use.

How have the cigarette companies attempted to dodge the charges thrown at them? They have stubbornly held to one supposed fact: Smokers do quit. Thus, they say, nicotine is not addictive. Statistics, however, show otherwise. True, 40 million Americans have quit. But 50 million more still smoke, and 70 percent of these say they want to quit. Of the 17 million who attempt to quit each year, 90 percent fail within a year.

After lung cancer surgery, nearly 50 percent of U.S. smokers return to the habit. Of smokers who have had heart attacks, 38 percent light up even before leaving the hospital. Forty percent of smokers who have a cancerous larynx removed will try to smoke again.

Of the millions of teenage smokers in the United States, three fourths say they have made at least one serious attempt to quit but have failed. Statistics also show that for many youths, smoking tobacco is a stepping-​stone to harder drugs. Adolescent smokers are more than 50 times as likely to use cocaine as are nonsmokers. A 13-​year-​old smoker agrees. “There’s no doubt in my mind that cigarettes are a gateway drug,” she wrote. “Almost everyone I know, except for three people, started smoking before doing drugs.”

What about low-​tar cigarettes? Studies show that they may, in fact, be more dangerous​—for two reasons: One, the smoker often inhales more deeply to extract the nicotine his system craves, exposing more lung tissue to the toxic effects of the smoke; two, the misconception that he is smoking a “healthier” cigarette may keep him from making the effort to quit altogether.

More than 2,000 studies have been done on nicotine alone. They reveal that nicotine is one of the most addictive substances known to man, and one of the most harmful. Nicotine accelerates the heart rate and constricts blood vessels. It is absorbed into the bloodstream in seven seconds​—even faster than an injection directly into a vein. It conditions the brain to want more, a craving that some say is twice as addictive as heroin.

Are the tobacco companies, despite their denials, aware of the addictive properties of nicotine? Indications are that they have known for a long time. For instance, a 1983 report shows that one tobacco company’s researcher noted that laboratory rats exhibited classic symptoms of addiction, regularly self-​administering doses of nicotine by hitting levers. Reportedly, the study was quickly suppressed by the industry and has come to light only recently.

The tobacco giants have not sat idly by while cannons fire salvos from all directions. The Council for Tobacco Research in New York City conducts what The Wall Street Journal calls “the longest-​running misinformation campaign in U.S. business history.”

Under the banner of conducting independent research, the council has invested millions of dollars in combating assailants. It all started in 1953 when Dr. Ernst Wynder of the Memorial Sloan-​Kettering Cancer Center found that tobacco tars painted on the backs of mice caused tumors. The industry established the council to neutralize the clear evidence gathering against their product, by countering with scientific evidence of their own.

How could council scientists, though, produce results so contrary to the findings of the rest of the research community? Recently released documents reveal an elaborate web of intrigue. Many council researchers, shackled by written contracts and controlled by squads of sharp-​eyed lawyers, found that the growing health fears were well-​founded. But when faced with the facts, the council, according to The Wall Street Journal, “sometimes disregarded, or even cut off, studies of its own that implicated smoking as a health hazard.”

Behind the walls of secrecy, the search for a safer cigarette continued for years. To do so publicly would have been a tacit admission that smoking was indeed hazardous to health. By the end of the 1970’s, a senior lawyer for a tobacco company recommended that efforts to produce a “safe” cigarette be abandoned as futile and that all related documents be stowed away.

Two things became clear from the years of experimenting: Nicotine is indeed addictive, and cigarette smoking does kill. Though vehemently denying these facts publicly, tobacco companies show by their actions that they know the facts all too well.

Charging deliberate manipulation, U.S. Food and Drug Administration (FDA) commissioner David Kessler said: “Some of today’s cigarettes may, in fact, qualify as high-​technology nicotine delivery systems that deliver nicotine in precisely calculated quantities . . . sufficient to create and to sustain addiction.”

Kessler revealed that tobacco companies own a number of patents proving their intent. One is for a genetically altered strain of tobacco with the highest nicotine yield known. Another process treats filters and papers with nicotine for an additional boost. Yet another administers more nicotine in the smoker’s first puffs than in the last. Additionally, industry documents show that ammonia compounds are added to cigarettes to free more nicotine from the tobacco. “Nearly twice the usual amount inhaled got into a smoker’s bloodstream,” says a New York Times report. The FDA has proclaimed that nicotine is an addictive drug and aims to regulate cigarettes more tightly.

Governments are dependent in their own way on cigarettes. The U.S. government, for instance, collects $12 billion a year in state and federal taxes on tobacco products. The federal Office of Technology Assessment, however, calculates a $68 billion a year price tag for smoking, based on health-​care costs and lost productivity.

Claims of economic rewards and plentiful jobs, benevolent support of the arts, fierce denials of health risks​—indeed, the tobacco industry has sent up some peculiar-​looking balloons in self-​defense. Whether they prove to be more effective than the balloon barrage over London or not remains to be seen.

But it is evident that the giant companies can no longer hide their true nature. They have made millions, and they have killed millions, but they seem unaffected that the bottom line is a terrible toll in human lives.

[Blurb on page 8]

They appear to be filled with a lot of hot air

[Blurb on page 9]

A government study implicates passive smoke as carcinogenic

[Blurb on page 10]

Nicotine is one of the most addicting substances known

[Blurb on page 11]

They have made millions; they have killed millions

[Box on page 10]

50,000 Studies​—What Have They Found?

Here is a small sampling of the health concerns raised by researchers in connection with tobacco use:

LUNG CANCER: Smokers make up 87 percent of lung-​cancer deaths.

HEART DISEASE: Smokers have a 70 percent greater risk of cardiovascular disease.

BREAST CANCER: Women who smoke 40 or more cigarettes daily have a 74 percent greater chance of dying from breast cancer.

HEARING IMPAIRMENT: Infants of smoking mothers have greater difficulty processing sound.

DIABETIC HAZARDS: Diabetics who smoke or chew tobacco are at higher risk for kidney damage and have more rapidly progressing retinopathy (a disorder of the retina).

COLON CANCER: Two studies involving more than 150,000 people show a clear link between smoking and colon cancer.

ASTHMA: Secondhand smoke can worsen asthma in youngsters.

PREDISPOSITION TO SMOKE: Daughters of women who smoked during pregnancy are four times more likely to smoke.

LEUKEMIA: Smoking appears to cause myeloid leukemia.

EXERCISE INJURIES: According to a U.S. Army study, smokers are more likely to suffer injuries while exercising.

MEMORY: High doses of nicotine may take a toll on mental dexterity while a person is performing complex tasks.

DEPRESSION: Psychiatrists are investigating evidence of a link between smoking and major depression as well as schizophrenia.

SUICIDE: A study of nurses showed that suicide was twice as likely among nurses who smoked.

Other dangers to add to the list: Cancer of the mouth, larynx, throat, esophagus, pancreas, stomach, small intestine, bladder, kidney, and cervix; stroke, heart attack, chronic lung disease, circulatory disease, peptic ulcers, diabetes, infertility, low birth weight, osteoporosis, and ear infections. Fire hazards may be added as well, as smoking is the chief cause of home, hotel, and hospital fires.

[Box on page 12]

Smokeless Tobacco–A Dangerous Substitute

The leader in the $1.1 billion snuff industry cagily reels in its small fry with flavored bait. It has flavored brands that are popular. The “little tobacco buzz” they deliver satisfies but not for long. A former vice chairman of this tobacco company said: “A lot of people may start on the more flavored products, but ultimately, they’ll come to [the strongest brand].” It is advertised as, “A Strong Chew for Strong Men” and, “It Satisfies.”

The Wall Street Journal, which reported on this strategy of the company, quoted its denial that “it doctors levels of nicotine.” The Journal also stated that two former tobacco chemists of the company, speaking on the topic for the first time, said that “while the company doesn’t manipulate nicotine levels, it does manipulate the amount of nicotine that users absorb.” They also say that the company adds chemicals to boost the alkalinity of its snuff. The more alkaline the snuff is, “the more nicotine is released.” The Journal adds this clarification concerning snuff and chewing tobacco: “Snuff, which sometimes is confused with chewing tobacco, is shredded tobacco that users suck on, but don’t chew. Users take a pinch, or ‘dip,’ and place it between the cheek and gum, shifting it about with their tongues and spitting occasionally.”

Flavored brands made for beginners free only from 7 to 22 percent of their nicotine for absorption into the bloodstream. The strongest brand can make new users gag. It is in a finely chopped form for “real” men. Seventy-​nine percent of its nicotine is “free,” available for immediate absorption into the bloodstream. In the United States, users begin dipping on the average at the age of nine. And what nine-​year-​old will long resist moving up to stronger brands and joining the “real” men?

The resulting dose of nicotine is actually more powerful than that from a cigarette. Users are reportedly 4 times more likely to develop mouth cancer, and their risk of developing throat cancer is 50 times greater than for nonusers.

Public outcry in the United States temporarily flared up when a lawsuit was brought against a tobacco company by the mother of a former high school track star who died from mouth cancer. He got a free can of snuff at a rodeo at age 12 and became a four-​can-a-week user. After he underwent a number of painful surgeries that carved up his tongue, jaw, and neck, his doctors gave up. The young man died at 19 years of age.

[Box on page 13]

How to Become a Quitter

Millions of people have successfully broken their nicotine addiction. If you are a smoker, even a longtime one, you too can shed this harmful habit. A few tips that may help:

• Know beforehand what to expect. The withdrawal symptoms may include anxiety, irritability, dizziness, headaches, sleeplessness, stomach upsets, hunger, cravings, poor concentration, and tremors. Not a pleasant prospect, to be sure, but the most intense symptoms last only a few days and gradually fade as the body becomes free of nicotine.

• Now the mental battle begins in earnest. Not only did your body crave nicotine but your mind was conditioned by behaviors associated with smoking. Analyze your routine to see when you automatically reached for a cigarette, and alter that pattern. For example, if you always smoked right after a meal, determine to get up right away and take a walk or wash the dishes.

• When an intense craving strikes, perhaps because of a stressful moment, remember that the impulse will usually pass within five minutes. Be prepared to occupy your mind by writing a letter, exercising, or eating a healthy snack. Prayer is a powerful help toward self-​control.

• If you are discouraged from failed attempts to quit, take heart. The important thing is to keep trying.

• If the prospect of gaining weight hinders you, keep in mind that the benefits of giving up cigarettes far outweigh the dangers of a few extra pounds. It may help to have fruit or vegetables handy. And drink plenty of water.

• To quit smoking is one thing. To stay off tobacco is quite another. Set time goals for being smoke free​—one day, one week, three months, forever.

Jesus said: “You must love your neighbor as yourself.” (Mark 12:31) To love your neighbor, stop smoking. To love yourself, stop smoking.​—See also “Smoking—​The Christian View,” in Awake!, July 8, 1989, pages 13-15.