Smoking heads the list of preventable causes of sickness in the U.S. and is blamed for one in every five deaths of Americans, according to the National Heart Lung and Blood Institute. But despite those scary statistics, the Centers for Disease Control and Prevention says about 42.1 million adults in the U.S. are still puffing away on cigarettes.
If you are one of them, there could be some surprising reasons behind your inability to quit. While it’s true the addictive nature of nicotine plays a major role in keeping people hooked on tobacco, researchers have found environmental and behavior triggers also drive the urge to light up.
Triggers can involve places (such as bars or a favorite easy chair you associate with relaxing and smoking), items like ashtrays and lighters, and people — friends who like to smoke as they chat or even characters in a movie or television show who are smoking. Other cues that spark a desire to have a cigarette include feelings (including being stressed or bored) and activities you do daily, like driving to and from work, according to the National Cancer Institute (NCI). Many people also crave a cigarette when they have an alcoholic beverage, drink coffee or tea, or finish a meal.
Some triggers may not be obvious. For example, research by psychologist Cynthia A. Conklin, PhD, of the University of Pittsburgh, revealed it doesn’t take being in a smoky bar with ashtrays to trigger a smoker. Just seeing photos of a bar without any sign of cigarettes in the picture can increase the desire to smoke.
Conklin’s findings suggest that any setting a person personally associates with smoking can spur cigarette cravings. Even a living room where a former smoker typically smoked that no longer has ashtrays and other smoking related items can still provoke the urge to light up.
A morning alarm clock triggers the desire for an immediate cigarette in many smokers, too. Pennsylvania State University researchers investigating the physical effects of early morning smoking found that 32 percent of research volunteers smoked their first cigarette of the day within 5 minutes of waking, 31 percent smoked within 6 to 30 minutes of waking, and 18 percent smoked within 31 to 60 minutes of waking. Having a morning cigarette is not only a hard habit to break, it can be an especially dangerous one. The study revealed the sooner a person smokes a cigarette upon waking, the more likely he or she is to develop lung or oral cancer.
Although advertisements for cigarettes can no longer be shown on television, the same rules don’t apply to e-cigarettes — and a study from the University of Pennsylvania's Annenberg School for Communication revealed watching e-cig commercials can trigger a craving for regular cigarettes in both current and former smokers.
"We know that exposure to smoking cues such as visual depictions of cigarettes, ashtrays, matches, lighters, and smoke heightens smokers' urge to smoke a cigarette, and decreases former smokers' confidence in their ability to refrain from smoking a cigarette," said Erin K. Maloney, PhD. "Because many e-cigarette brands that have a budget to advertise on television are visually similar to tobacco cigarettes, we wanted to see if similar effects can be attributed to e-cigarette advertising."
The results of research by Maloney and Joseph N. Cappella, PhD, revealed watching e-cigarette ads featuring a person inhaling (known as vaping) or simply holding an e-cigarette triggered a greater urge to have a cigarette in those who smoked, compared to cigarette smokers who didn’t see the commercials. In addition, ex-smokers who watched e-cigarette advertisements showing vaping were less confident they could resist lighting up than former smokers who watched e-cigarette ads that didn’t portray vaping.
Clearly, figuring out your personal smoking triggers, and finding ways to break the association that has you reaching for a cigarette, can be key to quitting the nicotine habit. The National Institutes of Health advise keeping a journal for at least for one week to identify your personal triggers. Make a note of each cigarette you smoke — or when you felt a strong urge to smoke — and write down what you were doing and thinking at the time. The goal is to find patterns that reveal your triggers.
Once you know what sparks the urge to light up, you can find ways to avoid the triggers you can, and cope with the ones you can’t. For example, if you always crave a cigarette during your drive to the office, you can tell anyone who rides with you that smoking in your car isn’t allowed and plan to chew gum or put a sugar-free lollipop in your mouth instead of smoking as you drive.
The urge to smoke subsides after about 15 minutes, according to the NCI. Resisting is easier if you take deep breaths and keep your hands busy with something other than a cigarette (such as writing or even doodling). Calling or texting someone you trust to distract you is helpful, too.
You can also call the NCI’s Smoking Quit line at 1-877-44U-QUIT to talk to an expert (for free) about quitting smoking. The NCI’s SmokeFree website offers more tips and resources on avoiding smoking triggers and learning to live tobacco-free.
April 21, 2015
Christopher Nystuen, MD, MBA