When it comes to healthy lifestyles, experts endlessly debate the merits and liabilities of our options. Is a plant-based Mediterranean diet healthier than the relatively meat-heavy Paleo diet? Are complex carbohydrates our friends or not? Should we all be working out 45 minutes a day or is it okay to just walk a brisk mile a few times a week? Do yoga and tai chi count as exercise? How much sleep do we need? How about red wine? And coffee?

Moderation may be the answer in most cases, but there is one lifestyle choice on which health experts unanimously agree: smoking.

If you don’t smoke cigarettes, don’t start. And if you do smoke, stop. Now.

In this country, smoking causes more than 480,000 deaths each year, according to the U.S. Centers for Disease Control, via health conditions that include chronic lung disease, high blood pressure, heart disease, stroke and lung cancer. Smoking significantly increases the risk of developing many other kinds of cancer, as well, and is a risk factor for serious medical conditions ranging from diabetes and macular degeneration to gum disease, osteoporosis and infertility.

But as almost any smoker who has tried will tell you, kicking the habit can be a real challenge.

And the longer you’ve smoked, the tougher it can be to give it up.

“It’s a very hard thing to do,” said Michelle Brown, a respiratory therapist and smoking cessation counselor at St. Joseph Healthcare in Bangor. She works in the pulmonary rehab program, helping patients with chronic lung disease make the best of their illness. Most of her patients are in their 40s, 50s or older. One requirement for participating in the program is a good-faith effort to quit smoking.

Brown helps them with four individual counseling sessions, identifying their routine smoking triggers, setting up a quit plan and, if they want it, access to nicotine replacement patches and gum. Other medications are available by prescription only.

“Because of their health problems, they all want to quit,” Brown said. “But they are discouraged from having tried to quit so many other times in the past. I tell them, ‘I can help, but I don’t have a magic bullet for this. You’re going to have to work really hard.’”

Personal motivations and social pressure

Age and a longtime habit can make it harder to stop smoking, no doubt. But there are also powerful motivations to quit later in life, including health concerns, changes in social acceptance, pressure from family and friends, and cost.

For 49-year-old Bryan Hardison of Orono, smoking was an easy habit to pick up when he started working as a firefighter about 27 years ago. “Almost everyone at the station smoked then,” he said. “Everyone smoked. All my friends and coworkers.”

It didn’t take long for Hardison, who is now a captain in the Orono Fire Department, to build up to a pack-a day-habit. It didn’t slow him down much and it helped him cope with the stress of his job. But a few years back, the town started cracking down on employee smoking. Hardison could no longer light up inside the station, or in any public vehicle. He and other smokers had to step outside to enjoy their habit.

Hardison found there was markedly less social acceptance for smoking, not only at work but everywhere he went. His wife and daughter didn’t want him smoking at home, and fewer people he knew were still smoking.

With a family history of cancer and heart disease, Hardison knew he should quit. Then, about five years ago, he got a severe case of bronchitis, an acute inflammation of the lungs often caused by exposure to cigarette smoke.

“I was in bed for a week,” he said. “The second time it happened, I said, ‘That’s it.’”

He hadn’t had a smoke in several days due to his illness.

“I just never picked it up again afterwards,” he said.

Although his employer offered access to counseling, nicotine replacement and other quit-smoking supports, Hardison wasn’t interested.

“I pretty much just did it on my own,” he said. It wasn’t easy.

“You miss your morning cigarette and coffee,” he said, but he worked through the cravings. At the same time, he and his family embarked on a general lifestyle overhaul, cleaning up their diets and building more exercise into their daily routines. They’ve all lost weight and feel better, he said. He notices a marked improvement in his breathing, and food tastes better since he quit smoking.

“I really don’t miss it anymore,” he said.

Miki Macdonald, a family nurse practitioner at St. Joseph Healthcare, said she regularly advises her primary care patients to stop smoking. “No matter who they are or how long they’ve been smoking, there’s always a reason to quit,” she said. “I try to focus on what matter most to them.”

For some patients, a growing concern about health is a strong motivation to stop smoking, even if they aren’t having specific disease symptoms. Patients already living with respiratory disease, heart disease or other smoking-related diagnoses may be eager to slow the progression of their disease and avoid hospitalization and loss of independence.

Other patients are driven to quit, or at least cut back, by the cost of cigarettes. People who started smoking in the 1960s, 70s or 80s paid less than a dollar per pack at the time, but now must come up with $6 or $8 a pack or more.

“I tell them, ‘You could save $2,000 a year and take a nice vacation in Florida,’” Macdonald said. Sometimes that’s enough to drive home the argument, or at least slow down the habit.

And, with advancing age, Macdonald said, some smokers find themselves ostracized from family events when younger relatives object to their habit. Non-smokers may complain that the smoker smells bad, or refuse to subject young children to a smoke-filled home environment.

Whatever the motivation, Macdonald said, smokers can only benefit by quitting or cutting back on their habits. Within just a few days of quitting, she said, lungs start to clear out, blood pressure drops and the senses of taste and smell become more acute. Moodiness and cravings may persist longer, she said, but most episodes pass within a couple of minutes.

Smokers often quit for a while and then start up again. “I tell them to keep working on it and one day they’ll be successful,” she said.

A recent CDC survey shows that many adults trying to quit smoking turn to vaping, or using smokeless electronic cigarettes, for nicotine replacement. Macdonald says this can be a helpful transitional strategy but is no substitute for a full quit.

“Let’s go for the gold and just stop putting junk in our bodies,” she said.

Think about quitting

Maine’s 2015 smoking rate for adults 18 and over was 19.5 percent compared to the national average of 16.8 percent, according to data from the Henry J. Kaiser Family Foundation. The Maine Shared Community Health Needs Assessment reports that the rate was 19.2 percent in Portland, 24 percent in Lewiston/Auburn and 29.4 percent in Bangor.

Smoking rates correlate with certain socio-economic conditions. It is more common among older people, military veterans, those with lower educational attainment and those who work in natural resource-based occupations such as forestry, fishing and agriculture.

For most smokers, trying to quit cold turkey and without support is a recipe for failure, according to Ken Lewis, director of the Maine Center for Tobacco Independence at MaineHealth in Portland. The center manages the Maine Tobacco Helpline, a phone-based program that offers a range of free support services to help smokers statewide quit successfully.

Since its founding in 2001, more than 120,000 adult Maine smokers have registered for Helpline services, resulting in more than 250,000 telephone counseling sessions. Other services, like nicotine replacement therapy, help to develop strategies to break old behaviors and deal with cravings, and follow-up phone counseling helps too.

“People who use the full suite of services are two and a half times more successful than those who don’t,” Lewis said. Still, he said, most people make several serious attempts — the average is eight — to quit before they are ultimately successful.

The number for the Maine Tobacco HelpLine is 1-800-207-1230.

Meg Haskell

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at mhaskell@bangordailynews.com.