Tobacco Facts.

Half of the U.S. population lives in areas where smoking is banned in workplaces, bars and restaurants.

More than 70% of Americans don’t allow smoking in their homes, including about 50% of current smokers.

Taxes have pushed the cost of smoking ever higher ($10 per pack in New York City) and the social costs—in disgusted looks and lectures from friends and family members—have escalated too.

Such inconveniences are forcing a sea change in smoking habits and upending traditional approaches to smoking cessation. For one thing, there’s a growing group of intermittent and secret smokers who seem to smoke as much for psychological and emotional reasons as nicotine addiction. In addition to breaking the physical addiction, smokers who want to quit today need to understand why, when and where they smoke, and challenge some of the thinking that goes along with it, cessation experts say.

” ‘Sneaking one in’ has become a smoker’s pastime and avocation,” says Timothy Stephens, a 40-year-old Manhattan lawyer who started smoking cigarettes in high school. Nowadays, with a wife and baby, he doesn’t smoke at home. He takes five-minute smoking breaks outside his office building (“four minutes if it’s cold”) and he drives to work from the suburbs instead of using public transit so he can get more smoking in.

Even though the percentage of American adults who smoke has stalled at about 20% in recent years, smokers are smoking fewer cigarettes than they used to (an average of 13 per day, down from 21 in 1980). And a growing proportion of smokers—roughly 25%—don’t smoke every day. One government study found that as many as half of American smokers either don’t smoke daily or smoke fewer than six cigarettes a day.

Phil Hodges, 46, an office worker in Washington, D.C., has his first cigarette of the day with his morning coffee. He has a second at work at 6:30 a.m., others at 8:30 and 2:30, and one after he works out at the gym, standing outside in his shorts and T-shirt. “I think it’s a mental reward,” Mr. Hodges says, explaining his urge to light up occasionally.

Researchers used to think light and intermittent smoking was a transitional phase for smokers on their way to quitting or ramping up to a more serious habit. But a few recent studies suggest that it’s a new, stable pattern particularly among young, college-educated smokers. An analysis of smoking patterns during the 1990s, published in the journal Nicotine & Tobacco Research last year, found that 18-to-29-year-olds were twice as likely as those aged 50 to 64 to be nondaily smokers. Many experts expect that pattern to continue. “Young people who have grown up with a smoke-free home, school and workplace environment may stabilize at a much lower dependence level than those without such restrictions,” the researchers wrote.

Light smokers are still putting their health at risk, however. “People shouldn’t fool themselves that just a couple of cigarettes won’t kill you,” says Thomas R. Frieden, director of the Centers for Disease Control and Prevention, who helped bring smoking rates in New York City down to 15% from 21% when he was the city’s health commissioner from 2002 until last year. “The bad news here is that really good studies show that just a very small number—three, for example—drastically increases the likelihood of heart attack and stroke.”

Why keep smoking at all, then?

Some experts blame the addictive power of nicotine, even at low levels, that leaves some smokers struggling to kick the habit. But others note that some intermittent smokers can go for days without a fix, particularly if they are accustomed to smoking only in certain circumstances. And some may be using nicotine patches, gum or lozenges to help quell their cravings. A study of 6,500 smokers in the U.S., U.K., Canada and Australia, published in the journal Addiction last year, found that one-third of those who used nicotine-replacement products were not attempting to quit, but to abstain temporarily or cut down.

“While we haven’t got the full picture, what’s clear is that there are multiple types of smokers that we need to better understand,” says Saul Shiffman, a professor of psychology and pharmaceutical science at the University of Pittsburgh. As part of his research, Dr. Shiffman is equipping 200 daily and 200 nondaily smokers with personal-digital assistants to record their cravings, triggers and motivations.

For most smokers, the desire to smoke is a complex mix of physical addiction, behavorial conditioning and psychological factors, says Daniel F. Seidman, director of Smoking Cessation Services at Columbia University Medical Center and author of a new book, “Smoke-Free in 30 Days.” He notes that smoking just a few cigarettes a day can be even harder to give up than a heavier habit, since each one carries more reward. “I think it’s a trap—you’re never learning other ways to cope.”

Here are some of the most common smoking triggers, and suggestions for counteracting them.

• Social Smoking: Lighting up a cigarette may be taboo in many social circles now. But in others, the negative image only adds to its allure. Smoking at parties, in bars that still permit it, on the golf course or in private gatherings can be a way for some people to fit in and project a certain image—something that tobacco companies long cultivated with ads showing smokers sharing glamorous or fun experiences.

Some work environments also are known for heavy smoking habits.

“Smoking is a huge part of the food industry. When the diners leave, that’s when the party starts for the workers,” says Jack Taconni, who owns a gourmet store and catering business in Scarsdale, N.Y., and recalls joining waiters, chefs and sous chefs sharing cigarette breaks out the back door of kitchens for years. He finally quit with the help of a smoking-cessation drug three years ago.

Tips: If smoking is a part of your social circle, try enlisting your friends to quit with you and get together in places where smoking is strictly prohibited. Try to cut down on alcohol, which frequently goes hand in hand with smoking. If you need the look and feel of a cigarette to fit in, try using a nicotine oral inhaler (a prescription device that looks like a plastic cigarette and contains a replaceable plug of nicotine) that can give you the illusion of smoking. But you may need to avoid heavy-smoking friends until you’ve broken the habit.

• Secret Smoking: Another group of smokers is desperately hiding their habit—from children, spouses, friends, parents and coworkers—because it’s not part of the image they want to project. They often smoke alone, and feel the urge whenever they think they won’t get caught.

“Smoking was a contradiction to everything else about me. I worked out religiously, maintained a healthy diet, rarely drank alcohol, and worked in health-care public relations, of all things,” says Karin, who was a closet smoker for years. But all the time and energy plotting her next cigarette created more stress than the cigarettes relieved, she says. And getting serious about her boyfriend, who didn’t know she smoked, provided the final incentive to quit, she says.

Tips: Spend as much time as possible with the people you’re hiding your habit from, and try to imagine how hard it would be explain a smoking-related illness to them.

• Stress Smoking: “If you ask people why they smoke, the most common answer you’ll hear is it’s for stress,” says Dr. Seidman. He notes that this is also a concept promoted by the tobacco industry for years. Some people smoke to relieve stress, and some smoke to rev themselves up, to focus and concentrate. “But if you ask people to think about how smoking really helps them cope with the challenges in their life, most of them can’t tell you. It’s not. It’s just buying you a minute of distraction.”

Tip: Some smokers believe a cigarette helps them concentrate and focus their attention. But smoking might only be a respite from symptoms of nicotine withdrawal. Using a nicotine patch or gum can help alleviate the urge, says Dr. Seidman. In the meantime, you can work on devising some other means of focusing.

• Emotional Smoking: Some smokers smoke to stifle unpleasant emotions such as anger or frustration. But using cigarettes to manage anger backfires in the long run, Dr. Seidman says. “If you automatically walk around the block and smoke, you never face the issue and fix it,” he says. Smokers who do this need to develop what he calls “emotional confidence” to confront their feelings, and “get comfortable in their own skin.”

Tip: Assertiveness-training, which is part of many smoking-cessation programs, can be very helpful for emotion-driven smokers. So can making a conscious effort to stand and face whatever emotion is threatening to engulf you. “Let the feeling pass without smoking, and you’ll find over time that you can cope with it better than you imagined,” Dr. Seidman says in his book.

A substantial number of smokers have more serious emotional issues. A Harvard Medical School study in 2007 estimated that nearly half (44%) of all U.S. cigarettes are smoked by people with a diagnosable mental illness, including depression, anxiety, alcoholism and schizophrenia.

Some depressed people think that smoking alleviates their symptoms. But Dr. Seidman argues that depression feeds on smoking instead, and exaggerates nicotine withdrawal symptoms.

Addressing the depression through psychotherapy, medication or both may substantially ease the urge to smoke. Some antidepressants do double duty—bupropion, for example, is marketed as Wellbutrin for depression and Zyban as a quit-smoking aid.

• Worried-About-Weight Smoking:. Many smokers keep smoking—or go back after they’ve quit—to suppress their appetite. Often they justify the health risks in the belief that being overweight is unhealthy too. And smoking takes a toll on appearance in other ways—including staining teeth, aging skin and leaching calcium from bones.

Tip: There’s some evidence that quitters who use nicotine replacements gain only about half as much weight as those who don’t. Substituting water for cigarettes or fattening food, and exercising more, can also help cut cravings and instill healthier habits

• Scared to Stop: One of the biggest reasons people don’t quit smoking is the fear they won’t be able to cope with life without cigarettes, Dr. Seidman says. But many who hold that view have never tried to stop. When circumstances force them to, they often find it isn’t as difficult as they expected.

Nestor Herrera, who started smoking as a boy in his native Cuba in the 1950s, never thought he could break the habit until he was diagnosed with emphysema and was told he didn’t have long to live.

Using a nicotine inhaler, and enrolling in Columbia’s stop-smoking clinic, made it easier than he expected, he says, and he has stayed off cigarettes for three years. “People who know me very well don’t believe that I did it,” says Mr. Herrera, 63, who no longer needs his oxygen tank to breathe.

Tip: One technique Dr. Seidman recommends on the path to quitting is “smoking by the clock”—smoking your usual number of cigarettes each day, but according to a rigid schedule, to separate it from your usual smoking triggers. Demonstrating to yourself that you can resist those urges will reassure you that you can exert control over your habits.

There are plenty of other tips for quitting—including throwing out all your cigarettes, matches and ashtrays to make it as inconvenient as possible, and finding a buddy to share the experience.

But learning to live without cigarettes may be even harder than quitting itself. That’s why the more you can understand your own behavior, and find other means for coping, the more successful you’ll be in the long run.

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