For Amy Sylvester, quitting smoking meant trying again. And again. And again.

She finally succeeded over a year ago, ditching for good a nine-year habit and taking a stand for her health and finances.

“I tried a bunch of times, thinking ‘I know I should quit. I know it’s bad for me,’ ” said Sylvester, 25, a state legislative worker from China. “What drove me is how much money it cost and I actually noticed that my lung function wasn’t as strong. That really freaked me out. The thought of getting something like emphysema or COPD (chronic obstructive pulmonary disease) was scary – scarier than cancer even.”

Sylvester tried to quit using a nicotine patch on several attempts, as well as a “half-hearted” effort to quit cold turkey. What finally worked for her was nicotine gum and a handy app on her phone called My QuitBuddy that showed her how much her health was improving and how much money she was saving by ditching cigarettes.

Sylvester’s story – making several attempts to quit smoking before succeeding – is quite common among smokers in Maine and across the U.S.

About 19.3 percent of adult Mainers smoke, slightly higher than the 16.8 percent nationally in 2014, according to the U.S. Centers for Disease Control and Prevention. Roughly two-thirds of smokers in the state and across the country report efforts to quit smoking in any given year, the CDC said.

“Typically, it takes multiple attempts,” said Fred Wolff, program manager of the Maine Tobacco Helpline. “Smokers become self-incriminating. There’s shame – they feel badly that they are doing something that they know is bad for them. But there’s also hope that they can succeed.”

Wolff said the most successful way to quit smoking involves a combination of counseling, such as the helpline, and the use of one of seven tobacco treatment medications. The medications include nicotine gum, inhalers, lozenges, nasal spray and patch, as well as two non-nicotine medications – bupropion and varenicline.

“The counseling component is important because on their own, people may not use the medication long enough or properly to be successful,” Wolff said. Smokers who use the helpline are two to three times more likely to quit than if they try alone, Wolff said.

The helpline works with about 7,000 smokers in Maine a year – from across the state and among diverse ages and socioeconomic groups – through nearly 12,000 counseling calls, Wolff said.

Smokers who call the helpline have access to up to eight weeks of free, generic nicotine patches, gum or lozenges. MaineCare participants, however, are not eligible for the free nicotine replacement therapies since they already qualify for such benefits under MaineCare.

TREATMENT OPTIONS

The patch is the overwhelming favorite among helpline participants, with 80 percent of people wanting to use it or try it as part of their effort to quit smoking, Wolff said.

For those who do not use the helpline or lack insurance that covers smoking-cessation medications, the cost ranges from about 31 cents per generic nicotine lozenge, 50 cents for each piece of generic nicotine gum, to $1.85 per generic nicotine patch. Inhalers start at about $40 and include 42 cartridges that are good for one day each.

That compares with a pack of cigarettes, which averaged $7.47 in Maine and $7.26 in the U.S. in 2015, according to theawl.com. Raising the price of cigarettes increases the number of people who quit, but Maine is not currently focused on this strategy, according to the Maine Center for Disease Control and Prevention.

Other remedies such as hypnosis and acupuncture lack scientific evidence to support their use in successful efforts to quit smoking, Wolff said.

Another controversial method is electronic cigarettes, vape pens or vaping.

E-cigarettes vary in appearance from a traditional cigarette, a pen or long, thin pipe. Despite the varied design, the gadgets essentially work the same: they contain a battery that heats a sensor when a person inhales. The smoker sees a glow similar to a traditional cigarette and a vapor is expelled.

In 2008, the World Health Organization deemed that marketers of e-cigarettes should stop suggesting that the product was a safe and effective was to quit smoking since there was no scientific proof the validate the product’s safety and efficacy. Since then, studies have conflicted on the safety of the products.

In Maine, e-cigarettes are considered a tobacco product and vaping is covered by the same laws as conventional smoking. Nationally, the FDA said on May 5 it would regulate e-cigarettes, cigars, hookah tobacco and pipe tobacco for the first time.

Last year, a report by Public Health England said that vaping was 95 percent safe and encouraged the medical licensing of e-cigarettes in the United Kingdom as a nicotine replacement therapy to help smokers quit smoking.

Vaping starter kits range start at about $40 and the e-liquid used in the product, roughly the same as smoking a carton of cigarettes, costs about $10 to $15

Fewer than 6 percent of Maine’s helpline participants reported trying e-cigarettes, Wolff said. That compares to 12.6 percent of Americans who reported having ever tried an e-cigarette as of 2014 and the 3.7 percent who use the product every day or some days, according to the CDC.

Regardless of the type of tobacco product used, Wolff said the biggest challenge is “dealing with all the dynamics of addiction and keeping people invested in being hopeful.”

Sylvester, who smoked about 15 Marlboro Lights cigarettes a day, said she still sometimes misses the ritual and smell and social aspect of smoking. But she’s proud of herself for quitting.

“I miss it a lot. When I see someone smoking, I want to sniff them,” Sylvester laughed. “For the most part I can recognize how hard it was to quit and I stay committed and focused.”

She used the money she saved from quitting smoking to help buy her first house. q

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