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Instead, a successful approach includes: Gradually reducing daily consumption instead of quitting suddenly Identifying triggers like chai, stress, or boredom Replacing the chewing habit with safer alternatives Building consistency for at least 36 months Permanent quitting happens when your brain no longer associates gutkha with relief or routine

Some actual responses by smokers in this stage have been the following: Anger: Just get off my back, all right? Entitlement: Who are you to tell me what to do? Ignorance: I already smoke a low-tar cigarette, so there's no need to quit. Denial: Some people get lung cancer from smoking, but it won't happen to me. Defiance: I'll smoke if I want to. The goal of counseling patients in the pre-contemplation stage is to introduce ambivalence, so they will begin to consider quitting

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153 The first finding was that the rates of periodontal disease severity (periodontal pocket depth (PPD) and bleeding on probing (BOP)) among EC smokers were significantly lower (42.5%) than in traditional smokers (72.5%), but were considerably higher as compared to non-smokers (28.2%)

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