Over the past year, sales of prescription stop-smoking aids have fallen 18 percent, according to IMS Health. Sales of the much-heralded stop-smoking pill Zyban tumbled 22 percent, while sales of the patch Habitrol, the No. 2 prescription aid, fell 43 perc

The drop in sales of stop-smoking aids is another indication of how difficult it is to get Americans to kick the habit. No one knows exactly why sales of these products are down, but doctors and researchers blame insurance companies that don't pay for cessation drugs and doctors who don't actively help their patients quit smoking. There has also been a dramatic increase in ''light smoking,'' and some experts believe the current crop of smokers is particularly hard to treat. In addition, many smokers have unrealistic expectations of the stop-smoking aids, giving up after one failed attempt when it takes the average quitter at least six to eight tries before success. The Surgeon General later this month is expected to issue broad new guidelines for doctors and clinics to use in helping the nation's 50 million smokers kick the habit. The message will be that insurance companies, doctors and smokers need to start viewing tobacco addiction as a chronic disease that may require several attempts to put in remission, says Michael Fiore, who chairs the federal panel writing the guidelines. ''We don't tell our diabetic patients that if the first medicine we give them doesn't normalize their blood sugar, they're a personal failure,'' says Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School. Another obstacle to quitting may be cost. Only about half of United States insurance companies reimburse patients for stop-smoking drugs and related counseling programs. Many consumers simply can't afford Zyban, which costs about $90 a month, for example. Doctors don't do enough, either. Although 70 percent of smokers visit a primary-care physician each year, only about half are urged during the visit to quit smoking, says Thomas Brandon, director of tobacco research at the H. Lee Moffitt Cancer Center in Tampa. These trends are particularly troubling given that smokers have a far better chance of quitting when they have help of some kind. A May report in the American Journal of Preventive Medicine found that 80 percent of would-be quitters in California opted for the ''cold turkey'' approach. But only 7 percent of those smokers were able to quit for 12 months, while 15 percent of those who used counseling or nicotine-replacement therapies succeeded. Some researchers believe the current crop of smokers are ''hard-core'' - highly addicted and difficult to treat. The theory is that with the health hazards related to smoking widely understood, the easiest cases have already quit. In the March issue of Nicotine and Tobacco Research, a review of smoking-cessation counseling programs showed success rates were 30 percent lower in the late 1990s than in the late 1970s, suggesting today's smokers are tougher cases, says Brandon. Researchers have also detected a shift in habits. In California, for instance, 24 percent of smokers are now light smokers, meaning they smoke less than four cigarettes a day. That compares to 16 percent in 1990, according to John Pierce, professor of cancer prevention at the University of California-San Diego. These are likely former heavy smokers who have been forced to ratchet down their smoking because they live in nonsmoking homes and work in nonsmoking offices. While less smoking is generally seen as a positive trend, there is concern that these light smokers may have a false sense of security about smoking less and therefore, are less motivated to quit. They're wrong. ''There's no safe level of smoking,'' says Fiore. Studies show that light smokers are highly efficient, taking more puffs, drawing the smoke deeper into their lungs and smoking down to the filter. Even smokers who smoke as few as one to four cigarettes a day still have markedly higher risk for heart attack, strokes and cancer. The new surgeon-general report is expected to offer new guidelines for having doctors and clinics provide every smoker with effective treatment, including using a combination of nicotine patches, gums, nasal sprays and inhalers, as well as Zyban. Meanwhile, other researchers are focusing on the 90 percent of quitters who don't last a year. The H. Lee Moffitt center is researching relapse prevention and offering support materials by mail. You can call 1-877-9KICKIT, for information. For smokers who want to quit, seeking help from a doctor or a counseling program offers the best chance of success. They advise smokers to consider using a stop-smoking aid even if it didn't work the first time. Set a definite quit date; don't just try to smoke less. And learn from past attempts what hurt and helped. Also, avoid alcohol. Finally, while medications help, nothing on the market entirely eliminates tobacco cravings.

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