Nina Ball regularly walks by a row of smokers outside the charter school in North Philadelphia where she helps youths find jobs and get into college. A year ago, she might have bummed a cigarette there.

But today, after a series of group counseling and fitness sessions at a local health clinic, she hopes she has replaced her addiction to nicotine with another obsession: a drive to write and perform poetry.

"When I'm keeping busy with things I love, I feel less of a need to smoke," said Ball, who ditched her Marlboro Menthol 100s 10 months ago.

As Ball learned, the methods to stop smoking are growing. A few programs offer group counseling and fitness together - to counter fears of weight gain and encourage overall health - along with nicotine replacement products and drugs. Most sessions are free, courtesy of the money that tobacco firms pay yearly to states to cover smokers' health-related costs.

Insurers also may cover some prescription drugs for those enrolled in a state-sponsored cessation program.

Hospitals, in addition, are pushing smoking cessation to their patients. Studies suggest that they are likelier to quit when the health risks are high.

Each year about 443,000 people die from smoking nationwide, including about 20,000 Pennsylvanians and 11,000 New Jersey residents.

The habit, the nation's leading cause of preventable death and disability, remains surprisingly persistent. Twenty-seven percent of adult Philadelphians smoke "every day or some days," according to a survey by the Public Health Management Corp.

About 18 percent of Pennsylvania teens smoke, and 18,400 children under age 18 start smoking every year.

In New Jersey, the rate for adult smokers - 14.8 percent - is lower than in Pennsylvania, experts say, in part because the Garden State has the nation's third highest excise tax on cigarettes - $2.70 per pack - compared with Pennsylvania's $1.35 a pack. New Jersey's tax helps fund smoking cessation classes.

Many programs in the city are based on the state Health Department's cessation curriculum, "Quit Smoking Comfortably," devised by Frank T. Leone, director of the University of Pennsylvania's Comprehensive Smoking Treatment Program, and his colleagues.

"Cessation preps the patient on what to expect and how to deal" with withdrawal symptoms and changes in daily routine, Leone said. For some, that might mean just counseling. For others, it could also mean medication.

The goal now, he said, is to "shift health-care providers away from an antismoking attitude and towards . . . managing and minimizing obstacles."

The most accessible medication, often offered free by cessation programs, is NRT, or nicotine replacement therapy. These include over-the-counter patches, gums and lozenges. Small doses of nicotine also come in prescription inhalers and nasal sprays.

Drugs that may help include bupropion, an antidepressant marketed as Zyban; and varenicline, or Chantix, a nearly four-year-old prescription drug.

"Varenicline seems to be the most effective," said Robert Schnoll, a Penn researcher who studies cessation medications. "In studies, those with a prescription have a lower reaction than we would see in the regular population. It's not for everybody but . . . it's promising."

Last month the Food and Drug Administration put a black box warning - its strongest - on both Zyban and Chantix, cautioning patients to talk to their doctors if they get depressed or hostile, or have suicidal thoughts. Such reactions can also occur from stopping smoking, the FDA noted.

Chantix held a 91.2 percent market share in 2008, according to IMS Health, which tracks drug sales. Nicotine was the second most prescribed drug, followed by buproprion, the former market leader.

At least some of Chantix's rise can be attributed to the tendency for any new drug to appeal to people's hopes that "this is the one," said Leone. He noted that buproprion also saw "tremendous uptake," but died down after a year or two.

For Ball, 26, smoking was a misguided way to declare her youthful independence. She learned how to smoke in hopes of snagging the role of a "bad ass" character in a high school play in Baltimore. The role went to a nonsmoking classmate, but from then on, Ball was hooked.