Stop Smoking News
Kicking the hard-core habit
Meg Dougherty and Darlene Richardson are pleasant, well-mannered women, but in the world of smoking-cessation counseling, they rank among the hard cases.
Dougherty started smoking cigarettes sometime in her 20s. She’s not sure how many attempts she has made to stop, but nothing worked for more than six months.
Richardson remembers exactly how and where she started: at a party shortly after her marriage at 21. And she stayed hooked for decades, even when “it made me feel like I was taking my tongue and licking an ashtray.”
Then, at age 50, both women enrolled in the JeffQuit smoking-cessation program at Thomas Jefferson University Hospital. The program, which instructors offer at sites around the country under the name QuitSmart, is for anyone 18 or older, but especially for those who have tried to stop and failed.
“It’s almost been too easy,” said Dougherty, a nurse who reports being smoke-free since March 2. “It’s the first time I can see myself quitting for years and years.”
Cessation researchers and counselors say that with the growing public awareness of smoking’s health risks, social rejection through smoke-free areas, and the rising price of cigarettes, it’s mostly folks such as Dougherty and Richardson who are left.
“Individuals who have continued to smoke despite pressure to quit tend to be more ‘hard-core’ than were smokers of several years ago,” says Robert Shipley, who developed the QuitSmart program (the parent of JeffQuit) and has led the Duke Medical Center Stop Smoking Clinic since its inception in 1977.
To reach this group, physicians, therapists, and researchers are enlarging their bag of tricks, repackaging old techniques, trying newer ones like acupuncture, and looking for genetic clues to what makes it harder for some people to quit.
They are prescribing antismoking drugs more aggressively while taking a gentler approach in counseling. One might call it “talk softly and carry a big prescription pad.”
“In every smoker, there’s a non-smoker trying to come out,” says Frank Leone, who directs the Comprehensive Smoking Treatment Programs at the Hospital of the University of Pennsylvania. “We want to make that as easy and effective as possible. The field has shifted toward being more supportive. ‘You deserve not to smoke and here’s how we’re going to do it.’ ”
Leone drew up the “Quit Smoking Comfortably” curriculum used in the free smoking-cessation classes and workshops offered by the Philadelphia Department of Public Health. The mix of prescribing and counseling is similar to that of QuitSmart.
Lorraine Dean, manager of the department’s Tobacco Policy and Control Program, said that about 800 people have taken the program in the last year.
Statistics bear out the need to reshuffle the smoking-cessation deck. As the percentage of adults who smoke has slowly fallen, so has the effectiveness of cessation programs.
At the time of the first Surgeon General’s Report in 1964, about 42 percent of adults over the age of 18 smoked cigarettes. By 2009, the figure was just under half that, although the decline has slowed in recent years.
But at the same time, Shipley says, smoking-cessation programs have proved less successful. He cites one study showing that the success rate (6-12 months of abstinence) grew from about 20 percent in 1965-69 to about 30 percent in 1970-74, but has been declining in recent years, slipping back to around 20 percent.
Prospective quitters may be getting some help on the DNA front.
A new study by researchers at the University of Pennsylvania indicated that the number of so-called mu opioid receptors in the brain may show why many people find it so tough to quit.
“For the first time, we’ve identified a mechanism that explains why people with a particular genetic background may be more prone to relapse when they try to quit smoking,” said study director Caryn Lerman, a psychiatry professor at the Penn medical school. Nicotine, she said, releases brain chemicals such as beta-endorphins, and those with more of these receptors found nicotine more pleasurable.
Medications that block the activity of these receptors have had mixed results, but further research may show how they can become more effective, Lerman said.
The researchers used positron emission topography (PET), a nuclear imaging technique, to measure the amount of mu opioid receptors in smokers’ brains. The machines are too expensive for use in treating individual smokers, Lerman said. But “eventually, we hope to be able to predict who will have the easiest time quitting” and design programs more tailored to the individual.
Meg Dougherty was sitting in a small circle of chairs in an exercise room in Jefferson’s Center City complex. “I feel like I should be wearing a ’smoke-free’ tiara,” said Dougherty, who lives in Overbrook.
Sitting beside her, smoking-cessation counselor Anna Tobia was a verbal streaming billboard of encouraging messages for Dougherty and two others. “You have to try new ways of coping, that’s what this comes down to. . . . You’ve given up so much. . . . I feel like without a doubt you’re going to stay.”
The four-week program costs $249, though many insurance plans will cover $200. It is based on moving slowly into abstinence. Tobia calls it a “warm chicken” approach compared with the “cold turkey” methods used years ago. Participants attend an opening class and then ease down into quitting by smoking progressively weaker brands of cigarettes. They may even have started wearing a nicotine patch before the program begins, flooding their bodies with nicotine the way one might have a large meal to kill the appetite. Nicotine gum and lozenges also are used.
Smokers who have tried and failed to quit are being reached with a program of supportive counseling, drugs, and other techniques.
Other weapons in the program’s arsenal are a tobacco-free fake cigarette with an adjustable draw to help them disassociate the hand-to-mouth movement of smoking from the pleasure sensations that follow – and discounted acupuncture and stress-reduction programs. There is also a self-hypnosis CD that another QuitSmart practitioner, Lafayette Hill and Jefferson University Hospital psychiatrist Francisco Merizalde, finds particularly helpful. “It’s the combination that makes it work,” he says.
The most commonly prescribed drugs are Chantix and Zyban, which contains the same medicine as the antidepressant Welbutrin. (It’s used to help break the addiction; there’s no assumption that smokers are depressed.)
Chantix was prescribed sparingly in past years due to possible side effects including depression and suicide attempts. But Shipley and other cessation experts say it is generally safe if used under supervision and that if nothing else works, it’s still a lot safer than continuing to smoke. He believes that a combination of drugs and mental reinforcement is most effective with most longtime smokers.
Whatever is prescribed for QuitSmart clients, however, it is buttressed by supportive group sessions and a self-hypnosis CD. Tobia makes herself available as much as possible by cellphone and frequently calls or e-mails clients while they are in the program or after completion.
New York City Smoking Ban Starts Today
Beginning today, Monday, May 23, 2011, smoking is not allowed in outdoor public spaces around New York City, including beaches, parks and plazas. (That means Central Park, Yankee Stadium, the Coney Island boardwalk and so on — or everywhere it’s fun to smoke.) Health officials have pointed toward second-hand smoke as the reason for the new policy. But will police actually be patrolling for public smokers? How will the ban be enforced in a city full of smokers? And what will happen to the loosie man?
The city is leaving most of the enforcement responsibility up to us. “We expect the new law will be enforced by New Yorkers themselves, who will ask people to follow the law and stop smoking,” read a joint press release from the Parks, Health and Transportation Departments. So look forward to some shouting matches on the Great Lawn.
But there’s also a $50 fine, if the complainer can get someone in charge to pay attention:
Q: What is the penalty for smoking in a park or other area where smoking is prohibited?
A: We expect that the new law will be enforced mostly by New Yorkers themselves, who will ask people to follow the law and stop smoking. This is how similar laws have worked in other places, including Chicago and Los Angeles. However, people who violate the new law could receive a $50 ticket.
Q: What should I do if someone refuses to stop smoking in a park, beach or other area where smoking is prohibited?
A: New Yorkers are encouraged to inform a Parks Department employee or a Park Enforcement Officer if one is available. Otherwise, complaints can be made by calling 311.
The city is also planning an ad campaign to alert everyone of the changes.
Expert smokers, who still own the sidewalk, to be extra aggressive today, exhaling onto every baby they see.
Reynolds Suggests Snusing As Tobacco Ban Takes Effect
The Wall Street Journal ’s David Kesmodel writes that R.J. Reynolds is “seizing on new antismoking laws in New York City” while the Winston-Salem Journal’s Richard Craver says the hometown tobacco company is merely “attempting to make lemonade” out of the ban on smoking in the city’s parks, beaches, boardwalks, and pedestrian plazas that was signed into law in February and takes effect today.
Whether you see it as an aggressive ploy to fill the void left when the last wisp of cigarette smoke wafted into the ozone layer at midnight, or as defensive move to salvage some sales out of yet-another intrusion on personal freedom, Reynolds has launched a newspaper campaign for Camel Snus this morning in local New York newspapers (except the New York Times, which does not accept tobacco advertising) as well as USA Today and the Wall Street Journal.
CSPnet.com has some thumbnail images of the full-page ads, which carry the headlines “NYC Smokers Enjoy Freedom Without the Flame” and “NYC Smokers Rise Above the Ban.” “Smokers, switch to smoke-free Camel Snus and reclaim the world’s greatest city,” reads the copy in one of the ads.
An R.J. Reynolds’ spokesman says the company simply wants to “make adult smokers in the city aware of a smoke-free tobacco product that’s available to them” and that “as trends in tobacco use change, Camel is transforming by offering adult smokers options, like smoke-free Camel Snus, to consider switching to.” It refers to the products as “spit-free, smoke-free, mess-free tobacco that comes in a small pouch” on its website. “Just slide it under your upper lip and enjoy.” It also plays up the two-century-old Swedish heritage of the product.
“Some public-health advocates, pointing to the difficulty of quitting smoking, argue that products like snus could play a role in reducing tobacco-related harm,” Kesmodel writes. “Others say the products may entice more people to take up tobacco, and could keep smokers who otherwise might drop tobacco altogether from doing so.”
Bill Godshall, the executive director of SmokeFree Pennsylvania, tells Craver that Reynolds is the first large U.S. tobacco company to encourage smokers to quit smoking by urging them to switch to a smokeless product. The ads, however, do not make any claims of reduced health risks, which doesn’t mean that anti-smoking groups find them acceptable.
“These ads continue Reynolds’ irresponsible marketing of snus as a way for smokers to get their nicotine fix in the growing number of smoke-free places,” says Campaign for Tobacco-Free Kids spokesman Vince Willmore.
In a separate piece in yesterday’s Winston-Salem Journal, Craver reports that Matthew Carpenter, an associate professor in the department of psychiatry and behavioral sciences and the department of medicine at the Medical University of South Carolina, is conducting a federally funded study that aims to answer two key questions in the debate: 1. Can a smokeless product … contribute to a smoker quitting cigarettes — particularly one who doesn’t want to stop? 2. If it does, could an increase in use of smokeless-tobacco products over cigarettes cause a net harm to the population?
But Matt Myers, president of the Campaign for Tobacco-Free Kids, says research should also evaluate whether the marketing of smokeless products result in more people actually using tobacco, “which could result in more deaths, not fewer.”
Craver discusses some prior research that indicates that the use of smokeless products may be effective in curbing withdrawal and craving among smokers who want to quit. But, he points out, “the evolution of some health-advocacy groups from anti-smoking to anti-tobacco is ratcheting up the moralistic aspect of buying and consuming a legal product.”
Ken Kendrick, the managing general partner of the Arizona Diamondbacks, published an op-ed piece in the Arizona Republic yesterday that calls on Major League Baseball to enact a ban on smokeless tobacco just like one that has been in effect for minor leagues teams since 1993.
“Ballplayers aren’t indulging a harmless habit when they use smokeless tobacco,” he writes. “They’re damaging their health with a product that causes cancer and other serious diseases. And they’re endangering the well-being of countless kids who look up to them and who copy everything major leaguers do.”
Kendrik says that while cigarette sales are down, the promotion of smokeless products as a substitute is having an effect: Smokeless-tobacco use by high-school boys has risen 36% since 2003. “Every time a kid sees a major-league player using smokeless tobacco,” he writes, “baseball is contributing free promotion.”
Tobacco use falls despite cuts to funding
Emily Kecskemety, a senior at Pittsford Sutherland High School, was watching the movie Hairspray one day and was bothered by all the smoking in the film.
The big-screen version of the Broadway musical had scenes with teens smoking in a high school bathroom, teachers smoking in the faculty lounge and pregnant mothers smoking during a dance number, even though it was a PG-rated movie.
She and other members of Reality Check, a high school club aimed at preventing teen smoking, created an awareness-raising activity out of the movie.
“A group of us decided to play a game and stomp our feet every time we saw something smoking-related and we couldn’t believe the significant amount of times we did see something,” Kecskemety, 17.
Pittsford’s Reality Check is one of a few teen-run anti-tobacco efforts still in existence in Monroe County after federal and state funding for such groups were cut. And although teen smoking rates are declining, concern remains that without such peer programs, the rates could again rise.
“These groups have to stay alive because smoking companies target teens and teen awareness efforts are some of the main reasons why smoking has gone down,” said David Walling, former Monroe County coordinator of Reality Check. “When teens educate other teens about the ways that tobacco companies are focusing on younger kids to get them hooked, kids get totally offended because they don’t want to be duped.”
Cigarette use by high school students declined from 27.1 percent in 2000 to 12.6 percent last year, according to the state Department of Health.
Close to 80 percent of adult smokers began before age 18, according to the Campaign for Tobacco-Free Kids.
New York budgeted $47 million in 2011-12 for tobacco-prevention initiatives, said Morris Peters, spokesperson for the state budget office, down $17 million from last year. Three years ago, the state spent upwards of $80 million annually on programs.
The New York state Department of Health Tobacco Control Program helps run Reality Check, a statewide initiative empowering youth to participate in reducing tobacco use among peers, removing tobacco advertising from magazines delivered to schools and removing tobacco use from movies rated G, PG and PG-13.