Q&A
Gary Giovino
Gary Giovino is professor and acting chair of the Department of Health Behavior, School of Public Health and Health Professions.
There’s no question that smoking can kill you. So why do people continue to smoke, or even take it up in the first place?
It’s really a multi-factorial, multi-level phenomenon. On the individual level, we understand clearly that nicotine is addictive. Recent research indicates that symptoms of addiction, such as loss of control, appear relatively early in the experimentation process. And most established smokers experience withdrawal (e.g., cravings, irritability, difficulty concentrating) when they go without smoking for a while, making the relief from withdrawal that smoking provides very reinforcing. Some confuse this with stress reduction. There appears to be a genetic component to addiction, such that some people will have more difficulty quitting than others—depending on how rapidly they metabolize nicotine. Optimism bias also plays a role. The vast majority of smokers recognize that smoking causes lung cancer, for example, but many underestimate their personal risk. Others attempt to reduce their risk by adopting ineffective strategies, such as smoking light or ultra-light cigarettes or taking vitamin pills. Smoking and attitudes about smoking among peers, older siblings and parents can influence initiation. Cigarette companies have spent more than $250 billion, in 2008 dollars, marketing their products since 1960, not including the market value of depictions of smoking in movies and on television. The tobacco companies have, for decades, prioritized making profits over protecting human health. They have promoted their products in ways to make them attractive, misled people to think that some cigarettes are less dangerous than others and manufactured their products to taste less harsh and deliver nicotine in biologically optimal ways. Governments influence consumption by setting excise tax rates—price is a major determinant of consumption—by deciding what level of protection from tobacco smoke pollution they will provide, and by deciding how strong a media campaign they will run.
Do nicotine patches and gum really work?
Clinical trials indicate that they double quit rates. One problem, though, is that people have many misperceptions about them. For example, only one-third of U.S. smokers recognize that using the patch is less risky than smoking—thus many people worry needlessly about the safety of these medications. With nicotine patch, gum or lozenge, prospective quitters are consuming one chemical, in pharmaceutical doses, whereas by smoking cigarettes they are inhaling 4,800 chemicals, 250 of which cause cancer or are toxic in other ways. And many smokers think nicotine-replacement products make you want to stop smoking or that they eliminate cravings. All they do is take the edge off the cravings. For more information, see the statement for consumers that Lynn Kozlowski, interim dean of the School of Public Health and Health Professions, several colleagues and I developed that provides advice on using over-the-counter nicotine replacement therapy to quit smoking.
In your experience, what’s the most effective way to quit smoking?
There are three keys to success. First, you have to be motivated to quit. No one will quit for you. Second, you have to be willing to make some changes in your life. If, for example, you always have a cigarette with your morning coffee, you have to be willing to change that habit. And third, you need to be willing to put up with the possibility of some temporary discomfort. Most people who quit do experience withdrawal, which can be a roller-coaster ride. But the longer you’re off, the less frequent and the less intense the cravings become. Regarding techniques, there is no “one-size-fits-all” recommendation. Some people need to cut down first and then quit. Some people quit all at once, without cutting down. Some people tough it out alone; others get help—the New York State Smokers’ Quitline (1-866-NYQUITS) offers coaching and free nicotine replacement therapy to eligible smokers. People need a plan for when the cravings come. Think of the 6 Ds: Delay—the craving will go away, whether or not you have a cigarette; Deep Breathe—to relax; Drink water—stay hydrated; Do something else—distraction helps take your mind off the withdrawal symptoms and can break old habits; Discuss—talk about what you’re going through with a friend or loved one or call the Quitline; and Don’t debate—the people who do the best are the people who’ve decided that smoking is no longer an option. When the little voice tells you that you can handle just one cigarette, remember that 80 percent of U.S. adults get through difficult situations without a cigarette and that you can, too.
Say you’ve finally decided to stop smoking. What’s the first thing you should do?
Pat yourself on the back! Then gather all your motivation and become focused on succeeding—most people have tried one or more times and have learned that you can’t have just that one cigarette. Understand the dangers of smoking and, more importantly, the benefits of quitting. Write down your reasons for quitting. Set a quit date. Some people report that prayer helps. Take it one day at a time—indeed, sometimes you have to take things one minute at a time. Stay off and reassess after 30 days.
Reader Comments