More than 3 million Floridians smoke cigarettes. And most of them, according to the 2006 Florida Adult Tobacco Survey, want to quit. • Experts say nicotine is one of the toughest addictions. Most people have to try at least a few times and techniques — sometimes in combination — before they succeed. We talked to a Moffitt Cancer Center researcher to get an overview on what seems to work, and a Columbia University expert and author who says his personalized plan is helping thousands to kick the habit.
"How's the smoking?" your doctor asks. You look away, and she presses a small pamphlet into your hand. "Read this," she says. "Maybe it will help."
But will it? Researchers at the Moffitt Cancer Center in Tampa want to find out. In April, Moffitt received a $2.8 million research grant from the National Cancer Institute to see how effective smoking cessation booklets are. Thomas Brandon, director of the Tobacco Research and Intervention Program at Moffitt and a psychology professor at the University of South Florida, filled us in on the project.
Does quitting cold turkey work?
"Cold turkey" means different things to different people. To some people it means quitting smoking without using medication. To some it means quitting all at once. People can succeed with both methods. My experience is that it is actually easier for most people to quit all at once.
How effective are over-the-counter and prescription products to stop smoking?
There are seven FDA-approved medications: five nicotine replacement therapies (gum, patch, inhaler, nasal spray, lozenge) and two non-nicotine medications: bupropion (Zyban) and varenicline (Chantix). In controlled clinical trials the five nicotine replacements and bupropion are roughly equally effective, doubling the cessation rate compared to placebo, and producing 6-month abstinence rates of 20 to 25 percent. Varenicline so far seems to do a little better, producing abstinence rates of 30 to 35 percent. All of these products work much better when combined with counseling, though.
Are there low-cost options for extra help?
There are a variety of minimal assistance resources available to smokers wanting to quit. These range from the types of pamphlets that we are studying in this project, to the state tobacco "quit lines," to a large choice of free and payment-based websites.
What about the TV ads for Tobacco Free Florida? Does that work?
Those ads are mostly publicizing Florida's tobacco telephone quit line, where smokers can receive some counseling and perhaps, if they qualify, some free medication. In general, studies have found that quit lines increase abstinence rates by about 5 percent compared to control conditions. That's pretty good, given the high reach that they have. (Tobacco Free Florida is online at www.tobaccofreeflorida.com; the Quit Line is toll-free 1-877-822-6669.)
How does that compare with pamphlets?
The little previous research on pamphlets indicates that they produce about 1 percent additional abstinence rates. However, most of those studies examined very short trifold pamphlets. We'll be looking at more intensive, comprehensive booklets, so we expect to find higher numbers. Our preliminary research found effects in the double digits, which would be very good given the potential reach of this sort of intervention.
Logan D. Mabe is a St. Petersburg writer and teacher. Contact him at firstname.lastname@example.org.
Need incentive ?
Consider what happens to your body after you stop smoking:
20 minutes after quitting: Heart rate and blood pressure drop.
12 hours: Carbon monoxide level in blood drops to normal.
2 weeks to 3 months: Circulation improves and lung function increases.
1 to 9 months: Coughing and shortness of breath decrease; cilia (tiny hairlike structures) regain normal function in lungs, increasing ability to handle mucus, clean lungs and reduce risk of infection.
1 year: Excess risk of coronary heart disease is half that of a smoker's.
5 years: Stroke risk is reduced to that of a non-smoker 5 to 15 years after quitting.
10 years: Lung cancer death rate is about half that of a person who continues smoking. Risk of other cancers decreases too.
15 years: Risk of coronary heart disease is the same as a non-smoker's.
SOURCE: American Cancer Society
The American Cancer Society says hypnosis for smoking cessation hasn't been well studied, in part because hypnosis methods vary widely. But if you think it might work for you, find out more at a June 12 seminar at Helen Ellis Memorial Hospital in Tarpon Springs, hosted by Rena Greenberg, president of Wellness Seminars and a certified hypnotist. The seminar starts at 10 a.m., and you can stay for the first 45 minutes to see what you think. After that, you can leave or pay the $79.99 fee for the rest of the session, which also includes a CD, booklet and free repetitions of the hypnosis for one full year. For information and registration, call toll-free 1-800-848-2822 or go to www.easywillpower.com.
Daniel Seidman is a psychotherapist who has spent most of his life thinking about smokers. He got started young.
"My earliest memories of my parents all feature smoking," Seidman writes in his new book, Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit. "My father died much too young — at 47 — from heart disease, and my mother died from the ravages of lung cancer at 59."
Seidman leads the smoking cessation service at Columbia University Medical Center in New York and has 20 years of research and experience helping smokers kick the habit for good. He has found that smokers become quitters when they can tailor their strategy.
Maybe you automatically light up during coffee breaks, parties or after meals. Maybe you smoke because you fear gaining weight. Or because you're under stress.
Discover what drives your cravings, and you increase your odds of quitting, Seidman says.
He introduced his plan to smokers outside his clinic as a guest on Oprah Winfrey's show, prompting 200,000 people to download his "Breathe Easier" program from Oprah's website.
We asked him about his book and the best hope for smokers.
Why did you write your new book?
What I found missing, and what I still find missing, is innovative, in-depth approaches to the real-life dilemmas faced by people quitting with insights based on intensive face-to-face clinical experience. Smoke-Free in 30 Days is directed at guiding different kinds of smokers through the entire quitting process — before, during and after.
You advise quitters to keep journals and chart their moods. How does that help?
Self-awareness is a crucial tool in the program. Instead of acting in an automatic way, awareness helps you interrupt established patterns and make important changes to support nonsmoking.
How do smokers' approaches to quitting differ?
Many smokers quit on their own with little or no help, while some smokers say it is the most difficult thing they have ever done. I think the "one-size-fits-all" approach, which dominates the popular marketplace for stop-smoking books, is outdated. Many of these books also take an anti-nicotine replacement therapy approach, which is very unfortunate because, when used appropriately, it can help build a smoker's confidence and ease withdrawal symptoms.
You write that "Recovery is not a triumph of willpower but a triumph of self-love, and of love from those around you." What does that mean?
Many smokers, especially men, think it's all about willpower. But I've helped many extremely strong and disciplined people to stop, and it's not just about being strong. Learning to take better care of and protect your body is an important act of self-love. Sometimes it's more about getting the proper help and support you need. Seeking effective help when you need it is a strength, not a weakness.
You emphasize that quitting smoking can be an adventure.
It's key that your smoke-free life will be better than life as a smoker. Most smokers who successfully quit enjoy the freedom from the hassle of being addicted. The point is this is an active, ongoing process.
— Logan D. Mabe
To get more information on Project Quit, or to volunteer for the study, call toll-free 1-877-954-2548 or visit www.moffitt.org/projectquit. For Florida's free smoking cessation program, Tobacco Free Florida, go to tobaccofreeflorida.com or call toll-free 1-877-822-6669.