To Your Health - “The Great American Smoke Out”

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Hello and welcome to the first installment of the HCAM News monthly medical segment To Your Health. I’m Dr. Jim Kenealy and I’ll be serving as your medical reporter for regular updates on health information, opinion, and the latest from the world of medicine and health care.
I can think of no more important topic for our introductory program than tobacco cessation. My patients know that I am particularly passionate about this issue as both my father and grandfather were stricken with complications from years of smoking - including emphysema, heart disease, stroke & cancer. I want to spare my patients and their families the pain and suffering endured by my loved ones who battled with this terrible addiction.

The American Cancer Society has traditionally set aside the third Thursday in November as the “Great American Smoke Out.” This nation-wide effort at tobacco cessation falls on November 19th this year. It provides all of us with the incentive to either stop smoking ourselves or encourage our friends and family to do so. It can be the first step on a difficult, but one-day-at a-time journey to breathing easier and living healthier.

Consider the facts:
Health complications from smoking affect the entire body. In addition to cancers of lungs, chronic obstructive pulmonary disease (COPD or emphysema), heart disease, and stroke; smoking can cause slow, less noticeable damage to many other organs and body systems. Cancers of the mouth, throat, voice box, tongue, esophagus, breast and bladder have all been linked to tobacco consumption.
Many women don’t realize that smoking can adversely affect fertility and is associated with premature and low birth weight babies.
There are even recent reports of links between tobacco consumption and Alzheimer’s disease, as well as other forms of dementia.
Remember, using so-called “smokeless” tobacco products, like snuff or chew, is not a safe way to quit or a healthier alternative to smoking. The use of these products just shifts the increased risk of cancer to the mouth, head, and neck. Smokeless tobacco users run the same risks of gum disease, heart disease, high blood pressure, and addiction as cigarette users, but an even greater risk of oral cancer. Smokeless tobacco also causes many other oral health problems, including tooth decay and chronic bad breath. Unfortunately, as cigarette sales have been declining for decades, smokeless tobacco sales have grown about 7 percent annually over the last four years. Smokeless tobacco presents a growing risk to our teens and children who are not aware of these risks and think that these products are safe alternatives to smoking. Teens need to get the message about using smokeless tobacco products. According to the Centers for Disease Control and Prevention, as many as 13 percent of high school boys and 2 percent of high school girls use smokeless tobacco. Teens who use smokeless tobacco products are more likely to become addicted to cigarettes later in life. As for cigars, well, a recent New England Journal of Medicine article demonstrated that there is no safe level of consumption for stogies either.

If you can’t quit for yourself, maybe you can be motivated by concern for those around you, especially your children and grandchildren. In July 2006, the Surgeon General released evidence supporting the fact that secondhand smoke presents a dangerous health hazard. More than 4,000 different chemicals have been identified in secondhand smoke and at least 43 of these chemicals cause cancer.

The new report states that there is no risk-free level of second hand smoke exposure. Although second hand smoke is dangerous to everyone; fetuses, infants, and children are at most risk. Even brief exposures can be harmful to children. This is because secondhand smoke can damage developing organs, such as the lungs and brain. Secondhand smoke exposure causes respiratory symptoms, including cough, phlegm, wheeze, and breathlessness, among school-aged children. Children with asthma exposed to secondhand smoke experience more frequent and severe attacks. I know from my own specialty that children exposed to secondhand smoke are at increased risk for ear infections and are more likely to need an operation to insert ear tubes. Unfortunately, parents who smoke outside the home, still bring in the smoke on their clothing, so this is not as helpful as you might think.

Of course, the easiest way to stop tobacco consumption is to never begin in the first place. But this can be tough, particularly for teens who are under peer pressure and subject to a barrage of glitzy multi-media advertising campaigns. A recent study found that 34 percent of teens begin smoking as a result of tobacco company promotional activities. Always remember that parents are a powerful role model. If you don’t smoke, your children are less likely to smoke. Conversely, if one parent smokes, then ½ of their children are likely to take up smoking; if both parents smoke, the odds are that all of their children will as well. As with any risky teen behavior, they will do as you do, not necessarily as you say. Also, don’t be afraid to talk to your children about smoking; they’ll be less likely to smoke than if you ignore the problem.

Kicking the habit is tough, but don’t despair or think that you are alone. There are resources out there to help you quit. The American Cancer Society on their website- has many useful tips on quitting smoking and smokeless tobacco as well. You can investigate Quitworks, a collaborative tobacco cessation program sponsored jointly by the Massachusetts Department of Health and several of the major health insurers. They provide support, counseling and smoking cessation aids such as nicotine patches. This program is credited with reducing the smoking rate among MassHealth enrollees by 26% in 2009. Check with your health insurer to see if they participate in Quitworks. A referral from a health care provider is necessary, so talk with your doctor as well.

Your doctor is always a good place to start with any tobacco cessation plan. He or she will have the experience and training to get you started on the right foot down the path to quitting. Also, lean on the support of family and friends. As with any addiction, living within the culture of that addiction is detrimental to rehabilitation. Smokers who live with other smokers can rarely quit on their own. Consider entering into a non-smoking pact with your smoking spouse, child, roommate or friend and vow to get through it together. It’s the best gift you can give to each other.

Avoid the temptation to just try to cut down. Nicotine consumption is a smoker’s response to stress. And, when life brings along some another dose of stress, which it always does, your tobacco consumption will escalate accordingly. I’ve rarely seen a patient who has been successful at tobacco cessation through the “attrition” method.

Finally, for those of us who are fortunate enough to be non-smokers or successful quitters, we need to help our loved ones and neighbors who still smoke to quit once and for all- not by chiding, guilt or scare tactics- but with encouragement, empathy and support. Nicotine addiction is a difficult and overpowering affliction, not a deep character flaw.

As we approach the Great American Smoke Out on November 19th let’s consider some things we can do together to create a “tobacco free” culture in Hopkinton:

Make your home and car smoke-free spaces for your family and for others.
Plan and insist on smoke-free social events.
Support businesses and activities that are smoke-free. Let other businesses owners know that you can’t support their businesses until they become 100 percent smoke-free too. In particular, pharmacies and other health care businesses who also sell tobacco products need to be made aware of the conflict of interest and hypocrisy inherent in such practices. They shouldn’t dispense health at one register and a known carcinogenic toxin at the next.
Let restaurant owners with outdoor smoking areas know that you would like to enjoy smoke-free al fresco dining as well.
Support tobacco education in our schools, even at the elementary grade levels.
We should all work together to uphold restrictions on tobacco advertising and promotions.

For some health problems it does take a village.

For HCAM News, I’m Dr. Jim Kenealy, speaking to your health.