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Smoke Signals 

Cigarette smokers have an uphill battle in their efforts to quit, but government regulations, high taxes, cultural trends and improved cessation programs may offer the incentives they need for success.

Tonya Guess knows what it is to love and lose. She loved cigarettes — the way they felt in her hand, the act of smoking and the stress relief they gave her. She also hated them: the addictive hold they had on her, the detrimental affect they had on her asthma and the fact that Andrae Boone, her fiance-now-husband, had never smoked and wanted her to quit.

  The Louisiana native became a heroine for thousands across the country when she let the world watch her monthlong journey to quit smoking in the fall of 2004. She had lots of support from the American Legacy Foundation (ALF), which followed her around with a camera, provided her with nicotine patches, counseling and other tools to kick the habit. The foundation also made her the poster girl for a $1.5 million Mary Quits campaign in Washington, D.C., where she worked at the Business Higher Education Forum on DuPont Circle. Her face was plastered on ads in newspapers and on posters all over the city. The ALF films can still be viewed at www.maryquits.com.

  "I was outside my work building having a smoke break and a woman walked up and asked me if I had ever tried to quit smoking," Guess says. "I told her, 'I have thought about quitting every day of my life and have been praying about it.'" Guess signed up for the Mary Quits program, and at the end of a month, she was smoke free.

  "I did quit and stayed quit for about three years," she says. "Then I just had a stressful day. I said, 'I want a cigarette,' and had one. Now I'm in further than I was before. It started with just one, then I waited a couple of months and had another one, then I had a whole pack."

  It's a powerful addiction many smokers understand. Despite widespread information about smoking-related health problems — including lung cancer, high blood pressure, heart and vascular disease and more — many people find it impossible to quit.

  "What we know about smoking cessation is that it's really hard and that the success rate for cold-turkey quitting is about 3 percent," says Dr. Aaron Kobernick, a pediatrician at Tulane University School of Medicine who arranged a partnership between Tulane and Louisiana Campaign for Tobacco Free Living (LCTFL) to teach future doctors and physicians in training how to help patients stop smoking. "Of the things people have tried, the two things that seem to help is counseling and medication together."

  Guess agrees. The nicotine patches helped to curb her craving for nicotine, and counseling as well as a program of staying busy with things like a gym membership, painting class and visits to local museums, etc., assisted in breaking the habit of smoking and the psychological dependency. That is, until she slid back into the habit.

  She tried to quit again a few months later. "I tried Chantix (a prescription medication) but , of course, right when it was beginning to work and I really didn't want [a cigarette] because it makes you sick (to smoke while taking the drug), I went home to visit my family in Louisiana and all of them smoke," Guess says. "That just put me over the edge.

  "I believe I really want to quit, but for some reason, I really can't overcome my desire to smoke."

It's a story with which many smokers can identify. The American Lung Association reports there are 43 million smokers in America, and of the 19 million who tried to quit in 2005 alone, only 4 to 7 percent were successful. Health professionals, smoking cessation clinicians and even the U.S. Surgeon General's office recognize cigarette smoking is more than a habit; it's an addiction to nicotine, one of the 599 additives the U.S. government has approved for use in the manufacture of cigarettes. The American Heart Association says, "Nicotine addiction has historically been one of the hardest addictions to break. It causes changes in the brain that make people want to use it more and more." In the 1988 report "Nicotine Addiction," the U.S. Surgeon General said "Pharmacological and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine."

  Although the hundreds of additives allowed in cigarettes are approved for use in foods, their structures change when burned. The National Cancer Institute says cigarette smoke contains as many as 4,000 chemicals and at least 43 are known carcinogens, including benzene, formaldehyde, ammonia, acetone, carbon monoxide and arsenic.

  The health effects can be devastating. In addition to being the No. 1 cause of lung cancer in both smokers and nonsmokers (through exposure to secondhand smoke), the Centers for Disease Control reports that cigarette smoking also can cause cancers of the lip, mouth, pharynx, esophagus, pancreas, larynx, cervix, bladder and kidney.

  Those harsh chemicals affect not only the smoker, but people exposed to the smoke, especially children, Kobernick says. "What we've seen is that if you're around secondhand smoke, you're at increased risk for asthma, sudden infant death syndrome and more frequent ear infections. These are well-established for secondhand smoke in the home. If you have children, it's crucial to quit smoking. That's where we know the most about secondhand smoke.

  "They're working on studies now in New Orleans ... sampling bartenders', waiters' and waitresses' saliva for cotinine — a marker metabolite of nicotine — to see how much exposure workers exposed to secondhand smoke are actually getting. The function is to gather evidence to get smoking out of bars and restaurants."

  In Louisiana, smoking already has been banned in office buildings, public buildings, restaurants and automobiles carrying passengers 13 years old or younger. Rep. Gary Smith, D-Norco, and Sen. Rob Marionneaux, D-Livonia, have filed separate bills to ban smoking in bars as well, and it would take effect as early as Aug. 15. The Louisiana Legislature will take up those bills during the legislative session that began last week.

  To make matters worse for smokers, on April 1 the government raised the federal tax on a pack of cigarettes from 39 cents to $1.01. Rep. Karen Carter Peterson, D-New Orleans, proposed a bill to raise the state tax by $1 per pack (it's now 36 cents) to raise an estimated $200 million a year for healthcare and to entice more smokers to quit. Gov. Bobby Jindal said he would veto the measure and it was butted out of committee last week.

  Antismoking advocates hope the federal tax hike will compel smokers to put down their cigarettes for good, and there are a wealth of help lines and smoking cessation programs to assist them (Louisiana residents can call 800-QUIT-NOW). One resource smokers underutilize, however, is their health care providers. Harris Interactive conducted a survey in November and December 2008 for The American Legacy Foundation, which found that 20 percent of the 340 smokers surveyed in New Orleans have never talked to their health care providers about their smoking, although 82 percent had tried unsuccessfully to kick their habit. (The survey included more than 1,000 smokers in New Orleans, Baltimore and St. Louis.) Kobernick says health care providers should be the first line of defense, which is why he arranged the partnership between Tulane and the LCTFL — to link doctors with the resources they need to help their patients.

  "The [LCTFL] had a ton of resources," he said. "In our clinic we started putting the resources in the hands of the clinicians. We've noticed that patients are then able to get the referrals they need. The smaller scope of the program was to get the resources available to clinics. The larger scope is to set this in motion for a larger system. We want to make sure the clinics have the resources they need and that the clinicians of tomorrow are trained to use them."

  Only about half of the smokers surveyed in New Orleans recognized they should talk to their doctor about smoking, and only about half of their doctors brought up the subject.

  "If you ask them, about 80 percent of smokers want to quit," Kobernick says. "If there was an easy way to quit, this wouldn't be a problem. But there are ways to get it done, and [doctors] can maximize the odds.

  "The most successful quitters are the ones who have a concrete plan in place. Over-the-counter remedies (including nicotine patches and gum), if they're used correctly and in conjunction with counseling, are good tools. Primary care doctors are the ones trained to make decisions and get patients on the right medications. There are a lot of choices."

  The survey also indicated that many smokers suffered a sense of guilt and shame about smoking. "Obviously that's not the environment to quit smoking," Kobernick says. "We need to treat it like a medical condition, use the best evidence we can, be empathetic, get a good program and support them.

  "The good news ... is that smoking is on the decline, especially among new smokers. We're moving in the right direction. In many cities that have gone smoke-free already, it's definitely made it less comfortable for people to use tobacco. It's become an issue in culture. That sense of shame is something we need to work with in terms of a motivating factor. These tax increases aren't just to make people angry and make them feel like second-class citizens. It's in the best interest of everyone."

Tonya Guess can attest to the elation of conquering cigarettes — and the deflation of being defeated by the habit.

  "It's something I think about every single day," she says. "I feel so much hurt, humiliation. I see people who stop and I think 'Why can they stop and not me?' When I quit before, I had so much support from my fiance, the Legacy Foundation, people at work, my friends. They all knew the task I was undertaking and they were rooting for me. Now I feel like I have had a relapse after having quit for so long. I feel like a failure. I pray that I will be able to quit again for good. I want to not desire them ever."

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