Thanks to education about the risks of smoking plus cessation and harm reduction efforts, fewer American adults smoke than at any time in the last century. Today, just 14% of adult males and 11% of females are smoking cigarettes. Yet that terrific achievement is tempered by the sobering reality that more than 30 million people across the country smoke.
Those smokers lead to half a million deaths each year, which is like nearly wiping out the entire state of Wyoming annually. We’ve had success but there is more work to do.
Each year since 1978, the American Cancer Society has hosted the Great American Smokeout on the third Thursday of November. The idea is that if we get people to quit for one day it might lead to two, and then forever. It’s more challenging than many realize. Yes, nicotine is addictive but so is caffeine, which means there is more to it than just a chemical. We now know there is a lifestyle aspect, there is a psychological aspect, and more. For some, smoking cessation and harm reduction are enough and nicotine replacement therapy, things such as nicotine patches and gum, do the job. Sweden has the lowest smoking rate in the world, the only country ahead of the U.S., because people use alternatives like snus, which provides nicotine but without the 200 cancer-causing chemicals in cigarette smoke.
For America to gain the top spot, we have to think about more than nicotine. For some, the ritual or even the oral benefit matter more than the nicotine, which is why older smokers who went “cold turkey” in the past lamented weight gain. They needed to do something with their mouths once per hour so they snacked more. Many said chewing gum helped there, as it replaces the ritual without the calories. Some use apps for support.
Whatever works, but we know it takes more than education. By now, anyone who wants to know is aware it is not too late to benefit from ending the cigarette habit. Even the most ardent smoker has been shown that elevated heart rate and blood pressure drop within 20 minutes of the last cigarette and that between two and twelve weeks after the last smoke, circulation improves and lung function increases. The risk of coronary heart disease is cut in half just one year after quitting, and after 15 years it can approach that of a nonsmoker.
So it takes more than knowledge about harm, it takes replacing some of the ritual, which means support from your tribe. For some that will mean a gradual reduction, like replacing one cigarette with a cup of coffee or a piece of gum during breaks. If you know someone who smokes, you can even proactively offer one of those as a substitute. Since cigarette smoking is a multi-factorial problem, the desire may pass once the psychological switch shuts off again. And just like how some overweight people associate a movie with popcorn, if the social aspect of smoking and fellowship is replaced by something else, it gradually becomes the thing people want.
Substitution and encouragement have been shown to be better than shaming, throwing facts at smokers, or engaging in the ‘quit or die’ posturing of regulations and lectures. America has made a lot of progress in ending smoking, we are ahead of Asia and Europe in that regard, but that is faint praise when we are talking about a product that will eventually kill half its customers.
This decade, let’s make the Great American Smokeout a thing of the past by making smoking itself a thing of the past.
Hank Campbell is the founder of Science 2.0, a 501(c)(3) science and health nonprofit organization.