Smokers Need More Than Motivation To Quit

It's been nearly half a century since U.S. Surgeon General Luther Terry declared that smoking was linked to lung cancer and was hazardous to health. Since then, smoking in the United States has been on the decline. How have most smokers left the habit behind? Some need medications like nicotine gum and patches to kick the habit.

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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. Im Renee Montagne.

LINDA WERTHEIMER, host:

And Im Linda Wertheimer.

Today in Your Health: quitting smoking. Theres still some 46 million smokers in the United States, but now theres an even larger group of ex-smokers. In a moment, well hear about an innovative program for low-income people trying to quit. First, NPRs Brenda Wilson reports on how antismoking efforts have evolved over the decades.

BRENDA WILSON: It's been nearly half a century since U.S. Surgeon General Luther Terry declared that smoking had been linked to lung cancer and was hazardous to health. Smoking in the United States has been on the decline. Has been on the decline ever since.

Dr. ANN MALARCHER (Centers for Disease Control and Prevention): Physicians started telling their patients about the dangers of tobacco use and letting them know that they should quit smoking.

WILSON: Dr. Ann Malarcher of the Centers for Disease Control and Prevention says smoke-free policies were mainly a patchwork in the early years after the surgeon generals report. Warnings were placed on cigarette packets. Radio and television cigarette ads were banned. Malarcher says people who wanted to quit were left to their own devices.

Dr. MALARCHER: Avoiding places were they typically smoked, avoiding situations where they wanted to have a cigarette, removing all tobacco products from their house, perhaps avoiding other smokers for a while.

WILSON: For millions and millions of Americans, such strategies worked, and they quit. Then, in 1984, the first nicotine gum became available by prescription as a way to help more people quit. A bigger nudge came in 1994 when California became the first state to outlaw smoking in all restaurants and bars.

As other states followed suit and smoking became less socially acceptable, the smoking rate fell to where it is today: 20 percent. John Hughes, a professor of psychiatry at the University of Vermont, works with people who have not been moved by these changes.

Dr. JOHN HUGHES (Psychiatry, University of Vermont): Well, public health messages - such as the media and increasing taxes and worksite restrictions -are very important in motivating people to quit. But they don't help them quit.

WILSON: Especially the hard-core smokers, he says.

Dr. HUGHES: There are some people that you can motivate and motivate and motivate, and they can't quit.

WILSON: And for such people, he says, medications can help. Theres the nicotine gum and patches, which can now be bought over the counter. Therere a total of seven medications. More are nicotine substitutes, but two are drugs that ease cravings. People can also get one-on-one counseling, call quit lines or join a support group.

Combined with medication, Hughes says, these methods are much more effective than trying to quit cold turkey. But most people don't avail themselves of drugs or counseling. Cost is a barrier, but the bigger reason, Hughes says, is that people think they ought to be able to quit on their own.

Dr. HUGHES: I think its because, you know, if you have drug abuse and you get over it on your own, you don't tell anybody about it. But if you quit smoking, if theres a conversation on smoking, you brag and tell about it. So I think people hear about other people who were fortunate enough to be able to do it on their own, and don't hear about the people that are struggling.

WILSON: But Simon Chapman at the University of Sydney in Australia says quitting smoking has become too medicalized.

Professor SIMON CHAPMAN (University of Sydney): The subtext of that is if you try to do it alone, you're unlikely to succeed.

WILSON: But Chapman and Hughes have conducted research that was funded by pharmaceutical companies. Even so, Chapman fears the balance in smoking control tilts towards the drug industry.

Mr. CHAPMAN: My objection is to the megaphoning, the drowning out effect of the hugely resourced messages which are going out to the community which are saying if you want to quit, don't try to do it alone.

WILSON: Its important to remember, he says, that 75 percent of the people who quit did do it on their own, without any help. But then theres the 25 percent who don't.

Brenda Wilson, NPR News.

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