Thomas McNees, 61, runs a shoeshine business at T.F. Green Airport in Rhode Island. These days, he no longer needs to worry about customers lining up as he ducks out of the terminal to grab a cigarette. McNees, who began smoking in his early teens, quit for a decade and then smoked a pack a day for the next quarter-century, has been tobacco-free for the past two years, other than a couple of brief lapses.
[See: 11 Items That Protect Your Health.]
Quit-and-restart cycles are common for long-term smokers. McNees first quit in 1979, when he got married, and restarted when that marriage ended in divorce. “It triggered a lot of anxiety and a lot of emotion,” he recalls. Sporadic attempts to quit didn’t take. “Nicotine is so addictive it should be a Schedule I drug,” he says. But he’s finally found a cessation method to kick the habit, hopefully forever.
Too often, psychological stress is cited as an insurmountable reason to keep smoking “for now” or delay cessation treatment. In reality, smoking is an unhealthy choice for temporary stress relief, and people who suffer from stress know it.
A recent study followed a group of highly stressed, heavy smokers from 1997 to 2015. Over time, participants reduced the number of daily cigarettes they smoked. More and more people tried to quit as the study progressed. Long-term smokers who tended to feel sad, nervous, restless, hopeless or worthless, or that everything they tried to do was an effort, were still highly interested in quitting, according to the study published online in October 2017 in the American Journal of Preventive Medicine.
That result was somewhat unexpected but quite encouraging, say Margarete Kulik, a researcher with the Center for Tobacco Control Research and Education at the University of California, San Francisco and the lead study author.
Cultural changes may have helped counter lingering attitudes that people under stress “need” to smoke more. “Over time, smoking had been denormalized,” Kulik says. Policies to discourage smoking — such as widespread bans in public place and higher cigarette taxes — have reached those with chronic stress, she says, just like the rest of the population.
Kulik says results from her study bear out that people feeling distress are still willing and motivated to quit smoking — they just might need some extra support to be successful.
The proportion of long-time smokers in the U.S. is estimated to range anywhere from 5 to 30 percent, with older adults most likely to fit the category. For certain groups, assumptions such as they can’t quit or that other issues outweigh all the health risks of smoking — cancer, heart disease, respiratory conditions and more — have unfortunately put quitting on the back burner.
[See: 7 Things You Didn’t Know About Lung Cancer.]
Along with people living under continual stress, those with low incomes or mental health diagnoses face extra quitting hurdles. Rural residents with distant health care sources or people without insurance often lack access to treatments that work.
For McNees, two factors made the difference. First, through customers, he heard about smoking cessation involving the drug varenicline (brand name Chantix). The treatment reduced his urge for nicotine, breaking the pattern of lighting up the next cigarette as soon as he put one down.
Second, thanks to Obamacare coverage, McNees is able to afford the medication, which retails at $400 a month or more — a cost beyond his reach. However, with cigarettes running roughly $10 a pack where he lives, smoking is nearly as expensive.
It’s not that people with extra challenges are unwilling to quit, but rather that they haven’t received the right care, says Jodi Prochaska, an associate professor of medicine at the Stanford Prevention Research Center. “When we reach individuals and provide evidence-based care, we get pretty similar quit rates to what you see in the general population,” says Prochaska, who is also president of the Society for Research on Nicotine and Tobacco.
Job-hunting is stressful. But instead of helping people get through the process, smoking reduces their prospects of being hired. A recent study led by Prochaska followed about 250 unemployed job seekers in the San Francisco Bay area who received services from employment agencies. Researchers tracked which participants were hired within a year.
Smokers were about 20 percent less likely to be employed, according to the study published in the May 2016 issue of JAMA Internal Medicine. Among smokers who found work, average hourly wages were significantly lower than for nonsmokers at $15.10 versus $20.27, respectively.
“We asked the smokers how they prioritized their discretionary spending [with major bills and rent paid],” Prochaska says. “At the top was cigarettes. Cigarettes came before mobile phone use, grooming needs and transportation. So we were thinking that focus on tobacco is hurting their resources in terms of finding work.”
In her role as a clinical psychologist, Prochaska treats many long-term smokers trying to move past the addiction. Among them, she describes a woman patient who had been told long ago that she was too stressed to quit: “She said, ‘Well, 43 years later I’m still stressed out and still smoking.'”
Lack of access to reliable quitting methods is the real barrier, Prochaska says. An approach that includes ongoing, tailored counseling, along with medication, is considered most effective. To work, motivational counseling should meet people in whichever stage they’re in, from just beginning to think about quitting to “OK, I’m starting today.” Providers should offer the best-available pharmacotherapy, she says: a combination of nicotine replacement, like patches, and varenicline.
No group should be written off as unable to quit smoking. The idea that addressing nicotine addiction simultaneously with other mental health issues is too much for patients to bear is contradicted by evidence, Kulik says. “It’s really important that health care providers in mental health settings make quitting smoking and cessation services more of a priority.”
Mental-health facilities have lagged in curbing or banning smoking, Prochaska agrees, although awareness has improved since the days when staff members would light up alongside patients. Now, she says, there’s a growing appreciation that people with mental health diagnoses are more likely to die from tobacco use than from schizophrenia or depression.
Sometimes, helping people quit means literally meeting them where they are, like rural Alaska. Smoking prevalence remains high in the state, where about half of men and one-third of women still smoke, Prochaska says. For her current research, her team is using bush planes to recruit participants of native Alaskan descent in rural villages, and providing video counseling from sites in Stanford and Anchorage.
[See: 11 Ways Rural Health Is Hazardous to Your Health.]
For McNees, quitting has reduced stress. “You develop a sense of calmness,” he says. “That everything’s really OK — you don’t need that cigarette.” To fill the void, he’s joined a health club and started swimming and working out as part of his transition to a nonsmoking lifestyle. “It’s really cool,” he says. “I’m really proud I was able to quit.”
More from U.S. News
Which Medical Screenings Should You Have in 2017?
8 Questions to Ask Your Pharmacist
11 Simple, Proven Ways to Optimize Your Mental Health
‘Hardcore’ Smokers Actually Want to Quit, Too originally appeared on usnews.com
