As New Year’s resolutions go, “Quit smoking” always ranks high on Americans’ lists. It’s also a stubbornly hard resolution to keep.
That’s why a program pioneered by a UC Davis doctor is ramping up efforts to get more smokers to take their last drag on a cigarette. Called UC Quits, it’s working to connect patients more quickly and seamlessly to a statewide smoking-cessation program.
Buster Halcomb, 66, is one of those patients. The Sacramento retiree, who has a chronic cough, got his first taste of tobacco at age 7, working as a shoeshine boy with a cigar stuck in his mouth. Later, he worked in Kentucky tobacco fields, harvesting sheaves of tobacco leaves. By age 14, he was often smoking and chewing tobacco – mostly without his parents’ knowledge – up to two packs a day.
Five decades later, dealing with emphysema and other health issues, he’s struggling to quit his lifelong habit. “My new granddaughter is my inspiration,” said Halcomb, who has nine kids and 22 grandchildren, the youngest born earlier this month. “My doctor has been after me for years to quit. Cigarette smoking shortens your life, and I’d like to see her and my other grandchildren grow up.”
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Through his UC Davis Health System doctor, he got an e-referral to the California Smokers’ Helpline, which provides free telephone counseling and other support to Californians trying to quit.
Launched in 2013 by Dr. Elisa Tong, a UC Davis associate professor of medicine, the UC Quits e-referral program is designed to easily enable doctors in any clinical setting – a routine office visit or a hospitalization – to connect patients via their electronic medical records with the Smokers’ Helpline. With the patient’s permission, doctors can electronically send the smoker’s phone contacts to the helpline, which will contact the patient within two days. It’s a reversal of the typical scenario, Tong said, where a doctor might suggest a patient make that initial call themselves.
“People’s lives are busy and they forget to call,” said Tong, who noted a study showing that having someone reach out and call patients results in a 13-fold increase in getting them connected to counseling. Funded by a $541,000 grant, UC Quits is now a collaboration among five UC medical school campuses: Davis, Irvine, Los Angeles, San Francisco and San Diego.
The UC effort comes as U.S. smoking rates have dropped – declining from 42 percent of adults in 1965 to 18 percent in 2012, although e-cigarette use, especially among teens and young adults, has accelerated, according to a 2014 U.S. surgeon general’s report. Tobacco has killed more than 20 million Americans prematurely in the past 50 years, the report said, which estimates 42 million Americans still puff away.
“If smoking persists at the current rate among young adults in this country, 5.6 million of today’s Americans younger than 18 years of age are projected to die prematurely from a smoking-related illness,” the report noted. It also cited a host of new diseases causally related to smoking, including diabetes, erectile dysfunction, macular degeneration eye disease, rheumatoid arthritis and congenital defects in infants.
In Sacramento County, smoking rates are especially high at nearly 18 percent, according to a June report by the California Tobacco Control Program, a division of the state Department of Public Health. Many counties with major urban areas have smoking rates below the statewide average of 13.8 percent, with the lowest – 6 percent – in Marin County. But, the report noted, the state’s “important exceptions” are San Francisco (14 percent) and Sacramento (17.9 percent) counties. With 6.2 percent of California’s adult population, those two counties have elevated smoking rates that “significantly impact” the statewide prevalence of smoking, the report said.
The California Smokers’ Helpline, based at the UC San Diego Moores Cancer Center, has 50 trained staffers who handle about 40,000 calls a year, according to helpline director Chris Anderson. The typical caller is about 50 years old, he said, but some have been as young as 14 or as old as over 90.
Calls typically go up after New Year’s Day, either because people had a smoking relapse during the holidays or have postponed quitting until the new year. “Quitting smoking is hard. It’s a chronic relapse condition, meaning it involves a lot of trial and error and false starts,” said Anderson. “Smokers can go through a (quit-and-relapse) cycle several times until they quit for good.”
Smokers’ Helpline counselors help assess smoking habits, set a quit-smoking date, discuss why previous attempts may not have worked and discuss nicotine-withdrawal options, such as gum, lozenges and patches, as well as prescription pills, nasal sprays and inhalers to fend off cravings. They’ll be a constant support line, following up by phone or text message as needed.
While some people quit cold turkey, others need support to break lifelong habits and ease their nicotine withdrawal.
The most crucial period typically is the first two weeks, when nicotine cravings are strongest and longstanding smoking habits are hardest to undo.
“It’s particularly insidious because it gets into people’s routines in a way that’s hard to shake,” said Anderson. “It’s that feeling of, ‘How am I going to get through stress or drinks with friends or emotional situations without my usual buddy, my cigarette?’ That’s a strong habit (to break).”
When a craving for a smoke comes on, new coping strategies are needed, said Anderson. “More than likely, it will pass in 10 minutes,” he said. “Drink water. Keep yourself busy. It will come and go and, in most cases, it will pass. It’s not going to get worse.”
Instead of reaching for that cigarette, smokers often need to find substitutes, such as toothpicks, candy or sunflower seeds to keep hands and mouth busy. Some keep a pack of cards handy to shuffle to occupy their hands. Spending time in movie theaters, malls or public settings where smoking is not allowed can be helpful.
Halcomb, for instance, said his hardest time is when he’s around other smokers, particularly at family parties. “You just have to say ‘I’m trying to quit smoking. Hope you don’t mind if I step away.’ ”
Given the intensity of nicotine’s grip, “it’s not a failure when you slip up because nicotine is so addictive,” said UC Davis’ Tong. “But every time you give your brain a break, it can make it easier to quit.”
Halcomb, who’s been smoke-free for about three weeks, already knows the benefits of quitting. A while ago, he and his wife managed to stop smoking for 33 days, and he vividly remembers the difference it made. “You feel better. Food tastes better. Coffee tastes better. Things smell better. You’re clearer-thinking.”
Now, about three weeks into his new resolve, Halcomb is hopeful this time it will be permanent. “I wish I’d never touched a cigarette,” said the retired machinist, who said his parents and 10 of his siblings have died from smoking-related illnesses. “When I slip, I scold myself but I talk to people who will encourage me. Nobody can do this for me … but (if it works), it’ll give me future years around my family.”
No Butts: Helping smokers quit
California Smokers’ Helpline: Operated by the UC San Diego cancer center for more than 20 years, the free telephone counseling (800-N0-BUTTS, or 800-662-8887) is offered in six languages. California smokers also can get daily text messages and self-help materials. Free nicotine patches are available for adults living with children ages 5 and under. For more information: nobutts.org
Asian Smokers’ Helpline: An offshoot of the California smokers’ hotline, it offers one-on-one counseling – nationwide – in four languages: Mandarin, Cantonese, Korean and Vietnamese. Callers receive one-on-one counseling, self-help materials and a free, two-week starter kit of nicotine patches sent to their home.
Guide for Quitting Chew: For users of smokeless tobacco, the National Institute of Dental and Craniofacial Research has step-by-step tips on how to quit.