Kicking the Habit May Require More Kick

Glimpse any two minutes of the popular television series Mad Men, a compelling mirror of 1960’s American culture, and chances are you’ll see at least one of them smoldering between someone’s fingers or lips.  In the boardroom.  On the airplane.  In the living room, kitchen and family car.  Even primary physicians during patient visits are smoking them.  Cigarettes are so prevalent on the set of Mad Men, it wouldn’t be surprising to see the line item “Lucky Strikes” hover at the top of the production budget.
Did our culture really embrace smoking that handsomely a mere few decades ago?  Have we truly reversed the direction of this single tenet of unhealthy behavior?
The good news is our culture has made significant strides away from smoking prevalence since the Surgeon General’s Advisory Committee on Smoking and Health published its comprehensive report linking cancer risks to smoking in 1964 (and Congress passed the Cigarette Labeling and Advertising Act the following year.)  The bad news is, even with the multitude of new research indicating a full range of additional health risks and morbidity impacts of tobacco use (from the gamut of cancers to heart disease, stroke and a myriad of others), the declining trend line of smoking prevalence has flat-lined.  In 2005, 20.9% of adults were classified as smokers.  In 2009, 20.6% were. That’s a half decade of virtually unchanged tobacco use declines.
Kicking the habit has also lost its steam in teen communities, as well.  Between 1997 and 2003, teenage smoking dropped from 36% to 22%.  However, in 2009 it remained virtually the same as the 2003 level.
Even more alarming, the Centers of Disease Control and Prevention just released a study indicating more than half (54%) of children between the ages of 3 and 11 years old are being exposed to second hand smoke.
Have we reached an unmovable wall of smoking decline and prevention?  Is an 80% non-smoking population the best we can hope for?
Hardly.  If you compare state by state smoking prevalence rates and examine the different state-sponsored approaches to tobacco use, you’ll easily note the relative impact.  California, for instance, has implemented aggressive and long running tobacco control programs and realized smoking prevalence declines by 40% virtually the same time period (between 1998 and 2006) the nationwide prevalence declines stalled.  As a result, lung cancer is now declining in California four times faster than the rest of the nation.  Maine, New York, and Washington have experienced 45-60% youth smoking prevalence reductions in recent years as a result of their sustained efforts directed at this population.
Sustained engagement, once again, proves key.  A recent study by the Oregon Health Science University supports this theory, as well.  They studied smokers trying to quit over a 12 week period and discovered those who ultimately do quit fall into one of two camps – those who abstain and quit immediately and those who relapse during early weeks of treatment but eventually quit.  The study emphasized how delayed quitters account for as much as one third of smokers who successfully remain abstinent one year post intervention – a significant population achieving healthy behavior change not immediately but over time.
Mad Men’s Don Draper may remain a hopeless chain smoker the remainder of the series, his lungs ever pocked with Lucky Strikes char.  It was the 1960’s, afterall.  But today’s smokers fare a far better chance to reform.  The right balance of motivation, education, intervention and sustained engagement can get them (and keep them) tobacco-free.