Tobacco Cessation and Healthy Habits Transcript
Host: Hello and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host Renee Fox, and my guest today is Dr. Megan Piper, professor in the University of Wisconsin Department of Medicine. Dr. Piper’s research focuses on understanding and treating tobacco dependence among people who smoke and people who use e-cigarettes with an additional focus on addressing issues of smoking related health inequity based on race, gender, and mental illness.
A Madison native, Dr. Piper completed her undergraduate degree in chemistry at Carlton College in Minnesota, her master’s degree in Clinical Psychology from the University of Miami in Ohio, and her PhD in clinical Psychology from the University of Wisconsin Madison. In addition to her role as professor, Dr. Piper is a research director at the University of Wisconsin Center for Tobacco Research and Intervention. This UW Center is nationally recognized for its groundbreaking tobacco research and its commitment to translating those research findings. The overall goal of the Center’s collective work is to reduce the physical, emotional, and financial consequences of smoking and to eliminate all tobacco product use. Dr. Piper, thank you so much for joining us today.
Guest: Thank you so much for having me.
Host: Can you start by telling us more about your research focus and the work at the UW Center for Tobacco Research.
Guest: Happy to. So my work focus is primarily on understanding this notion of dependence, you know, people smoke and use e-cigarettes and other tobacco products because it’s an addiction. It’s not a bad habit, it’s not a lifestyle choice. What may have started as a choice has for the vast majority of people who use these products actually become an addiction. And in order to truly treat that, we have to first understand what that means, understand how the brain has changed, understand how behaviors and social networks have changed, and then identify the most effective interventions to help people.
Because we know that the vast majority of people who smoke cigarettes want to quit and more than half are going to try every year. And so we want to make sure that when they do try, we have the best tools available for them. My focus has been on understanding and developing treatments, and that’s also the center’s focus as well.
And then the other piece I guess I would add is that in my research and also the center, we’re focusing on what we would consider priority populations. Populates where the use rates are much higher than in the general population and where perhaps they’re less likely to have access to treatment, or less likely to be able to quit even with treatment.
These groups include people with mental health issues. They include people from the LGBTQ plus community. They include racialized people from minoritized racial groups. Those with less education and lower income. And these are also, of course, the groups that are targeted by the tobacco industry.
So really part of our work is to reduce one of the leading health disparities, which is tobacco use.
Host: Let’s focus more on some of the reasons that someone would want to quit smoking or using tobacco products. Can you talk about some of the health risks associated with the various forms of tobacco use, whether that be through smoking, vaping, or chewing.
Guest: Sure, happy to. So one of the issues with tobacco use is that, um, again, it’s dependence. It, it causes changes in the brain and the brain structure and how it’s functioning, and that’s what keeps you smoking. But that’s all based on the molecule of nicotine. Nicotine is what causes dependence. It is all of the other chemicals that cause all of the health problems related.
So if we focus specifically on. When you burn a cigarette, when you, when you smoke a cigarette, you are creating 7,000 different chemicals and more than 50 of those cause cancer. And so when you’re absorbing those things into your lungs, it goes into every system in the body, and it causes more than half a million deaths every year in this country.
It causes deaths related to lung disease and cancer. People are also dying from strokes. They’re dying from, uh, lung diseases like COPD. And so all of these different health conditions are directly linked to people’s smoking. And what’s sad about this is not only are people more likely to die if they’re smoking, but they’re losing 10 to 20 years of their life.
So when you think about that, if you were to die, if you thought you would make it to 80 and instead you died at 60 or 70, What all would you miss? You might miss, you know, things that you had planned on for your retirement, major family milestones, children graduating from high school or college or marriage or grandchildren.
And so again, that’s why it’s so important to help people who have this tobacco dependence be able to quit so that they can avoid that extensive loss of life.
Host: Yeah. Great reminders and reasons to act to make that step and, and quit using. On the flip side, what are some of those positive benefits that people do experience after they quit?
Guest: Sure. And this is the important part to focus on. Quitting smoking is really hard, but there are some huge payouts when you’re able to be. First of all, we have to talk about saving money, right? The cost of cigarettes these days has just gotten higher and higher, and people talk about what could they do if they were able to save, you know, if you’re smoking a pack of Marlboros at $8 a pack, you know, how much money could you save over the course of a month?
And what could you do with that? So that’s one huge benefit. It’s also important to recognize that even if you’ve been smoking for 40. Your body can heal itself from some of this damage. So even after only 20 minutes of not smoking, your heart rate starts to come down and your blood pressure starts to drop.
So if you’re someone who’s already on blood pressure medication and you don’t like having to take it, quitting smoking may actually help your blood pressure improve to the point where you don’t need medications within two weeks to up to three months, your risk of a heart attack starts. After one year, that risk, the risk that smokers have of the higher risk of coronary disease becomes half of that as if you’d continued smoking.
And within five years, your risk of cancers, many of the cancers are cut in half. And so the notion that your body can heal itself over time is really important. And it doesn’t take decades and decades. Sometimes it just takes a few months. Another important improvement that can happen is improvement in.
Health people talk about smoking to help them deal with anxiety and depression. But what we also know is that every day you go through little mini episodes of withdrawal and craving, and that actually increases anxiety and can increase symptoms of depression. And what we see in our research that we’ve done is that when people are able to quit, they actually find significant improvements in mental health, less likely to have another depressive episode, reporting lower levels of.
So it can save money, it definitely can improve your health even in, in the short term, you can also demonstrate improved mental health. So I think those are some of the primary drivers, things that people have to remember are coming, when they’re able to quit smoking. Yeah, there’s one other thing. And that is regaining some control over your life. People who smoke talk about the fact that they’re always thinking about where they can go and when they can get outside to smoke a cigarette or when they are going to be able to have a chance to get to the store to get another pack because they’re running out.
And cigarettes start to control your life again because of that dependence. And so once you have broken free, then. You have this feeling. A lot of people talk about freedom where they’re not spending so much of their time in their lives thinking about when they’ll be able to smoke next.
Host: Yeah. And I understand that the Center has a statewide tobacco control program that has a lot of resources that anyone living in Wisconsin can tap into for help to quit tobacco use. So can you tell us a little bit more about the program and the resources that are available?
Guest: Sure. So our center runs, uh, we work with the state Wisconsin Tobacco control program to run the Wisconsin tobacco quit line. That is one 800 quit. Anybody in the state of Wisconsin can call. They have English operators.
They’ve got folks who speak Spanish. They are ready for people who are hearing impaired. But at one 800 quit. Now you are going to reach a caring, trained professional who is ready to help you quit smoking. Think about just cutting down, making changes. Uh, they’ll even help people who aren’t smokers but are trying to figure out ways to help friends and family who want to quit.
And so what the Quitline offers is free coaching, free counseling from these trained and caring experts. And right now, actually there’s a great opportunity because they’ll actually provide eight weeks of free nicotine replacement. So either nicotine patches or gum or lozenges, or even a combination of the patch and the gum, or the patch and the lozenges to anybody who signs up for the program, and then they’ll call you.
They will give you a call back to check on you. How are you doing? How is your quit plan going? So this eight weeks of medication and these different calls that are available, and while supplies last or until they run out of funding at the end of June. So that’s a great resource that we have. And even after that resource runs out, the Wisconsin tobacco quit line, you can call however often you would like.
You can talk to them as much as you’d like and they will send you two weeks. That’s the regular program is two weeks of free nicotine replacement products, um, and associated with the tobacco Quit Wisconsin tobacco Quit line is also, they have an app that you can have access to and some web program.
And so all of that is something that we administer through our center, uh, but it’s for all people, uh, in the state of Wisconsin. And another key resource I would also like to highlight is something called smokefree.gov. It is a website that is run by the National Cancer Institute, and it has fantastic programs.
It has a text to quit program you can sign up for, and they’ll send you texts to remind you about how much money you’re saving, to remind you of what a great job you’re doing, healing your body and taking care of your mental health by quitting. You can text back and ask for support if you’re having cravings or you need other support.
So it’s a really nice texting program as well as a website with fantastic resources. It even has specific resources for women, for veterans, and for other different groups, people with histories of depression. Again, lots of great information and support are out there when you’re ready to take advantage.
Host: Great resources, thank you. And we’re going to have those links in the show notes so you can find out a little bit more like the exact the phone number and website and how you can download the app. So check out our episode show notes for more details on those resources. And so, Dr. Piper, I know you mentioned nicotine replacement therapy. What are your thoughts on using those products and also if you could address prescription medications and how those resources may or may not be helpful in quitting.
Guest: Sure. Uh, so you bring up a really important issue, and that is the medications we have to help people quit smoking. People will talk about just needing willpower or just having to be strong, and that’s all it takes to quit smoking. But the problem is that a lot of people, when they try it that way, are not able to be successful. And so when I talk to people who are ready to quit smoking, we talk about having every tool possible in your toolbox. Medication to help you quit smoking is one of the critical tools.
I’ll talk to people and I’ll say, you know, if I sent you out to build a house, that would be a really big job and there’s no way I’d send you out to build a house and just give you a hammer. Right? You’d need to have a saw, you’d need to have measuring tools, you’d need to have all sorts of things.
Medication is one tool, and it’s really important. So let’s talk for a couple of minutes about what the different medications are. There are a bunch of different nicotine replacement medications. I mentioned them earlier. The patch, the nicotine lozenge or mini lozenge, the nicotine gum.
Those are the most popular. And then there are also two prescription medications. One is called Varenicline or Chantix, and the other is called Bupropion, which is the generic, or Wellbutrin is the, is the um, brand name. And all of these medications will double or triple your chances of being successful.
So nobody ever asks how you quit smoking. You don’t get docked points by your friends or your doctor if you use the medications. People are just so excited that you’re able to be smoke free. That it really doesn’t make sense not to use the medications. And here’s why. What these medications do is they, they help take the edge off your withdrawal symptoms again, because nicotine has changed the way your brain is structured.
Your brain is screaming out for nicotine. And that’s where those cravings come from. That’s where other withdrawal symptoms like irritability, like depression, like sadness, and all of those are. By these different medications, they really do reduce the cravings. But that still means you’re going to have a lot of work to do to change other things in your life, and you’re still going to have to cope with cravings.
You’re still going to be need to be strong. You’re still going to have to use willpower, but it makes it so that you are more in control of your quit attempt. So it is highly recommended that anybody who’s motivated to quit smoking and ready to give this a try, makes sure that they’re using either nicotine replace—ideally a patch in combination with the gum or the lozenge, or going to your doctor and getting a prescription for either Chantix or Wellbutrin to help you quit smoking. Or Iban is the other brand name for the, for the Bupropion or the Wellbutrin. And so reaching out, making sure you have those medications, and then making sure that you even if you slip up and have one cigarette or maybe two cigarettes after you’ve tried to quit, keep taking that medication because it’s going to help you right the ship. It’s going to help you keep doing what you’ve been doing, which is working really hard to improve your health. Uh, one other thing that the prescription medications also do, they help you do, is they make the cigarettes not quite so satisfying. So that’s another way that they can help you, uh, when you’re trying to quit smoking.
Host: Great description of all of those products. I really love the analogy of building a house and making sure you do have those tools. So according to the CDC statistic from 2020, there’s an estimated 30.8 million US adults who are still smoking cigarettes. And, many of them, according to their research, would like to quit, as you alluded to earlier. So what advice would you give to our listeners who maybe have tried quitting before without success and they’re ready to give it a try again?
Guest: I think the first thing I’d say is Congrats. Congratulations on getting yourself to a point where you’re ready to make a change. That’s, that’s a huge step. The second thing I think I’d say is, wow, I bet you’ve learned a lot from your prior quit attempts.
That’s how we want to think about quitting smoking, is that you may not have succeeded in past attempts, but I bet you learned something. I bet you learned about how bad those cravings could be. So maybe, I really do want to make sure I have a mini lozenge that I can use every time I would’ve normally smoked a cigarette.
Maybe you’ve learned, you know, I can’t hang out with these friends right now because they all smoke and so I need to find other folks to hang out with, or I need to make sure when I do hang out with them, we’re in a place where smoking’s not easily, um, happening. Maybe you’ve learned I can’t actually drink and stay smoke free because that’s when you know my inhibitions are down. I’m having fun, and the smoking and the drinking goes so well together. That’s usually where I slip up. Or maybe you’ve learned that when I get really stressed or really angry or really bored or sad, those are times when I go back to smoking.
So you’ve learned that that’s where you need the plan. That’s where you need to have a strategy or something to. Um, or you’re going to choose to, to figure out who you’re going to socialize with, um, so that you make those change changes proactively so that when you’re ready to quit, you know what the roadblocks are going to be and you’ve got a plan.
So, congratulations. Figure out what you’ve learned, because I bet you’ve learned more than you think you have. Use all the tools, make sure you have the medication. And if you say, well, I tried the patch before, or I’ve tried the Chantix before, great, that’s fantastic. And just because you weren’t successful in those prior attempts doesn’t mean the medication isn’t going to be helpful in this attempt.
So use the medication, use the supports, and the reason I think it’s important to keep using those meds, even if you haven’t been successful in the past, is because each quit is. You’re a different person now than you were the last time you tried to quit. You’ve learned more. Maybe your motivation has changed.
Maybe some of the people you spend time with has changed. Maybe you’ve got a new job. And all of these things make each quit different. And so again, having all the tools necessary, the medications, the plans for what you’re dealing with, craving or temptation in situations, and then get in. Making sure that you’ve got the support necessary.
This is really hard work, and who are the people that can support you and how can they do that? So it’s, it’s really the most important thing you can do for your health, but it’s not easy. And so make sure you’re getting all the tools and all the support that you need.
Host: And I’ve heard people who are quitting or who have quit, talk about replacing maybe an afternoon smoke break with a new healthy habit like eating an apple or going for a walk. How have you seen this type of behavior in adding a new, healthy habits help people successfully quit.
Guest: Yes, I think replacements are fantastic, especially healthy replacements. Um, you know, people talk about not wanting to gain weight when they quit smoking, so they don’t want to substitute a candy bar for a cigarette. But Tic-Tacs, um, you know, sugar-free candies going for a walk if you are used to getting a chance to get away from your work station and go and do something else relaxing. But now that you’re quitting smoking, you don’t get to go out and smoke. Well, then you’re sort of penalized for quitting. So going for a walk or taking that time to play a game on your phone or to talk to somebody using things that are positive and rewarding as substitutes for smoking is a great choice.
Um, and, you know, whatever those, whatever those different substitutes might be, whether it’s something, uh, some people talk about cutting up straws and chewing on straws. Uh, I worked with somebody who liked to chew on cinnamon. Or chew, uh, gum use Tic-Tacs, all sorts of hand to mouth things that people can find helpful. Drinking water. Drinking water can be another great substitute. It’s a hand to mouth gesture, um, and it’s real healthy for you.
Host: That’s great. So if we have a family member, a friend, coworker who is working on quitting, what are some things that we can do to help support their goal and also just to promote some healthy habits?
Guest: I think the number one thing you can do is ask directly, how can I help you? Some people really want that accountability. They want to be able to walk in every morning and tell you, Hey, made it all night smoke free. And then you can celebrate with them every single day that they’re able to. Other people don’t want to talk about it.
Uh, some people, when they’re trying to quit, they have a lot of shame and guilt over the fact that they still smoke or that they haven’t been able to be successful in the past, and they don’t want to look like a failure in anyone else’s eyes. So what they may say is, you know, just don’t mention it unless I bring it to you.
And then when they bring it to you, talk. How you know, how glad you are that they’re trying, how glad you are, that they’re willing to reach out and, you know, supporting them as they’re going through these, these different struggles. Because it is important to remember, again, this is dependence. This is addiction we’re talking about.
It’s not just a habit that they’re changing. And so it’s going to require learning new ways to be in the world, learning new ways to cope with emotions, uh, learning new ways to interact with friends in social settings when cigarettes are no longer part of the equation. Yeah, and I think the other important thing is to make sure you’re supporting every level of change, just because somebody tells you, you know, I quit smoking and I made it for two and a half weeks, but dang, now I’m back to like two cigarettes a day and I can’t.
Congratulations on getting down to two. That’s a huge step. Yeah, and I want to keep, you know, I am here to keep supporting you until you can make it down to zero. Zero is where you see all the health effects, but I’m really happy to support you as you get there.
Host: Hmm. Now I saw from the CDC’s national Youth Tobacco Survey in 2022, that one in 10 middle and high school students, about 3 million, had used tobacco during the last 30 days and most, the most common device that they used was e-cigarettes. Can you talk a little bit more about this trend in youth and then also just provide some advice for any of our listeners who might be parents that are wanting to help their children quit or avoid trying this in the.
Guest: Yes, the vaping epidemic has been a huge issue and a really scary one I think for parents and for educators, uh, and even for researchers because at first we didn’t know what this product was. Right. We didn’t understand what it was or how it was going to affect the body. Um, and the biggest understanding we have at this point is this is a nicotine delivery device. And again, nicotine is what causes dependence. That’s what goes in and changes the structure of the brain. And so that’s what we’re most concerned about.
Um, but then there’s also some evidence that it does impact lung health. And so again, we definitely don’t want kids to be using these products. The nice thing is that we’ve seen because of some policies that have been implemented, is that kids are having less access to e-cigarettes. There are fewer access to all of the different flavors, right?
That was the one of the scariest things. Cookies and cream, tutti fruity, naked unicorn. You know, these are definitely flavors that are targeted at kids, and kids picked it up. They loved it. It tasted great. It felt great. You know, kids used to describe vaping as steam cleaning your lungs, but because of the public health campaigns from the FDA, I think now kids are understanding that there’s a lot more in these vapes than just air and that, uh, they’re understanding that they’re taking nicotine into the system as well as other products, and that this isn’t a healthy thing to be doing.
Education played a huge role I think in driving down, cause we are starting to see these numbers fall, which is great to see. But if you want more information or you want, maybe you are somebody who uses e-cigarettes, um, or you know, someone who does, there’s one evidence-based program. Again, it’s a texting program called This is Quitting and it’s available from the Truth Initiative. So if you go to uh, truth initiative.org, you’ll find a lot of information for parents, for educators, for people who are using e-cigarettes on that website about how to quit, how to talk to kids about e-cigarettes. Uh, they have a wonderful resource there.
Host: Wonderful. And you can find that link to Truth initiative in our episode show notes as well. I’ve also heard the misconception that e-cigarettes are a helpful tool for adults who may be trying to quit smoking. So what would you say to anyone who is considering this approach and what should they be aware of?
Guest: Sure. So, I will even correct your question. This is one of the huge challenges with e-cigarettes. They were originally developed to be a substitute for conventional commercials, combustible cigarettes, and what happened was they started being targeted toward youth. When youth are using this, it is a definite public health emergency. We do not want, not tobacco naïve people using this. However, it was, as I said, it was developed as a substitute.
The goal being that perhaps there was a less dangerous way to deliver nicotine to the brain that could help people get off combustible. Again, combustibles have 7,000 chemicals and more than 50 are carcinogenic. And so could this be something that is not safe, but perhaps safer? And so we can’t actually, in the United States, do research on whether or not e-cigarettes help people quit.
It has to do with regulatory processes. But other countries have done this. And there’s a group called the Cochrane Group, and they do meta-analysis where they take all of the evidence from all these other studies, they put it together and they draw conclusions about the research. And what they say is based on the current research as of November, 2022, that e-cigarettes are actually as effective as nicotine replacement or more effective at helping people quit.
So, and they don’t seem to have the same number of, or they don’t seem to have any difference in the, in the number of, negative health effects or side effects between e-cigarettes and nicotine replacement products. So in fact, if you treat it like a nicotine replacement product, it does in fact help you quit smoking.
But there are two important caveats to that. The first one is when people use it to quit. The vast majority tend to keep using e-cigarettes. So you will have done a substitution, but you’re still going to be exposing yourself to some level of harm, and you’re still going to be exposing yourself to nicotine. So that’s one concern.
And the other concern is something that we call dual use, which is when people are smoking sometimes and using e-cigarettes other times. Mm-hmm. Again, if it’s a stepping stone to getting all the way off a combusted cigarette. Maybe people need to have a slower path, but if it’s a sustained pattern, then just cutting down a couple cigarettes a day and replacing them with the e-cigarette is actually not giving you much, if any health benefit, because even one cigarette a day increases your risk for cardiovascular disease.
So again, this is the really tricky area of e-cigarettes. It’s a both. It is both a public health threat to the youth and tobacco naïve people, but it has the potential to be a public health benefit if people can use it to get off combustibles and then can ultimately quit using e-cigarettes as well.
Host: Thank you for clarifying that and sharing the latest research. So I know there’s also been a growing trend in hookah bars and cafes. A lot of times you see them in urban areas around college campuses. Can you tell us a little bit more about what is in hookah and are there health risks with this product as well?
Guest: Sure, this is a great question because this is another, uh, really sort of emerging tobacco product. So hookah has become much more common. Um, it is basically a water pipe. You are drawing the tobacco smoke through water. Um, and so that makes, again, some people think that this is much safer, but actually, if you consume a full bowl of hookah, you are consuming what is approximately an entire package of cigarettes in a single sitting.
And again, it’s that combusted product that makes the difference. When you burn the product, you are creating so many more chemicals through combustion and you’re taking all of those into your lungs. So you have things that cause cancer, lung disease, heart disease, all sorts of different problems. And so hookah tends to be more of a social event.
You sort of go out to a hookah bar the way you might go to a cigar bar. But again, definitely not something safe to be doing, and it’s still delivering nicotine to your brain. So you could over repeated exposures or repeated nights at the hookah bar, develop dependence on nicotine.
Host: Hmm. Now, I understand the cancer risk reduces after quitting. So, but say someone has a long history of smoking. Should they still do any type of screenings to monitor any future health risks of showing up, like maybe lung cancer?
Guest: Sure. I think lung cancer screening is definitely important and it’s important. You know, screenings are important because they offer you a chance to do something good for yourself. By getting a lung cancer screening, you’re able to identify any potential problems as early as possible and get the necessary treatment. So one of the nice things about quitting smoking again, as you can see the healing. So you might actually see if you could have a lung function test and see if after a year of quitting smoking you have improved.
Has some of your lung function actually been restored now that your lungs are not coated in tar, and the Celia and your lungs are moving more, and you’ve actually improved some of your airflow. A lot of people that we work with that quit smoking talk about, you know, I used to go down to the basement to get my laundry, and I would have to stop halfway down or have to stop halfway back up and now I can go down and get the laundry and walk all the way back up and not out of breath. So there are a lot of different, uh, lung functions that can improve over smoking. And you could have tests for that, not necessarily a screening test, not that uh, there would be a necessarily intervention, other than a lung cancer screening test.
Host: Wonderful. Well, thank you so much for joining us today and for sharing all of this helpful information for our listeners. Really, appreciate it.
Guest: Well, thank you so much for having me. I feel like this is a really critical issue. It’s really critical. There’s one other piece that I wanted to add and that is that, you know, certain communities where the tobacco industry targets their advertising, they try to sort of come in as a wolf in sheep’s clothing by sponsoring events in our community.
And you know, they sponsor Black Lives Matter events. They sponsor, um, Cinco de Mayo events. They sponsor LGBTIQQ events. And they really are sort of insidious in how they try to make themselves look like community players when we know that those products are killing the people in those communities.
So we really have to make sure that everybody has access to these evidence-based treatments. Anybody in the state of Wisconsin can call the tobacco quit line or go to smokefree.gov and hopefully everybody in the state of Wisconsin is going to be able to make a really solid quit attempt this year. If you’re smoking, give it a try.
Get the support, get the meds, because it really is the number one thing you can do for your health.
Host: Wonderful. Thank you so much.
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Tobacco Cessation and Healthy Habits Show Notes
University of Wisconsin Center for Tobacco Research and Intervention
Discover resources and learn more about UW-CTRI’s tobacco research that is translated into tobacco treatment.
Wisconsin Tobacco Quit Line
For free assistance and a customized quit plan, call the Wisconsin Tobacco Quit Line at 1-800-QUIT NOW or text “READY” to 200-400.
The Truth Initiative
Teens and young adults can join for free by texting DITCHVAPE to 88709. Parents can text QUIT to (202) 899-7550 to sign up to receive text messages designed specifically for parents of vapers.
The information in this podcast does not provide medical advice, diagnosis or treatment. It should not be used as a substitute for health care from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.