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Smoke Gets in Their Eyes
The Washington Post
March 29, 2005
By Jennifer Huget
Special to The Washington Post
Despite Overwhelming Evidence That Smoking Kills, 46 Million Still
Do It.
What Are They Thinking?
You see them huddled against the wind
outside office buildings, cupping
hands to protect tiny flames. You see them in their cars, faces blurred
by
clouds of smoke. You smell them when they're sitting next to you on the
Metro. You hear them ask the salesclerk for a pack of Marlboro Lights,
and
you wonder: Who are these people?
By now, overwhelming evidence shows that smoking ravages your body,
encourages fatal disease and shortens your life. And these facts are
well
publicized, indeed unavoidable: Well-funded anti-smoking campaigns have
succeeded in painting the once-glamorized habit as dirty, smelly, costly
and
unsexy. Bans restrict smoking in all kinds of places where people used
to
light up.
And yet 22.5 percent of U.S. adults -- 46 million Americans -- continue
to
smoke.
Why? We put the question to several smokers, particularly people you
might
expect to know better, interviewing them first via e-mail, then by
phone;
their comments here come from both sorts of contacts. We were not out to
endorse their habit, or to preach (although we'd much rather be
referring
them to the Center for Tobacco Cessation at http://www.ctcinfo.org
, a site funded
by the American Cancer Society and the Robert Wood Johnson Foundation).
We
just wanted to understand it better.
Some told us they smoke because they like the taste -- or because they
know
how dreadful it feels to quit. Others said they'd developed a universe
of
habits in which lighting up plays a key role. Many started smoking when
they
were teenagers playing grown-up. They keep smoking, they said, to reduce
stress or boost productivity.
But when we asked experts on smoking behavior, we heard something else.
Martin Jarvis, professor emeritus of health psychology at University
College
London's department of epidemiology and public health, has spent 27
years
trying to figure smokers out; he published his "Why People
Smoke" in the
Jan. 31, 2004, issue of the British Medical Journal. In Jarvis's view
(shared by most of the medical world, including other researchers
interviewed for this story), the question can be answered in one word:
addiction.
"People's accounts of why they smoke are interesting, but not
necessarily
reliable," Jarvis writes. "You have to bear in mind that what
we're talking
about here is drug use, and people may not have accurate insight into
how
nicotine influences their behavior. So always take [their stories] with
a
large pinch of salt."
Sig Seidenman, a former Air Force pilot and ex-smoker who runs Stop
Smoking
Clinics at businesses and hospitals in the Baltimore/Washington area,
agrees. People's stories, said Seidenman, who has more than 20 years'
experience helping people quit, "are all just rationalizations.
[They're]
excuses people tell themselves so they don't have to face the stress and
strain of quitting. Because they're afraid."
That said, here are their accounts:
'I Smoked Because I Could'
Twenty-eight-year-old Mark Palacio dabbled in smoking as a teenager but
didn't take up the habit in earnest until his senior-year college
roommate
moved out, leaving Palacio with a room of his own. He relished the rush
of
independence: "I smoked because I could," he said. That was
six years ago.
He's puffed regularly ever since.
"What's worst," he said, "I write for a medical trade
magazine for radiology
and cancer care. I smoke because I feel like I have no reason not to. I
figure that at a pack a day [of Marlboro menthols] like I'm smoking now,
I
can go until I'm about 30 before I should seriously consider quitting --
again."
Palacio, who lives in Philadelphia, doesn't hang out with smokers or
look
for validation in ads. "I never thought there was anything special
about the
Marlboro Man," he says. He has quit a couple of times -- each time
resuming
the habit, once after a death in the family made him crave "that
emotional
boost" that smoking offered, another time after a movie planted the
idea.
And then there's alcohol. "Drinking makes it difficult" not to
smoke,
Palacio said. "A glass of scotch and a cigarette . . . I really
like that
taste. It's so memorable. When I quit [smoking] and then have a scotch,
it
tastes hollow. It's only half the taste."
Palacio has a mix of typical smoker traits -- took first drag when as a
teen, derives a sense of independence from smoking, triggered to smoke
by
external cues, ties smoking to other habits or behaviors, aware he
should
quit but unable to do so -- and the confounding should-know-better fact
of
working for an oncology publication. It's this complexity across the
broad
population of smokers that makes it hard to say just who "these
people" are.
'I Have Plenty of Years Ahead'
Like many others, Steve Irvine of Gaithersburg fell into smoking when he
was
a teenager. He hated the taste. "I really don't know why I
started," said
Irvine, 26. "A lot of my friends did it. I wanted to be in the 'in'
crowd.
It was nasty at first, but I got used to it."
Ten years later, Irvine, whose job installing parking-garage systems
keeps
him on the road, said cigarettes don't "taste bad to me
anymore." Even so,
he said, he's tried to quit -- but found he couldn't. "I felt
jittery if I
got stressed out," when he wasn't smoking, he said. "I would
be not the kind
of person you'd want to be around."
"I'll be blunt with you," Irvine wrote in an e-mail. "If
I had a better job
that was not as stressful, I probably would quit. But as for now, I will
continue to smoke."
The stress rationale doesn't move Seidenman. He advises would-be
quitters
who crave cigarettes under stress to make sure in advance there are none
within easy reach.
Irvine noted that two of his grandparents -- both smokers -- recently
were
diagnosed with emphysema, and he wrote, "I know what can happen to
me in the
long run." But, he said, "I'm only 26. I have plenty of years
ahead of me."
Maybe so. But in the March 9, 2002, British Medical Journal, Jarvis
pointed
out that "most smokers overestimate the likelihood of stopping in
the future
and greatly underestimate how long it is likely to take." While
some 83
percent of current smokers in Jarvis's survey of 893 Britons said they
wouldn't start smoking if they had it to do over again, the study
revealed
what Jarvis calls a "delusion gap": While 53 percent of those
surveyed
expected to stop smoking within two years, only 6 percent actually did
so.
'I Thoroughly Enjoy It'
If Sue Goodman were to quit smoking today, she said, it wouldn't be for
herself; it would be for her husband and dog. Her last dog died of lung
cancer, she explained. "I'm a heavy smoker. I know that's what
killed him."
Goodman doesn't wish the same fate on her 4-year-old Chesapeake Bay
retriever, Bo. But still she smokes -- as she's been doing, at the rate
of
two or more packs of More Menthol 120s a day, for 56 years (give or take
a
handful of periods when she tried to quit). That's about 817,600
cigarettes.
Research suggests that nearly all smokers take their first drags in
their
early teens. Goodman herself started at 14. "My girlfriend and I
did it as a
lark." At that age, she said, kids who smoked were "aping
adults. I just
kept it up."
(Not unusual, said Seidenman. "You can't tell a 13-year-old they'll
get
cancer when they're 55," he said. "They won't care.")
Goodman's long smoking history puts her at high risk of health problems
ranging from heart disease to emphysema to any number of cancers.
But Goodman, who lives in Lanham, has so far dodged all bullets. "I
thoroughly enjoy smoking, and am surprised I'm even alive after all this
time," she wrote in an e-mail. "I have regular lung X-rays
which don't show
anything negative; do not have emphysema or any difficulty breathing; am
a
rather sedentary person who does little exercise except for housework
and
gardening."
Goodman believes she's both physically and psychologically addicted to
smoking, not just to the nicotine, which she says gives her a slight
buzz,
but to her smoking routines. "You go to answer the phone, you smoke
a
cigarette. You eat, you smoke a cigarette. You work on the computer, you
smoke a cigarette," she said. "I don't smoke when I'm taking a
bath, though.
It can be done; I just haven't done it."
Whether she took to it at the start, she can't recall. But now, Goodman
said, "I don't remember ever not liking it."
'No One I Know Has a Problem'
New York computer programmer Bill Williams likes to cite people like
Goodman
as evidence that medical research linking smoking to poor health is
bunk.
The founder of the smokers' rights Web site http://www.smokinglobby.com
, Williams
said he made a conscious decision to start smoking 10 years ago, when he
moved to the city after college. Cigarettes "smelled good,"
and smoking
"seemed like a good thing to do," said Williams, 35.
"I grew up in a household where my dad smoked two packs a
day." His dad, who
quit when Williams was 15, remains healthy; Williams and his brother are
healthy, too, despite all that secondhand smoke. "My girlfriend's
parents
still smoke, and they have no problems. They're in their eighties."
"I have known many smokers, and I haven't known anyone who had any
health
problem or death due to it," Williams said. What about all the
research to
the contrary? Williams is unimpressed. "Nobody's come up with
definite
proof" that smoking's bad for you, he said. "I don't think the
studies are
bulletproof right now."
Jarvis isn't surprised by Williams's way of thinking.
"Smokers can also have very rosy spectacles when it comes to
judging adverse
effects on their health. Older smokers particularly seem to misinterpret
the
fact that they are still alive and kicking as evidence that their health
is
not at risk from smoking," said the British researcher.
But Williams remains unconvinced. "If somebody did come forth with
a study
that did definitely prove [that smoking's bad for your health], I might
reconsider. But nobody I know has had a problem."
Seidenman puts a different spin on Williams's rationale. "Okay,
I'll tell
you what," he said. "Let's meet down by the Washington Beltway
with
blindfolds on and cross the Beltway. Some of us will make it."
'People Rationalize Bad Habits'
Mary Sherman, 41, knows plenty of people who have had a problem.
"My father
died of cancer -- he smoked. My mom has emphysema -- she smoked."
Sherman
herself, who has been smoking since she was 17, is "in the process
of
quitting -- for the 150th time, it seems."
"I am otherwise a health nut," said Sherman, a paralegal who
lives in Falls
Church. "I eat organic foods, take supplements and vitamins, visit
the
doctor regularly, exercise. And yet, up until January, I continued to
smoke
a pack to a pack and a half a day. Why? Good question.
"The nicotine addiction is one part of it, but addiction to
cigarettes is
more complex than that," Sherman said. "It has something to do
with feeling
like you're getting away with something -- being the 'bad girl' yet
still
maintaining the 'good girl' façade."
Sherman started smoking as a teen, when the rest of her college-bound,
academically and athletically successful peer group took up the habit.
To
her, the act of smoking telegraphed a message: "I'm tough, I'm bad,
I can do
what I want. I'm independent." Still, after a while, she grew to
dislike it:
"the way it looked, the smell, the expense." So she stopped --
until her
husband, Sam, a nonsmoker, died of a heart attack in April 2003. The
stress
of that event "got me off on my last round of serious nonstop
smoking," she
said.
Sherman struggles to reconcile her firsthand knowledge of smoking's
devastation with her desire to smoke. Some days, she said, "I look
at it
somewhat as overeating or drinking too much," she explained.
"Why hasten a
process that's inevitable? Why speed up your own demise?"
Other times she finds herself thinking, "The heck with it. I like
smoking.
I'm going to keep smoking." Even when her father died, she said,
"in my
smoker's mind, it wasn't lung cancer" that killed him. "It was
not because
of smoking."
"People rationalize all kinds of bad habits," Sherman said.
Seidenman agrees: "Knowing that you shouldn't smoke and not smoking
are two
different things."
'Quitting Is Worse'
Published statistics on who smokes and why wouldn't likely lead you to
sniff
out a 59-year-old woman with a college degree and a job that puts her
well
out of poverty's reach.
Like Elaine Keller. A 59-year-old technical writer who lives in
Springfield,
Keller smokes about half a pack a day -- down from 2 1/2 packs -- of
generic-brand cigarettes, "augmented by two or three lozenges or
pieces of
nicotine gum." In the course of her work, Keller spends a lot of
time
tooling around on MedLine, the federal government's online library of
health-related research publications, so she's no stranger to smoking's
dangers.
"Why do I smoke, even though I know it is bad for me?" Keller
ruminates in
an e-mail. "Because I know, through bitter experience, that smoking
cessation is even worse for me."
Stop Smoking Clinic's Seidenman said Keller's feelings are common.
"One of
the main reasons people don't join the program is because they think
their
lives are going to be miserable" when they quit smoking, he said.
"These
people aren't willing to confront [that discomfort]."
Keller's last attempt to quit smoking -- with the help of nicotine
patches,
gum and lozenges -- led, she said, to a 35-pound weight gain. Worse, she
said, was her loss of ability to focus at work and on the road. When she
smoked, she said, "I was producing 10 pages a day" at work;
when she quit
(with the help of the patch) last December for about five weeks, she
said,
"I was down to two pages a day."
"It was like, forget it! I can't even read, let alone write,"
Keller said.
"I was also extremely depressed. I can't function, I can't think, I
can't
even drive a car. I was sleeping 12 hours a day."
So, though she said she's "concerned about my lungs," Keller's
still
smoking. "I don't think I'm in love with the cigarettes," she
said. "The
ritual is not important at all. I need the normalcy that nicotine
brings. If
I could find a way to get nicotine without drawing it in through my
lungs, I
would very happily give up smoking."*
Jennifer Huget is a regular contributor to the Health section.
http://www.washingtonpost.com/[...]r28?language=printer
Related link:
'What Is Wrong With These People?' Medical Experts Share Their Views -
Washington Post
http://www.washingtonpost.com/[...]A8069-2005Mar28.html
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