Ask Us Anything About… Smoking Cessation

A woman stands outdors, facing the camera. She holds up a cigarette as she breaks it in half in front of the camera.

Smoking is the leading cause of preventable death in the United States, killing almost half a million people every year. In this interview, we learn about the dangers of tobacco and strategies to quit smoking from Diane Schmeck, a pulmonary navigator of Penn State Health St. Joseph.

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Description – The video begins inside the Penn State Health St. Joseph’s Medical Center. Two people are standing next to each other. Standing from left to right are Diane Schmeck and Barbara Schindo.

Barbara Schindo – From Penn State Health St. Joseph, this is Ask Us Anything About Quitting Smoking. I’m Barbara Schindo. Smoking is the leading cause of preventable death in the United States, killing about 500,000 people a year. And today we’re going to talk about the dangers of tobacco and some strategies to help people quit smoking. I’m joined by Diane Schmeck, who is a pulmonary navigator at Penn State Health St. Joseph. We welcome your questions for Diane. If you have questions, whether you’re watching this live or watching on playback, just put your questions in the comment field and we will get an answer for you. So I want to start by bringing up something that I think is especially timely. There was a headline about this recently. Studies showing that people who smoke only a few cigarettes a day are doing as much damage to their lungs as people who smoke a whole pack a day. Did that shock you, seeing these studies?

Diane Schmeck  – In some ways it did surprise me, but in other ways, when I think about my patients that I meet here at the hospital and I see patients that have been very light smokers, and by light smokers we want to say, you know, about five cigarettes a day or less. And they are coming up with the chronic diseases of heart disease, lung disease, things that you would expect smokers to have, even COPD, you know, which is a combination of chronic bronchitis and emphysema. And, actually, we — I just read about a study out of Columbia University where they looked at smokers who smoked five cigarettes a day and within nine months they had the same kind of lung damage as a person who smoked a pack a day. So it is. It’s very concerning that such a small amount is causing that much damage.

Barbara Schindo – OK. So that’s a good thing for people to know who — there might be the myth that think, you know, “I just smoke two or three cigarettes a day. So I’m fine.” But that’s no true. OK. So we know that smoking can cause damage to the lungs. Are there other major health issues that are caused by smoking that people might not necessarily know about like strokes or heart disease?

Diane Schmeck  – Strokes. Heart disease is a big one. Things like you wouldn’t think about, but smoking’s actually been linked to 13 different cancers throughout the body, not just the lungs. Things like stomach, colon, pancreas, kidney, places you wouldn’t really think that smoking would affect, but it does. It’s also been linked to type 2 diabetes. In men actually 60% of men over 65 who had smoked or do smoke have erectile dysfunction. So it affects your blood vessels all through your body

Barbara Schindo – Wow. Just really everywhere. OK. So this is I guess a really easy question because it seems like there’s a lot of evidence to do this, but why should people quit smoking?

Diane Schmeck  – Why should people quit? Well, what I — when I counsel patients, I identify with them they need a powerful personal reason. We work in hospital systems, so we think, “Well, this reason has to be your health.” For everyone, it’s not their health. And so as a treatment counselor, I always ask a patient what would be your advantage to quit smoking? And I would say I met with a woman who had had a heart attack. I thought for sure she was going to say I just had a heart attack. Her answer was I want to babysit my grandchildren and if I continue to smoke, my daughter-in-law won’t let me have them overnight. So you have to find what that motivator is. For some people, it’s money. You don’t realize when you buy a pack at a time how much money you’re spending. We’re now over $9 a pack. You smoke a pack a day, you’re about $3,300 a year in cigarettes alone. Other people tell me that they’d like to go to an event or they would like to travel without feeling withdrawal symptoms or feeling like an outcast. And so there’s varied reasons, but we can never assume what a person’s reason is to quit. We need to ask them what that is and then help them make a plan around that.

Barbara Schindo – That’s some really good advice. Thank you. You are watching Ask Us Anything About Quitting Smoking with Diane Schmeck, pulmonary navigator at Penn State Health St. Joseph. We welcome your questions for Diane. Just post them in the comment field below this post and we will get you an answer. So what kind of strategies do you recommend to quit smoking? Is there one proven “this is the best way” or does it kind of vary from person to person?

Diane Schmeck  – Well, studies will show that the most successful rates of quitting are with a combination, a combination of counseling and the use of a nicotine replacement product, whether it’s a medication like Chantix or Wellbutrin or whether it’s an over-the-counter nicotine replacement product like the patch or the gum or the lozenge. So it’s combination therapy that will increase your success rate by 50% to 70%. So that’s significant. So we look at that as being support, somebody to walk you through it, somebody to be by you and to just keep encouraging you. Other ways people quit, they’ve tried cold turkey. That can work for some people, but the people I’ve seen it work the best in are people who’ve had a life event. They’ve had a stroke. They’ve had open heart surgery. They just say I’m done.

Barbara Schindo – Eye opening. I need to do something.

Diane Schmeck  – Right. But the truth of the matter is for most people who quit cold turkey, six months later they’re back to smoking. So what we recommend here at the hospital in every patient who comes in to see us here is we make sure that if it’s appropriate that they’re on a nicotine replacement product and then tap into either a group or an online community or internet reminders or whatever that would be.

Barbara Schindo – OK. So what about the people who say they have tried everything? They’ve tried to quit before. They’ve tried a patch. They feel really discouraged or they might feel like it is just not possible for them to quit. How do you help them?

Diane Schmeck  – How do I help them is first of all I give them information. Most people don’t realize that the research shows that the average person tries — — in their lifetime. A study out of Toronto put that number up to thirty. But the one thing we know is every time you try to quit, your success rate to quit the next time is higher. So I tell people never stop trying because the moment that you quit you begin to reduce your risk of death and heart disease and stroke. So it’s never too late to quit.

Barbara Schindo – OK. I think that’s really good for viewers and folks to know that it takes the average person a dozen times to actually do it. So, you know, keep that in mind and keep trying. So if somebody close to you decides they’re going to quit smoking, a spouse, a good friend, a loved one, how can, you know, how can you help? How can you help your spouse quit?

Diane Schmeck  – Well, 40% of people do say that the support of a good friend or a family member has affected them in helping them quit. What I do tell people is that you have to realize that the quitter is in charge of this process, and so you don’t judge. You don’t nag. What you do is you ask how you can help. Often the spouse will ask me how can they help because they’ve been nagging for years and it doesn’t work. And…

Barbara Schindo – It’s like just like throwing away a pack of cigarettes and hiding it is going to work.

Diane Schmeck  – So I’ll say things like, you know, make sure there’s healthy snacks in the house already cut up. If you knew your husband liked to smoke after dinner, suggest you go for a walk or go to a movie. Help that person make the behavior changes but do it in such a way that you’re not preaching at them. Other ways you can help is I’ve had spouses offer to go to quit smoking groups with their mate, which I think is awesome. That’s a sign of support. But most of all, you just have to let them go through the process. Don’t take it personally if somebody’s grumpy while they’re quitting. That’s most likely withdrawal symptoms, and they last about two weeks. But other than that, celebrate. Celebrate the success. Celebrate that first two weeks of quitting. Celebrate that first month. And, you know, do it together. Do it as a team.

Barbara Schindo – Very nice. Thank you. This is kind of a caveat of that. This is a question from personal experience. So both of my parents were smokers or are smokers. And my dad always said that you just need to stop smoking for three days and the nicotine will be out of your system. Is that a myth, or is that true?

Diane Schmeck  – Well, it is somewhat true that the nicotine is out of your system in about that amount of time, but the withdrawal symptoms last longer. So even though you may be nicotine free, your brain is still in that pattern of wanting it. And so it’s the withdrawal symptoms that most of the time take people back to smoking.

Barbara Schindo – Sure. You are watching Ask Us Anything About Quitting Smoking with Diane Schmeck from Penn State Health St. Joseph. If you are trying to smoke or if somebody you know is trying — trying to quit smoking. Oh my goodness. Not that. We’re not encouraging you to smoke. We’re encouraging you to quit smoking. If you are trying to quit smoking or if somebody you love is trying to quit smoking, there are ways you can help and feel free to share this useful information with them. Diane has been giving a lot of good tips about how to quit smoking. And we also welcome your questions for Diane, whether you’re watching live or if you’re watching on playback, just put your question in the comment field below the post and we will get an answer for you. So let’s talk about another hot topic, and that would be vaping or e-cigarettes.

Diane Schmeck  – Yes. E-cigarettes.

Barbara Schindo – Have you seen that this is a successful way that helps people quit or reduce their consumption of cigarettes?

Diane Schmeck  – There are a few small studies, actually one done even at Penn State Medical School, that do indicate that people, adults, that have used e-cigarettes have been able to quit tobacco by using e-cigarettes. The issue is we don’t have any long-term longitudinal studies yet on e-cigarettes. So we don’t know, you know, what will be the long-term effects, but at this point, we do know there’s less toxins and health risks in e-cigarettes than in tobacco.

Barbara Schindo – OK. And we all have seen — I’m sure a lot of folks have seen headlines about illnesses related to vaping and potential deaths that have been tied back to vaping. Are there concerns for smokers who are trying to quit to use that method? Like, should they have any concerns about using it as an alternative to cigarettes?

Diane Schmeck  – They need to be concerned about that. And, as I said, we don’t have the long-term studies and now we’re just — this summer we saw, you know, across 25 states very serious lung illnesses and damage done by e-cigarettes. Now, some of those e-cigarettes had THC in them, but most e-cigarettes have nicotine in them. So the e-cigarette does still keep you addicted to nicotine. So that’s one thing to remember. Also, in the cartridges, one cartridge for an e-cigarette can have as much nicotine or even more than a pack of cigarettes. So you are still getting that nicotine consumption but without all the toxins of tobacco, which there’s about 7,000 in tobacco itself. But we are seeing in e-cigarettes things like heavy metals, you know, lead, nickel. Also, some of the products in the cartridges themselves have been found to have formaldehyde, which is embalming fluid. It’s found to have an herbicide in them that is very damaging to the lungs and also propylene glycol, which is antifreeze. And the one thing I tell teens that are using e-cigarettes is to be very careful because the manufacturers are smart. And by flavoring and coloring these cartridges, that’s what draws the teens to it. But you have to realize that to color something and to flavor it you need a dye and you need an oil. So what an e-cigarette does is it’s battery powered and it superheats a liquid into an aerosol. And so you can imagine now you’re taking an oil or a dye and you’re vaporizing it and then you’re breathing it in. And so the damage we’ve seen to lungs has been sort of like an inflammation response to these toxins hitting it in very small particles.

Barbara Schindo – Wow. So a big issue with e-cigarettes is kind of the unknowns, that you don’t really know what’s in that cartridge and that’s where the trouble comes from. OK. And you had mentioned earlier for people quitting smoking things like support groups or online forums. So what type of resources are available to people who — somebody who might be watching this and say, “I want to quit smoking today. What do I do? Where do I go?”

Diane Schmeck  – Well, here in Berks County we have the Berks County Council on Chemical Abuse. They run many support groups, many of them bilingual. Also, I often refer people to the Pennsylvania Department of Health. They have great programs. They have internet counseling. Free phone counseling. They will send free nicotine replacement products to your home. They have just great resources. And when you call, you will speak to a counselor like me. So we refer people out like that. I’m also finding though that a lot of people aren’t group kind of people anymore. They don’t have the time. They’re embarrassed about trying to quit because they see themselves as a failure. And so, you know, they’re not really into groups. So those folks, there’s a lot of apps now for your phone, text messages, internet help, digital online communities which have been very successful.

Barbara Schindo – That is great to hear. They’re kind of, you know, making it — bringing it to you for the people, you know, making those resources available. I think that’s very helpful. And I think one big takeaway for me — and I think we’re about to wrap up here — but I think the biggest takeaway for me that I think people should keep in mind is you saying that it takes some people a dozen or more times trying to quit to actually quit. So I want to take that back to my loved ones who I think should be quitting and, you know, give them that advice. And I think that’s so important to know. So we thank you so much for your time.

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