The costs of smoking reveal themselves most brutally in midlife or later: increased risks of 15 types of cancer, heart disease, lung disease, stroke, diabetes, even osteoporosis.
But there’s no reason you should resign yourself to this fate. Despite the widespread assumption that after age 50 it’s too late — that longtime smokers won’t see substantial benefits if they kick the habit — recent analysis of data from 13 studies shows otherwise. When a smoker quits, even after many years of tobacco use, the risks of heart attack, stroke, chronic obstructive pulmonary disease (COPD) and other lung diseases quickly decline. So, too, the risk of other cancers, including esophgus, mouth, larynx and acute myeloid leukemia.
“The risks of cardiovascular disease deaths drops almost immediately,” Dr. Brawley says, noting that whenever new laws are established to prohibit smoking in restaurants and other public places, "within six months, those cities see the number of heart attacks going down among smokers and those exposed to second-hand smoke.” A 2009 study in Arizona suggests such bans also reduce the number of secondhand smoke-related strokes.
“The benefits are greater the earlier in life one quits, but there are significant benefits even for people in their 80s,” he says.
Research indicates that quitting for the sake of loved ones may help smokers rid themselves of the habit more successfully. Parents who are motivated by a desire to protect their children, for example, are more likely to give up cigarettes for good, according to a recent analysis of data from 18 studies.
Dr. Brawley emphasizes the importance of encouraging young people not to start smoking. “Ninety-six percent of smokers over age 40 began before they were 17 years old,” he says, adding, “We know that’s when the tobacco industry wants to handcuff them.”
Nicotine is more addictive than cocaine, Dr. Brawley says, which means giving up cigarettes is a challenge at any age. But research indicates that it’s no harder in midlife than in youth. What makes it most difficult is not how many years you’ve smoked but the extent of your daily habit.
“People who smoke two packs a day are more addicted than one-pack-a-day smokers,” Dr. Brawley explains. For this reason, light smokers — those who go through less than a pack a day — tend to be much more successful in their attempts to quit.
Still, even heavy smokers can kick the habit — despite tobacco companies’ desire to hang on to their customers, which is reflected in efforts ranging from direct mail to their infamously misleading “low tar” and “mild” marketing campaigns.
New (and Sometimes Dubious) Quitting Strategies
What appears to be the most effective strategy involves a combination of drug therapy and counseling, according to Dr. Brawley. “Counseling can be done one on one, with a doctor, social worker, psychology,” he says. “There’s even some data showing calls to a telephonic quit-tobacco help-line can work.”
There are no shortage of smartpone apps for quitting smoking available on the Internet. There’s even a free one developed by MMG for the Tobacco Control Research Branch of the National Cancer Institute.
Unproven and “snake oil” products that promise to help smokers quit are ubiquitous, Dr. Brawley cautions. Moreover, the notion that chewing tobacco is a less-dangerous alternative to cigarettes is completely wrongheaded, he says.
Nor has Nicobrevin, an over-the-counter herbal supplement that comes in capsule form (it’s a mixture of quinine, camphor and eucalyptus oil) been fully tested. Two clincal trials suggerst that Mecamylamine, a blood pressure medication, shows some promise when used in combination with nicotine replacement, because it binds to and blocks nicotine receptors. But clinical trials have not yet confirmed that preliminary finding, and used alone, it does not appear to be a useful anti-smoking medication.
Mental Health Factors Related to Quitting and How to Manage Them
Guilt and self-blame are counterproductive and “a documented barrier to cessation” that reduce the chances a smoker will successfully quit, according to Jane Cataldo, a geriatric nursing researcher at UC San Francisco. The tobacco industry maintains that addicted smokers are solely responsible for their behavior, and this contributes to self-blame, she notes.
These drugs don’t just alleviate the smoker’s depression; they also affect the brain in ways similar to nicotine-replacement therapy, research suggests. Other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and fluoxetine (Prozac), do not have that effect and, as a result, appear to be less useful in helping people stop smoking.
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Bryant Furlow is a medical journalist and investigative reporter who lives in Albuquerque, N.M.