I see your huddled masses. The contemplative professor; the stressed-out, Camel-wielding grad student; the depressed, rail-thin hipster undergrad tapping Parliaments, mourning that the Stars have supposedly sold out by opening for Death Cab for Cutie — all of you yearning to smoke free.
Sometimes I envy your bat signal: When alone at a party you break out a pack and watch others flock to you to bum a cigarette. I admire your determination: trudging through the rain, miraculously shielding smoldering fire from water, smoking despite the hailstorm of anti-smoking propaganda.
On Nov. 17, there’s more propaganda coming. When you walk down Library Walk you’ll see a Great American Smokeout table. The American Cancer Society has been sponsoring people to quit smoking during this national event for 29 years running. I expect the table will be there next year for 30th annual Great American Smokeout, since the anti-smoking campaign targeting youth, like the war on drugs, has been a fantastic failure. But it’s not for lack of trying.
Trying to get people to stop smoking is hard, thankless work. (I’m a student health advocate, I know.) No matter how much information you throw out there, smokers discount it. They see it as propaganda. They’re wary of the spin. People also overestimate the number of smokers (and presumably the size of the bandwagon) because, around campus, smokers seem to be everywhere — after all, they’re forced to smoke outside (20 feet from all UCSD buildings, to be precise.) Additionally, there is a lot of confusion surrounding the harmful effects of hookah-smoking, the latest college tobacco fad, but not much published research on its safety. I could tell you that quick-lighting charcoal releases a lot of carbon monoxide, and that New Orleans Health Director Kevin Stephens equates one water-bong use to smoking a pack, but no one wants to listen to a nagging Safety-Sam Poindexter — especially a nonsmoking one like me.
Perhaps we’re attacking this problem the wrong way. Smokers don’t need heavy-handed moralizing or pitying, self-righteous handholding. They don’t need informational harangues. All my smoking friends can complete my sentences about why smoking is unhealthy. Even hermits who shun all forms of media know that smoking is hazardous to their health (thank you, surgeon general). We’re all awash with health hazard information. But the discount rate remains high. I had discount rate explained to me rather eloquently by professor Clark Gibson: If I could give you $100 today, or $110 in one year, which would you take? If you’d rather have the money now, you’re discounting the $10, because a year seems impossibly far for such little difference. Discount rate is a value that quantifies how much you would rather have a benefit now versus benefits in the future. Choosing to have one cigarette now versus avoiding some potential health impairment in the future — which you might not live to see anyway — is hard to argue with. You just don’t expect future benefits to be that great.
Compound the high discount rate with the multifaceted reasons people smoke, and it’s difficult to come up with a single solution to the smoking problem that fits all young smokers — not to mention all smokers in general.
In his book “The Tipping Point,” Malcolm Gladwell suggests two tantalizing solutions worth exploring: (1) demolishing the addictive power of cigarettes and (2) zeroing in on the correlation between depression and smoking.
The first solution is rooted in the fact that 10 percent of American smokers regularly smoke five or fewer cigarettes per day and are not addicted. These “chippers” can skip smoking for one or more days and do not feel withdrawal or great personal distress when attempting to quit. If we cannot eliminate smoking completely, we want more chippers and fewer addicts. The American Cancer Society stresses that cessation should be advocated over reduction as the ultimate harm-reducing method, but sometimes cessation is near impossible. By regulating the amount of nicotine that goes into cigarettes and setting it below an addiction threshold, we can prevent a large number of people from becoming addicted. I’m not saying this will be easy, but it’s worth lobbying for.
Gladwell proposes the goal of setting the levels so low that even the heaviest smokers, who consume up to 30 cigarettes daily, could not get more than five milligrams of nicotine in a 24-hour period. According to a letter from doctors Neil Benowitz and Jack Henningfield published in the New England Journal of Medicine, “An absolute limit of 0.4 to 0.5 mg of nicotine per cigarette should be adequate to prevent or limit the development of addiction in most young people. At the same time, it may provide enough nicotine for taste and sensory stimulation.” Although, initially, smokers may overcompensate by smoking more cigarettes daily in order to get more nicotine, studies show this overcompensatory behavior does not persist past a few days or weeks.
The second solution is based on the strong correlation between smoking and depression, and the fact that smoking can be a cheaper way to self-medicate for disorders such as depression or attention deficit disorder. Gladwell cites a Glaxo Wellcome study that found that of smokers who took the antidepressant bupropion (commercially Zyban), 49 percent quit smoking after one month. When used in combination with the nicotine patch, 58 percent quit (compared to 23 percent in the placebo group). To put it simply, people who are depressed have lower levels of serotonin, dopamine and norepinephrine, and nicotine increases dopamine and norepinephrine levels — as does bupropion. However, drugs that only increase serotonin levels, such as Prozac and Zoloft, do not seem to help. At the risk of incurring Tom Cruise’s wrath, this is a promising solution.
In the end, one can always argue that everything is a stall. If Peter Jennings hadn’t died of lung cancer, he might have lived long enough to succumb to another type of cancer. There’s no actual argument here — we are all going to die eventually. But this fatalistic and cynical discounting ignores the value and quality of life. There are ways to die and tragic ways to die. Legislation won’t change overnight, and it takes a modicum of courage to get psychiatric help. But people who plan a quit date double their chances of success. If you’re waffling on whether or not to stop, maybe Thursday’s as good a day as any.
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