Ex-Smokers Now Outnumber Smokers, But Cessation Efforts Still Face Uphill Battle

CHICAGO

“Her death was senseless. If I could have videotaped her last moments, traveled back in time and showed her how horrible her death would be, I think she would’ve quit,” Joe Konrath said of his mother, Laura.

As it was, Laura Konrath had four strokes, two heart attacks and coronary artery blockages and was in constant pain from plaque in her body and brain. She died in January at 71 after smoking four to five packs a day since her teens.

Joe Konrath, a novelist from Schaumburg, Ill., bluntly blamed cigarettes in her obituary and suggested hers be a cautionary tale.

“Her family is angry that she suffered so much and died so young. They’re especially angry that she chose cigarettes over living a longer, healthier life,” he wrote.

“What my mother had to endure, what her family had to endure watching her die, was entirely preventable.”

Smoking cessation efforts show progress, there are now more ex-smokers than smokers, according to the U.S. Centers for Disease Control and Prevention. However, even though the Robert Wood Johnson Foundation reports cessation saved 8 million lives from 1964 to 2013, 17 million people died during that period of tobacco-linked problems.

The CDC predicts that if smoking continues at the current rate among U.S. youths, 1 in every 13 who are 17 or younger now will die prematurely from a smoking-related illness.

Of the almost 37 million people in the U.S. who smoke, 70 percent want to quit, said Dr. Steven Schroeder, director of the California-based Smoking Cessation Leadership Center, which is funded by the Robert Wood Johnson Foundation and the 1998 settlement between the four largest tobacco companies and states seeking to recoup costs for treating smokers.

But only a tiny percentage of smokers succeed in quitting without assistance, which is why the center is working on a number of fronts, pursuing policy changes and tobacco taxes to discourage sales; pressing college campuses and the military to keep younger people from starting; getting pharmacies to stop selling cigarettes; encouraging hospitals and medical professionals to step up efforts to persuade patients to quit.

A recent focus is on those with mental disorders and substance abuse problems who consume 40 percent of all cigarettes sold in the U.S.

“My mantra is, hate the smoke, love the smoker,” Schroeder said. Various approaches are necessary because “there’s no one way to get people to stop smoking.”

The graphic TV ads featuring people ravaged by smoking cause a spike in calls to quit lines each time they air, he said. But that tack doesn’t work with youths, who don’t think they’re ever going to get sick, leading to campaigns focusing on the bad behavior of the tobacco industry and how it’s not cool to date a smoker, he said.

The lead researcher in a study released in March by AARP and the National Institutes of Health hopes the main takeaway, that it’s better to quit at any age than to keep smoking, will aid cessation efforts.

The study, said to be the first to look at the effects of quitting on mortality rates of those in their 70s, was needed to see if the benefits already documented for those who quit earlier in life held true for those giving up smoking in their 60s, said Sarah Nash, a cancer epidemiologist in Anchorage, Alaska.

“We now have data that shows even those who quit in their 60s have reduced risk of death into their 70s and 80s,” she said. “We have evidence that clinicians should try to get people to quit even if they’re in their 60s.”

With the number of people 70 and older expected to more than double to 63.6 million in 2050 from 29.2 million in 2012, the effects of smoking on health care could be significant.

Study results, published in the American Journal of Preventive Medicine, involved more than 160,000 participants ages 70 to 82 who filled out questionnaires about smoking in 2004-05 as part of a different study on diet and health. They were followed until the end of 2011.

Almost 25 percent fewer study participants who quit smoking in their 60s died than those who continued smoking during the follow-up, the study found. Also, the “protective” effect of quitting in their 60s was even stronger for those who hadn’t had chronic obstructive pulmonary disease, strokes, heart disease or cancer. Current smokers were three times more likely to die in the time period studied than those who never smoked.

The study concluded it’s “even more remarkable” that quitting in their 60s benefits people in their 70s because those who quit tend to be motivated by poorer health.

Konrath’s frank obituary language inspired numerous promises to quit and comments from others who had to cope with smokers.

Wendy Filip, of Woodridge, Ill., was left to pick up the pieces after her husband’s mother committed suicide in 2007 rather than comply with her doctor’s ultimatum to quit smoking or no longer be his patient after he placed a stent in a coronary artery.

Her mother-in-law had tried to kill herself five years earlier upon learning she had multiple myeloma, and while Jackie Filip did not give up cigarettes, she promised her then-13-year-old granddaughter she would not attempt suicide again, Wendy Filip said.

Her death “really crushed (granddaughter) Kristin,” Filip said, and made both Kristin and her father, Joe, angry and bitter. It wasn’t until after Jackie Filip died that Kristin told her parents she had for years covered up her grandmother’s smoking, which was forbidden when the child visited.

Joe Filip’s father, who also smoked and scoffed that it wouldn’t kill him or his wife, was diagnosed with lung cancer when he was 75 and died two weeks later. Wendy Filip’s father had asthma that turned into COPD, but he continued smoking even while dragging around an oxygen tank, she said.

He was forced to quit about a year before his death in 2012 at age 82 when he was in a rehabilitation center. “But by then, it was too late,” Filip said.

“Smoking should be illegal,” she said. “I love that Illinois went smoke-free. It made it easier for my husband and me,” both of whom have asthma.

Futile as Konrath’s efforts were to get his mother to quit, he doesn’t see banning smoking as the answer.

“People are always going to do whatever they want to with their bodies,” he said. “If we want to properly educate people on the dangers of smoking, we have to start young. I think school field trips to hospices would be helpful.

“Everybody makes bad choices, and I think a lot of people have bad habits. Prohibition won’t stop human nature, but education might.”