Norwich - Giving up cigarettes can feel like losing a close friend, someone you've turned to relieve stress or boredom, to fit in socially and even to get work breaks others don't.
"It's one of the hardest things you'll ever do," Annette McDonald, respiratory therapist at The William W. Backus Hospital, told the six women and eight men gathered around a large table at the outpatient care center for the first night of an eight-week smoking cessation class this week.
As these smokers' stories made clear, though, their friendship with cigarettes had soured into an expensive, messy, smelly, destructive dependence they long to be rid of with the support of the group and the nicotine patches, lozenges and medications the program would provide. Mostly in their 40s, 50s and 60s, they talked about how they had been smoking since they were teenagers or younger and knew cigarettes were killing them, robbing them of time with their children, grandchildren and spouses.
"My dad died from (chronic obstructive pulmonary disease) and congestive heart failure, and now I'm going in the same direction," said Jan Hildebrand of Norwich, who said she started smoking when she took a waitressing job at age 19 so she could join her co-workers on breaks. "I've been diagnosed with emphysema, and the doctor found two cancerous polyps."
The start Tuesday of this Freedom from Smoking class at Backus, co-sponsored by the Uncas Health District, came on the eve of one of the most significant milestones in the history of anti-smoking efforts in this country. Today marks the 50th anniversary of the release of the surgeon general's report that first identified smoking as a major public health hazard and set the stage for a sea change in public attitudes and tolerance for cigarettes.
"It finally convinced the medical community that tobacco smoking was a major public health issue that required their complete support," said Thomas Babor, chairman of the Department of Community Medicine & Health Care at the University of Connecticut School of Medicine. "Until that time, the tobacco industry had neutralized the medical community by using doctors in the advertising, questioning the scientific evidence, and using other measures to minimize the health implications of cigarette smoking.
"Following the report, the tobacco industry lost all credibility."
New London pulmonologist Dr. Robert Keltner Jr. was a medical student when the report came out. "Everyone smoked then, even the doctors," he said.
While smoking rates have dropped by more than half in the last five decades, to about 25 percent of adults nationally and about 17 percent in Connecticut, "there are still too many people who smoke," Keltner said.
"I still see people who started smoking when they were 14 or 15, and start getting asthma in their 20s," he said. As they get older and continue to smoke, their risk of lung cancer, heart disease and a host of other health problems caused by smoking increases exponentially. But once they quit, he said, their bodies can eventually heal.
"If you're a cigarette smoker and you stop, in 13 to 15 years your risk is the same as that of non-smokers," Keltner said.
Thanks to a state grant, participants in the Freedom from Smoking group have some added incentives to help them succeed. The usual $50 fee that's refunded upon completion of the program is waived, and they'll get a $50 gift card instead, plus free Chantix smoking cessation medication if they have a doctor's prescription, or nicotine patches and lozenges when they reach "quit week" a month from now, Alice Facente, community health nurse at Backus, told the group.
"There are a range of behavioral and pharmacological treatments that all have been shown to be effective in helping people stop smoking," said Babor of the UConn medical school. "The largest challenge now from a public health perspective is the aggressive marketing of cigarettes in developing countries, which is creating epidemics of lung cancer and heart disease in countries like China."
In this country, Babor said, he expects restrictions on smoking in public places and high taxes on smoking to continue to increase. The average cost of a pack of cigarettes in Connecticut is about $9.30, the eighth highest in the nation.
"There is now good evidence that tobacco products are as harmful or even more harmful than illegal drugs, putting tobacco in a class with heroin, cocaine and methamphetamine in terms of its addictive properties and health damage," Babor said.
Motivated by family
For Janet Morris of Niantic, her family's disdain for her 42-year smoking habit is the main motivator.
"I would like to smell better," she said, adding that she washes her clothes often to get rid of the lingering stale cigarette odor, a smell that, McDonald noted, permeated the conference room where the group was meeting even though no one was lighting up. "My husband absolutely hates it. In fact, I think he's become allergic to it. When I walk past him, the coughing starts. My whole family is staunchly behind me trying to quit."
Robin Bleau shared a similar story of how smoking had a negative effect on her family.
"My kids used to say that when they were in school, other kids would say they could smell my cigarettes on them," said the 52-year-old Norwich resident, who started smoking at age 19.
But McDonald told the group that while loved ones can be important motivators, successful quitters do it mainly for themselves - to enjoy the benefits of being able to walk up stairs without getting out of breath and get more enjoyment out of good food and good smells. And to experience the satisfaction of knowing that they've conquered one of the most powerful of all addictions.
"Physically, nicotine is out of your body in 72 hours," McDonald said. "But once it's out of your system, there's the next step. It's how you feel mentally and how you handle social situations. You can learn how to step outside and get some deep breaths and some fresh air without having a cigarette in your hand."
Their homework over the next week would be to record their smoking behavior on "pack track" forms she provided, and to "find your pattern" for lighting up. After that, they should eliminate one "unnecessary" cigarette every two days - the ones they smoke just because they're bored or because they always smoke one after dinner - and to stop smoking in their homes and cars. In response to her question, group members identified the cigarettes they wouldn't be able to give up right away - the one after morning coffee, or when they wake in the middle of the night to relieve insomnia, or are with friends who smoke.
Carl Brathwaith of Mansfield spoke for many of the participants when he told how he'd tried to quit several times, only to pick up a cigarette again "when some things went bad."
"I'm hindered because I've never had success," he said, as others around the table nodded.
McDonald reassured him that many smokers try to quit several times before they succeed. And while the class would teach them quitting strategies, and the medications they would receive would help, in the end they'd have to rely on their own fortitude.
"There's going to come a moment when you'll have to put your foot down with yourself," she said. "It may be a couple of months after you've quit. You'll just have to say, 'I'm not doing it. I'm just not doing it.'"