When asked why I care so much about smoking cessation, I can’t relate any stories of family tragedies. Rather, my motivation comes from the fact that smoking exerts such a huge toll on health, and also that I lost many patients from smoking-induced diseases. But, like many of my generation, both my parents smoked. The recent confluence of Father’s Day and Mother’s Day reminds me of how they quit at relatively advanced ages, both without medical assistance, but with persistent nagging from their physician son.
Dad was both a pipe and cigarette (Chesterfield) smoker. When he was in his 60’s and I was living in Atlanta as an Epidemic Intelligence Officer at the Centers for Disease Control, he called to relate that he woke up wheezing that morning. “So I asked myself,” he recounted in his typically colorful way, “Who’s in charge here Schroeder, old man tobacco or you?” He managed to quit on the spot, and I think it was his first attempt. With mom it was not so easy. At one point she left a lighted Kool cigarette on a windowsill, igniting a curtain and causing a self-contained house fire that left every part of their modest home contaminated by smoke. But she kept on smoking. Then, in her early 70’s she got pneumonia and her convalescence was slow. She complained to me about her persistent cough, and I gave a blunt reply: “Mom, you won’t get any sympathy from me until you stop smoking.” To my astonishment and delight, she did quit.
Both my parents quit because of new medical symptoms that were related to smoking, and both lived to an advanced age, which probably would not have happened if they had kept smoking. Neither used either counseling or cessation medications, because those were not available at that time. But their stories illustrate three important lessons. First, medical symptoms and illnesses present a great opportunity to motivate smokers to quit. Second, it is never too late to quit, and at any age smoking cessation improves health and survival compared to those who continue to smoke. Third, most smokers still quit “cold turkey,” that is without any medical assistance, even though the odds of quitting that way are less than when they use smoking cessation tools. We know, of course, that quitting is hard, that using medications and getting counseling improves the odds of quitting, and that most people have to try many times before they are able to quit. But pounding away at the message that smoking is bad for you can yield dividends at the opportune moment, as it did for both my parents. Since decisions to quit can occur at any time, keeping on message may pay off at unexpected times, as it did with dad and mom.
Where did my parents buy their cigarettes? Mostly it was in grocery stores, but occasionally in pharmacies. When you think about, it seems wrong that places dedicated to selling health-promoting products like food and medications would also vend a deadly product. It was for that reason that many independent pharmacies have stopped selling cigarettes. San Francisco banned cigarette sales in pharmacies in 2008, and CVS in 2014 decided to stop selling all tobacco products in its pharmacies. It was hoped that the two other large national pharmacy chains, Rite-Aid and Walgreen, would follow the CVS example. But to date they have not, citing the potential income loss that would result. Recently, however, Rite-Aid announced that it would stop selling electronic cigarettes, but not combustible tobacco products. The logic behind that move escapes me, since although e-cigarettes are not harmless, they are much less dangerous than cigarettes. Of course, cigarettes are also a much more lucrative product for retail merchandisers. As smoking rates continue to decline, with more adult smokers quitting, continuing smokers smoking less, and young people less likely to start, we need to accelerate efforts to reach those remaining smokers. The messages are clear, and there is always hope, as happened late in life with my parents. I sent a lot of cards and gave some presents over the years to celebrate Father’s and Mother’s Day. But, in retrospect maybe my best gift was to persist in encouraging them to stop smoking.
Read Tiffany’s story in the CDC's Tips from Former Smokers Campaign about how the thought of missing out on any part of her daughter's life led her to quit smoking.