With old and new battles to fight, a fresh look at smoking is needed
Increase in teen smoking puts focus on parents and corporations
With the turn of the century, wellness professionals can look back with satisfaction at any number of accomplishments and exciting new developments. Unfortunately, some old problems remain with us, with tobacco use one of the most prominent. Perhaps most disturbing about this issue is that it has begun to resemble the Hydra — the mythical many-headed monster; when one head is lopped off, another grows back in its place.
It is gratifying to see a reduction in the overall number of smokers. However, recent statistics indicate increased use among teenagers. What’s more, the popularity of cigar smoking and ubiquitous lighting up on the "silver screen" have served to re-glamorize the habit.
But teenagers make up a very small percentage of the working population, and mass media hits home far from the workplace. Are these new developments the proper concerns of corporate health programs?
Experts say that in fact, they are, and until we successfully address these new challenges, as well as the still-nagging presence of hard-core smokers, the battle against smoking will remain far from won.
Teenage smoking, says Lewis Schiffman, president of Atlanta Health Systems, simply can’t be ignored by wellness professionals — or by employers.
"Teen smoking ought to be a serious concern for wellness professionals, because the smoking teenagers of today will be the smoking employees of tomorrow," he notes. "The tobacco companies have allocated a lot of resources to research how to get children and teenagers addicted to smoking. Additionally, for many parents, the idea of their child engaging in smoking is very upsetting and stress-producing, so this ties directly into work-family strategies."
Deal with teens now
Don R. Powell, PhD, president of the American Institute For Preventive Medicine, Farmington Hills, MI, agrees. "Teenagers are the children of employees, and parents who are concerned about a teenager who smokes could find it inhibits their productivity at work; you just can’t separate the two," he asserts.
"Today’s teenagers will be tomorrow’s work force," he continues. "We had begun to see decreases in teen smoking, but that is no longer the case now — according to the CDC, about three million children and adolescents smoke cigarettes and one million use smokeless tobacco. Each day some 3,000 teenagers become regular smokers and nearly 1,000 of them will eventually die as a result."
Schiffman lays the blame for this new wave of teen tobacco use squarely at the feet of Hollywood producers and the manufacturing companies. "We must educate employees and teens about the fact that cigarette manufacturers are helping to fund the cost of making movies, and in exchange, characters in these movies are encouraged to smoke and/or even show a particular brand of cigarette," he says. "Of course, the more intelligent actors will smoke fakes, but teenagers don’t know that. In addition, smoking feeds right into the inherently rebellious nature of being a teenager and adds to their bad kid’ image."
To combat this disturbing message, says Schiffman, "We need to expose the business ethics — or more aptly, the lack of ethics — of the tobacco companies," he says. "For children and teens, we need to reframe their perception about smoking so that they understand it isn’t really rebellion; it’s actually being controlled. And, additionally, the people who are trying to control them are also purposely robbing them of their youth and ultimately destroying their lives."
There are many strategies you can employ to fight against this growing trend, says Schiffman. "First, you can conduct educational programs for parents and disseminate information on the process by which people become addicted to tobacco," he suggests. "This includes both the physical and psychological addiction to this drug-delivery system.
"Additionally, when your company conducts smoking cessation classes, consider inviting parents to include their teenage children who are smokers in the class, assuming the class is conducted after normal working hours. My belief is that in addition to helping teens quit it will boost the overall success rate in the class for the adults who now want to be role models for their children."
Powell agrees with Schiffman that in your internal wellness campaigns, you should offer cessation programs to dependents. "We’ve had some corporate classes where they have been open to dependents, and sometimes teenagers have come in," he notes.
"As a good corporate citizen, companies can donate money to help fund anti-smoking ads and commercials in the various media," adds Schiffman. "They can also sponsor smoking cessation or smoking prevention programs in elementary and high schools. This also has the added benefit of gaining positive exposure for the sponsoring company."
"One of key issues is prevention and discouragement," says Powell. "If a child doesn’t start smoking by age 18, his chances of ever becoming a smoker are almost nonexistent."
Given this startling statistic, how can we discourage or prevent new smokers? "The image of the smoker needs be altered," says Powell. "Instead of being portrayed as glamorous, debonair, or cool, someone who smokes needs to be portrayed as uncool, unsophisticated, a loser.
"Effective advertising can do that," he emphasizes. "We created the Marlboro Man and the Virginia Slim’s woman — we can also create the Tarboro Man’ and Virginia Varicose,’ or tell women, You’ve come the wrong way, baby.’"
It’s critically important to catch smokers early, Powell adds, because "if you smoke three or more years, you will most likely become a hard-core smoker."
Powell would like to see an expanded effort to ban pro-smoking ads. "We should ban outdoor ads — especially near schools — and prohibit brand sponsorhip for sports events," he says. "We should eliminate tobacco ads in magazines that have youth readership."
That all sounds great, but what does that have to do with wellness professionals and their employers? Powell says it goes hand in hand with promoting community wellness. "What you’re starting to see are corporations taking more interest in their communities," he notes. "Companies can take a stand and promote health in their communities, as well as for their employees."
Schiffman agrees. "As wellness professionals, it is incumbent upon us not only to be healthy role models, but to take a stand for better health and quality of life in the larger community," he asserts. "Let’s just say no’ to corporate-induced health problems, whether they come from tobacco, or fat substitutes that rob our bodies of vital nutrients, or other products that are known to cause health risks."
Arnold, trash that cigar!
The recent popularity of cigar smoking, which unfortunately has been given a strong boost by celebrities, helps bring home the point that wellness professionals and corporations must become more active in the public arena — or at least in combating mass media messages — if they want to win the war against smoking.
Education is the key, says Powell, who is keenly aware of this new danger. "In the movie Reality Bites,’ in 14 of 40 scenes, the two lead actors were smoking," he notes. "But in a study conducted by the University of California Irvine, they found that if you ran a 30-second anti-smoking ad beforehand, it counteracted that message."
There are also some sobering facts wellness professionals should share with their employees, says Powell. "Second-hand cigar smoke is more poisonous than second-hand cigarette smoke; one cigar equals three cigarettes," he notes. "The carbon monoxide emission is 30 times greater in cigars than in cigarettes."
If you are already a cigarette smoker, the chances are that you will also inhale cigars, adds Powell. "Independent of that, cigar smoking increases the likelihood of cancer of the larynx, mouth, esophagus, and lungs. The death rates from cancer among cigar smokers are 34% higher than those of noncigar smokers. You are three to five times more likely to die of lung cancer, five times more likely to get emphysema. Also, nicotine does not have to be inhaled to damage your heart and lungs — it can be absorbed into the bloodstream through the mouth."
Most frightening of all, perhaps, is that fact that between 1993 and 1998, cigar sales increased 50%, says Powell.
"We’ve got to create an image that cigar smoking is as uncool as cigarettes," says Powell. "Today, more and more cigarette smokers have come to feel as outcasts; they have guilty looks on their faces. Now, we need to begin to look at people who smoke cigars with the same chagrin and scorn. And there’s good reason to — a lot of them probably just don’t realize how harmful it is."
The new coolness’ associated with cigar smoking, Powell insists, can be reversed. "The reason cigarettes became such a health issue recently was because of sidestream [second-hand] smoke, and the same issue needs to be centered around cigar smoking," he recommends. "This message should be publicized in your newsletters, put up on posters at your work site, and through all your corporate communication vehicles."
They’d rather die than quit
Finally, wellness professionals must continue to address the nagging issue of hard-core smokers. "Out of the 40 million people who smoke, there are some 12 million who are considered hard core," says Powell. "My definition of hard core’ is someone who smokes 25 or more cigarettes a day and who has smoked at that level for at least three years." The good news, says Powell, is that in 1965, 40% of the people who smoked were hard core smokers, and now the figure is closer to 25%. "These are the people who are resistant to smoking cessation programs," he says.
Schiffman is not surprised by the fact that a substantial number of employees continue to smoke. "Let’s understand once and for all that the use of tobacco is a drug addiction," he suggests. "This is not merely a bad habit that makes people in restaurants uncomfortable. The tobacco companies have deliberately — by their own admission — set out to get people addicted to this substance, knowing full well that it presented multiple hazards to their health. As such, we should treat tobacco use the same way we treat any other drug addiction. This may sound extreme, but addictionologists have reported that it can be more difficult to quit smoking than it is to stop using heroin."
"When you look at these hard-core smokers, they are both psychologically and physiologically addicted," Powell explains. "The hard-core smoker experiences 250 inhales and exhales per day. If you multiply that by 365, you get about 91,000 times a year. This is an overlearned habit; some smokers may be as addicted to inhaling and exhaling as they are to breathing."
Speed that kills
Physiological addiction is easily understood when you realize just how potent the cigarette "delivery system" is. "Within seven seconds of inhaling, nicotine goes to the receptors in your brain; that’s faster than if they were injected," notes Powell.
To address psychological addiction in his smoking cessation programs, Powell often uses "smokeless inhalation" — four or five deep breaths when employees get the urge to smoke. "You can also use oral and manual substitutes — even just snapping a wrist band when you get the urge distracts you from the habit’ aspect of smoking," he explains.
For employees who are physiologically addicted, nicotine replacement products like Nicotrol and Nicoderm can be helpful, as well as Zyban, which is an antidepressant.
"We try to concentrate the length of time in our program," says Powell. "We offer five consecutive one-hour sessions, all done within a week. Then, we follow up with self-help maintenance, using a 24-hour hotline."
"First, let’s understand that many of these people do want to quit and have tried to quit on at least one occasion, and may now feel the addiction is stronger than they are," says Schiffman. "Others are committed to a worseness’ lifestyle — as opposed to wellness — and see their smoking as a badge of courage."
In terms of helping these hard core smokers quit, says Schiffman, "One possible strategy is a substantial cash incentive for people who stay quit for more than one year." The minimum incentive offered should be $1,000, he suggests.
"Some companies may feel reluctant to do this because they believe it should be that individual’s responsibility to manage their own health," says Schiffman. "However, if people were responsible, we wouldn’t be a nation of overweight, unfit people. Additionally, the cost of having smokers on the company payroll drives up health care costs for everyone."
Another option, says Schiffman, is to utilize the services of your EAP (employee assistance program), but Powell is not so sure. "It’s tough to get someone in [to the EAP] because they don’t see themselves as being addicted," he notes. "Support groups are good, but hard-core smokers tend to drop out."
Whatever strategy you employ, says Schiffman, "Treat this for what it really is — a drug addiction."
Schiffman summarizes the sobering reality of smoking addiction as we enter the 21st century: "Smoking is still increasing among some groups, particularly teens and women, and people who continue to smoke in corporations are hard-core addicts. Some employees still don’t get that what they do is destructive, and a still larger group would like to quit but see quitting as beyond their reach. How do we reach those hard-core people, and also prevent proliferation of smoking among the employees of tomorrow? There is a corporate responsibility for building a health community — and as wellness professionals, we do have a responsibility to expose the lack of corporate ethics on the part of tobacco companies who have deliberately lied to the public. Why do we have that responsibility? Because smoking is a health issue, a business issue, and a morality issue. By exposing the truth, we may change employees’ perception about smoking."
• Lewis Schiffman, Atlanta Health Systems, 2516 Wowona Drive N.E., Atlanta, GA 30319. Telephone: (404) 636-9437. E-mail: [email protected].
• Don R. Powell, American Institute for Preventive Medicine, 30445 Northwestern Highway, Suite 350, Farmington Hills, MI 48334-3201. Telephone: (248) 539-1800. Fax: (248) 539-1808. E-mail: dpowell @ameritech.net.
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