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The Honolulu Advertiser
Posted on: Sunday, October 29, 2006

Cut the habit

Video: New anti-smoking rules go into effect Nov. 16
 •  New smoking law may shock many businesses

By Catherine E. Toth
Advertiser Staff Writer

State law is about to give you one more good reason to stop smoking.

BRUCE ASATO | The Honolulu Advertiser

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ABOUT THE LAW

On Nov. 16, smoking will be prohibited in enclosed or partially enclosed places of employment, including any area closed in by a roof, overhang or two walls. That includes restaurants, bars, lobbies, lδnai and covered walkways.

Smoking is also not allowed in facilities owned by the state or counties, or enclosed or partially enclosed places open to the public, including all airports. The ban also includes buses and taxis, along with sports arenas, outdoor stadiums and amphitheaters.

Lastly, no smoking is allowed within 20 feet of entrances, exits, windows and ventilation intakes.Smoking is allowed in private homes, unless they provide licensed childcare or healthcare services. Hotels may designate smoking rooms, but no more than 20 percent can be so designated, and they must all be on the same floor.

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BY THE NUMBERS

165,000

Islanders who smoke regularly

70

Percentage of smokers in Hawaiçi who want to quit

44.5 million

Number of U.S. adults who were smokers in 2004

20.9

Percentage of all U.S. adults who were smokers in 2004

14.6 million

Number of adult everyday smokers who stopped smoking for at least one day during the preceding 12 months because they were trying to quit

45.6 million

Number of adults who reported being former smokers in 2004, representing 50.6 percent of those who had ever smoked

87

Percentage of lung-cancer deaths caused by cigarette smoking every year in the U.S.

100,000

The estimated number of respiratory deaths caused by smoking per year in the U.S.

160,000

The estimated number of cardiovascular deaths caused by smoking per year in the U.S.

80,000

The estimated number of deaths from coronary heart disease caused annually in the U.S. by smoking

3,000

The estimated number of lung- cancer deaths among adult

non-smokers per year in the U.S.

Source: American Heart Association, Centers for Disease Control and Prevention, Coalition for a Tobacco Free Hawai'i, National Cancer Institute, U.S. surgeon generall

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On Nov. 16, a lot of those ashtrays will disappear as more public places become no-smoking zones.

BRUCE ASATO | The Honolulu Advertiser

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Rosalyn Payen relaxes with a smoke in a downtown park with friend, Ryan Gomes. Fewer outdoor areas will be smoking zones as of Nov. 16.

BRUCE ASATO | The Honolulu Advertiser

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You've tried to quit before.

Went cold turkey.

Bought the patch.

Even tried acupuncture.

But for some reason — stress at work, annoying weight gain, habitual Friday-night drinks — you just couldn't kick the habit.

Well, you might just have a no-fail reason to stop smoking next month.

On Nov. 16 — to coincide with the American Cancer Society's Great American Smokeout — a stringent statewide law will take effect that bans smoking from enclosed or partially enclosed places of employment, including restaurants, bars, sporting arenas and covered walkways.

Smoking will also not be allowed in state- or county-owned facilities, including all airports.

You won't even be able to smoke within 20 feet of any entrance, exit, window or ventilation intake.

That may be the final drag for the roughly 165,000 people who smoke in Hawai'i, according to the Coalition for a Tobacco Free Hawai'i.

Though the law was designed to protect workers and the public from secondhand-smoke exposure — an estimated 3,000 nonsmokers die each year from lung cancer — the ancillary effect may be getting smokers to quit, once and for all.

"This should provide good motivation for people who have tried to quit before to say, 'This is it. I'm going to make it work this time,' " said Julian Lipsher, public-health educator with the state Department of Health tobacco prevention and education program. "Data suggest from across the country that when workplace protection is put into effect, efforts to quit are increased."

And why not?

Not only are smoking-cessation programs abundant and nicotine-replacement products readily available, but Americans have become better educated about the health risks associated with smoking.

Consider these effects:

  • Cigarette smoking causes 87 percent of lung-cancer deaths in the U.S., according to the National Cancer Institute. Tobacco use also increases your risk of other cancers — including mouth, throat, kidney and stomach — and chronic diseases such as respiratory and cardiovascular.

  • Tobacco use remains the leading preventable cause of death in the U.S., causing more than 440,000 deaths each year and resulting in an annual cost of more than $75 billion in direct medical costs, according to the Centers for Disease Control and Prevention.

  • Smokers are twice as likely to die from heart attacks as non-smokers, according to the American Heart Association.

    So why are there still 44.5 million smokers nationwide?

    And why is smoking such a difficult habit to break?

    "It's hard work to quit smoking," said Dr. Tim McAfee, chief medical officer for the Hawaii Tobacco Quitline and a family physician in Seattle. "The key to success is translating the intent to quit into action ... Anybody can be successful at it."

    MOST WANT TO QUIT

    About 70 percent of all smokers say they want to quit, according to the CDC.

    But quitting takes more work than most smokers realize.

    "People believe that their will power is stronger than their addiction to nicotine," said Dr. Paul Morris, general and thoracic surgeon at The Queen's Medical Center. "That's simply not true."

    Nicotine is a drug found naturally in tobacco. It's highly addictive — as addictive as heroin or cocaine, according to the American Cancer Society.

    Over time, the body becomes physically and psychologically dependent on the drug, which produces a pleasurable feeling that makes the smoker want to smoke more.

    In addition, there's the social aspect of smoking.

    Many smokers light up in social situations, whether on breaks with co-workers or in bars with friends. Alcohol consumption often accompanies smoking.

    Scott Ishikawa, 25, started smoking right after high school. It quickly became part of his social scene.

    "When I first started, I never thought I'd be addicted," said the financial adviser from Mililani, who quit just last week. "At first, I'd only smoke when I drank, then only when I drank and was stressed out."

    Before he knew it, he was smoking more than a pack a day.

    "I like it, but it's an addiction," he said. "It's a love-hate relationship."

    Ishikawa is one of thousands of smokers who are getting help with their addiction.

    He opted to use medication — the newly FDA-approved Chantix (varenicline tartrate) — to curb his craving and ease withdrawal symptoms.

    (The other, more popular medication is Zyban, or bupropion hydrochloride, an antidepressant that has been found to reduce the urge to smoke.)

    But medication isn't the only way to quit.

    The FDA has approved the use of five other types of nicotine-replacement therapies — patches, gum, lozenges, inhalers and nasal sprays — which have proven effective in reducing symptoms and helping smokers kick the habit. Most can be purchased at drugstores.

    There are also alternative smoking-cessation methods, including hypnosis, acupuncture and low-level laser therapy.

    Studies have shown that tobacco users are up to three times more likely to quit successfully if they receive help, whether from group counseling or nicotine patches.

    "This is such a good time to quit because we know so much more about the resources available," said Dr. Diane Thompson, director of the cancer center program at The Queen's Medical Center.

    SPREAD THE WORD

    One of the first steps smokers should take is telling others about their plans to quit.

    "The biggest part is getting support," Thompson said. "Unfortunately, people don't talk about trying to quit with their family and friends. And we've found that their chances would be much better."

    So here's some good advice: Get family and friends to support your efforts to quit. Ask them not to smoke around you or offer you cigarettes. Get them to keep you on track.

    Better yet, get them to quit with you.

    "It's harder to quit if a lot of people in your home or social network are still smoking," McAfee said. "If you quickly mobilize your social support, you're more likely to be successful."

    Oftentimes, it takes a life-changing event to motivate smokers to quit for good.

    Alec Burnett, 42, of Hawai'i Kai, got a scare in June 2004 when his doctor diagnosed him with melanoma.

    "The cancer was it," said Burnett, the regional director for Hilton Supply Management and father of two, who was smoking nearly two packs a day. "That was pretty much the final say."

    That October, when his wife was pregnant with their second daughter, Burnett got a nicotine patch and committed to quitting for good.

    "Getting grief from friends, the smell, the expense of it, having kids — it was all just adding up," he said. "Then I was diagnosed with melanoma. Cancer. That was all I needed to hear."

    Rosalyn Payen, a 30-year-old legal advocate from Mo'ili'ili, has no plans to quit, not even after the smoking ban goes into effect next month.

    She doubts the ban will affect her — she smokes less than a pack a day — but she respects the protection it affords nonsmokers.

    "I feel bad smoking around nonsmokers," she said, taking a smoke break with a friend downtown on Wednesday. "I make an effort not to impose my choice on other people."

    But she doesn't think smoking will always be part of her life. She plans to quit once she has kids.

    "For me, right now," Payen said, "I want to live my life the way I want to."

    • • •

    QUICK-QUIT GUIDE

    Studies have shown that these five steps will help you quit and quit for good, according to the Centers for Disease Control and Prevention. You have the best chances of quitting if you use them together.

    1. Get ready: Set a quit date and change your environment. Get rid of all cigarettes and ashtrays in your home, office and car. Avoid situations where you'd be around smokers. Think about past attempts to quit and figure out what worked and what didn't. "Try to get your environment to be more favorable to your trying to quit rather than change your life on just will power," said Dr. Tim McAfee, chief medical officer for the Hawaii Tobacco Quitline.

    2. Get support: Studies have shown that you have a better chance of being successful if you have help. You can get support by telling your friends and family you're quitting, asking smokers to refrain from smoking around you, discussing cessation methods with your primary-care physician, or going to individual or group therapy. "Those who (quit) alone without telling anyone don't do nearly as well," said Dr. Diane Thompson, director of the cancer center program at The Queen's Medical Center.

    3. Learn new skills and behaviors: Find something to replace the act of smoking. Talk to someone, go for a walk, drink lots of water. When you first try to quit, change your routine.

    Drive a different route to work or drink tea instead of coffee. Do something to manage or reduce your stress. Plan something enjoyable to do every day. "Find ways to relax and reduce stress," Thompson said. "And reward yourself."

    4. Look into nicotine-replacement therapy: There are nicotine-replacement therapies designed to help you stop smoking and reduce the urge to smoke. The U.S. Food and Drug Administration has approved the following six medications to aid in smoking cessation:

    • Zyban or Chantix (available by prescription)
    • Nicotine gum (available over the counter)
    • Nicotine inhaler (available by prescription)
    • Nicotine nasal spray (available by prescription)
    • Nicotine patch (available by prescription and over the counter)
    • Nicotine lozenge (available over the counter)

    Consult a healthcare professional before starting any nicotine replacement therapy.

    And consider using these products in conjunction with other methods of aid, including individual counseling or smoking- cessation classes.

    "The big thing that helps people is if they reach out to get some kind of structured support for quitting," McAfee said. "Even just making a phone call ... There's no question that doing this makes it more likely a person will quit."

    5. Be prepared for relapse or difficult situations: Most relapses occur within the first three months after quitting. Don't be discouraged if you start smoking again; most people try several times before they finally quit.

    "The risk of relapse is highest within the first few days of quitting," McAfee said.

    Challenges you may face:

    • Alcohol: Smoking and alcohol consumption often go hand in hand. Avoid drinking alcohol. It lowers your chances of success.
    • Other smokers: Being around smokers may make you want to light up. Steer clear.
    • Weight gain: Many smokers gain weight after quitting, but usually less than 10 pounds. Eat a healthy diet and stay active. Exercise can improve your mood.
    • Mood swings, irritability, depression: There are a lot of ways to improve your mood other than smoking. Do things you enjoy.

    "If at first you don't succeed, reframe it," McAfee said. "Don't think of it as a failure. It's a partial success. Build on that."

    — Catherine E. Toth

    • • •

    RESOURCE LIST

    Here’s a list of tobacco-cessation services in Hawai'i, provided by the state Department of Health.

    Alliance of Hawaii Hypnotherapists: 521-2999

    American Lung Association: 537-5966, www.ala-hawaii.org. Lung Helpline: (800) LUNG-USA (586-4872)

    Castle Medical Center & Castle Center for Nicotine Dependency Treatment: 263-5050, www.castlemed.com (group and individual therapy, including classes)

    Hawaii Acupuncture Association: 538-6692

    State Department of Health, tobacco prevention and education program: 586-4613, Neighbor Islands: (888) 810-8112

    Hawaii Tobacco Quitline: Provides telephone counseling and nicotine-replacement therapy. (800) QUIT-NOW (784-8669), 3 a.m.- 9 p.m. Mondays-Fridays, 3 a.m.-6 p.m. Saturdays-Sundays

    Hickam Air Force Base Health and Wellness Center: 448-6170 (for active-duty military, retired military, Department of Defense civilian employees and their families)

    HMSA’s Ready, Set, Quit!: Provides telephone counseling, case management, tobacco-cessation classes and nicotine-replacement therapy. 952-4400; Neighbor Islands: (888) 225-4122, www.hmsa.com

    Kaiser Permanente’s Health Education Department, tobacco-cessation program: 432-2274; Maui: (808) 243-6483; Big Island: (808) 934-4077, www.kp.org

    Kalihi-Palama Health Center, Smoke Free Families program: 848-1438, www.healthhawaii.org

    Ke Ola Mamo, Native Hawaiian Health Care System: 848-8000, ext. 230; www.keolamamo.org

    Kokua Kalihi Valley, Comprehensive Family Services: 848-0976, www.kkv.net

    Straub Clinic & Hospital, Freedom From Smoking: 522-4325, www.straubhealth.org

    The Queen’s Medical Center, Health Education and Wellness: 547-4823, www.queens.org. Quit Tobacco Hotline: 537-7300

    Tripler Army Medical Center, tobacco-cessation program:
    433-1498, www.tamc.amedd.army.mil

    University Health Services tobacco-cessation program:
    956-3453, www.hawaii.edu/shs (for UH students)

    Waianae Coast Comprehensive Health Center, alternative smoking-cessation program: 696-1599, www.wcchc.com.

    • • •

    LEARN MORE

    American Cancer Society: www.cancer.org

    American Heart Association: www.americanheart.org

    American Lung Association of Hawai'i: www.ala-hawaii.org

    Centers for Disease Control and Prevention: www.cdc.gov/tobacco

    Coalition for a Tobacco Free Hawai'i: www.tobaccofreehawaii.org

    State Department of Health: www.hawaii.gov/health/tobacco

    National Cancer Institute: www.cancer.gov

    Smokefree: www.smokefree.gov

    The Foundation for a Smokefree America: www.anti-smoking.org

    U.S. surgeon general: www.surgeongeneral.gov

    Reach Catherine E. Toth at ctoth@honoluluadvertiser.com.