Calling it quits

Florida is one of seven states taking part in a study of strategies to help senior citizens quit smoking.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published December 17, 2002

As Florida shrinks the number of public places where smokers can light up, a national study wants those who have smoked the longest to figure out what might make them put their cigarettes out permanently.

A pilot program in Florida and six other states will test strategies from counseling to nicotine patches for those 65 and older who want to stop smoking. Many have had the habit for more than 30 years.

"It is never too late to stop smoking," Tommy Thompson, secretary of Health and Human Services, said in announcing the study.

The appeal to seniors reflects ongoing research showing that different kinds of therapy work for different ages, genders or ethnicities.

The pressure to quit for the approximately one-fourth of Florida's adult population that still smokes only increases with November's passage of Amendment 6. Propelled by concerns about the risks of secondhand smoke, the Florida law -- sometime next year -- will prohibit smoking in restaurants and workplaces where smoking areas had once been permitted. The law exempts private residences, designated hotel rooms, retail tobacco shops and stand-alone bars.

"There's so much social pressure to quit now. And yet only half of smokers have quit, and we think those cases were the easier ones," says Thomas Brandon, a nationally recognized expert in smoking cessation and director of the Tobacco Research and Intervention Program at H. Lee Moffitt Cancer Center & Research Institute in Tampa.

Smokers typically make six to eight attempts before succeeding, Brandon says.

The study, called the Medicare Stop Smoking Program, will be conducted in Florida, Alabama, Missouri, Nebraska, Ohio, Oklahoma and Wyoming, all states with a high number of older smokers.

Researchers want to test various treatments alone and in combination: in-person counseling, counseling by phone, nicotine patches, the prescription drug bupropion and educational materials such as letters and brochures.

Previous studies have shown that smokers usually need more than one kind of help -- nicotine patches and behavioral counseling, for example -- to quit the habit, which is as addictive as heroin.

The Medicare study wants to know what works for seniors.

Stopping is beneficial at any age, experts say. Smokers who quit during middle age can gain an average of seven years of life.

"If you quit at 65, you gain two years," Brandon says.

Lung and bronchial cancer are the leading cause of cancer death in Florida. About 12,000 Floridians die of lung cancer every year, and Hillsborough and Pinellas are in the top five counties statistically.

Those who stop smoking see rapid improvements in breathing and circulation, says the Centers for Medicare & Medicaid Services, the study's sponsor. They decrease their risk of heart disease and stroke within one year and can cut the risk of heart disease to that of a nonsmoker within five years.

Smoking exacerbates diabetes, osteoporosis, macular degeneration, cataracts and other conditions typically associated with aging.

Its effects on the body's circulatory system complicate surgery and interfere with the effectiveness of medications.

Seniors, more motivated by health concerns than the young, are also more successful at quitting, statistics show.

"There are tools available now, different products which can double the quit rate," says Brandon, adding that most smokers quit on their own without therapy or medical attention.

Brandon, one of the authors of the 1988 surgeon general's report on nicotine addiction, is a nationally recognized expert on smoking relapse. About 95 percent of all smokers relapse after quitting the first time, he says. Since the large majority attempt to stop on their own, he has developed assistance programs to reach them directly, such as brochures mailed to smokers who have recently quit to encourage continued abstinence.

"Tailoring or targeting intervention for certain groups of people makes sense," Brandon says.

An estimated one out of every three smokers is killed by their habit. No one knows who will die from smoking, but health benefits from quitting are guaranteed. Brandon recalls an elderly woman in group therapy who could finally take the stairs to the room where sessions were held without gasping at the top.

Results of the Medicare & Medicaid Services study on seniors are not due until 2005. Under current law, assistance to stop smoking is not a covered medical expense under Medicare because it is a preventive service rather than treatment of an illness or injury.

The Medicare and Medicaid system spends an average of $40-billion a year on smoking-related illnesses, but smoking cessation programs will not be covered without a legislative change.

How to sign up

Medicare Stop Smoking Program:

Participants must be enrolled in fee-for-service Medicare Part B. Therapies will be provided without charge for up to one year.

Toll-free 1-866-652-3446

www.cms.hhs.gov

Pregnant and Postpartum Smoking Study:

Women who recently quit smoking while pregnant and either remained nonsmokers or resumed smoking after giving birth are needed. Child care and compensation is available.

Toll-free 1-877-954-2548

www.moffitt.usf.edu/trip

Help for anyone who wants to quit:

The Quitline offers free counseling and information for Florida residents age 13 and older in English, Spanish, Creole and TDD for the hearing-impaired.

Toll-free 1-877-822-6669

Other resources:

American Cancer Society

Toll-free 1-800-227-2345

www.cancer.org

American Lung Association

Toll-free 1-800-586-4872

www.lungusa.org

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