Are You Still Smoking?

My parents once told me that when I was young, my pediatrician would walk into the exam room smoking. He apparently just strolled in with a cigarette hanging from his lips and a stethoscope around his neck. Hard to believe, isn’t it? Times have certainly changed.

In 1965, the Federal Cigarette Labeling and Advertising Act was passed, which required all cigarette packages to carry a warning label: “Caution: Cigarette smoking may be dangerous to your health.” US Code 1333, as it is known, drove a very effective ad campaign against cigarette smoking that eventually led to a 50-year decline in tobacco use in the U.S. At the time in 1965, 42 percent of Americans were daily smokers. The percentage of cigarette smokers in 2021 was 11.5 percent. Impressive stats, but unfortunately, cigarette smoking remains the leading cause of preventable death in the U.S., with approximately 480,000 a year, according to the CDC. A small portion, 41,000 of these deaths are in non-smoking adults, due to secondhand smoke exposure. Cigarettes cause 90 percent of lung cancer deaths, and in women, lung cancer is the leading cause of cancer death, surpassing breast cancer. Cigarettes cause 80 percent of all deaths from Chronic Obstructive Pulmonary Disease (COPD). Smoking increases the risk of coronary heart disease and stroke by two to four times.

I know how hard it is to quit. I watched my dad struggle for decades; he stopped and restarted over and over. He tried all the modalities, too: hypnosis, medications, nicotine replacement. Eventually, his stress levels got the best of him. We would find evidence of his chainsmoking in the backyard and knew he was hooked again. I also have dear friends who still smoke, and even though they know all these stats, the act of quitting is tough.

I could go on with the grim stats, but I would rather share some good news. When someone quits smoking, their physical health begins to improve immediately. Like, within minutes, blood pressure and heart rate drop, and within days, oxygen levels improve. Within five to ten years of quitting, the risks of head and neck cancer drop by half, and lung cancer risks drop by 50 percent after 10 years or more from quitting.

Some more good news: Research out of Harvard highlights a new angle for changing health behaviors. Ke Wang, a researcher and Ph.D. candidate, recently published on the concept of gratitude.

He argued in his work that the idea of gratitude had an effect on cigarette use. His results showed that individuals with higher rates of gratitude correlated with lower rates of smoking. Wang found that inducing gratitude in people who smoked also lowered their cravings for cigarettes. Individuals with gratitude show more enthusiasm for smoking cessation programs as well.

I am sure you have seen those ads on TV, highlighting people who have lost limbs, parts of their face, or even their voicebox due to smoking. The CDC broadcasts this campaign in an effort to get more people to quit smoking, but Wang’s research shows that fear and negative attitudes only move the needle so far. Wang felt so strongly about his research that he recommended injecting positive emotions and gratitude into antismoking campaigns to help improve quit rates. He even suggested exploring the concept of gratitude towards other addictions, such as alcohol use disorder.

So, if gratitude is so powerful, how should we go about practicing it? What is the most effective way to use gratitude to change behaviors?

Some recommendations from the researchers:

• Keep a gratitude journal. Writing a few lines each evening or morning and reviewing these periodically can help this become a practice.
• Mindfulness: This is all the rage of late. Perhaps it may sound like a cliche, but the research is solid. Mindfulness practices such as meditation or mindfulness-based stress reduction groups have shown good hard data in improving pain rates, stress levels, sleep, and anxiety.
• Expressing gratitude: This seems a little more nebulous and harder to wrap our hands around, but I think we can make it what we want to fit our lives. Thanking others in small ways: a handwritten note, a kind email, or even a genuine comment to others can be meaningful ways to express thanks.

This concept of gratitude as a way to change behavior is exciting and gives me hope.