When tobacco-producing North Carolina banned smoking in bars and restaurants earlier this year, smokers everywhere were put on notice. And this law has teeth – anyone can report violators to state officials and so far, they have. In January, the first month of the ban, smokefreenc.gov received nearly 40 complaints in Cumberland County alone. Smokers can be fined $50 per incident with restaurant and bar owners facing even stiffer penalties, up to $200. It’s a long way from just a year ago when the American Lung Association gave North Carolina a failing grade in its annual Tobacco Control Measures report card. North Carolina now joins dozens of other states with smoke-free laws. State schools became completely tobacco-free in 2008, and all 128 of North Carolina’s hospitals passed tobacco-free policies last summer. Tobacco is the number one preventable cause of death in the United States. It is also the leading cause of disability causing emphysema and chronic bronchitis. We’ve known all of this since the Surgeon General’s 1964 Report on Tobacco and Health so what took so long for hospitals, schools and restaurants to catch on? Quitting is hard. The good news is research is beginning to show that these bans do lead to a decrease in smoking. My mother quit 41 years ago after spending 10 years as a two-pack-a-day smoker. Why? She was returning to work as a kindergarten teacher in a school where she could not smoke, and a young friend was dying of lung cancer. But her doctors never advised her to quit. “Are you kidding me?” she asked. “The doctors all smoked at the time.” Physicians are now taught to advise people not to smoke. It is one of the five A’s for smoking cessation: ask, advise, assess, assist and arrange. If you are a smoker, or know a smoker, you can use these five A’s as well. Ask if the person smokes. Advise with individualized advice to quit smoking. Assess the person’s readiness to change. People can be “pre-contemplative,” a condition in which they haven’t even thought of quitting, “contemplative,” a time in which they are thinking about it but aren’t ready to commit, or in the “preparation,” “action,” or “maintenance” phases. You can actively help during the latter three phases of change. As a physician, I can prescribe a variety of medications, including Chantix, Zyban or nicotine replacement, or these medications in combination. You can assist by identifying smoking triggers such as driving, stress, etc., and devising alternatives to smoking such as pretzel sticks, deep breathing exercises or meditation. You can assist by being supportive when the inevitable nicotine withdrawal hits. It took my mom an entire summer to quit. She describes the process as extremely difficult, one that she’d never want to have to do again. Arrange for follow-up help. People are more successful if they receive assistance by phone or in person soon after they stop smoking. A toll-free number, 800-QUIT-NOW, offers support from a tobacco treatment specialist who will call at a time you request. A helpful Web site is quitnownc.org. My father started smoking in his late teens. Quitting wasn’t hard for him; he did it many times. He was a pack-a-day smoker for 20 years before he quit for an entire year, spooked by a suspicious “spot” on a chest X-ray. It turned out to be nothing. He stayed smoke free until one innocent cigarette and was back to a pack a day immediately. The final time he quit, he decided that he had had enough, he was ready. Nagging doesn’t help; scientific evidence supports this. Once you are ready to quit, you will. For my dad, quitting did not come soon enough – he died of lung cancer in 2007. Dr. Lenny Salzberg teaches and practices at the Southern Regional AHEC Family Medicine Center. To report violators of the smoking ban, visit smokefreenc.gov or call Cumberland County Public Health Director Buck Wilson at 433.3707.
