My Uncle Mick was short, scrappy, and fearless; perfect for our World War II submarine force. He was already in the Navy on Dec. 7, 1941, the date of the Pearl Harbor attack, and served throughout the war.
He died years ago from diseases related to his heavy use of cigarettes, a habit so common among veterans from that era that my family thought it was a perfect Christmas gift each year to give him two cartons of cigarettes.
A generation later, in 1967, during my time in Marine Corps boot camp, the drill instructors would break up the rigorous experience with an occasional smoke break, but only for the smokers. It didn't take long for the nonsmokers to respond to this incentive: There were more smokers coming out of boot camp than went in. Fortunately all branches of the military now encourage health, not cigarettes.
The first issue in 2017 of the Annals of Family Medicine identifies and prioritizes preventive measures to help busy primary-care practices determine where to put the emphasis in prevention during the limited time a provider has with a patient. The top three should be of interest to Arkansans. One of these, childhood immunizations, is no surprise given what has been happening for the last several months in Arkansas: mumps. Immunized kids are less likely to get mumps; and if they do get mumps, are far less likely to have serious disease.
The other two, one for adults and one for youth, speak to my Uncle Mick and me. For adults already smoking, the evidence is clear that a smoker's success at quitting increases if a doctor screens for tobacco use, encourages quitting, and helps with the treatment options that improve the likelihood of success: counseling and medications. However, only about half of smokers were advised by doctors to stop, even though two-thirds of smokers want to quit.
It is not difficult for physicians to get discouraged. Nicotine is a powerful addiction, and fewer than one in 10 smokers successfully quit in the preceding year; but the Centers for Disease Control reports that as of 2015, "three in five adults who had ever smoked had quit." Consistently doing the screening and recommending cessation is key, and it probably helps if providers bring up the topic at encounters other than an annual medical evaluation since so many of us do not get annual exams.
For young people ages 11-21, a brief screening augmented by a prevention message for those kids who don't smoke is helpful. I am not sure why I didn't start smoking in boot camp. I expect it was because my mother never smoked and only thought of smoking as an unnecessary expense and dirty habit. A primary-care provider conveying that message early in life helps prevent the addiction, expense, and heartache of long-term smoking.
Smoking rates in Arkansas have come down, but we still have significantly higher smoking rates than America as a whole. The best way to lower the number of smokers in Arkansas is to convince our kids to never begin.
One final point: Once a smoker is identified by a provider, it is important for a smoker and probably a smoker's family to talk about "Why Quit?"
A recent Arkansas Department of Health "Grand Rounds" emphasized this approach. Many smokers quit on their own without medical help after concluding that smoking is an obstacle in their life. They made the effort to quit because of a commitment to something or someone in their future: kids, grandkids, better health, better sex, more stamina outdoors, expense.
The list may be endless when all of our lists are put together, but for an individual smoker, a firm decision to quit may be motivated by just a handful of personal priorities and relationships. What is important in your life now? What is important to you for the future? Will smoking help or harm your opportunity to reach those goals? Doctors, nurses, friends, family members, and former smokers can help with the "why quit" discussion.
The CDC website promotes the 2017 "Tips From Former Smokers" campaign. These videos and stories are powerful messages from Americans who used to smoke. For a current smoker being seen in a doctor's office, getting good information about what is available for treatment, whether it is a Quit Line, counseling, or medications, can be helpful.
If smokers confront this unhealthy habit and think about two futures, one with tobacco and one without, a commitment to quit may ultimately beat a pack of cigarettes.
------------v------------
Vic Snyder is the corporate medical director for external affairs at Arkansas Blue Cross Blue Shield.
Editorial on 02/16/2017