Aimee Schiefelbein, Quit Coach, Service Delivery:

E-Cigarettes now come in a wide range of skins (colorful and sometimes flashy coverings), designs and flavors. There are even convenient carry cases available. Multiple websites selling e-cigarettes show models in alluring poses casually holding their fashionable e-cig that just so happened to match the model's outfit. Some articles play to the smokers’ insecurity that smoking is socially unacceptable, promising that e-cig skins make smoking more fashionable and even a point of pride for smokers who were formerly ashamed to smoke in public.

More and more I hear participants in our program saying they bought the e-cigarette from a single commercial they saw on TV or through an ad they saw on the internet. I have found most people report the e-cigarette did not live up to their expectations and did not satisfy their cravings, similar to the findings of Quit Coach Janice McMillan, who reported on the topic in a blog post last spring. Although the e-cigarette is generally marketed to NOT be a tool to quit smoking, most participants I've spoken with had bought them under the impression that it WOULD be an effective tool to help them quit. Many of the ads I see seem to be talking out of both sides of their mouth. One particular brand clearly claimed it is not an effective tool to help you quit smoking but then went on to explain how powerful the withdrawal symptoms from quitting can be. If they were getting consumers to buy it as an alternative to smoking, why would they even be mentioning this? The ad seems to say “we can't claim this is effective in helping you quit…but we are going to tell you how hard it is to quit and associate our product to being the thing that will make the withdrawal better.”

Although I believe many people have every intention of making informed choices, all of us are liable at some point in our life to get misled into buying something that doesn't work or live up to their promises. I doubt people buy the e-cig simply because the colors will match their favorite outfit, but the glamorization of the device seems to push people who were previously on the fence about it to consider it. I must confess, back when cell phone covers were the newest thing, I once briefly considered buying a certain kind of cell phone just so I could change the covers. It seems ridiculous when I think about it now, but it shows how easy it can be to be impacted by advertisement. Some of the participants I talk to bought the e-cig without realizing they have just been misled by a very intentional ad promising a happier and healthier life.

So my challenge to smokers is this: before you end up into buying the next flashy e-cigarette (or, for that matter, any quit smoking device) ask yourself, what is it I want? What is it this product promises to deliver? What is their success rate and what do studies show?

Janice Milliman, Quit Coach, Service Delivery:

The next time you go to a movie you're less likely to see someone light up on screen. A recent study published in the CDC's Morbidity and Mortality Weekly Report concluded that the frequency of smoking in films has greatly reduced in the last five years, thanks to anti-smoking efforts including that of the Smoke Free Movies campaign.

The movie industry and its various studios have received a great deal of pressure to reduce or eliminate tobacco from movies. Since 2007 smoking has been one factor considered for a movie's rating, among others such as sex, violence and language. In 2009 Viacom voluntarily complied and no longer shows smoking in any youth-rated movie.

It is ironic and unfortunate that around the same time we hear the great news about less smoking in the film industry, we are also hit with the bad news of Michael Douglas's throat cancer. Throughout his career, Douglas has been known as a smoker—cigars in particular—and frequently played movie characters that smoked. In a 1998 interview, Douglas said, “I like cigars because it gives people a chance for pause. It's a ritual. It gives you a chance to prepare your thoughts and to think a little bit. I really enjoy smoking with other people because the feeling of camaraderie is so nice. It's a sign of a certain quality of life, an opportunity to take a moment to enjoy not only the cigar, but to celebrate."

It is a common misperception that "enjoying" a cigar isn't smoking, or isn't as bad as a cigarette. Not true. In fact, cigars are wrapped in tobacco leaves, and like cigarettes, have been treated with chemicals to more efficiently deliver nicotine (making them more addictive, in other words). Large, individual cigars can contain more nicotine than an entire pack of cigarettes.

According to The Campaign for Tobacco Free Kids, "While many believe that cigars are safer than cigarettes because cigar smoke is not inhaled, studies have shown that cigar smokers actually do inhale – even when smoking large premium cigars – thereby absorbing smoke into their lungs and bloodstream, and depositing cigarette smoke particles in their lungs and even in their stomachs and digestive tract. Because large cigars do not have filters, smokers are exposed to more tobacco smoke and, especially, more toxins in the smoke...Cigar smoking is the second most common form of tobacco use among youth. The most recent data available show that 13.6 percent of high school students currently smoke cigars (19.4% among boys; 7.6% among girls).

Moviegoers might see Douglas's cigar smoking film characters as macho, powerful, or even sexy. But the course of his life has now changed as he undergoes treatment for throat cancer. Having to deal with, and possibly die from cancer, isn't macho, sexy or worth all the cigar "enjoyment" in the world.

There’s still work to be done if today’s actors are to protect themselves, each other, and their audiences from the dangers of tobacco use. Despite the recent decline in smoking prevalence on the silver screen, 50 percent of 2009 movies still depicted some kind of tobacco use (kids films actually ranked even higher than 50 percent). The CDC has suggested a total smoking ban on movies – and at the very least, an immediate “R” rating for any film that depicts the use of tobacco.

Janice Milliman, Quit Coach, Service Delivery:

Smoking can be a drain on your wallet as well as your time. How would life be different if you had more time in the day and more money in your pocket?

Saving money is probably the second most common motivating factorparticipants have to quit tobacco. With the cost of cigarettes on the rise, smoking is becoming an even more expensive habit. The Campaign for Tobacco Free Kids recently posted a state-by-state cost-per-pack comparison. While the average cost in the U.S. is $5.00-6.00 per pack, smokers in some states pay significantly more (New York - $8.79, Washington State - $7.36, and Hawaii - $7.39).

Participants love the cost savings calculator on Web Coach, the Quit for Life web-based support tool. It's staggering how much money can be saved by eliminating tobacco. A participant I talked with today spends $6.00 per day for cigarettes, which translates to $180 per month. Some participants say they'll spend the money saved on necessities like utility bills or groceries. With the extra $180 per month, the participant plans to get a YMCA membership so she can exercise, feel good about herself, and reduce stress.

What many smokers are surprised to learn when they quit is how much time they also save. As a busy working mom I know there's never enough time in the day. A typical pack-a-day smoker would have an extra 50 hours per month after quitting. Shocking, isn't it! I almost didn't believe it myself until I did the math. Here's how I calculated that figure:

Smoking 1 cigarette = 5 minutes
5 minutes x 20 cigarettes = 100 minutes
100 minutes x 30 days = 3000 minutes
3,000 minutes = 50 hours

With the extra time participants say they'll be able to spend more time with their kids, exercise, or accomplish necessary household chores. Other participants say, "I'm getting a lot more done during my work day which has actually relieved some of my stress too."

Quitting smoking leaves more money and time for necessities, but also for indulgences. If you had an extra $180 and an extra 50 hours per month, how would your life be different?

Reed Dunn, Recruitment Marketing Manager:

When I heard Beyonce’s latest single “Why Don’t You Love Me” a couple of months ago, I was glad to hear some new tunes from my girl. “Single Ladies” had been stuck in my head for far too long, and a good Beyonce jam always puts me in my happy place.

Then I saw the new music video. Totally retro – Rosie the Riveter kind of stuff – complete with … you guessed it … smoking.

This is not the first time Beyonce has used tobacco in a music video. Her lesser-known “Diva” features the pop star lighting up a cigar in the final scenes and tossing the lighter back to ignite a dramatic fire in which she walks away. She also has taken promotional photos for tours and previous engagements where she prominently displays a cigarette holder.

Beyonce sells a lot of music. But she also sells her sexy image, and the use of tobacco in combination with these videos and promotions is sending a negative message. Smoking is never sexy, no matter how good it seems to look in the video.

There’s a lot of smoke and mirrors in “Why Don’t You Love Me.” I just wish there were more mirrors and less smoke.

Even more concerning about Beyonce’s latest mini-movie is that her character appears to be smoking as a result of the stress trigger. She’s visibly upset because nobody will love her, and mascara is running down her face – ever so perfectly, of course.

The Quit Coaches at Free & Clear understand the variety of triggers for tobacco, and stress certainly tops the list of reasons people give for wanting to light a cigarette. Beyonce making it look even more attractive on an international level is not helping the case that tobacco should be avoided as a stress relief mechanism.

Whether you believe it or not, tobacco use among celebrities has a strong influence. Studies have shown smoking in movies and on screen has a powerful influence on children and teenagers, accounting for 52% of adolescents who start using tobacco.

Not to come down hard on just Mrs. Jay Z - I am well aware many other musicians and celebrities are doing the same thing in their videos, promotions, and photo shoots. I am not giving a pass to those rappers, rockers, actors, and teen heartthrobs at all.

I am just saying it is time for this smoking trend to end. We are no longer living in the days of James Dean or Elvis Presley. Smoking is not sexy, no matter how short you wear your skirt.

Aimee Schiefelbein, Quit Coach, Service Delivery:

Last December, New York City became the first U.S. city to require stores to post 4-square-foot warnings showing the physical effects of smoking near tobacco displays and smaller ones near check-out counters. Last month, a few retailers and the three big companies (Lorillard, R.J. Reynolds, and Philip Morris) filed a lawsuit challenging the New York Board of Health, claiming the regulation violates the First Amendment by requiring tobacco sellers "to undertake graphic advocacy on behalf of the city." In other words, the tobacco companies don't want you to realize what you are doing to your body because if you had a visual, if you heard the words, and if you read the warnings enough times you might quit.

This spring, Massachusetts appeared likely to become the first state to force retailers to prominently display graphic warnings about the health impact of cigarettes. Yet while members of the Public Health Council expressed support in advance of the planned vote, state officials now wait to see what happens in the pending New York lawsuit. The delay keeps Massachusetts from setting a precedent that could significantly decrease tobacco sales.

Why would this tactic work? Imagine for a moment: you smoke a pack a day. Your mother died of lung cancer and you were just diagnosed with COPD (Chronic Obstructive Pulmonary Disease). Intellectually you know quitting smoking is the best thing you can do for your health. You have gotten so used to cigarettes being a part of your life that you hardly notice you get winded quicker than normal because this is "normal" for you. You think, I'll quit eventually, I just need to get through the stress at work. You have all the reasons in the world to stop smoking but there is only one problem; you don't know if you want to. Part of this is because you can't see the long term benefits you would gain by quitting. You can't open up your chest and see the damage you have done to your lungs. You read the surgeon general's warning on a pack of cigarettes that says "Tobacco Smoke Increases the Risk of Lung Cancer and Heart Disease" and to you they are just words. You think to yourself, we're all going to die eventually so why not enjoy myself?
 
Later that day you enter a convenience store and while standing at the counter to buy your next pack of cigarettes you see a life size picture of a darkened and diseased smokers lung. Suddenly you feel a pit in your stomach and you recognize that this picture you are looking at is what you are doing to yourself. There is nothing left to the imagination, there is no way you can deny it. It's not just words on a pack of cigarettes; this is you. You picture your children and grandchildren living on without you. You say to yourself, I will die soon if I don't do something. You throw the cigarettes back on the counter and walk out, proclaiming your desire not to be enslaved by cigarettes any longer.

I wish every state would display graphic images of diseased lungs, rotting teeth, and damaged brains with the urge to quit tobacco. Not that I particularly want to see this as I am going to pay for my gasoline at the convenience store; in fact, it turns my stomach to look at some of the sample posters. However...I do believe these graphic images could prevent that person who is buying their next pack to think about their choice before they follow through. I think of a teenager going in to buy their first pack, only to be confronted by the reality of how smoking could impact their appearance. I think of my family members who struggle with their tobacco addiction, hoping maybe it will encourage them to quit too.

Will graphic displays actually help? Only time will tell. I do know one thing; we are bombarded every day with smoking advertisements. It's about time we see more concrete education challenging the tobacco industry.

Jason Kalivas, Quit Coach, Service Delivery:

Not long ago, I had the great fortune to spend two weeks on vacation in Europe, visiting friends, seeing sights, playing tourist. But, while I was glad to be away, I couldn't leave my job entirely behind. Europe, after all, has a lot of smokers.

I spent the first half of my trip in Denmark where, the World Health Organization tells me, 36.1% of men and 30.6% of women smoke. I'm happy to report that the friend I stayed with is not part of that statistic, and I got to breathe easy in her apartment. Germany's on a similar curve, with 37.4% of German men and 25.8% of German women smoking. My German friend does smoke, but only outside.

By way of contrast, the CDC says that in Washington, where I live, 18.9% of men and 15.3% of women smoke. So, in other words, I was almost TWICE as likely to meet a smoker in Europe as I am at home. That hurts me as a tourist, when I'm trying to admire the architecture at the Brandenburg Gate but am distracted by the cloud from the tourists next to me. But it hurts the Europeans, too, since twice as many of them will suffer from smoking-related illness as my fellow Washingtonians. Imagine that, if you knew twice the number of people you do now with asthma, with heart disease, with cancer. What would that be like?

But I don't want to paint an entirely black picture. Things in Europe are getting better. Since 2004, at least 10 European countries enacted some sort of work-place or public smoking ban, including Denmark and Germany. Some of them are strangely limited; like Denmark's, which only applies to restaurants above a certain size (my Danish friend noted that small spaces will get even more cloudy, as smokers crowd inside), or Germany's ban, which is still new and police aren't enforcing yet, in the hopes that restauranteurs will enforce it themselves. They're not.

What's more significant, though, is what I haven't found statistics for - the number of people interested in quitting. My last time in Europe, four years ago, there were just as many smokers, but they were content with their habits and addictions. This time, I met a few people who were actively quitting and many more who were in what we'd call the Contemplation stage - thinking about quitting, making plans, refusing to buy cigarettes as a first step. I was happy to give some tips to the folks I met, and even happier that they asked for my advice, when I told them what my job is.

It's my hope that European governments and businesses will follow and strengthen these trends, in the same way that Free & Clear's state and business clients are doing, and fund tobacco cessation programs to help their people along.

In the meantime, though, I have to say it was a relief that I could come home, dump the contents of my suitcase in the wash and put on clothes that don't smell like smoke.

On the unseasonably chilly Thursday morning of July 1, 2010, Free & Clear employees brought warmth to Seattle streets in a spontaneous outburst of celebration - a celebration of the freedom from tobacco, flash-mob style!

The Freedom from Tobacco mob, made up of Free & Clear employees and Seattle Chorus volunteers, gathered at Westlake Center around 11:45am Thursday to sing and dance to an a capella version of George Michael’s “Freedom 90.”  The event began with a single voice shouting Michael’s lyrics, “I think there’s something you should know!” and ended with a chorus of voices shouting “Freedom from Tobacco! 1-800-QUIT-NOW!”

After weeks of undercover planning sessions and secret rehearsals, the Free & Clear Flash mobbers uncovered the choreography perfected by Recruitment Marketing Manager, Reed Dunn, who acted as co-creative captain and choreographer. “I feel like a proud dad right now,” Dunn said Thursday, reflecting upon the hard work put in by the dancers, videographers, and organizers over the past two months.

Free & Clear’s Freedom from Tobacco flash mob event was created to give employees an opportunity to celebrate the freedom they help others achieve, as well as to spread awareness of the state quitlines that we help operate on a daily basis.

"My favorite thing about yesterday was the sense of camaraderie the event helped to foster," said Quit Coach Duncan Shea. "We should be proud to work in an organization that is willing to shake off the dust, shun the suit and tie and focus on engaging our participants and (very importantly) employees as humans who need something different on occasion."

Of course we made sure to record the event - a video of the flash mob is now live on YouTube and has also been posted to our Facebook page. Please watch, comment, and share with your friends and family!

Happy Independence Day from Free & Clear.

Carly Palady, Quit Coach, Service Delivery:

I grew up with an uncle who worked as a backstage guitarist for Poison, and a father who painted houses for Pink Floyd. Needless to say, there was never a quiet moment in our family. Pink Floyd's 'Have a Cigar' blared on the old record player at home along with the "Dark Side of the Moon" album, in my car the moment I turned 16, during Spring Break in college, and even while cleaning the house when my husband and I bought our first home a little over a year ago. More than anything, having a cigar in our culture has for a long time signified the "down-time with the boys, a have-a-beer-and-puff-a-few-on-poker-night," kind of thing. Are the cigars today really addictive? Can we become addicted to nicotine just by taking a few puffs a couple times a month? Why even bring-up this issue?

I bring it up because of the echo of questions I have received from many of my husband's friends asking me if a cigar every now and then is really that bad. The other night, my husband and I were hanging out with friends, and the 15-to-20-year-old guys were talking about their intention to start a “Cigar Night” one night a week for the duration of the summer. My stomach did flip-flops.

As a Quit Coach, I’ve talked to countless guys in the 'new cigar generation,' between the ages of 20-30, that are attempting to quit smoking cigars, many of whom say the trouble started because they and their friends did not think it was a dangerous habit. Many justify cigar “puffing” by thinking, "It's not like you're doing it every day." Their cigar smoking started out with "maybe one a month over a couple hands of poker," and now, a few years later, it's an addiction.

When I brought up my concerns to the guys planning the Cigar Night, one 21-year-old said to me, "Summer's coming up. It's cigar season, you know? Is a puff off of a cigar, rather than a cigarette, really that addictive if it's every now and then, and just puffing?

His question sparked a research opportunity – I told him I’d find out and get back to him. For all you poker-night guys with the stogie, the following information is for you:*

1. Nicotine Addiction according to the New York Times: "Scientists have found that nicotine is as addictive as heroin, cocaine or amphetamines, and for most people, more addictive than alcohol," states the article "Nicotine, Harder to Kick than Heroin," published in the New York Times Magazine.

2. Cigars are wrapped in tobacco leaves, which ferment for 3-5 months. This process produces various bacteria in the paper, AND, even if a person does not inhale, allows the Nicotine (the addictive substance), to absorb into the lining of mouth as easily as spit tobacco, or chew. Also, because of the new fermenting process, the smoke from your cigar also absorbs easily into the lining of your mouth. You DO NOT have to inhale, to be addicted, and to absorb chemicals. In fact, more nicotine is absorbed from cigars, than from cigarettes. The body absorbs 1-2mg of nicotine from an 8mg cigarette. The average cigar has between 100-200 mg of nicotine, or the equivalent of smoking ONE PACK OF CIGARETTES! (ACS). Some Cigars have 444mgs of nicotine! THIS MEANS: 1 Large Cigar can equal 2.5 PACKS of CIGARETTES!

3. Even if you do not inhale, and just puff: "A new trend among cigar companies is to change the fermenting process to make cigar smoke easier to inhale. This same curing and fermenting process further enhances the flavor but also increases the levels of harmful ingredients." (ACS) So, the tobacco companies are not in the mood to give you a good time- they aspire to get you to inhale, get you addicted, and then hopefully introduce you to other forms of tobacco. Only 23% of the United States currently smokes. They are losing customers, and the casual cigar smoker is next on their priority list as a 'possible target.'

4. If you do not inhale, but puff with the guys, you will still get smoke in your mouth, and secondhand smoke. "Secondhand smoke from cigars contains many of the same toxins (poisons) and carcinogens (cancer causing agents) as cigarette smoke. Some of the toxins or irritants in cigar smoke include": carbon monoxide (found in car exhaust), nicotine, hydrogen cyanide (found in execution gas), ammonia (Windex), volatile aldehydes.

Cigar smoke includes the following carcinogens (agents that cause cancer): benzene, aromatic amines (especially carcinogens such as 2-naphthylamine and 4-aminobiphenyl), vinyl chloride, ethylene oxide, arsenic (rat poisoning), chromium, cadmium (McDonald's recently recalled their Shrek glasses over this chemical!), nitrosamines, and polynuclear aromatic hydrocarbons.

5. Lastly, "Cigar tobacco has a high concentration of nitrogen compounds (nitrates and nitrites). When the fermented cigar tobacco (leaf) is smoked, these compounds give off several tobacco-specific nitrosamines (TSNAs), some of the most potent substances known to cause cancer in humans. Also, because the cigar wrapper is less porous than cigarette paper, the tobacco doesn't burn as completely. The result is a higher concentration of nitrogen oxides, ammonia, carbon monoxide, and tar -- all very harmful substances."

Fortunately, when I called up my 21-year-old neighbor and shared this information with him, he agreed that a night of poker, darts, and good ol' barbecuing  with the guys was a much better way to spend a summer’s evening than a cigar and the risk of an expensive addiction – both in terms of his wallet and his health.

*All research was gathered from the American Cancer Society's research page on Cigar smoking, which draws from the Center from Disease Control, and other Federally funded institutions.

Janice Milliman, Quit Coach, Service Delivery:

Scare tactics generally don't work for changing behavior, at least not for long. So I'm not convinced that putting up graphic pictures of diseased organs is an effective anti-smoking campaign.

New York and Massachusetts were the first to institute this new tactic, designed to deter kids from picking up the habit. The New York City Health Department states, "Point-of-purchase warnings are one of the best tools we have to keep the next generation of New Yorkers from becoming addicted. By trying to suppress this educational campaign, the tobacco industry is signaling its desire to keep kids in the dark." Additional support for the ads comes from Eric Lindblom, with the Campaign for Tobacco-Free Kids in Washington. "To have something there to remind them how horrible, how addictive this is, to tell them how to get help, we think it will be a very, very powerful tool for counteracting the power of tobacco advertising at the retail outlet."

The ads I've seen are quite graphic, impersonal, and ugly, to say the least. I know my kids, age 7 and 10, would find them alarming. Teenagers will say they're "totally gross," but usually are more motivated to quit when they learn smoking causes wrinkles. Is this really the best way to motivate kids to quit, or better yet, never start? Maybe not. The ads I've seen don't show or describe how addictive smoking or nicotine is. While most people have heard gory details of smoking's effects, many don't know how physically addictive nicotine is when inhaled through a cigarette.

I can't help but draw some correlation to other ad campaigns involving healthy behaviors. Take a look at the got milk? commercials and ads. Do they depict an older osteoporotic and bent over woman who didn't drink enough milk? No. Do they show what your bones look like with osteoporosis? No. When we're young, we don't think those things will ever happen to us. That type of advertising just doesn't work on kids.

The got milk? ads encourage kids to drink milk by showing celebrities--positive role models--with a milk 'stash. My daughter would be more impressed with a poster of Justin Bieber and the healthy lungs he has, than a poster of the black lungs of some nameless person.

Ian Bubenik, Quit Coach, Service Delivery:

As of yesterday, new FDA guidelines state that cigarettes may no longer be branded as light, mild, or low. However, recent changes in product packaging show that tobacco companies will continue to try and trick smokers by color-coding packs of cigarettes, reaching out to people who will associate colors with the packs they used to purchase - people who believe “light” cigarettes are actually healthier to smoke than regular cigarettes. A 2008 UCLA study found that "light" cigarettes deliver nearly as much nicotine to the body as other kinds. They also likely deliver it to the brain just as quickly. In addition, the 4,000 chemicals that are in regular cigarettes are in light cigarettes – whether they are blatantly packaged as such, or merely hinted at with color.

In other words, switching brands or colors won't do nearly as much good for your health as quitting completely. It's important to recognize how the tobacco industry may try to influence the thought process of a smoker.

If you are a smoker, have you had any of these thoughts recently?

1. It's okay to smoke because I'm only smoking light cigarettes.
2. It's okay to have just one cigarette.
3. I need to reward myself for my day. I'll have a cigarette.

We're here to help smokers quit when they're ready to reframe those thoughts and give quitting a try. If you’re ready, feel free to call a Quit Coach at 1-800-QUIT-NOW or visit www.quitnow.net.