Quitting Tobacco: A Facebook Live Q&A

Quitting smoking is hard. We know, we’ve helped over 1 million people quit. Find out what works and how to get started breaking nicotine addiction.


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Alyssa Paschke: Hello and welcome to our live Q and A this afternoon about quitting tobacco. My name is Alyssa Paschke and today I'm going to be speaking with Dr. Thomas Ylioja. He is the clinical director of the health initiatives program at National Jewish Health, which includes our QuitLogics and QuitLine programs. Today we're just going to be talking about different tips and best practices for starting to quit smoking. So if you have any questions out there in the audience feel free to type in a comment and we'll try to get to as many as possible.

Alyssa Paschke: So to start, thanks for speaking with us this afternoon. I just wanted to say that a lot of us out there know the dangers of smoking and that there are some serious health risks, so could you just go into detail a little more about why quitting is so important for our health?

Thomas Ylioja: Sure. Tobacco is really one of the worst things you can do for your health. It's the number one cause of preventable death, of disability. Every year about a half a million people actually die from tobacco-related diseases and millions more will be diagnosed with a chronic disease. So, for anybody who smokes, the best thing they can do to protect their health is to quit.

Thomas Ylioja: Everybody kind of knows the big things that smoking causes like cancer or cardiovascular disease, heart problems, lung problems.

Alyssa Paschke: Sure.

Thomas Ylioja: But many people don't know that it actually causes all kinds of diseases, including diabetes, reproductive problems and even bone fractures.

Alyssa Paschke: Wow, I didn't know all of that either, so that's really important information. So, if someone out there is thinking about quitting or they know someone who smokes that's considering quitting, what are some of the reasons people come to services like we have here to quit?

Thomas Ylioja: So one of the biggest reasons of course is health because people start to notice that they're having effects from using tobacco. It takes about 20 to 30 years for people to really start feeling the effects of tobacco, and a lot of times by then the damage has been done to the body. So it's really important to quit as early as possible. A big reason of course is health. Smoking is also pretty expensive. A lot of people talk about the financial pressures that are associated with smoking. They're trying to save money.

Thomas Ylioja: Along with health comes sort of all those things that health allows you to do, like having the energy to play with your kids, with your grandkids, to be able to take your pet out for a walk, those kinds of things that people start to notice that smoking is interfering with. So, that's one of the big driving factors.

Alyssa Paschke: Gotcha. So anybody that reaches out to quit smoking, maybe it's their first time they're trying to quit, or maybe it's down the road several attempts, what are some of the first steps that they should take?

Thomas Ylioja: Well the first step is always making the decision to actually quit. That doesn't mean it has to be tomorrow but it could be. It could be a New Year's resolution. People decide on New Year's Day they're going to quit. It can also be six months in the future. There's really no time frame on when you have to quit, but just making the decision to quit is the first step.

Thomas Ylioja: Then the next step is to kind of build your commitment to actually going through with a plan to quit smoking. That includes thinking about what it's going to be like, reaching out and getting support from some people, including calling the quit line or getting in touch with some other type of counseling service. For some people it's using medications. It's really just kind of planning out what you're going to do to be able to actually make the quit attempt successful.

Alyssa Paschke: So setting a date is really just kind of that first step.

Thomas Ylioja: Setting a date or even just deciding that you're going to do it. Setting a date is really good because it holds you to a goal that you have. So setting goals, rewarding yourself, tracking your progress. Those are all important pieces. But also letting other people know that you're trying to quit so that they can help you along the way, whether it's if you're having a craving and need to reach out to talk to somebody, or just having somebody who knows that you're trying to quit so they can ask you how it's going.

Alyssa Paschke: Yeah, and provide some support. So, that's great. So can you describe, let's say someone has decided they want to quit. They've gone through some of those steps. They've reached out to people for support, but what are some of the common reasons or factors in why someone might fall off and use tobacco or smoke again even though they've planned to quit?

Thomas Ylioja: Quitting isn't easy. Changing any behavior is not the easiest thing, otherwise we would all do it. We have to remember that nicotine is really highly addictive. It hits the brain in ways that make the brain feel like something really good has just happened.

Alyssa Paschke: Right.

Thomas Ylioja: That causes a really strong addiction. For a lot of people, when they're trying to quit, they get this urge. Their brain is telling them, go out and use that thing that makes you feel really good. So it's really easy to give into that urge if you don't have the support in place to help you out.

Alyssa Paschke: Okay. Yeah, that makes sense. Factors like stress or other triggers throughout the day, or different behaviors that you associate with using tobacco.

Thomas Ylioja: Right. So a lot of people do say that stress is a big factor in why they've either failed in a previous quit attempt or they've gone back to using tobacco. There's a couple pieces to that. One is that nicotine withdrawal feels a lot like stress. So, when people don't have nicotine in their system, they feel more stressed.

Alyssa Paschke: Okay.

Thomas Ylioja: Then another part is when they use tobacco, they're a lot of times using it to relieve stress. So they're in a stressful situation. They go out and they have a cigarette and it helps to reduce the stress, but it's doing two things. One, it's reducing the nicotine withdrawal, and the second thing is it's giving them a break.

Alyssa Paschke: Right, and that pleasure center feeling and rewarding yourself.

Thomas Ylioja: Right. Part of what people have to do then is figure out new ways of dealing with stress, planning on how they're going to deal with the urges. It's also other things like after a meal, or first thing in the morning, or different things like that. So it's finding new routines, it's finding new strategies, building a whole routine of a smoke free life is a big part of living.

Alyssa Paschke: Sure. So I guess, if someone did plan to quit and they were going through it for a while, they kind of fell off, what's a good strategy that they could use to get back on track with their quit plan?

Thomas Ylioja: It's important to remember that going back to tobacco use or going back to smoking is a normal part of quitting.

Alyssa Paschke: Sure.

Thomas Ylioja: Quitting is a process. It's not just a one time event. So, for some people, that means that they're able to do it really fast. Everybody has a story about somebody who just quit. They just decided they were going to quit and they did it. Most people, including myself, I was a former smoker, it took me a solid year of quitting and starting and quitting and starting before I finally figured it out. Part of that is just learning. So you're learning what kinds of things trigger you to want to use tobacco, and then putting in new things to avoid those situations, avoiding the triggers. So part of it is just remembering to learn from each time you slip, putting that into your quit plan so that next time you're not as triggered by whatever it was the first time.

Alyssa Paschke: Sure, and starting new routines seems like a good way to do that.

Thomas Ylioja: Absolutely.

Alyssa Paschke: I just wanted to pause real quick and see if any questions have come in from the audience?

Speaker 3: Yes, we have one question. Are there different suggestions for
quitting vaping versus tobacco cigarettes?

Thomas Ylioja: Really good question. Vaping is a tobacco product. It has nicotine in it. The FDA considers it to be a tobacco product, so the same kinds of strategies will work for quitting vaping as will work for quitting tobacco use generally. It's not really clear on how you might use medications to help with quitting electronic cigarettes or products like electronic nicotine devices. We have protocols at the QuitLine for how we will help somebody with switching over to better forms of nicotine like nicotine replacement therapy, patches, gum or lozenges rather than using the electronic devices.

Alyssa Paschke: Great. Thank you for the question. So, to keep going, I wanted to dive into the QuitLine program a little bit more. Could you describe a little bit about what it is and just how it helps people in general?

Thomas Ylioja: Yeah, so a big part of quitting, as I said, is getting the support from other people to help you build your quit plan, to kind of track your progress, and to move through the process of quitting. So a big part of what the QuitLine does is we have coaches who are really highly trained, in helping people who are trying to quit, build a quit plan, stick to it, build in the goals, build in the rewards. They're really there just providing supportive ears so there's somebody who can listen to you. They won't ever judge somebody about what their quit plan is. They're really ther. They know that when somebody is trying to quit it's really an individual personalized decision that they're doing and we're there to support them along their journey.

Thomas Ylioja: The other thing that the QuitLine offers is medication. So we offer nicotine replacement therapy and patches, gum, and lozenges to people who are eligible. We operate quit lines in several states, so each state sets different eligibility criteria for who can get medication. As long as you meet the eligibility criteria ... For example, in Colorado, as long as you're an adult, you'll probably be eligible for at least four to eight weeks of NRT through our program.

Alyssa Paschke: Does that all just mean over 18.

Thomas Ylioja: Over 18. Yeah, 18 and over I should say.

Alyssa Paschke: Okay.

Thomas Ylioja: Medications for quitting smoking are FDA approved for adults.

Alyssa Paschke: Okay, great. So along with the QuitLine, could you describe kind of the process, someone calls in, is there multiple coaching session or do the representatives here in our call center reach out to individuals on a consistent basis? How does the flow work in the coaching?

Thomas Ylioja: Good question. Essential what will happen is if somebody calls 1-800-QUITNOW, so everybody kind of knows that number. There's a lot of media around it. They'll be routed to our call center if they're from one of the state quit lines that we operate. So Colorado, if you call the 1-800-QUITNOW phone number, you'll be routed to us. We'll do a really quick registration process, your name, your date of birth, that kind of thing. Then we'll do a really quick intake that asks about your tobacco use history, and then we'll get you over to a coach.

Thomas Ylioja: Once you get to a coach, they'll really start working with you to understand why quitting is important, what your quit plan might be, what strategies you have, what supports you might already have that you haven't been thinking about, how to use them to help quit smoking. Then they'll usually offer the nicotine replacement therapy as well. Our standard program is five coaching calls. We really try to get people to do at least three coaching calls. The research suggests that at least three coaching calls significantly increases your chances of quitting for good. So we're really working to try and get people all the way through the program, but if they can complete at least three calls we're really happy for them.

Alyssa Paschke: Great. So do you have any information for us about kind of the success of the program since it's been implemented. I'm not sure if you have specific numbers on how many people kind of flow through the program, but just kind of overall success and how that compares to someone out there trying to quit on their own.

Thomas Ylioja: Yeah. So a couple of pieces to that. We've helped well over a million people in their quit attempts. So what we do at the quit line is we offer two pieces of really the best strategies that are proven to help people quit. That's providing support, so that's our coaches. They work with people to really provide them with the support they need to get through the process and then also with the medications, with nicotine replacement therapy.

Thomas Ylioja: The best way to actually quit is to use both the supports, so the coaching, and the medications together. Doing those together you can double your chances of successfully quitting for good.

Alyssa Paschke: Gotcha. That's great. So what about cost? If someone calls in, are there any associated costs? I'm not sure if medical insurance or anything is involved with that, but just was wondering what the costs are.

Thomas Ylioja: Yeah. The best part about our program is that everything that we deliver to people who call us is free.

Alyssa Paschke: Oh great.

Thomas Ylioja: We don't charge our callers for any of the coaching, for any of the medications. We sometimes have partners. We will partner with health plans to deliver their tobacco cessation coaching for them. But again, under the Affordable Care Act, tobacco cessation medications and coaching has to be given for free.

Alyssa Paschke: That's great. So I just wanted to see if any other questions have come in.

Speaker 3: We have a question from Sam. It says, what's the best way to motivate a loved one to quit?

Thomas Ylioja: Oh, good question Sam. How to motivate a loved one to quit is really important. Again, part of what we do and why it's successful is that we don't nag people to quit. We're really helping them to figure out what their reasons for quitting might be and trying to figure out what strategies they might want to use. You can call us actually and we'll give you more information. So you can call the QuitLine on behalf of somebody and ask them for what strategies we might recommend. We can talk to you about what kinds of things your loved one might be struggling with and think about some plans or strategies that you might want to use with them.

Thomas Ylioja: We can send you information, a package of materials, or you can go to our website. Every state has their own website. In Colorado, it's coquitline.org, but there's a lot of really good materials on there about what our program is and how it helps, and some strategies to help people who are trying to quit.

Alyssa Paschke: Great. Any other questions?

Speaker 3: Here's one. What advice do you have for parents who might have a teen smoker?

Thomas Ylioja: Probably a big part of that now is teens who are vaping. There's been a lot of news media around juuling. People are using, especially teens, Colorado has a really high rate of teens using electronic cigarette products like JUUL®. So there's a few things. One is we will help people who are as young as 12 at the QuitLine, so they can refer them into us for us to help them. We'll do kind of the same thing. We'll help them set goals, think about how they want to get rid of nicotine from their life, which is really important.

Thomas Ylioja: If parents are using tobacco themselves, one of the best ways is to actually quit themselves and show their teens how difficult that is and talk to them about it. We're here to help parents as well, so parents are trying to quit smoking or quit using electronic nicotine products. We can help them with that as well.

Speaker 3: We have a question from Rhonda that says, is the QuitLine available in all 50 states?

Thomas Ylioja: There are quit lines available in all 50 states and all the provinces in Canada and Puerto Rico. They're around the world. They're in Australia, Europe. There are quit lines everywhere, and that's one of the best things. There are places where people can go to get support to quit smoking, to quit using tobacco, and  generally speaking, at least in all the states in the US, for people who are eligible for service, it's free.

Speaker 4: How do they find the quit line number for their state?

Thomas Ylioja: So the good thing in the US is that 1-800-QUITNOW is the phone number in every state. The federal government actually subsidizes that phone number so that's their phone number and they will route you based on your area code. If you're like me and you come from a different state to Colorado, and you have an out of Colorado area code, you may get routed to a different quit line to begin with but they'll transfer you over the state based on your residence.

Alyssa Paschke: Great. There's also a lot of information online as well, like you mentioned, in Colorado. It's coquitline.org, but the national number is probably best for anybody who's out of state. Any other questions? Okay. Well I just wanted to touch again on  teen smoking because I know that's a big topic that's happening now. Can you just talk a little bit more about why the age requirement changed from, I believe it was 15 down to 12 for the quit line services.

Thomas Ylioja: Yeah. So there was some policy changes in the Colorado state level where they reduced the age of which teens have to get parental consent to engage in coaching around substance abuse, and tobacco is part of that. So, because they changed their age eligibility to 12, the Colorado quit line, the state department of public health environment asked us to also reduce our age of eligibility to 12. We do have other states that also have lowered the age eligibility down to 12. We are prepared to work with people who are that young. We don't provide medications to people who are under 18, again, because they're only approved for adults, but we will work with them to make a plan on how they're going to get nicotine out of their life.

Alyssa Paschke: Great. Yeah, that's probably to ... if you're starting early, definitely quitting early would be super important as well.

Thomas Ylioja: Yeah. Nicotine is really damaging to the adolescent’s developing brain. It has long term impacts on cognition, and learning, and memory, and those kinds of things. So we really want to help people live the best life they can, and that means getting nicotine out of their life.

Alyssa Paschke: Great. Well I'm glad that that service is absolutely available
right now. So I wanted to just wrap it up. I think we're ... oh, one more
question. Sorry.

Speaker 3: Yes, here's a question from Angela. Are there any tips for a couple attempting to quit together?

Thomas Ylioja: Really important to quit together. One of the biggest factors in people going back to smoking is if they have a loved one in their home who also smokes. It can be challenging. I won't sugar coat it there Angela. Both people can use the QuitLine. Both people should access the same resources, getting the individual counseling, using the medications. Use the ones that are going to be right for you. Don't use each others. Look for other sources of support as well. You may be relying on each other for support, but also remember to pull in other people to keep supporting you along that journey as well.

Thomas Ylioja: Most people in the United States who have ever smoked have quit. So anybody else who's trying can do it as well.

Alyssa Paschke: Any other questions? Nope? Okay, well I think we're almost out of time, so I wanted to wrap it up. I really appreciate you providing us with all this really useful information. For anybody out there who's watching, again, I just wanted to remind you can call 1-800-QUITNOW in any state, like Dr. Thomas Ylioja said, you can be routed to the quit line in your state. If you're in Colorado, you can visit .coquitline.org. If you'd like any other news and information from National Jewish Health you can sign up for our monthly newsletter on our website at www.njhealth.org. Thank you so much for watching.

Thomas Ylioja: Thank you.

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