For many tobacco users, kicking the habit is easier said than done.

Serious health issues related to smoking, including asthma, emphysema, lung cancer, esophageal cancer and heart disease, make tobacco use a top target of health care providers.

Nicotine addiction is strong, however, so tobacco users who yearn to give up the habit use a number of tools — medication, counseling and alternative sources of nicotine, like gum, patches or electronic cigarettes — to help curb the urge to smoke or chew.

Even with all of those tools available, it often takes tobacco users more than one attempt at quitting to remain tobacco free.

Kicking the habit

For more than two-thirds of her life, 52-year-old Sue Larsen was a smoker.

“I started when I was like 14 years old, and then when I moved out of my parents’ house when I was about 19, I really started smoking heavily,” Larsen said. “I think I averaged a pack and a half a day.”

Over time, her smoking habit became intertwined with everything she did.

“It’s your reward. You tell yourself, ‘If I get the dishes done, I can have a cigarette,’ and I smoked a lot in my car. As soon as I would get into the car, I would start it, roll down the window and light up,” Larsen said, laughing that the habit always took priority over fastening her seat belt.

When she gave up the habit about six weeks ago, she went through something of a grieving process.

“I just lost my best friend. My cigarettes have been with me for 38 years, longer than my kids have been alive,” she said. “They have been with me through the good times, the bad times, everything. I have always been able to turn to my cigarettes.”

Larsen’s sister, Shelly Moore-Valley, had a similar experience when she stopped smoking about 10 years ago.

“I got really depressed when I quit, probably for about two months or so. They say women are more emotional about smoking,” Moore-Valley said. “For women, smoking is like their friend — when they are stressed out, they go smoke. When you quit, you have to find another outlet.”

Moore-Valley is 50 and smoked for about 20 years. When she decided to finally quit, she went cold turkey.

“It was just time. I just decided I was ready,” she said.

Both women had participated in the Midwest Cancer Alliance's six-week cessation program periodically offered at St. Catherine Hospital, which culminated with a quit date, at which point Moore-Valley quit for good.

Larsen didn’t fare as well.

“I quit for about three months, and then one day, I came home and my husband was out having a cigarette, and I just took a drag off of it and within 24 hours, I was back to smoking as much as I did before I quit,” Larsen said.

Moore-Valley said that is why she hasn’t allowed herself so much as one drag from a cigarette.

“I gripe about the smell and stuff, but if I were to stick one in my mouth, I would start right back," she said. "There are people who can just smoke once in awhile, but I’m not one of them."

Making the case

Merilyn Douglass, an advanced practice registered nurse at the Grow Well Clinic, 302 N. Fleming St., said tobacco use is at the top of the risk factor list for a number of diseases and illnesses.

“I really think if anyone can make a decision to help improve their life, that would be the area I would focus and work on,” Douglass said. “There’s just nothing good about tobacco.”

Douglass said when most people think about health issues related to smoking, lung cancer comes to mind, but she said oral or esophageal cancer is the “ugliest” disease that smoking or chewing tobacco can cause.

Douglass saw the effects of that type of cancer, as well as the effects of radiation for treating it, when she worked for Heartland Cancer Center in Garden City.

She saw several patients who underwent surgery to remove cancer from their mouth or tongue come away with deformities. Radiation treatments for oral or esophageal cancer oftentimes lead to a loss of saliva glands, making it difficult for a patient to swallow.

Some patients also lose their voices, she said.

While it is a harsh reality, Douglass said she commonly uses that example to persuade her patients to give up tobacco, whether it’s smoking or chewing.

To get her patients on the right track, Douglass usually starts by gauging their desire to quit, and then asks if they have ever tried to quit before.

“I ask them what happened so we can talk about what was successful and what didn’t work so well for them,” she said.

She also asks patients to pick a quit date, and then based on their own individual lifestyles, helps them determine which tools might help them give up their tobacco use.

“Those include medication, counseling or providing them with coping strategies to get through the nervousness or past the oral habit,” Douglass said. “I have found that the smokers who say, ‘I’m just going to quit,’ but don’t have the tools, those are the one who tend to relapse or fail. That’s why the idea of setting the date and having all those tools in place to help seems to be more successful.”

Douglass said some patients opt for medication to help them quit, so she prescribes Chantix or Wellbutrin, each of which have been demonstrated to curb the urge to use tobacco.

Larsen credits Wellbutrin for helping her quit.

“The urge wasn’t as bad as I thought it was going to be, and it worked somehow because I still haven’t smoked,” she said.

Douglass said Chantix is typically more costly than Wellbutrin, but also has a higher success rate.

“Chantix boasts that it has a 50 percent success rate. That’s a pretty good rate. Wellbutrin has a 25 percent success rate,” she said.

She said combining one of those medications with therapy and coping strategies greatly increases the likelihood that a patient will cease using tobacco products.

But the medications aren’t without side effects.

According to the website drugs.com, some side effects of Chantix include abnormal dreams, nausea, trouble sleeping, unusual tiredness or weakness, and mood or behavior changes like anxiety, agitation and restlessness.

Douglass reassures her patients that most of those symptoms only affect about 10 percent of people who use the medication. She said that those who are ready to quit see any tool to help them as a step in the right direction, and a more positive choice than continued tobacco use.

“There’s a common statistic that says one in three smokers die of either heart disease or cancer, so that’s not very good odds,” Douglass said.

In some cases, Douglass encourages her patients to use nicotine patches, gum or lozenges to help them ease into a tobacco-free lifestyle.

Despite the unknowns of electronic cigarette use, as it isn’t currently regulated by the Food and Drug Administration, Douglass said she supports her patients who use them.

“As long as they’re cutting down on their nicotine, I just keep encouraging them,” she said.

Vaping and e-cigarettes

Jack Chandler smoked almost two packs of cigarettes a day for 40 years and made several attempts to stop, using nicotine patches, which he was allergic to, and medications like Chantix. Nothing worked.

That is, until a couple of years ago, when he was introduced to vaping by his stepson.

Vaping is inhaling or exhaling vapor produced by an e-cigarette.

Some smokers, in addition to being physically addicted to nicotine, also are addicted to the habit of holding a cigarette in their hands or having chew in their mouth.

For Chandler, it was all about the smoke.

“I need to see smoke coming out of my mouth, but vapor comes out now,” he said, as he took a puff off his vaporizer.

Vaporizers resemble pipes but have a heating element that creates vapor from e-liquid, the fluid that fuels e-cigarettes and mimics cigarette smoke.

Chandler works for Nathan Morrison, owner of Vapor Wave, 519 W. Mary St. in Garden City. Morrison began vaping two and a half years ago, before he opened the store where he now sells vaping supplies.

“I smoked and dipped, a pack and a half and a can of Copenhagen a day,” Morrison said. “I definitely had the chemical addiction.”

When he discovered vaping, he had trouble finding e-liquid with high enough concentrations of nicotine in it to satisfy his nicotine addiction, so he learned how to make his own.

That’s how his business came into being in November 2013.

Vapor Wave sells about 300 flavors of e-liquid, including every fruit flavor one can imagine, as well as bubble gum, cotton candy, champagne and Irish Cream.

The e-liquids are made by Morrison and his staff in a lab inside the store, where people also can purchase vaporizers or electronic pipes.

While he doesn’t have any official way of tracking it, Morrison estimates between 1,500 and 2,000 of his customers have substituted vaping for smoking cigarettes.

He admits some of his customers have gone back to cigarettes.

“Quitting is not something you always do the first time,” Morrison said. “I know a lot of people who have come back and have been successful.”

Andrew Walter also works for Morrison and went from smoking a pack and a half to two packs of cigarettes a day to vaping over two years ago. He has noticed a big improvement in his health.

“I wake up, I don’t have coughing fits, the house doesn’t smell like smoke, my clothes don’t smell bad, my car doesn’t smell bad,” Walter said.

Walter’s current favorite e-liquid, which contains some nicotine, is called Gold Label and tastes like an actual cigarette.

Customers can choose the levels of nicotine, if any, they want in the e-liquid they purchase.

Chandler, whose e-liquid had a banana cream flavor, first started vaping e-liquid containing higher amounts of nicotine, then gradually weaned himself with lower and lower dosages.

“Vaping helped me lower my nicotine to zero,” Chandler said.

Other resources

The Midwest Cancer Alliance (MCA), an outreach division of The University of Kansas Cancer Center, is offering an eight-week smoking cessation program at St. Catherine Hospital in Garden City beginning June 22. 

Similar to the program Moore-Valley and Larsen attended, the program includes eight sessions that meet from 5:30 to 6:30 p.m. every Wednesday through Aug. 10 and provides free smoking cessation materials developed by the Mayo Clinic Nicotine Dependence Center. The program also offers education, cognitive-behavioral therapy, pharmacologic therapy and relapse prevention strategies. 

The program does not require individuals to be ready to quit smoking, but those with some level of interest in quitting are best suited for the program. For more information, contact Shawna Deal at (620) 272-2529.

Donna Gerstner, chronic disease risk reduction coordinator with LiveWell Finney County, said there are also online resources available for people who want to quit. One such resource is KanQuit!, a free program offered by the Kansas Department of Health and Environment that provides participants with support through trained advocates who help them create plans for quitting tobacco and fighting nicotine cravings.

For more information about KanQuit!, visit ksquit.org or call (800) QUIT-NOW (784-8669).

The Quitline is available 24 hours a day/seven days a week online or by phone. Telephone counseling is available in English, Spanish and 150 other languages.

Gerstner said LiveWell Finney County, a health initiative created by the Western Kansas Community Foundation and the Finney County Community Health Coalition, also has presented ACE, a youth tobacco cessation program, to Garden City High School students.

“Most people start smoking in their teens, so if we can get them before they even get started, then we definitely help that next generation,” Gerstner said, adding that the goal is to offer the program at other schools in the county.

According to www.kdheks.gov, the primary goal of ACE is to help students who are using tobacco to quit.

To accomplish this goal, there are six program objectives: increase the number of schools with policies that support student cessation as either an alternative or complement to existing administrative punishment; increase student awareness of free cessation coaching services available in Kansas; increase the number of tobacco-using students registering for cessation coaching; increase student knowledge of the health dangers of tobacco use; increase the number of schools with comprehensive tobacco-free school grounds policies; and increase the number of schools integrating tobacco prevention and cessation education into relevant classes.

Visit www.kdheks.gov for more information about the ACE Kansas Youth Tobacco Cessation Program.