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Prakash Chandran: Tobacco use is the leading cause of preventable disease and death in the United States. In New York alone, smoking kills 28,000 people annually and roughly 750,000 adult New Yorkers live with smoking-related illnesses. With all of the data and proof around the clear dangers of smoking, why is it so hard to quit and where do you even begin?

Here with us to discuss is Kristen Richardson, Director of the CNY Regional Center for Tobacco Health Systems at St. Joseph's Health. This is St. Joseph's Health MedCast from St. Joseph's Health. My name is Prakash Chandran. So Kristen, it's really great to have you here today. Thank you so much for being here. You know, I just mentioned some heartbreaking stats. Can you talk a little bit more about what the data is saying about smoking in the US and New York?

Kristen Richardson: As you said, about 20% of deaths in the US are caused by smoking. And every time I hear that number, I'm just absolutely blown away. If you think about that, that's one out of every five deaths is associated with smoking. In the US currently, about 17% of US adults report that they are smokers, New York state 14%. And you might think, well, that's great, because we're lower than the national statistics. But, unfortunately, if you look at the disparities in our region, so Central New York, Onondaga and Syracuse, it doesn't look quite as rosy.

So in particular, in Onondaga county, rates of smoking based on income and disability are significant in terms of the disparities. Folks who have an income less than $25,000 a year in Onondaga county report smoking at 42%. So again, much higher than that 14% for the state or 17% for the US. And in Onondaga county, while 18% of adults report that they are smokers, if you're looking at Syracuse, the city, almost a quarter, 25% of folks report smoking. So those numbers are really inconsistent and vary based on where your are.

Prakash Chandran: Yeah, and I do want to get into that, but first I wanted to ask, have these numbers and statistics that we're talking about declined. I imagine that with all the press and publication around the dangers of smoking, they have, but maybe you can speak to that for us.

Kristen Richardson: Indeed the rates of cigarette smoking have significantly declined over the past several decades. Unfortunately, those gains have really been inconsistent, meaning they've gone up and down. And then additionally, some groups are still smoking more heavily or at higher rates and therefore suffer disproportionately from those smoking-related cancers and other diseases. So those populations tend to be people who experience inequities in many areas of their lives. So that would include people who are at a lower socio-economic level, those without a college degree, American Indians, Alaskan natives, African-American black community, LGBTQ communities, those in the military and those with behavioral health conditions.

Prakash Chandran: So you kind of touched on this already, but I'd like for you to unpack a little bit more some of the disparities that we see in Onondaga county smoking rates.

Kristen Richardson: So in Onondaga county, overall, 18% of adults are current smokers. But when you look at some of the things that would cause inequity, things like income, or things like disability or mental health, those numbers become much more significant. So folks who have an income less than $25,000 a year in Onondaga county, 42% of those adults are smokers. If you're looking at folks who report poor mental health, their rates are 36.5%. So really significantly different than if you look at the overall just the county.

Prakash Chandran: Yeah, absolutely. So, you know, one of the other things that I wanted to mention is that you have been seeing a lot of people transition to e-cigarettes, especially over the past couple of years. As far as I understand, e-cigarettes pose significant health risks. So can you talk a little bit about those and also how many people use them?

Kristen Richardson: Unfortunately, many people, especially young people believe that e-cigarettes are less harmful than traditional tobacco products. And what we're finding is that is just not the case, as you said. So we know that e-cigarettes include exposure to a host of harmful chemicals and to very high levels of nicotine. So the aerosol components in e-cigarettes contain carcinogens, which are cancer-causing chemicals. They also contain volatile, organic compounds, heavy metals, things like lead that we know are very dangerous to ingest and then chemicals that are linked specifically to lung disease.

So in terms of the outcomes, it looks to be pretty similar to tobacco products. We obviously have more statistics and a lengthier period of time to be studying the effects of tobacco products. But we know that those ultra-fine particles in e-cigarettes are inhaled even more deeply into the lungs, so there's no reason to believe that the outcomes would be anything but negative.

Prakash Chandran: And I've always just wondered why are e-cigarettes and vapes so appealing to young people?

Kristen Richardson: Yeah, I think that e-cigarettes, again, are particularly concerning for young people because they're often the first product that they use. They're readily available because they're often sold at a lower cost. Additionally, many of the flavorings in them tend to appeal to young people in particular. Again, going along with that incorrect idea that many people have that they're less harmful when you have a candy-flavored product, it doesn't seem as scary, right? Unfortunately, that leads to, again, young people believing that they're not as harmful, getting addicted to nicotine and then potentially using those nicotine-containing products or tobacco products lifelong.

Recently, some research in New York state showed that, over the past 30 days, 22% of high school students said they use some form of electronic vapor product. So that's a huge number of students in our state, yeah.

Prakash Chandran: Yeah. Wow. You know, I do want to talk about how hard it is to quit, especially if you're addicted. But first I just want to address that, you know, just from the environment that we live in, people are going to do what they're going to do. So just, I guess, from a restriction or jurisdiction standpoint, what can we do to discourage tobacco use?

Kristen Richardson: Sure. So a number of things that we have found to be helpful obviously have been enacted over the years, although I will say that there's always seems to be these loopholes or catches that are these workarounds that we have to work on continuously.

So tobacco taxes is one of the most effective strategies we have found. New York state has the second highest tax on tobacco products in the nation. And we have found in New York state for that to be very effective. Cost for a pack of cigarettes in New York state averages $12.85, which that's another one of those numbers that just kind of blows my mind when I think about, if someone smoked a pack of cigarettes a day or a pack every two or three days, that's a lot of money. So those taxes help discourage especially young people from starting.

Things like clean indoor air acts. So not allowing people to be smoking in spaces where they can expose others to secondhand smoke, is protective for the folks around them, so it doesn't allow people to be exposed to the secondhand smoke, but additionally discourages people from smoking and that it provides less opportunity for them to have an area to do so.

Specifically looking at young people, there's youth access laws. So raising that legal age to purchase tobacco and nicotine-containing products is a way to decrease the number of teens and young people who become smokers.

Flavor restrictions is another. It's really well-established that those flavorings in tobacco and nicotine-containing products is enticing to young people. So that when we make that illegal or limit that, young people are less exposed.

Licensing laws, so requiring people who are selling tobacco and e-cigarettes to have a license to do so and prohibiting the sale of tobacco products in pharmacies reduces the availability and also allows for state regulation and oversight of those sales. And then point-of-sale laws, so retailers are prohibited in New York state from redeeming any kind of coupon or discount for tobacco products.

Prakash Chandran: You know, we know that people know that smoking isn't good for them, but they're addicted. So can you talk a little bit about why it's so hard to quit?

Kristen Richardson: With addiction, it's something that people are not able to just stop using whatever that product is, whether it's nicotine or some other with a singular attempt. It often takes many tries before that's possible. Healthcare providers though are in a really critical position to help patients to quit smoking, because when a patient teams up with their healthcare provider, they can be provided treatments that are known to be effective and proven. We also know that by teaming up with a healthcare provider in that way, long-term quit rates more than double. So folks are twice as likely to be successful when they work with their healthcare provider, with their doctor or their nurse practitioner or whoever they see for their healthcare. That's an amazing increase in their likelihood of success.

Prakash Chandran: And I think that people are generally aware of this, but can you talk about some of the benefits of quitting?

Kristen Richardson: Quitting smoking has amazingly profound impact on both your current and longterm health at any age. Even if you are a lifelong smoker, a heavy smoker, no matter where you are, there are a lot of different interventions that are known to be effective and proven to lead to smoking cessation. We know that no matter how long you've been smoking, when you do stop -- This is amazing to me whenever I think of this, I find the body to be quite fascinating. So I apologize for being a bit of a nerd here -- But it's amazing to me within 20 minutes after you stopped smoking, your heart rate and your blood pressure drops. Twelve hours later, the carbon monoxide levels in your blood, which have been impacted by your smoking, return to normal. And then after three months, your lung function has measurably increased. So again, it's amazing that immediate and long-term, we know bottom line quitting is the best way for smokers to lower their risk of disease, so lung cancer, cardiovascular disease, chronic obstructive pulmonary disease, and for sure the best way to protect their family and loved ones from the risks associated with secondhand smoke.

Prakash Chandran: Yeah, absolutely. So given all that, if someone is listening to this and they're ready to quit smoking, what should they do?

Kristen Richardson: So for help quitting, all of us at the Central New York Regional Center for Tobacco Health Systems at St. Joseph's encourages folks to get in contact with their doctor. Call your healthcare provider. If you are unable to get in quickly for that or if that's not the route you want to go, we encourage folks to contact the New York State Smokers' Quitline. And you can do that either by phone or online. The Smokers' Quitline can be reached at 1-866-NY-QUITS or at www.nysmokefree.com.

Prakash Chandran: And what about the New Yorkers that are vaping a lot? Do they have a resource? Like, is there someone they can call?

Kristen Richardson: So one resource still would be the Smokers' Quitline for folks who are adults. However, for younger people who are looking to quit vaping, the Department of Health has partnered with the Truth Initiative, which a national not-for-profit public health organization, and they've created a New York State-specific version of their text-based intervention. And it's called Drop The Vape and for New Yorkers between 13 and 24, who want to stop vaping, they can enroll in a free anonymous text messaging program by texting DropTheVape to 88709.

Prakash Chandran: Yeah. So let's say they enroll in this anonymous free texting support, Drop The Vape, what exactly do they get out of it?

Kristen Richardson: So enrollees receive interactive daily text messages that are tailored to their signup date or to their target quit date if they choose to set one. And messages would include things like just encouragement, motivation, some tips, some skills and self-efficacy building exercises and coping strategies to help them through the day-to-day. It also does direct users to the New York State Quitline, which provides free and confidential quick coaching for people who vape or smoke. They do also provide a starter kits of nicotine replacement therapy for folks who are eligible in New York state to help them break their dependence on smoking or vaping, because again, it is that nicotine addiction that you're treating.

Prakash Chandran: So just before we close here today, there might be people listening that are addicted to cigarettes or addicted to vaping, and they feel like there's no hope. Maybe they've tried to quit before, but it's just ingrained in their daily routine. Maybe they feel like it's too late for them. What might you say to people that think this way?

Kristen Richardson: The most important thing I think I would want to make sure that folks knew is that it's never too late. It's never too late to quit. They're never too far gone. No matter how many years they've been smoking, no matter how much they do smoke, there is always the potential to stop.

The health benefits of quitting are real no matter how long they've been smoking. And I think the biggest thing for people to realize is they don't have to do it all at once or immediately today. They can get help and working with their healthcare provider, working with the Smokers' Quitline, having those resources and those supports, they can be successful. And people need to have a plan and have that support before they go forward with the process. I think when people feel alone, when they feel like this is all on them, it's too overwhelming. They need to have that support with their healthcare team with some coaching through a program like the New York State Smokers' Quitline and success is always possible.

Prakash Chandran: Well, Kristen, I think that's the perfect place to end. Thank you so much for your time today.

Kristen Richardson: Thank you.

Prakash Chandran: That was Kristen Richardson, Director of the CNY Regional Center for Tobacco health systems at St. Joseph's Health. For more information, contact the New York State Smokers' Quitline at 866-NY-QUITS or go to the website nysmokefree.com. For younger people between the ages of 13 to 24 who are looking to quit vaping, please enroll in free anonymous text support by texting DropTheVape, all one word, to 88709.

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This is St. Joseph's Health MedCast from St. Joseph's Health. I'm Prakash Chandran. Thanks so much for listening.