If anyone out there still thinks smoking is harmless, consider this: The regional cancer hospital has a robust research program bent on learning more about why some people smoke, what damage the addictive habit can cause, and which forms of tobacco and nicotine delivery cause the most harm.
“What motivates us is where the health risks are,” said Andrew Hyland, chairman of the Department of Health Behavior at Roswell Park Comprehensive Cancer Center, and head of the center’s Tobacco Control Program. “We try to minimize those and ultimately reduce the cancer burden in our area.”
Hyland is thankful that smoking rates among all age groups have fallen since he joined the Roswell Park staff in 1995.
“Smoking was everywhere back then,” he said. “It was a radical idea that you would not be able to smoke in a restaurant, anywhere you wanted really. Social norms have really changed a lot.”
Hyland credits research and decades-long public health advocacy for the impact. Still, cigarette smoking remains responsible for about one in five deaths in the United States each year, more than 480,000 in all, according to the federal Centers for Disease Control and Prevention, including more than 41,000 resulting from secondhand smoke exposure. Smokers also continue to die a decade earlier on average than nonsmokers.
The roughly 100 researchers and smoking cessation specialists on the Buffalo Niagara Medical Campus work in a region where smoking rates in several counties – including Erie and Niagara – are higher than the state and national average, and average health outcomes and longevity worse.
Smoking is the leading cause of preventable death across the U.S., according to the federal Centers for Disease Control and Prevention.
Roswell Park looks to change the smoking dynamics regionally and worldwide in a tobacco market that now includes “a wider range of products that span a continuum of risk,” Hyland said.
The cancer center plays headquarters to Smokers’ quitlines for both New York State and New Jersey. It offers smoking cessation outreach and education programs. Its scientists and medical staff also are involved in some of the most important research in the nation when it comes to the changing tobacco industry.
The PATH Study
“First and foremost, we know cigarettes are incredibly lethal,” Hyland said. “When people ask me about these other products, I say, ‘Let’s not forget that cigarettes cause an incredible amount of damage.’”
Why do people start to smoke despite clear warnings against the dangers? Why do they continue? How do they try to quit? What impact does their decision-making have on their longevity?
Hyland is the scientific leader of a study that started in 2013 and will track the tobacco-related behavior of 49,000 people in the U.S. and Canada for at least a decade. Subjects age 12 and older have agreed to answer questions about their tobacco use, as well as provide annual blood and urine samples, as part of the Population Assessment of Tobacco and Health (PATH) study.
“We’ll have a better understanding, for example, about what happens when someone switches from cigarettes to e-cigarettes, or quits cigarette smoking altogether,” Hyland said.
The U.S. Food and Drug Administration Center for Tobacco Products, which has the power to regulate tobacco use and sales, is funding the study through at least 2023. Other research institutions involved include Dartmouth College, the Truth Initiative, Rutgers University, the Medical University of South Carolina, and the universities of California, San Diego, Minnesota and Waterloo (in Ontario).
Maciej Goniewicz, a researcher in the Tobacco Research Laboratory at Roswell Park, has become an international expert on the effects of using electronic cigarettes.
The FDA announced in September they will consider banning flavored chemical liquids that fuel e-cigarettes after a Roswell-led study, the first of its kind, concluded that nicotine levels in a relatively new “pod” class of e-cigarettes – by far the most popular variety – nearly match those of traditional combustible cigarettes.
Goniewicz led the study of more than 500 e-cigarette users aged 12 to 21, published in the journal Tobacco Control, which represented the first reported independent findings on nicotine exposure among youths who use the systems.
“A number of studies on e-cigarettes really come down to trying to understand under what conditions might e-cigarettes be beneficial for public health,” Hyland said. “We know they have fewer toxins than cigarettes but they’re not toxin-free. We also know that there are some potential downsides. So what’s that boundary point? Then we can promote the things that would be more beneficial to public health. Nobody thinks kids should be using tobacco products or e-cigarettes ... but there’s lots of suggestive evidence that they might help adults quit smoking.”
Roswell also conducts studies on retail tobacco advertising. One current study involves sending tobacco users equipped with eye-tracking technology into retailers to determine what advertising images catch their attention, in what order, and for how long.
“There is some evidence to suggest that when kids are exposed to that advertising in the retail environment, it makes them more likely to start smoking in the future,” Hyland said. “The thing that’s more immediate is those adult smokers looking to quit. The cues and triggers they get from that advertising make them less likely to try to quit and make their quit efforts a little bit less successful.”
Hyland praised CVS and Wegmans for ending tobacco sales in their stores. He would like to see other pharmacies, in particular, follow suit.
"If I had to pick one other product to highlight, that's a water pipe, or hookah," Hyland said. Those aged 18 to 24 are just as likely to use a hookah as smoke a cigarette, he said, and both pose similar health risks.
"The smoke in a water pipe is filtered through water. There's this perception that this is safer, which is not true. There are loads of toxins in the smoke – and there's reason to think that it could be even worse because there are massive levels of carbon monoxide that get emitted into the air, off-the-charts kind of levels."
Hookah tobacco comes in flavors that attract users and mask the harshness, Hyland said. Pattern of use tends to be more infrequent, so that poses less risk than daily cigarette use – the same of which can be said about pipes and various types of cigars, which Roswell also studies.
Still, Hyland said, "If you're burning tobacco, it's going to be bad for you. That's what generates the majority of toxins: the smoke. The more you ingest – the more frequently you use, the more days – the more harmful it is."
Hyland warned, however, that studies have begun to show that health risks are driven by how long you use a tobacco product, and less so by how much of it that you use.
“So if you smoke 20 cigarettes a day and cut down to eight cigarettes a day, you might think that you're doing yourself a benefit,” he said. “There's some truth to that but if you continue to smoke, even at that lower level, you're still realizing most of that risk.
"We see that with e-cigarettes in particular, with people who think, 'I'll use an e-cigarette and just cut back on my cigarette smoking. Now I don't have to quit cigarettes. I feel good about that.' It's really counter-productive. If e-cigarettes are going to be used, users should be off cigarettes completely."
How to quit
Smoking cessation specialists “absolutely know how people quit smoking,” said Andrew Hyland, head of the Tobacco Control Program at Roswell Park Comprehensive Cancer Center. A good strategy includes:
Nicotine replacement therapy: Gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco.
Health providers: Doctors and others can talk strategy, underline the importance and help you find help.
Evidence-based services: Those include the New York State Smokers’ Quitline, based at Roswell Park (866-697-8487 or nysmokefree.com). This clearinghouse touts trained specialists who can help you create a plan to stop smoking, walk you through the quitting process, and plug you into a support program should you so choose.
“This is the first line of where people should be looking but, at the end of the day, whatever you have to do to get off of the cigarettes, do it,” Hyland said.
On average, it takes about 10 times to quit completely, Hyland said. “You’ve just got to keep at it. Each time you try to quit, it absolutely is a learning experience for the time when you ultimately are successful. Don’t beat yourself up. Gear up and get your plan for the next time.”
The Great American Smokeout – on Thursday – is a great time to quit. Click here for more tips on how to do so.
Twitter: @BNrefresh, @ScottBScanlon