Smokers are starting to feel the heat in Louisiana. Soon they will be banned from lighting up in restaurants and other public places, except for free-standing bars and gambling outlets. With the new smoking law taking effect on Jan. 1, 2007, national and state smoking-cessation experts agree that another tool has been added to Louisiana's anti-smoking arsenal: public policy. The law, when combined with other state programs like the Louisiana Campaign for Tobacco Free Living, demonstrates that the state is making an effort to curb smoking, and, as one anti-smoking activist put it, "for once we're not 49th or 50th" like we are in most other instances."
The onus for giving up the habit is still on the individual smoker, but there is free or cost-reduced assistance currently available for those who want to quit as well as a new prescription drug for nicotine addiction.
Thomas Lotz, executive director of the American Lung Association of Louisiana, was surprised and elated when the smoking ban bill passed. He points out that Louisiana is one of only 17 states that has some sort of smoke-free environment law. Though he thinks the law should have included bars and casinos, he is convinced that having these kinds of laws in place will have a substantial impact on smoking in our state and nationwide.
"The Centers for Disease Control (CDC) are trying to get the smoking rates below 12 percent by 2010," Lotz reports. "We believe the only way we're going to get anywhere close to that lofty goal is to insert public policy."
According to the CDC, 22.5 percent of adults in Louisiana smoke, compared with 20.6 percent of adults nationally. Lotz says California, with its low percentage of smokers at 15.1 percent, is considered the model for effective public policy, which combines laws banning smoking and raising excise taxes on cigarettes. The excise tax, which adds to the price of each pack of cigarettes, is particularly valuable in preventing teens from becoming regular smokers. Since teens have less discretionary income, cigarettes may become cost prohibitive.
Lotz disagrees with the old argument that smoking bans somehow infringe on smokers' rights. As Lotz puts it, when you limit the number of places a person can smoke, it forces the smoker to actively contemplate choosing to have a cigarette.
"If you were going to light up in a restaurant that wasn't smoke-free, there would be nothing that would change your behavior," Lotz says. "But if there are 'no smoking' signs posted, then you have to get into the conscious level of the brain that says 'you can't smoke here.' You have to make a decision to either go outside and smoke or decide to put the cigarette away and smoke later, which ultimately reduces the number of cigarettes you're going to smoke."
Part of the money raised in Louisiana from tobacco excise taxes goes directly to the Louisiana Campaign for Tobacco Free Living (TFL). The organization offers several services that aid smokers, including the Make Yours A Fresh Start Family program, which trains physicians and other health-care professionals to assist pregnant women and new mothers in kicking the habit. The group also provides smoking-cessation grants, advocates anti-smoking policies and operates a toll-free 24-hour hotline, 1-800 QUIT NOW.
Jason Melancon, a spokesperson for TFL, says that in 2005, the hotline's first year, the call center received more than 6,000 calls from across the state, making it the third busiest quit-smoking hotline in the country. Counselors who are extensively trained in the science of smoking cessation are available at the call center seven days a week. The counseling staff supports smokers in their decision to quit and presents them with behavior modification techniques.
Michael Cummings -- chairman of TFL's scientific advisory board and chairman of the health behavior department at Roswell Park Cancer Institute in Buffalo, N.Y. -- thinks the hotline is a good start, but he also feels it is missing a vital tool for individual smoking cessation: nicotine replacement therapy (NRT).
"You need some basic behavioral counseling support -- someone who knows what they're talking about to give you advice on a quit plan," Cummings says. "That should be combined with the availability of FDA-approved pharmacotherapy. Those are the minimum standards. Nicotine replacements run from patches, gum, inhalers, lozenges, nasal spray and non-nicotine prescription products."
Cummings, who runs a Quit-Smoking hotline for New York State, says that when they added a free two-week supply of NRT for callers, along with behavior modification, the program's rate of smokers who successfully quit rose from 22 percent to 33 percent. TFL recommends NRT to smokers who call the hotline and would like to include a free supply of NRT products in their program, but their budget can't accommodate it.
"We'd love to do it, but we just don't have the funding," Melancon says. "Our program is funded at about a third of what the CDC recommends."
Plus, there is a bit of a Catch-22 scenario surrounding TFL's financial resources. The organization is paid for by tobacco excise taxes to the tune of two cents per every 36 cents of excise tax on a pack of cigarettes. As Melancon puts it, "We're funded by smokers, so our budget is dependent on how much people smoke in Louisiana."
Melancon admits there would be many more calls to the center if they offered NRT, and Lotz agrees.
"The No. 1 call I get in my office is: 'How do I get free NRT?' They don't want to pay for it," Lotz explains. "If we ever get to that stage in Louisiana where we offer free or even cost-reduced NRT, our smoking problem would probably drop by half. The best silver bullet we have now is NRT."
For those who need more than phone calls, TFL and the American Lung Association are teaming up to offer "Freedom From Smoking" clinics in local hospitals statewide. The clinics range in cost from $10 to $75 and are six to eight weeks long, depending on the individual hospital. The intent of the clinics is to take smokers from the early stages of contemplating stopping the habit, to setting a specific date to quit, then following up with participants to avoid relapse. NRT is recommended. These clinics are led by various health-care professionals such as respiratory therapists and nurses as well as trained volunteers.
While most smoking-cessation programs take weeks to complete, Laser Concepts of Louisiana claims on its Web site (www.laserconceptsla.com) that "in 20 minutes you can become smoke free!" The company uses a low-level laser, instead of acupuncture needles, to stimulate points on the skin to relieve stress and anxiety and to block cravings for nicotine. Although clients can get unlimited booster treatments for six months in the case of a relapse, a company representative, Dr. Michael Tran, says it usually only takes one treatment.
Tran administers the lasers. He says the treatments are 80 to 85 percent successful, according to surveys completed by his clients. The Food and Drug Administration (FDA) has not approved the use of lasers for smoking cessation.
Other smoking-cessation experts, Cummings included, are very skeptical about laser treatment claims.
"It's a crock. Completely," says Cummings. "There's no evidence that would affect withdrawal or change urges. They say it's a form of acupuncture -- that's why they call it laser acupuncture. It doesn't do anything physiologically. There's no FDA approval."
For the first time in nine years, a new FDA-approved non-nicotine prescription drug, Chantix, has become available. The drug works by stimulating the body to produce more dopamine, a biological chemical, which relieves withdrawal symptoms, and by blocking the rapid nicotine delivery. In studies conducted by Pfizer, the pharmaceutical company that manufactures Chantix, the drug outperformed Zyban, another non-nicotine prescription drug. Cummings says this new drug therapy should be used in conjunction with behavior modification techniques.
A nicotine vaccine, in which antibodies bind to nicotine and prevent it from entering the brain, is being researched, but it will be three to five years before the final results are known.
While Cummings believes Louisiana has made significant progress in the battle against smoking, he does add that if the settlement from the Gloria Scott et al. vs. American Tobacco Company had been paid, life for smokers in Louisiana would be much different. In this landmark case, American Tobacco Company, along with other tobacco corporations, was successfully sued for misleading the public, manipulating nicotine levels and targeting youth with advertising and marketing. In 2004, a jury awarded $591 million to be used for programs to help Louisiana smokers quit. The case is currently under appeal.
"With that $591 million, you could make a big dent in the smoking problem in your state," Cummings says. "Louisiana would be the Mecca for smoking cessation."