Why Is Anyone Still Smoking?

It’s the leading cause of preventable death across much of Europe and North America, responsible for the loss of 41 million lives in the US, UK and Canada between 1960 and 2020. These staggering statistics beg the question: Why is anyone still smoking? Dr. Lynn Kozlowski, renowned expert in tobacco use and nicotine policy, is Professor Emeritus and Dean Emeritus of Community Health and Health Behavior at the University of Buffalo. A founding member of the Society for Nicotine and Tobacco Research, he has contributed to four U. S. Surgeon General reports on smoking. Host Alec Baldwin speaks with Dr. Kozlowski about how perceptions of smoking have evolved over the years, the dangers of smoking traditional cigarettes versus vaping, and his advice on what he believes is the best way to quit. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:34Speaker 01

  Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln Original Series, on the iHeart Radio app, YouTube, or wherever you get your podcasts.

• 1:05Speaker 02

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• 1:38Alec Baldwin?

  This is Alec Baldwin, and you're listening to Here's the Thing from iHeart Radio. These days, a pack of Marlboros could set you back $13. If you actually want to smoke them, you've got to stand in a designated area 25 feet from the building's entrance, and the package will contain the most dire warnings of illness and death. Overcoming these hurdles requires a true commitment to the habit. It's enough to ask, who is still smoking? My guest today, Dr. Lynn Kozlowski, is here to shed some light on this question. Dr. Kozlowski is an expert on tobacco use and nicotine policy,

• 2:21Alec Baldwin?

  and is professor emeritus and dean emeritus of Community Health and Health Behavior at the University at Buffalo. He is also a founding member of the Society for Nicotine and Tobacco Research and has contributed to four U.S. Surgeon General's reports on smoking. I wanted to know if Dr. Kozlowski was ever tempted to pick up a pack himself.

• 2:46Speaker 04

  I certainly tried to be a smoker. So, in high school, I experimented. In college, I had roommates who were devoted, heavy smokers. I tried to smoke. There was no moral sense that got in the way. I just kept getting sick from smoking, so it wasn't worth it to me. But, so it's fair to say, I was tempted. I tried. I experimented with packs of cigarettes and pipes and cigars and so on, but I never became a regular smoker.

• 3:14Alec Baldwin?

  I smoked, never heavily, never habitually. I'd smoke usually when I was shooting a film, because filmmaking is such a boring process. You work for 10 or 15 minutes, then you go away for an hour while they get ready for the next angle and so forth. And I smoked out of boredom on the sets of films and so forth. And whenever the project was over and I went home, quote unquote, I stopped smoking because the people in my life wouldn't tolerate that.

• 3:39Speaker 04

  So when you were smoking, how early in the morning did you have your first cigarette?

• 3:43Alec Baldwin?

  Probably in the afternoon. Like, when I was doing films and shooting, I didn't have the taste for it. And one thing I did for a period of time, I smoked cigars to give up cigarette smoking. I would be on the road, shooting films, traveling, and I'd be making films, and I could smoke cigars there unrepentantly because my wife was miles away. And I'd fire up, and there was a period when I was smoking, you know, three of these big fat boomers every day. Well, I want to ask you, in terms of, I can probably guess what the order is in terms of the number of people who are consuming the following, but I was wondering, from your research and from your work, are they all equivalently bad in their own way? And I'm talking about cigarettes, pipes, cigars, chewing tobacco.

• 4:26Speaker 04

  It's very different in terms of harms.

• 4:28Alec Baldwin?

  Right.

• 4:29Speaker 04

  And cigarettes are at the pinnacle of risk. And cigars, if you inhale them, or pipes, if you inhale them, are also pretty risky. So inhalation is a key issue with tobacco products.

• 4:41Alec Baldwin?

  Right.

• 4:42Speaker 04

  The key factors I think about in talking about different types of tobacco use. For it to be popular, it's got to get nicotine to the brain. Secondly, it's got to taste good. It's got to be pleasant for the user to be using. Often, non-users don't like it, but users like the taste of it and smell of it. And third, it's got to be a convenient product. So if you go back to the 1800s, when the US was a largely rural society, the most popular form of tobacco was smokeless tobacco, chewing tobacco. Wet snuff, moist snuff. It got nicotine to the brain, it tasted good to the user, and it also didn't burn the barn down in an agrarian society. So that was a real advantage. But at the end of the 1800s,

• 5:27Speaker 04

  something called the germ theory of disease became common, and public spitting got outlawed in major cities all over the country. So spitting became very inconvenient, and it's hard to use chewing tobacco if you don't have an opportunity to spit. In the late 1800s, cigars started to become popular.

• 5:46Alec Baldwin?

  But also, I want to interject that back in those days, there were spittoons everywhere.

• 5:50Speaker 04

  Oh, yeah.

• 5:50Alec Baldwin?

  There were places to spit.

• 5:51Speaker 04

  There's a wonderful account by Charles Dickens, who visited the United States when chewing tobacco was king, and he was grossed out by all the spitting that he saw. But General Ulysses S. Grant, former President Ulysses S. Grant, died a very public death in 1885 of jaw cancer. It was, The New York Times was reporting daily on the state of his health. And people got afraid of cigars, because here you have this major figure dying of a very painful jaw cancer. That set the stage for cigarettes. Cigarettes started, if you will, as a safer kind of smoke. It was, think of it, it was so safe, you could inhale it easily.

• 6:34Speaker 04

  So, in the early 20th century, that was the first time that there was a national marketing of cigarettes. Previously, there had been local brands of cigarettes. But then they became national brands like Camel and Lucky Strike and Chesterfield. And cigarette use started to take off dramatically. So physicians in the 1920s almost never sought a case of lung cancer in their patients. In the 1930s and 40s, they started to see lung cancer. And this is coincident with the rise in cigarettes. Now, marketing, modern marketing, emotionally based marketing, imagery based marketing, became important in the 20th century.

• 7:15Speaker 04

  And cigarettes was the biggest funder of advertising agencies. And there was no better marketer of cigarettes than movies. Companies were paying to get their products placed in movies. Now, I know, Alec, you were interviewed in the 2016 Toronto International Film Festival, and you talked about major actors who influenced you. And you spoke about their colorful stylized performances. I'd like to mention four people that you mentioned, in order. Jimmy Cagney, James Cagney. You mentioned his performance in White Heat. In that performance, Cody Jarrett doesn't touch a cigarette. Turns out that Cagney disliked cigarettes. He had been forced to market them in early films.

• 8:00Speaker 04

  Cagney was a pipe smoker. Cagney died at 86. Eighty-six years old, keep that in mind. Let's go to the next actor you mentioned, Humphrey Bogart. I would say that, for Humphrey Bogart, a cigarette was a kind of supporting actor in his performances. I mean, you can't imagine many of his performances without a cigarette being a player in it. Humphrey Bogart died of esophageal cancer at age 57. 57. Next, you mentioned Gary Cooper, who died at 60. Gary Cooper advertised Lucky's Strikes in the 1930s. In one of his print ads, he says, "Ever since switching to Lucky's, my throat has been in fine shape."

• 8:44Speaker 04

  Now, if you think of it, that's a bit of a health claim, that an irritating product is a more dangerous product. Clark Gable, you praise Clark Gable's performance in The Misfits. Two days after The Misfits wrapped, Gable had a heart attack and he was dead 10 days later, at age 59. Now, that comparison is just meant to get one's attention. That's not scientific data. But you've got Cagney dying at a ripe old age of 86, and these major figures dying much too young. Let me talk a bit about the percentage of smokers in the United States and how that rose. In 1940, young men at about 20 years old,

• 9:27Speaker 04

  80% of young men were smoking in 1940. 80%. If you jump to the most recent data provided by the CDC in 2021, looking at a similar age group, people 18 to 24, only 5% are smoking. So, think of it. When 80% of people are doing it, that's a very trendy activity. But the social pressures have changed. Smoking has become much more stigmatized. And, and the bans that have become commonplace on indoor smoking in government buildings in, in many states, that adds to the inconvenience of smoking.

• 10:08Alec Baldwin?

  Dr. Lynn Kozlowski. If you enjoy conversations with experts in public health, check out my episode with Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases.

• 10:23Speaker 05

  There's no other disease that can actually kill you by a respiratory route, that is, that people, half of them don't have any symptoms. When we realized that, it became clear that we really needed to do masks. But yet, people who want to be ultra-critical will say, "Oh, he flip-flops." If you don't change your mind with the evolution of the new information...

• 10:49Speaker 05

  Then you are really guilty of something that's not good.

• 10:54Alec Baldwin?

  To hear more of my conversation with Dr. Fauci, go to hereisthething.org. After the break, Dr. Lynn Kozlowski gives a risk assessment for smoking traditional cigarettes versus vaping.

• 11:14Speaker 00

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• 11:45Speaker 01

  Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by rising star Sienna Spiral. What is so fascinating to you about impermanence?

• 12:06Speaker 06

  Everything about us, everything we do is temporary. And I just got terrified of that. You know, what we do with our time and how I feel like the way the world is today and how fast-paced it is and how much we don't even acknowledge anything around us. How I felt temporary to the people around me and how that made me scared and how much I wanted to last and make an impact on people and I guess to change the way I looked at things and to change myself and to change how I guess I approached everything in my life. It's important that things are impermanent because nothing would feel special and enjoying, you know, learning to love with knowing it's not going to last.

• 12:40Speaker 01

  Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.

• 12:49Speaker 07

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• 13:29Alec Baldwin?

  I'm Alec Baldwin and you're listening to Here's the Thing. There are currently an estimated 28.3 million people in the United States who smoke, which incredibly is nearly 12% of adults. The figures can seem inexplicable when put up against the fact that smoking manufactured cigarettes is the leading cause of premature death in much of Europe and North America. And smoking-related diseases killed 41 million people in the U.S., U.K. and Canada between 1960 and 2020. Dr. Lynn Kozlowski has spent his career studying the deleterious effects of smoking.

• 14:11Alec Baldwin?

  Working with these statistics must be no easy task. So I was curious to learn how he found his way to this line of study.

• 14:21Speaker 04

  My doctoral dissertation, which was conducted in 1974, looked at the relationship between coffee drinking and nicotine use. Coffee drinking is cigarette smoking. So I had an early contact with cigarette research. And my mentor at Columbia University, Stanley Shacter, a very noted psychologist, I would say he was my beloved mentor and he was a very heavy smoker. And he got into smoking research initially because he was interested in the issue of, why does smoking seem to calm people down when they're in stressful circumstances?

• 14:57Alec Baldwin?

  What was his answer?

• 14:58Speaker 04

  Well, that's actually kind of interesting because what we looked at, I was involved with those studies, that it turns out that under stress, your urine becomes more acidic and you excrete more nicotine from your blood. And so that under stressful circumstances, more nicotine's leaving your bloodstream. And so you need to smoke more to maintain your doses of nicotine. And I would say the chapter, a very heavy smoker, smoked as soon as his eyes opened in the morning, he knew he was addicted to cigarettes. And so I learned a lot from him.

• 15:35Alec Baldwin?

  So throughout your career, smoking has been the bulwark of what you've done, correct?

• 15:40Speaker 04

  Yeah, largely. My first job was at Wesleyan University, and it was harder to do the kind of smoking research that I wanted to do there. And then I got a job in Toronto at the Addiction Research Foundation to become head of their behavioral research on tobacco use. And that was a perfect environment where I had physician colleagues, pharmacologist colleagues to collaborate with. So in Toronto, that was the focus of my research.

• 16:08Alec Baldwin?

  So when you start the Department of Health Behavior at the University of Buffalo, I mean, one would assume even somebody that doesn't know much about the infrastructure of academia and the protocols of academia, you don't just walk up and go, hey, I got this idea. What were you working on that they thought was important?

• 16:27Speaker 04

  Well, I think the reason I got that job is that I had long experience as a department head at Penn State. I'd been department head for a Department of I B Hareful of Health at Penn State for over a decade. And so that experience as an academic administrator, as well as having significant research credentials, was what wanted them to recruit me. They were trying to get the new School of Public Health and Health Professions accredited as a school of public health, and they needed to create that new department. And in terms of public health, tobacco use has been one of the major public health issues of 20th century.

• 17:08Alec Baldwin?

  For me, the arc of smoking, I mean, I remember when I first came into this business, people lit cigarettes on the set of the TV show at 30 Rockefeller Plaza. We'd be on the set of a soap opera that I was doing. The first job I had was one of the old school soap operas, and I could name a handful of people who were smokers. And those people who were non-smokers didn't really say anything. They didn't really complain. Now, you wouldn't hesitate to scold someone who's smoking publicly. I'll never forget, there was this line that someone said, they said, "The only outlaw smoking, only outlaws will smoke. You're really going to alienate them in a very strong and very kind of aggressive way."

• 17:46Speaker 04

  So in the 1980s, at the Addiction Research Foundation in Toronto, clinicians who were working with people with cocaine dependencies and opioid dependencies, in their clinical sessions, they would often share cigarettes. The clinician and the patient would share a cigarette. Now, after a decade's work, that stopped. That notion of it was appropriate for a clinician to be sharing a cigarette with somebody with alcohol or opioid problems, that was recognized as a noto, but in 1980, it was commonplace.

• 18:21Alec Baldwin?

  So for me, the next turn of the wheel, if you will, is these labels on cigarettes, which have become increasingly dire over the years have gone by. I mean, they might as well say, you know, if you smoke, one of your eyeballs is going to fall out. I mean, they make it as stark and as dramatic as they can. When those first came on, I recall that the tobacco industry fought it tooth and nail. They didn't want those warnings on those cigarette packs. Did that have a big effect on people, the warning labels?

• 18:47Speaker 04

  Yeah, in general, yes. I would say the United States is behind many other places in the world in terms of warning labels.

• 18:56Alec Baldwin?

  Where are the warning labels more effective, as far as you're concerned?

• 18:58Speaker 04

  Canada, the United Kingdom, they have graphic images.

• 19:03Speaker 04

  Of diseases and

• 19:05Alec Baldwin?

  A set of lungs.

• 19:06Speaker 04

  And so on, and so much so that there was, I'm sure it still happens in Canada, that when they first came on the pack, some smokers were buying little pouches or slip cases that they could put their packs in so they didn't have to look at the image of it. But no, there's no doubt that the strong warning labels do help remind smokers that it's a problem to be smoking.

• 19:31Alec Baldwin?

  Yeah, I mean, I was always wondering because I thought, here's a set of words on the side of a box, and you've got a cigarette in your hand, and you're just somebody who, smoking is as natural as breathing or drinking water. If you're a real smoker, it just doesn't even occur to you. And here's a bunch of words on a box. How much of an effect is that really going to have? But it had some effect.

• 19:49Speaker 04

  Yeah, actually, there've been, in the US, there've been some, I would call, negative effects to some of the warnings. You asked about the risks of different products. It turns out that smokeless tobacco products, like moist snuff, the thing you put between your cheek and gums, that's much, much less dangerous than cigarettes.

• 20:06Alec Baldwin?

  Really?

• 20:07Speaker 04

  Think about it. If you're not getting stuff in your lungs, that alone is going to knock off the majority of things that kill you from smoking. Lung cancer and respiratory diseases are the majority of things that kill you from smoking cigarettes. And with the first warning labels on smokeless tobacco products, included a warning label that the industry supported. And it was, "This product is not a safe alternative to cigarettes." Now, it turns out that the way consumers interpreted that warning, "This product is not a safe alternative to cigarettes", they interpreted it as saying they're just as dangerous as cigarettes. When in fact, they're much less dangerous than cigarettes. Let me give you a good example of that. I would bet you would think

• 20:52Speaker 04

  that oral tobacco like that is a major cause of oral cancer.

• 20:56Alec Baldwin?

  I would assume, yeah.

• 20:58Speaker 04

  Turns out cigarettes are a bigger cause of oral cancer than those products.

• 21:02Alec Baldwin?

  Why?

• 21:03Speaker 04

  Well, just because of the nature of the toxins exposed in the mouth and so on. So the people don't know that.

• 21:09Alec Baldwin?

  I would have assumed otherwise, yeah.

• 21:11Speaker 04

  Yeah, and it turns out there are gross misunderstandings about the risks of different tobacco. For example, If you're talking about vaping products, e-cigarettes, that public understanding of the harms of vaping products has gotten more mistaken and more mistaken. That a few years ago, about half of people were saying that vaping is equal in harm or more harmful than cigarettes. It turns out that 83% of smokers think that vaping is as dangerous or more dangerous than cigarettes.

• 21:46Alec Baldwin?

  And why do they think that?

• 21:47Speaker 04

  I'm not entirely clear why they do, but they're wrong. It turns out that, again, when you get all of the carcinogens out of smoke, and that's what you're taking to your lungs, you do your lungs a big favor. Now, still an addictive product, but it's much less dangerous than cigarettes. So it's, it, there's a lot of studies now showing that it's a useful tool for adult smokers to give up smoking, to switch to nicotine vape.

• 22:15Alec Baldwin?

  Well, I want to get to vape right after this next point, which is that, so when the next advancement, if you will, we have the labels, then you have the outright banning of smoking. You start having smoking is not allowed

• 22:28Speaker 04

  In many places, yeah.

• 22:29Alec Baldwin?

  In increasing number of places, and people have to go into a special room. Then they get rid of those rooms, they disappear. They had them at airports for a while. Here's the smoking room, and you saw everybody in a cloud of smoke inside some little chamber. I mean, I've lived in New York, you know, nearly all of my adult life, and you see people go from, they go outside, and they want to smoke so bad, and it's pouring rain, it's freezing cold, they're hunched over. Then they drive them away from the entrance of the building. The signs appear everywhere. You cannot smoke within 100 feet of this entrance or 50 feet. So people have to go down. They have to walk down to the side of the building and blah, blah, blah. I mean, we've made it as difficult as possible in many parts of the country. Is it having an effect?

• 23:15Alec Baldwin?

  Is smoking in a downward trend now in the 2023?

• 23:19Speaker 04

  Oh, definitely. I mean, it's a whole bunch of things that have ganged up on smoking to diminish it. I mean, the indoor smoking rules have had a big effect. Remember when there were television ads for cigarettes?

• 23:32Alec Baldwin?

  Of course.

• 23:33Speaker 04

  There was a period when there was an equal time law that you could get anti-smoking ads on TV. It turned out those anti-smoking ads had a big effect on discouraging smoking, so much so that the companies were kind of happy to get off TV because that equal time anti-smoking ad would go away.

• 23:54Alec Baldwin?

  Then that battle was over, yeah. Now, obviously, in the business I've worked in for several years, there's been a lot of push to cut smoking, that it was a bad idea and a poor role model for a lot of kids. But that idea, the social stigma, you know, in Hollywood and TV, you know, pretty much banning it. I mean, if you're going to smoke a cigarette, you better be playing Edward R. Murrow in order to be smoking a cigarette in the scene. But in my business, that had a profound effect, I think, which is they wanted us to be role models in some way.

• 24:26Speaker 04

  And you were role models. But let me say something about a watershed in the United States, and that was the 1964 Surgeon General's report, which came out declaring smoking as a cause of cancer. Within days of the 1964 report being released, Carlton cigarettes were advertised for the first time. Carlton were ultra, ultra-low tar cigarettes, 1-milligram tar, 0.1-milligram nicotine. And if you will, that was the start of an ultra-light, light boondoggle that came about right after the 1964 report, that people

• 25:08Speaker 04

  were thinking, I'm better off smoking a light cigarette than a full-flavored cigarette, I'm better off smoking an ultra-light. And it turned out, it took years of research to show that that wasn't the case, and that one of the key features in creating a 1-milligram tar cigarette is to take the filter and punch a whole bunch of holes in it. They'd make it 80% diluted with air. So when the smoking machine takes a puff on the cigarette, it's drawing in 80% air with each puff, and that's diluting it. Now, what does a human smoker do? With a cigarette that's 80% ventilated. Some push it a little bit further in their mouth and their lips cover the vents, and that gets more smoke to their lungs. Or they take bigger puffs, or they take more puffs.

• 25:53Speaker 04

  So, in the early days of this tar derby in the 60s, 70s, and 80s, standard smoking machine tests were conducted by the government. And it turned out that people don't smoke like smoking machines. They take bigger puffs if they want to, they take more puffs. And I had colleagues who did research on smoking machines that show you could have one cigarette that in a standard run in a smoking machine gave you 17mg of tar, one seven, 17mg of tar. But if you adjusted the machine to simulate a heavy smoke, big puffs, lots of puffs, you could get 70mg of tar from the same cigarette. So that, one of the key issues with cigarettes

• 26:37Speaker 04

  is that what you get from it depends how you puff on it. It's not like a pill, it's not like, with a bottle of beer, if you don't miss your mouth, you know how much alcohol you get from a bottle of beer. With a cigarette, it's a race between what's going in the air and what's going in your lungs. And people can compensate, and they did compensate.

• 26:55Alec Baldwin?

  Right, there's games you can play with smoking.

• 26:57Speaker 04

  And so that people from, with ultralight cigarettes could get as much as they were getting from full flavor. And that's actually one of the reasons why light and ultralight designations were removed. But people still know what a light and ultralight is because they can feel it from the taste of it, they taste different. I'm wondering if I could say a bit about cigars.

• 27:16Alec Baldwin?

  Please.

• 27:17Speaker 04

  The 64 report came out, and a few days later, the president of the American Medical Association was on the Today Show, saying, "If you can't give up cigarettes, you might switch to cigars or pipes, you'd be better off." Because, in the 64 report, cigars and pipes got a clean bill of health. It wasn't seen as a major cause of disease. And the reason for that was that the epidemiology at the time was based on people who were so-called "primary cigar smokers." They'd never smoked cigarettes, they'd only smoked cigars. And those "primary cigar smokers" tended to not inhale cigars. So-called "secondary cigar smokers," people who were cigarette smokers, switching to cigars.

• 28:00Speaker 04

  They tend to maintain the habit of inhalation. Uh huh. And that's a key issue in terms of the health risk. The other thing about cigars, as you know, smoking big cigars sometimes, that sometimes it could take as much as an hour to smoke a big cigar. Yes. You could smoke six cigarettes. Hopefully it does take an hour. You could, you could smoke six cigarettes in the same interval. Yes. So when somebody says, I just smoked two or three cigars, you gotta consider how big are those cigars? How much puffing are they doing? Are they inhaling? And to the extent they're inhaling, to the extent they're getting a lot of tobacco in their lungs, it's not a harm reducing product to be smoking cigars. The other thing about inhalation, I actually did research on this when I was in Canada,

• 28:45Speaker 04

  people can reliably tell you whether they inhale cigars or not. They know whether they inhale or not.

• 28:54Alec Baldwin?

  Tobacco expert Dr. Lynn Kozlowski. If you're enjoying this conversation, tell a friend and be sure to follow Here's the Thing on the iHeart Radio app, Spotify, or wherever you get your podcasts. When we come back, Dr. Lynn Kozlowski tells us what he believes is the best way to quit smoking.

• 29:23Speaker 08

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• 29:54Speaker 01

  Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by Miguel.

• 30:12Speaker 09

  That last year, finishing that record was the hardest experience of my life. To find your creativity and to believe in yourself, because somewhere in the midst of it. I stopped believing that my voice mattered and that I could find it again. That's a challenge. I was not feeling very confident creatively, only, again, defiant in my belief that what this is about is express something honest, say something honest.

• 30:48Speaker 01

  Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.

• 30:57Speaker 10

  This is Shirley Strawberry from the Steve Harvey Morning Show. Buy smart, drive for less, and trade for more. That's Toyota affordability. And it starts with a great deal on an all-wheel-drive Camry, Corolla Cross, or a Corolla Sedan with the latest features and tech. Or test drive a spacious Grand Highlander or adventure-ready RAV4. And with so many hybrid models available, you can enjoy longer trips without all the stops. While Toyota's legendary resale value means you could get more at trade-in, get a great deal today and a great value tomorrow. Shop toyota.com for deals and details. Toyota, let's go places.

• 31:41Alec Baldwin?

  I'm Alec Baldwin, and you're listening to Here's the Thing. The data is sobering. Smokers who start early in life and keep smoking can lose up to a decade of life expectancy. I wanted to know, for those who were interested, if Dr. Lynn Kozlowski thought there was a best time in their lives to quit smoking?

• 32:02Speaker 04

  As early as possible. Right. Thirty is a benchmark. If you can do it by thirty, and I think that needs to be promoted more widely. Right. Prabhat Ja, an epidemiologist at the University of Toronto, recently reviewed a lot of epidemiological studies and has come up with a very simple summary of the health risks of smoking. And the evidence shows that at least one in two smokers dies prematurely, and they lose, on an average, ten years of life. And if a smoker can stop at age thirty, they go back to the longevity expectations of a never smoker. So if you can get people to stop at age thirty, that's great. At age forty, it's ninety percent Of a return to being a never smoker.

• 32:45Speaker 04

  At age 50, you gain six years of life if you start smoking. And at age 60, it's four years of life. I think there are a number of tools that people have to help them quit smoking. But I want to emphasize that those are tools. And I think of changing a flat tire on a car. A lug wrench is a very useful tool for changing a flat tire. But it's a lot of work to change that tire. Any of these tools you might use. Forrenaclean is a prescription drug you might use to help quit smoking. Nicotine replacement products, patch, gum, lozenges, nicotine pouches, vaping. They're tools.

• 33:25Speaker 04

  And it's an important thing for the smoker not to be satisfied with just cutting down a bit on smoking. Your goal should be to try to get off smoking completely and switch to those other products. And then, once you're securely off smoking, you can think about getting off those other products.

• 33:43Alec Baldwin?

  So to the extent you can say, what do you think in the marketplace right now, would you say is among, not the best, but among the best ways to quit smoking?

• 33:52Speaker 04

  I think for older adult smokers, vaping products are among the best ways to quit smoking. That they can provide the most satisfactory substitution for cigarettes. The other thing about quitting smoking is that repeated attempts, smokers get better at it. For example, I've known people who've given up smoking. They've been off for several months. They go to a gathering where others are smoking and they think, I could just have one cigarette. They do, they end up there wrong. So the next time they try to give up smoking, they know better. They know better than to be fooled by the illusion that I could just have one. And then I think there's also a kind of no more nice guy effect, that people trying

• 34:32Speaker 04

  repeatedly give up, they finally dig their heels in and have learned from what did and didn't work. I mean, I had one person tell me, I tried this and I was off smoking for a year. And I said, "That's a pretty good technique to try again if you are off smoking for a year."

• 34:49Alec Baldwin?

  Why don't you renew that subscription for another year?

• 34:51Speaker 04

  But, so I think it's important for smokers to keep at it. Now, the other thing about the health risks of smoking, the cardiovascular risks diminish very quickly, within months, once you stop smoking. The cancer risks are a bit of a different animal. The process of smoking is causing some cancer-related issues to develop and it takes longer for you to get the benefit of stopping smoking with respect to cancer. But, the key message is, stop as soon as you can.

• 35:23Alec Baldwin?

  We'll get to vaping now, which is, I mean, to me, I find vaping just kind of, just exploded. And I live in New York and, you know, street level New York is nothing but food shops, coffee shops, and places to buy smoking paraphernalia and vaping. I was in a restaurant last night with my wife and a couple of friends. It's a very nice restaurant, actually, one that we go to all the time in our neighborhood. And some young guy was there, probably 25, in his late twenties, and his girlfriend. And he whips out a machine, you know, whips out the device, starts vaping in the restaurant, which I don't think he was necessarily, that wasn't permissible. But he goes in and vapes. And I thought, you know, what was the advent of vaping? Meaning, who developed this kind of stuff?

• 36:04Alec Baldwin?

  And to explain to people who think they know what vaping is, vaping is a delivery system for like a liquid form, or some kind of other kind of form of nicotine. And they've extracted all the bad stuff for most of it?

• 36:16Speaker 04

  Yeah, the key thing is that the tobacco's gone in vaping. And you can vape all kinds of drugs, like cannabis with a vaping product, if you want to, as well. But, the key advantage is that there's no combustion, that you don't get the smoke and the tar and the glop, and you don't get the complex ingredients arising from burned tobacco. First products were developed in China, but there've been a lot of different generations of products. And, it's interesting, I mentioned some of my college roommates smoked. And, the heaviest smoker I ever knew was my college roommate who smoked unfiltered black tobacco Golwas. You could hear him when he walked into the room, just by the sound of his inhalation,

• 37:00Speaker 04

  the "shhhhh," you could hear him walking into a room, he took such a big drag. I learned, years later, that he had switched to e-cigarettes, so I called him up. And said, you know, how could this be? You were the heaviest smoker I ever knew. And he said, I love him. Actually, it was interesting. He could indulge in his sense of connoisseurship by picking the right kind of vape product and the right kind of flavor he liked. But he was off cigarettes. And so that was very impressive to me, to have that one testimonial from an old friend who was able to switch to vape, said he was the better for it.

• 37:36Alec Baldwin?

  So is it safe to say that in terms of all the components that you regard and the metrics that you regard, that vaping is much safer than cigarette smoking?

• 37:45Speaker 04

  I have no doubt about it.

• 37:47Alec Baldwin?

  Right.

• 37:47Speaker 04

  Cigarettes, inhaled cigarette smokes are at the pinnacle of risk. Smokeless tobacco products are much less dangerous than cigarettes. Nicotine vaping is probably a little less dangerous than smokeless tobacco, nicotine pouches. You're really at quite low levels of harm. I don't want to suggest that any of these products are health foods, but they reduce risk dramatically.

• 38:10Alec Baldwin?

  But vaping hazards hazards as well?

• 38:12Speaker 04

  Well, the anti-tobacco forces were very quick to jump upon lung problems that were being caused by vaping. They even gave it a name, E-Valley, of electronic vaping lung disease. It turns out that that arose largely from people smoking black market cannabis vapes that were polluted with toxins, that did cause lung problems. In other countries, it was a non-issue that once they got rid of that black market vaping product, it hasn't been an ongoing issue. But the field has continued to latch on to this, oh, you can get lung problems from

• 38:54Speaker 04

  vaping based on this bout of lung disease a few years ago. But inhaled cigarettes are at the pinnacle of risk.

• 39:02Alec Baldwin?

  They're the highest threat.

• 39:03Speaker 04

  And vape takes a big jump down. And things like a pouch that have no inhalation at all are much, much less risky.

• 39:12Alec Baldwin?

  I will say that in my lifetime, borders a couple of different realities as far as smoking is concerned. My father was a cigarette smoker. He was a pipe smoker. He quit cigarettes to smoke pipes. He died at the age of 55 of lung cancer. My smoking, and I will say that with, unless I was completely inebriated, unless I was completely shitfaced on some drugs and alcohol. Which was certainly accompanied by a good amount of smoking, my drug use and drinking. But when I was in my right mind and I smoked, I knew it was wrong every time I did it. Every single time I put a cigarette in my mouth, I said, "This is wrong. I shouldn't do this." I remember saying to myself, "Okay, this is a stupid idea." Click and I'd light up.

• 39:53Speaker 04

  Yeah, even a long time ago, people called cigarettes coffin nails.

• 39:57Alec Baldwin?

  Right, right. But I was gonna say, I'm many years in sobriety, I'm clean and sober, 37 years. And the only reason I mention is because this idea of addiction, of finding a way to cure the addictive mechanism, the addictive synaptic, whatever it is that happens in human beings, as it relates to smoking, as it relates to eating, of course, smoking compounded with obesity, you know, people who are not even morbidly obese, but who are significantly overweight and smoke, I mean, that must be a double whammy for them, correct?

• 40:28Speaker 04

  Sure. I mean, it turns out that heavy smokers have a worse diet than non-smokers. Heavy smokers are more likely to eat more fried foods, fewer fruits and vegetables. There are a whole bunch of things going on with heavy smokers that contribute to health risks.

• 40:45Alec Baldwin?

  You were mentioning before the name of a drug, though I don't recall what you said.

• 40:49Speaker 04

  Vrennaclean.

• 40:49Alec Baldwin?

  Now, what is that?

• 40:50Speaker 04

  It's a drug that's FDA-approved smoking cessation aid.

• 40:55Alec Baldwin?

  That addresses addiction?

• 40:56Speaker 04

  It's treating addiction, yeah. It's a drug that's shown to help you stop smoking. That's a little bit, little bit too ambitious a claim. I mean, that, in terms of nicotine replacement products, like nicotine vape, it's a harm-reduction technique. You're replacing a very toxic form of nicotine use with a much less toxic form of nicotine use, but the addiction doesn't go away. It might be decreased.

• 41:21Alec Baldwin?

  That's a dream, isn't it, to address that addictive component in the human brain and human behavior?

• 41:26Speaker 04

  There are other factors, too. It's not just the addiction, it's the environment you're in. That, for example, if you have a spouse who smokes and isn't giving up, good luck trying to give up smoking yourself. I mean, that, so these powerful social factors. If you have coworkers who are your best friends going outside in the wintertime to smoke, you've got social pressures to continue to smoke. But go back to that figure of 5% of 18 to 25 year olds smoking in the United States now. That's a nice low number compared to the 80% in 1940. So there's been progress, there's been huge progress.

• 42:09Alec Baldwin?

  My thanks to Dr. Lynn Kozlowski. This episode was recorded at CDM Studios in New York City. We're produced by Kathleen Russo, Zach McNeese, and Maureen Hoban. Our engineer is Frank Imperial. Our social media manager is Danielle Gingrich. I'm Alec Baldwin. Here's the Thing is brought to you by iHeart Radio.

• 42:52Speaker 11

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• 44:21Speaker 00

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