20
Twenty is an interesting age, with varying feelings depending on which side of it you’re on. For those who are on the older side of it, twenty is a youthful age; the beginning of what is, to most, a defining decade in their lives. Yet, when you’re on the other side, twenty takes on a different connotation. Twenty marks the end of teen hood, catapulting you from teenager to young adult in the span of one birthday. While most would choose to wallow in some imagined loss of youth, I spent the days before my 20th birthday caught in meticulous math, counting on nicotine-stained fingers. I was 15 when I had my first cigarette and, at the cusp of my 20th birthday, I realized that 25% of life had been spent as a smoker. That fact terrified me more than any stop-smoking statistic I have ever heard.
“Ch-asian”
The endless influx of international students to America has lead to a new slang term being formed on college campuses: “ch-asian” chain-smoking Asian. I’ve listened to my American friends use the term many times, but I’ve never heard them ask why it’s so common for Asians to smoke. It’s a generally accepted notion on college campuses that international students smoke more, with many campuses, including Emory’s International Student and Scholar’s Program, offering “quit-smoking” education specifically designed for foreign students.
Most of us ch-asians began young. There are many things that keep a country defined as developing rather than developed. Bombay, India, my home city and the city where I first began smoking, is a city of 19 million people, with 60% of them living in slums. It’s difficult for a government to prioritize monitoring tobacco consumption when 41% of the nation is living under the poverty line. There was a running joke between my Korean friends and me in high school, in our countries, if you could see over the counter you were old enough to buy cigarettes. We weren’t too far off. A 2002 World Health Organization report said, “between 80,000 and 100,000 children worldwide start smoking every day - roughly half of whom live in Asia”.
And here I was, foolishly hoping that “ch-asian” is just a temporary term.
Social Smoker
I have a friend who would always laugh at the term “social smoker”. His name is Justin Martin and he was the only other smoker in my high school friends’ circle. Through eleventh grade, we would frequently find ourselves outside, late on Friday nights, getting our nicotine fix. He’d tell me how “social smoker” was his favorite oxymoron, “It’s the least social thing someone can do with their time, creeping downstairs, away from the party, to light a cig,” he’d say. He’d rant for two or three cigarettes (a smoker’s favorite way to measure length of conversations) about how much of a vice it was, separating him from the “real” party. I always wanted to point out to him that there were two of us standing there, and it’s tough to feel that sickening solitude of smoking when there’s someone else there with you.
There’s this odd bond that forms between smokers. Sometimes, it’s a close friend who you frequently share cigarettes with. Other times, its that glance exchanged between two students puffing frantically on pre-class cigarettes at nine in the morning. I call it smokers solidarity, that comforting feeling you get when you realize someone else is slowly killing themselves too.
Another friend of mine, Jenny Soiffer, who I met my freshmen year of college, had mastered the art of being a “social smoker.” On Fridays, in preparation for the night’s Frat party, she would buy herself a fresh pack of cigarettes. She counted them in front of me once, “The pack has twenty, right? So that’s ten conversations,” she said. She would stand outside parties, till everyone had sufficiently forgotten sobriety, and waited for the drunken draggers to bum cigarettes off her. It was her favorite weekend activity, chatting with those who only inhale when inebriated, who would constantly tell her with every drag, “I only smoke when drunk.”
Of the approximately 45 million smokers in the United States, 19% have uttered that statement, or something along the same lines, and define themselves as a “social smoker”. It’s a common occurrence, particularly on college campuses. A few cigarettes over the weekend, a flirtation with nicotine rather than a concrete commitment. A 2008 study, conducted at the University of Georgia, explored the ramifications and found that even sporadic smokers were 36 percent less responsive to changes in blood flow as non-smokers. Lee Stoner, lead author of the study and researcher at the Christian Church hospital in New Zealand, said in a press release, ““We wanted to determine whether occasional smoking can impair flow-mediated dilation and found that repeated bouts of cigarette smoking — even if classified as occasional — appear to increase the risk for developing cardiovascular disease in otherwise healthy, young people.”
I shared this with one of my “social smoker” friends. His response was simple, “It’s college, you’re supposed to be doing things that are bad for you,” he said, “You’re only young once right?” I remembered seeing that same statement, “You’re only young once, right?” on a poster in a doctor’s office, next to a giant lit cigarette hanging ominously on a fish hook.
Icons
I get excited every time I find out someone famous smokes. It’s the same thrill, the same connection, but amplified. It’s like a crack of reality in their synthetic celebrity, a realization that even our idols are susceptible to addiction.
In 2008, when President Obama won the biggest campaign of his life, he tackled a more personal one, quitting smoking. I remember giggling at the New York Times article that said he was quitting with “a strenuous use of nicotine gum,” smiling at his word choice.
In June of 2009, Obama passed the Family Smoking Prevention and Tobacco Act, giving the FDA unprecedented power to regulate tobacco consumption and production. Before signing the law, Obama discussed his own struggles with smoking saying, “I know how difficult it can be to break this habit,” and emphasizing the effect the law will have on stopping the growth of smokers under eighteen.
President Obama represents a lot of different things to a lot of different people. But, to me, he will always be a symbol of smoker redemption, fixing for others what was broken in him.
Emory Healthcare
Like most college campuses, Emory has made a substantial effort in recent years to shift away from smoking culture. For the last two years, Emory has adhered to Dekalb’s smoke-free policy, prohibiting smoking within 25 feet of any public building. Knowing that enforcing such a policy is difficult on a college campus, the University also offers multiple programs on smoke cessation, including Substance Abuse and Risk Reduction consultations on tobacco.
What interested me the most about Emory Healthcare’s Tobacco Education was their focus on employees and faculty as well as students in the college. Emory offers Faculty/Staff Assistance and Wellness Program (FASP) and Freedom from Smoking classes that are “open to all Emory faculty, staff, students, patients, friends and family”.
As of January 2011, the health insurance plan for Emory employees will change to charge a higher premium if the employee is a smoker. When I first heard this, I had to fight my reflexive “smokers have it so hard” response. Later, I spoke to my friend Joe O’Geen, the Residence Hall Director in Harris Hall. He told me how many people in the Residence Life Office had begun to quit to avoid higher healthcare costs. “The policy stinks for smokers,” he said, “but if it encourages more of my friends to quit it can’t really be considered a bad change for anyone.”
The Doctor
Eager to try anything to help me quit, I visited Emory’s Student Health Services. I walked up the two-flight outdoor entrance way and counted seven cigarette butts on my way to the door, one located right under a “do not smoke within 25 feet of this building” sign.
I began with Dr. Michael Allan, who administered a physical examination to help me see the damage I had done to my body in five years of smoking.
Unlike most of his previous patients, I went in hoping that he would find something wrong with me. I wanted a physical reason to quit, something that has gone wrong with my body now rather than speculating about all the future health effects.
He checked all my vitals, my blood pressure, and nose and throat. I was nervous when he moved to my lungs, trying hard to “breath deeply”.
“Physically, you’re alright,” Dr. Allan said when he had finished, “What you will notice though, is that your lung capacity is not as great as your friends, you’ll probably have a tough time keeping up with them when running.”
I think about the boys on my high school basketball team in Bombay. I remembered watching them run suicides; half court, full court, half court, full court, again and again. You could always spot the smokers; they were the ones who’d lag a little behind the rest, constantly coughing.
I appreciated Dr. Allan for his visual metaphors, explaining the effects of smoking on lung capacity in simple terms. “Lung capacity begins to deteriorate around 20, everyone’s capacity turns into a downward slope, like a hill,” he said, “Smoking kills the cilia in the lungs. The more you smoke, the steeper that hill gets. And no one wants to be driving down too steep a hill.”
Dr. Allan went on to discuss all the diseases I am more likely to contract as a smoker. He began with cancer, as most doctors do on the subject, explaining that smoking causes 90% of lung cancer cases. He emphasized the risk of other cancers for smokers including bladder, pancreatic, kidney, cervical, and esophagus cancer. There was also cardiovascular disease, made much more likely because of the increase in cholesterol from nicotine. He then moved on to Obstructive Pulmonary Diseases, which included emphysema and chronic bronchitis, explaining that both are caused by a decrease in lung function. It felt like a compilation of all the crash reports, from the smokers who’d driven down too steep a hill.
When he finished, Dr. Allan said, “But you knew all that already.” He was right, I did. I knew every negative effect of cigarette smoking acquired from the wide variety of voices over the years. Smokers can make a multitude of excuses for why they smoke, but not one, in today’s smoking-educated society, can claim they didn’t know the consequences.
The Therapist
After my visit, Dr. Allan sent me downstairs to the Substance Abuse and Risk Reduction section of the building. I walked through the narrow winding hallways until I found the office of Virginia Plummer, LCSW, one of the two substance abuse counselors at Emory. The room, though the same size, looked nothing like the exam room I’d sat in before. Instead of expensive medical equipment, two towering bookshelves were against the walls with titles like “It’s Okay” and “12 Stupid Things that Mess Up Recovery”. There were motivational posters with picturesque landscapes on every available wall space; the entire room seemed to ooze positivity.
Virginia, as she later gave me permission to call her, greeted me cheerfully. There were two large chairs with a couch in between. Unable to let myself slip into a thearapy cliché, I sat on a chair. She began by asking me to state in a few words why I was there. I said simply, “I’m a smoker who doesn’t want to be a smoker anymore.”
Virginia smiled at my response, and congratulated me, a completely unexpected commendation. I could not help but feel out of place. I knew the type of people who had been in that room with her, people dealing with serious physical and psychological addiction to substances that are so much more severe than cigarettes. Of the hundreds of students Virginia Plummer sees in a year, only around ten are there solely for quitting tobacco. “But,” says Virginia, “If someone walks in here, and they’re smoking at all, we talk about it.” She tells me about all the marijuana smokers she’s met, who proudly proclaim, “at least I don’t smoke cigarettes,” as if it is a point of pride. Her response to anyone who claims one drug can be “better” than another is always, “any mood altering drug has negative effects on your body, I never indulge students who try and convince me they’ve chosen the right one.”
We return to my addiction. “I’m not here to tell you, or anyone else, what to do,” Virginia assures me, “What we do here is meet somebody where they are. Try and address the dissonance between what they are doing and what they want to do.”
We worked on my “Wellness Plan,” a sheet of printer paper on which we wrote strategies to help me quit. We wrote things like, “Tell my smoking friends I’m quitting” and “Carry gum to chew”. At the end of our session, Virginia handed me the paper saying, “It’ll be good to have something concrete in your hand.” We said our goodbyes, arranged a follow-up appointment, and I left.
There was nothing negative to say about that experience. Virginia had been more than welcoming, and genuinely interested in helping me quit. Yet, at the end of the session, I found myself waiting for the “but you knew all that already”. Her tips to help me quit were nothing I hadn’t heard before, or couldn’t find online. I found myself phenomenally frustrated, unable to understand why I didn’t walk out of there knowing my next cigarette would be my last.
That’s when it really hit me. Addiction, in any form, is one individual’s relationship with something they crave. They are as unique as the person they’re paralyzing. Support is always helpful, particularly when dealing with vicious withdrawals, but it’s not a surefire solution. In the end, I am the only person who can add that soul-satisfying “non-“ in front of smoker.
Everything I do until I get to that point just feels like I’m blowing smoke.
