TIME public health

Paying People Could Help Them Quit Smoking

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Researchers offered women more than $1,000 to get them to stop smoking

Paying people to quit their bad health habits may be a powerful way to address public health issues like smoking, according to a new study in the BMJ. In the study, pregnant women were more than twice as likely to quit smoking when offered financial incentives than when they were given regular counseling.

“If financial incentives are effective and cost effective they may well have the future potential to sit with vaccines as an important preventive healthcare intervention strategy,” the study says.

The research, which looked at more than 600 pregnant women in the United Kingdom, offered women up to $1,200 dollars in shopping vouchers for following steps to quit smoking. Nearly a quarter of women who were offered the money successfully quit smoking. In the control group, a separate group of women received free nicotine therapy and were counseled on how to quit. Less than 9% of those women were able to kick the habit.

Read More: What I Learned From My $190,000 Surgery

That success gap remained when researchers followed up a year with the women in both groups who had quit. Fifteen percent of the women who had been paid to quit had stayed away from cigarettes, while only 4% of the counseling group quitters had done the same.

Using financial incentives to encourage better health behavior has been explored in depth in recent years by public health experts, but many remain skeptical due to underlying ethical concerns. Some have argued that such incentives are coercive and diminish a person’s sense of personal responsibility. But the researchers in this study argue that it can help in more ways than one; getting additional funds before a child’s birth helps the people who need financial assistance the most at the time they need help.

“In the developed world there is now a clear socioeconomic gradient in smoking, with tobacco use concentrated among the poorest in society,” the study says. “Receipt of financial incentives can contribute to needed household income in advance of the arrival of a baby in low income households.”

TIME Addiction

Typical American Smokers Burn Up at Least $1 Million During Their Lifetimes

Alaska smokers will spend over $2 million

American smokers spend at least $1 million dollars on cigarette-related expenditures over their lifetimes, according to a state-by-state analysis done by the financial consultancy company WalletHub.

The most expensive state for smokers is Alaska, where the habit costs over $2 million dollars on average. For a bargain, move to South Carolina, but that still comes in at nearly $1.1 million.

“I and most people really just think of the cost of cigarettes and taxes on the packs, but if you think about the healthcare costs, which can totally be avoided, healthcare insurance premiums, and in the workplace, bias against smokers, that can … add up,” said WalletHub spokeswoman Jill Gonzalez.

The study’s “average smoker” is someone who smokes one pack a day starting from the age of 18 (legal age to buy) and ending at 69 (the average age of death for a smoker).

So, if you’re looking for another excuse to quit, perhaps take a quick peak down millionaire’s row.

MONEY health

Smoking Can Cost You $1 Million to $2 Million in a Lifetime

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John Knil—Getty Images

Your pack-a-day habit isn't just destroying your lungs, but your bank account as well—more than you ever imagined.

According to the American Lung Association, tobacco kills nearly half a million Americans annually and costs the nation $333 billion per year in health-care expenses and lost productivity to boot. But it’s hard for the average person—specifically, the average smoker—to wrap one’s brain around such an enormous figure.

Coming to the rescue, timed to coincide with the CDC’s Tobacco Awareness Week, is a new state-by-state analysis from WalletHub detailing the lifelong financial costs of smoking for an individual. Because the average price of a pack of cigarettes varies widely around the country—$5.25 in Virginia, $8 in Michigan, $12.85 in New York—the lifetime outlay varies greatly from state to state as well. In all cases, though, the data gathered by WalletHub show that smoking is incredibly costly in addition to being potentially deadly.

The total cost per smoker is estimated at $1,097,690 in South Carolina—and it’s the least expensive state in the nation. A Kansas City Star headline noted that the “cost of smoking is cheap in Missouri … relatively,” as the state ranks as the eighth least expensive on WalletHub’s list, with the total cost for a lifetime of smoking running “only” $1,177,230. At the high end of the spectrum, there’s Rhode Island, Massachusetts, New York, and Connecticut, where the habit costs more than $1.9 million per person in a lifetime. Priciest of all is Alaska, which crosses the $2 million mark.

For a little perspective, federal data estimates that the cost of raising a child to age 18 is about $250,000—a big chunk of change, but only a small fraction of expenses reportedly incurred by smokers.

Right about now, the average smoker (or just the average reader with a healthy degree of skepticism) is probably thinking: hogwash. The process of coming up with such wild figures must involve a fair amount of smoke and mirrors, so to speak, right?

Let’s have a look at what WalletHub did, exactly. By far, the largest expense incorporated into the per-person total is the “tobacco cost per smoker,” measured at $786,346 in South Carolina, up to roughly $1.5 million in Alaska. WalletHub came up with that figure by multiplying the average price of a pack of cigarettes in each state by the number of days in 51 years. Fair enough. There are cheaper ways to go about buying cigarettes, like buying smokes by the case, but many people purchase by the pack.

What’s trickier is the way that WalletHub pumped up its tobacco cost estimates by calculating “the amount of return a person would have earned by instead investing that money in the stock market over the same period. We used the historical average market return rate for the S&P 500 minus the inflation rate during the same time period to reflect the return in present-value terms.” In other words, the assumption is that money not spent on cigarettes would have been dutifully and wisely invested over those same 51 years.

Similar assumptions have also been used in the now (mostly) discredited “latte factor,” which is the theory that holds that people can wind up with millions in the bank by cutting back on everyday expenses like a daily latte. Among other reasons, this line of thinking is questionable because people don’t necessarily invest money that they don’t spend on some product or service—they’re more likely to simply spend that money on something else.

WalletHub also includes other costs that many smokers never think about, factoring in added health care expenses (with state-by-state data from the CDC) and an 8% hit on income due to smoking, as determined in a study by the Federal Reserve Bank of Atlanta.

Add up all of these and a few other estimated expenses, and over the course of a half-century, the cost to the pack-a-day smoker runs $1 million to $2 million, according to WalletHub. Are the figures overblown? Well, perhaps a bit. There’s a good argument to be made that the data were construed to come up with totals that are as big and headline-worthy as possible. (After all, they got our attention.)

Nonetheless, even if the figures are on the inflated side, it’s an undeniable reality that the smoking habit costs big bucks over a lifetime. And oh yeah, it can make your lifetime a lot shorter. Let’s not forget that.

TIME Brands

One of the Last Marlboro Men Has Died

Darrell Hugh Winfield was discovered while working on a ranch in Wyoming

One of the last Marlboro Men died earlier this week.

85-year-old Darrell Hugh Winfield passed away Monday at his home in Riverton, Wyoming, the Associated Press reported.

Winfield, discovered by ad agency Leo Burnett in 1968 while working on a ranch, was the quintessential macho cowboy — a quality that made him one of the rugged faces of the cigarette company between the late 1960s and the late 1980s.

The Marlboro Man was first introduced in the 1950s in an attempt to sell filtered cigarettes to men. They had previously been targeted at women.

[AP]

TIME Addiction

How Your Period Affects Your Desire to Quit Smoking

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What that time of the month may mean for your resolution to quit smoking

Ladies, listen up. If you’re trying to quit smoking, you may want to pay attention to that time of the month, a new study says.

When it comes to nicotine addiction, prior research shows some gender differences can come into play. Women tend to get addicted to cigarettes more quickly and have a harder time quitting. Experts have puzzled over why that is, and in a new study published in Psychiatry Journal, researchers suggest that women’s menstrual cycles may cause changes in the brain that affect their desire to smoke, and may interfere with their ability to quit.

The researchers studied 34 men and women who smoked over 15 cigarettes a day. The participants filled out questionnaires and underwent MRI scans on their brains while they looked at smoking-related images.

The women underwent the imaging twice to take into account two different points during the menstrual cycle: the follicular phase and the mid-luteal phase. The follicular phase is the first part of a woman’s cycle which starts on the first day of her period and ends when ovulation starts. The luteal phase is from when ovulation starts to day one of the woman’s next cycle. The researchers looked at the mid-luteal phase so that ovulation had ended and and levels of the hormones estrogen and progesterone were higher.

While the study didn’t find differences in cravings between the men and the women overall, the researchers did find that women experienced more of the brain activations associated with uncontrollable urges to smoke at the beginning of the follicular phase. “Hormonal decreases of [estrogen] and progesterone possibly deepen the withdrawal syndrome and increase activity of neural circuits associated with craving,” study author Adrianna Mendrek a neuroscientist at the Institut universitaire en santé mentale de Montréal in a statement.

During the follicular phase, Mendrek and her colleagues observed that women had more activity in the frontal, temporal and parietal lobe of the brain, while during the luteal phase only the right hippocampus was similarly active. Understanding how the menstrual cycle influences cravings for cigarettes may help women quit, the authors suggest, though there may be more at play than the hormones associated with getting a period.

“The data do suggest that it may be easier for women to quit during the mid-lutael phase rather than in early follicular phase, but the psychosocial factors are probably much more important here,” says Mendrek in an email to TIME. For instance, beliefs about PMS and the fact that it can cause stress and depression may play into whether women find quitting smoking easier at different points during their cycle.

The current study was small with only 34 participants, and earlier research looking at whether women are more responsive to nicotine during various points in their cycle has been inconclusive. The researchers acknowledge that the findings are preliminary, but that they do support the need for more gender-specific cessation research and the possibility that it could help to take into account the menstrual cycle. For now, more confirmation is needed, as well as a better understanding of what biological and psychosocial factors contribute to smoking behaviors.

TIME Addiction

The Best Way to Kick Your Smoking Habit

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The more techy interventions, the better

If you’re really committed to quitting smoking for good, it’s time to get tech-savvy.

A new study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report shows that people who use both phone hotlines and online cessation services to help them quit are much more likely to say they’ve abstained from smoking compared to people who opt for just one or the other.

In general, smoking quitlines are proven to be successful interventions for smokers who want to kick the habit. They offer guidance, support and resources to keep quitters on track. Most quitlines also offer a web version of their services, but until now, it hasn’t been clear that more information really is better.

MORE: Here’s the Best Way to Get Someone to Quit Smoking

The new study suggests that it is. Researchers looked at 7,901 people who reported using either phone-only interventions, internet interventions only, or a combination of both. People who used both methods were significantly more likely to report they hadn’t smoked in 3o days when researchers followed up with them. The researchers speculate that dual usage may improve a quitter’s likelihood of succeeding, possibly because they’re strongly committed to their goal.

“Although telephone and Web-based interventions are effective in tobacco cessation, providing access to multiple types of cessation services might improve the odds of users in achieving long-term cessation,” the researchers write. The hope is that physicians will counsel patients on considering both interventions.

Our ever-connected climate may make this easier, and many public health initiatives are seeing success in sending educational text reminders. The National Institutes of Health (NIH) is paying particular attention to how social media and cell phones can best be used to help break addiction. In October, the NIH pledged $11 million to studying the use of social media to help understand, prevent and treat substance use and addiction.

So if you’re ready to accept the challenge of going cigarette-free in 2015, set yourself up for success and log in.

TIME Addiction

E-cigs Are the New Cool Thing for Teenagers

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High schoolers are more likely to smoke e-cigs than regular cigarettes

Electronic cigarettes are hugely popular with teenagers all across the United States, new government data shows, but fewer teens are smoking regular cigarettes—suggesting that e-cigs may attract young people who wouldn’t otherwise smoke.

Researchers surveyed 1,941 Hawaii high school students about their smoking behaviors as well as their relative risk for picking up smoking. Risk was assessed based on factors like sensation-seeking and prevalence of smoking among peers, parent support and academic involvement.

They found, in their study published in the journal Pediatrics, that about 17% of the high schoolers smoked e-cigarettes only, 12% smoked both e-cigarettes and conventional cigarettes, 3% only smoked conventional cigarettes, and 68% said they did not smoke.

MORE: Debate Over E-Cigs Lights Up

Students who smoked tobacco cigarettes, or who smoked both cigarettes and e-cigs, fell within the highest risk category for picking up the habit. E-cigarette users were lower on the risk threshold than those two groups, suggesting it’s attracting young people who wouldn’t necessarily be interested in conventional smoking. E-cigarette users and dual smokers were also more likely that nonsmokers to believe e-cigarettes are healthier than regular cigarettes.

“The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use,” the authors write.

Part of this perception and attraction to e-cigs could be the fact that they are heavily marketed in public places the authors suggest.

MORE: In Children’s Hands, E-Cigarettes Can Be Deadly

The trouble with e-cigs is that there’s still not enough research to make any definitive conclusions on their risks or benefits. Some experts argue that since e-cigarettes have fewer unhealthy components than traditional cigarettes, they are a better option. They have even been trumpeted as a possible quitting device. Other experts argue that e-cigarettes are just another gateway to nicotine use, and are therefore unacceptable. Whether young people can access them and get hooked is of great concern.

Currently, the U.S. Food and Drug Administration (FDA) only regulates e-cigarettes marketed for therapeutic purposes, and many products continue to be marketed and sold with little FDA interference. The agency has proposed a rule that would give it more regulatory power over e-cigarettes that would look similar to other tobacco products, but nothing has been finalized. The FDA has also suggested a ban on sale of e-cigs to minors. The agency admits there’s a lot that consumers don’t know about e-cigs, like if they lead young people to smoke other tobacco products or how much nicotine is actually inhaled in each use.

TIME Cancer

Why Smoking Causes Cancer In More Men Than Women

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Stubbed out cigarette in ashtray. Getty Images/OJO Images RF— Adam Gault

Yet another motivation for men to quit smoking

Men who smoke may be at greater risk for lung cancer than their female counterparts, according to a new study in the journal Science.

That might be because smoking reduces the number of Y chromosomes in blood cells. Previous research has shown that when blood cells lose Y chromosomes, which are only present in men, cancer is more likely to develop. While the precise relationship between Y chromosomes and cancer remains unclear, Y chromosomes are thought to play a role in tumor containment.

The study, led by a team at the Uppsala University in Sweden, examined data on several factors that might have led to a loss of Y chromosomes, including age, exercise, diabetes, cholesterol, education and alcohol. Smoking and age were the only factors associated with loss of Y chromosomes in the more than 6,000 men evaluated.

The study also provides some hope for men who want to quit smoking. Y chromosomes return to the blood cells of men who stop the habit, the study found.

“These results indicate that smoking can cause loss of the Y chromosome and that this process might be reversible,” said lead study author Lars Forsberg in a press release. “This discovery could be very persuasive for motivating smokers to quit.”

The American Cancer Society expects lung cancer to kill nearly 160,000 people in the United States in 2014, more than any other cancer.

TIME Cancer

U.S. Smoking Rate Hits Historic Low

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And the number of people who say they smoke every day has dropped, too

Cigarette smoking among American adults has hit at an all-time low, health officials said Wednesday.

The percentage of smokers over the age of 18 dropped from 20.9% in 2005 to 17.8% in 2013, according to a new Centers for Disease Control and Prevention (CDC) report. That’s the lowest rate of smoking adults since the CDC started tracking the numbers via its National Health Interview Survey in 1965. Over the course of eight years, the number of U.S. smokers dropped from 45.1 million to 42.1 million, the report reveals.

Still, the CDC worries too many Americans still smoke, and a Nov. 13 report from the agency showed that a high number of young people still smoke, putting millions at risk for premature death.

The good news for health officials is that people seem to be cutting back, if not quitting. The number of people who smoke every day has dropped nearly 4% from 2005 to 2013, and the proportion of smokers who smoke only some days has increased. Of course, smoking less habitually still poses tremendous danger for the health.

“Though smokers are smoking fewer cigarettes, cutting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits,” said Brian King, a senior scientific adviser with the CDC’s Office on Smoking and Health, in a statement.

Cigarette smoking continues to be the leading cause of preventable death among Americans, reportedly racks up $289 billion a year in medical costs and productivity loss.

Around 70% of all cigarette smokers want to kick the habit, and if a smoker quits by the time they turn 40, they can gain almost all of the 10 years of life expectancy they lose by smoking.

Americans who want to quit smoking can call 1-800-QUIT-NOW for free counseling and resources, or visit the CDC’s antismoking tips site here.

TIME health

Smoking News to Make You Cringe

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Stephen St. John—Getty Images/National Geographic Creative

Read TIME's reports from the era when the medical community thought it was O.K. to smoke

Thursday marks the American Cancer Society’s Great American Smokeout (GASO), a nationwide event encouraging smokers to kick the habit.

We know today that cigarette smoking causes serious diseases in every organ of the body, including lung cancer, diabetes, colorectal and liver cancer, rheumatoid arthritis, erectile dysfunction, age-related macular degeneration, and more. Tobacco use rakes up more than $96 billion a year in medical costs, and it’s estimated that 42.1 million people, or 18.1% of all adults in the U.S. smoke cigarettes.

This year marked the 50th anniversary of the historic 1964 Surgeon General’s report that concluded that smoking caused lung cancer, and should be avoided. Before then, smoking messaging was depressingly inaccurate. Despite concerns — initially from a small minority of medical experts — the tobacco industry boomed in the U.S., and even doctors considered the effects of cigarettes to be benign.

Here are some examples of tobacco-related beliefs that appeared through the years in TIME Magazine:

1923: In an article about a recent compilation of smoking-related data, TIME was mostly concerned with whether smoking made people more or less brainy: “The outstanding fact of this survey is that every man in the literary group smokes, and the majority of the literary women. Moreover, most of them consider its effects beneficial, and claim that their literary and imaginative powers are stimulated by it.” And later: “From the laboratory data, the author concludes that it is impossible to say that tobacco smoking will retard the intellectual processes of any one person, but in a large group it may be predicted that the majority will be slightly retarded.”

1928: Some experts tried early on to warn about the effect of nicotine, but were met with resistance. In an article about a researcher presenting data on nicotine and the brain, TIME writes: “Many U. S. doctors have contended and often hoped to prove that smoking does no harm. In Newark, N. J., five children of the Fillimon family have been smoking full-sized cigars since the age of two. The oldest, Frank, 11, now averages five cigars a day. All of these children appear healthy, go to school regularly, get good grades.”

1935: Questions began to be raised about the effects on infants, though uptake was limited: “Physiologists agree that smoking does no more harm to a woman than to a man, if harm there be. According to many investigators, the only circumstances under which a woman should not smoke are while she has anesthetic gas in her lungs (she might explode), and while she produces milk for her baby. Milk drains from the blood of a smoking mother those smoke ingredients which please her, but may not agree with her nursling.”

1938 Even if there might be adverse health events for some smokers, not all physicians agreed it was a universal risk: “In step with a recent upsurge of articles on smoking, in the current issue of Scribner’s, Mr. Furnas offers several anti-smoking aids for what they are worth. Samples: 1) wash out the mouth with a weak solution of silver nitrate which ‘makes a smoke taste as if it had been cured in sour milk'; 2) chew candied ginger, gentian, or camomile; 3) to occupy the hands smoke a prop cigaret. For many a smoker, however, this facetious advice may be unnecessary, since many a doctor has come to the conclusion that, no matter what else it may do to you, smoking does not injure the heart of a healthy person.”

1949: By the late 1940s, smoking had become a contentious debate in the medical community: “Smoking? Possibly a minor cause of cancer of the mouth, said Dr. MacDonald. But smoking, argued New Orleans’ Dr. Alton Ochsner, can be blamed for the increase of cancer of the lung. Surgeon Ochsner, a nonsmoker, was positive. Dr. Charles S. Cameron, A.C.S. medical and scientific director, who does smoke, was not so sure. For every expert who blames tobacco for the increase of cancer of the lung, he said, there is another who says tobacco is not the cause.”

1962 More evidence was linking tobacco to cancer, and some groups were trying to get pregnant women to quit out of potential risks to the child, but still: “Some doctors, though, see no direct connection between smoking and prematurity; they argue that the problem is a matter of temperament, that high-strung women who smoke would have a high proportion of “preemies” anyway.”

1964 In a historic move, the 1964 Surgeon General’s report officially stated that cigarette smoking causes cancer, giving authority to anti-smoking campaigns. TIME wrote:

The conclusion was just about what everybody had expected. “On the basis of prolonged study and evaluation,” the 150,000-word report declared, “the committee makes the following judgment: Cigarette smoking is a health hazard of sufficient importance in the U.S. to warrant appropriate remedial action.” More significant than the words was their source: it was the unanimous report of an impartial committee of top experts in several health fields, backed by the full authority of the U.S. Government.

Read TIME’s full 1964 coverage of the Surgeon General’s report, here in the TIME Vault: The Government Report

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