TIME Cancer

Smoking and Drinking Raise Your Risk for Oral HPV

smoking lit cigarette
Getty Images

Research sheds new light on HPV risk factors

Your favorite health vices—smoking and drinking—may pave paths to HPV, two new studies find.

A new study published in a research letter in JAMA looked at detailed health profiles from 6,887 participants in the National Health and Nutrition Examination Survey (NHANES). Those people with higher levels of biomarkers for tobacco exposure in their blood and urine also tended to have a higher prevalence of oral HPV type 16. That’s a strain that causes more than 90% of HPV-related oropharyngeal—or throat—cancers, says study co-author Dr. Gypsyamber D’Souza, associate professor at Johns Hopkins Bloomberg School of Public Health.

(By the way, you can only get oral HPV through intimate oral contact—not by sharing forks or kisses on the cheek, D’Souza says. It’s unclear whether French kissing, when you’re actually exchanging saliva, also does the trick.)

The main causes of throat cancers are tobacco, alcohol and HPV, she says, but since tobacco use has declined in the U.S., HPV is becoming an increasingly important player.

“HPV is the primary causal agent of HPV-related oral cancer,” D’Souza says, and most people clear the infections on their own. “But these results suggest that tobacco may make these infections less likely to clear, and therefore smokers may have a higher risk of eventually developing oropharyngeal cancers.”

The increased risk doesn’t only come from smoking cigarettes: the researchers found an association with oral HPV-16 and tobacco exposure in general, even at very low levels indicative of secondhand smoke. People who were current tobacco users had more cases of oral HPV-16 than former users or people who had never used it.

The good news is that the HPV vaccine protects against HPV type 16, and though it hasn’t been definitively shown yet to protect against oral infection, some data suggest that it does, D’Souza says.

In other HPV-related news, a separate questionnaire study on 1,313 men published earlier this month in BMJ found that men who reported drinking more alcohol tended to also have higher levels of HPV. In fact, the biggest drinkers in the study had 69% of HPV prevalence vs 57% among the men who drank the least. (For HPV types that may increase the risk of cancer, those numbers were 35% vs 23%.)

Neither study could definitively point to a cause or mechanism, but studies have shown that smoking and drinking have immunosuppressive effects, which can promote inflammation and infection.

“What this adds to the story is an understanding of one reason why people who have not had very heavy sexual history, people who’ve had one lifetime partner . . . develop these cancers,” D’Souza says. “This cross-sectional study suggests that in some people tobacco use might be an explanation.”

TIME Etiquette

An Open Letter to the Person Smoking Their E-Cigarette Indoors

Man smoking e-cigarette in public
BSIP/UIG—Getty Images/Universal Images Group

I see how it could be easy to view the world as your personal "vaping lounge," but I really wish you wouldn't

xojane

This story originally appeared on xoJane.com.

Dear person smoking their e-cig next to me in this coffee shop,

I really hate your e-cigarette.

I’m proud of you for taking steps to quit smoking and, yes, I would much rather you vape than smoke. Smoking is terrible, and I’m not calling for a sweeping ban of e-cigs.

But please, I am imploring you, stop vaping indoors. I know it’s “just water vapor,” but it is water vapor that smells terrible. The vapor that is wafting over from your table to mine does not smell like pancakes; it smells like a synthetic blend of sugar-free butterscotch candies and diacetyl. Sure, this is “better” than cigarette smoke, but stepping in cat poop is better than stepping in dog poop, and both are still terrible options.

I realize that you are breaking no laws. You are technically allowed to “vape” indoors. In large indoor spaces, your habit is not such a big deal. I can walk away from you or you will eventually walk away from me. I may be temporarily annoyed, but this too shall pass.

But just because you are “technically allowed” to do something, that doesn’t mean you should do it. In smaller spaces — spaces from which I cannot escape — in planes, cafes, and restaurants, you need to put that thing away. You are being rude. Like eating a large amount of garlic before boarding a 10-hour flight or wearing strong perfume to an expensive restaurant.

I’m sure you are experiencing a sense of freedom the likes of which you’ve never felt. You no longer have to brave the elements to get your nicotine fix. This must be especially nice if you live in an area with extreme weather. This freedom may let you live out smoking fantasies you never thought possible. I get it; the no smoking signs in airplane bathrooms are so admonishing, even I have been tempted to dismantle those smug little smoke detectors. After enduring all of the restrictions imposed on smokers, I can see how it could be easy to now view the world as your own personal “vaping lounge,” but I really wish that you wouldn’t.

In the case of restaurants and cafes, you are interfering with the food. Flavor is a combination of taste and smell, and with the smell of pina colada air freshener floating under my nose, I am having a hard time enjoying my coffee. Your bubble gum vapor is not welcome when I’m eating a grilled cheese. And — I may be overstepping my bounds here — but I really wish you wouldn’t exhale bacon flavored vapor around my beer. We’ve already established that bacon-flavored beer is pretty terrible. I know you can still smoke in a lot of bars, but I don’t go to those bars. Besides, that’s what the patio is for.

I don’t think I’m being completely unreasonable. Even e-cig companies seem to agree with me:

Even if you are at an establishment that allows vaping and someone sitting next to you seems uncomfortable or requests you to stop vaping, the best thing to do would be to respect their request. At work, it is a good idea to inform your colleagues about what you are doing. Smokers have been notorious because of a few rude ones who blow their tobacco smoke right into people’s faces. But since vaping is so new, the opportunity still exists for the community to create a positive view of this culture.

Currently, you are not creating a positive view of this culture.

Between vaping liquid being called things likes “lizard juice” and those ridiculous holsters, you need all the goodwill you can generate. Subjecting people to cloying, food-esque scents is not the way to go about it. Besides being annoying, you may be giving people headaches or allergic reactions.

I am glad you quit smoking. If the e-cigarette helps someone achieve that goal, I support their decision to purchase and use one. But please be mindful of those around you. Because while vaping is considerably safer than traditional cigarettes, it just doesn’t smell that great.

Claire Lower is a freelance writer living in Florida.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Research

Why Pregnant Women Who Smoke Might Have Kids With Worse Sperm

Pregnant smoking
Getty Images

One more bullet point on a long list of reasons to quit smoking

Add diminished fertility to the long list of reasons why women should avoid smoking while pregnant or breast feeding. The mice sons—called pups—of mothers exposed to the smoke equivalent of a pack of cigarettes a day during that time wind up with sperm that struggle in the reproduction process, according to a new study in mice published in the journal Human Reproduction.

“Our results show that male pups of ‘smoking’ mothers have fewer sperm, which swim poorly, are abnormally shaped and fail to bind to eggs during in vitro fertilisation studies,” said study leader Eileen McLaughlin, a chemical biology professor at the University of Newcastle in Australia, in a press release. “Consequently, when these pups reach adulthood they are sub fertile or infertile.”

Unlike previous research, the new study looked at pregnancy in mice to try to determine not just the consequences of smoking during pregnancy but also the mechanism behind it. Cigarette toxins affect the stem cells in the testes, McLaughlin says, which results in permanently lowered sperm production—and these results likely apply to humans, she adds. “We also know that oxidative stress induced by these toxins causes damage to the nuclei and mitochondria (the cell’s ‘power’ supply) of cells in the testes and this results in sperm with abnormal heads and tails, that are unable to swim properly or successfully bind and fuse with eggs.”

The knowledge that smoking has devastating long-term implications for the health of children is nothing new. Previous studies have suggested that smoking stems fetus growth, leads to premature delivery and causes birth defects. Nonetheless, 20% of women in the United States continue to smoke during pregnancy. The number is higher in Australia, where the study was conducted.

“We would ask that smoking cessation programmes continue to emphasise that women should avoid smoking in pregnancy and while breast feeding as the male germ line is very susceptible to damage during early development and the resulting sub fertility will not be apparent for several decades,” said McLaughlin.

TIME tobacco

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

Antismoking messaging works differently depending on who's watching, a new study shows

For years, the U.S. government has gone back and forth about whether or not it’s legal to force tobacco companies to use images of cancerous lungs and other graphic pictures on their cigarette packaging. The assumption, of course, is that the images will terrify any smoker into kicking the habit.

However, a new study published in the journal Nicotine & Tobacco Research shows that the graphic tactic might not work on all smokers. The effectiveness of antismoking messaging depends on the attitude of the smoker.

Researchers from the Georgetown Lombardi Comprehensive Cancer Center studied 740 smokers to figure out what type of antismoking campaigns worked best. They discovered that messages that stress the benefits of quitting, like “quitting smoking reduces the risk of death due to tobacco,” were more effective at getting smokers to quit if those smokers thought that quitting would be very hard. The more graphic and negative ads like “smoking can kill you” tended to work best for smokers who thought they could quit whenever they wanted.

One of the reasons motivating messaging worked best among smokers who viewed quitting as a challenge could be that they’re already well aware of the health risks. On the other hand, the researchers speculate that loss-framed messaging — the kind that focuses on the negative consequences of continuing a behavior — worked better for smokers who felt they had more agency in their cessation because the negative ads built up motivation to stop.

Ultimately, the researchers believe that having a mixture of various messaging strategies is the best way to appeal to a broad range of smokers, and that currently there are far more negative messages than positive ones.

That’s not to say that scary ads don’t work. For a couple years, the Centers for Disease Control and Prevention (CDC) has poured resources into an intensive ad campaign called “Tips From Former Smokers” which features real former smokers who have experienced serious setbacks from their habit, like no longer being able to speak properly or having a baby too early. During past campaigns, the CDC has said that their quit lines experience 80% more activity when the ads are running compared with the weeks before.

Terrifying ads aren’t going away anytime soon, but mixing in more motivating messages might appeal to would-be quitters of all kinds.

TIME Family

Why I Don’t Eat With My Kids

Who invited those two? The 'family dinner' ain't all it's cracked up to be
Who invited those two? The 'family dinner' ain't all it's cracked up to be GMVozd; Getty Images

The curative properties of the nightly family dinner have been greatly overexaggerated

I love my daughters, I really do, more than I can coherently describe. I love my dinner hours too — not nearly as much, of course, but I’ve been on familiar terms with dinner for a lot longer than I’ve been on familiar terms with my children. Frankly, I don’t see much reason to introduce them to each other.

It’s not that my wife and I don’t eat with our daughters sometimes. We do. It’s just that it often goes less well than one might like. For one thing, there’s the no-fly zone surrounding my younger daughter’s spot at the table, an invisible boundary my older daughter dare not cross with touch, gesture or even suspicious glance, lest a round of hostile shelling ensue.

There is too the deep world-weariness my older daughter has begun bringing with her to meals, one that, if she’s feeling especially 13-ish, squashes even the most benign conversational gambit with silence, an eye roll, or a look of disdain so piteous it could be sold as a bioterror weapon. Finally, there is the coolness they both show to the artfully prepared meal of, say, lemon sole and capers — an entrée that is really just doing its best and, at $18.99 per lb., is accustomed to better treatment.

All of this and oh so much more has always made me greatly prefer feeding the girls first, sitting with them while they eat and, with my own dinner not on the line, enjoying the time we spend together. Later, my wife and I can eat and actually take pleasure in the experience of our food. But that, apparently, is a very big problem.

We live in the era of the family dinner, or, more appropriately, The Family Dinner™, an institution so grimly, unrelentingly invoked that I’ve come to assume it has its own press rep and brand manager. The Family Dinner™, so parents are told, is now recognized as one of the greatest pillars of child-rearing, a nightly tradition you ignore at your peril, since that way lie eating disorders, obesity, drug use and even, according to a recent study out of McGill University, an increased risk of the meal skipper being cyberbullied.

O.K., there is some truth in all of this. Sit your kids down at the table and talk with them over dinner every day and you have a better chance of controlling what they eat, learning about their friends, and sussing out if they’re troubled about something or up to no good. But as with so much in the way of health trends in a gluten-free, no-carb, low-fat nation, enough, at some point, is enough.

For one thing, the always invoked, dew-kissed days of the entire nuclear family sitting down to a balanced, home-cooked meal were less than they’re cracked up to be. Ever hear of the Loud family? Ever watch an episode of Mad Men — particularly one that plays out in the Draper kitchen? Welcome to family dinner in the boomer era.

Much more important, as a new study from North Carolina State University shows, the dinner-hour ideal is simply not possible for a growing number of families. The researchers, a trio of sociologists and anthropologists, spent 18 months conducting extensive interviews with 150 white, African-American and Latina mothers from across the socioeconomic spectrum, and an additional 250 hours observing 12 lower-income and poor families to get at the truth of what’s possible at mealtime and what’s not.

The first problem, the moms in the study almost universally agree, is that it is always more time-consuming to prepare dinner than you think it will be. Michael Pollan, the ubiquitous author and food activist, has written, “Today, the typical American spends a mere twenty-seven minutes a day on food preparation, and another four minutes cleaning up. That’s less than half the time spent cooking and cleaning in 1965.” To which I say, huh? And so do the moms in the study.

“I just hate the kitchen,” said one. “I know I can cook but it’s the planning of the meal, and seeing if they’re going to like it, and the mess that you make, and then the mess afterwards.” Added another: “I don’t want to spend an hour cooking after I pick [my daughter] up from school every day.” All of that sounds a lot more familiar to me than Pollan’s rosy 27+4 formulation.

Even if prep time weren’t a problem, dealing with the scheduling vagaries in two-income households can require day-to-day improvisation that makes regular, predictable mealtimes impossible. One couple studied by the NC State researchers worked for the same fast-food company in different parts of the state. Both parents often don’t know the next day’s schedule until the night before, which means inventing dinner plans on the fly and often calling on a grandmother for help. That kind of scrambling is part of what the researchers describe as “invisible labor,” work that is every bit as much a part of dinner as preparing and serving the food, but is rarely acknowledged.

Finally, there is the eternal struggle of trying to prepare a meal that everyone at the table will tolerate — a high-order bit of probability math in which the number of acceptable options shrinks as the number of people who get to weigh in grows. “I don’t need it, I don’t want it, I never had it!” declared one 4-year-old in one observed household. Parents throughout history have dealt with that kind of reaction with all manner of wheedling, bargaining and here-comes-the-airplane-into-the-hangar games, to say nothing of one mother in the study who simply turned a timer on and told her child to keep eating until the buzzer sounded.

Again, none of these problems diminish the psychological and nutritional value of a family sitting down to eat a home-prepared meal together — but perhaps that meal should be an aspirational option, not a nightly requirement. The family-dinner ideal, the authors write, has become “a tasty illusion, one that is moralistic and rather elitist … Intentionally or not, it places the burden of a healthy, home-cooked meal on women.”

With that said, I shall now open some wine and grill my wife and myself some salmon. After all, the girls are in bed.

TIME Addiction

E-Cigarettes Are Gateway to Substance Abuse and Addiction

An e-cigarette on March 05, 2013 in Paris.
An e-cigarette in Paris on March 05, 2013 Kenzo Tribouillard—AFP/Getty Images

Nicotine, in any form, can prime the brain for harder drugs

For a product so young, e-cigarettes are already generating volumes of research. And the latest, appearing in the New England Journal of Medicine, suggests that e-cigarettes serve as a “gateway drug” — meaning they could make users more likely to use, and become addicted to, other drugs like cocaine.

The wife-husband research team Denise Kandel and Eric Kandel has been studying nicotine for years, and in their earlier work they found that nicotine dramatically enhanced the effects of cocaine by activating a reward-related gene and shutting off inhibition. When mice had nicotine before cocaine, they behaved differently too — they ran around more and spent more time in the space where they were fed, likely driven by a need to satisfy their craving for the drug.

Denise’s epidemiological data shows that similar effects might be occurring in people; most who start taking cocaine were smoking at the time, and her studies showed that nicotine can prime users to turn to harder drugs to keep the reward system satisfied. While e-cigarettes don’t contain the tar and other byproducts of regular tobacco-burning cigarettes, they still rely on nicotine, and the Kandels believe they would lead to similar use of other drugs. “E-cigarettes are basically nicotine-delivery devices,” she says, and Eric agrees. “This is a powerful facilitator for addiction to cocaine and perhaps other drugs as well,” he says. “If people knew that this is in fact the danger … they’d be much less enthusiastic about using nicotine.”

While some, including those in the health community, have supported e-cigs as a tool to help smokers quit, the backlash against them has been building. Last month, the American Heart Association released a policy statement calling for stricter laws, more industry oversight, and a ban on marketing and selling e-cigs to adolescents. Toronto just banned e-cigs from the workplace. And the World Health Organization recommended a host of new regulations around the growing e-cigarette market. At the same time, it’s not clear whether the devices actually help smokers to kick the habit; at least one study found that they don’t.

The Kandels argue that it’s time to consider nicotine’s effect not just on the lungs but on the brain as well. “The fact that this is a significant influence on encouraging or facilitating the use of other drugs is never discussed, and it’s just a major omission,” Eric says.

“We’ve worked very hard to reduce smoking in this country, and I think it’s been a fantastic success,” Denise says. With the introduction of e-cigs, “Now I think we’re on the verge of destroying all of the progress that we’ve [made].”

TIME Addiction

WHO Urges Tighter Regulation of E-Cigarettes

A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013.
A woman smokes an "Blu" e-cigarette in Washington, D.C., on Sept. 25, 2013. Jim Watson—AFP/Getty Images

The United Nations agency acknowledged both the "promise and threat" of the $3 billion industry

The World Health Organization recommended countries adopt a raft of tighter regulations over the sale and use of e-cigarettes Tuesday, including a ban on sales to minors, a ban on “vaping” indoors and tighter controls over advertising and flavored products.

The United Nations agency released a report on Tuesday that acknowledged both the “promise and threat” of the e-cigarette market, Reuters reports. The authors cast doubt on e-cigarette makers’ claims that the devices could help smokers kick the habit. Until those claims had been substantiated by a stronger body of scientific evidence, the U.N. health agency recommended that countries adopt regulations that would “minimize content and emissions of toxicants.”

Suggested regulations include restrictions on advertisements promoting e-cigarettes as a healthy alternative to smoking, prohibitions on sales to minors and sweetened flavors that might appeal to minors and a ban on using the devices indoors. The Food and Drug Administration proposed similar restrictions on sales to minors and advertising of e-cigarettes in April, but stopped short of banning television advertising or sweetened flavors.

The report comes amid a widening divide in the scientific community as to whether e-cigarettes constitute a help or a hindrance in the battle to stop people smoking. A group of 53 scientists signed an open letter to the WHO earlier this year urging officials to resist any measures that might suppress sales of e-cigarettes, calling them “part of the solution” in the fight against smoking.

[Reuters]

TIME Gadgets

The 4 Naggiest Products Ever…and Why You Want Them

Somewhere around my son’s 14th birthday, I grew weary of “gently reminding” him to stop wolfing down his food and to clean up his room. Of course he called these gentle reminders nagging, and we both came to realize it wasn’t a good thing. So how do you help someone who needs some coaching or gentle reminders to get out and exercise, sit up straight or quit a bad habit? We’ve found some gadgets and apps to help with that.

New devices equipped with Bluetooth Low Energy, which have enough battery power to run for days, alert you to your stats and behavior patterns. From eating to quitting smoking to practicing good posture, there’s a device to remind you of your good intentions — and unlike your parents, spouse or friends, if they start nagging too much, you can always turn them off.

Lumo Lift Posture Sensor

lumo lift
Lumo BodyTech

When I was growing up, my grandmother always reminded me to sit up straight. I straightened my back whenever the words came out of her mouth, whether I was standing up or sitting on the couch.

Lumo Lift is a wearable device that looks like a lapel pin with a magnetic clasp. The built-in sensor buzzes or vibrates to let you know when you’re slouching, gently nudging you to regain proper form. The vibration frequency can be adjusted to your preference.

If you need a visual reminder of how your posture can slip during the day, prop up your mobile device on your desk and watch the app react to your movements. As your body slouches, the stick figure on the screen slouches as well. As you straighten your back and open your shoulders, the figure does too — while displaying a happy face.

Like other fitness devices, Lumo Lift can track your daily activity to see if you’re reaching your goals. Aside from reminding you throughout the day, the app lets you see how much time you spend sitting, what distance you walked or how many calories you burned. Battery life is about five days. Lumo Body Tech calls this positive reinforcement throughout the day; I say it acts just like my grandma.

Price: $99 by preorder at Lumobodytech.com

June Sun Exposure Tracker

june
Netatmo

The beautiful, jewelry-like June bracelet from Netatmo measures how long you’ve been in the sun and, just like your mom, reminds you to reapply sunscreen. The sensor in the bracelet tracks UV intensity, sending it wirelessly to a mobile app. You tell the iOS app a little about you: whether you’re fair skinned and what color hair and eyes you have. Based on the local UV index, it calculates your maximum suggested daily sun exposure (which is likely a lot lower than you might think it should be).

If you’ve had too much sun and need to take action, the June will alert you to the need to put on a hat or sunglasses, or just move to a shadier spot. The sensor, made to look like a diamond that glistens in the sun, is available in platinum, gold and gunmetal. You can wear it as a bracelet or a brooch. Netatmo says the battery should last for about a month before needing a charge.

The downside of June is that while it’s splash- and sweat-resistant, it’s not water-resistant, so you need to take it off before you go for a swim — and if it’s tucked into your beach bag while you’re in the water, it’s not gauging your exposure to the sun. While it may not keep you from getting burned, the app is likely to help you become more aware of the damage the sun does to your skin.

Price: $99 at Netatmo.com

HAPIfork Food Consumption Pacer

hapifork
Hapilabs

The HAPIfork is a connected smart fork that lets you know when you’re eating too quickly. Just as your mother repeatedly reminded you that eating too quickly will give you an upset stomach, the HAPIfork measures the time between bites and then vibrates to let you know when you’re eating too quickly. The data collected from the fork is sent wirelessly to an app to track your progress.

Using the iOS or Android app, you can see how many bites (“fork servings”) you take per minute. And HAPIfork wants to be part of your overall healthier lifestyle, not just a nag at the dinner table. There’s a coaching program available with tips and advice to guide you through smarter eating, along with suggested meal plans.

You would think the HAPIfork is dishwasher safe. After all, you eat with it; you’ll want to wash it afterwards. Alas, only the tines and handle are waterproof, which means you need to remove the electronics from the fork before placing it in the dishwasher. HAPIfork says you can wash the entire fork under a faucet by hand.

Add to that the need to keep the fork with you at all times for tracking to be effective, and I’m not sure this one will take a bite out of my poor eating habits.

HAPIfork claims a two-week battery life.

Price: $99 at Hapi.com or Amazon

Quitbit Smoking Tracker

quitbit
Quitbit

If you hear “you really should quit smoking” a lot from a parent, child or spouse, it may be time to fire up the Quitbit. Currently available for preorder, the Quitbit is a battery-powered lighter that measures how often you light a cigarette. That’s right, it counts your smokes. But unlike a nagging spouse, it wirelessly tracks your smoking habits so you can see in real time how long it’s been since your last cigarette. The idea is to help you meet your goals and keep you motivated.

There’s a tiny digital screen on the lighter that tells you how many cigarettes you’ve gone through as well as how long it’s been since your last smoke. The iOS or Android app displays your smoking history and lets you set rules for when the lighter can be used. For instance, you can program it to only light a certain number of times a day or to hold off for two minutes after an initial attempt.

The Quitbit battery lasts for about a week or 100 lights, depending on how much you smoke. Quitbit says it’s received 55,000 preorders and expects to ship the items in December 2014, just in time for New Year’s resolutions.

Price: $150 for pre-order at Quitbitlighter.com

This article was written by Andrea Smith and originally appeared on Techlicious.

More from Techlicious:

TIME Cancer

Nearly 1 in 10 Cancer Survivors Still Smokes

And only about 40% said they planned to quit

Nearly one in 10 cancer survivors reports smoking years after their diagnosis, according to a new study from the American Cancer Society.

Researchers analyzed data from 2,938 patients nine years after their diagnosis, and 9.3 percent were current smokers (within the pat 30 days). Of those patients, 83 percent smoked every day, averaging 14.7 cigarettes per day.

The study, published in the journal Cancer Epidemiology, Biomarkers & Prevention, included patients with the 10 most common types of cancer: breast, prostate, bladder, uterine, melanoma, colorectal, kidney, Non-Hodgkin Lymphoma, ovarian, and lung.

The highest rates of smoking appeared in patients who were diagnosed with bladder (17.2 percent) and lung (14.9 percent) cancer, which are both smoking-related cancers.

Cigarette smoking is known to decrease the effectiveness of cancer treatments, increase the probability of recurrence, and reduce survival time.

“We need to follow up with cancer survivors long after their diagnoses to see whether they are still smoking and offer appropriate counseling, interventions, and possible medications to help them quit,” Lee Westmaas, director of tobacco research at the American Cancer Society (ACS) and lead author of the study, said in a statement.

Of the patients who reported smoking, 46.6 percent said they planned to quit, but 10.1 percent said they did not plan to quit, and 43.3 percent were unsure. In addition, 88.6 percent of the current smokers had quit before their diagnosis.

Researchers also looked at a variety of sociodemographic factors among the patients. Survivors were more likely to smoke if they were younger, female, had lower education, lower income or drank more alcohol. Those who smoked more, were older or were married were less likely to want to quit.

The study suggests the lack of intent to quit in older patients could suggest they don’t believe the difficulties of quitting will be worth the gains in quality of life or life expectancy.

Future studies should examine the importance of psychosocial variables and their relationships to current smoking or motivation to quit, the authors wrote in the study. “Those who smoke heavily long after their diagnosis may require more intense treatment addressing specific psychosocial characteristics such as perceptions of risk, beliefs of fatalism, etc. that may influence motivation to quit.”

TIME Culture

Up in Smoke: The Rise and Fall of Big Tobacco

"According to this survey, more doctors smoke Camels than any other cigarette," is just one of the phrases we no longer hear in commercials

Earlier this week, a $27.4 billion deal was announced that will merge two of the largest American tobacco companies, Reynolds American and Lorillard.

The deal comes at a time when cigarette smokers are at a steady decline. Even so, Marlboro still makes some lists of most valuable brands in the world.

And while it’s hard to remember the days when Camels were advertised as the most preferred cigarettes by doctors, a small segment of the industry is quickly growing: e-cigarettes.

Above, take a quick look at the history of America’s complicated relationship with the addictive habit.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser