More than anything, Gerrie Steed noticed the difference in smells when she quit smoking.
“All of a sudden, you can taste your food. You can smell,” she said one afternoon in March, five weeks smoke-free. “It was like I woke up.”
While advocates and state lawmakers spent February and March attempting to restrict smoking in shared public and workplaces, Steed visited a weekly group hosted by the health department and The Medical Center aimed at helping her kick the habit she’s held reluctantly for 26 years. On Tuesday, she’ll leave her last meeting as a former smoker.
Opponents to the legislation say business owners should have control over whether to forbid smoking in their establishments. In Kentucky, where the adult smoking rate sits at 28 percent (the highest in the country and 10 points higher than the national rate in 2012), proponents of smoking regulations say they’re in for an uphill slog.
‘We’re fighting culture’
The U.S. surgeon general submitted a report in January marking 50 years since the first report linked smoking and health problems.
Cancer. Respiratory disease. Cardiovascular disease. Kentucky ranks highest in rates of incidence and death because of lung cancer, according to the Centers for Disease Control and Prevention.
The surgeon general’s report also links smoking to Type II diabetes, colorectal cancer and eye problems.
“Some of these things we thought, but now there’s causal research,” said Carol Douglas, co-chairwoman of the Smoke Free Communities Coalition who works for the Barren River District Health Department.
The coalition meets quarterly for updates on various fronts. In March, a little more than a handful of regional health workers and supporters sat around a sturdy conference table in a small room at the health department on State Street in Bowling Green. Douglas led the meeting, listing accomplishments big and small:
•Signatures and surveys from multiple counties are stacking up in support of smoke-free indoor workplaces and public places.
•The Brickyard Cafe in Franklin and other businesses voluntarily changed their policies to restrict smoking inside their establishments.
“Some of them have been waiting for a local law or ordinance to go into effect for the state,” Douglas said. “Since that’s not happened, guess what? They’re doing it on their own. They’re sticking their toe in the water and they’re finding out, ‘Hey, we’re seeing people we’ve never seen before.’ “
•Butler, Logan and Simpson counties have launched a spit tobacco campaign that focuses on youth baseball and softball players.
•The Medical Center is targeting high-risk smokers for lung cancer screenings.
•A case before the Kentucky Supreme Court will determine whether a board of health can enact smoke-free regulations without prior legislative action from a fiscal court or municipality. It questions one of several ways local communities have tried to pass unpopular smoking policies.
“The future of Kentucky is very dependent on what we’re doing right now,” Douglas said. “We know we can change things through policy. ... If it were a courtesy issue, we wouldn’t have to have an ordinance. But we’re fighting culture.”
Culture is the point of greatest frustration and motivation. Amid impassioned discussions of how Kentucky ranks among other states in its poor health – of whether policymakers are acting on a responsibility to the majority – Dr. Gretchen Macy, a Western Kentucky University public health professor, quietly explained she could never stop fighting for a healthier state.
Macy, a Kentucky native, said she feels obligated to help no matter how long the process takes.
Policy remains a lofty goal for public health workers. Just as it takes an average of seven attempts to quit smoking, it takes years for policies to change. Douglas led the coalition through about eight years of advocating a smoking ordinance in Bowling Green before it passed in 2011. Lexington passed a law in 2003. Louisville had one two years later. In total, 23 Kentucky communities have legislation in place, Douglas said.
For smokers who try to quit, attempts typically fail until the individual finally believes his or her life would be better without tobacco. Macy said it’s a matter of “getting into their value system,” so it becomes a personal choice.
‘It’s something I wanted to do’
Steed moved to Bowling Green from Jacksonville, Fla., in 2012, joining family already living here. She brought with her an expensive smoking habit and a host of health problems.
After undergoing brain surgery, Steed lives normally, but doesn’t work. She is affected by a disease called trageminal neuralgia, a nerve disorder that causes extreme pain in the face. Her condition isn’t caused by smoking. She said a “breath of wind” can still set off an incredible amount of pain. But since she’s quit smoking, her symptoms have noticeably diminished.
In describing her path to quitting cigarettes, Steed is matter of fact until she talks about the pain that has faded and the senses that have improved. Then she’s giddy.
“Since I quit smoking, things just feel like they’re a little more calm. ... It’s not nearly as severe as it was back when I was smoking five weeks ago,” she said. “Just five weeks!”
She smoked a pack each day of premium brand 120s – the longest, most expensive kind of cigarette. They cost her, she guessed, $130 each month. That’s about as much as an electric bill, she said. She could absorb the cost when she worked, but now that she’s on disability, she knows she would have to quit smoking or cut out other expenses.
She smoked one cigarette for 20 minutes and she never smoked in the house. By the afternoon, she realized she’d been sitting on her deck most of the day.
“To not smoke anymore is hard. It’s really hard,” Steed said. She uses a nicotine patch to help her quit. “You get used to certain times of the day that you know you’re going to smoke, like, for example, first thing in the morning. So I miss that a lot. You know, it’s just a habit.
“The next time would be right after a meal. It doesn’t matter if it was a snack or a yogurt or a full meal, you had to have a couple cigarettes afterward. ... Now I’ve learned different things to do with my hands. I’ve started sewing, doing different crafts, working puzzles. It’s a little different for me because I don’t work, so I don’t have anything pressing that pulls me away from it.
“I used to smoke in my car. It’s hard to get in my car and not smoke there. You’ve got all these little triggers.”
As the years went on, her morning routine added a deep, painful cough.
“High blood pressure, high cholesterol. Pretty much I was a prime candidate for having a stroke or a heart attack. My coughing got to the point where I was actually vomiting because it was so deep trying to get that stuff up. ... It all stemmed back to the smoking.”
Steed tried to quit three times on her own. She faltered for various reasons, but in the most recent attempt, she resumed after 10 weeks smoke-free to handle the stress of her father’s heart attack.
Last year her mother suggested she try a support group-like class called the Cooper Clayton Method offered by the Barren River District Health Department in several counties. She joined one in February led by Douglas and hosted at The Medical Center in Bowling Green.
Steed points to the weekly meetings as a source of motivation and education that made quitting possible. Besides pinpointing weekly withdrawal effects and offering healthy diet tips, the setting maintains the social aspect of smoking.
“All my friendships started while smoking together outside,” Steed said. But now in the Cooper Clayton group “not only am I building new friendships, I’m also answering to them, per se. I don’t want to let them down as much as they don’t want to let me down.”
She was the youngest member of her group, which started with about a dozen participants and whittled down to five after a few weeks. They related to the struggle to quit and the threat to their health if they didn’t, Steed said.
Her family offers another branch of support. When she smoked, she said, she missed out on family time when she stepped outside. Now she calls them when she’s “having a moment.”
Throughout the 26 years she smoked, Steed was aware of the health problems she could incur. She noticed the difference as tobacco advertising went away and was replaced by anti-smoking public service announcements. She identified with sick smokers portrayed in campaigns.
In Florida, when co-workers complained about the cloud of smoke they walked through to get into the building, a new sign was posted to restrict the outdoor smoking area. This angered some who smoked, but Steed said she sympathized.
“I completely understood,” she said. “I don’t want anyone to pay for my choices.”
Still, it took her years to quit – to really want to quit. This time differed from the others.
“It’s something I wanted to do,” she said, pointing her finger at herself.
Her last class is Tuesday. She worries a little about taking off the last patch, but she’s confident she won’t go back to smoking.
“I don’t have any cravings at all,” she said. “I wake up in the morning and don’t think about it.”
‘Smoking has become a dirty word’
In policy-making, advocates wait for the right circumstances, too.
Dr. Cecilia Watkins, another WKU public health professor, helped Douglas push for the city council to approve its smoking ordinance.
It took years to get three affirmative votes, despite petitions – despite forums that put experts on a stage to explain smoking’s effect on health and business.
“Until we got three people to vote for it, we couldn’t win,” Watkins said.
Researchers found local indoor smoking bans had no negative economic impact on Kentucky communities, according to a study published in Nicotine & Tobacco Research in 2011.
Despite the data, state legislators shy away from passing a law. A bill in the legislature this session that would have banned smoking in public places and private businesses passed a House committee but never made it to a floor vote. This is the first year a bill was proposed in the Senate.
When the session ends April 15, restricting sales of e-cigarettes to minors will be all advocates have to show for their effort.
In January and February, the tobacco industry paid $188,380 to lobby the General Assembly, according to the Kentucky Legislative Ethics commission. The Kentucky Farm Bureau, which has said it lobbied against the statewide smoking ban, spent nearly $40,921 in those two months.
“You’ve got a lot of people here playing politics with people’s health in Kentucky,” Watkins said.
Steve Pratt, manager of the Burley Tobacco Growers Co-op, said the co-op (owned by tobacco growers in five states) is opposed to a statewide law against indoor smoking because it takes away personal choice. A former smoker, Pratt compared smoking to other risky behaviors – a diabetic person eating chocolate or a speeding driver. But the reaction to smoking is stronger, he said.
“Smoking has become a dirty word. It’s gotten to this point where if you tell someone that you smoke, it’s like, ‘Oh, you smoke,’ “ he said, adding a tinge of disgust to his voice.
But where opponents maintain a law would step on personal freedom, Macy and Watkins say a smoking law serves the greater good.
“One of the things we really try to do in public health is limit the amount of infringement on individual rights,” Macy said. “Obviously, the evidence is there that this is not just an individual level behavior. It’s something that impacts everything around you.”
Rod Keugel, president of the Council for Burley Tobacco, is the third generation to raise tobacco on his farm in Owensboro. He’s never used the product that keeps his farm on its legs.
“Nothing sustains this farm … like tobacco,” he said.
Burley tobacco accounted for 29 percent of U.S. tobacco production in 2011, according to the Agricultural Marketing Resource Center. That same year, the U.S. exported $1.15 billion in tobacco. Recent years have boasted “record high” export levels, the AgMRC reported.
Pratt said about 70 percent of burley tobacco is exported.
Keugel has found common ground with anti-smoking advocates. “I certainly don’t like riding in a car with people who are smoking. There are some limits.” He called his legislator on behalf of Tobacco Free Kids to support the smoking bill this session. He separates policy that addresses the health effects of smoking from his livelihood of growing tobacco.
“Some people see a controversy there, but I don’t. It’s not good for you. You shouldn’t use it,” Keugel said. “I can grow it safer than any other place in the world. We have regulations on what we can put on it, how it’s produced. It’s one thing to contain nicotine. It’s another to consume it when it’s laced with some unknown insecticide.
“You aren’t going to stop everybody from smoking in the U.S. But until they do, I’ll grow it.”
Macy said the most attainable way to eliminate smoking involves preventing people from picking up the habit. The Surgeon General report this year offers a bold goal to “make the next generation smoke free.” Kentucky Gov. Steve Beshear set a goal to reduce the state’s smoking rate by 10 percent in five years.
“You throw up obstacles and roadblocks that keep people from starting,” Macy said.
Roadblocks, such as CVS Caremark’s announcement in February that its stores will stop selling tobacco by Oct. 1, and Beshear’s proposal to raise the state cigarette tax from 60 cents to $1 would likely restrict access to tobacco, especially to minors.
In the absence of statewide legislation, public health experts such as Douglas work to “make the healthy way the easy way” by improving workplace and community support for people who want to quit.
“Kentucky is the right state for it,” Watkins said. “The No. 1 thing is going to be a policy, but you can’t just sit idly by.
“The best thing you can do is awareness and education. Again, getting into people’s values, and how do you get them to change that cultural thought that this is the norm, so it’s the way it’s got to be? A lot of people don’t like change. How do you get people to change?”