Smoke Gets in Their Eyes

Despite Overwhelming Evidence That Smoking Kills, 46 Million Still Do It. What Are They Thinking?

By Jennifer Huget -- Special to The Washington Post

You see them huddled against the wind outside office buildings, cupping hands to protect tiny flames. You see them in their cars, faces blurred by clouds of smoke. You smell them when they're sitting next to you on the Metro. You hear them ask the salesclerk for a pack of Marlboro Lights, and you wonder: Who are these people?

By now, overwhelming evidence shows that smoking ravages your body, encourages fatal disease and shortens your life. And these facts are well publicized, indeed unavoidable: Well-funded anti-smoking campaigns have succeeded in painting the once-glamorized habit as dirty, smelly, costly and unsexy. Bans restrict smoking in all kinds of places where people used to light up. And yet 22.5 percent of U.S. adults -- 46 million Americans -- continue to smoke.

Why? We put the question to several smokers, particularly people you might expect to know better, interviewing them first via e-mail, then by phone; their comments here come from both sorts of contacts. We were not out to endorse their habit, or to preach (although we'd much rather be referring them to the Center for Tobacco Cessation at www.ctcinfo.org, a site funded by the American Cancer Society and the Robert Wood Johnson Foundation). We just wanted to understand it better.

Some told us they smoke because they like the taste -- or because they know how dreadful it feels to quit. Others said they'd developed a universe of habits in which lighting up plays a key role. Many started smoking when they were teenagers playing grown-up. They keep smoking, they said, to reduce stress or boost productivity.

But when we asked experts on smoking behavior, we heard something else.

Martin Jarvis, professor emeritus of health psychology at University College London's department of epidemiology and public health, has spent 27 years trying to figure smokers out; he published his "Why People Smoke" in the Jan. 31, 2004, issue of the British Medical Journal. In Jarvis's view (shared by most of the medical world, including other researchers interviewed for this story), the question can be answered in one word: addiction.

"People's accounts of why they smoke are interesting, but not necessarily reliable," Jarvis writes. "You have to bear in mind that what we're talking about here is drug use, and people may not have accurate insight into how nicotine influences their behavior. So always take [their stories] with a large pinch of salt." Sig Seidenman, a former Air Force pilot and ex-smoker who runs Stop Smoking Clinics at businesses and hospitals in the Baltimore/Washington area, agrees.

People's stories, said Seidenman, who has more than 20 years' experience helping people quit, "are all just rationalizations. [They're] excuses people tell themselves so they don't have to face the stress and strain of quitting. Because they're afraid."

That said, here are their accounts:

'I Smoked Because I Could'

Twenty-eight-year-old Mark Palacio dabbled in smoking as a teenager but didn't take up the habit in earnest until his senior-year college roommate moved out, leaving Palacio with a room of his own. He relished the rush of independence: "I smoked because I could," he said. That was six years ago. He's puffed regularly ever since.

"What's worst," he said, "I write for a medical trade magazine for radiology and cancer care. I smoke because I feel like I have no reason not to. I figure that at a pack a day [of Marlboro menthols] like I'm smoking now, I can go until I'm about 30 before I should seriously consider quitting -- again."

Palacio, who lives in Philadelphia, doesn't hang out with smokers or look for validation in ads. "I never thought there was anything special about the Marlboro Man," he says. He has quit a couple of times -- each time resuming the habit, once after a death in the family made him crave "that emotional boost" that smoking offered, another time after a movie planted the idea.

And then there's alcohol. "Drinking makes it difficult" not to smoke, Palacio said. "A glass of scotch and a cigarette . . . I really like that taste. It's so memorable. When I quit [smoking] and then have a scotch, it tastes hollow. It's only half the taste."

Palacio has a mix of typical smoker traits -- took first drag when as a teen, derives a sense of independence from smoking, triggered to smoke by external cues, ties smoking to other habits or behaviors, aware he should quit but unable to do so -- and the confounding should-know-better fact of working for an oncology publication. It's this complexity across the broad population of smokers that makes it hard to say just who "these people" are.

'I Have Plenty of Years Ahead'

Like many others, Steve Irvine of Gaithersburg fell into smoking when he was a teenager. He hated the taste. "I really don't know why I started," said Irvine, 26. "A lot of my friends did it. I wanted to be in the 'in' crowd. It was nasty at first, but I got used to it."

Ten years later, Irvine, whose job installing parking-garage systems keeps him on the road, said cigarettes don't "taste bad to me anymore." Even so, he said, he's tried to quit -- but found he couldn't. "I felt jittery if I got stressed out," when he wasn't smoking, he said. "I would be not the kind of person you'd want to be around."

"I'll be blunt with you," Irvine wrote in an e-mail. "If I had a better job that was not as stressful, I probably would quit. But as for now, I will continue to smoke."

The stress rationale doesn't move Seidenman. He advises would-be quitters who crave cigarettes under stress to make sure in advance there are none within easy reach.

Irvine noted that two of his grandparents -- both smokers -- recently were diagnosed with emphysema, and he wrote, "I know what can happen to me in the long run." But, he said, "I'm only 26. I have plenty of years ahead of me."

Maybe so. But in the March 9, 2002, British Medical Journal, Jarvis pointed out that "most smokers overestimate the likelihood of stopping in the future and greatly underestimate how long it is likely to take." While some 83 percent of current smokers in Jarvis's survey of 893 Britons said they wouldn't start smoking if they had it to do over again, the study revealed what Jarvis calls a "delusion gap": While 53 percent of those surveyed expected to stop smoking within two years, only 6 percent actually did so.

'I Thoroughly Enjoy It'

If Sue Goodman were to quit smoking today, she said, it wouldn't be for herself; it would be for her husband and dog. Her last dog died of lung cancer, she explained. "I'm a heavy smoker. I know that's what killed him."

Goodman doesn't wish the same fate on her 4-year-old Chesapeake Bay retriever, Bo. But still she smokes -- as she's been doing, at the rate of two or more packs of More Menthol 120s a day, for 56 years (give or take a handful of periods when she tried to quit). That's about 817,600 cigarettes.

Research suggests that nearly all smokers take their first drags in their early teens. Goodman herself started at 14. "My girlfriend and I did it as a lark." At that age, she said, kids who smoked were "aping adults. I just kept it up."

(Not unusual, said Seidenman. "You can't tell a 13-year-old they'll get cancer when they're 55," he said. "They won't care.")

Goodman's long smoking history puts her at high risk of health problems ranging from heart disease to emphysema to any number of cancers.

But Goodman, who lives in Lanham, has so far dodged all bullets. "I thoroughly enjoy smoking, and am surprised I'm even alive after all this time," she wrote in an e-mail. "I have regular lung X-rays which don't show anything negative; do not have emphysema or any difficulty breathing; am a rather sedentary person who does little exercise except for housework and gardening."

Goodman believes she's both physically and psychologically addicted to smoking, not just to the nicotine, which she says gives her a slight buzz, but to her smoking routines. "You go to answer the phone, you smoke a cigarette. You eat, you smoke a cigarette. You work on the computer, you smoke a cigarette," she said. "I don't smoke when I'm taking a bath, though. It can be done; I just haven't done it."

Whether she took to it at the start, she can't recall. But now, Goodman said, "I don't remember ever not liking it."

'No One I Know Has a Problem'

New York computer programmer Bill Williams likes to cite people like Goodman as evidence that medical research linking smoking to poor health is bunk. The founder of the smokers' rights Web site www.smokinglobby.com, Williams said he made a conscious decision to start smoking 10 years ago, when he moved to the city after college. Cigarettes "smelled good," and smoking "seemed like a good thing to do," said Williams, 35.

"I grew up in a household where my dad smoked two packs a day." His dad, who quit when Williams was 15, remains healthy; Williams and his brother are healthy, too, despite all that secondhand smoke. "My girlfriend's parents still smoke, and they have no problems. They're in their eighties."

"I have known many smokers, and I haven't known anyone who had any health problem or death due to it," Williams said. What about all the research to the contrary? Williams is unimpressed. "Nobody's come up with definite proof" that smoking's bad for you, he said. "I don't think the studies are bulletproof right now."

Jarvis isn't surprised by Williams's way of thinking.

"Smokers can also have very rosy spectacles when it comes to judging adverse effects on their health. Older smokers particularly seem to misinterpret the fact that they are still alive and kicking as evidence that their health is not at risk from smoking," said the British researcher.

But Williams remains unconvinced. "If somebody did come forth with a study that did definitely prove [that smoking's bad for your health], I might reconsider. But nobody I know has had a problem."

Seidenman puts a different spin on Williams's rationale. "Okay, I'll tell you what," he said. "Let's meet down by the Washington Beltway with blindfolds on and cross the Beltway. Some of us will make it."

'People Rationalize Bad Habits'

Mary Sherman, 41, knows plenty of people who have had a problem. "My father died of cancer -- he smoked. My mom has emphysema -- she smoked." Sherman herself, who has been smoking since she was 17, is "in the process of quitting -- for the 150th time, it seems."

"I am otherwise a health nut," said Sherman, a paralegal who lives in Falls Church. "I eat organic foods, take supplements and vitamins, visit the doctor regularly, exercise. And yet, up until January, I continued to smoke a pack to a pack and a half a day. Why? Good question.

"The nicotine addiction is one part of it, but addiction to cigarettes is more complex than that," Sherman said. "It has something to do with feeling like you're getting away with something -- being the 'bad girl' yet still maintaining the 'good girl' façade."

Sherman started smoking as a teen, when the rest of her college-bound, academically and athletically successful peer group took up the habit. To her, the act of smoking telegraphed a message: "I'm tough, I'm bad, I can do what I want. I'm independent." Still, after a while, she grew to dislike it: "the way it looked, the smell, the expense." So she stopped -- until her husband, Sam, a nonsmoker, died of a heart attack in April 2003. The stress of that event "got me off on my last round of serious nonstop smoking," she said.

Sherman struggles to reconcile her firsthand knowledge of smoking's devastation with her desire to smoke. Some days, she said, "I look at it somewhat as overeating or drinking too much," she explained. "Why hasten a process that's inevitable? Why speed up your own demise?"

Other times she finds herself thinking, "The heck with it. I like smoking. I'm going to keep smoking." Even when her father died, she said, "in my smoker's mind, it wasn't lung cancer" that killed him. "It was not because of smoking."

"People rationalize all kinds of bad habits," Sherman said.

Seidenman agrees: "Knowing that you shouldn't smoke and not smoking are two different things."

'Quitting Is Worse'

Published statistics on who smokes and why wouldn't likely lead you to sniff out a 59-year-old woman with a college degree and a job that puts her well out of poverty's reach.

Like Elaine Keller. A 59-year-old technical writer who lives in Springfield, Keller smokes about half a pack a day -- down from 2 1/2 packs -- of generic-brand cigarettes, "augmented by two or three lozenges or pieces of nicotine gum." In the course of her work, Keller spends a lot of time tooling around on MedLine, the federal government's online library of health-related research publications, so she's no stranger to smoking's dangers.

"Why do I smoke, even though I know it is bad for me?" Keller ruminates in an e-mail. "Because I know, through bitter experience, that smoking cessation is even worse for me."

Stop Smoking Clinic's Seidenman said Keller's feelings are common. "One of the main reasons people don't join the program is because they think their lives are going to be miserable" when they quit smoking, he said. "These people aren't willing to confront [that discomfort]."

Keller's last attempt to quit smoking -- with the help of nicotine patches, gum and lozenges -- led, she said, to a 35-pound weight gain. Worse, she said, was her loss of ability to focus at work and on the road. When she smoked, she said, "I was producing 10 pages a day" at work; when she quit (with the help of the patch) last December for about five weeks, she said, "I was down to two pages a day."

"It was like, forget it! I can't even read, let alone write," Keller said. "I was also extremely depressed. I can't function, I can't think, I can't even drive a car. I was sleeping 12 hours a day."

So, though she said she's "concerned about my lungs," Keller's still smoking. "I don't think I'm in love with the cigarettes," she said. "The ritual is not important at all. I need the normalcy that nicotine brings. If I could find a way to get nicotine without drawing it in through my lungs, I would very happily give up smoking."

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