Hi, welcome, my name is Evelyn Sikorski, and I’m the Employee Wellness Manager here at the University of Vermont Medical Center, and I’m going to introduce today Elias Klemperer, a doctoral student here at the University of Vermont. I want to just welcome all of you to this livestream. Part of this interview is about the Great American Smokeout and it’s happening on November 16th. A lot of people who are smokers, or if you live with people who smoke, you may have a curiosity about how do I do this, what’s the best way to quit? How can I help someone else? All these questions really come up a lot for people who want to quit smoking. As you know, you might have heard this saying, behind every smoker is somebody who wants to quit. That’s really what this interview is all about, bringing some new awareness, some new ideas, some new research into the mix of helping you decide when it’s the right time for you or helping a family member.
So welcome and I’m going to introduce my guest, my guest is Elias Klemperer and he’s a clinical psychology doctoral candidate at the University of Vermont. He’s funded by the National Institute of Health and Studies with Dr. John Hughes, in the Vermont Center on Behavior and Health. His major research focus is on the role of nicotine reduction among cigarette smokers what want to quit someday but not now. Elias recently received the University of Vermont’s Most Innovative Research Award for unique, progressive and cutting edge research, as well as the National Institute on Drug Abuse Director’s Award, to present his research in the 2017 College Problem of Drug Dependence Conference. Elias is funded by The Center for Tobacco Products at the FDA, to conduct his dissertation on nicotine and cigarette reduction for smokers not ready to quit. He also provides psychotherapy for clients with tobacco use or other substance abuse disorders at the Vermont Psychological Services Clinic in Burlington, Vermont. So we welcome today Elias, to talk to us about the topic of helping people quit smoking. So, welcome. Thanks. That was a long introduction, thank you.
To start off Elias, can you just tell us a little bit about some of the cutting-edge research that you’ve been involved in? Yeah, thanks for having me, for the introduction. Yeah. So the research, I work mostly with Dr. John Hughes, looks at this population of smokers, You know, we have this interesting thing where most people who smoke cigarettes want to quit someday.
Absolutely. The vast majority of those people aren’t ready to quit in the near future, in the next month. So my research really looks at that population as what can we do to increase quitting among these people who don’t want to be smoking cigarettes but aren’t ready to make that quit right now. We look mostly at nicotine reduction, strategies to reduce the amount of nicotine you’re taking in, usually through reducing cigarettes per day that you smoke. But also, I’ve looked a little bit at motivational interventions to increase quitting among smokers who aren’t ready to quit right here, right now. What we found is that interestingly, it looks like greater and longer reductions in cigarettes per day increase quitting among people who weren’t initially ready to quit right now. We’re not quite sure how that affects people who already wanted to quit. So for those who are motivated to quit, we’re not quite sure how reducing actually affects the likelihood that they’ll quit.
We’ve also been finding that a very brief, often no more than 15 to 20 minutes motivational intervention can increase long term abstinence nonsmokers, who initially weren’t interested in quitting right here, right now. So those are some of the major findings that I’ve been working with in the Vermont Center of Behavior now. Then currently, my dissertation is looking at two different strategies to reduce nicotine use among smokers who, again, are not ready to quit right now. The first is the most common strategy, which is just cutting down on your cigarettes per day.
The second is an FDA proposed strategy to actually reduce the amount of nicotine in the cigarettes. So we’re looking at one group of people who are reducing the number of times per day that they’re going through that smoking behavior, the number of cigarettes they’re smoking. The other group of people who’s keeping the same amount of cigarettes, same behavior, but actually reducing the nicotine in those cigarettes. So we’ll see how that turns out. That’s the research cigarettes that are more regulated, not the regular cigarettes.
Exactly, those are not available on the market. Those are products we’re researching right now. Okay, well very interesting. Thanks. I’m sure we’ve got some questions here to ask you, so maybe to leave in some of the research to some of these questions I think that people ask over and over again. What advice do you have for smokers who want to quit now? Someone’s going to try to strike while the iron is hot. What’s the best advice? First of all, fantastic if you want to quit now. That’s exactly what needs to be happening and you’re not alone. True. That is where the vast majority of people who smoke cigarettes really want to quit. And if you’re ready to quit now, the advice is don’t delay.
Do it as soon as possible and, also, use the tools available to you. We know that medication is very effective. Using something like nicotine replacement therapy, the nicotine patch or nicotine gum actually doubles the chances of success in giving quit attempt. Using something like varenicline, otherwise known as Chantix, triples the effectiveness of a quit attempt. Those are very useful tools to help you quit. Those who are interested, we really recommend using medication. Okay, I really like that statement that you said, not to delay, because it’s really easy to get back into that cycle of like, oh, I wanted to do it but then you see someone smoking and you know, you don’t have that quit date or that plan.
Delaying just kind of delays the health benefits of actually taking the leap, I guess. Absolutely. Yeah, putting that patch on, I guess, right? Yeah. We’re going to talk about resources at the end so stay tuned viewers. We’ll give you resources to find the nicotine replacement that you’re looking for, if you are. So back to some advice, based on your research and your knowledge of people, what are some of the successes? What if somebody wants to to quit? They’re not quite ready, they’re not sitting on the fence mode. What’s their strategy? Yeah, great question, that’s actually most people. Maybe some of you who are tuning in today may be considering quitting but not sure if you want to in the near future.
Some advice there is, it looks like if you start by reducing with the intention of seeing how it could help you quit later, that might be an effective way to help you quit in the long term. So like if you smoke 10 cigarettes, go down to eight? Yeah, or even further, maybe cut it in half and see how that affects your ability to quit.
The important part there is when you feel able to quit or when you’re ready to quit. Again, don’t delay. Reducing is a means to quit and we really want to reinforce that message, that reducing helps you eventually to quit. It’s finding that tipping point. Exactly. Like I’m a smoker and I’m a smoke-free person now, that tipping point. Another interesting strategy that a number of studies have found to be pretty effective, is if you’re not sure if you want to quit, try putting a patch on while you continue smoking and see what happens. You might notice that you’re reducing your cigarettes per day, might notice that you have less and less cravings. You might notice that you’re more confident in your ability to quit. But just putting on a patch or starting to use nicotine gum while you’re continuing to smoke, could be a nice way to increase your skill set or your confidence in your ability to quit later.
I know that like in the workplace, for smokers to have to go outside, many people do continue to smoke but use the gum or the lozenge during the workday and refrain, cut back. So that’s an effective thing, right? Yeah, absolutely. It’s an effective way to do that. And there’s resources out that to help get that nicotine replacement so that’s really an important thing. Is it better to quit cold turkey or is it better to reduce? Do you have an opinion on that or see the research? Yeah, I do, and that’s a really great question. I’ll go back to what we started talking about, which is if you’re ready to quit, if you’re interested in quitting, don’t delay. There’s no reason to reduce cigarettes and delay a quit attempt. Instead, quit abruptly, quit right here, right now, and use medication to help you do that.
Really back to this distinction of if you feel like you can quit now and you’re ready to quit now, absolutely do it. If quitting is not an option, then try reducing. Then try this reducing in order to quit later. But if you feel ready to quit, now is the time. That’s interesting, yeah, that’s true. You know, while we’re on the topic, I wanted to go back to an earlier question about people who are ready to quit now. A really important part of that is persistence. We know that it actually takes at least, for a lot of people, five to seven times before you’re successful in quitting. So if you get discouraged at the second or third time and don’t try again, you’re really doing yourself a disservice. We know that continuing to try, if you get caught in that cycle, trying again, if you relapse, trying again, is the most effective way to eventually achieve abstinence.
How true, that can be applied to many habits– Absolutely. …we try to break in life. I know that there’s a lot of talk about the e-cigarette and I definitely want to get this question in from one of our listeners. Is using the e-cigarette a good way to quit regular cigarettes? Yeah, that’s a great question and the short answer is we need more research on this. The research hasn’t caught up to the product yet. But if we take everything we know about nicotine, take everything we know about cigarettes, it would make sense that using e-cigarettes would be an effective way to help you quit regular cigarettes or combustible cigarettes. We know that the nicotine patch, nicotine gum is very effective and we know that e-cigarettes deliver more nicotine that the patch or the gum. So there’s no reason to think that using e-cigarettes to quit smoking would not be effective.
In fact, that are a couple of randomized trials that support that so far but we do need more research before we know that for sure. That’s good to know. And one thing I’ll add to that before we move on, because I know a lot of people are interested in e-cigarettes, the most harmful part of cigarettes is the tar or the smoke. It’s not the nicotine necessarily. So we’re talking about using products like the patch or the gum or even e-cigarettes, we need to keep in mind that the smoke is really what does the harm. The tars are what does the harm, not necessarily the nicotine as much. Right, that’s really good information. Yeah, the tar can definitely muck up the health system. I always remember that quitting smoking is really the number one thing you can do for your health, because of the tar and the residual carcinogens that are in the smoke and all that other stuff.
Absolutely. Yeah, I guess that brings us to that point. In the last question here, before we get to the research that you’re doing and the resources, I wanted to ask you, there’s a lot of people including myself, who have family members who smoke and colleagues even. So how can I encourage them to maybe give this a try, make a plan, strike while the iron’s hot? What’s some advice there? Yeah, great, great question. You know, quitting is really hard and so it makes sense that it’s a repetitive cycle and that people have to try a number of times. As a friend or family member trying to support someone else to quit, providing that support is really important. There’s this common conception that people make change in response to a big ah-ha moment or this big realization. In fact some of the research suggests that we tend to make change after repetitive reminders, repetitive cues.
So it might be more important to have a larger number of reminders to quit smoking from different sources. From a family member, from a doctor, from an advertisement on TV, from another loved one, than to have one big, emotional breakthrough. So as a family member, we can provide some of those reminders. We don’t want to be nagging, but a few reminders about why we want them to quit, how we can support them to quit and how important it is to quit can be very useful.
That’s interesting, I remember walking up the stairs with a friend who was a smoker and she was so out of breath. She said, “Oh, I really need to quit smoking.” And I thought, well, this might be a good time for me to say something, which I did and got her to some of the resources and she made some quit attempts. I think it’s as simple as that, just to be able to speak up and listening to when the time is right when a loved one or co-worker is just kind of putting it out there. But we may know the resources and they may have forgotten or don’t know. So, interesting, that’s great. Tell us why someone would want to be part of a research project and how would they get in touch with research? Yeah, there’s a lot of really exciting research going on at the Vermont Center on Behavior and Health. We talked briefly about some of those reduced nicotine cigarettes. There are a number of studies looking at those products right now at UVM.
We also have a study going on with e-cigarettes, with withdrawal symptoms. If you’re interested in learning more, if any folks are interested in learning more about the research going on at the Vermont Center on Behavior and Health, you can go to UVMs website and look up VCBH or Vermont Center on Behavior and Health. All of our studies are listed there along with some information about those studies. Great, and I guess our message here today is don’t delay. You have some new ideas, I think some new information on how to kind of tackle a big health problem in a new way.