I’m Dorothy Hatsukami, Ph.D., a professor of psychiatry and a cancer researcher. I’ve conducted studies on tobacco addiction and its treatment for over 30 years. Recently, I worked with NPR’s Life Kit podcast on an episode about how to break the s...

Have you ever tried a cigarette?

I was an occasional smoker in the past. I don't currently smoke!

Thank you so much for all these great questions! Best of luck in quitting smoking. Feel free to listen to the Life Kit episode on how to quit smoking, with help from science. — Dorothy

How come some people can smoke their whole lives and die in their 70s-80s? Are they the mutants, or are the people who can't do that the mutants?

There are genetic differences in how people's bodies respond to cancer-causing chemicals and other toxic substances. Unfortunately, we don't know who will die prematurely from cigarette smoking and who will not. It's important to remember that about half of long-term smokers will die prematurely from a tobacco-caused disease, so better to quit now!

Do the urges to smoke ever go away completely?

I smoked for a decade (about 3/4 pack to a pack a day) and I’ve been tobacco free for going on 4 years now (I never vaped, even when quitting). About once a month or so, I’ll get an urge to smoke (typically when I’m drinking and socializing with friends who smoke). The urge is relatively easy to ignore and passes fairly quickly, but do those cravings ever go away? If so, how long does it typically take for them to fade completely?

Thanks in advance for your time and insight!

Ex-smokers differ in the length and intensity of their cigarette urges. Situations that have been paired with nicotine in the past can be tenacious in precipitating urges to smoke. It sounds that you have successfully resisted these urges and it is important to keep in mind that they will pass quickly each time you experience one. Make sure that you don't fool yourself into thinking you can have just one cigarette!

I quit 12 years ago with Chantix. For me, it was the only thing that helped.

Now that Chantix has been on the market for a long-ish time, are you seeing any newer long-term side effects from it?

None that have been currently published.

I am 11 days from 1 year smoke free after about 45 yrs of smoking (eventually) 2 packs a day not 1 cheat or even vaping or smoking pot NOTHING! The first month I ate candy, but that's it, since then I'm eating what I always ate, why am I gaining so much weight?

Congrats on your smoking cessation success. Nicotine can accelerate your metabolism but that does not mean that you should go back to smoking. The best course of action is to be careful about what you eat and to engage in physical activity. However, if you are concerned about the extent of weight gain, you might go see your physician.

Is quitting smoking the most important health goal for a person who smokes or is quitting nicotine the real goal? The continuum of risk places smoking on the riskier end of the scale than nicotine, is that a correct interpretation for people who smoke?

Quitting nicotine is the ultimate goal, but quitting smoking is a good step in the right direction. Smoking is by far the most toxic tobacco product.

I’ve quit for 28 days so far after 16 years of smoking. I’m now vaping instead... do you think this is a safer alternative? Can you offer any advice or what your thoughts and opinion are about this method of quitting? Thank you!!

Vaping nicotine has significantly fewer harmful chemicals than cigarettes, but the long-term consequences are unknown. Congrats on stopping smoking, but you might also want to consider making it a goal to also stop vaping.

Dr. Hatsukami, your research provided much of the support for the FDA’s advance notice of proposed rulemaking (ANPRM) to develop a tobacco product standard to set the maximum nicotine level for cigarettes. Regulations to cap nicotine levels in cigarettes were removed from the Unified Agenda, indicating it is not among FDA’s “most immediate priorities.” Do you think the FDA is still committed to working on this regulation? Do you think they should continue to advance this regulation to prevent new smokers and/or help current smokers quit?

I think that reducing nicotine content in cigarettes remains a priority for the FDA. I think we should continue to look at ways to dramatically reduce the disease and death caused by combusted tobacco products. Reducing nicotine in cigarettes would decrease the progression of experimentation to dependence in youth and help people quit smoking more easily. It has been projected that 8.5 million lives will be saved in the US by 2100 if a product standard to reduce nicotine on combusted products was implemented.

Do you feel that nicotine replacements, like the patch, gum etc are helpful, or is it better to rip off the band-aid?

Nicotine replacement can increase success rates for quitting smoking by almost two-fold.

How to break the habit of smoking once and for all?

The best way to quit smoking is using a combination of behavioral treatment and medications. For behavioral treatments, you can contact your state's quit line or smokefree.gov. There are a number of medications that are available to quit smoking that are over-the-counter or by prescription. The most effective medications are Chantix or a short- or long-acting nicotine replacement therapies. For example, combining gum and patch, or lozenge and patch. Ask your doctor what might be right for you.

How do you know if the person is a heavy smoker ?

Usually, they report smoking their first cigarette within 30 minutes of waking up.

Why and when do people start smoking?

The majority of smokers begin smoking before the age of 18 years old. When kids are younger, they are often exposed to peers or family members who are smoking, so there’s an element of role-modeling. Once they start experimenting, the addiction to nicotine can really take over, even if they think they won’t be addicted. About 1/3 of adolescents who try smoking become regular smokers.

I smoked for about ten years, but never more than 1-2 single cigarettes in a day, and not every day, sometimes going months without one. Most health forms ask how many packs a day smokers go through, how much does that small amount affect me now that I've quit? Is it something I really need to keep putting on all my health forms?

It's great that you quit, because even smoking a few cigarettes can increase your risk for cardiovascular disease. It is still a good idea for your doctor to know your history.

What are some actual stats on the increased risks for cancer or other diseases from smoking?

Sorry that I don't have the actual figures memorized, and it varies depending on the disease, but it is important to know that cigarettes increase the risk for 12 different cancers, cardiovascular disease, pulmonary disease, and negatively affect reproductive health. Smoking long-term kills 1 out of 2 consumers.

Dr. Hatsukami, much of your research has investigated very low nicotine cigarettes (VLN), manufactured by the company 22nd Century Group. This company has a Tobacco Products Scientific Advisory Committee (TPSAC) in a couple of weeks (Feb 14) to discuss its Modified Risk Tobacco Product Application (MRTP) seeking approval for the ability to disclose and market their cigarettes as “reduced exposure” to nicotine. Do you think the TPSAC will vote to approve their application? Do you think the FDA will ultimately approve their application? Do you think their product will be useful in helping people to quit smoking?

I can't answer this question. We will have to wait for the TPSAC response to the application.

do smoking cessation programs also work for non-smoking tobacco users (moist snuff, chew, etc.)?

Yes, the principles are the same, so they should work. However, some medications have not been found to be effective for some tobacco users, such as those who use smokeless tobacco. For example, nicotine replacement therapies are not effective, but Chantix has been found to be effective for smokeless tobacco users.

Do you believe that tobacco addiction is different enough from other chemical addictions that a person can be considered "sober" if they have stopped all other chemicals but continue to smoke?

Regardless of whether you call yourself sober or not, if you continue smoking but quit other substances, it would be best for your health if you also quit smoking. More people die of smoking-related illnesses than alcohol and drug abuse combined.

What role do you see VLN cigarettes playing in the future fight against nicotine addiction? What are your thoughts on the NPRM for Nicotine Reduction in combustible cigarettes being "shelved" by the FDA?

I do not believe that the FDA has shelved the idea of reducing nicotine content in cigarettes.

How could I help others to reduce the urge of smoking and end their habit ?

One thing to remember is nagging does not help. The best approach is to know what might be high-risk situations for the smoker and think about ways to avoid these situations or find alternatives to smoking when these situations arise.

is it healthier to smoke plain tobacco without all of the additives let's say to roll your own smokes?

Rolling your own cigarettes is just as unhealthy as conventional cigarettes. They have the same types of toxins in them and they are burned. All combusted tobacco products expose you to a number of cancer-causing chemicals and other toxins that cause cardiovascular and lung disease.

What do you think about very low nicotine products? Do they have a chance to help people quit?

Very low nicotine products might help people quit, but they have not been proven to be a cessation tool yet.

I remember helping my college roommate quit smoking. Poor guy smoked a pack a day and his hands were trembling. What in the cigarette/nicotine causes this reaction? Also are cigarette companies also the same ones selling the patches to quit --- seems mad shady if so...

It's difficult to know why the person experienced trembling while smoking. We do see tremor as a withdrawal symptom. With regards to tobacco companies also selling nicotine patches, I am not aware of any at this time.

What are tell-tale signs of chewing tobacco can be seen in person with tobacco addiction? What are long term consequences of chewing tobacco?

There is a great deal of variability in the amount of harmful chemicals in chewing tobacco in products sold in the U.S. Some have high levels of harmful chemicals while others tend to have lower levels. Smokeless tobacco has been shown to increase oral and esophageal cancer, pancreatic cancer, fatal heart disease, fetal toxicity and gum disease. However, some products have lower risk of these diseases based on the levels of harmful chemicals in them. The telltale sign for smokeless tobacco use, if a male, is a tin ring in their back pocket!

Can e-cigarettes help to break the habit of smoking?

There is limited evidence that e-cigarettes are an effective smoking cessation aid at this point in time. There was one large study that was conducted in the United Kingdom that showed e-cigarettes were more effective than nicotine replacement therapies, however, many of the people continued to use e-cigarettes even after a year. There is also some evidence that shows that people who use e-cigarettes more frequently might be more likely to quit smoking. It is not an FDA-approved cessation method, and the best approach is to use the FDA-approved medicines.

I'd read an article on a study into the effectiveness of nicotine on ADHD. It also claimed that bare nicotine just by itself was difficult to become addicted to. Considering I haven't heard anything else on the topic aside from that one article, was that just bunk science or is there any truth to the matter?

Currently there are more effective drugs for treating ADHD than nicotine. The science is not sufficient to support using nicotine for ADHD. Nicotine replacement therapies are typically less addictive than other tobacco products because of the slow absorption of nicotine in the body.

Is there any research on the effect of single serve (ie one cigarette) sales on quitting rates?

I am not aware of any research in this area.

Will the US continue to make vaping the devil, totally ignoring UK models of success, until Big Tabacco takes over the market? Is that why it is only Juul being attacked, because they are 65% independently owned and Marlboro's vape flopped in the US. All other major vape companies are 100% owned by the tabacco industries.

it's always about money over morals

Right now, the FDA has banned all flavors except menthol and tobacco for cartridge-based systems. However, they have allowed flavors in tank-based systems provided that the manufacturers are not promoting or marketing to youth. The Health and Human Services Secretary thought that this current approach would serve as an off-ramp for cigarettes smokers, who are unable to quit nicotine, and prevent it being on on-ramp for youth (who are most attracted to cartridges). In May of 2020, all manufacturing of e-cigarettes will need to obtain approval from the FDA for continued marketing of their products. We will see at that time which products remain on the market.