Despite medical research, advocacy, and educational campaigns, cigarette smoking remains rampant in the United States, and the health effects continue to mount.

To ramp up the campaign for lung health, the American Lung Association has instituted a “National Volunteer Medical Spokesperson Program.” Now in its fourth year, it has designated 18 professionals as volunteers. One of them is Jamie Garfield, associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University.

Jamie Garfield is an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University.
Courtesy of Temple
Jamie Garfield is an associate professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University.

Her specific clinical and research interests include lung cancer, tobacco use, and gender disparities in lung disease.

We spoke with her recently about lung health.

What is the burden and impact, specifically on women, of tobacco use and what is being done to reduce this burden?

Tobacco use is the single largest cause of death and disease in the U.S. Cigarette smoking kills almost half a million Americans each year. In addition to illness and the direct medical costs, there is also a loss of productivity. So the impact of smoking-related disease cannot be underestimated.

Although cigarette use is higher among men than women, health-related effects of tobacco use are greater in women. There is something about our chemistry, our hormones, the size of our airways, or our metabolism of nicotine that puts women at greater risk.

A tobacco-free society is our goal. We can advocate for proven tobacco control strategies such as smoke-free restaurants and public spaces and higher taxes on smoking products. States can prohibit things like flavors in e-cigarettes. Research has shown there are more than 7,700 different flavors, which clearly targets young adults and youths.

One of the ways the ALA has focused on getting nicotine and tobacco out of the hands of children is to advocate for “Tobacco 21” policies that increase the age limit for sales of tobacco to 21. So far, 15 states, including New Jersey, have passed this legislation. But in Pennsylvania, you can still buy cigarettes at age 18.

Smokers want to quit, but how? Is it more difficult for women?

I want to stress that everyone can quit, and you don’t have to quit alone. There are resources. There are support groups. Information is available through the ALA’s Freedom From Smoking program and locally at the Temple Lung Center. In addition, quit attempts with the help of pharmacotherapy, like nicotine replacement therapy, can increase your chance of success.

Your health-care provider should explain what is available, how it works, and what the risks are. It often takes many attempts before successfully quitting.

It is interesting that it is more difficult for women to quit than it is for men. Some of this has to do with triggers – emotional prompts, and reminders of smoking such as seeing an ashtray or having a cup of coffee in the morning. Women seem to be more susceptible to these triggers. Additionally, many women have concerns about weight gain after quitting smoking.

What about vaping?

When vaping first came onto the market, it was advertised as a smoking-cessation tool. But no e-cigarette has been found to be safe and effective by the FDA to help smokers quit. They are tobacco products.

E-cigarette use is an epidemic among youths. It is the most commonly used tobacco product among kids. One study has shown e-cigarette use among high school students increased by 78% between 2017 and 2018.

There are many reasons for its popularity. E-cigarettes don’t have a smell. You can smoke an e-cigarette and your mom and dad won’t know; your teachers at school won’t know. In fact, some e-cigarette cartridges look like USB drives. Parents and teachers don’t know what to look for. They don’t even know that they need to be having this conversation with their high-school or even middle-school kids until it’s too late.

Almost all e-cigarettes contain nicotine, and we know that nicotine is addictive and can harm adolescent brain development. In addition to nicotine, there are many other harmful chemicals in e-cigarettes — including acrolein, an herbicide — that can cause irreversible lung damage and lung disease.

The U.S. surgeon general has issued a report concluding that the use of e-cigarettes causes clear health risks, but the FDA has still failed to act to fully regulate e-cigarettes and protect kids. We cannot control what any e-cigarette contains. We certainly haven’t studied all the health effects. And we don’t know the long-term outcomes. If we sit by and don’t do anything, we’re going to see an increase in tobacco-related disease and another generation of tobacco-addicted Americans.

How would someone know if they have chronic obstructive pulmonary disease? What about screening for lung cancer?

COPD is the third-leading cause of death in the U.S., surpassed only by heart disease and cancer. It’s not decreasing nearly as quickly as the other two. And there’s no cure. Smoking is the primary cause of COPD, but it is not the only cause of COPD.

More than seven million women in the U.S. have COPD, and probably millions more have symptoms but are not diagnosed. This is because COPD is still thought to be a man’s disease. Many doctors don’t expect to see it in women, so they miss the proper diagnosis. The diagnosis is made with a test called spirometry, which is simple and painless. It takes about 15 seconds. Primary-care practices should all have spirometry.

As for lung cancer, the statistics are really sobering. Lung cancer is the No. 1 cancer-killer of women — more than breast cancer, ovarian cancer, and cervical cancer combined. It has the lowest five-year survival rate of all cancer types. Interestingly, in the last 41 years, the rate of new lung cancer cases has fallen 35% among men, while increasing 87% among women. This, in part, reflects differences in smoking patterns between men and women, but it also has to do with genetics, the effects of hormones, and exposures to indoor and outdoor air pollution.

Although there have been important advances in the treatment of lung cancer, we know that the greatest impact on lung cancer mortality is early detection. For high-risk individuals, screening with a low-dose CT scan reduces lung cancer mortality more than any chemotherapy or innovation in surgery ever will. This is why it’s so important for patients to ask their doctors if they should be screened.

What can people who don’t smoke do to improve lung health?

I can listen to my patient’s symptoms and history, I can recognize their risks, and I can screen them and treat them where appropriate. Everyone can also test their home for radon, a naturally occurring odorless, invisible gas that is the second-leading cause of lung cancer.

While these are proactive steps, I can’t control the pollution they breathe. Every year, the ALA puts out a State of the Air report that grades the air quality of metro regions. This year, the report found that four in 10 Americans live in a county with unhealthy air. Many places in the country have started to see more unhealthy air days than healthy air days.

So if people want to improve their lung health, they can advocate for clean air. They can support organizations and policies that are taking action on climate change and ozone and particle pollution. That’s the only way to do it.