ST. LOUIS - Eric Wolbert has been a nonsmoker for 30 days.
He quit his pack-a-day habit because he's watched cigarettes hurt too many people, including his grandparents, who died of lung cancer, he said.
Plus, smoking's getting too expensive.
"You can't find a pack that costs less than $4 anymore, and those are nasty ones," said Wolbert, 36, of Waterloo, Ill. "Right there, that's $2,200 a year up in smoke."
Wolbert signed up for Freedom From Smoking at Washington University's Siteman Cancer Center. It's a seven-week group-therapy session that takes place at other area hospitals, including St. Louis University Hospital and St. John's Mercy Medical Center.
This is Wolbert's third attempt at quitting. The first two times, his doctor prescribed Chantix, a drug that blocks nicotine receptors in the brain, and wished him luck.
Wolbert, who learned of about Freedom From Smoking from a co-worker, is confident he'll succeed this time.
Health and family organizations believe that the economic downturn, combined with higher tobacco taxes, makes this a good time for health care providers to help people like Wolbert quit smoking. And yet, they say, that's not happening.
Recently the American Legacy Foundation in Springdale, Ariz., which focuses on family health and wellness, conducted a survey of smokers. It found that about 78 percent of those in St. Louis (70 percent of those nationwide) are thinking about quitting, but only 32 percent have talked to a health care provider about it.
And even when they did, slightly more than a third were offered prescriptions for over-the-counter nicotine replacement products or prescription drugs like Chantix. Only 15 percent were offered self-help materials, informed about classes and counseling programs, shown a video about quitting or referred to a cessation specialist.
Matthew Kuhlenbeck, program officer with the nonprofit Missouri Foundation for Health, attributes this to a prevailing "don't ask don't tell" attitude in doctors' examining rooms.
And that's a shame, he said.
"In many ways, doctors are the best advocate for getting an individual to never start or quit," Kuhlenbeck said. "They carry a lot of weight with their patients."
Experts point to embarrassment on the part of smokers who have tried unsuccessfully to quit in the past as one reason they don't bring it up.
"Maybe it's OK for them to ask their doctor for help the first time, but what happens when you go back a year later and say, 'I need another prescription,' or 'I need to try again,'" said Michelle R. Bernth, spokeswoman for the American Lung Association. "It adds another layer to the smoking cessation that's not there with other conversations in doctors' offices. Although it's completely normal to have to try six to nine times, a lot of people view it as a failure."
The same goes for a lot of doctors, said Dr. Mario Castro, professor of pulmonary and critical care at Washington University School of Medicine.
"They're fatalistic about it," he said. "After they've tried getting a patient to quit a couple of times, they get discouraged. But I tell them that quitting is the most effective tool we have to lower the risk of lung disease and heart disease. And the more times they try to get patients to quit, the more chance they have of being successful."
Castro adds that a lot of doctors don't incorporate discussions about smoking into their general assessments of patients because they're too busy.
"They're usually focused on medical problems, but we try to encourage them to think of smoking as a vital sign," Castro said. "You get their blood pressure, pulse, height and weight, and if they're a smoker, you ask if they're interested in quitting. A number of physicians have already adopted this."
A lot of smokers think they can quit cold turkey.
James Harris, a retired supervisor with Laclede Gas Co., tried and succeeded 22 years ago.
"I didn't talk to a doctor about it," he said. "I think a lot of times, people don't want to quit, and they use excuses to start again."
The recent increase in tobacco taxes have spurred smoker Richard Gregory, 55, of Belleville, Ill., to think harder about quitting. If and when that day comes, he'll try to do it cold turkey, too, he said. He doesn't like the idea of putting drugs or nicotine replacement products in his body.
"I'll eat some candy or something," Harris said, laughing.
Typically, this isn't a good method, experts say. The American Legacy Foundation study found that only 3 percent to 5 percent of smokers who try to quit cold turkey stay smoke-free for up to a year.
Kuhlenbeck said a multiprong approach that includes prescriptions for nicotine replacement products or drugs like Chantix combined with counseling, have proved most effective.
"Doctors should be referring them to a counselor who can talk about when and why they smoke," he said. "What are the triggers? Is it when you're drinking at the bar or driving home from work? And what can you do instead of smoking? Then you balance that counseling with pharmaceutical therapies and figure out how they affect the smoker."
But Missouri, where studies have shown that 23 percent of residents smoke compared with 19.9 percent nationwide, ranks as one of the worst states when it comes to insurers paying for smoking cessation products and especially therapy.
According to the American Lung Association, a number of states, including Illinois, cover counseling and smoking cessation products for state employees and Medicaid clients. Some even require private insurers to cover such programs.
Missouri covers Chantix and two other drugs for state employees, but that's it.
This puts doctors in an uncomfortable position.
"When health care providers do talk to patients about quitting then go to prescribe something, insurance won't pay for it," Castro said. "So it's a matter of, 'Yes you should stop smoking, but I can't help you get financial help for it.'"
An assessment by the Missouri Foundation for Health recently found that of Missourians who earn $15,000 a year or less, 39.8 percent are smokers. That's compared with 13.6 percent of those who earn more than $75,000 a year.
Kuhlenbeck believes the higher rate among lower-income individuals correlates with a lack of access to health care. Compounding that are differences in their social settings and family histories - factors that are best addressed with therapy to help determine triggers and smoking alternatives, and then set up support systems among family and friends.
"Smoking is an addiction, and that's one piece that doesn't get catalogued well," Kuhlenbeck said. "It's often defined as a habit. But there's a psychological and physical addiction, and it's embarrassing and incredibly challenging to overcome."
The Freedom From Smoking program is free for Wolbert, who works as a computer support technician in Washington U.'s department of internal medicine.
In addition, he said, the program offered him $120 in nicotine replacement gum for only $15 - though he's hardly chewed any of it.
"It's my mind-set this time," Wolbert said. "Freedom From Smoking has helped a lot. But this time, I'm going into it as though I'm celebrating that I'm quitting rather than worrying about not being able to and how hard it was."
(c) 2009, St. Louis Post-Dispatch.
Distributed by McClatchy-Tribune Information Services.