Q & A: Hilary Tindle

Hilary A. Tindle, M.D., MPH, associate professor of Medicine and the founding director of the Vanderbilt Center for Tobacco, Addictions and Lifestyle (ViTAL), runs a program for hospitalized smokers called the Tobacco Treatment Service.  

How is the Tobacco Treatment Service working two years after it launched? 

Hospitalization is a great time to quit smoking, but not everyone is “ready” so we also try to make people more comfortable, especially if they are experiencing nicotine withdrawal. Withdrawal symptoms include irritability, difficulty concentrating or sleeping, headache and many other unpleasant sensations. We can treat withdrawal safely and easily with nicotine replacement such as nicotine patch, gum or lozenge or a combination of these. But cessation of tobacco use is the best outcome medically and psychologically. It’s a little known fact that people who quit smoking actually feel better after they’ve quit compared to those who keep smoking. 

Is there a one-size-fits-all approach that fails some smokers?  

We do know that people are much more likely to quit smoking when they get support during their quit attempt. This support means getting counseling—such as a group class or talking to a counselor at the free state quit line (1-800-QUIT NOW)—plus getting U.S. Food and Drug Administration-approved medication, such as the nicotine patch/gum/lozenge, varenicline (Chantrix) or bupropion (Zyban or Wellbutrin). A very large study was published in 2016 showing that all three of these medications are safe and effective. 

Do smokers use these aids to quit? 

Nationally, only about one-third of people who are trying to quit smoking use medication, and even fewer get counseling. That is why the annual quit rates are only about 5 percent among people who try to quit smoking. It looks like we really don’t know how to help people when, in fact, we do know how to help. It’s just that people aren’t being treated with the right tools. 

Are there differences between sexes and races in regard to smoking cessation challenges? 

In terms of treatment, we do not have different protocols for men and women. There is some evidence from clinical trials that women have a harder time staying off cigarettes long term, but this is still controversial. What we do know is that people differ by how quickly they metabolize or break down nicotine. About two-thirds of whites and half of African-Americans are “fast” metabolizers. These people tend to quit more often on varenicline compared to patch, while “slow” metabolizers don’t do any better on varenicline compared to patch. The biological information on nicotine metabolism seems much more important at this point than other personal characteristics. What’s more, this information can be measured with a blood test.