In the late 1979s Prochaska and DiClemente developed the Transtheoretical Model, also called the Stages of Change model. Their model evolved through studies examining the experiences of smokers who quit on their own versus those who required additional treatment to quit. Their finding? People quit smoking if they were *ready to do so.* Their Stages of Change model operates on the understanding that people do not change behaviors quickly and decisively. Change in behavior, especially habitual behavior, occurs continuously through a cyclical process.
Prochaska and DiClemente suggested six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.
So it was that in 1999, I had been thinking about the benefits of quitting my own smoking habit adopted in 1974. I wasn’t as young and resilient as I used to be, and I was listening to the mounting evidence that smoking was bad for me, and for those around me. But smoking is a tough habit to quit, and it wasn’t until former Governor Ruth Ann Minner signed the original Clean Indoor Air act in 2002 that I quit smoking. The signing of that bill was my cue to action to quit. I’d thought about it, I’d planned, and I acted. And it was tough in those first several months. EVERYTHING reminded me of smoking, from drinking coffee to walking outside, going to a bar to drifting off to sleep or waking up in the morning. And I stuck with it, and have been “first-hand” smoke free since then. Now, thirteen years later, I recoil at the smell of smoke - especially that of one of my neighbors who will periodically sneak outside late at night when no one else will know.
We were making great strides in Delaware toward reducing combustible tobacco usage - and then along came e-cigarettes and vaping, providing a new delivery system for an old and highly addictive substance - nicotine. This time it smelled – for lack of a better word - good. Fruity, herbal, dessert-like, candy-like… And a whole new generation of nicotine addicts was born.
Early this year, Governor Jack Markell signed amendments to the Delaware Clean Indoor Air Act into law, which add vaping and e-cigarette use into the broader statute prohibiting combustible tobacco products. In Delaware, individual municipalities can exercise even stricter restrictions - such as Bethany and Rehoboth Beaches’ prohibition of smoking on the beach.
Nicotine use, in any form, has downstream negative health impacts. Some of those impacts are based on the system of delivery: combustible smoking impacts the lungs, chewing impacts oral and periodontal health. However, all delivery systems raise blood pressure and heart rate, constrict blood vessels, and stimulate the central nervous system. A single drop of nicotine will kill a human being. Nicotine is, in short, an addictive poison to which the precautionary principle must be applied. Many say “better to switch to e-cigarettes over regular ones” to which we public health and medical professionals say - “better to quit entirely, and the sooner the better for yourself, and for those around you.”