Now that Life After Cigarettes has been out for a year and some change, I thought it might be an opportune moment to sift through my follow-up file and provide a few updates:
In Chapter 4, I mentioned evidence that in addition to increasing physical activity, it’s important to reduce sedentary time. A new study by Emmanuel Stamatakis and colleagues in the American Journal of Cardiology tracked over 4,500 Scottish men (Now, why do so many studies focus on men only? Where were all those Scottish women?) and concluded that too much sitting could reduce if not reverse the benefits of exercise. How much is too much? Wait for it: Two or more leisure hours/day in front of a screen doubled the risk of a cardiac event and four or more hours per day were associated with a 50% increase in the likelihood of dying from any cause. A lot of us are in trouble! My own solution (which so far as I know has never had the benefit of scientific testing) is to set a timer for 30 minutes when I sit at the computer and get up and do something else – anything else (except maybe eating) – for a few minutes whenever it rings. Getting up and exercising or just walking around during TV commercials is a similar strategy.
In Chapter 8, I spoke of my old, unrealized dream of using age progression software to allow women to visualize two different images of themselves in ten years: 1) how they might look if they continue to smoke; and 2) how they might look if they quit smoking today. The keep-smoking version would show more signs of aging, wrinkling, and graying; the woman would appear somewhat thinner, to be sure, but also more haggard and less shapely. I recently received an e-mail from a colleague captioned “You were right!!!” and citing a new article in the British Journal of Psychology entitled “Women smokers’ experiences of an age-appearance anti-smoking intervention: A qualitative study.” In this study, Sarah Grogan and colleagues used age-progression software to morph a photo of each participant’s face into smoking vs. not-smoking versions of herself at 2-year intervals. The authors reported that irrespective of parental status, age, or whether they were pregnant, participants reported that the images provoked a strong fear of visible aging, especially skin wrinkling, that translated to increased motivation to quit smoking. Further research will now be needed to confirm that that increased motivation to quit translates to actual quitting,
Under “Additional Reading and Resources” for Chapter 5, I cited Charla Krupp’s book How Not to Look Old: Fast and Effortless Ways to Look 10 Years Younger, 10 Pounds Lighter, and 10 Times Better. If you liked this book, or if you’re still too young to worry about looking old but have an interest in dressing thin, you might want to check out her latest book How to Never Look Fat Again: Over 1,000 Ways to Dress Thinner – Without Dieting! (Springboard Press, 2010). The kindle and hardcover editions are already available and the paperback version will be out in March. Like its predecessor, this book devotes each chapter to a single problem area (arm flap, big bust, muffin top, Buddha belly, etc.) and offers dozens of suggestions for nondietary, nonexercise, and (mostly) nonsurgical approaches to dealing with them. Photos provide horrible examples of what not to wear as well as alternatives that achieve the desired effect.
In a previous blog post I discussed food addiction. The link between food consumption and addictive behaviors, the neurobiological processes underlying this link, and the ways in which the food and advertising industries capitalize on it, are important areas of study for the Rudd Center for Food Policy and Obesity at Yale University, led by Dr. Kelly Brownell. Visit the Rudd Center’s website for further information on this and related topics.
My goal is to keep Life After Cigarettes fresh, vital, and in tune with the latest scientific research, so watch my blog for periodic updates like this one.
Ending a blogging drought to wish you a happy and a healthy 2011.
Yes, it’s that time again, a time that many see as an occasion to set goals for the coming year – goals we hope will make our lives richer in some way, so that when next December 31 rolls around, we can say, “I’m a better and a happier person than I was last year at this time.”
Alas, we all know New Year’s resolutions are easier made than kept. Indeed, the very term is often the butt of jokes – for example, about fitness classes that swell in January, crowding out regulars who aren’t worried because they know there will be plenty of floor space again by February. This discouraging track record might argue against making any resolutions at all, on the grounds that the implicit “now or never” approach is destructive, and that it’s better to make no promises to yourself at all than to make promises you are likely to break.
Still, there’s something about the idea of a fresh start that appeals to many. If you’re one of them, why not think about ways to make your resolutions stickier, make them work for you rather than against you?
One important way is to make realistic resolutions. The likelihood of going from a couch potato to an athlete overnight is remote; change in measured steps – achieving subgoals and then (if necessary or desired) recalibrating after they’re reached – works better for most people.
You might also consider adopting positive rather than negative resolutions. Health behavior experts use the term “loss-framed” for the negative approach because it focuses on what you have to give up rather than the benefits that will accrue. Quintessential negative resolutions that come near the top of most lists are “quit smoking” and “avoid overeating” – just the ones you’d expect to encounter on this blog! But before you give up on these goals altogether in favor of “visit Grandma more often” or “spend more time with friends,” let’s see if they can perhaps be recast in a more positive, “gain-framed” light.
Instead of “quit smoking,” how about substituting “explore the joys of the nonsmoking lifestyle?” Revel in white teeth and fingernails unstained by nicotine, in clothing free of burns, in hair that smells of your favorite shampoo, not of stale cigarette smoke. Enjoy your increased lung capacity by taking long walks around your neighborhood or in the woods. Participate fully in each moment, savoring precious time with your spouse or friend grandchild without the nagging intrusion of thoughts about your next cigarette.
And as a positive alternative to “avoid overeating,” try “explore the pleasurable possibilities of eating just what I need to reach and maintain a realistic (that word again!) healthy weight.” In the spirit of replacing quantity of food with quality – something I’ve blogged about previously – you may wish to eat more “real” food (from a farm, not a package) and prepare more meals at home – both additional positive goals. You may also wish to introduce more flexibility in how much you can eat by adding some enjoyable physical activity to your day. Although “exercise more” is technically a positive goal, many of us do not see it in that light! But most of us, if we really try, can identify some physical activity that adds a little fun to the day; and remember that as weight decreases the pleasure of moving your body increases. Whatever the official exercise guidelines may say, any increase in exercise counts as a step in the right direction.
The hope, of course, is that these positive or gain-framed resolutions will be more likely to last beyond the end of the first week in January than their negative, loss-framed counterparts. But just in case, let’s add one more positive resolution: “Forgive yourself if you come up short and get right back on the merry-go-round.” Many goals worth achieving take more than one try.
For additional suggestions on how to reach the goal of being a nonsmoker who looks good and feels great, presented in a gain-framed manner, please check out my book Life After Cigarettes. It was written with you in mind.
You might think the tobacco industry was in serious trouble. Public health campaigns to reduce smoking have resulted in cutting smoking rates in the U.S. from a peak over 60% in men and 40% in women to the current rate of around 20% (where, incidentally, it’s been stalled for several years). Government intervention has resulted in exposing deceitful practices designed to produce a more addictive product and sell it more effectively. Clean air legislation and workplace smoking bans have made it harder to smoke and tobacco taxes have made it more costly.
Ever nimble on its feet, the tobacco industry responded by emphasizing tobacco sales in other countries – particularly in the developing world, where markets are often unsaturated (for example, because of low smoking rates among women, making them an easy target) and government regulation is often lax. Then, another setback: In 2003, in response to these efforts to globalize the tobacco epidemic, the World Health Organization adopted the Framework Convention on Tobacco Control, which by 2005 had achieved the minimum 40 parties required for it to enter into force and now has 171 parties. (The process is still incomplete in the U.S.; the treaty was signed by President Bush in 2004 but never sent to the Senate for ratification.) The treaty provides for imposition of tighter controls on tobacco ingredients, packaging and marketing, expansion of cessation programs and smoke-free spaces, and increased taxes — measures that have all been shown to be effective in reducing smoking.
But don’t waste too much time feeling sorry for Big Tobacco. An article in today’s New York Times documents industry efforts, in anticipation of an international conference convening tomorrow in Punta del Este, Uruguay to add specific terms to the FCTC, to derail legislation mandating larger or more graphic warning labels by suing countries that pass these measures for loss of revenue. (The real goal here is not to remove health warnings altogether – health warnings have actually worked well for them by legitimizing the claim that if people choose to smoke, it’s not their fault – just to prevent them from dominating the package and actually becoming salient.) Even in the context of a faltering economy, the tobacco industry and its Mad Ave cronies are extremely adept at peddling an addictive product, and they have repeatedly shown themselves to be survivors.
My own concern is that they will attempt to circumvent the FCTC by creating a need for their product by publicizing effects that can be achieved or problems that can be addressed by smoking. It’s already been done at least once: Although I have no proof, it seems likely to me that they not only capitalized on our societal preference for thinness but actually contributed to it, by glorifying stick-thin models and promoting severe anxiety over images suggesting even a small increase in weight. It’s probably not even necessary to provide an overt link to cigarettes. Just as “everyone knows” that smoking is bad for you, “everyone knows” that smoking suppresses body weight. If it worked in the U.S., why not in Africa or Asia or South America?
Over the past few days a totally charming Sesame Street video, “I Love My Hair,” has gone viral. It was written by a White man named Joey Mazzarino for his 5-year-old Black daughter and depicts a little Black muppet girl singing a rousing paean to her curly hair. Never mind that a Black woman named Natasha Anastasia Tarpley wrote an equally charming children’s book of the same name more than a decade ago, or that it took a White man to draw Sesame Street’s attention to this issue. It is a touching testimonial to a father’s love for his little girl. Many Black women left comments on NPR’s website about what a difference it would have made to have had this song in their lives when they were growing up. It was noted that many adult Black women, including our First Lady, still straighten their hair.
Also among the comments were several from curlyheaded White women who had likewise despised their hair and longed for flowing blonde tresses they could flounce like Marsha Brady. One, from the South, spoke of having to endure racist abuse because of her corkscrew curls.
But wait. How many of those silky-haired blondes so envied by their peers actually love their hair? In my experience, dislike of one’s hair is more or less normative among American women. What is supposed to be our “crowning glory” somehow becomes the focus for feelings of inadequacy and insecurity. The term “bad hair day” has become synonymous with a nagging sense that something about us isn’t quite right. We regularly expose our bodies (not to mention our ground water and landfills) to toxic chemicals designed to crimp, relax, darken, lighten, glaze, highlight, lowlight, and otherwise bully our hair into submission so that maybe, just maybe, we can look better and feel better about ourselves.
I know. I endured many nights sleeping (or rather not sleeping) on giant rollers in hopes of looking like Joan Baez. I braided my unruly hair and pinned it up to subdue the frizzies. Then, at age 40, I belatedly awoke to the realization that many of my friends were paying good money to get their hair to do what I was trying so hard to get mine not to do. I went to a good hairdresser and got a flattering cut – and for a few short years, I actually grew fond of my curly mop. But then it started graying, and once again, dissatisfaction set in. I began coloring it, resulting in an uneasy truce that lasted a couple of decades, till I started noticing something disconcerting: My face was aging naturally; my hair was not. After much soul-searching, I decided to “go gray” (which for me meant several months of an ever-widening “skunk stripe” that couldn’t entirely be disguised; no one ever tells you, when you embark upon that 5-week recurring cycle of dying and retouching, how hard it is to escape).
Up until now I’ve been okay with my new “mature” look. Not thrilled, perhaps, but okay. When I saw this cute little video, however, it suddenly struck me that my gray hair might be something not just to tolerate but to celebrate. Why not, after all? I like seeing a head of hair that’s in sync with my face when I look in the mirror. I like being free of the chemical stew, the rigid scheduling, and the not inconsiderable expense required to keep the gray at bay. I like experimenting with new wardrobe colors to harmonize with my silver mane. And of course I still like my curls. Thanks to “I Love My Hair,” I’m actually feeling pretty good about my own natural “do” at the moment.
What has this got to do with smoking? Not much, probably – except that cigarettes are yet another toxic product used by many women to make themselves happier with the way they look and feel. Sometimes something comes along – a song, a poem, a painting, a book – with the power to raise our awareness and reframe the way we feel about ourselves. When I wrote my book, my dream was that it would work precisely that magic for its readers. Just as “I Love My Hair” has helped me feel good about my gray hair, I hope Life After Cigarettes helps women who have smoked not just tolerate a few extra pounds but truly embrace the look and feel of their new smoke-free bodies.
I marvel at how exportable American culture is. What is so seductive about our way of life? Why do others so readily adopt – and sometimes even improve on – our gadgets, our language, our clothing, our food, our habits both good and bad?
Having just spent two weeks in the U.K., I’m here to report that we Americans have no hammerlock on overweight and obesity. Clearly the British have managed to adopt the same combination of overeating and underexercising that has done us in. Like us, over 50% of them are overweight and a substantial portion meet criteria for obesity.
But surely not the French! A few years ago Mireille Guiliano, an executive at Veuve-Cliquot and still rail-thin well into her sixties, wrote a runaway bestseller assuring us that French Women Don’t Get Fat and telling us the secrets of their success. Follow the traditional French diet, take time to savor your food, don’t snack, and walk, walk, walk (no gyms for these women!), and you too can be as svelte as Catherine Deneuve.
I yield to no one as a Francophile and am a great fan of Guiliano and her book. I have no doubt that anyone who can tune out the siren song of American culture and follow Guiliano’s program will be the better (and probably the thinner) for it. But is it really true that French women don’t get fat? “Oh, but they do!” says Dr. France Bellisle, a French obesity researcher. In an interview with the International Herald Tribune, she indicated that while absolute rates are still lower than in the U.S. and other Europen countries, they are rising alarmingly – 5% annually since 1997. Nearly 40% of the French are now overweight (BMI at least 25), and over 11% are obese (BMI at least 30). Alas, the French have no immunity to obesity.
The more cynical among us may point to one other reason why French women don’t get fat – many of them smoke (not recommended by Guiliano, by the way). Indeed, the legendary Deneuve herself evidently contines to smoke, at least in part because she is terrified of gaining weight. She was once quoted in Britain’s Sunday Times Stylemagazine as saying, “I gave up for 12 years. Then, because of certain problems, certain difficulties, I started letting myself have three a day. Then it was six….” (A sadly familiar story and testimonial to the near impossibility of adhering to a smoking diet.)
The French are now confronting their smoking problem aggressively, so the stereotype of the slim and elegant French woman, cigarette in hand. may soon become a thing of the past. If you’ve read Life After Cigarettes or followed my blog, however, you know by now that decreases in smoking actually contribute only a small amount to the so-called obesity epidemic, and that most women who quit will be able to limit the amount of weight they gain to around 5-10 pounds – approximately one BMI unit and less than a dress size. You also know that even with those few extra pounds you will look and feel better than before, since except for suppressing weight, the effects of smoking on appearance and well-being are all negative (less feminine body shape, more skin wrinkling, less energy, detrimental effects on nails, teeth, hair, and posture, etc.). The trick is to embrace weight management practices that work for you (be they American, French, or whatever) and turn your back on the ubiquitous pressures in our environment to overeat and underexercise.
The aerobics classes at my gym encompass a wide range of ages, so one of the instructors focuses each of her sessions on a different decade’s music. And when she plays the oldies, the music of the fifties and sixties that I grew up with, I’m convinced my body thinks it’s in junior high school again. Just a few bars of “Dancing in the Street” and I’m as energized as I was when I first heard it at age twelve or thirteen.
If you find a little background music helps things along when you exercise, it’s not just your imagination. In a recent study, researchers found that the faster the tempo, the faster a group of exercyclists pedaled, and the faster their hearts beat. Why? According to Nina Kraus, professor of neurobiology at Northwestern University in Illinois, a possible explanation lies in the fact that humans, like songbirds, automatically feel the beat of a song; our hearts and our legs “want” to synchronize with the music. Music may also distract and make the time pass more quickly, diverting us from boredom and fatigue (and perhaps craving?).
So if you’re concerned about gaining weight after quitting smoking – in the spirit of “every little bit helps” – you might try adding a little music to your routine.
Today’s New York Times ran a story by reporter Lizette Alvarez on “The Holdouts” – professionals who, in defiance of increasingly menacing health warnings, spend their breaks dashing to an elevator, descending to the concrete canyon below, trudging to an area that meets the minimum requirement of being at least 25 feet from the skyscraper where they work, however inclement the weather, in order to have their smoke.
One of the people interviewed by Alvarez was Linda Greene, an executive assistant for a large financial services organization. Her story is all too familiar: At age 15, she filched an unfiltered Pall Mall from her sister’s cigarette pack, smoked it – and promptly threw up. Undeterred by her discomfort, not to mention a $100 bribe offered by her father, she persisted. “Everyone was doing it, advertising it, glamorizing it.” Sadly, 47 years later, she’s still smoking.
What keeps her doing it? Also a familiar story: “I don’t want to gain weight.”
Although weight concerns were not central to the article, a few clues are provided about the tradeoff Ms. Greene makes not just in terms of her long-term health but also, ironically, of social acceptability and of how she looks and feels on a daily basis.
She knows she should quit and she wants to quit – someday. “I have to decide I’m going to quit,” said Ms. Greene. “It can’t be someone else who decides.” Once again, a familiar story – it’s a control issue. And she’s absolutely right; unless she’s ready to quit, she probably will not succeed.
I wrote Life After Cigarettes for Linda Greene, and for women like her. I wanted to tell her about the control she’ll regain when she quits smoking. I wanted to offer a new perspective on her weight concerns and give her some ideas for managing her weight so that it maxes out within a dress size or a unit on the Body Mass Index. I wanted to share with her the gift of those ordinary moments she can enjoy relaxing with her colleagues when she’s not spending her breaks rushing out for a furtive cigarette. This is what I’d tell Linda Greene if I had the chance.
I recently had an e-mail from my old friend Lynn about our upcoming high school reunion (okay, I’ll ‘fess up, it’s our 50th): “Now if I could just drop 15 lbs without giving anything up… And the reunion is a few days after we get back from our September vacation so I don’t see dropping a few last minute pounds then. MOST of the time I’m very accepting of myself the way I am. Wonder what reunion anxiety comes under in the DSM.”
I’m attending not only that reunion but also the reunion of high school I’d have graduated from had my family not moved away just before I entered the 9th grade. So I have a double dose of it.
In fact, this is the second time I’ve written about an upcoming reunion. The first time was thirty years ago, when I wrote an article about my 20th high school reunion for a newspaper Sunday supplement (remember newspapers?) that started off with the statement that I’d bought a new outfit and dieted off 5 pounds for the occasion.
Some things never change.
As I recall, the lines after the one about dieting went something like: “Burst your buttons, teachers. Eat you hearts out, boys.” That’s the impression most of us want to make on the people we knew back then (and who still, in our minds, look like nubile, fresh-faced cheerleaders and lean, muscular quarterbacks – not like the face we see in the mirror, and possibly not like “they” looked even back then). And that hope, I think, gets at the root of Lynn’s implicit question about the source of the anxiety that so many of us suffer in connection with our upcoming reunions: We’ve set a standard for ourselves that will be difficult for anyone more than a few years past graduation to meet, especially if we’ve calibrated that standard to our high school ideas about beauty.
If you’re a former smoker and concerns about weight were part of your smoking dynamic, the thought of seeing the prom queen or your old boyfriend may spark second thoughts about the decision to quit. Don’t go there! If you’ve read Life After Cigarettes or followed this blog, you know that even if you gained the typical few pounds when you quit smoking, you’ve still come way out ahead in the appearance sweepstakes: No more cigarette burns on your clothes, no smell of tobacco smoke in your hair, no nicotine-stained nails and fingertips, whiter teeth, and fresher breath. If you’re a longer-term quitter and this is your twentieth or thirtieth reunion, not your first or fifth, you’ll have fewer wrinkles, less gray hair, a less gravelly voice, and a more feminine body shape than the prom queen who continued to smoke. If it’s your fortieth or fiftieth reunion, you’ll probably have noticeably more energy and you’re less likely to be stooped over from osteoporosis.
You may also be thinking: How will I feel when I’m thrown back in with the crowd I always smoked with? Will I be tempted? Am I in danger of relapse?
Studies of smoking relapse crises have identified a variety of circumstances in which relapse may occur. Although many are associated with negative states like depression or anger, a substantial number are triggered by social situations involving other smokers, eating, and especially alcohol consumption. So your intuition that temptation lurks in social events like reunions – or weddings or anniversary celebrations or holiday parties – is indeed correct.
How you confront that challenge turns out to be even more important than whether you actually experience withdrawal symptoms. There are three types of response you can make to ward off the danger of relapse. First, there are behavioral strategies. For starters, try to go easy on the food and alcohol. Sit at a nonsmoking table. A little exercise is a good distractor so be the first one to hit the dance floor. Second, talk to yourself. Stay focused. Enjoy the sensation, unavailable to smokers, of being able to hone in on a conversation without having your attention frayed at the edges by the niggling urge to smoke. Think about how much better you’ll feel tomorrow morning if your first waking thought isn’t, “oh, no!“ Impress your old schoolmates and teachers by radiating the beauty and confidence that comes with being in charge of your own life, not by falling back into those old destructive patterns. Finally, if like my friend Lynn, who has been smoke-free for many years but not completely nicotine free, this may be a Nicorette moment. Forewarned is forearmed, so go prepared.
In Life After Cigarettes, I mentioned my one-time wish to create a website to which a woman smoker could upload a current photograph. The idea was to use age-progression software—what the police use to visualize how someone who has been missing for several years might look now—to project two different outcomes: how she would look in ten or twenty years if she continued to smoke, vs how she would look if she quit smoking today. “The keep-on-smoking version would have more wrinkles, grayer hair, and other signs of more rapid aging than the stop-smoking version. The smoker would probably be slightly thinner but also—the flip side of thinner—more haggard and less shapely.”
I never had the chance to carry out this project, but here's a website that will allow you – not to visualize yourself in ten years, but at least to get an idea of your body shape in a few weeks or months if you quit smoking now and gain a few pounds as a result. You can either upload a photo of yourself or modify the model in the picture to reflect your current body shape by entering your weight and height. Note: I have no connection with this site or with Redbook. For all I know, there are many similar sites out there. Redbook created the site to show how you’d look if you lost a few (or many) pounds, but it works in reverse as well. I have no idea what algorithm they used to accomplish the morph nor how accurate it is, but it’s good enough for the present purpose.
Once you’ve entered your current weight and height, go ahead and dial it up ten pounds; or add a unit of BMI (5-7 pounds, depending on your height), which the site also allows you to do. I think you’ll be surprised. I think you’ll see it’s not all that big a deal, compared with the myriad improvements in your appearance and health that you’ll gain along with that handful of pounds.
Because this website fouses solely on weight, what it doesn’t show you is the beauty bonuses you’ll see as soon as you quit smoking: no more cigarette burns on your clothes, no smell of tobacco smoke in your hair, no nicotine-stained nails and fingertips, whiter teeth, fresher breath – the list goes on and on.
It also doesn’t show you the longer-term benefits for how you look and feel – fewer wrinkles, less gray hair, clearer voice, more feminine body shape, more energy, less stooped posture – marks of aging that happen earlier if you smoke than if you don’t.
But wait, what if you gain more than ten pounds? Please remember, the odds are very good that you, like the majority of quitters, will end up within the ten-pound window, particularly if you follow the suggestions I’ve made in Life After Cigarettes and elsewhere in this blog. Even a blip of two or three pounds the first week after quitting doesn’t presage out-of-control weight gain; it’s just your body readjusting to the loss of nicotine’s effects on appetite and blood volume. A few women may need some additional help in managing or adjusting to their new weight, but most of you just need to concentrate on growing into your virtual body, the one you see on your computer screen, and enjoying it.
I recently noticed that my son-in-law had lost the “baby weight” he’d put on a few years ago when my daughter was pregnant and regained his sleek rock musician physique. So when I saw him serving his own meals on the salad-size plates used by their nine-year-old son and a four-year-old daughter, I suspected there might be a connection. Sure enough, he told me he was on the “small plate diet” and had lost 15 pounds. (Full disclosure – he also started working out at his local gym.)
The Small Plate Movement, as its proponents prefer to call it, was launched in 2008 at the annual meeting of the American Public Health Association. It’s a collaborative effort by representatives of academia, government, media, and industry and includes two initiatives, one aimed at families, the other at restaurants. The underlying premise is simple: The standard diameter of our dinner plates has crept up to a baronial 12”, making servings that look generous on plates of more modest proportions seem downright stingy. If we downsize our plates to 10”, we tend to serve ourselves and eat around 20% fewer calories – a reduction most people can tolerate without even noticing, much less experiencing serious hunger pangs.
Another way you can use your plate to facilitate portion control, and at the same time promote nutritional balance, is to visualize that plate as a “pie” divided into 4 quarters. Reserve one of the four slices for protein (e.g., meat, beans, tofu), one for carbs (pasta, rice, potatoes), and the remaining two for veggies – say, a garden salad and a serving of broccoli or peas. To be true to the spirit of the thing, no heaping helpings and no overlapping!
This is all good news for anyone who struggles with her weight, but especially for someone who recently stopped smoking and could use a few simple tricks for managing the extra pounds that typically accompany quitting. Whoever thought the humble dinner plate could be such a good friend to former smokers?
Cynthia S. Pomerleau, Ph.D., is currently research professor emerita in the University of Michigan Department of Psychiatry. From 1985 to 2009 she served as director of the Nicotine Research Laboratory, where much of her research focused on the impact of smoking on women. She is the author of more than a hundred articles and book chapters on smoking and a contributor to the 2001 Surgeon General’s Report on Women and Smoking.