Roberta R., ND

For much of my life, I have been around smoking. As a young child, my father smoked in our home. I can still see him sitting by the gold-colored stove blowing his smoke into the vent fan. Maybe this eased his mind, but the vent was not actually connected to the outdoors. The fan simply sucked the smoke from one part of the house to another. It makes me remember how much I disliked that smell. I vowed to never smoke because I didn’t want to smell like that. Fast forward a few years, and I was working as a junior counselor at a summer camp. Someone offered me a cigarette and because it was familiar, I decided to try it. I had never felt a feeling like that in my life. And, I never would again. This is where my addiction to cigarettes began. I was 16 years old. I continued smoking to chase the initial feeling I got with that first cigarette.

My habit increased over the years until I was smoking over a pack daily. Early in 2003, more than 10 years after I smoked my first cigarette, I received a call from my dad. He said, “Hey kid, your dad has cancer”. To this point, I saw “other people” who were affected by lung cancer but, of course, it was not going to happen to me. I knew that cigarettes are what caused his cancer, but it did not change my smoking habit.

That was until I watched my normally physically strong father shake uncontrollably in response to chemotherapy. There were times where he could not eat, but when he did, he often threw up. He began losing weight. He lost his hair. I vividly remember the most difficult haircut I ever performed. He pulled gently on his hair and it came out with ease. He asked me to shave his head. He only experienced these things because he was having poison pumped into his body to fight something that could have been prevented.

In April 2003, my father had surgery to remove the lower two lobes of his right lung. We only have two lungs and losing the bulk of one of these vital organs may cause some lifestyle changes. When he finally came home, I was the one charged with his aftercare. This included monitoring his chest tube for drainage, changing bandages and taking him to appointments. While I was concerned for my father, my bigger concern was how I could continue to smoke and cover up the smell so he was not triggered into wanting to smoke. I knew I needed to quit, but I struggled for more than a year after my father’s cancer diagnosis.

It took many times, but I finally was successful. That was 15 years ago and it is something I reflect upon and share my knowledge of almost daily. Now, I am a registered nurse and will soon be starting a master’s program for Healthcare Education and Leadership. I am blessed to spend my days at the New Life Center in Fargo, N.D. Some may call this a “job”, but I feel it is truly my calling. I work at a shelter for men who are homeless. I am part of the shelter nursing program supported by our local healthcare organization. Smoking, quitting and wanting to quit are daily topics of conversation between myself and the guests of the shelter. I feel like I am a valuable resource for these men because I, too, have faced nicotine addiction. I understand the challenges that come with quitting and recognize the fears they have.

While it shouldn’t be surprising, looking at the hard numbers nearly put me into a state of shock. According to research, individuals facing homelessness are three times more likely to smoke than the general population. Tobacco use in shelters is commonly associated with other conditions such as mental illness and substance use. We cannot properly address nicotine addiction without addressing individuals’ mental health and substance use disorders. This provides substantial reasoning for an increase in funding for, and in support of, NRT programs. But we cannot stop there. This is a multifaceted health crisis and we will not have long term success without treating every aspect of the nicotine addiction. Being successful in assisting this population to give up nicotine will require attention to the comorbidities of tobacco dependence; untreated mental health and substance use disorders.

My concern as a nurse is that this population has a higher likelihood of suffering severe health consequences or complications due to a lack of, resistance to or inconsistent access to proper health care. At times, a cigarette is the only thing that some of these guys have to look forward to throughout the day. Smoking also provides these men something that is seemingly within their control after many have lost control over other parts of their lives. I want to do what I can to help, but I am only one person. Our shelter is currently is near capacity. Right now we are providing shelter for 128 men. To date, all of my NRT supply has come from donations. This does little for my ability to support these men long term. I lost my father in 2014 and lung cancer played a large part. The health challenges he experienced following the loss of a portion of his lung, and the cardiac deviation that occurred as a result, ultimately led to his death. If I can prevent any son, daughter, husband, or wife from losing a loved one unnecessarily, I will. But I cannot do it alone. I need your help.