The truth about closet smoking

Source: Best Health magazine, January/February 2014; Image: Thinkstock

Kim Sedgwick had a shameful secret: She was a smoker. For 11 angst-ridden years, the now-29-year-old Toronto woman hid her habit from her parents, boyfriends, clients, many friends and even her doctor, in order to maintain her image as the poster girl for healthy living. After all, she had grown up on organic food, traditional Chinese medicine and dance classes, and after graduating from university she worked as a fitness coach, then co-founded a natural health business with her sister.

But Sedgwick, who first started smoking at age 16, was sneaking up to a pack a day’during frequent trips to the corner store ‘to get milk.’ She craved those pockets of private time, but they came at a price. ‘I experienced such shame, because smoking does not in any way fit into that healthy image,’ says Sedgwick. She finally outed herself three years ago, when she realized that continuing to hide her habit might be more work than seeking support to quit.

What is closet smoking?

Closet smoking includes any secretive smoking behaviour, whether a pack a day or one cigarette a month, says Dr. Peter Selby, chief of the addictions division at Toronto’s Centre for Addiction and Mental Health, a Canadian leader in the area of smoking and addiction. Whether out of guilt, shame, avoidance of criticism, desire to avoid exposing others to second-hand smoke, reluctance to be a bad example to children or simply the thrill of keeping a secret, closet smokers go to great efforts to avoid being found out. The cover-ups may include popping breath mints, using air fresheners, sneaking puffs beside the bathroom window with the fan on high, freezing behind the garden shed, and going through several wardrobe changes throughout the day. For example, Marnie Giffen,* a Toronto-area mom, says that after dropping her kids at school she drives to a local park, covers her hair with a hoodie so it won’t pick up the smell of smoke, has a cigarette, then puts the hoodie in the trunk and drives to work.

We’ve come a long way, baby. But…

According to Statistics Canada, 17.5 percent of women in Canada smoke, or one in six. (In 2001, one in four women smoked; almost 50 years ago, it was one in three.) But Cindy Hall, a clinical therapist with Addiction and Mental Health Services at South Shore Health in Bridgewater, N.S.’a province that according to the 2013 Tobacco Report has the third-lowest smoking rate in the country’feels in her experience those stats can’t be accurate. ‘People fear judgment if they smoke, so they probably aren’t being honest.’ Another contrast between the official numbers and the stats from South Shore: Statistics Canada says 10.5 percent of Canadian women smoke while pregnant. South Shore’s stats show that 26 percent of pregnant women in Nova Scotia smoke.

With smoking banned in most indoor public spaces across Canada, the stigma may be what’s driving smoking underground. ‘The two demographics we tend to see as closet smokers are women who are pregnant or who have young children, and anyone with higher-than-average education and incomes,’ Selby says. The latter group, he adds, consider themselves people who ‘should know better.’

The health risks are high

And most men and women do know the health risks, which include two to four times the risk of heart disease and stroke compared to non-smokers, 12 to 13 times the risk of dying of chronic obstructive pulmonary disease (COPD), and a higher risk of osteoporosis, early menopause and many cancers, such as cervical, breast, colon and some ovarian cancers. Smoking can also cause higher rates of infertility, miscarriage, premature delivery, stillbirth and sudden infant death syndrome. Tobacco’s anti-estrogenic effects may cause fertility problems in the next generation, too, as daughters of mothers who smoke during pregnancy may be born with fewer than normal eggs.

There’s no such thing as a social smoker

Many closet smokers don’t even see themselves as smokers. Take Toronto yoga teacher Paige Goldman.* ‘I don’t feel like a card-carrying member of the smoking party,’ quips Goldman, 39. She never smokes in front of her yoga students or her three children, and never carries cigarettes (she conceals them in a drawer at home or bums them from friends who know her secret). She smokes between two and eight cigarettes a day. ‘It’s part reckless abandon and part relaxation,’ she says. She covers the smell with lemon juice on her fingers and lavender spray in her hair. ‘I’m super-healthy, I do a lot of walking and trail running, and I eat extremely well. I think of myself as a closet smoker or social smoker.’

Selby says there’s no such thing as a social or part-time smoker. Closet smokers sometimes twist reality to avoid facing the truth, and he adds that while there’s a long-standing belief among smokers’and even some healthcare professionals’that smoking fewer than five cigarettes a day carries little risk, there is no scientific evidence of that whatsoever. ‘Every cigarette does you harm,’ he says.

Selby adds that sometimes when smokers cut back on the number of cigarettes, they compensate by inhaling more deeply. ‘We’re not here to judge, only to assist, but it’s important that people know the facts. Even if you smoke occasionally, you’re still inhaling approximately 60 cancer-causing chemicals. There is no safe amount.’

Even a little bit is harmful

‘Even a small amount of tobacco smoke causes rapid inflammation in the lining of blood vessels and lungs,’ says Jill Hubick, a registered nurse, certified respiratory educator and health promotion coordinator with The Lung Association of Saskatchewan. Exposure to second-hand smoke or having a single cigarette may trigger an asthma attack, or a ‘lung attack’ in someone with COPD. ‘A lung attack, or flare-up, is a worsening of symptoms, such as extreme shortness of breath, and it can be as deadly as a heart attack,’ Hubick says. Smoking is a leading cause of lung cancer, and due to the increase in the number of women who took up smoking 40 to 50 years ago, there has been an increase in lung cancer rates among older women over the past 27 years. (However, men’s lung cancer rates have declined.) Also on the rise in women is COPD, and 80 to 90 percent of those cases are caused by smoking, Hubick says.

While smokers lose an average of a decade of lifespan, a major 2012 study of more than a million women in the U.K. found that the earlier you quit, the sooner you can reverse the harmful effects. Quitting before age 30 avoids over 97 percent of the mortality risk from smoking, the authors said, and quitting before age 40 avoids over 90 percent.

Hidden dangers

While it’s one thing to hide your smoking from your loved ones, it’s quite another to conceal it from your doctor’who is obligated to keep it confidential. Some of the chemicals in cigarettes cause certain medications to metabolize too quickly, which means smokers may need higher doses of drugs such as insulin, blood thinners, sleeping pills, antipsychotics and anti-anxiety medications. Since tobacco has chemicals that increase blood clotting and the hormones in low-dose birth control pills can increase the risk of blood clotting, smokers over age 35 who are on the pill have a higher risk of blood clots and stroke. Smokers undergoing any type of surgery, including cosmetic and dental surgery, are more likely to have complications such as infection and lung problems. ‘Not telling your surgeon you smoke can be as risky as eating before an operation,’ Selby says.

Nurse Janet Fellini* is fully aware of the health risks. That’s why she hides her smoking from her colleagues. ‘I’m sure they would have some choice things to say to me,’ says Fellini, 50, who lives in the southern Ontario countryside. She smokes five to 10 cigarettes a day while on walks or drives during her breaks, and she brushes her teeth and washes her face and hands before going back on the job. Why is she a closet smoker? ‘I think it’s rebelliousness. It’s like, I can do it and nobody can stop me.’

Many female smokers feel that way, says Lorraine Greaves, senior investigator for the British Columbia Centre of Excellence for Women’s Health in Vancouver. ‘They perceive smoking as control, freedom, independence,’ she says. ‘It’s ironic, because it’s exactly the opposite. Smoking ends up controlling you.’

The stigma against smoking becomes internalized, says Greaves, who is also a co-founder and past president of the International Network of Women Against Tobacco, and the author of Smoke Screen: Women’s Smoking and Social Control. ‘People become ashamed of their smoking and go to great lengths to hide it.’

Get the support you need

But there are two reasons why a cover-up may backfire, according to Greaves. First, your loved ones may already know but have chosen to avoid confrontation. Second, they are the people who can help you quit. Anti-smoking campaigns are increasingly emphasizing the importance of support, as opposed to blame. ‘Too often we blame the individual instead of the tobacco industry,’ says Hubick. ‘For most people who smoke, smoking is not a lifestyle choice. It’s an addiction.’

When Sedgwick finally came out of her smoky closet three years ago to seek help to quit, she was overwhelmed by the support she received from family, friends, her boyfriend, clients and her doctor. She abandoned the ‘perfect’ image she had been trying to maintain, gave herself permission to mess up once in a while, and asked loved ones not to make her feel guilty if she had a cigarette while she was in the process of weaning herself off them. Says Sedgwick, ‘Taking away the shame worked for me.’

This article was originally titled “The closet smokers among us” in the January/February 2014 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!

*Some names and identifying information changed by request