What You’ll Learn

A young man explains his perspective on the risk of health problems that his smoking may or may not pose to his future. Understanding his perspective provides insights on why people are reluctant to be screened for lung cancer and other preventive case. 

Interviewee: I live in Boston. I work, I do stuff online. I play video games. I’m a smoker. I spend a lot of time at home. I don’t go out much. I don’t like drinking, or I’m not an outside kind of guy. Hobbies? I play a lot of video games, I read, I listen to a lot of podcasts. I like horror, sci-fi, fantasy surrealist stuff.

VIVO : Does anything inspire you?

Interviewee: I think I’m inspired by really in-depth, fantastical stuff. Stuff that’s really well-built lore. I’m not a personal fan, but Lord of the Rings, that establishment of a universe, a creation, the Star Wars universe, for instance.

VIVO: Can you tell me about your experience in general with doctors? Have you ever had particularly poor or positive experiences? 

Interviewee: I’ll start with positives, because usually you go to the doctor and you get some vague stuff. “Well, it could be this, it could be that.” Back about eight months ago, beginning of February, end of January, I started waking up and every morning I’d get out of bed and I’d be really dizzy. I woke up and every time I got up it was the whole room was spinning.

I went to the doctor. I tried to get an appointment that day, but you know how it is. But they called me back the next morning and they were, “Can you come in at 11?” I was, “Absolutely swell, fine.” I got there and I talked to the doctor for 10 minutes before she looked me in the face and went, “Lay down. I want to see something.” Then she put her hand on my head and she twisted my neck and it induced the dizziness. She looked me right in the face and went, “You have vertigo.” There’s a specific kind of vertigo that happens when you change positions. I think it maybe even is called positional vertigo, something like that. What happens is, your inner ear, there’s liquid in there, and when you lay down and get up, it changes position. If there’s something in it, it can cause that disorientation.

But I’ve never had an appointment with a doctor where five, ten minutes in she looked me in the face and said, “Here is your problem. Here is what it is.” It’s usually a lot of, “Could be this, could be that. We’ll test this. Let’s do a test. Let’s see how it works out for a week.” It was wild to have an appointment where I left that day with an answer that was, “Oh, she knows this. She understands this.”

VIVO: Was that your primary care physician or another doctor?

Interviewee: I believe it was a specialist on inner ear stuff who happened to be in the… Because I was at local healthcare clinic, and I think she does weekly visits to different clinics, and luckily she happened to be there that week.

VIVO: You said you’d start with the positive. But that means that there’s probably a negative somewhere in there?

Interviewee: I’m a big guy, you can see that I’m a larger guy, so a lot of doctors default to that when they assume there’s a problem. I had a shoulder issue and they were, “Well, if you lost weight”, and I’m, “I mean, that’s great, but how am I going to lose weight when every time I try and pick something up my arm is killing me?” It’s a lot of dismissiveness, I think is the right word. A lot of, “Oh, well, it’s obviously that.”¬†

VIVO: When and why did you start smoking?

Interviewee: Go out with your friends to smoke a cigarette whenever you’re at a… I don’t drink now, but 10, 15 years ago, you go to a party or a club and your friend’s, “I’m going to go out and have a cigarette. You want to come with?” And then you’re standing there, “All right, yes, what the hell? Give me one.”

VIVO: How old were you when you started?

Interviewee: Maybe 22, 23. Infrequently, when I was really wasted at a party, maybe 18 or 19. I wasn’t one of those young smokers who’s having someone get me a pack when I was underage and stuff like that.

VIVO: Sure. It’s interesting, because if it’s social, things like that, how did it taste in the beginning? Did it feel disgusting in the beginning or did it feel something you wanted to do?

Interviewee: A lot of the times it was at parties and stuff, so taste wasn’t really a factor. After a certain number of drinks, you know? But when I first started it was before… Massachusetts has a law against menthol cigarettes now. You can’t buy them in Massachusetts anymore. Time was, I think it was menthol, so the taste was kind of, not obscured, but not as tobacco-y as I think maybe would’ve deterred me had I started with non-menthols.

VIVO: Did you ever think about the future or the here and now?

Interviewee: It’s usually a here and now thing. I’m addicted to it, let’s be real. I try and minimize it, I try to cut down. I’m down to less than a pack a week, so– I’m not actively trying to quit. The taste, sometimes I get halfway through a cigarette and I’m, “Oh, this is disgusting.”

Interviewee: I don’t know if it’s in my head, or if it’s based on something I’ve eaten, or maybe not eaten throughout the course of the day, but sometimes when you get to that last half a cigarette, maybe a little less, you’re, “Oh, I…” And then sometimes you’re, “I should be done with this, but this is a long and I’m not trying to have to buy another pack.”

VIVO: You know you’re addicted, and it doesn’t always taste good, but it’s still happening.

Interviewee:¬† know a lot of people for whom that is a struggle. My father has been smoking since he was 12, so it’s not something I’m not aware of, and I’m sure I need to stop. If I was actively trying to, that might come up. But I think right now I try and focus on minimizing it. Don’t fight myself when I want to have one, don’t beat myself up, but if you don’t need one…

I will say it is also situational with the weather. When it’s hot, I’m not even bothering. In the heat, I will not go out there. Anything higher than 80 degrees, it’s an unpleasant experience for me.

VIVO: Adding more fire and smoke doesn’t sound like it-

Interviewee: Well, that for sure, but also being outside in that heat is so oppressive. I’m, I’d rather not than have to deal with all that.

VIVO: Does any cancer or any other health issue run in your family?

Interviewee: I’m trying to think. I know I have a couple uncles who died of it. I believe my uncle died of kidney cancer, so I don’t know how affiliated with cigarettes that is. He was a smoker and he had quit years before he got cancer. My grandfather died of lung cancer. He was also a smoker, he smoked a pipe when I was little. He had given that up about 10 years before he got lung cancer. My mother’s side, not so much. They got all mental stuff, not so much cancer.

VIVOt: How much do you know about lung cancer? 

Interviewee: I know there’s different kinds of it. I believe emphysema is a form of it, right?

VIVO: Emphysema is the breathing part of it, and a lot of times people start with that and things happen, but it’s not cancer.

Interviewee: My father’s mother, I believe, had emphysema. She passed before I was born. And I know she was a heavy smoker. I know cancer is an umbrella term. There’s 20 bajillion different kinds. I’m sure there’s at least as many kinds of lung cancer as you could imagine. I know smoking is a factor, but I also know that there’s other factors. I live in a city, and the amount of buses that I’ve stood next to when they pulled off, I’m sure that’s factored into it. There’s other things you can smoke, marijuana off the top, that also probably factor into it. I know there’s a lot of different factors, and I know that cigarettes are probably the worst amongst them.

VIVO: As far as screenings go, you said that you hadn’t been screened and you’re a little nervous to do it. Why?

Interviewee: I’m nervous about doctors in general, automatically assuming the worst. Automatically, “Well, because of your weight, this. And because of…” A lot of taking things for granted, assumptions.

VIVO: If you wanted to get screened specifically for lung cancer, do you think that’s something you could walk into your doctor and ask for, or that your doctor would recommend?

Interviewee: If I asked for it, I imagine he’d set that up. As far as recommendations, I imagine that he would recommend them if there was some sort of symptom. If I was having difficulty breathing, or if there was a raspiness, or if when he used the stethoscope he heard something in my chest. But I haven’t… He hasn’t recommended it thus far.

VIVO: Is cancer ever a fear of yours, or again, is it not something that’s on your radar a lot of times?

Interviewee: It’s a concern. I don’t know that I’d say it’s a fear. I think, not to be grim, but I think, again, given the size and other aspects of my diet, my health or whatever, I think it’s kind of, let’s cross that bridge if we come to it, but we have other stops to worry about on the way.

And again, I know any smoking is bad, but I also know people who smoke 10 times as much as I do, who’ve thus far, knock on wood, haven’t had any health issues. I think there’s a degree to the concern you should have. You’re smoking a pack a day you need to be more worried about than if you’re smoking once a week, I think.

VIVO: Do you hang out with people who do and that makes you think about it more? Or is it more of a solitary thing?

Interviewee: Nowadays, I usually smoke with a friend of mine and we usually split one. We get the long, the hundreds, instead of the shorts, and we’ll pass it back and forth like a joint, rather than smoke a whole one. If we’re talking about people I know who smoke more, my dad for sure. My father, he finishes one and then 20 minutes later, “I’m going back out, son.”

VIVO: How old is he?

Interviewee: He turned 62 in August.

VIVO: Has he ever been screened for anything?

Interviewee: Oh yeah. He’s paranoid about it. My uncle has passed… What is this, ’24? I think it was ’22 he passed of kidney cancer. My dad’s paranoid about getting sick and stuff. It’s a lot of people passing in his orbit, so he’s been…. And my sisters both have tried to convince him to stop. I can’t be the one because I’m out there with them, but both of my sisters are, “You two need to cut that out.”

I hate listening to them. I tell them, “You don’t give me notes.”

VIVO: Any advice you’d give to a kid thinking about being in the same situation you were?¬†

Interviewee: If nothing else, don’t do it because it sucks having to pay for it. That’s my main issue with it. I’m down to less than a pack a week usually. Me and my friend split them, so we’ll split a pack every week, every other week. But I see my dad and he gets paid on the first or the third, and then by the 12th, 14th, he’s, “Hey, can I bum 10 bucks for a pack of cigarettes?” And it’s, “Yeah, you can because I’m going to smoke one or two of them with you, but damn, really? And it’s all the rest of the month. He goes through a pack every two days, and then, “Can I bum 10 bucks? Can I bum…” you know?

It’s a pain. It’s definitely something that if you can afford it, I would still recommend not doing it because you could pay for something else, but if you can’t afford it’s not worth the trouble. “Hey, can I bum a cigarette? Hey, can I bum a cigarette?” No one likes that guy.

VIVO: What advice would you give to somebody who smokes like you? 

Interviewee: It’s one of those live-your-own-life things. I think if you can get a friend who’s maybe also trying to quit. What’s it called? Accountability buddy. That’s the phrase. Maybe something like that. But I can’t give advice. It’s this problem I’m struggling with. My aunt did recently quit about a year now. But she’s had chronic bronchitis ever since.

And I think she swapped to the vape, which I know cigarettes are bad, we don’t know how bad those things are, so absolutely not. The difference between some of them is there’s, again, the marijuana ones, which are a lot of concentrated weed stuff, but then there’s the nicotine ones that you get at a corner store and a gas station. I know there’s nicotine in them, what the hell else? With weed, I get that there’s probably chemicals in there too, but I understand that they’re making it with weed. There’s no tobacco in these vapes, so what are they making them out of?

I think they smell as bad as cigarettes and then there’s this nasty saccharin odor, depending on what the flavor is. It’s burnt fruit, it’s burnt vanilla. It smells… Oh sorry. It smells burnt whatever the flavor is supposed to be. My aunt gets this cotton candy one. It smells putrid.

Part of it is, in my house at least, we don’t smoke inside. My mother was a former smoker, when she got pregnant with me, she gave it up cold turkey, right that. And all my aunts and uncles who smoke, give her shit, “You were that. You can’t”, and she’s still foot down, “Get out of my house with that. You can stand at the corner, you can stand right out front. You don’t have to go far, you cannot be indoors.” But for whatever reason, people think that the vape doesn’t count, and they’ll sit right across from you puffing that cotton candy chemical stuff, and it’s, “Hey man, I don’t blow cigarette smoke in your face.”

VIVO: Let’s talk about the future. What do you want to do? What are your dreams for the future?

Interviewee: Oh man, I don’t know. That’s an ongoing question. I live at home with my mom. I’ve never been a professional person. People who are, “My dream is to do this or be…”, I’m, I’d rather enjoy my life. I’d rather be comfortable. I have an uncle who drives for a living, and he’s 10 PM to 6 AM, and every day he gets home and about it. Then he chooses to go do… I understand that jobs are shifts, but then he’ll pick up shifts, he’ll choose to do extra ones. I don’t want that for myself, and I don’t want to be in a situation where that’s what I got for myself.

This is going to sound crazy, but I think so many jobs in our society are frivolous now. There’s so many of them that it’s email this back and forth, or pass the paper back and forth. I got paperwork to sign at the office for where I live right now, and it’s we’ve been calling and calling and you guys keep doing these same appointments. We could be doing this all in one hour, instead of you making this a five-day affair, so you have justification for getting paid for a whole week. I know that sounds… I overthink things like that.

VIVO: What do you do for work?

Interviewee: I do stuff online. I do surveys, I do product, things like that. Professionally, day-to-day, I don’t. I kinda… I’m a homemaker. I take things as they come. I know I should look towards the future more, but what future? Which one?

Society could collapse tomorrow and then all those plans about medical school in 10 years is out the window. I know it’s not likely, but there’s so many things to consider that trying to consider all of them drives me crazy, so I’d rather consider them as they happen. Forethought is not my strong suit.

VIVO: Do you ever think about fears for the future?

Interviewee: Oh God, yes. Not to be morbid or whatever, but everything going on societally, it’s so grim. I’m concerned about my health and whatever, but how pressing is that when there’s tragedies unfolding every day? And that’s not to say that my own stuff doesn’t matter, but it’s hard to think of a hypothetical sickness you could get in 10 years when you look on Twitter and kids are getting blown up today. What am I so special that I should have plans set up 10 years out, you know?

I consider health issues as they arise. A couple months ago, my doctor told me that the cholesterol was kind of high, so I should start taking this medication. I started taking the medication because that’s a concern that’s actively presenting itself as a problem that needs to be dealt with.

VIVO: What other medications do you take, if you don’t mind me asking?

Interviewee: I have GERD, gastroesophageal reflux disease, so I take omeprazole, which is Prilosec. But I’ve been told smoking makes that worse too. I guess the way you inhale and hold the smoke, it can weaken the valve that the stomach acid comes up through when you have something like GERD. That’s been an issue brought up. And I have the vertigo. I have something to deal with dizziness and nausea if it gets too bad, an as needed thing.

VIVO: What else do you think is important to know?  I know you said the present is the most important piece. What else is important to know if you were going to give advice to somebody on life? 

Interviewee: Don’t commit fully to something that’s not going to commit fully to you, whether that’s a job or a person. Because frankly, no job’s going to commit fully to you. No job is going to hold your position while you’re sick for two, three years. No boss is going to keep paying you if you can’t show up for work for six months because you have a health issue. No relationship is worth dropping every… I read a thing on Twitter yesterday where a woman dropped her whole life to move to Texas with her partner, and then a year and a half later, the partner went on vacation with his family, which, huge red flag, and then when he came home, he gave her a letter that was, “I don’t want to be with you. I don’t think our relationship has ever worked.” And it’s you moved across the country for this man.

But that’s the kind of thing that I’m talking about. You can’t commit fully to someone when they… Even in that story, he went on a family vacation without his partner. You’re married, or in a committed relationship with someone, you don’t take a week to go hang out with your family in the same state, with them sitting at home waiting for you. That should have been the biggest red flag right there. But you get what I’m saying, if someone’s not committing fully, don’t waste your breath and time committing fully to them or for them.

VIVO: What is some advice you’d give somebody about their health?

Interviewee: Go to the doctor. Go to the doctor. It sounds easy and simple, but people don’t. They have, “Oh, I’ll go for my yearly checkup.” If you’re hurting, if you’re feeling something that’s wrong, go to the doctor. Don’t wait for it to clear up, “Oh, it’ll pass.” Nothing that’s normal. If your shoulder hurts for two, three days, go to the doctor. You could sleep on something wrong. Sure, things happen. You stub your toe, that’s why your foot hurts. But days later, weeks later, you feel something’s still wrong, go to the doctor. I have this fight with my parents all the time. Go to the doctor, call the doctor, go to the appointment. And that’s for every doctor, your eye doctor, your teeth, everyone, all the doctors.

If you don’t need medicine, you don’t need medicine. If a doctor tells you you should be taking something, you talk to them, have a conversation about it. Don’t dismiss them out of hand.

VIVO: If you’re taking medicine for high cholesterol, is it preventative, do you think? Or do you think it’s to get the cholesterol down?

Interviewee: Both. I think probably both. I think it’s probably to keep it from increasing, and if we could bring it back down some, that’s probably the ideal situation.

I also think that, this is going to sound counterintuitive, but personal choice is a thing too. You can go to the doctors and still also go to the bar and do a line with your friends. And I’m not saying I do, that’s a hypothetical. But I live in a city with exhaust and fumes, and we devote so much of our cities to traffic and urban sprawl, that cigarettes are bad for me, so is standing on the corner outside. At least I get the decision to smoke my own cigarette. I don’t have the choice of whether or not the bus blows exhaust at me when it’s going by.

Participant Profile

• Male smoker in his 30s
• Boston, Massachusetts
• Works from home doing online surveys and product testing
• Currently smoking less than a pack per week
• Has GERD (gastroesophageal reflux disease) and high cholesterol
• Lives with his mother
• Enjoys video games, reading, podcasts, and horror/sci-fi content
• Notable challenges: Weight-related doctor bias, managing smoking addiction
• Prefers to focus on present rather than future planning