newsmaker: Jonathan Foulds, PhD
media coverage: Associated Press, The Star-Ledger, The New York Times

Anti-Smoking Activist
Won't Quit

by Mary Ann Littell

Jonathan Foulds has traveled a long distance from his hometown of Paisley, Scotland, to New Brunswick to be director of the Tobacco Dependence Program at UMDNJ's School of Public Health (SPH). Along the way, he has received a great deal of publicity for his expertise on smoking and nicotine addiction. In fact, on the day of this interview, a TV crew is on-site to film a segment about New Jersey's smoking cessation services.

Being in the media is good, says Foulds: "It is my practice not to turn down an interview with a journalist. After all, it's a free opportunity to get an important health message out to the public. The tobacco companies spend hundreds of millions of dollars on their PR campaign. We don't have that kind of money, so we need to take every opportunity to get the facts out about smoking."

There's no doubt Foulds knows what he's talking about. He trained with one of the premier smoking research groups in the world at the University of London's Institute of Psychiatry, under the leadership of Michael Russell. Researchers there were among the first to study nicotine's psychological and pharmacological effects. Foulds also conducted the first clinical trial of the nicotine patch in the United Kingdom, and along with other colleagues in the UK was the first in the world to directly compare the efficacy of the nicotine patch, gum, nasal spray and inhaler for smoking cessation.

Working with "the best" inspired Foulds to choose a career in smoking research. Laughing, he states, "One advantage is it's relatively easy to find research participants. You can shout out on the street, 'Who's a smoker?' and dozens come running."

More seriously, he says he had become very interested in studying the psychology of tobacco addiction. His PhD work examined the psychological effects of nicotine on cognitive performance and mood. He was also drawn to the simplicity of the smoking/health equation: "If you smoke, it eventually kills you. If you don't, you live a much healthier life."

Early in his career, Foulds lectured and continued his research on tobacco addiction in the U.K. He established a smoking cessation clinic at St. George's Hospital and Medical School in London, and later became Director of Research at Quit, a UK charity with a smoking cessation hotline that received 500,000 phone calls a year.

In 1999, Foulds was invited to speak at the World Health Organization's (WHO) conference in Helsinki. He addressed the question of harm reduction: Should public health advocates be encouraging people to switch to less harmful forms of tobacco, if they can't or won't give up tobacco altogether? "It's a very controversial topic," Foulds says.

In his presentation, Foulds cited a product called snus, a smokeless tobacco widely used in Sweden. "I stated that while there is no such thing as a cigarette that won't cause cancer, there are kinds of smokeless tobacco that have markedly lower risks, and that part of the reason smoking prevalence and lung cancer was so low in Sweden was because many Swedish men had successfully switched from cigarettes to snus," he says. "But the Swedish participants strongly objected. It created quite a stir."

At the WHO conference, Foulds met a fellow tobacco researcher from the U.S.: John Slade, MD, then a professor at SPH. They emailed back and forth over the next several months. In 2000, Slade offered Foulds a job directing a smoking cessation program that was to be set up with the funding from the state's Department of Health and Senior Services via the Master Settlement Agreement (settlement of a lawsuit which sued tobacco companies for the state's Medicaid costs caused by tobacco).

Foulds had already spent time in the U.S. A soccer star, he attended Andrew College, a two-year undergraduate school in Georgia, on a soccer scholarship. He only stayed a year, but it was a fruitful one. "The college was ranked top 10 nationally for soccer that year, and I also met my future wife there," he says. "We enjoyed our time in Georgia, and so years later, we named our first daughter Georgia. Just as well we didn't meet in Massachusetts."

As director of the Tobacco Dependence Program at SPH, Foulds oversees training and clinical activities designed to reduce the harm to health caused by tobacco. He says, "It is a pleasure to work at the Tobacco Dependence Program alongside colleagues he describes as national experts on tobacco addiction. He also continues to do research. He is currently studying the effects of glucose on smoking. "When people quit, they often put on weight," he says. "There is evidence that nicotine is an appetite suppressant, and that a craving for cigarettes after quitting may partly be misattributed craving for carbohydrates. Therefore, by giving glucose, we are reducing the craving for cigarettes by satiating the craving for carbohydrates."

The Tobacco Dependence Program sees highly addicted smokers. It uses a combination of medications and counseling, and has a long-term success rate of around 30 percent. Typically, people trying to quit on their own have only a 5 percent success rate.

The multidisciplinary team includes physicians and social workers - and you won't catch any of them out on the sidewalk having a quick cigarette. "You can't work here if you've used tobacco within the last six months," says the researcher.

Foulds has also received a great deal of media coverage recently (in such distant publications as Haaretz, an Israeli newspaper) as a strong advocate for the smoke-free workplace. "This kind of pollution in the air is akin to keeping asbestos in the roof," he says. "We've gotten rid of the asbestos. Now we need to get rid of tobacco smoke pollution."

As an aside, Foulds' early mentor, the previously mentioned Michael Russell, was the 1996 recipient of the Alton Ochsner Award, an international prize for outstanding research on tobacco consumption and health. The same award was given to UMDNJ-New Jersey Medical School's Oscar Auerbach 10 years earlier, for his studies linking smoking to cancer. Auerbach's research led to warnings being placed on cigarette packages about the health hazards of smoking. So Foulds continues a long tradition at UMDNJ as a voice against smoking, a tradition that was also upheld by John Slade until his death in 2002.

"Tobacco dependence treatment is one of the most straightforward ways to save a life," says Foulds. "Every person we help to quit gains, on average, eight more healthy years."