15 décembre 2009
Smoking rate before and after the implementation of the display ban
Simple comparisons of the smoking rate before and after the implementation of the
display ban are, therefore, likely to exaggerate its impact. To estimate the impact of
display bans on smoking rates accurately, one must necessarily take into account that
cigarette prices and other tobacco measures may also explain the observed decline. This
is what I have done using standard multiple regression techniques. These are standard
tools used in economics and in many other scientific fields to estimate the effect of one
factor of interest on a specific variable, when that variable is also influenced by many
other factors.
Using these techniques I have been able to (a) estimate the impact of the Icelandic
display ban on smoking prevalence taking into account that many other factors may
explain the decline in smoking rates; and (b) assess whether the estimated relationship
between the display ban and smoking prevalence is statistically significant or is the result
of random chance.
To isolate the effect of the display ban in Iceland I used multiple regression techniques to
compare the evolution of the smoking rate in Iceland after the implementation of the
display ban with the evolution of the smoking rate in Iceland before this ban was
implemented, and also with the evolution of the smoking rate in Norway and Sweden,
two countries which have not introduced display bans to date. The use of Norway and
Sweden as benchmarks for comparison is explained by common history and similar
attitudes and policies towards smoking.7
I found that that the Icelandic display ban had no statistically significant effect on
smoking prevalence. This is true for all age groups for which data was available: (1)
individuals aged 15 to 79 years and (2) individuals aged 15 to 24 years. That is, I found
no empirical support for the proposition that a display ban is likely to cause a reduction in
smoking prevalence.
06 novembre 2009
Treatment effectiveness is irrelevant if tobacco users
Treatment effectiveness is irrelevant if tobacco users are not aware of treatment options,
cannot access them, cannot afford them, or do not use them when they are available. Tobaccocessation
interventions can be delivered in many settings and formats. Health-care providers can
inform patients about the health effects of tobacco use and counsel them about treatment options
during routine appointments, patients can be referred to proactive or reactive telephone quitlines
for counseling and often medications, and patients can access computer-based programs that
offer counseling, support, and medications. Evidence-based systems-level interventions that are
particularly effective include tobacco-use identification systems, provider education, reminder
systems with feedback, and dedicated staff. For patients who are willing to quit, an evidencebased
algorithm known as the 5 A’s uses a decision tree to help health-care providers to
• Ask patients about tobacco use.
• Advise current users to quit.
• Assess smokers’ willingness to quit.
• Assist smokers who are willing to quit by providing appropriate tobacco-dependence
treatments.
• Arrange followup for smokers who want treatment.
That algorithm can be used by all health-care providers, including physicians, nurses,
psychologists, health educators, dentists, and pharmacists. For patients who are unwilling to quit,
health-care providers can use motivational interviewing to increase future cessation attempts.
Motivational interviewing can follow the 5 R’s: relevance (encourage patient to explain why
quitting is relevant to them), risks (ask patients to explain the adverse effects of tobacco use),
rewards (ask patients to identify the benefits of quitting), roadblocks (ask patients about the
barriers to their quitting), and repetition (use a motivational intervention each time a patient is
seen).
Many populations of tobacco users may be reluctant to quit, find it hard to quit, or be at
greater risk for adverse health outcomes from tobacco use; these special populations include
people who have psychiatric and medical comorbidities, deployed military personnel, and
hospitalized people. Tobacco addiction is much more prevalent in people who have mental
illness, including schizophrenia, major depression, posttraumatic stress disorder (PTSD), and
alcohol abuse. That is of concern given the increased numbers of veterans returning from the
conflicts in Iraq and Afghanistan with PTSD and the number of Vietnam veterans who have
PTSD. The PHS clinical-practice guideline provides evidence-based treatment protocols for
many special populations.
The issue of relapse from tobacco abstinence is well known; as many as 75% or 80% of
smokers who quit tobacco use will relapse within 6 months. Relapse-prevention interventions
include social support, use of medications, and avoidance of smoking cues.
Comprehensive tobacco-control programs also require surveillance information to help
staff to modify the programs to meet changing needs or to address disparities. Surveillance can
indicate whether policies are being enforced, medications are being correctly prescribed,
quitlines are being used, public-education campaigns are reaching target audiences, interventions
are improving health outcomes, and funds are being spent appropriately. Established
performance measures should be used to monitor program improvements. Surveillance tools
should be designed and operated to provide the necessary foundation for program evaluation,
which should be periodic and thorough and whose results should be disseminated publicly.
22 octobre 2009
Quitting Methods
Those standing to profit by selling quitting products paint cold turkey quitting as almost impossible with few succeeding. Take your own poll. What you will discover is that nearly 90% of all long-term ex-smokers and smokeless tobacco users quit cold turkey. Not only is it our most productive quitting method, it is fast and free. But quitting cold -- in ignorance and darkness -- can be frightening. When combined with education, skills development and ongoing support, no quitting product comes close. Not only do cold turkey quitters avoid potential medication side effects, they do not get hooked on the cure (nearly 40% of all nicotine gum users are chronic long-term users of at least 6 months). All pharmacology products share a common feature. They delay brain neuronal resensitization to varying degrees. What it means is that there is almost always some level of back-end re-adjustment, once they stop using the product, where they are left feeling temporarily de-sensitized.
Record Your Motivations - Once in the heat of battle, it is normal for the mind to quickly forget many of the reasons that motivated us to commence recovery. Imagine having a loving reminder letter listing all core motivations, carrying it with you, and making it your first line of defense - a motivational tool that can be pulled out during moments of challenge. As with achievement in almost all human endeavors, the wind beneath our recovery wings will not be strength or willpower but robust dreams and desires. Keep those dreams vibrant, on center-stage and calming the impulsive lizard brain and no circumstance will deprive you of glory.
Do Not Skip Meals - Nicotine was our spoon, with each puff, dip or chew releasing stored fats into the bloodstream. It allowed us to skip meals without experiencing wild blood-sugar swing symptoms such as an inability to concentrate (mind fog), the shakes, irritability or hunger related anxieties.
24 septembre 2009
Kübler-Ross grief cycle
The Kübler-Ross model identifies five discrete stages in the grief cycle when coming to terms with any significant emotional loss. Albeit chemical, dependency upon nicotine may have been the most intense and dependable relationship in our entire life. Unless wet and it wouldn’t light, never once did it let us down. Unlike when hunting for a lost pet or when our parents were angry with us, nicotine’s “aaah” was always there. If we smoked nicotine ten times per day and averaged 8 puffs per cigarette, that’s 80 times a day that we puckered our lips up to some nasty smelling butt spewing forth scores of toxins and thousands of chemicals. What human on earth did we kiss 80 times each day? Who did we depend upon 80 times a day?
How many
times each day did we write or say our name? Imagine being closer to our
addiction than our own name.
In 1982
Joel Spitzer applied the Kübler-Ross grief cycle model to the emotional
loss encountered when quitting smoking.346 The five stages of emotional recovery
include:
(1) Denial: “I’m not really going to quit. I’ll just pretend and see how far I get.”
(2) Anger: “Have I really had my last nicotine fix? “This just is not fair!”
(3) Bargaining: “Maybe I can do it just once more.” “I’ve earned a little reward.”
(4) Depression: “This is never going to end.” What’s the use?” “Why bother?”
(5) Acceptance “Hey, I’m feeling pretty good!” “I can do this!” “This is good.”
It’s important in navigating emotional recovery to not get stuck in a stage prior to acceptance. Seeing and understanding each stage’s roots will hopefully help empower a smoother and quicker emotional transition home. As we review each stage keep in mind the fact that the Kübler-Ross’s grief cycle of emotional loss is not etched in stone. Some phases may be absent while others get revisited.
15 septembre 2009
Symptoms of caffeine intoxication
An earlier study found that the clearance rate of caffeine from blood plasma averaged 114
milliliters per minute in nicotine smokers and 64 milliliters per minute in non-smokers.
Symptoms of caffeine intoxication have been seen with as little as 100 milligrams of
caffeine daily, and may include restlessness, nervousness (anxiety), excitement, insomnia,
a flushed face, increased urination and gastrointestinal complaints. Intoxication
symptoms seen when more than 1 gram of caffeine is
consumed per day include muscle twitching, rambling
flow to thoughts and speech, irregular or rapid heartbeat,
irritability and psychomotor agitation.
Many of us can handle a doubling of our daily caffeine
intake without getting the jitters. But how can we tell
whether the anxieties we feel are related to nicotine
cessation or too much caffeine? It isn’t easy.
Experiment with an up to 50% reduction in daily caffeine
intake if at all concerned. Be careful not to reduce normal
caffeine intake by more than 50% unless you want to add the symptoms of caffeine
withdrawal to those of nicotine withdrawal.
Caffeine withdrawal symptoms can include headache, fatigue, decreased energy,
decreased alertness, drowsiness, decreased contentedness, depressed mood, difficulty
concentrating, irritability, and a foggy mind. Symptoms typically begin 12 to 24 hours after caffeine use ends, reach peak intensity at 20 to 51 hours, and normally last 2 to 9 days.
25 août 2009
Little habit
"Nasty little habit?" We are true drug addicts in every sense! That’s right, look in the mirror
and you'll see an honest to goodness drug addict looking right back.
This is one of the most harmful rationalizations of all as it minimizes the risk of using
nicotine products in the minds of our children. While it clearly takes time and repetition to establish a habit, research suggests that “experimenting” with smoking nicotine just once
may be sufficient to begin fostering a loss of the autonomy to stop using it.
Adoption of the “habit” rationalization is also disabling to those already enslaved. Instead
of learning and living on the right side of the “Law of Addiction,” we reside in a pretend
world where some day we’ll awaken and at last discover how to control, mold, modify or
manipulate our nicotine use, so as to allow us to use or not use nicotine as often as we
please. At last we’ll discover how to have our cake and eat it too, ” or so we dream.
The phrase "nasty little habit" is just more junkie thinking. Such soft fuzzy words are used
to self minimize the hard cold reality of being chemically married to and dependent upon
nicotine. It’s much easier to tell yourself that all you have is some "nasty little habit." The
warmth of the phrase is akin to that found in the word "slip," a means to sugarcoat relapse
and failure.
Failing to use turn signals while driving is a "nasty little habit" and so is using too many
cuss words, cracking our knuckles or maybe even losing our temper too often.
But, we will not experience physical withdrawal symptoms if we start using turn signals, stop using cuss words, stop cracking our knuckles or when we learn to keep our temper in check. Chemical addiction does foster habits but it does so by forcing each of us to select patterns for the regular delivery of our addictive drug. Our addiction fathers our drug feeding habits, not the other way around. We would never develop a habit of sucking smoke into our lungs while talking on the telephone or after a meal unless the consequences of constantly falling reserves compelled us to do so. Nicotine dependency is extremely dependable. Our blood-serum nicotine level always declines by roughly half if we fail to replenish within two hours. We can depend upon our mind to begin issuing subtle urges to remind us that it is time to bring more nicotine into our body. Calling nicotine addiction a habit is like calling a young child a parent. It didn't take any two hours for my mind to generate the anxieties needed to compel me to smoke more.
At three packs-a-day, if I was on the phone and had not filled my nicotine tank in the past 15 to 20 minutes, then, like call waiting, a second message from my brain’s insula arrived, reminding me of my need to feed. Even food refueling would take a backseat to nicotine replenishment if the meal lasted much longer than 30 minutes. It limited uninterrupted driving time, romance, learning, exercise (if you can call it that), work, living and nearly every aspect of my life. Yes, it was almost always nearing time for another fix. Yes, I developed habits but not just for the sake of having habits. There were only two choices - smoke more nicotine or prepare for withdrawal. I wish it were just a "nasty little habit," I truly do. But, truth is, my name is John and I’m a recovered nicotine addict. Comfortably, I live just one puff away from three packs a day.
12 août 2009
Freedom Starts with Admitting Addiction
It was not easy looking in the mirror and at last seeing a true drug addict looking back. I felt like I was surrendering, that after all those failed attempts I’d lost, that I was a total and complete failure. But as horrible as that moment felt, doing so was the most liberating event in my life. It was then and there I no longer needed the long list of lies I’d invented to try and explain my captivity, my need for that next fix. Yes, there were countless times during my 30 years of bondage where I’d told myself that I was hooked or addicted.
But not until early 1999 did it hit me that, like alcoholism, it was for real. It was then that it hit me that I was no different from the methamphetamine or heroin addict. Dr. M.A.H. Russell, a psychiatrist and addiction researcher at London’s Institute of Psychiatry had me pegged all along. “There is little doubt that if it were not for nicotine in tobacco smoke, people would be little more inclined to smoke than they are to blow bubbles or to light sparklers, ” he wrote. “Cigarette-smoking is probably the most addictive and dependence-producing form of object-specific self-administered gratification known to man.” These now famous quotes by Dr. Russell date back to 1974.
Over the years, millions of nicotine addicts have tried proving Dr. Russell wrong. In January 2003, a Miami based company, the Vector Group Ltd., began marketing a nicotine-free cigarette called Quest in seven northeastern U.S. states. A novelty item, thousands of smokers rushed out to purchase their first pack of nicotine-free cigarettes but locating any smoker who returned to purchase a second pack has proven near impossible.
We would no more smoke nicotine-free cigarettes than we’d smoke dried leaves from the backyard. Hello! My name is John and I’m a comfortably recovered nicotine addict. It is not normal for humans to light things they place between their lips on fire and then intentionally suck the fire’s smoke deep into their lungs. Nor is it normal to chew or suck a highly toxic non-edible plant, hour after hour, day after day, year after year. We rationalize such irrational behavior because of the neuro-chemical reward we can steal by performing the act; a nicotine induced dopamine explosion.
Cuddling up to the warm, cozy rationalization that, at worst, all we have is some “nasty little habit” serves the tobacco industry well. While habits can be manipulated, modified, toyed with and controlled, nicotine addiction is an all or nothing proposition. The industry knows that so long as its marketing continues to sell nicotine addicts on the idea that they’re in full control, that they will likely continue to hand the industry their money until the day they die. Regardless of the delivery device or method used to introduce nicotine into the bloodstream, fully accepting that nicotine dependency has permanently altered our brain not only simplifies the rules of recovery, it provides the key to staying free. Thousands of words but only one guiding principle for keeping our dependency permanently under arrest ... No nicotine today! 67
05 août 2009
Stop using nicotine
any attempt to stop using nicotine is met with a rising tide
of anxieties. Soon, old nicotine use “aaah” memories that fill our brain memory banks
begin looking like life jackets. Instead of staying afloat for the up to three days needed to
navigate the roughest seas and see the emotional storms at last peak in intensity, hungry for
calm, in the mind of a nicotine addict the instant and obvious solution is to take the hook
and bite on old “aaah” memory bait.
We seek and find relief in the exact manner our
addiction conditioned us to generate relief. We reach for the very thing from which only
hours or days ago we were trying to flee. We reach for nicotine.
As illogical as it may sound, we convince ourselves that we can succeed if we just have a
little now, that we can stop using nicotine by using it. We sell ourselves on the belief that
this is our reward for having briefly succeeded in going without.
This quick fix isn’t a solution at all. It is a guarantee of continuing bondage within a cycle
of nicotine-dopamine highs and lows, a lower-intensity storm that’s never ending.
If an underlying current of physical withdrawal anxieties isn’t sufficient to get us to bite,
we face the conditioned consequences of years of nicotine feedings that involved
replenishment patterns that did not go unnoticed by the subconscious mind.
Our subconscious became conditioned to associate various activities, locations, times,
people and emotions with using nicotine. It learned to expect arrival of a new supply of
nicotine in specific situations or under specific circumstances. Insula driven urges, craves
and anxieties alert us when a conditioned use situation is encountered. Normally the urge
is so subtle it goes unnoticed but we reach for nicotine to satisfy it nonetheless.
This classical conditioning bell, like that which Pavlov used to teach his dogs to expect
food and start salivating, must now be un-rung. We must extinguish the flame of each
established feeding cue that we lit through association. But encountering a feeding cue
during a time when brain nicotine reserves are at or near depletion can trigger a brief yet
powerful anxiety episode. While seemingly unmanageable, and while recovery time
distortion can make minutes feel like hours, the episode will last less than three minutes
and is entirely manageable, as detailed in Chapter 11. Contrary to what we then feel, those
three minutes are extremely short lived in comparison to a life of addiction.
17 juillet 2009
Marketing of tobacco products
The Legislation would require tobacco manufacturers to register annually with the FDA and pay
fees assessed by the agency. The bill would require both tobacco manufacturers and
distributors of tobacco products to comply with federal regulations relating to the content,
labeling, and marketing of tobacco products.
CBO has identified two tribal governments
that manufacture and distribute tobacco products. Because those governments would be
required to comply with federal regulations authorized by the bill, they would face
intergovernmental mandates as defined in UMRA. Based on information from tribal and
federal officials, CBO estimates that the costs to tribal governments to comply with the
bill would be small and would not exceed the UMRA threshold for intergovernmental
mandates.
07 juillet 2009
Smoking restrictions in public places and private work sites
As information on the health consequences of exposure to environmental tobacco smoking (ETS) has become more widespread, governments at all levels in many countries have adopted policies to limit smoking in public places and private work sites.
A World Health Organization (1997) survey of
tobacco control policies in 134 countries indicated that the vast majority of countries had some form of
restrictions on smoking in public places. Although the restrictions are primarily intended to reduce
non-smokers’ exposure to ETS, they can also affect the smokers since the restrictions reduce the
smokers’ opportunities to smoke or otherwise raise the “cost” of smoking.
Smoking restrictions may
also alter the perceived norms related to smoking by changing attitudes concerning the social
acceptability of smoking.
The impact which smoking restrictions have on cigarette demand has been evaluated in a number of
studies. In general, smoking
restrictions have been found to reduce both smoking prevalence and average daily cigarette
consumption among smokers. For example, Yurekli and Zhang (2000) estimated that restrictions on
smoking reduced cigarette consumption per capita by 4.5 percent in the United States in 1995.