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Australia has won an important battle against the tobacco industry.  In 2011 Australia passed a law which required ‘plain packaging’ for all cigarette packs sold in the country.   That means the pack must have a graphic health warning, be one drab color, with the brand name in standard size and font.  Plain packaging has been shown to make it less likely young people start smoking, more likely that smokers will stop.  It also helps people who are trying to stop by reducing relapse risk from point of sale marketing.  It is very good for public health and will substantially reduce the cost of health care in the country.

Since 2011 Australia has been in litigation with tobacco companies who sued Australia for ‘theft of property’. The Supreme Court in Australia decided against the tobacco industry in 2012.  In anticipation of this, the tobacco companies relocated their local corporate headquarters to other countries and subsequently sued Australia for ‘theft of property’ meaning their packaging color schemes and branding.  The industry sponsored countries such as Honduras and Indonesia as plaintiffs in the suit.

Last week the World Trade Organization decided in Australia’s favor.  It did cost the country almost 40 million dollars, a cost which many other countries might have found too burdensome.  You can read more about the court decision: Australia wins landmark World Trade Organization ruling on tobacco plain packaging laws .

John Oliver on his show ‘this Week Tonight’ aired in 2015 a very funny and insightful discussion of the Australia plain packaging legal battles. He deftly illustrates the threat to other countries posed by the tobacco industry, while the pose as representatives of the public interest. You can view the episode: Tobacco: Last Week Tonight with John Oliver (HBO)

Don’t forget to celebrate your independence from tobacco on July 4th


When you stop smoking, you truly gain independence.  You no longer depend upon cigarettes to help you get going in the morning, to manage stress, to help you drive the car, or to enjoy your coffee.  You are no longer hounded to make a long march outside of our smoke-free buildings to alleviate withdrawal and are no longer bound to pay the tobacco company so that you can just feel normal.


If you have already stopped smoking, take a moment this July 4th to celebrate your freedom and think of all that you have gained since stopping smoking.  If you are considering quitting, use this day as a jumping off point.  Use all the tools available at to develop a plan and then begin to work on your plan for independence from tobacco.  Join in the independence celebration this year so that you will be around to celebrate for many years to come.

Tobacco use remains the #1 cause of preventable death in the United States and across the globe.  In 2015, tobacco was estimated to account for 7.2 million deaths worldwide.  By 2025 it is projected to cause 10 million deaths per year.  Tobacco use may kill 1 billion people in the world during this century.  And, do you know that most of those people, who will die from tobacco use, have not yet started to smoke.  You are never too young or too old to help your heart by quitting all tobacco use!


If you have known heart disease of any kind, or if you want to remove the #1 cause of heart disease, stroke, cancer, many major lung problems, as well as other illnesses, you want to quit all tobacco use. 


We know that when tobacco is burned, there are over 7000 chemicals released, including 60 cancer-causing agents.   The nicotine in tobacco narrows your body’s blood vessels while the carbon monoxide in tobacco can damage the inner lining of your blood vessels, around your heart and all over your body.  This damage to your vessels makes your coronary arteries, which supply oxygen and nutrition to your heart, more likely to narrow causing “hardening of the arteries” to develop. 


People who smoke are far more likely to have a heart attack than those who do not smoke.  Breathing in secondhand smoke can also cause changes in blood vessels and blood flow in people who do not smoke.  And, today, we are learning more about third-hand smoke, which is also very damaging.


What is your plan to stop smoking and stay quit?  Use the many tools available on EX to develop a plan that will work for you.  Reach out for support.  If you are interested in using medications, talk to a trusted professional, who is specialized in treating tobacco to discuss options for quitting.  Set a stop date and get ready to enjoy the many benefits of stopping.


Remember that quitting tobacco will improve blood pressure, lower your heartrate, lower cholesterol levels, and improve your overall health and well-being.


Taking care of yourself FIRST, is the BEST thing you can do for those you love and for the other priorities in your life!  Best of luck!


Want to learn more? Feel free to leave a comment!


Kathy Zarling, MS, APRN



Let’s face it- non-smokers are often not very nice to those who do. Smokers get judged, ignored, and even called names.  People who smoke are often the target of stigma and stereotypes. This stigma can have devastating consequences. Stigma is associated with reduced treatment adherence, potential delays in asking for help, getting treatment, and can increase the risk for depression.  Stigma can cause one to feel guilty and shameful. What can you do to prevent this stigma from getting the best of you?

  1. Understand that most people do not have any understanding of the addictive properties of tobacco and the difficulty involved in quitting.
  2. Stigma and stereotypes have been around for a long time and most likely will not go away – do not let them get in your way!
  3. Focus on YOU – what is in it for you? How will you benefit if you were able to quit? 
  4. Give yourself credit for what you are doing.
  5. Quitting smoking is hard work, it can take a few times before one is able to quit for good.

Think about how stigma may be playing a role in your efforts to quit.  Having the awareness of it may impact how you  react to it next time that you are faced with the  stereotypes or stigma associated with quitting.


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS


Failure to Launch

Posted by NDC.Treatment.Team Jun 13, 2018

In honor of social media terming this week as “men’s health week,” I have decided to inform you of just how smoking can play a lead role in infertility. Granted I will inform you of both men and women, it is something we sparingly see at the clinic but something that can be just as important when considering having a family.  Infertility is often thought of as a “female issue,” however that is not the case. Research suggests 35% of infertility cases are caused by male factors, 35% are caused by female factors, 20% come from both, and 10% is undetermined.


In men- Smoking increases the risk of low sperm count and erectile dysfunction (the inability to get or keep and erection). Toxins from cigarette smoke can also damage the genetic material in sperm, which can cause infertility or genetic defects in your children.


In women- Smoking makes it more difficult to become pregnant and if you are able to become pregnant, smoking increases your chance of having serious pregnancy complications. Such as: Miscarriage and ectopic pregnancy (when the fertilized egg implants outside the uterus, usually in a fallopian tube). Smoking affects each stage of the reproductive process, including egg and sperm maturation, hormone production and the environment in the uterus. It can also damage the DNA in both eggs and sperm.


Together- Smoking tobacco by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Research shows it is much easier for people to stop smoking if they do it with their partner. Deciding to quit together is a great way to increase your fertility and chances of having a healthy baby.


Laura McConahey MS

NDC Counselor/CTTS


Feel free to comment below on other questions you have on this or other topics regarding family, children, or pregnancy and I would be happy to address those in future blogs!

I have had many conversations lately with patients about how powerful their addiction is to nicotine. The conversations have made me think about all of you that are struggling to quit tobacco and the reasons I enjoy being a part of the journey.  I always feel privileged to be a part of someone’s quit attempt and walking beside them working through lapses, relapses, and celebrating triumphs.   Many people feel that you should just be able give up tobacco and it is no big deal to quit.  However, most often that is not the case, because nicotine alters the brain and you crave it.  This judgmental attitude often can lead to pointing fingers and shaming the individual who is trying to quit.  As many of you have experienced the blaming only makes this worse and you may give up.  I encourage you to keep trying because with each quit attempt important insight is gained.  You learn what works and what doesn’t work for you and this information puts you in a better place the next time you try to stop. 

When thinking about quitting, consider all of the tools that you will need to help you be successful.  Do you need medications to help with withdrawals and cravings, behavior therapy to help deal with habit, or support from places like

During your journey, it is important to treat yourself with love and kindness, you owe it to yourself.  Dealing with others can be hard enough; don’t let self-doubt or shame contribute.  Quitting is difficult and we are often our own worst critics.

One exercise to try is when you are feeling down on yourself during this quit is ask yourself, “What is it that I want out of this?” and focus on your answer.  I often use a mantra with many of my patients and maybe it can become one that works for you too, “Whatever follows I am                           is going to come looking for you.” For example, you can tell yourself, “I am not a smoker or I am going to overcome this” and before long it will become your new way of thinking.  The positive thinking will add to your beliefs and help with success.     

One final thought, give yourself time to process this big change, it is definitely something worth taking the time for.  Take a moment, listen to your body – what is it needing? Food, a friend, a good cry, distraction, or someone to listen?  Practicing good self-care by getting your body what it needs is important so you can be successful and get to TOBACCO FREE LIVING.


Heather Kraling-Coons

NDC Counselor/CTTS

We are in an era where less and less people are starting to use tobacco; there is greater awareness of health effects, online support (BecomeAnEX), and technology to have greater reach of individuals to services — but, we seem to have a disconnect in that we are not reaching youth/young adults to help them stop smoking.

As I have learned from many of you, you appreciate the support, guidance, and experiences that are shared within the EX community. Making a major life change is HARD; whether it is quitting smoking, chewing, or plain exercise and healthy eating! What I have seen on this site is others normalizing experiences, encouraging one another, and responding with empathy; all of which have helped individuals feel comfortable, welcomed, heard, not alone, and motivated! All of which are great and I believe so many people can benefit from these same feelings and connectedness.  

With that thought in mind; I am wondering what efforts you as EX community members and advocates have done to support others within your local communities?  

Here in Rochester, Minnesota there have been efforts to provide supportive counseling and Nicotine Replacement Therapy (NRT) through the local Salvation Army for individuals who do not have health insurance. Minnesota also has great Medical Assistance programs that cover tobacco cessation services.

Changing tobacco culture can take a village: we know that with increase taxes, increase age of purchase, and smoke-free policies can all help to reduce the number of individuals who start.  

What contributions have you made locally in your community? Or are there any opportunities to get involved in your community on the continuous battle against Big Tobacco?



To find out what is happening in your state visit the State of Tobacco Control 2018 | American Lung Association


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

As the weather gets warmer, we can all enjoy getting back outdoors and being active. You see, when you are physically active, endorphins in the brain are released, thus improving your mood.  So those pleasurable feelings that you previously associated with smoking, you can still have while obtaining them in a healthy new way.


And, while being more active in the summer is certainly a plus when quitting, often your normal routine is somewhat upset; or at the very least, different in the summer (i.e., kids are out of school, family vacations, home projects, etc.)  When people find that their normal routine is interrupted, this is also a good time to quit; as they don’t have those typical triggers in their day that have become so much a part of their everyday life.


Some steps you may want to consider as you prepare to quit:

  1. Begin by tracking when you are smoking.  This technique, often referred to as “journaling” or “logging” about your smoking is one way that you can make some steps toward quitting, without actually quitting right now. 

   Put a small notecard in your cigarette pack, and record:           

  1. The time of day you are smoking,  a rating of your current urge to smoke ( L-light, M-medium, or S-strong)
  2. Your current mood in one word (angry, stressed, happy, etc.), and
  3. What you are doing at this time (having coffee, working on a project, watching TV, etc.)

This is one way that you can begin the process of quitting smoking.  By considering what times of the day are going to be the most difficult for you when you quit, you can begin to plan those lifestyle changes that will be helpful to you when you quit (i.e., the times when a little physical activity, or merely a distraction or some kind, will be the most helpful such as a few minutes of meditation, calling a friend, or throwing a ball around). 

  1. Make an appointment with a tobacco treatment specialist, or your family care physician, to discuss medication options.  Plan on using at least two of the 7 approved smoking cessation medications (nicotine patch, nicotine inhaler, nicotine nasal spray, nicotine gum, nicotine lozenge, Bupropion, or Varenicline), and find a plan that is right for you.   
  2. Set a stop date.  When picking a stop day,  you may want to choose a day that may be less stressful – such as a day that you are not working;  or perhaps you would rather be working on your quit day, as you feel keeping busy would be helpful to you.  Again, this is your plan, and you know yourself the best.

When quitting smoking, with whatever medication plan you choose, plan on using it for at least 3 months.  It will take that long to get your new, smoke-free lifestyle into place.   After all, you have those 3 glorious months of summer to fine tune these changes, and make this quit attempt the one that really sticks!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS



The 10 Year Anniversary

Posted by Dr.Hays May 16, 2018

In 2008, the Truth Initiative and the Mayo Clinic Nicotine Dependence Center began a strategic partnership to support people in their efforts to become ‘tobacco free’. Since then, the EX program has helped many thousands of people to recover. The counseling staff at the Nicotine Dependence Center (NDC) is very happy to commemorate this milestone, and to continue to serve in our role as clinical partner to Truth and the EX Community.


The mission of the NDC is to inspire hope and empower change for healthier living and a future free from tobacco. During the past 30 years, in pursuit of this mission, we have provided counseling and treatment to 10’s of thousands of patients, trained thousands of health care providers to help their patients stop smoking, and have participated in hundreds of research studies to improve treatment of tobacco use disorder. But, none of our work is more germane to our mission than our relationship with EX and Truth.


As a society, we have made significant progress in addressing the tobacco epidemic. During the past 10 years smoking rates have declined from about 20% to about 16% today. But, almost 40 million Americans continue to smoke. The large majority of these people wish they never would have started, and if they don’t quit, more than half will die from a tobacco caused illness.

We still have important work ahead. We look forward to continuing to work with the community and the Truth team to develop new ways to connect with all those who want to stop and support them in becoming an ‘EX’.


Congrats and thanks for being part of this successful 10 year journey. We look forward to many more!


Dr. Hays and the NDC Treatment Team

So you’ve decided to quit tobacco and sure could use some support from your friends, family, loved ones, and of course the BecomeAnEX Community to make becoming tobacco free happen.  After all, as the trendy saying goes, “Team work makes the Dream Work!”.   You may feel you don’t need or want to ask for anyone’s support because this is “your thing, your battle, your fight”.  Let’s face it: you will not go through withdrawal and recovery in isolation if you live in modern society.  No matter how you may try to “bare it alone”, certain people will be in your presence during your “quit time”.  So, whether you like it or not you will be the beneficiary of people’s words and actions that will either encourage you or trigger your desire to use.  The bottom line, every social interaction affects you and has the potential to be helpful or harmful to your success.  Therefore, it is to your benefit to do what you can to increase the probability that those closest to you will interact with you in a way that is supportive of you quitting.


Alright, if you buy that argument, you are now thinking, o.k., well expert, what words and actions from others will be helpful for me in my quit journey? That, my friendly reader, is yours to determine.  You know yourself best, so dig deep and consider past challenges to identify what you benefit from.  Because you will undoubtedly be the recipient of their input it is in your best interest to figure out what you need and want.  Also, this is your quit journey, so it is your responsibility to share your findings with them.


To achieve these, take some time to be introspective, and reflective.


Ex. Introspective and reflective:  What would help me stay on the quit track?


Helpful is a very ambiguous term; what it is and how it “looks” is unique to the individual recipient.  

  1. Figure out what you need in the way of support and encouragement.
  2. Figure out what you do not need or like.
  3. Do not let SHAME, anxiety or fear keep you from expressing what you need.


Finally, to actually get this help, you need to make sure you best communicate your wants and needs to your loved ones. 

  1. Figure out and practice how you can best convey that message Specific:  Choose and practice wording that clearly communicates what you intend to say, i.e., gets your message across to them.
  2. Be careful of your approach and tone: Tell those who are closest to you exactly what you need in a loving way – Speak the truth in love.
  3. Be prepared to answer their questions without getting defensive.
  4. Find a comfortable space and time to communicate that message.
  5. Choose a setting where there are no distractions (noise, other people “butting in”.)
  6. Show gratitude for their willingness to support you.

Jennifer Burden, PhD

NDC Counselor/CTTS

Often times popular media headlines cloud our ability to weigh actual risks.  Just yesterday I had a group of patients who are interested in stopping smoking say “Well isn’t everything causing cancer? What about coffee?”  This allowed for a great discussion on weighing the risk and knowing the source of the media.

Take Coffee vs. Cigarettes for example:

A preliminary ruling by a Superior Court judge in California has created quite a buzz in the headlines about coffee causing cancer.  The decision may eventually require shops to put a warning label on coffee that contains acrylamide, a chemical formed when some coffee is roasted.   Acrylamide has been classified as a Class 2A carcinogen, meaning that it has been shown to cause cancer in animal studies, but studies done in humans have not found a clear association with cancer in the quantity of exposure typical in diet.  Acrylamide can also be found in breads, cookies, breakfast cereals, French-fried potatoes and some canned goods.

The health risks from coffee have been evaluated and debated for many years.   People who drink coffee tend to live longer, and may lower their risk from many cancers.  On the other hand, there may be health risks.   A helpful discussion among experts at the American Cancer Society concludes that there may be health benefits to drinking coffee, but further research is needed.  If you are concerned about acrylamide, it might be worthwhile to limit coffee intake, and eat fewer chips, cookies, and French fries.

If you truly want to reduce your risk for cancer, by far the most important thing you can do is stop smoking and stay stopped. 

The risk from smoking outweighs the risk from any other product made for regular human consumption.  Cigarettes are the only product that kills 60% of the people who use it as the manufacturer intends.  Tobacco is responsible for almost 1 in 5 deaths in the United States; it is known to cause 14 different types of cancer, including 90% of all lung cancers, the leading cause of cancer death for both men and women.  In addition it more than doubles the risk for coronary heart disease, stroke, and causes most cases of emphysema. 

So, don’t let the headlines cloud your vision.   Who knows what will come of the coffee labeling, or how much coffee you would need to drink to cause harm, but what we do know is tobacco products are are proven to harm, and the best single thing you can do for your health is to stop and stay stop.  BecomeanEX!


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS

As way of introduction, we are a group of Master’s/PhD level counselors and Certified Tobacco Treatment Specialist who provide tobacco treatment to individuals at the Mayo Clinic Nicotine Dependence Center. We are happy to announce we will be joining the BecomeAnEX community to continue writing blogs to support tobacco-free living. To learn more about our team visit our NDC Treatment Team profile page.


It has been an honor joining with the BecomeAnEX community and reading all the empowering stories you present. If you are thinking of quitting, have quit, or have many years of being quit under your belt, BecomeAnEX Community provides support near and far. We cannot wait to learn more about you, and let you get to know us, through participating in the community.


Keep working towards your goals!



NDC Treatment Team

The NDC Treatment Team


Channeling self-care?

Posted by Dr.Hays Apr 25, 2018

I wanted to give a shout out to psychick, who wrote a blog a while back on self-care and what it means to her in a very honest and very real tone.

We all have good days and bad days and practicing self-care can improve how you plan to quit tobacco and manage the stress of it all. Practice self-care for the best interest of you, this is YOUR quit attempt! Own your quit and make it something you want or are looking forward to. Think of all the reason you want to do this for YOU not for your doctor, spouse, friend, co-worker… YOU!

Make a plan:

One thing we practice at Mayo is HALT, making sure you are never too Hunger, Angry, Lonely, or Tired.  It is situations like these where we are spread thin and impulsively respond to stress in a way we later may disapprove of such as relapsing on tobacco, indulging in fatty food, drinking too much, or etc. Do a body scan- “what is it that I need in this moment to feel content?”

Before these moments of desperation occur; think of things you enjoy and can easily be distracted by…. Add that to your self-care plan. The more you plan the easier it will be to recall in times of need, so don’t wait, start thinking today!  

One of my patient’s would write down their favorite self-care strategies then when they had a craving they would pull from the jar. Example: hiking, biking, spa day, attend church, spend time with family, laugh, play with your dog, go for a run, the list goes on.

Send us what a good day looks like for you when you are keeping up with your self-care

Stay positive 
Dr. Hays


Spring: A time for growth

Posted by Dr.Hays Apr 18, 2018

Spring is a time for growth as the flowers start to show, the grass turns bright green, and we start to come out of our winter hibernation. This can be an exciting and hopeful prospect, especially when trying to quit tobacco. Keeping busy and distracted with pleasurable activities can be a great strategy as part of a plan to quit, and springtime affords many opportunities: walking, gardening, bike riding, or sitting outside and enjoying the fresh air.


Spring can be a time for optimism, with sunshine and warmer weather bringing positive thoughts and motivation for making a change. When people quit tobacco, it sometimes inspires a host of other healthy lifestyle changes.  Incorporating physical activity into your day may boost your quit plan by reducing nicotine withdrawal and cravings, and by helping to manage weight gain. It may also spark further motivation to stay quit when you start to notice that you can walk farther, stay out in the garden longer, or have more money in your pocket for new summer toys!


Plan to take advantage of the spring season this year and all of the opportunities it affords as you quit tobacco. Even better, quit with a friend and take up a new healthy hobby together – and share your ideas on The EX Community!


Dr. Hays


Weighing the Pros and Cons

Posted by Dr.Hays Apr 11, 2018

While giving up smoking is a hard thing to do, sometimes you have to consider the alternative.


What else are you really “giving up” by continuing to smoke?  Perhaps running after your 2 year-old granddaughter, blowing out candles on a birthday cake, singing the national anthem at a football game, helping your son move into his new home, dancing with your spouse at your high school homecoming, or even, walking your daughter down the aisle.


Life takes breath.  Breath is what gives life. 


People with severe chronic obstructive pulmonary disease (COPD), which includes conditions such as emphysema or chronic bronchitis, often have difficulty with many of the routine tasks of everyday life such as pushing a cart at the grocery store, walking to your car in a parking lot, or mowing the lawn. Not only does COPD affect your physical health, it can also affect your mental health as well, leading to anxiety, fear, and depression. Many who have been there know how scary it is for them when they have difficulty catching a breath.


So the next time you think about picking up a cigarette, think about this: 

Would you rather fight the urge to smoke every 10 minutes,  or fight to breath every 10 seconds?

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