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The US Surgeon General’s Report of 2014 stated that the evidence is sufficient to conclude that advertising and promotional activities by the tobacco companies cause the onset and continuation of smoking among adolescents and young adults. Philip Morris reported in 1999 that “the ability to attract new smokers and develop them into a young adult franchise is key to brand development.”  Smoking is instilled throughout contemporary culture and adversely influences the behavior of adolescents. Half of all movies for children under 13 contain scenes of tobacco use, and images and messages normalize tobacco use in magazines, on the internet, and at retail stores frequented by youth. Many of the video games that were released in the past few years, which were rated appropriate for “teen” audiences, feature characters who smoke. These characters are portrayed as tough and powerful, sending very dangerous messages to young people. Video game content descriptors often fail to mention tobacco use, making it difficult for parents to monitor the games. The depiction of tobacco use in games serves, in effect, as free advertising for tobacco companies, and a recruitment mechanism for the “replacement smokers” they need to make up for the 1,300 people who die each day from a tobacco related disease.


Second and Third Hand Smoke

Posted by Dr.Hays Jan 10, 2018

Exposure to secondhand smoke can cause many of the same diseases as active smoking. It increases the risks of contracting lung cancer by 30% and heart disease by 25%. Heart disease, lower respiratory tract infections, asthma, and lung cancer are the most common causes of deaths related to secondhand smoke. People can be exposed to secondhand smoke in homes, indoor work and public places, cars, outdoor places, and in multi-unit buildings even if nobody smokes in one’s own apartment-but people smoke elsewhere in the building.


Nicotine and other tobacco compounds accumulate on various surfaces (clothes, furniture, walls, and vehicles) and can stay there several months after smoking has stopped, even after the surfaces have been washed. These residues or third hand smoke contain several toxic compounds and have shown harmful effects on human cells and animals in laboratory studies. The nature and magnitude of and health effects are currently being studied. The health effects of exposure to vapor from e-cigarettes are unknown but are being researched as well. The inclusion of e-cigarettes in smoke free regulations is the only way to prevent any potential harm from exposure to e-cigarette vapor.

What is stress? The definition of stress is merely your reaction to an event, not the event itself. Quitting tobacco may place you in a position where you do not have that security/ comfort you once had, possibly leading to distress.


One concept that has been prominent in recovery communities for many years and is gaining more traction in the field of health and wellness is the idea of gratitude and mindfulness:

Gratitude is considered an attitude or expression of thankfulness and appreciation for what one has.  Simply, gratitude is about focusing on the positives in our lives instead of dwelling on the negatives.  Researchers are finding that an attitude of gratitude not only increases happiness and well-being, but can lessen feelings of stress, anger, and depression.

Mindfulness: a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations.


  1. Keep a gratitude journal – Each night try jotting down several things you are grateful for in your life.  They can be as simple as having a good book to read or being able to breathe fresh, clean air.
  2. Help others who are struggling – Being of service to others can help us appreciate what we have in our lives and can provide us with a different perspective on our own challenges.
  3. Keep an attitude of gratitude– Compare these two statements: “I can’t smoke today.” & “I don’t have to smoke.”  How we choose to think about a situation can determine how we feel and act.  Think positive!
  4. Develop a mantra - Many people in recovery recite the Serenity Prayer to appreciate what they can control and accept what they cannot.  Consider memorizing a favorite phrase or prayer that brings peace and positivity into your life.
  5. Find symbols that represent gratitude– Whether it’s writing down inspirational quotes, creating a gratitude board on Pinterest, or keeping a picture of your loved ones at work, surround yourself with the things that motivate you.


Explore brief mindfulness exercises by Dr. Sood of Mayo Clinic



A smoke free 2018

Posted by Dr.Hays Dec 27, 2017

The winter solstice is passed and each day brings more daylight then the next.  Similarly, if you’ve stopped smoking, or intend to stop for the New Year, each smoke free day in 2018 will bring more health and wealth than the day before.


Stopping smoking is the absolute best thing you can do for your health.  If you’ve stopped, congratulate yourself and take a moment to appreciate that you’ve done a wonderful thing. Know that your body thanks you.  Think about the money you saved.  Take a moment to imagine all the cigarettes that you did-not smoke. 


If you’re considering stopping, or planning another stop, the New Year is a great time to take that step.  Get prepared.  Use your past experience as a learning resource.  Explore the tools on EX, recruit your support, and step into a smoke free New Year!

Smoking only a cigarette or two each day would seem to be a lot less harmful than smoking a pack per day, but that’s not necessarily the case.  One problem is addiction. For most people who have an addiction to tobacco, reducing to a few will eventually result in relapse and a resumption of the amount to which they’ve become accustomed.   For most smokers, stopping altogether is easiest.


            However, even if permanent reduction to 1 or 2 were sustainable, the health consequences from smoking only a few are quite severe.  A large study published in Circulation found that heart attack risk, and cardiovascular disease risk from smoking even a cigarette or two per day can be as almost the same as for those who smoke 15-20 per day.       There seems to be no risk-free level of cigarette smoking.  


If you do smoke at all, the only healthy solution is to stop completely.  Also, keep in mind, that health benefits begin as soon as you stop.  Carbon monoxide levels become normal within a day or two, wounds, like from surgery, heal better, after 2 days of not smoking, and lung function improves significantly within 3 months. Within one year, your chance of having a heart attack is cut in half, and within 2-3 years it’s the similar to someone who has never smoked at all!.


Pope CA et al. Cardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke. Circulation. 2009;120:941-948.


Inoue-Choi M et al. Association of Long-term, Low-Intensity Smoking With All-Cause and Cause-Specific Mortality in the National Institutes of Health–AARP Diet and Health Study. JAMA Internal Medicine. 2017;177:87-95.


Team Approach to Quitting

Posted by Dr.Hays Dec 13, 2017

We at the Nicotine Dependence Center are thrilled to see all the support that is happening on the EX Community. 

I have heard a couple of concerns regarding how medications can change effects once you have quit as well as other health concerns. This may be possible, quitting tobacco is a big change and it can make for a disjoint in how your body runs on a day to day basis. Having a team approach which would include health care providers can be very helpful.

Quitting can change; blood pressure, sleep habits, effects of caffeine, and etc. depending on the person.  Therefore, medical staff can play an important role by monitoring and adjusting medications and you move about the quit process.

You’re not alone, keep others informed!


Behavioral Substitutes

Posted by Dr.Hays Dec 7, 2017

When quitting smoking, often one of the toughest parts is finding a suitable “substitute” for wanting something in your hand.


Suggestions for this include cinnamon sticks, cinnamon gum, or cinnamon candy.  Smokers say that the taste of cinnamon has the same ‘bite’ that a cigarette has.  Keeping a water bottle handy is another good idea – as water can curb cravings or urges also.  Many struggle with weight gain when they quit smoking, as they eat more to keep their hands and mouth busy.  Unfortunately, there is no magic remedy for this other than reaching for more sensible snacking such as vegetable sticks – celery, carrots.


Some people pick up a now hobby or interest when they quit smoking – craft work – wood-working, needlepoint, playing an instrument – such as guitar, will help with keeping one’s hands busy.  Besides this being a good behavioral substitute, it also “signals” to you that you are embarking on a new lifestyle.


There are so many options these days – such as hand-held video games, small magnetic sculptures, stress balls – even modeling clay can often hold one’s interest for some time – and keep your hands busy as well.  Many of these are inexpensive, and can easily get you through a craving – which typically lasts no more than 3-5 minutes.


You might be surprised at how just finding the “right substitute” can really help with that craving!!!


Cravings After Meals

Posted by Dr.Hays Nov 29, 2017

For many people, a particular challenge to becoming tobacco free is managing the desire to use tobacco after finishing a meal. This desire, like all cravings, becomes less intense and less frequent over time; however, the thought can persist for quite a while.  Understanding and planning for these cravings and thoughts can help extinguish the desire for a cigarette after a meal.


Tobacco, like any addictive substance, stimulates the reward system in the brain. In doing that it can become strongly associated with situations, moods, or emotions, that coincide with the tobacco use.  The pairing then reinforces that situation.  For example, having a cigarette after a meal will trigger the desire for a cigarette after the next meal. 


In addition, nicotine has a relatively unique characteristic of being a powerful ‘secondary reinforcement’.  That means that it enhances the enjoyment of the primary pleasure.  In the case of smoking after a meal, the satiety one feels after eating can seem to be more satisfying when accompanied with tobacco. The pairing then strengthens.


Here are a couple of suggestions to rewire that ‘after meal’ pairing.  1.) Remember, the craving for tobacco will go away in a few moments. 2.) Spend a mindful moment after the meal enjoying the feeling of satiety, or contemplating the taste of the good food just eaten. 3.) Distract your mind with a drink, even a sip of cool water. Your mind can’t focus simultaneously on a cigarette, and the taste of the liquid on your tongue.  4.) And most importantly, don’t smoke or dip.  Each time you finish a meal and don’t use tobacco, the association weakens.


I would be interested to hear from other members of the community on ‘beating the craving’ after a meal craving.

While some smokers report short-term benefits to symptoms that can be associated with mental illness studies that have measured symptoms such as anxiety, depression, stress, and quality life before and after smoking cessation find that cigarette use is associated with worsened mental health.  It may be that some of the benefits a person perceives comes from smoking may actually be due to the elimination of nicotine withdrawal symptoms.  Common symptoms of withdrawal include:  irritability, restlessness, insomnia, anxiety, depression, increased appetite, and poor concentration. The table below demonstrates the effect smoking cessation has on symptoms of mental health as well as the increases to psychological quality of life and positive affect.  The positive effect from stopping smoking is measured as similar to the effect experienced from common anti-depressants!


Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151.

Stopping smoking improves mental health
Taylor et. al. (BMJ 2014)

A couple of us at the Nicotine Dependence Center were recently looking at the discussions in the EX community ‘Mental Health Support’ group with great appreciation and admiration.  The perseverance and commitment to becoming tobacco free described by struggling members is moving and awe-inspiring.  And, the experience, strength and hope that members provide in support of their struggling compatriots is wonderful to read.


As you probably know, the reduction in smoking rates that has occurred in the United States over the past 50 years has tragically not happened for people who suffer with mental illness.  Individuals with mental health problems now smoke at 2-4 times the rate, and suffer more illness and early death, than those without mental health diagnosis. 


This tragedy continues, in-part, because of myths such as ‘people with psychiatric disorders are unmotivated to quit, or unable to quit’, or ‘stopping smoking will make mental health problems worse’.  These types of myths have led to tobacco treatment support that is less than sufficient for people with co-occurring mental health problems, and public health campaigns that have not reached out to mental health consumers.


This inequity needs to end.  As the EX discussions show, people with mental illness want to become tobacco free, and can become tobacco free.

It’s that time of the year, the third Thursday of November is known as the Great American Smokeout.  In 1977, the American Cancer Society launched this event to encourage smokers to quit for 24 hours. This event has helped people to learn about the many tools that they can use to help them quit and stay quit.  For some of you this may be your quit date, and for others it may just be a day on the calendar, either way we are glad you stopped by the blog to see what the Ex community has to offer. 


I am curious; it has now been 40 years since they launched the event, what are your thoughts on the Great American Smokeout?


For more information visit the Center for Disease Control: Get Ready...Set...Quit! Great American Smokeout | Features | CDC 

Ever wonder why someone who uses tobacco products are treated with essentially the same drug they are getting from tobacco?

The other components of burning tobacco cause all the harm. Nicotine is the addictive substance which is why we use it for treatment; however, nicotine itself is not causing cancer, heart conditions, or strokes. Without Nicotine, people would not use cigarettes or smokeless tobacco. In order to wean the brain off of the substance with (hopefully) little withdrawal symptoms, we substitute with nicotine replacements (patch, gum, lozenge, nasal spray, and inhaler).

Going back to the addictiveness of Nicotine, when inhaled through a cigarette, it is the fastest delivery of the drug to the brain; 7 to 10 seconds to be exact. Once the Nicotine has reached the brain, it releases an explosion of dopamine (feel good natural chemical), which is why the addiction can be so powerful. When we look at the delivery of Nicotine replacements it is much slower (several minutes) making it rare that individuals abuse or become addicted to these products. The products help to fill the void of nicotine from a cigarette and with the slow and steady release it allows your brain to crave less and less over time.


Here is a graph that demonstrates this:

People who are trying to stop smoking are all too frequently bombarded by confusing information about what works for helping people become tobacco free.  Cream of tartar, quit smoking magic, aromatherapy, essential oils, hypnosis, laser therapy, nicotine replacement, non-nicotine quit smoking medications, and e-cigarettes, are just a few of the myriad of choices that can be found from a web search.


The bottom line is stopping smoking. People can and do stop in a variety of ways.  However, as a health care practitioner my goal is to help our patients in ways that are most likely to be effective.  Fortunately, we have as much evidence for what helps people become tobacco free as we do for other chronic health problems like diabetes and hypertension, and more-so than we do for many other addictive disorders. The scientific evidence supports that a combination of counseling, peer support, FDA approved medications, and strategies to manage cues to smoke and to maintain motivation all work to significantly improve quit rates. 


At the risk of providing too much information, Tobacco Treatment Specialist are professionals who have been trained to provide evidence-based treatment for tobacco dependence.  Currently there are almost 20 schools that have been accredited to provide this type of training, and there is a new national certification just coming on-line.  If this description of Tobacco Treatment Specialists is TMI,  please just ignore. For those who are interested you can find more information about Tobacco Treatment Specialty at ATTUD-Association for the Treatment of Tobacco Use and Dependence 


Truth at Last

Posted by Dr.Hays Oct 20, 2017

Around Thanksgiving you should start seeing television advertisements from the tobacco industry. These are not what you might expect.  Finally, after years of litigation the big three tobacco companies have been ordered to run advertisements to partly correct ‘false and misleading (health) claims’ made by them to promote the sale of cigarettes. 


The courts decided in 2006 that the tobacco companies had deliberately deceived the public about the health effects from smoking. The judge in that case found the tobacco companies had mislead the public on the health effects from smoking, the addictiveness of smoking, impacts from second hand smoke, and low tar and nicotine cigarettes.  Since then the tobacco companies have been appealing.  But, at long last, they are ordered to issue ‘corrective statements’. 


You can find out more about this court ruling at  RICO | Public Health and Tobacco Policy Center 


Fall - A Time for Fresh Starts

Posted by Dr.Hays Oct 11, 2017

As we enter the season of autumn – I always feel a sense of new beginnings, and a ‘fresh start’.


For, this time of year is full of new beginnings:

  • kids going back to school with newly-sharpened pencils and a   fresh box of crayons;
  • the possibility of new friendships;
  • and, young adults beginning their college careers.


Perhaps, I’m thinking about starting a regular exercise regime.

I could begin by:

  •  parking farther from the shopping mall; 
  •  looking into that yoga class I been interested in; 
  •  or, taking a relaxing walk after dinner rather than sitting down in from of the TV.


As humans we are constantly changing as we are shaped by our everyday experiences.

And these changes are processes – often slow and methodical, a little at a time.


So it is with quitting smoking, and as this time of year is full of  ‘fresh starts’, make this fall a fresh start for you – by making small steps towards quitting smoking.


But just what would be some small steps to achieving that goal?

  • write down your reasons for quitting – and how you hope your life will be different as a non-smoker;
  • talking with your friend about quitting smoking with you;
  • or, even making an appointment and talk with a tobacco treatment specialist, or your doctor, about some of the medications out there now to help you quit.


These seem like small steps, yet they are giant leaps in how you will feel about yourself, just knowing you have begun the process.


Just taking small steps toward your goal could make you feel surprisingly productive, and energize you toward achieving the goal in the end – a smoke-free life.

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