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Many folks are convinced they perform their best — at work, in artistic pursuits, in life — when they’re smoking. As a painter and writer one said, “Smoking makes me more creative.”

 

Does it really?

 

Nope.

 

If you believe you do your best work while smoking, you’re giving cigarettes too much credit. A cigarette won't plant an idea in your mind that wasn’t already sprouting.

 

Smoking may seem like critical to your creative process, but in reality, it’s a distraction.

 

Every time your nicotine levels drop and the urge to smoke hits, you’re forced to interrupt your work — whether or not you’re on a roll. Your addiction always comes first!

 

In fact, you start becoming distracted even before the nicotine craving strikes. When your brain relies on the drug to keep you feeling “normal,” your concentration starts waning after about an hour. Soon enough, you’re thinking about your next cigarette — not the texture of your painting.

 

When you quit smoking, you might feel a bit “off” for a bit, but before long, you’ll get into a better, sharper, more productive groove.

 

That painter I mentioned? Much to his surprise, once he quit smoking, he became more prolific. “I actually have a portfolio,” he said, “rather than just wishing I had one.”

 

Do you fear that quitting smoking will compromise the quality of your work? Or that you just won’t feel like yourself when you quit?

 

Please share and experiences!

Many smokers fear that when they quit, withdrawal will never end. They’ll say, “What if I’m always miserable?”

 

That’s a natural concern. After all, nicotine cravings are real, and they’re not fun! But this doesn’t mean you’ll be plagued by cravings — or that they’ll be strong enough to drive you back to smoking.

 

Here are 3 ways to minimize how hard cravings hit and how long they last.

 

  • Use nicotine replacement therapy (NRT) with a strong enough nicotine dose. When smokers say, “The patch didn’t work” or “the gum didn’t help,” it’s often because they chose a patch with an inadequate nicotine dose or didn’t chew their gum on schedule. A trained tobacco specialist can help you use NRT correctly.
  • Don’t quit medication prematurely. Some newly quit smokers, emboldened by their success, ditch their medication when they’re still highly vulnerable to relapse. Remember: It’s smoking, not medication, that poses a danger!
  • Don’t expect medication to eliminate cravings. Even after nicotine has cleared your body, you can be tripped up by habit or emotional triggers. Be prepared! Learn alternative ways to occupy your hands, mouth, and mind, and work on replacing old routines with new ones.

 

You might hear former smokers say they still “crave” cigarettes years after quitting, but they’re not talking about “my chest is going to explode” feeling common in the first few weeks. They may occasionally think, “A cigarette would be nice right now,” but they quickly move on.

 

As one former smoker put it, “My fear of suffering was far greater than my actual suffering.”

 

Let us know: If you’ve relapsed recently, ? Next time around, what will you do differently to ease withdrawal?

 

If you’ve quit for good, how long did it take for your regular cravings to stop?

Have you ever stashed cigarettes in the closet or the freezer just before quitting?

 

Some smokers reason that a secret stash will give them “peace of mind” to focus on quitting, kind of like a security blanket. Others believe quitting in the face of temptation will only make them stronger.

 

This is faulty reasoning!

 

Keeping cigarettes around when you quit is not empowering; it’s sabotage.

 

If cigarettes are just a drawer pull away when a craving hits, you’re likely to act on impulse. You probably won’t stop and think: I’ve saved $350 this month not smoking or I’m really going to regret blowing my quit.

 

Nope, in the moment, when your chest is tightening or your mouth is watering, you’ll tell yourself: Eh, what’s one cigarette going to hurt?

 

Of course, “just one smoke” leads to another and another. . .

 

Sure, you can always head out to buy cigarettes, but unless you live next to a convenience store, making your purchase will take more than 5 minutes, which is how long a craving typically lasts. That 5-minute buffer is important. It gives you the time to think more clearly.

 

The problem with hiding cigarettes goes beyond temptation. It’s sending the wrong message to yourself. If you keep a pack hidden “just in case,” you’re conceding that you might smoke again.

 

You’re giving yourself an out — essentially preparing to slip up.

 

Instead, prepare to succeed by making a firm commitment to quit! Go full steam ahead, and destroy or give away every cigarette and ashtray you possess. Show yourself that you mean business — that you’re not just trying to quit. You are quitting.

 

What if you relapse? You’ll deal with it. Chances are, you’ve dealt with setbacks before. Most ex-smokers have blown a quit — or 20.

 

What’s important is committing 100% right now.

 

If you’re an ex-smoker, let us know: What did you do with your cigarettes right before you quit? What advice do you have for folks who are in the process of planning their quit?

Have you ever considered your cigarettes a friend? Does the prospect of giving up cigarettes make you feel sad or lonely?

 

These feelings are common among longtime smokers, and they won’t last forever, but it’s important to acknowledge and address them, so you can put 100% effort into quitting.

 

Our community is a great place to explore sadness or ambivalence about quitting — feelings that people who’ve never smoked may not understand or may even dismiss outright.

 

Some smokers don’t recognize their bond with cigarettes until they get serious about quitting. That’s when — in search of reasons not to quit — they start thinking: Cigarettes don’t pass judgment me. They don’t argue with me. They’ve always been there for me, through thick and thin. They are my loyal companion.

 

True enough! But let’s explore this notion further. If cigarettes are your friend, just what kind of friend are they?

 

In truth, they’re a “friend” that spends your hard-earned money, compromises your health and your pet’s, sucks up your time, invites dirty looks,  and exiles you from restaurants!

 

The reality is, cigarettes control you, demanding your time and attention throughout the day from when you wake up to when you go to bed.

 

Leaving an unhealthy relationship is never easy, but we’re all capable of it. Here are three approaches many smokers have used with success:

 

  • Write a “Dear John” letter to your cigarettes. For instance: “Dear cigarettes: You are stealing my money, my singing voice, and my stamina, and you make my car smell! I cannot be your friend anymore. Goodbye.”

 

  • Come up with a mantra to repeat whenever you feel the urge to smoke. For example: “You are not my friend; you are my enemy.”

 

  • Focus on the ways cigarettes have hurt your actual friends and loved ones. As one smoker put it: “You killed my grandfather and strapped my father to an oxygen tank. You are not going to do that to me. You are not my friend.”

 

Which, if any, of these strategies resonate with you? How will you break off your “friendship” with cigarettes?

Dr.Hays

NOPE, not one puff ever!

Posted by Dr.Hays Jun 28, 2017

Quitting smoking takes everything you have — all your focus, energy, and resolve. But once you’re “over the hump” and not fighting daily to stay tobacco free, you might let your guard down.

 

Maybe you’ll be hanging out with friend who smoke and think: I’m not addicted anymore. I can handle a puff.

 

Maybe after a stressful workday you’ll rationalize: What’s the harm? I’ve got 2 years tobacco free.

 

Maybe you’ll reward yourself for quitting by having “just one cigarette.”

 

Beware! Just when you think you’re no longer vulnerable to relapse — well, that’s when you are most vulnerable, especially if you’re drinking alcohol or dealing with stress or illness.

 

I’ve known former smokers who relapsed a decade or more after quitting. One woman, who’d quit smoking at age 28 relapsed at age 48! In the interim, she’d become a diehard non-smoker repulsed by the odor of cigarettes. Then one day, while at a bar on vacation, she impulsively bummed a smoke in a bar, figuring: I’m in control. This isn’t a problem.

 

Soon she was smoking a pack a day and trying to hide her addiction from her family. It was another five years before she quit for good.

 

As an ex-smoker, you must live by the NOPE rule: Not one puff ever.

 

Here are 5 ways to stop yourself from taking that fateful first puff.

 

  • Notice the moment risky thoughts surface, so you can act before your judgment gets too clouded. Tell yourself: I can feel myself heading down the wrong path!

 

  • Text or call a friend to talk you out of it.

 

  • Wear a rubber band or other reminder around your wrist. When temptation bubbles up, tug on the band to snap yourself back to reality.

 

  • Keep a counter-argument in your wallet or on your phone. For example: “Quitting has saved me $4,000 a year” or “I can keep up with my grandson!”

 

  • Visualize yourself as a smoker again: You’re worried about flight delays, how your clothes smell, whether you have enough cigarettes. Now imagine starting the quitting process over again.

 

           

Have you relapsed after taking “just one puff”? Tell us your story!

Do you fear it’s impossible to quit if you share a home with smokers?

 

It’s a challenge, to be sure. You may be frequently faced with temptation, and you may worry about offending the smokers you live with. As one former smoker put it: “I felt like I was saying, ‘By the way, I’m better than you — I don’t smoke.’”

 

Yet plenty of people who live with smokers are able to quit for good! Here are steps you can take to boost your odds of succeeding.

 

  • Negotiate house rules, ideally before you quit.

 

Don’t leave anything to chance! Let’s say your partner smokes on the deck every morning after breakfast, triggering you to light up in the car. Ask your partner to smoke in a different location, such as the back yard, or at a different time, like while you’re showering or after you leave for work.

 

If those you live with won’t agree to stop smoking in the house, designate one smoke-free room or, better yet, limit smoking to a single room. Ask them to keep cigarettes and ashtrays out of sight and not to smoke in the car with you.

 

  • Ask your housemates not to offer you a cigarette or let you bum one.

 

Of course, the responsibility to avoid cigarettes is yours, not theirs, but you certainly can enlist their help. Instruct them to say: “Sorry, you asked me not to let you bum a smoke and to remind you to pull out your list of reasons for quitting.”

 

  • Leave the room — or the house.

 

If you can’t avoid a housemate who’s smoking, don’t make yourself miserable — or vulnerable to relapse. Go elsewhere, and keep your hands, mouth, and/or mind busy. Give yourself a manicure or chew gum while you listen to a podcast.   

 

During those first few weeks, plan to spend less time at home. Visit the library or make plans with non-smoking friends. Go for a bike ride. Walk around the block.

 

Once you’re over the hump, you may find that living with a smoker actually strengthens your resolve to stay tobacco free. As one former smoker put it, “Listening to my wife cough every day is a huge motivator for me to never smoke again.”

 

If you quit while living with smokers, what advice do you have for others?

Dr.Hays

Fear of Gaining Weight: Part 2

Posted by Dr.Hays Jun 14, 2017

In a previous post about weight gain, I explained that while most smokers do pack on at least a few pounds after they quit, weight gain is not inevitable and certainly can be temporary.

Here are some strategies to avoid or minimize weight gain while you work to maintain your hard-earned quit. You can find additional strategies in our post titled Back to Blogging and Weight Management the "Mindful" Way

  • Plan what you’ll put in your mouth — besides a piece of chocolate! — when you experience a craving. Chew sugar-free gum, a straw, or a cinnamon stick.

 

  • Examine the emotional needs smoking filled for you, such as coping with stress or boredom, and learn ways to cope that don’t involve eating. For example: deep breathing, calling a friend, listening to a podcast, or posting on EX Community.

 

  • Don’t skip meals or deprive yourself of favorite foods. A restrictive diet will only make you more irritable and vulnerable to relapse.

 

  • Choose fresh fruits and veggies over processed snacks. Not only are baby carrots, tangerines, and apple slices more nutritious than, say, energy bars, but all that munching, peeling, and slicing will help keep you busy and distracted.

 

  • Stay active. Think smoking gives you pleasure? It’s no match for the sheer joy of taking a brisk walk without huffing and puffing! Start small: Use the stairs instead of the elevator, replace your smoke break with a 10-minute walk, walk the sidelines during your child’s sports game. Exercise keeps you busy, lowers stress, and burns calories all at once.

 

We don’t recommend trying to lose weight in the first few months after you quit smoking. Channel your energy into staying tobacco free. You have the rest of your life to lose weight, if that is a goal for you.

 

However, while you focus on quitting, there’s plenty you can do to keep your weight stable.

 

Let us know: What weight-control strategies do you plan to try? If you’ve already quit, what are your best tips for avoiding weight gain?

Have you put off quitting, or relapsed after a quit, because you fear gaining weight?

 

In this post I aim to help you overcome that fear, so you can focus on what matters most: overcoming . In a future post, I’ll discuss strategies to avoid or minimize weight gain once you quit.

 

It’s true most smokers put on weight after they quit. Nicotine suppresses appetite and elevates metabolism, so when you quit, you’re hungrier, and your body returns to a normal metabolism. Plus, your taste buds and sense of smell come back to life, so food is more appealing. Also, with cigarettes out of the picture, many folks use food to occupy their mouths and cope with stress.

 

But remember: While weight gain can be temporary, the effects of smoking may not be. Extra weight will not cause COPD, or lung cancer! And though excess weight does increase the risk of developing or aggravating diabetes, so does smoking.

 

At any rate, weight gain is not inevitable! About 16 percent of smokers actually lose weight when they quit, according to a review of 62 studies published in the British Medical Journal. Another 37 percent of quitters gain less than 11 pounds). Many folks feel so empowered by quitting and inspired by their newfound stamina that they start exercising and eating more healthfully.

 

If fear of weight gain is holding you back, start noticing your negative thoughts about your weight. Ask yourself: Are these thoughts accurate? Could they be excuses to keep smoking?

 

Let’s say your jeans fit more snugly, and you think: I’m worse off now than before I quit or My co-workers will think less of me if I gain 10 pounds.

 

Challenge these ideas!

 

Even if you have to buy a larger pair of jeans, are you truly “worse off” than when you were addicted to ? If a co-worker of yours gained 10 pounds after beating tobacco, would you think poorly of her? Or would you congratulate her on her tremendous accomplishment?

 

I think you know the answers.

 

Counter each negative thought with a positive one. For example: Now I don’t feel like an outcast at work, and I’m saving $250 a month!

 

If you’ve experienced anxiety about weight gain, please share your thoughts with the community!

More than 40% of smokers under the age of 18 smoke menthol cigarettes. The FDA has concluded that although menthol itself does not cause disease, it makes cigarettes more palatable.  Thus, menthol in cigarettes posed a public health risk.  The FDA is currently considering regulating menthol in cigarettes.  So, why all the “fuss” about menthol cigarettes?  What concerns are there about these tobacco products?  Let’s just consider a few facts about these products.

 

39% of menthol smokers reported they would quit smoking if menthol cigarettes were banned.  Prevalence of menthol cigarette smokers is higher among African-Americans, younger, and female smokers.  African American smokers favor mentholated cigarettes by a 3-fold margin.  Menthol cigarette smokers had significantly lower odds of stopping smoking than non-menthol users. 

 

Menthol cigarette use was associated with increased concentration of blood cadmium (a carcinogen) and higher levels of Carbon Monoxide with having smoked fewer cigarettes.  Women who smoked menthol cigarettes showed signs of greater tobacco dependence than non-menthol smokers.  Young people who first tried menthol cigarettes are at greater risk of progression to regular smoking and tobacco dependence. 

 

Tobacco companies continue to perform active research to identify the product that would be least “irritating” to the throat and most addictive to promote lifelong use of their product.  Menthol cigarettes are a “perfect” fit.  They entice people to smoke and keep people smoking cigarettes – the only product that will kill more than 60% of its consumers

Hello EXers,

 

I apologize for having disappeared during the past six weeks.  Frankly we were short on staff and not able to keep pace with the weekly blogs.  We’re back up to full staff and we plan to be back to our regular blogging schedule.  Here is some food for thought for our first week back:

 

Mindfulness, a concept originating from Buddhism and other eastern spiritual traditions, has gained a great deal of attention in recent scientific research.  Mindful eating involves deliberately tuning in to your own inner experiences; including thoughts, feelings, and behaviors. With this focus, you begin to be more aware of the sensory aspects of eating, such as the taste & texture of food, when you feel hungry and full, and whether you are actually hungry or just bored, anxious, sad or angry.

 

Below are some mindful principles that can help you manage your weight when you quit smoking.

 

  1. Control portions. people eat much more food when given unlimited quantities. Try to purchase food in smaller packages and use smaller serving dishes.
  2. Eat when you’re hungry. Let actual hunger cues, not emotions, guide you’re eating. Substitute a quick walk for a snack until actual hunger sets in. Do you eat while multitasking, such as watching TV, texting, driving, or working? Do you gulp the food down quickly without really tasting it? Begin to notice your automatic patterns & habits around eating that stop you from being fully present.
  3. Plan. Prepare healthy snacks ahead of time to eat throughout the day. A 200-calorie, whole grain, high-fiber snack can satisfy hunger between meals.
  4. Keep a food diary. Write down everything you eat and what was happening at the time to identify food triggers – hunger, stress, excitement or boredom.
  5. Slow down.  During each meal, chew slowly, savoring each bite; put your fork down between bites. This gives the body enough time to signal to the brain that it’s satisfied, not stuffed.
  6. Pay attention. Don’t eat in front of the TV or computer, while standing at the kitchen counter or talking on the phone. This can lead to losing track of how much you’ve eaten.
  7. Use technology. There are now apps that manage food records, count calories, help you track what you eat and even provide guidance on healthy food choices at the grocery store and restaurants.

 

The process of quitting smoking and lifestyle change can be long and sometimes difficult. Begin by trying to accept and love yourself right now, as you exist in this moment.  Give yourself credit for all that you are doing! Make a list of your reasons for wanting to be healthier and carry it with you. Focus on the realistic benefits you can achieve when you quit smoking such as improved health, mood, and energy. Imagine yourself in the future living a more vibrant, energetic life without smoking.

Dr.Hays

Stress and resilience

Posted by Dr.Hays Feb 15, 2017

Often we think of stress as something that is happening to us: too many demands, situations that aren’t resolving as we hoped, or a series of unfavorable events. However we might benefit from seeing stress in a different light, as how we react to events, rather than how events are happening to us.

 

Our body provides us with one underlying mechanism to address emergencies or ‘stressful’ situations. When challenging events happen, our sympathetic nervous system (SNS) becomes activated. At its core, this system is designed to focus our energy to manage potentially life-threatening situations. When faced with a difficult or ‘stressful’ situation, a cascade of neurochemical messengers and hormones signal our heart to begin racing, our pupils to dilate, our digestive system to slow and our mind to more narrowly focus upon danger. This response is more fitting to being surprised by an animal in the jungle rather than to reacting to ‘stressors’ of the modern day like needing to balance a checkbook, or organizing a busy workday. Many ills of our modern day can be attributed to an overactive SNS –flailing to address crises or stressors with a system built for different types of demands.

 

But there is a solution. The mind and body are equipped with a cognitive ability to reappraise threats and a parasympathetic nervous system (PNAS), which can turn-off the SNS with a relaxation response. Good stress management can be understood as using our reasoning to realistically appraise the demands in our life, and most importantly, building our ability to activate our PNAS. With our patients we try to formulate specific goals for recreation, physical activity, enjoyable social connections, and practiced relaxation such as deep breathing or meditation; all of which strengthen the PNAS.

 

There are many good books on resilience and stress management, some of which you might recommend in comments. One I would recommend is ‘Why Zebra’s Don’t Get Ulcers’ by Robert Sapolsky. Now in it’s third edition, the book provides a very accurate scientific description in a fun easy to read format.  

 

I would like to hear from you about strategies you have found helpful to manage stress and develop your 'relaxation response'.

A colleague of mine recently asked about a good book on the history of tobacco. She was especially interested in the battle waged to establish the scientific evidence about the health effects from tobacco use within the context of tobacco industry deceit and public relations efforts.  At the risk of providing TMI, I shared 3 titles (among a dozen I might have suggested).  I thought our community members might also be interested. 

 

Richard Kluger won the Pulitzer Prize for his extraordinary book: Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris.  The book has been called a tour-de-force, and I found it to be captivating and compelling.  Kluger narrates a sweeping history of tobacco from it's discovery in the 'New World' through its development as a financial behemoth.  He focuses on the 20th century battle for truth about tobacco and health by looking at the political, financial, medical, legal, social, and marketing issues through the eyes and actions of the key players involved in this fascinating story.

 

Another enjoyable read, published in 2007 is The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America by Allan Brandt.  The cigarette century is identified as the 20th century, in which 100,000,000 people died from tobacco ( THE TOBACCO ATLAS) and it takes the reader through to the early 21st century in which the World Health Organization predicts a death toll of 1 billion people, 10 x greater than the 'cigarette century.'  Dr. Brandt provides a clear view into the strategies and tactics used to cloud the truth and allow this enormous human tragedy to unfold.

 

One last book I would recommend is The Cigarette Papers by Stanton A. Glantz, John Slade, Lisa A. Bero, Peter Hanauer, Deborah E. Barnes, and C. Everett Koop.  It gives the real time history of the investigation and fact-finding from secret documents smuggled from the tobacco industry which gave the first shocking glimpses into the planned deception of the public regarding the dangers from tobacco and the extensive effort to develop a more addicting product. 

 

Or if you would rather just watch a good movie, The Insider with Russell Crowe, and Al Pacino tells the true life story of Dr. Jeffrey Wigand.  He was a Senior Vice President of a tobacco company.  His courageous defection from the  industry and subsequent truth telling cost him a great deal personally, but gave us access to those documents.  

As a support person, you can play a very important role in your friends or family member’s effort to stop smoking.  Partner support is shown to have a positive effect, but how best to help can be a challenge.

 

Here are some specific suggestions we have found that are helpful.

 

Be positive! Offer encouragement; affirm how proud you are of their effort.  Avoid bringing up past failed attempts; these past experiences are an important part of the learning process for becoming tobacco free for good.  Give your friend or family member some extra attention. If your significant other has just stopped, do something to celebrate his or her commitment to living a healthier, tobacco-free life. Believe in their ability to succeed, and realize that stopping can be very difficult.

 

Understand that stopping smoking can create a great deal of unexpected change.  Using tobacco fills many hours and is often used to cope with a variety of situations and emotions—from boredom, to stress, to anger, to joy. Your friend or family member is working to learn new methods of coping, and may be irritable, particularly during the early withdrawal period (up to a month following ending tobacco use). This irritability will ease as your friend or family member adapts to life as a nonsmoker. Be as understanding and supportive as you can.

 

Try to be open to how they feel you can be helpful.  During our residential treatment program for tobacco use, we have one session in which we invite family members.  We meet separately with family members, and ask each the family members what do they do to be helpful, and we ask the patients what can family members do to be helpful.  The lists are often dramatically different. Try to create an atmosphere in which they can tell you what will be helpful. As with it may be hard for him or her to share the difficulties and challenges that go along with ending tobacco use.

 

Being there for your loved one during this difficult time can be challenging.  But it can make all the difference.

Wow, the new site looks wonderful!  

 

Our team at the Mayo Clinic Nicotine Dependence Center heartily commend the EX Team for all the hard work that has brought about this new chapter in the ongoing mission to create a world where everyone who wants to stop smoking has all the support and capacity to make that happen.  

 

We also are very pleased to partner with the EX Team and all the community members and visitors to the BecomeAnEX site.  Tobacco use remains the leading cause of death in the United States.  Our work with patients and families often makes this statistic too very real.  Daily we see patients who are suffering, or dying, from the effects of an addiction that could have, and should have, been treated sooner.  This work is vitally important.

 

We look forward to working with you to provide hope and to deliver proven strategies that will correct the misunderstandings about the addiction, stop the blaming of the person suffering from the addiction, and change the current state in which there is too little access to support and treatment for this deadly addiction.  Together we can make a difference. 

Stopping smoking for even a short time before surgery significantly improves surgical outcomes and increases the likelihood that a patient will survive surgery.  Because of this, and because surgery can provide a good opportunity to effectively connect with smokers, the Society for Vascular Surgery and the Society for Vascular Nursing this week issued a joint statement encouraging vascular surgery teams to provide treatment for tobacco dependence for all smokers who are considering surgery.

Unfortunately, too often the manner in which smokers are approached within health care is ineffective, or even detrimental.  Sometimes patients are lectured about the health risks they face if they don’t stop.  If the person being lectured has tried to stop and ‘failed’ or if they feel stopping smoking is too difficult, this can cause shame, discouragement, or even unconscious discounting of the message.  None of which are helpful.

Other times people are given a limited ‘yes or no’ choice. ‘Do you want help to stop smoking?’  Unfortunately the lack of accurate information about treatment, or the fear that treatment means more lectures about smoking and health, too often results in a ‘no’, or ‘not at this time’.  Also, people usually think, incorrectly, that tobacco dependence counseling means they must be already committed to stopping or a 'quit date'.

We are looking at more proactive ways to make referrals within surgical groups, or other medical areas in which stopping smoking can be of enormous benefit.  We are piloting projects in which we automatically provide treatment as usual care, or ‘opt-out’ rather than ‘opt-in’ approaches.  For example, prior to surgery a patient who smokes will automatically have scheduled a visit with a Tobacco Treatment Specialist (TTS).  The TTS is trained to connect with patients, engender hope, provide education and options, respect a patient’s personal choice, and provide treatment as indicated.  A trained TTS doesn’t admonish a person for smoking, instead the TTS uses an empathic strength based approach to inform and build confidence.

Here we would like your opinion.  What are your thoughts about ‘opt-out’ rather than ‘opt-in’?  Should patients automatically be referred to treatment and support for stopping smoking? Or should we first ask if they ‘want help’ with the ‘yes or no’ as a final answer? Or, should we just give them a brochure or contact information and encourge them to call a tobacco quitline?  

We would also like to hear from you about any good and bad experiences you have had in health care encounters when tobacco use was broached.

Thanks as always!

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