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Big Tobacco Wins

Posted by NDC.Treatment.Team Nov 28, 2018

The single most effective way to reduce smoking is to increase the price of tobacco. Raising the cost of a pack of cigarettes increases the likelihood that a person will stop smoking, reduces the risk of relapse among people who have stopped, and maybe most importantly, reduces the likelihood that young people will start smoking.  Many health organizations such as the American Lung Association and the World Health Organization recommend increasing cigarette taxes as a basic tenet to reduce smoking rates and to decrease the health costs associated with smoking.


On November 6 two states, Montana and South Dakota, had initiatives on the ballot to raise the cigarette tax, and to use that revenue to increase access and affordability for health insurance.  Despite the proven benefit to health that passage could have had, big tobacco went all out to defeat these measures.  Altria/Phillip Morris and Reynolds America spent more than $17 for every man, woman, and child in Montana, and over $24 million dollars in total, in both states with a combined population of less than 2 million.   


Their big money campaign won, the initiatives were defeated, and the citizens of Montana and South Dakota lost. Big tobacco makes many claims to have ‘changed’, but they have not! They still prioritize their profits over the health of our nation.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

The holidays are just around the corner, and as you navigate your way to a smoke-free life, sometimes this time of year can be particularly daunting for a multitude of reasons.  While the holidays are often characterized in terms of enjoyment and togetherness, the inevitable “nuts and bolts” of the holidays can be rough for many people.  The November and December holiday celebrations, parties, and the like can often be quite difficult as we deal with family members, financial concerns, and/or the inevitably busy schedules of this time of year.


For those quitting tobacco, the stresses of this time of year can seem even harder. While quitting tobacco involves looking at the addiction component, it also involves making huge behavioral changes.  These changes are often the most difficult, as it involves really looking at those parts of your life that can be the most troublesome when quitting tobacco – and considering how to handle them now as a non-smoker.  These moments are often more “front and center” at the holidays than perhaps any other time of the year.


So what times of the holidays can be the biggest triggers times for you to smoke? 

Some use cigarettes as an escape route, to dodge uncomfortable or unwanted encounters with family or friends – Think of other ways you can leave a situation and practice – it will come in handy.


What about those times in the car on the way to Grandmother’s/Parents/Grandchildren's house?

Keep a water bottle handy, or try singing some holiday tunes with the radio, streaming from your phone, CD, or your iPod Touch.


What about the family members who still smoke – how do you deal with that?

Unfortunately, while most smokers really do want to quit; many are threatened by those who have quit and may try to do what they will to make you relapse.  Remember your goal – to stay quit, and to see how proud you will be of yourself as you achieve this goal.  Use “I messages” to express YOUR SINCERE DESIRE to quit tobacco will help you get the point across to those family members who may not be as supportive as you would like. Similarly, enlisting the support of one of two family members or friends that can be staunch supporters of your efforts can go a long way when those inevitable cravings or urges begin to overwhelm you.


There are situations that pop up; have a backup plan for how you plan to deal with them so on the day, your last resort is not to light up.


Throughout this eventful season:

Check on your self-care what can you do for you to make getting through the holiday chaos a bit easier? Holiday giving doesn’t always mean others, if we are constantly giving and never practicing self-care we can wear ourselves out. Be good to yourself this holiday season!


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

The Great American Smokeout began in the 70’s in Massachusetts to ask people to give up cigarettes for a day and donate the money towards a high school scholarship fund instead. This idea caught on across the country as the American Cancer Society adopted it and got nearly 1 million smokers to quit in 1976. Historically, the Great American Smokeout was designed to help individuals to quit and to change the attitudes of society around smoking, resulting in an increase in community programing and smoke-free laws. It is believed that by starting this, many smoke-free advocacy teams have started and have taken great strides into what our tobacco-free culture is today. Just to name a few of the groundbreaking campaigns that has occurred are: truth about chemicals, suits against manufacturers, Master Settlement Agreement, “corrective statements” advertising, and many more. There is obviously more to come now with the e-cigarettes, cigarettes, and heat-not-burn products.



Although with programing, education, and preventative measures; we have decreased the amount of individuals who start smoking through raising awareness and advocacy; I always wonder what this day means to many of you?


Some say this day is just another “Hallmark holiday” that adds pressure or unnecessary attention to their smoking behavior. Then there are some who use it as a quit date or the start of a goal to get the “ball rolling.”



Making a decision to quit is a personal choice, therefore whatever way and whenever you decide to quit, just know you are making your own history whatever day it falls on!


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

A smoking relapse can happen to anyone. You may have a gone a few months without smoking, but then one night for some unknown reason, you are out with friends and you decide to bum a smoke.


If this has happened to you, know you are not alone.  It is common for many people that quit smoking not to achieve long-term abstinence on their 1st, 2nd, or 3rd try. Mark Twain is reported to have said, “Quitting smoking is easy: I've done it thousands of times.”  In fact the average number of quit attempts is 30 times.  


When relapse occurs, it is common for people to feel depressed and identify themselves as a failure. BUT you are not a failure.  The truth is quitting smoking is hard work!!! Remind yourself to FORGIVE and ACCEPT that this is a challenge but to keep working towards your goal.


Reflect and re-frame your relapse. Think of it as an opportunity to gain more insight into your smoking behaviors and habits. Examine the things that have worked for you during past quit attempts and make a list.  Simultaneously, make a list of the things that did not work so well or put you at risk to smoke. All of this Information can be used to better prepare, better plan, and better manage your next quit.  Staying focused on “I’m a failure” makes it easy to stay stuck, as that colors the whole mind set and can cloud your vision.


Just like learning a new skill, staying quit takes practice and persistence --- the most important thing is that you keep TRYING! Think of quitting like learning to ride a bike.  You are likely to fall off a few times, but the only way to learn how to ride is to get back up and keep attempting until you are successful. I love this analogy demonstrated well on YouTube, it truly gets at not only the complexity of learning this skill but how your brain can adapt the new changes.

REMIND yourself WHY you are QUITTING and Keep Going Until You’re Smoke-Free


Heather Kraling-Coons, MA

NDC Counselor/CTTS


Reference: Chaiton, M., Diemert, L., Cohen, J. E., Bondy, S. J., Selby, P., Philipneri, A. & Schwartz, R. (2016). Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open, 6 (e011045).


The saying “stop bogarting… (Something)” stems from none other than famed film actor Humphrey Bogart. He was well known for perpetually having a cigarette hanging from his lips. Almost every movie scene he has some form of tobacco in his mouth. Tobacco was as much of a co-star as Lauren Bacall. Bogart continued to smoke and make very successful films until he died at the age 57 from lung cancer. The saying has morphed into meaning “to hold on to something and not share or pass it on”.


With regards to resentment we want to “stop holding onto it and let it go”, perhaps replace it gratitude?


Individual people that use tobacco have variance in the intensity of tobacco/nicotine dependence. While a few people only have minimal withdrawal and seemingly are able to quit without much help, the fact is most people cannot quit so easily. They may have significant withdrawal symptoms, urges, cravings and are at high risk for potential relapse for many months after stopping smoking. Many recovering smokers express anger and resentment towards tobacco, big tobacco companies, and at themselves. You may feel resentful because quitting tobacco was so difficult for you. Do you know someone that was able to “just throw” their cigarettes out the window and never smoke again? Most of us do, but if you could have quit that way, you would have done so a long time ago. A “quick fix” is not realistic for most people. For most, their addiction is far too intense for a “quick solution.” How about that for some resentment (and understandably so)?


So, now what…How do we begin to turn resentment into gratitude? 


Well it takes practice. Moving away from resentment requires moving toward “something” more life giving (and that “something” is the attitude of gratitude). Resentment blocks action; gratitude lets us move forward toward new possibilities. Resentment makes us cling to negative feelings; gratitude allows us to let go. Release your resentment and focus on being grateful for the progress you have made (or plan to make).


One possible exercise that can help is writing a “Good-bye” letter to tobacco. The “Good-bye” letter can help start the process of replacing resentment with gratitude. It gives you a chance to tell tobacco why you have left it behind so you are able to move forward.


Laura McConahey

NDC Counselor/CTTS


Weaken the Roots

Posted by NDC.Treatment.Team Oct 24, 2018

Quitting smoking was one of the hardest things I have ever done. I had quit many times, and like many went back to it for stress relief or when life got hard.  The last time I quit I made my mind up that I was not just quitting, but I was quitting for good – I was all in- and I would never smoke again.  I changed the way I thought about smoking.  Smoking was no longer going to have control over me and my life. 


Smoking thoughts were deep roots that had been planted in my brain for years!   Changing the way I thought about smoking was not always easy, but very important if I were to live smoke free. The old smoking beliefs (roots) were being weakened whenever I was able to change my thinking and tell myself something positive about quitting.  New roots started to grow and these were good, healthy roots.


 “One thought at a time” became my mantra.  Here are a few of the things I started to tell myself over and over again. 


I want control over my life

I am choosing to live smoke free

Smoking is dirty and it smells

Smoking is not an option

I am strong, healthy and want to live a long life

Smoking is not my identity


Just because it worked for me doesn’t mean will work for you, we are all different in a way unique to us. What are some things that you can do today that will help to weaken those old, unhealthy roots? Make a list of positive things you can tell yourself when you are thinking about smoking.  Practice them, memorize them, and use them until your new healthy roots start to take shape.


Therese Shumaker

Supervisor/ NDC Counselor/ CTTS


You Are Not Alone

Posted by NDC.Treatment.Team Oct 17, 2018

There is a complex relationship with depression and smoking. Rates of smoking are higher among individuals with depression.  


Individuals attending our tobacco treatment programs, note not only do they notice a change physically but they notice a reduction in anxiety and depression. It has been said, they no longer feel anxious about where, when, or how they will have a cigarette; therefore they do not have that sense of urgency in their day to execute an escape plan to light up.  Individuals also mention after several weeks of being quit, their mood has improved and they no longer feel they have to isolate from others. Isolation can occur in individuals who experience a depressed mood due to lack of motivation as well as individual using substances as they feel often like they are alone. Note these are anecdotal instances but it coincides with studies that have shown a decrease in anxiety and depression (to the extent of an anti-depressant) after several weeks of being quit.


There are probably a number of reasons underlying this complex relationship between depression and smoking.  Some people may use the boost they get from nicotine to treat underlying depression.  To complicate this picture, depression can be a nicotine withdrawal symptom.  Another cause of a depressed mood can be the feeling of loss and sadness that some smokers experience when they stop using tobacco.  When a person stops smoking, daily rituals that may have been a part of their life for many years are missing, and this may feel like a loss.  Feelings of loss can lead to other symptoms of depression.


Addressing depression can be an important part of your quit plan to not only quit but to avoid relapse back to smoking.  If you feel you might be experiencing symptoms of depression, talk with your health care provider.  There are ways to treat your depression while you continue on your smoke-free journey.


Counseling – Talking about what you’re experiencing can help improve knowledge of what it is you are going through and help to cope with the loss of no longer smoking.


Medication – While many medications are used to treat the symptoms of depression, Bupropion is often used for individuals who want to quit and have a history of depression. Varenicline may not be a medication suitable for you but talk with your health care provider if you believe a medication may help you in your quit.


Lifestyle Changes – Healthy eating, daily exercise, practicing relaxation techniques, and building a supportive network are activities that can help improve your mood.


As you begin to Re-Learn Habits, remember that depending on what is going on in your life, it is sometimes natural to feel down or sad.  However, if these feelings continue or become worse, be sure to speak with your care provider about what may best benefit you.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

Last week, that the Food and Drug Administration (FDA) seized documents from the JUUL company in an investigation of marketing of e-cigarettes to young people.


The action by the FDA is especially important given that JUUL accounts for more than 70% of the e-cigarette market, and that new studies are finding e-cigarettes are a gateway into nicotine addiction and tobacco use.


JUUL is not the only company that needs to be closely monitored to prevent direct and indirect marketing to young people.   As we discussed in an earlier blog, public health groups are asking the Federal Trade Commission (FTC) to stop tobacco companies from secretly using social media to sell their products to kids. 


Marketing an addicting and potentially deadly product directly to youth should be considered heinous.  Tobacco and e-cigarette manufacturers should of course proactively cease any direct or Indirect marketing to young people.  In the absence of moral leadership in these companies, strong action and close monitoring by the FDA and the FTC can serve a vital role to protect our young people.


Mike Burke, Ed.D

Program Director and NDC Counselor/ CTTS

Let’s practice: take your tobacco use

Think about your current (or past) thoughts about yourself and smoking.

Think of some of the fears around quitting or remaining quit.

Think about how these thoughts are affecting you and your ability to quit or remain quit



Take a deep breath in.


Now Exhale


Sometimes we need to put a wedge in the thought process to allow ourselves to examine some of the messages we are saying to ourselves.



NOW that you are aware of these thoughts, give yourself permission to feel that way. It is okay to express these emotions.  Once aware, determine a new thought or new behavior that better aligns with your values



Take this information with you and see how practicing acceptance can change your perspective and the paths you choose.


Virginia Fitch-Braun, MS

NDC Counselor/CTTS

Congratulations on deciding to quit smoking!!! But what if your partner isn’t ready to give up their own smoking habits? And their smoking is a constant trigger. 

The key is to have a plan in a place for yourself as to how you are going to quit.  The next step begins with open and honest communication with your partner.  Sit down and tell them your plan to quit smoking.  Ask your partner how they see themselves helping you. Your partner may surprise you and offer to change their smoking habits around you.  If not, trying explaining to them how their smoking may trigger a relapse.  If they are not willing to help, you can request that they no longer smoke around you, or at least give you a heads up, so you can leave the room.  You can also ask them to keep all their cigarettes, lighters, and ash trays out of sight, if that is helpful.  If they just plain won’t help and it feels as if they are trying to sabotage you, just know this is hard for them too.  The new habits you are creating for yourself may make your partner feel abandoned or just plain annoyed because they have to change too. Think of you and your spouse, do many of the activities you do together involve smoking?  My patients often tell me that smoking with their partner is the one time of the day that they look forward to because it provides some quiet time and a space for them to connect. 


In the end, there is no one solution for everyone, but openly expressing what you need and making requests, can initiate a conversation and lead to problem-solving.  Also, don’t forget to let your partner know that you appreciate all they are doing to help you with your quit!!


For those of you who have quit and your partner smoked or you were often around others who smoked, what kinds of things were most helpful for you?


Heather Kraling-Coons, MA

NDC Counselor/CTTS

Communication is key:


We talk about this with our patients often, and I believe that the key is having a conversation with your prospective support person about what YOU need.


What is considered support for one person may be not be seen that way by someone else.  While some may want to have friends or family asking them how they are doing; others may find that this is annoying and may want to be left alone.  Some may want their support people celebrating with them after then have been quit for 2 weeks by taking them to a movie, the mall, or for ice cream.  Others, who may be more private, may find that buying something nice for themselves with the money they saved from not smoking is celebration enough. Perhaps thinking of it in terms of the Pros and Cons of support for you may be a way to most quickly assess what you will see as supportive behavior, and what you would consider not supportive behavior.


While you were smoking, although you did not realize it, you may have often used the cigarette to “speak” for you. Yes – smoking is a kind of interpersonal communication. You used the cigarette, and act of lighting up, to say things such as “I need to talk”, “Let’s relax”, “I need to be alone”, “ I want to take care of you” or, “I’d like you to take care of me”.  So, again, a conversation with others regarding what you need may be necessary to have as you begin to articulate more clearly your needs to others as a non-smoker.


What can I do to support someone quitting smoking?  


When considering ways to support someone quitting tobacco, it is important to remember to keep it simple.  A phone call, text or even a short note left in their lunch can really mean a lot.  Perhaps suggesting a walk outside if you notice that they are fidgeting a little may be “just what the doctor ordered”.  The avoidance of “triggering” (those that were previously associated with smoking) people or situations is paramount those first few months after quitting. Finding a new interest, hobby, or activity, such as swimming or yoga, can assist with filling some of these voids in their life.  


Most importantly, quitting smoking is one of the most difficult addictions to quit.  And therefore, while relapse is a very real possibility, it is paramount that you recognize the immensity of this task, and verbalize your belief in the individual’s ability to conquer this addiction, and stay quit.


Barb Dallavalle, MA, LP

NDC Counselor/CTTS

Have you heard people talk about the birth of a baby saying that the infant came into this world “kicking and screaming”?   I wonder how babies must feel being born; they have been protected and safe in their mother’s womb for nine months.  What a shock to their tiny little bodies! The world that they once knew is forever changed; no wonder they come out kicking and screaming!!  


I believe that this analogy can be used to someone who is trying to quit using tobacco. Using tobacco for many years becomes comfortable; the user develops a sense of security over time.  Quitting may feel like that baby being born – a shock to the system –  giving up what was once thought as safe and secure, now becomes foreign; giving up the old, comfortable way of living to embark on something new, that  maybe you have never experienced it before.


What can help as you get through the process?

  1. Visualize yourself free from tobacco; what will you be doing when you are free from the perils of tobacco addiction?  How will you be spending your time? Remind yourself why you want to live a tobacco free life.
  2. Get active!  Physical activity can reduce withdrawal symptoms and urges to smoke.
  3. Consider the utility of Nicotine Replacement and /or medications to help with those cravings and urges.  
  4. Surround yourself with people who will support your efforts as you cope with the challenge of stopping tobacco use.  Your new support network can help you through the difficult times. Don't overlook the members here on EX as sources of support.


 Come out on the other side free from tobacco, “kicking and screaming”, ready for the new life you are about to embark on! You deserve it!


Therese Shumaker, MA

Supervisor/ NDC Counselor/ CTTS

Cigarettes are truly one of a kind. No other product- When used correctly kills more than ½ of its customers! However they do not receive the “recognition” they deserve.  News, social media and other outlets often focus on other terrible addictions. A prime example is the opioid epidemic. It seems like you cannot go 5 minutes without hearing about opioid use and abuse. While, this is certainly a very serious problem that needs attention and solutions it unquestionably is not the “biggest killer” around. That title is reserved for none other than-Tobacco! Tobacco is still the number 1 leading cause of preventable death in the United States. Nevertheless tobacco gets very little press or public outrage.


How can this change? Well we know that the tobacco companies would prefer that it does not. One thing that can be done is to not place blame or guilt on ourselves. Often many people are desperate to quit smoking and get stuck in a vicious cycle of not being able to quit and then feeling guilt and shame. Instead of blaming ourselves let’s take a closer look at who is to blame- Tobacco Companies!


Tobacco companies chemically engineered their products to produce maximum addictive properties. One tricky way they achieved this was by free-basing nicotine to the brain. Tobacco companies added ammonia to cigarettes to change the pH, thus allowing free-basing to occur. If you hear the words free-basing and instantly think of crack cocaine you are not alone! Actually the methods drug dealers and tobacco companies’ use are one in the same. They both add ammonia to their products to increase absorption and thus speed up the delivery to the brain. Tobacco companies also go to great lengths to ensure that there is a consistent amount of nicotine in each and every cigarette to maximize addictiveness. All of these manipulative and tricky processes add up to making it harder to quit smoking. While quitting smoking can be very challenging and the tobacco companies certainly are not making it any easier, it is important that you quit smoking. Use every tool and resources available to you and do not be afraid to ask for help. Because you too are “one of a kind”.


Laura McConahey MS

NDC Counselor/CTTS

You may have seen news reports this week about a petition to the Federal Trade Commission (FTC) from major public health groups to stop 4 major tobacco companies from using deceptive social media ads to target young people.   An international team of researchers, led by a professor from the University of Southern California found evidence of highly sophisticated and deceptive campaigns using social media posts on Instagram and Facebook to influence young people to smoke.


The study finds that posts and hashtags connected with tobacco industry products have been viewed 8.8 billion times in the U.S.  The companies use paid and unpaid ‘influencers’ and ‘public opinion formers’ to deceptively market their products.  The petition asserts that tobacco companies are violating federal law.  The practices certainly belie the industry’s promises to stop inducing young people to smoke and their claims that ‘We’ve changed’.


More than 1,000 people under the age of 18 begin smoking every day, and many of them will become addicted to tobacco.  The tobacco industry knows that if they can get people to start smoking their brand while young, they will have a customer for life. And, despite promises to the contrary, they don’t show any real concern that the young smokers’ lives may well be plagued by the many dreadful illnesses caused by their products.  Let’s hope the FTC takes the steps needed to protect our children. If not, I plan to write the FTC and make my feelings known.  How about you?


Mike Burke, Ed.D

Program Director and NDC Counselor/ CTTS

This article is adapted from the Truth Initiative article “4 things parents need to know about JUUL and nicotine addiction.


For those of you who are parents, there’s a new four-letter word you need to know: JUUL. It’s a brand name, a noun and even a verb: JUULing. It refers to a popular new e-cigarette that is reigniting concerns about nicotine addiction in youth.


We’ve seen lots of healthy discussion here on EX about e-cigarettes and their role as a quitting method. JUUL’s manufacturer says its product is marketed to help adult cigarette smokers quit, and we’re interested to hear whether you have experience using it in your quit.


But for those of you who are parents, there are good reasons to be concerned specifically with how much JUUL appeals to teenagers, and the increased risk of nicotine addiction that e-cigarettes may pose among youth. Here are the key things to know:


JUUL is “everywhere”

For those of you who are not familiar with it, here are the basics. JUUL manufacturers make about 20 million devices per month. The JUUL device looks like a USB memory stick and is relatively inexpensive. The cost for a new pod is $4 to $5 — less than a pack of cigarettes — after an initial outlay of about $35 to buy the JUUL product.


It has two components: a rechargeable heating element and a replaceable cartridge or pod. When charged and puffed, a solution contained in the pod is heated to create a vapor designed to be inhaled into the lungs. Each pod contains a high amount of nicotine, as well as benzoic acid, glycerol and propylene glycol, and a flavor, such as crème brulee, mango, fruit medley, cool mint, classic menthol or classic tobacco.


With its slick design and lower price point, JUUL has captured 68 percent of the e-cigarette market in just two years and caused alarm in schools across the country.


JUUL is easy to hide

JUUL is easy to hide from parents and teachers because it looks like a flash drive and can be charged in a USB port. It also does not produce a strong odor. These characteristics make it easy for kids to use is discreetly, especially in school. Kids can hide it in their pocket and take a couple of hits in a bathroom or even in the classroom. In fact, almost one-fifth of middle and high school students have seen JUUL used in school, according to a Truth Initiative® survey.


Kids are attracted to flavored e-cigarettes and believe they are less harmful

Flavors in tobacco products, including e-cigarettes, have been proven to attract kids. Research shows that young people are more likely to try flavored e-cigarettes and believe that they are less harmful than tobacco-flavored e-cigarettes. Many youth e-cigarette users also incorrectly believe they aren’t consuming nicotine when they vape. The majority of youth e-cigarette users think they vaped only flavoring, not nicotine, the last time they used a product, according to an annual national survey of more than 40,000 students from the University of Michigan Monitoring the Future study.


JUUL is incredibly addictive

While e-cigarettes are less toxic than cigarettes, they still contain toxins and the addictive chemical nicotine, which is harmful to adolescent brain development. The adolescent brain is also more susceptible to addiction. The amount of nicotine in one JUUL cartridge is roughly equal to a pack of cigarettes, or about 200 puffs, according to the product website. That’s double the concentration of nicotine found in other e-cigarettes, the American Academy of Pediatrics found.


Teenagers who use JUUL and other types of e-cigarettes are more likely to use combustible cigarettes.


Pediatricians are still learning about JUUL

Detecting and monitoring JUUL use can be a challenge for pediatricians. A Truth Initiative study published in Tobacco Control found that many young people refer to the use of JUUL as "JUULing," indicating that it is so distinctive, it is perceived as its own category. 


As a result, the people who use JUUL don’t consider themselves smokers. They use the term ‘JUUL,’ and if parents and pediatricians aren’t aware of what JUUL is, they might not even ask the right questions.


E-cigarettes are putting an entire generation at risk of nicotine dependence. This is why Truth Initiative, the American Academy of Pediatrics and other public health and medical groups and individual pediatricians are calling on the Food and Drug Administration to take immediate action to address the rising popularity of JUUL among youth. 

The bottom line for those of you who are parents: know about JUUL, ask about JUUL and be on the lookout for something that looks like a USB drive. We don’t want your kids to need EX down the road.


Dr. Hays

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