Erlotinib Dose-Adjusted For Smoking Status Effective As First Treatment For Head And Neck Cancer

Main Category: Cancer / Oncology
Also Included In: Ear, Nose and Throat;  Smoking / Quit Smoking
Article Date: 27 Jan 2012 – 4:00 PST

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Head and neck cancers respond well to the anti-cancer drug erlotinib when it is administered before surgery and a stronger dose is given to patients who smoke, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM.

Erlotinib is an oral anti-cancer drug that can slow a tumor’s growth and spread by inhibiting specific growth receptors on the surface of the cancer cells. Early detection of a patient’s response to EGFR inhibitors, such as erlotinib, is critical to personalizing head and neck cancer treatments.

In a first of its kind study in patients with head and neck cancer, researchers sought to determine how well tumors unaffected by other therapies respond to erlotinib, when the drug dose was adjusted according to the patient’s smoking status. It has been recently shown that smokers metabolize the drug faster than nonsmokers.

Nonsmokers received 150 mg per day and smokers received 300 mg per day for at least 14 days before surgery. A FDG-PET scan and neck CT was performed before treatment and at the end of erlotinib administration. In addition, an early FDG-PET was performed after four to six days of treatment.

The results showed that erlotinib is effective as a first line of therapy when the dose is adjusted per smoking status, even when used for a limited duration. Both smokers and nonsmokers tolerated the dose of erlotinib and neither experienced serious adverse effects. The study also showed that the FDG-PET scan taken early can show changes in the standard uptake value and predict a patient’s response to erlotinib.

“We hope our results will motivate clinicians to consider and investigate further the use of erlotinib in patients with head and neck cancer and adjust the dose for smoking status,” Mercedes Porosnicu, MD, lead author of the study and an assistant professor of internal medicine at Wake Forest Baptist Medical Center in Winston Salem, N.C., said. “We also hope that our study will help better select the patients expected to respond to erlotinib.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our cancer / oncology section for the latest news on this subject. The abstract, “Pilot study to evaluation the effect of erlotinib administered before surgery in operable patients with squamous cell carcinoma of the head and neck (SCCHN),” was presented as a poster presentation.
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Teen Secondhand Smoke Exposure Down, But Not Enough

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Academic Journal
Main Category: Smoking / Quit Smoking
Also Included In: Pediatrics / Children’s Health
Article Date: 06 Feb 2012 – 9:00 PST

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Secondhand Smoke (SHS) exposure among middle and high school students in the USA has dropped over the last ten years, researchers from the National Center for Chronic Disease Prevention and Health Promotion and the CDC (Centers for Disease Control and Prevention) reported in the March edition of Pediatrics. The authors explained that passengers in cars who accompany smokers run significant health risks, especially if they are children and teenagers.

Even though exposure has gone down over the last decade, 22.8% of students who did not smoke reported that they had breathed in environmental tobacco smoke during the previous seven days – 75.3% of smoking students had done so too.

Secondhand smoke, also known as environmental tobacco smoke, or passive smoking, refers to the unintended inhalation of tobacco smoke by other people, apart from the intended active smoker.

The authors explain that passive smoking can lead to: middle ear diseasedelayed lung growthexacerbations of asthma symptomsacute respiratory infectionsBrian A. King, PhD, MPH, and team set out to determine how much exposure there was among teenagers to secondhand smoke in nonpublic areas, especially cars and other motor vehicles. The authors explained that most previous studies had focused on environmental tobacco smoke exposure in the home.

Ich.Autofahrend.2006.MB
Non-smokers who sit with a smoking driver/passanger will inhale secondhand smoke

They gathered data from the National Youth Tobacco Survey for the years, 2009, 2006, 2004, 2002 and 2000. The survey is said to be a nationally representative one of sixth to twelfth graders. They assessed SHS exposure in motor vehicles across school years, gender and race/ethnicity.

They found that: SHS exposure dropped from 39% among non smokers in 2000, to 22.8% in 2009.SHS exposure fell from 82.3% among smokers in 2000, to 75.3% in 2009.In an Abstract in the journal, the authors concluded:

“SHS exposure in cars decreased significantly among US middle and high school students from 2000 to 2009. Nevertheless, in 2009, over one-fifth of nonsmoking students were exposed to SHS in cars. Jurisdictions should expand comprehensive smoke-free policies that prohibit smoking in worksites and public places to also prohibit smoking in motor vehicles occupied by youth.”

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our smoking / quit smoking section for the latest news on this subject. “Secondhand Smoke Exposure in Cars Among Middle and High School Students – United States, 2000-2009”
Brian A. King, PhD, MPH, Shanta R. Dube, PhD, MPH, and Michael A. Tynan, BA
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posted by Jesse on 6 Feb 2012 at 9:53 am

Will anyone think of the children? OMG please think of the children, poor children, such a tragedy. I’m going to call my state representatives to come up with new laws to forbid anything that harms the children. That includes forbidding them from running in the park because they can fall and get hurt. OMG the children.

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posted by Candace Krestel on 7 Feb 2012 at 6:00 am

I smoke but always am considerate of others. I always ask if they mind my smoking. I don’t smoke in other peoples houses and I think it’s wrong to smoke with kids in the car. As far as making it a law this is just another way to control what people are doing. Why don’t they ban drinking because that’s a killer too but it’s still legal because it makes money.

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Male Smoking Leads To Faster Cognitive Decline

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Academic Journal
Main Category: Smoking / Quit Smoking
Also Included In: Psychology / Psychiatry;  Alzheimer’s / Dementia
Article Date: 10 Feb 2012 – 6:00 PST

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Findings of a report published Online First in the Archives of General Psychiatry, one of the JAMA/Archives journals shows that men who smoke seem to be linked with a more rapid cognitive decline.

According to background information, smoking is more and more renown as a risk factor for dementia in the elderly. In 2010, the number of dementia diagnoses around the world was estimated at 36 million with numbers increasing and predicted to double every 20 years.

Séverine Sabia, Ph.D., of the University College London and her team assessed the link between smoking history and cognitive decline during the transition from midlife to old age by obtaining data from 5,099 men and 2,137 women from the Whitehall II cohort study, which is based on employees of the British Civil Service. The average age of the participants was 56 years at the first cognitive assessment.

In their new study, the researchers evaluated data from six assessments of smoking status over a 25 year-duration and three cognitive assessments over 10 years and established four major findings, which indicate that men who smoked are linked to a more rapid cognitive decline, and that those who continued smoking over the follow-up period had a bigger decline in all cognitive tests.

They also observed that those who quit smoking in the 10 years before the first cognitive measure were still at risk of greater cognitive decline, in particular in executive function, an overall term for various complex cognitive processes involved in achieving a particular goal, whereas there was no faster cognitive decline in long-term ex-smokers.

The researchers conclude:

“Finally, our results show that the association between smoking and cognition, particularly at older ages, is likely to be underestimated owing to higher risk of death and dropout among smokers.”

They also observed no link between smoking and cognitive decline in women, even though the underlying reasons remain unclear, and hypothesize that one explanation for the sex difference could be that men smoke greater quantities of tobacco.

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our smoking / quit smoking section for the latest news on this subject. Arch Gen Psychiatry. Published online February 6, 2012. doi:10.1001/archgenpsychiatry.2011.2016. Please use one of the following formats to cite this article in your essay, paper or report:

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Rise In Heart Disease Prevalence In The Gulf States Linked To Rapid Urbanisation As Well As Cultural Habits

Main Category: Heart Disease
Also Included In: Obesity / Weight Loss / Fitness;  Smoking / Quit Smoking;  Conferences
Article Date: 27 Jan 2012 – 0:00 PST

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While the rapid improvement in socio-economic conditions is thought responsible for the high rates of cardiovascular disease in the Gulf states, deep-rooted cultural factors also play a part. “We’re sitting on a time bomb,” says Professor Hani Najm, Vice-President of the Saudi Heart Association, whose annual conference begins Friday 27 January. “We will see a lot of heart disease over the next 15 to 20 years. Already, services are saturated. We now have to direct our resources to the primary prevention of risk factors throughout the entire Middle East.”

World Health Organization figures show that up to 60% of males in Arab countries and up to 70% of females are overweight and obese. Prevalence rates of diabetes and hypertension are around 25%, while inactivity rates among the over-20s are even higher. But the explanation, says Professor Najm, is not just rapid urbanisation and ubiquitous travel by car. There are, in addition, many social and cultural barriers to exercise, especially among women, who find it difficult to find the opportunities and encouragement to take organised exercise.

Smoking – cigarettes and waterpipe

And now there is further evidence that the cultural heritage of the Middle East may present yet another growing risk factor in the region’s battle against heart disease. The waterpipe – also know as the hookah or shisha – is now said to be used by up to 34% of Middle Eastern adolescents. Despite a perception that the risk of the waterpipe may be less than those of cigarettes, a recent report suggests that its “harmful effects are similar to those of cigarettes”, and that the waterpipe may offer “a bridge” to cigarette smoking.(1) The greatest prevalence of use – with up to 34% reported – is currently among adolescents and women.

A recent study from the Gulf Registry of Acute Coronary Events (GRACE), the region’s largest, found that 38% of patients registered were cigarette smokers and 4.4% waterpipe smokers.(2) The study, which included 6,701 consecutive acute coronary patients in Bahrain, Kuwait, Qatar, Oman, United Arab Emirates, and Yemen, found that the waterpipe smokers were older than the cigarette smokers and more likely to be female.

However, despite the relatively low rate of waterpipe smoking among the patients in this registry study, other studies report more widespread use throughout the region, and especially among the younger age groups. A study from 2004 found that 22% of men in two villages of Egypt reported current or past use of waterpipes, and the habit is increasingly evident even among student communities in the USA, Canada and Germany. The GRACE investigators said: “Although the prevalence of waterpipe smoking in the current registry was low (4.4%), with the current trend of popularity it is expected that physicians and specifically cardiologists across the globe can expect increasing number of their patients with Acute Coronary Syndromes to be waterpipe tobacco smokers.”

They attribute this rising popularity to the introduction of a sweet processed tobacco, the mistaken belief that any harmful effect is less than that of cigarettes, and a dearth of health warnings (as well as a dearth of data). Yet the investigators propose that waterpipe smoking may be associated with greater toxin exposure (because of longer episodes of use as well as more and larger “puffs”, with smoke inhalation as much as 100 times more than from a cigarette). They explain that a single waterpipe episode lasts between 30 and 60 minutes and may involve more than 100 inhalations, each approximately 500 ml in volume (with the smoke passing first through water). “Thus,” they write, “while smoking a single cigarette might produce a total of approximately 500 – 600 ml of smoke, a single waterpipe use episode might produce about 50,000 ml of smoke.”

The primary prevention of cardiovascular disease in the Middle East will occupy a full session of this year’s Annual Conference of the Saudi Heart Association, which, for the second year, will also feature a one-day collaborative programme with the European Society of Cardiology. Professor Najm highlights the efforts of the Association (and many regional health ministries) to develop prevention programmes, and regrets that the smoking policies of many countries – including Saudi Arabia – are not fully enforced. “The basic messages still need to be delivered,” he says. “With such a high prevalence of risk factors in our populations, especially among the young, I still expect rates of cardiovascular disease to increase even further over the next 20 years.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our heart disease section for the latest news on this subject. (1) Maziak W. The global epidemic of waterpipe smoking. Addictive Behaviors 2011; 36: 1-5.
(2) Al Suwaidi J, Zubaid M, El-Menyar AA, et al. Prevalence and outcome of cigarette and waterpipe smoking among patients with acute coronary syndrome in six Middle-Eastern countries. Eur J Cardiovasc Prevent Rehab 2011; DOI: 10.1177/1741826710393992
(3). Maziak W, Ward KD, Soweid RAA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327–333.
* Details of the ESC’s programme can be found at http://www.escardio.org/congresses/global-activities/saudi-arabia/saudi-heart/Pages/welcome.aspx
* Details of the SHA congress can be found at http://www.sha-conferences.com/
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Smoke-Free Laws Lead to Less Smoking At Home

HomeNewsSmoke-Free Laws Lead to Less Smoking At Home

February 14, 2012   Anti-tobacco laws in several European countries prompted many smokers to ban smoking at home and to cut their cigarette consumption, according to a study published in the journal Tobacco Control. The study looked at smoking habits in France, Germany, Ireland, and the Netherlands, both before and after bans on smoking in the workplace, restaurants, and bars took effect in the last decade. The trends in these countries were compared to Britain, which at the time did not have smoke-free legislation. After the law took effect, the percentage of smokers who banned all smoking at home rose by 17 percent in France, 25 percent in Ireland, 28 percent in the Netherlands, and 28 percent in Germany. The overall number of cigarettes that an individual smoked each day also fell significantly in Ireland, the Netherlands, and Germany. These findings rebut those who claim banning smoking in public places would simply shift the habit to home, exposing family members to dangerous second-hand smoke.

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Feb 14, 2012
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The Biggest Killers Of Japanese Adults Are Tobacco Smoking And High Blood Pressure

Main Category: Smoking / Quit Smoking
Also Included In: Hypertension;  Cardiovascular / Cardiology
Article Date: 25 Jan 2012 – 1:00 PST

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The life expectancy of a person born in Japan is among the highest in the world (82.9 years) yet tobacco smoking and high blood pressure are still the major risk factors for death among adults in Japan, emphasizing the need to reduce tobacco smoking and to improve ongoing programs designed to help people manage multiple cardiovascular risk factors, including high blood pressure, according to a study published in this week’s PLoS Medicine.

In an analysis of available data led by Nayu Ikeda from the University of Tokyo in Japan, the authors found that in Japan in 2007, tobacco smoking and high blood pressure accounted for 129,000 and 104,000 deaths, respectively, among adults aged 30 years and over. Physical inactivity accounted for 52,000 deaths, high blood glucose and high dietary salt intake accounted for 34,000 deaths each, and alcohol use for 31,000 deaths. Furthermore, the authors found that life expectancy at age 40 would have been extended by 1.4 years for both sexes, if exposure to multiple cardiovascular risk factors had been reduced to an optimal level.

According to the authors, in order to sustain the trend of longevity in Japan for the 21st century, additional efforts in a variety of fields are required for decreasing adult mortality from chronic diseases and injuries. They say: “A first step will be to powerfully promote effective programs for smoking cessation.”

Tobacco smoking is deeply rooted in Japanese society, but the authors argue that health professionals can play a big role: “Health care professionals, including physicians, who are highly conscious of the harms of tobacco will play the primary role in treatment of smoking and creating an environment for implementation of stringent tobacco control policies.

As for high blood pressure, the authors say: “it is urgent to establish a monitoring system for management of high blood pressure at the national level. Further investigation through national health surveys will help understand factors that contribute to the inadequate control of blood pressure in the Japanese population.”

The authors conclude: “Measuring the quality of the care that is actually delivered by interventions will be of paramount importance in the assessment of current policies and programs for the treatment of multiple cardiovascular risks including hypertension. These concerted actions in research, public health, clinical practice, and policymaking will be the key for maintaining good population health in the aging society.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our smoking / quit smoking section for the latest news on this subject. Funding: This research was supported by a Grant-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare (H22-seisaku-shitei-033) and a Grant-in-Aid for Scientific Research (B) from the Japan Society for the Promotion of Science (No. 2239013). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
Citation: Ikeda N, Inoue M, Iso H, Ikeda S, Satoh T, et al. (2012) Adult Mortality Attributable to Preventable Risk Factors for Non-Communicable Diseases and Injuries in Japan: A Comparative Risk Assessment. PLoS Med 9(1): e1001160. doi:10.1371/journal.pmed.1001160
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What Is Nicotine?

Editor’s Choice
Main Category: Smoking / Quit Smoking
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 26 Jan 2012 – 0:00 PST

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Nicotine is a nitrogen-containing chemical – an alkaloid, which is made by several types of plants, including the tobacco plant. Nicotine is also produced synthetically. Nicotiana tabacum, the type of nicotine found in tobacco plants, comes from the nightshade family. Red peppers, eggplant, tomatoes and potatoes are examples of the nightshade family.

Apart from being a substance found in tobacco products, nicotine is also an antiherbivore chemical, specifically for the elimination of insects – it used to be extensively used as an insecticide.

Pharmacologic effects – when humans, mammals and most other types of animals are exposed to nicotine, it increases their heart rate, heart muscle oxygen consumption rate, and heart stroke volume – these are known as pharmacologic effects.

Psychodynamic effects – the consumption of nicotine is also linked to raised alertness, euphoria, and a sensation of being relaxed.

Addictive properties – nicotine is highly addictive. People who regularly consume nicotine and then suddenly stop experience withdrawal symptoms, which may include cravings, a sense of emptiness, anxiety, depression, moodiness, irritability, and inattentiveness. The American Heart Association says that nicotine (from smoking tobacco) is one of the hardest substances to quit – at least as hard as heroin.

According to a report published by the Massachusetts Dept of Public Health, tobacco companies steadily increased the nicotine content of their cigarettes from 1998 to 2004, by approximately 10%. The higher the nicotine dose in each cigarette, the harder it is for the regular smoker to quit. The Department accused the tobacco companies of deliberately making their customers more addicted, so that they could secure sales. Doctors complain that this business strategy undermines the success rates of smoking cessation therapies.Link to article

According to Medilexicon’s medical dictionary:

Nicotine is “A poisonous volatile alkaloid derived from tobacco (Nicotiana spp.) and responsible for many of the effects of tobacco; it first stimulates (small doses), then depresses (large doses) at autonomic ganglia and myoneural junctions. Its principal urinary metabolite is cotinine.

Nicotine is an important tool in physiologic and pharmacologic investigation, is used as an insecticide and fumigant, and forms salts with most acids.”

Another study carried out at the National Institute on Drug Abuse found that nicotine consumption makes cocaine more addictive. (Link to article)

Nicotine’s molecular formula is C10H14N2.

The French ambassador in Portugal, Jean Nicot de Villemain, sent tobacco and seeds to Paris from Brazil in 1560, saying that tobacco had medicinal uses. From his name came the Latin name for the tobacco plant – Nicotianana tabacum.

Nicot sent snuff – powdered tobacco that is sniffed through the nostril – to Catherine de Medici, the Queen of France at the time. He said it would treat her migraines. Nicot, who suffered from headaches, said the snuff helped relieve symptoms. The Queen tried it and said it was effective. She said that tobacco should be called the Herba Regina (the herb of the queen).

In 1828, Wilhelm Heinrich Posselt, a doctor, and Karl Ludwig Reinmann, a chemist, both from Germany, first isolated nicotine from the tobacco plant. They said it was a poison.

Louise Melsens, a Belgian chemist and physicist, described nicotine’s empirical formula in 1843, and Adolf Pinner and Richard Wolffenstein, both chemists from Germany, described its structure in 1893.

In 1904, nicotine was first synthesized by A. Pictet and P. Crepieux.

Side effects of nicotine

Pharmacokinetics refers to what the body does to a substance, while pharmacodynamics refers to what a substance does to the body.

After inhaling tobacco smoke, nicotine rapidly enters the bloodstream, crosses the blood-brain barrier and is inside the brain within eight to twenty seconds. Within approximately two hours after entering the body, half of the nicotine has gone (elimination half-life of about two hours).

How much nicotine may enter a smoker’s body depends on: what type of tobacco is being usedwhether or not the smoker inhales the smokewhether a filter is used, and what type of filter it isTobacco products that are chewed, placed inside the mouth, or snorted tend to release considerably larger amounts of nicotine into the body than smoking.

Nicotine is broken down (metabolized) in the liver, mostly by cytochrome P450 enzymes. Cotinine is the main metabolite.

Nicotine is both a sedative and a stimulant. When our bodies are exposed to nicotine, we experience a “kick”- this is partly caused by nicotine’s stimulation of the adrenal glands, resulting in the release of adrenaline (apinephrine). This surge of adrenaline stimulates the body, there is an immediate release of glucose, as well as an increase in heart rate, respiration and blood pressure.

Nicotine also makes the pancreas produce less insulin, resulting in slight hyperglycemia (high blood sugar or glucose).

Indirectly, nicotine causes dopamine to be released in the pleasure and motivation areas of the brain. A similar effect occurs when people take heroin or cocaine. The drug user experiences pleasure. Dopamine is a brain chemical that affects emotions, movements, and sensations of pleasure and pain. Dopamine neurotransmitters are located in the substantia nigra, deep in the middle of the brain. Put simply, if your brain dopamine levels rise, your sensation of contentment is higher.

Depending on the nicotine dose taken and the individual’s nervous system arousal, nicotine can also act as a sedative.

Tolerance – the more nicotine we have, the higher our tolerance becomes, and we require higher doses to enjoy the same initial effects. As most of the nicotine in the body is gone during sleep, tolerance may have virtually disappeared first thing in the morning. That is why many smokers say their first cigarette of the day is the best, or strongest. As the day develops, nicotine has less of an effect, because of tolerance build-up.

Concentration and memory – studies have shown that nicotine appears to improve memory and concentration. Experts say that this is due to an increase in acetylcholine and norepinephrine. Norepinephrine also increases the sensation of wakefulness (arousal).

Reduced anxiety – nicotine results in increased levels of beta-endorphin, which reduces anxiety.

Humans get their nicotine “fix” primarily through smoking tobacco, but can also obtain it by snorting snuff, chewing tobacco, or taking NRTs (nicotine replacement therapies), such as nicotine gum, lozenges, patches and inhalators.

By far, the most popular way of consuming nicotine is by smoking cigarettes. Worldwide, over one billion people are regular tobacco smokers, according to WHO (World Health Organization).

Smoking in the USA – Approximately 23% of adult males and 18% of adult females in the USA are smokers. Over 400,000 thousand premature deaths in the country are caused by cigarette companies, nearly 20% of all deaths. More people die as a result of smoking than all the deaths due to HIV, vehicle accidents, murders, suicides, alcohol abuse and drug abuse combined.

Smoking in the UK – approximately 24% of the UK adult population are smokers, according to the NHS (National Health Service) – 25% of males and 23% of females. 114,000 smokers die prematurely in the UK every year.

The NHS, UK, says that about 70% of all British smokers would like to quit, but believe they cannot. Half of all smokers in the country eventually manage to give up successfully.

Cigarette smoking originates from the European exploration and colonization of the Americas, where tobacco was common. Smoking tobacco soon became popular in Europe, and then spread to the rest of the world.

Further reading:

– What Is Nicotine Dependence? What Are The Dangers Of Smoking?
– Seven Great Tips to Help Quit Smoking
– Myths And Truths About Therapeutic Nicotine
– Nicotine Patches, Gum, Don’t Help Smokers Quit Long-Term, New Study
– Many mistakenly think nicotine causes cancer, rather than the smoke

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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posted by Electricman on 26 Jan 2012 at 2:31 pm

Don’t belive the “harm reduction ” sites that would like you to believe their lies and misinformation that you can stay addicted forever
Nicotine -one of the most toxic and addicting of all drugs and it is toxic by all routes of exposure including the intact skin. ….also used as a contact insecticidal.

Which of the following poisons is the most deadly?
1. Arsenic
2. Strychnine
3. Nicotine
If you guessed # 3, you are correct. The lethal dosage for a 150 pound adult is 60 mg. The lethal dosage for # 2 is 75 mg and the lethal dosage for # 1 is 200 mg. In other words, nicotine is three times as toxic as arsenic and one and one half times as toxic as strychnine.

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From Cigarette To Emphysema: Mapping The Destructive Path

Main Category: Smoking / Quit Smoking
Also Included In: Respiratory / Asthma;  Immune System / Vaccines
Article Date: 20 Jan 2012 – 0:00 PST

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From the cherry red tip of a lighted cigarette through the respiratory tract to vital lung cells, the havoc created by tobacco smoke seems almost criminal, activating genes and portions of the immune system to create inflammation that results in life-shortening emphysema, said researchers led by those at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center.

In a report online in the journal Science Translational Medicine, the scientists, including two from The University of Texas MD Anderson Cancer Center, described the track the toxic smoke takes through the tissues and how they accomplish their destructive work.

“It’s like walking into a crime scene,” said Dr. Farrah Kheradmand, professor of medicine and immunology at BCM and a senior author of the report. In their current work, the scientists took cells present in the “crime scene” apart, piece by piece to elucidate what occurred when, and how.

It is a complicated story that took more than four years for her, her co-senior author Dr. David Corry and members of their laboratories and colleagues in the Dan L. Duncan Cancer Center at BCM to unravel, she said. Corry is professor and chief of the section of immunology, allergy and rheumatology in the department of medicine at BCM and a member of the faculty at the Michael E. DeBakey VA Medical Center.

“Previously, emphysema was thought to be a non-specific injurious response to long-term smoke exposure,” she said. “These studies show for the first time that emphysema is caused by a specific immune response induced by smoke.”

“It is a combination of little genes affected by an epigenetic factor,” she said. Epigenetics are factors that affect the way genes are expressed after DNA forms. Cigarette smoke is an environmental epigenetic factor.

“DNA is written in pen,” said Kheradmand, using a metaphor. “Epigenetics is written in pencil. If you have enough genes affected by epigenetic factors strung together, it can tip you over into lung damage and emphysema. The inflammation that drives emphysema could also drive cancer development, a testable hypothesis that we have begun to pursue.”

This study showed that the cigarette recruited antigen-presenting cells (cells that orchestrate the immune system’s response to antigens) as co-conspirators in the lung-destroying crime, using specific genes that regulate proteins in their deadly role.

To uncover the cause of tobacco- induced emphysema, they studied mice exposed to conditions that closely simulated how humans smoke. These animals developed the lung disease in three to four months. Certain inflammatory cells and genes proving crucial to the process, she said.

For example, the cytokine interleukin-17 was critical. “When we removed IL-17 from the mice, they did not develop emphysema in the same time span,” she said. “The number of a type of immune cell – the gamma delta T-cell – would increase dramatically in the crime scene of the lung, she said.”

“But when we took them out, the inflammation worsened. The gamma delta T-cells went there to dampen the inflammation,” she said. “When they become overwhelmed, the disease ensues.”

They confirmed that a subset of antigen-presenting cells (cells that present antigen to activate the immune system) are the key to orchestrating the disease. They had first found these cells in studies of human lung tissue. Then, they duplicated that finding in mice.

Dr. Ming Shan, now a postdoctoral associate in Kheradmand’s laboratory, then took the cells out of the lungs of the mice with disease and transferred into mice who had never been exposed to cigarette smoke. After three months, these mice showed inflammatory signs indicating that they were on the way to developing lung damage and emphysema.

When they analyzed “gene chips” to screen the disease-causing antigen-presenting cells recovered from lungs with emphysema, they uncovered the gene for osteopontin, which promotes initiation of the inflammatory cascade that damages lungs. Mice that lacked this gene were resistant to emphysema, said Kheradmand.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our smoking / quit smoking section for the latest news on this subject. Others who took part in this work include Xiaoyi Yuan,Li-zhen Song, Luz Roberts, Nazanin Zarinkamar, Alexander Seryshev, Yiqun Zhang and Susan Hilsenbeck, all of BCM and Seon-Hee Chang and Chen Dong of MD Anderson.
Funding for this work came from a Veterans Affairs merit award and the National Institutes of Health.
Baylor College of Medicine Please use one of the following formats to cite this article in your essay, paper or report:

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Identifying Patients With Increased Risk From Throat Cancer

Main Category: Ear, Nose and Throat
Also Included In: Cancer / Oncology;  Smoking / Quit Smoking;  Cervical Cancer / HPV Vaccine
Article Date: 18 Jan 2012 – 0:00 PST

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Independent of other factors, such as smoking history and HPV status, matted lymph nodes appear to signal increased chance of oropharyngeal cancer spreading to other parts of the body

Researchers at the University of Michigan Health System have found a new indicator that may predict which patients with a common type of throat cancer are most likely have the cancer spread to other parts of their bodies.

Patients with oropharyngeal squamous cell carcinoma who had “matted” lymph nodes – nodes that are connected together – had a 69 percent survival rate over three years, compared to 94 percent for patients without matted nodes, according to a study published online ahead of print publication in Head & Neck.

The oropharynx is an area that includes the back of the tongue, soft palate, throat and tonsils.

“The spread of cancer throughout the body accounts for about 45 percent of the deaths from oropharyngeal carcinoma,” says the study’s senior author, Douglas B. Chepeha, M.D., M.S.P.H., an associate professor of otolaryngology head and neck surgery at the U-M Medical School. “Our findings may help doctors identify patients who are at higher risk for having their cancer metastasize and who would benefit from additional systemic therapy. Conversely, some patients without matted nodes may benefit from a reduction of the current standard treatment, which would cut down on uncomfortable side effects.”

Notably, the findings indicate an increased risk independent of other established prognostic factors, such as the patient’s history of smoking or whether they have the Human papillomavirus (HPV), the study found. Smoking (tobacco and marijuana), heavy alcohol use and HPV infection have each been linked to the development of oropharyngeal squamous cell carcinoma.

Matted nodes appear to be an especially strong indicator of increased risk among patients who are HPV-positive, even though HPV-positive patients had better overall outcomes than their HPV-negative peers. The patients with the best outcomes were HPV-positive non-smokers.

“It’s not clear why we’re finding these survival differences for patients who have matted nodes,” says study lead author Matthew E. Spector, M.D., a head and neck surgery resident at U-M who won a national award from the American Head and Neck Society for this work. “It is possible that there are biological and molecular differences in these types of tumors, which can be explored in future research.”

The results affirm the value of having a team of doctors and researchers from different specialties – radiology, oncology, biostatistics and surgery – working together to find advances that can directly benefit patients, Chepeha says. “This was a collaborative effort and all of the authors made important contributions,” he adds.

The study tracked 78 cancer patients who were part of a clinical trial evaluating two cancer drugs in combination with intensity-modulated radiation therapy. All the patients had stage III or IV squamous cell carcinoma of the oropharynx and had not had any previous treatment. Sixteen of the 78 patients had matted nodes.

“It’s significant that we’ve identified this new marker that can help us predict which patients have worse survival odds,” Chepeha says. “Now we need to go one step further and figure out what mechanisms are at work and how we can use this knowledge to improve survival rates.”

Head and neck cancer statistics: An estimated 52,140 people will be diagnosed with head and neck cancer this year, and an estimated 11,460 people will die from the disease, according to the American Cancer Society.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our ear, nose and throat section for the latest news on this subject. Additional authors: K. Kelly Gallagher, M.D.; Emily Light, M.S.; Mohannad Ibrahim, M.D.; Eric J. Chanowski; Jeffrey S. Moyer, M.D.; Mark E. Prince, M.D.; Gregory T. Wolf, M.D.; Carol R. Bradford, M.D.; Kitrina Cordell, D.D.S, M.S.; Jonathan B. McHugh, M.D.; Thomas Carey, Ph.D.; Francis P. Worden, M.D.; Avraham Eisbruch, M.D., all of U-M.
Disclosure: None.
Funding: The research was supported by a Specialized Program of Research Excellence (SPORE) in Head and Neck Cancer grant from the National Cancer Institute.
Citation: “Matted Nodes Are Associated With A Poor Prognosis In Oreopharyngeal Squamous Cell Carcinoma Independent of HPV and EGFR Status,” Head & Neck, Jan. 13, 2012.
University of Michigan Health System Please use one of the following formats to cite this article in your essay, paper or report:

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14 Feb. 2012. APA

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How To Give Up Smoking

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Main Category: Smoking / Quit Smoking
Article Date: 08 Feb 2012 – 3:00 PST

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“It’s easy to quit smoking; I’ve done it hundreds of times.” — Mark Twain

There are many different ways to quit smoking. Some experts advocate using pharmacological products to help wean you off nicotine, others say all you need is a good counselor and support group, or an organized program. To add to the confusion, you may find there is a study that says this way works better than that one, and then when you look again, you find there is another study that says, no, that one works better than this one.

But one thing most experts agree on is that a combination works best. For example, nicotine replacement therapy on its own, or counseling on its own is not as effective as a combination of the two.

In this article you can read about some of the more common elements of successful quit smoking programs. And at the end is a list of Top Tips to Quit Smoking.

If you are looking to put together or select a quit smoking program, I suggest you consider four elements in your “combination”: Appropriate use of pharmacological products. If you feel you are severely addicted to smoking, you may wish to consider nicotine replacement products so your body gradually gets used to living without nicotine: always talk to your doctor, pharmacist, or qualified quitting expert first before using these drugs.
Advice and support. Advice and support can help you become more self-aware, identify your triggers and when moments of weakness may occur, develop strategies and contigencies, keep you realistically grounded and on track with your plan, and prevent relapse. Examples include one-to-one or in-person counseling, telephone counseling, internet programs, group support, mentoring, and coaching.
Measuring and recording. To help you see in black and white how much you smoke, how much it costs you, how much you could save; also keeping a journal of your quitting journey.
Improving your knowledge: Read the science, talk to experts, and learn for yourself how smoking damages your health and the health of those around you. Learn how others tackled the challenge.If you have had a health problem, such as a heart attack or stroke, or if you are pregnant or planning to start a family, go and see your doctor and discuss your quit plan before you start. There are more than 4,000 harmful chemicals in tobacco. Nicotine is the one that makes you addicted to smoking. The idea of nicotine replacement products is to help you gradually wean yourself off nicotine. They deliver a small amount of nicotine to relieve the symptoms of withdrawal. Giving up the replacement product is easier than giving up smoking.

Nicotine replacement products come in many forms, the main ones being: Nicotine gum,Nicotine patch,Nicotine nasal spray, andNicotine inhaler.Proper use of such products can often be the key to successfully quitting for good. Here is an example of how it works:

Stage 1: Stop smoking (NEVER use nicotine replacement products if you are still smoking).

Stage 2: Use nicotine replacement therapy (having first consulted an expert about the best product and dose for you) to help manage your cravings. Gradually reduce the dose in line with the program you are following.

Stage 3: Meanwhile, seek out and start on a support program, such as counseling or group therapy. Make sure you discuss your use of nicotine replacement products in your counseling so the two therapies work with each other.

Aim to be free of both cigarettes and the nicotine replacement product within three to six months.

To decide which product is most likely to help you, talk to a qualified expert. Go and see your doctor, he or she may advise you, or refer you to a smoking cessation expert who knows about appropriate use of nicotine replacement products.

Knowing how dependent you are on nicotine can help you decide whether you wish to use replacement products. Some quitting centres may ask you to fill in a short questionnaire, such as the “Fagerstrom Test” to assess your nicotine dependence. This asks you: How soon do you smoke your first cigarette after waking up?
Do you find it difficult to abstain from smoking in places where it is forbidden?
Which cigarette would you most hate to give up?
How many cigarettes do you smoke a day?
Do you smoke more frequently in the morning (in the hours after getting up), than the rest of the day?
Do you smoke even if you are so ill you have to stay in bed?Your answers generate a score that indicates how dependent you are on nicotine. The higher your dependence, the more likely you are to benefit from pharmacological products to help you cope with withdrawal symptoms and quit smoking.

Click here to seen an example of the Fagerstrom Test as part of online Quitting Smoking resources offered by the government of New South Wales in Australia.

Other products are also available, such as bupropion hydrochloride, that target the biologic basis of tobacco addiction. Bupropion is sold under various brand names, eg Zyban, Wellbutrin, and is available on prescription. The drug has a similar effect on the brain as nicotine, it boosts levels of dopamine and norepinephrine to create a sense of wellbeing and vitality. Like all nicotine substitutes, the drug is intended for use with a quit smoking behavior change program.

Evidence suggests that advice and support from others makes a difference to long-term success in quitting smoking. Randomized controlled trials of commonly used techniques, including one-to-one, group, and telephone counseling, show they help smokers quit and remain abstinent. Even brief advice from a doctor has an effect on cessation rates.

The World Health Organization (WHO) takes the view that any professional trained in the appropriate skill should be involved in helping smokers quit: that it is an activity for the whole health care system, providing as many access points as possible for smokers to connect with and benefit from support to help them quit.

Many quitting practitioners employ techniques from cognitive behavioural therapy (CBT). These help you change your habitual thinking and behavior around smoking: for example, identifying and managing triggers (the things that make you want to smoke), developing and reinforcing alternative “good habits” such as exercise, relaxation, or self-rewards for each day without a cigarette or each cigarette or packet not smoked.

The techniques should focus not only on the period leading up to and during quitting, but also afterwards, helping you sustain changes in thinking and behavior to remain abstinent.

You don’t have to go to a cognitive behavioral therapist to benefit from CBT techniques. Many other care professionals are trained in CBT because it complements how they deliver their own service. I have met doctors, nurses, social workers, physiotherapists, hypnotherapists, business coaches, Reiki healers and yoga teachers trained in CBT.

An effective program also offers several ways or “modalities” to help you stay connected and on track. For instance, as well as offering one-to-one advice and support, such a program might include group discussions, access to online materials and knowledge bases where you can read articles on smoking cessation, tips and stories from successful quitters, as well as the opportunity to pair up with a buddy or a mentor.

In the UK, under the NHS Smokefree campaign, there are free local services that provide expert advice, information and support to smokers who want to quit. They can help you get stop smoking aids such as nicotine patches and gum, or other prescription products from your GP such as Champix or Zyban if they are suitable for you.

One such example is in Buckinghamshire, where support centres throughout the county offer confidential sessions for a minimum of six weeks. They also work with local employers and set up free workplace groups for staff who find it difficult to get to support centres.

Many quitting programs have an element where where you sit down and quantify the effect that smoking has on your life. For example, you work out how many cigarettes you smoke per day, per week, per year, and how much this costs you. For some smokers this is often their first “reality check”.

For instance, if you smoke 20 per day at a cost of 4.95 a pack, then you discover that:
a wallet of money - savings if you quit smoking In a day you spend 4.95 on cigarettes.In a week you spend 34.65.In a month you spend 148.50.In a year you spend 1,806.75.In 5 years you spend 9,033.75.In 10 years you spend 18,067.50.Some people find it helps to keep a quit journal. You can use it to jot down your plan or little notes to remind you about why you want to quit, and to record snippets of your quitting experience. For example, you may wish to list your triggers and your options for alternative action to avoid taking up smoking again. You could list what you think will be your biggest challenges, such as keeping the weight off: how might you prepare for and deal with that?

Once you’ve reached your quit date, use your journal to keep track of how you are doing. How did you deal with those challenges?

Some people find their journal helps them put things in perspective. On bad days things can look much bleaker than they really are. Looking back through the journal you can see that there have been good days too: what was it about them that you can use in the bad days to help you along? Many countries have “quitlines” where you can call an expert who understands the health effects of smoking, the quitting process, and how difficult it can be to give up.

You may find it helps to stay motivated about quitting to keep up to date with the science surrounding tobacco and smoking. Finding out how other quitters faced and dealt with their challenges can also give you ideas that help you on your own quitting journey.

One resource that offers both these types of information and more is the About.com Smoking Cessation website.

Another resource that may help keep you motivated is the “Within 20 Minutes of Quitting” poster from the US Centers for Disease Control and Prevention (CDC). The poster, included in the 2004 US Surgeon General’s Report, lists the following statements: 20 minutes after quitting: your heart rate drops.
12 hours after quitting: carbon monoxide in your blood drops to normal.
2 weeks to 3 months after quitting: your heart attack risk begins to drop; your lung function begins to improve.
1 to 9 months after quitting: your coughing and shortness of breath decrease.
1 year after quitting: your added risk of coronary heart disease is half that of a smoker’s.
5 years after quitting: your stroke risk is reduced to that of a non-smoker’s 5 – 15 years after quitting.
10 years after quitting: your lung cancer death rate is about half that of a smoker’s; your risk of cancers of the mouth, throat, esophagus, bladder, kidney and pancreas decreases.
15 years after quitting: your risk of coronary heart disease is back to that of a non-smoker’s.You can also pick up leaflets, books, motivational CDs, and other resources at your doctor’s, local clinic, health centre and library. There are smoking cessation programs that come in a kit that you can have delivered to your home. In the UK, you can order a Quit Kit from the NHS. When you open the box, it contains materials and resources such as a guide, a route map of your day to day quitting journey, an addiction test, information about nicotine replacement products, calming audio downloads, a stress toy and a tool to help you work out how much money you can save by quitting.

An increasing number of do-it-yourself quit programs are also being offered over the internet. One example from the US is the free to use EX Plan, set up under the National Alliance for Tobacco Cessation. The program, which purports to “show you a whole new way to think about quitting” is based on personal experiences of real ex-smokers and research from the Mayo Clinic. You can explore the site before you sign up and register.

The EXPlan comprises three steps that have to be completed in sequence: How to Quit. This is the preparation phase, where you identify your triggers and patterns and “relearn how to handle them” without cigarettes. In this step you also gain knowledge about addiction and how smoking changes the brain, how medications work, and the importance of having a support network. There is also an online EX Community you can link up with.
Quit Smoking. This is where you set your quit date and put into practice what you learned in step 1.
Staying Quit. In this final step you learn how to keep on being an ex-smoker, make sure the weight stays off and stack up the rewards and benefits of your non-smoking lifestyle.Some nicotine replacement product manufacturers also have online programs. After registering, you answer questions about your smoking habits, reasons for quitting, potential barriers to quitting, what challenges you face, and other lifestyle factors. This information is then used to tailor program materials to the individual.

One such example is GlaxoSmithKline’s Committed Quitters designed to be used with their nicotine replacement gum, lozenges, and patches. Their program, which incorporates cognitive behavioral techniques, includes a cessation guide, tailored newsletters delivered via the web, and behavioral support messages that arrive by email over a 10-week period.

Registered users also have access to an online library of articles where they can read about the health risks of smoking, common misconceptions about quitting, how to deal with barriers, the financial costs of smoking, tips for planning and alternative activities.

choose a smoking quit date and stick to it List your own reasons for quitting.
Choose a “low stress” time to quit. Set a date and stick to it.
Build a support network around you. Ask for help from your dentist, doctor, family, friends, work colleagues.
Use medicines that help your body get used to life without nicotine: they can double your chances of quitting for good. Ask your doctor, dentist, pharmacist about them first.
Seek tobacco-free environments to curb your temptations: eg movies, theatres, libaries, restaurants.
Plan activities that leave no opportunity for smoking.
Remove smoking paraphernalia from your home, office and car.
Anticipate problems and have a realistic plan to deal with challenges (eg if going out with smokers, practise what you are going to say when you refuse a cigarette).
Exercise: not only can it make you feel better about yourself and your decision to quit, it is hard to smoke when you’re cycling, swimming, or jogging.
Keep your hands occupied. Take up some manual activities: woodworking, gardening, do the housework, keep some needlework or a small book of puzzles or crosswords with you.
Practise the 4Ds when you feel cravings coming on: Delay (craving will pass in 5 to 10 minutes); Drink water (helps wash toxins from your body, keeps your hands and mouth busy); Distract yourself (keep active, do something else); Deep breathing (inhaling and exhaling deeply is soothing and relaxing).Tips list is adapted from the American Dental Association’s Oral Health Topics.

And finally, the most important tip of all:

Persevere and don’t let setbacks get you down. It is like learning to ride a bike: when you fall off, just get back on again and keep trying. There will be bad days, and there will be good days.

Remember, the majority of successful quitters did not stop on their first quit attempt.

Written by Catharine Paddock PhD


Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our smoking / quit smoking section for the latest news on this subject. Additional sources: What Works to Quit: A Guide to Quit Smoking from tobacco-cessation.org; Oral Health Topics from American Dental Association; A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives, JAMA 2000; Physician advice for smoking cessation, T Lancaster & L Stead, Cochrane Database Syst Rev 2004; CDC “Within 20 Minutes” poster; smokefree.nhs.uk Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Catharine Paddock PhD. “How To Give Up Smoking.” Medical News Today. MediLexicon, Intl., 8 Feb. 2012. Web.
14 Feb. 2012. APA

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posted by azure on 11 Feb 2012 at 10:56 am

Too bad the US lags so far behind the UK in offering quit smoking assistance.

I stopped 7 years ago. There were no support groups w/in a 60-70 mile range. The only “cessation expert” was a guy who knew less than I did, was charging $200 for his “assistance” and had worked w/a total of 2 clients.

I used no nicotine replacement, I had tried the gum during an earlier unsuccessful attempt, the nicotine delivery system was unpleasant (and not an effective replacement) for me.

What helped me was a 1986 ACS Quit Smoking book I found for 50 cents at a library book sale. It utilized some of the techniques listed above. It recommended writing down your primary 1-2 reasons for quitting on piece of paper, sticking that in your wallet & reading it at least once a day. I guess now people could type it into their i-phones-perhaps have it as the background of their screen. Just so you’re reminded frequently of why you’re quitting.

The state I lived in uses a portion of its tobacco settlement money to have a “quit line”. You speak to someone for maybe 2 minutes, you are sent some stuff, and that’s it. There’s no follow up call, nothing. Not much value.

At the time, I found a UK NHS site that had a place for people to write what was an important factor in their quit effort (having a new baby in the house, not wanting to expose it to second hand smoke, etc.). I found reading those entries very helpful. I found another UK site that had utilized US Surgeon General reports to create a list of all the conditions that were triggered or worsened by smoking. Again, a UK site, not US site. I printed that out, looked at it every day for about 2 weeks.

I noticed that it listed an autoimmune disorder that I developed when I was in the late teens. I had had the initial diagnosis confirmed by a board certified specialist years later. The BC specialist did not even mention that smoking worsened, maybe even triggered, this condition. If she had, that knowledge might’ve provided additional motivation for me to stop smoking and I might’ve quit years sooner.

I did get some support from my friends.

Overall, I’d say the US does a much worse job of providing people w/the (free) tools for quitting smoking or making it easier for people who want to quit. Now some minimal smoking cessation assistance via health insurance is mandated. That’s progress but it’s still nothing like the assistance the UK provides.

Gee, a single payer system doing more in preventive health care, what a surprise.

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