Transcript Smoking Tobacco - Francis Marion University

Smoking Tobacco
William P. Wattles, Ph.D.
Psychology 314
Dose Response relationship

A quantitative relationship between the
dose of a drug and the degree of an
effect caused by the drug
2
Analyze nutrition from a chain
restaurant.

Choose a restaurant not chosen by
someone else. First come, first served.
3
Analyze nutrition from a chain
restaurant.
1.
2.
3.
4.
5.
Obtain a fact sheet with nutritional
information.
Analyze the fat content of at least ten
items
Discuss the nutritional strengths and
weaknesses of several items
Suggest which items appear healthier.
Attach the fact sheet to the paper.
4
American Legacy Foundation

Building a world
where young people
reject tobacco and
anyone can quit.

http://www.american
legacy.org/
5
The Smoking Scourge Among Urban
Blacks

http://www.nytimes.com/2007/10/20/health/20
tobacco.html
6
Employers see savings in helping
smokers to quit

http://www.nytimes.com/2007/10/26/bus
iness/26smoking.html?_r=1&oref=slogin
7
Workplace initiative
Act Now to Avoid Tobacco
Surcharge
 October 31 is the deadline to certify with
the Employee Insurance Program (EIP)
whether you use tobacco. Effective
January 1, 2010, a $25-a-month
surcharge will be added to the health
insurance premium of subscribers who
use tobacco

8
Segue


Article:Lack Of Progress Found In Reducing
Smoking
About 48 million Americans smoked in 1997
according to a survey.The Disease Control
and Prevention Centers estimated that 23.9
percent of men and 18.1 percent of women
smoked regularly. the overall smoking rate for
adults is 20.9 percent.
9
10
Costs of smoking
An estimated 430,070 Americans die
each year from diseases caused by
smoking.
 Smoking is responsible for an estimated
one in five U.S. deaths and costs the
U.S. at least $97.2 billion each year in
health care costs and lost productivity.

11
You don’t always die from tobacco
12
The respiratory system


Diaphragm and
intercostal muscles
contract to increase
volume of chest.
Resulting loss in
pressure causes air
to flow in

Air flows in through
the
–
–
–
–
–
nasal passages
pharynx
larynx
trachea
bronchi and
bronchioles
13
Gas exchange


Occurs in the alveoli
alveolus A tiny,
thin-walled,
capillary-rich sac in
the lungs where the
exchange of oxygen
and carbon dioxide
takes place. In this
sense, also called
air sac.


Bubbles with thin
skin
Due to diffusion
pressure carbon
dioxide moves from
the blood and
oxygen to it.
14
Foreign material enters via
respiratory system

Mucociliary
escalator.
protective
mechanism
–
–

mucous
cilia
smoke decreases
the effectiveness of
the Mucociliary
escalator.
15
Chronic obstructive pulmonary
disease

Chronic obstructive
pulmonary disease
(COPD) includes
emphysema and
chronic bronchitis-diseases that are
characterized by
obstruction to air
flow.




Emphysema and
chronic bronchitis
frequently coexist.
Thus physicians
prefer the term
COPD
Fourth leading
cause of death in
the U.S.
96,000 deaths
16
annually
Chronic obstructive pulmonary
disease

Approximately 80 to
90 % of COPD
cases are caused by
smoking; a smoker
is 10 times more
likely than a
nonsmoker to die of
COPD.
17
Chronic obstructive pulmonary
disease

Other known causes
are frequent lung
infections and
exposure to certain
industrial pollutants.
18
Chronic Bronchitis

Chronic bronchitis
is an inflammation
and eventual
scarring of the lining
of the bronchial
tubes.

An estimated 14
million people suffer
from chronic
bronchitis, the
seventh leading
chronic condition in
America.
19
Chronic Bronchitis

Symptoms of
chronic bronchitis
include:
–
–
–
chronic cough,
increased mucus
frequent clearing
of the throat
shortness of
breath.
20
Emphysema

Emphysema causes
irreversible lung
damage. The walls
between the air sacs
within the lungs lose
their ability to stretch
and recoil. They
become weakened
and break.

Elasticity of the lung
tissue is lost,
causing air to be
trapped in the air
sacs and impairing
the exchange of
oxygen and carbon
dioxide.
21
Emphysema

Symptoms of
emphysema include
cough, shortness of
breath and a limited
exercise tolerance.

Diagnosis is made
by pulmonary
function tests, along
with the patient's
history, examination
and other tests.
22
Emphysema

An estimated two
million Americans
have emphysema.
Of the emphysema
sufferers, 61 % are
male, and 39 % are
female.


While more men
suffer from the
disease than women,
the condition is
increasing among
women.
Between 1982 and
1994 the emphysema
prevalence rate in
women increased 11
23
%.
Cigarettes
Cigarettes contain at least 43 distinct
cancer-causing chemicals.
 Smoking is directly responsible for 87
% of lung cancer cases and causes
most cases of emphysema and chronic
bronchitis.

24
Cigarettes
Smoking is also a major factor in
coronary heart disease and stroke; may
be causally related to malignancies in
other parts of the body; and has been
linked to a variety of other conditions
and disorders, including slowed healing
of wounds, infertility, and peptic ulcer
disease.
 Causes “cigarette skin”

25
Cigarette Skin
Premature facial wrinkling in young
people is associated with smoking.
Therefore, it is suggested this should
now be added to the list of disorders
with which smoking is considered a
causative factor
 International Journal of Dermatology.

26
Cigarette Skin



Smokers tend to look older
than non-smokers of the
same age
Smokers' facial skin is more
likely than non-smokers to
have: wrinkles, crow's feet
and a sallow, yellow-grey
colouring
Smokers' skin can be
prematurely aged by
between 10 and 20 years
27
28
Smoking in pregnancy
Smoking in pregnancy accounts for an
estimated 20 to 30 % of low-birth weight
babies, up to 14 % of preterm
deliveries, and some 10 % of all infant
deaths.
 Even apparently healthy, full-term
babies of smokers have been found to
be born with narrowed airways and
curtailed lung function.

29
Smoking in pregnancy
Only about 30 % of women who smoke
stop smoking when they find they are
pregnant.
 26% of women in Kentucky and West
Virginia smoke during pregnancy.
Nationwide it is about 12%

30
Who smokes?
20.9% of adults smoke down from high
of 41% in 1965. Approx.. 50 million
 25% once smoked
 50% never smoked
 warning labels Since 1967
 television ads banned since 1970
 Men (23.9%) smoke slightly more than
women (18.1%)

31
Who smokes by race?
Blacks over 18 years of age have the
highest amount of smokers
 Whites 21.9%
 Blacks 21.5%
 Hispanic 16.2%
 Asian 14.4%

32

Smoking prevalence among people with
disabilities is nearly 50 percent higher
than among people without disabilities
(29.9 percent vs. 19.8 percent),
according to a new study from the
Centers for Disease Control (CDC)
33
Who smokes by education?
People with less formal education tend
to smoke more
 G.E.D. 43.2%
 9-11 years 32.6%
 college degree 10.7%
 graduate degree 7.1%

34
Who smokes by state?
Kentucky has the highest number of
adult smokers (27.6%)
 Utah has the lowest number of adult
smokers (10.5%)


35
Smoking and taxes

States with the highest cigarette taxes,
such as Connecticut, Massachusetts,
Montana, Washington, New Jersey
have lower rates of adult smokers!
36
Smoking and taxes

States with the lowest cigarette taxes,
such as South Carolina, Missouri,
Mississippi, Tennessee, Kentucky,
North Carolina have higher rates of
adult smokers!
37



Cigarette
Tax and
smoking
rank by
state
correlation
= .40
38
Who smokes by age

Nationwide, 70.2% of high school
students have tried cigarette smoking.
More than one-third (36.4%) of high
school students were current cigarette
smokers, i.e., smoked at least one
cigarette in the past 30 days.
39
Who smokes by age

White students
(19.9%) were more
likely than AfricanAmerican (7.2%) or
Hispanic (10.9%)
students to smoke
frequently.
40
Who smokes by country


In developed
countries, 41% of
men and 21% of
women regularly
smoke cigarettes.
In developing
countries, 50% of
men smoke, and 8%
of women.
41
rank m
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
nation
men
women
Bangladesh
69
15
Korea
68.2
6.7
Russian
67
30
Latvia
67
12
Dominican Republic
66.3
13.6
Tonga
65
14
Turkey
63
24
China
61
7
Fiji
59.3
30.6
Japan
59
14.8
Sri Lanka
54.8
0.8
Algeria
53
10
Indonesia
53
4
Samoa
53
1.6
Saudi Arabia
52.7
0
Estonia
52
24
South Africa
52
17
Kuwait
52
12
Lithuania
52
10
Poland
51
29
Seychelles
50.9
10.3
Bolivia
50
21.4
Albania
49.8
7.9
Cuba
49.3
24.5
Bulgaria
49
17
Thailand
49
4
Spain
48
25
Mauritius
47.2
3.7
Greece
46
28
Papua New Guinea
46
28
Israel
45
30
Cook Islands
44
26
Czech Republic
43
31
Slovakia
43
26
Jamaica
43
13
Philippines
43
8
Cyprus
42.5
7.2
Austria
42
27
Peru
41
13
Malaysia
41
4
Uruguay
40.9
26.6
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
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67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
France
Hungary
Argentina
Malta
Mongolia
Iraq
India
Uzbekistan
Brazil
Egypt
Morocco
Mexico
Lesotho
Italy
Portugal
El Salvador
Chile
Guatemala
Denmark
Germany
Norway
Netherlands
Switzerland
Honduras
Columbia
Slovenia
Costa Rica
Swaziland
Luxembourg
Singapore
Canada
Iceland
Belgium
Ireland
Australia
United States
United Kingdom
Pakistan
Finland
Turkmenistan
Nigeria
Paraguay
New Zealand
Bahrain
Sweden
Bahamas
40
40
40
40
40
40
40
40
39.9
39.8
39.6
38.3
38.3
38
38
38
37.9
37.8
37
36.8
36.4
36
36
36
35.1
35
35
33
32
31.9
31
31
31
29
29
28.1
28
27.4
27
26.6
24.4
24.1
24
24
22
19.3
27
27
23
18
7
5
3
1
25.4
1
9.1
14.4
1
26
15
12
25.1
17.7
37
21.5
35.5
29
26
11
19
23
20
8
26
2.7
29
28
19
28
21
23.5
26
4.4
19
0.5
6.7
5.5
22
6
24
3.8


Smoking
rates by
country
Ranked by
men’s rate
42
rank w
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
nation
men
Denmark
Norway
Czech Republic
Fiji
Israel
Russian
Canada
Netherlands
Poland
Greece
Iceland
Ireland
Papua New Guinea
Austria
France
Hungary
Uruguay
Cook Islands
Italy
Luxembourg
Slovakia
Switzerland
United Kingdom
Brazil
Chile
Spain
Cuba
Estonia
Sweden
Turkey
United States
Argentina
Slovenia
New Zealand
Germany
Bolivia
Australia
Costa Rica
Belgium
Columbia
Finland
women
37
36.4
43
59.3
45
67
31
36
51
46
31
29
46
42
40
40
40.9
44
38
32
43
36
28
39.9
37.9
48
49.3
52
22
63
28.1
40
35
24
36.8
50
29
35
31
35.1
27
37
35.5
31
30.6
30
30
29
29
29
28
28
28
28
27
27
27
26.6
26
26
26
26
26
26
25.4
25.1
25
24.5
24
24
24
23.5
23
23
22
21.5
21.4
21
20
19
19
19
41
42
43
44
45
46
47
48
49
50
51
52
53
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59
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67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
Finland
Malta
Guatemala
Bulgaria
South Africa
Bangladesh
Portugal
Japan
Mexico
Tonga
Dominican Republic
Jamaica
Peru
El Salvador
Kuwait
Latvia
Honduras
Seychelles
Algeria
Lithuania
Morocco
Philippines
Swaziland
Albania
Cyprus
China
Mongolia
Korea
Nigeria
Bahrain
Paraguay
Iraq
Pakistan
Indonesia
Malaysia
Thailand
Bahamas
Mauritius
India
Singapore
Samoa
Egypt
Lesotho
Uzbekistan
Sri Lanka
Turkmenistan
Saudi Arabia
27
40
37.8
49
52
69
38
59
38.3
65
66.3
43
41
38
52
67
36
50.9
53
52
39.6
43
33
49.8
42.5
61
40
68.2
24.4
24
24.1
40
27.4
53
41
49
19.3
47.2
40
31.9
53
39.8
38.3
40
54.8
26.6
52.7
19
18
17.7
17
17
15
15
14.8
14.4
14
13.6
13
13
12
12
12
11
10.3
10
10
9.1
8
8
7.9
7.2
7
7
6.7
6.7
6
5.5
5
4.4
4
4
4
3.8
3.7
3
2.7
1.6
1
1
1
0.8
0.5
0


Smoking rate by
country
Ranked by women’s
rate
43
Why smoke?
Why do you smoke?
 Why do you think people smoke?
 Is smoking cool?
 How could it be viewed as cool or sexy?
 What does someone get out of
smoking?

44

In the beginning, smoking is about
image. Three thousand American teens
will light up for the first time today and,
for most, says 17-year-old Alexandria
Drouin, "It's like, `I want to look cool.' "
45
Is smoking cool?
46

TV ads features a
46-year-old woman
who says she's
been smoking since
she was 13 and
can't kick her
addiction, even after
losing her voice box
to throat cancer in
1992.
47

Identified only as
"Debi," the woman
smokes through a
hole in her throat,
telling the audience
she tried to quit
when she became
aware of dangers to
her health, but
couldn't.
48
Teenagers and smoking

Reasons for starting:
–
–
–
tension control
rebelliousness
social pressure
49
Nicotine is an addictive drug, which
reaches the brain faster than drugs that
enter the body intravenously. Smokers
become not only physically addicted to
nicotine.
 Smokers also link smoking with many
social activities, making smoking a
difficult habit to break.

50

In 1994, an estimated 46 million adults
were former smokers. Of the current
smokers, 33.2 million persons reported
they wanted to quit smoking completely.
51
Quitting Smoking


An estimated 30% of
smokers make at
least one quit
attempt per year.
81% fail within the
first month.
52
Smoking and advertising

The cigarette companies spend $15
billion annually on advertising and
marketing campaigns to addict a new
generation of customers. That's $41
million every day.

http://www.ftc.gov/reports/cigarette05/0
50809cigrpt.pdf
53
Cigarette Advertising












Newspapers
Magazines
Outdoor
Transit
Point-of-Sale
Price Discounts
Promotional Allowances – Retailers
Promotional Allowances –
Wholesalers
Promotional Allowances – Other
Sampling Distribution
Specialty Item Distribution –
Branded
Specialty Item Distribution - NonBranded











Public Entertainment – Adult-Only
Public Entertainment – GeneralAudience
Sponsorships
Endorsements & Testimonials
Direct Mail
Coupons
Retail-Value-Added – Bonus
Cigarettes
Retail-Value-Added – Non-Cigarette
Bonus
Company Website
Internet –
Telephone
54
Quit smoking and advertising

Florida begins to spend $50 million of
Big Tobacco's money to pay for a teendirected, guerrilla-style advertising
campaign designed to reverse the rising
rate at which young people are taking
up cigarettes, cigars and chewing
tobacco.
55
Movie industry
One full-page newspaper ads attacked
the movie industry for making smoking
glamorous in films.
 "We're your best customers. So why are
you trying to kill us?”
 "Why does the film industry continue to
glamorize an addictive habit that often
ends in a slow, agonizing death?"

56

That, say those in charge of the ad
campaign, is the key. "The aim
here is to make rebelling against
manipulation as cool as smoking”
57
58
59

Bluntness, not subtlety, appears to be the key
to reaching both children and adults.
according to a review of broadcast and
billboard messages funded by state tobacco
taxes published in the March 11 issue of the
Journal of the American Medical Association.
"To compete with tobacco industry
advertising, anti-tobacco advertisements
need to be ambitious, hard-hitting, explicit,
and in your face,"
60
No smoking laws


California outlawed smoking in restaurants in
1994. The prohibition was extended to bars
and gambling establishments four years later.
Efforts to repeal it have failed.
In stark contrast to predictions of economic
ruin, bars around the state appear to have
enjoyed a healthy increase in business during
the first year of a controversial smoking ban,
fresh sales data show.
61
Economics

Researchers in 1997 found that 100%
smokefree restaurant and bar ordinances do
not adversely impact revenues. Sales tax
data, comparing restaurant sales in 15 cities
to total retail sales in the same cities, and
restaurant sales in 15 comparison cities. The
researchers also examined five cities and two
counties with smokefree bar ordinances.
62
Economics

In 1999, a study in the Journal of the
American Medical Association analyzed hotel
revenues in the states of California, Vermont
and Utah and the cities of New York, Los
Angeles, San Francisco, Boulder, Colo., and
Mesa and Flagstaff, Ariz. The study found
either a statistically significant increase in
hotel revenues or no significant change
63

Secondhand smoke is a known
carcinogen . Exposure to secondhand
smoke causes approximately 35,000
heart disease deaths and 3,000 lung
cancer deaths among nonsmokers in
the United States every year
64
65
Movies glamorize smoking

Teenagers are more likely to think
smoking is cool after they've watched
their Hollywood idols light up on screen
-- unless they've just seen an
advertisement reminding them that
tobacco is dangerous.
66
Pechmann Study

In a recent study involving more than
800 Southern California ninth-graders,
Pechmann found that showing just one
30-second anti-smoking ad immediately
before a film in which cigarettes play a
role makes teens immune to images
that glamorize smoking.
67
Pechmann Study

Those who saw the anti-smoking ad
emerged from the film with negative
views about smoking, while the others
expressed positive attitudes.
68
PHILADELPHIA -
Police have been told to
stub out their cigarettes
permanently after a
newspaper photograph
showed an officer
smoking as he helped
lift a man in a
wheelchair outside a
burning building
69

Both the New York City
and Los Angeles police
departments have strict
policies barring
uniformed officers from
smoking in public
70
Arkansas hospitals

Arkansas Act 134 of
2005, the law that
prohibits the smoking of
tobacco products in
hospitals and on their
grounds, becomes
effective on
October 1.
71
Tobacco company anti-smoking
ads

New anti-smoking ads  http://www.philipmorris
from the tobacco
usa.com
companies deserve
close scrutiny. In
December 1998, the
world's largest tobacco
company launched a
national media
campaign to prevent
youth smoking.
72
73

That's the whole
point of this
campaign - to
make not
smoking look so
uncool that it may
motivate kids to
smoke.

They want you to
reject the ad,
because a
rejection of any
anti-smoking
advertisement is
the best response
expected.
74
Stanford Study


Exposure to the
tobacco industry's
anti-smoking ads:
(a) does more to
encourage than
discourage youth
smoking (a
boomerang effect),
and

(b) makes youth
resistant to criticism
of the tobacco
industry (an
inoculation effect).
75
A National Legal-Action
Antismoking Organization

http://www.ash.org/
76
Advertising tax deduction

In May, House Republicans proposed
erasing the tobacco industry's tax
deduction for advertising. (Like all
businesses, the tobacco industry is
allowed to deduct the costs associated
with marketing its products.)
77
Advertising tax deduction
The repeal would have cost the tobacco
industry an estimated $1.6 billion a
year, raising the possibility that the
companies might spend less on
advertising. The media did not want to
lose the $5.1 billion tobacco spent on
advertising and promotion in
 1996.

78
First amendment?

After the media lobbying, the provision
was quietly dropped in June.
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Quitting smoking
In 1995, an estimated 68.2% of current
smokers reported that they wanted to
quit smoking completely.
 Quit attempts, abstaining from smoking
for at least one day during the
preceding 12 months, were made by
about 45.8% of current every-day
smokers.
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
Many do quit

About 23.3% of US adults (25 million
men and 19.3 million women) were
former smokers in 1995
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Self-help
Of smokers using the self-help
approach, about 20% remain tobaccofree for about 1 year.
 In the U.S., about 90% of successful
quitters have used some form of selfhelp method either alone or with other
methods.

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Self-help
The most successful self-help materials
address the physical, psychological,
and social components of nicotine
addiction and smoking behavior.
 The self-help information contains tips
on topics like quitting, diet, exercise,
relaxation, and how to stay off
cigarettes on a long-term basis.

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Group Help
Some organizations, like the American
Cancer Society, also offer highly
structured group support programs so
that an individual does not have to face
the problem alone. These groups try to
aid in the adjustment to a non-smoking
lifestyle.
 Of smokers participating in group
programs, about 33% are successful at
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1 year.

NICOTINE GUM
In 1984, the FDA approved nicotine
polacrix gum as a prescription drug
marketed under the brand name
Nicorette.
 Nicorette is one of the fastest selling
prescription drugs with the majority of
requests for the drug being made by
patients.

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NICOTINE GUM
This gum contains nicotine but less than
that in cigarettes (about 2mg per stick
instead of the 6-8mg in a single
cigarette).
 The nicotine is slowly released when
chewed (90% of the nicotine is released
in 20-30 minutes).

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NICOTINE GUM

Used properly, this gum helps the
nicotine addict to slowly wean
themselves from cigarettes by first
substituting the gum and then chewing
less and less of the gum.
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NICOTINE GUM
Most patients are advised to use the
gum for 3-6 months.
 Side effects of the gum may include:
nausea, dizziness, or overdoses.
 Studies have suggested that the gum is
effective in decreasing the amount of
symptoms experienced with the
withdrawal syndrome.

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Nicotine gum
There have been reports that use of the
gum with behavioral treatments has
provided success at 1 year in up to
37%.
 Without counseling and a physician's
instructions, success is low.

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Nicotine Patches
In the early 1990's, the FDA approved
the use of nicotine patches as
prescription drugs. These have been
marketed under the brand names
Habitrol and Nicoderm.
 Nicotine patches are put on the skin
(transdermal) and deliver nicotine in
lower amounts than those present in
cigarettes.

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Anti-Depressants
Several anti-depressant drugs have
been studied for their potential use in
smoking cessation.
 Recent studies of bupropion (a
serotonin uptake inhibitor) have shown
that this drug may be useful in heavily
addicted smokers when used in
combination with behavioral methods of
quitting.

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Anti-Depressants
There appears to be an increased quit
rate and a decreased relapse rate with
bupropion as compared to control
subjects.
 It is thought that bupropion may work
by decreasing the withdrawal symptoms
associated with nicotine addiction.

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Self-Management



Self-Monitoring
Stimulus Control
Nicotine Fading
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Tobacco Cessation Guideline

Office of the Surgeon General
– http://www.surgeongeneral.gov/tobacco/
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
Tobacco dependence is a chronic
condition that often requires repeated
intervention.

However, effective treatments exist that
can produce long-term or even
permanent abstinence.
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
Because effective tobacco dependence
treatments are available, every patient who
uses tobacco should be offered at least one
of these treatments.
– Patients willing to try to quit tobacco use should be
provided treatments identified as effective in this
guideline.
– Patients unwilling to try to quit tobacco use should
be provided a brief intervention designed to
increase their motivation to quit.
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

There is a strong dose-response relation
between the intensity of tobacco dependence
counseling and its effectiveness.
Treatments involving person-to-person
contact (via individual, group, or proactive
telephone counseling) are consistently
effective, and their effectiveness increases
with treatment intensity (e.g., minutes of
contact).
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Smoking Cessation

Three types of counseling and behavioral
therapies were found to be especially
effective and should be used with all patients
attempting tobacco cessation:
– Provision of practical counseling (problem
solving/skills training).
– Provision of social support as part of treatment
(intra-treatment social support).
– Help in securing social support outside of
treatment (extra-treatment social support).
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Medication and tobacco use

Numerous effective pharmacotherapies
for smoking cessation now exist. Except
in the presence of contraindications,
these should be used with all patients
attempting to quit smoking.
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
Five first-line pharmacotherapies were
identified that reliably increase longterm smoking abstinence rates:
– Bupropion SR.
– Nicotine gum.
– Nicotine inhaler.
– Nicotine nasal spray.
– Nicotine patch.
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
Tobacco dependence treatments are
both clinically effective and costeffective relative to other medical and
disease prevention interventions.
Therefore, insurers and purchasers
should ensure that:
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Insurance
All insurance plans include as a
reimbursed benefit the counseling and
pharmacotherapeutic treatments
identified as effective in this guideline.
 Clinicians are reimbursed for providing
tobacco dependence treatment just as
they are reimbursed for treating other
chronic conditions.

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
Quitting smoking is the most positive and
healthy lifestyle change you can make to
improve your overall health and well-being.
The moment you stop smoking is the start of
an amazing and magical healing process that
takes place within your body.
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104
Phillip Morris

Philip Morris U.S.A. believes that the
conclusions of public health officials
concerning environmental tobacco
smoke are sufficient to warrant
measures that regulate smoking in
public places.
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Life Skills Training




provide students with the necessary skills to
resist social (peer) pressures to smoke, drink
and use drugs,
help them to develop greater self-esteem,
self-mastery, and self-confidence,
enable children to effectively cope with social
anxiety
increase their knowledge of the immediate
consequences of substance use
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107
Free and Clear

http://www.freeclear.com/
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