The partial agonist varenicline (Chantix, Pfizer), which is commonly used as a smoking cessation treatment, may also be effective in treating cocaine dependence, new research suggests. In a small, randomized study of 37 cocaine-dependent adults, those treated with varenicline experienced significantly lower levels of reward effect from cocaine compared w their counterparts treated with placebo.

Participants receiving varenicline also had lower odds of cocaine use, which was the study’s primary outcome measure, but this finding was not statistically significant.

“Because it’s a small-scale study, it was underpowered. But the fact that we did see these effects with such low power suggests that there might really be something there,” lead author Jennifer G. Plebani, PhD, research assistant professor in the Department of Psychiatry and director of the Human Behavior and Pharmacology Laboratory in the Treatment Research Center at the University of Pennsylvania Perelman School of Medicine in Philadelphia, told Medscape Medical News.

Dr. Plebani noted that there are currently no established, proven medications for treating cocaine dependence.

“We have medications for treating opiate or alcohol dependence but nothing for this condition. So we’re cautiously optimistic. Anytime we have an additional tool that might help some patients, it’s worth considering” she said.

“I would tell clinicians that if they have someone who is cocaine dependent, and they are not responding to the treatment options that are currently available, it might be worth thinking about using varenicline. And I would recommend using it in combination with psychotherapy.”

The study is published in the February issue of Drug and Alcohol Dependence.

Cardiovascular, Neuropsychiatric Concerns

A recent meta-analysis published in the Canadian Medical Association Journal in July 2011 and reported at the time by heartwire, a sister publication of Medscape Medical News, raised concerns about varenicline and cardiovascular risk.

Researchers from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. told heartwire at the time that the results highlighted “how dangerous this drug is” and that it only offers “a very modest benefit.”

On the other hand, another investigator who has conducted research with the medication, Taylor Hays, MD, from the Mayo Clinic, wrote in an accompanying editorial that “the small absolute risk of cardiovascular events associated with varenicline treatment is outweighed by the enormous benefit for reducing cardiovascular morbidity and mortality that can be achieved with successful smoking abstinence.”

In addition, a study published in PLoS One in November 2011, investigators from Wake Forest also reported that varenicline was associated with a significantly increased risk for suicidal behavior and depression compared with other smoking cessation medications.

This was in marked contrast to a review by the US Food and Drug Administration (FDA) published the month before that examined 2 epidemiological studies that showed no differences in risk for neuropsychiatric adverse events between varenicline and nicotine replacement therapy.

However, the FDA also reported that these studies had a number of limitations and that clinicians should continue following the recommendations listed on the physician label and in the patient medication guide — and to carefully monitor use.

Nevertheless, “based on FDA’s assessment of currently available data, the Agency continues to believe that the drug’s benefits outweigh the risks and the current warnings in the Chantix drug label are appropriate,” the organization noted in a release at the time.

Telephone counseling is an effective way to help Asian immigrants quit smoking, say the authors of a study published online January 25 in the Journal of the National Cancer Institute. The 6-month abstinence rate among participants who received culturally appropriate telephone counseling plus self-help materials was double that associated with self-help materials alone, report the authors. “This study, to our knowledge, is the first large randomized trial testing the effect of telephone counseling on smoking cessation in Asian immigrant smokers.”

The efficacy of telephone counselling services for smoking cessation, known as quit lines, among the general American population is well-established, but it has been less clear whether those services would help speakers of Asian languages, mainly because of cultural considerations, lead author Shu-Hong Zhu, PhD, from the Department of Family and Preventive Medicine, University of California, San Diego, and colleagues write.

Between August 2004 and April 2008, smokers calling the Asian-language line of the California quit line received self-help materials in their preferred language: Chinese (Mandarin or Cantonese), Korean, or Vietnamese. Some callers also were randomly assigned to undergo telephone counseling, consisting of a 30- to 40-minute prequit session followed by up to 5 relapse-prevention calls within 30 days of quitting. The follow-up calls lasted 10 to 15 minutes and were designed to provide support, encourage accountability, and make any necessary adjustments to the participant’s smoking cessation plan. All of the calls were conducted in the smoker’s native Asian language.

The study included 2277 participants, of whom 729 were Chinese, 848 were Korean, and 700 were Vietnamese. A total of 1124 people were randomly assigned to the telephone counseling group, with the remaining 1153 receiving self-help alone. The mean number of cigarettes smoked per day was 15.6 (standard deviation, 8.9).

In an intention-to-treat analysis that included all randomized participants, with nonresponders being considered current smokers, 6-month prolonged abstinence from cigarettes was 16.4% among the counseling group and 8.0% among the self-help group, the difference between the groups equaling 8.4% (95% confidence interval [CI], 5.7% – 11.1%; P < .001). In a complete-case analysis, which included only patients who participated in follow-up evaluations at 4 and 7 months, 6-month prolonged abstinence was 20.0% in the telephone counseling group and 9.5% in the self-help group, with the difference between the groups equaling 10.5% (95% CI, 7.3% – 13.7%; P < .001).

“[T]he odds of 6-month prolonged abstinence in the counseling group were 2.26 times higher than those in the self-help group in the intention-to-treat analysis (counseling vs self-help, [odds ratio (OR)] = 2.26, 95% [confidence interval (CI)] = 1.73 to 2.94) and 2.38 times higher than those in the self-help group in the complete-case analysis (counseling vs self-help, OR = 2.38, 95% CI = 1.82 to 3.12),” the authors write.

This study “provided clear evidence of the efficacy of telephone quitlines in smokers of Asian ancestry,” Anthony J. Alberg, PhD, MPH, from the Cancer Prevention and Control Program, Hollings Cancer Center, and the Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, and Matthew J. Carpenter, PhD, from the Cancer Prevention and Control Program, Hollings Cancer Center, and the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, write in an accompanying editorial. “This suggests that telephone quitline interventions are also likely to be highly transportable to Asian countries. This is relevant to global tobacco control because Asia is one of the current epicenters of the worldwide tobacco addiction epidemic.”

According to the researchers, these findings provide the basis for increased public health interventions for Asian immigrants in the United States, as well as for “quitline counseling for smokers in Asian countries at large.”

The study was published online on January 10, 2012, in the journal Tobacco Control. The title of the study is “A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation”. And, the study is authored by Hillel R. Alpert and Gregory N. Connolly (both from the Center for Global Tobacco Control, Harvard School of Public Health) and Lois Biener (Center for Survey Research, University of Massachusetts).

The objective of the study by these three researchers was to determine the effectiveness of nicotine replacement therapies (NRTS) – what is commonly called nicotine patches and other such smoking cessation devices such as gum, inhalers, and nasal sprays.

The NRTs were used, within this study, either with or without professional smoking cessation counselors.

The study used 787 adult smokers from the state of Massachusetts who had quit smoking cigarettes within the past two years.

The Massachusetts researchers found that nearly 1 out of 3 participants had relapsed with the use of NRTs.

And, they also found that the chances of relapsing were “unaffected” by whether the participants used professional counseling or not.

By most estimates and polls, the number of teens who light up is on the decline, however, with an average ranging between 12 and 19 percent lighting up by grade 12, a new campaign is aiming to speak their la nguage. University of Michigan’s Llyod Johnston says that “This is very good news for the health and longevity of these young people,” pointing out that a decline of even 1 percent can equal the prevention of thousands of deaths related to smoking.

In an effort to continue the decline, the National Cancer Institute has launched a new initiative, including a special website, and Smartphone application, all with the goal of helping teens quit smoking before they become adults.

Finding the message that will resonate with adolescents isn’t always easy, according to the National Cancer Institute’s, Erik Auguston, as he feels they are not “receptive to messages about diseases they won’t develop for decades.” According to Auguston, often times when teens try to quit, they go at it alone and fail.

Citing that anti-smoking messaging is often speaking to adults, and excludes teens, the NCI’s Smokefree Teen Program has a different approach, with messaging that empower teens, such as “We’re NOT going to tell you what to do.” Other parts of the program include materials that are targeted at teen specific triggers, including mood, social life, and peer pressure.

The NCI will also speak their language by including social media and text messaging, where teens can turn to others for support and motivational messaging. The Smokefree T-X-T program offers 24 hour encouragement, advice, tips, all through texts and social media. Once they sign up, they pick an expected quit date, and supportive text messages are also sent for up to 6 weeks, providing further support and motivation.

USA Today reports that behavioral scientist Alexander Prokhorov feels the new program is a “gigantic step in the right direction.” Prokhorov has also developed a website that utilizes messages such about smoking staining teeth, creating bad breath, and being harmful to the environment.

We would like to know what you think about the National Cancer Institute’s new initiative to communicate directly with teens? In your mind is teen smoking still a big problem, or are you more concerned about other drug use?

Cigarette smoking is the leading preventable cause of death in the US, yet despite the well-documented negative health consequences, nearly one in five women still smoke. The American College of Obstetricians and Gynecologists (The College) encourages women to abstain from smoking during the Great American Smokeout on November 17, 2011, and use that day as a starting point to quit smoking for good.

More than 71,000 women will die from lung cancer—the leading cause of cancer death among women—in 2011. Eighty percent of lung cancer deaths are attributed to smoking. Smoking shaves an average of 14.5 years off the lives of female smokers.

“In addition to a greatly increased risk of lung cancer, women smokers have a higher risk of heart attack, stroke, emphysema, bronchitis, osteoporosis, rheumatoid arthritis, cataracts, infertility, early menopause, and more than 10 different cancers (including breast and cervical cancers) than nonsmokers,” said James N. Martin, Jr, MD, president of The College.

Pregnant women who smoke put their babies at a higher risk for preterm birth, low birth weight, placental abruption, sudden infant death syndrome, poor lung function, asthma, and bronchitis. The harmful chemicals in cigarette smoke are also passed through breast milk to babies. Exposure to secondary smoke has also been shown to be harmful.

Fortunately, smokers who quit can stop or reverse the damage caused by cigarettes. In the days and months after a person stops smoking, heart rate and blood pressure drop to healthier levels, and breathing, circulation, and sense of smell and taste may improve. Heart attack risk decreases by 50% after the first year of quitting, and the risk of developing lung cancer, heart disease, and other ailments fall to nearly that of a nonsmoker in the first few years.

Pregnancy is often a great motivator to quit smoking. Data from the Centers for Disease Control and Prevention show that in 2008, roughly 20% of pregnant women who smoked quit during pregnancy. “Women who stop smoking before 15 weeks of gestation receive the biggest maternal and fetal benefit,” said Dr. Martin. “Quitting in early pregnancy minimizes the risk of having a low birth weight baby caused by smoking during pregnancy.”

It takes most smokers several tries to successfully quit, and going “cold-turkey” can be extremely difficult because of nicotine withdrawal and cravings. There are a number of smoking cessation resources available. People who use telephone counseling are twice as likely to stop smoking as those who don’t get this type of intervention. Help from a counselor can keep quitters from making many common mistakes.

Women should talk to their doctor about methods that may increase the odds of permanently quitting, such as support groups, other local smoking cessation resources, and medical therapies. For nonpregnant women, nicotine replacement products that combat cravings (patches, gums, nasal sprays, etc) or medications (such as bupropion or varenicline), in combination with nicotine replacement, can double the chances of quitting. These methods have not been sufficiently evaluated for their safety or efficacy during pregnancy, however they can sometimes be used under close medical supervision.

For more information on the Great American Smokeout and smoking cessation, click here.

Many brave smokers will put their cigarettes down for the Great American Smokeout this Thursday and maybe even longer. “Yuma has the lowest smoker rates in Arizona, and we could conclude that those who do smoke are among the most addicted, the remaining are hardest to reach, which means that the people who do smoke need a lot of help,” said Christina Borrego, spokeswoman for Arizona Bureau of Tobacco Education & Prevention.

“They need to know how to do it right,” Borrego noted.

In support of employees and community members who will quit for at least that day, Yuma Regional Medical Center will hold a special celebration in the cafeteria from 11 a.m. to 1 p.m.

Hospital officials hope to inspire and encourage smokers to quit for one day and set a long-term plan to quit permanently.

“People have probably tried to quit but weren’t successful so what we’re doing at YRMC is encouraging them to try again,” said Apryl Brand, project coordinator for the hospital’s Smoking Cessation Project.

Although the Great American Smokeout celebration at the hospital is primarily focused on employees and their families, the public is welcomed.

Starting on that day, the hospital will start a smoking cessation support group from 5-6 p.m. at YRMC Cafeteria Dining Room A. It’s open to anyone interested in receiving help to quit tobacco use. Counselors trained by the American Cancer Society will be on hand.

“Research shows that support groups can influence someone’s health care a great deal,” Brand said. “They might meet someone at the support group, someone they can call when they need to and give each other encouragement.”

The Smoking Cessation Project has been meeting for a year to decide how to roll out a program. Members decided to do it in three phases: educating patients, helping employees and starting a support group.

The patient program will roll out soon, but the group has decided to kick off the employee program and support group on the day of the Great American Smokeout.

“We’re not there to condemn or coerce, just support people in their desire to quit,” Brand said.

As a chemotherapy nurse, Brand has seen the effect smoking has had on patients and their families.

“I have seen the sadness to families whose member have been diagnosed with lung cancer and COPD (chronic obstructive pulmonary disease),” she said.

“And then there’s second-hand. It smoke shows up as asthma and pneumonia in people who use tobacco and their children. People need to do this primarily for themselves and then their families.”

Brand noted 700 Yumans are diagnosed with cancer each year and that 30 percent of all cancer deaths come from tobacco use.

Statistics also note that smoking costs about $195 billion in annual health care costs and lost productivity in the workplace.

In addition, the American Cancer Society indicates that 87 percent of lung cancers are attributed to smoking. Tobacco-related diseases affect 443 Americans and are responsible for 1 in 5 deaths in the U.S.

“Now that’s a lot of people,” Brand said. “We hope to cut down those numbers so people can live a healthy life.”

She noted the challenges in quitting. “Cigarettes have a lot of chemicals, hazardous, toxic chemicals, that are added to addict people physiologically and psychologically. People have told me it’s worse than cocaine and alcohol.”

She’s also perturbed with the rising popularity of smokeless tobacco, which allows smokers to get their nicotine fix while working in smokeless facilities.

On a recent trip to Circle K, an employee told her he regularly uses smokeless tobacco at work.

“As a nurse, I just had to tell him (about the risks). I don’t meant to preach, but I have to educate people. It’s part of my oath to do no harm and educate people.”

She also worries that “kids are probably using this and their parents don’t even know it.”

The Smoking Cessation Project hopes to educate people about the risks associated with all types of tobacco use, including cancer of the mouth, throat, bad teeth and bad gums.

The group is working closely with the Arizona Smokers’ Helpline — www.ASHline.org — which offers personal coaching, prescription medication and free over-the-counter items such as nicotine gum, lozenges and patches to help smokers quit.

In addition, most insurance plans, including the Arizona Health Care Cost Containment System (AHCCCS) covers medication.

With the hope that many smokers will quit for the Great American Smokeout and beyond, Brand offered a piece of advice to nonsmokers.

“We need to go easy on people trying to quit. Their nerves are on the line. We need to support them by understanding that they are going through a lot.”

Smokers who suffer a stroke that causes a lesion at the insular cortex are more than 5 times more likely to stop their nicotine habit than those whose stroke did not result in such a lesion, according to a new study. In addition, the researchers found that preparedness to change also influenced successful smoking cessation poststroke.

The study results were not surprising, given that research has already shown that biological and psychological factors help explain smoking cessation in patients with stroke, said the study’s lead author, Rosa Suňer Soler, PhD, from the Neurology Department, Josep Trueta Hospital, Girona, Spain.

Biologically, the insular cortex may play an important role in emotional decision-making, and in terms of psychology, smoking behavior may be explained by stages, processes, and levels of change, Dr. Suňer told Medscape Medical News. “Before you stop smoking, you must be aware that you have a problem and take the decision to stop smoking.”
The analysis included 110 patients who were smokers when they suffered an acute stroke and were admitted to a stroke unit between January 2005 and July 2007. Researchers recorded sociodemographic and other variables, as well as information on smoking, including number of cigarettes smoked per day and level of nicotine dependence. In addition, they categorized patients according to their stage of preparedness to quit smoking before the stroke: precontemplation, contemplation, preparation, action (stopped smoking for less than 6 months), or maintenance (smoke-free for at least 6 months)

From computed tomography or magnetic resonance imaging scans, investigators classified lesions affecting the insular cortex by hemisphere (right or left side) and subtype (ischemic or hemorrhagic) and measured the volume of the cerebral infarct or hemorrhage.

Patients were evaluated at 3, 6, and 12 months after the stroke. Smoking abstinence was confirmed by recording expired carbon monoxide levels. Patients also assessed their difficulty in giving up smoking and their urge to restart the habit.

Patients smoked on average 27.6 cigarettes per day, had a mean score of 6.1 points in the Fagerström Test of nicotine dependence, and had started smoking at a mean age of 17.1 years. Of the sample, 85.5% said that before the stroke, they were not considering stopping smoking in the near future.

In 24.5% of the patients, the stroke-related lesion affected the insular cortex. At discharge, 69.1% of patients indicated they had given up smoking during hospitalization, including 88.9% of the patients with an insular cortex lesion and 62.7% of those without (P = .05).

At 1 year, 70.4% of participants with insular cortex lesions had stopped compared with 30.1% of those without (P < .001).

Having a lesion at the insular cortex was associated with significantly increased odds of quitting smoking (odds ratio, 5.42; 95% confidence interval, 1.95 – 15.01; P = .001).

According to Dr. Suňer, the insular cortex may regulate the experience of conscious urges and cravings with other specific brain areas. Disruption of hypocretin transmission in the insular cortex may also help explain decreased tobacco consumption in smokers with damage to this brain region, she added.

Having the intention to stop smoking before the stroke also increased the odds of successfully quitting the habit (odds ratio, 7.29; 95% confidence interval, 1.89 – 28.07; P = .004). In addition, patients who stopped smoking had a lessened perception of difficulty in stopping smoking.

“Considering our results, we must adjust therapeutic interventions to stages of change in patients” and help them to quit if they have raised a concern about smoking, said Dr. Suňer. She suggested that physicians systematically ask patients who smoke what stage they are at in terms of quitting.

Smoking Dangers

The study also showed that only a third of the patients associated stroke with their smoking habit. “It shows how little knowledge people have of the true dangers of smoking,” said Dr. Suňer. “We explain to our acute stroke patients the risk factors and the importance of prevention, but there must also be more information campaigns among the general population.”

As well as emphasizing this lack of awareness that smoking is a stroke risk factor, the study also highlights the fact that willingness and consideration to stop the habit before the stroke help patients quit afterward, said Joseph Broderick, MD, chair of neurology, University of Cincinnati, Ohio, and a member of the American Academy of Neurology, when asked to comment.

“It is also remarkable that despite a life-changing event such as a stroke, so many patients continue to smoke,” Dr. Broderick told Medscape Medical News.

Dr. Broderick questioned whether language disruption, which often accompanies insular damage in the dominant hemisphere, plays a role in smoking cessation.

“The volume of brain injury was similar for the smokers and those who successfully stopped,” he noted. “I wonder whether language impairment per se could be associated with increased likelihood of stoppage, rather than an effect upon emotional and reward processing in the brain.”

Practice administrator Glenn Jennings, M.B.A., lost both his parents to smoking-related illnesses and his father-in-law to lung cancer, so he and his wife, family physician Carrie Burns, M.D., already were advocates of not smoking well before their Baytown, Texas, practice participated in the AAFP’s Office Champions Tobacco Cessation Pilot Project.

“What the project did was raise our level of awareness in our office, give us some tools and make us do some thinking about how we could be more effective,” said Jennings, who served as the practice’s office champion. “We became more effective as an office in identifying people who needed to quit smoking and adding new procedures.”

Jennings’ experience with the pilot is far from unique. Forty-nine participating practices were asked to review patient charts before and after the 13-month pilot, which was based largely on the AAFP’s evidence-based Ask and Act program. The percentage of patient charts with documentation of tobacco use status increased from 82.1 percent to 90.2 percent during that period, while the percentage of charts with documentation that patients were offered cessation assistance increased from 47.8 percent to 72.1 percent.

Each practice was required to name an office champion to lead the project and a physician champion to ensure that the office champion had the support of staff. The office champions were required to complete a training program, identify and implement system changes to better integrate tobacco cessation activities into daily office routines, and create a culture that encourages cessation.

According to the pilot’s final report (19-page PDF; About PDFs), practices successfully implemented 85 percent of the changes identified in their implementation plans, and 98 percent of practices expressed confidence that the changes they did make could be sustained.

Many of the changes were based on a practice toolkit provided by the AAFP that includes the following resources:
quit-smoking posters;
a smoking cessation group visits guide;
billing and coding information for smoking cessation-related services;
patient education materials;
lapel pins; and
“prescription pads” that list helpful information for patients before, during and after they quit smoking.
Jennings said Burns’ office had patient education materials and quitline cards in the waiting room and every exam room. In addition, medical assistants reviewed a stop-smoking booklet with patients and gave copies to patients who indicated they were ready to quit. The medical assistants followed up with those patients a week after their appointments to check their progress.

A quitter is defined by Merriam-Webster dictionary as one who gives up too easily. Sometimes quitting isn’t as easy as it seems. Sometimes quitting isn’t always a negative thing. Army Staff Sgt. Latasha Wade, Headquarters and Headquarters Company, 3rd Maneuver Enhancement Brigade, knows how difficult it can be to quit. Quit smoking, that is. “I smoked for 16 years,” Wade said. “I quit smoking when I met my husband. At that time he had been cigarette free for two years and he didn’t want to relapse being around a smoker. So I quit smoking five months after we started dating.”

Wade quit gradually.

“I was hiding it from my husband while we were dating and eventually I got tired of hiding it and I quit,” Wade said. “The advice I would give someone who wants to quit smoking would be to find something to motivate them to quit. Be it for health reasons, saving money or their significant other.”

Among current U.S. adult smokers, 70 percent report that they want to quit completely, and millions have attempted to quit smoking, according to the Centers for Disease Control and Prevention.

“I consistently smoked for 10 years,” Army Staff Sgt. Kevin Hoffman of the 98th Maintenance Company said. “I thought, this isn’t helping me any, and I had a new son. It was also getting expensive anyways, so I quit. It took about six months.”

His first attempt to stop smoking cold turkey failed, so he took another approach and quit gradually.

“I started smoking again for a couple weeks and I was like, ‘naw, this is just wrong.’ So then I just started slowly stopping and then one day I just threw the pack of cigarettes I had left away and I refused to smoke from then on.”

Hoffman said the reasons to quit go beyond your own health.

“You need to quit for the people that you love if not for yourself,” he said.

Here on Joint Base Elmendorf-Richardson, for Soldiers, Airmen, civilians and family members who would like to quit using tobacco products, the opportunity to quit is locally available.

A great way to start is to attend a tobacco cessation class.

“If they are ready to quit smoking today, what we normally do is invite them to attend the class,” said Janice Fulton, a health educator, at the JBER Health and Wellness Center, or HAWC. “The research over time has shown that on doing tobacco cessation in a group setting with that kind of support just increases your chances for success.

“If you’re determined to absolutely, positively quit today, we will definitely sit down and talk with you. If you want to do medications, then we’ll refer you to one of the providers involved with the tobacco cessation program who are able to prescribe the tobacco cessation medications.”

“Sometimes the folks that attend the class bring a family member like a spouse who’s going to be their support system in their cessation efforts, so they’re perfectly welcome to come to the class also and hear the information,” Fulton said.

There needs to be an environment of support for people trying to quit, according to Rebecca Kleinschmidt, a Health Educator, who also works at the HAWC.

“If the environment they’re in doesn’t support those changes, it’s really difficult for people to stay tobacco free. There are a lot of different stages in the progress of change. Action is one of those, but if people are in the preparation stage and their not quite ready to change, but they’re thinking about it, they’re very welcome here. They don’t have to be actively quitting smoking in order to participate in our class.

“We get people who really need to build their confidence before they jump into trying to reduce or quit. This is a good place to learn some skills on how to build their confidence, how to set reasonable goals and learn tricks that will make them feel more powerful in this fight against tobacco.”

It’s normal for many tobacco users to try quitting several times before succeeding, according to Fulton.

“That’s typical,” Fulton said. “Most people will tell you they’ve tried 8-11 times before they finally quit and that’s ok. They can come back as often as they need to. That’s OK.

Kleinschmidt feels there is a decrease in smoking during the winter months.

“I think people, around the holidays and New Year’s, reflect upon changes that they want in their lives,” Kleinschmidt said. “In addition, because of policy changes and environmental changes, it’s more common that people have to smoke outside and in the cold winter months here, that’s sort of a barrier to people. So when they have to smoke outside when it’s so cold, it’s sort of a reminder too: ‘Do I really want to be doing this? Is this really worth it?’”

Smokeless tobacco is also addressed at the three-day class.

“Since I’ve been involved in the smoking cessation program I’ve seen an increase in smokeless tobacco use,” Fulton said. “There are a lot of folks who use both, smoke and use smokeless tobacco, and have a tendency to use smokeless tobacco when the weather prohibits them from going outside. We’ve seen those rates increasing over time.”

The first day of class covers methods of quitting, including pharmacotherapy. A medical staff member spends time with each participant talking about what medication they want to use, if any, and making sure there are no contraindications present.

The second day covers triggers of use, normal withdrawal symptoms, both physical and psychological, and addresses any issues the participants have experienced since the first class. This day also includes nutrition counseling. The HAWC dieticians address weight gain issues after tobacco.

Day three addresses stress management and techniques for dealing with daily stressors without resorting to tobacco use and relapse prevention.

“The training is not restricted to tobacco or nutrition,” Fulton said. “We can do other things like cold weather injury prevention, infectious disease, STDs or other health related training.

The HAWC can take that training to any unit, Army or Air Force, on JBER, according to Fulton.

“Our primary objective is to provide primary prevention, which is to help people with small lifestyle changes that reduce the risk of illness or disease,” Kleinschmidt said. “We also provide secondary prevention, which is for people who weren’t diagnosed with an illness or a disease, but their symptoms can be managed with lifestyle changes. For example, the diabetic patient can be given nutritional advice and be given help on becoming more active and they can really control their insulin levels and control their symptoms ultimately with lifestyle changes.

Tobacco cessation is just one area of emphasis for the HAWC. The center can build preventive health training programs for units on nutrition, fitness, cholesterol reduction, STD awareness and other issues upon request.

“We mainly go by what people want and what people need, but the top two causes of unintentional or preventable death are tobacco use and overweight due to poor nutrition and inactivity,” Kleinschmidt said. “Those are the two major things we focus on. So many people needlessly die because of those two issues that are lifestyle based.”