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Pay-for-Performance Gets Doctors to Push Smoking Cessation

Paying providers of health care to refer patients for help in quitting smoking really makes a difference.

A study, appearing in the current issue of the Archives of Internal Medicine, looked at programs that tie physician pay to the quality of care. The key measure was clinics’ referrals of patients in Minnesota to a tobacco quit line. Researchers compared clinics that were paid bonuses for making such referrals — $5,000 for 50 referrals and $25 for each referral beyond the initial 50 — to clinics that didn’t have a financial incentive.

It turned out that the clinics that were in the pay-for-performance program made 1,483 referrals to the quit line, an average of 11.4% of their patients who were smokers. Those that didn’t have the chance to earn extra money made 441 referrals, an average of 4.2% of their smokers.

The researchers, led by Lawrence An of the University of Minnesota, noted some important factors for success beyond cold cash. For one, Minnesota health plans collaborated to make the referral process easy for the clinics. The clinics were also rewarded regardless of what health plan their patients belonged to, meaning that they could make the same recommendation to all smokers.

Blue Cross and Blue Shield of Minnesota, which funded the study and payments to the clinics with money from a tobacco settlement, decided along with a number of other Minnesota health plans to continue with the program around smoking cessation, albeit with lower financial awards, a spokeswoman tells us.

One important note is that Smoke Away, though they care about you using their product, also would suggest doing whatever you can in order to quit smoking. For more information, log onto the Smoke Away support site to talk with people who have quit with our product.

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Women who smoke have heart attacks nearly 14 years earlier than women who don’t smoke, Norwegian doctors reported in a study presented to the European Society of Cardiology. For men, the gap is not so dramatic; male smokers have heart attacks about six years earlier than men who don’t smoke.

“This is not a minor difference,” said Dr. Silvia Priori, a cardiologist at the Scientific Institute in Pavia, Italy. “Women need to realize they are losing much more than men when they smoke,” she said. Priori was not connected to the research.

Dr. Morten Grundtvig and colleagues from the Innlandet Hospital Trust in Lillehammer, Norway, based their study on data from 1,784 patients admitted for a first heart attack at a hospital in Lillehammer.

Their study found that the men on average had their first heart attack at age 72 if they didn’t smoke, and at 64 if they did.

Women in the study had their first heart attack at age 81 if they didn’t smoke, and at age 66 if they did.

After adjusting for other heart risk factors like blood pressure, cholesterol and diabetes, researchers found that the difference for women was about 14 years and for men, about six years.

Previous studies looking at a possible gender difference have been inconclusive.

Doctors have long suspected that female hormones protect women against heart disease. Estrogen is thought to raise the levels of good cholesterol as well as enabling blood vessel walls to relax more easily, thus lowering the chances of a blockage.

Grundtvig said that smoking might make women go through menopause earlier, leaving them less protected against a heart attack. With rising rates of smoking in women – compared with falling rates in men – Grundtvig said that doctors expect to see increased heart disease in women.

“Smoking might erase the natural advantage that women have,” said Dr. Robert Harrington, a professor of medicine at Duke University and spokesman for the American College of Cardiology.

Doctors aren’t yet sure if other cardiac risk factors like cholesterol and obesity also affect women differently.

“The difference in how smoking affects women and men is profound,” Harrington said. “Unless women don’t smoke or quit, they risk ending up with the same terrible diseases as men, only at a much earlier age.”

The bottom line is this, smoking kills and you need to quit smoking. What are you going to do about it? Whether you use Smoke Away or not, is not the point. You have to quit smoking!

We spend an inordinate amount of time telling people, no, pleading with people to quit smoking either with the help of Smoke Away or without. The point being that is important for smokers to realize that quitting smoking is the name of the game because it kills you and it hurts others. With that in mind here are 11 thoughts and facts about second hand smoke you probably did not know,

  • Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of cancer in humans (Group A carcinogen).
  • Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.
  • Secondhand smoke causes approximately 3,400 lung cancer deaths and 22,700-69,600 heart disease deaths in adult nonsmokers in the United States each year.
  • Nonsmokers exposed to secondhand smoke at work are at increased risk for adverse health effects. Levels of secondhand smoke in restaurants and bars were found to be 2 to 5 times higher than in residences with smokers and 2 to 6 times higher than in office workplaces.
  • Since 1999, 70 percent of the U.S. workforce worked under a smoke-free policy, ranging from 83.9 percent in Utah to 48.7 percent in Nevada.  Workplace productivity was increased and absenteeism was decreased among former smokers compared with current smokers.
  • Eighteen states – Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, Washington and Vermont – as well as the District of Columbia prohibit smoking in almost all public places and workplaces, including restaurants and bars. Montana and Utah prohibit smoking in most public places and workplaces, including restaurants; bars will go smokefree in 2009. New Hampshire prohibits smoking in some public places, including all restaurants and bars. Four states – Florida, Idaho, Louisiana and Nevada – prohibit smoking in most public places and workplaces, including restaurants, but exempt stand-alone bars. Fifteen states partially or totally prevent (preempt) local communities from passing smokefree air ordinances stronger than the statewide law. Iowa, Nebraska and Oregon have passed legislation prohibiting smoking in almost all public places and workplaces, including restaurants and bars, but the laws have not taken effect yet.
  • Secondhand smoke is especially harmful to young children. Secondhand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in between 7,500 and 15,000 hospitalizations each year, and causes 430 sudden infant death syndrome (SIDS) deaths in the United States annually.
  • Secondhand smoke exposure may cause buildup of fluid in the middle ear, resulting in 790,000 physician office visits per year.  Secondhand smoke can also aggravate symptoms in 400,000 to 1,000,000 children with asthma.
  • In the United States, 21 million, or 35 percent of, children live in homes where residents or visitors smoke in the home on a regular basis. Approximately 50-75 percent of children in the United States have detectable levels of cotinine, the breakdown product of nicotine in the blood.
  • Research indicates that private research conducted by cigarette company Philip Morris in the 1980s showed that secondhand smoke was highly toxic, yet the company suppressed the finding during the next two decades.
  • The current Surgeon General’s Report concluded that scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke. Short exposures to secondhand smoke can cause blood platelets to become stickier, damage the lining of blood vessels, decrease coronary flow velocity reserves, and reduce heart rate variability, potentially increasing the risk of heart attack.
  • This is tough to watch but it cannot help but drive the point home that if you continue to smoke, you will end up like the person in this video. Smoke Away as it has maintained from day one of this blog, does not care how you quit, whether it’s with our product or not, we just want you to quit.

    Recently we have been getting a lot of calls and emails on just how to use Smoke Away and how it works.

    When you start the program, on your first night before you go to bed, you will take the recommended dosage of Formula 1 with some food or milk and get a good nights rest. When you awake you will repeat your dosage of Formula 1 with breakfast, lunch, and dinner. You will continue this regimen for three days. On the fourth day you will assess your progress. If you are feeling good, try to decrease the dosage by one capsule. If you are not feeling so good, then do not reduce your capsule intake.

    On the fifth and sixth days, if you are feeling pretty good, then reduce your capsule intake again, what this means is your body is slowly becoming adjusted to your new found system. Do not forget about the support and maintenance products. At this point you do not want to completely stop taking your dosages, in other words, do not reduce your dosage below one capsule three times a day.

    If you need temporary relief, and chances are you will, simply place three tablets of Smoke Away® Homeopathic Medicine under your tongue as soon as you need them. Take the Formula 2 maintenance formulas as directed. For more information on what else comes with your order, go to the Smoke Away products page for complete directions for usage.

    You should listen to the CD included in each kit sold on this site for at least 14 days. Even after that, continue to use as needed. The audio CD was created to give you encouragement and support, to help get you through the tough times. If you need more help, do not hesitate to call or email us, or even respond to this blog post. For more information you can also logo onto the Smoke Away support site as well.

    Think you know what’s up when it comes to cigarette smoking and its effects? Better think again!

    1. Myth: Nicotine causes cancer.

    Fact: Nicotine is not a carcinogen. However, there are 4,000 known chemicals in cigarettes, and more than 60 of them are carcinogens.

    2. Myth: Smoking is just a bad habit that you can stop at any time.

    Fact: There is a habit component to smoking, but there are also biological changes to the brain that create the addiction.

    Nicotinic acetylcholine receptors, which occur naturally in the brain, are activated when nicotine is consumed. The activation period is followed by a desensitized state in which the receptors become unresponsive. As more nicotine is consumed, and the number of unresponsive receptors increases, the smoker experiences less pleasure from each cigarette. This makes it necessary to increase the number of cigarettes smoked to achieve the desired level of pleasure.

    3. Myth: Low nicotine cigarettes are safer.

    Fact: The blend of tobacco in a low nicotine cigarette is exactly the same as in a regular cigarette. The reason cigarette companies can call them “low” has to do with the way nicotine levels are tested.

    As the regulator of cigarettes, the Federal Trade Commission tests for nicotine and tar levels with machines that draw air through a cigarette in two-second puffs, repeated once per minute, until the cigarette is burned to the filter. The smoke that is generated in this manner tests low in nicotine.

    However, this test doesn’t approximate the way people really smoke. Smokers will compensate for the lower yield of nicotine by puffing more, or taking longer drags. Consequently, the smoker will actually inhale the same or more nicotine and tar, even though it is considered a low-nicotine cigarette.

    Another reason the machine tests are considered inaccurate is cigarette manufacturers put ventilation holes in the filters. These holes allow more air to be drawn in, which dilutes the smoke going into the machine, making it seem as though the cigarette being tested contains less tar and nicotine. But when people actually smoke these cigarettes, their fingers generally cover the holes in the filters.

    4. Myth: Medicinal nicotine found in nicotine patches and nicotine gum is just as addictive as smoking.

    Fact: The delivery system used to bring nicotine to the brain is what determines the level of addictiveness. Medicinal nicotine is released slowly through the venous system. The brain receives only small quantities, reducing the potential for addiction.

    Inhaling brings nicotine to the brain extremely fast, which is why it is so addictive.

    “Inhaling gets nicotine to the brain within five heartbeats,” Hurt said.

    5. Myth: A smoker who tries to quit without assistance can maintain abstinence over the long term.

    Fact: Chances of long-term abstinence for smokers who try to go it alone are less than 5 percent. With assistance, the smoker’s chance of staying away from cigarettes increases to 30 to 35 percent.

    Smoke Away cannot emphasize enough how important it is to quit smoking either with our help or without. It’s your choice, make it today!

     

    A key mechanism by which smoking triggers genetic changes that cause lung cancer has been unravelled.

    Researchers have shown exposure to cigarette smoke slows production of a protein called FANCD2 in lung cells.

    This protein plays a key role in repairing damage to DNA, and causing faulty cells to commit suicide before they go on to become cancerous.

    The study, led by Oregon Health and Science University, appears in the British Journal of Cancer.

    LUNG CANCER
    Most common cancer in the world with 1.3 million people diagnosed every year
    Second most common form of cancer in the UK after breast cancer
    Over 38,300 new cases, and more than 33,000 deaths in the UK each year
    Smoking responsible for 90% of cases in the UK

    It raises hopes of improved treatments for the disease.

    Lead researcher Dr Laura Hays said: “These findings show the important role FANCD2 plays in protecting lung cells against cigarette smoke and may explain why cigarette smoke is so toxic to these cells.”

    The researchers suspect other proteins also play a role in fixing DNA and weeding out defective cells.

    However, their work showed that cells with very high levels of FANCD2 were resistant to the toxic effects of smoke – suggesting this protein is key.

    Artificial windpipe

    The researchers created an artificial windpipe in the lab to replicate the environment of a smoker’s lung.

    They then studied the effects of cigarette smoke on different proteins in cells and found that FANCD2 levels were low enough to allow DNA damage.

    FANCD2 is part of a family of proteins involved in an inherited condition called Fanconi anaemia.

    People with the condition are more likely to develop cancers at a young age and have low levels of these proteins.

    Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “This interesting piece of science adds to our understanding of why smoking is so deadly.

    “Smoking is the single biggest preventable cause of cancer and causes nine out of ten cases of lung cancer.

    “But the good news is that quitting works – after five years without smoking your risk of a heart attack will have fallen to half that of a smoker.

    “And after ten years your risk of lung cancer will have halved too.”

    So quit smoking! Why not quit smoking? What are the triggers that are causing you to continue to smoke? If we can ID those triggers, then the makers of Smoke Away believe that you’re well on your way to heading down the path of a successful quit. Check in with our users over at Smoke Away Support for even more tips and advice on how to quit smoking, whether you use our product or not. Just quit.

    Childhood cancer survivors who are most likely to develop tumours as adults continue to endanger their health by smoking, research suggests.

    A University of Birmingham(England) team found the highest smoking rates among patients whose type of treatment put them at greater risk later in life.

    Cancer campaigners have expressed concern that the survivors are exposing themselves to “avoidable” dangers.

    The researchers say more education is needed about the risks of smoking.

    We are very concerned that people are exposing themselves to a further completely avoidable risk for developing another cancer
    Professor Mike Hawkins
    Centre for Childhoold Cancer Survivor Studies

    The study, in the Journal of the National Cancer Institute, pinpoints three types of childhood cancer – Hodgkin’s lymphoma, soft tissue sarcomas and Wilms’ tumour – which are known to carry an increased risk of further tumours due to the form of radiotherapy and chemotherapy used to treat them.

    The researchers found that smoking was most common among people who had been treated for these cancers when children – nearly a quarter of the 10,000 former cancer sufferers surveyed.

    Overall, childhood cancer survivors are around half as likely as the general population to be regular smokers.

    Intervention call

    Researcher Dr Clare Frobisher, based at Birmingham’s Centre for Childhoold Cancer Survivor Studies, said: “It is worrying that those survivors who are most at risk of developing a new cancer as a result of their treatment, are more likely to be smokers than other childhood cancer survivors.

    INCREASED RISK
    A study of 16,541 survivors of childhood cancer found they were 6.2 times more likely to develop a second primary tumour than the general population
    After 25 years 4.2% of survivors had developed a second primary cancer
    The rate of second primary tumours among survivors of Hodgkin’s lymphoma was 9.2 times that of the general population, for Wilms’ tumour it was 6.9 times, and for soft tissue sarcoma it was 4.3 times
    Figures from the Centre for Childhood Cancer Survivor Studies

    “It is clear that more work needs to be done to make sure they are aware of their increased risk of a second cancer and other related health problems if they smoke.”

    The majority of smokers in the study took up smoking before the age of 20.

    Dr Frobisher said: “We think intervention programmes should be put in place early, targeting cancer survivors as young as 12.”

    Professor Mike Hawkins, director of the Centre for Childhoold Cancer Survivor Studies, said: “We are very concerned that people who have been exposed to radiation and chemotherapy drugs during treatment for cancer as a child are exposing themselves to a further completely avoidable risk for developing another cancer and other smoking-related diseases in later life.”

    Elspeth Lee, of the charity Cancer Research UK, said it was crucial that young cancer survivors were given all the necessary information and support to discourage tem for taking up smoking.

    Thanks to the development of better treatments for childhood cancer, almost eight in ten children now survive a diagnosis of the disease.

    It is estimated that there are more than 26,000 survivors of childhood cancer alive in Britain today.

    It is estimated that in the UK around 11 million adults – more than one in five of the population – smoke.

    Smoking is the single biggest preventable cause of cancer in the UK. It is responsible for nearly nine out of ten cases of lung cancer in the UK. With that being said, The makers of Smoke Away would like to stress that they want you to quit smoking, it does not matter how you do it just quit, whether its with our product or someone else’s.

     

    According to the Centers for Disease Control and Prevention (CDC), 44.5 million US adults were current smokers in 2006 (the most recent year for which numbers are available). This is 20.8% of all adults (23.9% of men, 18.0% of women) — more than 1 out of 5 people.

    When broken down by race/ethnicity, the numbers were as follows:

    Whites 21.9%
    African Americans 23.0%
    Hispanics 15.2%
    American Indians/Alaska Natives 32.4%
    Asian Americans 10.4%

    The numbers were higher in younger age groups. In 2006, CDC reported almost 24% of those 18 to 44 years old were current smokers, compared to 10.2% in those aged 65 or older.

    Nationwide, 22.3% of high school students and 8.1% of middle school students were smoking in 2004. More White and Hispanic students smoked cigarettes.  Can anyone tell me why the highest percentages would among American Indians and native Alaskans?

    Listen, as long as you’re sitting there wondering who smokes, why don’t you, if you smoke check out Smoke Away, or if you don’t but have a friend or loved one that smokes, steer them towards Smoke Away? What do you have to lose? Besides that craving to smoke?

    Tobacco is the leading preventable cause of death in the world, and yet it causes one in ten deaths among adults. In 2005, tobacco caused 5.4 million deaths, or an average of one death every six seconds. At the current rate, the death toll is projected to reach more than eight million annually by 2030 and a total of up to one billion deaths in the 21st century.
    Last month the World Health Organisation (WHO) announced World No Tobacco Day to highlight the dangers of cigarettes and their effects on younger generations. The WHO also revealed shocking statistics, such as tobacco kills 50 per cent of its users. This means, of the 1.3 billion smokers alive today, 650 million will be killed by tobacco.

    1. Why is smoking addictive?
    Nicotine is a psychoactive drug, which the body accepts like a “normal” messenger substance stimulating the electrical activity of the brain. It has calming effects, especially at times of stress. Smoking is a physical addiction, which is almost as strong as that of heroin, since nicotine also induces structural changes in the brain of smokers. When nicotine is suddenly withdrawn, normal functions in the brain and other parts of the body are disturbed resulting in withdrawal symptoms.
    2. What damage does smoking do to the body?
    Smoking causes many premature deaths from diseases that are largely preventable:Heart disease: Smoking is responsible for 30 per cent of all heart attacks and cardiovascular deaths. Cancer: At least 30 per cent of all cancer deaths are caused by smoking. Lung disease: More than 80 per cent of all lung problems, mainly chronic bronchitis and emphysema can be avoided by not smoking. Peripheral artery disease: Smoking is the main cause of peripheral artery occlusion, and this is extremely dangerous when associated with diabetes.
    Premature ageing of the skin: It also causes premature wrinkling of the skin of the face. On average, smokers look five years older than non-smokers of the same age.

    Others: It also contributes to stomach ulcers and osteoporosis, reduces female fertility and causes premature births and infant death.

    3. Why can smoking be even worse for men?
    Younger and middle-aged men are at a higher risk for premature arteriosclerosis and heart attacks than women of the same age. Therefore, male gender may be considered a risk factor in itself. Smoking does not just add on some risk, it multiplies the chances of developing heart disease.
    As smoking causes damage to blood vessels, it also impairs erections in middle-aged and older men and may affect the quality of their sperm. It can have the effect of sedating sperm and can impair their mobility.

    4. What are the best ways to quit smoking?
    You mean other than Smoke Away? All kidding aside, Self-help is, in fact, the only way to quit smoking. Others can give advice and support, but in the end it is up to the individual. To succeed you must have sufficient motivation to carry yourself through the task ahead. At least two-thirds of smokers are likely to find it difficult to give up smoking. However, it is not their fault that they find it difficult. They do not continue smoking because they are weak-willed or irresponsible, but because they are addicted. There are various motivations for trying to quit smoking:
    The most important is concern for health and well-being. The onset of minor ailments, such as coughs, sore throats, breathlessness, indigestion, and feeling generally less well and less fit, are early signs that the body has had enough.
    Some smokers come to resent the feeling of being controlled by their need to smoke, and are motivated to stop by their desire to regain control and self-mastery.
    To help make up your mind about stopping, make a list of all the reasons that are important for you. Make a similar list of all the positive benefits of smoking you will miss and any withdrawal difficulties you anticipate when you stop. Weigh up the lists and tell yourself that any suffering you may endure will be temporary and may last only a few weeks
    You must be prepared to work hard at stopping smoking. Here are the steps to take:
    Plan to stop on a particular day. Choose a time when you are not under too much pressure from other tasks and when you can avoid situations that you know will make it more difficult. Don’t put it off for too long unless you have to. Make plans to keep away from smokers and other tempting situations after you have stopped.
    Plan to stop smoking completely on your target day. Cutting down gradually is less effective. Telling too many people that you are going to stop is not always helpful. To be constantly asked how you are getting along can bring the subject to your mind just when you are learning not to think about it
    Prepare on a small card a list of your reasons for stopping. You may need to have this in your pocket or close at hand if things get difficult and your motivation falters after you have stopped. On the night before your target day, make sure all cigarettes, ashtrays and lighters are removed from your home. Of course the makers of Smoke Away would love for you to try our product, but we realize that sometimes you have to go through hell with a lot of different methods before you come to see us. That’s ok. Just as long as you quit in the end!

    5. How can quitting smoking be made easier?
    There is no drug for smoking that can cure your problem for you without you having to make any effort. However, there are some treatments that you can use to aid your self-help:
    Counseling and support, either in single sessions or in groups. It is also important that partners do not smoke or stop smoking at the same time. Otherwise, the smoker gets “re-infected” time and again.
    Hypnosis and acupuncture may help some people, but not everyone is susceptible to these techniques.
    Nicotine substitution like patches or chewing gum can help overcoming the habit of lighting a cigarette, and the dose can be tapered down over time.
    No one is born as a smoker. In all drug addictions, psychosocial factors determine the initial exposures. Addiction may subsequently develop if the drug has effects that people like or find rewarding. Younger people may think that it is “cool” to smoke because it makes them appear more “grown-up”. Ultimately, it is up to you to finally decide to quit smoking, on your terms.

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