Apparently Honda has not gotten the message that we have an obesity epidemic, and that too much sitting is one of the major contributors to poor health in industrialized countries. This week, Honda introduced the Uni-Cub, an electric personal mobility device. While products like this can be a wonderful boon for people with disabilities, it’s very disturbing that the market for the Uni-Cub seems to be primarily the able-bodied – those of us who really need to be doing less sitting, not more. The design of the device is even reminiscent of the animated movie “WALL-E”, where humans have been in space so long they are unable to walk and are ferried around in robotic chairs – and everyone is severely obese as a result.

I’m a huge fan of the concept of “SPA” – Spontaneous Physical Activity. SPA is any movement you get during your day that is not formal exercise, including fidgeting, pacing, and walking to your co-worker’s office or cube. Studies have shown that, depending on body size, people can burn an extra 500-700 calories a day just from increasing SPA. This could equate to losing several pounds a month, without changing anything else in your lifestyle, which makes it a great “easy win”.

Apart from the calorie-burning benefits of SPA, getting up and moving throughout your day is also important to lower your risk for chronic disease. Research has clearly established that too much sitting – even in people who get regular exercise – is an independent contributor to chronic disease risk. In Harvard’s large, longitudinal Nurses’ Health Study, every additional 2 hours of sitting at work was associated with a 5% increase in risk for obesity and a 7% increase in risk for diabetes (Hu et al., JAMA. 2003;289:1785-1791). Similarly, in a British study, sitting at work >3 hr/d was associated with a significant decrease in “good” HDL-cholesterol and a significant increase in risk of pre-diabetes in men (Pinto Pereira et al. PLoS ONE 2012; 7: e31132).

In striking contrast to Honda’s latest offering to help us sit more at work, a few years ago Dr. James Levine at the Mayo Clinic started promoting the “treadmill desk”. One of the leading researchers on the benefits of SPA, Dr. Levine points out that the human body is meant to move, and to spend most of the day moving. Our modern environment, where almost everything involves being sedentary, is totally mismatched to our genes and biology. The treadmill desk is one solution for people who have desk jobs to avoid the inevitable health problems that come from too much sitting.

If you don’t want to go that far, it’s easy to incorporate other ways to increase SPA throughout your day. I don’t have a treadmill desk, but I do have a standing workstation so that when I’m at my computer working, I am standing rather than sitting. I also make a conscious effort to stand up and pace whenever I am on a phone call. Every 30 minutes, if I’ve been sitting continuously, I try to at least stand up briefly and stretch. And of course wearing a pedometer and striving to get 10,000 steps a day is a good way to ensure that you are not spending too much time sitting.

While I celebrate the development of convenient, affordable personal mobility devices for individuals who are truly mobility impaired, if you are blessed with healthy legs I hope you will stand up (pun intended!) and “just say no” to devices like the Uni-Cub.

Dr. Jennifer Lovejoy is Vice President of Clinical Development & Support at Alere Wellbeing and past president of the Obesity Society. Dr. Lovejoy’s clinical research program has been funded by grants from the National Institutes of Health, the American Diabetes Association, the U.S. Department of Agriculture, and NASA. Read other blog posts by Jennifer Lovejoy.

Erin Thompson Curlett, Senior Content & Social Media Marketing Manager

We're happy to announce that on May 15 and May 22, Alere Wellbeing will host the complimentary live webinar, Deconstructing DASH: How Your Workforce Would Benefit from America's #1 Rated Diet. Obesity expert, Dr. Robert F. Kushner, Clinical Director of the Northwestern Comprehensive Center on Obesity, will provide an overview of DASH, compare it with other top-rated diets, and offer insight into the evidence behind its design. He will also discuss the keys to sustainable weight loss and best practices for employers selecting a worksite weight loss plan.

Webinar Description

With so many diets on the market to choose from, how do you choose the diet that is best for your employees and will deliver substantial, sustainable results that will improve their health and help lower your healthcare costs?

In January, U.S. News & World Report released its list of Best Diets for 2012. For the second year in a row, the government-endorsed Dietary Approaches to Stop Hypertension (DASH) Diet, came in first.

As a human resource professional, you know you would be hard pressed to find an adult at your organization who doesn't want to lose weight, improve their health, and increase energy. It's likely many of your employees have tried to lose weight on a diet, and after many failed attempts are at an impasse. It's time to find a sustainable solution.

Join us for our latest Clear Insights webinar , Deconstructing DASH: How Your Workforce Would Benefit from America's #1 Rated Diet, presented by Robert F. Kushner, MD, Clinical Director of the Northwestern Comprehensive Center on Obesity and one of the 22 expert panelists who rated the Best Diets for 2012. Dr. Kushner will provide an overview of DASH, compare it to other top-ranked diets, and offer insights into the evidence behind their design. Dr. Kushner will also discuss the keys to sustainable weight loss and best practices for employers to choose an effective worksite weight loss plan.

Dr. Robert Kushner

Dr. Kushner’s approach to sustainable weight loss includes improving diet, increasing physical activity, and engaging in personalized behavior change, as well as pharmacotherapy and bariatric surgery when appropriate. Dr. Kushner formerly served as president of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), and the American Board of Physician Nutrition Specialists (ABPNS). He is currently the first president of the new American Board of Obes

ity Medicine (ABOM) and a board member of the Obesity Action Coalition (OAC). He is on the editorial board for Obesity and the Journal of the American Dietetic Association.

Visit Clear Insights to register today.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Weight Talk®, an evidence-based personal coaching program built on the DASH Diet and designed to achieve measurable, sustainable weight loss.

Ken Wassum, Associate Director, Clinical Development & Support

Everyone in the field of tobacco dependence treatment can agree on one thing. There is no tobacco product or nicotine delivery device more dangerous than the traditional combustible cigarette. However, that is where the common ground seems to end when the discussion turns to the electronic cigarette.  And when those outside the field of tobacco dependence treatment weigh in the discussion gets even livelier! I know of no other device that has generated such strong feelings as the e-cigarette.

For those of you who may not be familiar with the e-cig it is a device that looks a lot like a cigarette. It has a cartridge with a nicotine solution, a battery, and a heating element. When the user takes a “drag” on it the battery vaporizes a small amount of the solution which the user takes into their mouth or lungs. It produces a vapor, not smoke.

A recent PubMed search using the term “electronic cigarette” yielded about 60 articles that have been published in scientific and health journals since 2007. To be very candid, I have not read all of these articles, just as I have not read every article on FDA-approved cessation medications that have been published in the past 5 years. But I have read a lot of them.

Over the past 3 years or so I have posted a number of blogs about the e-cigarette as I have been very intrigued by the device. I have worked in the field of tobacco dependence treatment for about 20 years and am committed to evidence-based treatment. I am also a former pack-a-day plus smoker who began smoking at age 16 and quit at age 41. So I know what it is to be a smoker and I have my own experience about what it took to quit. My father died of lung cancer, so like most Americans I have lost a family member to smoking. But, I also have a sound understanding of the 8700+ peer reviewed studies that provide the scientific evidence for what is proven to be effective in helping smokers quit.

Two primary things have to happen for a medication or drug delivery device (i.e. e-cigarette, nicotine patch, nicotine gum, etc.) to be an approved cessation tool. First, it has to be shown to be “effective” in helping smokers quit. To do this large studies lasting two or three years are conducted. Smokers are randomly assigned to a medication group or a “control” group who gets a placebo, but the smokers do not know which they have. For a drug to be “effective” it has to generate a statistically significant higher number of quitters using the medication than those who did not use the medication.  More than one study is required to demonstrate effectiveness.

Secondly, a medication or drug delivery device has to be proven to be “safe”. A drug or device that is not safe means that it has demonstrated harmful effects that outweigh the benefits or that demonstrate a significant risk to those who use it.
So where does this leave us with the e-cigarette when it comes to effectiveness and safety? To date a few studies have suggested that the e-cigarette might be effective in helping smokers quit. Studies by Eissenberg and others have shown the e-cig to “expose users to measureable levels of nicotine….and suppress nicotine withdrawal symptoms.” Dawkins produced similar results with a small group of smokers. Caponnetto and colleagues conducted a study where 3 smokers quit and another study where 40 smokers not interested in quitting “substantially reduced cigarette consumption”. All this is great, but the numbers are just too small to conclusively demonstrate that the device is “effective”. It looks promising, but needs more study that would randomize a much larger number of smokers to e-cigs and “placebo” e-cigs.

With regard to “safety” we have no data at all.  Analysis of a small number of e-cigs has turned up occasional toxins, albeit at very low levels. However no systematic safety analysis has been done. This is because the manufacturers of e-cigarettes made a conscious decision to not submit the product for approval as a cessation device, but as an alternative type of “cigarette”. For e-cigarettes to be considered a nicotine delivery cessation device (or medication), they have to go through the rigor of these trials. The risks are too great to use them as a cessation device on a large scale only to find that they cause long-term health problems. Safety has to be proved first.

At Alere Wellbeing we train our Quit Coaches not to “demonize” the e-cigarette. No one who comes to us using them is told that they must stop using the e-cigarette or that e-cigarettes are anywhere near as dangerous as a traditional cigarette. The same holds true for those who ask about using the e-cigarette to quit. Instead they are told that we don’t know whether they are truly effective in helping smokers quit and that we don’t know if they are safe. As such, the e-cigarette does not meet the criteria for an evidence-based method for helping smokers quit.

I personally think the electronic cigarette has great potential to be a useful tool to help smokers quit. But at this point it is just potential – we need more data to be sure we would not be doing harm in advising e-cigarette use. Until then we will recommend smokers use FDA-approved nicotine delivery medications.

Ken Wassum has been treating tobacco users for over 19 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Ken Wassum, Associate Director, Clinical Development & Support

For the past two or three decades, some brilliant people in the US and abroad have made a priority of reducing disease and death – and those committed to reducing the toll of tobacco continue to work tirelessly and with tremendous optimism. Having just returned from the 15th World Conference on Tobacco or Health in Singapore, I am encouraged by the progress made in some areas of tobacco control, yet very discouraged by the lack of progress in others.

Over the course of the next several weeks I will be posting a series of blog posts that address many of these issues and more in greater detail.

To get started, let’s look at some of the accomplishments we’ve made over the past couple decades:

• 174 countries have signed and ratified the World Health Organization’s Framework Convention on Tobacco Control that addresses the tobacco epidemic from both policy and treatment perspectives.
• More countries than ever provide access to toll-free tobacco Quitlines, including North America where all 50 states, 3 US territories, and 12 Canadian provinces have such services. Quitlines exist throughout Europe and in many parts of Asia and Oceania.
• Many countries with National Health Services, such as the UK, have expanded community-based clinical treatment for tobacco use.
• Graphic warnings on cigarette packs have been adopted by many countries around the world. In some countries “plain packaging” is on the horizon.
• Many countries have raised taxes on tobacco products, especially cigarettes, resulting in lower tobacco use prevalence.
• The US FDA has been given unprecedented authority to regulate tobacco products.
• Tobacco use prevalence in the US has declined from about 27% in 1991 to about 19% in 2010.

Yet, should you think these accomplishments mean we are “winning” the battle, here are some sobering, even chilling, facts:

• In 2011, tobacco use killed almost 6 million people worldwide.
• Global tobacco-related deaths have nearly tripled in the past decade.  The number of annual deaths in the US from tobacco use (443,000) has remained unchanged for the past couple decades.
• Each day, nearly 4,000 kids in the US try their first cigarette and an additional 1,000 kids under 18 years of age become new regular, daily smokers. That’s nearly 400,000 new underage daily smokers in this country each year.
• If trends continue, 1 billion people around the world will die from tobacco use and exposure during the 21st century. To put that mind-boggling number in perspective, that’s 1 person every 6 seconds.
• Tobacco tax revenues in the US have reached unprecedented levels at the state level and the national level, yet tobacco control remains shamefully under-funded and under-resourced. Margaret Chan, Director General of the World Health Organization, sums it up succinctly when she states, “Measures to tackle the epidemic remain seriously under-funded.”
• Cessation services to help tobacco users quit remains the “orphan” of tobacco control and fails to be resourced to its full potential. It has become an issue of social justice.
• The tobacco industry in their multi-national capacity have increased their efforts to both confound and delay tobacco control in the US and have increased efforts to sell their deadly products abroad, targeting women and children in developing countries. They continue to challenge the FDA in implementation of evidence-based initiatives by the Center for Tobacco Products.
• According to the March 2012 Surgeon General’s Report, one in five high school students in the US smokes, and over half of these youths also use a smokeless tobacco product. Nearly 90% of youths start smoking before the age of 18.

We are clearly at a crossroads. Smoke-free laws have taken effect across the US, and the public has the mistaken perception that the battle against tobacco use has been won. Yet those dying of tobacco-related diseases continue to die behind closed doors, away from public view. Dying from smoking is rarely quick and never painless. Many governments around the world, including the US, continue to underfund proven strategies to reduce disease and death caused by tobacco products and under-prioritize the enormity of the tobacco epidemic, especially among our children and our most vulnerable populations.

There is a lot to discuss here, so please stay tuned.

Ken Wassum has been treating tobacco users for over 19 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Jennifer Lovejoy, PhD, Vice President, Clinical Development & Support

Employers are increasingly realizing the benefits of covering bariatric surgery for eligible employees through their health plans. Two new clinical trials, which have confirmed the pronounced benefits of bariatric surgery in improving metabolic control in patients with Type 2 diabetes, will likely provide increasing rationale for doing so, as the overall cost effectiveness is clear in spite of the high surgical costs.

The association between obesity and Type 2 diabetes is well known. Over 80% of individuals diagnosed with Type 2 diabetes (formerly called “adult onset diabetes”) are overweight or obese. Obesity causes insulin resistance, a condition where the hormone insulin is ineffective at moving sugar from the bloodstream into the cells. In genetically susceptible individuals, insulin resistance combined with too little insulin secretion leads to diabetes. Obesity also increases whole-body inflammation, which is a primary cause of many of the complications of diabetes, including cardiovascular disease, nerve damage and kidney disease.

Many studies have shown that weight loss is very beneficial for people with Type 2 diabetes. Weight loss of as little as 5-10% through lifestyle modification improves control of blood sugar and reduces other risk factors in people with Type 2 diabetes. One of the largest studies to look at behavioral weight loss in Type 2 diabetes is the LookAHEAD trial. In this study (which is still on-going), participants who received the intensive lifestyle intervention maintained a 6% weight loss at 4 years and had significant reductions in their hemoglobin A1c (HbA1c) levels (a marker of blood sugar control). They also had sustained reductions in blood pressure and triglycerides.

Bariatric surgery produces much more dramatic weight loss and, therefore, much greater benefits in terms of diabetes control. The two new studies demonstrating this effect were both published in the New England Journal of Medicine and report very similar findings. In an Italian study, 75% - 95% of bariatric surgery patients had their diabetes go into complete remission off medication compared with none who received conventional medical therapy. Average starting BMI was 45 kg/m2 and this dropped to 29 kg/m2 2 years post-surgery. The U.S. study, STAMPEDE, was interesting in that it looked at patients with a lower range of starting BMI: 27-43 kg/m2. U.S. guidelines recommend bariatric surgery for BMI of 35 and above with obesity-related comorbidities, but a third of patients enrolled in STAMPEDE had BMI<35. Whether because of the lower BMIs or because it was shorter than the Italian study, STAMPEDE found that only 42% of patients had normalized their HbA1c levels by 1 year post surgery. Weight losses were ~55-65 pounds. Type of surgery did not make a significant difference in the STAMPEDE trial, but in the Italian study, patients who had the biliopancreatic-diversion procedure saw better results than those who had gastric bypass.

Previous studies have found long-term benefits of bariatric surgery on diabetes. One of the largest and longest studies of bariatric surgery is the Swedish Obesity Study (SOS). To date, SOS has 20-year follow up date on over 2000 patients who had bariatric surgery. Study results show that 70% of patients experienced total remission of diabetes after two years of follow-up, and 30% are still in remission 15 years after bariatric surgery.

It is also important to note that patients and payors should protect their investment in bariatric surgery by supporting patients with a behavioral program post-surgery to help maintain the weight lost. Patients who are not good candidates for surgery should consider engaging in a behavioral weight loss program, too - as studies like LookAHEAD and others show, you don’t need to have huge weight losses to achieve big benefits in diabetes.

Dr. Jennifer Lovejoy is Vice President of Clinical Development & Support at Alere Wellbeing and past president of the Obesity Society. Dr. Lovejoy’s clinical research program has been funded by grants from the National Institutes of Health, the American Diabetes Association, the U.S. Department of Agriculture, and NASA. Read other blog posts by Jennifer Lovejoy.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Accomplish® Program, a nutritional and lifestyle counseling program exclusively for weight loss surgery patients.

Ken Wassum, Associate Director, Clinical Development & Support

The CDC, and specifically its Office of Smoking and Health, should be heartily congratulated on the graphic ad promotional campaign scheduled to launch today, March 19. We’ve greatly anticipated these ads, especially in light of a recent (misguided) court ruling that the government could not require the tobacco industry to put graphic warnings on cigarette packs to replace the tired old ineffective warnings that have been on cigarette packs since the 1970’s.

After seeing the ads some in the press have wondered if the ads are too graphic and too shocking. I would suggest that they are not too graphic and the reason is that the public has become immune to the current warnings on cigarette packaging. Here are the facts after over 40 years of text-based warnings on cigarette packs:

• Over 1,200 people die every day (443,000 per year) in the US as a direct result of smoking.
• One of every two smokers will die prematurely.
• The average smoker will die 14 years early.
• Cigarettes are the only product sold in the US that when used as recommended (needless to say advertised, promoted and discounted) by the manufacturer results in disease and death.

There is hope that the new ads will help shed light on the harrowing reality of tobacco-related diseases. Cancer of the throat is an abstract concept for those who do not have it. The "Tip From a Former Smoker" ad featuring Terrie makes it real – certainly not as real as it is for her, but certainly a lot more real than a text on a cigarette pack that says, “Smoking can cause cancer of the throat.”

In response to these ads, the Atria Group, the parent company of Philip Morris USA and U.S. Smokeless Tobacco, states, “We support a three-part approach to reducing the harm caused by cigarette smoking: preventing underage tobacco use, promoting quitting and a focus on the development of and appropriate communications about potentially lower risk tobacco products,” the company said in a statement. “We believe we can play an important role in this effort and will continue to work with the FDA and others in public health to help reduce the overall harm of tobacco products.”

Yet the tobacco industry does everything it can to sell their deadly products to youth in the US and especially in foreign countries (like Indonesia) and promote their deadly products to adults in the US and overseas (like Camel Orbs).

So hats off to the CDC for taking action. Hopefully the courts will come to their senses and reverse the decision by Judge Richard Leon banning implementation of graphic warnings on cigarette packs. Let’s hope these new ads cause smokers to pick up the phone and call their state tobacco quitline for help.

Ken Wassum has been treating tobacco users for over 17 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Marie Gahler, Senior Manager, Weight and Nutrition Education Services

February is American Heart Health Month, a time to realize how prevalent and deadly heart disease is and learn whether our behaviors have us on the track to health or on the track to disease. On Valentine’s Day, we often think about our hearts in an abstract, romantic way, but it’s also a great time to take stock in our lifestyle and think about how our daily decisions affect our physical heart – the most important muscle in our body.

Cardiovascular disease is the leading cause of death in the United States; one in every three deaths is from heart disease and stroke, equal to 2,200 deaths per day. Though you may not have heart disease, many of us know someone who does or did and realize how devastating a disease it can be. For me it was my father who had high blood pressure and arthrosclerosis and died in his mid 60’s – an age that is not that far off for some of us.

As is the case with many health conditions, our genes do make a difference in our likelihood for developing heart disease. But there’s good news - there are many lifestyle behaviors that contribute significantly to the health of our heart and circulatory system. These behaviors mean that we actually have a significant amount of control over our heart health. For the first time, the American Heart Association has defined what it means to have ideal cardiovascular health, identifying seven health and behavior factors that impact health and quality of life. We know that even simple, small changes can make a big difference in living a better life.

Known as “Life’s Simple 7,” these steps can help add years to your life:

1. Don’t smoke
2. Maintain a healthy weight
3. Engage in regular physical activity
4. Eat a healthy diet
5. Manage blood pressure
6. Take charge of cholesterol
7. Keep blood sugar, or glucose, at healthy levels

As an Alere Wellbeing employee, it certainly feels good to know our programs address each of these 7 areas. Every day we talk with people who are working towards meeting these goals and we are able to help them. In September 2011 the Department of Health and Human Services launched the Million HeartsTM initiative that aims to prevent 1 million heart attacks and strokes in the U.S. over the next five years. They intend to do this by:

• Empowering Americans to make healthy choices such as avoiding tobacco use and reducing the amount of sodium and trans fat they eat. These changes will reduce the number of people who need medical treatment for high blood pressure or cholesterol—and ultimately prevent heart attacks and strokes.
• Improving care for people who do need treatment by encouraging a focus on the "ABCS"—Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation—four steps to address the major risk factors for cardiovascular disease and help to prevent heart attacks and strokes.

This second point – treatment - is something we as Alere employees can help with too. We commonly encourage our participants to follow all doctors’ orders. Many individuals with high blood pressure and high cholesterol don’t follow doctor’s orders and fail to take their medication or monitor their blood pressure. At our suggestion we can aid in making sure they understand the importance of getting regular medical treatment and taking all prescribed medication.

For more information on Alere Wellbeing's products and services,  visit www.alerewellbeing.com/our-services

Jennifer Lovejoy, PhD, Vice President, Clinical Development & Support

I’ve been interested in the fascinating work of the Institute for HeartMath (IHM) ever since scientists there discovered the amazing physical and mental health benefits that occur when people focus on heart-centered breathing combined with feelings of love, appreciation, or gratitude.

In decades of subsequent research, IHM researchers have shown that regularly practicing HeartMath techniques results in:

• Weight loss
• Better quality of sleep
• Lower blood pressure
• Less stress and anxiety
• Better management of chronic pain
• Improvement with panic attacks and depression

How does it work?

The heart has the strongest electromagnetic field in the body, and when your heart is beating in what the IHM calls a coherent pattern, the energy generated by your heart affects your other internal organs, even your brain. So bringing your heart into “coherence” is sort of like bathing your whole body in positive, balancing energy.

You can learn to recognize and then to cultivate the feeling of coherence in your body - in fact, we offer our Weight Talk^® participants an audio lesson called "The Quick Coherence Technique," which teaches the basic prinicples of coherence. When I practice this technique regularly, I not only feel calmer, but my mood tends to lift and I feel more energized.

The technique is simple and only takes a few minutes:

Step 1: Heart Focus – bring your attention to your heart.

Step 2: Heart Breathing – breathe deeply and regularly; imagine your breath coming into and out of your heart.

Step 3: Heart Feeling – maintain your focus and breathing, and activate positive feelings such as love, appreciation, or gratitude.

Recently, IHM started a grand experiment called the “Global Coherence Initiative”, which brings together people from all over the world to practice heart coherence at synchronized times. The researchers believe that if millions of people regularly cultivate love, appreciation, and gratitude, and live their lives with a “heart focus,” it just might change the world. I particularly like a quote from Confucius on their website:

"To put the world in order, we must first put the nation in order; to put the nation in order, we must put the family in order; to put the family in order, we must cultivate our personal life; and to cultivate our personal life, we must first set our hearts right."

What can you do this month to set your heart right?

For me, I plan to keep practicing the Quick Coherence technique, remembering that every time I do, I’m contributing a little bit to changing the world, one heart at a time!

Janice Milliman, Quit Coach, Service Delivery

Smoking is so addictive that many patients continue to smoke even after being diagnosed with lung cancer. I’ve talked with several participants who continue or return to smoking after having part of their lung removed (a lobectomy) or an entire lung removed (a pneumonectomy).

Fear is one barrier to quitting. If you’re attempting something you’ve never done before or only “failed” at in the past, it’s perfectly normal to be afraid or hesitant. If someone has smoked for 30+ years and never tried to quit before, they may have no idea what life will be like without smoking. It has become such a normal part of their life that the world seems up-side-down without it. If that same person has been diagnosed with cancer and is dealing with great uncertainty about the future, it isn’t unreasonable for them to move in the direction of normalcy (smoking) versus greater uncertainty (quitting smoking).

Nearly everyone knows that smoking can cause cancer. On the other hand, most people would have difficulty listing the benefits of quitting after being diagnosed with lung cancer. The diagnosis is scary and can feel like a death sentence. Without knowing the benefits of quitting after diagnosis some patients may think, “It’s too late to quit now. The damage is done.” The truth is that quitting smoking can make a huge difference for a lung cancer patient. Quitting will still be challenging, but instead of feeling hopeless and helpless, patients can feel more in control of the outcome of their lung cancer treatment.

Quitting smoking:

• Improves circulation throughout the body and healing of surgical wounds
• Reduces the chance of infection following surgery
• Improves the efficacy of chemotherapy and radiation
• Improves quality of life because those who quit have more energy, breathe easier and typically manage stress and anxiety in a more positive way
• Reduces the chance of cancer recurrence

Most people are quick to judge, criticize and shame smokers for continuing the deadly habit after cancer diagnosis. If nagging was an effective tactic, though, most smokers would have already quit. When we are unable to identify with someone else’s situation, it is easier to pass judgment or criticize. Since we know judgment and criticism won’t help someone quit smoking, the first step is moving toward greater understanding of their situation. We’re not giving the smoker excuses to continue their habit, but through understanding we can feel and demonstrate more compassion, which in the long run will more effectively help someone quit.

Lung cancer patients who smoke aren’t stupid or foolish, but they do need their doctor’s support to understand the benefits of quitting and guidance regarding medication to manage the nicotine withdrawal symptoms. Doctors should also encourage their patients to check on additional benefits and support they may be entitled to by calling 1-800-QUIT-NOW. It is never too late to quit smoking.

Janice Milliman, Quit Coach, Service Delivery:

The average lifespan of a worker bee is one year. On the opposite end of the spectrum is Yoda, who lived for 900 years. I definitely don’t want to see as many centuries as Yoda, but I do look forward to a long life well into my 80s, maybe even 90s.

Longevity is a common motivator for people trying to quit tobacco. It’s true that quitting tobacco extends your life, and improves quality of life at the same time. Participants share that by living longer they’ll be able to see their kids graduate from high school or watch grandkids grow into adulthood.  It saddens me, though, when participants talk of longevity in terms of living until age 60, or even early 70s. That still seems so young to me, and yet for them it may be an age they will never see.

My maternal Grandfather lived until age 94 and got to know his great-grandchildren. Such a gift for all of us! My dad was pleased just to reach the age of 60. As I wrote in a previous article, On Father's Day, A Tribute to My Smoke-Free Dad:

His father died shortly after retirement at age 62, from pneumonia. Only a few weeks later his mother, also 62, died of cancer. Although it's uncertain to what extent smoking contributed to their deaths, smoking certainly shaved years off their life.

Dad worried, probably more than most, that he wouldn't even live to see his 60's, and certainly not his 70's. Recently celebrating his 68th birthday (or "The 20th anniversary of my 48th birthday," as he says), he has well outlived the age when his parents died.

Like many of our participants, my Dad didn’t expect to ever blow out 60 candles on a birthday cake. Now in his early 70s he is going strong. My mom, also in her early 70s (sorry for spilling the beans on your age, mom), is preparing for another half-marathon walk. Some of our participants at that age can’t even walk to the mailbox because they’re short of breath from emphysema.

It causes me to wonder: Do people set low expectations because their parents died relatively young? Are they simply being practical about how much time tobacco is shaving off their life? Or, based on their current health, they realize that continuing the stated course will result in an early death. Most likely all three factors are taken into consideration, especially the latter. In our line of work it’s not uncommon to speak to participants who’ve had a stroke at age 40, quadruple bypass at age 45, or a partial lung removal at age 60. According to the Centers for Disease Control and Prevention, adults who smoke die about 14 years earlier than nonsmokers.

One thing I love about my job is helping participants see that it is never too late to quit tobacco. The body does amazing things to repair itself. Because of genetic factors we are not always in control of how long we live. We can, however, ensure the longest life possible by taking good care of our bodies. Yoda didn’t smoke, and look how long he lived!