Susan M. Zbikowski, PHD, Senior Vice President, Research, Training, & Evaluation 

I am pleased to announce that Alere Wellbeing had an important paper published this month in the Journal of Environmental and Public Health. Our article, “The 2009 US Federal Cigarette Tax Increase and Quitline Utilization in 16 States,” written by Terry Bush, Susan Zbikowski, Lisa Mahoney, Mona Deprey, Paul D. Mowery, and Brooke Magnusson, describes call volumes to 16 state quitlines, characteristics of callers, and cessation outcomes before and after the 2009 federal tax increase.

You may remember back to 2009 when smokers were once again hit with a large increase in the cost of their cigarettes. On February 4, 2009, the federal government enacted a 62-cent increase in the federal cigarette tax, along with increases in other tobacco taxes, to fund expansion of the State Children’s Health Insurance Program. The federal cigarette tax increased to $1.01 per pack on April 1, 2009. Right before the increase in cigarette tax was made public, tobacco companies sneaked in their own price increase on tobacco products. This dramatic increase in the costs of smoking was likely to be a tipping point for smokers to try to quit. With support from the Centers for Disease Control and Prevention (CDC), researchers at Alere Wellbeing decided to find out if these increased costs would result in more people calling state quitlines for help.

Results of this study were just released in the Journal of Environmental and Public Health. The study showed that the federal excise tax on cigarettes was associated with a 23.5% increase in calls to quitlines and attracted somewhat different types of smokers compared with the year before the tax. In particular, it seems that the tax had a greater impact on those who had less education and who were living with other smokers based on the increase in calls from this demographic. Although we also expected that more young smokers would call, this was not the case in this study.

Another important finding from the study was that quit rates among those who called after the tax increase did not differ from quit rates among those who called before the tax increase. The lack of a significant increase in quit rates is not surprising since the participating quitlines did not provide additional or different services to callers. Nonetheless, increasing the number of callers at the same quit rate means an increase in total number of successful quitters. In these 16 states, of the 19,911 additional tobacco users who called during the time of the tax an additional 5,714 would quit smoking (19,911 more callers after tax ∗ 28.7% quit rate).

If the money raised from increased taxation on cigarettes was put into cessation treatment, then it is likely the taxes would have an even greater effect on helping smokers to quit. Numerous studies have shown that quitlines increase ones chances for quitting, especially when multiple counseling calls plus nicotine replacement medications are made available. Unfortunately, states have been cutting back on the services they provide on order to contain costs. This study from Alere Wellbeing provides important data relevant to public health policy on tobacco control. Providing evidence-based cessation services combined with tax and price increases, smoke-free laws, anti-tobacco advertising, and bans on promoting tobacco use can increase quit rates and decrease the prevalence of tobacco use.

Allegra Wiborg, Lead Trainer, Service Delivery

Some people might think that the Quit For Life® Program helps a person quit tobacco. And they’d be half right. But really, we’re all about helping people quit tobacco, and stay quit.

In my last couple posts I’ve written about strategies and mind-sets Quit Coaches can help a participant cultivate to quit successfully. But, as I used to tell participants, “Quitting is half the battle” (only the callers born in the late ‘70s to early ‘80s picked up on the subtle G.I. Joe reference—but it’s a good analogy all the same) “staying quit is the other half.”

So if a participant has already quit and is feeling great, does he still need a Quit Coach? Think about it this way: becoming good at something takes time, whether it’s skiing, meditating, or living a tobacco-free life. Challenges creep up: hills that are steeper looking down than they seemed looking up, distracting voices in the other room, or a buddy accidently offering a cigarette to his newly quit friend. And when challenges arise—especially unplanned challenges—people often stumble.

That’s why Quit Coaches are trained to assess participants who are quit just as thoroughly as participants who are planning to quit. By “assess” I mean explore strengths and barriers that a person might have toward reaching her goal. And participants can still have challenges even when they are successfully quit: that old pack of cigarettes in the freezer, a family reunion where most members smoke, a bombshell stressful event waiting around the corner. Coaches ask questions to uncover information that participants might not even be aware of as a potential challenge to staying quit. Coaches can then present any concerns they have to the participant in order to build not a quit plan, but a stay quit plan.

Andy Roberts, the Quit For Life® Quality Director of Service Delivery, explains why speaking to a Quit Coach is still important for the participant who is quit—even if the participant feels he’s doing great.

Imagine you went to the doctor for a serious health issue; the doctor examined you, took some tests, gave you medicine, and then sent you on your way. When you came back for a follow-up appointment the doctor asked, “How are you feeling?” and you responded, “I’m not feeling symptoms right now.” Would you expect the doctor to say, “Okay, I take your word for it—bye,” or would you expect the doctor to say, “That’s great, now I’m going to examine you again to make sure that the issue has cleared.”

I would feel more comfortable working with the second doctor to better my health. I mean, even if I felt better, I’d like to have the sign off of a professional.

Each step in the quitting process has unique obstacles. Staying quit can be the last step, but it’s not an isolated event. It requires a new way of thinking—every minute, every hour, every day.  Staying quit does get easier with time, but it takes practice to develop the skill of living tobacco-free with confidence. Good thing there are professionals to help.

Mark Twain once said, “Quitting smoking is easy. I’ve done it hundreds of times.” Obviously, he never tried the Quit For Life® Program.

As a former Quit Coach®, Allegra remembers the importance of viewing each caller as an individual who brings their past and their personality to the behavior change process. And, she remembers the importance of treating each caller with care. These are elements she tries to share with Quit Coaches in her training classes. Read more of Allegra Wiborg's blog posts.

Learn about the Quit For Life® Program

Read more stories from current and former Quit Coaches

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.

Allegra Wiborg, Lead Trainer, Service Delivery

Remember that old Burger King slogan, “Have it your way”? That’s kind of what the Quit For Life®  Program is like. Except without the burgers. In fact, our company is the opposite of one that endorses a Whopper-eating lifestyle. But let me explain.

Each Quit For Life®  participant gets set up with their own Quit Coach®  to help them build an individualized quit plan. During the intervention, maybe a participant shares she wants to have a lot of vocal social support as she quits, or maybe a participant explains he just wants to let his mom know about his quit—and no one else. Either way is a fine part of a quit plan, as long as the participant is thinking about how they want support.

At Alere Wellbeing, we train Quit Coaches in the theory of participant as educator. That is, Quit Coaches ask probing questions but let the participant tell their story about what they need to quit successfully. How do Quit Coaches know what to ask about? They’re experts in the United States Public Health Clinical Guidelines’ five key behaviors to quitting tobacco:

1. Set a quit date
2. Use cessation medications
3. Develop urge management skills
4. Tobacco-proof the environment
5. Enlist support

While the Quit Coach®  is proficient in the five keys, the participant is the educator about what these keys will to look like in practice. One time a participant told me she wanted to have a funeral for her cigarettes, bury them in the backyard complete with a eulogy—voila! Tobacco-proofing! Another participant told me that when he was jonesing for a cigarette he was going to practice his nunchuck skills—certainly a way to manage your urges.

So, Quit Coaches are armed with the raw material, but the quit plan still needs to be assembled in a way that is palatable for the participant.

With Quit Coaches who assist with—instead of prescribe—a Quit Plan, participants can have it their way. And isn’t success delectable?

As a former Quit Coach®, Allegra remembers the importance of viewing each caller as an individual who brings their past and their personality to the behavior change process. And, she remembers the importance of treating each caller with care. These are elements she tries to share with Quit Coaches in her training classes. Read more of Allegra Wiborg's blog posts.

Learn about the Quit For Life® Program

Read more stories from current and former Quit Coaches

Janice Milliman, Quit Coach, Service Delivery

Tobacco use among adults who live below the poverty line was about 28 percent in 2010, compared to 19 percent for those at or above.  State Medicaid programs who serve those in poverty need to beef up their tobacco-cessation benefits and reduce the barriers enrollees face when trying to access those benefits.

Tobacco cessation benefits may include support calls and medication, such as nicotine replacement (patches or gum) or prescription medications. Tobacco users cost Medicaid programs much more than non-tobacco users, so according to the Tobacco-Free Kids January 2012 factsheet, Comprehensive Statewide Tobacco Prevention Programs Effectively Save Money, Medicaid programs have more to gain by funding and promoting tobacco cessation.  A recently published study on the  return on investment (ROI) of a state medicaid tobacco cessation program found that Massachusetts saved more than $3 for every $1 spent, and that the reductions in cardiovascular hospitalizations alone saved about $14.7 million for the state Medicaid program.

Medicaid programs have a specific process that each enrollee must adhere to in order to receive the benefits to which they are entitled. Such processes are in place likely to control cost, ensure proper treatment, and possibly to prevent fraud. Unfortunately, some state Medicaid programs have too many hoops to jump through. With so many possible breakdowns in the system, enrollees face delays in quitting, discouragement, and some simply give up. Additionally, many Medicaid enrollees are less-well educated and may have physical or mental limitations that make it more difficult to jump through hoops.

The million-dollar question is, then, if tobacco prevention and cessation programs reduce smoking, save lives, and save money by reducing tobacco-related health care costs, why don’t more state Medicaid programs allocate funding and create a reasonable process for accessing benefits?

Most tobacco users say quitting is one of the hardest things they've ever done. Janice, a Quit Coach®, feels that helping people succeed and overcome feelings of shame are some of the highlights working at Alere Wellbeing. Read more of Janice Milliman's blog posts.

Learn more about the Quit For Life® Program

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Trisha Tinsley, Lead Trainer, Service Delivery

While I was working on my bachelor's degree, I took an addiction studies class. After learning about the most common addictive substances, our professor gave us a writing assignment to argue which substances were the most harmful. I was encouraged to consider all facets of the word “harmful.” The damage it does to the user. The harm it does to society. The harm it does to the family. After careful consideration, I concluded it was a toss-up between cigarettes and alcohol. In the end I argued that alcohol was the most harmful substance, if only due to the lack of awareness about how alcohol is a more acceptable substance of abuse.

When I was in college, cigarettes were beginning to be frowned upon socially. There was also talk in the media and government about banning smoking in public places. Increased awareness of the dangers of second hand smoke was allowing people to finally come to terms with how we are impacted by tobacco not just on a personal level. However, even in 2000, people were not as aggressive with the discussion about how we are impacted by alcohol. This is not to say that there was not information out there but it seemed like old mind sets about alcohol were still pervasive and seemed harmful to me.

April is Alcohol Awareness Month. It is the perfect time to talk about how awareness can bring about change in how we view alcohol as an addictive substance and how it affects our personal health and society.

What does “alcohol awareness” mean? It is not being aware of who shakes the best cocktail or where the best happy hour is! I want to challenge all of us to think of “awareness” as being conscious about our views and how there can be room for change. Awareness does not always mean that you become more educated about an issue. A large part of awareness is being in tune with your thoughts and feelings about an issue...This is a perfect month to check our perceptions about alcohol.

This year for Alcohol Awareness Month the Center for Disease Control (CDC) is focusing on binge drinking, especially on the harmful effects it has on women. According to the CDC, binge drinking is considered having four or more drinks on one occasion for women and five or more drinks for men. Binge drinking was a perfect issue for me to use to begin to test people’s perceptions. Due to limited time and resources I conducted an informal poll on a sample of people. I posed two scenarios to my husband, two coworkers, three acquaintances at a party, my neighbor, a woman on the bus, a friend of my husband, a yoga teacher at my gym and, of course, my mother. Not entirely a fully baked study, but the findings were interesting nonetheless.

Consider two scenarios:

Imagine a woman (Woman A) at an after-work get-together where she is hanging out with her friends. She does four shots of liquor with her friends, all within an hour and a half.

Now imagine another woman (Woman B) who is across the street from Woman A at a convention center, at a four hour-long event, sipping slowly on a glass of wine while mingling. She has about four and half glasses during the whole event.

I asked people what they thought about these scenarios. Most people couldn't get over the fact that Woman A had four shots of liquor, frowning and asking, “Is it even safe to have that many drinks in that amount of time?” I inquired, “What do you think about our lady wine drinker?” and was met with very little thoughts of concern. Then I informed my informal survey-takers that, clinically, both of these women are considered to be displaying binge drinker behavior. This puzzled my participants. Most of the people said that Woman A was an alcoholic and could be in danger, which may or may not be true. But what was revealing to me was that they did not think the Woman B was at risk at all. They perceived that she was drinking moderately; it never occurred to them that she may or may not be abusing alcohol. I informed them that drinking in moderation is considered to be having one drink a day. I still found it hard to make my point that the second woman was not drinking moderately, even to the non-drinkers I was polling.

I topped off my research by asking, “Is drinking alcohol as harmful as smoking cigarettes?” Every person said no.

I then asked, “Is having one cigarette a day the same as one drink a day?”Every person said no. They all said one cigarette a day was worse than one drink a day.

Lastly I asked, “Consider a person who smokes one cigarette per day and one person who has one drink per day. Does it cost the same to drink as it does to smoke?"

This is a question that even stumped me. But after doing math with a couple of people, we concluded that a drink can be anywhere from $2.00 to $10.00 in the state of Washington. A pack of cigarettes in the State of Washington is around $9.00. There are 20 cigarettes in a pack. $9.00 divided by 20 is .45 cents a day. Wait just a second. Not considering anything else beside the pure cost, drinking alcohol is more expensive than smoking cigarettes? This floored most of the people I talked to.

Of course, the conversation was not to encourage people to stereotype women and alcohol or to have people leave thinking smoking is a cheaper or healthier habit. The main point was to open up a dialogue on society’s preconceptions of alcohol and offer alternative ways of thinking about it – that alcohol, like tobacco, is a substance of abuse.

I help people quit smoking for a living – I help them make healthier decisions every day. As a Quit Coach® and now as a Quit Coach® trainer I have remain committed to bringing awareness of the importance of behavior change – and why drinking alcohol deserves just as much attention as smoking.

In 2006 Trisha called into the Washington State Quit Line and talked with a Quit Coach® who helped her quit smoking. After successfully quitting tobacco, she aspired to become a Quit Coach for the Quit For Life® Program and began working for Alere Wellbeing in 2009. She now works as a trainer helping Quit Coaches to work with participants who call into the Quit For Life® Program and is an active member of the Alere Wellbeing Employee Advisory Board.

Learn about the Quit For Life® Program

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Erin Thompson Curlett, Senior Content & Social Media Marketing Manager

Today we are excited to announce our industry-leading tobacco cessation program, Quit For Life®, is now available in Spanish, removing language as a major barrier to quitting for Spanish speakers.

Quit For Life® in Spanish, available to employers and health plans, features phone-based coaching with a native Spanish-speaking Quit Coach®, integrated with Web Coach®, the most innovative and advanced online learning and social support community available for tobacco users. Clients receive dedicated account management, transparent reporting, and a customizable promotions package including a website (www.quitnow.net) and more than 100 materials and emails in Spanish.

Nearly 15 percent of our service delivery staff has been trained to support Spanish-speaking participants, including registration intake specialists, Quit Coaches, and supervisors. Quit For Life® has the highest standards for coaching in the industry, including ongoing mentoring, training, and evaluation.  As such, Spanish Quit Coaches must graduate from 12 weeks of immersive training on clinical protocols and tobacco cessation coaching, and 4 weeks of training on cultural and dialect differences, dosing regimens for medication, and symptomology. We recruit staff with a background or education in counseling, addiction studies, community health education, or social work. Our Spanish-speaking Quit Coaches are native speakers hailing from countries like Puerto Rico, Mexico, Colombia, and more.

Read the press release about Quit For Life® in Spanish

More information about Quit For Life® can be found at www.alerewellbeing.com or by emailing wellbeingsales@alere.com.

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.

Reed Dunn, Senior Recruitment Marketing Manager

Sheila Woods was no stranger to quitting tobacco.

A smoker for more than three decades, Sheila had tried to quit several times in the past. But she always returned to tobacco.

“I decided smoking was getting in the way of being a mother,” the mom of three said of her earliest quit. “I quit for eight years. I just did that cold turkey, but I always enjoyed the smell of cigarette smoke. Eight years later, we were at a concert outdoors, and a friend of mine was smoking …”

Needless to say, Sheila found herself reaching for cigarettes, again.

When Steelcase began offering the Quit For Life® Program to eligible employees, Sheila, an Operations Manager based in Grand Rapids, Mich., enrolled in the company’s free benefit.

“For the most part, it was really society and my feeling that smokers are just outcasts more and more so everywhere,” Sheila said of her decision to quit this time. “The state of Michigan also had banned smoking indoors.

“It’s one thing if you’re in Florida and have to smoke outside. But when you’re in Michigan in January, it’s a different thing.”

There were several other factors, including the upcoming wedding of her oldest daughter, a tobacco surcharge Steelcase was implementing on her insurance plan and other external pressures, that led to her ultimate decision to join the program.

“I started smoking at 16 to be cool and in the in crowd,” she said. “At 49, I realized I’m one of the only ones smoking.”

Sheila set a Quit Date for April 12, 2011, and she has been tobacco free since that date.

“That week, I was really having a bad week,” she said of her quit week. “I called the Coaches and asked what other kinds of support there was, and they told me about the gum and nicotine patches.”

She reached out to get nicotine patches, which are offered as part of the Quit For Life Program offering from Steelcase. Still, the quit wasn’t easy.

“I went through a month of hell,” Sheila said. “The phone calls were really what kept me going. They were a lot more helpful and valuable to me than I thought they would be.”

The Quit For Life Program’s Quit Coaches® had helped Sheila set a Quit Date that was specific to her individual tobacco use and desire to quit. They also were there for her during the difficult weeks that followed her quit.

“I did not look forward to those phone calls, but in retrospect they were probably the best part of me quitting.”

Having successfully quit using the Quit For Life Program, Sheila has even inspired a couple of other Steelcase employees to jump on board and enroll in the program. She said the program made a big difference in her quit success this time.

“I would definitely advise anybody to go through the program,” she said. “I did find it to be extremely helpful. … Look at all of the things available through the program and be prepared when the date comes.”

To enroll in the Quit For Life® Program and gain access to Quit Coaches and free nicotine patches or gum to assist with your quit, call 1-866-QUIT-4-LIFE (1-866-784-8454), or visit quitnow.net. For helpful quit tips, preparation advice, and to meet others like you, visit the Quit For Life® Facebook Page.

Erin Byrnes, Quit Coach, Service Delivery:

Thanks to the Campaign for Tobacco Free Kids' Knock Tobacco Out of the Park campaign and a national coalition of supporters, an agreement was reached in November that promises to improve the health of major league baseball. As of 2012, players, managers, and coaches will no longer be allowed to carry tobacco during games or to use it during TV interviews or when they have direct contact with the public.

I should clarify. They will not be allowed to carry it in their pockets during games. Carrying it in their mouths will still be fine.

While not realizing its ultimate goal of urging the league to ban tobacco altogether, the year-long campaign, mostly organized by public health and medical organizations, did manage to secure significant new tobacco regulations on and off the field. A great deal of support for the movement was garnered from politicians, youth baseball clubs, faith-based leaders, sports celebrities, and over 35,000 individual activists.

While this is a definite step in the right direction, the majors are way behind the times. Minor league baseball banned tobacco use completely almost 20 years ago. Smokeless tobacco products have been gaining popularity, especially among high school boys, where use is up over 30% since 2003. Big tobacco is getting free advertising from baseball that's reaching millions of youth - youth that are now supposed to be protected from their promotional efforts.

Professional athletes are heroes to many people. As long as kids see their favorite players ignoring the serious dangers of chewing tobacco and openly using it, the tobacco companies will continue chalking up runs and will remain in the lead.