Saturday, May 19, 2018

Missouri Statewide Comprehensive Tobacco Control Law


Missouri Statewide Comprehensive Tobacco Control Law
19 May 2018

The State of Missouri can now write a final comprehensive statewide tobacco control law. It needs to; or lose millions of dollars. Toxic tobacco smoke is no longer needed to manage nicotine levels. (See references below.)
Toxic tobacco smoke is the leading cause of preventable illness and early death. There is no safe level of tobacco smoke exposure. Nicotine addiction is of such a public health concern that smoking cessation is now free to every smoker.
Individuals at both ends of their life span (newborn, and the ill and infirm) are extra sensitive to toxic tobacco smoke to the extent that it can result in sudden death. Between these two extremes all individuals suffer from the aggravation of a large number of illnesses that can shorten a life by as much as 10 years.
The response time to tobacco smoke exposure is no longer 20-30 years (cancer). It is now known to be as short as 3 minutes (stroke and heart attack); 3 seconds to restrict blood flow and to irritate cell membranes (oxidative stress).
No one living in multi-unit housing (of any kind; memory care, assisted living, independent living, residential housing, condominium, nursing home, etc.) should be subjected to second hand tobacco smoke drifting into their living space; or third hand tobacco smoke carried into their living space on hair, cloths or bodies of caregivers and guests.
Any tobacco free property (combined with the use of nicotine replacements, when on duty), can satisfy the requirement of being free of all tobacco smoke exposure. Having no smokers guarantees clean air.
Low paying, high turnover rate, occupations need active smoking cessation programs in place when nicotine-addicted individuals (smokers who cannot resist adjusting their nicotine levels) are hired. Smokers who are that ill (addicted) must be restricted from working closely with patients, residents and customers.
Missouri needs a law that clears the air where uninformed addicted individuals and corporations fail to use free tools to promote smoking cessation. We need everyone to be aware of successful long term smoking cessation programs.
Educate everyone, restrict tobacco usage, and tax to reduce the known harm from tobacco smoke exposure. Vote YES. Half of any new tobacco tax money must be mandated to support prevention and cessation of smoking or vote NO.

Richard A. Hart, PhD.   www.residentialcarefortwo.blogspot.com     rahart1@outlook.com



Annotated References:
The Internet is loaded with exaggerated, dated, and intentionally misleading information. The same source may post opposing views at different times: consider the use of nicotine lozenges and vaping.
The strict separation of smoking and nicotine lozenges has evolved into using a lozenge to avoid smoking in restricted areas. Vaping has gone from ritualistic clouds of theater smoke (falsely labeled water vapor) to cloudless devices that resemble computer thumb drives leaving the CDC and FDA confused as to how to regulate the devices: smoking cessation and/or nicotine addicting.
Most of the information needed for tobacco smoke exposure control is provided by the best authorities, at the time, based on a review of numerous publications and a consensus with other authorities. They do no always agree: research, medical, marketing, and cult need to be identified and dated. 
           American Lung Association   www.lung.org   
This is a massive website with something for everyone. I have picked out what I found most useful and how to find it again.
Freedom From Smoking® Self-Help Guide  Self-guided workbook including key activities in an easy-to-follow format. Call 1-800-LUNGUSA to get a copy.
Facilitator Training   Become certified to lead a Freedom From Smoking group clinic and to conduct an in-house smoking cessation program as a part of new-hire training. Eight hours. $350. Clayton, MO, 7745 Carondelet Avenue, Suite 305    314-449-9145
Our Initiatives >Tobacco >Smokefree Environment includes (1) Smokefree Policies in Multi-Unit Housing, (2) Expanding Smokefree Communities, and (3) Workplace Wellness. These all apply to assisted living and memory care.

Our Initiatives > Support and Community > Corporate Wellness that includes an Improve Indoor Air Quality Tobacco-free policy that can be edited for Third Hand Smokefree in memory care.

State of Tobacco Control    www.lung.org/sotc   (January 24, 2018) An annual report on how the process of shutting down the marketing and sales of tobacco products is progressing without creating an extensive bootlegging operation.

SLATI (State Legislated Actions on Tobacco Issues) www.lungusa2.org  (2018) A detailed, annotated, easy to use, copy of state tobacco control laws.



Monday, May 7, 2018

Existentialism and Memory Care


This course by Jack Kultgen (Osher 1) has given me a new framework in which to think about death; the topic for the last of the eight meetings, this week. Death is always close in memory care (two living in adjoining apartments passed last week).
It is our concern for others while we are alive that matters. We will no longer be conscious after our own death; unless we build a framework in another dimension.
Existentialism starts with no external framework beyond one’s own existence.  We are only conscious of what we experience. Humans, dogs and cats seem programmed to seek new experiences, as extroverts and introverts (Osher 2).
Last year I ran onto “The Origin of Consciousness in the Break Down of the Bicameral Mind” by Julian Jaynes” (Book 4). This provides an evolutionary explanation for the development of consciousness, hypnosis and religion; in many ways around the world, at about the same time.
Some 20 years later Marcel Kuijsten, a rabbi, published “Gods, Voices and the Bicameral Mind, the Theories of Julian Jaynes” (Book 5) which supports the origins of God voices, and also hypnosis, as a natural development of the human mind we have today“.
In old Testament times, it is theorized, the left brain perceived messages from the right brain as voices from God. Commands were carried out without question. This worked until living groups, small cities, became too large; and little was known about how the dynamic continuing creation works as we do today.
Having now dismissed the two above books totaling 803 pages in three short paragraphs, I will try now to do the same for Margaret and me in memory care.
Death was once a natural event. It happened. Life was a time to enjoy, one day at a time. Memory care can extent life several years with a remarkable ability to maintain near normal consciousness to within hours to a few days of passing. However expected, death always seems to be a surprise to everyone.
Some 3,000 years of religious developments have created a variety of after-lives not shared with milkweeds and Monarch butterflies. Most of the great religions seem to have descended from the voices of the Gods often experienced in dreams and visions. This can be replaced by guided meditation, self-hypnosis, today.
Maggie will live and die as a Baptist, with Jesus Christ as Savior of her soul. This belief has served her, and her generation, well during her lifetime, and after she passes.
All of the great religions are interested in saving souls; but in their unique and combative way. This view is changing. Not saving souls from Hell and the Devil but saving mankind by saving the earth for the living, is now in.
The old Christen denominations that sing hymens are being replaced with community mega-churches that sing praises. Be thankful for having been given a life.
When you pass, your body dies like a milkweed or a Monarch butterfly. We are all part of the same miraculous creation. Celebrating the life lived, is in; grieving the death, is out.
Develop and use your God given talents for the betterment of everyone. Our calling now is to continue the creation at a higher level of consciousness, or pay the price of blind evolution: extinction. Save the earth.
This view of life causes our two years in Hawaii to haunt me. To control overpopulation, some years ago, each newborn that could sleep overnight without feeding was taken to a temple ground on a cliff over the ocean. If the baby was still there in the morning, all was well. If the baby was gone it was either in the ocean or selected for the royal family to raise. The mother would never know.
The great religions promote peace, charity, and love. The USA constitution promotes peace, prosperity, and the pursuit of happiness (create wealth as well as share wealth). [Earning wealth is more dependable, and acceptable, than finding wealth.]
Humans are the product of a violent turbulent past (geographically, biologically, and socially) that has left, remnants of each level of development, access to the most advanced level, for good and evil. Quit violating other people with your tobacco smoke, for example.
Education or extermination, modified by effective communication (and miscommunication), will drive the future of what we now call mankind: savage, civilized, robot, warm chip implant, cold solid state being.
Dreams of the future, as dreams in the past, help make sense of what we are doing now for individuals, beliefs, and nations. We must dream it to achieve it, or as a non-existentialist, just act or follow and not think about consequences (Osher 2).
Do what can be done, and persist until the times are right for success (Osher 3).

References:

Osher Lifelong Learning Institute at the University of Missouri, Spring 2018.

Osher 1: John Kultgen, Life Choices from Existential Perspectives: Kierkegaard and Sartre.

Osher 2: Cindy Claycomb, Understanding Behavior and Change Through Trans-State Induction Theory. [grounded in existentialism]

Osher 3: Michael Connelly, Before and After "How a Bill Becomes a Law:" The "How, What, Why and Why Not?" for Regular People.

Book 4: Julian Jaynes, 1976 & 1990. The Origin of Consciousness in the Break Down of the Bicameral Mind, 491 pages. ISBN: 0-618-05707-2  My posts: 
https://residentialcarefortwo.blogspot.com/2017/11/the-cost-in-lives-of-learning-to-use.html introspective minds. [Larry Brown, Faith in the Face of Tyranny. Osher Fall 2017]
https://residentialcarefortwo.blogspot.com/2017/10/who-we-are.html
https://residentialcarefortwo.blogspot.com/2017/06/mythos-and-logos.html

Book 5: Marcel Kuijsten, 2016. Gods, Voices and the Bicameral Mind: The Theories of Julian Jaynes, 312 pages. ISBN: 978-0-9790744-3-1  LCCN: 2016904044  My post: https://residentialcarefortwo.blogspot.com/2017/12/words-from-god-and-man.html

Tuesday, April 24, 2018

Smoking Cessation Worksheets


  1. Smoking Cessation Worksheets
  2. Inventory Story Addiction Management
  3. Before Preparing to Quit                           Free Sample Guided Meditation
  4. Preparing to Quit                                     
  5. Long Term Quitting 
  6. Behavior and Change

To the smoker who wants to quit to be a non-smoke:
Use these worksheets to externalize the many things that promote addiction and to create the new you: a former smoker a non-smoker. Be positive. Plan well.
To the smoker who wants to continue smoking:
Use these worksheets to externalize why and how you started smoking. Jot down other ways to solve your problems without using an expensive toxic smoke.
To the smoker who must stop smoking:
Quit! This order adds more stress to your day. This order may be the significant emotional event that makes you a non-smoker. Otherwise use the worksheets.
To the smoker who must stop smoking at work:
Use these worksheets to discover your smoking habit; those times you do not really need to smoke to control your addiction. Use smoke free nicotine sources.
To friends and coworkers:
Smoking leads to an addiction that is often difficult to break. Smokers often need the help of responsible (duty bound) friends and coworkers to quit.
To employers:
Corporate responsibility now includes freedom from tobacco smoke exposure. There is no risk free level of tobacco smoke exposure. Profit vs. illness.
To the city health department:
Thank you for the free individual smoking cessation program and the business group third hand smoke exposure programs. Prevention tops curing illness.
To the city council:
A draft ordinance to protect patients and residents in residential, health, and assisted living care facilities has been completed. Protect the infirm.
To the state of Missouri:
Writing a House bill to protect Missouri residents from third hand tobacco smoke exposure is scheduled for this summer. Educate, protect and tax.
To legal remedies:
The harm from tobacco smoke “beyond a reasonable doubt” is of a higher order than “the level of significance” of harm occurring. [State prison went tobacco free April 1st.]

Monday, April 23, 2018

Behavior and Change


  1. Smoking Cessation Worksheets
  2. Inventory Story Addiction Management
  3. Before Preparing to Quit                           Free Sample Guided Meditation
  4. Preparing to Quit
  5. Long Term Quitting 
  6. Behavior and Change

Deep down within us is our view of ourselves. In part, it is just us. In part, it is from our interactions with other people. Who we are then, is in part, who we choose to live and work with.
The process that forms our internal, abstract, self is called symbolization: what is good and what is bad (your initial experiences with smoking, for example). The PROCESS starts with a stimulus: your first cigarette.


At some point your BEHAVIOR includes smoking that cigarette. That experience produces a RESIDUAL including: touch, taste, odor, group acceptance, etc.
Each of these can be characterized by their intensity, variety, and cue value to repeat. Each RESIDUAL element can be rated as good and bad by SYMBOLIZATION.
SYMBOLIZATION personalizes these many factors. You share them with others: I like or do not like.
At this point there is the EXPECTATION that the experience is reproducible: I only smoke Marlboros. It is time to light up again. The cycle repeats, a bit faster each time.
When addiction sets in, one part of the structure of smoking has faded away: SYMBOLIZATION. You no longer have control. Nicotine levels fluctuate. Smoking brings relief.

[But smoking brings quick relief in two ways: It can both calm you down when agitated and perk you up when down. It is a high intensity drug addiction. Either way you feel better using a toxic smoke.]
You now need to review yourself as a smoker. Jot down the cost, the time, the illness, and how others view smokers on the past area on the worksheet. Times have changed since you took up smoking and got caught by addiction.

The tobacco cult is held together by ritual as well as habit and nicotine addiction. The ultimate expression of ritual is vaping without nicotine.
Now create a new state of being; leading your way out of the cult by a new set of behaviors. Now view yourself as a non-smoker on the worksheet.
A significant emotional event does this in a split second. A person who can see herself as a non-smoker can work to that image in days to weeks. Always be positive.
It takes through planning and a high emotional engagement. You have to want it to happen. Your friends and coworkers have to want it to happen too.
[Find a friend or coworker to quit smoking with you; to help with the planning and alternate activities. Include a former smoker or non-smoker.]
Happy people think and act in a consistent way such that they can feel good about themselves. Think smoke free, act smoke free, and feel smoke free; and you will become happy smoke free.


Sunday, April 22, 2018

Long Term Quitting


  1. Smoking Cessation Worksheets
  2. Inventory Story Addiction Management
  3. Before Preparing to Quit                           Free Sample Guided Meditation
  4. Preparing to Quit
  5. Long Term Quitting 

Successful quitting requires planning for withdrawal situations. Add these to the LONG TERM QUITTING worksheet as they arise.

You can get the feel of your withdrawal symptoms by creating and practicing alternate activities for your smoking behaviors. This practice may allow you to quit.
The decision to quit must be without reservation. It must be very important to you. It must involve an emotional commitment.
One resident recounted how his youngest daughter became sick one day as he drove her to school in his pickup truck; instead of his wife taking the two girls to school in her car. The older sister told her dad, “She always gets sick at school when you take us to school.” He never smoked another cigarette. This is a “significant emotional event”.
You are committing yourself to being a new person. Imagine that new person (more on why this is essential is on the next post).
Complete the “I am quitting because:” in one sentence. Then take from it a positive word or phrase for your mantra or prayer as: "I AM SMOKE FREE!!" Always be positive. Always be yours.
Date your commitment. Celebrate your commitment with friends and coworkers. Celebrate your weekly progress.
Make use of free smoking cessation programs and those covered by insurance. These tend to be marketed in 12-week periods. One size does not fit all.
You may quit by just reducing the number of cigarettes smoked. You may quit by practicing alternate activities (coffee or exercising). You may have a significant emotional event.
You may smoke a cigarette during the “12-week period”. No problem in Australia. This is a "relapse" for marketing purposes in the United States.

[The results from research and from actual application of research results are often different. Research results are based on a sample of many individuals expressed as the "average" non-existent individual. Application results are from how the program affects you as one individual. That is why the four worksheets progress from reducing your dosage of nicotine, to initial planning, to long term planning, to alternative nicotine sources.]
Long term quitting is until you no longer feel the need to smoke or have trusted alternate activities. This is something you can be proud of doing.
Smoking cessation aids (nicotine sources free of toxic tobacco smoke) can be helpful. They allow you (and those around you) to be free of tobacco smoke at work. You can use one each time you feel the need to smoke.



Saturday, April 21, 2018

Preparing to Quit


  1. Smoking Cessation Worksheets
  2. Inventory Story Addiction Management
  3. Before Preparing to Quit
  4. Preparing to Quit
  5. Long Term Quitting 

Copy the times you smoked from the previous chart onto the left 24-hour circle. Then pick out the situations that you can target as the easiest to modify. Then select trigger situations that must be avoided or changed (Free Sample Guided Meditation).

This is your battle plan. It is you versus addiction. If reducing your dosage of nicotine, by smoking less each week, is not making satisfactory progress, it is time to pick apart your behavior.
Smoking situations include not only the times you smoke, but also, the place and the activity. If you smoke more than one cigarette in a place or activity, target reducing one cigarette.
Trigger situations are more difficult to handle. They require CREATIVITY. They require breaking out of your addiction; a change in your behavior.
You cannot see your addiction, but you can see the behavior it controls. Some trigger situations can be changed. Some trigger situations must be avoided until you are no longer smoking.
Creativity is needed to sort out your triggers and to replace many of them. This requires becoming very conscious of your surroundings and your feelings each time you smoke.
Take a week to mark on the PREPARING TO QUIT worksheet your trigger situations. Make it as complete as you can. A missing trigger situation may upset your long term quitting.
Also create alternate activities. Practice them. Practice avoiding other trigger situations.





Friday, April 20, 2018

Before Preparing to Quit


  1. Smoking Cessation Worksheets
  2. Inventory Story Addiction Management
  3. Before Preparing to Quit                           Free Sample Guided Meditation
  4. Preparing to Quit                                     
  5. Long Term Quitting 
  6. Behavior and Change

You control when and where you smoke before addiction sets in. You have no problem with smoking restrictions or being considerate of other people.
Then something happens. You start to smoke more or more often. You may like the response your body makes to a toxic smoke.
Can your body’s response be obtained in some other less harmful way? Can you just stop smoking? Can you change habits?
If not, you have become addicted. Your “habit” is now also an addiction. That addiction is the number one cause of preventable illness and early death.
This is a serious public health matter. Yet, each cigarette only shortens your life by 11 minutes. The smoke, and your smoking, affects everyone around you.
Breaking free from nicotine addiction requires some planning. Your nicotine requirement needs to be judged. This is different for each person.

Make a short bar across the left 24 hour circle for each time that you feel the need for more nicotine (a smoke).
Make a short bar across the right 24 hour circle for each time that you do smoke a cigarette.
If the markings on these two circles are the same, you are responding to your addiction. If they are different, they are telling us that you still have some control.
Use that sense of control to manage your nicotine dosage. You can reduce the number of times you smoke and/or reduce the amount you smoke each cigarette.
This method allows many people to end their use of tobacco. Others need more planning.
Characterize (THINK, ACT, FEEL) the times you need to smoke on the BEFORE PREPARING TO QUIT worksheet. Do the same for the times you smoked.
We now know enough to plan for breaking out of your nicotine addiction. We know your dosage and something about the circumstances in which you smoke.
Pick out any situations you can target for dosage reduction. Pick out trigger situations that can be avoided or changed. Enter on the PREPARING TO QUIT work sheet.