SYRIAN GOVERNMENT TO BAN SMOKING IN PUBLIC PLACES

Posted by Alex,

Damascus (dpa) – The Syrian government announced on Tuesday that it will adopt an anti-smoking law “to protect people from the negative consequences of smoking on health, economy and environment”.

The law prevents smoking in public places and prohibits advertising of all tobacco products, reported the Syrian official news agency SANA.

Local statistics indicated that smokers represented 15 per cent of the population, or three million Syrians, with an average of one cigarette pack smoked a day.

Syrian smokers spend about 26 billion Syrian pounds (about 562 million dollars), on smoking, and each smoker spends around 8 per cent of yearly income on the habit.

Will the government ban include a ban on Argeeleh smoking?

Will the government ban include a ban on Argeeleh smoking?

Decision will probably be quite unpopular with smokers.

Decision will probably be quite unpopular with smokers.

Sources:

Charles Fred’s photostream

Pzambrano’s photostream

Comments (84)


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51. Rumyal said:

Smoking can be quite enjoyable and healthy if you stay away from Tobacco :-)

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December 17th, 2008, 11:00 pm

 

52. offended said:

‘Most’ syrian women don’t smoke, but quite a few smoke behind closed doors. Even the conservative ones.

And for those who would like to know, I do smoke argileh, a lot, but I am not a woman and not a conservative. And Hummous makes me gasy. I don’t mind gay weathermen although I find them quite awkward. I also find the creative Syrian lingerie quite appealing.

Have a good night.

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December 17th, 2008, 11:11 pm

 

53. offended said:

It’s amazing how many marriage proposals the shoe-throwing guy is getting from the Arab world and overseas. I think I might throw a shoe or two myself, if I ever got past the cavity check.

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December 17th, 2008, 11:13 pm

 

54. Alex said:

Rumyal,

Since you are in management, you probably do not do any C programming anymore and therefore … you are already retired from C… or an atheist Jew.

Offended,

I know you smoke Argeeleh … Zenobia, Innocent Criminal and I are apparently the only sane ones here.

Shai,

Sorry for all the typing Rumyal and I forced you to do yesterday morning (your time). It was an interesting discussion between you and Rumyal.

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December 17th, 2008, 11:22 pm

 

55. Enlightened said:

Offended!

Shoe throwing is not going to help you one iota!

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December 18th, 2008, 1:51 am

 

56. Rumyal said:

Alex,

I’m not quite reconciled to being a manager so I try to code in C++ every now and then to feel that I’m not a dead-weight but I’m not very successful over all. Since C++ is the programming language of Islam you can say I’m a Jewish atheist who’s a Muslim wanna-be which would figure just right if you ask AP and AIG :-)

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December 18th, 2008, 2:54 am

 

57. Shai said:

Rumyal,

I’d say you’re more of a “C++/-” type. That’s a Muslim wannabe, self-hating Jew… :-)

Alex,

No sweat about making me type so much yesterday (though I did sweat then…) I thoroughly enjoy discussion and yes, sometimes argumentation, with Rumyal. I’m only sorry we don’t have him in Israel – we need more open-minded intellectuals like him, to help pave a way for a better future. Unfortunately, and as the latest rounds of primaries amongst the three largest political parties show, we are strongly lacking such leadership. If Rumyal was ready to come back, and run for politics, I’ll promise to support his running for Minister of Programming… :-)

Offended,

If I start throwing shoes around, not only will no women around find me attractive or heroic, but chances are my own wife will have me institutionalized… But, more importantly, I also “do” argeeleh. I can’t say “smoke”, because I try to inhale very little. I try to visit my Arab friends at least once-twice a month, and each time we “do” argeeleh. The only thing I do enjoy smoking, every now and then, are cigars. Cigarettes, never have, never will. If you get there first, to our roadside cafe in Northern KSA, please order the argeeleh with cherry flavor for me… ;-)

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December 18th, 2008, 5:13 am

 

58. Rumyal said:

Shai,

Minister of Programming in the Eternal Homeland of the Jewish People wow what an honor! Look what “VB for dummies” can do for your career :-)

Glad to hear you broke some sweat, I’m afraid that with all the time you spend on the Net you don’t get a chance for phyiscal activity :-)

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December 18th, 2008, 5:46 am

 

59. Averroes said:

Alex,

That photo is priceless. This man will fail the most lax vehicle pollution level test, let alone human-grade pollution.

Jokes aside, I do not see the realization of the new law a reality. Too many Syrians smoke too much. You do not just ban smoking with a decree. There must be years of preparation starting at schools, media, and more.

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December 18th, 2008, 6:47 am

 

60. Shai said:

Rumyal,

Your arguments were fantastic, and did make it very difficult for me. The sweat came from having a great difficulty supporting my belief, from self-questioning it again and again, and from trying to explain what I still believe wasn’t a very successful argument (on my part).

Btw, I try to sweat at least once every day by working out 5-6 times a week. This week I decided to be sick… so I took time off, and unfortunately found myself online much more than I should have…

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December 18th, 2008, 7:21 am

 

61. Rumyal said:

Shai,

My dear friend, I was just joking a bit. I hope you get well soon.

Thinking about our discussion a little bit more, what is definitely true is that there has always been a lot of ambiuity in Israeli policy. Ambiguity is the hallmark of Israeli officialdom, to the point where you and I can’t tell (maybe nobody can tell) whether it’s the result of bumbling incompetence and political paralysis, or consistent planning. The truth is of course somewhere in the middle.

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December 18th, 2008, 7:53 am

 

62. Shai said:

Rumyal,

Yedidi, despite the fact that you now live so far away, you give FAR too much credit to our politicians, and their “consistent” or inconsistent planning. From everything I’ve seen, and indeed studied, all indications lead me to believe Israel has had NO POLICY over the past 30 years, at least, if not more. We have not acted, we’ve only reacted. Even settlements, in our own twisted way of thinking, as been a reaction. I truly WISH we had had some sort of policy, some kind of plan. Even a bad one. That way, at least we could check ourselves, learn from mistakes and correct them. But we don’t, we didn’t, and at the rate we’re creating impotent political parties, with amateur and often incompetent leaders, we’re quite likely to continue along this “consistent” road also well into the future.

This, I believe, is the main reason why we don’t yet have peace in our region (from our side). We haven’t decided what we want. When was the last time you heard a Prime Minister of Israel CLEARLY lay out “the plan”? And, how could he/she, when the people they elect to professional posts like Minister of Finance, Education, Transportation, Justice, etc. are nothing more than BA-graduates (in some general field) who made it to the top spots in their party’s primaries? They rotate them, the same people, and even those that fail miserably are allowed a 2nd chance, and a 3rd, and a 4th, …

But planning, ha! That fits more a joke on the Bazooka-bubble gum than Israeli politics… sadly enough.

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December 18th, 2008, 8:06 am

 

63. pamela said:

In my experience going to weddings I,ve seen women smoking where they usually wouldn,t …I was hoping they had more sense than their men folk..Someone noted that to get people to stop smoking you have to get them to be aware from an early age , therefore schools should be involved to promote anti smoking .I,ve seen school kids going to school in the early morning with a fag in their mouths!
My husband is a smoker , and has been for years , when I ask him to stop , he says he will when hes “unstressed” So either Syria makes peace with Israel so we can all be “unstressed” or smoking will carry on unabated at least in our house!

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December 18th, 2008, 9:46 am

 

64. why-discuss said:

“UE are preparing a project for the Palestinians:
- The Lebanese government would give passports to Palestinian refugees so they can travel.
- Refugees would be given work permit
- The refugees will be dispatched in the US, Canada, Australia and some european countries such as Norway and Sweden
Israel will accept the return of 12,000 and Lebanon would keep 50,000″
My comment: no mention about the financial compensation, or the refugees in Syria.

L’Orient le Jour 18 decembre 2008

jeudi 18 décembre 2008 | 5:00 | Beyrouth
Projet européen de règlement du dossier des réfugiés palestiniens
Dans les coulisses de la diplomatie de Khalil Fleyhane
Des sources diplomatiques dignes de foi ont fait état d’un nouveau projet concocté par l’Union européenne en vue
de définir les grandes lignes d’un règlement du problème des réfugiés palestiniens, notamment ceux établis au Liban.
Les sources indiquent que le projet en question sera transmis prochainement au président élu Barack Obama, partant du principe que l’affaire des réfugiés est « centrale et constitue un passage obligé » pour toute solution au Proche-Orient. Les lignes directrices de ce plan européen se définissent comme suit :
– Le gouvernement libanais devrait accorder aux réfugiés des passeports afin de faciliter leurs déplacements à l’étranger.
– Les réfugiés devraient obtenir des permis de travail.
– Les réfugiés devraient être répartis entre les États-Unis, le Canada, l’Australie et certains pays européens, tels que la Suède et la Norvège, et d’autres pays, dans des proportions qui devraient être définies avec les dirigeants de ces pays. Israël devrait accepter le retour de 12 000 réfugiés et le Liban devrait en accueillir 50 000.
Les sources diplomatiques susmentionnées soulignent que, face à « l’obstination d’Israël, une seule alternative se
pose : maintenir la crise actuelle en l’état, ou accepter la formule proposée » (par l’UE). « Les pays sondés pour accueillir des réfugiés palestiniens n’ont pas rejeté l’idée d’en accueillir un nombre restreint, d’autant qu’ils accordent l’hospitalité à des réfugiés d’autres pays », ajoutent les sources en question qui précisent que le projet européen n’a été élaboré qu’après que des dirigeants palestiniens eurent été consultés à ce propos.
Les mêmes sources ajoutent qu’elles ne savent pas quelle serait la réaction du gouvernement libanais et si ce dernier pourrait accepter d’accueillir 50 000 réfugiés palestiniens, sans leur accorder la nationalité, d’autant que toutes les parties libanaises s’opposent, à l’unisson, à toute implantation des Palestiniens. En tout état de cause, l’année 2009 pourrait être marquée par des pourparlers intensifs au niveau des deux volets syrien et palestinien du processus de paix. Un accord entre Israël, la Syrie et l’Autorité palestinienne aboutirait automatiquement à une relance du volet libano-israélien, affirment les sources précitées qui indiquent que la réponse du nouveau président américain à l’initiative européenne devrait être annoncée en février prochain. Et ces sources de rappeler que lors d’un entretien téléphonique avec le président de l’Autorité palestinienne, Mahmoud Abbas, le président élu Obama avait souligné qu’il plaçait le processus de paix au Proche-Orient en tête de ses priorités.

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December 18th, 2008, 9:47 am

 

65. Rumyal said:

Shai,

Just remember that “Isreal” is not only elected politicians and that planning is not usually the domain of politicians. When you look around you, I’m sure that you see a lot of artifacts which are the result of successful planning and execution.

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December 18th, 2008, 9:48 am

 

66. abu zatar said:

I DO NOT BELIVE THEY WILL EVER IMPLEMENT IT. LOOKAT THE SAFETY BELT IN THE CAR, MOST OF THE TIME THE DRIVERS JUST DRESS IT WITHOUT FIXING IT.ITS PLENTY OF LAWS, HERE IN SYRIA, NOT IMPLEMENTED. I TOOK HUNDREDS OF AIRPLANE IN MY LIFE? MANY DIFFERENT COMPANIES? AND BELIEVE ME, SYRIAN AIRLINE IS THE ONLY ONE WHERE CREW USED TO SMOKE IN THE TOILET.HABIBI, DO YOU REALLY BELIEVE THIS NEWS?

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December 18th, 2008, 10:53 am

 

67. abu zatar said:

I DO NOT BELIVE THEY WILL NEVER IMPLEMENT IT. LOOKAT THE SAFETY BELT IN THE CAR, MOST OF THE TIME THE DRIVERS JUST DRESS IT WITHOUT FIXING IT.ITS PLENTY OF LAWS, HERE IN SYRIA, NOT IMPLEMENTED. I TOOK HUNDREDS OF AIRPLANE IN MY LIFE? MANY DIFFERENT COMPANIES? AND BELIEVE ME, SYRIAN AIRLINE IS THE ONLY ONE WHERE CREW USED TO SMOKE IN THE TOILET.HABIBI, DO YOU REALLY BELIEVE THIS NEWS?

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December 18th, 2008, 10:54 am

 

68. offended said:

Shai,
Is it a coincidence that this is the first post on SC whose title in written in capitals? Do we smokers need to feel worried or discriminated against here?

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December 18th, 2008, 11:17 am

 

69. SimoHurta said:

Israel has had NO POLICY over the past 30 years, at least, if not more. We have not acted, we’ve only reacted. Even settlements, in our own twisted way of thinking, as been a reaction.

Of course Israel’s settlement policy has been a policy already before 1948. “You” had even settlements in Sinai and governmental plans of hugely increasing them before USA forced you to give Sinai back. Israel has been using settlements to get control of a larger area, covert military bases, as a source harm the local peoples life etc. Israel has always built settlements as an active tool for creating new facts on conquered land. That is an action not a reaction.

Surely I agree with Shai that Israel on the ruling level has had NO real POLICY with peace and building relations with Palestinians and the region. The negotiations with Palestinians have been a farce and aimed only to satisfy western audience without no real aim to give up West Bank. No rational government invests and lets it people to invest billions on occupied area if it is going to give it up. After Oslo and Annapolis Israel has only increased the “facts creating policy”.

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December 18th, 2008, 11:20 am

 

70. Shai said:

Offended,

And since it was Alex who posted it, it may indicate his own feelings about smoking. Although I wouldn’t call myself a “smoker” (that would be a disservice to “real smokers”), I can say that Alex’s campaign also against Argeeleh’s has, at times, come very close to Offending me… No, I’m kidding, it hasn’t. :-) Don’t take this personally, I’m sure Alex will still accept us. Hopefully…

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December 18th, 2008, 1:40 pm

 

71. norman said:

Shai,Offended,Zenobia,alex,

The question is not if smoking is bad or not , the question is does the government has the right to force people into doing something that they do not want to do and do they have the right to hurt themselves if they are not affecting others ,
I think everybody by now knows the risk of smoking and if they still want to kill themselves they should be able to do that as long as they not affecting others

By the way smoking and sun bathing make people look older .

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December 18th, 2008, 3:02 pm

 

72. Nour said:

Norman,

First, the government does have an interest in preventing illness and disease, because when people suffer from serious illnesses, such as cancer, they become a burden on society and the state. Second, while people may have a right to harm themselves, they have no right to cause harm or become a nuisance to others. If I choose not to smoke, I should not have to be forced to inhale your smoke in a public setting. You can choose to smoke in your own home without harming others, but when you’re smoking in public places you are infringing on the right of the non-smoker.

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December 18th, 2008, 4:45 pm

 

73. norman said:

Nour,

First , i agree with you about not smoking when other people are affected,

About the government interfering because of health cost , that can be achieved by insurance company charging smokers more than non smokers , in addition to tobacco tax used for health care .
The problem i have when do you stop , how about Alcohol , people drink and drive and have accidents and kill people , or they abuse their wives or spouses , The government would be better off banning alcohol ,

How about sexual orientation ,Or high fat diets , the government might want to interfere in that , should that be OK.

I do not.

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December 18th, 2008, 5:36 pm

 

74. Alex said:

Norman,

This is not a Syrian government invention. In Quebec we finally passed a similar law a couple of years ago that also made it impossible to smoke in public places and after considerable resistance, everyone got used to it and … what a difference!

Ask Zenobia how she almost gave up on Syria and decided to go back to the United States after she realized that there was no way to escape being surrounded by smokers everywhere she went.

Shai, Offended,

I can’t believe I wrote the title of this post in capital letters!

The past few years I learned to shut up and let smokers smoke. Although I was successful with younger friends who were starting to experiment with smoking, my efforts with established smokers were mostly useless. The best I could achieve was that when I was there, my friends would not smoke … same way they did not smoke when their parents were around.

This is the same idea behind the Clean Development Mechanism (CDM) arrangement (the Kyoto Protocol) … it is easier and more efficient to work on the underdeveloped sources of pollution… the new polluters.

And that’s the least I would hope to see out of this new law. No advertising, and a clear statement that smoking (at least outdoors) is against the law… it might make it less attractive for new smokers to continue smoking.

I hope this law will be part of a wider initiative that includes educational components.

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December 18th, 2008, 6:48 pm

 

75. Shai said:

Alex,

I can’t imagine another product out there, of any sort whatsoever, anywhere in the world, that has a gigantic label on it saying “If you use this product you’re going to die!!!”, and yet, billions use it, every day, sometimes 15 times a day, their entire lives.

Another amazing film (based on the true story), called “The Insider” (Russell Crowe, Al Pacino) came out in 1999 about a Vice President for R&D at Brown & Williamson (one of the tobacco giants) that turned whistle-blower, for the first time ever, about what really goes on in the cigarette industry. There, they call the cigarette a “delivery system”, intended to deliver nicotine directly to the brain. It’s effects, are what I wrote up above.

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December 18th, 2008, 7:10 pm

 

76. Alia said:

Norman,

I cannot believe that you are an oncologist and are against public health measures to reduce the prevalence of smoking on the basis of freedom of decision. Do you not counsel your patients to use protection against HPV ? Do you think that the government should not fight other types of drug uses like cocaine, heroine…their users are adults too : )

Very interesting article on the importance of the physicians attitude and engagement in smoking cessation

Smoke Screens: Hospitalists can Use Their Time With Patients to Help Them Kick the Habit

Andrea M. Sattinger

Hospitalist. 2007;11(8) ©2007 John Wiley & Sons, Inc.
Posted 08/28/2007

Introduction
Nobody thought it was possible. Could all indoor workplaces in Ireland—including pubs—be made smoke-free? Now, a law enacted in 2004 is seen as a triumph for public health policy worldwide.[1]

Smoking kills 438,000 people a year in the United States, and 8.6 million have a serious smoking-related illness.[2] Research shows many outpatient physicians do not judge it worthwhile to talk with their patients about quitting smoking because they assume they will have no effect. The assumption is that even if patients quit, they will relapse.

Yet ample evidence suggests hospitalists can have a positive effect by intervening during a patient’s hospital visit.

Data also show that an individual will relapse an average of seven times before being able to take the step for the long term. Relapse is a part of the process, each time teaching an individual something about his or her motivation and behavior.

“Doctors who address smoking with patients can double or even triple the chances of their quitting,” says Shawn Ralston, MD, pediatric hospitalist at Presbyterian Hospital in Albuquerque, N.M. A few pointed questions and a show of compassion to the patient in the hospital could make a world of difference.

Golden Opportunity
Stephen Liu, MD, MPH, a hospitalist and an assistant program director at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, N.H., has been interested in smoking-cessation interventions since his residency in DHMC’s Leadership Preventive Medicine Residency Program in 2003, where he worked on improving care for pneumonia patients. His efforts took off as a result of the Centers for Medicare and Medicaid Services (CMS) pay-for-performance measures, which made smoking-cessation counseling a key component of admission and discharge documentation for a number of disease states.

The approach used with adult patients at DHMC is the brainchild of Colleen Warren, a registered nurse on the medicine unit on which Dr. Liu worked.

“The more times that smokers hear the message [about quitting], the more likely they are to try to quit,” says Dr. Liu. “We capitalized on that [point when] we developed a tobacco treatment team in our hospital. The team, which includes two to five motivated nurses, social workers, or care managers in most units of the hospital, pursued training including an online tobacco treatment course through U Mass Medical Center.”

In January 2006, DHMC was awarded a grant from the New Hampshire Department of Health and Human Services to standardize the treatment of hospitalized smokers. This includes conducting tobacco screening, assessing a patient’s readiness to quit, providing brief counseling, documenting the status and stage of change into the electronic medical record, and referring the patient to community resources upon discharge. The funding allowed the institution to support Warren and Dr. Liu as they coordinated the team and its work. These efforts, including counseling, nicotine replacement therapy, and cessation medications, are also available free to DHMC employees.

DHMC is participating in the CMS demonstration project, in which the hospital publicly reports performance measures for several conditions on the CMS Web site. In addition, many more performance measures are publicly reported on the DHMC quality-measures Web site. Although the team initially targeted the intervention to performance measures related to pneumonia and heart failure hospitalizations, they decided to offer interventions to all patients admitted to the hospital. Of these patients, about 20% are smokers, Dr. Liu says.

Because financial support wasn’t available at first and staff time was voluntary, the work was more difficult. Data from a six-month pilot intervention on two inpatient floors at DHMC showed patient assessments increased from 2% to 85%. In addition, the percentage of eligible heart failure and pneumonia patients receiving smoking cessation advice or counseling prior to discharge has risen from 30% before 2005 to 80% to 90%.

“We have found that hospitalization is a golden opportunity to address smoking cessation in patients in that they become acutely aware of how the smoking has affected their health,” says Dr. Liu. Because patients frequently go without smoking for several days while hospitalized, they learn they can live without smoking and feel much better.

“The key for our kind of intervention is not only assessing it and addressing it while they are hospitalized, but making sure that we link them to resources after they leave,” Dr. Liu says. Those resources include telephone quit lines or local support groups and/or local cessation clinics.

Counseling patients can be personally and professionally fulfilling, says Dr. Liu. He recalls a 50-year-old man—a lifelong smoker—admitted for pancreatitis. The day he was discharged, he showed Dr. Liu a hospital-produced packet of information. The patient said he had been reading it during his stay, decided he was motivated to quit, and had called the quit line.

Dr. Liu and his team use what they call the five A’s:

Ask (does the patient smoke and has he/she tried to quit?);
Advise the patient to quit;
Assess (if the patient is ready to try to quit);
Assist (the patient in planning treatment and referrals); and
Arrange for a follow-up visit.

As part of their counseling, DHMC team members ask patients whether they have used assistive medication, such as nicotine-replacement therapy, bupropion (Wellbutrin) or varenicline (Chantix), in their attempts. They find out what patients have and have not tried. Then they ask, “How can we as a hospital help so that you will not restart smoking when you get home?”

A slightly longer counseling session with a motivated patient means a provider can explore whether they know their triggers for smoking, such as stress, alcohol use, or being around other smokers, and help the patient develop a proactive plan for when they are re-exposed to triggers upon discharge.

Counseling Parents Of Hospitalized Children
In Dr. Ralston’s case, her research and the research of others inspired her to begin counseling the parents of hospitalized children.[3-4] She was conducting research on respiratory illness, specifically bronchiolitis—the most common reason children are hospitalized.

She noticed the vast majority of children had had secondary smoke exposure. The work of C. Andrew Aligne, MD, formerly in the department of general pediatrics at the University of Rochester (N.Y.) Medical Center, inspired her.[5-6] His analyses of attributable risk data revealed that the major and preventable cause of death in children is secondary smoke from parents.

But the issue really crystallized for Dr. Ralston when she encountered the work of Jonathan Winickoff, MD, MPH, an assistant professor of pediatrics at Harvard Medical School and a researcher with the Massachusetts General Hospital Center for Child and Adolescent Health Policy in Boston.

“The AHRQ guidelines show a huge amount of literature that say hospitalization is a great time to address smoking in adults,” says Dr. Ralston. “The [quit rate in office patients] will move from 5% to 12% or 15%, depending on the message. But in hospitalized adults, the quit rate can rise to 25% or 27%. Dr. Winickoff said, ‘Why can’t hospitalization for children be a teachable moment for parents?’”[7]

Another researcher who inspired Dr. Ralston was William R. Miller, PhD, who created the motivational interviewing model. Motivational interviewing is used with individuals to elicit and examine the ambivalence surrounding their unhealthy behaviors. Dr. Miller, retiring this year from the University of New Mexico (Albuquerque), began his work in the area of alcohol abuse. He and his colleagues have increasingly used motivational interviewing in other areas of addiction.

Dr. Ralston says what she has learned from motivational interviewing—and how she counsels parents of hospitalized children differently because of it—primarily pertains to her willingness to talk to people about a difficult subject. Instead of bombarding parents with facts about how smoking is bad for their children—which they already believe but don’t want to talk about—she learned to focus on the parents’ needs instead of the effects on the child.

“And there is the issue of bringing it up when this is not technically your patient,” she says. But after fine-tuning and developing her technique, she now assumes a value-neutral, nonjudgmental, open-ended approach using motivational interviewing. “Eventually it becomes easy to do.”

When approaching a parent to offer help, says Dr. Ralston, “I will lead by acknowledging that the experience the parent is having is extremely stressful. Then, after addressing the primary illness of the child and what the plan is for that, I say, ‘I see [from our records] that you are smoking. Have you tried to quit? Are you interested in quitting now? What might I be able to do to help you?’ If there is an opening, then I’ll go into more extensive counseling.

“You don’t need all the data behind you. I use my expertise more to motivate pediatricians, not the parents.” Another tack she takes to motivate pediatricians to empathically address smoking is to ask them to think of something they do that they know is bad for them but that they continue to do.

Conclusion
“There have been some studies that have shown [disappointing] outcomes when we intervene with hospitalized patients, but I’m more optimistic,” says Dr. Liu. “I feel that as long as we can make a difference in some people’s lives and get them to quit after they leave the hospital, then it’s worth the effort.”

Look at what you are willing to do, advises Dr. Ralston. “If that is a brief message and then a referral to a quit line, that’s fabulous,” she says. “You still might double the quit rate.” Given the temporal nature of the hospitalist-patient relationship, there may be a good number of ways hospitalists could effect change by offering a few encouraging words.

References
Koh HK, Joossens LX, Connolly GN. Making smoking history worldwide. N Engl J Med. 2007 Apr 12;356(15):1496-1498.
Centers for Disease Control and Prevention. Targeting Tobacco Use: The Nation’s Leading Cause of Preventable Death, 2007. Available at http://www.cdc.gov/Tobacco/basic_information/00_pdfs/AAGTobacco2007.pdf. Last accessed June 18, 2007.
Ralston S, Kellett N, Williams RL, et al. Practice-based assessment of tobacco usage in southwestern primary care patients: a Research Involving Outpatient Settings Network (RIOS Net) study. J Am Board Fam Med. 2007;20(2):174-180.
Ralston S, Mahshid R. The pediatric hospitalist and the smoking parent. Pediatric Research Day 2006. Available at http://hsc.unm.edu/pedsresearch/ORAL%20PRESENTATIONS.htm Albuquerque: Office of Research and Creative Endeavors, Department of Pediatrics, University of New Mexico Health Sciences Center; 2006. Last accessed June 18, 2007.
Aligne CA, Stoddard JJ. Tobacco and children. An economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med. 1997 Jul;151(7):648-653. Erratum in: Arch Pediatr Adolesc Med 1997 Oct;151(10):988. Comment in: Arch Pediatr Adolesc Med. 1997 Dec;151(12):1269. Arch Pediatr Adolesc Med. 2000 Aug;154(8):850.
Leonard K, Mosquera M, Aligne CA. Pediatrics in the community: Taking a collective breath to help children who have asthma. Pediatr Rev. 2007;28:152-153.
Winickoff JP, Hillis VJ, Palfrey JS, et al. A smoking cessation intervention for parents of children who are hospitalized for respiratory illness: the stop tobacco outreach program. Pediatrics. 2003 Jan;111(1):140-145.

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December 18th, 2008, 7:46 pm

 

77. Alex said:

Why now?? … there is one month left anyway.

Top US diplomat David Welch resigns
December 18, 2008

US Secretary of State Condoleezza Rice announced on Thursday the resignation of David Welch, top Middle East diplomat, who mediated the Israeli-Palestinian negotiations and the US normalization process with Libya.

A career diplomat, Welch, 55, became the first US assistant secretary of state to resign in the transition of a US administration.

Welch said, “It’s been a good career to be an American diplomat… I was fortunate to work on the most exciting and challenging of issues.”

-AFP

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December 18th, 2008, 11:19 pm

 

78. norman said:

Alia, Alex,

Can you please cool down ,
first ,I do not smoke and never did , I made my wife stop smoking before we got married , She still does not smoke after 23 years , none of kids smoke and i made my brother ( The civil Engineer ) stop smoking ,
I get my patients to stop smoking and many do ,
Saying all that , I still do not think that it is of the government business to prohibit people from smoking , they should make it more expensive so children are not able to buy it , they should force restaurants to have a smoking and non smoking areas so people who do not smoke are not affected but for a country like Syria which is trying to bring tourists , banning smoking is counter productive ,
By the way Alex I understand what Zenobia went through when she was i Syria , I was there in 2003 and had to sit at the end of the table with the children which i enjoyed to stay away from the smokers in our company , I dealt with it , I did not complain, I could have even gone home .

Alia ,

We always have to think , how much the government has to do to protect us from ourselves and how much we should do , If we are going to leave it to the government to direct us to do the right thing then we do not deserve Democracy and a free discion ,
I can add Alcohol , which i think is more dangerous than Tobacco,
People drink and drive and kill people , spouses abuse their spouse after heavy drinking , it affects more people and alcoholics are a dangerous to others , I do not see you or others calling for the government to ban Alcohol , could that be because Alcohol is a drug and we like people to get numb and forget their sad lives .

government and healthcare providers should provide help to people who want to help themselves not forcing help down their throats.

Alia,
By the way I do not even drink Alcohol ,

Recently in Atlantic city they wanted to implement a ban on smoking in the casinos , they had to resend that law because of fear from the down turn in the economy and the chance that this law will push the Casinos into bankruptcy.
Syria can not and should not make it easier for people to go to Lebanon than to go to Syria and baning smoking could do that.

And that is my take.

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December 19th, 2008, 3:30 am

 

79. Nour said:

Norman,

Remember that the government is not banning smoking; it is merely controlling its use. Specifically, it is banning smoking in public places, because when you smoke in public places you are, by definition, affecting others. As for alcohol, the government does interfere in its usage also. In the US, for example, you have to obtain a license to sell alcohol, you may not sell it to people under 21, and you are not allowed to use it out in the streets, in public beaches, or in public parks. Moreover, in many states alcohol cannot be sold after 1:30 am and we know how strict the government has become on drinking and driving. Likewise, with respect to tobacco, the government is introducing limits on its use and consumption, and is not forbidding people from using it.

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December 19th, 2008, 3:32 am

 

80. norman said:

Nour,

We can not make meat eaters vegetarians over night , doing that and mandating restaurants having only vegetarian food will empty these restaurants , so will baning Tobacco in restaurants and public places it will only empty these restaurants of tourists and customers.and will drive the Syrian economy down hill , have a special places for smokers and for non smokers so they all will come out and eat , like in many states in the US.

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December 19th, 2008, 4:43 am

 

81. Alex said:

Norman,

Our restaurants and bars and cafes in Montreal are doing just fine after the government ban on smoking in public places. Many people were issuing warning like you are doing (since the Quebecois love to smoke etc)

But I support adding taxes on tobacco products … in addition to to banning smoking in public places.

Will soldiers be asked to not smoke?

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December 19th, 2008, 5:32 am

 

82. SimoHurtta said:

Finland has a new law proposal for increasing the tobacco laws and now under heavy debate. The proposal includes that shops must keep tobacco products in a a not transparent box and the shop can give the customer a list of available products but the customer is not allowed to take the paper with him/her. Selling tobacco to minors will be punishable by prison (in Finland causing death for example in traffic or some sexual crimes do not “cause” in most cases prison time). It will be criminal for a minor to have cigarettes in his/her pocket. Limits for smoking in private cars. No candies which “resemble” smoking (liquorice pipes). Etc. “They” are gradually shifting the tobacco products to level with have with illegal narcotics.

If we watch the health consequences in Finland of air “pollution” tobacco is certainly not the most serious. Living in a crowded city causes also burden to the lungs. In the seventies there were studies which claimed that living in a centre of a Finnish town is equal to over 10 daily cigarettes for non smokers. In Finland the problem especially in wintertime is the fine stone dust which the anti-skid tires of cars loose from the asphalt (causes asbestosis like consequences) and the numerous private fire places which burn wood in relative low temperatures which together in windless circumstances cause that the air quality drops dangerously low. And in Finland the towns are relative small and air is clean compared to more crowded countries and less developed countries.

In Finland alcohol and overweight are much more dangerous health risks than tobacco (about 35 percent of Finns smoke). I have never heard that somebody causes troubles under the influence of nicotine, but I can daily read from newspapers stories about crimes made under the influence of alcohol.

My opinion is that this smoking banning has reached its limits (banning smoking in closed public places like restaurants etc is understandable but not outdoors) and is nearing a level where the “majority” terrorises a relative big minority. Sure smoking is dangerous and everybody in developed countries knows that. But so is dangerous drinking soft drinks and eating candies, not to mention junk food. Alcohol is dangerous. Drinking to much fruit juices destroy the dental enamel. Etc. If the society takes to “demanding” attitude with the citizens health issues where are the limits? Will health “jihads /holy wars” against alcohol, hamburgers, sugar products be the next? Should we ban internet and computer games because they cause that some people move to little which lowers their potential life time expectation. Sure they could be argued with same or even better health argumentation as with tobacco.

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December 19th, 2008, 6:01 am

 

83. Alia said:

Norman,

I am cool. It is not about you smoking it is about you as a doctor talking about the matter in this manner. The idea being that the people who possess knowledge and are in a position to share it and to influence the process have more of an obligation.

Addiction is a disease and nicotine addiction has wide ranging consequences. Most people are not educated enough about those consequences, or about the telltale signs of addiction or the process of recovering from this addiction. Even the denial, “oh I can stop any time I want” or ” I am not addicted, I just enjoy smoking” are typical statements of addicts. It is not a matter of free choice here and it is affecting people individually and as a society.

Simo,

I think that the Northern European countries are specially plagued by alcoholism and its consequences. So are France and Germany in term of the cost on healthcare that it is putting on the country and in term of the sociological problems that it is creating. But there are politics there too. One of the most remarkable incidents in the history of science and politics happened in Munich in the early years of the 20th century. Kaiser Wilhelm visited Munich where the famous Emil Kraeplin a neuropsychiatrist worked and had been the first to identify, classify diseases due to the effect of alcoholism on the nervous system, and to speak strongly against alcohol. The Beer barons managed to prevent Kraeplin from being accepted for an audience with the Kaiser to push an agenda for restricitng alcohol production and usage. There were several scientific movements in Switzerland at the end of the 19th century into the 20th which strongly attempted to call for a ban on alcohol but they never took hold enough because no government supported them. The history of the Prohibition in the U.S. is also very instructive.
There is a tendency among humans to get addicted and this is being manipulated by providers of nicotine, alcohol, casinos, cocaine, etc…

I think it makes perfect sense to restrict alcohol as much as other drugs- Legistlation restricting the areas where people can smoke in the U.S. turned out to be the single biggest behavior modification program in the history of the world. But it did happen.

There are now also programs aiming to improve diet and prevent obesity starting in the schools and the fight against obesity is picking up momentum in some of the Western countries that are affected. Recently, most dramatically, India declared that Diabetes has become an epidemic since the country has become more prosperous.
And public health measures have started to be studied.

Now to the bigger question: Are all those steps contrary to human freedom. It seems to me that since man started living in society, certain behaviors have had to be restricted…for the good of the individual and of the society- “you cannot go and kill someone who has raped your daughter which would be a normal wish under certain circumstances, one has to settle for the process of the law”.
Ethicists are always standing in the grey zone trying to highlight the complexities of the trade-offs.

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December 19th, 2008, 12:28 pm

 

84. SimoHurtta said:

I think that the Northern European countries are specially plagued by alcoholism and its consequences.

That is mostly an urban legend Alia. In Nordic countries (all a round the world) we have the tendency of drinking much in a short time but relative rarely. That historical behaviour is basically caused by the requirements set by the cold temperature. In minus 20 Celsius you can’t run drunken all the time around like you can do in less colder areas, so drinking must be planned and “effective”. For this “climate” reason to be very drunk has not been a social tabu here, when it is in central and southern Europe. During the past decades also the drinking habits in Northern countries have become closer to those of Central Europe’s. More wine and beer instead of vodka. Surely we have alcoholics here, but I suppose the average livers are in better shape here than they are in Germany and France.

We had in Finland during the 20′s and 30′s a no alcohol laws as there were in USA. The joy when it was ended was unseen. Still in Finland and Sweden one can buy alcohol only from special by the state owned regulated shops besides the restaurants. Not so freely as in the rest of “civilized” world.

In Finland this no smoking on public places has also stirred a considerable amount of social “terrorism”. In many apartment buildings some non-smoking “experts” complain if others smoke on their own balcony claiming that they have to smell the tobacco. Well the same often elder ladies have usually no problems with smell and others suffering if they make cabbage based soups at home and the whole apartment building is smelling like a “Russian prison camp” (cabbage based foods are very popular in eastern Europe). :D

My point is that all living is dangerous and basically what ever you do you have to pay a price. Is using alcohol worse than eating legal perspiration drugs which affect to one’s psyche (which “they” sell in increasing amounts to an ever growing share of the population). Surely we need information about the consequences of using tobacco, alcohol, medicines, industrial foods etc, but I do not want live in a “Taleban” society where a bunch of fanatical health “experts” replace the religious “function” of (former and future) Afghanistan or present Saudi Arabia.

PS.
Alia a considerable amount of health professionals smoke, drink and eat junk food flavoured with chemicals of which effects we and they have no clue. I know several doctors and nurses who smoke. One hospital here even tried to order that their personnel is not allowed to smoke on free time away from the hospital (not to give a bad example as they said). I call that totalitarian behaviour. Well luckily they had to stop their “fascist” demands.

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December 19th, 2008, 3:29 pm

 

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