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Bismarck Tribune: Study links chemical in e-cigs to lung cancer

BLAIR EMERSON Bismarck Tribune
A new study found e-cigarettes may not be a safer alternative to smoking tobacco.
Harvard T.H. Chan School of Public Health recently published the results of a study that found popular e-cigarette flavors contain diacetyl, a chemical linked to a severe lung disease.
“This latest study … is yet another reminder that e-cigarettes are not a safe alternative to tobacco use,” said Jeanne Prom, executive director of the North Dakota Center for Tobacco Prevention and Control Policy.
Researchers studied 51 types of flavored e-cigarettes that appeal to youths. Many E-cigarette brands offer fruit and candy flavors, which Prom said are unique and target kids.
The North Dakota 2015 Youth Risk Behavior Survey reports that 22 percent of high school students report using e-cigarettes at least once in the month prior to taking the survey.
“Our own North Dakota high school students have tried these products,” Prom said. “It’s not a safe alternative. … You’re really just swapping out one poison for another.”

Diacetyl is a flavoring chemical linked to a type of lung disease called bronchiolitis obliterans, or “popcorn lung,” which got its name after workers contracted the lung disease while working in microwave popcorn factories.
Currently, e-cigarettes are unregulated, but the U.S. Food and Drug Administration has proposed a rule to regulate e-cigarettes just as the agency regulates cigarettes and other tobacco products.
“It is our hope that the FDA’s final rules are released very soon and can provide some regulatory framework that can lead to these products being more properly regulated and less available to kids,” she said.
http://bismarcktribune.com/news/study-links-chemical-in-e-cigs-to-lung-cancer/article_ff4f45b4-8374-5ae0-9588-32491eb790ad.html

Medical News Today: Graphic warnings on cigarette packets 'help smokers consider health risks'

Written by
With 2016 just around the corner, many individuals will be gearing up to take on one of the most challenging New Year’s resolutions: to quit smoking. But a new study suggests this challenge could be made easier if graphic warning labels were put on cigarette packets, after finding such warnings trigger more negative feelings toward smoking than text warnings alone.
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Lead study author Abigail Evans, a postdoctoral researcher at Ohio State University, and colleagues publish their findings in the journal PLOS One.
In 2011, the Food and Drug Administration (FDA) published a final rule that required tobacco companies to include color graphics on cigarette packets that depict the negative health implications of smoking.
In 2012, however, a US federal appeals court overturned the ruling, claiming the images put forward by the FDA were “unconstitutional” and were “unabashed attempts to evoke emotion […] and browbeat consumers into quitting.”
According to Evans and colleagues, their findings suggest the decision to overturn the FDA’s rule based on these grounds was wrong; the team says the graphic images do not “browbeat” consumers, and though they do evoke emotion in smokers, the researchers say these emotions make people think more carefully about the health risks of smoking.
“What the court is missing is that without emotions, we can’t make decisions,” says study coauthor Ellen Peters, professor of psychology at Ohio State. “We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

Feelings produced by graphic images ‘acted as a spotlight’

The team reached their conclusion by assessing 244 adults of an average age of 34 who smoked between 5-40 cigarettes a day.
For 4 weeks, smokers were given their preferred brand of cigarettes in packaging that had been modified; some packets contained warning text only – such as “cigarettes cause fatal lung disease” – some contained warning text plus one of nine graphics depicting the dangers of smoking, while others consisted of warning text, graphics plus additional text detailing the risk of every cigarette smoked.
The warning graphics used were developed by the FDA and contained disturbing images, such as a man smoking through a hole in his throat, depicting a surgical procedure known as a tracheostomy that is a result of some smoking-related cancers.
Each week for the 4-week period, smokers collected their cigarettes from the lab and completed surveys detailing how the new packaging made them feel about smoking.
Compared with participants who received text-only packaging, those who received packaging with graphic warnings were more likely to read or look closely at the information, were more likely to remember the information, and were more likely to report that the packaging made them feel worse about smoking.
“The feelings produced by the graphic images acted as a spotlight,” notes Peters. “Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks.”
In addition, smokers who received packaging with graphic warnings were also more likely to view the information as more “credible” than those who received text-only packaging, and they were also slightly more likely to say they planned to quit smoking.
“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” says Peters. “The effect was small, but it was not unimportant.”
Overall, the researchers say their findings show graphic warnings are more effective than text-only warnings for getting consumers to consider the health risks of smoking. They add: “Policies requiring such labels have the potential to reduce the number of Americans who smoke. The effect induced by graphic warning labels appears to have utility in communicating more and more credible information, useful to promoting risk perceptions and quit intentions among smokers in the US and around the world.”
This research supports another study reported by Medical News Today earlier this year, which found a combination of health warning graphics and text on cigarette packets increased knowledge about the dangers of smoking among young adults, compared with text-only warnings.

http://www.medicalnewstoday.com/articles/304495.php

WebMD News from HealthDay: Tobacco Exposure and Infertility, Early Menopause

By Kathleen Doheny, HealthDay Reporter

Smoking and being exposed to secondhand smoke may trigger early menopause and infertility in women, a new study suggests.
Other research has linked smoking with higher rates of infertility and perhaps earlier menopause. However, “secondhand smoke is less researched,” especially among never-smoking women, said study author Andrew Hyland, chair of health behavior at Roswell Park Cancer Institute, in Buffalo, N.Y.
In the study, Hyland and his colleagues evaluated women enrolled in the Women’s Health Initiative, a large study launched in 1991 to look at a variety of health issues in more than 160,000 generally healthy, postmenopausal women.
Hyland’s team looked at information about age of menopause and fertility, along with tobacco exposure, among some of the women enrolled in the study. The investigators evaluated information available on about 88,000 women to look at the fertility effects. They also looked at information on about 80,000 to examine onset of natural, or nonsurgical, menopause.
Both smoking and exposure to secondhand smoke were linked to fertility issues and early menopause (before the typical age of 50), the researchers found.
Compared with never smokers, current or former smokers were 14 percent more likely to be infertile and 26 percent more likely to have early menopause. Early menopause has been linked with a higher risk of death from all causes, Hyland pointed out.
Among never smokers, those exposed to the highest level of secondhand smoke (such as living with a smoker for 10 years or more) were 18 percent more likely to have fertility problems and early menopause, the study found.
Women who had ever smoked reached menopause about 22 months before those who never smoked or never were exposed to smoke. Those exposed to the highest level of passive smoke reached menopause 13 months earlier than those not exposed, the findings showed.
But the study cannot prove cause and effect, Hyland added. “This is an observational study looking at data already collected,” he said. “It [the link] could be something associated with early development and exposure as a young child.”

Smoke interacts with hormones and can have adverse effects as well, he added.

The study was published online Dec. 15 in the journal Tobacco Control.

The findings are a valuable reminder to avoid all smoke, said Patricia Folan, director of the Center for Tobacco Control at North Shore-LIJ Health System in Great Neck, N.Y.

“This study provides additional motivation and incentive for women of all ages to avoid smoking and exposure to secondhand smoke, as well as to quit smoking,” she said. Both are associated with premature birth, low birth weight, infant death and certain birth defects, she added.

“This evidence, in addition to the data from the current study, offers health care providers, particularly ob-gyn practitioners, the information needed to counsel women about the hazards of smoking and secondhand smoke, and to encourage cessation,” Folan said.

http://www.webmd.com/smoking-cessation/news/20151215/active-passive-smoking-tied-to-infertility-early-menopause-study

NBC News: Cigarette Smoke Might Cause Infertility, Early Menopause, Study Shows

by Maggie Fox

Tobacco smoke might do more than cause cancer, heart disease and lung damage. It might also injure fertility in women, researchers reported Tuesday.
Women who smoked the most, and who started at the youngest ages, went through menopause almost two years earlier than women who never smoked, Danielle Smith of the Roswell Park Cancer Institute in Buffalo and colleagues reported.
Women who remembered breathing in the most secondhand smoke went through menopause an average of 13 months earlier than women who didn’t think they’d ever breathed any in, the team reported in the journal Tobacco Control.
The team studied more than 93,000 women taking part in the Women’s Health Initiative Observational Study between 1993 and 1998. They filled out very detailed questionnaires on lifestyle habits, health problems and medical diagnoses.
They found that women who smoked 100 cigarettes or more in their lives had a 14 percent greater risk of infertility and a 26 percent greater risk of going through menopause before they turned 50.
The study helps confirm other studies that have linked smoking with early menopause.
Women who grew up with a smoker in the house for 10 years or more, those who lived with a spouse who smoked for 20 years or more, and those who worked with smokers for 10 years or more were 18 percent more likely to have had infertility problems than women who had never been passive smokers.
Overall, about 15 percent of the women said they had struggled to conceive for a year at a stretch or more, and 45 percent said they went through menopause before they turned 50.
There’s a debate over whether fertility rates have fallen, and many people have blamed chemicals known as endocrine disruptors in cans, bottles and in water supplies. But tobacco also contains these.
The toxins in tobacco smoke can interfere with the production of hormones related to fertility cycles, they can damage the production of egg cells, they can hurt the embryo before it gets implanted in the wall of the uterus, and they can restrict the processes that prepare a womb for pregnancy, the researchers said.
“Tobacco toxins also seem to lower the age of natural menopause by reducing circulating estrogen,” they wrote.
Smoking can also affect men in specific ways. For instance, it seems to damage the male Y chromosome especially badly.
Smoking is on the wane in the U.S. Last month, the Centers for Disease Control and Prevention reported the percentage of U.S. adults who smoke cigarettes declined from 20.9 percent in 2005 to 16.8 percent in 2014.
And smoking bans have made secondhand smoke in the workplace and public areas a thing of the past in most states.
http://www.nbcnews.com/health/womens-health/cigarette-smoke-might-cause-infertility-early-menopause-study-shows-n480661

USA Today Network: Study suggests link between flavor in e-cigarettes and lung disease

, USA TODAY Network
Flavored e-cigarettes may seem like an alternative to smoking, but researchers warn that flavored e-cigarettes may not be worth the unknown long-term risks.
Researchers at the Harvard University T.H. Chan School of Public Health tested 51 types of flavored e-cigarettes and flavor canisters for diacetyl, acetoin, and 2,3-pentanedione; three chemicals known to cause respiratory problems in factory workers.
The study tested popular e-cigarette flavors like bubble gum, cotton candy and tutti frutti, and found, at least one of the three chemicals were present in 47 of the 51 products they tested.
With around 7,000 e-cigarette flavors on the market, consumers are essentially at the mercy of the manufacturers, with little hope of knowing what chemicals are used in the products, according to Taylor Hays, director of Mayo Clinic Nicotine Dependence Center.
“There are no FDA regulations on these products. It’s the Wild West of e-cigarettes,” Hays told USA TODAY Network.
He says the popularity of e-cigarettes continues to grow among adults that think the products will wean them off of regular cigarettes and among younger users. The percentage of teens using e-cigarettes tripled from 2013 to 2014, according to an April report from the Centers for Disease Control and Prevention (CDC).
The study was published Wednesday in the journal Environmental Health Prospectives.
Diacetyl has been directly linked to “bronchiolitis obliterans,” which in serious cases can require lung transplants, according to Robert Kotloff, chair of pulmonary medicine at Cleveland Clinic.
The disease, also known as “popcorn lung,” got its name from workers who developed the disease after inhaling diacetyl while working in popcorn factories, according to Kotloff.
While the study doesn’t provide a concrete link between flavored e-cigarette use and lung disease, it does further the debate over the unknown long-term consequences of e-cigarettes use.
“[The study] is an intermediary step showing the presence of a compound which could potentially predispose individuals to develop bronchiolitis obliterans,” Kotloff told USA TODAY Network.
http://www.usatoday.com/story/news/nation-now/2015/12/09/chemical-flavor-e-cigarettes-lung-disease-harvard-study/77043340/

Penn State News: Potentially dangerous molecules detected in e-cigarette aerosols

By Scott Gilbert

HERSHEY, Pa. — Electronic cigarettes produce highly-reactive free radicals — molecules associated with cell damage and cancer — and may pose a health risk to users, according to researchers at Penn State College of Medicine.
The use of e-cigarettes is on the rise. According to the Centers for Disease Control and Prevention, more than 20 percent of young adults have tried e-cigarettes, and current smokers and recent former smokers are most likely to have used them.
E-cigarettes deliver nicotine in water vapor instead of by burning tobacco. The battery-operated devices have been marketed as an alternative to traditional cigarettes.
Despite their growing popularity, very little is known about toxic substances produced by e-cigarettes and their health effects.
“There’s a perception that e-cigarettes are healthier than regular cigarettes, or at least not as harmful as regular cigarettes,” said John P. Richie Jr., professor of public health sciences and pharmacology. “While e-cigarette vapor does not contain many of the toxic substances that are known to be present in cigarette smoke,  it’s still important for us to figure out and to minimize the potential dangers that are associated with e-cigarettes.”
Previous studies have found low levels of aldehydes, chemical compounds that can cause oxidative stress and cell damage, in e-cigarette “smoke.” But until now, no one has looked for free radicals, the main source of oxidative stress from cigarette smoke. Highly reactive free radicals are a leading culprit in smoking-related cancer, cardiovascular disease and chronic obstructive pulmonary disease.
Instead of smoke, e-cigarettes produce aerosols, tiny liquid particles suspended in a puff of air. The researchers measured free radicals in e-cigarette aerosols.
They found that e-cigarettes produce high levels of highly reactive free radicals that fall in the range of 1,000- to 100-times less than levels in regular cigarettes.
“This is the first study that demonstrates the fact that we have these highly reactive agents in e-cigarette aerosols,” Richie said. Results were published in the journal Chemical Research in Toxicology.
“The levels of radicals that we’re seeing are more than what you might get from a heavily air-polluted area but less than what you might find in cigarette smoke,” Richie said. The radicals are produced when the device’s heating coil heats the nicotine solution to very high temperatures.
Further research is needed to determine the health effects of highly reactive free radicals from e-cigarettes.
“This is the first step,” Richie said. “The identification of these radicals in the aerosols means that we can’t just say e-cigarettes are safe because they don’t contain tobacco. They are potentially harmful. Now we have to find out what the harmful effects are.”
Richie is currently conducting studies to carefully measure total numbers of free radicals in e-cigarette aerosols and to identify their chemical structures.
“That will help us interpret the data better to know how dangerous they are,” he said.
Other investigators on this project were Reema Goel and Jonathan Foulds, Department of Public Health Sciences, and Neil Trushin and Bogdan Prokopczyk, Department of Pharmacology, all at Penn State; Erwann Durand and Ryan J. Elias, Penn State College of Agricultural Sciences.
National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration funded this research. (P50-DA-036107)
http://news.psu.edu/story/383055/2015/12/02/research/potentially-dangerous-molecules-detected-e-cigarette-aerosols

AP: Higher cigarette taxes could save babies' lives, study finds

CHICAGO — When it costs more to smoke, fewer babies die, according to a new study that links rising cigarette taxes with declines in infant mortality, especially among blacks.
With nearly 4 million annual births nationwide, the results suggest that a $1 increase in cigarette taxes would be expected to lead to 750 fewer infant deaths each year, the researchers said.
Smoking during pregnancy can lead to complications including sometimes dangerous premature births and sudden infant death syndrome. U.S. smoking rates declined during years examined in the study – 1999 to 2010. The research, paid for by the National Institutes of Health, was published online Tuesday in the journal Pediatrics.
The study
Cigarettes are subject to state and federal excise taxes. Dr. Stephen Patrick of Vanderbilt University and colleagues examined data on changes in those taxes and cigarette prices from every state over 11 years. They also analyzed federal data on infant mortality in each state.
Taxes per cigarette pack increased from 84 cents to $2.37 on average, adjusted for inflation. Infant mortality per 1,000 births decreased from about 7 deaths to 6 deaths on average. Among blacks, deaths declined from about 14 to 11 per 1,000 births.
The researchers considered factors other than smoking that influence infant mortality, including family income and education, but still found a link with rising taxes.
The context
Almost 11 percent of U.S. women smoke during pregnancy, federal data show. Previous studies have linked higher cigarette taxes with declines in smoking during pregnancy and with better newborn health. The researchers say their work is the first examining these taxes and U.S. infant mortality rates.
Raising tobacco taxes is among strategies the Centers for Disease Control and Prevention supports to reduce smoking. A U.S. Surgeon General report last year said reducing smoking among pregnant women and women of reproductive age “remains a critical component of public health efforts to improve maternal and child health.”
The researchers say the taxes could have negative consequences for pregnant smokers who don’t quit and can’t afford to buy necessities because of high cigarette prices – a possibility the study didn’t examine. The study lacked information on all variables that could affect infant mortality. Still, they say their study adds to evidence for policymakers to consider in seeking ways to reduce infant deaths.
http://www.cbsnews.com/news/higher-cigarette-taxes-save-babies-lives-study-finds/

Healthline News: Teen E-Cigarette Use Linked to Breathing Problems

A study of adolescents in Hong Kong found respiratory issues were 30 percent more likely in vapers than non-vapers.
Written by Roberta Alexander

E-cigarettes and vaporizers, widely touted as a way to quit smoking, remain controversial. For every supporter who sees them as useful, there is a health expert suggesting that these products are dangerous in their own way.
A new study out of Hong Kong is not likely to settle the issue any time soon.
Researchers looked at the respiratory health of Chinese adolescents, both those who use e-cigarettes and those who do not. The results, published in JAMA Pediatrics, have raised concerns about the impact of e-cigarettes on the health of minors.

Ecig Teen
Indeed, one of the authors of the study, Daniel Ho, Ph.D., of the University of Hong Kong, said in a press release, “E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time.”
Ho is an associate professor in the School of Public Health whose main research interests are in adolescent health in relation to tobacco, alcohol, and obesity.
He and fellow researchers found that adolescents who use e-cigarettes were approximately 30 percent more likely to report respiratory symptoms than adolescents who do not use them.

Thousands of Students Studied

More than 45,000 students in Hong Kong participated in the study. Data was collected between 2012 and 2013.
Of the sample population, 1.1 percent of students reported e-cigarette use within the past 30 days. Those students were 30 percent more likely than their peers to report respiratory problems.
The results are suggestive but not definitive. Dr. Norman H. Edelman, senior consultant for scientific affairs for the American Lung Association, found the study intriguing.
“It’s important [but] we need to know if the lungs are injured. It’s not clear if this really affects the lungs. We’re not sure what the symptoms are,” Edelman told Healthline.
He wondered if the young subjects were reporting soreness in their throats, excessive coughing, or difficulty breathing. He would like to see a follow-up study, perhaps in the United States.
“We need to do lung function tests,” he said.
“Whenever you breathe in something, you don’t know what’s in it. Some of the data suggest irritation,” Edelman said. “We don’t know what the negative effects are. This is just a beginning.”
E-cigarettes and vaporizers use liquids that have varying amounts of nicotine or none at all. These liquids are not regulated by the U.S. Food and Drug Administration (FDA), but generally also contain propylene glycol, a suspected lung irritant, and vegetable glycerin.
“While supporters [of e-cigarette use] are optimistic about the potential for harm reduction in the minority of established cigarette smokers, [for] which convincing evidence is lacking, this does not seem to justify the potential harm of renormalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority of non-smoking young people,” Edelman said.

E-Cigarettes Gaining in Popularity

The use of e-cigarettes have surpassed the use of conventional cigarettes among young people in the United States.

Mitch Zeller, director of the Center for Tobacco Products at the FDA, called those numbers “astounding and concerning” in an interview earlier this year.
“Nicotine is very harmful to the developing child and adolescent brain,” Zeller said. “Parents should take no comfort in the fact that their kids are using an e-cigarette rather than a burning cigarette because of the presence of nicotine.”
http://www.healthline.com/health-news/teen-e-cigarrette-use-linked-to-breathing-problems-111715#1

Reuters Health: Adolescent e-cigarette use tied to breathing problems

BY ANDREW M. SEAMAN
Adolescents who reported using e-cigarettes were about 30 percent more likely to report respiratory symptoms than those who never used e-cigarettes, in a study from China.
The increased risk of breathing problems – like a cough or phlegm – varied depending on whether or not the adolescents also smoked traditional cigarettes.
“Among never smoking adolescents, e-cigarette users are twice as likely to report respiratory symptoms than non-users,” study author Dr. Daniel Ho, of the University of Hong Kong School of Public Health.
 
“E-cigarettes are certainly not harmless and serious health problems of long-term use will probably emerge with time,” Ho added in an email to Reuters Health.
E-cigarettes deliver nicotine through a vapor, which contains propylene glycol and flavoring chemicals known to be bothersome to the respiratory system, the researchers write in JAMA Pediatrics.
While past research found some short-term respiratory effects in adults after e-cigarette use, the researchers say no study had looked for these effects in adolescents.
The new findings are drawn from data collected between 2012 and 2013 from over 45,000 schoolchildren in Hong Kong with an average age of about 15.
Overall, 1.1 percent of students reported smoking e-cigarettes within the past 30 days, and about 19 percent of all students reported respiratory symptoms.
Students who smoked e-cigarettes were 30 percent more likely to report breathing problems, compared to those who didn’t use the devices.
The difference in breathing problems was most pronounced among students who said they never smoked traditional cigarettes. These students were over twice as likely to report breathing problems as those who didn’t use e-cigarettes.
Students who reported using e-cigarettes and also smoking traditional cigarettes at some point in their lives were at a 40 percent increased risk of breathing problems, compared to those who didn’t use the devices.
While the study can’t prove the devices caused breathing problems among children, the researchers say the findings support the World Health Organization’s recommendation to regulate e-cigarette use among children.
“Other studies have also shown that adolescent e-cigarette users are more likely to initiate cigarette smoking than non-users,” Ho said. “One in two smokers will be killed by tobacco; two in three if started from a young age.”
Parents, he said, can prevent e-cigarette and traditional cigarette use among their children by not using the devices or tobacco, not exposing their children to secondhand smoke and setting strict smoke-free rules at home.
“E-cigarette use is a controversial topic,” Ho said. “While supporters are optimistic about the potential for harm reduction in the minority of established cigarette smokers, (for) which convincing evidence is lacking, this does not seem to justify the potential harm of re-normalizing cigarette smoking, delaying smoking cessation, and escalating to real cigarette smoking, especially among the majority non-smoking young people.”
http://www.reuters.com/article/2015/11/09/us-health-ecigarettes-adolescents-breath-idUSKCN0SY22Y20151109#UoWlC6rr1iRdS4YY.99

Patient-centered care helps patients overcome mental illness and tobacco use

By Chizimuzo Okoli, Contributing columnist, Lexington Herald-Leader

People diagnosed with chronic mental illness will die an average of 10 years earlier than those without mental illness.
A number of social and biological factors contribute to early mortality, but 40 percent of people with a mental health condition also practice one of the most preventable health risk behaviors — smoking.
A study from the National Institutes of Mental Health found that people with a mental illness smoke nearly half of all cigarettes in America. The Journal of the American Medical Association provided evidence that people with severe mental illness are at a higher risk of cardiovascular death. Depression is three times higher in smokers than in non-smokers, and an estimated 70 to 85 percent of people with schizophrenia are tobacco users.
Evidence supports a bi-directional relationship between tobacco use and depression. For some patients, smoking can alleviate pre-existing symptoms of depression and anxiety by releasing dopamine, a source of pleasure, in the brain. But evidence also suggests that smoking causes depression and other forms of psychosis, and some people with decreased dopamine levels are genetically predisposed to tobacco use and dependence.
Health care providers must address the patient’s tobacco use, a chronic addictive condition, in conjunction with the mental illness to preserve health. To accomplish this, we must:
Treat both conditions at once
Some evidence-based pharmacological methods are dually effective in treating tobacco use and mental illness. For one, bupropion hydrochloride has proven successful in reducing depression and serving as a smoking cessation aid.
Acknowledge the mental health effects of quitting
The decision to quit smoking benefits the patient in the long term, but nicotine withdrawal might exacerbate or lead to depressive symptoms. Patients must communicate with a health care provider about any side effects associated with quitting, such as depression. Patients can also participate in group therapies or meet with a counselor to mitigate the negative effects of quitting smoking.
Ensure that intervention is patient-centered
When patients give up smoking, they’re letting go of a coping mechanism or a companion. The patient should remain the central focus in any intervention, and providers should act with empathy and understanding, because quitting is a process requiring perseverance. A patient-centered plan should incorporate aids to quit smoking as well as mental health support and accessible resources.

Dr. Chizimuzo Okoli is an assistant professor in the UK College of Nursing.

http://www.kentucky.com/2015/10/24/4103534/patient-centered-care-helps-patients.html