 Welcome to this edition of Abledon on Air, the one and only program that focuses on the needs, concerns, and achievements of The Diffinitely Abled. I've always been your host, Lauren Seiler, and on this program that focuses on the needs, concerns, and achievements of The Diffinitely Abled in Vermont and beyond, we will focus on smoking cessation and what we can do to possibly educate you to quit smoking and the dangers of it. With me to discuss these important, with us to discuss these important issues, are Lisa Champagne of Central Vermont Medical Center and Bill, for an hour? Of Washington County Mental Health. Welcome to Abledon on Air. Thank you for joining me. Thank you for joining us. What are the missions and goals? Let's start with both of you. Both of you can answer this. What are the missions and goals of your programs? How did they get started and why? As far as the hospital goes, our mission is to serve the needs of Central Vermont and health needs and at this point moving forward to continue to assist people that are still using tobacco. Numbers have dropped throughout the years, but we'd like to see them lower. Tobacco use is not only smoking, it's also other ways to introduce nicotine into your system such as oral or even people are vaping. Bill? Our program began, smoking cessation program began in January of 2003 and one of the things that we discovered among our clients was that an extraordinarily high percentage of them were smokers. In fact, we did a survey in October of 2008 and discovered that 56% of the consumers that we work with are smokers, which if you think about it in terms of the population at large, that's probably two to three times higher than the population at large. We did some more recent surveys and discovered that of the 390 consumers of our services that we have currently, that figure is down to 42%, which is a fairly significant drop, but it's also significantly higher than the population at large. Let me, if I could be clear about sort of who we serve. We provide mental health services to folks in Washington County. The specialized program that I work in works with people with diagnoses of schizophrenia, bipolar disorder, major depression and other major mental health disorders. And part of the problem that some of the folks have around nicotine dependency is that they tend to smoke cigarettes far more intensely. They tended to start smoking when those symptoms were developing in their late teens and early 20s. Is it due to peer pressure? Is part of it due to peer pressure? I'm glad you asked that. That's a significant part of it. For a lot of folks that we work with, some of their smoking habit developed when they were in the Old Vermont State Hospital. Or when they were living in group homes in this community or in other places, one of the things that happens is that that group of folks that we work with are extraordinarily high incidents of smokers, and that behavioral thing is just constantly reinforcing. So that's also one of the primary problems in helping them stop. Is it like pressure from their friends? Oh, absolutely. Absolutely. They get together and let's go outside and have a cigarette. Yeah, peer pressure. We want to ask both of you this question here. It says, well, part of your statistics, it says that your clients are at risk for dying 25 years or younger than the general population. Yes. Do you think tobacco companies, now I know tobacco companies have, some of them have been sued, Philip Morris and some others, because of the lies that they've been telling people. Yes. Has that changed? Or has that become an issue with, you know, because smoking causes death? Because of lung cancer. Lung cancer, right. Emphysema, heart disease. Yes. And I think your program was helped as well by some of the tobacco settlement money. Oh, it has been. In the early part of the 2000s. And that money helped a lot in terms of developing our respective programs. So the Vermont quit partners, they're throughout the whole state of Vermont. Yes. And our quit programs are offered in each hospital service area. We each cover certain counties. So, you know, I offer tobacco cessation workshops on campus at CVMC. We also try to bring them out to the community. You go to people's homes and have sessions there. We're not able to go to their homes, but we're able to go to, you know, employment sites. And, you know, we've held workshops and libraries. We could do it at a church. You know, employers, places. Now let's talk about the cost for a minute. Because a pack of cigarettes, depending on the brand. Whether it be, okay, we can, you know, free speech so we can mention. Whether it be Marlboro, Camel, right. They go between $7 to $8 a pack. But when you talk, get it having a carton of cigarettes. That's when you get into the money aspect. $150, $200. People, when you have to feed your family, you're taking money out of your children's mouths. You're feeding the habit and not feeding your family. Yes, it's a pleasant habit. Talk a little bit about, has that changed, has that gotten a little better? Because you still have the patches and you have other ways of quitting smoking. But how is the cost skyrocketed? I think one of the things that we've seen over the years is that the taxes on cigarette products have increased substantially. Is that tobacco and alcohol as well? I'm talking primarily about tobacco in this case. And one of the things that I think is interesting is that from what I understand, the information I've seen, is the cost of producing a pack of cigarettes by a tobacco company is about four cents or six cents. Per piece of cigarette. I'm talking about what it costs to on the line and put it in the truck. So what I'm saying is that the balance of the money that people pay for a pack of cigarettes is largely based on taxes and profits to tobacco companies. But notwithstanding that, and I think more specific to your question, most of the people that I work with are on fixed incomes. They're getting Social Security disability. They may have some small jobs on the side, but they have limited income. And there is no question about the fact that if they are smoking, let's say a carton a week, and that's costing $100. Because it's not unusual for people to smoke a pack, a pack and a third a day. But if they're spending $300 or $400 a month out of, let's say, $700 or $800 that they're paying, they may be getting Section 8 and other kinds of health care benefits, but the point is that's the single largest cost. And it squeezes out food and it squeezes out virtually everything else. And their health, I think, suffers largely as a result of that. I think when you're smoking you're not exercising, when you're smoking you're not watching your diet. And people, some of the data that we've seen indicates that they're dying 15 to 25 years earlier. Their life expectancy is that much less than the population at large. What do you think of those e-cigarettes now? Well, I think that e-cigarettes have been sold with the idea that this is like any other form of nicotine replacement therapy and it's not. No, it's not. They're not approved by the Food and Drug Administration and I think my experience... So, being, I apologize, being the fact that it's not approved by the Smoking and Drug Administration, does that make it more dangerous? Well, I think that they're suggesting that it's not useful in terms of if it's being sold as a way of stopping smoking. I mean, I think that's ludicrous. There's other harmful chemicals in those units. Like what, for example? Whatever the vape is. You mentioned vaping and I don't know. A lot of them have their batteries in them or they have some sort of chemical that creates a vapor and they're adjusting that. That's harmful. Nicotine and yeah. They have no idea how much nicotine they're receiving in these devices and you know, there's proven products out there that are available. Patches, gum, lozenges, you know, within my program. They're free if people, you know, attend the workshops. Most insurances are covered. Medicaid covers most of it, yeah. Those products and prescription products to help them. Does insurance pay for your pro like, okay, for example, if I was on a certain insurance and I wanted to get, we wanted to get a service, a counseling. It's considered counseling if I'm not mistaken. Would insurance pay for my- Our programs are free. If you attend our programs, we're able to assist you with free product. Patches, gum, lozenges, you know, you come in, we get you signed up. Support, you know, group setting, you know, information, trying to help people with their barriers and free product gets shipped to their house. How long does it take usually for a person to quit, I mean well. To go cold turkey. It varies. You know, it's an individual plan. It varies. You know, I look at it is, if they even come once, we've planted a seed. If they come once to one of our sessions we've planted a seed. They may not quit that given day or within, you know, four weeks. But, you know, their goal ideally is to quit. Our group is open-ended. Which means what? Which means that somebody can come to a group anytime and they can come to as many groups as they want. And we have some people who come time after time, weekend and week out. Part of the reason for that is that a lot of our folks, as I said earlier, are very dependent on nicotine. And so they will stop smoking for a while and they'll relapse and then they'll stop smoking for a while and they'll relapse. Or they'll very slowly reduce the amount of cigarettes that they're smoking every day. We have people who continue to come to group years after they've stopped smoking for ongoing support. And it's also extraordinarily helpful that they're there because I think it shows for those who are really struggling with stopping smoking that it's possible to do. Now, just so I can reiterate, your program in Washington County is only for clients. Clients of Washington County Mental Health Services. Yes, so bills program for those that are watching, bills program is only for people who are getting services through Washington County. And your program is for the public? Absolutely. Now, our question is this, the chewing tobacco. Chewing tobacco, snuff, as it's called, I think, yeah, snuff. A lot of the, talking a little bit about the history, major league baseball players used to chew that during national anthem, during breaks. And they spit, they sometimes spit out blood that gets nasty and you get mouth cancer from it. Is that more dangerous? Some tobacco products when you actually chew it, is it more dangerous than a cigarette? More vice versa. It's all dangerous. All dangerous. So it has the same chemicals as a cigarette itself. Well, there's higher incidences in there. You probably know this better than I do of mouth cancers, right? For those who are using chew or smokeless tobacco. They call it skull, that's the name of the... Oral cancer and you'll find that nowadays dentists actually will, during your, you know, your annual exams or by annual, they'll check for oral cancer, which is great. Yeah. So it's all one. You get cancer the same way it doesn't matter. Cigarettes chew. It's not like there is a version of nicotine or nicotine products that's less dangerous than the others. It's also equally. Now, how does the patch work? The patch is something you slap on and you slap it on every day and it comes in, what, three levels? Different milligram strains. So it's medication that's going into your lungs. It's nicotine. It replaces what, you know, persons quitting. They're giving up nicotine, you know, abruptly. And so it's a way to continue to have the nicotine but not, you know, the other harmful effects from the cigarette or the chew. And it delivers nicotine in a constant dose. They put a patch on every day. And new patch on every day. Gradually they start to, you know, lower their doses and wean themselves off of the patch. In terms of now, let's go back. In terms of all the money spent. Okay. What was one of the reasons why they had that lawsuit between the tobacco companies? Is it because they were telling wrongful truths to people? Or how was that working with the public? Because in terms of quitting smoking, right, which is really important and that's why we're here, to get people to quit. You know, so they know the dangers of tobacco. Right. That's the reason behind it. I mean, certainly one impression that I've had is that the single healthcare choice that you can make, that will affect your longevity and your resistance to disease is to decide or not to decide whether to smoke or not. So accordingly, if you think about treatment for heart disease or you think about treatment for lung cancer or you think about treatment for emphysema, that's a lot of healthcare costs. Yeah. And certainly this state and certainly Medicaid, Medicare costs, you know, were very significant. And I think one of the reasons that the states banded together to sue the tobacco companies back in the early 2000s was they needed some help in recovering some of those costs. You know, it was, you know, tobacco companies were making the profit and the states were left holding the bag in terms of the healthcare costs. And so I think that was a big part of it. That's my understanding. I agree with Bill. Yeah. And if you look at the package of cigarettes, it will, there's a warning on there, you know, that potentially can cause cancer and, you know, there's health risk. And it does exactly what it says. What are your future goals with your programs and how do you see your programs going into long term? Both of you? Well, one of the things, I'm sorry, I keep stepping in here. Go ahead, go ahead. No, I think one of the, it's interesting in terms of some of the policy changes that have happened over the years. And one of the things that I wanted to mention was that this hasn't come up here so far is the whole idea that there are lots of areas, you know, public spaces and communities, restaurants. Yeah. Lots of places, including healthcare organizations, including public housing organizations. Buildings have started to become more smoke free. Where smoking is prohibited, exactly. And so if you live in a subsidized housing, in a public housing situation, you can't smoke in that house. You can't smoke in your apartment. Or in terms of, because I've done culinary, so I've worked in kitchens, you're not allowed to smoke. If you smoke, you get to smoke within 25 feet of that establishment. So it's only been within, we started in 2014, we finished the policy in 2015. But Washington County Mental Health has numerous programs across, you know, Washington County in Barry, Montpelier, Waterbury, etc. And one of the things that, one of the things that we've done is we've established a smoke free campus. And the purpose of that is we're basically making a statement that smoking is unhealthy and that we want to encourage you to stop smoking. Real quick, did you want to ask a question? Yeah, smoking has been, you know, very expensive and, you know, people smoke because it's a bad habit and they don't want it, they smoke. Are they stopping smoking in restaurants? Completely, completely. I don't believe there's any restaurant that allows smoking. Because I know in New York they stopped, they stopped. Yeah, I think in Vermont. You're finding a lot more public places. In hospitals too, I guess. Because I see the work of smoke outside. You know, there's a new piece that's kind of getting out there, you know, the e-cigarettes. Yeah, yeah, yeah. Publicity, you know, how do they, you know, determine it's not really a cigarette. No, it's not really a cigarette. It's giving off a vape that is unhealthy. I hope kids are not picking up the teenagers. And moving forward, you know, the programs are out there to decrease, you know, tobacco use. People don't, sometimes don't look at tobacco use as people that use oral tobacco either. Yeah. What is the smoking age here in Vermont? Because we're building where we live and still come smoking soon, smoke free. 18, 20, okay, 18 to buy cigarettes, 21 to buy liquor. But they're looking to change the age to 21. I think in New York they did that. They raised it to 21 because if you get caught, they would find you. What are the misconceptions of, well, the misconceptions as far as smoking, you know, because years ago it turns to commercials and product placement. Oh, for example, cartoons, you would see a cartoon with a cigarette. You know, cigar, cigarette, Flintstones, for example. Oh, those western movies that spoke to cowboys. Cowboys. John Wayne with smoke. Marlboro Man. Marlboro Man. So what is your take on how media places cigarettes or is misleading people? What is your take on that? Well, I think we've seen over the years considerably less advertising for tobacco products. You know, and it's off of television, you don't hear it on the radios. As much. Right, I think there are, I don't think you find tobacco advertising much in magazines and newspapers and that kind of stuff. I think that a lot of, and it's interesting because I don't think that we're fully conscious of sort of where it is. I think there's still, you know, if you go into places that sell tobacco products, there's ads and stuff in there, but I think by and large they're off the, you know, you don't see them too much on the media much anymore. What is your take on how media plays a part? I think there's so much education out there about the bad effects of tobacco use and just, it's not, it's not out, it's not upfront anymore. There are some organizations sometimes that will work with different stores, even in this area, Central Vermont New Directions. What is New Directions? Central Vermont New Directions, they're here in Montpelier. So what is it? They work with substance abuse, alcohol, tobacco, and they have worked with some local stores, you know, so they're, the upfront advertising for tobacco is not right upfront, you know. Some of the stores are willing to, you know, buy into it, and I think, was it CVS that no longer sells tobacco? Yeah, CVS no longer sells. It's happening, and I think it's not going to go back. I guess the other one will follow, you know. We're going to move forward with this, but a lot of the tobacco companies, they find new ways to market different products that appeal to people and the youth. And, you know, hopefully we can keep the youth away from these products. Yeah. Last main question before we end, lung cancer, right? It's a big thing. Smoking can cause fires. You fall asleep. Oh yeah. There's two other questions. Dangers of, let's start with this one. Dangers with smoking. Like, so it's pregnant patients smoke. People fall asleep while the cigarette is burning, different things. How do you deal with those issues? But then more importantly, lung cancer is a biggie. When my father was smoking, before he died, the doctor showed him an x-ray of his lungs. Black lung, not so black lung. How long is the process, how long is the process with lung cancer? Like, how long will it take for a person to, if you smoke every day? Constantly, years and years and years and years. No matter if it's a pipe or a cigar. How long does it take to a person to get really sick? You can answer that question. I do think it's very individual. That just depends. An emphysema is usually the beginnings of emphysema. Long functioning is a pretty early indicator that people are starting to have problems. Yeah, breathing. Exactly. What's interesting is that, I don't know whether this is your experience, but my experience is people start coming to my group when they recognize that their health is being compromised. They're having problems breathing, they're experiencing some symptoms. And that's usually the first point at which they've got to figure out whether they're going to stop or not. Okay, the other question as far as dangers. Yeah. I mean, obviously some people should know not to sleep with an ashtray near an open mattress, but it does happen. One of the things I really want to bring up, and we haven't mentioned it, is the whole idea of secondhand smoke. Yeah, that's right. And the vulnerability that our children have, the vulnerability that babies have to increase levels of disease, colds, pulmonary problems as a result of having smokers in the household. And so, I mean, that's for a lot of reasons, that's kind of why in public places smoking is prohibited, because you're at risk if you go by. Now, I think it's a point of contention. How much smoke do you have to breathe in from somebody else before you're subject to disease? But I think it's kind of like zoning in Vermont. Most of us put up fences because we have good neighbors. And I think some of this is really about what's our behavior going to be like in the public, in the community, because we don't want to put our neighbors, the other people that we live with, at risk. That's why there's such an emphasis, I think, today on, you know, how do we manage secondhand smoke and what do we do to make it safer? How does your program deal with the secondhand smokers? Do they have a specific program for them? That becomes part of the topic sometimes, you know, as far as the ones that come that are smokers, you know, dealing with the partners that are always nagging them. And, you know, you're finding also that the public housing is not allowing tobacco. Yeah, well we live and they're going to stop it in July. Most people have been smoking and they're going to stop it completely. And sometimes you can't even smoke 25 feet from, you know, the property. Yeah, they want a certain amount of feet away from the property. The cost, you know, for liability. Also, when somebody moves out of that place, it's like thousands of dollars by time they repaint and sometimes they have to, you know, deal with the duct work and the heating system because that secondhand smoke has traveled through there. And there's something also called thirdhand. And what it is, is the residue, wherever the smoke is going in line, you know, there's chemicals there. It gets on your clothes also. Animals, you know, on the furniture or the carpet and, you know, they clean themselves so they adjust it. You know, little babies, if you have that nicotine and smoke residue, you know, wherever, they can absorb that through their skin because it's just so fragile. I'm not going to tell you something that one person walked into their office one day. This happened in Montpelier. She's on the side of the street waiting to cross the crosswalk. The car goes by and somebody flicks their cigarette out of the window. I think that one more time, sir. This woman was on the side of the road here in Montpelier waiting for traffic to clear to cross the crosswalk. The car goes by and a smoker throws their cigarette butt out the window. Oh, God. And Emperor hit the baby on the underside of the lid. Oh, my God. They got it and didn't hit their eye. It was just a little mark, but even at that, you know, there's so many dangers out there. Did they put the fire out? There was no fire. They just hit the baby. They hit the baby's skin. It burnt that child. I hope they catch the driver. And it's not just that. The cigarette butts are on the ground. Yeah, I see the volunteer garbage pickers out. They pick up a bunch of cigarettes off the floor. What's the fair hand part of tobacco use? They shouldn't have done that. It was stupid. We would like to thank you for joining us on this edition of Ableton on Air. For more information on Vermont Quit Partners, which is part of Central Vermont Medical Center, you can reach Lisa Champagne at LISA.Champagne-C-H-A-M-P-A-G-N-E at CVMC.org or reach her at 802-225-5680. That's 225-5680. And is there a number to reach? Yes, I can be reached through. I work here in Montpelier at Heaton Street. And my number is 223-6328. And I'm the only bill in the building, so I'd be happy to answer in the book. And just as a reminder, the bill's program is only for people who are getting services through Washington County Meta-Health. And while this program is airing in May, this is in a couple of days, it's Memorial Day. And let's bow our heads for a couple minutes of silence for our men and women in the Armed Forces. Well, that wraps up this edition of Ableton on Air. I'm Lauren Silan. I'm Lauren Silan. See you next time.