Quit Smoking Tip of The Week: Fight Post-Cessation Depression!

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Quitting smoking can momentarily bring on a more depressed mood as your body adjusts its hormone balance and the nicotine receptors slowly start to decrease back to a normal level. Think of it this way- when you smoke a cigarette, nicotine attaches to naturally occurring receptors in your brain. When this happens, you get a flood of dopamine (the feel good hormone). As time goes on and your smoking becomes a habit, your brain develops even more receptors allowing more nicotine to bind to receptors, resulting in a huge flood of dopamine. Well, your brain is not used to having this much dopamine readily available and down regulates this amount. Think of it as you listening to uncomfortably loud music and putting earplugs in to lessen what you can hear (Sleight, VJ. (2016, September 18) A craving is just your brain screaming, “WHERE’S MY NICOTINE?” Retrieved from https://www.linkedin.com/pulse/craving-just-your-brain-screaming-wheres-my-nicotine-vj/). This is what your brain does with dopamine.

white headphone

Once you stop smoking, your brain will take a while (a few weeks usually) to adjust to the lessened amount of dopamine that is being produced. Your brain is still down regulating the amount of dopamine being produced, leading to even less dopamine being processed in your brain than before you started smoking. So, you’ve turned the music down but you haven’t taken the earplugs out yet (Sleight, VJ.). The time it takes is different for everyone’s brain to adjust to the normal hormone levels now being produced (some only days, some up to a few weeks) and this could by why some people experience depressed symptoms after quitting tobacco use and some do not. It could also be the reason for increased agitation and feelings of anxiety as part of the withdrawals.

Also, as we dive into the winter season in Michigan we need to be aware that seasonal depression is among us. Up to 10% of adults will experience SAD, Seasonal Affective Disorder (Mental Health America, http://www.mentalhealthamerica.net/conditions/sad).

photography of trees covered with snow

Here are a few things that you can do consistently throughout the week to help fight the onset of depression or to just increase your happiness in general: 

  • Keep a Gratitude Journal
  • Savor the moment. This could be any moment- having dinner with a friend, talking with a loved one, walking outside, etc. Savor it by being completely present in this moment- no thoughts of the past or future, electronics put away, thoughts on what you feel, see and hear in that moment.
  • Be kind to someone. This could be someone that you know, or a complete stranger. But the idea is to act with kindness without expecting anything in return. Open the door for someone, smile at a stranger, give someone a compliment.
  • Spend less money on things and more on experiences (but free experiences are an added bonus). We get used to and bored with things. Experiences are encoded as memories that we can cherish forever, and they foster personal growth.
  • Make a new social connection or strengthen a friendship that you currently have. Say hi to a stranger, call a friend that you haven’t spoken to in a while, check-in on your neighbor.

These are just a few! I encourage you to do some of your own research, try out new things and see what works for you to lessen the seasonal blues. I strongly believe in taking care of your mental health and reaching the highest potential as possible regarding your happiness– we all deserve it! If you would like to work on more specific coping mechanisms with a smoking cessation counselor one on one to develop an individualized approach with tangible resources to help you quit with less distress, reach out to Amber Jager at (313)446-9817 for persons living in the Detroit area, and Erin Suprunk at (734)961-1077 for persons living in the Ypsilanti and Jackson area to see if you qualify for FREE smoking cessation services!

Please take into consideration that the combination of these activities are meant to be a part of lifestyle changes in order to help increase general happiness and fight off mild feelings of depression, but are in no means meant to treat Major Depressive Disorder or other extreme conditions that need to be treated by a physician. If you are experiencing suicidal thoughts or experiencing extreme or worsening depression, call the National Suicide Prevention Hotline at 1-800-273-8255. The Lifeline provides 24/7, free and confidential support for people in distress, and prevention and crisis resources for you or your loved ones.

National Suicide Lifeline

Quit Smoking Tip of the Week: Stay prepared with supplies!

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Find a place (your backpack, purse, home, car, etc.) where you can easily access a supply of gum, mints, toothpicks, fidget toys, and whatever else can keep your hands and mouth busy to distract you from the urge to smoke as well as fulfill the hand-to-mouth routine that your body has become used to from months to years of smoking. If you are interested in quitting or reducing your tobacco use, call (313)446-9817 to schedule an appointment with Amber Jager, Tobacco Treatment Reduction Program Specialist at the Detroit location, or (734)961-1077 to schedule an appointment with Erin Suprunuk, Tobacco Treatment Reduction Program Specialist at the Ypsilanti office. During your visit you can create a quit plan that includes individual tobacco counseling sessions with one of our specialists, or you can just stop by to pick up a quit kit that includes a variety of the above supplies listed to help you reduce and cope with smoking cravings! Below I have outlined a few more helpful things to keep with you for withdrawal symptoms and the quit-smoking-journey.

Your Quitting Tool-Kit

cinnamon stick

The Power of Cinnamon Sticks: You can purchase whole cinnamon sticks and literally replace them with your cigarettes. Of course you won’t light these up, but you can use cinnamon sticks to mimic the motion of how you use a cigarette: inhale with the cinnamon stick when you feel a craving, until this feeling subsides. This helps by adding the deep breathing that your body gets when smoking a cigarette and the motion can even help trick your body into thinking that you are smoking and calm the urge a bit. This does not work for everyone, but is worth a shot. An added bonus is that even just using cinnamon mints or cinnamon containing gums, oils, etc. help to drastically reduce sugar cravings! So if you’re concerned about weight gain and the craving for unhealthy food, try some cinnamon to combat this.

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Journal The Process: Keeping a journal on you can be very beneficial for you in order to understand your habits and help prevent relapse in the future. It can also be helpful to prevent boredom when used as a creative outlet. Something that I have most of my clients do, depending on their stage in the quitting process, is fill out a Pack Wrap. A Pack Wrap is where you record the feelings/triggers/actions that are occurring during the times when you smoke. The goal is for you and myself to understand what the most triggering situations/feelings are, and create an individualized and successful quit plan with the help of this information. How you do it: this is to be done before you actually quit smoking. Over the course of a few days to a week (I encourage recording a couple days during the week and one day on the weekend to get a full view of your habits) keep your journal on you throughout the entire day. Right before you smoke a cigarette, record the time of day, what you just did/are about to do, and what feelings you have. Even as adults, it can be hard to identify what exactly you are feeling, and this list of 57 different emotions can come in handy to give a name to what you feel.

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Stay Hydrated: The first 3-4 days are the most important when it comes to helping your body detox from nicotine and the many other substances that your body has absorbed from smoking. Try to drink half your body weight in ounces each days (if you weigh 150lbs, then you should be drinking about 75 ounces of water daily). Keeping a water bottle handy at all times, though, will help you with hunger cravings (a lot of the time we think we are hungry when we are just dehydrated), tiredness, headaches and coughing that all can occur at increased rates during the withdrawal stage.

What Does This Worse-Than-Normal Flu Season Mean for PLHIV?

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Sad woman with tissue and medicines lying on bedI found myself unable to sleep the other night because I was so worried about this year’s severe flu, and if I, a person living with HIV (PLHIV), am more susceptible to acquiring it. The stress of outbreaks is already heightened given the recently increased rates of Hep A. My paranoia isn’t unfounded; after all, HIV is a virus that weakens the immune system. And most of us Positive folks have received a stern warning from a doctor or nurse regarding the vulnerabilities of our weakened immune systems. In response to my concern, I looked into why this year’s flu is so bad and if PLHIV are more susceptible to flu in any given year.

Thankfully, the Washington Post read my mind and reported today on this flu season and why it is the most widespread (see map below) on record. The Post’s article explains that more than 8,900 people have been hospitalized since Oct. 1, the beginning of the flu season, and has lead to a higher than normal number of deaths of children.

The Center for Disease Control and Prevention (CDC) further explains that part of the problem this year is that this strain, H3N2, is one of the “nastiest” to confront our modern population. It is good at working around our immune systems’ defenses and current vaccinations are less effective at blocking it. They also state that the season was predicted to peak the first week of January, but rates have continued to rise. So we, as a general population, are up against a powerful influenza virus without knowing when it will end.

But what about us Positive folks? Are we even more at risk of catching this year’s scary flu? I read a December 2015 interview with Christina Schofield, M.D., from The Body Pro, a go-to site for many HIV health professionals. Dr. Schofield says, “There’s probably a little bit of physician bias, and a bit more cautious treatment toward patients that are HIV positive, despite the fact that our patient population is a very healthy HIV-positive population.” She continues, “I would say that, just because somebody’s got HIV doesn’t mean they’re going to have more severe disease.”

But us PLHIV know that not all of our HIV experiences are the same. If you are one who has an immune system already damaged by HIV, then your doctor may suggest flu-fighting medications sooner than they would to someone who was able to fight against their HIV earlier on.

Doctor giving patient a shot

With that said, it remains important to take steps to protect yourself against this year’s flu, just as your HIV-negative friends and family ought to do. The CDC continues to recommend a flu shot even though it has been less effective this year. They recommend it is because states where H3N2 has been prominent have also seen high rates of more common strains against which the current flu shot is more effective. They caution that there is still a long time to go in this flu season and, like stated above, it is very difficult to predict when it will end.

Beside the flu shot, there are many ways to protect yourself and we hear them every year: wash your hands with soap for at least 20 seconds; cover your mouth and nose when sneezing and dispose of tissues right away; avoid touching your nose, eyes, and mouth; and avoid contact with sick people. I’ve also seen it suggested that you keep your toothbrush away from others’, clean surfaces with anti-bacterial products, and frequently launder your bedding.

A note on adherence: It can be difficult to maintain your HIV-medication regimen when you are sick with the flu or otherwise. Heck, it can be hard to remain adherent even when you feel great. Remember: it’s just as important to take your antiretroviral therapy when you are sick as when you are not.

HIV Doesn’t Celebrate Holidays

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By: Jonathon Arntson

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No matter how much I teach and preach about HIV and taking control of it instead of letting it control you, I still have my own ongoing struggles. One of them is with adherence. It’s not because I question the medications or their importance. It’s because I have a tendency to let life get away from me. This shows up in a deeper depression, heavier drinking, lower funds, and less fresh, stable eating. I pamper myself with gifts, food, and décor. I also live across the state from my family and getting back to visit during the holidays can take a large bite of my wallet.

Sometimes, it gets really real like this week when I cancelled an infectious disease appointment because I wasn’t sure if I would have enough for the copay. I recently rented a car as an indulgence to visit family for Thanksgiving, but unfortunately I had to do the same the following week for a funeral in the same city across state. While giving me better options as far as schedule, this unexpectedly set back my wallet, and on top of that, I need to reschedule my appointment.

I’m not upset about not having money; I am upset about losing control over my treatment. I am undetectable, but I cannot continue proclaim so if I do not have the labs to prove it. My last labs are from July of 2017. Now I am at the mercy of Henry Ford’s appointment openings and running the risk of getting off my ID-appt-every-six months schedule. At least I have medication refills to last another couple months. I think. But I do not wish to make that yet another thing to have to handle and remember. Once those things start adding up, I tend to fail on all accounts. It’s happened before.

For more HIV and the holidays reads, check out Being Positive and Beating the Holiday Blues or this reminder from 1992 of how far we’ve come: Holidays and the Bad Tidings of H.I.V.

So, how could I have handled this better? For one, I could have looked before this past weekend to see when my appt was scheduled to take place. This would have reminded me to set aside the copay. Instead, I squandered it on a rental car (and Starbucks, to be honest) when I very well could have saved with Greyhound (and… Speedway?).

Perhaps that would have worked, but perhaps another angle to consider is the mental health benefit I had by renting a car. I used Turo, a site that connects you to vehicles listed by their owners. I had a 2016 Chrysler 200c. It was a sweet ride, and since I rely on bus and Uber here in Detroit, it felt awesome to speed down the freeway with music blasting. It was an expensive feeling, but I did a lot of thinking along the way and had numerous moments of clarity re: life.

Either way, I packed my travel pill case with a few Genvoya even though I knew I’d only need one. I managed to maintain my eating times so that I could take my medication at 7pm without suffering an upset stomach.

When I was home, I answered my family’s questions like, “How are you doing with… everything?” Y’know, everything being the menacing little virus that’s suppressed into some dark corner of my body (apparently the stomach and lymph node areas). Those moments make me yearn for the days when I could handle and sustain a stronger buzz. Now I have to face reality as it happens. But it’s all in the name of remaining adherent. Undetectable. Untransmittable.

Since my tolerance is diminished, I am also working to lessen the amount of alcohol I consume. I find this is connected to my medication–this has affected my adherence in the past. I take my medication between 7pm and 9pm. This is so I will have eaten dinner because my meds hurt my stomach if it is empty. However, if I drink around the same time as, or even hours after, taking my meds, I will certainly feel queasy and uneasy. Many times I wake up the next morning feeling like back in the day when I could have more than a bottle of wine and be okay the next day. But again, it’s reality-facing time and all that.

While we get to celebrate the holidays and hopefully have some time off with friends and family, we positive folks know the virus is always there waiting for an opportunity. As I move into Part 2 of the holidays, I seek to do a better job preparing for financial hiccups, upset stomachs, and several days of being away from my home without a maintained buzz. But hey! There are many more ways to make it through and even enjoy the time.

Enjoy your holidays!

Genvoya on ceramic tree

From Day One to Today: Becoming a PLHIV

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 By: Jonathon Arntson

Hello there. I’m Jonathon. I work at UNIFIED –  HIV Health and Beyond as the Health Education Coordinator. Three plus years ago I became HIV+. Since then I’ve experienced my ups and downs, but I keep myself getting through it with support from friends and family, helping others where I can, and maintaining a sense of humor no matter what. One way in which I am doing that is to share my experiences (adventures?) as a person living with HIV (PLHIV) who also works in the field. You can look forward to me sharing those with you a couple times a month. It’s my hope that my writings will prompt us to engage in progressive discussions about the state of HIV today. I also hope that anyone reading will be inspired to share their own stories. I shared my first day story on thebody.com. You can view it here and you will see snippets peppered into my ongoing posts. 

After I tested positive, I received the “first day” welcome kit of a blood draw, pamphlets, referrals, and you-must-use-condoms-now finger-waggings . Then, I arrived home to begin coping. I felt like I was beginning the same transition you witness in old vampire and werewolf films.

I noticed little changes here and there. After a while, the changes felt deeper like every bug bite or blood cell had mutated into weird little monsters. After a while, I didn’t even realize I had a fever until it began dissipating. I fell asleep and woke up a few hours later. But instead of waking up with powers or sharper teeth or fur all over, I felt exactly the same. And the fever had been a result of emotions. My blood felt the same inside me, and I would soon learn it looks the same. I was beginning the (still ongoing) grieving process.

Although I was still reeling from the werewolf episode, the day after my confirmatory result was also my first day back at work. At the time, I was working at a housewares store–the brand at which I had worked for five intermittent years. When I started that night’s shift, I’d mostly forgotten about my transition into a mutant. As happened too often at this job, I cut my finger on something. Getting cut is inevitable at this home store. Between glass, cardboard, splintered wood, and unloading trucks, getting cut is inevitable at this homestore; I endured hands covered in bandages on the weekly. I did not see it coming but this first day as a new creature gave me a crash-course in accepting myself as-is.

As soon as I cut my finger on a broken vase that a customer left sitting on a shelf, I was transported to a Tarantino film.

Blood sprayed from my hand, and then from my fingertips. Each blink changed my surroundings between neon colors like I was in an early iPod commercial-turned-horror film. I rushed to the restroom, locked myself in, grabbed a wad of paper towel, and crouched into a vertical version of the fetal position. I stayed in the restroom for half an hour as I worried about what I should do. I knew I needed to rinse off my hand but I was afraid to get blood on the faucet handles.

I finally overcame my dread and turned on the water. Instead of sticking my now mostly dried, bloody hand into the water, I plunged my face into the cascade and washed away the irrationality. I cleaned my hands, cleaned the minimal blood off the sink, and left the restroom to dress the wound as though nothing was out of the ordinary. To this day, I still have a small panicked feeling when I see my blood. This feeling diminishes the more I learn about HIV and how being undetectable equals untransmittable.

Speaking of undetectable, I will be sharing many posts grappling with the drama and trauma of being a patient and a case worker/educator.

Months after testing reactive, I volunteered at UNIFIED (formerly AIDS Partnership Michigan). I didn’t know how to talk about HIV or what I was going through. It was easier to say I was “fine” and gulp than to own up to my not knowing what the hell to do or say.

But I showed up, answered calls on the Michigan HIV/STD Hotline (800-872-2437), and covered the front desk. My time volunteering allowed me to hone my communication skills while building confidence in the facts surrounding HIV and how I engaged with them.

I then gained knowledge and confidence working on and off with CARES of SW Michigan and Mr. Friendly to co-facilitate weekend camps for positive men. We learned about disclosure, healthy relationships, and the ongoing science behind HIV. This involvement put me right in the middle of being a person with HIV as well as a counselor for my peers.

I spent my first year employed with UNIFIED as a Linkage to Care Specialist. I worked with newly diagnosed individuals, those who had fallen out of care, and those who had recently relocated to Metro-Detroit. I went through Linkage to Care as a client and when I had the opportunity to switch sides and become the specialist, I was anxious and excited. I had never had a “real job”  before. Taking that opportunity lead me to an even better one, and two months ago I became the Health Education Coordinator at UNIFIED. This position has me in charge of support and education groups, building and maintaining partnerships with peer AIDS service organizations (ASOs), medical clinics, and community agencies offering services to address needs well beyond HIV care.

Beside working at UNIFIED, I participate in panels and discussions as a PLHIV, work on the draft of an autobiography, and write letters to my legislators imploring them to support drastic augmentation to the Michigan HIV Disclosure Law. Lastly, I am working on a website that will offer a space for PLHIV and their loved ones to share their stories. This project has many logistics and barriers to deal with and I am moving very slowly. If you are inclined to help, I would never decline.

Thank you for reading and I look forward to offering you more insights and anecdotes about how I got to being more than just “fine.” Whew. It was really nice to write about myself without it being on a dating app.

Love, Jonathon

social media:

Facebook: jonathon.arntson

Instagram: @themanwiththemichigantattoo

Twitter: @monkeyboydet

Tobacco Reduction – What’s In A Quit Kit?

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By: Kayla Gamino (UNIFIED Tobacco Treatment Specialist)

An ample part of UNIFIED’s tobacco reduction program includes creating quit kits for clients.  During the initial assessment, we bring out the quit kit while discussing possible quit dates.  Each client accessing tobacco reduction services receives 1 quit kit for their time working with the tobacco treatment specialist.  Each quit kit includes: a journal, pens, candy/gum, educational tools, and fidget toys.

Journal- The journal is an especially important piece of the quit kit.  The journal is a good tool to help keep track of a person’s smoking habits prior to their quit date.  Many clients use it to write down when they have cravings, what they are doing when they have cravings, and how they are feeling when they have a craving.  This will help the tobacco treatment specialist and client to better come up with coping mechanisms and a quit plan together for when the client experiences cravings.  For example, if Mike records that he has a craving every time he is feeling bored then coming up with things for Mike to do while he is bored can help combat cravings.

Originally posted by gerimagsakay

Pens- The pens are good for when the client needs to journal.  We put 2-3 different colored pens in each quit kit to make it easier for the client to be able to journal. Pens can also act as a fidget toy.

Candy/Gum-  Each quit kit comes with a variety of candy.  We use Twizzlers, Life Savers, and mints normally.  The Twizzlers can help with the hand to mouth habit of smoking.  It is a similar shape to a cigarette.  The Life Savers, mints, and gum are good at combating the oral fixation that often comes with smokers.

Originally posted by fadedmapdots

Educational Tools-  In each quit kit, we put a pamphlet for the Michigan Tobacco Quit Line.  In the pamphlet, it gives little facts on how smoking affects the body as well as the number to the Quit Line for clients to utilize.  We also include a UNIFIED Tobacco Services palm card that has contact information and HIV and Tobacco use facts.  As an added bonus, we include the Michigan HIV/STD Hotline number.

Fidget Toys-  Each quit kit includes rubber bands that are used by switching wrists when a craving occurs.  It helps to keep the hands and mind busy.  Additionally, each client gets to choose another fidget toy.  We have two different options.  One is a bike chain fidget toy that is small enough to fit in a pants pocket.  The other is a Bendeez toy that can be molded into different shapes.  Both are used to help combat boredom and keep the hands and mind busy.

Originally posted by cracked

All of these items have gotten positive feedback from current tobacco clients.  If you are a current tobacco user and you think that a quit kit would be beneficial to your quit/reduction attempt, please contact UNIFIED- HIV Health and Beyond to meet with a Tobacco Treatment Specialist!

Introduction to UNIFIED’s Tobacco Reduction Program

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By: Kayla Gamino (UNIFIED Tobacco Treatment Specialist)

A session with the tobacco treatment specialists is different for everybody.  We meet you wherever you’re at and will continue to be there for you every step of the way.  It all starts with a referral from your case manager.  At each visit, they will ask about your tobacco use and assess your readiness to quit.  If you both decide that you are a good candidate for the tobacco program, the case manager will fill out a referral form with you and give it to the tobacco treatment specialists (TTS).

So how is your readiness to quit determined?  Through The FIVE A’s; ask, advise, assess, assist, and arrange.

  • Ask- Your case manager is required to ask every client about their tobacco use at each visit and record it in our records.
  • Advise-  If the client answered that they were a tobacco user, then the case manager will advise them to quit their tobacco use and discuss the benefits of doing so.
  • Assess-  Next, the case manager will assess the clients willingness and readiness to make a quit attempt.  If the client is interested in talking to the TTS about tobacco reduction, the case manager will then make the referral to the tobacco treatment specialist.  In some cases the case manager will refer the client, with the client’s consent, to the TTS before they are considered “ready” in order to get the client thinking about quitting and to help establish the relationship between the client and the tobacco treatment specialist.
  • Assist- At this point, the case manager and the tobacco treatment specialist have touched base and the client is now being assisted by completing sessions with the TTS.  During the sessions, the client and TTS will discuss reduction strategies and possible nicotine replacement therapy options.  These sessions can go many ways depending on the clients needs.  Some clients need to talk about outside sources that are affecting their tobacco use, while others simply want information on tobacco and health.
  • Arrange-  The TTS will arrange follow-ups with the client.  Depending on the clients stage of change and the client’s schedule, the TTS will likely meet weekly or biweekly with the client.  These follow-ups can be by phone or in person.  In some instances, the TTS will also meet the client at their home or a local business.  This is the point in the treatment where the TTS tries to meet the client wherever is easiest for them in order to help make the client more successful in their quit attempt.
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Originally posted by firelordasami

How we assess a client’s stage of change:
The Transtheoretical Model

The transtheoretical model is a behavior change model that was specifically created with tobacco cessation in mind.  The 5 stages of change are precontemplation, contemplation, preparation, action, and maintenance.  It is important to know that the stages of change are not linear (that they don’t go in a single straight order).  Someone can go from being in action to contemplation in an instance.

  • Precontemplation- the client is not ready to quit or is not even considered quitting.
  • Contemplation- the client is considering quitting in the next 6 months.
  • Preparation- the client is ready to quit within the next 30 days.
  • Action- the client is currently on their quit attempt.
  • Maintenance- the client has successfully quit for 6 months.
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Because the transtheoretical model is not linear, a client can attempt to quit many times before being successful.  It is important to know that the tobacco treatment specialists are aware that not everyone will be successful right off the bat.  The specialists are there to help the client every step of the way in a completely non-judgmental environment.  Whether you’ve been working with them for months and relapse, or you met with them once and decided the program isn’t for you, they will always be there for you when you are ready to talk again.

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Want to learn more about UNIFIED’s tobacco reduction program? Visit us online at http://miunified.org/Get-Help/Services/Tobacco-Reduction-Services for more information.

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