Building Your Own Quit Kit

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If you’re currently a client in Unified’s tobacco program, or if you’ve ever discussed the tobacco program with another UHHB provider, you might know that one of the services we offer through our program are quit kits. Our quit kits include a variety of items and resources including fidget toys, journals/puzzles/coloring pages, gum/candies, tea bags, outside resources like information for the Michigan Quit Line, and cough drops. However, it should be noted that this is not all a quit kit can contain, and there are multiple ways to add to your quit kit (if you’ve received one from UHHB or another service) or to build your own quit kit.

What is a quit kit?

A quit kit is a compilation of items, strategies, and resources to support someone who is looking to quit or reduce their own tobacco use. A good way to think about quit kits is that they are essentially a toolkit for quitting smoking. Oftentimes, we might think of the quit kit as something that is specifically for an individual’s quit day or only the first week or so of being quit. However, the true purpose of a quit kit is to be there to support you on your quit journey, whether that be your first day tobacco-free or your thirtieth. While this might predominantly be in times of frustration or when an individual is trying to cope with a particularly challenging craving, quit kits can also be there for moments of celebration as people begin to meet their quit goals.

Why is quitting so challenging?

Celebrating quit milestones is more important than people realize, and that’s because quitting is difficult. In our most recent Tobacco Talk Tuesday livestream, we discussed the dual nature of tobacco addiction and how that dual nature is what makes quitting so challenging for most, if not all, of those who are trying to quit smoking. The first part of this is an individual’s physical dependence on/addiction to nicotine. When someone uses tobacco products, the nicotine moves into the brain and activates a receptor that leads to the release of dopamine (a chemical that boosts your mood, motivation, and attention). This process happens within seconds and leaves people feeling great, so when the effects wear off they’re often left feeling stressed, anxious, or tense, which is the result of the body craving the next dose of nicotine. Over time, an individual will build up a tolerance to nicotine, and will therefore need to consume a greater amount in order for them to get the pleasurable effects from smoking. 

The nicotine addiction cycle.
Image from ResearchGate

The second part of this dual nature has to do with how an individual’s tobacco use has infiltrated their daily life. Someone looking to quit smoking must also address the patterns and habits that have become closely associated with their smoking. These might include: their cup of coffee in the morning, meals or snacks, driving, working out, smoke breaks at work, stress, specific places and people, as well as other various situations in which they might reach for a cigarette either before, during, or after it occurring. In order to find success in quitting, people often need to work to change these routines, which on it’s own can be challenging. 

It’s because of this dual nature that we suggest a two-sided strategy and response when it comes to quitting. This is done through a combination of pharmacotherapy (nicotine replacement therapies, Chantix, or Wellbutrin) with some form of behavioral intervention (individual counseling, support groups, or quitlines). 

Planning for your quit kit

Prior to starting your quit kit you might want to consider a few things:

  1. Have you already created a quit plan?
  2. Do you have a quit day (or a practice quit day!)?
  3. What does a typical day look like for you with smoking?
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If you’ve already created a quit plan you might have already considered and likely answered the second and third questions above. If you’ve created a quit plan, your quit kit should include items and resources that will support that plan. If you haven’t worked on creating a quit plan, tracking your smoking habits prior to creating a plan and building your kit may be beneficial. We often suggest individual’s track their habits over two days (a weekday and weekend) and write down what time they smoked, where they were/what they were doing, and how they were feeling at that time. Tracking your smoking habits will allow you to gain an understanding of what changes you might need to make in your daily life. Making sure your quit kit is ready (or at least partially ready) to go prior to your quit day is also important, and it might be useful to test out your quit kit on a practice quit day to see what was helpful and what was not. 

What goes in a quit kit?

When it comes to building your own quit kit, there are very few rules about what you can add to it. The most important thing to remember is that your quit kit should support you and your own quit efforts, and therefore items or resources that will help you cope with cravings or manage specific triggers should be included. The following list of items and resources isn’t a mandatory or even complete list by any means. Rather, it’s here to give ideas and be a starting point for anyone looking to put together their own quit kit.

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  • Fidget toys – bendy straws, stress balls, fidget cubes, putty, pipe cleaners, yarn loops, rubber bands
  • Colored pencils and coloring pages or books
  • Crosswords, Sudoku, or other puzzles
  • Journal and pens
  • Tea bags
  • Gum, mints, hard candies, lollipops
  • Plain or mint toothpicks
  • Cough drops
  • List of smoking triggers (and something you can do instead of smoking in that moment)
  • List of motivations to quit
  • Bubbles
  • List of snacks to replace smoking – carrots, celery, pickles, frozen grapes
  • A picture of something you’d like to buy with the money saved 
  • A planner or calendar 
  • A list of support or people you can call during a tough moment 
  • A book
  • Chosen quit medication(s)
  • Supplies for hobbies 
  • Quit smoking apps like quitStart (iOS, Android), Smoke Free (iOS, Android), and Kwit (iOS, Android)
  • Rewards for quit milestones
  • Recipes you want to try

Maybe some of these ideas have helped you on past quit attempts, or maybe a few will help you on a future quit attempt. Regardless of the items you choose to add to your quit kit, the most important thing is that the contents of your kit are there to support your quitting efforts.


Have additional questions about quit kits or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org 

Understanding E-cigarettes and Vaping

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“Would switching to an e-cigarette be helpful?” is not an uncommon question to hear working in tobacco treatment, even with the nationwide panic over vaping occurring just under a year ago. Since their introduction into the U.S. market in 2007, e-cigarettes have been seen as a way to potentially aid in tobacco reduction/cessation by many, but most specifically the industry’s marketing teams. Additionally they’ve been marketed towards teenagers and young adults through social media and youth-oriented flavors, and as result we’ve seen major growth in use over the last five to ten years. Because of this, it continues to be important to consider the health risks and concerns that come along with e-cigarette use. 

Background

E-cigarettes are a type of electronic nicotine delivery systems (ENDS), and are also commonly referred to as vapes or vape pens, as well as various brand names (example: JUUL). The devices work by producing an aerosol from a liquid that’s heated within the device by a metal coil, which the user then inhales. “E-liquids” are made up of nicotine, glycerin or propylene glycol, flavorings, and various chemicals. The aerosols that are inhaled may also contain  ultrafine particles and heavy metals like nickel, tin, and lead. 

When they were initially introduced to the market, e-cigarettes looked very similar to combustible cigarettes and were a disposable product. Since then, we’ve seen major changes to both the appearance and functional capabilities of these devices – and not necessarily for the better. E-cigarettes and vapes no longer have one design, instead they now might look like pens, lighters, highlighters, USB devices, or even inhalers. In addition to modern generations being refillable and/or reusable, users can modify what is being put into their e-cigarette which leads to the ability to use marijuana and other substances with these devices

Growth, Marketing, and Current Use

The first time I saw an e-cigarette was at least 10 years ago in a kiosk in the local mall (those who frequented Briarwood mall in the 2007-2010 might have memories of this as well), and what I remember specifically is that they were primarily being marketed as a way help adults who smoked quit cigarettes. At some point the kiosk was changed, and I didn’t really think about e-cigarettes or other ENDS products for many years. During this time, e-cigarette and vaping companies began to make major strides within the market, with focus shifting from current tobacco users looking to quit smoking to youth and young adults .

E-cigarettes are currently the most commonly used tobacco product among youth in the United States, with over 5 million middle and high school students reporting use within the last 30 days in 2019. Specifically between 2011 and 2015 we saw a 900% increase in use within this demographic. Some (and likely most) of this growth can be attributed to the youth-oriented marketing that has been present in the last 5-10 years. Examples of this marketing include brightly colored ads (like the one below), social media use (including hashtags like JUUL’s #vaporized), promotion through celebrities and “influencers”, and youth-targeted flavors (fruit, candy, and mint). These efforts have succeeded in reaching U.S. youth, with more than 5 in 10 (over 14 million) middle school and high school students reporting seeing e-cigarette advertising in 2018. 

People use e-cigarettes and vapes for numerous reasons. For adults these include: to aid in quitting combustible cigarettes, to get around smoke-free laws/regulations in public spaces, and that they view them as a “safer” or “healthier” option. Youth also often believe e-cigarettes and vapes to be less harmful than combustible cigarettes (many are also unaware that these products contain nicotine) and have cited novelty and flavors as additional reasons for use.

Health Risks

Being a “safer” alternative to smoking is a commonly cited reason for using an e-cigarette, as well as being a belief many have seen used to promote these products by companies and other pro-vaping organizations and groups. Something that is seen far less in these promotions is that “safer” does not mean SAFE. There are still health risks and concerns when it comes to e-cigarette and vaping product use, with more research on long term health impacts still needed. These risks include:

  • Nicotine/nicotine addiction – particularly a concern for those under the age of 25 and pregnant individuals as nicotine is associated with issues with attention, learning, mood, and impulse control within the developing brain
  • Harmful chemicals – including cancer causing chemicals and chemicals like diacetyl (chemical flavoring) which is linked with serious lung disease
  • Inhalation of ultrafine particles and heavy metals such as nickel, tin, and lead
  • Increased likelihood for dual use and increased likelihood for using combustible tobacco products later in life 
  • Unintentional injuries – such as explosions and/or fires caused by defective batteries or poisoning caused by swallowing, breathing, or absorbing e-cigarette liquid through the skin or eyes
  • Secondhand exposure to chemicals via aerosol 
  • E-cigarette or Vaping product use Associated Lung Injury (EVALI) – has been linked with vitamin E acetate and THC containing products, and research continues to look into other causes and risks

You can find more information on health risks and resources for discussing e-cigarettes (particularly with youth) on the CDC, Michigan Department of Health and Human Services, and Surgeon General webpages for e-cigarettes and vaping. 

Regulations 

E-cigarettes are currently regulated at the federal level by the FDA, which implemented regulations for sales and manufacturers, and some regulations to ban flavored (non-menthol) cartridges. Additionally, the FDA began recognizing ENDS as a tobacco product in 2016. In Michigan, we have two laws that currently regulate e-cigarette use and sales which:

  • Define “liquid nicotine” and “liquid nicotine container”, as well as establish minimum safety standards for these containers
  • Define e-cigarettes and vaping products separately from tobacco products
  • Requires these products to be stored in a locked case or behind the counter in vape and smoke shops
  • Prohibits sale to minors 
  • Prohibits use/possession by minors

Like the FDA, Michigan and other states across the country have attempted flavor bans or other regulations of flavored e-liquids. Overall there have been issues with these attempts not being strong enough. Menthol and mint flavors are often not being targeted by these bans, and some brands are able to avoid them through device design, allowing for flavors popular with youth to remain on the market. 

It should be noted that due to some of these efforts and restrictions at the federal and state level, there has been a shift in marketing tactics. Specifically JUUL, the largest e-cigarette and vaping company in the U.S., has removed their candy flavored “pods”, cleared out their social media, and given their website a sleeker and more mature look. With these changes, it appears they (along with other companies like IQOS) are now focusing their marketing on adults who currently smoke or adults who are looking to quit smoking. 

Use in Tobacco Cessation 

One of the most commonly asked questions when it comes to e-cigarettes and vaping products, and the question I decided to start this blog off with, is whether or not these devices are useful in quitting combustible cigarettes and other tobacco products. In a world that loves clear-cut answers, this one will certainly be unsatisfactory, and it is: we don’t know. Like long-term health impacts, there is still a need for more research on this topic moving forward. However, it should be noted by all who are considering using any form of these products that there currently is no evidence to support their usefulness in tobacco cessation. There is also concern that dual-use (i.e. use of an e-cigarette/vape and use of combustible cigarettes/tobacco products at the same time) may occur in those who try to use e-cigarettes to quit smoking. Additionally, e-cigarettes have not been approved by the FDA as an aid for quitting smoking, but there are currently seven approved quit medications that you can learn more about on our most recent tobacco blog.

The bottom line is that while these devices may be safer in some aspects, safer does not mean safe. Specifically, e-cigarettes and vapes are not safe for youth, people who are pregnant, and people who do not currently use tobacco products. There are numerous cessation aids and strategies that have been shown to be successful for people looking to quit their tobacco use, all of which should be considered first and foremost.

Have additional questions about a blog topic or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org 

Building Your Quarantine Routine

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It’s fair to say that our lives feel completely different than they did a month ago, with COVID-19 and stay at home orders turning our world upside down. This ever-changing new normal results in the loss of our daily routines and increased uncertainty about what the future may hold. Many of us are experiencing increased feelings of stress, frustration, boredom, anxiety, and depression. As such, it’s important to find a way to establish a sense of normalcy in our daily lives.

COVID-19 and Tobacco Use

For people who currently smoke, there are additional health concerns when it comes to dealing with the COVID-19 pandemic (as discussed in the most recent tobacco blog). COVID-19 is a lung infection, and therefore people who currently use tobacco are at a higher risk of developing more severe and/or prolonged symptoms if they do contract the virus. In addition to physical health, COVID- 19 can contribute to emotional triggers that may lead to an increased want or need to smoke. This can have a negative impact on your goals to reduce or quit your use, or even just increase your tobacco use overall

Why bother with a routine?

Having a daily or even a weekly routine can help support your physical and mental health, and help prevent an increased reliance on tobacco products. For some individuals who smoke, their tobacco use may be seen as one of the only things in their life they have full control of, and a global pandemic will likely only contribute to that. Having a routine may help provide structure to your day and give you a sense of control over your daily life during this time. 

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What should my daily routine look like?

It’s important to remember that your routine doesn’t need to look exactly like anyone else’s, have every minute of every day scheduled, or completely deviate from your current (or non-pandemic) routine. Your routine also doesn’t have to incorporate all of the following components, but rather use them as ideas to start structuring your life during the COVID-19 pandemic. 

  • Maintain a sleep schedule – keeping a consistent sleep schedule is important for your health in general, but during quarantine especially. Waking up and going to bed at similar times each day helps keep your days structured and promotes healthier sleep
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  • Get dressed for the day – when you don’t have anywhere to go it can be very tempting to remain in your pajamas all day. But getting dressed (or at least changing into something other than what you slept in) keeps your mornings consistent and allows for predictability in your life during an unpredictable time. 
  • Socialize while social distancing – perhaps one of the biggest changes as a result of the stay at home order is our new inability to spend time with other people in person (or at least other people who we don’t live with!). Even for those who often prefer to spend time alone, forced isolation can have a huge negative impact on mental and physical health. Fortunately, we live in a very tech-savvy time and physical presence isn’t always required for socializing with loved ones. Make plans with friends or family to have regular calls, text conversations, or video chat sessions. Or plan to read or watch the same books and movies together (Detroit and Ypsilanti public libraries have options for e-book downloads). 
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  • Get moving  for most people, increased time at home means less daily physical activity with most of the time we spend walking to or into different places being replaced by more time sitting or lying down. Finding ways to increase your movement throughout the week is important for your overall health, and can help you manage cravings. Take walks, have dance breaks, stretch/do yoga, go up and down stairs, or anything else that may get you moving.  
  • Don’t forget about meal times – eating meals as normal provides structure to your day. Try and eat around the same time each day and try to move to a new location to eat if you find yourself in one spot for most of the day. 
  • Do activities you enjoy – this is NOT going to be a blog that tells you you should be mastering your second, third, or fourth language by now. But, it is a good idea to try and incorporate activities you enjoy throughout your weekly schedule. Planning out time during the week to read, cook, watch favorite movies, knit, play games, etc. is a good way to boost your mood and keep your mind off smoking. This could be something you do for everyday, or for a few times throughout the week. 
Group of people reading and borrowing books

If you’ve read my previous blog, or if you’ve worked with me in the last few months to develop your tobacco reduction/quit plan, you probably know that I often encourage making small changes and building on those to create a larger, positive change. We’ve been dealing with a major change over the last month, and it’s been overwhelming to say the least. Remember the goal with creating a “quarantine routine” is to help deal with that change, support your physical and mental health, and hopefully keep you on track with your tobacco reduction/cessation goals (even if that goal is to just maintain the amount you’re currently smoking!). Pick one or two of the above ideas and see if they help to start, and go from there. Lastly, remember there are some days where routines will just go out the window, that’s normal and it’s okay to need those days!

Feel like you need to adjust your tobacco treatment plan due to COVID-19 or just interested in finding out more about Unified’s Tobacco Reduction services? Contact your local Tobacco Treatment Specialist:

Detroit:
Amber Jager – (269) 350-3826
ajager@miunified.org

Ypsilanti/Jackson:
Caitlyn Clock – (734) 489-9916
cclock@miunified.org