The Smoking Problem: An Inquiry into Health and Culture

1. Welcome To Video Culture This Week:

2. The Smoking Problem(What? there’s a problem?) An Inquiry Into Health and Culture Part III An Exploration of Solutions to the Problems

3. A Reminder • Do NOT be angry at smokers. It is not their fault! • They were lied to just like you, just like everyone else. This is for smokers as well as non-smokers

4. What is being done… • Government recommendations to doctors

5. China tells doctors to quit smoking • Health Care • 4 March 2009 • China has advised its male doctors, more than half of whom smoke, to set an example by quitting the habit, Reuters reported, citing state media. China is the world's largest cigarette producer and 320 million Chinese smoke. "Medical workers and those who make the decisions regarding people's health should take the lead to quit smoking and completely ban indoor smoking to set a good example for their patients and others who look up to them," Health Minister Chen Zhu said. About 56.8% of China's male doctors are smokers, the highest rate in the world, according to the China Preventive Medicine Association.

6. What is being done… • Government recommendations to doctors • Increasing the cigarette tax

7. Cigarette tax increased to cut smoking By Wang Xu, Tan Yingzi and Wang Zhuoqiong (China Daily)Updated: 2009-06-22 07:41 • The government has raised consumption tax on cigarettes by between 6 and 11 percent to curb smoking and add revenue to State coffers.

8. "The move will not only increase government revenue but also save the lives of millions," Li Ling, a professor at the National School of Development at Peking University, told Xinhua News Agency.

9. The Chinese Association of Tobacco Control said in a statement yesterday: "Efforts to increase the tobacco tax and lift tobacco prices have proven the most effective in reducing smoking among smokers of all income levels. It will prevent young people from smoking and encourage more smokers to quit the harmful habit."

10. The country has more than 350 million smokers, about a third of the population. Each year, more than 1 million people die from smoking-related illnesses. • Experts estimate that the annual death toll could rise to 2 million by 2025 and 3 million by 2050 as the effects of smoking start to appear on the increasing number of today's teenage smokers.

11. The nation is the world's largest cigarette market, with annual sales of two trillion cigarettes. But the government has been stepping up efforts to curb tobacco consumption over the years, especially after it joined the World Health Organization (WHO) Framework Convention on Tobacco Control in 2005.

12. Experts say the nation's taxation on tobacco products, about 40 percent on average, is well below that in most other countries, which is around 60 percent. • Even if the entire tax increase is borne by smokers, the price of an average cigarette packet on the mainland would be less than a third than in developed economies.

13. Li Lin, a clerk at a cigarette shop in Beijing's Chaoyang district, said the tax increase would further dent business, adding sales have dropped substantially this year due to the financial crisis.

14. But Li, who smokes two packs everyday, said increased prices would have no effect on him. "I can give up meals but not cigarettes," he said, puffing out a cloud of smoke.

15. The tax increase will add about 30 billion Yuan of extra revenue for the central government.

16. "The main purpose of this policy is to increase the tax revenue from cigarettes, not to control smoking in the country," Mao Zhengzhong, professor at the College of Public Health of Sichuan University, told China Daily yesterday.

17. He said cigarette makers may pass on all, or part of, the tax to retailers, or absorb it themselves. • Mao urged the government to increase the tax to 65 percent of the retail price to curb smoking, adding: "There is still a lot of room to raise the tax."

18. Smoking costs China 250 billion Yuan last year (Xinhua)Updated: 2006-11-18 • BEIJING, November 18 -- China incurred a loss of 250 billion Yuan (32.5 billion U.S. dollars) from smoking last year, said a report issued by the China Center for Economic Research with the Beijing University. • The cost exceeded the pre-tax profits of the country's tobacco industry, which totaled 240 billion Yuan last year as the largest source of China's tax revenues, according to statistics on the website of the State Tobacco Monopoly Administration.

19. Of the total cost, 166.56 billion Yuan was paid for medical treatment to 23 major diseases caused by smoking, which was calculated according to a national smoking rate of 35.8 percent found by the China National Nutrition and Health Survey. • At least another 86.11 billion Yuan of losses were caused by delay of work, passive smoking, fires, environmental pollution and shortened life span, as the report shows.

20. The government should increase the tax rate for tobacco enterprises and raise cigarette prices to reduce low-income smokers, said Lin Daqing, a professor with the University of Hong Kong. • China will consume 4.5 billion fewer packs of cigarettes each year if it makes the price of each pack 0.4 yuan higher, claimed Fred Cox, a senior director with the US-based Pfizer Pharmaceutical Company.

21. What is being done… • Government recommendations to doctors • Increasing the cigarette tax • Banning advertising by 2011 (a requirement of the WHO Framework Convention on Tobacco Control)

22. What is not being done… • Stopping support for the industry

23. China tobacco: A tough habit to break • 26 Sep 2007 • FROM THE ECONOMIST INTELLIGENCE UNIT • By Beth Walker

24. The (tobacco) industry generated 303 billion Yuan in taxes and profits in 2006, a figure that represented 7.7% of central government revenue. • The lure of these revenues still far outweighs concerns over the nation’s health. In March, 2007 at the Chinese People’s Political Consultative Conference, the need to introduce measures to control tobacco smoking was raised. The overwhelming response was that although smoking harms people's health, restraining smoking threatens social stability…or rather government income.

25. What is not being done… • Stopping support for the industry • Enforcing existing laws • Smoking is banned on trains and busses and in train and bus stations • Smoking is banned in medical facilities • Smoking is banned in schools • Ban smoking in movies and on TV

26. Group urges smoking ban in TV, film By Shan Juan (China Daily)Updated: 2009-07-30 07:40 • The Chinese Association on Tobacco Control (CATC) Wednesday called for tobacco-free TV and film screens in China, in an attempt to take the glamour out of smoking, especially for impressionable young people.

27. Currently, due to a lack of legislation and low awareness, many scenes in TV series and films - including those produced in China and those imported - contain smoking scenes, which has a negative impact on viewers, particularly on minors who are not mature and tend to follow and mirror others, said Xu Guihua, deputy director of CATC, a Beijing-based non-governmental organization.

28. The conclusion is based on studies jointly commissioned by CATC and the Chinese Center for Disease Control and Prevention (CDC), Xu told China Daily. • Of 144 box-office hit movies from 2004 to 2009, 66 of which were imported, about 69 percent contain tobacco-related scenes such as people smoking a cigarette or cigar, with ash tray or lighters in the background, the study found.

29. Among all of the movies "contaminated" with tobacco-related contents, the 2008 blockbuster Mei Lanfang, directed by leading Chinese director Chen Kaige, ranked at the top with 14.3 minutes of smoking, nearly 11.8 percent of the entire movie time, said Yang Jie, deputy director of the tobacco control office under CDC.

30. Red River, another Chinese film, which premiered in April, has the longest smoking scene this year: 7.6 minutes, according to the study. • More than 76 percent of the Chinese films contain smoking scenes, compared with one-third of imported films, Yang noted.

31. What is not being done… • Stopping support for the industry • Enforcing existing laws • Ban smoking in movies and on TV • Make quitting medications readily available • Set up quit smoking clinics

32. What about the Culture of Smoking? • What can you say when offered a cigarette? • What is good or bad about the following answers? • Accept the cigarette and smoke it. • Accept the cigarette but do not smoke it. (“I’ll smoke it later.”) • My doctor has asked me not to smoke. • My wife has asked me not to smoke. • No, thank you. • No, thank you; I am trying to take care of my health.

33. Role Play • Get in groups of three. • Create a situation. For example, one is a friend or businessman; one is to be offered the cigarette; the third can offer support to either of the others. • Have a conversation. • Switch roles.

34. What do you think? • Is it difficult to say no? • Is it possible to keep from smoking in China? • Other comments…

35. Vocabulary Review • Addiction • Addict • Addicted • Patriotic • Patriot • Patriotism

36. Withdrawal • Withdrawal is a term referring to the feelings of discomfort, distress, and intense craving for a substance that occur when use of the substance is stopped. These physical symptoms occur because the body had become metabolically adapted to the substance. The withdrawal symptoms can range from mild discomfort resembling the flu to severe withdrawal that can actually be life threatening.

37. Withdrawal There are five basic stages of withdrawal: • Withdrawal Stage – lasts up to 30 days and may be accompanied by fatigue, pain, anxiety, and depression. • Honeymoon Stage – the opposite of withdrawal that is often accompanied by feelings of energy, optimism, and confidence.

38. Withdrawal • The Wall Stage – time when most relapses occur due to the reemergence of feelings of anxiety and depression. • Adjustment Stage – a period of realization and acceptance that change is a lifelong struggle. • Resolution Stage – occurs after six months of sobriety or abstinence.

39. Cravings to smoke Irritable, cranky Insomnia Fatigue Inability to Concentrate Headache Cough Sore throat Constipation, gas, stomach pain Dry mouth Sore tongue and/or gums Postnasal drip Tightness in the chest Sweating Shaking Withdrawal Symptoms

40. How to Manage Withdrawal • The Five D's • Delay until the urge passes - usually within 3 to 5 minutes. • Distract yourself. Call a friend or go for a walk. • Drink water to fight off cravings. • Deep Breaths - Relax! Close your eyes and take 10 slow, deep breaths. • Discuss your feelings with someone close to you or on internet support forums. See http://quitsmoking.about.com/cs/cravingsandurges/a/withdrawal.htm

41. Other Ways to Manage Withdrawal • Exercise. If you're unaccustomed to exercising, start slowly. Take a 15-minute walk once or twice a day, and work up from there. Choose activities that appeal to you, so you'll do them consistently. Exercise reduces cravings to smoke while helping you feel better in general.Top 10 Reasons to Start Walking • Get More Rest. As smokers, our bodies were used to taking in not only nicotine, but all of the literally thousands of other chemicals in cigarette smoke. The stress of abruptly cutting off that supply, as unhealthy as it was, can leave us feeling tired and wilted. If you're fatigued and can manage it during the day, take a nap. And go to bed a little earlier than usual if you need to. It will do you good. • Chemicals in CigarettesOn the other hand, if you're at the opposite end of the spectrum and find yourself unable to sleep (which is common also), try taking a long walk several hours before bed.

42. Other Ways to Manage Withdrawal • Managing Insomnia When You Quit Smoking • Take a Multivitamin. Consider adding a good multivitamin to your daily regimen for the first few months after quitting tobacco. It will help offset nicotine withdrawal symptoms and replenish depleted nutrients.When Vitamin Supplements are Beneficial

43. Other Ways to Manage Withdrawal • Relaxation and Rewards. Take time alone to read a good book. Indulge in a hot bath at the end of the day. Whatever pampers and relaxes you is a great choice. Don't think of it as a luxury; think of it as a protective measure for your quit program.Cessation is hard work early on, and when we take the time to recharge our batteries and replenish our spirits, we put ourselves in the best possible position for continued success. Do this step religiously every single night, and you'll find that you are better equipped to start the next day off on the right foot.Top 10 Tension Busters

44. Five Steps to Quitting • Nicotine: A Powerful Addiction If you have tried to quit smoking, you know how hard it can be. It is hard because nicotine is a very addictive drug. Usually people make a few attempts to quit before they succeed, but many quit on their first attempt. Each time you try to quit, you can learn about what helps and what hurts. Quitting takes hard work and a lot of effort, but you can quit smoking.50,000,000 (million) Americans have quit using tobacco, you can too!

45. Good Reasons for Quitting Quitting smoking is one of the most important things you will ever do. • You will live longer and live better. • Quitting will lower your chance of having a heart attack, stroke, or cancer. • If you are pregnant, quitting smoking will improve your chances of having a healthy baby. • The people you live with, especially your children, will be healthier. • You will have extra money to spend on things other than cigarettes.

46. Five Keys for Quitting Studies have shown that these five steps will help you quit and quit for good. You have the best chances of quitting if you use them together. • Get ready. • Get support. • Learn new skills and behaviors. • Get medication and use it correctly. • Be prepared for relapse or difficult situations.

47. Set a quit date. Change your environment. Throw out ALL cigarettes and ashtrays in your home, car, and place of work. Ask visitors not to smoke in your home. Look at your past attempts to quit. Think about what worked and what did not. Once you quit, don't smoke again—NOT EVEN A PUFF! 1. Get ready

48. 2. Get support Research shows that you have a better chance of being successful if you have help. You can get support in many ways: • Tell your family, friends, and co-workers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out in front of you. • Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor). • Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Find a program at a local hospital or health center. Call your local health department for information about programs in your area.

49. 3. Learn new skills • Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task. • When you first try to quit, change your routine. Take a different route to work. Drink tea instead of coffee. Eat breakfast in a different place. • Try to reduce your stress. Take a hot bath, exercise, or read a book. • Plan to do something every day that makes you happy. • Drink a lot of water and other fluids.

50. 4. Get medication • Medications can help you reduce some of your urge to smoke. • The U.S. Food and Drug Administration (FDA) has approved these medications to help you quit smoking: the patch, nicotine gum, nicotine lozenges (available over the counter) and a nicotine inhaler, nasal spray and Zyban/Buproprion (all available by prescription) • Ask your health care provider for advice and carefully read the information on the package.