Particulate Air Pollution

Example: the smokestack of a coal plant ejects coal smoke into the air. Water vapor droplets in the clouds can pick up these smoke particles and drop them later in the form of acid rain.

How is particulate air pollution measured?
Due to the different sizes, shapes and chemical compositions of these microscopic particulate air pollution agents, the task of measuring the potential damage that they can do is often an arduous undertaking. Most agencies involved in pollution research and prevention classify these particles by size: fine particles are less than 2.5 microns (10^-6 m) across and inhalable coarse particles are between 2.5 and 10 microns across. To put these measurements into perspective, a human hair is usually between 70 and 100 microns thick; a red blood cell is about 7 microns across.

What are some other sources of particulate air pollution?

According to a study carried out by the US Environmental Protection Agency (EPA), one of the leading sources of fine particulate air pollution is also the oldest: fires. During 2002, EPA estimates put the quantity of fine particulate air pollution originating from fires at well over one million tons. Since man first learned to create a spark and build fires for light, warmth, and comfort, he has also sent untold tons of untreated, unfiltered smoke into the air. While the concern over particulate air pollution may be a recent occurrence, the sources and the issue itself are both as old as civilization, whether the source is a small campfire or a raging forest blaze.

According to the same study, road dust generated over eight hundred thousand tons of fine particulate air pollution, followed by electricity generation at five hundred thousand. Surprisingly, fossil fuel use (coal, oil, kerosene, gasoline) and automobile usage combined for less than four hundred thousand tons, less than a third of the total for fires.

Of course, air pollution is not limited to outdoor sources. Indoor air pollution can also be a major source of particulate air pollution. Dust, sheet rock particles, cigarette smoke and dirty ventilation systems can create fine particles that can contribute to an increase in indoor particulate air pollution.

Pain Control for Cancer Patients

Defined by pain expert Margo McCaffrey, MSN, RN, FAAN, pain is, “whatever the experiencing person says it is, and exists whenever he says it does.” This certainly holds true in the treatment of pain associated with cancer. Approximately 30% to 50% of all people with cancer will experience pain while undergoing treatment and 70% to 90% of individuals with advanced cancer will have pain associated with the disease.

The good news is that cancer pain is completely manageable with a host of treatments that are readily available. The bad news is that many cancer patients are often under treated for pain due to a variety of common reasons.

Physicians treating cancer patients may focus solely on controlling or treating the disease and the accompanying pain is left untreated. Patients may minimize their pain symptoms or may think the pain is “normal” and neglect to inform the physician of this symptom. In other circumstances patients may fear becoming addicted to pain medications and therefore refuse to take them. These reasons, while understandable, are invalid and the current treatments available can help patients manage their pain.

Each cancer patient will experience different levels and areas of pain. There are three common types of pain associated with cancer. Acute pain usually sets in quickly and lasts only brief amounts of time. Chronic pain is consistent pain that sometimes worsens and lasts for long periods of time. Breakthrough pain occurs in chronic pain sufferers whose pain is normally controlled by medication. The plan for managing this pain is different for each individual. The goal is to provide the best pain relief while avoiding as many side effects as possible.

First-line pain medications are those medicines that are readily available over the counter or by a doctor’s prescription. First-line pain medications are used to treat mild forms of pain associated with cancer and include ibuprofen, aspirin and acetaminophen. These over the counter medications are not usually habit forming and can reduce inflammation in diseased tissue.

Lung cancer and veterans

Veterans often develop cancer as a result of exposure to hazardous materials – even when the exposure happened decades ago. The herbicide Agent Orange was used in Vietnam and it is acknowledged to cause prostate and respiratory cancers. The Department of Veterans Affairs even states that any respiratory cancer in a veterans known to have served in an Agent Orange area automatically qualifies for benefits.

Lung cancer is also caused by exposure to asbestos, depleted uranium, and other materials that many servicemen encountered. Contrary to popular thinking, there are many causes of lung cancer beside tobacco.

There are two main types of lung cancer, small-cell lung cancer and non-small-cell lung cancer. The types have different staging classifications.

About 10 to 15 percent of lung cancers are small-cell. Small-cell lung cancer is categorized as either limited stage or extensive stage. In the limited stage, the cancer is found in one lung and the surrounding lymph nodes in that lung only. In the extensive stage, the cancer has spread into both lungs or other organs in the body.

Small-cell lung cancer tends to progress from the limited to the extensive stage fairly early, forming large tumors and entering other organs rather quickly. For this reason, surgery is often not an option for treatment for small-cell lung cancer. However, chemotherapy is often employed as a treatment.

Non-small-cell lung cancer makes up over 80 percent of all lung cancers. Within non-small-cell lung cancer are the subtypes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Non-small-cell lung cancer is categorized into four stages. The higher the number, the more advanced the cancer. Most lung cancers are diagnosed in Stage 3 or Stage 4.

Non-small-cell lung cancer can be treated by surgery, radiation, and chemotherapy. Doctors decide on a treatment plan based on the stage of the cancer, and the age and overall health of the patient.

If you think you could get lung cancer, be sure to get screened. The earlier the cancer is diagnosed, the better your chances will be.

Lung Cancer Patients Get Unequal Treatment

A new study from the MD Anderson Cancer Center in Houston found that patients who go to public hospitals for lung cancer care get less effective treatments than those who go to expensive cancer-oriented hospitals. The study also showed that patients who receive their care from public hospitals were nine times more likely to have severe symptoms when they check in for treatment than those who attend cancer centers such as MD Anderson.

The study examined the care in two Houston public hospitals, one Miami public hospital, and MD Anderson, one of the most respected cancer care centers in the world. Dr. Charles Cleeland, the study’s author, said that the disparity of care between public hospitals and cancer centers has existed “for the last couple of decades”. He also noted that lung cancer care “is less well managed” for patients who are poor, unemployed, members of minority groups or those that have little to no health insurance.

The number of public hospital patients experiencing symptoms before admitting themselves for care was nearly double that of cancer center patients. The study, which followed the patients’ progress for two months, showed major differences in the quality of care between the cancer center and the public hospitals. Dr. Cleeland said that patients in public hospitals that were displaying symptoms were “not being corrected”.

Dr. Cleeland also noted that the reasons for the differences in care between public hospitals and well-known cancer centers are “very complex”. “I don’t think it’s the intention of those caring for those folks,” he said. However, he did cite that the lack of access to technical resources or cancer specialists for those underserved patients might be some of the reasons behind the disparity.

A similar study conducted at the University of North Carolina found that African Americans are less likely than Caucasian patients to opt for surgery to remove lung tumors. Surgical tumor removal is often the most effective treatment in the early stages of the disease. Dr. Samuel Cykert, the UNC study’s author, attributed the differences to “unintended biases in physicians”. Dr. Cykert mentioned that doctors who work with underserved patients “would be less apt to recommend surgery” than they would for patients who could afford the procedure.

“Advocating for oneself is very important,” Dr. Cykert said. “Being passive is bad.”

The two doctors do agree on treating symptoms early, rather than allowing them to worsen before seeking help. Dr. Cleeland stressed that doctors, nurses and other health care professionals need to help patients with the symptoms of their lung cancer as much as with treating the cancer itself.

“I think we need to strategize about how to help them (underserved patients)”, he said. “This (study) is characterizing their experience.”

According to public health officials, 62 out of every 100,000 adults will be diagnosed with lung cancer each year. Underserved patients are more likely to engage in cigarette smoking, the primary cause of lung cancer in America, and are also more likely to die from lung cancer.

Sources:

http://www.reuters.com/article/2011/06/20/us-lung-cancer-patients-idUSTRE75J6Y320110620

Can Quitting Smoking Easily Be a Symptom of Lung Cancer?

An article in the most recent issue of the Journal of Thoracic Oncology detailed a study on patients who quit smoking with ease. The study showed that patients whose experience in quitting smoking had few or no troubles also developed lung cancer within three years of quitting. The study subjects quit smoking well before they exhibited any sings of the disease, which has convinced researchers that the comparative easiness of how the patients were able to quit could also be a symptom of lung cancer itself.

Researchers at the Thomas Jefferson University Medical Center in Philadelphia have hypothesized that active lung cancer cells release a compound that counteracts the body’s dependence on nicotine, the active ingredient in tobacco. Since one of the primary obstacles that smokers come across when attempting to quit smoking is nicotine addiction, the hardest part of quitting becomes much easier, albeit at a severe cost to the patient’s health.

The study looked at the behavior 115 former smokers who were later diagnosed with lung cancer. Out of those 115, 55 had gone through some type of program to quit smoking, such as nicotine gums or patches, well before they were diagnosed with the disease, with 31 reporting that they quit with ease. The data revealed that patients who had stopped smoking with very little or no difficulty showed symptoms of lung cancer in just over two years.

Dr. Barbara Campling and her team of researchers conducted the tests with patients at the Philadelphia Veterans Hospital. Dr. Campling and her group ascertained the level of the patient’s nicotine addiction through an interview and psychological test. The data from those tests showed that the patients who said they quit with ease were just as addicted to nicotine as those who either quit with difficulty or continued to smoke.

Dr. Campling also pointed out that her team’s findings might refute much of the popular belief behind smoking cessation and lung cancer. Many doctors previously believed that smokers eventually quit due to the visible symptoms of lung cancer, including heavy coughing and other respiratory issues, which made the task of inhaling the smoke more difficult.

The findings of this new study, despite the limited number of participants, have opened up other ideas on how to detect lung cancer in smokers. The news may lead to smokers who suddenly lose their cravings for nicotine to visit a doctor and determine if they are undergoing the early stages of lung cancer. As with most cancers, early detection is a key to any possible recovery.

The study may also lead to other potential applications for smoking cessation programs. If scientists can isolate the agent that induces the patients in the study to quit smoking immediately and painlessly, such a discovery could lead to new forms of therapy to help smokers quit the habit much easier.

Dr. Campling also suggests that smokers do not take the findings as a justification for continuing to smoke. She said that a smoker who does not consider quitting based on her study has “the absolutely wrong interpretation” of the findings.

Sources:

http://topnews.net.nz/reports/212505-ease-quitting-linked-lung-cancer

http://www.philly.com/philly/entertainment/20110307_If_quitting_comes_easy.html

http://www.washingtonpost.com/wp-dyn/content/article/2011/03/07/AR2011030703659.html

Fatigue and Mesothelioma

Fatigue is a common symptom of advanced mesothelioma. Fatigue is also commonly linked with cancer treatment and has an occurrence rate of 90% among patients receiving chemotherapy. There are many potentially underlying causes for both the symptoms. In majority of patients, the etiology of both the symptoms is multifactorial, with several of these contributing interrelated abnormalities. For instance, in a study involving patients with advanced cancer, it was noticed that fatigue correlated significantly with the intensity of dyspnea. This article will elaborate on the mechanisms, clinical features, assessment, and management of fatigue and dyspnea, which are two of the most common and often undertreated symptoms among cancer patients.

Fatigue

The National Comprehensive Cancer Network defines cancer-related fatigue as “a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.” Fatigue is often severe among cancer patients; has an identifiable anticipatory component; and results in general malaise, lack of energy, diminished mental functioning, and lethargy, all of which significantly impair quality of life. Fatigue can occur early during the progression of the disease; may worsen due to treatment, and can be found in almost all individuals with advanced cancer.

Sometimes, fatigue is referred to as tiredness, exhaustion, weakness, lack of energy, and asthenia. However, these terms may have varying implications for different patient populations. Further, different studies on fatigue and dyspnea have focused on different outcomes, which range from physical performance to just the subjective sensation.

Mechanism

The mechanisms involved in cancer-related fatigue are not clearly understood. It has been postulated that substances produced by the tumor result in fatigue. When blood from a fatigued subject was injected into a rested subject, it demonstrated manifestations of fatigue. When cytokines are produced in the host in response to the tumor, the same can also create a direct fatigue-inducing effect. Other potential causes of chemotherapy- or radiotherapy-induced fatigue include muscular or neuromuscular junction abnormalities. Hence, it can be concluded that fatigue results from not just one, but several different syndromes. In most patients with advanced cancer, multiple mechanisms are responsible for causing fatigue.

Clinical Features

In an individual patient, there are often multiple causes of fatigue with many interrelated factors.

Cachexia

A complex interaction of host and tumor products leads to cancer cachexia. Host cytokines, for instance tumor necrosis factor, interleukin-1 (IL-1), and IL-6 can potentially cause reduced food consumption, loss of body weight, a reduction in synthesis of both proteins and lipids, and increased lipolysis. Profound weakness and fatigue can be caused by the metabolic abnormalities responsible for the production of cachexia as well as the loss of muscle mass due to progressive cachexia. However, there are several abnormalities that can cause profound fatigue in patients who may not be experiencing significant weight loss.

Immobility

Reduced physical activity has demonstrated to cause deconditioning and diminished endurance to both physical exercise and routine daily activities. In comparison, overexertion is often the cause of fatigue among non-cancer patients. At risk are younger cancer patients receiving aggressive antineoplastic treatments, for instance radiation therapy and chemotherapy, and those who are making efforts to maintain their professional and social activities.

Psychological distress

In case of non-cancer patients who experience fatigue, the final diagnosis in around 75% of patients is psychological (for instance anxiety, depression, and other types of psychological disorders). The occurrence rate of major psychiatric disorders among cancer patients is relatively low. Nonetheless, symptoms of adjustment disorders and psychological distress with anxious or depressive moods are more common. Fatigue is often the most prevalent symptom among patients with a major depressive disorder or adjustment disorder.

Anemia

Low red blood cell count, if induced due to chemotherapy or advanced cancer, has been linked with fatigue, and treatment of the same helps improve symptoms of fatigue and quality of life among these patients. However, treatment of anemia among terminally ill patients may not help improve fatigue satisfactorily due to the multifactorial characteristic of its etiology. Fatigue can also occur due to the relatively more intense characteristics of other contributory factors.

Autonomic failure

Autonomic insufficiency is a medical complication that occurs frequently among patients with advanced cancer. Instances of autonomic failure have also been seen among patients with a specific type of severe chronic fatigue syndrome. While the connection between fatigue and autonomic dysfunction has not yet been established among cancer patients, the same should be suspected among patients with signs of autonomic failure including severe postural hypotension.

Heavy Cigarette Smoking On the Decline

A recent report from researchers at the University of California at San Diego has revealed that the habit of smoking at least one pack (20 cigarettes) a day has severely declined over the last fifty years. Investigators observed that the rate of decline was particularly noteworthy in California, where lung cancer rates also fell in proportion to the reduction in smoking rates. The data and the corresponding interpretation of the study were printed in the Journal of the American Medical Association’s March 2011 issue.

The UCSD study showed how much smoking has declined since the early 1960s. According to reports, more than fifty percent of all adult smokers in the US smoked at least one pack per day. That number fell to just over forty percent by 2007. “Moderate” smoking (10 to 20 cigarettes a day) rates also fell. In California, the number of moderate smokers fell from 11.1 percent of all adults in 1965, down to 3.4 percent in 2007. In other states, the number fell from 10.5 percent of all adults down to 5.4 percent.

The study credits much of the decline to smoking education programs. In 1964, the US Surgeon General released the first major findings on the correlation between cigarette smoking and lung cancer. Two years later, the Food and Drug Administration required mandatory warning labels on all cigarette packaging. Today, most cigarette packs and cartons carry warning labels, including warnings about how smoking can complicate pregnancy and lead to low birth rates in pregnant women who smoke.

Another factor attributed to the reduction in smoking rates is the development in new technologies to combat nicotine addiction. One of the primary reasons that smokers find quitting so difficult is the intense nicotine addiction that smoking brings. The invention of nicotine patches, lozenges and gums as part of a smoking cessation program has helped millions of smokers quit the habit over the last twenty years.

In addition to federal mandates requiring the addition of warning labels to cigarette packaging, many state and municipal jurisdictions created anti-smoking laws and ordinances. Several states added higher taxes to cigarettes, with California among the first to enact such statutes. Also, many cities passed local laws prohibiting smoking in bars, restaurants and public buildings.

Public awareness campaigns, such as those conducted by the American Heart Association, the American Lung Association and the American Cancer Society, also helped bring the issues of cigarette smoking to the attention of the American public. The campaigns highlighted many of the dangers that surround cigarette smoking, including lung cancer, throat cancer and emphysema.

As California took the lead in many of the anti-smoking efforts, the study also showed how lung cancer incidence rates declined in the state well before other states saw the same results. Deaths from lung cancer peaked in 1987 in California, with 109 per 100,000. The death rate fell to 77 per 100,000 in 2007. In other states, the lung cancer death rate peaked in 1993 at 117 per 100,000 and fell to 102 per 100,000 in 2007.

Sources:

http://www.npr.org/blogs/health/2011/03/16/134597676/heavy-smoking-is-fast-becoming-history?ps=sh_sthdl

http://www.wtma.com/rssItem.asp?feedid=116&itemid=29645079

http://health.usnews.com/health-news/managing-your-healthcare/articles/2011/03/15/heavy-smoking-declines-in-us

http://www.webmd.com/smoking-cessation/news/20110315/heavy-smokers-us-dwindling

http://www.cnn.com/2011/HEALTH/03/15/pack.smokers.now.rare/index.html

http://www.medicalnewstoday.com/articles/219085.php

http://www.latimes.com/health/boostershots/la-heb-california-smoking-20110316,0,5345363.story

http://en.wikipedia.org/wiki/Tobacco_packaging_warning_messages#United_States_of_America

Lung Cancer Rates Increase Among British Women

A new report by the group Cancer Research UK compares lung cancer rates in the British population from 1975 to 2008. The report showed that the number of women over sixty years of age diagnosed with lung cancer jumped from 5,700 in 1975 to 15,100 in 2008, an increase of nearly 165 percent in just over thirty years.

Also, the number of women overall diagnosed with lung cancer increased by 125 percent, from 7,800 in 1975 to 17,500 in 2008. By comparison, the number of men over sixty diagnosed with the disease actually fell, from 23,400 in 1975 to 15,100 in 2008.

The report cites the increase in the number of women taking up smoking in the 1960s and 1970s as the reason for the sharp increase. Statistics have shown that between 80 and 90 percent of all instances of lung cancer are tied to smoking.

Dr. Stephen Spiro, a spokesman for the British Lung Foundation, said that lung cancer has surpassed breast cancer as the leading cause of cancer deaths for women in Britain and several European nations. Dr. Spiro praised the efforts of government officials to raise the public’s awareness of the dangers of smoking, but also cited the fact that up to ten million adult Britons, about 20 percent of the population, still smoke.

Jean King, the director of tobacco control for Cancer Research UK, said that the group would continue to support smoking cessation programs. Also, Cancer Research UK is attempting to have advertisements for cigarettes covered or removed from stores that young people might frequent. Ms. King said that the advertising ban would “protect young people from being recruited into an addiction that kills half of all long term smokers”.

Sources:

http://www.mirror.co.uk/news/top-stories/2011/03/07/lung-cancer-rates-in-women-over-60-have-almost-trebled-in-past-40-years-115875-22971496/

http://www.cafonline.org/Default.aspx?page=19967

http://www.bbc.co.uk/news/health-12651455

Nanoparticles Communicate to Deliver Chemotherapy Drugs

Teams of researchers at opposite ends of the country have recently developed an improved system to deliver chemotherapy drugs to attack malignant cells. Scientists at both the Massachusetts Institute of Technology and the University of California at Sand Diego have devised a method involving microscopic machines known as nanoparticles. Although cancer researchers have used nanoparticles for several years to deliver chemotherapy treatments, this new method employs an added layer of accuracy.

While some cancer-fighting efforts with nanoparticles involve a single nanoparticle, the cooperative effort at MIT and UCSD involves a two-stage delivery system.  The first stage acts as a “scout”, locating the cancerous cells by tracking their protein emissions, which differ from those of health cells. Once the scout particle locates an area of malignant activity, it sends a signal to the second-stage nanoparticles. The second-stage particles deliver the chemotherapy drug and shrink the tumor.

Most methods that use nanoparticles to administer chemotherapy drugs are highly inefficient, with only one percent of the injected medication reaching the target. In tests on laboratory mice, the scientists found that the two-stage system delivered the drugs at 40 times the rate found in most single-stage methods. Geoffrey von Maltzahn, the lead author of the paper on this method, said that the dual-stage method “can improve the efficiency with which (nanoparticles) find and treat diseases like cancer.”

One of the keys to the success of the dual-stage system is that the “scout” particles are actually rod-shaped, microscopic gold particles. In addition to its connotations of wealth, gold is also highly conductive to both heat and electricity. When researchers shone a bright light on areas affected by the gold nanoparticles, the gold heated up and damaged the blood vessels around the tumor.

As the tumor began to bleed, the body sent a signal to its blood-clotting agents to create a protein known as fibrin. The second-stage nanoparticles also picked up on that signal and sent the drug to the bleeding tumor. The particles followed the signal deployed the drug to the tumor site. The blood clot closed around the malignant cells and sealed in the drug. This method improved both the accuracy and efficacy of the drug delivery system.

The method has shown great promise in the laboratory, as it improves the concentration of drugs delivered to the tumor site while greatly reducing the side effects associated with conventional chemotherapy treatments. However, much more research and effort will need to be done to see if it can be applied to human patients. One problem could be that the system could create blood clots in other areas of the body away from the tumor. Blood clots in the brain are often the source of strokes, and clots in the heart can cause pulmonary embolism and death.

“If you’re going to trigger coagulation, you want to be very selective, so that you don’t cause damage in other parts of the body,” said Dr. Anil Sood, an oncology specialist at the MD Anderson Cancer Center in Houston.

Related article

Sources:

http://www.popsci.com/science/article/2011-06/nanoparticle-teams-communicate-inside-body-target-tumors

http://blogs.discovermagazine.com/80beats/2011/06/21/two-types-of-nanoparticles-work-together-to-target-tumors/

http://bostinnovation.com/2011/06/21/mit-creates-new-nanoparticle-method-to-target-cancer-cells-more-effectively/

http://web.mit.edu/newsoffice/2011/swarming-nanoparticles-0620.html



Massachusetts Helps Vets Quit Smoking

State health officials in Massachusetts are developing measures to help the state’s military veterans quit smoking.  The new campaign is the second effort launched since 2008 to help veterans with this growing health problem.  Massachusetts Lieutenant Governor Tim Murray released a statement praising “the brave men and women” in uniform and said that the campaign would help to “provide (veterans) with the opportunity to live long, healthy lives”.

A report from the office of Governor Deval Patrick showed that nearly one-fourth of all Massachusetts veterans smoke cigarettes.  The US Centers for Disease Control and Prevention in Atlanta estimates that less than one-sixth of all adults in the Bay State smoke.  A related report from the Institute of Medicine showed that nearly one in three people on active military duty smoke, with the number rising to half or more among those veterans who have been deployed to war zones in Iraq and Afghanistan.

Coleman Nee, a veteran of the US Marine Corps during Operation Desert Storm in 1991, is now the Massachusetts Secretary of Veterans’ Services.  Mr. Nee also spoke out about the anti-smoking campaign, saying that smoking among veterans is “a very serious problem”.  He said that smoking is an issue for veterans’ services agencies as well as public health groups.  He called the addiction to smoking among service members “a real shame”.

Mr. Nee recalled that, during his time in the Marine Corps, he and other service personnel would receive cigarettes and smokeless tobacco as part of their care packages from home, a tradition that started back in World War I.  He remarked that this practice has since stopped; especially in light of the numerous health problems that smoking is now understood to cause.

A report from the state public health office revealed that cigarette smoking is the number-one cause of preventable disease and death in Massachusetts.  The report also estimates that health care costs for smokers add up to over $4.3 billion annually.

The public awareness campaign for veterans includes a toll-free number that offers support and information on smoking cessation programs.  When the first campaign started in 2008, thousands of veterans called the support hotline and obtained nicotine patches to help them quit the habit.  Massachusetts State Representative James E. Valle, chairman of the Joint Committee on Veterans and Federal Affairs, said that the program shows the state’s commitment to “helping those who have served” in uniform to lead healthier lives.

The moves to help veterans quit smoking come in light of a study commissioned by the Department of Defense in 2009.  The study examined the feasibility of banning smoking among all service personnel within the next decade.  All military bases prohibit smoking indoors, but the study also considers banning the sale of tobacco products on bases, as well as stopping troops in the field from smoking.

However, some military personnel are opposed to any ban on smoking.  Many see smoking as a stress reliever, especially during the heat of battle.  The Defense Department study also found that bases generate millions of dollars from tobacco sales, most of which goes toward covering the costs of programs for dependents and for recreation.

Sources:

http://www.wwlp.com/dpp/news/massachusetts/veterans-receive-help-to-stop-smoking

http://www.boston.com/news/local/massachusetts/articles/2011/03/08/veterans_get_help_to_quit_smoking/

http://articles.cnn.com/2009-07-12/us/military.smoking.ban_1_smokeless-tobacco-tobacco-sales-pancreatic?_s=PM:US