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You’ve Got Mail About Quitting Smoking

The road to snuffing out cigarettes once and for all can be a long one.

“I think the big thing for people to remember is that it usually takes multiple attempts to be successful at quitting smoking,” says Dr. Valerie Bonne, a pulmonologist at Froedtert & the Medical College of Wisconsin in Milwaukee who oversees the health system’s smoking cessation program. “So just because you’ve tried in the past and haven’t been successful doesn’t mean you aren’t going to be successful in the future.”

In fact, research published last year in BMJ Open, an online, open access journal, found that for many smokers it may take 30 or more quit attempts before they finally kick the habit. Along with being persistent, experts like J. Lee Westmaas, strategic director of tobacco control research at the American Cancer Society, recommend trying lots of different approaches to smoke out the leading cause of preventable death. “I would say use as many aids as you can,” he says.

For those trying to quit, one new quit aid on the horizon will be easily accessed with an internet connection and a smartphone, tablet or computer: tailored emails.

Research led by Westmaas and published in May in the journal Tobacco Control looked at the effect of sending multiple emails to smokers during a quit attempt that were customized based on information provided by those individuals, such as quit date, their top two reasons for quitting, top five triggers for smoking and intended use of cessation medications. The findings showed that approach yielded quit rates that were higher than for those who received a single, non-tailored email containing links to smoking cessation resources. Self-reported rates of abstinence from smoking at six months after enrollment in the randomized controlled trial were 36 percent in the multiple email group compared with 26.5 percent in the single email group.

[See: 10 Ways to Live Healthier and Save Money Doing It.]

What’s more — though smokers are encouraged to try different methods of quitting — the research found the emails worked as a stand-alone approach. Westmaas says some emails were tailored based on whether study respondents planned to use nicotine replacement therapy, which has been found to be helpful for those seeking to quit smoking. Those study participants who weren’t planning to use NRT received an email explaining why use of NRT is actually a good thing, he says. Those receiving multiple emails who planned on using NRT got messaging outlining all the different kinds of NRT.

“Interestingly though, when we looked at whether or not people had used NRT, our results were the same. So even when we controlled for use of NRT, we still found an effect of the intervention,” he says — that is, receiving multiple, tailored emails helped people quit smoking regardless. “The intervention was effective whether or not you use nicotine replacement therapy.”

One of the study’s limitations was that those who participated were generally well-educated. The majority were white, and only 20 percent reported a high school education or less, suggesting the possibility that results may not necessarily be generalizable to less educated or other racial or ethnic groups, the researchers wrote. They suggest that future research should examine how well tailored emails worked for these and other groups, such as cancer survivors or lesbian, gay, bisexual, transsexual and intersex groups.

At present, the email program studied isn’t available to the general public. But Westmaas says the American Cancer Society aims to make a similar program available soon. “We hope that by the beginning of next year we’ll have something ready,” he says, adding that it could be earlier depending on the success of efforts to secure funding for the program.

In the meantime, those who wish to get support for quit attempts but prefer to receive it in a way that fits with an on-the-go lifestyle can opt to receive text messages to support a quit attempt as well — like through smokefree.gov, a website created by the Tobacco Control Research Branch of the National Cancer Institute. NCI also offers QuitPal, a free app for iPhone or iPad, for a quit assist. The app has numerous interactive features, such as tracking smoking habits with a calendar and providing tips to deal with cravings. It also allows users to connect with social media, where they can see loved ones’ personalized video messages to support their progress.

[See: 10 Surprising Habits Killing Your Teeth.]

The point, however support is provided, is to deliver it in a way that best suits the individual. “It seems like people have preferences for how they want to receive information, especially about quitting,” Westmaas says.

While some gravitate toward group smoking cessation classes, for example, others prefer to talk one-on-one with a counselor or on a smoking quitline, like 1-800-QUIT-NOW (also affiliated with NCI). Others prefer less intrapersonal interaction, and technology provides a way to reach more people trying to quit. Some people in rural areas may not have access to smoking cessation programs, says Mary LeVasseur, manager of community health and wellness at Lancaster General Health, who’s responsible for the health system’s tobacco prevention and treatment programs.

The email approach is not meant to replace other options for quitting, Westmaas emphasizes, but rather to provide an additional one.

Experts point out, in particular, that medications and counseling in combination can be a powerful combination — even more effective than either alone. However, medications Chantix and Zyban are also associated with risks ranging from depressed mood, hostility and aggression to suicidal thoughts. “Most of the medication options and the nicotine-replacement options are fairly well tolerated” and effective, Bonne says. But experts say its important to keep doctors in the loop when issues arise to determine if medications or NRT should be stopped.

[See: 7 Things You Didn’t Know About Lung Cancer.]

If using NRT to break a tobacco addiction, talk with a health provider if you experience nausea, dizziness, weakness, vomiting, fast or irregular heartbeat, “mouth problems” with the lozenge or gum or redness or swelling of the skin around an NRT patch that doesn’t go away, the Food and Drug Administration recommends. Taken by mouth, the lozenges can cause a warm or tingling sensation; and users are urged to seek medical attention right away if they experience a severe allergic reaction — which may be marked by rash, itching, swelling of the mouth or difficulty breathing — or other serious side effects.

With any attempt to quit, experts say it’s important to take stock of even small successes — like not smoking for a short period, even if it doesn’t last. “We look at tobacco dependence as a chronic disease. So that’s the most important thing — knowing that people go through many different cycles of abstinence and remission,” LeVasseur says.

That’s not to say quitting for good isn’t possible. Rather, experts emphasize, it’s important to take the long view: Don’t be discouraged, and make as many quit attempts and use as many approaches as needed to kick the habit.

More from U.S. News

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You?ve Got Mail About Quitting Smoking originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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