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American Lung Association's Stop-Smoking Program Goes Online

Los Angeles Times Health Writer

Say this for the American Lung Association's brand-new quit-smoking class: If you want to light up, no need to step into the hallway. Nobody's going to give you the stink eye, or a disappointed shrug. In fact, if any of your classmates become overly judgmental or confessional, you may safely cut them off without shame.

You get all of this, plus the promise that the course--unveiled two weeks ago--will be there for you at any time: from the pre-breakfast nicotine jones all the way through the 3 a.m. so-I-can-sleep emergency. That's because the association's seven-week Freedom From Smoking course just went online (visit "We really want to reach smokers where they are," said Mary Ella Douglas, director of training at the association's Virginia chapter, who developed the Web-based course. "We think this is the way to do it."

The lung association is hardly the first to offer such a program on the Web; sites such as, the No Smoke Cafe and have been staples of online quitting support for years, and the net is teeming with dot-coms hawking everything from herbal concoctions to hypnosis techniques to help you quit "instantly and painlessly."

But the association's commitment represents a major play by a national public health organization to a method that is still unproven--changing addictive habits over the Internet. Contrary to what public health researchers advise, the lung association did not test its program as an online course before launching. "Look, we've had 20 years of experience with our quit-smoking clinics," says Douglas, "and I think we can bring this to all the people who want to quit but can't make the clinics. Not many people can commit to coming to classes once a week for seven weeks, for an hour and a half to two hours each time."

The interest is certainly out there. According to Chris Cartter, director of Quitnet, about a million smokers have dropped in since the site started in 1995. And during the last year, researchers at UC San Francisco have had a brisk response to their ongoing research program, The program's director, Ricardo F. Munoz, says that so far, many users are heavy smokers who tend to be well-educated, middle- to upper-middle-class. Three-quarters are women. The program recently added a Spanish version of its Web site.

In fact, researchers find that at any given time, about three-quarters of smokers want to quit. But only 15% of those actually commit to a cessation class, surveys find. This group of self-quitters represents a tremendous public health opportunity, doctors say, because cessation programs can post one-year success rates of up to 25%. "And when you combine counseling with nicotine replacement," says Douglas, "you can push that success rate up into the 30% range. We know that people are already trying self-help methods. Enrollment in the cessation clinics has been declining ever since you could get nicotine patches and the gum over the counter. So why not combine all those things with some online counseling?"

Like many quit-smoking programs, the lung association relies on some fairly standard methods. Pledge yourself to a quit date. Write down all the reasons you want to quit. Keep a smoke diary, noting situations when you are most likely to smoke. Develop strategies to avoid or diffuse those situations. Experiment with relaxation techniques, and tricks to distract yourself from cravings. Plus one more important component: communication with other quitters. Like Quitnet and other such sites, the Freedom From Smoking online site has message boards for support.

According to Steve Sussman, a professor of preventive medicine and psychology at USC, the true test of any site trying to break an addiction will be its own addictiveness. "The three most important things the sites can provide: tailored information for each user, interactive features--and fun," he says. "If people want to come back, I think these programs can be successful."

In just its first week or so, the lung association's online course has registered 650 users. "I don't think everyone realizes how much shame there still is in smoking, in trying to quit and failing," says Douglas. "Now, people can take one of our clinics anonymously, and consult us whenever they need to."

Testimony Links Lung Cancer And Smoking

ASSOCIATED PRESS, (10/2/98) "Lung Cancer Linked To Smoking," Aviva Brandt

Testifying in Washington state's Medicaid trial, Dr. David Burns from the University of California's medical school said that lung cancer became an epidemic 20 years after the invention of a machine that mass-produces cigarettes. According to Dr. Burns, although the death rate for most cancers has decreased or stabilized since 1930, the death rate for lung cancer has dramatically increased. Dr. Burns is the first witness to testify in Washington's lawsuit against the tobacco industry.

Smoking Reduction Law Passed in Durango

On Septemter 15, 1998, the Durango City Council voted 4-1 to enact a law regulating the advertising, sale and access of tobacco products to minors. The law goes into effect on October 21st. Specifically, the law:
  • prohibits tobacco sales to minors;
  • mandates that businesses that sell tobacco products must either keep the products behind a counter, locked up, or in an area where buyers do not have direct access;
  • prohibits advertising of tobacco products within 500 feet of a school;
  • prohibits cigarette vending machines in areas where minors have access; and
  • phohibts the selling of single cigarettes

FDA and NM Team Up to Enforce Tobacco Law

Associated Press, September 17, 1998

The U.S. Food and Drug Administration recently announced that the New Mexico Department of Health will receive nearly $214,000 to conduct approximately 5,500 unannounced retail compliance checks to ensure that tobacco is not being sold to children under 18. Results of the compliance checks will be sent to the FDA. First offenders will be warned. Thereafter, fines of $250 for a second offense to $10,000 for the fifth offense will be opposed.

A federal appeals court panel in Richmond, Va. ruled last month that the FDA lacks jurisdiction to regulate tobacco products. The U.S. Justice Department will seek review of the decision by the full Fourth Circuit of Appeals.

Justice Department Files Petition To Overturn Ruling On FDA

WALL STREET JOURNAL, (9/28/98), "US Seeks Reversal Of Ruling Denying FDA Tobacco Powers", p. A30
BLOOMBERG (on-line), (9/25/98), "Tobacco Regulation Of 'Grave' Importance, Appeal Says"
ASSOCIATED PRESS, (9/26/98), "FDA Control Of Tobacco Sought"

The Justice Department filed a petition asking the full Fourth Circuit Court of Appeals to reverse an August ruling by a three-judge panel of the court that found the Food and Drug Administration (FDA) lacks the authority to regulate tobacco.

"If those errors are not corrected, one of the most significant public health initiatives of the past 50 years will be thwarted, and the health -- and ultimately the lives -- of millions of people will be jeopardized," the Justice Department argued. In its petition, the Justice Department said that the federal Food, Drug and Cosmetic Act intentionally defined "drugs" to allow for broad interpretation, and that the three-judge panel "improperly" ruled that regulation of tobacco is outside of the FDA's authority. "Courts should pay deference to an agency's interpretation of the statute that Congress has directed it to administer," the appeal stated.