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- Some 44 million people, or about 19% of adults in the United States, smoke.
- The number of heavy (pack-a-day) smokers is also down. In 1965, 23% of the population smoked heavily. That number was down to 7% in 2007. Smoking cessation programs and smoke-free environments have played a role in the decline.
- Twenty-six states and the District of Columbia have enacted laws banning smoking in restaurants, bars, and workplaces. Ten other states have laws banning smoking in some of these places.
- Despite this progress, as of 2011 over 9% of people who smoke consumed 30 or more cigarettes a day.
New Research:
- Several small studies suggest E-cigarettes can help some people quit smoking, but other researchers worry that they may serve as gateway products leading to tobacco use. Because of safety concerns, the FDA has announced that it will regulate e-cigarettes in the same way that it regulates tobacco products.
- Men who are diagnosed with prostate cancer fare much worse if they smoke. Current smokers are more likely to have their prostate cancer return, and to die, than men who never smoked.
- Exposure to smoke is dangerous during pregnancy, and even women who don't smoke themselves can suffer the harmful effects of cigarettes. Pregnant women who are exposed to secondhand smoke increase their risk of having a stillbirth by 23% and increase their baby's risk of birth defects by 14%.
- Heavy smoking during middle age can lead to memory problems later in life. Middle-aged smokers are twice as likely as non-smokers to get Alzheimer's disease and dementia when they get older.
- Annual low-dose CT screening for lung cancer should be offered to current and former smokers who are between the ages of 55 - 74 years, have smoked at least 30 pack years, and have no history of lung cancer.
- Chest x-rays should not be offered as a screening tool.
Just under 44 million people, or about 19% of adults in the United States, currently smoke, according to a 2012 report by the U.S. Centers for Disease Control and Prevention (CDC). Smoking rates dropped by nearly 1% -- or 3 million people -- between 2005 and 2010. No significant change occurred between 2010 and 2011, the last year for which figures are available.
Heavy smoking (a pack-a-day habit) is also down from a few decades ago. Back in 1965, close to 23% of Americans were heavy smokers. Today, only about 7% smoke 20 cigarettes a day or more. California has been especially successful at reducing heavy smoking rates, in part due to smoking cessation programs and smoke-free environments. Despite this progress, as of 2011 over 9% of people who smoke consumed 30 or more cigarettes a day.
These reductions in overall smoking are good news, but smoking is still a big health problem. It kills 443,000 people a year in the United States, accounting for nearly 1 out of every 5 deaths.
Smoking in Childhood and Adolescence
Fewer teens are smoking today than in the late 1990s, but the decrease in teen smoking rates has slowed in recent years. In 2011, 23.2% of high school students used some form of tobacco product, down from 34.4% in 2000. Also among high school students, 15.8% were current cigarette users in 2011, compared with 27.9% in 2000.
The number of frequent smokers (defined as 20 or more cigarettes a month) dropped from about 13% in 1991 to 7% in 2009.
The younger children start smoking, the more likely they will smoke as adults. Smoking can become addictive very quickly. According to the American Cancer Society, the earlier you start smoking, the more likely you are to develop long-term nicotine addiction.
In the past, advertising played a major role in encouraging some teens to smoke. New regulations have made it much more difficult for advertisers to promote smoking to young people. However, scenes that show people smoking, often in a positive way, are still common in movies and television shows. This may be a major influence on the attitude toward smoking in children and adolescents.
Research has found that parents can discourage their children from smoking by:
- Not smoking themselves
- Telling their children they do not approve of smoking
- Closely monitoring their children's television and music-listening habits
- Being home for their kids and providing a structured home life
Doctors can also have a major effect on their young patients' smoking habits. However, less than half of teenagers say their doctors have ever asked them if they smoke (even though most teen smokers said they would admit to smoking if asked) or given them counseling on how to quit. Counseling may be of particular importance, considering that teens who smoke are more likely to attempt suicide than their non-smoking peers.
Gender, Age, and Ethnicity
|18 - 24 years
|25 - 44 years
|45 - 64 years
|65 years and older
|Source: CDC/MMWR Report 2010
While the percentage of adults over age 65 who smoke is lower than the percentage of smokers in other age groups, older adults usually have smoked for a long time (about 40 years) and tend to be heavier smokers, according to the American Lung Association. Because of this, older smokers are more likely to have smoking-related illnesses.
Among students (under age 18), Caucasians are more likely to smoke than Hispanics and African-Americans. The rate of smoking is highest among people of mixed race, followed by American Indians and Alaskan natives. Asians have the lowest smoking rates.
In general, the rate of smoking is highest in the Midwest and South and lowest in the Northeast and West. Utah has the lowest smoking rate in the United States.
Educational Level
People who have not graduated from high school or received their General Education Development (GED) certificate are more likely to smoke than those who attended college. The lowest smoking rates are in people with advanced graduate degrees.
Psychological and Physical Factors
Men and women with mental or physical disorders are about 50% more likely to smoke than people without such illnesses. Factors that can influence smoking include:
- Low self-esteem
- Behavioral problems (in teens)
- Depression
- Schizophrenia
- Physical disabilities
Having depression increases the likelihood that someone will smoke, and decreases their likelihood of quitting. Twice as many adults with depression are current smokers, compared to those without depression. The more severe their depression, the more likely people are to smoke.
Genetic Factors
Evidence strongly supports the idea that genes play a role in a person's dependence on nicotine. Researchers are now targeting specific genes that may be responsible for nicotine dependence. The same genes may be responsible for both nicotine and alcohol dependence.
Economic Factors
Some studies suggest that smoking becomes more widespread when it is cheaper to buy cigarettes. For example, states that have low taxes on cigarettes have a high proportion of smokers. Making it more expensive to smoke may reduce the number of smokers.
Nicotine Addiction
Nicotine is the chemical in cigarettes that makes them addictive. About 85% of smokers are addicted to nicotine. Higher levels of nicotine in a cigarette can make it harder to quit smoking. The amount of nicotine in cigarettes has steadily increased in the past decade. Higher nicotine levels have been found in all cigarette categories, including "light" brands.
Some researchers feel nicotine is as addictive as heroin. In fact, nicotine has actions similar to heroin and cocaine, and it affects the same area of the brain as these drugs.
Depending on the amount taken in, nicotine can act as either a stimulant or a sedative.
Cigarette smoking produces mental effects very quickly. For example, it can:
- Boost mood and relieve minor depression
- Suppress anger
- Enhance concentration and short-term memory
- Produce a sense of well-being
Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Nicotine, particularly in those first few cigarettes, increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations. This feeling is similar to getting a reward.
Over the course of a day, however, the nerve cells become desensitized to nicotine. Smoking becomes less pleasurable, and smokers may need to increase their intake to get their "reward." A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.
Smokeless Tobacco
Smokeless tobacco, also called spit tobacco, includes chewing tobacco (dip and chew), tobacco powder (snuff), as well as flavored tobacco lozenges. These products also contain nicotine.
With smokeless tobacco products, tobacco is absorbed by the digestive system or through mucus membranes. Smokeless tobacco contains at least 28 cancer-causing substances, and is not a safe substitute for smoking cigarettes or cigars. According to the National Institutes of Health, chewing on an average-sized piece of chewing tobacco for 30 minutes can deliver as much nicotine as smoking three cigarettes.
Smokeless tobacco is addictive, and evidence suggests that it increases the risk of oral cancer, gingivitis, and tooth loss. The risk of cancer in people who use smokeless tobacco is lower than that of smokers, but it is still higher than that of people who do not use tobacco at all. Using smokeless tobacco also seems to increase the risk of fatal heart attacks and strokes.
Pipes and Cigars
Pipe and cigar smoking are on the rise. Because pipe and cigar smokers often don't inhale, the common misperception is that they don't face as substantial a health risk as cigarette smokers. Yet research finds that smoking pipes or cigars causes harmful health effects similar to those of cigarettes.
People who smoke pipes or cigars are at greater risk for lung damage and chronic obstructive pulmonary disease (COPD), even if they never smoked cigarettes.
One type of pipe -- the water pipe (also known as a "hookah") -- is gaining popularity among college students, in part because of the mistaken belief that it is less harmful than regular cigarettes. Yet studies have found that smoking a water pipe carries the same risks as smoking cigarettes, including lung cancer, other lung disorders, and gum disease.
Health Risks
Smoking -- even just a few cigarettes a day -- has been linked to many serious health risks. Up to half of all current tobacco users will die from a tobacco-related disease, many of which are discussed below.
Effects on the Lungs
According to the American Lung Association, smoking is directly responsible for about 90% of the deaths due to lung cancer. The good news is that as smoking rates have declined, lung cancer rates have dropped too. In men, there were about 3% fewer cases of lung cancer in 2008 than in 2005. The risk in women fell by a little over 2% during the same time period.
Smoking is also responsible for most deaths due to COPD, which includes emphysema and chronic bronchitis. And smoking makes it harder to control asthma, by interfering with the response to steroid medicine and worsening lung function.
Cardiovascular Effects
Smoking, chewing tobacco, and being exposed to secondhand smoke all greatly increase the risk for heart attacks and strokes. The risk for heart problems in people who smoke or who are exposed to smoke may be three times greater than that of people who don't smoke. When people stop smoking, their risk of having a heart attack decreases over time.
Smoking also significantly increases the risk for peripheral artery disease, which damages the blood vessels in the legs and can lead to disability and amputation.
Effects on Male Fertility and Erectile Dysfunction
Smoking can harm a man's sexuality and fertility. Heavy smoking contributes to erectile dysfunction by decreasing the amount of blood flowing into the penis.
Smoking impairs sperm motility, reduces sperm lifespan, and may cause genetic changes that can affect a man's offspring. Men who smoke have less success with fertility treatments. They also have a lower sex drive and less frequent sex.
Effects on Female Infertility, Pregnancy, and Childbirth
Studies have linked cigarette smoking to infertility in women, and to health problems in their babies.
Negative effects of smoking include:
- Greater risk for infertility. Women who smoke one or more packs a day and who started smoking before age 18 are at greatest risk for fertility problems.
- Earlier menopause. Women who smoke tend to start menopause at an earlier age than non-smokers, perhaps because toxins in cigarette smoke damage eggs.
- Pregnancy complications, which increase with the number of cigarettes smoked.
Pregnancy complications that are more common in smokers include:
- Miscarriage
- Stillbirth
- Premature rupture of membranes
- Premature delivery
- Problems with the placenta
Smoking further increases the risk to the mother and unborn child in high-risk pregnancies.
Effects on the Unborn Child. Smoking during pregnancy increases the risk for:
- Low birth weight
- Birth defects (women who smoke during pregnancy have lower levels of folate, a B vitamin that is important for preventing birth defects)
- Obesity and diabetes
- Cleft lip (a split lip that has not closed during the fetus' development)
Some women have genes that may make them especially likely to deliver low-birth-weight infants if they smoke, although newborns of all female smokers are at greater risk for low birth weight. The good news is that women who stop smoking before becoming pregnant or during their first trimester of pregnancy reduce their risk of having a low-birth-weight baby compared to that of women who never smoked.
Women who want to become pregnant should make every attempt to stop smoking, and they should use smoking cessation aids before they try to conceive. Government guidelines recommend that doctors ask all of their pregnant patients about their tobacco use, and offer counseling to those patients who do smoke. After birth, if new mothers cannot quit, they should at least be sure not to smoke in the same room as their infant.
Pregnant women also need to avoid being around people who are smoking. Women who are exposed to secondhand smoke during pregnancy are 23% more likely to have a stillborn baby and 14% more likely to have a baby with a birth defect than women who are not exposed to secondhand smoke.
Effects on Bones and Joints
Smoking has many harmful effects on bones and joints:
- Smoking can slow the process that adds calcium to bones and makes them stronger. Women who smoke are at high risk for bone density loss and osteoporosis.
- Postmenopausal women who smoke have a significantly greater risk for hip fracture than those who do not smoke.
- Smokers are more likely to develop degenerative disorders and injuries in the spine.
- Smokers have more trouble recovering from surgery.
Smoking and Diabetes
Smoking may increase the risk of developing diabetes or glucose intolerance, a condition that precedes diabetes.
Smoking and the Gastrointestinal Tract
Smoking increases acid production in the stomach. It also reduces blood flow and the production of compounds that protect the stomach lining. This combination of effects increases the risk for certain gastrointestinal conditions.
Inflammatory Bowel Disease. Smoking has mixed effects on inflammatory bowel disease, the collective term for ulcerative colitis and Crohn's disease. Smokers have lower-than-average rates of ulcerative colitis, but higher-than-average rates of Crohn's disease. Smokers with Crohn's disease who quit smoking have less severe symptoms than those who continue to smoke.
Colorectal cancer. Smoking increases the risk of colorectal cancer and aggressive colon polyps, which are considered precursors to colon cancer. Cigarette smoking is also a known risk factor for pancreatic and gastric cancers.
Hepatitis and Cirrhosis. Smoking is linked to increased liver scarring (cirrhosis) from excessive drinking or chronic hepatitis B or C viruses.
Smoking and Other Types of Cancer
Bladder Cancer. Smoking is the single biggest risk factor for bladder cancer, which is diagnosed in about 70,000 Americans each year. The risk of bladder cancer among smokers may be even higher than was once thought. Current smokers are four times as likely to get the disease than non-smokers, and former smokers face double the risk of bladder cancer. Both female and male smokers face similar odds of getting bladder cancer.
Prostate Cancer. Men who smoke at the time of their diagnosis with prostate cancer fare much worse than non-smokers. Smokers are 61% more likely to see their prostate cancer return, and twice as likely to die from their cancer than men who never smoked. Men who quit smoking at least 10 years before their diagnosis are at the same risk as those who never smoked.
Smoking and Thyroid Disease
Cyanide, a chemical found in tobacco smoke, interferes with thyroid hormone production. Smoking triples the risk for developing thyroid disease, particularly hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid). Smoking has also been linked to goiter, a swelling of the thyroid that occurs in people who do not get enough iodine.
Smoking and Surgical Recovery
Smokers are at increased risk for heart and circulatory problems and delayed wound healing after surgery. Quitting smoking significantly lowers the risk of these complications. The longer patients are off cigarettes before their surgery, they better they will do after the procedure.
Smoking and Age-Related Disorders
The following age-related conditions are thought to occur at higher rates in smokers than non-smokers:
- Cataracts. Quitting smoking reduces your chances of needing cataract surgery in the future, although you will still face a greater risk for this surgery than non-smokers.
- Age-related macular degeneration (AMD). AMD is a leading cause of blindness in older people. Smoking is the second biggest risk factor for AMD, after age. Heavy smoking over a long period of time can significantly increase AMD risk.
- Alzheimer's disease and dementia. Heavy smoking during middle age increases the risk for Alzheimer's disease and dementia by 100% in later life.
- Gum disease and tooth loss. One-half or more of the cases of severe gum disease in American adults may be due to cigarette smoking.
- Wrinkles. Smokers are nearly five times more likely to develop more and deeper wrinkles as they age compared to nonsmokers.
- Baldness and premature gray hair. Certain chemicals in smoke break down in hair cells, which leads to hair damage.
- Hearing loss, particularly high-frequency hearing loss
- Incontinence
Secondhand Smoke
All burning tobacco products produce secondhand smoke. About 126 million non-smokers are exposed to secondhand smoke each year -- almost 22 million of them are children ages 3- 11. Secondhand smoke from parents has been shown to affect infants' lungs as early as the first 2- 10 weeks of life. This abnormal lung function could persist throughout a child's life.
Exposure to secondhand smoke in the home increases the risk for:
- Asthma and asthma-related emergency room visits in children who have existing asthma
- Weight problems
- Behavioral problems
- Lower respiratory tract infections (such as bronchitis or pneumonia)
Being exposed to secondhand smoke also increases the risk for heart attacks and lung cancer.
Smoking Bans
More and more households in the United States are banning smoking. The U.S. Centers for Disease Control and Prevention (CDC) reports that 75% of households forbid smoking at any time or place.
Smoking bans are extending to public places, as well. In 2002, Delaware became the first state to institute a smoke-free law. Since then, smoking bans have spread across the country. Currently, 26 states have laws prohibiting smoking in restaurants, bars, and offices. Ten other states have laws banning smoking in some of these places.
The risk of heart attacks in communities that enforce smoking bans has decreased by 17% overall. Younger people and non-smokers seem to benefit the most from such bans.
Quitting Smoking
It's never too late to quit smoking. According to the American Cancer Society, about half of all smokers who keep smoking will die from a smoking-related disease. Quitting has immediate health benefits.
Better Health After Quitting
Time after last cigarette
Physical Response
20 minutes
Blood pressure and pulse rates return to normal.
8 hours
Levels of carbon monoxide and oxygen in the blood return to normal.
24 hours
Chance of a heart attack begins to decrease.
48 hours
Nerve endings start to regrow. Ability to taste and smell increases.
72 hours
Bronchial tubes relax and the lungs can fill with more air.
2 weeks - 3 months
Circulation improves and lung function increases by up to 30%.
1- 9 months
Rates of coughing, sinus infection, fatigue, and shortness of breath decrease. Cilia in the airways regrow, improving the ability to clear mucus and clean the lungs, and reducing the chance of infection. Energy level increases.
Long-Term Effects
After a year, the risk of dying from a heart attack or stroke is reduced by up to 50%.
According to the National Institutes of Health, about 40% of smokers who want to quit make a serious attempt to do so each year, but fewer than 5% actually succeed. Available smoking cessation products and therapies are greatly underused. If more smokers asked for or were offered such help, quit rates could double or triple.
Some people have genes that make quitting easier. Researchers have identified more than 200 genes in people who have successfully quit smoking. The discovery of these genes could lead to new smoking cessation therapies that target a person's specific genetic makeup.
Nicotine Replacement Therapy
Nicotine replacement therapy involves the use of products that provide low doses of nicotine, without the contaminants found in smoke. The goal of therapy is to relieve cravings for nicotine and ease the symptoms of withdrawal.
In general, nicotine replacement therapy benefits moderate-to-heavy smokers the most. However, it does appear somewhat helpful for light smokers (people who smoke fewer than 15 cigarettes a day).
Combining nicotine replacement therapies may be more effective than using one alone. For example, a combination of the nicotine patch and nicotine gum, nasal spray, or lozenge helps smokers go smoke-free for a longer period of time before relapsing. Adding bupropion to nicotine replacement therapy also increases the chance for success.
Nicotine Patches. Nicotine patches deliver nicotine through the skin. This is called transdermal nicotine delivery. It is effective at reducing withdrawal symptoms. Nicotine patches are available over the counter.
Patches work in different ways:
- Step-Down Approach. Patches that use this method include NicoDerm CQ. The patches come in three strengths (21, 14, and 7 mg). You use the strongest dose first and reduce it gradually over a period of 8 - 10 weeks. A 21 mg patch is about equal to 15 cigarettes. A heavy smoker may need to wear two patches at first.
- Single-Step Approach. The single-step patch (Nicotrol) can be taken off after 16 hours and replaced 8 hours later. It can be used for only 6 weeks.
How patches are applied and used:
- A single patch is worn each day and replaced after 24 hours.
- To avoid skin irritation it is applied to different hairless areas above the waist and below the neck each day.
- People can wear the patches for 24 hours, but some have reported odd dreams and have disliked the sensation of wearing the patch during the night. However, people who wear the patch all the time have fewer withdrawal symptoms and slightly better quit rates than those who take it off at night.
- The FDA recommends using the patches for 3 - 5 months, although some studies suggest that using them for 8 weeks helps smokers achieve the maximum benefits.
Store and discard patches safely, particularly in homes with young children. Children have been poisoned and have gotten sick from wearing, chewing, or sucking on nicotine patches. Children should not come in contact with the patches, even while the smoker is wearing them. If a child puts on a patch, remove it and wash the affected skin right away. A child who has eaten nicotine or worn a patch for a long period of time may need urgent medical care.
Nicotine Gum. Nicotine gum (Nicorette) is available over the counter and has helped many people quit. Some people prefer gum to the patch because they can control the nicotine dosage, and chewing satisfies the oral urge associated with smoking.
Tips for using the gum:
- If you are just starting to quit, chew 1 - 2 pieces every hour or two. Do not chew more than 24 pieces a day.
- Gradually taper off. The goal is to stop using the gum by 3 months (although about 3% of people continue to use it long after they have quit smoking).
- Chew the gum slowly until it develops a peppery taste. Then tuck it between the gum and cheek, so that the nicotine can be absorbed.
- Coffee, tea, soft drinks, and acidic beverages may interfere with nicotine absorption, so wait at least 15 minutes after having one of these drinks before chewing a piece of gum.
Some people prefer other methods or cannot use the gum for the following reasons:
- They find the taste of the gum unpleasant.
- Side effects of the gum may include upset stomach, mouth sores, hiccups, and throat irritation.
- They are embarrassed to chew gum.
- They wear dentures.
Long-term dependence may be a problem with nicotine gum. Experts do not recommend that people chew nicotine gum for more than 6 months.
The Nicotine Inhaler. The nicotine inhaler resembles a plastic cigarette holder. It requires a prescription in the United States. The inhaler comes with several nicotine cartridges, which are inserted into the inhaler and "puffed" for about 20 minutes, up to 16 times a day. The dose is gradually decreased.
Several studies have reported that the inhaler triples quit rates (between 17 and 28%) compared with a placebo (6 - 9%) after 6 months. The inhaler has some advantages over other nicotine replacement products:
- It provides varying doses of nicotine on demand (as opposed to continuous doses with the patch or gum) and is relatively fast acting. Blood nicotine levels peak about 20 minutes after using the inhaler, comparable to the gum and faster than the patch.
- It satisfies oral urges.
- Most of the nicotine vapor is delivered into the mouth, not into the lung airways (although some people experience mouth or throat irritation and a cough).
Using a combination of the inhaler and the patch may be more effective than either method alone.
The Nicotine Nasal Spray. The nasal spray satisfies immediate cravings by providing fast doses of nicotine. (Nicotine levels peak within 5 - 10 minutes after administering the spray.) It may be useful together with slower-acting nicotine replacement therapies.
The spray can irritate the nose, eyes, and throat, so it may not be suitable for people with allergies or sinus infections. Most people, however, can tolerate the side effects, which usually go away within the first few days.
Nicotine Lozenge. A nicotine lozenge (Commit) is available over the counter. It is made from pressed tobacco and comes in two strengths for heavier or lighter smokers. Suck on one piece every 1 - 2 hours, then gradually taper off your use. Don't eat or drink 15 minutes before using a lozenge, and don't take more than 20 lozenges a day. Side effects include heartburn, hiccups, nausea, headaches, and cough. The Commit lozenge also contains phenylalanine, a chemical that certain people may need to avoid.
Electronic cigarettes (E-Cigarettes). Electronic cigarettes are cigarette-, cigar-, or pipe-shaped devices that deliver nicotine or other substances in the form of a vapor. Electronic cigarettes are marketed as quit-smoking aids because they are designed to give the feeling of smoking without actually lighting up.
Several small studies suggest E-cigarettes can help some people quit smoking, but other researchers worry that they may serve as gateway products leading to tobacco use. Because of concerns about e-cigarettes' safety, the FDA plans to regulate them just as it does tobacco products (they are currently regulated by the FDA only when marketed as a therapeutic product). This will require, among other things, that e-cigarette manufacturers provide the government with a list of ingredients contained in their products.
Facts about Nicotine Replacement Therapy:
- Not cheating on the very first day of nicotine-replacement use increases the chance of quitting permanently tenfold.
- The more cigarettes people smoke, the higher the dose of nicotine replacement they may need at first.
- Adding a counseling program can boost the effectiveness of any nicotine replacement program.
- Do not smoke while using nicotine replacement. It can cause nicotine to build up to toxic levels in your body.
- Nicotine replacement helps prevent weight gain while you are using it, but you are still at higher risk for gaining weight when you stop using all nicotine.
Side Effects. Side effects of any nicotine replacement product may include headaches, nausea, and other gastrointestinal problems. People often experience sleeplessness in the first few days, particularly with the patch, but the insomnia usually passes. Patients using very high doses of nicotine are more likely to have symptoms. Reducing the dose can prevent these symptoms.
Special Concerns for Specific Individuals. There has been some concern that the patch might be harmful for people with heart or circulatory disease, but studies are finding that it actually poses no danger for these individuals. In fact, the patch may help reduce angina attacks brought on by exercise. However, unhealthy cholesterol levels (lower HDL levels) caused by smoking will not improve with the nicotine patch. HDL levels will only improve when all nicotine is stopped.
Nicotine replacement may not be completely safe in pregnant women, although it has been used successfully in this group without problems. The unborn children of women who use the patch may have an increased heart rate.
Nicotine Products and Children. Keep all nicotine products away from children. Nicotine is a poison. Call a physician or poison control center immediately if a child has been exposed to a nicotine replacement product, even for a short period of time. Also call the doctor if a child has been exposed to a nicotine product and has any symptoms, including upset stomach, irritability, headache, rash, or fatigue.
Warnings Against Long-Term Use. No one should use nicotine replacement therapies as a long-term substitute for smoking. Any nicotine replacement therapy should only be used temporarily.
Antidepressants for Smoking Cessation
Bupropion (Zyban, Wellbutrin). Bupropion is a type of antidepressant that is also FDA-approved for smoking cessation. Bupropion differs from most other antidepressants in that it increases the effects of dopamine, the brain chemical that appears to play a strong role in nicotine addiction. Using bupropion along with nicotine replacement therapy may help control cigarette cravings.
People usually start taking bupropion a week or two before quitting, and continue taking it for 7 - 12 weeks. The usual maintenance dose is a 150 mg tablet taken twice a day. No single dose should be higher than 150 mg.
Side effects of bupropion include:
- Gastrointestinal problems
- Headaches
- Insomnia
- Dry mouth
- Irritation
In very rare cases, seizures have occurred, although usually in people who exceeded the recommended dose or who were already at risk for seizures.
Warning about Bupropion:In July 2009, the FDA required the makers of bupropion to add a Boxed Warning (the strongest possible warning) regarding serious mental health side effects that may occur while using the medication. These potentially serious side effects include "changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide." Patients taking this medication, as well as their family members, should be aware of these potential dangers and report any symptoms to their doctor immediately. Patients are also advised to stop taking the medication immediately if any of these symptoms occur.
Nortriptyline (Pamelor, Aventyl). The tricyclic antidepressant nortriptyline may reduce the actions of nicotine and help smokers quit. Quit rates with this medication are as high as 30%. Long-term abstinence rates are more than twice those of placebo (sugar pill). It is best to start taking this medication 10 - 28 days before your intended quit date.
Side effects of nortriptyline include:
- Drowsiness
- Dry mouth
- Changes in taste
- Constipation
In rare cases, tricyclic antidepressants like nortriptyline can have more serious side effects. An overdose can be deadly. Tricyclics may also pose a danger for patients with certain types of heart disease.
Varenicline. A newer drug called varenicline (Chantix) may work significantly better than bupropion. Unlike bupropion, it targets nicotine receptors in the brain, which helps reduce cravings. Varenicline can also help people wean themselves off smokeless tobacco.
Cigarette smokers ages 18 and older can use varenicline. This drug should not be combined with nicotine replacement therapy.
Warnings about varenicline (Chantix): Varenicline carries a Boxed Warning regarding serious mental health side effects that may occur while using the medication, or immediately after stopping it. These uncommon but potentially serious side effects include "changes in behavior, agitation, depressed mood, suicidal ideation and suicidal behavior." Recently, the FDA updated the varenicline label, after the drug was associated with an increased risk for heart problems, such as a heart attack and abnormal heart rhythms. Patients who take this medication should be aware of these potential dangers and report any symptoms to their doctor immediately.
Behavioral Methods and Counseling
Everyone who quits should aim to quit completely. Quitting completely is essential to regaining good health and reversing the harmful effects caused by smoking. Just reducing smoking, even by half, does not eliminate the risk for cancer and other health problems. Although smokers who cut back take in less smoke and nicotine, their bodies are still unable to heal completely from the ongoing intake of toxins. Changing to low-tar cigarettes is also not a solution. In fact, people who smoke these cigarettes tend to inhale more deeply, which may increase their health risks.
Most people who return to smoking "cheat" in the first few weeks. To help you make a quit-smoking plan and stick to it:
Create a List
Write down 10 reasons to quit. In addition to health reasons, the list might include:
- Having better smelling hair, clothes, and breath
- Having fewer wrinkles
- Enjoying the taste of food
- Saving money
Read the list often during the quitting process to help you stay motivated.
Decide on a Specific Quit Date
Some people find it helpful to choose a date when they anticipate having little or no stress for at least 3 days. Once you've chosen a date:
- Write out a quit contract, put the date on paper, and get a friend to sign it.
- Throw out all smoking paraphernalia the night before the quit date.
- Make plans to stay busy on the quit day, especially at night, when your urge to smoke will be high.
If quitting cold turkey isn't for you, gradually stopping is an equally effective approach. Reducing the number of cigarettes you smoke before your quit day might work just as well as stopping all at once.
Make an Oath
Take an extreme oath. For example, "If I smoke one more cigarette my dog will die." Although this seems absurd, some people who have failed with all other methods have reported that they quit completely and successfully after taking such an oath.
Let the Body and Mind Heal During Withdrawal
- Retreat from the world when cravings become overwhelming. Take a nap, warm bath, or showers; meditate or read a novel.
- Help your body get rid of nicotine. Drink plenty of water. Eat fresh fruits, vegetables, whole grains, and fiber-rich foods. Munch on carrots, apples, and celery.
- When cravings occur, hold your breath for as long as possible or take a few deep, rhythmic breaths.
- Use meditation or relaxation and deep breathing exercises, especially when you feel the urge to smoke.
Get Family and Friends Involved
- Tell your friends and family that you've already quit, so you'll be embarrassed if they catch you smoking.
- Fine yourself. Pay a family member or friend if they catch you smoking. The amount should be large enough ($5 - $20) to be a deterrent, but not so large as to be ridiculous. Save up for something special, or donate the money to charity.
- If your partner or friend smokes, try persuading him or her to quit. At the very least, ask the person not to smoke around you.
Studies continue to show that smokers who exercise can greatly increase their ability to quit smoking and reduce their risk for weight gain. When you have cravings:
- Dance
- Run
- Walk
- Jump up and down
- Stretch
- Do push-ups
- Do yoga
Older people and anyone with health problems should consult their health care provider before starting an exercise program.
Maintain a Healthy Diet
- Eat plenty of fresh, crunchy fruits and vegetables. This is also a useful way to satisfy oral cravings without adding many calories.
- Drink plenty of water and healthy beverages.
- Drink coffee or tea in moderation. These drinks may help prevent weight gain, and may also boost alertness and mood. Avoid caffeine in the evening, however, since sleep disturbances can be a problem during withdrawal.
Change Daily Habits
- Change your daily schedule, particularly eating times, as much as possible. Eat at different times of the day or eat many small meals instead of three large ones. Sit in a different chair or even a different room while you eat.
- If you smoke after eating, find other ways to end a meal. Play a tape or CD, eat a piece of fruit, get up and make a phone call, or take a walk (a good distraction that burns calories as well). If you normally have a cigarette with coffee, drink tea instead or use a different cup.
- Substitute oral habits by eating celery, chewing sugarless gum, or sucking on a cinnamon stick.
- Go to public places and restaurants where smoking is prohibited or restricted.
- Set short-term quitting goals and reward yourself when you meet them.
- Every day put the money you'd normally spend on cigarettes in a jar and buy something you want at the end of a set period of time.
- Find activities that focus your hands and mind but are not taxing or fattening, such as playing computer games or solitaire, knitting, sewing, or doing crossword puzzles.
About 4% of smokers who quit without any outside help succeed. Nevertheless, most people try to quit alone. The primary obstacle to quitting on your own is eliminating the habits associated with smoking. Excellent books, CDs, and manuals are available to help you quit on your own.
Smokers who use outside help have better luck, with success rates of 25 - 35%. Those who are counseled in addition to using nicotine replacement and bupropion have the best chance at quitting. Varenicline can double or triple your odds of staying off cigarettes.
Talking with a counselor can also help. Telephone counseling has been shown very effective for quitting smokeless tobacco.
Types of Behavioral Approaches
Problem Solving or Coping Strategies. Smokers are more likely to quit smoking when they learn thinking (cognitive) and behavioral techniques, stress management techniques, and ways to handle the symptoms of withdrawal and the urge to relapse. Smokers should look for programs that offer the following:
- Session lengths of 20 - 30 minutes
- Four to seven sessions
- A 2-week program
- An additional 2 weeks or more of follow-up contact
The Staged Approach. The staged approach customizes quitting interventions for each person, rather than using one general method. This approach takes the smoker through six stages of behavioral interventions:
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
People who follow this approach do not proceed from one stage to another in a step-by-step fashion. Instead, they cycle or spiral back and forth. Some people may move from stage 1 to 2 to 3, and then back to 2 again. You can stay in maintenance mode for years and then fall back to stage 2. Remember that this is normal -- if you tried quitting in the past and didn't stick with it, don't consider yourself a failure. Just try again.
Stage 1: Pre-Contemplation.
People at this stage have no plans or desire to stop smoking. They aren't even considering quitting. They may be unaware of the benefits of quitting. Or, they may have failed while trying to quit in the past and given up. There's no point in talking about how to start a smoking cessation program at this stage. Instead, it is important to think about how quitting will help you feel better, have more confidence, or live longer. You must identify the benefits before you will consider quitting. If you are at this stage, it can help to ask several friends or family members why they quit smoking.
Stage 2: Contemplation.
A person at this stage is thinking, "I think I should probably quit, but I need help getting started." People at this stage know that quitting is good for them, but it seems like a daunting task or they don't think they can pull it off. Some may have tried and failed in the past. If you are at this stage, write down (brainstorm) all of your potential roadblocks -- the things that you believe make quitting difficult -- and learn strategies to overcome or sidestep those hurdles. People at this stage might benefit from making a pledge, contract, or other commitment.
Stage 3: Preparation.
Smokers at this stage are ready to quit. The goal now is to create a specific action plan. You need to know which smoking cessation methods work and what support exists to help you quit. If you are at this stage, consider some backup plans -- what to do when the urge to smoke hits you.
Stage 4: Action!
People at this stage have just quit. This stage is where the most behavioral change occurs. It requires significant commitment and energy. If you are at this stage, keep talking to friends and family for inspiration. Review your backup plans. Reward yourself for small achievements. Having a fellow smoker quit with you can be a huge support as you both get through this stage.
Stage 5: Maintenance.
People at this stage have been smoke-free for at least 6 months. The goal now is to prevent a relapse. If you are at this stage, continue to be wary of roadblocks and keep reminding yourself of the benefits you have gained. Consider what you have enjoyed most about being smoke-free.
Alternative Methods for Quitting
Hypnosis. Although rigorous studies on hypnosis are lacking, some people report successfully quitting after hypnosis sessions. Hypnosis is only effective if you trust the therapist and can feel completely at ease in the vulnerable and passive state necessary for hypnotic suggestion.
Hypnosis sessions usually take about 1 hour. During a typical session, the hypnotherapist will use various techniques (such as imagery and silent counting) to put you into a relaxed state.
When you are very relaxed, but not asleep, the hypnotherapist will quietly suggest motivations for not smoking. The hypnotherapist should also reinforce a positive self-image while you are in deep relaxation. This helps many people avoid the depression that can accompany withdrawal.
You should be taught methods of self-hypnosis to use at home, and have one follow-up session to reinforce what you've learned.
Acupuncture and Acupressure. There is no scientific evidence that acupuncture helps people quit smoking, although this method is safe to try. The acupuncture technique for quitting smoking usually uses very tiny curved staples inserted into three different points around the edge of the ear. The procedure is painless. You will be told to press each staple in a certain order for a few seconds whenever you crave a cigarette. The acupuncturist may also use acupuncture points on other parts of your body. There are no side effects, except for some soreness if you press the acupuncture staple too hard.
A related technique called acupressure involves pressing certain points on your body when a craving hits. Some studies have reported good quit rates with acupuncture, but few rigorous studies have been conducted on acupressure.
Public Health Efforts and Social Pressure (Denormalization)
Denormalization is the idea that smoking is no longer normal. Examples include:
- Creating laws and local regulations that make smoking inaccessible in public places
- Raising prices on cigarettes
- Putting stricter limitations on cigarette advertising
Increasing taxes on cigarettes may be one of the most important methods for reducing smoking in the general population, particularly in younger people.
Evidence suggests that banning smoking in work and public places may lead to a higher quit rate than in places where smoking is permitted.
Symptoms of Withdrawal
After you quit smoking, you will have some withdrawal symptoms. These symptoms generally peak in intensity 3 - 5 days after you quit, and usually disappear after 2 weeks, although some may persist for several months.
The symptoms of withdrawal are both physical and mental.
Physical Symptoms.
- Tingling in the hands and feet
- Sweating
- Intestinal disorders (such as cramps and nausea)
- Headaches
- Sore throat, coughing, and symptoms of a cold
Treat withdrawal symptoms just like you would treat physical symptoms from an illness or disease.
Mental and Emotional Symptoms. Cravings can build up during withdrawal, sometimes to a nearly intolerable point. Nearly every moderate-to-heavy smoker who quits experiences more than one of the following emotional and mental responses to withdrawal:
- Temper tantrums, intense needs, feelings of dependency
- Insomnia
- Mental confusion, vagueness, or difficulty concentrating
- Irritability, restlessness, impatience, or anger
- Anxiety
- Depression
The first signs of nicotine withdrawal can appear within 30 minutes of a smoker's last cigarette. Within 3 hours, the person may experience anxiety, sadness, and difficulty concentrating.
Long-Term Depression
Depression is common in smokers during withdrawal and over the long term. In the short term, it can mimic the feelings of grief that a person might experience after the loss of a loved one.
Cigarette smoking is strongly linked to depression. People who are already prone to depression have a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least 6 months. What's more, depressed smokers are very unlikely to quit successfully. Only about 6% remain smoke-free after a year. Reasons for this include:
- Smoking may mask depression, which can become severe even after the early stages of withdrawal have passed.
- Some smokers feel such real emotional pain from nicotine withdrawal that they cannot justify quitting, even for the health benefits.
- Not only does the smoker suffer, but the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.
If you experience depression while quitting, try a combination of emotionally supportive therapy, nicotine replacement, and antidepressants such as bupropion (Zyban). If severe depression lasts beyond the withdrawal period, seek professional help as soon as possible.
Weight Gain
Quitting smoking does increase the risk for weight gain. After quitting smoking, your body's metabolism slows down, so you burn food more slowly. On top of that, quitting may give you the urge to snack more often.
Smokers who quit gain an average of 11 pounds by the end of their first year, and an extra 6 - 7 pounds in the next 4 years. However, the fear of weight gain shouldn't stop you from quitting smoking. Instead, you should use weight-control measures after quitting.
How to Keep the Weight Off After Smoking. Exercise is very helpful for controlling weight. To burn the same amount of calories as you did while smoking, take an extra 15-minute daily walk and eliminate 100 calories a day. Just a moderate increase in physical activity can keep weight gain to a minimum. Nicotine replacement therapy can also help prevent weight gain.
Combining behavioral therapy for smoking-related weight gain with the antidepressant bupropion can help people who are worried about gaining weight after quitting stop smoking for longer.
[See the Quitting Smoking section in this report.]
Failure to Quit
Biological, psychological, behavioral, and cultural factors all play a role in nicotine addiction, making smoking one of the hardest addictions to beat. About half of people who quit return to smoking. Even after years of not smoking, some ex-smokers still have occasional cravings for cigarettes.
In addition to depression, there are three other major reasons why people have a hard time quitting:
- Mental performance. Nicotine improves concentration and thinking. Quitting smoking temporarily impairs mental performance.
- Stress. Although smoking many not reduce stress, stopping increases it.
- Weight gain. Quitting smoking can cause weight gain, which is a major factor in smoking relapse. [See Weight Gain section in this report.]
The first 2 weeks of smoking cessation are critical to the overall success of the program. Smokers should seek all the help they can get during this period. Although withdrawal symptoms can be intense, treatments are available to reduce them.
Attempts to quit are never a waste of time, because you reduce the amount you smoke during these periods. People who keep trying have a 50 - 50 chance of finally quitting.
Risk Factors for Failure
Researchers have been trying to discover risk factors or sets of behaviors that can help predict why some people aren't able to quit smoking. Factors include:
- Being female
- Being a heavy smoker
- Inhaling deeply
- Being a long-term smoker
- Having severe withdrawal symptoms
However, only one factor consistently leads to failure in quitting. Cheating during the first 2 weeks of withdrawal nearly guarantees that a person will smoke again in 6 months.
Women and Smoking
Studies show that women have a harder time trying to quit smoking and have less success with abstinence programs than men. There are many possible reasons for this gender inequality:
- Nicotine has different effects on mood in women than in men. Women who quit may have greater anxiety and stress than men who quit.
- Women are not as physically dependent on nicotine as men, but they are more addicted to the behavior of smoking, which is the more powerful deterrent to quitting. This may be the reason why nicotine replacement, which only reduces cravings, is often not as effective in women.
- Women may fear weight gain after quitting more than men.
- During certain phases in the menstrual cycle, women may not respond as well to smoking cessation drugs.
- Men may be less supportive than women in helping their partners quit.
- Women who are trying to quit may miss the feeling of control associated with smoking more than men do.
In the past 50 years, a women's risk of dying from smoking related diseases has increased, and is now nearly equal to that of men.
On the positive side, evidence suggests that when women quit, their lung function improves more rapidly than in men who quit.
Lifestyle Changes
Smokers and former smokers should immediately begin to implement a healthier lifestyle and change any other behaviors that might be damaging their health.
Healthy Diet
Maintain a healthy diet by eating:
- Whole grains
- Fruits and vegetables (particularly dark-colored ones)
- Fish more than twice a week (this may help limit the damaging effects of tobacco on the body)
- Monounsaturated fats (found in olive oil) or fats from oily fish, instead of saturated fats
Regular exercise reduces a smoker's risk of heart disease (although still not to the level of a non-smoker). Exercise does not lower a smoker's risk for lung cancer or emphysema, however.
Regular Check-Ups
If you smoke, you should be screened for any smoking-related disorders:
- Have your cholesterol and blood pressure checked regularly.
- Women should have regular Pap smears to detect cervical cancer (how often you need a Pap smear depends on your age and medical history).
- All older adults should be screened for colon cancer.
A recent study, the National Lung Cancer Screening Trial, found that having an annual low-dose computed tomography (CT) scan can reduce lung cancer deaths in heavier smokers by 20%.
The American Lung Association and the National comprehensive Cancer Network now recommends low-dose CT screening for the following:
- Annual (for at least 2 years) should be offered to current and former smokers who are between the ages of 55 - 74 years, have smoked at least 30 pack years, and have no history of lung cancer.
- Chest x-rays should not be offered as a screening tool.
- Screening should not be viewed as an alternative to smoking cessation.
Screening CT scans produce many false-positive results. This means that many people have suspicious findings on a CT scan that do not turn out to be cancer after a lung biopsy is done. People not meeting the above criteria are unlikely to benefit from lung cancer screening at this time.
- http://www.cdc.gov/tobacco-- CDC's Smoking & Tobacco Use resources web site
- www.cancer.org -- American Cancer Society
- www.lungusa.org -- The American Lung Association
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Ebbert J, Montori VM, Erwin PJ, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD004306.
Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737-745.
Infante M, Cavuto S, Lutman FR, et al. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med. 2009;180(5):445-453.
Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E. Smoking and prostate cancer survival and recurrence. JAMA. 2011;305(24):2548-2555.
Klein R, Cruickshanks KJ, Nash SD, Krantz EM, Javier Nieto F, Huang GH, et al. The prevalence of age-related macular degeneration and associated risk factors. Arch Ophthalmol. 2010;128(6):750-758.
Ladeiras-Lopes R, Pereira AK, Nogueira A, ey al. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies.. Cancer Causes Control. 2008;19(7):689-701.
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Levine D. Bupriopion and cognitive behavioral therapy for weight-concerned women smokers. Arch Intern Med. 2010;170(6):543-550.
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Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54(14):1249-1255.
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Review Date: 2/26/2013�
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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Castle in the Sky (Tenku no shiro Rapyuta)
Starring Mayumi Tanaka, James Van Der Beek, Anna Paquin, Keiko Yokozawa, Kotoe Hatsui
Directed by Hayao Miyazaki
Running Time - 2:04
Genre - Action
Opened in Theaters - Wednesday, January 1st, 1986 (11528 days ago)
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This luxurious piece of furniture looks fantastic as part of a bold antique look which is sure to perk up any home. Glamorous carving in gold and a solid marble top makes this table hardwearing as well as beautiful looking. Ideal for use in your hallway, dining room or living room, this attractive table is sure to turn many heads.
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text: Any reviews on this thing?? A surfshops offering me a great deal on it ($550). The one he's got is a 6'0. I'm looking for a summer time board. Looks like its a great board, but I'm just a little concerned that it will be a little too big for me. I currently ride a 6'2 shortboard. Hows this board ride, and do you think that it will be responsive as a 6'0? My specs are 5'11 and 195lbs. Any advice would be greatly appreciated, as always. :) Thanks


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KEVIN WOODSAffiliation:
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Kevin Woods/Leonard Axelsson Quartet
Artist's BiographyTrumpeter/composer Kevin Woods is quickly emerging as one of the most melodic and emotive voices in improvised music on the west coast. His passion for performance and education has made him in demand as a leader and a sideman as well as a composer, arranger and clinician. Woods received his B.A. in Music from Western Washington University and his M.M. in Jazz Performance and Pedagogy from the University of Colorado, Boulder.
Kevin has performed with Cuban saxophonist and bandleader Paquito D\'Rivera, trombonist Slide Hampton, tenor saxophonist Joe Lovano, trumpeters Randy Brecker, Brian Lynch, Claudio Roditi and many others. He has been a member of numerous award-winning and nationally touring musical groups and has performed at many national and international music festivals. Woods has been featured in both Downbeat and Jazziz magazines and in 2007 he participated in Betty Carters Jazz Ahead residency at the John F. Kennedy Center in Washington D.C. Kevins debut album Ballad of the West received high praise and airplay on jazz radio stations throughout North America and Europe.
As an educator, Woods has taught at the University of Colorado, Boulder, Whatcom Community College, Western Washington University and Seakyung College in South Korea. He has given clinics and performances at public schools and colleges throughout the US and has served as adjudicator and clinician for many jazz festivals. Currently, Kevin lives in Spokane, Washington where he is active as a performer, educator and composer/arranger and serves as professor of jazz studies and trumpet at Spokane Falls Community College.


text: Library Movie Sat May 19 See the 2011 PG comedy movie starring Rowan Atkinson, and Gillian Anderson on Saturday, May 19 from 2-4 P.M. Rowan Atkinson (Mr. Bean) returns to the role of the accidental secret agent who doesn't know fear or danger in this comedy spy-thriller. Johnny English must stop a group of international assassins before they eliminate a Chinese leader and cause global chaos. - MA Image source: google.com The program is FREE and open to the public. See Adult Services to sign up or call 630-260-1550 for any questions or register online at www.glensidepld.org. Read more about Library Movie Sat May 19


text: It's that time again: Back-to-school time! Although it's been many a year since most of us here at BettyConfidential have gone back to school ourselves, we're sure that at least a few of you out there in Bettyland are either prepping to hit the books again yourselves or are getting your kids ready to do the same. For those of you in the college-age arena, this probably involves the R-word. That's right: Roommates. Some roommate situations are awesome; others, not so much; but regardless, living with someone else is always an experience worth having. And hey, you never know who you might meet—these 24 stars had no idea how big they would eventually make it when they paired off and shacked up together back in the day!


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Kalia's design studio is driven by water, the fluid muse to which they look at as a source of wellness and inspiration. The team designs, manufacturers, and distributes residential bathroom products that embody their quest to improve people's well-being. Founded in 2007 and based out of Quebec, Canada, they continues to bring water to clients in fresh, innovative ways.
The brand has a unique design personality. Knowing their clients' daily needs helps this comany come up with fixtures that are ergonomic, perfect for daily use, and are staunch allies in the modern bathroom - all without losing style, quality and functionality. Kalia's residential fixtures represent innovative, long-term solutions for their customers, all backed by a lifetime warranty. Start your own water story.


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I have a client who wants to set up a website doing administrative work for various businesses - the client would receive payments from the business' customers, take a small commission and pass the rest of the money onto the business. The problem is that, because my client is initially receiving the complete sum of money (before taking the commission only), he may have to pay VAT, because of the high turnover - is this correct? If so, my client has asked me whether there is a payment processor that offers a split payments system?
I don't mean this as a criticism, but it sounds like he'd be better off asking his accountant than his web designer. I'm not sure how tax works in the UK (that's where VAT applies, right?) but I think here in Australia you total everything that's come in and everything that's gone out, and the difference is your taxable income. But TBH, I let the accountant worry about all this, so I could be wrong.
Ralph is absolutely right. This is a question for an accountant, not a web designer. You should tell the client to seek appropriate professional advice.
That said, is this really an issue? Your client is registered for VAT (if he wasn't, then the issue wouldn't arise). Given that his clients are businesses, then they are presumably registered for VAT as well. So nobody will be out of pocket, as everyone concerned will simply reclaim the VAT.
That said, is this really an issue? Your client is registered for VAT (if he wasn't, then the issue wouldn't arise). Given that his clients are businesses, then they are presumably registered for VAT as well. So nobody will be out of pocket, as everyone concerned will simply reclaim the VAT.
From speaking to my client he thinks that if he took payments in this way, he would have to become VAT registered, though, I agree, this is more of a question for his accountant. VAT is different from income tax - it is based on turnover as opposed to profit. That's why he asked me about a split payments system.
It's many years since I worked in a VAT office (sorry :x) but yes, it sounds to me as if your client would need to register for VAT if his turnover exceeded the limit. I agree he should talk to his accountant - or even the VAT office. In my day, we really liked people who came and asked for advice up-front, rather than guessing and getting themselves into a fankle which we then had to sort out. Maybe things have changed with all the cut-backs, but it's worth a try.
Thanks, I'll get my client to enquire and then get back to me.
Presumably a payment processing system that divides the payment between 2 recipients doesn't exist then?
Actually I'm in the process of setting up an e-marketplace, like ebay/Amazon marketplace where I accept payments from customers on behalf of a third party seller, and I can confirm the advice I got directly from HMRC is that as long as I am acting as an agent, they are happy to consider the 'taxable supply' to be between the parties I am facilitating the transaction for. It doesn't matter if I'm the one initially receiving the money, it matters who the invoice is made out to for that 'supply'
The 'agent' only needs to consider the invoices they raise, i.e. that of their commission to their client for facilitating the transaction.
So if your client isn't vat registered, it's likely they could remain so unless they choose to (which may be advantageous) or if exceed the vat threshold via their commissions and other income . I have this in writing from HMRC, so it would be worth your client doing the same - it needed several phone calls and emails before I got it sorted, because it's not run of the mill advice. Unfortunately asking an accountant got me the quick, safe accountant answer 'it's turnover, you'll be liable for VAT'. But that didn't make sense to me, because the supply is what attracts the VAT and the initial supply is between the customer and seller, not the agent.
Yes it does - Paypal offers a way to split the money automatically, and can even retain your commission from what gets sent to the other party (or parties). I believe its called paypal adaptive payments
Also note that if your client is offering 'electronically supplied services' to anyone outside the EU, it will most likely be 'out of scope' of EU & UK VAT, so even if the commissions begin to build up, any commission earned from businesses who are based outside the EU would not be deemed a taxable supply and would therefore not count towards the VAT threshold.
Thanks shadowbox for your clear and concise explanation - that totally makes sense to me. I'll pass your advice onto my client and get him to contact HMRC to get the same in writing as you suggest.Thanks again.
One other point:
Topmonkey, you don't say what country you are in. We've been assuming you're in the UK (and so is your client). I'm not sure why we assumed that. If you are in another EU country, then then the principles of VAT are broadly similar, but the details might vary.
Topmonkey, you don't say what country you are in. We've been assuming you're in the UK (and so is your client). I'm not sure why we assumed that. If you are in another EU country, then then the principles of VAT are broadly similar, but the details might vary.
Yes I am UK based and so is my client, who will be dealing with businesses in the UK - at least to start with. Thanks for your help. Much appreciated.
This sounds interesting, however am I correct that your commission for facilitating the transaction will be VAT based? As unless your not VAT registered, I cannot understand how you would get away from charging your customers VAT on your part of the sale?
Also, considering you are facilitating the transactions, I assume that if your third party seller is VAT registered, you would charge the purchaser VAT on their behalf? And only pass the VAT back to the third party?
You are most probably wrong there, unless the UK VAT rules are completely different from the base EU ones. I run a company from within Bulgaria as well, and while the invoices sent outside EU is 0% VAT based, they do count towards the company VAT threshold (in the regards to if the company needs to be VAT registered). This is also how it works here in Norway for any invoices I send to foreign clients.
On a side note, what disadvantages are it you guys see with being VAT registered? As from a company side point I see only benefits with this, and all the companies I'm running I have elected to make them VAT registered from the start (since I knew we would pass the threshold withing the first few months anyway). This has really saved the companies money on the initial purchases for hardware/services etc.
Yes, the commission you charge the client would be a taxable supply.
The third party would include VAT in their pricing on my site, so the total price paid would include the VAT and would be passed on to the third party in full. The VAT for this supply would not be any of my concern as the contract is between the customer and this third party seller, so it is up to the seller how he accounts for VAT.
If I supply electronically supplied services to customers 'enjoying' those services outside the EU, they are not even zero rated, they are out of scope, they are not even taxable supplies - there is a big difference between 0% rated and 'out of scope' - out of scope means it doesn't even exist as far as VAT accountability is concerned. [Check this PDF for UK businesses, or [URL="http://customs.hmrc.gov.uk/channelsPortalWebApp/channelsPortalWebApp.portal?nfpb=true&pageLabel=pageVAT_ShowContent&id=HMCE_CL_001730&propertyType=document"]this](http://customs.hmrc.gov.uk/channelsPortalWebApp/channelsPortalWebApp.portal?nfpb=true&pageLabel=pageVAT_ShowContent&id=HMCE_CL_001727&propertyType=document) for EU businesses. I am not aware of the rules in Norway, but my understanding is that UK and EU VAT laws are the same so these should apply to Bulgaria.
We sell digital goods mainly to consumers, 25% of whom are in the EU. These customers would see a 20% increase in our product prices if we were VAT registered, so if we can avoid it, it's definitely beneficial compared to the saving we'd make in reclaiming a comparatively small amount of VAT each year from hardware or services we purchase in the course of running the business.


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Natural Gas Reduces Greenhouse Gas Emissions
Washington, D.C. - The American Gas Association (AGA) today released an analysis based on the U.S. Environmental Protection Agency's (EPA) annual Greenhouse Gas Inventory. EPA's report determines that there has been a recent increase in methane emissions resulting from the production of natural gas, but despite this determination, AGA concludes that total greenhouse gas (GHG) emissions are significantly less for natural gas than for coal or oil on a Btu equivalent basis. In addition, total GHG emissions per MMBtu of natural gas consumed were actually lower in 2009 than in 1990.
It has become abundantly clear that the increasing availability of natural gas, particularly natural gas developed from shale formations, offers the United States plentiful, domestic, clean, and affordable energy, said Dave McCurdy, president and CEO of AGA. Natural gas continues to reduce greenhouse gas emissions as demand increases and more efficient technologies for its production, delivery and use continue to develop, making the future for America's foundation fuel very bright.
The natural gas advantage is multiplied with the efficiency advantage offered by many gas applications. Greater efficiency means that less energy must be consumed to obtain the same product, whether it is heat, hot water or even electricity, so GHG emissions are reduced.
McCurdy added, AGA believes that a diversified energy portfolio will serve the nation best. It is critical to appreciate the inherent advantages in each energy source, and natural gas has the clear advantage in terms of GHG emissions. The industry is consistently working to improve technology and practices in order to continue to improve the production, transmission and delivery of this foundation fuel in a safe, reliable and environmentally sound way.
To read the AGA s complete analysis click here.
Clean, Domestic, Reliable Foundation Fuel Continues to Deliver


text:
Hi all,
I have posted this question a few weeks ago and had no replies?????
Here we go again, I think its a valid question and decent idea.
A lot of msf attacks present us with an url for the browser to be exploited right? We also need to send link to target for the link to be clicked and exploit run.
Links are hardwork nowadays nobody clicks them especially bit.ly, tiny url ect.
So far i have got dns spoofing working on (example) http:\\192.168.0.19:80 by way of the etter.dns file as follows:
*com A 192.168.0.19
*.co.uk A 192.168.0.19
*.net A 192.168.0.19
etc.... you get the idea, so when the target fires up the browser its exploited straight away without need of the link.
Now the problem is this: how do we get say: http:\\192.168.0.19:80\blahblah.com to dns spoof?
fake update page with link embedded into download button? fake update page is served on port 80 so wont work .
Any ideas?
Can i edit the etter.dns further to :
*com A 192.168.0.19:8180\blahblah.com
*.co.uk A 192.168.0.19:8180\blahblah.com
*.net A 192.168.0.19:8180\blahblah.com
regards Dee........


text:
kopia schweiziska kiockor | första kopia klockor | - kopia.
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Two townhouses in Armadale were just completed and we are quite happy with the results. Throughout the course, there was no major problems. And whenever an issue would arise, they would always come back to fix up the problems right away which we really appreciate. Reliable, p..
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The CoverItLive blog is a new enhancement to the Saint Leo Lions athletics website and designed to provide live, up-to-date analysis of select home or away events with corresponding timestamps. It is also a great chance for fans, parents and students, to interact as the game is in progress.
All participants in the blog are encouraged to ask moderated questions and support the Lions in a respectful manner.
SaintLeoLions.com will be going live with the blog for the first time at approximately 6:45 p.m.


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It was a good day for Ohio school levies
(Columbus) - Voters across Ohio approved 116 of 192 school tax issues during Tuesday's election.
"The overall results for this election are positive, with a 60% passage rate," said Ohio School Boards Association Director of Legislative Services Damon Asbury. "It appears that our voting public understands that local support is a critical part of the schoolfunding equation."
The passage rate for school issues Tuesday is largely consistent with previous years. Ohio voters approved 105 of 192 school tax issues in November 2012, a passage rate of 55%.
Fifty-one percent of school tax issues were approved in November 2011 and 62% were approved in November 2009, the last two off-year general elections.
Forty-two of 116 new school tax issues were approved on Tuesday, a passage rate of 36%. Seventy-four of 76 school tax renewal issues were approved, a passage rate of 97%. Asbury says both numbers are normal compared to the last decade.
Faced with funding challenges, declining revenues and a difficult economy, many school districts are forced to turn to their local communities for support.
Ohio schools that failed to get their issues approved will likely be forced to make difficult budget decisions, including new rounds of cuts.
"While there are signs the economy is improving in Ohio, many school districts in the state continue to experience funding challenges," said OSBA Executive Director Richard Lewis.
"In many cases, school districts have no choice but to turn to their communities to help maintain the high-quality instruction and services residents have come to expect."
Some school tax issues approved on Tuesday will not qualify for the 10% and 2.5% rollback property taxpayers have experienced for decades. The state budget approved by lawmakers this summer eliminated the rollback for new and replacement levies beginning in November.
The rollback was adopted in conjunction with the implementation of the income tax in the 1970s; some school leaders worry its elimination will make ballot issues harder to pass.
The OSBA says the elimination of the rollback means more of the tax burden will be shifted from the state to local residents.
Get breaking news sent to your mobile phone. Text "news" to 21095.
(Copyright © 2013 by Clear Channel, all rights reserved.)


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Goose Creek business owners say they are losing business due to smoking ban
From our News Partners at WCBD-TV:
Goose Creek's smoking ban has been in effect since July 1st. It means there is no smoking inside businesses in the city. Some business owners say it has had a dramatic impact on their business.
At Tuesday nights Goose Creek City Council meeting, Harold Dukes, the owner of Day Bingo in Goose Creek, told council that the smoking ban has hurt his business. "Our revenues fell down more than 50% and we will be closing, I imagine, in the next 30 to 60 days if we don't have some relief."
Dukes asked council to revisit the issue, and perhaps allow bars and bingo businesses to offer smoking in their businesses.
The fact that Dukes' business may be closing soon has his employees concerned.
Michele Ashe is the General Manager of Day Bingo. "I've already cut 60 hours a week in payroll."
Ashe says they keep track of customers each month, and they lost 200 customers in the month of July, compared to June, when smoking was allowed. They have cut 2 full time positions.
Ashe says that is just the beginning, "unless business picks back up, more cuts are coming."
Vicki Brogdon has worked at Day Bingo for about 14 years. She says she is working fewer hours and making less money. She doesn't understand why businesses like Day Bingo, which built separate rooms for smoking and non-smoking customers, including high-powered air scrubbers, can not offer smoking to their customers. "We've been like this for five or six years. We built this for the non-smokers. So it's been a big impact on our business. Very bad.
As Day Bingo loses business, so do other businesses nearby, like Bruce's Bar and Grill in the same shopping center. Bruce Witham owns the bar, "I mean it's hurt our business as much as it has the bingo parlor, because the bingo parlor is my business. We serve them food every day. They drastically lost a lot of customers and so have I.
Bruce says he has cut back from opening daily at noon to now opening at 4pm. He estimates he has lost 30-35% of his business, and he had to let one employee go so far.
Vicki over at the bingo parlor says she is very worried about not having a job in the near future. "It's a little terrifying. I have a home I have to pay for, you know a car, home electricity. And I can see it coming down to something soon."
Goose Creek Mayor Mike Heitzler says he voted against the smoking ban because he was concerned about issues like what these businesses are going through. He says he does not believe Council will revisit the issue. He said the only way that would be possible is if one of the four council members who voted for the ordinance were to bring the issue back up for discussion.
Photo Credit: Kentoh/Shutterstock


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Advertising content
July 11, 2014
From $319,900
253-929-6734 or quadranthomes.com
By Teresa Kenney
Special to NWhomes
AUBURN — Today and Sunday from 10 a.m.-6 p.m., Sonata Hill will host an open house with refreshments, giveaways and tours of the neighborhood's four model homes.
The collection of 72 homes is located in Auburn's Lea Hill area and has move-in-ready and presale homes for sale. For a limited time, homebuyers will receive a $5,000 credit to use at the builder's design studio, where they can select finishes, appliances, lighting and other options.
"Most of our homes back up to, or are adjacent to, a greenbelt, which is pretty unusual for a community of this size," says Angela Courtney, the sales manager at Sonata Hill. "There are parks that wrap around the greenbelt, and it's very peaceful and serene out here."
There is one move-in-ready home, and two other homes will be complete later this summer.
"The move-in-ready home is our 261 floor plan, which is a 2,640-square-foot, three-bedroom home with an open great-room layout," Courtney says. "The kitchen features a large island with seating for four, and there is a covered patio for outdoor entertaining. There is a private study off the dining area, and upstairs, the master retreat features a sitting area and a five-piece bath."
The two homes to be completed this summer feature the 240 and 221 floor plans. "We have model homes of both home designs, so homebuyers can get a firsthand feel for how the rooms flow," Courtney says.
The 2,495-square-foot 240 plan has a walk-in pantry in the kitchen and coffered ceilings in the dining area. The second level includes an open loft space, extra storage, and a laundry room with a sink and folding station.
The 221 plan includes 2,270 square feet of living space and has an open entrance area, a second-floor loft, and walk-in closets in all of the bedrooms.
For those purchasing presale, Quadrant Homes offers a personalization program called Built Your Way. Buyers can choose the layout, fixtures and design options for their home.
"Homeowners love Quadrant Homes' design flexibility," Courtney says. "In many cases, you can pick your homesite and your home plan. [The builder] has a number of flex options so homeowners can personalize their homes specifically for their lifestyles.
"If you view the community's floor plans at quadranthomes.com and click on 'personalize,' you can play around with the many options, from turning an open loft into a fourth bedroom to moving the fireplace in the great room or extending the shower in the master bath.
"It's all about creating spaces for how you like to live," she says.
Sonata Hill is located near several parks and trails, and is within walking distance of Green River Community College.
"The Auburn community has 28 parks and 23 miles of trails, many of which offer spectacular views of Mount Rainier," Courtney says. "We're also close to the Outlet Collection, as well as Mosby Farms, which offers farm-fresh produce, Northwest wine and beers, and gourmet food."
The 53-acre Auburn Game Farm Park has a sports complex, amphitheater, walking trails and sports courts. Highways 167 and 18 are also nearby.


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31 January 2015
24 January 2015
black book
Coca-Cola owns Simply Orange, which is made using a process they call Black Book. Since juice production is full of variables, including a peak growing season of only 3 months, this methodology was created to produce consistent orange juice year round. They won't tell anyone how exactly the Black Book formula works, but the consultant who designed it, Bob Cross of Revenue Analytics, shared it with Bloomberg Businessweek.
Black Book is an algorithm that includes data about consumer preferences and the 600 flavors that make up an orange. Coke matches this data to a profile detailing acidity, sweetness, etc. so that they can blend batches to replicate the same taste and consistency. Black Book also incorporates external factors, such as weather patterns, anticipated crop yields, and cost pressures to allow Coke to plan ahead and ensure they have supplies on hand.
Coca-Cola's Brazilian partner, Cutrale, processes the oranges, which are grown to Coke specifications. Satellite imaging allows them to order growers to pick their fruit at the best time, as determined by Black Book. The fresh-squeezed juice is stored in Cutrale's silos and transported via a 1.2 mile underground pipeline to Coke's packaging plant, where it is flash-pasteurized. It is then piped to storage tanks where it is slowly agitated and covered with a nitrogen gas blanked to keep out oxygen, which has been sucked out of the juice, as it will cause it to spoil.
The batches from different crops and seasons are separated, based on orange type, sweetness, and acidity. Blend technicians follow Black Book instructions, adding natural flavors and fragrances captured during squeezing back into the juice to make up for the flavor lost in processing. "When the juice is stripped of oxygen it is also stripped of flavor providing chemicals. Juice companies therefore hire flavor and fragrance companies, the same ones that formulate perfumes for Dior and Calvin Klein, to engineer flavor packs to add back to the juice to make it taste fresh. Flavor packs aren't listed as an ingredient on the label because technically they are derived from orange essence and oil. Yet those in the industry will tell you that the flavor packs, whether made for reconstituted or pasteurized orange juice, resemble nothing found in nature,"explains Alissa Hamilton, author of Squeezed: What You Don't Know About Orange Juice.
6 November 2014
young friends wearing clothes
y o u n g f r i e n d s w e a r i n g c l o t h e s
made by saliva + luzek recovered, sasha melnychuk, nik timkova
nodels: evdokia zamakhina, se niess, oldrich bystricky, daniel posta, zdenek vacek
wearing wang x h&m
30 August 2014
28 August 2014
12 May 2014
lay not my bones apart from thine
i have always been fascinated with ancient greek mythology and culture. i realise that my notion of ancient greece is idealised, that i may have not survived birth for being too weak, i could have been killed young, that there was slavery. however, comparing it to the present day, it seems to have been more pure, more basic, essential. we are slaves still, just in a different way. and i would rather die young than live numb. (or would i)
in my view, mythology speaks of human virtues (and weaknesses): of honour, strenght, health, love, relationship with the natural and supernatural.
some time ago, me and my friend who i miss dearly read the unabridged translated version of the odyssey by homer. we met multiple times, drank some coffee, smoked a few cigarettes, took turns and read out loud to each other. it was heartwarming and thrilling to follow odysseus's adventures. it seemed like a huge accomplishment when we finished reading the book. after the last sentence, we were silent for a while.
inspiration. influence. appropriation.
in my view, mythology speaks of human virtues (and weaknesses): of honour, strenght, health, love, relationship with the natural and supernatural.
some time ago, me and my friend who i miss dearly read the unabridged translated version of the odyssey by homer. we met multiple times, drank some coffee, smoked a few cigarettes, took turns and read out loud to each other. it was heartwarming and thrilling to follow odysseus's adventures. it seemed like a huge accomplishment when we finished reading the book. after the last sentence, we were silent for a while.
inspiration. influence. appropriation.
16 April 2014
10 February 2014
7 February 2014
hey bro i love you so
antoine93 (fka dresden dresses) performing in prague tomorrow (link here), i'll be playing before him, just a small dj set, really.
5 January 2014
sans everything
All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse's arms.
And then the whining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress' eyebrow. Then a soldier,
Full of strange oaths and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon's mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into the lean and slipper'd pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.
(W. Shakespeare, As You Like It)
27 December 2013
hay guyz this is my yung lean inspired outfitie
20 December 2013
i'm very happy that this photoshoot that you can see whole on paulina's tumblr here with kaa is this nice, i think it bears some honesty in it even though it's staged and i like the clash of cool and uncool. we are wearing clothes from adidas originals, they're pretty cool (have a look here).
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text:
ByDamian Paletta
The Gang is going on a field trip.
Remember the Senate's Gang of Six, the three Democrats and three Republicans who worked last year to come up with a deficit-reduction plan?
Well, their effort last year didn't go so well. But they are regrouping and have added two new members. Their goal is to sketch out a plan that would simultaneously help to reduce the deficit and avoid the sharp tax increases and spending cuts that are scheduled to begin Jan. 2, 2013. That way, if lawmakers are looking to cut a deal after the election, they'll have something on paper to offer.
The original members of the group are Sens. Mark Warner (D., Va.), Saxby Chambliss (R., Ga.), Kent Conrad (D., N.D.), Tom Coburn (R,. Okla.), Dick Durbin (D., Ill.), and Mike Crapo (R., Idaho). The new members are Sen. Michael Bennet (D., Colo.) and Sen. Mike Johanns (R., Neb.).
To focus their efforts, the group is heading on a multi-day retreat next week. The location is supposed to be a secret, but here's a hint: George Washington lived in a pretty amazing house nearby. (The fact that the lawmakers are going on a retreat was first reported by Politico).
The group's original plan was modeled off of the 2010 Simpson-Bowles fiscal commission package, which included tax increases and spending cuts to reduce the deficit by roughly $4 trillion over 10 years. Mr. Crapo has said that given the amount of time that has passed since those talks, the group should now really be shooting for a $5 trillion package.
Much of their effort depends on the outcome of the Nov. 6 elections. If President Barack Obama wins, there is expected to be a mad scramble to put together a bipartisan package before the end of the year. If Republican nominee Mitt Romney wins, lawmakers are expected to postpone major decisions until he has time to assemble his economic team.
But instead of waiting for voters to cast their ballots, the Senate group is pushing ahead in case the election outcome fuels interest in a mega-compromise that has so far eluded Congress and the White House.
Are there obstacles? Plenty. The White House is watching the gang's efforts with interest, but so far the group doesn't have formal buy-in from Senate leadership or House Republicans. There's a small group of House lawmakers who have called for similar proposals, but efforts there to legislate any deal have fallen flat.
Correction: Sen. Mike Johanns (R., Neb.) is the eighth member of group, not Sen. Lamar Alexander (R., Tenn.) as incorrectly reported in an earlier version of this post.


text:
Brevard, N.C. - The Brevard College softball team will start their doubleheader at 12 p.m. on Saturday with the Wingate University Bulldogs in an attempt to dodge afternoon showers in the Wingate, N.C. area.
Brevard (28-13 overall, 6-6 SAC) enters the contest on a four-game winning streak. The Tornados swept Lincoln Memorial University Wednesday in Harrogate, Tenn., taking game one 3-0 (in eight innings) and game two 4-3. Brevard earned two victories over Johnson C. Smith University Friday evening in Charlotte.