Palliative Care

Palliative Care

Palliative Care
offers an extra
level of care to
patients and
their families


Palliative care focuses on relief from pain, the symptoms and the stress of serious illness to improve quality of life for patients and their families. It is a team-based approach, involving specialty-trained doctors, nurses, and social workers who work with the patient’s other health care providers to offer an extra layer of support.

While its beginnings trace back with the hospice movement of the 1960s, palliative care is not end of life care and can be delivered alongside curative treatment. “Palliative care is a combination of specialty of care providers, just like in cardiology and pulmonary and cancer specialists, it’s also a service and certain skill set,” explained Dr. George Giokas, chief medical officer of St. Peter’s Health Partners (SPHP) palliative care service line. “Essentially, it’s an extra layer of support for patients and their families that have a serious illness, working with your doctors. We aim to provide the best possible care.”

Palliative Care Team

The palliative care team is assembled depending on the patient’s needs, location, and situation. “The beautiful thing about palliative care is that it is not just one staff person or provider. It’s the amazing coupling of a nurse practitioner, physicians assistant, or registered nurse and also a social worker,” noted Catherine Markey, Social Worker. In the Capital District, Dr. Giokas and his team are embedded in local hospitals and physicians offices. Their goal is to be present when they are most needed: at the beginning of treatment. “We are involved in supporting patients at any stage of their disease trajectory but frequently at the onset, the first moment you are diagnosed with stroke, heart failure, or heart attack. That moment is optimally appropriate to introduce palliative care,” said Dr. Giokas.

For those outside the medical community, not much is known about this service to patients and their families. One area is long-term care. “Most illness that palliative care works with, and honestly, most illness that people have are not sudden events that you have, heal from, and then it’s all over with. That might happen with a car accident, but for most people with heart failure or emphysema, or most cancers, people were living with it for decades at some time,” Dr. Giokas outlined. He also outlined the “healing” process, noting that in the physical sense, healing is a role for physical therapists and their staff. A palliative team looks beyond the diagnosis to help patients live their best life while living with their disease. “People don’t get better by themselves; they are usually in a community our family that supports the healing process.”

According to the CDC, approximately 53 million Americans are currently serving as informal caregivers for patients with a variety of illnesses. The other aspect of palliative care is providing support to caretakers and family members by explaining the medical treatment and discussing stress areas. The daily demands of administering medications, accompanying the patient to physician visits, and preparing prescribed meals can lead to stress for family members and spouses, especially when they are trying to raise a family or care for themselves. Dr. Giokas acknowledges that part of the challenge is offering advanced care for a growing, aging population that has a wide spectrum of health problems. “It’s rare for us to treat just one condition, like heart disease. Patients often have a mild element of emphysema, COPD, diabetes, or arthritis. As a team, we work with the provider to treat all of the patient’s problems.”

The role of women as caregivers

Heart disease is the leading killer for men and women in the United States. Assitance and care will typically fall onto family members and spouses — most of whom are women. Studies show that more than 50% of women in America will care for a family member at some point during their adult lives. In a recent survey among California residents, 16% were serving as caregivers; of these, an estimated 59% to 75% were women, most of whom were married. Their average age: 51 years old. The strain of caring for a heart disease patient has recently been identified as an independent risk factor, putting the caregiver at almost 2-fold higher risk of coronary artery disease. “We can explore the ways to cope with that stress, whether it’s bringing in more resources from the community, additional family members to help, or working on long-term coping strategies that deal with the hard emotions of dealing with heart failure in your life,” Markey added.

In recent years, many states have created these cross-disciplinary task forces and passed legislation to educate providers and the public. For example, Vermont requires health care providers to demonstrate competency in identifying and engaging patients who could benefit from palliative care. In our area, very few patients ask for palliative care. Most referrals come from physicians when they discuss the role of a caretaker with family members. “I often hear from patients and their families how much time we spend with them. On average, it’s about an hour per visit. Our follow-up visits can potentially be just as long. We get to know them and ask questions on topics that they are not used to discussing in the medical setting. I often hear people saying that they don’t feel alone anymore when dealing with their illness; they feel like they have someone walking with them,” Markey shared.

For more information on palliative care options, please ask your doctor or health care provider at your next appointment.

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Purpose in Life

Purpose in Life


Waking up with a positive attitude
at any age helps your heart health

It’s important to have a purpose
of life at every age in life

A recent study explored the role of life purpose in your heart health. Researchers from the University of Michigan School of Public Health and Health System followed nearly 7,000 adults over the age of 50 in the US Health and Retirement Study. Their findings were telling, having a purpose in life may decrease your risk of dying early. It’s also a modifiable risk factor that improves both physical and mental health.

Dr. Robert Benton is a board-certified cardiologist and Director of Clinical Research at Capital Cardiology Associates. Since 2011, Dr. Benton and fellow Capital Cardiology Associates physician Dr. Scott Morris, along with two clinical nurses, have participated in the “Walk With A Doc” program in Troy. Locally the walks happen on the second Saturday of the month. During the winter, the walks take place inside Robison Gym on the campus of Sage College. In the summer, the walks are outdoors at Troy Riverfront Park. Dr. Benton sees dual benefits in walking: the first is that walking is one of the best exercises for people of all ages and abilities. The second is the social aspect. “We talk about sports and politics, life… people get to know each other,” adds Benton. These small steps help to create a purpose in life that may move participants further from the risk of heart disease.

Defining a purpose in life

Purposeful living has been defined in various ways. In general, purpose in life can be defined as “a self-organizing life aim that stimulates goals,” promotes healthy behaviors, and gives meaning to life. Dr. Benton expanded on how purposeful living may have health benefits. “It’s concrete, those who have an aim in their life, a true meaning; they see the value in their life when they wake up every day.” Researchers found that people who didn’t have a strong life purpose were more likely to have cardiovascular and blood conditions. Dr. Benton concurred. “Lack of purpose leads to feeling hopeless. Those without hope are less likely to take good care of themselves.” The team examined studies that report that those who with a strong purpose in life engage in healthy behaviors, sleep better, have lower instances of stroke, depression, and diabetes. Simply put, being near death leads to a lower value in life, creating an opening for chronic illness.

Purpose in life is not solely an American value. A Japanese study investigated ikigai, which is defined as “something to live for, the joy and goal of living.” Globally, as adults age, our life purpose changes as we age. In our younger years, we tend to focus on our family and career. Fulfillment could be raising children, caring for older parents, building a career or business. Dr. Benton touched on the importance of having that feeling of accomplishment as a positive force in our life as we age.” Sometimes you might find a little fuzziness in life. It might be hard to set or finish goals on a timetable if you are retired or don’t have a specific function. For these folks, you need to find another way to contribute, either volunteer or become involved with a community group, that offers the opportunity to feel a purpose,” he said.

Got a second?

Your feedback is very helpful and means a lot

The role of stress in our daily life

One myth is that as we near retirement, life stresses will lessen. This is not true. “I have conversations with my patients on their lives, their interests, their stress (children or older parents they may care for). I try to find out about their life,” says Dr. Benton. “It’s important for me to have that conversation with them. Especially when you meet a person who’s had good blood pressure control, suddenly they come in, and their blood pressure reading is sky high or abnormal. I ask, ‘what else is going on in life?’ Who would not have some challenges in life that lead to more stress? This is related to high blood pressure, higher cortisol levels; these both cause long term damage from your body reacting to stress. I want to know what is stressing them out to cause them not to feel well.”

Stress leads to depression, which creates a feeling of hopelessness. Dr. Benton explained how stress and depression could attack your heart. “It’s important that if you feel it or are a friend or loved one of someone feeling hopeless that you talk with a doctor. This feeling of hopelessness can lead to takotsubo, better known as broken heart syndrome. This is when people go through terrible stress, and they have what looks like a heart attack, it’s scary to us. The theory is the severe outpouring of adrenaline causes decreased blood flow to the heart. We see this more and more. Obviously, they are acute situations. What helps? Activities, exercise, and having a sense of purpose in life.”

Syracuse University researchers found that vacationing is good for your heart. Taking time off improves your metabolic health as well as your mental health. Lowered metabolic risks are associated with improvements to overall heart health risks over one’s lifetime. They also found that vacation time is available to nearly 80 percent of full-time employees, but fewer than half utilize all the time available to them. “It’s vital, and I’m even going to do this for the first time in years, take a vacation,” said Dr. Benton. And if you can’t get away, he urges the need to “take a break to slow down. Meditate. Practice mindfulness. You are not built to go full speed 24/7.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.




Technology is bridging gaps in health care coverage with a virtual solution


In 1962, they imagined a future where a child who tried to use a “sick day” as an excuse to miss school (to avoid taking the dreaded “Space Calculus Test”), had his plot foiled by a house call with the doctor. In this scenario, the call to the doctor was answered immediately with the dedicated physician appearing on a monitor screen. He was able to see the patient, diagnose the problem, told Mom that her son was “fine”, and needed a full day of school. This scene played out on an episode of “The Jetsons” during a time when people had an optimistic view of medical advancements and diagnostic instruments of the future.

Today, technology is bridging gaps in health care coverage, offering a virtual solution for patients to communicate with their doctor when distances, location, or access present physical barriers. This is called “telemedicine,” and it is changing the face of healthcare. Telemedicine is defined as a cost-effective alternative to the more traditional face-to-face way of providing medical care with a distinct set of guidelines and insurance coverage approval steps. The goal of telemedicine is to deploy the latest technology to provide real-time communication between the patient and their doctor. This year, OakBend Medical Center, located in just outside of Houston, Texas, launched a telemedicine cart that allows cardiologists to virtually examine patients to determine whether they should be admitted to the hospital. We connected with Dr. Long Cao, a preventative cardiologist with Oak Bend Hospital, on a recent episode of HeartTalk presented by Capital Cardiology Associates.

“I was skeptical about how the patients would respond,” Dr. Cao shared. He was approached by hospital administrators who presented their rollout plan for the telemedicine cart. Dr. Cao’s apprehension was appropriately based. The technology’s start was a far picture than what was portrayed in the 1960s. “Everyone starts thinking of the early days; the early 2000s were when delays and images were fragmented. It felt primitive,” said Cao. As high-speed internet connections strengthed, pictures became clearer, sound quality improved, and data was transmitted in seconds — downloads opened almost immediately.

More than screen time

Video-conferencing is more mainstream thanks to webinars we attend, replacing in-person meeting. FaceTime enables us to “talk” with friends and family on our phones as though we were in the same room. “There are no delays; they can hear me, see me on screen. After a few minutes, we have a relationship, and they tell me what’s wrong and what is bothering them,” noted Dr. Cao. His patient visits are similar to the Jetson’s calling on their dedicated physician. “When the patient logs on, they see me waving and smiling. I try to make a joke to break the ice. I tell them, ‘Next you are going to see my hands come out of the side of the computer,’ and they start laughing. I introduce myself and say this doesn’t replace me being in front of you. The patients are very receptive.”

The telemedicine cart looks like any other piece of medical diagnostic equipment; however, Dr. Cao pointed out that it is loaded with the latest technology. It has multiple cameras and attachments that allow physicians to make remote patient visits. “The stethoscope attachment is very nice; it’s attached via Bluetooth. As I bring up the apparatus to listen to their heart, they can hear their heartbeat — see everything that I see on the monitors, making them actively involved and participating in their examination. There is also a sound wave feature that allows me to view the S1, S2, S3, and S4 (EKG) waves. This allows us to diagnose heart failure. It’s interspersing how these instruments are more accurate over distance than if they were in person. There is also an attachment for a camera that can zoom in 1000X, beyond what our human eyes can view. This camera can zoom into the wound to the point where I can see hair follicles and wound edging,” said Dr. Cao.

Hands off but still delivering a high-quality of care

Dr. Cao explained the importance of keeping the structure of the doctor visit, similar to the examination he would perform in person. There is a trained technician, either a medical assistant or registered nurse with the patient during the exam. “They would perform the exam while I ask the patient or technician questions on what they see or feel,” stated Dr. Cao. He sees roughly 30 patients a week using the cart. An estimated 7 million patients in the United States will use telemedicine services this year alone. As the services become more available, health care experts point that demand will continue to rise.

Telemedicine is also transforming patient care in rural and urban areas by offering advanced, specialized, and preventative care to patients that would not have local access. “Right now, we are at a time where we are seeing many heart failure patients. They are severe patients, but they can be managed if they are treated with appropriate medications. I’m not seeing heart attack patients. Those patients need to be seen immediately. However, for patients who have had a heart attack or have a week heart, who need monitoring of their medications, if there is a reservation on counseling them over the phone, this technology allows me to look at them, see their fluid levels, and treat them. Just being able to look at their leg swelling or other problems, listening to their heart, telemedicine allows me to adjust their medications or treat them at that time versus having them travel,” commented Dr. Cao. There is also a benefit to the physician. The downtime that would be spent traveling to the patient’s location can be directed to care and visits. “By removing the space barrier, I can segue and care for them. I could see them every month instead of them missing visits and needing hospital treatment.”

In the early 2000s, telemedicine was primarily paid out of pocket as it was seen as concierge medicine. Now that technology is more mainstream, insurance companies combined with patient demand has allowed for growth opportunities. New York became the twenty-second state to require private insurance companies to cover telehealth services when New York Governor Andrew Cuomo signed the State’s telehealth parity law, which went into effect Jan. 1, 2016. This law also authorized the New York Medicaid agency to increase coverage and reimbursement of telemedicine.

And what does the future hold for telemedicine? Will we ever live in a time where our dedicated physician is just a button away? “I could see the future where every house would have a monitor, and you will contract with a physician for treatment,” shared Dr. Cao.” We are also trying to introduce this to the EMS (Emergency Medical Services), my focus is on the heart, but there are trauma patients where we can start examining the patient while they are en route to the emergency room. For heart attack patients, I can see their EKG, exam the patient, and know that if this a severe heart attack, we can prepare the Cath lab for treatment. Where time is tissue – either in a stroke or heart attack – this technology can save lives.”

Written by Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

National Nursing Shortage

National Nursing Shortage


The Need For Nurses – Now

“Nurses are the backbone in so many instances that deliver direct patient care.”

A perfect storm is developing that will lead to a national nursing shortage in the coming years. Since 2009, The American Association of Colleges of Nursing has projected “a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows.” They have identified four areas that are contributing to the oncoming demand: lack of interest in nursing, the aging population, the expanding roles of nurses in primary care due to health care policy changes, and the ongoing bottlenecks in nursing education. Health care professionals are working to find a solution to address the two to three million Baby Boomers who will age into Medicare every year for the next 30 years. Joanne McCarthy, RN and Operations Manager of Capital Cardiology Associates, described how the shortage would impact the patients level of care. “Most of the time, when patients are complaining about things in the hospital, it’s about not getting enough attention. I think that reflects on the staffing shortage. I recently shared a presentation on Joy in the Workplace. 50% of physicians complain of burnout, over a third of nurses on their first year on the job are looking for a new employer based on exhaustion. I think the burnout is because there are not enough nurses to go around. When hospitals look at overhead, inevitably that is going to trickle down to how to try and do more with less.”

“Nurses are the backbone in so many instances that deliver direct patient care.” Maryellen King, NP

Capital Cardiology Associates

The need for new nurses

The median age of RNs is currently 46 years old with the largest group now in their 50s. A projected one million RNs that will retire by 2030, leaving severe shortages of nurses in areas of the country. A 2017 report from The National Center for Health Workforce Analysis states that by 2030, the number of registered nurses needed in the United States is estimated to skyrocket by 28.4% from 2.8 million to 3.6 million. California is expected to be short the most registered nurses (45,500), while Alaska is projected to have the most job vacancies (22.7%). In other industries, there is a future generation ready to step in to fill the voids. However, in nursing, there are education barriers and unique challenges facing the new wave of providers. Traditionally, young people interested in a nursing career would volunteer at their local hospital. Maryellen King, NP with Capital Cardiology Associates, began her career in high school. “I was working in a local hospital, bringing books to patients, helping the nurses with changing the linens, giving patients water, and I really liked what I was doing. I am a caregiver at heart. From there, I went to a diploma school of nursing, which that option of living and learning at the hospital is not available anymore. If you want to be a registered nurse now, programs are usually in college — starting with an associates degree program, then you can sit for your nursing license exam or baccalaureate degree. There is a push today for more nurses to be bachelor’s prepared.”

What is a Registered Nurse? Get the answers in this video.

In 2017, New York State enacted the BS in 10 Law based on the recommendation of The Institute of Medicine, who called for at least 80% of the RN population to be baccalaureate prepared by 2020. Nurses who graduate from a New York State diploma or associate degree program must now obtain a baccalaureate degree in Nursing within ten years of becoming a nurse. This new legislation which was intended to improve the overall quality of care by providing better patient outcomes from more educated nurses has created another barrier in the profession: a lack of teachers.

Martha Desmond, RN is the Nursing Department Chairperson at Hudson Valley Community College, she recalls the push for higher education for nurses that began in 1964 with the American Nurses Association House of Delegates first adopted a motion supporting baccalaureate education. “I’ve been a nurse for 40 years. When I graduated, a long time ago, they spoke about this. The whole thought on the BS in 10 is that the theory that is offered for the bachelor’s degree is very important. What’s offered on the associates level is skill sets, critical thinking, but you are not getting the next level of theory or the in-depth medical knowledge that comes with the bachelor’s program. Politically, this has been pushed for years. I think this makes for a better nurse, allowing them to think better on their feet and provide better patient care.”

The BS in 10 law is designed to promote higher education for RN’s while also creating leadership opportunities in education, management, and patient care. The legislation also encourages continuous learning. The medical field is always evolving with innovations and technology, driving new procedures and methods of care and treatment. As in most professional careers, current certifications and continuing education are valued among employees and employers. Currently, New York is the only State with such legislation, but New Jersey and Rhode Island have put forth BSN in 10 bills that have not passed. North Dakota had a similar law in 1987 but was forced to abandon it in 2003 due to a shortage of nurses. There are also 33 states known as “compact states” that recognize a valid RN license obtained in another compact state, allowing that nurse to practice without further requirements.

It is fair to note that with the BS in 10 law in place, New York is the Top 5 States with the least demand for nurses in 2030. The projections show an “overage” of around 18,000 more nurses than what the market calls. “Where I see the problem is on the education side,” shares Martha Desmond. The active RN’s aren’t the only ones looking at retirement: one-third of the current nursing faculty workforce in baccalaureate and graduate programs are expected to retire by 2025. “If we don’t start paying the educators more, there will be a shortage of younger faculty. That’s my fear. What’s going to happen to nursing educators?” The American Associate of Colleges of Nursing reported in March 2017 that the average salary for a master’s prepared Assistant Professor in schools of nursing was $78,575. The average salary of a nurse practitioner with that level of education is $97,083.

Navigating through the perfect storm

Many prospective nursing students seek nursing programs at community colleges or private schools, in large part because nursing schools run by hospitals closed in the mid-1980s. At that time, community colleges became a popular alternative. “Hudson Valley’s applicant pool has always been significantly high. I think it’s because of the cost and value of the program. For example, this year, we have had 900 applicants for our fall program that teaches 100 students,” states Desmond.

Hudson Valley Community College also created an option based on the growing demand of students returning to school for an education needed to start a new career path. The Advanced Option allows eligible students (BA degree) to begin the Nursing program in the summer, condensing two core clinical nursing courses (Nursing 1 and Nursing 2) in the first term. They’ll go into the traditional Nursing 3 in the fall and complete their studies the following spring with Nursing 4, where you will have the option to start taking courses towards your BSN degree through Empire State College. “I’m getting students with degrees in Biology, Psychology who are saying, ‘What I am going to do with this? I thought I wanted a career in research, but it’s not for me.’  They want to be a nurse. Because of the demand of these students, we have created this option,” says Desmond.

There are also online RN to BSN programs available to students. SUNY Empire State College (ESC) RN to Bachelor of Science in Nursing program for RN’s looking for part-time, online, or face-to-face courses. Most ESC students enroll on a part-time basis and complete the program in about 24-36 months. The University of Buffalo offers a two-year track BNS programs. Graduates report high satisfaction with the overall program, calling it a “transformational” experience. A BS in 10 years actually takes less time than you think, once you’ve completed to your associate’s degree in nursing certification, you are more than halfway to your BSN.

Looking back on the factors leading to the projected nursing shortage, it’s refreshing to learn that there is still interest in the field. “I wasn’t thinking about how far I could go with nursing, I was thinking about my options,” recalls Joanne McCarthy. “The flexible hours, you don’t have to work in a hospital, and when most women have to consider the needs of your family — when you have to balance that as a nurse, you still have a good job and make time to be home to take care of your family as well. When I worked three 10 hour shifts or three 12 hours, I looked at it this way; you’re out more but your home more. I personally think for those who have to meet the demands of family and career — it’s a great field. You can be a school nurse, a camp nurse, work for an insurance company, for a doctors office, you can work for the State. Some jobs let you work from home because of Telemedicine. There are plenty of options. I don’t know why someone wouldn’t consider nursing. And, if you want the critical medical experience, you can do that too.”

Capital Cardiology Associates currently has openings Medical Assistants and Registered Nurses. To view our opportunities, click below​.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

World No Tobacco Day 2019

World No Tobacco Day 2019


The fight for your life and

fresh air for all New Yorkers

Meet Harlan Juster, the doctor who is advancing

public health policies to tackle big tobaccO IN

New York STATE

According to the Centers for Disease Control, tobacco is the leading cause of preventable disease disability and death in both the United States and in New York State. In New York, tobacco use is responsible for more than 28,000 deaths every year — that’s more than alcohol, auto accidents, and shootings. Since 1964, the Surgeon General’s Warning has appeared on all tobacco products sold in the United States. Additionally, May 31st is World No Tobacco Day, intended to encourage 24 hours of abstinence from all forms of tobacco consumption around the globe. This year, I spoke with Dr. Harlan Juster, Director of the Bureau of Tobacco Control New York State Department of Health on the many coordinated efforts New York State offers to help New Yorkers quit smoking. After reading a few of his tweets, I was encouraged and excited to meet a health care professional who is taking big tobacco head-on, advocating public health policies.

It’s a fact that smoking increases the risk of severe health problems, many diseases, and death – not just for the smoker but also in the community. “We have 2 million smokers still in New York state, that’s about 14% of our adult population. Which is quite low, compared to other states,” noted Dr. Juster. America’s Health Rankings, published by the United Health Foundation, a not-for-profit, private foundation dedicated to improving health and health care, reported that Utah is the healthiest State with just 8.9% of the population smoking; West Virginia was least-healthiest at 26%. It’s estimated that just over 17% of the total U.S. population smokes. The target is to reduce the national prevalence of cigarette smoking among adults to 12% by 2020.

There are cost benefits to citizens, communities, and the health care system to having fewer smokers in the population. “The cost of tobacco-related health care in New York State annually alone is about $10 billion,” stated Dr. Juster. The CDC reports that smoking-related diseases cost the United States more than $300 billion a year, including nearly $170 billion in direct health care costs and more than $156 billion in lost productivity. The challenge in addressing the dangers and risk of smoking is that smoking is a very personal decision. Dr. Juster recognized the difference in taking a message he would share with a patient in his private practice versus a population of 2 million smokers across New York State. However, he also sees a unique opportunity to connect on an individual basis. “We know that 80% of smokers will see a health care provider every year, and that’s a perfect opportunity for that provider to step in and offer evidence-based tobacco treatment. That usually consists of counseling on the risks of smoking, but also to write prescriptions for treatment,” said Dr. Juster. Up to 70% of smokers want to quit and expect their physician will talk to them about it. Smokers who are advised by their doctor to stop smoking are nearly twice as likely to do so than those who are not. “From a public policy side, we want strong policies that keep youth from starting to smoke, like raising the cost of tobacco, removing the sale of tobacco products from pharmacies, maybe getting rid of some the flavors,” he concluded.

“Tobacco control is really one of the great public health success stories in this country.”

Dr. Harlan Juster

Director of the Bureau of Tobacco Control, New York State Department of Health

Resources to help you quit

From 2012-2013, the first quit smoking campaign aired, urging smokers to call 1-800-QUIT-NOW. At least 400,000 smokers quit due to those messages. In 2014, the CDC ran a second wave of that campaign when an estimated 104,000 Americans quit smoking for good. Dr. Juster’s Bureau of Tobacco Control has been funding the New York State Smokers’ Quitline since 2003. “It’s an outstanding service! Any smoker in New York State or someone who knows a smoker in New York State can call to get advice. They can talk with Quit Coaches to help plan to quit. Often they will receive two, three, or four weeks of free nicotine replacement therapy with to help with their quit attempt. The NYS Quitline is just as effective as other State’s programs but is much more efficient.”

Controversial advertising

Lately, the New York State Department of Health has come under fire from its graphic new ads urging citizens to quit smoking. Ironically, most of us are unaware of the over $1 million that the tobacco industry spends each hour on cigarette advertising and promotion. In the beginning, the ads were light, focused on creating a positive culture change. “We’ve done extensive research on what ad messages work and which do not,” said Dr. Juster. “We know that ads with humor or with soft messages like why you should quit did not work well. They did not compel people to make behavioral changes.” Below is an example of one of the State’s first commercials from 1984.

By 2000, the messaging evolved into ads that show the consequences of smoking or the emotional impact smoking has on smokers and their families. While the critics argued over the shock value, the ads worked driving calls to the Quitline. “As we have had success over the past twenty years, we have learned that smoking is not spread evenly across the population, it’s actually concentrated in certain areas. Individuals that are at low-income or less educated, those with substance abuse or mental illness, those with physical disabilities all tend to smoke at higher rates than the rest of the community. We are working on ways to reach them better. We currently rank in the top performing states with tobacco control. California, Massachusetts, Minnesota, New York, and Florida, these are states that are working together on tobacco control,” Dr. Juster shared.

Some European countries have taken notice of American success, taking extreme steps in their advertising campaigns or with new warning labels on tobacco products. Cigarette packs in Germany now display images of rotten teeth and blackened lungs. Certain cigarette manufacturers in the U.K. had to switch to plain packaging, without brands or imagery. Also, the top European court upheld a 2014 European Commission directive that banned flavored cigarettes, mandated that 65 percent of the surface of packs must be covered with health warnings and imposed restrictions on how much nicotine could be taken in through vaping e-cigarettes.

A 2016 study published in the American Journal of Preventative Medicine found that even current smokers believed e-cigarettes to be equally or more harmful than traditional cigarettes, a misperception that could dissuade many of them from switching to less dangerous e-cigarette products.

The next challenge

“Since the year 2000, the amount of youth smoking combustible cigarettes has steadily declined; in 2016 only 4% of high school age youth smoked cigarettes,” noted Dr. Juster. It’s frustrating to learn that over twenty years when the public health policy is turning the tide in the fight to reduce tobacco usage a new product enters the market, aimed at the most vulnerable targets: smokers who want to quit and young people. The challenge this time is e-cigarettes or electronic cigarettes, devices that allow users to inhale “vapors” rather than traditional cigarette smoke.

Every week on HeartTalk presented by Capital Cardiology Associates, we report on a new study or research that is published on the dangerous chemicals and other particles people are inhaling into their lungs while vaping. Some smokers use e-cigs as part of their quit plan. Currently, the FDA approves three other nicotine delivery systems — gum, lozenges, and patches — to help people quit traditional cigarettes. Other smokers are under the misconception that vaping is safer than smoking, where e-cigarette smokers can purchase extra-strength cartridges, which have a higher concentration of nicotine or increase the voltage of their device to get a bigger hit of the substance.

The other side of the coin is that young people are vaping at incredibly high rates. In 2015, the U.S. surgeon general reported that e-cigarette use among high school students had increased by 900 percent, and 40 percent of young e-cigarette users had never smoked regular tobacco. “We are starting to focus on vaping now,” declared Dr. Juster. “In our new budget from the Governor passed by the Legislation, two new laws will go into effect in New York State this year. One requires that anyone selling the [e-cig] liquids will have to register through the State’s Department of Tax and Finance. Step two is that they will also have to collect a 20% tax on the sale of the products. Raise the cost, who is the most price-sensitive consumers on vaping products? Young people. Vaping is a unique problem in that predatory practices are being conducted by some of the manufacturers, like Juul, who offer flavors that appeal to young people. Vaping has also been added to the Comprehensive Clear Air Act in New York State that forbids vaping in all places where cigarette smoking is banned indoors. If adults want to use these products, the most we can do is educate them on the dangers of dual-use – smoking cigarettes and electronic devices.”

One truth about the anti-tobacco fight is: there is always something new. “There are also new products on the horizon, beyond electronic cigarettes, like IQOS (I Quit Ordinary Smoking), a product of Philip Morris. Instead of a liquid being heated and aerosolized, it uses ground up tobacco. They claim because it’s not combusted or burned, it’s safer than a cigarette. Yet another device to sell their products,” said Dr. Juster.

Written by: Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.