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If Sitting is the New Smoking, Walking is a Powerful Antidote

Ever since I took up running in my early teens, I have always considered myself a runner. Never a particularly fast runner, mind you, but an every-other-day distance runner. I made a habit out of running all through high school and college, and even ran a marathon (my one and only) as I finished out my first year in medical school. And then life’s demands really set in. With the realities of a husband, three kids, and a demanding job, I found myself figuratively running all the time, but with so little to spare that even finding the time to finish watching a movie on a 5-day rental was a challenge, and my running went by the wayside altogether.

One of the disadvantages of having been a former distance runner is that it took me many years before I was able to convince myself that anything short of a five-mile run counted as real exercise. Concerningly, I’ve found that people contemplating exercise for the first time share this impression, making it a misperception that stands to seriously get in the way of getting up and getting active. And it’s clear that getting up and getting active is something we all could afford to do more of.

In fact, a 2012 Lancet article reported that “physical inactivity is a global pandemic, with far-reaching health, economic, environmental, and social consequences.” The New York Times recently reported that Americans are “thousands of steps behind” – walking barely half (5117) of the 10,000 steps per day typically recommended by the health community compared to countries like Japan (coming in at over 7000) and both Australia and Switzerland (both close to 10,000 per day). According to America’s health rankings, Nebraskans are not faring so well either, with nearly a quarter of us over eighteen reportedly doing no physical activity or exercise other than in the course of our regular job. With physical education time and funding being dropped from elementary, middle and high schools alike, we’re all but setting our children up to follow in our physical inactivity footsteps.

So what kind of far-reaching effects does all this physical inactivity have? According to epidemiologist Min Lee it “has an impact on health comparable that of smoking” – a troubling sentiment shared by a friend of mine, Nilofer Merchant, in her recent TED talk, in which she asserted that sitting has become the smoking of our generation.

If sitting and our tendency towards physical inactivity really is the new smoking, then the good news is that there is a powerful, easy to administer, and entirely free antidote. That antidote is walking. With the lowest dropout rate of just about any physical activity, it’s high time we all commit to doing more of it. To that end, I wanted to share some of the many convenient and motivating ways you can add more steps to your family’s day.

  • Walk and talk. Just like regular exercise, finding time to connect with friends is clearly an important aspect of well-being too. Instead of getting together for food and/or drinks, why not plan to take a walk and talk instead? If your days are filled with meetings, consider which might be just as fruitful if conducted while walking rather than sitting.
  • Make walking a club sport. Many area elementary schools have adopted walking clubs, in which children can come to school early and walk a mile or more with the peers, teachers, and/or parents. If your child’s elementary school doesn’t have one, consider volunteering to help get one off the ground!
  • Walk where you’re going. While October 9th has been officially recognized as International Walk to School Day, consider having your child walk to/from school every And while you’re at it, consider other daily activities where you might be able to walk rather than drive – the grocery store? The post office? Take a look around your neighborhood and you’re sure to find places within walking distance. Or simply add an evening walk around the block to your daily routine.
  • Measure your progress. Pedometers and other fitness tracking devices abound, and for good reason. For many of us, simply being able to see how many steps we have (or haven’t) taken in a day is enough to motivate us to get up and moving.
  • Watch while you’re walking. Can’t find time to walk? Consider taking a look at your TV viewing schedule and commit yourself to walking on a treadmill while you watch your favorite weekly show(s).
  • Walk the walk. Remember that as parents, we have a responsibility to set a good example for our children – which includes both talking the talk and walking the walk. After all, if we get it right, they are very likely to follow in our 10,000-plus steps-per-day footsteps!

Originally posted on Omaha World Herald’s Live Well Nebraska

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Why E-Cigarettes Have Me Worried

The more I hear about e-cigarettes, the more they have me worried. And unfortunately, I’m not the only one who’s hearing a lot about these increasingly popular “alternatives to tobacco cigarettes.” In fact, a recent nationally-representative survey found that 40 percent of Americans have heard of the electronic nicotine delivery systems (ENDS) affectionately referred to as “e-Cigs”, teens seem to be quite taken by them, and annual sales this year are shaping up to be a predicted $1 billion. But that’s not all. Here are a few other compelling reasons why I’m worried.

What you see isn’t always what you get. Ask any teen to describe what’s in an e-cig and the likely answer you’ll get is that it’s “just water vapor,” and therefore harmless. For those of you who have yet to pay much attention to e-cigs and don’t yet know what they actually are, let me explain why this is a dangerous misperception. E-cigs are devices – many of which are designed to look similar to cigarettes – that do in fact vaporize appealing-flavored solutions into a mist that can be inhaled into the lungs. But while “water vapor” may be what you see, what e-cig users actually get is a vaporized chemical mixture typically composed of nicotine, propylene glycol and other chemicals. And what we do know is that nicotine can be highly addictive.

What you don’t know can hurt you. Just because e-cigs don’t produce tar or ash like cigarettes do does not mean they’re safe. In fact, the World Health Organization (WHO)’s Tobacco Free Initiative states that the potential risks they pose for the health of users remain undetermined, the safety has not been scientifically demonstrated, and scientific testing indicates that there is significant variation in the amount of nicotine and other chemicals contained in each product. Their conclusion, and one that I share: Until e-cigs are deemed safe and effective and of acceptable quality by a competent national regulatory body, consumers should be strongly advised not to use any of these products.

E-cigs are a step in the wrong direction. According to the Legacy Foundation, youth cigarette use declined sharply between the mid-1990’s and 2010, leveled off in 2011, and continued to decrease in 2012. In contrast, the CDC reports that e-cigarette use by minors is rapidly increasing – having doubled between 2011 and 2012. While advocates argue that e-cigs are a “safer alternative” to cigarette smoking, there are no scientifically proven methods for using e-cigs as cigarette replacements. In the meantime, they have me and just about everyone I know who’s involved in promoting healthy behaviors worried because they run the very real risk of initiating new teen e-cig smokers and making smoking cool again.

Looks can be appealing. Speaking of cool – it’s not so long ago that cigarettes were considered cool. In fact, too many movies still portray those who smoke cigarettes to be dashing, daring and desirable. Now enter e-cigs and you’ve got a new and even more appealing high-tech design. Now I’m not just worried that all of the longstanding public health efforts directed towards keeping teens from smoking will go up in smoke, but quite possibly go up in vapor as well.

Jenny McCarthy can be quite convincing. As if the enticing flavors and the convenience and the easy accessibility of sleek new e-cigs wasn’t enough, Advertising Age recently reported that Jenny McCarthy – known for her many years speaking out against childhood vaccination despite nearly two dozen scientific studies to the contrary – has signed on to be the new face of the leading brand of e-cigarettes. And even though tobacco advertisers haven’t been allowed to advertise on TV since 1971, e-cigarette makers now can because unlike their tobacco-containing counterparts, e-cigs are not yet regulated by the FDA. This really has me worried, given that a recent study on the international reach of tobacco marketing among young children confirms that pro-smoking messages delivered through marketing and the media can reach very young children and influence attitudes and behaviors around smoking.

So now that you hopefully agree that I’m justifiably worried, I hope you’ll join me in being proactive about it. Talk to your kids about e-cigs. Find out what they know, what they’ve heard, what they’ve seen. And make very sure they are well-informed – both about what e-cigs are, and about what they’re not!

Originally posted on Omaha World Herald’s Live Well Nebraska

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The Great American Smokeout: Why We Need to Clear the Air…for Our Children’s Sake

I am pleased to note that November 18th is the 35th anniversary of the American Cancer Society’s Great American Smokeout. That said, I have to admit that the existence of this day also makes me a bit sad. Sad because people still smoke. Sad because even those who don’t – including children – are nevertheless at risk. And most of all, sad because smoking is both deadly and powerfully addictive.

The fact of the matter is that despite decades of clear messages about the risk of cigarette smoking, there’s still more than enough smoke to go around. So much so that the FDA has now decided to resort to more drastic, scare-tactic measures, since high taxes and an ever-present surgeon general’s warning that “Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy” hasn’t sufficed. Soon, fully half of each entire cigarette pack will be required to show grim images of what smoking actually does to you, with images of diseased lungs, toe tags and body bags up for consideration.

As a pediatrician, of course, my focus is on helping insure that all babies are born healthy; that all children are raised in environments that are nurturing, healthy and safe; and whenever humanly possible, keeping kids from trying out risky behaviors for themselves. Unfortunately, smoking puts children in the direct line of fire on all three fronts.

While getting people to stop smoking (or not to start in the first place) can be admittedly challenging, it is my sincere hope that it’s possible. Whenever anyone is faced with having to change a habit or behavior because it’s “good for them” – whether it has to do with losing weight, exercising more, improving one’s diet, or quitting smoking – they first have to want to change. I hope that a closer look at some compelling dangers our children face from cigarette smoke will provide added motivation to help clear the air of cigarette smoke once and for all.

  • Babies are at risk, even before they are born. According to the March of Dimes, expectant mothers who smoke are at greater risk for pregnancy complications including bleeding, serious problems with the placenta, and even stillbirth. Babies born to mothers who smoke are at greater risk for being born prematurely, being low birthweight, having birth defects such as cleft lip/palate, and a whole list of other serious health problems.
  • Sudden Infant Death (SIDS). According to the American Academy of Pediatrics, maternal smoking during pregnancy has emerged as a major risk factor in almost every study of SIDS and several studies also suggest that smoke in an infant’s environment after birth poses an added risk.
  • Breathing problems and increased infections. The EPA estimates that as many as 300,000 children under 18 months of age get bronchitis or pneumonia resulting in thousands of hospitalizations each year just from exposure to secondhand smoke….and this is only the tip of the cigarette iceberg. Children who are exposed to cigarette smoke also get more ear infections, and breathing problems include everything from coughing, wheezing, bronchitis and pneumonia to an increased risk of developing asthma, or more frequent and severe asthma attacks for those kids who already have asthma.
  • Smoke lingers. Smoking in a different room or away from your child may lessen the exposure a bit, but not enough to protect them. No amount of exposure is safe. Even when cigarette smoke is delivered secondhand, the end result is still dangerous exposure.
  • Glorified images of cigarette smoking are influencing our children. Most parents are unaware of the fact that despite all the known dangers of smoking, a CDC report reveals that more than half of PG-13 movies in 2009 still contained images of tobacco use. While you may be understandably tempted to say “so what?” this statistic becomes far more frightening when partnered up with the CDC’s statement that “exposure to onscreen smoking in movies increases the probability that youths will start smoking.” In fact, there are pediatricians who consider images of smoking in movies “the single biggest media risk to young people.” Yet Hollywood still allows for paid placement of cigarettes in movies. For anyone still tempted to blow off the impact that smoking in the movies has on children, I suggest you find out more at Smoke Free Movies.
  • Teens are still being tempted. When it comes to protecting kids from the dangers of cigarette smoke, we’re up against some very powerful forces: The addictive nature of tobacco makes it very difficult to quit once someone starts, and the continued portrayal of cigarettes as sexy and powerful in everything from celebrity magazines to movies serves as a powerful lure for our children. It’s no wonder that an estimated 20 percent of high schoolers smoke, and 4000 US teens each day still opt to gain firsthand experience of cigarettes’ harmful effects by trying out smoking for the first time.

Like elsewhere around the country, the good news is that if you want to quit, there are people, organizations and resources right here in Nebraska that are ready, willing and able to help you – from a free confidential Nebraska Tobacco Quitline (800-784-8669) to online support at QuitNow.ne.gov.

Whether you decide to take the first step for yourself, or for your children, you can start by joining Tobacco Free Nebraska, the American Cancer Society and Nebraska’s Department of Health and Human Services’ efforts as part of Thursday’s Great American Smokeout.

Originally posted on Omaha World Herald’s Live Well Nebraska