Tag Archives: Elsevier

Elsevier study: At what point does click-bait susceptibility become a mental health disorder?

17 Nov

Shahram Heshmat Ph.D. wrote in the Psychology Today article, 5 Patterns of Compulsive Buying: How do you know you have an addiction?

About 6% of the U.S. population can be said to have compulsive buying behavior with 80% of compulsive buyers being women. Many women have been socialized from a very young age to enjoy shopping with their mothers and friends (Workman & Paper, 2010). However, compulsive buying is likely to increase for men with the evolution of digital commerce. It is much faster and easier now to find what you are looking for.
Compulsive buying is similar to behavioral addiction, such as binge eating and gambling (Lawrence et al., 2014). Compulsive spending frequently co-occurs with other mental illnesses like depression, anxiety, and eating disorders. Unlike other addictions, which take hold in the teens, spending addictions mostly develop in the 30s when people achieve financial independence.
Compulsive buying is not listed as an addiction in the DSM-5. However, the impulse problem appears to share certain characteristics common in addictive disorders (Black, 2012).
1. Impulse purchase. Compulsive buyers often purchase things on impulse that they can do without. And they often try to conceal their shopping habits…. Compulsive buyers may develop into hoarders later in life after their products have accumulated with time (Mueller, 2007).
2. Buyers high. Compulsive shoppers experience a rush of excitement when they buy. The euphoric experience is not from owning something but from the act of buying it…. And this excitement can become addictive.
3. Shopping to dampen unpleasant emotions. Compulsive shopping is an attempt to fill an emotional void, like loneliness, lack of control, or lack of self-esteem. Often, a negative mood, such as an argument or frustration triggers an urge to shop. However, the decrease in negative emotions is temporary and it is replaced by an increase in anxiety or guilt (Donnelly et al., 2016).
4. Guilt and remorse. Purchases are followed by feelings of remorse. They feel guilty and irresponsible for purchases that they perceive as indulges. The result may be a vicious cycle, that is, negative feeling fuel another “fix,” purchasing something else.
5. The pain of paying. Paying with cash is more painful than paying with credit cards (Ariely and Kreisler, 2017). The main psychological force of credit cards is that they separate the pleasure of buying from the pain of paying. Credit cards seduce us into thinking about the positive aspects of a purchase. In fact, CBD is only prevalent in developed countries where there is a system of credit and a consumer culture. https://www.psychologytoday.com/intl/blog/science-choice/201806/5-patterns-compulsive-buying

See, Compulsive Shopping https://www.investopedia.com/terms/c/compulsive-shopping.asp and Compulsive Spending / Shopping https://www.goodtherapy.org/learn-about-therapy/issues/compulsive-shopping

Science Daily reported the Elsevier study: At what point does click-bait susceptibility become a mental health disorder?

A new study in Comprehensive Psychiatry, published by Elsevier, found that one third of a group of patients seeking treatment for buying-shopping disorder (BSD) also reported symptoms of addictive online shopping. These patients tended to be younger than the others in the study sample, experienced greater levels of anxiety and depression, and were likely to exhibit a higher severity of BSD symptoms.
“It really is time to recognize BSD as separate mental health condition and to accumulate further knowledge about BSD on the Internet,” explained lead investigator Astrid Müller, MD, PhD, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany. At present, BSD is not categorized as a separate mental health condition; it is characterized as “other specified impulse control disorder” in the recently released 11th revision of the International Classification of Diseases.
BSD is a cross-national problem that afflicts an estimated five percent of the population. It is characterized by extreme preoccupation with and craving for buying and/or shopping, as well as irresistible and identity-seeking urges to possess consumer goods. Patients with BSD buy more consumer goods than they can afford, need, or use. Their excessive purchasing serves to regulate emotions, e.g., to get pleasure, relief from negative feelings or cope with self-discrepancy. In the long run, the recurrent breakdown in self-control leads to extreme distress, psychiatric comorbidity, familial discord, clutter due to pathological hoarding of goods, and indebtedness and/or deception and embezzlement to enable continued spending despite insufficient finances.
As e-commerce has gained increasing popularity as a primary method for buying and shopping for goods over the past decade, a need has developed for mental health experts to explore whether traditional BSD manifests differently in the online retail market. The Internet offers a vast variety of shopping information and simultaneous access to many online stores, thereby meeting expectations for immediate reward, emotional enhancement, and identity gain.
Previous studies showed that certain Internet-specific aspects of buying and shopping, such as availability, anonymity, accessibility, and affordability, contribute to the development of an online subtype of BSD. However, there is a paucity of studies investigating addictive online shopping as a phenotype of BSD related to the problematic use of the Internet. This study, which analyzed data from earlier studies reporting on 122 treatment-seeking patients, is among the first to quantify and explore the phenomenon of online shopping in BSD diagnosed-patients…. https://www.sciencedaily.com/releases/2019/11/191114100911.htm

Citation:

At what point does click-bait susceptibility become a mental health disorder?
Date: November 14, 2019
Source: Elsevier
Summary:
A new study found that one third of a group of patients seeking treatment for buying-shopping disorder (BSD) also reported symptoms of addictive online shopping. These patients tended to be younger than the others in the study sample, experienced greater levels of anxiety and depression, and were likely to exhibit a higher severity of BSD symptoms.
Journal Reference:
Astrid Müller, Sabine Steins-Loeber, Patrick Trotzke, Birte Vogel, Ekaterini Georgiadou, Martina de Zwaan. Online shopping in treatment-seeking patients with buying-shopping disorder. Comprehensive Psychiatry, 2019; 94: 152120 DOI: 10.1016/j.comppsych.2019.152120

Here is the press release from Elsevier:

At what point does click-bait susceptibility become a mental health disorder?
One third of patients seeking treatment for buying-shopping disorder report symptoms of online shopping addiction, according to a new study published in Comprehensive Psychiatry

Philadelphia, November 13, 2019
A new study in Comprehensive Psychiatry, published by Elsevier, found that one third of a group of patients seeking treatment for buying-shopping disorder (BSD) also reported symptoms of addictive online shopping. These patients tended to be younger than the others in the study sample, experienced greater levels of anxiety and depression, and were likely to exhibit a higher severity of BSD symptoms.
“It really is time to recognize BSD as separate mental health condition and to accumulate further knowledge about BSD on the Internet,” explained lead investigator Astrid Müller, MD, PhD, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany. At present, BSD is not categorized as a separate mental health condition; it is characterized as “other specified impulse control disorder” in the recently released 11th revision of the International Classification of Diseases.
BSD is a cross-national problem that afflicts an estimated five percent of the population. It is characterized by extreme preoccupation with and craving for buying and/or shopping, as well as irresistible and identity-seeking urges to possess consumer goods. Patients with BSD buy more consumer goods than they can afford, need, or use. Their excessive purchasing serves to regulate emotions (e.g., to get pleasure, relief from negative feelings or cope with self-discrepancy). In the long run, the recurrent breakdown in self-control leads to extreme distress, psychiatric comorbidity, familial discord, clutter due to pathological hoarding of goods, and indebtedness and/or deception and embezzlement to enable continued spending despite insufficient finances.
As e-commerce has gained increasing popularity as a primary method for buying and shopping for goods over the past decade, a need has developed for mental health experts to explore whether traditional BSD manifests differently in the online retail market. The Internet offers a vast variety of shopping information and simultaneous access to many online stores, thereby meeting expectations for immediate reward, emotional enhancement, and identity gain.
Previous studies showed that certain Internet-specific aspects of buying and shopping, such as availability, anonymity, accessibility, and affordability, contribute to the development of an online subtype of BSD. However, there is a paucity of studies investigating addictive online shopping as a phenotype of BSD related to the problematic use of the Internet. This study, which analyzed data from earlier studies reporting on 122 treatment-seeking patients, is among the first to quantify and explore the phenomenon of online shopping in BSD diagnosed-patients.
Dr. Müller added, “We hope that our results showing that the prevalence of addictive online shopping among treatment-seeking patients with BSD will encourage future research addressing the distinct phenomenological characteristics, underlying features, associated comorbidity, and specific treatment concepts.”
Notes for editors
The article is “Online shopping in treatment-seeking patients with buying-shopping disorder,”by Astrid Müller, Sabine Steins-Loeber, Patrick Trotzke, Birte Vogel, Ekaterini Georgiadou, and Martina de Zwaan (https://doi.org/10.1016/j.comppsych.2019.152120). It appears in Comprehensive Psychiatry, volume 94 published by Elsevier.
This study is published open access and can be downloaded by following the DOI link above.
Full text of the article is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628or hmsmedia@elsevier.com to obtain copies. Journalists wishing to speak to the authors should contact Astrid Müller at mueller.astrid@mh-hannover.de.
About Comprehensive Psychiatry
Comprehensive Psychiatry is an open access, peer-reviewed journal that publishes on all aspects of psychiatry and mental health with a mission to disseminate cutting-edge knowledge in order to improve patient care and advance the understanding of mental illness. The Journal aims to publish high quality papers with a particular emphasis on the clinical implications of the work including an improved understanding of psychopathology.
About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. http://www.elsevier.com
Media contact
Eileen Leahy
Elsevier
+1 732 238 3628
hmsmedia@elsevier.com

Dr. April Benson wrote in Compulsive Shopping Treatment Overview:

As with most other addictive, impulse control, or compulsive disorders, there is a wide range of effective treatment options: drug treatment, individual, group, and couples therapy, counseling for compulsive buying, Debtors Anonymous, and Simplicity Circles can all be effective. The choice of what form or forms of compulsive shopping treatment to use with a particular person is a complex decision that goes well beyond the scope of this overview. For further information about making treatment decisions, consult my own writings, the For Therapists page of this website, as well as the bibliographic references at the end of each chapter in I Shop, Therefore I Am: Compulsive Buying and the Search for Self.
Psychotropic medications, including antidepressants, mood stabilizers, and opiod antagonists have been used to treat compulsive buying, with varying effectiveness. For further details, see McElroy and Goldsmith-Chapter 10 of I Shop, Therefore I Am and in Benson, April L. and Gengler, Marie. “Treatment of Compulsive Buying,” in Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment Handbook, Robert Coombs, (ed.), Wiley (2004).
Group therapy for compulsive buyers has been reported since the late 1980s. At least five different forms of group therapy have been utilized with this population. My own group compulsive shopping treatment model is an amalgam of three things: useful techniques from existing models; didactic and experiential material used in group treatment for Borderline Personality Disorder; and material I’ve found effective in my clinical practice. A study of the efficacy of this model has been submitted for publication to the Journal of Groups in Addiction and Recovery and two additional papers, one about the model itself, and the second, a case illustration of the model, will appear in Volume 8, Number 1, of the Journal of Groups in Addiction and Recovery (2013).
There are chapters about two of the existing group therapy models in my book, I Shop, Therefore I Am and I describe all five in detail in Benson, April L. and Gengler, Marie. “Treatment of Compulsive Buying,” in Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment Handbook, Robert Coombs, (ed.), Wiley (2004).
Couples therapy for compulsive buying is an extremely important treatment modality, because couples act as a financial unit and generally blend income as well as spending. Money issues are an intrinsic part of marriage and are often a source of intense and pervasive friction that can seep into other aspects of the relationship. Couples therapy is indicated when the compulsive spending problem can’t be dealt with adequately on an individual basis. Olivia Mellan, the country’s foremost expert in this area, discusses the treatment in Chapter 15, “Overcoming Overspending in Couples”, of I Shop, Therefore I Am.
How Does Compulsive Shopping Treatment Work?
Compulsive shopping treatment targets the specific problem and creates an action plan to stop the behavior. Targeted counseling for this problem alters the negative actions of compulsive buying and concurrently works toward healing the underlying emotions, although less emphasis is placed on exploring the emotional significance of compulsive buying than in traditional individual psychotherapy. The major premise of compulsive shopping treatment is the idea that insight alone will not stop the behavior. All stages in the compulsive buying cycle must be identified: the triggers, the feelings, the dysfunctional thoughts, the behaviors, the consequences of the behavior, as well as the meaning of the compulsive buying. Creating and using a spending plan is a cornerstone of compulsive shopping treatment. More information about compulsive buying counseling can be found in Karen McCall’s chapter “Financial Recovery Counseling”, as well as in my treatment chapter in Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment Handbook, Robert Coombs, (ed.), Wiley (2004).
Debtors Anonymous (D.A.) can be a powerful tool in recovery from compulsive buying, especially for compulsive buyers who have problems with debt. D.A. sees debting as a disease similar to alcoholism that can be cured with solvency, which means abstinence from any new debt. Since individuals are trying to control their lives with addictive debting, D.A. offers a regimented program of surrender and recovery, a program with a spiritual emphasis. Individual debtors work through the steps of the program with a sponsor, a more experienced member of the group, using newly acquired tools in conjunction with the steps. How Debtors Anonymous and psychotherapy can work synergistically is the topic of Kellen and Levine’s chapter of I Shop, Therefore I Am….. https://www.shopaholicnomore.com/complusive-shopping-treatment/

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Helen Keller

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Elsevier study: Novel study links fetal exposure to nicotine and sudden infant death syndrome

31 Mar

There are numerous reasons why smoking is considered bad for an individual and there are numerous research studies which list the reasons. Studies are showing how bad second hand smoke is for children. A MNT article, Smoking During Pregnancy May Lower Your Child’s Reading Scores:

Babies born to mothers who smoke more than a pack of cigarettes a day while pregnant have lower reading scores and a harder time with reading tests, compared with children whose mothers do not smoke.
This is the conclusion of a recent study conducted by researchers at Yale School of Medicine and published in The Journal of Pediatrics in November 2012. The reading tests measured how well children read out loud and understood what they were reading.
This isn’t the first study to suggest that smoking in pregnancy may affect a child’s future health and development. A study released in August 2012 said that smoking during pregnancy increases a child’s risk of asthma. In addition, a 2009 study linked smoking during pregnancy to behavioral problems among 3 and 4 year olds boys…. http://www.medicalnewstoday.com/articles/253100.php

An Inserm and Pierre and Marie Curie University study adds behavior problems to the list of woes children of smokers suffer.

Science Daily reported in Early exposure to tobacco can cause behavioral problems in children:

The consequences of tobacco exposure are widely documented. It leads to many illnesses, including asthma. However, the potential role of environmental tobacco smoke (ETS) is much less well known in terms of its link to behavioural problems in children. In this context, the team led by Isabella Annesi-Maesano, Inserm Research Director at Unit 1136, “Pierre Louis Public Health Institute” (Inserm/UPMC) examined the association between pre- and postnatal ETS exposure and behavioural problems in children….
These observations seem to confirm those carried out in animals, i.e. that the nicotine contained in tobacco smoke may have a neurotoxic effect on the brain. During pregnancy, nicotine in tobacco smoke stimulates acetylcholine receptors, and causes structural changes in the brain. In the first months of life, exposure to tobacco smoke generates a protein imbalance that leads to altered neuronal growth….. http://www.sciencedaily.com/releases/2015/09/150928103029.htm?utm_source=dlvr.it&utm_medium=facebook

Steven Reinberg reported in the Health Day article, Secondhand Smoke in Infancy May Harm Kids’ Teeth. http://consumer.healthday.com/kids-health-information-23/cavities-and-dental-news-118/secondhand-smoke-in-infancy-may-harm-kids-teeth-704482.html

Science Daily reported in Smoking fathers increase asthma-risk in future offspring:

A Norwegian study shows that asthma is three times more common in those who had a father who smoked in adolescence than offspring who didn’t.
It is well known that a mother’s environment plays a key role in child health. However, recent research, including more than 24,000 offspring, suggests that this may also be true for fathers….
Smoking fathers may influence gene control in children
Concerning mother’s smoking, the research found more offspring asthma if the mother smoked around pregnancy, consistent with previous studies. However, no effect of maternal smoking only prior to conception was identified. The difference from father’s smoking suggests effects through male sperm cells.
“Smoking is known to cause genetic and epigenetic damage to spermatozoa, which are transmissible to offspring and have the potential to induce developmental abnormalities,” explains Svanes.
It is previously known that nutritional, hormonal and psychological environment provided by the mother permanently alters organ structure, cellular response and gene expression in her offspring. Father’s lifestyle and age appear, however, to be reflected in molecules that control gene function.
“There is growing evidence from animal studies for so called epigenetic programming, a mechanism whereby the father’s environment before conception could impact on the health of future generations,” Svanes says…. https://www.sciencedaily.com/releases/2016/09/160928135903.h

Another study linked nicotine exposure to sudden infant death syndrome.

Science Daily reported in: Novel study links fetal exposure to nicotine and sudden infant death syndrome:

Fetal exposure to tobacco smoke in utero is associated with sudden infant death syndrome (SIDS) and cardiac arrhythmias in newborns. In a novel study in rabbits, investigators provide the first evidence linking fetal exposure to nicotine to long-term alterations of the cardiac sodium current. These changes may impair adaptation of the cardiac sodium current to sympathetic tone and prevent awakening from sleep apnea, leading to arrhythmias that could potentially be involved in SIDS. They report their findings in HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, published by Elsevier.
SIDS, or crib death, is the leading cause of death in the first year of life. In utero exposure to tobacco smoke remains the highest risk factor in 85 percent of cases. It therefore seems logical to prescribe nicotine replacement therapies (NRTs) to pregnant women who wish to quit smoking. Tobacco smoke contains over 3,000 toxic compounds identified so far, but out of all the toxic compounds found in smoke, only nicotine is associated with cardiac arrhythmias in newborns.
“Clinicians often prescribe NRTs to pregnant women who wish to quit smoking in order to reduce the number of crib deaths,” explained lead investigator Robert Dumaine, PhD, Department of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada. “However, our data show that nicotine alone is sufficient to alter electrical currents within the heart and generate arrhythmias leading to crib death.”
In the womb, the fetus cannot breathe on its own and its heart reacts to a reduction in oxygen by slowing the beating rate and its metabolism to preserve energy. This fetal adaptation is known as “diver reflex.” On the other hand, when an infant suffocates during sleep, the brain senses the reduction of oxygen in the blood and will trigger secretion of adrenalin (epinephrine) to accelerate heart rhythm. Once cardiac rhythm accelerates, in part due to increased excitability (sodium current) in the heart, the baby wakes up. This “resuscitation reflex” seems to be absent in babies with SIDS. Instead, those infants display a slowing of heart rate when lacking oxygen, as if their postnatal cardiac development had been delayed and still in a fetal state.
“The importance of this study is that, for the first time, we provide direct evidence that in utero exposure to nicotine has postnatal effects on the development of the heart and its response to adrenalin and may provide a basis to explain why some babies do not wake up during sleep apnea,” commented Dr. Dumaine. “Therefore, it might be worthwhile to revisit the clinical practice of prescribing the nicotine patch and other NRTs to pregnant women….” https://www.sciencedaily.com/releases/2019/03/190328150959.htm

Citation:

Novel study links fetal exposure to nicotine and sudden infant death syndrome
Date: March 28, 2019
Source: Elsevier
Summary:
In utero exposure to nicotine has postnatal effects on development of the heart and its response to adrenalin and may contribute to explanation of why some babies do not wake up during sleep apnea, according to a new study.
Journal Reference:
Michael Biet, Anh Tuan Ton, Jean-Francois Delabre, Nathalie Morin, Robert Dumaine. In utero exposure to nicotine abolishes the postnatal response of the cardiac sodium current to isoproterenol in newborn rabbit atrium. Heart Rhythm, 2019; 16 (4): 494 DOI: 10.1016/j.hrthm.2019.02.013

Here is the press release from Elsevier:

PUBLIC RELEASE: 28-MAR-2019
Novel study links fetal exposure to nicotine and sudden infant death syndrome
In utero exposure to nicotine has postnatal effects on development of the heart and its response to adrenalin and may contribute to explanation of why some babies do not wake up during sleep apnea, according to important new study published in HeartRhythm
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Philadelphia, March 28, 2019 – Fetal exposure to tobacco smoke in utero is associated with sudden infant death syndrome (SIDS) and cardiac arrhythmias in newborns. In a novel study in rabbits, investigators provide the first evidence linking fetal exposure to nicotine to long-term alterations of the cardiac sodium current. These changes may impair adaptation of the cardiac sodium current to sympathetic tone and prevent awakening from sleep apnea, leading to arrhythmias that could potentially be involved in SIDS. They report their findings in HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, published by Elsevier.
SIDS, or crib death, is the leading cause of death in the first year of life. In utero exposure to tobacco smoke remains the highest risk factor in 85 percent of cases. It therefore seems logical to prescribe nicotine replacement therapies (NRTs) to pregnant women who wish to quit smoking. Tobacco smoke contains over 3,000 toxic compounds identified so far, but out of all the toxic compounds found in smoke, only nicotine is associated with cardiac arrhythmias in newborns.
“Clinicians often prescribe NRTs to pregnant women who wish to quit smoking in order to reduce the number of crib deaths,” explained lead investigator Robert Dumaine, PhD, Department of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada. “However, our data show that nicotine alone is sufficient to alter electrical currents within the heart and generate arrhythmias leading to crib death.”
In the womb, the fetus cannot breathe on its own and its heart reacts to a reduction in oxygen by slowing the beating rate and its metabolism to preserve energy. This fetal adaptation is known as “diver reflex.” On the other hand, when an infant suffocates during sleep, the brain senses the reduction of oxygen in the blood and will trigger secretion of adrenalin (epinephrine) to accelerate heart rhythm. Once cardiac rhythm accelerates, in part due to increased excitability (sodium current) in the heart, the baby wakes up. This “resuscitation reflex” seems to be absent in babies with SIDS. Instead, those infants display a slowing of heart rate when lacking oxygen, as if their postnatal cardiac development had been delayed and still in a fetal state.
“The importance of this study is that, for the first time, we provide direct evidence that in utero exposure to nicotine has postnatal effects on the development of the heart and its response to adrenalin and may provide a basis to explain why some babies do not wake up during sleep apnea,” commented Dr. Dumaine. “Therefore, it might be worthwhile to revisit the clinical practice of prescribing the nicotine patch and other NRTs to pregnant women.”
Investigators measured the effect of nicotine on the response of cardiac sodium current (INa) to adrenergic stimulation in isolated cardiomyocytes in rabbits. They mated New Zealand female rabbits and after 14 days of gestation, implanted them subcutaneously with two osmotic pumps, each containing 2 ml of nicotine solution. The control group was exposed to saline solution instead of nicotine. Serum concentration of cotinine (nicotine metabolite) was measured every two days.
Results showed that isoproterenol, an analog of epinephrine (adrenaline) and a potent beta-adrenergic agonist, increased INa by 50 percent in newborn rabbits in the control group but had no effect in newborn rabbits that were exposed to nicotine in utero. Exposure of rabbit fetuses to nicotine while still in the womb reduced the response of their heart to adrenalin after birth. More specifically, they observed that the cardiac electrical current carried by sodium and responsible for excitability within the heart did not respond to adrenalin. Therefore, nicotine will impair acceleration of heart rate when adrenalin is released at the onset of sleep apnea, which is a potential mechanism leading to SIDS.
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See, Prenatal care fact sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html

Our goal as a society should be a healthy child in a healthy family who attends a healthy school in a healthy neighborhood. ©

Resources:

A History of Tobacco
http://archive.tobacco.org/History/Tobacco_History.html

American Lung Association’s Smoking and Teens Fact Sheet Women and Tobacco Use
African Americans and Tobacco Use
American Indians/Alaska Natives and Tobacco Use
Hispanics and Tobacco Use
Asian Americans/Pacific Islanders and Tobacco Use
Military and Tobacco Use
Children/Teens and Tobacco Use
Older Adults and Tobacco Use
http://www.lung.org/stop-smoking/about-smoking/facts-figures/specific-populations.html

Center for Young Women’s Health A Guide for Teens http://www.youngwomenshealth.org/smokeinfo.html

Kroger Resources Teens and Smoking
http://kroger.staywellsolutionsonline.com/Wellness/Smoking/Teens/

Teens Health’s Smoking
http://kidshealth.org/teen/drug_alcohol/tobacco/smoking.html

Quit Smoking Support.com
http://www.quitsmokingsupport.com/teens.htm

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