Staying off tobacco

Just knowing the health risks of tobacco (including lung cancer, head and neck cancers, and heart disease) and the mental health benefits of quitting tobacco (getting better quality sleep, improved mental health, and reduced stress levels) may not be adequate reasons to motivate smokers to quit. Studies show that campaigns which emphasize the truth about the tobacco industry and the real cost of smoking are more effective in helping people quit.

Social support helps people quit tobacco

But what else? Here are what the research says:

1. Guidance from a professional coach
Research shows that professional counselling can help smokers successfully quit: A coach or counsellor can help individuals develop a personal stop-smoking plan.

2. Reduce dependence using nicotine medicines 
There are 5 nicotine medicines which are recognised to boost the success of quitting tobacco: gum, patch, lozenge, nasal spray, and inhaler.

3. Going cold turkey isn’t for everyone
Quitting on willpower is the least successful way to quit tobacco. But counselling and nicotine substitutes are not the only available strategies. Exercise reduces the urge to smoke and withdrawal symptoms, while social support via social media is gaining popularity for its efficacy in helping ex-smokers stay tobacco-free. And there are a few more: hypnosis, acupuncture, yoga, and mindfulness are some of them.

4. Get the right kind of emotional support
Participants in a 2014 study were better at talking to their loved ones about quitting smoking if they had received face-to-face or online training on how to communicate their concern (without nagging or confrontation) than if they received only pamphlets.

5. Don’t be afraid to use your smartphone
A 2014 study showed that constant reminders from a text-messaging service helped people stay off tobacco.

6. Challenge your brain
Engaging in exciting activities (e.g., puzzles, hobbies, games), which challenge the brain, with a loved one can be an effective strategy for reducing nicotine cravings.

7. Use e-cigarettes to boost willpower
E-cigarettes create an inhalable nicotine vapour by heating a liquid nicotine solution. It’s not clear what the long-term effects are, but research shows e-cigarettes to be more effective in helping people successfully quit smoking compared to willpower alone or patches and gum. Recent reports do however caution the use of e-cigarettes (“No conclusive evidence that e-cigarettes help smokers quit: WHO report”, Today online, 27 August 2014).

29 ways to destress

There are only 3 days left before we can enjoy a day of rest (and possibly too much murukku). It’s only 68 days before the long weekend during Christmas this year and the ensuing three working days before the New Year, when everyone is at their desk but no one wants to do any work. Another 42 days to filing corporate annual tax returns. And another 26 days before children are free to roam the shopping malls downtown and prowl the science centre, zoo, and bird park.

In order that we don’t burn ourselves out to survive another fast-paced year in the corporate jungle, we can innoculate ourselves against stress. Here’s some things to try:

29. Do you precrastinate?
We can feel stressed out by our “to do” list, which more often than not gets longer as the day yawns on. Sometimes we get so stressed that the last thing that’s added to our list, is also the first thing we tackle, even when we’re in the middle of doing something else. Choosing to reply to a new email (precrastination) gets it off our list but may be counterproductive. It could be more efficient to let emails accumulate and reply to all of them at the end of the day.

 

28. Go away!
A 2014 study argues that multiple interruptions reduce quality of work produced. It may be a good idea to put your phone on “do not disturb” (only important calls will get through) and stop your email client from running in the background.

27. Indulge in a short break at the office
A 2014 study found that employees who took breaks while at work reported more satisfaction at work. But the study also showed that these were usually employees who had a physical job, or those who had jobs with a lot of face-to-face interactions, and needed to decompress with “alone time”. But breaks don’t have to be “workplace internet leisure browsing“; they can be time well-spent filling up at the water cooler or having breakfast!

26. Facebook at the office
According to this 2014 study, taking a 5-minute break to browse non-work-related websites helps younger employees stay focused at work. Using company internet to surf Facebook for 5 minutes was a more effective break than a similar duration spent comparing online insurance policies, doing nothing, or not taking a break. But it’s not for those aged 30 and up…

25. Smartphone breaks (and tea breaks) can be helpful 
We’re better at paying attention to a task which requires constant vigilance (think air traffic controllers) when we’re allowed brief breaks. A 2014 study observed that employees, who spent time playing a game, checking Facebook, or posting on Twitter while at work, had higher levels of mental well-being at the end of the day. The microbreaks help by allowing us to destress in between tasks. Though those in organizations where smartphones are not allowed, will probably need to do it the old-fashioned way — talking to co-workers in person or taking a tea break in another part of the building.

24. When TV is bad for you…
Apparently it’s hard to relax by watching TV or playing computer or video games. A recent study suggests that when we use TV and gaming as a distraction to escape more pressing tasks, we fail to be destressed from watching TV or from playing a computer or video game. Instead, we feel guilty for procrastinating on the pressing tasks. That’s not to say TV is not an effective way to destress. It is, but only if we’re not using it as a means to escape from a problem. If you’re not escaping, then go ahead…watch TV (skip to #13 and #14).

23. If you must procrastinate…
Then choose something that you have to do. If you’re at home, that could be the laundry, dishes, ironing, walking the dog, or dinner prep. If you’re at the office, that could be clearing out your inbox, tidying up your desk, backing up your data, or sorting out your filing. At least you’ll feel accomplished at the end of the day.

22. Get those creative juices flowing
A recent study has found that employees with creative pursuits outside work are more productive than their peers who don’t have such interests. Even being an audience member at a dance or musical performance or a visitor to an art gallery or museum exhibition can bestow benefits which include improved mental wellbeing and mood. It may be that creative hobbies help us relax during our downtime, which in turn boosts our effectiveness when we’re on the job in the work week.

21. Enjoy your time at work and at home
Although not all tasks are suited to being accompanied by music, music can be helpful in boosting productivity. And putting up the bass can make one feel empowered. So, put on those headphones and turn up the bass before that all-important client meeting, business negociation, or employee performance review.

20. Channel your spending towards friends and family
Spending on things which provide us opportunities for social interactions (e.g., meals, theatre shows) makes us happy. Relative to spending on things which are only appreciated by us. Research also shows that we’re happier when we spend on others rather than ourselves. And we’re most happy about charity donations when these further a cause supported by friends or family. What all this tells us is that we value social experiences. By that reasoning, we should expect to be ecstatic about making a home-made picnic for friends and family at Marina Barrage. Or a potluck get-together with all your office BFFs.

19. The magic of delegation
Some of the things that we do don’t need to be done by us. But giving responsibilities away takes practice. It helps if we also prepare by finding out ahead of time whom we can give the tasks away to. Here are some tips and a how-to guide.

18. Give it away, give it away now
There’s a difference between something which is important but not urgent, and something which is urgent but not important. It’s tough deciding which to do first. Here’s a step-by-step guide on what to do.

17. Say no (or else…)
Much easier said that done. But since we don’t have superpowers, we need to know what we do want to do and don’t want to do. It’s not just about finding ways to do things more efficiently (though that helps). We can do things which fit into the time available. Here’s how to go about doing it and a useful fact sheet. If not, you can appoint someone to remind you to say no.

16. Be assertive, not passive-aggressive
Part of “learning to say no” is learning to be assertive. Being assertive means saying what your needs and feelings are, with the right body language. This helps you manage your stress, particularly if we have difficulty turning down more work responsibilities. And prevent you from “vaguebooking” and “posting statuses for attention” for the next two hours, when you should be working!

15. Look into ways to improve yourself
Key competencies for employees in today’s workplace include awareness of one’s emotions, ability to manage one’s emotions, ability to motivate oneself, empathy, and the ability to manage relationships with others. You can’t change others; you can only change yourself. It’s an important part of stress management. Find out about yourself here.

14. Laugh it off
Laughter alleviates stress and protects against heart disease (read this article). It’s not just common sense. Laughter is the best medicine: Patients were found to cope better when their long-term chronic illnesses were explained with cartoons. Seeing the funny side of things helps us cope when life gets stressful (here’s the science behind it). Now you have an excuse to read Sherman’s lagoon. Or view some self-deprecating thoughts.

13. Have a good cry (and a friend to hold your hand)

Some argue that crying has a stress-reducing effect, but it appears that the benefits of a good cry may depend on who’s doing the crying and who they’re with at the time of their crying. Findings from a 2008 study suggests that having emotional support in the form of friends and family produces positive outcomes from the crying episode. So, station your social support network on your sofa, get ready the tissues, and turn on the K-drama channel…

12. Watch a funny movie
A recent study found that watching films with a stressful scene (heart surgery in the film Vertical Limit) makes our heart beat faster. And not in a good way. In contrast, watching a funny movie reduces anxiety levels. A 1991 study showed that we’re better at solving a problem when we’re experiencing a positive emotion than a negative one. It appears that we are more apt to think of possible solutions when we’re feeling happy.

11. Ready, steady, laugh!
In fact, just knowing that we’re about to laugh relieves stress. Anticipating a funny movie lowered stress hormones (cortisol) and two other mood-regulating hormones (adrenalin and a dopamine-related brain chemical). Amazing. Time to self-medicate with Toy Story 3 and Despicable Me 2!

10. Spend time on your financial health
When we have money problems at home, we spend time at work solving these problems or worrying about them. All this worrying can lead us to destressing in less than healthy ways. So it pays to keep tabs on your spending, saving, and investing (here are some tips for getting started).

9. Spend time with your kids
Toddler tantrums and preschool meltdowns are unlikely to be your idea of a restful weekend. Odd as it may sound, children can behave in much more predictable ways when they spend more time with their parents. And if parents engage in warm and consistent parenting, focusing on rewarding desirable behaviour and understanding their young children’s needs and feelings.

8. Spend time with your older kids too
Respectful communication is easier when you spend time doing day-to-day things with your teenagers. You may want to try a problem-solving approach when addressing a testy topic. Or assess the various sources of stress that your children are facing before tackling disagreeable topics.

7. Defend your ears
A study which found that elevated traffic noise produced higher blood pressure and heart rate, and higher levels of stress hormone, also showed that even low-level noise elicited a stress response, resulting in reduced motivation. Aside from sleep disturbances which in turn affect our ability to cope with stress, traffic noise is also thought to contribute to stress-related health problems such as stroke and heart disease. There are solutions being proposed in dense cities, but ear plugs are a good short-term solution in the meantime.

6. Greener is better
The participants of a large scale study reported better mental wellbeing as soon as they moved to a greener neighbourhood and this improvement was sustained for as long as 3 years after the move. In another study, residents in a neighbourhood with more trees and vegetation had fewer symptoms of anxiety, depression, and stress. Remarkable.

5. Popeye was right
Investing in a plant-based diet, as well as physical activity as part of one’s daily routine, a strong social support network, and a purpose-driven life, is one of the secrets to getting older with good mental and physical health.

4. Increase your sunshine vitamin
Nurses were more alert and experienced improved mood when they spent more time with daylight than artificial light (read about the study here). Blue light, which is more available from the morning sun than evening sun, regulates our sleep patterns, which in turn affects our ability to pay attention and solve problems during our working hours. Besides that, sunlight also provides us with vitamin D, which boosts your immune system and facilitates calcium absorption. Time to get make hay while the sun shines!

3. Get some zzz!
Whether it’s from disrupted sleep or a lack of sleep, poor quality sleep compromises our ability to remember things and impacts our mood. Studies also show that sleep deprivation puts adolescents at risk of depression and children at risk of obesity. The less we sleep, the faster we age. And here’s the really bad news: lack of sleep makes us crave junk food! Sleep is definitely a must-have.

2. Mindfulness
Studies show that spending a small amount of time a day focusing on breathing helps to lower blood pressure and stress hormone levels, alleviating stress and reduces burnout. Other benefits include improvements in other domains such as attention, decision-making, immune health, and emotion regulation. Mindfulness is not for everyone so similar techniques including yoga and tai chi are other alternatives. Yoga has been shown to improve brain function and psychological mood, lessen anxiety, lower inflammation, and alleviate stress. Relaxation is the cornerstone in managing stress.

1. Keep exercising!
Being physically active means having better physical wellbeing, brain function, and memory capacity. Exercise is not only effective in treating depression but prevents the onset of depression and reduces anxiety levels. Long-term physical activity has anti-aging properties, while exercise has been shown to suppress chronic inflammation. No pain, no gain.

Honesty is the best policy

Who wants wrinkly skin or bad breath?

The practice of having a smoking (and non-smoking) area in food establishments in Singapore stopped in 2006, according to Wikipedia. The ban was extended in 2009 to include open spaces such as bus stops, covered walkways, and lift lobbies. With the additional burden of cigarette tax, it’s no surprise that only 12.6% and 14.3% of the adult population were smokers in 2004 and 2010 respectively.

But smoking is not easily extinguished. A epidemiological study reports that 16% of the 6,616 adults sampled (aged 18 years or older) were current smokers in 2012. And over 4% met the criteria for dependence on nicotine. Dissuading over 150,000 residents from smoking in 6 years time is a lofty ambition indeed.

Among younger adults, smoking has, if anything, become more common. In 2004, 12.3% of adults aged 18 to 29 years were smokers. There were even more of them after that (17.2% in 2007 and 16.3% in 2010). So the Health Promotion Board will be trying new, innovative methods of persuasion to bolster the effects of legislation, tobacco taxes, and previous campaigns.

Far more men than women smoke in general (1 in 4 men smoke; 4 in 100 women smoke), but the balance is less striking among young adults. In 2007, 1 in 4 men in the 18 to 29 age range were smokers, while 9 in 100 women in the same age range were smokers.

And there is evidence that smoking begins early. A survey of 13,000 teenagers in 2000 found that a whopping 25% had smoked before, and more than 1 in 10 teenagers had smoked in the past month.

So it’s worth taking a look at what does work:

1. Vanity is one way to go
Current ads from the campaign, “The Real Cost“, have been found to be effective with smokers because the ads tell them about the adverse effects of tobacco which they are about. Teenagers are motivated to quit smoking because they don’t want wrinkly skin, yellow teeth, bad breath, or to perform more poorly at sports. Who does?

2. Keep parents out of it
A 2006 study did not find campaigns which featured parents talking to their teenagers about smoking to be effective. Watching the “Talk. They’ll Listen” campaign made older teenagers more likely not to perceive the adverse effects of smoking, more likely to smoke, and more likely to endorse smoking. 

3. Capitalize on emotional messages
A 1998 JAMA study found that campaigns which revealed industry manipulation and effects of second-hand smoke best at reducing cigarette consumption. This explains the success of “Truth“, a campaign which began in 2000. A 2010 study found that not only was the target audience of this campaign (children) more likely to express an intention not to smoke, but their secondary audience (young adults) were also more likely to express an intention to quit.

4. Anger is better than sadness
A 2014 study found that ads were more effective in improving anti-tobacco attitudes when actors delivered the same message with anger than when it was delivered with sadness.

5. Long-term consequences are not serious considerations
The 1998 study found that telling smokers about the long-term health consequences (heart disease, stroke, lung or head-and-neck cancers) does not motivate them to stop smoking.

A study published this year however indicated that hearing the facts for the first time could push some to quit. Over a third of the 1,404 smokers sampled in the study had never heard about the health effects of firsthand and secondhand smoke, how the industry had designed cigarettes to be addictive, or health risks from low-tar and light cigarettes. Those hearing these “corrective statements” for the first time were more motivated to quit than those who had heard these facts before.

6. Birds of a feather smoke less together
A 2009 study found that not only did cost-effective campaigns use a single clear message which appealed to their target audience, but they also used people, with whom target audiences could relate to, as spokespeople to promote the message. The campaign, “Finish It“, uses all three elements. As does the “The Real Cost” campaign (view the videos here and here).

7. Use an aggressive campaign
No, not bared teeth or threats. It’s exposure to campaign ads which increases quit rates. Calls to quit lines go up when campaigns with emotional and graphic content are on the air. A 2012 study showed that ad exposure increased intentions and attempts to quit.

8. Provide frequent cues about the health risks of smoking 
A 2014 study found that smokers who avoided looking at warning labels on cigarette packs did continue to think about health risks associated with smoking, which led to them being more likely to express an intention to quit, and subsequently to smoke less. That is to say, text-only reminders about health risks are effective for getting some smokers to consider quitting.

9. Present fewer cues to buy cigarettes
Smokers say they have fewer urges to smoke when cigarettes are hidden from display than when they are clearly visible at the cashier (“point of sale“), so says this 2014 study.

10. Get the message to kids before they start smoking
A 2003 study suggested that campaigns would be more effective at reducing smoking if they targeted their messages at pre-teenagers and younger teenagers. Yes, that means education in primary school. It’s because “young people who don’t start using tobacco by age 18 will most likely never start” (NIH).

What works? Research advocates a multi-prong approach. There’s no one-size-fits-all. The take-home message is that a workplace smoking cessation programme would need to be tailored to its target audience — the employees. But having clever ads (like these videos and these print ads) does help, of course.

What’s the difference between mental health and mental illness?

There are many local news stories which implicate mental health issues. But rarely an explanation about the mental health issue involved.

We use the term “mental illness” to refer to medical conditions including schizophrenia, depression, and bipolar disorder. Other times, we use the term “mental health” to refer to the same things.

But there are conceptual differences. WHO defines mental health as “a state of complete physical, mental and social well-being, and not merely the absence of disease“. That means that mental health is also about our immune system, physical health indices, life satisfaction, and psychological wellbeing, as well as our capacity to regulate mood and manage emotions, ability to manage daily stress, resilience, and coping mechanisms for dealing with stressful events.

The collaboration between mental health professionals and the police service (e.g., a UK pilot scheme) is a step in the right direction. Education is of course a reliable way to address mental health awareness issues at the workplace.

But what information is available about mental health in Singapore? A speedy search on google for local information about individual mental health issues and concerns yields at least one relevant website. Here’s a cheat sheet:

1. Stress
HPB lists the impact of stress on our physical and mental health: SAMH has useful tips for managing stress levels.

2. Depression
HPB lists symptoms to look out for: Insights into myths and misconceptions here.

3. Eating disorders
AWARE offers an FAQ on eating disorders here.

4. Anxiety
HPB offers an overview of anxiety, including symptoms and treatment options.

5. Obsessive Compulsive Disorder
HPB lists the symptoms of OCD.

6. Alcohol Dependence
NAMS lists the warning signs.

7. Gambling Problems
NAMS lists the signs to watch out for and offers a tool for self-assessment.

8. An Addiction to Gaming
Among the signs is the use of gaming as a means of escaping problems and the act of concealing game playing from family and friends. Read this NAMS overview.

9. Substance Dependence
Watch out for these behaviours in your co-workers (NAMS).

10. Schizophrenia
Schizophrenia is defined by IMH as “a disorder of fragmented mental processes”. Click here for more information.

11. Dementia
Working adults are increasingly faced with the challenges of juggling work and caregiving roles: Alzheimer’s Disease Association and HPB have fact sheets.

12. Learning Difficulties
Employees are also often parents who may have children with learning difficulties at school. Attention deficit (hyperactivity) disorder or ADHD information is available on Spark, while dyslexia assessments are available through the Dyslexia Association of Singapore. Autism resources are abundant at the Autism Resource Centre.

The International OCD Foundation has a useful fact sheet on hoarding. Finally, Singapore Focus on the Family offers advice for families faced with bullying at school, while the Media Literacy Council has information for individuals experiencing cyberbullying and AWARE has advice for personal protection orders and family violence.

Information is power. Don’t be afraid to use it.

Can’t stop playing candy crush — when does it become a problem?

Do you ever:

• feel “high” while playing an online/smartphone/video/computer game?
• feel the need to play for longer to get “high”?
• feel irritable, cranky, or grumpy when you’re not playing the game?
• find it difficult not to play the game?
• find that playing the game is the most important thing in your day?
• spend less time on (home)work or chores so that you can play for longer?
• spend less time with friends/family so that you play for longer?
• hide the amount of time you spend playing the game from friends/family?

How many questions above did you answer yes to?

According to a 2010 local study of 3,000 primary and secondary school children, 9 out of 100 children met the criteria for pathological gaming. This is somewhat higher than the 8% found to have 5 or more signs of a gaming addiction in a 2009 nationwide study of 1,178 American children aged 8 to 18 years. But as many as 10 and 11% of children meet the same criteria in South Korea and Germany respectively. While researchers are still investigating the extent of internet addiction among local children (a study is underway), it would appear that addiction to gaming is a real problem here.

A 2010 PBS documentary feature (e.g., One Game Too Many video) on children addicted to online gaming put the spotlight on South Korea, where children attend boot camps to achieve gaming rehabilitation. A 2013 CNN series on Gaming Reality illustrate that the problem has yet to go away. The 250-odd boot camps in China speak also to a bigger problem.

But restricting children from playing games is unrealistic to take. So what’s are parents to do?

1. Touch Cyber Wellness advocates selecting games which are age-appropriate and setting consistent boundaries to help children limit their gaming.

2. Parents can encourage their children and teenagers to take an interest in sports, exercise, hobbies, and other activities. Parents can practice what they preach by taking their children with them. Cyber Wellness counsellors take their charges rock-climbing or for a game of basketball. Cycling or roller-blading after roti prata and ice milo sounds like a Saturday morning well-spent to most!

3. Gaming can be a way to de-stress and it’s important for gaming not to be an escape outlet for teenagers who are experiencing signs and symptoms of depression and/or anxiety.

4. A 2014 study suggests that children of parents with a history of addictions are at risk for developing problem behaviours of their own. Parental controls could play an important role in pre-empting excessive gaming behaviours.

5. Those who perceived their parents to be not warm or caring towards them when they were children, were relatively more likely have an internet addiction, according to a 2014 study on young Greek adults. Keeping a channel of communication open between parents and children could therefore be important in preventing children from using gaming as strategy for managing family-related and homework stress.

6. A 2011 study on Dutch teenagers suggested that those with poorer social skills were among those who were likely to report problem gaming behaviours 6 months later. Parents can help by providing their teens with social and emotional support.

7. Teenagers who exhibit signs and symptoms of Attention-Deficit Hyperactivity Disorder (ADHD) and those who display hostility can be vulnerable to internet addiction, according to a 2009 study of 2, 293 Taiwanese 7th-graders. Parents may need to uphold rules and boundaries to help their teenagers (and children) regulate their playtime.

8. Depression and social phobia are among the outcomes of pathological gaming, according to the local 2011 study mentioned earlier (this study also finds lower social competence and impulsivity to be risk factors – see points #6 and #7 above).

8. It’s important to remember that games are not all bad. It depends on the nature of the game. Games which reward players for helping others, have a positive effect on children: Players show empathy and prosocial helping behaviours in their daily lives. Parents can encourage their children to play games which reward and reinforce desirable behaviours.

10. Games can be beneficial when played to challenge our brains. But we do need to recognize unhealthy gaming when we see it.

 

Ageing successfully

According to the World Health Organization (WHO), life expectancy and medical advances has lengthened lifespans in most countries, and the number of people aged 60 years and older has doubled since 1980. Living longer is easy, with the advances we’re making in the domain of science and medicine. But we’re probably more interested in answering the question of how we can age successfully. That and avoiding dementia.

On this International Day of Older Persons, let’s review what’s been known for a while:

1. Eat your veggies!

There’s no getting away from it. Studies show that those who live a long independent life in Okinawa eat lots of fruits and vegetables, as well as fish and whole-grains. Their habit of eating until they feel 80% full is also likely a major contributor to the reason for their disability-free longevity.

2. Stay active!

Research indicates that cardiovascular disease risk is a major contributor to Alzheimer’s and vascular dementia (Fratiglioni et al., 2004). Lowering this risk through regular, weekly moderate-to-vigorous exercise is one strategy. And also a reason why Sardinians, who herd sheep over steep hills, are reputed to age successfully (see this TED video about the blue zones).

3. Engage your social brain!

A review of the literature shows that adults who are socially active are also likely to have better psychological wellbeing in their later years; being engaged in social activities and having stronger social networks is a protective factor against dementia (Fratiglioni et al., 2004). Various studies show that religious attendance, community involvement, and being employed are associated with better mental wellbeing among older adults. These activities are also shown to be helpful for local residents too…

So to sum, it’s the same thing that us active younger (a little bit younger) adults need to start doing. But we just need to keep doing them!