Better ways to call it quits

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You likely know the reasons why you should quit smoking.

If you didn’t, here’s a fact sheet from the World Health Organization. You’re probably aware that stopping smoking reduces your risk of lung cancer, heart disease, and chronic obstructive pulmonary disease more commonly referred to as COPD (more facts here). A recent study has further shown that long-term smoking causes your brain’s cortex to thin. The good news is that stopping smoking will restore part of your cortex.

You probably also know that you can receive support from the Health Promotion Board on the Quit Smoking Helpline (1800 438 2000) and the I Quit mobile app. But you may not be aware that some ways to quit are better than others. Here’s what the experts say:

1. Cut back on nicotine slowly
A 2015 study shows that brain oxygen uptake and blood flow decreases up to 17% just 12 hours after people stop smoking. This nauseatingly unpleasant sensation is a likely obstacle for many aiming to stop smoking entirely. So actually, it seems that quitting gradually may be better in the long run than going cold turkey.

2. E-cigarettes are one way to quit smoking
recent study found that as many as a fifth of participants had quit smoking and were smoke-free 8 months after a 2-month study, during which they could use e-cigarettes. In another recent study involving randomized trials, more participants were smoke-free by the end of the year with e-cigarettes (9% quit smoking) than a placebo (4% quit smoking). It also turns out that the kind of e-cigarette you use and how often you use them may be more important than you thought. Recent reports suggest that e-cigarettes are effective if used regularly and if you use the refillable tank versions. The jury’s still out though, according to a 2015 meta-analysis of research: This analysis says that on the whole, e-cigarettes helped people stay smoke-free for a month but not 3 or 6 months after quitting.

3. Use concrete rewards
Give yourself an incentive to stop smoking. Don’t laugh. It works. Participants who earned a $20 gift card on their quit date and additional $5 each week for the following 12 weeks after the quit date, were much more likely to stay smoke-free than those who didn’t have a financial incentive to do so. In this 2014 study, about half were smoke-free a month after their quit date, and a third remained smoke-free 2 months after they stopped receiving any financial incentive.

A 2015 study found that adding a financial disincentive further improved quit rates. More people stayed smoke-free for 6 months if they received US$800 than if they had counselling or nicotine-replacement therapy (gum, medication, patches). But even more people stayed smoke-free if they not only received US$650 but also had to forfeit a US$150 deposit for not staying smoke-free 6 months after the quit date. So here’s a way for your supporters to do something concrete to up your chance of success. It’s better, of course, if your friends and family have deep pockets.

4. Consider coaching and counselling options
Getting help and support from an stop smoking specialist advisor has been shown to be one of the most effective strategies for helping smokers stay smoke-free. But not everyone wants or has time for one-to-one sessions. A 2014 study found that providing smokers with support through a virtual stop-smoking advisor via the interactive “StopAdvisor” website doubled quit rates among those from lower income groups. Unfortunately, that’s not an option here.

You can however receive support from smoking cessation programmes at the polyclinics — both the National Healthcare Group and SingHealth polyclinics offer them. Smoking cessation advisors can also help at the Department of Pharmacy at Changi General Hospital, Khoo Teck Puat Hospital, and National University Hospital, as well as at Singapore General Hospital (Department of Respiratory & Critical Care Medicine), Tan Tock Seng Hospital (Clinic 4A), and the National Skin Centre.

And everyone can get involved. Family and friends can getting involved too. Anyone can learn the basics of smoking cessation counselling — HPB provides Level 1 and Level 2 training, and continuing education Level 3 workshops.

There may also be a smoking cessation programme at your workplace: Check with your HR to find out more. And if there isn’t, consider seeking support from a professional counsellor — the Employee Assistance Programme or EAP at your workplace may be a good place to start.

5. Watch out for your cravings
A 2015 study found that brain areas associated with smoking cravings were much less activated for women during the ovulation period than a later part of the menstrual cycle. Even if you’re not planning to time your exit from nicotine, you could be mentally more prepared to do battle with your cravings before you get to that time of the month.

You can have all resources about how to best quit, but it’s the emotional support that’s most crucial to staying smoke-free. Just remember, there’s no one-size-fits-all solution to quitting. Have a happy smoke-free No Tobacco Day!

Ways to promote healthy lifestyles at the workplace

Someone in HR usually has the good fortune of having job of promoting a healthy lifestyle to the rest of the office. It may even fall on the shoulders of an interest group or a recreational activities committee. In other organizations, these brave souls have an official title – the workplace health committee.

But whatever their title, they will want to impress upon others the merits of eating more fruits and veggies. They will want to persuade their colleagues to switch from polished to unpolished rice. And they will aim to get everyone to chalk up 2.5 hours of moderate-intensity physical activity a week. They will cheer them all to get an annual basic health screen and goad others into the lecture theatre to learn more how they can manage their stress.

There are of course national campaigns with prizes to help these fortunate employees with their cause. And there are resources to fund workplace health endeavors. But the path to slow food and an active lifestyle is often paved with good intentions. With many a detour to the fast food restaurant and a back alley shortcut to chilli crab, Hokkien mee, and char kway teow. So, they could probably always do with more help.

Here are some lessons to be learnt from consumer research:

1. Some things are best seen in black and white
Some messages are best presented in monochrome. A 2015 study found that participants made more rational decisions when information was presented using black-and-white images than colour. In fact, researchers suggest that monochrome could be useful for situations concerning a distant future. Promoting a healthy lifestyle for the benefit of the family or a healthy retirement, may be best made in black-and-white, not in colour.

2. Don’t shortchange your employees when serving healthy food
We’re likely to enjoy the food more if we pay more for it, according to a 2014 study. Customers who participated in the study rated the food to be more enjoyable when they paid $8 for a all-you-can-eat high quality buffet in upstate New York than when they paid $4 for it. Those who paid less were more likely to say that they had overeaten, to feel guilty about the meal, and to say that they liked the meal less and less in the course of the meal. So don’t undercharge your employees for good quality healthy meals at the staff canteen.

3. Help us make good decisions with fewer choices
Having too many choices can lead to poor decision making. A 2015 study shows that participants don’t make optimal choices when they have to consider all 16 options together. Rather, they make better decisions when they use a strategy called sequential tournament, where they pick one of four options, until they make a final choice from the preliminary selections. Giving fewer options (and dietary information) at the canteen can help employees make healthier food choices.

4. Lighting affects our eating experience
We appear to experience emotions with more intensity on sunny days compared to overcast days. That we perceive food to taste more spicy and judge others to be more attractive when these are presented in bright light, are among the findings of this recent study. It seems that emotional messages are best received in bright lighting, whereas rational decisions may be better done with subdued lighting. That means it may be a good idea to turn up the lights for healthy lifestyle posters in the lift and lobby, and turn down the lights at the office canteen.

5. When to use questions and when to use statements?
Participants in a recent study responded more positively to ads with statements when they were in a state of higher excitement, but preferred ads phrased as a question when they were in a lower state of excitement. In the study, respondents were listening to music that was either stimulating or calming. It seems that when we’ve got a lot to process, we prefer to be told what to do; when we’re not so preoccupied, being asked a question will pique our interest. So poster campaigns in a busy lunch canteen will fare better as statements, whereas poster campaigns in a boring corner of the office may be better received as questions?

Just some food for thought.

Confidentiality is key

Young Woman Sitting Looking at Laptop Screen

There is increasing awareness about the need to support the mental wellness of employees at the workplace.

NEA and CPF were reported to be the “…latest to offer counselling services to staff” (Straits Times, 28 Oct 2013). Their efforts to provide their staff with access to paid-by-company counselling services are to be lauded. But as the author of a letter to the forum points out, the telephone as a platform for counselling is far from ideal (“Limitations of telephone counselling”, Straits Times, 29 Oct 2013).

There is a reason why the best practices guides (e.g., Buyer’s Guide by EAP Association, Buyer’s Guide by EASNA, Buyer’s Guide by the UK EAPA) recommend face-to-face counselling as an integral component of a comprehensive employee assistance programmes (EAP). While workplace telephone counselling provided by masters-level mental health professionals has been shown to have some effectiveness, it is noteworthy that telephone counselling was less helpful than face-to-face counselling for individuals experiencing poor psychological wellbeing (read this APA review for details).

There may be relatively less stigma for employees to access telephone counselling services, but “it has serious limitations as a clinical tool, including the absence of the ability to ‘see’ nonverbal cues from a client” (APA Monitor). Counsellors in a face-to-face session, in contrast, have the opportunity to show interest, concern, respect, receptiveness and support through direct eye contact and open body language. Indeed, research indicates that counsellors need to adjust their strategies for establishing rapport for a televideo conferenced counselling session (e.g., appropriate and careful placement of the videocamera, the use of gestures for taking turns to speak, increased use of nonverbal cues such as nodding and smiling).

Employee assistance programmes (EAPs) are designed to “improve and/or maintain the productivity and healthy functioning of the workplace, through the application of psychological principles, including specialized knowledge and expertise about human behaviour and mental health”. That is to say, EAPs support the mental wellness needs of employees by providing them with access to confidential counselling services, as well as education and awareness activities such as mental wellness talks, all of which are paid for by their employer.

And EAPs can only work if employees know about them. Knowing that one can seek help from a professional mental health professional is essential, if employees are to use EAP and if employers are to benefit from having employees who are more engaged at work.

But there is one thing even more important than telling employees that there is an EAP at work. Knowing that counselling services are completely confidential is the most important aspect of the EAP. Providing employees with assurance about the confidential nature of the counselling service is key to employees using their EAP.

Employees should know that all information shared would only be released with their written consent (see the limits of confidentiality from this APA FAQ). Even the fact that an employee has consulted with EAP should not be disclosed to his or her employer. Responsible employers will want to know how many employees used the service (to ascertain if it is useful) and the employees’ satisfaction with the service (to find out if employees felt counselling was helpful to them), not which employees used the service.