Ms. Linda Guhe, MSW, LCSW

The History of Tobacco and Health in America

Tobacco has been around since ancient times and� it has been significant throughout American history. When Christopher Columbus discovered America in 1492 he also discovered smoking tobacco. Tobacco proved to be quite appealing to those early explorers. As a result, tobacco from America spread to other parts of the world. Tobacco was first grown commercially in America in the early 1600s. In the 1800s, the revenue from taxed tobacco helped finance the Civil War. In the early 1900s, RJ Reynolds began producing and selling the first brand-name cigarette, Camel.

While popular and appealing, tobacco use has led to serious health problems in the United States and world-wide. Today, approximately 25 percent of Americans smoke. Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 people each year. The number of Americans using smokeless tobacco ranges from two percent to 9 percent. Financial costs of treating tobacco-related illnesses in the US are more than� 50 billion dollars a year.

Health Care Providers and Tobacco Dependence

It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community. However, because of an increasing awareness in recent years of the physical dangers to health, along with financial burden for society, tobacco has been gaining more attention in public health education and research. For example, the federal government is focussing on the problem with its� Healthy People 2010 initiative.� � Among the government’s� health objectives for the years 2000� through 2010� is a campaign to promote the cessation of tobacco use.

There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals. As a result, in comparison to experts in other kinds of disorders, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.

Money became available to fund tobacco dependence research as a result of the financial settlement of lawsuits filed against the tobacco companies by 46 states in 1994 and 1995.� The lawsuits were filed in response to financial burdens experienced by states in treating tobacco-related illnesses. Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and the states that filed the lawsuit has helped fund, draw interest to, and generate tobacco research.

Because of an increase in research in the last several years, we now have a better understanding of tobacco. We now know that tobacco products contain both (1) harmful toxins that damage health and (2) nicotine, which is a powerful addictive drug. Research has also led to the development of evidence-based methods of tobacco cessation treatments. As a result, the number of specialists in tobacco and the treatment of tobacco addiction have been increasing.

Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking, and for offering tobacco cessation treatment. In addition, there are multiple agencies providing information to the public on smoking and tobacco addiction, and help for quitting.

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Reprinted with permission of the organization People Living With Cancer

Introduction

For people diagnosed with cancer, an oncology social worker is an important member of the health-care team. An oncology social worker provides services, such as counseling, education, and information and referrals to community resources, including support groups. An oncology social worker often acts as a liaison between people with cancer and the medical team, and helps people find ways to navigate the health-care system. He or she works with the medical team to make sure people with cancer get the information they need to make informed choices about their care, and the support needed to manage the day-to-day challenges of living with cancer.

Taking Care of the Whole Person

An oncology social worker is a professional who has specialized training in how a diagnosis of cancer affects a person and his or her family and friends. An oncology social worker understands that there are many aspects of a person’s life outside of cancer, and that cancer affects each person in a different way. The oncology social worker’s expertise is a comprehensive view of the person living with cancer that is respectful of each individual’s ethnicity, spirituality, family situation, unique strengths and challenges, and it is his or her job to represent a person’s interests and needs to the medical team.

For most people, a cancer diagnosis brings with it new feelings and experiences. Talking to a professional who has helped other people manage similar situations may help a person find ways to improve quality of life, manage fears, and find hope. A social worker talks to people about the different aspects of adjusting to the cancer, and helps find strategies to adapt to, and manage health-care concerns. This can happen through individual, couples, and family counseling; support groups; and referrals to community agencies that have additional support programs.

A Bridge to the Medical Care Team

An oncology social worker has advanced training in cancer treatment, as well as in how treatments affect people living with cancer. Many people with cancer find that information that may have been easy to read and absorb in a textbook is much more difficult to understand when it pertains to their own health. A social worker helps gather the information people need to make decisions about their care. He or she may arrange a family meeting with the medical team, at which people’s care and treatment options may be discussed. A social worker can also refer people to additional educational resources and to community organizations that have information about cancer and treatment.

New Roles and Responsibilities

People may wonder how their parents, children, friends, and coworkers will react to their cancer, and how they will feel about that reaction. People may also wonder if there will be changes in their ability and desire to keep up with the many responsibilities of their life, such as a demanding job, taking care of young children, or helping an older parent. A social worker can arrange a meeting to talk about how those roles and responsibilities might change, and about what kind of support he or she wants and needs while going through treatment…Click here for the rest of this article

Army National Guard Specialist Chuck Ross

The Veteran’s Administration employs more than 4,400 MSWs to assist veterans and their families with individual and family counseling, patient education, end of life planning, substance abuse treatment, crisis intervention, and other services.

Please click here to read the article Leaving the War Half a World Away which is the story of Army National Guard Specialist Chuch Ross pictured above. When Mr. Ross returned home from the Iraq war experiencing symptoms of post traumatic stress disorder, he turned to social worker Dr. Rick Selig for help.

Below are links to additional articles about veterans affairs and social work.

• - About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans
• - Help for Spouses of Combat Vets With Post Traumatic Stress Disorder From People Who Know
• - When the Soldier Doesn’t Return: The Needs of American Families of Down Warriors in Iraq
• - What It’s Like to Help Disabled Veterans as a Veterans Health Administration Social Worker
• - Love, Honor, & Obey: Working With Military Men and Their Families
• - How Social Workers Help Veterans and Their Families
• - Help for World War II POWs: The Former POW Living History Project
• - Retired Army Colonel and Dean of the University of Maryland, Baltimore School of Social Work, Jesse J. Harris, PhD, Honored by the Maryland Legislature

By Sharon Covington, LCSW-C

Introduction

A woman once told me of the painful dilemma she experienced following her miscarriage. She had been longing to be pregnant, hoping for years to hear the words, “You’re going to have a baby.” When it finally happened, her spirits soared. But the elation quickly turned to despair when she started to bleed. The confirmation that there was “only an empty sack” was the final blow. She grieved intensely for many months over the loss of this precious baby. Also hurting, her husband felt powerless to help her. She poignantly reflected that she did not want to stop mourning, as it was her only tie to her baby. Resolving her grief would mean letting go of the biological child she might never have.

A miscarriage is an event full of dilemmas and conflicting emotions. If you are involved in the organization called RESOLVE (the National Infertility Association) and have had a pregnancy loss, you may wonder where you fit in. Having conceived, are you part of the fertile world or do you belong to the infertile world, not having given birth to a live baby? Others may try to minimize your pain by saying, “At least you can get pregnant.”

If you have had difficulty conceiving and then miscarried or if you have had repeated miscarriages, the dilemma grows. You continue to grieve for the wished-for child, while grieving at the same time for the baby you have lost. You feel you are so near and yet so far. For some, the pain is too great to consider trying again. For others, the hope generated from having conceived can be addictive, keeping them in treatment indefinitely. They struggle with the decision over when to stop trying and move on. Unlike other experiences that get easier to handle with repetition, having recurrent miscarriages makes it harder. It becomes especially difficult when you find support from family and friends diminishing with each loss, even though you need it more than ever.

New Technologies

Diagnostic and therapeutic technology available today make the miscarriage dilemma even more complex. During in vitro fertilization (IVF) eggs are retrieved and united with sperm in a laboratory, so that you know conception has taken place within hours of the event. When the embryo transfer fails to result in pregnancy, it can feel like a miscarriage.

With fertility treatment called gamete intrafallopian transfer or GIFT, the procedure is similar to IVF, but allows fertilization to occur naturally inside the woman’s fallopian tubes.

A third procedure called zygote intrafallopian transfert or ZIFT is similar to GIFT but the woman’s eggs are fertilized in a laboratory before they are inserted into her fallopian tubes.

With any pregnancy loss following IVF/GIFT/ZIFT, there is profound sadness and grief. And yet you may be instructed to undergo another cycle almost immediately. This can thwart your chance to grieve.

In addition, the new technologies used in early pregnancy often facilitate bonding and attachment to a developing baby. Blood tests can confirm a pregnancy before you have missed a period. Sonography enables you to see a heart beating or your tiny baby moving before others are even aware of the pregnancy. This visualization helps to confirm and make the pregnancy a reality. Finally, amniocentesis and chorionic villi sampling can provide information about your baby, including its sex, even before you are wearing maternity clothes. Each unique detail strengthens your feelings about your baby and can make a miscarriage feel like a death.

Grief and Loss After a Miscarriage

Yet miscarriage is enigmatic. Even though it can feel like a death, there is nothing tangible to mourn. There are no burials or memorial services to facilitate grieving. You may find yourself suffering intense emotions, often in isolation, as others may not understand the impact of your loss. The manner in which you grieve is highly individualistic and follows no predictable course; there are no instructions to follow. Much depends upon your own personality and life experiences.

Grief can feel like a tidal wave that sweeps over you with force and fury. Shock, anger, rage, guilt, blame, sadness and depression can engulf you, growing and cresting with time. It peaks somewhere between one to six months following a miscarriage. Nevertheless, swells of grief can be triggered long after the waters have settled. Difficult times include your first menstrual period, due date, Mother’s/Father’s Day, holidays, the anniversary of your miscarriage. It can be especially painful when a friend with whom you were pregnant delivers a healthy baby. As years pass, seeing this child can continue to trigger feelings as you recall what your child might have done at this age. Your triggers are unique and relate to memories and dreams about your baby. For some, triggers may be a song, holiday or time of the year, while for others it may be walking into the doctor’s office or passing a hospital.

Another aspect of the dilemma relates to the difference between men and women and the way they deal with grief following a miscarriage. A woman is usually more attached to the developing baby. The loss of the baby can feel like a loss of a part of herself, shattering her self-esteem and self-image. Her emotions may be more apparent as she tearfully needs to continue to talk about the experience. She may take longer than her spouse to heal emotionally from the miscarriage…Click here for the rest of this article.

By Terry A. Altilio, MSW, LMSW

Introduction

Pain is unique in that everyone has pain at some time or another and in fact it is essential to survival. Pain signals that the body is or has been injured and thereby warns us to take action. People who do not feel pain do not receive this signal and cannot protect themselves from further physical harm. Most of the time pain dissipates as healing takes place and we continue on the path of our lives.

As people grow from child to adult, they experience pain and are taught through their families, their cultures, and their spiritual beliefs how to think and act when in pain, what to expect from others, and the meaning of pain in their lives. While pain is a very personal and subjective experience, sometimes the impact expands beyond the individual to family, to work life and other areas of pleasure and fulfillment.

Physical and Emotional Factors

Over the years, research and clinical experience has led pain experts to believe that pain is not just physical but rather involves interrelated variables such as our unique history, the meaning of pain, motivational factors and emotions.

For example, the pain that results from a marathon run is filtered through feelings of accomplishment and pride and has a meaning that is infused with the months of training that preceded the race.

This experience is essentially different from pain caused by recurrent migraine headaches that are unpredictable, disruptive of work and family life, and bring to mind a flood of sadness and anger left over from an adolescence interrupted by the same pain problem.

Acute Pain

The two kinds of pain that people experience are acute and chronic pain. Acute pain is of recent onset and short duration and the response is often one of anxiety and an emergency fight or flight reaction. We have all experienced acute pain and usually expect that it will go away when the injury heals. Depending on the nature of the pain and our health behaviors, we may or may not seek medical attention. (more…)