Smoking is the most preventable cause of death in the world. Yet smoking remains a public health problem in many countries. To combat nicotine dependence, Global Bridges, an international coalition of health care organizations and professionals, has steadily worked to bring policy change and educational resources to countries across the globe.

Now in its tenth year, Global Bridges will advance its mission of bringing international awareness to nicotine dependence when representatives meet with Japanese health care leaders at the International Society for the Prevention of Tobacco-Induced Disease in Tokyo Oct. 13–15. Mayo Clinic will be represented by J. Taylor Hays, M.D., director of the Mayo Clinic Nicotine Dependence Center and Global Bridges, and Katie Kemper, executive director, Global Bridges.

Major conference themes will include smoke-free public places and support for tobacco cessation in Japan. This comes at an especially important time, as Japan is preparing for the Olympic Games to be held in Tokyo in August 2020. Japanese health officials are hoping to keep the event entirely tobacco-free. Unlike other developed countries, smoking in public places is allowed in much of Japan, making for a health challenge ahead of the Olympics.

Based at Mayo Clinic, Global Bridges is the only international network of health care professionals and organizations dedicated to advancing evidence-based treatment in tobacco cessation and tobacco control policy. Since its founding in 2010, Global Bridges has granted funds to tobacco cessation initiatives and trained health professionals in tobacco dependence.

Some notable milestones include:

• Continued work on implementing Article 14 of the World Health Organization Framework Convention on Tobacco Control, which aims to reduce tobacco dependence around the world
• Creating a coalition of more than 20,000 trainees representing 70 countries
• Grant-funding for tobacco cessation programs in Africa, China, Europe, Japan, Latin America, and the Middle East
• Providing assistance to over 17 million patients from 2010 to 2019

"We are proud to have brought together a global community of dedicated leaders who have improved the lives of millions of patients through the work of Global Bridges," says Kemper. "Health care professionals can and do make a significant impact by helping patients free themselves of this deadly addiction."

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About Global Bridges
Global Bridges connects and mobilizes an international network of health care professionals and organizations dedicated to advancing effective tobacco dependence treatment and advocating for proven tobacco control policies. Since its inception in 2010, Global Bridges grantees and partners have created culturally relevant training curricula based on established best practices and trained more than 20,000 health care professionals from 70 countries. In partnership with funders, such as Pfizer Global Medical Grants, Global Bridges offers competitive grant funding and guidance for evidence-based training. The Mayo Clinic Nicotine Dependence Center and the American Cancer Society, founding partners of Global Bridges, provide programmatic support.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside Look at Mayo Clinic for more information about Mayo.

Media contact:

• Emily Blahnik, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Watch: The Mayo Clinic News Network

Journalists: Broadcast-quality video (0:59) is in the downloads at the end of this post. Please "Courtesy: Mayo Clinic News Network." Read the script.

"There are lots of different chemical classes in the aerosol that we need to understand because, depending on exposure over time, they could lead to adverse health consequences," says Dr. Ebbert.

Right now, no one knows what's produced when e-cigarette juice is heated and aerosolized.

"You actually produce new chemical species in the aerosol that don't exist in the e-liquid because of the heating process. And what we need to understand is there's a lot of different products on the market, they're all operating at different temperatures, and those temperatures and the e-liquids in those substances result in potentially toxic exposures," says Dr. Ebbert.

These toxic ingredients may contribute to vaping-related illness.

"What we're trying to do in our lab is really focus on the aerosol because the aerosol is the risk," says Dr. Ebbert.

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***

Also in today's tips ...

'Herbal viagra': Is it safe?
Be wary of any product that claims to be a natural form of Viagra. These supplements can cause dangerously low blood pressure in some men, particularly those who take nitrate medications for heart problems. Learn more from Dr. Erik Castle, a Mayo Clinic urologist.

Slideshow: Balance exercises
Balance exercises can help you maintain your balance and confidence at any age. If you're an older adult, balance exercises are especially important because they can help you prevent falls and maintain your independence. Watch this slideshow for examples of balance exercises that may keep you surefooted and safe.

Nicotine dependence
Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and can lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety. While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers. Learn more about nicotine dependence and how you can break the habit.

Dental floss versus water pick: Which is better?
A water pick, also known as an oral pulsating irrigator, is a device that aims a stream of water at your teeth. A water pick can remove food particles from your teeth and may reduce bleeding and gum disease, but it isn't generally considered a substitute for brushing and flossing. Learn more from Dr. Thomas Salinas, a Mayo Clinic prosthodontist.

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Couples can face communication challenges during caregiving
Living with cancer is difficult for everyone involved, and couples can struggle with communication and expectations. Here are some ideas that may help cancer survivors and caregivers.

Nicotine dependence: An overview
Nicotine dependence is an addiction to tobacco products caused by the drug nicotine. While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers. But, regardless of how long you've smoked, stopping smoking can improve your health.

The post Living With Cancer: Bladder cancer appeared first on Mayo Clinic News Network.

ANSWER: Congratulations on taking that first step: deciding to quit smoking. Smokers and tobacco users are more likely to develop disease and die earlier than people who don't use tobacco. Because nicotine is highly addictive, it may take more than one try to quit. But it is possible. Thinking about how to go about quitting is important, and there are a number of resources available to help you quit.

While quitting either abruptly or gradually can work, quitting abruptly may work better, according to a recent study published in the Annals of Internal Medicine.

The study involved about 700 smokers randomly assigned to either quit tobacco use abruptly with the aid of nicotine replacement patches or gradually reduce tobacco use with the aid of nicotine patches and a two-week structured cigarette reduction program. Behavioral counseling was provided leading up to the quit day for both groups.

After four weeks, 49 percent of the abrupt quit group and 39 percent of the gradual reduction group remained tobacco-free. At six months, 22 percent of the abrupt quit group and 15.5 percent of the gradual reduction group remained tobacco-free.

It’s not entirely clear why this gap exists. It may be that the taper for the gradual reduction group was too sudden or the tapering schedule may have made it more difficult to initiate the quit date.

One thing is known: The best way to quit smoking is with the aid of one of several nicotine replacement products and behavioral counseling. Stopping smoking with no help — gradually or suddenly — isn’t as likely to help you quit.

In addition, each time a person tries to stop, the likelihood for success increases. If you’ve tried to stop smoking but failed, don’t give up. You’re more likely to succeed with repeated attempts, and behavioral counseling and medications to help.

Every state has a telephone quit line that you can access by calling 1-800-QUIT-NOW (800-784-8669 toll-free). Or go online to becomeanex.org or smokefree.gov, where you'll find more information and support to help you stop smoking for good. (adapted from Mayo Clinic Health Letter) — Dr. Jon Ebbert, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota

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DEAR MAYO CLINIC: I’m 47 years old and have been a smoker since I was 15. I’ve tried to quit more times than I can count. My wife says I should try nicotine replacement. But that doesn’t make sense to me. I want to be done with cigarettes and nicotine. How will putting more nicotine in my body help me kick this addiction?

ANSWER: When you’re trying to get rid of a cigarette habit that’s rooted in nicotine addiction, it may seem odd to look to nicotine for help. But nicotine replacement products are safe and effective aids for people trying to stop smoking. Particularly when paired with other smoking cessation techniques, nicotine replacement often serves as a bridge to a tobacco-free life.

The nicotine in cigarettes is highly addictive. Nicotine is what hooks you on smoking and keeps you smoking. However, nicotine is not the component in cigarettes that puts your health at risk. The real danger is tobacco.

Tobacco and tobacco smoke contain chemicals that cause lung cancer, as well as cancers of the mouth, throat, esophagus and larynx. Using tobacco can lead to other serious health problems, too, such as emphysema and chronic bronchitis. Two-thirds of all tobacco users eventually die of a tobacco-related illness. The sooner you stop putting tobacco into your body, the better off you will be.

Nicotine replacement products give you nicotine without tobacco. That helps relieve the withdrawal symptoms and cravings you may have if you try to quit smoking cigarettes without nicotine replacement. For many, going from tobacco to nicotine replacement is a critical and important step to a tobacco-free lifestyle.

Nicotine replacement doesn’t reinforce a cigarette habit the way tobacco does. You don’t get as much nicotine with nicotine replacement as you do with tobacco products, and nicotine replacement makes it significantly less likely that you will return to tobacco. Not using nicotine replacement reduces your chances of breaking free from tobacco.

A range of nicotine replacement products are available without a prescription. You can buy nicotine gum, patches and lozenges at most pharmacies and drug stores. Nicotine nasal spray and inhalers are available by prescription only.

Although nicotine replacement can be useful as you quit smoking, breaking a smoking habit is still hard, especially if you try to do it on your own. The best way to quit is to seek help from your doctor or a counselor trained as a tobacco treatment specialist. He or she can help you decide on the overall approach that’s best for you.

For example, along with nicotine replacement, other prescription medications may be helpful. Bupropion can help control nicotine cravings. Varenicline can reduce the pleasurable effects of smoking and lessen nicotine withdrawal symptoms.

Most health care providers also recommend behavioral therapy in addition to medication. Behavioral therapy often involves replacing old behaviors with new routines that aren’t associated with smoking.

For example, avoid places where you usually smoke. Instead, when you go out, visit places where smoking isn’t allowed. Try to spend time with people who don’t smoke or also want to stop smoking. Make it inconvenient to smoke by getting rid of your cigarettes. Chew gum while you drive, or take new routes to your usual destinations to keep your attention focused on your environment and away from smoking. If you usually have a cigarette with a cup of coffee or alcohol, drink water, soda or tea instead.

Nicotine replacement can be an integral step on the path to life without tobacco. But, to give yourself the best chance to stop smoking for good, seek help from a medical professional familiar with tobacco treatment. The effort will be well worth it, as the health benefits of not smoking are substantial, and they start accumulating almost immediately after you quit. — Dr. Jon Ebbert, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Nicotine can help you kick tobacco appeared first on Mayo Clinic News Network.

Myth or Matter-of-Fact: Beyond a certain age, the damage from smoking is done and quitting has no health benefit.

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Myth or Matter-of-Fact: Beyond a certain age, the damage from smoking is done and quitting has no health benefit.

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Follow #MayoClinicRadio and tweet your questions.

Mayo Clinic Radio is available on iHeartRadio.

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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A person could still light up a cigarette on an airplane or in a restaurant. Newspapers and magazines featured advertisements encouraging women to enjoy a Virginia Slims cigarette with its iconic slogan, "You've come a long way, baby!" Men were enticed to discover their rugged individualism in Marlboro Country. And the cartoon character Joe Camel was better known to some schoolchildren than was Mickey Mouse.

The Surgeon General had yet to declare nicotine addictive, and there was an impenetrable wall of silence around the tobacco industry. More than 28 percent of all Americans smoked a pack of cigarettes a day, according to the National Cancer Institute. And no one even mentioned secondhand smoke.

Now, 25 years later, success stories abound:

• More than 50,000 patients from 64 different countries have been treated for nicotine addiction at the Nicotine Dependence Center
• Only 18 percent of American adults smoke today, according to the American Cancer Society
• More than 15,000 health care professionals around the world have participated in the center's educational programs
• More than 1,300 health care providers from 46 states and 27 countries have completed training to become certified tobacco treatment specialists

The human face of nicotine addiction

Still, when the Nicotine Dependence Center staff members go to work every day, they are keenly aware of a disturbing fact that is as true today as it was in 1988.

"Tobacco use is still the single most preventable cause of premature death in the world," says Richard D. Hurt, M.D., founding director of the Nicotine Dependence Center.

According to the National Cancer Institute, an estimated 443,000 people in the United States will die in a given year because of tobacco-caused illnesses. Complications from tobacco use account for 1 in 5 deaths in the U.S. annually.

Worldwide, the news only gets bleaker. The World Health Organization estimates that there are more than 1 billion smokers and that the number is increasing. Tobacco products kill nearly 6 million people every year. If left unchecked, tobacco use will cause up to 1 billion deaths by the end of the 21st century.

More than its many successes, these facts — and the very human faces behind the numbers — drive Dr. Hurt and his colleagues. This urgency motivates them to improve treatment programs, to educate more health care providers in more countries, and to look for new answers for treatments through its groundbreaking research program.

From the start of the center, Dr. Hurt insisted on applying the Mayo Clinic philosophy as symbolized in the three shields of the clinic logo: medical practice, education and research.

"The emphasis has always been on the patient," Dr. Hurt says. "Now and when we first started the center in 1988, it was always about the patient. The clinical needs of the patient have driven our education and research programs."

Early nicotine addiction research

The research program at the Nicotine Dependence Center has been on the cutting edge of discovery since shortly after opening its doors in April 1988. By that September, Dr. Hurt had his first grant to study the effectiveness of the nicotine patch.

"At the time, nicotine gum was the only form of nicotine replacement therapy available to patients," Dr. Hurt says. "Now we have many options, but the research on the patch was a giant step forward."

Ivana T. Croghan, Ph.D., joined the staff of the Nicotine Dependence Center in 1991 and is now its research program coordinator. She and Dr. Hurt performed their first clinical trial together, studying nicotine replacement levels — the dose needed to compensate for nicotine from smoking — for patients using the patch.

"At the time, treatment with the patch was literally one size fits all," says Dr. Croghan, an experimental pathologist and epidemiologist at Mayo Clinic in Rochester, Minn. "We verified what we already instinctively knew: If one 21-milligram patch was appropriate for the one-pack-a-day smoker, then two patches for the two-pack-a-day smoker gave him the best chance of success in quitting."

Through the years, the research team has studied every form of nicotine replacement therapy available.

"We have conducted studies on the patch, gum, inhalers, lozenges and nasal spray," Dr. Croghan says.

"We studied how the brain controlled addiction and how that might be modulated," says Thomas P. Moyer, Ph.D., who used his expertise in the laboratory to support Dr. Hurt's early research and is now an emeritus Mayo Clinic laboratory pathologist. "We needed to understand the science behind how these factors influenced a person's addiction to nicotine."

The Nicotine Dependence Center is doing just that. The center's research team has conducted 110 randomized clinical trials involving more than 25,000 research participants in the last quarter century.

Interrupting the cycle of nicotine addiction

There's a simple power behind the idea that preventing a disease is better than having to treat it later. The wisdom of getting people to stop using tobacco products before needing intensive medical intervention has driven the Nicotine Dependence Center's research team since it began that first research study in 1988.

It's still a philosophy embraced today by Jon O. Ebbert, M.D., an internist at Mayo Clinic in Rochester and associate director for research in the center.

"If we can interrupt the cycle of addiction," Dr. Ebbert says, "we're giving (the patients) their lives back — lives that can be longer, healthier and freer of the many medical problems brought about by tobacco use."

Research in the Nicotine Dependence Center now includes behavioral interventions for tobacco users, population studies, studies on the cost-effectiveness of various interventions and outcomes research.

Researchers in the center have also studied medications to treat tobacco addiction. Two drugs, bupropion (Zyban) and varenicline (Chantix), have become staples in treating tobacco dependence.

"We've been very active in studying drug therapy as we researched how bupropion helps reduce nicotine cravings and how varenicline works with the nicotine receptors in the brain," Dr. Croghan says.

Using zebrafish to fight nicotine addiction

The minnow-like zebrafish emerged as a research model for behavioral studies of nicotine exposure about a decade ago. Because of their small size, fast reproductive cycles and externally developing transparent embryos, zebrafish have enabled studies that would not be feasible using traditional animal models.

"Amazingly, the zebrafish actually has 100 percent of many pathway genes," says biochemist Stephen C. Ekker, Ph.D., director of the Mayo Clinic Addiction Research Center in Rochester. "For example, the fish contains orthologues — the same copies — for all of the nicotinic receptors found in people."

Dr. Ekker and the Addiction Research Center team have shown that zebrafish respond to nicotine and frontline smoking-cessation therapies in the same way that humans do.

Because only about half the people who use varenicline find that it helps, researchers have used zebrafish and their ability to detect and block nicotine to study new drug combinations. The team has two promising leads in the zebrafish, representing potential help for patients who have not benefitted from current treatments.

"The advantage is that it helps us focus on potential medications that can help treat nicotine dependence," Dr. Croghan says. "Once we know that a drug has been successful with the zebrafish, we can move forward with the clinical trial with confidence."

Combination therapy for nicotine addiction

"Much of the fundamental work in nicotine research has been done here at Mayo," Dr. Ebbert says. "But three key areas of research really stand out: combination therapy, high-dose nicotine replacement therapy and new drug development. How tobacco dependence is treated is different today because of this work.

"Combination therapy is important because it can attack the addiction from different angles using different neuropharmacologic targets," he adds.

One way that combination therapy works is by using a long-acting product such as the patch in conjunction with a short-acting product such as nicotine gum, lozenges, inhalers or nasal spray. With the patch, the patient gets a steady release of nicotine that reduces withdrawal symptoms, with an occasional boost to the nicotine level from the short-acting product when nicotine cravings are the most intense.

"It is analogous to diabetes management with long-acting baseline insulin and short-acting insulin for meals," says J. Taylor Hays, M.D., a Mayo Clinic internist in Rochester and now director of the Nicotine Dependence Center. "Or like pain management with long-acting pain medicine taken on a regular schedule and 'rescue' treatment with a short-acting medication as needed."

The other approach to combination therapy is to combine two medications with different actions and different targets in the brain. But both targets are important in the reinforcing effects of nicotine.

"Varenicline targets the nicotine receptor, partially stimulating and partially blocking," Dr. Hays explains. "And bupropion, we believe, works by targeting increased dopamine in the reward center. By hitting both targets, we believe we may get an additive effect of the meds on reducing withdrawal and urges to smoke."

Still exploring new ideas

The work of the research program continues in important areas, including new drug therapy, new combination therapies, gender and tobacco use, and the connection between tobacco use and alcohol consumption. Dr. Ebbert hopes to add e-cigarettes to the list, as this popular new alternative nicotine delivery method remains largely unstudied.

How tobacco dependence is treated tomorrow will most likely be influenced by the work being done today by the Nicotine Dependence Center's research program. In the meantime, physicians and counselors in the center will continue to see patients, offering the best treatment options for the most preventable cause of premature death in the world.

The post Nicotine Dependence Center: 25 years of research appeared first on Mayo Clinic News Network.

"I had my last cigarette on Saturday, Nov. 22, 1975, at 3:30 in the afternoon," says Richard D. Hurt, M.D., an internal medicine specialist at Mayo Clinic in Rochester, Minn.

This was before the nicotine patch or gum or any of the other nicotine replacement therapies were available. This was before drug therapy or combination therapy increased the odds of success to quit smoking.

Mayo Clinic had just started its Smokers' Clinic, an outpatient support group that convened a few times a year. Dr. Hurt's wife, Mary, signed them up to attend the sessions. The education and group support — and a steady supply of Dynamints — were decisive in helping Dr. Hurt overcome his three-pack-a-day habit.

His own efforts to quit smoking also gave Dr. Hurt empathy for the struggles by the patients who would soon be coming to him for their smoking addictions.

Sounding like tens of thousands of people who have quit smoking before and since, Dr. Hurt says with a laugh, "Oh, I'd quit plenty of times before. Sometimes for even as long as a half an hour."

Then he grows serious. "It was the hardest thing I've ever done. For the longest time I would develop a strategy to get through the next hour without smoking. Then the hour after that. It wasn't easy, and I wasn't particularly pleasant to be around. Friends and colleagues wondered if I might want to start smoking again."

Formation of the Nicotine Dependence Center

The drive and determination that enabled Dr. Hurt to quit smoking were the same qualities he brought to his commitment to help people overcome their own nicotine addiction.

He first served as a group counselor at the Smokers' Clinic and later became its medical director, in addition to continuing his regular duties in internal medicine. He incorporated his work in addiction therapy with the group, but he believed much more help should be offered to smokers.

The idea of a program dedicated to tobacco dependence crystallized one day in a lunchroom cafeteria when Dr. Hurt met up for coffee with Kenneth Offord, now an emeritus research colleague at Mayo Clinic.

That morning in 1987, Dr. Hurt had received two phone calls from Mayo Clinic's hospital staff about patients with severe vascular disease that was caused, in part, by smoking. The referring physicians had asked Dr. Hurt what treatment existed that might help their patients stop smoking. The answer had been simple: "Nothing."

But "nothing" was no longer acceptable to Dr. Hurt. He organized an ad hoc group that planned for what would eventually become the Nicotine Dependence Center.

Offord, a member of the group, remembers back over the quarter century.

"Many people at Mayo have good ideas, but Richard had the chutzpah to carry his out," Offord says. "He was like the bulldozer who cleared the path. A lot of people helped build the infrastructure for the program, but Richard was there directing every step of the way. He was committed, and he brought together that rare combination of skills to make the center a success.

"We wanted to create a blue ribbon program," Offord adds. "We traveled to see the best programs in the world at the time. The best is where we began, and then Richard wanted to offer something better."

The strength of Dr. Hurt's personality and the level of his commitment were on display during the ensuing months of 1987 as he took his ideas for a formal medical nicotine treatment unit to different departments within Mayo Clinic — and was rejected. An anti-smoking program was still too new and controversial to warrant broad support.

Finally, he appealed directly to Mayo Clinic's governing board and won approval for a program independent of other Mayo Clinic departments. Later, it became the Nicotine Dependence Center and was put under the Department of Medicine, one of the departments that had earlier rejected the program.

The center "was only possible because Dr. Hurt was willing to stand up and speak out," adds Thomas P. Moyer, Ph.D., a close friend and now an emeritus Mayo Clinic laboratory pathologist. "His passion infected everyone around him. He has changed how we deal with the issue of tobacco addiction."

Taking on the tobacco industry

In 1994, the Minnesota attorney general and Blue Cross and Blue Shield of Minnesota sued the tobacco industry. When the case went to trial four years later, the state's key witness and the first to take the stand was Dr. Hurt. He testified for nearly a week.

To prepare for the trial, Dr. Hurt studied assiduously for two years, reviewing thousands of pages culled from 33 million pages of previously secret documents. What he found outraged him.

"The documents revealed that the tobacco industry had known for five decades — for five decades — that their products killed people," he says. "They knew it was addictive. They knew smoking led to serious diseases like lung cancer. It was bad enough they hid these findings, but the documents revealed that they had actively worked to make cigarettes even more addictive."

The case came to an end in 1998, with Big Tobacco agreeing to pay a $6.6 billion settlement and to release millions of damaging documents, a lawsuit that forever changed how the public, health care officials and regulatory agencies viewed the tobacco industry. The lawsuit is now recognized as one of the key tests against the power and influence of the tobacco industry and, because of Dr. Hurt's unshakable testimony, has contributed to dramatic changes in legal restrictions on tobacco products.

Dr. Hurt calls the Minnesota tobacco case "one of the most important events of the second half of the 20th century."

Still going strong

In the more than 25 years since its first patient was seen in April 1988, the Nicotine Dependence Center has reached a level of maturity that is reflected in the scope of its programs.

"Dr. Hurt mimicked Mayo Clinic's three shields of service from the very beginning, emphasizing patient care, education and research," says Ivana T. Croghan, Ph.D., an experimental pathologist and epidemiologist who joined the Nicotine Dependence Center staff in Rochester in 1991 and remains there today as the research program coordinator. "And he has emphasized that the needs of the patients have always come first."

Counselors and physicians at the Nicotine Dependence Center have treated more than 50,000 patients for tobacco dependence. And they've backed the patient care and the multilayered education programs with crucial research.

While it has taken a team effort to build and sustain the center, Dr. Hurt's role is not lost on his colleagues.

The Nicotine Dependence Center "would not be in existence today without the commitment and inspiration of Dr. Hurt," says Michael V. Burke, program coordinator for treatment. "His passion for the truth has changed how the world views nicotine addiction."

A global influence

Today, Dr. Hurt shares his commitment and passion with other health care professionals. With program coordinator Sheila K. Stevens, he directs the center's education program, training others to incorporate nicotine dependence treatment into their practices.

"Dr. Hurt's philosophy has always been to share staff between treatment and training," Stevens says. "The counselors who treat patients are the same counselors who teach other health care professionals around the world. By being active in treatment, our counselors are that much better educators for it."

The tobacco cessation efforts of the center are now global — and for good reason.

According to the World Health Organization (WHO), tobacco kills 6 million people each year, and that number is increasing. Left unchecked, tobacco use will kill 1 billion people in the 21st century. Developing countries, home of 80 percent of the world's smokers, are disproportionately affected by the tobacco epidemic, WHO predicts.

In 2010, Dr. Hurt led a group of visionary organizations and concerned individuals to change those numbers.

"We have developed a program here that has proved it can help with this health crisis, and we believed we had an obligation to do so," Dr. Hurt says.

The organizers knew such a program had to be international in scope and regional in application. They called it Global Bridges.

"People from all over were coming to us and asking for help," says Dr. Hurt, who also serves as chair of the Global Bridges executive team. "Global Bridges enhances access and adapts proven treatment methods to specific needs throughout each of the World Health Organization's six regions."

Founded by Mayo Clinic, the American Cancer Society and The University of Arizona, Global Bridges has offered state-of-the-art training for more than 800 professionals from nearly three dozen countries, as it strives to build a worldwide network of health care providers who will lead their countries in tobacco treatment. To date, the training program has been adapted and translated into Chinese, Arabic and Spanish.

It's still about the patient

Despite his international involvement and travel schedule, Dr. Hurt still finds time to practice in the clinic.

"First and foremost, it's still about helping patients overcome their addiction to nicotine," he says. "And we learn as much from them as they learn from us."

Seeing patients also gives Dr. Hurt the opportunity to let them know that one day in November many years ago, he, too, had a last cigarette, and that stopping smoking is still the hardest thing he has ever done.

The post Putting the hurt on tobacco addiction appeared first on Mayo Clinic News Network.