Head Transplants: Frankenstein or Science Fiction?

While public health is more aligned with population well-being, professionals are keeping a watchful eye on the recent talk of the first-ever human head transplant that has been in the news lately.

For those who may not have been paying attention to the medical news lately, reports from various reputable sources have found that Italian surgeon Dr. Sergio Canavero plans to conduct the world’s first human head transplant within the next two years. He actually has his patient set and ready to go. The donor body has yet to be identified.

Canavero first proposed the idea two years ago as a means of extending people’s lives whose bodies have been riddled with illnesses, cancers, or other incurable medical disorders. The first patient willing to have his head transplanted onto a new body is Valery Spiridonov, a 30-year-old Russian who suffers from Werdnig-Hoffman disease, a genetic disorder that causes his muscles to deteriorate. A donor body will be attached to Spiridonov’s head through spinal cord fusion, a process that has had some success in animals.

The first successful animal head transplant took place in 1970 where the head of a monkey was transplanted onto the body of another primate. The monkey lived for nine days before the body rejected the new organ. However, in the 1970s, there were few processes and medications that helped to keep transplanted organs from being rejected. Since then, the invention of drugs that assist with the acceptance of transplants, such as with lungs and hearts, can reduce the risk of rejection significantly.

For a head to be transplanted onto a new body, the spinal cord of the donor body will have to be fused onto the spinal cord of the recipient’s head. The process was described in a recent issue of the journal Surgical Neurology International.

What are the consequences for society if we are able to successfully transplant heads? Are we moving closer to the Frankenstein movies of the past or the upcoming science-fiction movies that haven’t yet been created?

Looking at the progression of organ transplantation, the field has brought forth tremendous challenges, the biggest one being a shortage of organs. As most people are aware, there is an organ transplant waiting list for various operations: liver, kidney, lung, eyes, heart and so on. Then, another big concern is the issue of organ trafficking and transplant tourism. In some cases, organ donation was no longer a voluntary notion but one of coercion and profit-making. That brought up the issue of organ trafficking. In Germany in 2012, a significant number of patient records were tampered with to increase the number of organs that could be used for transplants. In other words, people were donating organs that they had no intentions of giving up.

Earlier, organ trafficking involved the forced removal of organs from people, mainly those in prison who were to be executed. The practice was very common in China. It wasn’t until 2001 when the public became aware of the unethical removal of executed prisoners’ bodies.  Chinese authorities claim that the organ harvesting took place after the execution with permission, but these official statements are still questioned today. It was later discovered that some Chinese hospitals were actually taking organs from living people without permission and under torturous conditions.

What about head transplants? Could this possibly happen to someone’s head? When a donor (with or without consent) provides a kidney, lung or part of a liver, that person can still live and breathe. When a head is removed from a person’s body, death is eminent. The ethical nature of head transplantation could become a huge human rights concern if we aren’t careful in how we handle it.

The ethics of the head transplantation project that will likely take place a few short years from now must be investigated now before human head trafficking occurs much like other organ harvests of the past. Bioethical committees in many countries are now looking into the potential concerns that will likely follow a successful head transplant.


Works used to create this article:

30-year-old Russian man volunteers for world’s first human head transplant. (April 13, 2015). Retrieved from http://www.medicalnewstoday.com/articles/292306.php

Thomson, H. (Feb. 25, 2015). First human head transplant could happen in two years. Retrieved from http://www.newscientist.com/article/mg22530103.700-first-human-head-transplant-could-happen-in-two-years.html

Trey, T., Caplan, A. L., and Lavee, J. (2013). Transplant ethics under scrutiny – responsibilities of all medical professionals. Croatian Medical Journal, 54(1), 71-74.

 

 

Sick or Hospitalized? What happens to your pet?

It’s no secret that pets are wonderful for people of all ages, especially as we age. They keep us grounded, providing stress relief, loneliness support, and regular activity. But, what happens if you live alone and end up sick or in the hospital? What do you do with your pet?

According to the American Veterinary Medical Association, 36.5% of households own a dog, 30.4% own a cat, 3.1% have birds, and 1.5% have horses. In most cases, that ownership expands to one or more pets in the same house.

Research shows that about 30% of people age 65 and older live alone, with most of those being women. Most of them do not care to live with their adult children as this is often viewed as a sign of dependence. The key is that they prefer to stay as independent as possible. Because living alone – at any age – can promote periods of loneliness, pets have become excellent companions.

Older adults find that owning a pet has various psychological, physical and social health benefits. As part of the companionship aspect, pets prevent depression and mental stress. One particular study even found that seniors with pets had fewer doctor visits than those without pets. They also provide exercise – dogs need walked and cats need to play. Furthermore, the social benefit occurs especially among dog owners as walking a dog promotes conversation with other dog walkers and strangers who just want to pet your puppy. For older adults, regular conversation and interaction with people is necessary for enhanced mental well-being.

Okay, so we know pets are great for your health, but what happens to those same pets if the senior who owns them becomes sick, hospitalized, or dies? What then? Many people don’t consider the possibility and family members end up scrambling to take care of their loved ones furry companion. The Michigan State University School of Law discovered back in 2000 that about one quarter of pet owners will include their pets in their wills. For those famous pets, such as those formerly owned by actors and actresses, they will truly be taken care of simply because they have the money to ensure that it does. For the rest of us, it’s not really a given even if the pet is listed in the will.

The University’s School of Law also said that in most cases where money is left in a will to take care of the pets, the act cannot be carried out because there is no legal entity to serve as the beneficiary to enforce that gift. The animal usually ends up in a shelter or euthanized.

To make sure your companion is taken care of through your illness, hospitalization, or death, the Humane Society of the United States suggests taking several actions now to ensure your furry friend(s) is well cared for.

1. Find at least two responsible friends or family members who will agree to serve as a temporary emergency caregiver. Write down feeding instructions, veterinarian information, and any relevant details that they should know about your pet.

2. Carry a wallet-size card with the names and phone numbers of these emergency caregivers. This way, if you are hospitalized or unable to make the calls yourself, this card will be handy. Keep it with your medication listing or medical alert information so it will be easily visible. Yes, you could even create a bracelet much like the medical condition bracelets that people often wear.

3. Place the same information on the inside of both your front and back doors in case you die or are incapacitated at home and are rushed to the hospital.

4. Draw up a formal agreement with your long-term pet caregivers and have it notarized. Check annually that they are still able to fulfill that agreement. Remember, circumstances change and one of your caregivers may have relocated to a place that does not allow pets. Always keep that agreement updated.


Keep in mind that if you do nothing for your pet’s future, do not assume that your pet will be re-homed through a local shelter.  Shelters are already overcrowded with homeless animals. You may run the risk of euthanasia if you do not have alternative arrangements. There are some organizations nationwide that offer “pet retirement homes” or “sanctuaries” but these are rare. They often require a fee or donation to reserve a place for your pet.

One more thing to bear in mind: your pet has been used to personal attention and affection. Being placed in a facility – even a retirement pet home – is like confinement or institutionalization. They truly do not want to be caged any more than you would want to be confined. Your best option is to arrange for a family member or friend to take your pets in the event of an emergency and/or death. Don’t wait until you’re already ill or gone…work on it now so that your furry companions will be able to spend the rest of their lives in a happy home.

 

Works used for this article:

American Veterinary Medical Association. (2012). U.S. pet ownership statistics. Retrieved from https://www.avma.org/KB/Resources/Statistics/Pages/Market-research-statistics-US-pet-ownership.aspx.

Beyer, G. W. (2000). Pet Animals: What happens when their humans die? Retrieved from https://www.animallaw.info/article/wills-trusts-pet-animals-what-happens-when-their-humans-die

Hara, S. (2007). Managing the dyad between independence and dependence: Case studies of the American elderly and their lives with pets. International Journal of Japanese Society, 16(1), 100-114.

Humane Society of the United States. (n.d.) Providing for your pet’s future without you. Retrieved from https://www.petfinder.com/dogs/bringing-a-dog-home/providing-pets-future/

Do You Suffer from Exploding Head Syndrome?

Last week, I stumbled across a Yahoo! article that made me do a double-take: Exploding Head Syndrome.

Exploding what??

You may have run across it as well, yet, I wasn’t sure if this was scientific or a bunch of bunk. I did a little digging and discovered that “Exploding Head Syndrome (EHS)” actually exists. Research published last year in Cephalalgia, a journal published by the International Headache Society, looked into EHS as a significant and common occurrence among people when they move from sleep to awake and vice versa.

Of interest, this really isn’t a new phenomenon as it was discovered in medical literature dating as far back as 1890. It was described as a loud noise or pistol-shot in the brain. At the time, it was considered a significant disorder usually which occurred because the individual was suffering from another mental health disorder such as depression, compulsions or anxiety.

Thanks to modern science and research, we have learned that EHS is a benign disorder that occurs when people move from sleeping to waking or waking to sleeping. There is no pain involved; however, the violent boom can be terrifying and often described by individuals as pain.

Researchers found that explosion comes from the auditory neurons shutting down at once – basically crashing at once with a loud bang. Because of the extreme loudness in the head, people often mistake it for a seizure or a brain aneurysm. It is far more common in females than males. As reported in Cephalalgia, 61% of those suffering from EHS have been female ranging in age from 12 to 84. So, it can happen at just about any age; however, it is far more common among those in their 50s.

The American Sleep Association notes that EHS is not dangerous, but it does affect your ability to have a good night’s sleep. EHS is still associated with many mental disorders and some antidepressant drugs can eliminate the phenomenon. However, it has been noted that most often the main culprit is stress. The American Sleep Association strongly recommends that anyone suffering from poor sleep habits, not just EHS, consider stress-reducing techniques such as reading, yoga, music or a relaxing bath before bedtime.

Although it is not a significant health concern, the American Academy of Sleep Medicine strongly recommends that if your EHS is chronic (meaning that you have heard these noises regularly), that you may have something more serious such as another sleep disorder, a medical condition, mental health issue or substance abuse.

It is important to talk with your doctor about your EHS should it become a regular annoyance or if it significantly affects your ability to sleep.



Works used for this article:
American Academy of Sleep Medicine. (2014). Exploding head syndrome – overview and facts. Retrieved from http://www.sleepeducation.com/sleep-disorders-by-category/parasomnias/exploding-head-syndrome/overview-facts

American Sleep Association. (2015). Exploding head syndrome. Retrieved from https://www.sleepassociation.org/patients-general-public/exploding-head-syndrome/.

Birch, J. (2015). Exploding head syndrome: The weird sleep phenomenon that’s way more common than you thought. Retrieved from https://www.yahoo.com/health/exploding-head-syndrome-the-weird-sleep-115029839587.html.

Frese, A., Summer, O., and Evers, S. (2014). Exploding head syndrome: Six new cases and review of the literature. Cephalalgia, 34(10), 823-827.

 

Look left FIRST, then right…

One of the most annoying actions I have seen lately is the carelessness of drivers. I’m not referring to the speeders, the stop-sign runners or even the DUI offenders. I’m also not referring to the youth of today who may seem out of control when groups pile into one car for a joy ride through town. I’m referring to a simple rule that most of us seem to have forgotten: looking both ways before crossing the street!

The key here is “looking.” When you come to an intersection, the Pennsylvania Driving Manual states that you need to make sure the intersection is clear before proceeding. What it doesn’t say is how to do that. While it should be common sense, this simple act is not that simple for some people. The proper etiquette is to look left first, then right, then left. Regardless of which way you are turning (left or right) or going straight, you should always look to your left first because that direction displays the lane of traffic closest to you at that intersection. Once you look left, you need to look to your right – the lane farthest away from you – to check for oncoming traffic. Then, you look left again to double-check that the lane is still clear. After you established that it is safe, that you will not hit any person or another moving vehicle, you can continue on your way.

I cannot tell you how many times I have been nearly run into as a pedestrian, cyclist, or motor vehicle because someone did not look before pulling out at an intersection (usually a stop sign; sometimes out of a driveway). Just to ascertain that I wasn’t a personal target, I conducted an informal observation of my street intersection and found that nearly every vehicle pulled up to the stop sign, looked RIGHT only and then pulled out. Oh, and if they looked left at all, it was as they were pulling out…sometimes in front of other cars, pedestrians, or cyclists.

This is not a phenomenon unique to Pennsylvania roads…I’ve seen it many places in my travels across about half of our states. 

According to the Centers for Disease Control and Prevention, 4,743 pedestrians were killed in traffic accidents in the United States in 2012 and another 76,000 were injured. The National Highway Transportation Safety Administration stated that the number of pedestrian deaths by motor vehicle represents a 6 percent increase over the prior year. NHTSA revealed that 89 percent of those fatalities occurred in normal weather conditions with a large percentage being children.

It is also important to note that 52 percent of those car-pedestrian accidents were unrelated to alcohol (by either the pedestrian or driver), indicating other reasons for the collisions such as drivers or pedestrians simply not paying attention (i.e. not “looking”).

Whatever happened to looking both ways before you cross the road? We still teach our kindergarteners how to look left, right and then left again before crossing the street; why don’t we retain that through our adulthood? And, why don’t we use that same logic when operating a motor vehicle?

The old adage “look left, then right, then left again” actually is better because when you are crossing a two-way street, the lane closest to you will be coming from your left. So, you should look left first, then check the right side (the lane furthest from you) and re-look to your left before crossing the street.

The same is true if you’re in a car: look left toward the traffic that is in the lane closest to you, then right, then left again.

The point here is safety.

 

Works used for this article:

Centers for Disease Control and Prevention. (2015). Pedestrian safety. Retrieved from http://www.cdc.gov/Motorvehiclesafety/Pedestrian_safety/

National Highway Transportation Safety Administration. (2014). Traffic Safety Facts 2012 Data. Retrieved from http://www-nrd.nhtsa.dot.gov/Pubs/811888.pdf.

TXT's and ZZZZ's

Mobile phones have been blamed for numerous health and safety issues: talking while driving, texting while driving, texting while walking, cell phones and radiation dangers, and the list goes on. Well, we can add another one to the list this year: texting and sleep deprivation.

A 2014 study published in the Family Community Health journal found that mobile phones interfere with adolescent sleep simply by their keeping the electronic device in the bedroom through the night. According to the study, 63 percent of the adolescents surveyed took their phones to bed with them and 57 percent kept it on during the night. Furthermore, more than one-third of them texted after going to bed and almost 10 percent were awakened by incoming text messages.

The point these researchers are making is that mobile phones, while very useful, can be detrimental to your sleep health more than any other type of device. Televisions, video games, and computers typically are not turned back on to trigger an awakening, according to the study. Mobile phones will often buzz, ring, light up, or vibrate to jolt a sleeper awake.

A solid night’s sleep is important to overall well-being. The National Institutes of Health (NIH) lists several key reasons why sleep is one of the key ingredients to positive health:

1. It offers a rest cycle for the brain. Sleep affects alertness and mood, which helps you survive your daily activities. Without rest, the molecular balance in the brain doesn’t have time to regenerate. Proper sleep offers your brain improved reasoning and problem-solving skills. Furthermore, sleep deprivation causes an impairment similar to being drunk with a blood alcohol content of .08 percent – which is illegal for driving.

2. It affects growth and stress hormones. A lack of sleep increases your risk of obesity, heart disease and infections. According to the NIH, when you sleep, your heart rate, breathing rate, and blood pressure rise and fall – all key elements that are critical for cardiovascular health. Your body releases hormones to help repair cells that provide increased energy.

3. It affects your immune system. Sleep helps your body regenerate to boost its immunity to infections and diseases. It has also been shown to increase the efficiency of vaccinations.


A good night’s sleep is critical for health. Adults need between 7 and 9 hours; babies need about 16 hours, children need at least 10 hours, and teens should get at least 9 hours.

The Pew Research Center’s Internet and American Life Project discovered that 78 percent of all teens (12-17) now have a cell phone, and almost half of those own smartphones. Considering the recent study, it would appear that half of the nation’s teens are at risk for sleep deprivation simply because they take their cell phones to bed with them.

Parents: here are four important recommendations to help your teen get proper sleep:

·         Make sleep a priority. Make sure that your teen goes to sleep at an appropriate to so they gain that 9 hours of needed sleep

·         Make the bedroom a sleep haven. Keep the room cool, quiet and dark.

·         Keep the cell phone out of the “sleep haven.” When a teen spends daytime hours in the bedroom, the phone is fine. But, when it’s time for sleep, keep the cell phone somewhere else.

·         Keep your teen’s evening activities calm to avoid worry or stress. Make sure homework is completed long before bedtime, and high stress exercises should be completed at least an hour before bedtime.

 

Teens who sleep well are not only healthier but often perform better at school, sports, and other activities. So, keep the cell phone out of the bedroom at night…for your health!

 

Works used for this article:

Adachi-Mejia, A. M., Edward, P. M., Gilbert-Diamond, D., Greenough, G. P., and Olson, A. L. (2014). TXT me, I’m only sleeping. Adolescents with mobile phones in their bedroom. Family & Community Health, 37(4), 252-257.

Madden, M., Lenhart, A., Duggan, M., Cortesi, S., and Gasser, U. (2013). Teens and technology 2013. Pew Research Center. Retrieved from http://www.pewinternet.org/files/old-media/Files/Reports/2013/PIP_TeensandTechnology2013.pdf

National Institutes of Health. (2013). The benefits of slumber. Why you need a good night’s sleep. Retrieved from http://newsinhealth.nih.gov/issue/apr2013/feature1.

National Sleep Foundation. (2014). Teens and sleep. Retrieved from http://sleepfoundation.org/sleep-topics/teens-and-sleep

 

Obsessing about Healthy Eating could be Problematic

Eating disorders have just taken an interesting twist. We all understand the concepts of anorexia nervosa, bulimia, binge eating, and obsessive overeating, but did you know there are those with an unhealthy obsession with eating healthy?

Although the condition has recently been recognized as a new eating disorder, it is fast becoming a health concern for people with what has been coined “orthorexia nervosa.” The term means ortho means “right or correct” and the term orexis means appetite. Together, the term signifies a fixation on correct eating behaviors and was first identified by Dr. Steven Bratman who suffers from the disorder himself.  Bratman is a holistic physician practicing in Ft. Collins, Colorado, who is author of the book, Health Food Junkies, and “Alternative Medicine Sourcebook: A Realistic Evaluation of Alternative Healing Methods.”

Basically, these are individuals who have a preoccupation with healthy foods such as whole grains, fruits, and vegetables. These are considered “good” foods. Everything else is classified as “bad.” Furthermore, if they happen to give in to something they deem unhealthy, perhaps a cup of coffee (caffeine), they self-punish with exceptionally stricter eating, fasts and exercise.

Who would think that eating healthy would pose health risks? The issue lies not in the foods they are eating, but in what they are not eating couple with what they are thinking. A very restrictive diet coupled with an obsession with food can lead to a lack of poor nutrient balance. In addition, it can lead to the consumption of far fewer calories than what would be needed for daily survival. The human body’s needs vary based on gender, age, weight and height. Once you determine your basal metabolic rate (BMR), you can determine how many calories you need if you simply slept all day. In general, those calories are about 1200 for women and 1800 for men. With orthorexia, a person could literally eat vegetables all day and not consume 500 calories. That puts the body at a dangerous risk for disease and sickness.

Recent scientific studies have found several common characteristics among those with this condition. They believe that being overweight is a sign of weakness, they disapprove of people who do not eat like they do, they believe the most people can be blamed for their own diseases for what they consume, and they spend a significant amount of time preparing their meals.

This type of behavior is not considered a weight loss type of regime. It is an intense phobia about eating only “pure” food. Anything else is off limits, permanently. What’s interesting about the characteristics of someone with orthorexia is that their food intake is far more important than their personal values, interpersonal relationships, careers, family, and friends. Therefore, besides the potential of consuming too few calories to survive, they have also placed themselves into social isolation because of it.

Psychiatrists have developed a test to determine a diagnosis. Many of the questions revolve around your thoughts and feelings about food, diet, and life in general. It seems to fine to be concerned about your dietary intake, most of us do. However, it is not healthy to be obsessed with it. Bratman stresses that a healthy diet and being concerned about your foods is not an issue. It only becomes an issue when you add the following:

1. it is taking up an inordinate amount of time and attention in your life
2. deviating from the diet causes extreme guilt and punishment
3. it causes you to avoid others and become socially isolated

Our world is consumed with the concept of “health” foods. We have low-fat, no-fat, low-carb, no sugar, caffeine-free, and so on. Couple that with the society’s fixation on being thin and it is very easy to fall victim to the orthorexia mindset, especially if you are already vulnerable through low self-esteem.

If you think you might be a victim on orthorexia nervosa, you might want to talk with your doctor or a psychologist about the condition.

 

Works used for this article:
Bratman, S. (1997). Health Food Junkie. Obsession with dietary perfection can sometimes do more harm than good, says one who has been there. Retrieved from http://www.beyondveg.com/bratman-s/hfj/hf-junkie-1a.shtml

Bratman, S. (2015). What is orthorexia? Retrieved from http://www.orthorexia.com/

Brytek-Matera, A. (2012). Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? Archives of Psychiatry & Psychotherapy, 14(1), 55-60.

Collins, S. (2014). Approximately how many calories do you need to survive? Retrieved from http://www.livestrong.com/article/300423-approximately-many-calories-survive/

Kratina, K. (n.d.). Orthorexia nervosa. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa

Varga, M., Konkoly Thege, B., Dukay-Szabo, S., Tury, F., and van Furth, E. F. (2014). When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14(1), 1-23.

 

 

Smoking Bans Do Work - At Least in the US

In 2013, Time Magazine took a look at the smoking bans across the world to determine if they actually reduced smoking overall. Here’s a quick timeline of what they discovered:

• 2004: Ireland becomes the first country to ban smoking in the workplace. The following year, research discovered a 17% drop in respiratory issues throughout Ireland. SUCCESS!

• 2005: Italy banned smoking in all public places. Smoking rates dropped by about 4%, incidences of heart attacks decreased and cigarette sales dropped by 5.5%. SUCCESS!

• 2006: China made a move to reduce smoking for the Beijing Olympics. In 2011, a nationwide smoking ban in public places commenced. Reports found that 2012 smoking rates were 30% higher than in 1990. However, it is noted that more than one-third of the world’s smokers are Chinese. FAILURE!

• 2008: India banned smoking in the workplace with lawbreakers being charged a $4.50 fine. In 2013, reports claim that violations of the law are rampant. FAILURE!

• 2013: Russia banned smoking in most public venues and banned cigarette advertising from the streets. It’s too early to tell if the ban has been effective. The law is expected to reduce smoking by 15% by 2020. In fact, lawmakers in the country wanted to take it further by banning women under the age of 40 from smoking at all. That law did not pass. UNKNOWN.

Today, the United States does not have a nationwide smoking ban. The smoking laws are left to state and local governments. However, that doesn’t mean that the tobacco issue isn’t lying dormant at the federal level. In what public health officials consider their “Bible,” Healthy People 2020, the government has set forth 20 specific objectives to reduce the use of tobacco in the nation. So far, it seems to be working.

According to the Healthy People 2020 document, the proportion of smoking adults (ages 18 and older) dropped from 24% in 1997 to 18.2% in 2012. Furthermore, the percentage of youth smokers (grades 9-12) also dropped from 43.4% in 1997 to 22.4% in 2012.

The news gets even better: both children and nonsmoking adults who were exposed to second-hand smoke both dropped over the past five years. In fact, the reduction in exposure dipped below the original targeted numbers!

Also, the number of states with laws banning smoking in restaurants and at worksites increased from 2 in 2002 to 34 in 2013. Furthermore, the number of states banning smoking in bars went from 1 in 2002 to 28 in 2013. As of 2013, all but 14 states have banned smoking in at least one of three locations: private workplaces, restaurants or bars. Those 14 states with no statewide ban are California, Alaska, Texas, Wyoming, Oklahoma, Mississippi, Alabama, Georgia, South Carolina, Kentucky, West Virginia, Virginia, and Connecticut and Missouri. It is important to note that individual cities and communities may have smoking bans.

In Pennsylvania, the Clean Indoor Air Act of 2008 prohibits smoking in only 1 location: public places or workplaces. The law does not prevent smoking in restaurants or bars – however, individual owners may have applied the law to their establishment. As you know, many of the restaurants and bars in Meadville are smoke-free – thanks to the health-mindedness of their owners. In addition, individual municipalities may have smoking bans. Check your local municipal laws for details on smoking bans.

So, do smoking bans help? Based on the numbers from the tobacco use tracking in the United States – it sure does.

As a result, we are all just a little healthier thanks to cleaner air and cleaner lungs.

 

Works used for this article:

Balmforth, T. (2014). No smoking in Russia? Tough new antitobacco rules come to the land of cigarettes. Retrieved from http://www.rferl.org/content/russia-new-antismoking-law-land-of-cigarettes/25438520.html

HealthyPeople.gov. (2015). Tobacco use. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use/national-snapshot

Katz, A. (2013). Do national smoking bans actually work? Retrieved from http://world.time.com/2013/06/03/do-national-smoking-bans-actually-work/