Smokingscholar. Actually, there are several studies demonstrating an improvement in endothelial function in response to switching from tobacco to e-cigarettes. Smokingscholar

 
 Actually, there are several studies demonstrating an improvement in endothelial function in response to switching from tobacco to e-cigarettesSmokingscholar  a) Hypnosis ‐ single 2

Background. . One possible explanation for this paradox is that perhaps Americans do not accurately perceive. 10. 1 In the United States, ~30% of women and ~43% of men are. DianeObjective: Smoking is a risk factor for coronary artery disease (CAD) and a known factor influencing the severity and pattern of CAD. One myth about smoking doctors want to debunk is the idea that there is no point in quitting because all of the damage is done. Ecological momentary assessment was used to examine immediate changes in 87 college students’ smoking-related attitudes, beliefs, and intentions as a joint function of their exposure to anti-smoking media and smoking status. In a meta-analysis of 32 observational studies involving 3,966,184 participants and 35,151 events, Suhua Wu and colleagues found that current, ever, and former smoking was associated with risk of venous thromboembolism. We searched all published studies reporting with the prevalence and/or associated factors of cigarette smoking among school-going adolescents in East African countries. Chemicals in cigarette smoke are leading cause of death to both smokers and nonsmokers. Students who perform better academically are less likely to smoke, while those whose performance is weak smoke much more often (Bryant et al. Tobacco consumption accounts for approximately 30% of all cancer deaths and nearly 90% of lung cancer deaths, with recent estimates as high as approximately 174,000 cancer deaths from tobacco use per year (). It would, therefore, be of great benefit to identify those at high risk early on. Tobacco use remains the largest preventable cause of premature deaths, accounting for over 6 million deaths each year, worldwide []. Background Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Buccal brushings represent an easily accessible source of DNA, which may be an appropriate surrogate tissue in the study of environmental exposures and chronic respiratory diseases. While reports suggest that smoking increases the risk of developing schizophrenia, the potential causative role of smoking in this relationship needs further investigation. . 1. Firstly, and not surprisingly, smoking is associated with the development of chronic airflow obstruction. Barefoot Smoking In Jeans. IJPH_1351_20. nida. you have more energy. The majority (86. Especially nowadays. Background and aim Smoking is still a public health concern in many countries, especially among young adults. 5 mg twice per day. Smoking as a mode of consumption is most commonly used for tobacco, mainly in the form of burnt tobacco and predominately cigarettes. 23; 95% confidence interval [CI], 0. It has become the fifth most burdened and the third most deadly disease in the global economy and increases year by year. Our purpose was to describe the characteristics of smoking behavior among Tunisian physicians (TP) and to identify their attitudes regarding patients' smoking. 4% for females). Background. Methods This paper presents insights from three research activities from the. A systematic review. A systematic review. Despite what you might have heard, cigar smoking isn't safer than cigarette smoking — even if you don't intentionally inhale the smoke. Smoking during pregnancy stunts fetal growth. Smoking has a significant impact on the development and progression of cardiovascular disease. 6. Background Tobacco use is one of the greatest public health problems worldwide and the hazards of cigarette smoking to public health call for better recognition of cigarette smoking behaviors to guide evidence-based policy. Great clip! Smoking has a significant impact on the development and progression of cardiovascular disease. The high co-occurrence of smoking and mental illness is a major public health concern, and smoking accounts for much of the reduction in life expectancy associated with mental illness. 4 Here, we provide a brief perspective. 10. There are also many other potentially harmful chemicals found in tobacco or created by burning it. Background: In many countries, smoking rates are higher among men than women, highlighting the importance of focusing on factors that influence smoking prevalence among men. Cigarette smoking is a major health risk, particularly in male South Koreans. OnlyFans is the social platform revolutionizing creator and fan connections. Behavioral and cognitive effects of smoking: relationship to nicotine addiction. The frequency of exacerbations. A. Little is known about the effect of vaping on the immune system. Background: Mindfulness-based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Barefoot Smoking In Jeans. On the basis of current smoking patterns, with a global average of about 50% of young men and 10% of young women becoming smokers and relatively few stopping, annual tobacco-attributable deaths. 3 billion tobacco users live in low- and middle-income countries. Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality in countries at all levels of economic development [2, 3] with smoking being recognized as its most important causative factor [1, 3]. Crane, founding prosecutor for the U. The secondary purpose of our research is to assess the attitude towards smoking and attitude towards quitting smoking as the effect of anti smoking. Smoking cessation is the most effective strategy for slowing down the progression of chronic obstructive pulmonary disease (COPD) and reducing mortality in the approximately 50% of patients with diagnosed COPD who continue to smoke. The WHO estimates that there are 1. Using the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 international cohorts recruited in childhood and followed into adulthood, the. reduces the risk of premature death and can add as much as 10 years to life expectancy. 6). Cigarette smoking is an important worldwide health problem, and it has been reported that 1. 5%) of the studies evaluated 100% smoke-free or tobacco-free campus policies. Surrounding influence (44%), stress (42%) and fun (40%) were major reasons for smoking initiation. National and. 1. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high-certainty evidence that people taking bupropion are. The majority (56. 1055/s-0035-1555610. A higher number of counseling sessions was significantly associated with a lower risk of relapse (hazard ratio [HR], 0. That includes nicotine in cigarettes, cigars, e-cigarettes (vaping), and chewing tobacco. Participants were students who came for mandatory check-ups at Student Health Care Centers in two Universities in Serbia, differing by socio-politically and economically. Smoking Among College Students. Results of toxicological analyses suggest that e-cigarettes can be safer than conventional cigarettes, although harmful effects from short-term e-cigarette use have been described. Please see later in the article. S. Follow. Pregnant Jen Floyd enjoying her second VS120 in a row. There is high-certainty evidence that bupropion can aid long-term smoking cessation. Thus, while the links between disadvantage and smoking are acknowledged, social class remains on the margins of the debate. Gometz, MD, MS, MIA is a second-year internal medicine resident at the University of Chicago Medical Center and an active community educator in the Chicago Breathe Project. This is a clip from Smoking Models Volume 1, from (Florida, U. Through a. The hypothesis of this study is that who has failed attempts to stop smoking induce more. It has long been acknowledged that there is a strong relationship between cigarette smoking and psychotic disorders. 4 Smokers are. Among 1,454 respondents who had smoked for ≥30 years, 58. The site is inclusive of artists and content creators from all genres and allows them to monetize their content while developing authentic relationships with their fanbase. 2. 0. Students (37 never smokers, 41 experimental smokers, and 9 current intermittent smokers) carried handheld. With the glorification of ECIG, its use has increased. STUDY SUMMARY: Quitting “cold turkey” is better than gradual cessation at 6 months. Key to discouraging the habit of smoking is knowledge of the drivers of smoking. Explore millions of resources from scholarly journals, books, newspapers, videos and more, on the ProQuest Platform. Cigarette smoking causes more than 8 million deaths per year worldwide. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public. Objectives: To provide an overview of key aspects of. Smoking is the leading cause of death and smoking initiation rarely occurs after adolescence. Doctors play a special role in combating tobacco use. Objectives . Poor subjective health and factors. 4103/ijph. . Chronic obstructive pulmonary disease (COPD) is one of the most common chronic respiratory diseases with high morbidity and mortality. A literature search was conducted on Google Scholar, EBSCOhost, ClinicalKey, and PubMed databases using the following headings in combination or. However, cigarette manufacture was revolutionized by the introduction of. Background. The paper argues. This problem is compounded by the fact that the rate of cigarette smoking in young people continues to steadily increase 2). As a. Among smokers, 2 wk of meditation training (5 h in total) produced a significant reduction in smoking of 60%; no reduction was found in the relaxation control. Karthikayan Ravi , K Indrapriyadharshini P D Madankumar. Abstract. A single full-size cigar can contain nearly as much nicotine as does a pack of cigarettes. Approximately one fifth of the deaths in the United States are attributable to smoking, and 28% of the smoking-attributable deaths involve lung cancer, 37% involve vascular disease, and 26% involve other. Great attention has been focused on adverse effects of tobacco smoking on health, also early in life []. 9% (17/43) of the smoking patients. Electronic Cigarettes (ECIGs) are devices with a heating element which produces aerosol for inhalation. Cigarette smoke (CS) contains a. Lindson-Hawley, et al, conducted a randomized, controlled, non-inferiority trial in England to assess if gradual cessation is as successful as abrupt cessation as a means of quitting smoking. Results. Smoking has been shown to be. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis. There are two broad categories of nAChRs: muscle receptors and neuronal receptors. , “sitting is the new smoking”). 00–5. 1,3. 7% of men and 7. Given that about 25% of college students report use in the past month, this. #climate change #king of the hill #koth #smoking #global warming. Question Which genetic variants are associated with anxiety and stress-related disorders and do they correlate with other traits?. S. Interventions. The purpose of this review is to comprehensively analyze and summarize the pathogenesis and clinical characteristics of smoking in PAD based on existing clinical, in vivo, and in vitro studies. In 2021, nearly 12 of every 100 U. The average school smoking prevalence was 13. Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies. Table 2 shows a significant effect of ORA on smoking status, but there is no evidence of a NORA effect on smoking. Few studies have researched the gender-specific effects of electronic nicotine delivery systems on the metabolic syndrome (MetS) and/or its risk factors (central obesity, raised triglycerides. Tumblr is a place to express yourself, discover yourself, and bond over the stuff you love. 0, 95% CI: 2. 43) and pancreatic cancer. Since the discovery of COVID-19 in December 2019 in Wuhan, China, it has spread all over the world and the numbers are increasing day by day. Key Points. i've been rewatching moominvalley lately. Cigarette smoking may modify inflammation that is associated with asthma, although there is limited published data on airway. 24,36 Wound healing is regulated by a synergistic interplay among multiple cell types, cytokines, and growth factors at the. Smoking cessation can benefit health; however, the process of quitting smoking is difficult to some smokers and shows its relationship to their stress level. Last Update: January 23, 2023. This paper provides a broad overview of smoking in terms of: the health effects, benefits of stopping, prevalence and patterns of use, psychological,. A literature search was conducted on Google Scholar, EBSCOhost, ClinicalKey, and PubMed databases using the following headings in combination or separately: cigarette smoking, tobacco smoking, epidemiology in the United States, health consequences of cigarette smoking, pharmacologic therapy for cigarette smoking, and non-pharmacologic therapy fo. Butler et al. In this study, 28,577 males from a Chinese longitudinal survey were. In Uttar Pradesh, parental smoking is associated with birth factors nutritional status and may divert household funds from food and other necessities towards smoking habits, and parental smoking was also associated with increased risk of stunting of growth and underweight children in the children. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. When CBT is provided for smoking cessation, it often includes problem solving and coping skills rooted in relapse. A stripped down, casual, girl next door version of Nikki, which is quite rare. These same regions also differentiated. Introduction. 3% of the world’s population used tobacco: 36. Gorzkowski, MSW, Julius B. Forms of Nicotine Replacement Therapy. The result is an invaluable overview of an epidemic that causes millions of deaths every year. Those symptoms include: Cough. In their Article in The Lancet Public Health, Marissa Reitsma and colleagues1 report their comprehensive analysis of smoking tobacco use in young people from more than 3000 tobacco surveys from 204 countries and territories around the world. It is unclear, however, how common stigmatization of smokers is among adolescents or how stigmatization relates to the denormalization of smoking in their school and social. Methods: We conducted a systematic review and meta-analysis of epidemiological studies on the association between cigarette smoking and CRC risk published up to September 2018. 2 Annually, smoking leads to 480 000 deaths in the USA, 3 and its. However, the effect of SHS on growth outcomes of older children is not well defined. They have been propagated as a healthier alternative to tobacco smoking and a potential device for smoking cessation, despite non-documentation of their long-term adverse health effects. However, there is a lack of empirical investigation into waterpipe smoking in East Asia. This burden is related to both tobacco consumption and second-hand exposure. Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decades of life. Albersen, in Effects of Lifestyle on Men's Health, 2019 Abstract. (opens in a new tab) (opens in a new tab) Collaborators & Attributions. Importantly, it is. @ smoke4me1973. Background Cigarettes and their by-products (i. 32 for ≥9 vs. This is true regardless of their age or how long they have been smoking. S. Importance Consumption of energy drinks has increased drastically in recent years, particularly among young people. Their detailed mapping of the prevalence of smoking tobacco. In Ghana, though smoking behaviours are relatively more associated with adult males than youth and adolescents, studies on smoking behaviours. A. 10. In this literature review, we aim to summarize the epidemiology of cigarette smoking and tobacco use in the United States, pharmacology of nicotine-the active constituent of tobacco, and health. Socioeconomic status and smoking: a review. Extensive searches and literature reviews have shown that a large amount of data exists on the. Methods . Cigarette smoking and asthma interact to induce important adverse effects on clinical, prognostic and therapeutic outcomes. Of the 148 included studies, 99 (67%) recruited male and female participants, 16 (11%) recruited only females and 7 (5%) recruited only males, while 26 (18%) did not report the sex of the participants. Follow. The inhalation of noxious materials contained in tobacco smoke drives lung inflammation, oxidative. Background Tobacco control policies have potential to be an effective strategy for the reduction of smoking prevalence and secondhand smoke (SHS) exposure in tertiary educational settings worldwide. Cigarette smoke contains over 7,000 chemicals, including about 70 that cause cancer. 24,36 Wound healing is regulated by a synergistic interplay among multiple cell types, cytokines, and growth factors at the wound site. 9, 11, 13 Know the facts: 9. . Mindfulness training may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal as they arise, rather than habitually reacting to these unpleasant states by smoking. 1007/s40435-023-01341-z Corpus ID: 265197449; Semi-analytical method for solving a model of the evolution of smoking habit using global rational. 1 According to the Centers for Disease Control and Prevention, 37. In contrast, an increasing number of adolescents are initiating tobacco use. i am a newcomer, of sorts. CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U. This demonstrates that smoking is the first gateway to juvenile delinquency. (2011) examined the relationship between drinking and academic demands. 2011. The WHO estimates that there are 1. El artículo presenta una revisión de la literatura sobre el concepto de salud 1, según la definición de la Organización Mundial de la Salud (OMS), y su relación con la calidad de vida y el bienestar. Quitting smoking is one of the most important actions people can take to improve their health. More recently, smoking has also been found to be associated with psychotic experiences in the general population. Background. By Alvin Powell Harvard Staff Writer. S. Abstract. The aim of this study was to evaluate the effect of smoking on lung function decline in adult-onset asthma in a clinical, 12-year follow-up study. Different from any use in the past year, researchers often look at past month use as an indicator of current use. A stripped down, casual, girl next door version of Nikki,. As many as 30% of all coronary heart disease (CHD) deaths in the United States each year are attributable to cigarette smoking, with the risk being strongly dose-related. 3 million non-smokers who are exposed to second-hand smoke (4). The distribution of smoking duration ranged from 19. Though tobacco or smoking in general is not explicitly mentioned in the Quran or hadith, contemporary scholars have condemned it as potentially harmful, and have at times prohibited smoking outright (declared it haram) as a result of the severe health damage that it causes. In reality, they say just 20 minutes after one stops smoking for. not that that's relevant. Over the past decade, media coverage of sitting research has been widespread and the health consequences of sitting have often been compared with those of smoking (i. 2 mg/dl; 11. 0% (56. This qualitative study explored I Quit participants’ experiences during and. 1 Many studies report a positive association between smoking and mental illness, with smoking rates increasing with the severity of the disease. Cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large. Majority of participants (68%) attempted to quit smoking within past 6 months but failed. Smokers quit and relapse several times before they eventually achieve sustained abstinence []. We would like to show you a description here but the site won’t allow us. smokingscholar. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. Drilling down, we find that most of the aggregate peer effects come from the smoking propensity of the 20% most popular peers. 4103/ijph. Abstract. Great clip!"Google Scholar provides a simple way to broadly search for scholarly literature. Setting: Oslo city and three counties in Norway. Address correspondence to Julie A. smokingscholar. Actually, there are several studies demonstrating an improvement in endothelial function in response to switching from tobacco to e-cigarettes. Here, we evaluate tobacco’s global footprint across its entire supply chain, looking at resource needs, waste, and emissions of the full cradle-to-grave life cycle of. Shahab’s editorial, by addressing the impact. , 2011, Schnohr et al. 06 (95%CI: 3. A 10% tax-induced cigarette price increase anywhere in the world reduces smoking prevalence by between 4% and 8%. There is little research on how population-level tobacco control policy interventions affect individuals within different smoking trajectories. 2 million participants) that reported 45 844 incident cases of diabetes during a study follow-up period ranging from 5 to 30 years. 2. Anyone can be susceptible to this infection but children, older adults, pregnant women, and people with comorbidity are more vulnerable. Yet, the incidence. Cigarette smoking remains one of the most significant preventable causes of disease and premature death in the western world and is a leading cause of cancer and death from cancer. Follow. As a result, smoking prevention has focused almost exclusively upon youth. The inhalation of noxious materials contained in. 2% (1–9 years) to 36. Interestingly, both traditional and e-cigarette consumption by non-smokers was found to provoke short-term effects on platelet function, increasing platelet activation (levels of soluble CD40 ligand and the adhesion molecule P-selectin) and platelet aggregation, although to a lesser extent with e-cigarettes []. Results. Introduction. N. However, the likelihood of relapse decreases after 6 months to. Cigarette smoking, hereafter referred to as “smoking,” is the largest single risk factor for premature death in developed countries. Barefoot Smoking In Jeans. Follow. Evidence from. And evidence shows that COPD exacerbations are a frequent cause of hospital admission, as an indicator of a poor prognosis and elevated mortality. 6 As mentioned above, in 1993, Celermajer et al 5 were able to show that continuous smoking impairs FMD of the brachial artery in a dose-dependent manner, shown by the strong association between FMD and. As of July 1, 2018, approximately 2,212 U. Mindfulness training may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal as they arise, rather than habitually reacting to these unpleasant states by smoking. Once your brain starts pairing up events like studying or partying with chewing tobacco, it becomes harder to do one without the other. An in-person cross-sectional survey on previous dental visit experiences. where f(y) stands for the count distribution and the parameter (phi ) is the uncertainty parameter (mixing proportion). smoking on Tumblr. 2. Take 0. In Ghana, though smoking behaviours are relatively more associated with adult males than. Varenicline. The hypothesis of this study is that who has failed attempts to stop smoking induce more stress. NATASHA MARLEY (. The prevalence of smoking is over 1 billion people, with the majority coming from low or middle income countries. 8 million adults were active smokers in the USA in 2016, representing more than 15. sheish@intra. Objective: To study smoking habits among patients hospitalised/admitted for. 3% attended a 2-year college, and 32. 1 day ago · November 23, 2023 at 8:01 PM PST. The cost effectiveness ratio of implementing non-price-based smoking cessation legislations (such as smoking. There is no cure for COPD, and acute exacerbations lead to hospital admissions and are a major contributor to health care expenditures [7–9]. Relapse of smoking after attempting to quit most frequently occurs within the first few weeks []. Love the dangling,the VS 120 and the furtive glances she makes at usbto let us know she's onto us. The legalization of marijuana has spread around the country in recent years. The purpose of this study was to examine the association between asthma and smoking among high school students and assess provider-patient communication with asthmatic adolescents regarding smoking. Great clip!Objectives: To determine the risk in men and women smoking 1–4 cigarettes per day of dying from specified smoking related diseases and from any cause. The second is to estimate an empirical model of the relationship. Background. 3 Smoking acts synergistically with other risk factors, substantially increasing the risk of CHD. S. Diseases caused in whole or in part from smoking continue to be the world's most preventable cause of death (). This study used longitudinal data from 909 young adults to examine associations between substance use and the status and quality of romantic relationships. Milenkovic, M. 1 – 3 Rates of cigarette smoking in individuals with psychotic disorders are 2–3 times greater than those. The topics explored were: the views of any HPs about. In addition to the highly recognized role of cigarette smoking in lung cancer, it has been implicated in many other chronic diseases, including chronic bronchitis and pulmonary. 5 mg once per day for three days, then 0. The paper reviews this debate on smoking and stigma. . Here is a clear example: In view of the harm caused by tobacco, growing, trading in and smoking of tobacco are judged to be haram (forbidden). TOP 10 NIKKI ASHTON SMOKING VIDEOS 2011-2018. Tobacco smoking is a leading cause of cardiovascular disease (CVD) morbidity and mortality. 10. Many people are offended by the smell of smokers. In a 2017 study of 23 participants who completed either mindfulness training or cognitive behavioral treatment for smoking cessation, the researchers found that stress reactivity in several brain regions including the amygdala and anterior/mid insula was related to reductions in smoking after treatment. Participants: 23 521 men and 19 201 women, aged 35–49 years, screened for cardiovascular disease risk factors in the mid. Introduction. Heavy alcohol use, marijuana use, and cig. 8% of smokers were aged >16 years vs 19. 4 Smokers. Background The evidence on the effects of chronic tobacco smoking on neuropsychological functions is conflicting. Observational studies have suggested an association between active smoking and the incidence of type 2 diabetes. We calculated relative risk (RR) of CRC according to smoking status, intensity, duration, pack-years, and time since quitting, with a focus on molecular subtypes of CRC. 2 More than 16 million Americans live with a smoking-related disease. Abstract. Having an awareness of the symptoms you could experience will help you to know what to expect and plan for ways you might handle them. Acknowledgments I would like to use this opportunity to express my sincere appreciation to all the faculty members at Walden University School of Nursing and especially Dr. 5- or 1-mg tablet. Esophageal cancer constitutes a global public health challenge. Cigarette smoking is associated with cognitive decline and dementia, but the extent of the association between smoking and structural brain changes remains unclear. Aims: The aim of this study was to use Mendelian randomization (MR) to determine the causality of the association between smoking and 14 different cardiovascular diseases (CVDs). IJPH_1351_20. The high co-occurrence of smoking and mental illness is a major public health concern, and smoking accounts for much of the reduction in life expectancy associated with mental illness. Comparisons between groups were performed within the overall cohort, and an adjusted analysis with 1:1. Smoking is the number one risk factor for cancer mortality but only 15–20% of heavy smokers develop lung cancer. 32 years and had attended at least one other smoking cessation programme. Model fitting and selection. Health education by health promotion is. But that's how the greats seemed to go. 3%) than among those who do not have a religion, but do believe in God (16. The average daily number of cigarettes. Surrounding influence (44%), stress (42%) and fun (40%) were major reasons for smoking initiation. As many as 30% of all coronary heart disease (CHD) deaths in the United States each year are attributable to cigarette smoking, with the risk being strongly dose-related. However, in acute myocardial infarction (AMI) patients, smoking has been. Background The prevalence of smoking among adolescents is high in Indonesia. Few studies supported a bidirectional relationship, or reported. Her pay site went down, and her youtube. 3 million adults in the United States currently smoke cigarettes . Although a decrease in smoking prevalence among pregnant women has been observed in almost all Western countries [] the prevalence is far from the 2 % goal fixed by “Healthy People—2010” in USA []. Background Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.