The latest victims are identified as adults in Dubuque, Polk, Mills and Monona counties. To date, there have been 11 confirmed H1N1 deaths in Iowa, including 10 adults and one child.

“While school-age children have been most affected by the H1N1 virus over the past several weeks, surveillance is starting to show an increase in adult illness,” said Dr. Patricia Quinlisk, state medical doctor.

Symptoms of H1N1 influenza are similar to seasonal flue and include a fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some infected with the virus also experience diarrhea and vomiting.

“With H1N1 vaccine continuing to be allocated to states on a staggered basis, many adults are not yet in the priority group targeted for vaccination,” Quinlisk said. “Until more vaccine becomes available, it’s important for all Iowans to continue to take personal action to prevent the spread of illness.”

Iowans with questions about H1N1 should visit the IDPH Web site or phone the toll-free Influenza Hotline at 1-800-447-1985.

For the past several months, The Iowa Independent has documented the health costs associated with provider shortages in rural areas. Without sufficient providers, some rural residents are forced to travel significant distances for general health, mental health, dentistry and pharmaceutical services.

According to a 2007 study by the National Center for Rural Health Works at Oklahoma State University, one full-time primary care physician generates, on average, approximately $1.5 million in revenue, $900,000 in payroll and creates 23 jobs. The relatively large impact is created through clinic employment, inpatient services, outpatient activities and the multiplier effect of these contributions, and it does not include potential benefits to local pharmacies.

The study also documents another important factor: If primary health care services are not available in a rural town, residents will often travel to the nearest urban centers to meet their needs. Because such urban centers often provide expanded shopping and specialty service opportunities, the traveling patients will often make other purchases out of town that may have otherwise made locally.

In many ways, a general practitioner’s economic contributions are as important to a community as his/her medical contributions.

The National Center for Rural Health Works estimates that a rural community with a shortage as low as one-half of one full-time physician stands to loose $236,565 from clinic visits and $451,169 net revenue at a local hospital for in-patient and out-patient activity. When those figures are adjusted for indirect multipliers — for example, services purchased by the physician, the clinic and employees — the total impact of the shortage was 13.8 jobs and $533,493 in income.

Despite all the evidence, few rural areas currently target medical professionals as a part of their routine economic development efforts.

“Some of our larger communities struggle to attract health care providers to those communities, and I know that it gets very competitive as far as what they need to do in order to draw physicians, physician assistants, nurse practitioners, primary care providers and the whole gamut of health care providers,” said Tom Newton, director of the Iowa Department of Public Health. “It is gets very competitive to draw those individuals to your community. But when you look at the rural communities, the people (i.e., providers) just not willing to go out there and work.

“Somehow we need to re-invigorate those communities and show the benefits that they have and what they can offer to providers who are willing to go out there and work.”

It is typically only when a primary care physician leaves a community or retires that residents and local leaders understand the impact of that business on the local economy. And, unfortunately, creating a medical practice from scratch instead of transitioning from one physician to another is a much more formidable task.

There are, however, promising approaches rural communities could take to reduce the decline of medical professionals, but none is in widespread use.

Some rural communities are taking a “grow your own” approach, whereby community groups attempt to identify young adults — even as young as middle school or junior high students — who might have an interest in attending medical school. Through scholarships and other incentives, they pay for a student’s medical training in exchange for a promise to return to the community and practice medicine there.

Although most rural communities have been slow to adopt this approach, it is gaining momentum as smaller communities are faced with aging medical providers and few prospects to fill those potential voids in service. According to Newton, such approaches to provider shortages have been “the most effective” in bringing providers into rural areas.

“It is much easier for a young person to go back into a rural community if that’s where they grew up, and if that is where they raised, because they understand the benefits of living in those rural communities” he said.

Another, somewhat more popular method of training physicians and other health care providers for service in smaller communities is the implementation of rural residency programs. Not only do programs such as the Smoky Hill Family Medicine Residency Program in Kansas and the Durant Family Medicine Residency Program in Oklahoma prepare physicians for work in smaller communities and rural areas, but they also provide a boost to local communities where they operate.

“I think we also need to do a better job of selling what we have in Iowa. We don’t do that. We make a lot out of the fact that we don’t have oceans and we don’t have mountains, and everyone is under the assumption that is what attracts young people today. Well, to some degree it does. But, eventually those young people get married, have kids and have other priorities that begin to take precedent in their lives,” Newton said. “If they understand that there are safe communities, that have good schools, that have short commutes — ones in which there is a sense of community and they know their neighbors, and their patients and they can have a real relationship with them — there are aspects of that which are very appealing to people.”

As the recession takes its toll and small town populations continue to age, health care providers will become an increasingly important part of rural economic development. Doctors are an important component of the rural economy, improving conditions far beyond the walls of an examination room.

A total of eight states — Iowa, Nebraska, Wyoming, South Dakota, Kentucky, Montana, Indiana and Arkansas —  now have waiting lists associated with the AIDS Drug Assistance Program, a specific funding stream within Ryan White Part B that provides medications to individuals infected with HIV or who have AIDS. The federal dollars, which come to the state as grants, can be disbursed according to guidelines set by the state. In Iowa and Nebraska eligible persons must have an income that does not exceed 200 percent of the current Federal Poverty Income Guidelines. In addition, Iowa includes a $500 work deduction from the monthly gross salary of those employed.

Although it isn’t the first time states have had to institute waiting lists for participation in the program, this does mark the first time such waiting lists have been instituted without a clear path to additional funding to provide the needed funds. In 2004 and 2005, more than 100 Iowans were placed on a waiting list. That backlog was cleared only when the Iowa state government stepped forward and provided its own funding to the ADAP program, something it has continued to do since that time.

“With our current system the way it is, if the program doesn’t constantly receive increases in funding, we’re always going to run into this problem,” said Holly Hanson, Ryan White Part B program manager for the Iowa Department of Public Health. “Flat funding will never work for us because the medications are good and people are living longer with this disease — which is a good thing — but diagnosis [of new cases] remains steady.”

In short, funding has mostly remained at a consistent level since the 2005 increases due to state appropriations, but the numbers of people seeking assistance has continued to climb. Iowa has roughly 100 new individuals diagnosed as HIV positive each year. Nebraska diagnoses roughly 40 per year. For each individual receiving assistance, the states estimate they spend between $8,000 to $10,000 a year.

“The current economic situation is definitely a part of it,” said Steve Jackson, program manager for the Nebraska Department of Health and Human Services. “We are seeing individuals who are requesting — outside of ADAP — assistance with COBRA premiums. That’s an entirely different category. It does, however, impact the ADAP if those individuals don’t have good drug coverage on their COBRA fund. They can then request assistance through ADAP. We are seeing about a 10 percent increase in the number of individuals who come into the program each year, and our funding is just not keeping pace with that.”

Hanson added that the programs have also seen an increase in pharmaceutical costs, but that cost is far overshadowed by Iowa’s dramatic increase in program utilization.

“We are basically the safety net,” she explained. “And all of the clients are required to work with a case manager, and we are working with all of those on the waiting lists to ensure that they continue to have access to the medications they need.”

Both Iowa and Nebraska have been able to work with patient assistance programs within the various pharmaceutical companies so that all of the people currently on waiting lists are not being deprived of critical, life-saving medications. Nebraska has also been able to establish collaborative programs with other agencies within the medical community that can serve as a stop-gap measure while the waiting lists exist.

“The problem is that many of the people living with HIV are on highly active retroviral treatments, which means that they are taking several medications that are often from different pharmaceutical companies,” Hanson said. “With each medicine, the person needs to apply with the appropriate pharmaceutical company for patient assistance. Each program could have different deadlines and different renewal times — making the entire process much more labor intensive for both the patient and the case workers.”

Although HIV, the virus that can result in AIDS, was considered a terminal disease only a decade ago, it is now considered a serious, but chronic condition by most medical professionals. Medications, especially the retrovirals, are key to keeping the disease under control, and they require an extremely high adherence rate. If doses are missed or if medication is stopped, the virus could become resistant to the pharmaceutical regiment and the patient becomes much less likely to fight off infection.

Iowa receives roughly $1.7 million in federal funds that is earmarked specifically for ADAP, including a supplemental grant. Although the state had been contributing $550,000 to the program, that appropriation was cut this year by $28,000 to $525,000.  Nebraska receives roughly $2.5 million in federal funding, and $900,000 from the state.

The Ryan White Act is the primary vehicle used by the federal government to send money to the states for HIV/AIDS prevention, education and care. Within the program, formulas have been created that provide greater assistance to areas who have historically had a higher incidence of diagnosis. Those formulas are at least partly to blame for why Midwestern states are coming up short in assistance dollars, according to Brandon M. Macsata, chief executive officer of the ADAP Advocacy Association.

“HIV/AIDS is no longer a disease that primarily strikes gay men in big cities,” he said. “In fact, communities of color and women are disproportionately impacted by the disease, especially in rural communities. Our organization contends that the money should follow the disease, and that is not happening — which is why you see waiting lists in middle America and not in states like New York and California.”

His organization has joined with others who have asked Congress to continue with the reauthorization of the program for a few more years, so that a better determination can be made on how it is working and what changes might need to be made. He also advocates that that ADAP funding throughout the nation needs to be increased by $230 million, just to keep pace with the demand.

For now the state programs will continue to seek assistance for those in need as best they can.

“I think we will be OK through March 31, when the Ryan White fiscal year ends,” said Hanson. “But I’m really worried that if we receive flat-funding from the feds and the state… I don’t know that we could get through our next Ryan White grant cycle with even just the people we currently have enrolled. I guess we need to… well… we either need to come up with a new national health care plan or increase funding.”

The existing authorization for Ryan White funding — named for the Indiana teenager who became an international symbol of HIV/AIDS in the late 1980s as he fought to attend school after he was diagnosed with HIV — is scheduled to sunset on Wednesday. That is, barring no action from Congress, no more appropriations past the March 31 end of this fiscal year would be made.

A spokeswoman in U.S. Sen. Tom Harkin’s office confirmed to The Iowa Independent that Congress will not meet the deadline, but plans to issue a 30-day temporary extension so that mark-ups and drafts of a new bill can be created and passed by the end of October.

Although this reauthorization gives Congress an opportunity to look at ADAP and other funding formulas within Ryan White, passage of a new bill will likely not impact the existing shortages within the states.

A new lottery ticket is being sold to pay for the Iowa Veterans Trust Fund

For many Iowa veterans, the war-front follows them home, where they have to battle for benefits already promised to them by the government through the Iowa Veterans Trust Fund (VTF). The annual battle came to an end last week when the Iowa Lottery introduced the first of four games, Stars & Stripes, that will directly benefit the fund.

“We’re very excited about having a sustainable, annual funding source for the Iowa Veterans Trust Fund,” Kent Hartwig, legislative liaison for the Iowa Department of Veterans Affairs, told the Iowa Independent in a telephone interview. “The response from the veterans who have received assistance from this fund has been tremendous, and this will go a long way furthering our ability to help veterans who are in need.”To help bridge monetary gaps in federal benefits, lawmakers created the VTF in 2003 with the intent of giving the state flexibility with regard to Iowa’s returning veterans and their families, in particular issues that aren’t covered by federal funding such as job training, unemployment assistance, travel expenses for wounded veterans related to follow-up medical care, nursing home care, counseling programs and honor guard services.

Moreover, lawmakers intended for the VTF to eventually contain $50 million in 10 years, but only $5 million has been appropriated to the fund thus far, and Gov. Chet Culver’s 2008 budget did not contain any additional revenue for the fund.

To fill the gap left in Culver’s budget, Rep. McKinley Bailey, D-Webster City, a U.S. Army veteran who served in Afghanistan and Iraq, sponsored legislation, House File 2359, earlier this year that authorized the lottery games and appropriated the funds to the VTF. The new lottery games are estimated to generate up to $3 million a year for the trust fund at a minimal impact on the general fund.

“The trust fund was created to assist veterans and their dependents who slip through the cracks of the federal system,” Bailey said on the House floor in March. “As the wars in Afghanistan and Iraq continue, those cracks become more and more apparent. As a state we have an obligation, a sacred obligation, to ensure that our veterans are taken care of when they come home. That means picking up the slack for the federal government when it lets our veterans down.”

Even though Culver did not budget money for the VTF this year, he did sign the bill into law March 11, thus guaranteeing funding by removing appropriations from lawmakers and placing it in the hands of the Iowa Lottery.

“We have developed a good partnership with the Iowa Lottery,” Hartwig said. “This funding stream is a good way of doing it because it is outside the General Assembly. Before the VTF was appropriated on an annual basis, and now the lottery funds will go directly into the trust fund.”

“With the lottery, we are guaranteed to receive some amount of money every year; granted, this will vary depending on sales,” Hartwig said. “But now this is something we can count on annually to help grow the principal balance. Since we can only spend the interest, when the fund stays at $5 million, we are not able to expand our program.”

Hartwig said the VTF has given out over $100,000 since December, the biggest draw assisting unemployed veterans with service-related disabilities, who have seen gaps in their federal funding.

Moreover, Hartwig sees the IDVA’s new relationship with the Iowa Lottery as a plus, because it helps get the organization’s name out, marketing it through the tickets, which include the IDVA’s contact number at the top of every ticket. “For us, the lottery puts a spotlight on our organization. It creates a win-win situation (see below), especially since we don’t quite have the marketing resources as the Iowa Lottery.”

Benefits for veterans outweigh gambling concerns

The government’s growing dependency on using gambling revenues as a source of funding programs such as the VTF have sparked some concerns among those who deal with the negative effects of gambling.

“The new game is in line with the mission of the Iowa Lottery in terms of help and funding that is available,” Mark Vander Linden, head of the Iowa Department of Health’s Gambling Treatment and Prevention program, told the Iowa Independent during a telephone interview. “All states, except Alaska and Hawaii, have some sort of gambling. I think how Iowa chooses to addresses people who get into trouble because of gambling is probably one of the more progressive, especially in terms of using the revenues coming in from gambling to help those who are negatively affected by gambling.”

One-half of one percent of the gross revenues generated from the Iowa Lottery are earmarked for gambling treatment programs, including the 1-800-BETSOFF hotline run through Vander Linden’s office.

“The number of clients that we serve on the help line related to lottery gambling are relatively small,” Vander Linden said. “I don’t anticipate that this new scratch-off ticket is different enough to cause an increase in calls.”

However, Amy Kluver, a gambling treatment counselor at Problem Gambling Services, argues that lottery and scratch tickets may be part of a larger problem. “People think that taking care of the casino is the big issue, but there are definitely people who struggle with scratch tickets and pull tabs on a daily basis,” Kluver told the Iowa Independent in a telephone interview.

“Merging support for veterans with lottery tickets is an unfortunate aspect from our perspective,” Kluver said. “Our clients, who already have gambling problems, don’t need another reason or excuse to go out and buy another scratch ticket. They can certainly find enough reasons or excuses on their own, and this will merely supply them another reason.”

“Thankfully, not everyone has a gambling problem; it is just unfortunate that we have to turn to the lottery, especially from a gambling treatment counselor’s perspective, who sees people fueled by these types of addictions,” Kluver said. “It is unfortunate that veterans are not getting the care and service they deserve and should be getting, without having to depend on the lottery.”

Kluver, however, said that the state of Iowa is lucky that does have a program it can turn to increase funding for veterans they need. “I realize it’s not possible to find a program that makes everyone happy,” Kluver said. “But if people really want to help veterans, then they should donate money directly to them, which would be better than going out to buy a bunch of scratch tickets.”

Department of Public Health officials plan for public input on the rules, to be used as written for some time to enforce the ban, which goes into effect July 1. The Iowa Smoke Free Air Web site will soon feature a tool by which visitors can submit comments on the rules. This function will be available by June 15th and will remain active until the formal public comment period ends August 6th. The rules may be amended based on the additional comments — but any significant changes, such as an exemption for, say, indoor smoking in bars, would require legislative action.

As reported earlier by Iowa Independent, the draft rules, crafted with the intent of lawmakers in mind after after collaborative sessions involving the attorney general’s office, permit smoking on outdoor patio area of bars but not restaurants. The distinction between bars and restaurants is generally clear, but in the gray areas, the IDPH says “bars” serve food that is pre-packaged and “incidental” to the business, and cannot make and sell food from scratch if a smoking patio is desired.

One provision that is sure to spark some controversy is that no distance requirement from doors are in place for outdoor smoking as in other places, such as Washington State.

Casino gaming areas (but not stand-alone bars), 20 percent of rooms in hotels, the Iowa National Guard, the state’s Veterans Home and private residences are exempted from the ban.

Public health officials in the rules and in interviews with Iowa Independent have said the law is intended to be implemented largely through voluntary compliance and education. But the rules do say the IDPH may refer complaints regarding the law to “designated law enforcement authorities.”

One element of the ban that may strike some as unnecessary — since indoor public smoking is virtually eliminated — is that all public places and places of employment where smoking is not allowed must post non-smoking signs that can be downloaded at the Smokefree Air Act Web site.

“Sometimes people think it’s not going to happen to me because I live in Iowa,” said Patricia Young, HIV/AIDS/Hepatitis program coordinator with the Iowa Department of Public Health. “Sometimes until you know somebody who is living with HIV, it’s hard to understand it.”Iowans diagnosed with HIV infections last year rose to the highest level since reporting began in 1998, according to the Iowa Department of Public Health.

About 300 people are expected to attend the two-day conference, “Unity and Diversity: The Challenge for Change,” on June 3-4 at the Des Moines Airport Holiday Inn. The conference begins at 8:30 a.m. both days. Prospective attendees include health professionals, people living with HIV, community advocates and volunteers, among others.

The keynote speaker is Mindy Thompson-Fullilove, a research psychiatrist from the New York State Psychiatric Institute and professor of clinical psychiatry and public health at Columbia University. She has conducted research on AIDS, poor communities, and the connection between the collapse of communities and declining health. She will discuss overcoming societal and other barriers to bring people together.

More than two dozen sessions will cover a variety of topics, which include new prevention and care efforts using the Internet, reversing the HIV epidemic among gays, and AIDS and the black church. Other conference topics include HIV and sexually transmitted disease prevention and care; helping people change risky behaviors; developing and strengthening community partnerships; and care and treatment options.

One of the sessions will emphasize the need for family doctors to offer HIV testing during routine patient visits to help “normalize” HIV tests, Young said.

“Hopefully, this will decrease the stigma,” Young said.

The conference, which also includes information about hepatitis infections, is still accepting registrations.

“We wanted to make this conference very practical,” she said. “We really wanted to have some honest conversations about this and how it affects Iowans.”

With 17 licensed casinos across the state, almost 7 million Iowans gamble every year — and thousands of them report problems.

In February, the most recent data available, 695 people called the the state’s gambling hot line, I-800-Bets-Off (1-800-238-7633). The majority inquired about treatment for themselves or loved ones, the data show. Nearly 7,400 people called the hot line in 2007. The expansion of Iowa’s billion-dollar gambling industry is on hold for now, thanks to the Iowa Racing and Gaming Commission, which voted last month not to approve new casino licenses.

But many Iowans remain oblivious to the negative effects that gambling can have on individuals and their families, counselors warn.

“People really aren’t aware of the issues,” said Jill Jordahl-Ball, clinical coordinator at Problem Gambling Services in Des Moines. “Iowa has some pretty high statistics for issues of gambling.” 

Nearly 200 people will seek treatment services this year through the program, she said. Overall in 2007, 527 Iowans received gambling treatment services, according to state data provided by Jordahl-Ball. Slightly more men than women received treatment. Fifty percent, or 287 people, reported gambling debts of $5,000 or more. About 15 percent, or 77 people, were arrested because of gambling. The majority of people reported playing slot machines, followed by table games.

More than 2,400 people have voluntarily agreed to ban themselves from gambling venues, according to the Gaming Commission report. Gamblers on the list forfeited winnings of more than $500,000 to the Iowa Gambling Treatment fund. The Iowa Legislature this year considered allowing people to revoke the self-ban after certain criteria were met, but the proposal was defeated.

“Gambling addiction is devastating,” said Kim Rezarch, a counselor at Problem Gambling Services.  “People don’t understand it and what it does to people and families.”

“[Gambling is] a form of entertainment for a lot of people,” she went on. “For the majority of people, it’s fun. It’s a place to go. You lose $50 and you walk out,” Rezarch said. “For the people who are addicted, it’s devastating. It’s not just, `Well, I wish I could stop.’ It’s all-consuming.

“It’s as much of an addiction as cocaine, heroin or anything else,” Rezarch said. “Research shows it has the same chemical impact on the brain as a cocaine addict. It sends the same signals to the brain. I’ve worked in substance-abuse treatment for 10 years and this is much more devastating.”

In just six months working with problem gamblers, Rezarch has heard it all. One client lost $1 million at Prairie Meadows Racetrack and Casino. Some clients face prison sentences for embezzling money from their employers in order to gamble. One stole money from a church. Others lost businesses and homes. Some ban themselves from the casino for life, but sneak back inside, risking criminal charges.

“How do I get my mother out of the casino?” one person asked. “She’s been there for two days.”

People tend to underestimate the effects of problem gambling and aren’t aware of the different factors pointing to a problem. The warning signs include a preoccupation with gambling, using gambling as an escape, trying to win back money that was lost gambling, loss of interest in other activities, lying about wins and losses and betting until the last dollar is spent, according to the Iowa Department of Public Health. 

“People might have an idea that they’re gambling, but they have no idea that they’re leaving work to go [gamble],” Rezarch said, “that they’re pretending [to their families] to be at their friend’s house but they’re really going to Prairie Meadows. It’s very secretive because the debt — the finances are what’s at stake — so they’re not going to tell their spouse.”

Spouses of problem gamblers can sometimes get hit with a bombshell.

“I have a client who called his spouse and said, ‘By the way, the bank is coming to foreclose on our house in a half an hour. I lost everything gambling and we’ve got to move,’” Rezarch
said.

Casinos, with the bright lights, dinging machines and people meandering about, can be very seductive, Rezarch said, and it fills a void for a wide variety of people.

“The thing about gambling and alcoholism is that your body quits after awhile. You can only drink so much and then you pass out,” she said. “People gamble for 30 years, and it becomes so much a part of everything they are, that it’s their identity.”

Not all Iowa communities, however, are gung-ho about gambling. Just this week, 62 percent of Jasper County residents voted against bringing a casino to the Newton area.

Hope Through Treatment

Problem Gambling Services is a part of a non-profit organization called Mid-Eastern Council on Chemical Abuse or MECCA, which also offers community-based substance abuse and behavioral health services. The organization has a facility on the east side of Des Moines. A second location opened last November on the city’s northwest side to serve west-side and suburban clients. MECCA is working with nine Iowa counties and received a grant from the Iowa Department of Public Health to offer the services. Counselors also work with the state hot line.

The problem gambling program offers the first four hour-long sessions for free. There is also individual and group counseling. Other services include financial counseling and transitional housing for gamblers who have lost their homes or whose home environment is not conducive to helping them recover. Fees are based on a sliding scale, with gambling debts taken into consideration.

“Our counselors really meet the person where they’re at,” said Jordahl-Ball. “If someone calls into 1-800-Bets-Off just with a couple questions, that’s OK. They’re not forcing treatment. They’re not judged by any means. They’re met where they’re at, at that moment. We work with them to get them where they need to be.”

The number of gambling assessments and evaluations Rezarch does is on the rise, she said. During an evaluation, she and clients talk about what brought the person to the facility and what kind of gambling they engage in.

“With the background they tell me, I can pick up a few things of what kind of gambler they are. . .There’s a variety,” she said. “You can kind of tell the difference between someone who plays slots for three days straight to someone who goes and won’t leave a poker table.”

Clients then complete a Gambler’s Anonymous questionnaire and another screening tool. Rezarch explains the results to them. “You meet the criteria of pathological or addicted gambler based on what you reported,” she said. Then she tells them what it means.

“It’s usually something that they already know,” she said. “For people who don’t really think they have a problem, or usually it’s that they think they can control it, it might open their eyes a little bit.”

She also talks to them about treatment options, and depending on what their emotional state is, she conducts a mental health assessment.

Some people try to manage themselves via the state’s lifetime self-ban program. The self-ban works for some, but not others, Rezarch said. She has clients who haven’t gambled in more than five years who didn’t place themselves on the list. One client who self-banned was arrested once but has returned to Prairie Meadows about 20 times, she said.

“If you are absolutely ready to start working on your recovery and you think banning is going to be the first step in that, then I encourage it 100 percent,” she said.

But she doesn’t tout it for people who have any doubts about it.

“I don’t encourage them to get banned because in reality they’re going to the casino, and if they’re caught, it’s criminal charges on top of whatever else they’re dealing with,” she said.

That’s why Jordahl-Ball and Rezarch agree increasing awareness about gambling problems and emphasizing prevention are key.

Iowans need to start looking at their own behaviors and the behaviors of others in their lives — how much time is spent gambling and if the amount of time spent on gambling seems “normal,” Rezarch said.

“If my husband is going out to the casino four times a week, that’s probably not a good idea,” she said.

People also need to be aware of family finances.

“Generally what brings people here is debt,” Rezarch said. “They have lost something, and they’re about to get in big trouble financially. And they’ve had to come clean to their spouse. “

Jordahl-Ball said they want to help more clients before they hit bottom. She said counselors will give presentations to any company, agency, school or organization and do a one-minute to three-hour presentation about the warning signs and prevalence of gambling problems in Iowa.

“It is an issue that we need to be aware of,” she said.

Increasing awareness about the problem ultimately could lead more people to seek treatment before their lives are in shambles.

“With any addiction, if you work out all your issues, you can overcome it,” Rezarch said.
]]> http://iowaindependent.com/2193/the-hidden-human-toll-of-problem-gambling/feed 0 http://iowaindependent.com/1810/callers-flood-states-hot-line-for-free-nicotine-patches http://iowaindependent.com/1810/callers-flood-states-hot-line-for-free-nicotine-patches#comments Wed, 09 Jan 2008 20:21:16 +0000 Dana Boone http://iowaindependent.com/1810/callers-flood-states-hot-line-for-free-nicotine-patches Thousands of Iowans this month have flooded the state’s smoking cessation hot line with calls since it began offering free nicotine patches and gum, state health officials said.

The Iowa Department of Public Health began offering the nicotine patches and gum through the state’s “Quitline” at 1-800-QUIT-NOW or 1-800-784-8669. The free, confidential program is for Iowa smokers 18 and older who want to end their dependence on cigarettes and other tobacco products. The nicotine patches and gum help reduce the symptoms of withdrawal, health officials said.

State officials said the hot line has received 2,560 calls since Jan. 1.

“We did expect high call volume because of New Year’s resolutions and because of the offer of free nicotine patches and gum,” said Don McCormick, a department spokesman.

To receive a two-week supply of the nicotine patches and gum, participants must agree to take a brief health assessment and accept two follow-up calls from trained phone coaches. Participants also can sign up for ongoing support through eight additional calls from phone coaches.

Bonnie Mapes, director of the department’s Division of Tobacco Use and Prevention and Control, stressed the importance of the ongoing phone coaching and support.

“The reason we want them to do that is that telephone coaching doubles a person’s chances of quitting,” she said.

Of the 2,560 callers during the program’s first week, 2,151 requested the nicotine patches and gum, and 1,323 agreed to the telephone coaching.

“We’re encouraging people to sign up  for both,” she said. “I’m pleased to see that many people have done that.”

The program, financed in part by last year’s $1 tax increase on cigarettes, is part of several departmental efforts to improve the health of Iowans. Smoking can cause many diseases, including heart and lung disease and cancer, and is the leading cause of preventable death in the United States, Mapes said. The biggest killer of smokers is heart disease, she added, since smoking increases blood pressure and burdens the heart.

“As soon as you stop smoking,” she said, “the burden goes away.”

Yet many longtime smokers believe they won`t reap health benefits if they quit, Mapes said.

“That isn’t true at all,” she said. “Don’t think that just because you’ve smoked for 30 years that it’s too late. There are immediate and long-term benefits to quitting no matter how long you’ve smoked.”

People who quit also realize a financial benefit, she said. The average smoker goes through a pack of cigarettes a day at a cost of nearly $5 a pack, she said.

“It’s a huge monetary impact not just for the smoker, but for their family,” she said. “That’s the price of a gallon of milk. It’s an impact on the nutrition of the family.”

The state’s most recent adult tobacco survey, conducted in 2006, found that smoking is on the decline among Iowans who participated in random computer-assisted telephone interviews:

  * 18 percent of Iowans smoked cigarettes in 2006, down from 23 percent in 2002.
  * 34 percent of Iowans aged 18 to 24 smoked cigarettes.
  * 72 percent of smokers surveyed in 2006 wanted to quit smoking.

“It’s a drug addition,” Mapes said. “It’s not some habit. It isn’t a matter of choice. Ask any smoker and they’ll tell you that. The vast majority of them recognize that. . . . It`s not that they don`t want to quit.”

Data from the health department also show that in 2006 slightly more men smoked than women, 23 percent and 19 percent, respectively; and 21 percent of whites smoked, compared with 28 percent of other ethnic groups, which were not disaggregated in the report.

“We know that African-Americans are disproportionately affected by smoking,” Mapes said. “As adults, African-Americans have a higher smoking rate, and they tend to suffer more from smoking effects.”

Iowans with incomes below federal poverty guidelines were more likely to smoke, according to the report. Also, Iowans with general educational development certificates and high school diplomas were more likely to smoke than those with higher educational levels, the report found. 

Iowa smokers who qualify for the Medicaid program are eligible to receive up to 12 weeks of free nicotine patches and gum, but must first get a referral from their health care provider before calling the hot line  to sign up, Mapes said.

The program likely will run through 2011 as long as money is available, McCormick said. Smokers can take advantage of the program once a year, he said.
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Iowa’s “QUIT-NOW’ smoking cessation hot line:

Dial 1-800-QUIT-NOW or 1-800-784-8669 to sign up for the state’s free, confidential program, which offers nicotine patches and gum. The kits are shipped to participants within 24 hours.

The telephone line is open from 8 a.m. to 10 p.m. Monday through Friday and 9 a.m. to 5:30 p.m. on Saturday and Sunday. English-and Spanish-speaking counselors are available.

Beginning Monday, the hot line’s hours will extend from 7 a.m. to midnight Monday through Thursday, 7 a.m. to 9 p.m. Friday and 8 a.m. to 7 p.m. Saturday and Sunday.
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