PPAC Central

August brings with it a special reason to celebrate – National Family Fun Month. This wonderful occasion reminds us of the importance of spending quality time with our loved ones, creating cherished memories that last a lifetime. At the heart of this celebration stands the Wellsville YMCA, a place where families come together to experience joy, unity, and inclusivity.

The Wellsville YMCA goes above and beyond to make not only National Family Fun Month but a year full of an unforgettable experience for families. Throughout the year, the YMCA organizes a myriad of family-oriented events that cater to diverse interests and age groups like our Color Run, Golf Tournament, Trunk or Treat, Zombie Run, and Parent’s Night Out. The YMCA’s commitment to creating a welcoming atmosphere ensures that families of all shapes and sizes can come together to create cherished memories.

The spirit of National Family Fun Month extends beyond just the joy of participation; it’s about ensuring that every family can take part, regardless of their financial circumstances. The Wellsville YMCA’s financial assistance program plays a crucial role in making this a reality. By removing financial barriers, the Wellsville Y opens its doors to all families, enabling them to join in the festivities and experiences. This program aligns perfectly with the core values of National Family Fun Month, emphasizing inclusivity and the importance of family bonds.

The YMCA strives to be a haven of inclusivity, recognizing and embracing the diversity that enriches our communities. The Y goes the extra mile to ensure that families from various backgrounds feel welcome and valued. Collaborations with local organizations and community groups further enhance the inclusive environment, offering families the chance to connect with others who share their experiences.

As families gear up to make the most of National Family Fun Month, a few tips can help enhance their experiences. Encourage families to plan ahead and explore the diverse range of events the Wellsville Y offers. Trying out new activities together can be a great way to discover shared interests and passions. Additionally, connecting with other families during these events can lead to lasting friendships and a sense of belonging within our community.

Behind every event and program lies the real impact on families’ lives. Stories from families who have benefitted from the YMCA’s offerings highlight the transformative power of family-centered activities. These stories remind us that National Family Fun Month is not just a fleeting celebration but a source of lasting memories that shape family bonds and well-being. Through the YMCA’s efforts, families have found a place to create cherished moments that stand the test of time.

Visit Wellsville YMCA to learn more about what the YMCA has to offer or visit www.twintiersymca.org to learn about other locations’ programs

OR

Tyler Green | Associate Executive Director | tylerg@twintiersymca.org

Brianna Simms | NYS Executive Director of Childcare | briannas@twintiersymca.org

Kara Livermore | Director of Childcare | karas@twintiersymca.org

The Allegany Council on Alcoholism and Substance Abuse, Inc. (ACASA) is celebrating its 50^th year in service to Allegany County. The agency was established in 1973 as an information and referral service for residents of Allegany County. Since then, the agency has grown into three primary areas of service. These divisions are Outpatient Clinical Services, Prevention Education, and Residential Services.

 Allegany Council on Alcoholism and Substance Abuse, Inc. began to provide formalized counseling services in 1975.  The need for these services continued to grow over the next few years.  Then in the early 1980’s the clinical services for Allegany Council received licensure by the State of New York for the provision of Substance Abuse counseling services.  Over the next 40 years Allegany Council’s clinical services continued to maintain its licensure from New York State as a local treatment option for Allegany County Residents.

Today Allegany Council’s Outpatient Clinic provides multidisciplinary treatment to any person either referred or self-directed whose lives have been affected by alcohol and/or substance abuse. All our full-time counselors are licensed or certified by New York State and are available to deliver a wide range of evidence-based services. The clinic also has a Physician and nursing staff for the provision of Medically Assisted Treatment for opioid and other substance abuse addiction. We have added New York State certified Peer Advocates to our staff to help with outreach and engagement in the community.

The Prevention program really began to grow in 1977.  At this time the Prevention Education program began to start its outreach into the schools to initiate prevention education programs for school teachers and other school personnel.  The Prevention Education program has continued to grow over the years and continues to expand its scope of service.  The Prevention Program has grown to the point of providing New York State certified staff directly to the schools for the provision of evidence-based curriculum activities to 11 Allegany County school districts. This department also provides outreach to community agencies for prevention and education on Substance Abuse. This service to Allegany County is spearheaded by a community coalition called Partners for Prevention in Allegany County or PPAC.

The Residential division for the Allegany Council was established in 1986, the Trapping Brook Halfway House in Wellsville.  This Community Residence had a capacity of 15 beds to provide service for those individuals in recovery.  The Residential Program continued to grow and in 1990, Supportive Living facilities were added to the continuum of care for Allegany Council.  The Supportive Living program provides a place for individuals that have successfully completed halfway house treatment, to continue their recovery in a safe, sober environment. Currently Allegany Council continues to provide both services and currently operates a 17 bed Community Residence along with 8 Supportive Living beds in the community.

Allegany Council is an active member of the Allegany County community-based providers and works closely with many of the local social service agencies directly or through local coalitions. If you would like more information on Allegany Council, please go to alleganycouncil.org or ppaccentral.org. We would be happy to answer any questions or provide referral information, just email us at info@alleganycouncil.org or call the Outpatient Clinic at 585-593-6738.

Since 1992, the World Alliance for Breastfeeding Action (WABA) coordinates the World Breastfeeding Week (WBW) – a global campaign that aims to inform, anchor, engage and galvanize action on breastfeeding and related issues. Breastfeeding is one of the best investments in children’s and women’s health and survival. Breastfeeding could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual maternal deaths from breast cancer. However, workplace limitations remain the most common reason for women to never breastfeed or to stop breastfeeding earlier than recommended by World Health Organization (WHO) and UNICEF, or than they want themselves.

Only 10% of countries globally meet the International Labor Organization (ILO) standards on length, level of payment, and source of benefits of maternity leave. Even with adequate maternity and parental leave, lack of support for breastfeeding at the workplace can undermine breastfeeding. Only about 20% of countries meet ILO standards on provision of nursing breaks and facilities.

There is a need to improve access to paid maternity leave, and other breastfeeding services for women both inside and outside the workplace. Workers in the informal economy are particularly vulnerable and need attention because maternity entitlements remain inaccessible for many of them, especially in low- and middle- income countries.

Taking care of a newborn is a shared responsibility of all parents, thus the importance of the right to paternity leave to promote greater involvement of fathers in care responsibilities. Fathers need specified paternal leave, and parental leave should be granted, meaning the allocation of a period of leave to be shared between the two parents or partners. The purpose is to ensure that fathers or partners share childcare and domestic responsibilities equitably and reduce the gender gap.

#WBW2023 focuses on breastfeeding and employment/work. It aims to show the effect of paid leave, workplace support and emerging parenting breastfeeding norms, as parents themselves see them.

Target audiences, including governments, policymakers, health sectors, employers, communities, and parents, will all see that they have critical roles in empowering families and sustaining breastfeeding-friendly environments in the post-pandemic work life balance.

For local resources on breastfeeding contact the Allegany County Department of Health’s WIC Program (585) 593 – 2533. Also, follow them on Facebook at AlleganyCountyWIC, Instagram at alleganycowic, and Twitter at AlleganyCo_WIC.

July is Disability Pride Month. It is a time to celebrate Disability Pride; honoring the diversity within the disability community, reflecting on issues that people with disabilities are facing, and inspiring action to make the world more inclusive and accessible.

Disability Pride Month occurs in the United States every July to commemorate the passing of the landmark Americans with Disabilities Act (ADA) in July 1990. Celebrations are held all over the United States, as well as the United Kingdom, and South Africa.

Disability Pride celebrates all 1 billion people with disabilities, their identities and culture, and their contributions to society. It also seeks to change the way people think about and define disability, to end the stigma of disability, and to promote the belief that disability is a natural part of human diversity in which people living with disabilities can celebrate and take pride.

Embracing being different is what this month is about. It is a chance for people who live with a disability to take pride in being different and to show that they are part of the community, too.

Many people who see the word PRIDE during Disability Pride Month assume it is to recognize people with disabilities in the LQBTQIA+ community, but that is not the case. While it is important to recognize the disability PRIDE community, this month is for people with any disability, from Down syndrome to a physical disability to an unseen disability.

The Disability Pride Flag was created by Ann Magill and updated in 2021 to ensure accessibility, each color of the Disability Pride Flag represents a different type of disability: physical (red), cognitive and intellectual (yellow), invisible and undiagnosed (white), psychosocial (blue), and sensory (green).

Join The Arc Allegany-Steuben in celebrating Disability Pride Month in July by building more inclusive communities through awareness and acceptance and encouraging allyship and positive action.

Individuals often ignore the positive aspects of spirituality as it relates to recovery from addictions, trauma and various mental health issues.

The Substance Abuse and Mental Health Services Administration (SAMHSA), under the U.S. Department of Health and Human Services (HHS), says that:

“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”

Leaders at Allegany Hope have found this determination flashed on the screen over the years near the beginning of many training sessions on healing from trauma, but the spiritual well-being component ia promptly forgotten as the focus turns strictly to the mental health practices.

Our holistic health approach for Building Healthy Communities Through Health Families, however, focuses on what we describe as a three-legged stool approach in regard to holistic health:  physical, mental/emotional and spiritual.  When any one leg is or becomes shorter than the others, we find it often results in one’s life being thrown out of balance, thereby impacting the other two supporting legs.

The Federal Emergency Management Agency (FEMA) recognizes the important of the spiritual component for holistic recovery in times of disasters, encouraging building of a “Whole Community Approach to Emergency Management” which enlists faith communities for response to crises.

The HHS, in its “Youth Mental Health and Well-being in Faith and Community Settings:  Practicing Connectedness” toolkit, notes that “faith can be a community of belonging, connection and support” for many youth.  The agency has established a Center for Faith-based & Neighborhood Partnerships to aid in connecting communities with churches and other faith-based community organizations.

The Veterans Administration National Center for PTSD highlights the “Relationship of Trauma to

Spirituality,” as it describes “Spirituality and Trauma: Professionals Working Together.”

The Centers for Disease Control and Prevention (CDC) even publishes resources on how faith communities can aid in providing support to individuals in need of managing diabetes and smoking cessation.

SAMHSA notes in a report on “Promoting Wellness for Better Behavioral and Physical Health”

that “wellness is a holistic approach to health that is vital for improving outcomes among people with behavioral health conditions.”

Allegany Hope’s work in facilitating Christ-centered GriefShare and DivorceCare groups has found repeatedly that individuals embracing spiritual healing can discover significant victories in recovery from these traumas, often in shorter times to do so.

Celebrate Recovery and faith-based fatherhood initiatives, both inside and outside jails and prisons, have helped turn around destructive patterns for both individuals and their families.

Thus, the importance of spirituality and connection with safe faith communities shouldn’t be ignored by either individuals in various levels of crisis or those seeking to assist them.

Remember Prevention Works!

Casey Jones is president of Allegany Hope, a Christ-centered nonprofit ministry, who has been a facilitator for GriefShare, How to Help Grieving Children, DivorceCare, Life’s Healing Choices, Celebrate Recovery, Celebrate Recovery Inside (jails and prisons), InsideOut Dad, Malachi Dads, and other recovery ministries  He can be reached at AlleganyHopeWNY@outlook.com.

On Saturday, April 22 the Allegany County Spring Pill Drop was held in conjunction with the Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day. Friendship and Wellsville were chosen for the spring locations.  The pill drop event allows the community to drop off unused, expired, or unwanted medications, needles/sharps, and provides the opportunity for education on the location of the fourteen Take It to the Box locations throughout Allegany County.  

This event was held in partnership with the Allegany Council on Alcoholism and Substance Abuse, Inc.(ACASA), the Allegany County Sheriff’s Office, and Partners for Prevention in Allegany County(PPAC). Medications were accepted from 10am to 2pm, and between the two locations, a total of 11 cars participated and 40 pounds of medications were collected. “The DEA’s Take Back Day allows us to provide a needed resource for our citizens and help educate them on the proper disposal of medications, this in turn helps to keep these medications out of the wrong hands and from contaminating our environment,” stated Undersheriff Walt Mackney.

Each car that stopped received a Deterra bag, to dispose of medications properly at home and a Take It to The Box magnet, which lists all of the pill drop box locations throughout Allegany County, which includes:

• Alfred Pharmacy, 36 North Main Street, Alfred, NY 14802.
• Alfred State’s Office of University Police, 10 Upper College Drive, Alfred, NY 14802.
• Allegany County Sheriff’s Office, 4884 NY-19, Belmont, NY 14813.
• Cuba Pharmacy, 2 Center Street, Cuba, NY 14727.
• Cuba Police Department, 15 Water Street, Cuba, NY 14727.
• Fillmore Pharmacy, 10560 NY-19, Fillmore, NY 14735.
• Fisher’s Pharmacy, 138 North Main Street, Wellsville, NY 14895.
• Friendship Pharmacy, 9 West Main Street, Friendship, NY 14739.
• Jones Memorial Hospital, 191 North Main Street, Wellsville, NY 14895.
• Jones Memorial Medical Practice, 20 Main Street, Andover, NY 14806.
• Jones Memorial Medical Practice, 120 First Street, Bolivar, NY 14715.
• Nicholson Pharmacy, 36 Schuyler Street, Belmont, NY 14813.
• Tri-County Family Medicine, 12 North Church Street, Canaseraga, NY 14822.
• Wellsville Police Department, 46 South Main Street, Wellsville, NY 14895.

In 2022, 1,800 pounds of medications were collected from the pill drop box locations by the Sheriff’s Office. “The pill drop boxes continue to be used more and more by the community, which makes the pill drops less active than prior years, but the goal is for people to not hold onto their unused or unwanted medications,” states PPAC Coalition Coordinator Jon Chaffee.

More information about the pill drop box locations can be found at https://ppaccentral.org/takeittothebox/ .

The pill drop events and boxes are completely anonymous and confidential. The collected medications are transported to an undisclosed location for incineration by the Allegany County Sheriff’s Office. Incinerating the medications makes them useless to people and harmless to the environment.

Allegany County also has free sharps/needle disposal available at all Allegany County Transfer Stations. The days and times that these locations are open are different per location. Below is a listed of all the locations.

• Alfred, 394 Satterlee Hill Road. Open Friday, and Saturday 8am to 3:30pm.
• Belmont, 6006 County Road 48. Open Tuesday through Saturday 8am to 3:30pm.
• Bolivar, 135 Reed Street. Open Wednesday, Thursday, and Saturday 8am to 3:30pm.
• Canaseraga, 89 West Main Street. Open Saturday 8am to 3:30pm.
• Caneadea, 9425 Molyneaux Road. Open Wednesday and Saturday 8am to 3:30pm.
• Cuba/Friendship, 7912 County Road 20. Open Thursday and Saturday 8am to 3:30pm.
• Wellsville, 77 Dyke Street. Open Tuesday through Saturday 8am to 3:30pm.

For any questions on the Allegany County Sharps Disposal Program contact Recycling Coordinator Tim Palmiter (585) 268-7282. More information about the Sharps Disposal Program can be found at https://ppaccentral.org/needledisposal/ .

The agencies involved would like to send out a special “Thank You” to the Friendship and Wellsville Fire Departments for giving us a space to hold the pill drop event. The next pill drop event will be held in October, 2023. 

The Office of Cannabis Management (OCM) has announced that licenses for recreational cannabis dispensaries will start to be processed for Western New York. Currently, there are no licensed dispensaries in Western New York, which means that none of the cannabis products being sold at current businesses have gone through New York testing requirements, where or how the product has been grown or processed, or percentage of tetrahydrocannabinol (THC) the product contains. All licensed cannabis dispensaries will have a placard with a QR code that customers can scan to verify the business is licensed. OCM has a verification tool on their website that lists all New York licensed cannabis dispensaries, if a store is not on this list that means it is not a licensed dispensary.

Even though possession and use of cannabis has been legal for over a year in New York for adults 21 and older there are still several misunderstandings over what is legal and not legal.

• It is legal for an adult 21+ to possess 3 ounces of cannabis and 24 grams of cannabis concentrate.
• It is legal for an adult 21+ to “share” cannabis with another adult 21+ under the legal limit, without compensation. It is illegal to distribute or sell cannabis without a license.
• It is legal for adults to consume cannabis in private homes and places where tobacco can be smoked. Smoking cannabis is illegal in private businesses, in a vehicle, or any place tobacco cannot be smoked. In October of 2022, New York made all state parks and other public outdoor spaces smoke-free of cannabis and tobacco. 
• It is illegal for driver or passengers in a vehicle driving or parked to be using cannabis.
• It is illegal to drive under the influence of cannabis.

These are just some of the more common questions or comments from the public pertaining to what is legal and illegal. For more information people can visit www.cannabis.ny.gov/adult-use .

Young people also have misconceptions about cannabis that adults need to help them understand, especially that legal does not mean safe. Science has shown that THC can affect the developing brain, which is not fully developed until age 25-26. The part of the brain that is responsible for making decisions (the prefrontal cortex) is one of the last parts of the brain that develops and is particularly impacted by cannabis use. Negative cognitive effects can include difficulty thinking and solving problems, problems with memory and learning, reduced coordination, difficulty maintaining attention, and problems with school and social life after consistent consumption.  Frequent cannabis use in youth can increase the risk of mental health issues, including depression, social anxiety, acute psychosis, and schizophrenia. Cannabis consumption, especially frequent (daily or near daily) consumption and consumption that begins at an early age has been associated with schizophrenia and psychosis. Studies have shown that smoking cannabis exposes the user to the same types of dangerous chemicals as smoking cigarettes. A recent study out of Roswell Park Comprehensive Cancer Center found that vaping cannabidiol (CBD) leads to more severe lung damage than vaping nicotine.

Parents and mentors: You can impact whether the young people in your life consumes cannabis. Start the conversation with them early and have it often. Conversations about substance use should not be one sixty-minute conversation, but sixty, one-minute conversations. Make sure they understand the consequences and the negative impact it can have on their growing, developing brain. Pre-teens, teens, and young people in their early 20s tend to seek out new experiences and engage in risky behaviors, like using cannabis.  For conversations resources visit www.talkitover.org .

Parents and community members can also follow PPAC Central on Facebook, Instagram, and Twitter to receive current information on resources, activities, and family events.

This March 20th marks the 13th National Drug and Alcohol Facts Week (NDAFW), first launched in 2010 by the National Institute on Drug Abuse (NIDA).  The purpose of this week is to counteract the myths that youth get from the Internet, television, movies, music, or friends, and replace those myths with scientific facts about substances, addiction, and health. 

Listed below are teens’ ten most frequently asked questions from more than 118,000 queries received over the years during NDAFW.

10. Why do people use drugs when they know they might cause problems?

9.  What are the effects of drugs like Xanax and Percocet?

8.  What are bath salts?

7.  Can you get addicted to ADHD meds?

6.  Is vaping bad for you even if it’s just flavoring?

5.  How can I help someone with a problem stop taking drugs?  How can I help if they don’t

     want help?

4.  If a pregnant woman takes drugs/smokes/drinks alcohol, what happens to her baby?

3.  Can marijuana be used as medicine?

2.  Which is more habit-forming: smoking cigarettes or vaping nicotine?

1.  What is the worst drug?

Answers to these questions can be found by visiting “Start a Conversation: 10 Questions Teens Ask About Drugs and Health”.  The NIDA/NIH website is a wealth of information that includes the reasons for studying addiction in teens, signs and symptoms of drug use, video clips on the brain, and other related topics. The more informed our youth are about substances and the negative impact those substances can have on their lives, the less likely they are to engage in risky behaviors.

According to the local Allegany County data from the 2021 Risk and Protective Factor Survey, 12^th graders reported the following related to 30-day substance abuse.  74.1% had NOT used alcohol; 95.9% had NOT used traditional cigarettes; 72.4% had NOT used e-cigarettes; and 84.1% had NOT used marijuana.  We can all do our part by supporting our youth, getting the facts, and reminding them that NOT all youth are using substances, which is a popular myth among this population. 

You can help educate the young people in your life by sharing the below social media posts.

Remember, Prevention Works!

Resources

#onecaringadult

Talk 2 Prevent

Talk It Over

Did you know that March is Problem Gambling Awareness Month (PGAM)? With the expansion of gambling opportunities in NYS the gambling landscape has drastically changed.  This increase in accessibility and availability is putting more people at risk, making the work of raising awareness of problem gambling more important than ever before. 

Gambling means risking something of value on a game of chance in the hopes of a positive outcome. While many people participate in gambling activities, for some it can lead to problems.

Simply put, problem gambling is when gambling starts having a negative impact in your life. This impact can lead to gambling disorder or gambling addiction. The consequences can affect one’s mental health, damage relationships, create difficulty at work or school, and lead to financial problems.

Problem gambling can affect anyone, at any point in their lives and can also affect friends and families of those struggling with their gambling.  Often family members find themselves worried about loved ones, trying to help financially, and wondering how best to handle the situation. NYCPG provides connections to individualized support including counseling, peer support and referrals to anyone in need.

This month, the New York Council on Problem Gambling (NYCPG) and the Western Problem Gambling Resource Center is asking everyone across New York State – individuals, agencies and communities alike – to come together to shine a light on problem gambling. Together we can raise awareness of the issue of problem gambling and get those in need connected to support services in their own community. 

To find out how you can get involved in problem gambling efforts this month, and all year round, visit NYProblemGambling.org/PGAM.

The Western Problem Gambling Resource Center (PGRC) is a program of the New York Council on Problem Gambling dedicated to addressing the issue of problem gambling within New York State. The vision of the PGRC is the positive transformation of lives harmed by problem gambling. The PGRC focuses efforts on increasing public awareness of problem gambling; connecting clients with treatment, recovery and support services; working with the gaming industry to promote responsible gambling; and promoting healthy lifestyles which foster freedom from problem gambling. If you or someone you know needs help with a gambling problem, please call 716-833-4274 or email WesternPGRC@nyproblemgambling.org for confidential assistance. 

Smokeless tobacco contains 2,000 chemical compounds, including thirty that can cause cancer, such as formaldehyde, nickel, cadmium, and radioactive Polonium 210. The level of cancer-causing agents is as much as 100 times higher in smokeless tobacco than in other tobacco products.  These agents and other chemicals in smokeless tobacco cause rotting teeth and cancer in the mouth, esophagus, and pancreas. They can also cause gum disease, heart disease, and precancerous mouth sores. Treatment of oral cancers can result in removal of tissue and bone, including the tongue and jaw. 

Governor Hochul has proposed adding to the flavor ban in e-cigarettes to include banning flavors in all tobacco products, including smokeless tobacco products and menthol in cigarettes. The focus on banning flavors is not a new idea as flavors except menthol were banned in cigarettes in 2009, as the majority of young people who stated they smoked, smoked a cigarette that was flavored.

A study done by the Truth Initiative shows that 69% of youth (12-17 years-old) who first used a smokeless tobacco, used a flavored smokeless product. Research has shown that youth and young adults perceive flavored tobacco products as more appealing, better tasting and less harmful that non-flavored tobacco products. Flavors, especially sweet and fruit flavors, play a role in influencing tobacco use or experimentation in youth and young adults. Companies have also increased their flavor offerings to attract new users. For example, a study of internal tobacco industry documents found that smokeless tobacco product manufacturers added flavors to their products to attract new users, especially young males. The flavoring masks the harshness of the tobacco products which makes them more addictive and harder to quit. According to the Centers for Disease Control (CDC), flavored tobacco is more addictive than regular tobacco products.

Several studies of flavor restrictions at the state or local level, as well as the federal level, show that these policies do have positive impacts, especially on access to flavored products and in reducing youth use of tobacco products.

Tips for quitting include “S.T.A.R.”: setting a date, telling people about the quit attempt, anticipating challenges, and removing triggers.  Prior to the “Great American Spit Out” date of 2/23, all tobacco products, spit cans, etc., must be discarded.  A teeth-cleaning should be scheduled with the dentist, and, if there are tobacco stains on the hands, water with lemon juice is typically effective in removing those stains and smell of tobacco. The person quitting should inform as many people as possible of the quit date and must begin to think of oneself as a non-tobacco user.  This includes asking friends and family who use tobacco to either join that person in the quit attempt, or, to not use tobacco in the presence of that person and not to offer that person tobacco.  The “5 D’s” should also be practiced: drinking water to help with cravings and flush tobacco from the body; deep breathing; delaying the urge until it passes; doing something else; and discussing the issue with a supportive person.  Cinnamon sticks, cinnamon tea, cinnamon gum, and cinnamon candy all help to curb tobacco cravings.

Research has shown that tobacco users are most successful in quitting when they have some means of support, such as nicotine replacement products, counseling, prescription medications to reduce cravings, guide books, and the encouragement of friends and family.  Success rates increase when tools are combined, such as using nicotine replacement while attending classes.