Presentation on Tobacco

May 12, 2014

Smoking remains one of the leading causes of preventable illness, disability and premature death in Canada.

4 people die every day in Saskatchewan from tobacco related diseases.

Secondhand and third hand smoke affects others who are exposed to tobacco smoke including children and pets.

Two thirds of people who smoke are thinking of quitting.

www.makeapact.ca

About 77% of people in Saskatchewan do not smoke.

• Saskatchewan has one of the highest cigarette smoking prevalence rates in Canada.

• Consistent with national trends, smoking prevalence is highest among 20-24 year olds.

• Prevalence of smoking among 15-19 year olds is higher in Saskatchewan than the national average.

Government of Saskatchewan 2012

Teenage smokers are more likely to have seen a doctor or other health care professionals for an emotional or psychological complaint.

Teens who smoke are:3 times more likely than nonsmokers to use alcohol,8 times more likely to use marijuana and22 times more likely to use cocaine.

Smoking is associated with a host of other risky behaviors such as fighting and engaging in unprotected sex.

WHO: Tobacco Free Initiative 2014. Health effects of smoking among young people.

Impact on Mental Health

• 50-90% of mental health patients smoke

• 50% of all cigarettes smoked are by mental health patients

• 50% of smoking related deaths are mental health patients• Tobacco smoke affects absorption and metabolism of some

medications

CMHA April 2011

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Tobacco use is a health issue affecting the lives of

everyone… and is not “just a habit” but an

• Nicotine - powerful drug, as addictive as heroin or cocaine for

some

ADDICTION

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Quitting TobaccoThere are many reasons for quitting:• Health is usually the primary reason• CO$T can be a factor

Other motivators can play a role, such as the arrival of a new baby or thepurchase of a new home or vehicle….

When talking about tobacco use, it is important to ask about all forms of tobacco such as cigarettes, pipe, cigars, water pipes and spit tobacco….

No matter how tobacco is used, it has immediate & long-term health risks

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5 STEPS FOR QUITTING TOBACCO

1. GET READY

2. GET SUPPORT

3. LEARN NEW SKILLS & BEHAVIOURS

4. GET MEDICATION & USE IT CORRECTLY

5. BE PREPARED FOR RELAPSE

Having a Quit Plan is important to be successful in quitting tobacco

10 % of smoking is the addiction to

nicotine

90% of smoking is:

Habit and Routine

Positive association –with coffee, on the

phone, lunch breaks, etc

Socialization –fun with friends, gives you a

break, a reward, etc.

Coping mechanism –when you are

stressed, depressed, angry, etc.

This is actually the hard part of quitting. If you do some work on learning how to make new habits, routines, coping mechanisms, etc. then you have a

better chance of staying quit.

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Nicotine Withdrawal

• Fear of withdrawal can be a major barrier to quitting

• Not all experience withdrawal• Worst symptoms subside in just 72 hours &

cease in 7-10 days • Psychological symptoms:

strong cravings mood swingsanxiety crankinessdepression insomnia

Source: Ferguson.T. New York:Ballantine Books: Women and Tobacco

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What about Nicotine Replacement Therapy (NRT) ?

• Patch, gum, inhaler, lozenge and mist spray are available for purchase over the counter at supermarkets and pharmacies.

• Delivers clean nicotine at gradual doses• Doubles quit rate• With counseling, quit rate doubles again• Products have precautions

Patient concerns:

• 69% smokers believe NRT products as harmful as cigarettes

• Individuals need to receive accurate advice and clear reassurance on safety of products •British Thoracic Society 2004

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NRT Precautions• Cardiovascular Disease - caution in patients who have had a heart

attack; physician to review if even recent or disease unstable *• Diabetes - nicotine affects blood sugar levels so need to monitor *• Pregnancy - behavioral support first; if not successful in quitting need

to weight risk benefit of NRT. Risks to unborn baby less than from continued smoking *

• Breastfeeding - NRT reduces infants exposure to nicotine; use gum for example 2-3 hours prior to bf; if patch, remove at night *

• Adolescent - consider if highly nicotine dependent or history of failed previous attempt without NRT; combination of counseling, peer and family support and for some, NRT, is best approach *

Use of NRT should be discussed with physician and closely monitored with these groups * literature & research reviews

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Pharmacotherapy available by prescription:

• Champix® (varenicline)• Zyban® (buproprion)

• Start 7-14 days before quit date: to achieve steady state of blood levels of the drug

Refer to: www.rxfiles.caFor current information on Tobacco/Smoking

Cessation Pharmacotherapy

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“ If I quit smoking, I’ll gain weight..”• 2/3 of people do gain weight: less than 10 lbs• True Cause of weight gain:

– high fat, high calorie foods– enhanced taste & smell – lack of exercise

EAT RIGHT by following “Canada’s Food Guide to Healthy Eating” and stay active

“ Weight can be lost, lungs cannot”

… Average smoker would have to gain 125 lbs above their recommended weight to have the same health risk as smoking one

pack of cigarettes per day

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Tobacco Intervention is the single most effective step to lengthen & improve

patients’ lives

With intervention there will be:

- a significant reduction in number of tobacco users &

reduced exposure to secondhand and third hand

tobacco smoke

- a decrease in tobacco related disease

- a lowering of healthcare costs

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Brief ( 3 – 5 minutes or less) tobacco intervention encourages smokers to:

• think about their smoking• consider disadvantages of smoking• consider benefits of quitting

• Even those not ready to quit benefit from intervention & self-help materials to increase their awareness & motivation to quit

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Research shows that just by asking an individual “Do you smoke?” is not enough to motivate them to quit.

All health professionals need to advise and assist patients in their attempt to quit.

This is accomplished with the implementation of the 5 A’s of Tobacco Cessation Intervention.

5 A’s

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Ask - about tobacco use

Advise - to quit in a clear, strong &

personalized manner

Assess - willingness & readiness to quit

Assist - for quitting

Arrange - for counseling & pharmacotherapy

The best way to intervene is with the Best Practice…..

5 A’s of Tobacco Cessation Intervention

* developed by the National Cancer Institute & Agency for Healthcare Research & Quality

supported by the World Health Organization

Transtheoretical Model/ Stages of Change

Prochaska and DiClemente 1983

1. Pre-contemplation• Not really thinking about quitting• If challenged, will probably defend their smoking

behaviour• May be discouraged about previous attempts to

quit or believe they're too addicted to ever stop smoking

– As a clinician you can: » Raise doubts» Discuss natural consequences

2. Contemplation• Considering quitting sometime in the near future

(probably six months or less)• More aware of the personal consequences and consider

smoking a problem that needs resolution. • Open to receiving information about smoking and

identifying the barriers that prevent them from quitting.

– As a Clinician you can :» Discuss costs and benefits of changing and not

changing» Explore ambivalence » Critical thinking» Develop change options » Provide education

3. Preparation/Determination• Made the decision to quit and are getting ready to

stop smoking.• Taking small steps towards quitting - smoking

fewer cigarettes• Planning to quit within the next 30 days or have set

a quit date.–As a clinician you can: » Set goals and action plans » Identifying barriers to change and making

plans to deal with barriers »Provide encouragement and support »Connect with resources

4. Action• People are actively trying to stop smoking• This stage, generally lasting up to six months, is

the period during which smokers need the most help and support.

–As a clinician you can: »Normalize loss of comfortable old ways»Continue to work on step-by-step realistic goals »Help establishing new routines »Provide positive reinforcement

5. Maintenance

• Person has learned to anticipate and handle temptations to smoke and is able to use new ways of coping with stress, boredom and social pressures • May slip and have a cigarette, they try to learn from the

slip so it doesn't happen again. This helps to give them a stronger sense of control and the ability to stay smokefree.

– As a clinician you can: » Continue goal planning» Relapse prevention planning» Provide support and encouragement for alternative social

and recreational activities» Reinforce commitment

Adapted from 5 Stages to Quitting Health Canada 2009.

6. RelapseWhen the person falls back to an earlier stages of change.

–As a clinician you can:»Focus on elements of past progress, not present

“failures”»Recognition of warning signs»Encourage recovery based activities»Re-engaging support system»Back to basics

5Rs of Motivational Interviewing

RELEVANCE• “Do you feel quitting smoking is an important

thing to do for yourself and others around you?”

RISKS• “What effect do you think your continued

smoking will have on you and others around you?”

ROADBLOCKS• “What is stopping you from quitting?”REWARDS• “Can you identify the benefits of quitting for

yourself and not smoking around others?”REPETITION• Repeat interventions until smoker expresses

interest in quitting.

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Some healthcare professionals are concerned about whether they can issue credible advice …

•“What if I smoke ?”•“I’ve never smoked !“

•Ex-smokers

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But..“ I’ve Never Smoked…”

May feel uneasy providing advice, but:• remember overwhelming evidence linked to tobacco

use • become familiar with resources & tools in your

community to assist your patients to quit successfully

Just as healthcare professionals who have never been a parent, can support

new mothers.

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“ But I smoke…can I issue credible advice? ”

• You’ve seen death, disease & disability caused by tobacco

• You have likely experienced the addictive nature of your own tobacco use

• Whether or not you choose to quit, advising others to quit will help them move forward in choosing a healthy lifestyle as well as fill your obligations & expectations as a health care professional

Whether or not a healthcare provider

smokes, their professional advice isessential.

If the subject of addressing tobacco cessation is not mentioned, the individual may mistakenly perceive that quitting tobacco is not important.

Saskatoon Health RegionCommunity Addictions Services

-Tobacco Cessation Services-

• accepts self referrals & referrals from professionals/agencies• “Free” services by telephone, individual counseling, single session workshops

Main floor @ Sturdy Stone Building - 122 3rd Avenue North Saskatoon SK S7K 2H6

306 - 655 - 4100

Thinking of Quitting Smoking or Other Tobacco Products?*

Saskatoon Health Region Mental Health &

Addiction Services is offering a free education session to help adults who are considering

cutting down or quitting tobacco use.

Session Date: Tuesday May 27, 2014

Time: 5:00 – 6:30 pm

Location: Sturdy Stone Building – Main Floor, Suite 156 – 122 – 3rd Avenue North

(Please use the back door entrance located facing 4th Avenue North)

For more information call Lynn Isaak 306-655-4125. *Refers to tobacco in all forms: smoking cigarettes, pipe, cigars and using spit tobacco like snuff and chewing tobacco.

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Addiction Services 306-655-4100Tobaccofree Helpline 306-655-4685 Smokers’ Helpline 1-877-513-5333

Website: saskatoonhealthregion.ca

E-mail: tobaccofree@saskatoonhealthregion.ca

SUPPORT

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www.makeapact.caPartnership to Assist with Cessation of Tobacco

www.mn-s.caThe Green Light Program – Métis Nation – Sask. Health Department

www.rnao.org/smokingCessation/index.asp“Helping People Quit Smoking: Nursing Best Practice Guidelines”

OPPORTUNITIES for

ENHANCED LEARNING

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Everyone can make a difference

When a consistent, short ‘quitting tobacco’ message is given by many – nurses, physicians, dentists, pharmacists, other health professionals , there is a significant increase in the numbers quitting tobacco.

Thank You

Lynn IsaakAddiction Counsellor Mental Health and Addiction ServicesTobacco Cessation ProgramSturdy Stone Building122 – 3rd Ave. N.Saskatoon, SK S7K 2H6Phone: (306) 655-4125Email: marylynn.isaak@saskatoonhealthregion.ca