Transcript Slide 1 - Global Tobacco Control

Section B
Stages of Change Model
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
Is the Tobacco User Ready to Quit?
Regardless of what stage the parent or patient is in, provide
information about cessation to all tobacco users
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
2
The Stages of Change Model
Source: Prochaska, J.O., DiClemente, C.C., Norcross, J.C. (1992). In search of how people change. Applications to
addictive behaviors. Am Psychol. 47(9): 1102-1114.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Your Goal: Help the Tobacco User Take the Next Step
Help a pre-contemplator become a contemplator . . .
A contemplator start to make plans . . .
Someone who relapsed become “ready for action” . . .
And so on . . .
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
4
Be Specific
Use clear, strong messages
Anticipate challenges
 Ask about cues to use tobacco
 There are fewer cues in smoke free homes and cars
Practice problem-solving
Prescribe or provide information about pharmacotherapy
Help the parent set a quit date
Document your advice
Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical
Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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What Do You Say?
Clear
 “I strongly advise you to quit smoking.”
Strong
 “Eliminating smoke exposure of your son is the most important
thing you can do to protect the health of your child.”
Personalized—emphasize the impact on health, finances, the child,
family, or patient
 “Smoking is bad for you (and your child/family). I can help you
quit.”
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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An Intermediate Goal
“Secondhand smoke is bad for you and your family. Is it possible
for you to make your home and car tobacco free now?”
Smokers who live in tobacco free homes smoke fewer cigarettes,
which can help the next quit attempt succeed
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Rationalization
No one wants to believe that they’re hurting their child
 “. . . if she is there and we are smoking outside at least it's
very open.”
 “Our daughter never goes in that room. We have a fan and a
window and we leave the fan on when we’re smoking.”
 “There is no smoking allowed anywhere near my house, my
husband and I take turns going downstairs.”
Source: Tanksi, S., Gaffney, C. Unpublished data.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Be Specific . . .
Having a Smoke Free Home means no smoking ANYWHERE inside
the home or car!
It DOES NOT mean smoking . . .
 Near a window or exhaust fan
 In the car with the windows open
 In the basement
 Inside only when the weather’s bad
 Cigars, pipes, or hookahs
 On the other side of the room
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Assist Through Pharmacotherapy*
Everyone who uses tobacco should be offered pharmacotherapies
 Recommend and discuss use
Many are OTC
 Prescribe if possible
Even if OTC
Some insurance plans require prescription for
reimbursement or coverage
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
10
Assist by Following Up
Plan to follow up on any behavioral commitments made
 Just asking at the next visit makes a big impression
If they set a quit date
 Schedule follow-up in person or by telephone soon after the
quit date
Look for “teachable moments” in the future
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
11
Pediatricians Don’t Follow Through
Families who were initially identified as non-smoking on entry to a
practice were not asked again about smoking status (in spite of a
parent relapsing)
Source: Tanksi, S., Gaffney, C. Unpublished data.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Tobacco Use Can Be a Source of Family Discord
Smoking by a household member can be a source of tension
 Not always identified by the parent as a barrier
Moms are more often the “gatekeepers” for maintaining a smoke
free home
 May not be willing to risk a relationship
 Want to maintain peace, may rationalize the risk
Strategize with the parent about ways to deliver the “you can
quit” and “our home and car should be tobacco free” messages
Source: Tanksi, S., Gaffney, C. Unpublished data.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
13
Refer
To quit line, if available
To community and Internet resources
Give every tobacco user something that contains information about
quitting, the harms of tobacco use, etc.
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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What Do You Say?
“I recommend that you call this number. It’s a free service—and
the person on the other end of the telephone can help you get
ready to quit.”
“One thing that helps a lot is to learn as much as you can about
quitting—the more you know, the more successful you’ll be. The
quit line staff can help.”
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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Medications Work!
Used properly, medications can double the success of quit
attempts
Excellent resources exist:
 http://www.aafp.org/online/en/home/clinical/publichealth/t
obacco/nrt.html
 http://www.surgeongeneral.gov/tobacco/
 2009 Johns Hopkins Bloomberg School of Public Health;
American Academy of Pediatrics Julius B. Richmond Center of Excellence
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