Transcript "Tobacco Cessation Strategies and Resources: Epidemiology

Tobacco Cessation
Strategies and Resources:
Epidemiology, Evidence and
Availability
May 29, 2013
The National Tobacco-Free College Campus Initiative:
Building and Supporting Community Health on Campus
Michael C. Fiore, MD, MPH, MBA
Professor of Medicine
Director, Center for Tobacco Research & Intervention
University of Wisconsin School of Medicine and Public Health
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Today’s Talk
• The Epidemiology of Tobacco Use
and Cessation
• Tobacco Cessation Treatments – What
the Science Tells Us
• Tobacco-Free Campuses – An
Opportunity to Promote Cessation
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Today’s Talk
• The Epidemiology of Tobacco Use
and Cessation
• Tobacco Cessation Treatments – What
the Science Tells Us
• Tobacco-Free Campuses – An
Opportunity to Promote Cessation
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Smoking Prevalence Among Adults
18 and Older, United States, 1965-2011
2011 = 18.9%
Source: NHIS
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Four Populations in Particular
Continue to Smoke at High Rates:
― The Poor
― The least educated
― Those with co-morbid mental health or
addictive disorders
― Certain/Specific racial and ethnic
minorities: e.g.: Native Americans
Smoking Rates by Education
Source: National Health Interview Survey, United States—1965-2009
Smoking Rates by Poverty Status
Source: National Health Interview Survey, United States—1965-2009
Chronic Illnesses
Tobacco directly causes:
•  30% of all cancers, including 90% of
all lung cancers
•  30% of all cardiovascular
diseases
•  90% of all COPD
The Result
• More than 400,000 deaths each year
• 1 out of every 5 deaths in America
are directly caused by smoking
Acute Diseases
• In addition to chronic illnesses,
tobacco is also a cause of
acute illnesses:


Upper and lower respiratory
tract infections
Asthmatic exacerbations
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Epidemiology of Cessation
• 47 million adults in the U.S. continue to smoke
• Of those 47 million, almost 40 million report they
have tried to quit and have failed
• About 50% of smokers try to quit each year
• Most try to quit “cold turkey,” with less than
25% using evidence-based treatment
• Young and poor smokers are less likely to use
evidence based treatments
Economic Costs
•  $100 billion in added healthcare costs
•  $100 billion in lost productivity
• The Average Smoker costs  $1,600/year
more in healthcare costs than the average
non-smoker
• The Average Smoker
― takes 2 extra sick days/year
― is 8% less productive
― spends 30 minutes per work shift on
smoking rituals
Today’s Talk
• The Epidemiology of Tobacco Use
and Cessation
• Tobacco Cessation Treatments – What
the Science Tells Us
• Tobacco-Free Campuses – An
Opportunity to Promote Cessation
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Treating Tobacco Use and
Dependence: The Clinician’s Role
• 70% of smokers report that they want
to quit
• About 80% see a clinician each year
• Only about 25% of those seeing a
clinician leave that visit with evidencebased counseling and/or medication
The Guideline
• PHS Guideline
evidence-based
treatments
Counseling
 Medications
 Health System Changes

• 2008 - Updated
Guideline published
• Literature from1975 – 2007
• Approximately 8,700
total articles
Key Findings
Effective Tobacco Dependence
Treatments Consist of:
• Brief clinician coaching/counseling
• One of the 7 FDA Approved
medications
• Systems-level changes that
institutionalize cessation
treatment
The 5 A’s
for Patients Willing to Quit
• ASK all patients about their tobacco use
• ADVISE all smokers to quit
• ASSESS willingness to make a quit attempt
• ASSIST in quitting attempt (counseling &
meds)
• ARRANGE for follow-up
Counseling:
5 Key Points for the Smoker Willing to
Make a Quit Attempt
1. Set a quit date
2. Review past quit experience
3. Anticipate challenges to the
upcoming quit attempt
4. Other smokers in the household
5. Alcohol
Medications
Seven FDA-Approved Medications for
Tobacco Dependence
1.
2.
3.
4.
5.
6.
7.
Bupropion SR
Nicotine gum
Nicotine inhaler
Nicotine nasal spray
Nicotine patch
Nicotine lozenge
Varenicline
Cessation medications have been shown to
double or even triple quit rates
Motivational
Interventions
1. For smokers not yet ready to quit
2. Interventions that increase quit attempts
and success
Motivational Interviewing (MI)
Elements
Express Empathy
 Express empathy
• Open-ended
questions: “What
might happen if
you try to quit?”
• Reflect back
meaning: “I hear
that you are worried
about weight gain.”
Highlight Discrepancy
 Show discrepancy
between behavior &
goals:
• “So, you worry about hurting
your kids’ health, but can’t
seem to stop smoking?”
• “You really want to quit, but
don’t want to gain weight.”
 Support change talk:
“I can see you are already
planning how you will quit”
MI Elements (cont.)
Roll with Resistance
 Back off:
• “OK, I hear that this is not
the right time for you.”
• “Well, is there any
treatment that might
help?”
 Capture ambivalence:
“Part of you wants to
quit, but part is afraid
to try.”
 Ask permission to help
Support Self-Efficacy
 Build on past success:
• “You were able to quit for
several weeks last time.
That shows you have the
skills to quit.”
 Be open to
the patient’s
preferences/desires
Systems
Level
Change
Systems Intervention Strategies
1. Implement a tobacco user identification system
in every clinic
2. Provide education, resources, and feedback to
promote provider intervention
3. Dedicate staff to provide tobacco dependence
treatment, and assess the delivery of this treatment
in staff performance evaluations
4. Include tobacco dependence treatment (both
counseling and medication) identified as effective
in the USPHS Guideline as paid or covered services
for all subscribers or members of health insurance
packages
Smoking Status as a Vital Sign
The National Tobacco Quitline
1-800-QUIT NOW
Quitlines – A National Treatment
• 1-800-QUIT NOW
• Effective
• Available in all 50 States
• Services and promotion differ markedly
•  $130 Million in services in 2009
•  500,000 smokers served in 2009
Today’s Talk
• The Epidemiology of Tobacco Use
and Cessation
• Tobacco Cessation Treatments – What
the Science Tells Us
• Tobacco-Free Campuses – An
Opportunity to Promote Cessation
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A Campus-Wide Cessation
Program: Components
• Implement before smokefree campus
• Cessation as an option, not an obligation
• Message: Campus Smokefree Implementation –
A Great Time to Quit
• Three targeted populations: students, faculty,
staff
• Remove barriers to treatment access
• Implement ongoing systems of cessation, not
just a one-time program
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A Campus-Wide Cessation
Program: Elements of Success
• Integrate services into student, faculty, and staff
health services
• Identify a campus health services champion
• Publicize
• Remove cost/access barriers
• Designate a smoking cessation clinical
coordinator
• Use 1-800-QUIT NOW to supplement, not substitute
for, campus programs
• Expand insurance coverage to include
counseling and all FDA-approved medications
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www.ctri.wisc.edu
www.ctri.wisc.edu
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