Transcript Tobacco Cessation - Ohio Public Health Association

Basics of Tobacco Cessation
Intervening with tobacco users in a
systematic way, consistently
identifying tobacco users and
delivering an appropriate intervention
with every user will significantly
increase the number of clients who quit
using tobacco
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Tobacco use is the chief preventable cause of
illness and death in our society
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14,000
17,000
19,000
30,000
41,000
81,000
Drugs
AIDS
Homicide
Suicide
Motor Vehicles
Alcohol
• 436,000 $moking
Smoking-Attributable Morbidity Mortality and Economic Costs, CDC, 2002
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Smoking Related Diseases
• In addition to being a strong factor in the development of
lung cancer, cigarette smoking also increases the risk of
a number of other cancers, including mouth and throat
cancers, bladder, pancreatic, cervical and kidney cancer.
• Cancer is not the only disease caused by smoking. It
also causes most cases of COPD (chronic obstructive
pulmonary disease), and some 90 percent of COPDrelated deaths are caused by smoking. Heart disease
and strokes are often linked to smoking, and a number
of childhood diseases and conditions are linked to
smoking during pregnancy and/or secondhand smoke.
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Why don’t they just quit?
• Approximately 50% of current smokers reported making
a serious attempt to quit during the last year
• Nearly 80% of all current smokers indicate that they want
to quit smoking
• The causes of tobacco dependence are complex and
vary somewhat from person to person
Biological
Cultural
Psychological
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Biological Factors
• True drug dependence on nicotine
• Nicotine affects essential brain structures associated
with feelings of award and arousal
• These changes persist long after use stops
• Learned behaviors that form tobacco use patterns
• Withdrawal symptoms and cravings
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Psychological Factors
• Reinforced, conditioned drug taking behavior
• Habit, automatic behavior
• A coping mechanism for stress, lonely, bored,
happy, angry
• Self medicate for depression, anxiety
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Cultural Factors
• Group identity
• Social activity
• Cultural Practice
• National marketing by the tobacco industry
versus having a primary care giver ask and
advise
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Who Is Ready To Quit?
• Not everyone who uses tobacco is ready to quit
• Most have tried, some multiple times
• At any given time 20% are ready
40% are thinking about it
40% are not ready
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The Readiness to Change Model
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Readiness to Change Model
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Not Ready to Quit: Has no intention to quit within the next 6 months
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Thinking About Quitting: Intends to quit within the next 6 months
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Ready to Quit: Is willing to set a Quit Date within the next 30 days
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Quitting: Has remained tobacco free for less than 6 months
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Staying Quit: Has remained tobacco free for more than 6 months
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Relapse: Is using tobacco again after a period of being tobacco free
Because tobacco dependence is a chronic condition, tobacco users
typically cycle through multiple periods of relapse
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The 5 A s
Ask, Advise, Assess, Assist, Arrange
A brief tobacco intervention
Relevant to the person receiving it
Should include both the risks of using tobacco and the
rewards for quitting
Should be repeated to encourage tobacco users to quit and
allow for changes in their readiness to quit
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Ask
• Ask about tobacco use at every encounter with every person
• Displaying visible messages makes asking about tobacco use a
normal and expected part of each patient encounter
• Include tobacco use as a vital sign:
Have you ever used tobacco?
Do you use tobacco now?
Does anybody else in your home use tobacco?
I
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Advise
• In a clear, strong, and personalized manner, advise
every tobacco user to quit
• “One of the best things you can do to improve your health and the
health of your family is to quit smoking. We can help.”
• Personalize the message by tying tobacco use to the
person’s motivation
Health Status
Impact of their tobacco use on others
Pregnancy
Costs – social and economic
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Assess
• Determine the tobacco user’s willingness to
make a quit attempt at the present time
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Have you thought about quitting tobacco?
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When do you think you might be ready to quit?
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Are you willing to quit in the next 30 days?
• Provide information specific to that person
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Assist
Tobacco users who are willing to make a quit attempt need
help in developing a Quit Plan
Setting a Quit Date
Identifying social support
Providing specific problem – solving suggestions
Giving information about medications
Providing self-help materials
Referring to intensive services if interested
Assist the tobacco user who is not ready to quit
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It is not necessary or helpful to try to talk
someone into quitting
• People who are unwilling or unready to quit to make a
quit attempt may be ready next time
• Avoid being judgmental or trying to pressure the tobacco
user into quitting
• Offer written materials that emphasize the benefits of
quitting
• Provide a brief motivational intervention using the 5 R s
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5Rs
• Relevant information
• Risks
• Rewards
• Roadblocks
• Repetition promotes effective outcomes
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Arrange
Arrange for follow-up whenever possible
Within a week for a tobacco user making a quit attempt
Ask about tobacco status
Congratulate people who are tobacco free and support
them in staying Tabasco free
Support people who have relapsed and assist them in
making a new quit attempt
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2 A s and R
• Ask
• Advise
• Refer
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Motivational Interviewing
A directive client-centered counseling style for eliciting behavior change
by helping clients to explore and resolve ambivalence
• Motivation to change is elicited from the client
• It is the client’s task to articulate and resolve their ambivalence
• Stages of Change Model:
Precomtemplation
Contemplation
Preparation
Action
Maintenance
Relapse
• Eliciting change talk results in the client hearing themselves
advocate for their own change
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Our job is to help facilitate clients moving to the
next stage
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Open-ended questions
Affirm
Reflect what has been said
Summarize
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Desire
Ability
Reasons
Need
Steps taken
Commitment
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Developing discrepancy and increase motivation for change
This really works
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Psychiatric Nurse
Counseling Points
Breaking Barriers and Implementing Changes
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“The Significance of Tobacco Dependence in Persons with Mental Illness”
July 2010, Vol 1, No 1
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“Delivering Effective Pharmacologic and Nonpharmacologic Interventions
for Tobacco Dependence in Persons with Mental Illness”
September 2010, Vol 1, No 2
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“Treating Tobacco Dependence in Persons with Mental Illness: Identifying
Challenges and Opportunities”
December 2010, Vol 1, No 3
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Resources
Ohio Quit Line
1-800-QUIT-NOW
784-8669
The Breathing Association
614-437-1511
Laura Atkinson, Tom Houston, Gretchen Clark Hammond
Association for the Treatment of Tobacco Use & Dependence
Center for Evidence Based Practices
216-398-3933
Tobacco: Recovery Across the Continuum
And the usual suspects . . .
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