TACKLING TOBACCO DEATHS

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TACKLING TOBACCO DEATHS THE NURSES ROLE IN
TOBACCO CONTROL AND SMOKING CESSATION JENNIFER
PERCIVAL RCN TOBACCO POLICY ADVISOR
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Tobacco is a public health priority Source
WHO In the year 2000 1 in every 6 deaths
worldwide was caused by smoking By the year
2030 1 in every 3 deaths worldwide will be due to
smoking 70 of these deaths will be
in developing countries.
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THIS ADVERT WAS USED IN THE 1950S
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Tobacco advertisers have no boundaries
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Tobacco advertising has successfully encouraged
more women to start smoking
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Women and Tobacco

• In the UK lung cancer surpassed breast cancer as
  leading cause of cancer death in 1987
• Now more women die from lung cancer than breast,
  ovarian, cervical endometrial cancers combined

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The true picture is very different
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WHO THE SILENT EPIDEMIC
WORLD HEALTH ORGANISATION Epidemiologist Sir
Richard Peto Tobacco use is increasing. Over
100 million deaths from tobacco will occur during
the next 20 years. and if nothing changes there
will be ONE BILLION deaths this century.

• His research has shown
• Half of all regular smokers die prematurely
• ¼ in middle age (35-69)
• ¼ in old age
• Stopping before 35 avoids most of the risks of
  premature death.
• Stopping smoking works.

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The WHO Framework Conventionon Tobacco Control
(FCTC)Main Measures that 169 countries have
signed up to

• Ban all tobacco advertising
• Increase Tax on tobacco products
• Take effective measures on Passive smoking
• Put large Warnings on tobacco products
• Provide Public Education campaigns
• Provide Cessation Guidelines and Services
• Take Action on illicit trade/smuggling
• Control sale of tobacco to children/ minors

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Put large warnings on all tobacco products
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Provide Public Education campaigns
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Take effective measures on Passive smokingWHO
estimates that nearly 700 million, or almost
half of the worlds children, breathe air
polluted by tobacco smoke, particularly at home.
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Control sales of tobacco to minors!
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What is smoking?

• A Chronic relapsing dependence syndrome
• Use of the addictive drug nicotine
• Reinforced by sensory, behavioural and social
  conditioning
• Entrenched by powerful withdrawal syndrome
• Promoted commercially, exempt from consumer
  protection legislation

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Nicotine 4,000 chemicals Tar Carbon monoxide
Why are cigarettes so harmful?
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Stopping Smoking Withdrawal effects duration
and frequency

• Light-headedness
• Sleep disturbance
• Poor concentration
• Craving
• Irritability/aggression
• Depression
• Restlessness
• Increased appetite

• lt48 hrs 10
• lt 1 wk 25
• lt2 wks 60
• gt 2 wks 70
• lt 4 wks 50
• lt 4 wks 60
• lt 4 wks 60
• gt 10 wks 70

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Nicotine delivery
Royal College of Physicians, Nicotine Addiction
in Britain, 2000
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Nicotine Replacement Therapy, Zyban Champix
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Reasons for NRT failure

• Unrealistic expectations
• Incorrect use
• Not used for long enough
• Nicotine is often seen as the dangerous element
  in cigarette smoke
• Safety concerns can be a barrier to use

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Core communication skills

• Boost the persons motivation and self-efficacy
• Build rapport
• Use reflective listening
• Provide reassurance

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Standard Treatment Programme Pre Quit Assessment

• Assess current readiness and ability to quit
• Inform the client about your programme
• Assess current smoking
• Assess past quit attempts
• Explain how tobacco dependence develops
• Assess nicotine dependence

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My observations from working in the UK Stop
Smoking services are that direct persuasion is
not enough to make people decide to stop smoking
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People want the benefits of being a non smoker
. without recognising the often long process of
change they need to go through to acquire them.
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You will have already observed that direct
persuasion does not make people decide to
change
Miller WR et al. J Consult Clin Psychol
19936145561Miller and Rollnick, 1991
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GOOD ADVICE
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I knew you could get cancer from smoking, but
Id planned to give up long before that happened
to me

• Robert was diagnosed with cancer of his tonsils
  at age 36

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Reasons for Current Behaviour
ADVICE
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Reasons for Current Behaviour
ADVICE
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Current Behaviour
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Everyone has their own beliefs about safe
behaviour
This child is strapped in and protected from the
sun but....?
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A DIFFICULT TIME
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Problem Many pregnant women do not like
to say they smokeA carbon monoxide (CO)
test is an immediate and non-invasive biochemical
method for helping to assess whether or not
someone smokes
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THE CHANGE PROCESS

• No-one changes their behaviour without first
  changing their attitudes and beliefs.
• When a client argues with you it means you have
  made a wrong assumption.
• Long term behaviour change takes time to
  consolidate

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Principles of Motivational Interviewing

• Use a neutral manner to give clients information
  about the impact of their lifestyle on their
  health
• Help people interpret the health implications,
  risks and benefits of not changing.
• Assist people to explore for themselves the
  importance of making a specific change.
• Leave the responsibility for changing and the
  right to decide whether or not to change, with
  the client.

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Helping people to stop smoking

• Avoid making pressure to change this will create
  resistance. You can never win and, in the
  process, may lose the chance to help
• Roll with any resistance do not argue with the
  patient if they say their action is not harmful.
  Instead, respectfully clarify their own thoughts
  or views
• Support the patients self-confidence look for
  the positive aspects and build on them

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HELPING PEOPLE TO STOP SMOKING WHAT WORKS?

• Find out what the tobacco user already knows
  about the risks and seek permission to provide
  further information.
• Link these facts to their current health status
  or medical condition.
• Explain the short and long term benefits of
  quitting and assess their understanding.
• Try asking What do you think might happen
• to you if you continue to
  smoke?

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PEOPLE NOT READY TO STOP

• Respect their view
• It sounds like it would be hard for you to stop
  now
• Are you planning to be a life long smoker?
• If they say NO
• Ask What would need to change for you
• to consider stopping smoking?
• Explain your medical / social concerns
• Leave the subject open for future discussion

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Asking questions can plant aseed of change
New thoughts often help people think
differently about what they believe to be true.
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Unsure about change?

• Help them explore the perceived advantages and
  disadvantages of smoking
• Ask more about what brought them to see you and
  find out their concerns
• Describe any ambivalence you notice
• Plant a seed of change

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• Helping people to stop smoking
• Show empathy even if you do not share a persons
  viewpoint, find ways to show that you understand
  and respect them
• Identify discrepancies there are often
  differences between how a person behaves and how
  they see themselves
• Name these in a neutral way
• eg.Dont want their kids to start smoking

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People making plans to quit

• Congratulate this decision
• Check their expectations of changing
• Ask What could get in your way?
• What can you do to avoid that?
• What help will you need?
• Who can you ask?

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Helping people to change

• Ask-
• What are you planning to do next?
• Who are you going to ask to support you?
• What quit date have you decided? Can
  you commit to not having a single puff of a
  cigarette from then onwards?
• What medication are you going to use?

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RELAPSEWhy do smokers return to tobacco?

• Stopping under pressure from someone else
• Lack of personal motivation
• Attaching insufficient importance to stopping
• Withdrawal symptoms
• Poor timing
• A question of self-image
• I thought just one wouldnt hurt

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Relapse prevention

• Ask
• What makes this a good time to stop?
• If they have tried many times before
• What have you learnt from past attempts?
• What will you do differently now to stay stopped?
  
• How would you feel if you had a cigarette again?
• Who is going to support you?

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• Ive tried before, its too late now, the damage
  is already done
• My doctors told me to see you about quitting
  smoking
• 3 Ive really cut down since my heart attack.
• 4 I feel so low since Ive stopped smoking and
  I crave a smoke all the time.
• I want to give up, but its hard as my partner
  smokes.
• I dont like to ask my in-laws not to smoke in
  the house.

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Contact details

• jennifer.percival_at_usa.net
• Email address