Treating Tobacco Use and Dependence

1
Treating Tobacco Use and Dependence

• Recommendations for Implementing the U.S. Public
  Health Service Clinical Practice Guideline
• Adapted from Treating Tobacco Use and Dependence
  PowerPoint Presentation. Center for Tobacco
  Research and Intervention, University of
  Wisconsin. http//www.ctri.wisc.edu/main_dept/guid
  e/Guideline20CME5.ppt

2
Welcome!Eileen WolffDirector, Community Health
InitiativesAmerican Cancer Society
3
(No Transcript)
4
Tobacco Use Among Women

• One in every five women in the U.S. is a smoker.
  (CDC, 2001)
• Smoking rates peak between the ages of 20-44 when
  women are in their childbearing years.
• Smoking rates are highest among women who
• Have a high school education or less
• Live below the poverty level
• Are white

5

• About 90 of adult smokers started as teens
• Developmental
• Psychosocial
• Advertising

6
United StatesCamel RJ ReynoldsMagazineFlavors
of the Exotic Campaign, with a woman in a green
dress, bearing a tray of Camel's exotic
blends(Source Glamour Magazine)
Credit National Center for Tobacco-Free Kids
7
United StatesCamel RJ ReynoldsMagazinePart of
the "Pleasure to Burn" campaign featuring a young
African-American chanteuse cradling a microphone
and a smoldering cigarette. (Road Track, March
2001) (Source Greg Hunicutt)
Credit National Center for Tobacco-Free Kids
8
How can we reach pregnant women?

• Providing tobacco use interventions as a routine
  part of prenatal care can be effective in
  impacting the prevalence of smoking.
• The U.S. Public Health Service has established
  clinical guidelines for tobacco intervention.

9
Clinical Practice Guidelines for Treating Tobacco
Use Dependence (2000)
Report findings include 1. Tobacco dependence
is a chronic condition that often requires
repeated intervention. 2. Because effective
treatments are available, every tobacco-user
should be offered cessation treatment at every
visit.
10
Clinical Practice Guidelines for Treating Tobacco
Use Dependence (2000)
3. Clinicians and health care systems must
institutionalize the consistent identification,
documentation, and treatment of every tobacco
user. 4. Brief tobacco dependence treatment is
effective.
11
Clinical Practice Guidelines for Treating Tobacco
Use Dependence (2000)

• 5. There is a dose-response relation between
  intensity
• of counseling and its effectiveness.
• 6. Three effective types of behavioral therapies
  include
• Provision of practical counseling
  (problem-solving skills training)
• Clinician-delivered support (intra-treatment)
• Social support outside of treatment
  (extra-treatment)

12
Clinical Practice Guidelines for Treating Tobacco
Use Dependence (2000)
7. Numerous effective pharmacotherapies for
smoking cessation now exist and should be used
except in the presence of contraindications. 8.
Tobacco dependence treatments are both clinically
effective and cost-effective relative to other
medical and disease prevention interventions.
13
How do I treat tobacco users who are willing to
quit?
14
The 5 As

• For Patients Willing to Quit
• ASK about tobacco use
• ADVISE to quit
• ASSESS willingness to make a quit attempt
• ASSIST in quit attempt
• ARRANGE for follow-up

15
ASK about tobacco use
Systematically identify all tobacco users at
every contact. Identify current tobacco users and
recent quitters. Assess type and amount of
tobacco used, level of nicotine dependence, and
willingness to quit.
16
ADVISE

• Once tobacco use status has been identified and
  documented, advise all tobacco users to quit
• Even brief advice to quit results in greater quit
  rates
• Advice should be
• Clear
• Strong
• Personalized

As your health care provider, I must tell you
that the most important thing you can do to
improve your health is to stop smoking.
17
ASSESS
After providing a clear, strong, and personalized
message to quit, you must determine if the
patient is willing to quit at this time.
Are you willing to try to quit at this time? I
can help you.
18
ASSIST

• Help develop a quit plan
• Provide practical counseling
• Provide intra-treatment social support
• Help your patient obtain extra-treatment social
  support
• Recommend they discuss with their doctor
  pharmacotherapy
• Provide supplementary materials

19
Developing a Quit Plan

• Set a quit date
• Review past quit attempts
• Anticipate challenges
• Remove tobacco products
• Avoid
• Alcohol use
• Exposure to tobacco

20
ARRANGE

• Schedule a follow-up contact within one week
  after the quit date
• Telephone contact
• Quitlines
• The majority of relapses occur in the first two
  weeks after quitting

21
RELAPSE
How has stopping tobacco use helped you?

• Preventing Relapse
• Congratulate success
• Encourage continued abstinence
• Discuss with your patient
• Benefits of quitting
• Barriers
• If your patient has used tobacco, remind him or
  her that the relapse should be viewed as a
  learning experience
• Relapse is consistent with the chronic nature of
  tobacco dependence not a sign of failure

22
How do I treat tobacco users who are not willing
to make a quit attempt?
23
Treating patients who are not ready to make a
quit attempt

• RELEVANCE Tailor advice and discussion to each
  patient
• RISKS Outline risks of continued smoking
• REWARDS Outline the benefits of quitting
• ROADBLOCKS Identify barriers to quitting
• REPETITION Reinforce the motivational message at
  every visit

24
RELEVANCE

• Encourage the patient to indicate why quitting
  is personally relevant, being as specific as
  possible
• Disease status or risk
• Family or social situations
• Health concerns
• Age, gender
• Other important personal experiences or
  characteristics

25
RISKS

• Ask the patient to identify potential negative
  consequences of tobacco use
• Acute risks
• Long term risks
• Environmental risks

26
REWARDS

• Ask the patient to identify potential benefits
  of stopping tobacco use
• Improved health
• Food will taste better
• Improved sense of smell
• Save money
• Feel better about yourself
• Etc.

27
ROADBLOCKS

• Ask the patient to identify barriers or
  impediments to quitting and note elements of
  treatment (i.e., problem-solving,
  pharmacotherapy) that could address barriers
• Withdrawal symptoms
• Fear of failure
• Weight gain
• Lack of support
• Depression
• Enjoyment of tobacco

28
REPETITION

• The motivational intervention should be repeated
  every time with an unmotivated individual.
• Tobacco users who have failed in previous quit
  attempts should be told that most people make
  repeated quit attempts before they are
  successful.

29
Not since the polio vaccine has this nation had
a better opportunity to make a significant impact
in public health.- David Satcher, MD,
PhD,Former U.S. Surgeon General
30
RESOURCES

• American Cancer Society 1 800 ACS-2345
• NYS Quitline 1-888-609-6292 www.nysmokefree.com
• Great Start Quit Line 1 866 667-8278
• CDC 1-800-232-1311 (materials)
• Monroe and Finger Lakes Tobacco Coalitions
  585 442-4260
• Livingston County Tobacco Coalition 585 243-7524
• Steuben Tobacco Coalition 607 937-9922

31
Websites

• www.cancer.org
• www.helppregnantsmokersquit.org
• www.smokefreefamilies.org

32
QUESTIONS??????????
33
Thank you!