Nurses

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• Nurses Role in Tobacco Use Control
• Kawkab Shishani, PhD
• kshishani_at_wsu.edu

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Objectives

• Recognize that all tobacco forms are hazardous to
  health
• Realize the emerging threat from the rapidly
  growing smokeless tobacco industry globally
• Recognize the role of gender in tobacco use
• Apply smoking cessation counseling in practice
• Be actively involved in tobacco control at all
  levels

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Why Tobacco Use is Hazardous to Health

• Smoking is the chief avoidable risk factor for
  chronic diseases
• Smoking affects progression of chronic diseases
• Unlike the other risk factors, smoking affects
  smokers as well as those around them

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Tobacco Forms

• Smoke
• cigarettes
• cigars
• pipe
• waterpipe

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Tobacco Forms

• Smokeless
• Dip
• Snus
• Chewing
• Snuff

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Myths Associated with Smokeless Tobacco

• Smokeless tobacco is a safe alternative for
  smoking
• Smokeless tobacco IS NOT SAFE. It contains
  NICOTINE
• Chemical compounds added to smokeless tobacco
  include Ammonium (chloride Carbonate)
  Proplyene Glycol Ethyl Alcohol Sodium
  (Chloride, Carbonate, Saccharin Citrate) and
  many other chemical.

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Myths Associated with Smokeless Tobacco

• Smokers can quit by switching to smokeless
  tobacco
• Nicotine in all tobacco products causes addiction
• Switching from smoke to smokeless tobacco does
  not solve the problem

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E-cigarettes

• A battery operated device
• Filled with solution that contains nicotine
• When a user inhales, the vaporizer turns the
  liquid into a vapor
• Is not a safe alternative to cigarettes
• Poorly regulated nicotine content in the
  solution varies according to the manufacturer

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Burden of Tobacco Use

• 1.3 billion smokers
• 20 in developed countries
• 80 in developing countries
• Insufficient tobacco policies in developing
  countries lead to increase in
• Tobacco leaf production
• Cigarette production

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Women and Tobacco Use

• 250 million women smoke globally
• 22 of women in developed countries smoke
• 9 of women in developing countries smoke
• Male smoking rates are in slow decline
• Female smoking rates are still rising
• Tobacco industry target women through deceptive
  images (e.g. slim, menthol cigarettes)

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Women and Tobacco Use

• Nicotine metabolism may differ in women compared
  to men (Zeman, Hiraki, Sellers, 2002).
• Women take more puffs to have the same nicotine
  effect as men
• Women develop lung cancer with lower levels of
  smoking
• Women are less successful in quit attempts
• Women face more difficulties in quitting

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Passive Smoking

• Indoor
• Homes
• Schools
• Workplaces
• Hospitals, Primary care
• Public transportation
• Outdoor
• Parks
• Play grounds

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Tobacco Dependence
From Benowitz N. Nicotine Addiction. Primary Care
1999 26(3)611-31
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Why it is Difficult to Quit

• Coping with withdrawal symptoms
• Urges to smoke
• Craving
• Anxiety
• Restlessness
• Nervousness

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Why it is Difficult to Quit

• Adapting to withdrawal symptoms
• Headache
• Depressed mood
• Difficulty in concentrating
• Increased appetite

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Benefits of Quitting

• Immediate effect
• Breath smells better
• Food taste improves
• Yellow fingernails disappear
• Everyday activities become more enjoyable
• Teeth get whiter
• Improves lung functioning

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Benefits of Quitting

• Lowers the risk of
• Lung and other types of cancer
• Heart disease and stroke
• Respiratory diseases
• Women
• Reduce the risk of infertility
• Reduce the risk of having a low birth weight baby

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Role of Nurses in Tobacco Use Control

• Nurses are in direct contact with
• Patients at acute care settings
• Primary care centers
• Public

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Levels of Involvement in Tobacco Use Control

• Individual
• National
• International

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Individual level Providing Smoking Cessation
Counseling

• Article 14 FCTC
• Each country shall develop evidence based
  guidelines to promote cessation of tobacco use
  and adequate treatment for tobacco dependence

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Smoking Cessation Counseling

Fiore MC, Jaén CR, Baker TB, et al. Treating
Tobacco Use and Dependence 2008 Update. Quick
Reference Guide for Clinicians. Rockville, MD
U.S. Department of Health and Human Services.
Public Health Service. April 2009.
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5 As Model

• AskSystematically identify all tobacco users at
  every visit
• AdviseStrongly urge all tobacco users to quit
• AssessDetermine willingness to make a quit
  attempt
• AssistAid the patient in quitting (provide
  counseling and medication)
• ArrangeEnsure follow-up contact

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National Level

• Be actively involved in tobacco use control
  activities
• Network between your own institution and other
  national institutions that are involved in
  tobacco control to strengthen the national
  tobacco control efforts
• Be involved in developing and maintaining a
  systematic approach to treat tobacco dependence

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National Level

• Raise awareness of high risk groups about the
  dangers associated with tobacco use and
  dependency
• Lobby for health policies that ban tobacco use in
  public places
• Participate in putting into enforcement health
  policies that are related to smoking

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International Level

• Participate in international tobacco forums
• Collaborate with international scholars in
  developing new venues in tobacco control in your
  country
• Exchange expertise with tobacco use control
  activists form around the world

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Contact Information

• Kawkab Shishani, PhD
• kshishani_at_wsu.edu