Presentation on tobacco

1. Presentation on Tobacco May 12, 2014

2. Smoking remains one of the leading causes of preventable illness, disability and premature death in Canada. 4 people die every day in Saskatchewan from tobacco related diseases. Secondhand and third hand smoke affects others who are exposed to tobacco smoke including children and pets. Two thirds of people who smoke are thinking of quitting. www.makeapact.ca

3. About 77% of people in Saskatchewan do not smoke. Saskatchewan has one of the highest cigarette smoking prevalence rates in Canada. Consistent with national trends, smoking prevalence is highest among 20-24 year olds. Prevalence of smoking among 15-19 year olds is higher in Saskatchewan than the national average. Government of Saskatchewan 2012

4. Teenage smokers are more likely to have seen a doctor or other health care professionals for an emotional or psychological complaint. Teens who smoke are: 3 times more likely than nonsmokers to use alcohol, 8 times more likely to use marijuana and 22 times more likely to use cocaine. Smoking is associated with a host of other risky behaviors such as fighting and engaging in unprotected sex. WHO: Tobacco Free Initiative 2014. Health effects of smoking among young people.

5. Impact on Mental Health 50-90% of mental health patients smoke 50% of all cigarettes smoked are by mental health patients 50% of smoking related deaths are mental health patients Tobacco smoke affects absorption and metabolism of some medications CMHA April 2011

6. 6 Tobacco use is a health issue affecting the lives of everyone… and is not “just a habit” but an Nicotine - powerful drug, as addictive as heroin or cocaine for some ADDICTION

7. Quitting Tobacco There are many reasons for quitting: Health is usually the primary reason CO$T can be a factor Other motivators can play a role, such as the arrival of a new baby or the purchase of a new home or vehicle …. When talking about tobacco use, it is important to ask about all forms of tobacco such as cigarettes, pipe, cigars, water pipes and spit tobacco…. No matter how tobacco is used, it has immediate & long-term health risks 8

8. 9 5 STEPS FOR QUITTING TOBACCO 1. GET READY 2. GET SUPPORT 3. LEARN NEW SKILLS & BEHAVIOURS 4. GET MEDICATION & USE IT CORRECTLY 5. BE PREPARED FOR RELAPSE Having a Quit Plan is important to be successful in quitting tobacco

9. Nicotine Withdrawal Fear of withdrawal can be a major barrier to quitting Not all experience withdrawal Worst symptoms subside in just 72 hours & cease in 7-10 days Psychological symptoms: strong cravings mood swings anxiety crankiness depression insomnia 11 Source: Ferguson.T. New York:Ballantine Books: Women and Tobacco

10. What about Nicotine Replacement Therapy (NRT) ? Patch, gum, inhaler, lozenge and mist spray are available for purchase over the counter at supermarkets and pharmacies. Delivers clean nicotine at gradual doses Doubles quit rate With counseling, quit rate doubles again Products have precautions 12 Patient concerns: 69% smokers believe NRT products as harmful as cigarettes Individuals need to receive accurate advice and clear reassurance on safety of products British Thoracic Society 2004

11. NRT Precautions Cardiovascular Disease - caution in patients who have had a heart attack; physician to review if even recent or disease unstable * Diabetes - nicotine affects blood sugar levels so need to monitor * Pregnancy - behavioral support first; if not successful in quitting need to weight risk benefit of NRT. Risks to unborn baby less than from continued smoking * Breastfeeding - NRT reduces infants exposure to nicotine; use gum for example 2-3 hours prior to bf; if patch, remove at night * Adolescent - consider if highly nicotine dependent or history of failed previous attempt without NRT; combination of counseling, peer and family support and for some, NRT, is best approach * Use of NRT should be discussed with physician and closely monitored with these groups * literature & research reviews 13

12. Pharmacotherapy available by prescription: Champix® (varenicline) Zyban® (buproprion) Start 7-14 days before quit date: to achieve steady state of blood levels of the drug 14 Refer to: www.rxfiles.ca For current information on Tobacco/Smoking Cessation Pharmacotherapy

13. “ If I quit smoking, I’ll gain weight ..” 2/3 of people do gain weight: less than 10 lbs True Cause of weight gain : high fat, high calorie foods enhanced taste & smell lack of exercise EAT RIGHT by following “Canada’s Food Guide to Healthy Eating” and stay active “ Weight can be lost, lungs cannot” … Average smoker would have to gain 125 lbs above their recommended weight to have the same health risk as smoking one pack of cigarettes per day 15

14. Tobacco Intervention is the single most effective step to lengthen & improve patients’ lives With intervention there will be : - a significant reduction in number of tobacco users & reduced exposure to secondhand and third hand tobacco smoke - a decrease in tobacco related disease - a lowering of healthcare costs 16

15. Brief ( 3 – 5 minutes or less) tobacco intervention encourages smokers to: think about their smoking consider disadvantages of smoking consider benefits of quitting Even those not ready to quit benefit from intervention & self-help materials to increase their awareness & motivation to quit 17

16. 18 Research shows that just by asking an individual “Do you smoke?” is not enough to motivate them to quit. All health professionals need to advise and assist patients in their attempt to quit. This is accomplished with the implementation of the 5 A’s of Tobacco Cessation Intervention. 5 A’s

17. 19 A sk - about tobacco use A dvise - to quit in a clear, strong & personalized manner A ssess - willingness & readiness to quit A ssist - for quitting A rrange - for counseling & pharmacotherapy The best way to intervene is with the Best Practice….. 5 A’s of Tobacco Cessation Intervention * developed by the National Cancer Institute & Agency for Healthcare Research & Quality supported by the World Health Organization

18. Transtheoretical Model/ Stages of Change Prochaska and DiClemente 1983 1. Pre-contemplation Not really thinking about quitting If challenged, will probably defend their smoking behaviour May be discouraged about previous attempts to quit or believe they're too addicted to ever stop smoking As a clinician you can: Raise doubts Discuss natural consequences

19. 2. Contemplation Considering quitting sometime in the near future (probably six months or less) More aware of the personal consequences and consider smoking a problem that needs resolution. Open to receiving information about smoking and identifying the barriers that prevent them from quitting . As a Clinician you can : Discuss costs and benefits of changing and not changing Explore ambivalence Critical thinking Develop change options Provide education

20. 3. Preparation/Determination Made the decision to quit and are getting ready to stop smoking . Taking small steps towards quitting - smoking fewer cigarettes Planning to quit within the next 30 days or have set a quit date. As a clinician you can: Set goals and action plans Identifying barriers to change and making plans to deal with barriers Provide encouragement and support Connect with resources

21. 4. Action People are actively trying to stop smoking This stage , generally lasting up to six months, is the period during which smokers need the most help and support. As a clinician you can: Normalize loss of comfortable old ways Continue to work on step-by-step realistic goals Help establishing new routines Provide positive reinforcement

22. 5. Maintenance Person has learned to anticipate and handle temptations to smoke and is able to use new ways of coping with stress, boredom and social pressures May slip and have a cigarette, they try to learn from the slip so it doesn't happen again. This helps to give them a stronger sense of control and the ability to stay smokefree . As a clinician you can: Continue goal planning Relapse prevention planning Provide support and encouragement for alternative social and recreational activities Reinforce commitment Adapted from 5 Stages to Quitting Health Canada 2009.

23. 6. Relapse When the person falls back to an earlier stages of change. As a clinician you can: Focus on elements of past progress, not present “failures” Recognition of warning signs Encourage recovery based activities Re-engaging support system Back to basics

24. 5Rs of Motivational Interviewing RELEVANCE “Do you feel quitting smoking is an important thing to do for yourself and others around you ?” RISKS “What effect do you think your continued smoking will have on you and others around you?”

25. ROADBLOCKS “What is stopping you from quitting?” REWARDS “Can you identify the benefits of quitting for yourself and not smoking around others?” REPETITION Repeat interventions until smoker expresses interest in quitting.

26. 28 Some healthcare professionals are concerned about whether they can issue credible advice … “ What if I smoke ?” “I’ve never smoked !“ Ex-smokers

27. But..“ I’ve Never Smoked…” May feel uneasy providing advice, but: remember overwhelming evidence linked to tobacco use become familiar with resources & tools in your community to assist your patients to quit successfully Just as healthcare professionals who have never been a parent, can support new mothers . 29

28. “ But I smoke…can I issue credible advice? ” You’ve seen death, disease & disability caused by tobacco You have likely experienced the addictive nature of your own tobacco use Whether or not you choose to quit, advising others to quit will help them move forward in choosing a healthy lifestyle as well as fill your obligations & expectations as a health care professional 30

29. Whether or not a healthcare provider smokes , their professional advice is essential . If the subject of addressing tobacco cessation is not mentioned, the individual may mistakenly perceive that quitting tobacco is not important.

30. Saskatoon Health Region Community Addictions Services -Tobacco Cessation Services- accepts self referrals & referrals from professionals/agencies “Free” services by telephone, individual counseling, single session workshops Main floor @ Sturdy Stone Building - 122 3rd Avenue North Saskatoon SK S7K 2H6 306 - 655 - 4100

31. Addiction Services 306-655-4100 Tobaccofree Helpline 306-655-4685 Smokers’ Helpline 1-877-513-5333 Website : saskatoonhealthregion.ca E-mail: [email protected] 34 SUPPORT

32. www.makeapact.ca Partnership to Assist with Cessation of Tobacco www.mn-s.ca The Green Light Program – Métis Nation – Sask. Health Department www.rnao.org/smokingCessation/index.asp “Helping People Quit Smoking: Nursing Best Practice Guidelines” 35 OPPORTUNITIES for ENHANCED LEARNING

33. 36 Everyone can make a difference When a consistent, short ‘quitting tobacco’ message is given by many – nurses, physicians , dentists, pharmacists, other health professionals , there is a significant increase in the numbers quitting tobacco.

34. Thank You Lynn Isaak Addiction Counsellor Mental Health and Addiction Services Tobacco Cessation Program Sturdy Stone Building 122 – 3 rd Ave. N. Saskatoon, SK S7K 2H6 Phone: [phone] Email: [email protected]