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/guide/Guideline%20CME5.ppt

2. Welcome!Eileen WolffDirector, Community Health InitiativesAmerican Cancer Society

3. ACS Mission Statement The American Cancer Society is the nationwide community- based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service.

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 A’s • 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!