Smokeless Tobacco and Smoking Cessation Program

1. SmokelessTobacco and Smoking Cessation Program A Program from the Society of Otorhinolaryngology-Head and Neck Nursing, Inc. By Jan Adams, RN, BSN, MPA, CNA, CORLN

2. Train the Trainer • This course will assist you, the trainer, in presenting the SOHN Smoking Cessation Program to your patients, community and for yourself if you are a smoker • A CD of the Program is provided for your use.

3. Presenting the Program • The SOHN Smoking Cessation Program is designed in four parts. The entire program can be presented in one sitting or broken into smaller sessions. • Statistical information is provided to help the Trainer be better informed about tobacco and tobacco products.

4. Why are we here? • This course is presented to make you aware of the effects of tobacco, how it affects your performance and what resources are available to assist you in stopping tobacco use

5. What we will discuss • Facts and Figures about tobacco use in the US • Health risks associated with tobacco • Cigarette and smokeless tobacco use and abuse • How to quit-tips

6. Smokeless Tobacco and Smoking Cessation Program Overview • Session One: Tobacco Abuse: Facts and Figures • Complete registration information • Verbalize an understanding of the program • Schedule “Quit Day” • Complete the tobacco use record

7. Smokeless Tobacco and Smoking Cessation Program Overview • Session Two: Smoking Cessation: Issues and Strategies • Understanding addiction • Identify stages of behavior • What are the effects of tobacco on the body • Coping Strategies

8. Smokeless Tobacco and Smoking Cessation Program Overview • Session Three: Quitting Effectively • Quit day • Withdrawal Symptoms • Quitting tips

9. Smokeless Tobacco and Smoking Cessation Program Overview • Session Four: Maintaining a Tobacco Free Life Style • Strategies that help • Handling a lapse • Identify methods to remain smoke-free • References

10. Recommendation from the CDC and Public Health Service on Insurance coverage • Tobacco use treatment DOUBLES quitting success rates • Cover at least 4 30 minute sessions including telephone and individual counseling • Cover both Rx, OTC and prescription meds • Provide counseling and meds for 2 attempts/yr • Eliminate or minimize copays

11. Facts and Figures • 46 million Americans smoke cigarettes - 25% of the population • Most prevalent is age 25-44 • Average age to start smoking is 14.6 years old • One out of every 5 high school students smoke • 4400 children between the ages of 12 and 17 use tobacco for the first time every day

12. Facts and Figures 2004 – Age Estimates • 18-24 yo – 28.5% • 25-44 yo – 25.7% • 45-64 yo – 22.7% • Over 65 yo – 9.3% • Men – 25.2% • Women – 20.0%

13. Facts and Figures (Con’t) • In 2002 - 28.4% of high school students used tobacco • In 2002 - 13.3% of middle schoolers used tobacco • Unfortunately, from 2002-2004 this percentage has not changed

14. Non-Hispanic 21.7% Pipe use 3.7% Hispanic cigar use 10.8% Decreased to 17.1% Pipe use is 1.7% Cigar use is 13.3% Trends in Tobacco Use 2002 2004

15. Of Importance • Among smokers <18 years old 63.9% were not asked for proof of age to purchase tobacco • 62.1%were not denied their purchase when proof was shown • 15.1million (41.1%) of adult smokers have stopped at least once

16. Prevalence of Tobacco Use • Indian/Alaska Natives – 40.8% • Caucasian – 23.6% • African American – 22.4% • Hispanic – 16.7% • Asian – 13.3% Source: CDC, May 2004

17. LegislativeImpact • 16 states continue to have no restrictions on smoking • In 2004 – Delaware, Florida, Idaho, Maryland, New York and South Dakota banned smoking in workplaces and restaurants • Utah and Vermont banned smoking in restaurants • Delaware, Maine, Massachusetts, NY banned smoking in bars • Delaware, Massachusetts, NY banned smoking in all three!!!

18. More Facts • There are 4,000 substances found in cigarettes and 43 of them are known to cause cancer .

19. Facts and Figures • Smoking causes more deaths per year than all addictive substances combined - that is about 450,000 deaths per year • One out of every five deaths is from tobacco

20. Cigar and Pipe Smokers Beware! • Cigar use has increased by 34% • Mortality is lower than that of cigarette smokers but more than that of non-smokers • Mainly the 45-65 year olds

21. How safe is smokeless tobacco? • Tobacco in cigarettes is recognized as a major cause of cancer, heart disease and hundreds of deaths per year • Tobacco does not suddenly become safe when it is chewed instead of inhaled

22. Facts about Smokeless Tobacco: A Dangerous Alternative • Smokeless tobacco is highly addictive • It causes about 27,000 cases of oral cancer per year • It kills at a younger age than cigarettes • It has 100 times higher concentration of cancer-causing agents than cigarettes – (28) • Most commonly used by 18-25 yo • 7.6 million Americans over the age of 12 have used smokeless tobacco this month

23. Types of Smokeless Tobacco • Snuff or Dip – finely ground tobacco in dry or moist form such as Skoal or Copenhagen. Also comes in sachets • Chewing tobacco - loose leaf tobacco such as Red Man. It also comes in a plug , twist or loose leaf

24. Smokeless is more dangerous! • An average size dip or chew held in the gum for 30 minutes has as much nicotine a 4 cigarettes!

25. What you should know about Smokeless Tobacco • 1 tin of snuff contains a potentially lethal dose of nicotine • The nicotine in 2 tins per week equals smoking 1.5 packs of cigarettes per day • for every 5 tons of tobacco grown - 3 people die

26. What else you should know about Smokeless Tobacco • There has been a 50 fold increase in oral cancers in which smokeless tobacco accounts for 90% of those cancers • There is a 50% fatality rate in 5 years • 6.7% of HS students use smokeless • 3.7% of middle school students use smokeless

27. Types of Diseases Caused By Smokeless Tobacco • Throat cancer and oral cancer • bladder cancer • larynx (voice box) cancer • Stomach ulcers and/or cancer • heart attacks • lung disease

28. More Bad News…….. • Dippers are 4.5 times more likely to have high cholesterol • Women who use smokeless tobacco have 3 times more stillbirths • Smokeless tobacco causes gum disease, permanently stained teeth and tooth deformities

29. What are in ingredients in tobacco? • Polonium210 (nuclear waste) • Acetaldehyde (irritant) • Lead (nerve poison) • Formaldehyde (embalming fluid) • Cadmium (found in batteries)

30. More ingredients • N-Nitrosamines (known carcinogen) • Benzopyrene (known carcinogen) • Uranium 235 (nuclear waste) • Nicotine (addictive substance)

31. Nicotine Replacement Options • Gum, patches, spray, lozenge, Inhaler • Zyban ®, Wellbutrin® • Cold turkey

32. Advantages to Quitting • Within 20 minutes: • blood pressure and pulse drops to normal • body temperature in the feet and hands returns to normal

33. Within 8 hours Carbon monoxide level drops to normal oxygen level increases to normal Within 24 hours Chances of a heart attack drops by 50% Advantages to Quitting

34. Within 48 hours Nerve endings begin to re-grow The ability to smell and taste improves Within 72 hours Bronchial tubes relax lung capacity increases Advantages to Quitting

35. Within 1-9 months Coughing, sinus congestion and fatigue decreases Cilia re-grow lung cancer death rate is cut in half Overall energy level increases Incoming air thru the nose and air passages is cleaner and infections decrease Advantages to Quitting

36. Stages of Behavior Changes • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

37. Pre-Contemplation • Not considering a change at this point • May be defensive about tobacco use • Needs help realizing benefits of cessation

38. Contemplation • Intends to change - one day • Knows what tobacco does to the body • Costs outweigh benefits right now • Low self-confidence • Needs help identifying triggers and ways to quit

39. Preparation • Ready to learn • Making small changes to avoid tobacco • Needs to create a plan of action • Needs lots of support

40. Action • Making changes and monitoring progress • At great risk for lapse • Needs to be assertive • Needs support

41. Maintenance • Sustaining the change in behavior • Maintaining smoke-free for 6 months or more • Feels very confident • Needs a support group

42. Fagerstrom Level of Dependence Test • This test was developed by Fagerstrom and is frequently used in Smoking Cessation courses to determine the level of dependence

43. What are your likes and dislikes about tobacco? • Discussion of the likes and dislikes of tobacco often encourages one to find alternatives. • This helps identify visually what tobacco means to you

44. Quit Day • Make this a very special day !! Set a date and stick to it. • You must have a plan! • Review coping strategies. • Review your likes and dislikes. • Get rid of all tobacco products.

45. Triggers to Smoking/Chewing and Coping Techniques • What triggers you to use tobacco? Identify when you crave tobacco • In the car • When drinking • When stressed • What coping techniques may help alleviate use

46. Withdrawal Signs • Cravings • irritability • tenseness • trouble concentrating • constipation or irregularity • restlessness

47. Stress Management • Attitude • Think! • Count to ten • Relaxation exercises • Plan ahead • Learn to say “NO”

48. Tips For Quitting • Drink lots of water • Get rid of tobacco in the house and car • Remove all ashtrays • Increase fruits and veggies • Think positive • Call a friend for support • Hang out with Non-smokers

49. Maintaining Your Balance • Recreation - get outside • Social - avoid smoky places • Spiritual - get in touch • Physical - get active • Mental - relax • Vocational - stay busy

50. What if I slip? • Quit tobacco use immediately • Think about what happened and avoid it • Recognize that there was a problem • Learn from the mistake and move on