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PLAIN LANGUAGE SMOKING CESSATION

This lecture is one of a series on local public health recruited by Charles J. Vukotich, Jr. of the Allegheny County Health Department (PA), as a scholar in the Northeast Regional Public Health Leadership Institute, Class of 2000. For information contact: dcw01@health.state.ny.us.

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PLAIN LANGUAGE SMOKING CESSATION

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    1. PLAIN LANGUAGE SMOKING CESSATION A Low/No Literacy Approach Deborah J. Stefanucci Urqa@northwestphysicians.com http://npatotalcare.com/welcome.htm

    2. This lecture is one of a series on local public health recruited by Charles J. Vukotich, Jr. of the Allegheny County Health Department (PA), as a scholar in the Northeast Regional Public Health Leadership Institute, Class of 2000. For information contact: dcw01@health.state.ny.us

    3. Deborah J. Stefanucci is an LPN with 28 years experience in the operating room, who has been Director of UR/QA for Northwest Physicians Associates, PC (NPA) for the last 9 years. In 2002, NPA established a non-profit foundation to bring health information to the community. Ms. Stefanucci has been active in developing tobacco outreach programs for the foundation. In 2003, Ms. Stefanucci was conducting a smoking cessation class when one of the participants informed her that he was unable to read the information provided. Frustrated by the lack of materials for patients with low literacy, she developed the Plain Language Smoking Cessation Program. This program has been approved to the PA Department of Health. The principles of Plain Language can be adapted for any group. Ms. Stefanucci deals with a primarily Caucasian clients in rural PA. The pictures in this lecture are designed to look like her clients. It is improtant the pictures look like your clients, but the concepts and discussion can be used universally.In 2003, Ms. Stefanucci was conducting a smoking cessation class when one of the participants informed her that he was unable to read the information provided. Frustrated by the lack of materials for patients with low literacy, she developed the Plain Language Smoking Cessation Program. This program has been approved to the PA Department of Health. The principles of Plain Language can be adapted for any group. Ms. Stefanucci deals with a primarily Caucasian clients in rural PA. The pictures in this lecture are designed to look like her clients. It is improtant the pictures look like your clients, but the concepts and discussion can be used universally.

    4. LEARNING OBJECTIVES To understand the key concepts of smoking cessation. To understand the basic risks of smoking and the benefits of quitting.

    5. PERFORMANCE OBJECTIVES Provide smoking cessation classes for those with no/low literacy that are equivalent to those offered to generally. The program is a power point presentation along with this easy to follow guide for the instructor of the program. Instructors of this program must have a background in teaching smoking cessation for this program to be effectively. The total class time spent for teaching this program is four hours. It is the recommendation of the Coalition to have four classes. One class each week for a month until completed. The slides are divided into 4 sections. Each section will take one hour of class time to complete. There are notes along with the pictures to clue you with dialog and you can refer to the notes in this manual to assist you as you proceed as well. Good Luck! The program is a power point presentation along with this easy to follow guide for the instructor of the program. Instructors of this program must have a background in teaching smoking cessation for this program to be effectively. The total class time spent for teaching this program is four hours. It is the recommendation of the Coalition to have four classes. One class each week for a month until completed. The slides are divided into 4 sections. Each section will take one hour of class time to complete. There are notes along with the pictures to clue you with dialog and you can refer to the notes in this manual to assist you as you proceed as well. Good Luck!

    6. Opening remarks Begin introductions, introduce yourself and ask each participant name and where they are from; ask each participant how long they been smoking. Make sure you keep it informal and reassure them there will be no written or reading required from them, only hard work! Use this time to get to know each participant by name. Instruct the participants the next 4 weeks will be work and fun, be positive! Tell participant that smoking is a habit and addiction. Both of these must be confronted when quitting. Let the participant know you are there to encourage their commitment to quit and to instruct them with strategies and coping skills necessary for permanent success. Part of your job is to assist the participant develop new skills of coping with specific situations in which they used to smoke. Every opportunity to offer alternative ways of dealing with situations other than smoking will be new to the participants, this concept must be introduced from the beginning of the class. The concept that other opportunities are available to them will be a very powerful revelation to them. Remember be positive! Information used to develop this program is from the Clinical Practice Guidelines from the U.S. Department of Health and Human Services and can be referenced for additional information. Begin introductions, introduce yourself and ask each participant name and where they are from; ask each participant how long they been smoking. Make sure you keep it informal and reassure them there will be no written or reading required from them, only hard work! Use this time to get to know each participant by name. Instruct the participants the next 4 weeks will be work and fun, be positive! Tell participant that smoking is a habit and addiction. Both of these must be confronted when quitting. Let the participant know you are there to encourage their commitment to quit and to instruct them with strategies and coping skills necessary for permanent success. Part of your job is to assist the participant develop new skills of coping with specific situations in which they used to smoke. Every opportunity to offer alternative ways of dealing with situations other than smoking will be new to the participants, this concept must be introduced from the beginning of the class. The concept that other opportunities are available to them will be a very powerful revelation to them. Remember be positive! Information used to develop this program is from the Clinical Practice Guidelines from the U.S. Department of Health and Human Services and can be referenced for additional information.

    7. Congratulate participants for attending Congratulate each of the participant for attending cessation class. Let them know you understand how difficult this decision was for them and you are there to encourage and support their commitment to quit. Congratulate each of the participant for attending cessation class. Let them know you understand how difficult this decision was for them and you are there to encourage and support their commitment to quit.

    8. Chemicals Education for the participants about the chemicals they have been exposed to while smoking. Inform the participants there are over 5,000 chemicals in every cigarette. Use common term everyday terms when describing these additives: Paint thinner Insecticide Materials used to make moth balls Material used to fill holes in the road Metal Deadly poison Materials used in batteries Materials used to make dye Materials used in embalming Household cleaner Rat poison Lighter fluid Material that comes out of your cars tail pipe A cancer- causing radioactive element Insecticide that has been banned from general household use And 36 other known cancers causing additives. Explain that nicotine is the additive to the cigarettes that causes addition. The other additives are what cause the cancers, heart problems, emphysema, etc. Ask for input from the participants now knowing this information. Education for the participants about the chemicals they have been exposed to while smoking. Inform the participants there are over 5,000 chemicals in every cigarette. Use common term everyday terms when describing these additives: Paint thinner Insecticide Materials used to make moth balls Material used to fill holes in the road Metal Deadly poison Materials used in batteries Materials used to make dye Materials used in embalming Household cleaner Rat poison Lighter fluid Material that comes out of your cars tail pipe A cancer- causing radioactive element Insecticide that has been banned from general household use And 36 other known cancers causing additives. Explain that nicotine is the additive to the cigarettes that causes addition. The other additives are what cause the cancers, heart problems, emphysema, etc. Ask for input from the participants now knowing this information.

    9. Three aspects of smoking Discuss these three aspects of smoking with the participants: 1. Addiction, and the effects smoking and nicotine has on their bodies, make sure you use non-medical terms. 2. Habit, discuss how the participant has associated smoking with other activities and behaviors. (after meals, celebrations, etc.). The participant may automatically light a cigarette and then realize they did not remember lighting it. It has become automatic. A habit. Breaking the habit can be done by repeatedly interrupting the old behavior. 3. Psychological, discusses what are the positive benefits the participants thinks they are getting from smoking. (Stress relief, weight control, etc.) and how it is them and always has been them in control not the cigarettes. Discuss these three aspects of smoking with the participants: 1. Addiction, and the effects smoking and nicotine has on their bodies, make sure you use non-medical terms. 2. Habit, discuss how the participant has associated smoking with other activities and behaviors. (after meals, celebrations, etc.). The participant may automatically light a cigarette and then realize they did not remember lighting it. It has become automatic. A habit. Breaking the habit can be done by repeatedly interrupting the old behavior. 3. Psychological, discusses what are the positive benefits the participants thinks they are getting from smoking. (Stress relief, weight control, etc.) and how it is them and always has been them in control not the cigarettes.

    10. Nicotine addiction Discuss how nicotine addiction occurs, and its and effects on the body. Explain how nicotine reaches the brain and a chemical is release called Dopamine, which produces a pleasurable response to the smoking. When you break this addiction you will begin to enjoy life without the physical dependence to nicotine. Discuss how nicotine addiction occurs, and its and effects on the body. Explain how nicotine reaches the brain and a chemical is release called Dopamine, which produces a pleasurable response to the smoking. When you break this addiction you will begin to enjoy life without the physical dependence to nicotine.

    11. Carbon Monoxide testing Carbon Monoxide Testing Now is a good opportunity to check each participants Carbon Monoxide level. This information is very powerful to some participants and will be repeated at the last class. Inform them they will much happier with the results at the last class and will be able to see a significant difference. Carbon Monoxide Testing Now is a good opportunity to check each participants Carbon Monoxide level. This information is very powerful to some participants and will be repeated at the last class. Inform them they will much happier with the results at the last class and will be able to see a significant difference.

    12. What smoking robs you of Remind the participants that smoking robs you of your: Health Money Self esteem Get the participants to discuss how all of these will change with cessation. Remind the participants that smoking robs you of your: Health Money Self esteem Get the participants to discuss how all of these will change with cessation.

    13. Stages of quitting Now is time to discuss with your participants the stages necessary for quitting. (Remind them each person will have their own timetable for each stage and it should be individualized.) 1. Thinking about quitting- They are considering quitting but not made any definite plans, has not set a quit date. 2. Quitting- The participant is ready to quit, they may of already started changes in smoking behavior, or have a quit date picked. 3. Maintenance- The participant has not smokes for three weeks or longer, and has not had a cigarette during this time. Ask each participant where they are in the stages. Use this opportunity to help some participant who might be ready to move onto the quitting stage at this class. Remember your goal is to help the participant stay quit permanently. Now is time to discuss with your participants the stages necessary for quitting. (Remind them each person will have their own timetable for each stage and it should be individualized.) 1. Thinking about quitting- They are considering quitting but not made any definite plans, has not set a quit date. 2. Quitting- The participant is ready to quit, they may of already started changes in smoking behavior, or have a quit date picked. 3. Maintenance- The participant has not smokes for three weeks or longer, and has not had a cigarette during this time. Ask each participant where they are in the stages. Use this opportunity to help some participant who might be ready to move onto the quitting stage at this class. Remember your goal is to help the participant stay quit permanently.

    14. Set quit date. Instruct participants to set a quit date and stick to it. Have them choose on within the next two weeks. Discuss with them that this program will assist them in dealing with NRTs, behavior changes necessary for success, and what to do if they think they are going to slip. Pass out water bottles and tell participants you want them to increase their water intake significantly before next class. End of first class/questions? This portion will take 60 minutes to complete, if time allows engage the participants in their thoughts on NRTs how to obtain these products free if they are Crawford County residents. NRTs will be discussed in detail in the next session. Instruct participants to set a quit date and stick to it. Have them choose on within the next two weeks. Discuss with them that this program will assist them in dealing with NRTs, behavior changes necessary for success, and what to do if they think they are going to slip. Pass out water bottles and tell participants you want them to increase their water intake significantly before next class. End of first class/questions? This portion will take 60 minutes to complete, if time allows engage the participants in their thoughts on NRTs how to obtain these products free if they are Crawford County residents. NRTs will be discussed in detail in the next session.

    15. Health benefits 20 minutes Start Class ll. This section deals with health benefits from cessation and NRTs available for cessation. Behavior changes that must be made to successfully complete this program will be discussed in detail, make sure you have the participants actively involved in this process. Instruct participants that the following health factors occurs when they quit smoking: Within 20 minutes of smoking a cigarette: Pulse rate will return to normal Blood pressure drops to normal Body temperature of hands and feet increase to normal Start Class ll. This section deals with health benefits from cessation and NRTs available for cessation. Behavior changes that must be made to successfully complete this program will be discussed in detail, make sure you have the participants actively involved in this process. Instruct participants that the following health factors occurs when they quit smoking: Within 20 minutes of smoking a cigarette: Pulse rate will return to normal Blood pressure drops to normal Body temperature of hands and feet increase to normal

    16. Within 8 hours Within 8 hours: Carbon monoxide level in blood drops to normal The oxygen level in blood increases to normal Within 8 hours: Carbon monoxide level in blood drops to normal The oxygen level in blood increases to normal

    17. Within 24/72 hours Within 24 hours: The chance of heart attack decreases Nerve endings start to grow The ability to smell and to taste improves Within 72 hours: Bronchial tubes relax, making breathing easier. Lung capacity increases Within 1 to 9 months: Coughing, sinus congestion, fatigue, shortness of breath decreases. Cilia begin to regrow in the lungs, increasing ability to handle mucus, clean the lungs and reduce infection. Overall energy increases. Within 24 hours: The chance of heart attack decreases Nerve endings start to grow The ability to smell and to taste improves Within 72 hours: Bronchial tubes relax, making breathing easier. Lung capacity increases Within 1 to 9 months: Coughing, sinus congestion, fatigue, shortness of breath decreases. Cilia begin to regrow in the lungs, increasing ability to handle mucus, clean the lungs and reduce infection. Overall energy increases.

    18. 3-4year benefits Within 3 to 4 years: The risk of cancers of the bladder and larynx decreases. Within 3 to 4 years: The risk of cancers of the bladder and larynx decreases.

    19. Within 5 years Within 5 years: The risk of cancers of the esophagus and mouth decreases. The risk of cancer of the pancreas decreases. The risk of stroke is reduced to that of a non-smoker. Within 5 years: The risk of cancers of the esophagus and mouth decreases. The risk of cancer of the pancreas decreases. The risk of stroke is reduced to that of a non-smoker.

    20. Within 10 years Within 10 years: The lung cancer rate drops to that of a non-smoker. Within 15 years: The risk of coronary disease is now similar to that of a non-smoker Discuss the benefits of smoking cessation with the participants. Most participants are excited to learn they can start immediately seeing positive outcomes with cessation. Remember it is important to remain positive and reinforce all the benefits long and short term from cessation. This is a good point in the class to monitor each participants carbon monoxide. Explain that they will be rechecked at the last class to compare the health benefits of quitting. Within 10 years: The lung cancer rate drops to that of a non-smoker. Within 15 years: The risk of coronary disease is now similar to that of a non-smoker Discuss the benefits of smoking cessation with the participants. Most participants are excited to learn they can start immediately seeing positive outcomes with cessation. Remember it is important to remain positive and reinforce all the benefits long and short term from cessation. This is a good point in the class to monitor each participants carbon monoxide. Explain that they will be rechecked at the last class to compare the health benefits of quitting.

    21. Cost of smoking Ask each participant if they notice how much money they are spending weekly, monthly, yearly. Handouts of the cost of smoking are beneficial at this time. Assist participants who might need assistance with this tool. If you do not have this available use a calculator to establish how they are spending on tobacco. Ask each participant if they notice how much money they are spending weekly, monthly, yearly. Handouts of the cost of smoking are beneficial at this time. Assist participants who might need assistance with this tool. If you do not have this available use a calculator to establish how they are spending on tobacco.

    22. Saving money Have participants describe what they might do with the money saved weekly, monthly, and yearly. Use this time to let the participants be upbeat and positive about the future being smoke free. Ask them to start saving the money used on cigarettes immediately after they have started cessation. It is important for them to see how much they have been spending everyday on smoking, and how it is possible having their dreams come true with the extra monies. Have participants describe what they might do with the money saved weekly, monthly, and yearly. Use this time to let the participants be upbeat and positive about the future being smoke free. Ask them to start saving the money used on cigarettes immediately after they have started cessation. It is important for them to see how much they have been spending everyday on smoking, and how it is possible having their dreams come true with the extra monies.

    23. Starting to take control Starting to take control, using NRTs Review with the participants the following information on nicotine replacement therapy with the participants and instructed them on the use. It is very important to tell the participants that the NRTs are not the magic pills or cure for smoking. Behavior changes must be done by the participants. NRTs therapy controls- cravings, irritability, impatience, anxiety, restlessness, difficulty concentrating, drowsiness, decreased short time memory NRTs Delays and or decreases appetite, weight gain Starting to take control, using NRTs Review with the participants the following information on nicotine replacement therapy with the participants and instructed them on the use. It is very important to tell the participants that the NRTs are not the magic pills or cure for smoking. Behavior changes must be done by the participants. NRTs therapy controls- cravings, irritability, impatience, anxiety, restlessness, difficulty concentrating, drowsiness, decreased short time memory NRTs Delays and or decreases appetite, weight gain

    24. What is NRTs What is NRT? Instruct the participants that it will prevent withdrawal It will give the participant time to comfortably break the habit and psychological dependency of smoking. What is NRT? Instruct the participants that it will prevent withdrawal It will give the participant time to comfortably break the habit and psychological dependency of smoking.

    25. Description of NRTs NRTs available Patch Nicoderm - 21mg, 14 mg, 7mg, (original and clear) Habitrol - 21mg, 14 mg, 7 mg Nicotrol - 15mg. 10mg, 5mg Store brand- 22mg, 11mg Gum Nicorette (original, mint, orange) 2mg-if you smoke less than 24 cigarettes a day 4mg-if you smoke 25 or more cigarettes a day Generic (same dose) Lozenge-Commit (mint) 2mg-first cigarette more than 30 minutes from waking 4mg-first cigarette less than 30 minutes from waking. Advise participants to seek medical assistance with the best choice for them for NRT. Other NRTs that require a prescription are: Zyban Oral and nasal inhalers. NRTs available Patch Nicoderm - 21mg, 14 mg, 7mg, (original and clear) Habitrol - 21mg, 14 mg, 7 mg Nicotrol - 15mg. 10mg, 5mg Store brand- 22mg, 11mg Gum Nicorette (original, mint, orange) 2mg-if you smoke less than 24 cigarettes a day 4mg-if you smoke 25 or more cigarettes a day Generic (same dose) Lozenge-Commit (mint) 2mg-first cigarette more than 30 minutes from waking 4mg-first cigarette less than 30 minutes from waking. Advise participants to seek medical assistance with the best choice for them for NRT. Other NRTs that require a prescription are: Zyban Oral and nasal inhalers.

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