healthy air for kids campaign name title helping parents quit smoking for the health of their...

Healthy Air for Kids Campaign

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Helping parents quit smoking Helping parents quit smoking for the health of theirfor the health of their children.children.

Healthy Air for Healthy Air for KidsKids Campaign Campaign

“The scientific evidence is now indisputable: Secondhand smoke is a serious health hazard that can lead to disease and premature death in children.”

--Surgeon General Richard Carmona,

Surgeon General’s Report

June 27, 2006

2006 Surgeon General Report


Why Treat?

There are 4,000 chemicals in cigarette smoke.

There is no safe amount of secondhand smoke.

Breathing it for even a short time can have immediate adverse effects.

According to the Surgeon General:According to the Surgeon General:


Why Treat?

About 60 percent of children in Wisconsin suffer from second-hand smoke exposure.

--Surgeon General Report, 2006

In Wisconsin, 54 percent of middle school children are exposed to secondhand smoke.

--Burden of Asthma in Wisconsin, 2004


As a result, these kids develop pneumonia, ear infections, bronchitis, asthma, colic, reduced pulmonary function and SIDS.

Why Treat?


Parents want your help.

• 85% of parents who smoke want pediatricians to counsel them about quitting and prescribe tobacco cessation medications.

• Parents say, “It shows you care.”• Only 8% of parents who smoke are currently offered medication or counseling

Source: Pediatrics, 2005

• “Smoking cessation interventions during physician visits were associated with increased patient satisfaction with their care among those who smoke.”

Mayo Clinic Proc. 2001;76:138-143

Why Treat?


“In fact, when we don’t ask parents about smoking, they say, ‘What’s up?’ It’s like we don’t care. If I don’t ask parents about smoking, I’m really missing the boat.”

-- John Meurer, Chief of General Pediatrics, Medical College of Wisconsin, Wisconsin Pediatrician of the Year

Why Treat?


You can have a huge impact with a brief intervention.

– In a few minutes, you can help your patients live in a smoke-free environment and decrease the chances the children will ever light up.

– “Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates.”

Source: U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence

Why Treat?


– We’ll show you how to do it in a way that is: Brief. Safe. Effective.

Why Treat?


Three Tools

A quick reference guide to show you and your staff how to do a brief, effective intervention.


Three Tools

A laminated tobacco treatment chart to post on your office wall for quick reference.

1) 5 A’s for treatment

2) Medications chart


Three Tools

A note pad of tear sheets so you can walk your patients through their individualized plan to quit.


Posters & Brochures

We have developed posters & brochures for your waiting rooms.We have developed posters & brochures for your waiting rooms.


How to Treat

Help your patient’s parent(s) quit smoking by following the “5 A’s”: – Ask every parent at every patient visit.– Advise all tobacco users to quit.– Assess the parent’s willingness to quit.– Assist with counseling and medication.– Arrange follow-up care.


How to Treat: ASK.

Ask the parents, “Do you smoke?”

“Clinicians should routinely ask about secondhand smoke exposure, particularly when a child has had an illness caused by secondhand smoke.”

Former Surgeon General Richard Carmona, Surgeon General’s Report, June 27, 2006


CHILD VITAL SIGNS

Blood Pressure: _______________________________________________Pulse: ________________ Weight: ________________________________Temperature: _________________________________________________Respiratory Rate: ______________________________________________

Parent Smokes: YES no (circle one)

IF YES > continue with counseling

Child Exposed to Secondhand Smoke: YES no (circle one)

IF YES > urge smoke-free environments at all times

How to Treat: ASK.


Urge parents to quit smoking in a clear,

strong, personalized manner. Connect it to the child’s symptoms.

Frequent ColdsPneumoniaEar InfectionsBronchitis Asthma

Secondhand

Smoke

Research shows this is most effective.

How to Treat: ADVISE.


– “Second-hand smoke is making Tommy’s asthma worse… it could even be the cause.”

– “I strongly advise you to quit, which will help him get better.”

– “It’s not easy, but you can do it. We can help.”




Document it. Advice to quit should be noted in the child patient’s medical record.


How to Treat: ASSESS.

Ask the parent if he/she is willing to try to quit.

“Are you ready to quit within the next 30 days?”

• If yes, move on to ASSIST.

• If no, ask the parent to continue to seriously think about quitting.


How to Treat: ASSESS.

Strongly urge the parent not to smoke Strongly urge the parent not to smoke around the child.around the child. • “We know that if you smoke, it’s more likely Sally will

light up later in her life.”

• “There is no safe amount of second-hand smoke for Jaden.”

• “It’s especially dangerous in your home and car.”

• “Chemicals from smoke linger even after you put out your cigarette and the smoke disappears.”


For parents willing to make a quit attempt: provide counseling and recommend medication. This combination gives the parent the best chance to successfully quit.

Brief Intervention. Advise the parent to:• Review smoking history. This includes past quit attempts, amount smoked, current medications, etc.• Set a quit date, ideally within 2 weeks.• Completely abstain. “Not a single puff,” starting on the quit date, to prevent relapse.• Avoid alcohol. It’s strongly linked to smoking relapse.• Get support from family or peers.• Avoid other smokers.• Discuss challenges, particularly in the first few weeks, including nicotine withdrawal.

How to Treat: ASSIST.


Offer medication.

• You can prescribe medication or recommend OTC medication.

• Seven different FDA-approved cessation medications have been clinically proven to increase the chances of quitting – up to three times better than placebo.



Prescription medication.

Medicaid and BadgerCare cover the following prescription medications:

• Nicotine patch (when written as “legend nicotine patch”)• Nicotine inhaler• Nicotine nasal spray• Bupropion SR (generic or Zyban)• Varenicline (marketed as Chantix)



Recommend OTC medication.

• Nicotine patch• Nicotine gum • Nicotine lozenge



Nicotine Replacement Therapy (NRT)

• Nicotine is the active ingredient

• No evidence of increased cardiovascular risk with NRT

• Supplied as a steady dose (patch) or self-administered (gum, inhaler, nasal spray)

• Self-administered products should be used on a scheduled basis initially, then tapered to ad-lib use and eventual discontinued



Nicotine Replacement Therapy (NRT)

Contraindications:• Immediate myocardial infarction (< 2 weeks)• Serious arrhythmia• Serious or worsening angina pectoris• Accelerated hypertension

Use and Cost:• Varies by product and amount used (see UW-CTRI Medications Chart for details)



Nicotine gum

2 mg vs 4 mg Chew and park Absorbed in a basic environment Use enough pieces each day (6-16) OTC


Nicotine patch

Available as both prescription and OTC

A new patch is applied each morning

Rotating placement site can reduce irritation

Typical Dosing:– 4 weeks of 21 mg/day, then

– 2 weeks of 14 mg/day, then

– 2 weeks of 7 mg/day


Nicotine lozenge

2 or 4mg Use enough Benefits OTC Use enough (6-16 lozenges/day)


Nicotine inhaler

• Prescription only• May irritate mouth/throat at first (but improves with use) • Don’t drink acidic beverages during use • 6-16 cartridges/day • Inhale 80 times/cartridge • May save partially-used cartridge for next day • Use up to 6 months; taper at end


Bupropion SR

One of two non-nicotine medications approved by the FDA as an aid to quitting smoking

Available by prescription only Shown to be particularly effective for women

and patients diagnosed with depression Mechanism of action: blocks neural reuptake

of dopamine and/or norepinephrine


Bupropion SR

Contraindications– Seizure disorder– MAO inhibitor within previous 2 weeks– History of anorexia nervosa or bulimia– Current use of Wellbutrin or Zyban

Side effects– Insomnia– Dry mouth


Bupropion SR

Dosing: – Start 1-2 weeks before quit date– 150 mg orally once daily x 3 day– 150 mg orally twice daily x 7-12 weeks– No taper necessary at end of treatment

Maintenance:– Efficacious as maintenance medication for 6 months


Varenicline

This new Pfizer medication was approved by the FDA in May 2006

Like Bupropion, Chantix is available by prescription only

Unique: Varenicline is neither a nicotine replacement therapy nor does it actively reduce dopamine reuptake.

Varenicline acts on nicotine receptors with two types of action: It blocks some of the rewarding effects of nicotine (acts as an antagonist) and at the same time stimulates the receptors in a way that reduces withdrawal (acts as an agonist).


Varenicline

Dosing & MaintenanceStart varenicline one week before the quit date for maximum

effectiveness Recommended treatment is 12 weeks:

– Days 1-3………..1 pill (0.5 mg) per day– Days 4-7………..1 pill (0.5 mg) twice a day (am & pm)– Day 8-end………1 pill (1 mg) twice a day (am & pm)

An additional course of 12 weeks for maintenance can be considered


Varenicline

Contraindications

Use with caution and consider dose reduction in patients: ⇒ With significant renal impairment. ⇒ Undergoing dialysis.

Side effects⇒ Primary side effect is nausea

⇒Suggested solution is to reduce dosage


More than 70 percent of Wisconsin residents with private insurance are covered for at least one quit smoking medication.

Medicaid, BadgerCare and SeniorCare also cover tobacco dependence treatments.

How to Treat: Coverage.


Refer parents to the:

How to Treat: REFER.

• It’s free, confidential, and non-judgmental.

• Callers are 4 times more likely to quit than those who try to quit cold turkey.

• Services are available in virtually any language.


“Time is always short. I tell my patients: ‘Call the Wisconsin Tobacco Quit Line. They’re sharp. They can help you.’”

-- Dr. Pierce Sherrill, Aurora Healthcare

“The Quit Line was very helpful for me. I needed someone who was on my side... and they were.”

--Gloria Taylor


Other referral options:– A cessation program

in your clinic or system.

– A local community

program. For a list of programs in your county, visit:

http://www.ctri.wisc.edu/resources.html

How to Treat: ARRANGE.


Arrange for follow-up counseling.Arrange for follow-up counseling.

• If the parent has quit, congratulate him or her on a tremendous accomplishment!

• If the parent has relapsed, reassess the situation and encourage another quit attempt.

How to Treat: ARRANGE.

• Like diabetes or hypertension, tobacco dependence is a chronic disease and should be treated as such over time.

• Continue to encourage the parent to quit, focusing on maintaining a positive outlook.

• You can follow up or refer to the Quit Line.


CME credit.

FREE online CME for tobacco cessation treatment is available for:

– Physicians– Nurses – Pharmacists

Visit www.medscape.com/viewprogram/3607

Resources.


How it works:How it works:

1. The patient signs a consent form.

2. Your office faxes the form to the Quit Line.

3. The Quit Line calls the patient at a time requested by the patient.

4. The Quit Line faxes back a report to your office.

FREE to you and your patient!FREE to you and your patient!

How to Treat: Fax to Quit Program


• News• Research results• Treatment tools• Latest best practices

www. CTRI . WISC . EDU


Abby Kreul, right, 9 years old:

““It’s better now that It’s better now that Mom and Dad have Mom and Dad have quit because I don’t quit because I don’t get sick as much.”get sick as much.”

Make a Difference.


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www. CTRI . WISC . EDU

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