hertfordshire stop smoking service brief intervention training for health champions
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HERTFORDSHIRE STOP SMOKING SERVICE BRIEF INTERVENTION TRAINING FOR HEALTH CHAMPIONS Trainer: Janka Szocs Stop Smoking Specialist 22 nd April. What causes the most deaths per day worldwide?. Illegal Drugs. Aids. Smoking. Murder. Road Accidents. Suicide. - PowerPoint PPT PresentationTRANSCRIPT
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HERTFORDSHIRESTOP SMOKING SERVICE
BRIEF INTERVENTION TRAININGFOR HEALTH CHAMPIONS
Trainer: Janka Szocs Stop Smoking
Specialist22nd April
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What causes the most deaths per day worldwide?
Suicide
IllegalDrugsAids
Murder Road Accidents
Smoking
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Smoking causes approximately 13000 deaths per day worldwide
Suicide
IllegalDrugsAids
Murder Road Accidents
Smoking
More deaths than all of the other 5 added together
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Smoking
Smoking is responsible for 20% of all deaths in the UK.
300 deaths in the UK daily
50% of smokers die prematurely
Repeated quit attempts may be needed
Consider Smoking as: a powerful motivation to engage versus an impaired capacity for restraint1Robert west Maudsley clinic London
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£5.2 billon per year
Smoking:Cost to the NHS
Allender S, Blakrishnan R, Scarborough P, Webster P, Rayner M. The burden of smoking related ill health in the United Kingdom. Tobacco Control, 2009;18.262-267
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What’s in a cigarette?
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• More than 4,000 other chemicals in cigarette smoke,1 more than 50 of which are known to cause cancer2
• It is the mixture of toxins in cigarette smoke that is responsible for the majority of the harmful effects, not nicotine1
Myth: Nicotine causes the diseases related to smoking
1. www.treatobacco.net./English/keyfindings/key_finding_1.html Last accessed on 15.02.082. Hoffmann D & Hoffmann I. J Toxicol Environ Health 1997; 50(4):307-364.
FACTS: There is no evidence to suggest that nicotine causes cancer
3
http://smokeaway.files.wordpress.com
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Tar
•70% of the tar in smoke is deposited in the lungs.
•Many of the chemicals are known to cause cancers
•Damages lungs & cilia
•Stains fingers, teeth & hair
•? Low tar vs High tar
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Carbon Monoxide
Carbon monoxide is a clear odourless, poisonous gas that dissolves in the blood quicker than oxygen. It attached to the red blood cells reducing oxygen in the blood by up to 13%.
The body compensates by making more red cells, making the blood thicker and stickier so the heartHas to work harder resulting in an increased risk ofDeveloping coronary heart disease.
Carbon monoxide is harmful during Pregnancy as it reduces the amount of oxygencarried to the baby in the womb
Carbon monoxide levels can be measured using a CO monitor.
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MECHANISM OF ACTION OF NICOTINEIN THE BRAIN
MECHANISM OF ACTION OF NICOTINEIN THE BRAIN
• Nicotine binds to 42 nicotinic acetylcholine receptor stimulating dopamine release1-3
• This results in the satisfaction associated with smoking1-3
• A drop in nicotine levels leads to craving and withdrawal1,4
1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. Coe JW et al. J Med Chem 2005; 48: 3474-3477. 4. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004.
4
NIC NicotineDopamine
NucleusAccumbens(nAcc)
VentralTegmentalArea(VTA)
NIC
42
2
2
α4β2Nicotinic Receptor
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Anatomy & Physiology of Smoking
• Receptors in mid brain release dopamine when activated by smoking
• Smoking increases the number of receptors by 300%
• Takes 7-10 seconds for inhalation to reach brain
• Down regulation takes 8-12 weeks
• 80% relapse potential after 1 cigarette – greater than with other addiction
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1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004. 4. Caggiula AR et al. Physiol Behavior 2002; 77:683–687.
Pharmacological• Nicotine in tobacco smoke is highly addictive1,2
• Nicotine stimulates dopamine release in the brain, resulting in short-term
feelings of reward/satisfaction1,3
Behavioural
• Smoking-associated environmental stimuli play a role in reinforcing nicotine dependence4
THE PHARMACOLOGICAL AND BEHAVIOURALCOMPONENTS OF SMOKING DEPENDENCE
THE PHARMACOLOGICAL AND BEHAVIOURALCOMPONENTS OF SMOKING DEPENDENCE
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WHAT ARE THE HARMFUL EFFECTS OF
SMOKING?
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Long term effects
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Effects of Smoking in Pregnancy
– Miscarriage
– Stillbirth
– Premature membrane rupture
– Placenta praevia & abruption
– IUGR (Fetal growth retardation)
– Pre-term birth mature babies
– SIDS
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PRESENTATION HEADER/TITLESecondhand tobacco smoke Effects on Children
• Respiratory tract infections• Ear infections• Asthma• SIDS• Low birth weight• Meningitis• Behaviour problems• Risks in Adulthood
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DO PEOPLE WANT TO QUIT SMOKING?
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QUITTING SMOKING
• The majority of smokers want to quit (67%)1
• Most people try to quit without any assistance2
• Smokers are up to 4 times more likely to quit with help from a trained advisor
•75% smokers have tried to quit at some point in the past*
1 Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279.
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•The majority of smokers want to quit1
•Most people try to quit without any assistance2
•Only 3-5% of unaided quitters remain smoke-free after 6 to 12 months3
•Most smokers make five to seven attempts before they finally succeed3
•98% of smokers who relapse following a quit attempt are willing to try quitting again4
Quitting Smoking is difficult
1. Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279. 3. Hughes JR et al. Addiction 2004; 99:29-38. 4. Joseph A et al. Nicotine Tob Res 2004; 6:1075-1077.
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What % of smokers today think they will have stopped by next year?
50%
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What % will have done so?
2%
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Every smoker should be advised to quit, opportunistically, at least
annually. (unless in exceptional circumstances)[1]
NICE 2006
NICE GUIDELINES
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What % make a quitattempt
when offered treatment?
50%
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WHY USE A STOP SMOKING SERVICE?
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Smokers are
4 times
more likely to quit with pharmacotherapy and behavioural
support
Ref Bobak A 2007
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How can we increase the numbers of smokers using the service?
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How can you help?
• Make raising the issue of smoking a priority
• Use brief intervention techniques
• Promote the benefit of using the service
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What is a stop smoking brief intervention?
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What is a brief intervention?
Using opportunities to discuss a patient’s smoking
Part of normal
conversation
“Do you smoke?”
When a suitable opportunity
presents
Exploring a patient’s attitude to his/her smoking
Ask open questions
“What do you enjoy
about smoking?”
“What would need to
change for you to stop?”
Recognising when the smoker may be close to
wanting to change his/her behaviourSmoker may be ready to
quit
Feelings about smoking
change over time
Discussing FREE support that is available and making a referral to stop smoking service
4 times as likely to
succeed with help
Explain that there is help
available
Circumstances change, e.g. pregnancy
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Brief Intervention is:
A3 step
30 secondsystems based
approach
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The AAA Approach
3. ACT
ASK regularly and be approachable
ADVISE smoker of health benefits of stopping.
Link advice to any colleagues specific
conditions
ACT on colleagues response and refer to
stop smoking service for support
1. ASK
2. ADVISE
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ASK regularly and record smoking status
Use your own words, what feels appropriate for you
Examples of what you might ask:
• “Do you smoke?”
• “Can I ask if you smoke?”
• “Have you ever thought about stopping smoking?”
• “Would you like to stop smoking?”
• “Have you ever tried to stop smoking?”
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ADVISE smokers of health benefits of stopping
As a health professional it is my duty to advise you to stop smoking.
Stopping smoking is the best thing you can do to
improve your current and future health
Stopping smoking is the best thing
you can do for your health
You probably already know the
risks involved with smoking but I cannot stress enough how
important it is to stop. It is the best
way to improve your health
Examples of what you might say
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ACT on patient’s response and refer
You may choose to ask the patient if you can refer them
or
You may decide to refer unless they opt out
e.g. “Lots of patients succeed with support from the FREE stop smoking service and stop smoking medication. Can I refer you?”
e.g. “It is our policy to refer you to the stop smoking service. I can arrange that for you now”
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ACT on patient’s response and refer
The NHS provides free and effective treatment for
smokers like yourself. In fact you are up to four times
more likely to quit using this help than quitting by
yourself. Are you interested in finding out more about
this service?If you would like to give up smoking I
can help you
Examples of what you might say
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Providing a Brief Intervention
• It is quick (takes less than 30 seconds)
• You are offering treatment to a patient with a serious addictive condition which is dangerous to their health
• Most smokers want to quit
• Half the smokers offered treatment make an attempt to quit
• Treatment via the stop smoking service is four times more effective than trying to quit alone
• If the smoker does not want to quit, leave the door open (e.g. “I respect your decision. Perhaps we could talk about it again another time”)
Half the smokers offered treatment make an attempt to quit
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What does the stop smoking service offer?
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What does the stop smoking service offer?
Pharmacotherapy (on prescription)• Nicotine Replacement Therapy (NRT)• Zyban & Champix
Psychological SupportAt least 5 weekly meetings
with trained advisor
Carbon Monoxide Monitoring
The service is free
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What to expect from the stop smoking service
• A minimum of 5 appointments
• Initial appointment of 30 minutes:
– Understand how and why the patient smokes
– Agree the most appropriate pharmocotherapy
– Measure level of carbon monoxide in the body
• Further appointments of 15 minutes:
– Review progress and carbon monoxide levels
– Address difficulties and obstacles
Celebrate success!
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How to refer
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How to refer
Fax referral form to 01442 453070
Phone Hertfordshire Stop Smoking Service 0800 389 3 998
• Free resources (e.g. stop smoking leaflets in a variety of languages, posters) can be obtained from:
• www.healthpromotioninherts.nhs.uk
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NATIONAL CAMPAIGNS
• Non Smoking Day
• Stoptober
Great opportunity-Networking with Pharamacies, HSSSGet in contact with your locality specialist.
Information from Media is not linked together with Herts Stop Smoking Service.
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Further information is available from:
Stevenage/Welhat Specialist:[email protected]
07789505207
[email protected] Intervention Lead
Hertfordshire Stop Smoking Service0800 389 3 998
www.smokefreehertfordshire.nhs.uk
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Giving brief advice can only take 30 seconds, but can save a smoker’s life.
Stopping smoking works
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ANY QUESTIONS?
THANK YOU!