Interventions for Tobacco Users

Sandra Villalaz, MPH, RN, CHES

Learning Objectives

By the end of the presentation, you will be able to: Explain the magnitude of the problem of tobacco use. Discuss the role of the school nurse in encouraging

students to quit use of tobacco products. Discuss Clinical Practice Guidelines related to tobacco

cessation techniques. Describe evidence based practices for obtaining patient

follow through on tobacco cessation. Identify tobacco cessation-related community resources for

school health nurses to use in assisting students.

The Problem

Individual and Social Costs

Smoking tobacco is the single largest preventable cause of disease and premature death in the United States (U.S.).

In U.S., between 2000-2004, tobacco use contributed to: 443,000 premature deaths (9,637 in TX) Over 5.1 million years of potential life lost $193 Billion cost to society (>$12 Billion in TX)(Cancer Prevention and Early Detection Facts and Figures[ACS], 2011)

(Texas Cancer Facts & Figures [ACS] 2008)

Three Jumbo Jets

Crashing every day.

Individual and Social Costscontinued

Environmental Tobacco Smoke (ETS) now one of the leading causes of preventable death in U.S. 3400 lung cancer deaths 46,000 death from heart disease (nonsmokers) 150,000-300,000 respiratory infections in U.S. infants and

children, 18 months of age. 430 infant deaths related to Sudden Infant Death Syndrome

(SIDS)

(U.S. Surgeon General Report, 2006)

(ACS 2010)

Smoking Prevalence Cigarette consumption rates

National 20.6% adults aged 18 and older* (19.5% HSS Texas 17.9% ^

Prevalence highest among Non-Hispanic white and other Asian/API and Native

Americans Least educated

Cigar consumption rates National 5.4% of adults aged 18 and older

Prevalence highest among African Americans (8%) and American Indian/Alaska

Natives (6%)(*Cancer Prevention and Early Detection Facts & Figures, ACS 2011)(^TDSHS, Behavioral Risk Factor Surveillance System, 2009)

Tobacco Use and Texas High School Students

Cigarette use in last 30 days:21 % report use at least 1 day6% report use on 20 or more days 5% report smoked on school property 53% report did not try to quit

Other tobacco use in last 30 days:7% used chew tobacco, snuff or dip at least 1 day4% used chew tobacco, snuff or dip on school property at 1 day 16% smoked cigars, cigarillos or little cigars at least 1 day

Any tobacco use in last 30 days:27% reported use of any tobacco at least 1 day

Smokeless Tobacco Use Prevalence Adults (2009)

3.5% adults 18 years of age and older Usage highest among:

American Indian and Alaskan Natives and Whites In the South and North Central states Blue collar occupations and service/labor jobs Unemployed

High school students (2007) 13% male

(Centers for Disease Control and Prevention, [CDC] 2009)

Physical Impact of Smoking

Smoking “damages nearly every cell in your body.”

(Surgeon General Richard Carmona, USPHS, 2004) It can cause:

Cancers Chronic Obstructive Pulmonary Disease Heart Disease Cardiovascular Disease Gastrointestinal ulcers/periodontal disease Reproductive effects Eye disorders

(U.S. Surgeon General Report, 2004)

Physical Impact of Smokeless Tobacco Use

Causes: Cancers Leukoplakia Mouth and teeth disorders Reproductive disorders Nicotine addiction and dependence

(CDC 2009)

Role of the School Health Nurse

School Nurses Can Make a Difference

Nurses are an invaluable resource. Nurses are a trusted professional. Patients are more likely to quit

successfully with the nurses’ support. (Good, Frazier, Wetta-Hall, Ablah, & Molgaard, 2004)

We are failing our patients if we don’t offer smoking cessation help. (Roberts, 2002)

Common Barriers to Intervening

Lack of interest or motivation on behalf of patient

Invasion of patient privacy Lack of time of the nurse Lack of knowledge and resources of nurse

(Good, et al, 2004)

Best Practice Guidelines

Comprehensive Tobacco Prevention Program

Tobacco Free School Environment

Evidence based curriculum

Link to community-wide programs.

Provider Reminder System

What is it? Why is it considered important? How effective is it?

(USPHS, 2008)

USPHS Treating Tobacco Use and USPHS Treating Tobacco Use and DependenceDependence

Updated May 2008Updated May 2008

3 Factors Affecting Tobacco Addiction

Nicotine addiction Habitual behavior Emotional dependence

Nicotine Addiction

Temporary Condition

Habitual Behavior

Health Belief Model Potential susceptibility Potential seriousness Perceived costs Cue to action

(Green,2002)

Emotional Dependence

For AdultsBest FriendSocial environment is prime.

For AdolescentsCoolAdult-like

5A’s for Those Ready to Quit

1. Ask

2. Advise

3. Assess

4. Assist

5. Arrange

(USPHS, 2008)

5 R’s for those unwilling to quit

1. Relevance

2. Risks

3. Rewards

4. Roadblocks

5. Repetition

(USPHS, 2008)

5 A’s &5 A’s & R’s CARDR’s CARD

Tools to identify and Tools to identify and assess tobacco use assess tobacco use effectivelyeffectively

5 A’s Quick Guide: 5 A’s Quick Guide: Treat tobacco users Treat tobacco users willingwilling to quit to quit

5 R’s Quick Guide: 5 R’s Quick Guide: Treat tobacco users Treat tobacco users unwillingunwilling to quit to quit

Behavioral Interventions and Five month Quit Rates - Adults

(Hopkins, D 2008)

Self Help 12.3%

Proactive telephone counseling 13.1%

Group Counseling 13.9%

Individual counseling 16.8%

Pharmacotherapy

Nicotine replacement Various methods of administration No prescription is required All increase success rates for quit attempts

Tablets Bupropion and Varenicline Prescription required Increase success rates for quit attempts(Dougherty, P.,2008)

Recommended for adolescent

tobacco users only with

clinician order and tight follow-

up.

Preventing Relapse

On every visit that follows: Provide congratulation Offer support with community resources Encourage student to verbalize benefits Encourage student to make appointment if

relapse or temptation occurs

(Fiore,2008)

Resources for Students

Quit For Life - a quitline In Texas: 1-877-YES-QUIT (877-937-7848)

American Cancer Society www.cancer.org 1-800-ACS-2345

American Heart Association www.heart.org

American Lung Association www.lungusa.org Not–On-Tobacco –School-based teen stop smoking program

Resources for Professionals

National Institute on Drug Abuse (NIDA) – Parent & Teachers Guides and materials http://www.drugabuse.gov/parents-teachers

Guide for Treating Tobacco Use & Dependence www.surgeongeneral.gov

Quick Guide to Helping Tobacco Users www.dshs.state.tx.us/tobacco/default http://www.dshs.state.tx.us/Layouts/ContentPage.aspx?

PageID=34575&id=1651&terms=tobacco+cessation+toolkit American Cancer Society

www.cancer.org 1-800-ACS-2345

Centers for Disease Control and Prevention (CDC) – Adolescent and School Health http://www.cdc.gov/HealthyYouth/tobacco/index.htm http://cdc.gov/tobacco/quit_smoking/cessation/

youth_tobacco_cessationo Youth Tobacco Cessation: A Guide for Making

Informed Decisions American Lung Association

www.lungusa.org Youth Tobacco Cessation Collaborative

http://youthtobaccocessation.org/resources/programs.htm

Resources for Professionals

Conclusion

Final points

Tobacco cessation improves life and prevents death.

Be part of the solution. Be sure you address tobacco use with

every visit.

References

American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2009. Atlanta: American Cancer Society; 2009.

American Cancer Society. Cancer Facts & Figures 2010. Atlanta:American Cancer Society; 2010.

Dougherty,P. A new pharmaceutical approach to smoking cessation, Nursing for women’s health, 12(1), 66-69.

Fiore MC, Bailey, Cohen SJ, et. al. Treating Tobacco Use and Dependence. Rockville, MD: US Department of Health and Human Services. Public Health Service. 2008.

References

Good, M, Frazier,L, Wetta-Hall, R, Ablah, E, and Molgaard, C. Kansas office-based nurses’ evaluation of patient tobacco cessation activities. Journal of community health nursing, 21(2), 2004. 77-85.

Green, L. (2002). Health Belief Model. Lester Breslow. Gale Cengage Ed., 2002. Encyclopedia of Public Health. eNotes.com. 2006. Retrieved 28 Oct, 2010 http://www.enotes.com/public-health-encyclopedia/health-belief-model

Hopkins, David, Briss, Ricard, et. al. Review of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. American Journal of Preventive Medicine. 2008; 35(2):158-176. Review.

References Hopkins, D, Briss, P, Ricard, C, et. al. Review of Evidence

Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. American Journal of Preventive. 2001;20 (2S); 16-66. A report on findings and evidence.

Roberts, June. Kicking the habit. Aberdeen, UK: Primary health care, 12(9), Nov 2002., 27-32.

Smokeless Tobacco Fact sheet.(2009) retrieved October 27,2010. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless facts/index.htm

References

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, MD. Healthy people 2010 report. 2000. Retrieved 28 Oct 2010. http://www.health.gov/healthypeople/

U.S. Public Health Service. (2004). The health consequences of smoking: A report of the Surgeon General. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 25, 2010, from http://www.surgeongeneral.gov/library/smokingconsequences/ index.html

U.S. Public Health Service. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Washington, DC: U.S. Department of Health and Human Services. Retrieved October 25, 2010, from http://www.surgeongeneral.gov/library/secondhandsmoke/index.html