Encouraging Stopping Smoking

7/31/2019 Encouraging Stopping Smoking

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Encouraging Stopping

Smoking


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Part 1: Learning Objectives

Reasons for including counseling to stopsmoking into routine medical practice

Cognitive behavioral and pharmacologicalprocedures used to help people to stopsmoking

How to tailor smoking cessationprogrammes to the patients state of

readiness to quit


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Part 1: Learning Objectives

Incorporate smoking cessation efforts intonormal medical consultations

Assess the patients smoking history and

willingness to try to stop smoking

Deliver effective advice tailored to thepatients needs and state of readiness and

provide help and follow-up

Prescribe NRT appropriately


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Our Aim

Offer effective interventions for stoppingsmoking to patients during clinic visits

Information can be used to help preventtobacco use


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The Facts

Tobacco products = est to be responsiblefor 3M deaths annually worldwide

Tobacco is known or probable cause ofabout 25 diseases

Vast majority of smokers are in developingcountries, and most of them are men


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Health Risks

CVD

Lung cancer

COPD

Tumors of the mouth, larynx, esophagus,lip and bladder

NB and infant death

Cigarette-caused residential fires

Passive smoking deaths from lung cancer


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Health Risks

Male smokers are 22 times more at risk ofdying from lung cancer than male non-smokers

Female smokers 12 times more at riskthan female non-smokers


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Benefits of stopping smoking

Associated health risks diminishsubstantially in proportion to the period ofabstinence, eventually returning to the

level of non-smoker rates

Former smokers live longer

Reduce chances of having LBW

S i l T Ad l d


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Special Targets: Adolescents and

young adults

Average age begin to smoke


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Use tobacco for social and psychologicalreasons

Physical effects of nicotine initiate an

addiction process

Focus on more immediate health andphysical effects of smoking rather than

long-term consequences


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The clinician as an agent for thepromotion of smoking cessation

Access: high proportion of the populationconsult a PCP each year

Patient-acceptance : have authoritative

power and are generally regarded asreliable and knowledgeable sources ofhealth information

Doctors acceptance of their role: not onlytreating manifest disease but also as ahealth adviser to patients


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The clinician as an agent for thepromotion of smoking cessation

Should ask all patients over 15 aboutsmoking and tobacco use during each visit


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Doctors current performance in

promoting non-smoking

Major gap remains between acceptance ofsmoking risks and its transition into clinicalpractice

Detection of smokers


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The potential of medicalinterventions to stop smoking

Smokers who are advised by their doctorto stop smoking are nearly twice as likelyto do so than those who do not.

When combined with NRT appears to beeven more effective


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How doctors can encourage theirpatients to stop smoking

Pre-contemplation = has not stoppedsmoking and is not planning to stop

Contemplation = thought about quitting butis not ready to do so yet

Preparation = mentally willing to stopsmoking within the next month; made littlechanges to combat their smoking but havenot given up cigarettes completely


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Active = actually tried or is in the processof quitting smoking; often have relapsedand need to try to stop again

Maintenance = successfully given up for6mos or more and needs counseling tocontinue to stay off cigarettes


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2 main forms of NRT : gum and patch

Short questionnaire which measures thelevel of nicotine dependence

Nicotine gum dosing = 1 dose of 2mg gum inplace of every 2 cigarettes; 20 cigarettes/day= 1 dose of 4mg gum q3-4 cigarettes

Transdermal = >10 cigarettes/day should be

treated with the highest available dose of thebrand used.

After 1-2mos, weaning can be initiated


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Gum = total daily intake decreased by oneunit dose each week

Patches = each of the lower dosagesprescribed for 2-4wks

Should be advised of the more commonS/E prior to initiation of treatment


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The role of antidepressants

Depression my be a symptom of nicotinewithdrawal, and smoking cessationsometimes precipitates depression

Smoking appears to be due, in part, todeficits in dopamine, serotonin andnorepinephrine, all of which are increasedby antidepressants

Bupropion (slow release= 300mg/d x 7-12wks) nortriptyline


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Recommended steps in a MedicalIntervention

Structured behavioral approach that assistssmokers to quit is more effective than simpleadvice with or without information about risks

Recommended steps (5 As) Address

Assess

Advise

Assist

arrange


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Recommended steps in a MedicalIntervention

Represent a low cost intervention suitablefor incorporation into the routine practiceof health care providers in developing and

developed nations

More effective if tailored to the particularpatients health beliefs and readiness to

change


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Motivational Intervention

Statements of affirmation, encouragementand diplomacy form a large part of theinterview

Encourage patient to express and explore


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Techniques to aid patient recall ofinformation

Make info simple, clear and specific

Avoid technical terms

Speak slowly and clearly

Present advice in set categories Repeat important pcs of info

Stress importance of advice

Simple diagrams or models

Write down the most important instructions

Provide self-help materials


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Techniques to aid patient recallinformation

End of consultation:

Summarize the information

Check the patients understanding

Make sure there are no outstanding questions


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PART 2: Guidelines for medical

educators on how to teachcognitive-behavioral interventions

to help patients stop smoking

Purpose: describes the methods wherebymedical students can be taught the skillsnecessary for effective interventions to

help patients stop smoking


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The materials

Written language module summarizing thehealth risks of smoking and describing theprinciples and methods of cognitive-

behavioral and pharmacologicalinterventions for stopping smoking

Develop a videotape

Papers describing scientific work andvarious programmes in smoking cessation


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The process

Read the learning material

See one or two videotaped examples ofsmoking cessation intervention conductedby a doctor

Course lecturer

Practice the skills required

role play

Barrier assessment


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Thank you!

Encouraging Stopping Smoking

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