Tobacco Cessation Competency Class

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Tobacco Cessation Competency Class
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Section 1

• Statistics
• Effects of tobacco use on the body
• Special populations
• Gender
• Racial and ethnic minorities
• Hospitalized smokers
• Psychiatric co-morbidity and/or chemical
  dependency
• Children and adolescents
• Older smokers

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Section 1 Objectives

• The participant will
• Verbalize the impact of tobacco use
• List the gene affecting nicotine metabolism
• List one effect of tobacco use on the skin
• List one tobacco awareness program for children
  and adolescents

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Statistics
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Chief Avoidable Cause of Illness and Death in U.S.

• More than 440,000 deaths annually
• Lung cancer
• Ischemic heart disease
• Chronic Obstructive Pulmonary Disease (COPD)
• Over 75 billion in health care costs annually
• Over 80 billion in lost productivity annually

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Children and Adolescents

• gt6,000 children try cigarettes each day
• 3,000 become regular users each day
• 79 start by the ninth grade
• High school seniors
• 35 currently smoke
• 65 smoked at some time

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Genetic Link

• CYP2A6 nicotine metabolizing gene
• Mutation keeps nicotine in system longer
• Non-smokers are twice as likely to carry the
  mutation
• Smokers with the mutation smoke less
• Smokers with the efficient gene (no mutation)
  smoke more heavily to compensate

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Effects of Tobacco Use on the Body
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General Effects

• Positive
• Improves memory, especially long-term
• Increases accuracy/speed of information
  processing
• Increases pain threshold
• Reduces tension and anxiety
• Negative
• Chronic diseases of heart and lungs
• Cancer
• Stroke
• High blood pressure

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Specific Effects

• Eyes, nose, and throat
• Pulmonary
• Cardiovascular
• Gastrointestinal
• Reproductive
• Integumentary
• Endocrine
• Musculoskeletal

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Eyes, Nose Throat

• Within seconds
• Watering eyes
• Runny nose
• Cough
• Over time
• Abnormal thickening of membrane lining the throat
• Cellular changes linked to throat cancer
• Loss of smell and taste

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Pulmonary

• Compounds in cigarette smoke deposited as sticky
  tar on airways
• Injures the tissues
• Increases mucus production
• Thickens lining of bronchi ? cancer
• Paralyzes cilia
• Destroys elastin
• Respiratory rate increases, lungs work harder

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Cardiovascular

• Heart
• Rate increases by up to 30
• Cardiac dysrhythmias/myocardial infarction
• Blood vessels
• Increased fibrinogen and platelet counts
• Less elastic vessel walls
• Increased risk of artherosclerosis and thrombus
  development
• Reduced oxygen- carbon monoxide
• Peripheral vasodilation
• Blood pressure- elevates up to 15

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Gastrointestinal (GI)

• Decreased appetite
• Increased gastric secretions
• Decreased stomach emptying
• Loss of taste sensation
• Diarrhea/Constipation
• Often one predominates
• Same person can experience both

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Reproductive System

• Male
• Increased hepatic metabolism ? less testosterone
• 50 increase risk of impotence among smokers
• Sperm are less dense and less motile
• Female
• 72 fertility of non-smokers
• Increased risk of cervical cancer and ectopic
  pregnancy
• Earlier onset of menopause with worse symptoms

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Integumentary

• Loss of elastin- premature wrinkling
• Dry, grayish, wasted appearance
• Hollow cheeks
• Yellowing of fingernails

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Endocrine

• Increases
• Serotonin
• Endogenous opioid peptides
• Pituitary hormones
• Catecholamines
• Vasopressin
• Cortisol
• Decreases insulin

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Musculoskeletal

• Almost immediate relaxation of peripheral
  skeletal muscles

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Special Populations
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Considerations

• Generic treatments effective in all populations
• Racial and ethnic groups differ from whites
• Awareness of the health effects of smoking
• Often report a sense of fatalism
• Attempt to accommodate for differences
• Culturally sensitive audiovisual aids
• Patients primary language

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Gender

• Few differences from men in initiation or
  successful cessation identified
• Potential considerations
• Greater likelihood of depression
• Greater weight control concerns
• Less support for stopping
• Pregnancy may increase receptivity

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Pregnancy

• Quitting at any point decreases
• Spontaneous abortions
• Placental abruption
• Stillbirth
• Premature birth
• Low birth weight
• Sudden infant death syndrome
• One in four pregnant women quit
• Two-thirds restart after birth

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Racial/Ethnic Minorities (1 of 2)

• African Americans
• Prevalence rate is comparable
• Smoke fewer cigarettes on average
• Prefer mentholated brands
• Use brands with more nicotine and tar
• Higher cardiovascular disease and stroke risk
• Interventions
• Nicotine patch
• Clinical advice
• Counseling
• Self-help manuals

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Racial/Ethnic Minorities (2 of 2)

• American Indian/Alaska Native
• Higher prevalence rate than Caucasians
• Highest documented SIDS rate
• Interventions
• Screening for tobacco use
• Clinical advice and reinforcement
• Follow-up materials

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Hospitalized Smokers

• May be particularly motivated to quit
• Hospitalization may have been caused or
  exacerbated by smoking
• Temporarily housed in a smoke-free environment
• Interventions
• Document tobacco use status on admission
• Flag chart to prompt provider to advise smoking
  cessation
• Use counseling and pharmacotherapy to
• Maintain abstinence
• Treat withdrawal symptoms

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Psychiatric Co-morbidity and/or Chemical
Dependency

• Psychiatric disorders and other dependencies are
  more common in smokers
• Considerations
• Exacerbation of co-morbid condition
• Altered pharmacokinetics of psychiatric
  medications
• Increased risk of relapse
• Can treat concurrent to treating other chemical
  dependencies
• Little evidence individuals relapse to other drug
  use when they stop smoking

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Children and Adolescents (1 of 2)

• Quit rates for adolescents in cessation programs
  are higher
• Community and school based
• Project Towards No Tobacco Use (TNT)
• Minnesota Smoking Prevention Program
• Students Helping Others Understand Tobacco
  (SHOUT)
• Parents receiving second-hand smoke exposure
  information can reduce
• Childhood exposure
• Parental smoking rates

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Children and Adolescents (2 of 2)

• This population faces significant barriers to
  quitting
• Lack of information
• No support from parents (who are often unaware of
  use)
• Social pressure to continue
• Interventions
• No smoking pledge
• Information on immediate rather than long-term
  effects
• Appearance
• Health

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Older Smokers

• Clear benefits to quitting at any age
• Increased recovery from illnesses
• Improved cerebral circulation
• Better quality of life
• Interventions
• Buddy support
• Age-tailored self- help
• Proactive telephone counseling

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Questions?