Smoking Cessation Program

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Smoking Cessation Program

• Dr. Rasha Salama
• PhD Community Medicine
• Suez Canal University
• Egypt

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Facts about Smoking

• Most of those killed by tobacco are not
  particularly heavy smokers and most started as
  teenagers.
• Approximately 50 percent of smokers die
  prematurely from their smoking, on average 14
  years earlier than non-smokers.
• Smoking kills one in two of those who continue to
  smoke past age 35.
• There is evidence that smoking can cause about 40
  different diseases.
• the preventable mortality attributed to smoking
  is 8 percent of deaths in females and 19 percent
  in males.
• Smoking is socioeconomically patterned with
  higher rates of smoking in lower socio-economic
  groups. Thus tobacco smoking produces a greater
  relative burden of disease and premature death in
  lower socioeconomic groups and is a major
  contributor to socioeconomic inequalities in
  health.

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Facts (cont.)

• Smoking, especially current smoking, is a crucial
  and extremely modifiable independent determinant
  of stroke.
• Second-hand smoke (also called environmental
  tobacco smoke) is a Class A carcinogen and
  contains approximately 4,000 chemicals.
• Exposure of children to second-hand smoke
• can cause middle ear effusion
• increases the risk of croup, pneumonia and
  bronchiolitis by 60 percent in the first 18
  months of life
• increases the frequency and severity of asthma
  episodes
• is a risk factor for induction of asthma in
  asymptomatic children.

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Benefits of Smoking Cessation

• These points may be helpful in motivating people
  to quit smoking. Many smokers deny being at
  increased risk of cancer and heart disease and
  more accurate perception of risk may assist
  cessation efforts.
• It is beneficial to stop smoking at any age. The
  earlier smoking is stopped, the greater the
  health gain.
• Smoking cessation has major and immediate health
  benefits for smokers of all ages. Former smokers
  have fewer days of illness, fewer health
  complaints, and view themselves as healthier.
• Within one day of quitting, the chance of a heart
  attack decreases.
• Within two days of quitting, smell and taste are
  enhanced.
• Within two weeks to three months of quitting,
  circulation improves and lung function increases
  by up to 30 percent.

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• Excess risk of heart disease is reduced by half
  after one years abstinence. The risk of a major
  coronary event reduces to the level of a never
  smoker within five years. In those with existing
  heart disease, cessation reduces the risk of
  recurrent infarction or death by half.
• Former smokers live longer after 10 to 15 years
  abstinence, the risk of dying almost returns to
  that of people who never smoked. Smoking
  cessation at all ages, including in older people,
  reduces risk of premature death.
• Men who smoke are 17 times more likely than
  non-smokers to develop lung cancer. After 10
  years abstinence, former smokers risk is only
  30 to 50 percent that of continuing smokers, and
  continues to decline.

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• Women who stop smoking before or during the first
  trimester of pregnancy reduce risks to their baby
  to a level comparable to that of women who have
  never smoked. Around one in four low birth weight
  infants could be prevented by eliminating smoking
  during pregnancy.
• The average weight gain of three kg and the
  adverse temporary psychological effects of
  quitting are far outweighed by the health
  benefits.

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Evidence for Effectiveness of Health Professional
Intervention

• A Cochrane review of 16 RCTs found simple advice
  from doctors had a significant effect on
  cessation rates (OR for quitting 1.69 95
  confidence interval 1.451.98).
• When trained providers are routinely prompted to
  intervene with people who smoke, they achieve
  significant reductions in smoking prevalence (up
  to 15 percent cessation rates compared with 5 to
  10 percent in non-intervention sites).
• Doctors and other health professionals using
  multiple types of intervention to deliver
  individualized advice on multiple occasions
  produce the best results. Frequent and consistent
  interventions over time are more important than
  the type of intervention.

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Smoking Cessation Program

• The only way any country can substantially reduce
  smoking and other tobacco use within its borders
  is to establish a well-funded and sustained
  comprehensive tobacco prevention program that
  employs a variety of effective approaches.
• Nothing else will successfully compete against
  the addictive power of nicotine and the tobacco
  industry's aggressive marketing tactics.

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ESSENTIAL COMPONENTS

• The following elements must all be included
  to maximize the success of any program to reduce
  tobacco use. Conducted in isolation, each of
  these elements can reduce tobacco use, but done
  together they have a much more powerful impact
• Public Education Efforts
• Community-Based Programs
• Helping Smokers Quit (Cessation)
• School-Based Programs
• Enforcement
• Monitoring and Evaluation
• Related Policy Efforts

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Public Education Efforts

• Research has demonstrated that tobacco
  industry marketing increases the number of kids
  who try smoking and become regular smokers. Not
  surprisingly, one of the best ways to reduce the
  power of tobacco marketing is an intense campaign
  to counter these pro-smoking messages.

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Public Education Efforts (cont.)

• These efforts must include multiple paid media
  (TV, radio, print, etc.), public relations,
  special events and promotions, and other efforts.
  
• Counter-marketing efforts should target both
  youth and adults with prevention and cessation
  messages.

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Community-Based Programs

• Because community involvement is essential to
  reducing tobacco use, a portion of the tobacco
  control funding should be provided to local
  government entities, community organizations,
  local businesses, and other community partners.

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Community-Based Programs (cont.)

• These groups can effectively engage in a number
  of tobacco prevention activities right where
  people live, work, play, and worship, including
• direct counseling for prevention and to help
  people quit,
• youth tobacco education programs,
• interventions for special populations,
• worksite programs, and
• training for health professionals.

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Helping Smokers Quit (Cessation)

• A comprehensive tobacco control program should
  not only encourage smokers to quit but also help
  them do it. In fact, most smokers want to quit
  but have a very difficult time because nicotine
  is so powerfully addictive.
• To help these smokers, cessation products and
  services should be made more readily available
  and more affordable.
• Moreover, treatment programs are most effective
  when they utilize multiple interventions,
  including pharmacological treatments, clinician
  provided social support, and skills training.

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Helping Smokers Quit (Cessation) (cont.)

• Cessation services can be provided through
  primary health care providers, schools,
  government agencies, community organizations, and
  telephone "quit lines.
• Staff training and technical assistance should be
  a part of all programs to treat tobacco
  addiction and following the cessation guidelines
  from the Agency for Health Care Policy and
  Research will increase the effectiveness of any
  cessation efforts in clinical settings.

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School-Based Programs

• School-based programs offer a useful way to
  prevent and reduce tobacco use among kids,
  especially when based on the CDCs Guidelines for
  School Health Programs to Prevent Tobacco Use and
  Addiction.
• To operate most effectively, school-based
  programs must include curricula that have been
  shown to be effective, as well as tobacco-free
  policies, training for teachers, programs for
  parents, and cessation services.

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School-Based Programs (cont.)

• Students must learn not only the dangers of
  tobacco use but life skills, refusal skills, and
  media literacy in order to resist the influence
  of peers and tobacco marketers.
• It is critical that the school programs be
  integrated with other community-based programs
  and with counter-marketing efforts.

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Enforcement

• Rigorously enforcing laws prohibiting tobacco
  sales to youth and limiting exposure to
  secondhand smoke is an essential element of
  creating an environment conducive to reducing
  tobacco use.
• These enforcement efforts should include
  penalties for violators, and compliance enhancing
  education.

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Enforcement (cont.)

• To increase tobacco control enforcement, funds
  must be provided to enforcement agencies to make
  sure other enforcement efforts are not
  compromised.
• Other agencies and organizations should also be
  supported to provide related educational efforts
  to raise awareness of the laws and their
  enforcement and to promote compliance.

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Monitoring and Evaluation

• Every element of a comprehensive tobacco control
  program should be rigorously evaluated throughout
  its existence.
• Careful monitoring and evaluation methods should
  be built-into the programs to provide the data
  necessary for continual improvement.

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Monitoring and Evaluation (cont.)

• Process measures should be developed to monitor
  the activities conducted under the program from
  the outside, as well, in order to block the
  misuse of funds and promote their most efficient
  and effective use.
• Regular measurements of key outcomes should also
  be conducted to assess progress and further
  improve their performance.

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Related Policy Efforts

• Additional policy initiatives have been proven
  effective in reducing tobacco use -- especially
  as part of a comprehensive strategy.
• These policies include
• increases in cigarette excise taxes,
• restrictions on tobacco marketing to kids,
• increased penalties for selling tobacco to kids,
• new restrictions on environmental tobacco smoke
  in public places.

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GUIDING PRINCIPLES

• Past experience with tobacco control efforts
  indicates that five principles should guide the
  development of a successful state program to
  prevent and reduce tobacco use
• 1. It must be comprehensive.
• Stopgap or partial measures will meet with
  only partial success. Elements work most
  effectively when they are combined in
  complementary fashion.

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GUIDING PRINCIPLES (cont.)

• 2. It must be well funded.
• Unless properly financed, tobacco prevention
  will have little effect against the marketing
  efforts of the tobacco industry (over 8 billion
  each year).
• CDC has issued funding guidelines for state
  tobacco control programs, which can serve as a
  basis for planning.

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GUIDING PRINCIPLES (cont.)

• 3. It must be sustained over a long period of
  time.
• While short-term attitudinal changes can occur
  relatively early, it will take years to achieve
  the significant behavioral and cultural changes
  necessary to reduce tobacco use substantially and
  maintain low levels.
• If tobacco control programs are not sustained
  over many years, the chances for success will be
  diminished, and any early gains may be lost in
  subsequent years.

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GUIDING PRINCIPLES (cont.)

• 4. It must operate free and clear of political
  and tobacco industry influence.
• History warns us that the tobacco industry will
  employ every manner of tactics to divert money
  from tobacco prevention and to interfere with any
  tobacco prevention efforts that are undertaken.
• To avoid this tobacco industry sabotage, new
  tobacco control programs must be set up to be
  independent of these influences and insulated
  from them.

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GUIDING PRINCIPLES (cont.)

• 5. It must address high-risk and diverse
  populations.
• The needs of special populations can and must be
  taken into account in designing and disseminating
  the various elements of the tobacco control
  program (e.g. youth, and women).

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• Guidelines for
• Individual Smoking Cessation

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Introduction

• There is good evidence that even brief advice
  from health professionals has a significant
  effect on smoking cessation rates. A supportive,
  ongoing relationship with a health professional
  is often an essential precursor to successful
  quitting.
• Success in quitting smoking depends less on any
  specific type of intervention than on delivering
  personalized empathic smoking cessation advice to
  smokers, and repeating it in different forms from
  several sources over a long period.
• Smoking cessation is a dynamic process that
  occurs over time rather than a single event.
  Smokers cycle through the stages of
  contemplation, quitting and relapse an average of
  three to four times before achieving permanent
  success.

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• Tobacco dependence is a chronic condition that
  often requires repeated intervention. However,
  effective treatments exist that can produce
  long-term abstinence.
• These guidelines are designed for smoking
  cessation providers to assist all clients with
  smoking cessation.

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Promoting Smoking Cessation

• THE FIVE AS
• ASK
• ASSESS
• ADVISE
• ASSIST
• ARRANGE

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ASK
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ASSESS
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ADVISE
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ASSIST
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ARRANGE
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Smoking Addiction Calculator

• The Fagerström test is a standard questionnaire
  that is used to determine if a smoker is addicted
  to nicotine.
• There are several versions of the Fagerström
  test. The one we will use has 6 multiple-choice
  questions. Each of the multiple-choice responses
  has a point score.
• After the person has answered all the questions,
  you need to add all points from the individual
  questions this should give an integer between 0
  and 10.
• The person is then probably strongly addicted if
  the total score is 8 or more addicted if the
  score is 6 or 7 mildly addicted if the score is
  3, 4, or 5 and not addicted if the score is 2 or
  less.

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• Q1 When do you smoke your first cigarette of the
  day?
• Allowed responses within 5 minutes (3 pt),
  6-30 minutes (2 pt) 31-60 minutes (1 pt) more
  than 60 minutes after waking up (0 pt)
• Q2 Do you find it hard not to smoke in places
  where it is forbidden, such as in a cinema?
• Allowed responses yes (1 pt), no (0 pt)
• Q3 Which cigarette would you most hate to give
  up?
• Allowed responses the first one in morning
  (1 pt) any other one (0 pt)
• Q4 How many cigarettes do you smoke in a day?
• Allowed responses 10 or less (0 pt) 11-20
  (1 pt) 21-30 (2 pt) 31 or more (3 pt)
• Q5 Do you smoke more after waking up than during
  the rest of the day?
• Allowed responses yes (1 pt), no (0 pt)
• Q6 Do you still smoke if you are so sick that
  you're in bed most of the day?
• Allowed responses yes (1 pt), no (0 pt)

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Thank you