Tobacco Cessation Competency Class

1
Tobacco Cessation Competency Class

• Section 5 Special Topics

2
Special Topics

• Patient Weight Gain
• Other Tobacco products
• Clinical Training
• Economic Aspects of Tobacco Cessation
• Alternative Treatments
• Stress Reduction

3
Patients Weight Gain

• Weight gain often follows smoking cessation.
• Most people gain lt10 lbs.
• Some gain up to 30 lbs.
• Females gain slightly more weight than males.

4
Patients Weight Gain 2

• Some groups have a higher risk for major weight
  gain.
• African-Americans.
• People lt 55 years old.
• Heavy smokers ( gt 25 cigarettes/day).

5
Patients Weight Gain 3

• Concern about weight causes certain groups to
  restart smoking more than others
• Female European-Americans
• Adolescents who are concerned about their weight
• Active duty soldiers

6
Exercise to Manage Weight Gain

• Smoking cessation along with increased physical
  activity decreases the amount of weight gained
• A regular exercise program combined with a
  cognitive behavioral smoking cessation program
• Increases long-term smoking abstinence
• Delays weight gain

7
Causes of Post-cessation Weight Gain

• Increased intake of food and/or alcohol
• Metabolic adjustments
• A patient will gain weight even if caloric intake
  does not change

8
Physiological Fact

• Once an individual relapses to his/her
  pre-cessation smoking rate, he/she will lose all
  or some of the weight gained during the cessation
  attempt.

9
Nicotine Replacement to Manage Weight Gain

• Nicotine gum decreases weight gain.
• The more nicotine gum used the less weight gained.

10
Nicotine Replacement to Manage Weight Gain

• Unfortunately weight is gained after the
  individual ceases to use nicotine gum.
• The individual will gain the same amount of
  weight as if the nicotine gum was never used.

11
Bupropion SR to Manage Weight Gain

• Bupropion SR use delays post-cessation weight
  gain.
• Unfortunately, the patient gains weight after
  Bupropion SR is discontinued.
• The individual gains the same amount of weight as
  if Bupropion SR was never used.

12
Clinical Recommendations That Address Weight Gain

• Acknowledge the likelihood of weight gain.
• Inform the individual about weight gain.
• Prepare the individual about weight gain.
• Acknowledge the significance of weight gain to
  the individual.

13
Clinical Recommendations That Address Weight Gain2

• Counter exaggerated fears about weight gain.
• Even without any attempt at exercise/dieting ,
  weight gain is usually lt 10lbs.
• Medications are available to limit the amount of
  weight gained.
• The weight gained is a minor health risk compared
  to the risk of continued smoking.

14
Clinical Recommendations That Address Weight Gain
3

• Counter exaggerated fears about weight gain.
• Focus on smoking cessation first,
• Then focus on health related issues, not just
  weight.
• Proper nutrition.
• Limiting alcohol use.
• Regular exercise.
• Proper sleep/rest.
• Reduction of fat intake.

15
Benefits of Smoking Cessation Vs. Weight Gain

• Added years of healthy living
• Better physical appearance
• Less wrinkled skin
• Whiter teeth
• Fresher breath
• Feeling good about quitting

16
Other Tobacco Products

• Smokeless tobacco (spit tobacco) also has serious
  health consequences.
• Addiction to nicotine.
• Abrasions on teeth.
• Leukoplakia.
• Gingival recession.
• Periodontal bone loss.
• Oral cancer.
• Cardiovascular disease.
• Spit tobacco use has increased in recent years.

17
Other Tobacco Products 2

• Cigar smoking has serious health consequences.
• Addiction to nicotine.
• Coronary artery disease.
• Chronic obstructive pulmonary disease (COPD).
• Lung and other cancers.

18
Other Tobacco Products 3

• Cigar use trends
• Sales increased 50 between 1993 and 1997.
• In 1997, about 6 million teenagers used at least
  one cigar in the previous year.

19
Clinical Recommendations That Address Smokeless
Tobacco Use

• Use dental clinicians to advise individuals to
  quit using smokeless tobacco.
• Use tobacco cessation efforts to
• Identify smokeless tobacco users.
• Use the same counseling cessation. Interventions
  recommended for smokers.

20
Clinical Recommendations That Address Other
Tobacco Products Use

• Identify users of cigars, pipes, and other
  combustible forms of tobacco.
• Strongly urge them to quit.
• Use the same counseling cessation interventions
  recommended for smokers.
• Nicotine gum and patch have not been proven to
  increase abstinence from these products.

21
Recommendations for Clinical Staff Training for
Tobacco Cessation

• Train clinicians in effective tobacco cessation
  treatments.
• Training is necessary if guideline
  recommendations are to be implemented.
• Clinicians lack of relevant knowledge is a
  barrier to intervention.

22
Recommendations for Clinical Staff Training for
Tobacco Cessation 2

• Clinicians-in-training and practicing physicians
  should receive smoking cessation training
• 69 of U.S. Medical school do not required
  tobacco cessation training
• Should be required for all disciplines
• Licensing and certification exams for all
  disciplines should have questions about tobacco
  use cessation
• Specialty societies should adopt standards of
  competence in tobacco cessation for all members

23
Recommendations for Clinical Staff Training for
Tobacco Cessation 3

• Clinicians who currently use any tobacco product
  should participate in smoking cessation programs
  to stop their own tobacco use permanently.
• Clinicians are role models.
• Prevalence of use among clinicians is decreasing.
• 5.5 among physicians.
• 7.4 among dentists.
• 8.7 among physical therapists.
• 22 among registered nurses.

24
Cost Effectiveness of Smoking Cessation
Treatments

• Cessation treatments (including pharmacotherapy)
  are extremely cost effective.
• Cessation treatments compare favorably with
  routinely reimbursed medical interventions and
  preventive screenings.

25
Cost Effectiveness of Smoking Cessation
Treatments 2

• Cessation treatments can prevent costly diseases
  like heart and lung diseases and cancer.
• Cessation treatment called the gold standard of
  preventive interventions.
• Cessation treatment for pregnant women
• Decreases the number of low birth weight babies.

26
Cost Effectiveness of Smoking Cessation
Treatments 3

• Cessation treatment for pregnant women
• Decreases the number of perinatal deaths.
• Reduces physical problems during infancy and
  childhood.
• Reduces cognitive problems during infancy and
  childhood.
• Reduces behavioral problems during infancy and
  childhood.
• Also yields important health benefits for the
  mother.

27
Health Plan Coverage of Smoking Cessation
Treatment

• Inadequate health plan coverage
• Reduces access to cessation services.
• Results in fewer people who benefit from
  cessation services.

28
Health Plan Coverage of Smoking Cessation
Treatment 2

• Full health plan coverage
• Increases utilization of cessation services.
• Decreases prevalence of smoking among plan
  members.

29
Health Plan Coverage of Smoking Cessation
Treatment 3

• Prepaid/discounted drug benefits
• Increases the number of patients who receive
  pharmacotherapy.
• Increases smoking abstinence rates.

30
Stress Reduction With Tobacco Cessation

• The key to managing stress is to alternate
  intense periods of purposeful activity with time
  out periods.
• Stress vacations or islands of peace are key to
  successful stress management.

31
Stress Reduction With Tobacco Cessation 2

• Unfortunately, many tobacco users use tobacco to
  provide islands of peace
• Successful smoking cessation requires the
  establishment of other islands of peace

32
7-step Process of Stress Management

• 1. Understand personal key stressors.
• 2. Identify personal stress signals.
• 3. Schedule islands of peace daily.
• 4. Explore new relaxation techniques and.
• Choose the best one.

33
7-step Process of Stress Management

• 5. Rehearse and visualize the relaxation plan.
• 6. Execute the relaxation plan.
• 7. Modify and adapt the plan, as needed.

34
Understanding Personal Key Stressors

• Short-term stress is dealt with quickly and is
  followed by a period of relaxation to allow the
  body to recover.
• Long-term stress occurs when subsequent
  short-term stressors occur before full recovery.

35
Understanding Personal Key Stressors 2

• Smokers rely heavily on cigarettes when
  experiencing long-term stress.
• Smoking to deal with long-term stress
• Is a temporary solution.
• Helps to repress feelings (rather than deal with)
  anger and sadness.
• Helps to ignore situations (rather than deal with
  them).

36
Understanding Personal Key Stressors 3

• Common stress signals
• Digestive upset - increased
  alcohol use
• Headaches - increased drug
  use
• Insomnia - grouchiness
• Loss of appetite - irritability
• Binge eating - increased
  smoking
• Feelings of hopelessness
• Increased distractibility

37
Identifying Stress Signals

• Common stress signals
• Digestive upset
• Headaches
• Insomnia
• Loss of appetite
• Binge eating
• Feelings of hopelessness
• Increased distractibility

• Increased alcohol use
• Increased drug use
• Grouchiness
• Irritability
• Increased tobacco use

38
Schedule Daily Islands of Peace

• Suggestions for islands of peace.
• Schedule blocks of quiet time in advance.
• Review your schedule for the upcoming week.
• Dedicate at least one evening to do an activity
  that brings personal enjoyment.
• Schedule time to call people you care about.
• Schedule lunch dates with friends.

39
Schedule Daily Islands of Peace 2

• Seize opportunities to take short breaks.
• Seize opportunities to physically relax.
• Exercise to break stress.
• Interact with pets.
• Discover new ways to relax.

40
Explore Other Options

• Develop contingency plans and others options to
  use for your islands of peace life is
  unpredictable

41
Any Questions for the Group?