Interventions for Tobacco Users

1
Interventions for Tobacco Users

• Sandra Villalaz, MPH, RN, CHES

2
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.

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• The Problem

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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 (gt12 Billion in TX)
• (Cancer Prevention and Early Detection Facts and
  FiguresACS, 2011)
• (Texas Cancer Facts Figures ACS 2008)

5
Three Jumbo Jets
Crashing every day.
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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)

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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)

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Tobacco Use and Texas High School Students

• Cigarette use in last 30 days
• 21 report use at least 1 day
• 6 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 day
• 4 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

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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)

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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)

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Physical Impact of Smokeless Tobacco Use

• Causes
• Cancers
• Leukoplakia
• Mouth and teeth disorders
• Reproductive disorders
• Nicotine addiction and dependence
• (CDC 2009)

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Role of the School Health Nurse
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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 dont offer
  smoking cessation help. (Roberts, 2002)

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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)

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Best Practice Guidelines
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Comprehensive Tobacco Prevention Program

• Tobacco Free School Environment
• Evidence based curriculum
• Link to community-wide programs.

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Provider Reminder System

• What is it?
• Why is it considered important?
• How effective is it?
• (USPHS, 2008)

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USPHS Treating Tobacco Use and Dependence

Updated May 2008
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3 Factors Affecting Tobacco Addiction

• Nicotine addiction
• Habitual behavior
• Emotional dependence

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Nicotine Addiction

Temporary Condition
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Habitual Behavior

• Health Belief Model
• Potential susceptibility
• Potential seriousness
• Perceived costs
• Cue to action
• (Green,2002)

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Emotional Dependence

• For Adults
• Best Friend
• Social environment is prime.
• For Adolescents
• Cool
• Adult-like

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5As for Those Ready to Quit

• Ask
• Advise
• Assess
• Assist
• Arrange
• (USPHS, 2008)

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5 Rs for those unwilling to quit

• Relevance
• Risks
• Rewards
• Roadblocks
• Repetition
• (USPHS, 2008)

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5 As Rs CARD

• Tools to identify and assess tobacco use
  effectively
• 5 As Quick Guide Treat tobacco users willing to
  quit
• 5 Rs Quick Guide Treat tobacco users unwilling
  to quit

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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
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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.
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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)

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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
• NotOn-Tobacco School-based teen stop smoking
  program

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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.as
  px?PageID34575id1651termstobaccocessationto
  olkit
• American Cancer Society
• www.cancer.org
• 1-800-ACS-2345

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Resources for Professionals

• 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/yout
  h_tobacco_cessation
• Youth Tobacco Cessation A Guide for Making
  Informed Decisions
• American Lung Association
• www.lungusa.org
• Youth Tobacco Cessation Collaborative
• http//youthtobaccocessation.org/resources/program
  s.htm

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Conclusion
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Final points

• Tobacco cessation improves life and prevents
  death.
• Be part of the solution.
• Be sure you address tobacco use with every visit.

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References

• American Cancer Society. Cancer Prevention
  Early Detection Facts Figures 2009. Atlanta
  American Cancer Society 2009.
• American Cancer Society. Cancer Facts Figures
  2010. AtlantaAmerican Cancer Society 2010.
• Dougherty,P. A new pharmaceutical approach to
  smoking cessation, Nursing for womens 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.

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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- en
  cyclopedia/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.

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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.
  200120 (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_she ets/smokeless/smokeless
  facts/index.htm

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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/libr
  ary/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/secondhands
  moke/index.html