Brief Counselling for Tobacco Use Cessation

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Drusilla Cain
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1 Brief Counselling for Tobacco Use Cessation Revised Fall

2 Overview & Agenda Impact of Tobacco Use Cessation & Comprehensive Tobacco Control Nicotine & Nicotine Delivery Systems Prevalence & Trends Health Effects & Recovery Predictors of Tobacco Use The Nature of Tobacco Addiction Evidence-Based Intervention Strategies Pharmacotherapy Supports & Resources

3 Introductions 1. Who are you? (write your name and organization on an index card) 2. Where do you work? (place your card on the map) 3. How has tobacco affected you?

4 Learning Objectives Increase knowledge, skills & confidence using evidence-based brief cessation counselling techniques & strategies Provide opportunity to practice implementing an intervention & learn from each other Motivate participants to provide brief cessation counselling to all clients Raise awareness of community resources, referral options and professional development opportunities.any others?

5 4 A s Program Adapted from RNAO best practice ASK ADVISE Program Training and Consultation Centre Have you used any form of tobacco in the past six months? Have you recently quit? Are you interested in quitting? As your health care provider, the most important advice I can give you is to quit smoking. Brief Cessation Counselling ASSIST ARRANGE Provide Self-Help Materials Motivational Approach Cognitive-Behavioural Strategies Pharmacotherapy Quit Plan Referral SHL/Community Resources Follow up

6 The Burden of Tobacco Use In Canada, 47,000 deaths a year due to tobacco-related disease (Health Canada, 2004) Tobacco use kills 1 in every 2 smokers On average, a smoker loses 22 years of life Tobacco-related diseases cost the Ontario economy approximately $1.93 billion annually in health care costs $5.8 billion in productivity losses and 500,000 hospital days each year Cost per capita is approximately $500 per person (CTUMS, 2002)

8 Eliminate tobacco-related illness and death in Ontario rapidly, equitably, and cost-effectively

11 Tobacco & Nicotine Program Training and Consultation Centre

12 Types of Tobacco Program Training and Consultation Centre

15 Traditional Use of Tobacco Program Training and Consultation Centre

16 Tobacco Use Trends Source: Propel Centre for Population Health Impact (2009). Tobacco Use in Canada: Patterns and Trends

17 Tobacco Use in Ontario Source: Propel Centre for Population Health Impact (2009). Tobacco Use in Canada: Patterns and Trends

18 Tobacco Use In Ontario cont d Source: Propel Centre for Population Health Impact (2009). Tobacco Use in Canada: Patterns and Trends

19 Current Smoking By Level of Education (18+ Years) Source: Centre for Addiction and Mental Health Monitor 2009

20 Current Smoking by TCAN Region (Past 30 days) Source: Canadian Community Health Survey 2007/08

21 Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general US Department of Health and Human Services (USDHHS), 2004

Health Effects of Tobacco Use Cancers: bladder, brain tumour, breast, cervix, esophagus, kidney, larynx, leukemia, liver, lung, lymphoma, nasal sinus, oral cavity, pancreas, stomach, throat, uterus

22 Health Effects of Tobacco Use Cancers: bladder, brain tumour, breast, cervix, esophagus, kidney, larynx, leukemia, liver, lung, lymphoma, nasal sinus, oral cavity, pancreas, stomach, throat, uterus Respiratory Disease: acute respiratory infections, asthma, bronchitis, chronic airway obstruction, chronic respiratory symptoms, COPD, emphysema, lower respiratory illness, reduced lung function Cardiovascular Disease: abdominal aortic aneurysm, atherosclerosis, coronary heart disease, peripheral vascular disease, stroke Pregnancy: infertility & sub-fertility, low birth weight, placenta previa, preterm delivery, stillbirth, sudden infant death syndrome Other: ear problems, middle ear disease, osteoporosis, peptic ulcers, periodontitis, premature death, surgical complications 22

23 Second Hand Smoke Program Training and Consultation Centre

24 The Road to Recovery Program Training and Consultation Centre

25 It s never too late Fletcher, D., & Peto, R. (1977). The natural history of chronic airflow obstruction. British Medical Journal, 1,

26 Who Smokes? Blue collar workers (manufacturing & trades) Young adults, especially men 25 to 29 years of age Unemployed Ontarians Aboriginal Ontarians GLBT Moderate or problem gamblers High risk drinkers People with mood disorders & other mental health issues

27 The Cycle of Nicotine Addiction Dopamine Nicotine

28 Why People Use Tobacco Powerful physical addiction Behavioural addiction Social addiction Psychological addiction Self-identity Nicotine addiction is a chronic, relapsing condition

29 Do People Really Want to Quit? Quitting Behaviour, Current Smokers, Ages 12+, ON ( ), % Source: OTRU (2010) Evidence to Inform Smoking Cessation Policy making in Ontario

30 Stages of Behavioural Change 30

31 A Motivational Approach

32 A person will not always remember what you said or did, but will always remember how you made them feel.

33 The Therapeutic Relationship 33

34 Motivational Interviewing Principles 1. Avoid arguing 2. Express empathy 3. Develop discrepancy 4. Roll with resistance 5. Support self-efficacy Strategies Ask permission Ask open-ended questions Reflective listening Elicit change talk Explore importance & confidence

35 Motivational Interviewing is a client-centred, directive method for enhancing intrinsic motivation 35

36 36 Program Training and Consultation Centre

37 Readiness Ruler How important is it to change this behaviour? How confident are you that you could make this change? How ready are you to make this change?

38 Follow-up Questions Why are you at (current score) and not zero? What would it take for you to get from (current score) to (higher score)? What has made this change this important to you so far, as opposed to it being unimportant (zero)? What would it take to make this change even more important to you?

40 PROS OF SMOKING CONS OF SMOKING CONS OF QUITTING PROS OF QUITTING

42 Tobacco use cessation is not a single event, but a process that involves a change in lifestyle, values, social circles, thinking and feeling patterns and coping skills.

43 WHAT WORKS? 43

44 4 A s Program Adapted from RNAO best practice ASK ADVISE Program Training and Consultation Centre Have you used any form of tobacco in the past six months? Have you recently quit? Are you interested in quitting? As your health care provider, the most important advice I can give you is to quit smoking. Brief Cessation Counselling ASSIST ARRANGE Provide Self-Help Materials Motivational Approach Cognitive-Behavioural Strategies Pharmacotherapy Quit Plan Referral SHL/Community Resources Follow up

45 Withdrawal and Recovery Cravings Anger Irritability Jittery Low energy Restlessness Cough, Dry Throat Impaired Concentration Sadness Dizziness Fatigue Headache Trouble Sleeping Constipation Weight Gain Change in Appetite

46 Stop-Smoking Medications Program Training and Consultation Centre

47 Things to consider What dosages are available? What dose should be taken? How is it used? How long can it be used? Can it be combined with any other quit-smoking medication? Any contraindications or adverse side effects?

48 The Cycle of Addiction Program Training and Consultation Centre

49 Efficacy of Nicotine Replacement Therapy (NRT) Comparison N Trials N Participants Pooled OR (95% CI) Gum 52 17, ( ) Patch 37 16, ( ) Nasal spray ( ) Inhaler ( ) Tablets/lozenges ( ) Combination vs single type ( ) Any NRT vs control , ( ) 1. Silagy c et al. Cochrane Database Syst Rev. 2004;(3):CD Stead L, Lancaster T. Int J Epidemiol. 2005;34:

50 Monthly Costs Bupropion $ 57 + $10 dispensing fee = $67 Varenicline $ dispensing fee = $124 Nicotine patch $ 80 - $136 Nicotine gum $112 - $184 Nicotine inhaler $147 - $160 Nicotine lozenge $120 - $168 Smoking (1 pack/day) $10.00 x 30 = $300

51 Review Impact of Tobacco Use Cessation & Comprehensive Tobacco Control Nicotine & Nicotine Delivery Systems Prevalence & Trends Health Effects & Recovery Predictors of Tobacco Use The Nature of Tobacco Addiction Evidence-Based Intervention Strategies Pharmacotherapy Supports & Resources

4 A s Program Adapted from RNAO best practice ASK ADVISE Program Training and Consultation Centre Have you used any form of tobacco in the past six months? Have you recently quit?

52 4 A s Program Adapted from RNAO best practice ASK ADVISE Program Training and Consultation Centre Have you used any form of tobacco in the past six months? Have you recently quit? Are you interested in quitting? As your health care provider, the most important advice I can give you is to quit smoking. Brief Cessation Counselling ASSIST ARRANGE Provide Self-Help Materials Motivational Approach Cognitive-Behavioural Strategies Pharmacotherapy Quit Plan Referral SHL/Community Resources Follow up

53 Who should do brief cessation counselling?

54 Readiness On a scale of 1-10, how important is it to you to provide brief cessation counselling? On a scale of 1-10, how confident are you that you can provide brief cessation counselling?

55 Be Part of the Solution 1 to 3 minutes Leads to 14% abstinence 1 in 40 smokers Quit when advised by a professional 1 in 3 smokers Make a serious quit attempt every year, BUT don t ask for help! Evidence-Based Simple & Effective

56 What is PTCC? Resource Centre of the Smoke-Free Ontario Strategy since 1993 Funded by Public Health Ontario 4 partners: Cancer Care Ontario Region of Waterloo Public Health Sudbury and District Health Unit Propel Centre for Population Health Impact

57 PTCC Mission PTCC increases the capacity of organizations and providers to deliver effective, comprehensive, tobacco use reduction interventions in Ontario

58 PTCC Services Technical assistance, training & resource development Knowledge development, exchange & programming to increase the use of research & practice-based evidence (LEARN, Communities of Practice) Media relation training & consultation services through Media Network

59 Contacting PTCC or Call/ staff and consultants directly

60 Clinical Practice Guidelines RNAO BP Guideline: Integrating Smoking Cessation into Daily Nursing Practice CAN-ADAPTT - Canadian Action Network for the Advancement, Dissemination and Adoption of Practiceinformed Tobacco Treatment Treating Tobacco Use and Dependence 2008 Update

61 Tobacco Use Cessation Support Professional and Community Resources Local Public Health Unit Smokers Helpline CAN-ADAPTT, STOP, TEACH at CAMH

62 Resources for Heath Care Professionals RNAO BP Guideline: Integrating Smoking Cessation into Daily Nursing Practice CAN-ADAPTT Treating Tobacco Use and Dependence 2008 Update Smoking Cessation Rounds Alcohol-Drug Education Service: Helping Women Quit UW-CTRI: Tobacco Treatment for Health Care Providers

63 Additional Training Opportunities Registered Nurses Association of Ontario E-learning module Ontario Tobacco Research Unit Tobacco and Public Health: From Theory to Practice 3 modules: Prevention, Protection, Cessation TEACH , ext Training in intensive cessation interventions

64 Thank You! Program Training and Consultation Centre

Helping People Quit Tobacco

Helping People Quit Tobacco Peter Selby MBBS, CCFP, MHSc, ASAM Associate Professor, University of Toronto Clinical Director, Addictions Program, CAMH Principal Investigator, OTRU Disclosures! Grants/research