A Coach s Guide to Spit Tobacco Education

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1 A Cach s Guide t Spit Tbacc Educatin Mdule 7 OUTLINE Gals T increase caches, players and parents knwledge abut the imprtance f quitting all frms f tbacc and help available. Objectives By the end f the learning sessin, participants will: 1. Understand the imprtance f quitting all frms f tbacc. 2. Recgnize the imprtance f psitive rle mdels and encurage a tbacc-free lifestyle. 3. Knw 3 resurces available t supprt quitting and hw t access them. Cach/ Facilitatr Rle 1. Review the Participant Handuts and Backgrund infrmatin and ensure yu knw and understand the mdule cntent befre yu prceed. 2. Phtcpy the Participant Handuts, Activity Sheets and Evaluatin Frms. 3. Prvide each player a cpy f the Participant Handuts and Activity Sheet(s). 4. Depending n the size f the team, yu may want t split the team int 2 r mre discussin grups. Have the participants review the infrmatin in the handuts and cmplete the Activity. If yu split int grups, cmplete the Activity, then share answers with the large grup. 5. Add additinal cmments and infrmatin frm the Backgrund materials as needed t ensure that cmplete infrmatin is cvered and help t facilitate discussin. Evaluatin Backgrund Activity Participant Handuts 1. Distribute the Participant Evaluatin Frms, instruct participants nt t put their name r ther identifying infrmatin n the evaluatins and cllect them after cmpletin. 2. Cmplete the Cach/ Facilitatr Evaluatin Frm. 3. Review evaluatins t assess the participants learnings, behavirs. 4. Submit evaluatins t CATRAC fr the seasn as per instructins included in the Intrductin. Nictine dependence Quitting Spit Tbacc; sme special cncerns Recgnizing Nictine Dependence Nictine Levels f Ppular Brands Quitting Guide 1

2 A Cach s Guide t Spit Tbacc Educatin Mdule 7 BACKGROUND Nictine Dependence Definitin Nictine dependence is an addictin t tbacc prducts caused by the drug nictine. Smke frm all tbacc prducts including spit tbacc cntains thusands f chemicals, including abut 3 times the amunt f nictine fund in cigarettes. Nictine dependence means the user can't stp using the substance, even thugh it's causing harm. Nictine prduces chemical changes in the brain that are permanent and md-altering effects that prduce temprary feelings f pleasure. These effects spur cntinued use f tbacc and lead t dependence. At the same time, quitting tbacc use causes withdrawal symptms, including irritability and anxiety. Nictine dependence brings a hst f health prblems. While it's the nictine in spit tbacc that keeps the user hked, the txic effects cme mainly frm the ther substances fund in spit tbacc. Tbacc users have significantly higher rates f heart disease, strke and cancers. Spit tbacc users have very high rates f head and neck cancers at very yung ages that can lead t permanent disfigurement and death as well as pancreatic cancer. Spit tbacc users have mre ral health prblems like cavities, tth staining and lss and gum prblems. What yu need t knw abut spit tbacc The nictine fund in all tbacc prducts is a highly addictive drug that acts quickly n the brain and ther bdy systems. Spit tbacc prducts cntain even mre nictine than cigarettes. An average dip/ pinch f spit tbacc held in the muth fr 30 minutes delivers abut the same amunt f nictine as smking 3 cigarettes. A 2 can per week spit user gets the same amunt f nictine as a pack and a half per day smker. Snus delivers a pwerful dse f nictine: eight milligrams in each puch, as reprted by manufacturers R.J. Reynlds Tbacc Cmpany. A puch amunts t a single dse. Causes Nictine is the chemical in spit tbacc that keeps the user hked. It fllws the same brain mechanism as ccaine addictin. It increases the release f brain chemicals called neurtransmitters, which help regulate md and behavir. One f these neurtransmitters is dpamine, which prduces feelings f pleasure. Getting that dpamine bst is a big part f the addictin prcess. The cncentratin f nictine in spit tbacc prducts is up t three r mre times as cncentrated as is fund in cigarettes. This means that yuth trying spit tbacc may be much mre quickly addicted. 2

3 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Tbacc dependence invlves psychlgical as well as physical factrs. Behavirs and cues that yu may assciate with tbacc use include: Certain times f the day, such as with mrning cffee r during breaks at wrk After a meal Drinking alchl Certain places r friends Talking n the phne r driving Stressful situatins r when feeling tired r dwn Fr athletes during sprts related activities T vercme dependence n tbacc, quitting means managing the physical dependence and the behavirs and rutines that the user assciates with using it. Symptms In sme peple, using any amunt f tbacc can quickly lead t nictine dependence. Symptms that signal addictin include: Inability t stp. The user has made ne r mre serius, but unsuccessful, attempts t stp. Increasing frequency and amunt used. The amunt used increases, the frequency f use increases ver time and the user chses prducts with higher amunt f nictine. Withdrawal symptms are experienced with abstinence. Attempts at stpping have caused physical and md-related symptms, such as strng cravings, anxiety, irritability, restlessness, difficulty cncentrating, depressed md, frustratin r anger, increased hunger, insmnia, and cnstipatin r diarrhea. Cntinued use despite health prblems. Even thugh prblems have develped i.e. muth lesins r tth prblems, the user hasn't stpped r can't stp. Give up scial r recreatinal activities in rder t cntinue using. May stp ging t places r engaging in activities where use is restricted r prhibited r stp scializing with certain family members r friends because they dn t apprve f use. Surce: May Clinic. Online resurce Nictine Dependence 3

4 A Cach s Guide t Spit Tbacc Educatin Mdule 7 BACKGROUND Quitting Spit Tbacc; sme special cncerns Surveys shw that mst peple wh use spit tbacc wuld like t quit In many ways, quitting smkeless tbacc is a lt like quitting smking. Bth invlve tbacc prducts that cntain nictine, and bth invlve the physical and psychlgical parts f addictin. Many f the ways t handle the psychlgical hurdles f quitting are the same. But there are 2 parts f quitting that are unique fr ral tbacc users: There is ften a strnger need fr ral substitutes (having smething in the muth) t take the place f the chew, snuff, r puch. The disappearance f muth sres and gum prblems caused by the smkeless tbacc prvides a readily visible benefit f quitting. 1 Help With Addictin Sme peple are able t quit n their wn, withut the help f thers r the use f medicines. But fr many tbacc users, it can be hard t break the scial and emtinal ties t spit tbacc use while getting ver nictine withdrawal symptms at the same time. Frtunately, there are many surces f supprt ut there -- bth frmal and infrmal. (Where t get help; included in the Quitting Guide Participant Handut) 1 American Cancer Sciety Website; Smkeless Tbacc and Hw t Quit 4

5 A Cach s Guide t Spit Tbacc Educatin Mdule 7 PARTICIPANT ACTIVITY SHEET Tpic: Recgnizing Nictine Addictin Task: Take the Nictine Addictin Screening Quiz S yu ve used spit tbacc. Wnder if yu re addicted t nictine? Time t find ut. Think abut yur wn use f spit tbacc. Check all that apply t yu. I n lnger feel sick r dizzy when I use spit tbacc like I did when I first started. I use spit tbacc mre ften and in mre situatins I ve switched t strnger prducts (cntain mre nictine) I swallw the juice frm my spit tbacc ften I smetimes sleep with spit tbacc prducts in my muth I take my first pinch/ dip in the mrning first thing in the mrning I find it hard t g mre than a few hurs withut taking a dip r pinch I have strnger cravings nw when I g withut using spit tbacc I avid peple wh dn t apprve f my spit tbacc use I hide my spit tbacc use frm peple r certain peple I dn t g t places where I can t use spit tbacc penly The mre items yu check the mre likely yu are addicted t the nictine in spit tbacc. If yu checked 3 r mre items, yu might want t take the Spit Tbacc Dependency Test 5

6 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Spit Tbacc Dependency Test Questin Answers Pints 1. Hw sn after yu wake up t d yu place yur first dip? 2. Hw ften d yu intentinally swallw tbacc juice? 3. Which chew wuld yu hate t give up mst? 4. Hw many cans/puches per week d yu use? 5. D yu chew mre frequently during the first hurs after awakening than during the rest f the day? 6. D yu chew if yu are s ill that yu are in bed mst f the day? Ttal Scre Key 7-10 Pints = High Dependence 4-6 Pints = Mderate Dependence 0-3 Pints = Light Dependence Within 5 minutes 6 30 minutes minutes After 60 minutes Always Smetimes Never The first ne in the mrning Any ther Mre than Yes N Yes N If yu d like t be free frm addictin t nictine, be sure t take hme the Participant Handut; Quitting Guide Spit Tbacc a Guide fr Quitting. PARTICIPANT HANDOUT 6

7 A Cach s Guide t Spit Tbacc Educatin Mdule 7 In general, mist snuff has the highest nictine cntent and lse-leaf chewing tbacc has the lwest, with plug tbacc falling in the middle. High nictine cntent r high frequency f use may increase the likelihd f nictine addictin. Different brands f mist snuff and lse-leaf smkeless tbacc frm different cmpanies were tested. Tgether the brands represent nearly 91 percent f the market share fr mist snuff and 76 percent fr lse-leaf chewing tbacc. Brand and Prduct Mist Snuff Cpenhagen (any type) Skal (any type except Bandits) Kdiak (any type) Silver Creek (fine cut) Timberwlf (any type) Redwd Skal Bandits (mint r wintergreen) Cugar Lng Cut (wintergreen) Silver Creek Cherry (straight r lng cut) Cugar Natural (regular r lng cut) Cugar (wintergreen) Skal Bandits (straight) Hawken (wintergreen) Tabka Chewing Tbacc WB Cut Granger Red Man Levi Garrett Beech-Nut Taylr s Pride Nictine Levels f Ppular Brands Level f Nictine Very high High Medium Lw High Surces: Stepanv Irina, Jensen Jni, Hatsukami Drthy and Hecht Stephen S. (2008) New and traditinal smkeless tbacc: Cmparisn f txicant and carcingen levels. Nictine and Tbacc Research 10:12 Surce: Natinal Institute f Dental and Cranifacial Research Natinal Institutes f Health USA. Online resurce: Spit Tbacc a Guide fr Quitting. Lw 7

8 A Cach s Guide t Spit Tbacc Educatin Mdule 7 PARTICIPANT HANDOUT Quitting Guide Quitting Plan S yu're a spit tbacc user and yu'd like t quit. Kicking the spit r chew habit can be tugh, but it can be dne, and yu can d it. The best way t quit spit tbacc is t have a quit date and a quitting plan. These methds make it easier. Try what yu think will wrk best fr yu. Decide t quit Quitting spit tbacc is nt smething yu d n a whim. Yu have t want t quit t make it thrugh thse first few weeks ff tbacc. Yu knw yur reasns fr stpping. Dn't let utside influence -like peer pressure- get in yur way. Fcus n all yu dn't like abut dipping and chewing. Reasns t quit Here are sme reasns given by thers. Are any f them imprtant t yu? T avid health prblems T prve I can d it I have sres r white patches in my muth T please smene I care abut T set a gd example fr ther team mates T save mney I dn't like the taste I have gum r tth prblems It's disgusting Because it's banned at wrk r schl I dn't want it t cntrl me My girlfriend (r a girl I'd like t date) hates it My physician r dentist tld me t quit 8

9 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Pick a quit date Pick yur quit date. Even if yu think yu're ready t quit nw, take at least a week t get ready. But dn't put ff setting a date. Get psyched up fr quitting Cut back befre yu quit by tapering dwn. Have yur physician r dentist check yur muth. Ask whether yu need nictine replacement therapy (gum, nictine patches, etc.). There is n "ideal" time t quit, but lw-stress times are best. Having a quit date in mind is imprtant, n matter hw far ff it is. But it's best t pick a date in the next tw weeks, s yu dn't put it ff t lng. Pick a date that lks gd fr yu and write it in belw. THIS IS MY QUIT DATE MONTH: DATE: YEAR: FILL IT IN! Cut back befre yu quit Sme peple are able t quit spit tbacc "cld turkey". Others find that cutting back makes quitting easier. There are many ways t cut back: Taper dwn. Cut back t half f yur usual amunt befre yu quit. If yu usually carry yur tin r puch with yu, try leaving it behind. Carry substitutes instead sugar-free chewing gum r hard candies, and sunflwer seeds. During this perid, yu might als try a mint-leaf snuff. Cut back n when and where yu dip r chew. First, ntice when yur cravings are strngest. What events trigger dipping r chewing fr yu? D yu always reach fr a dip after meals? When yu wrk ut? In yur car r truck? On yur jb? Dn't carry yur puch r tin. Use a substitute instead. G as lng as yu pssibly can withut giving int a craving, at least 10 minutes. Try t g lnger and lnger as yu apprach yur quit day. Nw, pick three f yur strngest triggers and stp dipping r chewing at thse times. This will be hard at first. The day will cme when yu are used t ging withut tbacc at the times yu want it mst. 9

10 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Ntice what friends and c-wrkers wh dn't dip r chew are ding at these times. This will give yu ideas fr dip r chew substitutes. It's a gd idea t avid yur dipping and chewing pals while yu're trying t quit. That will help yu avid the urge t reach fr a can r chew. Switch t a lwer nictine tbacc prduct. This way, yu cut dwn yur nictine dse while yu're getting ready t quit. This can help t prevent strng withdrawal when yu quit. Dn't switch t ther tbacc prducts like cigarettes r cigars! In fact, if yu already smke, this is a gd time t quit smking t. That way yu can get ver all yur nictine addictin at nce. Right befre yur quit day...build a supprt team Let friends, family, and teammates knw yu're quitting. Warn them that yu may nt be yur usual self fr a week r tw after yu quit. Ask them t be patient. Ask them t stand by t listen and encurage yu when the ging gets rugh. Suggest ways they can help, like jining yu fr a run r a walk, helping yu find ways t keep busy, and telling yu they knw yu can d it. If they've quit, ask them fr tips. If they use dip r chew, ask them nt t ffer yu any. They dn't have t quit themselves t be supprtive, but maybe smene will want t quit with yu. Quit day! Make yur quit day special right frm the beginning. Yu're ding yurself a huge favr. Change daily rutines t break away frm tbacc triggers. When yu eat breakfast, dn't sit in the usual place at the kitchen table. Get right up frm the table after meals. Make an appintment t get yur teeth cleaned. Yu'll enjy the fresh, clean feeling and a whiter smile. Keep busy and active. Start the day with a walk, run, swim, r wrkut. Aerbic exercise will help yu relax. Plus, it bsts energy, stamina, and all-arund fitness and curbs yur appetite. Chew healthy substitutes. Try sugar-free hard candies r gum, cinnamn sticks, mints, beef jerky, r sunflwer seeds. Carry them with yu and use them whenever yu have the urge t dip r chew. What Abut Medicatins? Nictine replacement therapy and nn-nictine replacement therapy (buprpin) are apprved by Health Canada fr smking cessatin. Hwever, these prducts have nt been apprved fr spit tbacc cessatin. Further research is needed t determine their effectiveness fr helping spit tbacc users quit. Yur First Week ff Spit Tbacc: Cping with Withdrawal 10

11 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Withdrawal symptms dn't last lng Symptms are strngest the first week after yu quit. The wrst part is ver after 2 weeks. As time passes, yu'll feel better than when yu dipped r chewed. S be patient with yurself. Urges t dip, cravings -- especially in the places yu used t dip the mst Wait it ut. Deep breathing and exercise help yu feel better right away. Feeling irritable, tense, restless, impatient Walk away frm the situatin. Deep breathing and exercise help t blw ff steam. Ask thers t be patient. Cnstipatin/irregularity Add fiber t yur diet (whle grain breads and cereals, fresh fruits and vegetables). Hunger and weight gain Eat regular meals. Feeling hungry is smetimes mistaken fr the desire t dip r chew. Desire fr sweets Reach fr lw-calrie sweet snacks (like apples, sugar-free gums and candies). ABOUT WEIGHT GAIN Nictine speeds up metablism, s quitting spit tbacc may result in a slight weight gain. T limit the amunt f weight yu gain, try the fllwing: Eat well-balanced meals and avid fatty fds. T satisfy yur cravings fr sweets, eat small pieces f fruit. Keep lw-calrie fds handy fr snacks. Try ppcrn (withut butter), sugar-free gums and mints, fresh fruits, and vegetables. Drink 6 t 8 glasses f water each day. Wrk abut 30 minutes f daily exercise int yur rutine; try walking r anther activity such as running, cycling, r swimming. Yur Secnd Week: Dealing with Triggers Yu've made it thrugh the hardest part - the first week. If yu can stay ff ne week, then yu can stay ff tw. Just use the same willpwer and strategies that gt yu this far. 11

12 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Cravings may be just as strng this week, but they will cme less ften and g away sner. Be prepared fr temptatin Tbacc thughts and urges prbably still bther yu. They will be strngest in the places where yu dipped r chewed the mst. The mre time yu spend in these places withut dipping r chewing, the weaker the urges will becme. Avid alchlic beverages. Drinking them culd bust yur plan t quit. Knw what events and places will be triggers fr yu and plan ahead fr them. Write dwn sme f yur triggers. And write what yu'll d instead f dip r chew. It may be as simple as reaching fr gum r seeds, walking away, r thinking abut hw far yu've cme. MY STRONGEST TRIGGERS TRIGGER 1: TRIGGER 2: TRIGGER 3: FILL IT IN! Tips fr Ging the Distance CONGRATULATIONS! Yu've brken free f a tugh addictin. If yu can stay ff 2 weeks, then yu knw yu can beat this addictin. It will get easier. Keep using whatever wrked when yu first quit. Dn't expect new rituals t take the place f spit tbacc right away. It tk time t get used t chewing r dipping at first, t. 12

13 A Cach s Guide t Spit Tbacc Educatin Mdule 7 Keep up yur guard. Cntinue t plan ahead fr situatins that may tempt yu. What if yu shuld slip? Try nt t slip, nt even nce. But, if yu d slip, get right back n track. Dn't let feelings f guilt lead yu back t chewing r dipping. A slip des nt mean "failure". Figure ut why yu slipped and hw t avid it next time. Get rid f any leftver tbacc. Pick up right where yu left ff befre the slip. If slips are frequent, r yu are dipping r chewing n a regular basis, make a new quitting plan. Quitting takes practice. The spit tbacc habit can be tugh t beat. Mst users dn't quit fr gd n the first try. Dn't give up! Figure ut what wuld have helped. Try a new apprach next time. Talk t yur physician r dentist fr extra help. Yu may als wish t call ne f these services fr additinal guidance and supprt: Smkers Helpline Celebrate Yur Success! Cngratulatins! Yu've dne it. Yu've beaten the spit tbacc habit. Yu're imprving yur health and yur future. Celebrate with the peple n yur "supprt team." Offer yur supprt t friends and teammates wh are trying t quit using tbacc. Pledge t yurself never t take anther dip r chew. Surce: "Spit Tbacc: A Guide fr Quitting" is als available as a bklet. NIH Publicatin N

14 A Cach s Guide t Spit Tbacc Educatin Mdule 7 PARTICIPANT EVALUATION Please take a mment t tell us what yu thught f tday s learning sessin n 1. Have yu learned smething new abut: Spit tbacc and yur health? Yes N (circle ne) Hw t quit? Yes N (circle ne) Where t get help t quit? Yes N (circle ne) 2. Hw culd we have made this sessin better fr yu? Mre infrmatin Less infrmatin I liked I didn t like Mre time Less time Other: 3. Please answer the fllwing: a) Are yu currently using spit tbacc? Yes, I am currently using spit tbacc (Even 1 pinch/ puch in the last 2 weeks) N, I quit within the last 6 mnths N, I quit mre than 6 mnths ag N, I have never used spit tbacc 14

15 A Cach s Guide t Spit Tbacc Educatin Mdule 7 COACH/ FACILITATOR EVALUATION 1. Were the participants able t: a. Understand the imprtance f quitting all frms f tbacc. Yes N (circle ne) b. Recgnize the imprtance f psitive rle mdels and supprt t supprt a tbacc-free lifestyle. Yes N (circle ne) c. Knw 3 resurces available t supprt quitting and hw t access them. Yes N (circle ne) 2. Hw many participants were in attendance? 3. Was the activity apprpriate fr the grup? If nt, why? 4. Did yu implement the activity as utlined, r did yu have t alter the plan t suit the grup? If altered, what changes did yu make? 15

16 A Cach s Guide t Spit Tbacc Educatin Mdule 7 16

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