Smoking Cessation in Mental Health and Primary Care Practice
|
|
- Giles Copeland
- 5 years ago
- Views:
Transcription
1 Smoking Cessation in Mental Health and Primary Care Practice 13 th Annual Statewide Integrated Care Conference Integrating Substance Use, Mental Health, and Primary Care Services: Courageous and Compassionate Care Steven A. Schroeder, MD Distinguished Professor of Health and Health Care Department of Medicine, UCSF Director, Smoking Cessation Leadership Center 10/19/2016
2 Disclosure Dr. Steven Schroeder does not have relevant financial relationships with commercial interests.
3
4 The Health Consequences of Smoking: 50 Years of Progress A Report of the Surgeon General
5 50 Years of Tobacco Control JAMA
6 It s a New Era
7 Tobacco s Deadly Toll 540,000 deaths in the U.S. each year* 4.8 million deaths world wide each year --Current trends show >8 million deaths annually by ,000 deaths in the U.S. due to second-hand smoke exposure 14 million in U.S. with smoking related diseases (60% with COPD) 42.1 million smokers in U.S. (76.9% daily smokers, averaging 14.2 cigarettes/day, 2013) * Carter et al, NEJM, Feb 12, 2015
8 Percent 60 TRENDS in ADULT SMOKING, by SEX U.S., Trends in cigarette current smoking among persons aged 18 or older Male Male 15.1% of adults are current smokers Female Female 18.8% 14.8% % want to quit Graph provided by the Centers for Disease Control and Prevention Current Population Survey; NHIS. Estimates since 1992 include some-day smoking. * 2015 early NHIS data
9 Percent/Number of Cigarettes Smoked Daily Smoking Prevalence and Average Number of Cigarettes Smoked per Day per Current Smoker *January-March 2015: 15.3% prevalence! Source: Schroeder, JAMA 2012; 308:1586; *CDC/NCHS, National Health Interview Survey, 1997-March 2015, Sample Adult Core
10 Behavioral Causes of Annual Deaths in the United States, Sexual Alcohol Motor Guns Drug Obesity/ Smoking Behavior Vehicle Induced Inactivity * Source: Mokdad et al. JAMA 2004;291: ; Mokdad et al. JAMA. 2005; 293:293 Flegal KM, Graubard BI, Williamson DF, Gail, MH. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005;293: * Also suffer from mental illness and/or substance abuse
11 U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, Health Consequences of Smoking Cancers Acute myeloid leukemia Bladder and kidney Cervical Colon, liver, pancreas Esophageal Gastric Laryngeal Lung Oral cavity and pharyngeal Prostate ( survival) Pulmonary diseases Acute (e.g., pneumonia) Chronic (e.g., COPD) Tuberculosis Cardiovascular diseases Abdominal aortic aneurysm Coronary heart disease Cerebro-vascular disease Peripheral arterial disease Type 2 diabetes mellitus Reproductive effects Reduced fertility in women Poor pregnancy outcomes (ectopic pregnancy, congenital anomalies, low birth weight, preterm delivery) Infant mortality; childhood obesity Other effects: cataract; osteoporosis; Crohns; periodontitis,; poor surgical outcomes; Alzheimers; rheumatoid arthritis; less sleep
12 Causal Associations with Second-hand Smoke Developmental Low birthweight Sudden infant death syndrome (SIDS) Pre-term delivery -- Childhood depression Respiratory Asthma induction and exacerbation Eye and nasal irritation Bronchitis, pneumonia, otitis media, bruxism in children Decreased hearing in teens Carcinogenic Lung cancer Nasal sinus cancer Breast cancer? (younger, premenopausal women) Cardiovascular Heart disease mortality Acute and chronic coronary heart disease morbidity Altered vascular properties There is no safe level of second-hand smoke. USDHHS. (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General.
13 The Toll from Smoking: An Apparent Paradox As prevalence declines, toll increases Reason is increased appreciation of damage caused by smoking, esp. COPD Estimates of annual deaths and morbidity should soon plateau and then fall, but still at very high rate of damage
14 Smoking and Behavioral Health: The Heavy Burden 200,000 annual deaths from smoking occur among patients with CMI and/or substance abuse This population consumes 40% of all cigarettes sold in the United States -- higher prevalence -- smoke more -- more likely to smoke down to the butt People with CMI die earlier than others, and smoking is a large contributor to that early mortality Greater risk for nicotine withdrawal Social isolation from smoking compounds the social stigma
15 Sources: Tsai & Rosenheck, Psychiatric Services, 2012; Parker et al., Addict Med, Vulnerable Populations Higher smoking rates have persisted among: Individuals with mental and/or SU disorders (38%) The poor (below poverty level: 29%; Medicaid: 37%) Least educated (GED: 41%; Less than H.S.: 24%) LGBT persons (27%) Chronically homeless (80%) Incarcerated persons (70% 83%) HIV infected (50%)
16 Industry Targets BH population Pushed Doral to homeless shelters, and psychiatric facilities R.J. Reynolds &"consumer subcultures, (gay/castro)" and "street people Sub Culture Urban Marketing
17 Smoking Prevalence and Substance Abuse 53-91% of people in addiction treatment settings use tobacco (Guydish et al, Nicotine and Tobacco Research, June 2011, p 401) Tobacco use causes more deaths than the alcohol or drug use bringing clients to treatment: death rates among tobacco users nearly 1.5 times the rate of death from other addiction-related causes (SAMHSA N-SSATS Report September 2013) Stopping smoking increases odds of abstinence (SAMHSA N- SSATS Report September 2013)
18 How Can You Help Smokers to Quit?
19 Dopamine Reward Pathway Prefrontal cortex Dopamine release Nucleus accumbens Ventral tegmental area Stimulation of nicotine receptors Nicotine enters brain
20 Nicotine Addiction Tobacco users maintain a minimum serum nicotine concentration in order to Prevent withdrawal symptoms Maintain pleasure/arousal Modulate mood Users self-titrate nicotine intake by Smoking more frequently Smoking more intensely Obstructing vents on low-nicotine brand cigarettes
21 Tools for Smoking Cessation 5A s (Ask, Advise, Assess, Assist, Arrange) AAR (Ask, Advise, Refer) Quitlines NRT and other medications Counseling and behavioral change strategies Peer-to-peer intervention
22 Responses to Patient Who Smokes Unacceptable: I don t have time. Acceptable Refer to a quit line and/or web program Establish systems in your office and hospital Become a cessation expert
23 Tobacco Dependence Treatment Persons with mental illnesses and substance use disorders benefit from same interventions as general population Combination of counseling and pharmacotherapy should be used whenever possible Duration of treatment might be longer View failed quit attempt as a practice, not failure
24 TOBACCO DEPENDENCE: A 2-PART PROBLEM Tobacco Dependence Physiologic Behavioral The addiction to nicotine Treatment The habit of using tobacco Treatment Medications for cessation Behavior change program Treatment should address the physiologic and the behavioral aspects of dependence.
25 PHARMACOTHERAPY Clinicians should encourage all patients attempting to quit to use effective medications for tobacco dependence treatment, except where contraindicated or for specific populations* for which there is insufficient evidence of effectiveness. * Includes pregnant women, smokeless tobacco users, light smokers, and adolescents. Medications significantly improve success rates. Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.
26 Pharmacologic Methods: First-line Therapies* Three general classes of FDA-approved medications for smoking cessation: Nicotine replacement therapy (NRT) -- nicotine gum, patch, lozenge, nasal spray, inhaler Partial nicotine receptor agonist -- varenicline --? cytisine in the future Psychotropics -- sustained-release bupropion * Counseling plus meds better than either alone Currently, no medications have an FDA indication for use in spit tobacco cessation.
27 Caveats About Cessation Literature Smoking should be thought of as a chronic condition, yet drug treatment often short (12 weeks) in contrast to methadone maintenance Great spectrum of severity and addiction; treatment should be tailored accordingly Volunteers for studies likely to be more motivated to quit Placebo and drug groups tend to have more intensive counseling than found in real practice world; and counseling is not a monolithic black box Most drug trials exclude patients with mental illness
28 Percent quit LONG-TERM ( 6 month) QUIT RATES for AVAILABLE CESSATION MEDICATIONS Active drug Placebo Nicotine gum Nicotine patch Nicotine lozenge Nicotine nasal spray Data adapted from Cahill et al. (2012). Cochrane Database Syst Rev; Stead et al. (2012). Cochrane Database Syst Rev; Hughes et al. (2007). Cochrane Database Syst Rev Nicotine inhaler Bupropion Varenicline
29 Financial Impact People with mental illnesses and/or addictions may spend up to 1/3 their income on cigarettes* A pack a day smoker spends on average $5.51** per day $38.57 per week $ per month $1, per year $18, per 10 years *Steinberg, 2004 **Average national price 2015 (American Lung Association)
30 Myths About Smoking and Behavioral Health Tobacco is necessary self-medication (industry has supported this myth) They are not interested in quitting (same % wish to quit as general population) They can t quit (quit rates same or slightly lower than general population) Quitting worsens recovery from the mental illness (not so; and quitting increases sobriety for alcoholics) It is a low priority problem (smoking is the biggest killer for those with mental illness or substance abuse issues) Source: Prochaska, NEJM, July 21, 2011
31 Power of Peers Peer-led support groups, community referrals, etc. Train peers to integrate tobacco cessation & wellness services into existing roles and responsibilities. Embedded model uses programs that have peer specialists on staff or as volunteers
32 New Cautions About Varenicline In addition to older concerns about increased suicide risks (rare but possible causation) and cardiac rhythm problems (controversial) New March 2015 warnings about potential for rare seizures and lower alcohol tolerance
33 2016 EAGLES Study Shows Varenicline Safety* Large RCT, with 1026 psychiatric pts receiving varenicline No increase in psychiatric symptoms, but much greater smoking cessation FDA considering whether to retain black boxed warning, but FDA reviewers currently questioning efficacy of EAGLES Study (not all adverse events noted) 2 FDA panels advise removing black boxed warning for neuropsychiatric risks (September 2016) * Anthenelli et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled
34 Tapering as a Way to Quit JAMA Feb 17, 2015: Varenicline for 24 weeks with intent to reduce daily #cigs by 50% within 4 weeks, 75% by 8 weeks, and quit attempt at week 12 By week 52, continuous abstinence = 27% for V, 10% for control. Much greater reduction of daily cigs by weeks 4 and 8 for V group
35 Evidence Review* shows Stopping Smoking Increases MH Cochrane Collaborative meta-analysis of 26 papers Smoking cessation leads to: depression, anxiety, stress and mood and quality of life Effect sizes of smoking cessation > or = anti-depressive drugs for mood or anxiety disorders * Taylor et al, BMJ, 2014
36 Quitlines and Behavioral Health Do quitlines work for people with MI and/or SUD? Are they able to meet the demand?
37 % Smoking Self-Reported Mental Health Issues Among Helpline Callers Depression (Zhu,et al, Unpublished data) Anxiety Bipolar Schizophrenia Drug/Alcohol Any
38 Conclusion and Next Steps
39 Smoking Profile, 2016 Most policymakers live in a non-smoking gated community Smoking now marginalized to poor and disadvantaged, plus some young immortals Thus tobacco control=social justice issue New products/markets: e-cigs and marijuana Tobacco industry fights domestic rear guard action while expanding overseas
40 The Electronic Cigarette* Aerosolizes nicotine in propylene glycol soluent; e-cig products in evolution Nicotine content in cartridge varies Safety unproven, but >cigarette smoke Probably deliver < nicotine than promised Unclear if help smokers quit Not approved by FDA My advice: avoid unless patient insists September 2016: Cochrane review suggests that e-cigarettes can help people quit smoking; also no noted health side effects from vapers up to 2 years >50% of teen vapers only use flavoring, not nicotine** * Cobb & Abrams. NEJM July 21, 2011; Fiore, Schroeder, Baker, NEJM Jan 23, 2014
41 Cigarette and E-Cigarette Use among High School Students, Source: Youth Risk Behavior Survey
42 Schroeder Conclusions regarding Electronic Cigarettes Products evolving, so risk reports dated Data on smoking cessation efficacy unclear;? 15% or so Much safer than combustible cigs (British MDs: 5% risk) Riskier than room air Second hand exposure less dangerous than regular cigs, but should not expose others in closed spaces Flavored marketing targets youth; should ban Nicotine exposure to adolescent brain unwise Ideal solution=cessation, but keep away from youth No evidence large scale gateway
43
Saving Lives: What You Can Do To Help Reduce Tobacco Use in Community Mental Health Settings
Saving Lives: What You Can Do To Help Reduce Tobacco Use in Community Mental Health Settings Doug Tipperman Tobacco Policy Liaison Substance Abuse and Mental Health Services Administration U.S. Department
More informationWhat Physicians Should Know About Smoking, 2012
What Physicians Should Know About Smoking, 2012 Steven A. Schroeder, MD U. Colorado, DGIM April 24, 2012 Topics for Today What we know about tobacco use What we don t know enough about Accelerating progress
More informationTHE WEBINAR WILL BE STARTING SHORTLY.
THE WEBINAR WILL BE STARTING SHORTLY. Please do the following prior to the webcast: 1. To listen to audio by phone, dial 1-888-585-9008 Conference Room 355-990-303 2. Check your system requirements by
More informationIntervention Strategies for Tobacco and Behavioral Health
Intervention Strategies for Tobacco and Behavioral Health Steven A. Schroeder, MD May 19, 2014 Presentation courtesy of The Smoking Cessation Leadership Center and Rx for Change Conflict of Interest? Smoking
More informationSmoking Cessation. MariBeth Kuntz, PA-C Duke Center for Smoking Cessation
Smoking Cessation MariBeth Kuntz, PA-C Duke Center for Smoking Cessation Objectives Tobacco use at population level Tobacco use and control around the world What works for managing tobacco use Common myths
More informationBrief Counselling for Tobacco Use Cessation
Brief Counselling for Tobacco Use Cessation Revised Fall 2011 www.ptcc-cfc.on.ca Overview & Agenda Impact of Tobacco Use Cessation & Comprehensive Tobacco Control Nicotine & Nicotine Delivery Systems Prevalence
More informationThe Science and Practice of Perinatal Tobacco Use Cessation
1 The Science and Practice of Perinatal Tobacco Use Cessation Erin McClain, MA, MPH Catherine Rohweder, DrPH Cathy Melvin, PhD, MPH erin_mcclain@unc.edu Prevention of Tobacco Use and Secondhand Smoke Exposure
More informationEffective Treatments for Tobacco Dependence
Effective Treatments for Tobacco Dependence Abigail Halperin MD, MPH Director, University of Washington Tobacco Studies Program Ken Wassum Associate Director of Clinical Development and Support Quit for
More informationTobacco Control should be a Mainstay of Behavioral Health
Tobacco Control should be a Mainstay of Behavioral Health Steven A. Schroeder, MD National Conference on Tobacco and Behavioral Health The Smoking Cessation Leadership Center and Rx for Change May 19,
More informationPharmacotherapy for Tobacco Dependence Treatment
Pharmacotherapy for Tobacco Dependence Treatment Nancy Rigotti, MD Professor of Medicine, Harvard Medical School Director, Tobacco Research and Treatment Center, Massachusetts General Hospital nrigotti@partners.org
More informationSmoking Cessation in Pregnancy. Jessica Reader, MD, MPH Family Medicine Obstetrics Fellow June 1st, 2018
Smoking Cessation in Pregnancy Jessica Reader, MD, MPH Family Medicine Obstetrics Fellow June 1st, 2018 Tobacco Cessation in Pregnancy: Objective 1. Overview of the negative effects of tobacco abuse in
More informationTobacco treatment for people with serious mental illness (SMI)
Tobacco treatment for people with serious mental illness (SMI) An opportunity to close the mortality gap Massachusetts Mental Health Center 1 National Resource Center for Academic Detailing A compelling
More informationTobacco Cessation, E- Cigarettes and Hookahs
Objectives Tobacco Cessation, E- Cigarettes and Hookahs Discuss evidence-based tobacco cessation interventions including pharmacologic options. Review e-cigarette and hookah facts and safety considerations.
More informationTreating Tobacco Use:
Treating Tobacco Use: Optimizing for the Best Outcomes Nancy Rigotti, MD Director, MGH Tobacco Research and Treatment Center Professor of Medicine, Harvard Medical School nrigotti@partners.org Primary
More informationLinda Sarna, RN, DNSc, FAAN. Marjorie Wells, PhD, RN, FNP
Helping Smokers Quit: Indiana Linda Sarna, RN, DNSc, FAAN Stella Aguinaga Bialous, RN, DrPH, FAAN Marjorie Wells, PhD, RN, FNP From Guideline to Practice: A Nursing Intervention to Help Smokers Quit Funded
More informationStrategies for Integrating Smoking Cessation & Wellness into Psychiatric & Substance Abuse Treatment Settings
Strategies for Integrating Smoking Cessation & Wellness into Psychiatric & Substance Abuse Treatment Settings Antoine Douaihy, MD Associate Professor of Psychiatry University of Pittsburgh School of Medicine
More informationSmoking Cessation. Samer Kanaan, M.D.
Smoking Cessation Samer Kanaan, M.D. Goals Understand the Societal impact of Smoking Smoking Cessation: The 5 A Model - Ask, Advise, Assess, Assist, Arrange Review The Stages of Change Review smoking cessation
More informationEffectively Addressing Co-Occurring Nicotine Dependence and Marijuana Use. Chad Morris, PhD March 7, 2018
Effectively Addressing Co-Occurring Nicotine Dependence and Marijuana Use Chad Morris, PhD March 7, 2018 2018 BHWP Behavioral Causes of Death in U.S. 2018 BHWP 2018 BHWP Health Disparities Population Behavioral
More informationTobacco Use Dependence and Approaches to Treatment
University of Kentucky UKnowledge Nursing Presentations College of Nursing 11-2011 Tobacco Use Dependence and Approaches to Treatment Audrey Darville University of Kentucky, audrey.darville@uky.edu Chizimuzo
More informationHow to help your patient quit smoking. Christopher M. Johnson MD, PhD
How to help your patient quit smoking Christopher M. Johnson MD, PhD Outline Smoking and its effects on IBD CD UC Clinical interventions Pharmacotherapy Resources Outline Smoking and its effects on IBD
More informationEVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO
EVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO Lena Matthias Gray, MSA, CTTS-M University of Michigan MHealthy Tobacco Consultation Service Overview of Tobacco Use The World Health Organization
More informationCigarettes and Other Tobacco Products
Cigarettes and Other Tobacco Products Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC),
More informationProject TEACH Addressing Tobacco Treatment for Pregnant Women Jan Blalock, Ph.D.
Project TEACH Addressing Tobacco Treatment for Pregnant Women Jan Blalock, Ph.D. Prevalence of Smoking and Cessation During Pregnancy In 2014, 14% in women with Medicaid coverage versus 3.6% of women with
More informationHealth Risks Posed by Smoking
Tobacco Interventions for Urgent Care Patients Alan A. Ayers, MBA, MAcc Content Advisor, Urgent Care Association of America Associate Editor, Journal of Urgent Care Medicine Vice President, Concentra Urgent
More informationSmoking Cessation Strategies in 2017
Smoking Cessation Strategies in 2017 Robert Schilz DO, PhD, FCCP Division of Pulmonary, Critical Care and Sleep Medicine Director of Lug Transplantation University Hospitals of Cleveland Case Western University
More informationTobacco Dependence Treatment From Neurobiology through Public Policy
Tobacco Dependence Treatment From Neurobiology through Public Policy Mary Ellen Wewers, PhD, MPH, RN Professor Emerita The Ohio State University College of Public Health Disclosures Funding from the National
More informationHealth Promotion Research: Smoking Cessation. Paula Sawyer
Running Header: Smoking Cessation Health Promotion Research: Smoking Cessation Paula Sawyer Smoking Cessation 2 Abstract A review of the negative effects of smoking is provided, as well as brief description
More informationVarenicline Update. Serena Tonstad, MD, PhD Dept of Preventive Cardiology Ullevål University Hospital Oslo, Norway
Varenicline Update Serena Tonstad, MD, PhD Dept of Preventive Cardiology Ullevål University Hospital Oslo, orway October 23, 2015 Disclosures related to smoking cessation: Pfizer, Mceil, ovartis Binding
More informationSMOKING CESSATION WORKSHOP. Dr Mark Palayew December
SMOKING CESSATION WORKSHOP Dr Mark Palayew December 5 2016 Conflicts of Interest None Case 1 Mr. T is a 55 year old smoker 2 packs/day He has been smoking continuously since age 16 When he wakes up at
More informationPHARMACOTHERAPY OF SMOKING CESSATION
PHARMACOTHERAPY OF SMOKING CESSATION Domenic A. Ciraulo, MD Director of Alcohol Pharmacotherapy Research Center for Addiction Medicine Department of Psychiatry Massachusetts General Hospital Disclosure
More informationRegistered Nurses Referral to Quitlines: Helping Smokers Quit (RNQL HSQ) in Louisiana
Rx for change Registered Nurses Referral to Quitlines: Helping Smokers Quit (RNQL HSQ) in Louisiana Linda Sarna, RN, PhD, FAAN UCLA School of Nursing Stella Aguinaga Bialous, RN, DrPH, FAAN Tobacco Policy
More informationQuit (RNQL-HSQ) in Louisiana
Rx for change Registered Nurses Referral to Quitlines: Helping Smokers Quit (RNQL-HSQ) in Louisiana Linda Sarna, RN, PhD, FAAN UCLA School of Nursing Stella Aguinaga Bialous, RN, DrPH, FAAN Tobacco Policy
More informationPharmacological Treatments for Tobacco Users with Behavioral Health Conditions
Pharmacological Treatments for Tobacco Users with Behavioral Health Conditions Jill M Williams, MD Professor Psychiatry Director, Division Addiction Psychiatry Robert Wood Johnson Medical School Disclosures
More informationSmoking Cessation: Where Are We Now? Nancy Rigotti, MD
Smoking Cessation: Where Are We Now? Nancy Rigotti, MD Director, MGH Tobacco Research and Treatment Center Professor of Medicine, Harvard Medical School nrigotti@partners.org OVERVIEW The challenge for
More informationTobacco & Nicotine: Addiction and Treatment
Tobacco & Nicotine: Addiction and Treatment Tim McAfee, MD, MPH Chief Medical Officer - Free & Clear 206-876-2551 - tim.mcafee@freeclear.com Affiliate Assistant Professor, University of Washington, School
More information3. Chantix [package insert]. New York, NY: Pfizer, Inc,; Ramon JM, Morchon S, Baena A, Masuet-Aumatell C. Combining varenicline and nicotine
How can there be a warning regarding concomitant use of varenicline with nicotine replacement therapy yet patients can be on varenicline and smoke concurrently? April 20, 2017 The United States (US) Preventive
More informationA systems approach to treating tobacco use and dependence
A systems approach to treating tobacco use and dependence Ann Wendland, MSL Policy Analyst & Cessation Programs Manager NYSDOH Bureau of Tobacco Control ann.wendland@health.ny.gov A systems approach to
More informationBackground. Abstinence rates associated with varenicline
What are the range of abstinence rates for varenicline for smoking cessation? Do they differ based on treatment duration? Are there any studies utilizing 3-4 months of varenicline treatment? Background
More information8/9/18. Objectives. Smoking. Disclosure Statement. The presenters have no real or potential conflicts of interest related to the presentation topic.
Disclosure Statement Multifaceted Smoking Cessation Strategies for Nurse Practitioners The presenters have no real or potential conflicts of interest related to the presentation topic. Dr. Susan Chaney,
More informationSlide 1. Slide 2. Slide 3. Reducing Tobacco Use and Nicotine Dependence in Clinical Settings. Goals for Today
Slide 1 UNIVERSITY OF HAWAI I CANCER CENTER Reducing Tobacco Use and Nicotine Dependence in Clinical Settings Pebbles Fagan, Ph.D., M.P.H. Associate Professor and Program Director Cancer Prevention and
More informationUpdate on Medications for Tobacco Cessation
Update on Medications for Tobacco Cessation Marc Fishman MD Johns Hopkins University Dept of Psychiatry Maryland Treatment Centers Baltimore MD MDQuit Best Practices Conference Jan 2013 Nicotine Addiction
More informationSmoking Cessation A Clinicians Perspective. Jeff Wilson, MD
Smoking Cessation A Clinicians Perspective Jeff Wilson, MD Overview Tobacco control what we have accomplished and the road ahead Role of the health care professional Using pharmacotherapy Electronic cigarettes
More informationDrug Use Evaluation: Smoking Cessation
Drug Use Research & Management Program Oregon State University, 3303 SW Bond Av CH12C, Portland, Oregon 97239-4501 Phone 503-947-5220 Fax 503-494-1082 Drug Use Evaluation: Smoking Cessation Tobacco cessation
More informationIs Vaping a Valid Strategy for Smoking Cessation? Myths and Facts Jaspreet S. Brar. MD, PhD Community Care Behavioral Health Organization
Is Vaping a Valid Strategy for Smoking Cessation? Myths and Facts Jaspreet S. Brar. MD, PhD Learning Objectives What are e-cigarettes and vapes? Myths and Facts related to vaping Vaping for harm reduction
More informationPharmacologic Therapy for Tobacco Use & Dependence
Pharmacologic Therapy for Tobacco Use & Dependence Thomas Gauvin, MA, TTS Mayo Clinic Nicotine Dependence Center Rochester, MN 2013 MFMER slide-1 Learning Objectives Understand the 7 first line medications
More informationMeasure #114: Preventive Care and Screening: Inquiry Regarding Tobacco Use
Measure #114: Preventive Care and Screening: Inquiry Regarding Tobacco Use 2010 PQRI REPTING OPTIONS F INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage of patients aged 18 years or older who
More informationPopulation-level Strategies to Prevent and Reduce Tobacco Use Success and Challenge
Population-level Strategies to Prevent and Reduce Tobacco Use Success and Challenge Harlan R. Juster, Ph.D. Director, Bureau of Tobacco Control New York State Department of health November 6, 2013 Learning
More informationSmoking Cessation. Disclosures. Thank You. None
Smoking Cessation Dr. Jamie Kellar; BSc, BScPhm, PharmD Clinician Educator Centre for Addiction and Mental Health Assistant Professor Leslie Dan Faculty of Pharmacy Disclosures None Thank You Several slides
More informationBASIC SKILLS FOR WORKING WITH SMOKERS
BASIC SKILLS FOR WORKING WITH SMOKERS Course Description Goals and Learning Objectives 368 Plantation Street, Worcester, MA 01605 www.umassmed.edu/tobacco 2018 Basic Skills for Working with Smokers 1 Table
More informationAHEC Tobacco Online Modules
AHEC Tobacco Online Modules www.aheceducation.com This program is sponsored by the Florida AHEC Network and the Florida Department of Health. In July 2007, the Florida legislature appropriated funds to
More informationTobacco Cessation: Best Practices in Cancer Treatment. Audrey Darville, PhD APRN, CTTS Certified Tobacco Treatment Specialist UKHealthCare
Tobacco Cessation: Best Practices in Cancer Treatment Audrey Darville, PhD APRN, CTTS Certified Tobacco Treatment Specialist UKHealthCare Objectives 1. Describe the current state of tobacco use treatment
More informationTRENDS IN TOBACCO UNDERSTAND 5/26/2017 LEARNING OBJECTIVES. Understand the types of tobacco products trending in today s market & associated risks
TRENDS IN TOBACCO And What Employers Can Do to Support Cessation Katy Tombaugh, Certified Tobacco Treatment Specialist Founder & CEO, Wellness Collective LEARNING OBJECTIVES Understand the types of tobacco
More informationBASIC SKILLS FOR WORKING WITH SMOKERS
BASIC SKILLS FOR WORKING WITH SMOKERS Course Description Goals and Learning Objectives 55 Lave Ave No, Worcester, MA 01655 www.umassmed.edu/tobacco 2016 Basic Skills for Working with Smokers 1 Table of
More informationHelping 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
More informationTobacco Cessation: Priority for Health Providers. Acknowledgements. Tobacco Cessation: Secondhand Smoke. Smoke-Free Environment & CA
Acknowledgements Smoking Cessation Leadership Center http://smokingcessationleadership.ucsf.edu/ Rx for Change http://rxforchange.ucsf.edu/ Tobacco Use and Dependence: 2008 Update http://www.surgeongeneral.gov/tobacco
More informationProject ECHO Importance of Treating Tobacco Use In People With Behavioral Health Disorders Jan Blalock, Ph.D.
Project ECHO Importance of Treating Tobacco Use In People With Behavioral Health Disorders Jan Blalock, Ph.D. High Levels Of Tobacco Use Almost twice as likely to smoke as people without disorders (36.1%
More informationAdolescents and Tobacco Cessation
Adolescents and Tobacco Cessation Jonathan D. Klein, MD, MPH American Academy of Pediatrics Julius B. Richmond Center and the University of Rochester Rochester, NY Goal To review current evidence and perspectives
More informationTobacco Cessation for People with Disabilities. Christopher M. Anderson 2011 Disability and Health Partners Meeting June 14 16, 2011
Tobacco Cessation for People with Disabilities Christopher M. Anderson 2011 Disability and Health Partners Meeting June 14 16, 2011 The California Smokers Helpline Established 1992 by UCSD researchers
More informationLinda Sarna, RN, DNSc, FAAN. Marjorie Wells, PhD, RN, FNP
Helping Smokers Quit: West Virginia Linda Sarna, RN, DNSc, FAAN Stella Aguinaga Bialous, RN, DrPH, FAAN Marjorie Wells, PhD, RN, FNP From Guideline to Practice: A Nursing Intervention for Helping Smokers
More informationTobacco Cessation for Women of Reproductive Age. Erin McClain, MA, MPH
Tobacco Cessation for Women of Reproductive Age Erin McClain, MA, MPH Tobacco Use During Pregnancy in NC 2 1 in 10 babies in NC are born to women reporting tobacco use during pregnancy In some counties
More informationHIV and Aging. Making Tobacco Cessation a Priority in HIV/AIDS Services. Objectives. Tobacco Use Among PLWHA
HIV and Aging Making Tobacco Cessation a Priority in HIV/AIDS Services June 27, 2008 Amanda Brown, MPH Ruth Tripp, MPH, RN Objectives To explore existing knowledge of the HIV and smoking connection. To
More informationBrief Intervention for Smoking Cessation. National Training Programme
Brief Intervention for Smoking Cessation National Training Programme Introduction Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about
More informationSupporting smokers with mental health problems
Collaboration for Leadership in Applied Health Research and Care South London (CLAHRC South London) Supporting smokers with mental health problems Ann McNeill, Professor of Tobacco Addiction Dr Debbie
More informationAn Evidence-based Approach to Address Tobacco Dependence Treatment in Mental Health and Addictions Settings
University of Kentucky UKnowledge Nursing Presentations College of Nursing 11-2011 An Evidence-based Approach to Address Tobacco Dependence Treatment in Mental Health and Addictions Settings Chizimuzo
More informationHeather Dacus, DO, MPH Preventive Medicine Physician Director, Bureau of Chronic Disease Control New York State Department of Health
Heather Dacus, DO, MPH Preventive Medicine Physician Director, Bureau of Chronic Disease Control New York State Department of Health Disclosure Heather Dacus has no real or perceived vested interests that
More informationTobacco Use and Reproductive Health: An Update
Project with Alberta Health Services Christene Fetterly Gail Foreman and Tasha Allen Tobacco Use and Reproductive Health: An Update Lorraine Greaves PhD Nancy Poole PhD Natalie Hemsing, Research Associate,
More informationOutpatient Tobacco Addiction Treatment Pathway Additional Notes
Outpatient Tobacco Addiction Treatment Pathway Additional Notes First Line: Varenicline (provide in conjunction with counselling/support, but if such support is refused or is not available, this should
More informationChantix Label Update 2018
Chantix Label Update 2018 Chantix (varenicline) Prescribing Information Chantix Prescribing Info URL and Disclaimer Please refer to the full Prescribing Information on important treatment considerations
More informationTOBACCO USE AMONG AFRICAN AMERICANS
TOBACCO USE AMONG AFRICAN AMERICANS Each year, approximately 45,000 African Americans die from smoking-related disease. 1 Smoking-related illnesses are the number one cause of death in the African-American
More informationTOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS
Learning Objectives TOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS Cheyenne Newsome, PharmD PGY2 Ambulatory Care Resident University of New Mexico College of
More informationTobacco Use and Cessation in Psychiatric Patients
Tobacco Use and Cessation in Psychiatric Patients John Spangler, MD, MPH Professor of Family Medicine Wake Forest School of Medicine NCPA, October 2015 Disclosure I have no relevant financial relationship
More informationEvidence-based Practice
Evidence-based Practice Michael V. Burke, EdD Assistant Professor of Medicine Treatment Program Coordinator Mayo Clinic Nicotine Dependence Center May, 2013 Learning objectives At the end of this presentation
More informationTOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS
TOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS Cheyenne Newsome, PharmD PGY2 Ambulatory Care Resident University of New Mexico College of Pharmacy Learning
More information9/28/2017. Nicotine Addiction : Past, Present and Future. How to Use this Tutorial. Something to Think About
Nicotine Addiction : Past, Present and Future Robert W. Murphy PharmD, BCPS St. Vincent Evansville Date How to Use this Tutorial Introduction History Clinical pharmacology of nicotine Pharmacotherapy of
More informationMy Mask. I keep it all inside. Because I d rather. The pain destroy me. Than everyone else. Anon.
My Mask KL I keep it all inside Because I d rather The pain destroy me Than everyone else. Anon. 43 K. N. Roy Chengappa, M.D., FRCPC Professor of Psychiatry, University of Pittsburgh School of Medicine,
More informationIntroduction to pharmacotherapy
Introduction to pharmacotherapy Dr. Shamim Jubayer. Research Fellow Dept. Epidemiology and Research National Heart Foundation Hospital And research Institute Effective tobacco cessation medications The
More informationAddressing Smoking Among Individuals with Behavioral Health Issues
Addressing Smoking Among Individuals with Behavioral Health Issues Carlo C. DiClemente, Ph.D. Director of MDQuit Janine C. Delahanty, Ph.D. Associate Director of MDQuit MHA Annual Conference May 4, 2011
More information4/2/2015. Inpatient Smoking Cessation. Smoking Cessation Documentation Patient's Stage of Behavior Change
Implementing Updates Barbara Darsow COTA/BA, CES TEAM Project: Promoting in Hospital Patients 1996 Smoke Free 2000 Coalition Completed Training Smoking cessation counselor at Mayo Clinic Tobacco research
More informationTobacco Use in Adolescents
Tobacco Use in Adolescents Joycelyn Lawrence, MD Leonard Miller School of Medicine at the University of Miami Department of Family Medicine 1 Overview Description: This section will introduce you to the
More informationAsk-Advise-Refer Brief Interventions for Assisting Patients with Quitting
Ask-Advise-Refer Brief Interventions for Assisting Patients with Quitting TRAINING OVERVIEW Epidemiology of Tobacco Use Addiction to Nicotine Medications for Smoking Cessation Changing Behavior Referring
More informationIntegrating Tobacco Cessation into Practice
Integrating Tobacco Cessation into Practice Presented To Smoking Cessation Leadership Center PIONEERS FOR SMOKING CESSATION CAMPAIGN By Carol Southard, RN, MSN Tobacco Treatment Specialist Northwestern
More informationVarenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks?
Varenicline and cardiovascular and neuropsychiatric events: Do Benefits outweigh risks? Sonal Singh M.D., M.P.H, Johns Hopkins University Presented by: Sonal Singh, MD MPH September 19, 2012 1 CONFLICTS
More informationWanting to Get Pregnant
Continuing Medical Education COPD Case Presentation LEARNING OBJECTIVES Those completing this activity will receive information that should allow them to Assist a patient in developing a quit plan; Advise
More informationYou Can Make a Difference!
You Can Make a Difference! How to help your clients become tobacco free What Does Smoking Cost Us? One study estimates that cost savings of between $1,142 and $1,358 per pregnancy can be achieved for each
More informationAn Evolving Perspective on Smoking Cessation Therapies
An Evolving Perspective on Smoking Cessation Therapies Andrew Pipe, CM, MD Chief, Division of Prevention & Rehabilitation University of Ottawa Heart Institute Faculty/Presenter Disclosure Andrew Pipe,
More informationBreaking the Chains of Nicotine Dependence - A Breakthrough Approach
Breaking the Chains of Nicotine Dependence - A Breakthrough Approach Dr Rob Young Senior Lecturer & Consultant Physician Auckland Hospital, New Zealand Smoking Cessation in 2001 Smoking contributes to
More informationMonth/Year of Review: March 2014 Date of Last Review: April 2012
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119 Copyright 2012 Oregon State University. All Rights
More informationWorld no tobacco day. Narayana Medical Journal Vol 1: Issue 2. Review: Gowrinath K. Published online: Oct 2012
Narayana Medical Journal Vol 1: Issue 2 Review: World no tobacco day Gowrinath K Published online: Oct 2012 Tobacco smoking is the single most important preventable cause of sickness and premature death.
More informationTRENDS IN SUBSTANCE USE AND ASSOCIATED HEALTH PROBLEMS
Fact Sheet N 127 August 1996 TRENDS IN SUBSTANCE USE AND ASSOCIATED HEALTH PROBLEMS Psychoactive substance use is an increasing public health concern. Problems associated with this use cover a broad spectrum
More informationE-CIGARETTE OR DRUG DELIVERY DEVICE?
E-CIGARETTE OR DRUG DELIVERY DEVICE? Schroeder Institute Researchers Raise Questions About Safety, Usage and Future Implications of New Nicotine Delivery Products Release Date: July 20, 2011 Washington,
More informationTobacco Cessation: Strategies for Creating Policy to Improve Outcomes
Tobacco Cessation: Strategies for Creating Policy to Improve Outcomes Shelina D. Foderingham, MPH MSW Director of Practice Improvement National Council for Behavioral Health Change Package Family and Patient-Centered
More informationOver the Road Truck Driver Who Smokes
Continuing Medical Education Case Presentation 1 CME Credit Physicians Physician Assistants Nurse Practitioners Over the Road Truck Driver Who Smokes RELEASE & REVIEW DATE This activity was last reviewed
More informationPharmacotherapy Safety and Efficacy in Adolescent Smoking Cessation
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2011 Pharmacotherapy Safety and Efficacy in
More informationAvailability, Affordability, and Prices of Smoking Cessation Drugs in 9 Countries: Preliminary Findings
Availability, Affordability, and Prices of Smoking Cessation Drugs in 9 Countries: Preliminary Findings Arusyak Harutyunuyan, MD, MPH Principal Investigator AUA School of Public Health Introduction Numerous
More informationTreating Tobacco Use Disorders as an Addiction: Why clinicians should address it, and some tools to help them. PAM BENNETT KATHY GARRETT
Treating Tobacco Use Disorders as an Addiction: Why clinicians should address it, and some tools to help them. PAM BENNETT KATHY GARRETT Objectives Why Tobacco Use should be viewed as an addiction Why
More informationMEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Smoking Cessation Products LAST REVIEW 5/8/2018 THERAPEUTIC CLASS: Psychiatric Disorders REVIEW HISTORY 5/17, 5/16, 5/15,
More informationUpdates in the Treatment of Tobacco Use Disorder
Updates in the Treatment of Tobacco Use Disorder Jill M Williams, MD Professor Psychiatry Director, Division Addiction Psychiatry Robert Wood Johnson Medical School Disclosures Grant Support from Pfizer
More informationEffects of Smoking and Methods of Cessation By Chetan Kaher
Effects of Smoking and Methods of Cessation By Chetan Kaher Cigarette smoking is the leading cause of preventable death in the United States. It accounts or almost 500,000 deaths per year, or one in every
More informationSetting the Stage: Tobacco s Impact on Smokers, Employers, and Florida
Setting the Stage: Tobacco s Impact on Smokers, Employers, and Florida Thomas H. Brandon, Ph.D. H. Lee Moffitt Cancer Center & Research Institute Florida Tobacco Cessation Summit October 14, 2010 Moffitt
More informationSmokeless Tobacco Cessation: Review of the evidence. Raymond Boyle, PhD Tobacco Summit 2007 MDQuit.org
Smokeless Tobacco Cessation: Review of the evidence Raymond Boyle, PhD Tobacco Summit 2007 MDQuit.org Previous Reviews of ST evidence Hatsukami and Boyle (1997) Evidence base is limited by small sample
More information