Program Training and Consultation Centre

Transcription

1 Program Training and Consultation Women and Tobacco Launch of PTCC s Women & Tobacco InfoPack Webinar presented by Janet Nevala Thursday, June 17th, 1:30-3:00pm Women and Tobacco

2 Program Training and Consultation Program Training and Consultation Lead Ontario provincial tobacco control resource centre Responsible for leading & coordinating tobacco control capacity building & knowledge exchange in support of the Smoke Free Ontario Strategy Partnership of: Cancer Care Ontario Region of Waterloo Public Health Sudbury and District Health Unit Propel for Population Health Impact 2

3 Objectives of webinar: Program Training and Consultation To highlight content in the InfoPack To increase understanding of the material presented in the InfoPack

4 Tips for asking a question: Program Training and Consultation 1. Use the raise hand function on your screen to let us know that you want to ask a question. When you re called on, un-mute your phone using *7 and ask your question. 2 Cli k th h t t b t k i iti dt i 2. Click on the chat tab to ask in writing- and type in your question.

5 Poll Questions Program Training and Consultation How many people are participating with you at your computer? Have you already read the InfoPack?

6 Purpose of the InfoPack Program Training and Consultation Provide a better understanding of: why to approach the issue from a gender-specific manner tobacco use trends for women why girls and women may start and continue to smoke how smoking affects women s health the challenges women face when attempting to quit how to assist women to quit tobacco use

7 Sex vs. gender Sex = biology Gender = social context Impacts of tobacco use vary in men and women, due to biological differences and social roles held by women and men across the lifecourse Program Training and Consultation

8 Determinants of Health Program Training and Consultation Income and social status Social support networks Culture Healthy child development Physical environments Personal health practices and coping skills Health services Gender Biology and genetic endowment Employment Education Social environments (Health Canada, 1999)

9 Program Training and Consultation Trends in smoking among Canadian women Women and Tobacco

10 Tobacco Use statistics Ontario Gender Current smokers Female 14% 12.1 Male 20% 17.5 Program Training and Consultation Daily cigarette consumption Canada Age in years Daily Smokers Non daily Smokers Females % 5.4% % 6.0% % 3.9% Overall 11.6% 4.2% (Canadian Tobacco Use Monitoring Survey, 2008)

11 Tobacco Use Statistics Program Training and Consultation Recently women in low and middle income countries have started smoking 20% of women globally will be smokers in 2025, compared to 12% currently (Samet & Yoon, 2001; World Health Organization (WHO), 2007) Some groups of women with significantly higher smoking rates (est %) (Greaves et al., 2006; Remafedi et al., 2008) Aboriginal and First Nations Lesbian and bisexual Living with a mental illness Homeless

12 Smoking gprevalence for women is higher among: Low-educated women Low-income women Single moms

13 Characteristics ti of girls who initiate smoking Parents or friends smoke Weaker attachments to parents and family Smoking prevalence perceived to be higher than reality Inclined to risk taking Believe that smoking can control weight Positive image of smokers (USDHHS, 2001)

14 Program Training and Consultation Reasons why women smoke Women and Tobacco

15 Nicotine Addiction Nicotine causes release of dopamine, making the smoker feel good (Corrigall, Coen & Adamson, 1994; Fagerstrom, 2002) Dopamine decrease between cigarettes leads to withdrawal symptoms of irritability and stress (Jarvis, 2004; Dani & De Biasi, 2001) Smoker craves nicotine to release more dopamine to restore pleasure and calmness (Fagerstrom, 2002; Jarvis, 2004) Women and men may respond to nicotine differently (Samet & Yoon, 2001)

16 The meaning that smoking plays in women s lives Study conducted by Dr. Lorraine Greaves included interviews with 35 female smokers 5 major themes emerged about why women smoke: 1. To organize social relationships 2. To create an image 3. To control emotions 4. To help handle dependency 5. As a source of identity (Greaves, 1996)

17 Smoking to control weight Some women may use smoking as a deliberate weight maintenance strategy But research suggests that few women use smoking for this purpose, and relationship between dieting and smoking is complex (Nichter et al., 2004) Smoking as coping mechanism Smoking as coping mechanism for mental illness

18 Program Training and Consultation Tobacco Industry Marketing to Women Theme of the 2010 World No Tobacco Day

19 Tobacco Industry Marketing to Women Images of attractive, slim models are at odds with real health consequences of smoking (USDHHS, 2001; Greaves et al., 2006) light, low tar, smooth are preferred by women (USDHHS, 2001) Targeting to young, less educated women with iil virile and d maverick ik images (Barbeau, Leavy-Sperounis & Balbach, 2004)

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21 Tobacco Industry Marketing to Girls Flavoured cigarillos dramatic sales increase between 2001 and 2008 (Health Canada, 2009; NSRA, 2008) Sold in tubes resembling lip-gloss and felt-tip markers; candy flavours (Physicians for a Smoke-Free Canada, 2008) Bill C-32 bans flavouring and requires min. 20/pkg law fully in effect on July 5, 2010 From

22 Questions?

23 Program Training and Consultation Health Consequences for Women Women and Tobacco

24 Health Consequences for Women Cardiovascular disease Lung cancer Breast cancer Other cancers Chronic obstructive pulmonary disease Osteoporosis Reproductive health and pregnancy (Collishaw et al., 2009; USDHHS, 2004)

25 Program Training and Consultation Women & Cardiovascular Disease (CVD) Women who smoke 1-4 cigarettes/day have 2X the risk of CVD as women who have never smoked (USDHHS, 2004) Women who smoke have 2X the risk of heart attack than men who smoke; risk increases with use of oral contraceptives (Samet & Yoon, 2001) Risk of stroke among current women smokers is over 2X the risk for never smokers (Bhat et al., 2008) Smoking cessation reduces excess risk, no matter what age women stop smoking (PHAC, 2008; USDHHS, 2001)

26 Women & Lung Cancer Program Training and Consultation 80% of lung cancer deaths caused by smoking (USDHHS, 2004) Women who smoke have 13X higher risk of death from lung cancer compared to never smokers (CDC, 2004) Canadian woman s lifetime probability of developing lung cancer is estimated at 1 in 16 and dying from lung cancer is 1 in 18 (Canadian Cancer Society, 2009) : Men s lung cancer rates declined but women s rates increased, and now are at a plateau in Ontario (CCO, 2010) Reflects tobacco consumption patterns

27 Women & Breast Cancer Program Training and Consultation Breast tissue very sensitive to carcinogen exposure during growth stages (i.e. during puberty and first pregnancy) (Band et al., 2002) Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009) Smoking is causally linked with breast cancer (both pre- and post-menopausal) Second-hand smoke is causally linked with breast cancer in younger, primarily premenopausal women (Collishaw et al., 2009)

28 Program Training and Consultation Women & Chronic Obstructive Pulmonary Disease In 2005, 425,000+ Canadian women over age 35 were diagnosed with COPD and more than 4,300 died from COPD (Lung Association, 2006) COPD has affected more men than women but rates for women are rising and expected to surpass men s soon (PHAC, 2008) Research suggests physicians may be underdiagnosing g COPD in women (Camp & Goring, 2007; Lung Association, 2006)

29 Program Training and Consultation Reproductive health effects of smoking Altered menstrual function (Hornsby et al.,1998) Increased risk of heart disease among those women who take oral contraceptives (Chasan-Thaber & Stampfler, 1998) Increased risk for cervical cancer (USDHHS, 2001) Early onset of menopause (Parente, 2008) Increased likelihood of primary and secondary infertility and delays in conceiving (Samet & Yoon, 2001)

30 Smoking & Pregnancy Program Training and Consultation Smoking during last pregnancy: 9% of Canadian women aged years 22% of Canadian women aged years (CTUMS, 2008) Smoking during pregnancy increases the risk of: Miscarriage Stillbirth Low birth weight SIDS Childhood asthma (USDHHS, 2001) Exposure to SHS during pregnancy is also harmful for the fetus

31 Questions?

32 Program Training and Consultation Smoking Cessation Strategies Women and Tobacco

33 Smoking Cessation 43% of Ontario current smokers reported making a serious quit attempt in 2006 (OTRU, 2008) Fear of withdrawal can be a major barrier to quitting Combine pharmacotherapy with advice and behavioural support (Fiore et al., 2008) Women may have less success in maintaining abstinence after quitting, worry more about weight gain, report more symptoms of depression than men (Samet & Yoon, 2001)

34 Pharmacotherapy Program Training and Consultation Nicotine replacement therapy (NRT) Nicotine patch (long-acting), g) gum/chewing g pieces, lozenges, inhaler Women may not receive advice re. NRT as often as men (Sarna & Bialous, 2004) Prescription medications Bupropion, p Varenicline Refer to US Clinical Practice Guidelines Treating Tobacco Use and Dependence (2008), CAN-ADAPTT clinical practice guidelines later this summer net or for more info

35 Program Training and Consultation Behavioural Counseling for women Try close, informal, personal and small group interactions; set up women-only groups (Greaves, 1996) Explain health benefits of quitting smoking Help woman develop quit plan and set quit date Help her learn about role of smoking in her life and assess readiness to quit Acknowledge benefits that women feel they get from smoking. Help her develop alternatives Relaxation exercises (stress reduction) Sports and fitness (to build self-esteem) Healthy snack break or listen to music (to replace cigarette break)

36 Special considerations for women Program Training and Consultation Weight gain 3.8 kg mean weight gain in women attributable to smoking cessation vs. 2.8 kg in men (Samet & Yoon, 2001) If woman concerned about weight gain possibility: Reassurance that some is normal and that health risks of smoking outweigh some risks of some weight gain Advise starting or increasing physical activity Stress importance of a healthy diet Encourage use of pharmacotherapy known to delay weight gain (Fiore, 2008)

37 Special considerations for women Program Training and Consultation Smoking and the menstrual cycle Women may smoke more in the premenstrual phase as they experience symptoms of PMS makes quit attempt more difficult during this time, so advise women to quit right after their period starts Women more likely to relapse during premenstrual phase (Perkins et al., 2000)

38 Cessation during Pregnancy Program Training and Consultation While some women may quit smoking before or during pregnancy, rates of relapse to smoking during the postpartum period are high Nearly 70% of women relapse to smoking after birth (B.C. Alcohol-Drug Education Service, 2007) Guidelines for assisting pregnant women with cessation: Avoid blame or guilt Recognize the stigma women face and help them cope with this For long term success, focus on the importance of cessation for the woman herself (B.C. Alcohol-Drug Education Service, 2007) Resources for cessation during pregnancy: Pregnets Tobacco-related interaction patterns (TRIPs)

39 Program Training and Consultation Comprehensive Approach to Tobacco Control for women Women and Tobacco

40 Community Partnerships Program Training and Consultation Identify allies; create partnerships Identify priorities and goals include women of the community itself with development of goals develop policies with social justice lens/equity focus address meaning of smoking and links to identity, risks, dependency

41 Public Policy Examine policy to determine impact on women and girls, esp. low socioeconomic status Assess cost of NRT and other stop-smoking smoking medications Assess access to gender-specific smoking cessation services (Greaves & Jategaonkar, 2006) Policies need to go beyond tobacco control to address Child care, community health care, income equality (Health Canada, 1999) Program Training and Consultation

42 Key messages - What you can do Program Training and Consultation Integrate messages on health effects of tobacco use at all ages Offer smoking cessation through regular health and pre and post-natal care Recognize that gender plays a role Call for more research on: Barriers to cessation Effectiveness of programs for women Gender differences in treatment outcomes Encourage reporting of gender-specific results of studies Expose tobacco industry marketing to women Examine public policies impact on women

43 PTCC Resources Program Training and Consultation Brief Counseling for Smoking Cessation InfoPack Workshops Brief counseling for smoking cessation Smoking cessation and pregnancy Consultations by phone or in-person Call or visit cfc

44 Questions? Program Training and Consultation

45 Selected Resources Program Training and Consultation Active and Free Take 5 Action Primer Expecting to Quit Better practices for smoking cessation in pregnant and postpartum girls and women, Health Canada tabac/expecting grossesse/index eng.php AWARE (Action on Women s Addictions Research & Education) Helping Women Quit A guide for non-cessation workers Stop Smoking Cessation Resources for those who work with women Couples and smoking: What you need to know when you are pregnant women/couplesandsmoking htm

46 Selected Resources Program Training and Consultation Echo: Improving Women s Health in Ontario Project for an Ontario Women s Health Evidence-Based Report (POWER study) Women and Smoking: An Interdisciplinary Examination of Socioeconomic Influences. Proceedings From the College on Problems of Drug Dependence Mini-conference, April 9-10, 2008, Annapolis, MD, USA (Drug and Alcohol Dependence. October 1, 2009, 104(Suppl 1): S1-130.) 130.) Gender and Health Collaborative Curriculum BC of Excellence for Women's Health Pregnancy and smoking cessation website h b /b h iti ti / ti /d

47 Thank you! Janet Nevala Erika Steibelt Thanks to co-author Kirsten Sears And Laura McCammon-Tripp for assistance with webinar development