HERTFORDSHIRE
STOP SMOKING SERVICE
BRIEF INTERVENTION TRAINING
FOR HEALTH CHAMPIONS
Trainer: Janka Szocs
Stop Smoking
Specialist
22nd April
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What causes the most deaths per day worldwide?
Illegal
Drugs
Aids
Smoking
Murder
Suicide
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Road
Accidents
Smoking causes approximately 13000 deaths per day
worldwide
Illegal
Drugs
Aids
Smoking
Murder
Road
Accidents
Suicide
More deaths than all of the other 5 added together
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Smoking
Smoking is responsible for 20% of all deaths in the
UK.
300 deaths in the UK daily
50% of smokers die prematurely
Repeated quit attempts may be needed
Consider Smoking as: a powerful motivation to
engage versus an impaired capacity for restraint1
Robert west Maudsley clinic London
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Smoking:
Cost to the NHS
£5.2 billon per year
Allender S, Blakrishnan R, Scarborough P, Webster P, Rayner M. The burden of smoking
related ill health in the United Kingdom. Tobacco Control, 2009;18.262-267
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What’s in a
cigarette?
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Myth: Nicotine causes the diseases
related to smoking
FACTS: There is no evidence to suggest that nicotine causes cancer
•
•
More than 4,000 other
chemicals in cigarette
smoke,1 more than 50 of
which are known to
cause cancer2
It is the mixture of toxins
in cigarette smoke that
is responsible for the
majority of the harmful
effects, not nicotine1
3
http://smokeaway.files.wordpress.com
1.
2.
www.treatobacco.net./English/keyfindings/key_finding_1.html Last accessed on 15.02.08
Hoffmann D & Hoffmann I. J Toxicol Environ Health 1997; 50(4):307-364.
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Tar
•70% of the tar in smoke is
deposited in the lungs.
•Many of the chemicals are
known to cause cancers
•Damages lungs & cilia
•Stains fingers, teeth & hair
•? Low tar vs High tar
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Carbon Monoxide
Carbon monoxide is a clear odourless, poisonous gas that dissolves
in the blood quicker than oxygen. It attached to the red blood cells
reducing oxygen in the blood by up to 13%.
The body compensates by making more red cells, making the blood
thicker and stickier so the heart
Has to work harder resulting in an increased risk of
Developing coronary heart disease.
Carbon monoxide is harmful during
Pregnancy as it reduces
the amount of oxygen
carried to the baby in the womb
Carbon monoxide levels can be
measured using
a CO monitor.
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MECHANISM OF ACTION OF NICOTINE
IN THE BRAIN
Nucleus
Accumbens
(nAcc)
•
•
•
Nicotine binds to 42 nicotinic
acetylcholine receptor
stimulating dopamine release1-3
This results in the satisfaction
associated with smoking1-3
A drop in nicotine levels leads
to craving and withdrawal1,4
Ventral
Tegmental
Area
(VTA)
NIC
2 2
4
2
4
α4β2
Nicotinic
Receptor
NIC
Nicotine
Dopamine
1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. Coe JW et al. J Med Chem 2005; 48: 3474-3477. 4.
West R, Shiffman S. Smoking
cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004.
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Anatomy & Physiology of Smoking
• Receptors in mid brain release dopamine
when activated by smoking
• Smoking increases the number of
receptors by 300%
• Takes 7-10 seconds for inhalation to reach
brain
• Down regulation takes 8-12 weeks
• 80% relapse potential after 1 cigarette –
greater than with other addiction
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THE PHARMACOLOGICAL AND BEHAVIOURAL
COMPONENTS OF SMOKING DEPENDENCE
Pharmacological
•
Nicotine in tobacco smoke is highly
addictive1,2
•
Nicotine stimulates dopamine release in
the brain, resulting in short-term
feelings of reward/satisfaction1,3
Behavioural
•
Smoking-associated environmental
stimuli play a role in reinforcing nicotine
dependence4
1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. West R, Shiffman S. Smoking cessation. Fast Facts.
Indispensable guides to
clinical practice. Health Press, Oxford, 2004. 4. Caggiula AR et al. Physiol Behavior 2002; 77:683–687.
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WHAT ARE THE
HARMFUL EFFECTS OF
SMOKING?
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Long term effects
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Effects of Smoking in Pregnancy
– Miscarriage
– Stillbirth
– Premature membrane rupture
– Placenta praevia & abruption
– IUGR (Fetal growth retardation)
– Pre-term birth mature babies
– SIDS
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Secondhand tobacco smoke
PRESENTATION HEADER/TITLE
Effects on Children
•
•
•
•
•
•
•
•
Respiratory tract infections
Ear infections
Asthma
SIDS
Low birth weight
Meningitis
Behaviour problems
Risks in Adulthood
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DO PEOPLE WANT TO
QUIT SMOKING?
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QUITTING SMOKING
•
The majority of smokers want to quit (67%)1
• Most people try to quit without any assistance2
• Smokers are up to 4 times more likely to quit with
help from a trained advisor
•75% smokers have tried to quit at some point in the
past*
1 Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14.
2. Jarvis MJ. BMJ 2004; 328:277-279.
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Quitting Smoking is difficult
•The majority of smokers want to quit1
•Most people try to quit without any assistance2
•Only 3-5% of unaided quitters remain smoke-free
after 6 to 12 months3
•Most smokers make five to seven attempts before
they finally succeed3
•98% of smokers who relapse following a quit
attempt are willing to try quitting again4
1. Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279. 3. Hughes JR et al. Addiction
2004; 99:29-38.
4. Joseph A et al. Nicotine Tob Res 2004; 6:1075-1077.
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What % of smokers today think they will
have stopped by next year?
50%
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What % will
have done so?
2%
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NICE GUIDELINES
Every smoker should be
advised to quit,
opportunistically, at least
annually.
(unless in exceptional circumstances)[1]
NICE 2006
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What % make a quit
attempt
when offered treatment?
50%
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WHY USE A STOP
SMOKING SERVICE?
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Smokers are
4 times
more likely
to quit with pharmacotherapy and behavioural
support
Ref Bobak A 2007
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How can we increase the numbers of
smokers using the service?
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How can you help?
•
Make raising the issue of
smoking a priority
•
Use brief intervention
techniques
•
Promote the benefit of
using the service
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What is a stop smoking
brief intervention?
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“What would
What Circumstances
is a brief intervention? need to
Explain that
change, e.g.
there
is help
pregnancy
Using
opportunities
to discuss
available
change for
patient’s
smoking
you to stop?”
a
Recognising when the smoker may be close to
4 times as
wanting to change his/her behaviour
likely to
succeed with
Smoker may
Exploring a patient’s attitude to his/her smoking
help
be ready to
quit
Discussing FREE support that is available
“Do you
smoke?”
and making a referral to stop smoking service
Ask open
questions Part of
normal
When a suitable
conversation
opportunity
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presents
“What do
you enjoy
Feelings about
about
smoking
smoking?”
change over
time
Brief Intervention is:
A
3 step
30 second
systems based
approach
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The AAA Approach
1. ASK
2. ADVISE
3. ACT
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ASK regularly and be
approachable
ADVISE smoker of health
benefits of stopping.
Link advice to any
colleagues specific
conditions
ACT on colleagues
response and refer to
stop smoking service for
support
ASK regularly and record smoking status
Use your own words, what feels appropriate for you
Examples of what you might ask:
• “Do you smoke?”
• “Can I ask if you smoke?”
• “Have you ever thought about stopping smoking?”
• “Would you like to stop smoking?”
• “Have you ever tried to stop smoking?”
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ADVISE smokers of health benefits of stopping
As a health professional
it is my duty to advise
you to stop smoking.
Stopping smoking is the
best thing you can do to
improve your current
and future health
Stopping smoking
is the best thing
you can do for your
health
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Examples of what
you might say
You probably
already know the
risks involved with
smoking but I
cannot stress
enough how
important it is to
stop. It is the best
way to improve your
health
ACT on patient’s response and refer
You may choose to ask the patient if you can refer them
e.g. “Lots of patients succeed with support from the FREE stop smoking
service and stop smoking medication. Can I refer you?”
or
You may decide to refer unless they opt out
e.g. “It is our policy to refer you to the stop smoking service. I can
arrange that for you now”
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ACT on patient’s response and refer
The NHS provides free and
effective treatment for
smokers like yourself. In
fact you are up to four times
more likely to quit using this
help than quitting by
yourself. Are you interested
in finding out more about
this service?
www.hertsdirect.org
Examples of what
you might say
If you would like to
give up smoking I
can help you
Providing a Brief Intervention
• It is quick (takes less than 30 seconds)
• You are offering treatment to a patient with a serious addictive
•
•
•
condition which is dangerous to their health
Most smokers want to quit
Half the smokers offered treatment make an attempt to quit
Treatment via the stop smoking service is four times more effective
than trying to quit alone
Half the smokers offered treatment make an attempt to
quit
• If the smoker does not want to quit, leave the door
open (e.g. “I respect your decision. Perhaps we could
talk about it again another time”)
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What does the stop
smoking service offer?
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What does the stop smoking service offer?
Pharmacotherapy (on prescription)
• Nicotine Replacement Therapy (NRT)
• Zyban & Champix
Carbon Monoxide
Monitoring
Psychological Support
At least 5 weekly meetings
with trained advisor
The service is free
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What to expect from the stop smoking service
•
•
•
A minimum of 5 appointments
Initial appointment of 30 minutes:
– Understand how and why the patient smokes
– Agree the most appropriate pharmocotherapy
– Measure level of carbon monoxide in the body
Further appointments of 15 minutes:
– Review progress and carbon monoxide levels
– Address difficulties and obstacles
Celebrate success!
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How to refer
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How to refer
Fax referral form to 01442 453070
Phone Hertfordshire Stop Smoking Service 0800 389 3
998
•
Free resources (e.g. stop smoking leaflets in a
variety of languages, posters) can be obtained from:
• www.healthpromotioninherts.nhs.uk
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NATIONAL CAMPAIGNS
• Non Smoking Day
• Stoptober
Great opportunityNetworking with Pharamacies, HSSS
Get in contact with your locality specialist.
Information from Media is not linked together
with Herts Stop Smoking Service.
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Further information is available from:
Stevenage/Welhat Specialist:
janka.szocs@hertfordshire.gov.uk
07789505207
Helen.cleary@hertfordshire.gov.uk
Workplace Intervention Lead
Hertfordshire Stop Smoking Service
0800 389 3 998
www.smokefreehertfordshire.nhs.uk
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Stopping smoking works
Giving brief advice can only take 30 seconds,
but can save a smoker’s life.
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ANY QUESTIONS?
THANK YOU!
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