confidence importance ladder_maudsley_model_nrt for young smokers 2011
DESCRIPTION
TRANSCRIPT
nicotine replacement therapy for young smokers
+
a toolkit for practitioners ++
a practical guide for smoking cessation & young people compliant with the national minimum data set
smokingcessation toolkit for young people
Contents
2. Contents4. ACknowledgements5. BACkgRoUnd
5. WhyisanNRTBasedCessationToolkit NeededforYoungPeople?
6. OverviewofYouthCessation
7. LessonsfromthePilotProgrammein Scotland8. AmodelFoRYoUtHCessAtIon
8. MaudsleyandYoungPeople
9. AboutthisToolkit
10. TheReferralProcess
12. RecruitingYoungPeopleintoyour CessationService13. CessAtIonsUPPoRtFoRYoUngPeoPle
13. CessationSupport
13. DesirableSkills
13. RunningaGroup15. PRogRAmme
15. SomePointstoConsider
16. YoungPeopleandtheirTobaccoUse
16. Cannabis
17. YoungPeopleandCannabis
17. QuittingCannabis18. AlteRnAtIVestogRoUPsUPPoRt
18. OnetoOneSupport
18. TextMessageSupport
19. PharmacyServices
20.nICotIneRePlACementtHeRAPY(nRt)
21. GoodPractice
22. NRTProducts23. nAtIonAlmonItoRIng
23. MinimumDataSet
23. Paperwork
23. OtherOutcomes
24. CarbonMonoxideMonitoring25. 7weekPRogRAmme
25. GuidanceNotes
25. Week1–Introduction&PreparationWeek
28. Week2–Information&Preparation
30.Week3–QuitWeek!!
31. Week4to6–GroupSupport
32. Week7–PreventingRelapse &LookingAhead
33. BeyondWeek7…34.APPendICes
34.Appendix1:ClientQuestionnaire
35. Appendix2:ClientConsentForm
36. Appendix3:ClientRecordCard
37. Appendix4a:EndOfGroupClassification
38. Appendix4b:ClassificationGuidanceNotes
39. Appendix5:YouthReferralPathway
40.Appendix6:TextMessageSupport
41. Appendix7a:BriefInterventions
42.Appendix7b:BriefInterventionFlowchart
43.Appendix7c:BriefInterventions GuidanceNotes
44.Appendix8:MarketingMaterials
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45.HAndoUts
45.Handout1: NicotineDependence Questionnaire1
46.Handout2: NicotineDependence Questionnaire2
47. Handout3:ReferralForm
48.Handout4:NRTContract
49.Handout5:WeeklyChecklist
50.Handout6:OnetoOne
51. Handout7:NRTAdviceSheet
54.Handout8:StagesofChange
55. Handout9:StagesofChange
56. Handout10:ReflectiveStaircase
57. Handout11:CarbonMonoxideStaircase
58. Handout12:QuittingDiary
59. Handout13:GroupAgreement
60.Handout14a: Importance/Confidence Ladder(GuidanceNotes)
61. Handout14b:ConfidenceLadder
62. Handout15:TheFourWhysExercise
63. Handout16:AmIReadytoStopSmoking?
64.Handout17:FeelingsAboutQuitDay
65. Handout18:MyStopSmokingDiary
66.Handout19:‘MyActionPlan’
67. Handout20:Coping
68. Handout21:Coping
69. Handout22:DiscussionaboutCoping
70.Handout23:Quitting
71. Handout24:QuitChart
72. Handout25:Withdrawal
73. Handout26: Discussion-Nicotine Dependence
74. Handout27:Maintenance
75. Handout28:Relapse
76. Handout29:WhatabouttheFuture?
77. Handout30:PeopleBingo
78. Handout31:TruthorLieGame
79. Handout32:SmokingWordsearch
80.Handout33:CSI–Glasgow
81. Handout34:FactorMyth?82. UseFUlResoURCes83. toolkItReFeRenCes
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Acknowledgements
ThistoolkitwasdevelopedbyGlasgowCommunityHealthPartnership(CHP)NorthwestSector,onbehalfofNHSGreaterGlasgow&Clyde(NHSGG&C)YouthTobaccoActionGroup.
FundingforthisprojectwassecuredfromtheTobaccoPreventionFundadministeredlocallybyNHSGG&CSmokefreeServices.
Wewouldliketoexpressourthankstothemanywhocontributedtothisproject,especiallythefollowing:
• EastRenfrewshireCommunityHealthCare Partnership(CHCP,)HazelAnnMcWhirter andtheyoungpeopleinvolvedinClarkston SmokingInitiative
• NHSGG&CYouthTobaccoAction Groupmembers
• UrbanFoxProjectandNortheast GlasgowSectorwww.urban-fox.org
• NHSGG&CSmokefreeServices
• ScottishTobaccoControlAlliance(STCA)Youth andTobaccoForummembers
• PupilsfromSpringburnAcademy andJohnPaulAcademy
• YouthHealthServiceinMaryhill www.yhs-ng.co.uk
• NicolaMathieson,SarahDuncan, SarahNeilsonandGeriLucasfor theirsubstantialinput
ContactRobbie Preece Health Improvement Senior - Tobacco
Carol Beckwith Health Improvement Practitioner - Tobacco
Glasgow CHP Northwest Sector Gartnavel Royal Hospital Modular Building 1055 Great Western Road Glasgow, G12 0XH
Tel:0141 232 2110
Email:[email protected]:[email protected]
CopiesofthisToolkitwillbeavailableonSmokefreeServiceswebsite:www.nhsggcsmokefree.org.uk
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Background
wHYIsAnnRtBAsedCessAtIontoolkItneededFoRYoUngPeoPle?DespiteasignificantreductioninoverallsmokingratesinScotlandinrecentyears,smokingremainsthesinglebiggestcauseofpreventableprematuredeath.ThishasacostimplicationtotheScottisheconomyof£837millioneachyear1andinexcessof£409millioneachyeartotheNHSinScotland.2
Mostrecentstatisticsinclude:
• Between1996and2008thenumberof15year oldssmokinginScotlandfellfrom30%to15%
• ThemajorityofScottish15yearoldshavesaid thattheyhaveneversmokedacigarette3
• Moregirlsthanboyssmoke–16%of15year oldgirlscomparedto14%of15yearoldboys areregularsmokers
• Scotlandcomparesfavourablytoother Europeancountriesforsmokingprevalence inboysbutlessfavourablyforprevalence in15yearoldgirlsAlthoughoverallsmokingratesin13to15yearoldsshowsageneraldownwardtrend,thisisnotreflectedinthe16to24agegroupwheretheoveralltrendislessclear.ItisstillestimatedthatinScotland,approximately15,000youngpeoplebetweentheagesof13and24,takeupsmokingeachyear.4
YouNG PeoPle Need To quIT
Thevastmajorityofsmokerstakeupthehabitasteenagersandmanyyoungpeoplewhosmokewillcontinuetosmokefortherestoftheirlives.Studieshavesuggestedthatchildrenwhosmokearemorelikelytoreportpooracademicperformance,bemorepessimisticaboutthefuture,dislikeschoolandhaveanunhealthydiet.Smokinghasalsobeenassociatedwiththeuseofalcoholandillegaldrugs.5
Theearlierpeoplestart,themorelikelytheyaretosmokelongerandtodieearlyasaresultofsmoking.Achildwhostartssmokingat14oryoungeris4timesmorelikelytodieoflungcancerthansomeonewhostartstosmokeatage25oroverand15timesmorelikelytodieasaresultoflungcancerthansomeonewhoneversmokes.Itisalsoknownthat82%ofadultsmokersstartsmokingintheirteens.6
Youngpeopleareoneofthe3prioritygroupsforsmokingcessationserviceshighlightedbytheScottishExecutive7,withspecifictargetssetforreducingprevalenceamongyoungpeople.Theseareto:
• Reducethelevelofsmokingamongst13year oldgirlsfrom5%in2006to3%in2014
• Reducethelevelofsmokingamongst13year oldboysfrom3%in2006to2%in2014
• Reducethelevelofsmokingamongst15year oldgirlsfrom18%in2006to14%in2014
• Reducethelevelofsmokingamongst15year oldboysfrom12%in2006to9%in2014TheScottishGovernmentaimstoreducethelevelofsmokingamongst16to24yearoldsfrom26.5%in2006to22.9%in2014.
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YouNG PeoPle WaNT To quIT
TheScottishSchoolsAdolescentLifestyleandSubstanceUseSurvey(SALSUS)surveyof23,000Scottish13and15yearoldsfoundthat70%oftheregularsmokershadalreadytriedbutfailedtogiveup.8Bytheirlateteens,mostregularsmokersdonotseethemselvesasaddictedtonicotine,withmanybelievingtheyarestillincontrolandcouldstopiftheywantedto.
Surveyssuggestthatthemajorityof11to16yearoldswhoareregularsmokerswanttogiveupandarewillingtoseekhelptodoso.
Surveysalsoshowthatwhilstrecognisingthehealthhazards,someyoungpeoplesmokeasameansofcopingwithanxiety,controllingweightorcreatingapositiveself-imageandidentity.9Themainperceivedpositiveeffectofsmokingforyoungpeopleisthatit‘helpspeoplerelaxiftheyfeelnervous’.10
YouNG PeoPle CaN quIT
Smokingcessationservicesareaimedprimarilyatadults,anditisunlikelythattheseserviceswillbesuitableforyoungsmokers.Althoughtheevidenceforeffectivesmokingcessationinterventionsforyoungpeopleislimited,thereislittleexperienceintheUKofsettingupandrunningsuchinterventions,11evidencefromsurveysindicatethatamajorityof11to16yearoldswhoareregularsmokerswanttogiveupandarewillingtoseekhelptodoso.
…Idowanttostopsmoking,butit’sreallyhard…”Secondaryschoolpupil,15,Glasgow
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oVeRVIewoFYoUtHCessAtIonItisclearfromcurrentresearchthatthereisnosinglereasonthatexplainswhyyoungpeopletakeupsmoking.Thisisillustratedinthe2006reportTowardsaFutureWithoutTobacco,12wherefactorsthatinfluenceyouthsmokingaredescribed.Asyoungpeopleareoneofthe3prioritygroupsforsmokingcessationserviceshighlightedbytheScottishExecutive13andinlinewiththecurrentrecommendationstotheScottishGovernmentfromActiononSmokingandHealthScotland,14(ASHScotland)itisnecessaryto“createasupportiveenvironmentforsmokerswhowanttoquit”.
Despitethefactthatthecurrentevidencefortheeffectivenessofcessationworkwithyoungpeopleisweak,publichealthguidancefromNationalInstituteofHealthandClinicalExcellence15(NICE)recommendsthat:
…nRtshouldbeusedwithyoungpeopleaged12to17attheirrequestandwherethereisevidenceofnicotinedependence.”NationalInstituteofHealthandClinicalExcellence
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NICEhavealsorecommendedthattheuseofNicotineReplacementTherapy(NRT)inthisagegroupshouldbepartofasupervisedregimewithavailableintensivesupportinordertoencourageadherence.16
AtrialintheU.S.showedthatwhen13to17yearoldsusedeithertheNRTpatchorgum,itwaseffectiveindecreasingthenumberofcigarettessmoked.17
Whilstyouthsmokinghasbeenidentifiedasapriority,itisclearthattherearestillanumberofgapsinprovisionintheNHSGG&CHealthBoardarea.AfteranextensivemappingexerciseitisclearthatcessationprovisionforyoungpeopleintheNHSGG&CHealthBoardareaisstillinitsinfancy.
lessonsFRomtHePIlotPRogRAmmeInsCotlAndTheYoungPeopleandSmokingCessationPilotProgrammeinScotlandhighlightedkeypointsforconsiderationfordesigninganddeliveringNRTbasedyouthcessationservices.18
InApril2002NHSHealthScotlandandASHScotlandfundedamajorprogrammeofeightpilotcessationprojects,whichaimedtoengagewithyoungpeoplewhowantedtoquitsmokingandtoidentifyacceptableandpotentiallyeffectiveapproachestohelpthemquit.Settingsincludedayouthoffenderinstitution;formalandinformalyouthvenues;ahospitalmaternityservice;college,schoolandcommunityvenuesandtheWorldWideWeb.Themainaimsofthepilotprogrammewere:
• Toidentifyacceptableandpotentially effectiveapproachestohelpyoung smokerstoquit
• Toenhancetheknowledge,skillsand confidenceofyoungpeopletosupport futureattemptstoquitsmoking19
leaRNING PoINTS:
TheoutcomesoftheScottishpilotssuggestthatforayouthcessationservicetobeaseffectiveaspossibleitshouldbe:
• Person-centred
• Flexible,butsetwithintheparametersand resourcesoftheservice
• Engagingavailableexpertiseinyouthwork andtobacco
• Developandestablishstrongandeffective referralsystems
• Raisetheprofileoftobaccoharm
• Bemindfulofthemanycompeting commitmentsandinterestsofyoungpeople
• Beawarethatsomeyoungpeoplemayuse cannabisinconjunctionwithtobacco
• Seektoincreaseyoungpeoples’motivation forstoppingsmoking
• Addressstafftrainingneeds
• Maintainqualityandconsistencyofsupportas muchaspossible
• Ensureaconfidentialservicethatrespectsthe rightsofyoungpeople
• Makesurethatthelocationandaccesstothe serviceisaspracticalaspossible
• Makesurethattheminimumdatasetis recordedaswellasrecordinganyother indicatorsoroutcomesthathavebeenagreed
• Beawareoftheproblemsofworkingwithin settimescales,especiallyinschoolsettings, whenworkingwithyoungpeople
• Understandthecomplexityofaddiction, dependenceandmotivation
• Beawarethatforyoungpeople,motivation maynotbeconsistentandmaychangefrom weektoweek
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A model for Youth Cessation
mAUdsleYAndYoUngPeoPle
NHSGG&Cusea7weekwithdrawalorientatedgroupapproachdevelopedattheMaudsleyHospitalinLondon,andreferredtointhisdocumentastheMaudsleymodel
Aspreviouslymentioned,itisarequirementthatanycessationworkmustbedeliveredbycessationtrainedadvisors,andthisisthecaseforcessationworkwithbothadultsandyoungpeople.
TheScottishPilotProgrammeshighlighteddifficultiesinusingarigidmodelwhenworkingwithyoungpeople20howeverasMaudsleyreliesonaclosedgroupstructureitthereforefitswellwithmanyyouthsettings.
Groupworkwithyoungpeoplewillpresentdifferentissuestothoseencounteredwhenworkingwithadults.Examplesofissuesmightincludefriendshipgroups,gender,numbersandtimeconstraints.
Aflexibleapproachisnecessarywhendeliveringcessationsupporttoyoungpeopleduetothechangingnatureoftheirsmokingpatterns.TheMaudsleymodel,usedbytheadultcessationservice,doesnotalwaysallowforflexibilityandthiswashighlightedintheScottishPilotProgrammes.
Itisimportantthataservicemodelisdevelopedforyouthcessationwhichisinformedbybestpracticefromtheadultcessationservice,theScottishPilotProgrammesandfromresearchfindings.
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9NicotineReplacement:ASevenWeekProgramme
ABoUttHIstoolkItaIM of THIS ToolkIT
This toolkit is designed to support local smoking cessation services to create capacity to offer cessation support to young people.
The toolkit is specifically designed to support compliance with the National Minimum data Set (MdS) which Scotland’s Health Boards use to monitor cessation services jointly with the Information Services division.WHo IS THIS ToolkIT foR?
ThistoolkitenablesanyNHSGG&Ctrainedsmokingcessationadvisortodeliveraninterventionthatsupportsayoungperson’squitattempt.
ItisrecommendedbestpracticethatcessationadvisorscompleteNHSGG&C’sYoungPeopleandTobaccotrainingandhaveadegreeofyouthworkskillsinordertodeliverappropriatecessationinputstoyoungpeople.
INTeNSIve SuPPoRT GuIdaNCe
ThistoolkitwillprovideguidancefortrainedcessationadvisorswhowanttoprovideNRTbasedsupporttoayoungpersonwhetherthatisaspartofastopsmokinggrouporonaonetoonebasis.Thetoolkitcanbeusedtoprovidestructureanddirectiontodevelopflexibleprogrammesfordeliveryinyourarea.
Recentfindingsindicatethatakeyfactorindeterminingthesuccessofasmokingcessationprogrammeforyoungpeopleisthedegreetowhichtheprogrammeengagesthemwithemphasisonhowtheprogrammeisdeliveredaswellasonthecontent.21
TheguidanceprotocoloutlinedinthisdocumenthasbeeninformedbybestpracticefromtheadultcessationserviceandthelessonsandfindingsfromresearchandtheScottishPilotProgramme.22ItisbasedlooselyontheMaudsley7weekapproachandusesthisasatemplateforstructuringyouthcessationsupport.
for any other staff who are not cessation trained that would like to be able to offer brief advice, the toolkit provides information on how to raise the issue of smoking and carry out BriefInterventions (see appendix 7a to 7c for further information). The current training that is available is Raising the Issue of Smoking and this is available for anyone who wants to learn more about Brief Interventions. Information about this is available from:
SmokefreeServiceson01412014876oremail:[email protected]
FurthercessationtrainingforyouthworkerswillbeavailableinthenearfutureandinformationwillshortlybeavailableonASHScotland’swebsiteat:www.ashscotland.org.uk/training/
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tHeReFeRRAlPRoCessItisimportantthatpartnerorganisationshaveaclearunderstandingofhowtomakeappropriatereferralstoyouthcessationservices.TherelevantinformationthatwillbeusefulforthereferralprocesscanbefoundinboththeYouthReferralPathway(Appendix5)andtheBriefInterventionsguidance(Appendix7ato7c).
theYouthCessationReferralPathway(Appendix5)hasbeendesignedtogiveguidancetothosewishingtosupportyoungpeoplewhoexpressadesiretostopsmoking.FollowingthepathwayshouldresultinmorecontinuityandconsistencyofserviceacrossNHSGG&C.
Youth Referral Pathway
Contactthenamedyouthcessationreferralcontactwithinpostcodearea(e.g.FillinlocalyouthcessationReferralFormorcalldirect)orCallsmokelineon0800848484.
Alternativelyadvertisewebaddress(w-west,smokefreeservices)andphonenumber(Youngscot).
Yes
1.Identifiesthemselvesasasmoker
2.Adviseswantstostopsmoking
3.Assessifyoungpersonismotivatedtostopsmoking
YoUngPeRson‘UndeR18’
Isyoungpersonmotivatedtostopsmoking? no
Advisesupportavailableif/
whenreadytostop.
•AdvisortocontactYPtoarrangemeeting
•Advisortoconfirmmeetingondayorday beforescheduledmeeting
•Advisorassessesyoungperson’snicotine dependenceandmotivationtoquit
•Arrangesfurthersessionsifappropriate
•namedcontactrefersyoungpersontolocallytrained facilitatorbasedwithinyouthhealthserviceor voluntaryserviceinYoungPerson(YP)area.
•FacilitatorcontactsYPandarrangesmeeting.
•Facilitatortoconfirmmeetingondayordaybefore scheduledmeeting.
•Facilitatorassessesnicotinedependenceand motivationtoquit.
•Arrangesfurthersessionsifappropriate.
•Paperworktobecompletedateachcontact.
•Completedpaperworktobesenttosmokefreeservices
optionsforCH(C)P
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11NicotineReplacement:ASevenWeekProgramme
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RefeRRalS – SoMe PoINT To CoNSIdeR
If a young person attends a group because they are motivated to stop smoking, the likelihood of a positive outcome is much greater. It is important that young people choose to attend a smoking cessation group because they want to make a quit attempt.
a YouNG PeRSoN NeedS To Be WIllING To CoMMIT To a GRouP:
as well as feeling motivated to quit, it is vital that young people are prepared to make an effort to attend cessation support sessions in order to make a quit attempt. If a young person is caught smoking in school and directed towards a cessation group, they may not actually be willing to make a quit attempt but simply attends the group to avoid receiving a punishment exercise. finding a way for the young person to demonstrate their commitment to attending a group might be to use an informal contract or agreement provided that they have not been pressurised to participate.
Young people who are referred to a youth cessation service must demonstrate a dependence on nicotine and also a motivation to quit.
Youngpeopleofcoursecanselfrefertolocalservices.Aswithadultservicesselfreferralsfrequentlyrepresentthemosthighlymotivatedquittersandthereforeselfreferralshouldbeencouragedwhereverpossible.Marketingstrategiesshouldreflecttheneedtopromoteselfreferral.
Anamedyouthcessationcontactshouldbenegotiatedinlocalareaswhowillbeabletosignpostyoungpeopletoanappropriateservice.TheyouthcessationmarketingmaterialsBUttoUtshouldbeavailableinyourareaandtheyareincludedinappendix 8forreference.
In Handout 3 there is an example of a Client Referral form that you may want to give to those who are referring into your service.
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ReCRUItIngYoUngPeoPleIntoYoURCessAtIonseRVICeAcommonproblemreportedduringtheScottishPilotProgrammeswasthattherewasdifficultyinenlistingyoungpeopleintocessationprogrammes.In order to raise the profile of Youth Cessation support available in your area, here are some suggestions for marketing and promotion:
• Outreach–visitsmokerscornerinschools
• Leaflets–distributeviaclassregistrationin school,youthorganisations,youthhealth services,sportsclubs,after-schoolclubs
• School–Personal&SocialEducationLessons, classregistration,schoolinfo-pointscreens, schoolhealthstaff
• Texting
• Noticeboardsinschools,communitycentres, leisurecentres,youthprojects
• Posters
• Newsletters
• Referralboxordrop-box
• Trainteachingstaffinbriefintervention
• Preventionandeducationinputsinschools andyouthprojects
• Socialnetworking
• MakelinkswithotherHealthImprovement programmes
BUttoUtmaterialsareavailablefromyourlocalSmokefreeServicesco-ordinator(SeeAppendix8).
TRaINING
Thosewhoarereferringintoyourservicemaybenefitfromreceivingtrainingintobaccoandrelatedissues.Improvingtheirknowledgeandconfidencetoundertakebriefinterventionsshouldhaveapositiveimpactonbuildingcapacity.
ThereareanumberoftrainingopportunitiescurrentlyavailablefromNHSGG&CSmokefreeServices.
Theseinclude:
• Raising the Issue of Smoking
• Young People and Tobacco
• Cannabis Training ForfurtherinformationabouttrainingopportunitiescontactSmokeFreeServiceson0141 201 4876oremail:[email protected]
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Cessation Support for Young PeopleCessAtIonsUPPoRt
Cessationsupportcanbedeliveredinagroupsettingoronaonetoonebasis,regardlessofwhethertheserviceisforadultsoryoungpeople.Groupsupporthasbeenevidencedtobe4timesmoreeffectiveinhelpingpeopletostopsmoking.
This section provides guidance for practitioners about the practicalities of organising and running a youth cessation group and one to one sessions.
desIRABleskIllsDesirableskillsofayouthcessationadvisor:
• Goodcommunicationskills
• Goodgroupworkskills
• Knowledgeoftherightsofyoungpeoples especiallyinrelationtotheirrightto confidentiality
• Youthworkskills
• Knowledgeofthecycleofchangeandits applicationinyouth/tobaccosettings
• Awarenessofthereasonswhyyoungpeople smoke
• Havinganholisticapproachtoyoungpeople makingaquitattempt(awarenessofother linkedbehaviourse.g.alcohol,drugs, relationshipsetc)
• HavinggoodknowledgeofcurrentChild Protectionpolicy
RUnnIngAgRoUPThings to think about when setting up a cessation group for young people:veNue
Commonsettingsthatyoungpeopleattendare:
• School,youthclubs,residentialplacements, accommodatedcare,college,universityand workplace.
Whateverthevenueyouwillneed:
• Accesstoaprivatespacewithadequateroom fortheplannedactivitiesandfortheOneto Onesessions
• Gettheenvironmentright–forexample,ifthe groupisinaschool,willitbebetterwithor withoutateacherpresent?Theenvironment shouldberelaxedenoughthattheyoung peoplefeeltheycanopenlydiscussconcernsSTaffING
• Youshouldalwaystrytoensurethatanystaff inthesettingarebothsupportivetowardsthe youngpeoplewhoaremotivatedtomakea quitattemptandthattheyfullyrespecta youngperson’srighttoconfidentiality
• Thesuccessofagroupisheavilyinfluenced bywhethertheyoungpersontruststhose whoareprovidingtheservice
• Youshouldhaveadequatestaffingforthe group–aminimumof2staffisrecommended asgivingonetoonesupportandtaking CarbonMonoxide(CO)readingscanbetime consuming
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14NicotineReplacement:ASevenWeekProgramme
GRouP SIze/MakeuP
• Considerwhattheidealnumberisforthe groupandwhetheryoushoulddecideona minimumnumberbeforestartingagroup. Agroupsizeofbetween8and14youngpeople isrecommendedwith10beingtheoptimum. Ifthegroupistoobigitwillbeunmanageable andthiscouldmakeitdifficultforthegroup toworkeffectively
• Thereareadvantagesanddisadvantagesof havingamixedgroup(ageorgender). Staffwhoareworkingwithyourgroupof youngpeoplemaybeabletoadviseonthis
• Thereareadvantagesanddisadvantagesof havinggroupsofclosefriendsasthiscanhelp createasupportiveenvironmentforsomebut canalsohavepotentialforcausingothersto feelleftout
• Forayoungpersonnotinapeergroup, heorshemaybeisolated,lacksupportand faceopposition
• Youngpeoplemaydropinandoutofafixed group.Thismaypresentdifficultieswiththe consistencyofthegroup
• Havinggroupsof‘strangers’canbeproblematic whentransferredtogroupsofyoungpeople andtheymaybemoretalkativeiftheyknow someoneelseinthegroup.
GRouP dYNaMICS
Gooddynamicsinagroupcanfostergoodteamwork,positiveconflictresolution,peersupportaswellasavoidingfewercliquesorsolitaryindividuals.Thingsthatinfluencegroupdynamicsareindividualneeds,personalitydifferences,ageandgenderdifferencesaswellasgroupresilience(howthecombinedstrengthsofthegroupcompensateforthelimitationsofindividuals).
Practitionerswhohavegoodyouthworkingskillswillbefamiliarwiththechallengesofyouthgroupdynamics.Howeverifapractitionerlacksexperienceinworkingwithyoungpeople,workingwithothermoreexperiencedpartnersmaybehelpful.
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somePoIntstoConsIdeRThistoolkitprovidesanoutlineofa7weekprogrammeandincludeshandoutsaswellaspaperworkfortheMDS.
• Youwillneedtofindastructurethatworksfor thegroupwhileatthesametimekeepingit flexibleinaccordancewiththebroaderneeds oftheindividualsinvolved
• Runningarigid7weekprogrammemaybe unworkableduetothenatureofayoung person’sprogressthroughthestagesof change
• Youmayneedtoconsiderwhethertoinclude morethantwopreparationweeksdepending onhowreadytheyoungpersonistoquit. Itwillbeadvantageousforyouifthose referringintoyourservicehavedonesome preparatoryworkintheformofawareness raisingandbriefintervention.Youmaystillneed tospendsometimeworkingthroughsomeof theinitialstagesofchangewithayoungperson duetothechangingnatureofayoungperson’s readinesstochange
• Inthefirstsession,establishgroundrules aboutwhatisacceptablebehaviourand ensurethatthegroupareinagreement withthese
• Planhowyoucanensurethatthepaperwork iscompletedandtheminimumdataset collected. This must be a priority
• MakesureyouallowtimeforOneto Onesessions
• Bemindfuloftimeconstraintswhenworking insomevenues(e.g.schools)
• Rememberthatsomepeoplerespondbetter toindividualsupportandmayfinditdifficult toparticipateinagroup
• Bearinmindthatyoungpeopleoften demonstratelimitedunderstandingofthe effortrequiredfromthemwhenmakingan NRTsupportedquitattempt
• Youngpeoplemaydisclosepersonal informationtoyouduringaonetoone– bepreparedforthisandrefertotheNHS ChildProtectionPolicyifnecessary
• Addresstheyoungperson’sunderstanding ofsmokingandmotivationtoquit
• Haveagoodunderstandingoftherole ofsmokinginayoungpersons’life
• Makesureyoucanrecommendcoping strategiesthatarehelpfulandrelevantfor youngpeople
• Youmayneedtotakeintoaccountthat someoftheactivitiesinthistoolkitwill needpreparationtimeintheinitialstages
• Bearinmindthatayoungpersonmay needongoingsupportafterweekseven anditmightbeusefultobuildthisintoyour programme.Thissupportcanbeofferedbythe practitionerinanexistingyouthhealthservice, bythepharmacyservicethattheyoungperson hasengagedwith,textmessageorother media,oranyotherframeworksthatareinplace
Programme
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16NicotineReplacement:ASevenWeekProgramme
YoUngPeoPleAndtHeIRtoBACCoUseYouwillfindthatyoungpeople:
• Oftensmokefordifferentreasonsthan adultsdo
• Canbesignificantlyinfluencedbypeers
• Areextremelylikelytobeconcerned aboutconfidentialitywhenseeking stopsmokingadvice
• Mayengagedifferentlywiththetraditional cycleofchangemodelassmokingpatterns arelikelytobeerratic(theymaywanttostop onWeek1butbyWeek2theymayhave changedtheirmind).
• Mayfindthattheiruseofcannabisprevents themstoppingsmoking
• Maynotstopsmokingbutmaydemonstrate otherchangesinbehaviourorattitudes
• Mayhavelittleornoknowledgeofstop smokingservicesworkinginsomevenues (e.g.schools)
CAnnABIs‘THe CaNNaBIS effeCT’
CannabisisaClassBdrug(MisuseofDrugsAct,2009).Whenworkingwithyoungpeopleyoushouldexpecttobeaskedaboutcannabis.Cannabisisamildhallucinogeni.e.itcanalterthewaycoloursandshapesareseen.
Cannabisismostusuallyfoundas:
• Thedriedleavesand/orfloweringtops oftheplant.(knownasgrassorweed)
• Blocksofresin(hash,potorblow)
HoW IS IT uSed?
• Around75%ofcannabisisrolledand smokedwithtobacco
• Waterpipe/Bong
• Pipe
• Neatcannabis
• Eaten
• HotknivesMostpeoplewhosmokecannabissaythatthemostcommoneffectsare:
• Relaxationandtiredness
• The‘munchies’-feelinghungry
• Beingtalkative
• Thingssounding,lookingand tastingdifferently
• Somefeelthatitmakesthemtense andanxious
Cannabisisoftendescribedasthe‘elephantintheroom’whichcannolongerbeignored.”
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YoUngPeoPleAndCAnnABIs• Cannabisisthemostwidelyusedillegaldrug intheUK.Althoughpeopleofallagesuseit, itismostusedbythoseaged16to29
• Manyyoungpeopleusecannabisbecausetheir friendsareusingitsothattheyfeelpartofthe grouporbecausetheyfeelunderpressure
• Thosewhousecannabis,mostoftensmoke itwithtobacco
• Someyoungpeoplewouldliketostopsmoking tobaccobutdonotwanttostopusingcannabis
• Somewhousecannabiswithtobaccowould notnecessarilyseethemselvesasbeing asmoker
• Smokingcannabiswithtobaccoincreasesthe damagetothemouth,throatandlungs
• Cannabisusemayhaveanadverseimpact onmentalhealthPeoplemayexperiencesome,allornoneofthefollowingeffectsafterusingcannabis:• Moodswings
• Beingunabletofocusproperly
• Feelingdizzy
• Feelingdownordepressed
• Strugglingatworkorschool
• Lungproblems
• Feelinganxiousorworried
• Heartracing
• Seeingorhearingthings
• Feelingsuspicious
• Itmayaggravateexistingconditionslike asthma,bronchitisandemphysema
• Cuttingyourselfofffrompeople
• Fertilityproblems,i.e.lowerspermcountand troublegettingpregnant
NicotineReplacement:ASevenWeekProgramme17
Doctorsnowbelievethattheriskofdevelopingapsychoticillness,suchasschizophrenia,isincreasedthemorefrequentlythatcannabisisused.Thisriskismuchgreaterifayoungpersonstartssmokingcannabisbeforetheageof15.
QUIttIngCAnnABIsYoungpeoplearemostlikelytobesmokingcannabiswithtobaccoandthereforewillgothroughthesamewithdrawalsassomeonequittingtobaccoalone.TheymaybenefitfromusingNRTandmustbecommittedtoquittingsmokingtobaccoandcannabis.
• Adequatepreparationtoquitisvital
• Withdrawalfromcannabisandtobaccoisno worsethanfromtobaccoalone
• Lookatareaswheretheymightstruggle e.g.iftheyareusingittorelaxandde-stress, helpthemfindalternativecopingstrategies
• Establishwhytheywanttoquit
Formoreinformationoncannabisanditseffectsvisit:
www.talktofrank.com
www.lifeline.org.uk
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onetoonesUPPoRtSomeyoungpeoplemaywishtoreceiveonetoonecessationsupportratherthanattendacessationgroup.
OnetoonesupportshouldfollowtheoutlinegiveninHandout 6 “What to do in a one to one”,anditcanbetailoredtosuittheindividualconcerned.Additionally,someoftheactivitiesinthetoolkitcanbemodifiedforuseinaonetoonesituation.
Onetoonesupportcan:
• Helpwhereayoungpersondoesnotfunction wellinalargegroup
• Makeiteasiertodiscussbarrierstostopping smoking
• Provideabetterplatformforgivinginformation
• Allowyoutogivesupportwithnodistractions
• Makeitmorepossibletofollowastructured (7week)programme
• Allowthepractitionertogainadeeper understandingoftheissuesthatyoung peopleface
• Provideopportunitytooffermoreintense support
• Canbelesstimeintensive
• Maymeanthatlessplanningisrequired?
• BUTalsomeansthereislessopportunityfor peersupport
Onetoonesupportforayoungpersoncanbeverysimilartotheframeworkusedwhenrunninganadultonetooneservice.
Aswiththeadultservice,thesupportcanbemoretailoredtofittheneedsoftheyoungpersonastherearemanyfewerthingstodistract.Thisalsomeansthatayoungpersonmaydiscloseissuestoyouthatareunrelatedtosmokingbecausetheyfeelthattheyareinasafeenvironment.Thisbeingthecase,allpractitionersshouldbefamiliarwithcurrentChildProtectionPolicyandshouldapplythistotheirpractice.
textmessAgesUPPoRtTextinghasbeenusedsuccessfullyinsomeareasforsendingremindersaboutgroupsandalsoforsendingmotivationaltexts.Thisissomethingyoumightwanttoconsiderusingwhenyouaresupportingyoungpeopleinaquitattempt.
Youmustfirstobtainconsentforsendingtextmessagesandtheremaybesomeissuesaroundconfidentialitywhenusingtexting.Youcanoffertosendtextmessagesthatare‘safe’i.e.areunidentifiableifreadbyathirdpartyandexamplesoftextsthatcouldbesentare:
InformationononewayofsettingupatextingserviceisinAppendix6andaconsentsectionisincludedontheClientConsentForminAppendix2.
…youhavesetyourgoalsandyoucanreallydoit…seeyounextweekatgroup…”
“
…youaredoingreallywell…keepupthegoodwork…seeyouFridayatyouthgroup/inschool…”
“
Alternatives to Group Support
NicotineReplacement:ASevenWeekProgramme18
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19NicotineReplacement:ASevenWeekProgramme
Phone or visit the pharmacies that the young people will be collecting their NRT from and tell them that you are running a group, as some pharmacists may not be used to giving NRT to young people.
PHARmACYseRVICesYoucandirectayoungpersontoalocalpharmacywheretheywillbegiventhefullrangeofsupportcurrentlyofferedwithintheadultservice.
Good PRaCTICe
Tomakethejourneysmootherforayoungpersonyoumightwantto:
find out if there are ‘rules’ for collecting NRT as some may prefer that the NRT Request form is left and then collected at a later date.
on the first visit to the pharmacy, go with the young person to establish good relationships and to help the young person to become familiar with the pharmacy procedures
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ThereislittlegoodevidencetoshowthatNRTworkswithyoungpeoplealthoughtheuseofNRTwithbehaviouralsupporthasnotbeenextensivelytestedtodate.NeverthelessNRTcanbeprescribed,whenrequested,wherethereisevidenceofnicotineaddiction.
Nicotinereplacementtherapyisanextremelysafeproduct.NRTdeliversalowlevelofnicotinethroughasteadydosingsystemwithouttheother4000chemicalswhichenterthebodywhensmokingtobacco.SmokersusingNRTarenottakinganythingnewintotheirbodiessoshouldnothaveanyreactiontonicotine.
InScotland,NRTcanbeprescribedtoyoungpeopleaged12andabove.
ClINICal CRITeRIa foR CauTIoN:
• Pregnantorbreastfeedingwomenshouldbe referredtothepregnancyservicesforspecialist helpbyatrainedmidwife.(Formoreinformation callSmokefreeServiceson01412014654)
• 12-16yearolds–AlthoughNRTissuitablefor teenagers,itisrecommendedthatthisgroup shouldnotuseNRTunlesstheyhaveaccess toasupportnetworktoensurethatnicotine dependencyandmotivationtostophas beenassessed
• Clientswithmentalhealthproblemsandon medicationshouldbeadvisedtoinformtheir GPifusingNRT
TherearedifficultiesinmeasuringtheeffectivenessofNRTwithyoungpeople,largelyduetotheirpooradherencetotherapywhichthereforemeansthatlevelsofNRTareoftennotatatherapeuticlevel.YoushouldstilladvisetouseNRTwhererequestedinlinewithsmokingcessationNICEguidelines.
Althoughtherehavebeenfewstudies,atrialintheU.S.showedthatwhen13to17yearoldsusedeithertheNRTpatchorgum,itwaseffectiveindecreasingthenumberofcigarettessmoked.24
Nicotine Replacement Therapy (NRT)
NeitherBupropion(Zyban)norVarenicline(Champix)arelicensedforusebythoseundertheageof18.Ifayoungpersonaged18expressesapreferenceforeitherofthesetreatmentstheyshouldbeadvisedonthisinlinewiththeadultguidelines.
WhenyouareexplaininghowNRTworksyoumightneedtoputalotofemphasisonthefactthatthereisno‘magicformula’thatmakesthemstopsmokingandthattheywillneedtomakeasustainedphysicalefforttochangetheirbehaviour.
YoungpeoplemaypresentbarrierstomakeexcusesforincorrectuseofNRT.
GivingoutannRtadvicesheetin(handout7)alongwiththePharmacyRequestFormwillremindthemofthingsthattheycandothatwillhelpthemuseNRTmoreeffectively.
TherearefactorsthatmayneedtobetakenintoaccountwhenprescribingNRTtoyoungpeople.
…nRtshouldbeusedwithyoungpeopleaged12to17attheirrequestandwherethereisevidenceofnicotinedependence…”(NICE2008)
“
…Idon’twanttousepatches…theymademefeelreallysick…”
“
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21NicotineReplacement:ASevenWeekProgramme
Adherenceinyoungpeoplecanbepoorerthaninadultsandassuchtherearesomeproductsthatencouragebettercompliancemorethanothers.Youmaywanttotakethisintoaccountwhendiscussingproductswithayoungperson.thetableofnRtProductsoutlinessomeoftherelativeprosandconsofthevariousproducts(seeHandout7).
WhendiscussingNRT,itmaybecomeapparentthatyoungpeoplemayhavebeeninfluencedbytheopinionsofotherpeople.Forexampleayoungpersonmaybealreadyprejudicedagainstusingthepatchbecauseeithertheyhavetrieditduringapreviousquitattempt,theyknowsomeonewhohasuseditandfailedtoquitorbecausetheyfeelitistoovisibletootherpeople.
IfayoungpersonexpressesapreferenceforanyNRTproductyouwillneedtomakesurethattheyfullyunderstandhowitistobeused.StresstheimportanceofthemcollectingtheirfirstsupplyofNRTpriortoquitdaybutfurthermore,ensurethattheyunderstandthattheyneedtocollecttheirNRTfromthepharmacyeaCH Week!
Failuretocollectprescriptionsandyoungpeoplesharingprescriptionsareadditionalfactorsthatcaninterferewithadherence.Youwillbealmostguaranteedtofindthatatleastoneyoungpersoninthegroupwillhave‘borrowed’apatchortwofromsomeoneelsebecausetheyhavefailedtocollecttheirNRTfromthepharmacy.
goodPRACtICe
…patchesdon’twork;mymumtriedthemandtheydidnaework…”
“
…IthoughtIcouldonlycollectitonathursday…”
“
…Idon’twantpatches–Idon’twantmymumtoknowIsmoke…”
“
…canItakemypatchofftosmoke…?”
“
…I’venotbeentogetmypatchesyet–Igotoneoffmypal…”
“
When you are recommending a product, it can be useful to take note of the pharmacies that the young people will be collecting their NRT from. This will enable you to make a courtesy call/visit to the pharmacies and let them know that you have some young people that will be coming to collect NRT as the pharmacists may be ufamiliar with dispensing NRT to this younger age group.
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as dual NRT therapy is not approved for under 18’s, scoring through the additional products on the Pharmacy Request form prevents any client adding a second product to the form
OtherissuesthatmayarisewhenyoungpeoplerequestNRT:
• YoungpeoplemayasktochangetheirNRT productregularly
• Youngpeoplemaysaythattheyhavelosttheir PharmacyRecommendationForm
Therewillbesomeissuesaroundissuingduplicateformsthatyoumayhavetoaddressifthesesituationspresentthemselves.
When recommending NRT products to young people guidelines state that YP (for young person) should be put at the top right hand side of the pharmacy recommendation form.
nRtPRodUCtsTheuseofNRTwithyoungpeoplehasnotbeenextensivelytestedtodate,inpartduetotheirpooradherencetotherapy.NeverthelessNRTshouldbeprescribed,whenrequested,wherethereisevidenceofnicotineaddictionandinlinewithsmokingcessationNICEguidelines.
NRT PRoduCT CHoICe
NHSGG&CprescribingguidelinesrecommendtheNicorette16hourpatchasthefirstlinechoiceforNRT.Inexceptionalcircumstances,clientsmayuseanotherproducte.g.allergytothepatchorapreviousunsuccessfulattempttoquitusingthepatch.Ifanalternativeproductisrecommendedthenthereasonmustbestatedontheform.
Itisimportantthatthefirstpriorityistheclientandhelpingthemtohaveasuccessfulquitattempt.
AdetailedlistofNRTproductsisavailableinhandout 7.
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National Monitoring
mInImUmdAtAsetTheMinimumDataset(MDS)isforrecordingthecoredatarequiredforanonymousnationalmonitoringofclientswhoaccessScottishNHSHealthBoardspecialistsmokingcessationservices,takepartinastopsmokingintervention,andwhosetaquitdatewiththeserviceduringthecourseoftheintervention.TheMDSispartofthedatacollectionandmonitoringworkofPartnershipActiononTobaccoandHealth(PATH),whichhasthefollowingobjectives:
• topromotegoodpracticeindatacollection forsmokingcessationservices
• todevelopastrategyforthenational monitoringofsmokingcessationservices
• tosupportsmokingcessationserviceswith datacollection,evaluationandmonitoring
• toofferguidancetosmokingservicesonusing clientdatainaccordancewithdataprotection andrelatedlegislation
• tosupportthedevelopmentofsmoking cessationinformationandresearchstrategies
PAPeRwoRkItisarequirementoftheservicethatappropriaterecordsarekeptofreferralsandinterventionsforbothinternal(NHSGG&C’sTobaccoPlanning&ImplementationGroup)andexternal(InformationServicesDivisionISD)audit.
Withintwoweeksofcompletionofanintervention,i.e.grouporonetoonesupport,therequiredpaperworkshouldbereturnedtoInformationServices(DataTeam)forprocessingandevaluationpurposes.Foreveryclientthereshouldbe:
• Completed Client questionnaire (appendix 1)N.B.shouldclientshavedifficultywithcompletionbecauseofliteracyproblems,thenthefacilitatorshouldassist.Alternately,clientsmayrefusetoanswersomequestionsontheformandthisshouldbenotedforthedataentrystaff
• Client Consent form (appendix 2) whichmust besignedanddatedbythefacilitatorand client.Ifnot,alldatabecomesinvalid
• Client Record Card(Appendix3)(detailsof theintervention)
• Pharmacy Recommendation form (ifapplicable)
Inadditiontothis,ifyouhavebeenrunningagroupthenanend of Group Classification form(Appendix4a/b)shouldbeaddedtothedatabeingreturned.
It is essential that data is returned accurately and timeously in accordance with your locally agreed procedures so that it is entered on the central database for monitoring purposes.
This information is also used for following up clients.
otHeRoUtComesAcommonthemethatemergesinavailableliteraturerelatingtosmokingandyoungpeopleisthelackofinformationonanychangesinbehaviourorreductioninsmokingfollowinginterventions.
These‘softer’outcomesarehelpfulinbuildingunderstandingofyouthsmokingpatternandtrajectories25.
Oneoftherecommendationsthathascomeoutoftheanalysisrelatingtoaction10oftheSmokingPreventionActionPlanisthat “youth tobacco projects should be encouraged to give careful consideration to the potential value of collecting and publishing data about reductions or changes in smoking (in addition to measurements of abstinence) in order to build our understanding of youth smoking patterns and trajectories”26
NicotineReplacement:ASevenWeekProgramme23
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24NicotineReplacement:ASevenWeekProgramme
Traditionallythequitratesforyoungpeoplearelow.Youmightconsiderotheroutcomesthatyoucouldcollectasanydatathatiscollectedcanthenbeusedtobetterinformyouthtobaccoworkaswellasfillingthegapthatexistsinunderstandinghowyouthsmokingchangesovertime.
Some possible outcomes that you might measure are listed below:
• Reductioninsmoking–aspathwaytoquitting altogetherbutthismaypromotethenotion thatsmokingoccasionallyisacceptable
• Changeinattitudetowardssmoking
• Increaseddesiretostopsmoking
• Changeinhowacigaretteissmokedie.not smokingthewholecigarette/takingsmaller draws
• Validatedquitsbutforlessthan4weeks (thereforenotrecordedassuccessfulquit)
• Increasedknowledgeaboutsmokingandrisk
• Increasedknowledgeofmythsaboutsmoking
• Attitudestosmokingmovingfrompositiveto negative
• Increasedconfidenceincopingmechanismsto dealwithstressesandinfluencesonsmoking
• Moredeterminednottosmoke
• Increasedmotivationtostopsmoking
• Lessuseofcannabis
• Increasedknowledgeofservicestosupport quitattempts
• Decreasedcravings
• decreasednumbersofcigarettessmokedwhile usingNRT
YoucanusetheReflectivestaircase(Handout10)torecordsomeofthesesofterindicatorsbynotingwhatyouarerecordingatthetopandthedateoneach“step”.
Inaddition,theConfidence ladder (Handout14a/b),quit Chart(Handout24)and“am I ready to Stop Smoking?” (Handout16)canallbeusedforthis.
Thisdatawouldideallybecollectedlocallyandbemadeavailableforanyresearchinthefuture.
a key purpose of evaluation is to help improve our service by learning how and why some things work and some do not. The type of outcomes listed above will make this possible.
CARBonmonoxIdemonItoRIngAswellasverifyingsmokingstatus,carbonmonoxide(CO)monitoringcanbeagoodmotivationaltoolforyoungpeoplewhoaretryingtostopsmoking.
COmonitoring:
• Canverifyaself-reportedquit
• Canhelpyoungpeopleengagewellwiththe stopsmokingprocess
• IsatoolforpromotingdiscussionofCOlevels
• Worksasagoodmotivationaltoolwhenyoung peopleseetheirreadinggodownsoquickly
WhenworkingwithyoungpeopleuseCOmonitoringwithcaution.MeasuringCOlevelsinyoungpeoplecansometimesbeproblematicandyoushouldbearinmindthefollowing:
• IftheCOmonitorhasayouthfunction,ensure thatitissetcorrectlypriortouse
• Ifareadingbelow4isobtained,thisisnot alwaysanindicatorof‘non-smoking’status. Issueswiththeerraticnatureofyouthsmoking meansthatitmaynotalwaysreflectan accuratesmokingstatus
• Ifthereadingislowandayoungpersonisstill smoking,itcanencouragecomplacency
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gUIdAnCenotesThisisanexampleofasevenweekprogrammebasedlooselyaroundthe7weekMaudsleymodelthattrainedcessationadvisorscanusewithgroupsofyoungpeoplewhowanttomakeaquitattempt.Additionalpreparationtimemayneedtobebuiltintoyourgroupprogrammesothatanyquitattemptismadeafterreadinesstoquitandmotivationhavebeenfullyexplored.Thismaymeanthatthegrouprunsformorethan7weeks,andtheprogrammeshouldbeadaptedaccordingly.
Note:ItisessentialthattheminimumdatasetisrecordedforSmokeFreeServicesanditisdesirablethatagreed‘softer’outcomesberecordedinordertoinformfuturework.
NB.This7weekprogrammeisaguideforusingwithgroupsofyoungpeopleanditshouldbetailoredtosuityourlocalsituation.Youcanusetheguidanceinthe“OnetoOne”sectionwhenadvisingindividualyoungpeople-someoftheresourcesmaybemoresuitableforonetooneadvicethanothersfortheyoungperson.
Youwillneedtoallowadequatetimeforpreparationmakingsurethatyouhaveallthematerialsandresourcesthatyouneedforeachweek’sprogramme.ThereisamaterialschecklistinHandout 5.
The exercises that follow are there to provide guidance and to support you to engage with young people. There may be other exercises and activities that you are familiar with that you find are more appropriate to use.
other Resources may be available from other organisations e.g. Royston Stress Centre (www.roystonstress.org.uk) and GaSP (www.gasp.org.uk).
SupportingresourcesmaybeavailablefromlocalHealthImprovementTeams.VisitSmokefreeServiceswww.nhsggcsmokefree.org.ukformoreinformation.
7 Week Programme
Graphicphotographicimagesarereadilyavailableonlineeg.GoogleImagesandthesecanbeusefulforactivitieslikeCSI-Glasgow.
Forexample,usingphotographsofcelebritieswhosmoke/don’tsmokecanbeusedwhenhavingdiscussionsaboutsmokingandtheinfluenceofcelebrity,imageandtobaccopackagingwhichillustratesomeofthewaysinwhichtobaccoisbeingmarketed.Seewww.w-west.org.ukforinformationon“ThePlainTruth”abouttobaccopackagingandmarketing.
Week 1–Introduction&Preparationweek(canbe1ormoreweeksindurationdependingonreadinessofyoungpeople)
Week 2–PreparationweekFocusonpreparingforquitweek(week3)anddiscussingandagreeingNRT
Week 3–Quitweek
Weeks 4 to 6–Groupsupport
Week 7–Lookingahead,maintainingquitandfuturesupport
week1–IntRodUCtIonAndPRePARAtIonweek• Introductions
• agreeing an agenda/group agreement
• expectations about the group
• Setting a quit date & preparation
• Previous quit attempts – discussion
• Cycle of change
• Information about cigarettes
• Complete paperwork (unless awareness week only)
• Summary and looking ahead to week 2
NicotineReplacement:ASevenWeekProgramme25
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26NicotineReplacement:ASevenWeekProgramme
week1INTRoduCTIoNS
Introduceyourself,findouteveryone’sname–youmightwanttogetthegrouptowritetheirnamesonastickylabel(includingyou!).Anicebreakerissometimesusefulasitmayhelpyoungpeoplebecomealittlemorerelaxedandcomfortablee.g.People Bingo, (handout 30) or Truth and lies (handout 31).GRouP aGReeMeNT
Givinganoutlineofwhatthegroupisaboutandwhatwillhappenateachsessioncanbereassuringforthegroupmembers.
Itishelpfulifthegroupisabletoregulateitsownbehavioursobeginbysettingsomegroundrulestogether.OnewayofdoingthisistohelpthegroupcreateagroupAgreement(seehandout13forguidanceandsuggestions).
eXPeCTaTIoNS aBouT THe GRouP
Tryandfindoutwhatthegroupmembershopetogetoutofthegroup.
• Whyaretheythere?
• Whatdotheyunderstandby‘groupsupport’?
• Emphasisethatwhattheycontributeis importantandalsothateveryoneisdifferent andmaythereforehavedifferentexperiences, thoughtsandopinions.
SeTTING a quIT daTe
Explainthereasonformakingthequitdateonweekthreeandnotonweekone.Tellthemwhyitisimportanttohaveaperiodofpreparationandatthispointyoucouldlinkinadiscussionaboutthecycle of change(seebelow).
Thismightbeagoodtimetoaskpeopleiftheyhavetriedtoquitinthepastandwhatitwaslikeforthem.WHaT’S YouR STaGe? seestagesofChangemodel(s)–handouts8&9
Iftheyhavepreviouslytriedtoquityoucouldask:
• Whatwasitlikethelasttimeyoustopped/tried tostop?
• Howlongdidyoustopfor?
• Howdidyoufeel?
• Whatwashardaboutit?
• Whatwasgoodaboutit?
• Whatmadeyoustartagain?
• Whatwouldyoudodifferentlynexttime?
Tryandsteertheconversationawayfromtheconceptof‘failure’andencouragethemtofocusonwhatwasgoodabouttheexperienceandthethingstheydidthatworkedforthem.
TheConfidence Scale/laddercanbeagoodtooltouseintheearlystagesofagroup.(Handout 14a/b)
Ifthereareanypeopleinthegroupthathavenevertriedtoquit,itcanbehelpfultogetaninsightintowhattheythinkitmightbelikebyasking:
• Whatdoyouimaginewillbehard?
• Whathaveyouheardotherpeoplesaying?
• Howdoyouthinkyouwillcope?
• Howconfidentareyou?
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Youcoulduseflash Cards (handout 26)withsmokingrelatedwordstogetsomediscussiongoing.Wordssuchasaddiction, habit and dependence/stressillustratethatsmokingisnotjustaboutahabitbutisamuchmorecomplexmixofseveralthings.Thisactivityworkswellifyoucanencouragetheyoungpeopletomakethediscussionrelevantforthempersonally.
SMokING dIaRY
Usingasmokingdiary(handouts12&18)beforequittingisagoodwayforayoungpersontorecordanormalsmokingday.Thediarywillhelpidentifythetimeswhentheyoungpersonfindsitmostdifficulttogowithoutacigaretteaswellasidentifyingotherbehaviourthattheyassociatewithsmoking.Thiswillhelpthemplanhowtheywillcopewithquitting.INfoRMaTIoN aBouT CIGaReTTeS
What’sinacigarette?Youcanuseresourcesincludingthechemicalboardandthetarjartoillustratethe4000+chemicals.
Askquestionslike‘Wheredoestarcomefromandwhatharmdoesitdo?’
a good activity for generating discussion on this is the ‘CSI – Glasgow activity’ (handout 33)
One to One – Seeing Clients Individually (see Handout 6)
Complete paperwork
Usethetemplatesinappendices 1 to 4 tocollectalltherequireddatafortheminimumdataset.ThisinformationMUSTbecollectedandMUSTbereportedtoSmokeFreeServices.
• Thetemplatescover:
• Clientquestionnaire
• Clientconsentform
• Weeklyrecordcard
Inadditiontotheabove,thepharmacy NRT request form formspartoftheminimumdatasetandacopyshouldberetainedforforwardingtoSmokefreeServicesifNRTisrequested.
Ensurethecentralelectronicdatabaseisupdatedonaweeklybasis.Afterthefinalweek,theminimumdatasetshouldbesenttoSmokeFreeServiceswhowillinturnforwardthedatatotheISD.
Handout 16, ‘am I ready to stop smoking?’isausefulexercise.Thisallowstheyoungpeopletoidentifytheirownprioritiesandreasonsforwantingtostoportocontinuesmoking.Allowthemtimetothinkandreflectonhowtheyfeelanddon’tbeoverlyconcernedaboutperiodsofsilence.
a different exercise is ‘theFourwhys’that you can use to help young people explore any ambivalence they might feel towards stopping smoking.
(seehandout15)
AddICtIon
stRess
HABIt
dePendenCe
NicotineReplacement:ASevenWeekProgramme27
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28NicotineReplacement:ASevenWeekProgramme
CHeCk!:
• ConsentFormsigned
• COchecked
• RecordCardupdated
• PharmacyRecommendationformcompleted
• Requirestextsupport?
(Remember,ifsession1isforpromotingawarenessandgivinginformationonlyitwillnotbenecessarytocompletepaperworkatthisstage).Summary and look ahead to week 2
week2–InFoRmAtIon&PRePARAtIon• Re-visit group agreement
• focus on preparation for quit day
• feelings about quit day
• action planning
• keeping a diary
• Withdrawal
• one to one consultation/NRT option agreed/ record keeping/Co monitor
• Complete paperwork if not done previously
• discuss using text support/motivation
• Summary and looking ahead to week 3
week2Welcomeeveryoneback(especiallyifanynewmembers).Itwillprobablybeusefultohaveeveryonewriteanamestickeragain.
GoovertheGroup agreement (Handout 13).Askifanyonehasanythingtoaddandcheckeveryoneishappywithit.
Weektwowillprimarilybeaboutpreparing for quit week:Howiseveryonefeeling?TheSmoking diary (handouts 12 & 18)isusefulforfindingoutwhateveryonehaslearnedfromkeepinganoteoftheirtypicalsmokingday.Youcouldusespecificquestionshere:
• Were there any particular times when you felt you really needed a cigarette?
• Which cigarettes did you enjoy the most?
• What activities made you want a cigarette?
• did being with particular people make you feel more like having a cigarette?
• Were there any cigarettes that you smoked but feel you didn’t really need to smoke?
• Were there any cigarettes that you felt you really couldn’t do without? feelINGS aBouT quIT daY
Howdoestheyoungpersonfeelaboutsettingaquitdate?
Anactivitytopromotediscussionherecouldbetowriteonflipchartordrawreadymadecardsfromabagthatidentifiesparticularfeelingsthatareassociatedwithmakingplanstostopsmoking:(See handout 17)
ConFIdent
deteRmIned
sCARed
negAtIVe
woRRIed
exCIted
AnxIoUs
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NicotineReplacement:ASevenWeekProgramme29
ReadY To quIT – aCTIoN PlaNNING
Iftheyoungpersonisreadytosetaquitdatethenusinganactionplanisonewaytoensurethattheyhaveagoodunderstandingofwhattheyneedtodotomakeaconfidentquitattempt.
Youcanusetheaction Plan (Handout 19)oryoucoulduseflipcharttomakeitlessofanindividualexerciseandmoreofagroupexercise.
TheStop Smoking diary (Handout 12 & 18)canhelpthemidentifysmokingpatternsinthedaysrunninguptoquitdayandcanenabletheyoungpersontomakerealisticplansforhowtheywillcopewithcravingsandwithdrawal.WITHdRaWal
Ayoungsmokerislikelytobeconcernedaboutwithdrawal,especiallyiftheyhavehadapreviousquitattempt.
Discussionaboutdiscomfortanddifficultieswithwithdrawalcanhelpdispelcommonmythsaboutwithdrawalaswellasprovidinganopportunityforyoungpeopletosharesolutionsandcopingstrategies.
discussion starters:
• Whatworriesyoumostaboutstopping?
• Whathaveyouheardotherpeoplesayabout theirownexperiencesofstoppingsmoking?
• Whathaveyouheardotherpeoplesayabout howtheycopewithwithdrawal?
• Canyouthinkwhatmightworkforyou?WITHdRaWal – Handout 25
Youcouldmakesomecardswithcommonwithdrawalsymptomsandusethemasdiscussionpoints.Encouragetheparticipantstothinkaboutwhattheyknowaboutandwhattheycoulddoiftheyexperienced,forexample,headachesforexample-helpthemlookfortheirownsolutions.
oNe To oNe
Complete paperwork NRT – Pharmacy Request form Co Reading
Itisuptoyouasapractitionerwhenyoudothis.Abenefittodoingitatthestartofthesessionisthattherewillbelesspressureontimelateron.Howevertherearealsobenefitstodoingitattheendofthesessionasthisthenallowsyoutochecktheparticipantsunderstandingofwhathasbeensaid,andalsotoreinforcetheexpectationsaroundcollectionofprescriptionsandcorrectuseofNRT.
Bearinmindthatayoungpersonmaydiscloseotherunrelatedinformationtoyouatthistimeandyoumayfinditusefultohaveavailabledetailsofotherservices/agenciessothatyoucansignpostyoungpeopletothem.
InCReAsedAPPetIte
CRAVIngs
IRRItABIlItY
HeAdACHes
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30NicotineReplacement:ASevenWeekProgramme
CaRBoN MoNoXIde ReadINGS
UsingCOmonitoringwithyoungpeopleisareallygoodwaytoletthemseetheeffectthatsmokingishavingontheirhealth.Inamixedsmoking/non-smokinggroup,thisisespeciallyevident.Itisagoodmotivationaltoolfortheyoungpeopleaswellasgivingtherequireddataforquitverification.
Itisnotunusualforyoungpeopletobealarmedabouttheorangeandredlightsonthemonitor–reassurethemaboutthisandthatthelightswillchangetogreenwhentheyquitsmoking.
TherecanbeissuesinusingCOlevelsasameasureofyoungpeoples’smokingasitdoesnotalwaysreflecttheoftenerraticnatureofhowyoungpeopleusetobacco.Ifayoungpersoncontinuestosmokeyetregistersalowreading,youshouldbeawareofthepossibilitythattheprocesshasthepotentialtobecomecounterproductive.TheCarbon Monoxide Staircase(Handout11)canbeausefulvisualtoolthatletstheyoungpersonseethechangesintheirCOlevels.MaINTaINING MoTIvaTIoN aNd avaIlaBle TeXT SuPPoRT
Remindthegroupabouttheiragreementandaboutsupportingoneanother.Emphasisethatonlythosewhohaveindicatedwillreceiveatextmessageon(specify day)andthatunlesstheyhaverequesteda‘safe’messagethenthetextwillbeexplicitlyaboutstoppingsmokingandattendingthegroup.
finally remind the group:
• tocollecttheirNRT
• tostarttheirNRTonQuit Day
• nottosmokeoncetheystartNRT
• thatyouwillsendthemareminderbytext (thosewhohaveelected)
• THaT THeY CaN do IT!
CHeCk!:
• ConsentFormsigned
• COchecked
• RecordCardupdated
• PharmacyRequestformcompleted
• Requirestextsupport?
week3–QUItweek!!• agreement again!
• Review preparations
• Confirm that NRT has been started
• feelings about quitting
• Share coping strategies?
• encourage group to support one another
• looking ahead
• one to one sessions/Co monitoring/record keeping
• Summary and looking ahead to week 4
week3Welcomeeveryoneback(thereshouldbenonewmembersifyouarerunningaclosedgroup).HopefullyeveryonewillhavemanagedtocollecttheirNRTandshouldhavestartedusingit.Youshouldnotbesurprisedtofindthatsomehavefailedtocollectit,havelosttheirprescriptionorhave‘borrowed’patchesfromsomeoneelse.EmphasisethatitisimportantforthemtocollecttheirownprescriptionasborrowingNRTfromotherswillleavesomeoneelseshort!
Youmaywanttore-visitthegroupagreementandremindthemofthevalueofpeersupport.
Takesometimetoletthemreview their preparations fromthepreviousweek(s)–lookingataction Plans andSmoking diaries canhelpthemfocusagainonhowtheythoughttheywouldcopewithwithdrawalandcravingsaswellasremindingthemtobeextraawareoftheir‘trigger’points.
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feelINGS aNd CoPING
Iftheyhavenotalreadycompletedanaction Plan,(Handout19)encouragethemtodoso.Thiscanbedoneinthecontextofadiscussion.InHandout 21 therearesomequestionstohelpgetthisconversationstarted.
Youcouldaskthemtocompletethe‘Reflective Staircase’ (Handout 10) tomeasureconfidenceandlinkthiswiththeiraction Plans (Handout 19)tohelpthemincreasetheirconfidencelevels.
Discusshowgroupsupportcanhelpwhenmakingchangesandwhencopingwithwithdrawalsymptoms(see Handout 20)Handout 22givesanactivityforgeneratingdiscussionassmallgroupsandcomingbackintoalargergrouptoshareideasaboutcopingandsupportingeachother.lookING aHead
Whatproblemsmighttheycomeupagainstinthefollowingweeks?
Howwilltheydealwiththem?Helpthemidentifypotentiallytrickysituationswheretheyarelikelytofinddifficultyinresistingtheurgetosmokeacigarette.
UsethequestionsinHandout 21 toencouragetheyoungpeopletothinkabouthowtheywillcopeandtothinkofsolutionsforthemselves.oNe To oNe
UsethistimetocheckthattheyhaveagoodunderstandingofhowtouseNRT.
Co Reading Complete Paperwork
CHeCk!:
• COchecked
• RecordCardupdated
• Requirestextsupport?
finally remind the group:
• tocollecttheirNRT
• tousetheirNRT
• nottosmokewhileusingNRT
• thatyouwillsendthemareminderbytext (thosewhohaveelected)
• THaT THeY CaN do IT!
• Thattheyarenownon-smokers!
week4to6–gRoUPsUPPoRt• Review the week
• What has been good/bad?
• looking ahead
• Increasing motivation
• Practical advice
• dealing with withdrawal
• one to one session/Co monitoring/record keeping
• Summary and looking ahead
weeks4to6Welcomebacktoweek4/5/6.
Reviewtheweek,findouthowtheyhavecopedwithstopping,andwhethertheyhavemanagedawholeweekwithoutsmokingorwhethertherehasbeenarelapse.
Positivereinforcementisessentialwithyoungpeople.Iftheyhavestoppedsmokingandthenhadasubsequentrelapseyoushouldstillputtheemphasisonthefactthattheyhavemanagedtostopsmokingforthistimeandmakeitapositiveeventratherthana‘failure’–helpthemseeitasanachievement.Itisimportantforthemtorememberthatthisisajourneyandthattheycanlearnfromsetbacksandturnthemintopositiveexperiences.
NicotineReplacement:ASevenWeekProgramme31
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32NicotineReplacement:ASevenWeekProgramme
GRouP SuPPoRTSTIll SToPPed? – dISCuSSIoN
Handout 27 Thisactivityshouldgeneratediscussionaboutwhathasgonewellandwhathasnotgonesowell,andshouldencouragethemtohelpandsupporteachother.RelaPSed? – dISCuSSIoN
Handout 28Positivereinforcementiftheyhavegonewithoutcigaretteswhentheywouldnormallyhavesmokedcanbeverypowerful.Ifyoucanusearelapseexperiencetore-engagewithayoungperson,andyoucanencouragethemtotryagainandtolearnfromthepast.ThereisanactivityinHandout28thatrelatestothis.
YoucouldcheckoutatthispointimportanceandconfidenceusingtheImportance/ConfidenceladderinHandout14a/btodeterminewhethertheirrelapsehashadanimpactontheirconfidencelevels.GoovertheirActionPlan(Handout19)toseewhetheritneedstobemoreeffectiveormorerealistic.
Asktheyoungpeopletoremindthemselveswhytheyarestoppingandwhattheywanttoachieve.
one to one Co Readings Paperwork
CHeCk!:
• COchecked
• RecordCardupdated
• Requirestextsupport?fINallY ReMINd THe GRouP:
• tocontinuetocollecttheirNRT
• tokeepusingtheirNRTeveniftheythinkthey mightnotneedit
• nottosmokewhileusingNRT–notevenapuff!
• thatyouwillsendthemareminderbytext (thosewhohaveelected)
• THaT THeY CaN do IT!
• Thattheyarenownon-smokers!
week7–PReVentIngRelAPse&lookIngAHeAd• The last week!
• Being a non-smoker!
• Reflecting on how things have gone
• Staying confident
• looking ahead
• Staying motivated
• Supporting one another
• one to one/Co monitoring/record keeping
• future support/Pharmacy support / Youth Health Service
• Summary and well done! (hopefully!)
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week7Welcometothelastweek.Congratulatethemonmakingittoweek7anddiscusshowtheweekhasbeen.Establishcurrentsmokingstatusandthismightbeagoodtimetodotheone to ones.
Check Co readings Complete paperwork Record end of group status/classification CHeCk!:
• COchecked
• RecordCardupdated
• Requirestextsupport?
• Endofgroupclassificationcompleted
SuCCeSSful quIT
Praisethemfortheirsuccessandreassurethemthatchanginganybehaviourtakesawhiletoestablish.Encouragethemtokeepfocusedandusetheiraction Plans (Handout 19)toremindthemselvesofthetechniquesthattheyknowworktohelpthemcopewithdifficultsituationsandcravings.
RemindthemtocontinuewiththeirNRTanditmightbehelpfultolookattheConfidence ladder (Handout 14a/b)andseehowmuchmoreconfidencetheynowhaveaboutstoppingandstayingstopped.IfyouareusingtheCarbon Monoxide Staircase (Handout 11) thenthismightbeagoodtimetolettheyoungpersonseetheCOlevelsandusethistoshowthemhowmuchtheyhaveachieved.dISCuSSIoN aBouT THe fuTuRe
Encouragediscussionaboutthenextfewweeksandabouthowitfeelsnowthatthegroupisfinishing.SeeHandout 29forstarterpointstohelpwithdiscussion.
RelaPSe
Reviewtherelapseusingthediscussionpointsfromlastweek(Handout 28).Istheyoungperson
readytomakeanotherquitattempt?Iftheyarenotreadythentellthemaboutthesupportthatwillbeavailabletotheminthefutureandmakesurethattheyknowhowtoaccessit.Reassurethemthatthisrelapsedoesnotaffectanyfuturesupport.Iftheyarereadytomakeanotherquitattempt,discussthiswiththemandagreehowitwillgoforward.SuMMaRY aNd PlaNNING foR THe fuTuRe
Youmaywanttogivetheyoungpeoplecertificatesofachievementhoweveryoumayfindthatthisisnotuniversallypopularastheymightfeelitdetractsfromtheir‘streetcred’!
Giveplentyofencouragementandremindthemofhowfartheyhavecomeandthattheyarenownon-smokers.Checkthattheyknowhowtoaccesssupportshouldtheyneeditandmaketime,ifpossible,foranyquestionstheymighthave.
Youmightwanttooffertextsupporttothemeitherweeklyoratanotheragreedtimeinterval.When the group is finished, collect all paperwork including the end of group classification sheet and return these to your administrator which will then be forwarded to smoke free services.
BeYondweek7…Makesuretheyoungpersonknowswheretogetsupportafterthegrouphasfinished.Theycanbedirectedtoanotherservicee.g.YouthHealthServicesorPharmacyoryoucouldcontinuetosupportthemonanarrangedbasiseitherinperson,byphoneorbytext.
NicotineReplacement:ASevenWeekProgramme33
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APPendIx1: ClIentQUestIonnAIRe
ABoUtYoU– ReMeMBeR, THIS IS CoNfIdeNTIal
1. Name:2. Address:
6.Dateofbirth:__/__/__ 7.Gender:qMaleqFemale
8.Iffemale,pregnant?qYqNqUnknown
3.Postcode:4.MobileNumber:5.Landline:
8.whatdoyoudo?Areyou:(pleasetickonebox)qInpaidemploymentqAtschool/collegeoruniversityqFull-timeparentorcarerqUnemployed
q Permanentlysickordisabledq Notknown/missingq Other(pleasestatebelow) ___________________________________________
tobaccoUseandQuitAttempts10.Onaverage,howmany cigarettesorroll-upsdoyou smokeinaday?q10orlessq11-20q21-30qMorethan30qUnknown
11.Howsoonafteryoucandoyou smokeinthemorning?qWithin5minutesq6-30minutesq31-60minutesqAfter60minutesqUnknown
12.Howmanytimeshaveyoutried toquitinthepastyear?qNoquitattemptsqOnceq2or3timesq4ormoretimesqUnknown
Quitdetails14.Datereferredtoservice:__/__/__
15.Quitdate:__/__/__
16.Dateofinitialappointment:__/__/__
9.doyoureceivefreeprescriptions? q YesqNoqUnknown
7.HowwoUldYoUdesCRIBeYoURetHnICgRoUP?(Choose oNlY oNe which best describes your ethnic background):
A.whiteqScottishqEnglishqWelshqNorthernIrishqBritishqIrishqGypsy/TravellerqPolishqAnyotherwhiteethnicgroup, pleasespecify
C.Asian,AsianscottishorAsianBritishqPakistani,PakistaniScottishorPakistani BritishqIndian,IndianScottishorIndianBritishqBangladeshi,BangladeshiScottish orBangladeshiBritishqChinese,ChineseScottish orChineseBritishqOther,pleasespecify
e.otherethnicgroupqArabqOther,pleasestatebelow: _____________________
B.mixedormultipleethnicgroupsqAnymixedormultipleethnic groups,pleasestatebelow ___________________________
d.African,CaribbeanorBlackq African,AfricanScottishorAfricanBritishq Caribbean,CaribbeanScottish orCaribbeanBritishq Black,BlackScottishorBlackBritishq Other,pleasespecify
F.qNotDisclosed
NicotineReplacement:ASevenWeekProgramme34
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35NicotineReplacement:ASevenWeekProgramme
APPendIx2:ClIentConsentFoRm
YOUTHSMOKINGCESSATIONCONSENTFORM(PleaseInitial)
IunderstandtheinformationIhavereceivedaboutthestopsmokingserviceandhavehadtheopportunitytoaskquestions.IunderstandthatmyparticipationisvoluntaryandIamfreetowithdrawatanytime.
Iamwillingformydetailstobekeptonaconfidentialdatabase,formyinformationtobeusedinrelationtotheserviceandnotidentifyingmeinanyway.Iagreetobecontactedinfutureinconnectionwithmysmoking(4weeks,3monthsand12months.)
Iagreetomydoctorbeingcontactedregardingmytreatmentandprogresswithgivingupsmoking.
Iwishtoreceivetextmessages
MOBILENUMBER:_________________________________
dataconfidentialityandsecurity
TheinformationprovidedbyyouwillbeheldinasecureenvironmentinaccordancewithTheDataProtectionAct(1998).Theinformationwillonlybeusedtoassesstheoutcomeofthisprojectandnodetailswillbepassedontoanyorganisationswhoarenotinvolvedintheoutcomesassessment.
GP:...............................................................................................................................................................................................
Practice:....................................................................................................................................................................................
OwnTelNo:.............................................................................................................................................................................
Signed(Youngperson):....................................................................................................................................................
Signed(Advisor):................................................................................................. Date....................................................
(Initial)
(Initial)
(Initial)
(Initial)
(Initial)
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APPendIx3:ClIentReCoRdCARd
ClI
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NR
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Var
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eeks
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Clie
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q
smok
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atus
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=S
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dua
lPro
duct
s
NicotineReplacement:ASevenWeekProgramme36
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37NicotineReplacement:ASevenWeekProgramme
APPendIx4A:endoFgRoUPClAssIFICAtIon
ENDOFGROUPCLASSIFICATION
GROUPLOCATION:
GROUPDATES:
GROUPFACILITATORS:
TotalnumberofclientsattendedWeek 1 or 2:
Totalnumberofclientsmaking a quit attempti.e.attendedWeek 3 or beyond:
Week7Classification: Number:
Non-smoker:Smoker:ClientWithdrew:
OverallTotalCessationRate(%):
Comments:
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APPendIx4B:ClAssIFICAtIongUIdAnCenotes
non-smokeR–verbalverificationthatnocigaretteshavebeensmokedduringweeks3AND4postquitweek.Itisnotsufficienttoknowthesmokingstatusonlyatweek4postquitweek.
smokeR–verbalverificationthatanysmokinghastakenplaceineitherweek3ORweek4postquitweek.Even‘justapuff’isenoughtoclassifysomeoneasasmoker.
ClIentwItHdRew–asbefore:clientswhoverballywithdrawfromtheservice,clientswhodonotcompletethesessions,clientswhocannotbecontactedbytelephoneetc.
ClIentdIed–clientdiesduringtheirquitattempt.
noConsent–clientdoesnotcompleteconsentformeitherthroughchoiceorbecausetheyhavee.g.notattendedagroup.
old/NeW ClaSSIfICaTIoNSTC=Non–smokerOC,RS,US(ifsmokingweek6)=SmokerCW,US(ifnotsmokingweek6)=Client Withdrew
HowtoCAlCUlAteendoFgRoUPClAssIFICAtIon
q TotalnumberofclientsNon-smokeratweek7q Dividedbynumberofclientswhomadeaquitattempti.e.attended week3orbeyondq %
NicotineReplacement:ASevenWeekProgramme38
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39NicotineReplacement:ASevenWeekProgramme
APPendIx5:YoUtHReFeRRAlPAtHwAY
Youth Referral Pathway
Contactthenamedyouthcessationreferralcontactwithinpostcodearea.(e.g.FillinlocalyouthcessationReferralFormorcalldirect)orCallsmokelineon0800848484.
Alternativelyadvertisewebaddress(w-west,smokeFreeservices)andphonenumber(Youngscot).
•AdvisortocontactYPtoarrangemeeting
•Advisortoconfirmmeetingondayorday beforescheduledmeeting
•Advisorassessesyoungperson’snicotine dependenceandmotivationtoquit
•Arrangesfurthersessionsifappropriate
•namedcontactrefersyoungpersontolocallytrained facilitatorbasedwithinyouthhealthserviceor voluntaryserviceinYParea.
•FacilitatorcontactsYPandarrangesmeeting.
•Facilitatortoconfirmmeetingondayordaybefore scheduledmeeting.
•Facilitatorassessesnicotinedependenceand motivationtoquit.
•Arrangesfurthersessionsifappropriate.
•Paperworktobecompletedateachcontact.
•Completedpaperworktobesenttosmokefreeservices
optionsforCH(C)P
Yes
1.Identifiesthemselvesasasmoker
2.Adviseswantstostopsmoking
3.Assessifyoungpersonismotivatedtostopsmoking
YoUngPeRson‘UndeR18’
Isyoungpersonmotivatedtostopsmoking? no
Advisesupportavailableif/when
readytostop.
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APPendIx6:textmessAgesUPPoRt
tosendtextmessAgesUPPoRtYoUwIllneedtoHAVeACCesstoAnnHs.netemAIlAddRess.
• Signintothenhs.netwebsite
• Clickon‘Tools’
• ClickonSMSandFax
• Inthe‘To’fieldenterthemobilenumberyouwanttosendthemessageto asfollows07……[email protected]
• Click‘addtorecipients’
• Typeyourmessageandclick‘Send’
• ‘Queuedforsubmission’willappear–clickOK
• YourtextmessagehasnowbeensenttHIngstoRememBeRwHenUsIngtHetextseRVICe:
• Youneedtoobtainsignedconsenttousetextmessaging
• Youshouldensurethatitiscleartotheclientthatthetextwillbeexplicitin itsmeaning
• Shouldtheypreferthatanytextsentisdonesoinawaythatthirdpartiesdo notknowthattheyareattendingastopsmokinggroup,youshouldensure thattheymakethiscleartoyou
NicotineReplacement:ASevenWeekProgramme40
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41NicotineReplacement:ASevenWeekProgramme
APPendIx7A:BRIeFInteRVentIons
TheBriefInterventionguidancecanbeusedbypractitionerswhoarenottrainedincessation.Thiswillenablethemto‘raisetheissueofsmoking’withayoungperson.InformationabouthowtosignpostayoungpersontoavailablecessationsupportisincludedintheYouth Cessation Referral Pathway(Appendix1)anditisrecommendedthatpractitionershighlightavailablesupportoptionstoayoungpersonwhoiskeenandmotivatedtomakeaquitattempt.
Briefinterventionsinvolveopportunisticadvice,discussion,negotiationorencouragement.Theyarecommonlyusedinmanyareasofhealthimprovementandaredeliveredbyarangeofprimaryandcommunitycareprofessionals.
Forsmokingcessation,briefinterventionstypicallytakebetween5and10minutesandmayincludeoneormoreofthefollowing:
• simpleopportunisticadvicetostop
• anassessmentofthepatient’scommitmenttoquit
• anofferofpharmacotherapyand/orbehaviouralsupport
• provisionofself-helpmaterialandreferraltomoreintensivesupportsuch astheNHSStopSmokingServices27.
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APPendIx7B:BRIeFInteRVentIonFlowCHARt
Helping a smoker to stop smoking – What’s involved Briefinterventionsflowchart
Thisflowchartshowsthepathwayyoucanfollowinraisingthesubjectofsmokingwithyourclients/patients.Usingit,youcanfindoutfirstiftheyareinterestedinstoppingandthenpointthemtothebesthelpavailable.
Tohelpyou,wehavesuggestedspecificquestionsbutyoumaywanttoasktheseinyourownwords,dependingonwhoyouaretalkingto.Note: Smokingcessationservicestendtobebetterunderstoodbymembersofthepublicas‘stopsmokingservices’.
Ask:doyou(still)smoke?DOCUMENTHAVINGASKEDQUESTIONPLUSRESPONSE
Ask:Haveyoueverthoughtaboutsmokinganditseffects(e.g.onyourhealth;itscost)?DOCUMENTHAVINGASKEDQUESTIONPLUSADVICEGIVEN
Ask:Areyouinterestedintryingtostopand,ifso,doyoufeelmotivatedtostopnoworinthenearfuture?
Ask:wouldyoulikehelpfromthelocalstopsmokingservices?
Refertolocalservicesand/orgivethetelephonenumberforSmokeline:0800848484ordetailsofthewebsitewww.canstopsmoking.com(bothofwhichhaveinformationonlocalservices)
Givebriefinformationonhowtostop,linkinginwithmedicalconditionwhereapplicable.Helpthemtochoosemedication(seeHelping smokers to top for advice).Prescribeorarrangeaprescription.Reinforceencouragingpatientstoattendservices.Arrangeafollow-upintwoweekstocoincidewithendofprescriptionsupply.
Give:• informationonhowtostop• Aspiremagazineandany otheravailablematerials• Smokelinenumber: 0800848484• www.canstopsmoking.com• informationaboutlocal services
Congratulate.
Brieflyoutlinetheindividualisedhealthrisksofsmokingandbenefitsofstopping.GiveAspiremagazine.
Acceptanswerwithoutjudging.Leaveofferofhelpopen.GiveAspiremagazineandanyotherinformation.
Encouragethesmokertoconsiderservicestoincreasechancesofstoppingandstayingstopped,andemphasisetherangeofservicesavailable.Ask:wouldyouliketousenRtorothermedication?
Givereminderthatstopsmokingservicesarealwaystheretohelpiftheyarefindingitdifficulttostaystopped.
Givereminderthatstopsmokingservicesarealwaystheretohelpifthesmokerdecidestoquitsometimeinthefuture.
no
no
no
no
no
Yes
Yes
Yes
Yes
Yes
NicotineReplacement:ASevenWeekProgramme42
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43NicotineReplacement:ASevenWeekProgramme
APPendIx7C:BRIeFInteRVentIonsgUIdAnCenotesgUIdAnCenotes
YeS: Manysmokerssay‘yes’becausetheyknowitistheexpectedanswer.Trytoconfirmwhattheyreallyfeelorknow.Iftheyseemgenuinelyawareoftheriskstotheirhealth,eitherbeforeorafteryourexplanation,thenyoucanmoveontothenextquestion.3.AReYoUInteRestedIntRYIngtostoPAnd,IFso,doYoUFeelmotIVAtedtostoPRIgHtnowoRIntHeneARFUtURe?
No: Iftheyareclearlynotinterestedintryingtostopinthenearfuture,acceptthiswithoutjudgementandleavethedooropenforafutureconsultation.Tellthemiftheyeverwanttodiscusssmokinginthefuture,youwouldbehappytodoso,andtoofferhelpiftheywish.
YES:Theymaysay‘yes’becausetheyaremotivatedorbecausetheyfeelthisisthedesiredanswer.Iftheyseemunsure,emphasisethesupportthatisfreelyavailableandexplainthatthiswillgreatlyincreasetheirchancesofstopping.Iftheydoseemgenuinelyinterestedinstoppingandreadytostopinthenearfuture,ask:4.woUldYoUlIkeHelPFRomtHeloCAlstoPsmokIngseRVICes?
(Stop smoking services are specialist smoking cessation services, supported by the NHS, with staff trained to national standards and having dedicated time set aside to provide group and 1:1 support for a series of planned sessions, and where the client is followed up.)
No:Iftheydonotwanthelp,askifthisisbecausetheyfeeltheycanstopwithouthelp,orbecauseofsomeotherreason.Offerwhatadviceyoucanandemphasisethatusingtherightsupportcanmakeitmuchmorelikelytheywillquitandstaystopped.(Clinicians: You can still offer NRT or other medication and these patients will require follow-up if they do not attend services.)
YeS: Givethemthedetailsforlocalservices,thenumberforSmokeline(0800848484)orsignpostthemtowww.canstopsmoking.comwhichcanprovidethemwithinformationonlocalservicesaswellasofferingmoregeneraladvice.Reinforceandencourageattendanceatservicesandrefertoservicesifyouareabletodoso.5.woUldYoUlIketoUsenRtoRotHeRmedICAtIon?
(This should only be asked if the patient has declined the offer of a referral.)
No: Ifnot,trytofindoutwhetherthisisbecauseofconcernsaboutsafety,oriftheyareconfidentabouttheirchancesofstoppingunaided.Emphasisestronglythatthepharmaceuticaltreatments(pharmacotherapy)aregenerallysafeifusedappropriately,andincreasetheirchancesofstopping.Reinforcethatservicesandpharmaceuticaltreatmentsareavailableshoulddecidetotrythemlateroriftheirownroutedoesn’tworkoutinthelong-term.
YeS:Discusstheoptionswiththemtohelpthemchoose,andprescribeappropriately.Ifyoucannotprescribe,arrangeforthemtogetaprescription.Intermsofothermedication,bupropion (zyban) and varenicline (Champix) may not always be appropriate for patients with other health issues. Refer to local guidance/protocols for dispensing before prescribing.
encourageattendanceatservices.Ifprescribinghastakenplace,requestthattheymakeanappointmentfortwoweeks’timetoreviewtheirquitattempt(andtocoincidewithendofinitialprescriptionsupply).makesuretheyhavethesmokelinenumber(0800848484)andencouragethemtocalliftheyneedhelp.
Brief interventions contribute to saving lives.Themaineffectistotriggerquitattemptsandtopromptsmokerstoseeksupportfromsmokingcessationservices.Acombinationofbehaviouralsupportwithpharmacotheraphyi.e.nicotinereplacementtherapy(NRT),bupropion,varenicline,canachievequitratesofaround15%atsix-monthsfollow-up.Comparedwithotherlife-savingmedicalinterventions,smokingcessationservicesofferexcellentvalueformoneyforeachyearoflifegained.It is important to try establish rapport and empathy with the smoker. You can do this by listening, not trying to persuade, and by avoiding judgmental responses to their answers.Encouragingsmokerstothinkaboutstoppingsmokingandusingservicesindoingso,andtherebytheirchancesofsuccess,whileincreasingunderstandingofthebenefitsofquittingandleavingthedooropenforafuturequitattempt,arekeyelementsofabriefintervention. 1. dotHeYsmoke?oRdoYoUstIllsmoke?
No:Iftheydon’tsmoke,orhavestopped,congratulatethemanddocumenttheirsmokingstatusinyournotes.
YeS: Iftheydo,documenthavingaskedthemplustheirresponseinthenotesandthentrytoestablishiftheyunderstandthespecificeffectsofsmokingandtheextentofthedangersforthempersonally.Trynottoaskaleadingquestion.Wewouldsuggest:2.HAVeYoUeVeRtHoUgHtABoUtsmokIngAndItseFFeCts(e.g.onYoURHeAltH;ItsCost?)
No:Iftheyanswer‘no’orseemunsure,outlinethehealthriskstothemandthebenefitsofstopping,andexplainthatitisworthstopping.InformationontherisksisavailableinHelpingsmokerstostop,orinAspiremagazineandotherleaflets(availablefromthelocalNHSBoard).Documentaskingthequestionandyouradviceinthenotes.
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APPendIx8mARketIngmAteRIAls
NicotineReplacement:ASevenWeekProgramme44
OUT
UTT
UNDER 18 AND THINKING OF STOPPING SMOKING?STOP SMOKING SERVICE
FOR YOUNG PEOPLE IN
EAST DUNBARTONSHIRE
For free and confidential
information, advice
and support –
Call or text Lesley on
07919990010
To find out more about tobacco
check out: www.w-west.org.ukSTOP SMOKING SERVICE FOR YOUNG PEOPLE
IN EAST DUNBARTONSHIRE For free and confidential information, advice and
support – Call or text Lesley on 07919990010To find out more about tobacco check out: www.w-west.org.uk
OUTUT
T UNDER 18 AND THINKING OF STOPPING SMOKING?
for more information on how to obtain BuTT ouT promotional material contact Smokefree Services on 0141 201 4620/4627
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HAndoUt1:nICotInedePendenCeQUestIonnAIRe1
Yes no
1. Haveyouevertriedtoquitbutcouldn’t?
2. Doyousmokenowbecauseitisreallyhardtoquit?
3. Haveyoueverfeltlikeyouwereaddictedtotobacco?
4. Doyoueverhavestrongcravingstosmoke?
5. Haveyoueverfeltlikeyoureallyneededacigarette?
6. Isithardtokeepfromsmokinginplaceswhereyouarenot supposedto?Whenyouhaven’tusedtobaccoforawhile... ORwhenyoutriedtostopsmoking?
7. Didyoufindithardtoconcentratebecauseyoucouldn’tsmoke?
8. Didyoufeelmoreirritablebecauseyoucouldn’tsmoke
9. Didyoufeelastrongneedorurgetosmoke?
10. Didyoufeelnervous,restlessoranxiousbecauseyou couldn’tsmoke?
totAlsCoRe
Source:DiFranza,J.R.;Savageau,J.A;Fletcher,K.;Ockene,J.KMcNeil,A.D.;Coleman,M.;Wood,C.(2002)‘‘Measuringthelossofautonomyovernicotineuseinadolescents:TheDevelopmentandAssessmentofNicotineDependenceinYouths(DANDY)Study.’’ArchivesofPediatricAdolescentMedicine156:397-403HONC(HookedonNicotineChecklist)TobaccoControl,September
2002,DrJ.RDiFranza.
NicotineReplacement:ASevenWeekProgramme45
theHookedonnicotineChecklist(HonC)
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46NicotineReplacement:ASevenWeekProgramme
HAndoUt2:nICotInedePendenCeQUestIonnAIRe2
1. Howmanycigarettesadaydoyousmoke? a. Lessthan1aday b.1-10cigarettesaday c. 11-20cigarettesaday d.21-30cigarettesaday d.Morethan30
2. doyouinhale? a. Always b.Quiteoften c. Seldom d.Never
3. Howsoonafteryouwakeupdoyousmokeyourfirstcigarette? a. Withinthefirst30minutes b.Morethan30minutesafterwakingbutbeforenoon c. Intheafternoon d.Intheevening
4. whichcigarettewouldyouhatetogiveup? a. Firstcigaretteinthemorning b.Anyothercigarettebeforenoon c. Anyothercigaretteafternoon d.Anyothercigaretteintheevening
5. doyoufinditdifficulttorefrainfromsmokinginplaceswhereitis forbidden(church,library,movies,etc.)? a. Yes,verydifficult b.Yes,somewhatdifficult c. No,notusuallydifficult d.No,notatalldifficult
6. doyousmokeifyouareillandyouareinbedmostoftheday? a. Yes,always b.Yes,quiteoften c. No,notusually d.No,never
7. doyousmokemoreduringthefirst2hoursthanduringtherest oftheday? a. Yes b.No
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HAndoUt3:ReFeRRAlFoRm
Name:........................................................... D.O.B:.........................................M/F........................
Adress...................................................................................................................................................
.......................................................................... Postcode....................................................................
EmailAddress....................................................................................................................................
School:......................................................... Group/Service......................................................
Referredby:................................................ ContactNo..............................................................
DateofReferral........................................
CANWECONTACTYOUVIA:
TELEPHONEYES/NOLETTERYES/NOTEXTYES/NOEMAILYES/NO
Reasonforreferral/otherInformation:
PleAseRetURnto:smokeFReeCommUnItYseRVICes
gartnavalRoyalHospitalmodularBuilding,1055greatwesternRoad,g120xH
Forfurtherinformationortodiscussthisreferralcontactuson
01412322110thankyouforyourreferral
thisformshouldbecompletedwiththeYoungPerson
CommUnItYsmokeFReeseRVICesREFERRALFORM
NicotineReplacement:ASevenWeekProgramme47
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48NicotineReplacement:ASevenWeekProgramme
q Iunderstandthattheproductisamedicineandwillbe usedbymeandonlyme.
q Iwillspeakto(nameofadvisor)ifIhaveanyquestions aboutmyproduct.
q Iunderstandhowtheproductshouldbeused.
q Iagreetocollecttheproductonaweeklybasis.
q IunderstandthatifIdonotfollowthis,myprescription willbereviewed.
mYnRtContRACt(NAME)
Signed(Youngperson):.........................................................................................................
Signed(Advisor):................................................................. Date........................................
HAndoUt4:nRtContRACt
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wee
k1
Pape
rwor
k
Pens
Act
ivit
ysh
eets
stic
kers
Co
m
onit
or
oth
er
Res
ourc
es
Flip
C
hart
whi
te
Boa
rd
Pens
wee
k3
wee
k6
wee
k2
wee
k5
wee
k4
wee
k7
HAndoUt5:weeklYCHeCklIst
NicotineReplacement:ASevenWeekProgramme49
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50NicotineReplacement:ASevenWeekProgramme
Participantsareseenindividuallyduringsession1.Forthisyoushouldmakesureyouhavethefollowing:
• NicotineReplacementTherapyPharmacy RequestForm
• Completedclientquestionnaireandclient consentform
• Clientrecordcard
Firstly,youshouldcheckthroughtheclientquestionnaireandensureithasbeencompleted.Iftheclienthasmissedoutaquestion,bringthistotheirattention.Iftheydonotwanttoanswerthequestionthereisnocompulsiontodoso,althoughanexplanationastowhyitisbeingaskedmighthelp.Pleasecheckthatyouhaveacorrectaddressandphonenumberfortheclient.ThedetailsarekeptonaprivatedatabaseatSmokefreeServicesandarenotpassedontoanyotherorganisations.
Secondly,ensurethattheclienthassignedanddatedtheconsentform(thisisvitalforfollowup).Youmustalsosignanddatethisform.
Thirdly,discusstheproductsthathavebeenspokenaboutinthegroup.Asexplainedearlier,theNicorette16hourpatchisthefirstlineproductbuttheclientshouldbeallowedtouseanotherproductiftheyhaveanallergytothepatch,havepreviouslybeenunsuccessfulonthepatchorhavemoreconfidenceinanotherproduct.Ifanotherproductischosen,anexplanationshouldbeputinthe‘ReasonforRequest…’boxonthePharmacyRequestForm.
SuitabilityforproductsifappropriateshouldbecheckedagainsttheNRTchart(e.g.iftheysmokemorethan20aday,aninhalatorwouldnotbeappropriateetc).Atthebeginningofthe1to1,youshouldcheckthehowaddictedtheyoungpersonisusingthenicotinedependencequestionnairesandtherefore,compatibilityofdifferentproducts.
Fourthly,enteralltheinformationontotheclientrecordcard:thedate,productchosen,manufacturer,dose(ifappropriate)andanycomments.
Finally,givethewhitecopyoftherecommendationformtotheclienttotaketothenearestparticipatingSmokefreepharmacy.Keeptheyellowcopyfortheclientrecords.
1to1’sarealsodoneinthefollowingweeksbuttheyaremuchbrieferthanweekone.ThepurposeistomonitorNRTuse,allowstheclienttoraiseissues/askquestionstheymaynotwanttointhegroupandtaketheCOreadings.Theclientrecordcardshouldbecompletedeachweek.The1to1shouldnotbeusedasanopportunitytodiscussthequitter’sprogressthisshouldbedoneinthegroup.
HAndoUt6:onetoone
wHAtdoIdoInA1to1?
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HAndoUt7:nRtAdVICesHeet
PRodUCt
Patches
HowtoUseIt
•10mgpatch•15mgpatch•16hourpatchPutoninmorningandtakeoffbeforegoingtobedRemovetheoldpatchandreplacewithafreshpatcheachday.Disposeofpatchcarefullysochildren/petscan’tgetaholdofthemThepatchshouldbeplacedonahairlesspartoftheupperbody.PutontheoppositesideofthebodyeachdaytoavoidirritationUnlessyousmokelessthan10cigarettesaday,youshouldstartonthefullstrengthpatch.
AdVAntAges
PatchgivesaconstantlevelofnicotinethroughoutthedayEasytouse,discreteifunderclothing.Noneedto‘do’anythingoncepatchison.
dRAwBACks
SomepeoplecomplainofoccasionallyfeelingsickwhileusingthepatchSomepeoplethinkthatthepatchcanbetakenofftosmokebutnicotinecontinuestobeinyourbodyforseveralhoursaftertakingapatchoff.RememberingtoputitoninthemorningIttakesafewhoursbeforetheeffectsofthepatcharefeltCanbedifficulttoremovefrompackaging
tHIngstowAtCHoUtFoR!
Remindyoungpersontoeatbreakfastbeforeputtingonpatchasthiscanmakelesssusceptibletofeelingnauseous.Changetheplacethatthepatchisputontominimiseirritation.Putpatchonahairlessplaceontheupperbodye.g.upperarm,toreduceirritationwhenremovingMayneedscissorstoopenpackaging
microtabs Smalltabletsthatareplacedunderthetonguewheretheyslowlydissolve(takesabout30minutes).Theareaunderthetonguehaslotsofbloodvesselswherethenicotineisabsorbed.Lessthan20cigarettesaday:1tabletperhourMorethan20cigarettesaday:2tabletsperhourUsualdose8-12/16-24
QuitediscreetCanbeusedwhenhavingacravingtosmokeIsfast-acting
NeedtouseregularlytogetfullbenefitNeedtoanticipatecravingsNeedtoavoiddrinkingwhilemicrotabisinthemouthNeedtobelefttodissolveandmustn’tbechewed,sucked
AvoiddrinkingwhenusingthemicrotabsMaycausehiccupsandheartburn
NicotineReplacement:ASevenWeekProgramme51
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52NicotineReplacement:ASevenWeekProgramme
PRodUCt HowtoUseIt AdVAntAges dRAwBACks tHIngsto
gum Availablein2strengths:2mgand4mgItisnotchewedlikenormalchewinggum–chewslowlyuntilthetastebecomesstrongandthenparkitbetweenthecheekandthegumtoallowthenicotinetobeabsorbedthroughtheliningofthemouth.Whenthetastefades,chewagainandthenparketc.8-12piecesperday.Butshouldnotexceed15piecesperday
CantasteunpleasantatfirstbutmostpeoplegetusedtoitveryquicklyDiscrete
CantasteunpleasantCan’tbeusediforthodonticbracesarewornYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectivelyCancauseindigestionandnauseaifnotchewedcorrectlyasitirritatesthegut
AvoiddrinkingwhenusingthegumDon’tchewitlikeregulargum–rememberto‘parkit’!”Avoidgumifyoungpersonhasbraces
(continuedover)
Inhalator PlasticmouthpieceandnicotinecartridgeswhichyouinsertintothemouthpieceDrawonitlikeacigarette.Thenicotineisabsorbedintheliningofthemouthandthethroatunlikecigaretteswhichareabsorbedinthelungssoyoudon’tgetthesameeffectasacigarette.6-12cartridgesperday.Eachcartridgecontains20minutespuffingtimealthoughthisdoesn’tneedtobepuffedallattheonetime–itcanbebrokendowntofour5minutesessionsifpreferred–thenicotinedoesn’tescapeafterthecartridgeispierced
ItcanbequitestrongatfirstandcancatchthebackofthethroatbutsomepeoplelikethatasitremindsthemofsmokingInhalatorgoodifbingesmokesatweekendsforexampleMimicssmokingbehaviourIsabitofa‘gadget’CanbeusedwhenhavingacravingSUITABLEFORTHOSEWHOSMOKELESS
NeedtoanticipatecravingstouseeffectivelyQuitevisibletouseMaycausecough/irritationinmouthandthroatYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectively
Goodifyoungpersonmainlysmokesatweekendin‘binges’
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PRodUCt HowtoUseIt AdVAntAges dRAwBACks tHIngstowAtCHoUtFoR!
lozenge Atabletwhichis‘parked’inbetweenthecheekandtheguminasimilarwaytothechewinggumNottobesuckedorcrunched–mustallowto
CantasteunpleasantatfirstbutmostpeoplegetusedtoitveryquicklyDiscrete
NotsuitableforpeoplewhosufferfromPhenylketonuria(PKU)(arareblooddisorderthatisgenerallytestedforinnewbornbabies)UnpleasanttastetostartwithMaycauseirritationofmouthandthroat,increasesalivation,hiccups,heartburn
ShouldnotdrinkanythingwhenlozengesareinthemouthasitaffectstheabsorptionYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectively
nasalspray ThefastestactingNRTproductandonlysuitableforheaviersmokers(i.e.morethan20cigarettesperday)Itisasmallbottleofnicotinesolution.PressthetopdownandameasureddoseofnicotineisdeliveredUsage:(onespraypernostril=1dose)Recommendeddosageis1-2dosesperhourwithamaximumof64spraysperday(i.e.32sprayspernostril)
MostpeoplefinditagoodproductiftheypersevereVeryfastactingCanbeusedwhenhavingcravings
UnpleasanttouseIttakesgettingusedto:causesirritationtothenosecausing,sneezing,coughingandrunningeyesandnose.Butmostpeoplegetusedtoitandthesymptomscalmdownwithin48hoursYoungpeopleoftenfinditdifficulttoperseverethroughtheunpleasanteffects
Youngpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectivelyNotpopularoptionforyoungperson
NicotineReplacement:ASevenWeekProgramme53
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54NicotineReplacement:ASevenWeekProgramme
PRe-
Co
nte
mPl
AtI
on
Co
nte
mPl
AtI
on
det
eRm
InA
tIo
n/
PReP
AR
AtI
on
AC
tIo
nm
AIn
ten
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Ce
Rel
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e/
ReC
YCle
no
/d
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lm
AY
Be
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,let
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otI
VAte
dd
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gIt
/g
olI
VIn
gIt
Ug
H
HAndoUt8:stAgesoFCHAnge
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lapse
lapse
lapse
Not interested in change
HAndoUt9:stAgesoFCHAnge
Relapsing
Maintaining change
Preparing to change
Making changes
Thinking about
change
NicotineReplacement:ASevenWeekProgramme55
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56NicotineReplacement:ASevenWeekProgramme
HAndoUt10:ReFleCtIVestAIRCAse
Name:.............................................................
Usethistorecordotherindicatorsofchange.Marktheoutcomeatthetop,e.g.“lesscigarettessmoked”andrecordthedataontheladderasappropriate.
Date:__/__/__
Date:__/__/__
Date:__/__/__
Date:__/__/__
Date:__/__/__
Date:__/__/__
Date:__/__/__
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HAndoUt11:CARBonmonoxIdestAIRCAse
Name:...............................................................
Date:
30
27
24
21
18
15
12
9
6
3
0
Co
Rea
din
gs
NicotineReplacement:ASevenWeekProgramme57
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58NicotineReplacement:ASevenWeekProgramme
HAndoUt12:QUIttIngdIARY
dA
tew
how
as
Iwit
h?tI
me
How
was
If
eelin
g?w
hat
was
Id
oing
?d
idI
ne
edit
?d
idI
enjo
yit
?If
you
kno
w w
hat
kind
of s
mok
er y
ou a
re it
can
mak
e
it a
bit
eas
ier
to w
ork
out
an a
ctio
n p
lan
for
your
self
w
hen
you
are
tryi
ng t
o q
uit.
If y
ou a
nsw
er t
he q
uest
ions
at
the
top
of t
he d
iary
and
mak
e a
note
of t
he
cig
aret
tes
you
smok
e in
a d
ay it
can
hel
p y
ou s
ee
if th
ere
is a
pat
tern
to
your
sm
okin
g b
ehav
iour
.
1.W
hen
do
yo
um
ost
wan
ta
cig
aret
te?
2.
Whe
nd
oy
ou
smo
kem
ost
?
3.
Wha
tp
arti
cula
rac
tivi
ties
mak
eyo
ulig
htu
p?
4.
Any
sp
ecia
ltim
es?
5.
Pla
ces?
6.
Peo
ple
?
7.
Whi
chc
igar
ette
sd
oy
ou
enjo
ym
ost
of
all?
8.
Whi
chc
igar
ette
sco
uld
yo
uha
vee
asily
do
ne
wit
hout
?
9.
Ifyo
u’ve
foun
da
pat
tern
to
yo
urs
mo
king
,how
are
you
go
ing
to
cha
nge
this
?
10.H
owc
onfi
den
tar
eyo
uab
out
qui
ttin
g?
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HAndoUt13:gRoUPAgReement
Agroupagreementorcontractwhicheveryonecansignisawayofhelpingthegroupregulateits’ownbehaviourbyagreeingtoasetof‘rules’thattheyhavecreatedthemselves(flipchartworkswellforthis).Thiswaythegrouparesigningtheiragreementtoacodeofbehaviourthattheythemselveshavesetanditalsoletsthemknowwhattheycanexpectfromyouasapractitioner.
Itwillmostlikelycoverthingssuchasstandardsofbehaviourandlanguage,respectingoneanother,allowingotherstospeakwithoutinterruption,keepingconfidentialityandalsowhatwillhappenifanypersondoesnotabidebytheagreement.Thismaymeanthatyouhavetoexploresomeissues,forexampletheirunderstandingof‘respect’or‘confidentiality’.
SaMPle GRouP aGReeMeNT fRoM a SCHool SToP SMokING GRouP
‘Alldiscussionsinthegroupstaysinthegroup’
‘letpeoplespeak’
‘noviolence’
‘noabusingeachother’
‘noslaggingeachother’
‘tellthestorynottheperson’
‘Besupportiveofeachother’
‘everythingstaysintheroom’
‘Anyproductsthroughpharmacywillnotbesharedinformation’(withparents/teachers)
‘no-onecansaynothing’
‘secret,can’ttellmum’
NicotineReplacement:ASevenWeekProgramme59
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60NicotineReplacement:ASevenWeekProgramme
HAndoUt14A:ImPoRtAnCe/ConFIdenCelAddeR(gUIdAnCenotes)
Asktheyoungpeopletoindicatehowimportantitisforthemtostopsmokingatthisearlystageandhowconfidenttheyareaboutbeingabletoquit.Markitonthescale(askthemtowriteinthedate).
Thiscanberetainedbythefacilitatorwiththerestoftheweeklyrecordsandtheexercisecanberepeatedatalaterpointintheprogramme.Thiswilldemonstratetotheyoungpersonhowtheirmotivationandconfidencecanchangeovertime.
Ifsomeonehasmadeapreviousquitattemptandisnotveryconfidentabouttryingagain,theconfidencescalecanletthemseehowstoppingsmokingislikeajourneyandthatitmaytakeseveralattemptsbeforetheysucceed.
Insteadofusingtheladdertemplateforthisexerciseyoucouldmakeitmoreinteractiveandgettheyoungpeopletovisualiseascaleacrosstheroomandaskthemtostandonthescaleaccordingtohowconfidenttheyfeelaboutbeingabletostopsmoking.
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HAndoUt14B:ConFIdenCelAddeR
Name:.............................................................
10
9
8
7
6
5
4
3
2
1
notVeryImportant
ReallyImportant
notVeryConfident
ReallyConfident
NicotineReplacement:ASevenWeekProgramme61
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62NicotineReplacement:ASevenWeekProgramme
Thisexerciseletstheyoungpeoplegetinvolvedintalkingaboutboththeperceivedbenefitsofsmokingandthenegativeeffectsofsmoking.Youcanuseaflipchartorwhiteboardtowritetheanswers.Eitheryoucandothewritingoryoucouldlettheyoungpeopledoitthemselves(bemindfulofliteracyissues).Thisexercisecanalsobedoneverbally.
HAndoUt15:tHeFoURwHYsexeRCIse
smokIng gIVIngUP
The good things about smoking
The NoT so good things about smoking
The NoT so good things about giving up
The good things about giving up
stARtHeRe
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HAndoUt16:AmIReAdYtostoPsmokIng?
What do I enjoy about smoking?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Why do I want to stop smoking?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
NicotineReplacement:ASevenWeekProgramme63
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64NicotineReplacement:ASevenWeekProgramme
HAndoUt17:FeelIngsABoUtQUItdAY
ConFIdent
deteRmIned
sCARed
negAtIVe
woRRIed
exCIted
AnxIoUs
Whenacardistakenoutofthebag,askthemiftheythinkthefeelingappliestothemandifsoaskthemtoexplainwhy.Aftertheyhavedrawnthecardsaskthemtoputthemintoonepileifittheycanrelatetothefeelingandintoanotherpileiftheycannotrelatetoit.Attheendoftheexerciselooktoseeiftheyhaveidentifiedwithmainlypositiveornegativefeelingsandthisshouldgeneratemorediscussion.Reassurethemthatalloranyofthesefeelingsarenormal.
Analternativeexerciseistouseaflipchart/post-itsorawhiteboardinsteadofthecards.Writethefeelingsupsothegroupcanseethem,anddiscussiftheyoungpeoplecanrelatetothemornot.
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HAndoUt18:mYstoPsmokIngdIARY
use the diary to identify your smoking habits
stoPsmokIngdIARY
Name:.................................................................................................... Day:..........................................
use for 3-7 days
Cigarettenumber time whoyouwerewith whatwereyoudoing? enjoyed
Yes/no
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
NicotineReplacement:ASevenWeekProgramme65
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HAndoUt19:‘mYACtIonPlAn’
66NicotineReplacement:ASevenWeekProgramme
PRePARIngtoQUIt stAYIngstoPPed
HowtoCoPewItHCRAVIngs mYRewARdFoRstoPPIng
Myquitdateis:.......................................................................................................................................
mYACtIonPlAn
ItreallyhelpsifyoucanprepareyourselfforQuitDay.Whatthingscanyoudothatwillhelpyougetreadyforwhenyoustopsmoking?Herearesomeideas;buysugarfreegum,alwayshaveabottleofwater,signupforanexerciseclass,tellyourfriendsandfamily.Whatwillworkforyou?Before I stop smoking I will prepare myself for quit day by:
1...................................................................................................
2..................................................................................................
3..................................................................................................
4..................................................................................................
Whenyoustopsmokingyoumightexperiencecravings.Whatdoyouthinkyoucoulddotohelpyoucopewithcravings?
If I get a craving for a cigarette I will:
1...................................................................................................
2..................................................................................................
3..................................................................................................
4..................................................................................................
wHoCAnHelPmewItHtHIs?
Makeanotehereofthepeoplewhowillhelpandsupportyouwhenyouaretryingtostopsmoking.
These people will help me:
1...................................................................................................
2..................................................................................................
3..................................................................................................
Stoppingsmokingisagreatachievementandyoumightdecidethatyoudeservearewardasatreat.
I will give myself a reward when (fill in your own occasions):
1.Istopfor?......days
2.Ihavestoppedfor?......weeks
3.Imanageadifficultsituation?
4.After?......months
Stoppingsmokingisn’talwayseasy–youmightneedtotryseveraltimesbeforemanagingtostop.Itisimportantthatyougetenoughsupportwhenyouaretryingtostopsotalktoyoursupportadvisoraboutit–itreallywillhelp!
If I am finding things difficult I will:
1...................................................................................................
2..................................................................................................
3..................................................................................................
4..................................................................................................
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HAndoUt20:CoPIng
CoPIngACtIVItY
Askthegroupifanyonehasexperienceofsomeonehelpingthemwithasituationthattheyhavefounddifficult.Askthemtodescribewhatthepersondidforthemthatmadethesituationeasierandwhythiswasimportant.
Relatethistothegroupanduseittodemonstratethatsometimesdoingsomethingthatisreallydifficultcanbemadealittlebiteasierwhensomeonestandsalongsideandsupportsthem.Explainthatthisiswhatthegroupisfor–thattheothersinthegroupcankeepthemmotivatedwhenthegoinggetstoughandtheyfeelasifitistoohard.
NicotineReplacement:ASevenWeekProgramme67
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68NicotineReplacement:ASevenWeekProgramme
HAndoUt21:CoPIng
dIsCUssIonABoUtCoPIng
• Whatwouldyouliketobeabletodointhissituation?
• Howwouldyoufeelifyoumanagedtogetthroughthissituationwithout smokingacigarette?
• Howdoyouthinkotherpeoplehavecopedwiththissituation?
• Whatcouldyoudodifferentlynexttimeyoufacethissituation?
• Whatdoyouthinkyourfriendswouldsaytoyouiftheyknewyouwere concernedaboutgettingthroughthissituation?
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HAndoUt22:dIsCUssIonABoUtCoPIng
Dividethegroupupintosmallergroups(3or4groupsifpossible)orifitisasmallgroupthenworkingtogetherisfine.
Headup3sheets(flipchart)withtheheadings;
• How to deal with a craving
• How to say no
• alternatives to smoking
Givethegroups5minutestolistasmanythingsaspossibleundertheheadingtheyhavebeengiven.
Bringthegroupbacktogetherandeachshouldreadouttheirlist.
Inthelargegroupaskthemtomakeanewlistora‘TopTenTips’forstoppingsmoking.
ToP TeN TIPS foR SToPPING SMokING
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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HAndoUt23:QUIttIng
ACtIVItY
• Howisthefirstdayofbeinganon-smoker?
• Howdoyoufeel?
• Howdidyoucopewithoutyourfirstcigarette?
• Howwillyoucopewithyour‘difficult’cigarette?
• Whatwillyoudoinsteadofsmokingthatcigarette?
• Whatwillyoudowhenyouarewithyoursmokingfriends?
• Whatwillyoudoifsomeoneoffersyouacigarette?
• Whatwillmakequittingdifficult?
• Whatcouldhelpmakequittingeasier?
• Whocanhelpyouandsupportyou?
• Whomighttryandpreventyouquittingormakeitdifficult?
• Whatwillyoudoifyoufeelyoureallyneedacigarette?
• Remindmeagainwhyyouwanttostop
• Whatareyoumostlookingforwardtoaboutbeinganon-smoker?
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HAndoUt24:QUItCHARt
Mark your quit day with a ‘q’ – every day that you go without a cigarette put a tick 4 in the box. If you smoke on any day then write in the number of cigarettes that you have on that day.
mYQUItCHARt
Name:...................................................................
JAn mAY sePtmARCH JUlY noVFeB JUne oCtAPRIl AUg deC
1.
5.
9.
13.
17.
21.
25.
29.
3.
7.
11.
15.
19.
23.
27.
31.
2.
6.
10.
14.
18.
22.
26.
39.
4.
8.
12.
16.
20.
24.
28.
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72NicotineReplacement:ASevenWeekProgramme
HAndoUt25:wItHdRAwAl
InCReAsedAPPetIte
IRRItABIlItY
HeAdACHes
CRAVIngs
use these cards to promote discussion about common feelings and symptoms of withdrawal (add others as required)
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HAndoUt26:dIsCUssIon-nICotInedePendenCe
AddICtIon
HABIt
dePendenCe
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74NicotineReplacement:ASevenWeekProgramme
stIllstoPPed?–dIsCUssIon
• Howareyoufeeling?
• Howareyoucoping?
• Hasitbeenasyouexpected?
• Whatarethegoodthingsabouthavingstoppedfor(x)weeks
• Hasitbeendifficult?Tellmeaboutthat.Howhaveyoucoped?
• Doyoufeelanybenefitsfromstopping?
• Whathaveotherpeoplesaidtoyou?
• Doyoustillfeelmotivated?
• Howconfidentdoyoufeel?
• Whathaveyounoticedsinceyoustoppedsmoking?
HAndoUt27:mAIntenAnCe
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RelAPse–dIsCUssIon
• Whatwasitthatmadeyouhavethatcigarette?
• Wherewereyou?Whowereyouwith?Whatwereyoudoing?
• Didyouenjoyit?
• Whatdidyoufeelduringandafter?
• Howdoyoufeelaboutitnow?
• Whatcouldyouhavedonedifferently?
• Whatcouldyouhavedoneinsteadofhavingacigarette?
• Doyoustillwanttoquit?
• Doyoufeelreadytotryagain?
HAndoUt28:RelAPse
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76NicotineReplacement:ASevenWeekProgramme
HAndoUt29:wHAtABoUttHeFUtURe?
dIsCUssIonABoUttHeFUtURe
• Howdoyoufeelaboutgoingitalone?
• Howhaveyoucopedwithstressfulsituations?Howdidthatgo?
• Whenisyourmostdifficulttime?
• Whathasthisexperiencebeenlike?
• Tellmeagainwhyyouwantedtostop.
• Doyoufeeldifferentnow?Tellmeaboutthat.
• Howmuchmoneyhaveyousaved?
• Howdoyouthinkyouwillcopenowthatthegrouphascometoanend?
• HowdoyouthinkyouwillcopewhenyourNRTcomestoanend?
• Howdoyouseethefuture?
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HAndoUt30:PeoPleBIngo
Give each person a sheet which you should fill out with things like: ‘only drinks Irn Bru’, ‘has a pet hamster’ or ‘is wearing black shoes’ – they should find someone who ‘matches the description’ and write their name in the box. first person to complete the sheet is the winner. If possible, each person’s name should only appear once.
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only drinks Irn Bru Has a Pet Hamster
Is Wearing Black Shoes
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78NicotineReplacement:ASevenWeekProgramme
HAndoUt31:tRUtHoRlIegAme
tRUtHoRlIe?
Everyonesitsinacircle.Thefacilitatorkicksoffbymakingonetrueandone
falsestatementaboutthemselves.Everyonehastoguesswhichstatementsaretrueandwhichare‘lies’.
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HAndoUt32:smokIngwoRdseARCH
EMPHYSEMANEUROTRANSMITTERCIGARDOPAMINEADDICTIONREWARD
SMOKINGWITHDRAWALCIGARETTECANCERDRUGACETYLCHOLINE
BRAINBLOODSTREAMRECEPTORNICOTINETOBACCO
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A Z W S A M E S Y H P M ER O T P E C E R Q Y I N PR E S L O L J G T R I E NB N I A R B U O D L P U ML R Z W A R T M O O T R KO X Q A D E I H P R Z O RO Q A R W O C C A B O T ND S E D E L D G M R F R OS Y G H Y U I J I K I A IT X P T C C L V N J B N TR N E I M A R T E Y I S CE C Q W O Z C D O P M M IA D D R Y C T A R E N I DM O T K Z Q P O N A T T DN E T T E R A G I C W T AG E U N I C O T I N E E LA L S G N I K O M S I R R
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80NicotineReplacement:ASevenWeekProgramme
HAndoUt33:CsI–glAsgow
AgAmeBAsedARoUndtHetVsHowCsI
Drawabodyonflipchartpaper(lifesizeisgood),andsetthesceneexplainingthatthisisthebodyofa40yearold,20adaysmoker.Askthegroupwhattheywouldexpecttofindonorinsidethebody,giventhattheywereasmoker.Askthemtodrawtheansweronthebody.
Youwillbelookingforanswerslike‘blackenedlungs’oryellowteethandfingersetc.Usethetarjarandchemicalboardtoillustratethis.
Usinggraphicimages(seeGoogleimages)usuallyprovokesastrongreactionfromyoungpeopleandhelpstoillustratesomeoftheconditionsthattheywillhavetalkedaboute.g.lungcancerandheartdisease.
Avariationofthisistohavetwocoloursofpost-itnotes(oneforpositiveandonefornegative)andmakealistoftheeffectsofsmokingandbenefitsofquitting.
Asktheyoungpeopletoselectsomeoftheharmfuleffectsandalsothebenefitsofquittingandwritethemonthepost-its(oneperpost-it).Inturnaskthemtostickthenotesonthe‘body’wheretheeffectwouldbe.Usethistogeneratediscussionabouttheeffectsofsmoking.
Forexample:
• Howseriousaretheeffects?
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HAndoUt34:FACtoRmYtH?
Preparesomestatementsthatcanbereadoutorproducedonlaminatedcardthatarepopularopinionormyths,andusethemtoguidediscussionaboutsomeoftheacceptedthinkingabouttobacco.for example:
once you start smoking you can’t stop! –MYTH;nicotineaddictionfreewithin2weeks
If I stop smoking I will put on a lot of weight-Discuss
More boys smoke than girls –MYTH;atage15moregirlsthanboyssmoke
Most young people smoke cigarettes–MYTH;mostyoungpeopledonot
Most adults smoke cigarettes–MYTH;usedtobethecaseinthe60’sand70’sbutnow
Smoking makes you look tough–DOESIT?DISCUSS
Smoking makes you look cool–DISCUSS
Smoking makes you look grown up –DOESIT?DISCUSS
I just smoke now and then and I’ll never get hooked–MYTH;mostpeoplewhosmokestartedbeforetheywere19
Smoking never did my gran any harm and it’s not going to harm me–DISCUSS
lung cancer? That won’t happen to me!–90%oflungcancersarecausedbysmoking
There are a lot more dangerous things out there than smoking–smokingkillsmorepeoplethanillegaldrugs,suicide,roadaccidentsetc
You have to die sometime so who cares about smoking?–smokingisthesinglebiggestmostpreventablecauseofprematuredeath
By the time I get older there will be a cure for cancer–DISCUSS
I couldn’t relax without a cigarette–smokingincreasesbloodpressure,heartrateetc
Smokers have more fun–DISCUSS
Smoking around children doesn’t harm them–DISCUSSsecondhandsmokeandsocialnorms
I’ll worry about the damage it does in the future–damagetolungsetcisreversiblebutpermanentdamagecanneverberepaired
I’ll give up when I’m a bit older–mostadultsstartedsmokingwhentheywereteenagersandmosthavetomakeseveralattemptsbeforetheymanagetostopsmoking
Smoking doesn’t cost that much money–calculatecostofsmokingandrelatetothecostofsomethingsthatyoungpeoplemightwanttobuye.g.computers,car,holidays,clothes
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Useful Resources
Ifyourequireanyfurtherinformationonanyofthecontentthefollowinglinksaregivenasahelpfulguide;aCTIoN oN SMokING foR HealTH (aSH)
Acampaigningpublichealthcharityworkingtoeliminatetheharmcausedbytobacco.
www.ash.org.uk
aSH (aCTIoN oN SMokING foR HealTH) SCoTlaNd
Raisesawarenessabouttobaccouseanditsharmfuleffects,andcontributestotheimplementationofpublichealthpoliciestohelpsmokerstoquitandtoprotectchildrenfromtobacco.
www.ashscotland.org.uk
CaN SToP SMokING
DevelopedbyNHSHealthScotland,thiswebsiteprovidesinformationonthereasonsbehindwhypeoplesmokeandthesupportthatisavailableiftheyarelookingtoquit.Localsmokingcessationservicescanbefoundonthiswebsite.
www.canstopsmoking.com
CleaRING THe aIR
InformationaboutScotland’sbanofsmokinginpublicplaces.
www.clearingtheairscotland.com
GaSP
Tobaccoresourcesavailabletobuy–leaflets,activitypacks,displays,postersetc.
www.gasp.org.uk
NHS SToP SMokING SeRvICeS
NHSGG&CSmokefreeServicesareresponsibleforawiderangeoftobaccoprojectsaimedatreducingthedamagefromtobacco.Offersvarioussupportservicesforquittingsmoking.
Smokeline telephone number: 0800 84 84 84
www.nhsggcsmokefree.org.uk
THe loW-doWN
Providesinformationaboutteenagehealthforteenagersandalsoforthosewhoworkwiththem.
www.getthelowdown.co.uk
ToBaCCo INfoRMaTIoN SCoTlaNd
TobaccoInformationScotlandprovidessmokingandtobacco-relatedinformationinScotland.
www.tobaccoinscotland.com
W-WeST (WHY WaSTe eveRYTHING SMokING ToBaCCo)
Scotland’sfirstpro-choicesmokinginformationmovement,ledbyyoungpeopleforyoungpeople.W-WESTaimstogiveyoungpeoplethefactsaboutsmokingtoenablethemtomakeinformedchoices.
W-WEStoffersfreetrainingforexistingPeerEducationProjectsintheGreaterGlasgow&Clydearea.Thistrainingwillgiveyoungpeereducatorstheknowledgetheyneedtodiscusssmokingandtobaccousewiththeyoungpeopletheyworkwith.
www.w-west.org.uk
Alltelephonenumbersandwebsiteaddresseswerecorrectattimeofpublication.Theauthorcannotbeheldresponsibleforthecontentsofanypagesreferencedbyanexternallink.
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Toolkit References
1. Taulbut,M.Gordon,D.andMcKenzie,K.TobaccosmokinginScotland:anepidemiologybriefing.[Online]. Edinburgh:NHSScotlandandScottishPublicHealthObservatory.2008Availablefrom: www.scotpho.org.uk/home/Publications/scotphoreports/pub_tobaccobriefing.asp [Accessed12November2010]
2. AllenderS,BalakrishnanR,ScarboroughP,WebsterP,RaynerM.Theburdenofsmokingrelatedillhealthsin theUK.TobaccoControl.2009;18:262-267.
3. ActiononSmokingandHealth(Scotland)(AshScotland).StateoftheNation:Measuringprogresstowards atobacco-freeScotland[Online].Availablefrom:www.ashscotland.org.uk/policy/state-of-the-nation [Accessedon12November2010]
4. ActiononSmokingandHealth(Scotland)(AshScotland)BriefingonYoungPeopleandTobaccoMarch2010 [online].Availablefrom:www.ashscotland.org.uk/ash/files/young_people_and_tobacco_March2010.pdf [Accessed4November2010]
5. ScottishPublicHealthObservatory.TobaccoUse[online]. Availablefromhttp://www.scotpho.org.uk/home/Behaviour/Tobaccouse/tobacco_intro.asp
6. ScottishExecutive.TheTobaccoandPrimaryMedicalServices(Scotland)Act2010:AConsultationonTobacco DraftRegulations[online]April2010.Availablefromhttp://www.scotland.gov.uk/Publications/2010/04/27151930/5
7. ScottishExecutive.ABreathofFreshAirforScotland.ImprovingScotland’sHealth:Thechallenge–tobacco controlactionplan[online].Edinburgh,ScottishExecutive,2004.Availablefrom: http://www.scotland.gov.uk/Publications/2004/01/18736/31540
8. CurrieC,FairgrieveJ,AkhtarP,CurrieD.ScottishSchoolsAdolescentLifestyleandSubstanceuseSurvey (SALSUS)NationalReport:SmokingDrinkingandDrugUseamong13and15yearoldsinScotland2002.Scottish Executive2003.Availablefromwww.drugmisuse.isdscotland.org/publications/abstracts/salsus_national02.htm
9. ScottishExecutive.Towardsafuturewithouttobacco:TheReportofTheSmokingPreventionWorkingGroup [online]November2006.Availablefromhttp://www.scotland.gov.uk/Publications/2006/11/21155256/5
10.NHSHEALTHDEVELOPMENTAGENCY.SmokingInterventionswithChildrenandYoungPeopleJune2004.
11. NHSHEALTHDEVELOPMENTAGENCY.SmokingInterventionswithChildrenandYoungPeople[online] June2004.Availablefromhttp://www.nice.org.uk/nicemedia/documents/CHB6-smoking-interventions-14-7.pdf
12.TheSmokingPreventionWorkingGroup.TowardsaFutureWithoutTobacco.[Online].ScottishExecutive2006. Availablefromhttp://www.scotland.gov.uk/Publications/2006/11/21155256/0
13.ScottishExecutive.ABreathofFreshAirforScotland.ImprovingScotland’sHealth:Thechallenge–tobacco controlactionplan[online].Edinburgh,ScottishExecutive,2004.Availablefrom: http://www.scotland.gov.uk/Publications/2004/01/18736/31540
14.ActiononSmokingandHealth(Scotland)AshScotland)BeyondSmokeFreeOctober2010[online]. Availablefrom:http://www.ashscotland.org.uk/policy/beyond-smoke-free
15.NICE(2008b)Smokingcessationservicesinprimarycare,pharmacies,localauthoritiesandworkplaces, particularlyformanualworkinggroups,pregnantwomenandhardtoreachcommunities.NICEpublichealth guidance10.LondonNationalInstituteHealth&ClinicalExcellence.
16. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10ofthe SmokingPreventionActionPlan(May2010)
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17. MoolchanE.T.,Robinson,M.L.,ErnstM,CadetJ.L.,PickworthW.B.,HeishmanS.J.,etal.Safetyandefficacyof thenicotinepatchandgumforthetreatmentofadolescenttobaccoaddiction.Paediatrics2005Apr;115(4): e407-14.
18. HEALTHSCOTLAND.ExternalEvaluationoftheNHSHealthScotland/ASHScotlandYoungPeople andSmokingCessationPilotProgramme(June2006)[online]. Availablefromhttp://www.healthscotland.com/documents/1381.aspx[Accessed16November2010]
19. HEALTHSCOTLAND.ExternalEvaluationoftheNHSHealthScotland/ASHScotlandYoungPeople andSmokingCessationPilotProgramme(June2006)[online]. Availablefromhttp://www.healthscotland.com/documents/1381.aspx[Accessed16November2010]
20. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10ofthe SmokingPreventionActionPlan(May2010)
21. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10 oftheSmokingPreventionActionPlan(May2010)
22. HEALTHSCOTLAND.ExternalEvaluationoftheNHSHealthScotland/ASHScotlandYoungPeople andSmokingCessationPilotProgramme(June2006)[online]. Availablefromhttp://www.healthscotland.com/documents/1381.aspx[Accessed16November2010]
23. ActiononSmokingandHealth(Scotland)(AshScotland).Fags‘n’Hash–TheEssentialGuidetoCuttingDown theRisksofUsingTobaccoandCannabis(2005) http://www.playfieldinstitute.co.uk/information/pdfs/leaflets/substance_misuse/leaflet_Fags_and_Hash_guide_to_cutting_down_the_risks_of_using_tobacco_and_cannabis.pdf
24. MoolchanE.T.,Robinson,M.L.,ErnstM,CadetJ.L.,PickworthW.B.,HeishmanS.J.,etal.Safetyandefficacyof thenicotinepatchandgumforthetreatmentofadolescenttobaccoaddiction.Paediatrics2005Apr;115(4):e407-14.
25. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10ofthe SmokingPreventionActionPlan(May2010)
26. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10ofthe SmokingPreventionActionPlan(May2010)
27. NICE(2006)PH1Briefinterventionsandreferralforsmokingcessation:guidance. http://www.nice.org.uk/guidance/PH1/guidance
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