what we need to know about smoking & tobacco addiction
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What we need to know about smoking & tobacco addiction. Facts & Figures. Prevalence rates of nicotine dependence in people with mental health & addictions services is estimated at 50 – 90%. Mental Health nurses smoking prevalence is twice as high as general nurses (29% vs 14%*). - PowerPoint PPT PresentationTRANSCRIPT
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What we need to know about smoking & tobacco
addiction
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Facts & Figures
• Prevalence rates of nicotine dependence in people with mental health & addictions services is estimated at 50 – 90%.
• Mental Health nurses smoking prevalence is twice as high as general nurses (29% vs 14%*).
• General population’s prevalence of nicotine dependence 21%*.
Source*:2006 New Zealand Census data
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Facts & Figures
• Within NZ 1/3 of all cigarettes are consumed by people with a mental illness of at least 12 mths*.
• Anecdotally screening and treatment for nicotine dependence hasn’t been offered by health services to people with mental health and addiction issues.
• People with serious mental illness have a life expectancy 15 yrs less than general population
*Ref. Tobias M, Templeton R & Collins Tobias S (2008). How much do mental disorders contribute to New Zealand's tobacco epidemic? BMJ
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What’s in tobacco smoke?
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The Risks of Smoking
• About half of all people who smoke die from a smoking-related disease– 500 people/year in NZ– On average die 15 yrs younger– Those killed in middle age (25%
of all smokers) lose many years of productive life
• Smoking also causes loss of quality of life (eg. due to breathlessness)
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What is in a cigarette?
• Tobacco cigarettes contain over 4000 chemicals, many of which are highly toxic.
• 40 are known cancer-causing substances
• Nicotine is a drug that occurs in tobacco. It causes addiction but is not cancer-causing.
• The tars and gases in cigarettes cause the most damage.
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Nicotine!
• When we quit smoking, we can feel the effects of ‘nicotine withdrawal’.
A major factor that maintains a smoking habit over time is addiction to nicotine
• We may get tense, or crave cigarettes. But these feelings are only temporary…
• We become addicted to nicotine very quicklyEven as quickly as with one puff!
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Nicotine withdrawal symptom
Duration Proportion of those trying to quit who are affected
Irritability / aggression
< 4 weeks 50%
Depression < 4 weeks 60%
Restlessness < 4 weeks 60%
Poor concentration
< 2 weeks 60%
Increased appetite
> 10 weeks 70%
Light-headedness
< 48 hours 10%
Night-time awakenings
< 1 week 25%
Craving > 2 weeks 70%
Jarvis MJ. ABC of smoking cessation. Why people smoke. BMJ 2004;328:277-9.).
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People want to stop smoking
– 69% of smokers tried to quit in last 5 yrs– 44% of smokers tried to quit at least once in the last year– Maori, Pacific and young smokers just as likely to have
tried to quit– 72% of 15 to 19 yr old smokers would not smoke if they
had their life again
Ref. 2009 New Zealand Tobacco Use Survey. MoH. 2010.
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How can people best be supported to become
smokefree?
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The ABC Approach
•A - ask whether a person smokes
•B - give brief advice to quit to all people who smoke
•C – make an offer of, and provide or refer for cessation support
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How does the ABC work?
• Aims to provide better help for smokers to quit.• Can be easily integrated into everyday practice,
so that smokers are presented with every opportunity to quit.
• Can be personalised.• Emphasises being encouraging and providing
people the support and tools they need to become smokefree.
“A little and often by many over time works.” (Fiore 2000)
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A- Ask
• Ask whether a person smokes & document in notes
• Ask routinely &• At least every six months
“Are you currently smoking?”
“Last time we caught up you were smoking, how are you doing with that?”
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B- Brief Advice
• Personalise your advice
• Acknowledge that it’s difficult
• Be supportive
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PHARMACOLOGICAL
•Nicotine replacement therapy (NRT) patches/gum/lozenges subsidised•Other medications available on prescription (Zyban, Nortriptyline subsidised & Champix subsidised for eligible people)
BEHAVIOURAL
•Telephone/Txt-based support - Quitline - SmokeStop•Face-to-face support - Asian Smokefree - Aukati KaiPaipa - Pacific Quit Service - Pasifika Smoking Cessation - Pregnancy Services - Specialist Hospital Services - Local Quit Smoking Coaches
Combining both gives the greatest chance of success
C – Cessation (Quit) support
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What is NRT?
• NRT safely replaces some of the nicotine that is normally provided by tobacco, and reduces the severity of withdrawal symptoms.
• NRT roughly doubles the likelihood of a successful quit attempt.
• There are a range of products available, and different products will suit different people.
• Not a magic cure – effort, support and strategies are also needed.
• Only $3 for 8 weeks supply
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Quitting without supportThe majority of people who quit this way will relapse in the first week
Only 2.5%
abstinent at 1-year
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Impact of Increasing Quit Attempts and Support
Aveyard and West. Managing Smoking Cessation. BMJ 2007;335:37-41
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“We must do everything we can to help people quit smoking and to stop young
people from being tempted to
take up the habit" Hon Tariana Turia
Associate Minister of Health