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What we need to know about smoking & tobacco addiction

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%*).

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What we need to know about smoking & tobacco addiction

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  1. What we need to know about smoking & tobacco addiction

  2. 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

  3. 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

  4. What’s in tobacco smoke?

  5. 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)

  6. 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.

  7. Nicotine! A major factor that maintains a smoking habit over time is addiction to nicotine • We become addicted to nicotine very quicklyEven as quickly as with one puff! • When we quit smoking, we can feel the effects of ‘nicotine withdrawal’. • We may get tense, or crave cigarettes. But these feelings are only temporary…

  8. 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.).

  9. 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.

  10. How can people best be supported to become smokefree?

  11. 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

  12. 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)

  13. 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?”

  14. B- Brief Advice • Personalise your advice • Acknowledge that it’s difficult • Be supportive

  15. C – Cessation (Quit) support • 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 • PHARMACOLOGICAL • Nicotine replacement therapy (NRT) • patches/gum/lozenges subsidised • Other medications available on • prescription (Zyban, Nortriptyline • subsidised & Champix subsidised for • eligible people) Combining both gives the greatest chance of success

  16. 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

  17. Quitting without support The majority of people who quit this way will relapse in the first week Only 2.5% abstinent at 1-year

  18. Impact of Increasing Quit Attempts and Support Aveyard and West. Managing Smoking Cessation. BMJ 2007;335:37-41

  19. “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

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