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Introduction to Smoking Cessation

Introduction to Smoking Cessation. Edward Anselm, M.D. Chief Medical Officer FidelisCare, New York EdwardAnselmMD.com eanselm@msn.com. Self Efficacy. The perception that one can master a certain task or perform adequately in a given situation. Performance accomplishments

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Introduction to Smoking Cessation

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  1. Introduction to Smoking Cessation Edward Anselm, M.D. Chief Medical Officer FidelisCare, New York EdwardAnselmMD.com eanselm@msn.com

  2. Self Efficacy • The perception that one can master a certain task or perform adequately in a given situation. • Performance accomplishments • Vicarious experience • Verbal persuasion and social influence

  3. New York City Trends *Chart from NYC DOHMH available at www.nyc.gov

  4. Targeted Marketing • Women • Young People • Racial and Ethnic Minorities • Lesbian/Gay/Bisexual/Transgender

  5. Role of the Physician Ask about smoking Advise tobacco users to quit Assess readiness to quit Assist with a plan for quitting Arrange follow-up

  6. Effect of General Practitioners’ Advice Against SmokingRussell, MAH et al, , BMJ 1979 2, 231-5

  7. Ask about smoking Ask about smoking at every visit. Do you smoke? How much do you smoke each day? What brand do you smoke? Have you ever smoked other brands?

  8. Vital Signs Stamp VITAL SIGNS Blood Pressure: Pulse: Weight: Temperature: Respiratory Rate: Tobacco Use: Current Former Never (circle one)

  9. Advise tobacco users to quit “ I want you to quit smoking.” “It is important for you to quit smoking.” “Tell me about your previous attempts to quit.” “Why did you go back to smoking?”

  10. Assess readiness to quit Do you believe you will be able to quit smoking in the next six months? Do you believe you will be able to quit smoking in the next month? Would you like to set a date?

  11. Assist with a plan for quitting Contracting for Behavior Change Setting a quit date Use of printed materials Set expectations Follow-up visit/phone call Use of medication Use of support groups

  12. A CONTRACT TO QUIT SMOKING • AGREE TO QUIT SMOKING ON _________________ • I WANT TO QUIT SMOKING BECAUSE___________________ • MY REWARDS WILL BE __________________________

  13. How much does it cost you to smoke?

  14. Arrange follow-up Telephone Office visit Find out what went wrong Ask patient to recommit to plan

  15. The Impact of Physician Advice to Quit Smoking Simple advice 5% Advice plus follow-up 10% % of all smokers abstinent at one year after intervention

  16. Enhancing the Impact of Simple Advice and Follow-up Medication doubles or triples the impact of any intervention Group support doubles the impact of any intervention

  17. Role of the Physician Ask about smoking Advise tobacco users to quit Assess readiness to quit Assist with a plan for quitting Arrange follow-up

  18. The Behavior of Smoking I Early Experimentation Brand Identification Regular Smokers Chippers Light Smokers Heavy Smokers Interest in quitting

  19. The Behavior of Smoking II Nicotine is an addictive drug Nicotine delivery to brain in eight seconds Most smokers maintain a steady level of nicotine 10-12 puffs per cigarette 20 cigarettes per day (200 puffs) 7300 cigarettes per year (73,000 puffs)

  20. The Behavior of Smoking III Oft repeated habit Social situations Stress management Associated with food, alcohol Low awareness of risk Fear of failure Episodic Mood Management

  21. Nicotine Withdrawal Anxiety irritability anger restlessness difficulty concentrating

  22. The Natural History of Smoking Cessation 50 Million former smokers 5-8 efforts to quit smoking Each effort resulted in longer periods of abstinence from smoking Process over several years

  23. Methods of Smoking Cessation Self Help Physician Advice Counseling Social Support Telephonic Support and Advice Smoking Cessation Classes Medication Hypnosis/Acupuncture

  24. Smoking Cessation and Weight Gain Smokers weigh less than non-smokers 5-10 pound gain, on average Less initial weight gain with use of medication

  25. Why do people relapse? Nicotine withdrawal Alcohol Stress Social situation

  26. What to do if your patient relapses Find out why More intensive treatment Referral for intensive program Psychiatric evaluation

  27. Use of Medication Nicotine Patch Nicotine Gum, Nasal Spray Nicotine Lozenge, Inhaler Buproprion, and other Antidepressants Combination Therapy Varenicline (Chantix) Rimonibant Nicotine Vaccine

  28. Role of the Physician Ask about smoking Advise tobacco users to quit Assess readiness to quit Assist with a plan for quitting Arrange follow-up

  29. Smoking and Mental Illness JAMA 2000 Nov 22-29; 284 (20): 2606-10

  30. Tobacco Use and Mental Health • Nicotine and self medication • Episodic mood management • Depression • Substance abuse • Anxiety Disorders • OCD, ADD • Schizophrenia

  31. Self Efficacy • The perception that one can master a certain task or perform adequately in a given situation. • Performance accomplishments • Vicarious experience • Verbal persuasion and social influence

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