HERTFORDSHIRE STOP SMOKING SERVICE BRIEF INTERVENTION TRAINING FOR HEALTH CHAMPIONS

1. HERTFORDSHIRESTOP SMOKING SERVICEBRIEF INTERVENTION TRAINING FOR HEALTH CHAMPIONS Trainer: Janka Szocs Stop Smoking Specialist22nd April

2. What causes the most deaths per day worldwide? Illegal Drugs Aids Smoking Murder Road Accidents Suicide

3. Smoking causes approximately 13000 deaths per day worldwide Illegal Drugs Aids Smoking Murder Road Accidents Suicide More deaths than all of the other 5 added together

4. Smoking Smoking is responsible for 20% of all deaths in the UK. 300 deaths in the UK daily 50% of smokers die prematurely Repeated quit attempts may be needed Consider Smoking as: a powerful motivation to engage versus an impaired capacity for restraint1 Robert west Maudsley clinic London

5. Smoking: Cost to the NHS £5.2 billon per year Allender S, Blakrishnan R, Scarborough P, Webster P, Rayner M. The burden of smoking related ill health in the United Kingdom. Tobacco Control, 2009;18.262-267

6. What’s in a cigarette?

7. More than 4,000 other chemicals in cigarette smoke,1 more than 50 of which are known to cause cancer2 It is the mixture of toxins in cigarette smoke that is responsible for the majority of the harmful effects, not nicotine1 Myth: Nicotine causes the diseases related to smoking FACTS: There is no evidence to suggest that nicotine causes cancer 3 http://smokeaway.files.wordpress.com • www.treatobacco.net./English/keyfindings/key_finding_1.html Last accessed on 15.02.08 • Hoffmann D & Hoffmann I. J Toxicol Environ Health 1997; 50(4):307-364.

8. 70% of the tar in smoke is deposited in the lungs. • Many of the chemicals are known to cause cancers • Damages lungs & cilia • Stains fingers, teeth & hair • ? Low tar vs High tar Tar

9. Carbon Monoxide Carbon monoxide is a clear odourless, poisonous gas that dissolves in the blood quicker than oxygen. It attached to the red blood cells reducing oxygen in the blood by up to 13%. The body compensates by making more red cells, making the blood thicker and stickier so the heart Has to work harder resulting in an increased risk of Developing coronary heart disease. Carbon monoxide is harmful during Pregnancy as it reduces the amount of oxygen carried to the baby in the womb Carbon monoxide levels can be measured using a CO monitor.

10. MECHANISM OF ACTION OF NICOTINEIN THE BRAIN Nicotine binds to 42 nicotinic acetylcholine receptor stimulating dopamine release1-3 This results in the satisfaction associated with smoking1-3 A drop in nicotine levels leads to craving and withdrawal1,4 Nicotine Dopamine NIC NucleusAccumbens(nAcc) VentralTegmentalArea(VTA) NIC 2 2 4 4 2 α4β2 Nicotinic Receptor 1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. Coe JW et al. J Med Chem 2005; 48: 3474-3477. 4. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004.

11. Anatomy & Physiology of Smoking • Receptors in mid brain release dopamine when activated by smoking • Smoking increases the number of receptors by 300% • Takes 7-10 seconds for inhalation to reach brain • Down regulation takes 8-12 weeks • 80% relapse potential after 1 cigarette – greater than with other addiction

12. THE PHARMACOLOGICAL AND BEHAVIOURALCOMPONENTS OF SMOKING DEPENDENCE • Pharmacological • Nicotine in tobacco smoke is highly addictive1,2 • Nicotine stimulates dopamine release in the brain, resulting in short-term feelings of reward/satisfaction1,3 • Behavioural • Smoking-associated environmental stimuli play a role in reinforcing nicotine dependence4 1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004. 4. Caggiula AR et al. Physiol Behavior 2002; 77:683–687.

13. WHAT ARE THE HARMFUL EFFECTS OF SMOKING?

14. Long term effects

15. Effects of Smoking in Pregnancy • Miscarriage • Stillbirth • Premature membrane rupture • Placenta praevia & abruption • IUGR (Fetal growth retardation) • Pre-term birth mature babies • SIDS

16. Secondhand tobacco smoke PRESENTATION HEADER/TITLE • Effects on Children • Respiratory tract infections • Ear infections • Asthma • SIDS • Low birth weight • Meningitis • Behaviour problems • Risks in Adulthood

17. DO PEOPLE WANT TO QUIT SMOKING?

18. QUITTING SMOKING • The majority of smokers want to quit (67%)1 • Most people try to quit without any assistance2 • Smokers are up to 4 times more likely to quit with help from a trained advisor • 75% smokers have tried to quit at some point in the past* 1 Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279.

19. Quitting Smoking is difficult • The majority of smokers want to quit1 • Most people try to quit without any assistance2 • Only 3-5% of unaided quitters remain smoke-free after 6 to 12 months3 • Most smokers make five to seven attempts before they finally succeed3 • 98% of smokers who relapse following a quit attempt are willing to try quitting again4 1. Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279. 3. Hughes JR et al. Addiction 2004; 99:29-38. 4. Joseph A et al. Nicotine Tob Res 2004; 6:1075-1077.

20. What % of smokers today think they will have stopped by next year? 50%

21. What % will have done so? 2%

22. NICE GUIDELINES Every smoker should be advised to quit, opportunistically, at least annually. (unless in exceptional circumstances)[1] NICE 2006

23. What % make a quitattemptwhen offered treatment? 50%

24. WHY USE A STOP SMOKING SERVICE?

25. Smokers are4 timesmore likely to quit with pharmacotherapy and behavioural support Ref Bobak A 2007

26. How can we increase the numbers of smokers using the service?

27. Make raising the issue of smoking a priority Use brief intervention techniques Promote the benefit of using the service How can you help?

28. What is a stop smoking brief intervention?

29. Circumstances change, e.g. pregnancy What is a brief intervention? “What would need to change for you to stop?” Explain that there is help available Using opportunities to discuss a patient’s smoking Recognising when the smoker may be close to wanting to change his/her behaviour 4 times as likely to succeed with help Smoker may be ready to quit Exploring a patient’s attitude to his/her smoking “Do you smoke?” Discussing FREE support that is available and making a referral to stop smoking service Ask open questions “What do you enjoy about smoking?” Part of normal conversation Feelings about smoking change over time When a suitable opportunity presents

30. Brief Intervention is: A 3 step 30 second systems based approach

31. The AAA Approach 1. ASK ASK regularly and be approachable ADVISE smoker of health benefits of stopping. Link advice to any colleagues specific conditions ACT on colleagues response and refer to stop smoking service for support 2. ADVISE 3. ACT

32. ASK regularly and record smoking status Use your own words, what feels appropriate for you Examples of what you might ask: • “Do you smoke?” • “Can I ask if you smoke?” • “Have you ever thought about stopping smoking?” • “Would you like to stop smoking?” • “Have you ever tried to stop smoking?”

33. ADVISE smokers of health benefits of stopping As a health professional it is my duty to advise you to stop smoking. Stopping smoking is the best thing you can do to improve your current and future health Examples of what you might say You probably already know the risks involved with smoking but I cannot stress enough how important it is to stop. It is the best way to improve your health Stopping smoking is the best thing you can do for your health

34. ACT on patient’s response and refer You may choose to ask the patient if you can refer them or You may decide to refer unless they opt out e.g. “Lots of patients succeed with support from the FREE stop smoking service and stop smoking medication. Can I refer you?” e.g. “It is our policy to refer you to the stop smoking service. I can arrange that for you now”

35. ACT on patient’s response and refer The NHS provides free and effective treatment for smokers like yourself. In fact you are up to four times more likely to quit using this help than quitting by yourself. Are you interested in finding out more about this service? Examples of what you might say If you would like to give up smoking I can help you

36. Providing a Brief Intervention • It is quick (takes less than 30 seconds) • You are offering treatment to a patient with a serious addictive condition which is dangerous to their health • Most smokers want to quit • Half the smokers offered treatment make an attempt to quit • Treatment via the stop smoking service is four times more effective than trying to quit alone Half the smokers offered treatment make an attempt to quit • If the smoker does not want to quit, leave the door open (e.g. “I respect your decision. Perhaps we could talk about it again another time”)

37. What does the stop smoking service offer?

38. What does the stop smoking service offer? • Pharmacotherapy (on prescription) • Nicotine Replacement Therapy (NRT) • Zyban & Champix Carbon Monoxide Monitoring Psychological Support At least 5 weekly meetings with trained advisor The service is free

39. What to expect from the stop smoking service • A minimum of 5 appointments • Initial appointment of 30 minutes: • Understand how and why the patient smokes • Agree the most appropriate pharmocotherapy • Measure level of carbon monoxide in the body • Further appointments of 15 minutes: • Review progress and carbon monoxide levels • Address difficulties and obstacles Celebrate success!

40. How to refer

41. How to refer • Fax referral form to 01442 453070 • Phone Hertfordshire Stop Smoking Service 0800 389 3 998 • Free resources (e.g. stop smoking leaflets in a variety of languages, posters) can be obtained from: • www.healthpromotioninherts.nhs.uk

42. NATIONAL CAMPAIGNS • Non Smoking Day • Stoptober Great opportunity- Networking with Pharamacies, HSSS Get in contact with your locality specialist. Information from Media is not linked together with Herts Stop Smoking Service.

43. Further information is available from: Stevenage/Welhat Specialist: janka.szocs@hertfordshire.gov.uk 07789505207 Helen.cleary@hertfordshire.gov.uk Workplace Intervention Lead Hertfordshire Stop Smoking Service 0800 389 3 998 www.smokefreehertfordshire.nhs.uk

44. Stopping smoking works Giving brief advice can only take 30 seconds, but can save a smoker’s life.

45. ANY QUESTIONS?THANK YOU!