1 / 137

Historica Vital et Mortis 1622

“The use of tobacco… conquers men with a certain secret pleasure so that those who have once been accustomed thereto can hardly be restrained therefrom” Sir Francis Bacon. Historica Vital et Mortis 1622. Tobacco Facts.

nerina
Download Presentation

Historica Vital et Mortis 1622

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “The use of tobacco…conquers men with a certain secret pleasure so that those who have once been accustomed theretocan hardly be restrained therefrom” Sir Francis Bacon Historica Vital et Mortis 1622

  2. Tobacco Facts • #1 public health problem in the United States • Most preventable cause of morbidity and mortality • Causes more deaths each year than alcohol, motor vehicle accidents, suicide, AIDS, homicide, illicit drugs and fires combined • Proven risk factor for heart disease, malignant neoplasms and stroke • One-third of all tobacco users will die prematurely

  3. ComparativeCauses of Annual Deaths in the United States Number of Deaths (thousands) AIDS Alcohol Motor Homicide Drug Suicide Smoking Vehicle Induced Source: CDC

  4. Impact of Smoking • Smoking is now conclusively linked to acute myeloid leukemia and cancers of the cervix, kidney, pancreas and stomach • Smoking is now also known to cause pneumonia, abdominal aortic aneruysm, cataracts and periodontitis • Smoking harms nearly every organ of the body, damaging a smoker's overall health even when it does not cause a specific illness

  5. Impact of Secondhand Smoke • Many millions of Americans are still exposed to secondhand smoke • Secondhand smoke exposure causes disease and premature death • Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. respiratory symptoms and slows lung growth children • Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer • The scientific evidence indicates that there is no safe level of exposure to secondhand smoke • Eliminating smoking in indoor spaces fully protects people from exposure to secondhand smoke - separating sections, air cleaning systems, and ventilating buildings cannot eliminate the risk of exposure

  6. Smoking Statistics • About 44.5 million Americans are current smokers – 20.9% • 23.4% of men and 18.5% of women smoke in US • Prevalence • Native Americans & Alaskan Natives (33.4%), • Persons reporting two or more races (31.0%) • Caucasians (22.2 %) • African Americans (20.2 %) • Hispanics (15.0 %) • Southeast Asians (11.3 %)

  7. Smoking Incidence & Scope • In 2002, 17.3 percent of pregnant women aged 15 to 44 smoked cigarettes in the past month compared with 31.1 percent of nonpregnant women of the same age group. • The annual toll on the nation’s health and economy is staggering: 440,000 deaths, 8.6 million people suffering from at least one serious illness related to smoking, • $75 billion in direct medical costs; $82 billion in lost productivity.

  8. Smoking Trends • Since 1974, the smoking prevalence in men has decreased by about 1% a year, in women 0.33% • Prevalence has remained fairly constant since 1992 • Children raised in households where one or both parents smoke are 2 to 5 times more likely to smoke • 1/3 of households with children under 6 years old contains at least one smoker • 90% of smokers begin smoking before age 21

  9. Tobacco is Not an Equal OpportunityKiller • Smoking affects young, the poor, depressed, uninsured, less educated, blue-collar, and minorities most in the US • Addiction affects those with the least information about health risks, with the fewest resources to resist advertising, and the least access to cessation services • Those below poverty line are >40% more likely to smoke than those above poverty line

  10. 38% of persons with 9-11 yrs education 40% of cooks/truckers 1/3 of service workers covered by smoke-free policies Social norm for low SES different from high SES 13% of persons with college degree or higher 3% of lawyers ½ of white collar workers covered by smoke-free policies Higher SES less likely to be exposed to parent/peer smokers Unequal Patterns of Use and Exposure

  11. Smoking Population Trend Lines The Department of Health and Human Services has set a goal of reducing smoking prevalence to 12% or less by 2010.

  12. Cessation Facts • About 30% of patients are current smokers • 70% of smokers say they are “interested” in quitting • Only 10 to 20% plan to quit in the next month • About 46% of smokers try to quit in a given year • The majority of smokers try to quit on their own • Overall, self-quitters have a success rate of 2 to 5% • Half of all smokers eventually quit

  13. Tobacco Intervention • 75% of health providers THINK it is a good idea • 10% routinely do it - not confident about subject - questionable goals - afraid of negative reaction from patient - feel patient might be offended - not enough reimbursement - not enough time

  14. Dental Intervention • 33-50% of smokers report visiting a dentist annually • 40% of dentists do not routinely ask about tobacco use • 60% do not advise tobacco users to quit

  15. Practice Implications • Only a minority of smokers report being advised to quit by a health care provider • There is substantial evidence that even brief smoking cessation counseling can be effective • Tobacco use status assessment, documentation and intervention by RDH and/or DDS would have a huge impact on cessation efforts

  16. History of the SCI • 14 member task force met September 2003 • Summit sponsored by the RWJF SCLC • Grant awarded in November 2003 • A nationwide campaign designed to promote smoking cessation intervention by dental hygienists "The advice of a dental hygienist can be a major motivation for a quit attempt by a patient who smokes.“ -- Tammi O. Byrd, RDH, ADHA President 2003-2004

  17. ADHA Tobacco Cessation Task Force Tammi O. Byrd, RDH Katie L. Dawson, RDH, BS Jacquelyn L. Fried, RDH, MS JoAnn R. Gurenlian, RDH, PhD Kirsten Jarvi, RDH, BS C. Austin Risbeck, RDH Rebecca Wilder, RDH, BS, MS Lisa M. Esparza, RDH, BS Maria Perno Goldie, RDH, MS Barbara Heckman, RDH, MS Kathleen Mangskau, RDH, BS, MPA Margaret M. Walsh, MS, Ed.D

  18. The Objective • Baseline and Target: • Increase to 50 the percentage of dental hygienists that screen their clients regarding tobacco use (rate, type and amount) by 2006.Baseline 25% in 2001 Journal of Dental Hygiene study • (Winter 2001)

  19. Main Elements of the SCIYear One Educational Program: Ask. Advise. Refer. SCI Liaison Program: Designate a liaison in each state Dedicated Website: www.askadviserefer.org

  20. SCI Year Two • Grant renewed November, 2004 • SCI Project Manager, January, 2005 • SCI Administrative Assistant • SCI Liaisons in-state support • Six state presentations

  21. SCI Year Three • Grant renewed November, 2005 • SCI Project Consultant • SCI Administrative Assistant • SCI Liaison education support • Twelve district presentations

  22. Three Minutes or Less Can Save Lives • The advice of a health care professional can more • than double smoking cessation success rates. • Tobacco dependence is a chronic disease • that demands treatment. • Effective interventions have been established and • should be utilized with every current and former • tobacco user. • There is no other clinical practice that has more • impact on reducing illness, preventing death, and • increasing quality of life.

  23. Does patient/client now use tobacco? If NO: If YES: Did patient once use Is patient now willing tobacco? to quit? If NO: If YES: If YES: No intervention required. If NO: Provide appropriate Prevent Relapse Encourage continued Promote motivation to quit. referral. abstinence. Ask. Advise. Refer. Systematic Approach

  24. Ask. Advise. Refer. = 5 A’s Ask Ask. Every patient/client about tobacco use. Advise Assess Assist Advise. Every tobacco user to quit. Arrange Refer. Determine willingness to quit. Provide information on quitlines. Refer to Quitlines ADHA Smoking Cessation Initiative (SCI)

  25. SCI Protocols Step 1: Ask 1 min • Systemically ask every client about tobacco use at every visit. • Determine if client is current, former, or never tobacco user. • Determine what form of tobacco is used. • Determine frequency of use. • Document tobacco use status in the dental record.

  26. SCI Protocols Step 2: Advise 1 min • In a clear, strong, and personalized manner, urge every tobacco user to quit. • Tobacco users who have not succeeded in previous quit attempts should be told that most people try repeatedly (on average 3 to 8 times) before permanent quitting is achieved. • Employ the teachable moment: link oral findings with advice.

  27. SCI Protocols Step 3: Refer 1 min • Asses if client is interested in quitting. • Assist those interested in quitting by providing information on: • Statewide or national quitlines, websites and local cessation programs. • Use proactive referral if available • Request written permission to fax contact information to a cessation quitline or program. Inform the client that cessation program staff will provide follow-up. • Document referral on dental record. • Use reactive referral – provide client with contact information • Arrangefollow-up at periodontal maintenance visit and/or schedule a phone call

  28. What are Quitlines? Tobacco Quitlines are telephone-based tobacco cessation services available in all states and are accessed through a new federal toll-free number. They provide callers with a number of services: • Individualized telephone counseling • Educational materials • Referrals to local programs

  29. Refer to: Current list of all state quitlines: www.askadviserefer.org Department of Health and Human Services Quitline: 1-800-QUITNOW (784-8669) Information Service Website: http://www.smokefree.gov Web based cessation program: http://smokefree.gov/ or http://www.quitnet.com

  30. Online Smoking Cessation Assistance • On-line smoking cessation services now available for smokers who prefer using computers over telephones • Anonymity is a plus, as with telephone quitlines • Early studies show promising efficacy • www.quitnet.com • www.smokeclinic.com • www.tobaccoschool.com

  31. SCI Scripts If the client uses tobacco: “How many cigarettes per day do you smoke” “How many cigars per day do you smoke?” “How many bowls of pipe tobacco do you use per day?” “How many dips of chewing tobacco do you use per day?” “Do others in your household use tobacco?”

  32. SCI Scripts For the client who never regularly used tobacco: “Congratulations, you have made a wise decision to protect your health.” “Congratulations on being a non-smoker.”

  33. SCI Scripts For the client who quit using tobacco: “Congratulations, you made a wise decision.” “Congratulations on quitting tobacco use. We have some good programs to help you remain tobacco-free. I can give you the contact information for the program.”

  34. SCI Scripts For the client who currently uses tobacco: “Have you thought about quitting?” “I can help you even if you do not want to quit. Let me give you the phone number for the statewide quitline. You can receive free counseling on how to quit and remain tobacco-free.” “Quitlines have had proven success in helping people get through the difficult stages of quitting and many people prefer to use them.”

  35. SCI Scripts More available scripts for: • Pregnant mothers • Hospitalized clients • Heart Attack clients • Parents of children and adolescents • Lung, head and neck cancer clients • Youth

  36. Nicotine Dependence • The most powerful of all addictions to overcome • Nicotine acts on nicotinic acetylcholine receptors in both the central nervous system and the peripheral nervous system resulting in a physical and biologic basis for physical dependence • Psychological dependence • Habitual dependence

  37. Dopamine Pleasure Norepinephrine Appetite Suppression Acetylcholine Arousal, Cognitive Enhancement Vasopressin Memory Serotonin Mood Modulation ß-endorphin Anxiety Reduction Neurochemical Effects of Nicotine Nicotine Benowitz NL. Primary Care. 1999;26: 619.

  38. Biology of Addiction • Addictive drugs stimulate release of dopamine (brain neurotransmitter) • Dopamine produces feelings of pleasure • Pleasure reinforces repeat administration • Tolerance develops • Abrupt discontinuation leads to symptoms of withdrawal

  39. Nicotine use for pleasure, enhanced performance, mood regulation Tolerance and physical dependence Nicotine use to self- medicate withdrawal symptoms Nicotine abstinence produces withdrawal symptoms Nicotine Addiction Cycle Benowitz NL. Med Clin North Am. 1992; 76: 423.

  40. Cigarette is a highly engineered drug-delivery system Inhaling produces a rapid distribution of nicotine to the brain Drug levels peak within 10 seconds in the brain Acute effects dissipate within minutes, causing the smoker to continue frequent dosing throughout the day Average smoker takes 200-300 boluses to the brain per day Easy to get, easy to use, and it is legal! Unique Qualities of Nicotine Addiction Through Smoking

  41. Primary routes: respiratory tract, buccal mucosa, skin Absorption is pH-dependent Oral absorption - mouth is acidic - oral tobacco products buffered to increase mouth pH to 7.0-8.0 - pH-altering beverages affect absorption Nicotine Absorption Benowitz NL. Primary Care. 1999;26: 619.

  42. Lung absorption: ionized & non-ionized 90% absorption across respiratory epithelium Alkaline form irritates throat Ionized form allows more nicotine to be dissolved in the tar droplets Absorbed in tar, nicotine is less irritating to throat Nicotine Absorption Benowitz NL. Primary Care. 1999;26: 619.

  43. Rates of Absorption Benowitz NL. Primary Care. 1999;26: 619.

  44. Constant craving of cigarettes Insomnia Irritability Anxiety Frustration Anger Depression Difficulty concentrating Restlessness Decreased heart rate Increased appetite Fatigue Nicotine Withdrawal Symptoms Withdrawal peaks within 24-48 hours and diminishes over 1 to 3 months.

  45. Assessing the Degree of Addiction • How many cigarettes are smoked on average per day? • How much time typically elapses between waking and the first cigarette? • What is the longest period of time between cigarettes before craving?

  46. Assessing Nicotine Dependence 1. How soon after you wake do you smoke your first cigarette or take your first dip? • <30 minutes 2 • 31 - 60 minutes 1 • >60 minutes 0 2. How many cigarettes per day or tins per week do you use? • <10 cigarettes or <1 tin 0 • 11 - 20 cigarettes or 1 - 2 tins 1 • 21-30 cigarettes or >2-3 tins 2 • >30 cigarettes or > 3 tins 3 3. Do you find it difficult to refrain from using tobacco in places where it is forbidden (e.g., movies, work, etc)? Yes 1 No 0 Scoring: 0 - 2 (LOW) 3 - 4 (MEDIUM) 5 - 6 (HIGH)

  47. Treatment Facts • The efficacy of several smoking cessation therapies is well established • All proven treatments appear to be equally effective: quit rates are doubled • Early evidence suggests allowing smokers to choose treatment produces better outcomes • The Agency for Health Care Policy and Research (AHCPR) published updated smoking cessation guidelines in 2000 for primary care clinicians

  48. Clinical Interventions • The “5 A’s” for patients willing to make a quit attempt • The “5 R’s” for patients unwilling to make a quit attempt at this time • Relapse prevention for patients who have recently quit • Intensive interventions should be provided when possible • Health care administrators, insurers, and purchasers should institutionalize guideline findings

More Related