It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens

1. It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens Objectives: • Identify stages of change and types of senior smokers • Describe sessions of comprehensive curriculum and intervention strategies targeting seniors • Identify types of screenings for participants I

2. It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens Experiences with the program: • Senior citizens need more group support and frequent encouragement to change behavior • Curriculum components could be expanded to a 12 week behavior modification program I

3. It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens The Challenges... • Develop a draft cessation curriculum • Field test the curriculum • Research to further construct a model cessation program

4. Can you Imagine? • Giving up smoking after 50 years • Giving up coffee after 50 years • Giving up chocolate after 50 years • How would you deal with changing your behavior and what kind of programs would be available for help?

5. Stages of Change (TTM) • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

6. Seniorsand Smoking • Lowest smoking prevalence of all age groups; Highest rate of those in maintenance stage • Gain in total number of senior smokers • Fewer interested in quitting (57.1 vs. 68.2) least likely to have tried to quit in past year • More at preparation stage

7. Stage of Change Distribution for Current Smokers

8. Sub-types Among Senior Smokers • The Pre-contemplation Rejecters • The Discouraged Pre-contemplators • The Active Avoiders • Early Contemplators

9. Rejecters • Highly addicted • Heavy to moderate smokers • Few or no lifetime quits • No intention to quit

10. Discouraged • Highly addicted • Heavy smokers • Multiple lifetime quits • Conditional intention to quit

11. Active Avoiders • Moderate to low addiction • Moderate to light smokers • Long term or vague intent to quit • Few or no quit attempts OR has multiple prolonged stops with restarts

12. Early Contemplators • Classic “contemplation stage” • Health event or externally driven • Shorter-term intent to quit

13. Implications for Cessation Programming • Cessation intervention must start at the pre- contemplation stage • Establish “ask, assess, advise, assist” in community- based settings • Train staff to use client-centered counseling to support movement toward cessation • Use simple “typing” protocol; Build in richer reinforcement for movement

14. It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens Curriculum Development and Session Content Joy Shepherd

15. Program Content • Targets seniors; local advertising • Pre-and post-health screening and questionnaire • 1 hour sessions weekly for four weeks • 6 weeks of nicotine replacement therapy

16. Session 1: Thinking About Quitting • Thinking about quitting • Reasons seniors want to quit • Reasons they smoke • Habit • Psychological dependence • Physical addiction Set a Quit Date!

17. Session 2: Understanding How to Quit • Health hazards (Acute, Long-term, and Environmental) • Why quit after this long? • Stages of quitting and ways to stop • Quit tips Let them talk!

18. Session 3: Understanding Withdrawal and Avoiding Weight Gain • History of failure • Cravings and stress • Weight gain and how to avoid it • Eating habits and exercise • How to cope with withdrawal symptoms Let them talk!

19. Session 4: Understanding Relapse • Handling a relapse and tips to cope with urges • Common triggers • Marking progress • Rewards from quitting Let them know they CAN do it and stick with it!

20. Tips for success • Advertise locally – TV, Radio, Flyers • Congratulate them on even “small” improvements! • Give them a certificate! • Encourage the development of a support group! Let them talk!

21. It’s Never Too Late To Stop: Tobacco Cessation for Senior Citizens Project Activities Phyllis Martin

22. Smoking Cessation Classes For Senior Citizens • 5 counties: Poinsett, Craighead, Clay, Lawrence, Cross • 55 years and older • Initial and post blood pressure, body temperature and lung function screenings • Free 6 week supply of nicotine replacement patches • 6 month follow up survey and screenings

23. Smoking Cessation Classes • Class size 1-10 • Ages range from 55 to 70 • Most working part-time or not at all • Smokers for 30 – 50 years

24. Health Screening Results • Initial Lung Function: • Mild restriction/obstruction • Moderate restriction • Severe obstruction • Moderate severe obstruction • 3 Week Post Lung Function: • Moderate/mild restriction • Mild obstruction

25. Health Screening Results • 6 Month Post Lung Function: • Severe Restriction/obstruction • Mild Restriction • Moderate Severe Restriction

26. Health Screening Results • Initial Blood Pressure: • 180/89 • 141/85 • 164/102 • 116/54 • 149/92 • 161/100

27. Health Screening Results • 3 Week Post Blood Pressure: • 158/78 • 122/79 • 120/59 • 107/57 • 155/57 • 150/50

28. Health Screening Results • 6 Month Post Blood Pressure: • 130/79 • 115/73 • 115/73 • 97/62 • 161/82

29. Health Screening Results • Initial Body Temperature: • 98.1 • 97.6 • 97.1 • 97.2 • 99.2 • 97.3

30. Health Screening Results • 3 Week Post Body Temperature 97.6 98.3 97.2 98.3 97.7 98.4

31. Health Screening Results • 6 Month Post Body Temperature: 97.9 98.7 97.1 97.5 98.6

32. Case Study 1 • Age: 69 year old Race: White female • Started Smoking: Sophomore year in college • Years Smoked: 50 years; 1pack per day • Quit Date: March 5, 2003 Method: Cold Turkey • As of November 2003, still not smoking!!

33. Case Study 2 • Age: 68 years old Race: White male • Started Smoking: 11 years old • Years Smoked: 50 years; 2 pack per day • Quit Date: February 4, 2003 Method: NRP • As of November 2003, still not smoking

34. Conclusion of Classes: • Strong recruitment is essential • Participants receptive to material • Participants shared common experiences • Group support is important factor to participants • Nicotine replacement very helpful

35. Presentations to Elementary Schools • Letters sent to 36 schools in the 5 county area • 6 schools requested speakers • Target: 4th grade students • Group range: 50- 235 • Speakers: Volunteer Senior Citizens and • Program Coordinator • Pre- and post-surveys given to students

36. Presentations to Schools • Information Presented: • Chemicals in cigarettes • Cost of smoking • Health dangers of smoking • Dangers of second hand smoke

37. Presentations to Schools (Cont.) • Information Presented: • Other effects of smoking: • Dental • Smell in clothes,car, house, etc • Models presented: • Death of a Lung • Mr. Gross Mouth • A year’s Worth of Tar

38. Findings at Schools • Some students already smoking. • Students very receptive to comparison of money spent on cigarettes vs. money being saved for toys, clothes, etc. • Students very receptive to models shown and to senior citizens presentations. • Students very receptive to health risks associated with smoking.

39. Conclusions • Cessation intervention must start at the • Pre-contemplation stage • Congratulate participants on small successes • Group support is important to participants • Let participants talk • Health screenings are important to show • participant’s health improvements