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Tobacco Cessation staff training for HealthPoint, Federal Way, WA

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  • Message – smoking is a larger issue for homeless population than for average population
  • What causes people to contract a tobacco-related disease? Chemicals and additives in tobacco cause much of the problems. Write down four chemicals you think are in tobacco. In reality there are about 4000 chemicals in tobacco. 250 are toxic. Over 60 are cancer-causing. ( Surgeon General’s 2006 Report)
  • Cite more specifically
  • Insert video link
  • Circles not equal size for all people
  • Advising will not harm relationship with client, studies show satisfaction improves in other treatment settings the more a staff counsels on quitting
  • Not a yes/no question
  • Do not need to be done in order
  • Health pointfw 081010

    1. 1. Nori de la Peña Michael Leon-Guerrero Public Health - Seattle & King County Tobacco Prevention Program (206) 296-7613 Brief Tobacco Intervention Skills (BTIS) training Summer 2010 DESC training [email_address] Framing the issue, understanding the addiction and implementing an effective intervention program HealthPoint August 10 th , 2010
    2. 11. Overview <ul><li>Frame the issue </li></ul><ul><li>What’s new: mental illness/alternative products </li></ul><ul><li>Three-link chain of addiction </li></ul><ul><li>2A’s </li></ul><ul><li>5A’s </li></ul><ul><li>Resources </li></ul>
    3. 12. Smoking Statistics <ul><li>Those with mental health issues smoke more </li></ul><ul><ul><li>US: 22.5% v. 34.8% (MI in lifetime) v. 41.0% (MI in last month) </li></ul></ul><ul><li>The poor smoke more than the rich </li></ul><ul><ul><li>KC: 10% for > $50,000/yr v. 25% for <$15,000/yr </li></ul></ul><ul><li>70% of homeless people smoke (three times national rate) MI purchase nearly 50% of all cigarettes </li></ul><ul><li>Homeless, substance abusers and the mentally ill more vulnerable to health effects of smoking </li></ul>
    4. 13. Doctors advise adolescents about tobacco <2% of visits Medical Bias in Considering Tobacco a &quot;Drug of Abuse&quot;
    5. 14. Tobacco smoke: <ul><li>No safe level of exposure </li></ul><ul><li>Class A carcinogen (causes cancer) </li></ul><ul><li>Over 60 chemicals cause cancer </li></ul><ul><li>Over 2000 chemicals total </li></ul><ul><li>Effects every system in the body </li></ul>
    6. 15. A Toxic Waste Dump <ul><li>Arsenic </li></ul><ul><li>Ammonia </li></ul><ul><li>Benzene </li></ul><ul><li>Carbon Monoxide </li></ul><ul><li>Ethanol </li></ul><ul><li>Formaldehyde </li></ul><ul><li>Hydrogen Cyanide </li></ul><ul><li>Lead </li></ul><ul><li>Methane </li></ul><ul><li>Mercury </li></ul><ul><li>Silicon </li></ul><ul><li>Polonium 210 </li></ul><ul><li>Vinyl Chloride </li></ul><ul><li>Urethane </li></ul><ul><li>Tar (resinous matter from burning tobacco and includes most of the carcinogenic substances) </li></ul>
    7. 16. An Unfair Share of Mortality Number of Deaths (thousands) Source: CDC AIDS Alcohol Motor Homicide Drug Suicide Smoking Vehicle Induced Est. 200,000 per year for mentally ill and SA
    8. 17. The Double Whammy! <ul><li>As smoking rates fall in the general population, smoking is concentrating in the poor </li></ul><ul><ul><li>Populations with less access to care have fewer chances to quit or to get treatment for smoking related diseases </li></ul></ul><ul><ul><li>Tobacco companies actively target folks living with mental illness and substance use </li></ul></ul>
    9. 19. SUCCESS = <ul><li>Everyone is asked tobacco status and advised then referred </li></ul><ul><li>Tobacco status is documented </li></ul><ul><li>Follow-up happens at each visit </li></ul>
    10. 22. Mental Health and Nicotine 44% of all cigarettes bought & consumed in the US are by individuals living with mental illness.
    11. 23. MI and Nicotine <ul><li>7.1 % of the US population has a psychiatric illness; however this populations buys/consumes 44.2% of all cigarettes </li></ul><ul><li>Smoking rates are 3-5 times higher </li></ul><ul><li>Successful in stopping their tobacco use </li></ul>
    12. 24. Unfair Share of the Burden <ul><li>Without help, nearly 60% of mental health clients will die from tobacco related illness. </li></ul>
    13. 25. Be Aware That: <ul><li>Tobacco dependence is chronic </li></ul><ul><li>Tobacco users may have other addictions </li></ul><ul><li>The physical environment is part of the message </li></ul><ul><li>Other community agencies promoting cessation </li></ul>
    14. 26. Alternative tobacco
    15. 29. Your Role <ul><li>Your clients have many competing health/mental health/substance use issues: </li></ul><ul><li>Helping them quit smoking will directly improve their overall health. </li></ul>
    16. 30. WHY don’t they just QUIT?
    17. 31. Why Don’t They Just Quit? + No Cessation Help
    18. 38. The intervention: 2A’s & R Site Champ
    19. 39. ASK <ul><li>Ask clients at screening or when appropriate if they smoke </li></ul>
    20. 40. ADVISE <ul><li>Urge every tobacco user to quit </li></ul><ul><li>Clear : “One of the best things you can do for your health is to quit smoking. I can help you.” </li></ul><ul><li>Strong : “As your case manager, I need you to know that quitting smoking is one of the most important things you can do for your health.” </li></ul><ul><li>Personalized : Tie tobacco use to current health issues, relationships, or economic stress </li></ul>
    21. 41. <ul><li>1) SITE CHAMP </li></ul><ul><li>2) 1-800-QUIT NOW </li></ul><ul><li>1-877-2NO FUME </li></ul><ul><li> </li></ul>REFER
    22. 42. Washington State Quitline – OVER 18 <ul><li>Free telephone counseling for people ready to quit in the next 30 days </li></ul><ul><li>Proven to increase success in quitting for many </li></ul><ul><li>Includes different pharmacotherapy benefits for different populations </li></ul>
    23. 43. Medicaid eligible: <ul><li>Free services available for 18+ clients: </li></ul><ul><li>Phone counseling and follow-up support calls through the quit line </li></ul><ul><li>Nicotine patches or gum through the quit line, if appropriate </li></ul><ul><li>Prescription medications recommended by quit line and prescribed by individual physicians, if appropriate </li></ul>
    24. 44. Is the Quitline a Good Fit? <ul><li>Does your client have </li></ul><ul><ul><li>A phone line? </li></ul></ul><ul><ul><li>An address for mailings? </li></ul></ul><ul><li>Is your client comfortable with telephone counseling? </li></ul><ul><ul><li>Video and sample call on web can show them what it’s like </li></ul></ul><ul><li>Do they use interpreter services? </li></ul><ul><ul><li>Quitline has English and Spanish </li></ul></ul><ul><ul><li>Other languages available through telephone interpreter </li></ul></ul><ul><li>Has your client already used the benefit this year? </li></ul>
    25. 45. “ Ask” Identify Tobacco Use /exposure to smoke Document chart “ Advise” To Quit “ Assess” willingness to quit “ Assist” with quitting “ Arrange” Follow-up Quitline 1-800-QUITNOW 1-877-2NO FUME Local Resources DESC champ (Provided by Sophie Balk, MD, Albert Einstein College of Medicine) Referrals The 5 A’s
    26. 46. ASSESS <ul><li>Ask every tobacco user about quitting </li></ul><ul><li>Examples: </li></ul><ul><ul><li>“On a scale of 1 to 10, how ready do you feel to quit?” </li></ul></ul><ul><ul><li>“Have you thought about quitting in the next 30 days?” </li></ul></ul><ul><li>If the client is ready to quit in the next 30 days provide assistance </li></ul><ul><li>If the clients is not ready to quit provide a motivational intervention (5R’s) </li></ul>
    27. 48. ASSIST <ul><li>Help the ready client make a quit plan </li></ul><ul><li>Set a quit date in 30 days </li></ul><ul><li>Plan to tell friends </li></ul><ul><li>Anticipate challenges </li></ul><ul><li>Plan to remove tobacco products </li></ul><ul><li>Recommend NRT use </li></ul>
    28. 49. ARRANGE <ul><li>Plan a time to follow-up after quit-date </li></ul><ul><li>Congratulate success </li></ul><ul><li>Address challenges/relapse </li></ul><ul><li>Assess NRT use </li></ul>
    29. 50. Benefits of Quitting 10 Years Risk of HD/Stroke almost the same as a non-smoker 5 Years Lung Cancer Death Rate Decreases by 50% 2Weeks-3 Months Circulation Lung Function 48 Hours Taste/Smell Nerve Endings 8 Hours 02 Levels 20 Minutes BP  Body Temp 
    30. 51. The 5R’s: Not Ready to Quit REPITITION – Repeat motivational intervention ROADBLOCKS – client identifies barriers REWARDS – client identifies benefits of quitting RISKS – client identifies risks of smoking RELEVANCE – Specific and personal reasons The 5 R’s
    31. 52. Motivational Interviewing Is <ul><li>Starting where client is </li></ul><ul><li>Understanding client’s frame of reference </li></ul><ul><li>Knowing choice to change is client’s </li></ul><ul><li>Exploring options with client </li></ul><ul><li>Finding and reinforcing the client’s motivation to change </li></ul>
    32. 53. Motivation Enhancing Skills OARS - toolkit for SUCCESS! <ul><li>Open ended questions </li></ul><ul><li>Affirmation </li></ul><ul><li>Reflections </li></ul><ul><li>Summarize </li></ul>
    33. 54. Nicotine Replacement Therapy in biologically addicted adults <ul><li>NRT increases quit success (patch/counseling doubles rate) </li></ul><ul><li>Safe, FDA approved, available OTC </li></ul><ul><li>Reduces most withdrawal symptoms so quitter can comfortably break the habit </li></ul><ul><li>Eliminates the reinforcing effect of nicotine as administered through smoking </li></ul>
    34. 55. What NRT Does Not Do <ul><li>Without behavioral change/counseling, NRT does not increase quit rates </li></ul><ul><li>NRT does not replace smoking </li></ul><ul><ul><li>clients will still want to smoke </li></ul></ul><ul><ul><li>Does not provide bolus effect (nicotine rush) </li></ul></ul>
    35. 56. Patch Counseling <ul><li>Apply promptly at quit date </li></ul><ul><li>Replace patch every day to dry, clean, hairless place </li></ul><ul><li>Rotate sites over a seven day period </li></ul><ul><li>Follow treatment plan for decreasing dose over time </li></ul>
    36. 57. Patch Side Effects <ul><li>Vivid dreams </li></ul><ul><ul><li>Can remove before bed </li></ul></ul><ul><ul><li>New patch first thing in morning </li></ul></ul><ul><li>Localized skin reactions (rash) </li></ul><ul><ul><li>Up to 50% of clientss have mild form </li></ul></ul><ul><ul><li>Less than 5% discontinue therapy </li></ul></ul>
    37. 58. Smoking and NRT <ul><li>client should stop smoking on quit date </li></ul><ul><li>“Slipping” will happen, and is not harmful </li></ul><ul><li>If client continues to smoke after starting patch </li></ul><ul><ul><li>Assess if they are really ready to quit </li></ul></ul><ul><ul><li>Address triggers for smoking </li></ul></ul><ul><ul><li>Nausea, dizziness, vomiting </li></ul></ul>
    38. 59. Quitting the Three Link Chain NRT?? Behavioral Counseling Posters Groups Activities + Cessation Help @ DESC
    39. 60. <ul><li>The best way to quit smoking is to combine a smoking cessation message with a behavior modification program . </li></ul><ul><li>Some clients may benefit from NRT </li></ul><ul><li>Or medication. </li></ul>
    40. 61. Relapse Is Common <ul><li>Tobacco dependence is chronic </li></ul><ul><li>Cycle through relapse and remission </li></ul><ul><li>5 to 7 times not uncommon </li></ul><ul><li>7% long-term success quit on own </li></ul><ul><li>Relapse not a failure—for clients or you </li></ul>
    41. 62. Policies <ul><li>Tobacco policy </li></ul><ul><li>Tobacco free campus </li></ul><ul><li>I-901 compliance </li></ul>
    42. 64. Public Health Contact <ul><li>Community Tobacco Cessation Partnership </li></ul><ul><li>206-296-7613 </li></ul><ul><li>[email_address] </li></ul><ul><li>For questions, and staff cessation referrals. </li></ul>
    43. 65. Selected References <ul><li>Slide 4: </li></ul><ul><ul><li>National Co morbidity Survey </li></ul></ul><ul><ul><li>Washington State BRFSS 200-2004 Data: </li></ul></ul><ul><ul><li>Connor et al, Smoking Cessation in a Homeless Population: There is a Will, but is There a Way? J Gen Int Med 2002;17:396-372. </li></ul></ul><ul><li>Slide 19: </li></ul><ul><ul><li>Connor et al, Smoking Cessation in a Homeless Population: There is a Will, but is There a Way? J Gen Int Med 2002;17:396-372. </li></ul></ul><ul><li>Slide 40: </li></ul><ul><ul><li>Joseph Am. NEJM 1996 335:1792-8. </li></ul></ul><ul><ul><ul><li>JACC 29:1422-31 </li></ul></ul></ul><ul><li>Slide 47: </li></ul><ul><ul><li>Merck Manual, 2000 </li></ul></ul>
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