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  1. 1. BRIEF INTERVENTION IN SMOKING CESSATION Encouraging Smokers to Stop Smoking A guide for health care professionals
  2. 2. <ul><li>‘All health professionals should understand the principles of Brief Intervention for smoking cessation. It is to be routine practice to consider the need for Brief Intervention at every patient contact’ </li></ul><ul><li>Surgeon General’s Policy Letter 02/04 </li></ul>SGPL
  3. 3. What is Brief Intervention? <ul><li>“ Brief intervention is used to motivate attempts at smoking cessation. </li></ul><ul><li>It is aimed at individual smokers and should be used by all health care professionals opportunistically. </li></ul><ul><li>Brief intervention is part of the framework for smoking cessation” </li></ul><ul><li>(Surgeon General’s Policy Letter, 2004) </li></ul>
  4. 4. Role of the health worker <ul><li>Your role is Important and the </li></ul><ul><li>time spent is Worthwhile </li></ul><ul><li>Brief advice is one of the most cost effective interventions in medicine. </li></ul><ul><li>The key messages to get across are that smoking is dangerous and it is worthwhile stopping. </li></ul>
  5. 5. Why? <ul><li>By raising the issue of smoking and referring smokers to a local smoking cessation clinic, you are offering them the best chance to stop smoking. </li></ul><ul><li>Smoking cessation is the most effective way to help smokers quit and preserve life. </li></ul>
  6. 6. Some examples of health risks from smoking Stroke Depression Hearing loss Mouth cancer, tooth & gum disease Heart disease Back pain Osteoporosis (females ) Impotence, infertility (males) Reduced fertility, miscarriage (females)+ low birth weight babies, still birth, cot death Disease of the blood vessels Eye disease Neck pain Cancer of gullet Lung disease: cancer, bronchitis, emphysema etc Stomach ulcers / cancer Ulcers and cancer of the gut Tendon injuries
  7. 7. Health Risks <ul><li>Smoking causes thickening of the blood vessels and high blood pressure & is a major cause of stroke. Female smokers using the contraceptive pill are especially at risk. </li></ul><ul><li>Smoking increases the risk of heart disease such as angina and aortic aneurysm. </li></ul><ul><li>Smokers are 10 times more likely to die from lung cancer than non-smokers. </li></ul>
  8. 8. <ul><li>Smoking is one of the leading cause of male impotence, lower quality and quantity of sperm. </li></ul><ul><li>The incidence of low birth weight is twice as high among smokers as non-smokers. </li></ul><ul><li>Women who smoke during pregnancy have a greater chance of premature labour and miscarriage. </li></ul>
  9. 9. Smoking and Oral Health <ul><li>Smoking is associated with: </li></ul><ul><li>halitosis (bad breath) </li></ul><ul><li>premature tooth loss </li></ul><ul><li>gingivitis (inflammation of the gums) </li></ul><ul><li>staining and abrasion of teeth </li></ul><ul><li>periodontal disease </li></ul><ul><li>other malignant oral lesions </li></ul>
  10. 10. Passive smoking and children <ul><li>Children exposed to cigarette smoke are: </li></ul><ul><li>More likely to suffer from chronic cough, wheeze and acute respiratory illness. </li></ul><ul><li>More likely to suffer from chronic middle ear infections (glue ear). </li></ul><ul><li>At increased risk of sudden infant death (Cot death). </li></ul>
  11. 11. Benefits of Stopping Smoking (1) <ul><li>20 minutes: blood pressure and pulse rate returns to normal </li></ul><ul><li>24 hours: Carbon Monoxide is eliminated from the body. The lungs start to clear out mucus. </li></ul>
  12. 12. Benefits of stopping smoking (2) <ul><li>48 hours: Nicotine is no longer detectable in the body. </li></ul><ul><li>3 days: breathing becomes easier as the bronchial tubes begin to relax. </li></ul><ul><li>2-12 weeks: circulation improves </li></ul>
  13. 13. More Benefits…. <ul><li>3-9 months: lung function increased by about 10%. </li></ul><ul><li>5 years: risk of heart attack falls to about half that of a smoker. </li></ul><ul><li>10 years: risk of lung cancer falls to about half that of a smoker </li></ul>
  14. 14. How to give Brief Advice <ul><li>Keep the discussion brief and offer the smoker a leaflet he/she can keep. </li></ul><ul><li>Adapt the information you give as necessary. </li></ul><ul><li>Most smokers know smoking is bad. So, your main aim is to let them know there is now effective help available if they want to stop. </li></ul>
  15. 15. The 4 “A’s” of Brief Intervention <ul><li>ASK about smoking at every opportunity </li></ul><ul><li>ADVISE all smokers to stop </li></ul><ul><li>ASSIST the smoker to stop </li></ul><ul><li>ARRANGE a referral to the smoking cessation service </li></ul>
  16. 16. 1. ASK <ul><li>Do you use tobacco?” </li></ul><ul><li>How much? </li></ul><ul><li>Do you want to stop? </li></ul><ul><li>Have you tried before? </li></ul>
  17. 17. 2. ADVISE <ul><li>Discuss any health problems which may be related to smoking </li></ul><ul><li>Personalise the cessation message </li></ul><ul><li>Advise clearly the necessity of stopping now </li></ul><ul><li>Commend nonusers </li></ul>
  18. 18. 3. ASSIST <ul><li>Provide information literature </li></ul><ul><li>Consider advising use of NRT for strongly addicted patients </li></ul><ul><li>Provide motivating literature for the patient who is not ready to stop </li></ul><ul><li>Refer to a smoking cessation clinic </li></ul>
  19. 19. 4. ARRANGE <ul><li>Telephone call to smoking cessation adviser / clinic or provide contact details </li></ul><ul><li>Follow up the referral </li></ul><ul><li>Ask uninterested patients again at their next regular visit if they have reconsidered </li></ul>
  20. 20. Nicotine Replacement Therapy <ul><li>Patch: it is discreet and easy to use. </li></ul><ul><li>Gum: it allows good control of nicotine dose. </li></ul><ul><li>Inhalator: if the smoker misses the ritual of smoking. </li></ul><ul><li>Lozenge: discreet and good dose control </li></ul><ul><li>Spray: better for very addicted smokers. </li></ul>
  21. 21. REMEMBER <ul><li>Brief advice on the dangers of smoking and the benefits of stopping smoking should be given at any opportunity. </li></ul><ul><li>Just 3 minutes of your time could help to improve the health and life expectancy of smokers. </li></ul><ul><li>The time spent really is worthwhile . </li></ul>