This document provides information on a presentation about tobacco. Some key points: - Smoking remains a leading cause of preventable illness and death in Canada. Saskatchewan has high smoking rates, especially among youth. - Secondhand and thirdhand smoke harm others exposed to tobacco smoke. Quitting tobacco can be challenging due to nicotine addiction and behavioral factors. - Healthcare providers should use the 5 A's approach (Ask, Advise, Assess, Assist, Arrange) to counsel patients on quitting smoking. This involves discussing reasons to quit, barriers to quitting, and treatment options like nicotine replacement therapy. - While some providers may hesitate to counsel patients due to their own smoking status,

1. Presentation on Tobacco
May 12, 2014

2. Smoking remains one of the leading causes of
preventable illness, disability and premature death in
Canada.
4 people die every day in Saskatchewan from tobacco
related diseases.
Secondhand and third hand smoke affects others who are
exposed to tobacco smoke including children and pets.
Two thirds of people who smoke are thinking of quitting.
www.makeapact.ca

3. About 77% of people in Saskatchewan
do not smoke.
• Saskatchewan has one of the highest cigarette
smoking prevalence rates in Canada.
• Consistent with national trends, smoking
prevalence is highest among 20-24 year olds.
• Prevalence of smoking among 15-19 year olds
is higher in Saskatchewan than the national
average.
Government of Saskatchewan 2012

4. Teenage smokers are more likely to have seen a
doctor or other health care professionals for an
emotional or psychological complaint.
Teens who smoke are:
3 times more likely than nonsmokers to use
alcohol,
8 times more likely to use marijuana and
22 times more likely to use cocaine.
Smoking is associated with a host of other risky
behaviors such as fighting and engaging in
unprotected sex.
WHO: Tobacco Free Initiative 2014. Health effects of smoking among young people.

5. Impact on Mental Health
• 50-90% of mental health patients smoke
• 50% of all cigarettes smoked are by mental health patients
• 50% of smoking related deaths are mental health patients
• Tobacco smoke affects absorption and metabolism of some
medications
CMHA April 2011

6. 6
Tobacco use is a health issue
affecting the lives of everyone…
and is not “just a habit” but an
• Nicotine - powerful drug, as addictive
as heroin or cocaine for some
ADDICTION

8. Quitting Tobacco
There are many reasons for quitting:
• Health is usually the primary reason
• CO$T can be a factor
Other motivators can play a role, such as the arrival of a new baby or the
purchase of a new home or vehicle….
When talking about tobacco use, it is important to ask about all forms of
tobacco such as cigarettes, pipe, cigars, water pipes and spit tobacco….
No matter how tobacco is used, it has immediate & long-term health risks
8

9. 9
5 STEPS FOR QUITTING TOBACCO
1. GET READY
2. GET SUPPORT
3. LEARN NEW SKILLS & BEHAVIOURS
4. GET MEDICATION & USE IT CORRECTLY
5. BE PREPARED FOR RELAPSE
Having a Quit Plan is important to be
successful in quitting tobacco

10. 10 % of
smoking is the
addiction to
nicotine
90% of smoking is:
Habit and Routine
Positive association –
with coffee, on the
phone, lunch breaks,
etc
Socialization –fun with
friends, gives you a
break, a reward, etc.
Coping mechanism –
when you are
stressed, depressed,
angry, etc.
This is actually the
hard part of quitting. If
you do some work on
learning how to make
new habits, routines,
coping mechanisms,
etc. then you have a
better chance of
staying quit.

11. Nicotine Withdrawal
• Fear of withdrawal can be a major barrier to
quitting
• Not all experience withdrawal
• Worst symptoms subside in just 72 hours &
cease in 7-10 days
• Psychological symptoms:
strong cravings mood swings
anxiety crankiness
depression insomnia
11
Source: Ferguson.T. New York:Ballantine Books: Women and Tobacco

12. What about Nicotine Replacement
Therapy (NRT) ?
• Patch, gum, inhaler, lozenge and mist spray are available for
purchase over the counter at supermarkets and
pharmacies.
• Delivers clean nicotine at gradual doses
• Doubles quit rate
• With counseling, quit rate doubles again
• Products have precautions
12
Patient concerns:
• 69% smokers believe NRT products as harmful as cigarettes
• Individuals need to receive accurate advice and clear
reassurance on safety of products
•British Thoracic Society 2004

13. NRT Precautions
• Cardiovascular Disease - caution in patients who have had a heart attack;
physician to review if even recent or disease unstable *
• Diabetes - nicotine affects blood sugar levels so need to monitor *
• Pregnancy - behavioral support first; if not successful in quitting need to
weight risk benefit of NRT. Risks to unborn baby less than from continued
smoking *
• Breastfeeding - NRT reduces infants exposure to nicotine; use gum for
example 2-3 hours prior to bf; if patch, remove at night *
• Adolescent - consider if highly nicotine dependent or history of failed
previous attempt without NRT; combination of counseling, peer and family
support and for some, NRT, is best approach *
Use of NRT should be discussed with physician and closely
monitored with these groups
* literature & research reviews
13

14. Pharmacotherapy available by prescription:
• Champix® (varenicline)
• Zyban® (buproprion)
• Start 7-14 days before quit date: to achieve
steady state of blood levels of the drug
14
Refer to: www.rxfiles.ca
For current information on Tobacco/Smoking Cessation
Pharmacotherapy

15. “ If I quit smoking, I’ll gain weight..”
• 2/3 of people do gain weight: less than 10 lbs
• True Cause of weight gain:
– high fat, high calorie foods
– enhanced taste & smell
– lack of exercise
EAT RIGHT by following “Canada’s Food Guide to Healthy Eating” and stay
active
“ Weight can be lost, lungs cannot”
… Average smoker would have to gain 125 lbs above their
recommended weight to have the same health risk as smoking one
pack of cigarettes per day
15

16. Tobacco Intervention is the single
most effective step to lengthen &
improve patients’ lives
With intervention there will be:
- a significant reduction in number of tobacco users &
reduced exposure to secondhand and third hand
tobacco smoke
- a decrease in tobacco related disease
- a lowering of healthcare costs
16

17. Brief ( 3 – 5 minutes or less) tobacco
intervention encourages smokers to:
• think about their smoking
• consider disadvantages of smoking
• consider benefits of quitting
• Even those not ready to quit benefit from
intervention & self-help materials to increase their
awareness & motivation to quit
17

18. 18
Research shows that just by asking an individual “Do you
smoke?” is not enough to motivate them to quit.
All health professionals need to advise and assist patients
in their attempt to quit.
This is accomplished with the implementation of the 5 A‟s
of Tobacco Cessation Intervention.
5 A‟s

19. 19
Ask - about tobacco use
Advise - to quit in a clear, strong &
personalized manner
Assess - willingness & readiness to quit
Assist - for quitting
Arrange - for counseling & pharmacotherapy
The best way to intervene is with the
Best Practice…..
5 A‟s of Tobacco Cessation
Intervention
* developed by the National Cancer Institute & Agency for Healthcare Research & Quality
supported by the World Health Organization

20. Transtheoretical Model/
Stages of Change
Prochaska and DiClemente 1983
1. Pre-contemplation
• Not really thinking about quitting
• If challenged, will probably defend their smoking
behaviour
• May be discouraged about previous attempts to
quit or believe they're too addicted to ever stop
smoking
– As a clinician you can:
» Raise doubts
» Discuss natural consequences

21. 2. Contemplation
• Considering quitting sometime in the near future
(probably six months or less)
• More aware of the personal consequences and
consider smoking a problem that needs resolution.
• Open to receiving information about smoking and
identifying the barriers that prevent them from
quitting.
– As a Clinician you can :
» Discuss costs and benefits of changing and not
changing
» Explore ambivalence
» Critical thinking
» Develop change options
» Provide education

22. 3. Preparation/Determination
• Made the decision to quit and are getting ready to
stop smoking.
• Taking small steps towards quitting - smoking fewer
cigarettes
• Planning to quit within the next 30 days or have set
a quit date.
–As a clinician you can:
»Set goals and action plans
»Identifying barriers to change and making plans
to deal with barriers
»Provide encouragement and support
»Connect with resources

23. 4. Action
• People are actively trying to stop smoking
• This stage, generally lasting up to six months, is
the period during which smokers need the most
help and support.
–As a clinician you can:
»Normalize loss of comfortable old ways
»Continue to work on step-by-step realistic goals
»Help establishing new routines
»Provide positive reinforcement

24. 5. Maintenance
• Person has learned to anticipate and handle
temptations to smoke and is able to use new ways of
coping with stress, boredom and social pressures
• May slip and have a cigarette, they try to learn from
the slip so it doesn't happen again. This helps to give
them a stronger sense of control and the ability to
stay smokefree.
– As a clinician you can:
» Continue goal planning
» Relapse prevention planning
» Provide support and encouragement for alternative
social and recreational activities
» Reinforce commitment
Adapted from 5 Stages to Quitting Health Canada 2009.

25. 6. Relapse
When the person falls back to an earlier stages of change.
–As a clinician you can:
»Focus on elements of past progress, not present
“failures”
»Recognition of warning signs
»Encourage recovery based activities
»Re-engaging support system
»Back to basics

26. 5Rs of Motivational Interviewing
RELEVANCE
• “Do you feel quitting smoking is an important
thing to do for yourself and others around
you?”
RISKS
• “What effect do you think your continued
smoking will have on you and others around
you?”

27. ROADBLOCKS
• “What is stopping you from quitting?”
REWARDS
• “Can you identify the benefits of quitting for
yourself and not smoking around others?”
REPETITION
• Repeat interventions until smoker expresses
interest in quitting.

28. 28
Some healthcare professionals are
concerned about whether they can
issue credible advice …
•“What if I smoke ?”
•“I’ve never smoked !“
•Ex-smokers

29. But..“ I‟ve Never Smoked…”
May feel uneasy providing advice, but:
• remember overwhelming evidence linked to tobacco
use
• become familiar with resources & tools in your
community to assist your patients to quit successfully
Just as healthcare professionals who
have never been a parent, can support
new mothers.
29

30. “ But I smoke…can I issue credible advice? ”
• You’ve seen death, disease & disability caused by
tobacco
• You have likely experienced the addictive nature of your
own tobacco use
• Whether or not you choose to quit, advising others to
quit will help them move forward in choosing a healthy
lifestyle as well as fill your obligations & expectations as
a health care professional
30

31. Whether or not a healthcare provider
smokes, their professional advice is
essential.
If the subject of addressing tobacco
cessation is not mentioned, the individual
may mistakenly perceive that quitting
tobacco is not important.

32. Saskatoon Health Region
Community Addictions Services
-Tobacco Cessation Services-
• accepts self referrals & referrals from professionals/agencies
• “Free” services by telephone, individual counseling, single session workshops
Main floor @ Sturdy Stone Building - 122 3rd Avenue North Saskatoon SK S7K 2H6
306 - 655 - 4100

33. Thinking of Quitting Smoking or
Other Tobacco Products?*
Saskatoon Health Region Mental Health &
Addiction Services is offering a free education
session to help adults who are considering
cutting down or quitting tobacco use.
Session Date: Tuesday May 27, 2014
Time: 5:00 – 6:30 pm
Location: Sturdy Stone Building – Main Floor, Suite
156 – 122 – 3rd
Avenue North
(Please use the back door entrance located facing 4th
Avenue North)
For more information call Lynn Isaak 306-655-4125.
*Refers to tobacco in all forms: smoking cigarettes, pipe, cigars and using spit tobacco like snuff and chewing tobacco.

34. Addiction Services 306-655-4100
Tobaccofree Helpline 306-655-4685
Smokers‟ Helpline 1-877-513-5333
Website: saskatoonhealthregion.ca
E-mail: tobaccofree@saskatoonhealthregion.ca
34
SUPPORT

35. www.makeapact.ca
Partnership to Assist with Cessation of Tobacco
www.mn-s.ca
The Green Light Program – Métis Nation – Sask. Health Department
www.rnao.org/smokingCessation/index.asp
“Helping People Quit Smoking: Nursing Best Practice Guidelines”
35
OPPORTUNITIES
for
ENHANCED LEARNING

36. 36
Everyone can make a difference
When a consistent, short „quitting tobacco‟ message is given
by many – nurses, physicians, dentists, pharmacists, other
health professionals , there is a significant increase in the
numbers quitting tobacco.

37. Thank You
Lynn Isaak
Addiction Counsellor
Mental Health and Addiction Services
Tobacco Cessation Program
Sturdy Stone Building
122 – 3rd Ave. N.
Saskatoon, SK S7K 2H6
Phone: (306) 655-4125
Email: marylynn.isaak@saskatoonhealthregion.ca