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TACKLING TOBACCO DEATHS THE NURSES ROLE IN TOBACCO CONTROL AND SMOKING CESSATION JENNIFER PERCIVAL RCN TOBACCO POLICY ADVISOR Slide 2 Tobacco is a public health priority Source: WHO In the year 2000 1 in every 6 deaths worldwide was caused by smoking By the year 2030 1 in every 3 deaths worldwide will be due to smoking 70% of these deaths will be in developing countries. Slide 3 THIS ADVERT WAS USED IN THE 1950S Slide 4 Tobacco advertisers have no boundaries Slide 5 Tobacco advertising has successfully encouraged more women to start smoking Slide 6 Slide 7 Slide 8 Slide 9 Women and Tobacco In the UK lung cancer surpassed breast cancer as leading cause of cancer death in 1987 Now more women die from lung cancer than breast, ovarian, cervical & endometrial cancers combined Slide 10 The true picture is very different Slide 11 His research has shown: Half of all regular smokers die prematurely: in middle age (35-69) in old age Stopping before 35 avoids most of the risks of premature death. Stopping smoking works. WHO THE SILENT EPIDEMIC WORLD HEALTH ORGANISATION Epidemiologist Sir Richard Peto Tobacco use is increasing. Over 100 million deaths from tobacco will occur during the next 20 years. and if nothing changes there will be ONE BILLION deaths this century. Slide 12 Slide 13 The WHO Framework Convention on Tobacco Control (FCTC) Main Measures that 169 countries have signed up to Ban all tobacco advertising Increase Tax on tobacco products Take effective measures on Passive smoking Put large Warnings on tobacco products Provide Public Education campaigns Provide Cessation Guidelines and Services Take Action on illicit trade/smuggling Control sale of tobacco to children/ minors Slide 14 Slide 15 Put large warnings on all tobacco products Slide 16 Provide Public Education campaigns Slide 17 WHO estimates that nearly 700 million, or almost half of the worlds children, breathe air polluted by tobacco smoke, particularly at home. Take effective measures on Passive smoking WHO estimates that nearly 700 million, or almost half of the worlds children, breathe air polluted by tobacco smoke, particularly at home. Slide 18 Control sales of tobacco to minors! Slide 19 Slide 20 Slide 21 A Chronic relapsing dependence syndrome Use of the addictive drug nicotine Reinforced by sensory, behavioural and social conditioning Entrenched by powerful withdrawal syndrome Promoted commercially, exempt from consumer protection legislation What is smoking? Slide 22 Why are cigarettes so harmful? Nicotine 4,000 chemicals Tar Carbon monoxide Slide 23 Light-headedness Sleep disturbance Poor concentration Craving Irritability/aggression Depression Restlessness Increased appetite10 wks 70% Stopping Smoking Withdrawal effects: duration and frequency Slide 24 Royal College of Physicians, Nicotine Addiction in Britain, 2000 Nicotine delivery Slide 25 Nicotine Replacement Therapy, Zyban & Champix Slide 26 Reasons for NRT failure Unrealistic expectations Incorrect use Not used for long enough Nicotine is often seen as the dangerous element in cigarette smoke Safety concerns can be a barrier to use Slide 27 Slide 28 Core communication skills Boost the persons motivation and self-efficacy Build rapport Use reflective listening Provide reassurance Slide 29 Standard Treatment Programme Pre Quit Assessment Assess current readiness and ability to quit Inform the client about your programme Assess current smoking Assess past quit attempts Explain how tobacco dependence develops Assess nicotine dependence Slide 30 My observations from working in the UK Stop Smoking services are that direct persuasion is not enough to make people decide to stop smoking Slide 31 People want the benefits of being a non smoker . without recognising the often long process of change they need to go through to acquire them. Slide 32 Slide 33 Miller WR et al. J Consult Clin Psychol 1993;61:45561; Miller and Rollnick, 1991 You will have already observed that direct persuasion does not make people decide to change Slide 34 GOOD ADVICE Slide 35 Slide 36 I knew you could get cancer from smoking, but Id planned to give up long before that happened to me Robert was diagnosed with cancer of his tonsils at age 36 Slide 37 ADVICE Reasons for Current Behaviour Slide 38 ADVICE Reasons for Current Behaviour Slide 39 Slide 40 Current Behaviour Slide 41 Everyone has their own beliefs about safe behaviour This child is strapped in and protected from the sun but....? Slide 42 Slide 43 A DIFFICULT TIME Slide 44 Problem: Many pregnant women do not like to say they smoke A carbon monoxide (CO) test is an immediate and non-invasive biochemical method for helping to assess whether or not someone smokes Slide 45 THE CHANGE PROCESS No-one changes their behaviour without first changing their attitudes and beliefs. When a client argues with you it means you have made a wrong assumption. Long term behaviour change takes time to consolidate Slide 46 Principles of Motivational Interviewing Use a neutral manner to give clients information about the impact of their lifestyle on their health Help people interpret the health implications, risks and benefits of not changing. Assist people to explore for themselves the importance of making a specific change. Leave the responsibility for changing and the right to decide whether or not to change, with the client. Slide 47 Helping people to stop smoking Avoid making pressure to change: this will create resistance. You can never win and, in the process, may lose the chance to help Roll with any resistance: do not argue with the patient if they say their action is not harmful. Instead, respectfully clarify their own thoughts or views Support the patients self-confidence: look for the positive aspects and build on them Slide 48 Slide 49 HELPING PEOPLE TO STOP SMOKING WHAT WORKS? Find out what the tobacco user already knows about the risks and seek permission to provide further information. Link these facts to their current health status or medical condition. Explain the short and long term benefits of quitting and assess their understanding. Try asking: What do you think might happen to you if you continue to smoke? Slide 50 PEOPLE NOT READY TO STOP Respect their view It sounds like it would be hard for you to stop now Are you planning to be a life long smoker? If they say NO Ask: What would need to change for you to consider stopping smoking? Explain your medical / social concerns Leave the subject open for future discussion Slide 51 Asking questions can plant a seed of change New thoughts often help people think differently about what they believe to be true. Slide 52 Unsure about change? Help them explore the perceived advantages and disadvantages of smoking Ask more about what brought them to see you and find out their concerns Describe any ambivalence you notice Plant a seed of change Slide 53 Helping people to stop smoking Show empathy: even if you do not share a persons viewpoint, find ways to show that you understand and respect them Identify discrepancies: there are often differences between how a person behaves and how they see themselves Name these in a neutral way eg.Dont want their kids to start smoking Slide 54 Slide 55 People making plans to quit Congratulate this decision Check their expectations of changing Ask What could get in your way? What can you do to avoid that? What help will you need? Who can you ask? Slide 56 Helping people to change Ask:- What are you planning to do next? Who are you going to ask to support you? What quit date have you decided? Can you commit to not having a single puff of a cigarette from then onwards? What medication are you going to use? Slide 57 RELAPSE Why do smokers return to tobacco? Stopping under pressure from someone else Lack of personal motivation Attaching insufficient importance to stopping Withdrawal symptoms Poor timing A question of self-image I thought `just one wouldnt hurt Slide 58 Relapse prevention Ask: What makes this a good time to stop? If they have tried many times before: What have you learnt from past attempts? What will you do differently now to stay stopped? How would you feel if you had a cigarette again? Who is going to support you? Slide 59 1. Ive tried before, its too late now, the damage is already done 2.My doctors told me to see you about quitting smoking 3 Ive really cut down since my heart attack. 4 I feel so low since Ive stopped smoking and I crave a smoke all the time. 5I want to give up, but its hard as my partner smokes. 6I dont like to ask my in-laws not to smoke in the house. Slide 60 Contact details jennifer.percival@usa.net Email address