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					Confident Conversations
    About Tobacco
     Agenda for Today’s Session

1. Why is this important?

2. What is your role?

3. Maine Treatment Resources
1. Why Is It Important
To Discuss Tobacco Use?
       Health Impact of Tobacco Use

More people die from tobacco than from alcohol, other drugs,
homicides, suicides and motor vehicle accidents combined
                    U.S. Preventable Causes of Death, 2000
Toxins in Tobacco Harmful to Health

       • Over 4,000 chemicals

       • Over 50 are carcinogenic
                Secondhand Smoke Risks

  •   Heart attack
  •   Lung cancer
  •   Other cancers
  •   Asthma
  •   Allergic responses


  •   Ear infections and colds
  •   Bronchitis, pneumonia, and other
      lung infections
  •   Increases allergies and asthma
      and makes them worse
  •   Burns and fire deaths
                                     Risk to the Fetus
            (from primary smoking or secondhand smoke)

 • Low birth weight
 •    Higher risk of delivering a preterm infant
 •    Higher perinatal mortality
 •    Increased bleeding during pregnancy
 •    Higher risk of miscarriage
 •    Higher risk of birth defects
 •    Development of weaker lungs
 •    Greater risk of respiratory infections

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General,
U.S. Department of Health and Human Services (2006)
           Tobacco Smoke and Pets

• Malignant lymphoma in cats
• Lung cancer in dogs
• Nasal cancer in dogs
                Thirdhand Smoke
 Thirdhand smoke is the toxic particles that remain after
  visible smoke is gone: They pose a risk to infants and
  children who inhale them
 250 poisonous chemicals in cigarette smoke include
  lead, arsenic, cyanide
 Babies and young children absorb, swallow or inhale
  residue from clothes, upholstery, rugs, toys, skin & hair
 Studies are in process to measure the level of health
  effects on babies and children
            Thirdhand Smoke
Thirdhand smoke can:
   • Affect brain development

   • Cause learning or cognitive defects

   • React with other chemicals in the air to form
     strong cancer causing agents
      Secondhand & Thirdhand Smoke

Ventilation does not eliminate the risk

Separation within a house does not eliminate the risk
What to do to protect children, the elderly and others?
   • ‘Take it outside’ and wear jacket/cap that can be removed
     before returning inside
   • Don’t smoke in the car
   • Don’t allow others to smoke in the home and car
   • Quit smoking
            New Tobacco Products
• Are not banned by smoke-free laws
• Were designed to be used where smoking is not
• Are still harmful because they contain tobacco
• Are still addictive because they contain nicotine
2. What is your role?
             Encourage Change
• Begin with listening

• Seek to understand

                         • Serve as an ally

                         • Offer respect
  Give Clear and Consistent Messages

• Quitting is very important to your client’s health
• You have a significant influence over your clients
• They appreciate your asking about their tobacco use
• Your help gives clients resources and helps them to be
Understanding Tobacco Treatment

           • Tobacco is a chronic disease
           • Tobacco is an addiction
           • Quitting is a process

           Public Health Service Guidelines
               Has evidence-based methods
               Prepares physicians to use 5 A’s
               Describes approved Nicotine
                Replacement Therapy (NRT)
             Evidence-Based Methods

• Talking (less than 5 minutes) is effective in
  helping people quit

• Approved medications (nicotine patch,
  lozenge and gum) increase the rate of

• Positive support is helpful
The Five A’s, Recommended for Health Care
 ASK about tobacco use, every time.

 ADVISE quitting.
 ASSESS interest in quitting.
 ASSIST by offering help when ready to try.
 ARRANGE follow-up

Treating Tobacco Use and Dependence (2008)
We recommend that you use the first
          three A’s:


 • Do you smoke or use other tobacco?

 • Any use in the past 6 months?

 Have you tried to stop in the past?

 How did that go?

 How do you feel about quitting?

• Provide appropriate resources

• Refer to the Maine Tobacco HelpLine

• Refer to local resources & support groups
     Understanding Slips & Relapse

• Slips and relapse are part of the quitting process

• Avoid shame and blame – focus on what was

• Re-assess readiness to quit and agree on next steps

• Each time someone tries to quit, the chances of
  success get better, not worse!
3. Maine Treatment Resources
             Maine Tobacco HelpLine
• Is free and available to any Maine resident
• Is a HelpLine and not a “ Hot Line”
• When people call and register:
   They receive a quit packet with information
   A quit date is set and a quit plan created
   Caller will receive 4 follow-up calls
   If eligible, the caller may have the opportunity to participate
    in the medication program
 Medication Voucher Program of the
     Maine Tobacco HelpLine
• Nicotine patch, gum or lozenge
       4   week supply, given for up to 8 weeks

• Eligibility: 18 or over, no insurance, or insurance
  with no Nicotine Replacement Therapy (NRT)
        MaineCare does provide coverage for NRT

• Paperless process: the individual just picks up the
  NRT at the pharmacy of his/her choice
                   Build a Routine
• Discuss tobacco status at each visit; be comfortable with
  the process.

• Use the 3 A’s: Ask, Assess, Arrange

• Chart progress at each visit

• Remember that relapse is part of the process. Encourage
 the client to continue with their quit attempts

• Provide information about the Maine Tobacco HelpLine
Local Resources
        Help for Your Clients
Partnership For A Tobacco-Free Maine Phone:

    (District Tobacco Coordinator name
              and number here)

       (HMP name and number here)

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