Promoting Smoke Free Families by rBZ8GsU3


									               Promoting Smoke-free Families
                     Ways YOU can help your patients and
                         their families quit smoking

                Your name, institution, etc. here

(can paste to each slide)
…dedicated to eliminating children’s exposure to tobacco
and secondhand smoke
               Learning Objectives

To understand:
• The harms of secondhand smoke (SHS) exposure
• The influential role YOU have when delivering the “You
  should quit” message
• The importance of a smoke free home
• How to refer clients and their families to 1-800-QUIT-NOW
             Local Adult Tobacco Use

• ___% of ___ adults smoke
   – US 20%; Utah 12%; Kentucky 28%

• ___% of ___ African Americans
   – ___% of ___ Caucasians

• ___% ___ adults, no high school diploma
   – ___% ___ adults, more than high school diploma

• ____ deaths every year
   – ___% of deaths
       Many Children Are Exposed

• More than 30% of children live with at least one
• Younger children spend most of their time with a
  parent; if that parent smokes, SHS exposure can
  be highly significant
• Exposures occur in the home, child care, car
            Tobacco-Free Homes
               are Protective

• Children and adolescents who live in tobacco-free
  homes are less likely to use tobacco
• Strict smoke free home rules encourage cessation
  among smoking members of household
• Home smoking bans reduce smoking rates and
  cigarette consumption among youth
   The Health Effects of Tobacco Use
                                              Otitis Media
                                              Fire-related Injuries
                                                                        to Start
Meningitis                        Childhood

                        Infancy                Adolescence

                                                                      Nicotine Addiction
                           In utero      Adulthood

  Low Birth Weight
  Neurologic Problems                         Cancer
                                              Cardiovascular Disease
        SHS Exposure Causes Death
          and Disease in Children

• ~6,200 children die each year in the U.S. as a
  result of SHS exposure
• ~5.4 million childhood illnesses are attributed to
  SHS exposure
• Annual costs attributable to SHS exposure: ~$4.6
          Tobacco and Adolescents

• Each day, 3,450 US adolescents start using
• Experimentation (first step towards addiction) at
  earlier and earlier ages (10.7% by age 13)
• 26% of high school students are current tobacco
  Tobacco Use As an Infectious Disease

• Is tobacco use a disease transmitted by exposure?
   – Increased access to tobacco products for
   – Modeling of tobacco use behaviors?
   – Normalization of tobacco use?
                       Tobacco Use
                     During Pregnancy

• Stillbirth, SIDS
• Premature delivery, low birth weight
• Placental abruption – the placenta tears away from the
• Cancers
• Neurological, psychological, developmental effects
      Immediate Effects of SHS Exposure

• Decreased lung function
• Respiratory infections
• Asthma
• Ear infections
• Meningitis, pneumonia
• Household fires
        SHS Health Effects in Adults
• Cancers
• Respiratory
• Heart disease
   – Immediate increase in heart disease and stroke risk
     with one cigarette!

• Increased infection
• Decreased fertility
                 Long Term Effects of
                    SHS Exposure

• Increased risk of cancers
   – Adult leukemia and lymphoma associated with exposure to maternal
     smoking before age 10

• Increased risk of lipid and cholesterol disorders?
• Metabolic syndrome? (a newly recognized syndrome
  associated with diabetes and cardiovascular disease)
          SHS Exposure and Asthma

• SHS exposure increases frequency of episodes and
  severity of symptoms
• SHS exposure causes asthma symptoms in 200,000-
  1 million kids
Principles of Tobacco Dependence

    • Nicotine is addictive
    • Tobacco dependence is a chronic
    • Effective treatments exist
    • Every person who uses tobacco should be
      offered treatment
           Smokers Want to Quit

• 70% of tobacco users report wanting to quit
• Most have made at least one quit attempt
• Cite health expert advice as important
  • Regardless of type! THIS MEANS YOU!
                 Counseling 101

• Patients and families expect you to discuss tobacco
• If counseling is delivered in a non-judgmental
  manner, it is usually well-received
• Even small “doses” are effective - and cumulative!
               The Theory…
        Assessing Stage of Readiness



                  Ready for Action     Relapse



Behavior change occurs in stages – not all at once
Your Goal: Help the Tobacco User Take the
                Next Step

 Help a precontemplator become a contemplator…
 …a contemplator start to make plans…
 …someone who relapsed become “ready for
 And so on….
              Brief Intervention

• Minimal interventions lasting less than 3 minutes
  increase overall tobacco use abstinence rates.
• Every tobacco user should be offered at least a
  minimal intervention, whether or not he or she is
  referred to an intensive intervention.
The 5 As   “2As and an R”

  Ask      Ask

 Assess       Advise

Arrange    Refer
               2 As and an R: ASK

• Ask about tobacco use and SHS exposure at every
• Make asking routine, consistent, and systematic
– Use standardized documentation
– Document as a “vital sign”
• Just asking can double quit attempts
                How Do You Ask?
• Don’t lead: “You don’t smoke, do you?”
• Depersonalize the question: “Does anyone living in your
  home use tobacco in any way?” “Who is it?” “Where do
  they smoke?” “Is that inside the house?”
• Explore: “You say no one smokes around your son. What
  does that mean?”
• Don’t judge – check your body language, tone of voice,
  the phrasing of the question
            2 As and an R: ADVISE
• Strongly advise every tobacco user to quit
• Provide information about cessation to all
  tobacco users
• Strongly urge smoke free homes and cars
• Look for “teachable moments”
• Personalize health risks
• Document your advice
                      What Do You Say?

• Clear: “I advise you to quit smoking.”
• Strong: “Eliminating smoke exposure of your son is the most
  important thing you can do to protect the health of your
• Personalized: Emphasize the impact on health, finances, the
  child, family, or patient.
   •   “Smoking is bad for you (and your child/family). I can help you quit.”
   •   “Tobacco smoke is bad for you and your family. You should make your
       home and car smoke free.”
                        Be Specific…
• Having a smoke free home means no smoking
  ANYWHERE inside the home or car!
• It DOES NOT mean smoking:
  –   Near a window or exhaust fan
  –   In the car with the windows open
  –   In the basement
  –   Inside only when the weather’s bad
  –   Cigars, pipes, or hookahs
  –   On the other side of the room
            2 As and an R: REFER

• To quit line, 1-800-QUIT-NOW
• To community and Internet resources
• Give every tobacco user something that contains
  information about quitting, the harms of tobacco
  use, etc.
                What Do You Say?

• “You should call this number. It’s a free service – and
  the person on the other end of the telephone line
  can help you get ready to quit.”

• “You should learn as much as you can about quitting
  – the more you know, the more successful you’ll be.”

• It takes only 30 seconds to refer a
  patient to a toll-free tobacco use
  cessation quitline
• Quitlines are staffed by trained
  cessation experts who tailor a plan
  and advice for each caller
• 1-800-QUIT-NOW callers are routed to
  state-run quitlines or the National
  Cancer Institute quitline
             Advantage of Quitlines

• Accessibility
• Appeal to those who are uncomfortable in a
  group setting
• Tobacco users more likely to use a quitline than
  face-to-face program
• No cost to patient
• Easy intervention for healthcare professionals
    -Fax-back referral services
              Medications Work!
• Bupropion SR (Zyban ®) & Varenicline (Chantix ®)
  • Start BEFORE the quit date
  • Prescription needed
• Nicotine replacement products
  • Gum, patch, lozenge
  • Others need prescription
  • Under 18 years need prescription
                    Follow Up

• Ask clients how they’re doing
• Ask them if their home and car are smoke free
• Ask them if they called 1-800-QUIT-NOW
                      For the
               Unwilling/Not Ready
• The “5 Rs”
  –   Relevance
  –   Risks
  –   Rewards
  –   Roadblocks
  –   Repetition
             Community Advocacy

• Community and school education programs
• Be politically active
• Advocate for (and support!) smoke free
• Participate in media presentations
                   State Info

        Logo for state program here
 _____ provides the latest tobacco
 cessation treatments to help tobacco
 users quit, including FREE patches,
 lozenges, and counseling for __ residents!
  – Patient educational materials are available in English
    and (other languages).

              Web address here
                       Net Effect

If you see 100 families every year, and 20% of those parents
If you advise every parent who smokes to quit, 20 parents
    receive the advice.
If 10% of those advised quit, then you’ve helped 2 parents
    quit! And at least 2 children are no longer exposed!
If all your colleagues counseled…?

You should now understand:
• The harms of secondhand smoke (SHS) exposure
• The influential role YOU have when delivering the
  message “You should quit”
• The importance of a smoke free home
• How to refer clients and their families to 1-800-
 Need more information?
The AAP Richmond Center
     Audience-Specific Resources
       State-Specific Resources
        Cessation Information
        Funding Opportunities
     Reimbursement Information
      Tobacco Control E-mail List
    Pediatric Tobacco Control Guide

Skull of a Skeleton with
Burning Cigarette
Antwerp 1885-1886
Van Gogh Museum

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