Tobacco Cessation Competency Class

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Section 1
• Statistics • Effects of tobacco use on the body • Special populations
– – – – – – Gender Racial and ethnic minorities Hospitalized smokers Psychiatric co-morbidity and/or chemical dependency Children and adolescents Older smokers
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Section 1 Objectives
The participant will: • Verbalize the impact of tobacco use • List the gene affecting nicotine metabolism • List one effect of tobacco use on the skin • List one tobacco awareness program for children and adolescents
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Statistics

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Chief Avoidable Cause of Illness and Death in U.S.
• More than 440,000 deaths annually
– Lung cancer – Ischemic heart disease – Chronic Obstructive Pulmonary Disease (COPD)

• Over $75 billion in health care costs annually • Over $80 billion in lost productivity annually
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Children and Adolescents
• • • • >6,000 children try cigarettes each day 3,000 become regular users each day 79% start by the ninth grade High school seniors
– 35% currently smoke – 65% smoked at some time
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Genetic Link
• CYP2A6 – nicotine metabolizing gene • Mutation keeps nicotine in system longer
– Non-smokers are twice as likely to carry the mutation – Smokers with the mutation smoke less – Smokers with the efficient gene (no mutation) smoke more heavily to compensate

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Effects of Tobacco Use on the Body

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General Effects
• Positive
– – – – – – – – Improves memory, especially long-term Increases accuracy/speed of information processing Increases pain threshold Reduces tension and anxiety Chronic diseases of heart and lungs Cancer Stroke High blood pressure - Special populations Section 1

• Negative

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Specific Effects
• • • • • • • • Eyes, nose, and throat Pulmonary Cardiovascular Gastrointestinal Reproductive Integumentary Endocrine Musculoskeletal
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Eyes, Nose & Throat
• Within seconds
– Watering eyes – Runny nose – Cough

• Over time
– Abnormal thickening of membrane lining the throat – Cellular changes linked to throat cancer – Loss of smell and taste
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Pulmonary
• Compounds in cigarette smoke deposited as sticky tar on airways
– – – – – Injures the tissues Increases mucus production Thickens lining of bronchi  cancer Paralyzes cilia Destroys elastin

• Respiratory rate increases, lungs work harder
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Cardiovascular
• Heart
– Rate increases by up to 30% – Cardiac dysrhythmias/myocardial infarction

• Blood vessels
– Increased fibrinogen and platelet counts – Less elastic vessel walls – Increased risk of artherosclerosis and thrombus development – Reduced oxygen- carbon monoxide – Peripheral vasodilation

• Blood pressure- elevates up to 15%
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Gastrointestinal (GI)
• Decreased appetite
– Increased gastric secretions – Decreased stomach emptying – Loss of taste sensation

• Diarrhea/Constipation
– Often one predominates – Same person can experience both

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Reproductive System
• Male
– Increased hepatic metabolism  less testosterone – 50% increase risk of impotence among smokers – Sperm are less dense and less motile

• Female
– 72% fertility of non-smokers – Increased risk of cervical cancer and ectopic pregnancy – Earlier onset of menopause with worse symptoms
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Integumentary
• • • • Loss of elastin- premature wrinkling Dry, grayish, wasted appearance Hollow cheeks Yellowing of fingernails

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Endocrine
• Increases
– Serotonin – Endogenous opioid peptides – Pituitary hormones – Catecholamines – Vasopressin – Cortisol

• Decreases insulin
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Musculoskeletal
Almost immediate relaxation of peripheral skeletal muscles

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Special Populations

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Considerations
• “Generic” treatments effective in all populations • Racial and ethnic groups differ from whites
– Awareness of the health effects of smoking – Often report a sense of fatalism

• Attempt to accommodate for differences
– Culturally sensitive audiovisual aids – Patient’s primary language

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Gender
• Few differences from men in initiation or successful cessation identified • Potential considerations
– Greater likelihood of depression – Greater weight control concerns – Less support for stopping – Pregnancy may increase receptivity
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Pregnancy
• Quitting at any point decreases
– Spontaneous abortions – Placental abruption – Stillbirth – Premature birth – Low birth weight – Sudden infant death syndrome

• One in four pregnant women quit • Two-thirds restart after birth
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Racial/Ethnic Minorities (1 of 2)
• African Americans
– – – – – – – – – Prevalence rate is comparable Smoke fewer cigarettes on average Prefer mentholated brands Use brands with more nicotine and tar Higher cardiovascular disease and stroke risk Nicotine patch Clinical advice Counseling Self-help manuals

• Interventions

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Racial/Ethnic Minorities (2 of 2)
• American Indian/Alaska Native
– Higher prevalence rate than Caucasians – Highest documented SIDS rate

• Interventions
– Screening for tobacco use – Clinical advice and reinforcement – Follow-up materials
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Hospitalized Smokers
• May be particularly motivated to quit
– Hospitalization may have been caused or exacerbated by smoking – Temporarily housed in a smoke-free environment

• Interventions
– Document tobacco use status on admission – Flag chart to prompt provider to advise smoking cessation – Use counseling and pharmacotherapy to
• Maintain abstinence • Treat withdrawal symptoms
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Psychiatric Co-morbidity and/ or Chemical Dependency
• Psychiatric disorders and other dependencies are more common in smokers • Considerations
– – – – Exacerbation of co-morbid condition Altered pharmacokinetics of psychiatric medications Increased risk of relapse Can treat concurrent to treating other chemical dependencies – Little evidence individuals relapse to other drug use when they stop smoking
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Children and Adolescents (1 of 2)
• Quit rates for adolescents in cessation programs are higher • Community and school based
– Project Towards No Tobacco Use (TNT) – Minnesota Smoking Prevention Program – Students Helping Others Understand Tobacco (SHOUT)

• Parents receiving second-hand smoke exposure information can reduce
– Childhood exposure – Parental smoking rates
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Children and Adolescents (2 of 2)
• This population faces significant barriers to quitting
– Lack of information – No support from parents (who are often unaware of use) – Social pressure to continue

• Interventions
– No smoking pledge – Information on immediate rather than long-term effects
• Appearance • Health
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Older Smokers
• Clear benefits to quitting at any age
– Increased recovery from illnesses – Improved cerebral circulation – Better quality of life

• Interventions
– Buddy support – Age-tailored self- help – Proactive telephone counseling
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Questions?

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