1. www.hertsdirect.org HERTFORDSHIRE STOP SMOKING SERVICE BRIEF INTERVENTION TRAINING FOR HEALTH CHAMPIONS Trainer: Janka Szocs Stop Smoking Specialist 22 nd April

2. www.hertsdirect.org What causes the most deaths per day worldwide? Suicide Illegal Drugs Aids Murder Road Accidents Smoking

3. www.hertsdirect.org Smoking causes approximately 13000 deaths per day worldwide Suicide Illegal Drugs Aids Murder Road Accidents Smoking More deaths than all of the other 5 added together

4. www.hertsdirect.org Smoking Smoking is responsible for 20% of all deaths in the UK. 300 deaths in the UK daily 50% of smokers die prematurely Repeated quit attempts may be needed Consider Smoking as: a powerful motivation to engage versus an impaired capacity for restraint1 Robert west Maudsley clinic London

5. www.hertsdirect.org £5.2 billon per year Smoking: Cost to the NHS Allender S, Blakrishnan R, Scarborough P, Webster P, Rayner M. The burden of smoking related ill health in the United Kingdom. Tobacco Control, 2009;18.262-267

6. www.hertsdirect.org What’s in a cigarette?

7. www.hertsdirect.org More than 4,000 other chemicals in cigarette smoke, 1 more than 50 of which are known to cause cancer 2 It is the mixture of toxins in cigarette smoke that is responsible for the majority of the harmful effects, not nicotine 1 Myth: Nicotine causes the diseases related to smoking 1. www.treatobacco.net./English/keyfindings/key_finding_1.html Last accessed on 15.02.08 2. Hoffmann D & Hoffmann I. J Toxicol Environ Health 1997; 50(4):307-364. FACTS: There is no evidence to suggest that nicotine causes cancer 3 http://smokeaway.files.wordpress.com

8. www.hertsdirect.org Tar 70% of the tar in smoke is deposited in the lungs. Many of the chemicals are known to cause cancers Damages lungs & cilia Stains fingers, teeth & hair ? Low tar vs High tar

9. www.hertsdirect.org Carbon Monoxide Carbon monoxide is a clear odourless, poisonous gas that dissolves in the blood quicker than oxygen. It attached to the red blood cells reducing oxygen in the blood by up to 13%. The body compensates by making more red cells, making the blood thicker and stickier so the heart Has to work harder resulting in an increased risk of Developing coronary heart disease. Carbon monoxide is harmful during Pregnancy as it reduces the amount of oxygen carried to the baby in the womb Carbon monoxide levels can be measured using a CO monitor.

10. www.hertsdirect.org MECHANISM OF ACTION OF NICOTINE IN THE BRAIN Nicotine binds to  4  2 nicotinic acetylcholine receptor stimulating dopamine release 1-3 This results in the satisfaction associated with smoking 1-3 A drop in nicotine levels leads to craving and withdrawal 1,4 1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. Coe JW et al. J Med Chem 2005; 48: 3474-3477. 4. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004. 44 NIC Nicotine Dopamine Nucleus Accumbens (nAcc) Ventral Tegmental Area (VTA) NIC 44 22 22 22 α4β2 Nicotinic Receptor

11. www.hertsdirect.org Anatomy & Physiology of Smoking Receptors in mid brain release dopamine when activated by smoking Smoking increases the number of receptors by 300% Takes 7-10 seconds for inhalation to reach brain Down regulation takes 8-12 weeks 80% relapse potential after 1 cigarette – greater than with other addiction

12. www.hertsdirect.org 1. Jarvis MJ. BMJ 2004; 328:277-279. 2. Dani JA, Harris RA. Nature Neuroscience 2005; 8:1465-1470. 3. West R, Shiffman S. Smoking cessation. Fast Facts. Indispensable guides to clinical practice. Health Press, Oxford, 2004. 4. Caggiula AR et al. Physiol Behavior 2002; 77:683–687. Pharmacological Nicotine in tobacco smoke is highly addictive 1,2 Nicotine stimulates dopamine release in the brain, resulting in short-term feelings of reward/satisfaction 1,3 Behavioural Smoking-associated environmental stimuli play a role in reinforcing nicotine dependence 4 THE PHARMACOLOGICAL AND BEHAVIOURAL COMPONENTS OF SMOKING DEPENDENCE

13. www.hertsdirect.org WHAT ARE THE HARMFUL EFFECTS OF SMOKING?

14. www.hertsdirect.org Long term effects

15. www.hertsdirect.org Effects of Smoking in Pregnancy –Miscarriage –Stillbirth –Premature membrane rupture –Placenta praevia & abruption –IUGR (Fetal growth retardation) –Pre-term birth mature babies –SIDS

16. www.hertsdirect.org PRESENTATION HEADER/TITLE Secondhand tobacco smoke Effects on Children Respiratory tract infections Ear infections Asthma SIDS Low birth weight Meningitis Behaviour problems Risks in Adulthood

17. www.hertsdirect.org DO PEOPLE WANT TO QUIT SMOKING?

18. www.hertsdirect.org QUITTING SMOKING The majority of smokers want to quit (67%) 1 Most people try to quit without any assistance 2 Smokers are up to 4 times more likely to quit with help from a trained advisor 75% smokers have tried to quit at some point in the past* 1 Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279.

19. www.hertsdirect.org The majority of smokers want to quit 1 Most people try to quit without any assistance 2 Only 3-5% of unaided quitters remain smoke-free after 6 to 12 months 3 Most smokers make five to seven attempts before they finally succeed 3 98% of smokers who relapse following a quit attempt are willing to try quitting again 4 Quitting Smoking is difficult 1. Boyle P et al. Eur J Public Health 2000; 10(3 Supplement):5-14. 2. Jarvis MJ. BMJ 2004; 328:277-279. 3. Hughes JR et al. Addiction 2004; 99:29-38. 4. Joseph A et al. Nicotine Tob Res 2004; 6:1075-1077.

20. www.hertsdirect.org What % of smokers today think they will have stopped by next year? 50%

21. www.hertsdirect.org What % will have done so? 2%

22. www.hertsdirect.org Every smoker should be advised to quit, opportunistically, at least annually. (unless in exceptional circumstances) [1] NICE 2006 NICE GUIDELINES

23. www.hertsdirect.org What % make a quit attempt when offered treatment? 50%

24. www.hertsdirect.org WHY USE A STOP SMOKING SERVICE?

25. www.hertsdirect.org Smokers are 4 times more likely to quit with pharmacotherapy and behavioural support Ref Bobak A 2007

26. www.hertsdirect.org How can we increase the numbers of smokers using the service?

27. www.hertsdirect.org How can you help? Make raising the issue of smoking a priority Use brief intervention techniques Promote the benefit of using the service

28. www.hertsdirect.org What is a stop smoking brief intervention?

29. www.hertsdirect.org What is a brief intervention? Using opportunities to discuss a patient’s smoking Part of normal conversation “Do you smoke?” When a suitable opportunity presents Exploring a patient’s attitude to his/her smoking Ask open questions “What do you enjoy about smoking?” “What would need to change for you to stop?” Recognising when the smoker may be close to wanting to change his/her behaviour Smoker may be ready to quit Feelings about smoking change over time Discussing FREE support that is available and making a referral to stop smoking service 4 times as likely to succeed with help Explain that there is help available Circumstances change, e.g. pregnancy

30. www.hertsdirect.org Brief Intervention is: A 3 step 30 second systems based approach

31. www.hertsdirect.org The AAA Approach 3. ACT ASK regularly and be approachable ADVISE smoker of health benefits of stopping. Link advice to any colleagues specific conditions ACT on colleagues response and refer to stop smoking service for support 1. ASK 2. ADVISE

32. www.hertsdirect.org ASK regularly and record smoking status Use your own words, what feels appropriate for you Examples of what you might ask: “Do you smoke?” “Can I ask if you smoke?” “Have you ever thought about stopping smoking?” “Would you like to stop smoking?” “Have you ever tried to stop smoking?”

33. www.hertsdirect.org ADVISE smokers of health benefits of stopping As a health professional it is my duty to advise you to stop smoking. Stopping smoking is the best thing you can do to improve your current and future health Stopping smoking is the best thing you can do for your health You probably already know the risks involved with smoking but I cannot stress enough how important it is to stop. It is the best way to improve your health Examples of what you might say

34. www.hertsdirect.org ACT on patient’s response and refer You may choose to ask the patient if you can refer them or You may decide to refer unless they opt out e.g. “Lots of patients succeed with support from the FREE stop smoking service and stop smoking medication. Can I refer you?” e.g. “It is our policy to refer you to the stop smoking service. I can arrange that for you now”

35. www.hertsdirect.org ACT on patient’s response and refer The NHS provides free and effective treatment for smokers like yourself. In fact you are up to four times more likely to quit using this help than quitting by yourself. Are you interested in finding out more about this service? If you would like to give up smoking I can help you Examples of what you might say

36. www.hertsdirect.org Providing a Brief Intervention It is quick (takes less than 30 seconds) You are offering treatment to a patient with a serious addictive condition which is dangerous to their health Most smokers want to quit Half the smokers offered treatment make an attempt to quit Treatment via the stop smoking service is four times more effective than trying to quit alone If the smoker does not want to quit, leave the door open (e.g. “I respect your decision. Perhaps we could talk about it again another time”) Half the smokers offered treatment make an attempt to quit

37. www.hertsdirect.org What does the stop smoking service offer?

38. www.hertsdirect.org What does the stop smoking service offer? Pharmacotherapy (on prescription) Nicotine Replacement Therapy (NRT) Zyban & Champix Psychological Support At least 5 weekly meetings with trained advisor Carbon Monoxide Monitoring The service is free

39. www.hertsdirect.org What to expect from the stop smoking service A minimum of 5 appointments Initial appointment of 30 minutes: –Understand how and why the patient smokes –Agree the most appropriate pharmocotherapy –Measure level of carbon monoxide in the body Further appointments of 15 minutes: –Review progress and carbon monoxide levels –Address difficulties and obstacles Celebrate success!

40. www.hertsdirect.org How to refer

41. www.hertsdirect.org How to refer Fax referral form to 01442 453070 Phone Hertfordshire Stop Smoking Service 0800 389 3 998 Free resources (e.g. stop smoking leaflets in a variety of languages, posters) can be obtained from: www.healthpromotioninherts.nhs.uk

42. www.hertsdirect.org NATIONAL CAMPAIGNS Non Smoking Day Stoptober Great opportunity- Networking with Pharamacies, HSSS Get in contact with your locality specialist. Information from Media is not linked together with Herts Stop Smoking Service.

43. www.hertsdirect.org Further information is available from: Stevenage/Welhat Specialist: janka.szocs@hertfordshire.gov.uk 07789505207 Helen.cleary@hertfordshire.gov.uk Workplace Intervention Lead Hertfordshire Stop Smoking Service 0800 389 3 998 www.smokefreehertfordshire.nhs.uk

44. www.hertsdirect.org Giving brief advice can only take 30 seconds, but can save a smoker’s life. Stopping smoking works

45. www.hertsdirect.org ANY QUESTIONS? THANK YOU!