1. Promoting Smoke-free Families Your name, institution, etc. here Ways YOU can help your patients and their families quit smoking YOUR LOGO HERE (can paste to each slide)

2. …dedicated to eliminating children’s exposure to tobacco and secondhand smoke

3. 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

4. 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

5. Many Children Are Exposed More than 30% of children live with at least one smoker 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

6. 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

7. The Health Effects of Tobacco Use SIDsBronchiolitisMeningitis Infancy Low Birth Weight Stillbirth Neurologic Problems In utero Asthma Otitis Media Fire-related Injuries Influences to Start Smoking Nicotine Addiction Cancer Cardiovascular Disease COPD Adulthood Adolescence Childhood

8. 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 billion

9. Tobacco and Adolescents Each day, 3,450 US adolescents start using tobacco Experimentation (first step towards addiction) at earlier and earlier ages (10.7% by age 13) 26% of high school students are current tobacco users

10. Tobacco Use As an Infectious Disease Is tobacco use a disease transmitted by exposure? – Increased access to tobacco products for experimentation – Modeling of tobacco use behaviors? – Normalization of tobacco use?

11. Tobacco Use During Pregnancy Stillbirth, SIDS Premature delivery, low birth weight Placental abruption – the placenta tears away from the uterus Cancers Neurological, psychological, developmental effects

12. Immediate Effects of SHS Exposure Decreased lung function Respiratory infections Asthma Ear infections Meningitis, pneumonia Household fires

13. SHS Health Effects in Adults Cancers Respiratory Heart disease – Immediate increase in heart disease and stroke risk with one cigarette! Increased infection Decreased fertility

14. 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)

15. 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

16. Principles of Tobacco Dependence Treatment Nicotine is addictive Tobacco dependence is a chronic condition Effective treatments exist Every person who uses tobacco should be offered treatment

17. 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!

18. Counseling 101 Patients and families expect you to discuss tobacco use If counseling is delivered in a non-judgmental manner, it is usually well-received Even small “doses” are effective - and cumulative!

19. The Theory… Behavior change occurs in stages – not all at once Assessing Stage of Readiness Precontemplation Contemplation Ready for Action Action Maintenance Relapse

20. 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 action”… And so on….

21. 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. Brief Intervention

22. The 5 As Assess Ask Advise Assist Arrange Ask Advise Refer “2As and an R”

23. 2 As and an R: ASK Ask about tobacco use and SHS exposure at every visit Make asking routine, consistent, and systematic – Use standardized documentation – Document as a “vital sign” Just asking can double quit attempts

24. 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

25. 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

26. 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 child.” 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.”

27. 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

28. 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.

29. 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.”

30. 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 Quitlines

31. 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 Advantage of Quitlines

32. 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 THE DIRECTIONS!!!

33. 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

34. For the Unwilling/Not Ready The “5 Rs” – Relevance – Risks – Rewards – Roadblocks – Repetition

35. Community Advocacy Community and school education programs Be politically active Advocate for (and support!) smoke free environments Participate in media presentations DON’T USE TOBACCO IN ANY FORM!

36. Web address here LIST MATERIALS/SERVICES AVAILABLE: _____ 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). State Info Logo for state program here

37. Net Effect If you see 100 families every year, and 20% of those parents smoke, 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…?

38. Summary 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- QUIT-NOW

39. www.aap.org/richmondcenter 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

40. Questions? Skull of a Skeleton with Burning Cigarette Antwerp 1885-1886 Van Gogh Museum Amsterdam