1. Addressing Tobacco Use within College Health Services National Conference of Tobacco or Health December 12, 2003 – Boston, MA Michael P. McNeil, M.S. Coordinator, Temple Health Empowerment Office (THEO) Adjunct Faculty, Public Health Temple University Chair, Tobacco Intervention & Prevention Subcommittee American College Health Association (ACHA)

2. Session Objectives At the conclusion of this session, participants will be able to: Discuss recommended strategies for identifying and screening tobacco use in the clinical setting. Discuss tobacco use and dependence treatment in college health services. Discuss strategies for linking tobacco cessation and prevention with the clinical services on campus.

3. Who Are You? Administrators Clinicians Counselors Health Educators Nurses/Nurse Practioners Pharmacists Physicians/Physician Assistants Other Multiple Titles

4. So Why Tobacco Among College Students? 1987 11% of college students are regular tobacco users 1995 29% were current cigarette smokers (had smoked one or more cigarettes during the 30 days preceding the survey) (NCHRBS) 28% reported receiving information on tobacco use prevention from their college or university 1999 35% of high school students currently use some form of tobacco (cigarettes, smokeless, cigars, pipes, bidis, or kreteks) (National Youth Tobacco Survey)

5. So Why Tobacco? continued… 2003 23% of men are smokers 20% of women are smokers (National College Health Assessment, Spring 2003)

6. Before They Get To Campus… Health History Form Include open-ended tobacco use questions “Number of cigarettes smoked daily” “Amount of dip/snuff used daily” Dose & Frequency are important to know so that you are prepared to address the students tobacco use at first visit Remember that parents often complete these forms and may not know of a students’ tobacco use

7. Arriving @ Student Health Sign In Desk Signage that advises a tobacco-free space Information about cessation services Waiting Spaces Posters that promote cessation and/or non-use messages Reading Materials Select publications that have few, if any, tobacco ads Sticker campaigns Exam Rooms Posters that promote cessation and/or non-use messages Quit kits in every room

8. Charting Flag outside of all charts to indicate tobacco user Should note difference between cigarettes and smokeless tobacco along with dose/frequency Have a marker to indicate students that have quit Note in chart on every visit – use suggested questions for assessment Praise students that have quit Verbal reward from health care provider may have an impact on relapse prevention

9. Questions To Ask During The Visit Initial Question “When was the last time you used a tobacco product?” Those that identify smoking “So you smoke about a pack a day?” Those that identify smokeless tobacco “So you use about a can of dip/snuff each day?”

10. Vitals Consider the tobacco questions a part of your vitals that are checked on every visit This helps send the message that you are concerned about this issue and helps student to know that help is available Make sure to be as non–judgmental as possible – never push the issue.

11. Stages Of Change Pre-contemplation Never considered quitting use Contemplation Thought about cessation, not made serious attempt Ready for Action Desires to make serious quit attempt Action In process of quitting (may still be using) Maintenance Has ceased use – trying not to restart Relapse Prevention Replaced all negative tobacco behaviors with positive choices

12. The 5 A’s Ask whether the student smokes Advise the student to quit Assess whether the student wants to make a quit attempt Assist the student in developing a plan Arrange follow-up www.surgeongeneral.gov/tobacco

13. Quit Kits Information sheet on cessation products & services Reply card Gum/Mints/Sugar Free Candy Straw/Toothpick Social support options “Quitting smoking is easy. I’ve done it thousands of times.” -Mark Twain

14. Behavioral Options Group support Individual support Phone/E-Mail Some students are concerned about gaining weight – sessions of proper nutrition, cooking classes, etc. can help

15. Pharmacotherapy Bupropion SR (Zyban) Second Line Therapy Nortriptyline Clonidine Nicotine Replacement Therapy Patch Inhaler Gum Nasal Spray Lozenges Water “I won’t use drugs to quit smoking” –19 year old college student

16. Combination Therapy Combinations of cessation efforts/options have shown better results Consider offering multiple pharmacology and behavioral choices to students

17. Make It Easy Consider cost-recovery based offerings of pharmacotherapy options Consistent and convenient access to cessation support is critical to success Consistency in student/provider contact (relationship building) may help

18. Making The Links Who is offering your cessation services? Physician, Nurse Practioner, Nurse, Counselor, Health Educator, Peer Educator What training do they have? Mayo Clinic Treating Nicotine Dependence University of Florida Online Certification Program Who coordinates your prevention services? Are they linked with cessation? Do you review efforts & charts?

19. Your Turn… Questions Comments Cares Concerns Thank you for sharing your valuable time and energy with me. I hope that this session met your personal and professional goals for today. Please let me know how I may be of assistance to you in the future.

20. Contact Me Michael P. McNeil, M.S. Coordinator, Temple Health Empowerment Office (THEO) Student Health Services - Mitten Hall, Lower Level 1913 N. Broad Street Philadelphia, PA 19122 Phone (215) 204-7509 E-mail mpmcneil@temple.edu “You can’t teach what you don’t know and you can’t lead where you won’t go.” - Dr. M. Joycelyn Elders