1. 1 Tobacco Road: How to Navigate the Tricky Corners, Detours and Pot Holes of Tobacco Cessation Presented By: Bill Byron

2. 2 Workshop Agenda Tobacco Use Dependency Consequences to Smoking Quit Tips Local and National Resources

3. 3 Did You Know… Tobacco kills more than 430,000 U.S. citizens each year-more than alcohol, cocaine, heroin, homicide, suicide, car accidents, fire, and AIDS combined. Tobacco use is the leading preventable cause of death in the United States.

4. 4 Tobacco Use Dependency Tobacco Addiction: Physical Psychological Emotional American Lung Association www.lungusa.org

5. 5 Physical Dependency to Tobacco Nicotine is the addictive product that acts on the brain Addiction is characterized by compulsive drug- seeking and use, even in the face of negative health consequences National Institute on Drug Abuse

6. 6 Physical Dependency to Tobacco After exposure to nicotine… –a “kick” is experienced –adrenal glands react and release epinephrine (adrenaline) –the body then releases glucose, blood pressure, respiration and heart rate increases National Institute on Drug Abuse

7. 7 Nicotine also stimulates the pleasure center of the brain and affects dopamine levels Makes you feel good Increases nicotine receptors in the brain which increases tolerance for the drug Physical Dependency to Tobacco Interesting Fact: Nicotine reaches the brain in 7-10 seconds National Institute on Drug Abuse

8. 8 Physical Dependency to Tobacco Questions to Ask Yourself or Someone You Know Who Smokes? 1.Do you have your 1 st cigarette within 30 minutes after waking? 2.Do you smoke when you are sick? 3.Do you find it difficult to refrain from smoking for a few hours? 4.Do you physically feel bad when you don’t smoke? American Lung Association www.lungusa.org

9. 9 Psychological Dependency to Tobacco This is the mind’s response to smoking Learned Behavior Triggered Behavior Automatic Behavior American Lung Association www.lungusa.org

10. 10 Psychological Dependency to Tobacco Automatic Behavior by the Numbers! 10X20=200 Inhalations Per Cig.Cigs. Per DayInhalations Per Day 20X365=7,300 Years Days Per YearDay in 20 Years

11. 11 Psychological Dependency to Tobacco 7, 300X200= DaysInhalations Per Day 1,460,000 Inhalations for a 20 year smoking history American Lung Association www.lungusa.org

12. 12 Emotional Dependency to Tobacco This is the connection one feels towards their tobacco product “It’s for me!” “Cigarettes are my friends” “Cigarettes are always there for me” American Lung Association www.lungusa.org

13. 13 Consequences to Smoking

14. 14 Tobacco Use in NH Cigarette smoking rate in NH: –Adults – 20.5% –High School Students – 20.5% Annual deaths in NH: –Adults – 1,800 –Kids under the age of 18 who will die prematurely – 31,000 Campaign for Tobacco Free Kids, 2007

15. 15

16. 16 American Lung Association, 2007 What’s in Cigarettes?

17. 17 Consequences to Smoking American Lung Association www.lungusa.org

18. 18 Consequences to Using Spit Tobacco What’s in Spit Tobacco?  Nicotine  Carcinogens  Sugar  Sodium National Spit Tobacco Education Program – www.nstep.orgwww.nstep.org Centers for Disease Control

19. 19 Quit Tips

20. 20 Make the Decision to Quit Determine what your quit date will be –Make it for a few weeks out –Record it on your calendar –Tell your family and friends Prepare for your quit date Make a list of why you want to quit American Lung Association American Cancer Society Quit Tips

21. 21 20 minutes after quitting: Your heart rate and blood pressure drop. 12 hours after quitting: The carbon monoxide level in your blood drops to normal. 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. 1 to 9 months after quitting: Coughing and shortness of breath decrease, regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. 1 year after quitting: The excess risk of coronary heart disease is half that of a smokers. 5 to 15 years after quitting: Your stroke risk is reduced to that of a non- smoker. 10 years after quitting: The lung cancer death rate is about half that of a person who continues smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases. 15 years after quitting: The risk of coronary heart disease is the same as a non-smoker’s. American Cancer Society When smokers quit – what are the benefits over time?

22. 22 Learn About Your Smoking Habit Determine your smoking pattern –Track when you have each cigarette/dip/chew –Track need and mood for each cigarette/dip/chew Determine why you smoke –Stimulation –Handling –Pleasurable Relaxation –Crutch: Tension Reduction –Craving (physical/psychological) –Habit American Lung Association American Cancer Society Quit Tips

23. 23 Talk To Your Providers Discuss your smoking habit with your physician Ask about your options for over-the-counter nicotine replacement therapies and prescribed smoking cessation medication Learn about the medical and wellness benefits that are available to assist you through the quitting process American Lung Association American Cancer Society Quit Tips

24. 24 Set up a support system American Lung Association American Cancer Society Quit Tips Surround yourself with positive people Don’t put yourself into a situation that will make you want to smoke

25. 25 Prepare for Urges & Cravings Behavioral Tips –Avoid triggers –Change habits –Use alternatives –Practice deep breathing –Delay –Remember: The urge will pass whether you smoke or not –Reward yourself American Lung Association American Cancer Society Quit Tips

26. 26 Prepare for Your Quit Date Practice saying “No thank you, I don’t smoke” or “I can quit smoking” Reflect on past quit attempts Get rid of all cigarettes and smoking paraphernalia Reward yourself American Lung Association American Cancer Society Quit Tips

27. 27 Pharmacy Benefit Program Enhancements – Effective 10/1/2010 New Coverage for Physician-Prescribed Tobacco Treatment Medications and Over-the-Counter (OTC) Medications You may purchase tobacco treatment prescriptions and over-the counter medications to help you quit using tobacco products –Nicotine Replacement Therapy Patches, Gum, and Lozenge –Bupropion –Zyban –Nicotrol Nasal Spray –Nicotrol Inhaler –Varenicline –Chantix

28. 28 Pharmacy Benefit Program Enhancements – Effective 10/1/2010  Ask your doctor if a prescription or OTC medications would help you with your quit attempt –A prescription is also required for all OTC medications  Present your CVS Caremark prescription ID card with your prescription at the local retail pharmacy, or you can fill through the mail order program  The same copays apply to tobacco treatment medications and OTC medications as all other prescription copays

29. 29 Pharmacy Benefit Program Enhancements – Effective 10/1/2010 Dependence counseling programs available  Your Employee Assistance Program – Call 800.852.3345, ext. 4336  NH Smokers’ Helpline 800-Try-To- STOP (800.879.8678)  Other group counseling programs are also offered in your local community, hospital and workplace setting

30. 30 Smoking Cessation Resources In NH –QuitWorks™- NH –1-800-TRY-TO-STOP, Department of Health & Human Services –Community-based programs, Center for Health Promotion, local hospitals, non-profit organizations, etc. National –QuitNet - www.quitnet.orgwww.quitnet.org –Freedom From Smoking® Online program – www.lungusa.org www.lungusa.org

31. 31 Smoking Cessation Resources Breathe New Hampshire www.breathenh.orgwww.breathenh.org NH Department of Health and Human Services www.dhhs.nh.gov www.dhhs.nh.gov Centers for Disease Control www.cdc.govwww.cdc.gov American Lung Association www.lungusa.orgwww.lungusa.org American Cancer Society www.cancer.orgwww.cancer.org MayoClinic www.MayoClinic.comwww.MayoClinic.com National Spit Education Program www.nstep.org www.nstep.org

32. 32 Questions?