1. Nurses’ Role in Tobacco Use Control Kawkab Shishani, PhD kshishani@wsu.edu

2. Objectives o Recognize that all tobacco forms are hazardous to health o Realize the emerging threat from the rapidly growing smokeless tobacco industry globally o Recognize the role of gender in tobacco use o Apply smoking cessation counseling in practice o Be actively involved in tobacco control at all levels

3. Why Tobacco Use is Hazardous to Health o Smoking is the chief avoidable risk factor for chronic diseases o Smoking affects progression of chronic diseases o Unlike the other risk factors, smoking affects smokers as well as those around them

4. Tobacco Forms o Smoke cigarettes cigars pipe waterpipe

5. Tobacco Forms o Smokeless Dip Snus Chewing Snuff

6. Myths Associated with Smokeless Tobacco o Smokeless tobacco is a safe alternative for smoking Smokeless tobacco IS NOT SAFE. It contains NICOTINE Chemical compounds added to smokeless tobacco include: Ammonium (chloride & Carbonate); Proplyene Glycol; Ethyl Alcohol; Sodium (Chloride, Carbonate, Saccharin & Citrate); and many other chemical….

7. Myths Associated with Smokeless Tobacco o Smokers can quit by switching to smokeless tobacco Nicotine in all tobacco products causes addiction Switching from smoke to smokeless tobacco does not solve the problem

8. E-cigarettes o A battery operated device o Filled with solution that contains nicotine o When a user inhales, the vaporizer turns the liquid into a vapor o Is not a safe alternative to cigarettes o Poorly regulated; nicotine content in the solution varies according to the manufacturer

9. Burden of Tobacco Use o 1.3 billion smokers 20% in developed countries 80% in developing countries o Insufficient tobacco policies in developing countries lead to increase in: Tobacco leaf production Cigarette production

10. Women and Tobacco Use o 250 million women smoke globally o 22% of women in developed countries smoke o 9% of women in developing countries smoke o Male smoking rates are in slow decline o Female smoking rates are still rising o Tobacco industry target women through deceptive images (e.g. slim, menthol cigarettes)

11. Women and Tobacco Use o Nicotine metabolism may differ in women compared to men (Zeman, Hiraki, & Sellers, 2002). o Women take more puffs to have the same nicotine effect as men o Women develop lung cancer with lower levels of smoking o Women are less successful in quit attempts o Women face more difficulties in quitting

12. Passive Smoking o Indoor Homes Schools Workplaces Hospitals, Primary care o Public transportation o Outdoor Parks Play grounds

13. Tobacco Dependence From Benowitz N. Nicotine Addiction. Primary Care 1999; 26(3):611-31

14. Why it is Difficult to Quit o Coping with withdrawal symptoms Urges to smoke Craving Anxiety Restlessness Nervousness

15. Why it is Difficult to Quit o Adapting to withdrawal symptoms Headache Depressed mood Difficulty in concentrating Increased appetite

16. Benefits of Quitting o Immediate effect: Breath smells better Food taste improves Yellow fingernails disappear Everyday activities become more enjoyable Teeth get whiter o Improves lung functioning

17. Benefits of Quitting o Lowers the risk of: Lung and other types of cancer Heart disease and stroke Respiratory diseases o Women: Reduce the risk of infertility Reduce the risk of having a low birth weight baby

18. Role of Nurses in Tobacco Use Control o Nurses are in direct contact with Patients at acute care settings Primary care centers Public

19. Levels of Involvement in Tobacco Use Control o Individual o National o International

20. Individual level: Providing Smoking Cessation Counseling o Article # 14 FCTC “Each country shall develop evidence based guidelines to promote cessation of tobacco use and adequate treatment for tobacco dependence”

21. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009. Smoking Cessation Counseling

22. 5 A’s Model o Ask—Systematically identify all tobacco users at every visit o Advise—Strongly urge all tobacco users to quit o Assess—Determine willingness to make a quit attempt o Assist—Aid the patient in quitting (provide counseling and medication) o Arrange—Ensure follow-up contact

23. National Level o Be actively involved in tobacco use control activities o Network between your own institution and other national institutions that are involved in tobacco control to strengthen the national tobacco control efforts o Be involved in developing and maintaining a systematic approach to treat tobacco dependence

24. National Level o Raise awareness of high risk groups about the dangers associated with tobacco use and dependency o Lobby for health policies that ban tobacco use in public places o Participate in putting into enforcement health policies that are related to smoking

25. International Level o Participate in international tobacco forums o Collaborate with international scholars in developing new venues in tobacco control in your country o Exchange expertise with tobacco use control activists form around the world

26. Contact Information Kawkab Shishani, PhD kshishani@wsu.edu