1. What we need to know about smoking & tobacco addiction

2. Facts & Figures Prevalence rates of nicotine dependence in people with mental health & addictions services is estimated at 50 – 90%. Mental Health nurses smoking prevalence is twice as high as general nurses (29% vs 14%*). General population’s prevalence of nicotine dependence 21%*. Source*:2006 New Zealand Census data

3. Facts & Figures Within NZ 1/3 of all cigarettes are consumed by people with a mental illness of at least 12 mths*. Anecdotally screening and treatment for nicotine dependence hasn’t been offered by health services to people with mental health and addiction issues. People with serious mental illness have a life expectancy 15 yrs less than general population *Ref. Tobias M, Templeton R & Collins Tobias S (2008). How much do mental disorders contribute to New Zealand's tobacco epidemic? BMJ

4. What’s in tobacco smoke?

5. The Risks of Smoking About half of all people who smoke die from a smoking-related disease –500 people/year in NZ –On average die 15 yrs younger –Those killed in middle age (25% of all smokers) lose many years of productive life Smoking also causes loss of quality of life (eg. due to breathlessness)

6. What is in a cigarette? Tobacco cigarettes contain over 4000 chemicals, many of which are highly toxic. 40 are known cancer-causing substances Nicotine is a drug that occurs in tobacco. It causes addiction but is not cancer- causing. The tars and gases in cigarettes cause the most damage.

7. Nicotine! When we quit smoking, we can feel the effects of ‘nicotine withdrawal’. A major factor that maintains a smoking habit over time is addiction to nicotine We may get tense, or crave cigarettes. But these feelings are only temporary… We become addicted to nicotine very quickly Even as quickly as with one puff !

8. Nicotine withdrawal symptom Duration Proportion of those trying to quit who are affected Irritability / aggression < 4 weeks50% Depression< 4 weeks60% Restlessness< 4 weeks60% Poor concentration < 2 weeks60% Increased appetite > 10 weeks70% Light- headedness < 48 hours10% Night-time awakenings < 1 week25% Craving> 2 weeks70% Jarvis MJ. ABC of smoking cessation. Why people smoke. BMJ 2004;328:277-9.).

9. People want to stop smoking –69% of smokers tried to quit in last 5 yrs –44% of smokers tried to quit at least once in the last year –Maori, Pacific and young smokers just as likely to have tried to quit –72% of 15 to 19 yr old smokers would not smoke if they had their life again Ref. 2009 New Zealand Tobacco Use Survey. MoH. 2010.

10. How can people best be supported to become smokefree?

12. The ABC Approach A - ask whether a person smokes B - give brief advice to quit to all people who smoke C – make an offer of, and provide or refer for cessation support

13. How does the ABC work? Aims to provide better help for smokers to quit. Can be easily integrated into everyday practice, so that smokers are presented with every opportunity to quit. Can be personalised. Emphasises being encouraging and providing people the support and tools they need to become smokefree. “A little and often by many over time works.” (Fiore 2000)

14. A- Ask Ask whether a person smokes & document in notes Ask routinely & At least every six months “Are you currently smoking?” “Last time we caught up you were smoking, how are you doing with that?”

15. B- Brief Advice Personalise your advice Acknowledge that it’s difficult Be supportive

16. PHARMACOLOGICAL Nicotine replacement therapy (NRT) patches/gum/lozenges subsidised Other medications available on prescription (Zyban, Nortriptyline subsidised & Champix subsidised for eligible people) BEHAVIOURAL Telephone/Txt-based support - Quitline - SmokeStop Face-to-face support - Asian Smokefree - Aukati KaiPaipa - Pacific Quit Service - Pasifika Smoking Cessation - Pregnancy Services - Specialist Hospital Services - Local Quit Smoking Coaches Combining both gives the greatest chance of success C – Cessation (Quit) support

17. What is NRT? NRT safely replaces some of the nicotine that is normally provided by tobacco, and reduces the severity of withdrawal symptoms. NRT roughly doubles the likelihood of a successful quit attempt. There are a range of products available, and different products will suit different people. Not a magic cure – effort, support and strategies are also needed. Only $3 for 8 weeks supply

18. Quitting without support The majority of people who quit this way will relapse in the first week Only 2.5% abstinent at 1-year

19. Impact of Increasing Quit Attempts and Support Aveyard and West. Managing Smoking Cessation. BMJ 2007;335:37-41

20. “We must do everything we can to help people quit smoking and to stop young people from being tempted to take up the habit" Hon Tariana Turia Associate Minister of Health