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)

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

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

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

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

Tobacco-Free Homesare 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

The Health Effects of Tobacco Use

SIDsSIDsBronchiolitisBronchiolitisMeningitisMeningitis

InfancyInfancy

Low Birth WeightLow Birth WeightStillbirthStillbirthNeurologic ProblemsNeurologic Problems

In uteroIn utero

AsthmaAsthmaOtitis MediaOtitis MediaFire-related InjuriesFire-related Injuries

InfluencesInfluencesto Startto StartSmokingSmoking

Nicotine AddictionNicotine Addiction

CancerCardiovascular DiseaseCOPD

AdulthoodAdulthood

AdolescenceAdolescence

ChildhoodChildhood

SHS Exposure Causes Deathand 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

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

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?

Tobacco UseDuring Pregnancy

• Stillbirth, SIDS

• Premature delivery, low birth weight

• Placental abruption – the placenta tears away from the uterus

• Cancers

• Neurological, psychological, developmental effects

Immediate Effects of SHS Exposure

• Decreased lung function

• Respiratory infections

• Asthma

• Ear infections

• Meningitis, pneumonia

• Household fires

SHS Health Effects in Adults• Cancers

• Respiratory

• Heart disease– Immediate increase in heart disease and stroke risk

with one cigarette!

• Increased infection

• Decreased fertility

Long Term Effects ofSHS 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)

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

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

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!

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!

The Theory…

Behavior change occurs in stages – not all at once

Assessing Stage of Readiness

Precontemplation

Contemplation

Ready for Action

Action

Maintenance

Relapse

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….

• 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

The 5 As

AssessAssess

AskAsk

AdviseAdvise

AssistAssist

ArrangeArrange

AskAsk

AdviseAdvise

ReferRefer

“2As and an R”

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

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

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

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.”

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

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.

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.”

• 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

• 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

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!!!

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

For theUnwilling/Not Ready

• The “5 Rs”– Relevance– Risks– Rewards– Roadblocks– Repetition

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!

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

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…?

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

www.aap.org/richmondcenter

Need more information?The AAP Richmond Center

Audience-Specific Resources State-Specific ResourcesCessation InformationFunding Opportunities

Reimbursement InformationTobacco Control E-mail List

Pediatric Tobacco Control Guide

Questions?

Skull of a Skeleton withSkull of a Skeleton with

Burning CigaretteBurning Cigarette

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