What we need to know about smoking & tobacco

addiction

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

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

What’s in tobacco smoke?

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)

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.

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 quicklyEven as quickly as with one puff!

Nicotine withdrawal symptom

Duration Proportion of those trying to quit who are affected

Irritability / aggression

< 4 weeks 50%

Depression < 4 weeks 60%

Restlessness < 4 weeks 60%

Poor concentration

< 2 weeks 60%

Increased appetite

> 10 weeks 70%

Light-headedness

< 48 hours 10%

Night-time awakenings

< 1 week 25%

Craving > 2 weeks 70%

Jarvis MJ. ABC of smoking cessation. Why people smoke. BMJ 2004;328:277-9.).

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.

How can people best be supported to become

smokefree?

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

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)

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?”

B- Brief Advice

• Personalise your advice

• Acknowledge that it’s difficult

• Be supportive

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

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

Quitting without supportThe majority of people who quit this way will relapse in the first week

Only 2.5%

abstinent at 1-year

Impact of Increasing Quit Attempts and Support

Aveyard and West. Managing Smoking Cessation. BMJ 2007;335:37-41

“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