Transcript WDHB Tobacco Control Plan 2010-2011

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 cancercausing.
• The tars and gases in cigarettes cause the
most damage.
Nicotine!
A major factor that
maintains a smoking habit
over time is addiction to
nicotine
• We become addicted to nicotine very quickly
Even as quickly as with one puff!
• When we quit smoking, we can feel the effects of ‘nicotine
withdrawal’.
• We may get tense, or crave cigarettes. But these feelings
are only temporary…
Nicotine
withdrawal
symptom
Irritability /
aggression
Duration
Proportion of those trying to
quit who are affected
< 4 weeks
50%
Depression
< 4 weeks
60%
Restlessness
< 4 weeks
60%
Poor
concentration
< 2 weeks
60%
Increased
appetite
> 10 weeks
70%
Lightheadedness
< 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
C – Cessation (Quit) support
BEHAVIOURAL
PHARMACOLOGICAL
•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
•Nicotine replacement therapy (NRT)
patches/gum/lozenges subsidised
•Other medications available on
prescription (Zyban, Nortriptyline
subsidised & Champix subsidised for
eligible people)
Combining both gives the
greatest chance of success
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 support
The 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