Smoking Cessation training
Very Brief Advice
Presented by Julia Wolska
Written by Jane Stephenson-Glynn and Julia Wolska
Public Health, LBTH
Tower Hamlets
• Tower Hamlets has one of the highest smoking
rates in the country 22.1% (nationally 18%) 2014
• High prevalence of smokeless tobacco users2
•
•
30% of Bangladeshi man
49% of Bangladeshi women
• Shisha pipe use is increasing in young adults
• Illicit tobacco is highly accessible
Tobacco use in Tower Hamlets
Chewing
Tobacco Chewing/Smokeless Tobacco
Chewing tobacco
• Pieces of tobacco are chewed or placed between the cheek and
gum or teeth. The nicotine in the piece of chewing tobacco is
absorbed through the mouth tissues
Paan chewing
• Can include mixture of tobacco, spices, supari (betel nuts), grated
coconut wrapped in betel leaf
• 20% of Tower Hamlets pop regularly use Paan
• Belief that it aids digestion
• Act as mouth freshener
• Oral health risk – 5 time more likely to be at risk of oral cancer
(Mouth Cancer Foundation 2009)
Shisha Facts
• Shisha is as harmful as cigarettes.
• Water does not filter out toxins.
• Shisha can cause serious heart and lung diseases and cancers.
• Herbal and fruit flavours mask the cancer chemicals.
• Herbal shisha is as bad as tobacco shisha
(due to presence of combustion
products caused by burning of herbs and charcoal, responsible for lung and heart disease, and
cancer).
Shisha Facts cont.
• Second-hand smoke from shisha session is more damaging than passive
smoke from cigarettes.
• Light headed feeling is the start of carbon monoxide poisoning.
• Shisha has nicotine and can lead you to smoking cigarettes.
• Sharing same shisha is not safe and may spread infections like herpes.
What’s in tobacco smoke?
Contents of a cigarette
• Lead – high blood pressure, nerve disorders, muscle pain and even
fertility problems
• Copper – Smokers have about twice as much of this metal in their
bodies as do non-smokers. Chronic (long term) exposure can result
in a build up in the kidneys, causing kidney disease
• Mercury – Chronic exposure is known to cause adverse effects on
mood, behaviour and memory, including irritability, tiredness,
sleeplessness, tremors and damage to the nerves in the arms and
legs
• Aluminum – Chronic exposure can cause shortness of breath,
weakness and cough
• Acetone – Inhalation can cause dizziness and headache
The three main components are:
• Nicotine
• Tar
• Carbon Monoxide
Tar
• The name given to all the other chemicals in the smoke particles
• Linked to cancer, lung disease, heart disease and many others
diseases
• Approximately 4,000 chemical compounds have been identified
in cigarette smoke, of which 69 are known to cause cancer
• The sticky brown substance that stains smokers’ fingers and
teeth a yellowy-brown
• About 70% of the tar inhaled stays in the smokers lungs
• Many of the substances in tar are known to cause cancer
• Irritants in tar can also damage the lungs by causing narrowing of
the small tubes (bronchioles) and damaging the small hairs (cilia)
that help protect the lungs from dirt and infection
Carbon Monoxide (CO)
A very poisonous gas
• Colourless
• Odourless
• Tasteless
Carbon Monoxide (CO) results from:
• Incomplete burning of natural gas and any carbon containing
material
• It is produced in car exhaust fumes, fires and from tobacco smoke
What Does CO Do to the Body?
Heart:
• To compensate for the shortage of oxygen, the heart has to work
harder (beat faster) to get enough oxygen to all parts of the body
• The heart itself gets less oxygen increasing the risk of heart damage
Circulation:
• CO binds much easier to Haemoglobin (Hb) in the blood than oxygen
binds to Hb
• The COHb causes thicker blood and the arteries get coated with a
thick fatty substance
• This causes circulation problems and high blood pressure, with
increased risk of a heart attack and stroke
• Hands and feet can become colder as less blood circulates to the
extremes
What Does CO Do to the Body?
Breathing:
• The reduced supply of oxygen means smokers can easily get out of
breath when exercising as there is little extra oxygen available for the
increased demand
• The lack of oxygen can also cause tiredness and lack of concentration
Pregnancy:
• The supply of oxygen required by the baby for healthy growth is
reduced when the pregnant mother smokes
Nicotine
• Nicotine is what makes smoking addictive, while carbon monoxide
and tar can cause serious disease.
Nicotine’s Effect on the Brain
• Nicotine is not a natural substance in the body, it affects
neurotransmitters in the brain
• When nicotine stimulates receptors in the brain ‘feel
good’ chemicals are released
• Exposure to nicotine at a young age will fundamentally change
the structure of the brain, resulting in an acquired drive or
desire for nicotine
Withdrawal
symptoms
Duration
Prevalence (%)
Urges to smoke
< 2 weeks
70%
Increased appetite
> 10 weeks
70%
Restlessness
> 4 weeks
60%
Poor concentration
> 2 weeks
60%
Irritability/aggression
< 4 weeks
50%
Sleep disturbance
< 1 week
25%
Low mood/Depression
> 4 weeks
60%
Constipation
>4 weeks
17%
Mouth Ulcers
>4 weeks
40%
Light headedness
< 48 hrs
10%
Smoking Affects the Whole Body
Diseases caused by smoking
Smoking causes many serious and fatal diseases, the most common are:
• Coronary heart disease
• Cancer – lung, mouth, nose and throat, larynx, oesophagus,
pancreas, bladder, stomach, leukaemia, kidney
• Chronic bronchitis
• Chronic obstructive pulmonary disease (COPD)
 Emphysema
 Pneumonia
Others
• Impotence
• Peptic ulcers
• Adverse effects on fertility (both men and women)
• Diabetes (Type 2 non insulin dependant)
Health benefits of giving up
•
•
•
•
Stopping smoking is the biggest single thing a person can do to
improve their health
Once a person stops taking in carbon monoxide, tar and the other
chemicals their body can start to repair the damage done by
smoking
Giving up increases a persons chances of living a longer and
healthier life
Giving up will:
 Reduce chances of developing cancer
 Help breathing
 Reduce phlegm in the lungs – cough less (eventually)
 Improve sense of taste and smell
 Stop hair, skin and breath smelling of smoke
 Stop any decline in lung efficiency
Time Since Quitting
Beneficial Health Changes
20 Minutes
Blood pressure and pulse return to normal for the individual. Circulation
improves – especially to hands and feet
8 Hours
Blood oxygen levels return to normal. Chances of having a heart attack
begin to fall
24 Hours
Carbon monoxide leaves the body. Lungs start to clear out the mucus and
debris
48 Hours
The ability to taste and smell is greatly improved
72 Hours
Breathing becomes easier. Bronchial tubes begin to relax and energy levels
increase
2-12 Weeks
Circulation improves throughout the body
3-9 Months
Coughs, wheezing and breathing problems improve as lung function is
increased by up to 10%
1 Year
Risk of heart attack falls to about half of that of a smoker
Stop Smoking Medications
NRT
• Nicotine Replacement Therapy (NRT) is licensed
for use in YP (12 years and up)
• There are 8 different NRT products (patch, gum, inhalator, microtabs, mini
lozenges, nasal spray, mouth spray, mouth strips)
• Research shows that using NRT doubles the
smokers chances of successfully stopping
• NRT works by giving ‘clean’ nicotine to prevent
withdrawal symptoms and gradually ‘weans’ the
patient off the nicotine (as the amount of nicotine is
reduced over the course of treatment)
Champix (Varenicline)
• Prescription only stop smoking medicine
• Very effective although not a magic pill! (will power is still essential)
• Works by blocking nicotine receptors in brain – reducing addictive power
of smoking and helping with cravings and withdrawal symptoms
Very Brief Advice (VBA)
A simple form of advice designed to be used opportunistically in
less than 30 seconds in almost any consultation with a smoker.
VBA - 3 A’s
ASK
ADVICE
ACT
ASK - and record smoking status
Do
“Do you smoke?”
Don’t
“Do you want to stop?”
ADVISE
“The most effective way to stop and stay
stopped is with support and medication.”
ACT
On client’s response. Build confidence and
refer to appropriate service.
ASK
open ended questions, offer smokers opportunity to process
information and decide if they are ready.
ADVICE
- dispel any misconceptions – shisha just as bad.
Inform them that the most successful way of quitting is with
support.
ACT – refer them onto specialist service.
VBA for smoking cessation is about….
• Raising the issue, routinely asking smoking status
• Exploring what smoking means to the individual
• Enabling the smoker to believe that they could stop
smoking if they choose to do so
• Checking levels of knowledge and beliefs about smoking
• Correcting misinformation
• Giving further information, advice and support
• Outlining the benefits of getting help and making quitting
easier for them if they access the service
• Referring to stop smoking service.
Stop smoking interventions
Brief interventions:
• Brief opportunistic advice provided by front line staff coming
into contact with smokers
• Smokers are asked about their smoking status and given
relevant information
• Smokers are signposted/referred to relevant stop smoking
service
Intermediate interventions:
• Delivered by level 2 advisors
• Offering one to one sessions which include preparation and
setting a quit date, advice on medications, behavioural
support and follow up sessions
Stop smoking interventions cont.
Specialist interventions delivered by Specialist Stop
Smoking Services:
• Smokers with complex needs
• Further support e.g. heavy smoker/one who has tried
unsuccessfully to quit before
• Specialist support for language/culture
• 1:1 and group sessions
• Pregnant
• Mental health patients
• It’s also a service of choice
Our tobacco cessation services
•
Pharmacies – 6 weeks programme based on 1:1 sessions
•
GP surgeries hosting specialist stop smoking service
clinics (8 weeks programme, 1:1 or group sessions)
•
Specialist service – for those who need more intensive
support, 1:1 and group sessions
•
Pregnancy service
•
BME Tobacco Project
Local Stop Smoking Services Contact Details
Specialist smoking cessation service
Service of choice and also for patients with further needs,
e.g. mental health, COPD, heavy smokers.
Tel: 0800 169 1943 or 020 7882 8230
Fax: 020 7791 1774
E-mail: [email protected]
Local Stop Smoking Services Contact Details
Specialist Pregnancy Service
Tel: 0800 169 1943 or 020 7882 8230
Fax: 020 7791 1774
E-mail: [email protected]
Local Stop Smoking Services Contact Details
BME Stop Tobacco Project
Offers culturally sensitive advice for the Black and Minority
Ethnic community who smoke cigarettes or chew paan with
tobacco.
Both male and female specialist advisers are available and
clients can be seen in a number of venues.
Tel (men): 020 7882 8660
Tel (women): 020 7882 8669
E-mail: [email protected]
Fax: 020 7791 1774
Your role
• Providing high quality Very Brief Advice on benefits of
stopping smoking and the most effective way to stop and stay
stopped, which is with support and medication
• Recording smoking status in the Lifestyle Intervention
template, incl. taking CO reading (as a motivational tool)
• Actively referring, if appropriate, via referral on EMIS web
Further training, reading and resources
Training:
VBA- online training : National Centre for Smoking Cessation and Training – Its free and
covers 2 subjects: how to offer brief smoking cessation support & the effects of passive
smoking http://elearning.ncsct.co.uk/vba-launch & http://elearning.ncsct.co.uk/shs_vbalaunch
Advisor training
http://www.ncsct.co.uk/training-and-assessment
National Centre for Smoking Cessation and Training – covers higher level training on
becoming a stop smoking practitioner. All courses are Department of Health accredited and
you will gain a certificate for each upon completion.
Free stop smoking resources:
http://smokefree.nhs.uk/resources/
http://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf
LBTH Public Health Tobacco Control Team
Jane Stephenson-Glynn
[email protected]
Public Health Strategist/Programme Manager
0207 092 7537
Julia Wolska
[email protected]
Public Health Advisor
0207 092 7387
Mutiur Rahman
[email protected]
Public Health Advisor
0207 092 7385