Cessation of Smoking

Question 1

Principal fatal diseases caused by smoking

are

Answer 1

cancer, COPD and CVD

Question 2

Health benefits of smoking cessation

Answer 2

Increased longevity
• Stabilisation of lung cancer risk (but not absolute decline)
• Heart disease risk declines towards non- smoker level over 10 years
• Accelerated decline in lung function reduced
• Improved reproductive health
• Improved recovery from surgery

Question 3

20 mins after quitting

Answer 3

blood pressure and pulse rate return to normal

Question 4

8 hours after quitting

Answer 4

blood nicotine & CO halved, oxygen back to normal

Question 5

24 hours after quitting

Answer 5

CO eliminated; lungs start to clear mucus etc.

Question 6

47 hours after quitting

Answer 6

nicotine eliminated; senses of taste & smell much improved.

Question 7

72 hours after quitting

Answer 7

breathing easier; bronchial tubes begin to relax; energy levels increase

Question 8

2-12 weeks after quitting

Answer 8

circulation improves

Question 9

3-9 months after quitting

Answer 9

lung function increased by <10%; coughs, wheezing decrease

Question 10

5 years after quitting

Answer 10

risk of heart attack halved

Question 11

10 years after quitting

Answer 11

risk of lung cancer halved compared to continued smoking;

risk of heart attack equal to never- smoker’s.

Question 12

What are the Psychological pathways to Quitting

Answer 12

transtheoretical Model of Behaviour Change

stage model

Question 13

what are the 6 steps in the stage model

Answer 13

pre-contemplation 
contemplation 
preparation 
action 
maintenance 
relapse

Question 14

pre-contemplation

Answer 14

Characteristics: Lack of Awareness or lack of intent to change
• Strategy: Short messages to attract attention, bring up potentially novel and highly relevant facts previously not considered

Question 15

Contemplation

Answer 15

• Characteristics: Increased awareness of negative aspects of smoking. Has intention to quit within 6 months.
• Strategy: Dispel Negative Myths about quitting smoking; reinforce willpower to quit

Question 16

Preparation

Answer 16

• Characteristics: Some small behavioral changes to quit have been made; intent to quit within 1 month (can set a “quit date”)
• Strategy: Longer messages, offer concrete tips and methods

Question 17

Action

Answer 17

• Characteristics: Individual has implemented plan to stop, still adjusting to the change
• Strategy: Offer specific relapse prevention advice for nicotine dependence to include advice on the nicotine patch

Question 18

Maintenance

Answer 18

• Characteristics: Long term adjustment as a non-smoker, content with new lifestyle without cigarettes
• Strategy: Congratulate and advise ongoing vigilance to keep off cigarettes

Question 19

4 A’s Approach to Smoking Cessation

Answer 19

Consistent with strategies developed by the National Cancer Institute, the American Medical Association, and others

Question 20

The 4 A’s

Answer 20

ask - about tobacco use
advise - to quit

Assess - willingness

Assist - in quit attempt
arrange - follow up

Question 21

advise

Answer 21

must be clear, strong

and personalised

Question 22

Assess

Answer 22

• Assess the patient’s willingness to quit within the next 30 days.
• If a patient responds that s/he would like to try to quit within the next 30 days, move on to the Assist step.
• If the patient does not want to try to quit, use the 5 R’s to try to increase motivation.

Question 23

Assist

Answer 23

• Suggest and encourage the use of problem-solving methods and skills for smoking cessation
• Provide social support as part of the treatment
• Arrange social support in the smoker’s environment
• Provide specific self-help smoking cessation materials

Question 24

Arrange

Answer 24

• Follow up to monitor progress and provide support
• Encourage the patient
• Expresswillingnessto help
• Ask about concerns or difficulties
• Invitept.totalkabout his/her success

Question 25

the 5 R’s

Answer 25

relevance 
risks 
rewards 
roadblocks 
repetition

Question 26

relevance

Answer 26

• Ask patient to identify why quitting might be personally relevant, such as:
– children in her home
– need for money
– history of smoking- related illness

Question 27

risks

Answer 27

• Ask, “What have you heard about smoking ?”

* Reiterate benefits for the patient and his/her children

Question 28

Rewards

Answer 28

• Your will get more oxygen after just 1 day
• Your clothes and hair will smell better
• You will have more money
• Food will taste better
• You will have more energy

Question 29

Roadblocks

Answer 29

• Negative moods
• Being around other smokers
• Triggers and cravings
• Time pressures

Question 30

Overcoming Roadblocks: Negative Moods

Answer 30

• Suck on hard candy
• Engage in physical activity
• Express yourself(write, talk)
• Relax
• Think about pleasant, positive things
• Ask others for support

Question 31

Triggers and Cravings

Answer 31

Cravings will lessen within a few weeks
• Anticipate “triggers”: coffee breaks, social gatherings, being on the phone, waking up
• Change routine—for example, brush your teeth immediately after eating
• Distract yourself with pleasant activities: garden, listen to music

Question 32

Time Pressures

Answer 32

• Change your lifestyle to reduce stress • Increase physical activity