smoking cessation

Question 1

what are the general effects of use of tobacco on health?

Question 2

what is the stage model of behaviour change?

Question 3

what is failure of clinicians and systems to offer the cost-effective stop smoking treatments as?

Answer 3

unethical and negligent

Question 4

why do people smoke?

Answer 4

• experimenting with smoking
• influence of background
• after initial aversion, adolescent smokers inhale the same amount of nicotine as adults
• smoking behaviour is minted y the positive and negative reinforcing properties of nicotine
• social, econi=omical, political influences

Question 5

who are most likely to smoke?

Answer 5

men are more likely to smoke than women (15.9% of men, 12.5% of women)

Question 6

describe the prevalence os smoking?

Answer 6

14.1% of adults >= in the UK smoke
- the highest prevalence of smoking tobacco in mixed ethnic group

Question 7

what are the health risks of smoking?

Answer 7

• one of the greatest causes of illness and premature death in UK (16% of deaths in Scotland are related to smoking)
• average smoker looses 7.5 yrs of life

Question 8

what are disease caused by smoking?

Answer 8

• cancer
• COPD
• CVD

Question 9

what are the effects of cessation of smoking on mortality?

Answer 9

• cessation at 50 yrs halves the risk
• before 30 avoids almost all excess risk
• on average cigarets smoker die q0 yrs younger

Question 10

benefits of smoking cessation?

Answer 10

• increased longevity
• stabilisation of lung cancer risk
• heart disease risk declines
• accelerated decline in lung function reduced
• ## improved recovery from surgery

Question 11

what are the health benefits of quitting smoking over time?

Question 12

what are the psychological pathways to quitting ?

Answer 12

• transtheoretical model of behaviour change
• a stage model
• each stage denotes a greater inclination to change outcome, typically behaviour, than the previous one.
• proposes 5 stages of change

Question 13

what are the 5 stages to change in the stage model?

Answer 13

1- pre contemplation (not ready yet)
2- contemplation (thinking about it)
3- preparation (getting ready)
4- action (doing it)
5- maintenance (sticking with it)

Question 14

pre contemplation:
characteristics and strategy?

Answer 14

characteristics= lock of awareness or lack of intent to change

strategy = short messages to attract attention, bring up potentially novel or highly relevant facts previously not considered

Question 15

contemplation:
characteristics and strategy?

Answer 15

characteristics= increased awareness of negative aspects of smoking. beginning to consider giving up, probably at some ill defined time in the future.

strategy = dispel negative myths about quitting smoking, reinforce will power

Question 16

preparation:
characteristics and strategy:

Answer 16

characteristics = some small behavioural changes to quit have been made, intend to quit within the month

strategy= longer messages, offer concrete tips and methods to help smoking.

Question 17

action:
characteristics and strategy?

Answer 17

characteristics= individual has implemented plan to stop, still adjusting to chnage

strategy= offer specific relapse prevention advise for nicotine dependance to individual advise on the nicotine patch

Question 18

maintenance:
characteristics and strategy?

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

pros of stage model?

Answer 19

• acknowledges individual stages of readiness, and allows for interventions to be tailored accordingly
• may be useful to HCPs to know that some people are just not ready to change
• accounts for release

Question 20

cons of stage model?

Answer 20

• not all people move through every stage, some move backwards, forwards or miss some stages out completely
• change might operate on a continuum rather than in discrete stages

Question 21

what are the 4 A’s approach to smoking cessation?

Answer 21

1- ASK about tobacco use
2- ADVISE to quit
3- ASSIST in quitting attempt
4- ARRANGE follow up

Question 22

what kind of advise should yo give?

Answer 22

clear, strong personalised

Question 23

if the patient does not want to quit, what should you do?

Answer 23

use the 5 R’s to try to increase motivation

Question 24

what are the 5 R’s?

Answer 24

1- Relevance
2- Risk
3- Rewards
4- Roadblocks
5- Repetition

Question 25

why would quitting be personally relevant for a patient?

Answer 25

• children in their home
• need for money
• history of smoking related illnesses

Question 26

what are the roadblocks?

Answer 26

• negative moods
• being around other smokers
• triggers and cravings
• time pressure

Question 27

how to over come negative moods?

Answer 27

• hard candy
• engage in PA
• express yourself
• relax
• think about pleasant, positive things
• ask other for support

Question 28

how to over come the roadblock of being surrounded by other smokers?

Answer 28

• ask them to quit with you
• ask other not to smoke around you
• assign non smoking areas
• leave the room when others are smoking
• keeps hands/mouth busy

Question 29

how to over come triggers and cravings?

Answer 29

• cravings will lessen ver weeks
• anticipate the triggers (coffee breaks)
• change routine
• distract self with pleasant activities

Question 30

how to overcome time pressures?

Answer 30

• change your lifestyle to reduce stress
• increase physical activity

Question 31

what are negative belies held by GP’s about smoking cessation?

Answer 31

• discussion is to time consuming
• ineffective
• lacked confidence in cessation advise
• discussions unpleasant
• lacked confidence in knowledge
• cessation considered outside professional duty
• inappropriate