BRIEF INTERVENTION IN SMOKING CESSATION

Encouraging Smokers to Stop Smoking

A guide for health care professionals

‘All health professionals should understand the principles of Brief Intervention for smoking cessation. It is to be routine practice to consider the need for Brief Intervention at every patient contact’

Surgeon General’s Policy Letter 02/04

SGPL

What is Brief Intervention?

• ““Brief intervention is used to motivate Brief intervention is used to motivate attempts at smoking cessation.attempts at smoking cessation.

• It is aimed at individual smokers and It is aimed at individual smokers and should be used by all health care should be used by all health care professionals opportunistically.professionals opportunistically.

• Brief intervention is part of the framework Brief intervention is part of the framework for smoking cessation”for smoking cessation”

(Surgeon General’s Policy Letter, 2004)(Surgeon General’s Policy Letter, 2004)

Role of the health worker

Your role is Important and the

time spent is Worthwhile

Brief advice is one of the most cost effective interventions in medicine.

• The key messages to get across are that smoking is dangerous and it is worthwhile stopping.

Why?

• By raising the issue of smoking and referring smokers to a local smoking cessation clinic, you are offering them the best chance to stop smoking.

• Smoking cessation is the most effective way to help smokers quit and preserve life.

Some examples of health risks from smoking

Stroke DepressionHearing loss

Mouth cancer, tooth & gum disease

Heart disease

Back pain

Osteoporosis (females)

Impotence, infertility (males)

Reduced fertility, miscarriage (females)+ low birth weight babies, still birth, cot death

Disease of the blood vessels

Eye disease

Neck pain

Cancer of gullet

Lung disease: cancer, bronchitis, emphysema etc

Stomach ulcers / cancer

Ulcers and cancer of the gut

Tendon injuries

Health Risks

• Smoking causes thickening of the blood vessels and high blood pressure & is a major cause of stroke. Female smokers using the contraceptive pill are especially at risk.

• Smoking increases the risk of heart disease such as angina and aortic aneurysm.

• Smokers are 10 times more likely to die from lung cancer than non-smokers.

• Smoking is one of the leading cause of male impotence, lower quality and quantity of sperm.

• The incidence of low birth weight is twice as high among smokers as non-smokers.

• Women who smoke during pregnancy have a greater chance of premature labour and miscarriage.

Smoking and Oral Health

Smoking is associated with:

• halitosis (bad breath)

• premature tooth loss

• gingivitis (inflammation of the gums)

• staining and abrasion of teeth

• periodontal disease

• other malignant oral lesions

Passive smoking and children

Children exposed to cigarette smoke are:

• More likely to suffer from chronic cough, wheeze and acute respiratory illness.

• More likely to suffer from chronic middle ear infections (glue ear).

• At increased risk of sudden infant death (Cot death).

Benefits of Stopping Smoking (1)

• 20 minutes: blood pressure and pulse rate returns to normal

• 24 hours: Carbon Monoxide is eliminated from the body. The lungs start to clear out mucus.

Benefits of stopping smoking (2)

•48 hours: Nicotine is no longer detectable in the body.•3 days: breathing becomes easier as the bronchial tubes begin to relax.•2-12 weeks: circulation improves

More Benefits….

•3-9 months: lung function increased by about 10%.•5 years: risk of heart attack falls to about half that of a smoker.•10 years: risk of lung cancer falls to about half that of a smoker

How to give Brief Advice

• Keep the discussion brief and offer the smoker a leaflet he/she can keep.

• Adapt the information you give as necessary.

• Most smokers know smoking is bad. So, your main aim is to let them know there is now effective help available if they want to stop.

The 4 “A’s” of Brief Intervention

•ASK about smoking at every opportunity•ADVISE all smokers to stop•ASSIST the smoker to stop•ARRANGE a referral to the smoking cessation service

1. ASK

• Do you use tobacco?”

• How much?

• Do you want to stop?

• Have you tried before?

2. ADVISE

• Discuss any health problems which may be related to smoking

• Personalise the cessation message• Advise clearly the necessity of

stopping now• Commend nonusers

3. ASSIST

• Provide information literature• Consider advising use of NRT for

strongly addicted patients• Provide motivating literature for the

patient who is not ready to stop• Refer to a smoking cessation clinic

4. ARRANGE

• Telephone call to smoking cessation adviser / clinic or provide contact details

• Follow up the referral

• Ask uninterested patients again at their next regular visit if they have reconsidered

Nicotine Replacement Therapy

• Patch: it is discreet and easy to use.

• Gum: it allows good control of nicotine dose.

• Inhalator: if the smoker misses the ritual of smoking.

• Lozenge: discreet and good dose control

• Spray: better for very addicted smokers.

REMEMBER

• Brief advice on the dangers of smoking and the benefits of stopping smoking should be given at any opportunity.

• Just 3 minutes of your time could help to improve the health and life expectancy of smokers.

• The time spent really is worthwhile.