Cessation Programming Tips
Get the Facts
For Individuals: Ready, Set, Quit!
For Health Care Advocates
References
Get The Facts
Nicotine is the psychoactive drug in tobacco products that produces dependence. Most smokers are dependent on nicotine, and smokeless tobacco use can also lead to nicotine dependence. Nicotine dependence is the most common form of chemical dependence in the United States. Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol. Examples of nicotine withdrawal symptoms include irritability, anxiety, difficulty concentrating, and increased appetite. Quitting tobacco use is difficult and may require multiple attempts, as users often relapse because of withdrawal symptoms. Tobacco dependence is a chronic condition that often requires repeated intervention.
Health Benefits of Cessation
People who stop smoking greatly reduce their risk of dying prematurely. Benefits are greater for people who stop at earlier ages, but cessation is beneficial at all ages.
Smoking cessation lowers the risk for lung and other types of cancer. The risk for developing cancer declines with the number of years of smoking cessation.
Risk for coronary heart disease, stroke, and peripheral vascular disease is reduced after smoking cessation. Coronary heart disease risk is substantially reduced within 1 to 2 years of cessation.
Cessation reduces respiratory symptoms, such as coughing, wheezing, and shortness of breath. The rate of decline in lung function is slower among persons who quit smoking.
Women who stop smoking before or during pregnancy reduce their risk for adverse reproductive outcomes such as infertility or having a low-birth-weight baby.
Quitting Interest and Behavior Among Tobacco Users
Among current U.S. adult smokers, 70% report that they want to quit completely. In 2006, an estimated 19.2 million (44.2%) adult smokers had stopped smoking for at least 1 day during the preceding 12 months because they were trying to quit.
An estimated 45.7 million adults were former smokers in 2006.
More than 54% of current high school cigarette smokers in the United States tried to quit smoking within the preceding year.
Tobacco Use Cessation Methods
Brief clinical interventions by health care providers can increase the chances of successful cessation, as can counseling and behavioral cessation therapies. Treatments with more person-to-person contact and intensity (e.g., more time with counselors) are more effective. Individual, group, or telephone counseling are all effective.
Pharmacological therapies found to be effective for treating tobacco dependence include nicotine replacement products (e.g., gum, inhaler, patch) and non-nicotine medications, such as bupropion SR (Zyban) and varenicline tartrate (Chantix™).
Source: Fiore MC, Jaen CR, Baker TB, et al., Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
For Individuals: Ready, Set, Quit!
Get ready to quit
Set a quit date and get rid of all cigarettes and smoking paraphernalia in your home, car, and workplace. Replace them with objects such as beads, stones, or marbles that can keep your hands occupied when you quit.
Review your motivations for quitting.
Identify what you will do to succeed.
Review you past quit attempts. What helped you stay quit as long as you did? What caused problems for you? What led to your relapse?
Rally support. Tell your relatives and friends you are quitting. Ask for their support and ask them not to smoke around you and not to offer you cigarettes.
If your state has one, call a tobacco quit line and talk to a phone counselor about quitting. Washington State Quit Line: 1-800-QUIT-NOW, 1-800-784-8669. Hours: Monday - Sunday: 5 a.m. to 9 p.m. If you call at any other time, just leave a message. They will call you back.
Talk to your clinician. Ask him or her to suggest a nicotine replacement therapy right for you. The following treatments are currently recommended as smoking cessation aids: nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch (”the patch“). Buproprion SR is another treatment available, but must be administered by a physician.
Find support!
Get involved in a smoking cessation support group at your clinic, tribal or community center. Social support will increase your likelihood of quitting and staying quit.
Get involved in a smoking cessation program. One successful American-Indian specific program is “Second Wind.” For information or to get a copy of this curriculum, contact Cynthia Coachman at Muscogee (Creek) Nation, 800-782-8291 ext. 285
About those cravings. . .
Do a deep breathing exercise: Exhale deeply, contracting the belly then inhale slowly as you expand the abdomen with air. Continue inhaling as you expand the chest. While inhaling, raise your shoulders up towards your ear. Hold your breath and this position for a few comfortable seconds. Exhale in reverse pattern, slowly—Release shoulders, relax chest, contract the belly. Repeat.
Keep your hands busy! Rub a worry stone. Knead play dough. Fiddle with magnets. Knit. Braid.
Relax! Take a hot bath. Burn candles or incense. Try a deep breathing exercise.
Occupy your mouth! Chew gum. Chew on a toothpick, bark, or a root. Eat a healthy snack (carrots, celery, or fruit). Drink a glass of water. Talk with a supportive relative or friend.
Invigorate! Exercise. Take a brisk walk. Put a rubber band around your arm and lightly snap yourself when you have a craving.
More Quit Tips
For more help quitting, visit the Washington State Department of Health Quit Line webpage by clicking HERE
For Health Care Advocates
Ten Key Guideline Recommendations
(Excerpted from “Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline.” For complete report,Click Here)
The overarching goal of these recommendations is that clinicians strongly recommend the use of effective tobacco dependence counseling and medication treatments to their patients who use tobacco, and that health care systems, insurers, and purchasers assist clinicians in making such effective treatments available.
1. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.
2. It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting.
3. Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in this Guideline.
4. Brief tobacco dependence treatment is effective. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in this Guideline.
5. Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt:
•Practical counseling (problemsolving/skills training)
•Social support delivered as part of treatment
6. Numerous effective medications are available for tobacco dependence, and clinicians should encourage their use by all patients attempting to quit smoking—except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). Clinicians also should consider the use of certain combinations of medications identified as effective in this Guideline. Seven first-line medications (5 nicotine and 2 non-nicotine) reliably increase long-term smoking abstinence rates:
7. Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication.
8. Telephone quitline counseling is effective with diverse populations and has broad reach. Therefore, clinicians and health care delivery systems should both ensure patient access to quitlines and promote quitline use.
9. If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational treatments shown in this Guideline to be effective in increasing future quit attempts.
10. Tobacco dependence treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication identified as effective in this Guideline as covered benefits.
Source: Fiore MC, Jaen CR, Baker TB, et al., Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Quit Kits
Providing Quit Kits are an inexpensive way to put information and tools into the hands of your community members who want to quit smoking! Quit Kits can be distributed at health fairs, tribal events, and made available by request. Possible kit contents:
References
2. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2000 [cited 2006 Nov 06]. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm.
3. American Society of Addiction Medicine. Nicotine Dependence and Tobacco. Public Policy of ASAM; 1996 [cited 2006 Nov 06]. Available from: http://americ20.temp.veriohosting.com/ppol/NICOTINE%20DEPENDENCE%20&%20TOBACCO%2010-96%20(1).htm.
4. U.S. Department of Health and Human Services. The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service; 1986. NIH Pub. No. 86-2874 [cited 2006 Nov 06]. Available from: http://profiles.nlm.nih.gov/NN/B/B/F/C/.
5. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994 [cited 2006 Nov 06]. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1994/index.htm.
6. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Gritz ER, et al. Treating Tobacco Use and Dependence: Quick Reference Guide for Clinicians. [cited 2006 May 23]. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 2000. Available from: http://www.surgeongeneral.gov/tobacco/default.htm.
7. Centers for Disease Control and Prevention. The Health Benefits of Smoking Cessation. Atlanta, GA: U.S. Department of Health and Human Services, CDC, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1990. DHHS Pub. No. (CDC) 90-8416 [cited 2006 Nov 06]. Available from: http://profiles.nlm.nih.gov/NN/B/B/C/T/.
8. Centers for Disease Control and Prevention. Women and Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2001 [cited 2006 Nov 06]. Available from: http://www.cdc.gov/tobacco/sgr/sgr_forwomen/index.htm.
9. Centers for Disease Control and Prevention. Cigarette Smoking Among Adults—United States, 2000. Morbidity and Mortality Weekly Report [serial online] 2002;51(29):642–645 [cited 2006 Nov 06]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5129a3.htm.
10. Centers for Disease Control and Prevention. Cigarette Smoking Among Adults—United States, 2006. Morbidity and Mortality Weekly Report [serial online] 2007;56(44):1157–1161 [cited 2007 Nov 8]. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm.
11. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System. Youth Online: Comprehensive Results, 2005. [updated 2006 Apr 5; cited 2006 Nov 06]. Available from: http://www.cdc.gov/healthyyouth/tobacco/index.htm.
12. U.S. Food and Drug Administration. The FDA Approves New Drug for Smoking Cessation. FDA Consumer; July–August 2006 [cited 2008 Jan 31]. Available from: http://www.fda.gov/fdac/features/2006/406_smoking.html.
