Smoking Cessation, 1/2004, Revised 1/2009, Updated 7/2009, T238-16-C24 Reproduction of material for...

Smoking Cessation, 1/2004, Revised 1/2009, Updated 7/2009, T238-16-C24Reproduction of material for use other than intended purpose requires the written consent of OptumHealth.

Training Programs

© 2008 OptumHealth

Smoking Cessation

Choices and ChallengesUpdated by Peggy McMahon, RN, MSN, MPS

Workbook

2

Agenda

Introduction

Review Agenda and Learning Points

Opening Exercise

Explore Behaviors Associated With Tobacco Use

Personal Positives and Negatives

Reasons to Stop Smoking

Physiology

Effect of Nicotine on Body Smokeless Tobacco

Health Benefits of Quitting

Process of Quitting

Stages of Quitting

Awareness Visualization

Decision Action

Methods

Medications

Maintenance

Ongoing Recovery

Symptoms of Withdrawal Alternatives to Triggers

Closing

Personal Plan Three Vital Steps

3

Learning Points

Participants will:

• Explore the behaviors associated with personal tobacco use

• Describe the physiology of quitting

• Identify the process of quitting, including methods and medications

• Discuss recovery and maintenance

• Make a personal plan for quitting

Consult your physician before beginning any smoking cessation program or adopting any suggestions made in this handbook or by the trainer.

It’s easy to quit smoking. I’ve done it a thousand times.—Mark Twain

2

Learning Points

• Explore the behaviors associated with personal tobacco use.

• Describe the physiology of quitting.

• Identify the process of quitting, including methods and medications.

• Discuss recovery and maintenance.

• Make a personal plan for quitting.

Presented by Working SolutionsLive and work well.

©Working Solutions 2004

Breathing Free Version 1Reproduction of material for use other than intended purpose requires the written consent of UBH.

Breathing FreeAn Introduction to Effective Smoking

Cessation Techniques

4

Explore Your Habit

Quadrant 1 Quadrant 2Reasons I like to smoke Reasons I hate to smoke

Quadrant 4Reasons I want to keep smoking

Quadrant 3Reasons I want to quit

5

Explore Your Habit (Continued)Use Your Strengths; Plan for Your Weaknesses

Quadrant 1 Quadrant 2Reasons I like to smoke Reasons I hate to smoke

Quadrant 4Reasons I want to keep smoking

Quadrant 3Reasons I want to quit

Weakness Strength

Strength Weakness

My main strength:

I will use it by:

My main weakness:

My plan to get around it is:

6

From the following list, check your top five reasons for quitting tobacco. Of those

five items, put a * next to the one that is most significant to you.

_____ You will live longer.

_____ You will reduce your risk of stroke and heart attack.

_____ You will reduce your risk of getting a wide variety of cancers.

_____ You can save money.

_____ You will sleep better.

_____ You may become a calmer person.

_____ You will become less likely to have an accident.

_____ You will heal faster.

_____ Your children will be healthier.

_____ Your bones will be stronger.

_____ The environment will be cleaner.

_____ Your teeth will be cleaner and your breath, clothes, hair, home and car will smell better.

_____ You will increase your sense of smell and taste, and decrease the risk of gum disease.

_____ You will reduce the risk of an accidental fire in your home.

_____ You will have more energy and vitality.

_____ You will look and feel younger and slow down the development of wrinkles.

_____ You will feel happy knowing you are doing something good for yourself.

_____ You will have a powerful sense of accomplishment!

Some Good Reasons to Stop Smoking

7

Smokeless Tobacco

Not a safe choice Plug, leaf and snuff are three smokeless tobaccos that have become more popular as the number of adults smoking cigarettes has decreased. This doesn’t mean that smokeless tobaccos are safe. Smokeless tobaccos are not safe alternatives to cigarettes; they can lead to many health problems.

The effects of smokeless tobacco The Surgeon General’s Advisory Committee has found that smokeless tobacco is dangerous to one’s health.

Research has found that smokeless tobacco, as well as cigarettes, has many cancer-causing substances. A recent study found that people who use smokeless tobacco are almost four times more likely to get cancer of the mouth, lips and gums. (Third National Cancer Survey.) The risks also add up the longer one uses smokeless tobacco.

Other problems caused by using smokeless tobacco include gingivitis (gum disease), tooth loss, and damage to the mucous membranes in the mouth, throat and nose. It also has a number of fairly immediate and harmful effects as well; after only a few years of using smokeless tobacco, open sores and scars may develop in the mouth.

Smokeless tobacco and pregnancy Studies have found high levels of heavy metals, i.e. lead and

cadmium, in the blood of users; using smokeless tobacco while pregnant may harm the baby.

Smokeless tobacco and cigarettes Smokeless tobacco also has some of the same effects as cigarettes. For example, studies have found that, just like cigarette smokers, smokeless tobacco users will have high levels of nicotine in the blood, a higher heart rate and high blood pressure.

Lastly, it is important to note that, just like cigarettes, the nicotine in smokeless tobacco is addictive — causing a chemical dependence that’s very hard to break.

3

Smokeless Tobacco

Smokeless tobacco is not harmless!

8

Health Benefits of Quitting Smoking*

*Assuming no other illnesses and assuming individual is in otherwise 100 percent normal health

Within 20 Minutes Blood pressure drops to a level close to that before the last cigarette; temperature of

hands and feet increases to normal

8 Hours Carbon monoxide level in the blood drops to normal

24 Hours Chance of heart attack decreases

2 Weeks-3 Months Circulation improves and lung function increases up to 30 percent

1 Month-9 Months Coughing, sinus congestion, fatigue and shortness of breath decrease; cilia regain

normal function in the lungs, increasing the ability to handle mucus, clear lungs and

reduce infection

1 Year Risk of coronary heart disease is reduced to half that of a smoker

5 Years Risk of a stroke is reduced to that of a nonsmoker 5-15 years

after quitting

4

Health Benefits of Quitting12 1

2

3

456

9

78

10

11

Blood pressure drops CO level in blood drops to normal

12 12

3

456

9

78

10

11 12 12

3

456

9

78

10

11

Coronary heart disease risk drops to half

2009

20102019

Lung cancer death rate

drops to half

2026

Disease risks same as

nonsmoker’s

9

Health Benefits of Quitting Smoking*

*Assuming no other illnesses and assuming individual is in otherwise 100 percent normal health

10 Years Lung cancer death rate decreases to about half that of a continuing smoker’s; risk of cancer of the mouth, throat, esophagus, bladder, kidney and pancreas decrease

15 Years Risk of coronary heart disease is that of a nonsmoker’s

4

Health Benefits of Quitting12 1

2

3

456

9

78

10

11

Blood pressure drops CO level in blood drops to normal

12 12

3

456

9

78

10

11 12 12

3

456

9

78

10

11

Coronary heart disease risk drops to half

2009

20102019

Lung cancer death rate

drops to half

2026

Disease risks same as

nonsmoker’s

10

Stages of Quitting Tobacco Use

I. Awareness Toying with the idea of quitting (70 percent of smokers)» Keep thinking about quitting.

II. Visualization Serious intentions to quit» Mentally prepare; list reasons for quitting.» Anticipate potential difficulties (withdrawal symptoms, lack

of support).

III. Decision Making decision to quit; making plan; visualization» Set a target quit date (to begin within next two weeks).» Develop a plan for triggers, unexpected events, living with a

current user, possible relapse (note that relapse often occurs within first three months).

» Review previous attempts to quit—what worked, what didn’t.

5

Stages of Quitting

AwarenessToy with quitting

VisualizationSerious intentions

DecisionMake plan; engage support

ActionInvolved in activities of quitting; select method

MaintenanceRemain smoke-free

11

Stages of Quitting Tobacco Use (Continued)

IV. Action Actively involved in quitting tobacco use (Continuum of activities)

Get support:» Inform family, friends, co-workers and ask for their

support. Note: not everyone may be supportive as they may feel resentful of the change and their loss of a “smoking buddy.”

Control your environment:» Toss out all tobacco paraphernalia—cigarettes, lighter,

matches, ashtrays, pouches, etc.» Clean clothes, car, carpet, furniture and draperies to get

rid of stale smoke smell.» Spend as much time as possible in nonsmoking

environments i.e. movie theatres, library—especially during the first few difficult days and weeks.

» Stay busy; change routine.» Gather resources—pamphlets, booklets, manuals,

videos, audiotapes, support groups, community programs, hotline numbers, computer programs, etc.

5

Stages of Quitting






12


If cutting back to cut out tobacco» Switch to a brand you don’t like.» Determine the amount of tobacco you will allow

yourself each day.» Smoke half of the cigarette; draw a line on the cigarette

with a pen to mark the stop point.» Use your other hand to smoke with.» Buy one pack at a time (rather than carton) to make

smoking inconvenient.» Make tobacco and accompanying paraphernalia —

matches/lighters — difficult to find or out of reach.» Make using unpleasant, e.g. don’t empty ashtrays.

Wellness» Experience withdrawal—it is a normal process usually

lasting one to two weeks and is an important signal your body is healing itself.

» “Nothing bad lasts forever”—make it a point to get through withdrawal so that you won’t need to experience it all over again with another attempt to quit.

» Become aware of the difference between “overwhelming desire” to use vs. “effects of withdrawal.”

» Have teeth cleaned, buy a new toothbrush.» Eat healthy food and exercise moderately.» Have healthy oral substitutes available—hard candy,

gum, nuts, sunflower seeds, straws, stir sticks, toothpicks, pencils, popcorn, etc.

5

Stages of Quitting






13


V. Maintenance Sustaining your role as a nonuser; avoiding relapse» Mark your progress and congratulate yourself on

successes—daily, weekly, monthly.» Recognize when you are in dangerous situations, for

example: arguing, bad moods, drinking alcohol, being around other users, under pressure, stressed, etc.

The only reason we fail is that our desire to succeed is not strong enough.

5

Stages of Quitting






14

Methods of Quitting

See Appendices A and B for a full discussion of a variety of methods for quitting tobacco.

• Nicotine replacement

• Cold turkey

• Self-help materials

• Group support/counseling

• Alternative therapies such as hypnosis or acupuncture

• Behavior Modification

6

Methods of Quitting

Self-help materials

Behavior modification

Group support/counseling

ConditioningMedication

Cold turkey

Nicotine replacement

Alternative therapies

15

Methods of Quitting (Continued)

Medication A vital step in quitting is to manage nicotine cravings. Many people

have used various medications to help them stop using tobacco. There are benefits and risk factors associated with these medications. The Appendices will give you an overview of the most widely used medications for tobacco cessation.

Methods I’ve tried before:

Methods I plan to use now:

A habit cannot be tossed out the window. It must be coaxed down the stairs a step at a time.—Mark Twain

6

Methods of Quitting

Self-help materials

Behavior modification

Group support/counseling

ConditioningMedication

Cold turkey

Nicotine replacement

Alternative therapies

16

Symptoms of recovery, also known as withdrawal symptoms, may vary in length depending on the individual and may begin within a few hours after the last use of tobacco. Symptoms peak within the first few days and may subside within a few weeks. For some people, however, symptoms may persist for months or longer.

Some symptoms you may experience include:

___ Irritability and tension

___ Cognitive and attention deficits

___ Feelings of frustration and anger

___ Fatigue

___ Headaches

___ Increased appetite

___ Tightness in chest

___ Nervousness

___ Difficulty sleeping

___ Dry throat/mouth

___ Cough

___ Dizziness

___ Increased thirst

___ Hoarseness

___ Stiffness

___ Tingly fingers

___ Feelings of depression

Symptoms of Recovery

7


“Recovery is a journey. The goal is not simply to quit, but to stay quit.”

~Terry A. Rustin, M.D.

17

Which of these are your biggest concerns? Place a check by the top five symptoms you are most concerned about experiencing upon quitting.

Even though these possible symptoms may seem overwhelming, keep in mind that there are many methods and tips that can help you deal with these symptoms. The following segments will explain some of the stages that you might encounter and some recommended steps/tips to help you quit using.

“Recovery is a journey. The goal is not simply to quit, but to stay quit.” —Terry A. Rustin, M.D.

Symptoms of Recovery (Continued)

7


“Recovery is a journey. The goal is not simply to quit, but to stay quit.”

~Terry A. Rustin, M.D.

18

My Triggers

Become aware of your triggers, then prepare a tool box of alternatives. Refer to the list you made at the beginning of the session. Other triggers may include:

Anxiety Being around smokers Cravings Depression Difficulty concentrating Drinking coffee or tea Enjoying meals Facing boredom Facing the morning Handling stress

My personal triggers:

Having a drink Insomnia Irritability, anger and frustration Relaxing Restlessness Remembering the good times Rewarding yourself Talking on the telephone Traveling by car Watching TV

8

My Triggers

19

The following exercise can help you through the quitting process by developing alternatives to tobacco triggers which you have identified. List 5-15 minute and 30-60 minute alternatives that you think would work best for you in overcoming or postponing the urge to use tobacco.

5-15 Minute Alternatives

• Color code pens on desk• Straighten desk drawers/locker• Clean purse/wallet• Weed small section of the garden• Organize tool box/tackle box, tapes, CDs• Brush teeth• Water the plants• Wash the leaves on the plants• ____________________________________• ____________________________________• ____________________________________• ____________________________________• ____________________________________• ____________________________________

Alternatives to Triggers

Adapted from Rustin, Terry A., M.D. ©1994, Quit and Stay Quit, Center City, MN: Hazelden. Used with permission.

8

My Triggers

20

30-60 Minute Alternatives• Exercise!!• Yoga• Walk around building/to car and back• Reorganize files• Learn a new job technique from co-worker/boss• Touch up paint on walls• Change oil in car• Needlepoint/knit• Read• Take dog for a walk• Take kids to the park• ____________________________________• ____________________________________• ____________________________________• ____________________________________• ____________________________________• ____________________________________

Alternatives to Triggers (Continued)

9

Three Vital Steps**Roberta Lee, MD. Beth Israel Medical Center for Health and Healing, More, June 2009.

Reprinted with permission

Conquer Nicotine Cravings

Fill the tobacco vacuum

Become an exerciser

21

My Triggers and Possible Alternatives

Use your list of triggers from the opening exercise, choose the top five triggers that cause you to want to use tobacco and list possible alternatives you can try instead.

Triggers Alternatives Argument with co-worker Go for a walk; clean; take deep breaths;

journal Driving Sing; keep car smoke-free — have it

detailed, put potpourri in the ash tray After eating Brush and floss teeth; leave table Need something to hold Hold pen/pencil, carrot, straw; knit;

doodle; call a friend Need energy Mild exercise; chew gum; get enough rest;

read

1. ____________________________ ________________________________

2. ____________________________ ________________________________

3. ____________________________ ________________________________

4. ____________________________ ________________________________

5. ____________________________ ________________________________

Adapted from Rustin, Terry A., M.D. ©1994, Quit and Stay Quit, Center City, MN: Hazelden. Used with permission.

Alternatives to Triggers (Continued)

9

Argument Go for a walk…

Driving Sing, have car detailed…

After a meal Brush/floss teeth…

Something to hold Knit, doodle…

Need a “lift” Mild exercise; chew gum; read…

My Triggers and Possible Alternatives

Triggers Alternatives

22

Remember the three Vital Steps as you make your plan:

1. Conquer nicotine cravings.

2. Fill the tobacco vacuum.

3. Become an exerciser!*

I am currently in the ________________________ stage of quitting and within the next

two weeks plan to be in the ____________________stage.

My goal quit date is ___________________________.

The three things I will do within the next week to prepare for quitting are:

1._________________________________________________

2._________________________________________________

3._________________________________________________

The method(s) I will choose to help me quit is/are ______________________________.

What/who are my resources?

__________________________ __________________________

__________________________ __________________________

__________________________ __________________________

Personal Action Plan

*Lee, M.D., Roberta. Beth Israel Medical Center for Health and Healing, More, June, 2009. Reprinted with permission

10

Making A Plan

Determine current stage

Set goal quit date

Make list of three things you will do within the next week to

prepare

Choose a method(s) to use

Identify your resources; contact each one

23

Books

American Lung Association. How to Quit Smoking Without Gaining Weight. Pocket, 2004.

Brizer, M.D., David. Quitting Smoking for Dummies. For Dummies, 1 Edition, 2003.

Dodds, Bill. 1440 Reasons to Quit Smoking: 1 For Every minute of the Day. Meadowbrook, 2000.

Ehrman, Jane Pernotto. Positive Affirmations for Being Smoke-Free: Guided Imagery for Smoking Cessation. Playaway, 2009.

Ferguson, Tom. The No-Nag, No-Guilt, Do-It-Your-Own Way Guide to Quitting Smoking. Ballantine Books, 1988.

Fisher, Edwin B. American Lung Association 7 Steps to a Smoke-Free Life. John Wiley & Sons, 1998.

Herrick, M.D., Charles and Charlotte Herrick, RN, PhD and Marianne Mitchell, APRN. 100 Questions and Answers About How to Quit Smoking. Jones and Bartlett Publishers, 2009.

Holmes, Peter & Peggy Holmes. Out of the Ashes: Help for People Who Have Quit Smoking. Fairview Pr., 1992.

Jones, David C. Yes! You Can Stop Smoking: Even if Your Don’t Want To. E and E Publishing, 2007.

Kleinman, Lowell, M.D.; Deborah Messina-Kleinman, M.P.H.; Mitchell Nides. Complete Idiot’s Guide to Quitting Smoking. Alpha Books, 2000.

Klesges, Robert C. & Margaret Debon. How Women Can Finally Stop Smoking. Hunter House, 1994.

Mayer, Gerald S. When It Hurts Too Much to Quit: Smoking and Depression. Desert City Pr., 1997.

Further Reading & Additional Resources

11

The Journey…

Congratulations for moving toward being a non-smoker!

“A journey of a thousand miles begins with a single

step.” ~Lao Tzu

What one step will you take today to get started?

24

McCall, Steve. How to Quit Smoking: The Cold Eagle Method. Eagle Reef Publishing, 2002.

Parkinson, D.C., Anthony. The Layman’s Guide to Smoking Cessation. Lulu.com, 2007.

Riley, Gillian. How to Stop Smoking and Stay Stopped for Good. Edbury Press, 2007.

Reilly, Thomas J. You’ve Got the Power: A Smoking Cessation Program. Booksurge Publishing, 2006.

Stevic-Rust, Lori & Anita Maximin. The Stop Smoking Workbook. New Harbinger Pubns., 1996.

West, Robert and SDaul Shiffman. Smoking Cessation (Fast Facts). Health Press, 2007.

Whelan, Elizabeth M.; American Council on Science and Health; American Council on Science. Cigarettes: What the Warning Label Doesn’t Tell You: The First Comprehensive Guide to the Health Consequences of Smoking. Prometheus Books, 1997.

Additional ResourcesDue to rapid changes occurring on the Internet, we cannot guarantee the availability of these Websites.

www.cancer.org American Cancer Society 404-320-3333

www.nci.nih.gov National Cancer Institute 800-4-CANCER (800-422-6237

www.amhrt.org American Heart Association 800-AHA-USA1 (242-8721)

www.nicotine-anonymous.org Nicotine Anonymous 415-750-0328

www.lungusa.org American Lung Association 212-315-8700 www.cdc.gov/tobacco Office on Smoking & Health 800-311-3435 Centers for Disease Control and Prevention

www.quitnet.com

www.mayoclinic.com/print/chewing-tobacco/CA000019/METHOD=print

Further Reading & Additional Resources (Continued)

11

The Journey…

Congratulations for moving toward being a non-smoker!

“A journey of a thousand miles begins with a single

step.” ~Lao Tzu

What one step will you take today to get started?

25

Appendices

A Methods of Quitting

B Further Information About Nicotine Replacement

C Twelve Reasons to Kick the Habit

D Tips for Immediately After Quitting

E Weight Gain

F Coping With Stress

G Facts About Smoking

H Secondhand Smoke

I Smoking and Children

26

Appendix A: Methods of QuittingNicotine Replacement Doubles rate of success• Nicotine Patch

– Positives: Available over-the-counter Steady, unchanging dose No surge of nicotine levels Only need to apply once daily Minimal side effects

– Negatives: No “rush” as with cigarettes Side effects (depending on dose) include: Dizziness/headache Racing heartbeat

Stiffness and muscle aches Nausea, vomiting

Skin irritations (redness/rash)• 16-Hour Patch (Usually recommended for light to average smokers)

– Positives: Less likely to cause side effects– Negatives: Does not deliver nicotine at night so is not helpful for early

morning withdrawals• 24-Hour Patch

– Positives: Steady dose of nicotine Helps with early morning withdrawal

– Negatives: More side effects such as disrupted sleep patterns and skin irritation

• Nicotine Gum– Positives: Available over-the-counter

Minimal side effects (good for people with sensitive skin) You control nicotine dosage Convenient

– Negatives: Surges in nicotine levels Have to use several times daily (limited to no

more than 20 times/day) Long-term dependence (not

recommended for longer than six months) Side

effects may include: Hiccups

Mouth ulcers Nausea

Jaw discomfort Racing heartbeat

Throat irritation

27


• Nicotine Nasal Spray– Positives: Easy to use

Delivers nicotine quickly to bloodstream through nose Immediate relief of withdrawal symptoms

– Negatives: Prescription only Not recommended for people with asthma,

allergies, nasal polyps or sinus problems Danger of using more than needed

Side effects which may last one to two weeks include: Nasal irritation

Runny nose and watery eyes Sneezing and coughing

• Nicotine Inhalers (plastic rod with a nicotine plug)– Positives: Delivers nicotine vapor to mouth instead of lungs

Smoker may feel he or she is substituting some of behavioral aspects of smoking

– Negatives: Prescription only Throat irritation

Coughing

Cold Turkey– Positives: Immediate health benefits with nicotine elimination– Negatives: Low quit rates

Self-help Materials– Positives: Much information available and easily attainable– Negatives: Low quit rates

Amount of information can be overwhelming for some

Group Behavior Therapy plus Nicotine Replacement– Positives: Support group– Negatives: Requires self-disclosure which may be uncomfortable for

some peoplePhysician Counseling

– Positives: Support system Can provide information and supplemental

prescriptions if appropriate– Negatives: Immediate access to physician can be limited

Some individuals intimidated by doctors

28


Acupuncture– Positives: May decrease or eliminate cravings

May calm the nervous system which helps maintain willpower– Negatives: Low quit rates

Hypnosis– Positives: Uses suggestions to the unconscious mind to make smoking

unappealing– Negatives: Low quit rates

Conditioning (Aversion therapy, i.e. rapid smoking, rapid puffing, additional smoke exposure)– Positives: Can reduce automatic or mindless smoking– Negatives: Can become physically ill

Low quit rates

Zyban (An antidepressant)– Positives: Controls cravings

Reduces withdrawal symptoms Very effective with nicotine replacement

– Negatives: Prescription only May be adverse side effects

Chantix (Latest prescription medication)– Positives: Blocks nicotine receptors in the brain which may make quitting

easierReduced withdrawal symptoms; reduced pleasure

from smokingMore effective than the nicotine patch; more people

were able to remain smoke-free

29


– Negatives: May cause recurrence of old psychiatric illnesses or worsen current psychiatric illnesses, even if under control

Side effects include nausea, headache, vomiting, gas, insomnia, vivid/abnormal dreams, changes in the way food tastes

Those taking this medication may experience anxiety, nervousness, tension, depression,

unusual behaviors; thinking about or attempting suicideShould not be taken with other quit smoking

medicationsMay affect ability to driveShould not be taken if pregnant or breast-feedingMay alter effects of other medications or supplements

Behavior Modification: This includes using filters, watching self in mirror while smoking, avoiding automatic smoking, making smoking inconvenient, making smoking unpleasant (don’t empty ashtrays, hold ashes in hand rather than use ashtray, smoke a brand you don’t like), keeping a smoking record (number, time, place, reasons), cutting down on number smoked per day, postponing smoking, smoking odd/even hours, finding new habits

– Positives: Can help you quit (not a substitute for smoking) Helps you become aware of habituate nature of smoking

– Negatives: Requires regular monitoring and tracking Requires you to participate in activities you may find unpleasant

30

Appendix B: Further Information About Nicotine Replacement

— Nicotine Gum

How Do I Use Nicotine Gum?• You must stop using tobacco all together when you start using the gum.• Do not use more than 30 pieces of nicotine gum or 20 pieces of a different size dosage

of nicotine• As your need to use smokeless tobacco goes away—usually within 2-3months—use

fewer pieces of gum.• Stop when you are using 1 or 2 pieces a day—unless your doctor tells you otherwise.• Carry the gum with you at all times in case you feel the need to smoke again.

Possible Side Effects• More common side effects may include: bleeding gums, too much saliva, hiccups,

indigestion, slight swelling of the mouth, injury to teeth or cheeks, nausea, upset stomach and sore throat.

• Less common or rare side effects may include: diarrhea, dry mouth, swollen gums, tongue, throat, or mouth sores, muscle pain, rashes and sweating.

• If these or other symptoms develop or get stronger, inform your doctor at once.

Special Warnings About Nicotine Gum• Nicotine gum has nicotine in it and is strong, potentially addicting medication. Follow

instructions to avoid side effects and addiction.• Do not use the gum for more than six months: it can be harmful and addicting.• Chew the nicotine gum slowly and follow your doctor’s instructions to avoid side

effects and addiction.• Do not eat or drink 15 minutes before or while chewing the gum.• If you develop an allergic reaction (hives or rash), stop using the gum and contact your

doctor.• Before using nicotine gum, talk with your doctor about your medical history.• The gum may be harmful if taken with other drugs/medications. Even mild drugs such

as caffeine or non-aspirin pain reliever can be harmful when taken with nicotine gum.• Do not use the gum if you are pregnant, planning to become pregnant, or

breastfeeding.

31

Nicotine Gum (Continued)

Overdose• Too much of any medication can have a serious outcome. Overdose may occur if you

chew too many pieces of gum or if you smoke while you are using the gum.• Symptoms of nicotine gum overdose may include: stomach pain, fuzzy vision, cold

sweat, diarrhea, trouble breathing, trouble hearing, dizziness, exhaustion, fainting, headache, low blood pressure, mental confusion, nausea, paleness, fast and irregular pulse, too much saliva, “the shakes” and vomiting.

© 2006 State of Arizona. Funded by the Arizona Department of Health Services Office of Tobacco Education & Prevention Program in partnership with the Mel & Enid Zuckerman College of Public Health at the University of Arizona.

32

Appendix B: Nicotine Inhaler

What is a Nicotine Inhaler?• A Nicotine Inhaler is the only stop smoking aid that helps with both the physical and

psychological aspects of smoking.• A Nicotine inhaler, or the nicotine inhalation system, is a mouthpiece and a cartridge,

that looks much like a plastic, hollow cigarette, into which a nicotine- filled cartridge, is placed. A person breathes in nicotine-filled air through the mouthpiece and refills the nicotine cartridge as needed.

Does the Nicotine Inhaler Work?• In two studies of more than 400 heavy smokers, those who used the Nicotine inhaler

were more likely to be smoke free six and 12 weeks after quitting than those using a placebo inhaler.

• After one year, when inhalers had not been used for six months, those who had used nicotine inhalers were two times more likely to be smoke free. In one of the studies, 45 percent of those using the Nicotine Inhaler were smoke free after six weeks, compared with 14 percent of those using the placebo. Nicotine Inhaler users were 11 percent smoke-free after a year compared with five percent in the placebo group.

How the Nicotine Inhaler Works• The person inhales about 30 percent of the nicotine found in a cigarette without the

tar and carbon monoxide and this helps to lessen the need or craving for cigarettes. Craving is the most important withdrawal symptom, since it is the symptom that keeps most smokers from being able to quit.

• Since the Nicotine Inhaler is similar in shape to a cigarette, it helps to fulfill the need to hold something in their hands while trying to quit.

• Little nicotine is carried to the lungs, showing that most is absorbed in the membranes of the mouth, very much like nicotine gum.

Possible Side Effects• Side effects were mouth and throat irritation from the nicotine, but this usually goes

away or lessens as people adjust their use of the product.


33

Appendix B: Nicotine Patch

What Do Patches Do?• Nicotine, the habit-forming drug in tobacco, is a stimulant, or mood lifter. When you

give up smoking, you give up nicotine. You want cigarettes and may also have such feelings as being worried, angry, irritated, frustrated, restless or have concentration problems. When you wear a nicotine patch, nicotine steadily goes out of the patch, through your skin, and into your bloodstream, keeping an even, low amount of nicotine in your body. This amount of nicotine is less than you would get from smoking, but it may be enough to keep you from wanting cigarettes or having other withdrawal symptoms.

Important Facts About Nicotine Patches• You should only use patches as part of a stop-smoking program that also offers ways

to change your smoking behavior through counseling.• If you have not stopped smoking after four weeks of using nicotine patches, it is likely

that the patch treatment will not work for you.

Possible Side Effects• The most common side effects that you may have are: itching and burning, a rash, or

redness of the skin in the place where the patch has been placed.• Less common side effects that you may have are: abnormal dreaming, allergic

reactions, back or chest pain, constipation, cough, diarrhea, dizziness, drowsiness, dry mouth, headache, high blood pressure, impaired concentration, indigestion, inflammation of sinuses, menstrual irregularities, nausea, nervousness, numbness, pain, pins and needles sensation, sleeplessness, sore throat, stomach pain, sweating, taste changes, tingling, vomiting, weakness.

• It is important to see a doctor if you have any strong symptoms.

Special Warnings About Nicotine Patches• Do not use any form of tobacco while wearing a patch! You could overdose! Also,

know that nicotine stays in your body many hours after taking off the patch.• Do not use a patch if you have had an allergic reaction to other patches or adhesive

tape.

34

Nicotine Patch (Continued)

• Before you use any brand of nicotine patch, make sure your doctor knows if you have, or have ever had, any of the following: chest pain from a heart condition (angina), diabetes requiring insulin injections, heart attack, high blood pressure (severe), irregular heartbeat (arrhythmia), kidney disease, liver disease, overactive thyroid, skin disease, ulcers or any other serious illness.

• The effects of nicotine patches can change if you are using other medications, so check with your doctor before using patches along with: Tylenol, No Doz, Dristan, blood pressure medication, Insulin, Lithium, and many other drugs.

• Used patches can poison a child or pet. Throw away your used patch by placing it in its own wrapper or aluminum foil and throwing it out of the reach of children and animals.


35

Appendix B: ChantixWhat is Chantix (varinicline)?• Chantix is a prescription medicine to help adults stop smoking. It works best when

used as part of a stop-smoking program that helps you change your smoking behavior.

How does it work?• Chantix binds to nicotine receptors in the brain and thereby, blocks the ability of

nicotine to activate these receptors. The smoker does not feel the pleasure from nicotine.

Who should NOT take Chantix?• Chantix has not been studied in children under 18 years of age and is therefore, not

recommended for this age group.

Tell your doctor before starting Chantix if you:• Have kidney problems or get kidney dialysis.• Are pregnant or plan to become pregnant. Chantix has not been studied in pregnant

women. It is not known if Chantix will harm your unborn baby. It is best to stop smoking before you become pregnant.

• Are breastfeeding. Although it was not studied, Chantix may pass into breast milk.• Tell your doctor about all your other medicines including prescription and

nonprescription medicines, vitamins and herbal supplements. Especially tell your doctor if you take insulin, asthma medicines or blood thinners.

What are the common side effects?• Nausea• Sleep disturbance • Constipation • Gas • Vomiting

How effective is Chantix?• In studies comparing Chantix to a placebo (sugar pill), persons who took Chantix were

about 3.5 times more successful at not smoking after 12 weeks than persons who took a placebo.


36

Appendix B: ZybanWhat is Zyban?• Zyban (bupropion hydrochloride) is a prescription medicine that does not contain

nicotine and helps people quit smoking. For many people, it cuts down on cravings and withdrawal symptoms such as: irritability, frustration or anger, anxiety, trouble concentrating, restlessness and depression.

• Zyban should be used with a personalized support program such as phone counseling or cessation classes.

Does Zyban Work?• One study found that smokers using Zyban quit smoking more than smokers using a

nicotine patch; using both Zyban and a nicotine patch helped even more. Everyone in the study was also given brief individual counseling to stop smoking.

How Does Zyban Work?• Zyban works with the chemicals in the brain — dopamine and norepinephrine — that

are associated with nicotine addiction, cravings and withdrawal symptoms.• You do not have to stop smoking when you begin using Zyban. It is recommended that

after two weeks of using Zyban, you should stop smoking and follow the rest of the treatment plan.

You Should Not Take Zyban if You:• Have a seizure disorder, for example, epilepsy.• Are taking Wellbutrin, or any other medicines that have bupropion hydrochloride.• Have or had an eating disorder, for example, bulimia or anorexia nervosa.• Are currently taking or have recently taken a monoamine oxidase inhibitor (MAOI).• If you drink alcohol. It is best not to drink alcohol while taking Zyban. If you drink

alcohol and suddenly stop, you may increase your chance of having a seizure. It is very important to talk about this with your doctor.

• Are pregnant or breast-feeding.

Possible Side Effects• You may get dry mouth and have trouble sleeping. These effects should be mild and

often disappear after a few weeks. If you have trouble sleeping, avoid Zyban too close to bedtime. A few people get skin rashes and shakiness and have had to stop using Zyban. If you get a rash or a more serious side effect, contact your doctor or health care professional.


37

1. You will live longer.

According to the Centers for Disease Control and Prevention (CDC), men who quit smoking between ages 35 and 39 add about five years to their lives. Women in this age category who quit, live about three years longer. If you quit between ages 65 and 69, you'll probably live about a year longer.

2. You will reduce your risk of stroke and heart attack.

Research at Harvard Medical School shows that smoking doubles your risk of stroke. Smoking also adds the equivalent of 10 years of aging to your arteries, say researchers at the Bowman Gray School of Medicine in Winston-Salem, N.C.

3. You can save money.

If you're a pack-a-day smoker who spends about $3.50 per pack, that's about $1275 a year you could save or spend on something else.

4. You will sleep better.

Smokers often have trouble falling asleep and report more nightmares than nonsmokers, say researchers at the University of Wisconsin at Madison. The stimulating effects of nicotine, nightly nicotine withdrawal and breathing difficulties are all factors that may make it difficult for smokers to sleep soundly.

5. You may become a calmer person.

Your need for nicotine can make you irritable, anxious and tense.

6. You will become less likely to have an accident.

According to the CDC, smokers are 1.5 times more likely to have an automobile accident than nonsmokers.

Appendix C:Twelve Reasons to Kick the Habit

38

7. You will heal faster.

University of Texas Southwestern Medical School researchers found, on average, a smoker's broken bone will take almost twice as long as a nonsmoker's to heal. And researchers at the Baylor College of Medicine found quitting smoking speeds recovery from wounds and surgery.

8. Your children will be healthier.

Children of smokers are more likely to be sick with coughs and colds and have weaker lungs than children of nonsmokers, according to the American Academy of Pediatrics. These children also have a higher risk for ear infections and hearing problems, bronchitis, pneumonia and asthma.

9. Your bones will be stronger.

Australian researchers found that women who smoke a pack a day begin menopause with five to 10 percent less bone than nonsmokers.

10. The environment will be cleaner.

The U.S. Environmental Protection Agency (EPA) classified secondhand smoke as a Group A carcinogen, meaning it is one of the most toxic substances released in the air known to cause cancer. Other Group A carcinogens include benzene (also found in cigarettes), radon and asbestos.

11. Your breath will smell better and your teeth will be cleaner.

Smoking not only causes bad breath, it marks your teeth with a yellowish stain.

12. It's never too late.

According to the American Cancer Society, within five years after quitting, your risk of lung cancer is cut in half. Within 15 years, you are no more likely to develop lung cancer than someone who has never smoked.

©1999 Optum. All rights reserved. Reprinted from the Taking Care program, "I'm Going to Kick Those Butts."

Twelve Reasons to Kick the Habit (Continued)

39

1. For the first few days after you quit, spend as much free time as possible in places where smoking is prohibited—libraries, museums, theaters, churches.

2. Drink large quantities of water and fruit juice.

3. Avoid alcohol, coffee and other beverages that you associate with smoking.

4. Strike up a conversation instead of a match for a cigarette.

5. If you miss the sensation of having a cigarette in your hand, play with something else such as a pencil, a paper-clip, a marble.

6. If you miss having something in your mouth, try toothpicks, cinnamon sticks or celery.

7. Avoid temptation by staying away from situations you associate with pleasurable smoking.

8. Find new habits and develop a nonsmoking environment around you.

9. Stress constructive, not destructive, thinking to lessen discomfort.

10. Avoid resuming the habit by anticipating future situations or crises that might lead to smoking, and assert your reasons for not giving in.

11. Take deep rhythmic breaths similar to smoking to relax.

12. Remember your goal and the fact that the urge will eventually pass.

13. Think positive thoughts and avoid negative ones.

14. Brush your teeth.

15. Do brief exercise—isometrics, pushups, deep knee bends, walk up a flight of stairs or touch your toes.

16. Call a supportive friend.

17. Compile a list of "Urge Activities" and start at the top when it hits.

18. Eat several small meals. This maintains constant blood sugar levels and helps prevent the urge to smoke. Avoid sugary or spicy foods that trigger a desire for cigarettes.

19. Above all, reward yourself. Plan to do something fun for doing your best.

Appendix D:Tips: Immediately After Quitting

40

• Not everyone gains weight during the quitting process.• Average weight gain is 5-10 pounds. • Less than four percent of those quitting gain more than 20 pounds.• Nicotine increases metabolism so there may be weight gain even if there is no change in

calorie intake; it may be necessary to cut up to 200 calories a day.• There is a physiological basis to increased appetite and cravings for sweets.• Fat from diet may be converted to body fat.

However:• Health benefits of not smoking far outweigh the effects of adding a few pounds.• Individuals are more likely to be successful with quitting smoking if they deal with

smoking first and later take steps to reduce their weight.How to Reduce Weight Gain and Stress• Eat plenty of fruits and vegetables; limit fat intake.• Drink plenty of water.• Eat a good breakfast and don’t skip meals. You may want to eat four smaller meals each

day rather than two to three larger meals. • If you need a snack, make sure its low calorie/low fat/low sugar snacks.• Limit caffeine, alcohol, sugar and chocolate, especially if these trigger a desire to

smoke.• Take multivitamins.• Get plenty of rest.• Exercise regularly:

– Set a goal of 30 minutes of physical activity three or four times a week.– Walking is great exercise and routinely will increase the chances of successfully

staying quit.– Regular exercise helps:

• Reduce stress• Burn calories and tone muscles• Keep your mind off smoking• Alleviate or reduce the temporary sense of depression some individuals

experience

Appendix E: Weight Gain

It’s not whether you get knocked down. It’s whether you get up again. —Vince Lombardi

41

Appendix F: Coping With Stress

The Relationship Between Thinking, Feeling and Behaving

Relieving Stress

• Take time out to breathe, stretch, nap, meditate or exercise.• Get it off your chest because bottling your feelings just increases stress. • Talk to a loving friend or relative. • Reward yourself. • Schedule more fun.

Relaxation: Breath AwarenessSit in a balanced position. Settle into your chair so you feel as little strain as possible on your lower back or abdominal muscles. Imagine a cord attached to the top of your head, pulling your spine perfectly straight and aligned from the top of your head to the bottom of your spine. Move your feet around until they are both comfortably placed on the floor, approximately one and one-half feet apart and with your calves perpendicular to the floor. Lift your hands and drop them to your thighs. Now visualize the cord being cut and allow your head to move very slowly to a comfortable position.Take a deep breath and gently and easily exhale.Allow your next breath to be the one your body takes itself and watch your abdomen expand as you breathe in and contract as you breathe out.When you feel settled into your breathing, say to yourself on the in breath, “ I am...” and on each breath out, “...relaxed.” Allow your body to slip into relaxation easily and comfortably.Continue this practice and soon you will be able to relax simply by taking a deep breath.

Stressful Thoughts

“I cannot do this.”

“This is awful! I cannot believe it!”

“Oh my gosh, what a mistake I’ve made.”

Stress-Reducing Thoughts

“I don’t know how to do this, but I have learned new tasks before. I am sure I can get on top of this, too.”

“Okay, this is not good. However, it is not the end of the world.”

“Well, at least this is fixable. I am human and I make mistakes.”

42

Smoking Increases Morbidity and Mortality• Smoking is the No. 1 preventable cause of death in the United States.• Each year smoking kills more people than AIDS, alcohol, drug abuse, car accidents,

murders, suicides and fires combined!• Statistically, smokers die 10 to 12 years younger than nonsmokers.• Smoking is the main cause of bronchitis, emphysema and lung cancer.• Over 10 million people in the United States have died from smoking-attributable causes

since the first Surgeon General’s report on smoking and health in 1964.• Dropped cigarettes are the leading cause of residential fire fatalities.

Women and Smoking• Smoking causes an increased risk for cervical cancer.• The lung cancer death rate among women has increased by more than 400 percent during

the past 30 years and is continuing to rise.• Since 1987, more women have died each year from lung cancer than breast cancer, which

was the major cause of cancer death in women for more than 40 years.• Smoking dramatically increases the risk of heart disease if oral contraceptives are used.• Tobacco use has a damaging effect on a women’s reproductive health; smoking

contributes to complications during pregnancy, early menopause and reduced fertility.• There is an increased risk of miscarriage, stillbirth, pre-term delivery and infant death. It

is also a cause of low birth weight in infants.• Infants are more likely to die from Sudden Infant Death Syndrome (SIDS) if their mothers

smoke during pregnancy or resume smoking after delivery.

Appendix G:Did You Know…?

43

Did You Know…? (Continued)

Nicotine• Nicotine can act as both a stimulant and a sedative. After exposure to nicotine,

adrenaline is released into the body which causes a sudden release of glucose as well as an increase in blood pressure, respiration and heart rate.

• Nicotine suppresses insulin output from the pancreas, which means that tobacco users are always slightly hyperglycemic.

• Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation; smokeless tobacco delivers higher concentrations of nicotine than cigarettes do.

• Nicotine is a poisonous alkaloid found in tobacco and used in insecticides. At higher doses, such as that which can be found in some insecticide sprays, nicotine can be extremely toxic, causing vomiting, tremors, convulsions and death.

• Nicotine poisoning has been reported from accidental ingestion of insecticides by adults from ingestion of tobacco products by children and pets. Death usually results in a few minutes from respiratory failure caused by paralysis.

44

• Secondhand smoke is also known as Environmental Tobacco Smoke (ETS) or passive smoke. ETS is a combination of:

Sidestream smoke: a mixture of smoke produced at the burning ends of cigarettes, cigars, pipes

Mainstream smoke: exhaled by the smoker

• ETS contains the same harmful chemicals as the smoke that smokers inhale. In fact, because sidestream smoke is formed at lower temperatures, it gives off even larger amounts of cancer-causing substances.

• Secondhand smoke is now classified as a Class A Carcinogen (this class includes only 15 other substances such as Asbestos, Radon and Benzene).

Secondhand Smoke Can Cause Lung Cancer in Nonsmokers

• A nonsmoker who is married to a smoker has a 30 percent greater risk of developing lung cancer than a nonsmoker living with a nonsmoker.

• Secondhand smoke causes:

– 3,000 lung cancer deaths in nonsmokers annually– Heart disease, lung cancer and other cancers resulting in over 60,000

deaths annually

Appendix H:Secondhand Smoke

45

Secondhand Smoke Is a Serious Risk to Children

• Causes ear infections; causes a build-up of fluid in the middle ear, a sign of chronic middle ear disease

• Causes and worsens asthma and other acute respiratory infections such as bronchitis and pneumonia

Parents Are Important Role Models

• Parental smoking influences attitudes toward smoking at a young age. Children of parents who smoke:

– Are twice as likely to begin smoking– Assume smoking is an acceptable way to handle stress and boredom– Develop a positive attitude toward smoking– Are more tolerant of the unpleasant effects such as odors and stale smoke

Appendix I:Smoking and Children

Date post:	22-Dec-2015
Category:	Documents
Upload:	shanna-cole
View:	214 times
Download:	1 times

Smoking Cessation, 1/2004, Revised 1/2009, Updated 7/2009, T238-16-C24 Reproduction of material for...

Documents