lifestyle smoking Flashcards
(14 cards)
definitions:
* Smoking: drawing into the mouth, and
usually the lungs, smoke from burning
tobacco
– Cigarettes, cigarillos, cigars, pipes or
water pipes
- ‘Smokeless’ tobacco: chewing, sniffing,
wad in the mouth between the cheeks and
gums
- Smoking cessation:
- Quit attempt: an intention not to smoke any more cigarettes from a given point in time (a ‘quit
attempt’) - followed by —- of urges to
smoke resulting in a period of abstinence - Lapse: smokes on an — but then resumes —
- Short term abstinence: up to —
- Long term abstinence: at least —, more typically —
- No agreed definition of ‘stopped smoking’
self conscious resistance
occasion
abstinence
4 weeks
6 months , 12 months
smoking and health :
* 30% of
coronary heart
disease
* 75% of
cancers
* 90% of — , with
25% of lung
cancer deaths
among non-
smokers due
to passive
smoking
* Secondhand
smoke causes
1% of all
deaths
* 80% of cases
of chronic —
airways
disease
info:
* Kills 1 in 2 smokers
* Over 6000 die per annum
* ~€500 million spent
* >300,000 bed days
lung cancer
obstructive
Time since quit Health benefits
20 min: — and — return to normal
8hrs: — level in blood returns to normal
24hrs: — eliminated, lungs start to clear — , etc
48hrs: Sense of — and — improves
72hrs: — easier, — levels increase
2-12 wks: — improves
3-9 months: Lung function increases by < — %; coughs, — decreases
1 year: Risk of heart attack halved versus continued smoking
5 years: Risk of cancer halved versus continued smoking
10 years: Risk of heart attack equal to never-smokers
also: Improved mental health, improved recovery from surgery,
improved reproductive health….
bp and hr
02
carbon monoxide
mucus
taste and smell
breathing , energt
circulation
10%
cough , wheeze
benefits of quitting:
Age-dependant:
* Quit before ~35:
✓ — life expectancy
* Quit after ~35:
✓ — months of healthy
life expectancy for
every year quit
✓ — hours for every day
quit
Comparison to other
interventions?
* Statins postpone death
by median of 3-4 days
over 2-6 years…
* Cancer drugs help you
survive a median of ~1-
3 months
* Single most important
health intervention for
smokers is to —
same
2-3
4-6 hrs
quit
smoking initiation:
* —- : Children with
peers, elder siblings or
parents who smoke are more
likely to initiate smoking than
children with non-smoking
significant others.
* Social pressure, social
learning and reinforcement:
If friends smoke, a
child/young person can
develop shared positive
attitudes towards smoking, or
reduced perceptions of risk.
* Weight control: Identified
as a motive for smoking
initiation and maintenance
among —
* Attitudes towards smoking:
May emerge during
adolescence, may be a
gender difference (fitness v
weight control).
* Risk-taking or problem
behaviours: Smoking is
often associated with other
problem behaviours such as
truancy, petty theft, underage
drinking.
* Health cognitions such as
‘unrealistic optimism’
regarding the potential of
experiencing negative health
outcomes.
modelling
young girls
smoking maintenance - why do ppl continue to smoke:
* Physical dependence
– — in cigarettes is addictive
– Stimulates the release of — , —- and causes an increased —
– Physical dependence arises when an individual develops —- to the effects of nicotine and smokes more to achieve the same effect or avoid withdrawal
* Psychological dependence
– Perceived to help cope with stress or anxiety?
– Reinforcement through pleasure or enjoyment
– Lack of belief in ability to stop
– Enjoy it!
nicotine
natural opiates
beta endorphins
metabolic rate
tolerance
1- * Number of pack years = (number of cigarettes smoked per — x number of — smoked)/ —
* Research has shown that even very young smokers can be very addicted
– Pack-years may not be best
indicator of addiction, difficulty
quitting
2- assess level of dependance:
Heaviness of smoking index (HSI)
1. How soon after you wake up do you smoke
your first cigarette?
> 60 mins = 0, 31-60 mins = 1, 6-30 mins = 2,
< 5 mins = 3
2. How many cigarettes do you smoke per day?
10 or less = 0, 11-20 = 1, 21-30 = 2, 31+ = 3
Scoring
Points summed across both measures
Higher scores = higher levels of addiction
* — : low addiction
* — : moderate addiction
* — : high addiction
— better than —
per day x years / 20
0-2
3-4
5-6
HSI
pack years
49% of current smokers have tried to quit
during past year
* How?
– 58% used willpower –
– 25% used —
– 19% used — therapy
* No difference between smokers living in deprived and smokers living in affluent areas in
making an attempt to quit during the past 12 months
* Most smokers want to quit
* 3-5% of unaided quit attempts are successful at
one year
* After — , relapse is ~50%
* Can healthcare professionals help?
– Brief advice increases cessation rates
– More intensive advice doubles quit rates
– Pharmacotherapy in those who are nicotine dependent
(Front-line: Combination —- replacement therapy;
Varenicline not currently available!)
alone
e ciggerates
nicotine replacement
6 months
nicotine
5 As for smoking cessation:
1- — : document status in chart
2- — : for health effects
3- — : readiness to quit and nicotine dependance
4- —: strategies , pharmacology
5- — : patient must be contact airer 1 month
ask
advise
assess
assist
arrange follow up
Motivational Interviewing
The intervention generally considered most likely to
be effective for people who are — to engage in change
Motivational interview (MI) is deliberately non-confrontational – the key questions within the interview are:
* ‘What are some of the good things about your present behaviour?’
* ‘What are the not-so-good things about your present behaviour?’
Other key elements and strategies include:
* expressing empathy by the use of reflective listening (see the section on problem-focused counselling)
* avoiding arguments by assuming that the individual is responsible for
the decision to change
* ‘rolling with resistance’ rather than confronting or opposing it
* supporting self-efficacy and optimism for change
reluctant
Problem Solving – Smoking Cessation
Smoking is driven by two processes:
* a — response to a variety of cues within the
environment – picking up the telephone, having a cup of
coffee, and so on – the so-called habit cigarette.
* a — need for nicotine – to top up levels of nicotine and prevent the onset of withdrawal symptoms.
Accordingly, when an individual stops smoking, they may
have to deal with
* the loss of a powerful means of altering mood and level of
attention.
* withdrawal symptoms as a consequence of a biological
dependence on nicotine.
* the urge to smoke, triggered by environmental cues.
conditioned
physiological
comparing medications > 6 months quit rates:
- Current
recommendations:
1) Refer to —
supports,
2) prescribe
combined — and —
- Prescribe based
on — and patient —
- — are not yet recommended as
quit aides
- successful interventions: — , — and —-
approaches can be
successful
behaviroals
NRTS and varenciline
contradictions and preference
e cigarettes
population , community and individuals
Conclusions and practical application
* Younger, more socially disadvantaged, and certain ethnic
groups more likely to smoke
* Serious adverse health effects of smoking
– Several benefits of smoking cessation
– Vaping is controversial
* People start smoking and maintain smoking behaviours for
different reasons
* 5As: Assessment and interventions for smoking
– Always ask, advise, assess, assist, arrange follow-up
* Assessment – use — or — for dependence
* Advise – brief advice effective, adding NRT/varenicline enhances this
* Follow-up – you, other HCPs or quitlines etc.
HSI or pack years
