Smoking Cessation
Program
Dr. Rasha Salama
PhD Community Medicine
Suez Canal University
Egypt
Facts about Smoking
Most of those killed by tobacco are not particularly heavy
smokers and most started as teenagers.
Approximately 50 percent of smokers die prematurely from
their smoking, on average 14 years earlier than nonsmokers.
Smoking kills one in two of those who continue to smoke
past age 35.
There is evidence that smoking can cause about 40 different
diseases.
the preventable mortality attributed to smoking is 8 percent
of deaths in females and 19 percent in males.
Smoking is socioeconomically patterned with higher rates of
smoking in lower socio-economic groups. Thus tobacco
smoking produces a greater relative burden of disease and
premature death in lower socioeconomic groups and is a
major contributor to socioeconomic inequalities in health.
Facts (cont.)
Smoking, especially current smoking, is a crucial
and extremely modifiable independent determinant
of stroke.
Second-hand smoke (also called environmental
tobacco smoke) is a Class A carcinogen and
contains approximately 4,000 chemicals.
Exposure of children to second-hand smoke:
can cause middle ear effusion
increases the risk of croup, pneumonia and bronchiolitis
by 60 percent in the first 18 months of life
increases the frequency and severity of asthma episodes
is a risk factor for induction of asthma in asymptomatic
children.
Benefits of Smoking Cessation
These points may be helpful in motivating people to quit
smoking. Many smokers deny being at increased risk of
cancer and heart disease and more accurate perception
of risk may assist cessation efforts.
It is beneficial to stop smoking at any age. The earlier
smoking is stopped, the greater the health gain.
Smoking cessation has major and immediate health benefits
for smokers of all ages. Former smokers have fewer days of
illness, fewer health complaints, and view themselves as
healthier.
Within one day of quitting, the chance of a heart attack
decreases.
Within two days of quitting, smell and taste are enhanced.
Within two weeks to three months of quitting, circulation
improves and lung function increases by up to 30 percent.
Excess risk of heart disease is reduced by half
after one year’s abstinence. The risk of a major
coronary event reduces to the level of a never
smoker within five years. In those with existing
heart disease, cessation reduces the risk of
recurrent infarction or death by half.
Former smokers live longer: after 10 to 15 years’
abstinence, the risk of dying almost returns to that
of people who never smoked. Smoking cessation
at all ages, including in older people, reduces risk
of premature death.
Men who smoke are 17 times more likely than
non-smokers to develop lung cancer. After 10
years’ abstinence, former smokers’ risk is only 30
to 50 percent that of continuing smokers, and
continues to decline.
Women who stop smoking before or during
the first trimester of pregnancy reduce risks
to their baby to a level comparable to that
of women who have never smoked. Around
one in four low birth weight infants could be
prevented by eliminating smoking during
pregnancy.
The average weight gain of three kg and
the adverse temporary psychological
effects of quitting are far outweighed by the
health benefits.
Evidence for Effectiveness of
Health Professional Intervention
A Cochrane review of 16 RCTs found simple advice from
doctors had a significant effect on cessation rates (OR for
quitting 1.69; 95% confidence interval 1.45–1.98).
When trained providers are routinely prompted to intervene
with people who smoke, they achieve significant reductions
in smoking prevalence (up to 15 percent cessation rates
compared with 5 to 10 percent in non-intervention sites).
Doctors and other health professionals using multiple types
of intervention to deliver individualized advice on multiple
occasions produce the best results. Frequent and consistent
interventions over time are more important than the type of
intervention.
Smoking Cessation Program
The only way any country can substantially
reduce smoking and other tobacco use
within its borders is to establish a wellfunded and sustained comprehensive
tobacco prevention program that employs a
variety of effective approaches.
Nothing else will successfully compete
against the addictive power of nicotine and
the tobacco industry's aggressive
marketing tactics.
ESSENTIAL COMPONENTS
The following elements must all be included to
maximize the success of any program to reduce
tobacco use. Conducted in isolation, each of these
elements can reduce tobacco use, but done
together they have a much more powerful impact:
Public Education Efforts
Community-Based Programs
Helping Smokers Quit (Cessation)
School-Based Programs
Enforcement
Monitoring and Evaluation
Related Policy Efforts
Public Education Efforts:
Research has demonstrated that tobacco
industry marketing increases the number of
kids who try smoking and become regular
smokers. Not surprisingly, one of the best
ways to reduce the power of tobacco
marketing is an intense campaign to
counter these pro-smoking messages.
Public Education Efforts (cont.):
These efforts must include multiple
paid media (TV, radio, print, etc.),
public relations, special events and
promotions, and other efforts.
Counter-marketing efforts should
target both youth and adults with
prevention and cessation messages.
Community-Based Programs:
Because community involvement is
essential to reducing tobacco use, a
portion of the tobacco control funding
should be provided to local
government entities, community
organizations, local businesses, and
other community partners.
Community-Based Programs (cont.):
These groups can effectively engage in a
number of tobacco prevention activities
right where people live, work, play, and
worship, including:
direct counseling for prevention and to help
people quit,
youth tobacco education programs,
interventions for special populations,
worksite programs, and
training for health professionals.
Helping Smokers Quit (Cessation):
A comprehensive tobacco control program should
not only encourage smokers to quit but also help
them do it. In fact, most smokers want to quit but
have a very difficult time because nicotine is so
powerfully addictive.
To help these smokers, cessation products and
services should be made more readily available
and more affordable.
Moreover, treatment programs are most effective
when they utilize multiple interventions, including
pharmacological treatments, clinician provided
social support, and skills training.
Helping Smokers Quit
(Cessation) (cont.):
Cessation services can be provided
through primary health care providers,
schools, government agencies, community
organizations, and telephone "quit lines.“
Staff training and technical assistance
should be a part of all programs to treat
tobacco addiction; and following the
cessation guidelines from the Agency for
Health Care Policy and Research will
increase the effectiveness of any cessation
efforts in clinical settings.
School-Based Programs:
School-based programs offer a useful way
to prevent and reduce tobacco use among
kids, especially when based on the CDC’s
Guidelines for School Health Programs to
Prevent Tobacco Use and Addiction.
To operate most effectively, school-based
programs must include curricula that have
been shown to be effective, as well as
tobacco-free policies, training for teachers,
programs for parents, and cessation
services.
School-Based Programs (cont.):
Students must learn not only the dangers
of tobacco use but life skills, refusal skills,
and media literacy in order to resist the
influence of peers and tobacco marketers.
It is critical that the school programs be
integrated with other community-based
programs and with counter-marketing
efforts.
Enforcement:
Rigorously enforcing laws prohibiting
tobacco sales to youth and limiting
exposure to secondhand smoke is an
essential element of creating an
environment conducive to reducing
tobacco use.
These enforcement efforts should include
penalties for violators, and compliance
enhancing education.
Enforcement (cont.):
To increase tobacco control enforcement,
funds must be provided to enforcement
agencies to make sure other enforcement
efforts are not compromised.
Other agencies and organizations should
also be supported to provide related
educational efforts to raise awareness of
the laws and their enforcement and to
promote compliance.
Monitoring and Evaluation:
Every element of a comprehensive
tobacco control program should be
rigorously evaluated throughout its
existence.
Careful monitoring and evaluation
methods should be built-into the
programs to provide the data
necessary for continual improvement.
Monitoring and Evaluation (cont.):
Process measures should be developed to
monitor the activities conducted under the
program from the outside, as well, in order
to block the misuse of funds and promote
their most efficient and effective use.
Regular measurements of key outcomes
should also be conducted to assess
progress and further improve their
performance.
Related Policy Efforts:
Additional policy initiatives have been
proven effective in reducing tobacco use -especially as part of a comprehensive
strategy.
These policies include:
increases in cigarette excise taxes,
restrictions on tobacco marketing to kids,
increased penalties for selling tobacco to kids,
new restrictions on environmental tobacco
smoke in public places.
GUIDING PRINCIPLES
Past experience with tobacco control
efforts indicates that five principles should
guide the development of a successful
state program to prevent and reduce
tobacco use:
1. It must be comprehensive.
Stopgap or partial measures will meet with
only partial success. Elements work most
effectively when they are combined in
complementary fashion.
GUIDING PRINCIPLES (cont.)
2. It must be well funded.
Unless properly financed, tobacco
prevention will have little effect against
the marketing efforts of the tobacco
industry (over $8 billion each year).
CDC has issued funding guidelines for
state tobacco control programs, which
can serve as a basis for planning.
GUIDING PRINCIPLES (cont.)
3. It must be sustained over a long
period of time.
While short-term attitudinal changes can occur
relatively early, it will take years to achieve the
significant behavioral and cultural changes
necessary to reduce tobacco use substantially
and maintain low levels.
If tobacco control programs are not sustained
over many years, the chances for success will
be diminished, and any early gains may be lost
in subsequent years.
GUIDING PRINCIPLES (cont.)
4. It must operate free and clear of
political and tobacco industry influence.
History warns us that the tobacco industry will
employ every manner of tactics to divert money
from tobacco prevention and to interfere with
any tobacco prevention efforts that are
undertaken.
To avoid this tobacco industry sabotage, new
tobacco control programs must be set up to be
independent of these influences and insulated
from them.
GUIDING PRINCIPLES (cont.)
5. It must address high-risk and
diverse populations.
The needs of special populations can
and must be taken into account in
designing and disseminating the various
elements of the tobacco control program
(e.g. youth, and women).
Guidelines for
Individual Smoking
Cessation
Introduction
There is good evidence that even brief advice from
health professionals has a significant effect on
smoking cessation rates. A supportive, ongoing
relationship with a health professional is often an
essential precursor to successful quitting.
Success in quitting smoking depends less on any
specific type of intervention than on delivering
personalized empathic smoking cessation advice
to smokers, and repeating it in different forms from
several sources over a long period.
Smoking cessation is a dynamic process that
occurs over time rather than a single event.
Smokers cycle through the stages of
contemplation, quitting and relapse an average of
three to four times before achieving permanent
success.
Tobacco dependence is a chronic
condition that often requires repeated
intervention. However, effective
treatments exist that can produce
long-term abstinence.
These guidelines are designed for
smoking cessation providers to assist
all clients with smoking cessation.
Promoting Smoking Cessation
THE FIVE A’S:
ASK
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ADVISE
ASSIST
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Smoking Addiction Calculator
The Fagerström test is a standard questionnaire that is used to
determine if a smoker is addicted to nicotine.
There are several versions of the Fagerström test. The one
we will use has 6 multiple-choice questions. Each of the
multiple-choice responses has a point score.
After the person has answered all the questions, you need to
add all points from the individual questions; this should give
an integer between 0 and 10.
The person is then probably strongly addicted if the total
score is 8 or more; addicted if the score is 6 or 7; mildly
addicted if the score is 3, 4, or 5; and not addicted if the
score is 2 or less.
Q1: When do you smoke your first cigarette of the day?
Allowed responses: within 5 minutes (3 pt), 6-30 minutes (2 pt); 31-60
minutes (1 pt); more than 60 minutes after waking up (0 pt)
Q2: Do you find it hard not to smoke in places where it is forbidden, such
as in a cinema?
Allowed responses: yes (1 pt), no (0 pt)
Q3: Which cigarette would you most hate to give up?
Allowed responses: the first one in morning (1 pt); any other one (0 pt)
Q4: How many cigarettes do you smoke in a day?
Allowed responses: 10 or less (0 pt); 11-20 (1 pt); 21-30 (2 pt); 31 or more
(3 pt)
Q5: Do you smoke more after waking up than during the rest of the day?
Allowed responses: yes (1 pt), no (0 pt)
Q6: Do you still smoke if you are so sick that you're in bed most of the
day?
Allowed responses: yes (1 pt), no (0 pt)
Thank you