Smoking Cessation Toolkit - Quality Insights Quality Innovation Network [PDF]

Patient Edition

Break Free Quit Smoking Today

Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

50th Anniversary of the First Surgeon General’s Report on Smoking and Health The first Surgeon General’s Report on smoking and health was released in January 1964 by Dr. Luther Terry. The report identified smoking as a cause of lung cancer in men. News coverage of the report was extensive, and the report became one of the top 10 news stories of the year. Consider these statistics: • Since 1964, smoking prevalence among U.S. adults has been reduced by half. Approximately 66 percent of Americans smoked in the 1960s. Today, that number has dropped to 19 percent. • In 2013, approximately 409,000 adults in West Virginia were smokers and 28.2 percent of West Virginia’s adults were smokers. This was the 2nd highest rate in the U.S. While progress has been made nationally and locally, smoking is still a threat to health in West Virginia. Unfortunately, tobacco use remains the leading preventable cause of disease, disability, and death in the United States. In January 2014, the Surgeon General released the 50th anniversary Surgeon General’s Report (SGR) on smoking and health. The report highlights 50 years of progress in tobacco control and prevention, presents new data on the health consequences of tobacco use, and details initiatives that can end the tobacco use epidemic in the U.S. For more information, please visit www.surgeongeneral.gov. For questions or inquiries about the 50th Anniversary campaign, please email [email protected].

Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Table of Contents OVERVIEW........................................................................................................1 WHAT IS THE PURPOSE OF THIS TOOLKIT? .................................................................... 1 WHAT EVERYONE SHOULD KNOW ABOUT STOPPING THE HABIT OF SMOKING ........................ 1 AFTER THE LAST CIGARETTE ...................................................................................... 1 HOW TO USE THIS TOOLKIT ...................................................................................... 1 SO GLAD YOU DECIDED TO QUIT! .....................................................................2 ADD YOUR REASONS TO QUIT HERE: ......................................................................... 3 DID YOU KNOW? ..............................................................................................3 SUFFER WITH DEPRESSION? .............................................................................4 HELPFUL TIPS TO QUIT ............................................................................................ 4 AFTER THE LAST CIGARETTE – RELAPSE PREVENTION ....................................... 5 COMMON NICOTINE RECOVERY SYMPTOMS ................................................................. 7 AVOID NEGATIVE SELF-TALK ..................................................................................... 8 TOOLKIT REFERENCES ..................................................................................... 10 NATIONAL TOBACCO CESSATION RESOURCES ................................................ 12 STATE RESOURCES .......................................................................................... 12 OTHER RESOURCES ......................................................................................... 12 ADDENDUM: TRACKING FORM....................................................................... 13 TRACKING FORM ................................................................................................. 13

Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Overview What is the purpose of this toolkit? Addiction to nicotine is higher among people who suffer with depression or mental illness (Morris, et al., 2009). This toolkit will highlight the health dangers of smoking and the benefits of quitting. We hope to give you information that will help you through the process of quitting and prevent a relapse. What everyone should know about stopping the habit of smoking There are many benefits to quitting smoking. Benefits include improved health, saved money, and much more. Health benefits can start almost immediately. This toolkit will attempt to show these benefits. After the last cigarette Slips and relapses are very common. You are better off to plan ahead and be prepared. Don’t let a slip or relapse end your efforts. This toolkit will attempt to provide you with the programs, advice, resources and encouragement you need to stop smoking. How to use this toolkit This toolkit contains information to help you stop smoking. It will provide you with options, support and programs to guide you through the process of quitting tobacco and the challenging times encountered after the last cigarette.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

So glad you decided to quit! Quitting smoking is a very important decision in your life. Now that you have decided to quit, here are some resources and guidelines with encouragement to help you through this process. • The West Virginia Tobacco Quitline is free to use. Quitline coaches can help you get ready to quit and support you in staying tobacco free. They may also be able to provide nicotine replacement medicines at no cost to you. Call 1-888-QUIT-NOW for free help. • Central West Virginia Aging Services, Inc. offers the Helping Hands Program. This is a resource for in-home services that may help you pay for nicotine replacement therapy or medication to help you quit smoking if you qualify. You can call 1-800-296-0069 for more information. • OneHealth is a website that works similarly to Facebook. You join the community and connect with peers to receive support. Chosen usernames can keep you anonymous. The site is secure and will give you access to helpful tools and resources to help achieve your goals. Visit http://about.onehealth.com/howitworks/ for more information. • The Bureau for Behavioral Health and Health Facilities has several locations that provide resources to help you quit smoking. Visit www.dhhr.wv.gov/bhhf or call 1-304-356-4811 for more information. • West Virginia Advocates provide resources that can help you quit smoking. Visit www.wvadvocates.org or call 1-800-950-5250 for more information. • FMRS Health Systems, Inc. is an organization developed to assist people in identifying and addressing emotional, behavioral, developmental or substance abuse problems in an effort to prevent more serious difficulties from occurring in the future. FMRS has facilities located in Fayette, Monroe, Raleigh and Summers counties.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Add Your Reasons to Quit Here: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Remember WHY you want to quit. For some people, factors include health, money or family. Always remember your reasons.

Did you know? Did you know that smoking harms nearly every organ of the body? (QuitNet, 2013). And did you know that in as little time as 20 minutes, your body begins to react to the change? Here are just a few of the changes your body will experience after you quit smoking to improve your health. • Approximately 20 minutes after you quit smoking, your heart rate and blood pressure drop. (Mahmud, et al., 2003) • Approximately 12 hours after quitting, the carbon monoxide level in your blood drops to normal. (US Dept. of Health and Human Services, 1990) • Two weeks to three months after quitting, your circulation improves and your lung function increases. (US Dept. of Health and Human Services, 1990) • One to nine months after quitting, coughing and shortness of breath decrease. (US Dept. of Health and Human Services, 1990) • One year after quitting, the excess risk of coronary heart disease is half that of a continuing smoker. (US Dept. of Health and Human Services, 2010) Of course benefits continue year after year that you are smoke-free. Five years after quitting, you even cut your risk of cancer in half (IARC, 2007).

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Remember that first puff you ever took? It’s likely that the experience wasn’t great. Your lungs probably tried to reject the smoke from the start. Just like you adjusted to liking cigarettes, you will need to adjust to not smoking.

Suffer with depression? Research shows that if you are a smoker who also suffers with depression, you may think that smoking helps relieve some of the depression symptoms. However, this is only temporary. Cigarettes contain thousands of chemicals. These chemicals cause both short-term and long-term changes in the brain. Short term changes include a sense of relief from depression and an improved ability to concentrate. However, in the long term, you may experience less relief of depression symptoms. In fact, you may begin to feel more anxious, depressed and unable to concentrate. This can make you think you need to or want to smoke even more. Even though research shows that smoking and depression go hand-in-hand, there is no proven correlation between the two. So, if you do suffer with depression, you will want and need support from: • • •

Family Friends Your Physician

Tell them what you need from them to support you in quitting smoking. There are resources listed at the end of this toolkit that will give you the support needed. These include: • •

Help Us Quit (www.HelpUsQuit.org) WV Quitline (www.wvquitline.com)

Quitting isn’t easy and it may take you several tries. But you learn something each time you try. Remember - the urge to smoke will come and go. Helpful tips to quit

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

• Have a quit plan. • Talk with your physician about medications that may help you quit. • Get help through free resources such as WV Quitline. • Throw away ashtrays, lighters and any remaining cigarettes. • Keep your home, car and workplace smoke-free. • Try to avoid social situations where others will be smoking and ask friends not to smoke around you. • Try to avoid stressful situations that will make you want to smoke. • Chew gum or munch on veggies. • Reward yourself for not smoking. There are currently seven FDA-approved medications to help you quit smoking. Talk to your physician to see if medication is right for you. Medications include: 1. Chantix 2. Zyban or Wellbutrin 3. Nicotine Replacement Therapies (NRT) A. Patch B. Gum C. Inhaler D. Nasal spray E. Lozenge E-cigarettes are not an approved therapy for quitting smoking. Consult with your physician before using these devices.

After the Last Cigarette – Relapse Prevention You did it! You have smoked your last cigarette! Now what? Preparing for those times when you are going to want to smoke is the best defense. Slips and relapses are common.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

• A “slip” occurs by smoking one cigarette or two when you are first quitting. • A “relapse” happens when you begin smoking and smoke just like you were before you quit. It’s important to recognize what triggers the urge to smoke. Here are a few common triggers: • • • • • • • •

Driving Stress Alcohol Pressure at work Arguments Boredom Finishing a meal Relaxing

Triggers are the moods, feelings, places or things that you do in life that make you want to smoke. Life will continue. Personal tragedies, loss of loved ones, job stress, kids and more will always be factors of life. It is very important to know that live goes on whether you smoke or not. To keep from relapsing, you must be prepared to meet life head-on and not reach for that pack of cigarettes because you are facing a stressful situation or a painful situation. The only result you will face is the challenge of quitting again. The best mantra is “Not One Puff Ever!” or (N.O.P.E.) (Bainbridge, 2006). Dependence on tobacco has a lot of the same features that a chronic disease has. In short, this means that for years you may occasionally have cravings that are associated with certain situations and /or memories that make you want to smoke. In fact, you may always have occasional cravings to smoke (Stevens, 2013). It may be helpful to write down what causes the urge to smoke and what you can do to distract yourself from the urge. Many people report having slips and

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

relapses. As mentioned above, there is a difference between a slip and a relapse. A slip is smoking one or two cigarettes when first attempting to quit, but you don’t pick the habit back up as before. A relapse is going back to smoking just as before. The important thing to remember here is to make a plan to quit again as soon as possible. Don’t waste the opportunity to learn from what caused you to slip or relapse. Write it down so you will recognize it and be better prepared when it comes around again. If you do slip, don’t let that turn into a relapse. Immediately make plans to quit again. Common nicotine recovery symptoms • • • • • • • • • • • • • •

Cravings to smoke Irritable, cranky Insomnia Fatigue Inability to concentrate Headache Cough Sore throat Constipation, gas, stomach pain Dry mouth Sore tongue and/or gums Postnasal drip Tightness in the chest The urge to snack

Managing these symptoms will be tough, but it can be done, especially if you are prepared. Learn what to expect and be ready to meet those challenges head on. Pay attention to signs of a potential relapse. Stress will also be a factor in the early stages of smoking cessation. Our ability to manage stress improves once we recover from nicotine addiction. However, it may temporarily increase early in the process because the body is learning to live without a daily dose of thousands of chemicals in cigarettes. There are many

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

stress-reducing programs to help you through this process. Keeping yourself busy with other activities that you enjoy will be a great start. Here are a few suggestions for managing stress: • Remind yourself that this will pass. • Avoid situations, places and people that you associate with smoking. • Try taking ten deep breathes through your nose blowing out through your mouth. • Smokefree.gov (http://www.smokefree.gov) is a website that has a stepby-step guide to help you manage withdrawal symptoms. If your physician has prescribed a medication to help you quit smoking, be sure to use it properly and talk to your physician before quitting the medication on your own. Some people may experience weight gain as a result of quitting smoking. Try not to take on too many life changes at once. Remember to eat healthy, get some physical exercise and keep the priority on quitting smoking. A little weight gain is far less harmful to you than smoking. Avoid negative self-talk If you do have a slip or relapse, be sure to avoid negative self-talk. Examples include statements like: • “I’ve been smoking so long, the damage is already done.” • “I’m too addicted to stop smoking.” • “I’ll just have one.” When you have some of these negative thoughts, try one of the following replacement techniques to get back on track. Smoking is not only an addiction, but also a habit where you use your hands. Replacing that activity will help. • Keep your hands busy. • Take a deep breath.

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• • • • •

Smoking Cessation Toolkit for Patients

Pay attention to your positive talk. Go for a walk. Phone a friend. Review your reasons for quitting. Remember: You are a non-smoker.

Plan ahead for slips and relapse. The key to staying smoke-free is to know what triggers you to smoke and preparing yourself to deal with those triggers (Canadian Public Health Association, 2006). Be patient with yourself. This is a life-changing event and it will take time to adjust to your smoke-free lifestyle. Congratulations on deciding to quit smoking and enjoy your smoke-free lifestyle.

Do you use a smart phone? Visit HHS.gov or HHS Mobile Apps to get tools to help you quit.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Toolkit References Bainbridge, L. (2006) “Not One Puff Ever (N.O.P.E.) Part Two.” Retrieved October 8, 2013 from http://quitsmoking.about.com/od/preventingrelapse/a/nopeparttwo.htm. Canadian Public Health Association (2006) Stop smoking: a cessation resource for those who work with women. Retrieved September 19, 2913 from http://www.cpha.ca/uploads/progs/_/smoking/sect_1_e.pdf CDC Centers for Disease Control and Prevention (2006) History of the Surgeon General’s reports on smoking and health. Retrieved Sept 5, 2013 from http://www.cdc.gov/tobacco/data_statistics/sgr/history. CDC Centers for Disease Control and Prevention (2013) Quit tips. Retrieved September 19, 2013 from http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/quit_tips/index. htm. Hajek P, Stead LF, West R, Jarvis M, Lancaster T. (2009) Relapse prevention interventions for smoking cessation. The Cochrane Database of Systematic Reviews. (1) CD003999. Husney A, Hughes J. (2011) Quitting smoking: preventing slips or relapses. WebMD. Retrieved September 13, 2013 from http://www.webmd.com/smoking-cessation/quitting-smoking-preventing-slipsor-relapses. IARC. (2007) Tobacco control: reversal of risk after quitting smoking. IARC Handbooks of Cancer Prevention. Vol. 11. p 341. Mahmud A, Freely J. (2003) Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension. 41:183-187. Martin, T. (2013) After the last cigarette: the benefits of smoking cessation begin. Retrieved Sept 13, 2013 from http://quitsmoking.about.com/cs/afterquitting/a/after_quitting.htm.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

Morris C., Waxmonsky J., May M., et al. (2009) The tobacco cessation toolkit for mental health providers. University of Colorado Denver, Department of Psychiatry, Behavioral Health and Wellness Program. QuitNet Counselor. (2013) Preventing a relapse. Healthways QUITNET. The Quit Blog. Retrieved Sept 13, 2013 from http://blog.quitnet.com/quitblog/bid/100239/Preventing-a-Relapse. Spitzer, J. (1986) The Medical Implications of Smoking. Retrieved on October 8, 2013 from http://whyquit.com/joel/Joel_02_03_medical.html. Stevens, S.K. (2013) Tobacco Dependence as a Chronic Disease. Retrieved on December 11 from http://www.mayo.edu/research/documents/tobaccodependence-as-a-chronic-disease-mdash-stevens/DOC-10031956. U.S. Department of Health and Human Services. (2010) How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. U.S. Department of Health and Human Services. (1990) The health benefits of smoking cessation. Public Health Service. Centers for Disease Control. Center for Chronic Disease prevention and Health Promotion. Office on Smoking and Health. DHHS Publication No. (CDC) YO-K-116.

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Project IMPACT – Care Transitions

Smoking Cessation Toolkit for Patients

National Tobacco Cessation Resources American Cancer Society: http://www.cancer.org American Public Health Association: http://www.apha.org/ Association for the Treatment of Tobacco Use and Dependence: http://www.attud.org/ Centers for Disease Control and Prevention: http://www.cdc.gov/tobacco Quitline 1-800-QUIT-NOW: http://1800quitnow.cancer.gov/ Nicotine Anonymous: http://www.nicotine-anonymous.org/ Consumers Helping Others Improve their Condition by Ending Smoking (CHOICES): http://www.njchoices.org National Association of State Mental Health Program Directors: http://www.nasmhpd.org/ National Institute on Drug Abuse (NIDA): http://www.nida.nih.gov/DrugPages/Nicotine.html Smoking Cessation Leadership Center: http://smokingcessationleadership.ucsf.edu/ Society for Research on Nicotine and Tobacco: http://www.smt.org STEPP: http://www.steppcolorado.com Surgeon General: http://www.surgeongeneral.gov/ Tobacco Cessation Leadership Network: http://www.tcin.org/

State Resources Bureau for Behavioral Health and Health Facilities: www.dhhr.wv.gov/bhhf FMRS Health Systems Inc.: www.fmrs.org West Virginia Advocates: www.wvadvocates.org West Virginia American Lung Association: www.lunginfo.org WV Division of Tobacco Prevention: www.wvdtp.com WV Tobacco Cessation Quitline: www.wvquitline.com

Other Resources Tobacco Cessation Program Charleston, WV: www.camc.org/TobaccoCessaton The Mayo Clinic Quit Smoking: www.mayoclinic.com

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Smoking Cessation Toolkit for Patients

Addendum: Tracking Form Tracking Form Instructions:

1. Print this form. 2. Cut it out and carry it with you. 3. Record every cigarette you have for the next few days. 4. Print off the questions and answer them. Cigarette #

Time/Place

Who With?

Mood (Good, Bad, or Not Sure)

Rate 1 to 5 (1=I could have done without it. 5=I really had to have this cigarette)

This material was prepared by Quality Insights, the Medicare Quality Innovation Network - Quality Improvement Organization for West Virginia, Pennsylvania, Delaware, New Jersey and Louisiana under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication number QI-B1-072814

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