Smoking
60 carcinogens
Second hand smoke, from burning/exhalation
ThirdHS from clothes/carpet
Nicotine reaches brain in 8s > Dopamine release > relaxation
Adrenaline, noradrenaline, cortisol release
Suppress appetite, increases metabolic rate, increases heart rate, BP, PVR
Pleasure, increases alertness
As addictive as cocaine, heroin
Prevalence
10% of pregnant women smoke
20% of Australian children live with indoor smokers (150,000 deaths)
20% of Teens smoke
50% of indigenous men smoke
75% of smokers start in adolescence
Risk
Single parent
Parental, sibling, peer smoking
Lower socioeconomic status (income, education, occupation, wealth accumulation)
Permissive parenting
Media exposure
Mood disorders
Risky behaviour
Illegal
Intervention (1:40 will quit will brief intervention, 1:10 with 20m)
Ask (if over 10yo), in car or home?, how much, last cig
Assess willingness to quit, dependence
Advise to quit: Supportive, non-confrontational - Health, financial (+?personal) benefits, Laws outside home.
Assist
Arrange follow up
Ask: <30m from waking, >15/day or withdrawals = dependence
Assist (Plan)
Motivators (for adolescence behaviour, Adults - stress, wt gain, withdrawal)
Ask them!
Teeth discolouration
Bad breath
Bad taste
saving money
control
less chemicals
improved fitness
Adults: health of children/self, finance, friends/family request
Complications
SIDS
Asthma
OM
LRTI (croup, bronchiolitis, pneumonia)
Learning difficulties
Behaviour
Pneumonia, emphysema, cancer
Peripheral vascular disease, CAD, stroke, impotence, macular degeneration
ADHD
Gastric ulcers, cancer
Stroke
Wrinkles, wound infections
Bladder cancer
osteoporosis
Gum disease, oral cancer
Hair loss
Pancreas cancer
Cervical cancer
infertility, IUGR, early menopause,
Improvements in:
20mins - tachycardia
12hr - carbon monoxide
2m - heart attack to non-smoker
5m - coughing/dyspnoea
5y - stroke to non-smoker
10y - halve cancer risk
15y - all cause mortality to non-smoker
Nicotine withdrawal (80% prev with quitting)
insomnia
irritability
restlessness
poor concentration
weight gain
low mood
bradycardia
increased appetite and weight gain
Ref: KidsQuit - Edmore
Second hand smoke, from burning/exhalation
ThirdHS from clothes/carpet
Nicotine reaches brain in 8s > Dopamine release > relaxation
Adrenaline, noradrenaline, cortisol release
Suppress appetite, increases metabolic rate, increases heart rate, BP, PVR
Pleasure, increases alertness
As addictive as cocaine, heroin
Prevalence
10% of pregnant women smoke
20% of Australian children live with indoor smokers (150,000 deaths)
20% of Teens smoke
50% of indigenous men smoke
75% of smokers start in adolescence
Risk
Single parent
Parental, sibling, peer smoking
Lower socioeconomic status (income, education, occupation, wealth accumulation)
Permissive parenting
Media exposure
Mood disorders
Risky behaviour
Illegal
- in cars with <16yo
- on public transport, playgrounds, sports facilities, shops
- Outdoor dining areas
- Marketing (plain package, out of view)
Intervention (1:40 will quit will brief intervention, 1:10 with 20m)
Ask (if over 10yo), in car or home?, how much, last cig
Assess willingness to quit, dependence
Advise to quit: Supportive, non-confrontational - Health, financial (+?personal) benefits, Laws outside home.
Assist
Arrange follow up
Ask: <30m from waking, >15/day or withdrawals = dependence
Assist (Plan)
- Remove triggers
- Develop coping stratergies: drink water, exercise, hang with non-smokers, reward
- Prepare environment: notify family and friends, throw out cigarettes
- Anticipate +/- treat withdrawal
- Cold turkey (64%)
- GP for pharmacotherapy
- NRT (26%)
- Varenicline
- Bupropion
- NO safety data on e-cigarettes, don't recommend
- Quit line 13 78 48 (QUIT) + resource pack (Quit Tips) + faxed referral
- Set goals inc quit date
- CBT
- Information
- Motivators
- CBT
- Car and home smoke free zone, smoking jacket, wash hands, ash trays only outside,
- Follow-up in 2 weeks
- Resp CNC if reps issues
- Referral to adolescent medicine
- http://www.oxygen.org.au - Adolescents
- http://www.icanquit.com.au - Smokers
- http://www.quitnow.gov.au - Smokers
- http://www.smarterthansmoking.org.au - Teachers
- http://aascp.org.au
- Quit pack order form (NSW only)
- Check medications that might be effected i.e. CYP1A2
Motivators (for adolescence behaviour, Adults - stress, wt gain, withdrawal)
Ask them!
Teeth discolouration
Bad breath
Bad taste
saving money
control
less chemicals
improved fitness
Adults: health of children/self, finance, friends/family request
Complications
SIDS
Asthma
OM
LRTI (croup, bronchiolitis, pneumonia)
Learning difficulties
Behaviour
Pneumonia, emphysema, cancer
Peripheral vascular disease, CAD, stroke, impotence, macular degeneration
ADHD
Gastric ulcers, cancer
Stroke
Wrinkles, wound infections
Bladder cancer
osteoporosis
Gum disease, oral cancer
Hair loss
Pancreas cancer
Cervical cancer
infertility, IUGR, early menopause,
Improvements in:
20mins - tachycardia
12hr - carbon monoxide
2m - heart attack to non-smoker
5m - coughing/dyspnoea
5y - stroke to non-smoker
10y - halve cancer risk
15y - all cause mortality to non-smoker
Nicotine withdrawal (80% prev with quitting)
insomnia
irritability
restlessness
poor concentration
weight gain
low mood
bradycardia
increased appetite and weight gain
Ref: KidsQuit - Edmore