Smoking and cessation Flashcards
Impact of smoking.
a) 4 economic costs of smoking
b) 4 health costs
c) 5 cancers (other than lung) linked to smoking
d) Secondhand smoke: i) Obstetric, ii) Paediatric
a) Absenteeism, healthcare costs, lower productive output due to early deaths, fag breaks, cigarette butts, individual cost (£3000/year for a 20/day smoker)
b) Cancer, CVD, lung disease (e.g. COPD), Crohn’s, hearing loss, T2DM, osteoporosis, impaired wound healing and increased infection, PUD, sexual dysfunction, mental health, widening inequalities
c) Bladder, stomach, mouth/throat, kidney, pancreatic
d) i) LBW and complications, ii) SIDS, increased risk of smoking
Smoking cessation.
a) NCSCT: i) who are they? ii) what 3 functions do they have?
b) Success: i) 2 best interventions? ii) ___ time better than _____ alone. iii) 1-year success rates?, iv) Cost-effectiveness (vs. average life-saving treatments)
c) Define ‘quitter’
d) Proportion of smokers who: i) Want to quit, ii) Try to quit each year, iii) Successfully quit each year
a) Deliver training, conduct research, provide stop smoking support
b) i) NRT/Champix + Solo/group behavioural therapy;
ii) 4x better than cold turkey (and 2x better than medication alone);
iii) 15-30% 1-year success,
iv) £1,000 per life-year gained (vs. £15,000 average)
c) 4 weeks of no smoking (though 52-week abstinence a better measure)
d) i) 75%, ii) 39%, iii) 5%
Tobacco control.
a) What are the WHO Tobacco Control Convention’s MPOWER measures to reduce smoking?
b) What are the 3 public health QOF indicators?
c) These relate to the three goals in what public health initiative?
a) MPOWER:
Monitor tobacco use and prevention policies
Protect people from tobacco use
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
b) Adults smoking prevalence, 15yr old prevalence, mothers at time of delivery
c) Healthy Lives, Healthy People.
Smoking prevalence demographics.
a) Teenage boys vs girls
b) Adult men vs women
c) Socioeconomic groups. - and their decline?
d) Other at-risk groups
e) Peak age prevalence
f) Peak age incidence
a) Slightly higher in teenage girls
b) Slightly higher in men.
c) Higher in C2DE vs ABC1 (decline equal)
d) Lesbian and gay, mental health issues, alcohol abuse, Bangladeshi and Pakistani men
e) Mid-twenties
f) Teenage years
Smoking cessation demographics.
a) Younger or older - more likely to try stopping? More likely to be successful?
b) Adult men vs women. Difference in quitting/accessing treatment?
c) Quitting success vs dependency
d) Other groups who require more support to quit
a) Younger more likely to try; older more likely to be successful
b) Same difficulty in quitting but women access treatment more than men
c) Less dependent = more likely to quit
d) Are younger; Smoke first thing on waking, or they interrupt their sleep to smoke (i.e. are more dependent); Have a partner who smokes or they live with people who smoke; Come from a low paid manual job or are unemployed; Have a mental health problem or illness; Are drug or alcohol dependent
Two NICE guidelines that are relevant
What are the three cornerstones of public health policy with regards smoking?
NICE NG92 - Stop smoking interventions and services
NICE PH45 - Smoking: harm reduction
Prevention, cessation and harm reduction
Public health awareness campaigns
a) Name three seasonal ones
b) Healthy Lives, Health People
c) Name a childhood obesity one
a) Dry January, Stoptober, No Smoking Day (March)
b)
c) Change4Life
4 conditions that smoking may reduce the risk of
UC, PD, pre-eclampsia, morning sickness during pregnancy
Benefits of cessation:
a) Quitting at 35
b) Quitting at 65
c) Average smoker saves how much per year?
d) Effect on risk of i) Lung cancer, ii) CVD, iii) COPD progression, iv) Self-reported healthiness, happiness and life satisfaction
a) quitting at age 35 adds an average of 10 years (equivalent life expectancy to never smokers)
b) quitting at 65 adds 3 years of life.
c) £1500/year
d) The risk of lung cancer stops increasing when smokers quit; The increased risk of heart disease diminishes by 50% within the first year of stopping;
The rate of progression for COPD is drastically slowed once a smoker stops smoking; iv) All improve
Pregnancy and smoking.
a) Fertility issues in i) male smokers, ii) female smokers
b) Prevalence of smoking in mothers at delivery
c) Quitting success in women who learn they are pregnant
d) Effects of smoking in pregnancy
e) Long-term effects on children born to smokers
a) i) reduced sperm count, poor sperm motility, impotence, ii) hormonal changes
b) 10%
c) 25%
d) LBW, prematurity, miscarriage/ stillbirth
e) SIDS, behavioural/learning difficulties, smoking, respiratory problems
Smoking and mental illness
a) Higher in what 4 conditions
b) Cessation has what effect on: i) anxiety, ii) depression
c) Smoking results in increased clearance of what 3 psychiatric drug classes? Due to what? What needs to be done therefore?
d) Also results in higher clearance of what other drugs?
a) anxiety, depression, psychosis, alcohol misuse
b) lower; no effect
c) antidepressants, antipsychotics, anxiolytics; stimulate liver enzyme involved in metabolism (P450?); need higher doses
d) Insulin, theophylline
Nicotine
a) How it works: receptors, areas, addiction mechanism
b) How long does nicotine ‘hit’ take?
c) Nicotine elimination rate
d) Average dose per cigarette? What if smoked as hard as possible?
e) Test for nicotine dependence
a) Nicotine mimics acetylcholine; it attaches itself to ACh receptors in the ventral tegmental area, causing dopamine release in the nucleus accumbens. This process is important in the development and maintenance of addiction (chemical reward system). Social cues (being with smokers; alcohol use) may trigger cravings.
b) A few seconds
c) The concentration falls by half every 90-120 minutes which means that after a night’s sleep most smokers have very little or no nicotine in the body - explains the significance of knowing how long after waking they have their first cigarette in the morning is as a measure of nicotine dependence.
d) 1mg; 6mg if smoked hard. Varies between cigarettes
e) Fagerstrom (FTND)
Nicotine craving and withdrawals
a) Mechanism
b) Social cues that can cause cravings
c) Resisting cravings creates an ____ to smoke
d) Symptoms of withdrawal
e) How long do most withdrawal symptoms last? Which last longer/permanently?
a) Used to high levels of nicotine; when there is no (or less) nicotine dopamine levels drop in the nucleus accumbens causing an ‘abnormal drive state’
b) Being with smokers; alcohol use; being in a situation where they normally smoke
c) Urge
d) Depressed mood; Irritability; Restlessness; Difficulty concentrating; Increased appetite; Weight gain; Cough; Constipation; Mouth ulcers
e) A few weeks; increased appetite and weight gain
Smoking cessation: behavioural support
a) How much more likely to succeed on quitting than those without support?
b) Good behaviour change techniques
c) i) What is a useful monitoring tool? Cutoff? ii) Other biomarker than we can use?
d) What behavioural support method has best evidence of success? Beware of…?
e) Session schedule
a) 4 times
b) Establishing a good rapport; Ensuring realistic expectations of stop smoking medications; Good medication compliance; Ensuring realistic expectations of cravings and withdrawal symptoms; Helping them to change their routine to avoid smoking; Using CO monitoring as a motivational tool; Stressing the importance of the ‘not a puff’ rule and gaining commitment from them; Supporting them through their quit attempt and giving praise for not smoking;
c) Carbon monoxide (hold breath for 15 seconds and expire). Cutoff: 10ppm (in reality, it is rare to see >5ppm in non-smokers); Cotinine (nictonine metabolite in saliva/urine - eliminated more slowly than CO) - may be useful in pregnancy
d) Closed group - with 15+ people; including those who may adversely affect the group dynamic
e) At least six sessions: Once before quitting; Once on the quit day; Once a week for at least four weeks after the quit date
Stop smoking medications
a) 2 most common
b) 1 other
a) NRT, Champix (varenicline)
b) Buproprion
