ABC: a lifesaving intervention for smokers

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ABC a lifesaving intervention for smokers

• Vicki Oldfield and Dorothy Clendon
• Ministry of Health

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The risks of smoking are large

• About half of long term smokers die from a
  smoking-related disease
• On average they lose 15 years of life
• 25 of smokers die in middle age
• Around 5000 smoking-related deaths each year

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The size of the problem
Tobias M, Templeton R, Collings S. Tob Control.
2008 Oct17(5)347-50. Epub 2008 Jul 3
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Cigarette consumption in New Zealand
Tobias M, Templeton R, Collings S. Tob Control.
2008 Oct17(5)347-50. Epub 2008 Jul 3
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Prevalence of smoking and depression
Depressed Patients
General Population
26
44
56
74
Current Smokers
Nonsmokers
Farrell et al. Int Rev Psychiatry. 20031543-49
Mackay et al. The Tobacco Atlas. 2nd ed. 2006.
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Smoking prevalence in nursing staff

• Smoking prevalence in nurses is less than 15,
  but

29 of mental health nurses smoke
ASH-KAN AOTEAROA ASSESSMENT OF SMOKING HISTORY,
KNOWLEDGE AND ATTITUDES OF NURSES IN NEW ZEALAND.
Available online at www.ash.org.nz
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Impacts of Smoking Health Effects

• Psychiatric patients who smoke have
• Higher incidence of illicit drug use
• Poorer treatment compliance
• Lower Global Assessment Functioning (GAF) score
• More hospitalisations
• Higher medication doses

Williams et al. Addict Behav. 2004291067-1083
Dalack et al. Am J Psychiatry. 19981551490-1501
Montoya et al. Am J Addict. 200514(5)441-454.
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Impacts of Smoking - Financial Implications

• Smoking imposes a significant financial burden

Monthly Budget (in a sample of people with
schizophrenia)
Cigarettes
Food, Shelter, Other
Steinberg et al. Tob Control. 200413206-208.
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Stopping smoking works

• There are benefits from quitting at any age
• Smokers who quit before age 35-40 reduce their
  risk of dying early to that of a non-smoker over
  time
• Most smokers want to quit
• 69 of smokers tried to quit in last 5 years
• 44 of smokers tried to quit at least once in the
  last year
• Maori, Pacific and young smokers and those with
  mental illness are just as likely to have tried
  to quit
• NZ Tobacco Use Survey 2006
• There is a gap between current and best practice

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Why Increase Quit Attempts?
Aveyard and West. Managing Smoking Cessation. BMJ
200733537-41
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ABC a simple reminder to provide brief advice
routinely

• New Zealand Smoking Cessation Guidelines
• A Ask whether a person smokes
• B give Brief advice to quit to all people who
  smoke and
• C make an offer of Cessation treatment
  provide and/or refer
• This replaces the 5 As

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Brief Advice

• The key to increasing quit rates is to prompt
  more smokers to make more supported quit attempts
  more often
• Importantly brief advice by health professionals
  is proven to be effective
• NNT 40
• Brief advice is just that brief! It is not a
  counseling session
• The purpose is to prompt a smoker to consider or
  make a quit attempt

Silagy C, Stead LF. Physician advice for smoking
cessation. Cochrane Database Syst Rev
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Cessation Support - Effective treatments

• Pharmacological
• Nicotine replacement therapy
• Varenicline
• Bupropion
• Nortriptyline

• Behavioural
• Telephone support
• - Quitline
• Txt-based support
• Face-to-face support
• - Aukati Kai Paipa
• - Local Cessation Practitioners

• Effective interventions can improve success
  rates by up to 300
• Ministry of Health. New Zealand Smoking
  Cessation Guidelines. 2007

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Is Cessation Safe in the Mentally Ill?

• Anxiety disorders
• No evidence of exacerbation of anxiety disorders.
• Schizophrenia
• Not associated with exacerbation of psychosis.
• Depression
• Mixed evidence regarding exacerbation of
  depressive symptoms.

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Some real life evidence

• In an observational study comparing NRT with
  varenicline
• 412 smokers seeking treatment (111 with mental
  illness) from a UK NHS stop smoking clinic
• Validated short-term quit rates
• Results showed
• Varenicline was superior to NRT
• Varenicline equally effective in mentally ill and
  non-mentally ill persons
• No worsening of mental illness observed.

Stapleton J, et al. Addiction (2007) 103 146-154.
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Supporting ABC in practice

• Making NRT more available
• Increased range and capacity of cessation
  services
• Improving referral systems between
  primary/secondary care and cessation services
• Training in ABC
• Improving data collection and feedback

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• ABC Training

• Training designed for Healthcare Professionals
• www.smokingcessationabc.org.nz
• An internet based, e-learning tool
• 20-40 minutes to complete
• Endorsed by RNZCGP (CME points)
• Printable certificate (for credit towards
  professional development)
• Register as a Quit Card provider

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• Smoking is too big to ignore

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