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Freshstart Facilitator Training

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Title: Freshstart Facilitator Training


1
Freshstart Facilitator Training
2
Freshstart History of Tobacco Control
  • Nicotiana tabacum - native to the Western
    Hemisphere and was unknown to Europeans prior the
    voyage of discovery. Native Americans used
    tobacco in their culture for religious and for
    recreational purposes. In many other cultures,
    tobacco was used by shamans and was reserved for
    ritual use.
  • Tobacco was introduced to France in 1556,
    Portugal in 1558, and Spain in 1559, and England
    in 1565.
  • The first successful commercial crop was
    cultivated in Virginia in 1612 by Englishman John
    Rolfe. Within seven years, it was the colony's
    largest export.

3
Freshstart
  • The Virginia Colonies in North America developed
    around a tobacco economy in the early 17th
    century. Tobacco was exported to Europe for pipe
    smoking and stuff, while cigars came for the
    Spanish colonies. Tobacco was used as an exchange
    medium in this era.
  • At first, tobacco was produced mainly for
    pipe-smoking, chewing, and snuff. Cigars didn't
    become popular until the early 1800s. Cigarettes,
    which had been around in crude form since the
    early 1600s, didn't become widely popular in the
    United States until after the Civil War, with the
    spread of "Bright" tobacco, a uniquely cured
    yellow leaf grown in Virginia and North Carolina.

 
4
Freshstart Mass Production of Tobacco
  • Cigarette sales surged again with the
    introduction of the "White Burley" tobacco leaf
    and the invention of the first practical
    cigarette-making machine, sponsored by tobacco
    baron James Buchanan "Buck" Duke, in the late
    1880s.
  • James Bonsack invented the cigarette making
    machine in 1881 that could make 120, 000
    cigarettes in a day. Bonsack went into business
    with Buck Duke and they built a factory. They
    made 10 million cigarettes the first year and
    about 1 billion 5 years later.

 
5
Freshstart Research Begins
  • In the May 27, 1950 issue of JAMA, Morton Levy
    published the first major study definitively
    linking smoking to lung cancer.
  • In the same issue, "Tobacco Smoking as a
    Possible Etiologic Factor in Bronchiogenic
    Carcinoma A Study of 684 Proved Cases," by Ernst
    L. Wynder and Evarts A. Graham of the United
    States, found that 96.5 of lung cancer patients
    interviewed were moderate heavy-to-chain-smokers.
  • 1950 RICHARD DOLL and A BRADFORD HILL publish
    first report on Smoking and Carcinoma of the Lung
    in the British Medical Journal, finding that
    heavy smokers were fifty times as likely as
    nonsmokers to contract lung cancer.

 
.
6
Freshstart Smoking and Cancer
  • In 1964, Luther Terry, M.D., released the report
    of the Surgeon General's Advisory Committee on
    Smoking and Health. That landmark document, now
    referred to as the first Surgeon General's Report
    on Smoking and Health, was America's first widely
    publicized official recognition that cigarette
    smoking is a cause of cancer and other serious
    diseases.
  • The 1964 report on smoking and health had an
    huge impact on public attitudes and policy. A
    Gallup Survey conducted in 1958 found that only
    44 percent of Americans believed smoking caused
    cancer, while 78 percent believed so by 1968.

 
7
Freshstart Public Health Interventions
  • In 1965, Congress required all cigarette packages
    distributed in the United States to carry a
    health warning, and since 1970 this warning is
    made in the name of the Surgeon General. In 1969,
    cigarette advertising on television and radio was
    banned, effective September 1970.
  • Cigarette sales in the U.S. have fallen by more
    than 21 since the state Attorneys General
    negotiated the landmark 1998 tobacco Master
    Settlement Agreement (MSA), which imposed public
    health restrictions on the advertising, promotion
    and marketing of cigarettes by tobacco companies.

 
8
Freshstart Review and Discussion (III)
  • Review Material
  • Questions?

 
9
Freshstart Comprehensive Tobacco Control
  • Preventing the initiation of tobacco use among
    young people.
  • Promoting quitting among young people and
    adults.
  • Eliminating nonsmokers exposure to
    environmental tobacco smoke (ETS).
  • Identifying and eliminating the disparities
    related to tobacco use and its effects among
    different population groups.

CDC Best Practices for Comprehensive
TobaccoControl Programs, August 1999
 
10
Freshstart ACS and Tobacco Control
  • RESEARCH and EPIDEMIOLOGY
  • The American Cancer Society is the largest source
    of private, not-for-profit cancer research funds
    in the US, second only to the federal government
    in total dollars spent. In 2004, the Society
    spent nearly 131 million in research. Since
    1946, the Society has invested more than 2.8
    billion in cancer research.
  • Internationally, the department collaborates with
    the World Health Organization to publish tobacco
    control country profiles, plus a monograph on
    tobacco consumption, production, and trade in 197
    countries.

 
11
Freshstart ACS and Tobacco Control
  • COMMUNITY PROGRAMS and SERVICES
  • The American Cancer Society works collaboratively
    with our national partners to implement
    comprehensive tobacco control programs. The
    Society advocates for social environmental change
    at the national, state, and community levels that
    prevents young people from starting to use
    tobacco and provides support for those who wish
    to stop smoking.
  • The Society has joined other health, education,
    and social service agencies to promote
    comprehensive school health education and
    National School Health Education Standards.

 
12
Freshstart ACS and Tobacco Control
  • ADVOCACY
  • Grassroots action, direct lobbying, and applied
    policy analysis work to influence policy, laws,
    and regulations affecting the Society's
    nationwide priorities and 2015 goals.
  • Enhance or ensure the role of the US Food and
    Drug Administration in regulating tobacco
    products
  • Ensure funds derived from the 1998 multi-state
    tobacco settlement are at least partially
    obligated toward tobacco prevention and cessation
    programs
  • Enact smoke-free ordinances at the local and
    state level to ensure all workers are protected
    from secondhand smoke exposure in their place of
    employment

 
13
Freshstart ACS Tobacco Milestones
  • 1954 The Society's Hammond-Horn study shows the
    first link between smoking and lung cancer.
  • 1959 The Society's Cancer Prevention Study I (CPS
    I) begins, which shows that cigarette smoking
    leads to early death from lung cancer.
  • 1960 The Society takes a leading role in
    challenging and eliminating tobacco advertising.
  • 1970 The Surgeon General concurs with the
    findings of Society research irrefutably linking
    cigarette smoking to cancer.
  • 1977 The Society's first annual Great American
    Smokeout publicizes the dangers of smoking with
    the media and the general public.
  • 1982 Freshstart program is developed and
    implemented nationwide.

 
14
Freshstart ACS Tobacco Milestones
  • 1982 The Society joins with the American Heart
    Association and American Lung Association to form
    the Coalition on Smoking or Health to advocate
    for federal tobacco control policy.
  • 1982 The Society launches Cancer Prevention
    Study II (CPS II) of 1.2 million volunteers to
    determine risk factors for cancer mortality. To
    date, the study has demonstrated that secondhand
    smoke increases mortality from lung cancer and
    heart disease.
  • 1990 The Society pushes legislation for clean
    indoor air acts in local communities, tobacco
    taxation, and elimination tobacco industry
    advertising targeting children.
  • 1990 At the 7th World Conference on Tobacco or
    Health in Perth, Australia, Society
    representatives launch the "Trade for Life"
    program to fight the aggressive marketing of
    cigarettes in developing countries.

 
15
Freshstart ACS Tobacco Milestones
  • 1991 Society-funded research shows that young
    children recognize Joe Camel as easily as Mickey
    Mouse, demonstrating that the cartoon character
    reaches an audience well under the legal smoking
    age
  • 1991 The American Stop Smoking Intervention Study
    for Cancer Prevention (ASSIST) Program launches.
    This is the world's largest demonstration project
    for tobacco control and is a joint effort between
    the National Cancer Institute (NCI) and the
    Society.
  • 1993 The US Environmental Protection Agency
    classifies environmental tobacco smoke as a Group
    A (known human) carcinogen
  • 1994 The Society asks the FDA to reconsider
    regulation of tobacco products and prompts
    congressional hearings.

 
16
Freshstart ACS Tobacco Milestones
  • 1999 Through Operation Settle Up, the Society
    helps secure nearly 300 million in settlement
    money earmarked for state tobacco prevention and
    control programs.
  • 2000 Society epidemiologists prove that long-term
    cigarette smoking is associated with increased
    risk of death from colon cancer.
  • 2000 ACS launches clinical trial in Texas for
    Quitline. By 2005, Quitline has served over
    190,000 callers.
  • 2005 ACS targets lung cancer for 2015
    goals -reduce incidence of cancer by
    25 -reduce mortality by 50 -increase quality
    of life for survivors

 
17
Freshstart Nicotine and Its Effects
  • As a stimulant - immediately after exposure to
    nicotine, there is a "kick" caused in part by the
    drug's stimulation of the adrenal glands and
    resulting discharge of epinephrine (adrenaline).
    The rush of adrenaline stimulates the body and
    causes a sudden release of glucose as well as an
    increase in blood pressure, respiration, and
    heart rate.
  • Nicotine also suppresses insulin output from the
    pancreas, which means that smokers are always
    slightly hyperglycemic.
  • In addition, nicotine indirectly causes a
    release of dopamine in the brain regions that
    control pleasure and motivation.
  • In contrast, nicotine can also exert a sedative
    effect, depending on the level of the smoker's
    nervous system arousal and the dose of nicotine
    taken.

18
Freshstart
  • Can effect the way medications are metabolized
    important to tell physician about quit if taking
    medications
  • May be masking depression, anxiety or other
    mental health condition
  • Tobacco dependence is a true addiction with a
    clear neurophysiological components
  • Pharmacotherapy allows quitter to focus on
    behavioral and psychological aspects of quitting
  • People using NRT are 1.5 2 times more likely
    to successfully quit than are those using
    placebo

 
19
Freshstart Foundations of Tobacco Cessation
  • US Public Health Services Clinical Practice
    Guidelines Treating Tobacco Use and Dependence
  • Identifies effective, experimentally validated
    tobacco dependence treatment and practices using
    meta-analysis
  • Additionally, ACS programs integrate counseling
    strategies identified as effective in treating
    addiction

 
20
Freshstart Intensive Treatment Findings
  • There is a strong dose relationship between
    counseling intensity and cessation success and
    effectiveness increases with treatment intensity.
    (sessions longer than 10 minutes with 4 or more
    sessions)
  • Involving multiple types of providers may
    enhance abstinence rates.
  • Proactive telephone counseling, individual and
    group counseling are equally effective.

 
21
Freshstart
  • Particular types of counseling and behavioral
    therapies are especially effective. Should
    involve problem solving/skill training and
    intra-treatment and extra-treatment social
    support.
  • Pharmacotherapies such as bupropion SR or
    nicotine replacement therapies increase
    abstinence rates. Use should be encouraged for
    all quitters, with a few special circumstances.
  • Tobacco dependence treatments are effective
    across diverse populations (gender, age,
    ethnicity).

 
22
Freshstart Choosing a Cessation Program
Freshstart Choice of quitting strategies Enhanced social support Connection to community Quit with a friend/partner May work better for hardcore quitters Quitline Confidentiality Specific quitting program Convenience Support from counselor Can start any time
 
23
Freshstart How People Change
  • Stages of Change - Prochaska DiClemente

 
24
Freshstart Stages of Change
  • Precontemplation I have no interest in
    changing
  • Contemplation I want to change, but I really
    like the way things are.
  • Preparation I am ready to change.
  • Action I have changed.
  • Maintenance I have changed and am continuing
    the change.
  • Relapse can occur at any time or any stage.

 
25
Freshstart Ambivalence
  • Heart of the change process
  • Occurs throughout the stages of change
  • Ignoring ambivalence leads to resistance and
    failure

 
26
Freshstart Decisional Balance
  • Increases motivation by identifying barriers to
    problem-solve



Advantages of Tobacco
Advantages of Quitting (What are the
benefits of smoking?) (What are the benefits
of quitting?)
Disadvantages of Tobacco
Disadvantages of Quitting (What are
the negative consequences (What are the
negative consequences of smoking?)
of quitting?)
 
27
Freshstart Supporting Change
  • Active listening and empathy
  • Normalizing ambivalence
  • Encouraging participants to find their own
    solutions
  • Supporting hope and ability to change
  • Offering choices and information
  • Teaching problem solving and coping mechanisms

 
28
Freshstart The program in detail.
29
Freshstart Qualities of a Facilitator
  • You have what it takes!
  • You are committed to the maintenance of health
    through good self-care.
  • You believe it is important that individuals stop
    smoking.
  • You enjoy working with groups.
  • You are empathetic, perceptive, and have a good
    sense of humor.
  • You have the ability to speak in a direct, simple
    manner.

30
Freshstart Qualifications of a Facilitator
  • A non-smoker
  • An ex-smoker (off cigarettes for more than six
    months)
  • Has group facilitation skills
  • Is an advocate for smoking cessation
  • Is objective
  • Will understand the goals of Freshstart
  • Will accept the time commitment to lead the
    Freshstart program within your organization from
    start to finish
  • Is empathetic, fair, and has good communication
    skills

31
Freshstart How It Works
  • Four one-hour group sessions that take place
    twice a week for two weeks.
  • Freshstart is flexible
  • You may offer longer sessions
  • You may conduct the programs over four weeks
  • KEY Freshstart content must always be presented

32
Freshstart Program Materials
  • Freshstart Facilitator Training PowerPoint
  • Freshstart Four Session Training PowerPoint
  • Freshstart Facilitator Guide
  • Freshstart Participant Guide
  • Freshstart Program Brochures
  • Index cards 3½ x 5

Indicates materials needed for each Freshstart
session
33
Freshstart Additional Materials
  • Information and statistics may be obtained from
    the Society Web site www.cancer.org
  • Cancer Facts and Figures 2006
  • Cancer Prevention and Early Detection 2006
  • American Cancer Society print materials related
    to tobacco use can be ordered by calling
    1-800-ACS-2345
  • When Smokers Quit
  • Set Yourself Free A Smokers Guide
  • Smart Move

34
Freshstart Facilitator Responsibilities
  • See that all participants are involved in the
    Freshstart process
  • Be able to summarize the program content
  • Be familiar with the Participants Guide as well
    as the Facilitators Guide
  • Begin and end sessions on time
  • Keep a record of participants progress
  • Report number of participants who attend the
    Freshstart program (Freshstart Reporting Excel
    Spreadsheet)
  • Encourage and support participants

35
Freshstart Your Role as a Facilitator
  • You are not a lecturer.
  • You are NOT expected to be an expert on all
    aspects of smoking.

36
Freshstart General Session Format
  • Phase One Individual attention
  • Phase Two Strategies and Information
  • Phase Three Review and Discussion
  • Phase Four Assignments

37
Freshstart Phase I Individual Attention
  • 15 20 minutes in length
  • Personal Introductions (Session One)
  • Questions / Sharing of experiences (Session Two
    Four)

38
Freshstart Phase II Strategies and Information
  • 15 20 minutes
  • Content addresses session objective(s)
  • Questions at this time should be for
    clarification only (discussion will follow)

39
Freshstart Phase III Review and Discussion
  • 15 20 minutes
  • Brief review of materials covered
  • Discussion of content presented
  • Encourage participants to share ideas and
    experiences

40
Freshstart Phase IV Assignments
  • 5 minutes
  • Tell participants which section of their
    Freshstart Guide to read prior to the next group
    session.
  • Call attention to the individual goals
    participants have set for themselves
  • Quit date
  • Approach to quitting

41
Freshstart Program Content
  • BASIC REMINDERS
  • Be familiar with the Facilitators Guide and the
    Participants Guide.
  • Do not announce the beginning of each phase

42
Freshstart Session One
  • Welcome participants/Facilitator introduction
  • Introduce/explain the Freshstart Program
  • Distribute Participant Guides
  • Discuss Nicotine Dependence and Addiction
    Psychological Reasons for Smoking
  • Quitting Reminders

43
Freshstart Individual Attention (I)
  • Participant Introductions Four Questions
  • What benefits do you hope to achieve from
    quitting?
  • What triggers your desire to smoke?
  • What motivated you to come today?
  • What is the average number of cigarettes you
    smoked up to this session?

Review session one objectives
44
Freshstart Strategies and Information (I)
  • Fears of Quitting Tobacco
  • Approaches to Quitting
  • - Cold Turkey
  • - Gradual (tapering vs. postponing)
  • - The Quitline
  • - Nicotine Replacement Therapy (NRT)
  • Physiological Effects of Smoking
  • Physical Effects of Smoking

45
Freshstart Review and Discussion (I)
  • Review Material
  • Questions?
  • Making This Attempt Your Last

46
Freshstart Assignments (I)
  • Set a Quit Date!
  • www.cancer.org What approach is better for
    you?
  • Review Session One

47
Freshstart Individual Attention (II)
  • Questions from session one
  • Personal experiences to share
  • Session Two Objective

48
Freshstart Strategies and Information (II)
  • Withdrawal Symptoms
  • Fighting Withdrawal Symptoms
  • Being Assertive
  • Thinking Positively
  • Making This Time Unique

49
Freshstart Review and Discussion (II)
  • Review Material
  • Questions?

50
Freshstart Assignments (II)
  • Keep individual Quit Date
  • Review Session Two start using relaxation
    exercises
  • Four Practical Tips
  • Complete Assertiveness Chart at home

51
Freshstart Individual Attention (III)
  • Questions from Session Two
  • Share personal experiences
  • Session Three Objective

52
Freshstart Strategies and Information (III)
  • Physical Improvements Following Cessation
  • Weight Gain
  • Alcohol
  • Interpersonal Support

53
Freshstart Review and Discussion (III)
  • Review Material
  • Questions?

 
54
Freshstart Assignments (III)
  • Review Session Three continue using relaxation
    exercises
  • Four Practical Tips

55
Freshstart Individual Attention (IV)
  • Questions from Session Three
  • Share personal experiences
  • Session Four Objective

56
Freshstart Strategies and Information (IV)
  • Ripple Benefits of Smoking
  • How to Avoid Returning to Smoking
  • Long-term Benefits
  • What If You Still Havent Quit or You Have a
    Relapse?

57
Freshstart Review and Discussion (IV)
  • Review Material
  • Questions?

58
Freshstart Assignments (IV)
  • Exchanging phone numbers
  • Review all sessions of the Freshstart program,
    including Additional Tips to Help You Remain
    Smoke Free
  • Contact American Cancer Society 1-800-ACS-2345

59
Freshstart Additional Materials
  • Freshstart Reporting Sheets
  • Freshstart Facilitator Training
  • Freshstart Cessation Program
  • Ordering Materials for Freshstart sessions

60
Thank you!
Questions acsworkplacesolutions_at_cancer.org
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