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Chronic Conditions - Excessive Tobacco Use

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Kate Booth

on 3 March 2015

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Transcript of Chronic Conditions - Excessive Tobacco Use

Tobacco Use

What is excessive tobacco exposure?
How is it defined?
In the Western world:
Tobacco responsible for the most preventable deaths
(Healey 2011)

In Australia:
2010 - 16.4% of males and 13.9% of females >14 years daily smokers
(AIHW 2011)
Tobacco basics:
No tobacco exposure is safe
(Australian Drug Foundation 2012)

Environmental Tobacco Smoke (ETS) remains as a serious issue
(Vineis et al. 2007)
What is in a cigarette?
What level of tobacco exposure is safe?
What defines excessive tobacco use?
Very low to Low nicotine dependency:
First cigarette comes within 30 minutes of waking
>10 cigarettes smoked a day
Have a history of withdrawal
(Lifescripts 2012)

Moderate to high nicotine dependency:
All of the above, plus
First cigarette of day most important of the day
>25 cigarettes smoked a day
(Lifescripts 2012)
What defines nicotine dependence and a high dependence?
Tobacco use:
Defined by nicotine dependence
(Lifescripts 2012)
Nicotine dependence cannot be defined by a single measure - dependence is different for everyone
(Fidler et al. 2011)
There are over 4000 chemicals in cigarettes, 60 carcinogenic
Three main chemicals:
Carbon monoxide
(Australian Drug Foundation 2012)
In Australia:
Tobacco is responsible for 7.8% of the burden of disease
2004-2005 - Cost of tobacco approximately $AU 12.0 billion
(AIHW 2011)
Tobacco basics:
How is excessive tobacco use measured?
To which chronic conditions is excessive tobacco use related?
Many chronic conditions have been shown by studies to be linked to tobacco usage
Both active and passive/ETS smoking responsible
(Vineis et al. 2007)
Chronic conditions:
Chronic Obstructive Pulmonary Disease (COPD)
(Baena-Cagnani et al. 2009)
Respiratory conditions:
(AIHW 2012)
Cardiovascular disease
Coronary heart disease
Ischemic stroke
Hemorragic stroke (Cerebrovascular disease)
Increased blood pressure
(Risk Factors for Coronary
Heart Disease 2011)
(Appel and Llinlas 2009)
Cardiovascular conditions:
Smoking increases risk of developing osteoporosis
(Clinical Review: Osteoporosis 2012)

Risk increased with alcohol consumption
(Lin et al. 2012)

Many studies have found links between tobacco smoking and alcohol consumption
(Henemyre et al. 2003)
Osteoporosis and links:
What role might a physio-
therapist have in the management of tobacco use?
What strategies exist for the management of excessive tobacco use? What is the evidence for these strategies?
Strategies for Management of Tobacco Use:
Strategies for Management of Tobacco Use:
Smoke free policies decrease ETS (second hand smoking)
(Pierce, Leon 2008)
South Australia Law 31 May 2007
$200 fine
(Tobacco in Australia 2012)
Strategies for Management of Tobacco Use:
Media campaigns reduce youth taking up smoking
(Brinn et al. 1998)
Longer education decreases smoking
(Zhu et al. 1996)
Strategies for Management of Tobacco Use:
Where in the continuum of care is assessment of the risk factor appropriate?
The Continuum of care relates to the assessment of tobacco use over a person’s whole life and the effect it has on the development of chronic disease.
Continuum of Care:
Higher prevalence of common diseases such as COPD
(Yanbaeva et al. 2007)
smoking 1 to 4 cigarettes per day increased chances of dying from specified smoking related diseases
(Bjartveit and Tverdal 2005)
Even light smoking increases the risk of chronic conditions
Adolescent tobacco use:
Adult long life tobacco users:
Starting smoking before 21 makes it harder to quit
(Healey 2006)
Long term smokers start in their teenage years and are addicted to nicotine
(Healey 2006)
Teenagers are quite impressionable, so importance of continuum of care is evident here
Teen smokers:
Leads to increased risk of lung cancer, stroke and heart disease
(WHO 2012)
Decreased lung capacity
Decreased rate of lung growth
Experience shortness of breath reduced physical fitness
(Tobacco in Australia 2011)
Alters the heart development
Increased risk of developing chronic excess weight problems
Substantial delays in early neurological development
(Sowan and Stember 2000)
Tobacco use during pregnancy:
What resources exist which help support the management of the risks associated with excessive tobacco exposure?
Cancer Council and the Heart Foundation
Aims to create a society free from the harm caused by tobacco
(Quit SA 2012)
Quit SA:
QuitSA Website/Twitter/ Facebook:
Increase the price of tobacco products
(Tobacco in Australia 2012)
Increased exposure to anti-tobacco advertisement
Pro-tobacco advertising increases youth usage
(Brownson and Wegner 2010)
Interactive Seminars:
24 hour free telephone counseling service
For the Younger Generation:
Kick It:
Quitting in the workplace
The Tobacco and Mental Illness Project
Smarter than Smoking SA
Kick It
•AIHW, 2011, 2010 National Drug Strategy Household Survey report, Drug statistics series no. 25, retrieved 12 August 2012, <http://www.aihw.gov.au/publication-detail/?id=32212254712&libID=32212254712>
•AIHW, 2012, Chronic Disease Determinants, retrieved 12 August 2012, <http://www.aihw.gov.au/chronic-disease-determinants/>
•AIHW, 2012, Risk Factors, retrieved 8 August 2012, <http://www.aihw.gov.au/risk-factors-health-priority-areas/#Tobacco%20smoking>
•AIHW, 2012, Tobacco Smoking, retrieved 12 August 2012, <http://www.aihw.gov.au/risk-factors-tobacco-smoking/>
•Appel, L., & Llinas, R., 2009, 'Risk Factors for a Stroke', Hypertension & Stroke, pp. 43-50, viewed 8 August 2012.
•Australian Drug Foundation, 2012, Tobacco Facts, Victoria, viewed 8 August 2012, <http://www.druginfo.adf.org.au/drug-facts/tobacco>
•Australian Physiotherapy Association 2011, Plain tobacco packaging will support smoking cessation, media release, Australian Physiotherapy Association, Victoria, 26 August, viewed 12 August 2012, <http://physiotherapy.asn.au/images/Document_Library/Media_Releases/2011/110825%20plain%20tobacco%20packaging.pdf>.
•Baena-Cagnani et al. 2009, 'Impact of environmental tobacco smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis', Current Opinion In Allergy & Clinical Immunology, vol. 9, no. 2, pp. 136-140, viewed 12 August 2012.
Bjartveit,K, Tverdal, A 2005, ‘Health consequences of smoking 1–4 cigarettes per day’, Tobacco Control, vol. 14, no. 5.
Brinn et al. 1998 Mass media interventions for preventing smoking in young people. Cochran Database of Systematic Reviews, Art no. CD004704. <http://www.ncbi.nlm.nih.gov/pubmed/18254058>
The Cancer Council 2012, Measures of Dependence, Victoria, viewed 12 August 2012, <http://www.tobaccoinaustralia.org.au/6-5measures-of-dependence>
The Cancer Council 2012, Role of general practice and other health professional settings, Victoria, viewed 12 August 2012, <http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-10-role-of-general-practice-and-other-health-pro>
Clinical Review: Osteoporosis, 2012, GP: General Practitioner, pp. 33, viewed 8 August 2012.
Ferretter I, Supporting smoking cessation: a guide for health professionals, The Royal Australian College of General Practitioners, Australia, Melbourne.
Fidler et al. 2011, 'Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerström Test for Nicotine Dependence and its components', Addiction, vol. 106, no. 3, pp. 631-638, viewed 14 August 2012.
Healey, J 2006, Issues in Society: Tobacco Use, The Spinney Press, Thirroul, NSW, Australia.
Henemyre et al. 2003, ‘Nicotine Stimulates Osteoclast Resorption in a Porcine Marrow Cell Model’, Journal of Periodontology, vol. 74, no. 10, pp. 1440-1446, viewed 12 August 2012.
Kick It, 2011 Kick It, <http://kickit.quitsa.org.au/aspx/web-links.aspx> viewed on 10 August 2012
Lifescripts, 2012, Lifescripts mythology card: smoking, retrieved 14 August 2012, <http://www.health.gov.au/internet/main/publishing.nsf/Content/lifescripts-gen-methsmo>
Lin et al. 2012, 'Neighbourhood matters: Perceptions of neighbourhood cohesiveness and associations with alcohol, cannabis and tobacco use', Drug & Alcohol Review, vol. 31, no. 4, pp. 402-412, viewed 12 August 2012.
OxyGen (2012) Australian Government, <http://www.oxygen.org.au/> accessed 12 August 2012
Pierce, J, Leon, M, 2008, ‘Effectiveness of smoke-free policies’, The Lancet Oncology, vol. 9, no. 9, pp. 614-615.
Quit SA Facebook, <https://www.facebook.com/quitsa>, accessed 12 August 2012.
Quit SA twitter, <https://twitter.com/QuitSA1/>, accessed 12 August 2012
Quit SA, 2012 Quit SA, Adelaide viewed on 12 August 2012 <http://www.quitsa.org.au/aspx/quit_sa_programs.aspx>
Quit SA, Addiction Questionnaire, South Australia, viewed 23 August 2012, <http://www.quitsa.org.au/aspx/addiction_questionnaire.aspx>
Remington et al. 2010, Chronic Disease Epidemiology and Control, 3rd edn, American Public Health Association, Washington.
Richmond et al. 1993, ‘One year evaluation of three smoking cessation interventions administered by general practitioners’, US National Library of Medicine, vol. 18, no. 2, pp. 99-187.
Risk Factors for Coronary Heart Disease 2011, Coronary Heart Disease, pp. 5-18, viewed 8 August 2012.
Sowan, N, Stember, M 2000 “Effect of Maternal Prenatal Smoking on Infant Growth and Development of Obesity” The Journal of Perinatal Education, viewed 10th August 2012 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595035/>
Tobacco in Australia 2011, Health effects for younger smokers, Viewed August 12th 2012 <http://www.tobaccoinaustralia.org.au/chapter-3-health-effects/3-21-health-effects-for-younger-smokers>
Tobacco in Australia 2012, Tobacco in Australia: facts and issues a comprehensive online resource, Cancer Council, viewed 23 August 2012, <http://www.tobaccoinaustralia.org.au/>
Tobacco in Australia 2012, Tobacco in Australia: legislation, viewed 23 August 2012, < http://www.tobaccoinaustralia.org.au/15-7-legislation>
Vineis et al. 2007, 'Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study', Environmental Health: A Global Access Science Source, vol. 6, p. 7, viewed 8 August 2012.
World Health Organisation (2012), “Health effects of smoking among young people” viewed 11th August 2012 <http://www.who.int/tobacco/research/youth/health_effects/en/>
Yanbaeva et al. 2007 “The Systemic effects of smoking“ American College of Chest Physicians, accessed on 10th August 2012 <http://journal.publications.chestnet.org/article.aspx?articleid=1085097>
Zhu et al. 1996, ‘The relationship between cigarette smoking and education revisited: implications of categorized persons’ educational status’, American Journal of Public Health, vol. 86, no. 11, pp. 1582-1589.
Zwar et al. 2011, ‘Supporting smoking cessation: a guide for health professionals, The Royal Australian College of General Practitioners, pp. 1- 80.
National President of the Australian Physiotherapy Association states:

“As front-line health professionals physiotherapists are acutely aware of the importance of smoking cessation and reducing exposure to tobacco smoke. Physiotherapists often treat conditions that stem from the effects of smoking, such as emphysema, chronic obstructive pulmonary disease and lung cancer”
(APA 2011)
A guide for health professionals in support of smoking cessation
(RACGP 2011)

Management tailored to patients current needs and preferences

Referral to Quit SA, General Practitioner (GP) or Tobacco Treatment Specialist for Counselling, Medication and/or Pharmacotherapy such as Nicotine Replacement Therapy (NRT)
(RACGP 2011)
Managing tobacco use:
Products Available:
Electronic Cigarettes
Nasal Sprays
(RACGP 2011)
Nicotine replacement therapy (NRT):
Measured as ‘Level of Nicotine Dependence’
(Cancer Council 2012)

Measuring Tools:

‘Fagerstrom’ Test for Nicotine Dependence
(Quit SA 2012)

‘Lifescripts’ Smoking Assessment Form
(Cancer Council 2012)

Ideal for clinical use in regards to time taken to complete and cost of printing
Measuring tobacco
5 to 6 objective questions
Answers converted to a score on a number scale
Position on number scale determines ‘Level of Nicotine Dependence’
Recorded as Very Low, Low, Moderate or High Dependence
(Cancer Council 2012)
About the surveys:
(Cignature 2012)
(My No Smoking 2012)
A.D.A.M (2012)
A.D.A.M (2012)
Anatomy Box (2012)
A.D.A.M (2012)
Tobacco in Australia (2007)
Zhu et al. (1993)
Tobacco in Austral (2012)
Australian National Preventative Health Agency (2011)
QuitSA (2012)
QuitSA (2012)
Quitline (2012)
Quit (2012)
MyQuitCOACH (2012)
Smarter Than Smoking (2012)
Kick It (2012)
What role might a physiotherapist have in the assessment of excessive tobacco use?
5 A’s (strong evidence)
Arrange follow up
(Zwar et al. 2011)
How Can a Physiotherapist Assess Tobacco Use of a Patient?
Not ready to quit
Unsure if they are ready to quit
Ready to quit
Level l, strength A
Non-confrontational advise to quit
Explain benefits
Easy to understand for uneducated person
Make it personal
Level lll, strength C
Are they ready to quit or do they need more assistance?
Nicotine dependence
Lifescript, helps decide when to quit through a plan by health professional (Lifescripts 2011)
Level ll, strength A
Identifying smoking status
Questions asked e.g. “Are you a smoker?”
Level l, strength A
Discuss progress
What works/what didn’t work
Coping strategies
Arrange Follow Up:
Lifescripts (2011)
Lifescripts (2011)
Lifescripts (2011)
Lifescripts (2011)
Lifescripts (2011)
Lifescripts (2011)
Full transcript