SMOKING IN WY AND NATIONALLY

Percent Who Smoke

25.0 20.0

Smoking Rates in WY and US, 2011-2014 23.0 21.8 20.6 19.5

21.2

19.6

15.0

19.0

18.1 National

10.0

Wyoming

5.0 0.0 2011

2012

2013

BRFSS, http://www.cdc.gov/brfss/data_tools.htm

2014

SMOKING IN WY Smoking Rates in WY by Sex, 2011-2014 30

Percent

25 20

24.2 21.8

15

24.6

18.9

22.1 19.2

20.7 18.2

Men Women

10 5 0 2011

2012

2013

BRFSS, http://www.cdc.gov/brfss/data_tools.htm

2014

SMOKING AND PREGNANCY Percent of Women Smoking in the Perinatal Period, Wyoming 2007-2013, PRAMS 40

Percent of Women

35 30 25

Last 2 years

20

3 mos prior to pregnancy

15

Last 3 mos of pregnancy

10

3 mos postpartum

5 0 2007

2008

2009

2010 Year

2011

2012

2013

YOUTH AND SMOKING

A NEW CHALLENGE

QUITLINE Quitlines work to help people quit tobacco.

§ The Quitline works : § 30% Quit rate NRT+Counseling § 46% Quit rate Chantix+Counseling § Convenient cessation counseling § Medications provided at no cost – sent directly to patient § Serves populations at their time of need – quitting is impulsive Contracted through National Jewish Health – top respiratory hospital in the nation.

WHAT IS IT? Coaching Program – 5 coaching Sessions (usually 1-2 weeks apart) § Motivational Interviewing FREE Nicotine Replacement Therapy+ Quit Meds § 12 weeks of patches/gum/lozenges § Chantix at no cost (3 months) – with prescription § Wellbutrin at no cost (3 months) – with prescription § Comprehensive Program

§ Phone coaching, materials sent via mail/email, text support+apps, quit meds 24/7 online program available

PREGNANCY PROTOCOL Incentivized Program - $5 Visa pre-paid card per call while pregnant – up to $25 - $10 Visa pre-paid card per call postpartum – up to $40 One on One Coaching Relationship - Female coach Postpartum coaching and support. - MUST be pregnant at time of enrollment– verified by provider. - NRT/Quit meds available (MUST be approved by physician)

Tailored program specifically for the American Indian population - Program offers similar medication options - More counseling sessions which tend to be shorter - Native cessation counselors - Respects traditional/ceremonial tobacco use - differentiates ceremonial tobacco from addictive and harmful commercial tobacco

IS YOUR PATIENT READY? Transtheoretical Model of Behavior Change

MOTIVATIONAL INTERVIEWING Motivational Interviewing (MI) is a client centered, yet directive, method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. A counselor using an MI style expresses empathy, develops discrepancy, reduces resistance and supports client self-esteem.

MOTIVATIONAL INTERVIEWING IS… •

Collaborative - equal power relationship between patient and provider. Vital in behavior change as the patient is ultimately responsible for their change.

•

Evocative - understand the patient’s perspective, their needs, and their experiences. You are not there to give them what they need

•

Honors Patient Autonomy - Providers may inform, warn, advise the patient, but ultimately it is their own journey.

4 GUIDING PRINCIPLES OF MI 1. Resist the “Righting Reflex”: Don’t get power hungry in your position of knowledge, rather than telling the patient what to do, consider exploring their history of tobacco use. 2. Understand your patient’s motivations: Why do they wish to quit, or not quit? What have they tried/how were they successful/where did they go wrong? 3. Listen to your patient: show empathetic interest in the patient and their experiences, reflect on their experience. 4. Empower your patient: Provide assistance, information if the patient is interested, ask every time about their progress.

BEING A GOOD GUIDE •

ASK where the person wants to go, wants to do, previous quit attempts, what the benefits of quitting would be, and get to know the persons motivation.

•

INFORM the person of their options, offer assistance, explain what help is available.

•

LISTEN to what the person wants to do, respect autonomy and offer help accordingly.

OARS •

Open-ended questions – give patients flexibility with what they share, patients may elaborate on what they say further.

•

Affirmations – build rapport with patient. Avoid being judgmental or critical of patient.

•

Reflective listening – reflect back what the patient has told you. Shows patient you are listening and that you are understanding where they come from.

•

Summaries – shows you were tuned in, allows for clarification from the patient, and allows for further discovery from the patient.

WHAT CAN YOU DO AS PROVIDERS? *Saying “you need to quit” doesn’t help!

Ask patient if they smoke § Ask why they smoke and if they want to quit.

Advise of the health risks, issues with their health. § How does smoking impact their condition?

Refer to get help to quit § Provide information or fax/e-refer to quitline

NICOTINE REPLACEMENT THERAPY - PATCH •

24 hour patch

•

3 steps (21mg, 14mg, 7mg)

•

1 patch per day, not recommended to smoke on the patch

•

Can be used in conjunction with gum, lozenge, buproprion

NICOTINE REPLACEMENT THERAPY - GUM •

2mg and 4mg gum available

•

Recommended to use on a schedule, not as needed

•

Slow chew, then tuck in between cheek and gum

•

Some people can get addicted

NICOTINE REPLACEMENT THERAPY - LOZENGE •

2mg and 4mg available

•

Ideal for people who have dentures

•

Use on a schedule

•

Tuck between cheek and gum

•

Addiction possible

NICOTINE REPLACEMENT THERAPY - OTHER Nasal spray and Inhaler – both require prescription

OTHER PRESCRIPTION DRUGS

FAX REFERRAL - PROVIDER

FAX REFERRAL - PATIENT

E-REFERRAL

CONTACT INFO Feel Free to contact me for WQTP questions, paper referral forms/brochures [email protected]