TOBACCO CESSATION

CONTENT:- INTRODUCTION TOBACCO USE IN INDIA ILL EFFECTS OF TOBACCO PRIMARY PHYSIOLOGIC EFFECT OF NICOTINE BENEFITS OF TOBACCO CESSATION SMOKING CESSATION

INTERVENTIONS

CLINICAL PRACTICE GUIDLINE FOR CESSATION MANAGEMENT

INTRODUCTION CESSATION, DERRIVED FROM A LATIN WORD TO

CEASE MEANS TO STOP OR BRING TO END

TOBACCO USE IS ONE OF THE GREATEST GLOBAL PUBLIC HEALTH CHALLENGE.

IT IS INTERESTING TO KNOW THAT WORLD WIDE 4.9 MILLION PEOPLE WILL DIE PREMATUARELY DUE TO TOBACCO RELATED DISEASE, AND ALSO CAUSES $157 BILLION LOSS ANNUALLY.

TOTAL GLOBAL SMOKING PREVALENCE IS 29% BY GENDER, 47.5% OF MALE & 10.3% OF WOMEN SMOKES.

TOBACCO USE IN INDIATODAY, INDIA IS THE BIGGEST TOBACCO MARKET IN THE

WORLD RANKING THIRD IN TOTAL TOBACCO CONSUMPTION.

IN INDIA,IT IS ESTIMATED THAT THERE ARE MORE THAN 250 MILLION TOBACCO USERS OUT OF WHICH ABOUT 8,00,000 DIE EVERY YEAR DUE TO TOBACCO RELATED ILLNESS.

ABOUT 19 PERSONS PER LAC HAVING ORAL CANCER.

ILL EFFECTS OF TOBACCO SMOKING TOBACCO CAUSES CHRONIC LUNG AND

HEART DISEASES, AND CANCERS OF THE LUNG, ESOPHAGUS, LARYNX, MOUTH, AND BLADDDER.

SMOKING ALSO CONTRIBUTES TO CANCERS OF THE PANCREAS, KIDNEY, AND CERVIX.

SMOKELESS TOBACCO CAN LEAD TO ORAL CANCERS ESPECIALLY OF LIP, TONGUE, MOUTH, GINGIVA & THROAT AND CONTRIBUTES TO PERIODONTITIS AND TEETH LOSS.

IF YOU ARE A SMOKER THEN YOU CAN BE ONE OF THEM

TOBACCO & PASSIVE-SMOKERS

NON-SMOKERS ARE ALSO ADVERSELY AFFECTED BY ENVIRONMENTAL TOBACCO SMOKE.

SPECIALLY CHILDRENS ARE SUSPECTED TO PNEUMONIA, BRONCHITIS AND EXACERBATION OF BRONCHIAL ASTHMA

EACH YEAR, BECAUSE OF EXPOSURE TO ENVIRONMENTAL TOBACCO SMOKE, AN ESTIMATED 3,000 NONSMOKING AMERICANS DIE OF LUNG CANCER, AND 3,00,000 CHILDREN SUFFER FROM LOWER RESPIRSTORY TRACK INFECTION .

IT CAN BE A CAUSE OF LUNG CANCER IN NON-SMOKERS.

IT IS ASSOCIATED WITH HIGHER DEATH RATES FROM CARDIOVASCULAR DISEASES IN NONSMOKERS.

ASSOCIATED WITH INCREASED RISK OF SUDDEN INFANT DEATH SYNDROME.

TOBACCO AND FORMERSCHILDREN AND ADULTS WORKING IN TOBACCO FARM

SUFFER FROM GREEN TOBACCO SICKNESS.

TOBACCO WORKERS ARE EXPOSED TO ORGANOPHOSPHATE PESTICIDES, WHICH ARE HIGHLY TOXIC AND CAN LEAD TO SERIOUS NEURO-PSYCHIATRIC SYNDROME.

TOBACCO USAGE BY HEALTH PROFESSIONALS

HEALTH PROFESSIONALS PLAY A MAJOR ROLE INTOBACCO CONTROL, BUT UNFORTUNATELY TOBACCO CONSUMPTION IN THIS GROUP IS QUIT HIGH.

HEALTH PROFESSIONALS WHO CONSUME TOBACCO THEMSELVES ARE OFTEN LESS LIKELY TO ENGAGE THAN THEIR NON TOBACCO USING COUNTERPARTS

GLOBAL HEALTH PROFESSIONAL SURVEY WAS DEVELOPED BY WHO, CDC & THE WORLD PROFESSIONAL AGENCIES.

PRIMARY PHYSIOLOGIC EFFECT OF NICOTINE

NICOTINE WAS FIRST ISOLATED FROM THE TOBACCO PLANT IN 1828 BY GERMAN CHEMIST POSSELT & RIEMMEN.

IT QUICKLY DESTRIBUTED THROUGH THE BLOOD STREAM & CAN CROSS BLOOD-BRAIN BARRIAR.

WITHIN 7 SECONDS IT REACHES THE BRAIN. SMOKELESS TOBACCO, WHICH ARE HELD IN THE

MOUTH BETWEEN THE LIP & GUM, OR TAKEN IN THE NOSE, THE AMOUNT RELEASED IN THE BODY TENDS TO BE MUCH GREATER THAN SMOKED TOBACCO.

NICOTINE CAN INCREASE THE HEART RATE BY 10-15 BEATS/MIN.

IT INCREASES METABOLIC RATE IT CAUSES CUTANEOUS & CORONARY

VASOCONSTRICTION. IT INCREASES BLOOD PRESSURE BY 5-10mm hg. NICOTINE CAN INDUCE PATHOGENIC CHANGESTO THE

ENDOTHELIUM THAT ARE ASSOCIATED WITH THE ATHEROSCLEROTIC PROCESS.

IT CAUSES LIPOLYSIS.ALTHOUGH SMOKING IS IMPLICATED IN THE

DEVELOPMENT OF CANCER, NICOTINE ITSELF IS NOT CARCINOGENIC, UNLESS IT UNDERGOES NITROSATION TO FORM NITROSAMINES.

Effects of NicotinePositive:

Anxiolysis

Cognitive Enhancement

Cerebro-vasodilation

Neuroprotection

Analgesia

Anti-psychotic

Negative:

Gastrointestinal Distress

Hypothermia

Emesis

Hypertension

Seizures

Respiratory Distress

BENEFITS OF TOBACCO CESSATIONSMOKING CESSATION BENEFITS MEN AND WOMEN AT

ANY AGE AND HEALTH BENEFITS ARE IMMEDIATE AND SUBSTANTIAL.

EARLY IMPROVEMENT THAT OCCURES WITHIN A FEW WEEK INCLUDES BETTER PULMONARY FUNCTION AND EXERCISE TOLERANCE.

IN INDIVIDUALS WHO QUIT SMOKING BEFORE THE AGE OF 50 YRS, THE RISK OF DYING IN THE NEXT 15 YRS IS HALF THAT OF A SMOKER.

THE RISK OF DYING FROM CANCER AFTER 10 YRS IN PERSONS WHO QUIT SMOKING IS 30-35% OF THAT OF REGULAR SMOKER.

SMOKERS HAVE TWICE RISK OF DYING FROM CHD WHICH IS REDUCED BY HALF AFTER 1YR OF CESSATION.

THE RISK OF RECURRENT HEART ATTACKS AND CARDIOVASCULAR DEATHS ARE MARKEDALLY REDUCED (50% OR MORE) AFTER SMOKING CESSATION.

IF SMOKINNG MOTHER STOPS SMOKING BEFORE 3-4 MONTHS OF PREGNANCY THEN INFANT BIRTH WEIGHT WILL BE THE SAME AS THAT OF NONSMOKERS.

SMOKING CESSATIONINTERVENTIONS

THERE ARE FIVE BASIC STEPS TO HELP SMOKERS QUIT

INCREASE THE PRICE OF A

PACK OF CIGARETTES

BAN SMOKING IN PUBLIC PLACES

CREATE & DISSEMINATE

EFFECTIVE COUNTER

MARKETING MASSAGES

ABOUT SMOKING

BAN TOBACCO ADVERTISING

& PROMOTION.

PROVIDE CESSATION

AIDS

SMOKING CESSATION TREATMENT, INCLUDING BOTH COUNSELING AND PHARMACOLOGICAL THERAPY, CAN BE DELIVERED IN CLINICAL SETTINGS OR BY TRAINED COUNSELORS IN SITES SUCH AS TELEPHONE “ QUIT LINES .“

HELPING SMOKERS QUIT MUST BE INDIVIDUALISED & CHARACTERIZED BY PERSISTENCE AND WIILINGNESS BY BOTH CLINICIANS AND PATIENTS TO TRY VARIOUS TREATMENTS.

CLINICIANS CAN HELP THE PATIENTS BY SIMPLY ASKING ABOUT TOBACCO USES AND BY REFERRING TO THE VARIOUS TOBACCO CESSATION CENTRES.

Center

Shree Krishna hospital and PSM college

National Institute of Mental Health and Neurosciences (NIMHANS)

Jawaharlal Nehru Cancer Hospital & Research Center

PGIMER

Cancer Institute (Adyar Cancer Institute)

A.H. Regional Cancer Centre

Institute of Human Behaviour & Allied Sciences (IHBAS)

Chittaranjan National Cancer Institute

Regional Cancer Center

Place

Anand

Bangalore

Bhopal

Chandigarh

Chennai

Cuttack

Dilshad Garden

Kolkatta

Thiruvananthapuram

State

Gujarat

Karnataka

Madhya Pradesh

Chandigarh

Tamil Nadu

Orissa

Delhi

West Bengal

Kerala

Center

Vallabhbhai Patel Chest Institute

Vaidya Hospital

Bhagwan Mahaveer Cancer Hospital & Research Center

King George’s Medical College

Indira Gandhi Institute of Cardiology

Directorate of Hospital and Medical Education

Dr. Bhubaneswar Borooh Cancer Institute ( Regional Institute for Treatment and Research)

MNJ institute of Oncology and Regional Cancer Center

Tata Memorial Hospital

Place

University Of Delhi

Panaji

Jaipur

Lucknow

Patna

Aiswal

Guwahati

Hyderabad

Mumbai

State

Delhi

Goa

Rajasthan

Uttar Pradesh

Bihar

Mizoram

Assam

Andhra Pradesh

Maharashtra

CLINICAL PRACTICE GUIDLINE FOR CESSATIONU.S. PUBLIC HEALTH SERVICE SPONSERED CLINICAL

PRACTICE GUIDLINE RECOMMENDS THAT ALL HEALTH CARE PROVIDERS USE AN EVIDENCE BASED TOBACCO USE CESSATION.

CONSELLING PROTOCOL KNOWN AS THE “5A’s” & “5R’s” RULE TO IDENTIFY & HELP TREAT ALL PATIENTS WHO USE TOBACCO.

THE GUIDLINE CONTENTS FOLLOWING EIGHT KEY FINDINGS

AND RECOMMMENDATIONS.EFFECTIVE T/T OF TOBACCO CESSATION EXIST BUT OFTEN REQUIRES REPEATED

INTERVENTIONS.

EVERY PATIENT WHO USES TOBACCO SHOULD BE OFFERED ATLEAST ONE SUCH T/T.

CESSATION COUNSELLING SHOULD BE PART OF REGULAR CLINICAL PRACTICE.

BRIEF T/T IS EFFECTIVE.

PERSONAL & LONGER CONTACT INCREASES EFFECTIVENESS OF T/T.

SKILL ORIENTED COUNSELLING AND SOCIAL SUPPORT ARE ESPECIALLY EFFECTIVE.

PHARMACOTHERAPIES SHOULD BE USED WITH ALL PATIENTS.

T/T IS CLINICALLY & ALSO COST EFFECTIVE AND SHOULD BE REIMBURSED BY INSURANSES

“5A’s” & “5R’s” RULEEVERY HEALTH CARE PROVIDER SHOULD FOLLOW 5A’s

& 5R’s RULE.5A’s RULE SHOULD BE FOLLOWED IN PATIENTS WHO

ARE WILLING TO QUIT THE TOBACCO.5R’s RULE SHOULD BE FOLLOWED IN PATIENTS WHO

ARE UNWILING TO QUIT THE TOBACCO.

5A’s RUL

E

ASK

ADVISE

ASSESASSIST

ARRANGE

5R’s RUL

E

RELEVANCE

RISK

REWARDSROADBLOCKS

REPETATION

MANAGEMENT

COUNSELING

BEHAVIORAL MANAGEMENTPHARMACOTHERAPY

COUNSELING

The odds of a smoker quitting are increased both by counseling and by pharmacological treatment.

Counseling requires at least 10 minutes duration. The counseling interventions typically included the

following components:- Review of the participant's smoking history and

motivation to quit; Help in identification of high-risk situations and

smoking cues; Generation of problem-solving strategies to deal

with high-risk situations.

Counseling is a collaborative process in which the counselor assists the client in facilitating behavior change, enhancing coping skills, promoting decision making and improving relationships.

Counselors may also have provided non-specific support and encouragement and as well as written materials, video or audiotapes.

BEHAVIORAL THERAPYIn contrast, behavioral therapy helps smokers avoid

stimuli that trigger smoking, such as alcohol, first morning coffee, stress, and associating with other smokers.

Behavioral strategies also attempt to alter the usual smoking routine, anticipate cravings, and address the consequences of nicotine withdrawal, such as oral needs, weight gain, and cravings.

BEHAVIOURAL PRINCIPLES FOR CESSATION1. Attitudinal Change:- Identifying, challenging and

substituting glamorous thought associated with tobacco use such as “feeling like a hero”, being centre of attraction, appearing to be performing well, increased concentration etc.

2. Cue identification and management:- Identifying the cues associated with tobacco (like foods, cigarette packs, ashtrays or particular places) and removing / avoiding them.

3. Creation of oversize states:- Using methods to make tobacco use unpleasant and distasteful or by increasing taxes.

4. Reward punishment paradigm:- Reinforcing the patients for not smoking with the presentation of some reward or punishing for smoking by the loss of some reward.

5. Behavioral coping:- Substituting maladaptive behaviors like anger with the adaptive ones like exercising, removing oneself from the situation etc and utilizing skills to manage triggers.

PHARMACOTHERAPY

TWO GENERAL CLASSES OF DRUGS ARE APPROVED BY US FOOD AND DRUG ADMINISTRATION FOR

CESSATION

NICOTINE REPLACEMENT

PRODUCTSPSYCHOTROPIC

DRUGS

NRT NRT STANDS FOR NICOTINE REPLACEMENT THERAPY. IT IS AN EFFECTIVE AID TO TOBACCO CESSATION. TOBACCO IN TAKERS WHO ARE DEPENDANT ON

NICOTINE SHOULD BE OFFERED NRT. CHOICE OF NRT PRODUCT SHOULD BE

INDIVIDUALISED BASED ON• PATIENT PREFERANCE• TOLERANCE OF ADVERSE EFFECT• SMOKING HABIT

PATIENTS WITH SEVERE NICOTINE ADDICTION ARE PRESCRIBED COMBINATION NRT

OBTAINING NICOTINE IS CONSIDERABELY SAFER THAN SMOKING AND SMOKELESS TOBACCO

PRESCIBING DETAILS FOR NRT

FORMULATION

GUM

PATCH

INHALATOR

NASAL SPRAY

SUBLINGUAL TABLETS

DOSAGE

2 mg OF PIECE4 mg OF PIECE

16 h PATCH : 15, 10 OR 5 mg24 h PATCH : 21, 14 OR 7 mg

10 mg PER CATRIDAGE

10 mg/ml PER SPRAY0.5 mg PER SPRAY

2 mg PER PIECE4 mg PER PIECE

USE

CHEW GUM UNTIL TASTE IS STRONG, THEN REST GUM BETWEEN GUM & CHEEK; CHEW AGAI N WHEN TASTE FADED

ONCE DAILY ON UNBROKEN SKIN; REMOVE BEFORE BED OR NEXT MORNING; FRESH SITE

INHALE AS REQUIRED

ONE SPRAY EACH NOSTRIL AS REQUIRED

REST UNDER TOUNGE UNTIL DISSOLVED

FORMULATION

LOZENGE

DOSAGE

1 mg PER PIECE2 mg PER PIECE4 mg PER PIECE

USE

PLACE BETWEEN GUM AND CHEEK AND ALLOW TO DISSOLVE

CHEWING GUM ADVANTAGES:-

Nicotine gum may satisfy oral cravings, It may delay weight gain after cessation, and lends

itself to titration for control of withdrawal symptoms.

DISADVANTAGE:- Its major disadvantages include that its use may not

be socially acceptable, It may adhere to dental work such as fillings and

bridges, It must be used properly to be effective.

PATCHESThe nicotine patch is emerging as a mainstay for

pharmacological treatment of smoking cessation.It is often used in combination with other forms of

nicotine replacement and psychotropic medications.ADVANTAGES:- Its major advantages are consistent

levels of nicotine delivery, easy use, and good compliance.

DISADVANTAGE:- Insomnia(greater with the 24-hourpatch), Inability to titrate dose, Allergic reactions to the patch adhesive ( patients

with dermatological conditions are advised against its use),

Morning nicotine cravings with the 16-hour release form.

NOTE :-• In general, greater levels of smoking call for higher-

dose patches, Patch sites should be rotated to avoid skin reactions.

• Most patients can tolerate the skin irritation, which topical corticosteroids can ameliorate.

NICOTINE LOZENGE ADVANTAGE:-

Can satisfy oral cravings It is easy to use More socially acceptable In many patients, the lozenge is well tolerated.

DISADVANTAGE:- Heavy users may note adverse effects of

hiccups, nausea, flatulence.

NASAL SPRAYUsing nasal spray to deliver periodic doses of nicotine

more closely mimics the act of smoking.ADVANTAGE:-

Rapid absorption, Ease of titrating doses to attain desired nicotine

levels, Similarity to the act of smoking.

DISADVANTAGE:- A high rate of nasal and throat irritation (generally

tolerated by users), The risk of dependence, The need to wait up to 5 minutes before driving

because of local reactions and sneezing. CONTRAINDICATIONS:-

Patients with chronic nasal disorders or reactive airway disease should not use the spray.

Should be used cautiously in patients with bronchospastic disease.

PSYCHOTROPIC DRUGSThe only psychoactive drug currently recommended

by the FDA for cessation is bupropion.Prescribed in 150-mg doses as a sustained release

capsule.Bupropion seems to act by decreasing both the

craving for cigarettes and the symptoms of nicotine withdrawal.

Given the high prevalence of smokers who are depressed.

HOW TO USE?????????????????? It is easy to use and can be taken in combination

with NRT. The drug should be started at least 1 week before

the cessation date to achieve stable blood levels. Initially, the patient should take 1 pill each

morning for 3 days, increasing to twice a day if tolerated, although once a day may sufficient in some patients.

Treatment usually is recommended for 2 to 3 months after the cessation date, but in selected cases it may be taken for up to a year.

ADVANTAGE:- It is easy to use and can be taken in combination

with NRT. Has the added advantage of treating both conditions

i.e. smoking and depression simultaneously. DISADVANTAGE:-

Bupropion is contraindicated for patients with seizure disorders or conditions that might predispose to seizures.

Adverse reactions among those without risk of seizure include insomnia (mitigated by taking the second dose in late afternoon rather than at bedtime) and dry mouth.

FUTURE MEDICATION OPTIONS Several potential new medications for cessation are

currently in field tests and not yet approved by the FDA.

Varenicline, may offer an alternative to bupropion. Rimonabant is a cannabinoid receptor inhibitor that

blocks the reinforcing effects of nicotine and also suppresses appetite.

Nicotine vaccine produces antibodies to nicotine and thus reduces nicotine levels.

Preventive Strategies

Preventing people from tobacco consumption is one the major challenges that one faces . Any prevention programme should cover at least three aspects.

1. Keep people specifically teen agers from picking up the habit.

2. Protect people from second hand smoke.

3. Help people quit.

1. Keep People Specifically Teenagers From Picking Up The Habit

It is one of the earliest but most effective step in tobacco prevention.

the role of parents is most important. The most effective manner to prevent the habit is by

serving as effective role models i.e. being non consumers of tobacco themselves.

Parents and school should be involved in programme that elaborate harmful effect of tobacco consumption.

Stressing the fact to kids that tobacco consumption is not a habit but addiction is also important

2. Protect People From Second Hand Smoke

This require formulation and implementation of policies.

make public places smoke free zones. Creating awareness to the dangers of second hand

smoke though media.

3. Help People Quit

About 70% of people addicted to tobacco try and quit sometime but they don’t get success.

During this period person require proper counseling and support.

Group that help in counseling and support include health professionals and social workers, they help to quit the tobacco habit consumption.

These group or organization should be easily accessible and consist of trend professionals to provide proper counseling and medications like nicotine replacements patches.

Tobacco Use Prevention and Cessation In Dental

hygiene Education

The first tobacco use prevention and cessation strategy adapted for dental clinician entitled ‘The dentist’s role in helping patients to stop smoking’ was published in 1970 by Arden G. Christen

Six year before the general assembly of the American Dental Association ‘adopted a resolution that ADA member be encouraged to inform their patients of the health hazards of the use of tobacco and especially with young people against acquiring the habit of cigarette smoking (ADA. 1964)

Objectives of Tobacco Cessation

A complete programme seemed to be applicable for dental school clinical setting (GUBA 1990). Their programme consisted of six objectives, as follows:-

Objective 1 : the dental clinic patients reception areas will provide a non smoking atmosphere where the dental faculty, staff and students actively serve as non smoking health oriented role models.

Objective 2 : information will be provided to patients concerning the risks of continued smoking and the substantial benefits of quitting.

Objective 3 :information, guidance and support will be offered to those patients who want to quit. The guidance included record keeping for patient follow up.

Objective 4 : The patients will be referred either to a formal behaviorally or psychologically oriented group or to a private smoking cessation programme.

Objective 5 : Patients who have previously entered the quit moving programme will be followed up at subsequent appointment to a certain what spa city cessation and maintenance strategies they have used and whether they have achieved their goal.

Objective 6 : The over all clinical smoking cessation programme will be critiqued at periodic intervals to assess progresses and assess problem

Role Of Oral Health Professionals In Tobacco Control

The W.H.O. considers tobacco the single most important cause preventable death worldwide.

Any effort to reduce its spread is often dismissed as being a needless preoccupation with a trivial problem.

In implementing tobacco control, health professionals have crucial role to play in creating a tobacco free environment.

The oral health professionals should strengthen their contribution to tobacco cessation programmes are :-

i. They are specially concerned about the adverse effect in the oropharangeal area of the body that are caused by tobacco practices.

ii. They meet, on a regular basis, children, youth and their care givers, thus providing opportunities to influence to entirely avoid, postpone, initiation or quit using tobacco before they become strongly dependent.

iii. They often have more time with patients then many other clinicians, providing opportunities to integrate education and intervention.

iv. They often treat women of childbearing age, thus are able to inform such patients about the potential harm to their babies from tobacco use.

v. They are as effective as other clinician in helping tobacco user quit and results are improved when more than one discipline assists individual during the quitting process.

vi. They can build their patient’s interest in discontinuing tobacco use by showing actual tobacco effects in the mouth.

Oral health teams and oral health organization directly, appropriately and routinely involved in influencing patient and the public at large to help in tobacco control. Tobacco cessation is an integral

part of national oral health programme, based on careful planning, monitoring and evaluation and partnership-building.

Oral health professionals have a prominent role in tobacco control. They can play an important role at an

i. individual level

ii. At the local/society level

iii. At the national level

i. At the individual level they can educate the people they come across with on the harmful effects of tobacco consumption.

a. They should use every opportunity to incorporate cessation counseling into their practices. These counseling should be stimulating and non judgmental.

b. They should get involved wit local tobacco control group or organization.

c. They can propose that question on tobacco use be including in medical history for all patients as a par of monitoring signs.

d. Implement curriculum changes in health processional schools to enhance knowledge and kills in intervention in tobacco prevention, smoking cessation and efforts to reduce exposure to second hand smoke.

ii. At the society level or local health level.

Local health professional organization can be formed which apart from encouraging cessation work with patients would ensure their members take individual action in other ways in the community.

a. Explore the benefits of visiting schools to discuss the impact of tobacco and industry tactics with student, staff and parents.

b. Establish tobacco free and smoke free school, hospitals, restaurants and other public places.

c. Persuade government to ban tobacco advertising.

d. Invite politicians to meetings where the harsh realities of tobacco use are being explained and policy solutions discussed.

e. Actively participate in World No Tobacco Day every 31 May.

iii. At the national level

Organizations could be formed. These organizations should work to raise awareness among their individual members about tobacco.

a. They could share new scientific research findings new developments in cessation and policy developments.

b. They should highlight scientific evidence o harmful effect to tobacco use though the media.

c. They can carry out surveys on tobacco consumption habits and attitude towards tobacco consumptions.

d. Actively participate in World no Tobacco Day every 31 May.

Barriers For tobacco Cessation

Evidence reviewed confirmed that the integration and success of tobacco cessation counseling in a dental practice setting involves change in knowledge, attitudes and behavior of both dental team members and their patients.

The following three categories are emerging as primary themes for barriers in tobacco cessation

i. Barrier to implementing tobacco use cessation counseling.

ii. Barrier to participation in tobacco use cessation (by clinician or patients)

iii. Barrier to effectiveness of tobacco use cessation counseling.

Barrier to implementation of tobacco use cessation counseling

a. Lack of feeling that is part of their responsibility or feeling that it is appropriate role.

b. Discomfort with discussing tobacco use.

c. Doubts by clinician of the value or legitimacy of counseling.

d. Lack of financial incentives.

e. Lack o time.

f. Lack of knowledge and skills.

g. Lack of resources

h. Lack of team approach and communication.

a. Lack of early education.

b. Belief that patients would not cooperate.

c. Fear of damaging dentist patient rapport.

d. Lack of staff loyally.

e. Lack of organization and plan.

f. Fatalistic attitude toward prevention.

ii. Barriers to participation in tobacco use cessation

By Clinician:-

a. Lack of early education.

b. Tobacco used by clinician.

c. Lack of time.

d. Lack of visible effects of tobbaco use in oral cavity.

e. Lack of team approach and communication.

f. Frustration over success rates.

g. Failures in previous attempts.

h. Legal limitations on prescribing NRTs.

By Patients:-

a. Lack of openness or expectation of dental personnel involvement.

b. Lack of patient awareness

c. Discomfort in discussing.

Barrier to effectiveness of tobacco use cessation counseling

a. Lack of resources and source for referral.

b. Time spent in counseling.

c. Lack of regular patient attendance.

d. Discomfort discussing tobacco use.

e. Non existence of smoke free practice.

f. Lack of knowledge and skills.

g. Approach to tobacco cessation in prescriptive manner.

CONCLUSION: -

In India around about 8,00,000 people dies annually because of use of tobacco, because of lack of proper cessation program & its knowledge and lack of interest of counseling for the same.

There should be ban on advertisement of tobacco products, and strict prohibition of use of these products in the public places should be done, strict action should be taken against them who don’t obey this rule.

It is seen that the tobacco use is increased because of the attractive packets and advertisement, it should be prohibited and instead of this tobacco cessation and ill effects of tobacco related videos or films has to be shown.

We have various centers in India for tobacco cessation but these are not sufficient and most of the peoples don’t even know about them. So proper advertisement of these centers should be done.

Education related tobacco should be included from the first standard syllabus of the student so that they will be well aware about the ill effects of tobacco.

Awards should be given to the tobacco users who quitted it, so as other people can take inspiration from them.

THANKS FOR YOUR

CO-OPERATIO

N