Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of...
-
date post
22-Dec-2015 -
Category
Documents
-
view
216 -
download
2
Transcript of Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of...
![Page 1: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/1.jpg)
Tobacco Cessation In Special Populations
Eric L. Johnson M.D.
Assistant Professor
Department of Family and Community Medicine
University of North Dakota
School of Medicine and Health Sciences
![Page 2: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/2.jpg)
Objectives
• Identify the scope of tobacco’s impact in North Dakota
• Discuss common disease states associated with tobacco use
• Discuss and apply tobacco cessation needs for special populations
![Page 3: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/3.jpg)
Special Populations• Diabetes- already at high risk for
cardiovascular disease, smoking as a cause/exacerbation of diabetes
• Pregnancy- poorer pregnancy outcomes• Mental Illness/Chemical Dependency- -
high utilization, difficult to treat• Adolescents- Difficult to engage, limited
data on medications• Native Americans- High utilization, barriers
![Page 4: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/4.jpg)
Overview of Tobacco
![Page 5: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/5.jpg)
Smoking Causes Death
Smoking causes approximately
• 90% of all lung cancer deaths in men• 80% of all lung cancer deaths in women• 90% of deaths from chronic obstructive
lung disease (COPD)
CDC
![Page 6: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/6.jpg)
Smoking Causes DeathCompared with nonsmokers smoking
increases risk of—• Coronary heart disease by 2 to 4 times• Stroke by 2 to 4 times• Men developing lung cancer by 23 times• Women developing lung cancer by 13 times• Dying from chronic obstructive lung diseases
(COPD) by 12 to 13 times
CDC
![Page 7: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/7.jpg)
![Page 8: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/8.jpg)
Secondhand Smoke DeathsUnited States• Lung cancer – 4,000 deaths annually • Ischemic heart disease – 45,000 deaths
annually
North Dakota• 80-140 deaths annually
CDC
![Page 9: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/9.jpg)
% Adults who smoke
BRFSS 2009, CDC
State by State Smoking
![Page 10: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/10.jpg)
Tobacco Use in North Dakota
• ~100,000 ND adults and ~8,000* HS students smoke cigarettes
• ~20,000 ND adults and ~3,800^ HS students use spit tobacco
(BRFSS 2008)
(YRBS 2005,2007,2009)
![Page 11: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/11.jpg)
Tobacco Use in North Dakota• Between 2001 and 2009, Adult
smoking rates in North Dakota dropped from 23.2% to 18.6%
• Highest West Virginia 25.6%
• Lowest Utah 9.8%
• About half of smokers report cessation attempts annually
Behavioral Risk Factor Surveillance System (BFRSS)MMWR
![Page 12: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/12.jpg)
Tobacco’s Health Cost inNorth Dakota
• Smoking-attributable direct medical expenditures:
$250,000,000• Smoking-attributable productivity costs:
$192,000,000• Medicaid expenditures for smoking-related illnesses and
diseases:
$47,000,000
Annual Costs! CDC. Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) report, 2008. CDC Data Highlights, 2006.
![Page 13: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/13.jpg)
General Issues in Smoking Cessation
• Triggers• Mood changes• Withdrawal symptoms (most smokers
underestimate)• Weight gain• Lack of support• Exposure to other smokers
![Page 14: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/14.jpg)
Tobacco Cessation Counseling
• Brief counseling (i.e., 5A’s)• Classes• Quitline/Quitnet/Quitplan• 3rd party payer programs
![Page 15: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/15.jpg)
Pharmacotherapy
• Nicotine replacement therapy (NRT)• Bupropion (Zyban, Wellbutrin) • Varenicline (Chantix)
• First-line therapies USPHS Guidelines 2008
![Page 16: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/16.jpg)
Smoking and Diabetes
![Page 17: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/17.jpg)
Smoking and Diabetes• Strong Association between smoking
history and development of Type 2 Diabetes
• Now thought to be an independent risk factor, like obesity
• Several large studies to date with more recent interest
• Already a high risk CVD population• Glucose control may be worse
![Page 18: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/18.jpg)
Does smoking cause diabetes?
• Growing evidence points to smoking as an independent risk factor for developing diabetes
• Large prospective studies with multivariate adjustments still do point to a causal link
![Page 19: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/19.jpg)
Smoking and Diabetes Risk
• Women’s Health Study RR 1.42 AJPH 1993
• Men’s Health Professionals Study RR 1.94 BMJ 1995
• Osaka Study RR 1.47- 1.73 Diabetes Med 1999
• Physician’s Health Study RR 2.1 Am J Med 2000
• Cancer Prevention Study 1 RR 1.45-2.1 I Jour Epi 2001
![Page 20: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/20.jpg)
Smoking and Diabetes
• The Translating Research Into Action for Diabetes (TRIAD) Study
• Smoking increased relative risk of all cause mortality of 1.44
McEwon, et al Diabetes Care 2007
![Page 21: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/21.jpg)
Passive (Second Hand)Smoking and Diabetes
• The High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study
• Relative risk of type 2 Diabetes 1.81 with secondhand exposure
• Relative risk of type 2 Diabetes 1.99 for active smokers
Hayashino, et al Diabetes Care 2008
![Page 22: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/22.jpg)
Effects of smoking on diabetes
• Increased random and fasting glucose • Increased HbA1C• Increased insulin resistance• All these despite a lower average BMI
• Recent study showed 9.8% of youth with diabetes smoke Reynolds, et al ADA meeting abstract 2008
Haire-Joshu, et al Diabetes Care 1999
![Page 23: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/23.jpg)
Medications for Smoking Cessation in Diabetes
• NRT• Buproprion• Varenicline (Chantix)
• All can be used in diabetes, avoidance of weight gain important
![Page 24: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/24.jpg)
Tobacco and Diabetes• Smoking is a cause of type 2 diabetes• Smoking worsens diabetes control• Smoking increases risk of CVD and other
complications• Smoking cessation is critical in diabetes• Consider appropriate medications• Refer to ND Quitline/Quitnet, MN Quitplan, other
local resources
![Page 25: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/25.jpg)
Tobacco and Pregnancy
![Page 26: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/26.jpg)
Tobacco Cessation in Pregnancy
• Benefits in pregnancy and long term health (interventions in younger women)
• Reduce Cardiovascular Complications• Reduce Lung Disease• Reduce Cancer• Reduce Type 2 Diabetes• Economic benefit for individual and society
![Page 27: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/27.jpg)
Smoking in Pregnancy
• Smoking in pregnancy higher in North Dakota than national average: 18% vs. 11%
• Smokers tend to be from lower socioeconomic and educational classes
• WIC smoking population as high as 40%+ in North Dakota
North Dakota Department of Health
![Page 28: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/28.jpg)
Smoking in Pregnancy
• ~75% of pregnant smokers desire quitting• ~25-30% actually quit during pregnancy• ~50% resume after pregnancy• Smoking Cessation is most successful
prior to pregnancyRuggiero L, et al Addict Behav. 2000 Mar-Apr;25(2):239-51Ebert LM Fahey K Women Birth. 2007 Dec;20(4):161-8Tong VT, et al Am J Prev Med. 2008 Oct;35(4):327-33.
![Page 29: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/29.jpg)
Complications of Smoking in Pregnancy
• Fourfold increase in small for gestational age; Increased prematurity
• Twice the rate of spontaneous abortions• Increased risk of abruptio placentae,
placenta previa, premature and prolonged rupture of membranes
Russell, T, et al Nicotine & Tobacco Research, Vol6, Supp 2. Apr. 2004Gabbe: Obstetrics 4th ed 2002 George L, et al Epidemiology. 2006 Sep;17(5):500-5Faiz AS, Ananth CV.J Matern Fetal Neonatal Med. 2003
![Page 30: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/30.jpg)
Complications of Smoking in Pregnancy
• Intrauterine growth restriction• Stillbirth• Ectopic pregnancy• Infertility• Poor wound healing/surgical outcomes
Russell, T, et al Nicotine & Tobacco Research, Vol6, Supp 2. Apr. 2004Gabbe: Obstetrics 4th ed 2002 Högberg L, Cnattingius G. BJOG. 2007 Jun;114(6):699-704.
![Page 31: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/31.jpg)
Fetal/Child Effects of Maternal Smoking in
Pregnancy• Sudden infant death syndrome (SIDS) and
increased respiratory illnesses in children • Possible Association with maternal
smoking and ADHD/Behavioral Disorders• Congenital Anomalies (i.e., cleft lip/palate,
cardiac)Linnett KM, et al Pediatrics 2005; 116: 462-467Malik S, et al Pediatrics 2008 Apr;121(4):e810-6Shi M, et al Am J Hum Genet. 2007 Jan;80(1):76-90
![Page 32: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/32.jpg)
Smoking Cessation Interventions in Pregnancy
• Brief Office Counseling• Smoking Cessation Class (i.e., Public
Health)• Third Party Payer programs• Quitlines• Online programs (i.e., Quitnet)• Pharmacologic
![Page 33: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/33.jpg)
Pharmacotherapy for Pregnant Smokers
• NRT- Category D. Secreted in breast milk. Crosses placenta
• Buproprion (Wellbutrin, Zyban)- Category B. Metabolites in breast milk. Risk of seizure (low). Increase spontaneous abortion 1st trimester?
• Varenicline (Chantix)- No data (yet)
Oncken CA, Kranzler HR Nic Tob Res Nov 2009
![Page 34: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/34.jpg)
Pharmacotherapy for Pregnant Smokers
• USPHS 2008 more limited recommendations vs USPHS 2000
• ACOG 2005: NRT for heavy smokers if other nonpharmacologic interventions fail
![Page 35: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/35.jpg)
Pharmacotherapy for Pregnant Smokers
• NRT use must be risk vs benefit
-heavy smoker, relapsers, other risk ? (i.e. CVD risk factors)
-if NRT used, intermittent (gum, lozenge)
-higher birth weight?• Buproprion? 1 study shows benefit *• Varenciline- not recommended presently
*Chan B et al J Add Dis (24) 19-23 2005
![Page 36: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/36.jpg)
Pharmacotherapy for Pregnant Smokers
• Smoking, Nicotine, and Pregnancy Trial• Currently underway (UK study)• Projected publication is 2013
![Page 37: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/37.jpg)
• Pregnancy affords a great opportunity• Multiple short term followup clinic visits• Phone calls/e-mail/quitline/quitnet• ASK every time• Options every time• North Dakota data encouraging
Smoking Cessation Interventions in Pregnancy
![Page 38: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/38.jpg)
Tobacco Use and Mental Illness
![Page 39: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/39.jpg)
Tobacco Use and Mental Illness
• Tobacco use in patients with a psychiatric diagnosis ~41%
• Tobacco use patients without a psychiatric diagnosis ~20%
Lasser, et al JAMA 2000
![Page 40: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/40.jpg)
Tobacco Use and Mental Illness
• Lifetime quit rates for ever smokers with a psychiatric diagnosis 16%-26%
• Lifetime quit rates for ever smokers without psychiatric diagnosis ~42%
• Persons with mental illness consume 30-50% of all tobacco sold in the U.S.
Lasser, et al JAMA 2000Fagerstrom and Aubin Curr Med Res Op 2009
![Page 41: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/41.jpg)
Mental Illness Smoking Rates
• Schizophrenia 80%+• Depression 40-60%• Bipolar Disorder 40-70%• Anxiety Disorders 20-50%• PTSD 50-65%
![Page 42: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/42.jpg)
Factors Influencing Smokingin Mental Illness
• Nicotine may improve symptoms of schizophrenia
• Nicotine may improve symptoms of depression
• Withdrawal from nicotine may exacerbate symptoms in mental illness
Dalak, et al Am J Psych 1999Malpass and Higgs Psychopharm 2007
![Page 43: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/43.jpg)
Smoking Cessation Interventions in Mental
Illness• Brief Office Counseling (5 A’s)• Smoking Cessation Class
(i.e., Public Health, Lung Association)• Third Party Payer programs• Quitlines• Online programs (i.e., Quitnet)• Pharmacologic
![Page 44: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/44.jpg)
Considerations/Complications of Smoking Cessation Therapy In Mental
Illness• Tobacco can lower serum levels of some
psychiatric drugs • Induction of CYPIA2• Therefore, cessation may alter serum
levels of some psychiatric drugs• Monitoring for side effects, change in
status, etc important
Fagerstrom and Aubin Curr Med Res Op 2009
![Page 45: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/45.jpg)
Management of Emergent Psychiatric Symptoms in Tobacco Cessation
• Monitor for symptoms• NRT +/- buproprion if appropriate
(depression)• Adjustment of other psych medications• Cognitive behavioral therapy (CBT)• Motivational Interviewing• Varenicline?
Can exacerbate some symptoms
![Page 46: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/46.jpg)
Medications for Tobacco Cessation in Mental Illness
• NRT: Be aware of interactions with psych meds, but more data
• Buproprion: May be useful to co-manage depression, depends on other meds used
• Varenicline: Not a lot of data, but can exacerbate some symptoms
Fagerstrom and Aubin Curr Med Res Op 2009
![Page 47: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/47.jpg)
Tobacco Use and Chemical Dependency
![Page 48: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/48.jpg)
Tobacco and Chemical Dependency
• We treat all other aspects of chemical dependency simultaneously
• Nicotine (tobacco) is an addictive drug with adverse health effects
• Treat chemical dependency, need to lower risk of dying prematurely from a tobacco related disease in recovery
![Page 49: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/49.jpg)
Nicotine Dependence in the Chemically Dependent Population
• Smoking rate in the general population ~20%• Smoking rate in the chemically dependent
population ~80+%
• Smoking is more deadly to chemically dependent population:
4 times the death rate of non-smokers
51% of deaths from tobacco
33% of deaths from drugs or alcoholCDC 2005; Walsh, etal Drug & Alcohol Review (24) 2005; Hurt, et al Alcoholism: Clin & Exp Res (18) 1994
![Page 50: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/50.jpg)
Benefits of Smoking Cessation in CD Treatment
• Smoking tobacco and drinking alcohol are strongly inter-related
Gulliver, et al J Stud Alc 2000
• Urges to smoke = Urges to drink
Cooney, et al Psych Addict Beh 2007
• Increased smoking = Increased drinking Barrett, et al Drug Alc Dep 2006
• Other concomitant addictions are treated
![Page 51: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/51.jpg)
Benefits of Smoking Cessation in CD Treatment
• Smoking Cessation integrated into treatment without jeopardizing recovery goals
Cooney, et al Psych Addict Beh 2007
• Smoking Cessation can improve drinking outcomes
Friend and Pagano J Sub Ab Treat 2005
• Tobacco Counseling may reinforce alcohol treatment Friedmann, et al J Sub Ab Treat 2005 Kalman, et al J Sub Ab
Treat 2006
![Page 52: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/52.jpg)
Pharmacotherapy in CD Treatment
• Nicotine Replacement Therapy may be more important
Hurt Alcoholism: Clin and Exp Res 2002
Hurt, et al Addiction 1995
• Buproprion (maybe): Contraindicated in history of head injury,seizures, or an ongoing risk for withdrawal syndrome
• Varenicline (maybe): Monitor psych status, not enough data in CD population
![Page 53: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/53.jpg)
Tobacco and Adolescents
![Page 54: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/54.jpg)
Adolescent Smoking in ND
• 22.4 % Grade 9-12• 7.3 % Grade 7-8• 47 % Grad 9-12 smoked at least once• 53 % of the current smokers in grades 9-
12 tried to quit smoking during the previous year
YRBS 2009
![Page 55: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/55.jpg)
Adolescent Smoking Cessation Barriers
• Difficult to engage (some trials end because of low enrollment/dropouts)
• Difficult to comprehend long-term health consequences
![Page 56: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/56.jpg)
Smoking Interventions in Adolescents
• Direct counseling increases quit rate to ~11% (about 6% with ‘usual care’
• Counseling of parents may be of benefit• Presently USPHS has no specific
medication recommendation• NRT has been shown to be safe• Tobacco Taxes as intervention?• School based prevention?
![Page 57: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/57.jpg)
Tobacco and Native Americans
![Page 58: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/58.jpg)
Tobacco Use in Native Americans
• Native American population: 49.3% adults use tobacco (highest smoking rate of any ethnic group in U.S.)
• Quitline utilization has been good in North Dakota (~8% of all callers, 6% of total population)
![Page 59: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/59.jpg)
Tobacco Cessation in Native Americans
• Needs to be culturally significant and relevant
- i.e.,true ceremonial use not a cessation focus- Specialized programs “All Nations Breath of Life”• Like other populations, urban vs rural different• Low cost of tobacco is a cessation barrier on
reservations
![Page 60: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/60.jpg)
Summary
• Common special populations with tobacco cessation needs
• Different approaches for different populations
• Some type of counseling (brief in office, Quitline/Quitnet/Quitplan, class, etc) can be used for all
![Page 61: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/61.jpg)
Contact us
[email protected] To schedule a lecture/conference or to
request materials, please contact:Melissa Gardner
Phone: 701-777-3191 [email protected]
![Page 62: Tobacco Cessation In Special Populations Eric L. Johnson M.D. Assistant Professor Department of Family and Community Medicine University of North Dakota.](https://reader038.fdocuments.net/reader038/viewer/2022110323/56649d795503460f94a5c138/html5/thumbnails/62.jpg)
Slide Decks/Media
• Media Links:• Dr. Johnson's Slide Decks
http://www.med.und.edu/familymedicine/slidedecks.html