Top 10 Tips to Quit Smoking

1st Annual Smoking Cessation DayCounty of Los Angeles – Public Health

February 1, 2019

Gary J Tedeschi, PhDClinical Director

California Smokers’ HelplineUniversity of California, San Diego

Acknowledgements• University of California, San Diego • California Smokers’ Helpline • Shu-Hong Zhu, Principal Investigator• Sharon Cummins, Director of External Affairs

• California Department of Public Health• Tobacco Control Program• April Roeseler, Branch Chief• Mary Strode, Program Consultant

• First 5 California• Silvia Flores, Program Consultant

Learning Objectives

• Review the main factors of nicotine dependence

• Identify the key concepts for quitting smoking

• Increase knowledge of cessation resources and support services

Topics

•Why it’s hard to quit & stay quit• The four-headed dragon of nicotine dependence

• Top 10 tips to quit smoking

• California Smokers’ Helpline• Referral options & resources

Why is it Hard to Quit (and stay quit)?

The Four-Headed Dragon of Nicotine Dependence

The Four Heads

Physical Behavioral SocioculturalPsychological

Physical Dependence• The body’s need for nicotine• Chemical changes in the brain• Over time nicotine changes the way neurotransmitters

operate• This creates a new “nicotine normal” state• Quitting disrupts this state and leads to physical withdrawal

Behavioral Dependence• Learned behavior associated with smoking• Often referred to as “habit”• For regular smokers, lighting up is an integral part of the daily

routine• Smokers report that cigarettes help with things like: • Stress• Concentration• Appetite• Breaks• Boredom• “Friendship”

• Quitting leaves a very big hole

Psychological Dependence• The mind's desire to smoke• Less tangible or obvious• Ambivalence• Feeling two ways about quitting

• Positive expectancy• Specific vs. general

• Self-efficacy• Perception of ability

• Self-image• Smoker vs. nonsmoker

Sociocultural Factors

• Family & peer influence• Family and societal norms

• Demographics• Traditional uses of tobacco and acculturation

• Environment• Economics & availability

• Advertising• Impact of the tobacco industry targeting

The Four Heads

Physical Behavioral SocioculturalPsychological

Helping Patients/Clients Quit•When collaborating with patients/clients on strategies

consider all factors:

• Physical

• Behavioral

• Psychological

• Sociocultural

• Look for these in in the Top 10 Tips…

Quitting smoking can feel like an overwhelming task. If you break it down into smaller parts,

it seems more doable.

Top 10 Tips to Quit Smoking

Top 10 Tips

1. Find a reason to quit

2. Make a plan

3. Call 1-800-NO-BUTTS

4. Get support

5. Use a quitting aid

6. Make home & car smoke-free

7. Set a quit date

8. Quit on the quit date

9. Picture being a nonsmoker

10. Keep trying

#1 Find a Reason to Quit• You might ask:• What are your main reasons to quit smoking?• Was there something that triggered your decision

to quit now? What was it?

• What do you like about smoking? • What will you miss?

• What don’t you like about smoking?

Additional Questions

•What worries you about your smoking? •What has smoking stopped you from doing?•What do you think will happen if you don't quit? •What would it take for you to feel ready to quit?

#2 Make a PlanIdentify at least 3 “trigger” situations

Common Triggers

First thing in the morning Coffee, soda, or alcoholBefore bed On a breakAs a reward After mealsDriving StressBoredom Watching TVHighly emotional situations (accident, death, divorce, etc.)

Being around smokers

Curb appetite Cravings

Behavioral & Cognitive Strategies• Change what you do• Eat or drink something• Keep busy• Break the association & change routine• Use an approved quitting aid

• Change how you think• Consider what is gained by becoming a non-smoker• Normalize thoughts (fears, concerns, reactions to

withdrawals)• Repeat positive self-affirmations • Think positively

#3 Call 1-800-NO-BUTTS

• FREE statewide cessation program

• Started in 1992 by UCSD researchers

• All services are confidential

• Validated in randomized controlled trials

• Trained counselors help with a tailored plan and offer support

• Multiple languages

• Open 6 days, 78 hours/week

• >21,000 registered users in 2018

#4 Get Support

• Discuss the plan with trusted people• Friends, family, professionals

• Spend time with nonsmokers• Volunteer or take a class• Connect with support groups, church, 12-step

program, co-workers, etc.• Visit www.nobutts.org

#5 Use a Quitting Aid

Nicotine Replacement Therapy (NRT)

Non-nicotine Medication

Patch (OTC) *Bupropion SR (Zyban)Gum (OTC) *Varenicline (Chantix)

Lozenge (OTC)

Inhaler (Rx)Nasal Spray (Rx)

*Black box warning removed by FDA

#6 Make Home & Car Smoke-free

• Seeing others smoke and having ashtrays and lighters around can be a trigger• Secondhand smoke is not safe• Since January 1, 2008 it has been illegal to

smoke in a car with anyone under 18• Stand up for your right to a healthy

environment

#7 Set a Quit Date

• Capitalizes on current motivation• Establishes a commitment• Sets a tangible goal - date to work toward• Provides a way to be active in the quitting process• Creates personal accountability

v Set a quit date within 2 weeks

#8 Quit on the Quit Date

• Sounds obvious, but giving it a try is critical• Planning is good… doing is even better• Important – Give it a try!

Mon Tues Wed Thurs Fri Sat Sun

X X X X X X XX X MY QUIT

DAY!!

#9 Picture Being a Nonsmoker• After quitting people can think

of themselves in one of two main ways:

1. As a smoker who’s just not smoking

2. As a nonsmoker, where smoking is no longer an option, in any situation

#10 Keep Trying

• How many tries does it take to quit for good?

• 10 to 12 attempts on average*

•What does this mean?

• It’s hard to quit, but it is possible

* Zhu (Sept., 2007) Oceania Tobacco Control Conference, Auckland, NZ.

Understanding Slips & Relapse

• Slips & relapse are normal: • It is common and not a reason to feel like a failure• The quitting process is NOT perfect; think of past changes

(e.g., first job, quitting drugs, changing eating/exercise habits)• Remember that quitting is a PROCESS

You haven’t failed until you stop trying!

Top 10 Tips1. Find a reason to quit

2. Make a plan

3. Call 1-800-NO-BUTTS

4. Get support

5. Use a quitting aid

6. Make home & car smoke-free

7. Set a quit date

8. Quit on the quit date

9. Picture being a nonsmoker

10. Keep trying

What is Your Role?

Clinical Practice Guidelines

• All clients should be screened for tobacco use, advised to quit and offered intervention

• There is a dose response relationship with the amount of contact provided

Clinical Practice Guidelines

Evidence-Based Model: The 5 A’s

Ask: Systematically identify all tobacco users at every opportunity

Advise: Advise tobacco users to quit

Assess: Assess each tobacco user’s willingness to quit

Assist: Assist tobacco users with a quit plan

Arrange: Arrange follow-up contact

Ask: Systematically identify all tobacco users at every opportunity

The Helpline provides behavior modification counseling (quit plan and quit date)

The Helpline provides up to 4 follow-up calls – timing is based on the probability of relapse.

The 5 A’s and A, A, R

Advise: Advise smokers to quit

Arrange: Arrange follow-up contact

Assist: Assist smokers with a quit plan

Assess: Assess each smoker’s willingness to quit

Refer to the California Smokers’ Helpline, Peer-to-peer counselor and/or other cessation program

Current Helpline Services• Individual telephone counseling• 1 pre-quit call• Up to 4 relapse prevention calls

• Self-help materials• After-hours recorded messages• Text messaging program at www.nobutts.org• Online CHAT at www.nobutts.org• Smart phone App (iOS and Android)

• Some callers are eligible for free nicotine patches• Smokers living in homes with children 0-5• Asian language line callers

Helpline Numbers

• English 1-800-NO-BUTTS (1-800-622-8887)

• Spanish 1-800-NO-FUME (1-800-456-6386)

• Korean 1-800-556-5564

• Mandarin 1-800-838-8917

• Cantonese 1-800-838-8917

• Vietnamese 1-800-778-8440

• TDD/TYY 1-800-933-4TDD (1-800-993-4833)

• Chewline 1-800-844-CHEW (1-800-844-2439)

What Happens in Each Call?

• Intake call– Determine needs, ~8 min. call

• Initial session– Comprehensive, ~30 min. call– Preparation to quit– Setting a quit date

• Follow-up sessions– Up to four 5-8 minute calls– Relapse prevention– Pharmacotherapy review

Days after quitting

Relapse-Sensitive Scheduling

Source: Zhu & Pierce (1995), Prof. Psych. Res.& Practice, 26, 624-625

Perc

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bstin

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3014730 1

100

80

60

40

20

0

Relapse Curves for 3 Groups

0

20

40

60

80

100

0 30 60 90 120 150 180 210 240 270 300 330 360

Days after quitting

Perc

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bstin

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Multiple CounselingSingle CounselingSelf-Help

Zhu et al. JCCP, 64, 202-211

Helpline Intervention Summary

• 1 planning call (25-30 minutes)• Up to 4 follow-up calls (5-8 minutes)• Help clients to:– Identify a strong reason (Motivation)–Bolster belief in ability (Confidence)–Develop a solid plan (Skills)–Adopt a new view of self (Self-image)–Keep trying (Perseverance)

Helpline Referral Options & Resources

Self-Referral

Can be ordered at www.nobutts.org

• How to refer to the Helpline: • Select “Community Resource Linkage” under the “Specialty Type”

dropdown• Select “Smokers’ Helpline” under “Specialty Type”

• Once referral is received, the Helpline proactively reaches out to patient • For more info contact Carrie Kirby at (858) 300-1054 or

ckirby@ucsd.edu

eConsult

Other Online Referral Options

Web-Based DIRECT Peer to PeerDescription Refer online at

www.nobutts.orgRefer via secure email Refer via Electronic

Health Record

Cost Free Varies Varies

Reporting Aggregate referral disposition

Aggregate referral disposition

Individual patient referral disposition

How to Get Started

Register online at www.nobutts.org

Complete online request form or contact Carrie Kirby at (858) 300-1054 or meaningfuluse@ucsd.edu

Helpline Website - www.nobutts.org

Free Helpline MaterialsDownload free materials at www.nobutts.org

Thank you!

Gary Tedeschi, PhDClinical Director

California Smokers’ HelplineUniversity of California, San Diego

858-300-1044gtedeschi@ucsd.edu