Smoking Stats. The Lung Association and Smokers Helpline. The Newfoundland and Labrador Smokers Helpline CARE Fax Referral Program

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1 The Newfoundland and Labrador Smokers Helpline CARE Fax Referral Program Presenter: Raelene Goosney, B.Sc., MPH Director (Acting) of the Smokers Helpline The Lung Association and Smokers Helpline Lung Association Involved in Tobacco Control since the mid-1960 s Traditionally, smoking cessation efforts scattered and urbanized Launched The Smokers Helpline on January 1, 2000 For the first time we could offer the entire province an accessible cessation service more coordinated, comprehensive services, free of charge The Smokers Helpline is not just a smoking cessation call centre; it operates as a hub or point-of-entry for all tobacco-related inquiries. Smoking Stats Smoking rates have declined significantly over the years. In 1966, 45% of those aged 15 and older were smokers. In 1999/2000, the smoking rate in NL was 28%. Since 2005 the smoking rate has hovered at 20-21%, and is currently 20%. 1

2 Smoking Stats From the 2012 Canadian Tobacco Use Monitoring Survey (CTUMS): In NL, 19.7% of the population age 15 years and older are current smokers. (16.1% in Canada) Age % % % % 15+ (Males) 23% 15+ (Females) 17% Smoking Rate Males appear to smoke more (16.4 cigarettes per day) than females (13.5 cigarettes per day). Tobacco contains Formaldehyde Arsenic Ammonia Methanol (Rocket Fuel) Acetone Hydrogen Cyanide (Rat Poison) Carbon Monoxide 2

3 and Nicotine Nicotine is a powerful moodaltering substance that is extremely toxic and addictive Smoking is the #1 cause of premature death and illness in NL Top 3 Smoking-Attributable Causes of Death in Canada #1 Lung cancer #2 Ischemic heart disease Cancers #3 Chronic airways Lung obstruction 1 Respiratory disease Chronic airways obstruction Bronchus Lip, Oral cavity/pharynx Asthma Esophagus Larynx, trachea Bronchitis/emphysema Cervix uteri Urinary bladder Pneumonia/influenza Stomach Colon Respiratory tuberculosis Leukemia Pancreas Kidney Liver other urinary Pediatric disease Low birth weight Respiratory conditions-newborn Cardiovascular disease Respiratory distress syndrome Ischemic heart disease Sudden Infant Death Syndrome Cerebrovascular disease Rheumatic heart disease Atherosclerosis Reproductive Problems 17 Hypertension Reduced fertility Aortic aneurysm Spontaneous Abortion Pulmonary heart disease Placental abruption Other arterial disease Smoking & Health Stats 17% of all deaths in NL are related to tobacco use, of which the leading causes are chronic diseases including cancer, cardiovascular disease and lung disease (Newfoundland and Labrador Centre for Health Information, 2012) Up to 80% of coronary hear disease, 90% of Type 2 diabetes and one-third of cancers can be avoided by changing to a healthier diet, increasing physical activity and stopping smoking (World Health Organization, 2012) 3

4 Tobacco Addiction In 1988, the U.S Surgeon General identified nicotine as the addictive ingredient in tobacco. It was concluded that nicotine addiction is similar to addiction to heroin or cocaine. World Health Organization (WHO) recognizes tobacco use as an addiction stating that it is seen falsely as a personal choice Tobacco addiction/dependence is identified in the ICD & DSM Tobacco Addiction DSM describes and categorizes nicotine dependence as a mental condition, belonging to the category of substance related disorders (positive diagnosis 3 or more criteria are met within 1-year time span) Tolerance Withdrawal Smoking more than usual Persistent desire to smoke despite efforts to decrease intake Extensive time spent smoking or purchasing tobacco Postponing other commitments to smoke Continuing to smoke despite health hazards Other criteria considered for diagnosing tobacco addiction: Time-to-first cigarette Number of cigarettes smoked per day Measures of craving Tobacco Addiction Inhalation of tobacco smoke rapidly delivers nicotine to the brain where it interacts with various nicotine receptors and triggers the release of neurotransmitters including dopamine that has reinforcing effects. Between cigarettes, brain nicotine levels gradually decrease, triggering several processes that contribute to the cycle of craving and the urge to smoke that maintains nicotine dependence 4

5 Tobacco Addiction Development and continuation of addiction to tobacco is affected by: Tobacco industry marketing Social determinants of health (income, social status, education and social support) - The choices we make are shaped by the choices we have People who use tobacco tend to: Start young Develop addiction Struggle with addiction for years Tobacco addiction/dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Every Action Counts Provincial Tobacco Reduction Strategy (TRS) Vision: To significantly improve the health of Newfoundlanders and Labradorians by reducing the harm caused by tobacco use, especially among priority populations. Goals: Encouraging and assisting people to successfully quit using tobacco Preventing children, youth and young adults from starting to use tobacco Protecting people from exposure to second-hand smoke Changing attitudes about tobacco use Every Action Counts Provincial Tobacco Reduction Strategy Dependant on commitment and co-operation of all partners and stakeholders in the province Working together we can prevent children from starting to smoke, protect people from the harms of second-hand smoke, help and increase the number of people who quit, and continue to change attitudes towards tobacco use Protecting the health of our children, our families, and our communities and enables people to live healthier and longer lives 5

6 Smokers Helpline Services For Tobacco Users Telephone Counseling Proactive: 6-12 sessions Convenient, personalized Self-Help Materials Quit kits, pamphlets, booklets, videos, etc. Website/E-Counseling Private e-counseling Automated quit messages ( and/or Text) Group Counseling You Can Stop By Starting With Us New Helpline Website Launched in January 2014 Some of the Highlights: New Look Updated information Enhanced features: Self-assessment tests Interactive body Goal-setting tool Quit Journey self-help information Resources for helping someone quit: including a new resource for assisting individuals with mental illness and other addictions Check Us Out on Facebook & Twitter!!! Facebook: The Newfoundland and Labrador Lung Association Twitter 6

7 Smokers Helpline Services For HPs/Workplaces/Students/Community Resource Materials Pamphlets, booklets, videos, etc. Promotional items for prizes Workplace Kits CARE Kits Tobacco SPEAK (Shared Practice, Education, And Knowledge) Conference Calls SHL E-Newsletter SHL Website Training Workshops/Conferences Training on a variety of tobacco cessation topics including Facilitator Training to offer the Lung Association group counselling program You Can Stop by Starting With Us Presentations/Displays Schools, Workplaces, Community Organizations Smokers Helpline Hours of Operation: 9am 9pm Monday to Thursday, 9am 5pm Friday 24-hour messaging Open limited hours on statutory holidays Outside hours of operation, an automated greeting invites callers to: Leave a message to have a counsellor call them back. Hear quit tips Visit the Helpline website for peer support and selfhelp information. Highlights of the Helpline Service Free Convenient Evidence-based, effective intervention for smoking cessation provides assurance to health care providers referring to the Helpline service Decreases barriers to treatment overcome geographical limitations of traditional face-to-face interventions Flexible - can be tailored to callers needs Provides some anonymity Builds on the interventions offered by healthcare providers Proactive calls increases likelihood of follow-up We are right here in our province to serve our province! 7

8 Graphic Health Warnings The quitline number is right on the tobacco packages Health Canada states that the intent of the new warning messages is to clearly communicate health risks, invoke emotional response and further motivate individuals to quit smoking. The number on the package connects directly to provincial Smokers Helplines. Callers from Newfoundland and Labrador connect with the Helpline based in St. John s, NL. Currently, the NL SHL is involved in the Health Canada evaluation of the information included these warnings. Provincial Smoking Cessation Program As of October 1, 2014, Government of NL implemented a new Smoking Cessation Program Provides access to 2 smoking medications, Champix and Zyban, to individuals 18 years of age and older who smoke and meet eligibility requirements under the NLPDP Different from coverage individuals receive under NLPDP Co-Pay Arrangement The program will pay the majority of the cost of drugs and dispense fees. Individuals will contribute a small amount (up to a maximum of $75 per year) towards the costs to support their efforts to quit smoking 8

9 CARE Fax Referral Program Free, quick, easy way for health care providers and community leaders to refer patients to the Smokers Helpline for help with tobacco cessation. 1 st Smoking Cessation Fax Referral Program in Canada. Abbreviated version of the 5As (Ask, Advise, Assess, Assist, Arrange). CAN-ADAPTT Counselling & Psychosocial Approaches 5 As Ask, Advise, Assess, Assist, Arrange ASK: Tobacco use status should be updated, for all patients/clients, by all health care providers on a regular basis ADVISE: Health care providers should clearly advise patients/clients to quit. ASSESS: Health care providers should assess the willingness of patients/clients to begin treatment to achieve abstinence (quitting). ASSIST: Every tobacco user who expresses the willingness to begin treatment to quit should be offered assistance. ARRANGE: Health care providers should conduct regular follow-up to assess response, provide support and modify treatment as necessary. Health care providers are encouraged to refer patients/clients to relevant resources as part of the provision of treatment, where appropriate. CARE Fax Referral Program Ask the person if they use tobacco products or have recently quit. If they answers yes, briefly discuss and Advise tobacco cessation. Ask if they would like to be referred to the Smokers Helpline for free support in quitting and/or staying tobacco-free. If the person consents, Refer them to the Helpline by completing the CARE Fax Referral Form. Fax the Referral Form to the Smokers Helpline at If the person declines, provide the Smokers Helpline toll-free number ( )and website ( and encourage them to call when they are ready. 9

10 CARE Referral Form Who can refer? Anyone!...with client consent What Happens When You Refer? Faxes are picked up every half-hour from SHL secure fax line; intake workers are scheduled to work everyday to ensure quick response time. First call attempt within 72 hours of receiving fax; 3-5 call attempts are made for each referral. If the client is reached, intake is completed, information package sent, counselling services and community referrals are arranged. If unsuccessful in reaching a client, a Smokers Helpline pamphlet and letter is sent encouraging them to call. Brief History of CARE CARE was initiated in 2004 focused on physicians In 2005, CARE expanded to focus on nurses To date, CARE has been officially launched to physicians, nurses, pharmacists, social workers, teachers, school counselors and psychologists, respiratory therapists, dietitians, dentists, dental hygienists, dental assistants, and a variety of workplaces There has also been a project which focused on seniors through a partnership with the Seniors Resource Centre 10

11 Nurses CARE SHL introduced CARE Program at the NL Nurses' Respiratory Society Meeting, 2004 NLNRS supported CARE and made recommendations to ARNNL Board to endorse and develop Nurses CARE Program. Launched pilot on November 30, 2005 to 500 nurses across the province. Roll-out to all nurses during Spring, clients referred by nurses from November 30, 2005 May 30, 2006 (6 months). Success of CARE Nearly 70% of Smokers Helpline clients are referred through CARE Achieved great success in reaching a high proportion of people in the province who smoke Directly attributed to the outstanding work of our partners involved in CARE CARE has increased the SHL call volumes without expensive media and promotion costs Evaluation Data Twenty-three percent of evaluation participants reported being smoke-free for at least 30 days when contacted at seven-month follow-up. Most follow-up participants who were smoking at intake took at least one action toward quitting (89%) such as: cutting down the amount smoked (77%) making a quit attempt lasting at least 24 hours (69%) setting a quit date (42%). SHL users are satisfied with the service they received and 94% of follow-up participants reported they would recommend the service to a friend. 11

12 Fiscal Year (April 1 March 31) 2003/04 (Pilot with Doctors only) Total CARE Referrals /05 (Launch with Doctors) /06 (Pilot with Nurses) /07 (Launch with Nurses) / / / / / / / Total CARE Referrals CARE Referrals Decreases in CARE Referrals 2009/10* to 2013/14 Total CARE Referrals decreased by 59% *2009/10 was chosen since it was a peak year for the Smokers Helpline Challenges of CARE Effectively incorporating CARE into existing policies, protocols, strategies, etc. Information transmission to Helpline Depends on our partners (external organizations, health professionals, employers, etc.) 12

13 Referral Sources CARE Type Fiscal Year # of Referral Sources (HPs) Nurse CARE Pilot Program *Year of Official Launch % calculated based on membership (practiciting) updates from ARNNL 2004/ / /07* / / / / / / / Total Referrals Importance of Getting Involved with CARE Over 70% of people who smoke want to quit. Many just don t know how or where to go for support. Most people who smoke see a health professional at least once a year. Opportunity to: advise people who smoke about the negative effects of smoking link people who smoke with supports to help them become smoke free. Importance of Getting Involved with CARE Intervention time = increase in success Investment to maintain and enhance the operation and promotion of quitlines is vital to the future success of quitlines and the ability to help tobacco users quit 13

14 Best Practices Easy ways to incorporate CARE into practice: CARE Forms accessible Post SHL posters/brochures as a reminder to staff and clients Contact the SHL to schedule training sessions on CARE and tobacco control within your region/field Promote CARE through various communication tools (newsletters, blasts, etc.) Discuss CARE as part of policy and standard protocols Future of CARE The SHL would love to hear from you! You use CARE, you know what works, what doesn t work and so on. Let us know! We want to make CARE work for you and your patients! References Els, C., Kunyk, D., Selby, P. (2012). Disease interrupted: Tobacco reduction and cessation. Health Canada, CAN-ADAPTT. Health Canada. (2012). Canadian tobacco use monitoring survey. Retrieved from Health Canada website: Makomaski Illing EM, Kaiserman, MJ. (2004). Mortality attributable to tobacco use in Canada and its regions, Can J Public Health, 95: Newfoundland and Labrador Centre for Health Information. (2012). Analysis of proposed goal indicators in relation to provincial data and trends in tobacco use, prevalence of chronic illness and hospitalization rates. St. John s, NL: NLCHI. The Newfoundland and Labrador Alliance for the Control of Tobacco (ACT). (2013). Every action counts! Tobacco reduction strategy Newfoundland and Labrador St. John s, NL: ACT. World Health Organization (WHO). (2012). Tobacco free initiative. Retrieved from WHO website: 14

15 Thank You! For more info/resources contact: Smokers Helpline