Page 21 - Delaware Medical Journal - March 2016

PUBLIC HEALTH
TABLE 2: 5 A’s for Tobacco Cessation
5 A’s8
STRATEGIES
ASK about tobacco use and document.
Motivate and develop a rapport: “It sounds like there is a part of you that wants to smoke, but also a part of you that wants to quit.”
ADVISE tobacco users to quit.
Use personalized, clear messaging.
ASSESS readiness to quit.
Tailor interventions to level of readiness to quit 19
•Pre-contemplation (not even thinking about quitting)
•Contemplation (seriously thinking about quitting)
•Preparation (thinking about quitting, looking into medications or programs)
•Action (actively quitting, setting a quit date/plan in place)
•Maintenance (quit for 3-6 months or more)
Assess hospitalized tobacco users interest in medications for relief of withdrawal symptoms.
Motivate: “If I could help you get some support, would you be willing to give quitting a try?”
ASSIST with medications, tobacco cessation coaching, and motivation.
•Introduce a variety of outpatient tobacco cessation counseling options.
•Motivate: “Tobacco cessation coaches know what it is like to
try to quit, and they know what works. They really get to know you and individualize a quit plan for you and your life.”
ARRANGE for follow up contact to provide support.
Sample models include:
•Follow-up phone calls
•Interactive Voice Response tele- phone technology
•Tobacco cessation telephone Quitlines
Nicotine used for pleasure and mood regulation
Nicotine used to self medicate withdrawal
Nicotine cravings
Abstinence causes withdrawal
FIGURE 1
The Cycle of Nicotine Dependence
NICOTINE PHYSIOLOGY
Tobacco smoke contains more than 4,000 compounds, many of which are toxic, mutagenic, or carcinogenic. Nicotine is considered to be the most addictive agent in tobacco products.4 Nicotine affects various Table 1 outlines the neurotransmitters involved and their effects.5
Nicotine has four major physiological effects on the human body:
1) cardiac and respiratory effects; 2) central nervous system effects;
3) tolerance; and 4) nicotine addiction. Nicotine causes tachycardia, vasoconstriction, and rise in blood pressure. It binds to nicotinic acetylcholine receptors in the central nervous system thereby releasing dopamine, which induces the feeling of pleasure. Nicotine has a half-life of two hours and clears rapidly from the central nervous system leading to withdrawal symptoms and craving for tobacco. Nicotine withdrawal symptoms include irritability, restlessness, low mood, increased appetite, insomnia, and poor concentration. Nicotine addiction is conditional on the amount and the way in which nicotine is delivered. It is easily absorbed in the lung, oral, and nasal mucosa as well as skin.6 Cigarette smoke is the most rapid and effective way of delivering nicotine to the brain.4 Figure 1 explains the cycle of nicotine dependence.
Del Med J | March 2016 | Vol. 88 | No. 3 85