Supporting Youth to be Tobacco Free

Trish Hill, Interior HealthAndrea Winckers, BC Cancer Agency

Learning Outcomes

At the end of the session, participants will have an increased understanding of:·       The latest evidence on youth and tobacco use·       Cessation medications and ways to support successful quitting·       Tobacco industry marketing tactics o youth·       Environmental damage and social justice issues And will have greater confidence in:·       Addressing tobacco with youth/young adults who smoke·       Using interactive tools to educate and motivate youth to take action on tobacco

Tobacco Facts

Tobacco kills 6000 people a year in B.C. including about 110 non-smokers

Kills ½ of long term users when used exactly as intended by the manufacturer

Causes twice as many deaths as vehicle crashes, alcohol, suicide, homicide, and HIV combined

4,000 + chemicals in cigarette smoke, more than 50 are cancer-causing

Reduces immunity and interferes with wound healing, even among younger users

Tobacco Facts

Youth and Tobacco Products

Nicotine is one of the most addictive substances known

Youth often underestimate their

dependence

Tobacco dependence is associated

with addiction to other substances

Treatment of other addictions is more

successful if tobacco is included

Support Youth

Youth are increasingly asking for help to quit

but are not well supported

Young people are subjected to multi-million

dollar marketing campaigns by tobacco

companies

85% of current smokers started before age

18

Tobacco Use in BC

Rates in Interior region are higher than the provincial average (15%), at 17% (106,500 smokers)

Youth Tobacco Use in BC

BC youth smoking rates are lower than the national average

11% for BC youth aged 15-19 (BC Stats 2008)

31% for aboriginal youth (BC Stats

2008)

Higher prevalence among those with lower socio-economic levels, mental health and addictions issues

Youth Feedback

Ever Thought of Quitting Video

Support at school – West Kootenay Youth Forum Feedback

Not being supported Give out gum – gum therapy Refer to Freedom Quest Incentives – not nec. Works Teachers put stress on students Support for stress More contact with youth workers - busy

Gross Vid 1

http://www.youtube.com/watch?v=5qYh2tosxos

Forms of Tobacco

Cigarettes, pipes or cigars

Smokeless tobacco (chew or snuff)

Newer alternatives:

Paan (betel nut and candy)

Dissolvable tobacco products

Electronic cigarettes

The CigaretteHundreds of additives are used to:

Increase uptake of nicotine to the brain (ammonia)

Keep the cigarette from going out

Mask the taste (sugars, cocoa, other flavourings)

Make smoke more tolerable to the lungs (bronchodilators)

Combustion (CO) and chemicals from soil, fertilizers and pesticides

Cigarillos

New legislation regulates flavourings, packaging and size but loopholes are appearing

Packaged to look like lip gloss and markers.

Smokeless Tobacco

Snuff (3.6 mg of nicotine after 30 min)

Chew tobacco (4.5 mg after 30 min)

Snus (new in Canada)

Cigarettes: 1 mg nicotine

Smokeless is not Harmless

Oral cancer

Leukoplakia

Periodontal disease and dental

cavities

Target Consumers

Athletes

Male

Youth

Smokers

Gross Vid 2

http://www.youtube.com/watch?v=1MF4sCvkAAA&NR=1

Psychological Effects

More likely to have depression

More likely to have other addictions

More severely dependent

Often lack effective alternative coping skills

Depression and Smoking

The 5 most Effective Interventions:

1. Increase price

2. Reduce tobacco promotions

3. Create smoke-free public places

4. Counter-advertising

5. Cessation supports for tobacco users*

Support and Respect

Tobacco addiction should be considered a chronic condition which requires ongoing support and repeated intervention

Tobacco users should be treated with respect, dignity and sensitivity when they are offered tobacco intervention

Tobacco users have the right to decide whether, when, and how they will stop using

Positive Influences

Mentoring by successful youth quitters

Create trust by using a non-judgemental, supportive approach

Recommendations by peers to quit

Perception that their tobacco use is hurting someone else (e.g. exposing a younger sibling to second-hand smoke, modeling tobacco use to younger students)

Brief Interventions are Effective

Minimal interventions lasting less than three minutes increase overall quit rates – teachable momentSmoking cessation interventions delivered by multiple types of service providers markedly increase cessation ratesStopping is a process which may take several attempts – brief Interventions support this processThere are many opportunities to support youth to be smoke-free

• http://www.youtube.com/watch?v=oAoUeIDQsoo

The 3 A’s of Tobacco Cessation:

Ask … Advise … Assist

Designed for use by non-healthcare professionals

Coaches the practitioner how to communicate effectively to help with the difficult process of changing behavior and overcoming addiction

TEAMTobacco Education & Action Module

Tailored Interventions

Goal setting, development of coping skills and self efficacy, cognitive reframing, problem solving, positive reinforcement – Developing a Quit Plan - TEAM

Stop Smoking Medications

NRT: patches, gum, lozenges, inhaler

Bupropion (Zyban)

Varenicline (Champix)

Insufficient evidence that they are effective for general youth population, yet effective in adult populations to increase odds of quitting

Advise heavily addicted youth to discuss medications with their physician or pharmacist

MotivationSocial injustice

Environmental devastation

Marketing to youth

Formerly emphasis was on the dangers of tobacco

Traditional use of tobacco: a positive model for aboriginal and non-aboriginal youth

I’ll tell you why I like the cigarette business. It costs a penny to make. Sell it for a dollar. It’s addictive. And there’s fantastic brand loyalty.

http://www.youtube.com/watch?v=JndtG8Y7yfw

A Global Epidemic

Tobacco is grown in over 120 countries on more than 4 million hectares of the world’s agricultural land

Tobacco companies use exploited labour

Child labour is very inexpensive…

Environmental Impacts

Pesticide and fertilizer runoff from fields

Massive deforestation associated with tobacco curing

Workers suffer:

Pesticide poisoning

Green tobacco sickness

Lung damage

Environmental Impacts

Worldwide, an estimated 3/4 of a billion kilograms of cigarette butts are disposed of every year

They deposit nicotine, heavy metals, plastic fibers, benzene and other carcinogens into our environment

Cigarette butts can take up to 15 years to break down

Scenarios

1. You are a youth worker. Tyler (16) is in your office talking about an incident where he lost his temper. During the discussion he lets you know that he’s really trying hard to quit smoking and it’s turned him into a bit of a jerk.

2. You are a family friend. Christy is an 18 year-old who’s just found out that she’s two months pregnant. At a backyard BBQ, you notice that she’s on her 4th cigarette of the evening. She sits down beside you and starts to talk about her pregnancy.

Traditions

Please respect traditional use of tobacco

Social Ecosystem

Public Policy

Community( resources, norms)

Organizational(social, economic, political)

institutions)Interpersonal

(family, friends, social networks)

Individual (knowledge,

attitudes, skills, genetics)

Research states:

That fear-based just-say-no approaches to drug education do not work, and they never have. To date, traditional drug education programs have failed to have any significant influence on student behaviours.

Similarly, zero-tolerance drug policies have failed to solve student drug issues (instead they isolate the students who need connection with peers and caring adults the most).

Centre for Addictions Research of BC

Research States

Creating healthy physical and social environments for learning that builds connections. Benefits both academic and social development. Reduce engagement in high risk behaviours.

Developing health literacy – understanding skills and confidence needed to survive and thrive in world where substance use is common.

Asset – focused approach seeks to build on supporting personal capacity. 40 Developmental Assets.

Cognizant of risk – what factors about the environment contribute to risk? Important to know how to address risk and compensate for it.

Interactive Activity

Bullring Activity – Each string represents an asset and a risk your school currently has in regards to tobacco use.

Multiple uses: triggers, supports, personal assets etc…

Whole School Approach

Involves 3 interconnected areas for action that address student’s needs for: a healthy environment to learn and grow; healthy relationships and connections with peers, teachers and other school staff, and exposure to learning environments that help gain the knowledge and skills required to maximize their health and wellbeing. (Dan Reist)

Areas for Action: Utilizing the 4 Pillars framework: Policy; Parnership & Sevices; Social & Physical Environment; Teaching & Learning

Utilizing the 4 Pillars Framework:

Brainstorm for each pillar what your school could do to address tobacco use.

How does your school function to promote wellbeing?

How does your school address building personal capacity?

Resources

QuitNow:1-877-455-2233 www.quitnow.ca

Click on “Resources for Health Professionals”

http://www.becomeanex.org/

www.bccancer.bc.ca/PPI/Prevention/tobacco

www.interiorhealth.ca >choose health> tobacco reduction

www.otru.org→ Training → Online Course → Tobacco and Public Health: from Theory to Practice.

http://www.healthyheart.bc.ca/clinicalprevention

More Links

Global social justice issues: http://www.globalissues.org/article/533/tobacco http://www.eclt.org/ http://www.who.int/tobacco/resources/publications/rights_child/en/ http://www.corpwatch.org/article.php?id=14947 Environmental Impacts: http://www.nsra-adnf.ca/cms/file/pdf/factsheet.pdf http://www.ash.org.uk/files/documents/ASH_127.pdf http://www.who.int/tobacco/en/atlas16.pdf

Tobacco Free Youth