Confidence importance ladder_maudsley_model_nrt for young smokers 2011

nicotine replacement therapy for young smokers

+

a toolkit for practitioners ++

a practical guide for smoking cessation & young people compliant with the national minimum data set

smokingcessation toolkit for young people

Contents

2. Contents4. ACknowledgements5. BACkgRoUnd

5. WhyisanNRTBasedCessationToolkit NeededforYoungPeople?

6. OverviewofYouthCessation

7. LessonsfromthePilotProgrammein Scotland8. AmodelFoRYoUtHCessAtIon

8. MaudsleyandYoungPeople

9. AboutthisToolkit

10. TheReferralProcess

12. RecruitingYoungPeopleintoyour CessationService13. CessAtIonsUPPoRtFoRYoUngPeoPle

13. CessationSupport

13. DesirableSkills

13. RunningaGroup15. PRogRAmme

15. SomePointstoConsider

16. YoungPeopleandtheirTobaccoUse

16. Cannabis

17. YoungPeopleandCannabis

17. QuittingCannabis18. AlteRnAtIVestogRoUPsUPPoRt

18. OnetoOneSupport

18. TextMessageSupport

19. PharmacyServices

20.nICotIneRePlACementtHeRAPY(nRt)

21. GoodPractice

22. NRTProducts23. nAtIonAlmonItoRIng

23. MinimumDataSet

23. Paperwork

23. OtherOutcomes

24. CarbonMonoxideMonitoring25. 7weekPRogRAmme

25. GuidanceNotes

25. Week1–Introduction&PreparationWeek

28. Week2–Information&Preparation

30.Week3–QuitWeek!!

31. Week4to6–GroupSupport

32. Week7–PreventingRelapse &LookingAhead

33. BeyondWeek7…34.APPendICes

34.Appendix1:ClientQuestionnaire

35. Appendix2:ClientConsentForm

36. Appendix3:ClientRecordCard

37. Appendix4a:EndOfGroupClassification

38. Appendix4b:ClassificationGuidanceNotes

39. Appendix5:YouthReferralPathway

40.Appendix6:TextMessageSupport

41. Appendix7a:BriefInterventions

42.Appendix7b:BriefInterventionFlowchart

43.Appendix7c:BriefInterventions GuidanceNotes

44.Appendix8:MarketingMaterials

NicotineReplacement:ASevenWeekProgramme2

45.HAndoUts

45.Handout1: NicotineDependence Questionnaire1

46.Handout2: NicotineDependence Questionnaire2

47. Handout3:ReferralForm

48.Handout4:NRTContract

49.Handout5:WeeklyChecklist

50.Handout6:OnetoOne

51. Handout7:NRTAdviceSheet

54.Handout8:StagesofChange

55. Handout9:StagesofChange

56. Handout10:ReflectiveStaircase

57. Handout11:CarbonMonoxideStaircase

58. Handout12:QuittingDiary

59. Handout13:GroupAgreement

60.Handout14a: Importance/Confidence Ladder(GuidanceNotes)

61. Handout14b:ConfidenceLadder

62. Handout15:TheFourWhysExercise

63. Handout16:AmIReadytoStopSmoking?

64.Handout17:FeelingsAboutQuitDay

65. Handout18:MyStopSmokingDiary

66.Handout19:‘MyActionPlan’

67. Handout20:Coping

68. Handout21:Coping

69. Handout22:DiscussionaboutCoping

70.Handout23:Quitting

71. Handout24:QuitChart

72. Handout25:Withdrawal

73. Handout26: Discussion-Nicotine Dependence

74. Handout27:Maintenance

75. Handout28:Relapse

76. Handout29:WhatabouttheFuture?

77. Handout30:PeopleBingo

78. Handout31:TruthorLieGame

79. Handout32:SmokingWordsearch

80.Handout33:CSI–Glasgow

81. Handout34:FactorMyth?82. UseFUlResoURCes83. toolkItReFeRenCes

3NicotineReplacement:ASevenWeekProgramme

Acknowledgements

ThistoolkitwasdevelopedbyGlasgowCommunityHealthPartnership(CHP)NorthwestSector,onbehalfofNHSGreaterGlasgow&Clyde(NHSGG&C)YouthTobaccoActionGroup.

FundingforthisprojectwassecuredfromtheTobaccoPreventionFundadministeredlocallybyNHSGG&CSmokefreeServices.

Wewouldliketoexpressourthankstothemanywhocontributedtothisproject,especiallythefollowing:

• EastRenfrewshireCommunityHealthCare Partnership(CHCP,)HazelAnnMcWhirter andtheyoungpeopleinvolvedinClarkston SmokingInitiative

• NHSGG&CYouthTobaccoAction Groupmembers

• UrbanFoxProjectandNortheast GlasgowSectorwww.urban-fox.org

• NHSGG&CSmokefreeServices

• ScottishTobaccoControlAlliance(STCA)Youth andTobaccoForummembers

• PupilsfromSpringburnAcademy andJohnPaulAcademy

• YouthHealthServiceinMaryhill www.yhs-ng.co.uk

• NicolaMathieson,SarahDuncan, SarahNeilsonandGeriLucasfor theirsubstantialinput

ContactRobbie Preece Health Improvement Senior - Tobacco

Carol Beckwith Health Improvement Practitioner - Tobacco

Glasgow CHP Northwest Sector Gartnavel Royal Hospital Modular Building 1055 Great Western Road Glasgow, G12 0XH

Tel:0141 232 2110

Email:[email protected]:[email protected]

CopiesofthisToolkitwillbeavailableonSmokefreeServiceswebsite:www.nhsggcsmokefree.org.uk


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http://www.urban-fox.org

http://www.yhs-ng.co.uk

www.nhsggcsmokefree.org.uk

Background

wHYIsAnnRtBAsedCessAtIontoolkItneededFoRYoUngPeoPle?DespiteasignificantreductioninoverallsmokingratesinScotlandinrecentyears,smokingremainsthesinglebiggestcauseofpreventableprematuredeath.ThishasacostimplicationtotheScottisheconomyof£837millioneachyear1andinexcessof£409millioneachyeartotheNHSinScotland.2

Mostrecentstatisticsinclude:

• Between1996and2008thenumberof15year oldssmokinginScotlandfellfrom30%to15%

• ThemajorityofScottish15yearoldshavesaid thattheyhaveneversmokedacigarette3

• Moregirlsthanboyssmoke–16%of15year oldgirlscomparedto14%of15yearoldboys areregularsmokers

• Scotlandcomparesfavourablytoother Europeancountriesforsmokingprevalence inboysbutlessfavourablyforprevalence in15yearoldgirlsAlthoughoverallsmokingratesin13to15yearoldsshowsageneraldownwardtrend,thisisnotreflectedinthe16to24agegroupwheretheoveralltrendislessclear.ItisstillestimatedthatinScotland,approximately15,000youngpeoplebetweentheagesof13and24,takeupsmokingeachyear.4

YouNG PeoPle Need To quIT

Thevastmajorityofsmokerstakeupthehabitasteenagersandmanyyoungpeoplewhosmokewillcontinuetosmokefortherestoftheirlives.Studieshavesuggestedthatchildrenwhosmokearemorelikelytoreportpooracademicperformance,bemorepessimisticaboutthefuture,dislikeschoolandhaveanunhealthydiet.Smokinghasalsobeenassociatedwiththeuseofalcoholandillegaldrugs.5

Theearlierpeoplestart,themorelikelytheyaretosmokelongerandtodieearlyasaresultofsmoking.Achildwhostartssmokingat14oryoungeris4timesmorelikelytodieoflungcancerthansomeonewhostartstosmokeatage25oroverand15timesmorelikelytodieasaresultoflungcancerthansomeonewhoneversmokes.Itisalsoknownthat82%ofadultsmokersstartsmokingintheirteens.6

Youngpeopleareoneofthe3prioritygroupsforsmokingcessationserviceshighlightedbytheScottishExecutive7,withspecifictargetssetforreducingprevalenceamongyoungpeople.Theseareto:

• Reducethelevelofsmokingamongst13year oldgirlsfrom5%in2006to3%in2014

• Reducethelevelofsmokingamongst13year oldboysfrom3%in2006to2%in2014

• Reducethelevelofsmokingamongst15year oldgirlsfrom18%in2006to14%in2014

• Reducethelevelofsmokingamongst15year oldboysfrom12%in2006to9%in2014TheScottishGovernmentaimstoreducethelevelofsmokingamongst16to24yearoldsfrom26.5%in2006to22.9%in2014.


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YouNG PeoPle WaNT To quIT

TheScottishSchoolsAdolescentLifestyleandSubstanceUseSurvey(SALSUS)surveyof23,000Scottish13and15yearoldsfoundthat70%oftheregularsmokershadalreadytriedbutfailedtogiveup.8Bytheirlateteens,mostregularsmokersdonotseethemselvesasaddictedtonicotine,withmanybelievingtheyarestillincontrolandcouldstopiftheywantedto.

Surveyssuggestthatthemajorityof11to16yearoldswhoareregularsmokerswanttogiveupandarewillingtoseekhelptodoso.

Surveysalsoshowthatwhilstrecognisingthehealthhazards,someyoungpeoplesmokeasameansofcopingwithanxiety,controllingweightorcreatingapositiveself-imageandidentity.9Themainperceivedpositiveeffectofsmokingforyoungpeopleisthatit‘helpspeoplerelaxiftheyfeelnervous’.10

YouNG PeoPle CaN quIT

Smokingcessationservicesareaimedprimarilyatadults,anditisunlikelythattheseserviceswillbesuitableforyoungsmokers.Althoughtheevidenceforeffectivesmokingcessationinterventionsforyoungpeopleislimited,thereislittleexperienceintheUKofsettingupandrunningsuchinterventions,11evidencefromsurveysindicatethatamajorityof11to16yearoldswhoareregularsmokerswanttogiveupandarewillingtoseekhelptodoso.

…Idowanttostopsmoking,butit’sreallyhard…”Secondaryschoolpupil,15,Glasgow

“

oVeRVIewoFYoUtHCessAtIonItisclearfromcurrentresearchthatthereisnosinglereasonthatexplainswhyyoungpeopletakeupsmoking.Thisisillustratedinthe2006reportTowardsaFutureWithoutTobacco,12wherefactorsthatinfluenceyouthsmokingaredescribed.Asyoungpeopleareoneofthe3prioritygroupsforsmokingcessationserviceshighlightedbytheScottishExecutive13andinlinewiththecurrentrecommendationstotheScottishGovernmentfromActiononSmokingandHealthScotland,14(ASHScotland)itisnecessaryto“createasupportiveenvironmentforsmokerswhowanttoquit”.

Despitethefactthatthecurrentevidencefortheeffectivenessofcessationworkwithyoungpeopleisweak,publichealthguidancefromNationalInstituteofHealthandClinicalExcellence15(NICE)recommendsthat:

…nRtshouldbeusedwithyoungpeopleaged12to17attheirrequestandwherethereisevidenceofnicotinedependence.”NationalInstituteofHealthandClinicalExcellence

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NICEhavealsorecommendedthattheuseofNicotineReplacementTherapy(NRT)inthisagegroupshouldbepartofasupervisedregimewithavailableintensivesupportinordertoencourageadherence.16

AtrialintheU.S.showedthatwhen13to17yearoldsusedeithertheNRTpatchorgum,itwaseffectiveindecreasingthenumberofcigarettessmoked.17

Whilstyouthsmokinghasbeenidentifiedasapriority,itisclearthattherearestillanumberofgapsinprovisionintheNHSGG&CHealthBoardarea.AfteranextensivemappingexerciseitisclearthatcessationprovisionforyoungpeopleintheNHSGG&CHealthBoardareaisstillinitsinfancy.

lessonsFRomtHePIlotPRogRAmmeInsCotlAndTheYoungPeopleandSmokingCessationPilotProgrammeinScotlandhighlightedkeypointsforconsiderationfordesigninganddeliveringNRTbasedyouthcessationservices.18

InApril2002NHSHealthScotlandandASHScotlandfundedamajorprogrammeofeightpilotcessationprojects,whichaimedtoengagewithyoungpeoplewhowantedtoquitsmokingandtoidentifyacceptableandpotentiallyeffectiveapproachestohelpthemquit.Settingsincludedayouthoffenderinstitution;formalandinformalyouthvenues;ahospitalmaternityservice;college,schoolandcommunityvenuesandtheWorldWideWeb.Themainaimsofthepilotprogrammewere:

• Toidentifyacceptableandpotentially effectiveapproachestohelpyoung smokerstoquit

• Toenhancetheknowledge,skillsand confidenceofyoungpeopletosupport futureattemptstoquitsmoking19

leaRNING PoINTS:

TheoutcomesoftheScottishpilotssuggestthatforayouthcessationservicetobeaseffectiveaspossibleitshouldbe:

• Person-centred

• Flexible,butsetwithintheparametersand resourcesoftheservice

• Engagingavailableexpertiseinyouthwork andtobacco

• Developandestablishstrongandeffective referralsystems

• Raisetheprofileoftobaccoharm

• Bemindfulofthemanycompeting commitmentsandinterestsofyoungpeople

• Beawarethatsomeyoungpeoplemayuse cannabisinconjunctionwithtobacco

• Seektoincreaseyoungpeoples’motivation forstoppingsmoking

• Addressstafftrainingneeds

• Maintainqualityandconsistencyofsupportas muchaspossible

• Ensureaconfidentialservicethatrespectsthe rightsofyoungpeople

• Makesurethatthelocationandaccesstothe serviceisaspracticalaspossible

• Makesurethattheminimumdatasetis recordedaswellasrecordinganyother indicatorsoroutcomesthathavebeenagreed

• Beawareoftheproblemsofworkingwithin settimescales,especiallyinschoolsettings, whenworkingwithyoungpeople

• Understandthecomplexityofaddiction, dependenceandmotivation

• Beawarethatforyoungpeople,motivation maynotbeconsistentandmaychangefrom weektoweek


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A model for Youth Cessation

mAUdsleYAndYoUngPeoPle

NHSGG&Cusea7weekwithdrawalorientatedgroupapproachdevelopedattheMaudsleyHospitalinLondon,andreferredtointhisdocumentastheMaudsleymodel

Aspreviouslymentioned,itisarequirementthatanycessationworkmustbedeliveredbycessationtrainedadvisors,andthisisthecaseforcessationworkwithbothadultsandyoungpeople.

TheScottishPilotProgrammeshighlighteddifficultiesinusingarigidmodelwhenworkingwithyoungpeople20howeverasMaudsleyreliesonaclosedgroupstructureitthereforefitswellwithmanyyouthsettings.

Groupworkwithyoungpeoplewillpresentdifferentissuestothoseencounteredwhenworkingwithadults.Examplesofissuesmightincludefriendshipgroups,gender,numbersandtimeconstraints.

Aflexibleapproachisnecessarywhendeliveringcessationsupporttoyoungpeopleduetothechangingnatureoftheirsmokingpatterns.TheMaudsleymodel,usedbytheadultcessationservice,doesnotalwaysallowforflexibilityandthiswashighlightedintheScottishPilotProgrammes.

Itisimportantthataservicemodelisdevelopedforyouthcessationwhichisinformedbybestpracticefromtheadultcessationservice,theScottishPilotProgrammesandfromresearchfindings.


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ABoUttHIstoolkItaIM of THIS ToolkIT

This toolkit is designed to support local smoking cessation services to create capacity to offer cessation support to young people.

The toolkit is specifically designed to support compliance with the National Minimum data Set (MdS) which Scotland’s Health Boards use to monitor cessation services jointly with the Information Services division.WHo IS THIS ToolkIT foR?

ThistoolkitenablesanyNHSGG&Ctrainedsmokingcessationadvisortodeliveraninterventionthatsupportsayoungperson’squitattempt.

ItisrecommendedbestpracticethatcessationadvisorscompleteNHSGG&C’sYoungPeopleandTobaccotrainingandhaveadegreeofyouthworkskillsinordertodeliverappropriatecessationinputstoyoungpeople.

INTeNSIve SuPPoRT GuIdaNCe

ThistoolkitwillprovideguidancefortrainedcessationadvisorswhowanttoprovideNRTbasedsupporttoayoungpersonwhetherthatisaspartofastopsmokinggrouporonaonetoonebasis.Thetoolkitcanbeusedtoprovidestructureanddirectiontodevelopflexibleprogrammesfordeliveryinyourarea.

Recentfindingsindicatethatakeyfactorindeterminingthesuccessofasmokingcessationprogrammeforyoungpeopleisthedegreetowhichtheprogrammeengagesthemwithemphasisonhowtheprogrammeisdeliveredaswellasonthecontent.21

TheguidanceprotocoloutlinedinthisdocumenthasbeeninformedbybestpracticefromtheadultcessationserviceandthelessonsandfindingsfromresearchandtheScottishPilotProgramme.22ItisbasedlooselyontheMaudsley7weekapproachandusesthisasatemplateforstructuringyouthcessationsupport.

for any other staff who are not cessation trained that would like to be able to offer brief advice, the toolkit provides information on how to raise the issue of smoking and carry out BriefInterventions (see appendix 7a to 7c for further information). The current training that is available is Raising the Issue of Smoking and this is available for anyone who wants to learn more about Brief Interventions. Information about this is available from:

SmokefreeServiceson01412014876oremail:[email protected]

FurthercessationtrainingforyouthworkerswillbeavailableinthenearfutureandinformationwillshortlybeavailableonASHScotland’swebsiteat:www.ashscotland.org.uk/training/

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mailto:sfstraining%40nhsggc.org.uk?subject=

www.ashscotland.org.uk/training/

tHeReFeRRAlPRoCessItisimportantthatpartnerorganisationshaveaclearunderstandingofhowtomakeappropriatereferralstoyouthcessationservices.TherelevantinformationthatwillbeusefulforthereferralprocesscanbefoundinboththeYouthReferralPathway(Appendix5)andtheBriefInterventionsguidance(Appendix7ato7c).

theYouthCessationReferralPathway(Appendix5)hasbeendesignedtogiveguidancetothosewishingtosupportyoungpeoplewhoexpressadesiretostopsmoking.FollowingthepathwayshouldresultinmorecontinuityandconsistencyofserviceacrossNHSGG&C.

Youth Referral Pathway

Contactthenamedyouthcessationreferralcontactwithinpostcodearea(e.g.FillinlocalyouthcessationReferralFormorcalldirect)orCallsmokelineon0800848484.

Alternativelyadvertisewebaddress(w-west,smokefreeservices)andphonenumber(Youngscot).

Yes

1.Identifiesthemselvesasasmoker

2.Adviseswantstostopsmoking

3.Assessifyoungpersonismotivatedtostopsmoking

YoUngPeRson‘UndeR18’

Isyoungpersonmotivatedtostopsmoking? no

Advisesupportavailableif/

whenreadytostop.

•AdvisortocontactYPtoarrangemeeting

•Advisortoconfirmmeetingondayorday beforescheduledmeeting

•Advisorassessesyoungperson’snicotine dependenceandmotivationtoquit

•Arrangesfurthersessionsifappropriate

•namedcontactrefersyoungpersontolocallytrained facilitatorbasedwithinyouthhealthserviceor voluntaryserviceinYoungPerson(YP)area.

•FacilitatorcontactsYPandarrangesmeeting.

•Facilitatortoconfirmmeetingondayordaybefore scheduledmeeting.

•Facilitatorassessesnicotinedependenceand motivationtoquit.

•Arrangesfurthersessionsifappropriate.

•Paperworktobecompletedateachcontact.

•Completedpaperworktobesenttosmokefreeservices

optionsforCH(C)P


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“

RefeRRalS – SoMe PoINT To CoNSIdeR

If a young person attends a group because they are motivated to stop smoking, the likelihood of a positive outcome is much greater. It is important that young people choose to attend a smoking cessation group because they want to make a quit attempt.

a YouNG PeRSoN NeedS To Be WIllING To CoMMIT To a GRouP:

as well as feeling motivated to quit, it is vital that young people are prepared to make an effort to attend cessation support sessions in order to make a quit attempt. If a young person is caught smoking in school and directed towards a cessation group, they may not actually be willing to make a quit attempt but simply attends the group to avoid receiving a punishment exercise. finding a way for the young person to demonstrate their commitment to attending a group might be to use an informal contract or agreement provided that they have not been pressurised to participate.

Young people who are referred to a youth cessation service must demonstrate a dependence on nicotine and also a motivation to quit.

Youngpeopleofcoursecanselfrefertolocalservices.Aswithadultservicesselfreferralsfrequentlyrepresentthemosthighlymotivatedquittersandthereforeselfreferralshouldbeencouragedwhereverpossible.Marketingstrategiesshouldreflecttheneedtopromoteselfreferral.

Anamedyouthcessationcontactshouldbenegotiatedinlocalareaswhowillbeabletosignpostyoungpeopletoanappropriateservice.TheyouthcessationmarketingmaterialsBUttoUtshouldbeavailableinyourareaandtheyareincludedinappendix 8forreference.

In Handout 3 there is an example of a Client Referral form that you may want to give to those who are referring into your service.

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ReCRUItIngYoUngPeoPleIntoYoURCessAtIonseRVICeAcommonproblemreportedduringtheScottishPilotProgrammeswasthattherewasdifficultyinenlistingyoungpeopleintocessationprogrammes.In order to raise the profile of Youth Cessation support available in your area, here are some suggestions for marketing and promotion:

• Outreach–visitsmokerscornerinschools

• Leaflets–distributeviaclassregistrationin school,youthorganisations,youthhealth services,sportsclubs,after-schoolclubs

• School–Personal&SocialEducationLessons, classregistration,schoolinfo-pointscreens, schoolhealthstaff

• Texting

• Noticeboardsinschools,communitycentres, leisurecentres,youthprojects

• Posters

• Newsletters

• Referralboxordrop-box

• Trainteachingstaffinbriefintervention

• Preventionandeducationinputsinschools andyouthprojects

• Socialnetworking

• MakelinkswithotherHealthImprovement programmes

BUttoUtmaterialsareavailablefromyourlocalSmokefreeServicesco-ordinator(SeeAppendix8).

TRaINING

Thosewhoarereferringintoyourservicemaybenefitfromreceivingtrainingintobaccoandrelatedissues.Improvingtheirknowledgeandconfidencetoundertakebriefinterventionsshouldhaveapositiveimpactonbuildingcapacity.

ThereareanumberoftrainingopportunitiescurrentlyavailablefromNHSGG&CSmokefreeServices.

Theseinclude:

• Raising the Issue of Smoking

• Young People and Tobacco

• Cannabis Training ForfurtherinformationabouttrainingopportunitiescontactSmokeFreeServiceson0141 201 4876oremail:[email protected]


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Cessation Support for Young PeopleCessAtIonsUPPoRt

Cessationsupportcanbedeliveredinagroupsettingoronaonetoonebasis,regardlessofwhethertheserviceisforadultsoryoungpeople.Groupsupporthasbeenevidencedtobe4timesmoreeffectiveinhelpingpeopletostopsmoking.

This section provides guidance for practitioners about the practicalities of organising and running a youth cessation group and one to one sessions.

desIRABleskIllsDesirableskillsofayouthcessationadvisor:

• Goodcommunicationskills

• Goodgroupworkskills

• Knowledgeoftherightsofyoungpeoples especiallyinrelationtotheirrightto confidentiality

• Youthworkskills

• Knowledgeofthecycleofchangeandits applicationinyouth/tobaccosettings

• Awarenessofthereasonswhyyoungpeople smoke

• Havinganholisticapproachtoyoungpeople makingaquitattempt(awarenessofother linkedbehaviourse.g.alcohol,drugs, relationshipsetc)

• HavinggoodknowledgeofcurrentChild Protectionpolicy

RUnnIngAgRoUPThings to think about when setting up a cessation group for young people:veNue

Commonsettingsthatyoungpeopleattendare:

• School,youthclubs,residentialplacements, accommodatedcare,college,universityand workplace.

Whateverthevenueyouwillneed:

• Accesstoaprivatespacewithadequateroom fortheplannedactivitiesandfortheOneto Onesessions

• Gettheenvironmentright–forexample,ifthe groupisinaschool,willitbebetterwithor withoutateacherpresent?Theenvironment shouldberelaxedenoughthattheyoung peoplefeeltheycanopenlydiscussconcernsSTaffING

• Youshouldalwaystrytoensurethatanystaff inthesettingarebothsupportivetowardsthe youngpeoplewhoaremotivatedtomakea quitattemptandthattheyfullyrespecta youngperson’srighttoconfidentiality

• Thesuccessofagroupisheavilyinfluenced bywhethertheyoungpersontruststhose whoareprovidingtheservice

• Youshouldhaveadequatestaffingforthe group–aminimumof2staffisrecommended asgivingonetoonesupportandtaking CarbonMonoxide(CO)readingscanbetime consuming


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GRouP SIze/MakeuP

• Considerwhattheidealnumberisforthe groupandwhetheryoushoulddecideona minimumnumberbeforestartingagroup. Agroupsizeofbetween8and14youngpeople isrecommendedwith10beingtheoptimum. Ifthegroupistoobigitwillbeunmanageable andthiscouldmakeitdifficultforthegroup toworkeffectively

• Thereareadvantagesanddisadvantagesof havingamixedgroup(ageorgender). Staffwhoareworkingwithyourgroupof youngpeoplemaybeabletoadviseonthis

• Thereareadvantagesanddisadvantagesof havinggroupsofclosefriendsasthiscanhelp createasupportiveenvironmentforsomebut canalsohavepotentialforcausingothersto feelleftout

• Forayoungpersonnotinapeergroup, heorshemaybeisolated,lacksupportand faceopposition

• Youngpeoplemaydropinandoutofafixed group.Thismaypresentdifficultieswiththe consistencyofthegroup

• Havinggroupsof‘strangers’canbeproblematic whentransferredtogroupsofyoungpeople andtheymaybemoretalkativeiftheyknow someoneelseinthegroup.

GRouP dYNaMICS

Gooddynamicsinagroupcanfostergoodteamwork,positiveconflictresolution,peersupportaswellasavoidingfewercliquesorsolitaryindividuals.Thingsthatinfluencegroupdynamicsareindividualneeds,personalitydifferences,ageandgenderdifferencesaswellasgroupresilience(howthecombinedstrengthsofthegroupcompensateforthelimitationsofindividuals).

Practitionerswhohavegoodyouthworkingskillswillbefamiliarwiththechallengesofyouthgroupdynamics.Howeverifapractitionerlacksexperienceinworkingwithyoungpeople,workingwithothermoreexperiencedpartnersmaybehelpful.

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somePoIntstoConsIdeRThistoolkitprovidesanoutlineofa7weekprogrammeandincludeshandoutsaswellaspaperworkfortheMDS.

• Youwillneedtofindastructurethatworksfor thegroupwhileatthesametimekeepingit flexibleinaccordancewiththebroaderneeds oftheindividualsinvolved

• Runningarigid7weekprogrammemaybe unworkableduetothenatureofayoung person’sprogressthroughthestagesof change

• Youmayneedtoconsiderwhethertoinclude morethantwopreparationweeksdepending onhowreadytheyoungpersonistoquit. Itwillbeadvantageousforyouifthose referringintoyourservicehavedonesome preparatoryworkintheformofawareness raisingandbriefintervention.Youmaystillneed tospendsometimeworkingthroughsomeof theinitialstagesofchangewithayoungperson duetothechangingnatureofayoungperson’s readinesstochange

• Inthefirstsession,establishgroundrules aboutwhatisacceptablebehaviourand ensurethatthegroupareinagreement withthese

• Planhowyoucanensurethatthepaperwork iscompletedandtheminimumdataset collected. This must be a priority

• MakesureyouallowtimeforOneto Onesessions

• Bemindfuloftimeconstraintswhenworking insomevenues(e.g.schools)

• Rememberthatsomepeoplerespondbetter toindividualsupportandmayfinditdifficult toparticipateinagroup

• Bearinmindthatyoungpeopleoften demonstratelimitedunderstandingofthe effortrequiredfromthemwhenmakingan NRTsupportedquitattempt

• Youngpeoplemaydisclosepersonal informationtoyouduringaonetoone– bepreparedforthisandrefertotheNHS ChildProtectionPolicyifnecessary

• Addresstheyoungperson’sunderstanding ofsmokingandmotivationtoquit

• Haveagoodunderstandingoftherole ofsmokinginayoungpersons’life

• Makesureyoucanrecommendcoping strategiesthatarehelpfulandrelevantfor youngpeople

• Youmayneedtotakeintoaccountthat someoftheactivitiesinthistoolkitwill needpreparationtimeintheinitialstages

• Bearinmindthatayoungpersonmay needongoingsupportafterweekseven anditmightbeusefultobuildthisintoyour programme.Thissupportcanbeofferedbythe practitionerinanexistingyouthhealthservice, bythepharmacyservicethattheyoungperson hasengagedwith,textmessageorother media,oranyotherframeworksthatareinplace

Programme


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YoUngPeoPleAndtHeIRtoBACCoUseYouwillfindthatyoungpeople:

• Oftensmokefordifferentreasonsthan adultsdo

• Canbesignificantlyinfluencedbypeers

• Areextremelylikelytobeconcerned aboutconfidentialitywhenseeking stopsmokingadvice

• Mayengagedifferentlywiththetraditional cycleofchangemodelassmokingpatterns arelikelytobeerratic(theymaywanttostop onWeek1butbyWeek2theymayhave changedtheirmind).

• Mayfindthattheiruseofcannabisprevents themstoppingsmoking

• Maynotstopsmokingbutmaydemonstrate otherchangesinbehaviourorattitudes

• Mayhavelittleornoknowledgeofstop smokingservicesworkinginsomevenues (e.g.schools)

CAnnABIs‘THe CaNNaBIS effeCT’

CannabisisaClassBdrug(MisuseofDrugsAct,2009).Whenworkingwithyoungpeopleyoushouldexpecttobeaskedaboutcannabis.Cannabisisamildhallucinogeni.e.itcanalterthewaycoloursandshapesareseen.

Cannabisismostusuallyfoundas:

• Thedriedleavesand/orfloweringtops oftheplant.(knownasgrassorweed)

• Blocksofresin(hash,potorblow)

HoW IS IT uSed?

• Around75%ofcannabisisrolledand smokedwithtobacco

• Waterpipe/Bong

• Pipe

• Neatcannabis

• Eaten

• HotknivesMostpeoplewhosmokecannabissaythatthemostcommoneffectsare:

• Relaxationandtiredness

• The‘munchies’-feelinghungry

• Beingtalkative

• Thingssounding,lookingand tastingdifferently

• Somefeelthatitmakesthemtense andanxious

Cannabisisoftendescribedasthe‘elephantintheroom’whichcannolongerbeignored.”

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YoUngPeoPleAndCAnnABIs• Cannabisisthemostwidelyusedillegaldrug intheUK.Althoughpeopleofallagesuseit, itismostusedbythoseaged16to29

• Manyyoungpeopleusecannabisbecausetheir friendsareusingitsothattheyfeelpartofthe grouporbecausetheyfeelunderpressure

• Thosewhousecannabis,mostoftensmoke itwithtobacco

• Someyoungpeoplewouldliketostopsmoking tobaccobutdonotwanttostopusingcannabis

• Somewhousecannabiswithtobaccowould notnecessarilyseethemselvesasbeing asmoker

• Smokingcannabiswithtobaccoincreasesthe damagetothemouth,throatandlungs

• Cannabisusemayhaveanadverseimpact onmentalhealthPeoplemayexperiencesome,allornoneofthefollowingeffectsafterusingcannabis:• Moodswings

• Beingunabletofocusproperly

• Feelingdizzy

• Feelingdownordepressed

• Strugglingatworkorschool

• Lungproblems

• Feelinganxiousorworried

• Heartracing

• Seeingorhearingthings

• Feelingsuspicious

• Itmayaggravateexistingconditionslike asthma,bronchitisandemphysema

• Cuttingyourselfofffrompeople

• Fertilityproblems,i.e.lowerspermcountand troublegettingpregnant


Doctorsnowbelievethattheriskofdevelopingapsychoticillness,suchasschizophrenia,isincreasedthemorefrequentlythatcannabisisused.Thisriskismuchgreaterifayoungpersonstartssmokingcannabisbeforetheageof15.

QUIttIngCAnnABIsYoungpeoplearemostlikelytobesmokingcannabiswithtobaccoandthereforewillgothroughthesamewithdrawalsassomeonequittingtobaccoalone.TheymaybenefitfromusingNRTandmustbecommittedtoquittingsmokingtobaccoandcannabis.

• Adequatepreparationtoquitisvital

• Withdrawalfromcannabisandtobaccoisno worsethanfromtobaccoalone

• Lookatareaswheretheymightstruggle e.g.iftheyareusingittorelaxandde-stress, helpthemfindalternativecopingstrategies

• Establishwhytheywanttoquit

Formoreinformationoncannabisanditseffectsvisit:

www.talktofrank.com

www.lifeline.org.uk

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http://www.talktofrank.com

www.lifeline.org.uk

onetoonesUPPoRtSomeyoungpeoplemaywishtoreceiveonetoonecessationsupportratherthanattendacessationgroup.

OnetoonesupportshouldfollowtheoutlinegiveninHandout 6 “What to do in a one to one”,anditcanbetailoredtosuittheindividualconcerned.Additionally,someoftheactivitiesinthetoolkitcanbemodifiedforuseinaonetoonesituation.

Onetoonesupportcan:

• Helpwhereayoungpersondoesnotfunction wellinalargegroup

• Makeiteasiertodiscussbarrierstostopping smoking

• Provideabetterplatformforgivinginformation

• Allowyoutogivesupportwithnodistractions

• Makeitmorepossibletofollowastructured (7week)programme

• Allowthepractitionertogainadeeper understandingoftheissuesthatyoung peopleface

• Provideopportunitytooffermoreintense support

• Canbelesstimeintensive

• Maymeanthatlessplanningisrequired?

• BUTalsomeansthereislessopportunityfor peersupport

Onetoonesupportforayoungpersoncanbeverysimilartotheframeworkusedwhenrunninganadultonetooneservice.

Aswiththeadultservice,thesupportcanbemoretailoredtofittheneedsoftheyoungpersonastherearemanyfewerthingstodistract.Thisalsomeansthatayoungpersonmaydiscloseissuestoyouthatareunrelatedtosmokingbecausetheyfeelthattheyareinasafeenvironment.Thisbeingthecase,allpractitionersshouldbefamiliarwithcurrentChildProtectionPolicyandshouldapplythistotheirpractice.

textmessAgesUPPoRtTextinghasbeenusedsuccessfullyinsomeareasforsendingremindersaboutgroupsandalsoforsendingmotivationaltexts.Thisissomethingyoumightwanttoconsiderusingwhenyouaresupportingyoungpeopleinaquitattempt.

Youmustfirstobtainconsentforsendingtextmessagesandtheremaybesomeissuesaroundconfidentialitywhenusingtexting.Youcanoffertosendtextmessagesthatare‘safe’i.e.areunidentifiableifreadbyathirdpartyandexamplesoftextsthatcouldbesentare:

InformationononewayofsettingupatextingserviceisinAppendix6andaconsentsectionisincludedontheClientConsentForminAppendix2.

…youhavesetyourgoalsandyoucanreallydoit…seeyounextweekatgroup…”

“

…youaredoingreallywell…keepupthegoodwork…seeyouFridayatyouthgroup/inschool…”

“

Alternatives to Group Support


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Phone or visit the pharmacies that the young people will be collecting their NRT from and tell them that you are running a group, as some pharmacists may not be used to giving NRT to young people.

PHARmACYseRVICesYoucandirectayoungpersontoalocalpharmacywheretheywillbegiventhefullrangeofsupportcurrentlyofferedwithintheadultservice.

Good PRaCTICe

Tomakethejourneysmootherforayoungpersonyoumightwantto:

find out if there are ‘rules’ for collecting NRT as some may prefer that the NRT Request form is left and then collected at a later date.

on the first visit to the pharmacy, go with the young person to establish good relationships and to help the young person to become familiar with the pharmacy procedures

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ThereislittlegoodevidencetoshowthatNRTworkswithyoungpeoplealthoughtheuseofNRTwithbehaviouralsupporthasnotbeenextensivelytestedtodate.NeverthelessNRTcanbeprescribed,whenrequested,wherethereisevidenceofnicotineaddiction.

Nicotinereplacementtherapyisanextremelysafeproduct.NRTdeliversalowlevelofnicotinethroughasteadydosingsystemwithouttheother4000chemicalswhichenterthebodywhensmokingtobacco.SmokersusingNRTarenottakinganythingnewintotheirbodiessoshouldnothaveanyreactiontonicotine.

InScotland,NRTcanbeprescribedtoyoungpeopleaged12andabove.

ClINICal CRITeRIa foR CauTIoN:

• Pregnantorbreastfeedingwomenshouldbe referredtothepregnancyservicesforspecialist helpbyatrainedmidwife.(Formoreinformation callSmokefreeServiceson01412014654)

• 12-16yearolds–AlthoughNRTissuitablefor teenagers,itisrecommendedthatthisgroup shouldnotuseNRTunlesstheyhaveaccess toasupportnetworktoensurethatnicotine dependencyandmotivationtostophas beenassessed

• Clientswithmentalhealthproblemsandon medicationshouldbeadvisedtoinformtheir GPifusingNRT

TherearedifficultiesinmeasuringtheeffectivenessofNRTwithyoungpeople,largelyduetotheirpooradherencetotherapywhichthereforemeansthatlevelsofNRTareoftennotatatherapeuticlevel.YoushouldstilladvisetouseNRTwhererequestedinlinewithsmokingcessationNICEguidelines.

Althoughtherehavebeenfewstudies,atrialintheU.S.showedthatwhen13to17yearoldsusedeithertheNRTpatchorgum,itwaseffectiveindecreasingthenumberofcigarettessmoked.24

Nicotine Replacement Therapy (NRT)

NeitherBupropion(Zyban)norVarenicline(Champix)arelicensedforusebythoseundertheageof18.Ifayoungpersonaged18expressesapreferenceforeitherofthesetreatmentstheyshouldbeadvisedonthisinlinewiththeadultguidelines.

WhenyouareexplaininghowNRTworksyoumightneedtoputalotofemphasisonthefactthatthereisno‘magicformula’thatmakesthemstopsmokingandthattheywillneedtomakeasustainedphysicalefforttochangetheirbehaviour.

YoungpeoplemaypresentbarrierstomakeexcusesforincorrectuseofNRT.

GivingoutannRtadvicesheetin(handout7)alongwiththePharmacyRequestFormwillremindthemofthingsthattheycandothatwillhelpthemuseNRTmoreeffectively.

TherearefactorsthatmayneedtobetakenintoaccountwhenprescribingNRTtoyoungpeople.

…nRtshouldbeusedwithyoungpeopleaged12to17attheirrequestandwherethereisevidenceofnicotinedependence…”(NICE2008)

“

…Idon’twanttousepatches…theymademefeelreallysick…”

“


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Adherenceinyoungpeoplecanbepoorerthaninadultsandassuchtherearesomeproductsthatencouragebettercompliancemorethanothers.Youmaywanttotakethisintoaccountwhendiscussingproductswithayoungperson.thetableofnRtProductsoutlinessomeoftherelativeprosandconsofthevariousproducts(seeHandout7).

WhendiscussingNRT,itmaybecomeapparentthatyoungpeoplemayhavebeeninfluencedbytheopinionsofotherpeople.Forexampleayoungpersonmaybealreadyprejudicedagainstusingthepatchbecauseeithertheyhavetrieditduringapreviousquitattempt,theyknowsomeonewhohasuseditandfailedtoquitorbecausetheyfeelitistoovisibletootherpeople.

IfayoungpersonexpressesapreferenceforanyNRTproductyouwillneedtomakesurethattheyfullyunderstandhowitistobeused.StresstheimportanceofthemcollectingtheirfirstsupplyofNRTpriortoquitdaybutfurthermore,ensurethattheyunderstandthattheyneedtocollecttheirNRTfromthepharmacyeaCH Week!

Failuretocollectprescriptionsandyoungpeoplesharingprescriptionsareadditionalfactorsthatcaninterferewithadherence.Youwillbealmostguaranteedtofindthatatleastoneyoungpersoninthegroupwillhave‘borrowed’apatchortwofromsomeoneelsebecausetheyhavefailedtocollecttheirNRTfromthepharmacy.

goodPRACtICe

…patchesdon’twork;mymumtriedthemandtheydidnaework…”

“

…IthoughtIcouldonlycollectitonathursday…”

“

…Idon’twantpatches–Idon’twantmymumtoknowIsmoke…”

“

…canItakemypatchofftosmoke…?”

“

…I’venotbeentogetmypatchesyet–Igotoneoffmypal…”

“

When you are recommending a product, it can be useful to take note of the pharmacies that the young people will be collecting their NRT from. This will enable you to make a courtesy call/visit to the pharmacies and let them know that you have some young people that will be coming to collect NRT as the pharmacists may be ufamiliar with dispensing NRT to this younger age group.

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as dual NRT therapy is not approved for under 18’s, scoring through the additional products on the Pharmacy Request form prevents any client adding a second product to the form

OtherissuesthatmayarisewhenyoungpeoplerequestNRT:

• YoungpeoplemayasktochangetheirNRT productregularly

• Youngpeoplemaysaythattheyhavelosttheir PharmacyRecommendationForm

Therewillbesomeissuesaroundissuingduplicateformsthatyoumayhavetoaddressifthesesituationspresentthemselves.

When recommending NRT products to young people guidelines state that YP (for young person) should be put at the top right hand side of the pharmacy recommendation form.

nRtPRodUCtsTheuseofNRTwithyoungpeoplehasnotbeenextensivelytestedtodate,inpartduetotheirpooradherencetotherapy.NeverthelessNRTshouldbeprescribed,whenrequested,wherethereisevidenceofnicotineaddictionandinlinewithsmokingcessationNICEguidelines.

NRT PRoduCT CHoICe

NHSGG&CprescribingguidelinesrecommendtheNicorette16hourpatchasthefirstlinechoiceforNRT.Inexceptionalcircumstances,clientsmayuseanotherproducte.g.allergytothepatchorapreviousunsuccessfulattempttoquitusingthepatch.Ifanalternativeproductisrecommendedthenthereasonmustbestatedontheform.

Itisimportantthatthefirstpriorityistheclientandhelpingthemtohaveasuccessfulquitattempt.

AdetailedlistofNRTproductsisavailableinhandout 7.


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National Monitoring

mInImUmdAtAsetTheMinimumDataset(MDS)isforrecordingthecoredatarequiredforanonymousnationalmonitoringofclientswhoaccessScottishNHSHealthBoardspecialistsmokingcessationservices,takepartinastopsmokingintervention,andwhosetaquitdatewiththeserviceduringthecourseoftheintervention.TheMDSispartofthedatacollectionandmonitoringworkofPartnershipActiononTobaccoandHealth(PATH),whichhasthefollowingobjectives:

• topromotegoodpracticeindatacollection forsmokingcessationservices

• todevelopastrategyforthenational monitoringofsmokingcessationservices

• tosupportsmokingcessationserviceswith datacollection,evaluationandmonitoring

• toofferguidancetosmokingservicesonusing clientdatainaccordancewithdataprotection andrelatedlegislation

• tosupportthedevelopmentofsmoking cessationinformationandresearchstrategies

PAPeRwoRkItisarequirementoftheservicethatappropriaterecordsarekeptofreferralsandinterventionsforbothinternal(NHSGG&C’sTobaccoPlanning&ImplementationGroup)andexternal(InformationServicesDivisionISD)audit.

Withintwoweeksofcompletionofanintervention,i.e.grouporonetoonesupport,therequiredpaperworkshouldbereturnedtoInformationServices(DataTeam)forprocessingandevaluationpurposes.Foreveryclientthereshouldbe:

• Completed Client questionnaire (appendix 1)N.B.shouldclientshavedifficultywithcompletionbecauseofliteracyproblems,thenthefacilitatorshouldassist.Alternately,clientsmayrefusetoanswersomequestionsontheformandthisshouldbenotedforthedataentrystaff

• Client Consent form (appendix 2) whichmust besignedanddatedbythefacilitatorand client.Ifnot,alldatabecomesinvalid

• Client Record Card(Appendix3)(detailsof theintervention)

• Pharmacy Recommendation form (ifapplicable)

Inadditiontothis,ifyouhavebeenrunningagroupthenanend of Group Classification form(Appendix4a/b)shouldbeaddedtothedatabeingreturned.

It is essential that data is returned accurately and timeously in accordance with your locally agreed procedures so that it is entered on the central database for monitoring purposes.

This information is also used for following up clients.

otHeRoUtComesAcommonthemethatemergesinavailableliteraturerelatingtosmokingandyoungpeopleisthelackofinformationonanychangesinbehaviourorreductioninsmokingfollowinginterventions.

These‘softer’outcomesarehelpfulinbuildingunderstandingofyouthsmokingpatternandtrajectories25.

Oneoftherecommendationsthathascomeoutoftheanalysisrelatingtoaction10oftheSmokingPreventionActionPlanisthat “youth tobacco projects should be encouraged to give careful consideration to the potential value of collecting and publishing data about reductions or changes in smoking (in addition to measurements of abstinence) in order to build our understanding of youth smoking patterns and trajectories”26


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Traditionallythequitratesforyoungpeoplearelow.Youmightconsiderotheroutcomesthatyoucouldcollectasanydatathatiscollectedcanthenbeusedtobetterinformyouthtobaccoworkaswellasfillingthegapthatexistsinunderstandinghowyouthsmokingchangesovertime.

Some possible outcomes that you might measure are listed below:

• Reductioninsmoking–aspathwaytoquitting altogetherbutthismaypromotethenotion thatsmokingoccasionallyisacceptable

• Changeinattitudetowardssmoking

• Increaseddesiretostopsmoking

• Changeinhowacigaretteissmokedie.not smokingthewholecigarette/takingsmaller draws

• Validatedquitsbutforlessthan4weeks (thereforenotrecordedassuccessfulquit)

• Increasedknowledgeaboutsmokingandrisk

• Increasedknowledgeofmythsaboutsmoking

• Attitudestosmokingmovingfrompositiveto negative

• Increasedconfidenceincopingmechanismsto dealwithstressesandinfluencesonsmoking

• Moredeterminednottosmoke

• Increasedmotivationtostopsmoking

• Lessuseofcannabis

• Increasedknowledgeofservicestosupport quitattempts

• Decreasedcravings

• decreasednumbersofcigarettessmokedwhile usingNRT

YoucanusetheReflectivestaircase(Handout10)torecordsomeofthesesofterindicatorsbynotingwhatyouarerecordingatthetopandthedateoneach“step”.

Inaddition,theConfidence ladder (Handout14a/b),quit Chart(Handout24)and“am I ready to Stop Smoking?” (Handout16)canallbeusedforthis.

Thisdatawouldideallybecollectedlocallyandbemadeavailableforanyresearchinthefuture.

a key purpose of evaluation is to help improve our service by learning how and why some things work and some do not. The type of outcomes listed above will make this possible.

CARBonmonoxIdemonItoRIngAswellasverifyingsmokingstatus,carbonmonoxide(CO)monitoringcanbeagoodmotivationaltoolforyoungpeoplewhoaretryingtostopsmoking.

COmonitoring:

• Canverifyaself-reportedquit

• Canhelpyoungpeopleengagewellwiththe stopsmokingprocess

• IsatoolforpromotingdiscussionofCOlevels

• Worksasagoodmotivationaltoolwhenyoung peopleseetheirreadinggodownsoquickly

WhenworkingwithyoungpeopleuseCOmonitoringwithcaution.MeasuringCOlevelsinyoungpeoplecansometimesbeproblematicandyoushouldbearinmindthefollowing:

• IftheCOmonitorhasayouthfunction,ensure thatitissetcorrectlypriortouse

• Ifareadingbelow4isobtained,thisisnot alwaysanindicatorof‘non-smoking’status. Issueswiththeerraticnatureofyouthsmoking meansthatitmaynotalwaysreflectan accuratesmokingstatus

• Ifthereadingislowandayoungpersonisstill smoking,itcanencouragecomplacency

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gUIdAnCenotesThisisanexampleofasevenweekprogrammebasedlooselyaroundthe7weekMaudsleymodelthattrainedcessationadvisorscanusewithgroupsofyoungpeoplewhowanttomakeaquitattempt.Additionalpreparationtimemayneedtobebuiltintoyourgroupprogrammesothatanyquitattemptismadeafterreadinesstoquitandmotivationhavebeenfullyexplored.Thismaymeanthatthegrouprunsformorethan7weeks,andtheprogrammeshouldbeadaptedaccordingly.

Note:ItisessentialthattheminimumdatasetisrecordedforSmokeFreeServicesanditisdesirablethatagreed‘softer’outcomesberecordedinordertoinformfuturework.

NB.This7weekprogrammeisaguideforusingwithgroupsofyoungpeopleanditshouldbetailoredtosuityourlocalsituation.Youcanusetheguidanceinthe“OnetoOne”sectionwhenadvisingindividualyoungpeople-someoftheresourcesmaybemoresuitableforonetooneadvicethanothersfortheyoungperson.

Youwillneedtoallowadequatetimeforpreparationmakingsurethatyouhaveallthematerialsandresourcesthatyouneedforeachweek’sprogramme.ThereisamaterialschecklistinHandout 5.

The exercises that follow are there to provide guidance and to support you to engage with young people. There may be other exercises and activities that you are familiar with that you find are more appropriate to use.

other Resources may be available from other organisations e.g. Royston Stress Centre (www.roystonstress.org.uk) and GaSP (www.gasp.org.uk).

SupportingresourcesmaybeavailablefromlocalHealthImprovementTeams.VisitSmokefreeServiceswww.nhsggcsmokefree.org.ukformoreinformation.

7 Week Programme

Graphicphotographicimagesarereadilyavailableonlineeg.GoogleImagesandthesecanbeusefulforactivitieslikeCSI-Glasgow.

Forexample,usingphotographsofcelebritieswhosmoke/don’tsmokecanbeusedwhenhavingdiscussionsaboutsmokingandtheinfluenceofcelebrity,imageandtobaccopackagingwhichillustratesomeofthewaysinwhichtobaccoisbeingmarketed.Seewww.w-west.org.ukforinformationon“ThePlainTruth”abouttobaccopackagingandmarketing.

Week 1–Introduction&Preparationweek(canbe1ormoreweeksindurationdependingonreadinessofyoungpeople)

Week 2–PreparationweekFocusonpreparingforquitweek(week3)anddiscussingandagreeingNRT

Week 3–Quitweek

Weeks 4 to 6–Groupsupport

Week 7–Lookingahead,maintainingquitandfuturesupport

week1–IntRodUCtIonAndPRePARAtIonweek• Introductions

• agreeing an agenda/group agreement

• expectations about the group

• Setting a quit date & preparation

• Previous quit attempts – discussion

• Cycle of change

• Information about cigarettes

• Complete paperwork (unless awareness week only)

• Summary and looking ahead to week 2


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www.roystonstress.org.uk

www.gasp.org.uk

http://www.w-west.org.uk


week1INTRoduCTIoNS

Introduceyourself,findouteveryone’sname–youmightwanttogetthegrouptowritetheirnamesonastickylabel(includingyou!).Anicebreakerissometimesusefulasitmayhelpyoungpeoplebecomealittlemorerelaxedandcomfortablee.g.People Bingo, (handout 30) or Truth and lies (handout 31).GRouP aGReeMeNT

Givinganoutlineofwhatthegroupisaboutandwhatwillhappenateachsessioncanbereassuringforthegroupmembers.

Itishelpfulifthegroupisabletoregulateitsownbehavioursobeginbysettingsomegroundrulestogether.OnewayofdoingthisistohelpthegroupcreateagroupAgreement(seehandout13forguidanceandsuggestions).

eXPeCTaTIoNS aBouT THe GRouP

Tryandfindoutwhatthegroupmembershopetogetoutofthegroup.

• Whyaretheythere?

• Whatdotheyunderstandby‘groupsupport’?

• Emphasisethatwhattheycontributeis importantandalsothateveryoneisdifferent andmaythereforehavedifferentexperiences, thoughtsandopinions.

SeTTING a quIT daTe

Explainthereasonformakingthequitdateonweekthreeandnotonweekone.Tellthemwhyitisimportanttohaveaperiodofpreparationandatthispointyoucouldlinkinadiscussionaboutthecycle of change(seebelow).

Thismightbeagoodtimetoaskpeopleiftheyhavetriedtoquitinthepastandwhatitwaslikeforthem.WHaT’S YouR STaGe? seestagesofChangemodel(s)–handouts8&9

Iftheyhavepreviouslytriedtoquityoucouldask:

• Whatwasitlikethelasttimeyoustopped/tried tostop?

• Howlongdidyoustopfor?

• Howdidyoufeel?

• Whatwashardaboutit?

• Whatwasgoodaboutit?

• Whatmadeyoustartagain?

• Whatwouldyoudodifferentlynexttime?

Tryandsteertheconversationawayfromtheconceptof‘failure’andencouragethemtofocusonwhatwasgoodabouttheexperienceandthethingstheydidthatworkedforthem.

TheConfidence Scale/laddercanbeagoodtooltouseintheearlystagesofagroup.(Handout 14a/b)

Ifthereareanypeopleinthegroupthathavenevertriedtoquit,itcanbehelpfultogetaninsightintowhattheythinkitmightbelikebyasking:

• Whatdoyouimaginewillbehard?

• Whathaveyouheardotherpeoplesaying?

• Howdoyouthinkyouwillcope?

• Howconfidentareyou?

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Youcoulduseflash Cards (handout 26)withsmokingrelatedwordstogetsomediscussiongoing.Wordssuchasaddiction, habit and dependence/stressillustratethatsmokingisnotjustaboutahabitbutisamuchmorecomplexmixofseveralthings.Thisactivityworkswellifyoucanencouragetheyoungpeopletomakethediscussionrelevantforthempersonally.

SMokING dIaRY

Usingasmokingdiary(handouts12&18)beforequittingisagoodwayforayoungpersontorecordanormalsmokingday.Thediarywillhelpidentifythetimeswhentheyoungpersonfindsitmostdifficulttogowithoutacigaretteaswellasidentifyingotherbehaviourthattheyassociatewithsmoking.Thiswillhelpthemplanhowtheywillcopewithquitting.INfoRMaTIoN aBouT CIGaReTTeS

What’sinacigarette?Youcanuseresourcesincludingthechemicalboardandthetarjartoillustratethe4000+chemicals.

Askquestionslike‘Wheredoestarcomefromandwhatharmdoesitdo?’

a good activity for generating discussion on this is the ‘CSI – Glasgow activity’ (handout 33)

One to One – Seeing Clients Individually (see Handout 6)

Complete paperwork

Usethetemplatesinappendices 1 to 4 tocollectalltherequireddatafortheminimumdataset.ThisinformationMUSTbecollectedandMUSTbereportedtoSmokeFreeServices.

• Thetemplatescover:

• Clientquestionnaire

• Clientconsentform

• Weeklyrecordcard

Inadditiontotheabove,thepharmacy NRT request form formspartoftheminimumdatasetandacopyshouldberetainedforforwardingtoSmokefreeServicesifNRTisrequested.

Ensurethecentralelectronicdatabaseisupdatedonaweeklybasis.Afterthefinalweek,theminimumdatasetshouldbesenttoSmokeFreeServiceswhowillinturnforwardthedatatotheISD.

Handout 16, ‘am I ready to stop smoking?’isausefulexercise.Thisallowstheyoungpeopletoidentifytheirownprioritiesandreasonsforwantingtostoportocontinuesmoking.Allowthemtimetothinkandreflectonhowtheyfeelanddon’tbeoverlyconcernedaboutperiodsofsilence.

a different exercise is ‘theFourwhys’that you can use to help young people explore any ambivalence they might feel towards stopping smoking.

(seehandout15)

AddICtIon

stRess

HABIt

dePendenCe


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CHeCk!:

• ConsentFormsigned

• COchecked

• RecordCardupdated

• PharmacyRecommendationformcompleted

• Requirestextsupport?

(Remember,ifsession1isforpromotingawarenessandgivinginformationonlyitwillnotbenecessarytocompletepaperworkatthisstage).Summary and look ahead to week 2

week2–InFoRmAtIon&PRePARAtIon• Re-visit group agreement

• focus on preparation for quit day

• feelings about quit day

• action planning

• keeping a diary

• Withdrawal

• one to one consultation/NRT option agreed/ record keeping/Co monitor

• Complete paperwork if not done previously

• discuss using text support/motivation


week2Welcomeeveryoneback(especiallyifanynewmembers).Itwillprobablybeusefultohaveeveryonewriteanamestickeragain.

GoovertheGroup agreement (Handout 13).Askifanyonehasanythingtoaddandcheckeveryoneishappywithit.

Weektwowillprimarilybeaboutpreparing for quit week:Howiseveryonefeeling?TheSmoking diary (handouts 12 & 18)isusefulforfindingoutwhateveryonehaslearnedfromkeepinganoteoftheirtypicalsmokingday.Youcouldusespecificquestionshere:

• Were there any particular times when you felt you really needed a cigarette?

• Which cigarettes did you enjoy the most?

• What activities made you want a cigarette?

• did being with particular people make you feel more like having a cigarette?

• Were there any cigarettes that you smoked but feel you didn’t really need to smoke?

• Were there any cigarettes that you felt you really couldn’t do without? feelINGS aBouT quIT daY

Howdoestheyoungpersonfeelaboutsettingaquitdate?

Anactivitytopromotediscussionherecouldbetowriteonflipchartordrawreadymadecardsfromabagthatidentifiesparticularfeelingsthatareassociatedwithmakingplanstostopsmoking:(See handout 17)

ConFIdent

deteRmIned

sCARed

negAtIVe

woRRIed

exCIted

AnxIoUs

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ReadY To quIT – aCTIoN PlaNNING

Iftheyoungpersonisreadytosetaquitdatethenusinganactionplanisonewaytoensurethattheyhaveagoodunderstandingofwhattheyneedtodotomakeaconfidentquitattempt.

Youcanusetheaction Plan (Handout 19)oryoucoulduseflipcharttomakeitlessofanindividualexerciseandmoreofagroupexercise.

TheStop Smoking diary (Handout 12 & 18)canhelpthemidentifysmokingpatternsinthedaysrunninguptoquitdayandcanenabletheyoungpersontomakerealisticplansforhowtheywillcopewithcravingsandwithdrawal.WITHdRaWal

Ayoungsmokerislikelytobeconcernedaboutwithdrawal,especiallyiftheyhavehadapreviousquitattempt.

Discussionaboutdiscomfortanddifficultieswithwithdrawalcanhelpdispelcommonmythsaboutwithdrawalaswellasprovidinganopportunityforyoungpeopletosharesolutionsandcopingstrategies.

discussion starters:

• Whatworriesyoumostaboutstopping?

• Whathaveyouheardotherpeoplesayabout theirownexperiencesofstoppingsmoking?

• Whathaveyouheardotherpeoplesayabout howtheycopewithwithdrawal?

• Canyouthinkwhatmightworkforyou?WITHdRaWal – Handout 25

Youcouldmakesomecardswithcommonwithdrawalsymptomsandusethemasdiscussionpoints.Encouragetheparticipantstothinkaboutwhattheyknowaboutandwhattheycoulddoiftheyexperienced,forexample,headachesforexample-helpthemlookfortheirownsolutions.

oNe To oNe

Complete paperwork NRT – Pharmacy Request form Co Reading

Itisuptoyouasapractitionerwhenyoudothis.Abenefittodoingitatthestartofthesessionisthattherewillbelesspressureontimelateron.Howevertherearealsobenefitstodoingitattheendofthesessionasthisthenallowsyoutochecktheparticipantsunderstandingofwhathasbeensaid,andalsotoreinforcetheexpectationsaroundcollectionofprescriptionsandcorrectuseofNRT.

Bearinmindthatayoungpersonmaydiscloseotherunrelatedinformationtoyouatthistimeandyoumayfinditusefultohaveavailabledetailsofotherservices/agenciessothatyoucansignpostyoungpeopletothem.

InCReAsedAPPetIte

CRAVIngs

IRRItABIlItY

HeAdACHes

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CaRBoN MoNoXIde ReadINGS

UsingCOmonitoringwithyoungpeopleisareallygoodwaytoletthemseetheeffectthatsmokingishavingontheirhealth.Inamixedsmoking/non-smokinggroup,thisisespeciallyevident.Itisagoodmotivationaltoolfortheyoungpeopleaswellasgivingtherequireddataforquitverification.

Itisnotunusualforyoungpeopletobealarmedabouttheorangeandredlightsonthemonitor–reassurethemaboutthisandthatthelightswillchangetogreenwhentheyquitsmoking.

TherecanbeissuesinusingCOlevelsasameasureofyoungpeoples’smokingasitdoesnotalwaysreflecttheoftenerraticnatureofhowyoungpeopleusetobacco.Ifayoungpersoncontinuestosmokeyetregistersalowreading,youshouldbeawareofthepossibilitythattheprocesshasthepotentialtobecomecounterproductive.TheCarbon Monoxide Staircase(Handout11)canbeausefulvisualtoolthatletstheyoungpersonseethechangesintheirCOlevels.MaINTaINING MoTIvaTIoN aNd avaIlaBle TeXT SuPPoRT

Remindthegroupabouttheiragreementandaboutsupportingoneanother.Emphasisethatonlythosewhohaveindicatedwillreceiveatextmessageon(specify day)andthatunlesstheyhaverequesteda‘safe’messagethenthetextwillbeexplicitlyaboutstoppingsmokingandattendingthegroup.

finally remind the group:

• tocollecttheirNRT

• tostarttheirNRTonQuit Day

• nottosmokeoncetheystartNRT

• thatyouwillsendthemareminderbytext (thosewhohaveelected)

• THaT THeY CaN do IT!

CHeCk!:

• ConsentFormsigned

• COchecked


• PharmacyRequestformcompleted


week3–QUItweek!!• agreement again!

• Review preparations

• Confirm that NRT has been started

• feelings about quitting

• Share coping strategies?

• encourage group to support one another

• looking ahead

• one to one sessions/Co monitoring/record keeping


week3Welcomeeveryoneback(thereshouldbenonewmembersifyouarerunningaclosedgroup).HopefullyeveryonewillhavemanagedtocollecttheirNRTandshouldhavestartedusingit.Youshouldnotbesurprisedtofindthatsomehavefailedtocollectit,havelosttheirprescriptionorhave‘borrowed’patchesfromsomeoneelse.EmphasisethatitisimportantforthemtocollecttheirownprescriptionasborrowingNRTfromotherswillleavesomeoneelseshort!

Youmaywanttore-visitthegroupagreementandremindthemofthevalueofpeersupport.

Takesometimetoletthemreview their preparations fromthepreviousweek(s)–lookingataction Plans andSmoking diaries canhelpthemfocusagainonhowtheythoughttheywouldcopewithwithdrawalandcravingsaswellasremindingthemtobeextraawareoftheir‘trigger’points.

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feelINGS aNd CoPING

Iftheyhavenotalreadycompletedanaction Plan,(Handout19)encouragethemtodoso.Thiscanbedoneinthecontextofadiscussion.InHandout 21 therearesomequestionstohelpgetthisconversationstarted.

Youcouldaskthemtocompletethe‘Reflective Staircase’ (Handout 10) tomeasureconfidenceandlinkthiswiththeiraction Plans (Handout 19)tohelpthemincreasetheirconfidencelevels.

Discusshowgroupsupportcanhelpwhenmakingchangesandwhencopingwithwithdrawalsymptoms(see Handout 20)Handout 22givesanactivityforgeneratingdiscussionassmallgroupsandcomingbackintoalargergrouptoshareideasaboutcopingandsupportingeachother.lookING aHead

Whatproblemsmighttheycomeupagainstinthefollowingweeks?

Howwilltheydealwiththem?Helpthemidentifypotentiallytrickysituationswheretheyarelikelytofinddifficultyinresistingtheurgetosmokeacigarette.

UsethequestionsinHandout 21 toencouragetheyoungpeopletothinkabouthowtheywillcopeandtothinkofsolutionsforthemselves.oNe To oNe

UsethistimetocheckthattheyhaveagoodunderstandingofhowtouseNRT.

Co Reading Complete Paperwork

CHeCk!:

• COchecked



finally remind the group:

• tocollecttheirNRT

• tousetheirNRT

• nottosmokewhileusingNRT



• Thattheyarenownon-smokers!

week4to6–gRoUPsUPPoRt• Review the week

• What has been good/bad?

• looking ahead

• Increasing motivation

• Practical advice

• dealing with withdrawal

• one to one session/Co monitoring/record keeping

• Summary and looking ahead

weeks4to6Welcomebacktoweek4/5/6.

Reviewtheweek,findouthowtheyhavecopedwithstopping,andwhethertheyhavemanagedawholeweekwithoutsmokingorwhethertherehasbeenarelapse.

Positivereinforcementisessentialwithyoungpeople.Iftheyhavestoppedsmokingandthenhadasubsequentrelapseyoushouldstillputtheemphasisonthefactthattheyhavemanagedtostopsmokingforthistimeandmakeitapositiveeventratherthana‘failure’–helpthemseeitasanachievement.Itisimportantforthemtorememberthatthisisajourneyandthattheycanlearnfromsetbacksandturnthemintopositiveexperiences.


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GRouP SuPPoRTSTIll SToPPed? – dISCuSSIoN

Handout 27 Thisactivityshouldgeneratediscussionaboutwhathasgonewellandwhathasnotgonesowell,andshouldencouragethemtohelpandsupporteachother.RelaPSed? – dISCuSSIoN

Handout 28Positivereinforcementiftheyhavegonewithoutcigaretteswhentheywouldnormallyhavesmokedcanbeverypowerful.Ifyoucanusearelapseexperiencetore-engagewithayoungperson,andyoucanencouragethemtotryagainandtolearnfromthepast.ThereisanactivityinHandout28thatrelatestothis.

YoucouldcheckoutatthispointimportanceandconfidenceusingtheImportance/ConfidenceladderinHandout14a/btodeterminewhethertheirrelapsehashadanimpactontheirconfidencelevels.GoovertheirActionPlan(Handout19)toseewhetheritneedstobemoreeffectiveormorerealistic.

Asktheyoungpeopletoremindthemselveswhytheyarestoppingandwhattheywanttoachieve.

one to one Co Readings Paperwork

CHeCk!:

• COchecked


• Requirestextsupport?fINallY ReMINd THe GRouP:

• tocontinuetocollecttheirNRT

• tokeepusingtheirNRTeveniftheythinkthey mightnotneedit

• nottosmokewhileusingNRT–notevenapuff!



• Thattheyarenownon-smokers!

week7–PReVentIngRelAPse&lookIngAHeAd• The last week!

• Being a non-smoker!

• Reflecting on how things have gone

• Staying confident

• looking ahead

• Staying motivated

• Supporting one another

• one to one/Co monitoring/record keeping

• future support/Pharmacy support / Youth Health Service

• Summary and well done! (hopefully!)

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week7Welcometothelastweek.Congratulatethemonmakingittoweek7anddiscusshowtheweekhasbeen.Establishcurrentsmokingstatusandthismightbeagoodtimetodotheone to ones.

Check Co readings Complete paperwork Record end of group status/classification CHeCk!:

• COchecked



• Endofgroupclassificationcompleted

SuCCeSSful quIT

Praisethemfortheirsuccessandreassurethemthatchanginganybehaviourtakesawhiletoestablish.Encouragethemtokeepfocusedandusetheiraction Plans (Handout 19)toremindthemselvesofthetechniquesthattheyknowworktohelpthemcopewithdifficultsituationsandcravings.

RemindthemtocontinuewiththeirNRTanditmightbehelpfultolookattheConfidence ladder (Handout 14a/b)andseehowmuchmoreconfidencetheynowhaveaboutstoppingandstayingstopped.IfyouareusingtheCarbon Monoxide Staircase (Handout 11) thenthismightbeagoodtimetolettheyoungpersonseetheCOlevelsandusethistoshowthemhowmuchtheyhaveachieved.dISCuSSIoN aBouT THe fuTuRe

Encouragediscussionaboutthenextfewweeksandabouthowitfeelsnowthatthegroupisfinishing.SeeHandout 29forstarterpointstohelpwithdiscussion.

RelaPSe

Reviewtherelapseusingthediscussionpointsfromlastweek(Handout 28).Istheyoungperson

readytomakeanotherquitattempt?Iftheyarenotreadythentellthemaboutthesupportthatwillbeavailabletotheminthefutureandmakesurethattheyknowhowtoaccessit.Reassurethemthatthisrelapsedoesnotaffectanyfuturesupport.Iftheyarereadytomakeanotherquitattempt,discussthiswiththemandagreehowitwillgoforward.SuMMaRY aNd PlaNNING foR THe fuTuRe

Youmaywanttogivetheyoungpeoplecertificatesofachievementhoweveryoumayfindthatthisisnotuniversallypopularastheymightfeelitdetractsfromtheir‘streetcred’!

Giveplentyofencouragementandremindthemofhowfartheyhavecomeandthattheyarenownon-smokers.Checkthattheyknowhowtoaccesssupportshouldtheyneeditandmaketime,ifpossible,foranyquestionstheymighthave.

Youmightwanttooffertextsupporttothemeitherweeklyoratanotheragreedtimeinterval.When the group is finished, collect all paperwork including the end of group classification sheet and return these to your administrator which will then be forwarded to smoke free services.

BeYondweek7…Makesuretheyoungpersonknowswheretogetsupportafterthegrouphasfinished.Theycanbedirectedtoanotherservicee.g.YouthHealthServicesorPharmacyoryoucouldcontinuetosupportthemonanarrangedbasiseitherinperson,byphoneorbytext.


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APPendIx1: ClIentQUestIonnAIRe

ABoUtYoU– ReMeMBeR, THIS IS CoNfIdeNTIal

1. Name:2. Address:

6.Dateofbirth:__/__/__ 7.Gender:qMaleqFemale

8.Iffemale,pregnant?qYqNqUnknown

3.Postcode:4.MobileNumber:5.Landline:

8.whatdoyoudo?Areyou:(pleasetickonebox)qInpaidemploymentqAtschool/collegeoruniversityqFull-timeparentorcarerqUnemployed

q Permanentlysickordisabledq Notknown/missingq Other(pleasestatebelow) ___________________________________________

tobaccoUseandQuitAttempts10.Onaverage,howmany cigarettesorroll-upsdoyou smokeinaday?q10orlessq11-20q21-30qMorethan30qUnknown

11.Howsoonafteryoucandoyou smokeinthemorning?qWithin5minutesq6-30minutesq31-60minutesqAfter60minutesqUnknown

12.Howmanytimeshaveyoutried toquitinthepastyear?qNoquitattemptsqOnceq2or3timesq4ormoretimesqUnknown

Quitdetails14.Datereferredtoservice:__/__/__

15.Quitdate:__/__/__

16.Dateofinitialappointment:__/__/__

9.doyoureceivefreeprescriptions? q YesqNoqUnknown

7.HowwoUldYoUdesCRIBeYoURetHnICgRoUP?(Choose oNlY oNe which best describes your ethnic background):

A.whiteqScottishqEnglishqWelshqNorthernIrishqBritishqIrishqGypsy/TravellerqPolishqAnyotherwhiteethnicgroup, pleasespecify

C.Asian,AsianscottishorAsianBritishqPakistani,PakistaniScottishorPakistani BritishqIndian,IndianScottishorIndianBritishqBangladeshi,BangladeshiScottish orBangladeshiBritishqChinese,ChineseScottish orChineseBritishqOther,pleasespecify

e.otherethnicgroupqArabqOther,pleasestatebelow: _____________________

B.mixedormultipleethnicgroupsqAnymixedormultipleethnic groups,pleasestatebelow ___________________________

d.African,CaribbeanorBlackq African,AfricanScottishorAfricanBritishq Caribbean,CaribbeanScottish orCaribbeanBritishq Black,BlackScottishorBlackBritishq Other,pleasespecify

F.qNotDisclosed


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APPendIx2:ClIentConsentFoRm

YOUTHSMOKINGCESSATIONCONSENTFORM(PleaseInitial)

IunderstandtheinformationIhavereceivedaboutthestopsmokingserviceandhavehadtheopportunitytoaskquestions.IunderstandthatmyparticipationisvoluntaryandIamfreetowithdrawatanytime.

Iamwillingformydetailstobekeptonaconfidentialdatabase,formyinformationtobeusedinrelationtotheserviceandnotidentifyingmeinanyway.Iagreetobecontactedinfutureinconnectionwithmysmoking(4weeks,3monthsand12months.)

Iagreetomydoctorbeingcontactedregardingmytreatmentandprogresswithgivingupsmoking.

Iwishtoreceivetextmessages

MOBILENUMBER:_________________________________

dataconfidentialityandsecurity

TheinformationprovidedbyyouwillbeheldinasecureenvironmentinaccordancewithTheDataProtectionAct(1998).Theinformationwillonlybeusedtoassesstheoutcomeofthisprojectandnodetailswillbepassedontoanyorganisationswhoarenotinvolvedintheoutcomesassessment.

GP:...............................................................................................................................................................................................

Practice:....................................................................................................................................................................................

OwnTelNo:.............................................................................................................................................................................

Signed(Youngperson):....................................................................................................................................................

Signed(Advisor):................................................................................................. Date....................................................

(Initial)

(Initial)

(Initial)

(Initial)

(Initial)

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APPendIx3:ClIentReCoRdCARd

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APPendIx4A:endoFgRoUPClAssIFICAtIon

ENDOFGROUPCLASSIFICATION

GROUPLOCATION:

GROUPDATES:

GROUPFACILITATORS:

TotalnumberofclientsattendedWeek 1 or 2:

Totalnumberofclientsmaking a quit attempti.e.attendedWeek 3 or beyond:

Week7Classification: Number:

Non-smoker:Smoker:ClientWithdrew:

OverallTotalCessationRate(%):

Comments:

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APPendIx4B:ClAssIFICAtIongUIdAnCenotes

non-smokeR–verbalverificationthatnocigaretteshavebeensmokedduringweeks3AND4postquitweek.Itisnotsufficienttoknowthesmokingstatusonlyatweek4postquitweek.

smokeR–verbalverificationthatanysmokinghastakenplaceineitherweek3ORweek4postquitweek.Even‘justapuff’isenoughtoclassifysomeoneasasmoker.

ClIentwItHdRew–asbefore:clientswhoverballywithdrawfromtheservice,clientswhodonotcompletethesessions,clientswhocannotbecontactedbytelephoneetc.

ClIentdIed–clientdiesduringtheirquitattempt.

noConsent–clientdoesnotcompleteconsentformeitherthroughchoiceorbecausetheyhavee.g.notattendedagroup.

old/NeW ClaSSIfICaTIoNSTC=Non–smokerOC,RS,US(ifsmokingweek6)=SmokerCW,US(ifnotsmokingweek6)=Client Withdrew

HowtoCAlCUlAteendoFgRoUPClAssIFICAtIon

q TotalnumberofclientsNon-smokeratweek7q Dividedbynumberofclientswhomadeaquitattempti.e.attended week3orbeyondq %


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APPendIx5:YoUtHReFeRRAlPAtHwAY

Youth Referral Pathway

Contactthenamedyouthcessationreferralcontactwithinpostcodearea.(e.g.FillinlocalyouthcessationReferralFormorcalldirect)orCallsmokelineon0800848484.

Alternativelyadvertisewebaddress(w-west,smokeFreeservices)andphonenumber(Youngscot).

•AdvisortocontactYPtoarrangemeeting

•Advisortoconfirmmeetingondayorday beforescheduledmeeting

•Advisorassessesyoungperson’snicotine dependenceandmotivationtoquit

•Arrangesfurthersessionsifappropriate

•namedcontactrefersyoungpersontolocallytrained facilitatorbasedwithinyouthhealthserviceor voluntaryserviceinYParea.

•FacilitatorcontactsYPandarrangesmeeting.

•Facilitatortoconfirmmeetingondayordaybefore scheduledmeeting.

•Facilitatorassessesnicotinedependenceand motivationtoquit.

•Arrangesfurthersessionsifappropriate.

•Paperworktobecompletedateachcontact.

•Completedpaperworktobesenttosmokefreeservices

optionsforCH(C)P

Yes

1.Identifiesthemselvesasasmoker

2.Adviseswantstostopsmoking

3.Assessifyoungpersonismotivatedtostopsmoking

YoUngPeRson‘UndeR18’

Isyoungpersonmotivatedtostopsmoking? no

Advisesupportavailableif/when

readytostop.

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APPendIx6:textmessAgesUPPoRt

tosendtextmessAgesUPPoRtYoUwIllneedtoHAVeACCesstoAnnHs.netemAIlAddRess.

• Signintothenhs.netwebsite

• Clickon‘Tools’

• ClickonSMSandFax

• Inthe‘To’fieldenterthemobilenumberyouwanttosendthemessageto asfollows07……[email protected]

• Click‘addtorecipients’

• Typeyourmessageandclick‘Send’

• ‘Queuedforsubmission’willappear–clickOK

• YourtextmessagehasnowbeensenttHIngstoRememBeRwHenUsIngtHetextseRVICe:

• Youneedtoobtainsignedconsenttousetextmessaging

• Youshouldensurethatitiscleartotheclientthatthetextwillbeexplicitin itsmeaning

• Shouldtheypreferthatanytextsentisdonesoinawaythatthirdpartiesdo notknowthattheyareattendingastopsmokinggroup,youshouldensure thattheymakethiscleartoyou


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APPendIx7A:BRIeFInteRVentIons

TheBriefInterventionguidancecanbeusedbypractitionerswhoarenottrainedincessation.Thiswillenablethemto‘raisetheissueofsmoking’withayoungperson.InformationabouthowtosignpostayoungpersontoavailablecessationsupportisincludedintheYouth Cessation Referral Pathway(Appendix1)anditisrecommendedthatpractitionershighlightavailablesupportoptionstoayoungpersonwhoiskeenandmotivatedtomakeaquitattempt.

Briefinterventionsinvolveopportunisticadvice,discussion,negotiationorencouragement.Theyarecommonlyusedinmanyareasofhealthimprovementandaredeliveredbyarangeofprimaryandcommunitycareprofessionals.

Forsmokingcessation,briefinterventionstypicallytakebetween5and10minutesandmayincludeoneormoreofthefollowing:

• simpleopportunisticadvicetostop

• anassessmentofthepatient’scommitmenttoquit

• anofferofpharmacotherapyand/orbehaviouralsupport

• provisionofself-helpmaterialandreferraltomoreintensivesupportsuch astheNHSStopSmokingServices27.

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APPendIx7B:BRIeFInteRVentIonFlowCHARt

Helping a smoker to stop smoking – What’s involved Briefinterventionsflowchart

Thisflowchartshowsthepathwayyoucanfollowinraisingthesubjectofsmokingwithyourclients/patients.Usingit,youcanfindoutfirstiftheyareinterestedinstoppingandthenpointthemtothebesthelpavailable.

Tohelpyou,wehavesuggestedspecificquestionsbutyoumaywanttoasktheseinyourownwords,dependingonwhoyouaretalkingto.Note: Smokingcessationservicestendtobebetterunderstoodbymembersofthepublicas‘stopsmokingservices’.

Ask:doyou(still)smoke?DOCUMENTHAVINGASKEDQUESTIONPLUSRESPONSE

Ask:Haveyoueverthoughtaboutsmokinganditseffects(e.g.onyourhealth;itscost)?DOCUMENTHAVINGASKEDQUESTIONPLUSADVICEGIVEN

Ask:Areyouinterestedintryingtostopand,ifso,doyoufeelmotivatedtostopnoworinthenearfuture?

Ask:wouldyoulikehelpfromthelocalstopsmokingservices?

Refertolocalservicesand/orgivethetelephonenumberforSmokeline:0800848484ordetailsofthewebsitewww.canstopsmoking.com(bothofwhichhaveinformationonlocalservices)

Givebriefinformationonhowtostop,linkinginwithmedicalconditionwhereapplicable.Helpthemtochoosemedication(seeHelping smokers to top for advice).Prescribeorarrangeaprescription.Reinforceencouragingpatientstoattendservices.Arrangeafollow-upintwoweekstocoincidewithendofprescriptionsupply.

Give:• informationonhowtostop• Aspiremagazineandany otheravailablematerials• Smokelinenumber: 0800848484• www.canstopsmoking.com• informationaboutlocal services

Congratulate.

Brieflyoutlinetheindividualisedhealthrisksofsmokingandbenefitsofstopping.GiveAspiremagazine.

Acceptanswerwithoutjudging.Leaveofferofhelpopen.GiveAspiremagazineandanyotherinformation.

Encouragethesmokertoconsiderservicestoincreasechancesofstoppingandstayingstopped,andemphasisetherangeofservicesavailable.Ask:wouldyouliketousenRtorothermedication?

Givereminderthatstopsmokingservicesarealwaystheretohelpiftheyarefindingitdifficulttostaystopped.

Givereminderthatstopsmokingservicesarealwaystheretohelpifthesmokerdecidestoquitsometimeinthefuture.

no

no

no

no

no

Yes

Yes

Yes

Yes

Yes


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APPendIx7C:BRIeFInteRVentIonsgUIdAnCenotesgUIdAnCenotes

YeS: Manysmokerssay‘yes’becausetheyknowitistheexpectedanswer.Trytoconfirmwhattheyreallyfeelorknow.Iftheyseemgenuinelyawareoftheriskstotheirhealth,eitherbeforeorafteryourexplanation,thenyoucanmoveontothenextquestion.3.AReYoUInteRestedIntRYIngtostoPAnd,IFso,doYoUFeelmotIVAtedtostoPRIgHtnowoRIntHeneARFUtURe?

No: Iftheyareclearlynotinterestedintryingtostopinthenearfuture,acceptthiswithoutjudgementandleavethedooropenforafutureconsultation.Tellthemiftheyeverwanttodiscusssmokinginthefuture,youwouldbehappytodoso,andtoofferhelpiftheywish.

YES:Theymaysay‘yes’becausetheyaremotivatedorbecausetheyfeelthisisthedesiredanswer.Iftheyseemunsure,emphasisethesupportthatisfreelyavailableandexplainthatthiswillgreatlyincreasetheirchancesofstopping.Iftheydoseemgenuinelyinterestedinstoppingandreadytostopinthenearfuture,ask:4.woUldYoUlIkeHelPFRomtHeloCAlstoPsmokIngseRVICes?

(Stop smoking services are specialist smoking cessation services, supported by the NHS, with staff trained to national standards and having dedicated time set aside to provide group and 1:1 support for a series of planned sessions, and where the client is followed up.)

No:Iftheydonotwanthelp,askifthisisbecausetheyfeeltheycanstopwithouthelp,orbecauseofsomeotherreason.Offerwhatadviceyoucanandemphasisethatusingtherightsupportcanmakeitmuchmorelikelytheywillquitandstaystopped.(Clinicians: You can still offer NRT or other medication and these patients will require follow-up if they do not attend services.)

YeS: Givethemthedetailsforlocalservices,thenumberforSmokeline(0800848484)orsignpostthemtowww.canstopsmoking.comwhichcanprovidethemwithinformationonlocalservicesaswellasofferingmoregeneraladvice.Reinforceandencourageattendanceatservicesandrefertoservicesifyouareabletodoso.5.woUldYoUlIketoUsenRtoRotHeRmedICAtIon?

(This should only be asked if the patient has declined the offer of a referral.)

No: Ifnot,trytofindoutwhetherthisisbecauseofconcernsaboutsafety,oriftheyareconfidentabouttheirchancesofstoppingunaided.Emphasisestronglythatthepharmaceuticaltreatments(pharmacotherapy)aregenerallysafeifusedappropriately,andincreasetheirchancesofstopping.Reinforcethatservicesandpharmaceuticaltreatmentsareavailableshoulddecidetotrythemlateroriftheirownroutedoesn’tworkoutinthelong-term.

YeS:Discusstheoptionswiththemtohelpthemchoose,andprescribeappropriately.Ifyoucannotprescribe,arrangeforthemtogetaprescription.Intermsofothermedication,bupropion (zyban) and varenicline (Champix) may not always be appropriate for patients with other health issues. Refer to local guidance/protocols for dispensing before prescribing.

encourageattendanceatservices.Ifprescribinghastakenplace,requestthattheymakeanappointmentfortwoweeks’timetoreviewtheirquitattempt(andtocoincidewithendofinitialprescriptionsupply).makesuretheyhavethesmokelinenumber(0800848484)andencouragethemtocalliftheyneedhelp.

Brief interventions contribute to saving lives.Themaineffectistotriggerquitattemptsandtopromptsmokerstoseeksupportfromsmokingcessationservices.Acombinationofbehaviouralsupportwithpharmacotheraphyi.e.nicotinereplacementtherapy(NRT),bupropion,varenicline,canachievequitratesofaround15%atsix-monthsfollow-up.Comparedwithotherlife-savingmedicalinterventions,smokingcessationservicesofferexcellentvalueformoneyforeachyearoflifegained.It is important to try establish rapport and empathy with the smoker. You can do this by listening, not trying to persuade, and by avoiding judgmental responses to their answers.Encouragingsmokerstothinkaboutstoppingsmokingandusingservicesindoingso,andtherebytheirchancesofsuccess,whileincreasingunderstandingofthebenefitsofquittingandleavingthedooropenforafuturequitattempt,arekeyelementsofabriefintervention. 1. dotHeYsmoke?oRdoYoUstIllsmoke?

No:Iftheydon’tsmoke,orhavestopped,congratulatethemanddocumenttheirsmokingstatusinyournotes.

YeS: Iftheydo,documenthavingaskedthemplustheirresponseinthenotesandthentrytoestablishiftheyunderstandthespecificeffectsofsmokingandtheextentofthedangersforthempersonally.Trynottoaskaleadingquestion.Wewouldsuggest:2.HAVeYoUeVeRtHoUgHtABoUtsmokIngAndItseFFeCts(e.g.onYoURHeAltH;ItsCost?)

No:Iftheyanswer‘no’orseemunsure,outlinethehealthriskstothemandthebenefitsofstopping,andexplainthatitisworthstopping.InformationontherisksisavailableinHelpingsmokerstostop,orinAspiremagazineandotherleaflets(availablefromthelocalNHSBoard).Documentaskingthequestionandyouradviceinthenotes.

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APPendIx8mARketIngmAteRIAls


OUT

UTT

UNDER 18 AND THINKING OF STOPPING SMOKING?STOP SMOKING SERVICE

FOR YOUNG PEOPLE IN

EAST DUNBARTONSHIRE

For free and confidential

information, advice

and support –

Call or text Lesley on

07919990010

To find out more about tobacco

check out: www.w-west.org.ukSTOP SMOKING SERVICE FOR YOUNG PEOPLE

IN EAST DUNBARTONSHIRE For free and confidential information, advice and

support – Call or text Lesley on 07919990010To find out more about tobacco check out: www.w-west.org.uk

OUTUT

T UNDER 18 AND THINKING OF STOPPING SMOKING?

for more information on how to obtain BuTT ouT promotional material contact Smokefree Services on 0141 201 4620/4627

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HAndoUt1:nICotInedePendenCeQUestIonnAIRe1

Yes no

1. Haveyouevertriedtoquitbutcouldn’t?

2. Doyousmokenowbecauseitisreallyhardtoquit?

3. Haveyoueverfeltlikeyouwereaddictedtotobacco?

4. Doyoueverhavestrongcravingstosmoke?

5. Haveyoueverfeltlikeyoureallyneededacigarette?

6. Isithardtokeepfromsmokinginplaceswhereyouarenot supposedto?Whenyouhaven’tusedtobaccoforawhile... ORwhenyoutriedtostopsmoking?

7. Didyoufindithardtoconcentratebecauseyoucouldn’tsmoke?

8. Didyoufeelmoreirritablebecauseyoucouldn’tsmoke

9. Didyoufeelastrongneedorurgetosmoke?

10. Didyoufeelnervous,restlessoranxiousbecauseyou couldn’tsmoke?

totAlsCoRe

Source:DiFranza,J.R.;Savageau,J.A;Fletcher,K.;Ockene,J.KMcNeil,A.D.;Coleman,M.;Wood,C.(2002)‘‘Measuringthelossofautonomyovernicotineuseinadolescents:TheDevelopmentandAssessmentofNicotineDependenceinYouths(DANDY)Study.’’ArchivesofPediatricAdolescentMedicine156:397-403HONC(HookedonNicotineChecklist)TobaccoControl,September

2002,DrJ.RDiFranza.


theHookedonnicotineChecklist(HonC)

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HAndoUt2:nICotInedePendenCeQUestIonnAIRe2

1. Howmanycigarettesadaydoyousmoke? a. Lessthan1aday b.1-10cigarettesaday c. 11-20cigarettesaday d.21-30cigarettesaday d.Morethan30

2. doyouinhale? a. Always b.Quiteoften c. Seldom d.Never

3. Howsoonafteryouwakeupdoyousmokeyourfirstcigarette? a. Withinthefirst30minutes b.Morethan30minutesafterwakingbutbeforenoon c. Intheafternoon d.Intheevening

4. whichcigarettewouldyouhatetogiveup? a. Firstcigaretteinthemorning b.Anyothercigarettebeforenoon c. Anyothercigaretteafternoon d.Anyothercigaretteintheevening

5. doyoufinditdifficulttorefrainfromsmokinginplaceswhereitis forbidden(church,library,movies,etc.)? a. Yes,verydifficult b.Yes,somewhatdifficult c. No,notusuallydifficult d.No,notatalldifficult

6. doyousmokeifyouareillandyouareinbedmostoftheday? a. Yes,always b.Yes,quiteoften c. No,notusually d.No,never

7. doyousmokemoreduringthefirst2hoursthanduringtherest oftheday? a. Yes b.No

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HAndoUt3:ReFeRRAlFoRm

Name:........................................................... D.O.B:.........................................M/F........................

Adress...................................................................................................................................................

.......................................................................... Postcode....................................................................

EmailAddress....................................................................................................................................

School:......................................................... Group/Service......................................................

Referredby:................................................ ContactNo..............................................................

DateofReferral........................................

CANWECONTACTYOUVIA:

TELEPHONEYES/NOLETTERYES/NOTEXTYES/NOEMAILYES/NO

Reasonforreferral/otherInformation:

PleAseRetURnto:smokeFReeCommUnItYseRVICes

gartnavalRoyalHospitalmodularBuilding,1055greatwesternRoad,g120xH

Forfurtherinformationortodiscussthisreferralcontactuson

01412322110thankyouforyourreferral

thisformshouldbecompletedwiththeYoungPerson

CommUnItYsmokeFReeseRVICesREFERRALFORM


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q Iunderstandthattheproductisamedicineandwillbe usedbymeandonlyme.

q Iwillspeakto(nameofadvisor)ifIhaveanyquestions aboutmyproduct.

q Iunderstandhowtheproductshouldbeused.

q Iagreetocollecttheproductonaweeklybasis.

q IunderstandthatifIdonotfollowthis,myprescription willbereviewed.

mYnRtContRACt(NAME)

Signed(Youngperson):.........................................................................................................

Signed(Advisor):................................................................. Date........................................

HAndoUt4:nRtContRACt

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wee

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HAndoUt5:weeklYCHeCklIst


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Participantsareseenindividuallyduringsession1.Forthisyoushouldmakesureyouhavethefollowing:

• NicotineReplacementTherapyPharmacy RequestForm

• Completedclientquestionnaireandclient consentform

• Clientrecordcard

Firstly,youshouldcheckthroughtheclientquestionnaireandensureithasbeencompleted.Iftheclienthasmissedoutaquestion,bringthistotheirattention.Iftheydonotwanttoanswerthequestionthereisnocompulsiontodoso,althoughanexplanationastowhyitisbeingaskedmighthelp.Pleasecheckthatyouhaveacorrectaddressandphonenumberfortheclient.ThedetailsarekeptonaprivatedatabaseatSmokefreeServicesandarenotpassedontoanyotherorganisations.

Secondly,ensurethattheclienthassignedanddatedtheconsentform(thisisvitalforfollowup).Youmustalsosignanddatethisform.

Thirdly,discusstheproductsthathavebeenspokenaboutinthegroup.Asexplainedearlier,theNicorette16hourpatchisthefirstlineproductbuttheclientshouldbeallowedtouseanotherproductiftheyhaveanallergytothepatch,havepreviouslybeenunsuccessfulonthepatchorhavemoreconfidenceinanotherproduct.Ifanotherproductischosen,anexplanationshouldbeputinthe‘ReasonforRequest…’boxonthePharmacyRequestForm.

SuitabilityforproductsifappropriateshouldbecheckedagainsttheNRTchart(e.g.iftheysmokemorethan20aday,aninhalatorwouldnotbeappropriateetc).Atthebeginningofthe1to1,youshouldcheckthehowaddictedtheyoungpersonisusingthenicotinedependencequestionnairesandtherefore,compatibilityofdifferentproducts.

Fourthly,enteralltheinformationontotheclientrecordcard:thedate,productchosen,manufacturer,dose(ifappropriate)andanycomments.

Finally,givethewhitecopyoftherecommendationformtotheclienttotaketothenearestparticipatingSmokefreepharmacy.Keeptheyellowcopyfortheclientrecords.

1to1’sarealsodoneinthefollowingweeksbuttheyaremuchbrieferthanweekone.ThepurposeistomonitorNRTuse,allowstheclienttoraiseissues/askquestionstheymaynotwanttointhegroupandtaketheCOreadings.Theclientrecordcardshouldbecompletedeachweek.The1to1shouldnotbeusedasanopportunitytodiscussthequitter’sprogressthisshouldbedoneinthegroup.

HAndoUt6:onetoone

wHAtdoIdoInA1to1?

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HAndoUt7:nRtAdVICesHeet

PRodUCt

Patches

HowtoUseIt

•10mgpatch•15mgpatch•16hourpatchPutoninmorningandtakeoffbeforegoingtobedRemovetheoldpatchandreplacewithafreshpatcheachday.Disposeofpatchcarefullysochildren/petscan’tgetaholdofthemThepatchshouldbeplacedonahairlesspartoftheupperbody.PutontheoppositesideofthebodyeachdaytoavoidirritationUnlessyousmokelessthan10cigarettesaday,youshouldstartonthefullstrengthpatch.

AdVAntAges

PatchgivesaconstantlevelofnicotinethroughoutthedayEasytouse,discreteifunderclothing.Noneedto‘do’anythingoncepatchison.

dRAwBACks

SomepeoplecomplainofoccasionallyfeelingsickwhileusingthepatchSomepeoplethinkthatthepatchcanbetakenofftosmokebutnicotinecontinuestobeinyourbodyforseveralhoursaftertakingapatchoff.RememberingtoputitoninthemorningIttakesafewhoursbeforetheeffectsofthepatcharefeltCanbedifficulttoremovefrompackaging

tHIngstowAtCHoUtFoR!

Remindyoungpersontoeatbreakfastbeforeputtingonpatchasthiscanmakelesssusceptibletofeelingnauseous.Changetheplacethatthepatchisputontominimiseirritation.Putpatchonahairlessplaceontheupperbodye.g.upperarm,toreduceirritationwhenremovingMayneedscissorstoopenpackaging

microtabs Smalltabletsthatareplacedunderthetonguewheretheyslowlydissolve(takesabout30minutes).Theareaunderthetonguehaslotsofbloodvesselswherethenicotineisabsorbed.Lessthan20cigarettesaday:1tabletperhourMorethan20cigarettesaday:2tabletsperhourUsualdose8-12/16-24

QuitediscreetCanbeusedwhenhavingacravingtosmokeIsfast-acting

NeedtouseregularlytogetfullbenefitNeedtoanticipatecravingsNeedtoavoiddrinkingwhilemicrotabisinthemouthNeedtobelefttodissolveandmustn’tbechewed,sucked

AvoiddrinkingwhenusingthemicrotabsMaycausehiccupsandheartburn


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PRodUCt HowtoUseIt AdVAntAges dRAwBACks tHIngsto

gum Availablein2strengths:2mgand4mgItisnotchewedlikenormalchewinggum–chewslowlyuntilthetastebecomesstrongandthenparkitbetweenthecheekandthegumtoallowthenicotinetobeabsorbedthroughtheliningofthemouth.Whenthetastefades,chewagainandthenparketc.8-12piecesperday.Butshouldnotexceed15piecesperday

CantasteunpleasantatfirstbutmostpeoplegetusedtoitveryquicklyDiscrete

CantasteunpleasantCan’tbeusediforthodonticbracesarewornYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectivelyCancauseindigestionandnauseaifnotchewedcorrectlyasitirritatesthegut

AvoiddrinkingwhenusingthegumDon’tchewitlikeregulargum–rememberto‘parkit’!”Avoidgumifyoungpersonhasbraces

(continuedover)

Inhalator PlasticmouthpieceandnicotinecartridgeswhichyouinsertintothemouthpieceDrawonitlikeacigarette.Thenicotineisabsorbedintheliningofthemouthandthethroatunlikecigaretteswhichareabsorbedinthelungssoyoudon’tgetthesameeffectasacigarette.6-12cartridgesperday.Eachcartridgecontains20minutespuffingtimealthoughthisdoesn’tneedtobepuffedallattheonetime–itcanbebrokendowntofour5minutesessionsifpreferred–thenicotinedoesn’tescapeafterthecartridgeispierced

ItcanbequitestrongatfirstandcancatchthebackofthethroatbutsomepeoplelikethatasitremindsthemofsmokingInhalatorgoodifbingesmokesatweekendsforexampleMimicssmokingbehaviourIsabitofa‘gadget’CanbeusedwhenhavingacravingSUITABLEFORTHOSEWHOSMOKELESS

NeedtoanticipatecravingstouseeffectivelyQuitevisibletouseMaycausecough/irritationinmouthandthroatYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectively

Goodifyoungpersonmainlysmokesatweekendin‘binges’

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PRodUCt HowtoUseIt AdVAntAges dRAwBACks tHIngstowAtCHoUtFoR!

lozenge Atabletwhichis‘parked’inbetweenthecheekandtheguminasimilarwaytothechewinggumNottobesuckedorcrunched–mustallowto

CantasteunpleasantatfirstbutmostpeoplegetusedtoitveryquicklyDiscrete

NotsuitableforpeoplewhosufferfromPhenylketonuria(PKU)(arareblooddisorderthatisgenerallytestedforinnewbornbabies)UnpleasanttastetostartwithMaycauseirritationofmouthandthroat,increasesalivation,hiccups,heartburn

ShouldnotdrinkanythingwhenlozengesareinthemouthasitaffectstheabsorptionYoungpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectively

nasalspray ThefastestactingNRTproductandonlysuitableforheaviersmokers(i.e.morethan20cigarettesperday)Itisasmallbottleofnicotinesolution.PressthetopdownandameasureddoseofnicotineisdeliveredUsage:(onespraypernostril=1dose)Recommendeddosageis1-2dosesperhourwithamaximumof64spraysperday(i.e.32sprayspernostril)

MostpeoplefinditagoodproductiftheypersevereVeryfastactingCanbeusedwhenhavingcravings

UnpleasanttouseIttakesgettingusedto:causesirritationtothenosecausing,sneezing,coughingandrunningeyesandnose.Butmostpeoplegetusedtoitandthesymptomscalmdownwithin48hoursYoungpeopleoftenfinditdifficulttoperseverethroughtheunpleasanteffects

Youngpersonmaynotanticipatetimesofcravingsandthereforeproductdoesn’tworkeffectivelyNotpopularoptionforyoungperson


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PRe-

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HAndoUt8:stAgesoFCHAnge

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lapse

lapse

lapse

Not interested in change

HAndoUt9:stAgesoFCHAnge

Relapsing

Maintaining change

Preparing to change

Making changes

Thinking about

change


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HAndoUt10:ReFleCtIVestAIRCAse

Name:.............................................................

Usethistorecordotherindicatorsofchange.Marktheoutcomeatthetop,e.g.“lesscigarettessmoked”andrecordthedataontheladderasappropriate.

Date:__/__/__

Date:__/__/__

Date:__/__/__

Date:__/__/__

Date:__/__/__

Date:__/__/__

Date:__/__/__

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HAndoUt11:CARBonmonoxIdestAIRCAse

Name:...............................................................

Date:

30

27

24

21

18

15

12

9

6

3

0

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Rea

din

gs


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HAndoUt12:QUIttIngdIARY

dA

tew

how

as

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me

How

was

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ork

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1.W

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ost

wan

ta

cig

aret

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2.

Whe

nd

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ost

?

3.

Wha

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4.

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sp

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5.

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ces?

6.

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ple

?

7.

Whi

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oy

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ym

ost

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8.

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9.

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?

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out

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ttin

g?

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HAndoUt13:gRoUPAgReement

Agroupagreementorcontractwhicheveryonecansignisawayofhelpingthegroupregulateits’ownbehaviourbyagreeingtoasetof‘rules’thattheyhavecreatedthemselves(flipchartworkswellforthis).Thiswaythegrouparesigningtheiragreementtoacodeofbehaviourthattheythemselveshavesetanditalsoletsthemknowwhattheycanexpectfromyouasapractitioner.

Itwillmostlikelycoverthingssuchasstandardsofbehaviourandlanguage,respectingoneanother,allowingotherstospeakwithoutinterruption,keepingconfidentialityandalsowhatwillhappenifanypersondoesnotabidebytheagreement.Thismaymeanthatyouhavetoexploresomeissues,forexampletheirunderstandingof‘respect’or‘confidentiality’.

SaMPle GRouP aGReeMeNT fRoM a SCHool SToP SMokING GRouP

‘Alldiscussionsinthegroupstaysinthegroup’

‘letpeoplespeak’

‘noviolence’

‘noabusingeachother’

‘noslaggingeachother’

‘tellthestorynottheperson’

‘Besupportiveofeachother’

‘everythingstaysintheroom’

‘Anyproductsthroughpharmacywillnotbesharedinformation’(withparents/teachers)

‘no-onecansaynothing’

‘secret,can’ttellmum’


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HAndoUt14A:ImPoRtAnCe/ConFIdenCelAddeR(gUIdAnCenotes)

Asktheyoungpeopletoindicatehowimportantitisforthemtostopsmokingatthisearlystageandhowconfidenttheyareaboutbeingabletoquit.Markitonthescale(askthemtowriteinthedate).

Thiscanberetainedbythefacilitatorwiththerestoftheweeklyrecordsandtheexercisecanberepeatedatalaterpointintheprogramme.Thiswilldemonstratetotheyoungpersonhowtheirmotivationandconfidencecanchangeovertime.

Ifsomeonehasmadeapreviousquitattemptandisnotveryconfidentabouttryingagain,theconfidencescalecanletthemseehowstoppingsmokingislikeajourneyandthatitmaytakeseveralattemptsbeforetheysucceed.

Insteadofusingtheladdertemplateforthisexerciseyoucouldmakeitmoreinteractiveandgettheyoungpeopletovisualiseascaleacrosstheroomandaskthemtostandonthescaleaccordingtohowconfidenttheyfeelaboutbeingabletostopsmoking.

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HAndoUt14B:ConFIdenCelAddeR

Name:.............................................................

10

9

8

7

6

5

4

3

2

1

notVeryImportant

ReallyImportant

notVeryConfident

ReallyConfident


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Thisexerciseletstheyoungpeoplegetinvolvedintalkingaboutboththeperceivedbenefitsofsmokingandthenegativeeffectsofsmoking.Youcanuseaflipchartorwhiteboardtowritetheanswers.Eitheryoucandothewritingoryoucouldlettheyoungpeopledoitthemselves(bemindfulofliteracyissues).Thisexercisecanalsobedoneverbally.

HAndoUt15:tHeFoURwHYsexeRCIse

smokIng gIVIngUP

The good things about smoking

The NoT so good things about smoking

The NoT so good things about giving up

The good things about giving up

stARtHeRe

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HAndoUt16:AmIReAdYtostoPsmokIng?

What do I enjoy about smoking?

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Why do I want to stop smoking?

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.


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HAndoUt17:FeelIngsABoUtQUItdAY

ConFIdent

deteRmIned

sCARed

negAtIVe

woRRIed

exCIted

AnxIoUs

Whenacardistakenoutofthebag,askthemiftheythinkthefeelingappliestothemandifsoaskthemtoexplainwhy.Aftertheyhavedrawnthecardsaskthemtoputthemintoonepileifittheycanrelatetothefeelingandintoanotherpileiftheycannotrelatetoit.Attheendoftheexerciselooktoseeiftheyhaveidentifiedwithmainlypositiveornegativefeelingsandthisshouldgeneratemorediscussion.Reassurethemthatalloranyofthesefeelingsarenormal.

Analternativeexerciseistouseaflipchart/post-itsorawhiteboardinsteadofthecards.Writethefeelingsupsothegroupcanseethem,anddiscussiftheyoungpeoplecanrelatetothemornot.

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HAndoUt18:mYstoPsmokIngdIARY

use the diary to identify your smoking habits

stoPsmokIngdIARY

Name:.................................................................................................... Day:..........................................

use for 3-7 days

Cigarettenumber time whoyouwerewith whatwereyoudoing? enjoyed

Yes/no

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.


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HAndoUt19:‘mYACtIonPlAn’


PRePARIngtoQUIt stAYIngstoPPed

HowtoCoPewItHCRAVIngs mYRewARdFoRstoPPIng

Myquitdateis:.......................................................................................................................................

mYACtIonPlAn

ItreallyhelpsifyoucanprepareyourselfforQuitDay.Whatthingscanyoudothatwillhelpyougetreadyforwhenyoustopsmoking?Herearesomeideas;buysugarfreegum,alwayshaveabottleofwater,signupforanexerciseclass,tellyourfriendsandfamily.Whatwillworkforyou?Before I stop smoking I will prepare myself for quit day by:

1...................................................................................................

2..................................................................................................

3..................................................................................................

4..................................................................................................

Whenyoustopsmokingyoumightexperiencecravings.Whatdoyouthinkyoucoulddotohelpyoucopewithcravings?

If I get a craving for a cigarette I will:

1...................................................................................................

2..................................................................................................

3..................................................................................................

4..................................................................................................

wHoCAnHelPmewItHtHIs?

Makeanotehereofthepeoplewhowillhelpandsupportyouwhenyouaretryingtostopsmoking.

These people will help me:

1...................................................................................................

2..................................................................................................

3..................................................................................................

Stoppingsmokingisagreatachievementandyoumightdecidethatyoudeservearewardasatreat.

I will give myself a reward when (fill in your own occasions):

1.Istopfor?......days

2.Ihavestoppedfor?......weeks

3.Imanageadifficultsituation?

4.After?......months

Stoppingsmokingisn’talwayseasy–youmightneedtotryseveraltimesbeforemanagingtostop.Itisimportantthatyougetenoughsupportwhenyouaretryingtostopsotalktoyoursupportadvisoraboutit–itreallywillhelp!

If I am finding things difficult I will:

1...................................................................................................

2..................................................................................................

3..................................................................................................

4..................................................................................................

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HAndoUt20:CoPIng

CoPIngACtIVItY

Askthegroupifanyonehasexperienceofsomeonehelpingthemwithasituationthattheyhavefounddifficult.Askthemtodescribewhatthepersondidforthemthatmadethesituationeasierandwhythiswasimportant.

Relatethistothegroupanduseittodemonstratethatsometimesdoingsomethingthatisreallydifficultcanbemadealittlebiteasierwhensomeonestandsalongsideandsupportsthem.Explainthatthisiswhatthegroupisfor–thattheothersinthegroupcankeepthemmotivatedwhenthegoinggetstoughandtheyfeelasifitistoohard.


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HAndoUt21:CoPIng

dIsCUssIonABoUtCoPIng

• Whatwouldyouliketobeabletodointhissituation?

• Howwouldyoufeelifyoumanagedtogetthroughthissituationwithout smokingacigarette?

• Howdoyouthinkotherpeoplehavecopedwiththissituation?

• Whatcouldyoudodifferentlynexttimeyoufacethissituation?

• Whatdoyouthinkyourfriendswouldsaytoyouiftheyknewyouwere concernedaboutgettingthroughthissituation?

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HAndoUt22:dIsCUssIonABoUtCoPIng

Dividethegroupupintosmallergroups(3or4groupsifpossible)orifitisasmallgroupthenworkingtogetherisfine.

Headup3sheets(flipchart)withtheheadings;

• How to deal with a craving

• How to say no

• alternatives to smoking

Givethegroups5minutestolistasmanythingsaspossibleundertheheadingtheyhavebeengiven.

Bringthegroupbacktogetherandeachshouldreadouttheirlist.

Inthelargegroupaskthemtomakeanewlistora‘TopTenTips’forstoppingsmoking.

ToP TeN TIPS foR SToPPING SMokING

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.


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HAndoUt23:QUIttIng

ACtIVItY

• Howisthefirstdayofbeinganon-smoker?

• Howdoyoufeel?

• Howdidyoucopewithoutyourfirstcigarette?

• Howwillyoucopewithyour‘difficult’cigarette?

• Whatwillyoudoinsteadofsmokingthatcigarette?

• Whatwillyoudowhenyouarewithyoursmokingfriends?

• Whatwillyoudoifsomeoneoffersyouacigarette?

• Whatwillmakequittingdifficult?

• Whatcouldhelpmakequittingeasier?

• Whocanhelpyouandsupportyou?

• Whomighttryandpreventyouquittingormakeitdifficult?

• Whatwillyoudoifyoufeelyoureallyneedacigarette?

• Remindmeagainwhyyouwanttostop

• Whatareyoumostlookingforwardtoaboutbeinganon-smoker?

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HAndoUt24:QUItCHARt

Mark your quit day with a ‘q’ – every day that you go without a cigarette put a tick 4 in the box. If you smoke on any day then write in the number of cigarettes that you have on that day.

mYQUItCHARt

Name:...................................................................

JAn mAY sePtmARCH JUlY noVFeB JUne oCtAPRIl AUg deC

1.

5.

9.

13.

17.

21.

25.

29.

3.

7.

11.

15.

19.

23.

27.

31.

2.

6.

10.

14.

18.

22.

26.

39.

4.

8.

12.

16.

20.

24.

28.


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HAndoUt25:wItHdRAwAl

InCReAsedAPPetIte

IRRItABIlItY

HeAdACHes

CRAVIngs

use these cards to promote discussion about common feelings and symptoms of withdrawal (add others as required)

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HAndoUt26:dIsCUssIon-nICotInedePendenCe

AddICtIon

HABIt

dePendenCe


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stIllstoPPed?–dIsCUssIon

• Howareyoufeeling?

• Howareyoucoping?

• Hasitbeenasyouexpected?

• Whatarethegoodthingsabouthavingstoppedfor(x)weeks

• Hasitbeendifficult?Tellmeaboutthat.Howhaveyoucoped?

• Doyoufeelanybenefitsfromstopping?

• Whathaveotherpeoplesaidtoyou?

• Doyoustillfeelmotivated?

• Howconfidentdoyoufeel?

• Whathaveyounoticedsinceyoustoppedsmoking?

HAndoUt27:mAIntenAnCe

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RelAPse–dIsCUssIon

• Whatwasitthatmadeyouhavethatcigarette?

• Wherewereyou?Whowereyouwith?Whatwereyoudoing?

• Didyouenjoyit?

• Whatdidyoufeelduringandafter?

• Howdoyoufeelaboutitnow?

• Whatcouldyouhavedonedifferently?

• Whatcouldyouhavedoneinsteadofhavingacigarette?

• Doyoustillwanttoquit?

• Doyoufeelreadytotryagain?

HAndoUt28:RelAPse


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HAndoUt29:wHAtABoUttHeFUtURe?

dIsCUssIonABoUttHeFUtURe

• Howdoyoufeelaboutgoingitalone?

• Howhaveyoucopedwithstressfulsituations?Howdidthatgo?

• Whenisyourmostdifficulttime?

• Whathasthisexperiencebeenlike?

• Tellmeagainwhyyouwantedtostop.

• Doyoufeeldifferentnow?Tellmeaboutthat.

• Howmuchmoneyhaveyousaved?

• Howdoyouthinkyouwillcopenowthatthegrouphascometoanend?

• HowdoyouthinkyouwillcopewhenyourNRTcomestoanend?

• Howdoyouseethefuture?

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HAndoUt30:PeoPleBIngo

Give each person a sheet which you should fill out with things like: ‘only drinks Irn Bru’, ‘has a pet hamster’ or ‘is wearing black shoes’ – they should find someone who ‘matches the description’ and write their name in the box. first person to complete the sheet is the winner. If possible, each person’s name should only appear once.


only drinks Irn Bru Has a Pet Hamster

Is Wearing Black Shoes

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HAndoUt31:tRUtHoRlIegAme

tRUtHoRlIe?

Everyonesitsinacircle.Thefacilitatorkicksoffbymakingonetrueandone

falsestatementaboutthemselves.Everyonehastoguesswhichstatementsaretrueandwhichare‘lies’.

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HAndoUt32:smokIngwoRdseARCH

EMPHYSEMANEUROTRANSMITTERCIGARDOPAMINEADDICTIONREWARD

SMOKINGWITHDRAWALCIGARETTECANCERDRUGACETYLCHOLINE

BRAINBLOODSTREAMRECEPTORNICOTINETOBACCO


A Z W S A M E S Y H P M ER O T P E C E R Q Y I N PR E S L O L J G T R I E NB N I A R B U O D L P U ML R Z W A R T M O O T R KO X Q A D E I H P R Z O RO Q A R W O C C A B O T ND S E D E L D G M R F R OS Y G H Y U I J I K I A IT X P T C C L V N J B N TR N E I M A R T E Y I S CE C Q W O Z C D O P M M IA D D R Y C T A R E N I DM O T K Z Q P O N A T T DN E T T E R A G I C W T AG E U N I C O T I N E E LA L S G N I K O M S I R R

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HAndoUt33:CsI–glAsgow

AgAmeBAsedARoUndtHetVsHowCsI

Drawabodyonflipchartpaper(lifesizeisgood),andsetthesceneexplainingthatthisisthebodyofa40yearold,20adaysmoker.Askthegroupwhattheywouldexpecttofindonorinsidethebody,giventhattheywereasmoker.Askthemtodrawtheansweronthebody.

Youwillbelookingforanswerslike‘blackenedlungs’oryellowteethandfingersetc.Usethetarjarandchemicalboardtoillustratethis.

Usinggraphicimages(seeGoogleimages)usuallyprovokesastrongreactionfromyoungpeopleandhelpstoillustratesomeoftheconditionsthattheywillhavetalkedaboute.g.lungcancerandheartdisease.

Avariationofthisistohavetwocoloursofpost-itnotes(oneforpositiveandonefornegative)andmakealistoftheeffectsofsmokingandbenefitsofquitting.

Asktheyoungpeopletoselectsomeoftheharmfuleffectsandalsothebenefitsofquittingandwritethemonthepost-its(oneperpost-it).Inturnaskthemtostickthenotesonthe‘body’wheretheeffectwouldbe.Usethistogeneratediscussionabouttheeffectsofsmoking.

Forexample:

• Howseriousaretheeffects?

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HAndoUt34:FACtoRmYtH?

Preparesomestatementsthatcanbereadoutorproducedonlaminatedcardthatarepopularopinionormyths,andusethemtoguidediscussionaboutsomeoftheacceptedthinkingabouttobacco.for example:

once you start smoking you can’t stop! –MYTH;nicotineaddictionfreewithin2weeks

If I stop smoking I will put on a lot of weight-Discuss

More boys smoke than girls –MYTH;atage15moregirlsthanboyssmoke

Most young people smoke cigarettes–MYTH;mostyoungpeopledonot

Most adults smoke cigarettes–MYTH;usedtobethecaseinthe60’sand70’sbutnow

Smoking makes you look tough–DOESIT?DISCUSS

Smoking makes you look cool–DISCUSS

Smoking makes you look grown up –DOESIT?DISCUSS

I just smoke now and then and I’ll never get hooked–MYTH;mostpeoplewhosmokestartedbeforetheywere19

Smoking never did my gran any harm and it’s not going to harm me–DISCUSS

lung cancer? That won’t happen to me!–90%oflungcancersarecausedbysmoking

There are a lot more dangerous things out there than smoking–smokingkillsmorepeoplethanillegaldrugs,suicide,roadaccidentsetc

You have to die sometime so who cares about smoking?–smokingisthesinglebiggestmostpreventablecauseofprematuredeath

By the time I get older there will be a cure for cancer–DISCUSS

I couldn’t relax without a cigarette–smokingincreasesbloodpressure,heartrateetc

Smokers have more fun–DISCUSS

Smoking around children doesn’t harm them–DISCUSSsecondhandsmokeandsocialnorms

I’ll worry about the damage it does in the future–damagetolungsetcisreversiblebutpermanentdamagecanneverberepaired

I’ll give up when I’m a bit older–mostadultsstartedsmokingwhentheywereteenagersandmosthavetomakeseveralattemptsbeforetheymanagetostopsmoking

Smoking doesn’t cost that much money–calculatecostofsmokingandrelatetothecostofsomethingsthatyoungpeoplemightwanttobuye.g.computers,car,holidays,clothes


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Useful Resources

Ifyourequireanyfurtherinformationonanyofthecontentthefollowinglinksaregivenasahelpfulguide;aCTIoN oN SMokING foR HealTH (aSH)

Acampaigningpublichealthcharityworkingtoeliminatetheharmcausedbytobacco.

www.ash.org.uk

aSH (aCTIoN oN SMokING foR HealTH) SCoTlaNd

Raisesawarenessabouttobaccouseanditsharmfuleffects,andcontributestotheimplementationofpublichealthpoliciestohelpsmokerstoquitandtoprotectchildrenfromtobacco.

www.ashscotland.org.uk

CaN SToP SMokING

DevelopedbyNHSHealthScotland,thiswebsiteprovidesinformationonthereasonsbehindwhypeoplesmokeandthesupportthatisavailableiftheyarelookingtoquit.Localsmokingcessationservicescanbefoundonthiswebsite.

www.canstopsmoking.com

CleaRING THe aIR

InformationaboutScotland’sbanofsmokinginpublicplaces.

www.clearingtheairscotland.com

GaSP

Tobaccoresourcesavailabletobuy–leaflets,activitypacks,displays,postersetc.

www.gasp.org.uk

NHS SToP SMokING SeRvICeS

NHSGG&CSmokefreeServicesareresponsibleforawiderangeoftobaccoprojectsaimedatreducingthedamagefromtobacco.Offersvarioussupportservicesforquittingsmoking.

Smokeline telephone number: 0800 84 84 84

www.nhsggcsmokefree.org.uk

THe loW-doWN

Providesinformationaboutteenagehealthforteenagersandalsoforthosewhoworkwiththem.

www.getthelowdown.co.uk

ToBaCCo INfoRMaTIoN SCoTlaNd

TobaccoInformationScotlandprovidessmokingandtobacco-relatedinformationinScotland.

www.tobaccoinscotland.com

W-WeST (WHY WaSTe eveRYTHING SMokING ToBaCCo)

Scotland’sfirstpro-choicesmokinginformationmovement,ledbyyoungpeopleforyoungpeople.W-WESTaimstogiveyoungpeoplethefactsaboutsmokingtoenablethemtomakeinformedchoices.

W-WEStoffersfreetrainingforexistingPeerEducationProjectsintheGreaterGlasgow&Clydearea.Thistrainingwillgiveyoungpeereducatorstheknowledgetheyneedtodiscusssmokingandtobaccousewiththeyoungpeopletheyworkwith.

www.w-west.org.uk

Alltelephonenumbersandwebsiteaddresseswerecorrectattimeofpublication.Theauthorcannotbeheldresponsibleforthecontentsofanypagesreferencedbyanexternallink.


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www.ash.org.uk

www.ashscotland.org.uk

www.canstopsmoking.com

www.clearingtheairscotland.com

http://www.gasp.org.uk

http://www.nhsggcsmokefree.org.uk

www.getthelowdown.co.uk

www.tobaccoinscotland.com

http://www.w-west.org.uk

Toolkit References

1. Taulbut,M.Gordon,D.andMcKenzie,K.TobaccosmokinginScotland:anepidemiologybriefing.[Online]. Edinburgh:NHSScotlandandScottishPublicHealthObservatory.2008Availablefrom: www.scotpho.org.uk/home/Publications/scotphoreports/pub_tobaccobriefing.asp [Accessed12November2010]

2. AllenderS,BalakrishnanR,ScarboroughP,WebsterP,RaynerM.Theburdenofsmokingrelatedillhealthsin theUK.TobaccoControl.2009;18:262-267.

3. ActiononSmokingandHealth(Scotland)(AshScotland).StateoftheNation:Measuringprogresstowards atobacco-freeScotland[Online].Availablefrom:www.ashscotland.org.uk/policy/state-of-the-nation [Accessedon12November2010]

4. ActiononSmokingandHealth(Scotland)(AshScotland)BriefingonYoungPeopleandTobaccoMarch2010 [online].Availablefrom:www.ashscotland.org.uk/ash/files/young_people_and_tobacco_March2010.pdf [Accessed4November2010]

5. ScottishPublicHealthObservatory.TobaccoUse[online]. Availablefromhttp://www.scotpho.org.uk/home/Behaviour/Tobaccouse/tobacco_intro.asp

6. ScottishExecutive.TheTobaccoandPrimaryMedicalServices(Scotland)Act2010:AConsultationonTobacco DraftRegulations[online]April2010.Availablefromhttp://www.scotland.gov.uk/Publications/2010/04/27151930/5

7. ScottishExecutive.ABreathofFreshAirforScotland.ImprovingScotland’sHealth:Thechallenge–tobacco controlactionplan[online].Edinburgh,ScottishExecutive,2004.Availablefrom: http://www.scotland.gov.uk/Publications/2004/01/18736/31540

8. CurrieC,FairgrieveJ,AkhtarP,CurrieD.ScottishSchoolsAdolescentLifestyleandSubstanceuseSurvey (SALSUS)NationalReport:SmokingDrinkingandDrugUseamong13and15yearoldsinScotland2002.Scottish Executive2003.Availablefromwww.drugmisuse.isdscotland.org/publications/abstracts/salsus_national02.htm

9. ScottishExecutive.Towardsafuturewithouttobacco:TheReportofTheSmokingPreventionWorkingGroup [online]November2006.Availablefromhttp://www.scotland.gov.uk/Publications/2006/11/21155256/5

10.NHSHEALTHDEVELOPMENTAGENCY.SmokingInterventionswithChildrenandYoungPeopleJune2004.

11. NHSHEALTHDEVELOPMENTAGENCY.SmokingInterventionswithChildrenandYoungPeople[online] June2004.Availablefromhttp://www.nice.org.uk/nicemedia/documents/CHB6-smoking-interventions-14-7.pdf

12.TheSmokingPreventionWorkingGroup.TowardsaFutureWithoutTobacco.[Online].ScottishExecutive2006. Availablefromhttp://www.scotland.gov.uk/Publications/2006/11/21155256/0

13.ScottishExecutive.ABreathofFreshAirforScotland.ImprovingScotland’sHealth:Thechallenge–tobacco controlactionplan[online].Edinburgh,ScottishExecutive,2004.Availablefrom: http://www.scotland.gov.uk/Publications/2004/01/18736/31540

14.ActiononSmokingandHealth(Scotland)AshScotland)BeyondSmokeFreeOctober2010[online]. Availablefrom:http://www.ashscotland.org.uk/policy/beyond-smoke-free

15.NICE(2008b)Smokingcessationservicesinprimarycare,pharmacies,localauthoritiesandworkplaces, particularlyformanualworkinggroups,pregnantwomenandhardtoreachcommunities.NICEpublichealth guidance10.LondonNationalInstituteHealth&ClinicalExcellence.

16. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10ofthe SmokingPreventionActionPlan(May2010)


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http://www.scotpho.org.uk/home/Publications/scotphoreports/pub_tobaccobriefing.asp

http://www.ashscotland.org.uk/policy/state-of-the-nation

http://www.ashscotland.org.uk/ash/files/young_people_and_tobacco_March2010.pdf

http://www.scotpho.org.uk/home/Behaviour/Tobaccouse/tobacco_intro.asp

http://www.scotland.gov.uk/Publications/2010/04/27151930/5


http://www.drugmisuse.isdscotland.org/publications/abstracts/salsus_national02.htm


http://www.nice.org.uk/nicemedia/documents/CHB6-smoking-interventions-14-7.pdf



http://www.ashscotland.org.uk/policy/beyond-smoke-free


17. MoolchanE.T.,Robinson,M.L.,ErnstM,CadetJ.L.,PickworthW.B.,HeishmanS.J.,etal.Safetyandefficacyof thenicotinepatchandgumforthetreatmentofadolescenttobaccoaddiction.Paediatrics2005Apr;115(4): e407-14.

18. HEALTHSCOTLAND.ExternalEvaluationoftheNHSHealthScotland/ASHScotlandYoungPeople andSmokingCessationPilotProgramme(June2006)[online]. Availablefromhttp://www.healthscotland.com/documents/1381.aspx[Accessed16November2010]



21. HEALTHSCOTLAND.AsynthesisandanalysisofcurrentinformationandevidencerelatingtoAction10 oftheSmokingPreventionActionPlan(May2010)


23. ActiononSmokingandHealth(Scotland)(AshScotland).Fags‘n’Hash–TheEssentialGuidetoCuttingDown theRisksofUsingTobaccoandCannabis(2005) http://www.playfieldinstitute.co.uk/information/pdfs/leaflets/substance_misuse/leaflet_Fags_and_Hash_guide_to_cutting_down_the_risks_of_using_tobacco_and_cannabis.pdf

24. MoolchanE.T.,Robinson,M.L.,ErnstM,CadetJ.L.,PickworthW.B.,HeishmanS.J.,etal.Safetyandefficacyof thenicotinepatchandgumforthetreatmentofadolescenttobaccoaddiction.Paediatrics2005Apr;115(4):e407-14.



27. NICE(2006)PH1Briefinterventionsandreferralforsmokingcessation:guidance. http://www.nice.org.uk/guidance/PH1/guidance

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http://www.healthscotland.com/documents/1381.aspx



http://www.playfieldinstitute.co.uk/information/pdfs/leaflets/substance_misuse/leaflet_Fags_and_Hash_guide_to_cutting_down_the_risks_of_using_tobacco_and_cannabis.pdf

http://www.playfieldinstitute.co.uk/information/pdfs/leaflets/substance_misuse/leaflet_Fags_and_Hash_guide_to_cutting_down_the_risks_of_using_tobacco_and_cannabis.pdf

http://www.nice.org.uk/guidance/PH1/guidance

Confidence importance ladder_maudsley_model_nrt for young smokers 2011

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