RMTTSC Program Program Overview Rocky Mountain Tobacco Treatment Specialist Certification RMTTSC Program This specialized program is designed to Build on your existing knowledge and skills ID: 779047
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Slide1
Rocky Mountain Tobacco Treatment Specialist Certification
(RMTTS-C
) Program
Slide2Program Overview
Rocky Mountain
Tobacco Treatment Specialist Certification (RMTTS-C) Program
Slide3This specialized program is designed to:
Build on your existing knowledge and skills
Provide the information, resources and skills you need to become a Certified Tobacco Treatment Specialist
Share ways to effectively implement evidence-based tobacco cessation strategies
RMTTS-C Program Overview
Slide4Tobacco Treatment Specialist
Core Competencies
Tobacco dependence knowledge and education
Diversity
and specific health issues
Assessment interviewing
Treatment planningPharmacotherapyCounseling skillsRelapse preventionDocumentation and evaluationLaw and ethicsProfessional developmentProfessional resources
Training covers
the 11 TTS core competencies:
Slide5RMTTS-C Program Objectives
Received
training in all evidence-based tobacco cessation interventions and treatments, both pharmacological and counseling, including behavior change strategies and cognitive behavioral
therapy
The
knowledge and skills to successfully treat any individual for tobacco dependence and to work effectively as a
Tobacco Treatment Specialist
Slide6Certification Requirements
To receive
certification
, participants must:Score at least 80% on all components of the quizzes and combined final examinationProvide documentation of at least 240 hours of experience* (post-course completion) in which course content was utilized*up to 120 pre-course hours can be counted if you have a clinical degree or prior experience working in the field of tobacco cessation
Slide7RMTTS-C
Examinations
Training manual
Training slides with notesProgram resources & references
Training quizzes and exams
Two short quizzes—Days 2 & 3
Written exam—Day 4Oral exam—Day 4
Slide8Training Agenda
Day One
Tobacco Fundamentals
Priority Populations
Motivational
Interviewing
Assessment InterviewDay TwoQuizPharmacotherapyCognitive & Behavioral InterventionsTreatment PlanningDay ThreeQuiz
Relapse
Prevention
Skills Integration
Documentation/Evaluation & Resources
Ethical Practice & Professional Development
Day Four
Final Exam
Oral Exam
Slide9Discussion
RMTTS-C Program Overview
Slide10Tobacco Fundamentals
Module 1:
Slide11Module 1: Tobacco Fundamentals
Objectives
Describe the impact of tobacco use and U.S. trends
Explain health consequences of tobacco use and the benefits of quittingProvide information on tobacco productsDescribe the physical and behavioral aspects of tobacco dependence
Introduce evidence-based tobacco cessation treatment strategies
Slide12The Burden of Tobacco
Slide13This is a Critical Issue
What is killing the majority of us is not infectious
disease,
but our chronic and modifiable
behaviors
Slide14Burden of Tobacco
480,000 tobacco-related deaths
in the U.S. each
year6 million
tobacco-related deaths worldwide each year
16 million people living with a tobacco-related chronic illness
42,000 deaths each year in the U.S. due to second-hand smoke exposureIt is estimated that one person dies from a tobacco-related illness every 6 seconds
Slide15Behavioral Causes of Death in U.S.
Slide16Annual Causes of Death
in the United States, 2013
Chronic Respiratory
Diseases*
Accidents**
*
Tobacco Related IllnessesNumber of deaths (thousands)**Tobacco Use is a Risk Factor
Slide17Trends
in U.S.
Adult Smoking
16.8%
of adults are current smokers
Slide18Rates of Tobacco Use
21.3%
of adults in the U.S. currently use tobacco products
Cigarettes – 16.8%
Smokeless – 2.6%
Cigars, cigarillos or small cigars – 2.0%
Electronic cigarettes – 1.9%Waterpipes/hookah – 0.5%Pipes – 0.3%
Slide19Health Consequences of Tobacco Use
Slide202010
Report of the Surgeon General
: How Tobacco Smoke Causes Disease
Any level of exposure to tobacco smoke is harmfulNumber and severity of health problems are directly related to how long a person smokes or is exposed to smoke
Smoking light, organic, or filtered cigarettes does not decrease your risk of disease
MAJOR FINDINGS
:
Slide212014
Report of the Surgeon General
:
The Health Consequences of SmokingSmoking is linked to diseases of nearly all organs in the body
Research continues to identify smoking-related diseases
New evidence reveals that exposure to secondhand smoke is associated with increased risk for stroke
Disease risks for women are now equal to those for menMAJOR FINDINGS
:
Slide22Tobacco Use Increases Risk for Specific Medical Disorders
2 to 4 times increased risk for coronary heart disease
2 to 4 times increased risk for stroke
Relative risk for lung cancer death is now 25 times higher for smokers
12 to 13 times increased risk of death from chronic obstructive lung diseases
The rate of death from smoking-related diseases is
three times higher among current smokers than those who have never smoked
Slide23How Tobacco Harms You
From The Tobacco Atlas Third Edition
Slide24Common Tobacco-Induced Disorders
Cardiovascular Disease
Heart Disease
Stroke
Aneurysm
Peripheral Arterial Disease
Slide25Common Tobacco-Induced Disorders
Smoking can cause cancer in almost every part of your body
Smoking
causes
cancer
through:
Slide26Common Tobacco-Induced Disorders
Chronic
Obstructive Pulmonary
Disease (COPD)—including emphysema and chronic bronchitisTobacco use causes COPD through two mechanisms:
Oxidative Stress
Damage to lungs caused by the free radicals in tobacco smoke
Protease-Antiprotease ImbalanceIncreasing destructive enzymatic activity that damages lung structure and elasticity
Slide27The Dangers of Secondhand Smoke
There is no safe level of
secondhand smoke
Being around tobacco smoke is directly linked to
disease and
premature death
in nonsmokersSerious health effects on children and adults include sudden infant death syndrome (SIDS), lung and ear problems, and asthma
Slide28The Dangers of Third-Hand Smoke
Particles and gases left behind after a cigarette is extinguished
Third-hand smoke
Collects on fabrics and surfaces and present in air
Can remain for months
Early research links exposure to multiple adverse health outcomes
Infants and children are at particular risk due to increased exposure
Slide29Smokeless Tobacco Health Effects
There is no safe form of tobacco
Contains 28 known cancer-causing chemicals, including tobacco-specific nitrosamines, a chemical directly related to the risk of cancer
Smokeless tobacco has been linked to these diseases:
Oral cancer
Esophageal cancer
Pancreatic cancerStomach cancer Heart disease
Gum
disease
Oral
lesions
Slide30Quitting Smoking has Many
Health Benefits
20 minutes
blood pressure returns to baseline
12 hours
oxygen levels return to normal; carbon monoxide
drops significantly48 hours sense of smell and taste begin to return to normal72 hours breathing is easier and lung function increases1-9 months chronic cough decreases; breathing improves, overall energy levels increase
1 year
risk of heart disease, stroke, and heart attack less than half that of a smoker
10 years
lowered risk of some cancers
15 years
risk of heart disease is equal to someone who has never smoked
Within…
Slide31Benefits of Quitting
Years of extended life
Age at cessation (years)
Quitting smoking at ANY age leads to a longer and healthier life
Slide32Benefits of Quitting
Improve health
and overall quality of
lifeIncrease healthy years of life
Improve mortality from tobacco-related illnesses
Save money by not
purchasing tobacco productsQuitting smoking is a right and individuals should have access to cessation services
Slide33Tobacco
&
Nicotine Products
Slide34Tobacco Products
that are
Smoked
Cigarettes: Most common form of tobacco in the U.S.
Cigars
:
One cigar has as much tobacco as a pack of cigarettesContain high levels of nicotineClove cigars/bidis: Cloves are a mixture of tobacco and cloves and have twice the nicotine compared to cigarettesBidis look like marijuana joints, come in candy flavors, and have
higher levels of tar, carbon monoxide, and nicotine than
cigarettes
Slide35Tobacco Products that are Smoked
Waterpipe
smoking (hookah): Tobacco flavored with fruit pulp, honey, and molasses
Often used for longer amounts of time than cigarettes,
so
more tar and nicotine is inhaledPipes: Puffed into the mouth, typically not inhaledOne of the least commonly used forms of tobacco
Slide36Smokeless Tobacco Products
In 2013, about 2.6% of Americans used smokeless tobacco
Rates of use for smokeless tobacco have not changed over the last five decades
Dissolvable
Tobacco
Snus
Dry Snuff
Chewing
Tobacco
Wet Snuff
Slide37A battery-powered electronic
device that provides doses of nicotine in a vapor
form
Ingredients:Propylene glycol and/or glycerinNicotine, 0-20mg/ml
Flavoring and other additives
E-Cigarettes
Slide38Not an FDA-approved cessation device
Do not address addiction to nicotine or behavior patterns
Unknown health risks
E-cigarettes are not “emission-free”Contain harmful chemicalsNo long-term studies
E-Cigarettes
Slide39Chemicals in Tobacco Products
Ammonia
Cadmium
Arsenic
Butane
Slide40Marijuana Smoke
Marijuana smoke contains several of the same carcinogens as the tar from tobacco
Secondhand marijuana smoke contains 50 harmful chemicals (70% more than tobacco smoke)
Marijuana smoke contains significant amounts of mercury, lead, ammonia, and hydrogen cyanide, among others Respiratory symptoms caused by marijuana smoke include
:
Chronic bronchitis
Frequent phlegmShortness of breathFrequent wheezingChest sounds without a cold
Slide41Tobacco
Dependence
Slide42Bio-Psycho-Social Model
Slide43Tobacco Dependence H
as Two
Parts
Courtesy of the University of California, San Francisco
Tobacco dependence is a 2-part
problem
Physical
Behavior
Treatment
Treatment
The addiction to nicotine
Medications for cessation
The habit of using tobacco
Behavior change program
Treatment should address both the addiction
and
the habit.
Slide44Nicotine Delivery
Cigarettes and other devices are the vehicles for maximal delivery of nicotine to the brain
Cigarettes can readily deliver approximately 1-2 mg of nicotine which is delivered approximately 10 seconds after inhalation
Smokers manipulate the intake of nicotine from different cigarettes to achieve and maintain the desired level of nicotine Nicotine is readily
absorbed through oral and nasal mucous
membrane (e.g., smokeless tobacco)
Slide45Psychoactive Effects of Nicotin
e
Stimulant (short puffs, low blood level)
Stimulates nerve transmissionNorepinephrine, dopamineEnhanced concentration
Alertness
Increased arousal
Sedative (long puffs, high blood level)Inhibits nerve transmissionSerotonin, opioidPain reductionReduced anxiety
Slide46Tobacco Use Cycle
Slide47Nicotine Withdrawal Effects
Irritability, frustration, anger
Anxiety
Difficulty c
oncentrating
Restlessness, impatience
Depressed mood Insomnia Increased appetite
Most
symptoms:
Appear
within the first 1–2
days
Peak
within the first
week
Decrease within
2–4
weeks
Slide48Tobacco Dependence H
as Two
Parts
Courtesy of the University of California, San Francisco
Tobacco dependence is a 2-part
problem
Physical
Behavior
Treatment
Treatment
The addiction to nicotine
Medications for cessation
The habit of using tobacco
Behavior change program
Treatment should address both the addiction
and
the habit.
Slide49Psychological
Factor
s
Relieves tension and anxiety in the short-term and is often used to cope with stressPart of a daily ritualA way to manage body image and food intake
Slide50Social Considerations
Want to feel like “part of a group”
Social networks
Peer influenceEnhance popularity
Associated with social activities
Slide51Changing Behaviors
People smoke in many different
situations:
When drinking coffee
While driving in the car
When bored
While stressed
When on the computer
After
meals
During breaks at work
While on the telephone
When spending time with family or friends who use tobacco
While drinking alcohol or using drugs
Slide52The Challenges of Quitting
Quitting requires:
Motivation
New coping skillsChanging behaviors
Slide53Factors that Influence Tobacco Cessation
Slide54Bio-Psycho-Social Model
Slide55Biological Factors
Nicotine = powerful chemical compound
Dopamine reward pathway
Physical and emotional withdrawal symptoms
Slide56Psychological Factors
Perception of inability to handle stress
Fear of failure
Worries about past cessation attempts
Slide57Socio-Cultural Factors
Contextual and demographic variables
Change in public attitudes toward tobacco use
State and federal smoking bansAffordable Care Act (ACA)
Slide58Environmental Factors
Factors that
promote
quitting:Household tobacco bansCommunity “anti-smoking” normsWorkplace smoking policiesMedia campaigns
Slide59Introduction to Tobacco Cessation Treatment Strategies
Slide60Tobacco Cessation Treatment Strategies
There are many different options for tobacco cessation
. The most effective approach combines elements of numerous strategies, such as:
Tobacco cessation medications
Cognitive and behavioral treatments
Supportive education about costs of tobacco use
Referral to tobacco cessation resources and supports
Slide61Treatment Format
Abstinence
Rate
Unaided4-7%
Self-help
11-14%
Quitline11-15%Individual counseling15-19%Group counseling12-16%Medication alone22%Medication +
counseling
25-30%
Tobacco Cessation Treatment Strategies
Slide62Discussion
Tobacco Fundamentals