p a ce (P revention a nd C essation E ducation )

1. pace(Prevention and Cessation Education) Collaboration of 12 US medical schools funded by the National Cancer InstituteBoston UniversityCase Western Reserve UniversityDartmouth CollegeHarvard UniversityLoma Linda UniversityUniversity of Alabama – BirminghamUniversity of California – Los AngelesUniversity of IowaUniversity of KentuckyUniversity of MassachusettsUniversity of RochesterUniversity of South Florida

2. pace Goals • Develop, refine, and integrate new educational modules • Train medical school faculty • Disseminate resources to other universities

3. Where You Come In… Using curricular assessments done at all 12 medical schools, our national conference reached a consensus… Most U.S. medical students graduate without adequate tobacco cessation and prevention skills • Preceptorship Module • Community Experience Module • Pediatrics/Family Medicine Module

4. Tobacco Educationfor the Pediatrics/Family Medicine Clerkship Reducing Exposure to Environmental Tobacco Smoke (ETS)

5. Learning Goals for this Module You will be able to: • Define secondhand smoke/ETS • Appreciate the scope and impact of ETS on children and adults • Assess the amount of ETS experienced by children at each visit/contact • Encourage a smoke free environment during all regular and sick visits

6. Learning Goals for this Module • Assist parents in creating a smoke free environment • Screen parents for current smoking status and readiness for change • Offer smoking cessation treatment to parents and/or refer them to their providers

7. Learning Goals for this Module You will be able to: • Define secondhand smoke/ETS • Appreciate the scope and impact of ETS on children and adults • Assess the amount of ETS experienced by children at each visit/contact • Encourage a smoke free environment during all regular and sick visits

8. Defining Secondhand Smoke/ETS Massachusetts Medical Society Anti-Tobacco Contest Winner

9. Defining Secondhand Smoke/ETS • Secondhand smoke, also known as environmental tobacco smoke (ETS), is a mixture of the smoke given off by the burning of tobacco products (sidestream smoke) and the smoke exhaled by smokers (mainstream smoke). Refs:Health Effects of Exposure to Environment Tobacco Smoke. Smoking and Tobacco Control Monograph No. 10 National Cancer Institute; 1999. NIH Pub. No. 99-4645. 10th Report on Carcinogens. Research Triangle Park, NC: U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program, December 2002.

10. Defining Secondhand Smoke/ETS • Secondhand smoke contains a complex mixture of more than 4,000 chemicals • Over 50 of these chemicals are carcinogenic.

11. Learning Goals for this Module You will be able to: • Define secondhand smoke/ETS • Appreciate the scope and impact of ETS on children and adults • Assess the amount of ETS experienced by children at each visit/contact • Encourage a smoke free environment during all regular and sick visits

12. The Scope and Impact of ETS Massachusetts Medical Society Anti-Tobacco Contest Winner

13. Health Effects of ETS • More than 1 out of 3 children have a parent who smokes • Because their lungs are not fully developed, young children are particularly susceptible to secondhand smoke. • Parents who smoke subject their children (and unborn children) to a range of health risks that can be divided into prenatal, post-natal and longer term Refs:Health Effects of Exposure to Environment Tobacco Smoke. Smoking and Tobacco Control Monograph No. 10 National Cancer Institute; 1999. NIH Pub. No. 99-4645. Women and Smoking: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001.

14. Prenatal Risks • Low birthweight • Miscarriage • Premature delivery • Stillbirth • Sudden Infant Death Syndrome (SIDS) • Neurobehavioral problems

15. Postnatal Risks • Higher rates of: • Pneumonia • Otitis Media • Asthma and asthma exacerbations • Invasive meningitis • Colic • Respiratory complications under anesthesia • Sudden Infant Death Syndrome (SIDS)

16. Longer-term Risks • Reduced pulmonary function • Dental decay

17. Other Points to Consider • The health consequences of ETS are significant for all family members • The American Heart Association now recommends limiting ETS for everyone • More than 70% of mothers who stop smoking during pregnancy will relapse after giving birth

18. Estimated U.S. Morbidity and Mortality in Nonsmokers Associated with ETS

19. But Can You Make A Difference? Becoming a Piece of the Puzzle

20. Why Intervene? Teachable Moments • Health effects associated with ETS are substantial but often hidden • Physicians are a respected source of information • Many opportunities to intervene • Brief interventions are effective • Limiting exposure to ETS results in proven benefit to children

21. Respected Source of Information • Pediatrician and Family Medicine counseling has been recommended for: • physical activity • motor vehicle injuries • youth violence • injuries • unintended pregnancy • ETS counseling is a natural extension

22. Many Opportunities to Intervene • Newborn visits • 12 well-child visits are recommended during the first 6 years of life • Unscheduled, acute care visits (may be ETS-related) • Otitis media • Asthma and asthma exacerbations • Bronchitis

23. Simple advice (brief interventions) from a physician is effective in promoting long-term cessation Parents may not be aware of the serious health effects of ETS–ask parents to name effects Brief Interventions are Effective

24. Proven Benefits of Limiting ETS • Breathe better and grow better • 33% fewer school absences • Four times less likely to become a cigarette smoker Refs:Need refs here

25. Learning Goals for this Module You will be able to: • Define secondhand smoke/ETS • Appreciate the scope and impact of ETS on children and adults • Assess the amount of ETS experienced by children at each visit/contact • Encourage a smoke free environment during all regular and sick visits

26. Assessing the Amount of ETS Massachusetts Medical Society Anti-Tobacco Contest Winner

27. Brief Counseling Model Remembering the 5 A’s • Ask • Assess • Advise • Assist • Arrange

28. Start by Asking • Open ended questions • Use a non-confrontational style and tone • Link your questioning to the reason for visit/contact

29. Assessing Exposure Include all potential sources of exposure • Home • Car • Daycare • Family • Relative • Friends

30. Learning Goals for this Module You will be able to: • Define secondhand smoke/ETS • Appreciate the scope and impact of ETS on children and adults • Assess the amount of ETS experienced by children at each visit/contact • Encourage a smoke free environment during all regular and sick visits

31. Encourage a Smoke Free Environment Massachusetts Medical Society Anti-Tobacco Contest Winner

32. Brief Counseling Model Remembering the 5 A’s • Ask • Assess • Advise • Assist • Arrange

33. Encourage a Smoke Free Environment • Give a positive message • Focus on benefits to child • Roll with resistance/obstacles • Recognize and acknowledge barriers

34. Common Barriers to Quitting • Fear of failure • Nicotine withdrawal • Loss of a coping tool • Family and friends who smoke • Weight gain

35. Barriers to Limiting ETS • Logistics • Parenting is stressful • Do not want to upset others by asking them to change their behavior

36. Motivating Caregivers to Quit! • They will have more energy and breathe easier • Saves money that can be spent on other things • Clothes, hair, and home smell better • Food tastes better • Can feel good about what they have done for themselves and their child

37. How to Motivate Limiting ETS • Remain focused on the health benefits for the child • Fewer acute care visits • Less absenteeism • Empower parent/caregiver to act on behalf of the child • Make mom a hero

38. Make Mom a Hero! • Keeps message positive and focused on the child’s benefit • Consider using a Smoke Free Pledge

39. Another Piece of the Puzzle!

41. Learning Goals for this Module • Assist parents in creating a smoke free environment • Screen parents for current smoking status and readiness for change • Offer smoking cessation treatment to parents and/or refer them to their providers

42. Creating a Smoke Free Environment Massachusetts Medical Society Anti-Tobacco Contest Winner

43. Brief Counseling Model Remembering the 5 A’s • Ask • Assess • Advise • Assist • Arrange

44. Creating a Smoke Free Environment • Set realistic goals • Provide a range of options from smoking cessation to any gains in limiting ETS • Empower parent/caregiver • Provide handouts

45. Practical Suggestions • Quit • Smoke outside ONLY • Open a window • Ask others to do the same

46. Learning Goals for this Module • Assist parents in creating a smoke free environment • Screen parents for current smoking status and readiness for change • Offer smoking cessation treatment to parents and/or refer them to their providers

47. Screening Parents/Caregivers Massachusetts Medical Society Anti-Tobacco Contest Winner

48. A Missed Opportunity • In the event that the parent or caregiver is interested in smoking cessation, it provides an opportunity to benefit two patients • Simply asking them about their desire to quit may open up an otherwise missed opportunity • It is not Pandora’s Box- Be prepared to respond to a positive response

49. Learning Goals for this Module • Assist parents in creating a smoke free environment • Screen parents for current smoking status and readiness for change • Offer smoking cessation treatment to parents and/or refer them to their providers

50. Helping Parents/Caregivers to Quit Massachusetts Medical Society Anti-Tobacco Contest Winner