( */ 5 5 & 4 & 3 " $ ) 5 - " & ) : 3 " . * 3 1 F I U P U O J *.1-&.&/5*/(50#"$$0$0/530- >C9>6C=:6AI=H:GK>8:ID7688D8DCIGDAI6H@;DG8: ImplementIng tobacco control Into the prImary healthcare SettIng Indian Health Service Tobacco Control Task Force U.S. Department of Health and Human Services Version 2 Copyright ©2009 State of Arizona acknowledgement Trudy Griffin-Pierce, PhD (1950 -2009) Associate Professor, Department of Anthropology, The University of Arizona The Indian Health Service Tobacco Control Task Force and contributors to the Implementing Tobacco Control into the Primary Healthcare Setting Fieldbook wish to pay special tribute to Dr. Griffin-Pierce who passed away suddenly. Dr. Griffin-Pierce is author of the Through Native Eyes introductions of the Fieldbook. Additionally, she selflessly contributed her original art work that introduces each Unit. She was of Catawba heritage with an unrelenting love of the Navajo culture nurtured since childhood and actualized by an adoptive Navajo family. She authored five published books about Native Americans and won awards for her artful publications. Dr. Griffin-Pierce was admired by her students and brought energy and spirit to every event involving the publication of this Fieldbook. We miss her presence as we revise this edition of the Fieldbook............ table of contentS Welcome meSSage ........................................................................................................................................................................................................I natIonal tobacco InItIatIve IndIan health ServIce, trIbal, and Urban health SyStemS .............................................................................................................................................III U.S. PUBLIC HEALTH SERVICE CLINICAL PRACTICE GUIDELINE ...........................................VII POSTERS..............................................................................................................................................................................................VIII UnIt one: tradItIonal and commercIal tobacco .................................................................................................1 TOBACCO DEPENDENCE AS A MAJOR PUBLIC HEALTH PROBLEM ................................5 COMMERCIAL TOBACCO ...................................................................................................................................................5 The Dangers of Tobacco ...............................................................................................................................................5 SMOKELESS TOBACCO ..........................................................................................................................................................9 Nicotine in Smokeless Tobacco (Spit Tobacco) .....................................................................................9 Nicotine Absorption in Chewing ..........................................................................................................................10 Consequences of Smokeless Tobacco Use................................................................................................10 Smoke-Free Laws and New Products on the Market ....................................................................12 ENVIRONMENTAL TOBACCO SMOKE (SECOND-HAND SMOKE) .....................................13 Environmental Tobacco Smoke Is Toxic ......................................................................................................14 Major Conclusions of The Health Consequences of Involuntary Exposure to Tobacco Smoke .........................................................................................15 UnIt tWo: tobacco dependence treatment .................................................................................................................19 MAKING A PLAN TO QUIT .............................................................................................................................................22 Talking Circle ...........................................................................................................................................................................22 SCREENING AND ASSESSMENT FOR TOBACCO USE ...................................................................... 23 LeVELS OF IntensitY in TOBaccO Dependence TREATMENT INTERVENTIONS .................................................................................................................................. 23 Minimal Interventions ....................................................................................................................................................24 Low-Intensity Counseling (Brief Interventions) ....................................................................................24 High-Intensity Counseling (Intensive Interventions) ........................................................................24 THE FIVE A MODEL (BRIEF INTERVENTIONS)............................................................................................ 25 Ask .....................................................................................................................................................................................................28 Advise .............................................................................................................................................................................................28 Assess ..............................................................................................................................................................................................29 Assist .................................................................................................................................................................................................31 Arrange ..........................................................................................................................................................................................35 Brief Intervention Flow Chart ................................................................................................................................36 QUIT PLAN ........................................................................................................................................................................................ 37 ASSESSING NICOTINE DEPENDENCE ..................................................................................................................38 DETERMINATION OF BASELINE TOBACCO USE AND VERIFICATION ........................39 Carbon Monoxide ..............................................................................................................................................................39 CO Monitors ............................................................................................................................................................................40 Cotinine .........................................................................................................................................................................................41 KNOWLEDGE IS NOT ENOUGH ...............................................................................................................................42 UnIt three: IntenSIve tobacco dependence InterventIonS ...........................................................45 PEACEMAKER .................................................................................................................................................................................47 INTENSIVE TOBACCO DEPENDENCE TREATMENT INTERVENTIONS.........................48 Intensity of Treatment by Healthcare Professionals ......................................................................49 Common Elements of Practical Counseling (Problem Solving/Skills Training) .......................................................................................................................50 Common Elements of Intra-Treatment Supportive Interventions ...................................51 Common Elements of Extra-Treatment Supportive Interventions .................................51 Fagerström Test for Nicotine Dependence............................................................................................. 52 QUITTING! .........................................................................................................................................................................................54 WHY CAN’T I JUST QUIT?................................................................................................................................................55 The Three-Link Chain of Tobacco Dependence .................................................................................55 WHY DO I SMOKE?.................................................................................................................................................................. 59 VaLidated IntensiVE TOBaccO Dependence TReatment PROGRAMS SPECIFIC TO AMERICAN INDIAN/ALASKA NATIVE COMMUNITY MEMBERS ...........................................................................................................................63 Puyallup Tribal Health Clinic (PTHA) Intensive Intervention System ...........................63 Second Wind: An Intensive Stop-Smoking Curriculum