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Quitting Smoking

QUITTING SMOKING

 

eResources for Health Care Professionals

eLearning ABC - Help your client quit smoking

Quitting Smoking      

eResources for Health Care Professionals

Welcome to this eLearning ABC module!

Studies showed that a three-minute advice on smoking cessation by a health care professional would significantly increase the chance of successful quitting. A comprehensive smoking cessation service would not only broaden your scope of clinical service, but also help establish rapport between you and your clients.

  1. How you can make a difference
  2. What is ABC for quitting smoking?
    1. Ask
    2. Brief Advice
    3. Cessation Support
  3. Take Home Message
  4. Assessment

 

1. How you can make a difference

Smoking is the biggest preventable cause of death in Hong Kong and in many countries. Although the smoking prevalence has dropped from 23% in 1982 to 10.7% in 2012, the number of adult daily cigarette smoker is still as high as 645,000. Disease caused by smoking and secondhand smoke imposed a HK$5.3 billion economic and medical burden on our society annually. As such, Hong Kong and many countries have enhanced the efforts in promoting smoking cessation in addition to strengthening their tobacco control measures and legislations.

According to the Thematic Household Survey in 2012, about 303,200 smokers (near half of the smoking population) in Hong Kong wanted to quit. Apart from their own or family health reason, a significant portion (18.6%) of ex-daily smokers in Hong Kong decided to quit because they had been advised by health care professionals to do so.

Quitting is not as easy as it sounds. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple quit attempts. More than half would need to go through the process at least twice to succeed in kicking the habit. Apart from dealing with the problem of nicotine dependence, we have to bear in mind that behavioural modification and adjustment on  lifestyle during the course of smoking cessation are just as important. A comprehensive cessation programme should encompass all these elements.

Even if a comprehensive counselling session is not feasible during your daily encounter with smokers, you can perform “ABC” to help them quit smoking.

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2. What is ABC for quitting smoking?

 

Ask  
  1. Ask all people if they smoke and document.
  2. Update regularly - at least once a year.
Brief Advice
  1. Motivate every smoker to quit.
  2. Explain that a smoking cessation programme comprises assessment, counselling and pharmaotherapy if necessary.
  3. Offer support to quit according to their stage of change and acknowledge that some need multiple quit attempts.
Cessation Support Recommend that the best results are achieved by combining behavioural therapy with medicine.
  1. Recommend DH Quitline (1833 183) to all smokers by completing the fax-to-quit form so that Quitline staff will contact your client for follow up service,
  2. Refer your client to Smoking Cessation Centres,
  3. Give your client a Quitcard, or
  4. Provide cessation support yourself if you feel able to do so. 

A - Ask

What and whom should I ask?

It is important that you ask all clients their smoking status and document it in their health record. For those who smoke or have recently stopped smoking, the status should be checked and updated regularly e.g. annually.

For smokers, enquire on their smoking history -

  • Years of smoking
  • Amount used each day (cigarettes per day)

B - Brief Advice

You should:

  1. Motivate every smoker to quit.
  2. Explain that a smoking cessation programme comprises assessment, counselling and pharmacotherapy if necessary.

    Counselling (motivational interviewing) and medication are effective when used by themselves for treating tobacco dependence. The combination of counselling and medication, however, is more effective than either alone.

    Individual, group and telephone counselling are effective. Their effectiveness increases with treatment intensity.

    • Motivational Interviewing

      Motivational Interviewing (MI) was developed by William Miller and Stephen Rollnick in the 1980s. MI is defined as a collaborative conversation style for strengthening a person’s own motivation and commitment to change. It is a patient-centered style of counselling designed to help people change through exploring and resolving ambivalence about change.

      MI is being adopted in helping people to quit smoking. A large and increasing number of controlled research studies have shown that MI is significantly more effective than no treatment for substance use including tobacco use.

    • Pharmacotherapy

      Smokers often have insufficient understanding of the possible withdrawal symptoms in the process of quitting. Once a smoker refrains from smoking, the nicotine level inside his/her body will start to drop gradually. The quitter may experience short-term discomforts such as dizziness, headache, fatigue, poor concentration, dry mouth and throat, cough and hunger. All these symptoms increase the chance of failure in quit attempt but most of these discomforts would subside in 2 to 3 weeks’ time.

      Studies showed that pharmacotherapies can alleviate withdrawal symptoms and increase the success rate effectively. Besides, the medication can also become an incentive for the quitter to attend follow-up consultation on schedule. Common first-line supplementary medication for smoking cessation nowadays can be broadly divided into two categories: nicotine replacement therapy (NRT) and non-nicotine medications. For details, please go to drugs for quitting smoking.

    • Tips on Smoking Cessation

      For smokers who find it inconvenient to receive smoking cessation service and wish to quit on their own, you can pass them the following practical tips.

      • Recognise your reasons for quitting smoking
      • Assess the barriers you may encounter during smoking cessation, and figure out the corresponding counteractions
      • Dispose all smoking tools and cigarettes. Stay away from secondhand smoke and places frequented by smokers
      • When you feel craving for a cigarette, distract yourself as far as possible by calling friends who have successfully quitted, or leaving your work for a while to take deep breaths or do stretching exercises
      • Seek help from family members, friends, colleagues and smoking cessation partners. Tell them your feeling so as to seek their support and encouragement.
      • Develop new interests to replace smoking with healthy activities such as reading, horticulture, keeping fish, knitting or participating in community activities. 
      • Maintain a balanced diet. Avoid high-fat, high-cholesterol or high-sugar food. Never eat excessively to compensate for tobacco cravings to prevent weight gain. Avoid alcoholic or caffeinated beverages such as strong tea, coffee and milk tea to avoid stirring up the urge to smoke.
      • When someone offers you a cigarette, tell him/her firmly that you have quitted smoking and take the initiate to advise him/her to quit.
  3.  Offer support to quit and acknowledge that some need multiple quit attempts.

    • advice on problem solving skills e.g. skills on coping with stress and
    • social support delivered as part of a treatment.

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C - Cessation Support

You should recommend that the best results are achieved by combining behavioural therapy with medicine.

  1. Recommend DH Integrated Smoking Cessation Hotline (1833 183) to all smokers by completing the fax-to-quit form so that Quitline staff will contact your client for follow up service
  2. Refer your client to smoking cessation centres
  3. Give your client a Quitcard or
  4. Provide cessation support yourself if you feel able to do so
  • Smoking Cessation Service Providers in Hong Kong

  1. Integrated Smoking Cessation Hotline of the Department of Health (1833 183)

    The hotline (1833 183) is run by the nurses of the Department of Health. It coordinates various smoking cessation services provided by the Department of Health (DH), Tung Wah Group of Hospitals (TWGHs), Hospital Authority (HA), Pok Oi Hospital (POH) and the University of Hong Kong (Youth Quitline).

    A computerised call handling system is also set up to provide information on smoking cessation and medication in Cantonese, Putonghua and English round the clock. Users may assess their nicotine dependence via the system and obtain the test result as well as other useful information by fax.

  2. Smoking Cessation Centres

    Medications and counselling for smoking cessation are provided at centres or clinics. At present, there are a number of smoking cessation clinics run by DH, TWGHs, POH, HA and various organisations. Some private doctors and private hospitals also provide smoking cessation services that smokers may join.


Department of Health

Education and Training Centre in Family Medicine
Address: 2/F, Ngau Tau Kok Jockey Club Clinic, 60 Ting On Street, Ngau Tau Kok


Tung Wah Group of Hospitals - Integrated Centre on Smoking Cessation

The Department of Health collaborates with the Tung Wah Group of Hospitals to launch a community-based smoking cessation programme. Several Integrated Centres on Smoking Cessation are established by the Tung Wah Group of Hospitals to provide the community with free smoking cessation services in various time frames including evening hours and weekends. 


Hospital Authority

The Hospital Authority (HA) operates over 50 Smoking Counselling and Cessation Centres, providing smoking cessation services through counselling and provision of pharmacological interventions.

HA also has a "Quitline" (2300 7272) for enquiry and telephone counselling services.


Pok Oi Hospital

Free smoking cessation services including counselling and acupuncture are provided by POH Chinese medicine practitioners in 20 mobile clinics and 5 clinics which serve over 100 locations at different districts. Three Chinese Medicine Community Health Care Centres are established to support these mobile clinics.


United Christian Nethersole Community Health Service

The United Christian Nethersole Community Health Service aims to provide free smoking cessation services targeting ethnic minorities and new immigrants.  The service provides treatment to quit smoking and multilingual information on smoking cessation to cater the need of this community.  The enquiry telephone number is 3156 9012.


  1. The Quitcard can be obtained for referring your client to various smoking cessation services. Download the request form here.

For more information, call our Quitline 1833 183.

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3. Take Home Message
  • Tobacco dependence is a chronic disease but effective treatment is available. 
  • Your 3-minute advice can make a difference to a smoker's life.
  • ABC is all that you need to do.
  • Ask all clients their smoking status.
  • Briefly advise them on the benefit of quitting.
  • Refer them for Cessation support.

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4. Assessment

1 CME or CNE point will be awarded to those who attain a passing score of 60%.

Please click here to enter the assessment section.

 
 
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