TOBACCO REDUCTION AND CESSATION believe the most reasonable response to the tobacco epidemic is comprehensive tobacco control—a comprehensive, coordinated, and multi-level strategy involving all of the pillars of tobacco control; prevention, protection and cessation. [...] For the purposes of increasing the addictive nature of nicotine, smoked tobacco through the design of cigarettes delivers nicotine in a free-based format to the brain (i.e. [...] One of the changes is the addition of the criterion of craving as well as the general amalgamation of the categories of abuse and dependence into a single entity (in the DSM-IV-TR the diagnostic entity of abuse did not exist for nicotine but does for other sub- stances of abuse). [...] The current criteria and protocols for the diagnosis and assessment of severity of tobacco use disorder are outlined in Chapter 6. As noted earlier, in this volume the term tobacco addiction is used interchangeably with the DSM-5 term tobacco use disorder, denoting the former diagnostic entity of nicotine dependence. [...] Article 14 of the WHO FCTC addresses cessation and recommends the development and dissemination of appropriate, comprehensive, and integrated treatment guidelines based on scientific evidence and best practices.7 The US Public Health Service-sponsored Clinical Practice Guideline update identifies the ‘5-A’ model for treating tobacco use and dependence.10 This includes asking about tobacco use with
Authors
- Bibliography, etc. Note
- Includes bibliographical references
- Control Number Identifier
- CaOOCEL
- Date published
- 2014.
- Description conventions
- rda
- Dewey Decimal Classification Number
- 362.29/66
- Dewey Decimal Edition Number
- 23
- Distributor
- Canadian Electronic Library (Firm),
- General Note
- Issued as part of the desLibris books collection
- ISBN
- 9782763719900 9782763719894
- LCCN
- HV5732
- LCCN Item number
- D611 2014eb
- Modifying agency
- CaBNVSL
- Original cataloging agency
- CaQQLA
- Physical Description | Extent
- 1 electronic text (xiii, 393 pages)
- Published in
- Ottawa, Ontario
- Publisher or Distributor Number
- CaOOCEL
- Rights
- Access restricted to authorized users and institutions
- System Control Number
- (CaBNVSL)slc00234123 (OCoLC)876860945 (CaOOCEL)447206
- System Details Note
- Mode of access: World Wide Web
- Transcribing agency
- CaQQLA
Table of Contents
- Introduction 17
- 1 23
- Disease Interrupted 23
- Charl Els, Diane Kunyk and Peter Selby 23
- The potential of cessation policies 25
- Tobacco use and addiction 27
- Clinical practice guidelines 29
- Treatment 33
- Social justice 35
- Conclusions 36
- References 36
- 2 39
- Legal Duty to Treat Tobacco Use and Addiction 39
- Patrick Hlavac-Winsor, Charl Els, David Sweanor and Diane Kunyk 39
- Duty to diagnose 41
- Duty to refer 41
- Duty to instruct the patient 42
- Causation 42
- Conclusion 47
- References 48
- Foundations 49
- 3 51
- Health Effects of Tobacco and Secondhand Smoke 51
- Roberta Ferrence, Sarah Muir and Jaclyn Kaye 51
- Mechanisms for health effects 53
- Smoking 53
- Smokeless tobacco 54
- Other tobacco products 55
- E-cigarettes 55
- Secondhand smoke 56
- Thirdhand smoke 60
- Waterpipe (hookah, shisha or narghile) smoking 61
- Nicotine 64
- Benefits and risks of quitting 65
- Conclusion 66
- References 67
- 4 71
- Evidence for Developing and Implementing Cessation Services 71
- Robert Schwartz, Jolene Dubray, Anne Philipneri, Michael Chaiton and Shawn O’Connor 71
- Global trends in tobacco use and cessation 72
- Smoking related mortality and morbidity in canada 74
- Tobacco use in canada 75
- General analysis of current smoking by sub-populations 77
- Smoking and other chronic disease risk factors 81
- Smoking cessation in Canada 82
- Consumption 86
- Dependence (addiction) 87
- Summary 87
- References 88
- 5 91
- Nicotine 91
- Hans Rollema 91
- History 91
- Chemistry, pharmacology, and pharmacokinetics of nicotine 93
- Nicotinic acetylcholine receptors: properties and function 97
- Nicotine addiction 103
- Nicotine and nachr ligands as therapeutics 107
- Summary 111
- References 111
- Tobacco Reduction and Cessation 115
- 6 117
- Assessing Tobacco Use in Clinical Practice: A Step-Wise Approach 117
- Milan Khara, Amit Rotem and Allison van Driesum 117
- Assessment protocol 118
- Step 1: identification of tobacco users 118
- Step 2: triage 120
- Step 3: measurement of outcomes 126
- Summary 127
- References 127
- 7 129
- Unassisted Cessation 129
- Diane Kunyk and Charl Els 129
- Unassissted and assisted tobacco reduction and cessation 130
- Access to tobacco reduction and cessation interventions 134
- Situating unassissted and assisted cessation 135
- References 137
- Tobacco cessation self-help books 139
- Marilyn Herie 139
- 8 143
- Psychosocial Interventions 143
- Stephanie Cohen, Rosa Dragonetti, Marilyn Herie and Megan Barker 143
- Brief interventions 145
- Intensive counselling 152
- Cognitive-behavioural approaches 153
- Motivational interviewing 158
- Group treatment 161
- Tobacco cessation quitlines 164
- Web-assisted tobacco interventions 165
- Contingency management 166
- Conclusion 168
- References 169
- 9 173
- Pharmacotherapies 173
- CAN-ADAPPT summary statements for pharmacotherapy 173
- 9.1 175
- Nicotine Replacement Therapies 175
- John Hughes 175
- Formats available 175
- Mechanism of action 176
- Pharmacokinetic comments 176
- Indications and clinical use 177
- Nicotine gum 178
- Nicotine inhaler 179
- Nicotine lozenge 179
- Nicotine mouth spray 179
- Nicotine patch 180
- Combined nicotine patch and nicotine gum/inhaler/lozenge/mouth spray 180
- Combined nrt + psychosocial treatment vs otc nrt 181
- Contraindications 181
- Warnings and precautions 182
- Efficacy 183
- Adverse reactions 183
- Dosage and administration 184
- Overdosage 184
- The future of nrt 185
- Summary 185
- Patient Handout: Nicotine Gum 186
- Ron Pohar 186
- Patient Handout: Nicotine Patch 188
- Ron Pohar 188
- Patient Handout: Nicotine Inhaler 190
- Ron Pohar 190
- Patient Handout: Nicotine Lozenge 192
- Ron Pohar 192
- Patient Handout: Nicotine Mouth Spray 194
- Ron Pohar 194
- 9.2 197
- Sustained-Release Bupropion (Bupropion SR) 197
- Peter Selby and Andriy Samokhvalov 197
- Mechanism of action 198
- Pharmacokinetics 198
- Indications and clinical use 199
- Contraindications 199
- Adverse reactions 200
- Overdose 200
- Drug interactions 200
- Use during pregnancy and lactation 201
- Effects on weight 201
- Efficacy 201
- Re-treatment 202
- Relapse prevention 202
- Delayed response 202
- Combination therapy 203
- Smokeless tobacco users 203
- Effectiveness in the real world 203
- Women 204
- Unmotivated smokers 204
- Conclusion 204
- Patient Handout: Sustained-Release (SR) Bupropion 205
- Ron Pohar 205
- 9.3 209
- Varenicline 209
- Jotham Coe 209
- Indications 210
- Mechanism of action 210
- Pharmacokinetics 210
- Clinical studies / efficacy 211
- Contraindications 213
- Adverse effects 213
- Drug interactions 215
- Dosage 216
- Overdosage 216
- Combination therapy 217
- Conclusion 217
- Patient Handout: Varenicline 218
- Ron Pohar 218
- 9.4 221
- Cardiovascular Complications of Pharmacotherapy for Smoking Cessation 221
- Serena Tonstad 221
- Nicotine replacement therapy 221
- Bupropion 224
- Varenicline 225
- Conclusion 230
- 9.5 231
- Neuropsychiatric Considerations 231
- Charl Els 231
- 9.6 235
- Seizing the potential of electronic cigarettes 235
- The public health potential of reduced-risk alternatives to cigarettes 235
- David Sweanor 235
- The public health potential of reduced-risk alternatives to cigarettes 235
- From a theoretical to a practical discussion: the advent of electronic cigarettes 237
- E-cigs as a smoking cessation intervention 239
- Challenges to our regulatory frameworks 240
- The perceived benefits and risks 242
- Future directions 244
- References 246
- Special Settings 259
- 10 261
- Detoxification: Treatment of Tobacco Withdrawal 261
- Charl Els, Diane Kunyk, Yoram Barak, Eileen Thomas and Debra Scharf 261
- Background 262
- Nicotine withdrawal syndrome 264
- Forcing patients to quit smoking? 266
- Tobacco detoxification 266
- Detoxification management 267
- The challenge with outdoor smoking 268
- Legal implications 269
- Summary 272
- References 272
- 11 275
- Hospital-Initiated Smoking Cessation: The Ottawa Model for Smoking Cessation 275
- Robert Reid, Kerri-Anne Mullen and Andrew Pipe 275
- Clinical practice guidelines and best practices for hospital-initiated interventions 276
- The Ottawa model for smoking cessation 278
- Challenges and systemic barriers to implementation and sustainability 283
- Summary and future directions 285
- References 286
- 12 289
- Tobacco Use and Addiction Management in Primary Care Settings 289
- Diane Kunyk, Sophia Papadakis, Charl Els and Emilene Reisdorfer 289
- Opportunity 290
- Tobacco use screening and treatment by healthcare professionals 291
- Rates of tobacco treatment delivery in primary care settings 293
- Barriers to implementation 295
- Systems level supports for intervention 296
- Efficacy of interventions in primary care 297
- Models of intervention 299
- Conclusions 300
- References 301
- 13 305
- Cessation and the Workplace 305
- Diane Kunyk, Charl Els and David van Driesum 305
- Smoking as a cause of absenteeism and “presenteeism” 305
- Towards a tobacco-free workforce 307
- Tobacco withdrawal 308
- Workplace tobacco cessation 308
- Conclusion 309
- References 310
- Disproportionally Affected Populations 311
- 14 313
- Nontraditional Tobacco Use among Aboriginal Canadians 313
- Dennis Wardman, Rod McCormick, Daniel McKennitt and Pamela O’Donaghey 313
- Literature review 315
- Prevalence of tobacco use among aboriginal canadians 316
- Risk factors that contribute to high smoking rates 317
- Implications and key learnings from empirical research 321
- Applications for healthcare providers 323
- Reversing nontraditional tobacco use and restoring tobacco’s rightful role in aboriginal communities 328
- References 329
- 15 333
- Treatment of Tobacco Addiction in Mental Health and Addictive Disorders 333
- Marleen Filimon and Tony George 333
- The epidemiology of tobacco dependence in mental health and addictive disorders 334
- Neurobiology of tobacco use and comorbidity with mental health and addiction disorders 335
- Clinical assessment of tobacco addiction in the mental health and addictive disorder population 337
- Treatment options for tobacco addiction in mental health and addiction disorders 339
- Conclusions and recommendations 343
- Acknowledgements 344
- References 344
- 16 351
- Imagine: Gender-Specific Tobacco Reduction and Cessation Strategies in Pregnancy and the Postpartum 351
- Joan L. Bottorff, John L. Oliffe, Lorraine Greaves, Nancy Poole, Gayl Sarbit and Natalie Hemsing 351
- Pregnant and postpartum women 353
- Expectant and new fathers 360
- Supporting cessation efforts among expectant and new fathers 366
- Conclusion 367
- References 368
- 17 371
- Young People and Smoking Cessation 371
- Becky Freeman 371
- Youth smoking rates 371
- Summary of the limited evidence of tailored youth cessation interventions 372
- What works best to reduce youth smoking? 373
- Future of youth and young adult smoking cessation: digital communications show promise 377
- Conclusion 380
- References 380
- Parting thoughts 385
- 18 387
- Ethical Contemplations 387
- Diane Kunyk, Charl Els and Peter Selby 387
- Public health model 388
- Parting thoughts 393
- References 394
- Contributors 397
