BRIEF

TOBACCO
INTERVENTION
SKILLS (BTIS)

GAY B. ARDANAS, MD
MUNICIPAL HEALTH OFFICER
LGU-TALISAYAN SMOKE-FREE INITIATIVES
LEVELS OF INTENSITY IN TOBACCO INTERVENTIONS

 MINIMAL INTERVENTION
 Provided without any significant personal interactions
 Limited effect on any given person but are worthwhile because they reach many people and are
inexpensive
 Less than 3 minutes

 BRIEF INTERVENTION
 Requires personal interaction
 Based on the 5As ( Ask, Advise, Assess, Assist and Arrange)
 Last 3 to 10 minutes

 INTENSIVE INTERVENTION
 Include established programs as well as other multi session treatment programs.
 Trained providers
 4 or more therapeutic session whose content have been scientifically proven must take place. Each
session must be longer than 10 minutes
 Tobacco users must be informed and educated about the various medications currently available to
assist them in quitting.

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WHO IS READY TO QUIT?

 Not everyone who uses tobacco is ready to quit.

 About 20 % of tobacco users are ready to quit, 40 % are thinking about quitting and 40 % are
not ready to quit (Prochaske et. al. 1997)

 When you are intervening with a tobacco user, it is helpful to know how ready that person is to
quit so that you can:

 Give the right help.

 Be efficient and effective.
THE READINESS TO CHANGE MODEL

Not Ready to Quit

Thinking about quitting

Staying quit Ready

Termination Relapse
to Quit

Quitting
 NOT READY TO QUIT
 Has no intention to quit within the next six (6) months

 THINKING ABOUT QUITTING

 Intends to quit within the next six (6) months

 READY TO QUIT
 Willing to set a quit date within the next thirty (30) days

 QUITTING
 Has quit using tobacco for less than six (6) months

 STAYING QUIT
 Remained tobacco free for more than six (6) months

 STAYING QUIT
 Remained tobacco free for more than six (6) months

 RELAPSE
 Using tobacco again after a period of being tobacco free
THE FIVE (5) A’S
1. ASK

 Ask about tobacco use at every encounter.

 Sometimes asking people about their tobacco use can feel uncomfortable. The
recommendation is to keep it simple:
 Do you use Tobacco?
 Does anybody else in your house use tobacco?

2. ADVISE

 Effective advice includes Relevant information, emphasis on Risks and Rewards,

identification of Roadblocks and Repetition at each encounter.
3. ASSESS


4. ASSIST
 Assist the tobacco user in quitting
 Tobacco users who are willing to make a quit attempt at the time of the encounter need
assistance in developing a Quit Plan.
 The Core components of a quit plan include:
1. Setting a quit date
2. Identifying social support
3. Providing Specific Problem Solving suggestion
4. Giving information about medications
5. Providing self help materials
6. Referring to intensive services, if appropriate.
 Tobacco users who are unwilling to consider quitting can also be assisted. With these
individual:
 Avoid being judgemental or trying to pressure the tobacco user into quitting
 Offer selp help materials or literature that emphasizes the benefits of quitting tobacco
 Provide a brief motivational intervention

5. ARRANGE
 Arrange for follow-up whenever possible.
 Whenever possible, arrange the follow-up within a week after the individuals quit date. During
the follow-up contact:
 Ask about tobacco status
 Congratulate individuals who are tobacco free and support them in staying quit
 Support people who have relapsed and assisted them in making a new quit attempt.
BRIEF INTERVENTION FLOW CHART
1. ASK
Do you use tobacco?
Current No Congratulate!

yes

2. ADVISE 3. ASSESS

Advise to quit -5Rs Willing to discuss?

No Yes

4. ASSIST
Ready to set quit date
Not Ready to Quit
within one month
No Yes
ASSIST
Ready to quit –Quit plan

5. ARRANGE
I’VE QUIT USING TOBACCO AND NOW I'M FEELING…..

 DEPRESSED
Positive things to do:
 Call a relative or a friend
 Go to a movie, a concert or a show with someone
 Use prayer or meditation

 INSOMNIA
Positive things to do:
 Avoid Caffeine (coffee)
 Read in Bed

 IRRITABILITY, FRUSTRATION, ANGER

Positive things to do:
 Take a walk or exercise
 Talk to a friend or relative about how you feel
 STOP, close your eyes (unless you’re driving) Breathe in deeply through your nose and breathe
out through your mouth (Repeat this a few times)
BENEFITS OF QUITTING TOBACCO

 Improved Health
 Food will taste better
 Improved sense of smell
 Save money
 Feel better about yourself
 Home, car and breath will smell better
 Can stop worrying about quitting
 Set a good example for kids
 Have healthy babies and children
 No worrying about exposing others to smoke
 Feel better physically
 Perform better in sports
NEGATIVE CONSEQUENCE OF TOBACCO USE

 SHORT TERM RISK:

 Stained teeth
 Bad breath
 Shortness of breath
 Provokes asthma attacks
 Impotence
 Infertility
 LONG TERM RISK:
 Heart attacks and strokes
 Lung and other cancers (larynx, oral cavity, esophagus)
 Chronic Obstructive Pulmonary Disease (Emphysema)
 ENVIRONMENTAL RISK:
 Increased risk of lung cancer in spouse and children
 Higher rates of smoking by children of smokers
 Increased risk of asthma
 Middle Ear disease and respiratory infections in children of smokers
OTHER CONDITIONS ASSOCIATED WITH TOBACCO USE

 Hair loss
 Cataracts
 Wrinkling
 Skin cancer
 Osteoporosis
 Stomach ulcers
 Psoriasis
 Cervical Cancer
 gum ulcers
 Hearing impairment
 Worn down teeth
 Deformed sperm
 MY QUIT PLAN

Congratulations on your decision to quit using tobacco!

1. My quit date is:

month/day/year
2. My support persons are:
___________(wife, friend, significant others)
___________ (Health support group, church or prayer group)
 ANXIETY
Positive things to do:
 Do nothing for 10 minutes
 Do some stretching exercise
 Do one thing at a time
 Silent time for spiritual connections (prayers, mantra, humming songs)
 Laugh with someone.

 DIFFICULTY CONCENTRATING
Positive things to do:
 Take breaks
 Do important tasks when you are most alert
 Avoid sitting in the same position too long

 RESTLESSNESS
Positive things to do:
 Try squeezing a rubber ball or stress reliever
 Chew sugarless gum or candy, a carrot, or a toothpick
 Work on a hobby, take one day at a time
 INCREASED APPETITE OR WEIGHT GAIN
Positive things to do:

 Eat at least 5 serving of fruits and vegetables everyday.

 Eat lean cuts of meat and low fat dairy products
 Avoid fast food/ convenience food and fried food
 Walk whenever possible, aim for 20 to 30 minutes a day
 Drink lots of water 4 liters/day
 Regular exercise ( aerobics, gym, basketball, swimming)
 Gardening, house repairs, others