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Active IQ Level 2 Award in Smoking Awareness and Cessation (sample manual)

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Manual<br />

<strong>Level</strong> 2 <strong>Award</strong> <strong>in</strong><br />

Smok<strong>in</strong>g <strong>Awareness</strong><br />

<strong>and</strong> <strong>Cessation</strong><br />

Version A<strong>IQ</strong>004334


Section 1: Key UK statistics related to smok<strong>in</strong>g<br />

Demographics of smokers <strong>in</strong> the UK<br />

Accord<strong>in</strong>g to National Institute for Cl<strong>in</strong>ical Excellence <strong>and</strong> the British Medical Journal it is estimated that more<br />

than 8.5 million people <strong>in</strong> the UK are smokers. The National Office of Statistics General Household Survey <strong>and</strong><br />

General Lifestyle Survey estimates the figure at 20% of the population based on their respondents. Smok<strong>in</strong>g<br />

is becom<strong>in</strong>g less prevalent; hav<strong>in</strong>g dropped from around 45% of the population <strong>in</strong> 1974. The <strong>in</strong>troduction of<br />

‘smokefree’ legislation <strong>in</strong> 2007 appears to have reduced the <strong>in</strong>cidence by around 1%.<br />

Men have always smoked more than women, although this difference is levell<strong>in</strong>g out as shown <strong>in</strong> table 1.1<br />

<strong>and</strong> figure 1.1.<br />

Table 1.1: Prevalence of smok<strong>in</strong>g by gender<br />

Men<br />

Women<br />

1974 51% 41%<br />

2011 21% 19%<br />

Figure 1.1: Prevalence of smok<strong>in</strong>g by gender 1974-2011<br />

60<br />

50<br />

40<br />

30<br />

20<br />

10<br />

0<br />

1974<br />

1978<br />

1982<br />

1986<br />

1990<br />

1994<br />

1998<br />

All men 16 <strong>and</strong> over<br />

2000<br />

2001<br />

2002<br />

2003<br />

2004<br />

2005<br />

2006<br />

2007<br />

2008<br />

2009<br />

2010<br />

2011<br />

All women 16 <strong>and</strong> over<br />

There are certa<strong>in</strong> population groups with a significantly higher than average <strong>in</strong>cidence of smok<strong>in</strong>g, these<br />

<strong>in</strong>clude:<br />

• Young adults (20-34 years old).<br />

• Men from South Asian communities (Specifically Bangladeshi <strong>and</strong> Pakistani men, Indian men are less<br />

likely to smoke than the UK average).<br />

• People from lower socioeconomic groups (determ<strong>in</strong>ed as unemployed or fulfill<strong>in</strong>g <strong>manual</strong> operational job<br />

roles).<br />

In 2010, young adults were the highest consumers of cigarettes: 28% of 20-24-year-olds <strong>and</strong> 26% of those<br />

aged 25-34 reported be<strong>in</strong>g smokers. Those aged 60 <strong>and</strong> over reported the lowest prevalence of smok<strong>in</strong>g at<br />

just 13% of the population.<br />

4 | Copyright © 2016 <strong>Active</strong> <strong>IQ</strong> Academy Ltd. Not for resale


Figure 1.2: Map of health <strong>in</strong>equalities <strong>in</strong> Engl<strong>and</strong><br />

Smok<strong>in</strong>g is more common <strong>in</strong><br />

Wales (24%) <strong>and</strong> Scotl<strong>and</strong><br />

(24%) than <strong>in</strong> Engl<strong>and</strong> (19%).<br />

Smok<strong>in</strong>g rates also vary by<br />

region <strong>in</strong> Engl<strong>and</strong>. The map of<br />

health <strong>in</strong>equalities (figure 1.2)<br />

reflects where the higher rates<br />

of premature death, l<strong>in</strong>ked<br />

to socioeconomic status <strong>and</strong><br />

<strong>in</strong>cidence of smok<strong>in</strong>g, can be<br />

found. For example, smok<strong>in</strong>g<br />

prevalence was higher <strong>in</strong><br />

Yorkshire <strong>and</strong> the North West<br />

(both 21%) than it was <strong>in</strong><br />

London (16 %).<br />

Smok<strong>in</strong>g is the lead<strong>in</strong>g cause<br />

of preventable disease <strong>and</strong><br />

premature death <strong>in</strong> the UK.<br />

Over 100,000 people die<br />

annually <strong>in</strong> Brita<strong>in</strong> as a result<br />

of smok<strong>in</strong>g. This equates to<br />

18% of all deaths <strong>in</strong> adults<br />

aged 35 <strong>and</strong> older.<br />

Revenue earned from tobacco tax<br />

In 2011-2012, the Treasury received £9.5 billion <strong>in</strong> revenue from tobacco tax (exclud<strong>in</strong>g VAT). Includ<strong>in</strong>g VAT<br />

(at an estimated £2.6 billion) total tobacco revenue was £12.1 billion. This is equivalent to around 2% of total<br />

Government revenue. The price of a pack of 20 premium br<strong>and</strong> cigarettes currently costs around £7.45, of<br />

which £5.80 (78%) is tax.<br />

Accord<strong>in</strong>g to the Office for National Statistics (ONS) ‘Consumer Trends’ report, the total UK household<br />

expenditure on tobacco has more than trebled from 1980 to 2011. In 2011 £18.3 billion was spent on<br />

tobacco. Tobacco smuggl<strong>in</strong>g costs the treasury <strong>and</strong>, although it is estimated to have dropped s<strong>in</strong>ce 2008,<br />

it is estimated that smuggl<strong>in</strong>g of illicit cigarettes accounts for 10% of the market (about £1 billion tax loss<br />

annually). Smuggl<strong>in</strong>g is far higher for h<strong>and</strong> rolled tobacco <strong>and</strong> is estimated to account for almost half of the<br />

loose tobacco smoked <strong>in</strong> the UK.<br />

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Short-, medium- <strong>and</strong> long-term health implications of smok<strong>in</strong>g<br />

Smok<strong>in</strong>g is the lead<strong>in</strong>g preventable cause of mortality <strong>in</strong> the UK, account<strong>in</strong>g for around 100,000 deaths each<br />

year. At a global level the smok<strong>in</strong>g death toll is estimated to reach 6 million people each year, with a year<br />

on year <strong>in</strong>crease. Every organ <strong>and</strong> system of the body is affected by smok<strong>in</strong>g <strong>and</strong> the medium- to long-term<br />

impact on each system of the body is identified next.<br />

Nervous system changes<br />

Altered bra<strong>in</strong> chemistry: The reduced number of dopam<strong>in</strong>e receptors <strong>in</strong> bra<strong>in</strong> neurons can cause greater<br />

difficulty <strong>in</strong> obta<strong>in</strong><strong>in</strong>g pleasure from more natural sources such as eat<strong>in</strong>g <strong>and</strong> sex.<br />

Sensory acuity: This results from damage to nerve cells. A loss of subtlety <strong>in</strong> sensation, along with more<br />

obvious reductions to the sensitivity of special senses like olfaction (smell) <strong>and</strong> taste. Vision <strong>and</strong> hear<strong>in</strong>g<br />

are also impaired by smok<strong>in</strong>g due to the damage to blood vessels supply<strong>in</strong>g these organs with oxygen <strong>and</strong><br />

nutrients.<br />

Mental health conditions: There is a strong l<strong>in</strong>k between smok<strong>in</strong>g <strong>and</strong> mental health. For most conditions it<br />

is unclear whether smok<strong>in</strong>g is a causative factor or an outcome of the condition. There is some evidence to<br />

suggest that smok<strong>in</strong>g may be a causal factor <strong>in</strong> the development of depression <strong>and</strong> certa<strong>in</strong>ly <strong>in</strong>creases the risk<br />

of develop<strong>in</strong>g an episode of major depression.<br />

The smok<strong>in</strong>g rate <strong>in</strong> the general population is 19%. Table 1.2 <strong>in</strong>dicates the smok<strong>in</strong>g rates amongst people<br />

with different mental health conditions <strong>and</strong> the variation from average.<br />

Table 1.2: Summary of f<strong>in</strong>d<strong>in</strong>gs from 2007 Adult Psychiatric Morbidity Survey (APMS)<br />

Condition Smok<strong>in</strong>g prevalence Variation from average<br />

Probable psychosis 40% +21%<br />

Depressive episode 37% +18%<br />

Phobias 37% +18%<br />

Post-traumatic stress disorder 37% +18%<br />

Generalised anxiety disorder 36% +17%<br />

Obsessive compulsive disorder 34% +14%<br />

Panic disorder 31% +11%<br />

Attention deficit hyperactivity disorder 31% +11%<br />

Mixed anxiety <strong>and</strong> depression 29% +10%<br />

Eat<strong>in</strong>g disorder 20% +1%<br />

Medium- to long-term effects of smok<strong>in</strong>g are a decl<strong>in</strong>e <strong>in</strong> bra<strong>in</strong> function <strong>and</strong> an <strong>in</strong>crease <strong>in</strong> the risk of develop<strong>in</strong>g<br />

dementia <strong>and</strong> Alzheimer’s disease. This is thought to be a result of reduced blood flow <strong>and</strong> <strong>in</strong>creased free<br />

radical damage to bra<strong>in</strong> cells. This f<strong>in</strong>d<strong>in</strong>g is conclusive from several recent <strong>and</strong> large-scale studies <strong>and</strong> refutes<br />

early research that suggested a potential protective effect of smok<strong>in</strong>g aga<strong>in</strong>st Alzheimer’s disease. Research<br />

<strong>in</strong>to the effect of pure nicot<strong>in</strong>e on development of Alzheimer’s is ongo<strong>in</strong>g <strong>and</strong> may demonstrate a protective<br />

effect.<br />

Smok<strong>in</strong>g is viewed as a form of self-medication by many smokers with mental health conditions. Despite<br />

evidence <strong>and</strong> NICE guidance to the contrary, many professionals work<strong>in</strong>g with<strong>in</strong> the field of mental health<br />

hold the same belief as patients. Research has shown that smok<strong>in</strong>g cessation <strong>in</strong>terventions can be equally<br />

successful for people with mental health conditions as they are <strong>in</strong> the general population. It has also been<br />

demonstrated that smok<strong>in</strong>g cessation does not worsen symptoms of mental health conditions <strong>and</strong> reduces<br />

anxiety levels after the <strong>in</strong>itial withdrawal period.<br />

Copyright © 2016 <strong>Active</strong> <strong>IQ</strong> Academy Ltd. Not for resale | 9


Section 3: Key components of tobacco products <strong>and</strong> their<br />

effects on the body<br />

Substances <strong>and</strong> chemicals found <strong>in</strong> tobacco products<br />

It is frequently cited that over 4000 different chemicals are found <strong>in</strong> tobacco smoke. One research study<br />

(Rodgman <strong>and</strong> Perfetti, 2009) found 7357 chemical compounds. The content of each cigarette varies slightly<br />

by component, but there are likely to be over 7000 different chemicals <strong>in</strong> a cigarette. Of these chemicals the<br />

number quoted to be carc<strong>in</strong>ogens also varies (from 40-70) depend<strong>in</strong>g on the source of <strong>in</strong>formation.<br />

Tobacco smoke is a complex chemical system comprised of gas <strong>and</strong> particulate components, the mixture of<br />

chemicals <strong>in</strong> each phase varies accord<strong>in</strong>g to the way a cigarette is smoked. Some of the chemicals <strong>and</strong> their<br />

other uses are neatly summarised <strong>in</strong> figure 3.1.<br />

Figure 3.1: Some chemicals <strong>in</strong> tobacco smoke <strong>and</strong> their other uses<br />

Effects of nicot<strong>in</strong>e on the body<br />

Nicot<strong>in</strong>e is the ma<strong>in</strong> drug compound found <strong>in</strong> tobacco. Nicot<strong>in</strong>e is an alkaloid compound; a type of chemical<br />

often found <strong>in</strong> plants as a natural defence aga<strong>in</strong>st be<strong>in</strong>g eaten by <strong>in</strong>sects <strong>and</strong> mammals. Once <strong>in</strong> the human<br />

body, nicot<strong>in</strong>e mimics the common neurotransmitter chemical acetylchol<strong>in</strong>e giv<strong>in</strong>g it a psychoactive effect. It is<br />

this same effect which makes it highly addictive. All of the nicot<strong>in</strong>e <strong>in</strong>haled <strong>in</strong> a puff of smoke can be absorbed<br />

across the lung fluid membranes <strong>in</strong>to the blood. The nicot<strong>in</strong>e passes <strong>in</strong>to the bloodstream <strong>and</strong> reaches the<br />

bra<strong>in</strong> with<strong>in</strong> seconds of <strong>in</strong>hal<strong>in</strong>g the smoke.<br />

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Short-, medium- <strong>and</strong> long-term benefits of smok<strong>in</strong>g cessation<br />

The greatest s<strong>in</strong>gle action that a smoker can take to improve health <strong>and</strong> reduce risk of disease is to give<br />

up. There are many other benefits to quitt<strong>in</strong>g smok<strong>in</strong>g <strong>and</strong> these may be just as important (or even more<br />

important) to an <strong>in</strong>dividual <strong>and</strong> should not be disregarded.<br />

Short-term benefits<br />

Some smokers will identify sav<strong>in</strong>g money as an important reason for stopp<strong>in</strong>g smok<strong>in</strong>g. Ask<strong>in</strong>g these people<br />

to identify a way of monitor<strong>in</strong>g the amount of money they have saved <strong>and</strong> allocat<strong>in</strong>g this towards a reward can<br />

act as an <strong>in</strong>centive to give up <strong>and</strong> help to ma<strong>in</strong>ta<strong>in</strong> their identity as a non-smoker.<br />

The smell of smoke on cloth<strong>in</strong>g <strong>and</strong> breath will be gone <strong>in</strong> a very short time after quitt<strong>in</strong>g. This benefit<br />

may be an important motivator if smok<strong>in</strong>g is no longer accepted by the smoker’s family or peers. In these<br />

cases, seek<strong>in</strong>g social support from those people may be important to re<strong>in</strong>force the new behaviour through<br />

compliments <strong>and</strong> acknowledgement.<br />

20 m<strong>in</strong>utes<br />

Blood pressure <strong>and</strong> heart rate decrease<br />

12 hours<br />

Blood carbon monoxide<br />

levels normalise<br />

48 hours<br />

Sensory acuity <strong>in</strong>clud<strong>in</strong>g smell<br />

<strong>and</strong> taste improve<br />

Carbon monoxide levels <strong>in</strong> the blood fall quickly after smok<strong>in</strong>g the last cigarette <strong>and</strong> fall to the level of a<br />

non-smoker after 12 hours. This has numerous health benefits as more oxygen can be transported <strong>in</strong> the<br />

blood <strong>and</strong> often results <strong>in</strong> a noticeable difference <strong>in</strong> the appearance of the sk<strong>in</strong> <strong>and</strong> the whites of the eyes.<br />

Many smokers report enjoy<strong>in</strong>g food <strong>and</strong> dr<strong>in</strong>k more <strong>and</strong> hav<strong>in</strong>g an <strong>in</strong>creased awareness <strong>and</strong> sensation of<br />

flavours <strong>and</strong> smells after stopp<strong>in</strong>g.<br />

Medium-term benefits<br />

Once a smoker is past the withdrawal symptoms of nicot<strong>in</strong>e addiction <strong>and</strong> has begun to <strong>in</strong>ternalise <strong>and</strong><br />

<strong>in</strong>tegrate the identity of be<strong>in</strong>g a non-smoker <strong>in</strong>to their sense of self it would be easy to th<strong>in</strong>k that the worst is<br />

over <strong>and</strong> the cessation has been successful.<br />

1 month<br />

Erectile dysfunction reduces<br />

Post-operative heal<strong>in</strong>g improves<br />

Face sk<strong>in</strong> pallor <strong>and</strong> wr<strong>in</strong>kles<br />

improve<br />

6 months<br />

Cardiorespiratory function improves<br />

Anxiety <strong>and</strong> depression levels decrease<br />

Overall life satisfaction improves<br />

1 year<br />

Coronary heart disease risk is reduced by<br />

50%<br />

Periodontal disease significantly reduced<br />

Sense of taste <strong>and</strong> smell improved<br />

22 | Copyright © 2016 <strong>Active</strong> <strong>IQ</strong> Academy Ltd. Not for resale


The reality is that a large proportion of ex-smokers beg<strong>in</strong> smok<strong>in</strong>g aga<strong>in</strong> six-twelve months after stopp<strong>in</strong>g.<br />

There can be many reasons for this, but it is clear that the need to support the ma<strong>in</strong>tenance of new replacement<br />

behaviours <strong>and</strong> a true <strong>in</strong>tegration of the non-smoker identity are important.<br />

Some of the additional health improvements over the first n<strong>in</strong>e-twelve months <strong>and</strong> beyond (up to five years)<br />

can be used to re<strong>in</strong>force <strong>and</strong> affirm that the decision to stop smok<strong>in</strong>g was a good one <strong>and</strong> that it is worth<br />

rema<strong>in</strong><strong>in</strong>g a non-smoker. These additional advantages (along with non-health-related benefits) may help to<br />

outweigh the perceived disadvantages of be<strong>in</strong>g a non-smoker.<br />

Long-term benefits<br />

The long-term health benefits of be<strong>in</strong>g a non-smoker are enormous. The magnitude of the benefits can<br />

depend on the age at which the person stops smok<strong>in</strong>g. A person who stops smok<strong>in</strong>g before the age of 30<br />

has a life expectancy similar to that of a non-smoker. Even quitt<strong>in</strong>g at the age of 60 can extend lifespan by<br />

an average of three years.<br />

5 years<br />

Stroke risk reduced to nonsmoker<br />

levels<br />

Significant reduction <strong>in</strong> risk<br />

for several cancers<br />

10 years<br />

Risk of dy<strong>in</strong>g from lung cancer<br />

reduced by 50%<br />

Risk of larynx <strong>and</strong> pancreas<br />

cancer reduced<br />

15 years<br />

Coronary heart disease reduces to levels of<br />

non-smokers<br />

Risk of develop<strong>in</strong>g COPD significantly<br />

reduces<br />

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