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Disease Interrupted, tobacc...

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Disease Interrupted, tobacco reduction ans cessation 1
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
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
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
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
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
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
18 387
Ethical Contemplations 387
Diane Kunyk, Charl Els and Peter Selby 387
Public health model 388
Parting thoughts 393
References 394
Contributors 397

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