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Good Morning! Welcome to DAY 3

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Were you able to complete the Values Check #2 exercise last night?a. Yes b. No c. I meant to, but was busy doing other things.

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Values Exercise # 2 Choose the answer closest to yours : Smokers are ________”? a. Addicted b. My friends and family c. In need of help d. Coerced by Big Tobacco e. Other

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Values Exercise # 2 Choose the answer closest to yours : “Women smoke because _______”? a. They think it’s feminine b. They want to control their weight c. They love to smoke d. It helps their stress levels e. Other

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Values Exercise # 2 Choose the answer closest to yours : “Cardiovascular disease is caused by _________”? a. Lack of exercise b. Genetics c. Smoking- no matter how much d. Pollution e. Other

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Values Exercise # 2 Choose the answer closest to yours : “Tobacco manufacturers are _______”? a. Too powerful b. Gazillionaires c. Killing millions of people every year d. Coercing children and youth to smoke through their advertising campaigns e. Other

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Specific Populations and Tobacco Use

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Mental health issues Medical issues Addictions Gambling disorders People who are homeless or underhoused Older AdultsLGBTTTIQQ persons Youth Pregnant women Incarcerated individuals Military recruits Ethno-cultural groups Aboriginal Persons Why Focus on Specific Populations?

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I have, or my organization has, cessation services available for specific populations.a. We are structured to be accessible to a range of populations. b. We are accessible to a few specific populations on an as-needed basis. c. I am not sure what is available. d. Limited cessation services are available for specific populations.

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Small Group DiscussionAt your tables, please share your experiences providing cessation services to specific populations….. What are some key considerations? What questions to do you have?

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Introduction Historical perspective Barriers to tobacco control Associations: complex Understanding remains incomplete Association is: robust, reproducible, and clinically significantJoseph et al., 2004 Masterson & O’Shea, 1984 Zuckermann & Kuhlman, 2000 Brandt & Gardner, 2000 Els, Kunyk, 2008.

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In which type of disorder would we see the highest rate of smoking prevalence? a. Anxiety disorder b. Major depression c. Bi-polar disorder d. Schizophrenia e. Personality disorders

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Prevalence of Smoking in Psychiatric & Substance Use DisordersSmoking prevalence (%)Clinical groupSZBPDMDDPDOCDPTSDAlcoholCocaineOpioidGen US pop10080604020 0Substance use disordersPsychiatric disordersNon-psychiatric/-substance use disordersSZ, schizophrenia; BPD, bipolar disorder; MDD, major depressive disorder; PD, panic disorder; OCD, obsessive-compulsive disorder; PTSD, post-traumatic stress disorderKalman et al (2005) Am J Addict 14(2): 106-123

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Youth & Smoking: There is no significant difference between the number of teenage males and teenage females who smokea. True b. False – Significantly more teenage females smoke c. False – Significantly more teenage males smoke

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Youth and SmokingSmoking youth aged 15-19: 14% (CTUMS, 2010 Wave 1) Lowest rate recorded since Health Canada first began recording prevalence 13% males, 14% females reported smoking 8% reporting daily smoking 6% occasional smoking Average 11.6 cigarettes per day 25% purchased discount-brand cigarettes, 19% from First Nations' reserve, 5% that may have been smuggled (CTUMS, 2009 Annual Results)CTUMS, 2010, Wave 1 Results – February-June

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Young Adult Male Smoking: 20-24 Years of Age24.3% are Current Smokers has consumed 100 cigarettes in his/her life and has smoked within the last 30 days 16.5% are Daily Smokers has consumed 100 cigarettes in his/her life and has smoked daily for the last 30 days 68.7% are Never Smokers Someone who has not smoked in the last 30 days 75.7% are Non Smokers Someone who has never smoked 100 cigarettes or more in his life Canadian Tobacco Use Monitoring Survey, 2009

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Other Associations in YouthDe Von Figueroa-Moseley et al., 2004 4. Dube et al., 2003 Nichols & Harlow, 2004 5. Potter et al., 2004 Menutt et al., 2002 6. Cornelius et al., 2001 Sexual and physical abuse/trauma Other psychiatric disorders Eating disorders Depressive disorders Suicide attempts ADHD Impoverished and dysfunctional households

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Tobacco and Mental Illness Mental illnesses associated with higher rates: Schizophrenia Major mood disorders Depression Mania / Bipolar illness Alcohol use Other substance-related disorders Anxiety disorders Personality disordersHughes et al., 1986 3. Breslau et al., 1991,1994 Grant et al., 2004 4. Lasser et al., 2000

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Smoking and SchizophreniaPrevalence rates of 72.5% (up to 90%) More likely to smoke and less likely to quit Biological variables Quitting smoking may impact on symptoms of schizophrenia: Positive symptoms Negative symptoms Cognitive symptomsBaker et al., (2010). Smoking and Schizophrenia: Treatment approaches within primary care. Primary Psychiatry, 17(1):49-54

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Psychotropic Drug InteractionsImpacted: Clozapine Olanzapine Haloperidol Chlorpromazine CaffeineNot Impacted: Risperidone Ziprasidone Aripiprazole Quetiapine Bupropion DeLeon, J. (2004). Psychiatric Serv. 55: 491-493.

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Psychotropic Drug Interaction Example: Clozapine Smoking cessation leads to increased clozapine plasma levels of up to 50%, which could lead to adverse events and toxicity (1) Increase could persist to up to 4 weeks Plasma levels should be monitored frequently (2) Dose may require lowering of 30-40% of original dose (3) Warning signs that medication dose needs adjusting (3) Worsening psychiatric symptoms Excessive fatigue or sleepiness Extrapyrimidal effects (i.e. tremor, slurred speech, dystonia) SeizuresCormac et al. (2010) De Leon (2004) Lowe & Ackman (2010)

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Treatment ImplicationsNRT Bupropion Atypical antipsychotics VareniclineAddington, et al., 1998 Chou et al., 2004 George at al, 2000 Evins et al., 2005

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Prevalence of Smoking: Patients with DepressionFarrell et al (2003) Int Rev Psychiatry 15(1-2): 43-49; Mackay et al (2006) The Tobacco Atlas 2nd edGeneral populationDepressed patientsNonsmokersCurrent smokers26%56%74%44%

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Mood DisordersTreatment implications: NRT Anti-depressants Varenicline Bupropion Thorsteinsson et al., 2001 Hayford et al., 1999 Chengappa et al., 2001

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Smoking and DepressionFowler J., et al (1996) Proc Natl Acad Sci USA 93: 14065-14069Tobacco smoke exposure is associated with a marked reduction in brain MAO A, which suggests that MAO A inhibition needs to be considered as a potential contributing variable in the high rate of smoking in depression.

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Fowler et al (2003) Proc Natl Acad Sci USA 100(20): 11600-11605Monoamine Oxidase (MAO) Enzyme Inhibition in SmokersThis study showed that smokers have significantly reduced MAO B in peripheral organs, particularly in the heart, lungs, and kidneys, when compared with non-smokers.

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Last Updated: 8th March 2018

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