Concept of education

10. Health education: principles, methods and techniques. Smoking as a health and social problem. The potential of prevention

Health education
 Health education of people (population) for a good lifestyle requires 3 conditions:

o To know: knowledge, cognition
o Ability: have the conditions – good choice of food, enough money, good flat, hygienic conditions, etc... o To want: will to have a good lifestyle

 Patient Education: the process of influencing patients’ behaviour and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health

o The leading causes of death (ex: heart disease, cancer, stroke, lung disease and injuries) are closely linked to unhealthy Lifestyles

 To provide effective patient education, a variety of practical skills must be mastered and it is the duty of all medical professionals to Have them

o Special branch of medicine – good organization and choice of methods
o Individual forms oriented to specific population groups – good choice of method and language to be understandable for

them (e.G. Different language for small children than adult people)
o The media role (TV, radio, internet...), health consciousness and compliance of therapy are also very important

•   Methods: dialogue, lecture, poster, brochures, etc...

•   Medical professionals should set a good example, e.G. Non-smoking areas, propagators of healthy lifestyle, all staff should make Health Education for patients and population

  Smoking

•   Background:

o Tobacco is an agricultural product processed from the leaves of plants and is used mainly for recreational purposes
o Due to the addictive properties of nicotine, tolerance and dependence develop
o Worldwide, 48M people die every year as a consequence of smoking
o 1 in every 4 citizens die from tobacco-related disease (cancer, cardiovascular, non-neoplastic respiratory diseases, etc) o In the Czech Republic, there are 2.3M smokers (250 000 <18y)

o Associated conditions: 20% of male ED
o Each cigarette shortens life by 5 minutes; 15 years over a lifetime o If a smoker stops smoking, the risk of AMI decreases:

•   By 30% in a matter of hours

•   By 50% in years

•   Modes of consumption: smoking, chewing, snuffing, or dipping tobacco

•   Forms of smoking

o Active smoking – cigarette, cigar, pipe
o Passive smoking – second-hand smoking
o Special – water pipe (worse than smoking cigarettes) o Smokeless tobacco:

 Oral – chewed (banned in Europe – except for Sweden)  Classification of smokers:

o Occasional
o Addicting (situational) – psychological dependence
o Mental addiction – those whose motivation is relaxation, calming and removing a feeling of emptiness

o Mental and physical dependence – palpitations, sweating, flushing, tremors and restlessness in the absence of smoking  Health problems of tobacco usage:

o Heart attacks, strokes
o COPD
o Cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer)
o Peripheral vascular disease and hypertension
o In pregnancy: premature births and low birth weight, and increases the chance for Sudden Infant Death Syndrome o The effects depend on the number of years that a person smokes and on how much the person smokes

 The earlier the start, the higher in tar increases the risk of these diseases  Options for treatment:

o Unassisted methods: gradual decrease towards complete cessation
o Medications including nicotine replacement therapy (NRT): patches, gum, inhalers, sprays and lozenges (FDA approved)

 Nicotine replacement therapy  Non-prescription

o Chewing gum – 2-4mg of nicotine; one gum corresponds to about 1 cigarette; effects last about 30 minutes

o Patch – 16-24h (the 16h patch may cause night-time withdrawal). Local erythematous reactions Are normal due to the addition of vasodilators. Used for at least 3 months

o Inhaler

•   Can be used by pregnant women, children and people with CVD

•   Side effects – allergy or physiological reaction to vaso-relaxing substances

   Bupropion–antidepressant

•   The exact mechanism is unknown

•   For heavy smokers, it can be combined with NRT, but only from D day

•   1-2 weeks before D-Day

•   Relative contraindications include – pregnancy, seizures, epilepsy, active or history of bulimia or anorexia,

  concomitant use of MAOi

o TCAs – e.G. Bupropion helps with withdrawal symptoms, cravings and urges

 CI: epilepsy or seizure disorders
o Nicotinic partial agonists – varenicline
o Individual and group counselling including coaching, motivational interviewing, CBT and pharmacological counselling.

•   Self help groups

•   Self help books

o ‘‘Faux’’ cigarette can be used as an alternative to smoking as well as cessation o Alternatives such as acupuncture, herbs, hypnosis

WHO preventing activities of tobacco using

 In June 2002, the WHO ‘Tobacco Free Initiative’ organised a meeting to develop ‘Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence’ for governments, non-governmental organizations and health professionals interested in making Public health gains in the short and medium term

o The policy recommendations were published in June 2003
 A smoking cessation policy should be part of any comprehensive tobacco-control policy if smoking cessation efforts are to be effective and sustainable 

 Strategy:

o A supportive environment, including a decrease in accessibility of tobacco products, a reduction in social acceptance of tobacco consumption and an increase in information, will improve the likelihood of smokers quitting

o All tobacco-users should be offered effective treatment for tobacco dependence
o Member States should develop evidence-based national policy guidelines for the treatment of tobacco dependence
o Awareness should be increased among health-care professionals, administrators, and policy-makers of both the benefits and cost effectiveness of smoking cessation interventions relative to other health-care interventions

o Training should be provided to all health-care providers at primary care, community and national level to enable them to deliver smoking cessation interventions effectively

o New partnerships are needed to increase commitment and the pool of financial and technical support for implementing evidence-based treatment

 ’Help for life without tobacco’ is the new EU’s antismoking campaign directed at young people, non-smokers and people who would like to quit smoking

o The 3 priorities of the “help” campaign are

•   Smoking prevention

•   Giving up smoking

•   The dangers of passive smoking

o Some strategies:

•   For youth tobacco: educational resources and materials such as videos, posters with celebrities and tobacco free

  sports initiatives

•   Smoking banned in public places

 Legislation:
o Increase taxes on smoking

o Establish non-smoking public areas
o Ban tobacco advertising
o Stop sponsorships by tobacco companies o Stronger health warnings

 Prevention In Families: Parents should not smoke at home