COMPARISON OF CURRENT PHARMACOTHERAPY FOR NICOTINE DEPENDENCE TREATMENT* Product Brand Names

Nicotine Patch NICOTROL® NICODERM CQ®

Nicotine Gum NICORETTE ®

Nicotine Lozenge COMMIT ®

Nicotine Nasal Spray NICOTROL ® NS

Nicotine Inhaler NICOTROL® INHALER

generic

Bupropion HCI SR Tablet ZYBAN ®

Varenicline Tablet CHANTIX™

generic

generic

Availability Product Strengths

Initial Dosing

OTC 15 mg

1 patch / 16 hours

OTC 21 mg 14 mg 7 mg

1 patch / 24 hours

2 mg (for smokers of 4 mg

< 24 cigarettes/day) (for smokers of > 25 cigarettes/day)

OTC 2 mg (for those who start

Time to Peak Plasma Level Recommended Treatment Duration Adverse Reactions

Same as above

5-10 hours

10 weeks

8-10 weeks

(2-6 weeks per dose level)

(2-4 weeks per dose level)

• Mild skin reaction (Rotate and use steroid cream or try a different brand.)

• Mild skin reaction (Rotate and use steroid cream or try a different brand.)

• Vivid dreams, sleep disturbances

Rx

Rx

Rx

10 mg / ml

10 mg / cartridge (2mg absorbed/ cartridge)

150 mg

0.5 mg and 1 mg

smoking after 30 minutes of waking)

4 mg (for those who start smoking within 30 minutes of waking)

1 piece / 1 or 2 hours

1 lozenge / 1 or 2 hours

1-2 doses / hour (1 dose = 2 sprays or 1 per nostril)

6-16 cartridges / day

150mg / day (days 1-7***)

0.5 mg once daily (days 1-3) 0.5 mg twice daily (days 4-7)

24 pieces / 24 hours

5 lozenges / 6 hours or 20 lozenges/day

5 doses / hour or 40 doses/day

16 cartridges / day

300mg / day (days 8+)

1 mg twice daily (day 8 – End of treatment)

20-30 minutes

20-30 minutes

5-7 minutes

15 minutes

3 hours

3 – 4 hours

8-12 weeks

12 weeks

3-6 months

Up to 6 months, taper during final 3 months

(remove at night)

Maximum Dosing

Rx

• Mouth soreness

• Headaches

• Hiccups

• Insomnia

• Dyspepsia • Mild, transient jaw ache (Correct technique.)

• Nausea if swallowed or chewed

• Dependence potential • Local transient irritation in nose, throat and eyes

• Mouth and throat irritation (Resolved through regular use.)

• Dyspepsia

7-12 weeks

12 weeks

(In special circumstances, may take for up to 6 months)

(An additional 12 weeks can be prescribed for patients who have successfully stopped smoking at the end of 12 weeks.)

• Dry mouth; • Insomnia (Avoid use at bedtime.)

• Shakiness • Skin rash

• Nausea • Headache • Insomnia • Abnormal dreams

(Correct technique.)

(Resolved through regular use.)

Cautions: Pregnancy, 2-week post myocardial infarction, serious arrhythmia or serious angina, peptic ulcers.

Cautions: Pregnancy, 2-week post myocardial infarction, serious arrhythmia or serious angina, peptic ulcers. Contraindications: Asthma; rhinitis; nasal polyps; sinusitis.

Cautions: Pregnancy, 2-week post myocardial infarction, serious arrhythmia or serious angina, peptic ulcers. Contraindications: Allergy to menthol.

Contraindications: Seizure disorder; current use of Wellbutrin/bupropion; current or prior bulimia or anorexia nervosa; current or recent use of MAO inhibitors; bupropion allergy.

Cautions: Pregnancy and severe renal impairment.

(Remove at bed time. Note that dose will be lower if removed.)

Cautions and Contraindications

Cautions: Pregnancy, 2-week post myocardial infarction, serious arrhythmia or serious angina, peptic ulcers. Contraindications: Severe eczema or other skin disease; allergy to adhesive tape.

Approximate Price**

$128 total, $2.28/day

$368 total, $4.38/day

$465 total, $5.54/day

$631 total, $6.44/day

$859 total, $5.12/day

$190 total, $2.18/day

$336 total, $4.00/day

Instructions for Use

Stop all tobacco use prior to treatment. Apply 1 patch to healthy, clean, dry, hairless skin such as upper arm or hip. Remove and replace daily. Some brands are for 24-hour wear; some are for daytime wear only. Remove 2 hours before prolonged strenuous exercise.

Stop all tobacco use prior to treatment. Bite gum slowly until you notice a peppery taste and a slight tingle. Then park between your cheek and gum. When taste and tingle fade, bite until it starts working again, then park in another part of your mouth. Continue for 30 minutes.

Stop all tobacco use prior to treatment. Allow lozenge to dissolve slowly over 20-30 minutes without chewing or swallowing. Occasionally move the lozenge from one side of your mouth to the other.

Stop all tobacco use prior to treatment. Blow nose if it is not clear. Tilt head back slightly. Insert tip of bottle as far into nostril as is comfortable. Breathe through mouth. Spray once in each nostril. Do not sniff or inhale while spraying. If nose runs, gently sniff to keep spray in nose. Wait two or three minutes before blowing nose.

Stop all tobacco use prior to treatment. Pull off the top of the mouthpiece. Press one cartridge firmly into bottom of mouthpiece until seal breaks. Replace top. Align marks to close. Inhale a short breath to the back of mouth or puff in short breaths. Do not inhale to lungs. The nicotine in a cartridge lasts for about 20 minutes of active puffing.

Start using bupropion one to two weeks before quitting tobacco use. Take 1 tablet orally (150 mg) each morning for 7 days.*** Then take a tablet each morning and another each evening.

Start using CHANTIX one week before quitting tobacco use. CHANTIX should be taken after eating and with a full glass of water. Days 1 – 3, take one 0.5 mg tablet once daily. Days 4 – 7, take 0.5 mg tablet twice daily. Day 8 – end of treatment, take 1 mg tablet twice daily.

Cautions: Pregnancy, 2-week post myocardial infarction, serious arrhythmia or serious angina, peptic ulcers. Contraindications: Severe TMJ disease or other jaw problems; presence of dentures or other dental appliances.

* Inclusion of this adult dosage chart is strictly for the convenience of the prescribing provider. Please consult the Physicians’ Desk Reference or the product manufacturer for complete product information and contraindications. ** Prices are based on those found at www.drugstore.com (Rite Aid) in September 2006 and were calculated from the midpoint of the highest and lowest recommended dosages. The price/day is averaged across the full regimen. All prices are based on the generic brand except the lozenge, nasal spray and inhaler, which are not yet available in generic form. By comparison, the average price of cigarettes in Utah is $4.09/pack.4 ***Package insert says 1 tablet a day for 3 days. Seven-day instructions are an off-label suggestion to avoid side effects.

Community Partnerships 2005-2007

County

Lead Agency

ITPC OFFICE Indiana Tobacco Prevention and Cessation Agency INFO

Primary Contact

Phone Number Primary Contact

Becky Haywood

317.234.1784

Fax Number Primary Contact 317.234.1786

E-Mails Primary Contact

Street Address Lead Agency

City

State Zip Code Lead Agency Contact or CEO

E-mail Lead Agency Contact

Indianapolis

IN

46204

Karla Sneegas

317.234.1784

317.234.1786

[email protected]

260.724.6030 260.420.7494 812.376.5916 219.261.2871 765.857.8911 765.483.4450 812.988.5487 765.379.2314 574.722.9523 812.283.2411 812.864.2289 765.379.2314 821.275.5116 821.275.5116 812.537.5065 812.663.4220 260.927.0996 765.281.2733 812.683.6403

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Decatur Fort Wayne Columbus Fowler Hartford City Lebanon Nashville Delphi Logansport Jeffersonville Brazil Frankfort Mitchell Mitchell Lawrenceburg Greensburg Auburn Munice Huntingburg

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46733 46805 47201 47944 47348 46052 47448 46923 46947 47130 47834 46041 47446 47446 47025 47240 46706 47305 47542

Cathy Malkani

260.724.9128

260.724.6030

[email protected]

Julia Abedian Myra E. Rennick Kathy Bantz Cindy A. Murphy Auditor Mary Jones Larry Ulrich Martin Padgett Joe Dierdorf Nancy Ward David L. Miller David L. Miller Mary Burris Tina Hoeing Brenda Daley

812.376.5426 765.793.4881 765.348.7222 765.482.3942 812.988.5495 765.564.3420 574.722.5151 812.283.2109 812.448.9001 765.659.6355 812.849.4457 812.849.4457 812.926.6236 812.662.6096 260.927.1706

812.376.5815 765.793.4884 765.348.1620 765.483.4450 812.988.5487 765.564.6161 574.722.9523 812.283.2688 812.442.0425 765.659.6391 812.849.4467 812.849.4467 812.9266236 812.663.4220 260.927.0996

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

410 Winchester St. 2200 Lake Avenue, Suite 290 2400 E. 17th Street 5465 N 600 E 110 W. Washington Street 116 W. Washington St. B202 P.O. Box 37 101 W. Main St. 1015 Michigan Ave 1220 Missouri Ave 609 E. National Ave One S. Jackson St. 521 West Main Street 521 West Main Street P.O. Box 3581 6152 E. State Rd. 46 P.O. Box 406; 301 S. Union St. 806 W. Jackson Street 1900 Medical Arts Dr.

Barry Humble Dick Conklin Peggy Voelz Janie Petersen Debra McGriff-Tharp Delana Bennington Linda L. Hobbs Brandie Oliver Amy Sweet Vanessa Smith Brandie Oliver Beth Godlevske Beth Godlevske Donna Thacker Tina Hoeing Brenda Daley Ashlee B. Bane Shannon Hildebranski

260.724.9128 260.420.7585 812.375.3194 219.261.2871 765.857.2749 765.482.6099 812.988.7997 756.379.9707 574.722.5151x263 812.285.5877 812.864.2289 765.379.9707 812.275.3182 812.275.3182 812.537.5065 812.662.6096 260.927.1706 765.281.2745 812.683.6441

Elkhart Fayette Floyd Fountain

Elkhart Co. Health Dept. (Tobacco Control of Elkhart County) Community Education Coalition Our Place Drug and Alcohol Education Services, Inc. Community Action Program, Inc. of Western Indiana

Mark W. Potuck Karolyn Buckler MeriBeth Adams-Wolf Kathy Walker

574.523.2117 765.825.7633 812.923.3400 765.793.4881

574.523.2158 765.825.1693 812.923.9870 765.793.4884

[email protected] [email protected] [email protected] [email protected]

608 Oakland Ave. 3013 Virginia Ave 101 St. Anthony Dr. ; P.O. Box 8 418 Washington St.

Elkhart Connersville Mt. St. Francis Covington

IN IN IN IN

46516 47331 47146 47932

Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson/Switze rland Johnson Knox LaGrange Lake LaPorte Lawrence Madison Marion Marshall Miami Monroe Montgomery Morgan Newton Noble Orange Owen

Stayin' Alive-Franklin County LCC/Franklin Co. Gov Fulton Co. Health Dept. Gibson Co. Health Dept. Grant Co. Health Dept. Boys & Girls Club of Greene County Hamilton Co. Council on Alcohol and Other Drugs Hancock Memorial Hospital and Health Services Harrison Co. Hospital Foundation Hendricks County Health Dept. Interlocal Community Action Program, Inc. St. Joseph Hospital STOP of Huntington County Seymour Boys & Girls Club Jasper Foundation, Inc. Jay Co. Hospital

Kim Linkel Linda Lukens Petersen Martha Caine Lisa Rapp Nancy Cummings George L. Kristo Brandee Bastin Jennifer A. Riley Michael McDonald Nancy McCauley Joy Edwards Melissa Phillips Jeff Joray Debbie Bowsher Deb McGriff-Tharp

812.934.2298 574.224.5152 812.476.1471 765.651.2401 812.384.4538 317.776.8429 317.468.4162 812.738.8708 317.745.9609 765.521.1401 765.456.5941 260.358.0175 812.622.2434 765.473.4640 260.726.1847

812.934.4702 574.223.2335 812.401.4199 765.651.2419 812.384.8769 317.776.8413 317.468.6201 812.738.7829 317.745.9218 765.593.2510 765.456.5387 260.356.9683 812.524.1856

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

459 Main Street 125 E. 9th Street 800 S. Prince Street 401 South Adams Street 31 W. Main Street One Hamilton County Square, Suite 29 801 N. State Street 245 Atwood Street 355 S. Washington Street, Suite 210 1912 Bundy Avenue 1907 W. Sycamore 579 Nancyk Crossing 950 N. O'brien Street P.O. Box 508 500 W. Votaw Street

Brookville Rochester Princeton Marion Bloomfield Noblesville Greenfield Corydon Danville New Castle Kokomo Roanoke Seymour Peru Portland

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

812.265.0598 317.346.3733 812.895.9622 ex 16 260.336.9349 219.757.1830 219.326.6260 812.275.3182 765.683.0452 317.221.3099 574.936.5141 765.475.8908 812.353.9595 765.364.7870x102 765.342.1013 765.473.4640 260.636.3365 812.723.2621 812.828.9622

812.265.0291 317.346.3738 812.882.3947 260.248.4799 219.757.1856 219.362.9405 821.275.5116 765.683.0462 317.221.3114 574.936.5128 765.475.8530 812.353.5220 765.364.7890 765.349.9021

812.828.9329

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

P.O. Box 477 One King's Daughters' Dr. 1125 W. Jefferson St.; P.O. Box 549 2010 College Ave. 229 River Run Court 8400 Louisiana Street 800 Lincolnway, Suite 200 521 West Main Street 1220 Meridian St. 3838 N. Rural St. 224 N. Michigan St. 275 W. 12th Street P. O. Box 1149 116 N. Green Street 61 N. Jefferson Street, Suite 5 P.O. Box 508 100 E. Main Street 35 North Public Square 111 Hwy. 46 West

Madison Franklin Vincennes Columbia City Merrillville LaPorte Mitchell Anderson Indianapolis Plymouth Peru Bloomington Crawfordsville Martinsville Peru Albion Salem Spencer

765.492.5836

[email protected]

Kelly Center, 444 South 6th Street, Suite 1

Terre Haute

765.569.2969

Lead Contact Fax Number

150 W. Market Street, Suite 406

Boys & Girls Club of Decatur, Inc. Tobacco Free Allen County Columbus Regional Hospital Foundation Community Action Program Inc. of Western IN Blackford Co. Auditor's Office Boone Co. Health Dept. Brown County Gov. -Auditor Carroll Co. Health Dept. Four Co. Counseling Center Clark Memorial Hospital Clay Gov. Clinton Co. Local Coordinating Council Hoosier Uplands Economic Development Corporation Hoosier Uplands Economic Development Corp. Citizens Against Substance Abuse (CASA) Community Action Coalition Drug Free DeKalb Co. Family Service of Delaware Co., Inc. St. Joseph's Hospital

Parke

Lead Contact Phone Number

[email protected]

Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur DeKalb Delaware Dubois

The King's Daughters' Hospital and Health Services Kimberly Crawford Johnson Memorial Hospital Jane Blessing Vincennes YMCA Jennifer Holscher Council for a Drug-Free LaGrange Co. Dave Bell Geminus Corp. Cynthia A. Sampson Healthy Communities of LaPorte Co. Sandra Gleim Hoosier Upland Economic Development Corp. Beth Godlevske Healthy, Tobacco-Free Madison Co., Inc. Karesa Knight Health and Hospital Corporation of Marion Co. Liza Sumpter Women's Care Center Jennifer Hunsberger Dukes Health Systems LLC Sharon Andersen Bloomington Hospital Ted Jackson Montgomery Co. AHEAD Coalition, Inc. Kelly Trusty Prime Time of Morgan Co., Inc. Sandra S. Theiebe Jasper Foundation, Inc. Debbie Bowsher Drug-Free Noble Co., Inc. Randy Handshoe PACT, Inc. dba Hoosier Hills PACT Rhonda Carchano Owen Co. Family YMCA Teena Jennings Indiana Communities for Drug-Free Youth d.ba C.H.A.N.C.E.S. fo Indiana Youth Michelle Stucker

Director

260.726.1975

260.636.6861

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

County

Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community

Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur DeKalb Delaware Dubois

Rodney Coats/Sheila Clark

812.683.2121 574.523.2100 765.825.7633 812.923.3400 756.793.4881

574.295.6186 765.825.1693 812.923.9870 756.793.4884

[email protected] [email protected] [email protected] [email protected]

Community Community Community Community

Elkhart Fayette Floyd Fountain

47012 46975 47670 46953 47424 46060 46140 47112 46122 47362 46901 46783 47274 46970 47371

Aixsa Perez Cindy Bernzott MeriBeth Adams-Wolf Steve Proctor Bob Brack/Louis Linkel/ Tom Wilson Diane Jones Kanda Walden Kathy Glickfield Carol Byers George L. Kristo Bobby Keen Steve Taylor Cathy Grindstaff Kevin P. Polivick Darcy Burthay Jan Williams Steve Stanfield Linda Reiners Terry Brown/ Joy Littler

765.647.4985 574.223.5152 812.385.3831 765.651.2401 812-384-4538 317.776.8429 317.462.5544 812.738.4251 317.745.9609 765.529.4403 765.456.5941 260.356.9681 812.522.2434 219.866.5899 260.726.1847

574.223.2335 812.386.8027 765.651.2419 812-384-8769 317.776.8413 317.468.4222 812.738.7829 317.745.9218 765.593.2510 765.456.5387 269.356.9683 812.524.1856 219.866.0555 260.7261975

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47250 46131 47591 46725 46410 46350 47446 46016 46205 46563 46970 47402 47933 46151 46970 46701 47167 47460

Roger Allman Tom Berry Brenda Cummings Jim Carr Heather McCarthy Sandra Gleim David L. Miller Karesa Knight Mattew R. Gutwein Jenny Hunsberger Mike Funk Larry Bailey Kelly Trusty Sandra S. Thiebe Linda Reiners Janet Stock Jon Kuss Kris Kirchner

812.265.5211 317.736.3577 812.882.3828 260.499.6351 219.757.1830 219.326.6260 812.849.4457 765.683.0452 317.221.2009 574.936.5141 765.472.8000 812.336.6821 765.339.7966cell 765.342.1013 219.866.5899 260.636.2320 812.883.3318 812.828.9622

812.265.0291 317.763.2692 812.882.3947 260.463.7835 219.757.1856 219.362.9405 812.849.4467 765.683.0462 317.221.2020 574.936.3842 765.473.8244 812.353.9339

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson/Switze rland Johnson Knox LaGrange Lake LaPorte Lawrence Madison Marion Marshall Miami Monroe Montgomery Morgan Newton Noble Orange Owen

IN

47807

Brandon Halleck

812.232.5190

812.234.0711

765.349.9021 219.866.0555 260.636.6861 812.883.3365 812.828.9329

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

[email protected]

Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community

Community Parke

Community Partnerships 2005-2007

Perry Pike

Lincoln Hills Development Corp. Pike Co. Health Dept.

Porter Posey Pulaski Putnam Ripley Rush Scott Shelby Spencer St. Joseph Starke Steuben Sullivan Tippecanoe Tipton Union Vanderburgh

Jan Sprinkle Samantha Sheffler

812.547.3435 812.582.0442

812.547.3466 812.749.4987

219.464.6823x5480 812.476.1471 574.946.6017 765.653.6157 812.689.7356 765.629.2074 812.752.7239 317.398.3135 812.547.2299 574.239.8585x380 574.772.3353 260.668.1000x2400 812.894.9951 765.494.6644 765.675.8741 765.458.5393x32 812.467.0728

219.464.5425 812.401.4199 574.946.3209 765.655.2625 812.689.4786

Vermillion Vigo Wabash Warren Warrick Washington

The Lutheran Association Assoc. dba Valparaiso Univ. Natalie Rivich/Susan Gleason Promoting a Drug Free Community in Posey Co., Inc. LCC Martha Caine Pulaski Memorial Hospital Jean Widup Putnam County Hospital Meredith Williams Ripley Co. Health Dept. Cathy May Local Coordinating Council/Rush Co. Schools Tammy Jackman Scott Co. Family YMCA Sondra Hook Shelby Co. Drug Free Coalition John Heaton Lincoln Hills Development Corp. Kaye Kleeman Healthy Communities Initiative Roz Summerlin Starke United Jennie Carter Drug Free Steuben/Steuben Co. Gov. Marty McNeal C.H.A.N.C.E.S…for Indiana Youth Carrie Evans Purdue University Julie Novak Tipton Hospital Debra Bennington Union County Tobacco Coalition Kim Klein University of Evasville/Smokefree Communities Terri Brown Indiana Communities for Drug-Free Youth d.ba C.H.A.N.C.E.S. fo Indiana Youth Michelle Stucker C.H.A.N.C.E.S…for Indiana Youth Carrie Evans Our Children, Our Future, Inc. Dan Gray Community Action Program, Inc. of Western Indiana Kathy Walker University of Evasville/Smoketree Communities Johnny Kincaid Washington Co. Substance Abuse Council Sharon Purlee

Wayne Wells White Whitley

Partnership for a Drug Free Wayne Co. Caylor-Nickel Foundation Jasper Foundation, Inc. Whitley Co. Drug-Free IN

765.973.8526 260.824.5019 765.473.4640 260.723.5911

Amy Stadick Molly Lesnet Debbie Bowsher Patricia Weybright

812.208.5708 812.323.5190 260.563.7727 765.793.4881 812.467.0728 812.883.1446

302 Main Street ; P.O. Box 336 801 Main Street

Tell City Petersburg

IN IN

47586 47567

Larry K. Kleeman Lori Pipes

812.547.3435 812.354.8797

812.547.3466 812.354.2532

[email protected] [email protected]

Community Perry Community Pike

836 LaPorte Ave 905 Smith Rd P.O. Box 279 1542 S. Bloomington Street P.O. Box 143 330 W/ 8th Street 805 Community Way 54 W. Broadway, Suite 7 P.O. Box 336; 302 Main Street 401 E. Colfax Ave. Suite 310 P.O. Box 131 700 W. Maumee 444 S. 6th Street 302 Woods Street, Young Room 735 1000 South Main Street 6 West South Street 1605 John Street

Valparaiso Mt. Vernon Winamac Greencastle Osgood Rushville Scottsburg Shelbyville Tell City South Bend Knox Angola Terre Haute West Lafayette Tipton Liberty Evansville

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46383 47620 46996 46135 47037 46173 47170 46176 47586 46617 46534 46703 47807 47907 46072 47353 47714

Janet Brown Donna Curtis Richard Mynark Dennis Weatherford Cathy May Fred Smith Jason Enrique John Heaton Larry Kleeman Marilyn Eber M.J. Zembala Lisa Lysaght Brandon Halleck Heather Watkins Shelley Huff Virginia Bostick Johnny Kincaid

219.464.5000 812.838.2591 574.946.2100 765.653.5121 812.689.7356 765.932.4186 812.752.7239 317.398.3135 812.547.3435 574.2398585x324 574.772.7506 260.665.6579 812.894.9951 765.494.9381 765.675.8582 765.458.5464 812.467.0728

219.464.5425 812.838.2333 574.946.3209 765.655.2625 812.689.4786

[email protected] [email protected]

812.467.0734

[email protected] [email protected] [email protected]; [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

[email protected]

Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community Community

Porter Posey Pulaski Putnam Ripley Rush Scott Shelby Spencer St. Joseph Starke Steuben Sullivan Tippecanoe Tipton Union Vanderburgh

765.492.5836 812.234.0711 260.563.2320 765.793.4884 812.467.0734 812.883.0400

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Kelly Center; 444 South 6th Street 444 S. 6th Street 111 South Wabash Street 418 Washington St. 1605 John Street 806 Martinsburg Road, Suite 203

Terre Haute Terre Haute Wabash Covington Evansville Salem

IN IN IN IN IN IN

47807 47807 46992 47932 47714 47167

Brandon Halleck Brandon Halleck Stacy McBride Steve Proctor Johnny Kincaid Sharon Purlee

812.232.5190 812.323.5190 260.563.5153 756.793.4881

812.234.0711 812.234.0711 260.563.2320 756.793.4884

812.883.1446

812.883.0400

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Community Community Community Community Community Community

Vermillion Vigo Wabash Warren Warrick Washington

[email protected] [email protected] [email protected] [email protected]

2325 Chester Blvd, Springwood Hall, Rm 103 Richmond 311 South Scott Street Bluffton P.O. Box 508 Peru 111 North Main Street South Whitley

IN IN IN IN

47374 46714 46970 46787

Berry C. Ritter John Stead Terry Corso Dale Moser/Matt Rentschler

765.489.4026 260.824.5019 574.583.8217 260.244.3000

260.824.7054 574.583.4706 260.244.7380

[email protected] [email protected] [email protected] [email protected]

Community Community Community Community

Wayne Wells White Whitley

812.752.3260 317.398.3135 812.547.0939 574.289.0358 574.772.3353 260.665.2320 812.234.0071 765.494.6339 765.675.6952

260.824.7054 260.723.4724

812.752.3260 317.398.3135 812.547.3466 574.289.0358 574.772.7506 260.624.3033 812.234.0071 765.494.1630 765.675.8345

[email protected] [email protected]

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

side 1

side 2

Cessation Counseling

Motivating A Patient To Quit Smoking

Ask

Ask about tobacco use. Identify and document tobacco use status for each patient.

Relevance

Advise

Provide information that has the greatest impact on the patient’s disease status, family or social situation (e.g., children and second-hand smoke), health concerns, age or gender.

Assess

Acute risks: shortness of breath, exacerbation of asthma, harm to pregnancy, impotence, infertility, increased blood carbon monoxide, bacterial pneumonia; increased risk for surgery

Advise to quit. In a clear, strong, and personalized manner, urge every tobacco user to quit. Assess willingness to make a quit attempt. Determine the patient’s readiness to make a change.

Assist

Assist in the quit attempt. Use counseling and pharmacotherapy to help a patient quit.

Arrange

Arrange follow-up. Schedule a follow-up contact, preferably within the first week after the quit date.

Risks

Long-term risks: heart attacks, strokes, lung and other cancers, chronic obstructive pulmonary diseases, long-term disability and need for extended care Environmental risks: increased risks of lung cancer and heart disease in spouses; higher rate of smoking by children of tobacco users; increased risk of low birth weight babies, SIDS, asthma, middle ear disease, and respiratory infections in children of smokers

Rewards

Highlight benefits most relevant to the patient, such as better health, improved sense of taste and smell, money saved, good example for children, more physically fit, and reduced wrinkling and aging of skin.

Roadblocks

322 Canal Walk Indianapolis, IN 46202-3268 (800) 257-4762 · (317) 261-2060 FAX (317) 261-2076 www.ismanet.org

Ask the patient to identify barriers to quitting, such as withdrawal symptoms, fear of failure, weight gain, lack of support and depression. Note elements of cessation treatment, such as problem solving or pharmacotherapy.

Repetition

Repeat the motivational intervention each time the patient has an office visit. Let the patient know that most people make repeated attempts to quit before