Smoking Cessation Project Proposal

This proposal discusses about the strategies that will be adopted for implementation of a smoking cessation clinic at King Abdulaziz University Hospital, Jeddah.

Running head: PROJECT PROPOSAL
Smoking cessation project proposal
Masters’ Degree in Primary Care Mental Health
Name of the Student
Name of the University
Author Note

1PROJECT PROPOSAL
Executive summary
Tobacco is responsible for nicotine dependence that results in serious health problems.
Taking efforts to quit smoking largely reduces the risks of onset of any smoking related
comorbidities. Nicotine dependence often requires recurrent treatment and its cessation
brings about significant positive changes in the physical and mental health and wellbeing of
the smokers. This proposal discusses about the strategies that will be adopted for
implementation of a smoking cessation clinic at King Abdulaziz University Hospital, Jeddah.

2PROJECT PROPOSAL
Table of Contents
Project title:................................................................................................................................3
Importance of this project:.........................................................................................................3
Background literature review:....................................................................................................3
Project design and methodology:...............................................................................................5
Resources Needed:.....................................................................................................................9
Benefits of project to:.................................................................................................................9
Ethical, legal and moral implications:........................................................................................9
Timeline plan:..........................................................................................................................10
References................................................................................................................................11

3PROJECT PROPOSAL
Project title:
Implementation of smoking cessation clinic at King Abdulaziz University Hospital in
Jeddah.
Importance of this project:
According to estimates presented by the World Health Organisation an estimated 1.1
million people smoked tobacco in the year 2015 (1). Further statistical evidences elaborate on
the fact that greater prevalence of tobacco smoking has been found in Europe (29.4%),
Western Pacific (24.5%), America (16.9%) and South-East Asia (16.9%), respectively (2).
An analysis of the prevalence of tobacco use data also suggests that almost 14.9% youth were
current tobacco smokers in Saudi Arabia, in 2016. 12.2% adults from Saudi Arabia also
reported tobacco smoking behaviour (3).
Time and again it has been proved that there are several benefits of smoking
cessation. It refers to the process of quitting or discontinuing tobacco smoking (4). Owing to
the fact that smoking has been identified as the leading avoidable reason for worldwide death,
there is a need to implement smoking cessation program at the clinic, with the aim of
bringing about a significant reduction in the risks of acquiring tobacco-related illnesses such
as, oral and lung cancer, COPD, and coronary heart disease (5).
Background literature review:
Smoking cessation most often encompasses encouraging individuals to quit and also
helps them to avert from smoking, upon deciding to participate in cessation programs.
Incorporation of smoking cessation approaches, interventions, and education are prerequisites
of primary care clinical practice. However, the smoking status is most often not evaluated,
during all patient encounters. Nicotine withdrawal during participation in cessation programs
often results in the precipitation of depressive symptoms among the target population.

4PROJECT PROPOSAL
Findings from this review suggested that long-term smoking cessation is facilitated by the
administration of antidepressants like nortriptyline and bupropion, thereby confirming the
importance of antidepressant medication during implementation of smoking cessation
programs (6). The benefits of smoking cessation were rightly explained by other researchers
who suggested that participating in activities that aid quitting smoking allows the cancer
patients to survive for an additional 10 years, after being diagnosed with the terminal illness.
Reports from another research also affirmed that cessation of smoking is correlated with a
reduction in anxiety, stress and depression (7). The findings also elaborated on the fact that
cessation helps in uplifting the mood of the smokers and also increases their health related
quality of life (HRQoL), thereby enhancing their overall wellbeing (8).
Researchers also opined that while smoking cigarettes is correlate with a reduced
body weight, cessation of tobacco smoking results in an increase in weight. Most smokers
who quit smoking report signs and symptoms of weight gain, thus correlating cessation with
an increase in energy intake, reduction in the basal metabolic rate, and reduction in physical
activity (9). There are well documented evidences for the increased prevalence of smoking
and tobacco-associated morbidity and mortality among people suffering from chronic mental
disorders. Extended maintenance on pharmacotherapy approaches reduce the rates of relapse,
without any untoward impacts on the psychiatric symptoms (10). Additionally, it was stated
by researchers that sustained smoking after diagnosis of cancer is significantly associated
with reduced treatment effectiveness, lessened survival rate, augmented jeopardy for second
primary malignancies, and decline of the quality of life (11). Owing to the fact that the
perceptions and principles of the residents of Saudi Arabia differs from the rest of the world
due to cultural differences, there is a need to implement the smoking cessation clinic in this
nation. This will help in determining the cultural barriers that might be encounteredduring the
procedure.

5PROJECT PROPOSAL
Project design and methodology:
The project will target all healthcare providers and professionals working in the hospital,
and all patients who visit the hospital for treatment (inpatients and outpatients). The major
steps that are imperative for the implementation of the program are:
 Gathering commitment from the leadership- Construction of the clinic will typically
begin by seeking permission from the leadership of the King Abdulaziz University
Hospital for convening an assortment of several healthcare leaders, who work with a
multidisciplinary focus. Their help will facilitate promotion of the program.
 Stakeholder engagement- A systematic approach will be adopted for engaging all
shareholders in active participation in the program. Logic models and stakeholder
analysis will help in accomplishing this goal, thereby increasing sustainability of the
program (12).
 Training hospital staff- Evidence-based training will be provided to the hospital staff
on the comprehensive strategies that they can adopt for facilitating tobacco cessation
such as (13). The staff will also be trained to deliver such as, counselling and self-
help. The staff should achieve the CTTS credential, prior to offering support to the
clients.
The project will encompass the 5’A’ model that will comprise of the following steps:
1. Ask- All the clients will be asked about their smoking habits, their previous attempts
at quitting smoking, followed by recording the smoking status among ex-smokers.
2. Assess- Those who confirm smoking habits will be questioned to determine their
readiness to adopt cessation. Intervention will be based on the Fagerstrom Test for
Nicotine Dependence where patients will be asked to fill out questionnaires based on

6PROJECT PROPOSAL
their smoking habits (14). The scores will determine the strategies that must be
adopted for addressing smoking cessation in individual clients.
3. Advice- All smokers will be asked to quit smoking in a non-judgmental and clear
manner. Use of tobacco in relation to a range of social and health issues will be
discussed (15).
4. Assist- The clients will be categorised into three groups namely, not ready, unsure,
and ready. Those who are not ready will be taught about quitting benefits, effects of
active and passive smoking, and use of Quitline. Unsure clients will be asked about
their perception, and offered a Quitkit. Ready clients will be encouraged, followed by
pharmacotherapy and referral to a specialist (15).
5. Arrange- The tables given below provide an indication of the pharmacotherapy
interventions:
Dosage Nicotine
dependency
Generic product Dosage instructions
Patches High (>10/day) Nicotine
transdermal patches
21mg/24 hrs
14 day interval, 6-8
weeks, later on
reduced to 2 weeks
Patches Low (<10/day) Nicotine
transdermal patches
7mg/24 hrs
Sublingual tablets High (>20/day) 2mg nicotine sugar
free tablets
2 weeks at
maximum dose
(single use)
Sublingual tablets Low (<20/day) Half amount
(combined with

7PROJECT PROPOSAL
patches)
Inhalator All 10mg and 15 mg
nicotine inhalation
cartridge
2 weeks at
maximum dose
(168*10mg/
84*15mg)
Nasal Spray All Nicotine 500μg/dose
spray 200 dose
2 weeks at
maximum dose
Quickmist All Nicotine
oromucosal spray
1mg/dose 150 dose
2 weeks at
maximum dose
Table 1- Pharmacotherapy intervention
Source-(16)
Dosage Nicotine dependency Generic product Dosage instructions
Varenicline All Varenicline (tartarate)
500μg/ 56-tablet pack
500μg/daily for 3 days
for adults, later on
increased to twice
daily
Bupropion All Bupropion
hydrochloride
150mg/60-tablet pack
150mg/daily for 6
days for adults, later
on increased to twice
daily.
Table 2- Medications for smoking cessation
Source-(16)
Following intervention, the clients will be categorised as successful or relapsed. The
former will be congratulated on their efforts, and provided ongoing encouragement. The latter

8PROJECT PROPOSAL
will be provided support and the reasons for relapse will be explored. Use of nicotine
replacement therapy (NRT) will also form an essential aspect of the cessation program. Some
key attributes of NRT that need to be followed at the hospital are given below:
Area Consideration
Cardiac Safe and effective, to be used with caution
among patients with serious arrhythmia,
angina pectoris, or immediate myocardial
infarction
Critical care Determined on an individual basis
Dementia, delirium No evidence, might lead to agitation
Frail elderly No relevant long term impacts
Emergency General prescription (to be considered for
differential diagnosis)
Mental health/psychiatry Safe, combination therapy to be used, high
dose needed
Internal medicine Routine administration, defer NRT until
patients are removed from vasopressor or
inotrope administration
Plastic surgery Must be a deliberate decision
Vascular surgery General prescription
Women’s health Safe for pregnant women
Table 3- Considerations for NRT in hospital setting
Source- (17)

9PROJECT PROPOSAL
Resources Needed:
 Stakeholders
 Physicians and nurses
 Quitline
 Quitkit
 Online websites
 Fax
Benefits of project to:
1. Myself- I will gain a sound understanding of the cultural values and perceptions that
people in Saudi Arabia hold, regarding smoking, its ill effects and cessation.
2. Patients- It will help them quit smoking activities, which in turn will enhance their
physical and mental health and improve the quality of life.
3. Community- Reduced smoking habits will lower the rates of comorbid conditions,
and result in a healthier community
Ethical, legal and moral implications:
Autonomy of the clients must be restored while implementing the 5’A’ model, and
subjecting the clients to any kind of intervention programs (either psychotherapy or
medication management). Efforts will also be maintained to keep the client information
private and confidential, in addition to preventing access by any third party. The smoking
cessation clinic will also be conduct in a manner that no harm is met out towards the clients.
All questions asked during interaction with the clients, and the interventions will be
implemented in a manner that is in alignment with the cultural values and preferences of the
nation.

10PROJECT PROPOSAL
Timeline plan:
Although smoking cessation should be a continuous process, this project will be
conducted for three months, and a report will be submitted to the university after a year.

11PROJECT PROPOSAL
References
1. World Health Statistics data visualizations dashboard. [Internet]. World Health
Organization. 2015 [cited 8 February 2019]. Available from:
http://apps.who.int/gho/data/view.sdg.3-a-data-reg?lang=en
2. Prevalence of tobacco smoking. [Internet]. World Health Organization. 2015. [cited 8
February 2019]. Available from:
3. WHO report on the global tobacco epidemic- Country profile Saudi Arabia [Internet].
World Health Organization. 2017 [cited 8 February 2019]. Available from:
https://www.who.int/gho/tobacco/use/en/https://www.who.int/tobacco/surveillance/
policy/country_profile/sau.pdf
4. BinDhim NF, McGeechan K, Trevena L. Who uses smoking cessation apps? A
feasibility study across three countries via smartphones. JMIR mHealth and uHealth.
2014;2(1):e4.
5. Zwar NA, Mendelsohn CP, Richmond RL. Supporting smoking cessation. BMJ. 2014
Jan 14;348:f7535.
6. Hughes JR, Stead LF, Hartmann‐Boyce J, Cahill K, Lancaster T. Antidepressants for
smoking cessation. Cochrane database of systematic reviews. 2014(1).
7. Sitas F, Weber MF, Egger S, Yap S, Chiew M, O'Connell DL. Smoking cessation
after cancer.
8. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in
mental health after smoking cessation: systematic review and meta-analysis. Bmj.
2014 Feb 13;348:g1151.

12PROJECT PROPOSAL
9. Pistelli F, Aquilini F, Carrozzi L. Weight gain after smoking cessation. Monaldi
Archives for Chest Disease. 2009;71(2).
10. Tidey JW, Miller ME. Smoking cessation and reduction in people with chronic mental
illness. Bmj. 2015 Sep 21;351:h4065.
11. Florou AN, Gkiozos IC, Tsagouli SK, Souliotis KN, Syrigos KN. Clinical
significance of smoking cessation in subjects with cancer: a 30-year review.
Respiratory Care. 2014 Dec 1;59(12):1924-36.
12. Clinician’s Guide to Treating Tobacco Dependence. [Internet]. American Association
for Respiratory Care. 2014 [cited 8 February 2019]. Available from:
https://www.aarc.org/wp-content/uploads/2014/11/tobacco-guide.pdf
13. Ucar EY, Araz O, Yilmaz N, Akgun M, Meral M, Kaynar H, Saglam L. Effectiveness
of pharmacologic therapies on smoking cessation success: three years results of a
smoking cessation clinic. Multidisciplinary respiratory medicine. 2014 Dec;9(1):9.
14. Abroms LC, Johnson PR, Heminger CL, Van Alstyne JM, Leavitt LE, Schindler-
Ruwisch JM, Bushar JA. Quit4baby: results from a pilot test of a mobile smoking
cessation program for pregnant women. JMIR mHealth and uHealth. 2015;3(1):e10.
15. Quick guide to smoking cessation brief intervention- Smoking Cessation 5As.
[Internet]. NSW Government.2016. [cited 8 February 2019]. Available from:
https://www.health.nsw.gov.au/tobacco/Factsheets/tool-2-guide-5as.pdf
16. Primary Care Stop Smoking Pharmacotherapy Prescribing Summary. [Internet].
BNF. 2013. [cited 8 February 2019]. Available from:
http://www.wales.nhs.uk/sitesplus/documents/888/NRT%20summary%20final
%2027%2009%2013.pdf

13PROJECT PROPOSAL
17. Prescribing Nicotine Replacement and Managing Nicotine Withdrawal in
Hospitalized Patients. [Internet]. Winnipeg Regional Health Authority. 2012. cited 8
February 2019]. Available from:
http://www.wrha.mb.ca/professionals/tobacco/files/InterimGuidance.pdf