1. CAN-ADAPTT AGM 2010 : Population Approaches to Smoking Cessation in Canada October 1 st, 2010 Ottawa, Ontario

2. Welcome/Bienvenue While we wait to get started  Tell people who you are  What ‘hat’ you are wearing  What you hope to get out of today  Favourite vacation location  Name your table……a Fall theme…..

3. Introduction: CAN-ADAPTT Team  Jess Rogers – Manager  Rosa Dragonetti – Clinic manager  Janet Ngo – Coordinator, Western Canada  Tamar Meyer – Coordinator, Ontario  Katie Hunter – Coordinator, Atlantic Canada  Stephanie Elliott – Administrative Secretary  Dr. Peter Selby – Principal Investigator  Dr. John Garcia –Lead, system level interventions for cessation

4. Team Members  Executive Committee  Evaluation Committee Opportunity to get involved  Guideline Development Group  Professional Advisory Committee Opportunity to get involved

5. AGENDA 9:00-9:20Introduction 9:20-10:00Overview of CAN-ADAPTT progress 10:00-10:15Setting the Stage - P.Selby 10:15-10:45“Population approaches to tobacco use cessation programming and current capacity in Canada”- J.Garcia 10:45-11:00Break 11:00-12:00Small group discussion

6. AGENDA 12:00-12:30Report back 12:30-1:30 Networking Lunch 1:30-1:45Where do we go next? – J.Garcia 1:45-3:45Small group discussion and report back 3:45-4:00Closing remarks, Next steps - P.Selby and J. Rogers 4:30-6:00Networking Reception

7. Objectives for Today 1.Learn about current status of CAN-ADAPTT project:  Engagement/Network Membership  Dissemination/Implementation Highlights  Version 2.0 Launch/Wiki 2.Contribute to development of CAN-ADAPTT’s population/systems level standards for tobacco use cessation systems

8. CAN-ADAPTT  Unique guideline development and dissemination project Practice informed approach Practice Based Research Network (PBRN) Dynamic Online

9. Dissemination & Engagement Stakeholders Professional Advisory Groups National Network Practitioners Researchers Policy-makers Practice-informed Research Agenda Seed grants Discussion board AGM Knowledge Translation Seed grants Discussion board PRACTICE RESEARCH Canadian Clinical Practice Guideline

10. Health Canada Funding  Funding provided by the Drugs and Tobacco Initiatives Program, Health Canada  3 year funding March 20, 2008 - March 31, 2011

11. Overview of CAN-ADAPTT Progress 1.Engagement and Network Membership 2.Dissemination/Implementation Highlights 3.Seed Grants and Research Agenda 4.Version 2.0 Launch

12. 1. Engagement and Network Membership

13. Timeline/Work Plan  March 2008: Focus on provider and practitioner organizations  March, 2009: Ontario coordinator  October, 2009: Western and Eastern coordinators  Spring, 2010: Engagement beyond providers  Fall, 2010: Quebec Coordinator

14. Network Membership  Multi-sectoral  Multi-disciplinary  National

15. Network Membership  Multi-sectoral  Multi-disciplinary  National Psychologist Physician OT/PT/Chiropractor Counselor/Therapist/Social Worker Respiratory Therapist/Asthma Educator Pharmacist Dental professional Nurse professional Number of Network Members  >700 members across Canada

16. Network Membership  Multi-sectoral  Multi-disciplinary  National

17. Member Survey: Reason for Joining the Network % of participants who identified this reason as their reason for joining “to a great extent” (n=141) To conduct practice-informed research to address gaps To provide input into identifying knowledge gaps To contribute to promoting the adoption of the guideline To build relationships/collaboration with tobacco control professionals To get updates on tobacco control news and events To gain access to CAN-ADAPTT’s guideline

18. Moving forward (targets for next 7 months)  Increase Network Membership Professional representation Increase regional reach  Launch Version 2.0 on Wiki Platform  Translate Version 2.0 in French and launch  Launch Version 3.0  Engage Partners, Stakeholders in dissemination plan  Build sustainability around the Network, guideline and research agenda

19. 2. Dissemination/ Implementation Highlights

20. Dissemination/Implementation  National and provincial conferences Exhibits, poster and oral presentations, workshops  Stakeholder engagement Regional teleconferences, meetings, committee/coalition membership  Communications Stakeholder articles, e-blasts, journals, listservs

21. Some sense of numbers….. 26 Oral and poster presentations: To a variety of practitioner and academic audiences 17 Exhibit tables: At a variety of practitioner conferences across Canada 5 Workshops: Integrating CAN-ADAPTT guideline in practice/identifying barriers to implementation Plus, many upcoming dissemination opportunities confirmed and in development…

22. CAN-ADAPTT TRAVELS

23. Western Canada - Highlights Successes:  College of Registered Dental Hygienists of Alberta (CRDHA)  University of Alberta Dental Hygiene program Next steps:  engagement on applying the guideline

24. Ontario - Highlights Key Successes  Canadian and Ontario Association of Public Health Dentistry conference keynote, workshop  Ontario Respiratory Care Society keynote, workshop

25. Atlantic Canada – Highlights Key successes:  Significant increase in Atlantic Canada representation  Numerous collaborations/ connections established across provinces/disciplines Next Steps:  Pursue workshop opportunities

26. Benefits of Joining Individuals & organizations  Access to up-to-date clinical practice guideline  Opportunities to contribute to the development of Canada’s first national CPG  Links to a variety of resources including websites, projects, literature reviews and articles  Updates on meetings/conferences  A discussion board to connect with colleagues, share resources and comment on the guideline  Disseminate and Implement the guideline

27. 3. Seed Grants and Research Agenda

28. CAN-ADAPTT Seed Grants  23 applications received from across Canada; 12 funded  Applicants: researchers, practitioners, and collaborations of both. Topic Themes Proposed Products Scientific publications Academic posters Grant proposals Collaborative meetings Optometry Women’s health Addictions Mental health/ psychiatry Health sciences Specific populations Role of HCPs Counselling Capacity and theory building Disciplines

29. Development of a Practice-Informed Research Agenda Research Agenda Existing guidelines* Comprehensive literature search* Organizational reports* CAN-ADAPTT network feedback* March 2009-June 2010 Summer 2010 version Fall 2010 version Winter 2011 version Feedback from stakeholders and collaborating organizations Ongoing CAN-ADAPTT Executive committee September 2010 February 2011 CAN-ADAPTT Network feedback April 2010 (member survey) October 2010 (AGM) Ongoing (discussion board) June 2010- March 2011 Health Canada submission March 2011 * Details in following section www.can-adaptt.net Updated: June 30, 2010

30. 4. Version 2.0 Launch

31. Scope of CAN-ADAPTT

32. Clinical Practice Guideline  Sections Launched Counselling Hospital based populations Youth (Child and Adolescents) Pregnant and Breastfeeding Women Mental Health and Other Addictions Aboriginal Peoples  Upcoming Launches Pharmacotherapy  Levels of evidence/grade of recommendation

33. Guideline Development Group  Gerry Brosky, MD (Counselling)  Alice Ordean, MD (Pregnant and Breastfeeding Women)  Peter Selby, MBBS/ Charl Els, MBChB (Mental Health and Addictions)  Sheila Cote-Meek, PhD (Aboriginal)  Bob Reid, PhD (Hospital-based)  Jennifer O’Loughlin, PhD (Youth)  Paul McDonald, PhD (Pharmacotherapy)

34. Guideline Development Process

35.  Applied principles of ADAPTE…..  Review existing smoking cessation CPGs (internationally and across disciplines)  CPGs rated using the AGREE instrument  Highest-scoring CPGs were used  Sections subject to ongoing input by CAN- ADAPTT network (PBRN, partners etc.)

36. Version 2.0 TODAY

37.  Background and Evidence Overview  Summary Statements  Clinical Considerations  Tools and Resources  Future Research Structure of the guideline CAN-ADAPTT Network Direct input Suggestions for Review

38. Levels of Evidence/Grade of Recommendations  Summary statements are rated based on the GRADE system  Required consensus of the Guideline Development Group Grade of Recommendation High Low Level of Evidence Weak Strong GRADE system of Ratings 1A1B1C 2A2B2C

39. Next Steps for the guideline  Integrate outcomes of today’s workshop to create Version 3.0 Launch date: January 2011  Continue to build clinical considerations Use of a wiki platform GDG and network involvement  Continue engagement and dissemination

40. 2.2 Next Steps: Online engagement  Website New (internal) provider New website – launching winter 2010  Wiki platform Launched for AGM (Oct 1)  Twitter Launching in October

41. Objective for today…. Inform CAN-ADAPTT’s guideline on population level approaches for tobacco use cessation

42. “Setting the Stage” Dr. Peter Selby Principal Investigator, CAN-ADAPTT

43. Setting the Stage…  Opportunity for collaborative approach in developing key principles for an effective smoking cessation system in Canada  Identifying gaps and ways to work together

44. Society Behaviour and Biology: Making the Case for EBB interventions T.A. Glass, M.J. McAtee / Social Science & Medicine 62 (2006) 1650–1671

45. The Smoking Environment in Canada About one in five Canadians (5.7 million) 12yrs or older, are daily or occasional smokers* Average cigarettes smoked per day = 13.3** 37,000 Canadians die from smoking per year – 100 infants/year 1 in 5 deaths are due to smoking 1 in 2 smokers die from smoking-related diseases * Canadian Community Health Survey (Statistics Canada), 2010 **CTUMS 2009

46. Burden of Addiction  Smoking rates are higher among: Young adults Less than high school education Blue collar Mentally ill Aboriginal Poor

47. Never too late to Quit Quitting smoking at any age may increase life expectancy  Quitting smoking before age 30 = normal life expectancy Age stop smoking byLife years gained <30 years10 <40 years9 <50 years6 <60 years3

48. “Smoking cessation is a critical aspect of the management of many chronic diseases, both in terms of treatment outcome, progression of disease, comorbidities, quality of life, and survival.” (Gritz et al., 2007) “Smoking cessation is a critical aspect of the management of many chronic diseases, both in terms of treatment outcome, progression of disease, comorbidities, quality of life, and survival.” (Gritz et al., 2007) Hard things to do….large benefits to doing them….

49. Providing Smoking Cessation  Many Providers Physicians, RNs, NPs, Dental Hygenist, Assistants, Opthalmologists, Chiropractors, Pharmacists, Social Workers, Mental Health Counselors, RTs, etc….  Many Settings Hospital, Primary Care, Community, Long term care, Specialty Care, etc.  Opportunities!!!!

50. Levers and Opportunities Training of HCPs Guidelines Patient/client tools Provider tools/resources Incentives Mass Media Policy Priority Setting Engage community Research Clinical Strategies (5A’s, Ottawa Model) Funding: programs Funding: pharmacotherapy Public/Consumers Existing programming Partnerships Opinion leaders/Champions

51. Need for alignment  Fragmented smoking cessation system across Canada Information sources (cpg’s, tools etc.) Settings (clinical, community, hospital, primary care) Professionals Funding Funding of effective interventions Educational opportunities in smoking cessation

52. Provider Approaches Organizational Level Population Level Approaches & policy Importance of alignment and integration of approaches

53. Intent of the White Paper  Starting point……  Build from evidence, experience and current capacity to frame the context for smoking cessation guideline  Opportunity today and over Fall 2010 for us to reflect, discuss and revise the White Paper

54. Today’s Approach  Opportunity to have important conversations in a collaborative way  Helpful hints: Focus on what matters Contribute your thinking Listen to understand Link and connect ideas Have FUN! Be CREATIVE!

55. Population approaches to tobacco use cessation programming & current capacity in Canada 60 minutes John Garcia, PhD

56. Understand your perspectives on  important components of cessation systems  existing challenges and barriers, successes and where gains can be made  emerging opportunities and needs for smoking cessation system development  What needs to be addressed in a CAN- ADAPTT “System Guideline for Population- based Tobacco Use Cessation”?

57. Perspectives: Cessation system, What are we talking about?  Clinical Intervention? Not just a program or intervention  Public Health Approach? “the organized efforts of society to improve health and well- being and to reduce inequalities in health” (PHAC)  A goal beyond cessation of tobacco use alone? Harm reduction – reducing disease, disability and death?  Relationship between tobacco control and cessation? both a context and the approach?

58. Exploring Components of Effective Smoking Cessation System(s) Across Canada  CAN-ADAPTT team work to create white paper Starting place only, stimulate discussion CDC, IOM, NCI,Ontario (TF, UW, SFO-SAC)  Major components and what we mean: Goals Principles Strategies Tactics

59. Tobacco Control – classic goals 1.Preventing tobacco use, 2.Encouraging and motivating quitting tobacco use, 3.Protecting the public from exposure to tobacco smoke, and 4.Denormalization of tobacco and tobacco industry  Tobacco control is not equivalent to cessation  Some are questioning this orientation

60. Cessation System Goals – 6 identified on page 3  Reduce the health consequences (i.e. harm) of the use of tobacco products  Motivate attempts to quit tobacco use  Support tobacco users in their efforts to quit tobacco use

61. Cessation System Goals (continued)  Facilitate tobacco users stopping use at an earliest age possible  Address the needs of high priority populations to eliminate or reduce inequities in burden of diseases caused by tobacco products (e.g. Aboriginal People, occupational, SES groups), including those who may be at elevated risk due to other health conditions (e.g. mentally ill, poly-drug users)

62. Cessation System Goals (continued)  Encourage repeated sustained quitting and reduction of long-term use in order to reduce health burden among those who have difficulty quitting

63. Cessation System Goals  Do these goals make sense/resonate?  Alternative goals – for the population-based system?

64. Key Guiding Principles – page 4 & 5 Tobacco Use Cessation System should be:  Continuous – range of interventions, integrated  Goal and Objective Directed  Evidence-based  Comprehensive and integrated  Aligned – across disciplines, interventions/strategies, decision-makers (across levels)

65. Key Principles Build from/include:  Strong relationships with smokers Not just “one offs”: family members, friends, colleagues  SDOH/Equity and concern for vulnerable populations  Continuous learning cycle Evidence-inspired, tailoring, continuous improvement  Commitment to invest in research  Roles for a range of health care providers, range of capacities and roles

66. Proposed structure of a tobacco use cessation system Strategies Approaches to achieving the goal(s) Goals and Principles Key concepts informing the organization and management of the system Tactics How would you go about executing the strategy? What activities are required? Where would resources be spent? Actions Pragmatic, action-oriented and implementable tactics necessary to move toward goals and objectives This morning This afternoon

67. After the break…..Let’s Discuss 1.What is the current status of tobacco use (smoking) cessation systems in Canada?  What’s working well?  What are the emerging opportunities for system development?  What are some of the major challenges for cessation system development?

68. Evidence and Experience  Focus on areas where there is some degree of evidence around impact, effectiveness and/or trends in practice.  Acknowledge continuous learning cycle and opportunity to build from best practice and experience

69. BREAK

70. Small Group Discussion Questions 1.What is the current status of tobacco use (smoking) cessation systems in Canada?  What’s working well?  What are the emerging opportunities for system development?  What are some of the major challenges for cessation system development?  25 minutes

71. Building from your conversation….. 2.What are the key principles that should be considered in the design of tobacco use cessation systems in Canada? Please use the White Paper as a starting point only. Go beyond it and generate new principles. 25 Minutes

72. Large Group Report Back Focus your report back on:  What were the emerging opportunities?  Was there general agreement with the Principles in the White Paper?  What changes/additions did your group discuss making to the Key Principles? 40 Minutes

73. Networking Lunch 12:30-1:30 Visit display tables at the back of the room Network with colleagues and meet new people Explore CAN-ADAPTT Wiki Introduce yourself to the CAN-ADAPTT team!

74. Welcome Back….  Review discussion from this morning…..

75. Proposed structure of a tobacco use cessation system Strategies Approaches to achieving the goal(s) Goals and Principles Key concepts informing the organization and management of the system Tactics How would you go about executing the strategy? What activities are required? Where would resources be spent? Actions Pragmatic, action-oriented and implementable tactics necessary to move toward goals and objectives This morning This afternoon

76. Strategies #1 Planning and Priority Setting #2 Policy Interventions #3 Health Communication and Media Interventions for Population Level Tobacco Cessation #4 Healthcare Setting/Organization and Community Interventions #5 Population-level Cessation Interventions

77. Strategies #6 Training or Building Capacity Among HCP’s in the Provision of Smoking Cessation Interventions #7 Investment #8 Evaluation #9 Surveillance and Monitoring #10 Alignment and Coordination

78. White paper….drilling down  World Café Format  Opportunity to have important conversations in a collaborative way 1:40 – 3:45

79. How does it work? Discuss specific strategies  Round 1: stay at your current table Quick Report Back  Round 2: travel to a new table  Round 3: travel to a new table  Round 4: return to your original table Group Discussion

80. Round #1: Table Talk  Explore the strategy your table has been assigned  Have the important aspects been captured?  Are there additional tactics that could be considered/included? 20 minutes

81. Report Back  5 minutes/table  Introduce the strategy  Was there general agreement that the strategy is important/should be included?  What revisions/additions would you suggest? 40 minutes total

82. Travel Time  Travel to a NEW table for Round 2 of small group discussion  Table Leads STAY at your first table 5 minutes

83. Round #2: Table Talk  Have the important and relevant strategies been captured?  What is missing? What needs to be added? 15 minutes

84. Travel Time  Travel to a NEW table for Round 3 of small group discussion  Table Leads STAY at your first table 5 minutes

85. Round #3: Table Talk  Table leads take 5 minutes describing what was discussed in Round #2  If there was one thing that hasn’t been said but is needed what is it? 20 minutes

86. Travel Time  Travel ‘Home’ 5 minutes

87. Large Group Report Back  What key themes emerged? 20 minutes

88. “Where do we go next?”

89. Think about…. 1.Explore opportunities for collaboration, importance of alignment and how to move forward 2.How might we learn from the experience of different jurisdictions as they implement tobacco use cessation systems across Canada and abroad?

90. Moving Forward  What needs to happen next week, next month, this year……..beyond? 10 minutes

91. Wrapping Up  Reflection and Next Steps  Evaluation  Acknowledgements  Thank you Reception

92. For more information CAN-ADAPTT 175 College Street T: 416-535-8501 ext 7427 E: can_adaptt@camh.net www.CAN-ADAPTT.net