Clearing the Air: Brief Strategies for Smoking Cessation

Susan D. Schaffer, FNP, PhD, CS

Disclosures

Topics in Advanced Practice Nursing eJournal. 2002;2(1) 

In This Article

Abstract and Introduction

Abstract

Although cigarette smoking is the most important preventable cause of disease and death in the United States, clinicians have been slow to use brief clinical interventions that have demonstrated efficacy in helping smokers achieve abstinence. All patients presenting for healthcare should be asked about tobacco use and all smokers should be asked about their willingness to make a quit attempt in the near future. Smokers willing to make a quit attempt should be assisted with the development of a quit plan, provided with appropriate supplementary materials, and scheduled for follow-up. Approved smoking cessation pharmacotherapy (nicotine replacement therapy [NRT] or bupropion [Zyban]) should be offered to all smokers willing to make a quit attempt unless contraindications exist. Intensive behavioral interventions or combined pharmacotherapy may be indicated for those with comorbid psychiatric problems and for those who are very concerned with weight gain.

Introduction

Cigarette smoking has been identified as the most important preventable cause of death and disease in the United States.[1] Smoking is responsible for 20% of all deaths in the United States, and 45% of smokers will die of a tobacco-induced disorder.[2] Well aware of the health risks, 70% of current smokers have made at least 1 prior quit attempt, and 46% attempt to quit each year.[3] The good news is that 50% of those who have ever smoked are now abstinent.[4] The bad news is that only 7% of smokers who make attempts to quit smoking on their own during a given year are still abstinent at the end of the year.[5] These data support the concept of tobacco dependence as a chronic disease requiring ongoing assessment and repeated intervention.[6]

Although there is substantial evidence that brief clinical interventions can double or triple the likelihood that a smoker will be successful in a single quit attempt,[6] clinicians have been slow to intervene with their smoking clients. Although 70% of smokers see a healthcare provider each year, a recent study confirmed that only 15% of smokers who saw a physician in the past year were offered assistance with quitting, and only 3% were given a follow-up appointment to address this topic.[6] After meta-analysis of 180 randomized controlled studies that substantiated the efficacy of smoking cessation treatments, authors of a recent multiagency clinical practice guideline suggested that "failure to treat tobacco use -- the chief cause of preventable disease and death -- constitutes an inappropriate standard of care" (p. vi).[6] In order to decrease the negative health effects of smoking, assessment of smoking status and systematic treatment of smokers must become a routine part of primary care visits. All it takes is 3 easy steps: 1) identify tobacco users, 2) provide brief clinical interventions, and 3) provide relapse prevention treatment.

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