Smoking cessation

Cigarette smoking is the primary cause of chronic obstructive pulmonary disease, and smoking cessation is the most effective means of stopping the progression of chronic obstructive pulmonary disease. Worldwide, approximately a billion people smoke cigarettes and 80% reside in low-income and middle-income countries. Though in the United States there has been a substantial decline in cigarette smoking since 1964, when the Surgeon General's report first reviewed smoking, smoking remains widespread in the United States today (about 23% of the population in 2001). Nicotine is addictive, but there are now effective drugs and behavioral interventions to assist people to overcome the addiction. Available evidence shows that smoking cessation can be helped with counseling, nicotine replacement, and bupropion. Less-studied interventions, including hypnosis, acupuncture, aversive therapy, exercise, lobeline, anxiolytics, mecamylamine, opioid agonists, and silver acetate, have assisted some people in smoking cessation, but none of those interventions has strong research evidence of efficacy. To promote smoking cessation, physicians should discuss with their smoking patients "relevance, risk, rewards, roadblocks, and repetition," and with patients who are willing to attempt to quit, physicians should use the 5-step system of "ask, advise, assess, assist, and arrange." An ideal smoking cessation program is individualized, accounting for the reasons the person smokes, the environment in which smoking occurs, available resources to quit, and individual preferences about how to quit. The clinician should bear in mind that quitting smoking can be very difficult, so it is important to be patient and persistent in developing, implementing, and adjusting each patient's smoking-cessation program. One of the most effective behavioral interventions is advice from a health care professional; it seems not to matter whether the advice is from a doctor, respiratory therapist, nurse, or other clinician, so smoking cessation should be encouraged by multiple clinicians. However, since respiratory therapists interact with smokers frequently, we believe it is particularly important for respiratory therapists to show leadership in implementing smoking cessation.     

Smoking cessation

Smoking has been determined as a cause of chronic obstructive pulmonary disease (COPD) in most patients. Smoking cessation should be stressed above everything else for COPD patients under all conditions. A smoking habit is determined not as a preference but as a dependency on tobacco; therefore, smoking cessation is difficult solely based on one's motivation. Smoking cessation therapy is employed with cessation aids. Now, we can use nicotine-containing gum, patches, and the nicotine-receptor partial agonist varenicline. First, nicotine from tobacco is replaced with a nicotin patch, or a nicotine-free condition is induced by varenicline. Subsequently, the drugs are gradually reduced. In Japan, smoking cessation therapy is covered by public health insurance as definite requirements.     

Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 - 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 – 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Smoking cessation in pregnancy

One in four pregnant women smokes throughout pregnancy and these women tend to be young, single, of lower educational achievement and in manual occupations. About 25 per cent of pregnant smokers stop for part of their pregnancy, mostly within the first trimester, but 75 per cent return to smoking after the birth of their child (Owen and Penn, 1999).     

A cross-sectional survey of factors associated with the uptake of smoking cessation aids among smokers and ex-smokers

Background: A cross-sectional survey was conducted in Germany via the online panel PsyWeb with the aim of assessing factors associated with the uptake of smoking cessation aids among smokers and ex-smokers.

Methods: Of the 10,000 panel members invited to participate in the survey, 624 took part.

Main Outcome Measures: Outcomes were measured via questionnaires to assess the uptake of smoking cessation aids, health literacy, readiness to change smoking behavior, and the Fagerström Test for Nicotine Dependence.

Results: There was no association between gender or educational status and use of smoking cessation aids according to chi-square tests of independence. Logistic regression showed that health literacy, degree of tobacco dependence, and readiness to change were significantly associated with the uptake of smoking cessation aids. Smokers with a high degree of nicotine dependence, high readiness to change, and low health literacy were more likely to use aids.

Conclusion: The survey results can be used to develop psychological approaches and interventions to promote smoking cessation, e.g., interventions to increase readiness to change among smokers may increase the uptake of aids. Moreover, the results may help to improve patient care by disseminating information on effective aids and thereby promoting smoking cessation among relevant patient groups.     

Smoking cessation in practice

Smokers expect health care professionals to help them stop smoking. Brief physician advice effectively increases cessation rates and should be given in a supportive and positive atmosphere emphasizing short-term benefits of cessation. Accurate information on withdrawal, weight gain, and nicotine gum should be offered, and systematic follow-up should be provided.     

Smoking cessation and cancer

OBJECTIVES: To provide an overview of scientifically based smoking cessation interventions for delivery to all tobacco-dependent users. DATA SOURCES: Research studies, published articles, and government reports. CONCLUSION: Smoking cessation interventions for patients with cancer remain poorly described with only a few studies investigating the efficacy of smoking cessation among this population. However, data suggest that quitting smoking after the diagnosis of cancer improves survival and quality of life. IMPLICATIONS FOR NURSING PRACTICE: Nurses serve a critical role in tobacco-dependence treatment. Innovative interventions for cessation, such as quit lines, telephone counseling, web-based information, and computerized cessation materials are now available.     

Smoking patterns and preferences for technology assisted smoking cessation interventions among adults with opioid and alcohol use disorders

ABSTRACT

Background: Smoking remains a major public health burden among persons with opioid and/or alcohol use disorder.

Methods: A 49-item semi-structured survey was conducted among urban, inpatient detoxification program patients eliciting demographic and clinical characteristics, smoking profile, technology use patterns, and preferences for adopting technology-based smoking cessation interventions. Multivariate logistic regression models further evaluated the association between participant demographic and clinical characteristics and technology preferences.

Results: Participants were mostly male (91%), and admitted for detoxification for alcohol (47%), heroin (31%), or both alcohol and heroin (22%). Past 30-day smoking was reported by 78% of the sample. Mobile phone ownership was common (89%); with an average past-year turnover of 3 mobile phones and 3 phone numbers. Computer ownership was low (28%) and one third reported daily internet use (34%). Telephone (41%) and text message-based interventions (40%) were the most popular platforms to facilitate smoking cessation.

Conclusions: Despite concurrent AUD-OUD, most respondents had attempted to quit smoking in the last year and preferred telephone- and text message-based interventions to facilitate smoking cessation. High turnover of mobile phones, phone numbers, and limited access to computers pose barriers to dissemination of technology-based smoking cessation interventions in this vulnerable population.     

Smoking cessation buddies in COPD

After a buddy system was developed to support the pulmonary rehabilitation programme, staff at the Hope Street specialist respiratory service developed a buddy-led smoking cessation clinic to support patients with chronic obstructive pulmonary disease, and their family or carers, through their quit attempts. Initial findings showed the buddy-led clinic helped 83% of those who enrolled in the first six months to quit within four weeks. Results were sustained, with a 12-month long-term quit rate of 50%. Results suggest that specialist smoking cessation clinics for patients with COPD, supported by buddies with similar experiences, can improve motivation and short and long-term quit rates.     

Smoking cessation and environmental hygiene

Although there are nonmodifiable genetic risk factors for COPD, most known risk factors for development and progression of COPD can be corrected. Continued efforts to encourage smoking cessation and measures to reduce exposure to SHS, outdoor air pollution, biomass smoke, and occupational and related amateur exposures will have a significant impact on worldwide health.     

Smoking cessation in hospitalized patients

The components of readiness to change for smoking cessation that are found in the general population are also applicable to hospitalized smokers. Smoking cessation interventions must be specifically tailored to subgroups among hospitalized patients, with emphasis on smoking-related diagnosis when applicable. Interventions should include key components related to smoking cessation, such as knowledge, self-efficacy, exposure to smoking, and social support. Interventions that include relapse prevention and are conducted in the context of other risk reduction strategies should be developed.