Pharmacologic interventions for smoking cessation

According to the US Public Health Service, all patients attempting to quit smoking should be encouraged to use one or more effective pharmacotherapy agents for cessation except in the presence of special circumstances. This article provides an overview of the pharmacologic agents for acute and critical care nurses to consider when intervening with tobacco-dependent patients. Medications addressed in this article include (1) first-line agents (nicotine replacement therapy, sustained-release bupropion) that have proven efficacy and are approved by the Food and Drug Administration (FDA) for smoking cessation, (2) second-line agents (nortriptyline, clonidine) that have proven efficacy but no FDA indication for smoking cessation, (3) approaches that use of combination or high-dose therapy, (4) herbal therapies, and (5) emerging therapies that are currently under investigation.     

Successful interventions for smoking cessation in pregnancy

The purpose of this article is to evaluate research regarding beneficial approaches to smoking cessation interventions during pregnancy. Research about nicotine replacement, nurse-managed counseling sessions, hypnosis, and behavioral modifications are presented. One of the most useful types of program for smoking cessation in pregnancy (as measured by cotinine-validated abstinence) described in the literature thus far has been the nurse-managed smoking cessation program, which includes a 15-minute individualized counseling session combined with a telephone contact 7-10 days after the prenatal visit. More research is needed in this important area of nursing practice.     

Review of perinatal partner-focused smoking cessation interventions

One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors.     

Gender's effect on the efficacy of smoking cessation interventions

Evidence-based guidelines and subsequent studies support the effectiveness of counselling and pharmacotherapy as first-line smoking cessation interventions. Gender is one of many factors that may have an impact on the efficacy of smoking cessation interventions. There is only very limited evidence, however, to answer the question of how gender influences the effectiveness of smoking cessation interventions. Research does suggest that concern about weight gain is related to women's confidence in their ability to stop smoking and this should be kept in mind when designing interventions. In the meantime, any client who indicates a desire to stop smoking should be offered one of the smoking cessation interventions that are already available.     

Clinical governance for nurses: smoking cessation interventions

AIM: To raise clinical governance issues by drawing on a Health Education Authority-sponsored review of the style, form and effect of a smoking cessation service in north west Lancashire. This service operated for five years before the government's decision to set up smoking cessation services. METHOD: A postal survey was undertaken of 800 clients. RESULTS: 193 people responded. Of these, 132 (68 per cent) claimed to be helped by the service. Proactive telephone contact, carbon monoxide monitoring, the six-week course, nicotine replacement therapy, and reading materials were well received. Thirty six per cent of the respondents were not smoking at the time of the survey. CONCLUSION: Nursing staff are increasingly expected to provide smoking cessation support. The government is funding this work and monitoring the number of clients helped, rather than the quality of the service. However, in terms of clinical governance, the quality of the service is crucially important.     

An integrated approach to prenatal smoking cessation interventions.

This article encourages the incorporation of smoking cessation activities into routine nursing care in the prenatal period. A brief background is given regarding the problem of smoking in women--especially pregnant women and adolescents. A model is suggested that integrates the Stages of Change framework with a program for planning, implementing, and evaluating smoking cessation activities in the clinical setting. The use of biochemical testing for cotinine, a biomarker of nicotine, is also explored as an evaluation tool and a method of self-report confirmation. The nurse is uniquely poised to reduce both the healthcare and economic burden of smoking during pregnancy. Because cigarette smoking is a major public health problem in the United States today, it is important for nurses to have a background in smoking assessment, cessation, and evaluation methods. It is critical for all nurses in obstetric, pediatric, hospital, and clinic settings to use this knowledge to assist vulnerable clients in achieving lifetime abstinence from cigarettes.     

Effectiveness of smoking cessation interventions integrated into primary care practice

Using a complete factorial design, we tested three interventions for smoking cessation in routine primary care practice. The interventions tested were 1) physician counseling, 2) mailed letters and educational materials designed by the National Cancer Institute (NCI), and 3) referral to smoking cessation classes. Thirty-seven family practice physicians at three of Group Health's outpatient facilities participated. Patient participation rates were 95%, and follow-up was complete for 92% of those participating. None of the interventions had any effect on point prevalence of quitting as determined 8-9 months later by self-report. However, the combination of physician counseling and NCI materials doubled the odds of occurrence of significant antismoking behavior (quit, quit and relapse, or cut down) during the ensuing 8-9 months in those individuals receiving that combination. Referral to smoking cessation classes was strikingly ineffective in this setting. Of 369 individuals designated by study design for referral, only 14% even investigated the classes. This compares with a 10% self-referral rate for those persons not designated for referral by our study design. Our results and other recent work suggest that more intensive interventions on multiple occasions based on relapse prevention strategies hold promise for future success in smoking cessation efforts in primary care.     

Developing guidelines for smoking cessation interventions for pregnant adolescents.

More than 400,000 deaths a year in the United States are attributed to active and passive tobacco smoke exposure. Healthy People 2000 objectives target a reduction in the tobacco use of high-risk populations such as youth and pregnant women. This article describes guidelines for health professionals to address smoking cessation when working with pregnant adolescents and teen mothers who smoke.     

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. OBJECTIVES: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. METHODS: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. RESULTS: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. CONCLUSIONS: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.     

A systematic review of smoking cessation interventions in the emergency setting

Study objective

Cigarette smoking remains the leading cause of preventable death in the United States, and tobacco use rates are known to be higher among emergency department (ED) patients than in the general population. Despite recommendations from the Society for Academic Emergency Medicine and the American College of Emergency Physicians, many emergency clinicians remain uncertain about the benefits of providing ED-based smoking cessation interventions. To address this gap in knowledge, we performed a systematic review of cessation interventions initiated in the adult or pediatric ED setting.

Methods

We conducted an electronic search of the MEDLINE and CINAHL databases through February 2014 and hand searched references from potentially relevant articles. We identified eligible studies, evaluated bias and validity, and extracted data and synthesized findings.

Results

Seventeen studies underwent critical appraisal, with 13 included in qualitative synthesis. The majority (11/13, 85%) of investigations did not report significant differences in tobacco abstinence between cessation intervention groups. The 2 studies reporting significant differences in cessation both used motivational interviewing-based interventions. Two studies evaluated patient satisfaction with ED-based tobacco cessation interventions, and both reported greater than 90% satisfaction.

Conclusions

Findings indicate that ED visits in combination with ED-initiated tobacco cessation interventions are correlated with higher cessation rates than those reported in the National Health Interview Survey. Clear data supporting the superiority of one intervention type were not identified. Lack of a standardized control group prevented quantitative evaluation of pooled data, and future research is indicated to definitively evaluate intervention efficacy.     

Predictors of response to brief smoking cessation interventions for adolescents who have contravened school smoking policy

Objective: To determine factors impeding favourable response to brief interventions for smoking by Australian middle high school students.

Method: Predictors of smoking at one month follow‐up were examined in 56 Queensland state high school students (34% female) who had received a brief smoking cessation intervention. The potential predictors included smoking days/week at Time 1, academic performance, nicotine dependence, parental care, problem drinking, and peer smoking.

Results: After accounting for academic performance, small variations in outcomes across two intervention types, and Time 1 smoking, problem drinking emerged as a modest predictor of smoking outcome. Peer smoking and parental care did not predict changes in smoking.

Conclusions: Brief tobacco cessation programmes may benefit from routine screening and an additional focus on heavy drinking.     

Update on smoking cessation therapies

As a reflection of an exponential increase in smoking rates throughout the world during the last century, the economic and human burden of mortality and morbidity related to smoking is now clearly defined. Smoking cessation is associated with health benefits for people of all ages. In this paper we provide a comprehensive review of current licensed pharmacological smoking cessation agents including efficacy and safety profiles, with comparisons of individual therapies available. Furthermore, we offer a prospective on the need for further testing of other agents including novel avenues of therapy.