Department of Family Medicine
Health Promotion: Smoking Cessation and Smokeless Tobacco
The figures are alarming
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In the United States, over 400,000 people die
each year from smoking-related illnesses
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Each day, 3000 teens begin smoking
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Smoking during pregnancy is the most
preventable cause of low birth weight infants, yet approximately 25% of
women smoke during pregnancy
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30% of all cancer deaths are tobacco-related
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There are currently approximately 46 million
smokers in the United States
Of all the lifestyle factors that negatively influence your patients' health,
smoking is one of the most challenging behaviors to combat. As with many
addictive behaviors, the physiological effects of nicotine are powerfully
reinforcing to the smoker.
Historically, patient compliance with smoking cessation recommendations has
been very low. However, this may be partly due to a mismatch between the type of
interventions offered and the stage of change of the patient. As providers
become more aware of the importance of assessing the patient's stage of change
and gain skill in tailoring interventions to individuals, successful
interventions may increase. To review stages of change in the Tool
box, click here.
It is important to remember that even very brief interventions of only a few
minutes may be effective to help your patients quit or begin to move along the
stage progression. For example, the precontemplative smoker (not thinking about
quitting) may require several discussions about the health ramifications of
smoking, brochures or other patient education materials, and perhaps a session
with a patient educator to even begin the process of moving towards
contemplation. In this case, success must be defined as any progression, however
slow, towards preparation to quit. Patience and persistence on the part of the
entire health care team are required.
The Agency for Healthcare Research and Quality has updated its 1996 Smoking
Cessation Clinical Practice Guideline in the form of a US Public Health Service
report which may be accessed at http://www.surgeongeneral.gov/tobacco.
See also the Consensus Statement published in JAMA,
June 28, 2000, Vol 283(24). This article outlines the background and key
recommendations of the revised guideline. It includes excellent information in
the form of tables for enhancing motivation to quit, counseling and behavioral
therapies, and guidelines for prescribing pharmacotherapies.
For your computer-literate patients, the World Wide Web contains a multitude
of sites that may be helpful to them by offering information, chat rooms, and
on-line support groups as an adjunct to clinician-provided support. You may want
to recommend the following sites:
AllHealth's
Kick Butt Challenge
American
Heart Association
American Lung
Association
Just for Teens - Quit
Smoking
US Surgeon
General
Smokeless Tobacco
Smokeless Tobacco (chew, snuff, dip) is not a safe alternative to cigarettes.
These products are highly addictive (Henningfield, et al) and have been linked
to cancer of oral cavity and increased risk of cancer of the esophagus, larynx,
and stomach (Andrews, et al). Adolescent use of smokeless products is a
particular concern, as adolescent usage rose by one-third between 1991 and 1997
(from 27.5% to 36.4%) and decreased only slightly to 34.8% in 1999 (CDC).
For more information on smokeless tobacco and how to quit, see:
National Spit Tobacco Education
Program
Quit Smokeless
Tobacco Information and
Prevention Source
References
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Andrews J, Severson H, Lichtenstein E, Gordon J,
et al. Evaluation of a dental office tobacco cessation program : Effects on
smokeless tobacco use. Annals of Behavioral Medicine
1999;21(1);48-53.
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CDC Youth Risk Behavioral Surveillance Surveys,
available on-line at: http://www.cdc.gov/nccdphp/dash/yrbs/index.htm.
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Henningfield J, Fant R, Tomar S. Smokeless
tobacco: An addicting drug. Advances in Dental Research
1997;11:330-35.
Contact Information
Dr. Peggy J. Wagner
Research Director
Email: pwagner@mcg.edu
(706) 721-7589 |
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