2nd Place Diversity Essay
Assisting Smoking Cessation: An Essential Portion of Primary Care
By: Kathryn Ann Burns, DeSales University
Smoking is the leading cause and contributor to many preventable diseases and deaths in the United States. It accounts for one in five deaths each year. 443,000 deaths annually are attributable to cigarette smoking (Woolf S, 2008). Smoking is the major cause of lung cancer, stroke, ischemic heart disease, chronic obstructive pulmonary disease, and many other cancers. It contributes to chronic heart failure as well as hypertension (Smoking and Tobacco Use, 2009). Smoking causes more than “twice as many deaths as alcohol consumption, motor vehicle accidents, firearm use, unsafe sexual behavior, and illicit drug use combined” (Woolf S, 2008). 20.9% of adults over the age of 18 in the United States are smokers as of June 2008 which is slightly higher than the 19.7% of adults reported in 1997. Smoking results in a 22 times higher risk of lung cancer in men and 12 times higher risk in women as compared to non-smokers. There is also a tenfold increase in the risk of dying from chronic obstructive lung disease. Cigarette smoking also increases the risk of cardiovascular disease by 2-4 times that of a non-smoker. (Smoking and Tobacco Use, 2009).
Smoking is a preventable cause of disease that must be intercepted. Primary prevention starts at a young age. As practitioners, we must act to stop our patients from ever picking up a cigarette and in this way, we act to prevent multiple health conditions later on in life. For those who are smokers, it is our responsibility to help these patients to quit in order to prevent further damage and health problems in the future, a form of secondary prevention. The United States is aware of the risks of smoking and has taken small steps to decrease smoke inhalation. For example, many states have mandated that bars and restaurants be smoke-free environments which has been beneficial at limiting where people smoke and smoke exposure (CDC, 2009). However, this does not necessarily stop people from smoking. Thus, as practitioners we must help our patients to understand the significant health risks associated with smoking and assist them, when they are willing, to quit. We do our patients a disservice by treating the secondary causes of cigarette smoking, such as COPD, lung and bladder cancer, instead of treating the source (McGinnis JM, 1993). The National Commission on Prevention Priorities listed “helping patients to quit smoking” as among the top three most effective and cost effective clinical preventive services that a practitioner can offer to his or her patients (Maciosek MV, 2006).
Although clinicians recognize that smoking is a major health risk for patients, they have also met failure in attempting to help patients quit. This lack of success remains the reason most practitioners do not effectively attempt to intervene with patients. “Repeated failures to help patients stop smoking frequently causes clinicians to be discouraged and reinforces the belief that nothing can be done…” (Woolf S, 2008). However, as evidence has shown advisement from a clinician to stop smoking helps patients to quit. Practitioners know firsthand the adverse effects of smoking because they treat the secondary effects of smoking on a daily basis. For this reason, clinicians must make every effort to assist those who are willing to quit and to encourage those who are not ready to quit to begin thinking about the long term health effects of continued smoking (Kenford SL, 1993).
The 5 “As” are the most important guideline to follow in helping patients with smoking cessation:
• Ask all patients about smoking
• Advice those who do smoke to stop
• Assess if he or she is willing to make an attempt to quit
• Assist a patient’s efforts with developing a quit date, providing self-help material, and possibly smoking cessation medication
• Arrange a follow-up to reassess (Woolf S, 2008)
Clinicians should recommend over-the-counter (OTC) nicotine replacement as a means of quitting because of the addicting nature of nicotine. These methods have been attempted by many with little success. However, what works for one patient will not work for all patients, thus as clinicians we must be patient and tailor our treatment according to what the patient is likely to comply. If OTC nicotine replacement fails, pharmacologic agents should be attempted including bupropion, varenicline tartrate, clonidine, and nortriptyline (Service, 2009). Attempts to create a nicotine vaccine which would act to prevent the transfer of nicotine through the blood-brain barrier are currently in development (Woolf S, 2008). Though we cannot wait for a vaccine to change habits, we must act now.
Follow up is imperative. Patients need to know that clinicians have a vested interest in their health and in their attempt to quit. If they feel an obligation to report to someone about the amount they have smoked in the past week or month, they are more likely to put the cigarette down. “A person who comes to the office after being a nonsmoker for 1-2 weeks has a much improved chance of remaining abstinent than those without follow-up” (Kenford SL, 1993). Many patients will relapse, and this is very common, but it takes true dedication to go back to putting the cigarette down. As clinicians we must remain committed to this goal of prevention by providing patients other treatment options, as well as reinforcing and supporting patients to begin the smoking cessation process again (Maciosek MV, 2006).
Clinicians can make a large impact on the health and quality of life of many individual patients, as well as having an enormous health impact for our country, if we take the time to talk about quitting. “100,000 clinicians using effective intervention strategies could potentially assist more than 3 million smokers to quit each year” (Woolf S, 2008). Cigarette smoking is one of the largest health concerns of our time and it will continue to be until more people find reason to quit. Clinicians must remain steadfast in their attempts to help patients quit because even one patient who puts the pack of cigarettes down is a success.
Bibliography
CDC. (2009, June 1). Retrieved June 16, 2009, from Tobacco/Smoking: http://www.cdc.gov/nceh/dls/tobacco.htm
Kenford SL, F. M. (1993). Predicting smoking cessation: who will quit with and without the nicotine patch. JAMA , 589-594.
Maciosek MV, C. A. (2006). Priorities for improving utilization of clinical preventative serveices results. Am J Prev Med , 52-61.
McGinnis JM, F. W. (1993). Actual causes of death in the United States. JAMA , 2207-2212.
Service, U. P. (2009, January 15). Treating tobacco use and dependence- provider’s packet. A how-to-guide for implementing the public health service clinicial practice guidelines. Retrieved June 16, 2009, from Surgeon General: http://www.surgeongeneral.gov/tobacco/clinpack.html
Smoking and Tobacco Use. (2009, May 20). Retrieved June 16, 2009, from http://www.cdc.gov/tobacco/
Woolf S, J. S.-L. (2008). Health Promotion and Disease Prevention in Clinical Practice. Philadelphia: Lippincott Williams and Wilkins.