Tobacco Cessation in Primary Care: Maximizing Intervention Strategies

Abstract

The most effective preventive intervention that a clinician can provide for tobacco-using patients against heart disease, cancer, cerebrovascular disease and chronic obstructive pulmonary disease is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete smoking cessation. Reduction provides no direct health benefits to the individual smoker. Interventions are readily available, but underutilized, in part due to lack of clinician training and organizational support.The present article summarizes the current guidelines for smoking cessation interventions as a framework from which to start. The guidelines incorporate the Transtheoretical Model of patient behavioral change and the "Five A's": Ask, Advise, Assess, Assist and Arrange. Pharmacotherapeutic tools, including nicotine replacement therapies (nicotine gums, patches, nasal sprays, inhalers and new therapies) and non-nicotine therapies (bupropion, clonidine, nortriptyline and other antidepressants and anxiolytics) are considered. Adherence validation methods, new approaches to tobacco and addiction treatment that appear in the recent research literature are reviewed.Beyond this framework, specific categories of tobacco users (including smokeless tobacco users), cultural and ethnic minorities, adolescents using snuff and bidis, women, Medicaid recipients, and users of multiple forms of tobacco require special consideration.With this framework and the modifications that may be required for specific categories of patients, practicing clinicians can incorporate into daily practice a successful tobacco cessation intervention program with quit rates approaching 20%.

Influência do tabagismo atual na aderência e nas respostas à reabilitação pulmonar em pacientes com DPOC

“…In fact, previous studies considered the inclusion of smokers 11,12,30,31 . The negative and nihilistic psychological profile of many of these patients 29 and its possible influence on adherence to the program and relapse of ex-smokers have been cited as possible deterrents to their inclusion in PR. Young et al 32 , for example, reported that current smoking was associated with non-adherence to the PR.…”

“…Although PR is considered useful for most patients in the moderate to advanced stages of the disease, the availability of such programs is limited, which stimulated the investigation of the most common limiting factors, especially current smoking. In this context, it should be recognized that smokers with lung or heart disease known to be associated with smoking and who continue to smoke have lower adherence to drug treatment than those who quit 28,29 .…”

Cognitive-Behavioral Therapy Methods in Tobacco Addiction

“…Bırakmayı düşünme aşamasında olanlardan %5'i relaps olmadan sürdür-me aşamasında kalırlar. Yeniden başlayanların %15'i düşünmeme, diğer %85'i düşünme ve hazırlık aşama-larına dönüş yapmaktadır (15) .…”

“…Değişim aşamaları ile değişim yöntemleri arasında-ki ilişkiye bakıldığında, değişimin başlangıç dönem-lerinde daha çok bilişsel yöntemler kullanılırken, hazırlık, hareket ve devam ettirme gibi ilerleyen aşamalarında davranışsal yöntemlerin kullanıldığı görülmektedir (15). (17,18) .…”

A group-randomized tobacco trial among 30 Pacific Northwest colleges: Results from the Campus Health Action on Tobacco study

“…These intervention activities were summarized in a handbook that was presented to the CABs at the individual colleges. To ensure some commonalty of activities, an intervention manual was created that divided activities into four major categories: (a) increasing the awareness of the dangers of tobacco smoke (Backinger, Fagan, Matthews, & Grana, 2003), (b) increasing campus awareness and enforcement of restrictive tobacco control policies (Ding, 2005), (c) increasing awareness and availability of tobacco cessation resources (Abdullah, Lam, Chan, & Hedley, 2004;Anczak & Nogler, 2003;Mermelstein & Turner, 2006), and (d) increasing awareness of the special strategies employed by the tobacco industry to target special populations, such as minorities and students living in Greek housing (Hammond et al, 2005). As noted above, the intervention activities were selected based on previous studies that had shown effective cessation/prevention activities among adolescents and young adults.…”