Smoking Cessation (Archived)

Excerpt

Tobacco use, primarily cigarette smoking, is the leading cause of preventable disease and death in the United States. It is well established that smoking increases the risk of different forms of cancer, including lung, liver, and colorectal. Eighty-five percent of lung cancers occur in smokers. Also, smoking increases the risk of respiratory diseases (such as chronic obstructive pulmonary disease) and cardiovascular disease. During pregnancy, smoking increases the rate of complications, including miscarriage, stillbirth, preterm birth, fetal growth restriction, and congenital anomalies. Neonatal and pediatric complications of exposure to cigarette smoking include sudden infant death syndrome and abnormal lung function in children, such as asthma. Despite the magnitude of disease burden related to smoking, 42.1 million adults in the United States smoke cigarettes, according to the National Health Interview Survey data from 2013. This makes quitting smoking one of the most important yet challenging steps a person can take to improve his or her health, and most smokers make several attempts to quit before achieving abstinence from smoking.

Assisting patients with smoking cessation is one of the most important primary care tasks, and the benefits of assessing patients’ smoking behavior are well established. The US Preventive Services Task Force (USPSTF) recommends using the 5 As:

1. Ask about smoking

Office systems should ensure that smoking status is documented at every visit.

1. Advise to quit

Use clear, personalized messages. Even brief advice from a physician can improve quit rates compared with patients who receive no advice.

1. Assess willingness to quit

Patients assessed as not yet willing to quit should receive the motivational intervention.

1. Assist in quitting

Ask patients who are willing to set a quit date.

1. Arrange follow-up and support

There is substantial evidence that behavioral interventions alone or in combination with pharmacotherapy improve the achievement of smoking cessation. Both behavioral interventions and pharmacotherapy are effective and recommended, and combinations of interventions are most effective. The best and most effective interventions are those that are feasible for the individual.