What is the primary care physician's approach (from a public health standpoint) to patients who smoke - Essay Example

If current trends continue, another 25 million Americans will be killed by cigarette smoking, including 5 million children. Tobacco use continues to cause a substantial public health burden. Unless and until a nicotine reduction strategy is successfully implemented, however, the central aim for tobacco policy must continue to be reducing the number of tobacco users through a two-pronged strategy of reducing initiation and facilitating cessation (CDC, 2004a). In the 1980s, clinical strategies for reducing tobacco gained momentum with the increased understanding of the addictive nature of nicotine.

In 1984, the Food and Drug Administration (FDA) began to approve medications to help smokers quit. In the 1990s, strategies were developed to reach smokers with intensive counseling services and clinical practice guidelines outlined the strong evidence base for effective clinical interventions. However, despite the implementation of effective clinical strategies, the treatment of tobacco dependence is not fully integrated into routine clinical care, and effective treatments are neither widely available to all smokers nor covered under private and public insurance (CDC, 2004).

Virtually everywhere, people use tobacco; not all of them die from it. The pandemic seems selective and whimsical. Some smokers consume a pack a day until they die of an unrelated cause in their 90s. Other smokers die unexpectedly of cardiovascular disease in their 30s. Then again, so do some nonsmokers. Scientists can predict that tobacco-related disease will strike a certain proportion of users, although they cannot predict precisely who those users will be. A 1964 report of the U.S. Surgeon General did not apply the word addiction to tobacco use because scientific evidence was incomplete.

It did, however, indicate that nicotine was the primary reinforcing pharmacologic agent in tobacco that led to continued use. Smoking was