Smoking cessation - Essay Example

Smoking Cessation Introduction: Cigarette smoking continues to be one of the major causes of avertable morbidity and early mortality. The primary causes of death from smoking are due to cardiovascular diseases, chronic obstructive pulmonary disease (COPD) and lung cancer. Smoking increases the risk of fatal heart diseases, atherosclerosis, stroke, diabetes, hypertension, lung cancer and cancers of mouth, throat, pancreas, kidney, bladder and cervix (Gerhardt and Stuart, 2009). It has also been associated with increased incidence of stroke, peptic ulcers, leukemia, respiratory infections etc (Pignone and Salazar, 2009). Despite the overwhelming health consequences, cigarette smoking rates continue to rise exponentially. According to CDC (2007), approximately 5000,000 people die annually from cigarette smoking. In a population of 45 million adults in U.S. 21% are cigarette smokers (Gerhardt and Stuart, 2009). Major component of cigarette; nicotine is extremely addictive and it increases the level of dopamine in brain creating feelings of satisfaction and contentment. Cessation of smoking causes withdrawal symptoms. Smoking cessation ensures a better health quality of life by reducing the risks of coronary artery disease, stroke and COPD. According to Pignone and Salazar (2009), smoking cessation can increase life expectancy of up to 3 years in women smokers and 2 years in men. In other researches, the life expectancy of a non-smoker is 13-14 years higher than a smoker (Chandler and Rennard, 2010). Studies have confirmed that smoking cessation has inflicts immediate health benefits to the individual. Several interventions are successful in smoking cessation which includes counseling, pharmacotherapy or a combination of both. In this respect, the most important factor is client’s self chosen health goal to quit smoking and both pharmacotherapy and counseling prove to be useful for such patients, however, in patients with unwilling behavior to quit pharmacotherapy is ineffective. Medical counseling approach should emphasize on health and economic benefits of cessation, motivational interviews, patient education on disease risk factors, community/family support and relapse prevention. Pharmacological therapies consist of nicotine replacement therapy which includes nicotine patch, gums, lozenges, nasal sprays, inhalers etc. (Pignone and Salazar, 2009). All of these have shown to be equally effective in smoking cessation. In addition, anti-depressant therapy with drugs such as Bupropion, varenicline and Clonidine have been proven as effective smoking cessation agents. Several studies have suggested that a combination of these pharmacological therapies is quite effective i.e. nicotine gum with nicotine patch etc. (Chandler and Rennard, 2010). Non-pharmacological interventions include practices such as hypnosis, acupuncture, herbal supplement, support groups etc. Several studies have been conducted over the past few decades to relate smoking cessation and health promotion in individuals. Two of these are discussed below. Ellerbeck et al., (2009), studied the varying levels of disease management in randomized trials. The research divided the clients into three treatment groups i.e. pharmacotherapy alone (nicotine replacement and anti-depressant therapy i.e. bupropion), combined pharmacotherapy with moderate intensity disease management and high intensity disease management comprising of counseling and provider feedback on smokers with or without the desire to quit. For pharmacotherapy with moderate intensity disease management, 2 counseling calls were made in every 6 months whereas in high intensity disease management 6 counseling calls were made in 6 months. Results demonstrated that self reported abstinence rates were much better in moderate and high intensity disease management than in pharmacotherapy alone. 23.5% and 27.9% abstinence rates were reported respectively for these groups. This group (37-60% patients) reported to have discussed smoking cessation and its potential benefits with their physicians. Also, free pharmacotherapy was also found to be an incentive for quitting in poor socio-economic groups. This study suggests that in the presence of free pharmacotherapy and management practices, most of the smokers ceased smoking. However, one of the major issues that remain is the identification and reaching out in the form of medical therapy and counseling to the prospective smoking quitters. This study is only limited to self reported data from the smokers for a period of only two years and also the findings rely on nicotine patch and bupropion and do not specify the new emerging pharmacotherapy on the front. A study of health consequences by sustained smoking cessation was conducted by Bjartveit and Tverdal (2009) and was based on determining the health risk in sustained ex-smokers, compared with never smoker and sustained smokers. Research suggested that sustained ex-smokers and never smokers were had no significant differences with respect to health risks while, sustained smokers had higher values for age, blood pressure, total serum cholesterol, body mass index than non-smokers. The research also concentrated specifically on both sexes which were found to have no significant differences. Men and women who resumed smoking after quitting, were found to be at a much higher risk for stroke, ischemic heart diseases and cancers. Nevertheless, the health risks and mortality rate were found to be lower than in sustained smokers. This study indicates that smoking cessation has positive health effects and reduced risk of tobacco related diseases. As this study focuses on sustained smokers, non-smokers, and sustained ex-smokers, it adds new dimension in patient identification and medical counseling of potential quitters. However, this study fails to define the time period for which ex-smokers have refrained from smoking and also it does not cover individuals who are non-daily smokers. The responsibility of a professional nurse as a direct health care provider and educationalist is essential in providing clients with necessary information, education and support to facilitate smoking cessation and in turn improve health quality and disease prevention of clients. Nurses being one of the largest and important heath care providers play a pivotal role in smoking cessation of clients through required education and interventions, therefore, decreasing premature mortality and tobacco related health care costs. For successful interventions, professional nurses should integrate evidence based recommendations for smoking cessation and incorporate them in practical management (Gerhardt and Stuart, 2009). With respect to the above mentioned studies, nursing practices should focus more on employing several techniques such as identification of susceptible clients motivated for smoking, communication techniques to mediate with smokers, awareness of treatment options, counseling and patient education regarding health promotion and disease prevention etc. Also, regular follow ups should be stressed in patients to avoid relapse. Smokers are most likely to quit during acute cases of illness either inpatient or outpatient. The best opportunity therefore, is to educate and aware the clients about the health risks posed by smoking. In this regard, motivational and behavioral interventions are necessary by the health care providers specifically nurses at an individual level. Public health measures may help as well in the form of smoking bans, public education, advertisement restriction, cigarette taxes etc. (Chandler and Rennard, 2010). References: Bjartveit, K. and Tverdal, A. (2009). Health consequences of sustained smoking cessation. Tob Control ;18:197-205 doi:10.1136/tc.2008.026898. Chandler, M. and Rennard, S. (2010). Smoking cessation. doi: 10.1378/chest.09-0124 CHEST. vol. 137 no. 2. pp 428-435. Ellerback, E., Mahnken, J., Cupertino, A., Cox, L., Greiner, K., Mussaulman, L., Nazir, N, Shireman, T., Resnicow, K. and Ahluwalia, J. (2009). Effects of varying levels of disease management on smoking cessation: A randomized trial. Annals of Internal medicine. Vol. 150, no. 7. Pp 437-446. Gerhardt, J. and Stuart, T. (2009). Smoking cessation education in elderly. RN journal of Nursing. www.rnjournal.com. Pignone, M. and Salazar, R. (2009). Disease prevention and health promotion. In McPhee SJ, Papadakis, MA, eds. Current Medical Diagnosis and Treatment. 49th ed McGraw-Hill 2010: pp 1-20. Read More