Smoking cessation

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Abstract

Smoking is a risk factor for the four leading causes of death in the United States, yet 48 million Americans—24% of the U.S. adult population—continue to smoke. Approximately 70% of people who smoke visit a physician each year, yet only half report ever being advised to quit smoking by their physician. Smoking cessation is difficult due to nicotine addiction and withdrawal symptoms. Expert groups such as the National Cancer Institute and the Agency for Health Care Policy and Research offer protocols for smoking cessation that primary care physicians can use in their office practice. Recent developments in the pharmacotherapy of smoking cessation has led the U.S. Public Health Service to update the practice guidelines for treating tobacco use and dependence. Pharmacotherapy, which includes nicotine replacement therapy, offers assistance to patients who want to stop smoking. However, the cost of pharmacotherapy may be a barrier for some. Other nonpharmacologic therapies, such as counseling, are also effective.

Section snippets

Benefits of smoking cessation

In a prospective study of 7178 people aged 65 years or older, total mortality among those who smoked was twice that of those who had never smoked (20), whereas subjects who smoked previously had cardiovascular mortality rates similar to those who had never smoked. The risk of developing coronary artery disease can be reduced by half after 1 year of smoking cessation, and after 2 years the risk equals that of people who never smoked (21). Another study found that among men who had quit smoking,

Counseling

A MEDLINE search was performed to find articles that addressed the efficacy of counseling in smoking cessation. Key words used included smoking, cessation, and counseling in combination. Articles published since 1990 were considered for review. Articles were selected based on the presence of statistical data addressing the efficacy of counseling intervention in smoking cessation.

Physician communication about the benefits of smoking cessation and encouragement to quit has proven to be

Pharmacologic methods of smoking cessation

Types of nicotine replacement therapy include nicotine polacrilex gum, the transdermal patch, the nicotine nasal spray, and the nicotine inhaler 31, 35, 36, 37 (Table 2). The U.S. Public Health Service recommends that all persons who are trying to quit smoking should receive pharmacotherapy for smoking cessation 14, 15. However, special consideration should be given before using pharmacotherapy in certain patients, including those with medical contraindications, who are pregnant or breast

Cost of pharmacotherapy

A survey of 25 insurance plans found that only 7 (28%) covered some form of treatment for smoking cessation (57). The average cost for each person who stopped smoking successfully ranged from $797 for patients with standard coverage, which covered 50% of behavioral services and all of the costs of nicotine replacement therapy, to $1171 for patients with full coverage (58).

The estimated numbers of people who smoke who need to be treated per person who quits successfully varies from 6 to 20 for

Conclusion

Smoking prevalence in the United States has decreased since the 1960s, probably because of the recognition that smoking is a major modifiable risk factor for the leading causes of death. However, nearly one fourth of men and women in the United States continues to smoke. Recent advances in pharmacotherapy offer help for patients who are attempting to quit smoking.

References (60)

  • Smoking-attributable mortality and years of potential life lost—United States, 1988

    MMWR Morb Mortal Wkly Rep

    (1991)
  • M.K McGinnis et al.

    Actual causes of death in the United States

    JAMA

    (1993)

  • Achievements in public health, 1900–1999: tobacco use—United States, 1900–1999

    MMWR Morb Mortal Wkly Rep

    (1999)

  • Cigarette smoking among adults—United States, 1998

    MMWR Morb Mortal Wkly Rep

    (2000)
  • R Doll et al.

    Mortality in relation to smoking20 years’ observation of male British doctors

    BMJ

    (1976)
  • N.L Benowitz et al.

    Establishing a nicotine threshold for addiction. The implications for tobacco regulation

    N Engl J Med

    (1994)

  • Diagnostic and Statistical Manual of Mental Disorders

  • T.F Heatherton et al.

    The Fagerstrom Test for Nicotine Dependencea revision of the Fagerstrom Tolerance Questionnaire

    Br J Addict

    (1991)
  • J.F Etter et al.

    Validity of the Fagerstrom test for nicotine dependence and of the heaviness of smoking index among relatively light smokers

    Addiction

    (1999)
  • M Manley et al.

    Clinical interventions in tobacco controla National Cancer Institute training program for physicians

    JAMA

    (1991)

  • The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline

    JAMA

    (1996)

  • A clinical practice guideline for treating tobacco use and dependencea US Public Health Service Report

    JAMA

    (2000)
  • M.C Fiore

    US Public Health Service clinical practice guidelinetreating tobacco use and dependence

    Respir Care

    (2000)
  • M.C Fiore

    The new vital signassessing and documenting smoking status

    JAMA

    (1991)
  • M.C Fiore et al.

    Cigarette smokingthe clinician’s role in cessation, prevention, and public health

    Dis Mon

    (1990)
  • Frank, E., Winkleby, M.A., Altman, D.G., et al. Predictors of physician’s smoking cessation advice. JAMA...
  • A.Z LaCroix et al.

    Smoking and mortality among older men and women in three communities

    N Engl J Med

    (1991)
  • L Rosenberg et al.

    The risk of myocardial infarction after quitting smoking in men under 55 years of age

    N Engl J Med

    (1985)
  • I Kawachi et al.

    Smoking cessation in relation to total mortality rates in women. A prospective cohort study

    Ann Intern Med

    (1993)
  • C Fletcher et al.

    The natural history of chronic airflow obstruction

    BMJ

    (1977)

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