Health Promotion Research: Smoking Cessation. Paula Sawyer

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1 Running Header: Smoking Cessation Health Promotion Research: Smoking Cessation Paula Sawyer

2 Smoking Cessation 2 Abstract A review of the negative effects of smoking is provided, as well as brief description of some of the medications and therapies available for treatment. How nurses can aid patients in their efforts to quit, and current legislation in Michigan is also discussed.

3 Smoking Cessation 3 Smoking Cessation As Nursing has continued to develop it has become our mission not only to help heal the sick, but also to promote health and well being in our patients and the communities we serve. We encourage and teach healthy habits, and likewise try to discourage unhealthy vices. In the United States, annually, smoking results in 440,000 deaths and $193 billion in healthcare costs and lost productivity (CDC, p.1, 2009). Despite these numbers 46 million adults continue to smoke, and each day tobacco companies gain another 1,000 smokers in young people (CDC, 2009). Rice and Stead specifically reviewed advice given by nurses and found this to highly effective in promoting smoking cessation when compared with no intervention. Nurse initiated advice should be considered a front line therapy (JBI, p.1,01 The call to arms has been made, and it is up to nurse s to use their skills in the fight to improve the well being of our patients and communities. Why the Concern With all the studies that have been done on the effects of smoking, we can no longer claim ignorance like our grandparents. According to the 2004 Surgeon General s report on the health consequences of smoking, smoking harms almost every organ of the body (Hudmon and Corelli, p.293, 09). Smoking Smoking has been linked to multiple health problems. Cancers such as: Acute myeloid leukemia, bladder, cervical, esophageal, gastric, kidney, laryngeal, lung, oral cavity, pharyngeal, and pancreatic (Hudmon and Corelli, 09). It also has been associated with

4 Smoking Cessation 4 cardiovascular diseases such: abdominal aortic aneurysm, coronary heart disease, cerebrovascular disease, and peripheral arterial disease (Hudmon and Corelli, 09). It can lead to both acute and chronic pulmonary diseases such as: laryngitis, pharyngitis, bronchitis, pneumonia, chronic obstructive pulmonary disease, and poor asthma control (Hudmon and Corelli, 09). On average men and women lose 13.2 and 14.5 years of life because of smoking (Hudmon and Corelli, p. 293, 09). Nicotine Nicotine is the drug in cigarettes that causes addiction. It increases the release of a brain chemical called dopamine, which results in feeling good (). The immediate effects of nicotine include: increased blood pressure, increased heart rate, thickening of the blood, narrowing of arteries, decrease in skin temperature, increase in respirations, stimulation of the central nervous system, vomiting, and diarrhea(). Some of the long term effects of nicotine include: high blood pressure, blockage of blood vessels, depletion of vitamin C, and reduction in the effectiveness of the immune system, weight loss, dry skin, bronchitis, emphysema, and stomach ulcers. Like any other addiction there are symptoms of withdrawal: drop in pulse rate, drop in blood pressure, disturbance of sleep, slower reactions, tension, restlessness, depression, irritability, constipation, difficulty in concentration, and cravings. Most withdrawal symptoms generally manifest within hours after quitting and gradually dissipate over two to four weeks; however, strong cravings for tobacco can persist for months or even years (Hudmon and Corelli, 293, 09). Second Hand

5 Smoking Cessation 5 Smoking does not just affect the smoker, but also has an impact on the health of adults and children who surround them. Every year an estimated 50,000 deaths are the result of exposure to second hand smoke (Hudmon and Corelli, 09). Early Cessation Healthy People 2010 has (U.S. Department of Health and Human Services, 2000) has identified the reduction of adolescent smoking as a public health goal (Fritz, Wider, Harden, and, Harrick s, p.21, 08). Twenty-three percent of high school students report using cigarettes, and fourteen percent report smoking cigars (Fritz et al, 08). The younger a person is when they start smoking the more addicted they become has been suggested by research (Fritz et al, 08). That is why it is so important to start interventions while they are young. Research has suggested that adolescent quit rates are highest when tobacco cessation programs are school based, and yet these programs are only required in ten percent of states nationally (Fritz et al, p.21, 08). Research has shown the need for more education at this level. Teens still perceive smoking cigarettes as nonaddictive and therefore think quitting is relatively easy (Fritz et al, 08). Increasing education and offering more cessation programs in schools is a direct and effective root for us to reach potential and young smokers before the tobacco industry has them hooked. School nurses can be a key component in this as nurses are perceived by adolescents as being knowledgeable and non-judgmental making them a valuable resource (Fritz et al 08).

6 Smoking Cessation 6 Quitting Methods NRT Nicotine Replacement Therapy (NRT) has proven to be a very effective method in smoking cessation. NRT is available in a range of methods of administration, including gum, patch, inhalers, intranasal sprays, and sublingual tablets (JBI, p.3, 08). Antidepressant and Opioid antagonist are some other medications used. However opioids had little effect and the antidepressants must be weighed against their potential side effects (JBI, 08). Therapies Both Individual and group therapies have shown some success rate, but work best when used over a long period of time (JBI, 08). Smoking is both an addiction and a habit, and as we know habits take both time to form and time to break. What can we do As Nurses The role of the professional nurse as direct care provider and educator is pivotal in providing clients with the information and support necessary to facilitate smoking cessation and improve client health outcomes (Gerhardt and Stuart, p.1, 09). As nurses assessing a patient s need for further education is just another part of the job. A program called quitworks recommends five steps for healthcare providers to help their patients quit (Massachusetts, 09). The first step is asking about tobacco use each visit (Massachusetts Department of public health, 09). Often times in the hospital this is done as part of the patient s profile on admission. Next is advising them to quit (Massachusetts Department of public health, 09) Taking the time to reinforce what they may know

7 Smoking Cessation 7 already and answer any questions they might have. Keeping in mind the transtheoritcal model our third step is to assess their willingness to quit (Massachusetts Department of public health, 09). The last two steps are assisting them and arranging follow up care because there is a higher success rate with long term support (Massachusetts Department of public health, 09). Making appropriate consults and attaining the order for any pharmacological that may be appropriate is a good way to get them started on their way to quitting. As a Community Though smoking remains legal communities are passing legislation to discourage it. May first of this year Michigan will become the 38 th state to pass a bill prohibiting smoking in public areas state wide (Aber, 09). It will apply to all restaurants, bars and other public places, excluding only tobacco stores and casinos. In order to encourage compliance with the new law after May first businesses and citizens who do not comply will pay a $100 fine the first offense and $500 for each offense after. This is not the first step Grand Rapids has seen towards becoming smoke free (Aber, 09). In May of 2003 the three major hospitals: Spectrum Health, Metro, and Saint Marys, in GR made their campuses smoke free (MMPC, 03). NRTs were offered to patients, staff, and visitors in order to support this effort (MMPC, 03). Because second hand smoke is such a health risk protecting non-smokers and encouraging smokers to quit. It is a delicate balance for legislation to support the rights of those who chose not to smoke without infringing upon the rights of those who do.

8 Smoking Cessation 8 Conclusion Smoking continues to plague the health of our patients and communities. Educating our youth not to start is a step, but we must continue to support those who are already addicted. Unlike other addictions smoking affects the health of those who surround the addict. Policies to protect the health of our communities should continue to be implemented and enforced

9 Smoking Cessation 9 Reference Greater Dallas council on alcohol and drug abuse (gdcada). (06, March). Retrieved March 29, 2010 Fritz, D. J., Wider, L. C., Hardin, S. B., & Horrcks, M. (2008). Program Strategies for Adolescent Smoking Cessation [Electronic version]. The Journal of School Nursing, 24(1), JBI. (2008). Smoking cessation interventions and strategies. Best Practice, 12(8), 1-4. Retrieved from CINAHL database. Aber, Nicole. "Michigan became 38th state to ban smoking." The Michigan daily (2009): 1-2. Web. 29 Mar MMPC. Smoke-free policy takes effect at Grand Rapids hospitals. N.p., May Web. 29 Mar Gerhardnt, J., & Stuart, T. L. Smoking Cessation Education in the Elderly. RN Journal, 1-3. Retrieved March 29, 2010 Massachusetts Department of Public health. (n.d.). Quitworks. Retrieved March 29, 2010 JBI. (2001). Smoking cessation interventions and strategies. Best Practice, 5(3), 1-6. Retrieved from CINAHL database. CDC. (2000). Strategies for reducing exposure to environmental tobacco smoke, increasing tobacco-use cessation, and reducing initiation in communities and health-care systems. MMWR: Morbidity & Mortality Weekly Report, 49(RR-12), Retrieved from CINAHL database.

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NCDs Risk Factor No. 3 - Smoking. Commonwealth Nurses Federation

NCDs Risk Factor No. 3 - Smoking Commonwealth Nurses Federation Overview Definition of smoking and passive smoking Complications associated with smoking Disease process of smoking Reasons for smoking The