The time is always right to address smoking cessation. On average, smokers die 13 to 14 years earlier than nonsmokers. Every year in the United States, one in five people die of smoking-related causes. Approximately 49,000 of these are the result of secondhand smoke exposure.1 A newer concern is exposure to thirdhand smoke, or the residual pollutants found on surfaces, in dust, and in the air. Research is needed to define risk and potential harmful effects of this type of exposure, especially for infants.
The Office of the U.S. Surgeon General has issued 34 reports on smoking. The first report, Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service was released in 1964 and changed the American public's beliefs about the correlation between cigarette smoking and lung cancer.2 Prior to this report, a Gallup poll taken in 1958 revealed that 44% of Americans believed smoking caused cancer. By 1968, that number had increased to 78%.3
Years later, Healthy People (HP) 2010 did not achieve its goal of reducing the percentage of smokers over the age of 18 to 12%, so the target remains the same for HP2020. The overall objective is to, "reduce illness, disability, and death related to tobacco use and secondhand smoke exposure."4
Prevention efforts
The latest report, Preventing Tobacco Use Among Youth and Young Adults5 was released in March 2012. According to the CDC, every day in the United States approximately 3,800 youth under the age of 18 pick up a cigarette, and 1,000 become daily smokers. This statistic represents 19.5% of high school students and 5.2% of middle school students. Of adult cigarette smokers who smoke daily, 88% admit starting before the age of 18 and 99% by age 26. High school students also smoke cigars (14%) and use smokeless tobacco (8.9%).6 The most successful antismoking strategies with this population have been directed toward preventing the initiation of smoking.
As of April 1, 2012, 35 states, the District of Columbia, and several other U.S. territories had enacted laws prohibiting smoking in public places. Beginning on September 22, 2012, new health warnings will be required on cigarette packages and advertisements. By October 22, 2012, cigarettes without the new health warnings will no longer be distributed for sale in the United States.7 These actions represent progress, but healthcare providers still play a major role in helping individuals quit smoking.
How to help patients quit
Many resources are available to professionals and patients to assist in smoking cessation efforts, and can be found at http://www.smokefree.gov/. Treating Tobacco Use and Dependence: 2008 Update: Clinical Practice Guideline8 presents the latest evidence on the effectiveness of different strategies for smoking cessation, including clinical interventions, counseling and behavioral therapy, pharmacologic interventions, complementary therapies, and more.
A good rule of thumb is to follow the five A's-Ask, Advise, Assess, Assist, and Arrange. Ask every patient at every visit about smoking because behaviors change. The first step toward successfully meeting the HP2020 goal is to identify individuals who currently smoke and determine their readiness to quit. And then follow through.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
Editor-in-Chief
[email protected]
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