1. Froelicher, Erika Sivarajan MA, MPH, PhD, ES, RN
  2. Kohlman, Virginia Carrieri DNSc, RN

Article Content

Smoking continues to be a major cause of preventable illness, disability, and premature death in this country and has been identified by the World Health Organization as a global epidemic.1-3 Despite progress in reducing the prevalence of tobacco use, in 2000, there were still 46.5 million adults in the United States who were smokers, of whom 26% were men and 21% were women.4


Nurses make a real difference in smoking cessation, helping to increase quitting success rates in hospitals, cardiac and pulmonary rehabilitation programs, and outpatient settings. Nurse-led interventions for smoking cessation increase the chance of successful quitting by 50%. Yet, only 20% to 30% of nurses provide smoking cessation interventions to their patients, a statistic that clearly can be improved. Furthermore, nurses who smoke perceive themselves as not being credible role models as smoking cessation interventionists. Clearly, insufficient attention has been given to the problem of peer support from nonsmoking nursing professionals for those nurses who do smoke and would like to quit.


Nurses have a tremendous opportunity to assist in tobacco-control efforts.5-11 However, smoking among nurses limits their ability to be strong tobacco-control advocates.


A very real barrier to conducting smoking cessation interventions with patients is the nurses themselves who continue to smoke and lack confidence in their ability to support patients in their efforts to stop smoking.12-18 That number, estimated at 18% in the United States, marks the highest percentage of smokers among all health professionals.


A new program called Tobacco Free Nurses, an initiative funded by a grant from the Robert Wood Johnson Foundation, will help nurses nationally and internationally, both in their efforts to support their patients' smoking cessation efforts and to provide support and strategies for the nurse who wants to quit smoking. "Tobacco Free Nurses" is the first program of its kind in the United States that will help nurses to quit smoking and also to serve as one Web site ( for all the resources that nurses need to support their patients in smoking cessation. This initiative combines the efforts of nurse leaders from cardiovascular, pulmonary, and oncology specialties and is aimed at supporting the largest group of health professionals, the national and international community of nurses, to provide support for their patients and their colleagues for quitting smoking.


In the past, there has been no coordinated effort to support nurses in their own cessation efforts or to stress the critical importance of being smoke-free role models.19 Dr Sarna and her colleagues have worked with a variety of nursing organizations and tobacco-control experts to help us develop this nationwide initiative that will provide nurses who smoke with cessation resources.


One of these resources will include $100 of free, individualized smoking-cessation services that will be offered through the Internet for each nurse who chooses to participate. In addition, in partnership with nursing organizations including the American Association of Colleges of Nursing, the American Nurses Foundation, and the National Coalition for Ethnic Minority Nurses, a variety of activities will be developed to support smoking-cessation efforts for the workforce and the public.


In addition to individual nurses who smoke, the nursing profession as a whole has had limited leadership in the tobacco control movement. The "Tobacco Free Nurses" researchers hope to expand nursing leadership in tobacco control through another Robert Wood Johnson Foundation grant funded through its Smoking Cessation Leadership Center at the University of California, San Francisco. Additional work by the authors on smoking in women and smoking among nurses are provided below.


Our patients suffer every day from the symptoms they experience from diseases that result from smoking, including cardiovascular and pulmonary diseases, and a number of cancers. The "Tobacco Free Nurses" initiative provides a new and tremendous opportunity for nurses in every practice setting around the world to assist their patients and especially their own colleagues in their efforts to stop smoking.




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Additional Readings


Froelicher ES, Christopherson DJ, Miller HN, et al. Women's initiative for nonsmoking (WINS) IV: baseline results of 278 women smokers with cardiovascular disease. Heart Lung. 2002; 31(1):3-14.


Mahrer-Imhof R, Froelicher ES, Li W, Parker KM, Benowitz N. Women's Initiative for Nonsmoking (WINS V): under-use of nicotine replacement therapy (NRT). Heart Lung. 2002;31(5):368-373.


Froelicher ES, Li WW, Mahrer-Imhof R, Christopherson D, Stewart AL. Women's Initiative for Non-Smoking (WINS) VI: reliability and validity of health and psychosocial measures in women smokers with cardiovascular disease. Heart Lung. 2004;33(3):162-175.


Froelicher ES, Li W, Sohn M, Max W, Bacchetti P. Women's Initiative for Nonsmoking (WINS) VII: evaluation of health service utilization and costs after hospitalization among women with cardiovascular diseases. J Cardiac Rehabil. 2004;24:218-228.


Froelicher ES, Miller HN, Christopherson DJ, et al. High rates of sustained smoking cessation in women hospitalized with cardiovascular disease: the Women's Initiative for Nonsmoking (WINS). Circulation. 2004;109(5):587-593.


Sohn M, Hartley C, Froelicher ES, Benowitz NL. Tobacco use and dependence. Semin Oncol Nurs. 2003;19(4):250-260.


Hutchinson KM, Froelicher ES. Population at risk for tobacco-related disease. Semin Oncol Nurs. 2003;19(4):276-283.


Sarna L, Aguinaga BS, Hutchison KM, Williams BS, Froelicher ES, Wewer ME. Views of African-American nurses about tobacco cessation and prevention. J Natl Black Nurs Assoc. 2003;14(2):1-8.


Aguinaga BS, Sarna L, Wewers ME, Froelicher ES, Danao L. Nurses' perspectives on smoking initiation, addiction, and cessation. Nurs Res. 2004;53(6):387-395.


Sarna L, Bialous AS, Wewers ME, Froelicher ES, Danao L. Nurses, smoking and the workplace. Res Nurs Health. 2005;28:79-90.