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Smoking Cessation: Where to Begin?

image003072018Cigarette smoking contributes to 480,000 deaths annually in the U.S. alone and is the top preventable risk factor for cancers and cardiovascular and respiratory diseases. In fact, "smoking causes more deaths every year than alcohol use, firearm-related incidents, HIV, illegal drug use, and motor vehicle injuries combined, translating to the cause of nearly 1 in 5 deaths."

While the Centers for Disease Control and Prevention reported a 5.4 percent decrease in adults who smoked in 2016 compared to 2005, 38 million Americans still continue to smoke. Below are several methods clinicians can leverage to encourage smoking cessation and help to curb these statistics:

Recognition and the 5 A’s
Providers often use the method of recognition to record a patient’s smoking status, as they would with a vital sign, or use the “ask, advise, refer,” approach. These methods allow providers to ask patients about their tobacco status, encourage them to quit smoking and refer them to evidence-based smoking cessation interventions. Another beneficial approach that providers can leverage is to follow the 5 A’s:

  1. Ask about smoking.
  2. Advise the person to quit through clear, personalized messages.
  3. Assess the willingness to quit.
  4. Assist in quitting.
  5. Arrange follow-up and support.

Effective Behavioral Interventions 
A strong link exists between counseling intensity and smoking cessation rates. According to the Public Health Service Guidelines, more than four in-person group or individual counseling sessions are recommended. However, smoking cessation rates may in fact halt after 90 minutes of total counseling time.

According to the U.S. Preventive Services Task Force, the rate of smoking cessation may increase from 10 percent to 17 percent among individuals using any form of nicotine replacement therapy. For instance, bupropion SR may increase the rate of smoking cessation from 11 percent to 19 percent, while varenicline may increase the rate of smoking cessation from 12 percent to 28 percent.

Behavioral Support with Pharmacotherapy Interventions
Studies support that while pharmacotherapy interventions alone can achieve a smoking cessation rate of 18 percent, combining this intervention with behavioral support may help to increase the rate of smoking cessation to 21 percent.

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