Healthcare Professionals Can Help People Quit Using Tobacco

By Rachell Grounds

The Centers for Disease Control and Prevention (CDC) reports that tobacco use, including cigarette smoking, cigar smoking, and smokeless tobacco use, remains the leading preventable cause of death in the United States. According to the Campaign for Tobacco-Free Kids, each year in North Carolina cigarette smoking results in 12,220 deaths among adults.

It is obvious that tobacco use is a major public health concern for North Carolina and for the entire Nation. With more than 70% of current smokers showing interest in quitting, it is imperative that healthcare professionals know if their patients are tobacco users.

Healthcare providers can play a vital role in assisting users in quitting. When tobacco use status is known by the healthcare professional, it is more likely that the patient will quit using tobacco. Tobacco use is an extremely complicated addiction to break and it may take multiple attempts and repeated interventions to assist those using tobacco.

Health professionals can help reduce the number of tobacco users in North Carolina by implementing the “5A’s” (Ask, Advise, Assess, Assist, Arrange) into every patient’s visit (Fiore et al., 2008). The “5A’s” can be used by all types of clinicians and, in fact, the more coordination among clinicians and staff, the more likely it is that the intervention will be effective.

ASK Patient About Tobacco Use:
Tobacco use information is an important part of the patient’s health. It is vital to know if the patient is a tobacco user to be able to address other health issues related to tobacco use.

Ask Everyone:
Make it a daily routine to ask every patient about tobacco use. Try making the question open-ended like “How often do you use tobacco products?” This helps patients to feel comfortable discussing their use.

Ask Children and Adolescents:
In North Carolina, 10,400 teens will become daily smokers each year, therefore, it is crucial that tobacco use is discussed with children and adolescents. It is important for healthcare providers to communicate to the youth the dangers of tobacco.

Ask Parents:
According to the Surgeon General, there are no safe levels of secondhand smoke. Parents who smoke inside the home or vehicle are harming their children. If parents are not ready to quit, ask them to take it outside. Tobacco use status should be visible on the patient’s chart to healthcare providers and clinic staff. A sticker identifying patient tobacco use is a simple strategy in assisting the clinicians and staff.

ADVISE Tobacco Users to Quit and Non-Smokers to Never Start:
Patients listen to their healthcare providers and want to heed their advice. Even brief advice can increase patient quit rates and long-term abstinence rates. Healthcare provider’s recommendations should be known to the patient and there should be frequent discussions about tobacco.

ASSESS Patient’s Willingness to Quit:
Assess the patient’s interest in quitting by asking:
“Do you want to quit?”
“Do you feel ready to quit?”
“Are you ready to quit?”

Since 70% of smokers say they want to quit, it is necessary to understand how the patient feels about quitting to determine how best to help them. Even though many smokers are not ready to quit, regular discussions about quitting can be helpful.

If a patient is ready to quit, provide them with assistance such as Nicotine Replacement Therapies, local cessation classes, the NC Quitline or refer them to www.BecomeAnEX.com. If the patient clearly states they are not ready to quit, let them know that when they are ready there are resources out there to help them make the change.

ASSIST With Quitting Tobacco
Help the patient prepare to quit by following the acronym STARR (Fiore et al., 2008).
Set a quit date. The quit date should be within the next two weeks.
Tell family, friends, and coworkers about quitting and request understanding and support.
Anticipate challenges with quitting especially during the first few weeks. During the first few weeks there will be nicotine withdrawal symptoms.
Remove all tobacco products from the environment. Change daily work routes or school routes, clean out the car, clean house and throw away all ashtrays.
Recommend the use of approved medications unless advised against it due to health concerns by a healthcare provider.

Medications increase quitting success and help reduce the withdrawal symptoms. FDA-approved medications include: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varencline.

ARRANGE Follow-Up Services
Arrange a follow-up visit with the patient for one to two weeks after the quit date, which is when withdrawal symptoms will be at their worst. After the first follow up, additional visits should be scheduled at the end of the first, second, and third months after quitting since the relapse rates are highest within the first three months. Encourage patients to call the NC Quitline at 1-800-Quit-Now (1-800-784-8669). This telephone resource offers callers free one-on-one support in quitting tobacco. NC Quitline will connect people to an experienced Quit Coach who will help them create a quit plan and help the tobacco user through the plan. NC Quitline is a free, confidential service available 8 a.m. to 3 a.m., seven days a week. The next step in becoming an ex-smoker can be just a simple phone call away.

Reference:
Fiore MC, Jaen, CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guidelines. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.