Tobacco: Five Cases: Basic Tobacco Cessation Interventions
Goal:

To improve the learners' understanding of how to provide basic behavioral and pharmacological tobacco interventions for patients at various stages of quitting.

: 1 hr

After completing this activity participants will be able to:

  • Apply basic behavioral interventions for tobacco cessation

  • Apply basic pharmacological tobacco use interventions

  • Determine a patient's stage of quitting, and use it to choose the appropriate tobacco cessation intervention

  • Determine other characteristics or needs of individual patients who smoke (e.g., concerns about weight gain, amount smoked, history of failed attempts at quitting smoking, etc.), and use the information to choose clinical interventions


Professional Practice Gaps

Tobacco use is still fairly common; in the United States. Approximately 28.4% of persons aged 12 or older used a tobacco product in the last month in a 2008 survey (NSDUH, 2009). Tobacco is estimated to be responsible for 443,000 premature deaths annually (CDCP, 2008).

The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). They found that medication and counseling are more effective for promoting tobacco cessation than no treatment and that intervention effectiveness increases with increased intervention intensity. The Clinical Practice Guideline (Fiore, et al., 2008), also provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use.

Despite the documented need for tobacco cessation and effectiveness of clinical interventions and availability of practice guidelines, many physicians still are not providing evidence-based tobacco interventions. A number of studies have found that screening for tobacco use and recommending cessation occurs as frequently as 75% of the time, other appropriate tobacco interventions are made by primary care physicians less frequently (Schnoll R et al, 2006; Braun et al, 2004; Jaen et al, 2001; Ellerbeck et al, 2001).

Training physicians in evidence-based, brief tobacco interventions in order to assure that all physicians know and are confident to provide tobacco interventions will help address this practice gap.

References
Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000--2004. Morbidity and Mortality Weekly Report (MMWR). 2008; 57(45): 1226–1228. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medicine. 2004; 27(4): 316-322.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, DHHS Publication SMA 09-4434 . 2009. Available at: http://archive.samhsa.gov/data/NSDUH/2k8nsduh/2k8Results.htm Accessed on: 2009-09-10.
Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Smoking. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. 1986.
US Public Health Service. Treating tobacco use and dependence. Office of the Surgeon General Website. 2008. Available at: http://www.ncbi.nlm.nih.gov/books/NBK63952/ Accessed on: 2010-06-15.