Tobacco Cessation
Goal:

To improve the learners' understanding of basic behavioral tobacco interventions for patients and the process of change in tobacco cessation.

: 1.25 hrs

After completing this activity participants will be able to:

  • Use the 5 steps of smoking cessation intervention (the 5 A's)

  • Use knowledge of the prevalence of tobacco use and tobacco-associated mortality to guide treatment of patients

  • Use knowledge of tobacco initiation, tobacco dependence, interest in quitting, and racial/ethnic differences to guide treatment of patients

  • Use knowledge of the smoking cessation cycle to tailor behavioral tobacco interventions to patients in each stage in the cycle

  • Use awareness of typical patterns of smoking relapse to help prevent patients from relapsing to smoking


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) and cause significant morbidity (Surgeon General, 2004).

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, 2004; 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
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Report to congress on the prevention and treatment of co-occurring substance abuse disorders and mental disorders. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf. 2005. Available at: http://www.nasmhpd.org/sites/default/files/CoOccurringIVFinalReportsubmitted.pdf Accessed on: 2007-07-19.
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): .
US Dept of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf Accessed on: 2004-12-17.