Smoking cessation interventions

Effective and timely administration of smoking ces-
sation interventions can significantly reduce the risk
of smoking-related disease [110]. Recognizing the
complexity of tobacco use is a necessary first step
in developing effective interventions and trials for
cessation and prevention. The biobehavioral model
of nicotine addiction and tobacco-related cancers
presents the complex interplay of social, psycho-
logical, and biological factors that influence tobacco
use and addiction (Figure 1.1). These factors in turn
mediate dependence, cessation, and relapse in most
individuals, and treatment has been developed to
addressmany of the factors noted in themodel [38].
The health care provider’s role
and responsibility
Health care providers are uniquely positioned to
assist patients with quitting, having both access to
quitting aids and commanding a level of respect that
renders themparticularly influential in advising pa-
tients on health-related issues. To date, physicians
have received the greatest attention in the scien-
tific community as providers of tobacco cessation
treatment. Although less attention has been paid to
other health care providers such as pharmacists and
nurses, they too are in a unique position to serve
the public and situated to initiate behavior change
among patients or complement the efforts of other
providers [64,111].
Fiore and associates conducted a meta-analysis
of 29 investigations in which they estimated that
compared with smokers who do not receive an in-
tervention from a clinician, patients who receive
a tobacco cessation intervention from a physician
clinician or a nonphysician clinician are 2.2 and
1.7 times as likely to quit smoking at 5 or more
months postcessation, respectively [112]. Although
brief advice from a clinician has been shown to
lead to increased likelihood of quitting, more in-
tensive counseling leads to more dramatic increases
in quit rates [112]. Because the use of pharma-
cotherapy agents approximately doubles the odds
of quitting [7,112], smoking cessation interventions
should consider combining pharmacotherapy with
behavioral counseling.
To assist clinicians and other health care providers
in providing cessation treatment, the US Public
Health Service has produced a Clinical Practice Guide-
line for the Treatment of Tobacco Use and Dependence
[112]. The Guideline is based on a systematic re-
viewand analysis of scientific literaturewhich yields
a series of recommendations and strategies to as-
sist health care providers in delivering smoking
cessation treatment. The Guideline emphasizes the
importance of systematic identification of tobacco
users by health care workers and offering at least
brief treatment interventions to every patient who
uses tobacco. Among the most effective approaches
for quitting are behavioral counseling and pharma-
cotherapy, used alone or, preferably, in combination
[112].