Smoking Cessation: The Importance of Pharmacist Interventions To Successful Outcomes
Glen E. Farr, PharmD*
*Professor of Clinical Pharmacy, Associate Dean for Continuing Education, University of Tennessee College of Pharmacy, Knoxville, Tennessee.
Address correspondence to: Glen E. Farr, PharmD, Professor of Clinical Pharmacy, Associate Dean for Continuing Education, University of Tennessee College of Pharmacy, Suite 213, Conference Center Building, 600 Henley Street, Knoxville, TN 37996. E-mail: firstname.lastname@example.org.
Among preventable diseases, smoking is the leading cause of morbidity and mortality. It is responsible for approximately 1 in 5 deaths each year.1 Despite this fact, in 2005, approximately 20% of the US adult population continued to smoke.2 The decline in smoking has leveled off and the number of smokers now remains relatively constant. Among adolescent smokers, declines in smoking prevalence appear to have plateaued, with the prevalence among high school students (23%) remaining stable from 2003 to 2005.3 More than 40% of current cigarette smokers had stopped smoking for at least 1 day in the previous year. The Healthy People 2010 goals to reduce smoking to 16% or less among adolescents and 12% or less among adults will most likely be missed unless there is a significant push from the private and public sectors to help individuals successfully achieve smoking cessation.
The US Food and Drug Administration (FDA) has battled the tobacco industry and attempted to impose regulations. However, regulation of the tobacco industry has met with significant opposition. Recognizing the addictive nature of nicotine and the well-described impact of smoking on morbidity and mortality, David Kessler, MD, former head of the US FDA, began investigating the possibility of regulating nicotine as a drug, despite opposition from the tobacco industry. In his book, A Question of Intent: A Great American Battle with a Deadly Industry, he outlines his battle to improve tobacco regulation, including recognition of nicotine as a drug. Although he faced stiff opposition because of the economic impact of tighter control on the tobacco industry, he wrote, "product that kills people–when used as intendedÑis different. No one should be allowed to make a profit from that."4 Although strong regulation of the tobacco industry has not come to fruition, the efforts of the US FDA spurred tobacco industry executives to admit that nicotine is addictive.
Because of Herculean efforts, such as those spearheaded by Dr Kessler, acceptance of tobacco has declined and the atmosphere continues to change. Employers are recognizing the economic benefits of a smoke-free workplace and an increasing number of cities are enforcing smoke-free zones. Still, much work remains to lessen the negative impact of tobacco on the health of individuals and the economic burden of tobacco-related disease.
Healthcare providers, including pharmacists, are needed more than ever to take a proactive role in assisting smoking-cessation efforts. Pharmacotherapy, counseling, and behavioral therapy help to promote cessation and should become a part of the standard of care. Patients are insufficiently counseled and educated about the need for lifestyle changes that can help overcome the challenges associated with nicotine addiction.5
For many chronic diseases, the pharmacist is in an opportune position to impact positive health behaviors. This is also true for smoking cessation. However, few pharmacists feel ready to fully embrace this role; few pharmacists actually participate in smoking cessation activities.6 In a recent survey, only 8% of pharmacists reported that they had received formal training for tobacco counseling, but almost all respondents indicated that improving their knowledge about smoking-cessation counseling would increase their willingness to participate and the quality of the interaction.7 Ideally, pharmacists should assess patients and their readiness to quit, provide education about behavioral modification and available pharmacotherapies, and follow up with patients to support their efforts to quit smoking.8
With a goal of increasing pharmacists' smoking-cessation involvement, this issue of University of Tennessee Advanced Studies in Pharmacy provides pharmacists with the most up-to-date strategies to help smokers quit through behavioral modification and other interventional strategies. Charles Vega, MD, reviews the physiologic properties of nicotine that contribute to difficulties with smoking cessation. The health effects of smoking are discussed, in addition to the health effects of inadvertent exposure to nicotine through secondhand smoke. Smoking cessation is associated with numerous health benefits, many of which do not require the passage of years to be realized.
A review of pharmacologic agents that can assist with smoking cessation is provided by Melody Ryan, PharmD, MPH, including information about the first new pharmacologic agent in more than a decade that is approved for smoking cessation. General quit rates, contraindications, and adverse effects of each class are discussed. Additionally, the role of the pharmacist is emphasized in a smoking-cessation algorithm.
Jill M. Williams, MD, provides insight into nonpharmacologic strategies for the facilitation of smoking cessation and motivating an individual to quit. In her article, Dr Williams explores the different types of nonpharmacologic interventions available.
There is a great need for reinitiating the downward trend in tobacco usage in the United States. Pharmacists are ideally suited to be instrumental in bringing about this change. Tools are available to assist pharmacists, but they must be aware of them and knowledgeable about how to use these strategies for successful outcomes.
1. Centers for Disease Control and Prevention. Adult cigarette smoking in the United States: current estimates. Available at: http://www.cdc.gov/tobacco/data_statistics/Factsheets/adult_cig_smoking.htm. Accessed May 1, 2007.
2. Centers for Disease Control and Prevention. Tobacco use among adults–United States, 2005. MMWR Morb Mortal Wkly Rep. 2006;55:1145-1148.
3. Centers for Disease Control and Prevention. Cigarette use among high school students–United States, 1991-2005. MMWR Morb Mortal Wkly Rep. 2006;55:724-726.
4. Kessler D. A Question of Intent: A Great American Battle with a Deadly Industry. New York, NY: PublicAffairs; 2001.
5. Heaton P, Frede S. Patients' need for more counseling on diet, exercise, and smoking cessation: results from the National Ambulatory Medical Care Survey. J Am Pharm Assoc. 2006;46:364-369.
6. Ashley M, Brewster J, Victor J. Pharmacists' smoking cessation practices: relationship to their knowledge and skills, attitudes and perceptions of roles. J Am Pharm Assoc. 2006;46:727-737.
7. Hudmon K, Prokhorov A, Corelli R. Tobacco cessation counseling: pharmacists' opinions and practices. Patient Educ Couns. 2006;61:152-160.
8. Small R, James C. Smoking cessation: pharmacists helping patients kick the habit. J Am Pharm Assoc. 2003;43:S26-S27.