Smoking Cessation Programs Smoking Cessation

Smoking Cessation Programs

Smoking Cessation

Evaluation of Smoking Cessation Programs

Smoking is a national health epidemic that claims the lives of many individuals annually. This is particularly alarming due to the preventable nature of smoking related illnesses. Smoking is associated with many pulmonary diseases, cardiovascular issues, as well as cancers. Individuals who smoke throughout their life decrease their life expectancy by 10 years (Quist-Paulsen, 2008). While many individuals who smoke have expressed the desire to quit, only five percent who attempt to stop without a formal intervention are successful (Smith, 2009). Smoking cessation programs take many forms from informal advice giving to formal interventions such as pharmacology and behavioral support programs. Research indicates that the most successful interventions combine both pharmacology and psychological interventions to address both the physical and mental aspects of addiction and withdrawal.

Evaluation of Smoking Cessation Methods

Smoking is a national health hazard that claims a life every six seconds (World Health Organization, 2009). Smoking related diseases are one of the leading causes of death in the world claiming over 5 million lives annually (World Health Organization, 2009). Yet it is a preventable disease, one in which morbidity and mortality do not need to be the outcome (Huang, 2004). Tobacco products cause harm to many bodily systems leading to disease and potential fatality. This public health epidemic has led to many respiratory problems such as Chronic Obstructive Pulmonary Disease (COPD), asthma, and lung cancer (Raherison et al., 2005; van der Vaart, 2005). A person who smokes continually throughout their lifespan shortens their life expectancy by approximately 10 years and it has been estimated that each cigarette smoked reduces life expectancy by 11 minutes (Quist-Paulsen, 2008).

Pulmonary and cardiovascular diseases are among the most common smoking related illnesses resulting in 50% and 35% of smoking related deaths annually (Quist-Paulsen, 2008). An additional one third of smoking related deaths are the result of cancer, primarily lung cancer (Quist-Paulsen, 2008). In fact, smoking is responsible for 30% of all cancer related deaths. Approximately two-thirds of smokers who smoke continually throughout their life die of smoking related illnesses. Current smokers are also two to four times more likely to develop coronary artery disease than their non-smoking counterparts (van der Vaart, 2005).

While smoking impacts all populations equally it is reported that 90% of smoking initiation occurs during adolescence and further that those adolescents who smoke at least monthly continue to smoke into adulthood (De Leeuw, Scholte, Sargent, & Engels, 2010). Tobacco consumption is increasing in young women throughout the world and it is believed that at this rate, women who smoke may triple throughout the current generation (WHO, 2009). Further, persons of low socioeconomic standing are also believed to at increased risk to begin smoking and to struggle with the rising financial burden that this addiction takes on poor households (Kenzdor et al., 2010).

Tobacco products include an addictive constituent known as nicotine. Nicotine from a cigarette is able to reach the brain in ten seconds where it binds to nicotinic acetylecholine receptors creating a release of neurotransmitters and hormones such as dopamine, norepinephrine, and serotonin (Carrozzi, Pistelli & Viegi, 2008). These substances are responsible for the pleasant effects experienced in smoking such as increased pleasure, improved mood, increased attention, and weight loss (Carrozzi, Pistelli, & Viegel, 2008). Chronic exposure to nicotine increases expression of nicotine receptors in the brain and lead to a tolerance of nicotine's physiological effects which causes increased dependence and withdrawal symptoms at cessation (Wang et al., 2009; Carrozzi, Pistelli & Viegi, 2008). These withdrawal symptoms include irritability, restlessness, anger, trouble concentrating, depressed mood, insomnia, decreased heart rate, increased appetite and weight gain (Carrozzi, Pistelli & Viegel, 2008). Nicotine dependence is the result of not only the desire to experience the pleasant effects of the nicotine on the body but also due to the desire to avoid withdrawal symptoms (Carrozzi, Pistelli & Viegel, 2008). Therefore regular smoking maintains a level of nicotine in the body that allows for normal functioning.

Yet tobacco users who have smoked for a significant period of time have been found to have a strong desire to stop. The majority of smokers over the age of 30 express a desire to quit whereas their younger counterparts often do not see the potential negative outcomes (Smith, 1999). Studies have found that as smokers age they recognize the increasing medical risk associated with smoking. Many tobacco users decide to quit for health and financial reasons. Success rates for persons who quit smoking are poor without formal cessation interventions with only 5% of all persons who quit smoking "cold turkey" maintaining abstinence (Smith, 2009).

Smoking is a health epidemic that has been shown to create a substantial health burden and expense. Health care expenditures as well as lost productivity from smoking and smoking related illnesses total more than 193 million dollars annually (Smith, 2009). Smoking cessation programs have been proven to be much more cost effective than the medical care interventions that are associated with smoking related illnesses (Barnett, Wong & Hall, 2009). Despite the costs associated with treatment which can range from $500.00 to $7,500.00 the cost effectiveness of this program is estimated to be between $5,000.00 to $12,000.00 per person that quits (Barnett, Wong & Hall, 2009). Therefore it is believed that the expenses saved from medical bills as well as the increased life expectancy of individuals who stop smoking are far less expensive than continued tobacco use.

There is evidence to suggest that many of the health risks and respiratory symptoms experienced as the result of smoking can be reversed if smoking cessation is achieved (Caponetta & Polosa, 2008). Health care practitioners should educate their patients on the dangers of smoking, the preventable nature of smoking-related diseases, and the benefits of quitting (O'Donovan, 2009). In fact, physicians are required to ask all patients about any smoking behaviors and should encourage smoking cessation in all persons who report smoking (Thy, Boker, Gallefoss, & Bakke, 2007). However, many physicians are dissuaded by the lack of effectiveness of smoking cessation programs and the time consuming process of evaluating for smoking behaviors and therefore do not follow through with this intervention (Caponetta & Polosa, 2008; O'Donovan, 2009). This skepticism that can be observed in physicians and health care practitioners can get in the way of the efficacy of smoking cessation programs. Therefore, the health care industry may need to refocus the understanding of smoking cessation to include knowledge regarding the natural process of smoking cessation (O'Donovan, 2009). Health care practitioners must include in their expectations the fact that most smokers experience at least one relapse during their treatment process and support during this time will ensure that cessation can be once again obtained (O'Donovan, 2009). In many cases it may take multiple attempts before an individual is able to maintain their abstinence and interventions that are flexible in order to meet these needs are the most successful.

Yet many smokers are also disappointed in their lack of response to smoking cessation efforts and failure to achieve long-term results (Polosa et al., 2009). In the United States more than 70% of adults who smoke have attempted to stop at least once during their lifetime with 41% of adults attempting to quit in the last year (Polosa et al., 2009). However, only 7% of all smokers who try to quit on their own achieve success, indicating that interventions are necessary to aid in goal attainment. Health care practitioners, including respiratory therapists must implement a multifaceted approach due to the complexity of tobacco dependence (Polosa et al., 2009). Presently, there are numerous types of smoking cessation programs currently in existence ranging from informal advice giving, psychological interventions and support programs, as well as pharmacological and behavioral interventions.

Huang (2005) reports that smoking cessation programs that are able to integrate psychological and physiological interventions are the most likely to obtain long-term cessation in participants. One must gain insight into the various individual and socio-environmental factors that lead up to engagement in smoking behaviors in order to successfully achieve abstinence. This will allow for the identification of individual characteristics that may lead to success in a smoking cessation program (Caponetta & Polosa, 2008). Studies have found that the combination of counseling based interventions and pharmacological interventions can achieve greater results than either intervention alone (Huang, 2005; Rovina et al., 2009).

Pharmacological interventions such as nicotine replacement therapy (NRT) have become increasingly popular in smoking cessation programs and have been proven to increase the likelihood of success (Apelber, Onicescu, Avila-Tang & Samet, 2010; Hudmon, Corelli & Prokhorov, 2010). NRT has become widespread in the United States with interventions such as the nicotine patch, gum, lozenge readily available at the local pharmacy (McIvor et al., 2009). Other pharmacological interventions including varenicline and sustained-release bupropion hydrochloride are also common in smoking cessation. The cost of these interventions appears to be relatively small with the average smoker ranging from $250 to $2,330 (Salize et al., 2009). The cost effectiveness of these interventions is quite high despite the moderate quit rates that they produce. In fact these moderate quit rates are substantially higher than health care interventions (Salize et al., 2009; Wang et al., 2009).

Psychological interventions such as support groups, counseling sessions, and guided quit plans have been proven most effective when coupled with pharmacological interventions (Huang, 2005). Cessation programs need to be interactive and engage the participant in the treatment process as well as identifying individual characteristics that have led to the smoking behavior and tailoring interventions to meet these needs (Rovina et al., 2009). Those programs that emphasized lectures, consultations, and group discussions were found to have a 40% quit rate with the majority of participants failing to reduce their daily cigarette consumption (Huang, 2005). Smoking cessation programs also exist in the workplace and focus on self-efficacy and social support achieved a 19% participant quit rate (Huang, 2005). Programs that utilized pharmacological interventions alone such as the transdermal nicotine patch have achieved smoking cessation rates of 30% at the one year marker (Huang, 2005).