Page 819 - Cardiac Nursing

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C HAPTER 3 4 / Smoking Cessation and Relapse Prevention 795
Vulnerable Populations greater number and variety of quitting strategies, including individ-
ual strategies, like reading cessation materials, smoking substitutes,
Vulnerable populations include, but are not limited to, the eco- relaxation techniques, seeking support, hypnosis, and acupuncture
nomically disadvantaged, underinsured or uninsured, migrant than do men. 126 Specific benefits of smoking cessation we have
workers, immigrants, incarcerated, homeless, lesbian, gay, bisexual, found helpful to discuss with women include improved complex-
or transgender populations, ethnic minorities, and infants and ion, fewer wrinkles, no odor of cigarettes on their breath or in their
young children. These populations are vulnerable because of inad- hair or clothes, and better health for children and family members.
equate, inappropriate, or unavailable resources and/or inadequate Given the limited information on characteristics predictive of
knowledge of the numbers and needs of these populations as a re- smoking cessation success in women and the limited number of
sult of inadequate census and research data. 53 In general, smoking women-only smoking cessation studies, the information on how
cessation interventions have, for the most part, been successful in specifically to support the female smoker in quitting is limited.
a variety of different types of populations from blue collar work-
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ers 123 to those enrolled in managed care medical programs ;
therefore, it is in the best interest of the smoker no matter his or Nurses
her age, ethnicity, lifestyle, or occupation to receive a smoking ces- Although nurses know that smoking has a negative impact on
sation intervention that is as individually tailored as possible. With health, especially cardiovascular health, only 20% to 30% of
time and further research, the hope is that current intervention nurses provide smoking cessation interventions to their patients. 6
strategies are found to be effective in these populations or that new One of the barriers to conducting smoking cessation interventions
strategies will be developed and found efficacious. for nurses is the nurses themselves who continue to smoke. 128 The
prevalence of smoking among nurses has been reported at ap-
Women proximately 15% for registered nurses and 28% for licensed voca-
tional nurses. 129 Furthermore, nurses who smoked expressed guilt
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The most recent Surgeon General’s Report, Women and Smoking, about their behavior and the public’s perception, as well as feeling
reiterates the need for smoking cessation efforts targeted directly at a lack of peer and management support regarding smoking cessa-
women because approximately 3 million women in the United tion attempts. 130 A study also showed that nurses who smoke
States have died since 1980 from a smoking-related disease. 124 Of were perceived as taking more breaks and spending less time with
even further concern is that the World Health Organization’s Re- patients than those who do not smoke. 131
port, Women and the Tobacco Epidemic: Challenges for the 21st Cen- A program called Tobacco Free Nurses is an initiative funded by
tury, confirms that the problem is not restricted to the United a grant from the Robert Wood Johnson Foundation. Tobacco Free
y
States. 125 Some researchers have found that women are less likely to Nurses is the first program to help nurses to quit smoking nation-
quit smoking than men are, 46 whereas others have found similar ally and internationally and to support their patients’ smoking ces-
cessation rates. 123,126 It is generally believed, however, that women sation efforts. The program also provides a Web site
respond differently to smoking cessation interventions. Some possi- (http://www.tobaccofreenurses.org) for all the resources that nurses
ble explanations are differences in physiology and behavioral and need to support themselves and their patients in smoking cessation.
psychological factors. For example, the menstrual cycle may play a The Tobacco Free Nurses initiative will provide a new and tremen-
role in smoking cessation. The symptoms of menstrual distress in- dous opportunity for nurses in various clinical settings to assist pa-
clude depression, irritability, anxiety, tension, decreased ability to tients and their own nursing colleagues in smoking cessation.
concentrate, and weight changes, all of which are also symptoms of
nicotine withdrawal. Withdrawal has been shown to be greater International Considerations
when the quit date is set during the luteal phase (ovulation to day
before menses) of the menstrual cycle as opposed to the follicular In Chapter 43, Figure 43-2 shows the regions of the world with
phase (day 1 of menses to day 15). Therefore, it may be valuable to very high smoking prevalence, and given the long latency period
assess the menstrual cycle pattern before setting a quit date to re- between the exposure to tobacco and diseases most of these coun-
duce compounding withdrawal with normal menstrual distress. 127 ties have not seen the devastating health consequences. Nurses
Behavioral and psychological factors that play a major role in smok- and public health officials can play an important role acquiring
ing cessation for women are fear of weight gain, low social support, the skills for counseling smokers to quit by using a guide for
reliance on cigarettes for control of negative affect or stress manage- nurses to help smokers quit. 63 Setting up a systems approach to
ment, and self-efficacy in quitting. 107 These factors must be ad- identify smokers for every health care encounter sends a powerful
dressed when implementing a smoking cessation intervention with a message to all smokers about the need for them to consider smok-
woman. For example, the WINS study found that low self-efficacy ing cessation. Additionally the WHO convention framework legal
and living with a smoker were predictive of smoking at 6 and policy statements can be used by Ministries of Health to combat
12 months of follow-up. In addition, women who perceived them- aggressive cigarette advertisement for youths and adults.
selves to be in “fair” or “poor” health were more likely to be smok-
ers at 12 months. 14 Furthermore, women who were 62 and older
had higher abstinence rate than did those younger than 62 years. SUMMARY
Their abstinence rates were 52% versus 38% and this difference was
37
statistically significant. Gritz et al. also found that a higher educa- A systematic approach to smoking cessation leads to better out-
tion level and a “white collar” job classification were also predictive comes. The measure of success should be based on the frequency
of smoking cessation in a workplace-based study. 123 As always, it is with which the nurse asks about a patient’s smoking status. Mul-
best to tailor the intervention to the individual patient when possi- ticomponent strategies that include strong physician and nurse
ble. It is important to note, however, that women prefer to use a advice, self-help materials, behavioral counseling, pharmacologic