Page 508 - Encyclopedia of Nursing Research

SmOKIng CeSSATIOn n 475

advance our knowledge on the importance of in 1996 by the U.S. public health Service
sleep and its importance to symptom man- Agency for healthcare Research and
agement, illness/disease prevention, and Quality (AhRQ), and revised in 2000. The S
health promotion. 2008 update emphasizes tobacco depen-
dence is a chronic medical condition, requir-
Joan L. Shaver ing repeated interventions and multiple quit
attempts (Fiore et al., 2008). The major strat-
egies to managing tobacco dependence are
the “5 A’s”: ask the patient about tobacco use,
Smoking ceSSation advise tobacco cessation, assess willingness to
quit, assist with the quit attempt, and arrange
for follow-up to prevent relapse. Tobacco use
Forty-six million (18.4%) American adults needs to be confirmed each visit, patients
continue to smoke, despite evidence that should receive a brief intervention at every
tobacco is responsible for 443,000 deaths in visit. All tobacco users attempting to quit
the United States each year and is the sin- should receive one of the seven AhRQ-
gle most preventable cause of death. During recommended first-line pharmacotherapies
2000–2004, the Centers for Disease Control for smoking cessation.
and prevention (CDC) estimated health care O’Connell (2009) reviewed theories used
costs associated with smoking or smoking- in nursing research on smoking cessation.
attributable diseases at $96 billion. lost pro- She reported 65 of 137 studies (47%) used one
ductivity costs exceeded $97 billion (CDC, or more formal theories. The most frequently
2010e). Of concern is the increase in smok- used theory was prochaska and DiClemente’s
ing prevalence in adolescents, with 4,000 (1983) Transtheoretical model (prochaska
children and adolescents smoking their first et al., 1994) followed by Bandura’s (1977, 1977)
cigarette and 1,200 becoming regular ciga- self-efficacy theory. The most widely used
rette smokers every day. Seventy percent of concepts included nicotine dependence,
the approximately 45 million smokers in the social support, high risk situations, affect
United States want to quit, with about 44% mood, and influence of diagnosis. O’Connell
trying each year. Only 4% to 7% will be suc- noted the guideline (Fiore et al., 2008) does
cessful (Fiore et al., 2008). not mention stage of change, although it does
Smoking cessation, or smoking absti- mention several concepts frequently used
nence, differs from a quit episode, which is in nursing research. She also reported the
considered as 24 hours of continuous absti- absence of biobehavioral models, although
nence (Ossip-Klein et al., 1986). Smoking ces- research published by nurses in nonnursing
sation is defined as the discontinuation of a journals was not reviewed. Theory-driven
smoking behavior. The behavior is character- research contributes to the organization and
ized as dynamic and is often accompanied by interpretation of findings, aiding policy mak-
periods of slips and relapses. Smoking cessa- ers lobbying for changes in smoking-related
tion and tobacco use are important areas of laws and health care policies.
research for nurses. nurses are in frequent Written guidelines with recommenda-
contact with smokers, and their high credi- tions for abstinence outcome measurements
bility allows them to represent key smoking were developed by a subcommittee of the
cessation interventionists, capable of imple- Society for Research on nicotine and Tobacco
menting effective cessation programs (Fiore (hughes et al., 2003). prolonged abstinence,
et al., 2008). defined as sustained abstinence after an
Treating Tobacco Use and Dependence initial two week grace period, is the recom-
Clinical Practice Guideline was first published mended as the primary outcome measure. A