Page 510 - Encyclopedia of Nursing Research

SmOKIng/TOBACCO AS A CARDIOVASCUlAR RISK FACTOR n 477

(p < 0.01). The authors concluded that inten- 2009). The World health Organization proj-
sive smoking cessation programs are effec- ects that by 2030 smoking will kill at least 10
tive in patients admitted for coronary artery million individuals annually, making it the S
bypass graft and acute myocardial infarction, leading cause of death worldwide (peto &
and future research should focus on dissem- lopez, 2001).
inating findings into standard practice for Smoking is a complex addictive disorder
cardiac patients (Smith & Burgess, 2009). that causes physiological and psychological
Smoking continues to be pronounced addiction. nicotine, which has both stim-
in the less educated and poor (CDC, 2009). ulating and tranquilizing effects, leads to
efforts to promote cessation and abstinence addiction. Smoking is also an over learned
in these individuals have, to date, been rel- habit which is associated with many aspects
atively unsuccessful. Their lack of engage- of daily life such as driving in a car, eating a
ment in preventive health care services may, meal, or drinking caffeine. Finally, it is used
in part, be due to barriers to access and lack as a coping mechanism to help individuals
of information about prevention and avail- deal with emotions such as stress, boredom,
able cessation resources (U.S. Department of frustration, and anger. The success of inter-
health and human Services, 2000). Although ventions to help individuals quit smoking
the evidence-based AhRQ clinical prac- must focus on the complexity of the behavior,
tice cessation guideline has been developed including nicotine addiction, the psychosocial
and updated (Fiore et al., 2008), its testing influences, and the habit. Although smoking
among vulnerable populations remains lim- remains a complex condition requiring both
ited. The guideline deserves further exam- pharmacological and behavioral approaches
ination among minority groups, pregnant to helping an individual with cessation, epi-
and postpartum women, hIV+ persons, and demiologic data suggest that 70% of all smok-
smokers who are poor and often experienc- ers in the United States want to quit and
ing a comorbid condition, such as cancer or approximately 44% report they attempt to
chronic obstructive pulmonary disease. quit annually (Fiore et al., 2008). The annual
smoking cessation rate of 4% to 7% associated
Gretchen A. McNally with office practice interventions may dis-
Mary Ellen Wewers courage clinicians and patients; however, it is
important that health care professionals not
become complacent about this behavior. A
small percentage drop in cessation rates has
Smoking/tobacco aS a large population benefits. Recent approaches
to treating both tobacco use and dependence
cardiovaScular riSk factor recognize that smoking is a chronic condi-
tion requiring multiple attempts until success
is reached. It is encouraging that two thirds
Over the past four decades, smoking has of smokers who relapse want to try and quit
declined in the United States by 50% among again within 30 days (Fiore et al., 2008). As
adults 18 years and older. Although this the largest group of health care professionals,
decline has certainly impacted the rate of nurses play a prominent role in helping indi-
reduction in cardiovascular disease and viduals to quit smoking.
other chronic conditions, the annual death The prevalence of smoking in the
toll continues to approach 435,000 individu- United States is now 46,000,000 (24,800,000
als in the United States, and worldwide males and 21,100,000 females), represent-
more than 5 to 6 million deaths occur annu- ing 20.6% of the adult population, or one
ally (American heart Association, 2010; Jha, in five adults (American heart Association,