Page 512 - Encyclopedia of Nursing Research

SmOKIng/TOBACCO AS A CARDIOVASCUlAR RISK FACTOR n 479

evidence (e.g., pregnant women, smokeless increases the likelihood that health care pro-
tobacco users, light smokers [<10 cigarettes fessionals will intervene to fully provide the
per day], and adolescents); (5) state quit lines 5 “A’s” that support cessation (Fiore et al., S
and the 1–800-QUIT-nOW are effective 2008). A large number of nurses intervene
compared with no or minimal intervention; to ask and assist individuals with cessation
and (6) having tobacco covered as a bene- (73%), but far fewer intervene to offer phar-
fit is likely to increase the rate of those who macotherapies (24%), community resources
receive treatment, make a quit attempt, and (22%), or a quit line (10%) (Sarna et al., 2009).
attain abstinence (Fiore et al., 2008). evidence nurses are in unique settings such as schools
continues to indicate that in health care set- whereby prevention curricula may be offered,
tings smoking cessation is enhanced when home health settings where interventions
multiple health care professionals offer the may be provided, and in large organiza-
same message about the importance of ces- tions where they can advocate for significant
sation, high intensity counseling greater changes in public policy such as increasing
than 10 minutes with a total duration of 30 tobacco taxes.
minutes or more, multiple follow-up sessions nurse investigators have played a key
(four to eight times), and provide multiple role in developing and testing efficacious
formats such as self-help materials combined interventions in various treatment settings
with individual counseling and pharmaco- such as hospitals and clinics. Their work
therapy (Fiore et al., 2008). most notably increases the odds ratio that
Seven medications approved by the Food a patient will quit by approximately 1.28
and Drug Administration are now being rec- (Rice & Stead, 2009). hospital-based nursing
ommended as effective pharmacotherapies interventions have shown considerable suc-
for use with smoking cessation, including five cess when highly systematized for both car-
nicotine replacement therapies, buproprion diovascular patients and those with various
chloride (zyban, Wellbutrin), and varenicline medical and surgical diagnoses (Froelicher
(Chantix). Cessation rates are more than dou- et al., 2004; miller, Smith, DeBusk, Sobel, &
ble compared with placebo when any med- Taylor, 1997; Rigotti, munafo, & Stead, 2008;
ication is used to helped smokers quit, and Smith & Burgess, 2009).
combining medications may further increase Future research is needed by nurse inves-
success (Fiore et al., 2008). nurses have a key tigators who ultimately care for patients in
role to play in not only educating individuals multiple health care settings. Such research
about pharmacotherapies but also providing includes testing successful interventions in
follow-up as unless carefully prescribed use disadvantaged populations, using teach-
is often ineffective (Sarna et al., 2009). able moments in settings such as emergency
nurses may contribute significantly rooms to advocate for cessation, replicating
to both prevention and tobacco cessation. hospital-based interventions online, and
Although 13.9% of nurses continue to smoke, examining further training with the 5 “A’s” to
this rate has declined significantly over the determine if greater multicomponent strate-
last three decades, increasing the likelihood gies (pharmacotherapies, self-help materials,
that more nurses will intervene with indi- quit-line referrals, etc.) might be improved.
viduals to help them in the quitting process In summary, the smoking decline over
(Sarna et al., 2009). Because of their key role the past three decades offers hope that this
and the health hazards of smoking, nurses addictive behavior may someday become a
who smoke must seek support for quitting. distant memory. however, continued work
In addition, studies indicate that having ces- in the United States and in developing coun-
sation training and believing that offering tries is needed to achieve this goal. nurses
treatment is a professional responsibility and other health care professionals are in key