Cessation of smoking
Psychosocial forces lead to initiation of smoking, especially among teenagers. Later, drug addiction and psychological factors help maintain dependence on tobacco. It is estimated that more than 36 million people in the United States have stopped smoking; 95 percent of these succeeded without formal assistance. Many long-term smokers quit because of smoking-related health problems. This seems to explain the observation that the death rate of men smoking more than 20 cigarettes a day was somewhat higher in the months immediately after quitting than that of continuing smokers. Thereafter, a gradual decline in death rates was observed in ex-smokers. Ten or more years after quitting, the death rate of those who had smoked more than 20 cigarettes a day decreased about two-thirds, and the death rate of individuals who had smoked 20 cigarettes a day or less was about the same as that of nonsmokers. Ex-smokers usually experience prompt symptomatic improvement. On the average they also gain approximately 5 lb.
In the United States more than 80 percent of cigarette smokers would like to stop smoking. Many self-care and organized programs are available to assist these individuals. Organized programs employ several techniques including instruction, counseling, withdrawal clinics, behavioral modification, hypnosis, aversive conditioning, self-monitoring, and drug therapy. In these programs 1-year abstinence rates of 20 to 30 percent are common. Relapse usually occurs during the 3-month interval after quitting. Successful programs emphasize maintenance of the nonsmoking state during this critical period.
Although only 10 percent of physicians smoke, a minority of patients report receiving advice from their physician to quit. Controlled trials have shown that physician counseling increases long-term smoking cessation rates. Polls also show that patients are inadequately informed about the hazards of smoking. All smokers should be encouraged to quit, especially those in high-risk groups with chronic pulmonary disease, coronary artery disease, and pregnancy. Physicians can help their smoking patients in the following manner:
1 Obtain a quantitative smoking history.
2 Explain the health risks in a personally relevant fashion.
3 Emphasize the benefits associated with cessation.
4 Advise and assist the patient to quit smoking.
5 Provide self-help reading materials.
6 Consider referring the patient to a formal treatment program.
7 Support the patient in a maintenance program.
A nicotine-containing chewing gum, which helps alleviate withdrawal symptoms, may be a useful adjunct in medically supervised programs. Patients who are unable or unwilling to stop cigarette smoking should be assisted to reduce their smoke exposure by smoking fewer cigarettes, inhaling less, taking fewer puffs, and leaving a longer stub.
Political, social, and cultural forces play a critical role in the individual decision to start or stop smoking. For this reason, physicians should lead and support efforts to increase tobacco excise taxes, to eliminate all tobacco advertisements and promotional activities, and to ban smoking in public places.
Ultimately, primary smoking prevention in the pediatric and adolescent age groups may be the most effective program. Young people who have been trained to resist social pressures, who understand the consequences of smoking to their health, and who appreciate the difficulty of quitting are less likely to start smoking.