Thank you for inviting me here today. It is my plan to speak to the board of the hospital about the history of tobacco, its original purpose, and the medical concerns that smoking raises and the proposal as well as the cost effectiveness of an anti-smoking program with emphasis on preventing the patients relapse after being discharged from the hospital. In order to create a positive change in patients lives it is best to utilize the time spent in the hospital as the perfect opportunity to increase their awareness of treatment programs and educational opportunities available to those wishing to cease smoking.
The history of tobacco is long and convoluted. It was considered a medicinal herb by native tribes and an influence on popular culture. While tobacco has been available for centuries the American population has cultivated tobacco since 1612. Seven years after the first crop was harvested tobacco became the largest cash crop in Virginia. Tobacco was first grown for use in pipe-smoking and chewing, the cigar did not become popular until the early 1800’s (Apperson, 2006). The negative health effects of tobacco were not initially known. The European doctors followed the Native American belief that tobacco could be used as an effective medicine and often prescribed it (Apperson, 2006). During that time period smoking was a socially acceptable past-time however as the increases in research have proven continuing to use tobacco present a significant health concern.
The beginnings of United States legislation and public policy began in the early 1960’s the Surgeon General’s Advisory Committee on Smoking and Health was formed in response to the growing amount of scientific literature available (Apperson, 2006). In 1965 Congress passed the Federal Cigarette Labeling and Advertising Act which required the surgeon general’s warnings on all cigarette packages. In 1971 all broadcast advertising was banned (Apperson, 2006). In 1990 the restrictions on cigarette smoking were increased to include all interstate buses and domestic airline flights lasting six hours or less (Apperson, 2006).. The first lawsuits from states were filed in 1994 seeking to recoup the Medicare expenses created by smoking from the cigarette companies (Apperson, 2006).
The dependence upon nicotine fostered an environment where smoking was acceptable. Because of this culture of acceptance the increase in medical research that has proven that smoking causes more health problems then any other recreational activity while decreasing the number of adults who smoke has not deterred the younger generation from beginning the habit.
Cigarette smoking is well known to cause many negative health factors such as cancer, peptic ulcers, Chronic Obstructive Pulmonary Disease (COPD) and coronary heart disease. When all of the diseases that cigarette smoking causes are combined more then 1/6 or 430,700 of all deaths annually can be traced back to this one cause (Apperson, 2006). Therefore decreasing the number of smokers remains the single best way to prevent each of those deaths. While the cases of smoking in older people have decreased the amount of teenagers who smoke have increased indicate an increase in smoking related health problems in the future.
Smoking remains the leading cause of preventable disease in America. Research has shown that individuals who have stopped smoking experience better health over the rest of their lives resulting in a better quality of life. Increasing the amount of education about the dangers of smoking and the increased health benefits of quitting will increase the health of the community. There will be less second-hand smoke in public areas to contaminate non-smokers and the hospital will be less over-populated with patients needing treatment for preventable diseases. It is important that the community take steps to increase the effectiveness of smoking-cessation programs. This paper is designed to inform individuals in the community of the various forms of the available programs with special emphasis on the anti-smoking program that research has shown to be the most effective.
While smoking-cessation programs have been created over the years, additional research has shown that smokers have the best chance of quitting when they have a support network. When a patient is admitted to the hospital, the hospital staff has the best opportunity to assist them in quitting in part because of the inability to smoke in the hospital combined with the educational opportunities available at the hospital.
There are many treatment options available to individuals who wish to quit. Nicotine replacement therapies, self-help materials, and group counseling sessions can all be utilized to increase the chances of an individual to stop smoking. The research that has been completed shows that multiple sessions of group behavior modification programs provide the most effective in helping smokers to quit; however, most smokers will not attend them. Therefore relaying on those sessions is an infective way to decrease this hazard to public health. By identifying situations in which smokers are willing to listen and respond to a cessation intervention those interventions can be tailored to that teachable moment.
While there are many programs available to individuals who wish to quit research has shown that the method with the highest success rate combines several methods into one. The combination of health care provider support, nicotine replacement therapies and increased training in coping mechanisms results in a success rate as high as 58% (Health, 2000). The physical and psychological affects of nicotine must be addressed when designing a treatment program so that the individual needs of the smoker can be met (Health, 2000).
While researching the problems caused by smoking the studies examined have shown that a period of hospitalization can have a positive effect on decreasing smoking if the hospital takes advantage of it with a proper smoking-cessation program. When a patient is hospitalized because of a cardiac event it has the possibility of increasing the smoker’s motivation and readiness in accepting smoking-cessation advice. The patient’s long term abstinence to smoking is related to their belief that cigarettes contributed to their cardiac problems. The cessation advice given should reinforce the connection between cigarettes and the cardiac problem (Health, 2000).
Many patients are forced to stop smoking while in the hospital but are unable to continue abstaining from cigarettes after they had been discharged. Many studies have shown that programs that were developed specifically for use of patients in the hospital combining smoking-cessation and relapse-prevention programs have a better chance of success then smoking-cessation programs alone (Stevens, V.J., Russell E. Glasgow, R.E., 1993). In surveys conducted with smokers the reason voiced most often as being the catalyst to stop smoking was a concern about their health (Stevens, V.J., Russell E. Glasgow, R.E., 1993). While the patients are in the hospital the perfect opportunity is created to promote a smoking-cessation program. Their presence in the hospital brings about the realization that their health problems are a result of their lifestyle and can prompt changes if handled correctly by the hospital staff.
There has been a significant amount of research done which illustrates the increased risks of smoking after Coronary Artery Bypass Grafting (CABG) surgery. The study found that smokers who continued to smoke or started to smoke after undergoing CABG surgery increased the risk of myocardial infraction (Health, 2000). Because of this increased health risk healthcare providers must stress the importance of not smoking.
The Agency for Healthcare Research and Quality (AHRQ) has published guidelines for smoking cessation programs. Before publishing those standards 3,000 studies underwent analysis looking for methods that would increase the effectiveness of any program (Health, 2000). Through their research they found that patients that had received CABG surgery would quit smoking under several circumstances; including when they learned that the surgery was necessary, upon admission to the hospital, following treatment or hospital discharge (Health, 2000).
According to AHRQ’s guidelines nurses should ask each patient about their cigarette use during each visit and advise their patients that use tobacco to quit each time. Nurses are the largest category of healthcare providers and are positioned in every level of healthcare because of their position they have the best chance of influencing their patients to quit smoking (Health, 2000). The percentage of smokers who had received advice on smoking-cessation was 92%; however, only 61% of those smokers received that advice from physicians. This statistic shows the importance of health care providers to communicate with their patients about the dangers and risks of smoking and provide information and encouragement on programs that will help them stop smoking (Health, 2000).
Researches in 15 studies have shown that nurses treating patients admitted to the hospital in acute care settings with cardiac difficulties were more open for smoking-cessation advice from nurses then patients admitted for other diagnosis (Health, 2000). As there is more available research to the lay person that smoking can result in heart problems or cancer, patients in the hospital for those problems are ready to listen to advice on their habits. The guidelines developed by the AHRQ can be used by any nurse to implement a variety of smoking-cessation programs in the clinical setting (Health, 2000).
In order to implement a smoking-cessation program the financial resources must be available. The training of the counselors in smoking-cessation techniques, the bed-side counseling as well as the required follow up ranges in cost from 3,697 dollars to 7,444 dollars (Meenan, R.T., 1998). While these numbers look large the program is less expensive then other lifesaving treatments and becomes more cost-effective as the program is utilized (Meenan, R.T., 1998). Even the presence of one smoking-cessation session at the hospital with qualified counselors can create a positive impact in the patient’s ability to quit (Segnan, N., et. al. 1991). In one study where there were three groups with combined with one central group who received no counseling about smoking and the three other groups which received slightly more counseling and support depending on the group. The only group that did not see an increase in patients abstaining from cigarettes was the group with no counseling (Segnan, N., 1991). The effects of the other treatment programs increased in success with the increase in counseling; however, the differences in those groups were only different in result by several percentage points (Segnan, N., 1991).
After researching the history of tobacco use as well as the various programs that can be used to decrease the amount of cigarette users in America the best program would focus on individuals admitted to a hospital. The hospital should focus on the implementation of these programs by increasing the financial contributions to educational outreach programs and considering seeking federal assistance in the training of hospital staff. As the number of smokers decrease the amount of healthcare related illness will also decrease. Taking advantage of the available research and helping the communities form these programs will provide the most effective results. The research has shown that nurses and other health care providers are in the best position to impact the success or failure of those programs. Success can be determined by how much time the nurses spend with the patient focusing on smoking-cessation programs, as well as their willingness to follow up with the patient once they have been discharged. By taking advantage of the period of time in which the patient is hospitalized and forbidden to smoke to teach them better habits influences a positive change in the patient’s life. It is possible to transform smokers to ex-smokers by treating the entire individual rather then only treating the disease.
References
Apperson, G.L. (2006). The Social History of Smoking. Biblio Bazaar. London, England.
Colditz, G.A. (2000). Illnesses Caused by Smoking Cigarettes. Cancer, Causes & Control. 11(1). 93-97.
Graham-Garcia, J., Health, J. (2000). Urgent Smoking Cessation Interventions; Enhancement the Health Status of CABG patients. The American Journal of Nursing. 100(5). 19-23.
Meenan, R.T., Stevens, V.S., Hornbrook, M.C., Chance, P., Glasgow, R.G., Hollis, J.F., Lichtenstein, E., Vogt, T.M. Cost-Effectiveness of a Hospital-Based Smoking Cessation. Medical Care. 36(5). 670-678.
Segnan, N., Ponti, A., Battista, R.N., Senore, C., Rossa, S., Shapiro, S.H., Aimar, D. (1991). Randomized Trial of Smoking Cessation Interventions in General Practice in Italy. Cancer Causes & Control, 2(4), 239-246.
Stevens, V.J., Glasgow, R.E., Hollis, J.F., Lichtenstein, E., Vogt, T.M. (1993). A Smoking Cessation Intervention for Hospital Patients. Medical Care, 31(1), 665-72.