Elsevier

Disease-a-Month

Volume 36, Issue 4, April 1990, Pages 183, 186-242
Disease-a-Month

Cigarette smoking: The clinician's role in cessation, prevention, and public health

https://doi.org/10.1016/0011-5029(90)90007-EGet rights and content

Abstract

Cigarette smoking is the most important preventable cause of illness and death in the United States, responsible for 390,000, or one sixth, of all deaths. Although smoking prevalence has decreased among adults, from 40% in 1965 to 29% in 1987, 49 million Americans continue to smoke. Smoking rates have declined at a slower rate among blacks, women, young people, and the less educated, groups that must be targeted for tobacco use prevention interventions.

The clinician is uniquely positioned to reduce the enormous health toll from cigarette smoking. As a first step, physicians are urged to assess tobacco use during every patient visit by making smoking status a new vital sign.

Although 85% of all smokers quit on their own, physicians can greatly facilitate this process. A brief intervention for physicians to help their smoking patients quit, based on a program of the National Cancer institute, is presented. This program includes asking about smoking status during every clinic visit, advising all smoking patients to quit, assisting smokers by setting a quit date and using nicotine gum, if appropriate, and arranging follow-up with smokers who try to quit. Cessation rates of 5% to 25%, sustained for at least 1 year, are consistent with a successful, physician-mediated intervention program. Physicians are also urged to prevent smoking initiation among adolescents, particularly young girls and those not aspiring to attend college.

Physicians can also reduce the enormous toll of tobacco use by acting at the public health and public policy levels. Recording tobacco use as a contributing or the underlying cause on death certificates, if appropriate, will assist in public health surveillance. Also, clinicians are urged to work at the organizational, community, and governmental levels to promote tobacco-free environments.

References (115)

  • J.M. Last

    Controlling the smoking epidemic

    Am J Prev Med

    (1985)
  • The Health Consequences of Smoking for Women: A Report of the Surgeon General

    (1980)
  • Smoking-attributable mortality and years of potential life lost: United States, 1984

    MWWR

    (1987)
  • National Research Council

    Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects

    (1986)
  • M.C. Fiore et al.

    Trends in cigarette smoking in the United States: The changing influence of gender and race

    JAMA

    (1989)
  • J.P. Pierce et al.

    Trends in cigarette smoking in the United States: Projections to the year 2000

    JAMA

    (1989)
  • J.P. Pierce et al.

    Trends in cigarette smoking in the United States: Educational differences are increasing

    JAMA

    (1989)
  • E.C. Hammond et al.

    Smoking habits of men and women

    J Natl Cancer Inst

    (1961)
  • M.A. Orlandi

    Gender, differences in smoking cessation

    Women Health

    (1986)
  • J.M. McGinnis et al.

    Tobacco and health trends in smoking and smokeless tobacco consumption in the United States

    Annu Rev Public Health

    (1987)
  • Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al. Quitting smoking in the United States in 1986 (submitted for...
  • M. Fiore et al.

    Smoking cessation: Data from the 1986 Adult Use of Tobacco Survey

  • Tobacco Use in 1986: Methods and Basis Tabulations From the Adult Use of Tobacco Survey: U.S. Dept of Health and Human...
  • J.L. Schwartz

    Review and Evaluation of Smoking Cessation Methods: The United States and Canada, 1978–1985

  • World Health Organization

    Sixth Review of Psychoactive Substances for Intervention Control

    (1982)
  • W.A. Hunt et al.

    Relapse rates in addiction programs

    J Clin Psychol

    (October 1971)
  • J.H. Jaffe

    Drug addition and drug abuse

  • M.A.H. Russell et al.

    Effect of nicotine chewing gum as an adjunct to general practitioners' advice against smoking

    Br Med J

    (1983)
  • K. Jamrozik et al.

    Placebo-controlled trial of nicotine chewing gum in general practice

    Br Med

    (1984)
  • D.M. Wilson et al.

    A randomized trial of a family physician intervention for smoking cessation

    JAMA

    (1988)
  • British Thoracic Society

    Comparison of four methods of smoking withdrawal in patients with smoking related diseases

    Br Med J

    (1983)
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