Smoking Cessation. A Critical Component of Medical Management in Chronic Disease Populations
ABSTRACT Many innovative and effective smoking-cessation treatments, both behavioral and pharmacologic, have been developed over the past several decades. However, these treatments traditionally have been developed for use with populations of healthy smokers. Despite the disease management implications, efforts to design and evaluate cessation interventions targeting smokers diagnosed with chronic diseases are reported infrequently in the literature. The purpose of this paper is to provide a brief overview of the evidence linking continued smoking to disease progression and adverse treatment outcomes across a range of common chronic diseases: cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, asthma, cancer, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Where studies are available, the efficacy of smoking-cessation interventions specifically developed or applied to these patient populations is reviewed. Finally, limitations and gaps in smoking research and treatment with chronically ill patients are discussed, and future research priorities are recommended.
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Journal of Clinical Nursing 07/2011; 20(13-14):2087-9. DOI:10.1111/j.1365-2702.2010.03655.x · 1.23 Impact Factor
- "The changing expectations that nurses deliver these interventions in an acute care environment, and not just primary care settings, are a consequence of the increased awareness of the importance of continued smoking in negatively affecting recovery and quality of life after discharge (Gritz et al. 2007). Furthermore, hospitalisation provides a 'window of opportunity' for smokers to quit and for nurses to intervene. "
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- "The scant preliminary data that is specific to persons living with HIV suggests that in comparison to a conventional, less intensive intervention, a more intensive approach that combines behavioral and pharmacologic treatments shows better potential. Gritz et al. (2007) and Vidrine et al. (2006) compared physician advice to quit, written materials, and nicotine patch to a more intensive approach that combined behavioral and pharmacologic treatments (physician advice to quit, written materials, nicotine patch plus eight proactive counseling sessions delivered via cell phone) in a preliminary efficacy trail and found that the intensive treatment group at 3-month follow-up data was significantly more likely to have quit smoking compared to participants receiving only the standard-care treatment (36.8% vs. 10.3%, p < .01). A larger efficacy trial of the intervention is currently under way and will provide additional, much needed data on possible mediators and moderators of treatment outcomes (R01CA097893). "
ABSTRACT: As many as 50-70% of persons infected with HIV are current smokers. Compelling evidence concerning the risks of cigarette smoking to persons living with HIV urges the inclusion of smoking treatment protocols in contemporary models of HIV care. Yet in spite of growing awareness of this problem, persons living with HIV are not being effectively treated for tobacco use. To further an understanding of contributing factors and define directions for evidenced-based intervention, factors associated with smoking behavior among persons living with HIV are examined.AIDS education and prevention: official publication of the International Society for AIDS Education 07/2009; 21(3 Suppl):106-21. DOI:10.1521/aeap.2009.21.3_supp.106 · 1.51 Impact Factor
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- "Most clinical trials of medication efficacy, whether sponsored for drug registration, or by independent and government supported research, have evaluated adult cigarette smokers without other major active illness and thus the clinical practice guideline recommendations are on a strong foundation for these populations. Populations with major chronic diseases have been little studied even though some of these would have much to benefit by smoking cessation (Gritz et al., 2007). For example, cancer patients have been little studied even though smoking cessation can improve prognosis in some cases as well as quality of life (Gritz et al., 2008). "
ABSTRACT: Several pharmacotherapies for tobacco dependence and withdrawal have been approved by the Food and Drug Administration to aid smoking cessation. These medicines double to triple the odds of cessation compared to placebo, with the diversity in chemical entity (e.g., nicotine, varenicline, bupropion) and route (e.g., nicotine gum and transdermal patch) providing options for people who find a given medication unacceptable or ineffective. Treatments in development include vaccines, combinations of existing products, and new indications, such as reduced tobacco use and exposure. These therapies have been developed on the foundation of research on the neuropharmacology of tobacco dependence and withdrawal. Ongoing research is expected to contribute to more efficacious use of existing therapies and the development of new approaches. This article addresses these developments as well as the challenges to medication development. Challenges include understanding the population-based and individual differences in the vulnerability to dependence and responsiveness to various treatment options, which could contribute to effective treatment to patient matching. Research on the CNS effects of administration and withdrawal of nicotine and other tobacco product constituents is expanding, providing the basis for more effective therapeutic approaches and new medications development. Additionally, whereas medications are approved on the basis of standardized assessments of efficacy and safety in clinical trials, the public health impact of medications depends also on their appeal to smokers and their effectiveness in actual use settings. Research on more effective medication use along with policies that support improved access and utilization are vital to conquering the tobacco epidemic.Pharmacology [?] Therapeutics 05/2009; 123(1):1-16. DOI:10.1016/j.pharmthera.2009.03.011 · 7.75 Impact Factor