Smoking Cessation. A Critical Component of Medical Management in Chronic Disease Populations
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.
Available from: onlinelibrary.wiley.com
- "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. "
Available from: Nancy A Hessol
- "The widespread use of anti-retroviral therapies has resulted in a dramatic reduction of HIV-related morbidity and mortality.4,5 Improvements in the care and longevity of persons with HIV have increased the attention on smoking cessation for HIV-infected individuals.1,2,6 "
[Show abstract] [Hide abstract]
ABSTRACT: Cigarette smoking is an important risk factor for adverse health events in HIV-infected populations. While recent US population-wide surveys report annual sustained smoking cessation rates of 3.4-8.5%, prospective data are lacking on cessation rates for HIV-infected smokers.
To determine the sustained tobacco cessation rate and predictors of cessation among women with or at risk for HIV infection.
Prospective cohort study.
A total of 747 women (537 HIV-infected and 210 HIV-uninfected) who reported smoking at enrollment (1994-1995) in the Women's Interagency HIV Study (WIHS) and remained in follow-up after 10 years. The participants were mostly minority (61% non-Hispanic Blacks and 22% Hispanics) and low income (68% with reported annual incomes of less than or equal to $12,000).
The primary outcome was defined as greater than 12 months continuous cessation at year 10. Multivariate logistic regression was used to identify independent baseline predictors of subsequent tobacco cessation. A total of 121 (16%) women reported tobacco cessation at year 10 (annual sustained cessation rate of 1.8%, 95% CI 1.6-2.1%). Annual sustained cessation rates were 1.8% among both HIV-positive and HIV-negative women (p = 0.82). In multivariate analysis, the odds of tobacco cessation were significantly higher in women with more years of education (p trend = 0.02) and of Hispanic origin (OR = 1.87, 95% CI = 1.4-2.9) compared to Black women. Cessation was significantly lower in current or former illicit drug users (OR = 0.42 95% CI = 0.24-0.74 and OR = 0.65, 95% CI = 0.49-0.86, respectively, p trend = 0.03) and women reporting a higher number of cigarettes per day at baseline (p trend < 0.001).
HIV-infected and at-risk women in this cohort have lower smoking cessation rates than the general population. Given the high prevalence of smoking, the high risk of adverse health events from smoking, and low rates of cessation, it is imperative that we increase efforts and overcome barriers to help these women quit smoking.
Available from: ncbi.nlm.nih.gov
- "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). "
[Show abstract] [Hide abstract]
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.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.