Objective of Treatment ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

from฀smoking-related฀diseases,฀yet฀experience฀physical,฀social฀and฀psychological฀rewards฀ from฀cessation.฀Clinicians฀managing฀the฀care฀of฀smokers฀can฀be฀effective฀in฀promoting฀ smoking฀cessation,฀regardless฀of฀the฀smoker’s฀age฀or฀duration฀of฀smoking฀history.฀The฀ AHRQ฀guideline฀recommends฀clinicians฀to฀ask,฀advice,฀assess,฀assist฀and฀arrange฀follow- up฀for฀all฀smokers.฀Pharmacological฀and฀behavioural฀therapies฀are฀recommended฀to฀assist฀ with฀the฀cessation฀process.฀Gerontological฀nurses฀can฀play฀a฀key฀role฀in฀optimizing฀health฀ and฀successful฀aging฀by฀reducing฀tobacco฀use฀in฀older฀adults฀ [11] .

10.3 Self-Help Interventions by the Smoker

Undoubtedly,฀the฀ideal฀situation฀is฀for฀the฀smoker฀to฀decide฀one฀day,฀more฀or฀less฀sponta- neously,฀to฀give฀up฀smoking฀and฀from฀that฀time฀onwards฀never฀to฀smoke.฀This฀type฀of฀ decision฀is฀commonly฀taken฀on฀special฀days฀of฀the฀year฀e.g.฀as฀a฀New฀Year’s฀resolution฀ Odds฀ratio Assessment Reference Reduced฀smoking – ßß – Self-help฀interventions 1.23฀1.01–1.49 Û [25] Self-help฀intervention฀with฀ telephone฀counselling 1.62฀1.33–1.97 Ý [25] Training฀by฀health฀care฀ professionals 1.48฀1.20–1.83 Û [56] Nurse-managed฀counselling 1.43฀1.24–1.66 Ý [65] Physician฀counselling 1.69฀1.45–1.98 Ý [59] Individual฀counselling฀short฀ counselling฀session,฀ booklet,฀etc. 1.55฀1.27–1.90 Û [114] Group฀therapy฀behavioural฀ therapy 2.10฀1.64–2.70 ÝÝ [70,฀114] Hypnotherapy + Û [115] Aversion฀therapy฀aversive฀ stimulation 2.08฀1.39–3.12 Ý [77] Aversion฀therapy฀general 1.19฀0.77–1.83 Û [77] Acupuncture 1.22฀0.99–1.49 ßß [106] Table 10.2 ฀฀฀Assessment฀of฀non-drug฀treatment฀modalities฀to฀promote฀smoking฀cessation,฀compiled฀ from฀the฀Cochrane฀Database ÝÝ ฀Claim฀e.g.฀on฀eficacy฀supported฀by฀several฀suitable,฀valid฀clinical฀studies฀e.g.฀randomised฀ clinical฀trials฀or฀by฀one฀or฀more฀valid฀meta-analyses฀or฀systematic฀reviews.฀Positive฀claim฀clearly฀ conirmed Ý ฀Claim฀e.g.฀on฀eficacy฀supported฀by฀at฀least฀one฀suitable,฀valid฀clinical฀study฀e.g.฀randomised฀ clinical฀trial.฀Positive฀claim฀conirmed ßß ฀Negative฀claim฀e.g.฀on฀eficacy฀supported฀by฀one฀or฀more฀suitable,฀valid฀clinical฀studies฀e.g.฀ randomised฀clinical฀trials฀or฀by฀one฀or฀more฀valid฀meta-analyses฀or฀systematic฀reviews.฀Negative฀ claim฀clearly฀conirmed Û ฀No฀reliable฀study฀results฀available฀to฀conirm฀a฀positive฀or฀negative฀effect.฀This฀may฀be฀due฀to฀the฀ absence฀of฀suitable฀studies,฀but฀also฀to฀the฀availability฀of฀several฀studies฀with฀contradictory฀results +฀No฀usable฀studies and,฀more฀rarely,฀is฀also฀acted฀upon.฀Greater฀seriousness฀is฀attached฀to฀decisions฀that฀are฀ prompted฀by฀personal฀illness฀or฀by฀the฀illness฀or฀death฀of฀a฀family฀member฀or฀close฀friend.฀ From฀our฀own฀experience฀of฀counselling฀smokers,฀we฀know฀that฀even฀heavy฀smokers฀ 40–60฀cigarettesday฀can฀carry฀through฀such฀decisions฀without฀major฀effort.฀The฀6฀stud- ies฀published฀to฀date฀in฀which฀self-help฀interventions฀led฀to฀successful฀smoking฀cessation฀ for฀6–9฀months฀OR฀=฀1.08;฀CI:฀0.81–1.44฀or฀12฀months฀OR฀=฀1.0;฀CI:฀0.75–1.34฀are฀ of฀ limited฀ value฀ because฀ biochemical฀ variables฀ were฀ measured฀ in฀ only฀ isolated฀ cases฀ [12] .฀The฀support฀of฀a฀partner฀was฀described฀as฀an฀increasing฀successful฀aspect฀for฀quit- ting฀ in฀ only฀ 2฀ of฀ the฀ 6฀ studies฀ [12] .฀ Smokers฀ whose฀ partners฀ are฀ non-smokers฀ or฀ ex- smokers฀are฀more฀likely฀to฀be฀successful฀at฀quitting฀ [13,฀14] .฀Currently฀married฀smokers฀ have฀a฀higher฀chance฀of฀success฀than฀divorced,฀widowed฀or฀never฀married฀smokers฀ [15] .฀ The฀support฀of฀the฀spouse฀may฀be฀beneicial฀for฀success฀ [16,฀17] .฀If฀smokers฀are฀con- stantly฀ nagged,฀ face฀ complaints฀ about฀ their฀ behaviour฀ or฀ are฀ repeatedly฀ criticised฀ for฀ failed฀attempts฀to฀ quit฀smoking,฀then฀ their฀ position฀becomes฀entrenched฀ [18] .฀Studies฀ indicating฀the฀positive฀inluence฀of฀the฀spousepartner฀in฀this฀context฀are฀countered฀by฀ others฀which฀are฀critical฀of฀their฀role฀ [19,฀20] .฀Two฀systematic฀studies฀report฀the฀support- ive฀effect฀of฀a฀partner฀in฀achieving฀smoking฀cessation฀ [21,฀22] ,฀in฀one฀case฀including฀the฀ recommendations฀of฀the฀AHQR฀ [21] . However,฀ numerous฀ organisations฀ also฀ provide฀ self-help฀ manuals฀ designed฀ to฀ assist฀ smokers฀who฀wish฀to฀quit฀ [23,฀24] .฀Consulting฀a฀therapist,฀in฀addition,฀may฀enhance฀the฀ effectiveness฀of฀the฀method฀ [23] .฀Standard฀instructions฀have฀been฀found฀to฀be฀less฀effective฀ than฀personalised฀instructions฀tailored฀for฀a฀group฀of฀smokers฀OR฀=฀1.41;฀CI:฀1.14–1.75฀ [25] .฀Overall,฀instructions฀on฀smoking฀cessation฀are฀assessed฀as฀useful฀and฀more฀effective฀ than฀attempting฀smoking฀cessation฀without฀instructions. Sporting฀ activities฀ are฀ a฀ key฀ aspect฀ of฀ self-help฀ to฀ achieve฀ smoking฀ cessation฀ [26] .฀ Physical฀exercise฀has฀a฀beneicial฀effect฀on฀cravings฀ [27] ,฀depressed฀mood฀ [28] ,฀sleep฀dis- turbances฀ [29] ,฀feelings฀of฀tension฀ [30] ,฀stress฀situations฀ [31] ฀and฀on฀weight฀gain฀following฀ smoking฀cessation,฀an฀aspect฀that฀is฀especially฀important฀for฀women฀ [32–34] .฀Sport฀also฀ has฀a฀positive฀effect฀on฀relapses฀ [35] ,฀coping฀with฀the฀smoking฀problem฀ [36] ฀and฀self- esteem฀ [37] .฀Overall,฀of฀course,฀physical฀activity฀confers฀health฀beneits฀on฀the฀ex-smoker฀ [38] ;฀heavy฀smokers฀often฀already฀notice฀this฀just฀2฀or฀3฀weeks฀after฀stopping฀smoking฀and฀ they฀volunteer฀this฀information฀spontaneously฀during฀counselling฀sessions.฀Out฀of฀a฀total฀ of฀8฀studies฀of฀this฀aspect฀published฀to฀date,฀6฀could฀not฀be฀assessed฀because฀patient฀num- bers฀were฀too฀small.฀In฀the฀inal฀analysis,฀therefore,฀only฀1฀study฀provided฀positive฀evi- dence฀of฀the฀effect฀of฀vigorous฀exercise฀in฀terms฀of฀smoking฀cessation฀OR฀=฀2.36;฀CI:฀ 0.97–5.70฀ [39] ,฀with฀a฀deinite฀increase฀in฀continuous฀abstinence฀compared฀with฀controls฀ 11.9฀vs.฀5.4;฀p฀=฀0.05฀ [39] . To฀determine฀whether฀exercise-based฀interventions฀alone฀or฀combined฀with฀a฀smoking฀ cessation฀programme฀are฀more฀effective฀than฀a฀smoking฀cessation฀intervention฀alone,฀ Ussher฀searched฀the฀Cochrane฀Tobacco฀Addiction฀Group฀specialized฀register฀for฀studies฀ including฀ the฀ terms฀ “exercise”฀ or฀ “physical฀ activity”฀ and฀ MEDLINE,฀ EMBASE,฀ PsycINFO,฀ CINAHL,฀ Dissertation฀ Abstracts฀ and฀ SPORTDiscus.฀ Randomized฀ trials฀ which฀compared฀an฀exercise฀programme฀alone฀or฀an฀exercise฀programme฀as฀an฀adjunct฀ to฀a฀cessation฀programme฀with฀a฀cessation฀programme฀recruiting฀smokers฀or฀recent฀quit- ters,฀and฀with฀a฀follow-up฀of฀6฀months฀or฀more฀were฀included฀in฀the฀ [40] .฀Eleven฀trials฀