Ex-smokers live longer than those who continue to smoke. The extent to which life span
improves depends on the length of time since quitting, number of cigarettes smoked over
how many years and the health status of the ex-smoker.
However, quitting is beneficial even in the presence of disease, eg patients with
chronic obstructive airways disease will have improved lung function and symptomatology.
Even lung cancer patients can help avoid second cancers and terminal respiratory
infections. Of course, early cessation, with the support of education from health
professionals and stop smoking programmes, will have greater health benefit by preventing
the development of disease rather than its progression.
Although health issues are often given as the main reason for stopping smoking, for
those who have yet to develop disease these events may be far less relevant than social or
financial issues, or the health of their family.
Medical practitioners and other health care workers can help by emphasising the
positive benefits of quitting. Discussion of withdrawal symptoms with the patient can also
help them prepare for the process of quitting. It may be worthwhile for health
professionals to think about their own behaviour and attitudes to smoking and how this
affects their advice to patients.
HOW MEDICAL PRACTITIONERS AND OTHER HEALTH CARE WORKERS CAN HELP
Individual approaches
A good start is to document each patient's smoking history as part of general
history-taking on initial presentation. When time allows, the patient can be encouraged to
talk about their smoking using a non-judgemental question such as, 'How do you feel about
your smoking?' A helpful model to use when assessing the smoker's readiness to quit
identifies three stages:
- Not ready – They are likely to become defensive and resistant to simple advice to
stop. Gentle encouragement of the patient to think about their habit and making it clear
that you are available for further support is the most effective approach.
- Unsure – The advantages of continuing to smoke are still as important as the
advantages of quitting. Discussion can focus on weighing up the pros and cons and any
other specific concerns.
- Ready – They will respond positively to advice to stop and can be given more
specific help on how to deal with withdrawal symptoms. Provide follow-up to encourage
their efforts and deal with continuing difficulties (Mendelssohn and Richmond, 1992).
It is therefore useful to identify how ready the patient is to change in order to
provide the most appropriate individual assistance. An approach that helps the patient to
take control and responsibility for the problem is more likely to be successful than
systematically giving advice to stop or telling the patient what to do.
Relapses
Many ex-smokers relapse, especially in the setting of social events, peer pressure and
alcohol. Patients should be encouraged to view these as learning experiences, and to learn
from there how to avoid future relapses when they try again. Subsequent attempts are often
easier for this reason.
Additional approaches
- Nicotine chewing gum – useful for the very physically dependent. The chewing
tablets can prevent withdrawal symptoms. The patient should follow the enclosed
instructions carefully to avoid unpleasant side effects.
- Nicotine patches – useful for very physically dependent but motivated patients.
Manufacturers emphasise the need for concomitant support from the medical practitioner.
- Acupuncture
- Hypnosis
- Specialist clinics
- Self-help and GP assistance kits.
Resources available for the cessation of smoking
1. How to help smokers to quit: a guide for the health professional
An easy to use guide to give health professionals tips in counselling smokers with a
brief intervention. The guide also outlines the stages a smoker goes through when quitting
and illustrates how a health professional can help using The Can Quit Book.
2. The can quit book
A book for all smokers. Based on years of research and practical knowledge, it gives
advice on recognising why people smoke, the health facts about smoking and an individual's
health, preparing to quit and techniques to give up smoking and stay stopped.
Both resources are available from:
Victorian Smoking and Health Program (Quit)
PO Box 888Carlton South Vic. 3053
Telephone (03) 663 7777
Fax (03) 663 7761.
Note: No fee for orders in Victoria, small fee for orders interstate.
3. Smokescreen for the 1990s
The stop smoking programme for use by medical practitioners, obtained through the
Prince of Wales Hospital, New South Wales.
There are two kits available:
- one kit for GPs
- self-help kit for smokers that can be displayed in the surgery.
Kits available from:
The Smokescreen Unit
Prince of Wales Hospital
High Street
Randwick NSW 203
Telephone (02) 399 4766
Fax (02) 399 2196.
4. Sick of smoking?
A manual for helping patients stop smoking, obtained through the South Australian
Health Commission:
Sick of Smoking Officer
College House15 Gover Street
North Adelaide SA 5006
Telephone (08) 267 1249.
General and community approaches
- Assist in educational programmes, especially in schools. Young people and women are
particularly likely to take up smoking.
- If you smoke yourself, try to give up smoking or at least not smoke publicly.
- Have a non-smoking policy in your workplace and other workplaces that you may visit.
- Be aware of the consequences of smoking, and know of the referral agencies available to
help smokers.
- Congratulate people when they finally break the habit.
- Sympathise and offer encouragement to those people who require additional support and
time to give up smoking.
Recent evidence has come to light showing the harmful effects of tobacco smoke on the
health of non-smokers.
Cigarette smoke can be separated into two components, mainstream smoke which is inhaled
by the active smoker, and sidestream smoke, the unfiltered smoke released from the end of
a lit cigarette, which results in passive smoking in non-smokers.
The dangers of passive smoking are highlighted by the knowledge that 85% of cigarette
smoke is released as sidestream smoke. Since the sidestream smoke is unfiltered it
contains higher concentrations of dangerous chemicals. The effects of this harmful smoke
in non-smokers can lead to increased incidence of bronchitis, pneumonia, and other chest
illness in children, Sudden Infant Death Syndrome, lung cancer and lung disease. In
addition, the irritants in tobacco smoke are a major concern to people with asthma and
people with allergies, especially of the eyes, nose and throat.
Recent estimates suggest that annually approximately 150 deaths from lung cancer and
1000 deaths from heart disease in Australia are due to passive smoking (Holman, Armstrong,
Arias et al., 1988).
Health risks of passive smoking
- Higher concentrations of cancer-causing agents in sidestream smoke.
- Aggravation of asthma.
- Aggravation of allergic conditions – cigarette smoke results in irritation of the
eyes, nose and throat, and also headaches and coughs in non-smokers.
- Cancer, particularly lung cancer.
- Respiratory illness is increased – noticeable in children of active smokers who
suffer from more acute respiratory illness, wheezing, middle ear infections, sore throats
and problems of lung infection.
- Sudden Infant Death Syndrome.
- Growth – may be a combination of the mother smoking during pregnancy, and passive
smoking by the child after birth.
- Increased incidence of bronchitis, pneumonia, and chest illness in adults and children.
- Meningitis – recent studies indicate a possible association between meningococcal
disease and passive smoking during childhood.
- Heart disease – increases the risk of coronary heart disease.
At work
The legal ramifications of smoking in the workplace are now becoming apparent. In
Australia there have been at least 10 cases since 1980 where workers have received
compensation for injuries incurred as a result of passive smoking in the workplace. As a
result increasing numbers of employers are making their workplaces smoke-free.