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PUBLIC HEALTH
TABLE 3: Online Resources for Tobacco Cessation
American Lung Association Freedom From Smoking®
www.ffsonline.org
American Cancer Society – QuitBuddy Texts
www.cancer.org
Delaware Quitline’s Online Support
www.quitsupport.com
National Cancer Institute
www.smokefree.gov
Quitnet
www.quitnet.org
Quitters Circle
www.quitterscircle.com
decreased withdrawal symptoms. Although a 2011 meta-analysis15 raised concerns about the cardiovascular safety of varenicline, a subsequent meta-analysis16 and a FDA review17 both demonstrated Varenicline also has been shown to be safe and effective in smokers with cardiovascular disease.18 Due to a possible association with mood changes and suicidal ideation, physicians should use caution when prescribing varenicline to patients with psychiatric disorders.
A multitude of studies have shown that any cardiovascular risks
of smoking cessation in patients with CAD and ACS. It remains imperative to provide smokers with intensive therapy, in terms of both pharmacological agents and ancillary support, to aid in their cessation attempts.
HELPING PATIENTS QUIT TOBACCO
Clinicians in various practice settings are well positioned
to educate and motivate tobacco users to quit. Even a brief intervention of less than three minutes has been shown to
make a difference in tobacco cessation outcomes.8 However, effective approaches for tobacco cessation are not consistently implemented. Clinicians cite common barriers to tobacco cessation including time constraints, competing demands, and even their own biases toward tobacco users. To meet regulatory requirements, health care professionals often address tobacco brochures. Alternately, clinicians may resort to an authoritative approach of simply telling patients what to do, or not do.
Particularly for patients who are not thinking about quitting, there is a better approach. The U.S Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence8 supports using based on motivational interviewing principles. Strategies and sample scripting for motivational interviewing techniques are included tobacco cessation intervention, commonly referred to as the “5 A’s,” are summarized in Table 2. It is important to develop rapport early in the intervention by communicating empathy, actively listening,
TOBACCO CESSATION RESOURCES IN DELAWARE
The majority of tobacco users want to quit and just over half of them attempt quitting each year.20 When smokers use the evidence-based
treatment of medication plus counseling, long-term abstinence rates are 25-30 percent vs. only 6 percent for those who try
to quit on their own.20 Since only one in three people seek treatment when trying to quit, physicians play an important role in connecting patients to evidence-based treatment for tobacco cessation to maximize their success.
Delaware Quitline (1-866-409-1858
or 1-800-QUIT-NOW)
In Delaware, we are fortunate to have a state-funded Quitline that has extensive tobacco cessation resources. Delaware is one of the only states to offer free face-to-face tobacco cessation counseling rates in Delaware are higher than the national average. Additionally, Delaware is the only state to offer all seven FDA-approved tobacco cessation medications. Individuals who enroll in the Delaware Quitline program may be eligible for free tobacco cessation medication. Lastly, Delaware has an easy way for health care professionals to refer patients, who are ready to quit in the next 30 days, to the Quitline. Clinicians fax a form (Figure 2) to the Delaware Quitline, which will attempt to reach the patient within 72 hours of receiving the form. Note that the form must be signed by the patient.
American Lung Association
The American Lung Association’s Freedom From Smoking® program is widely available in community locations throughout Delaware. Not On Tobacco is offered in select high schools. For more information about program locations and schedules, call 1- 800-LUNG-USA or visit http://lunginfo.org.
Online Resources
There are a many online resources for tobacco cessation. A few of the major sites are listed in Table 3.
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