Abstract
We describe practical, effective, office-based methods for physicians to use to assist patients to stop smoking that do not require special training or support personnel. Brief counseling achieves smoking cessation in a small percent of well patients but is more effective in patients with smoking-related illnesses or abnormal laboratory test results. Routine prescribing of nicotine gum without participation by the patient in a smoking-cessation program does not increase smoking cessation, and we do not recommend it. The prevention of smoking relapse can probably be enhanced by scheduling follow-up office visits after the patient has quit. Failure to quit on initial attempts should not discourage physicians and patients, since most successful abstainers usually must make several attempts to quit. We outline for physicians two approaches, one brief and one more intensive, to help patients stop smoking.
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Selected References
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- Altman D. G., Flora J. A., Fortmann S. P., Farquhar J. W. The cost-effectiveness of three smoking cessation programs. Am J Public Health. 1987 Feb;77(2):162–165. doi: 10.2105/ajph.77.2.162. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Anda R. F., Remington P. L., Sienko D. G., Davis R. M. Are physicians advising smokers to quit? The patient's perspective. JAMA. 1987 Apr 10;257(14):1916–1919. [PubMed] [Google Scholar]
- Baer J. S., Holt C. S., Lichtenstein E. Self-efficacy and smoking reexamined: construct validity and clinical utility. J Consult Clin Psychol. 1986 Dec;54(6):846–852. doi: 10.1037//0022-006x.54.6.846. [DOI] [PubMed] [Google Scholar]
- Bronson D. L., O'Meara K. The impact of shared medical records on smoking awareness and behavior in ambulatory care. J Gen Intern Med. 1986 Jan-Feb;1(1):34–37. doi: 10.1007/BF02596322. [DOI] [PubMed] [Google Scholar]
- Burt A., Thornley P., Illingworth D., White P., Shaw T. R., Turner R. Stopping smoking after myocardial infarction. Lancet. 1974 Feb 23;1(7852):304–306. doi: 10.1016/s0140-6736(74)92607-5. [DOI] [PubMed] [Google Scholar]
- Cambien F., Richard J. L., Ducimetiere P., Warnet J. M., Kahn J. The Paris Cardiovascular Risk Factor Prevention Trial. Effects of two years of intervention in a population of young men. J Epidemiol Community Health. 1981 Jun;35(2):91–97. doi: 10.1136/jech.35.2.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campbell I. A., Hansford M., Prescott R. J. Effect of a "stop smoking" booklet on smokers attending for chest radiography: a controlled study. Thorax. 1986 May;41(5):369–371. doi: 10.1136/thx.41.5.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chu F. Z., Day R. G. Smoking recognition by family physicians. J Fam Pract. 1981 Apr;12(4):657–660. [PubMed] [Google Scholar]
- Cohen S. J., Christen A. G., Katz B. P., Drook C. A., Davis B. J., Smith D. M., Stookey G. K. Counseling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders. Am J Public Health. 1987 Mar;77(3):313–316. doi: 10.2105/ajph.77.3.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Coppotelli H. C., Orleans C. T. Partner support and other determinants of smoking cessation maintenance among women. J Consult Clin Psychol. 1985 Aug;53(4):455–460. doi: 10.1037//0022-006x.53.4.455. [DOI] [PubMed] [Google Scholar]
- Cummings K. M., Giovino G., Jaén C. R., Emrich L. J. Reports of smoking withdrawal symptoms over a 21 day period of abstinence. Addict Behav. 1985;10(4):373–381. doi: 10.1016/0306-4603(85)90034-6. [DOI] [PubMed] [Google Scholar]
- Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fagerström K. O. A comparison of psychological and pharmacological treatment in smoking cessation. J Behav Med. 1982 Sep;5(3):343–351. doi: 10.1007/BF00846161. [DOI] [PubMed] [Google Scholar]
- Fagerström K. O. Effects of nicotine chewing gum and follow-up appointments in physician-based smoking cessation. Prev Med. 1984 Sep;13(5):517–527. doi: 10.1016/0091-7435(84)90020-3. [DOI] [PubMed] [Google Scholar]
- Fagerström K. O. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3(3-4):235–241. doi: 10.1016/0306-4603(78)90024-2. [DOI] [PubMed] [Google Scholar]
- Glasgow R. E., Schafer L., O'Neill H. K. Self-help books and amount of therapist contact in smoking cessation programs. J Consult Clin Psychol. 1981 Oct;49(5):659–667. doi: 10.1037//0022-006x.49.5.659. [DOI] [PubMed] [Google Scholar]
- Glassman A. H., Jackson W. K., Walsh B. T., Roose S. P., Rosenfeld B. Cigarette craving, smoking withdrawal, and clonidine. Science. 1984 Nov 16;226(4676):864–866. doi: 10.1126/science.6387913. [DOI] [PubMed] [Google Scholar]
- Greene H. L., Goldberg R. J., Ockene J. K. Cigarette smoking: the physician's role in cessation and maintenance. J Gen Intern Med. 1988 Jan-Feb;3(1):75–87. doi: 10.1007/BF02595761. [DOI] [PubMed] [Google Scholar]
- Hjermann I. Smoking and diet intervention in healthy coronary high risk men. Methods and 5-year follow-up of risk factors in a randomized trial. The Oslo study. J Oslo City Hosp. 1980 Jan;30(1):3–17. [PubMed] [Google Scholar]
- Hughes J. R., Hatsukami D. K., Pickens R. W., Svikis D. S. Consistency of the tobacco withdrawal syndrome. Addict Behav. 1984;9(4):409–412. doi: 10.1016/0306-4603(84)90043-1. [DOI] [PubMed] [Google Scholar]
- Hughes J. R., Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry. 1986 Mar;43(3):289–294. doi: 10.1001/archpsyc.1986.01800030107013. [DOI] [PubMed] [Google Scholar]
- Hughes J. R., Miller S. A. Nicotine gum to help stop smoking. JAMA. 1984 Nov 23;252(20):2855–2858. [PubMed] [Google Scholar]
- Hymowitz N. Community and clinical trials of disease prevention: effects on cigarette smoking. Public Health Rev. 1987;15(1-2):45–81. [PubMed] [Google Scholar]
- Jamrozik K., Fowler G., Vessey M., Wald N. Placebo controlled trial of nicotine chewing gum in general practice. Br Med J (Clin Res Ed) 1984 Sep 29;289(6448):794–797. doi: 10.1136/bmj.289.6448.794. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jamrozik K., Vessey M., Fowler G., Wald N., Parker G., Van Vunakis H. Controlled trial of three different antismoking interventions in general practice. Br Med J (Clin Res Ed) 1984 May 19;288(6429):1499–1503. doi: 10.1136/bmj.288.6429.1499. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Janz N. K., Becker M. H., Kirscht J. P., Eraker S. A., Billi J. E., Woolliscroft J. O. Evaluation of a minimal-contact smoking cessation intervention in an outpatient setting. Am J Public Health. 1987 Jul;77(7):805–809. doi: 10.2105/ajph.77.7.805. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kornitzer M., Dramaix M., Kittel F., De Backer G. The Belgian heart disease prevention project: changes in smoking habits after two years of intervention. Prev Med. 1980 Jul;9(4):496–503. doi: 10.1016/0091-7435(80)90044-4. [DOI] [PubMed] [Google Scholar]
- Lam W., Sze P. C., Sacks H. S., Chalmers T. C. Meta-analysis of randomised controlled trials of nicotine chewing-gum. Lancet. 1987 Jul 4;2(8549):27–30. doi: 10.1016/s0140-6736(87)93061-3. [DOI] [PubMed] [Google Scholar]
- Li V. C., Coates T. J., Spielberg L. A., Ewart C. K., Dorfman S., Huster W. J. Smoking cessation with young women in public family planning clinics: the impact of physician messages and waiting room media. Prev Med. 1984 Sep;13(5):477–489. doi: 10.1016/0091-7435(84)90016-1. [DOI] [PubMed] [Google Scholar]
- Lichtenstein E., Weiss S. M., Hitchcock J. L., Leveton L. B., O'Connell K. A., Prochaska J. O. Patterns of smoking relapse. Health Psychol. 1986;5 (Suppl):29–40. [PubMed] [Google Scholar]
- Mattson M. E., Pollack E. S., Cullen J. W. What are the odds that smoking will kill you? Am J Public Health. 1987 Apr;77(4):425–431. doi: 10.2105/ajph.77.4.425. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mausner J. S., Mausner B., Rial W. Y. The influence of a physician on the smoking of his patients. Am J Public Health Nations Health. 1968 Jan;58(1):46–53. doi: 10.2105/ajph.58.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mermelstein R., Lichtenstein E., McIntyre K. Partner support and relapse in smoking-cessation programs. J Consult Clin Psychol. 1983 Jun;51(3):465–466. doi: 10.1037//0022-006x.51.3.465. [DOI] [PubMed] [Google Scholar]
- Morris J. F., Temple W. Spirometric "lung age" estimation for motivating smoking cessation. Prev Med. 1985 Sep;14(5):655–662. doi: 10.1016/0091-7435(85)90085-4. [DOI] [PubMed] [Google Scholar]
- Ockene J. K., Benfari R. C., Nuttall R. L., Hurwitz I., Ockene I. S. Relationship of psychosocial factors to smoking behavior change in an intervention program. Prev Med. 1982 Jan;11(1):13–28. doi: 10.1016/0091-7435(82)90002-0. [DOI] [PubMed] [Google Scholar]
- Oster G., Huse D. M., Delea T. E., Colditz G. A. Cost-effectiveness of nicotine gum as an adjunct to physician's advice against cigarette smoking. JAMA. 1986 Sep 12;256(10):1315–1318. [PubMed] [Google Scholar]
- Page A. R., Walters D. J., Schlegel R. P., Best J. A. Smoking cessation in family practice: the effects of advice and nicotine chewing gum prescription. Addict Behav. 1986;11(4):443–446. doi: 10.1016/0306-4603(86)90025-0. [DOI] [PubMed] [Google Scholar]
- Pederson L. L., Baldwin N., Lefcoe N. M. Utility of behavioral self-help manuals in a minimal-contact smoking cessation program. Int J Addict. 1981 Oct;16(7):1233–1239. doi: 10.3109/10826088109039176. [DOI] [PubMed] [Google Scholar]
- Pederson L. L. Compliance with physician advice to quit smoking: a review of the literature. Prev Med. 1982 Jan;11(1):71–84. doi: 10.1016/0091-7435(82)90006-8. [DOI] [PubMed] [Google Scholar]
- Richmond R., Webster I. Evaluation of general practitioners' use of a smoking intervention programme. Int J Epidemiol. 1985 Sep;14(3):396–401. doi: 10.1093/ije/14.3.396. [DOI] [PubMed] [Google Scholar]
- Rogot E., Murray J. L. Smoking and causes of death among U.S. veterans: 16 years of observation. Public Health Rep. 1980 May-Jun;95(3):213–222. [PMC free article] [PubMed] [Google Scholar]
- Rose G., Hamilton P. J. A randomised controlled trial of the effect on middle-aged men of advice to stop smoking. J Epidemiol Community Health. 1978 Dec;32(4):275–281. doi: 10.1136/jech.32.4.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Russell M. A., Jarvis M. J. Theoretical background and clinical use of nicotine chewing gum. NIDA Res Monogr. 1985;53:110–130. [PubMed] [Google Scholar]
- Russell M. A., Merriman R., Stapleton J., Taylor W. Effect of nicotine chewing gum as an adjunct to general practitioner's advice against smoking. Br Med J (Clin Res Ed) 1983 Dec 10;287(6407):1782–1785. doi: 10.1136/bmj.287.6407.1782. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Russell M. A., Wilson C., Taylor C., Baker C. D. Effect of general practitioners' advice against smoking. Br Med J. 1979 Jul 28;2(6184):231–235. doi: 10.1136/bmj.2.6184.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schachter S. Recidivism and self-cure of smoking and obesity. Am Psychol. 1982 Apr;37(4):436–444. doi: 10.1037//0003-066x.37.4.436. [DOI] [PubMed] [Google Scholar]
- Shaughnessy A. F., Davis R. E., Reeder C. E. Nicotine chewing gum: effectiveness and the influence of patient education in a family practice. J Fam Pract. 1987 Sep;25(3):266–269. [PubMed] [Google Scholar]
- Shiffman S. A cluster-analytic classification of smoking relapse episodes. Addict Behav. 1986;11(3):295–307. doi: 10.1016/0306-4603(86)90057-2. [DOI] [PubMed] [Google Scholar]
- Stewart P. J., Rosser W. W. The impact of routine advice on smoking cessation from family physicians. Can Med Assoc J. 1982 May 1;126(9):1051–1054. [PMC free article] [PubMed] [Google Scholar]
- Thompson R. S., Michnich M. E., Friedlander L., Gilson B., Grothaus L. C., Storer B. Effectiveness of smoking cessation interventions integrated into primary care practice. Med Care. 1988 Jan;26(1):62–76. doi: 10.1097/00005650-198801000-00007. [DOI] [PubMed] [Google Scholar]
- Tønnesen P., Fryd V., Hansen M., Helsted J., Gunnersen A. B., Forchammer H., Stockner M. Effect of nicotine chewing gum in combination with group counseling on the cessation of smoking. N Engl J Med. 1988 Jan 7;318(1):15–18. doi: 10.1056/NEJM198801073180104. [DOI] [PubMed] [Google Scholar]
- Tønnesen P., Fryd V., Hansen M., Helsted J., Gunnersen A. B., Forchammer H., Stockner M. Two and four mg nicotine chewing gum and group counselling in smoking cessation: an open, randomized, controlled trial with a 22 month follow-up. Addict Behav. 1988;13(1):17–27. doi: 10.1016/0306-4603(88)90021-4. [DOI] [PubMed] [Google Scholar]
- Wechsler H., Levine S., Idelson R. K., Rohman M., Taylor J. O. The physician's role in health promotion--a survey of primary-care practitioners. N Engl J Med. 1983 Jan 13;308(2):97–100. doi: 10.1056/NEJM198301133080211. [DOI] [PubMed] [Google Scholar]
- Wells K. B., Lewis C. E., Leake B., Schleiter M. K., Brook R. H. The practices of general and subspecialty internists in counseling about smoking and exercise. Am J Public Health. 1986 Aug;76(8):1009–1013. doi: 10.2105/ajph.76.8.1009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Werkö L. Prevention of heart attacks. A multifactorial preventive trial in Gothenburg, Sweden. Ann Clin Res. 1979 Apr;11(2):71–79. [PubMed] [Google Scholar]
- Wilson D., Wood G., Johnston N., Sicurella J. Randomized clinical trial of supportive follow-up for cigarette smokers in a family practice. Can Med Assoc J. 1982 Jan 15;126(2):127–129. [PMC free article] [PubMed] [Google Scholar]
- Windsor R. A., Green L. W., Roseman J. M. Health promotion and maintenance for patients with chronic obstructive pulmonary disease: a review. J Chronic Dis. 1980;33(1):5–12. doi: 10.1016/0021-9681(80)90080-6. [DOI] [PubMed] [Google Scholar]