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To the Editors:

I found the article "Tobacco Dependence Curricula in Acute Care Nurse Practitioner Education" (January 2002:27–33) very informative. On a weekly basis, I observe junior high school students walking to and from school smoking with their friends or by themselves. Tragically, they don’t understand the impact smoking will have on their future health. The former Surgeon General, David Kessler, MD, reports that more than 3000 teenagers will start to smoke each day. He refers to this as a "pediatric epidemic." Over the next century, there will be half a billion tobacco-related deaths worldwide.¹

It is imperative that we educate smokers and potential smokers about the health risks associated with tobacco. Unfortunately, healthcare professionals are not currently prepared for this task. The graduate school in which I am enrolled as a public health/family nurse practitioner student addresses this issue for only 1 or 2 hours during the entire curriculum.

In a survey of 126 US medical schools, the majority average less than 1 hour of instruction per year in smoking-cessation techniques. Only 3 medical schools offer courses devoted to tobacco education.²

Patients look to healthcare professionals for guidance to help them quit smoking. The 5 A’s (ask, advise, assess, assist, arrange) and the 5 R’s (relevance, risk, rewards, roadblocks, and repetition), along with pharmacological and other strategies to assist patients in quitting smoking, are motivational tools that need to be reinforced every time a smoking patient has a scheduled visit.³

Another guideline⁴ suggests ways that smokers can minimize their withdrawal cravings. It instructs the patient to increase fluid intake, especially water, herbal teas, and fruit juices, while avoiding or limiting the intake of coffee, soft drinks, and alcoholic beverages. The guideline encourages a low-calorie diet by snacking on carrots and other vegetables while not skipping meals. It also suggests that a regular exercise program will promote health and provide a new routine. The patient can try taking deep breaths to help the urge to smoke go away. Additionally, getting more rest will diminish nicotine cravings.

Pharmacological treatment can reinforce psychological motivation. Agents used for smoking cessation are bupropian SR, nicotine inhaler, nicotine nasal spray, nicotine patch, and nicotine gum.

Healthcare professionals can address the psychological needs by having patients remind themselves daily why they are quitting smoking. They should encourage patients to avoid places that they connect with smoking. They can also assist in developing and implementing a plan to help relieve stress. By setting up a support system with friends, family members, or a support group, the patient can receive help when the cravings become overwhelming.³

Tobacco use has deadly effects on smokers. Preventive steps need to be taken in the nation’s healthcare education programs. Nurses play a critical role as nurse educators in the deterrence of tobacco use. For healthcare professionals to be more effective, smoking-cessation techniques need to be covered more in depth in core curricula.

Anne Robinette, RN, BSN
Rockport, Mo

References

1. Sarna L. Prevention: tobacco control and cancer nursing. Cancer Nurs. 1999;22:21–28.[Medline]
2. Ferry L, Grissino L, Runfola P. Tobacco dependence curricula in US undergraduate medical education. JAMA. 1999;282:825–829.[Abstract/Free Full Text]
3. Department of Health and Human Services. Treating tobacco users and dependence: the quick reference guide. Available at: http://www.surgeongeneral.gov/tobacco. Accessed on February 15, 2002.
4. Department of Health and Human Services. You can quit smoking: tips for the first week. Available at: http://www.surgeongeneral.gov/tobacco. Accessed on February 15, 2002.

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