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New Year's resolution: why now is the best time to quit

Jennifer Percival
RN RM RHV FETCDip
Project Manager
RCN Tobacco Education

Many nurses see a rush of smokers each January as this is a popular time for people to attempt to quit the habit, but how important is timing? A new study found that spur-of-the-moment attempts to stop smoking are more likely to succeed than planned ones.(1) Researchers interviewed over 1,900 smokers and ex-smokers about their attempts to quit. Sixty-five per cent of the unplanned quit attempts had succeeded for at least six months. This compared with 45% of those who had planned to give up in advance.
It has traditionally been thought that the best way to beat the habit is for smokers to go through several stages - thinking about stopping, planning an attempt and making that attempt. The researchers said their findings do not imply that planning to quit is counterproductive. Professor West said: "The results do not mean that we should tell everyone to stop without planning ahead, but they do tell us something about the state of mind of the smoker who wants to quit."
Dissatisfaction with being a smoker creates a kind of tension. Then, when that tension is high, even quite a small trigger makes the smoker decide that the time has come to stop. These new findings suggest that some people can stop on the spur of the moment and that others benefit from planning a quit date.
Choosing the right date to stop smoking is a personal matter. Preparation is also generally advised, but for some people a spur of the moment decision also works. Either way, as a health professional your support will beimportant.

Changes to the NRT licensing arrangements
All smokers are encouraged to use a treatment product as this doubles their chance of success. However, many professionals have been confused over the different warnings and have had concerns about the safety of NRT products. So, it is a great step forward to learn that the Committee on Safety of Medicines (CSM) has recognised that, while nicotine has pharmacological effects, in most circumstances, the well-established dangers of continued smoking far outweigh any risk from NRT.(2) This means healthcare professionals can now safely advise on the use of NRT in the following groups:

Adolescents
NRT may be used by adolescents aged 12-18 years old, but as there are limited data on the safety and efficacy, duration should be restricted to 12 weeks.

Pregnant smokers
Ideally, pregnant women should stop smoking without using NRT but, if this is not possible, NRT may be recommended to assist a quit attempt as it is considered that the risk to the fetus of continued smoking by the mother outweighs any potential adverse effects of NRT. The decision to use NRT should be made following a risk-benefit assessment as early in pregnancy as possible. The aim should be to discontinue NRT use after 2-3 months. Intermittent forms of NRT are preferable during pregnancy, although a patch may be appropriate if nausea and/or vomiting are a problem. If patches are used, they should be removed before going to bed at night.

Breastfeeding
NRT can be used by women who are breastfeeding. The amount of nicotine the infant is exposed to from breastmilk is relatively small and less hazardous than the secondhand smoke they would otherwise be exposed to if the mother continued to smoke.

Cardiovascular disease
In patients with stable cardiovascular disease, NRT is a lesser risk than continuing to smoke. Dependent smokers with a myocardial infarction (MI), severe dysrhythmia or recent cerebrovascular accident (CVA) who are in hospital, should be encouraged to stop smoking with nonpharmacological interventions. NRT should be offered in any case where the alternative is the patient resuming smoking.

Using NRT to "cut down" cigarette consumption
NRT can now be used while still smoking with a view to reducing the amount smoked as a prelude to quitting. Details are available from the ASH website.(3)

Combining two products
More than one form of NRT can now be used concurrently. Combinations of patch and gum or inhalator may be useful for smokers who have relapsed when using a single form of NRT.

Product information
Some current packs may still contain outdated advice in the Patient Information Leaflet (PIL). This will be rectified soon. Further information on the recommendations is available on the ASH website.

Shock tactics - do antismoking campaigns drive smokers to quit?
Just as the New Year's rush ended, the Department of Health launched a new hard-hitting TV campaign to raise awareness of the emotional impact of smoking on both the people who become ill and their families. The new antismoking television adverts feature a real family. Trudi Endersby is only 43 but has terminal lung cancer and secondary brain cancer.
She is seen speaking frankly about "taking a gamble with smoking ... and losing". Trudi, who along with her daughters has already chosen her burial plot, now lives with the tragic consequences of her smoking habit. The films show her two daughters, aged 11 and 20, coming to terms with the results of their mother's 25-year-long smoking addiction. Trudi was only 38 when she was first diagnosed with an inoperable Pancoast tumour. Her life has been a daily struggle since then, as to control her pain she has needed radiotherapy, chemotherapy, daily morphine and steroids. The secondary tumour on her brain causes her to experience dizziness, pins and needles, headaches and be unbalanced in her walk. Her doctors have warned that it is unlikely that she will survive for more than two years and could die at any time.
The family volunteered to show the truth about smoking in order to encourage other smokers to give up before it was too late. Trudi said: "I'd never wish my suffering on my worst enemy."
Trudi's eldest daughter, Kirsti, explained: "My family and I have to live with the consequences of smoking every day. For us it's too late to undo the damage caused, but I just hope our ads help encourage those who do still have a second chance to give up smoking for good. I'm an ex-smoker so I know how difficult it can be to quit, but I also know what it's like having to plan your own mother's funeral and help prepare your little sister for a life without her mum. Nothing is more difficult than that."
The campaign is combined with adverts that promote the free help and support available through the NHS Stop Smoking services. Past campaigns featuring real people who are ill from smoking have been some of the most effective screened, resulting in thousands of referrals to the NHS Stop Smoking services.
So with the recent ban on smoking set to take effect in the summer of 2007, the new hard-hitting TV and radio campaigns, and the changes to the prescribing arrangements for NRT, now is a better time than ever to talk to smokers about stopping.
Just remember that each smoker is an individual who, when they decide to stop smoking, will have to find a way to live their lives without using tobacco. Providing motivational support plus a treatment product is the most effective method of helping them stop. But this still leaves room for a great variety of individual approaches, as each smoker has to learn how to get through the first 24 hours and each day after that without smoking. Apply your expert help and knowledge, as there has never before been so much on offer to help people quit.

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References

  1. West R, Sohal T. "Catastrophic" pathways to smoking cessation: findings from a national survey. Available from http://bmj.bmjjournals.com/cgi/content/abstract/bmj.38723.573866.AEv1
  2. Committee on Safety of Medicines. New advice on use of nicotine replacement therapy (NRT): wider access in at-risk populations. Available from http://www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dDocName=CON20229...
  3. ASH. Nicotine assisted reduction to stop (NARS):guidance for health professionals on this new indication for nicotine replacement therapy. Available from http://www.ash.org.uk/html/cessation/Smoking%20reduction/NARS051014.pdf
  4. ASH. Nicotine replacementtherapy: guidance for health professionals on changes in the licensing arrangements for nicotine replacement therapy. Available from http://ash.org.uk/html/cessation/Smoking%20reduction/NRT051229.pdf

Resources
Action on Smoking and Health (ASH)
W:www.ash.org.uk