Smoking Cessation Strategies Pharmacists Can Use to Engage Patients and Promote Action
Now is a good time to encourage patients to stop smoking because November 17 is the Great American Smokeout, an event aimed at encouraging smokers to make a plan to quit. Many communities’ attention will be focused on smoking following the nationwide event, and the best way to grab the attention of a new group of smokers is to stop repeating the same old warnings that have become so commonplace they’re easy to tune out.
Pharmacists have a better chance of getting the message across and engaging patients by targeting health concerns that haven’t been widely advertised, like smoking’s detrimental impact on Crohn’s disease and letting them know that smoking is the top risk factor for bladder cancer—the fourth most common cancer in men.
Prevalence of Cigarette Smoking in the U.S.
Smoking cessation campaigns have resulted in some success. The proportion of adults who smoke cigarettes declined from nearly 21 percent in 2005 to 15 percent in 2015, while the proportion of daily smokers dropped from 16.9 percent to 11.4 percent.1 However, prevalence rates continue to show significant differences between various demographic factors:
- More men smoke than women – prevalence is 16.7 percent among men and 13.6 percent among women.
- Adults aged 25 to 44 have the highest consistent prevalence – 17.7 percent in this age group smoke.
- Adults younger than 25 have prevalence rates ranging from 34 percent among those with a GED to a low of 3.6 percent in those with a graduate degree.
- People with incomes below the poverty level have a smoking prevalence of 26 percent, which is double the 13.9 percent in people earning above that level.
- Smoking prevalence is also higher among adults with a disability, ranging from 21.5 percent in adults reporting they have a disability to 40.6 percent in people with psychological disorders.
While the downward trend in smoking is great, the fact is that smoking prevalence rates are still high. The survey that produced the data is likely to have underestimated prevalence due to a response rate of just 55.2 percent, which caused the researchers to suspect a nonresponse bias. Another concern on the horizon is that spending on tobacco control programs across all states is projected to be well below the level needed to continue the downward trend. These factors all converge to point to the importance of ongoing community support from pharmacists.
Smoking Cessation Strategies That Target Unique Patients
Your patients expect to see advertisements warning them about dangers like lung cancer and pulmonary disease. There’s even a television campaign aimed at teens and young adults telling them that smokers earn less money over their lifetimes compared to nonsmokers. While there’s nothing wrong with the ongoing themes, you have a better chance of getting attention by putting up informative posters that target health risks people seldom hear about, such as:
November is also Bladder Health Month—and smoking is the biggest risk factor for bladder cancer—so the Great American Smokeout offers a prime opportunity to focus on this health concern. The risk of bladder cancer may seem like a remote concern to some patients because it’s primarily diagnosed in people older than 55, but it’s vital to stress the importance of quitting cigarettes while they’re young enough to prevent the cancer from forming. You may want to target men because they’re at a higher risk than women. In fact, bladder cancer is the fourth most common cancer in men.2
- Smokers are at least three-times more likely to get bladder cancer as nonsmokers.3
- Bladder cancer is the fourth most common cancer in men—lifetime risk of developing bladder cancer in men is about 1 in 26; for women the chance is 1 in 88.
- Smoking causes half of all bladder cancers in men and women.
- Bladder cancer accounts for 5 percent of all new cancers in the US.
Aggravated Crohn’s disease:
A study published in the July 2016 issue of the Journal of Clinical Gastroenterology found that only half of all patients with inflammatory bowel disease (IBD) are aware that smoking aggravates symptoms of Crohn’s disease.4 More importantly, their intent to quit smoking was directly related to their awareness of the association. Out of 259 patients who completed the survey, nearly 20 percent were smokers. Based on the estimated 780,000 Americans with Crohn’s disease—growing at the rate of 33,000 new cases yearly—that 20 percent represents a significant number of patients who need to learn about the impact of smoking on their disease.5
You can also target patients who aren’t currently diagnosed with IBD with two other pieces of information:
- Smokers have double the risk for developing Crohn’s disease compared to nonsmokers.
- Exposure to passive smoke during childhood may increase the risk for Crohn’s, although few studies have been published and more research is needed to verify the association.6
Outreach Should Include Referrals and Funding Information
The goal of putting up posters about smoking and its association with bladder cancer and Crohn’s disease is getting patients to ask about help with smoking cessation, so it’s smart to create an endcap display with products they can use. Also be sure the posters suggest they “ask the pharmacist,” as you can provide additional information about online or local smoking cessation programs and let patients know whether their insurance might cover such costs.
- American Lung Association: Their website includes links to two online support communities, a self-help workbook, and recommends a mobile app to develop a personalized quitting plan.7
- American Cancer Society: Offers online advice to get smokers over the rough patches and links to other online resources.8
- Confirmation of insurance coverage: Patients with private insurance will need to check about their coverage. While changes in coverage may take place over the next few years, the Affordable Care Act currently requires all Medicaid programs to cover smoking cessation programs, but no specific guidelines have been established when it comes to FDA-approved medications and the different forms of counseling. Medicare currently covers two counseling attempts for all participants, for a total of eight sessions every 12 months. Questions still abound about precise coverage, so it’s essential to encourage patients to check in with their invidual plans.9
Improve Health and Life Expectancy by Supporting Smoking Cessation
The list of health concerns related to smoking is quite long. In addition to the obvious effects on lungs, the bladder, and the gastrointestinal tract, nearly every organ can be affected and lifespan inevitably shortens. Cigarette smoking causes nearly one in five deaths and kills more than HIV, alcohol, illegal drugs, motor vehicle injuries, and firearm-related incidents combined.10 As a serious addiction that’s hard to stop, smokers truly need wide-spread support, including the awareness, information, and guidance offered by pharmacists.
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- “Current Cigarette Smoking Among Adults – United States, 2005 – 2015,” November 2016, http://www.cdc.gov/mmwr/volumes/65/wr/mm6544a2.htm?s_cid=mm6544a2_w ↩
- “Key Statistics for Bladder Cancer,” May 2016, http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-key-statistics ↩
- “Bladder Cancer Risk Factors,” May 2016, http://www.cancer.org/cancer/bladdercancer/detailedguide/bladder-cancer-risk-factors ↩
- “Patients With Inflammatory Bowel Disease Are Unaware of the Impact of Smoking on Their Disease,” July 2016, https://www.ncbi.nlm.nih.gov/pubmed/26196475 ↩
- “The Facts About Inflammatory Bowel Disease,” November 2014, http://www.ccfa.org/assets/pdfs/updatedibdfactbook.pdf ↩
- “The Influence of Second-Hand Cigarette Smoke Exposure During Childhood and Active Cigarette Smoking on Crohn’s Disease Phenotype Defined by the Montreal Classification Scheme in a Western Cape Population, South Africa,” September 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589355/ ↩
- “How to Quit Smoking,” accessed November 2016, http://www.lung.org/stop-smoking/i-want-to-quit/how-to-quit-smoking.html ↩
- “Quitting Smoking: Help for Cravings and Tough Situations,” November 2014, http://www.cancer.org/healthy/stayawayfromtobacco/quitting-smoking-help-for-cravings-and-tough-situations ↩
- “Obama Administration Delays Necessary Tobacco Cessation Coverage Clarification,” October 2016, http://www.lung.org/about-us/media/press-releases/obama-administration-delays-tobacco-cessation-coverage-clarification.html ↩
- “Health Effects of Cigarette Smoking,” October 2015, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/ ↩