32 PART I: PATIENT EDUCATION
havenotmadehealthychoices,theseaccoladeswillmake
a signicant difference in making greater strides toward
thesuccessoftheirmodicationplan.
Smoking
Smoking continues in today’s society with an estimated
20.6percent
14
ofalladults(aged18yearsandolder)par-
ticipating.Cigarettesmokingisamajorcauseofmorbidity
andmortalityintheUnitedStates;itcausedapproximately
443,000deathsasreportedin2008asaresultofprimary
andsecondarysmoke
15
(Figure 3–1).Itisahighlyaddic-
tive behavior that has both physical and psychological
components.Withtheexceptionofalcoholuse,itmaybe
themostdifcultbehaviortomodify.Therearenolow-or
moderate-use levels considered to be appropriate. Total
cessationistheonlyacceptablehealthchoice.Manysmok-
ersquitforaperiodoftime,andthemajoritywhorelapse
dosowithinayear.
Thereareanumberofsmokingcessationprogramsand
medical practices that offer cessation programs. Well-
planned,directed,anddeliveredcessationprogramswith
support groups tend to have better success rates. Some
cessationprogramsemploytechniquesusingpharmaceuti-
calaids,suchasvariousnicotinedeliverysystemsfornico-
tinereplacementtherapy(NRT), suchas gum, lozenges,
nasalspray,transdermalpatches,andinhalers.Thegum,
lozenges,andpatchesareavailableoverthecounter, but
thesprayandinhalerarebyprescriptiononlyintheUnited
States.Replacementmethodsaremeanttobeatemporary
solution,andthegoalistoweanthepatientfromallnico-
tineusewithin3to6 monthsdependingonthetypeof
NRT used. Systemic prescription medications, such as
bupropion(150mgSR)orvarenicline(0.5mgor1mg)
may also be considered. Bupropion can be used in con-
junctionwithNRT.Prescriptionmedicationshaveproven
to be benecial, but as with all medications, results are
specictotheindividualandprecautionsshouldbetaken
for side effects. The healthcare provider should consult
package information, support information, and the
Physicians’ Desk Referenceforproductinformation.Support
shouldbegivenineverywaypossibletopatientswhoare
tryingtostopsmoking.
Regardlessofthemethodchosenforsmokingcessation,
somegeneralstepsshouldbetakenpriortobeginningthe
cessationeffort.Itisessentialtodiscusssmokingcessation
ateveryvisit.Themorefrequentthediscussion,themore
likelythesuccessofbehavioralmodication.Motivational
interviewing techniques have proven to be benecial in
smokingcessation.
7
Healthcareproviderswhobecomewell
practicedinthefourprinciplesofmotivationalinterviewing
willndthatthepatientwillgainownershipoverhisorher
behaviormodicationprocessmuchmorequickly.Health-
care providers should educate patients to the benets of
cessationandtherisksofcontinuation.Patientsshouldbe
helped to understand why and when they smoke. These
things can be completed in the context of motivational
interviewing. The patient’s signicant others should be
Table 3–1
Physical Activity Guidelines for Americans
For important health benets adults need at least:
2 hours and 30 minutes (150 minutes) of moderate-
intensity aerobic activity (i.e., brisk walking) every
week
and
muscle-strengthening activities on 2 or more days a
week that work all major muscle groups (legs, hips,
back, abdomen, chest, shoulders, and arms).
Or
1 hour and 15 minutes (75 minutes) of vigorous-
intensity aerobic activity (i.e., jogging or running)
every week
and
muscle-strengthening activities on 2 or more days a
week that work all major muscle groups (legs, hips,
back, abdomen, chest, shoulders, and arms).
Or
An equivalent mix of moderate- and vigorous-intensity
aerobic activity
and
muscle-strengthening activities on 2 or more days a
week that work all major muscle groups (legs, hips,
back, abdomen, chest, shoulders, and arms).
Source: Centers for Disease Control and Prevention. Physical activity for
everyone. http://www.cdc.gov/physicalactivity/everyone/guidelines/
adults.html. Accessed August 15, 2010.
Other
Diagnoses
44,000
Stroke
15,900
Other Cancers
35,300
Lung Cancer
128,900
Ischemic Heart
Disease
126,000
Chronic Obstructive
Pulmonary Disease
92,900
*Average annual number of deaths, 2000-2004.
ABOUT 443,000 U.S. DEATHS ATTRIBUTABLE
EACH YEAR TO CIGARETTE SMOKING*
Figure 3–1 Annual deaths attributable to cigarette smoking—United
States, 2000–2004.
Source: CDC SAMMEC, MMWR 2008;57(45):1226–1228.

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