The term “smoking cessation” is used to refer to the act of quitting smoking. Smoking cessation involves breaking both the smoking habit and nicotine addiction. Research has shown that breaking nicotine addiction and the smoking habit are hard tasks and requires special intervention measures, such as medical and therapeutic treatments and counseling (Karnath, 2002). According to Karnath (2002), smoking cessation is accompanied by severe withdrawal effects, such as anxiety, depression, agitation, insomnia, and weight gain. Nevertheless, these withdrawal effects are often temporary, and quitting smoking yields substantial health benefits, including reducing the risks of cancer and heart diseases that are elevated by smoking.
Despite the difficult nature of smoking cessation, various methods, programs, and resources are available for helping the addicts to successfully rehabilitate from smoking. For instance, there are numerous specialists, such as counselors and doctors, who have been trained to help addicts to quit smoking without or with minimal struggles (Karnath, 2002). Drugs, such as atypical antidepressants and nicotine agonists have been used to successfully help smoking addicts quit the smoking habit (Karnath, 2002). Besides, some individuals successfully quit unassisted, either nicotine gum and patches, cold turkey, or using electronic cigarettes (Karnath, 2002). To modify my smoking behavior, I conducted literature review on smoking cessation with the aim of developing the actual implementation of my smoking cessation. More specifically, I performed a comparative analysis of the various available smoking cessation procedures to come up with the best plan of action that may I needed to apply to help in addressing my smoking habit, and subsequently help to prevent the health issues that come with smoking.
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Problem Statement
Two factors triggered me to decide starting smoking cessation. First, smoking has been the leading factor in causing my health issues and degradation my financial status. Secondly, smoking is a dangerous environmental polluting factor. Generally, s moking is the leading risk factor for causing avoidable deaths in the United States (Karnath, 2002). Smoking exposes both the active smokers and the passive smokers to dangerous health issues, such as lung cancer, heart diseases, and respiratory health issues (Staff, 2019). Smoking emissions, such as carbon (II) oxide and carbon (IV) oxide act as air pollutants, and subsequently endanger all the earthly life forms (Staff, 2019). Carbon (II) oxide is highly poisonous and when inhaled complicates the respiratory organs, or even leads to death. Carbon (IV) oxide, on the other hand acts as a greenhouse gas, leading to global warming. Despite these health problems accruing from smoking, 24% of the United States’ adult population continues to smoke (Staff, 2019). About 70% of this smoking population usually visits various healthcare facilities in the United States, yet only 50% of these patients report to have been advised to quit smoking by their healthcare professionals (Staff, 2019). Even those who are advised to stop smoking find it difficult to quit due to the addictive power of the nicotine and the severity of the accompanying withdrawal effects.
Consequently, I decided to do smoking cessation program to act as an example to the rest of the smokers so that they also borrow from my experience and help in establishing a healthy nation. Some of the expert groups, such as Agency for Health Care Policy, the National Cancer Institute, and other researchers have previously suggested varying protocols for smoking cessation interventions for use by physicians in their office practices. For example, pharmacotherapy practices, particularly replacement therapy, have been recommended for the patients wishing to quit smoking (Staff, 2019). However, pharmacotherapy has not been successful due to high cost requirements. Thus, smoking continues to threaten both human lives and other life-forms on earth. For effective smoking cessation, I chose the incorporation of non-pharmacologic therapies, such as counseling, along with the pharmacotherapy practices for effective smoking cessation (Staff, 2019). Physicians, individuals, or group counseling offer education programs that play a key role in managing the psychological part of smoking addiction, and subsequently help the smokers to effectively quit smoking (Staff, 2019). Thus, if the non-pharmacologic therapy practices are implemented, the national will become a smoke free in the near future.
Summary of the Four Primary Sources
Four primary credible resources related to smoking cessation practices were used to back up this research. The credibility of the resources was examined based on time of publication, the authors’ profile, and the purpose of the article used as a source. For instance, the four primary articles used to back up this research are not older than ten years of publication, are authored by specialists in the field of healthcare, and are written purposely to address the challenges offered by smoking cessation. A summary of the four selected articles for supporting this research is as described below:
Do, HP., Tran, BX., Pham, QL., Nguyen, LH., Tran, TT., Latkin, CA., Dunce, MP., & Baker, PRA. (2018). Which eHealth interventions are most effective for smoking cessation? A systematic review: Journal of Patient Preference and Adherence. 12: 2065-2084.
In this article, the authors conducted a systematic review to investigate the most effective method for smoking cessation. The article purposed at synthesizing the evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions for the purpose of helping people quit smoking. During their research, Do et al. (2018) used four data bases, including MEDLINE, The Cochrane, PsycINFO, and Embase and relevant key search terms to come up with relevant studies. Their review involved 108 studies and 110,372 participants. Do et al. (2018) concluded that interventions with web-based and mHealth smoking cessation moderately increased abstinence.
This article was useful for this research as it is related to smoking cessation. In fact, the article provided the best smoking cessation practices, which were the key area of this research paper. The authors of this article are all professionals from distinct health institutions, such as Duy Tan University, Hanoi Medical University, and Hue University. This implies that the information obtained in this article is reliable and credible for use in this research paper. Besides, the article was published in 2018, meaning that it is up to date.
Hersi, M., Traversy, G., Thombs, B. D., Beck, A., Skidmore, B., Groulx, S., … Stevens, A. (2019). Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review. Systematic reviews , 8 (1), 28. DOI: 10.1186/s13643-018-0928-x
In this article, Hersi et al. (2019) purposed at determining the effectiveness of stop smoking strategies for adult people. Some of the strategies investigated in this article are electronic cigarettes, pharmacotherapy, exercise interventions, behavior change interventions, complementary, and alternative medicine interventions. Vulnerable groups used in this study included adults with co-morbid conditions, various demographic factors, pregnant women, and distinction of opportunistic and treatment seeking patients. According to this article, smoking cessation minimizes the risk of diseases related to smoking and premature death (Hersi et al., 2019). This article established that the earlier recommendations for smoking cessation intervention guidelines given by the international organizations are consistent with the recommended pharmacotherapies, such as NRT, bupropion, and varenicline, and behavioral interventions for smoking cessation (Hersi et al., 2019).
Several factors made this article credible and reliable for use in this research. First, the article was written by authors of high profile. All authors are professionals from recognized institutions, such as Ottawa Hospital Research Institute, Public Health Agency of Canada, and Knowledge Synthesis Group. Secondly, the article was critical for the research, as it related to smoking cessation. The information availed by this article was pivotal in coming up with the recommendations that this research paper adopted. Finally, the article is up to date, as it was published in 2019; meaning that it covers all the emerging intervention factors for smoking cessation.
Kim, B., Yoo, S., & Cho, S-i. (2018). Association between stages of change for smoking cessation and electronic cigarette use among adult smokers: A nationwide cross-sectional study in Korea. PLoS ONE 13(9): e0204244. https://doi.org/10.1371/journal.pone.0204244
The primary goal of this article was to investigate whether those people who are ready to quit smoking are more likely to use electronic cigarette than those who are not ready to quit. The research used public data from 2014 Korea Community Health Survey for disease control and prevention. The participants used in this study are those with certain characteristics of socio-demographic factors, such as sex, marital status, education, age, and income, as well as cessation-related factors, such as self-reported stress, family smoking status, alcohol consumption, and districts with smoke-free regulation residences. In this article, Kim, Yoo, and Cho (2018) established that smokers aged below 50 years are more likely to use electronic cigarettes in some point of their lifetime than those smokers in the precontemplation stage.
Although this article was centered at making a comparison between the stages of change for smoking cessation and electronic cigarette among adult smokers, it played a key role in determining the role of e-cigarette in enhancing smoking cessation. The article was credible for use because it was written and published by reliable authors. For instance, the authors are all recognized people from distinct healthcare institutions, such as Ministry of Health and Welfare, and Seoul National University. The article was published in 2018, meaning that it contains information that is up to date.
Odorico, M., Goff, D.L., Aerts, N., Bastiaens, H., & Reste, J.Y.L. (2019). How to Support Smoking Cessation in Primary Care and the Community: A Systematic Review Of Interventions For The Prevention Of Cardiovascular Diseases: Vascular Health and Risk Management, 15: 485-502.
The authors of this article primarily aimed at identifying effective non-pharmacological interventions for smoking cessation that may be useful in a community setting or in a primary care setting. According to this article, community-based public interventions, such as mass media involvement, information campaigns, community events, are among the identified non-pharmacological interventions (Odorico et al., 2019). Although these public-based intervention methods for smoking cessation showed little effect on quitting rates among adults, Odorico et al. (2019) found that the methods had significant positive impacts in increasing the smoking cessation rates among the young smokers. Perhaps, the variation in the influence of the community-based public interventions for smoking cessation between adults and young generation is because youth are more followers of mass media than the aged.
This article is also related to smoking cessation, hence useful for coming up with reliable recommendations for this research article. The authors are from recognized healthcare institutions, such as University of West Brittany and University of Antwerp; hence the information offered in this article was credible and reliable for use in the research. The article was published in 2019, hence up to date, and subsequently contains the current information regarding smoking cessation. Other articles consulted in this research are listed in the reference page.
Review of Empirical Articles
Most of the consulted articles had performed an overview of a variety of “stop smoking” interventions. More specifically, most of the scholars conducted studies to compare the efficacy of a variety of pharmacological interventions and non-pharmacological interventions for smoking cessation. The most cited pharmacological interventions for smoking cessation are bupropion, cytisine, NRT, and varenicline. Physician counseling, on the other hand, has been highly recommended by most of the articles. Therefore, most of the articles centered their studies on examining the advantages of non-pharmacological interventions over the pharmacological interventions for smoking cessation. Also, the merits of pharmacological interventions over the merits of non-pharmacological interventions have been examined.
Most of the consulted articles used a systematic review of international CVD prevention guidelines as well as international guidelines applied in various countries of study. Other articles used a comparative analysis of the effectiveness of the existing interventions for smoking cessation and the most recent interventions for smoking cessation. Yet, other articles used randomized trials to compare between the effectiveness of the available intervention procedures for smoking cessation. The participants used in most of the consulted articles are those with certain characteristics of socio-demographic factors, such as sex, marital status, education, age, and income, as well as cessation-related factors, such as self-reported stress, family smoking status, alcohol consumption, and districts with smoke-free regulation residences.
Most of the authors appreciate the contribution of the pharmacological interventions for smoking cessation in improving the chances of quitting. The effectiveness of these pharmacological interventions varies from one drug to the other. For instance, a combination of NRT and varenicline has been cited as the most effective pharmacotherapies for smoking cessation interventions (Cahill et al., 2013). However, Do et al. (2018) established that non-pharmacological interventions for smoking cessation are the most effective for yielding long-term quitting. For instance, p hysicians, individuals, or group counseling offer education programs that play a key role in managing the psychological part of smoking addiction, and subsequently help the smokers to effectively quit smoking (Staff, 2019). Overall, most of the authors recommend the application of both pharmacological and non-pharmacological interventions for smoking cessation in order to yield a long-lasting solution to the smokers. These results offered an excellent foundation for the smoking cessation practices that I adopted.
The Behavior Change Plan for Smoking Cessation
The smoking cessation practice that I adopted was in line with the earlier findings from the literature review and other implementation plans developed by authors, such as Gould et al. (2017). In this regard, I established that the best behavior change plan for smoking cessation should be based on a combination of both pharmacological and non-pharmacological interventions. Other words, the best evidence-based smoking cessation care should combine the application of counseling and appropriate forms of pharmacotherapy (Gould et al., 2017). A combination of the two methods of treatment is likely to yield better results than when each intervention is used alone. For instance, non-pharmacological therapies, such as counseling, play a key role in managing the psychological part of smoking addiction (Staff, 2019). The pharmacological therapies, such as combined NRT and varenicline, on the other hand, play a critical role in eradicating the withdrawal symptoms, such as depression, increased appetite, irritability, difficult concentrating, restlessness, weight gain, and trouble sleeping (Staff, 2019).
For the sake of the readers who may wish to adopt my smoking cessation plan, I find this information necessary for them: pharmacological therapies work best for smokers willing to quit. According to Cornuz and Willi (2008), recommendation for smoking cessation program for smokers unwilling to quit is usually immature and ineffective. Thus, smokers unwilling to quit should first be taken through a counseling program using the “ 5 Rs ” (relevance, risks, rewards, roadblocks, and repetition) motivation intervention as provided by the USA practice guidelines (Cornuz & Willi, 2008). This counseling program involves identification of the relevance of the smoking cessation to the patient, identification of the risk factors associated with smoking, identification of the rewards of smoking cessation to the patient, identification of the roadblocks towards smoking cessation and the best practice to overcome them, and the repetition of the patient education on the importance of quitting each time the patient visits the clinic (Cornuz & Willi, 2008). This counseling procedure is critical for slowly triggering the smokers to accept quitting.
For my case, I was already willing to quit smoking; therefore, I went direct to the next intervention step, which is attempting the smoking cessation. Here, I consulted my physician on the best cessation plan. The physician, provided me with the most applicable counseling, provided intra-treatment social support, helped me with extra-treatment support, made the appropriate recommendation for the approved pharmacotherapy, and provided supplementary materials for smoking cessation (Cornuz & Willi, 2008). Next, the physician offered me with the basic didactic information regarding smoking cessation (Cornuz & Willi, 2008). For instance, the physician advised me to make quitting the first priority. Withdrawal effects occurred on the fourth week after attempting to quit (Cornuz & Willi, 2008). Therefore, my physician subjected me to thorough treatment using a combination of NRT and varenicline, which facilitated my recovery from the withdrawal effects. Besides, my physician performed relapse prevention on me, where I successfully overcame any set-back during the quitting process (Cornuz & Willi, 2008). For instance, the physician advised me to bank on my strengths while trying to overcome my weaknesses.
Other factors that need to be put into considering were social and economic factors that drive people into smoking habits. These factors include cigarette prices, social norms, and the marketing behavior of the cigarettes (Cornuz & Willi, 2008). My physician advised me to avoid areas where I was likely to have quick access to the cigarettes. Besides, I followed the behavior change wheel, as described on Figure 1 below, for effective modification of my behavior. The behavior change wheel (BCW) follows the COM-B model (Gould et al., 2017). According to Gould et al. (2017), this model expands to capability (C), opportunity (O), and motivation (M), which combine to define behavior (B). As can be seen on Figure 1 below, the behavior change wheel is utilized to connect behavioral influences, as identified by the COM-B to potential intervention functions as well as policy categories (Gould et al., 2017).
Figure 1: Behavior Change Wheel, image by Gould et al. (2017).
Evaluation of the Change Implementation
This change implementation involves a combination of both pharmacological and non-pharmacological therapies for smoking cessation. To come up with a tangible plan of action for the implementation, three steps were followed. First, literature review was conducted to identify the pharmacological therapies that are currently recommended by the specialists from various healthcare institutions. This helped to come up with the best treatment plan for the withdrawal effects that accompany smoking cessation. In this regard, a combination of NRT and varenicline was identified as the best treatment practice for the withdrawal effects of smoking cessation. Secondly, literature review was conducted to come up with the most effective non-pharmacological interventions for smoking cessation. Here, counseling, following 5Rs of motivation, was recommended. Finally, literature review was conducted to establish which intervention plan (between pharmacotherapy and non-pharmacotherapy) gives the best results. Although many authors recommend non-pharmacotherapy intervention over pharmacotherapy, this paper later established that a combination of the two would work better than when one is used independently.
Generally, my smoking cessation plan has been a successful one. After following the above described procedure for smoking cessation, I learnt that smoking cessation is possible. It only calls for one’s commitment to adhere to the quitting program for successful rehabilitation. However, my smoking cessation plan was encompassed with some set-backs. Severe withdrawal effects, such as agitation, irritability, increased appetite, and depression occurred on the fourth week after attempting to quick. As a result, I sought medication from my physician to overcome the withdrawal effects. Besides, consulting the physician and the purchase of drugs, such as NRT and varenicline was costly, and I spend a significant amount of money before I fully recovered from the smoking habit. However, the plan yielded substantial benefits to me, such as restoring my health, minimizing my future financial expenditures, and environmental conservation. This plan is suitable for use in creating a smoking-free nation, and subsequently helps in eliminating the rising cases of avoidable health hazards and deaths associated with smoking. The results availed in this paper are, therefore, recommendable for use at the clinic setting to help in fostering smoking cessation .
References
Cahill, K . , Stevens, S . , Perera, R . , & Lancaster, T . (2013) . Pharmacological interventions for smoking cessation: an overview and network meta-analysis: Cochrane Database Syst Rev. 31 (5): CD009320; DOI: 10.1002/14651858.CD009329.pub2
Cornuz, J., & Willi, C. (2008). Nonpharmacological smoking cessation interventions in clinical practice: European Respiratory Review. 17 : 187-191; DOI: 10.1183/09059180.00011003
Gould, G.S., Bar-Zeev, Y., Bovill, M. et al. (2017). Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implementation Sci 12, 114; DOI: 10.1186/s13012-017-0645-1
Karnath, B. (2002). Smoking Cessation: PlumX Metrics. 112(5): 399-405. DOI: https://doi.org/10.1016/S0002-9343(01)01126-3
Staff. (2019). Smoking Cessation: Pharmacist. 44 (7): 13-14. [Online]. Retrieved December 11, 2019; from https://www.uspharmacist.com/article/smoking-cessation-1
