Maximizing Smoking Cessation in Clinical Practice: Pharmacologic and Behavioral Interventions

Authors

  • Mitchell Nides PhD,

    1. From Los Angeles Clinical Trials, Los Angeles, CA;1 the University of Arizona, Tucson, AZ;2 the UCLA School of Nursing, Los Angeles, CA;3 and UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA4
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  • 1 Scott Leischow PhD,

    1. From Los Angeles Clinical Trials, Los Angeles, CA;1 the University of Arizona, Tucson, AZ;2 the UCLA School of Nursing, Los Angeles, CA;3 and UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA4
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  • 2 Linda Sarna RN, DNSc,

    1. From Los Angeles Clinical Trials, Los Angeles, CA;1 the University of Arizona, Tucson, AZ;2 the UCLA School of Nursing, Los Angeles, CA;3 and UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA4
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  • and 3 Sarah E. Evans PhD 4

    1. From Los Angeles Clinical Trials, Los Angeles, CA;1 the University of Arizona, Tucson, AZ;2 the UCLA School of Nursing, Los Angeles, CA;3 and UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA4
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Mitchell Nides, PhD, President, Los Angeles Clinical Trials, Director, “Picture Quitting,” The Entertainment Industry's Quit Smoking Program, 2990 South Sepulveda Boulevard, Suite 308, Los Angeles, CA 90025
E-mail: mnides@laclinicaltrials.com

Abstract

Clinicians are in a unique position to reduce cardiovascular morbidity and mortality by helping their patients quit smoking. At each visit, clinicians should document smoking status, provide strong and clear advice to quit, and recommend and prescribe pharmacotherapy for patients who are motivated to quit, which can double the odds of success. Effective pharmacotherapies include nicotine replacement, bupropion, and varenicline, which was recently approved by the Food and Drug Administration. Behavioral counseling to develop a quit plan and extended follow-up are critical to maximize quit rates but are rarely provided by clinicians due to time constraints and lack of expertise. As an alternative, the authors recommend referral to telephone quitlines that provide no-cost behavioral counseling by specialists. Hospitals should implement systemwide procedures to ensure that smokers are identified at admission and trained staff is available to provide smoking cessation consults that include a minimum of 20 minutes of inpatient counseling with follow-up for at least 1 month.

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