Quit Smoking: how professionals can help

Smoking increases the risk of cancer, heart disease, organ failure, and infections. With education, came the gradual decline of the prevalence of smoking in adults globally. But, it is no doubt, still one of the world’s leading health problems. Asia is home to the largest tobacco-producing companies and tobacco use is a major public health problem. However, some Asian nations have seen reduced tobacco use amongst their citizens, especially in Japan and Singapore, with the aid of legislation. Japan effectively banned smoking indoors since April last year. And Singapore just increased their minimum legal age for smoking to 21 years old.  But regardless of age, gender, or health status, quitting smoking has both short-term and long-term health benefits. Here’s a guide to how professionals can help you quit smoking. 

Quit Smoking: Adult Population 

A framework called the Five A’s has positive and consistent outcomes in helping smokers quit. The 5 A’s used by clinicians, which will be posed to a smoker, are:

Ask about tobacco use
Know the frequency, extent, type of tobacco use (e.g. cigars, pipes, smokeless tobacco, hookahs, bidis, electronic cigarettes), degree of dependence, and readiness to quit. 

Advise quitting
The rate of quitting increases if a clinician takes as little as 5 minutes to share cessation advice.  

Assess readiness to quit
To understand the smoker’s perspective to be able to provide a more individualised treatment plan. 

Assist smokers that are ready to quit
At this stage, clinicians explore resources and previous attempts to quit as well as methods that have previously been unsuccessful or successful. 

Arrange a follow-up
This aims to provide positive reinforcement, and to monitor responses to treatment. 

For individuals prepared to quit, a combination of pharmacotherapy and behavioural support is available. For individuals still in the decision making stages, motivation is a key factor needed for a more proactive approach. Relapse is also common among smokers with a lack of behavioural support. Smoking cessation may also bring about strong withdrawal symptoms, weight gain, and mood changes. 

Quit Smoking: Adolescent Population 

The biggest predictor of smoking in adulthood is smoking during adolescence, and adolescents are more vulnerable to forming smoking habits. 90% of adult smokers have smoked a cigarette before the age of 20.

Similar to the 5 A’s framework used in adult smoking cessation, adolescents can also be motivated to quit smoking by being counselled using the 6 A’s framework:

Anticipating the risk of smoking or vaping
Adolescents raised in households with parents or other family members who smoke often smoke as well. This risk should be highlighted and discussed to avoid the initiation of smoking. 

Asking about smoking or vaping and exposure
This can be done in confidentiality in the absence of authority figures to encourage the adolescent to speak honestly and freely about their exposure to tobacco.

Advising about the benefits of smoking cessation and discussing the risks of vaping
This is done to encourage adolescents to either quit or stay away from such products. In providing such advice, acute and chronic complications associated with smoking or vaping are also highlighted.

Assessing readiness to quit
An adolescent may be encouraged to quit within 30 days and in making this assessment, important things to discuss include the motivation to quit, possible obstacles, and past attempts to quit.

Assisting those who are ready to quit
Measures to assist those who are ready to quit includes determining a date to quit, counselling, and self-help resources. Further assistance can be provided by informing friends and family to create a supportive social environment that will encourage quitting. Possible challenges are identified so the adolescent is aware of things to avoid to prevent a relapse, these include experiencing withdrawal symptoms, cravings, changes to sleeping patterns, mood, and appetite, as well as other potential barriers like peer influence. 

Arrange follow up
Follow-ups should ideally be scheduled within the first week, and subsequent regular follow-ups can be arranged as indicated by a doctor. 

To further assist individuals who may not be ready to quit, various rewards systems, motivational techniques, or patient education may be explored. Patient education includes focusing on the benefits of smoking cessation such as improved physical fitness. Pharmacotherapy and nicotine replacement options may also be recommended for individuals with nicotine dependence. 

Behavioural Management and Pharmacotherapy 

Various behavioural management strategies can be utilised to successfully cease smoking. Some examples include: identifying triggers, encouraging appropriate responses, problem solving and coping skills, stress management, relaxation techniques, and supportive therapy. Participating in individual or group counselling may also have positive outcomes. While web applications and phone applications are available, more studies are still required to validate their claims of success.  

For ease of cessation, nicotine replacement therapy (NRT) is recommended as the first-line agent in providing nicotine without tobacco. There are long and short-acting NRTs which have been proven to be safe and effective (gastrointestinal side effects should be expected). Examples of NRTs include transdermal patches, chewing gums, lozenges, inhalers, nasal sprays, mouth sprays, and sublingual tablets. Prescription medication may also be recommended. A combination of different pharmacotherapy methods are recommended by medical professionals and self-medication is not advised. 

Pros and Cons

 The health benefits of smoking cessation are undeniable, in fact, some can be observed as soon as 8-12 hours of quitting. Smoking cessation reduces the risk of heart disease, cancers, lung disease, infections, diabetes, and osteoporosis. It also decreases the risk of fractures, fertility issues, stomach ulcers, oral / gum disease, eye disorders, and postoperative complications. 

However, there are also consequences that should be made known to those who wish to quit smoking. Due to the psychoactive nature of nicotine, dependence and tolerance are expected. The most common withdrawal symptoms are weight gain, depression in those with baseline psychiatric conditions, cough or mouth ulcers.