Encouraging smoking cessation is the most effective intervention family physicians and nurse practitioners can make to improve their patients’ quality of life and increase their lifespan (1
). In as little as 30 s, Canadian family physicians can help their patients double or triple their chances of quitting (3
). This can significantly improve patients’ current and future health, as well as the sustainability of public health in Canada.
Currently, more than 4.9 million (18.6%) adult Canadians smoke (4
). Rates vary by province, with the highest in Saskatchewan (23.7%), and lowest in British Columbia (16.4%) and Ontario (16.6%) (). More Canadian men than women are current smokers, but this gap is closing because more men are quitting whereas quit rates among women have plateaued. Overall, smoking prevalence has decreased significantly in the past decade. This is likely due to an increase in tobacco prices, public education about the dangers of smoking, the existence of smoking bans in public places from coast to coast, changes in the public’s and the media’s attitudes toward smoking, and the availability of new and more efficacious treatments for tobacco dependence.
Figure 1) The percentage of current smokers by province, 2006. The column at the far right represents the national rate (Total). AB Alberta; BC British Columbia; MB Manitoba; NB New Brunswick; NL Newfoundland and Labrador; NS Nova Scotia; ON Ontario; PE Prince (more ...)
Busy practitioners sometimes miss the opportunity for providing smoking cessation interventions because of competing health priorities, lack of confidence and the significant difficulties patients have in quitting, even in the face of serious smoking-related illnesses (5
). Moreover, certain myths persist that prevent some health care providers from following through with smoking cessation advice (). This helps explain why a survey (6
) of family physicians in Montreal, Quebec, found that only 10.5% provided ‘thorough’ smoking cessation counselling, and less than one-half offered adjunct support to patients. In contrast, a recent survey (7
) found that more than one-half of smokers would be interested in nicotine replacement therapy if it were offered free of charge.
Common myths among physicians regarding smoking
Smoking kills one in two smokers (8
), and the sequelae of tobacco dependence kill approximately 10% of adults worldwide (9
). No other product exists that causes the premature death of 50% of those who use it exactly as intended. Tobacco use is a risk factor for six of the eight leading causes of death worldwide, including ischemic heart disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis, and cancers of the trachea, bronchus and lung (10
). Moreover, recent data from the Nurses’ Health Study (11
) indicate that current smokers have nearly three times the risk of premature death compared with nonsmokers. The data also show that smokers have more than seven times the risk of developing smoking-related cancers. Another study (12
) indicated that when heavy smokers reduced their daily cigarette smoking by as much as 50% without going on to quit, their risk for premature death is not significantly lowered.
In Canada, smoking is the leading preventable cause of premature death (13
). It is estimated that 515,608 years of life were lost prematurely in Canada in 2002 – 316,417 years in men and 199,191 years in women (14
). Family physicians and nurse practitioners are uniquely positioned to initiate smoking cessation because they see their patients more frequently and for longer periods of time than do specialists, and often develop a strong rapport with their patients. Because smoking is a chronic addiction, repeated, opportunity-based interventions are most effective in addressing physical dependence and modifying deeply ingrained patterns of beliefs and behaviour. Simple counselling advice, support and appropriate pharmacotherapy can be effective in many cases (1
). The present article identifies current international best practices that family physicians and nurse practitioners can use to help their patients stop smoking and discusses them into the context of therapies available in Canada.