Cigarette Smoking Cessation Involving the 5-A Framework

Abstract

Occupational health nurses (OHNs) need to have adequate knowledge and skills to manage and educate individuals about smoking cessation.

Cigarette smoking is associated with significant health problems, accounting for approximately half a million deaths annually in the United States (U.S. Department of Health and Human Services [U.S. DHHS], 2014). Smoking-related diseases account for 32% of coronary heart disease deaths, 87% of lung cancer deaths, and 79% of all cases of chronic obstructive pulmonary disease (COPD; U.S. DHHS, 2014). Adverse physical effects include weight loss, elevated blood pressure, and heart rate (U.S. DHHS, 2014). Tobacco addiction is recognized as a serious disorder. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) describes 11 criteria to diagnose tobacco use disorder; at least two must be present in the prior 12 months, which could guide occupational health nurses (OHNs) during an initial assessment of workers with possible addiction (Saunders, 2017).

Many methods are available for smoking cessation. OHNs are well positioned to counsel workers to employ “quitline” counseling at https://www.cancer.gov/contact to improve cessation rates. The “5-A” framework intervention for smoking cessation can be effective which uses “ask, advise, assess, assist, and arrange” (U.S. Preventive Services Task Force [U.S. PSTF], 2014, para. 9). First, ask about smoking use that the U.S. PSTF (2014) encourages screening for tobacco use in all adults aged ≥18 years. Second, advise workers on how to quit using explicit personalized messages linked to their health goals of smoking cessation. Third, OHNs should assess previous attempts and barriers to quitting smoking, history of smoking, and willingness to quit. Finally, assist workers when they are deciding to quit smoking, provide information about pharmacotherapy, and arrange for counseling therapy sessions (U.S. PSTF, 2014).

Pharmacotherapy options include nicotine replacement therapy (NRT), sustained-release bupropion, and varenicline (Food and Drug Administration [FDA], 2016). NRT, such as lozenges, nicotine transdermal patches, gum, inhalers, or nasal spray, helps smokers to gradually taper off smoking tobacco over a period of months. NRTs are not recommended for individuals with unstable angina or those pregnant or breastfeeding.

Transdermal nicotine patches cause hypersensitivity, palpitations, tachycardia, and headache so caution is advised when using. Nicotine nasal dosages are 0.5 mg per actuation with a tapered dose over 4 to 6 weeks (FDA, 2016). Common reactions are nasal irritation, cough, rhinitis, and rhinorrhea; however, bronchospasm is a severe reaction. A nicotine inhaler is contraindicated with individuals with asthma, hepatic impairment, and cardiovascular diseases. Individuals may experience reactions when taking nicotine transmucosal (gum) such as hiccups, dyspepsia, diarrhea, or flatulence.

Bupropion hydrochloride treats smoking addiction and is prescribed 150 mg by mouth twice daily for 7 to 12 weeks. Contraindications are breastfeeding, seizure, and suicidal ideation; adverse side effects are tachycardia, insomnia, and weight loss (Stassinos & Klein-Schwartz, 2016). Chantix (varenicline) is another drug prescribed 1 mg orally twice daily for 11 weeks, and can cause nausea. OHNs should advise workers to take this medication with a full glass of water. Other severe complications are cardiac problems and mood behaviors (FDA, 2016).

Tobacco addiction is a serious public health issue. OHNs are well positioned to help workers quit smoking. Teaching smoking cessation using the “5-A” items of “ask, advise, assess, assist, and arrange” could be an effective intervention for workers.