Use 5A approach to help smokers kick the habit
All five 'As' must be followed
If your work site has a smoking cessation program, it stands a better chance of success if the "5A Program" recommended by the U.S. Public Health Service (USPHS) and others is used, but only if it is used diligently. (See box.)
Contrary to the commonly held belief that smokers don't like nurses or doctors asking about their smoking, a multi-agency study that surveyed 4,200 health maintenance organization (HMO) participants who smoke found that smokers want health care professionals to discuss smoking cessation with them, and are more satisfied with their health care benefits when they receive help with quitting.1
"Research shows that nurses are very effective at helping people to stop smoking," says Linda Sarna, RN, DNSC, FAAN, principal investigator for the Tobacco Free Nurses Initiative (TFNI) and professor at the University of California at Los Angeles School of Nursing. "Because of their sheer numbers and public trust, nurses are in a unique position to help patients end their tobacco use."
The USPHS clinical practice guideline for tobacco — the 5A Program — calls on health care providers to "ask, advise, assess, assist, and arrange," each one a step toward helping a smoker stop smoking. But for the 5A approach to work, all five steps have to be observed, the authors of the HMO study conclude.
Although most smokers surveyed said they were asked about smoking (90%) and more than two-thirds (71%) were advised to quit, only about half were assessed for their willingness to quit (56%) and given assistance for quitting (49%). Arrangements for follow up were provided only to 9% of the smokers. The decline in adherence to the progressive steps of the 5A Program coincided with a decline in effectiveness and in the HMO participants' satisfaction with their health benefits.
"Effective tobacco control… requires offering cessation services to all smokers," the authors report. "Even light smoking carries substantial health risks, and lighter smokers may be less aware of this danger."
The 5A approach is central to the TFNI, Sarna points out. A pocket guide produced by the initiative, "Helping Smokers Quit: A Guide for Nurses," encourages nurses to follow the 5As to cessation intervention (www.tobaccofreenurses.org or www.ahrq.gov/path/tobacco.htm). The initiative aims to enlist the aid of the country's 2.2 million practicing nurses to help people give up smoking.
"If each U.S. nurse helps just one person quit smoking per year, they could triple the current U.S. cessation rate," Sarna suggests.
And when the workplace is a hospital, it's an especially effective place to emphasize smoking cessation, according to a study conducted by TFNI.
"The benefits of supporting smoking cessation in the work site could have an immediate positive impact on nurses' health, and might result in other positive outcomes (e.g., reduced sick time)," the study concludes. "The benefit to patients must also be emphasized, as non-smoking clinicians are more likely to provide cessation interventions than their smoking counterparts."
[For more information, contact:
Linda Sarna, RN, DNSC, FAAN, lead investigator, Tobacco Free Nurses Initiative; professor, University of California at Los Angeles College of Nursing. Phone: (877) 203-4144. E-mail: [email protected].
Tobacco Free Nurses Initiative, School of Nursing, University of California, Los Angeles Factor Building, R4-262, Box 956918, Los Angeles, CA 90095. Phone: (877) 203-4144. Web site: www.tobaccofreenurses.org.]
Reference
1. Quinn VP, Stevens VJ, Hollis JF, et al. Tobacco cessation services and patient satisfaction in nine non-profit HMOs. Am J Prevent Med 2005; 29:2.
If your work site has a smoking cessation program, it stands a better chance of success if the "5A Program" recommended by the U.S. Public Health Service (USPHS) and others is used, but only if it is used diligently.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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