Value of the ventilation / perfusion scan in acute pulmonary ...

ly addicted smoker in organized cessation programs. Similar (4) advising patients to seek the support, even if quitting "on
" ,. recommendations were made recently by a National Cancer their own," ofaspouse, friend, or someone else in a position to
Institute expert advisory panel, which also encouraged pro- help reinforce their decision to quit. Finally, recent research
! jects that will provide self-help materials to high-risk popula- suggests that, while training physicians to give advice about
..tions, especially blacks, Hispanics, and pregnant women, smoking cessation can increase patient quit attempts, it will
whose particular needs have often been neglected in our take greater effort-perhaps several follow-up visits or consmoking-cessation
efforts." tacts-to reduce the high relapse rates experienced.,..e..l.
Smoking-Cessation Researchers. In addition to finally pro- 8 1b provide those involved in reducing smoking pre'llaviding
evidence for the widespread belief that the majority of leme with the most expedient means of doing so. Too often,
smokers who quit do so on their own, the findings of Fiore et al those charged with reducing smoking prevalence, such as
call our attention to several potential research questions. physicians, nurses, dentists, public health officers, and smok-
What detennines relapse, and how can it be prevented? How ing-cessation program coordinators, are not provided with or
can we motivate more smokers to make Seri01tS quit at- aware of the most appropriate information available to help
tempts? What are the most effective means of dissemination smokers stop, especially on their own. II For physicians, this
and adoption of successful cessation methods? may mean not being aware of effective cessation strategies' or
Smokers. Important messages for smokers in this article the proper use of nicotine gum (or the transcutaneous nicotine
are (1) they can quit; (2) they can successfully stop smoking if patch that may soon be available). It could also mean being
they do so on their own (especially by setting a specific quit unaware of the special help for heavy smokers that organized
date and stopping cold turkey on that date); (3) smoking- cessation programs can provide. For public health officers
cessation programs are helpful for some, especially heavier, and smoking-cessation program directors, it could be not
more addicted smokers: and (4) permanent quitting from a realizing the importance of providing simple self-help materifirst
or second attempt is unusual; the smoker may suffer an al to as many smokers as possible and not limiting their efforts
initial relapse and need to learn from that experience in order to those who have already expressed an interest in giving up
to make another, successful, quit attempt. tobacco. The importance of a variety of providers and a menu
A major conclusion that may be drawn from these data, of methods becomes more important as more smokers are
then, is that we do not need to expand our efforts to involve motivated to make serious quit attempts.
more smokers in formal cessation programs. Nevertheless, With the knowledge that there will be more than 2 million.
I. \ve should not abandon these programs. 7 as some, such as the tobacco-related deaths worldwide from tobacco this year, it is ..
American Lung Association's "Freedom From Smoking" clin- obviously necessary to expand our efforts to reduce smoking
ic program, are successful, and we need to maintain a variety prevalence not only in the United States and other industrialof
approaches to cessation. This is especially true for heavier ized countries but, especially, in the developing world, where
smokers who wish to try to quit \\;th the more formal meth- the tobacco industry is increasing its markets and the rates of
od!l. We do need to focus on the broad pllblic health implica- tobacco-related death are rising. Next week's World Notions
of our !lmoking-cessation efforts, and our agenda should Tobacco Day (May 31), sponsored by the World Health Orgainclude
the following goals: nization, provides an excellent opportunity to embark on a
8 1b motivate more smokers to make serious quit at. renewed effort to help those who want to quit smoking to do
tempts. While physicians are in a unique position to motivate so, and to help those who do not now smoke, especially in
smokers, it is equally important to motivate the smoker on a developing countries, to remain nonsmokers.
society-wide basis, so that nonsmoking
... ki
cues, such as in-
1 d Thomas. J Glynn, PhD
creased tobacco taxes, restnctlve smo ng po ICles, an coun-
teradvertising campaigns, become "persistent and inescap- 1: Pierce JP. Fiore MC, Novotny TE. Hatziandreu EJ, Davis RM. Trends in
bl "
a e.
Th
e
N t . 1 C
a lona ancer
I t ' t t and
ns I u e
the Amen 'can CIgarette smoking In the Umted States: projectIons
1989;261:61-65.
to the year 2000. JAMA.
Cancer Society, through their upcoming American Stop 2. Fiore MC, Novotny TE. Pierce JP, et aI. Methods used to quit smoking in the
Smoking Intervention Study for Cancer Prevention, will pro- United States; do ce!!:88tion programs help? JA,\1 A. 19!MJ;263:2760-2765.
., .." 3. Prochaska JO, DiClemente CC. Stages and processes of self-change of
VIde a major demonstration of this strategy. smoking: towani an integrative model of change. J COn81tlt Clin Psychol.
8 1b increase s1tCCeSS rates amacco and Health In pre..sso
1
(1) motivating smoking patients to make senous, SltStalned
quit attempts; (2) helping patients learn, prior to the quit
. d . f t. 1 0th
attempt, about the seventy and uratlon 0 poten la WI -10.
9. Cohen SJ, Stookey GK. Katz BP. Droo..k CA. Smit..h OM. Encourag1ng
primary ~ physici&ft8 t~ help smokers quIt: a randomized, controlled tnal.
Ann Int~ Med. 1989:110..648-652. '
Cummings SR. Coates TJ, Richard RJ. et aI. Training physicians in counsel-
I i drawal symptoms; (3) prescribing, for heavily addicted smok- ing about smoking cessation: a randomized trial of the 'Quit Cor Life' programo
firs .o th ' 30 ° t f kin g or a Ann Int~ Mad. 1989:110:640-647.
ers (eg, t CIgarette WI m mmu es ~ ~ 11. Glynn TJ, Boyd GM. Gruman JC. Self-Gllided Stmtegies for Smoking
cigarette habit of more than a pack a day), a mcotme replace- Ce3sation: A Program Plan1!$TJ GltiU.. Bethesd..a. ~d: National Cancer Instlment
product, after careful explanation of its proper use; and tute. In preMo National Institutes of Health publicatIon 90-3104.
2796 JAMA. May 23/30. 1990- Vol 263. No 20 Editorials
~III-.
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