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Great American Smokeout: a great day for clinicians to help patients quit.

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This Thursday, November 19th is the 2009 “Great American Smokeout”. This is a day that has been set up by the American cancer Society as one day each year for all smokers to try to quit, and to make it last for at least the whole day. Of course, the idea is that once the smoker is off to a good start they will try to keep it going for another day, and another. So if you are a smoker, this is an ideal day to have a go at quitting, and I hope you can find some useful advice on this blog. If you are interested in specific topics or smoking cessation aids, you will probably be able to find a blog post on it by using the “Search Health Experts” search box on the right.

But today I’d like to add a slightly different angle to Great American Smokeout. For over 20 years we have been encouraging clinicians to intervene with all of their smoking patients. Very simple mnemonics were developed to try to remind doctors to assess and treat tobacco dependence in their patients. We had the “4 As” then the “5 As”, and now some have realized that the last few A’s (Assist and Arrange) are usually not happening and so are pushing “2 As and an R” which basically means “Ask the patient if they use tobacco, Assess dependence and motivation and Refer to a specialist service”. There are many reasons why the 5As (Ask, Advise, Assess, Assist, Arrange) are only rarely implemented. These include lack of training, lack of financial reimbursement and lack of confidence in effectiveness. So my suggestion is that all clinicians make Great American Smokeout the one day of the year when they make a serious attempt to implement the 5 As with all their patients and try to help their smoking patients to quit.

Some colleagues and I recently wrote a short paper that is designed to remind clinicians to treat tobacco dependence like any other serious modifiable risk factor for disease. It points out that smoking is a unique risk factor in that it is causally related to diseases affecting every organ system, but also that we have relatively effective treatments. The paper is freely available online from today, and I hope it might encourage more clinicians to help their patients to quit, particularly on Great American Smokeout.

Reference
Foulds J, Schmelzer AC, Steinberg MB. Treating tobacco dependence as a chronic illness and a key modifiable predictor of disease. International Journal of Clinical Practice. (In press).

You can access the free preview version of the paper online at:
http://www3.interscience.wiley.com/journal/122685385/abstract
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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