Tobacco Use Prevention-How To Help Your Patients Stop Smoking.

A pocketguide version of this section, with additional guidelinges for patient counseling, can be ordered through the Physician Oncology Education Program.

From " A for Effort: The Doctor's Role ," a pocketguide to smoke-free patients, produced by the TMA Physician Oncology Education Program.

Most smokers who relapse after quitting do so within three months. Lapses are common during every attempt. Help with getting back on track is important - don't dwell on failures! It is extremely rare for smokers who have abstained for a year to relapse. The American Cancer Society is an excellent source for information about smoking cessation programs and/or specialists in addiction in most communities. Physicians can be leaders and can influence the adoption of smoke-free civic ordinances, drug awareness resistance education programs in schools, and promote more healthful communities.  

Frequently Asked Questions  

1. What should be included in a smoking history?
    Ask the patient:

  • Have you ever smoked?
  • At what age did you start?
  • How many cigarettes do you smoke in a typical day?
  • Do you smoke within 30 minutes of arising or awake at night to smoke?

2. How is readiness to change determined?
    Ask the patient:

  • Have you considered quitting?
  • What experience have you had in trying to quit?
  • What do you plan to do to improve your chances of success when you try to quit?
  • What can I do to help?

3. What about nicotine replacement therapy?

Patients who are dependent on nicotine will smoke within 30 minutes of arising or will awake at night to smoke. They are candidates for temporary replacement therapy - gum or transdermal patch. (Advise patients to read and follow closely the packaging inserts on dosing.) These products have been shown to be more effective when combined with counseling.


* The American Cancer Society estimates that in 1998 about 175,000 cancer deaths are expected to be caused by tobacco use. American Cancer Society Cancer Facts & Figures, 1998.  

* In Texas, more than 25,000 deaths were attributable to smoking in 1990. National Center for Chronic Disease Prevention and Health Promotion/Office on Smoking and Health.  

* Cigarettes kill more Americans each year than AIDS, alcohol, car accidents, murders, suicides, illegal drugs and fires combined. Smokers who die as a result of smoking would have lived an average 12 to 15 years longer if they had not smoked. U.S. Department of Health and Human Services, 1995.  

* The Centers for Disease Control estimated that in 1993 the health-care costs associated with smoking totaled $50 billion:

  • $26.9 billion for hospital costs
  • $15.5 billion for doctors
  • $4.9 billion in nursing home costs
  • $1.8 billion for prescription drugs
  • $900 million for home health-care expenditures

* The Office of Technology Assessment calculated the social costs attributable to smoking in 1990 at $68 billion:

  • $20.8 billion in direct health-care costs
  • $6.9 billion in lost productivity
  • $40.3 billion in lost productivity from premature death

* The average teenage smoker starts at 14 ½ years old and becomes a daily smoker before age 18. More than 80 percent of all adult smokers had tried smoking by their 18 th birthday, and more than half of them had become regular smokers by that age. U.S. Department of Health and Human Services, 1995.  

* Everyday, 3,000 young people become regular smokers. Currently, more than 3 million children and adolescents smoke cigarettes, and 1 million adolescent boys use smokeless tobacco. U.S. Department of Health and Human Services, 1995.  

* Among infants to 18 months of age, secondhand smoke is associated with as many as 300,000 cases of bronchitis and pneumonia each year. U.S. Department of Health and Human Services, 1993.  

* Secondhand smoke from a parent's cigarette increases a child's chances for middle ear problems, causes coughing and wheezing, and worsens asthma conditions. U.S. Department of Health and Human Services, 1993.  

* In 1986, the Surgeon General reported that smokeless tobacco (plug, leaf, snuff) "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence." American Cancer Society Cancer Facts & Figures, 1996.  

Tobacco industry  

* The tobacco industry flooded Congress and the two major political parties last year with a record $4.1 million in political contributions (more than double the contributions in 1993). Common Cause, 1996.  

* The value of U.S. leaf and tobacco product experts hit a record $6.7 billion in 1994. Daily News, Snyder, Texas, April 5, 1995.  

* In 1993, the tobacco industry spent $6.2 billion on advertising and promoting cigarettes and smokeless tobacco. Tobacco advertising has increased more than 1500 percent between 1970 (the year before TV and radio advertising was banned) and 1992. U.S. Department of Health and Human Services, 1995.  

* According to Current Population Survey, 1992-1993, 75.8 percent of adults in Texas think that advertising of tobacco products should be restricted.

Company   Major Brands   Annual Tobacco Sales   U.S. Market Share  
Philip Morris Marlboro, Basic, Merit, Benson & Hedges, Virginia Slims $26 billion 47.8%
R.J. Reynolds Camel, Winston, Salem, Doral $8 billion 24.9%
Brown & Williamson Kool, GPC, Lucky Strike, Pall Mall, Carlton $4.2 billion 17.5%
Lorillard Tobacco Newport, Old Gold, Kent $1.9 billion 8.2%
Liggett Group Chesterfield, L&M, Lark $147 million 1.6%
U.S. Tobacco Skoal, Copenhagen $1.1 billion 37% of smokeless market

SOURCES FOR TABLE: Maxwell Market reports, Standard & Poor's reports, the Tobacco Institute

Smokeless Tobacco  

* Some consider spit tobacco, also known as smokeless tobacco, to be a safe alternative to smoking cigarettes. In reality, the use of smokeless tobacco can cause attrition of tooth structure, staining, halitosis, periodontal disease, leukoplakia and cancer of the mucous membranes.

* Smokeless tobacco is defined as tobacco that is used either orally or through the nasal cavity. There are two primary forms of smokeless tobacco which are generally referred to as "snuff" and "chewing tobacco."

* Snuff is composed of finely ground tobacco which can be either moist or dry. It is most commonly used orally by placing a portion or "dip" in between the lip and gum and holding it in place for a prolonged period of time. Snuff may also be used by snorting it through the nose.

* Chewing tobacco usually is shredded or loose-leaf tobacco, but can also be found as dried bricks or twisted strands. It is primarily used orally by placing it into the mouth and chewing. It is often held in the mouth for prolonged periods of time.

* Regardless of the way it is used, smokeless tobacco contains known carcinogens and varying concentrations of the highly addictive drug nicotine. The average nicotine content in one "dip" of snuff is approximately four times that of one cigarette.

* Between the years 1970 and 1987, smokeless tobacco use among young men increased steadily, with a 40% increase in the use of moist snuff. Data from the U.S. Department of Agriculture substantiates a decline in the production of cigarettes and an almost three-fold increase in the production of smokeless tobacco products over the same time period.

* The Centers for Disease Control and Prevention's 1995 Youth Risk Behavior Survey reported that about 20% of male high school students used smokeless tobacco.

* Data from the Behavioral Risk Factor Surveillance System indicates that the prevalence of smokeless tobacco use in Texas is approximately 4.6% (9% among males and less than 1% for females).

* The 1994 Texas School Survey on Substance Abuse found that the average age for initiation of use is 10 years old, and that 29% of secondary school students reported ever having used smokeless tobacco.

Other resources  

National Cancer Institute's Cancer Information Service, (800) 4-CANCER

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