NurseWeek: Smoke signals

Smoke signals
California's anti-tobacco campaign sees fewer deaths by lung and bronchial cancer

By Megan Malugani
February 5, 2001
Photo: Photodisc

Many nurses are motivated to participate in smoking cessation and prevention initiatives because they witness firsthand the devastation that tobacco causes their patients, but the nursing profession could be doing even more to spread the anti-tobacco message.


	You've read the article. Now tell us what you think. For more information Nursing Center for Tobacco Intervention Federal health officials’ smoking cessation clinical guidelines For a copy of the updated smoking cessation clinical practice guidelines, call the Agency for Healthcare Research and Quality at (800) 358-9295. Help patients kick the habit Some nurses may be hesitant to address tobacco addiction with their patients because they don’t know what to say or do. Linda Sarna, DNSc, RN, FAAN, associate professor at the UCLA School of Nursing, offers some tips: Assess tobacco use in every encounter, just as you would take a patient’s temperature or blood pressure. Realize that tobacco addiction is a chronic illness. Don’t be discouraged if your patient doesn’t quit the first time he or she tries. Don’t blame your patient or yourself for a relapse. Follow federal health officials’ scientifically based strategies on smoking cessation. Nicotine replacements or medication may be advisable. ~ Megan Malugani

When Debi made her debut on California televisions in 1997, she smoked cigarettes through a hole in her neck. Despite suffering throat cancer and enduring a laryngectomy, she hadn’t been able to kick the habit. "The tobacco industry said nicotine is not addictive. Why do they say that?" asks Debi in the memorable TV commercial.

Debi is one of the most effective elements of a comprehensive, aggressive tobacco education campaign that California launched in the late 1980s. The campaign has been working, health officials say. Not only did Debi finally quit smoking (as featured on a follow-up TV ad released last November), lung and bronchial cancer rates in California decreased 14 percent between 1988 and 1997, according to a recent report from the CDC. In comparison, the estimated drop nationwide was only 2.7 percent.

"California is a model for the world," said oncology nurse Linda Sarna, DNSc, RN, FAAN, associate professor at the UCLA School of Nursing. "We’re doing things on a grassroots level to fight the tobacco industry," said Sarna, also a volunteer for the American Cancer Society.

The great California smokeout
California voters, policy-makers, health professionals and advocacy organizations have a strong history of crusading against tobacco use. In 1988, California voters passed Proposition 99, which raised the price of tobacco. Part of the additional tax money generated through Proposition 99 was earmarked for tobacco education campaigns at the state and local levels. In the 1990s, state legislators also passed laws mandating smoke-free workplaces, including restaurants and bars.

This multifaceted approach has yielded enormously positive results, said Ken August, spokesman for the California Department of Health Services. About 18 percent of California adults smoke, the lowest rate in the country next to Utah, August said. As a result of the decrease in smoking, an estimated 3,000 to 4,000 fewer lung cancer cases and 2,000 fewer deaths occurred last year in the state, August said. "We’re really just beginning to witness the full health benefits of the campaign."

"It’s fantastic," said state health director Diana Bontá, DrPH, RN. "We have the most aggressive program in the country and we’re really seeing results," she said.

Lung and bronchial cancer rates in California decreased 14 percent between 1988 and 1997, according to the CDC. In comparison, the estimated drop nationwide was only 2.7 percent.

Nurses kick butts
Nurses have played a major role in the state’s anti-smoking efforts, Bontá said. "Nurses have been a tremendous resource," she said. "People respond very positively when a nurse takes the time to talk to them about the need to stop smoking for their own health and the health of their families," Bontá said. "Nurses are able to make tremendous headway because they are so trusted."

Tobacco education is "one of the most important interventions a nurse can make," Sarna said. Many nurses are motivated to participate in smoking cessation and prevention initiatives because they witness the devastation tobacco causes their patients, she said.

However, the nursing profession could be doing even more to spread the anti-tobacco message, Sarna said. Some nurses still don’t recognize the link between use of tobacco products and associated symptoms, or don’t feel equipped to address tobacco addiction with patients, Sarna said. An updated set of smoking cessation clinical practice guidelines released by federal health officials last year can assist nurses who aren’t sure how to address the issue, she said.

The road ahead
California continues to be a leader in the battle against tobacco. "Other states are asking for our advice," Bontá said. But there still is a tough road ahead. One of the biggest challenges is helping adolescents quit smoking, said David Burns, MD, professor of medicine at the University of California, San Diego, and a volunteer with the American Lung Association. Another challenge is persuading health care insurers to address tobacco issues on a systemwide basis, Burns said.

Finally, California must deal with the public relations campaign that the tobacco industry is waging. A television ad, "Crocodile Tears," is the first ad in the country to take on the tobacco industry’s efforts to upgrade its image, August said. "This ad speaks to the fact that while a new image campaign is under way, the fact of the matter is that the industry continues to sell products that lead to diseases," he said.