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Prevention of chronic disease

Smoking

Guidelines for preventive activities in general practice
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​Smoking status and interest in quitting should be assessed and documented in the medical record for every patient >10 years of age.3,13,60 All patients who smoke, regardless of the amount they smoke, should be offered smoking cessation advice. This should include the following actions:

  • Ask about their interest in quitting (B).
  • Advise to stop smoking (A), agreeing on quit goals and offer pharmacotherapy to all patients smoking more than 10 cigarettes per day unless contraindicated, especially if there is evidence of nicotine dependence (A).
  • Offer referral to a proactive telephone call-back cessation service (eg Quitline 13 7848; A).
  • Follow up to support maintenance and prevent relapse using self-help or pharmacotherapy (A).

To assess nicotine dependence, ask about the:60

  • number of minutes between waking and smoking the first cigarette
  • number of cigarettes smoked a day (there is a high likelihood of nicotine dependence if the person smokes within 30 minutes of waking and smokes more than 10–15 cigarettes a day)
  • type of craving or withdrawal symptoms experienced in previous quit attempts.
Smoking: Identifying risks

Table 7.1.1

Smoking: Identifying risks
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At an individual patient level, GPs and their teams can influence smoking rates by systematically providing opportunistic advice and offering support to all attending patients who smoke.67 Where this is insufficient, other effective treatment strategies include referral to the Quitline,68 pharmacotherapy 69,70 and motivational interviewing.71,72

Tobacco use is most effectively treated with a comprehensive approach involving behavioural support and pharmacotherapy. Combined pharmacotherapy and behavioural support increases the success of smoking cessation.73

Pregnant women find it especially difficult to quit; pregnancy alters nicotine metabolism and heightens withdrawal symptoms and the support from partners is an important element in quitting. Higher smoking rates in disadvantaged individuals reflect greater neighbourhood disadvantage, less social support, greater negative effect and lower self-efficacy.21,28 Removing access barriers and providing incentives to motivate patients to quit may improve quit rates.

Patients should be reviewed within one week and again after one month of stopping smoking in order to help increase the long-term chance of quitting.

There is a lack of consistent, bias-free evidence that acupuncture, acupressure or laser therapy have sustained benefit on smoking cessation for longer than six months.74 There is insufficient evidence that electronic cigarettes(e-cigarettes) help smokers to stop smoking when compared with nicotine patches or placebo.75

The CEITC provides resources and strategies.

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