Smoking cessation

counselling
 Tobacco smoking
Tobacco smoking is one of the world’s single biggest preventable causes of
death. It is estimated that tobacco smoking kills more than five million people
every year – more than tuberculosis, HIV/AIDS and malaria combined-WHO

In Zimbabwe, among people aged 15 - 49 years, 28% men and less than 1%
women currently smoke tobacco.
Nearly 70% of adults who smoke say they want to quit and 3 in 5 adults who
ever smoked have quit successfully.

All healthcare workers need the skills and capacity to effectively engage with
active smoking behaviour to reduce the burden and cost to healthcare systems
 Interventions
The goal should be for every tobacco user to be identified and
offered at least a brief intervention at every clinical
consultation.

Repeated encouragement and assistance provided by more

than one healthcare worker, through a range of supportive
options, increase the likelihood of abstinence.
Stepwise approach - 5A’s framework
Asking about smoking status
The first step is to routinely ask all patients about their smoking
status.

Clinicians should use open-ended questions and be

non-judgmental when asking questions about the patient's
smoking history, the number of cigarettes smoked per day, the
duration of smoking, and any previous quit attempts.
Alerting the patient to the benefits of quitting
While it is important to advice patients about risks of smoking, alerting patients on the
benefits of quitting has proven to be more effective.

Benefits of quitting start within days as the carbon monoxide levels decrease and oxygen
levels increase

Clinicians can offer a ‘benefits card’ to the patient so that they stay motivated.

Benefits of quitting:
Reduced risk of coronary heart disease, stroke and cancers
Less respiratory infections, coughs and colds.
Food tastes better.
Better smelling hair, breath, clothes, house etc
Safe environment for children and other non- smokers because of reduced
secondhand smoke.
Saving money.
Engagement in other recreational activities as one deals with craving.
Assessing readiness to make a quit attempt
It is essential to assess the patient's readiness and motivation to quit smoking.

Clinicians can use various scales to gauge the patient's willingness to make a quit attempt.
Understanding the patient's motivation and confidence levels can help tailor the support and
interventions accordingly.

A person can fall into one of these four stages of quitting smoking

Stage 1: Not seriously thinking about quitting (Precontemplation)

Stage 2: Thinking about the pros and cons of quitting (Contemplation)

Stage 3: Intending to quit and taking actions to do so (Action)

Stage 4: Remaining off smoking or returning to it (Maintenance/ Relapse

 Assist: Assisting those willing to quit

The clinician and patient can work together to develop a personalised quit plan, set a
quit date, and identify triggers and coping strategies.

Combining counseling and medications can more than double the chances of
successfully quitting.

Using combinations of nicotine replacement therapy (NRT), such as long-acting

NRT (patch) with short-acting NRT (gum or lozenge), can further increase the
likelihood of quitting.

Text messaging and web-based cessation interventions can help people

successfully quit smoking.
 Assist:
The ‘not-ready-to-quit smoker’
For individuals who are not ready or willing to quit, on-going encouragement and offers
of support are necessary.

Assisting the patient to identify the perceived benefits that they gain from smoking and
their perceived barriers to quitting can lay the foundation to behavioural change at a
later date and enhance the possibility of a quit attempt.
 Arranging for follow-up
The final step involves scheduling follow-up appointments, whether in person or
virtually to provide ongoing support and referral to further resources, such as quit
lines.

During these follow-up visits, the clinician can monitor the patient's progress,
address any challenges or relapses, and adjust the quit plan as needed.

This ongoing support and accountability can significantly improve the chances of
successful smoking cessation.
 Withdrawal Symptoms
What to say to smokers about Withdrawal symptoms:

Withdrawal symptoms usually occur within 24 hours of stopping smoking or reducing the number of
cigarettes smoked per day.
These symptoms are signs that the body is recovering from smoking and smokers must know that fact.

Examples: Lack of concentration, feeling tired, headaches, restlessness, hunger and coughing.
Most symptoms end within 2 -4 weeks but the urge to smoke will last much longer.

When experiencing withdrawal symptoms smokers going through

quitting could :
take slow deep breaths
sip on water
do other things like taking a walk
keep their hands busy
reassure themselves that the urge will soon fade.
An Example of a ‘benefits card’