Smoking Cessation Nursing Interventions

Smoking is one of the world's biggest habits to pick up, and one of the hardest habits to

break. People in almost all age groups smoke, but most people begin to smoke when they are

teenagers. One of the main contributions to smoking comes from the influence of friends and

family that smoke, and due to the convenience of new products that are available such as e-

cigarettes and vaping devices.

People develop a dependence on nicotine because after one cigarette or puff of a vape,

nicotine levels begin to drop, and this triggers the craving to smoke more because of the need to

raise nicotine levels again, and it releases dopamine which temporarily makes people feel good.

The main factors that cause people to smoke are peer pressure, risk-taking behaviors, parental

influence, stress relief, and advertising influences. Any form of smoking causes numerous health

risks all over the body, and the longevity of this habit increases health risks over time. Potential

risk factors include impairment of the central nervous system; damage to vision and optic nerves,

airways, lungs, and the cardiovascular system; fertility issues for both men and women; and

nonsmokers are exposed to these risks around those who smoke. A research study discussing the

health effects associated with smoking discovered that with smoking alone, “36 health outcomes

that were selected based on existing evidence of a smoking relationship included 16 cancers, 5

CVDs, and 15 other diseases” (Dai et al. 2022). To avoid these risk factors of smoking and

potential diseases, we researched several interventions to help aid the cessation of smoking.

These interventions include pharmacological therapies of bupropion and varenicline, nicotine

replacement therapy, and nonpharmacologic therapy.

Tobacco is exceedingly known as one of the most harmful yet addictive substances

around the world, accounting for millions of health issues each year for people in the United
States alone. Nicotine, which is the highly addictive active ingredient in tobacco, is found in

most tobacco products ranging from cigarettes and cigars to water pipes and vapes (Onor et al.,

2017). Despite the widespread knowledge about the harsh reality of tobacco use, the United

States’ national prevalence for current tobacco product use was 21.3% in adults aged 18 years or

older. The use of electronic cigarettes specifically has been rapidly increasing in recent years,

rising from 1.9% in 2012 to 3.3% within just two years, according to the 2013-2014 National

Adult Tobacco Survey. Young adults ranging from age 18 to 24 are the largest number of

consumers on newer brands of these e-cigarettes such as vapes and hookahs. While the statistics

regarding tobacco and nicotine use are concerning, the FDA has approved of two pharmacologic

therapy drugs to aid in smoking cessation.

One of these pharmacologic therapy drugs approved by the FDA is bupropion, which is

known as a first line agent to help smoking cessation. Bupropion was the first non-nicotine agent

to effectively treat tobacco independence, and sole therapy with the drug was found to

significantly increase long term smoking abstinence at a success rate of 38.2%. Bupropion helps

users quit smoking through reducing withdrawal symptoms. Bupropion inhibits dopamine and

norepinephrine reuptake, which constitutes a mechanism of antidepressant action. Some adverse

effects of Bupropion are insomnia, dry mouth, and seizure which was seen very rarely in

participants partaking in the study. While bupropion has been proven to have high success rates,

it is not the most effective drug in smoking cessation.

The most successful pharmacologic therapy drug in increasing long term smoking

abstinence is known as varenicline. Varenicline is a partial smoking agonist that binds and

produces partial stimulation of the nicotine receptor which reduces the symptoms of nicotine

withdrawal. Through the stimulation of dopamine turnover, varenicline provides relief from
nicotine cravings and withdrawal symptoms that may occur. Research shows that varenicline had

the highest quit rates at 45.5% and is found to increase the odds of quitting three times greater

than the other pharmacologic therapies. Some adverse effects of this drug include nausea,

insomnia, and headache. While Varenicline alone has extremely high smoking cessation rates, it

has been found that the most success is seen with the combination of a pharmacologic agent as

well as nonpharmacologic options such as nicotine gum or patches (Onor et al., 2017). A study

showed the highest quit rates overall were found to be in males, those working in an occupation,

and those who did not have someone smoking at home. In regards to this study, “31.8% of the

participants initially quit by intervention and 9% quit some short period after the intervention.

They also found that the relapse rate after initial cessation was 19%” (Saylan et al., 2021).

For patients taking both Bupropion and Varenicline, it is very important for the nurse to

educate them on medication compliance and connect them to other resources that they may need.

One way the nurse could help is by providing other medications they may need to help with

adverse effects. For example, if they have nausea or vomiting, the nurse could administer

Ondansetron (Zofran) to help combat their symptoms which ultimately could help improve their

compliance. Also, regarding compliance, the nurse could educate patients on the importance of

following their medication regimen for smoking cessation. Another example of a nursing

intervention would be for the nurse to administer Acetaminophen or Ibuprofen to help reduce a

patient’s headache. Lastly, the nurse could connect patients to resources or therapy to see if there

are environmental factors that are causing them to be stressed and more prone to tobacco use.

Even though smoking cessation can seem impossible to some, there are a variety of

pharmacological and nonpharmacological therapies that can assist each individual to reach the

outcomes they are looking for.

 The use of Nicotine Replacement Therapy (NRT) has been shown to increase the rate of

smoking cessation and has decreased the rate of smoking relapses. According to the research

article “Nicotine replacement therapy sampling for smoking cessation within primary care”. The

article looks to compare the use of Nicotine Replacement Therapy to the standard care you

would receive at a primary care facility during a routine clinical visit. The goal is to see if the use

of an NRT is effective enough to keep smokers engaged in the treatment and give up the use of

smoking to their nicotine fix. They split up a group of 1245 adult volunteers into two categories

(those who used Nicotine Replacement Therapy and those who used standard care) and

monitored them for a month with further reassessments coming one, three and six months after

the initial experiments. Of the 1245 adult smokers (61% female and 39% male with an average

age of 50 years old) that participated in this experiment the article states that “the samplers who

used Nicotine Replacement therapy had a higher abstinence rate through six months and

increased quit attempts on follow ups.”(Carpenter etc, para six, 2020). The article goes on to

state that “providing smokers with Nicotine Replacement therapy for two weeks increased quit

attempts, use of stop smoking medications and length of smoking abstinence compared to the

individuals who received standard care in a primary care setting.” (Carpenter etc, para seven,

2020). At the sixth month point, the abstinence rate of the experimental group was at 12%

compared to the control group who were at 8%, The experimental group reported that the use of

any NRT medication was at 65% compared to just 25% in the control group and finally the

number of overall quit attempts in the initial month were at 24% in the experimental group

compared to just 18% in the control group. As you can see from the article, the use of Nicotine

Replacement Therapy had a higher efficiency rate than the use of standard care.
 Another article that we are going to look at is “Effectiveness of Nicotine Replacement

Therapy on Smoking Reduction and Cessation among Tuberculosis Patients: A Randomized

Controlled Trial in India''. India is one of eight countries that makes up over two-thirds of the

world's tuberculosis cases and also has the second highest rate of tobacco use in the entire world.

The article looked at participants who developed tuberculosis through the use of smoking and

determined whether or not Nicotine Replacement Therapy helped them stop their addiction. The

study took place between January 2019 through December of 2020 with 150 adult volunteers

who were broken up into an experimental group and a control group. According to the article

they state that “The experimental group was given an NRT containing 2 mg of nicotine chewing

gum for three months while the control group was given non-nicotine chewing gum”.

(Purushothama etc, pg 2, 2022) The article goes on to state that “After six months, a follow up

review was done and determined that the experimental group reported a significant reduction of

smoking cessation and overall nicotine use compared to those in the control group.”

(Purushothama etc, pg 1, 2022) During this study, there was a significant effectiveness of

Nicotine Replacement Therapy for smoking reduction. Furthermore, there were no reported

adverse effects from anybody in the experimental group who used the 2 mg of nicotine chewing

gum. During the follow up visit at the six month point, it was reported that the quit rate among

the participants was at 34% in the experimental group compared to 29% in the control group.

The number of participants who remained smoking abstinent was at 49% in the experimental

group and 43% in the control group. Finally, the number of people who self-reported that they

smoked daily was also down in the experimental group compared to those who were in the

control group. Through the use of both of these articles, we can see that the use of Nicotine

Replacement Therapy had a high rate of success when it comes to smoking cessations. In both
articles, the experimental group who received the NRT medications had better results in every

category (whether it was smoking abstinence, quit attempts, daily smoking, or continued use of

any form of an NRT) then those who were in the control group.

A part of our focus in interventions to help patients beat their smoking addiction was

looking into non-pharmacological methods. These interventions would involve no use of any

medicines or supplements as a part of the intervention. However, in the two systematic reviews

we researched, the non-pharmacological interventions were just supplemented and not the entire

care plan for the patients being researched. The two publications we investigated were,

“Effectiveness of non-pharmacological community-based nursing interventions for smoking

cessation in adults: A systematic review,” by Belgin Atkin, Yeter Kitis, and Handan TERZ˙I, as

well as “Non-pharmacological interventions for tobacco cessation: A systematic review of

existing practices and their effectiveness,” by Shyam Kanhaiya Saroj1, Tushti Bhardwaj. The

non-pharmacological interventions include exercise based, telephone-based proactive

counseling, mobile phone SMS (Short Message Service) based, smartphone app (application)

based, web-based intervention, and self-help material. All these interventions were added to a

care plan to see how much more they can help a patient quit if performed.

In the first review , “Effectiveness of non-pharmacological community-based nursing

interventions for smoking cessation in adults: A systematic review,” by Belgin Atkin, Yeter

Kitis, and Handan TERZ˙I, they reviewed 14 different databases from 2008 to 2017 using the

Quality assessment tool for quantitative studies. Doing so they looked into 3 different methods,

behavioral support, self-help material, telephone-based counseling, and texting patients about

quitting smoking. Counseling every twice a week for 30 minutes, 1 motivational meeting once a
month, as well as self-help books were found to help decrease smoking in patients by 5.6%.

When patients were only given 8 page self-help booklets that included information on ways to

quit smoking as well as the health benefits, it showed no real improvements. When patients were

constantly given counseling as well as weekly motivational talks it showed great promise. The

number of cigarettes smoked decreased significantly as well as many 24 hour attempts at quitting

smoking. However, for all 3 there was not enough data to make any conclusions on the relapse

rates of smokers related to these interventions. The study found that the nursing-based

interventions were good at changing the mentality and knowledge deficit surrounding smoking

cessation, but not give good cessation/relapse rates.

In the second review, “Non-pharmacological interventions for tobacco cessation: A

systematic review of existing practices and their effectiveness,” by Shyam Kanhaiya Saroj1,

Tushti Bhardwaj, they reviewed 11 articles out of 2,114 publications from 2010 to 2020. The

methods in these 11 articles include exercise based, telephone-based proactive counseling,

mobile phone SMS (Short Message Service) based, smartphone app (application) based, web-

based intervention, and self-help material. When yoga was added to a patient's care plan it was

found 53.2% had quit smoking for three months in one study and in other patients were 37%

more likely to quit. For tele-health services, a self-report study had found that 12.8% had quit

over 12 months and in another self-reported study 16.8% had quit over 6 months. In another

study that used a smartphone app to help smokers quit, it found a 24.6% decrease over 6 months.

The app tracked behavior and allowed for a more personalized plan and motivation. Website

based help, working similar to the app, respectively help 24% and 19.3% in two different studies.

Self-help material was found to help in 3 different groups a respective 7%, 6.3% and 15.6%

patients. SMS text message reminders to quit smoking reportedly helped 11.46% of patients quit
smoking over a 6 month period. Overall, the results of this study conclude that Behavioral

counseling is the most effective non-pharma logical based method, but combining multiple

methods will help increase the effectiveness of tobacco cessation.

Nicotine is one of the top ten most common substances to become addicted to in the

United States, and the rate of addiction continues to grow every year. The most common and

familiar tobacco products used are cigarettes, chewing tobacco, and e-cigarettes. A research

study focusing on the impact of cigarette and e-cigarette use history and their transition patterns

concluded that, “established cigarette smokers without a history of e-cigarette use were more

likely to continue smoking cigarettes, relative to switching to exclusive e-cigarette use. However,

among established cigarette smokers with a history of e-cigarette use, we did not observe

statistically significant differences in the likelihood of continuing cigarette smoking relative to

switching to exclusive e-cigarette use. Established e-cigarette users were less likely to transition

to exclusive cigarette smoking, relative to exclusive e-cigarette use” (Wei et al. 2020). This

research study only focuses on the history of tobacco use, and does not focus on the harms of

smoking and interventions to quit smoking as we focused on in our paper.

In our research of smoking cessation interventions, we have found several therapy

options to help aid smokers combat their nicotine addictions. One of the options is

pharmacological therapy using medication. One therapy drug option is Bupropion, this helps

users quit smoking through reducing withdrawal symptoms. There are some effects with the use

of this drug, and it has had high success rates, but is not the most effective drug. The most

successful therapy drug is Varenicline. This provides relief from nicotine cravings and

withdrawal that may occur after nicotine use. This drug has the highest quitting rates among

other pharmacological therapies. Another therapy option is Nicotine Replacement Therapy, this
option gives people nicotine in the form of patches, sprays, or gum replacing other nicotine

products that have harmful chemicals in them like cigarettes. People who used nicotine

replacement therapy had higher success rates of quitting and remained abstinent from smoking

more than groups of people who used standard care or non-nicotine products. The last therapy

option we researched was non-pharmacological therapies, which involves no use of medication

or any form of nicotine supplements. There are different methods used in this type of therapy

such as, behavioral support, self-help material, telephone-based counseling, and web-based

interventions. These methods helped decrease the amount of smoking for some, and helped

others quit smoking completely over different periods of time depending on the methods used.

Combining different methods helps increase the effectiveness of smoking cessation through this

type of therapy. In summary, all of these interventions help aid smoking cessation, some may be

more effective than others, but depending on the type of therapy smokers choose, they will be

able to quit smoking and overcome their addiction.