15 Smoke in mirrors: the continuing problem of tobacco use
15 Smoke in mirrors: the continuing problem of tobacco use
Sharon Connor, PharmD
Topic Area
Tobacco use
Learning Objectives
At the end of this case, students will be able to:
- Describe the prevalence of smoking in the United States
- List the health disparities in smoking prevalence
- Discuss the levels of influence that impact smoking behaviors
- Create a smoking cessation plan for an underserved patient
Introduction
Smoking is the leading preventable cause of death in the United States.1 Approximately 14% of the adult population are current smokers.2 The rate of smoking continues to drop yearly, but disparities exist. The prevalence of smoking in medically underserved communities remains high, particularly among populations experiencing homelessness. Rates of cigarette smoking among homeless adults are three to four times higher than the general population.3 The rate of smoking-induced death and disease among the homeless are also disproportionately high. Despite the high rate of smoking, homeless smokers do not differ from the general population in their desire to quit.3 Smokers with substance use disorder have an even higher prevalence and smoke at five times the rate of the general population.4 Between 70-90% of individuals receiving treatment for substance use disorder smoke cigarettes.4 The impact on death rates is significant, in fact they have twice the expected rate of deaths attributable to tobacco use than in the general population.5 Like smokers who are homeless, individuals with substance use disorder are interested in quitting.5
Smoking cessation services are not always offered to these populations due to the belief that quitting is a low priority or may interfere with substance abuse recovery. The literature supports that smoking cessation does not generally adversely affect substance use outcomes.6 Effective smoking cessation services for the medically underserved are needed to reduce tobacco-related health disparities.
Pharmacists are key advocates in assisting patients toward cessation. Quit rates are higher when a pharmacist is involved. Pharmacists are accessible in most communities and nicotine replacement product are available over the counter. Nicotine replacement products will help with the physical aspects of addiction, but patients need more than just a product when trying to quit. They need assistance with behavioral modification and support. In addition, patients need a program that is tailored to their specific needs. In order enhance the delivery of services, there are pharmacist-focused materials available through the Centers for Disease Control and Prevention.7
Also needed is a setting that promotes cessation. One must consider the social determinants of health when creating a program.8 If the program fails to be comprehensive and these factors are not addressed, disparities may persist.
Case
Scenario
You are a pharmacist that volunteers in a drug and alcohol rehabilitation facility for men. Many of the men desir