Medical Care
Treatment for environmental tobacco smoke (ETS) exposure (secondhand smoke) consists of avoidance of ETS. This single step, although difficult for many families, can be facilitated with education about ETS effects and assistance with smoking cessation. [16, 17]
As a first, and often more manageable, step for families, a recommendation is made to stop smoking in the home or car. This simple step can reduce clinical symptoms of asthma and lead to reductions in maintenance therapy. In clinical practice, this recommendation must convey the importance of avoidance of these behaviors at all times, not simply while the child is in the home. Similarly, smoking in a distant area of the home is unacceptable; parents can be told, "Having a smoking area in your home is like having a urinating area in the bathtub."
The effect of residual smoke or the odor of smoke in the home or on the clothing of the parents on the health of children is unknown, as is the value of cleaning up the environment after smoking cessation. Air filtration is insufficient to prevent the effects of ongoing exposure (without concomitant cessation), suggesting that the single best step is for the smoking to stop.
Initiation of smoking cessation helps the health of the child exposed to ETS as well as that of the caregivers who smoke. A multitude of methods are available to help smokers quit; however, most people quit on their own and not through organized programs or with the help of others, such as a therapist, group, physician, or acupuncturist. Methods to quit smoking include the following:
-
Self-care (without professional or medical assistance)
-
Group programs
-
Hypnosis or self-hypnosis
-
Acupuncture
-
Physician counseling
-
Commercial smoking cessation programs
-
Mass media or community programs
-
Behavioral programs (including aversive therapy, rapid smoking, or gradual withdrawal)
The impetus to quit for many people comes from the advice or warnings of a physician, reinforcing the importance of the role played by the doctor and of ascertaining smoking behaviors. Although the percentage of people who succeed in quitting after a brief warning by a physician is small, [20] the yield is large because so many people smoke. If all doctors counseled all smokers who came to them to quit and only 4% of those smokers succeeded in quitting, approximately 1.5 million smokers would become ex-smokers.
The training of physicians in smoking cessation techniques and in the use of transdermal delivery of nicotine ("the patch") increases the success rates as much as 7-fold. All methods of quitting are enhanced by the addition of medical therapy to treat nicotine addiction. The use of the patch or of nicotine chewing gum enhances quit rates in smokers regardless of the quitting method used. The requirement of a physician to prescribe the nicotine patch may increase quit rates due to physician intervention.
The odds of successfully quitting are enhanced by subsequent attempts to quit, reinforcing the importance of education to help motivate the smoker to attempt or reattempt to quit.
Diet and Activity
Diet
Although nicotine can be found in small amounts in some dietary sources (see Laboratory Studies), data suggesting a dietary role in smoking cessation are sparse.
Dietary counseling may be important because weight gain while quitting smoking is an important cause of relapse.
Sometimes, incorporation of smoking cessation within a general health maintenance program focuses on the role of dietary changes in helping to reduce overall cardiovascular risk factors, and incorporation of such a program is associated with improved success in quitting.
Activity
The role of exercise in reduction of relapse in smoking cessation is not well proven.
Successful cessation attempts are known to be associated with efforts to increase exercise in both men and women, though the role of counseling in eliciting this behavior (as opposed to self-motivation) is less certain.
