Patient discussions
The following brief message (STAR) to the patient provides guidance on planning a stopping attempt.
S: Set a stop date within 2 weeks.
T: Tell family, friends, and co-workers about your plans and ask for support.
A: Anticipate ways to deal with times you are at high risk for smoking.
R: Remove cigarettes, matches, and ashtrays from your home, car, work, and other places where you smoke.
The patients should follow up with the clinic or with a behavioural support service (quitline, group, or other) within a week of the stopping date.
Online web-based resources for patients are available in most countries. Examples include the following:
Explain to patients that even ‘light’ smoking (i.e., fewer than 5 cigarettes per day) still carries health risks. Smoking one cigarette per day carries around 40% to 50% of the excess risk for developing coronary heart disease and stroke of smoking 20 cigarettes per day, and smoking 5 cigarettes per day has around 55% to 65% of the excess risk.[16] Smokers can expect positive changes as soon as 2 weeks after stopping, and people with heart disease who stop smoking are likely to experience a decreased risk in future heart attacks or other events linked to the heart or blood vessels, such as stroke.[220]
People may have questions about the role of e-cigarettes as potential smoking cessation aids. It is important to inform people about the variety of products and services available to help them stop smoking, and be involved in a discussion of the risks and benefits of each. Professional medical bodies in different countries have varying stances on the use of e-cigarettes for smoking cessation based on the available evidence and public health considerations, and so clinicians should be familiar with local guideline recommendations. Use of e-cigarettes for smoking cessation is not typically recommended by guidelines or professional medical bodies in the US or Europe (excluding the UK).[146][147] In the UK, the National Institute for Health and Care Excellence (NICE) and the Royal College of Physicians (RCP) support the use of nicotine e-cigarettes as a smoking cessation tool in adults in certain circumstances: for example, when licensed treatments are not sufficient.[63][148][149]
There is universal agreement among professional medical bodies worldwide that e-cigarettes should be discouraged in people who have never smoked, and that they should not be used for smoking cessation in children and adolescents, owing to potential safety risks in this age group, as well as to a lack of evidence supporting their efficacy compared with behavioural support and nicotine replacement therapy.
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