Letters to the Editor
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"Smoking Control Strategies for Patients for the Busy Practitioner"
According to the National Health Survey 1998, smoking prevalence in Singapore is on the decline (from 18.3% in 1992 to 15% in 1998), except for females in the age group of 18 to 24. Smoking is more prevalent among Malays than Chinese and Indians. As can be seen from the response to Quitline, interest in quitting smoking is tremendous this year. However, public education through mass media is only a part of the multi-pronged approach in smoking control.
The doctorís role
Though the media blitz is subsiding, doctors have an important role in sustaining smoking cessation interest all year round. Studies have shown that a physicianís advice, supported with a self-help pamphlet, can increase the success rates of cessation tremendously. The following is a simple, tried-and-tested approach to smoking cessation that can be used even at your busy practice.
Stage The Smoker: As part of the smoking history routinely elicited, identify the smokerís stage of intention to stop. Prochaska and DiClementeís Transtheoretical Model of Behaviour Change identifies stages of readiness for smokers. For each stage of readiness, different strategies are called for.
Pre-contemplation Stage : Has he ever thought about quitting? If not, emphasise the harmful effects of smoking and how it relates to his medical condition and his family. Encourage him to think about stopping. Equip him with pamphlets on harmful effects of smoking. Reinforce the message each time he sees you.
Contemplation Stage: He has thought about stopping but has not done anything yet. Encourage him to start reducing the number of cigarettes or set a Quit date. Follow up on his progress each time he sees you; document this in your clinical notes.
Action Stage: He wants to stop and is preparing to stop. Prepare him mentally for withdrawal symptoms that he is likely to experience, such as lethargy, headaches, irritability, cough, tingling of finger-tips, increased appetite, etc. For those who are ready to quit, you can do the following:
Equip him with a QuitKit
The QuitKit is a useful aid that contains useful advice and essential information presented in laymanís terms that can prompt him to think about quitting and guide him through the quitting process. Go through the contents with him briefly. QuitKit is available from National Health Education Dept (NHE) in four languages.
Rope in family and friends
The family practice setting provides a valuable opportunity to rope in his family and friends to support him and reinforce his cessation efforts. A supportive environment is vital to successful cessation. Equip them with Helperís Kits; these contain information for supporters on how to help smokers quit, and are also available from NHE in four languages.
Managing the cessation yourself
Time and simple counselling skills are needed to manage your patientís cessation. Refer to "Talk to your Patients about Smoking : A Guide for the Busy Health Professional" for more details on how to help your patients quit. The Guide is available from NHE.
Need for Smoking Cessation Services and the Nicotine Patch
Heavier smokers (at least 20 sticks per day) may require nicotine patches, which are now available as a non-prescription item from pharmacies. Some heavy smokers may also prefer individual or group smoking cessation counselling programmes that deal with behaviourial and stress management techniques.
R E S O U R C E S
QuitKits, Helperís Kits and pamphlets
QuitLine: 1800-438 2000
"Talk to your Patients about Smoking :
A Guide for the Busy Health Professional"
Posters, slide sets and video tapes
Materials are available from Health Information Centre at the National Health Education Department. Please fax in all requests.
Tel : 435 3954
Fax : 536 1277/ 438 3609
URL : http://www.gov.sg/moh/nhe/index.html
Smoking Cessation Services
Under 18 years
Please call for inquiries and appointments. Individual and group programmes are available.
Walk-in cases will also be seen at hospital services.
NATIONAL HEALTH EDUCATION DEPT, MOH