"Smoking Cessation in Emergency Department" is a wonderful example of a paper on addiction. Emergency department patients among smokers have higher incidence rates than the general population (Pelletier, Strout, & Baumann, 2014). The prevalence of smoking among emergency department patients is 21% - 48% (Pelletier et al. , 2014); while the national average for the US adult smokers is 18.1 % (CDC, 2014). Smoking is a major causal factor in cardiovascular diseases; tobacco smoke contains chemicals that harm the heart and blood vessels (NHLBI, 2011). According to the American Heart Association (AHA), the majority of people in the US visit the emergency department after experiencing chest pain (AHA, 2013). The emergency department is a suitable place to initiate the treatment of smoking cessation primarily for high-risk patients. Smoking Cessation Intervention in the Emergency Department Emergency Department-Led Smoking Cessation on Chest Pain Patients A smoking cessation (SC) intervention - a disease deterring program - is useful in disease prevention. Even after the implementation of the Affordable Care Act in 2009, 20% of the Americans between 18 and 64 years of age still receive primary care from the emergency department (ED) (Schriger & Barrett, 2013). More American deaths are attributed to tobacco use each year than vehicular accidents, alcohol abuse, firearms, drug use, and infections combined (Anders et al. , 2011). Health disparities associated with the prevalence of tobacco use are twice as much in the underserved group as they are in the high-income group (Anders et al. , 2011). The aforementioned authors also state that people with limited resources and minimal access to healthcare immensely suffer from tobacco-related diseases. The purpose of this paper is to chronicle the prevailing effects of SC intervention on ED patients relative to their plausibility of quitting. Smoking Cessation Treatment SC response in the ED provides a way to abate smoking habits. In a study by Academic Emergency Medicine, researchers conducted a pre- and post- quasi-experimental design study on two EDs to appraise the effects of SC intervention built on the 5 A’ s. The provider – a nurse or physician – would make an intervention on an existing tobacco user by implementing the five steps: Ask- about the patient’ s current smoking status Advice- to stop smoking and give valuable information about SC Assess – the patient’ s readiness to quit smoking Assist – with finding community resources available Arrange- for the patient’ s follow-up care The study incepted with 789 pre-trial participants and 650 subjects appeared in the post-ED interview (Katz et al. , 2012). The aforementioned study reported an increase in the participants’ readiness to quit and engage in a smoking-counseling program. The reports suggest that ED providers can convey effective SC to smokers and nurses can significantly make SC interventions. Anders et al. , (2011) sponsored a research study about the effectiveness of brief intervention (BI) with supplemental faxed referrals to state-sponsored tobacco quitlines. Research participants were smokers who appeared in ED with non-urgent health issues. ED department conducted the research in an urban teaching facility with 48,000 annual ED visits (Anders et al. , 2010). The experimental method used was a randomized, controlled, and single-blinded design. The research resulted in a significant difference in SC enrollment with state-sponsored tobacco quitline; with 15.5% and 2.7% program enlistments for the intervention group and control group respectively. Bock et al.
(2008) conducted the Chest Pain Smoking Study (CPSS) to determine the effectiveness of a tailored SC intervention compared to traditional SC information.
Subjects of the research were adult smokers who were admitted to a 24-hour observation unit (OBS) with a major complaint of chest pain. CPSS adopted a randomized and controlled clinical trial design to evaluate the usefulness of a brief, motivationally tailored SC approach among patients diagnosed with chest pain admitted to the OBS unit. This clinical study showed positive results after one month, with 16.8% and 27.3% smoking abstinence for the traditional SC method and the tailored SC intervention group respectively (Bock et al. , 2008). Literature Disparities Australia’ s SC campaign failed to influence the Aboriginal and Torres Strait Islander population (Bond, Brough, Spurling, & Hayman, 2012). According to Bond et al.
(2012), Australia – as a world leader for tobacco control – failed to communicate the anti-smoking effort effectively with the indigenous populace. The aforementioned authors stated that the country’ s anti-smoking efforts fell short of engaging the indigenous society in its socio-economic message. Another reason Australia’ s anti-smoking program failed was that it conveyed a stigma to the native people. The smoking crusade movement was perceived as an apparatus for despotism among the indigenous group and inspired resistance and resentment (Bond et al. , 2012). In another article by the Journal of Cancer Education, a quasi-experimental SC study was conducted on patients with head and neck cancer. Two groups of subjects participated in the study; the usual care (UC) group – or control group – and the enhanced care (EC) group which received one hour of enhanced SC teachings. The study reported an improved delivery of SC treatment to the EC; however, it did not produce SC outcome. According to Gosselin et al. , (2011), an external element – such as the condition of the unit – during the conduction of SC to the EC group could have caused the program’ s failure. The aforementioned authors believed that a one-hour time of SC intervention to the EC group was insufficient to translate into a positive cessation outcome. Conclusion The high prevalence of tobacco use among ED patients gives ED nurses and physicians the opportunity to consider SC interventions. The amount of evidence provided by three-research study analyses suggests that an engaging SC program in the ED may serve to abate modifiable health risk behaviors. Addressing SC treatment to smokers in ED can improve population health. Although the research studies reported by Katz, et al. , Anders, et al. , and Bock, et al. , produced significant SC outcomes, the clinical data is limited. The sample size in each experiment is small, and some of the studies are without randomization. According to Polit & Beck (2012), randomization is considered the gold standard for a research study. Further research is needed to determine whether SC interventions are effective during ED visits and to identify the treatment that provides optimal results.
Anders, M. E., Sheffer, C. E., Barone, C. P., Holmes, T. M., Simpson, D. D., & Duncan, A. M. (2011). Emergency Department-Initiated Tobacco Dependence Treatment. American Journal of Health Behavior, 35(5), 546-556.
American Heart Association (2013). Post-er for chest pain reduces the risk of heart attack, death. Retrieved from http://newsroom.heart.org/news/post-er-care-pain-reduces-risk-of-heart-attack-death
Bock, B. C., Becker, B. M., Niaura, R. S., Partridge, R., Fava, J. L., & Trask, P. (2008). Smoking cessation among patients in an emergency chest pain observation unit: outcomes of the Chest Pain Smoking Study (CPSS). Nicotine & Tobacco Research, 10(10), 1523-1531.
Bond, C., Brough, M., Spurling, G., & Hayman, N. (2012). ‘It had to be my choice’ Indigenous smoking cessation and negotiations of risk, resistance, and resilience. Health, Risk & Society, 14(6), 565-581. doi: 10.1080/13698575.2012.701274
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Gosselin, M.-H., Mahoney, M. C., Cummings, K. M., Loree, T. R., Sullivan, M., King, B. A., Hyland, A. (2011). Evaluation of an intervention to enhance the delivery of smoking cessation services to patients with cancer. Journal of Cancer Education, 26(3), 577-582. doi: 10.1007/s13187-011-0221-3
Katz, D. A., Vander Weg, M. W., Holman, J., Nugent, A., Baker, L., Johnson, S., Titler, M. (2012). The Emergency Department Action in Smoking Cessation (EDASC) Trial: Impact on Delivery of Smoking Cessation Counseling. Academic Emergency Medicine, 19(4), 409-420. doi: 10.1111/j.1553-2712.2012.01331.x
National Heart, Lung, and Blood Institute (2011). How does smoking affect the heart and blood vessels? Retrieved from
Pelletier, J. H., Strout, T. D., & Baumann, M. R. (2014). A systematic review of smoking cessation interventions in the emergency setting. American Journal of Emergency Medicine, 32(7), 713-724. doi: 10.1016/j.ajem.2014.03.042
Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Schriger, D. L., & Barrett, T. W. (2013). Continuing Care for Patients Choosing the Emergency
Department as a Site for Primary Care: Feasibility, Benefits, and EMTALA Considerations: Answers to the March 2013 Journal Club Questions. Annals of Emergency Medicine, 62(2), 187-193. DOI: 10.1016/j.annemergmed.2013.04.005