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"Smoking Control Strategies for Patients for the Busy Practitioner"

The National Smoking Control Campaign 1999 features gripping post-mortem images of smoker’s arteries, lungs and brains, first developed in the Australian 1997 Quit Campaign. The fear-inducing approach has been shown to be effective when coupled with a call for action. Hence, the other two elements of the Campaign are the Quitline (for telephone counselling), and the QuitKit and Helper’s Kit (self-help kits with tips on smoking cessation). As at 26 June 1999, 10,340 calls to Quitline were received, far exceeding previous total calls to Quitline (1,019 calls in 1998 and 1,065 calls in 1997).

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.

Though the media blitz is subsiding, doctors have an important role in sustaining smoking cessation interest all year round. Studies have shown that a physician’s 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 smoker’s stage of intention to stop. Prochaska and DiClemente’s 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 layman’s 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 Helper’s 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 patient’s 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.

QuitKits, Helper’s 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

O Child Guidance Clinic (IOH) : 435 3878

Adults

O Call It Quits, StayWell Centre (IOH) : 435 3729

O Stop Smoking Clinic (IMH) : 389 2126

O SGH Smoking Cessation Programme :

321 4377

O TTSH Smoking Cessation Programme :

357 8188

O Smoking Cessation Programmes at :

* Tampines Polyclinic : 786 4070
* Toa Payoh Polyclinic : 259 6833
* Bukit Batok Polyclinic : 566 4583

O Singapore Cancer Society : 421 5806

O Youngberg Wellness Centre : 566 0229

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