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After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:


  1. Evaluate the individualized benefits and barriers for smokers who want to participate in a formalized smoking cessation program.

  2. Assess OTC and prescription pharmacotherapy treatments that would be most successful for a particular smoker in his or her cessation attempt.

  3. Develop individualized strategies for a smoking cessation attempt, including behavioral change, stress management, and pharmacotherapeutic factors.

  4. Evaluate and overcome barriers in order to implement smoking cessation services within a community pharmacy or clinic.

  5. Analyze the business management aspects needed to create and maintain smoking cessation services, such as recruitment, developing interdisciplinary support systems, and reimbursement issues.


Current estimates in 2012 show that approximately 45.3 million adults (19.3%) were smokers in the United States, including 21.5% men and 17.3% women.1 The prevalence has decreased slightly over the past several years. However, nicotine use still represents the single most preventable cause of premature death in the United States at over 440,000 people dying per year from smoking-related causes.1 This is one out of every five deaths due to smoking. Every year, smoking results in 5.6 million years of life lost prematurely and approximately 92 billion dollars of lost productivity. The amount of annual death in the United States resulting from smoking is more than that resulting from alcohol-related deaths, motor vehicle and gun accidents, homicides, and suicides combined. Indeed, the statistics are staggering!


The statistics regarding who in the population is most likely to smoke is interesting as well.1 Adults living below the poverty line are more likely to smoke than those living at or above the poverty line (28.9% versus 18.3% are smokers, respectively). Those with a GED diploma are more likely to smoke (45.2%), with 33.8% of those who have less than a high school education to consider themselves as “current” smokers. The most likely ages for smoking are adults between 25 and 44 years of age (22%), and American Indians and Alaskan Natives are the most likely ethnic groups who smoke (31.4%). Of interest, the 19.3% of Americans who smoke can be described as “regular” smokers, and greater than 80% of these smoke daily. Approximately 70% of polled smokers stated that they wanted to quit and have had at least one quit attempt in the past year.


The Impact of Nicotine Use


Approximately 8.6 million people in the United States have at least one serious smoking-related illness.2 Smokers most often die from lung cancer, but the second and third most likely cause of death for smokers is chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD), respectively. Smokers should be aware of the variety of cancers that can be caused by smoking. For example, cancer of the larynx, lip, tongue, esophagus, bladder, pancreas, kidney, cervix, and uterus are all associated with smoking.2 Smoking increases the risk of death from ...

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