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The 40-year Public Health Battle Against Cigarette Smoking: Are We Winning?

Hughes, Suzanne MSN, RN; Hayman, Laura L. PhD, RN, FAAN

The Journal of Cardiovascular Nursing: March-April 2005 - Volume 20 - Issue 2 - p 146–147
DEPARTMENT: Progress in Prevention

Suzanne Hughes, MSN, RN Heart and Vascular Center, Akron General Medical Center, Akron, Ohio.

Laura L. Hayman, PhD, RN, FAAN Professor, Division of Nursing, The Steinhardt School of Education, New York University, New York.

Corresponding author Suzanne Hughes, MSN, RN, Heart and Vascular Center, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307 (e-mail:

On May 27, 2004, Surgeon General Richard Carmona issued his report, The Health Consequences of Smoking: A Report of the Surgeon General. 1 This latest report expanded the list of illnesses caused by smoking. There is now clear evidence linking smoking to leukemia, cataracts, pneumonia, and cancers of the cervix, kidney, pancreas, and stomach. Abdominal aortic aneurysm was added to the list of vascular complications from smoking. It has now been determined that smoking harms essentially every major organ. It was noted that the “low-tar” and “low-nicotine” products have no proven benefit to health. Surgeon General Carmona also highlighted the important acute and long-term benefits of smoking cessation. This is the latest of the surgeon general's reports, the 28th since the first landmark report was issued in 1964. 2

Nurses have long been in the front lines in initiatives directed at smoking cessation and prevention. One very powerful new resource with a nursing focus is the Web site 3 This site, funded by the Robert Wood Johnson Foundation, is designed both for nurses who themselves desire to quit smoking as well as for nurses seeking to help others quit successfully. The Web site contains an interactive site feature associated with QuitNet, an online program with a history of success. The site has many helpful educational resources, as well as an extensive bibliography of nursing publications relevant to tobacco prevention and control. A section of this bibliography contains an outstanding list of publications by nurses who have implemented smoking-cessation strategies for various subgroups of patients, from school-based interventions for adolescents 4 to programs directed toward women hospitalized with cardiovascular disease. 5

On November 10, 2004, then–HHS Secretary Tommy Thompson announced a series of new initiatives directed toward helping Americans kick the habit. 6 He announced the establishment of a national quitline (1–800-QUITNOW) and recommended that healthcare providers encourage tobacco users to call this number for help and advice, and to identify local resources. In addition, Secretary Thompson announced that as of January 5, 2005, all campuses of HHS will be tobacco-free.

On November 12, 2004, the Centers for Disease Control and Prevention published State-specific Prevalence of Current Cigarette Smoking Among Adults— United States 2003. 7 The data published in this report were obtained from the Behavioral Risk Factor Surveillance System (BRFSS). It was noted that the prevalence of cigarette smoking varies widely (10%–34%) among states. The lowest prevalence of cigarette smoking was in Utah, the only state that has achieved the 2010 national health objective (<12% of adults smoking cigarettes). The prevalence of smoking was highest in Kentucky. The median prevalence of adult smoking in the United States stands at 22.1% in 2003, down only a single percentage point from 2002. The report noted the evidence that reduction in smoking is proportionate to the dollars spent on comprehensive tobacco-control programs. Few states, however, are spending the minimum CDC-recommended amount; overall spending for comprehensive tobacco-control programs was down 28% in the past 2 years.

Recently, there has been additional attention to the health risks associated with secondhand, or sidestream, smoke. A small but compelling study from an experience in a Montana town published in April 2004 garnered interest in the potential benefits to public health of a public smoking ban. 8 The town of Helena, Mont, imposed an ordinance banning smoking in all public places in June 2002. In December 2002, opponents of this law won a suspension of the enforcement of this law. This 6-month smoke-free period in a geographically isolated community was associated with a remarkable decrease in the number of hospital admissions for myocardial infarction, compared with the same 6-month period in the years prior to and following the smoking ban. In the 6-month period from June through November 2002, there were 24 AMI admissions versus an average of 40 AMI admissions during the same months in the other years from 1998 through 2003.

A recent American Heart Association statement reviewed the contribution of secondhand smoke (SHS) to air pollution. The statement reports that SHS directly affects approximately two third of the US population. Furthermore, it is estimated that 35,000 to 65,000 ischemic heart disease deaths annually are attributable to SHS! The report terms the air pollution from SHS “one of the most preventable causes of cardiovascular deaths.” 9

The opportunity for nurses to contribute strength and passion in the battle against the health ravages of cigarette smoking has never been greater. It is key that we continually update ourselves on the resources available to support this important work. As clinicians, educators, researchers, and advocates, we face a challenge that, when met, will carry enormous potential benefits to cardiovascular health.

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1. US Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Washington, DC: US Dept of Health & Human Services, Centers for Disease Control & Prevention, National Center for Chronic Disease Prevention & Health Promotion, Office on Smoking & Health; 2004.
2. US Surgeon General's Advisory Committee on Smoking and Health. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. US Department of Health, Education & Welfare, Public Health Service. Washington, DC: US Government Printing Office; 1964.
3. Accessed December 4, 2004.
4. Hamilton G, O'Connell M, Cross D. Adolescent smoking cessation: development of a school nurse intervention. J Sch Nurs. 2004;20: 169–174.
5. Froelicher E, Miller NH, Christopherson DJ, et al. High rates of sustained smoking cessation in women hospitalized with cardiovascular disease: the Women's Initiative for Nonsmoking (WINS). Circulation. 2004;109(5):587–593.
8. Sargent RP, Shepherd RM, Glantz SA. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ. 2004;doi: 10.1136/bmj.38055.715683.55.
9. Brook RD, Franklin B, Cascio W, et al. Air pollution and cardiovascular disease: a statement for healthcare professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation. 2004;109: 2655–2671.
© 2005 Lippincott Williams & Wilkins, Inc.