Trying to Quit?

The amount of nicotine in many brands of cigarettes increased by nearly ten percent from 1998 to 2004, according to a study by the Harvard School of Public Health and the Massachusetts Department of Health.

Belinda Borrelli, PhD, clinical psychologist for the Centers for Behavioral and Preventive Medicine at The Miriam Hospital, says that cigarettes with higher levels of nicotine are more addicting. Though half a million people each year die from smoking,  and despite known health risks and effective behavioral and pharmacological treatments for smoking cessation, 21 percent of the population continues to smoke.

Borrelli is trying to help. Focusing on those who are most resistant to quitting, her research is determining the effectiveness of capitalizing on “teachable moments.”

One of her first studies involved patients who were receiving treatment for another medical condition. Home health care nurses providing treatment used one of two types of smoking cessation interventions. The first involved motivational interviewing and feedback on the amount of carbon monoxide found in their lungs (interventional group). The second followed standard U.S. Department of Health and Human Services guidelines for smoking cessation (control group). Borrelli discovered that the additional feedback information and guidance from the visiting nurses helped raise a patient’s perception of risk and thus contributed to a higher quit rate in the interventional group. She developed a pocket guide from this study and also trained all Miriam Hospital nurses in this cessation method.

Borrelli and colleagues then followed this model in a series of studies with parents who smoke and have children with asthma. Home health care nurses used smoking cessation intervention with parents of children receiving home health care for asthma. One involved feedback about their own health and the level of smoke exposure to the child (risk approach); the other intervention employed a more educational approach based on clinical guidelines. The risk approach objectively informed parents about the amount of smoke the child was exposed to (e.g., “Your child was exposed to as much smoke as if she smoked eight cigarettes.”). The risk approach outperformed the educational approach, with almost double the quit rates.

Borrelli said that many smokers believe that it is safe to smoke in another room or outside.  However, she says, metal particles in the smoke are brought inside and travel through the air and into children’s lungs. She stresses that there is really no safe level of smoking for either the parent or the child.

Borrelli hopes to continue to identify populations that are particularly difficult to reach and treat for smoking cessation.

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