who received usual care (Duffy et al., 2006). As in patients with CVD and COPD, smoking-cessation interventions for cancer patients must factor in the medications that the patients are taking for the cancer (and other possible comorbidities) and their psychologic status. Smoking-cessation intervention studies of cancer patients have not shown a consistent effect, and more research is needed. Future studies should use the evidence-based treatments set forth in the 2008 PHS guideline (Fiore et al., 2008), combine behavioral counseling and pharmacologic treatments, involve the provider treatment team, and validate outcomes.

Two chronic diseases exacerbated by smoking are diabetes and asthma. Smoking puts diabetic patients at higher risk for vascular disease, stroke, nephropathy, neuropathy, lower-extremity morbidity, and premature death from CVD (Haire-Joshu et al., 1999; Phisitkul et al., 2008). Smoking-cessation intervention trials have had mixed findings, but in large trials, nurse-delivered interventions and motivational interviewing have shown favorable results (Canga et al., 2000; Davies et al., 2008; Persson and Hjalmarson, 2006). Further research on motivational interviewing by a primary-care nurse is under way (Jansink et al., 2009).

In people with asthma, symptoms may be triggered and aggravated by active smoking and by secondhand smoke. Other adverse effects among asthmatic smokers include increased frequency of attacks, increased symptom severity, higher hospitalization rates, and rapid decline in lung function (Althuis et al., 1999; Sippel et al., 1999; Siroux et al., 2000; Yun et al., 2006). Cigarette smoking may reduce the effectiveness of steroid treatment for asthma (Tyc and Throckmorton-Belzer, 2006). Smoking prevalence in adult asthmatics is similar to that in the general population (Thomson et al., 2004), and intervention studies in adults have not been reported. Adolescents with asthma are more likely than nonasthmatic adolescents to have parents that smoke (Otten et al., 2005).

Other Special Populations of Tobacco Users

The 2008 PHS guideline and some Cochrane reviews have assessed the efficacy of tobacco-cessation treatments for several specific groups; some of the results have particular relevance for the populations served by DoD’s TRICARE health system and VA. The populations include hospitalized smokers, older smokers, racial and ethnic minority populations, women, pregnant smokers, and smokeless-tobacco users. In general, the literature on tobacco-cessation treatments for those populations is sparse.



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