Despite countless public service ads, educational programs and the scary warnings on cigarette packs, roughly one in every five American adults still smokes. However, a new systematic review finds that nurses can get the "quit now" message across effectively.

The analysis of 31 clinical studies comprising 12,000 adult smokers finds that smokers offered advice by nurses have an increased likelihood of quitting compared to smokers without such intervention.

Even though nurses already have heavy workloads, helping smokers stop is an important responsibility, said Virginia Hill Rice, a professor at Wayne State University College of Nursing.

"Smoking is fueling so many health problems. In the long run [nurses] can reduce their workload by an investment upfront," said Rice, the lead review author.

Past research has shown the vast majority of smokers want to quit. Many see a health care professional every year, and nurses are a key part of that visit. As health advocates, they can have "a profound effect on the reduction of tobacco use," Rice said.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Studies analyzed involved at least two groups of patients: one that received advice from nurses and another that did not. Some studies were low intensity, involving a single 10-minute consultation with no more than a single follow-up session, while high-intensity intervention provided longer consultations in which patients were given materials and strategies and received additional follow-up care.

All the studies were randomized clinical trials, but differed in sample size, intervention structure and the degree of nurse involvement. Results varied across studies and the review does not draw broad conclusions. However, Rice said that among those given no intervention, less than 3 percent were able to quit. Among those given strategies to quit by nurses, 15 percent to 20 percent were successful.

More than half of the studies involved hospitalized patients. "Some surgeons will not do bypass surgery unless their patient quits," Rice said. "Those with a scar on their chests have a constant reminder of why they quit. "

Overall, the results of the analysis "support a modest but positive effect for smoking cessation intervention by nursing," the researchers conclude.

Offering a detailed smoking intervention might not always be possible for time-strapped nurses, however, they "can always advise their patients to quit and then offer referrals to tobacco treatment specialized services, such as dedicated treatment specialists, quit lines or Web-based resources," said Mary Ellen Wewers, associate dean for research at the Ohio State University College of Public Health.

"Nurses have definitely been shown to be effective interventionists," Wewers said. As part of the health care team, nurses "ask patients about their smoking status and advise smokers to quit. They also participate in treatment by recommending pharmacotherapy and behavioral counseling."

Follow-up is essential, Wewers said, and Rice concurred: "As people go through withdrawal, they need guidance and continual support."

The challenge, according to the review, "will be to incorporate smoking cessation interventions as part of standard nursing practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice to quit along with reinforcement and follow up."

The next steps are for stronger research trials. "Evidence-based practice is an important part of nursing today. The more evidence there is to support nursing's role, the more it will become part of the job," Rice said. "We need to look at the factors that influence success and focus on them."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit cochrane for more information.

Rice VH, Stead LF. Nursing interventions for smoking cessation (Review). Cochrane Database of Systematic Reviews 2008, Issue 1.

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