Women Hospitalized for Heart Disease May Be Primed to Quit Smoking.

2001 JAN 11 - (NewsRx.com) -- Smoking cessation programs for hospitalized women with heart disease may have lasting effects, according to a University of California, San Francisco, researcher.

Not only is the medical event a stimulus to quit smoking, but patients are forced to comply with nonsmoking policies of hospitals. This creates a teachable moment that may lead to long-term abstinence, according to Erika Froelicher, RN, PhD, UCSF professor of physiological nursing and epidemiology and biostatistics.

Froelicher's intervention, which is described in the November/December 2000 issue of Heart and Lung, is one of the first to focus on smoking cessation in women recovering from heart disease. The Women's Initiative for Nonsmoking (WINS) is testing the short- and long-term effectiveness of nurse-managed relapse prevention programs for women who are forced to abstain from smoking for 48-72 hours during hospitalizations.

"The program has been successfully implemented in more than 140 women and has proven to be feasible and well accepted by women and their health care providers," said Froelicher.

The intervention begins when physicians come to the bedside to strongly urge patients to quit smoking. The next step includes a 45-minute one-to-one counseling session at bedside. Nurse managers offer relapse prevention training and information about weight gain, alcohol use, exercise, stress management, social support, and nicotine replacement therapy (NRT). Nurses monitor progress by telephoning patients at home two, seven, 21, 28, and 90 days following the initial session. Because the average smoker attempts to quit three times before achieving success, nurses stress urge control methods and how to deal with "slips," or brief relapses.

"The program allows women to develop and practice tools that help them avoid smoking in risky situations," said Froelicher. Patients are taught to recognize situations in which they are at high risk to smoke. These include social situations (when drinking an alcoholic beverage with friends or when someone offers them a cigarette); emotional or negative mood situations (when feeling anxious, depressed, or uncomfortable); crutch situations (when needing more energy or wanting to keep slim); self-image situations (when wanting to feel more mature or attractive); time-structuring situations (when feeling bored); and restless situations (when wanting to relax or when waiting for someone or something).

Next patients are taught ACE strategies. ACE is an acronym for Avoid, Cope, Escape. If a woman does not feel ready to handle a particular risky situation, she is instructed to avoid it, until her confidence to handle the situation improves, explained Froelicher. If she cannot avoid the risky circumstance, then coping is required. Possible coping strategies include distraction (any activity or thought process that gets her mind off smoking), incompatible behaviors (knitting or other tasks that use the hands, sucking on hard candy, or eating raw vegetables), and positive self-talk. Escape is the final option if neither of the others is feasible. In this case, women ...