- Email: [email protected]
Guide to tobacco intervention
DISSECTING ROOM
Books Guide to tobacco intervention
Websites
lthough the dangers of tobacco use have been recognised for at least half a century, one quarter of American adults continue to smoke, and tobacco use ranks as the leading cause of preventable death in the USA. While we may be heartened that the prevalence of cigarette smoking has declined in the past few decades, the rate of that decline is slowing recently.
provide tobacco dependence treatment. The appendix of the book is a trove of such reproducible handouts. Although it does not attempt to be as comprehensive on all aspects of nicotine addiction or epidemiology as C T Orleans’ and J Slade’s landmark Nicotine Addiction: Principles and Management (1993), nonetheless, it is an extremely valuable handbook for clinicians. I found myself reading with interest and beneficial effect ways to improve my own brief counselling skills. The book also sparked conversations with colleagues about starting a tobacco intervention clinic and about having tobacco treatment support group meetings for our patients—all made much easier with step-by-step guidelines on what specifically to do at various times in relation to the patient’s quit date. This book is not without its drawbacks, however. I was disappointed to find that smokeless tobacco intervention was relegated to one paragraph, buried within the chapter on pharmacotherapy. This tobacco product has a distinct epidemiology, health-effect profile, and addiction potential, and smokeless tobacco interventions usually require different approaches than smoking interventions. Since the book purports to address tobacco dependence, not just cigarette smoking, I was hoping to find a broader approach, perhaps even one addressing cigar or pipe smoking, too. Although the text discusses certain at-risk populations and ways to motivate them (pregnant women or depressed patients, for example), I would like to have seen more attention paid to “culturally competent” tobacco intervention. Native Americans, for example, have the highest rates of tobacco use in the USA, yet approaches to helping them quit often differ from those used among whites or African Americans, and such issues are not addressed. But enough of these minor quibbles. This is an excellent book, a must-have for any clinician that works with patients who use tobacco. It provides the busy clinician with resources for brief and more lengthy interventions. With an additional focus on work site and community interventions, I predict this book also will become popular among public-health and occupational medicine workers. As a medical educator focused on tobacco intervention training, I am going to use this text as I teach medical students and residents how to help their patients quit using tobacco.
Cancer control tools http://cancercontrolplanet.cancer.gov The US National Cancer Society, CDC, and Substance Abuse and Mental Health Services” recently launched a new web portal, Cancer Control PLANET (Plan, Link, Act, Network with Evidence-based Tools), a resource that “serves as a doorway to new evidence-based tools that can help communities better understand and address their cancer burden”. For now, the site offers resources in the areas of tobacco control and physical activity; tools for sun safety, cancer screening, and informed decision making.
John G Spangler e-mail: [email protected]
Marilynn Larkin e-mail: [email protected]
A
The Tobacco Dependence Treatment Handbook: A Guide to Best Practices David B Abrams, Raymond Niaura, Richard A Brown, et al, eds. New York: The Guilford Press, 2003. Pp 359. $35.00. ISBN 1 572 30849 4.
Moreover, smoking among adolescents may be increasing, and tobacco use remains high among diverse populations, such as Native Americans, individuals with psychiatric disorders, and those with limited education or income. Worse, tobacco use is on the increase in many developing countries around the world, as tobacco companies set their targets on untapped markets. Health-care providers have a critical role in addressing use of tobacco worldwide. Indeed, in the USA, most smokers claim they would quit if offered clear advice from their health-care provider. A major reason cited by health-care professionals for not counselling their patients to quit is a lack of training: we know patients should quit using tobacco, but how do we help them? Enter The Tobacco Dependence Treatment Handbook. This extremely useful text builds on the evidence-based strategies suggested by the US Public Health Service’s Clinical Practice Guideline for Treating Tobacco Use and Dependence. It offers practical ways for health-care providers and public-health officials alike to develop, support, and implement tobacco interventions within clinical encounters, work sites, and community agencies. In this way, it is a road map, with detailed directions, of how to arrive at tobacco treatment in various settings. Rarely have I found a tobacco treatment text to be so helpful. Beginning with a brief evidence-based rationale for intervention, the book devotes chapters to assessment, increasing motivation, brief and more intensive interventions, interventions among those with psychological comorbidity, pharmacotherapy and contextual and systems factors supporting treatment (eg, clinic protocols, work-site promotion). What is most remarkable is that this text provides all the tools, questionnaires, and motivational materials that one would need to
THE LANCET • Vol 361 • May 31, 2003 • www.thelancet.com
Ethical choices in long-term care http://www.who.int/chronic_conditions/ ethical_choices.pdf Long-term care for people with chronic illnesses and disabilities presents an “urgent challenge”, according to WHO, which estimates that the need will increase in developing countries by as much as 400% in coming years. This 104-page tome (pdf) grew out of an international conference on ethics and long-term care held in July, 2002. Included are perspectives on social justice, caregiver relationships, and the roles of society, families, and other stakeholders. Linus Pauling and DNA http://osulibrary.orst.edu/specialcollections/ coll/pauling/dna/index.html This fascinating site, recently launched by the University of Oregon, “recounts the saga of the discovery [of DNA] from the largely unknown viewpoint of the major “loser” in the race”: Linus Pauling. Highlights include a 34-page, illustrated narrative of the race; more than 300 original source materials, including letters, published papers, and audiovisual clips; and a detailed look at Pauling”s personal and professional communications in 1952–53. Acronyms and abbreviations http://www.chemie.fu-berlin.de/ cgi-bin/acronym The Institute of Chemistry in Berlin has posted an acronyms and abbreviations database with more than 12 000 entries. Although geared towards chemistry and spectroscopy, the database offers plenty of other potentially relevant, interesting results. This site could be especially useful if an unfamiliar acronym pops up while one is doing web research.
1919
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Books Guide to tobacco intervention
Websites
lthough the dangers of tobacco use have been recognised for at least half a century, one quarter of American adults continue to smoke, and tobacco use ranks as the leading cause of preventable death in the USA. While we may be heartened that the prevalence of cigarette smoking has declined in the past few decades, the rate of that decline is slowing recently.
provide tobacco dependence treatment. The appendix of the book is a trove of such reproducible handouts. Although it does not attempt to be as comprehensive on all aspects of nicotine addiction or epidemiology as C T Orleans’ and J Slade’s landmark Nicotine Addiction: Principles and Management (1993), nonetheless, it is an extremely valuable handbook for clinicians. I found myself reading with interest and beneficial effect ways to improve my own brief counselling skills. The book also sparked conversations with colleagues about starting a tobacco intervention clinic and about having tobacco treatment support group meetings for our patients—all made much easier with step-by-step guidelines on what specifically to do at various times in relation to the patient’s quit date. This book is not without its drawbacks, however. I was disappointed to find that smokeless tobacco intervention was relegated to one paragraph, buried within the chapter on pharmacotherapy. This tobacco product has a distinct epidemiology, health-effect profile, and addiction potential, and smokeless tobacco interventions usually require different approaches than smoking interventions. Since the book purports to address tobacco dependence, not just cigarette smoking, I was hoping to find a broader approach, perhaps even one addressing cigar or pipe smoking, too. Although the text discusses certain at-risk populations and ways to motivate them (pregnant women or depressed patients, for example), I would like to have seen more attention paid to “culturally competent” tobacco intervention. Native Americans, for example, have the highest rates of tobacco use in the USA, yet approaches to helping them quit often differ from those used among whites or African Americans, and such issues are not addressed. But enough of these minor quibbles. This is an excellent book, a must-have for any clinician that works with patients who use tobacco. It provides the busy clinician with resources for brief and more lengthy interventions. With an additional focus on work site and community interventions, I predict this book also will become popular among public-health and occupational medicine workers. As a medical educator focused on tobacco intervention training, I am going to use this text as I teach medical students and residents how to help their patients quit using tobacco.
Cancer control tools http://cancercontrolplanet.cancer.gov The US National Cancer Society, CDC, and Substance Abuse and Mental Health Services” recently launched a new web portal, Cancer Control PLANET (Plan, Link, Act, Network with Evidence-based Tools), a resource that “serves as a doorway to new evidence-based tools that can help communities better understand and address their cancer burden”. For now, the site offers resources in the areas of tobacco control and physical activity; tools for sun safety, cancer screening, and informed decision making.
John G Spangler e-mail: [email protected]
Marilynn Larkin e-mail: [email protected]
A
The Tobacco Dependence Treatment Handbook: A Guide to Best Practices David B Abrams, Raymond Niaura, Richard A Brown, et al, eds. New York: The Guilford Press, 2003. Pp 359. $35.00. ISBN 1 572 30849 4.
Moreover, smoking among adolescents may be increasing, and tobacco use remains high among diverse populations, such as Native Americans, individuals with psychiatric disorders, and those with limited education or income. Worse, tobacco use is on the increase in many developing countries around the world, as tobacco companies set their targets on untapped markets. Health-care providers have a critical role in addressing use of tobacco worldwide. Indeed, in the USA, most smokers claim they would quit if offered clear advice from their health-care provider. A major reason cited by health-care professionals for not counselling their patients to quit is a lack of training: we know patients should quit using tobacco, but how do we help them? Enter The Tobacco Dependence Treatment Handbook. This extremely useful text builds on the evidence-based strategies suggested by the US Public Health Service’s Clinical Practice Guideline for Treating Tobacco Use and Dependence. It offers practical ways for health-care providers and public-health officials alike to develop, support, and implement tobacco interventions within clinical encounters, work sites, and community agencies. In this way, it is a road map, with detailed directions, of how to arrive at tobacco treatment in various settings. Rarely have I found a tobacco treatment text to be so helpful. Beginning with a brief evidence-based rationale for intervention, the book devotes chapters to assessment, increasing motivation, brief and more intensive interventions, interventions among those with psychological comorbidity, pharmacotherapy and contextual and systems factors supporting treatment (eg, clinic protocols, work-site promotion). What is most remarkable is that this text provides all the tools, questionnaires, and motivational materials that one would need to
THE LANCET • Vol 361 • May 31, 2003 • www.thelancet.com
Ethical choices in long-term care http://www.who.int/chronic_conditions/ ethical_choices.pdf Long-term care for people with chronic illnesses and disabilities presents an “urgent challenge”, according to WHO, which estimates that the need will increase in developing countries by as much as 400% in coming years. This 104-page tome (pdf) grew out of an international conference on ethics and long-term care held in July, 2002. Included are perspectives on social justice, caregiver relationships, and the roles of society, families, and other stakeholders. Linus Pauling and DNA http://osulibrary.orst.edu/specialcollections/ coll/pauling/dna/index.html This fascinating site, recently launched by the University of Oregon, “recounts the saga of the discovery [of DNA] from the largely unknown viewpoint of the major “loser” in the race”: Linus Pauling. Highlights include a 34-page, illustrated narrative of the race; more than 300 original source materials, including letters, published papers, and audiovisual clips; and a detailed look at Pauling”s personal and professional communications in 1952–53. Acronyms and abbreviations http://www.chemie.fu-berlin.de/ cgi-bin/acronym The Institute of Chemistry in Berlin has posted an acronyms and abbreviations database with more than 12 000 entries. Although geared towards chemistry and spectroscopy, the database offers plenty of other potentially relevant, interesting results. This site could be especially useful if an unfamiliar acronym pops up while one is doing web research.
1919
For personal use. Only reproduce with permission from The Lancet Publishing Group.