EXTRAS

In the US, the number of young adult smokers (aged 18 to 29 years) who consume less
than 5 cigarettes per day has increased from 4.7% in 1992 to 6.0% in 2002 (Pierce et al.,
2009). According to the 2002 National Survey on Drug Use and Health, more than one third of
all adult smokers report smoking less than daily. The 2007 Behavioral Risk Factor Surveillance
Survey data indicate that 26% of adult smokers were nondaily smokers. The prevalence
estimates of light and intermittent smoking are likely an underestimate because most surveys
rely on self-report measures, and nondaily smokers tend to self-classify as nonsmokers
(Fergusson and Horwood , 1995; Schane, 2009; and Shiffman, 2009).
As smoking patterns continue to change, there will be a shift in the US smoking
population from daily, addicted tobacco users who smoke for the clear physiological and
psychological benefits of nicotine to the low-level or occasional smoker who may not experience
the same degree of nicotine dependence (Glantz et al., 2009)

Population studies attribute a substantial proportion of the decline in cardiovascular diseases

seen in some high-income countries (HICs) in recent decades to falling rates of smoking
secondary to aggressive policy interventions (Chow et al., 2009; Menotti et al., 2007; Vartiainen
et al., 1994; Pell et al., 2008)

Cigarette smoking is associated with an increased incidence of acute MI. Cessation of smoking
significantly reduces this risk over a one- to three-year period with an exponential decline
approaching the risk in ex-smokers within five years of cessation (Rosenberg et al., 1985 and
Lightwood and Glantz, 1997).

Several years after stopping smoking, clients have a death rate from heart attack almost as low
as that of people who never smoked (Black and Hawks, 2005).

It increases the mortality rate of middle-aged clients with CHD, greatly potentiates the
development of peripheral vascular disease and worsens hypertension. The death rate for
coronary heart disease is 70% greater in cigarette smokers than in nonsmokers (Black and
Hawks, 2005).

Therefore, as also shown by other studies of De Vries et al. (1998) and Bolman & De Vries (1998),
coronary patients who give up smoking need to make significant alterations in their activities
and way of life (psychological, social, cultural, etc.). Participation in organised programmes,
such as a smoking cessation clinic with coordinated activities (drug therapy, psychological
support, motivation, group therapy) is a good solution (McAlister et al., 2001 and Murchie et al. 2003).

In the study of Molyneux et al. (2003)., the patients who did not participate in the
desensitisation programme did not have good results. However, health care professionals need
to invest greater efforts in helping post-infarction patients not only to give up smoking, but also
to avoid relapse. Therefore, continuing efforts are required to persuade patients to change their
behaviour and way of thinking and to participate in such programmes.

No significant difference in motivation questionnaire scores between those who gave up

smoking and those who resumed. It seems that post-infarction patients, because of the good
clinical and haemodynamic condition they enjoy at the end of their hospitalisation,
underestimate the risk of smoking as a factor in secondary prevention. The same finding has
been reported by Strecher et al. (1995), while Rigotti et al. (2003) observed that patients who were
candidates for coronary bypass surgery stopped smoking, but without there being any definite
change in their behaviour or goals.

When asked about the factors that motivate them to consider quitting, smokers most
frequently mention the effect of smoking on their health and fitness and the cost of cigarettes. In
a national survey conducted in mid- to late-2010 44% of smokers mentioned cost. The desire to
improve fitness (25%), pressure from family and friends (27%) and worry about smoking
affecting the health of others (18%) are also frequently mentioned (Australian Institute of Health
and Welfare. 2011).

three important elements in smoking cessation programs in cardiac patients:

1. You have to inform on the health hazards of continued smoking, thereby
increasing the patients motivation to stay free of smoking (fear arousal
message). It may be important to repeat this information as patients may forget
and deny.
2. You have to follow-up the patients for several months. Someone has to care about
the patients and their smoking behaviour. The patients need to know that someone
is going to call them, and ask whether they are still free of smoke.
3. We believe most patients, especially those smoking within 30 min of waking,
should be offered nicotine replacements and/or bupropion. Further studies are
needed to determine the efficacy of this strategy.
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