Cook Addresses Government Stakeholders on How to Motivate People to Consider Quitting

Dr. Jessica Cook
Dr. Jessica Cook

UW-CTRI Director of Veterans Research Dr. Jessica Cook recently presented to the US Cessation Workgroup. Her presentation was called Treating Smokers Unwilling to Quit: What Have We Learned?

Cook noted 80 percent of people who smoke see a doctor each year and asked, why do so few (about five percent) engage in recommended smoking cessation treatment? While most patients who smoke indicate an intention to quit eventually, only about 10-30 percent are ready for it during their clinic visit. This means most patients who smoke leave clinical visits without treatment for their tobacco dependence given that the only option typically is traditional tobacco cessation treatment.

So, how can clinicians better engage these individuals?

Some evidence suggests smoking reduction treatment, including offering nicotine replacement medications, can encourage reluctant patients to engage in some treatment. Nicotine replacement can help patients smoke less, increase the time between their cigarettes, and aid in resisting cues to smoke.

Research indicates that 25-30 percent of primary care patients are willing to try this approach to reduce their smoking.

“We think this could expand reach by making sure we have a treatment option for all people who smoke, including those not ready to quit now,” Cook said.

It’s important for clinicians to know that using nicotine patches, lozenges or gum while smoking carries no additional risk. It can also help move a patient closer to being ready to quit smoking, Cook said. Some patients have even said using nicotine replacement medications while smoking helped them quit smoking entirely, even though they initially had no intention to quit.

Cook cautioned against pressing the issue if patients aren’t ready to quit smoking. Instead, Cook recommended saying something like, “You could use the reduction approach to change some of your smoking patterns or gain some control over your smoking.”

Thanks to her VA Merit Grant, Cook and her team are sending postcards to all Veterans who smoke at the Madison VA. They’re about two-thirds of the way through recruiting 500 participants. “Just offering an option for those not ready to quit has really expanded the reach of tobacco treatment at the Madison VA,” she said.

Cook said additional research is needed to address questions like:

  • Can pre-quit varenicline help for those unwilling to quit? Cook said there’s a grant proposal in progress to answer that.
  • How do we encourage clinicians to offer pre-quit nicotine-replacement medications?
  • How do we help health systems to systematically reach more patients who aren’t yet ready to quit smoking?

“I think we’re doing innovative work in this area,” Cook said.