Motivation, physical activity and smoking cessation

Abstract

Smoking remains the biggest cause of morbidity worldwide; in the UK annually, despite being completely avoidable, smoking results in around 45,000 cancer deaths and 110,000 hospital admissions [1]. Simple methods are available which health professionals can use to help smokers to stop permanently; physicians’ brief advice against smoking is effective and 2% of all those advised can be expected to stop permanently for at least 6 months [2]. Behavioural support, provided by appropriatelytrained health professionals either to smokers individually [3] or in groups [4], is more effective; smokers who are sufficiently motivated to attend these time consuming treatments have substantially better chances of achieving long term abstinence. Clearly, maximising the impact of physicians’ and other health professionals’ brief advice and also the number of smokers who access more intensive behavioural support is of utmost public health importance and three papers in this journal address provide insight into how these might be achieved. In a secondary analysis of data from a randomised controlled trial, asthma published in the present issue of Patient Education and Counseling [5], Halterman and colleagues investigated motivation to stop smoking amongst parents of children with asthma. Higher motivation is vital for smokers to fight their nicotine addiction; it increases their likelihood of seeking out and using evidence-based cessation support [6] and their odds of successfully becoming exsmokers in any one quit attempt [7]. Almost 40% of parents smoked in Halterman’s study and, in univariate analyses, previous parental quit attempts, perceiving children’s asthma control to be poor and beliefs that asthma symptoms would improve with parental smoking cessation were all associated with greater motivation. However, the only factor independently associated with parental motivation to stop smoking was a parental belief that their child’s asthma was uncontrolled. This mirrors findings in other patient groups; for example, smokers who suffer from respiratory symptoms and attribute these to their smoking are much more likely to intend stopping than thosewho experience symptoms but believe there are other causes for these [8]. A simple message for clinicians is that, where children’s asthma is not controlled and parents smoke, these adults are likely to be receptive to sensitive discussion of their smoking habit coupled with an offer of help. As problem-orientated approaches to raising [9] and giving [10]