Twenty-five years ago, you could be flying at 39,000 feet and still be inhaling cigarette smoke. Smoking’s pervasiveness in U.S. culture was far and wide, and it wasn’t until cancer research findings—coupled with public policy and healthcare education—that the dangers of smoking caught on with the general public. Since then, smoking rates have declined.

Bars, restaurants, movie theaters, malls, doctor’s offices, and countless other public facilities have made the transition from smoking to nonsmoking. Societal attitudes toward smoking have changed, the government has instituted regulations that ban smoking from certain areas, and the prevalence of smoking cessation campaigns have risen sharply. Yet, even with the abundance of knowledge and prevention efforts, many Americans continue to smokehealthcare professionals included—often with deadly consequences. 

Currently, tobacco use is one of the leading causes of preventable disease in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 480,000 deaths annually are related to tobacco use and smoking, which translates into one in every five deaths. Although the number of smokers in the United States has declined steadily since 2005, 15.1% of Americans are still considered to be full-time tobacco users. Quietly nestled somewhere among those numbers are many oncology nurses who smoke.

Seeing a Problem, Making a Change

Two oncology nurses recognized a drastic need for tobacco cessation programs to support oncology nurses, as they attempt to support their patients with cancer. ONS member Linda Sarna, PhD, RN, FAAN, interim dean for the UCLA School of Nursing, and Stella Bialous, RN, DrPH, associate professor in residence at the University of San Francisco’s Center for Tobacco Control Research and Education, launched Tobacco Free Nurses (TFN) in 2003 to help nurses reduce the death and disability associated with tobacco use and exposure to secondhand smoke.

“TFN’s goals were to decrease barriers to nurses’ involvement in tobacco control by increasing their knowledge about tobacco control, especially tobacco dependence treatment, to increase opportunities for nursing leadership and advocacy in the field, and to help nurses quit smoking,” Sarna says. “We developed web-based resources that could be widely available and would have the broadest reach for nurses in the United States and worldwide.”

As former smokers may tell you, quitting is often easier said than done. Nicotine is an extremely addictive agent, and finding the right way to quit isn’t easy. Beyond that, healthcare professionals are often hesitant to approach patients about smoking habits if they themselves are active smokers. Sarna and Bialous knew the challenges and worked to design a program to help overcome those obstacles.

Beating the Odds Against Tobacco Cessation

“Smoking among healthcare professionals is a barrier to their interventions with patients, as well as a threat to their own health,” Sarna notes. “In the United States and many countries, nurses have had higher smoking rates than other providers. TFN was the first national initiative to offer services to nurses who smoke through a web-based resource, Nurses QuitNet.”

Sarna and Bialous knew that education and misconceptions about quitting were among obstacles to tobacco cessation efforts in healthcare providers and patients alike. They focused on enhancing nursing knowledge and providing helpful resources, so oncology nurses could then spread cessation efforts to their patients—an important endeavor throughout the entire spectrum of cancer treatment.

“Tobacco control is important for oncology nurses during the entire continuum of care. Preventing tobacco use and helping people quit—including nurses—will decrease the risk for cancer,” Sarna says. “For patients, quitting smoking, even after a cancer diagnosis, will decrease side effects and improve quality of life and long-term survival. It decreases the risk for recurrence and second primary cancers. Even at the end of life, supporting patients who use tobacco will decrease suffering.”

Ultimately, smoking cessation efforts start at the top. If providers have the resources to quit without relapse, then they’ll feel empowered to share that knowledge with their patients. TFN exists as a tool to spur that change in practices throughout the country, aiming to drive down smoking rates and eliminate preventable cancers.

ONS supports the International Society of Nurses in Cancer Care’s position statement on global tobacco control, which says that nurses should be fully educated on the effects of tobacco products and take a leadership role in tobacco control activities. For more information, read the full position statement.

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