Case Presentation #1

Amy is an 18-year-old college freshman who started smoking at age 13 with her friends. She started smoking one to two cigarettes when she was at school and gradually increased through her teens as a way to stay thin and be with her friends who also smoked. At age 18, she now smokes one pack per day, and doesn't see why "everyone is concerned." She doesn't notice any ill effects, in fact, it helps her calm herself when she's facing a big exam or getting ready for a date.

As Amy's nurse at her annual gynecology visit for birth control prescription, what strategies can be used to advise Amy about the hazards of smoking? What are some effective tips?

Actual health effects related to smoking include: relaxation vs. stimulation, bad breath and other tobacco related smells, premature wrinkles.

What are Amy's risk factors related to smoking?

Birth control pills are her risk factor.

What strategies can be implemented to assist her in making lifestyle changes? What smoking cessation techniques may be helpful to her?

Ask: Pattern of tobacco use, triggers, previous quit attempts.

Advise: Address her fear of weight gain, provide motivational information related to her current health status, self-help literature, and information regarding the dangers related to birth control use while using tobacco.

Assist: Teach her strategies to incorporate dietary and exercise lifestyle changes, teach problem solving/skills training to enhance coping with stress. Nicotine replacement therapy, such as a patch, may be appropriate in weaning from the nicotine. Buproprion HCL may be started, but realize that it takes approximately eight days to raise blood levels sufficiently to reduce/prevent craving.

Arrange: Schedule follow up telephone support. Refer for group support if she desires. Reinforce short term successes.