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Nursing Scholarship and Leadership in Tobacco Control

May 29, 2013

Linda Sarna, Stella Bialous, and the
Health Behavior Expert Panel

Executive Summary

Tobacco use and exposure to tobacco smoke remain the leading cause of preventable death and disease in the United States and worldwide. Research demonstrates that nurses, and professional nursing organizations, can make a significant difference in minimizing this disease-burden caused by tobacco through nursing research, policy, practice, and education. The American Academy of Nursing recommends that tobacco control receives priority corresponding with the death and disease impact of tobacco use on nursing research, education, health policy, and health care agenda. Actions are needed to ensure that all nurses are prepared to implement evidence-based interventions to assist tobacco users to quit and to support the implementation of tobacco control policies. Employers of nurses and nursing schools need to ensure that access to tobacco dependence treatment is provided to nurses and nursing students. Greater investment and focus are needed to ensure equality in access to tobacco-dependence treatment as well as equality and access to policies that protect against tobacco harms.


Worldwide, more than 1 billion people smoke, one of 10 youths smoke, and 50% of youths are exposed to tobacco smoke in public places. Six million tobacco-related deaths occur every year, including 600,000 people killed through exposure to second hand tobacco smoke. If trends continue, by 2030 more than 8 million people will die annually because of tobacco use, 80% in low and middle income countries (WHO, 2011).  In the United States, cigarette smoking is responsible for 443,000 deaths per year, including victims of secondhand tobacco smoke (Centers for Disease Control and Prevention [CDC], 2008). Thus, 20% of all deaths in the US are caused by tobacco use. It is estimated that in 2011, approximately 43.8 million adults (19% of all adults) smoked cigarettes (men 21.6%, women 16.5%) (CDC, 2012). A little over one half of all smokers (51.8%) made a quit attempt lasting one or more days in 2011 (CDC, 2012). However, most current smokers did not receive support from a health care professional during their quit attempt, decreasing the probability of achieving long-term abstinence (Fiore et al. 2008).  Clinical practice guidelines on the treatment of tobacco use dependence are available (Fiore et al., 2008) but are not used as best practices in nursing (Bialous & Sarna, 2009).

The American Academy of Nursing, representing nurse policy leaders, scientists, and clinicians, recognizes that tobacco use and exposure to tobacco smoke continue to be the leading cause of preventable death and illness in the United States and the world and that nurses can make a difference in confronting this epidemic.  All people should have the right to receive effective tobacco dependence treatment services according to the 2008 U.S. Department of Health and Human Services guideline, Treating Tobacco Use and Dependence (e.g., pharmacotherapy and behavioral therapies; counseling that is accessible, effective, and sustained).

State of the Science and solutions

An overview of nurse-led scholarship in tobacco control was conducted by the American Academy of Nursing’s Expert Panel on Health Behavior, Tobacco Control subgroup (Sarna et al., 2012). This analysis revealed nurses’ contributions to scholarship in the field as well as gaps in the literature. Specific recommendations for the profession were made based upon a synthesis of nurse-led scholarship in the field and meta-analyses in the areas of tobacco prevention, tobacco dependence treatment, and reducing exposure to secondhand smoke. Included in the review were appraisals of theoretical and methodological issues, special populations of smokers, how healthcare systems address tobacco control, and tobacco health policy.  

  • This analysis supports the importance of the Academy’s commitment to affirm nursing involvement in the prevention of tobacco-related disease, disability, and death. Nursing action  could accelerate the prevention of uptake of tobacco use, help tobacco users quit, and protect against exposure to secondhand smoke. Nurses can address this issue with their usual sensitivity to the disparities and special needs of different populations.
  • The Academy asserts that, given the evidence, tobacco assessment and dependence treatment should be an expected part of nursing care delivered at all health care encounters.

Position statement:

As tobacco use is a worldwide epidemic that requires the leadership and active involvement of nurses, the Academy adopts the following positions:

  • Tobacco control should receive high priority on any nursing research, education, health policy, and health care agenda.
  • At a minimum, all nurses should assess tobacco use and willingness to quit, provide advice to quit, and refer tobacco users to existing resources, including telephone quitlines (1-800 Quit Now).
  • Nursing curricula should include information about the health effects of tobacco use, exposure to secondhand smoke, prevention of tobacco use, tobacco control policies, and science-based strategies for tobacco dependence treatment, as well as clinical practice opportunities, to ensure that all nurses are competent in tobacco control and cessation interventions.
  • Essential competencies related to tobacco control should be included as part of basic licensure for nursing practice.
  • Practicing nurses should be provided with educational workshops and professional education regarding tobacco control.
  • Greater investments are needed in federal, state, and local tobacco-control programs to reach tobacco-related objectives, including addressing the needs of youth, people with low-income, ethnic minorities, LGBT, those with mental illness, and other communities that are targeted by the tobacco industry.
  • More funding is needed for nursing research on tobacco use, prevention, cessation interventions, and reduction of exposure to secondhand smoke in people with and at risk for tobacco-related diseases and diseases aggravated by tobacco use.
  • Smoking among the profession is a barrier to interventions, and nurses worldwide should serve as tobacco-free role models. Employers of nurses and nursing educators should provide cessation resources and services for all nurses and student nurses who use tobacco.


Bialous, S. & Sarna, L. Opportunities for Nursing Research in Tobacco Control. Annual Review of Nursing Research, Volume 27, Number 1, 2009, pp . 393-409

Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults — United States, 2011. Morbidity and Mortality Weekly Report 2012;57(45):1226–8 [accessed 2013 January 15].

Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;61(44):889–94 [accessed 2013 January 15].

Fiore, M, Jaen, CR, Baker, TB. Bailey, WC, Benowitz, NL, Curry, SJ, et al.. (2008). Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service

Sarna L, Bialous SA, Chan SC, Hollen P & O’Connell, KA (2012). Making a difference: Nursing scholarship and leadership in tobacco control. Nursing Outlook, July 23 (Epub ahead of print).

World Health Organization. (2011). WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Retrieved August 28, 2012 from

Additional reading

American Lung Association. The state of tobacco control.

Sarna, L., & Bialous, S. (2005). Tobacco control in the 21st century: A critical issue for the nursing profession. Research in Theory and Nursing Practice, 19(1), 15–24.

Sarna, L & Bialous, SA. Why Nursing Research in Tobacco Control? Annual Review of Nursing Research, Volume 27, Number 1, 2009 , pp. 3-31(29),

Sarna, L & Bialous, SA (Volume editors).  Advancing Nursing Science in Tobacco Control: Annual Review of Nursing Research, Volume 27, Number 1, 2009, Springer Publishing, New York.

U.S. Department of Health and Human Services. (2012) Healthy People 2020, Topics & Objectives: Tobacco Use : Retrieved August 28, 2012, from

U.S. Department of Health and Human Services. (2004). The health consequences of smoking: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

World Health Organization. (2010). WHO global status report on NCDs. Geneva, World Health Organization, Retrieved August 29, 2012 from

World Health Organization. (2012). Tobacco Industry Interference: A Global Brief.  Retrieved on August 28, 2012 from