Innovative Journal of Medical and Health Science 5:3 May - June (2015) 114 – 120. Contents lists available at www.innovativejournal.in INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCE Journal homepage: http://innovativejournal.in/ijmhs/index.php/ijmhs 114 IMPLEMENTATION OF PATERNALISM PHILOSOPHY AND SMOKING CESSATION GUIDELINES TO MOTIVATE JORDANIAN PATIENTS WITH CARDIOVASCULAR DISEASE TO QUIT SMOKING Rami Azmi Elshatarat 1, 2, * , Majed Sa'ad Al-Za'areer 2 , Natheer Mahmoud Albdour 2 , Mustafa Y. Yahya 1, 3 , Zyad T. Saleh 4 , Mohammed A. Albalawi 5 , Roqia S. Maabreh 6 1 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA 2 College of Nursing Science, Al-Ghad International Colleges for Applied Medical Sciences, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia 3 Cardiac Arrhythmia Service and Cardiac Electrophysiology Clinic, Stanford University Medical Center, Stanford, California, USA 4 Faculty of Nursing, The University of Jordan, Amman, Jordan 5 Colleges of Medicine and College of Nursing Science, Taibah University, Al-Madinah Al-Munawarah, Kingdom of Saudi Arabia 6 College of Nursing Science, Al-Ghad International Colleges for Applied Medical Sciences, Dammam, Kingdom of Saudi Arabia. ARTICLE INFO ABSTRACT Corresponding Author: Rami Azmi Elshatarat, RN, CNS, MSc, PhD. College of Nursing Science Al-Ghad International Colleges for Applied Medical Sciences Al-Madinah Al-Munawarah Kingdom of Saudi Arabia elshatrat@hotmail.com Key words: Paternalism Philosophy; Smoking Cessation; Jordan; Cardiovascular Disease DOI:http://dx.doi.org/10.15520/ijm hs.2015.vol5.iss3.71.114-120 The prevalence of smoking and cardiovascular disease (CVD) is high among Jordanian population. Despite Jordanian government establishment of tobacco control regulations, Jordanians still smoke in public areas and indoor work places. Implementation of paternalistic laws through prohibiting of smoking in public places and indoor areas, selling tobacco to minors and increasing taxes on tobacco products have been recognized as effective strategies to control smoking and limit its' harm. Government should take firm actions to enforce these regulations to protect Jordanians from the hazards of second-hand smoking. Tobacco use has strong addictive properties. Smoking cessation interventions are necessary to reduce health hazards of tobacco use. According to tobacco cessation guidelines, clinicians should assess smoking behavior at each patient visit and assist patients to quit smoking. Also, clinicians should provide counseling and pharmacological treatment to patients who are willing to quit smoking. On the other hand, patients who are unwilling to quit smoking, motivational intervention and improve patients' self efficacy to quit smoking are highly recommended to help those patients to make attempts to quit smoking in the future. ©2015, IJMHS, All Right Reserved Abbreviations: CVD: Cardiovascular Disease; CHD: coronary heart disease; JD: Jordanian dinar; NRTs: nicotine replacement therapies INTRODUCTION Cardiovascular disease (CVD) is a leading cause of death for both men and women worldwide [1, 2]. In 2008, about 17 million died from CVD of all deaths in the world [2]. The mortality rate from CVD is gradually increasing to reach 23.3 million people by 2030 [2, 3]. More than 80% of all deaths results from CVD disproportionately take place in the low and middle income countries [2]. In the Middle East, 54% of deaths from non- communicable diseases are due to CVD [4]. In Jordan, CVD is the first leading cause of death, which is responsible for about 35% of all deaths [5]. In Jordan, tobacco use, diabetes mellitus, hypertension and hyperlipidemia are the most common risk factors for coronary heart disease (CHD) [6]. The majority of Jordanian patients with CHD had at least one of the previous risk factors [6]. Tobacco use is a significant preventable risk factor for cardiovascular disease, including coronary syndromes, congestive heart failure and cerebrovascular accident [1, 2, 7]. Tobacco users are more likely to have higher serum levels of cholesterol and platelet aggregation, arteriosclerosis and atherosclerosis [7, 8]. Smoking cessation programs are necessary to prevent cardiac events and sudden death [7]. Despite many patients made attempts to quit smoking, they were unsuccessful [7, 9-12]. Benowitz and his colleagues reported that 80% of American smokers who attempted to quit smoking independently, were relapsed within the first month of abstinence; and only 3% of them remained abstinent for 6 months after they quitting [10]. In a previous Jordanian study, Elshatarat and his colleagues [13] reported that 40% of cigarette smokers with CVD who made attempts to quit smoking within 12 months of hospitalization, were unsuccessful to quit smoking [13]. Generally, the failure of smoking cessation may be due to