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Abstract
This clinical case conference discusses 3 cases of patients using electronic cigarettes. Electronic cigarettes, also referred to as electronic nicotine delivery systems or "e-cigarettes," generally consist of a power source (usually a battery) and a heating element (commonly referred to as an atomizer) that vaporize a solution (e-liquid). The user inhales the resulting vapor. E-liquids contain humectants such as propylene glycol and/or vegetable glycerin, flavorings, and usually, but not always, nicotine. Each patient's information is an amalgamation of actual patients and is presented and then followed by a discussion of clinical issues.
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Clawson AH, Robinson LA, Ali JS. Physician Advice to Adolescents About Smoking: Who Gets Advised and Who Benefits Most? J Adolesc Health 2016; 58:195-201. [PMID: 26802992 PMCID: PMC4724383 DOI: 10.1016/j.jadohealth.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/09/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The Clinical Practice Guidelines instruct physicians to ask their patients about smoking and to advise against tobacco use. Physicians are urged especially to attend to racial minorities and teens because of these groups' increased susceptibility to smoking. Research on race and physician advice against smoking has produced contradictory findings. The purpose of this study is to clarify the relationships between physician communication about tobacco, race, and smoking among adolescents. METHODS This cross-sectional retrospective study explored (1) racial differences in rates of receiving physician communication and (2) whether the relationship between physician communication and smoking among adolescents was moderated by race. Multiple measures of smoking status were used (e.g., intentions to quit, quit attempts, quits, relapse status). We used a large (N = 5,154), predominately African-American (82.9%) sample of 11th graders. RESULTS Regular smokers were more likely to be screened about smoking. African Americans were more frequently advised against tobacco than Caucasians. Among African Americans, nonsmokers were most likely to be both screened and advised; among Caucasians, regular were most likely to be screened and advised. Overall, physician intervention was associated with greater benefits for young African Americans, including fewer intentions to smoke, greater likelihood of quitting, and less relapse. CONCLUSIONS Physician communication about smoking may hold particular promise for African-American teens, reducing health disparities because of racial differences in smoking-related mortality and morbidity. Physicians should be encouraged to screen and advise all young people about tobacco, regardless of race or smoking status.
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Affiliation(s)
- Ashley H. Clawson
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
| | - Leslie A. Robinson
- Department of Psychology, The University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152
| | - Jeanelle S. Ali
- Department of Psychology, The University of Memphis, Department of Psychology, 400 Innovation Dr., Memphis, TN 38152
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103
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Newman-Casey PA, Dayno M, Robin AL. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:5-20. [PMID: 27134639 DOI: 10.1586/17469899.2016.1134318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. METHODS A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. RESULTS Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.. CONCLUSION The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma.
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Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Department of Ophthalmology, University of Maryland, Baltimore, MD, USA; Departments of Ophthalmology & International Health, Johns Hopkins University, Baltimore, MD
| | - Megan Dayno
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Alan L Robin
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Leone FT, Evers-Casey S, Mulholland MA, Sachs DPL. Integrating Tobacco Use Treatment Into Practice: Billing and Documentation. Chest 2016; 149:568-575. [PMID: 26426215 DOI: 10.1378/chest.15-0441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/01/2022] Open
Abstract
Balancing population-based efforts to modify the social and environmental factors that promote tobacco dependence with efforts to improve the delivery of case-based treatments is necessary for realizing maximum reductions in the cost and consequences of the disease. Public health antismoking campaigns following the 1964 Surgeon General's report on the health risks of smoking have changed social norms, prevented initiation among youth, and promoted abstinence among the addicted. However, the rate of progress enjoyed to date is unlikely to continue into the coming decades, given that current annual unassisted cessation rates among prevalent smokers remains fairly low. With more than 1 billion patient interactions annually, there is an enormous unrealized capacity for health-care systems to have an effect on this problem. Clinicians report a perceived lack of reimbursement as a significant barrier to full integration of tobacco dependence into health care. A more complete understanding of the coding and documentation requirements for successful practice in this critically important area is a prerequisite to increasing engagement. This paper presents several case-based scenarios illustrating important practice management issues related to the treatment of tobacco dependence in health care.
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Affiliation(s)
- Frank T Leone
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Comprehensive Smoking Treatment Program, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, Philadelphia, PA.
| | - Sarah Evers-Casey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Comprehensive Smoking Treatment Program, University of Pennsylvania, Philadelphia, PA
| | - Mary A Mulholland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David P L Sachs
- Palo Alto Center for Pulmonary Disease Prevention, Palo Alto, CA
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105
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AlAteeq M, Alrashoud AM, Khair M, Salam M. Smoking cessation advice: the self-reported attitudes and practice of primary health care physicians in a military community, central Saudi Arabia. Patient Prefer Adherence 2016; 10:651-8. [PMID: 27175065 PMCID: PMC4854249 DOI: 10.2147/ppa.s103010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brief advice on smoking cessation from primary health care (PHC) physicians reduces smoking prevalence. However, few studies have investigated the provision of such advice by PHC physicians providing services to military communities. The aim of this study was to evaluate PHC physicians' attitudes toward and practice of delivering smoking cessation advice to smokers in a military community in central Saudi Arabia. METHODS A self-reported survey of PHC physicians was conducted in 2015 using a previously validated tool. The age, sex, educational level, job title, experience and previous smoking cessation training of each physician was recorded. Attitude (ten statements) and practice (six statements) were evaluated on a five-point Likert scale. Scoring system was applied and percentage mean scores (PMS) were calculated. Descriptive/statistical analyses were applied to identify factors that were significantly associated with a positive attitude and favorable practice (PMS >65 each). P-values <0.05 were considered to be significant. RESULTS Response rate was 73/150 (48.6%), of which equal sex distribution (52%:48%) was observed, with a mean age of 35.3±9.6 years. General practitioners constituted 71.4%, followed by consultants (17.9%) and specialists (10.7%). Those with a postgraduate education formed 49.3%, while experience averaged 9.5±9.2 years. Approximately 56% had not attended a smoking cessation educational program in the previous year. Approximately 75% of physicians had a positive attitude (PMS =72.4±11.2), while 64.4% reported favorable practice (PMS =65.3±27.7). Higher education levels were significantly more associated with positive attitude than lower education levels (adj. odds ratio [OR] 95% confidence interval [CI] =17.9 [1.3-242.3]; adj. P=0.03). More experienced physicians (adj. OR [95% CI] =9.5 [1.6-54.6]) and those with positive attitude (adj. OR [95% CI] =6.1 [1.6-23.3]) were more likely to report a favorable practice, compared to the less experienced (adj. P=0.012) and physicians with a negative attitude (adj. P=0.008). CONCLUSION Provision of smoking cessation advice by primary health care physicians serving a military community is significantly associated with their attitude and years of experience. Patients who are seeking smoking cessation advice should be referred to physicians with higher levels of education. Routinely scheduled training on proper delivery of smoking cessation advice may increase physicians' confidence; improve their attitude, and subsequently, their practice.
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Affiliation(s)
- Mohammed AlAteeq
- Department of Family Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz M Alrashoud
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Khair
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Correspondence: Mahmoud Salam, National Biobanking Section, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences (Mail Code 1515), Ministry of National Guard Health Affairs, Riyadh 22490, Saudi Arabia, Tel +966 1 534 284 644, Email
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106
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Bae J, Ford EW, Huerta TR. The Electronic Medical Record's Role in Support of Smoking Cessation Activities. Nicotine Tob Res 2015; 18:1019-24. [PMID: 26659415 DOI: 10.1093/ntr/ntv270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/05/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Electronic medical records (EMRs) have been touted as a tool for improving physicians' performance in the effort to reduce smoking harm. The purpose of this research is to assess EMR sophistication and functionality in relationship to smoking status documentation, cessation counseling, and medication use in ambulatory care settings. METHODS Regression analyses of the 2007-2010 National Ambulatory Medical Care Survey were conducted to measure the association between EMR sophistication and smoking status recorded, smoking cessation counseling, and medication prescribing during visits. In general, EMR sophistication is measured by the presence of interactive EMR capabilities where "advanced" systems include functionalities for clinical decision support and management of orders and tests compared to "basic" systems. RESULTS Physicians using advanced EMR systems were significantly more likely to record smoking status, counsel patients on smoking cessation, and document prescribing medications to support cessation efforts than doctors using less sophisticated technologies. CONCLUSIONS Generally, the use of more sophisticated EMRs were associated with improved smoking cessation support by physicians in the ambulatory environment. Physicians purchasing or upgrading an EMR system should include the smoking cessation support features as part of their requirements. Future stages in the federal government's EMR Meaningful Use incentives and rewards program should include explicit metrics related to smoking cessation activities. IMPLICATIONS The findings of this article contribute to current literature on EMR and smoking cessation by providing empirical evidence that advanced EMR systems with features like clinical reminders serve to influence the structure of the clinical encounter such that clinicians are significantly more likely to document smoking, engage in counseling, and prescribe medications. Physicians purchasing or upgrading an EMR system should include the smoking cessation support features as part of their requirements. Future stages in the federal government's EMR Meaningful Use incentives and rewards program should include explicit metrics related to smoking cessation activities.
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Affiliation(s)
- Jaeyong Bae
- School of Nursing and Health Studies, Northern Illinois University, Dekalb, IL;
| | - Eric W Ford
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Timothy R Huerta
- Departments of Family Medicine and Biomedical Informatics, Ohio State University College of Medicine, Columbus, OH
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107
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Knowledge and practices of tobacco dependence treatment among junior doctors in a Malaysian teaching hospital. J Smok Cessat 2015. [DOI: 10.1017/jsc.2014.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Junior doctors are ideally placed to assist smokers quit yet little is known about their knowledge and practices.Aims: To determine knowledge and practices in providing smoking cessation support, among junior doctors in a Malaysian teaching hospital.Methods: In 2012, all junior doctors at University Malaya Medical Centre were invited to complete a self-administered questionnaire. The data were collated and analysed using standard descriptive methods.Results/Findings: Seventy per cent (n = 122/173) of those eligible completed the questionnaire, 71% reporting cessation training at medical school. Most (90%) asked patients their smoking status but only 52% asked about quitting. Sixty-one per cent lacked confidence in providing assistance to quit, especially female doctors (70.8%, p<0.01). Most (80%) were unaware of local cessation clinics, and over half (59%) were unaware of the existence of guidelines for smoking cessation (p<0.001).Conclusions: Asking about smoking was undertaken at satisfactory levels, but low knowledge, confidence and skills among this group of junior doctors indicates that cessation education should be included in undergraduate and in postgraduate curriculum training programmes. Awareness of specialist services and guidelines should be raised. Our findings are unlikely to be unique to this hospital, suggesting the need for a nationally consistent approach.
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108
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van Eerd EAM, Risør MB, van Rossem CR, van Schayck OCP, Kotz D. Experiences of tobacco smoking and quitting in smokers with and without chronic obstructive pulmonary disease-a qualitative analysis. BMC FAMILY PRACTICE 2015; 16:164. [PMID: 26537703 PMCID: PMC4634152 DOI: 10.1186/s12875-015-0382-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 10/30/2015] [Indexed: 12/20/2022]
Abstract
Background Smokers with chronic obstructive pulmonary disease (COPD) seem to be a special subgroup of smokers that have a more urgent need to quit smoking but might find it more difficult to do so. This study aimed to explore which justifications for tobacco smoking and experiences of quitting were commonly shared in smokers with and without COPD, and which, if any, were specific to smokers with COPD. Methods In ten primary healthcare centres in the Netherlands, we conducted semi-structured, in-depth interviews in 10 smokers with and 10 smokers without COPD. Results Three themes were generated: ‘balancing the impact on health of smoking’, ‘challenging of autonomy by social interference’, ‘prerequisites for quitting’. All participants trivialized health consequences of smoking; those with COPD seemed to be less knowledgeable about smoking and health. Both groups of smokers found autonomy very important. Smokers with COPD were indignant about a perceived lack of empathy in their communication with doctors. Furthermore, smokers with COPD in particular had little faith in the efficacy of smoking cessation aids. Lastly, motivation for quitting was dominated by fluctuation and smokers with COPD specifically maintained that their vision of life was linked with quitting. Conclusions The participants showed many similarities in their reasoning about smoking and quitting. The corresponding themes argue for a less paternalistic regime in the communication with smokers with attention required for the motivational stage and room made for smokers’ own views, and with clear information and education. Furthermore, addressing social interactions, health perceptions and moral agendas in the communication with smokers with COPD may help to make smoking cessation interventions more suitable for them. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0382-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva A M van Eerd
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| | - Mette Bech Risør
- Department of Community Medicine, General Practice Research Unit, UiT The Arctic University of Tromsø, Tromsø, Norway.
| | - Carolien R van Rossem
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| | - Onno C P van Schayck
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, Netherlands.
| | - Daniel Kotz
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD, Maastricht, Netherlands. .,Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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109
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Keto J, Jokelainen J, Timonen M, Linden K, Ylisaukko-oja T. Physicians discuss the risks of smoking with their patients, but seldom offer practical cessation support. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:43. [PMID: 26525302 PMCID: PMC4630922 DOI: 10.1186/s13011-015-0039-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022]
Abstract
Background Our aim was to study the smoking cessation-related 1) attitudes & experiences and 2) consultation practices of Finnish physicians and to determine if there is a relationship between the two. Methods An online survey on smoking cessation was sent to 39 % of all Finnish physicians, with emphasis on physicians working in fields relevant to smoking cessation. A total of 1141 physicians (response rate 15 %) responded to the online survey, 53 % of whom were employed in primary health care. A total of 1066 respondents were eligible for the analysis. The questionnaire included questions on the physician’s own smoking status, their attitudes and experiences on smoking cessation, and the implementation of smoking cessation in clinical practice. Two sub-scales concerning smoking-related consultation activities were constructed: one for conversation, and another for practical actions. Results The most common consultation activities (respondents who reported doing the following actions “nearly always”) were asking how much the patient smokes (65 %), marking smoking status in patient records (58 %) and recommending quitting to the patient (55 %). The least common activity was prescribing withdrawal medication (4 %). Primary care physicians were more active than those working in secondary health care in nearly all activities mapped. A positive attitude and experiences on smoking cessation were associated with actively offering withdrawal support. Those who were familiar with the local treatment guidelines for tobacco addiction were 30 % more active in offering practical cessation help to their patient. The respondents were more active in discussing smoking with their patients than in offering practical cessation help. Conclusion Physicians offer their patients practical cessation support relatively infrequently. Practical cessation calls for continuous education of physicians about the nature of tobacco and nicotine addiction, the role of smoking as a risk factor for various diseases, and the practical measures needed for smoking cessation. Secondary care physicians should acknowledge the authority they pose toward smoking patients.
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Affiliation(s)
- Jaana Keto
- Department of General Medicine, Faculty of Medicine, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland.
| | - Jari Jokelainen
- Department of General Medicine, Faculty of Medicine, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland. .,Unit of General Practice, Oulu University Hospital, FIN-90014, Oulu, Finland.
| | - Markku Timonen
- Department of General Medicine, Faculty of Medicine, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland.
| | - Kari Linden
- Pfizer Oy, Tietokuja 4, FIN-00330, Helsinki, Finland.
| | - Tero Ylisaukko-oja
- Department of General Medicine, Faculty of Medicine, University of Oulu, P.O. Box 5000, FIN-90014, Oulu, Finland.
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Houston TK, Sadasivam RS, Allison JJ, Ash AS, Ray MN, English TM, Hogan TP, Ford DE. Evaluating the QUIT-PRIMO clinical practice ePortal to increase smoker engagement with online cessation interventions: a national hybrid type 2 implementation study. Implement Sci 2015; 10:154. [PMID: 26525410 PMCID: PMC4630887 DOI: 10.1186/s13012-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Effective web-assisted tobacco interventions (WATIs) have been underutilized by smokers; moreover, despite practice guideline recommendations, clinical teams do not routinely refer smokers to WATIs. Our goal was to test a clinical practice innovation, an ePortal designed to change practice and patient behavior. Our hypotheses were that the integrated system would result in increased smoker referrals, with an automated follow-up system resulting in more smoker registrations and finally augmentations of the WATI would result in more smokers quitting at 6 months. Methods Practice ePortal Implementation Trial: Practices (n = 174) were randomized to an online practice ePortal with an “e-referral tool” to the WATI (e-referred smokers received automated email reminders from the practice) and with practice feedback reports with patient tracking and practice-to-patient secure messaging versus comparison (a paper “referral prescription”). Implementation success was measured by the number of smokers referred and smokers registering. Clinical Effectiveness Trial: To estimate the effectiveness of the WATI components on 6-month smoking cessation, registered smokers were randomized into three groups: a state-of-the-art tailored WATI control [control], the WATI enhanced with proactive, pushed tailored email motivational messaging (messaging), and the WATI with messaging further enhanced with personal secure messaging with a tobacco treatment specialist and an online support group (personalized). Results Practice ePortal Trial results: A total of 4789 smokers were referred. The mean smokers referred per practice was not statistically different by group (ePortal 24.89 (SD 22.29) versus comparison 30.15 (SD 25.45), p = 0.15). The e-referral portal implementation program resulted in nearly triple the rate of smoker registration (31 % of all smokers referred registered online) versus comparison (11 %, p < 0.001). Clinical Effectiveness Trial results: Active smokers randomized to the personalized group had a 6-month cessation rate of 25.2 %, compared with the messaging group (26.7 %) and the control (17 %). Next, when using an inverse probability weighted selection model to account for attrition, those randomized to the two groups that received motivational messaging (messaging or personalized) were more likely to quit than those in the control (p = 0.04). Conclusions Among all smokers referred, the e-referral resulted in nearly threefold greater registrants (31 %) than paper (11 %). The practice ePortal smokers received multiple reminders (increasing registration opportunities), and the practices could track patient progress. The result was more smokers registering and, thus, more cessation opportunities. Combining the proactive referral and the WATI resulted in higher rates of smoking cessation. Trial Registration Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0336-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas K Houston
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA. .,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA. .,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Rajani S Sadasivam
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeroan J Allison
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arlene S Ash
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Midge N Ray
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas M English
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy P Hogan
- VA eHealth Quality Enhancement Research Initiative and Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Avenue N, Worcester, MA, USA.,Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel E Ford
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Härter M, Bartsch AL, Egger N, König HH, Kriston L, Schulz H, Tiemann M, Brütt AL, Buchholz A. Evaluating a collaborative smoking cessation intervention in primary care (ENTER): study protocol for a cluster-randomized controlled trial. Trials 2015; 16:447. [PMID: 26452466 PMCID: PMC4600205 DOI: 10.1186/s13063-015-0977-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/28/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Tobacco consumption is a preventable risk factor for chronic disease and complicates the treatment of medical conditions. Therefore, the German health insurance company AOK NORDWEST has developed a collaborative smoking cessation intervention for individuals with cardiovascular disease, chronic obstructive pulmonary disease and heavy smokers, with the aim of reducing tobacco consumption. The objective of the study ENTER is to evaluate the effectiveness of the collaborative smoking cessation intervention and determine its cost-effectiveness. METHODS/DESIGN This study is a cluster-randomized controlled trial conducted with 40 medical practices that are being selected from different geographic regions in Germany. Participating medical practices will be randomly allocated to either the intervention or control group. Within the medical practices, a total of 800 patients will be recruited for participation in the study and blinded to group assignment. Patients are included in the study if they are 18 years or older, insured by AOK, heavy smokers (smoke at least 20 cigarettes per day) and/or suffer from chronic obstructive pulmonary disease or cardiovascular disease. Exclusion criteria are patients who are nonsmokers, who have cognitive impairments or who are illiterate. Physicians from medical practices in the intervention group will motivate patients to participate in a smoking cessation program offered by the health insurance, refer them to the program and ask about their program participation. Physicians from medical practices in the control group will provide usual care. Data collection will take place on the date of study inclusion and after 6 and 12 months. The primary outcome is the amount of cigarettes consumed during the past 30 days, 12 months after the initial medical consultation. Secondary outcomes are abstinence from smoking, health-related quality of life and respiratory complaints. Moreover, a process evaluation and health economic analysis will be performed. DISCUSSION The results of this study will help to determine whether the collaborative smoking cessation intervention is an effective and feasible way to promote smoking cessation in the primary care setting and provide evidence regarding its cost-effectiveness. TRIAL REGISTRATION German Clinical Trials Register DRKS00006079 . Registered 4 June 2014.
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Affiliation(s)
- Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anna-Lena Bartsch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Nina Egger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Michael Tiemann
- Department of Prevention and Health Promotion, AOK NORDWEST, Kopenhagener Straße 1, 44269, Dortmund, Germany.
| | - Anna Levke Brütt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Robinson LA, Clawson AH, Weinberg JA, Salgado-Garcia FI, Ali JS. Physician Intervention for Improving Tobacco Control Among Parents Who Use Tobacco. Clin Pediatr (Phila) 2015; 54:1044-50. [PMID: 25609099 DOI: 10.1177/0009922814567304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has demonstrated that parents who smoke are often inadvertent sources of their children's first cigarettes. Teaching parents to restrict their tobacco may give pediatricians another method for helping parents who are not ready to quit smoking. This purpose of this study was to determine the feasibility of a program training pediatricians to discuss tobacco control with smoking parents and to examine changes in parents' tobacco control after the physician intervention. One month after the intervention by pediatricians, parents reported significantly improved tobacco control. They were more likely to count their packs and cigarettes and to keep their tobacco products at work and on their person. Parents reported restricting household control of adult smoking, and children were exposed to significantly less secondhand smoke. These results showed that it is possible to integrate advice about tobacco control into a busy pediatric practice and to improve parents' restrictions of their tobacco products.
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Martín Cantera C, Puigdomènech E, Ballvé JL, Arias OL, Clemente L, Casas R, Roig L, Pérez-Tortosa S, Díaz-Gete L, Granollers S. Effectiveness of multicomponent interventions in primary healthcare settings to promote continuous smoking cessation in adults: a systematic review. BMJ Open 2015; 5:e008807. [PMID: 26428333 PMCID: PMC4606220 DOI: 10.1136/bmjopen-2015-008807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers. DESIGN A systematic review of randomised and non-randomised controlled trials was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish. METHODS We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted. RESULTS Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences. CONCLUSIONS Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.
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Affiliation(s)
- Carlos Martín Cantera
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Puigdomènech
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Jose Luis Ballvé
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Lucía Arias
- Centre d'Atenció Primària (CAP) Florida Nord, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ramon Casas
- Centre d'Atenció Primària (CAP) Sant Antoni, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Lydia Roig
- Centre d'Atenció Primària (CAP) La Garriga, Institut Català de la Salut (ICS), La Garriga, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sabadell, Spain
| | - Santiago Pérez-Tortosa
- Centre d'Atenció Primària (CAP) La Llagosta, Institut Català de la Salut (ICS), La Llagosta, Spain
| | - Laura Díaz-Gete
- Centre d'Atenció Primària (CAP) la Sagrera, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Sílvia Granollers
- Centre d'Atenció Primària (CAP) Esplugues de Llobregat, Institut Català de la Salut (ICS), Esplugues de Llobregat, Spain
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Blackburn M, Stathi A, Keogh E, Eccleston C. Raising the topic of weight in general practice: perspectives of GPs and primary care nurses. BMJ Open 2015; 5:e008546. [PMID: 26254471 PMCID: PMC4538258 DOI: 10.1136/bmjopen-2015-008546] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/03/2015] [Accepted: 07/16/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) and primary care nurses' perceived barriers to raising the topic of weight in general practice. DESIGN A qualitative study using the Theoretical Domains Framework (TDF). 34 semistructured interviews were conducted to explore views, opinions and experiences of initiating a discussion about weight. Content and thematic analyses were used to analyse the interview transcripts. SETTING General practices located in one primary care trust in the South West of England. PARTICIPANTS 17 GPs and 17 nurses aged between 32 and 66 years. The modal age range for GPs was 30-39 years and for nurses, 40-49 years. RESULTS Barriers were synthesised into three main themes: (1) limited understanding about obesity care, (2) concern about negative consequences, and (3) having time and resources to raise a sensitive topic. Most barriers were related to raising the topic in more routine settings, rather than when dealing with an associated medical condition. GPs were particularly worried about damaging their relationship with patients and emphasised the need to follow their patient's agenda. CONCLUSIONS Uncertainty about obesity, concerns about alienating patients and feeling unable to raise the topic within the constraints of a 10 min consultation, is adding to the reluctance of GPs and nurses to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic.
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Affiliation(s)
| | | | - Edmund Keogh
- Department of Psychology, University of Bath, Bath, UK
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Lang M, Waterworth S, O'Brien A. What are the factors that influence the delivery of smoking cessation advice in critical care? Nurs Crit Care 2015; 23:237-244. [PMID: 26177914 DOI: 10.1111/nicc.12190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The world's leading cause of preventable deaths, diseases and disabilities is smoking. Hospitalization can provide an opportunity for smokers to quit. Previous research found that smokers make up a high percentage of patients admitted to intensive care. Health care professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice. AIM To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings. DESIGN Quantitative design using an online survey. METHODS This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14-bed general intensive care and a 16-bed cardiovascular intensive care unit. The target population for this research was the nursing and medical staff working in adult critical care environments. RESULTS The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments. CONCLUSIONS The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and extubated patients. Further research might be required to confirm this. RELEVANCE TO CLINICAL PRACTICE The provision of smoking cessation advice is an on-going World Health Organization and New Zealand Government priority and all parts of the health sector need to provide responses. However, responses need to be adapted to the specific context such as the unique challenges of critical care.
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Affiliation(s)
- Markus Lang
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Susan Waterworth
- Faculty of Medical and Health Sciences/School of Nursing, University of Auckland, Auckland, New Zealand
| | - Anthony O'Brien
- Faculty of Medical and Health Sciences/School of Nursing, University of Auckland, Auckland, New Zealand
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Hsu EL, Sonn K, Kannan A, Bellary S, Yun C, Hashmi S, Nelson J, Mendoza M, Nickoli M, Ghodasra J, Park C, Mitchell S, Ashtekar A, Ghosh A, Jain A, Stock SR, Hsu WK. Dioxin Exposure Impairs BMP-2-Mediated Spinal Fusion in a Rat Arthrodesis Model. J Bone Joint Surg Am 2015; 97:1003-10. [PMID: 26085534 DOI: 10.2106/jbjs.n.01311] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cigarette smoking inhibits bone-healing and leads to increased rates of pseudarthrosis. However, the mechanisms behind these effects are controversial. Dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin)--a cigarette smoke constituent and potent activator of the aryl hydrocarbon receptor (Ahr)--negatively impacts bone quality and osteoblast differentiation. We hypothesized that activation of the Ahr by dioxin would inhibit bone morphogenetic protein (BMP)-2-mediated spinal fusion in a rat arthrodesis model. METHODS Female Long-Evans rats were pretreated with dioxin or vehicle in six weekly doses, followed by bilateral posterior lumbar spinal fusion across the L4-L5 transverse processes using recombinant human BMP (rhBMP)-2. Treatments continued until sacrifice at four weeks postoperatively. A third group was treated with dioxin for six weeks, followed by a recovery period of four elimination half-lives to assess the reversible effects of dioxin exposure on spinal fusion capacity. Bone formation and fusion capacity were evaluated using fusion scoring, radiography, micro-computed tomography, and histologic analysis. RESULTS Fusion scores for dioxin-treated and dioxin-recovery rats were significantly lower than those for controls. Although fusion rates were also significantly reduced in dioxin-treated animals relative to controls (50% versus 100%, respectively), rates were not significantly reduced in dioxin-recovery animals (80%). CONCLUSIONS Dioxin treatment significantly inhibited spinal fusion in a rat arthrodesis model, and a prolonged cessation of dioxin exposure facilitated only a partial recovery of bone-healing capacity. This finding indicates that, although the effects of dioxin are persistent, an extended recovery from exposure could potentially restore bone regeneration in vivo. CLINICAL RELEVANCE Development of a pharmacologic agent that reduces the adverse effects of cigarette smoke on bone-healing could prove useful to orthopaedic surgeons. Since dioxin and other similar cigarette smoke toxins exert their effects through Ahr pathway activation, the receptor represents a potential therapeutic target to improve spinal fusion rates in patients who smoke.
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Affiliation(s)
- Erin L Hsu
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Kevin Sonn
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Abhishek Kannan
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sharath Bellary
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Chawon Yun
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - John Nelson
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Marco Mendoza
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Michael Nickoli
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Jason Ghodasra
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Christian Park
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sean Mitchell
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Amruta Ashtekar
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Anjan Ghosh
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Akshay Jain
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Stuart R Stock
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
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Hammal F, Chappell A, Pohoreski K, Finegan BA. Expanding the reach of the Quitline by engaging volunteers to market it in hospitals and shopping venues - a pilot study. Tob Induc Dis 2015; 13:13. [PMID: 26074751 PMCID: PMC4465019 DOI: 10.1186/s12971-015-0040-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, although there are periodic media campaigns to raise awareness of Quitlines, these services are underused. We sought to determine if a dedicated kiosk, similar to that used in the retail industry but staffed by volunteers trained in smoking cessation techniques, would be effective method to enhance Quitline reach. METHODS We located a kiosk in the foyer of two hospitals and in two shopping malls in Edmonton, Canada between Feb/2012 and July/2014. The cessation intervention was based on the 5 A's approach. Outcome was assessed by number of visits to the kiosk and referral rates to the Quitline. A cross sectional survey among small sample of visitors was used for evaluation. Descriptive statistics were used to summarize visitors' data. RESULTS Of 1091 kiosk visitors, 53.3 % were current smokers, of whom 93.3 % indicated a willingness to quit. Of these, 32.1 % requested a Quitline referral at the time of the kiosk visit. Referral requests to the Quitline were greater when the kiosk was located in the non-hospital setting 39.1 % compared to 31.1 % in hospitals (P = 0.2). Referrals from the kiosk represented 6 % of total referrals received by the provincial Quitline during the study period. Following referral the Quitline was able to reach 50 % of those referred, of those, 17 % refused to proceed. At seven month follow up 30 day abstinence rate was 3.8 % of smokers who wished quit. Visitors agreed that the kiosk design was interesting (89.3 %) and increased their knowledge about tobacco and cessation options (88.8 %) and encouraged them to take action to quit (85.7 %). CONCLUSIONS A "volunteer manned kiosk" can increase awareness of smoking cessation resources in the community and increase referral rates to Quitline services.
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Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Alyssa Chappell
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Katherine Pohoreski
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Barry A. Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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van Eerd EAM, van Rossem CR, Spigt MG, Wesseling G, van Schayck OCP, Kotz D. Do we need tailored smoking cessation interventions for smokers with COPD? A comparative study of smokers with and without COPD regarding factors associated with tobacco smoking. Respiration 2015; 90:211-9. [PMID: 26022403 DOI: 10.1159/000398816] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of tobacco smoking in patients with chronic obstructive pulmonary disease (COPD) is high. It is assumed that this group of smokers has more difficulties quitting than smokers without COPD. In order to increase the effectiveness of smoking cessation treatments in smokers with COPD it is important to identify any smoking-related factors which are specific to this group of smokers. OBJECTIVE To compare smokers with COPD with smokers without COPD regarding factors associated with tobacco smoking and quitting. METHODS We conducted a questionnaire survey in all smoking patients with a recorded diagnosis of COPD from a large Dutch primary health care network. We compared this group with twice as many age-, sex- and health care centre-matched smokers without COPD. RESULTS Respondents were 107 smokers with COPD and 86 smokers without COPD. The number of attempts to quit was similar in both groups but more smokers with COPD had ever used pharmacological, behavioural and alternative smoking cessation treatments. Furthermore, smokers with COPD more often received triggers to quit from their environment and from their general practitioner, and they were more concerned about, and aware of, the health risks of smoking. Importantly, smokers with COPD reported higher levels of depression and cigarette dependence and a lower self-efficacy to refrain from smoking than smokers without COPD. CONCLUSION Smokers with COPD differ from smokers without COPD on several factors which are associated with tobacco smoking and quitting. Taking into account these differences may help to increase the effectiveness of smoking cessation treatments for the specific group of smokers with COPD.
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Affiliation(s)
- Eva A M van Eerd
- Department of Family Medicine, Maastricht University Medical Centre, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
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Chinese Pediatrician Attitudes and Practices Regarding Child Exposure to Secondhand Smoke (SHS) and Clinical Efforts against SHS Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5013-25. [PMID: 26006117 PMCID: PMC4454951 DOI: 10.3390/ijerph120505013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
Background: Secondhand Smoke (SHS) exposure is a leading cause of childhood illness and premature death. Pediatricians play an important role in helping parents to quit smoking and reducing children’s SHS exposure. This study examined Chinese pediatricians’ attitudes and practices regarding children’s exposure to SHS and clinical efforts against SHS exposure. Methods: A cross-sectional survey of pediatricians was conducted in thirteen conveniently selected hospitals in southern China, during September to December 2013. Five hundred and four pediatricians completed self-administered questionnaires with a response rate of 92%. χ2 tests were used to compare categorical variables differences between smokers and non-smokers and other categorical variables. Results: Pediatricians thought that the key barriers to encouraging parents to quit smoking were: lack of professional training (94%), lack of time (84%), resistance to discussions about smoking (77%). 94% of the pediatricians agreed that smoking in enclosed public places should be prohibited and more than 70% agreed that smoking should not be allowed in any indoor places and in cars. Most of the pediatricians thought that their current knowledge on helping people to quit smoking and SHS exposure reduction counseling was insufficient. Conclusions: Many Chinese pediatricians did not have adequate knowledge about smoking and SHS, and many lacked confidence about giving cessation or SHS exposure reduction counseling to smoking parents. Lack of professional training and time were the most important barriers to help parents quit smoking among the Chinese pediatricians. Intensified efforts are called for to provide the necessary professional training and increase pediatricians’ participation in the training.
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Health care workers' knowledge, attitudes and practices on tobacco use in economically disadvantaged dominican republic communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:4060-75. [PMID: 25872018 PMCID: PMC4410233 DOI: 10.3390/ijerph120404060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 11/22/2022]
Abstract
Tobacco use is increasing globally, particularly in low and middle-income countries like the Dominican Republic (DR) where data have been lacking. Health care worker (HCW) interventions improve quit rates; asking patients about tobacco use at each visit is an evidence-based first step. This study provides the first quantitative examination of knowledge, attitudes and practices of DR HCWs regarding tobacco use. All HCWs (N = 153) in 7 economically disadvantaged DR communities were targeted with anonymous surveys. Approximately 70% (N = 107) completed the primary outcome item, asking about tobacco use at each encounter. Despite >85% strongly agreeing that they should ask about tobacco use at each encounter, only 48.6% reported doing so. While most (94.39%) strongly agreed that smoking is harmful, knowledge of specific health consequences varied from 98.13% for lung cancer to 41.12% for otitis media. Few received training in tobacco intervention (38.32%). Exploratory analyses revealed that always asking even if patients are healthy, strongly agreeing that tobacco causes cardiac disease, and always advising smoke-free homes were associated with always asking. Overall, results demonstrate a disconnect between HCW belief and practice. Though most agreed that always asking about tobacco was important, fewer than half did so. Gaps in HCW knowledge and practices suggest a need for education and policy/infrastructure support. To our knowledge, this is the first reported survey of DR HCWs regarding tobacco, and provides a foundation for future tobacco control in the DR.
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Role of mobile phone technology in tobacco cessation interventions. Glob Heart 2015; 7:167-74. [PMID: 25691312 DOI: 10.1016/j.gheart.2012.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 03/25/2012] [Indexed: 11/23/2022] Open
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Sivadasan Pillai H, Ganapathi S. Tobacco Cessation Approaches and Impact on CVD. Glob Heart 2015; 7:129-38. [PMID: 25691309 DOI: 10.1016/j.gheart.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- Harikrishnan Sivadasan Pillai
- Department of Cardiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India; Correspondence: S. Harikrishnan
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Panda R, Persai D, Venkatesan S. Missed opportunities for brief intervention in tobacco control in primary care: patients' perspectives from primary health care settings in India. BMC Health Serv Res 2015; 15:50. [PMID: 25638245 PMCID: PMC4318137 DOI: 10.1186/s12913-015-0714-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND World Health Organization has called for tobacco cessation to be integrated into primary care. Primary Health Centres (PHC) offer opportunities for tobacco-use screening and brief cessation advice but data on such activities in developing countries such as India are limited. The aim of this study was to investigate screening and brief intervention practices of health service providers in primary care. METHODS This cross-sectional study was conducted in 2012 among 1,549 patients aged over 18 years visiting PHCs in 12 districts of two Indian states- Andhra Pradesh and Gujarat. Responses were collected using an interviewer-administered questionnaire. Information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised to quit tobacco use. The primary outcome was whether patients were screened during their visit to the PHC. Data analysis was performed using multi-level logistic regression. RESULTS Less than one-third (447) of patients were screened for tobacco use during their visit to the PHC. People presenting with respiratory complaints were 84% more likely (OR: 1.84; 95% CI: 1.30 to 2.62) to be screened for tobacco use when compared to those with general ailments. Number of quit attempts in the past 12 months was strongly associated with the outcome of being screened for tobacco use, indicating that people who had more than 5 quit attempts were two times more likely to be screened for tobacco use than those who had never attempted to quit tobacco (OR: 1.99; 95% CI: 1.03 to 3.8). Among the 447 patients who were screened for tobacco use, only 136 reported to have been counselled and merely 67 patients received suggestions on ways to quit tobacco. CONCLUSION Our results show that opportunities for screening and providing tobacco use cessation advice were largely missed by the health service providers. Our study suggests that there is an urgent need to incorporate tobacco cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and counselling to quit tobacco.
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Affiliation(s)
| | - Divya Persai
- Public Health Foundation of India, New Delhi, India.
| | - Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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125
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Greaves L. The meanings of smoking to women and their implications for cessation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1449-65. [PMID: 25633033 PMCID: PMC4344676 DOI: 10.3390/ijerph120201449] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/30/2014] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
Smoking cigarettes is a gendered activity with sex- and gender-specific uptake trends and cessation patterns. While global male smoking rates have peaked, female rates are set to escalate in the 21st century, especially in low and middle income countries. Hence, smoking cessation for women will be an ongoing issue and requires refreshed attention. Public health and health promotion messages are being challenged to be increasingly tailored, taking gender into account. Women-centred approaches that include harm-reduction, motivational interviewing and trauma-informed elements are the new frontiers in interventions to encourage smoking cessation for women. Such approaches are linked to the meanings of smoking to women, the adaptive function of, and the overall role of smoking cigarettes in the context of women’s lives. These approaches respect gender and sex-related factors that affect smoking and smoking cessation and respond to these issues, not by reinforcing destructive or negative gender norms, but with insight. This article discusses a women-centred approach to smoking cessation that could underpin initiatives in clinical, community or public health settings and could inform campaigns and messaging.
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Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, E311-4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
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126
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Cooper S, Foster K, Naughton F, Leonardi-Bee J, Sutton S, Ussher M, Leighton M, Montgomery A, Parrott S, Coleman T. Pilot study to evaluate a tailored text message intervention for pregnant smokers (MiQuit): study protocol for a randomised controlled trial. Trials 2015; 16:29. [PMID: 25622639 PMCID: PMC4318454 DOI: 10.1186/s13063-014-0546-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/30/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Smoking in pregnancy is a public health problem. Self-help smoking cessation support can help pregnant women to stop smoking, but the effects of delivering this kind of support via SMS text message are not known. A previous randomised controlled trial (RCT) demonstrated the feasibility and acceptability of providing such support to pregnant smokers using an automated, tailored text message intervention called MiQuit. This larger RCT will estimate key parameters for and will test the feasibility of delivering a major trial run within the United Kingdom National Health Service settings aimed at providing definitive evidence on the utility of MiQuit for helping pregnant smokers to stop. METHODS/DESIGN This will be a multi-centre, parallel group RCT. Participants are being identified in 16 English antenatal care settings and must be >16 years old, pregnant, <25 weeks gestation, smoke >1 daily cigarette, have smoked >5 daily cigarettes before pregnancy, and able to understand texts in English. After consenting and the collection of baseline data, participants are randomised to control or intervention groups in a 1:1 ratio; randomisation is stratified by trial site and gestation and employs computer-generated pseudo-random code using random permuted blocks of randomly varying size, and held on a secure server. All participants receive a National Health Service (NHS) leaflet aimed at helping them to stop smoking. Intervention group women also receive the 12-week MiQuit programme of tailored, supportive, interactive text message, self-help cessation support. Women are followed up by telephone 4 weeks after randomisation and at 36 weeks gestation. The study aims to recruit 400 women, and with this sample we will be able to estimate trial centres' recruitment rates to within +/-1% (margin of error = half width of 95% confidence interval); individual trial groups' ascertainment of rates for smoking outcomes between 4 weeks after randomisation until approximately 36 weeks gestation to within +/-4%, and across both groups, the combined cessation rate at 36 weeks +/-3%. DISCUSSION Pilot trial completion will provide data to facilitate planning for a definitive trial investigating whether MiQuit works for smoking cessation in pregnancy. TRIAL REGISTRATION ClinicalTrials.gov NCT02043509 Registered 14 January 2014.
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Affiliation(s)
- Sue Cooper
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Katharine Foster
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Felix Naughton
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| | - Stephen Sutton
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Michael Ussher
- Population Health Research Institute, Hunter Wing, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Matthew Leighton
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, C Floor, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, C Floor, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Steve Parrott
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
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Tang MW, Oakley R, Dale C, Purushotham A, Møller H, Gallagher JE. A surgeon led smoking cessation intervention in a head and neck cancer centre. BMC Health Serv Res 2014; 14:636. [PMID: 25527115 PMCID: PMC4301942 DOI: 10.1186/s12913-014-0636-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The government has recognised the role of healthcare professionals in smoking cessation interventions with integrated care pathways for identification and referral of at-risk patients who smoke. Referral for suspected cancers has been suggested as a 'teachable moment', whereby individuals are motivated and more likely to adopt risk-reducing behaviours. A head and neck cancer referral clinic could therefore provide opportunities for smoking cessation intervention. This study aims to pilot a brief smoking cessation intervention during a consultation visit for patients referred with suspected head and neck cancer and evaluate its acceptability and impact. METHODS A brief script for smoking cessation intervention which included a smoking cessation referral was designed to be delivered to patients attending a rapid access clinic. Patient outcome data was collected by the stop smoking team for patients who accepted the referral. A subset of these patients was also interviewed by telephone; these findings were combined with data provided by the stop smoking services to assess the acceptability and impact of pilot smoking cessation intervention on patients. RESULTS In total, 473 new patients attended the clinic during the study period, of whom 102 (22%) were smokers. Of these, 80 (78%) accepted a referral to stop smoking services. A total of 75 (74%) patients were approached subsequently in a telephone survey. Of the 80 newly referred patients, 29 (36%) quit smoking at least temporarily. Another eight patients reduced their smoking or set a quit date (10%), so the experience of attending the clinic and the intervention impacted favourably on almost half of the patients (46%). The patient survey found the intervention to be acceptable for 94% (n = 50) of patients. Qualitative analysis of patient responses revealed five elements which support the acceptability of the intervention. CONCLUSIONS The findings of this pilot study suggest that discussion of smoking cessation with patients referred for suspected head and neck cancer may have an impact and facilitate the process towards quitting. A possible diagnosis of cancer appears to present a 'teachable moment' to encourage positive health behaviour change.
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Affiliation(s)
- Ming Wei Tang
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Denmark Hill Campus, London, SE5 9RS, UK.
| | | | | | - Arnie Purushotham
- Guy's & St Thomas NHS Foundation Trust, Division of Cancer Studies, King's College London, London, UK.
| | - Henrik Møller
- King's College London, Cancer Epidemiology and Population Health, London, UK.
| | - Jennifer Elizabeth Gallagher
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Denmark Hill Campus, London, SE5 9RS, UK.
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Buchbinder M, Wilbur R, Zuskov D, McLean S, Sleath B. Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: a mixed-methods study of patient-provider communication. BMC Health Serv Res 2014; 14:651. [PMID: 25526749 PMCID: PMC4300850 DOI: 10.1186/s12913-014-0651-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While primary care medical clinics have been the most common setting for the delivery of advice about smoking cessation, the hospital emergency department (ED) is a valuable context for counseling medically underserved tobacco users. We conducted a secondary analysis based on a larger audio-recorded study of patient-provider communication about pain and analgesics in the ED. Within a sample of ED patients with back pain, the purpose of this mixed-methods study was to examine how physicians and nurse practitioners capitalize on "teachable moments" for health education to offer spontaneous smoking cessation counseling in the ED. METHODS Patients presenting to an academic ED with a primary complaint of back pain were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim. Two coders reviewed each transcript to determine whether smoking was discussed and to build a corpus of smoking-related discussions. We then developed inductively generated coding categories to characterize how providers responded when patients endorsed smoking behavior. Categories were refined iteratively to accommodate discrepancies. RESULTS Of 52 patient-provider encounters during which smoking was discussed, two-thirds of the patients indicated that they were smokers. Providers missed opportunities for smoking cessation counseling 70% of the time. Eleven encounters contained teachable moments for smoking cessation. We identified four primary strategies for creating teachable moments: 1) positive reinforcement, 2) encouragement, 3) assessing readiness, and 4) offering concrete motivating reasons. CONCLUSIONS Most providers missed opportunities to offer teachable moments for smoking cessation. In encounters that contained teachable moments, providers employed multiple strategies, combining general advice with motivation tailored to the patient's particular circumstances. Creating motivational links to enhance smoking cessation efforts may be possible with a minimal investment of ED resources.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 S. Columbia St., 341A MacNider Hall CB 7240, Chapel Hill, NC, 27599, USA.
| | - Rachel Wilbur
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Diana Zuskov
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Samuel McLean
- Departments of Anesthesiology and Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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129
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Passey ME, Sanson-Fisher RW, Stirling JM. Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant indigenous women. Matern Child Health J 2014; 18:2293-9. [PMID: 24150690 PMCID: PMC4220103 DOI: 10.1007/s10995-013-1373-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.
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130
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Liira H, Engberg E, Leppävuori J, From S, Kautiainen H, Liira J, Remes-Lyly T, Tikkanen H, Pitkälä K. Exercise intervention and health checks for middle-aged men with elevated cardiovascular risk: a randomized controlled trial. Scand J Prim Health Care 2014; 32:156-62. [PMID: 25434409 PMCID: PMC4278388 DOI: 10.3109/02813432.2014.984967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the effects of a health check by a nurse alone or combined with an exercise intervention in middle-aged men at increased cardiovascular risk. DESIGN A randomized controlled trial. SETTING AND INTERVENTION Primary care in Kirkkonummi municipality with 36 000 inhabitants. A health check by a nurse alone or combined with an exercise intervention to controls with no intervention was compared. SUBJECTS A total of 168 men aged 35 to 45 years with at least two cardiovascular risk factors and physical activity (PA) frequency < 3 times a week. MAIN OUTCOME MEASURES Metabolic syndrome (MetS) as defined by International Diabetes Federation/American Heart Association and self-reported PA frequency. RESULTS Overall, focusing on health increased physical activity frequency in middle-aged men. After one year, 19% had increased PA to ≥ 3 times a week (95% CI 12-26). All study groups increased PA to ≥ 3 times: 26% of men in the exercise intervention group, 15% of men in the health check group, and 16% of controls. The differences between the groups were not statistically significant. The intervention did not have any meaningful impact on MetS or other cardiovascular outcomes at one-year follow up. CONCLUSIONS Physical activity increased in all study groups of middle-aged men in this health-promotion trial. The interventions had no effect on metabolic syndrome or other cardiovascular outcomes in the participants. The trial increased awareness and collaboration in physical activity promotion among municipal health care and exercise services.
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Affiliation(s)
- Helena Liira
- Department of General Practice, School of Medicine, University of Tampere
- Unit of Primary Health Care, Helsinki University Central Hospital and Department of General Practice, University of Helsinki
| | - Elina Engberg
- Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki
- Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki
| | - Jenni Leppävuori
- Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki
- Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki
| | - Svetlana From
- Unit of Primary Health Care, Helsinki University Central Hospital and Department of General Practice, University of Helsinki
| | | | - Juha Liira
- Finnish Institute of Occupational Health, Helsinki
| | | | - Heikki Tikkanen
- Department of Sports and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki
- Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki
| | - Kaisu Pitkälä
- Unit of Primary Health Care, Helsinki University Central Hospital and Department of General Practice, University of Helsinki
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131
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Codern-Bové N, Pujol-Ribera E, Pla M, González-Bonilla J, Granollers S, Ballvé JL, Fanlo G, Cabezas C. Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis. BMC Public Health 2014; 14:1225. [PMID: 25427643 PMCID: PMC4289187 DOI: 10.1186/1471-2458-14-1225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/17/2014] [Indexed: 12/03/2022] Open
Abstract
Background Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS). Methods Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction. Results Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed. Conclusions Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.
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Affiliation(s)
- Núria Codern-Bové
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma de Barcelona, C/De la Riba, 90, 08221 Terrassa, Spain.
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Santana López S, Perdomo Hernández MDC, Montero Díaz R. [Cardiovascular hyperreactivity to physical stress predicts high blood pressure in working populations: 4 years follow-up]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2014; 26:268-273. [PMID: 24703199 DOI: 10.1016/j.arteri.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION High blood pressure (HBP) is a disease, and as well as a risk factor for other diseases, such as atherosclerosis. Cardiovascular hyperreactivity (CVHR) is a predictor for this disease. The aim of this study was to demonstrate if CVHR to physical stress predicts HBP in working populations. METHODS A four year (2008-2012) cohort study was conducted on two population groups: CVHR (48), and normal cardiovascular reactivity (40) after applying the Sustained Weight test. A survival analysis was used to predict HBP, and the χ(2) test and hazard ratio, with a confidence interval of 95%, were used for the statistical analysis. CONCLUSIONS The CVHR is a predictor of HBP, determined by the Sustained Weight test. The working populations can be stratified according to cardiovascular reactivity in order to introduce preventive health actions on the modifiable cardiovascular risk factors of future hypertensives in the workplace.
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Affiliation(s)
- Sandra Santana López
- Medicina Interna, Instituto Nacional de Salud de los Trabajadores Asistencia Médica, La Habana, Cuba.
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Duaso MJ, McDermott MS, Mujika A, Purssell E, While A. Do doctors' smoking habits influence their smoking cessation practices? A systematic review and meta-analysis. Addiction 2014; 109:1811-23. [PMID: 25041084 DOI: 10.1111/add.12680] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/18/2014] [Accepted: 06/30/2014] [Indexed: 12/14/2022]
Abstract
AIMS To assess the association between doctors' smoking status and the use of the '5As' of smoking cessation. METHODS A systematic search of 11 databases covering English and Spanish language publications since 1996 was undertaken. Studies were included if they reported doctors' smoking status (current, former or never smoker) and rates of practising any of the 5As of smoking cessation (Ask; Advise; Assess; Assist; and Arrange). Frequencies and proportions were extracted from individual papers and risk ratios (RR) were calculated. A random-effects meta-analysis model was used to assess the effect of the doctor's personal smoking history. Covariate effects were explored using meta-regression for three pre-specified study characteristics: doctors' role, smoking prevalence of the sample and study quality. RESULTS Twenty studies were included in this systematic review. The RR of always asking patients about their smoking was not associated significantly with doctors' smoking status [RR = 0.98; 95% confidence interval (CI) = 0.94-1.02; P = 0.378; I(2) = 0.00%; 10 studies]. Meta-analysis suggested that doctors who were current smokers had a 17% increased risk of not advising their patients to quit compared with never-smokers (RR = 0.83; 95% CI = 0.77-0.90; P < 0.000; I(2) = 82.14%; 14 studies). However, high levels of heterogeneity were found that were not explained by the meta-regression. Regarding assisting patients to quit, never smokers were more likely to counsel than current smokers (RR = 0.92; 95% CI = 0.85-0.99; P = 0.036; I(2) = 0.00%; three studies) but less likely to make a referral (RR = 1.40; 95% CI = 1.09-1.79; P = 0.009; I(2) = 0.00%; five studies). No statistically significant differences were found in arranging future contact by smoking status (RR = 0.80; 95% CI = 0.52-1.23; P = 0.315; I(2) = 47.03%; four studies). CONCLUSIONS Smoking status of doctors may affect their delivery of smoking cessation treatments to patients, with smokers being less likely than non-smokers or ex-smokers to advise and counsel their patients to quit but more likely to refer them to smoking cessation programmes.
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Affiliation(s)
- Maria J Duaso
- Department of Postgraduate Research, Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
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134
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Petre B, Torbey S, Griffith JW, De Oliveira G, Herrmann K, Mansour A, Baria AT, Baliki MN, Schnitzer TJ, Apkarian AV. Smoking increases risk of pain chronification through shared corticostriatal circuitry. Hum Brain Mapp 2014; 36:683-94. [PMID: 25307796 DOI: 10.1002/hbm.22656] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 12/23/2022] Open
Abstract
Smoking is associated with increased incidence of chronic pain. However, the evidence is cross-sectional in nature, and underlying mechanisms remain unclear. In a longitudinal observational study, we examined the relationship between smoking, transition to chronic pain, and brain physiology. In 160 subjects with subacute back pain (SBP: back pain lasting 4-12 weeks, and no prior back pain [BP] for at least 1 year) pain characteristics, smoking status, and brain functional properties were measured repeatedly over 1 year. Sixty-eight completed the study, subdivided into recovering (SBPr, n = 31) and persisting (SBPp, n = 37), based on >20% decrease in BP over the year. Thirty-two chronic back pain (CBP: duration > 5 years) and 35 healthy controls were similarly monitored. Smoking prevalence was higher in SBP and CBP but not related to intensity of BP. In SBP, smoking status at baseline was predictive of persistence of BP 1 year from symptom onset (differentiating SBPp and SBPr with 0.62 accuracy). Smoking status combined with affective properties of pain and medication use improved prediction accuracy (0.82). Mediation analysis indicated the prediction of BP persistence by smoking was largely due to synchrony of fMRI activity between two brain areas (nucleus accumbens and medial prefrontal cortex, NAc-mPFC). In SBP or CBP who ceased smoking strength of NAc-mPFC decreased from precessation to postcessation of smoking. We conclude that smoking increases risk of transitioning to CBP, an effect mediated by corticostriatal circuitry involved in addictive behavior and motivated learning.
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Affiliation(s)
- Bogdan Petre
- Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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135
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Kotz D, Brown J, West R. Prospective cohort study of the effectiveness of smoking cessation treatments used in the "real world". Mayo Clin Proc 2014; 89:1360-7. [PMID: 25282429 PMCID: PMC4194355 DOI: 10.1016/j.mayocp.2014.07.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the "real-world" effectiveness of commonly used aids to smoking cessation in England by using longitudinal data. PATIENTS AND METHODS We conducted a prospective cohort study in 1560 adult smokers who participated in an English national household survey in the period from November 2006 to March 2012, responded to a 6-month follow-up survey, and made at least 1 quit attempt between the 2 measurements. The quitting method was classified as follows: (1) prescription medication (nicotine replacement therapy [NRT], bupropion, or varenicline) in combination with specialist behavioral support delivered by a National Health Service Stop Smoking Service; (2) prescription medication with brief advice; (3) NRT bought over the counter; (4) none of these. The primary outcome measure was self-reported abstinence up to the time of the 6-month follow-up survey, adjusted for key potential confounders including cigarette dependence. RESULTS Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the 6-month follow-up survey were 2.58 (95% CI, 1.48-4.52) times higher in users of prescription medication in combination with specialist behavioral support and 1.55 (95% CI, 1.11-2.16) times higher in users of prescription medication with brief advice. The use of NRT bought over the counter was associated with a lower odds of abstinence (odds ratio, 0.68; 95% CI, 0.49-0.94). CONCLUSION Prescription medication offered with specialist behavioral support and that offered with minimal behavioral support are successful methods of stopping cigarette smoking in England.
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Affiliation(s)
- Daniel Kotz
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands; Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom.
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, United Kingdom
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136
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Nkire N, Udoh G, Elahi M, Cotter D, MacHale S. Screening and Recording of Patients' Alcohol-use Habit by Clinicians in a Tertiary Accident and Emergency Unit in Ireland. Ann Med Health Sci Res 2014; 4:590-3. [PMID: 25221710 PMCID: PMC4160686 DOI: 10.4103/2141-9248.139333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Alcohol is widely consumed in Ireland; more so in major urban centers. Alcohol-related problems account for a significant number of Accident and Emergency (A and E) department presentations in Ireland. As a result, the national alcohol policy calls on doctors to be proactive in screening for and addressing alcohol misuse. Aim: The aim of the following study is to determine if patients presenting to a tertiary North Dublin A and E were asked about their alcohol use habit and if it was recorded. Materials and Methods: This was a descriptive observational study involving the retrospective review of case-notes for all patients who were assessed at the A and E Department of a North Dublin general hospital over a 1 week period for screening about their alcohol use habit. Data was entered into and analyzed using Microsoft Excel. Results: Only 17% (106/613) of the A and E attendees over the study period were asked about their alcohol use habit or had it recorded. No case-note examined documented use of alcohol screening instruments. Conclusion: This study has revealed an inadequacy of enquiry about alcohol use habit. In light of high rates of alcohol misuse in Ireland we suggest the need for improved enquiry/screening and recording of alcohol use among all patients attending A and E's.
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Affiliation(s)
- N Nkire
- Department of Psychiatry, South Tipperary Mental Health Service, Dublin, Ireland ; Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
| | - G Udoh
- Psychiatry Training Scheme, Glasgow Deanery, UK ; Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
| | - M Elahi
- Department of Psychiatry, Limerick Mental Health Services, Limerick, Ireland ; Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
| | - D Cotter
- Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
| | - S MacHale
- Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
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137
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Haddad L, El-Shahawy O, Ghadban R. Comparison of barriers to cessation among Arab American smokers of cigarettes and waterpipe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9522-31. [PMID: 25226410 PMCID: PMC4199033 DOI: 10.3390/ijerph110909522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
This cross-sectional study examined the differences in barriers to cessation and reasons for quitting smoking among dual smokers of cigarettes and waterpipe tobacco, exclusive cigarette smokers and exclusive waterpipe smokers. Participants were Arab American adults residing in Richmond, Virginia, who were recruited from Middle Eastern grocery stores, restaurants/lounges and faith and charity organizations. The study yielded several key findings: (1) Exclusive cigarette and waterpipe smokers had similar mean barriers to quitting and were more concerned about their health than dual smokers. (F(2, 150) = 5.594, p = 0.0045). This implies that barriers to smoking and health concerns could be a function of the individual who smokes rather than the modality of smoking itself. (2) Exclusive cigarette or waterpipe smokers and dual smokers may have different reasons for quitting, since they have different reasons for smoking. The proportion of smokers who endorsed smoking as a messy habit as the reason among exclusive cigarette smokers was 0.37, whereas the proportion among exclusive waterpipe smokers was 0.04 and among dual smokers 0.39. The difference in proportions is significant, χ2 (df = 2, N = 154) = 13.17, p = 0.0014. In summary, this study supports the need to further investigate dual cigarette and waterpipe smokers, as the study results indicate greater barriers to smoking cessation in this group. Recognition and understanding of these barriers among dual tobacco users would be important for any future tobacco intervention among waterpipe smokers.
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Affiliation(s)
- Linda Haddad
- College of Nursing, University of Florida, Gainesville, FL 32604, USA.
| | - Omar El-Shahawy
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA 23219, USA.
| | - Roula Ghadban
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23219, USA.
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138
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Ancellin R, Bessette D, Chauvet C, Deutsch A, Gaillot J, Lasserre A, Philibert V. La prévention des cancers : rôle et implication des professionnels de santé (in partie III : Les nouveaux enjeux de la prévention et du dépistage). ONCOLOGIE 2014. [DOI: 10.1007/s10269-014-2426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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139
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Okeke PI, Ross AJ, Esterhuizen T, Van Wyk JM. Tobacco and alcohol use among healthcare workers in three public hospitals in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2012.10874177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- PI Okeke
- Department of Family Medicine, University of KwaZulu-Natal, Durban
| | - AJ Ross
- Department of Family Medicine, University of KwaZulu-Natal, Durban
| | - T Esterhuizen
- Programme of Biostatistics, Research Ethics and Medical Law, College of Health Sciences, University of KwaZulu-Natal, Durban
| | - JM Van Wyk
- School of Undergraduate Medical Education, University of KwaZulu-Natal, Durban
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140
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Neptune D, Bonevski B, Enninghorst N, Balogh ZJ. The prevalence of smoking and interest in quitting among surgical patients with acute extremity fractures. Drug Alcohol Rev 2014; 33:548-54. [DOI: 10.1111/dar.12170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/07/2014] [Indexed: 11/27/2022]
Affiliation(s)
- DeWayne Neptune
- Department of Traumatology and Orthopaedics; John Hunter Hospital; Newcastle Australia
| | - Billie Bonevski
- Cancer Institute NSW and School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - Natalie Enninghorst
- Department of Traumatology and Orthopaedics; John Hunter Hospital; Newcastle Australia
| | - Zsolt J. Balogh
- Department of Traumatology and Orthopaedics; John Hunter Hospital; Newcastle Australia
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141
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Gomez MM, LoBiondo-Wood G. Lung Cancer Screening With Low-Dose CT: Its Effect on Smoking Behavior. J Adv Pract Oncol 2014; 4:405-14. [PMID: 25032020 PMCID: PMC4093451 DOI: 10.6004/jadpro.2013.4.6.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer screening provides an opportunity for smoking cessation interventions. A review of the literature found that smokers who participated in lung cancer screening had a higher smoking cessation rate compared with smokers in the general population. However, the randomized controlled trials included in the review did not identify any difference in smoking cessation rates between the individuals who had a CT scan to screen for lung cancer and unscreened control groups. Multiple studies observed participants for lengths of time ranging from 1 to 36 months and concluded that individuals who received abnormal CT results had a higher smoking cessation rate compared with participants with normal CT results. A single study that observed participants for 6 years initially found similar increased cessation rates among those with abnormal CT results, but at the conclusion of the study the difference in cessation rates had dissipated. Lung cancer screening produces a teachable moment when individuals may be more receptive to smoking cessation interventions. Advanced practitioners should take an active role in promoting smoking cessation interventions and fostering this teachable moment created by lung cancer screening.
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142
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Panaitescu C, Moffat MA, Williams S, Pinnock H, Boros M, Oana CS, Alexiu S, Tsiligianni I. Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians. NPJ Prim Care Respir Med 2014; 24:14022. [PMID: 25010432 PMCID: PMC4373378 DOI: 10.1038/npjpcrm.2014.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). AIM To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. METHODS A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. RESULTS Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients' inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. CONCLUSIONS Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.
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Affiliation(s)
| | - Mandy A Moffat
- Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Ioanna Tsiligianni
- Agia Barbara Health Care Centre, Crete, Greece
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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143
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Tait RJ, McKetin R, Kay-Lambkin F, Carron-Arthur B, Bennett A, Bennett K, Christensen H, Griffiths KM. A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial. JMIR Ment Health 2014; 1:e1. [PMID: 26543901 PMCID: PMC4607377 DOI: 10.2196/mental.3278] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/11/2014] [Accepted: 08/06/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users. OBJECTIVE The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group. METHODS We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and "readiness to change". The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment. RESULTS We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43%) intervention and 45/79 (57%) control participants provided follow-up data. In the intervention group, 51/81 (63%) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16). CONCLUSIONS This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP).
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Affiliation(s)
- Robert J Tait
- National Drug Research Institute Faculty of Health Sciences Curtin University Perth Australia ; National Institute for Mental Health Research The Australian National University Canberra Australia
| | - Rebecca McKetin
- Centre for Research on Ageing, Health and Wellbeing The Australian National University Canberra Australia
| | - Frances Kay-Lambkin
- National Drug and Alcohol Research Centre University of New South Wales Sydney Australia ; Centre for Translational Neuroscience and Mental Health University of Newcastle Newcastle Australia
| | - Bradley Carron-Arthur
- National Institute for Mental Health Research The Australian National University Canberra Australia
| | - Anthony Bennett
- National Institute for Mental Health Research The Australian National University Canberra Australia
| | - Kylie Bennett
- National Institute for Mental Health Research The Australian National University Canberra Australia
| | - Helen Christensen
- National Institute for Mental Health Research The Australian National University Canberra Australia ; Black Dog Institute University of New South Wales and Prince of Wales Hospital Sydney Australia
| | - Kathleen M Griffiths
- National Institute for Mental Health Research The Australian National University Canberra Australia
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144
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[Risk factor management of coronary heart disease : what is evidence-based?]. Herz 2014; 39:483-94. [PMID: 24894947 DOI: 10.1007/s00059-014-4108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In patients with coronary heart disease the further course of the disease can be substantially influenced by means of a targeted treatment of risk factors. A reduction of hospital referrals, an improvement in quality of life and an extension in life expectation by secondary prophylactic measures have been well documented. In addition to an optimized medicinal therapy, an often drastic change in lifestyle with a focus on a consistent abstinence from nicotine, a healthy diet and regular physical exercise is necessary. Data from healthcare research show that these targets are only insufficiently achieved. The implementation of current guidelines should therefore be rigorously applied. There is a need for research particularly with respect to the prognostic significance of beta blocker therapy for patients with stable coronary heart disease and preserved left ventricular function, the prognostic significance of targeted weight loss for overweight or obese coronary heart disease patients, the effectiveness of psychosocial interventions in the various patient groups and their implementation into routine care. Research is also necessary with respect to optimization of structured rehabilitation programs and improvement in patient compliance.
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145
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Champassak SL, Goggin K, Finocchario-Kessler S, Farris M, Ehtesham M, Schoor R, Catley D. A qualitative assessment of provider perspectives on smoking cessation counselling. J Eval Clin Pract 2014; 20:281-7. [PMID: 24628799 PMCID: PMC4441728 DOI: 10.1111/jep.12124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Few studies have examined doctors' views about counselling unmotivated smokers. This study explored doctors' perceptions of useful strategies to motivate patients to quit, how receptive they felt patients were to these strategies, and the benefits and drawbacks of discussing smoking cessation with patients. METHODS Fourteen semi-structured qualitative interviews were conducted with doctors and resident doctors. RESULTS Strategies reported by providers included: educating about the health risks of smoking, using 'scare tactics' to highlight the harmful effects and providing advice about how to quit. Providers believed that most patients were receptive to their strategies, but noted that they lacked feedback to know for sure. Providers saw the possibility of improving patients' health and decreasing overall health care costs as potential benefits, but cited the potential to damage rapport, competing priorities during already rushed visits and uncertainty about the effectiveness of their efforts as drawbacks that reduced their motivation to raise the issue with patients. CONCLUSIONS Doctors believe in the potential benefits of smoking cessation counselling but predominantly report focusing on enhancing patient's risk perceptions. They did not report attempting to use the wider array of recommended and empirically supported methods to counsel their patients. Providing doctors with increased training in motivational counselling and feedback about the efficacy their efforts or supplementing doctor care with behaviour change specialists would likely increase the benefits of counselling to patients.
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Affiliation(s)
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children’s Mercy Hospital and Clinics, University of Kansas Medical Center, USA
| | - Sarah Finocchario-Kessler
- Department of Psychology, University of Missouri - Kansas City, USA
- Department of Family Medicine, University of Kansas Medical Center, USA
| | - Maghen Farris
- Department of Psychology, University of Missouri - Kansas City, USA
| | - Maniza Ehtesham
- School of Medicine, University of Missouri - Kansas City, USA
| | - Rachel Schoor
- Department of Psychology, University of Missouri - Kansas City, USA
| | - Delwyn Catley
- Department of Psychology, University of Missouri - Kansas City, USA
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Bowker KA, Lewis S, Coleman T, Vaz LR, Cooper S. Comparison of cotinine levels in pregnant women while smoking and when using nicotine replacement therapy. Nicotine Tob Res 2014; 16:895-8. [PMID: 24634462 PMCID: PMC4015104 DOI: 10.1093/ntr/ntu029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/05/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) helps smokers quit smoking, but trials indicate that there is no evidence that it is effective during pregnancy. As metabolism increases during pregnancy, NRT may deliver insufficient nicotine to alleviate withdrawal symptoms. There is mixed evidence as to what levels of cotinine are reached from nicotine exposure during pregnancy while using NRT compared with smoking. METHODS We analyzed data on 33 pregnant participants from the NRT arm of a randomized control trial who had stopped smoking and were still using 15 mg/16 hr nicotine patches 1 month after quitting. Salivary cotinine levels when smoking at baseline were compared with levels on NRT at 1 month using the Wilcoxon test. RESULTS Cotinine levels were a median of 98.5 ng/ml while smoking and 62.8 ng/ml while using NRT and remaining abstinent (p = .045). Participants with the highest cotinine measurements when smoking also tended to have the steepest reduction in cotinine levels while using NRT. This was most noticeable among participants with baseline cotinine levels more than 150 ng/ml (n = 9) who had a greater reduction in median cotinine levels (median difference -134.8 ng /ml [95% CI = -144.5 to -125.9]) than those with a baseline cotinine level under 150 ng/ml (n = 24; median difference -27.9 ng/ml [95% CI = -49.35 to -1.75]). CONCLUSIONS In a pragmatic trial that replicated clinical practice, cotinine levels generated using NRT during pregnancy were lower than levels achieved from smoking. Although the sample size of this study was small, our findings are significant and are consistent with the hypothesis that NRT patches deliver an inadequate dose of nicotine to aid smoking cessation during pregnancy.
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Affiliation(s)
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Luis R. Vaz
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
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147
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Sharma A, Szatkowski L. Characteristics of smokers who have never tried to quit: evidence from the British Opinions and Lifestyle Survey. BMC Public Health 2014; 14:346. [PMID: 24721488 PMCID: PMC4008410 DOI: 10.1186/1471-2458-14-346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
Background An understanding of the characteristics of smokers who have never tried to quit may be useful to help identify and target these individuals and encourage them to attempt to give up smoking. Using national survey data we investigated variables associated with smokers reporting never having tried to quit. Methods Using data from the 2007 and 2009 UK Office for National Statistics Opinions and Lifestyle Survey we identified all self-reported current smokers aged 16+. The primary outcome was response to the question ‘have you ever tried to quit smoking?’ Univariable and multivariable logistic regression quantified the association between this outcome and several potential explanatory variables, including age, sex, socioeconomic status, health status, smoking behaviour, and knowledge of the dangers of smoking. Results Desire to quit was the most significant independent predictor of whether a smoker reported never having tried to quit. Smokers who reported that their health was good or very good were more likely to report never having tried to quit than those whose health was fair, bad or very bad (OR 1.59, 95% CI 1.05-2.41). Smokers who reported that no family members, friends or colleagues had been trying to get them to quit smoking in the last year were more likely to report never having tried to quit than those who reported that someone was trying to persuade them (OR 1.57, 95% CI 1.09-2.28). Smokers who hadn’t received any cessation advice from a health professional in the last five years which they considered to be helpful were also more likely to report never having tried to quit. Conclusions Smokers who do not want to quit, who are in good health, whose friends and family are not trying to get them to quit, and who do not report receiving helpful advice to quit from a health professional, are more likely to report never having tried to quit.
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Affiliation(s)
| | - Lisa Szatkowski
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, NG5 1 PB Nottingham, UK.
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148
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Knowledge about health effects of cigarette smoking and quitting among Italian university students: the importance of teaching nicotine dependence and treatment in the medical curriculum. BIOMED RESEARCH INTERNATIONAL 2014; 2014:321657. [PMID: 24804212 PMCID: PMC3997155 DOI: 10.1155/2014/321657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/25/2014] [Indexed: 11/24/2022]
Abstract
Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived.
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149
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Abstract
The United States is currently experiencing a primary care shortage. One solution to improving health care is to increase the utilization of existing health care providers, particularly dentists, an opportunity that has been largely ignored. By employing mid-level providers for less complex procedures to deliver more accessible dental care at lower cost, dentists can redistribute tasks to their office workforce. They can then serve as oral physicians who can provide limited preventive primary care, including screening for chronic diseases, while continuing to oversee all dental care, whether provided by dentists or non-dentists. Thus, they could improve the health of the US population as well as increase access to dental care at lower cost, while partially alleviating the primary care shortage by filling a need for the screening aspects of primary care.
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150
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Blanco L, Garcia R, Pérez-Stable EJ, White MM, Messer K, Pierce JP, Trinidad DR. National trends in smoking behaviors among Mexican, Puerto Rican, and Cuban men and women in the United States. Am J Public Health 2014; 104:896-903. [PMID: 24625159 DOI: 10.2105/ajph.2013.301844] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States. METHODS We analyzed data from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods. RESULTS Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers. CONCLUSIONS Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.
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Affiliation(s)
- Lyzette Blanco
- Lyzette Blanco and Dennis R. Trinidad are with the School of Community and Global Health, Claremont Graduate University, Claremont, CA. Robert Garcia is with the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Eliseo J. Pérez-Stable is with the Department of Medicine, University of California, San Francisco. Martha M. White, Karen Messer, and John P. Pierce are with the Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla
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