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Wen YW, Wang IT, Hu YT, Cheng HM, Cheng KW, Shiu MN, Tsai YW. Duration of varenicline prescription and efficacy of smoking cessation treatment: an observational study in Taiwan. Prev Med 2022; 161:107091. [PMID: 35660554 DOI: 10.1016/j.ypmed.2022.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022]
Abstract
Although varenicline has had a significant effect on smoking cessation in randomized clinical trials, the dose-effect of varenicline treatment for smoking cessation in real-world settings remains unclear. This study aimed to evaluate the association between the duration of varenicline prescription and smoking cessation in Taiwan after adjusting for potential confounding effects and endogeneity bias. A total of 5106 Taiwanese participants received varenicline monotherapy for smoking cessation between March 2012 and September 2016. Multinomial logistic regression (MLR) was used to analyze the association between varenicline prescription duration and smoking cessation, stratified by the frequency of smoking clinic visits and propensity scores of early stopping of smoking cessation treatment. Compared to the reference of nonquitting, longer durations of varenicline prescription were associated with the greater likelihood of immediate and complete quitting (OR = 1.08, 95% CI = 1.02-1.14) and late quitting (OR = 1.14, 95% CI = 1.07-1.20). Among those who were more likely to continue visiting smoking clinics, longer use of varenicline was significantly associated with an increase in immediate-and-complete quitting (OR = 1.19, 95% CI = 1.15-1.23) and late quitting (OR = 1.24, 95% CI = 1.20-1.28). Varenicline prescription duration was not associated with smoking cessation among smokers who visited smoking clinics once. The relationship between varenicline prescription duration and smoking cessation was modified by the frequency of smoking clinic visits and was dependent on quitting process patterns. Encouraging smokers to continue visiting the smoking cessation clinic and use medication will help smoking cessation efforts in Taiwan.
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Affiliation(s)
- Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - I-Ting Wang
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Tzu Hu
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
| | - Hao-Min Cheng
- Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kai-Wen Cheng
- Department of Health Administration, Governors State University, IL, USA
| | - Ming-Neng Shiu
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Nahvi S, Adams TR, Ning Y, Zhang C, Arnsten JH. Effect of varenicline directly observed therapy versus varenicline self-administered therapy on varenicline adherence and smoking cessation in methadone-maintained smokers: a randomized controlled trial. Addiction 2021; 116:902-913. [PMID: 32857445 PMCID: PMC7983847 DOI: 10.1111/add.15240] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 08/24/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Level of adherence to tobacco cessation medication regimens is believed to be causally related to medication effectiveness. This study aimed to evaluate the efficacy of varenicline directly observed therapy (DOT) on varenicline adherence and smoking cessation rates among smokers with opioid use disorder (OUD) receiving methadone treatment. DESIGN Multicenter, parallel-group two-arm randomized controlled trial. SETTING Urban opioid treatment program (OTP) in the Bronx, New York, USA. PARTICIPANTS Daily smokers of ≥ 5 cigarettes/day, interested in quitting (ladder of change score 6-8), in methadone treatment for ≥ 3 months, attending OTP ≥ 3 days/week. Participants' mean age was 49 years, 56% were male, 44% Latino, 30% Black, and they smoked a median of 10 cigarettes/day. INTERVENTIONS Individual, block, random assignment to 12 weeks of varenicline, either directly observed with methadone (DOT, n = 50) or via unsupervised self-administered treatment (SAT, n = 50). MEASUREMENTS The primary outcome was adherence measured by pill count. The secondary outcome was 7-day point prevalence tobacco abstinence verified by expired carbon monoxide (CO) < 8 parts per million. FINDINGS Retention at 24 weeks was 92%. Mean adherence was 78.5% [95% confidence interval (CI) = 71.8-85.2%] in the DOT group versus 61.8% in the SAT group (95% CI = 55.0-68.6%); differences were driven by DOT effects in the first 6 weeks. CO-verified abstinence did not differ between groups during the intervention (P = 0.26), but was higher in the DOT than the SAT group at intervention end (DOT = 18% versus SAT = 10%, difference = 8%, 95% CI = -13, 28); this difference was not significant (P = 0.39) and was not sustained at 24-week follow-up. CONCLUSIONS Among daily smokers attending opioid treatment programs, opioid treatment program-based varenicline directly observed therapy was associated with early increases in varenicline adherence compared with self-administered treatment, but findings were inconclusive as to whether directly observed therapy was associated with a difference in tobacco abstinence.
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Affiliation(s)
- Shadi Nahvi
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Tangeria R. Adams
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY
| | - Yuming Ning
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY
| | - Chenshu Zhang
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY
| | - Julia H. Arnsten
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, 111 East 210th Street, Bronx, NY
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Oyapero A, Olatosi O, Olagundoye O. Are Nigerian oral health workers overlooking opportunities to promote interventions for tobacco smoking cessation? POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/132292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Peckham E, Arundel C, Bailey D, Crosland S, Fairhurst C, Heron P, Hewitt C, Li J, Parrott S, Bradshaw T, Horspool M, Hughes E, Hughes T, Ker S, Leahy M, McCloud T, Osborn D, Reilly J, Steare T, Ballantyne E, Bidwell P, Bonner S, Brennan D, Callen T, Carey A, Colbeck C, Coton D, Donaldson E, Evans K, Herlihy H, Khan W, Nyathi L, Nyamadzawo E, Oldknow H, Phiri P, Rathod S, Rea J, Romain-Hooper CB, Smith K, Stribling A, Vickers C, Gilbody S. A bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health: the SCIMITAR+ RCT. Health Technol Assess 2020; 23:1-116. [PMID: 31549622 DOI: 10.3310/hta23500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is a high prevalence of smoking among people with severe mental ill health (SMI). Helping people with SMI to quit smoking could improve their health and longevity, and reduce health inequalities. However, those with SMI are less likely to access and engage with routine smoking cessation services than the general population. OBJECTIVES To compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation (BSC) intervention with usual stop smoking services for people with SMI. DESIGN A pragmatic, two-arm, individually randomised controlled trial. SETTING Primary care and secondary care mental health services in England. PARTICIPANTS Smokers aged ≥ 18 years with SMI who would like to cut down on or quit smoking. INTERVENTIONS A BSC intervention delivered by mental health specialists trained to deliver evidence-supported smoking cessation interventions compared with usual care. MAIN OUTCOME MEASURES The primary outcome was self-reported, CO-verified smoking cessation at 12 months. Smoking-related secondary outcomes were self-reported smoking cessation, the number of cigarettes smoked per day, the Fagerström Test for Nicotine Dependence and the Motivation to Quit questionnaire. Other secondary outcomes were Patient Health Questionnaire-9 items, Generalised Anxiety Disorder Assessment-7 items and 12-Item Short-Form Health Survey, to assess mental health and body mass index measured at 6 and 12 months post randomisation. RESULTS The trial randomised 526 people (265 to the intervention group, 261 to the usual-care group) aged 19 to 72 years (mean 46 years). About 60% of participants were male. Participants smoked between 3 and 100 cigarettes per day (mean 25 cigarettes per day) at baseline. The intervention group had a higher rate of exhaled CO-verified smoking cessation at 6 and 12 months than the usual-care group [adjusted odds ratio (OR) 12 months: 1.6, 95% confidence interval (CI) 0.9 to 2.8; adjusted OR 6 months: 2.4, 95% CI 1.2 to 4.7]. This was not statistically significant at 12 months (p = 0.12) but was statistically significant at 6 months (p = 0.01). In total, 111 serious adverse events were reported (69 in the BSC group and 42 in the usual-care group); the majority were unplanned hospitalisations due to a deterioration in mental health (n = 98). The intervention is likely (57%) to be less costly but more effective than usual care; however, this result was not necessarily associated with participants' smoking status. LIMITATIONS Follow-up was not blind to treatment allocation. However, the primary outcome included a biochemically verified end point, less susceptible to observer biases. Some participants experienced difficulties in accessing nicotine replacement therapy because of changes in service provision. Efforts were made to help participants access nicotine replacement therapy, but this may have affected participants' quit attempt. CONCLUSIONS People with SMI who received the intervention were more likely to have stopped smoking at 6 months. Although more people who received the intervention had stopped smoking at 12 months, this was not statistically significant. FUTURE WORK Further research is needed to establish how quitting can be sustained among people with SMI. TRIAL REGISTRATION Current Controlled Trials ISRCTN72955454. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emily Peckham
- Department of Health Sciences, University of York, York, UK
| | | | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | - Paul Heron
- Department of Health Sciences, University of York, York, UK
| | | | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Tim Bradshaw
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Michelle Horspool
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | | | - Tom Hughes
- Research and Development, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Suzy Ker
- North East York Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust, York, UK
| | - Moira Leahy
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Joseph Reilly
- North East York Community Mental Health Team, Tees, Esk and Wear Valleys NHS Foundation Trust, York, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | - Emma Ballantyne
- Research and Development, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Polly Bidwell
- Research and Development, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Susan Bonner
- Research and Development, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton on Tees, UK
| | - Diane Brennan
- Research and Development, Lincolnshire Partnership NHS Foundation Trust, Sleaford, UK
| | - Tracy Callen
- Research and Development, Solent NHS Trust, Portsmouth, UK
| | - Alex Carey
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Charlotte Colbeck
- Research and Development, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Debbie Coton
- Research and Development, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Emma Donaldson
- Research and Development, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Kimberley Evans
- Research and Development, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Hannah Herlihy
- Research and Development, Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Wajid Khan
- Research and Development, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Lizwi Nyathi
- Research and Development, Lincolnshire Partnership NHS Foundation Trust, Sleaford, UK
| | - Elizabeth Nyamadzawo
- Research and Development, Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Helen Oldknow
- Research and Development, Rotherham Doncaster and South Humber NHS Foundation Trust, Doncaster, UK
| | - Peter Phiri
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Jamie Rea
- Research and Development, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Kaye Smith
- Research and Development, Solent NHS Trust, Portsmouth, UK
| | - Alison Stribling
- Research and Development, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Carinna Vickers
- Research and Development, Somerset Partnership NHS Foundation Trust, South Petherton, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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Sharma A, Chhabra KG, Agarwal S, Bhansali S, Singh P, Nagrale RG. Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India. J Family Med Prim Care 2020; 9:2963-2968. [PMID: 32984156 PMCID: PMC7491764 DOI: 10.4103/jfmpc.jfmpc_155_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco. Materials and Methods: It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview. Results: Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC. Conclusion: From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.
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Affiliation(s)
- Ashish Sharma
- Department of Home Science, University of Rajasthan, Jaipur, Rajasthan, India
| | - Kumar Gaurav Chhabra
- Department of Public Health Dentistry, Sharad Pawar Dental College and Hospital, DMIMS (Deemed to be University), Sawangi, (Meghe) Wardha, Maharashtra, India
| | - Sunita Agarwal
- Department of Home Science, University of Rajasthan, Jaipur, Rajasthan, India
| | - Suman Bhansali
- Department of Preventive and Social Medicine, S.N Medical College, Jodhpur, Rajasthan, India
| | - Pooja Singh
- Department of Pedodontics and Preventive Dentistry, K.S.D Jain Dental College and Hospital, Kolkata, West Bengal, India
| | - Renuka G Nagrale
- Department of Public Health Dentistry, M A Rangoonwala College of Dental Sciences and Research Centre, Azam Campus 2390-B, K.B, Hidayatulla Rd, Camp, Pune, Maharashtra, India
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The influence of smoking on the prevalence of respiratory symptoms among young people. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract16162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Smoking is a preventable risk factor of chronic respiratory diseases.
Aim. To study the incidence of smoking and assess its impact on the prevalence of respiratory symptoms in the young population.
Methods. Based on the GA2LEN questionnaire, a survey of 1252 residents of one Moscow district aged 1524 years was conducted (response rate 85.0%). The statistical analysis was performed using the Statistica software package, version 10; EPINFO, version 7 (WHO).
Results. The incidence of smoking was 13.2% among men and 13.0% among women (p=0.895). Regular smoking in young people is registered from the age of 10 years and older. The intensity of smoking was higher in men than in women. The prevalence of respiratory symptoms in smokers (S) was higher than that in non-smokers (NS). 19.1% of NS and 26.3% (p0.001) of S among men, as well as 15.9% of NS and 29.5% of S (p0.001) among women noted wheezing in the chest; 30.3% of S and 19.3% of NS (p0.001) among men and 33.0% of NS and 38.6% of S (p=0.009) among women experienced symptoms of allergic rhinitis in the last 12 months; 20.3% of NS and 25.0% of S (p=0.012) among men and 18.1% of NS and 27.3% of S (p0.001) among women had nasal congestion for at least 12 weeks.
Conclusions. The adverse effects of smoking on the respiratory health of young people requires an active prevention to reduce the prevalence of respiratory symptoms and the severity of chronic respiratory diseases.
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Barhwal KK, Boppana S, Vashishtha V, Mahapatra SC. Conscious Abstinence from Smokeless Tobacco Evokes Higher Withdrawal Response and Impairs Cognitive Performance Independent of Sympathetic Response. Ann Neurosci 2020; 27:29-39. [PMID: 32982097 PMCID: PMC7499824 DOI: 10.1177/0972753120927515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION High consumption of smokeless tobacco in adult Indian population increases the risk of developing oral cancers leading to high morbidity and mortality. Though the influence of abstinence from smoking on cognitive performance has been widely studied, the effect of smokeless tobacco on cognitive performance and its association with withdrawal symptoms is less understood. This study comparatively investigates the effect of short-term conscious abstinence and distraction during abstinence from smokeless tobacco consumption on the craving, withdrawal symptoms, sympathetic response, and cognitive performance in tobacco addicts. METHODS Age, sex, education and socioeconomic status matched control (N = 15) and smokeless tobacco addicts (N = 60) were recruited from residential areas in Bhubaneswar for the study. Following randomization of the addicts, conscious abstinence (N = 30) was induced by informed abstinence from tobacco consumption for 8 hours, while distracted cessation (N = 30) was induced by involving the participants in a cognitively engaging task for 8 hours during uninformed tobacco abstinence. RESULTS The results of the study show higher withdrawal symptoms and reduced cognitive performance in volunteers with conscious abstinence which was positively correlated. The decreased cognitive performance in conscious cessation was independent of tobacco-induced increase in the LF:HF ratio and cotinine concentration in saliva. CONCLUSION While conscious abstinence results in higher withdrawal symptoms, distraction during abstinence lowers these symptoms. Inclusion of distraction sessions during cessation can, therefore, be a new element in tobacco control strategies.
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Affiliation(s)
- Kalpana Kumari Barhwal
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sujwal Boppana
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | | | - Sushil Chandra Mahapatra
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Warsi S, Elsey H, Boeckmann M, Noor M, Khan A, Barua D, Nasreen S, Huque S, Huque R, Khanal S, Shrestha P, Newell J, Dogar O, Siddiqi K. Using behaviour change theory to train health workers on tobacco cessation support for tuberculosis patients: a mixed-methods study in Bangladesh, Nepal and Pakistan. BMC Health Serv Res 2019; 19:71. [PMID: 30683087 PMCID: PMC6347762 DOI: 10.1186/s12913-019-3909-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers’ delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs. Methods Using the “capability, opportunity, and motivation as determinants of behaviour” (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers. Results Qualitative results highlighted gaps in the majority of health workers’ knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs’ non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients. Conclusions TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals’ knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care. Trial registration ISRCTN43811467. Electronic supplementary material The online version of this article (10.1186/s12913-019-3909-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sahil Warsi
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK.
| | - Melanie Boeckmann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Amina Khan
- The Initiative, Orange Grove Farm, Banigala, Islamabad, Pakistan
| | - Deepa Barua
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Samina Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Rumana Huque
- ARK Foundation, House B130, Road 21, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Sudeepa Khanal
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - Prabin Shrestha
- HERD International, P O Box Number: 24144, Thapathali 11, Kathmandu, Nepal
| | - James Newell
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Omara Dogar
- The Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Kamran Siddiqi
- The Hull York Medical School, University of York, York, YO10 5DD, UK
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Madewell ZJ. The belief that secondhand smoke causes serious illness among Chinese smokers: Smoking cessation and intention to quit. Tob Prev Cessat 2018; 4:5. [PMID: 32411836 PMCID: PMC7205068 DOI: 10.18332/tpc/82813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/07/2018] [Accepted: 01/12/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Approximately 70% of Chinese adults are exposed to secondhand smoke (SHS) each week and 100 000 people die from SHS every year in China. This study evaluates associations between the belief that SHS causes serious illness and intention to quit, attempts to quit, and quitting smoking, among Chinese adult smokers. METHODS A nationally representative sample of 4866 current and former adult smokers in the Global Adult Tobacco Survey was used for analysis. Multivariable weighted regression models were built to determine significant associations between smoking cessation behavior and the belief that SHS causes serious illness. RESULTS The belief that SHS causes serious illness was associated with intention to quit (AOR 1.62, 95% CI: 1.24, 2.12) and quitting smoking (AOR 1.44, 95% CI: 1.15, 1.81). Other variables associated with smoking cessation behavior included not permitting smoking at home (intending: AOR 1.59, 95% CI: 1.10, 2.31; attempting: AOR 1.73, 95% CI: 1.25, 2.40; quitting: AOR 2.71, 95% CI: 1.90, 3.89) and the belief that smoking causes serious illness (attempting: AOR 1.63, 95% CI: 1.14, 2.33; quitting: AOR 1.66, 95% CI: 1.21, 2.28). CONCLUSIONS These results indicate that believing SHS causes serious illness may play a role in quitting smoking. In China's collectivistic culture, interventions should focus on how SHS exposure affects the health of friends and family. This message can be combined with other proven tobacco control methods such as: smoking bans in public places, warning labels on cigarette packages, high cigarette taxes, and mass media campaigns to reduce tobacco use.
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Adapting, Pilot Testing and Evaluating the Kick.it App to Support Smoking Cessation for Smokers with Severe Mental Illness: A Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020254. [PMID: 30720772 PMCID: PMC5858323 DOI: 10.3390/ijerph15020254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 12/28/2022]
Abstract
(1) Background: While the prevalence of tobacco smoking in the general population has declined, it remains exceptionally high for smokers with severe mental illness (SMI), despite significant public health measures. This project aims to adapt, pilot test and evaluate a novel e-health smoking cessation intervention to assist relapse prevention and encourage sustained smoking cessation for young adults (aged 18⁻29 years) with SMI. (2) Methods: Using co-design principles, the researchers will adapt the Kick.it smartphone App in collaboration with a small sample of current and ex-smokers with SMI. In-depth interviews with smokers with SMI who have attempted to quit in the past 12 months and ex-smokers (i.e., those having not smoked in the past seven days) will explore their perceptions of smoking cessation support options that have been of value to them. Focus group participants will then give their feedback on the existing Kick.it App and any adaptations needed. The adapted App will then be pilot-tested with a small sample of young adult smokers with SMI interested in attempting to cut down or quit smoking, measuring utility, feasibility, acceptability, and preliminary outcomes in supporting their quit efforts. (3) Conclusions: This pilot work will inform a larger definitive trial. Dependent on recruitment success, the project may extend to also include smokers with SMI who are aged 30 years or more.
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PATI S, CHAUHAN A, MAHAPATRA S, SINHA R, PATI S. Practicing health promotion in primary care -a reflective enquiry. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E288-E293. [PMID: 29707659 PMCID: PMC5912790 DOI: 10.15167/2421-4248/jpmh2017.58.4.749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. METHODS An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. RESULTS The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. CONCLUSION We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.
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Affiliation(s)
- S. PATI
- Department of Health and Family Welfare, Government of Odisha, Odisha, India
| | - A.S. CHAUHAN
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - S. MAHAPATRA
- Indian Institute of Public Health, Bhubaneswar, Bhubaneshwar, Odisha, India
| | - R. SINHA
- Independent Researcher, New Delhi, India
| | - S. PATI
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Odisha, India
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Jhanjee S, Lal R, Mishra A, Yadav D. A Randomized Pilot Study of Brief Intervention versus Simple Advice for Women Tobacco Users in an Urban Community in India. Indian J Psychol Med 2017; 39:131-136. [PMID: 28515547 PMCID: PMC5385739 DOI: 10.4103/0253-7176.203121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM The study aimed to assess the efficacy of providing brief intervention (BI) for women tobacco users in a community-based setting. METHODS In this open-labeled randomized study, a representative sample of women (n = 100) from a community in East Delhi were screened using Alcohol, Smoking and Substance Involvement Screening Test. Eligible women were randomized to BI or simple advice (SA) arms. At baseline, they were assessed for tobacco use characteristics and severity of nicotine dependence using Fagerstrom's test for nicotine dependence. Intervention in the form of a single session of BI or SA to quit tobacco was provided at baseline. All participants were assessed at 1 week and 3 months following intervention. The principal outcome was self-reported abstinence from tobacco use at 3 months follow-up. RESULTS The mean age of the sample was 43 years (standard deviation = 13). Most women were married (80%), housewives (69%), illiterate (61%), socioeconomically disadvantaged and were smokeless tobacco users (94%). The subjects in the BI group were twice more likely to stop tobacco use as compared to individuals in the SA group (odds ratio = 2.2, 95% confidence interval: 0.962-5.197, P = 0.06). CONCLUSION The study results are suggestive of beneficial effect of BI. A larger study might provide more significant results.
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Affiliation(s)
- Sonali Jhanjee
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lal
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwami Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Yadav
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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National estimates and correlates of secondhand smoke exposure in US cancer survivors. J Cancer Surviv 2017; 11:469-476. [PMID: 28224453 DOI: 10.1007/s11764-017-0605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Cancer survivors comprise a vulnerable population for exposure to secondhand smoke (SHS). This study examined and compared the prevalence, time trends, and predictors of SHS exposure between nonsmoking adult cancer survivors and nonsmoking adults without cancer history (control group). METHODS Data were obtained from the 2001-2012 National Health and Nutrition Examination Survey (survivors: n = 2168; controls: n = 19,436). All adults ≥20 years of age who reported not smoking and had a serum cotinine level of 0.015-10 ng/mL were included in the study. Prevalence and 95% confidence intervals, weighted linear regression of prevalence on year for trend analysis, and logistic regression analysis were performed with adjustments made for the complex survey design. RESULTS Survivors were significantly less likely to be exposed to SHS (65.4 vs. 70.6%, respectively). Exposure over time decreased by 16% (from 67.1% in 2001 to 53.3% in 2012) among survivors and by 24% (from 72% in 2001 to 56% in 2012) among controls. Exposed survivors were more likely to be young (OR = 0.98 [95% CI = 0.97-0.99]), non-Hispanic Black (2.51 [1.49-4.26]), with some college education (2.47 [1.56-3.93]), a high school education (2.72 [1.76-4.19]), less than a high school education (2.49 [1.58-3.91]), and poor (1.80 [1.10-2.96]). CONCLUSION Considerable numbers of US cancer survivors are exposed to SHS and exposure disparities persist. IMPLICATIONS FOR CANCER SURVIVORS More efforts are needed to develop and test population policies and clinical-based interventions targeting cancer survivors.
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Downie LE, Douglass A, Guest D, Keller PR. What do patients think about the role of optometrists in providing advice about smoking and nutrition? Ophthalmic Physiol Opt 2017; 37:202-211. [DOI: 10.1111/opo.12353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Laura E. Downie
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
| | - Amanda Douglass
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
| | - Daryl Guest
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
| | - Peter R. Keller
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
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Wise M, Nutbeam D. Enabling health systems transformation: what progress has been made in re-orienting health services? ACTA ACUST UNITED AC 2016; Suppl 2:23-7. [PMID: 17685076 DOI: 10.1177/10253823070140020801x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Ottawa Charter has been remarkably influential in guiding the development of the goals and concepts of health promotion, and in shaping global public health practice in the past 20 years. However, of the five action areas identified in the Ottawa Charter, it appears that there has been little systematic attention to the challenge of re-orienting health services, and less than optimal progress in practice. The purposes of re-orienting health services as proposed in the Ottawa Charter were to achieve a better balance in investment between prevention and treatment, and to include a focus on population health outcomes alongside the focus on individual health outcomes. However, there is little evidence that a re-orientation of health services in these terms has occurred systematically anywhere in the world. This is in spite of the fact that direct evidence of the need to re-orient health services and of the potential benefits of doing so has grown substantially since 1986. Patient education, preventive care (screening, immunisation), and organisational and environmental changes by health organisations have all been found to have positive health and environmental outcomes. However, evidence of effectiveness has not been sufficient, on its own, to sway community preferences and political decisions. The lack of progress points to the need for significant re-thinking of the approaches we have adopted to date. The paper proposes a number of ways forward. These include working effectively in partnership with the communities we want to serve to mobilise support for change, and to reinforce this by working more effectively at influencing broader public opinion through the media. The active engagement of clinical health professionals is also identified as crucial to achieving sustainable change. Finally we recognize that by working in partnership with like-minded advocacy organizations, the IUHPE could put its significant knowledge and experience to work in leading action to transform health care systems to make a major contribution to the improvement of public health. (Promotion & Education, 2007, Supplement (2): pp 23-27).
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Schoj V, Mejia R, Alderete M, Kaplan CP, Peña L, Gregorich SE, Alderete E, Pérez-Stable EJ. Use of Smoking Cessation Interventions by Physicians in Argentina. J Smok Cessat 2016; 11:188-197. [PMID: 27594922 PMCID: PMC5007078 DOI: 10.1017/jsc.2014.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Physician-implemented interventions for smoking cessation are effective but infrequently used. We evaluated smoking cessation practices among physicians in Argentina. METHODS A self-administered survey of physicians from six clinical systems asked about smoking cessation counselling practices, barriers to tobacco use counselling and perceived quality of training received in smoking cessation practices. RESULTS Of 254 physicians, 52.3% were women, 11.8% were current smokers and 52% never smoked. Perceived quality of training in tobacco cessation counselling was rated as very good or good by 41.8% and as poor/very poor by 58.2%. Most physicians (90%) reported asking and recording smoking status, 89% advised patients to quit smoking but only 37% asked them to set a quit date and 44% prescribed medications. Multivariate analyses showed that Physicians' perceived quality of their training in smoking cessation methods was associated with greater use of evidence-based cessation interventions. (OR = 6.5; 95% CI = 2.2-19.1); motivating patients to quit (OR: 7.9 CI 3.44-18.5), assisting patients to quit (OR = 9.9; 95% CI = 4.0-24.2) prescribing medications (OR = 9.6; 95% CI = 3.5-26.7), and setting up follow-up (OR = 13.0; 95% CI = 4.4-38.5). CONCLUSIONS Perceived quality of training in smoking cessation was associated with using evidence-based interventions and among physicians from Argentina. Medical training programs should enhance the quality of this curriculum.
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Affiliation(s)
- Veronica Schoj
- Fundacion Interamericana del Corazon Argentina, Buenos Aires, Argentina
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Mariela Alderete
- Fundacion Interamericana del Corazon Argentina, Buenos Aires, Argentina
| | - Celia P Kaplan
- Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco
| | - Lorena Peña
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Steven E Gregorich
- Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco
| | - Ethel Alderete
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); Universidad Nacional de Jujuy, Argentina
| | - Eliseo J Pérez-Stable
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina; Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco
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Capozzi B, Chez A, Carpenter T, Hubert L, Hewan-Lowe L, Ozcan A, Sahni S. Osteopathic Medical Student Administered Smoking Cessation Counseling is an Effective Tool. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2016; 8:187-90. [PMID: 27213143 PMCID: PMC4866475 DOI: 10.4103/1947-2714.179958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Physician counseling on the risks of tobacco smoking and the benefits of cessation has been shown to be an effective method of increasing the rate of smoking cessation. Using the “Help Your Patients Quit Smoking: A Coaching Guide” also referred to as the “7A's of Smoking Cessation” guideline from the New York City Department of Health and Mental Hygiene is thought to be effective to convey the importance of smoking cessation. Aim: To study the efficacy of the “7A's of Smoking Cessation” guideline counseling conducted by osteopathic medical students. Materials and Methods: Osteopathic medical students were trained to counsel smokers for 3–10 min based on New York City Department of Health's “7A's of Smoking Cessation” guidelines by a licensed physician. Students then counseled health fair participants who were cigarette smokers for 3–10 min. Postcounseling, participants were administered an 4 question survey to evaluate the effect counseling had on their desire to quit smoking. Survey data were collected and analyzed. Institutional Review Board approval was obtained for this study. Results: A total of 13 anonymous health fair participants who were also smokers were administered both counseling sessions and surveys. 11/13 (84.6%) participants stated that the session motivated them to quit smoking. 9/13 (69.2%) participants responded that they were now motivated to discuss smoking cessation with their doctor after being counseled. Of these participants 12/13 (92.3%) had previously attempted to quit smoking without success. Conclusion: Participants reported an increased willingness to stop smoking after being counseled by osteopathic medical students. Participants also reported an increased motivation to discuss smoking cessation with their physician. These findings indicate that smoking cessation counseling administered by osteopathic medical students effectively in encouraging smokers to consider reduction or cessation of tobacco use.
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Affiliation(s)
- Barbara Capozzi
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, NY 10027, USA; Department of Clinical Education, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA
| | - Ariel Chez
- Department of Primary Care , Touro College of Osteopathic Medicine , New York, NY 10027 , USA
| | - Taissia Carpenter
- Department of Primary Care , Touro College of Osteopathic Medicine , New York, NY 10027 , USA
| | - Laura Hubert
- Department of Primary Care , Touro College of Osteopathic Medicine , New York, NY 10027 , USA
| | - Lissa Hewan-Lowe
- Department of Primary Care , Touro College of Osteopathic Medicine , New York, NY 10027 , USA
| | - Asli Ozcan
- Department of Primary Care , Touro College of Osteopathic Medicine , New York, NY 10027 , USA
| | - Sonu Sahni
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, NY 10027, USA; Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY 11040, USA; Center for Heart and Lung Research, Feinstein Institute for Medical Research, Manhasset, NY 11030, USA
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Levy JM, Abramowicz S. Medications to Assist in Tobacco Cessation for Dental Patients. Dent Clin North Am 2016; 60:533-40. [PMID: 27040301 DOI: 10.1016/j.cden.2015.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Smoking is the leading cause of preventable illness in the United States. Without assistance, only 3% to 6% of smokers successfully quit after 1 year. Nicotine replacement therapy (NRT), buproprion, and varenicline are first-line pharmacologic therapies. These medications function by reducing nicotine withdrawal symptoms and the desire to smoke. When first-line therapy does not lead to successful smoking cessation, combinations of varenicline with NRT, buproprion with NRT, and varenicline with buproprion may be efficacious. Behavioral therapy also plays a role in smoking cessation and the combination of pharmacologic therapy with behavioral therapy is more effective than either therapy alone.
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Affiliation(s)
- Joshua M Levy
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, 1365 Clifton Road, Suite 2300, Building B, Atlanta, GA 30322, USA
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1365 Clifton Road, Northeast, Suite 2300 Building B, Atlanta, GA 30322, USA.
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Selvamary AL, Aswath Narayanan MB, Doss J, Ramesh Kumar SG. Effectiveness of cognitive behavior therapy in tobacco cessation at a dental setting: A hospital-based randomized controlled trial. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2016. [DOI: 10.4103/2319-5932.195845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Brewer L, Mellon L, Hall P, Dolan E, Horgan F, Shelley E, Hickey A, Williams D. Secondary prevention after ischaemic stroke: the ASPIRE-S study. BMC Neurol 2015; 15:216. [PMID: 26492943 PMCID: PMC4619229 DOI: 10.1186/s12883-015-0466-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/07/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Survivors of ischaemic stroke (IS) are at high-risk for future vascular events. Comprehensive information on the adequacy of secondary prevention after IS is lacking despite the knowledge that appropriate secondary prevention improves long-term patient outcomes. ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) aimed to prospectively assess secondary prevention in patients 6 months following IS. METHODS Consenting patients admitted with IS to three Dublin hospitals were recruited over 1 year, from October 2011. At 6 months post IS a comprehensive assessment was completed, modelled on the EUROASPIRE protocol for evaluation of the adequacy of secondary prevention in post-discharge cardiac patients. This assessment included measurements of blood pressure, body mass index and fasting lipid and glucose profiles. Secondary preventive medications and smoking status were also documented. RESULTS Three hundred two patients (58 % male) participated, of whom 256 (85 %) were followed-up at 6 months. Mean age was 69 years (range 22-95). At follow-up, 68 % of patients had a BMI >25 kg/m(2) and 16.4 % were still smoking. Almost two-thirds (63.4 %) had a blood pressure >140/90 and 23 % had low-density-lipoprotein >2.5 mmol/L. 28 % of diabetic patients had HbA1c ≥ 7 %. Ninety seven percent of patients were on anti-platelet and/or anticoagulant therapy. Of those with atrial fibrillation, 82 % were anti-coagulated (mean INR of 2.4). Ninety-five percent were on lipid-lowering therapy and three-quarters were on anti-hypertensive therapy. CONCLUSION This prospective multi-centre survey of IS patients demonstrated a high prevalence of remaining modifiable risk factors at 6 months post stroke, despite the widespread prescription of secondary preventive medications. There is scope to improve preventive measures after IS (in particular blood pressure) by incorporating evidence-based guidelines into quality assurance cycles in stroke care.
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Affiliation(s)
- Linda Brewer
- Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland.
| | - Lisa Mellon
- Department of Psychology, RCSI, Dublin, 2, Ireland.
| | | | - Eamon Dolan
- Department of Geriatric & Stroke Medicine, Connolly Hospital, Blanchardstown, Dublin, 15, Ireland.
| | | | - Emer Shelley
- Department of Epidemiology and Public Health, RCSI, Dublin, 2, Ireland.
| | - Anne Hickey
- Department of Psychology, RCSI, Dublin, 2, Ireland.
| | - David Williams
- Department of Geriatric & Stroke Medicine, Royal College of Surgeons in Ireland (RCSI), Beaumont Hospital, Dublin, 9, Ireland.
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Abstract
People living with human immunodeficiency virus (HIV) are living longer since the advent of effective combined antiretroviral therapy (cART). While cART substantially decreases the risk of developing some cancers, HIV-infected individuals remain at high risk for Kaposi sarcoma, lymphoma, and several solid tumors. Currently HIV-infected patients represent an aging group, and malignancies have become a leading cause of morbidity and mortality. Tailored cancer-prevention strategies are needed for this population. In this review we describe the etiologic agents and pathogenesis of common malignancies in the setting of HIV, as well as current evidence for cancer prevention strategies and screening programs.
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Affiliation(s)
- Priscila H Goncalves
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jairo M Montezuma-Rusca
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas S Uldrick
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Downie LE, Keller PR. The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation. PLoS One 2015; 10:e0124533. [PMID: 25886641 PMCID: PMC4401759 DOI: 10.1371/journal.pone.0124533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/14/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. METHODS A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. RESULTS A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05) less likely to enquire about patients' smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05). Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2%) and dry eye disease (63.9%). The primary source of evidence used to guide practitioners' nutrition-related patient management was reported to be peer-reviewed publications. CONCLUSIONS These findings demonstrate that there are no clear predictors of practitioner behavior across the three domains. Overall, this study suggests that there is scope for Australian optometrists to improve their routine engagement by questioning patients, as well as providing evidence-based clinical advice, about smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health.
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Affiliation(s)
- Laura Elizabeth Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia 3010
| | - Peter Richard Keller
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia 3010
- Macular Research Unit, Centre for Eye Research Australia, East Melbourne, Victoria, Australia 3002
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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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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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Sutfin EL, Swords DC, Song EY, Reboussin BA, Helme D, Klein E, Wolfson M. Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers. Am J Health Promot 2014; 30:e41-9. [PMID: 25372237 DOI: 10.4278/ajhp.130820-quan-436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. DESIGN We conducted a mixed-methods study with an online survey and qualitative interviews. SETTING Study setting was student health clinics on college campuses. SUBJECTS Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). MEASURES Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices. ANALYSIS Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. RESULTS A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports. CONCLUSION This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.
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Finnigan JP, Sikora AG. Counseling the patient with potentially HPV-related newly diagnosed head and neck cancer. Curr Oncol Rep 2014; 16:375. [PMID: 24488548 DOI: 10.1007/s11912-013-0375-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The recent emergence of a clinically distinct subset of head and neck cancers (HNC) caused by infection with the human papillomavirus (HPV) necessitates critical reevaluation of the existing counseling paradigm for patients with newly diagnosed HNC. Herein we propose a structural framework for patient counseling in which HPV testing is incorporated and the impact of HPV-status is discussed in the context of multiple medical and psychosocial domains. We strive to maintain a balance between making recommendations based on the best available scientific evidence and acknowledgment of uncertainty for both patients and providers. We anticipate that both the standard-of-care diagnostic workup and treatment, and counseling guidelines for these patients will change rapidly in the years ahead, as data from ongoing and planned prospective clinical trials become available.
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Affiliation(s)
- John P Finnigan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, USA,
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Borgan SM, Jassim G, Marhoon ZA, Almuqamam MA, Ebrahim MA, Soliman PA. Prevalence of tobacco smoking among health-care physicians in Bahrain. BMC Public Health 2014; 14:931. [PMID: 25200373 PMCID: PMC4165905 DOI: 10.1186/1471-2458-14-931] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/26/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is a clear shift in smoking habits among the Middle Eastern population with a recent and alarming increase in the prevalence of waterpipe (shisha) smoking. This phenomenon has not yet been studied sufficiently across the physician population. Therefore, we set out to establish the smoking status of primary healthcare physicians in the kingdom of Bahrain. METHODS A self-administered questionnaire was distributed to a random sample of 175 out of the total 320 primary care physicians. Descriptive analysis was performed on all data and associations between variables were tested using Fishers Exact t test with statistical significance set as P-value < 0.05. RESULTS One hundred and fifty two physicians agreed to participate in the study. Sixty seven percent of physicians were females and the mean (SD) age was 45 (10) years. The majority of the physicians were married (93%) and of Bahraini nationality (76%). Ever-smokers were 11% of the population while current smokers corresponded to 8.6%. Waterpipe was the most common method of tobacco smoking followed by cigarettes. Among male physicians, the prevalence of current 'waterpipe only' smokers was 12%, followed by 4% and 2% corresponding to 'cigarette only' smokers and both, respectively. There were only three female smokers in the population, two 'waterpipe only' smokers and one cigar smoker. Of those who smoked waterpipe (n = 9; 6%), 33% smoked daily, 44% smoked weekly and 22% smoked at least once a month. Current smoking status was associated with male gender (P < 0.001) and showed a male to female smoking ratio of (10:1). CONCLUSION Waterpipe smoking rates exceeded cigarette smoking among the population of physicians in Bahrain. Prevalence of smoking remains unacceptably high among male physicians. Assessment of physicians' knowledge of the harmful effects of waterpipe tobacco smoking is warranted to plan future interventions.
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Affiliation(s)
- Saif M Borgan
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Ghufran Jassim
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Zaid A Marhoon
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Mohamed A Almuqamam
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Mohamed A Ebrahim
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
| | - Peter A Soliman
- Department of Family and Community Medicine, Royal College of Surgeons in Ireland- Medical University of Bahrain, P.O. Box 15503, Adliya, Kingdom of Bahrain
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Walters EL, Reibling ET, Wilber ST, Sullivan AF, Gaeta TJ, Camargo CA, Boudreaux ED. Emergency department provider preferences related to clinical practice guidelines for tobacco cessation: a multicenter survey. Acad Emerg Med 2014; 21:785-93. [PMID: 25112653 DOI: 10.1111/acem.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/09/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to assess current emergency department (ED) provider practices and preferences for tobacco cessation interventions. The ED is an opportune place to initiate smoking cessation interventions. However, little is known about ED provider current practices and preferences for cessation counseling in the ED. METHODS This was a survey of ED providers conducted in 2008-2009 (including physicians, nurse practitioners, physician assistants, and nurses), working at least half-time at 10 U.S. academic EDs, regarding adherence to clinical practice guidelines ("5 As") and preferences for cessation interventions/styles. Data analysis occurred in 2012-2013. RESULTS The response rate was 64% (800 out of 1,246 completed surveys). Providers reported strongest adherence to asking about patient smoking status, followed by advising, with significant variance by clinical role. Assessing, assisting, and arranging support for patients was low overall. Most frequently used interventions were to provide patients with a list of telephone numbers for stop-smoking counseling (87%), pamphlets on smoking health risks and the benefits of stopping (85%), and referrals to the National Toll-Free Smoker's Quitline (84%). Most providers (80%) were supportive of personally conducting brief (less than 3 minutes) smoking cessation counseling sessions during the ED visit, emphasizing education and encouragement. The least appealing intervention was writing a prescription for nicotine replacement therapies or medications to stop smoking (35%). CONCLUSIONS Interventions most likely to be used were brief and delivered with a positive tone and included referral to external resources. The logical next step is to design and test interventions that ED providers find acceptable.
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Affiliation(s)
- Elizabeth L. Walters
- The Department of Emergency Medicine; Loma Linda University Medical Center; Loma Linda CA
| | - Ellen T. Reibling
- The Department of Emergency Medicine; Loma Linda University Medical Center; Loma Linda CA
| | - Scott T. Wilber
- The Department of Emergency Medicine; Summa Akron City Hospital; Akron OH
| | - Ashley F. Sullivan
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - Theodore J. Gaeta
- The Department of Emergency Medicine; New York Methodist Hospital; Brooklyn NY
| | - Carlos A. Camargo
- The Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - Edwin D. Boudreaux
- The Department of Emergency Medicine; University of Massachusetts Medical School; Worcester MA
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2022:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. METHODS SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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Sarkar BK, Shahab L, Arora M, Lorencatto F, Reddy KS, West R. A cluster randomized controlled trial of a brief tobacco cessation intervention for low-income communities in India: study protocol. Addiction 2014; 109:371-8. [PMID: 24417235 DOI: 10.1111/add.12420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/01/2013] [Accepted: 11/11/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND India has 275 million adult tobacco users and tobacco use is estimated to contribute to more than a million deaths in the country each year. There is an urgent need to develop and evaluate affordable, practicable and scalable interventions to promote cessation of tobacco use. Because tobacco use is so harmful, an increase of as little as 1 percentage point in long-term quit success rates can have an important public health impact. This protocol paper describes the rationale and methods of a large randomized controlled trial which aims to evaluate the effectiveness of a brief scalable smoking cessation intervention delivered by trained health professionals as an outreach programme in poor urban communities in India. METHODS/DESIGN This is a pragmatic, two-arm, community-based cluster randomized controlled trial focused on tobacco users in low-income communities. The treatment arm is a brief intervention comprising brief advice including training in craving control using simple yogic breathing exercises (BA-YBA) and the control arm is very brief advice (VBA). Of a total of 32 clusters, 16 will be allocated to the intervention arm and 16 to the control arm. Each cluster will have 31 participants, making a total of 992 participants. The primary outcome measure will follow the Russell Standard: self-report of sustained abstinence for at least 6 months following the intervention confirmed at the final follow-up by salivary cotinine. DISCUSSION This trial will inform national and international policy on delivery of scalable and affordable brief outreach interventions to promote tobacco use cessation in low resource settings where tobacco users have limited access to physicians and medications.
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Affiliation(s)
- Bidyut K Sarkar
- Public Health Foundation of India, New Delhi, India; Department of Epidemiology and Public Health, University College London, London, UK
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Mahabee-Gittens EM, Dixon CA, Vaughn LM, Duma EM, Gordon JS. Parental tobacco screening and counseling in the pediatric emergency department: practitioners' attitudes, perceived barriers, and suggestions for implementation and maintenance. J Emerg Nurs 2013; 40:336-45. [PMID: 24029045 DOI: 10.1016/j.jen.2013.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/02/2013] [Accepted: 06/01/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The pediatric emergency department (PED) is a venue that underuses parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners' attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, as well as to solicit suggestions for improving the sustainability and maintenance of such practices. METHODS We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice. RESULTS Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing "prearranged" counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (eg, changes in children's secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of onsite tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, as well as the importance of intervention "champions" in the PED. DISCUSSION By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.
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Gold standard program for heavy smokers in a real-life setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4186-99. [PMID: 24022655 PMCID: PMC3799509 DOI: 10.3390/ijerph10094186] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/22/2013] [Accepted: 08/30/2013] [Indexed: 11/17/2022]
Abstract
Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.
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Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159-219. [PMID: 23771844 DOI: 10.1093/eurheartj/eht151] [Citation(s) in RCA: 3184] [Impact Index Per Article: 289.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Giuseppe Mancia
- Centro di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Milano, Italy.
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Advice about diet and smoking for people with or at risk of age-related macular degeneration: a cross-sectional survey of eye care professionals in the UK. BMC Public Health 2013; 13:564. [PMID: 23759079 PMCID: PMC3695797 DOI: 10.1186/1471-2458-13-564] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 05/30/2013] [Indexed: 12/20/2022] Open
Abstract
Background In the absence of a cure, there has been considerable interest in attempts to prevent or reduce the progression of age-related macular degeneration (AMD) by targeting particular modifiable risk factors. The aim of this study was to conduct a cross-sectional survey of the current practice of UK eye care professionals in relation to advice given on diet and other lifestyle modifications for patients with or at risk of AMD. Methods Optometrists and ophthalmologists on the membership databases of professional organisations for the two professions were invited to participate in an online survey. The survey was open for 12 weeks between July and September 2012. Results A total of 1,468 responses were received (96.3% from optometrists and 3.7% from ophthalmologists). The response rate of those receiving the invitation was 16.2% (1,414/8735) for optometrists and 6% (54/1460) for ophthalmologists. A majority of respondents reported that they frequently provide dietary advice to patients with established AMD (67.9%) and those at risk of AMD (53.6%). Typical advice consisted of a recommendation to eat plenty of leafy green vegetables and eat more oily fish. The decision to recommend nutritional supplements was based on the risk of progression to advanced AMD, with approximately 93% of respondents recommending supplementation in a patient with advanced AMD in one eye. However for the majority, the type of supplement recommended did not comply with current best research evidence, based on the findings of the Age-related Eye Disease Study (AREDS). Only one in three optometrists regularly assessed smoking status and advised on smoking cessation. Conclusions Within a large sample of eye care professionals, consisting predominantly of optometrists, who responded to a cross-sectional survey, there was active engagement in providing nutritional advice to patients with or at risk of AMD. However, the results demonstrate a need to raise awareness of the evidence underpinning the use of nutritional supplements together with an increased involvement in targeted smoking cessation.
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Walter FM, Prevost AT, Birt L, Grehan N, Restarick K, Morris HC, Sutton S, Rose P, Downing S, Emery JD. Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care. Br J Gen Pract 2013; 63:e393-400. [PMID: 23735410 PMCID: PMC3662456 DOI: 10.3399/bjgp13x668186] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/09/2012] [Accepted: 01/30/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care. AIM To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer. DESIGN AND SETTING Two-stage diagnostic validation study in 10 general practices in eastern England. Method Participants aged 18-50 years were identified via random sampling from electronic searches of general practice records. Participants completed a FHQ then had a three-generational 'gold standard' pedigree taken, to determine disease risk category. In stage 1, the FHQ comprised 12 items; in stage 2 the shorter 6-item FHQ was validated against the same 'gold standard'. RESULTS There were 1147 participants (stage 1: 618; stage 2: 529). Overall, 32% were at increased risk of one or more marker conditions (diabetes 18.9%, ischaemic heart disease 13.3%, breast cancer 6.2%, colorectal cancer 2.2%). The shorter 6-item FHQ performed very well for all four conditions: pooled data from both stages show diabetes, sensitivity = 98%, specificity = 94%; ischaemic heart disease, sensitivity = 93%, specificity = 81%; breast cancer, sensitivity = 81%, specificity = 83%; colorectal cancer, sensitivity = 96%, specificity = 88%, with an area under the receiver operating characteristic curve of 0.90 for males and 0.89 for females. CONCLUSION This brief self-completed FHQ shows good diagnostic accuracy for identifying people at higher risk of four common chronic diseases. It could be used in routine primary care to identify patients who would be most likely to benefit from a more detailed pedigree and risk assessment, and consequent management strategies.
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Affiliation(s)
- Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [PMID: 23728631 DOI: 10.1002/14651858.cd000165.pub4.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. SELECTION CRITERIA Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. AUTHORS' CONCLUSIONS Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 2Research Division, Fundación Universitaria deCiencias de la Salud, University, Bogotá, Colombia. UK.
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Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database Syst Rev 2013; 2013:CD000165. [PMID: 23728631 PMCID: PMC7064045 DOI: 10.1002/14651858.cd000165.pub4] [Citation(s) in RCA: 446] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. SELECTION CRITERIA Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. AUTHORS' CONCLUSIONS Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 2Research Division, Fundación Universitaria deCiencias de la Salud, University, Bogotá, Colombia. UK.
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Díaz-Gete L, Puigdomènech E, Briones EM, Fàbregas-Escurriola M, Fernandez S, del Val JL, Ballvé JL, Casajuana M, Sánchez-Fondevila J, Clemente L, Castaño C, Martín-Cantera C. Effectiveness of an intensive E-mail based intervention in smoking cessation (TABATIC study): study protocol for a randomized controlled trial. BMC Public Health 2013; 13:364. [PMID: 23597262 PMCID: PMC3648415 DOI: 10.1186/1471-2458-13-364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensive interventions on smoking cessation increase abstinence rates. However, few electronic mail (E-mail) based intensive interventions have been tested in smokers and none in primary care (PC) setting. The aim of the present study is to evaluate the effectiveness of an intensive E-mail based intervention in smokers attending PC services. METHODS/DESIGN Randomized Controlled Multicentric Trial. STUDY POPULATION 1060 smokers aged between 18-70 years from Catalonia, Salamanca and Aragón (Spain) who have and check regularly an E-mail account. Patients will be randomly assigned to control or intervention group. INTERVENTION Six phase intensive intervention with two face to face interviews and four automatically created and personal E-mail patients tracking, if needed other E-mail contacts will be made. Control group will receive a brief advice on smoking cessation. OUTCOME MEASURES Will be measured at 6 and 12 months after intervention: self reported continuous abstinence (confirmed by cooximetry), point prevalence abstinence, tobacco consumption, evolution of stage according to Prochaska and DiClemente's Stages of Change Model, length of visit, costs for the patient to access Primary Care Center. STATISTICAL ANALYSIS Descriptive and logistic and Poisson regression analysis under the intention to treat basis using SPSS v.17. DISCUSSION The proposed intervention is an E-mail based intensive intervention in smokers attending primary care. Positive results could be useful to demonstrate a higher percentage of short and long-term abstinence among smokers attended in PC in Spain who regularly use E-mail. Furthermore, this intervention could be helpful in all health services to help smokers to quit. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01494246.
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Affiliation(s)
- Laura Díaz-Gete
- Centre d’Atenció Primària (CAP) La Sagrera, Institut Català de la Salut, Barcelona, Spain
| | - Elisa Puigdomènech
- Primary Healthcare Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP- Jordi Gol, C/Sardenya 375, Barcelona, entresuelo 08025, Spain
| | - Elena Mercedes Briones
- Primary Healthcare Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP- Jordi Gol, C/Sardenya 375, Barcelona, entresuelo 08025, Spain
| | | | - Soraya Fernandez
- Centre d’Atenció Primària (CAP) La Sagrera, Institut Català de la Salut, Barcelona, Spain
| | - Jose Luis del Val
- Primary Healthcare Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP- Jordi Gol, C/Sardenya 375, Barcelona, entresuelo 08025, Spain
| | - Jose Luis Ballvé
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | | | - Jessica Sánchez-Fondevila
- Primary Healthcare Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP- Jordi Gol, C/Sardenya 375, Barcelona, entresuelo 08025, Spain
| | | | - Carmen Castaño
- La Alamedilla Health Centre, Castilla y León Health Service–SACYL, Salamanca, Spain
| | - Carlos Martín-Cantera
- Primary Healthcare Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP- Jordi Gol, C/Sardenya 375, Barcelona, entresuelo 08025, Spain
- Centre d’Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut, Barcelona, Spain
- Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Geense WW, van de Glind IM, Visscher TLS, van Achterberg T. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study. BMC FAMILY PRACTICE 2013; 14:20. [PMID: 23394162 PMCID: PMC3575260 DOI: 10.1186/1471-2296-14-20] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 02/05/2013] [Indexed: 12/02/2022]
Abstract
Background The number of chronically ill patients increases every year. This is partly due to an unhealthy lifestyle. However, the frequency and quality of (evidence-based) health promotion activities conducted by Dutch general practitioners (GPs) and practice nurses (PNs) are limited. The aim of this pilot study was to explore which lifestyle interventions Dutch GPs and PNs carry out in primary care, which barriers and facilitators can be identified and what main topics are with respect to attitudes towards health promoting activities. These topic areas will be identified for a future, larger scale study. Method This qualitative study consisted of 25 semi-structured interviews with sixteen GPs and nine PNs. ATLAS.ti was used to analyse the transcripts of the interviews. Results All GPs and PNs said they discuss lifestyle with their patients. Next to this, GPs and PNs counsel patients, and/or refer them to other disciplines. Only few said they refer patients to specific lifestyle programs or interventions in their own practice or in the neighbourhood. Several barriers and facilitators were identified. The main topics as barriers are: a lack of patients’ motivation to make lifestyle changes, insufficient reimbursement, a lack of proven effectiveness of interventions and a lack of overview of health promoting programs in their neighbourhood. The most cited facilitators are availability of a PN, collaboration with other disciplines and availability of interventions in their own practice. With respect to attitudes, six different types of GPs were identified reflecting the main topics that relate to attitudes, varying from ‘ignorer’ to ‘nurturer’. The topics relating to PNs attitudes towards health promotion activities, were almost unanimously positive. Conclusion GPs and PNs all say they discuss lifestyle issues with their patients, but the health promotion activities that are organized in their practice vary. Main topics that hinder or facilitate implementation are identified, including those that relate to attitudes of GPs and PNs.
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Affiliation(s)
- Wytske W Geense
- Scientific Institute for Quality of Healthcare, IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands, P.O. Box 9101, Nijmegen, HB 6500, The Netherlands.
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Bize R, Burnand B, Mueller Y, Rège-Walther M, Camain JY, Cornuz J. Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Syst Rev 2012; 12:CD004705. [PMID: 23235615 DOI: 10.1002/14651858.cd004705.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH METHODS For the most recent update, we searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register in July 2012 for studies added since the last update in 2009. SELECTION CRITERIA Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, a pooled effect was estimated using a Mantel-Haenszel fixed-effect method. MAIN RESULTS We included 15 trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that carbon monoxide (CO) measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other 11 trials due to the presence of substantial clinical heterogeneity. Of the remaining 11 trials, two trials detected statistically significant benefits: one trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12, 95% CI 1.24 to 3.62) and one trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77, 95% CI 1.04 to 7.41) but enrolled a population of light smokers and was judged to be at unclear risk of bias in two domains. Nine further trials did not detect significant effects. One of these tested CO feedback alone and CO combined with genetic susceptibility as two different interventions; none of the three possible comparisons detected significant effects. One trial used CO measurement, one used ultrasonography of carotid arteries and two tested for genetic markers. The four remaining trials used a combination of CO and spirometry feedback in different settings. AUTHORS' CONCLUSIONS There is little evidence about the effects of most types of biomedical tests for risk assessment on smoking cessation. Of the fifteen included studies, only two detected a significant effect of the intervention. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial but the evidence is not optimal. A trial of carotid plaque screening using ultrasound also detected a significant effect, but a second larger study of a similar feedback mechanism did not detect evidence of an effect. Only two pairs of studies were similar enough in terms of recruitment, setting, and intervention to allow meta-analyses; neither of these found evidence of an effect. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.
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Affiliation(s)
- Raphaël Bize
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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Huang PH, Kim CX, Lerman A, Cannon CP, Dai D, Laskey W, Peacock WF, Hernandez AF, Peterson ED, Smith EE, Fonarow GC, Schwamm LH, Bhatt DL. Trends in smoking cessation counseling: experience from American Heart Association-get with the guidelines. Clin Cardiol 2012; 35:396-403. [PMID: 22753250 DOI: 10.1002/clc.22023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Successful smoking cessation in stroke and coronary artery disease (CAD) patients is important, as smoking contributes to significant morbidity and mortality. The American Heart Association developed Get With The Guidelines (GWTG) to improve compliance with national guideline recommendations for cardiovascular care. Using data from GWTG, we examined trends associated with the smoking-cessation counseling (SCC) performance measure. HYPOTHESIS Implementation of a systematic quality improvement program will increase compliance with the SCC performance measure. METHODS We evaluated compliance with SCC in current or recent smokers identified from 224 671 CAD admissions between 2002 and 2008 in the GWTG-CAD database, and from 405 681 stroke admissions between 2002 and 2007 in the GWTG-Stroke database. Additionally, we examined adherence to other performance and quality measures related to CAD and stroke care. RESULTS Overall, 55 904 GWTG-CAD and 58 865 GWTG-Stroke admissions were used for the analysis. Rates of SCC improved in each successive year during the study, from 67.6% to 97.4% (P < 0.001) in GWTG-CAD and from 40.1% to 90.7% (P < 0.001) in GWTG-Stroke. Compliance with SCC was up to 34.7% lower (P < 0.0001) in GWTG-Stroke compared with GWTG-CAD, but this difference decreased to 6.7% (P < 0.0001) by the end of the study period. Compliance with many other performance and quality measures was significantly lower among patients not receiving SCC. CONCLUSIONS Get With The Guidelines has improved compliance with the SCC performance measure among patients with CAD and stroke. Although the initial disparity in rates of SCC between CAD and stroke patients gradually improved, the difference remained significant.
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Affiliation(s)
- Pei-Hsiu Huang
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Duffy SA, Ronis DL, Titler MG, Blow FC, Jordan N, Thomas PL, Landstrom GL, Ewing LA, Waltje AH. Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial. Trials 2012; 13:125. [PMID: 22852834 PMCID: PMC3533810 DOI: 10.1186/1745-6215-13-125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 06/08/2012] [Indexed: 11/25/2022] Open
Abstract
Background The objectives of this smoking cessation study among hospitalized smokers are to: 1) determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2) compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome) post-recruitment; and 3) determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with adjustment for the clustering of patients within hospital units. Regression analyses will test the moderation of the effects of the interventions by patient characteristics. Cost-effectiveness will be assessed by constructing three ratios including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Discussion Given that nurses represent the largest group of front-line providers, this intervention, if proven effective, has the potential for having a wide reach and thus decrease smoking, morbidity and mortality among inpatient smokers. Trial registration Dissemination of Tobacco Tactics for Hospitalized Smokers NCT01309217
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Affiliation(s)
- Sonia A Duffy
- School of Nursing, University of Michigan, Ann Arbor, MI 48109-5482, USA.
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Ripoll J, Girauta H, Ramos M, Medina-Bombardó D, Pastor A, Alvarez-Ossorio C, Gorreto L, Esteva M, García E, Uréndez A, Buades A, Torres E. Clinical trial on the efficacy of exhaled carbon monoxide measurement in smoking cessation in primary health care. BMC Public Health 2012; 12:322. [PMID: 22551017 PMCID: PMC3390274 DOI: 10.1186/1471-2458-12-322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/02/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Smoking cessation is beneficial for our health at any point in life, both in healthy people and in people already suffering from a smoking-related disease. Any help to quit smoking can produce considerable benefits for Public Health. The purpose of the present study is to evaluate the efficacy of the CO-oximetry technique together with brief advice in smoking cessation, in terms of reduction of the number of cigarettes or in the variation of the motivation to quit smoking at month 12 compared with brief advice alone. METHODS/DESIGN Randomised, parallel, single-blind clinical trial in a primary health care setting in Majorca (Spain). Smokers in contemplation or pre-contemplation phase will be included in the study. EXCLUSION CRITERIA Smokers in preparation phase, subjects with a terminal illness or whose health status does not allow them to understand the study or complete the informed consent, and pregnant or breastfeeding women. The subjects will be randomly assigned to the control group (CG) or the intervention group (IG). The CG will receive brief advice, and the IG will receive brief advice together with a measurement of exhaled CO. There will be follow-up evaluations at 6 and 12 months after inclusion. 471 subjects will be needed per group in order to detect a difference between groups ≥ 5%. PRIMARY OUTCOME sustained smoking cessation (at 6 and 12 months) confirmed by urine cotinine test. SECONDARY OUTCOMES point smoking cessation at 6 and 12 months both confirmed by urine cotinine analysis and self-reported, reduction in cigarette consumption, and variation in phase of smoking cessation. DISCUSSION CO-oximetry is an inexpensive, non-invasive, fast technique that requires little technical training; making it a technique for risk assessment in smokers that can be easily applied in primary care and, if proven effective, could serve as a reinforcement aid in smoking cessation intervention activities. TRIAL REGISTRATION Current Controlled Trials ISRCTN67499921.
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Affiliation(s)
- Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Helena Girauta
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Maria Ramos
- Public Health Department, Balearic Islands Health Department, Mallorca, Spain
| | | | - Agnès Pastor
- Sineu Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | | | - Lucía Gorreto
- Emili Darder Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Maria Esteva
- Artà Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Elena García
- Sant Agustí Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Ana Uréndez
- Son Pisà Health Care Centre, Baleares Health services-IbSalut, Mallorca, Spain
| | - Ana Buades
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
| | - Elena Torres
- Primary Care Research Unit of Mallorca, Baleares Health services-IbSalut, Mallorca, Spain
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Parker WA, Steyn NP, Levitt NS, Lombard CJ. Health promotion services for patients having non-comminicable diseases: feedback from patients and health care providers in Cape Town, South Africa. BMC Public Health 2012; 12:503. [PMID: 22762453 PMCID: PMC3433333 DOI: 10.1186/1471-2458-12-503] [Citation(s) in RCA: 29] [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: 04/04/2012] [Accepted: 06/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken. METHODS A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. RESULTS Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. CONCLUSION The majority of patients attending PHC facilities want to receive lifestyle modification education. There is not however, one specific method that can be regarded as the gold standard. Patients' preferences regarding health education methods differ, and they are more likely to be susceptible to methods that do not involve much reading. Health education materials such as posters, pamphlets and booklets should be used to supplement information received during counselling or support group sessions.
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Affiliation(s)
- Whadi-ah Parker
- Centre for the Study of the Social and Environmental Determinants of Nutrition, Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa
| | - Nelia P Steyn
- Centre for the Study of the Social and Environmental Determinants of Nutrition, Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa
| | - Naomi S Levitt
- Diabetes and Endocrine Unit, Department of Medicine, University of Cape Town, Obervatory, 7925, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, Cape Town, South Africa
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Collins BN, Ibrahim J. Pediatric Secondhand Smoke Exposure: Moving Toward Systematic Multi-Level Strategies to Improve Health. Glob Heart 2012; 7:161-165. [PMID: 24040587 DOI: 10.1016/j.gheart.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Bradley N Collins
- Associate Professors, Department of Public Health, College of Health Professions and Social Work, Temple University 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor Philadelphia, PA 19122, USA
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Gong J, Zhang Z, Zhu Z, Wan J, Yang N, Li F, Sun H, Li W, Xia J, Zhou D, Chen X. Cigarette smoking and anti‐smoking counseling practices among physicians in Wuhan, China. HEALTH EDUCATION 2012. [DOI: 10.1108/09654281211237153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chisholm A, Hart J, Lam V, Peters S. Current challenges of behavior change talk for medical professionals and trainees. PATIENT EDUCATION AND COUNSELING 2012; 87:389-394. [PMID: 22205055 DOI: 10.1016/j.pec.2011.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/28/2011] [Accepted: 12/03/2011] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To explore medical professionals' and trainees' experiences and views of behavior change talk in various health care settings to develop current understanding of the challenges that underlie this phenomenon. METHODS Qualitative, semi-structured interviews were conducted with medical professionals and trainees (n=29). Grounded theory principles informed sampling, data collection and analysis. To achieve maximum variance, participants with different levels of experience were purposively sampled from a range of primary and secondary care settings. Analysis was iterative, involving a constant comparative approach allowing emergent ideas to be tested in subsequent interviews until thematic saturation was reached. RESULTS Three emergent themes described reasons for not engaging in behavior change talk with patients: (1) 'personal challenges'; (2) 'somebody else's responsibility' and (3) 'prioritizing the doctor-patient relationship'. CONCLUSION Despite increasingly being recognized as a core aspect of medical practice and education, medical professionals and trainees remain unprepared to discuss health-related behavior change with patients and unclear of their roles within contemporary health care. PRACTICE IMPLICATIONS Formal training in theory-based behavior change techniques is likely to help empower doctors and mitigate many of the barriers found, particularly in relation to socially and emotionally uncomfortable topics that are perceived to threaten the doctor-patient relationship.
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Affiliation(s)
- Anna Chisholm
- School of Psychological Sciences, University of Manchester, Manchester, UK.
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Chew L, Lee HP. Live It Up Without Lighting Up. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n5p184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Hin Peng Lee
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
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Burton C. Heavy tailed distributions of effect sizes in systematic reviews of complex interventions. PLoS One 2012; 7:e34222. [PMID: 22479569 PMCID: PMC3313970 DOI: 10.1371/journal.pone.0034222] [Citation(s) in RCA: 16] [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: 10/04/2011] [Accepted: 02/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Systematic reviews of complex interventions commonly find heterogeneity of effect sizes among similar interventions which cannot be explained. Commentators have suggested that complex interventions should be viewed as interventions in complex systems. We hypothesised that if this is the case, the distribution of effect sizes from complex interventions should be heavy tailed, as in other complex systems. Thus, apparent heterogeneity may be a feature of the complex systems in which such interventions operate. METHODOLOGY/PRINCIPAL FINDINGS We specified three levels of complexity and identified systematic reviews which reported effect sizes of healthcare interventions at two of these levels (interventions to change professional practice and personal interventions to help smoking cessation). These were compared with each other and with simulated data representing the lowest level of complexity. Effect size data were rescaled across reviews at each level using log-normal parameters and pooled. Distributions were plotted and fitted against the inverse power law (Pareto) and stretched exponential (Weibull) distributions, heavy tailed distributions which are commonly reported in the literature, using maximum likelihood fitting. The dataset included 155 studies of interventions to change practice and 98 studies of helping smoking cessation. Both distributions showed a heavy tailed distribution which fitted best to the inverse power law for practice interventions (exponent = 3.9, loglikelihood = -35.3) and to the stretched exponential for smoking cessation (loglikelihood = -75.2). Bootstrap sensitivity analysis to adjust for possible publication bias against weak results did not diminish the goodness of fit. CONCLUSIONS/SIGNIFICANCE The distribution of effect sizes from complex interventions includes heavy tails as typically seen in both theoretical and empirical complex systems. This is in keeping with the idea of complex interventions as interventions in complex systems.
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Affiliation(s)
- Christopher Burton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
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Long-term effectiveness of adolescent brief tobacco intervention: a follow-up study. BMC Res Notes 2012; 5:101. [PMID: 22339943 PMCID: PMC3341189 DOI: 10.1186/1756-0500-5-101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 02/16/2012] [Indexed: 11/26/2022] Open
Abstract
Background Brief tobacco intervention has been used in promoting smoking cessation and preventing the initiation of smoking. We used a cohort born in 1979 (n = 2 586) from four cities in Finland. Those born on odd days received up to four brief tobacco interventions during their annual school dental check-ups in 1992-1994 (at the age of 13-15). Those who were born on even days were used as a control group. In 2008 a follow-up questionnaire was sent to the cohort. The aim of this study was to ascertain the long-term effectiveness of brief tobacco intervention given in dental health care during school age. Findings Responses were received from 529 people in the intervention group and 491 in the control group. In the intervention group and control group by the age of 29 there were 15.3% and 18.5% smokers respectively. This difference was not statistically significant. The difference between groups was similar to that observed when they were 14 years old. Conclusions Brief tobacco intervention performed in dental health care in adolescence did not show effectiveness in the long-term follow-up. This type of intervention alone is insufficient to prevent smoking but supports other anti-smoking activities. Trial Registration This study was registered at http://clinicaltrials.gov (NCT01348646).
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