1
|
Nian T, Guo K, Liu W, Deng X, Hu X, Xu M, E F, Wang Z, Song G, Yang K, Li X, Shang W. Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC Med 2023; 21:378. [PMID: 37775745 PMCID: PMC10542700 DOI: 10.1186/s12916-023-03087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. METHODS A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. RESULTS A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. CONCLUSIONS The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
Collapse
Affiliation(s)
- Tao Nian
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Kangle Guo
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wendi Liu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xinxin Deng
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Xiaoye Hu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
| | - Meng Xu
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Fenfen E
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Ziyi Wang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Guihang Song
- Gansu Provincial Medical Security Bureau, Lanzhou, 730000, People's Republic of China
| | - Kehu Yang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Xiuxia Li
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, People's Republic of China
| | - Wenru Shang
- Evidence Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, People's Republic of China.
- Vidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Collaborative Innovation Center of First Hospital, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| |
Collapse
|
2
|
Public Health Practitioners’ Knowledge towards Nicotine and Other Cigarette Components on Various Human Diseases in Pakistan: A Contribution to Smoking Cessation Policies. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7909212. [PMID: 36225984 PMCID: PMC9550448 DOI: 10.1155/2022/7909212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
Smoking cessation seems to be a weak link in the struggle against tobacco epidemic in Pakistan. Awareness regarding nicotine is lacking not only in the general population but also among public health practitioners. This lack of knowledge is one of the key barriers to bringing down the prevalence of smoking. Using primary survey data and nonparametric econometric techniques, this study assesses the knowledge of nicotine and harm reduction among public health practitioners in Pakistan. Results indicate physicians have misconceptions about nicotine. The majority of the medical professionals associate nicotine use with birth defects, cancer, cardiovascular illness, and chronic obstructive pulmonary disease (COPD). More than two-thirds of doctors (70%) strongly agreed and 17.9% somewhat agreed with the statement that nicotine causes cancer. This study suggests physicians need to be better informed about the fact that nicotine in tobacco products is addictive while chemicals, particularly those causing combustion, are the primary risk sources for tobacco-related illnesses. Misconceptions regarding nicotine can be quickly remedied with communication interventions. This study also suggests that alternative nicotine delivery systems can help smoking cessation and reduce the consumption of combustible tobacco in Pakistan.
Collapse
|
3
|
Buczkowski K, Dachtera-Frąckiewicz M, Luszkiewicz D, Klucz K, Sawicka-Powierza J, Marcinowicz L. Reasons for and Scenarios Associated with Failure to Cease Smoking: Results from a Qualitative Study Among Polish Smokers Who Had Unsuccessfully Attempted to Quit. Patient Prefer Adherence 2021; 15:2071-2084. [PMID: 34556977 PMCID: PMC8453429 DOI: 10.2147/ppa.s320798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Most smokers attempt to quit smoking, but few are successful. Data regarding the reasons for this relapse and the course of the relapse process may be helpful for determining efficient methods of smoking cessation. This study aimed to identify the causes of and scenarios associated with smoking relapse after effective smoking cessation. PATIENTS AND METHODS We conducted 20 semi-structured interviews with smokers who had previously unsuccessfully attempted to quit. The data underwent qualitative content analysis. RESULTS Three major themes were identified: reasons for smoking relapse; smoking relapse scenarios; and perception of the influence of personal environments, including family and physicians, on refraining from smoking after cessation. The first theme comprised the following subthemes: insufficient willpower and self-discipline, contact with smokers, exposure to stressful situations, lack of family support, weight gain, and insufficient improvement in one's mental and physical well-being. The second theme contained enjoyable social events, professional life, critical events, and encouragement to smoke from family members. The respondents frequently emphasized the large role of interaction with other smokers. CONCLUSION The predominant factors underlying smoking relapse include insufficient willpower and self-discipline and exposure to stress. The most frequent relapse scenario concerned experiencing negative or positive emotions when interacting with other smokers.
Collapse
Affiliation(s)
- Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University, Torun, Poland
- Correspondence: Krzysztof Buczkowski Email
| | | | - Dorota Luszkiewicz
- Department of Family Medicine, Nicolaus Copernicus University, Torun, Poland
| | - Katarzyna Klucz
- Department of Family Medicine, Nicolaus Copernicus University, Torun, Poland
| | | | - Ludmila Marcinowicz
- Department of Obstetrics, Gynaecology and Maternity Care, Faculty of Health Sciences, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
4
|
Zhang L, Li J, Lv Y, Yang X, Bai L, Luo Y, Chen Y, Zhao Y. Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students. Tob Induc Dis 2020; 18:65. [PMID: 32818028 PMCID: PMC7425755 DOI: 10.18332/tid/125231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China. METHODS A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model. RESULTS In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05). CONCLUSIONS Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.
Collapse
Affiliation(s)
- Li Zhang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Jun Li
- The Office of Chongqing Medical University, Chongqing, China
| | - Yalan Lv
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xia Yang
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Li Bai
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Yong Zhao
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Balázs P, Grenczer A, Rákóczi I, Foley KL. Continued smoking versus spontaneous quitting among pregnant women living in a high risk environment. Cent Eur J Public Health 2019; 26:164-170. [PMID: 30419616 DOI: 10.21101/cejph.a5048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In Hungary, 37% of women living in poverty were smokers in 2012. There are no valid data of pregnant women's spontaneous smoking cessation. METHODS Our retrospective cohort study (2009-2012) targeted the most underdeveloped regions with an estimated 6-8.5% of Roma population. The sample (N = 12,552) represented 76% of the target population i.e. women in four counties in a year delivering live born babies. Chi-square probe and multivariable logistic regression model (p < 0.05) were used to assess relationship between socio-demographic characteristics and spontaneous cessation. RESULTS Prior to pregnancy, the overall smoking rate was 36.8%. That of women in deep poverty and Roma was 49.7% and 51.1%, respectively. 70.3% of smokers continued smoking during the pregnancy. Among them 80.6% lived in deep poverty. Spontaneous quitting rate was 23.0%. Factors correlated with continued smoking included being Roma (OR = 1.95), undereducated (OR = 2.66), living in homes lacking amenities (OR = 1.48), and having regularly smoking partner (OR = 2.07). Cessation was promoted by younger age (≤ 18 years) (OR = 0.18), being married (OR = 0.50), and the first pregnancy. CONCLUSIONS Tailored cessation programmes are needed for Roma, older, low-income, and multiparous women who are less likely to quit on their own. Engaging husbands/partners is essential to reduce smoking among pregnant women and second-hand smoke exposure.
Collapse
Affiliation(s)
- Peter Balázs
- Institute of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Grenczer
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | | | - Kristie L Foley
- Wake Forest University Medical School, Comprehensive Cancer Center, Winston-Salem, NC, USA
| |
Collapse
|
6
|
Newhouse R, Janney M, Gilbert A, Agley J, Bakoyannis G, Ferren M, Mullins CD, Johantgen M, Schwindt R, Thoele K. Study protocol testing toolkit versus usual care for implementation of screening, brief intervention, referral to treatment in hospitals: a phased cluster randomized approach. Addict Sci Clin Pract 2018; 13:28. [PMID: 30587235 PMCID: PMC6307302 DOI: 10.1186/s13722-018-0130-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alarming rates of unhealthy alcohol, non-prescription drug, and tobacco use highlight the preventable health risks of substance abuse and the urgent need to activate clinicians to recognize and treat risky use. Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and effective processes to identify, reduce and prevent risky use of substances. This paper describes a study protocol testing implementation of a toolkit to enhance use of SBIRT in acute care settings to recognize and address patient risky alcohol, drug, and tobacco use. METHODS This study uses a phased cluster randomized mixed method design to test nurse-led implementation of an SBIRT toolkit on one medical-surgical unit at 14 acute care hospitals (critical access, community and academic health centers). Medical surgical units will be randomly assigned to implement the SBIRT toolkit (engagement and communication, assessment, planning, training, and evaluation tools) or a wait-list usual care control group that begins implementation 6 months later. Primary endpoints are documentation of SBIRT delivery in randomly selected electronic medical records at baseline, 6 months and 12 months after group 1 implementation (61 records per unit per time period, N = 2562). Two surveys will be administered to unit nurses: smoking cessation activities will be assessed at baseline and SBIRT use will be assessed on randomly-selected days after implementation. In addition, site coordinators will complete a baseline capacity assessment, an implementation fidelity survey post-implementation, and a structured interview at the end of the study. Multilevel mixed-effects effects logistic and linear models will be used to analyze use of SBIRT and cost outcomes. DISCUSSION This study will guide subsequent SBIRT implementation, dissemination, and spread across rural, community and urban healthcare systems throughout the state and beyond. The long-term objective is to activate clinicians to recognize, intervene and refer people with risky substance use to improve health and decrease substance use disorders. Trial registration ClinicalTrials.gov NCT03560076.
Collapse
Affiliation(s)
- Robin Newhouse
- Indiana University School of Nursing, 600 Barnhill Drive, NU 132, Indianapolis, IN 46202 USA
| | - Michelle Janney
- Indiana University Health, Fairbanks Hall, 340 West 10th Street, Indianapolis, IN 46202 USA
| | - Anne Gilbert
- Indiana University Health, Methodist Hospital, 1701 N. Senate Blvd, Indianapolis, IN 46202 USA
| | - Jon Agley
- Institute for Research on Addictive Behavior, Indiana University School of Public Health - Bloomington, 501 N. Morton Street, Suite 110, Bloomington, IN, 47404 USA
| | - Giorgos Bakoyannis
- Indiana University Fairbanks School of Public Health and School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202 USA
| | - Melora Ferren
- Indiana University Health, Fairbanks Hall, 340 West 10th Street, Indianapolis, IN 46202 USA
| | - C. Daniel Mullins
- University of Maryland School of Pharmacy, Saratoga Building, 12th Floor, 220 Arch Street, Baltimore, MD 21201 USA
| | - Meg Johantgen
- University of Maryland School of Nursing, 655 W. Lombard Street, Baltimore, MD 21201 USA
| | - Rhonda Schwindt
- The George Washington University School of Nursing, 1919 Pennsylvania Ave. NW, Ste. 500, Washington, DC 20006 USA
| | - Kelli Thoele
- Indiana University School of Nursing, 600 Barnhill Drive, NU 132, Indianapolis, IN 46202 USA
| |
Collapse
|
7
|
Hors-Fraile S, Malwade S, Spachos D, Fernandez-Luque L, Su CT, Jeng WL, Syed-Abdul S, Bamidis P, Li YCJ. A recommender system to quit smoking with mobile motivational messages: study protocol for a randomized controlled trial. Trials 2018; 19:618. [PMID: 30413176 PMCID: PMC6230227 DOI: 10.1186/s13063-018-3000-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 10/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Smoking cessation is the most common preventative for an array of diseases, including lung cancer and chronic obstructive pulmonary disease. Although there are many efforts advocating for smoking cessation, smoking is still highly prevalent. For instance, in the USA in 2015, 50% of all smokers attempted to quit smoking, and only 5–7% of them succeeded – with slight deviation depending on external assistance. Previous studies show that computer-tailored messages which support smoking abstinence are effective. The combination of health recommender systems and behavioral-change theories is becoming increasingly popular in computer-tailoring. The objective of this study is to evaluate patients’s smoking cessation rates by means of two randomized controlled trials using computer-tailored motivational messages. A group of 100 patients will be recruited in medical centers in Taiwan (50 patients in the intervention group, and 50 patients in the control group), and a group of 1000 patients will be recruited on-line (500 patients in the intervention group, and 500 patients in the control group). The collected data will be made available to the public in an open-source data portal. Methods Our study will gather data from two sources. The first source is a clinical pilot in which a group of patients from two Taiwanese medical centers will be randomly assigned to either an intervention or a control group. The intervention group will be provided with a mobile app that sends motivational messages selected by a recommender system that takes the user profile (including gender, age, motivations, and social context) and similar users’ opinions. For 6 months, the patients’ smoking activity will be followed up, and confirmed as “smoke-free” by using a test that measures expired carbon monoxide and urinary cotinine levels. The second source will be a public pilot in which Internet users wanting to quit smoking will be able to download the same mobile app as used in the clinical pilot. They will be randomly assigned to a control group that receives basic motivational messages or to an intervention group, that receives personalized messages by the recommender system. For 6 months, patients in the public pilot will be assessed periodically with self-reported questionnaires. Discussion This study will be the first to use the I-Change behavioral-change model in combination with a health recommender system and will, therefore, provide relevant insights into computer-tailoring for smoking cessation. If our hypothesis is validated, clinical practice for smoking cessation would benefit from the use of our mobile solution. Trial registration ClinicalTrials.gov, ID: NCT03108651. Registered on 11 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3000-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Santiago Hors-Fraile
- Universidad de Sevilla, Seville, Spain.,Maastricht University, Maastricht, The Netherlands
| | - Shwetambara Malwade
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | | | | | - Chien-Tien Su
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | | | - Shabbir Syed-Abdul
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
| | | | - Yu-Chuan Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
8
|
Hors-Fraile S, Schneider F, Fernandez-Luque L, Luna-Perejon F, Civit A, Spachos D, Bamidis P, de Vries H. Tailoring motivational health messages for smoking cessation using an mHealth recommender system integrated with an electronic health record: a study protocol. BMC Public Health 2018; 18:698. [PMID: 29871595 PMCID: PMC5989385 DOI: 10.1186/s12889-018-5612-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/25/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Smoking is one of the most avoidable health risk factors, and yet the quitting success rates are low. The usage of tailored health messages to support quitting has been proved to increase quitting success rates. Technology can provide convenient means to deliver tailored health messages. Health recommender systems are information-filtering algorithms that can choose the most relevant health-related items-for instance, motivational messages aimed at smoking cessation-for each user based on his or her profile. The goals of this study are to analyze the perceived quality of an mHealth recommender system aimed at smoking cessation, and to assess the level of engagement with the messages delivered to users via this medium. METHODS Patients participating in a smoking cessation program will be provided with a mobile app to receive tailored motivational health messages selected by a health recommender system, based on their profile retrieved from an electronic health record as the initial knowledge source. Patients' feedback on the messages and their interactions with the app will be analyzed and evaluated following an observational prospective methodology to a) assess the perceived quality of the mobile-based health recommender system and the messages, using the precision and time-to-read metrics and an 18-item questionnaire delivered to all patients who complete the program, and b) measure patient engagement with the mobile-based health recommender system using aggregated data analytic metrics like session frequency and, to determine the individual-level engagement, the rate of read messages for each user. This paper details the implementation and evaluation protocol that will be followed. DISCUSSION This study will explore whether a health recommender system algorithm integrated with an electronic health record can predict which tailored motivational health messages patients would prefer and consider to be of a good quality, encouraging them to engage with the system. The outcomes of this study will help future researchers design better tailored motivational message-sending recommender systems for smoking cessation to increase patient engagement, reduce attrition, and, as a result, increase the rates of smoking cessation. TRIAL REGISTRATION The trial was registered at clinicaltrials.org under the ClinicalTrials.gov identifier NCT03206619 on July 2nd 2017. Retrospectively registered.
Collapse
Affiliation(s)
- Santiago Hors-Fraile
- Department of Architecture and Computer Technology, Universidad de Sevilla, ETSII, Avenida Reina Mercedes S/N, 41012 Seville, Spain
- Department of Health Promotion, School for Public Health and Primary Care (Caphri), Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Francine Schneider
- Department of Health Promotion, School for Public Health and Primary Care (Caphri), Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, The Netherlands
| | - Luis Fernandez-Luque
- Qatar Computing Research Institute, Hamad bin Khalifa University, Education City, Doha, Qatar
- Salumedia Tecnologías, Avenida República Argentina 24, Edificio Torre de los Remedios, Planta 5, Módulo A, Seville, Spain
| | - Francisco Luna-Perejon
- Department of Architecture and Computer Technology, Universidad de Sevilla, ETSII, Avenida Reina Mercedes S/N, 41012 Seville, Spain
| | - Anton Civit
- Department of Architecture and Computer Technology, Universidad de Sevilla, ETSII, Avenida Reina Mercedes S/N, 41012 Seville, Spain
| | - Dimitris Spachos
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Bamidis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hein de Vries
- Department of Health Promotion, School for Public Health and Primary Care (Caphri), Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, The Netherlands
| |
Collapse
|
9
|
Liu X, Lu W, Liao S, Deng Z, Zhang Z, Liu Y, Lu W. Efficiency and adverse events of electronic cigarettes: A systematic review and meta-analysis (PRISMA-compliant article). Medicine (Baltimore) 2018; 97:e0324. [PMID: 29742683 PMCID: PMC5959444 DOI: 10.1097/md.0000000000010324] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) are a prevalent smoking cessation aid worldwide; however, a consensus regarding their efficacy and safety has yet to be reached. METHODS We conducted a systematic review of the literature from related studies written in English or Chinese and published between January 1, 2003, and July 30, 2017. Eligible studies reporting the number of smokers who reduced or quit smoking and suffered from adverse events after e-cigarette use were selected according to predefined criteria; pertinent data were then extracted for a meta-analysis. RESULTS Our search produced 198 articles; of these publications, 14 including 35,665 participants were analyzed. The pooled efficacy rate of e-cigarettes ranged from 48.3% to 58.7% for smoking reduction and from 13.2% to 22.9% for smoking cessation. The pooled rate of adverse events associated with e-cigarettes ranged from 49.1% to 51.6% based on 11 studies including 16,406 participants. The most prevalent adverse events were mouth or throat irritation, anxiety, depressed mood, nausea, and insomnia. No significant differences in overall CO2 exhalation (eCO) levels were observed after e-cigarette use according to the data from 5 studies. CONCLUSION Our findings suggest that e-cigarettes are moderately effective with regard to smoking reduction and smoking cessation. eCO levels are unreliable for evaluating the efficacy of e-cigarettes. E-cigarette related adverse events frequently occur, especially due to high-dose nicotine-containing cartridges.
Collapse
Affiliation(s)
- Xing Liu
- The Department of Orthopedics, The Chongqing Traditional Chinese Medicine Hospital
- The Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Wan Lu
- The Department of Hyperbaric Oxygen, The 452 Hospital of PLA, Chengdu
| | - Sheng Liao
- The Department of Trauma and Microsurgery, The 324 Hospital of PLA
| | - Zhongliang Deng
- The Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zhongrong Zhang
- The Department of Trauma and Microsurgery, The 324 Hospital of PLA
| | - Yun Liu
- The Department of Urinary Surgery, The Second Affiliated Hospital of The Army Medical University, Chongqing, China
| | - Weizhong Lu
- The Department of Orthopedics, The Chongqing Traditional Chinese Medicine Hospital
| |
Collapse
|
10
|
Sung B. Effects of Different Types of Smoking Cessation Treatments for South Korean Adult Smokers without an Intention to Quit. J Lifestyle Med 2018; 8:33-41. [PMID: 29581958 PMCID: PMC5846642 DOI: 10.15280/jlm.2018.8.1.33] [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] [Received: 10/22/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022] Open
Abstract
Background While there are many different ways to quit smoking, current methods are not equally successful. The objective of this study was to analyze the effects of different types of stop smoking treatment for South Korean adult smokers without an intention to quit. Methods This cross-sectional study used data of 14,174 adults (age 19 years and over) from the Korea national health and nutrition examination survey (2007–2012) who have experience of smoking. The data were analyzed using multiple logistic regression. Results According to multiple logistic regression analysis, the education and counseling plus prescription drug group (OR = 14.831, 95% CI = 1.256 to 175.136) and education and counseling plus NRT group (OR = 3.060, 95% CI = 1.971 to 4.748) were associated with increased odds of quitting success compared to the no intervention group. Second, the education and counseling group was associated with increased odds of quitting success compared to the no intervention group (OR = 4.944, 95% CI = 3.463 to 7.058). Third, education and counseling plus NRT (OR = 0.325, 95% CI = 0.161 to 0.657) and NRT alone (OR = 0.322, 95% CI = 0.175 to 0.593) were associated with decreased odds of quitting success compared to the group using prescription drug only. Conclusion These findings suggest that an approach utilizing education and counseling plus prescription drugs is the most successful type of stop smoking treatment for South Korean adult smokers without an intention to quit.
Collapse
Affiliation(s)
- Baksun Sung
- Research Committee, Korea Institute for Health and Welfare Policy, Seoul, Korea
| |
Collapse
|
11
|
Abstract
BACKGROUND Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017. SELECTION CRITERIA Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings. AUTHORS' CONCLUSIONS There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.
Collapse
Affiliation(s)
- Virginia Hill Rice
- Wayne State UniversityCollege of Nursing5557 Cass AvenueDetroitMichiganUSA48202
| | - Laura Heath
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jonathan Livingstone‐Banks
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | | |
Collapse
|
12
|
Wiggers J, McElwaine K, Freund M, Campbell L, Bowman J, Wye P, Wolfenden L, Tremain D, Barker D, Slattery C, Gillham K, Bartlem K. Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial. Implement Sci 2017; 12:105. [PMID: 28830568 PMCID: PMC5567434 DOI: 10.1186/s13012-017-0636-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. METHODS A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia. A 12-month implementation intervention was delivered sequentially in each of three geographically and administratively defined groups of facilities. The intervention consisted of six key strategies: leadership and consensus processes, enabling systems, educational meetings and training, audit and feedback, practice change support, and practice change information and resources. Client-reported receipt of three elements of preventive care: assessment; brief advice; referral for four behavioural risks: smoking, inadequate fruit and/or vegetable consumption, alcohol overconsumption, and physical inactivity, individually, and for all such risks combined were collected for 56 months (October 2009-May 2014). Segmented logistic regression models were developed to assess intervention effectiveness. RESULTS A total of 5369 clients participated in data collection. Significant increases were found for receipt of four of five assessment outcomes (smoking OR 1.53; fruit and/or vegetable intake OR 2.18; alcohol consumption OR 1.69; all risks combined OR 1.78) and two of five brief advice outcomes (fruit and/or vegetable intake OR 2.05 and alcohol consumption OR 2.64). No significant increases in care delivery were observed for referral for any risk behaviour, or for physical inactivity. CONCLUSIONS The implementation intervention was effective in enhancing assessment of client risk status but less so for elements of care that could reduce client risk: provision of brief advice and referral. The intervention was ineffective in increasing care addressing physical inactivity. Further research is required to identify barriers to the provision of preventive care and the effectiveness of practice change interventions in increasing its provision. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12611001284954 . Registered 15 December 2011. Retrospectively registered.
Collapse
Affiliation(s)
- John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kathleen McElwaine
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Libby Campbell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Paula Wye
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Danika Tremain
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Daniel Barker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | | | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia
| | - Kate Bartlem
- Hunter New England Population Health, Wallsend, Australia
- School of Psychology, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| |
Collapse
|
13
|
Zhou Y, Jiang R, An L, Wang H, Cheng S, Qiong S, Weng Y. Benzo[a]pyrene impedes self-renewal and differentiation of mesenchymal stem cells and influences fracture healing. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 587-588:305-315. [PMID: 28249752 DOI: 10.1016/j.scitotenv.2017.02.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 05/20/2023]
Abstract
Mesenchymal stem cells (MSCs) are implicated in the bone-forming process during fracture repair. Benzo[a]pyrene (BaP)-a cigarette smoke component and powerful motivator of the aryl hydrocarbon receptor (Ahr)-unfavorably influences bone condition and osteoblast differentiation. The first thing we noticed decreases self-renewal and differentiation of human bone marrow mesenchymal stem (hBM-MSCs) from smokers and activates Ahr signaling in MSCs by up-regulating the Ahr target gene cytochrome P450 (CYP) 1B1 expression. In vitro studies, we employed C3H10T1/2 and bone marrow mesenchymal stem cells (BM-MSCs) with BaP and discovered that BaP impaired innate properties of MSCs. Further investigation into MSCs showed that exposure to BaP activated Ahr signaling and inhibited TGF-β1/SMAD4 and TGF-β1/ERK/AKT signaling pathways. Corresponding with the outcomes, tibial fracture calluses produced by BaP-administered rats appeared to delay healing. This effect of BaP was abrogated by resveratrol, a natural Ahr antagonist, in vitro and in vivo. These data demonstrated that Ahr may play a key role in BaP-impaired innate properties by inhibiting SMAD-dependent signaling pathways TGF-β1/SMAD4 and SMAD-independent TGF-β1/ERK/AKT signaling pathways. Furthermore, resveratrol inhibited MSCs from adverse effects caused by BaP.
Collapse
Affiliation(s)
- Yiqing Zhou
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China
| | - Rong Jiang
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China
| | - Liqin An
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China
| | - Hong Wang
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China
| | - Sicheng Cheng
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China
| | - Shi Qiong
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China.
| | - Yaguang Weng
- Department of Laboratory Medicine, M.O.E. Key Laboratory of Laboratory Medicine Diagnostics, Chongqing Medical University, Chongqing 400016, PR China.
| |
Collapse
|
14
|
Chan SSC, Cheung YTD, Fong DYT, Emmons K, Leung AYM, Leung DYP, Lam TH. Family-Based Smoking Cessation Intervention for Smoking Fathers and Nonsmoking Mothers with a Child: A Randomized Controlled Trial. J Pediatr 2017; 182:260-266.e4. [PMID: 27989407 DOI: 10.1016/j.jpeds.2016.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/10/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine whether a family-based intervention targeting both smoking fathers and nonsmoking mothers in well-child health clinics is effective in increasing fathers' abstinence from cigarette smoking. STUDY DESIGN This parallel 2-arm randomized controlled trial recruited a total of 1158 families with a daily-smoking father, a nonsmoking mother, and a child aged 0-18 months from the 22 maternal and child health centers in Hong Kong. The intervention group received the family-based intervention, including 6 nurse-led individual face-to-face and telephone counseling sessions within 1 month after recruitment and a voluntary face-to-face family counseling session (FCS). The control group received a leaflet, a self-help booklet, and brief quitting advice only. Father-reported 7-day and 6-month abstinence, smoking reduction, quit attempts, mother-reported help and support, and child salivary cotinine level were assessed at 12 months. Generalized estimating equation models were used to compare these outcomes between the 2 study groups. RESULTS Compared with the control group, the intervention group reported a greater prevalence of 7-day (13.7% vs 8.0%; OR, 1.92; 95% CI, 1.16-3.17; P < .01) and 6-month self-reported abstinence (13.4% vs. 7.5%; OR, 2.10; 95% CI, 1.30-3.40; P < .01). Within the intervention group, compared with receipt of individual counseling only, participation in the FCS was associated with increases in fathers' self-reported abstinence (20.2% vs 12.3%; P = .02), mothers' help (66.1% vs 43.8%; P < .01), and support to the fathers (55.0% vs 45.4%; P < .01). CONCLUSIONS The family-based smoking cessation intervention for the families in the well-child healthcare setting was effective in increasing the fathers' self-reported abstinence. Additional participation in the FCS increased mothers' help and support to the fathers. TRIAL REGISTRATION Controlled-trials.com: ISRCTN99111655; Hkuctr.com: HKUCTR-465.
Collapse
Affiliation(s)
| | - Yee Tak Derek Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong; School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong.
| | | | - Karen Emmons
- Kaiser Foundation Research Institute, Menlo Park, CA
| | | | - Doris Yin Ping Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| |
Collapse
|
15
|
VanDevanter N, Katigbak C, Naegle M, Zhou S, Sherman S, Weitzman M. Nursing Education to Reduce Use of Tobacco and Alternative Tobacco Products: Change Is Imperative. J Am Psychiatr Nurses Assoc 2017; 23:414-421. [PMID: 28778128 DOI: 10.1177/1078390317711252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco use continues to be the leading cause of preventable death worldwide. OBJECTIVE To assess perceived tobacco educational preparation of undergraduate and graduate nurses in a large urban university. DESIGN A cross-sectional web-based survey of all nursing students in an urban college of nursing was conducted to assess perceived tobacco educational content, skills, and self-efficacy for cessation counseling with patients who smoke cigarettes and use alternative tobacco products (e.g., hookah and e-cigarettes). RESULTS Participants reported the most education about health effects of tobacco use (67%), and less than 6% reported education about alternative tobacco products. While the majority of nurses agreed that advising patients to quit is a priority, less than 40% reported receiving sufficient training in cessation counseling. CONCLUSIONS There continues to be a compelling need articulated by leaders in tobacco policy and research over the past decade for a more vigorous response by nurses to the tobacco epidemic.
Collapse
Affiliation(s)
- Nancy VanDevanter
- 1 Nancy VanDevanter, DrPh, RN, FAAN, New York University Rory Meyers College of Nursing, New York, NY; Associates of the NYU Global Institute of Public Health, New York, NY, USA
| | - Carina Katigbak
- 2 Carina Katigbak, PhD, RN, ANP-BC, Boston College, Chestnut Hill, MA, USA
| | - Madeline Naegle
- 3 Madeline Naegle, PhD, CNS-PMH, BC, FAAN, New York University Rory Meyers College of Nursing, New York, NY; Associates of the NYU Global Institute of Public Health, New York, NY, USA
| | - Sherry Zhou
- 4 Sherry Zhou, MD, University of Michigan, Ann Arbor, MI, USA
| | - Scott Sherman
- 5 Scott Sherman, MD, MPH, New York University School of Medicine, New York, NY; Associates of the NYU Global Institute of Public Health, New York, NY, USA; NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
| | - Michael Weitzman
- 6 Michael Weitzman, MD, New York University School of Medicine, New York, NY; Associates of the NYU Global Institute of Public Health, New York, NY, USA; NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
| |
Collapse
|
16
|
Kopp BT, Ortega-García JA, Sadreameli SC, Wellmerling J, Cormet-Boyaka E, Thompson R, McGrath-Morrow S, Groner JA. The Impact of Secondhand Smoke Exposure on Children with Cystic Fibrosis: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13101003. [PMID: 27754353 PMCID: PMC5086742 DOI: 10.3390/ijerph13101003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/01/2022]
Abstract
Secondhand smoke exposure (SHSe) has multiple adverse effects on lung function and growth, nutrition, and immune function in children; it is increasingly being recognized as an important modifier of disease severity for children with chronic diseases such as cystic fibrosis (CF). This review examines what is known regarding the prevalence of SHSe in CF, with the majority of reviewed studies utilizing parental-reporting of SHSe without an objective biomarker of exposure. A wide range of SHSe is reported in children with CF, but under-reporting is common in studies involving both reported and measured SHSe. Additionally, the impact of SHSe on respiratory and nutritional health is discussed, with potential decreases in long-term lung function, linear growth, and weight gain noted in CF children with SHSe. Immunologic function in children with CF and SHSe remains unknown. The impact of SHSe on cystic fibrosis transmembrane conductance regulator (CFTR) function is also examined, as reduced CFTR function may be a pathophysiologic consequence of SHSe in CF and could modulate therapeutic interventions. Finally, potential interventions for ongoing SHSe are delineated along with recommended future areas of study.
Collapse
Affiliation(s)
- Benjamin T Kopp
- Section of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.
| | - Juan Antonio Ortega-García
- Paediatric Environmental Health Specialty Unit, Department of Pediatrics, Clinical University Hospital Virgen of Arrixaca, Murcia 30120, Spain.
| | - S Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD 20205, USA.
| | - Jack Wellmerling
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA.
| | - Estelle Cormet-Boyaka
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA.
| | - Rohan Thompson
- Section of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
| | - Sharon McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD 20205, USA.
| | - Judith A Groner
- Section of Ambulatory Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205, USA.
| |
Collapse
|
17
|
Smit ES, Candel MJJM, Hoving C, de Vries H. Results of the PAS Study: A Randomized Controlled Trial Evaluating the Effectiveness of a Web-Based Multiple Tailored Smoking Cessation Program Combined With Tailored Counseling by Practice Nurses. HEALTH COMMUNICATION 2016; 31:1165-1173. [PMID: 26934538 DOI: 10.1080/10410236.2015.1049727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study investigated the effects of Web-based multiple computer tailoring and counseling by a practice nurse (MTC) compared with computer tailoring without counseling (MT) and usual care (UC) on smoking cessation rates, via a randomized controlled trial with 414 Dutch adult smokers, recruited by 91 practice nurses from May 2009 to June 2010. Logistic multilevel regression analyses were conducted with 24-hour point prevalence, 7-day point prevalence, and prolonged abstinence after 6 and 12 months as dependent variables and experimental condition as the independent variable. After 6 and 12 months, 38% and 56% of respondents were followed up, respectively. At both follow-ups, no main effects of the interventions could be identified when comparing them with care as usual and with each other-neither in analyses using available data nor in analyses using a negative scenario in which respondents lost to follow-up were considered to still be smoking. A Web-based multiple computer-tailored smoking cessation program combined with a single face-to-face counseling session by a practice nurse may not be more effective than this computer-tailored program alone or than usual smoking cessation care in the general practice setting. Yet before concluding that the addition of counseling to Web-based computer tailoring cannot be successful, more research needs to be conducted to identify the optimal number of counseling sessions to be combined with the Web-based program and to how to best attune the two modalities.
Collapse
Affiliation(s)
- E S Smit
- a Department of Communication Science, Amsterdam School of Communication Research/ASCoR , University of Amsterdam
- b CAPHRI/Department of Health Promotion , Maastricht University
| | - M J J M Candel
- c CAPHRI/Department of Methodology and Statistics , Maastricht University
| | - C Hoving
- b CAPHRI/Department of Health Promotion , Maastricht University
| | - H de Vries
- b CAPHRI/Department of Health Promotion , Maastricht University
| |
Collapse
|
18
|
Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Boupha B, Shi G, Turdaliyeva BS. Clinicians' knowledge and practices regarding family planning and intrauterine devices in China, Kazakhstan, Laos and Mexico. Reprod Health 2016; 13:70. [PMID: 27283191 PMCID: PMC4901518 DOI: 10.1186/s12978-016-0185-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. METHODS A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. RESULTS Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. CONCLUSIONS This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.
Collapse
Affiliation(s)
- Steven J Hoffman
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada.
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada.
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - G Emmanuel Guindon
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John N Lavis
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Centre for Health Economics & Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Harkanwal Randhawa
- Global Strategy Lab, Centre for Health Law, Policy & Ethics, Faculty of Law, University of Ottawa, Fauteux Hall, 57 Louis Pasteur Street, Ottawa, ON, K1N 6N5, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | | | - Boungnong Boupha
- Foreign Affairs Committee and Women's Caucus, Laos National Assembly, Vientiane, Lao PDR
| | - Guang Shi
- Democratic Party of Peasants & Workers in China, Beijing, China
| | - Botagoz S Turdaliyeva
- Department of Health Policy & Management, Kazakh National Medical University, Almaty, Kazakhstan
- Evidence-Based Health Centre, Almaty, Kazakhstan
| |
Collapse
|
19
|
Darlow SD, Heckman CJ, Munshi T, Collins BN. Thirdhand smoke beliefs and behaviors among healthcare professionals. PSYCHOL HEALTH MED 2016; 22:415-424. [PMID: 27231157 DOI: 10.1080/13548506.2016.1189579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thirdhand smoke (THS) refers to tobacco smoke contaminants and by-products that remain in the environment after a cigarette is extinguished. The purpose of this study was to assess beliefs and behaviors regarding THS among healthcare professionals, and to examine associations among smoking attitudes/beliefs, provider demographics, and THS beliefs and behaviors. Healthcare professionals (N = 204) at a comprehensive cancer center and affiliated general hospital in a northeastern urban area completed online questionnaires. About one third of the respondents had heard of THS before completing the survey, and more than two thirds of the sample believed that THS issues do not receive enough attention. Being female, likelihood of discussing THS with others, endorsing the belief that smoking affects the quality of parenting, and support for government action towards smoking bans were significantly associated with providers' belief that THS is harmful. Endorsing the belief that smoking affects the quality of parenting and belief that THS is harmful were significantly associated with the likelihood of discussing THS with others. Findings shed light on THS beliefs and behaviors of healthcare providers (a group of individuals that could be trained to educate and advise patients about THS) and inform recommendations for new tobacco policies and clinical guidelines for best practices in tobacco control and prevention.
Collapse
Affiliation(s)
- Susan D Darlow
- a National Comprehensive Cancer Network , Fort Washington , PA , USA
| | - Carolyn J Heckman
- b Cancer Prevention and Control , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Teja Munshi
- c Bloustein Center for Survey Research, Rutgers University , New Brunswick , NJ , USA
| | - Bradley N Collins
- d College of Public Health, Temple University , Philadelphia , PA , USA
| |
Collapse
|
20
|
Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Dejman M, Falahat K, Malek-Afzali H, Ramachandran P, Shi G, Yesudian CAK. Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis. Am J Trop Med Hyg 2016; 94:959-970. [PMID: 26903613 PMCID: PMC4856627 DOI: 10.4269/ajtmh.15-0538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023] Open
Abstract
Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.
Collapse
Affiliation(s)
- Steven J. Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
| | | | | | | | | | | | | | | | - Parasurama Ramachandran
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
| | | | | | | |
Collapse
|
21
|
McElwaine KM, Freund M, Campbell EM, Bartlem KM, Wye PM, Wiggers JH. Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians. Implement Sci 2016; 11:50. [PMID: 27052329 PMCID: PMC4823902 DOI: 10.1186/s13012-016-0409-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/16/2016] [Indexed: 01/11/2023] Open
Abstract
Background Primary care nurses and allied health clinicians are potential providers of opportunistic preventive care. This systematic review aimed to summarise evidence for the effectiveness of practice change interventions in increasing nurse or allied health professional provision of any of five preventive care elements (ask, assess, advise, assist, and/or arrange) for any of four behavioural risks (smoking, inadequate nutrition, alcohol overconsumption, physical inactivity) within a primary care setting. Methods A search of Medline, Embase, PsycInfo, and CINAHL databases was undertaken to locate controlled intervention trials published between 1992 and May 2014 that provided practice change interventions to primary care nurses and/or allied health professionals to increase preventive care. The effect of interventions aimed at increasing the provision of any of the five care elements for any of the four behavioural risks was examined. A narrative synthesis was utilised. Results From 8109 articles, seven trials met the inclusion criteria. All trials bar one, assessed multi-strategic practice change interventions (three to five strategies) focused on care by nurses (six trials) or mixed nursing/allied health clinicians. One trial examined care provision for all four risks, five trials examined care for smoking only, and one trial examined care for alcohol consumption only. For the six trials reporting significance testing (excludes one smoking care trial), significant effects favouring the intervention group were reported in at least one trial for smoking risk assessment (2/4 trials reported an effect for at least one analysis of an assessment outcome), brief advice (2/3), assistance (2/2), and arranging referral (2/3); alcohol risk assessment (1/2) and brief advice (1/2); inadequate nutrition risk assessment (1/1); and physical inactivity risk assessment and brief advice (1/1). When the number of analyses undertaken within trials focusing on smoking care was considered, the results were less promising (e.g. of the 15 analyses conducted on brief advice variables across three trials, four showed a positive effect). Conclusions Evidence for the effect of practice change interventions on preventive care by primary care nurses or allied health providers is inconclusive given the small number of trials and inconsistency of results between and within trials. Systematic review registration number None Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0409-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia. .,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,, Postal address: Locked Bag 10, Wallsend, NSW, 2287, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW, 2287, Australia.,Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
22
|
VanDevanter N, Zhou S, Katigbak C, Naegle M, Sherman S, Weitzman M. Knowledge, Beliefs, Behaviors, and Social Norms Related to Use of Alternative Tobacco Products Among Undergraduate and Graduate Nursing Students in an Urban U.S. University Setting. J Nurs Scholarsh 2016; 48:147-53. [DOI: 10.1111/jnu.12192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy VanDevanter
- Upsilon , Associate Professor, New; York University College of Nursing NYU Global Institute of Public Health; New York City NY USA
| | - Sherry Zhou
- Resident; University of Michigan School of Medicine; AnnArbor MI USA
| | - Carina Katigbak
- Alpha Chi , Assistant Professor; Boston College School of Nursing; Chestnut Hill MA USA
| | - Madeline Naegle
- Upsilon , Professor, New York University College of Nursing; NYU Global Institute of Public Health; New York City NY USA
| | - Scott Sherman
- Associate Professor, New York University School of Medicine, NYU Global Institute of Public Health; NYU/Abu Dhabi Public Health Research Center; New York City NY USA
| | - Michael Weitzman
- Professor, New York University School of Medicine, NYU Global Institute of Public Health; NYU/Abu Dhabi Public Health Research Center; New York City NY USA
| |
Collapse
|
23
|
Challenges of Integrating Tobacco Cessation Interventions in TB Programmes: Case Studies from Nepal and Pakistan. J Smok Cessat 2016. [DOI: 10.1017/jsc.2015.20] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Offering tobacco cessation interventions to TB patients is highly desirable due to the interaction between TB and tobacco use and the potential benefits of quitting. However, implementing such interventions in TB programmes remains a challenge and an under-researched area. Using two initiatives to implement tobacco cessation within TB programmes in Nepal and Pakistan as case studies, we describe these challenges and highlight lessons learnt in the process.Methods: We first conducted a documentary review of all published and unpublished reports of the two initiatives including relevant qualitative and quantitative data and its’ analyses. We then analysed this information using the Consolidated Framework for Implementation Research (CFIR) under the five domains of implementation: intervention characteristics, outer settings, inner settings, participant characteristics and the process of implementation.Findings: We faced a number of challenges in implementing tobacco cessation within TB programmes both in Nepal and in Pakistan. These included: doubts about the contextual relevance of the intervention, environments conducive to smoking and political inertia for a cultural shift, service providers’ workload, priorities, and their motivation and capacity to deliver tobacco cessation, and inadequate training and support during implementation. We learned that by adapting intervention to the local context, securing mandate from higher authorities, aligning tasks to service providers’ roles and receptivity, building capacity through adequate training and providing support, monitoring and feedback during implementation can help in integrating tobacco cessation within TB programmes.Conclusions: Lessons from existing studies can help TB programmes in implementing tobacco cessation interventions and enable greater integration and sustainability of cessation services within routine TB care.
Collapse
|
24
|
Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev 2015:CD009670. [PMID: 26457723 DOI: 10.1002/14651858.cd009670.pub3] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective pharmacotherapies are available to help people who are trying to stop smoking, but quitting can still be difficult and providing higher levels of behavioural support may increase success rates further. OBJECTIVES To evaluate the effect of increasing the intensity of behavioural support for people using smoking cessation medications, and to assess whether there are different effects depending on the type of pharmacotherapy, or the amount of support in each condition. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in May 2015 for records with any mention of pharmacotherapy, including any type of nicotine replacement therapy (NRT), bupropion, nortriptyline or varenicline that evaluated the addition of personal support or compared two or more intensities of behavioural support. SELECTION CRITERIA Randomized or quasi-randomized controlled trials in which all participants received pharmacotherapy for smoking cessation and conditions differed by the amount of behavioural support. The intervention condition had to involve person-to-person contact. The control condition could receive less intensive personal contact, or just written information. We did not include studies that used a contact-matched control to evaluate differences between types or components of support. We excluded trials recruiting only pregnant women, trials recruiting only adolescents, and trials with less than six months follow-up. DATA COLLECTION AND ANALYSIS One author prescreened search results and two authors agreed inclusion or exclusion of potentially relevant trials. One author extracted data and another checked them.The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. We calculated the risk ratio (RR) and 95% confidence interval (CI) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS Forty-seven studies met the inclusion criteria with over 18,000 participants in the relevant arms. There was little evidence of statistical heterogeneity (I² = 18%) so we pooled all studies in the main analysis. There was evidence of a small but statistically significant benefit from more intensive support (RR 1.17, 95% CI 1.11 to 1.24) for abstinence at longest follow-up. All but four of the included studies provided four or more sessions of support to the intervention group. Most trials used NRT. We did not detect significant effects for studies where the pharmacotherapy was nortriptyline (two trials) or varenicline (one trial), but this reflects the absence of evidence.In subgroup analyses, studies that provided at least four sessions of personal contact for the intervention and no personal contact for the control had slightly larger estimated effects (RR 1.25, 95% CI 1.08 to 1.45; 6 trials, 3762 participants), although a formal test for subgroup differences was not significant. Studies where all intervention counselling was via telephone (RR 1.28, 95% CI 1.17 to 1.41; 6 trials, 5311 participants) also had slightly larger effects, and the test for subgroup differences was significant, but this subgroup analysis was not prespecified. In this update, the benefit of providing additional behavioural support was similar for the subgroup of trials in which all participants, including controls, had at least 30 minutes of personal contact (RR 1.18, 95% CI 1.06 to 1.32; 21 trials, 5166 participants); previously the evidence of benefit in this subgroup had been weaker. This subgroup was not prespecified and a test for subgroup differences was not significant. We judged the quality of the evidence to be high, using the GRADE approach. We judged a small number of trials to be at high risk of bias on one or more domains, but findings were not sensitive to their exclusion. AUTHORS' CONCLUSIONS Providing behavioural support in person or via telephone for people using pharmacotherapy to stop smoking has a small but important effect. Increasing the amount of behavioural support is likely to increase the chance of success by about 10% to 25%, based on a pooled estimate from 47 trials. Subgroup analysis suggests that the incremental benefit from more support is similar over a range of levels of baseline support.
Collapse
Affiliation(s)
- Lindsay F Stead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
| | | | | |
Collapse
|
25
|
Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
Panda R, Srivastava S, Persai D, Mathur MR, Modi B, Dave P, Arora M. Preparedness of frontline health workers for tobacco cessation: An exploratory study from two states of India. J Family Med Prim Care 2015; 4:298-304. [PMID: 26288762 PMCID: PMC4535082 DOI: 10.4103/2249-4863.161301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The 5As approach is a clinic-based approach and has been developed for primary health care providers who are uniquely positioned to interact with tobacco users. The 5As stands for: Ask about tobacco use at every visit, advise tobacco users to quit, assess readiness to quit, assist quit attempts through counseling and pharmacotherapy and arrange follow-up to prevent relapse. The present study explores whether auxiliary nurse midwives (ANMs) adhere to the 3As from the recommended 5As model for tobacco cessation. Materials and Methods: The study was a cross-sectional study conducted among 501 ANMs in the state of Gujarat and Andhra Pradesh. Descriptive analysis and chi-square test were employed to test the differences in knowledge levels and practices of ANMs. Bivariate logistic regression was used to examine the association between each predictor variable separately and the outcome variables after adjusting for age and location. Data was analyzed using SPSS version 17 software. Results: Majority of ANMs reported that they were aware of respiratory illnesses, tuberculosis, lung and oral cancer as conditions caused due to tobacco consumption. Awareness of adverse reproductive and child health effects associated with tobacco use was very low. Only about one third of respondents informed all patients about harmful effects. Only 16% of ANMs reported having ever received any on-job training related to tobacco control. ANMs who reported receiving training in tobacco control were about two times more likely to provide information on health effects of tobacco as compared to those who reported not being trained in tobacco control in the state of Gujarat. Conclusions: A majority of ANMs ask patients about tobacco use but provide advice only to patients suffering from specific diseases. A context-specific capacity building package needs to be designed to equip ANMs in recommended 5As approach in tobacco cessation.
Collapse
Affiliation(s)
- Rajmohan Panda
- Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India
| | - Swati Srivastava
- Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India
| | - Divya Persai
- Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India
| | - Manu Raj Mathur
- Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India
| | - Bhavesh Modi
- Department of Preventive and Social Medicine, Government Medical College, Gujarat, India
| | - Paresh Dave
- Department of Health and Family Welfare, Government of Gujarat, Gujarat, India
| | - Monika Arora
- Department of Non Communicable Diseases, Public Health Foundation of India, New Delhi, India
| |
Collapse
|
27
|
Gichuki JW, Opiyo R, Mugyenyi P, Namusisi K. Healthcare Providers' Level of Involvement in Provision of Smoking Cessation Interventions in Public Health Facilities in Kenya. J Public Health Afr 2015; 6:523. [PMID: 28299144 PMCID: PMC5349271 DOI: 10.4081/jphia.2015.523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/21/2015] [Accepted: 07/13/2015] [Indexed: 01/14/2023] Open
Abstract
Healthcare providers can play a major role in tobacco control by providing smoking cessation interventions to smoking patients. The objective of this study was to establish healthcare providers' practices regarding smoking cessation interventions in selected health facilities in Kiambu County, Kenya. This was a descriptive cross-sectional study carried out among healthcare providers working in public health facilities in Kiambu County, Kenya. Self-administered questionnaires were distributed to 400 healthcare providers selected using a two-stage stratified sampling technique. Only 35% of the healthcare providers surveyed reported that they always asked patients about their smoking status. Less than half (44%) reported that they always advised smoking patients to quit. Respondents who had received training on smoking cessation interventions were 3.7 times more likely to have higher practice scores than those without training (OR = 3.66; 95%CI: 1.63-8.26; P = 0.003). Majority of the healthcare providers do not routinely provide smoking cessation interventions to their patients. Measures are needed to increase health worker's involvement in provision of smoking cessation care in Kenya.
Collapse
Affiliation(s)
| | - Rose Opiyo
- School of Public Health, University of Nairobi , Kenya
| | - Possy Mugyenyi
- Center for Tobacco control in Africa, School of Public Health, Makerere University , Uganda
| | - Kellen Namusisi
- Center for Tobacco control in Africa, School of Public Health, Makerere University , Uganda
| |
Collapse
|
28
|
Ganz O, Fortuna G, Weinsier S, Campbell K, Cantrell J, Furmanski WL. Exploring Smoking Cessation Attitudes, Beliefs, and Practices in Occupational Health Nursing. Workplace Health Saf 2015; 63:288-96. [DOI: 10.1177/2165079915578582] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore occupational health nurses’ attitudes, beliefs, and practices regarding the delivery of smoking cessation services to workers. The study included 707 members of the American Association of Occupational Health Nurses (AAOHN) who completed a one-time survey during the fall of 2012. Results indicated that occupational health nurses believed that evidence-based treatments are at least somewhat effective and that they should provide smoking cessation services to their workers; however, a majority of occupational health nurses reported that they did not have appropriate smoking cessation training or guidelines in their workplaces. Occupational health nurses would benefit from training in the use of smoking cessation guidelines and evidence-based smoking cessation interventions, which could be used in their clinical practice. Employers should ensure that workplace policies, such as providing coverage for cessation services, facilitate smokers’ efforts to quit. Employers can benefit from many of these policies through cost savings via reduced health care costs and absenteeism.
Collapse
Affiliation(s)
| | | | | | - Kay Campbell
- American Association of Occupational Health Nurses
| | | | | |
Collapse
|
29
|
Lang M, Waterworth S, O'Brien A. What are the factors that influence the delivery of smoking cessation advice in critical care? Nurs Crit Care 2015; 23:237-244. [PMID: 26177914 DOI: 10.1111/nicc.12190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The world's leading cause of preventable deaths, diseases and disabilities is smoking. Hospitalization can provide an opportunity for smokers to quit. Previous research found that smokers make up a high percentage of patients admitted to intensive care. Health care professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice. AIM To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings. DESIGN Quantitative design using an online survey. METHODS This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14-bed general intensive care and a 16-bed cardiovascular intensive care unit. The target population for this research was the nursing and medical staff working in adult critical care environments. RESULTS The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments. CONCLUSIONS The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and extubated patients. Further research might be required to confirm this. RELEVANCE TO CLINICAL PRACTICE The provision of smoking cessation advice is an on-going World Health Organization and New Zealand Government priority and all parts of the health sector need to provide responses. However, responses need to be adapted to the specific context such as the unique challenges of critical care.
Collapse
Affiliation(s)
- Markus Lang
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Susan Waterworth
- Faculty of Medical and Health Sciences/School of Nursing, University of Auckland, Auckland, New Zealand
| | - Anthony O'Brien
- Faculty of Medical and Health Sciences/School of Nursing, University of Auckland, Auckland, New Zealand
| |
Collapse
|
30
|
Hsu EL, Sonn K, Kannan A, Bellary S, Yun C, Hashmi S, Nelson J, Mendoza M, Nickoli M, Ghodasra J, Park C, Mitchell S, Ashtekar A, Ghosh A, Jain A, Stock SR, Hsu WK. Dioxin Exposure Impairs BMP-2-Mediated Spinal Fusion in a Rat Arthrodesis Model. J Bone Joint Surg Am 2015; 97:1003-10. [PMID: 26085534 DOI: 10.2106/jbjs.n.01311] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cigarette smoking inhibits bone-healing and leads to increased rates of pseudarthrosis. However, the mechanisms behind these effects are controversial. Dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin)--a cigarette smoke constituent and potent activator of the aryl hydrocarbon receptor (Ahr)--negatively impacts bone quality and osteoblast differentiation. We hypothesized that activation of the Ahr by dioxin would inhibit bone morphogenetic protein (BMP)-2-mediated spinal fusion in a rat arthrodesis model. METHODS Female Long-Evans rats were pretreated with dioxin or vehicle in six weekly doses, followed by bilateral posterior lumbar spinal fusion across the L4-L5 transverse processes using recombinant human BMP (rhBMP)-2. Treatments continued until sacrifice at four weeks postoperatively. A third group was treated with dioxin for six weeks, followed by a recovery period of four elimination half-lives to assess the reversible effects of dioxin exposure on spinal fusion capacity. Bone formation and fusion capacity were evaluated using fusion scoring, radiography, micro-computed tomography, and histologic analysis. RESULTS Fusion scores for dioxin-treated and dioxin-recovery rats were significantly lower than those for controls. Although fusion rates were also significantly reduced in dioxin-treated animals relative to controls (50% versus 100%, respectively), rates were not significantly reduced in dioxin-recovery animals (80%). CONCLUSIONS Dioxin treatment significantly inhibited spinal fusion in a rat arthrodesis model, and a prolonged cessation of dioxin exposure facilitated only a partial recovery of bone-healing capacity. This finding indicates that, although the effects of dioxin are persistent, an extended recovery from exposure could potentially restore bone regeneration in vivo. CLINICAL RELEVANCE Development of a pharmacologic agent that reduces the adverse effects of cigarette smoke on bone-healing could prove useful to orthopaedic surgeons. Since dioxin and other similar cigarette smoke toxins exert their effects through Ahr pathway activation, the receptor represents a potential therapeutic target to improve spinal fusion rates in patients who smoke.
Collapse
Affiliation(s)
- Erin L Hsu
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Kevin Sonn
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Abhishek Kannan
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sharath Bellary
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Chawon Yun
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sohaib Hashmi
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - John Nelson
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Marco Mendoza
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Michael Nickoli
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Jason Ghodasra
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Christian Park
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Sean Mitchell
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Amruta Ashtekar
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Anjan Ghosh
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Akshay Jain
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Stuart R Stock
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University, 676 North Saint Claire Street, Suite #1350, Chicago, IL 60611. E-mail address for E.L. Hsu:
| |
Collapse
|
31
|
Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
| |
Collapse
|
32
|
Smith AL, Carter SM, Chapman S, Dunlop SM, Freeman B. Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers. BMJ Open 2015; 5:e007301. [PMID: 25933811 PMCID: PMC4420973 DOI: 10.1136/bmjopen-2014-007301] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted. DESIGN Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis). PARTICIPANTS 21 Australian adult ex-smokers (aged 28-68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance. SETTING Community, Australia. RESULTS Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the 'right' or 'better' choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers' beliefs and decisions about quitting. CONCLUSIONS The reasons for smokers' rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers' reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice.
Collapse
Affiliation(s)
- Andrea L Smith
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Simon Chapman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sally M Dunlop
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Cancer Screening and Prevention, Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Becky Freeman
- Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
33
|
Passey ME, Sanson-Fisher RW, Stirling JM. Supporting pregnant Aboriginal and Torres Strait Islander women to quit smoking: views of antenatal care providers and pregnant indigenous women. Matern Child Health J 2014; 18:2293-9. [PMID: 24150690 PMCID: PMC4220103 DOI: 10.1007/s10995-013-1373-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.
Collapse
|
34
|
Choi SH, Waltje AH, Ronis DL, Noonan D, Hong O, Richardson CR, Meeker JD, Duffy SA. Web-enhanced tobacco tactics with telephone support versus 1-800-QUIT-NOW telephone line intervention for operating engineers: randomized controlled trial. J Med Internet Res 2014; 16:e255. [PMID: 25447467 PMCID: PMC4260077 DOI: 10.2196/jmir.3375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Novel interventions tailored to blue collar workers are needed to reduce the disparities in smoking rates among occupational groups. OBJECTIVE The main objective of this study was to evaluate the efficacy and usage of the Web-enhanced "Tobacco Tactics" intervention targeting operating engineers (heavy equipment operators) compared to the "1-800-QUIT-NOW" telephone line. METHODS Operating engineers (N=145) attending one of 25 safety training sessions from 2010 through 2012 were randomized to either the Tobacco Tactics website with nurse counseling by phone and access to nicotine replacement therapy (NRT) or to the 1-800-QUIT-NOW telephone line, which provided an equal number of phone calls and NRT. The primary outcome was self-reported 7-day abstinence at 30-day and 6-month follow-up. The outcomes were compared using chi-square tests, t tests, generalized mixed models, and logistic regression models. RESULTS The average age was 42 years and most were male (115/145, 79.3%) and white (125/145, 86.2%). Using an intent-to-treat analysis, the Tobacco Tactics website group showed significantly higher quit rates (18/67, 27%) than the 1-800-QUIT NOW group (6/78, 8%) at 30-day follow-up (P=.003), but this difference was no longer significant at 6-month follow-up. There were significantly more positive changes in harm reduction measures (quit attempts, number of cigarettes smoked per day, and nicotine dependence) at both 30-day and 6-month follow-up in the Tobacco Tactics group compared to the 1-800-QUIT-NOW group. Compared to participants in the 1-800-QUIT NOW group, significantly more of those in the Tobacco Tactics website group participated in the interventions, received phone calls and NRT, and found the intervention helpful. CONCLUSIONS The Web-enhanced Tobacco Tactics website with telephone support showed higher efficacy and reach than the 1-800-QUIT-NOW intervention. Longer counseling sessions may be needed to improve 6-month cessation rates. TRIAL REGISTRATION Clinicaltrials.gov NCT01124110; http://clinicaltrials.gov/ct2/show/NCT01124110 (Archived by WebCite at http://www.webcitation.org/6TfKN5iNL).
Collapse
Affiliation(s)
- Seung Hee Choi
- Michigan State University, College of Nursing, East Lansing, MI, United States
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Hunter C, Chew-Graham CA, Langer S, Drinkwater J, Stenhoff A, Guthrie EA, Salmon P. 'I wouldn't push that further because I don't want to lose her': a multiperspective qualitative study of behaviour change for long-term conditions in primary care. Health Expect 2014; 18:1995-2010. [PMID: 25376672 PMCID: PMC5810675 DOI: 10.1111/hex.12304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/17/2023] Open
Abstract
Background Health outcomes for long‐term conditions (LTCs) can be improved by lifestyle, dietary and condition management‐related behaviour change. Primary care is an important setting for behaviour change work. Practitioners have identified barriers to this work, but there is little evidence examining practices of behaviour change in primary care consultations and how patients and practitioners perceive these practices. Objective To examine how behaviour change is engaged with in primary care consultations for LTCs and investigate how behaviour change is perceived by patients and practitioners. Design Multiperspective, longitudinal qualitative research involving six primary health‐care practices in England. Consultations between patients with LTCs and health‐care practitioners were audio‐recorded. Semi‐structured interviews were completed with patients and practitioners, using stimulated recall. Patients were re‐interviewed 3 months later. Framework analysis was applied to all data. Participants Thirty‐two people with at least one LTC (chronic obstructive pulmonary disease, diabetes, asthma and coronary heart disease) and 10 practitioners. Results Behaviour change talk in consultations was rare and, when it occurred, was characterized by deflection and diffidence on the part of practitioners. Patient motivation tended to be unaddressed. While practitioners positioned behaviour change work as outside their remit, patients felt uncertain about, yet responsible for, this work. Practitioners raised concerns that this work could damage other aspects of care, particularly the patient–practitioner relationship. Conclusion Behaviour change work is often deflected or deferred by practitioners in consultations, who nevertheless vocalize support for its importance in interviews. This discrepancy between practitioners’ accounts and behaviours needs to be addressed within primary health‐care organizations.
Collapse
Affiliation(s)
- Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, Staffs, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | | | - Alexandra Stenhoff
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Elspeth A Guthrie
- Manchester Mental Health and Social Care Trust, Manchester, UK.,University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| |
Collapse
|
36
|
Ramos-Morcillo AJ, Ruzafa-Martínez M, Fernández-Salazar S, del-Pino-Casado R, Armero Barranco D. [Attitudes of physicians and nurses towards health prevention and promotion activities in Primary Care]. Aten Primaria 2014; 46:483-91. [PMID: 24768655 PMCID: PMC6985606 DOI: 10.1016/j.aprim.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the attitudes of physicians and registered nurses in the Andalusian Public Health System towards preventive and health promotion (PHP) interventions in the context of Primary Health Care and the relationship with occupational variables and self-reported competence in PHP. DESIGN Multicenter, observational, descriptive study. LOCATION Primary Health Care (PHC), Andalusia, Spain. PARTICIPANTS A total of 282 professionals (physicians and nurses) from 22 Healthcare centers of the Andalusian public health system and who participated in the validation of CAPPAP were included. PRINCIPAL MEASUREMENTS The attitude of physicians and registered nurses towards PHP activities consisted of five dimensions: improvements necessary, perception of peers attitude, importance, obstacles, and improvement opportunities. The validated CAPPAP questionnaire was used. Occupational variables and questions about self-reported competence in PHP were also included. RESULTS All dimensions of CAPPAP exceeded the midpoint of the scale (2.5), with their values varying between 3.06 (SD: 0.76) in "improvement necessary", and 4.39 (SD: 0.49) in "importance". The self-declared social, occupational, and competences variables have a statistically significant relationship with the dimensions of the attitude of the professionals except: job experience in PHC, training and implementation of scheduled PHP activities. CONCLUSIONS The attitudes of physicians and registered nurses towards PHP activities are acceptable, and work must be done to sustain it. Healthcare organizations should implement interventions adapted to different professional profiles. They should also increase activities to improve professional skills in order to provide the appropriate care.
Collapse
Affiliation(s)
| | | | - Serafín Fernández-Salazar
- Hospital de Alta Resolución Sierra de Segura, Agencia Sanitaria Alto Guadalquivir, Puente de Génave, Jaén, España
| | | | | |
Collapse
|
37
|
Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychol Rev 2014; 9:323-44. [PMID: 25104107 PMCID: PMC4566873 DOI: 10.1080/17437199.2014.941722] [Citation(s) in RCA: 548] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/02/2014] [Indexed: 01/04/2023]
Abstract
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural science journals. Of secondary interest we developed a list of agreed criteria for judging the quality of the theories. We identified 82 theories and 9 criteria for assessing theory quality. The potential relevance of this wide-ranging number of theories to public health interventions and the ease and usefulness of evaluating the theories in terms of the quality criteria are however yet to be determined.
Collapse
Affiliation(s)
- Rachel Davis
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Zoe Hildon
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lorna Hobbs
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
38
|
Evaluation of a theory-based education program to motivate nursing students to intervene with their seriously mentally ill clients who use tobacco. Arch Psychiatr Nurs 2014; 28:277-83. [PMID: 25017562 DOI: 10.1016/j.apnu.2014.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/21/2022]
Abstract
Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.
Collapse
|
39
|
Duffy SA, Ronis DL, Karvonen-Gutierrez CA, Ewing LA, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C, Reeves P, Flanagan P. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Ann Behav Med 2014; 48:265-74. [DOI: 10.1007/s12160-014-9605-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
40
|
van den Wijngaart LS, Sieben A, van der Vlugt M, de Leeuw FE, Bredie SJH. A Nurse-Led Multidisciplinary Intervention to Improve Cardiovascular Disease Profile of Patients. West J Nurs Res 2014; 37:705-23. [DOI: 10.1177/0193945914533427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The aim of this study was to evaluate the impact of a structured screening and nurse-based intervention on cardiovascular risk factors. In patients with established cardiovascular disease, a cardiovascular risk profile was assessed, and lifestyle was evaluated by using an automated questionnaire. A multidisciplinary team proposed an integral individualized plan of care on the basis of these assessments. During follow-up, a nurse-led lifestyle intervention program and the best medical treatment were offered. A total of 328 outpatients were included. After screening, a follow-up term of at least 1 year was reached in 176 patients (59.9%). Low-density lipoprotein cholesterol and systolic blood pressure were significantly reduced. A reduction in the amount of smoking, alcohol consumption, and unhealthy eating habits was observed. However, the amount of physical activity was unaffected, and body mass was increased. A structural evaluation of cardiovascular risk factors and an integrated nurse-led approach can successfully reduce risk in cardiovascular patients.
Collapse
Affiliation(s)
- L. S. van den Wijngaart
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, The Netherlands
| | - A. Sieben
- Department of Surgery, Radboud University Nijmegen Medical Centre, The Netherlands
| | - M. van der Vlugt
- Department of Cardiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - F. E. de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - S. J. H. Bredie
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, The Netherlands
| |
Collapse
|
41
|
Lepage M, Renaud L, Champagne F, Rivard M. Évaluation comparative de stratégies visant à augmenter les interventions de courte durée pour le sevrage tabagique auprès du personnel infirmier de milieux hospitaliers : résultats d'une étude expérimentale. Rech Soins Infirm 2014. [DOI: 10.3917/rsi.116.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
42
|
McElwaine KM, Freund M, Campbell EM, Slattery C, Wye PM, Lecathelinais C, Bartlem KM, Gillham KE, Wiggers JH. Clinician assessment, advice and referral for multiple health risk behaviors: prevalence and predictors of delivery by primary health care nurses and allied health professionals. PATIENT EDUCATION AND COUNSELING 2014; 94:193-201. [PMID: 24284164 DOI: 10.1016/j.pec.2013.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Primary care clinicians have considerable potential to provide preventive care. This study describes their preventive care delivery. METHODS A survey of 384 community health nurses and allied health clinicians from in New South Wales, Australia was undertaken (2010-11) to examine the assessment of client risk, provision of brief advice and referral/follow-up regarding smoking inadequate fruit and vegetable consumption, alcohol misuse, and physical inactivity; the existence of preventive care support strategies; and the association between supports and preventive care provision. RESULTS Preventive care to 80% or more clients was least often provided for referral/follow-up (24.7-45.6% of clinicians for individual risks, and 24.2% for all risks) and most often for assessment (34.4-69.3% of clinicians for individual risks, and 24.4% for all risks). Approximately 75% reported having 9 or fewer of 17 supports. Provision of care was associated with: availability of a paper screening tool; training; GP referral letter; and number of supports. CONCLUSION The delivery of preventive care was limited, and varied according to type of care and risk. Supports were variably associated with elements of preventive care. PRACTICE IMPLICATIONS Further research is required to increase routine preventive care delivery and the availability of supports.
Collapse
Affiliation(s)
- Kathleen M McElwaine
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Elizabeth M Campbell
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - Carolyn Slattery
- Population Health, Hunter New England Local Health District, Newcastle, Australia.
| | - Paula M Wye
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | | | - Kate M Bartlem
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia; Faculty of Science and Information Technology, The University of Newcastle, Newcastle, Australia.
| | - Karen E Gillham
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Newcastle, Australia; Faculty of Health, The University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Clinical Research Centre, Newcastle, Australia.
| |
Collapse
|
43
|
Rahman MA, Wilson AM, Sanders R, Castle D, Daws K, Thompson DR, Ski CF, Matthews S, Wright C, Worrall-Carter L. Smoking behavior among patients and staff: a snapshot from a major metropolitan hospital in Melbourne, Australia. Int J Gen Med 2014; 7:79-87. [PMID: 24470770 PMCID: PMC3896283 DOI: 10.2147/ijgm.s54230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A cross-sectional study was conducted to provide a snapshot of smoking behavior among staff and patients at a major metropolitan hospital in Melbourne. Methods Patients and staff were surveyed using a questionnaire exploring demographics, nicotine dependence (Fagerstrom test), readiness to quit, and preference for smoking cessation options. Results A total of 1496 people were screened within 2 hours; 1,301 participated (1,100 staff, 199 patients). Mean age was 42 years, 68% were female. There were 113 (9%) current smokers and 326 (25%) ex-smokers. Seven percent of the staff were current smokers compared with 19% of the patients. The Fagerstrom test showed that 47% of patients who smoked were moderately nicotine dependent compared with 21% of staff. A third of the staff who smoked did not anticipate health problems related to smoking. Most patients (79%) who smoked disagreed that their current health problems were related to smoking. Although more than half of the current smokers preferred pharmacotherapy, one in two of them did not prefer behavior counseling; with consistent results among staff and patients. Multivariate analyses showed that patients were three times more likely (odds ratio 3.0, 95% confidence interval 1.9–4.7) to smoke than staff. Conclusion This study reports lower prevalence of smoking among hospital staff compared with national data. It also indicates an under-appreciation of health effects of smoking, and a preference not to use conventional methods of quitting.
Collapse
Affiliation(s)
- Muhammad Aziz Rahman
- St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, VIC, Australia ; The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia
| | - Andrew M Wilson
- The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia ; St Vincent's Hospital, Melbourne, VIC, Australia ; The University of Melbourne, Melbourne, VIC, Australia
| | | | - David Castle
- The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia ; St Vincent's Hospital, Melbourne, VIC, Australia ; The University of Melbourne, Melbourne, VIC, Australia
| | - Karen Daws
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - David R Thompson
- The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia
| | - Chantal F Ski
- The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia
| | | | - Christine Wright
- The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia
| | - Linda Worrall-Carter
- St Vincent's Centre for Nursing Research (SVCNR), Australian Catholic University, Melbourne, VIC, Australia ; The Cardiovascular Research Centre (CvRC), Australian Catholic University, Melbourne, VIC, Australia ; St Vincent's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
44
|
Abstract
Smoking cessation strategies are barely discussed in nursing education programs, even though initial education shapes how future professionals practice their profession. The aim of this research is to describe the practices, attitudes, and beliefs of nursing educators of Quebec with regard to smoking cessation strategies in initial nursing education. A descriptive design was chosen along with an online questionnaire. A total of 278 educators (20.8%) participated in the survey. Although educators recognize the importance of incorporating smoking cessation strategies into their teaching practice, they allocate an average of only one hour per year to the topic. Tobacco use is addressed mostly in terms of risk factors, with little focus on how to help patients quit. The perceived obstacles are related to false beliefs and a lack of knowledge. The results of this study demonstrate the need to raise educators’ awareness of the importance of incorporating smoking cessation strategies into classroom teaching.
Collapse
Affiliation(s)
- Mario Lepage
- Université du Québec en Outaouais, Gatineau, Canada
| | - Louise Dumas
- Université du Québec en Outaouais, Gatineau, Canada
| | | |
Collapse
|
45
|
Gierisch JM, Fish LJ. Capsule commentary on Katz et al., Implementing smoking cessation guidelines for hospitalized veterans: effects on nurse attitudes and performance. J Gen Intern Med 2013; 28:1493. [PMID: 23739811 PMCID: PMC3797355 DOI: 10.1007/s11606-013-2503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, USA
| | | |
Collapse
|
46
|
Chamberlain C, O’Mara-Eves A, Oliver S, Caird JR, Perlen SM, Eades SJ, Thomas J. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; 10:CD001055. [PMID: 24154953 PMCID: PMC4022453 DOI: 10.1002/14651858.cd001055.pub4] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this fifth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 March 2013), checked reference lists of retrieved studies and contacted trial authors to locate additional unpublished data. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, randomised cross-over trials, and quasi-randomised controlled trials (with allocation by maternal birth date or hospital record number) of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, and subgroup analyses and sensitivity analysis were conducted in SPSS. MAIN RESULTS Eighty-six trials were included in this updated review, with 77 trials (involving over 29,000 women) providing data on smoking abstinence in late pregnancy.In separate comparisons, counselling interventions demonstrated a significant effect compared with usual care (27 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.75), and a borderline effect compared with less intensive interventions (16 studies; average RR 1.35, 95% CI 1.00 to 1.82). However, a significant effect was only seen in subsets where counselling was provided in conjunction with other strategies. It was unclear whether any type of counselling strategy is more effective than others (one study; RR 1.15, 95% CI 0.86 to 1.53). In studies comparing counselling and usual care (the largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy (eight studies; average RR 1.06, 95% CI 0.93 to 1.21). However, a clear effect was seen in smoking abstinence at zero to five months postpartum (10 studies; average RR 1.76, 95% CI 1.05 to 2.95), a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77), and a significant effect at 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), but not in the longer term. In other comparisons, the effect was not significantly different from the null effect for most secondary outcomes, but sample sizes were small.Incentive-based interventions had the largest effect size compared with a less intensive intervention (one study; RR 3.64, 95% CI 1.84 to 7.23) and an alternative intervention (one study; RR 4.05, 95% CI 1.48 to 11.11).Feedback interventions demonstrated a significant effect only when compared with usual care and provided in conjunction with other strategies, such as counselling (two studies; average RR 4.39, 95% CI 1.89 to 10.21), but the effect was unclear when compared with a less intensive intervention (two studies; average RR 1.19, 95% CI 0.45 to 3.12).The effect of health education was unclear when compared with usual care (three studies; average RR 1.51, 95% CI 0.64 to 3.59) or less intensive interventions (two studies; average RR 1.50, 95% CI 0.97 to 2.31).Social support interventions appeared effective when provided by peers (five studies; average RR 1.49, 95% CI 1.01 to 2.19), but the effect was unclear in a single trial of support provided by partners.The effects were mixed where the smoking interventions were provided as part of broader interventions to improve maternal health, rather than targeted smoking cessation interventions.Subgroup analyses on primary outcome for all studies showed the intensity of interventions and comparisons has increased over time, with higher intensity interventions more likely to have higher intensity comparisons. While there was no significant difference, trials where the comparison group received usual care had the largest pooled effect size (37 studies; average RR 1.34, 95% CI 1.25 to 1.44), with lower effect sizes when the comparison group received less intensive interventions (30 studies; average RR 1.20, 95% CI 1.08 to 1.31), or alternative interventions (two studies; average RR 1.26, 95% CI 0.98 to 1.53). More recent studies included in this update had a lower effect size (20 studies; average RR 1.26, 95% CI 1.00 to 1.59), I(2)= 3%, compared to those in the previous version of the review (50 studies; average RR 1.50, 95% CI 1.30 to 1.73). There were similar effect sizes in trials with biochemically validated smoking abstinence (49 studies; average RR 1.43, 95% CI 1.22 to 1.67) and those with self-reported abstinence (20 studies; average RR 1.48, 95% CI 1.17 to 1.87). There was no significant difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however the effect was unclear in three dissemination trials of counselling interventions where the focus on the intervention was at an organisational level (average RR 0.96, 95% CI 0.37 to 2.50). The pooled effects were similar in interventions provided for women with predominantly low socio-economic status (44 studies; average RR 1.41, 95% CI 1.19 to 1.66), compared to other women (26 studies; average RR 1.47, 95% CI 1.21 to 1.79); though the effect was unclear in interventions among women from ethnic minority groups (five studies; average RR 1.08, 95% CI 0.83 to 1.40) and aboriginal women (two studies; average RR 0.40, 95% CI 0.06 to 2.67). Importantly, pooled results demonstrated that women who received psychosocial interventions had an 18% reduction in preterm births (14 studies; average RR 0.82, 95% CI 0.70 to 0.96), and infants born with low birthweight (14 studies; average RR 0.82, 95% CI 0.71 to 0.94). There did not appear to be any adverse effects from the psychosocial interventions, and three studies measured an improvement in women's psychological wellbeing. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy, and reduce low birthweight and preterm births.
Collapse
Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alison O’Mara-Eves
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Jenny R Caird
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| | - Susan M Perlen
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sandra J Eades
- School of Public Health, Sydney School of Medicine, University of Sydney, Sydney, Australia
| | - James Thomas
- EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK
| |
Collapse
|
47
|
Jones SE, Hamilton S. Introducing a new stop smoking service in an acute UK hospital: A qualitative study to evaluate service user experience. Eur J Oncol Nurs 2013; 17:563-9. [DOI: 10.1016/j.ejon.2013.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/17/2013] [Accepted: 01/26/2013] [Indexed: 10/27/2022]
|
48
|
Robson D, Haddad M, Gray R, Gournay K. Mental health nursing and physical health care: a cross-sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness. Int J Ment Health Nurs 2013; 22:409-17. [PMID: 23066812 DOI: 10.1111/j.1447-0349.2012.00883.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post-registration physical health-care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post-registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.
Collapse
Affiliation(s)
- Debbie Robson
- Institute of Psychiatry, King's College London, London, UK.
| | | | | | | |
Collapse
|
49
|
Naranjo A, Bilbao A, Erausquin C, Ojeda S, Francisco FM, Rúa-Figueroa I, Rodríguez-Lozano C. Results of a specific smoking cessation program for patients with arthritis in a rheumatology clinic. Rheumatol Int 2013; 34:93-9. [PMID: 24005567 DOI: 10.1007/s00296-013-2851-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
The purpose of this study is to evaluate an intervention program in smoker patients. We selected consecutive active smoker patients with rheumatoid arthritis, spondyloarthritis, or connective tissue diseases. The intervention consisted of the following: (1) a baseline visit, which included verbal and written advice by the rheumatologist, emphasizing the practical benefits of smoking cessation. Patients completed a questionnaire that included smoking dependence tests and previous attempts to quit. (2) A follow-up visit to the nurse in the 3rd month for reinforcement and the receiving of pharmacological treatment to help patients quit smoking. The primary outcome was total abstinence in the last 7 days of a phone interview at 3, 6, and 12 months. The secondary outcome was a reduction in cigarette consumption by at least 50%. A total of 945 patients were screened. About 185 (19.5%) were current smokers, and 152 were included for intervention. In the previous 5 years, the mean annual withdrawal rate was 4.6%. The smoking cessation rate was 11.8, 14.4, and 15.7% at 3, 6, and 12 months (OR compared with previous cessation rate 3.8 (CI 95% 1.8-8.1)). Twenty-nine patients (19%) reduced ≥50% of the cigarette consumption at 12 months. The linear regression analysis showed that a score of less dependence (p = 0.03) and previous attempts to quit smoking (p = 0.04) were significantly associated with definitive smoking cessation at 12 months. One out of six patients quit smoking with the aid of an educational program which included verbal and written advice by the rheumatologist and the nurse. As far as we know, this is the first interventional study in smoker patients with arthritis.
Collapse
Affiliation(s)
- Antonio Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, C/Barranco de La Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain,
| | | | | | | | | | | | | |
Collapse
|
50
|
Choi SH, Pohl JM, Terrell JE, Redman RW, Duffy SA. Factors Associated With Smoking Among Operating Engineers. Workplace Health Saf 2013. [DOI: 10.3928/21650799-20130816-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|