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Papadakis S, Anastasaki M, Papadakaki M, Antonopoulou Μ, Chliveros C, Daskalaki C, Varthalis D, Triantafyllou S, Vasilaki I, McEwen A, Lionis C. 'Very brief advice' (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user's perspective. BMC FAMILY PRACTICE 2020; 21:121. [PMID: 32580760 PMCID: PMC7315478 DOI: 10.1186/s12875-020-01195-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients' motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA. METHODS Semi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data. RESULTS The majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP's VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports. CONCLUSIONS VBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient's motivation to make an aided quit attempt.
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Affiliation(s)
- Sophia Papadakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece
| | - Maria Papadakaki
- Department of Social Work, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | | | | | | | | | | | - Irene Vasilaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, Dorchester, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, P.O. Box: 2208, 71003, Heraklion, Crete, Greece.
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Girvalaki C, Papadakis S, Vardavas C, Petridou E, Pipe A, Lionis C. Smoking cessation delivery by general practitioners in Crete, Greece. Eur J Public Health 2018; 28:542-547. [PMID: 29140450 DOI: 10.1093/eurpub/ckx201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Tobacco dependence treatment in clinical settings is of prime public health importance, especially in Greece, a country experiencing one of the highest rates of tobacco use in Europe. Methods Our study aimed to examine the characteristics of tobacco users and document rates of tobacco treatment delivery in general practice settings in Crete, Greece. A cross-sectional sample of patients (n = 2, 261) was screened for current tobacco use in 25 general practices in Crete, Greece in 2015/16. Current tobacco users completed a survey following their clinic appointment that collected information on patient characteristics and rates at which the primary care physician delivered tobacco treatment using the evidence-based 4 A's (Ask, Advise, Assist, Arrange) model during their medical appointment and over the previous 12-month period. Multi-level modeling was used to analyze data and examine predictors of 4 A's delivery. Results Tobacco use prevalence was 38% among all patients screened. A total of 840 tobacco users completed the study survey [mean age 48.0 (SD 14.5) years, 57.6% male]. Approximately, half of the tobacco users reported their general practitioner 'asked' about their tobacco use and 'advised' them to quit smoking. Receiving 'assistance' with quitting (15.7%) and 'arranging' follow-up support (<3%) was infrequent. Patient education, presence of smoking-related illness, a positive screen for anxiety or depression and the type of medical appointment were associated with 4 A's delivery. Conclusion Given the fundamental importance of addressing tobacco treatment, increasing the rates of 4 A's treatment in primary care settings in Greece is an important target for improving patient care.
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Affiliation(s)
- Charis Girvalaki
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
| | - Sophia Papadakis
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Constantine Vardavas
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
| | - Eleni Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christos Lionis
- Department of Medicine, Clinic of Social and Family Medicine, University of Crete, Heraklion, Crete, Greece
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Owusu D, Quinn M, Wang KS, Aibangbee J, Mamudu HM. Intentions to quit tobacco smoking in 14 low- and middle-income countries based on the transtheoretical model. Drug Alcohol Depend 2017; 178:425-429. [PMID: 28710966 DOI: 10.1016/j.drugalcdep.2017.05.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Over 80% of the world's one billion tobacco smokers reside in low- and middle-income countries (LMICs); therefore, it is important to understand factors that promote intention to quit smoking in these countries. This study evaluated factors associated with three stages of intention to quit tobacco smoking among adults in LMICs. METHODS Data from 43,540 participants of the Global Adult Tobacco Survey in 14 LMICs were analyzed. Intentions to quit smoking were categorized into precontemplation (referent category), contemplation, and preparation stages based on the transtheoretical model. A multinomial logit model was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Approximately 82%, 14%, and 4% of the smokers were in precontemplation, contemplation, and preparation stages, respectively. Rural residents had increased odds of being in contemplation stage (OR=1.41, 95% CI=1.09-1.83) compared to urban residents. Compared to homes where smoking was allowed, smoke-free homes were associated with increased odds of contemplation (OR=1.77, 95% CI=1.41-2.23) and preparation (OR=2.18, 95% CI=1.78-2.66). Exposure to anti-smoking messages in more than one media channel was associated with increased odds of contemplation (OR=1.60, 95% CI=1.33-1.92) and preparation (OR=1.73, 95% CI=1.28-2.33) compared to no exposure to anti-smoking messages. CONCLUSION The results suggest that anti-smoking media campaigns and smoke-free policies may promote intention to quit smoking in LMICs. While these suggest the need for implementation of comprehensive anti-smoking campaigns and smoke-free policies, longitudinal studies are required to confirm these findings and to evaluate how intention to quit translates into quit attempts in LMICs.
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Affiliation(s)
- Daniel Owusu
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Jocelyn Aibangbee
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Hadii M Mamudu
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
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Gikas A, Lambadiari V, Sotiropoulos A, Panagiotakos D, Pappas S. Prevalence of Major Cardiovascular Risk Factors and Coronary Heart Disease in a Sample of Greek Adults: The Saronikos Study. Open Cardiovasc Med J 2016; 10:69-80. [PMID: 27429668 PMCID: PMC4945772 DOI: 10.2174/1874192401610010069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/20/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Comprehensive data regarding prevalence of coronary heart disease (CHD) and associated factors in different geographical regions are very important to our understanding of global distribution and evolution of CHD. The aim of this study was to assess the current prevalence of self-reported risk factors and CHD in Greek adult population.
Methods: A community-based cross-sectional study was
conducted in May 2014, during an election day, among residents of Saronikos municipality (Attica region). Data were collected from face-to-face
interviews. The study sample included 2636 subjects (men, 49.5%; mean age, 50.5; range 20-95 years), with similar age and sex distribution to the
target population.
Results: The age-standardized prevalence rates of five major risk factors were as follows: type 2 diabetes 11.1%, hypercholesterolemia
(cholesterol>240 mg/dl or using cholesterol-lowering medication) 23.8%, hypertension 27.2%, current smoking 38.9% and physical inactivity 43%. Of the participants,
only 21% were free of any of these factors. Clustering of two to five risk factors was more frequent among persons aged 50 years and older as compared with younger
ones (60% vs 27%, P=0.000). The age-adjusted prevalence of CHD was 6.3% (in men, 8.9%; in women, 3.8%) and that of myocardial infarction was 3.6% (in men, 5.2%; in
women, 2.1%). According to multivariate analysis age, gender, education level, obesity, diabetes, hypercholesterolemia, hypertension and ever smoking were strongly
associated with CHD. Conclusion: Classic risk factors are highly prevalent and frequently clustered, especially in adults aged 50 years and older. These findings
raise concerns about future trends of already increased rates of CHD. Multifactorial and integrated population-based interventions need to be applied to reduce the burden of cardiovascular conditions.
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Affiliation(s)
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Institute and Diabetes Centre, Attikon University General Hospital, Athens University Medical School, Greece
| | - Alexios Sotiropoulos
- Third Department of Internal Medicine and Diabetes Centre, Saint Panteleimon General Hospital, Nikea-Pireaus, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition Science and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Stavros Pappas
- Third Department of Internal Medicine and Diabetes Centre, Saint Panteleimon General Hospital, Nikea-Pireaus, Greece
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Karanikolos M, Heino P, McKee M, Stuckler D, Legido-Quigley H. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:208-40. [DOI: 10.1177/0020731416637160] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.
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Affiliation(s)
- Marina Karanikolos
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pia Heino
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Helsinki, Helsinki, Finland
| | - Martin McKee
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Lidón-Moyano C, Martín-Sánchez JC, Saliba P, Graffelman J, Martínez-Sánchez JM. Correlation between tobacco control policies, consumption of rolled tobacco and e-cigarettes, and intention to quit conventional tobacco, in Europe. Tob Control 2016; 26:149-152. [PMID: 26888824 DOI: 10.1136/tobaccocontrol-2015-052482] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 01/25/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyse the correlation between the implementation of tobacco control policies and tobacco consumption, particularly rolling tobacco, electronic cigarettes (e-cigarettes) users and the intent to quit smoking in 27 countries of the European Union. DESIGN Ecological study with the country as the unit of analysis. DATA SOURCES We used the data from tobacco control activities, measured by the Tobacco Control Scale (TCS), in 27 European countries, in 2010, and the prevalence of tobacco consumption data from the Eurobarometer of 2012. ANALYSIS Spearman correlation coefficients (rsp) and their 95% CIs. RESULTS There was a negative correlation between TCS and prevalence of smoking (rsp=-0.41; 95% CI -0.67 to -0.07). We also found a negative correlation (rsp=-0.31) between TCS and the prevalence of ever e-cigarette users, but it was not statistically significant. Among former cigarette smokers, there was a positive and statistically significant correlation between TCS and the consumption of hand-rolled tobacco (rsp=0.46; 95% CI 0.06 to 0.70). We observed a similar correlation between TCS and other tobacco products (cigars and pipe) among former cigarette smokers. There was a significant positive correlation between TCS and intent to quit smoking in the past 12 months (rsp=0.66; 95% CI 0.36 to 0.87). CONCLUSIONS The level of smoke-free legislation among European countries is correlated with a decrease in the prevalence of smoking of conventional cigarettes and an increase in the intent to quit smoking within the past 12 months. However, the consumption of other tobacco products, particularly hand-rolled tobacco, is positively correlated with TCS among former cigarette smokers. Therefore, tobacco control policies should also consider other tobacco products, such as rolling tobacco, cigars and pipes.
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Affiliation(s)
- Cristina Lidón-Moyano
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Patrick Saliba
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Jan Graffelman
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jose M Martínez-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Tobacco Control Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Dom G, Samochowiec J, Evans-Lacko S, Wahlbeck K, Van Hal G, McDaid D. The Impact of the 2008 Economic Crisis on Substance Use Patterns in the Countries of the European Union. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13010122. [PMID: 26771628 PMCID: PMC4730513 DOI: 10.3390/ijerph13010122] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
Background: From 2008 on, a severe economic crisis (EC) has characterized the European Union (E.U.). However, changes in substance use behavioral patterns as a result of the economic crisis in Europe, have been poorly reflected upon, and underlying mechanisms remain to be identified; Methods: In this review we explore and systematize the available data on the effect of the 2008 economic crisis on patterns of substance use and related disorders, within the E.U. countries; Results: The results show that effects of the recession need to be differentiated. A number of studies point to reductions in population’s overall substance use. In contrast, an increase in harmful use and negative effects is found within specific subgroups within the society. Risk factors include job-loss and long-term unemployment, and pre-existing vulnerabilities. Finally, our findings point to differences between types of substances in their response on economic crisis periods; Conclusions: the effects of the 2008 economic crisis on substance use patterns within countries of the European Union are two-sided. Next to a reduction in a population’s overall substance use, a number of vulnerable subgroups experience serious negative effects. These groups are in need of specific attention and support, given that there is a real risk that they will continue to suffer negative health effects long after the economic downfall has formally been ended.
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Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp 2640, Belgium.
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin 71-460, Poland.
| | - Sara Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, SE5 8AF, UK.
| | | | - Guido Van Hal
- Medical Sociology and Health Policy, Antwerp University, Antwerp 2640, Belgium.
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
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Bacigalupe A, Shahidi FV, Muntaner C, Martín U, Borrell C. Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:5-35. [DOI: 10.1177/0020731415611634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.
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Affiliation(s)
- Amaia Bacigalupe
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Faraz Vahid Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, Korea University
| | - Unai Martín
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
- OPIK-Research Group on Social Determinants of Health and Demographic Change
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona 08023, Spain
- Ciber de Epidemiología y Salud Pública, 28029, Spain
- Universitat Pompeu Fabra, Barcelona 08003, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona 08025, Spain
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