Physician-delivered advice to quit smoking among Italian smokers

Tobacco Cessation Curriculum in Medical Schools: a Scoping Review

This scoping review aims to identify interventional training courses on tobacco cessation counseling skills of medical students, identify the most appropriate teaching method, and the ideal stage to provide such training. We retrieved articles published since 2000 from two electronic peer-reviewed databases (PubMed and Scopus) and hand-searched reference lists of selected articles. Articles published in English, with a clearly defined curriculum, reporting knowledge, attitude, cessation counseling skills of medical students post-training, and cessation-related outcomes of patients participating in student-led counseling sessions, were considered for inclusion. We used the York framework to guide this scoping review. First, data from studies meeting the inclusion criteria were charted using a standardized form. Subsequently, related studies were organized under three themes that emerged in the review process-lectured-based, web-based, and multi-modal curriculum. We concluded that a short but focused lecture-based curriculum combined with peer role-play or standardized/real patient interactions effectively develops the necessary knowledge and skills of undergraduate medical students to provide tobacco cessation counseling to patients. However, studies consistently report that the gains in knowledge and skills after cessation training is acute. Therefore, continued participation in cessation counseling and periodic review of cessation-related knowledge and skills post-training is warranted.

Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan

INTRODUCTION

Health professionals are to play an essential and effective role in tobacco control. Toombak is a popular form of smokeless tobacco, locally made and used among Sudanese. It is associated with oral and systemic health hazards, particularly oral cancer. This study was set out to assess health professions students' perception of their status as future role models for their patients and the public regarding Toombak use cessation and to explore socio-cognitive covariates of perceived role model status.

MATERIALS AND METHODS

A cross-sectional study was conducted in 2013-2014 using a self-administered questionnaire among health professions students enrolled in Medicine, Pharmacy, Dentistry and Nursing colleges in Khartoum state, Sudan. A total of 1530 participants were recruited from colleges using a cluster stratified sampling procedure.

RESULTS

The majority of the participants (88.2%) were 19-22 year old, females showed predominance (66.1%). Most of the participants (69.7%) scored good knowledge of Toombak-related therapies. The majority (97%) had a positive attitude towards banning Toombak use in public. Half of the participants (50.4%) confirmed availability of Toombak control policy in their college, while 66% reported receiving training in Toombak cessation. Only 9.2% of the participants reported that they have ever used Toombak; among them, 69.5% were current daily users. Less than half (47.8%) reported a positive perception of their status as a role model. Logistic regression model revealed that tobacco cessation training, availability of college policy and positive attitudes towards banning Toombak use in public were strong predictors of with a positive perception of role model status.

CONCLUSION

Imposing Toombak control policies within colleges combined with formal training in cessation methods, would reinforce the positive perception of health professions students as a role model, particularly the students themselves seem to be ready for such systematic training.

Assessment of Tobacco Habits, Attitudes, and Education Among Medical Students in the United States and Italy: A Cross-sectional Survey

Objectives

Medical students represent a primary target for tobacco cessation training. This study assessed the prevalence of medical students’ tobacco use, attitudes, clinical skills, and tobacco-related curricula in two countries, the US and Italy, with known baseline disparities in hopes of identifying potential corrective interventions.

Methods

From September to December 2013, medical students enrolled at the University of Bologna and at Brown University were recruited via email to answer survey questions assessing the prevalence of medical students’ tobacco use, attitudes and clinical skills related to patients’ smoking, and elements of medical school curricula related to tobacco use.

Results

Of the 449 medical students enrolled at Brown and the 1426 enrolled at Bologna, 174 Brown students (38.7%) and 527 Bologna students (36.9%) participated in this study. Italian students were more likely to smoke (29.5% vs. 6.1%; p<0.001) and less likely to receive smoking cessation training (9.4% vs. 80.3%; p<0.001) than their American counterparts, even though the majority of students in both countries desired smoking cessation training (98.6% at Brown, 85.4% at Bologna; p<0.001). Additionally, negative beliefs regarding tobacco usage, the absence of formal training in smoking cessation counseling, and a negative interest in receiving specific training on smoking cessation were associated with a higher risk of not investigating a patient’s smoking status during a routine history and not offering tobacco cessation treatment to patients.

Conclusions

Medical curricula on tobacco-related health hazards and on smoking cessation should be mandatory in order to reduce smoking among medical students, physicians, and patients, thereby improving tobacco-related global health.

Smoking cessation support for regular smokers in Hungarian primary care: a nationwide representative cross-sectional study

OBJECTIVES

Our study aimed to evaluate the effectiveness of general practitioners' (GPs') smoking cessation support (SCS).

STUDY DESIGN

We carried out a cross-sectional study between February and April 2016.

SETTING AND PARTICIPANT

A sample of 2904 regular smokers aged 18 years or older was selected randomly from 18 general medical practices involved in a national representative, general medical practice-based morbidity monitoring system. The GPs surveyed the selected adults and identified 708 regular smokers.

MAIN OUTCOME MEASURES

Multivariate logistic regression models have been applied to evaluate the determinants (age, gender, education, smoking-related comorbidity, smoking intensity, intention to quit smoking and nicotine dependence) of provision of GP-mediated SCS such as brief intervention, pharmacological and non-pharmacological programmatic support.

RESULTS

According to the survey, 24.4% of the adults were regular smokers, 30% of them showed high nicotine dependence and 38.2% willing to quit smoking. Most of the smokers were not participated in SCS by GPs: brief intervention, programmatic non-pharmacological support and pharmacotherapy were provided for 25%, 7% and 2% of smokers, respectively. Low-nicotine-dependence individuals were less (OR 0.30, 95% CI 0.12 to 0.75), patients with intention to quit were more (OR 1.49, 95% CI 1.00 to 2.22) likely to receive a brief intervention. Vocational (OR 1.71, 95% CI 1.13 to 2.59) and high school education (OR 2.08, 95% CI 1.31 to 3.31), chronic obstructive pulmonary disease and cardiovascular diseases (OR 3.34, 95% CI 1.04 to 10.68; OR 3.91, 95% CI 2.33 to 6.54) increased the probability to receive support by GP.

CONCLUSIONS

Although there are differences among smokers' subgroups, the SCS in Hungarian primary care is generally insufficient, compared with guidelines. Practically, the pharmacological support is not included in Hungarian GPs' practice. GPs should increase substantially the working time devoted to SCS, and the organisation of primary healthcare should support GPs in improving SCS services.

GHPSS Multicenter Italian Survey: Smoking Prevalence, Knowledge and Attitudes, and Tobacco Cessation Training among Third-Year Medical Students

Aims and background

Healthcare professionals have an important role to play both as advisers – influencing smoking cessation – and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.

Methods and study design

A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.

Results

Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03–3.97).

Conclusions

This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

General Practitioners and Dentists: A Call for Action Against Tobacco

INTRODUCTION

To investigate the frequency of advice to quit smoking received by the Italian population from general practitioners (GP) and dentists, we analyzed a cross-sectional study.

METHODS

A face-to-face survey was conducted in 2014 on 3052 individuals, representative of the general Italian population aged 15 years or more.

RESULTS

During the previous year, 89% of individuals (82% of smokers) reported that they had visited a GP while 71% (67% of smokers) had visited a dentist. Among smokers, 25% reported that they had received advice to quit smoking from their GP, and 26% from their dentist. Advice by GPs was less frequently received by smokers with higher education (multivariate odds ratios (OR) were 0.48 for intermediate and 0.38 for high as compared to low education), and more frequently by heavy smokers (≥15 cigarettes/day; OR = 1.78), those with intention to quit (OR = 2.59), with previous quit attempts (OR = 2.09), and those aware of the existence of smoking cessation services (OR = 1.59). Advice by dentists was more frequently received by smokers aged 25-44 years (OR = 3.55 compared to those aged 15-24) and those with an intention to quit (OR = 2.46). Among Italian current smokers, 32% reported that their GP and 17% that their dentist was a current smoker. The corresponding figures among young smokers were 40% and 26%, respectively.

CONCLUSION

Healthcare providers have the potential to become a key reference point in the fight against smoking. However, before acting, GPs and dentists should set a good example: those who smoke should urgently quit or at least refrain from smoking during working hours.

IMPLICATIONS

GPs and dentists, reaching the large majority of Italian smokers, can make a major contribution in the fight against tobacco. Future studies are needed to investigate possible reasons of the apparently high smoking prevalence among GPs, in order to develop tailored smoking cessation interventions for healthcare providers.

Effectiveness of advice from physician and nurse on smoking cessation stage in Taiwanese male smokers attending a community-based integrated screening program

BACKGROUND

A screening program provides a teachable moment for primary prevention such as encouraging smoking cessation. However, little is known about the efficacy of smoking cessation intervention delivered to the general population through a community-based screening program.

METHODS

A quasi-experimental untreated control design with pre-test and post-test was conducted with 42 subjects receiving advice from physician and nurses (the PNA group), 39 receiving an informational leaflet (the leaflet group), and 308 control subjects.

RESULTS

The overall rate of reaching the action stage was 25 %, 5.7 %, and 7.8 in the PNA group, the leaflet group, and the control group, respectively. In approximately 45-60 % of all participants, the stage remained unchanged. Such an association between the intervention groups and stage changes was statistically significant (p = 0.02). The PNA group was more likely to have the improvement of stage (forward transition toward action stage) than the control group [adjusted odds ratio (aOR) = 2.27 (1.07-4.84)]. Deterioration (backward transition toward precontemplation) in the PNA intervention group was 37 % lower than that in the control group [aOR = 0.63 (0.20-2.01)].

CONCLUSIONS

This study demonstrated that smoking cessation advice from physician and nurse is conducive to smoking cessation, as shown by greater movement toward and less movement away from smoking cessation through a community-based integrated screening platform.

Hospital doctors' smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre

PURPOSE

Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians' smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field.

METHODS

A Web-based survey was sent to 285 physicians.

RESULTS

The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients' smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients' stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward.

CONCLUSIONS

This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians' smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.

Smoking Knowledge, Attitude, and Practices Among Health Care Professionals from Sulaymaniyah City/Iraq

BACKGROUND

Smoking is a serious risk to health globally. Health care professionals play a key role in the prevention of smoking as they are considered a role model by patients.

OBJECTIVES

The aims of this study are to evaluate smoking rate among physicians and dentists from Sulaymaniyah, Iraqi Kurdistan, Iraq, and to understand their knowledge and attitudes toward tobacco smoking.

METHODS

A cross-sectional web-based survey was conducted involving physicians and dentists working in both University of Sulaimani and Sulaymaniyah Teaching Hospitals. A questionnaire created based on World Health Organization Global Health Professional Survey with slight modifications was emailed to the study participants and the responses received were analyzed.

RESULTS

Incidence of smoking among physicians and dentists was 26.5%, with a significantly higher rate among male compared to female health care professionals. The mean age of starting smoking was 22.3 (±4.8) years. Only 7.3% of health care professionals received formal training on smoking cessation. All responders agreed that smoking is harmful to health. However, ever smokers compared to never smokers were less likely to agree that health care professionals should set a positive impact by not smoking.

CONCLUSION

Smoking rate is high among physicians and dentists from Sulaymaniyah city/Iraq, and at the same time, there is a low rate of training on smoking cessation.

Reduction of risk of dying from tobacco-related diseases after quitting smoking in Italy

AIMS AND BACKGROUND

The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction.

METHODS

Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers.

RESULTS

Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively.

CONCLUSIONS

Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.

Are primary care physicians prepared to assist patients for smoking cessation? Results of a national Italian cross-sectional web survey

OBJECTIVE

The primary purpose of this study is to explore primary care physicians' (PCPs') knowledge, attitudes and self-reported activities provided to patients for smoking cessation. The secondary purpose is to identify the relationships between physician-related characteristics and knowledge, attitudes and self-reported activities for smoking cessation.

METHOD

A national cross-sectional web survey was conducted in Italy from April through September 2012.

RESULTS

722 PCPs completed the questionnaire. The great majority indicated the correct proportion of smokers among patients with lung cancer, the smoking abstention required for risk reduction after smoking cessation, and tobacco as a known major risk factor for chronic obstructive pulmonary disease (COPD), whereas 28.7% knew the Fagerstrom test for the assessment of nicotine dependence. Almost all PCPs reported that they ask all patients if they smoke, inform about the dangers of smoking and recommend to quit smoking, whereas prescription of recommended drugs for smoking cessation varied from 37.7% for nicotine replacement therapy to 4.9% for varenicline.

CONCLUSION

Despite a positive attitude, Italian PCPs are not prepared to deliver effective interventions for smoking cessation in their patients.

Knowledge, attitudes, and smoking behaviours among physicians specializing in public health: a multicentre study

Background. Healthcare professionals have an important role to play both as advisers—influencing smoking cessation—and as role models. However, many of them continue to smoke. The aims of this study were to examine smoking prevalence, knowledge, attitudes, and behaviours among four cohorts physicians specializing in public health, according to the Global Health Profession Students Survey (GHPSS) approach. Materials and Methods. A multicentre cross-sectional study was carried out in 24 Italian schools of public health. The survey was conducted between January and April 2012 and it was carried out a census of students in the selected schools for each years of course (from first to fourth year of attendance), therefore among four cohorts of physicians specializing in Public Health (for a total of n. 459 medical doctors). The GHPSS questionnaires were self-administered via a special website which is created ad hoc for the survey. Logistic regression model was used to identify possible associations with tobacco smoking status. Hosmer-Lemeshow test was performed. The level of significance was P ≤ 0.05. Results. A total of 388 answered the questionnaire on the website (85%), of which 81 (20.9%) declared to be smokers, 309 (79.6%) considered health professionals as behavioural models for patients, and 375 (96.6%) affirmed that health professionals have a role in giving advice or information about smoking cessation. Although 388 (89.7%) heard about smoking related issues during undergraduate courses, only 17% received specific smoking cessation training during specialization. Conclusions. The present study highlights the importance of focusing attention on smoking cessation training, given the high prevalence of smokers among physicians specializing in public health, their key role both as advisers and behavioural models, and the limited tobacco training offered in public health schools.

Knowledge about health effects of cigarette smoking and quitting among Italian university students: the importance of teaching nicotine dependence and treatment in the medical curriculum

Aims of the study were to compare medical students (MS) to non-MS with respect to their knowledge of smoking and to investigate the effect of a short educational intervention on MS knowledge. MS (n = 962) and students of architecture and law (n = 229) were asked to complete a 60-item questionnaire addressing knowledge of smoking epidemiology and health effects (“Score 1”), and effectiveness of cessation treatments (“Score 2”). Upon completion of questionnaire, fourth year MS received a lecture on tobacco dependence. These students were asked to complete the same questionnaire one and two years later. Mean values for Score 1 were 48.9 ± 11.5% in MS and 40.5 ± 11.4% in non-MS (P < 0.001; d = 0.69). Respective values for Score 2 were 48.1 ± 10.8% and 42.6 ± 10.6% (P < 0.001; d = 0.50). Fifth year students who had attended the lecture in year 4 scored higher than students who had not attended the lecture. Significant differences were noted one but not two years after the educational intervention. In conclusion, MS know slightly more about smoking-related diseases and methods to achieve cessation than nonmedical students; a short educational intervention was associated with better knowledge one year later, but the effect was moderate and short-lived.

Smoking cessation counselling practices of family physicians in Jordan

Objectives: To assess the smoking cessation counselling practices of family physicians in Jordan and assess their perception about the availability of smoking cessation resources and about the barriers to effective smoking cessation practices. Methods: A pre-structured questionnaire was distributed to 124 family physicians practicing in teaching and Ministry of Health medical centres in Jordan. All participants were asked about their smoking cessation practices and about the barriers to effective smoking cessation practices. Results: Only 39.8% reported that they assess the willingness of the patients to quit smoking and 28.2% reported that they discuss counselling options with smokers. Considerably fewer percentages of physicians reported that they prepare their patients for withdrawal symptoms (11.6%), discuss pharmacotherapies (4.9%), describe a nicotine patch (5.0%), and provide patients with self-help materials (6.7%). The two factors cited most often by physicians as significant barriers to smoking cessation counselling were lack or too few available cessation programmes (90.3%) and limited training for physicians on tobacco and cessation interventions (90.3%). Conclusion: While a high proportion of Jordanian family physicians reported that they usually ask patients about smoking status and advise them to stop smoking, they do not regularly provide extensive assistance to help their patients to quit smoking. Lack or too few available cessation programmes and limited training for physicians on smoking cessation interventions were identified as the two major barriers to effective smoking cessation counselling.

Patterns of smoking prevalence among the elderly in Europe

Scant information is available on determinants of smoking prevalence in the vulnerable population of the elderly, particularly in Europe. Therefore, we analyzed smoking patterns among older adults (≥65 years old), using data from a representative survey based on 3,071 elderly, conducted in 17 European countries in 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project. Overall smoking prevalence in 17 European countries was 11.5% (15.3% in men and 8.6% in women). An inverse relation with level of education was observed among men, while no specific pattern was evident among women. Smoking prevalence was highest in eastern/central Europe for men (20.3%) and northern Europe for women (13.1%). In both sexes combined, smokers were more frequent in countries with low implementation of tobacco control activities (14.9%). Anti-tobacco campaigns and smoking cessation interventions specifically targeted to the elderly are urgently needed in Europe.

Italy SimSmoke: the effect of tobacco control policies on smoking prevalence and smoking attributable deaths in Italy

Background

While Italy has implemented some tobacco control policies over the last few decades, which resulted in a decreased smoking prevalence, there is still considerable scope to strengthen tobacco control policies consistent with the World Health Organization (WHO) policy guidelines. The present study aims to evaluate the effect of past and project the effect of future tobacco control policies on smoking prevalence and associated premature mortality in Italy.

Methods

To assess, individually and in combination, the effect of seven types of policies, we used the SimSmoke simulation model of tobacco control policy. The model uses population, smoking rates and tobacco control policy data for Italy.

Results

Significant reductions of smoking prevalence and premature mortality can be achieved through tobacco price increases, high intensity media campaigns, comprehensive cessation treatment program, strong health warnings, stricter smoke-free air regulations and advertising bans, and youth access laws. With a comprehensive approach, the smoking prevalence can be decreased by as much as 12% soon after the policies are in place, increasing to a 30% reduction in the next twenty years and a 34% reduction by 30 years in 2040. Without effective tobacco control policies, a total of almost 300 thousand lives will be prematurely lost due to smoking by the year 2040.

Conclusion

Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps identify information gaps in surveillance and evaluation schemes that will promote the effectiveness of future tobacco control policy in Italy.

Cigarette smoking knowledge and perceptions among students in four Italian medical schools

INTRODUCTION

Tobacco smoking is the leading cause of premature death in the developed world. Advice and assistance by physicians help smokers quit, but little attention has been paid to the topic of tobacco dependence in the curricula of Italian medical schools. Consequently, few physicians follow the clinical practice guidelines for treating dependence.

METHODS

This study was conducted on 439 students at 4 Italian medical schools in 2010. Students were asked to complete a 60-item questionnaire. Two scores were computed: Score 1 assessed knowledge of the epidemiology of smoking, risks associated with smoking, and benefits of cessation. Score 2 assessed knowledge of tobacco dependence treatment guidelines and the effectiveness of treatments. A score of less than 60% indicated insufficient knowledge.

RESULTS

Medical students had limited knowledge of the epidemiology of smoking, attributable morbidity and mortality, and the benefits of cessation. This limited knowledge was reflected by the finding that 70% of students had a total Score 1 less than 60% of available points. Knowledge of clinical guidelines, perceived competence in counseling smokers, and treatment of addiction was also insufficient, as 76% of students achieved a total Score 2 of less than 60%.

CONCLUSIONS

Our data demonstrate that Italian medical students have limited knowledge about tobacco dependence, how to treat it, and the critical role of the physician in promoting cessation. Taken together with research from other countries, these findings suggest that medical schools do not offer adequate training in tobacco dependence and provide a rationale for modifying the core curriculum to include more information on tobacco dependence treatment.

Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: a three-arm cluster randomized trial

BACKGROUND

Brief advice for smoking patients has not been sufficiently integrated in routine care. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting.

METHOD

151 practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up.

RESULTS

Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p<.01) and 127% (p=.02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p=.02) and 32% (p=.01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention.

CONCLUSIONS

Computer-based interventions alone or in addition to conventional practitioner-delivered advice can foster the participation of general medical practices in tobacco control.

Smoking counseling practices of physicians in the United Arab Emirates

Background. Despite the cost effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. Methods. A cross-sectional mail survey was conducted in a sample of general practitioners in the United Arab Emirates (UAE), emirates of Sharjah, Dubai and Abu Dhabi, to document cessation-counseling practices and identify correlates of these activities. Results. Of 391 eligible GPs, 218 (56%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, less than half of GPs (47%) indicated that they have the skills to help their patients quit smoking and only 24% knew of community resources to refer patients to. GPs who perceived physician barriers in offering smoking counseling as very important were significantly less likely to ascertain smoking status of most of their patients (OR: 0.28, 95% CI: 0.09,0.88). Moreover, high self-efficacy and favorable beliefs/attitudes were significantly associated with high level of counseling completeness (OR: 4.44, 95% CI: 1.21, 16.37; OR: 3.78, 95% CI: 1.25, 11.35; respectively). Conclusion. Support, training and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation-counseling practices among general practitioners in the UAE.

Utilizing audit and feedback to improve hospitalists' performance in tobacco dependence counseling

INTRODUCTION

Hospitalized smokers benefit from smoking cessation counseling and nicotine replacement therapy (NRT). However, inpatient providers who care for hospitalized patients carry out these preventive measures inconsistently.

METHODS

We designed a peer-led audit and feedback intervention to improve (a) the frequency of smoking cessation counseling and (b) the appropriateness of the prescribing of NRT by hospitalist practitioners in our hospital. Documentation of tobacco cessation counseling in progress notes and discharge summaries and the ordering and dosing of NRT were assessed for 30 hospitalists before and after an intervention. This intervention included specific feedback on their counseling and prescribing practices as well as education and was delivered as part of a one-on-one academic detailing session.

RESULTS

Five hundred and forty five and 1,119 patient-days were considered for this analysis in the pre- and postperiods, respectively. Documentation of tobacco dependence counseling in progress notes increased from 36% to 44% (p = .002) and from 7.5% to 46.8% in discharge summaries (p < .0001) following the intervention. The appropriateness of NRT dosing increased from 26% (before) to 64% (after) the intervention (p < .0001).

DISCUSSION

A peer-led audit and feedback intervention for hospitalists significantly increases the frequency of smoking cessation counseling and the adequacy of NRT prescribing for hospitalized smokers.

Faculty development in tobacco cessation: training health professionals and promoting tobacco control in developing countries

ISSUES

Cessation programs are essential components of comprehensive tobacco control. Health-care providers, especially physicians, have major responsibility for role modeling and promoting cessation. For successful, sustainable cessation training programs, countries need health-care professionals with knowledge and skills to deliver and teach tobacco cessation.

APPROACH

Review literature relevant to faculty development in tobacco cessation and discuss its strategic potential in tobacco control.

KEY FINDINGS

Faculty development is essential for sustainable tobacco cessation training programs, and a potentially powerful strategy to shift professional and societal norms towards cessation and support of comprehensive tobacco control in countries with normative tobacco use and underdeveloped tobacco control programs.

IMPLICATIONS

Medical faculty are in a key position to influence tobacco cessation and control programs because of their roles as educators and researchers, receptivity to innovation and, influence on competencies and standards for medical education and practice. Faculty development programs must consider the number and type of faculty, and tobacco cessation curricula needed. Faculty development fosters the ability to institutionalise cessation education for students and community practitioners. Academic faculty are often leaders in their professional disciplines, influential in establishing clinical practice standards, and technical experts for government and other key health organisations.

CONCLUSION

Training health-care professional faculty to become knowledgeable and committed to tobacco cessation opens opportunities to promote cessation and shift professional and societal norms away from tobacco use.

Quit smoking advice from health professionals in Taiwan: the role of funding policy and smoker socioeconomic status

Objectives

In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counselling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007).

Methods

We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined.

Results

The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice.

Conclusions

During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups.

Tobacco sales to minors in Italy

AIMS AND BACKGROUND

One of the strategies to control tobacco is to limit purchase of cigarettes to minors. To understand the attitudes of Italian adults towards regulations to prevent minors from purchasing tobacco products, we added specific questions to the annual survey on smoking in Italy.

METHODS

During March-April 2007, we conducted a survey on smoking on 3,057 subjects representative of the Italian population aged > or = 15 years. Two specific questions were included, one investigating the attitudes towards the proposed legislation prohibiting purchase of tobacco to individuals under 18 years of age (instead of 16 years) as a policy to reduce smoking prevalence and consumption. The second question asked whether the current tobacco sales-to-minors law was observed.

RESULTS

Overall, 78% of Italians believed that a restriction of the current tobacco sales-to-minors law could be moderately to extremely effective as a strategy to decrease smoking prevalence and consumption. More than 90% of Italians reported that they had never seen in their lifetime a retailer refusing to sell cigarettes to an adolescent or requesting the minor's identification or age.

CONCLUSIONS

A restriction of the legislation, increasing to 18 years the minimum age for purchasing tobacco, would limit access to tobacco products by minors, only if adopted together with systematic and effective enforcement measures.

Socio-demographic variation in smoking habits: Italy, 2008

OBJECTIVE

To provide updated information on smoking prevalence in Italy, with a focus on demographic and socio-economic characteristics.

METHOD

The survey was conducted during March-April 2008 on a sample of 3035 individuals (1459 men and 1576 women) aged 15 years or over representative of the Italian population in terms of age, sex, geographic area, and socio-economic characteristics.

RESULTS

In 2008, 22.0% (95% confidence interval, CI: 20.5-23.5) of Italians described themselves as current cigarette smokers (26.4% of men, 17.9% of women); ex-smokers were 18.4% (95% CI: 17.0-19.8; 24.1% of men, 13.2% of women). By the year 2012 the number of former could exceed that of current smokers. Smoking prevalence in the young (15-24 years) was around 30% in males, and almost 20% in females. For both sexes, current smoking was less prevalent in higher (22.9% of men, 20.1% of women) than in lower educated participants (34.8% of men, 22.1% of women), and in northern (22.5% of men, 16.1% of women) than southern Italy (31.8% of men, 18.4% of women).

CONCLUSION

In 2008, smoking prevalence was the lowest observed over the last 50 years, in Italy. However, part of the fall is likely due to increased under-reporting, since these survey figures are appreciably under-estimated as compared to sale data. Subjects with less privileged socio-economic characteristics should be considered target populations for tobacco control.

National survey of the smoking cessation services in Italy

This investigation is aimed at providing information about structural and organizational characteristics of smoking cessation services (SCS) set up within the Italian National Health Service. Local health units and hospitals are the main institutions connected with SCS which are mainly located within the Department of Drug Addiction and the Department of Lung and Breath Care. SCS provide different tobacco-use cessation programs. Although pharmacotherapy is always used, a combination of therapeutic treatments is highly preferred. This study shows the importance of maintaining a national coordination among different SCS supporting their activity and encouraging the start up of additional services throughout the country.

Smoking cessation advice: Swiss physicians lack training

OBJECTIVES

To assess the use and appropriateness of medical advice for smoking cessation provided by registrars in a General Medicine Outpatient Department to an unselected patient population in Switzerland.

METHODS

A prospective observational study in which 314 consecutive outpatients were contacted by phone within 24h after their consultation. Questions and information concerning smoking asked and/or provided by the registrar to patients were collected.

RESULTS

Eleven registrars (mean age 34 years (range 29-40), 54% females, mean of 5 years (range 3.5-6 years) postgraduate medical training) worked in the Basel University Hospital Medical Outpatient Department during the study period from 01.01.2006 to 31.03.2006. In total 314 participants (mean 48 years, age range 16-71 years, 50% females) completed the study. Registrars queried 81% of the patients about smoking, but inquired about smoking duration only in 44% of the patients. Twenty-eight percent of the patients received information about the risks related to smoking, whereas cessation was discussed only with 10% and offered to 9% of the patients.

CONCLUSION

Though most junior physicians in the survey asked about smoking, they failed to appropriately address tobacco-related health issues and offer cessation advice in the majority of cases. Extended regular training for physicians on smoking-related issues will be necessary in order to improve counselling of smokers and meet the global tobacco challenge.