Obstetricians, gynecologists and the anti-smoking campaign: a national survey

What components of smoking cessation care during pregnancy are implemented by health providers? A systematic review and meta-analysis

BACKGROUND

Pregnancy is an opportunity for health providers to support women to stop smoking.

OBJECTIVES

Identify the pooled prevalence for health providers in providing components of smoking cessation care to women who smoke during pregnancy.

DESIGN

A systematic review synthesising original articles that reported on (1) prevalence of health providers' performing the 5As ('Ask', 'Advise', 'Assess', 'Assist', 'Arrange'), prescribing nicotine replacement therapy (NRT) and (2) factors associated with smoking cessation care.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and PsycINFO databases searched using 'smoking', 'pregnancy' and 'health provider practices'.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies included any design except interventions (self-report, audit, observed consultations and women's reports), in English, with no date restriction, up to June 2017.

PARTICIPANTS

Health providers of any profession.

DATA EXTRACTION, APPRAISAL AND ANALYSIS

Data were extracted, then appraised with the Hawker tool. Meta-analyses pooled percentages for performing each of the 5As and prescribing NRT, using, for example, 'often/always' and 'always/all'. Meta-regressions were performed of 5As for 'often/always'.

RESULTS

Of 3933 papers, 54 were included (n=29 225 participants): 33 for meta-analysis. Health providers included general practitioners, obstetricians, midwives and others from 10 countries. Pooled percentages of studies reporting practices 'often/always' were: 'Ask' (n=9) 91.6% (95% CI 88.2% to 95%); 'Advise' (n=7) 90% (95% CI 72.5% to 99.3%), 'Assess' (n=3) 79.2% (95% CI 76.5% to 81.8%), 'Assist (cessation support)' (n=5) 59.1% (95% CI 56% to 62.2%), 'Arrange (referral)' (n=6) 33.3% (95% CI 20.4% to 46.2%) and 'prescribing NRT' (n=6) 25.4% (95% CI 12.8% to 38%). Heterogeneity (I2) was 95.9%-99.1%. Meta-regressions for 'Arrange' were significant for year (p=0.013) and country (p=0.037).

CONCLUSIONS

Health providers 'Ask', 'Advise' and 'Assess' most pregnant women about smoking. 'Assist', 'Arrange' and 'prescribing NRT' are reported at lower rates: strategies to improve these should be considered.

PROSPERO REGISTRATION NUMBER

CRD42015029989.

Does cigarette smoking affect seminal fluid parameters? A comparative study

OBJECTIVE

To study the effect of cigarette smoking on seminal fluid parameters, namely; volume, sperm concentration, and motility, as well as morphology, leukocyte infiltration, among males complaining of infertility.

METHODS

Between August 2010 and July 2011, seminal fluid analysis was done for 1438 males who are partners of couples who visited the infertility clinic at Prince Rashid Ben Al Hassan Hospital (PRH) for infertility. The men who fit the inclusion criteria (n=960) were classified into two groups: group a (non-smokers; n=564) and group B (smokers; n=396), which represents 41.25% of the study group. Seminal fluid was collected using masturbation after 3-5 days of abstinence then analyzed for volume, sperm count, sperm concentration, motility and morphology. In order to analyze whether the number of cigarettes smoked per day has an effect on the spermatogram; the smoking men were divided into two subgroups: the heavy smokers (n=266) and non-heavy smokers (n=130).

RESULTS

A total of 960 adult males were enrolled. Their age ranged between 21 and 76 years, 564 were non-smokers with mean age of 36. 45±6.27 (Mean±SD). Three-hundred-and-ninety-six were smokers with a mean age of 34.35±4.25 (Mean±SD). There was a significant effect of smoking on the motility of sperms and the ratios of abnormality (p<0.005). Concentration appeared not to be affected by smoking. Furthermore, the group of heavy smokers were found to have lower sperm concentrations and a higher percentage of abnormal sperms compared to the non-heavy smokers.

CONCLUSION

Cigarette smoking has a deleterious effect on some of the seminal fluid parameters (motility, morphology and leukocyte count) which in turn may result in male subfertility.

Smoking prevalence, attitudes, and perceived smoking prevention and control responsibilities and behaviors among physicians in Jordan

This study identifies smoking prevalence among physicians in Jordan. It also assesses their attitudes, perceived smoking prevention, and control responsibilities and behaviors. A cross-sectional survey was administered to 251 physicians from public and private hospitals in Jordan. The response rate was 67%. The prevalence of smoking is 22.4% for male and 9.1% for female physicians. Among current or former smokers, 81.1% (n = 73), 29.1% overall, had smoked in front of a patient. The physicians believed that physician counseling could more effectively prevent patients from smoking than influencing patients to quit smoking. Approximately 56.2% of physicians had ever counseled patients about smoking and 34.3% regularly counseled patients about smoking. Only 18.3% (n = 46) had received training, either in medical school or thereafter, on counseling patients about smoking. Physicians with training on counseling patients about smoking cessation were significantly more likely to have counseled or to routinely counsel patients to help them quit or not start smoking. Training also lowered the percentage of smokers who smoked in front of patients.