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Wee LH, West R, Tee GH, Yeap L, Chan CMH, Ho BK, Perialathan K, Nik Mohamed MH, Michie S, Jackson SE. Effectiveness of training stop-smoking advisers to deliver cessation support to the UK national proposed standard versus usual care in Malaysia: a two-arm cluster-randomized controlled trial. Addiction 2021; 116:2150-2161. [PMID: 33220115 PMCID: PMC8359305 DOI: 10.1111/add.15346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
AIMS To assess the effectiveness of training stop smoking services providers in Malaysia to deliver support for smoking cessation based on the UK National Centre for Smoking Cessation and Training (NCSCT) standard treatment programme compared with usual care. DESIGN Two-arm cluster-randomized controlled effectiveness trial across 19 sites with follow-up at 4-week, 3-month, and 6-month. SETTING Stop smoking services operating in public hospitals in Malaysia. PARTICIPANTS Five hundred and two smokers [mean ± standard deviation (SD), age 45.6 (13.4) years; 97.4% male] attending stop smoking services in hospital settings in Malaysia: 330 in 10 hospitals in the intervention condition and 172 in nine hospitals in the control condition. INTERVENTION AND COMPARATOR The intervention consisted of training stop-smoking practitioners to deliver support and follow-up according to the NCSCT Standard Treatment Programme. The comparator was usual care (brief support and follow-up). MEASUREMENTS The primary outcome was continuous tobacco smoking abstinence up to 6 months in smokers who received smoking cessation treatment, verified by expired-air carbon monoxide (CO) concentration. Secondary outcomes were continuous CO-verified tobacco smoking abstinence up to 4 weeks and 3 months. RESULTS Follow-up rates at 4 weeks, 3 months and 6 months were 80.0, 70.6 and 53.3%, respectively, in the intervention group and 48.8, 30.8 and 23.3%, respectively, in the control group. At 6-month follow-up, 93 participants in the intervention group and 19 participants in the control group were abstinent from smoking, representing 28.2 versus 11.0% in an intention-to-treat (ITT) analysis assuming that participants with missing data had resumed smoking, and 52.8 versus 47.5% in a follow-up-only (FUO) analysis. Unadjusted odds ratios (accounting for clustering) were 5.04, (95% confidence interval (CI) = 1.22-20.77, P = 0.025) and 1.70, (95% CI = 0.25-11.53, P = 0.589) in the ITT and FUO analyses, respectively. Abstinence rates at 4 week and 3 month follow-ups were significantly higher in the intervention versus control group in the ITT but not the FUO analysis. CONCLUSIONS On an intention-to-treat analysis with missing-equals-smoking imputation, training Malaysian stop smoking service providers in the UK National Centre for Smoking Cessation and Training standard treatment programme appeared to increase 6 month continuous abstinence rates in smokers seeking help with stopping compared with usual care. However, the effect may have been due to increasing follow-up rates.
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Affiliation(s)
- Lei Hum Wee
- Universiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | | | | | - Bee Kiau Ho
- Ministry of HealthBandar Botanic Health CentreMalaysia
| | | | | | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Sheffer CE, Al-Zalabani A, Aubrey A, Bader R, Beltrez C, Bennett S, Carl E, Cranos C, Darville A, Greyber J, Karam-Hage M, Hawari F, Hutcheson T, Hynes V, Kotsen C, Leone F, McConaha J, McCary H, Meade C, Messick C, Morgan SK, Morris CW, Payne T, Retzlaff J, Santis W, Short E, Shumaker T, Steinberg M, Wendling A. The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2416. [PMID: 33801227 PMCID: PMC7967787 DOI: 10.3390/ijerph18052416] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/27/2023]
Abstract
Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.
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Affiliation(s)
- Christine E. Sheffer
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abdulmohsen Al-Zalabani
- Tobacco Treatment Specialist Training and Certification Program at College of Medicine, Taibah University, Madinah 42353, Saudi Arabia;
| | - Andrée Aubrey
- Tobacco Treatment Specialist Course, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
| | - Rasha Bader
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Claribel Beltrez
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Susan Bennett
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Ellen Carl
- Tobacco Treatment Specialist Training Program, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Caroline Cranos
- Tobacco Treatment Specialist Training Program, Center for Tobacco Treatment Research and Training, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Audrey Darville
- BREATHE Online Tobacco Treatment Specialist Training Program, College of Nursing, University of Kentucky, Lexington, KY 40504, USA;
| | - Jennifer Greyber
- Duke-UNC Tobacco Treatment Specialist Training Program, Duke Smoking Cessation Program, Duke Cancer Center, Durham, NC 27705, USA;
| | - Maher Karam-Hage
- Tobacco Treatment Training Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Feras Hawari
- Tobacco Dependence Treatment Training, King Hussein Cancer Center, Amman 11941, Jordan; (R.B.); (F.H.)
| | - Tresza Hutcheson
- Tobacco Treatment Specialist Training Program, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Victoria Hynes
- Tobacco Treatment Education & Training Program, MaineHealth Center for Tobacco Independence, Portland, ME 04101, USA;
| | - Chris Kotsen
- Tobacco Treatment Specialist Training Program, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA;
| | - Frank Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Jamie McConaha
- Tobacco Treatment Specialist Training and Certificate Program, School of Pharmacy, Duquesne University, Pittsburg, PA 15282, USA;
| | - Heather McCary
- Tobacco Treatment Specialist Certification Program, The Breathing Association, Columbus, OH 43203, USA;
| | - Crystal Meade
- Tobacco Prevention and Control Program, Wellness and Prevention Department, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA;
| | | | - Susan K. Morgan
- Tobacco Treatment Training Program, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA;
| | - Cindy W. Morris
- Rocky Mountain Tobacco Treatment Specialist Training Program, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Payne
- ACT Center for Tobacco Treatment, Education and Research, University of Mississippi Medical Center Cancer Institute, Jackson, MS 39213, USA;
| | - Jessica Retzlaff
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Wendy Santis
- Council for Tobacco Treatment Training Programs, Inc., Madison, WI 53704, USA; (J.R.); (W.S.)
| | - Etta Short
- Optum’s Quit for Life Program, Eden Prairie, MN 55344, USA;
| | - Therese Shumaker
- Tobacco Treatment Specialist Training Program, Mayo Clinic Nicotine Dependence Center, Rochester, MN 55905, USA; (S.B.); (T.S.)
| | - Michael Steinberg
- Rutgers Tobacco Dependence Program, New Brunswick, NJ 08903, USA; (C.B.); (M.S.)
| | - Ann Wendling
- Tobacco Cessation Program, Healthways, A Sharecare Company, Franklin, TN 37067, USA;
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Bull ER, Dale H. Improving community health and social care practitioners' confidence, perceived competence and intention to use behaviour change techniques in health behaviour change conversations. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:270-283. [PMID: 32643231 DOI: 10.1111/hsc.13090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self-rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2-day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence-based BCTs (e.g. Action Planning), plus person-centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1-10) pre-course and post-course, and provided acceptability data. 177 participants aged 20-64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology-based skills training can improve practitioner confidence, competence and intention to use evidence-based BCTs; further evaluation is needed to assess practice change.
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Affiliation(s)
- Eleanor R Bull
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
- Psychology Services, NHS Education for Scotland, Edinburgh, UK
| | - Hannah Dale
- Psychology Services, NHS Education for Scotland, Edinburgh, UK
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Baliunas D, Ivanova A, Tanzini E, Dragonetti R, Selby P. Impact of comprehensive smoking cessation training of practitioners on patients' 6-month quit outcome. Canadian Journal of Public Health 2020; 111:766-774. [PMID: 32441021 DOI: 10.17269/s41997-020-00318-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Smoking remains a leading public health issue and health care practitioners (HCPs), who play an important role in supporting and promoting patients' cessation efforts, need educational initiatives that improve their ability to provide effective clinical care. The objective of this study was to compare patient-reported abstinence from smoking following treatment by HCPs trained in an intensive tobacco cessation program and those trained in less intensive programs. METHODS A secondary data analysis of two overlapping samples of patients who received most of their treatment from one identifiable HCP (n = 26,590) or all of their treatment from one identifiable HCP (n = 20,986) was assessed. Patients were residents of Ontario, Canada, who enrolled in a publicly funded smoking cessation treatment program between 01 May 2014 and 31 October 2016 and completed the 7-day point prevalence of smoking question at 6-month follow-up. Treatment was provided by HCPs who engaged in the intensive Training Enhancement in Applied Counselling and Health (TEACH) Core course, or those who engaged in one or more other training programs. Generalized estimating equation (GEE) logistic regression was used to compare smoking abstinence between groups. RESULTS After adjustment for both patient- and practice-level covariates, a significant association was found between being treated by a TEACH-trained HCP and the likelihood of smoking abstinence at 6-month follow-up in both analytic samples (most care sample: OR = 1.10, 95% CI = 1.01, 1.20; all care sample: OR = 1.12, 95% CI = 1.02, 1.24). CONCLUSION Implementation of comprehensive cessation training to support HCP delivery of smoking cessation treatment should be considered to improve patient outcomes.
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Affiliation(s)
- Dolly Baliunas
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna Ivanova
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elise Tanzini
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Peleki T, Girvalaki C, Lozano F, Radu-Loghin C, Nguyen D, Harutyunyan A, Bakhturidze G, Trofor A, Demin A, Stoyka O, Tsiou C, Papadakis S, Vardavas CI, Behrakis PK. Short-term impact of the EuroPean Accredited Curriculum on Tobacco Treatment Training (EPACTT) program. Tob Prev Cessat 2018; 4:28. [PMID: 32411854 PMCID: PMC7205079 DOI: 10.18332/tpc/92484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers' knowledge, attitudes and self-efficacy related to tobacco dependence treatment. METHODS A pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program. RESULTS In all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers' self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed. CONCLUSIONS The results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.
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Affiliation(s)
- Theodosia Peleki
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Medicine, Athens, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Francisco Lozano
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Cornel Radu-Loghin
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Dominick Nguyen
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | | | | | - Antigona Trofor
- University of Medicine and Pharmacy ‘Grigore T.Popa’, Iasi, Romania
| | - Andrey Demin
- Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University under the Ministry of Health of the Russian Federation, Russia
| | | | | | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Institute of Public Health, American College of Greece, George D Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
| | - Panagiotis K. Behrakis
- Institute of Public Health, American College of Greece, Athens, Greece
- George D Behrakis Research Lab, Hellenic Cancer Society, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Ye L, Goldie C, Sharma T, John S, Bamford M, Smith PM, Selby P, Schultz ASH. Tobacco-Nicotine Education and Training for Health-Care Professional Students and Practitioners: A Systematic Review. Nicotine Tob Res 2018; 20:531-542. [PMID: 28371888 DOI: 10.1093/ntr/ntx072] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/28/2017] [Indexed: 11/12/2022]
Abstract
Introduction The objective of this systematic review was to investigate what education and training characteristics prepares and supports health-care professionals (HCPs) in the delivery of competent and effective care to clients who use tobacco-nicotine. Aims and Methods A search of eight bibliographic databases for English-language peer-reviewed publications from January 2006 to March 2015. Studies were included if they met the a priori inclusion criteria, which consisted of: (1) quantitative study design and (2) focus on tobacco-nicotine education or training for HCP students and practitioners. All studies were independently screened for inclusion by two reviewers. Data from included studies were extracted for study characteristics and key outcomes then critically appraised for methodological quality. Results Fifty-nine studies were included for narrative synthesis. Two categories emerged: (1) curriculum characteristics (n = 10) and (2) education and training interventions (n = 49). Included curriculum studies identified the following themes: content, intensity, competencies evaluation, and barriers. Study findings about education and training interventions were grouped by level of education (prelicensure, post-licensure, and faculty training), teaching modality, health discipline, and the associated HCP and client outcomes. Conclusions This comprehensive review suggests that there is a lack of consistency in HCP tobacco-nicotine education and training characteristics. This paper provides valuable categorization of the most frequently utilized components of academic curriculum and discusses the interventions in relation to HCP and client outcomes. Gaps in the literature are highlighted, and the need for standardization of tobacco-nicotine training competencies and evaluation is discussed. Future research investigating the most effective approaches to training is needed. Implications This systematic review summarizes existing tobacco-related curriculum components (content, intensity, competency evaluation, and barriers) and training interventions for health-care professionals worldwide and demonstrates that they are associated with positive health-care professional outcomes (knowledge, attitudes, behaviors, and skills) and client outcomes (quit attempts and smoking abstinence).
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Affiliation(s)
- Lisa Ye
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Catherine Goldie
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, ON, Canada
| | - Tanvi Sharma
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Sheila John
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Megan Bamford
- International Affairs and Best Practice Guidelines, Registered Nurses' Association of Ontario, Toronto, ON, Canada
| | - Patricia M Smith
- Human Science Division, Northern Ontario School of Medicine, ON, Canada
| | - Peter Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Asper Clinical Research Institute, Winnipeg, MB, Canada
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Huang P, Shen Z, Wang C, Qian W, Zhang H, Yang Y, Zhang M. Altered White Matter Integrity in Smokers Is Associated with Smoking Cessation Outcomes. Front Hum Neurosci 2017; 11:438. [PMID: 28912702 PMCID: PMC5582085 DOI: 10.3389/fnhum.2017.00438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/16/2017] [Indexed: 01/03/2023] Open
Abstract
Smoking is a significant cause of preventable mortality worldwide. Understanding the neural mechanisms of nicotine addiction and smoking cessation may provide effective targets for developing treatment strategies. In the present study, we explored whether smokers have white matter alterations and whether these alterations are related to cessation outcomes and smoking behaviors. Sixty-six smokers and thirty-seven healthy non-smokers were enrolled. The participants underwent magnetic resonance imaging scans and smoking-related behavioral assessments. After a 12-week treatment with varenicline, 28 smokers succeeded in quitting smoking and 38 failed. Diffusion parameter maps were compared among the non-smokers, future quitters, and relapsers to identify white matter differences. We found that the future relapsers had significantly lower fractional anisotropy (FA) in the orbitofrontal area than non-smokers, and higher FA in the cerebellum than non-smokers and future quitters. The future quitters had significantly lower FA in the postcentral gyrus compared to non-smokers and future relapsers. Compared to non-smokers, pooled smokers had lower FA in bilateral orbitofrontal gyrus and left superior frontal gyrus. In addition, regression analysis showed that the left orbitofrontal FA was correlated with smoking-relevant behaviors. These results suggest that white matter alterations in smokers may contribute to the formation of aberrant brain circuits underlying smoking behaviors and are associated with future smoking cessation outcomes.
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Affiliation(s)
- Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Zhujing Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Wei Qian
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Huan Zhang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang UniversityHangzhou, China
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, BaltimoreMD, United States
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
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Simonavicius E, Robson D, McEwen A, Brose LS. Cessation support for smokers with mental health problems: a survey of resources and training needs. J Subst Abuse Treat 2017; 80:37-44. [PMID: 28755771 PMCID: PMC5555355 DOI: 10.1016/j.jsat.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 01/05/2023]
Abstract
AIMS Around thirty percent of smokers have a mental health problem. Smoking cessation has been associated with mental health benefits, but smoking prevalence remains high in populations with mental health problems. This study aimed to assess mental health related knowledge, practice, and training needs of practitioners supporting smoking cessation. METHODS UK stop smoking practitioners (n=717) recruited via a database of a national provider of smoking cessation training in June 2016 sufficiently completed an online survey about available resources, knowledge, confidence, and training needs related to smoking cessation and mental health. Responses were described and compared between practitioners with a mental health lead and those without such a lead in their service using chi-square statistics and t-tests. RESULTS A considerable proportion agreed (37%) or were undecided (28.9%) that smoking helped people with mental health problems feel better and agreed (17.2%) or were undecided (30.2%) that cessation would exacerbate mental health symptoms. Only 11.6% said their service had designated funding for smokers with mental health problems and 26.5% were or had a staff member who was a dedicated lead practitioner for mental health work. Practitioners from services that had a dedicated mental health lead were more confident in supporting smokers with different mental health problems and using different pharmacotherapies (all p<0.001) and were more likely to disagree that cessation was detrimental (p=0.001). A majority of practitioners were interested in training, particularly about smoking cessation effects on psychiatric medication (84.3% of n=632) and how to tailor stop smoking support to clients with mental health problems (82.4%). CONCLUSION Practitioners who support smoking cessation have limited knowledge about mental health and smoking but are willing to learn and improve. However, they are hindered by a lack of resources.
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Affiliation(s)
- Erikas Simonavicius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Debbie Robson
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andy McEwen
- National Centre for Smoking Cessation and Training, 1 Great Western Industrial Centre, Dorchester, United Kingdom
| | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom
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Conlon K, Pattinson L, Hutton D. Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients. Radiography (Lond) 2017; 23:256-263. [PMID: 28687295 DOI: 10.1016/j.radi.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/09/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES A systematic review of the literature was conducted. The review was conducted using a search of the literature for all years up to October 2016. Statements that identified facilitators, barriers or recommendations surrounding smoking cessation delivery were extracted and analogous statements aggregated to enable thematic analysis. After searching multiple databases and the application of exclusion and inclusion criteria, a total of 19 acceptable studies were identified. KEY FINDINGS Delivery of cessation by oncology professionals was impacted by their own knowledge and views, their perception of the benefits to patient health and by the workplace procedures within their institution. CONCLUSION Oncology practitioners worldwide face similar issues in delivering smoking cessation advice. By improving training programs that address the attitudes and beliefs which facilitate or block delivery of smoking cessation and by implementing systemic changes within cancer centres, delivery of smoking cessation should be enabled.
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Affiliation(s)
- K Conlon
- Sheffield Hallam University, Sheffield, UK
| | | | - D Hutton
- Transforming Cancer Care, The Clatterbridge Cancer Centre NHS FT, Wirral, UK
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Bauld L, Hiscock R, Dobbie F, Aveyard P, Coleman T, Leonardi-Bee J, McRobbie H, McEwen A. English Stop-Smoking Services: One-Year Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1175. [PMID: 27886140 PMCID: PMC5201316 DOI: 10.3390/ijerph13121175] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/02/2022]
Abstract
The UK is a global leader in stop-smoking support-providing free behavioral support and cessation medication via stop smoking services (SSS) without charge to smokers. This study aimed to explore the client and service characteristics associated with abstinence 52 weeks after quitting. A prospective cohort study of 3057 SSS clients in nine different areas of England who began their quit attempt between March 2012 and March 2013 was conducted. Important determinants of long-term quitting were assessed through quit rates and multivariable logistic regression. Our results showed that the overall weighted carbon monoxide validated quit rate for clients at 52 weeks was 7.7% (95% confidence interval (CI) 6.6-9.0). The clients of advisors, whose main role was providing stop-smoking support, were more likely to quit long-term than advisors who had a generalist role in pharmacies or general practices (odds ratio (OR) 2.3 (95% CI 1.2-4.6)). Clients were more likely to achieve abstinence through group support than one-to-one support (OR 3.4 (95% CI 1.7-6.7)). Overall, one in thirteen people who set a quit date with the National Health Service (NHS) Stop-Smoking Service maintain abstinence for a year. Improving abstinence is likely to require a greater emphasis on providing specialist smoking cessation support. Results from this study suggest that over 18,000 premature deaths were prevented through longer-term smoking cessation achieved by smokers who accessed SSS in England from March 2012 to April 2013, but outcomes varied by client characteristic and the type of support provided.
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Affiliation(s)
- Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Rosemary Hiscock
- UK Centre for Tobacco and Alcohol Studies.
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| | - Fiona Dobbie
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK.
- UK Centre for Tobacco and Alcohol Studies.
| | - Paul Aveyard
- UK Centre for Tobacco and Alcohol Studies.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
| | - Tim Coleman
- UK Centre for Tobacco and Alcohol Studies.
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies.
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Hayden McRobbie
- UK Centre for Tobacco and Alcohol Studies.
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
| | - Andy McEwen
- UK Centre for Tobacco and Alcohol Studies.
- National Centre for Smoking Cessation and Training (NCSCT), 1 Great Western Industrial Centre, Dorchester DT1 1RD, UK.
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11
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Content and Methods used to Train Tobacco Cessation Treatment Providers: An International Survey. J Smok Cessat 2016; 12:213-220. [PMID: 29861787 DOI: 10.1017/jsc.2016.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There are limited existing data describing the training methods used to educate tobacco cessation treatment providers around the world. Aims To measure the prevalence of tobacco cessation treatment content, skills training and teaching methods reported by tobacco treatment training programs across the world. Methods Web-based survey in May-September 2013 among tobacco cessation training experts across six geographic regions and four World Bank income levels. Response rate was 73% (84 of 115 countries contacted). Results Of 104 individual programs from 84 countries, most reported teaching brief advice (78%) and one-to-one counseling (74%); telephone counseling was uncommon (33%). Overall, teaching of knowledge topics was more commonly reported than skills training. Programs in lower income countries less often reported teaching about medications, behavioral treatments and biomarkers and less often reported skills-based training about interviewing clients, medication management, biomarker measurement, assessing client outcomes, and assisting clients with co-morbidities. Programs reported a median 15 hours of training. Face-to-face training was common (85%); online programs were rare (19%). Almost half (47%) included no learner assessment. Only 35% offered continuing education. Conclusion Nearly all programs reported teaching evidence-based treatment modalities in a face-to-face format. Few programs delivered training online or offered continuing education. Skills-based training was less common among low- and middle-income countries (LMICs). There is a large unmet need for tobacco treatment training protocols which emphasize practical skills, and which are more rapidly scalable than face-to-face training in LMICs.
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12
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Sohanpal R, Rivas C, Steed L, MacNeill V, Kuan V, Edwards E, Griffiths C, Eldridge S, Taylor S, Walton R. Understanding recruitment and retention in the NHS community pharmacy stop smoking service: perceptions of smoking cessation advisers. BMJ Open 2016; 6:e010921. [PMID: 27388355 PMCID: PMC4947750 DOI: 10.1136/bmjopen-2015-010921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To understand views of pharmacy advisers about smoker recruitment and retention in the National Health Service community pharmacy stop smoking programme. DESIGN Thematic framework analysis of semistructured, in-depth interviews applying the Theoretical Domains Framework and COM-B behaviour change model. We aimed to identify aspects of adviser behaviour that might be modified to increase numbers joining and completing the programme. PARTICIPANTS 25 stop smoking advisers (13 pharmacists and 12 support staff). SETTING 29 community pharmacies in 3 inner east London boroughs. RESULTS Advisers had preconceived ideas about smokers likely to join or drop out and made judgements about smokers' readiness to quit. Actively recruiting smokers was accorded low priority due in part to perceived insufficient remuneration to the pharmacy and anticipated challenging interactions with smokers. Suggestions to improve smoker recruitment and retention included developing a more holistic and supportive approach using patient-centred communication. Training counter assistants were seen to be important as was flexibility to extend the programme duration to fit better with smokers' needs. CONCLUSIONS Cessation advisers feel they lack the interpersonal skills necessary to engage well with smokers and help them to quit. Addressing advisers' behaviours about active engagement and follow-up of clients, together with regular skills training including staff not formally trained as cessation advisers, could potentially boost numbers recruited and retained in the stop smoking programme. Adjustments to the pharmacy remuneration structure to incentivise recruitment and to allow personalisation of the programme for individual smokers should also be considered.
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Affiliation(s)
- Ratna Sohanpal
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Liz Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Valerie Kuan
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elizabeth Edwards
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie Taylor
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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13
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Kehlet M, Heeseman S, Tønnesen H, Schroeder TV. Perioperative smoking cessation in vascular surgery: challenges with a randomized controlled trial. Trials 2015; 16:441. [PMID: 26438129 PMCID: PMC4595121 DOI: 10.1186/s13063-015-0965-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods A single-blinded randomized clinical trial conducted at two vascular surgery departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments’ standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According to the power calculation a total of 144 patients were needed in the trial. Results Due to slow patient inclusion, the trial was terminated prior to fulfilling the power calculation. Thirty-two patients were included in the trial from March 2011 to September 2012. Of these, 11 were randomized to the GSP intervention and 21 as controls. There was no difference in 30-day complication rates or 6-week abstinence rates between the two groups. Conclusions A trial assessing the effect of smoking cessation on postoperative complications on the day of soft tissue surgery is still needed. If another trial is to be planned it must be more pragmatic with less extended inclusion criteria and conducted nationally or internationally to ensure enough patients for the trial. Trial registration ClinicalTrials.gov (NCT01469091). Registration date: 27 October 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0965-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mette Kehlet
- Vascular Clinic, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Sabine Heeseman
- Vascular Clinic, Lillebaelt Hospital, Søndre Boulevard 29, 5000, Odense C, Denmark.
| | - Hanne Tønnesen
- WHO-CC Clinical Health Promotion Centre, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark. .,Clinical Health Promotion Centre, Department of Health Sciences, Lund University, Skåne University Hospital, Södra Förstadsgatan 101, 214 28, Malmö, Sweden.
| | - Torben V Schroeder
- Vascular Clinic, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Centre for Clinical Education, University of Copenhagen and Capital Region of Denmark, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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14
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Song F, Maskrey V, Blyth A, Brown TJ, Barton GR, Aveyard P, Notley C, Holland R, Bachmann MO, Sutton S, Brandon TH. Differences in Longer-Term Smoking Abstinence After Treatment by Specialist or Nonspecialist Advisors: Secondary Analysis of Data From a Relapse Prevention Trial. Nicotine Tob Res 2015; 18:1061-6. [PMID: 26152558 PMCID: PMC4826486 DOI: 10.1093/ntr/ntv148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/27/2015] [Indexed: 11/14/2022]
Abstract
Introduction: Smokers receiving support in specialist centers tend to have a higher short-term quit rate, compared with those receiving support in other settings from professionals for whom smoking cessation is only a part of their work. We investigated the difference in longer-term abstinence after short-term smoking cessation treatment from specialist and nonspecialist smoking cessation services. Methods: We conducted a secondary analysis of data from a randomized controlled trial of self-help booklets for the prevention of smoking relapse. The trial included 1088 short-term quitters from specialist stop smoking clinics and 316 from nonspecialist cessation services (such as general practice, pharmacies, and health trainer services). The difference in prolonged smoking abstinence from months 4 to 12 between specialist and nonspecialist services was compared. Multivariable logistic regression analyses were conducted to investigate the association between continuous smoking abstinence and the type of smoking cessation services, adjusted for possible confounding factors (including demographic, socioeconomic, and smoking history variables). Results: The proportion of continuous abstinence from 4 to 12 months was higher in short-term quitters from specialist services compared with those from nonspecialist services (39% vs. 32%; P = .023). After adjusting for a range of participant characteristics and smoking variables, the specialist service was significantly associated with a higher rate of longer-term smoking abstinence (odds ratio: 1.48, 95% CI = 1.09% to 2.00%; P = .011). Conclusions: People who receive support to stop smoking from a specialist appear to be at lower risk of relapse than those receiving support from a nonspecialist advisor.
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Affiliation(s)
- Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom;
| | - Vivienne Maskrey
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Annie Blyth
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Garry R Barton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norwich Clinical Trial Unit, University of East Anglia, Norwich, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Max O Bachmann
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Thomas H Brandon
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
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15
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Brose LS, McEwen A, Michie S, West R, Chew XY, Lorencatto F. Treatment manuals, training and successful provision of stop smoking behavioural support. Behav Res Ther 2015; 71:34-9. [PMID: 26057438 DOI: 10.1016/j.brat.2015.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Translating evidence-based behaviour change interventions into practice is aided by use of treatment manuals specifying the recommended content and format of interventions, and evidence-based training. This study examined whether outcomes of stop smoking behavioural support differed with practitioner's use and evaluation of treatment manuals, or practitioner's training. METHODS English stop smoking practitioners were invited to complete an online survey including questions on: practitioners' training, availability, use and perceived utility of manuals, and annual biochemically-validated success rates of quit attempts supported (practitioner-reported). Mean success rates were compared between practitioners with/without access to manuals, those using/not using manuals, perceived utility ratings of manuals, and consecutive levels of training completed. RESULTS Success rates were higher if practitioners had a manual (Mean (SD) = 54.0 (24.0) versus 48.0 (25.3), t(838) = 2.48, p = 0.013; n = 840), used a manual (F(2,8237) = 4.78, p = 0.009, n = 840), perceived manuals as more useful (F(3,834) = 2.90, p = 0.034, n = 840), and had completed training (F(3,709) = 4.81, p = 0.002, n = 713). Differences were diminished when adjusting for professional and demographic characteristics and no longer reached statistical significance using a conventional alpha for perceived utility of manuals and training status (both p = 0.1). CONCLUSIONS Practitioners' performance in supporting smokers to quit varied with availability and use of treatment manuals. Evidence was weaker for perceived utility of manuals and practitioners' evidence-based training. Ensuring practitioners have access to treatment manuals within their service, promoting manual use, and training practitioners to competently apply manuals is likely to contribute to higher success rates in clinical practice.
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Affiliation(s)
- Leonie S Brose
- National Addictions Centre, UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK.
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Xie Yin Chew
- Department of Psychology and Language Sciences, University College London, London, UK.
| | - Fabiana Lorencatto
- Health Services Research and Management, School of Health Sciences, City University London, London, UK.
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