Predictors of tobacco control among nursing students

Prevalence of smoking in nursing students worldwide: A meta-analysis of observational studies

BACKGROUND

Smoking is common among nursing students worldwide, but the reported prevalence is inconsistent across epidemiological studies. This is a meta-analysis of the prevalence of smoking in nursing students worldwide.

DESIGN

Meta-analysis of observational studies.

SAMPLE

A total of 46 studies were included in this meta-analysis.

METHOD

Electronic databases (PubMed, Medline, PsycINFO, EMBASE and Web of science) were independently and systematically searched by two investigators from their commencement date up to 12 May 2018. Studies that reported the smoking rate of nursing students were included and analyzed using random-effects model.

RESULTS

The pooled prevalence of current smoking was 26.6% (95% CI: 22.9-30.4%), while pooled prevalence of previous smoking was 15.5% (95% CI: 11.8-19.3%). Subgroup analyses showed that smoking rate was higher in male compared with female students (39% vs 25.2%, P < .001), while survey time, sample size, age, study design and academic year did not moderate the smoking rate (all P > .05).

CONCLUSION

This meta-analysis confirmed that smoking is common in nursing students. Considering the negative impact of smoking on health, appropriate smoking cessation measures for nursing students should be developed.

Preparing nurses to intervene in the tobacco epidemic: Developing a model for faculty development and curriculum redesign

As the largest group of health professionals, nurses have a tremendous potential to help curb the tobacco epidemic. However, studies conducted across a range of global settings continue to indicate that both practicing nurses and nursing student have limited knowledge, skills and confidence needed to implement evidence-based tobacco cessation interventions. A contributing factor is the limited inclusion of tobacco control content in nursing curricula. Additionally, there is limited understanding of nurse educators' knowledge and perceptions about teaching tobacco dependence content. This paper presents the Loma Linda University School of Nursing's concurrent experience with both faculty development and curriculum redesign in the area of tobacco dependence prevention and treatment. An internal survey was administered at baseline and at 2-year follow-up to assess faculty's knowledge, perceptions and practices related to teaching tobacco dependence content and skills (n = 42). Faculty and curriculum development strategies and resources utilized, evaluation findings and subsequent lessons learned are described. The findings have implications for nursing programs seeking to enhance their curricula and commitment to ensuring that their graduates are prepared to provide evidence-based tobacco cessation interventions with each patient they encounter.

Factors Affecting Korean Registered Nurses' Intention to Implement Smoking Cessation Intervention

Objectives

Nurses have been identified as an instrumental partner in tobacco reduction. This study aimed to examine factors affecting Korean nurses' intention to implement smoking cessation intervention in Busan, Korea.

Methods

The participants were a total of 215 Korean registered nurses. A self-administered questionnaire evaluated predisposing factors, motivational factors (attitude, social influence, and self-efficacy) and intention to implement smoking cessation intervention. Data were analyzed by t tests, Pearson's correlation, and hierarchical multiple regression.

Results

The mean age of the participants was 28.12 ± 5.72 years. The majority of the participants were staff nurses (85.6%), and 64.2% of the sample had < 5 years of work experience. Significant predictors of intention to implement smoking cessation intervention included perceived barrier of smoking cessation intervention (β = −0.128, p = 0.023), willingness to receive smoking cessation training (β = 0.123, p = 0.034), more positive attitude (β = 0.203, p = 0.002), higher social influence (β = 0.292, p < 0.001), and higher self-efficacy toward smoking cessation intervention (β = 0.151, p = 0.021), which explained 45% of the total variance of intention to implement smoking cessation intervention.

Conclusion

Attitude, social influence, and self-efficacy towards smoking cessation intervention had a significant positive influence in determining the intention to implement smoking cessation intervention. These findings can be used to develop evidence-based smoking cessation training programs for nurses in Korea. The programs should aim for positive attitude, higher social influence, and higher self-efficacy in hospital settings.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

Smoking habits of students of nursing: a questionnaire survey (2004-2006)

AIM

To determine changes in the prevalence of tobacco use among students of nursing and associated factors.

BACKGROUND

The prevalence and distribution of smokers among nursing students varies according to the country and period of study.

METHOD

Transversal descriptive study by self-answered questionnaire. Eight hundred and fifty four subjects (94.9%) were questioned in the period 2004-2006.

FINDINGS

Twenty eight percent of the students declared themselves to be smokers. The habit began before the students started university. The tendency of prevalence by year of survey and by graduation year was downward. The students shown a low nicotine dependency according to Fagerström and little motivation to give up. The average age at the onset of consumption was 14.6 (1.8) years. From the logistical regression analysis, the model best explaining the prevalence of tobacco consumption included the variable of year surveyed and academic background, those coming from the baccalaureate showing a lesser prevalence and tendency to smoke.

CONCLUSIONS

Tobacco consumption among students of health sciences was less than in the general population of the same age but high given their future profession. The tendency to smoke is decreasing and most started smoking before joining the university. We recommend an intensification of actions directed at teenagers and the promotion of anti-tobacco campaigns in universities.

Beliefs, knowledge, and self-efficacy of nursing students regarding tobacco cessation

INTRODUCTION

Evidence-based clinical interventions for smoking cessation have proven to be effective in reducing smoking rates among patients who use tobacco. Ensuring that registered nurses (RNs) are knowledgeable and have the self-efficacy to provide such clinical interventions can contribute to declines in tobacco use among their patients who smoke. The aim of this study was to determine if baccalaureate nursing (BSN) students in Minnesota received training in the clinical treatment of tobacco dependence and to identify perceived barriers that may limit their ability to intervene with their patients.

METHODS

Quantitative descriptive, with data collected in spring of 2007. The sample was 675 senior BSN students enrolled in ten Minnesota private and public institutions. The survey questionnaire included demographics, knowledge about tobacco treatment, personal tobacco-use history, beliefs about smoking, self-efficacy, and behavioral application of cessation intervention.

RESULTS

BSN students generally reported that they were comfortable assessing tobacco use among their patients and referring tobacco users to cessation resources. Nursing students who considered themselves smokers (7.9%) and who reported using tobacco in the last 30 days but did not consider themselves smokers (17.5%) indicated more agreement regarding the positive aspects of smoking, and were less likely to view it as their professional responsibility to help smokers quit, than did non-smoking nursing students (74.6%).

CONCLUSIONS

Nursing students' personal smoking behaviors affected their beliefs about smoking and their view about the professional role in helping smokers quit. These findings have implications for undergraduate nursing programs regarding professional role socialization and education about clinical smoking cessation interventions.

Do medical students know enough about smoking to help their future patients? Assessment of New York City fourth-year medical students' knowledge of tobacco cessation and treatment for nicotine addiction

PURPOSE

Practicing physicians underutilize U.S. Department of Health and Human Services evidence-based approaches to nicotine addiction and treatment. Few studies have assessed medical student knowledge in this area. This study examined New York City fourth-year medical students' knowledge of tobacco cessation and treatment of nicotine addiction.

METHOD

The authors conducted a Web-based survey, comprising 27 closed- and open-ended questions, of six of seven New York City medical schools in the spring of 2004. They drew questions from international, national, and local surveys on tobacco and health, U.S. Department of Health and Human Services tobacco treatment guidelines, and prior studies. Primary outcome measures were knowledge of the epidemiology of smoking, benefits of cessation and treatment of nicotine addiction, clinical cessation practices, and students' use of tobacco and intentions to stop smoking.

RESULTS

Of 943 fourth-year medical students, 469 (50%) completed an online survey. Students had good knowledge of the epidemiology of smoking, including its prevalence and health effects, with most responding correctly to relevant questions (mean correct response 79%; SD = 9.4). Students demonstrated a fair understanding of the benefits of cessation (mean correct response, 67%; SD = 19.2) and treatment of nicotine addiction (mean correct response, 61%; SD = 13.2). Three hundred students (64%) rated their own preparation to assist patients to quit as less than adequate.

CONCLUSIONS

Fourth-year medical students at the participating schools in New York City understood the harms of smoking but needed more information on the benefits of stopping smoking and treatment of nicotine addiction.

Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study

BACKGROUND

Physician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US.

METHODS

Data were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico Hispanic Medical Society in the year 2001. Domains of interest included counseling practices, self-efficacy, attitudes/responsibility, and knowledge/skills. Returned surveys were analyzed to obtain frequencies and descriptive statistics for each survey item. Other analyses included: bivariate Pearson's correlation, factorial ANOVAs, and multiple linear regressions.

RESULTS

Respondents (n = 45) reported a low level of compliance with tobacco control guidelines and recommendations. Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices (r = .35, variance shared = 12%). Self-efficacy and gender were both significantly correlated to tobacco related practices (r = .42, variance shared = 17%). A significant correlation was also found between self-efficacy and knowledge/skills (r = .60, variance shared = 36%). Attitudes/responsibility was not significantly correlated with any of the other measures.

CONCLUSION

More resources should be dedicated to training Hispanic physicians in tobacco intervention. Training may facilitate practice by increasing knowledge, developing skills and, ultimately, enhancing feelings of self-efficacy.

Tobacco use amongst nursing and physiotherapy students: a cross sectional questionnaire survey

AIM

The aim of this research was to evaluate the prevalence, knowledge and attitudes of tobacco use in the students of the School of Health Sciences in the Campus of Ponferrada (University of León, Spain). Two-hundred and sixty-six (88.3% of respondents) students were assessed by a confidential questionnaire, which was distributed, completed by the students and collected in the same session.

METHODS

This was a descriptive quantitative survey research design to examine the tobacco use among nursing and physiotherapy students.

RESULTS

The global prevalence was 29.3%. In relation to academic courses we have observed statistical significance (p=0.006). Therefore students increased tobacco use while their training at the school. Seventy (89.7%) of students were smokers prior to commencing degree. Nursing students declared were unfamiliar with strategies and methods to help people to quit. The first academic course students (78.6%) significantly differed (p=0.009) from second and third course. We have found scores statistically significant (p=0.04) about the students opinion about health professionals social role function.

CONCLUSION

Tobacco consumption in university health students in the third year was higher than people aged 16-24 years old reported from the National Health Survey. The findings showed a great need to improve the curricular content in the area of tobacco including information, prevention, and treatment.

A systematic review of tobacco smoking among nursing students

This study was conducted to systematically and critically evaluate the large number of academic publications which have investigated tobacco smoking among nursing students in recent years. It was performed as a state-of-the-art examination of all modern literature published in peer-reviewed, English-language journals since 1990. Although smoking appears to be fairly common among nursing students, its prevalence and distribution varies widely depending on the country of study and time period during which the research was undertaken. Although there is some evidence to suggest that smoking rates increase by year of study in the nursing course, not all research has shown a clear association in this regard. Similarly, the value of anti-smoking interventions for nursing students appears to be limited, based on currently available information. Given these conflicting issues, further research which helps to ascertain why student nurses do not wish to give up their habit is clearly needed both locally and internationally. The development of an international smoking questionnaire may also be useful to help standardize future research on tobacco usage among this vulnerable demographic.

Determination of Smoking Habits and Personality Traits Among Nursing Students

The purpose of this research was to determine the smoking habits of students who receive nursing education in universities and their personality traits. We found that 29.2% of the students were habitual smokers, and the average score on the Fagerström Nicotine Dependence Test was 3.4 +/- 2.3. A significant difference in statistical terms was marked between the participants' smoking habits and the self-control factor. Because we found that the level of smoking among individuals with high self-control is rather low, providing information to students on quitting smoking and periodically assessing smoking status are recommended. In addition, individual improvement programs focused on the development of self-control can be added to nursing curricula.

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND

It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement.

OBJECTIVES

To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions.

METHODS

Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes.

RESULTS

Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups.

CONCLUSIONS

Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Meta-Analysis of the Efficacy of Tobacco Counseling by Health Care Providers

Given the proportion of American adults who smoke, even if health professionals only have a small effect on quit rates, the public health impact of this change could potentially be enormous. Yet, health care providers may differ in their cessation efficacy. The purpose of this study was to evaluate recent rigorous trials of smoking cessation counseling among physicians, nurses, dentists, and teams of providers: (1) to compare providers on the efficacy of cessation and (2)to determine which intervention and study characteristics explain variations in intervention effects. Thirty-seven randomized clinical trials or quasi-experiments (with control groups) of health care provider–delivered smoking cessation interventions, out of over 200 articles that were published between 1990 and 2004 were collected through searches of Medline, CINAHL, PSYCINFO, and dissertation abstracts, as well as hand searches. The outcome modeled was the mean difference between intervention and control groups in the cessation rates using Hedges g. The univariate results revealed that receiving advice from any health care professional produced increases in quit rates. Multivariate analyses of intervention effects on cessation revealed that physicians were most effective, followed by multiprovider teams, dentists, and nurses. The findings suggest that contact with a health care professional will increase cessation; however, additional training in tobacco control for nurses is warranted. Longer-term studies of smoking cessation, particularly among dentists, are necessary.

Smoking as a symbol of friendship: Qualitative study of smoking behavior and initiation of a group of male nurse students in Iran

The study of smoking initiation and behavior of nurses and nurse students is important when considering their professional health promotion roles. In the present qualitative study, 26 nursing students of all grades from two nursing schools in the capital city of Iran were surveyed to explore their reasons for smoking. Through in-depth and semistructured interviews, participants were encouraged to talk about their smoking behavior and explain initiating reasons freely. Majority of the participants began smoking before commencing nursing, while only a few initiated smoking after entering into nursing school. Reasons for smoking included belonging to a group and as a symbol of friendship and mutual trust. Indeed, peer group behaviors influenced most participates to commence smoking and social influences also emerged as a theme in this study.

A comparison of smoking habits among medical and nursing students

OBJECTIVE

The approach and credibility of future physicians and nurses as treatment providers for smoking- and tobacco-related diseases may be influenced by their smoking habits. We compared smoking habits among medical and nursing students, and examined whether these habits changed during the course of education for each cohort.

METHOD

Over 1,100 medical and nursing students from a university were surveyed in year 2000 using a questionnaire that included the Fagerstrom test for nicotine dependence (FTND).

RESULTS

A total of 397 medical students and 126 nursing students completed the survey. Significantly fewer medical students (3.3%) smoked compared to nursing students (13.5%). Also, significantly more nursing students were former smokers (17.8%) than medical students (9.8%). The severity of nicotine dependence, as indicated by the total FTND score as well as scores on five of the six items on the FTND, was significantly lower among medical students compared to nursing students. Smoking or quit rates did not differ across class years in both groups; however, unlike nursing students, time since quitting significantly differed across class years for medical students. Although smoking habits appear to change little during the course of education for both medical and nursing students, many smokers may have quit just prior to entering medical school but not nursing school.

CONCLUSIONS

The findings confirm the continuing decline in smoking among medical students in the United States; however, increased efforts to promote tobacco education and intervention among nursing students seem necessary. Nevertheless, both groups appear to have the potential to be credible advisors to patients and public regarding smoking cessation.

International efforts in tobacco control

OBJECTIVES

To review international nursing involvement in tobacco control and discuss opportunities and challenges to enhance nurses' participation in decreasing tobacco-related morbidity and mortality.

DATA SOURCES

Published literature and published and unpublished material developed by nurses in their tobacco control initiatives.

CONCLUSION

Worldwide, nurses have been involved in tobacco control. However, many opportunities remain for involvement in the areas of education, research, and practice.

IMPLICATIONS FOR NURSING PRACTICE

There are numerous opportunities for nurses throughout the world to enhance their involvement in tobacco control.

Nursing students' beliefs about smoking, their own smoking behaviors, and use of professional tobacco treatment intervention

As the largest group of health care professionals, nurses are in a unique position to influence their patients who smoke. They also have more contact with patients than any other provider. The purpose of this survey study was to describe nursing students' beliefs about cigarette smoking, their smoking behaviors, and use of evidence-based tobacco treatment intervention. Of 200 surveyed, undergraduate nursing students, only 6% were smokers. The most inaccurate perception about tobacco treatment was that counseling of less than 3 minutes did not have an effect on improving smoking quit rate. Eight percent of surveyed smokers reported providing tobacco use treatment to all patients who smoke compared with 26% of non-smokers. Smoking-related morbidity and mortality warrant consistent use of clinical practice guidelines by nursing students and professional nurses.