Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours

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.

Comparison of peer education and the classic training method for school aged children regarding smoking and its dangers

The aim of the present study is to compare the knowledge levels acquired from two different methods of teaching (peer education and a classic training method) about smoking and its dangers to school aged children. This study was an experimental design with pre- and post-tests. A total of 354 students, 253 of whom were from the peer education school, and 101 of whom were from the classic training school, were included. The study results found that the mean post-test scores of the students in the peer education school were significantly increased, indicating a greater level of knowledge (p<.05).

Health-promotion behaviors of undergraduate nursing students: a survey analysis

AIM

To examine health promotion behaviors and barriers to health promotion in traditional and nontraditional nursing students in an associate degree nursing program in the northeastern United States.

BACKGROUND

Nursing students are exposed to concepts of health promotion in the nursing curriculum, but do not necessarily apply them to their own lives. Examining the variables affecting the health behaviors of nursing students may provide the information required to motivate lifestyle changes in this population.

METHOD

A cross-sectional descriptive design was used to examine the relationship between study variables.

RESULTS

Nontraditional nursing students participate in health promoting behaviors less often than traditional nursing students and experience more barriers to health promotion.

CONCLUSION

Implementation of health promotion programs targeting nontraditional students may lead to improved health among these individuals, which may result in increased success in nursing programs.

Pregnant Turkish women with low income: their anxiety, health-promoting lifestyles, and related factors

This paper presents anxiety levels, health-promoting lifestyles and related factors among pregnant Turkish women with low income. A descriptive correlation and cross-sectional study was conducted at a state maternity hospital in Western Turkey. The paper reports on the data (n = 195) from the Spielberg State and Trait Anxiety Inventory (STAI), the Health-Promoting Lifestyle Profile (HPLP) and a sociodemographic questionnaire. The average HPLP score was low (mean 2.57, SD 0.42). The average STAI score was high (40.67 ± 9.48; 46.40 ± 8.09, respectively). A significant relation was detected between the trait anxiety, state anxiety, antenatal visit, perception of social support, living environment, family type and HPLP (P < 0.05). A moderately negative relation was detected between the mean STAI and HPLP scores. The findings indicate information and data should be provided for service planning and community care to support pregnant Turkish women with low income in communities.

Knowledge, attitudes and beliefs about tobacco use after an educative intervention in health sciences' students

PURPOSE

To examine the effectiveness of a tobacco control course on the improvement of knowledge, attitudes and beliefs about smoking among health sciences' students.

METHODS

This was a quasi-experimental study of community intervention carried out during the years 2005-2008, at 2 university health science centres in northwest Spain. A total of 290 students on the intervention and 256 on the control campus took part in the study. The intervention consisted of a course on the prevention and control of tobacco use offered only on the intervention campus. Data were collected before the intervention and 6 months afterwards.

RESULTS

After the course, significant differences between groups were observed in the improvement of knowledge, attitudes and perceived ability to act in tobacco control.

CONCLUSIONS

The introduction of training concerning smoking through active methodologies had a positive impact on the knowledge, attitudes and beliefs about tobacco of students.

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.

How healthy are our nurses? New and registered nurses compared

This study examined the health behaviour of nursing staff, comparing registered and pre-registered nurses in terms of their self-reported health and lifestyle behaviour. In total, 325 pre-registered nurses and 551 registered nurses, based at the same university teaching hospital and located within an acute NHS trust, completed a self-administered health and lifestyle questionnaire survey. With the exception of smoking behaviour, registered nurses generally had a healthier lifestyle compared with pre-registered nurses. However, when examining the overall health profile of the sample, the study reveals that there is room for improvement in the health and lifestyle behaviour exhibited by both registered and pre-registered nurses. Almost half of the sample failed to meet public health recommendations for levels of physical activity, almost two-thirds did not consume five portions of fruit or vegetables daily and almost half ate foods that were high in fat and sugar content on a daily basis. These findings are alarming given the current government emphasis on the health of NHS staff and the important role that nurses play in influencing lifestyle choices among their patients. There is an urgent need to target education and support services to improve the diet and exercise habits of nursing professionals.

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.

Assessment of dental faculty, staff, and students on knowledge of health effects associated with tobacco use

OBJECTIVES

This study examined the knowledge of the health effects associated with tobacco use among dental school faculty, staff, and students.

METHODS

A 30-item survey instrument was pilot-tested to ensure content validity prior to implementation. A total of 724 surveys were distributed through campus mail.

RESULTS

A total of 344 (47.51%) survey instruments were returned. 71.8 percent of respondents reported using tobacco sometime during their life, 21.8 percent had smoked at least one cigarette a day for the past 30 days, but only 8.4 percent considered themselves to be smokers. Of the 71.8% reported using tobacco sometime during their lifetime, 49.7 percent reported being very confident about their ability to quit using tobacco, 32.6 percent reported that it would be unlikely for their tobacco use to result in negative health effects, and 31.7 percent reported that they were not worried about negative health effects associated with tobacco use.

CONCLUSIONS

This study reveals a lack of knowledge of dental school faculty, staff, and students on the negative personal health effects associated with tobacco use.

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.

[Smoking among nursing and physical therapy students of the University of the Balearic Islands: opinions on regulation of smoking in public places]

OBJECTIVE

To evaluate the prevalence, opinions and attitudes of nursing and physical therapy students at the University of the Balearic Islands toward smoking in public places and the influence of regulatory policies.

METHOD

We performed a cross-sectional, descriptive, observational study using a self-administered questionnaire. The survey was designed to evaluate opinions on and the degree of agreement with smoking and regulatory policies on this issue. The assessment was performed using Likert scales. The survey was offered to all students attending class in the core subject with the greatest number of enrolled students on a normal academic day between February 15 and March 15, 2006. We calculated 95% confidence intervals for proportions. The Chi square test was used to compare qualitative variables and Student's t-test was used for quantitative variables.

RESULTS

The sample consisted of 345 students, 82.2% of whom were women. The mean age was 21.9 years. The prevalence of regular smokers was 26.1% (26.9% among women and 22.6% among men). Almost all (93.8%) of the respondents agreed that smoking should be banned in closed spaces in educational institutions and 70.9% believed that the law should be complied with at the University of the Balearic Islands, with differences between 2003 and 2006.

CONCLUSIONS

Smoking was less prevalent in our population than in the general regional and national populations, as well as in other Spanish nursing students of the same age and gender. The prevalence of occasional smokers has fallen since 2003. Most students had a favorable view of the new Smoking Prevention Act.

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

BACKGROUND

To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period.

AIM

To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan.

METHODS

This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale.

RESULTS

The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model.

CONCLUSIONS

This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.

Correlation of the health-promoting lifestyle, enrollment level, and academic performance of College of Nursing students in Kuwait

This descriptive study of 224 nursing students assessed their health-promoting lifestyle profile and correlated it with the levels of enrollment in nursing courses and academic performance. The health-promoting lifestyle profile was measured by Walker's Health-promoting Lifestyle Profile II instrument. Academic performance was measured by assessing the nursing grade point average and general grade point average of the students. The students had positive health-promoting lifestyles with significant differences noted between males and females in the overall profile, physical activity, interpersonal relations, and stress management. Sociodemographic variables, such as age, nationality, and marital status, but not income, showed an association with students' health-promoting lifestyles. A significant correlation was noted between students' nursing enrollment and level of health responsibility. No significant correlation was established between a health-promoting lifestyle and academic performance. This study poses a challenge for nurse educators to provide an effective environment to maximize students' potential to be future vanguards of health.

Survey of student nurses and midwives: smoking and alcohol use

This article presents findings from a survey of 186 first year nursing and midwifery students that relate to their smoking and alcohol consumption. Of the students sampled, 28% were cigarette smokers. This is higher than the smoking rate of 25% for the adult population in the UK. The majority of the students who smoked said that they would like to stop smoking. Most of the students (86.5%) reported having drunk alcohol on at least one occasion during the previous week, with 26.5% having had a drink on three or four days. The amount consumed over the week ranged from no drinks to 90, with the mean being 13.72.Worryingly, 74% had exceeded the daily benchmarks for low-risk drinking on at least one occasion during the week for which consumption was reported, and 55% were drinking at binge levels. The findings raise concerns for the future health of many of our students and for their roles as health promoters.

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.

A cluster-randomized trial on smoking cessation in German student nurses

OBJECTIVES

To evaluate the effect of a specific intervention on smoking cessation in health professionals.

METHODS

Between 2003 and 2004, a cluster-randomized trial was performed in 32 schools of nursing with 956 student nurses in Southwest Germany. Students in the intervention group received three teaching units each lasting 1 day on how to give advice to people who want to stop smoking. The program addressed only nurses' professional role and not their individual smoking behavior. After a follow-up of 13 months, the change in smoking status was determined. Secondary endpoints included changes of smoking-related factors like stages of smoking or knowledge about health risks.

RESULTS

Change of smoking status in the desired direction (stopping smoking or not starting smoking) occurred less often in the intervention than in the control group, but the difference did not reach statistical significance (odds ratio 0.69, 95% confidential interval: 0.43, 1.10). The program was successful in delivering medical knowledge (P=0.0056) and in enhancing competence in giving advice to smokers (P<0.0001).

CONCLUSIONS

The applied approach is able to improve student nurses' medical knowledge and to augment their competence in giving advice to smokers, but it is not an effective strategy to reduce their own smoking behavior.

The use of contingency management to reduce cigarette smoking among college students

The current study tested the feasibility of using contingency management to reduce cigarette smoking among college students. Eighty-eight undergraduate smokers were enrolled in a 3-week ABA study. During the baseline weeks, participants earned noncontingent monetary payments for attending data collection sessions. During the intervention week, participants earned monetary payments contingent on demonstrating recent abstinence. Participants were randomly assigned to either a low- or a high-reinforcer magnitude condition that controlled the amount of money that could be earned during the intervention week. Cigarette smoking was significantly reduced during the intervention week relative to the baseline weeks, and greater reductions were achieved under the high-reinforcer magnitude condition. These results suggest that cigarette smoking among college students is responsive to contingency management procedures.

The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.

School Nurses' Opinions About the Prevention of Tobacco Use

To further understand school nurses' tobacco policy beliefs and attitudes toward tobacco companies, a convenience sample of 53 school nurses completed questionnaires about anti-tobacco policies and attitudes toward tobacco companies. Overall, these nurses strongly agreed with tobacco policies such as banning youths from wearing clothing with a tobacco logo to school and fining restaurant owners who permit smoking. In addition, these nurses on average were negative toward tobacco companies. For example, they thought that tobacco companies and advertising leads to youth tobacco use. However, this group of school nurses thought that youths were basically neutral toward tobacco companies. Considering their professional experience with tobacco prevention at school, school nurses would be logical designers of tobacco prevention school interventions. An implication of these results is that school nurse education should include policy and activism components.

Undergraduate nursing students' attitudes towards smoking health promotion

Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students' attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents' attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non-smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.

Caring for Self While Learning to Care for Others: A Challenge for Nursing Students

While learning to care for others, undergraduate nursing students often fail to care for themselves. This study examined the effect of a self-care intervention on undergraduate nursing students. Self-care is the practice of health-related activities in which individuals engage to adopt a healthier lifestyle. A pretest-posttest, single group design was used to test whether students increased their self-care activities after completing a course requiring self-care. Full-time junior nursing students (N = 67) were required to complete a lifestyle self-care plan and use 2 hours of practice time per week to engage in self-care behaviors. A measure of components of a healthy lifestyle, the Health-Promoting Lifestyle Profile-II, showed an increase on six of the seven scales. These findings suggest that nursing students may increase self-care when given time to develop self-care strategies as part of a nursing course.

Nurses, smoking, and the workplace

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.

Nursing students' perceptions of smoking prevention

Smoking behaviors of student nurses may have a profound effect on the implementation of smoking-prevention activities in the future, as they are the future nurses. The aim of the study was to evaluate the prevalence of smoking among student nurses in Israel and to identify factors associated with the students' attitude to their role in smoking prevention and to nurses as role models regarding smoking. Student nurses from three large academic schools (782 respondents) answered a self-administered questionnaire. About 22% reported being current smokers. The latter more frequently reported positive attitudes to nurses' smoking and saw no ethical problems in their smoking. Smokers also reported less frequently that nurses should be active in smoking prevention. In a logistic regression model, attitudes to nurses' role in smoking prevention, smoking status, and having friends who smoked were associated with the attitude to nurses as role models. Attitude to nurses as role models was the main variable explaining variance in attitudes to nurses' role in prevention. Smoking status and students' social environment exerted a marked influence on students' attitudes to smoking role modeling. A more holistic approach to student nurses' education about smoking prevention is called for.