Nursing staff anxiety versus smoking habits

Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army

The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.

Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis

OBJECTIVES

To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population.

METHODS

We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231.

RESULTS

229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population.

CONCLUSIONS

HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.

An international review of tobacco smoking research in the nursing profession, 1976-2006

Tobacco smoking represents a contentious issue in the nursing profession, and one that has now become an important topic in nursing research. Despite this fact, the epidemiological quality of research varies widely, and it has been difficult to accurately determine the true incidence of smoking among nurses. Given these inconsistencies, we conducted a state-of-the-art review to identify international trends in tobacco usage among nurses, to ascertain how the epidemiological quality of research has improved over the past 30 years, and also to elucidate the directions in which nursing research has evolved. A total of 73 English-language studies that met the inclusion criteria were located and analysed. Overall, our review suggests that, while tobacco smoking among nurses appears to be decreasing in many countries during recent years, the international trend is far from uniform, and some developed nations still report high smoking rates among their nursing staff. From a methodological perspective, the relative epidemiological quality of smoking research has also fluctuated over time, making it difficult to compare the results of one study to the next. Despite these caveats, tobacco smoking remains a key topic in nursing research, as well as a critically important occupational-health issue for the entire nursing profession. In order to make the next generation of tobacco research data as comparable as possible, future scholars should consider devising and implementing a standardised format for conducting international tobacco smoking research within the nursing profession.

Pain and Anxiety versus Sense of Family Support in Lung Cancer Patients

Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient's quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger's State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain.

Military exceptionalism or tobacco exceptionalism: how civilian health leaders' beliefs may impede military tobacco control efforts

Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers' rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military-civilian partnerships that include educating civilian health leaders about military policy development and implementation.

The relationship between workplace, job stress and nurses' tobacco use: a review of the literature

The aim of this study was to provide a summary of the existing published knowledge on the possible relationship between the workplace as a stressor factor and nurses’ tobacco use. A systematic review of the literature from 1995 to 2009, using the MEDLINE database took place. Studies, that referred to nurses’ smoking habit exclusively or as a part of the study, were included in the review. 491 studies were retrieved and their titles/abstracts were examined systematically. Twenty one studies were retrieved for further consideration by a comprehensive literature review. Ten studies fulfilled the eligibility criteria and they were examined further. There is a conflict on the possible relationship between workplace as a stressor factor and nurses’ smoking habits, because there is no evidence on if the nurses’ work environment causes smoking initiation.

Challenging the smoking culture within a mental health service supportively

Smoking is an entrenched part of the culture of mental health care services. This paper discusses the smoking culture in mental health care settings and demonstrates a supportive model to engage staff to actively address their tobacco use and to influence a change in smoking-related workplace policy, practice, and culture. With management endorsement, two 9-week staff smoking cessation support groups were implemented and subsidized nicotine replacement therapy was provided to staff within the Alma Street Mental Health Service, Fremantle Hospital, Western Australia. Eighteen staff members from nursing, social work, administration staff, and patient care assistants participated in the group programme. At the conclusion of the programme, 61% (n = 11) of participants had quit as a result of the groups. Furthermore, a 3-month follow-up evaluation revealed that 39% (n = 7) of the group had abstained from smoking because of the programme. More importantly, the groups engaged staff to discuss workplace smoking issues and produced five recommendations to review policy and practice to further influence a change in the smoking culture of the mental health care service. The groups also provided the opportunity to develop a model of intervention to address smoking in a mental health setting and to raise the public health role of mental health nurses.

Smoking among Greek nurses and their readiness to quit

AIM AND RATIONALE: The preventable nature of smoking-associated diseases places a responsibility on health professionals for smoking-related health promotion. This paper disseminates information from a survey of qualified Greek nurses, comparing smoking attitudes, influences on smoking behaviours and desire to quit with their motivation to act as health promoters with patients and other health professionals who smoke.

METHOD AND SAMPLE

A random sample (n=402) of qualified nurses employed by hospitals in Athens was surveyed with a self-administered questionnaire in a cross-sectional survey which had a 73% response rate. Following quality control measures, a final sample of 308 was achieved.

RESULTS

Results showed that almost half of the nurses in the sample were current smokers, almost a quarter were former smokers, with just less than a third non-smokers. Using the Stages of Change model as a measure, the survey reported that 11% of the smokers in the sample expressed a desire to stop within the next month, another 12% in the coming 6 months and 23% of current smokers were still in the pre-contemplation stage. The main reasons given for continuing to smoke included using tobacco for enjoyment and as a coping mechanism for stress. Organizational problems were identified as the main source of stress. Finally, the majority of respondents confirmed the important part that they can play as role models in promoting health behaviours in their patients.

CONCLUSIONS

Findings suggest that smoking prevalence among qualified Greek nurses is greater than that reported in the general Greek population. Implications and recommendations for nursing practice, education and research include the early provision of smoking education in nurse training. Interventions should be directed at nurses who smoke to assist them to stop and to maintain cessation according to their stages of change.

Evaluation of smoking cessation success in adults

BACKGROUND

Smoking is a preventable cause of increased morbidity and mortality. Therefore, interventions have been used to assist smokers in overcoming their addiction. The aim of the study was to describe factors associated with smoking cessation, in patients applied to our smoking cessation (SC) unit in 1999, in a prospective study.

METHODS

Patients were followed-up during two years. Detailed medical history, Fagerstrom test, Hospital Anxiety and Depression (HAD) scale questionnaire, Motivation scale and replacement therapy were systematically recorded.

RESULTS

Three hundred patients (58% men, 42% women) applied to the SC unit from January to December 1999. The mean age was 42 yrs old. They smoked in average 24 cig/d. Mean duration of smoking was 20 years. Fagerstrom score was 5.86 (min 0; max: 10). Patients seemed to be more anxious (score 9.6) than depressed (5.09), according to the HAD score. 79% of them received both psychosocial intervention, pharmacotherapy and nicotine replacement therapy. 66% of patients were followed-up (n=198). Two years later, the smoking cessation rate was 12% (n=36). Motivation, Fagerstrom and HAD scores were not associated with the quitting rate. Quitting rate was higher (25.9%) in patients who attempted to quit smoking for the first time than in others (19%). By contrast, the quitting rate was significantly associated with age (P=0.03).

CONCLUSION

Success to quit smoking was positively associated with age, and negatively with alcohol dependence.

Relaxation training methods for nurse managers in Hong Kong: a controlled study

Nurse managers are under increased stress because of excessive workloads and hospitals' restructuring which is affecting their work tasks. High levels of stress could affect their mental health. Yet, few stress management training programmes are provided for this population. The purpose of this study was to apply stretch-release relaxation and cognitive relaxation training to enhance the mental health for nurse managers. A total of 65 nurse managers in Hong Kong were randomly assigned to stretch-release relaxation (n = 17), cognitive relaxation (n = 18), and a test control group (n = 35). Mental health status was assessed using the Chinese version of State-Trait Anxiety Inventory and the Chinese version of the General Health Questionnaire. Participants were assessed at the pretreatment session, the fourth posttreatment session, and at the 1-month follow-up session. The results revealed both the stretch-release and cognitive relaxation training enhanced mental health in nurse managers in Hong Kong. The application of relaxation training in enhancing mental health status for nurses and health professionals is discussed.

Does moderate alcohol use affect health-care costs? A propensity analysis of female health-care workers

AIMS

To determine differences in health-care costs associated with moderate alcohol consumption among female health-care workers while controlling for other risk factors that may be correlated with alcohol use.

DESIGN AND SETTING

Non-randomized, prospective, observational study of health-care costs by female health-care workers in a large managed care organization recruited between 1 January 1998 and 1 July 2000.

PARTICIPANTS

Six hundred and eighty-five female employees, continuously and stably employed by the managed care organization, who received health-care through the affiliated managed care organization. All women completed a health risk appraisal as part of the company's Employee Wellness Plan; 218 women were categorized as moderate drinkers and 467 as abstainers/light drinkers.

MEASUREMENTS

Total costs of in-plan and out-of-plan health-care utilization, by type of service, during the 6 month period after completing the health risk survey were calculated.

FINDINGS

Using 218 one-to-one matched pairs of moderate drinkers and abstainers/light drinkers, no significant differences in total, outpatient or inpatient costs were observed during the 6 month observation period. Pharmacy costs were significantly lower for moderate drinkers (-43 dollars, 95% CI = -88.82 dollars to -2.41 dollars), primarily due to differences in costs from anxiolytic (including barbiturates and benzodiazepines), hypnotic and sedative drug fills.

CONCLUSIONS

Findings demonstrate the value of risk factor matching when studying the relationship between alcohol use and health-care utilization. The discovery of differential pharmacy utilization raises the possibility that alcohol consumption may reduce the use of prescribed central nervous system depressants.

Nursing and tobacco reduction: a review of the literature

Nurses have an instrumental role to play in tobacco reduction, which is one strategy used to address tobacco use; a primary source of preventable morbidity and mortality globally. The following review addresses activities by two groups of nurses: nursing governance bodies and nurse scientists, whom together provide vision and knowledge to support and shape nursing practice. While nursing governance bodies and scientists have contributed a great deal to tobacco reduction, there are also gaps. Areas that require strengthening are: support for tobacco dependent nurses, basic nursing education concerning tobacco dependency treatment, and integration of tobacco dependence treatment into nursing practice.

Smoking related to anxiety and depression in Greek medical staff

We assessed the relation of anxiety and depression to smoking behavior in a sample of 80 physicians and surgeons, using the Spielberger State-Trait Anxiety Scale and the Beck Depression Inventory. 27 doctors were nonsmokers, 14 were former smokers, and 39 were current smokers. Current smokers showed significantly higher Anxiety and Depression scores compared to nonsmokers and former smokers, while the latter presented significantly lower Anxiety scores than nonsmokers. In current smokers, the daily quota of cigarettes was not correlated with Anxiety or Depression scores. From our results we can hypothesize that, among medical staff, smoking behavior is more anxiety-related than depression-related. In conclusion, we believe that interventions such as stress management techniques could be effective in lessening Anxiety and diminishing the need for relief searched for in smoking.