1
|
Sun S, Yu H, Ling J, Yao D, Chen H, Liu G. The influence of health literacy and knowledge about smoking hazards on the intention to quit smoking and its intensity: an empirical study based on the data of China's health literacy investigation. BMC Public Health 2023; 23:2355. [PMID: 38017398 PMCID: PMC10685583 DOI: 10.1186/s12889-023-17292-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE This study explored the relationship between smokers' health literacy, knowledge of smoking hazards, and their intention to quit. METHODS Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. RESULTS Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005). CONCLUSION General health literacy may play a role in facilitating smokers' progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.
Collapse
Affiliation(s)
- Siwen Sun
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huifang Yu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Jie Ling
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Dingming Yao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
| | - Guilin Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
2
|
Rojewski AM, Palmer AM, Toll BA. Treatment of Tobacco Dependence in the Inpatient Setting. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
3
|
Aggarwal M, Grady A, Desai D, Hartog K, Correa L, Ostfeld RJ, Freeman AM, McMacken M, Gianos E, Reddy K, Batiste C, Wenger C, Blankstein R, Williams K, Allen K, Seifried RM, Aspry K, Barnard ND. Successful Implementation of Healthful Nutrition Initiatives into Hospitals. Am J Med 2020; 133:19-25. [PMID: 31494109 DOI: 10.1016/j.amjmed.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/14/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023]
Abstract
Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.
Collapse
Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, Florida.
| | - Ariel Grady
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Daya Desai
- University of Florida, Gainesville, Florida
| | | | - Lilian Correa
- Department of Medicine, NYC Health + Hospitals/Bellevue, New York
| | | | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colo
| | | | - Eugenia Gianos
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Koushik Reddy
- Division of Cardiology, James A. Haley VA Medical Center, Tampa, Fla
| | - Columbus Batiste
- Division of Cardiology, Kaiser Permanente Riverside Medical Center, Riverside, Calif
| | - Christopher Wenger
- Division of Preventative Cardiology, Lancaster General Hospital/Penn Medicine, Lancaster, Pa
| | - Ron Blankstein
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Kim Williams
- Division of Cardiology, Rush University Medical Center, Chicago, Ill
| | - Kathleen Allen
- Geisel School of Medicine, Dartmouth Medical School, Hanover, NH
| | - Rebecca M Seifried
- Division of Cardiology, Walter Reed National Military Medical Center, Bethesda, Md
| | - Karen Aspry
- Brown University, Warren Alperty Medical School, Providence, RI
| | - Neal D Barnard
- George Washington University School of Medicine, and Physicians Committee for Responsible Medicine, Washington, DC
| |
Collapse
|
4
|
Orthopaedic trauma patients and smoking: Knowledge deficits and interest in quitting. Injury 2016; 47:1206-11. [PMID: 27090096 DOI: 10.1016/j.injury.2016.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smoking is associated with increased complications in fracture care. Smoking cessation has a positive impact on outcomes. It is unknown whether orthopaedic trauma patients understand the ill effects of smoking on fracture care and whether knowledge can improve cessation interest. We hypothesized that (1) smokers less fully understand the negative effects of smoking than do nonsmokers, (2) an increased proportion of orthopaedic trauma patients are further in the process of change to quit smoking, (3) increased knowledge predicts increased readiness to quit, and (4) minimal education through a survey can improve interest in smoking cessation. METHODS Single-centre cross-sectional cohort survey study. Patients were approached consecutively for participation. Patients 18 years or older with a new fracture in our clinic for follow-up were eligible. Smokers and nonsmokers were included and surveyed regarding demographics. Smokers were asked questions about fractures and general knowledge questions regarding the effects of smoking on health. Smokers' interest in smoking cessation was assessed with direct questions, and transtheoretical model stage of change was queried before and after survey administration. RESULTS One hundred twelve patients participated (44 smokers, 68 nonsmokers; 75 male patients, 37 female patients). Forty-eight percent of smokers stated that the fracture made them more likely to quit. Smokers answered more questions incorrectly than did nonsmokers (p=0.003). An increased percentage of smokers were in favourable stages of change compared with a population-based tobacco survey (68% versus 54%, p=0.008). Survey administration increased interest in quitting in 48%, and 11% modified their stage of change towards quitting. Smokers scoring higher on knowledge questions had more than 2-fold increased odds of being in a favourable stage of change (p=0.013; odds ratio, 2.13; 95% confidence interval, 1.744-3.855). CONCLUSIONS Compared with nonsmokers, smokers less fully understand the negative effects of smoking on fracture care and general health. A large proportion of orthopaedic trauma patients who smoke are interested in smoking cessation and are possibly further along the pathway to change than expected. Brief education through a survey can increase interest in quitting. Formal education intervention may improve cessation rates and fracture outcomes.
Collapse
|
5
|
Stages of change, determinants, and mortality for smoking cessation in adult Taiwanese screenees. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:301-12. [PMID: 24504568 DOI: 10.1007/s11121-014-0471-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We aimed to investigate the associations between three smoking-related constructs (pros and cons of smoking, temptation to smoke, and self-efficacy of resisting smoking) and stage of change (precontemplation, contemplation, preparation, and action) based on the transtheoretical model among smokers attending a community-based screening program. We also assessed their effects on long-term all-cause mortality. A prospective cohort study, with an average of 7 years of follow-up, was conducted by enrolling 454 male smoking screenees. The comparisons of the mean score of each variable pertaining to three smoking-related constructs across four stages of smoking cessation were assessed by analysis of variance. The impacts of both smoking-related constructs and smoking cessation stage measured at baseline on 7-year mortality were assessed by using proportional hazards regression model. The differences in the mean scores of pros and cons of smoking, temptation to smoke, and self-efficacy of resisting smoking across four stages of smoking cessation were statistically significant (P < 0.01). The precontemplation group and the contemplation group as opposed to the action group increased the risk for all-cause mortality, but the size of effect was not statistically significant (P = 0.39) when age, duration of smoking, and three smoking- related constructs were controlled. Those with a lower social aspect of self-efficacy were approximately threefold [adjusted hazard ratio = 3.22 (95 % CI 1.26-8.21)] risk for all-cause death compared with those with a higher one. Three smoking-related constructs were highly associated with smoking cessation stage, and low self-efficacy was independently predictive of long-term mortality among male smokers attending a community-based screening program.
Collapse
|
6
|
Moran A, Lederer A, Johnson Curtis C. Use of Nutrition Standards to Improve Nutritional Quality of Hospital Patient Meals: Findings from New York City's Healthy Hospital Food Initiative. J Acad Nutr Diet 2015; 115:1847-54. [PMID: 26320410 DOI: 10.1016/j.jand.2015.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most hospital patient meals are considered regular-diet meals; these meals are not required to meet comprehensive nutrition standards for a healthy diet. Although programs exist to improve nutrition in hospital food, the focus is on retail settings such as vending machines and cafeterias vs patient meals. New York City's Healthy Hospital Food Initiative (HHFI) provides nutrition standards for regular-diet meals that hospitals can adopt, in addition to retail standards. OBJECTIVE This study was undertaken to describe regular-diet patient menus before and after implementation of the HHFI nutrition standards. DESIGN The study involved pre- and post- menu change analyses of hospitals participating in the HHFI between 2010 and 2014. PARTICIPANTS/SETTING Eight New York City hospitals, selected based on voluntary participation in the HHFI, were included in the analyses. MAIN OUTCOME MEASURES Nutritional content of regular-diet menus were compared with the HHFI nutrition standards. STATISTICAL ANALYSES PERFORMED Nutrient analysis and exact Wilcoxon signed-rank tests were used for the analysis of the data. RESULTS At baseline, no regular-diet menu met all HHFI standards, and most exceeded the daily limits for percentage of calories from fat (n=5), percentage of calories from saturated fat (n=5), and milligrams of sodium (n=6), and they did not meet the minimum grams of fiber (n=7). Hospitals met all key nutrient standards after implementation, increasing fiber (25%, P<0.01) and decreasing sodium (-19%, P<0.05), percentage of calories from fat (-24%, P<0.01), and percentage of calories from saturated fat (-21%, P<0.05). A significant increase was seen in fresh fruit servings (667%, P<0.05) and decreases in full-fat and reduced-fat milk servings (-100%, P<0.05), refined grain servings (-35%, P<0.05), and frequency of desserts (-92%, P<0.05). CONCLUSIONS Regular diet menus did not comply with the HHFI nutrition standards at baseline. Using the HHFI framework, hospitals significantly improved the nutritional quality of regular-diet patient menus. The standards were applied across hospitals of varying sizes, locations, menu types, and food service operations, indicating feasibility of this framework in a range of hospital settings.
Collapse
|
7
|
HIV risk-reduction counseling and testing on behavior change of MSM. PLoS One 2013; 8:e69740. [PMID: 23922787 PMCID: PMC3726787 DOI: 10.1371/journal.pone.0069740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/11/2013] [Indexed: 12/02/2022] Open
Abstract
HIV and AIDS incidence in China is high among men who have sex with men (MSM) and ours was one of few studies in China to evaluate the role of HIV risk reduction counseling and testing. Respondent-driven sampling (RDS) was used to recruit 430 MSM. Participants were followed up at 6, 12 and 18 months to evaluate behavioral changes after counseling to reduce risk behaviors. At baseline, HIV prevalence was 4.7%, whereas HIV incidence was 5.2 per 100 person-years. The incidence was 3.8 during six to 12 months, and 1.1 during 12 to 18 months. During the study period, the reported unprotected anal intercourse (UAI) significantly decreased from 60.9% to 42.9%. The proportion of participants who had one or no partner significantly increased from 40.9% to 48.0%. The study also found that some risk behaviors decreased between baseline and 12 months, followed by a slight increase between 12 and 18 months. Reductions in UAI can be achieved through counseling and testing, but may wane over time. Future programs should consider HIV risk-reduction counseling and testing for interventions in MSM in China.
Collapse
|
8
|
Abstract
BACKGROUND Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting. OBJECTIVES To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. SELECTION CRITERIA Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted to facilities that primarily treat psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow-up of less than six months. Both acute care hospitals and rehabilitation hospitals were included in this update, with separate analyses done for each type of hospital. DATA COLLECTION AND ANALYSIS Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS Fifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48; 25 trials). A specific benefit for post-discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post-discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non-significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. These trials were all conducted in acute care hospitals. A comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials). AUTHORS' CONCLUSIONS High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals. There was no evidence of effect for interventions of lower intensity or shorter duration. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone.
Collapse
Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School,Boston,Massachusetts, USA.
| | | | | | | |
Collapse
|
9
|
Jung GW, Senthilselvan A, Salopek TG. Likelihood of dermatology patients to inquire about sun protection measures during a regular clinic visit. J Cutan Med Surg 2012; 15:266-74. [PMID: 21962186 DOI: 10.2310/7750.2011.10054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health information-seeking behavior refers to ways individuals acquire health information. Few studies demonstrate its association with skin cancer. OBJECTIVES To determine the likelihood of patients to inquire about sun protection methods from dermatologists and whether such knowledge will affect their preventive behaviors. METHODS Over a 2-month period, 396 dermatology patients completed a survey assessing their sun awareness knowledge and inquiry about sun protection measures. Features associated with increased skin cancer risk were correlated with patients' inquiry about sun protection information and their future intentions to practice safe sun behavior. RESULTS One in seven patients (13.8%) inquired about sun protection measures. Patients with features known to be associated with increased skin cancer risk infrequently inquired about sun protection methods (4.5-23.8%). Post-physician counseling, patients with previous sun awareness education had a greater intention to use sunscreen routinely (41.4% vs 28.3%, p = .01), avoid the sun (31.2% vs 18.2%, p = .004), and wear sun-protective clothing (32.5% vs 23.2%., p = .05). CONCLUSION Patients' desire for medical information from physicians does not translate efficiently into seeking sun awareness information from dermatologists. Dermatologists should play a greater proactive role in skin cancer prevention through initiation of regular personalized discussions on sun awareness issues.
Collapse
Affiliation(s)
- Gordon W Jung
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | |
Collapse
|
10
|
Brehaut JC, Hamm R, Majumdar S, Papa F, Lott A, Lang E. Cognitive and Social Issues in Emergency Medicine Knowledge Translation: A Research Agenda. Acad Emerg Med 2007. [DOI: 10.1111/j.1553-2712.2007.tb02377.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Abstract
BACKGROUND An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Initiating smoking cessation services during hospitalisation may help more people to make and sustain a quit attempt. OBJECTIVES To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PSYCINFO in January 2007, and CINAHL in August 2006 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. SELECTION CRITERIA Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted for psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow up of less than six months. DATA COLLECTION AND ANALYSIS Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS Thirty-three trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (Odds Ratio (OR) 1.65, 95% confidence interval (CI) 1.44 to 1.90; 17 trials). No statistically significant benefit was found for less intensive counselling interventions. The one study that tested a single brief (<=15 minutes) in-hospital intervention did not find it to be effective (OR 1.16, 95% CI 0.80 to 1.67). Counselling of longer duration during the hospital stay was not associated with a higher quit rate (OR 1.08, 95% CI 0.89 to 1.29, eight trials). Even counselling that began in the hospital but had less than one month of supportive contact after discharge did not show significant benefit (OR 1.09, 95% CI 0.91 to 1.31, six trials). Adding nicotine replacement therapy (NRT) did not produce a statistically significant increase in cessation over what was achieved by intensive counselling alone (OR 1.47, 95% CI 0.92 to 2.35, five studies). The one study that tested the effect of adding bupropion to intensive counselling had a similar nonsignificant effect (OR 1.56, 95% CI 0.79 to 3.06). A similar pattern of results was observed in smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the odds of smoking cessation (OR 1.81, 95% CI 1.54 to 2.15, 11 trials), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. AUTHORS' CONCLUSIONS High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. These interventions are effective regardless of the patient's admitting diagnosis. lnterventions of lower intensity or shorter duration have not been shown to be effective in this setting. There is insufficient direct evidence to conclude that adding NRT or bupropion to intensive counselling increases cessation rates over what is achieved by counselling alone, but the evidence of benefit for NRT has strengthened in this update and the point estimates are compatible with research in other settings showing that NRT and bupropion are effective.
Collapse
Affiliation(s)
- N A Rigotti
- Massachusetts General Hospital, General Internal Medicine Unit, S50-9, Boston, Massachusetts 02114, USA.
| | | | | |
Collapse
|
12
|
Chouinard MC, Robichaud-Ekstrand S. Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease. ACTA ACUST UNITED AC 2007; 14:51-8. [PMID: 17301627 DOI: 10.1097/hjr.0b013e328014027b] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several authors have questioned the transtheoretical model. Determining the predictive value of each cognitive-behavioural element within this model could explain the multiple successes reported in smoking cessation programmes. The purpose of this study was to predict point-prevalent smoking abstinence at 2 and 6 months, using the constructs of the transtheoretical model, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. DESIGN The study follows a predictive correlation design. METHODS Recently hospitalized patients (n=168) with cardiovascular disease were pooled from a randomized, controlled trial. Independent variables of the predictive transtheoretical model comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. RESULTS Compared to smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-re-evaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy and stages of change at baseline were predictive of smoking abstinence after 6 months. Other variables found to be predictive of smoking abstinence at 6 months were an increase in self-efficacy; an increase in positive social support behaviour and a decrease of the pros within the decisional balance. CONCLUSIONS The results partially support the predictive value of the transtheoretical model constructs in smoking cessation for cardiovascular disease patients.
Collapse
|
13
|
Balkstra CR, Fields M, Roesler L. Meeting Joint Commission on Accreditation of Healthcare Organizations requirements for tobacco cessation: the St. Joseph's/Candler Health System approach to success. Crit Care Nurs Clin North Am 2006; 18:105-11, xiii. [PMID: 16546013 DOI: 10.1016/j.ccell.2005.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Health care institutions can no longer treat only the sequelae of tobacco use. Smoking-cessation programs must be instituted to meet health promotion and education goals developed on admission for all patients. Leading authorities, such as the Joint Commission on Accreditation of Health Care Organizations and the Centers for Medicare and Medicaid Services, now include tobacco-cessation counseling as quality performance measures. This article discusses successful strategies that health care professionals have used at St. Joseph's/Candler Health System in Savannah, Georgia, to meet these standards.
Collapse
Affiliation(s)
- Cynthia R Balkstra
- St. Joseph's/Candler Health System, Inc., 5353 Reynolds Street, Savannah, GA 31405, USA.
| | | | | |
Collapse
|
14
|
Chouinard MC, Robichaud-Ekstrand S. The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease. Nurs Res 2005; 54:243-54. [PMID: 16027567 DOI: 10.1097/00006199-200507000-00006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoking is an important risk factor for cardiovascular disease (CVD), and quitting is highly beneficial. Yet, less than 30% of CVD patients stop smoking. Relapse-prevention strategies seem most effective when initiated during the exacerbation of the disease. OBJECTIVE A nurse-delivered inpatient smoking cessation program based on the Transtheoretical Model with telephone follow-up tailored to levels of readiness to quit smoking was evaluated on smoking abstinence and progress to ulterior stages of change. METHOD Participants (N = 168) were randomly assigned by cohorts to inpatient counseling with telephone follow-up, inpatient counseling, and usual care. The inpatient intervention consisted of a 1-hr counseling session, and the telephone follow-up included 6 calls during the first 2 months after discharge. The nursing intervention was tailored to the individual's stage of change. End points at 2 and 6 months included actual and continuous smoking cessation rates (biochemical markers) and increased motivation (progress to ulterior stages of change). RESULTS Assuming that surviving patients lost to follow-up were smokers, the 6-month smoking abstinence rate was 41.5% in the inpatient counseling with telephone follow-up group, compared with 30.2% and 20% in the inpatient counseling and usual care groups, respectively (p = .05). Progress to ulterior stages of change was 43.3%, 32.1%, and 18.2%, respectively (p = .02). Stage of change at baseline and intervention predicted smoking status at 6 months. DISCUSSION This tailored smoking cessation program with telephone follow-up significantly increased smoking cessation at 6 months, and progression to ulterior stages of change. The telephone follow-up was an important adjunct. It is, therefore, recommended to include such comprehensive smoking cessation programs within hospital settings for individuals with CVD.
Collapse
Affiliation(s)
- Maud-Christine Chouinard
- Module des sciences infirmières et de la santé, Université du Québec à Chicoutimi, Québec, Canada.
| | | |
Collapse
|
15
|
DeJong SR, Veltman RH. The effectiveness of a CNS-led community-based COPD screening and intervention program. CLIN NURSE SPEC 2004; 18:72-9. [PMID: 15164668 DOI: 10.1097/00002800-200403000-00012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES The purpose of this study was to evaluate the effectiveness of a screening program in identifying undiagnosed individuals with chronic obstructive pulmonary disease (COPD). THEORETICAL RATIONALE: Underdiagnosis of COPD is common. Symptoms do not usually become apparent until the disease is advanced. Consequently, by the time a diagnosis of COPD is made, based on symptoms, the individual has often lost up to 50% or more of their original lung capacity. Early diagnosis and intervention has been demonstrated to have an impact in slowing the progression of the disease. The study was based on the premise that when individuals become self-aware of their risk factors related to disease, they are more likely to change their behaviors. The Transtheoretical Model describes how individuals move through various stages of change and how they can be helped in transitioning from one stage to another. DESCRIPTION OF THE PROJECT Subjects (n = 243) were recruited via letter, newspaper, and physician referral. The screening program consisted of (1) pulmonary function testing using a handheld spirometry device, (2) education about the test results and COPD, and (3) smoking cessation counseling. Current smokers and those found to have obstruction were contacted at 8 to 12 weeks after screening. OUTCOME Results indicated that 209 (86%) of participants were at risk for developing COPD as evidenced by current or past smoking status. Mild to moderate stage obstructive disease was found in 55 subjects (23%). Of 61 subjects contacted after the screening, 29 smokers (47%) indicated they had stopped smoking, were in the process of quitting, or were seriously considering quitting. CONCLUSIONS Results support the use of a community-screening program to identify and help modify risk factors for COPD. IMPLICATIONS FOR NURSING PRACTICES: This project provides an example of how a clinical nurse specialist (CNS) can exercise all the spheres of CNS influence: the patient/client sphere, the nursing personnel sphere, and the organization sphere. In addition, the COPD screening project demonstrated how a CNS can successfully lead and direct a community initiative and influence others in changing behavior to enhance their state of health.
Collapse
|
16
|
Abstract
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.
Collapse
Affiliation(s)
- Annette S H Schultz
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
| |
Collapse
|
17
|
Rigotti NA, Munafo MR, Murphy MF, Stead LF. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2003:CD001837. [PMID: 12535418 DOI: 10.1002/14651858.cd001837] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Providing smoking cessation services during hospitalisation may help more people to attempt and sustain a quit attempt. OBJECTIVES To determine the effectiveness of interventions for smoking cessation in hospitalised patients. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group register, CINAHL and the Smoking and Health database in March 2002 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted. SELECTION CRITERIA Randomised and quasi-randomised trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters. We excluded studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS Two authors extracted data independently for each paper, with disagreements resolved by consensus. MAIN RESULTS Seventeen trials met the inclusion criteria. Intensive intervention (inpatient contact plus follow-up for at least one month) was associated with a significantly higher quit rate compared to control (Peto Odds Ratio 1.82, 95% CI 1.49-2.22, six trials). Interventions with less than a month of follow-up did not show evidence of significant benefit (Peto Odds Ratio 1.09, 95% CI 0.91-1.31, seven trials). There was no evidence to judge the effect of very brief (<20 minutes) interventions delivered only during the hospital stay. Longer interventions delivered only during the hospital stay were not significantly associated with a higher quit rate (Peto Odds Ratio 1.07, 95% CI 0.79-1.44, three trials). Although the interventions increased quit rates irrespective of whether nicotine replacement therapy (NRT) was used, the results for NRT were compatible with other data indicating that it increases quit rates. There was no strong evidence that clinical diagnosis affected the likelihood of quitting. REVIEWER'S CONCLUSIONS High intensity behavioural interventions that include at least one month of follow-up contact are effective in promoting smoking cessation in hospitalised patients. The findings of the review were compatible with research in other settings showing that NRT increases quit rates.
Collapse
Affiliation(s)
- N A Rigotti
- ICRF General Practice Research Group, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF.
| | | | | | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Smoking increases the renal risk both in diabetic and in nondiabetic renal disease. The purpose of the present review is to summarize the current state of knowledge about this important remediable renal risk factor. RECENT FINDINGS The deleterious effect of smoking on renal function extends beyond patients with primary or secondary renal disease and patients with a renal transplant, because recent studies document a relation between smoking and loss of filtration rate, even in cardiovascular high-risk populations without primary renal disease such as the elderly, the patient with severe essential hypertension, or the patient with widespread atherosclerosis. Furthermore, recent studies show that in nondiabetic patients without primary renal disease, albuminuria, a potential surrogate marker of glomerular damage, is correlated with smoking. The mechanisms underlying the adverse renal effects of smoking are still incompletely understood. Beyond its effect on progression of renal failure, smoking is also an important cardiovascular risk factor in the patient with renal failure or the patient with a renal transplant. SUMMARY Smoking is one of the most important remediable renal risk factors. The exact mechanisms of smoking-induced renal damage remain to be determined. For all the above reasons cessation of smoking should be recommended to renal patients - a recommendation which is infrequently given and even less frequently followed.
Collapse
Affiliation(s)
- Stephan R Orth
- Division of Nephrology and Hypertension, Inselspital, University of Berne, Berne, Switzerland
| | | |
Collapse
|
19
|
Orth SR. Cigarette smoking: an important renal risk factor - far beyond carcinogenesis. Tob Induc Dis 2002; 1:137-55. [PMID: 19570254 PMCID: PMC2671650 DOI: 10.1186/1617-9625-1-2-137] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2002] [Revised: 08/29/2002] [Accepted: 08/30/2002] [Indexed: 12/20/2022] Open
Abstract
In recent years, it has become apparent that smoking has a negative impact on renal function, being one of the most important remediable renal risk factors. It has been clearly shown that the risk for high-normal urinary albumin excretion and microalbuminuria is increased in smoking compared to non-smoking subjects of the general population. Data from the Multiple Risk Factor Intervention Trial (MRFIT) indicate that at least in males, smoking increases the risk to reach end-stage renal failure. Smoking is particularly "nephrotoxic" in older subjects, subjects with essential hypertension and patients with preexisting renal disease. Of interest, the magnitude of the adverse renal effect of smoking seems to be independent of the underlying renal disease. Death-censored renal graft survival is decreased in smokers, indicating that smoking also damages the renal transplant. Cessation of smoking has been show to reduce the rate of progression of renal failure both in patients with renal disease or a renal transplant. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in blood pressure and presumably intraglomerular pressure) and chronic effects (e.g., endothelial cell dysfunction). Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly survival of smokers with diabetes mellitus on hemodialysis is abysmal. In the present review article the current state of knowledge about the renal risks of smoking is reviewed. It is the aim of the article to point out that smoking not only increases the risk of renal cell carcinoma or uroepithelial cell carcinoma, but also the risk of a faster decline of renal function. The latter is a relatively new negative aspect which has not been widely recognized.
Collapse
Affiliation(s)
- S R Orth
- Division of Nephrology and Hypertension, University Hospital Berne (Inselspital), Berne, Switzerland.
| |
Collapse
|