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Streck JM, Rigotti NA, Livingstone-Banks J, Tindle HA, Clair C, Munafò MR, Sterling-Maisel C, Hartmann-Boyce J. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev 2024; 5:CD001837. [PMID: 38770804 PMCID: PMC11106804 DOI: 10.1002/14651858.cd001837.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND In 2020, 32.6% of the world's population used tobacco. Smoking contributes to many illnesses that require hospitalisation. A hospital admission may prompt a quit attempt. Initiating smoking cessation treatment, such as pharmacotherapy and/or counselling, in hospitals may be an effective preventive health strategy. Pharmacotherapies work to reduce withdrawal/craving and counselling provides behavioural skills for quitting smoking. This review updates the evidence on interventions for smoking cessation in hospitalised patients, to understand the most effective smoking cessation treatment methods for hospitalised smokers. OBJECTIVES To assess the effects of any type of smoking cessation programme for patients admitted to an acute care hospital. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 7 September 2022. SELECTION CRITERIA We included randomised and quasi-randomised studies of behavioural, pharmacological or multicomponent interventions to help patients admitted to hospital quit. Interventions had to start in the hospital (including at discharge), and people had to have smoked within the last month. We excluded studies in psychiatric, substance and rehabilitation centres, as well as studies that did not measure abstinence at six months or longer. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was abstinence from smoking assessed at least six months after discharge or the start of the intervention. We used the most rigorous definition of abstinence, preferring biochemically-validated rates where reported. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 82 studies (74 RCTs) that included 42,273 participants in the review (71 studies, 37,237 participants included in the meta-analyses); 36 studies are new to this update. We rated 10 studies as being at low risk of bias overall (low risk in all domains assessed), 48 at high risk of bias overall (high risk in at least one domain), and the remaining 24 at unclear risk. Cessation counselling versus no counselling, grouped by intensity of intervention Hospitalised patients who received smoking cessation counselling that began in the hospital and continued for more than a month after discharge had higher quit rates than patients who received no counselling in the hospital or following hospitalisation (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.24 to 1.49; 28 studies, 8234 participants; high-certainty evidence). In absolute terms, this might account for an additional 76 quitters in every 1000 participants (95% CI 51 to 103). The evidence was uncertain (very low-certainty) about the effects of counselling interventions of less intensity or shorter duration (in-hospital only counselling ≤ 15 minutes: RR 1.52, 95% CI 0.80 to 2.89; 2 studies, 1417 participants; and in-hospital contact plus follow-up counselling support for ≤ 1 month: RR 1.04, 95% CI 0.90 to 1.20; 7 studies, 4627 participants) versus no counselling. There was moderate-certainty evidence, limited by imprecision, that smoking cessation counselling for at least 15 minutes in the hospital without post-discharge support led to higher quit rates than no counselling in the hospital (RR 1.27, 95% CI 1.02 to 1.58; 12 studies, 4432 participants). Pharmacotherapy versus placebo or no pharmacotherapy Nicotine replacement therapy helped more patients to quit than placebo or no pharmacotherapy (RR 1.33, 95% CI 1.05 to 1.67; 8 studies, 3838 participants; high-certainty evidence). In absolute terms, this might equate to an additional 62 quitters per 1000 participants (95% CI 9 to 126). There was moderate-certainty evidence, limited by imprecision (as CI encompassed the possibility of no difference), that varenicline helped more hospitalised patients to quit than placebo or no pharmacotherapy (RR 1.29, 95% CI 0.96 to 1.75; 4 studies, 829 participants). Evidence for bupropion was low-certainty; the point estimate indicated a modest benefit at best, but CIs were wide and incorporated clinically significant harm and clinically significant benefit (RR 1.11, 95% CI 0.86 to 1.43, 4 studies, 872 participants). Hospital-only intervention versus intervention that continues after hospital discharge Patients offered both smoking cessation counselling and pharmacotherapy after discharge had higher quit rates than patients offered counselling in hospital but not offered post-discharge support (RR 1.23, 95% CI 1.09 to 1.38; 7 studies, 5610 participants; high-certainty evidence). In absolute terms, this might equate to an additional 34 quitters per 1000 participants (95% CI 13 to 55). Post-discharge interventions offering real-time counselling without pharmacotherapy (RR 1.23, 95% CI 0.95 to 1.60, 8 studies, 2299 participants; low certainty-evidence) and those offering unscheduled counselling without pharmacotherapy (RR 0.97, 95% CI 0.83 to 1.14; 2 studies, 1598 participants; very low-certainty evidence) may have little to no effect on quit rates compared to control. Telephone quitlines versus control To provide post-discharge support, hospitals may refer patients to community-based telephone quitlines. Both comparisons relating to these interventions had wide CIs encompassing both possible harm and possible benefit, and were judged to be of very low certainty due to imprecision, inconsistency, and risk of bias (post-discharge telephone counselling versus quitline referral: RR 1.23, 95% CI 1.00 to 1.51; 3 studies, 3260 participants; quitline referral versus control: RR 1.17, 95% CI 0.70 to 1.96; 2 studies, 1870 participants). AUTHORS' CONCLUSIONS Offering hospitalised patients smoking cessation counselling beginning in hospital and continuing for over one month after discharge increases quit rates, compared to no hospital intervention. Counselling provided only in hospital, without post-discharge support, may have a modest impact on quit rates, but evidence is less certain. When all patients receive counselling in the hospital, high-certainty evidence indicates that providing both counselling and pharmacotherapy after discharge increases quit rates compared to no post-discharge intervention. Starting nicotine replacement or varenicline in hospitalised patients helps more patients to quit smoking than a placebo or no medication, though evidence for varenicline is only moderate-certainty due to imprecision. There is less evidence of benefit for bupropion in this setting. Some of our evidence was limited by imprecision (bupropion versus placebo and varenicline versus placebo), risk of bias, and inconsistency related to heterogeneity. Future research is needed to identify effective strategies to implement, disseminate, and sustain interventions, and to ensure cessation counselling and pharmacotherapy initiated in the hospital is sustained after discharge.
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Affiliation(s)
- Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts (MA), USA
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, USA
| | | | - Hilary A Tindle
- Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carole Clair
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Marcus R Munafò
- School of Experimental Psychology and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
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Abstract
BACKGROUND Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017. SELECTION CRITERIA Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings. AUTHORS' CONCLUSIONS There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.
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Affiliation(s)
- Virginia Hill Rice
- Wayne State UniversityCollege of Nursing5557 Cass AvenueDetroitMichiganUSA48202
| | - Laura Heath
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jonathan Livingstone‐Banks
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Elshatarat RA, Yacoub MI, Khraim FM, Saleh ZT, Afaneh TR. Self-efficacy in treating tobacco use: A review article. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816667137] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Globally, tobacco use continues to be a major health care concern. Despite strong recommendations to quit smoking, tobacco users are experiencing difficulties in quitting. The purpose of this integrative review is to discuss self-efficacy theory as an important behavioral therapy for treating tobacco use and nicotine dependence. Moreover, the paper proposes a literature-derived model that employs self-efficacy as a central component for treating tobacco use and nicotine dependence. Eleven relevant articles were included in this review. Self-efficacy has an important role in smoking cessation. Improving self-efficacy enhances the individual’s success in quitting tobacco use and preventing relapse. Moreover, incorporating self-efficacy as a cognitive behavioral intervention has shown various degrees of success for treating tobacco use and nicotine dependence. In order to offer guidance to health care providers assisting in quitting tobacco, a model that integrates self-efficacy as a central component of the quitting process is proposed.
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Affiliation(s)
- Rami Azmi Elshatarat
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Mohammed Ibrahim Yacoub
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
- Clinical Nursing Department, The University of Jordan, Amman, Jordan
| | - Fadi Marwan Khraim
- Department of Medical and Surgical Nursing, Taibah University, Madinah, Kingdom of Saudi Arabia
- School of Nursing, Memorial University of Newfoundland, Canada
| | - Zyad Taher Saleh
- Clinical Nursing Department, The University of Jordan, Amman, Jordan
| | - Tareq Rateb Afaneh
- Nursing Education Department, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
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Abstract
BACKGROUND Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group specialized Register and CINAHL in June 2013. SELECTION CRITERIA Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS Forty-nine studies met the inclusion criteria. Pooling 35 studies (over 17,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention to increase the likelihood of quitting (RR 1.29; 95% CI 1.20 to 1.39). In a subgroup analysis the estimated effect size was similar for the group of seven studies using a particularly low intensity intervention but the confidence interval was wider. There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized adults also showed evidence of benefit. Eleven studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Six studies of nurse counselling on smoking cessation during a screening health check or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions. AUTHORS' CONCLUSIONS The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses, with reasonable evidence that intervention is effective. The evidence for an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.
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Affiliation(s)
- Virginia Hill Rice
- College of Nursing, Wayne State University, 5557 Cass Avenue, Detroit, Michigan, USA, 48202
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Elshatarat RA, Stotts NA, Engler M, Froelicher ES. Knowledge and beliefs about smoking and goals for smoking cessation in hospitalized men with cardiovascular disease. Heart Lung 2013; 42:126-32. [PMID: 23290660 PMCID: PMC4748847 DOI: 10.1016/j.hrtlng.2012.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe perceptions of smoking in men hospitalized with cardiovascular disease (CVD). BACKGROUND Smoking is a major risk factor and associated with the high prevalence of CVD in Jordan. METHODS The study design was cross-sectional with a convenience sample. A structured interview was conducted in 112 men who were hospitalized with CVD. RESULTS The study showed that 91% of men hospitalized with CVD smoked daily. The majority (83%) had attempted to quit smoking in the past without help from others, and intended to quit in the future using the same previously unsuccessful method. They were unaware of the hazards of smoking such as stroke; or the long term health benefits of quitting smoking. Logistic regressions showed that men were more confident in quitting smoking if they had a high income (OR: 7.7; 95% CI: 2.7, 22.3), longer hospitalizations (OR: 2.6; 95% CI: 1.3, 5.3), or were hospitalized in acute cardiac settings (OR: 3.9; 95% CI: 1.2, 12.7), and admitted with a diagnosis of MI or angina (OR: 3.0; 95% CI: 1.1, 8.3). CONCLUSION Assessment of smoking status with smoking cessation counseling is paramount in hospitalized men with CVD who smoke.
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Affiliation(s)
- Rami Azmi Elshatarat
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
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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.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School,Boston,Massachusetts, USA.
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Hu D, Yu D. Epidemiology of cardiovascular disease in Asian women. Nutr Metab Cardiovasc Dis 2010; 20:394-404. [PMID: 20591635 DOI: 10.1016/j.numecd.2010.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 02/05/2010] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
This article presents data on CVD and risk factors in Asian women. Data were obtained from available cohort studies and statistics for mortality from the World Health Organization. CVD is becoming an important public health problem among Asian women. There are high rates of CHD mortality in Indian and Central Asian women; rates are low in southeast and east Asia. Chinese and Indian women have very high rates and mortality from stroke; stroke is also high in central Asian and Japanese women. Hypertension and type 2 DM are as prevalent as in western women, but rates of obesity and smoking are less common. Lifestyle interventions aimed at prevention are needed in all areas.
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Affiliation(s)
- D Hu
- Department of Preventive Medicine, Shenzhen University School of Medicine, 3688 Nanhai Avenue, Shenzhen, Guangdong 518060, China.
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8
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Li WW, Froelicher ES. Predictors of smoking relapse in women with cardiovascular disease in a 30-month study: extended analysis. Heart Lung 2008; 37:455-65. [PMID: 18992629 DOI: 10.1016/j.hrtlng.2008.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 07/18/2008] [Accepted: 07/22/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify predictors of long-term cessation after intervention for woman hospitalized with cardiovascular diseases (CVD). METHODS A randomized clinical trial (RCT) with a 30-month follow-up was conducted, recruiting 277 woman smokers with CVD from 10 hospitals. The intervention consisted of inpatient and outpatient counseling on smoking cessation and pharmacological protocol. Psychophysiological factors and time since quitting associated with relapse in the literature were assessed in our prediction model. RESULTS The nine independent variables for smoking relapse included time since quitting, group assignment, the interaction between time and group assignment, serious quit attempts and five and psychophysiological factors. Lower self-efficacy at baseline was a significant predictor of relapse (OR = 0.98, 95%CI = 0.97,0.99). Another predictor was the interaction between time and group assignment and the finding showed that for the usual care group, increase in time since quitting provided a significant protective factor (OR = 0.69, 95%CI = 0.60,0.79). CONCLUSIONS Cessation programs should include content on self-efficacy to help prevent relapse. The interaction between time and group warrants further investigation for its prediction for relapse.
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Affiliation(s)
- Wen-Wen Li
- School of Nursing, San Francisco State University, San Francisco, California 94132, USA
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Evidence-Based Practice to Assist Women in Hospital Settings to Quit Smoking and Reduce Cardiovascular Disease Risk. J Cardiovasc Nurs 2008; 23:397-406. [DOI: 10.1097/01.jcn.0000317449.87649.8e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sohn M, Benowitz N, Stotts N, Christopherson D, Kim KS, Jang YS, Ahn MS, Froelicher ES. Smoking behavior in men hospitalized with cardiovascular disease in Korea: A cross-sectional descriptive study. Heart Lung 2008; 37:366-79. [DOI: 10.1016/j.hrtlng.2007.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 10/13/2007] [Accepted: 11/05/2007] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Healthcare professionals, including nurses, frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES To determine the effectiveness of nursing-delivered smoking cessation interventions. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group specialized register and CINAHL in July 2007. SELECTION CRITERIA Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow up of at least six months. DATA COLLECTION AND ANALYSIS Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed effect model and reported the outcome as a risk ratio (RR) with 95% confidence interval (CI). MAIN RESULTS Forty-two studies met the inclusion criteria. Thirty-one studies comparing a nursing intervention to a control or to usual care found the intervention to significantly increase the likelihood of quitting (RR 1.28, 95% CI 1.18 to 1.38). There was heterogeneity among the study results, but pooling using a random effects model did not alter the estimate of a statistically significant effect. In a subgroup analysis there was weaker evidence that lower intensity interventions were effective (RR 1.27, 95% CI 0.99 to 1.62). There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized patients also showed evidence of benefit. Nine studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Five studies of nurse counselling on smoking cessation during a screening health check, or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions. AUTHORS' CONCLUSIONS The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses to patients, with reasonable evidence that intervention is effective. The evidence of an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice, so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow up.
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Affiliation(s)
- V H Rice
- Wayne State University, College of Nursing, 5557 Cass Avenue, Detroit, Michigan 48202, USA.
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Sohn M, Stotts NA, Benowitz N, Christopherson D, Kim KS, Jang YS, Ahn MS, Froelicher ES. Beliefs about health, smoking, and future smoking cessation among South Korean men hospitalized for cardiovascular disease. Heart Lung 2007; 36:339-47. [PMID: 17845880 DOI: 10.1016/j.hrtlng.2006.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2005] [Accepted: 11/13/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND A particularly high rate of smoking among South Korean men corresponds to high rates of cardiovascular disease. OBJECTIVES This study evaluated South Korean men hospitalized with cardiovascular disease to explore beliefs about the health benefits of smoking cessation, to determine smoking cessation intentions, and to identify factors associated with confidence in quitting smoking. METHODS This was a cross-sectional, descriptive study. RESULTS Of the study's 97 participants, only 78% believed that smoking cessation avoids or decreases the chance of developing heart disease; 93% reported their intention to quit; 74% had moderate to high confidence about quitting within the month after hospital discharge; and 88% preferred to quit by themselves without help. Significant predictors of low confidence in quitting were being married (odds ratio: 5.54, 95% confidence interval: 1.33-23.08); being alcohol dependent (odds ratio: 3.25, confidence interval: 1.20-8.80); and starting to smoke at or before 20 years of age (odds ratio: 2.96, confidence interval: 1.14-7.68). CONCLUSION The study's participants were motivated to quit smoking for their health, but they must be educated to understand that smoking is addictive and that special intervention is needed.
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Affiliation(s)
- Min Sohn
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
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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.
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Affiliation(s)
- N A Rigotti
- Massachusetts General Hospital, General Internal Medicine Unit, S50-9, Boston, Massachusetts 02114, USA.
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Wharf Higgins J, Young L, Cunningham S, Naylor PJ. Out of the mainstream: low-income, lone mothers' life experiences and perspectives on heart health. Health Promot Pract 2006; 7:221-33. [PMID: 16585145 DOI: 10.1177/1524839905278883] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular disease remains a health issue in North America, particularly for marginalized citizens. Although lifestyle issues and behavioral risk reduction continue to dominate prevention initiatives, an emerging literature suggests that contextual factors such as poverty and social exclusion also influence health. Using group and personal interviews (N = 38), this research explored the social and economic contexts shaping heart health-related experiences from the perspectives of low-income, lone mothers. The transcripts were analyzed using McKinlay and Marceau's upstream-midstream-downstream framework. The overriding pattern characterizing lone mothers' discussions was that the women felt out of the mainstream of everyday life. They lacked the resources and power to effect change, particularly regarding heart health behaviors that were not perceived to be a priority compared to more pressing survival issues. Results are discussed in terms of concepts from the population health and social determinants literature, concluding with policy implications for enhancing health while living in poverty.
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Affiliation(s)
- Joan Wharf Higgins
- School of Physical Education, University of Victoria, British Columbia, Canada.
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15
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Doolan DM, Froelicher ES. Efficacy of smoking cessation intervention among special populations: review of the literature from 2000 to 2005. Nurs Res 2006; 55:S29-37. [PMID: 16829774 DOI: 10.1097/00006199-200607001-00005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The United States Public Health Service acknowledges in the 2000 Clinical Practice Guideline for Treating Tobacco Use and Dependence that certain special populations have unique needs and considerations in regard to smoking cessation interventions. In a review of the current smoking cessation literature, the following special populations were identified: women; older adults; gay, lesbian, bisexual, and transgender smokers; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; American Indians and Alaska Natives; African Americans; Hispanics; and Asian Americans. Existing smoking cessation research pertaining to these special populations was assessed, and an agenda for future research is proposed in this presentation. The available smoking cessation randomized clinical trials for efficacy and other research relevant to these groups is insufficient. Recent progress has been made in research in the areas of smoking cessation and women; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; and African Americans. There is, however, a paucity of research evaluating smoking cessation interventions and older adults; gay, lesbian, bisexual, and transgender smokers; American Indians and Alaska Natives; Hispanics; and Asian Americans. Further research relevant to the smoking cessation needs of these special populations can enable nurses and other healthcare providers to administer culturally adequate and efficacious smoking cessation interventions to these groups.
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Affiliation(s)
- Daniel M Doolan
- Department of Physiological Nursing, University of California, San Francisco 94143-0610, USA
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Affiliation(s)
- Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California at San Francisco, 94143, USA.
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17
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Taylor-Piliae RE, Haskell WL, Froelicher ES. Hemodynamic responses to a community-based Tai Chi exercise intervention in ethnic Chinese adults with cardiovascular disease risk factors. Eur J Cardiovasc Nurs 2005; 5:165-74. [PMID: 16314148 DOI: 10.1016/j.ejcnurse.2005.10.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Revised: 10/18/2005] [Accepted: 10/19/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among older adults worldwide, including Europe, Asia, and North America. In the United States (US), CVD is also the leading cause of death among Asian-Americans. Physical activity has been shown to reduce CVD risk factors. Reduction in blood pressure (BP) in response to Tai Chi (TC) exercise in persons with CVD risk factors have been reported, though not in ethnic Chinese living in the US. AIM Hemodynamic responses to a 12-week community-based TC exercise intervention among ethnic Chinese with CVD risk factors were examined. METHODS Quasi-experimental design. Ethnic Chinese > 45 years old with at least 1 major CVD risk factor, living in the San Francisco Bay Area, attended a TC intervention three times a week for 12 weeks. A 2-min step-in-place test assessed aerobic endurance. BP and heart rate were measured at rest, and within 1-min after the step-test. Data were collected at baseline, 6 and 12 weeks. RESULTS A total of 39 subjects (69% women), 66 +/- 8.3 years old, with hypertension (92%), hypercholesteremia (49%), and/or diabetes (21%), and 1 current smoker participated. Adherence to the intervention was high (87%). Subjects were sedentary at baseline, though had a statistically significant improvement in aerobic endurance over-time (eta2 = 0.39). At baseline, the average BP at rest was 150/86, while BP in response to the step-test was 178/99. Clinically and statistically significant reductions in BP at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed. CONCLUSIONS This innovative, culturally relevant, community-based 12-week TC exercise intervention, appealed to Chinese adults with CVD risk factors, with significant reductions in BP and improvement in aerobic endurance. Given the number of persons estimated to have HTN and other CVD risk factors, the identification of new approaches to improve health, combined with risk factor reduction is needed. This is particularly important, given the rise in HTN among adults in the US and the associated public health burden of HTN. TC has the potential to reduce expenditures associated with CVD by facilitating a lifestyle that promotes physical activity, while remaining a low-tech, low-cost alternative to exercise.
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Affiliation(s)
- Ruth E Taylor-Piliae
- Stanford Prevention Research Center, School of Medicine, Stanford University, Hoover Pavilion, MC 5705, 211 Quarry Road, Room N229, Stanford, CA 94305-5705, USA.
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18
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Abstract
More than 500,000 US women die of cardiovascular disease (CVD) annually, exceeding deaths for cancer, accidents, and diabetes combined. Yet women are largely unaware of this and fear breast cancer more. One way of changing this number is to change the way we approach CVD, that is, to practice preventive healthcare. Until recently, guidelines for women with CVD were derived largely from research conducted primarily on white middle-aged men. Although evidence-based medicine is still lacking, guidelines and recommendations specifically for women are now available and include aggressive management of the risk factors of smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity. Unless women are educated regarding these risk factors and are enabled to make lifestyle changes, their chances of modifying and reducing their risks are severely impaired.
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Affiliation(s)
- Peggy Hardesty
- Division of Cardiology, University of Kentucky, 800 Rose Street, Goode, Lexington, KY 45036-029, USA.
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19
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Buchanan L. Commentary. West J Nurs Res 2005. [DOI: 10.1177/0193945904272651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Buchanan LM, El-Banna M, White A, Moses S, Siedlik C, Wood M. An Exploratory Study of Multicomponent Treatment Intervention for Tobacco Dependency. J Nurs Scholarsh 2004; 36:324-30. [PMID: 15636412 DOI: 10.1111/j.1547-5069.2004.04059.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To conduct an exploratory study of two interventions to help smokers abstain over a period of 3 months. The specific aims were to describe the outcomes, test feasibility of the study design, and evaluate effect size. DESIGN AND METHODS A randomized experimental design was used in a sample of 42 patients who received multicomponent treatment intervention (MTI) or standard care (SC) in a midwestern city in the United States. Variables were behavioral (quit rate, self-efficacy, motivation), psychosocial (depression, partner interaction), and symptom management (use of nicotine replacement therapy [NRT]). Data analysis included descriptive statistics and repeated measures ANOVA. RESULTS The typical participant was Caucasian, middle aged, nicotine dependent, married or partnered, and employed, and had a high school education. Participants in the MTI group were more likely to use NRT and to have higher self-reported quit rates at follow-up. Statistically significant differences were found between groups over time for self-efficacy and positive to negative behavior ratio. Barriers to quitting were relapse, stress, weight gain, lack of support, and depression that were more frequent in the SC group. For effect size (0.25), probability level (.05), and power (.80), a sample size of 140 patients was calculated. CONCLUSIONS The MTI group had higher quit rates, more NRT, higher self-efficacy, and more positive behavioral interactions. Limitations of the study included self-report of tobacco use, small sample, and attrition. The investigators suggest a future study with a larger sample to test whether multicomponent interventions with telephone calls after discharge are more effective than is standard care in helping patients to quit and continue to abstain from smoking.
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Affiliation(s)
- Lynne M Buchanan
- College of Nursing, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
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21
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Froelicher ES, Sohn M, Max W, Bacchetti P. Women's Initiative for Nonsmoking-VII: evaluation of health service utilization and costs among women smokers with cardiovascular disease. ACTA ACUST UNITED AC 2004; 24:218-28. [PMID: 15286526 DOI: 10.1097/00008483-200407000-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The Women's Initiative for Nonsmoking (WINS), a randomized clinical trial of a smoking cessation intervention for women with cardiovascular disease, permitted an assessment of the types and costs of health services women used during the 30 months after their hospitalization with cardiovascular disease. METHODS A prospective design nested within WINS was used for this study. A structured telephone interview guide included questions about medical services and 15 categories of prevention services, including cardiac rehabilitation at 6, 12, 24, and 30 months. Costs were estimated from state and national databases. RESULTS The 277 women studied had a mean age of 60.7 +/- 10 years. They had smoked approximately 40 +/- 11.4 years. More than 50% of the women had one or more risk factors for cardiovascular disease. During the first 6 months after the index hospitalization, 94% had a physician visit, 39% had an emergency-room visit, and 36% had a hospital admission. Prevention services used were home healthcare by nurse or home health aide (26%), a cardiac rehabilitation program, including Multifit and Heart Smart (19%), and physical therapy (14%). Usage decreased over the 30 months. For the women who used any service, the mean total monthly cost per woman was 913 dollars +/- 1204 dollars. CONCLUSIONS This is the first report on health service use by women smokers with cardiovascular disease. Data collection using a telephone interview guide proved feasible for evaluating health service use. The greatest costs resulted from hospital admissions and physician and emergency-room visits. Considering the high prevalence of risk factors in this cohort, secondary prevention services were severely underutilized. By increasing referrals to such services, physicians and nurses might influence women to reduce their risk for subsequent cardiovascular disease.
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Affiliation(s)
- Erika Sivarajan Froelicher
- Department of Physiological, Nursing, School of Nursing, University of California San Francisco, 94143-0610, USA.
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22
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Young LE, James AD, Cunningham SL. Lone motherhood and risk for cardiovascular disease: the National Population Health Survey (NPHS), 1998-99. Canadian Journal of Public Health 2004. [PMID: 15490920 DOI: 10.1007/bf03405140] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine whether lone parenthood among Canadian women is associated with risk factors for cardiovascular disease (CVD). METHODS The sample was from the National Population Health Survey (NPHS) and it included 2,184 mothers (women with dependent children < 18 years of age) of whom 478 were lone (22%) and 1,706 (78%) were partnered mothers. Descriptive statistics and multiple logistic regression were undertaken with weighted data. RESULTS Compared to partnered mothers, lone mothers were significantly younger, and reported lower levels of education and income. Lone mothers reported significantly lower levels of health, less social support, and more distress and depression than partnered mothers. Further, lone mothers were significantly more likely to be smokers than partnered mothers. Odds ratios for being a lone mother and current smoker on social assistance in this analysis was 4.15 (95% CI 2.27-7.60), and for those reporting low or mid/high incomes respectively, were 2.99 (1.51-5.90) and 3.01 (1.93-4.70). There were no significant differences between the two groups for obesity or physical activity. CONCLUSIONS Smoking is a significant CVD lifestyle risk for lone mothers. Smoking occurred in the context of considerable life stress, depression, and distress pointing to links between health behaviour, psychosocial factors, and CVD health. These results suggest that lone mothers are a key target group for primary prevention in the CVD field. Programs and policies that support lone mothers in their goals of attaining healthier lifestyles have the potential to contribute to the prevention of cardiovascular disease in Canadian women.
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Affiliation(s)
- Lynne E Young
- School of Nursing, University of Victoria, Vancouver, BC, Canada.
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23
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Abstract
Nursing research has contributed to our knowledge of patients with coronary heart disease (CHD), although much of the research has focused on acute cardiac events. Active and ongoing programs of research into CHD patient outcomes are essential as significant gaps remain. Consistently effective strategies to help patients change risk behaviors, recognize salient symptoms, manage their CHD and ischemic symptoms, improve function and quality of life, and prevent subsequent coronary events are needed, especially in the elderly and those with multiple comorbidities.
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Affiliation(s)
- Christi Deaton
- School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, United Kingdom.
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24
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Froelicher ES, Li WW, Mahrer-Imhof R, Christopherson D, Stewart AL. Women's Initiative for Non-Smoking (WINS) VI: reliability and validity of health and psychosocial measures in women smokers with cardiovascular disease. Heart Lung 2004; 33:162-75. [PMID: 15136776 DOI: 10.1016/j.hrtlng.2004.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We present psychometric properties of 9 health and psychosocial measures in a sample of hospitalized women with cardiovascular disease. This information will be useful to others needing to make choices about selection of health and psychosocial measurements in women smokers. METHODS Psychometric properties were examined using baseline measures from a cross-sectional study, nested within a randomized clinic trial, Women's Initiative for Non-Smoking. Women smokers hospitalized with cardiovascular disease were recruited from 10 hospitals in the San Francisco Bay Area. Measures included the perceived stress scale, a depression screener, self-efficacy, the sense of mastery scale, and measures of health-related quality of life from the Medical Outcomes Study. RESULTS The sample of 277 women smokers ranged in age from 34 to 86 years (mean = 61 +/- 10.1). Studies of variability, including floor/ceiling effects, skewness, range, mean, and SD, indicated that most measures had sufficient variability to be predictive and detect both positive and negative changes over time. Internal-consistency reliabilities ranged from 0.63 to 0.86. Preliminary evidence of construct validity was found, with most hypotheses being confirmed. CONCLUSIONS The battery of tests included in the Women's Initiative for Non-Smoking trial may be useful in identifying women at high risk of relapse and in detecting short-term quality-of-life outcomes. The measures generally performed well and show promise for advancing our understanding of the process of successful smoking cessation in this population. SUMMARY Psychometric properties of the perceived stress scale, a depression screener, self-efficacy for quitting smoking, the sense of mastery scale, and measures of health-related quality of life from the Medical Outcomes Study in 277 women smokers hospitalized with cardiovascular disease were examined. The measures generally performed well and show promise for advancing our understanding of smokers in this population.
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Affiliation(s)
- Erika Sivarajan Froelicher
- Department of Physiological Nursing at the School of Nursing, University of California San Francisco, 94143-0610, USA
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25
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Sivarajan Froelicher ES, Miller NH, Christopherson DJ, Martin K, Parker KM, Amonetti M, Lin Z, Sohn M, Benowitz N, Taylor CB, Bacchetti P. High Rates of Sustained Smoking Cessation in Women Hospitalized With Cardiovascular Disease. Circulation 2004; 109:587-93. [PMID: 14769679 DOI: 10.1161/01.cir.0000115310.36419.9e] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although men hospitalized with cardiovascular disease (CVD) show high smoking-cessation rates, similar data for women are lacking. We tested the efficacy of smoking-cessation intervention in women hospitalized for CVD. METHODS AND RESULTS In this randomized controlled trial conducted from 1996 to 2001, 277 women diagnosed with CVD (mean age 61+/-10 years) were randomly assigned within 1 of 12 San Francisco Bay Area hospitals to a usual-care group (UG; n=135) or intervention group (IG; n=142). Baseline histories were obtained, and interviews to ascertain self-reported smoking status occurred at 6, 12, 24, and 30 months after hospitalization. The UG received strong physician's advice, a self-help pamphlet, and a list of community resources. The IG received strong physician's advice and a nurse-managed cognitive behavioral relapse-prevention intervention at bedside, with telephone contact at intervals after discharge. The groups were similar demographically and had smoked cigarettes for a median of 38 (IG) or 40 (UG) years. Time to resumption of continuous smoking was assessed by Kaplan-Meier analysis, and risk differences between groups were determined. Time smoke-free was significantly greater for the IG than the UG (P=0.038). Point prevalence for nonsmoking at the interviews was somewhat greater for the IG than the UG (P>0.15 at all times). CONCLUSIONS Cognitive behavioral intervention resulted in longer average times to resumption of smoking, but in these 2 groups of older women with limited social and financial resources, long-term success rates were similar. Systematic identification of smokers and even the brief intervention afforded the UG yielded a high smoking-cessation rate over time.
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Affiliation(s)
- Erika S Sivarajan Froelicher
- University of California at San Francisco, Department of Physiological Nursing, School of Nursing, San Francisco, CA 94143-0610, USA.
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26
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Abstract
OBJECTIVES To provide an overview of US population groups at particular risk for tobacco-related diseases. DATA SOURCES Surgeon General's reports, other official reports, published articles, research studies. CONCLUSION The burden of tobacco-related health alterations in known and less known population groups with reduced or absent access to primary health care services, infer that epidemiologic measures may be underestimated. Underestimations of these persons at risk have implications for future resource planning, allocation, and service. IMPLICATIONS FOR NURSING PRACTICE Nurses can assist in the identification of and access to at-risk populations before morbidities are at a late stage of diagnosis.
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Affiliation(s)
- Kim M Hutchinson
- Wake Forest University Health Sciences, Department of Public Health Sciences, 2000 W First St, Suite 244, Winston-Salem, NC 27157, USA
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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.
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Affiliation(s)
- N A Rigotti
- ICRF General Practice Research Group, Institute of Health Sciences, Old Road, Headington, Oxford, UK, OX3 7LF.
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Mahrer-Imhof R, Froelicher ES, Li WW, Parker KM, Benowitz N. Women's Initiative for Nonsmoking (WINS V): under-use of nicotine replacement therapy. Heart Lung 2002; 31:368-73. [PMID: 12487015 DOI: 10.1067/mhl.2002.126539] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the use of nicotine replacement therapy (NRT) in a nurse-managed smoking cessation program. DESIGN A cohort design nested within the WINS randomized clinical trial was used with follow-up at 2, 7, 21, 28, and 90 days. SETTING The study took place in 10 hospitals in the San Francisco Bay Area. SUBJECTS Participants included 142 women hospitalized with cardiovascular disease (CVD). OUTCOME MEASURE The outcome measure was the use of NRT after having been assessed as eligible for its use. INTERVENTION NRT was used as an adjunct in the behavioral intervention protocol. NRT was recommended during the hospital intervention and during the 90-day outpatient phase. RESULTS Of 142 women in the intervention group, 127 met the criteria for NRT use. During the 5 follow-up assessments, the reported NRT use ranged from 9% to 22%. CONCLUSION A low NRT use rate among women with CVD is evident. The results suggest that future research about NRT myths pertaining to women is needed. Nurses can help patients dispel these myths and prevent smoking relapse in women with CVD.
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Affiliation(s)
- Romy Mahrer-Imhof
- Department of Physiological Nursing, School of Nursing, University of California-San Francisco, San Francisco, CA, USA
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