Awareness, practices, and barriers regarding smoking cessation treatment among physicians in Saudi Arabia

Client's perception toward services of smoking cessation clinics in Riyadh, Saudi Arabia

Background

In Saudi Arabia, approximately 70,000 deaths yearly occur from diseases caused by smoking. Assessing patients' smoking behavior in primary care has apparent benefits. Assisting patients with smoking cessation is one of the essential roles of primary care. This study evaluated the quality of smoking cessation clinic counseling in Riyadh, Saudi Arabia, based on customer opinions of such services.

Methods

This research employed a cross-sectional approach involving individuals attending smoking cessation clinics located within primary health care centers in Riyadh city. The participants were chosen through random selection. They were informed about the study's objectives, and those who consented to take part were contacted and provided with an online questionnaire to complete.

Results

A total of 340 subjects participated (95.6%) of them were males, and 41.2% were in the age group of 25 to 35 years old. The common modality of tobacco use was cigarettes (82.6%), and 87.9% reported consuming tobacco daily. The mean (±SD) total score of the Fagerstrom Test of Nicotine Dependence was 5.03 (±2.36), and the highest percentage (44.4%) of the participants had a moderate level of nicotine dependence. The vast majority (93.8%) of the participants had former quitting experiences. Half (50.9%) of the participants showed complete satisfaction with the cessation clinics, while 13.2% and 9.1% of them were not satisfied or slightly satisfied, respectively.

Conclusion

The majority of smoking cessation clinic visitors were satisfied with the services provided, exceeding three-quarters of them, with half totally satisfied.

Healthcare providers' knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape

Background

Clinicians are crucial in encouraging smokers to quit through behavioural or pharmacological smoking cessation interventions. Smokers quit better with professional help. The level of healthcare providers' (HCPs) knowledge, attitudes and counselling skills related to effective smoking cessation support in the study area remains uncertain.

Aim

The study aimed to determine HCPs' knowledge, attitudes and practices (KAP) on smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape.

Setting

Sol Plaatje's 13 district municipality clinics, Kimberley, Northern Cape.

Method

A descriptive, cross-sectional analytical study involving healthcare workers in the above setting.

Results

A total of 165 HCPs, including medical officers, professional nurses, enrolled nurses and assistant-enrolled nurses working in primary healthcare clinics, were invited to participate in the study, with 156 completing the questionnaires. About 53.9% had no knowledge of South African tobacco smoking cessation guidelines, while 87.2% knew the importance of counselling patients about smoking and its impact on quitting. The majority of them did not know the medicines recommended for tobacco treatment in South Africa. About 89.7% expressed that smoking cessation counselling is an important part of their jobs. However, less than half indicated that they make follow-up arrangements for those attempting to quit.

Conclusion

The study revealed gaps in KAP regarding smoking cessation among the respondents, necessitating the need for continuing education on the existing smoking cessation guidelines among these HCPs.

Contribution

The results of this study will help to improve smoking cessation intervention knowledge among health providers.

Implementing smoking cessation in routine primary care-a qualitative study

Background

The use of digital tools has been proposed as a solution to some of the challenges of providing preventative services in primary care. Although there is a general acceptance among patients to use digital self-help tools to quit smoking, and healthcare organizations are increasingly urged to incorporate these tools in clinical practice, it is unclear how and for whom these innovations can be incorporated into clinical practice.

Objectives

To explore health care professionals' perceptions about smoking cessation practice in routine primary care and the use of digital tools in this work.

Methods

A qualitative study with nine in-depth telephone interviews with health care professionals working in primary care in Sweden. Convenience sampling and snowball technique was used as recruitment strategy. Informants included registered, district and auxiliary nurses as well as behavioral therapists. All informants were female, between 43 and 57 years old and experience of working with smoking cessation in primary care and possibility to recommend digital interventions to smokers.

Results

Informants described smoking cessation practice in primary care as (i) identifying smoking patients, (ii) pursuing standardized routines for smoking cessation practice and (iii) keeping smoking cessation practice on the agenda. Digital tools were described by informants to be used in different ways: (i) replicating practice, (ii) complementing practice and (iii) enabling access to health care practitioners. Finally, the analysis showed that patients' expectations and behaviors contributed to how and when smoking cessation practice was conducted, including the use of digital tools.

Conclusions

Implementing smoking cessation practice in primary care in Sweden encompass continuous work of reaching smoking patients, building buy-in among peers and keeping tobacco on the practice agenda. Digital interventions are used to replicate, complement and enabling access to care. The findings suggest that poor continuity of staff and negative attitudes towards preventative work may challenge smoking cessation practice. However, societal changes in the awareness of the health risks of tobacco use including shifting social norms regarding the acceptance of smoking may contribute to a normalization of speaking about smoking in primary care practice. Increased knowledge is needed on how, and for whom digital tools can be incorporated in clinical practice.

Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia

Background. Healthcare workers (HCWs) can play a signifi- cant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke. Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia. Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated. Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs- based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) sys- tem-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC. Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the deliv- ery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.

Screening and management of tobacco, alcohol, and unhealthy drug use in Saudi Arabia: uptake and practices from primary care physicians' perspective

BACKGROUND

Screening and management of tobacco, alcohol, and unhealthy drug use by primary care physicians are crucial because a minority of individuals seek medical advice. However, data regarding this practice are limited. The study objective was to assess the screening practices of primary care physicians in Saudi Arabia for tobacco, alcohol, and unhealthy drug use, barriers to screening, and management of such cases.

METHODS

In this cross-sectional study, an online survey was sent to primary care physicians in Saudi Arabia.

RESULTS

A total of 952 physicians participated in the study. Most did not use validated screening tools. A significant proportion of physicians believed that the patient could not answer accurately about using alcohol or drugs and considered it socially unacceptable to ask about these substances. Family physicians screened their patients more frequently for smoking than general practitioners (P < 0.05). More years of experience and practice in the Northern Province of Saudi Arabia were predictors of frequent screening for alcohol and drug use (P < 0.05 and P < 0.01, respectively). Providing information about the risks of these behaviours and brief motivational interviews were the most reported practices.

CONCLUSIONS

Most physicians did not utilize validated screening tools. Addressing these barriers is a crucial step in initiating effective screening programmes. Several barriers have been reported from the physicians' perspective; further study to explore these issues from patients' perspectives is suggested. Moreover, raising physicians' awareness about using validated screening tools and locally available services is recommended.

Practice, barriers, and facilitators of healthcare providers in smoking cessation in Mexico

OBJECTIVE

To assess the clinical practice, barriers, and facilitators in promoting smoking cessation in primary healthcare clinics in Mexico City.

MATERIALS AND METHODS

A mixed method design was used. Surveys (n = 70) and semi-structured interviews (n = 9) were conducted with health personnel involved in smoking cessation clinics.

RESULTS

Quantitative data revealed that physicians were more likely than nurses to 1) ask patients if they smoke (57.9% vs 34.5%, p = .057), 2) ask patients if they are interested in quitting smoking (65.7% vs 26.9%, p = .003), 3) provide advice to quit smoking (54.3% vs 29.2%, p = .056), and 4) assess whether pharmacotherapy is needed (21.9% vs 10%, p = .285). Qualitative data showed that nurses were more likely than physicians to report lack of resources to refer patients to smoking cessation services, lack of pharmacotherapy availability, and lack of provider training in smoking cessation. Reported barriers include lack of motivation among patients, lack of time for assessment, long appointment wait times, and lack of training. Reported facilitators include existence of smoking cessation programmes and pharmacotherapy at no cost to the patient, and having a multidisciplinary team.

CONCLUSIONS

Due to numerous barriers, smoking cessation interventions are partially implemented in primary care clinics in Mexico City. A restructuring of services is necessary, and nurses should be given a more prominent role.

[Factors associated with medical residents' brief counseling]

INTRODUCTION

Smoking is a public health problem. Physicians have an important role in the fight against smoking, particularly by means of the brief advice they can give. The aim of this work was to study the prevalence of brief advice application by medical residents and to identify factors that may condition its practice.

METHODS

We conducted a descriptive and analytical study with prospective data collection that included 302 residents practicing in Tunisia who had agreed to respond to an online questionnaire submitted in February and March 2020.

RESULTS

Residents' mean age was 28±2 years and the gender ratio was 0.65. Sixty-four percent of them were non-smokers. During their practice, 94% systematically identified their patients' smoking status, but 61.9% were unfamiliar with the concept of brief advice. Residents' brief advice application rate was 57.6%. In multivariate analysis, the factors impacting brief advice application were: gender (OR=0.321, p=0.0001), familiarity with brief counseling (OR=2.808, p=0.002) and having observed brief advice being given by a senior physician (OR=2.328, p=0.0001).

CONCLUSION

The rate of brief advice application remains low. On this subject, improved theoretical and practical teaching during medical studies is essential.

Exploratory randomised trial of face-to-face and mobile phone counselling against usual care for tobacco cessation in Indian primary care: a randomised controlled trial protocol for project CERTAIN

INTRODUCTION

Despite widespread use of smokeless tobacco products by people within the Indian subcontinent, there is little awareness among Indians of its health hazards when compared with smoked tobacco. We hypothesise that mobile phone counselling will be feasible and effective for smokeless tobacco cessation intervention in India. This paper presents the protocol of the development and conduct of an exploratory trial before progression to a full randomised controlled trial.

METHODS AND ANALYSIS

An exploratory randomised controlled trial will be conducted in urban primary health centres in the state of Odisha, India. A total of 250 smokeless tobacco users will be recruited to the study (125 in each arm). Participants in the intervention arm will receive routine care together with a face-to-face counselling intervention followed by advice and reminder mobile messages. The control arm will receive routine care, delivered by a primary care physician based on 'Ask' and 'Advice'. All participants will be followed up for 3 months from the first counselling session. The primary outcome of this trial is to assess the feasibility to carry out a full randomised controlled trial.

ETHICS AND DISSEMINATION

Ethical approvals were obtained from the Institutional Ethics Committee of Public Health Foundation of India, Health Ministry's Screening Committee, Odisha State Ethics Board and also from University College London Research Ethics Committee, UK. The study findings will be published in a peer-reviewed scientific journal.

TRIAL REGISTRATION NUMBER

CTRI/2019/05/019484.

Health Workers' Practice Towards Smoking Cessation Intervention Based on 5A's Model and Associated Factors in Public Hospitals, Hadiya Zone, Southern Ethiopia

Background

The tobacco pandemic is one of the world's most serious public health concerns, killing more than 8 million lives per year. The worst burden is in low- and middle-income countries. Unless appropriate action is taken, the burden may worsen. Health workers are among the actors to implement smoke cessation interventions. However, the level of intervention practices towards smoke cessation was not defined.

Objective

To determine health workers' practice towards smoke cessation interventions based on 5A's model and associated factors in public hospitals.

Methods

Facility-based cross-sectional design was used. All public hospitals found in the Hadiya zone were included in the study. From each public hospital, representative number of health workers, who fulfil inclusion criteria, were included in the study. A total of 323 sample size of health workers were used. A self-administered questionnaire was employed to collect data. Both descriptive and advanced analyses were performed using SPSS software version 20.0. In bivariable analysis, variables with p-value < 0.25 were considered for multivariable analysis. Finally, odds ratio with 95% CI and p-value < 0.05 were used to declare factors as significantly associated with the outcome variable.

Results

About 97% of health care workers had poor practice on smoking cessation interventions. About 7.4% (23) health workers reported as they were current smokers. Moreover, only 28% of health workers asked their patients about smoking status. Being females, having <10 years of service, training and having good knowledge was significantly associated with the outcome variable.

Conclusion

Majority of the healthcare workers surveyed did not provide smoking cessation interventions. Identified statistically significant factors with the practice of smoke cessation interventions in this study were sex, knowledge, training and service years. Therefore, strategies should be designed and implemented to improve and equip the health workers towards practising of smoke cessation interventions by instituting smoke cessation programs.

Lifestyle Counseling for Patients with Type 2 Diabetes in the Southwest of Saudi Arabia: An Example of Healthcare Delivery Inequality Between Different Healthcare Settings

Purpose

Adherence to a healthy lifestyle can have a positive impact on the course of diabetes management. This investigation aims to study lifestyle counseling provision among patients with type 2 diabetes in Saudi Arabia and the delivery of lifestyle counseling within different healthcare settings.

Methods

This cross-sectional investigation was conducted in the Jazan region in Saudi Arabia. Data were collected using a semi-structured questionnaire during phone interviews. The questionnaire measured items related to the demographics of the patients, diabetes diagnoses, and follow-up locations. The items pertaining to lifestyle counseling were related to whether the patients were given an assessment of dietary and physical activity levels, receipt of a personalized lifestyle change plan, and smoking cessation therapy among smokers. Odds ratios (ORs) were calculated to estimate the probability of receiving the lifestyle counseling items in primary healthcare centers (PHCs) compared to other healthcare facilities.

Results

A total of 461 patients diagnosed with diabetes were identified. The development of symptoms or complications related to diabetes was the main cause of diagnosis (63%). Sixty-six patients reported not attending a follow-up at any healthcare facility. The ORs of receiving a lifestyle plan and having daily caloric needs calculated were higher among patients who followed up at hospitals, diabetes centers or within the private sector compared to those who went to PHCs (ORs: 1.8 [1.1–2.8] and 2.7 [1.2–5.9] respectively). In all the identified healthcare settings, health education was mostly provided by the treating physicians, indicating the limited role of nutritionists or health educationists.

Conclusion

This study suggests a limited receipt of lifestyle counseling services for patients with type 2 diabetes in PHCs compared to other healthcare facilities. The majority of counseling services were provided by physicians, which indicates the limited inter-disciplinary involvement of other health professionals, such as nutritionists and health educationists.

When primary care providers and smokers meet: a systematic review and metasynthesis

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Changes in Attitude to Waterpipe Tobacco Smoking among Youngsters in Eastern Province, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

A growing number of epidemiological evidence suggests a significant increase in waterpipe tobacco smoking, and its potential to become a major public health concern in most Arabic countries, including Saudi Arabia.

METHODS

A cross-sectional study was carried out to assess the prevalence of intention to quit among ever users of waterpipe and intention to start among the never users. The study also investigated the barriers that may prevent users from quitting or trigger the nonusers to start waterpipe smoking. The study consisted of 464 university students from Eastern Province, Saudi Arabia.

RESULTS

One hundred and sixty-eight (36.2%) participants were responded that they had WTS at least one time in the past. Among the ever users of WTS, 120 (71.4%) participants had made an attempt or more to quit WTS in the past, 64 (38.1%) had made more than one attempt, and nearly two-third expressed the intention to quit WTS in the future. Forty (13.5%) out of 296 never-users expressed their intention to start WTS in the future. The study further showed that peer influence, social acceptance, and risk perception were significant predictors of intention to start or stop WTS among students.

CONCLUSION

It is promising that substantial users have the intention to discontinue WTS, though a fraction of never users wish to try WTS in the future.<br />.

Does Medication Sampling Improve Compliance with Brief Advice? Results from a Pragmatic Randomized Clinical Trial

Introduction

The 5As model is a standard component of most guidelines for tobacco treatment. Unfortunately, provider adherence to this model is modest.

Aims

Providing physicians with adjunctive tools to adhere to 5As guidelines may serve as a catalyst for brief advice delivery.

Methods

This was a secondary data analysis of a cluster randomized clinical trial assessing the uptake and impact of free nicotine replacement therapy (NRT) sampling versus standard care in primary care. Patients reported receipt of separate elements of the 5As model, assessed one month following a baseline visit. Analyses compared patients who recalled receipt of brief advice among those who received NRT vs. standard care. Additional analyses examined demographic predictors of receiving brief advice. Results/Findings. Medication sampling did not improve compliance with ask, advise, or assess. Receipt of “assistance” was significantly higher among NRT recipients (70%) (p ≤ 0.0001). The NRT sampling group was more likely to have received all components (p = 0.004). As age increased, being asked (p = 0.006), advised (p = 0.05), and assessed (p = 0.003) decreased. Non-Whites reported higher rates of assessment (p = 0.02).

Conclusions

Provision of NRT sampling increased provider compliance with some elements of the brief advice model, thus enhancing the impact of cessation advice within primary care. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02096029.

The Emerging Global Tobacco Treatment Workforce: Characteristics of Tobacco Treatment Specialists Trained in Council-Accredited Training Programs from 2017 to 2019

Tobacco use is projected to kill 1 billion people in the 21st century. Tobacco Use Disorder (TUD) is one of the most common substance use disorders in the world. Evidence-based treatment of TUD is effective, but treatment accessibility remains very low. A dearth of specially trained clinicians is a significant barrier to treatment accessibility, even within systems of care that implement brief intervention models. The treatment of TUD is becoming more complex and tailoring treatment to address new and traditional tobacco products is needed. The Council for Tobacco Treatment Training Programs (Council) is the accrediting body for Tobacco Treatment Specialist (TTS) training programs. Between 2016 and 2019, n = 7761 trainees completed Council-accredited TTS training programs. Trainees were primarily from North America (92.6%) and the Eastern Mediterranean (6.1%) and were trained via in-person group workshops in medical and academic settings. From 2016 to 2019, the number of Council-accredited training programs increased from 14 to 22 and annual number of trainees increased by 28.5%. Trainees have diverse professional backgrounds and work in diverse settings but were primarily White (69.1%) and female (78.7%) located in North America. Nearly two-thirds intended to implement tobacco treatment services in their setting; two-thirds had been providing tobacco treatment for 1 year or less; and 20% were sent to training by their employers. These findings suggest that the training programs are contributing to the development of a new workforce of TTSs as well as the development of new programmatic tobacco treatment services in diverse settings. Developing strategies to support attendance from demographically and geographically diverse professionals might increase the proportion of trainees from marginalized groups and regions of the world with significant tobacco-related inequities.

Smoking cessation and shared decision-making practices about lung cancer screening among primary care providers

Objective

We describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS).

Methods

Family, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns.

Results

Of 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p < 0.01). The majority of providers (47, 92%) reported that they engage in informed/shared decision‐making about LCS, although only about one‐third (17, 33%) indicated using a patient decision aid. Pulmonary medicine providers were more likely to use decision aids than providers from internal or family medicine (p < 0.04).

Conclusions

Within the context of LCS, primary care providers report often having conversations about smoking cessation with their patients who smoke, have no clear preference for type of treatment, and rarely use follow‐up calls or visits pertaining to quitting smoking. While many providers report engaging in shared decision‐making about LCS, few use a decision aid for this conversation.

Smoking cessation knowledge, attitude and practices among tuberculosis physicians: A qualitative study

INTRODUCTION

Smoking cessation interventions within tuberculosis (TB) care are feasible, effective and efficient for increasing smoking cessation rates. We aimed to assess TB physicians’ smoking cessation knowledge, attitude, and practices (KAP).

METHODS

We conducted a qualitative study with 21 TB physicians and utilized directed deductive content analysis with predefined knowledge, attitude, and practice categories. Physicians’ practice was analyzed using the ABC approach (Ask, Brief advice, and Cessation support).

RESULTS

Physicians acknowledged the importance of quitting for improved treatment outcomes and decreased risk of TB relapse. Physicians revealed presumed drug interactions, possible side effects of pharmacotherapy, and reluctance to take additional medications as challenges of smoking cessation interventions. Physicians asked about smoking behavior and provided a brief quitting advice to TB patients; however, implementation of cessation support was limited due to poor knowledge of evidence-based cessation methods and the absence of formal tobacco dependence treatment algorithms within TB care.

CONCLUSIONS

TB physicians’ KAP on smoking cessation was limited. Interventions targeting physicians’ knowledge and skills, and formalization of tobacco dependence treatment within TB care, are core for improving their smoking cessation practices in Armenia.

Barriers to and Facilitators of Adherence to Clinical Practice Guidelines in the Middle East and North Africa Region: A Systematic Review

The current review aims to investigate the barriers to and facilitators of the adherence to clinical practice guidelines (CPGs) in the Middle East and North Africa (MENA) region. English language studies published between January 2010 and May 2019 were searched on PubMed, Embase, and EBSCO. The barriers were categorized as clinician-related factors, such as lack of awareness of familiarity with the CPGs, and external factors, such as patients, guidelines, and environmental factors. The search identified 295 titles, out of which 15 were included. Environmental factors, specifically lack of time, resources, incentives, availability, and costs of treatment or diagnostic tests, training, and dissemination plans were the most commonly identified barriers. The familiarity with or awareness of healthcare professionals about the guideline, guideline characteristics, lack of agreement with the guidelines and preference in clinical judgment, physician self-efficacy, and motivation were reported to a lesser extent. Few studies reported on the compliance of facilitators with the guidelines including disseminating and advertising guideline materials, education and training on the guidelines, regulatory and financial incentives, and support from institutions. The review highlights that the studies on barriers to and facilitators of compliance with CPGs in the MENA region are limited in number and quality.

Smokers' and Non-Smokers' Attitudes towards Smoking Cessation in Saudi Arabia: A Systematic Review

Literature on smoking in Saudi Arabia is extensive. However, studies capturing the attitudes of both smokers and non-smokers towards smoking cessation are few. A PRISMA-P protocol guided systematic searches in MEDLINE and CINAHL on MeSH terms (smoking cessation AND Saudi Arabia). Peer reviewed articles in English were included in the narrative analysis. Screening reduced the 152 articles identified to 15 and independent critical appraisal identified 10 final articles for review. Few adopted validated survey tools or mentioned the best practice to be followed. There was considerable variation in the prevalence of smoking reported (13.7–49.2%) and survey response rates (8.9–100%). There was a paucity of quality evidence but it is clear that the smoking pandemic is still resonant in Saudi Arabia. Despite support for education programs to prevent the uptake of smoking, policy-driven action to reduce environmental second-hand smoking, and provision of support for smoking cessation, more needs to be done.

Smoking behavior of primary care physicians and its effect on their smoking counseling practice

Context:

Smoking among the primary care physicians (PCPs) is detrimental to not only their own health but it may also affect their attitude and practice towards smoking cessation counseling.

Aims:

We aimed to assess the smoking behavior of primary care physicians and its effect on their patient smoking counseling practices.

Subjects and Methods:

A cross-sectional study was conducted among the primary care physicians (N = 261) working under the Ministry of Health in Riyadh city, Saudi Arabia during May to June 2018. The data was collected using a self-administered questionnaire that was based on global adult tobacco survey. The participants were selected through simple random sampling.

Results:

About 16% of PCPs were found to be current smokers while about 9.6% were ex-smokers. On binomial logistic regression current smoking was observed to be independently associated with gender, specialty, and years of work experience (P < 0.01). The practice of smoking cessation advice was found to be significantly associated with physicians’ current smoking status after adjusting for other factors; PCPs who were non-smokers were 2.97 (95% CI 1.34-6.54) times more likely to always advice patients on cessation as compared to smoking colleagues.

Conclusions and Implications:

Smoking behavior of physicians was found to affect their patient smoking cessation counseling. This finding should be used in while planning and training staff for smoking cessation services in primary care settings.

Waterpipe smoking cessation: knowledge, barriers, and practices of primary care physicians- a questionnaire-based cross-sectional study

BACKGROUND

While cigarette smoking has been considered the most relevant tobacco product worldwide, waterpipe tobacco smoking (WTS) has increased in prevalence globally and calls for more considerable attention now. However, little is known about WTS cessation knowledge and clinical practices among physicians, particularly in Lebanon. This study aims to examine the knowledge, barriers, and cessation practices of primary care practitioners towards WTS.

METHODS

A cross-sectional study where an anonymous self-reported questionnaire was completed by physicians attending the Annual Conference of the Lebanese Society of Family Medicine for family medicine physicians, general practitioners, and internists in Lebanon.

RESULTS

Out of 180 attendees, 105 primary care practitioners (PCPs) responded to the questionnaire. Only 38.1% of the physicians think similar techniques are used for the cessation of smoking of both cigarette and waterpipe. Similarly, 30.5% of the physicians believe that nicotine replacement therapy works in the cessation of waterpipe smoking. There was a statistically significant difference between the percentage of physicians who counsel for cigarette smoking and those who counsel for waterpipe smoking cessation (p = 0.005) where 30% of the physicians tend to counsel against cigarette smoking more than waterpipe smoking.

CONCLUSIONS

This study shows a difference in the attitude and behavior of PCPs towards cigarette and waterpipe smoking cessation. Moreover, there is a lack of knowledge about water pipe smoking cessation techniques. There is a great room for continued medical education to PCPs in their private practice to improve their knowledge.

Factors associated with smoking cessation and smoking cessation interventions in the Gulf Cooperation Council countries

Objectives:

To examined published literature describing the predictors of smoking cessation (SC) and cessation interventions in Gulf Cooperation Council (GCC) countries.

Methods:

Systematic literature review using PubMed, Google Scholar, and grey literature. The study was conducted between October and December of 2017. Inclusion criteria were studies reporting factors associated with SC or studies of utilization or delivery of SC medications in GCC countries.

Results:

Twenty-one articles met the study criteria. Thematic analysis revealed factors associated with SC that were classified as individual or clinician level. Individual-level factors were access and cost of SC medications, knowledge about harms, concern about health, self-efficacy, perceived stress, level of tobacco consumption, belief about SC medications, clinician advice, social support, and enforcement of smoke-free ban. Clinician-level factors were time to provide counseling, training to assist patients, patient acceptance, best practice for treating patients, resources, perception related to responsibilities, and knowledge about effective medications.

Conclusion:

This review revealed perceived barriers to SC among smokers and clinicians in GCC countries. It highlighted cultural factors that need to be addressed by tobacco use policies in GCC countries to help smokers quit.

Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia

BACKGROUND

Despite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia.

METHODS

A sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015-May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients' motivation to quit, poor compliance with the treatment, patients' withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings.

CONCLUSIONS

Targeted interventions are needed to address barriers that limited PHPs' involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs' knowledge and skills in delivering smoking cessation counseling, to increase patients' demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.

The Difference a Decade Makes: Smoking Cessation Counseling and Screening at Pediatric Visits

INTRODUCTION

There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children.

METHODS

Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics.

RESULTS

In 1997-1999, 1.5% of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8% in 2009-2011 (P < .001). A marked increase from 4.1% to 11.1% was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95% CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95% CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses.

CONCLUSION

These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented.

IMPLICATIONS

A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.