Tobacco use prevalence, knowledge and attitudes among Italian hospital healthcare professionals

Quality of life in working populations with and without musculoskeletal pain in Saudi Arabia

BACKGROUND

Musculoskeletal (MSK) pain can negatively affect work life and quality of life (QoL).

OBJECTIVE

This study characterizes the QoL of workers in Saudi Arabia and compares it between adults of working age with and without MSK pain.

METHODS

This is a descriptive cross-sectional study. The Short Form-36 (SF-36) instrument was used to measure eight domains that describe QoL among workers with and without MSK pain. Descriptive statistics and parametric tests enabled comparisons between the two sets of workers.

RESULTS

A total of 2042 workers participated in the study. The majority of them had experienced MSK pain during the last 12 months. In addition, the results for most SF-36 domains varied significantly across age and gender groups. Workers who lacked MSK pain over the last 12 months reported higher means for all SF-36 domains, with the exception of the physical function domains.

CONCLUSION

This study found that the majority of workers experience MSK pain. In all bodily regions, neck and back pain are the most frequently reported areas of discomfort for these employees. Workers without MSK pain experience better QoL. This observation suggests the need for managers to pay closer attention to workers with MSK pain, as these employees experience significantly lower QoL. To prevent or reduce MSK pain, workers should undergo routine medical examination and early intervention for MSK pain. These preventative measures can help to increase workers' QoL.

Smoking Prevalence, Knowledge and Perceptions on Tobacco Control Among Healthcare Professionals: A Survey in an Italian Cancer Center

Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in "IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion.

Determinants of smoking cessation counseling favorable practice for primary care physicians: A cross-sectional study from Palestine

Background:

Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants.

Methods:

Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah.

Results:

295 physicians were enrolled in the study with an 86% response rate. 75.5% (n = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31–41%). Attitude is the main predictor of favorable practice (P value = 0.002, adjusted OR = 1.1).

Conclusion:

Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.

Global Cardiovascular Risk Profile of Italian Medical Students Assessed by a QR Code Survey. Data from UNIMI HEART SURVEY: Does Studying Medicine Hurt?

Background: Few studies to date have addressed global cardiovascular (CV) risk profile in a “protected” young population as that of medical school students. Objective: to assess CV traditional risk factors and global CV risk profile of Italian medical students throughout the six years of university. Methods: A cross-sectional survey accessible online via quick response (QR) code was conducted among 2700 medical students at the University of Milan, Italy. Data on baseline characteristics, traditional CV risk factors, diet, lifestyle habits, and perceived lifestyle variations were evaluated across different years of school. Results: Overall, 1183 students (mean age, 22.05 years; 729 women (61.6%)) out of 2700 completed the questionnaire (43.8% rate response). More than 16% of the students had at least 3 out of 12 CV risk factors and only 4.6% had ideal cardiovascular health as defined by the American Heart Association. Overweight, underweight, physical inactivity, sub-optimal diet, smoke history, and elevated stress were commonly reported. Awareness of own blood pressure and lipid profile increased over the academic years as well as the number of high-blood-pressure subjects, alcohol abusers, and students constantly stressed for university reasons. Moreover, a reduction in physical-activity levels over the years was reported by half of the students. Conclusion and Relevance: This study demonstrates that a “protected” population as that of young medical students can show an unsatisfactory cardiovascular risk profile and suggests that medical school itself, being demanding and stressful, may have a role in worsening of the lifestyle.

The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis

AIMS

To gain new insights into the experiences of nurses who smoke and to understand the impact of those experiences on their delivery of smoking cessation interventions.

DESIGN

A meta-ethnographic synthesis.

DATA SOURCES

CINAHL, Embase, MEDLINE, PsychINFO, Web of Science and grey literature databases were searched from their inception to April 2019.

REVIEW METHODS

Meta-ethnography was employed to synthesize findings from included studies. The CASP qualitative checklist was used to appraise the quality of each study, and the GRADE-CERQual approach to appraise review findings. The synthesis is reported in accordance with the eMERGe reporting guidance.

RESULTS

From an initial search outcome of 6,019 citations, 13 studies were included detailing the experiences of 195 nurses who were smokers or ex-smokers. Four main themes were identified beliefs, dissonance, coping mechanisms and workplace policies. An integrated conceptual map was proposed on the basis of findings. Nurses who smoke were aware of tobacco harms and their role in addressing tobacco use, which resulted in experiences of guilt and stigma. Workplace policies played a crucial role in the creation of cognitive dissonance. Nurses used different strategies to cope with dissonance such as rationalizing smoking benefits, hiding their smoking behaviour, denial of smoking risks, and failing to engage with smoking cessation interventions. Some nurses expressed more positive aspirations to cope with their dissonance, including a willingness to quit and to embrace smoking cessation interventions with their patients.

CONCLUSION

Implementing smoke-free policies and supportive interventions targeting nurses' cognitive dissonance may assist them to quit smoking and improve their engagement in smoking cessation practices.

Smoking Prevalence, Attitudes and Behavior among Dental Students in Poland and Italy

The aim of the study was to perform preliminary research to compare the smoking prevalence, attitudes and behavior between dentistry students in two universities in Europe using the standardized Global Health Professions Student Survey (GHPSS) questionnaire. This was cross-sectional carried out among dentistry students from the Medical University in Bialystok, Poland and Sapienza University of Rome, Italy. There were 582 participants; 282 were Italians, 202 were smokers and 42% were Italians. The response rate was 79.9% of Italian students and 79.6% of Polish students. The prevalence of smoking was significantly higher among Italian students (42% vs. 28.0%). Attitudes and behaviour of smokers and non-smokers differed statistically. Polish and Italian dental students presented statistically different behavior regarding the time to smoke the first cigarette, the willingness to stop smoking and trying to stop smoking in the last year. The multiple logistic regression analysis revealed that two independent variables, exposure to second-hand smoke (SHS) both at home and in public places (OR = 3.26 and OR = 5.9, respectively), showed a significantly higher occurrence of smoking. There is a high use of tobacco among dental students, which is particularly high in Italian dental students. Students realizes the positive perception of their own tobacco counsellor role in a dental setting. Dental students should be role models to their peers and patients.

Assessment of Mental Health Factors among Health Professionals Depending on Their Contact with COVID-19 Patients

It seems that the medical personnel in contact with patients infected with SARS-CoV-2 are at an especially high risk of adverse psychological effects. Therefore, the aim of this study was to assess the mental health factors among healthcare workers by quantifying the severity of anxiety, depression, and sleep disorders during the current SARS-CoV-2 pandemic, while taking into account coexisting diseases. The study involved 441 healthcare professionals including 206 healthcare workers at emergency wards, infectious wards, and intensive care units. The control group consisted of 235 healthcare workers working in wards other than those where individuals from the study group worked. Regression adjusted by age, gender, the occurrence of hypertension, diabetes mellitus, dyslipidemia, asthma, autoimmune diseases, and cigarette smoking showed the elevated risk of anxiety on the Generalized Anxiety Disorder (GAD-7) scale (OR = 1.934; p < 0.001), depression on the Patient Health Questionnaire (PHQ-9) scale (OR = 2.623; p < 0.001), and sleep disorders on the Insomnia Severity Index (ISI) scale (OR = 3.078; p < 0.001). Our study showed that healthcare workers who are exposed to SARS-CoV-2-infected patients at emergency wards, infectious wards, and intensive care units are at a much higher risk of showing symptoms of anxiety, depression, and sleep disorders than healthcare workers working in other wards.

Smoking cessation interventions on health-care workers: a systematic review and meta-analysis

Objective

The authors carried out a systematic review and a meta-analysis on smoking cessation interventions on health -care workers to clarify the state of the art interventions and to identify the best one.

Materials and Methods

This review was registered with PROSPERO: CRD42019130117. The databases PubMed, Scopus, Web of Science and CINAHL were searched until December 2018. Quality of all studies included in the systematic review was assessed according to the Newcastle-Ottawa Scale (NOS) on cohort or cross-sectional studies and to the Cochrane Risk of Bias Tool for Randomized Controlled Trials. Meta-analysis and meta-regression analyses were also carried out for cohort studies (quasi-experimental or a before-after studies design) and clinical trials.

Results

Twenty–four studies have been included in the analysis: four before-after, 13 cross-sectional, three quasi-experimental studies and four clinical trials. Articles were heterogeneous (P for homogeneity <0.01), but they have all shown positive results since they reached the goal of smoking cessation among health-care workers, even if with different proportions. Meta-analysis was performed on 10 studies (six cohort studies and four clinical trials), showing a 21% of success rate from the application of smoking cessation interventions, either pharmacological or behavioral ones. The resulted pooled RR (Risk Ratio) was 1.21 (95% CI [1.06–1.38]), being 24% of success rate from clinical trials (pooled RR 1.244; 95% CI [1.099–1.407]) and 19% of success rate from cohort studies (pooled RR 1.192; 0.996–1.426). However, two studies have confidence intervals which include unity and one study has a wide confidence interval; as a consequence, the meta-analysis for its results depends heavily on one single study. Meta-regression analysis revealed that results were influenced by the number of participants.

Conclusion

Both policy and pharmaceutical interventions can obtain positive results in quitting smoking among health-care workers. However, as shown by our review, combination approaches can produce better results in terms of cessation percentages and smoking abstinence.

Cigarette smoking at workplace among resident physicians and nurses in Mansoura University Hospital

Smoking at workplace (WP) is common among healthcare workers. A cross-sectional study was conducted upon resident physicians and nurses to determine the prevalence of WP smoking and its associated factors. A questionnaire was used to collect socio-demographic and occupational data, smoking history, nicotine dependence, and attitude toward smoking and its control in WP. More than one-fifths (22.7%) of residents and nurses were current WP smokers. Significant independent predictors are having shift work, high nicotine dependence, and having positive attitude toward smoking with AOR (95% CI): 29.4 (4.9-177.1), 18.2 (3.3-101.1), and 0.16 (0.02-0.84), respectively. The prevalence of smoking among resident physicians and nurses in Mansoura University Hospital is relatively high. Enforcement of WP smoking-free policies is required together with encouragement of positive attitude toward smoking cessation.

Smoking in nursing students: A prevalence multicenter study

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

Tobacco use and attitudes on tobacco control among faculty members of a medical school in Northern Cyprus (tobacco use among medical teachers)

The smoking prevalence of medical faculty members has not been a subject of research as frequently as physicians and medical students. The objective of this study was to determine the status of tobacco use and some attitudes among medical faculty members of a Northern Cyprus university. The data were collected by a questionnaire of 22 questions, developed in compliance with WHO guidelines. The data were analyzed using IBM-SPSS 23.0 with p < .05 evaluated as significant. For this cross-sectional study, 128 members of the 146 academics responded (response rate of 87.7%). Lifetime smoking frequency was 46.9%. Current smokers comprised 21.9% while 7.0% consumed non-cigarette products with overall tobacco use of 26.6%. Of the smokers, 52.9% had started smoking at medical school. Regarding doctors being nonsmoking role models, positive attitudes were expressed significantly more by non-smokers than smokers. Only 33.8% were covering tobacco control in their teaching programs while 86.5% had positive attitudes for comprehensive tobacco control in the curriculum. The medical faculty members had a relatively high frequency of tobacco use and the tobacco issue did not have sufficient content in the education programs. Promisingly, the majority of the medical faculty members were in a supportive attitude for comprehensive tobacco control education.

Tobacco consumption and environmental exposure among healthcare students in King Saud University in Riyadh

OBJECTIVES

The goal of this study was to determine the prevalence of tobacco smoking in healthcare students at a university in Riyadh, Saudi Arabia, along with environmental exposure and potential influential factors.

METHODS

This observational cross-sectional study was conducted at King Saud University from January-April 2019. It included 1,273 randomly selected male and female first- to fifth-year undergraduate healthcare students from all health colleges at the university. The study used a self-administrated questionnaire and descriptive data analysis. Associations between variables were tested using a Chi-square test with the statistical significance set at P value < 0.05.

RESULTS

Among the 1,273 respondents, the prevalence of tobacco product smoking was 13.7%. The prevalence was highest in the College of Applied Science (34.5%) and lowest in the College of Pharmacy (10.9%). Among those 18- to 21-year-olds, the prevalence was 43.1%, while it was 51.1% for the 22-25 age group and only 5.8% for those 26 or older. Common reasons for smoking cigarettes included having fun or passing time (45.2%) and relieving stress (33.3%). Among those who smoked a water-pipe (12.5%), the most common reason was to enjoy its flavors (42.1%). The prevalence of secondhand smoking at home was 31.7%, and environmental exposure was 42.5%.

CONCLUSION

Tobacco consumption is a common problem among healthcare students including cigarette as well as the increasing consumption of water-pipe in addition to secondhand smoking. Along with proven strategies to promote smoking cessation, including smoke-free laws, improved access to effective quitting treatments and media campaigns are needed to reduce tobacco consumption.

CONSUMPTION OF PSYCHOACTIVE SUBSTANCES BY NURSING WORKERS: AN INTEGRATIVE REVIEW

ABSTRACT Objective: to analyze the scientific evidence available on the factors and implications related to the use of psychoactive substances by nursing workers. Method: an integrative review, which had the following as selection criteria: primary studies, published between 2008 and 2017, without language restrictions and that included aspects related to the consumption of psychoactive substances by nursing professionals. The bibliographic survey was carried out in the months of September and October 2018, in the following databases: CINAHL, MEDLINE, SCOPUS, Web of Science and LILACS, BDENF and IBECS via the Virtual Health Library. Results: a total of 14 articles were analyzed, with predominance of cross-sectional (28.57%), qualitative descriptive (28.57%), and quantitative descriptive (14.28%) studies, with significant samples ranging from 12 to 33,588 nursing professionals, and with 2C level of evidence (100.00%). The synthesis of knowledge was formulated in two categories: Predisposing factors for the consumption of psychoactive substances by nursing workers; and Implications of the use of psychoactive substances in personal life and in the quality of nursing care. Conclusion: the evidence found shows that the use of psychoactive substances represented a reality present in the daily lives of nursing workers and the close relationship with the working conditions represented the main associated factor, with the work environment being the major influencer for consumption.

Prevalence of smoking in nursing students worldwide: A meta-analysis of observational studies

BACKGROUND

Smoking is common among nursing students worldwide, but the reported prevalence is inconsistent across epidemiological studies. This is a meta-analysis of the prevalence of smoking in nursing students worldwide.

DESIGN

Meta-analysis of observational studies.

SAMPLE

A total of 46 studies were included in this meta-analysis.

METHOD

Electronic databases (PubMed, Medline, PsycINFO, EMBASE and Web of science) were independently and systematically searched by two investigators from their commencement date up to 12 May 2018. Studies that reported the smoking rate of nursing students were included and analyzed using random-effects model.

RESULTS

The pooled prevalence of current smoking was 26.6% (95% CI: 22.9-30.4%), while pooled prevalence of previous smoking was 15.5% (95% CI: 11.8-19.3%). Subgroup analyses showed that smoking rate was higher in male compared with female students (39% vs 25.2%, P < .001), while survey time, sample size, age, study design and academic year did not moderate the smoking rate (all P > .05).

CONCLUSION

This meta-analysis confirmed that smoking is common in nursing students. Considering the negative impact of smoking on health, appropriate smoking cessation measures for nursing students should be developed.

Cigarette and E-Cigarette Use and Smoking Cessation Practices among Physicians in Poland

Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians’ behaviors toward smoking and vaping cessation interventions; and to assess differences in the tobacco cessation interventions recommended for cigarette smokers and users of electronic cigarettes (e-cigarettes). A questionnaire-based survey was conducted in 2018 among physicians attending mandatory public health training courses delivered at the School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland. The questionnaire included 25 questions related to tobacco product use and smoking cessation interventions. Data were obtained from 423 physicians (64.3% female; mean age 32.0 ± 5.8 years) with response rate of 84.6%. Current cigarette smoking was declared by 7.8% of participants; 1.9% of participants were e-cigarette users and 1.9% used heated tobacco. Smoking cessation interventions were offered more often to patients who smoked cigarettes than those who used e-cigarettes (p < 0.001). Physicians’ behaviors toward smoking cessation and vaping cessation interventions were associated with (p < 0.05) physicians’ smoking status and self-declared knowledge about smoking cessation methods. Among physicians in Poland, discussion of smoking cessation was not common behavior and limited mainly to identification of smoking status.

Cigarettes and Water Pipe Smoking Prevalence, Knowledge, and Attitudes Among the Palestinian Physicians in the West Bank

Background

Tobacco use is one of the major public health threats nowadays. Smoking can affect everybody organ. Health professionals should play pivotal roles in tobacco control, and their attitude and practice toward tobacco use can affect the health of the community. Therefore, assessing and influencing physicians' attitudes and practice are one of the alternatives to reduce smoking prevalence in the community. We aimed to assess smoking status among medical physicians in the West Bank, Palestine to better understand their future role in any smoking cessation program.

Material and methods

A cross-sectional study using the World Health Organization Global Health Professional Survey questionnaire was conducted. A non-probability sampling technique from a total of 6500 physicians registered in the Palestinian Medical Association in the West Bank was used.

Results

The age ranged from 23 to 78 years with a mean of 34.92 years. Current smokers represented 60.3%. Of them, 18.5% were both cigarettes and water pipe smokers. The main reason that motivates the physician to smoke is experimenting (57.9%). Also stress (31.8%) and social pressure (26.4%) were of the most common causes to start smoking. Almost all medical doctors have a high level of knowledge regarding the health consequences of smoking. Smokers were less likely to hold favorable attitudes toward smoking cessation and support tobacco control policy compared with non-smokers (P-values < .05).

Conclusions

Physicians' degree of awareness and knowledge about their role in aiding patients to quit smoking are high. However, smokers' attitudes toward smoking cessation programs need to be improved to increase their involvement in such interventional programs.

Prevalence and personal attitudes towards tobacco smoking among Palestinian healthcare professionals: a cross-sectional study

BACKGROUND

Little is known about tobacco smoking behaviors of healthcare professionals in the Middle East where stress conditions are high and tobacco smoking regulations are either absent or loose. The objective of this study was to identify the prevalence of and attitudes toward tobacco smoking among healthcare professionals.

METHODS

Trained senior medical students conducted a cross-sectional survey study in all governmental and non-governmental hospitals in Nablus city (Palestine) using a self-administered questionnaire containing both open-and closed-ended questions.

RESULTS

In total, 708 healthcare professionals participated in the study. The mean age of the participants was 31.4 ± 9.6 years. Forty-five (6.4%) participants were ex-smokers, 419 (59.2%) were never smokers, and 244 (34.5%) were current tobacco smokers. One hundred and forty-two (58.2%) tobacco smokers reported that they smoke inside the hospital and 119 (48.8%) reported that they think of quitting smoking. Univariate analysis indicated that age, gender, marital status, family history of tobacco smoking, country of graduation, and night shifts were significantly associated with tobacco smoking status. No significant difference (p = 0.156) in prevalence of tobacco smoking was found between physicians and other healthcare professionals. Binary logistic regression indicated that older age, male gender, and having a positive family history of smoking were significant predictors of being a current tobacco smoker. Non-smokers had significantly higher frequency of patient counseling than current smokers.

CONCLUSION

Palestinian healthcare professionals have relatively higher prevalence of tobacco smoking compared to the general population. Urgent national intervention and strict implementation of "No Smoking Law" in health institutions and in public places are needed to root out this negative behavior.

GHPSS Multicenter Italian Survey: Smoking Prevalence, Knowledge and Attitudes, and Tobacco Cessation Training among Third-Year Medical Students

Aims and background

Healthcare professionals have an important role to play both as advisers – influencing smoking cessation – and as role models. The aims of this study were to examine smoking prevalence, knowledge and attitudes among Italian university students attending medical schools using the Global Health Professions Student Survey (GHPSS) approach.

Methods and study design

A multicenter cross-sectional study was conducted among University students of 9 Italian medical schools (age ranging between 19 and 29 years). The GHPSS questionnaire was self-administered. A logistic regression model was used to identify possible factors associated with tobacco smoking status. Data were analyzed with the software SPSS 19.0 for Windows.

Results

Seven hundred thirty medical students (response rate 100%) were enrolled. The prevalence of current smokers was 20.4% (males 22.4%, females 19.1%). Of the total sample, 87.7% believed that health professionals should receive specific training in techniques to quit smoking, and 65% believed that health professionals had a role in giving advice or information about smoking cessation. However, 89.4% answered that they had not received specific training on smoking cessation techniques. Multivariate analysis showed that students belonging to universities in southern Italy were more likely to be smokers (OR = 2.00; 95% CI: 1.03–3.97).

Conclusions

This Italian multicenter survey found that one fifth of future medical doctors are smokers. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Prevalence, habits and personal attitudes towards smoking among health care professionals

BACKGROUND

Tobacco use is the second major cause of morbidity and the 4th most common health risk factor in the world. Medical professionals have a critical role in the process of smoking cessation both as advisers and behavioural models for the citizens. The aim of this study was to investigate the prevalence of smoking among health care professionals, their smoking habits and personal attitudes toward smoking, role and the responsibility of health care professionals in the prevention of smoking.

RESULTS

Out of the total number of examinees, 175 (35,1%) are active smokers, 29 (5,8%) are former smokers, and 295 (59,1%) are non-smokers. Nurses with secondary education disagree the most with the claim that passive smoking is more harmful to health (χ2 test, p = .008), also with the claim that the introduced Smoking Act is fair to smokers (χ2 test, p = .021). More nurses with secondary education disagree completely or partially that one should pay attention to smoking in the presence of non-smokers (χ2 test, p = .012).

CONCLUSION

Training programs for health care workers are needed to improve their ability in smoking cessation techniques to provide active support to their patients.

Awareness and knowledge of cardiovascular disease risk factors among medical students

BACKGROUND

The aim of this study was to assess the knowledge and attitude of medical students in relation to cardiovascular disease (CVD) risk factors as well as to assess the impact of medical education on their knowledge and recognition of the importance of implementation of preventive measures.

METHODS

This cross-sectional study included 514 students in the second year of studying at the Faculty of Medicine in Belgrade, Serbia (younger students response rate 79.57%) and 511 students in the last year of education (older students response rate 90.21%). For data collection, an anonymous self-administered questionnaire was used, which included two types of questions about CVD risk factors and questions about the student's attitude.

RESULTS

Older students knew significantly more about CVD risk factors than students who were at the beginning of their medical studies; however, more than half of the older students did not know the correct answers about CVD risk factors. The only exceptions were questions about "bad" and "good" cholesterol, metabolic syndrome (MSy) and lipid lowering therapy in high risk subjects. Physical inactivity, obesity, type 2 diabetes, smoking and hypertension were not ranked highly enough as important CVD risk factors. Compared groups of students did not significantly differ in attitude scores. The majority of them recognized CVD as the leading cause of death, had normal weight and knew their own blood pressure.

CONCLUSION

Knowledge of medical students from Belgrade about CVD risk factors should be improved.

Awareness, Attitude and Use of Tobacco among Medical Students in Chennai

BACKGROUND

Health professionals have an important role to play in the fight against tobacco. As individuals, health professionals can help educate the population; as community members, they can support anti-smoking policies; and, at a societal level, they can influence national and global tobacco control efforts. The objectives of the study was to estimate the prevalence of tobacco use among medical students in Chennai and to measure the extent of attitude toward, behavior around and knowledge of tobacco use among medical students.

METHODS

This cross-sectional study was conducted among 400 medical students from 4 randomly selected medical colleges, comprised of 1 government and 3 private medical colleges in and around Chennai, India. The Global Health Professional Students Survey (GHPSS), a standardized college-based tool, was administered to students in the four medical colleges.

RESULTS

The proportion of students who ever tried cigarette smoking was found to be 10.9% (males, 23.5% and females, 1.8%). The prevalence of exposure to tobacco smoke at home was found to be 34.2%. A majority of students agreed that smoking should be banned. The proportion of students who wanted to quit smoking cigarettes and who ever tried to stop smoking were 29.8% and 34.6% respectively. Only 23.6% of the students said they have received formal training in smoking cessation techniques.

CONCLUSION

As indicated by the majority of the medical students queried, there is a need for formal training in smoking cessation techniques, and this training should be included in the medical curriculum, such that students can instruct or counsel their patients.

General Practitioners and Dentists: A Call for Action Against Tobacco

INTRODUCTION

To investigate the frequency of advice to quit smoking received by the Italian population from general practitioners (GP) and dentists, we analyzed a cross-sectional study.

METHODS

A face-to-face survey was conducted in 2014 on 3052 individuals, representative of the general Italian population aged 15 years or more.

RESULTS

During the previous year, 89% of individuals (82% of smokers) reported that they had visited a GP while 71% (67% of smokers) had visited a dentist. Among smokers, 25% reported that they had received advice to quit smoking from their GP, and 26% from their dentist. Advice by GPs was less frequently received by smokers with higher education (multivariate odds ratios (OR) were 0.48 for intermediate and 0.38 for high as compared to low education), and more frequently by heavy smokers (≥15 cigarettes/day; OR = 1.78), those with intention to quit (OR = 2.59), with previous quit attempts (OR = 2.09), and those aware of the existence of smoking cessation services (OR = 1.59). Advice by dentists was more frequently received by smokers aged 25-44 years (OR = 3.55 compared to those aged 15-24) and those with an intention to quit (OR = 2.46). Among Italian current smokers, 32% reported that their GP and 17% that their dentist was a current smoker. The corresponding figures among young smokers were 40% and 26%, respectively.

CONCLUSION

Healthcare providers have the potential to become a key reference point in the fight against smoking. However, before acting, GPs and dentists should set a good example: those who smoke should urgently quit or at least refrain from smoking during working hours.

IMPLICATIONS

GPs and dentists, reaching the large majority of Italian smokers, can make a major contribution in the fight against tobacco. Future studies are needed to investigate possible reasons of the apparently high smoking prevalence among GPs, in order to develop tailored smoking cessation interventions for healthcare providers.

Hospital doctors' smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre

PURPOSE

Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians' smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field.

METHODS

A Web-based survey was sent to 285 physicians.

RESULTS

The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients' smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients' stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward.

CONCLUSIONS

This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians' smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.

Smoking Knowledge, Attitude, and Practices Among Health Care Professionals from Sulaymaniyah City/Iraq

BACKGROUND

Smoking is a serious risk to health globally. Health care professionals play a key role in the prevention of smoking as they are considered a role model by patients.

OBJECTIVES

The aims of this study are to evaluate smoking rate among physicians and dentists from Sulaymaniyah, Iraqi Kurdistan, Iraq, and to understand their knowledge and attitudes toward tobacco smoking.

METHODS

A cross-sectional web-based survey was conducted involving physicians and dentists working in both University of Sulaimani and Sulaymaniyah Teaching Hospitals. A questionnaire created based on World Health Organization Global Health Professional Survey with slight modifications was emailed to the study participants and the responses received were analyzed.

RESULTS

Incidence of smoking among physicians and dentists was 26.5%, with a significantly higher rate among male compared to female health care professionals. The mean age of starting smoking was 22.3 (±4.8) years. Only 7.3% of health care professionals received formal training on smoking cessation. All responders agreed that smoking is harmful to health. However, ever smokers compared to never smokers were less likely to agree that health care professionals should set a positive impact by not smoking.

CONCLUSION

Smoking rate is high among physicians and dentists from Sulaymaniyah city/Iraq, and at the same time, there is a low rate of training on smoking cessation.

Tobacco Smoking Habits Among First Year Medical Students, University of Prishtina, Kosovo: Cross-sectional Study

Introduction:

Tobacco smoking remains the leading causes of preventable morbidity and mortality in the world, requiring intensified national and international public health response. World Health Organization (WHO) has urged health professional organizations to encourage and support their members to be models for not using tobacco products and promote tobacco-free culture. Healthcare students are the future authority of the health society, they are in a position to play a vital role and have impact on social norms related to smoking.

Aim:

To determine the prevalence of tobacco smoking among healthcare students of Medical Faculty, University of Prishtina in Kosovo, so that recommendations can be made for its cessation among healthcare providers and thereafter the community.

Materials and methods:

Descriptive cross-sectional study was conducted using self-administrated questionnaire prepared for this purpose. A total of 284 first year healthcare students of Medical Faculty, University of Prishtina in Kosovo were enrolled in the study. The data were analyzed using SPSS 22.

Results:

All respondents completed the questionnaire, giving a response rate of 100% (general medicine=180, dentistry = 104). The prevalence of students who have ever smoked was 53.2%. However, only 8.9% (9.1% M vs. 8.7% F) of the general medicine students and 5.8% (4.8% M vs. 6.5% F) of dentistry students declared that smoke tobacco every day. Overall, the research shows that the prevalence of occasional smokers among medical students in Kosova is quite high.

Changes in use, knowledge, beliefs and attitudes relating to tobacco among nursing and physiotherapy students: a 10-year analysis

AIM

To analyse changes in prevalence, knowledge, beliefs and attitudes relating to smoking among undergraduate nursing and physiotherapy students over a 10-year period.

BACKGROUND

Few studies have been performed to describe changes in the use of tobacco and associated characteristics.

DESIGN

This study was a sequential cross-sectional study.

METHODS

A self-administered survey was performed during three academic years among nursing and physiotherapy students in a Spanish Faculty of Health Sciences.

FINDINGS

The proportion of smokers among nursing and physiotherapy students in 2003, 2008 and 2013 was 29·3%, 24·7% and 18·2% respectively. The ages when participants first smoked did not vary over the years. The Fagerström test showed low nicotine dependence. A significantly high percentage of students stated they were unaware of the link between smoking and bladder cancer and oral leukoplakia. Students declared they were unaware of the association between under-weight new-borns and second-hand smoke. The majority of students recognized that healthcare professionals were role models in society, there being little variation over the years studied. In relation to education and training, the study showed a need to inform students about methods and strategies to help people quit smoking.

CONCLUSIONS

The prevalence of smoking among nursing and physiotherapy students decreased over the ten years. Active programmes should be implemented to encourage those university students who smoke to break this habit. The decline over the years in knowledge about smoking provided evidence of a significant deficit in undergraduate training.

Antibiotic use: a cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy

Background

Since antibiotic resistance has become a worldwide public health concern and is in part related to physicians’ lack of knowledge, it is essential to focus our attention on healthcare profession students. The present study aims at evaluating the knowledge and attitudes of the School of Medicine’s students towards antibiotic usage and antibiotic resistance.

Methods

In December 2013, a cross sectional study was conducted amongst medical, dental, nursing and other health care profession students of the School of Medicine at the University of Torino. Students of all the academic years took part in this study. Questionnaires were submitted during regular lectures (only students who attended courses on one specific day were surveyed) and the data collected was analyzed using StataMP11 statistical software.

Results

Overall, 1,050 students were interviewed. The response rate was 100%. Around 20% of the sample stated that antibiotics are appropriate for viral infections and 15% of the students that they stop taking those drugs when symptoms decrease. Results of the multivariate analyses showed that females were more likely than males to take antibiotics only when prescribed (OR 1.43, 95% CI 1.04–1.98). Interestingly, students with a relative working in a health-related field, as well as those who took at least one course of antibiotics in the last year, had a lower probability of taking those drugs only under prescription (OR = 0.69 95% CI: 0.49–0.97 and OR = 0.38 95% CI: 0.27–0.53, respectively).

Conclusion

The present paper shows how healthcare profession students do not practice what they know. Since those students will be a behavioral model for citizens and patients, it is important to generate more awareness around this issue throughout their studies. It would be advisable to introduce a specific course and training on antibiotics in the core curriculum of the School of Medicine.

Knowledge, attitudes and tobacco use among nursing and physiotherapy students

BACKGROUND

As future health educators, nursing and physiotherapy students will play an essential role in the prevention of smoking.

AIM

To determine the prevalence of smoking among students and to analyse their knowledge of and attitudes towards smoking.

METHOD

This was a descriptive cross-sectional study using an anonymous questionnaire and conducted in a Spanish Faculty of Health Sciences in 2013.

FINDINGS

247 nursing and physiotherapy students (82.33%) participated in the study. The global prevalence of smoking (18.2%) was lower compare with the general population group of the same age. We have observed statistical significance in relation to previous studies. Nursing and physiotherapy students showed a low nicotine dependence. We found a lack of knowledge about the harmful effects of cigarette consumption on health. Statistically significant results were also found in relation to degree courses (p < 0.01) as regards students' opinions about their knowledge of strategies and methods to help patients stop smoking.

CONCLUSION

Most students started smoking before commencing their university studies; consequently, interventions should focus on cessation programmes. An analysis of university curricula leading to the award of a degree in the health sciences could serve to identify educational deficiencies in order to implement the necessary modifications.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This paper presents an update in tobacco use characteristics amongst nursing and physiotherapy students. Those results have showed a need to improve the curricula in order to develop specific programmes to improve knowledge, attitudes and beliefs. Measures to prevent smoking must be taken at school.

Fighting against cigarette smoking among medical students: a success story

A survey in the year 2007 among medical students of Ankara University Medical School to assess the smoking rates showed that 25.1 % of them were smoking. Moreover, the smoking rate was 35 % at sixth grade students and 60 % of the smokers specified that they started smoking at medical school. This report provides a successful approach to decrease smoking among medical students by measures against starting smoking. An "Antismoking Group" composed of voluntary academic staff, nurses, students, psychologists, and a social worker of the medical school was established to engage in lowering the smoking rate and eliminating it eventually among our students. Several methods including regular monthly meetings, annual "Smoking or Health" symposiums, and lectures to first, second, and third grade students to increase their awareness related to harms of smoking and their role in the fight against smoking were carried out. Our surveys in the years 2009 (641 students) and 2012 (975 students) showed that total smoking rates dropped to 15.0 and 11.0 %, respectively (p < 0.0002). Moreover, the smoking rate for the sixth grade students dropped from 35.0 % in 2007 to 21.8 and 8.8 % in the years 2009 and 2012, respectively (p < 0.0002). In 2012, the smoking rates of first year and sixth year students were 7.8 and 9.0 %, respectively. These close rates of smoking at the first and last years of medical school training and the significant drop in smoking rates in 5 years confirm that our group pursued a realistic and successful strategy against smoking.

Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies

BACKGROUND

To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies.

METHODS

We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register.

RESULTS

Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. 'Mouth and throat irritation', 'nausea', 'headache' and 'dry cough' were the most frequently AEs reported.

CONCLUSIONS

The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.

Smoking ban policies in Italy and the potential impact of the so-called Sirchia Law: state of the art after eight years

OBJECTIVE

The aim of the present work is to describe the state of the art of tobacco habits in Italy, eight years after the law was introduced.

METHODS

Time series analyses, based on estimates of smoking prevalence/consumption derived from the openly available data of national surveys performed during the 2001-2013 period, were performed. Data have been expressed in percentage of smokers and daily cigarettes consumption. Time changes are expressed as expected annual percentage change (EAPC).

RESULTS

Over time, the percentage of Italian smokers shows a constant and statistically significant decrease (from 28.9% in 2001 to 20.6% in 2013, EAPC = -2.6%, and P < 0.001). Regarding data stratified by gender, we found a stronger reduction among men (EAPC = -2.9%, P < 0.001) than in women (EAPC = -2.5%, P < 0.001). Similarly, the consumption of tobacco smoking, measured as the number of daily cigarettes smoked, registered a downward trend (P < 0.001). No join point (time point when a significant trend change is detected) resulted from the trend analysis.

CONCLUSIONS

Data show a constant decrease of tobacco consumption in Italy, with no join point related to the introduction of the banning law. These findings require to reflect on the priorities of the smoking banning policies that may be focused on other intervention activities such as to increase the price of cigarettes.

Graduate nurses and nursing student's behaviour: knowledge and attitudes toward smoking cessation

BACKGROUND

Smoking remains the largest single cause of preventable mortality. In rural Australia where the incidence of smoking is higher, health is substantially worse than other Australians. Smoking cessation is difficult with many attempts made before success. Health professionals are in a prime position to assist smoking cessation but are failing to consistently assess tobacco use and assist patients quit. Nurses who form the largest cohort of health care professionals, should play a part in smoking cessation yet their influential role is hugely underutilised. Given the strategic place of nurses to advance the anti-smoking message during clinical interactions, data was needed on smoking rates as well as on smoking attitudes and behaviours.

OBJECTIVES

To determine the smoking rates and behaviour as well as attitudes of nurses toward assisting hospitalised patients to cease smoking.

DESIGN

Descriptive survey research design.

PARTICIPANTS

Non-probability sampling of undergraduate nursing students (n=153) and graduate nursing students (n=64) from a regional nursing school in an Australian university.

METHODS

Survey.

RESULTS

Factor analysis revealed four clearly differentiated factors, non-smoker's rights, cessation beliefs, cessation attitudes and therapeutic relationships. Significant differences were present in nurse's perceptions of smoking rights across age categories but not for other factors, no significant gender differences were noted across categories, nor were significant differences noted between levels of nursing qualifications across categories however smoking status revealed significant differences in perceptions of rights.

CONCLUSIONS

Student and graduate nurses are aware that they are role models and that they have an influential role in modifying patient behaviour. When it comes to assisting patients to cease tobacco use, age and smoking status of nurses influence their actions. Nursing curriculums need to emphasise the role nurses play in smoking cessation and give them the tools they need to help patients QUIT.

Tobacco use among health care workers in southwestern Saudi Arabia

The present study targeted health care workers (HCWs) in Governmental Hospitals and Primary Health Care Centers in Abha City, southwestern Saudi Arabia. An anonymous self-report questionnaire was used to assess tobacco use and the reasons for smoking. The present study included 736 HCWs. The overall prevalence of tobacco use amounted to 26.3% (14.8% current and 11.5% former users). In a binary logistic regression analysis, males were found significantly more prone to smoke compared to females (aOR = 3.081, 95% CI: 2.004–4.739). Similarly, parental history of tobacco use was found to be a significant risk factor (aOR = 1.540, 95% CI: 1.040–2.278). Among current users, 89.9% were interested in quitting and 66.1% tried before to quit. The prevalence of smoking among HCWs in the present study, besides being a public health problem, represents a potential barrier in involving this group as a first line for tobacco control. There is a need for a national intervention programme in the country in a tailored manner for HCWs to control tobacco use parallel to the running national program for public. These interventions should begin early in basic medical education and to be applied continually during one's medical career.

Smoking health professional student: an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Quality of life among healthcare workers: a multicentre cross-sectional study in Italy

OBJECTIVE

To evaluate the quality of life among doctors, nurses, and occupational safety and health technologists (OSHT).

STUDY DESIGN

Cross-sectional study was undertaken in a population of healthcare workers in 10 Italian regions.

METHODS

The Italian version of short form-36 (SF-36) was anonymously and voluntarily self-administered by participants to assess the perceived health-related quality of life (HRQOL). The HRQOL scores for the sample and the Italian population were compared. A multiple linear regression was performed to assess the influence of age, gender, role, socializing time, working time, years spent in healthcare and years spent in the specific department on the SF-36 score.

RESULTS

The sample included 324 healthcare workers [57.1% women, mean age 39.0 (standard deviation 10.2) years]: 52.6% were medical doctors, 36.8% were nurses and 10.5% were OSHTs. Workers with a career of >15 years achieved a general health score lower than that of workers with a shorter career, while those who spent more time in socializing activities achieved a higher mental health score. The multivariate analysis showed that increasing age is positively related to role emotional levels (β = 0.243; P = 0.002), while it appears to be inversely related to general health (β = -0.218; P = 0.007) and physical function (β = -0.246; P = 0.001). Nurses had lower scores for bodily pain (β = -0.214; P < 0.001), social function (β = -0.242; P = 0.001) and role emotional (β = -0.211; P = 0.006) compared with doctors. Compared with the general Italian population, healthcare workers had higher scores for general health, physical function, role physical, bodily pain and mental health, and lower scores for vitality, social function and role emotional.

CONCLUSIONS

Healthcare workers have different levels of HRQOL related to their professional role. In particular, nurses have lower quality of life. These results may help to identify the main roles and attitudes that could cause frustration, dissatisfaction and emotional stress in healthcare workers.

Smoking behaviour predicts tobacco control attitudes in a high smoking prevalence hospital: a cross-sectional study in a Portuguese teaching hospital prior to the national smoking ban

BACKGROUND

Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC) attitudes before the national ban came into force in January 2008.

METHODS

Questionnaire-based cross-sectional study, including all eligible staff.

SAMPLE

52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR) was performed to identify factors associated with smoking status and TC attitudes.

RESULTS

Smoking prevalence was 40.5% (95% CI: 33.6-47.4) in males, 23.5% (95% CI: 19.2-27.8) in females (p < 0.001); 43.2% in auxiliaries, 26.1% in nurses, 18.9% among physicians, and 34.7% among other non-health professionals (p = 0.024). The findings showed a very high level of agreement with smoking bans, even among smokers, despite the fact that 70.3% of the smokers smoked on the premises and 76% of staff reported being frequently exposed to second-hand smoke (SHS). In addition 42.8% reported that SHS was unpleasant and 28.3% admitted complaining. MLR showed that smoking behaviour was the most important predictor of TC attitudes.

CONCLUSIONS

Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.

The Gap between Tobacco Treatment Guidelines, Health Service Organization, and Clinical Practice in Comprehensive Cancer Centres

Smoking cessation is necessary to reach a higher quality of life, and, for a cancer patient, it represents an important step in improving the outcome of both prognosis and therapy. Being a cancer patient addicted to nicotine may be a critical situation. We conducted a survey to monitor how many comprehensive cancer centres in Italy have an outpatient smoker clinic and which kinds of resources are available. We also inquired about inpatient services offering psychological and pharmacological support for smoking cessation, reduction, or care of acute nicotine withdrawal symptoms. What we have witnessed is a significant gap between guidelines and services. Oncologists and cancer nurses are overscheduled, with insufficient time to engage in discussion on a problem that they do not consider directly related to cancer treatment. Furthermore, smoking habits and limited training in tobacco dependence and treatment act as an important barrier and lead to the undervaluation of smokers' needs.