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Chen CH, Lin TM, Hung SC, Wu MJ, Tsai SF. A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation. Tob Induc Dis 2023; 21:127. [PMID: 37818037 PMCID: PMC10561597 DOI: 10.18332/tid/170626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/25/2023] [Accepted: 08/04/2023] [Indexed: 10/12/2023] Open
Abstract
Cigarette smoking is a critical issue in caring for patients of chronic kidney disease (CKD). However, there is no routine care program designed for combining both smoking cessation and CKD care. The process of our quality improvement (QI) collaboration used data under our routine payment-for-performance for pre-end-stage renal disease (P4P Pre-ESRD) in Taichung Veterans General hospital from 2020 to 2022. We share our experience with a QI project that integrates the Ottawa model for smoking cessation (OMSC) with the Pre-ESRD care program as part of routine CKD care. The electronic health information systems were improved to reduce workload of medical staff. The number was more for both qualified CKD educators and nephrologists for smoking cessation. The access and availability for smoking cessation were immediate and convenient for patients. Specifically, all the actions were performed by CKD educators, with nephrologists overseeing the process in routine care. By combining OMSC with the Pre-ESRD program, we were able to provide smokers with satisfactory access and availability to smoking cessation services within our healthcare facility. The smoker cases found were more in number (206 in 2020, 344 in 2021, and 421 in 2022). Before the integrated OSTC-Pre-ESRD program (in 2020), the proportion of smokers was 3.88%. After implementing the integrated program, smokers increased significantly on a yearly basis (9.69% in 2021 and 9.82% in 2022). Finally, case numbers of on-site smoking cessations increased significantly after implementing the integrated system (0 in 2020, 17 in 2021, and 20 in 2022). All CKD patients for smoking cessation were also more (8 in 2020, 46 in 2021, and 38 in 2022). After implementing the QI program, focusing on the integrated OMSC-Pre-ESRD program, we found more smokers undergoing smoking cessation. This QI program highlighted the importance of better access and availability for smoking cessation.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Life Science, Tunghai University, Taichung City, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
- Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Tzu-Mei Lin
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Su-Chi Hung
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Life Science, Tunghai University, Taichung City, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
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Meyerhoff J, Kornfield R, Mohr DC, Reddy M. Meeting Young Adults' Social Support Needs across the Health Behavior Change Journey: Implications for Digital Mental Health Tools. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2022; 6:312. [PMID: 36387059 PMCID: PMC9662762 DOI: 10.1145/3555203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In pursuit of mental wellness, many find that behavioral change is necessary. This process can often be difficult but is facilitated by strong social support. This paper explores the role of social support across behavioral change journeys among young adults, a group at high risk for mental health challenges, but with the lowest rates of mental health treatment utilization. Given that digital mental health tools are effective for treating mental health conditions, they hold particular promise for bridging the treatment gap among young adults, many of whom, are not interested in - or cannot access - traditional mental healthcare. We recruited a sample of young adults with depression who were seeking information about their symptoms online to participate in an Asynchronous Remote Community (ARC) elicitation workshop. Participants detailed the changing nature of social interactions across their behavior change journeys. They noted that both directed and undirected support are necessary early in behavioral change and certain needs such as informational support are particularly pronounced, while healthy coping partnerships and accountability are more important later in the change process. We discuss the conceptual and design implications of our findings for the next generation of digital mental health tools.
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Affiliation(s)
- Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rachel Kornfield
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Madhu Reddy
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA
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Smoking and COVID-19: Adding Fuel to the Flame. Int J Mol Sci 2020; 21:ijms21186581. [PMID: 32916821 PMCID: PMC7555793 DOI: 10.3390/ijms21186581] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a ‘cytokine storm’ which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.
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Borsari L, Storani S, Malagoli C, Filippini T, Tamelli M, Malavolti M, Nicolini F, Vinceti M. Impact of Referral Sources and Waiting Times on the Failure to Quit Smoking: One-Year Follow-Up of an Italian Cohort Admitted to a Smoking Cessation Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1234. [PMID: 29891823 PMCID: PMC6025586 DOI: 10.3390/ijerph15061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/01/2018] [Accepted: 06/09/2018] [Indexed: 11/21/2022]
Abstract
In Italy, the National Health Service offers specialized evidence-based support to smokers who would like to quit through smoking cessation (SC) services. We conducted a two-year prospective study, involving all 288 subjects treated for smoking cessation at the SC service of Reggio Emilia, to assess the association of referral sources and waiting times with the risk of treatment failure, by following participants up to one year after the quit date. We performed Cox-regression analysis, including demographic and smoking-related characteristics as confounding variables. The treatment failure rate at 12 months was 59.4% (171/288), including only 12 subjects lost to follow-up. The main mode of entry was self-referral (42.4%), followed by 32.6% from general practice, 17.4% from hospital and 7.6% from other sources. Only 27.8% participants were involved in the SC-program within 60 days of the first contact, as the guidelines suggest. The risk of treatment failure at 12 months showed little association with the type of referral source, while it correlated with waiting times ≥ 60 days (hazard ratio = 1.59; 95% confidence interval 1.10⁻2.29). This study provides evidence of long-term high quit rates from a SC service, with few subjects lost to follow-up and biochemical verification of almost all abstinent subjects. Timeliness in care provision could further improve the outcome.
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Affiliation(s)
- Lucia Borsari
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy.
| | - Simone Storani
- Local Health Authority of Reggio Emilia-IRCCS, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Carlotta Malagoli
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Tommaso Filippini
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Marco Tamelli
- Promotion Health Researcher, League against Cancer, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Marcella Malavolti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
| | - Fausto Nicolini
- Local Health Authority of Reggio Emilia-IRCCS, via Amendola 2, 42122 Reggio Emilia, Italy.
| | - Marco Vinceti
- Department of Biomedical, Metabolic and Neural Sciences, CREAGEN-Environmental, Genetic and Nutritional Epidemiology Research Center, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Tseng TS, Moody-Thomas S, Horswell R, Yi Y, Celestin MD, Jones KD. Using a health informatics system to assess effect of a federal cigarette tax increase on readiness to quit among low-income smokers, Louisiana, 2009. Prev Chronic Dis 2014; 11:E52. [PMID: 24698530 PMCID: PMC3976230 DOI: 10.5888/pcd11.130203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction Health informatics systems are a proven tool for tobacco control interventions. To address the needs of low-income groups, the Tobacco Control Initiative was established in partnership with the Louisiana State University Health Care Services Division to provide cost-effective tobacco use cessation services through the health informatics system in the state public hospital system. Methods In this study we used a Web-based, result-reporting application to monitor and assess the effect of the 2009 federal cigarette tax increase. We assessed readiness to quit tobacco use before and after a cigarette tax increase among low-income tobacco users who were outpatients in a public hospital system. Results Overall, there was an increase in readiness to quit, from 22% during the first week of February to 33% during the first week of April, when the tax went into effect. Smokers who were female, 31 or older, African American, and assessed at a clinic visit in April were more likely to report readiness to quit than were men, those aged 30 or younger, those who were white, and those who were assessed at a clinic visit in February. Conclusion A health informatics system that efficiently tracks trends in readiness to quit can be used in combination with other strategies and thus optimize efforts to control tobacco use. Our data suggest that a cigarette tax increase affects smokers’ readiness to quit and provides an opportunity to intervene at the most beneficial time.
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Affiliation(s)
- Tung-Sung Tseng
- Louisiana State University Health Sciences Center, School of Public Health, 2020 Gravier St, New Orleans, LA 70112. E-mail:
| | | | | | - Yong Yi
- Louisiana State University, New Orleans, Louisiana
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Chou LP, Chang HF, Kao C, Lin W, Huang CL. Smoking cessation in Taiwanese male smokers with coronary artery disease: influencing factors and policy implications. Int Nurs Rev 2013; 60:244-50. [PMID: 23692009 DOI: 10.1111/inr.12004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate factors affecting smoking cessation in male smokers with coronary artery disease. DESIGN A descriptive, correlation, cross-sectional study was conducted. METHODS Data were collected using a questionnaire constructed by a literature review of research on smoking cessation in male smokers including demographics and smoking background, as well as psychological, interpersonal and environmental factors. A total of 130 male patients with coronary artery disease were recruited from the cardiac clinic at a regional hospital in Taiwan from August to December 2008. The response rate was 93% (n = 121). Descriptive statistics, chi-square, t-tests and logistic regression analysis were conducted. RESULTS During the survey, 64.5% of the respondents reported that they had stopped smoking after a coronary event. Five factors were significantly associated with smoking cessation after diagnosis of coronary artery disease: age, the severity of heart diagnoses, antismoking norms (perceived that smoking was against the social norms), nicotine dependence level, and contrary views of smoking (perceived negative expectancy of smoking). Multivariate analysis revealed antismoking norms to be the most important predictor (AOR = 4.27; P < .05) after adjusting age. CONCLUSION The study highlights the need to develop smoking cessation interventions that specifically counsel patients with coronary artery disease about these information, such as the disease risk and development, health consequences of smoking, and dependence therapy. Additionally, government support for tobacco control programmes in hospitals and elsewhere is designed to have a beneficial effect on patients' smoking behaviours primarily by increasing antismoking norms.
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Affiliation(s)
- L-P Chou
- Department of Medicine, Sin-Lau Christian Hospital, Tainan, Taiwan
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Earl GL, Henstenburg JA. Dietary approaches to hypertension: a call to pharmacists to promote lifestyle changes. J Am Pharm Assoc (2003) 2013; 52:637-45. [PMID: 23023845 DOI: 10.1331/japha.2012.10241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe guideline updates regarding a dietary approach to preventing or treating hypertension and to encourage pharmacists to provide education to patients on the Dietary Approaches to Stop Hypertension (DASH) diet and reducing dietary sodium intake. DATA SOURCES Abstracts and published articles identified by searching Medline (January 2001 to July 2011) and International Pharmaceutical Abstracts (January 2001 to July 2011) using the terms hypertension, cardiovascular risk, risk reduction behavior, health behavior, community pharmacy services, counseling, diet, and sodium-restricted diet, as well as reports from the Institute of Medicine and Dietary Guidelines for Americans 2010. DATA SYNTHESIS In the Dietary Guidelines for Americans 2010, the recommended daily dietary sodium intakes for individuals with hypertension, chronic kidney disease, and diabetes was reduced to less than 1,500 mg per day. All other healthy individuals are recommended to achieve dietary sodium intakes of less than 2,300 mg per day. Americans are consuming excessive amounts of dietary sodium in the form of processed foods, which poses a barrier to blood pressure control. Pharmacists should recommend the DASH diet as a way to reduce intake of dietary sodium and use available nutrition resources found on the ChooseMyPlate.gov and Food and Drug Administration websites. Pharmacists should integrate approaches using behavioral and motivational strategies to provide education that is culturally sensitive and appeals to individuals with marginal health literacy. CONCLUSION Community and ambulatory practice pharmacists, as well as collaborative practice models between pharmacists and physicians, should optimize medication management and incorporate lifestyle interventions that reduce dietary sodium intake as part of a comprehensive approach to improve hypertension outcomes.
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Affiliation(s)
- Grace L Earl
- Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19104, USA.
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Medbø A, Melbye H, Rudebeck CE. "I did not intend to stop. I just could not stand cigarettes any more." A qualitative interview study of smoking cessation among the elderly. BMC FAMILY PRACTICE 2011; 12:42. [PMID: 21627833 PMCID: PMC3132720 DOI: 10.1186/1471-2296-12-42] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 05/31/2011] [Indexed: 11/16/2022]
Abstract
Background Every year, more than 650,000 Europeans die because they smoke. Smoking is considered to be the single most preventable factor influencing health. General practitioners (GP) are encouraged to advise on smoking cessation at all suitable consultations. Unsolicited advice from GPs results in one of 40-60 smokers stopping smoking. Smoking cessation advice has traditionally been given on an individual basis. Our aim was to gain insights that may help general practitioners understand why people smoke, and why smokers stop and then remain quitting and, from this, to find fruitful approaches to the dialogue about stopping smoking. Methods Interviews with 18 elderly smokers and ex-smokers about their smoking and decisions to smoke or quit were analysed with qualitative content analysis across narratives. A narrative perspective was applied. Results Six stages in the smoking story emerged, from the start of smoking, where friends had a huge influence, until maintenance of the possible cessation. The informants were influenced by "all the others" at all stages. Spouses had vital influence in stopping, relapses and continued smoking. The majority of quitters had stopped by themselves without medication, and had kept the tobacco handy for 3-6 months. Often smoking cessation seemed to happen unplanned, though sometimes it was planned. With an increasingly negative social attitude towards smoking, the informants became more aware of the risks of smoking. Conclusion "All the others" is a clue in the smoking story. For smoking cessation, it is essential to be aware of the influence of friends and family members, especially a spouse. People may stop smoking unplanned, even when motivation is not obvious. Information from the community and from doctors on the negative aspects of smoking should continue. Eliciting life-long smoking narratives may open up for a fruitful dialogue, as well as prompting reflection about smoking and adding to the motivation to stop.
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Affiliation(s)
- Astri Medbø
- Institute of Community Medicine, University of Tromsø, 9037 Tromsø, Norway.
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Nyamathi A, Sinha K, Greengold B, Cohen A, Marfisee M. Predictors of HAV/HBV vaccination completion among methadone maintenance clients. Res Nurs Health 2010; 33:120-32. [PMID: 20143328 DOI: 10.1002/nur.20371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This randomized, controlled study (N = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion among clients undergoing methadone maintenance (MM) treatment. Participants were recruited from five MM treatment sites in Southern California and randomized into three groups: Motivational Interviewing-Single (MI-Single), Motivational Interviewing-Group (MI-Group); and Nurse-Led Hepatitis Health Promotion (HHP). All were offered the three-series HAV/HBV vaccine. A total of 148 participants completed the vaccine. Groups did not differ in rate of vaccination completion (73.6%, HHP group, vs. 65% and 69% for the MI-Single and MI-Group, respectively). The equivalence of findings across groups suggests the value of including nurses with a comprehensive health focus in promoting vaccination completion.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, University of California-Los Angeles, Box 951702, Los Angeles, CA 90095-1702, USA
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