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Gordon JS, Armin JS, Giacobbi P, Hsu CH, Marano K, Sheffer CE. Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2023; 12:e48898. [PMID: 37351932 DOI: 10.2196/48898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines. OBJECTIVE This study aims to test the efficacy of Be Smoke Free, a telephone-delivered GI treatment for smoking cessation. METHODS This multisite randomized clinical trial (RCT) will compare a novel telephone-delivered GI tobacco cessation treatment with a standard evidence-based behavioral treatment. The study will be conducted over 5 years. In phase 1, we refined protocols and procedures for the New York State and West Virginia sites for use in the RCT. During phase 2, we will conduct an RCT with 1200 participants: 600 (50%) recruited via quitlines and 600 (50%) recruited via population-based methods. Participants will be randomly assigned to either the GI condition or the behavioral condition; both treatments will be delivered by trained study coaches located at the University of Arizona. Assessments will be conducted at baseline and 3 and 6 months after enrollment by University of Arizona research staff. The primary outcome will be self-reported 30-day point prevalence abstinence 6 months after enrollment. Secondary outcomes include biochemically verified 7-day point prevalence abstinence 6 months after enrollment. RESULTS Recruitment in West Virginia and New York began in October 2022. As of March 31, 2023, a total of 242 participants had been enrolled. Follow-up assessments began in November 2022. As of March 31, 2023, of the 118 eligible participants, 97 (82.2%) had completed the 3-month assessment, and 93% (26/28) of eligible participants had completed the 6-month assessment. Biochemical verification and qualitative interviews began in April 2023. Recruitment will continue through 2025 and follow-up assessments through 2026. Primary results are expected to be published in 2027. CONCLUSIONS The Be Smoke Free study is a first-of-its-kind RCT that incorporates GI into telephone-based tobacco cessation treatment. If successful, Be Smoke Free will have substantial benefits for the long-term health of people who use tobacco across the United States. TRIAL REGISTRATION ClinicalTrials.gov NCT05277831; https://clinicaltrials.gov/ct2/show/NCT05277831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/48898.
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Affiliation(s)
- Judith S Gordon
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
| | - Peter Giacobbi
- College of Applied Human Sciences, West Virginia University, Morgantown, WV, United States
- School of Public Health, West Virginia University, Morgantown, WV, United States
| | - Chiu-Hsieh Hsu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kari Marano
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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Abstract
Tobacco use will kill a projected 1 billion people in the 21st century in one of the deadliest pandemics in history. Tobacco use disorder is a disease with a natural history, pathophysiology, and effective treatment options. Anesthesiologists can play a unique role in fighting this pandemic, providing both immediate (reduction in perioperative risk) and long-term (reduction in tobacco-related diseases) benefits to their patients who are its victims. Receiving surgery is one of the most powerful stimuli to quit tobacco. Tobacco treatments that combine counseling and pharmacotherapy (e.g., nicotine replacement therapy) can further increase quit rates and reduce risk of morbidity such as pulmonary and wound-related complications. The perioperative setting provides a great opportunity to implement multimodal perianesthesia tobacco treatment, which combines multiple evidence-based tactics to implement the four core components of consistent ascertainment and documentation of tobacco use, advice to quit, access to pharmacotherapy, and referral to counseling resources.
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The Effectiveness and Cost of an Intervention to Increase the Provision of Preventive Care in Community Mental Health Services: Protocol for a Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053119. [PMID: 35270810 PMCID: PMC8910711 DOI: 10.3390/ijerph19053119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Preventive care to address chronic disease risk behaviours is infrequently provided by community mental health services. In this cluster-randomised controlled trial, 12 community mental health services in 3 Local Health Districts in New South Wales, Australia, will be randomised to either an intervention group (implementing a new model of providing preventive care) or a control group (usual care). The model of care comprises three components: (1) a dedicated ‘healthy choices’ consultation offered by a ‘healthy choices’ clinician; (2) embedding information regarding risk factors into clients’ care plans; and (3) the continuation of preventive care by mental health clinicians in ongoing consultations. Evidence-based implementation strategies will support the model implementation, which will be tailored by being co-developed with service managers and clinicians. The primary outcomes are client-reported receipt of: (1) an assessment of chronic disease risks (tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol use and physical inactivity); (2) brief advice regarding relevant risk behaviours; and (3) referral to at least one behaviour change support. Resources to develop and implement the intervention will be captured to enable an assessment of cost effectiveness and affordability. The findings will inform the development of future service delivery initiatives to achieve guideline- and policy-concordant preventive care delivery.
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Panda R, Omar R, Hunter R, Prabhu RR, Mishra A, Nazareth I. 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. BMJ Open 2022; 12:e048628. [PMID: 34992102 PMCID: PMC8739426 DOI: 10.1136/bmjopen-2021-048628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Rajmohan Panda
- Research, Public Health Foundation of India, Gurgoan, Haryana, India
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rajath R Prabhu
- Research, Public Health Foundation of India, Gurgoan, Haryana, India
| | - Arti Mishra
- Research, Independent Consultant, New Delhi, India
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
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Liu J, Brighton E, Tam A, Godino J, Brouwer KC, Smoot CB, Matthews E, Mohn P, Kirby C, Zhu SH, Strong D. Understanding health disparities affecting utilization of tobacco treatment in low-income patients in an urban health center in Southern California. Prev Med Rep 2021; 24:101541. [PMID: 34976615 PMCID: PMC8683857 DOI: 10.1016/j.pmedr.2021.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/04/2022] Open
Abstract
Tobacco use disproportionately affects low-income communities. Prevalence among patients in Federally Qualified Health Centers (FQHCs) is higher (29.3%) than the general population (20%). Little is known about the rates of referrals to cessation services and cessation pharmacotherapy practices in FQHCs. This study will examine referral and prescribing patterns based on patient characteristics at a large FQHC in Southern California. We conducted a retrospective analysis of EHR data from 2019. Patients who were ≥ 18 years old and had "tobacco use" as an active problem were included in analyses. We characterized the proportion of 1) those who were referred to California Smokers' Helpline (CSH), 2) referred to smoking cessation counseling (SCC) at the FQHC clinic, or 3) received pharmacotherapy. Associations of demographic characteristics and comorbidities with referral types and uptake of services were evaluated using mixed-effects multinomial and logistic regressions. Of the 20,119 tobacco users identified, 87% had some cessation intervention: 66% were advised to quit and given information to contact CSH, while 21% were referred to SCC. Patients were least likely to get referred to cessation services if they had more medical, psychiatric, or substance use comorbidities, were in the lowest income group, were uninsured or were Hispanic. Although EHR systems have enhanced the ease of screening, most patients do not receive more than brief advice to quit during a PCP visit. Most (70%) low-income smokers see their PCPs at least once a year, making FQHCs excellent settings to promote smoking cessation initiatives in low-income populations.
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Affiliation(s)
- Jie Liu
- Family Health Centers of San Diego, United States
| | - Elizabeth Brighton
- Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Aaron Tam
- Family Health Centers of San Diego, United States
| | - Job Godino
- Family Health Centers of San Diego, United States
| | - Kimberly C. Brouwer
- Department of Family Medicine and Public Health, University of California, San Diego, United States
| | | | - Eva Matthews
- Family Health Centers of San Diego, United States
| | - Paloma Mohn
- Family Health Centers of San Diego, United States
| | - Carrie Kirby
- Cancer Prevention & Control Program, Moores Cancer Center, University of California, San Diego, United States
| | - Shu-Hong Zhu
- Cancer Prevention & Control Program, Moores Cancer Center, University of California, San Diego, United States
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, United States
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Zale EL, Maisto SA, De Vita MJ, Hooten WM, Ditre JW. Increasing cessation motivation and treatment engagement among smokers in pain: A pilot randomized controlled trial. Exp Clin Psychopharmacol 2021; 29:593-604. [PMID: 32757595 PMCID: PMC8499853 DOI: 10.1037/pha0000424] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tobacco smokers with co-occurring pain report greater difficulty quitting, face unique cessation challenges, and may benefit from targeted smoking interventions. We developed and tested a brief motivational intervention aimed at increasing knowledge of pain-smoking interrelations, motivation to quit, and cessation treatment engagement among smokers in pain. Nontreatment seeking daily cigarette smokers with chronic pain (N = 76, 57.9% women, 52.6% White) were randomized to the targeted or ask, advise, refer (AAR) intervention. The targeted intervention included personalized feedback and pain-smoking psychoeducation to help participants develop discrepancy between continued smoking and desired pain outcomes. At postintervention, the targeted intervention (vs. AAR) increased knowledge of pain-smoking interrelations and several indices of motivation to quit smoking (ps < .01). Participants who received the targeted intervention were also more likely to accept information about and report intention to engage evidence-based cessation treatments (ps < .05). Increased knowledge of pain-smoking interrelations mediated postintervention effects on motivation to quit and willingness to learn about treatments. At 1-month follow up, gains in knowledge of pain-smoking interrelations were maintained (p = .009). Participants who received the targeted intervention were more likely to report having subsequently engaged cessation treatment (p = .019), but this was not mediated by increased knowledge of pain-smoking interrelations. Smokers with chronic pain may benefit from targeted interventions that address smoking in the context of pain. Smokers in pain may become increasingly motivated to quit and engage cessation treatment as they become aware of how smoking may exacerbate their pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - W. Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine
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Agaku I, Odani S, Gordon J. State-specific changes in receipt of cessation counseling from dentist and physician offices, 2011–2015. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/136451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Liu B, Zhan S, Wilson KM, Mazumdar M, Li L. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094593. [PMID: 33926078 PMCID: PMC8123707 DOI: 10.3390/ijerph18094593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
Objective: We aimed to examine the influence of increasing levels of discussion (both asked and advised, either asked or advised but not both, and neither asked nor advised) on quit behavior. Methods: We included 4133 adult current smokers from the 2015 National Health Interview Survey. The primary outcomes were quit intent and quit attempt, and the secondary outcomes were methods used for quitting. We used an instrumental variable analysis, as well as propensity score weighted and multivariable logistic regressions. Results: Compared to no discussion, having both or only one discussion, respectively, increased quit intent (OR = 1.65, 95% CI = 1.63–1.66 and OR = 1.02, 95% CI = 0.99–1.05), quit attempt (OR = 1.76, 95% CI = 1.75–1.77 and OR = 1.60, 95% CI = 1.57–1.63). Among those who attempted to quit (n = 1536), having both or only one discussion increased the use of pharmacologic (OR = 1.99, 95% CI = 1.97–2.02 and OR = 1.56, 95% CI = 1.49–1.63) or behavioral (OR = 2.01, 95% CI = 1.94–2.08 and OR = 2.91, 95% CI = 2.74–3.08) quit methods. Conclusions: Increasing levels of provider–patient discussion encourages quit behavior, and should be an integral part of reducing the health and economic burden of smoking. Strategies that promote the adherence and compliance of providers to communicate with patients may help increase the success of smoking cessation.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Correspondence:
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA; (S.Z.); (M.M.); (L.L.)
- Tisch Cancer Institute, New York, NY 10029-6574, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
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Gordon JS, Bell ML, Armin JS, Giacobbi PR, Nair US. A telephone-based guided imagery tobacco cessation intervention: results of a randomized feasibility trial. Transl Behav Med 2021; 11:516-529. [PMID: 32542352 PMCID: PMC7963280 DOI: 10.1093/tbm/ibaa052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence supports the use of guided imagery for smoking cessation; however, scalable delivery methods are needed to make it a viable approach. Telephone-based tobacco quitlines are a standard of care, but reach is limited. Adding guided imagery to quitline services might increase reach by offering an alternative approach. PURPOSE To develop and test the feasibility and potential impact of a guided imagery-based tobacco cessation intervention delivered using a quitline model. METHODS Participants for this randomized feasibility trial were recruited statewide through a quitline or community-based methods. Participants were randomized to guided imagery Intervention Condition (IC) or active behavioral Control Condition (CC). After withdrawals, there were 105 participants (IC = 56; CC = 49). The IC consisted of six sessions in which participants created guided imagery audio files. The CC used a standard six-session behavioral protocol. Feasibility measures included recruitment rate, retention, and adherence to treatment. We also assessed 6-month quit rates and consumer satisfaction. RESULTS Both the IC and CC protocols were feasible to deliver. We finalized protocols and materials for participants, coaches and study staff, and delivered the protocols with fidelity. We developed successful recruitment methods, and experienced high retention (6 months = 81.9%) and adherence (all sessions = 66.7%). Long-term quit rates (IC = 27.9%; CC = 38.1%) compared favorably to those of quitlines, and program satisfaction was high, suggesting that the protocols are acceptable to smokers and may contribute to smoking abstinence. CONCLUSIONS The guided imagery intervention is feasible and promising, suggesting that a fully powered RCT to test the efficacy of the intervention is warranted. TRIAL REGISTRATION NUMBER NCT02968381.
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Affiliation(s)
| | - Melanie L Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Julie S Armin
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - Peter R Giacobbi
- College of Physical Activity and Sport Sciences and School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Uma S Nair
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database Syst Rev 2021; 2:CD005084. [PMID: 33605440 PMCID: PMC8095016 DOI: 10.1002/14651858.cd005084.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dental professionals are well placed to help their patients stop using tobacco products. Large proportions of the population visit the dentist regularly. In addition, the adverse effects of tobacco use on oral health provide a context that dental professionals can use to motivate a quit attempt. OBJECTIVES To assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register up to February 2020. SELECTION CRITERIA We included randomised and quasi-randomised clinical trials assessing tobacco cessation interventions conducted by dental professionals in the dental practice or community setting, with at least six months of follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts for potential inclusion and extracted data from included trials. We resolved disagreements by consensus. The primary outcome was abstinence from all tobacco use (e.g. cigarettes, smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. Individual study effects and pooled effects were summarised as risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel random-effects models to combine studies where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarised secondary outcomes narratively. MAIN RESULTS Twenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings. Five studies included only smokeless tobacco users, and the remaining studies included either smoked tobacco users only, or a combination of both smoked and smokeless tobacco users. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. We judged three studies to be at low risk of bias, one to be at unclear risk of bias, and the remaining 16 studies to be at high risk of bias. Compared with usual care, brief advice, very brief advice, or less active treatment, we found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. We found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). We did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions. AUTHORS' CONCLUSIONS There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health.
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Affiliation(s)
- Richard Holliday
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Philip M Preshaw
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Fehily C, Hodder R, Bartlem K, Wiggers J, Wolfenden L, Dray J, Bailey J, Wilczynska M, Stockings E, Clinton-McHarg T, Regan T, Bowman J. The effectiveness of interventions to increase preventive care provision for chronic disease risk behaviours in mental health settings: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101108. [PMID: 32477852 PMCID: PMC7248238 DOI: 10.1016/j.pmedr.2020.101108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/01/2020] [Accepted: 04/26/2020] [Indexed: 11/25/2022] Open
Abstract
Clinical practice guidelines direct mental health services to provide preventive care to address client chronic disease risk behaviours, however, this care is not routinely provided. The aim of this systematic review was to synthesise evidence regarding the effectiveness of interventions to increase provision of preventive care by mental health services; by care element (ask, assess, advice, assist, arrange) and risk behaviour (tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity). Electronic bibliographic databases, Google Scholar, relevant journals, and included study reference lists were searched. Eligible studies were of any design with a comparison group that reported the effectiveness of an intervention to increase the provision of at least one element of preventive care for at least one risk behaviour in a mental health setting. Twenty studies were included, most commonly examining smoking (n = 20) and 'ask' (n = 12). Meta-analysis found interventions involving task shifting were effective in increasing smoking 'advice' (n = 2 RCTs; p = 0.009) and physical activity 'advice' (n = 2 RCTs; p = 0.002). Overall, meta-analysis and narrative synthesis indicated that effective intervention strategies (categorised according to the Effective Practice and Organisation of Care taxonomy) were: task shifting, educational meetings, health information systems, local consensus processes, authority and accountability, and reminders. The most consistent findings across studies were with regard to preventive care for smoking, while conflicting or limited evidence was found regarding other risk behaviours. While further rigorous research examining key risk behaviours is recommended, the findings may inform the selection of strategies for future interventions and service delivery initiatives.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Rebecca Hodder
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Kate Bartlem
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Julia Dray
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - Jacqueline Bailey
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
| | - Magda Wilczynska
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, Randwick, NSW, Australia
| | - Tara Clinton-McHarg
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Timothy Regan
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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Fehily C, Ling R, Searles A, Bartlem K, Wiggers J, Hodder R, Wilson A, Colyvas K, Bowman J. An economic evaluation of a specialist preventive care clinician in a community mental health service: a randomised controlled trial. BMC Health Serv Res 2020; 20:405. [PMID: 32393307 PMCID: PMC7212584 DOI: 10.1186/s12913-020-05204-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinical practice guidelines and policies direct community mental health services to provide preventive care to address chronic disease risks, however, such care is infrequently provided in routine consultations. An alternative model of care is to appoint a clinician to the dedicated role of offering and providing preventive care in an additional consultation: the 'specialist clinician' model. Economic evaluations of models of care are needed to determine the cost of adhering to guidelines and policies, and to inform pragmatic service delivery decisions. This study is an economic evaluation of the specialist clinician model; designed to achieve policy concordant preventive care delivery. METHODS A retrospective analysis of the incremental costs, cost-effectiveness, and budget impact of a 'specialist preventive care clinician' (an occupational therapist) was conducted in a randomised controlled trial, where participants were randomised to receive usual care; or usual care plus the offer of an additional preventive care consultation with the specialist clinician. The study outcome was client acceptance of referrals to two free telephone-based chronic disease prevention services. This is a key care delivery outcome mandated by the local health district policy of the service. The base case analysis assumed the mental health service cost perspective. A budget impact analysis determined the annual budget required to implement the model of care for all clients of the community mental health service over 5 years. RESULTS There was a significantly greater increase from baseline to follow-up in the proportion of intervention participants accepting referrals to both telephone services, compared to usual care. The incremental cost-effectiveness ratio was $347 per additional acceptance of a referral (CI: $263-$494). The annual budget required to implement the model of care for all prospective clients was projected to be $711,446 over 5-years; resulting in 2616 accepted referrals. CONCLUSIONS The evaluation provides key information regarding the costs for the mental health service to adhere to policy targets, indicating the model of care involved a low per client cost whilst increasing key preventive care delivery outcomes. Additional modelling is required to further explore its economic benefits. TRIAL REGISTRATION ACTRN12616001519448. Registered 3 November 2016, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371709.
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Affiliation(s)
- Caitlin Fehily
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Rebecca Hodder
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Andrew Wilson
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- The Australian Preventive Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
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Gordon JS, Giacobbi P, Armin JS, Nair US, Bell ML, Povis G. Testing the feasibility of a guided imagery tobacco cessation intervention delivered by a telephone quitline: Study protocol for a randomized controlled feasibility trial. Contemp Clin Trials Commun 2019; 16:100437. [PMID: 31508532 PMCID: PMC6727006 DOI: 10.1016/j.conctc.2019.100437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 11/03/2022] Open
Abstract
Background Guided imagery (GI) is an evidence-based method that uses the imagination to practice and achieve a desired outcome. Little research has focused on how GI can be delivered to smokers using remote or virtual methods, such as a telephone-based intervention. Telephone-based services for tobacco cessation (quitlines) have emerged as standard of care for tobacco cessation. However, quitlines reach only a small fraction of smokers, and men and racial/ethnic minorities are less likely to use quitlines than majority women. GI has the potential to attract under-served minority groups as well as smokers who are looking for an alternative approach to cessation. The present study is designed to test the feasibility and potential impact of a GI tobacco cessation intervention delivered by telephone. This study compares the GI intervention with a standard behavioral (SB) intervention. Methods Participants (N = 100) are randomized to either the GI (intervention) or SB (control) condition. Each condition features a 6-week intervention in which participants work with coaches to quit tobacco. Primary outcomes are feasibility related (recruitment, retention, adherence), and secondary outcomes include cessation at 6 months post-intervention (7-day and 30-day abstinence). Discussion A GI intervention delivered via quitline would allow for scalability and dissemination, potentially reaching a more representative group of smokers. Results from this study will determine the feasibility of delivering the GI intervention, and describe the reach of the intervention to under-represented tobacco users. If successful, our study results will guide the design and conduct of a future efficacy trial.
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Affiliation(s)
| | - Peter Giacobbi
- West Virginia University, Social and Behavioral Sciences, School of Public Health, USA
| | - Julie S Armin
- University of Arizona, Department of Family and Community Medicine, USA
| | - Uma S Nair
- University of Arizona, Mel and Enid Zuckerman College of Public Health, USA
| | - Melanie L Bell
- University of Arizona, Mel and Enid Zuckerman College of Public Health, USA
| | - Gayle Povis
- University of Arizona, College of Nursing, USA
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Bartlem K, Wolfenden L, Colyvas K, Campbell L, Freund M, Doherty E, Slattery C, Tremain D, Bowman J, Wiggers J. The association between the receipt of primary care clinician provision of preventive care and short term health behaviour change. Prev Med 2019; 123:308-315. [PMID: 30930261 DOI: 10.1016/j.ypmed.2019.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 02/25/2019] [Accepted: 03/28/2019] [Indexed: 11/26/2022]
Abstract
Primary healthcare services are recommended to provide preventive care to address chronic disease risk behaviours. However, all care elements are infrequently provided, and there is a need to understand the impact of partial care provision on behaviour change. This study examined the association between variable levels of preventive care receipt from primary care clinicians on short-term behaviour change for four risk behaviours. A survey was undertaken with 5639 Australian community health service clients (2009-2014). Clients self-reported: engagement in risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, physical inactivity) in the month prior to and four week post their community health service appointment; receipt of preventive care during appointments (assessment, advice, referral/follow-up) for each behaviour. Univariate regression models explored the association between change in risk status and preventive care received. The odds of behaviour change for those receiving all three care elements was significant for all behaviours, compared to no care, ranging from 2.02 (alcohol consumption, 95% CI 1.16-3.49) to 4.17 (inadequate fruit and/or vegetable consumption, 95% CI 2.91-5.96). Receipt of both assessment and advice increased the odds of behaviour change, compared to no care, for all behaviours except smoking, ranging from 2.32 (physical inactivity, 95% CI 1.60-3.35) to 2.83 (alcohol consumption, 95% CI 1.84-4.33). Receipt of 'assessment only' increased the odds of behaviour change, compared to no care, for inadequate fruit and/or vegetable consumption (OR = 2.40, 95% CI 1.60-3.59) and physical inactivity (OR = 2.81, 95% CI 1.89-4.17). Results highlight the importance of primary care clinicians providing best practice preventive care to maximise client behaviour change.
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Affiliation(s)
- Kate Bartlem
- School of Psychology, University of Newcastle, Callaghan, Australia; Hunter New England Population Health, Wallsend, Australia.
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Kim Colyvas
- School of Mathematical and Physical Sciences, University of Newcastle, Callaghan, Australia
| | - Libby Campbell
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Megan Freund
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma Doherty
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | | | - Danika Tremain
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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Cockburn N, Gartner C, Ford PJ. Smoking behaviour and preferences for cessation support among clients of an Indigenous community-controlled health service. Drug Alcohol Rev 2018; 37:676-682. [DOI: 10.1111/dar.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/21/2017] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Cockburn
- School of Dentistry; The University of Queensland; Brisbane Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health; The University of Queensland; Brisbane Australia
| | - Pauline J. Ford
- School of Dentistry; The University of Queensland; Brisbane Australia
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Nair US, Reikowsky RC, Wertheim BC, Thomson CA, Gordon JS. Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline. Am J Health Promot 2018; 32:1510-1517. [PMID: 29325439 DOI: 10.1177/0890117117749366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate how mode of entry into a quitline influences program utilization and quit outcomes among clients seeking cessation services. DESIGN This is a retrospective analysis of clients receiving quitline services from January 2011 to June 2016. SETTING The study was conducted at the Arizona Smokers' Helpline. PARTICIPANTS Enrolled clients completed a 7-month follow-up (N = 18 650). MEASURES The independent variable was referral mode of entry (ie, proactive, passive, and self-referral). Outcome variables included tobacco cessation medication use, number of coaching sessions completed, and 30-day tobacco abstinence at 7 months. ANALYSIS Logistic regression was used to analyze tobacco abstinence after controlling for potential confounders. RESULTS Compared to self-referred clients, proactively referred clients were least likely (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.97), whereas passively referred clients were most likely (OR: 1.14; 95% CI: 1.00-1.30) to report tobacco abstinence. Proactively referred (OR: 0.79; 95% CI: 0.70-0.88), but not passively referred, clients were 21% less likely to report tobacco cessation medication use than self-referred clients. CONCLUSION Proactive referrals are associated with lower utilization of tobacco cessation medication and less successful quit outcomes; however, provider referrals are critical to reaching tobacco users who may have more significant health risks and barriers to quitting. Examining potential barriers among both providers and provider-referred clients is needed to inform improvements in training providers on brief interventions for tobacco cessation.
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Affiliation(s)
- Uma S Nair
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ryan C Reikowsky
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Cynthia A Thomson
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Judith S Gordon
- 3 College of Nursing, University of Arizona, Tucson, AZ, USA
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Russo ET, Reid M, Taher R, Sharifi M, Shah SN. Referral Strategies to a Tobacco Quitline and Racial and/or Ethnic Differences in Participation. Pediatrics 2018; 141:S30-S39. [PMID: 29292304 DOI: 10.1542/peds.2017-1026g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tobacco use inflicts a disproportionate burden of disease on people of color. We evaluated the reach among African American and Hispanic smokers in Boston of 2 referral strategies to the Massachusetts quitline: (1) a provider-referred strategy based in pediatric and dental clinics and (2) a targeted media campaign to promote self-referral to the quitline. METHODS Selected demographic characteristics of Boston quitline participants during the study period (2010-2012) were compared between strategies. Self-referred smoker characteristics were also compared in the years before and after the media campaign. Finally, the characteristics of quitline participants were compared with smokers in the 2010 Boston Behavioral Risk Factor Surveillance Survey. RESULTS During the study period, 4066 smokers received cessation services from the quitline; 3722 (91.5%) were self-referred, and 344 (8.5%) were referred by pediatric and dental providers. The proportion of black (31.6%) and Hispanic (20.3%) participants referred by providers was higher than among self-referred participants (18.3% and 7.8%, respectively; P <.001). Overall, provider-referred participants were less likely to be white (17.9%) than to be people of color. Self-referred smokers were more likely to be white (68.0%) than the estimated population of Boston smokers overall (62.9%; P <.001). CONCLUSIONS The large-scale media campaign, which promoted self-referral, was associated with higher quitline participation overall, but the provider-referred strategy based in community health centers yielded participation from a greater proportion of smokers of color. The 2 strategies reached different subpopulations of smokers, and their combined reach enhanced access to cessation services among smokers from different racial and ethnic backgrounds.
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Affiliation(s)
| | - Margaret Reid
- Boston Public Health Commission, Boston, Massachusetts
| | - Rashida Taher
- Boston Public Health Commission, Boston, Massachusetts
| | - Mona Sharifi
- Division of General Academic Pediatrics, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Snehal N Shah
- Boston Public Health Commission, Boston, Massachusetts.,Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
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Virtue SM, Waldron EM, Darabos K, DeAngelis C, Moore DA, Fornatora M, Tellez M. Dental Students' Attitudes Toward Tobacco Cessation in the Dental Setting: A Systematic Review. J Dent Educ 2017; 81:500-516. [PMID: 28461627 DOI: 10.21815/jde.016.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
Abstract
Many dental schools have integrated tobacco cessation into their predoctoral curricula. However, dental students' perceptions should be taken into consideration when designing those curricula. The aim of this study was to systematically review the published literature on dental students' attitudes and perceptions regarding tobacco cessation. The research team conducted a search for articles through April 2016 using the following electronic databases: Medline, PsychInfo, Cochrane Library, and CINAHL. Each abstract and/or article was reviewed for inclusion. Data were extracted from all included articles. Each was rated for quality appraisal by two reviewers. The initial search identified 2,035 articles, and 38 of those were included in the review. The majority were cross-sectional and sampled students from one dental school. There was wide variation in the measurement of dental student attitudes. Overall, the majority of students in these studies reported believing it is within the scope of dental practice to address tobacco use with patients, but there was variability in terms of the practice of specific tobacco cessation strategies. The most common perceived barrier was patient resistance/lack of motivation. In most of the studies, the majority of students were interested in being trained in tobacco cessation. The findings suggest that dental students will respond positively to receiving tobacco cessation education while in dental school and that educators should include strategies to help future dentists deal with patient resistance. Future studies should focus on the development of a validated measure of dental student attitudes toward tobacco cessation and longitudinal, multi-institutional research that can provide more generalizable findings.
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Affiliation(s)
- Shannon Myers Virtue
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University.
| | - Elizabeth M Waldron
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
| | - Katie Darabos
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
| | - Courtney DeAngelis
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
| | - David A Moore
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
| | - Maria Fornatora
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
| | - Marisol Tellez
- Dr. Myers Virtue is Assistant Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Waldron is Research Assistant, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University; Ms. Darabos is a doctoral student, Department of Psychology, City University of New York; Ms. DeAngelis is a doctoral student, Department of Psychology, LaSalle University; Dr. Moore is a postdoctoral fellow, MD Anderson Cancer Center, Cooper University Hospital; Dr. Fornatora is Associate Dean for Academic Affairs, Maurice H. Kornberg School of Dentistry, Temple University; and Dr. Tellez is Associate Professor, Department of Pediatric Dentistry and Community Oral Health Sciences, Maurice H. Kornberg School of Dentistry, Temple University
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Randomized controlled trial of emergency department initiated smoking cessation counselling and referral to a community counselling service. CAN J EMERG MED 2017; 20:556-564. [PMID: 28693638 DOI: 10.1017/cem.2017.345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Worldwide, tobacco smoke is still the leading cause of preventable morbidity and mortality. Many smokers develop chronic smoking-related conditions that require emergency department (ED) visits. However, best practices for ED smoking cessation counselling are still unclear. METHODS A randomized controlled trial was conducted to determine whether an "ask, advise, and refer" approach increases 12-month, 30-day quit rates in the stable adult ED smoking population compared to usual care. Patients in the intervention group were referred to a community counselling service that offers a quitline, a text-based program, and a Web-based program. Longitudinal intention-to-treat analyses were performed. RESULTS From November 2011 to March 2013, 1,295 patients were enrolled from one academic tertiary care ED. Six hundred thirty-five were allocated to usual care, and 660 were allocated to intervention. Follow-up data were available for 70% of all patients at 12 months. There was no statistically significant difference in 12-month, 30-day quit rates between the two groups. However, there was a trend towards higher 7-day quit attempts, 7-day quit rates, and 30-day quit rates at 3, 6, and 12 months in the intervention group. CONCLUSION In this study, there was a trend towards increased smoking cessation following referral to a community counselling service. There was no statistically significant difference. However, if ED smoking cessation efforts were to provide even a small positive effect, such an intervention may have a significant public health impact given the extensive reach of emergency physicians.
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Gordon JS, Armin JS, Cunningham JK, Muramoto ML, Christiansen SM, Jacobs TA. Lessons learned in the development and evaluation of RxCoach™, an mHealth app to increase tobacco cessation medication adherence. PATIENT EDUCATION AND COUNSELING 2017; 100:720-727. [PMID: 27839891 PMCID: PMC5385274 DOI: 10.1016/j.pec.2016.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/22/2016] [Accepted: 11/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In this project we developed and evaluated a mobile health app to improve adherence to tobacco cessation medication. METHODS The study was conducted in three phases: (1) Create app with input from our consultant, focus groups and user testing; (2) Test feasibility of the app; and (3) Develop and user-test the barcode scanner. RESULTS Focus group feedback was instrumental in developing content and creating the user interface. User testing helped to identify problems and refine the app. The feasibility trial provided "real world" testing. We experienced challenges in recruitment due to the inclusion criteria. We had high attrition due to technical issues, medication side effects, enrollment procedures, and lack of personal contact. Among the five retained participants, use of the app was associated with good medication adherence and high consumer satisfaction. CONCLUSION The small sample size limits the generalizability of the findings and the conclusions that can be drawn from the study. However, the feasibility trial enabled the team to identify ways to improve the conduct of this and other mHealth studies. PRACTICAL IMPLICATIONS We should expand RxCoach to include all prescription and over-the-counter tobacco cessation medications, and re-test for feasibility using lessons learned to improve recruitment and retention.
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Affiliation(s)
- Judith S Gordon
- University of Arizona, Department of Family and Community Medicine, Tucson, AZ, United States.
| | - Julie S Armin
- University of Arizona, Department of Family and Community Medicine, Tucson, AZ, United States
| | - James K Cunningham
- University of Arizona, Department of Family and Community Medicine, Tucson, AZ, United States
| | - Myra L Muramoto
- University of Arizona, Department of Family and Community Medicine, Tucson, AZ, United States
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Shaik SS, Doshi D, Bandari SR, Madupu PR, Kulkarni S. Tobacco Use Cessation and Prevention - A Review. J Clin Diagn Res 2016; 10:ZE13-7. [PMID: 27437378 DOI: 10.7860/jcdr/2016/19321.7803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/15/2016] [Indexed: 11/24/2022]
Abstract
Tobacco use is a major preventable cause of premature death and disease, currently leading to over five million deaths each year worldwide. Smoking or chewing tobacco can seriously affect general, as well as oral health. Oral health professionals play an important role in promoting tobacco free-lifestyles. They should counsel their patients not to smoke; and reinforce the anti-tobacco message and refer the patients to smoking cessation services. Dentists are in a unique position to educate and motivate patients concerning the hazards of tobacco to their oral and systemic health, and to provide intervention programs as a part of routine patient care. Tobacco cessation is necessary to reduce morbidity and mortality related to tobacco use. Strategies for tobacco cessation involves 5 A's and 5 R's approach, quit lines and pharmacotherapy. Additionally, tobacco cessation programs should be conducted at community, state and national levels. Various policies should be employed for better tobacco control. Governments should implement the tobacco control measures to reduce the prevalence of tobacco use and exposure to tobacco smoke. In addition, there should be availability of leaflets, brochures, continuing patient education materials regarding tobacco cessation.
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Affiliation(s)
- Sabiha Shaheen Shaik
- Senior Lecturer, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Dolar Doshi
- Professor, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Srikanth Reddy Bandari
- Reader, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Padma Reddy Madupu
- Reader, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Suhas Kulkarni
- Professor and Head, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
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Fucito LM, Czabafy S, Hendricks PS, Kotsen C, Richardson D, Toll BA. Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco. Cancer 2016; 122:1150-9. [PMID: 26916412 PMCID: PMC4828323 DOI: 10.1002/cncr.29926] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.
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Affiliation(s)
- Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Sharon Czabafy
- Wellspan Ephrata Community Hospital Wellness Center, Stevens, Pennsylvania
| | - Peter S. Hendricks
- Department of Human Behavior, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, Robert Wood Johnson University Hospital, Somerville, New Jersey
| | - Donna Richardson
- Tobacco Dependence Program, Cancer Institute of New Jersey, School of Public Health, Robert Wood Johnson Medical School at Rutgers, New Brunswick, New Jersey
| | - Benjamin A. Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
- Hollings Cancer Center, Charleston, South Carolina
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Albert DA, Bruzelius E, Ward A, Gordon JS. Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.4.tb06098.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Emilie Bruzelius
- Mailman School of Public Health and Section of Population Oral Health; College of Dental Medicine; Columbia University
| | - Angela Ward
- Section of Population Health; College of Dental Medicine; Columbia University
| | - Judith S. Gordon
- Department of Family and Community Medicine; University of Arizona
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Kruger J, O'Halloran A, Rosenthal AC, Babb SD, Fiore MC. Receipt of evidence-based brief cessation interventions by health professionals and use of cessation assisted treatments among current adult cigarette-only smokers: National Adult Tobacco Survey, 2009-2010. BMC Public Health 2016; 16:141. [PMID: 26868930 PMCID: PMC4751655 DOI: 10.1186/s12889-016-2798-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background Helping tobacco smokers to quit during a medical visit is a clinical and public health priority. Research suggests that most health professionals engage their patients in at least some of the ‘5 A’s’ of the brief cessation intervention recommended in the U.S. Public Health Service Clinical Practice Guideline, but information on the extent to which patients act on this intervention is uncertain. We assessed current cigarette-only smokers’ self-reported receipt of the 5 A’s to determine the odds of using optimal cessation assisted treatments (a combination of counseling and medication). Methods Data came from the 2009–2010 National Adult Tobacco Survey (NATS), a nationally representative landline and mobile phone survey of adults aged ≥18 years. Among current cigarette-only smokers who visited a health professional in the past 12 months, we assessed patients’ self-reported receipt of the 5 A’s, use of the combination of counseling and medication for smoking cessation, and use of other cessation treatments. We used logistic regression to examine whether receipt of the 5 A’s during a recent clinic visit was associated with use of cessation treatments (counseling, medication, or a combination of counseling and medication) among current cigarette-only smokers. Results In this large sample (N = 10,801) of current cigarette-only smokers who visited a health professional in the past 12 months, 6.3 % reported use of both counseling and medication for smoking cessation within the past year. Other assisted cessation treatments used to quit were: medication (19.6 %); class or program (3.8 %); one-on-one counseling (3.7 %); and telephone quitline (2.6 %). Current cigarette-only smokers who reported receiving all 5 A’s during a recent clinic visit were more likely to use counseling (odds ratio [OR]: 11.2, 95 % confidence interval [CI]: 7.1–17.5), medication (OR: 6.2, 95 % CI: 4.3–9.0), or a combination of counseling and medication (OR: 14.6, 95 % CI: 9.3–23.0), compared to smokers who received one or none of the 5 A’s components. Conclusions Receipt of the ‘5 A’s’ intervention was associated with a significant increase in patients’ use of recommended counseling and medication for cessation. It is important for health professionals to deliver all 5 A’s when conducting brief cessation interventions with patients who smoke.
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Affiliation(s)
- Judy Kruger
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 30341, USA. .,Office on Smoking and Health, Centers for Disease Control and Prevention, 4770 Buford Highway, N.E., F-79, Atlanta, GA, 30341-3724, USA.
| | - Alissa O'Halloran
- Contractor (NGIS) for Office on Smoking and Health, National Center for Chronic Disease Prevention, Atlanta, GA, 30341, USA
| | | | - Stephen D Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 30341, USA
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53711, USA
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Giacobbi P, Hingle M, Johnson T, Cunningham JK, Armin J, Gordon JS. See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity. JMIR Res Protoc 2016; 5:e12. [PMID: 26795257 PMCID: PMC4742619 DOI: 10.2196/resprot.5126] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/22/2015] [Accepted: 11/05/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors-exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions. OBJECTIVE The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers. METHODS We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application's usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones. RESULTS The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app "most days" for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking). CONCLUSIONS We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics.
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Affiliation(s)
- Peter Giacobbi
- Sport Sciences, Epidemiology, West Virginia University, Morgantown, WV, United States.
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Ford P, Tran P, Keen B, Gartner C. Survey of Australian oral health practitioners and their smoking cessation practices. Aust Dent J 2015; 60:43-51; quiz 128. [PMID: 25721277 DOI: 10.1111/adj.12270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Smoking is a significant health and economic burden in Australia. Studies of smoking cessation practices in dental settings have primarily concentrated on dentists rather than other oral health practitioner (OHP) groups (dental hygienists, dental therapists and oral health therapists). The aim of this study was to measure Australian OHPs' attitudes, behaviours, interest and barriers to delivering smoking cessation interventions. METHODS Members of the two peak professional bodies representing Australian OHPs were invited to participate in an anonymous online questionnaire. RESULTS There were discrepancies between practitioner attitudes and current smoking cessation practices. While the majority of practitioners (90.1%) frequently screened for smoking behaviour, fewer (51.1%) assisted patients to quit smoking. The principal form of assistance was referral to Quitline (45.7%) or to a general medical practitioner (44.4%). The most prevalent barriers identified were lack of knowledge of pharmacological treatments (45.8%) and lack of access to smoking cessation resources (44.2%). Contrary to international studies, time and financial incentive were not commonly cited barriers to delivering smoking cessation interventions. CONCLUSIONS This survey identifies a need for continuing education in smoking cessation practice. Dissemination of policies, guidelines and resources may assist OHPs to become more engaged and confident in delivering smoking cessation interventions as part of their routine practice.
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Affiliation(s)
- P Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland
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Persistence of smoking-cessation decision support use in a dental practice. Am J Prev Med 2015; 48:722-8. [PMID: 25736977 DOI: 10.1016/j.amepre.2014.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A computer-assisted tobacco decision support tool increased dental practitioners' (dentists and dental hygienists) advice to quit smoking and referral to a quitline during a group randomized trial. The purpose of this study is to document the extent to which use persisted after the trial. METHODS Electronic dental record (EDR) data from 2010 to 2013 were analyzed in 2014 for use of computer-assisted tobacco intervention tool advice scripts and referral to a quitline during four periods: during the trial and post-trial when only intervention clinic dental practitioners had access to the tool, and during full deployment, both before and after an EDR modification. RESULTS Intervention clinic dental practitioners (18.5 dentist full-time equivalents [FTEs] and 27.8 dental hygienist FTEs practicing in seven clinics) referred 19.0% of 1,368 smokers to a quitline during the trial and referred 15.4% of 4,011 smokers post-trial. After full tool deployment but pre-EDR change, these dental practitioners referred 15.6% of 2,214 intervention clinic smokers, whereas 18.3 dentist FTEs and 29.7 dental hygienist FTEs practicing in eight clinics referred 8.5% of 2,113 smokers. Post-EDR change, dental practitioners referred 12.2% of 2,214 intervention clinic smokers and 8.1% of 2,399 control clinic smokers to a quitline. In the last three quarters of observation, clinic script use ranged from 15.4% to 65.8% and referral to a quitline ranged from 2.0% to 18.7% of visits. CONCLUSIONS Although EDR design affected rates of referral, dental practitioners persisted in using a computer-assisted tobacco intervention tool to refer smokers to a quitline.
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Wanyonyi KL, Radford DR, Gallagher JE. Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England. HUMAN RESOURCES FOR HEALTH 2014; 12:65. [PMID: 25407478 PMCID: PMC4247654 DOI: 10.1186/1478-4491-12-65] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/25/2014] [Indexed: 05/23/2023]
Abstract
BACKGROUND Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.
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Affiliation(s)
- Kristina L Wanyonyi
- />King’s College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, SE5 9RS UK
| | - David R Radford
- />Teaching Division, King’s College London Dental Institute, Guys Tower, Guys Hospital, St Thomas Street, London, SE1 9RT UK
- />University of Portsmouth Dental Academy, William Beatty Building, Hampshire Terrace, Portsmouth, Hampshire, PO1 2QG UK
| | - Jennifer E Gallagher
- />King’s College London Dental Institute, Division of Population and Patient Health, Bessemer Road, London, SE5 9RS UK
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Real-world impact of quitline interventions for provider-referred smokers. Am J Prev Med 2014; 47:392-402. [PMID: 25240965 DOI: 10.1016/j.amepre.2014.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 04/18/2014] [Accepted: 05/20/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The healthcare provider-referral quitline model has potential to help identify and connect more smokers to effective cessation services as compared to the self-referral model alone. However, research is limited as to whether provider-referred smokers, who may have more barriers to quitting, can have similar rates of quit success using traditional quitline interventions as self-referred smokers. PURPOSE To (1) determine how provider-referred smokers may differ from self-referred smokers in their demographics, service utilization, and quit rates and (2) quantify the impact of traditional quitline services on provider-referred smokers' ability to quit. METHODS Data were collected for 2,737 provider-referred and 530 self-referred Massachusetts quitline clients between November 2007 and February 2012. Analysis was performed in 2012. Wald chi-square tests and two-sample t-tests were used to identify differences between the two referral populations. A multivariable logistic regression model was used for each referral population, and smoker quit status at follow-up was the primary outcome. Tests and models were weighted using inverse probability of treatment weights propensity score weighting method. RESULTS Compared with self-referred smokers, provider-referred smokers were more likely to be non-white, less educated, and have public insurance. They were less ready to quit and had lower service utilization and quit rates. In both referral populations, clients who used services had greater odds of quitting than those who did not. CONCLUSIONS Expanding the provider-referral model may require quitlines to address the various risk factors associated with this population. Providers serve critical roles in preparing patients for quitline participation prior to referral.
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Gonzalez M, Sanders-Jackson A, Glantz SA. Association of strong smoke-free laws with dentists' advice to quit smoking, 2006-2007. Am J Public Health 2014; 104:e88-94. [PMID: 24524506 DOI: 10.2105/ajph.2013.301714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association of smoke-free laws with dentists' advice to quit smoking and referral to a quit line, among smokers who reported visiting the dentist in the past 12 months. METHODS We used the 2006 to 2007 Tobacco Use Supplement of the Current Population Survey merged with the American Nonsmokers' Rights Foundation Local Ordinance Database of smoke-free laws. The dependent variables were advice from a dentist to quit smoking and referral to a quit line, and the independent variable of interest was 100% smoke-free law coverage. We controlled for respondent demographics and an index of state-level smoking ban attitudes (included to ensure that the effect detected was not the result of social attitudes). RESULTS Smoke-free law coverage was associated with dental advice to quit smoking (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01, 1.59; P = .041), but not with referral to a quit line (OR = 1.33; 95% CI = 0.79, 2.25; P = .283). CONCLUSIONS Interventions with dentists are needed to increase referrals to quit lines and other smoking cessation efforts.
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Affiliation(s)
- Mariaelena Gonzalez
- The authors are with the Center for Tobacco Control Research and Education, and Stanton A. Glantz is also with the Philip R. Lee Institute for Health Policy Studies and the Department of Medicine, University of California San Francisco
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Díaz-Toro EC, Fernández ME, Correa-Fernández V, Calo WA, Ortiz AP, Mejía LM, Mazas CA, Santos-Ortiz MDC, Wetter DW. Promoting tobacco cessation and smoke-free workplaces through community outreach partnerships in Puerto Rico. Prog Community Health Partnersh 2014; 8:157-68. [PMID: 25152097 PMCID: PMC4237274 DOI: 10.1353/cpr.2014.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. OBJECTIVES The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. METHODS Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. RESULTS Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. CONCLUSIONS This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.
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Spring B, Ockene JK, Gidding SS, Mozaffarian D, Moore S, Rosal MC, Brown MD, Vafiadis DK, Cohen DL, Burke LE, Lloyd-Jones D. Better population health through behavior change in adults: a call to action. Circulation 2013; 128:2169-76. [PMID: 24100544 PMCID: PMC4074536 DOI: 10.1161/01.cir.0000435173.25936.e1] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Brondani MA, Pattanaporn K. Integrating Issues of Substance Abuse and Addiction into the Predoctoral Dental Curriculum. J Dent Educ 2013. [DOI: 10.1002/j.0022-0337.2013.77.9.tb05581.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Mario A. Brondani
- University of British Columbia; Faculty of Dentistry, Department of Oral Health Sciences
| | - Komkham Pattanaporn
- University of British Columbia; Faculty of Dentistry, Department of Oral Health Sciences
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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. SELECTION CRITERIA randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. DATA COLLECTION AND ANALYSIS One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. MAIN RESULTS Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, > 24,000 participants, risk ratio (RR) for cessation at longest follow-up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Three studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that tested the provision of access to a hotline two detected a significant benefit and one did not.Telephone counselling not initiated by calls to helplines also increased quitting (51 studies, > 30,000 participants, RR 1.27; 95% CI 1.20 to 1.36). In a meta-regression controlling for other factors the effect was estimated to be slightly larger if more calls were offered, and in trials that specifically recruited smokers motivated to try to quit. The relative extra benefit of counselling was smaller when it was provided in addition to pharmacotherapy (usually nicotine replacement therapy) than when the control group only received self-help material or a brief intervention.A further eight studies were too diverse to contribute to meta-analyses and are discussed separately. Two compared different intensities of counselling, both of which detected a dose response; one of these detected a benefit of multiple counselling sessions over a single call for people prescribed bupropion. The others tested a variety of interventions largely involving offering telephone counselling as part of a referral or systems change and none detected evidence of effect. AUTHORS' CONCLUSIONS Proactive telephone counselling aids smokers who seek help from quitlines. Telephone quitlines provide an important route of access to support for smokers, and call-back counselling enhances their usefulness. There is limited evidence about the optimal number of calls. Proactive telephone counselling also helps people who receive it in other settings. There is some evidence of a dose response; one or two brief calls are less likely to provide a measurable benefit. Three or more calls increase the chances of quitting compared to a minimal intervention such as providing standard self-help materials, or brief advice, or compared to pharmacotherapy alone.
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Affiliation(s)
- Lindsay F Stead
- Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
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Tomar SL. Tobacco-Use Interventions Delivered by Oral Health Professionals may Increase Tobacco Cessation Rates. J Evid Based Dent Pract 2012; 12:62-4. [DOI: 10.1016/j.jebdp.2012.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Freeman T, Roche AM, Williamson P, Pidd K. What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking? Nicotine Tob Res 2012; 14:1040-7. [DOI: 10.1093/ntr/ntr329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sheffer MA, Baker TB, Fraser DL, Adsit RT, McAfee TA, Fiore MC. Fax referrals, academic detailing, and tobacco quitline use: a randomized trial. Am J Prev Med 2012; 42:21-8. [PMID: 22176842 DOI: 10.1016/j.amepre.2011.08.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/20/2011] [Accepted: 08/30/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Fax referral programs quickly and economically can link smokers' visiting primary care clinics to state-based telephone quitlines. Yet, it is unclear how to optimize use of this strategy. PURPOSE To evaluate the potential of enhanced academic detailing in clinics (i.e., on-site training, technical assistance, and performance feedback) to boost utilization of a fax referral program called Fax to Quit. DESIGN Participants were randomized to one of two intervention conditions. SETTING/PARTICIPANTS Participants were drawn from 49 primary care clinics in southeastern Wisconsin. The sample size was based on a power analysis in which the control intervention condition was estimated to generate 0.5 referrals/clinic/month and the experimental condition 2.0 referrals/clinic/month. INTERVENTIONS One of two fax referral program interventions was administered: the control condition Fax to Quit-Only (F2Q-Only) or the experimental condition Fax to Quit plus Enhanced Academic Detailing (F2Q+EAD). MAIN OUTCOME MEASURES Clinic- and clinician-specific referral and quality referral rates (those resulting in quitline enrollment) were measured for 13 months post-intervention, starting in March 2009. RESULTS Mean number of post-intervention referrals/clinician to the Wisconsin Tobacco Quitline was 5.6 times greater for F2Q+EAD (8.5, SD=7.0) compared to F2Q-Only (1.6, SD=3.6, p<0.001). The F2Q+EAD (4.8, SD=4.1) condition produced a greater mean number of quality referrals/clinician than did the F2Q-Only (0.86, SD=1.8, p<0.001) condition. Data were analyzed in 2010. CONCLUSIONS Enhanced academic detailing, which included on-site training, technical assistance, and performance feedback, increased the number of referrals more than fivefold over a fax referral program implemented without such enhanced academic detailing. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT00989755.
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Affiliation(s)
- Megan A Sheffer
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Ojima M, Hanioka T, Tanaka H. Necessity and readiness for smoking cessation intervention in dental clinics in Japan. J Epidemiol 2011; 22:57-63. [PMID: 22156286 PMCID: PMC3798581 DOI: 10.2188/jea.je20110038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 09/14/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The necessity and readiness for smoking cessation intervention in dental clinics was assessed by investigating smoking status and stage of behavior change in patients and the attitudes of dentists toward the effects of smoking on their patients, respectively. METHODS A self-administered questionnaire was mailed to 1022 dentists randomly selected from the Japanese Dental Association database. The questionnaire survey consisted of 1 section for dentists and 1 for patients aged 20 years or older and was scheduled to be completed at the dentists' clinics on a designated day in February 2008. RESULTS The response rate to the questionnaire was 78.2% from among target dental clinics and 73.7% and 74.7% for patient and dentist questionnaires, respectively. Data from 11,370 patients and 739 dentists were analyzed. The overall smoking prevalence among the patients (25.1%) was similar to that reported by the National Health and Nutrition Examination Survey, and young female patients had a markedly higher smoking prevalence. More than 70% of patients who smoked were interested in quitting. Although the prevalence of current smoking among dentists (27.1%) was significantly higher than that reported among Japanese physicians (15.0%), approximately 70% of dentists were concerned about the effects of smoking on patient health and prohibited smoking inside their clinic. CONCLUSIONS Many smokers who were interested in quitting, particularly young women, visited dental clinics, and most dentists believed that smoking was harmful for their patients. These results indicate that smoking cessation intervention in dental settings is necessary and that dentists are ready to provide such interventions.
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Affiliation(s)
- Miki Ojima
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Takashi Hanioka
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, Fukuoka, Japan
| | - Hideo Tanaka
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
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Experienced barriers and facilitators for integrating smoking cessation advice and support into daily dental practice. A short report. Br Dent J 2011; 210:E10. [DOI: 10.1038/sj.bdj.2011.241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2010] [Indexed: 11/09/2022]
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Shelley D, Anno J, Tseng TY, Calip G, Wedeles J, Lloyd M, Wolff MS. Implementing Tobacco Use Treatment Guidelines in Public Health Dental Clinics in New York City. J Dent Educ 2011. [DOI: 10.1002/j.0022-0337.2011.75.4.tb05076.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Donna Shelley
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
| | | | - Tuo-Yen Tseng
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
| | - Greg Calip
- Fred Hutchinson Cancer Research Center; University of Washington
| | - John Wedeles
- Department of Prevention and Community Health; George Washington University School of Public Health and Health Services
| | | | - Mark S. Wolff
- Department of Cariology and Comprehensive Care; New York University College of Dentistry
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MacKinnon DP, Luecken LJ. Statistical analysis for identifying mediating variables in public health dentistry interventions. J Public Health Dent 2011; 71 Suppl 1:S37-46. [PMID: 21656950 PMCID: PMC3366631 DOI: 10.1111/j.1752-7325.2011.00252.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This article provides an overview of statistical mediation analysis methods in the evaluation of public health dentistry interventions. METHODS AND RESULTS First, reasons for conducting mediation analysis are outlined, followed by a discussion of the link between the mediation model and theoretical bases of interventions. Second, the basic statistical procedures in mediation analysis are presented. An example application to data from a hypothetical intervention is provided in Appendix A. Third, interpretation of the results from statistical mediation analysis is described along with additional information pertinent to identifying true mediation relations. CONCLUSIONS Guidelines for describing mediation analyses in research articles related to public health dentistry intervention studies are outlined.
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Affiliation(s)
- David P MacKinnon
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
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Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions? J Am Dent Assoc 2010; 141:1000-7. [PMID: 20675426 DOI: 10.14219/jada.archive.2010.0314] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care. METHODS The authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants. RESULTS At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F(1,66) = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F(1,66) = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies. CONCLUSIONS The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office-based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling. CLINICAL IMPLICATIONS The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.
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Health professional's perceptions of and potential barriers to smoking cessation care: a survey study at a dental school hospital in Japan. BMC Res Notes 2010; 3:329. [PMID: 21138553 PMCID: PMC3016266 DOI: 10.1186/1756-0500-3-329] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 12/07/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is currently accepted as a well-established risk factor for many oral diseases such as oral cancer and periodontal disease. Provision of smoking cessation care to patients with oral problems is a responsibility of health care professionals, particularly dentists and dental hygienists. This study examined the smoking-related perceptions and practices of dental school hospital-based health professionals in Japan. FINDINGS A cross-sectional study design was used. The sample was formed from dentists, dental hygienists, physicians and nurses of a dental school hospital in Tokyo, Japan (n = 93, 72%). Participants were asked to complete an 11-item questionnaire assessing demographic variables and smoking history, provision of smoking cessation advice or care, attitudes about smoking cessation, and perceived barrier(s) to smoking cessation care. Eighteen percent of participants reported being current smokers and 15% reported being ex-smokers, with higher smoking rates reported by dentists compared with other health professionals (p = 0.0199). While recognizing the importance of asking patients about their smoking status, actual provision of smoking cessation advice or care by participants was relatively insufficient. Interventions such as 'assess willingness to make a quit attempt' and 'assist in quit attempt' were implemented for less than one-quarter of their patients who smoke. Non-smokers were more likely to acknowledge the need for increased provision in smoking cessation care by oral health professionals. 'Lack of knowledge and training' was identified as a central barrier to smoking cessation care, followed by 'few patients willing to quit'. CONCLUSIONS A need for further promotion of smoking cessation activities by the health professionals was identified. The findings also suggest that dentists and dental hygienists, while perceiving a role in smoking care, do require training in the provision of smoking cessation care to hospital patients. In order to overcome the potential barriers, it is necessary to provide staff with appropriate training and create an atmosphere supportive of smoking cessation activities.
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Gordon JS, Andrews JA, Albert DA, Crews KM, Payne TJ, Severson HH. Tobacco cessation via public dental clinics: results of a randomized trial. Am J Public Health 2010; 100:1307-12. [PMID: 20466951 PMCID: PMC2882418 DOI: 10.2105/ajph.2009.181214] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit. METHODS We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group. RESULTS We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence (F(1,12) = 6.84; P < .05) and prolonged abstinence (F(1,12) = 14.62; P < .01) than did those in the usual care group. CONCLUSIONS The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans.
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Gonseth S, Abarca M, Madrid C, Cornuz J. A pilot study combining individual-based smoking cessation counseling, pharmacotherapy, and dental hygiene intervention. BMC Public Health 2010; 10:348. [PMID: 20565724 PMCID: PMC2894778 DOI: 10.1186/1471-2458-10-348] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/17/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention. METHODS Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month. RESULTS 39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence. DISCUSSION We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field. TRIAL REGISTRATION NUMBER ISRCTN67470159.
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Affiliation(s)
- Semira Gonseth
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, 1011 Lausanne, Vaud, Switzerland
| | - Marcelo Abarca
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, 1011 Lausanne, Vaud, Switzerland
| | - Carlos Madrid
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, 1011 Lausanne, Vaud, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, 1011 Lausanne, Vaud, Switzerland
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The effect of linking community health centers to a state-level smoker's quitline on rates of cessation assistance. BMC Health Serv Res 2010; 10:25. [PMID: 20100348 PMCID: PMC2823740 DOI: 10.1186/1472-6963-10-25] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 01/25/2010] [Indexed: 11/15/2022] Open
Abstract
Background Smoking cessation quitlines are an effective yet largely untapped resource for clinician referrals. The aim of this study was to assess the effect of a fax referral system that links community health centers (CHCs) with the New York State Quitline on rates of provider cessation assistance. Methods This study was conducted in four CHCs using a quasi experimental study design. Two comparison sites offered usual care (expanded vital sign chart stamp that prompted providers to ask about tobacco use, advice smokers to quit, assess readiness, and offer assistance (4As)) and two intervention sites received the chart stamp plus an office-based fax referral link to the New York State Quitline. The fax referral system links patients to a free proactive telephone counseling service. Provider adherence to the 4 As was assessed with 263 pre and 165 post cross sectional patient exit interviews at all four sites. Results Adherence to the 4As increased significantly over time in the intervention sites with no change from baseline in the comparison sites. Intervention sites were 2.4 (p < .008) times more likely to provide referrals to the state Quitline over time than the comparison sites and 1.8 (p < .001) times more likely to offer medication counseling and/or a prescription. Conclusions Referral links between CHCs and state level telephone quitlines may facilitate the provision of cessation assistance by offering clinicians a practical method for referring smokers to this effective service. Further studies are needed to confirm the efficacy of fax referral systems and to identify implementation strategies that work to facilitate the utilization of these systems across a wide range of clinical settings.
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Patwardhan PD, Chewning BA. Ask, advise and refer: Hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.17.04.0005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objectives
A preliminary qualitative study was conducted to identify key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).
Methods
Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.
Key findings
All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist-patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.
Conclusions
This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation discussions. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.
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Affiliation(s)
- Pallavi D Patwardhan
- Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Betty A Chewning
- Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
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Goniewicz ML, Lingas EO, Czogala J, Koszowski B, Zielinska-Danch W, Sobczak A. The role of pharmacists in smoking cessation in Poland. Eval Health Prof 2009; 33:81-95. [PMID: 20042417 DOI: 10.1177/0163278709356190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Poland, 38.0% of men and 25.6% of women smoke daily. One method for expanding access to smoking cessation services is through community-based pharmacists. Surveys were administered in 2007-2008 to (a) current smokers, (b) members of a pharmacy association, and (c) pharmacy students in their final year of training. Pharmacists were the highest ranked health professionals to whom Polish smokers reported they would turn for information about pharmacological support for smoking cessation. Most pharmacists (79%) reported their knowledge allowed them to provide basic smoking cessation information to their patients. Pharmacy students reported being more able to provide information about the health consequences of tobacco smoking than to help patients quit smoking (85% vs. 61%). In Poland, community-based pharmacists are positioned to provide smoking cessation interventions to all segments of the population. To extend and promote smoking cessation efforts, comprehensive tobacco cessation training should be a required component of the pharmacy school curriculum.
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