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Zyambo C, Siziya S, Ng'ambi W, Gakumo AC, Burkholder GA, Hendricks PS. Receipt of healthcare provider’s advice for smoking
cessation and quit attempts in Zambia. POPULATION MEDICINE 2023. [DOI: 10.18332/popmed/157138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Roscoe S, Boyd J, Buykx P, Gavens L, Pryce R, Meier P. The impact of disinvestment on alcohol and drug treatment delivery and outcomes: a systematic review. BMC Public Health 2021; 21:2140. [PMID: 34809603 PMCID: PMC8609850 DOI: 10.1186/s12889-021-12219-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the context of substantial financial disinvestment from alcohol and drug treatment services in England, our aim was to review the existing evidence of how such disinvestments have impacted service delivery, uptake, outcomes and broader health and social implications. METHODS We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42020187295), searching bibliographic databases and grey literature. Given that an initial scoping search highlighted a scarcity of evidence specific to substance use treatment, evidence of disinvestment from publicly funded sexual health and smoking cessation services was also included. Data on disinvestment, political contexts and impacts were extracted, analysed, and synthesized thematically. RESULTS We found 20 eligible papers varying in design and quality including 10 related to alcohol and drugs services, and 10 to broader public health services. The literature provides evidence of sustained disinvestment from alcohol and drug treatment in several countries and a concurrent decline in the quantity and quality of treatment provision, but there was a lack of methodologically rigorous studies investigating the impact of disinvestment. CONCLUSIONS This review identified a paucity of scientific evidence quantifying the impacts of disinvestment on alcohol and drug treatment service delivery and outcomes. As the global economy faces new challenges, a stronger evidence base would enable informed policy decisions that consider the likely public health impacts of continued disinvestment.
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Affiliation(s)
- Suzie Roscoe
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
- School of Humanities and Social Science, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Lucy Gavens
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Robert Pryce
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
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Tsai SY, Huang WH, Chan HL, Hwang LC. The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study. Tob Induc Dis 2021; 19:82. [PMID: 34720797 PMCID: PMC8534426 DOI: 10.18332/tid/142664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/11/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure. METHODS Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants’ blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive. RESULTS During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure (-5.0±19.0 vs -1.9±15.2 mmHg, p=0.018) and diastolic blood pressure (-3.1±12.9 vs -1.1±9.6 mmHg, p=0.016). After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group. CONCLUSIONS The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group.
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Affiliation(s)
- Szu-Ying Tsai
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Family Medicine, Taipei City Hospital, Zhongxing Branch, Taipei City, Taiwan
| | - Wei-Hsin Huang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Hsin-Lung Chan
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Wang SK, Kao CW, Chuang HW, Tseng YK, Chen WC, Yeh CC, Lai CY, Yen LC, Chiu YL. Government's subsidisation policy and utilisation of smoking cessation treatments: a population-based cross-sectional study in Taiwan. BMJ Open 2021; 11:e040424. [PMID: 33441354 PMCID: PMC7812102 DOI: 10.1136/bmjopen-2020-040424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study examined the associations between the Second-Generation Cessation Payment Scheme (SCPS) and the use of smoking cessation treatments. Furthermore, these associations were compared between light and heavy smokers in Taiwan. DESIGN This study had a cross-sectional design. SETTING Data were obtained from the Taiwan Adult Smoking Behaviour Surveillance System 2010-2011 and 2013-2014; data for each year consisted of a nationally representative sample of adults aged 18 years and older. PARTICIPANTS Current smokers who had either quit or made a serious attempt to quit smoking were selected for the analysis. PRIMARY OUTCOME MEASURE The primary outcome measure was the use of a smoking cessation clinic or pharmacy in a twice daily to quit smoking. RESULTS According to multivariate analysis, the SCPS was positively associated with the combined use of a smoking cessation clinic and a pharmacy (OR=3.947; 95% CI: 1.359 to 11.463) when individual-level predictors (gender, age, education level, marital status, monthly household income, daily cigarette consumption, smoking status and self-reported health) were controlled. Heavy smokers showed a significant increase in the sole use of a pharmacy (OR=1.676; 95% CI: 1.094 to 2.569) and combined use of a smoking cessation clinic and pharmacy (OR=8.984; 95% CI: 1.914 to 42.173) after the SCPS was introduced. In addition, when related factors were controlled, the use of smoking cessation services was more frequent among heavy smokers than light smokers, including any treatment (OR=1.594; 95% CI: 1.308 to 1.942), a smoking cessation clinic (OR=1.539; 95% CI: 1.232 to 1.922), a pharmacy (OR=1.632; 95% CI: 1.157 to 2.302) and the combination of a smoking cessation clinic and pharmacy (OR=4.608; 95% CI: 1.331 to 15.949) . CONCLUSIONS The SCPS subsidisation policy increased the use of smoking cessation treatments, particularly among heavy smokers.
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Affiliation(s)
- Sheng-Kuang Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Medical Administrative Department, Taichung Army Forces General Hospital, Taichung, Taiwan
| | - Chi-Wen Kao
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Hui-Wan Chuang
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Kai Tseng
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wan-Chun Chen
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Chih Yeh
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Yu Lai
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Li-Chen Yen
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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Chung WS, Kung PT, Chang HY, Tsai WC. Demographics and medical disorders associated with smoking: a population-based study. BMC Public Health 2020; 20:702. [PMID: 32414354 PMCID: PMC7227312 DOI: 10.1186/s12889-020-08858-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background Few studies have investigated factors associated with smoking behaviors. In this population-based study, we investigated demographics and medical comorbid diseases to establish a prediction model for smoking behaviors by using the National Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD). Methods We enrolled individuals aged ≥40 years who had participated in the NHIS in 2001, 2005, and 2009. We identified the smoking behaviors of the study participants in the NHIS. Smoking behaviors were divided into ever smokers (current smokers and ex-smokers) and nonsmokers (never smokers).We defined medical comorbid disorders of the study participants by using medical claim data from the NHIRD. We used multivariable logistic regression models to calculate the adjusted odds ratio and 95% confidence interval for variables associated with smoking. The significant variables in the multivariable model were included in the receiver operating characteristic curves (ROC) to predict the sensitivity and specificity of the model. Results In total, 26,375 participants (12,779 men and 13,596 women) were included in the analysis. The prevalence of smoking was 39.29%. The mean ages of the 16,012 nonsmokers were higher than those of the 10,363 smokers (57.86 ± 12.92 years vs. 53.59 ± 10.82 years). Men outnumbered women among smokers (68.18% vs. 31.82%). Male sex, young age and middle age, being insured categories, residence in suburban areas, and chronic obstructive pulmonary disease (COPD) were independent factors associated with smoking. The area under the ROC curve of these significant factors to predict smoking behaviors was 71.63%. Conclusion Sex, age, insured categories, residence in suburban areas, and COPD were associated with smoking in people.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan.,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hui-Yun Chang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan.
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Gao W, Sanna M, Branston JR, Chiou HY, Chen YH, Wu A, Wen CP. Exploiting a low tax system: non-tax-induced cigarette price increases in Taiwan 2011-2016. Tob Control 2019; 28:e126-e132. [PMID: 31164488 PMCID: PMC6996108 DOI: 10.1136/tobaccocontrol-2018-054908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/11/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This study aims to analyse the non-tax-induced price increasing strategies adopted by tobacco industry in Taiwan, a high-income country with comprehensive tobacco control policies but low tobacco taxes and a declining cigarette market. METHODS Using governmental tax, price and inflation data, we analysed cigarette sales volume, affordability, affordability elasticity of demand, market share, pricing and net revenue of the top five tobacco companies in Taiwan from 2011 to 2016 when no tax increases occurred. RESULTS Total revenue after tax grew significantly for all the major transnational tobacco companies between 2011 and 2016 at the expense of the state-owned Taiwan Tobacco and Liquor Corporation. In terms of market share, Japan Tobacco (JT) was the leading company, despite experiencing a small decline, while British American Tobacco and Imperial Brands remained stable, and Philip Morris International increased from 4.7% to 7.0%. JT adopted the most effective pricing strategy by increasing the real price of its two most popular brands (Mevius and Mi-Ne) and, at the same time, doubling the sales of its cheaper and less popular brand Winston by leaving its nominal retail price unaltered. CONCLUSIONS Low and unchanged tobacco taxes enable tobacco companies to use aggressive pricing and segmentation strategies to increase the real price of cigarettes without making them less affordable while simultaneously maintaining customers' loyalty. It is crucial to continue monitoring the industry's pricing strategies and to regularly increase taxes to promote public health and to prevent tobacco industry from profiting at the expense of government revenues.
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Affiliation(s)
- Wayne Gao
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Mattia Sanna
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | | | - Hung-Yi Chiou
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Allison Wu
- Master's Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- China Medical University Hospital, Taichung, Taiwan
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Factors Correlated with Success Rate of Outpatient Smoking Cessation Services in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061218. [PMID: 29890766 PMCID: PMC6025172 DOI: 10.3390/ijerph15061218] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Abstract
Smoking is the leading cause of preventable death. The purpose of this study was to explore the patient’s and physician’s factors that are correlated with smoking cessation success rate. A total of 877 smokers who visited the outpatient smoking cessation services at a medical center in Northern Taiwan were recruited for the study. Phone interviews were carried out six months after the initial visit to evaluate the success rate of smoking cessation. The result showed that the abstinence rate at six-month was 37.7%. By the multivariate logistic regression model, the predictive factors of abstinence were smokers who had a lower Fagerström test for cigarette dependence (FTCD), lower exhaled carbon monoxide (CO) concentration, or who smoked less than 20 cigarettes per day at the first visit. Smokers who had more than one smoking cessation outpatient visit or seen by physicians who, on average, delivered more than one smoking cessation consultations per week also led to a higher success rate. Therefore, we suggest that physicians should put more efforts and encourage follow-up visits for some smokers by knowing their characteristics at the first visit. Furthermore, physicians with more experience in smoking cessation consultation seemed to be more likely to help patients to quit smoking successfully.
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Chang SL, Huang YL, Lee MC, Hu S, Hsiao YC, Chang SW, Chang CJ, Chen PC. Association of Varicose Veins With Incident Venous Thromboembolism and Peripheral Artery Disease. JAMA 2018; 319:807-817. [PMID: 29486040 PMCID: PMC5838574 DOI: 10.1001/jama.2018.0246] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Varicose veins are common but rarely associated with serious health risks. Deep venous thrombosis (DVT), pulmonary embolism (PE), and peripheral artery disease (PAD) are also vascular diseases but associated with serious systemic effects. Little is known about the association between varicose veins and the incidence of other vascular diseases including DVT, PE, and PAD. OBJECTIVE To investigate whether varicose veins are associated with an increased risk of DVT, PE, or PAD. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using claims data from Taiwan's National Health Insurance program. Patients aged 20 years and older with varicose veins were enrolled from January 1, 2001-December 31, 2013, and a control group of patients without varicose veins were matched by propensity score. Patients previously diagnosed with DVT, PE, or PAD were excluded. Follow-up ended December 31, 2014. EXPOSURES Presence of varicose veins. MAIN OUTCOMES AND MEASURES Incidence rates of DVT, PE, and PAD were assessed in people with and without varicose veins. Cox proportional hazards models were used to estimate relative hazards, with the control group as reference. RESULTS There were 212 984 patients in the varicose veins group (mean [SD] age, 54.5 [16.0] years; 69.3% women) and 212 984 in the control group (mean [SD] age, 54.3 [15.6] years; 70.3% women). The median follow-up duration was 7.5 years for DVT, 7.8 years for PE, and 7.3 years for PAD for patients with varicose veins, and for the control group, follow-up duration was 7.6 years for DVT, 7.7 years for PE, and 7.4 years for PAD. The varicose veins group had higher incidence rates than the control group for DVT (6.55 vs 1.23 per 1000 person-years [10 360 vs 1980 cases]; absolute risk difference [ARD], 5.32 [95% CI, 5.18-5.46]), for PE (0.48 for the varicose veins group vs 0.28 for the control group per 1000 person-years [793 vs 451 cases]; ARD, 0.20 [95% CI, 0.16-0.24]), and for PAD (10.73 for the varicose veins group vs 6.22 for the control group per 1000 person-years [16 615 vs 9709 cases]; ARD, 4.51 [95% CI, 4.31-4.71]). The hazard ratios for the varicose veins group compared with the control group were 5.30 (95% CI, 5.05-5.56) for DVT, 1.73 (95% CI, 1.54-1.94) for PE, and 1.72 (95% CI, 1.68-1.77) for PAD. CONCLUSIONS AND RELEVANCE Among adults diagnosed with varicose veins, there was a significantly increased risk of incident DVT; the findings for PE and PAD are less clear due to the potential for confounding. Whether the association between varicose veins and DVT is causal or represents a common set of risk factors requires further research.
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Affiliation(s)
- Shyue-Luen Chang
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Yau-Li Huang
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Mei-Ching Lee
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
| | - Sindy Hu
- Vein Clinic, Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan
- Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chee Jen Chang
- Research Services Center for Health Information, Graduate Institute of Clinical Medicine, Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Chun Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
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Lin YK, Hsu HL, Lin WC, Chang JH, Chang YC, Chang CL, Yuan KSP, Wu AT, Wu SY. Efficacy of postoperative radiotherapy in patients with pathological stage N2 epidermal growth factor receptor wild type adenocarcinoma and squamous cell carcinoma lung cancer. Oncotarget 2017; 8:35280-35288. [PMID: 27835914 PMCID: PMC5471054 DOI: 10.18632/oncotarget.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/28/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Few large, prospective, randomized studies have compared the effects of postoperative radiotherapy (PORT) in pathological N2 (pN2) with those of surgical resection alone. in terms of long-term survival in lung adenocarcinoma (adenoCA; wild-type [WT] epidermal growth factor receptor [EGFR]) and squamous cell carcinoma (squCA) settings. This nationwide cohort study clarifies the role of PORT in the survival of pN2 lung adenoCA (WT EGFR) and squCA patientsPatients and Methods: We analyzed data of patients with adenoCA (WT EGFR) and squCA collected from the Taiwan Cancer Registry database. The patients were categorized into five groups according to the treatment modality: Group 1 (surgery alone), Group 2 (adjuvant chemotherapy [CT] alone), Group 3 (adjuvant radiotherapy [RT] alone), Group 4 (adjuvant concurrent chemoradiotherapy [CCRT]), and Group 5 (adjuvant sequential CT and intensity-modulated RT [IMRT]). RESULTS We enrolled 588 lung adenoCA (WT EGFR) and squCA patients without distant metastasis. After adjustments for age at surgery, surgical years, and Charlson comorbidity index scores, the multivariate Cox regression analysis demonstrated that adjusted HRs (aHRs; 95% confidence intervals [CIs]) for the overall mortality of female lung adenoCA (WT EGFR) patients were 0.257 (0.111-0.594), 0.530 (0.226-1.243), 0.192 (0.069-0.534), and 0.399 (0.172-0.928) in Groups 2, 3, 4, and 5, respectively. For male lung squCA patients, the aHRs (95% CIs) for overall mortality were 0.269 (0.160-0.451), 0.802 (0.458-1.327), 0.597 (0.358-0.998), and 0.456 (0.265-0.783) in Groups 2, 3, 4, and 5, respectively. CONCLUSIONS Adjuvant CCRT or sequential CT and IMRT at ≥5000 cGy significantly reduced the mortality rate of female lung adenoCA (WT EGFR) and male squCA pN2 patients.
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Affiliation(s)
- Yen-Kuang Lin
- Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Han-Lin Hsu
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Cheng Lin
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jer-Hwa Chang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yw-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chia-Lun Chang
- Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kevin Sheng-Po Yuan
- Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Alexander T.H. Wu
- Ph.D. Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Biotechnology, Hungkuang University, Taichung, Taiwan
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Pifarré M, Carrera A, Vilaplana J, Cuadrado J, Solsona S, Abella F, Solsona F, Alves R. TControl: A mobile app to follow up tobacco-quitting patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 142:81-89. [PMID: 28325449 DOI: 10.1016/j.cmpb.2017.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Tobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem and an increasing number of smokers seeks medical assistance to quit their habit. In this context, there is the need to develop mHealth Apps that assist and manage large smoke quitting programs in efficient and economic ways. OBJECTIVES Our main objective is to develop an efficient and free mHealth app that facilitates the management of, and assistance to, people who want to quit smoking. As secondary objectives, our research also aims at estimating the economic effect of deploying that App in the public health system. METHODS Using JAVA and XML we develop and deploy a new free mHealth App for Android, called TControl (Tobacco-quitting Control). We deploy the App at the Tobacco Unit of the Santa Maria Hospital in Lleida and determine its stability by following the crashes of the App. We also use a survey to test usability of the app and differences in aptitude for using the App in a sample of 31 patients. Finally, we use mathematical models to estimate the economic effect of deploying TControl in the Catalan public health system. RESULTS TControl keeps track of the smoke-quitting users, tracking their status, interpreting it, and offering advice and psychological support messages. The App also provides a bidirectional communication channel between patients and clinicians via mobile text messages. Additionally, registered patients have the option to interchange experiences with each other by chat. The App was found to be stable and to have high performances during startup and message sending. Our results suggest that age and gender have no statistically significant effect on patient aptitude for using TControl. Finally, we estimate that TControl could reduce costs for the Catalan public health system (CPHS) by up to € 400M in 10 years. CONCLUSIONS TControl is a stable and well behaved App, typically operating near optimal performance. It can be used independent of age and gender, and its wide implementation could decrease costs for the public health system.
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Affiliation(s)
- Marc Pifarré
- Department of Computer Science & INSPIRES, University of Lleida, Jaume II 69, E-25001 Lleida, Spain.
| | - Adrián Carrera
- Department of Computer Science & INSPIRES, University of Lleida, Jaume II 69, E-25001 Lleida, Spain.
| | - Jordi Vilaplana
- Department of Computer Science & INSPIRES, University of Lleida, Jaume II 69, E-25001 Lleida, Spain.
| | | | - Sara Solsona
- Hesoft Group, Partida Bovà, 15, E-25196, Lleida, Spain.
| | - Francesc Abella
- Department of Basic Medical Sciences & IRBLleida, University of Lleida, Avda Alcalde Rovira Roure 80, E-25198, Lleida, Spain.
| | - Francesc Solsona
- Department of Computer Science & INSPIRES, University of Lleida, Jaume II 69, E-25001 Lleida, Spain; Hesoft Group, Partida Bovà, 15, E-25196, Lleida, Spain.
| | - Rui Alves
- Department of Basic Medical Sciences & IRBLleida, University of Lleida, Avda Alcalde Rovira Roure 80, E-25198, Lleida, Spain.
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Molarius A, Hellstrand M, Engström S. Social differences in who receives questions and advice about smoking habits when visiting primary care - Results from a population based study in Sweden in 2012. Prev Med Rep 2016; 5:236-240. [PMID: 28127526 PMCID: PMC5256667 DOI: 10.1016/j.pmedr.2016.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/05/2016] [Accepted: 12/17/2016] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to examine whether there are social disparities in who receives questions and advice on smoking habits when visiting primary care and whether these disparities can be explained by differences in smoking habits. The study is based on 30,188 individuals aged 16–84 years who responded to a population survey questionnaire in 2012 in four counties in mid-Sweden (response rate 51%). Multivariate logistic regression models were used in statistical analyses. A total of 32% of those who visited a health care centre during the last three months reported that they were asked about their smoking habits during their latest visit, 6% received advice. In general, daily smokers received more often questions, and especially advice, than non-smokers. Persons with low education received more advice than persons with high education due to higher smoking prevalence. However, persons on disability pension and the unemployed were less frequently asked about their smoking habits than employees even though they smoke more. Women received less often questions and advice than men. Persons born outside the Nordic countries received advice twice as often as native Swedes regardless of whether they were daily smokers or not. In Sweden, those who are asked and, in particular, receive advice about changing their smoking habits while visiting primary care are mainly those who need it most. But the findings also imply that measures to reduce smoking should be intensified for women and are perhaps too intense for persons born outside the Nordic countries. We studied social disparities in receiving questions/advice on smoking in primary care. Persons with low education received more advice due to higher smoking prevalence. Women received less often questions and advice than men. Persons born outside Scandinavia received advice twice as often as native Swedes. Disparities by gender and country of birth were not explained by smoking prevalence.
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Affiliation(s)
- Anu Molarius
- Competence Centre for Health, Västmanland County Council, Västerås, Sweden; Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
| | - Mats Hellstrand
- Competence Centre for Health, Västmanland County Council, Västerås, Sweden
| | - Sevek Engström
- Competence Centre for Health, Västmanland County Council, Västerås, Sweden; Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
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Smoking cessation and receipt of cessation advice from health professionals among older smokers in Taiwan. Prev Med 2016; 91:89-95. [PMID: 27496393 DOI: 10.1016/j.ypmed.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the prevalence and correlates of smoking cessation and receiving professional cessation advice among older smokers in Taiwan. METHODS Cross-sectional data from the 2008-2010 and 2012 Taiwan Adult Smoking Behavior Survey was used to form a sample of 4081 recent active smokers aged 50+, comprising current smokers and former smokers who quit smoking within the past 12months. We examined three outcome variables: quit attempt in the past 12months, successful cessation for at least 3months, and receipt of health professional cessation advice. Multivariate logistic regressions were used to identify significant correlates. RESULTS During the study period, the annual quit attempt rate was 41.4%, annual successful cessation rate was 4.7%, and prevalence of receiving cession advice among smokers who visited health professionals within the past 12months was 72.3%. After controlling for other covariates, quit attempts were significantly higher in 2009 and positively associated with higher education, poorer health status, smoke-free homes, and receipt of cessation advice. Successful cessation was significantly higher in 2009, positively associated with older age, higher income, and smoke-free homes, and negatively associated with receiving cessation advice. Receipt of cessation advice was significantly lower in 2010 and 2012, positively associated with male gender, older age, and poorer health status, and negatively associated with higher education. CONCLUSIONS Our results suggest that targeting lower educated and lower income subgroups, adopting effective strategies to increase voluntary smoke-free home rules, and improving professional cessation advice will have great potential to further reduce smoking prevalence in older smokers.
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Wu TY, Hung LY, Chie WC, Chiu TY, Guo FR. Change of government's subsidization policy improves smoking cessation services: a cross-sectional study from the perspectives of physicians. BMC Public Health 2016; 16:415. [PMID: 27188506 PMCID: PMC4869352 DOI: 10.1186/s12889-016-3052-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background The Taiwanese government increased financial subsidies for smoking cessation services in 2012. We aimed to evaluate the effects of this new policy on smoking cessation services from the physician’s perspective. Methods This was a cross-sectional nationwide survey. Physicians who provided smoking cessation services for more than ten patient encounters in the preceding year of the new policy (February 2011 to March 2012) were recruited. The questionnaire was developed by two experts and was validated by a committee consisting of 11 delegates. Results We sent a total of 1,319 questionnaires. The response rate was 45.9 %. The majority of respondents were male (88.4 %), middle-aged (65.3 %), and worked as family physicians (56.1 %). Most physicians agreed that the new policy had increased the number of patients seeking smoking cessation, increased patients’ willingness to adopt pharmacotherapy, helped physicians to prescribe medications, improved patients’ adherence to medications, and improved quality of care. These changes were most prominent in medical centers. Changes in the practice of the 5As (ask, advise, assess, assist, arrange) were moderate. Among different medical settings, the most significant change was an increase in the expenditure on smoking cessation medications. Conclusions The new subsidization policy in Taiwan has improved smoking cessation services. Overall, physicians reported positive effects of the new policy. Further study is warranted to evaluate the long-term influence of the policy.
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Affiliation(s)
- Tai-Yin Wu
- Department of Preventive Medicine, Renai Branch, Taipei City Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ling-Yu Hung
- Department of Family Medicine, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan.
| | - Fei-Ran Guo
- Department of Family Medicine, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan.
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Chang YY, Yu SM, Lai YJ, Wu PL, Huang KC, Huang HL. Improving smoking cessation outcomes in secondary care: Predictors of hospital staff willingness to provide smoking cessation referral. Prev Med Rep 2016; 3:229-33. [PMID: 27419019 PMCID: PMC4929235 DOI: 10.1016/j.pmedr.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 02/01/2016] [Accepted: 02/29/2016] [Indexed: 01/06/2023] Open
Abstract
Since implementation of the New Smoking Cessation Policy in Taiwan, more patients are attending smoking cessation clinics. Many of these patients were referred by hospital staff. Thus, factors which influence the hospital staff's willingness to refer are important. In this study, we aim to understand the relation between smoking cessation knowledge and willingness for referral. A cross-sectional study using a questionnaire was conducted with staff of a community hospital during the year 2012–2013. Willingness to provide smoking cessation referral and relevant correlated variables including demographic data, knowledge of basic cigarette harm, and knowledge of resources and methods regarding smoking cessation were measured. A total of 848 of 1500 hospital staff returned the questionnaire: 249 physicians (29.4%), 402 nursing staff (47.4%), and 197 administration staff (23.2%). 790 (93.2%) staff members have never smoked, 19 (2.2%) had quit smoking, and 39 (4.6%) still smoke. 792 (93.4%) members had interest in receiving smoking cessation education. The mean total score (highest potential score of 6) of basic cigarette harm knowledge was 4.56 (± 1.25). The mean total score (highest potential score of 7) of resources and methods about smoking cessation was 4.79 (± 1.35). The significant variable correlated with willingness to refer was total score of resources and methods about smoking cessation. Hospital staff who knew more about resources and methods about smoking cessation were more willing to refer smoking patients to the smoking cessation service. Thus, continuing medical education for hospital staff should include resources and methods about smoking cessation to promote smoking cessation. Knowledge of methods and resources for smoking cessation increases referral rates. Just educating about smoking harm will not increase willingness for referral. Education should include resources and methods about smoking cessation.
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Affiliation(s)
- Yin-Yu Chang
- Department of Family Medicine, Taiwan Adventist Hospital, 424 Sec. 2 Bade Road, Songshan District, Taipei City 105, Taiwan
| | - Shu-Man Yu
- Department of Family Medicine, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian District, New Taipei City 231, Taiwan
| | - Yun-Ju Lai
- Department of Family Medicine, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian District, New Taipei City 231, Taiwan
| | - Ping-Lun Wu
- Department of Family Medicine, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian District, New Taipei City 231, Taiwan; Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, 1 Changde Street, Zhongzheng District, Taipei City 100, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, 1 Changde Street, Zhongzheng District, Taipei City 100, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, Cardinal Tien Hospital, 362 Zhongzheng Road, Xindian District, New Taipei City 231, Taiwan; Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, 1 Changde Street, Zhongzheng District, Taipei City 100, Taiwan; School of Medicine, Fu-Jen Catholic University, 510 Zhongzheng Road, Xinzhuang District, New Taipei City 242, Taiwan
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Chen PC, Kuo RNC, Lai CK, Tsai ST, Lee YC. The relationship between smoking status and health-related quality of life among smokers who participated in a 1-year smoking cessation programme in Taiwan: a cohort study using the EQ-5D. BMJ Open 2015; 5:e007249. [PMID: 25953727 PMCID: PMC4431071 DOI: 10.1136/bmjopen-2014-007249] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the relationship between smoking status and health-related quality of life 1 year after participation in a smoking cessation programme in Taiwan. DESIGN A cohort study of smokers who voluntarily participated in a smoking cessation programme with two follow-up assessments of smoking status via telephone interview, conducted 6 months and 1 year after finishing the smoking cessation programme. SETTING Hospitals and clinics providing smoking cessation services. PARTICIPANTS A total of 3514 participants completed both telephone interviews, which represents a response rate of 64%. After the interviews, participants were divided into four groups according to their smoking status: (1) long-term quitters: participants who had quit tobacco use for 1 year; (2) short-term quitters: participants who had been smoking for at least 6 months and then quit tobacco for 6 months after participating in the programme; (3) relapsed smokers: participants who relapsed into tobacco use after ceasing tobacco use for 6 months; and (4) continuing smokers: participants who failed to quit smoking for at least 1 year, despite participating in the programme. INTERVENTIONS The Outpatient Smoking Cessation Service of Taiwan provides counselling and pharmacotherapy to individuals seeking to quit smoking. PRIMARY OUTCOMES The health-related quality of life of the participants was measured using an approved Chinese version of the EuroQol-5D-3L (EQ-5D-3L) descriptive system. RESULTS After controlling for sex, age, education, marital status, job status, monthly income and disease status at baseline, our results revealed that long-term (OR=0.61 (0.48 to 0.77)) and short-term (OR=0.65 (0.54 to 0.79)) quitters experienced less anxiety and depression than did continuing smokers. CONCLUSIONS Our study provides evidence to support claims that all quitters, regardless of whether they stop smoking for 6 months or 1 year, have better quality of life with regard to anxiety or depression.
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Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Health and Welfare, School of Metropolitan Governance, University of Taipei, Taipei, Taiwan
| | - Raymond Nien-Chen Kuo
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Chih-Kuan Lai
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Tzu Tsai
- Center for Preventive Services, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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Vilaplana J, Solsona F, Abella F, Cuadrado J, Alves R, Mateo J. S-PC: an e-treatment application for management of smoke-quitting patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 115:33-45. [PMID: 24742965 DOI: 10.1016/j.cmpb.2014.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 02/06/2014] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
The main objective of this paper is to present a new program that facilitates the management of people who want to quit smoking, implemented through an e-treatment software called S-PC (Smoker Patient Control). S-PC is a web-based application that manages groups of patients, provides a bidirectional communication through mobile text messages and e-mails between patients and clinicians and offers advice and control to keep track of the patients and their status. A total of 229 patients were enrolled in the study, randomly divided into two groups, although some variables were tested to ensure that there were no significant differences between the groups that could have an impact on the outcome of the treatment. There were no significant differences between the two groups regarding the ratio/number of males/females, tobacco dependence, co-oximetry, average cigarette consumption, current age and age when smoking started. The first group was made up of 104 patients (45.4% of the total) and followed a treatment that incorporated the S-PC tool, while the second one had 125 patients without the S-PC tool. S-PC was evaluated for its effectiveness at assisting the patients to give up smoking, and its effect on clinician time management. 74% of the S-PC group completed the treatment without relapses and remained abstinent three months after the completion of the treatment, understanding abstinence as being continuous (with no relapses allowed and co-oximetry below 1 ppm) from the day of stopping. In contrast only 45.6% of the No S-PC group completed the treatment without relapses and remained abstinent three months after completion of the treatment. The rate of admittance to the program has doubled in one year and patients went from having to wait for 3 months to be immediately admitted into the program. This therapeutic e-health program aims at maximizing the number of patients that a professional can effectively help to quit smoking. In addition, the system also detects patients who are not progressing appropriately, allowing the professional to improve their treatment parameters dynamically.
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Affiliation(s)
- Jordi Vilaplana
- Departament d'Informàtica i Enginyeria Industrial & INSPIRES, Universitat de Lleida, Av. Jaume II no 69, 25001 LLeida, Spain
| | - Francesc Solsona
- Departament d'Informàtica i Enginyeria Industrial & INSPIRES, Universitat de Lleida, Av. Jaume II no 69, 25001 LLeida, Spain.
| | - Francesc Abella
- Unitat de Tabaquisme de l'Hospital Santa Maria, Alcalde Rovira Roure, 44, 25198 LLeida, Spain
| | | | - Rui Alves
- Departament de Ciències Mèdiques Bàsiques & IRBLleida, Universitat de Lleida, Montserrat Roig no 2, 25008 LLeida, Spain
| | - Jordi Mateo
- Departament d'Informàtica i Enginyeria Industrial & INSPIRES, Universitat de Lleida, Av. Jaume II no 69, 25001 LLeida, Spain
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Li IC, Lee SYD, Chen CY, Jeng YQ, Chen YC. Facilitators and barriers to effective smoking cessation: counselling services for inpatients from nurse-counsellors' perspectives--a qualitative study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4782-98. [PMID: 24806190 PMCID: PMC4053899 DOI: 10.3390/ijerph110504782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Abstract
Tobacco use has reached epidemic levels around the World, resulting in a world-wide increase in tobacco-related deaths and disabilities. Hospitalization presents an opportunity for nurses to encourage inpatients to quit smoking. This qualitative descriptive study was aimed to explore nurse-counsellors' perspectives of facilitators and barriers in the implementation of effective smoking cessation counselling services for inpatients. In-depth interviews were conducted with 16 nurses who were qualified smoking cessation counsellors and who were recruited from eleven health promotion hospitals that were smoke-free and located in the Greater Taipei City Area. Data were collected from May 2012 to October 2012, and then analysed using content analysis based on the grounded theory approach. From nurse-counsellors' perspectives, an effective smoking cessation program should be patient-centred and provide a supportive environment. Another finding is that effective smoking cessation counselling involves encouraging patients to modify their lifestyles. Time constraints and inadequate resources are barriers that inhibit the effectiveness of smoking cessation counselling programs in acute-care hospitals. We suggest that hospitals should set up a smoking counselling follow-up program, including funds, facilities, and trained personnel to deliver counselling services by telephone, and build a network with community smoking cessation resources.
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Affiliation(s)
- I-Chuan Li
- Institute of Clinical and Community Health Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
| | - Shoou-Yih D Lee
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, 1420 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Chiu-Yen Chen
- Department of Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
| | - Yu-Qian Jeng
- Jhubei City Health Center, Public Health Bureau, HsinChu County Government, No. 89, Guangming 2nd St., Zhubei City, Hsinchu County 30251, Taiwan.
| | - Yu-Chi Chen
- Department of Nursing, School of Nursing, National Yang-Ming University, No. 155, Section 2, Li-Nong St. Beitou, Taipei 11221, Taiwan.
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Tsai YW, Chang LC, Sung HY, Hu TW, Chiou ST. The impact of smoke-free legislation on reducing exposure to secondhand smoke: differences across gender and socioeconomic groups. Tob Control 2013; 24:62-9. [PMID: 24014636 DOI: 10.1136/tobaccocontrol-2013-051004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). METHODS An annual sample of about 13,000-14,000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. RESULTS The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. CONCLUSIONS The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status.
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Affiliation(s)
- Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Li-Chuan Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Hai-Yen Sung
- Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Teh-Wei Hu
- School of Public Health, University of California, Berkeley, California, USA
| | - Shu-Ti Chiou
- Institution of Public Health & Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China Health Promotion Administration, Ministry of Health and Welfare, New Taipei City, Taiwan, Republic of China
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Chen PC, Lee YC, Tsai ST, Lai CK. A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint. Nicotine Tob Res 2011; 14:522-30. [PMID: 22180585 DOI: 10.1093/ntr/ntr241] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study applied a cost-benefit analysis from a societal viewpoint to evaluate the Outpatient Smoking Cessation Services (OSCS) program. METHODS The costs measured in this study include the cost to the health sector, non-health sectors, the patients and their family, as well as the loss of productivity as a result of smoking. The benefits measured the medical costs savings and the earnings due to the increased life expectancy of a person that has stopped smoking for 15 years. Data were obtained from the primary data of a telephone survey, the literatures and reports from the Outpatient Smoking Cessation Management Center and government. Sensitivity analyses were conducted to verify the robustness of the results. RESULTS There were 169,761 cases that participated in the outpatient smoking cessation program in the years 2007 and 2008, of those cases, 8,282 successfully stopped smoking. The total cost of the OSCS program was 18 million USD. The total benefits of the program were 215 million USD with a 3% discount rate; the net benefit to society was 196 million USD. After conducting sensitivity analyses on the different abstinence, relapse, and discount rates, from a societal perspective, the benefits still far exceeded the costs, while from a health care perspective, there was only a net benefit when the respondent's abstinence rate was used. CONCLUSIONS From a societal perspective, the OSCS program in Taiwan is cost-beneficial. This study provides partial support for the policy makers to increase the budget and expand the OSCS program.
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Affiliation(s)
- Pei-Ching Chen
- Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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Chang FC, Chung CH, Yu PT, Chao KY. The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan. HEALTH EDUCATION RESEARCH 2011; 26:179-191. [PMID: 21084424 DOI: 10.1093/her/cyq073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.
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Affiliation(s)
- Fong-ching Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 10610, Taiwan.
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