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Melzer AC, Campbell ME, Hagedorn HJ, Fu SS. Clinician Views of Proactive Tobacco Treatment Programs: A Qualitative Evaluation. J Gen Intern Med 2024:10.1007/s11606-024-08834-3. [PMID: 38831247 DOI: 10.1007/s11606-024-08834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Proactive tobacco treatment programs are an evidence-based strategy to recruit patients who smoke to make supported quit attempts. However, such programs are rarely implemented. We performed a qualitative assessment of clinicians to inform the creation of a proactive outreach program for patients with chronic obstructive pulmonary disease (COPD) who smoke. METHODS Informed by the Consolidated Framework for Implementation Research, we conducted semi-structured interviews to assess clinician views of proactive outreach, including barriers, program structure, and the use of technology. Clinicians included primary and specialty care physicians, nurses and advanced practice providers, pharmacists, respiratory therapists, a psychologist, and relevant members of leadership. Interviews were transcribed and analyzed using directed content analysis. RESULTS Clinicians in all roles identified that proactive outreach could be an effective use of resources to help patients with COPD who smoke quit with several advantages over the current state. Clinicians disagreed on the priority population (e.g., younger patients, sicker patients), and to some extent on whether proactive outreach is a clinical priority. Though they supported that technology could be part of the outreach program, most advocated for multiple avenues (phone calls, drop-in clinic, texting), as these patients were perceived to be low technology utilizers. The primary implementation barriers were competing priorities and cost, as well as unclear billing and staffing models. CONCLUSIONS Clinicians support proactive outreach for patients with COPD, but the optimal way to structure, staff, and fund such programs remains unclear. Health systems should leverage implementation strategies to speed uptake of these potentially life-saving programs.
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Affiliation(s)
- Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Megan E Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Hildi J Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Steve S Fu
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Elf JL, Horn K, Abroms L, Stanton CA, Cohn AM, Spielberg F, Gray T, Harvey E, Debnam C, Kierstead L, Levy ME, Castel A, Monroe A, Niaura R. Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke. J Assoc Nurses AIDS Care 2023; 34:363-375. [PMID: 37378565 PMCID: PMC10803179 DOI: 10.1097/jnc.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.
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Affiliation(s)
| | | | | | | | - Amy M. Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Tiffany Gray
- George Washington University, Washington, D.C., USA
| | | | - Charles Debnam
- Deputy Chief Executive Officer of Community Wellness Alliance, Washington, D.C., USA
| | | | | | | | - Anne Monroe
- George Washington University, Washington, D.C., USA
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3
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Pashutina Y, Kotz D, Kastaun S. Attempts to quit smoking, use of smoking cessation methods, and associated characteristics among COPD patients. NPJ Prim Care Respir Med 2022; 32:50. [DOI: 10.1038/s41533-022-00316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
AbstractWe explored past-year quit attempts, cessation methods used, and associations with sociodemographic, smoking, and health-related characteristics among smoking patients with chronic obstructive pulmonary disease (COPD) in Germany. Cross-sectional survey data of 509 past-year smokers (current smokers and ≤12 months abstinent) with COPD (ICD-10 code J44.x and FEV1/FVC <0.70) from 19 pulmonary primary care practices were used. Associations were explored between age, sex, educational qualification, lung function, urges to smoke, psychological distress, and (a) ≥1 past-year quit attempt (yes/no), (b) use of ≥1 evidence-based smoking cessation method (yes/no). Of all patients, 48.5% (n = 247, 95% confidence interval (CI) 44.2–52.9) reported ≥1 past-year quit attempt. Such an attempt was positively associated with the male sex (Odds Ratio (OR) = 1.50, 95% CI 1.01–2.24) and negatively associated with time spent with urges to smoke (OR = 0.69, 95% CI 0.52–0.91). During the most recent past-year quit attempt, one-third of the patients used ≥1 evidence-based smoking cessation method (31.2%, 95% CI 25.4–37.0), which was positively associated with the strength of urges to smoke (OR = 1.62, 95% CI 1.09–2.41). Combined behavioural and pharmacological treatments were used by 4.0% (n = 10, 95% CI 1.6–6.5). Electronic cigarettes were used most frequently (21.5%, 95% CI 16.3–26.6). Although a high proportion of COPD patients in German pulmonary primary care attempt to quit smoking, only a few of them use evidence-based methods as assistance for quitting.
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Takala J, Vähätalo I, Tuomisto LE, Niemelä O, Ilmarinen P, Kankaanranta H. Documentation of smoking in scheduled asthma contacts in primary health care: a 12-year follow-up study. NPJ Prim Care Respir Med 2022; 32:44. [PMID: 36271085 PMCID: PMC9587006 DOI: 10.1038/s41533-022-00309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Smoking among asthmatics is common and associates with poorer asthma control, more rapid lung function decline and higher health care costs in dose-dependent manner. No previous real-life studies exist, however, on how smoking status and pack-years are documented in scheduled asthma contacts in primary health care (PHC) during long-term follow-up, and how often patients are advised to quit smoking. In this real-life 12-year follow-up study, we showed that out of all scheduled PHC asthma contacts (n = 603) smoking was mentioned only in 17.2% and pack-years only in 6.5%. Smoking data was not recorded even once in 70.9% of never smokers, 64.7% of ex-smokers and 27.3% of current smokers. Smoking including pack-years were mentioned more often if nurse took part on the scheduled contact. For current smokers, smoking cessation was recommended only in 21.7% of their scheduled contacts. Current smokers used more antibiotics and had more unscheduled health care contacts during follow-up.
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Affiliation(s)
- Jaana Takala
- Department of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. .,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. .,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Khan A, Green K, Smoll N, Khandaker G, Gartner C, Lawler S. Roles, experiences, and perspectives of the stakeholders of "10,000 Lives" smoking cessation initiative in Central Queensland: findings from an online survey during COVID-19 situation. Health Promot J Austr 2022; 33 Suppl 1:316-326. [PMID: 35322498 PMCID: PMC9087515 DOI: 10.1002/hpja.598] [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: 10/18/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Issue addressed The “10,000 Lives” initiative was launched in Central Queensland in November 2017 to reduce daily smoking prevalence to 9.5% by 2030 by promoting available smoking cessation interventions. One of the main strategies was to identify and engage possible stakeholders (local champions for the program) from hospitals and community organisations to increase conversations about smoking cessation and referrals to Quitline. We aimed to understand the roles, experiences and perceptions of stakeholders (possible champions for delivering smoking cessation support) of the “10,000 Lives” initiative in Central Queensland, Australia. Methods We conducted a mixed‐method online survey during the COVID‐19 situation (23 June 2020 to 22 August 2020) with a cross‐section of possible stakeholders who were targeted for involvement in “10, 000 Lives” using a structured questionnaire with mostly closed‐ended questions. Questions were asked regarding their roles, experiences and perceptions about smoking cessation and “10,000 Lives”. Results Among the 110 respondents, 52 (47.3%) reported having provided smoking cessation support, including referral to Quitline, brief intervention and promoting existing interventions. Among them (n = 52), 31 (59.6%) were from hospitals and health services, 14 (26.9%) were from community services and three (5.8%) were from private medical practices while four of them did not report their setting. Twenty‐five respondents (22.7%) self‐identified as being directly involved with the “10, 000 Lives” initiative, which significantly predicted provision of smoking cessation support (OR 6.0, 95% CI: 2.1‐19.8). However, a substantial proportion (63.5%) of those (n = 52) who reported delivering cessation support did not identify as contributing to “10,000 Lives”. Conclusions Stakeholders from hospitals, health services and community services are the main providers of smoking cessation support in Central Queensland. More could be done to support other stakeholders to feel confident about providing cessation support and to feel included in the initiative. So what? Engaging with a range of stakeholders is critical for health promotion program success, to further develop the program and to ensure its sustainability. As such, funding needs to be allocated to the activities that enable this process to occur.
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Affiliation(s)
- Arifuzzaman Khan
- School of Public Health, The University of Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Australia
| | - Kalie Green
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Australia
| | - Gulam Khandaker
- School of Public Health, The University of Queensland, Australia.,Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Australia
| | - Sheleigh Lawler
- School of Public Health, The University of Queensland, Australia
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Nemmar A, Al-Salam S, Beegam S, Zaaba NE, Ali BH. Effect of smoking cessation on chronic waterpipe smoke inhalation-induced airway hyperresponsiveness, inflammation, and oxidative stress. Am J Physiol Lung Cell Mol Physiol 2021; 320:L791-L802. [PMID: 33719568 DOI: 10.1152/ajplung.00420.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Waterpipe smoking (WPS) prevalence is increasing globally. Clinical and laboratory investigations reported that WPS triggers impairment of pulmonary function, inflammation, and oxidative stress. However, little is known if smoking cessation (SC) would reverse the adverse pulmonary effects induced by WPS. Therefore, we evaluated the impact of WPS inhalation for 3 mo followed by 3 mo of SC (air exposure) compared with those exposed for either 3 or 6 mo to WPS or air (control) in C57BL/6 mice. To this end, various physiological, biochemical, and histological endpoints were evaluated in the lung tissue. Exposure to WPS caused focal areas of dilated alveolar spaces and foci of widening of interalveolar spaces with peribronchiolar moderate mixed inflammatory cells consisting of lymphocytes, macrophages, and neutrophil polymorphs. The latter effects were mitigated by SC. Likewise, SC reversed the increase of airway resistance and reduced the increase in the levels of myeloperoxidase, matrix metalloproteinase 9, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor-α, interleukin (IL)-6, and IL-1β in lung tissue induced by WPS. In addition, SC attenuated the increase of oxidative stress markers including 8-isoprostane, glutathione, and catalase induced by WPS. Similarly, DNA damage, apoptosis, and the expression of NF-κB in the lung induced by WPS inhalation were alleviated by CS. In conclusion, our data demonstrated, for the first time, to our knowledge, that SC-mitigated WPS inhalation induced an increase in airway resistance, inflammation, oxidative stress, DNA injury, and apoptosis, illustrating the benefits of SC on lung physiology.
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Affiliation(s)
- Abderrahim Nemmar
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Suhail Al-Salam
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sumaya Beegam
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Nur E Zaaba
- Department of Physiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Badreldin H Ali
- Department of Pharmacology and Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
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Sales MPU, Araújo AJD, Chatkin JM, Godoy ID, Pereira LFF, Castellano MVCDO, Tanni SE, Almeida AÁD, Chatkin G, Silva LCCD, Gonçalves CMC, Botelho C, Santos UP, Viegas CADA, Sestelo MR, Meireles RHS, Correa PCRP, Oliveira MEMD, Reichert J, Lima MS, Silva CARD. Update on the approach to smoking in patients with respiratory diseases. J Bras Pneumol 2019; 45:e20180314. [PMID: 31271604 PMCID: PMC6715029 DOI: 10.1590/1806-3713/e20180314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 02/26/2023] Open
Abstract
Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.
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Affiliation(s)
| | - Alberto José de Araújo
- . Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - José Miguel Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | | | - Suzana Erico Tanni
- . Disciplina de Pneumologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil
| | | | - Gustavo Chatkin
- . Escola de Medicina. Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Luiz Carlos Côrrea da Silva
- . Pavilhão Pereira Filho da Santa Casa, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | | | - Clóvis Botelho
- . Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá (MT) Brasil
- . Centro Universitário de Várzea Grande - UNIVAG - Várzea Grande (MT) Brasil
| | - Ubiratan Paula Santos
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | | | - Ricardo Henrique Sampaio Meireles
- . Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, (RJ), Brasil
- . Instituto Estadual de Doenças do Tórax Ary Parreiras - IETAP - Secretaria Estadual de Saúde do Rio de Janeiro, Niterói (RJ) Brasil
| | | | | | - Jonatas Reichert
- . Secretaria de Saúde do Paraná - SESA-PR - Curitiba (PR) Brasil
| | - Mariana Silva Lima
- . Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil
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Peiffer G, Underner M, Perriot J. [COPD and smoking cessation: Patients' expectations and responses of health professionals]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:375-390. [PMID: 30455124 DOI: 10.1016/j.pneumo.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The importance of smoking cessation in the management of COPD is well-established: the benefit of quitting smoking as regards morbidity and mortality outcomes in patients, is unquestioned. The smoking cessation in COPD patients is difficult: high levels of consumption, the duration of smoking, high dependence level, psychological co-morbidities such as anxiety and depression, lower socio-economic and intellectual level, constitute barriers. Studies have shown that patients often minimize the risks of smoking, that others do not believe in the benefits of quitting or doubt their ability to quit smoking. The patients' experience, and expectations with regard to smoking cessation are incompletely satisfied: are considered, the smoking characteristics of these patients, the understanding of the tobacco dependence, the beliefs and ideas of smokers, the knowledge of smoking cessation methods, the role of validated aids and alternative treatments, failure management. The answers of the health professionals can be in several directions: establishment of a better communication patient-doctor (empathy), more centered on the needs of the smoker, the role of the motivation and the place of the motivational interview, the understanding of the mechanisms of addiction, a better individualisation of therapeutics, the necessity of a extended follow-up, the contribution of modern technologies, the electronic cigarette, the smoking cessation in respiratory rehabilitation, guidelines that address smoking cessation treatment.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57038 Metz, France.
| | - M Underner
- Centre hospitalier Henri Laborit, unité de recherche clinique, 86000 Poitiers, France
| | - J Perriot
- Dispensaire Emile Roux - CLAT 63, 11, rue Vaucanson, 63100 Clermont-Ferrand, France
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Perriot J, Underner M, Peiffer G, Dautzenberg B. [Helping smoking cessation in COPD, asthma, lung cancer, operated smokers]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:170-180. [PMID: 29748064 DOI: 10.1016/j.pneumo.2018.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 02/05/2023]
Abstract
Smoking is the cause of addictive behavior. Tobacco addiction is a chronic disease that makes difficult to stop smoking and leads to further use. Smoking is a risk factor for COPD, asthma and lung cancer; it may be the cause of severe perioperative complications. This finding justifies that smokers benefit from advice of stopping smoking and smoking cessation assistance. Helping patients to stop smoking increases the chances of quitting, improves the prognosis of tobacco-related diseases, the effectiveness of their treatments and the quality of life of the patients. This article updates the modalities of smoking cessation assistance in smokers with COPD, asthma and lung cancer in operated patients. The goal of the management must be the complete cessation of tobacco smoke intoxication, which alone reduces tobacco mortality.
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Affiliation(s)
- J Perriot
- Dispensaire Emile-Roux, CLAT63, centre de tabacologie, 11, rue Vaucanson, 63100 Clermont-Ferrand, France.
| | - M Underner
- Centre hospitalier Henri-Laborit, unité de recherche clinique, 86000 Poitiers, France
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - B Dautzenberg
- Groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France
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