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

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.

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

AIMS

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

DESIGN

A meta-ethnographic synthesis.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

The Attitudes About Law Number 4207 Among Health Administration Students

Aim: ‘National Tobacco Control Program’ had developed in Turkey by the Ministry of Health in 2009 with amendment of Law 4207 and all closed places became smoke-free. The National Media Campaign has been initiated with the “Smoke Free Air-Zone” slogan for raising public awareness. The aim of our study is to determine the smoking status and attitude of Health Management students about Law 4207 in a university in Turkey, four years after the application of Smoke Free Air-Zone. Methods: In this study we used a questionnaire with 33 questions, which was developed by researchers and Fagerstrom Nicotine Dependent Test to obtain the addiction level of the smokers. Results: Sixty-two percent of 244 students were female. 3.3% were ex-smokers and 10.7% were active smokers. 5.2% of females and 19.3% of males were smoking. 87.5% of smokers think smoking habbit is harmful. 41.4% of the students thought that Law 4207 was generally accepted by the society. Conclusion: Reducing the smoking prevalence and increasing the awareness about the Law 4207 among health administrators is very important for the imlementation of health policy. So our research has an importance to highlight this subject and increase the awareness of the campaign. Keywords: administrators, Law 4207, smoking cessation, tobacco use cessation

Prevalence of smoking in nursing professionals of a cardiovascular hospital

ABSTRACT Objective: to identify the prevalence of smoking in nursing professionals and to determine the relationship of the habit with clinical and socio-demographic characteristics. Method: nursing professionals of a cardiovascular hospital answered a questionnaire on smoking and dependence degree, socio-demographic characteristics, personal and family background, smoking characteristics, motivational stages, depression, perceived and occupational stress. The relationship between the explanatory variables and smoking was investigated. Results: among 656 participants, 77.6% were non smokers, 12.2% former smokers, and 10.2% smokers. Most were female, with complete high school, Catholic, married, household income between three and five minimum wages, position as nursing assistant, had double shifts, and were responsible for family income. The nicotine dependence of smokers ranged from low to moderate. Conclusion: the study has shown low prevalence of smoking in nursing professionals. Education level, religion, marital status, job position, responsibility for family income, history of depression and alcoholism, chest "wheezing" and other symptoms were significantly associated with being a smoker or former smoker.

Non-compliance and associated factors against smoke-free legislation among health care staffs in governmental hospitals in Addis Ababa, Ethiopia: an observational cross-sectional study

Background

In 2014, the Ethiopian government passed a new smoking legislation that banned smoking in public and workplaces including health care facilities. However, data’s on level of non-compliance and associated factors with non-compliance towards smoke-free legislation in hospital settings of the country has not been studied yet.

Methods

Hospital-based Cross-sectional study design triangulated with observational study was conducted in five hospitals. Data were collected through direct observation and interviews using checklist, structured and pre-tested questionnaires for observational study and survey of hospital employee respectively. Nine data collectors and one supervisor were involved in data collection. Three hundred fifty (350) health care staffs were interviewed. Fifteen (15) buildings were purposively observed for observational non-compliance in the selected hospitals. Data were entered by Epi Info and analyzed using SPSS version 21 software. Logistic regression was used to compute the crude and adjusted odds ratios for the factors affecting employee non-compliance with the legislation. A p-value of < 0.05 at 95% CI was considered to be statistically significant.

Results

Anti-smoking signs were absent from a high proportion of hospital areas (97% overall) although visible cigarette butts were generally not observed in most areas of the hospitals. Non-compliance level among health care staffs was 50(10.3%).Associated factors affecting to the non-compliance level of the staff were: being male (AOR = 5.89, p value = 0.001), having poor knowledge (AOR = 2.71, p-value = 0.022) and having Unfavorable attitudes (AOR = 6.15, p-value = 0.000).

Conclusions

Non-compliance level was high and needs careful implementation for 100% smoke-free legislation in addressing knowledge and attitudes of health care staffs.

Dejavniki, povezani z uporabo tobaka pri zdravstvenih delavcih

Uvod: Razširjenost kajenja med zdravstvenimi delavci postaja resen problem. Glavni namen raziskave je bil spoznati dejavnike, ki so povezani z uporabo tobaka zdravstvenih delavcev.Metode: V raziskavi je bil uporabljen integrativni pregled znanstvene literature s področja razširjenosti kajenja med zdravstvenimi delavci in dejavnikov, povezanih z uporabo tobaka pri zdravstvenih delavcih. Uporabljene so bile mednarodne podatkovne baze CINAHL, PubMed, SpringerLink, prav tako pa smo literaturo iskali tudi s pomočjo spletnega brskalnika Google (Google učenjak). S pomočjo ključnih besed razširjenost kajenja med zdravstvenimi delavci, prevalence of smoking, nurses, professionals, tobacco use, smokers, healthcare professionals se je v končno analizo uvrstilo 13 zadetkov, ki so ustrezali vključitvenim kriterijem. Za prikaz pregleda podatkovnih baz in odločanja o uporabnosti pregledanih virov je bila uporabljena metodologija PRISMA. Zbrani podatki so bili analizirani z metodo metasinteze.Rezultati: Identificirali smo 23 kod, ki smo jih glede na lastnosti in medsebojne povezave združili v štiri vsebinske kategorije: (1) nadzor nad tobakom, (2) socialni dejavniki, povezani z uporabo tobaka, (3) ekonomski dejavniki, povezani z uporabo tobaka, (4) zavedanje zdravstvenih delavcev o pomenu promocije nekajenja. Kot najpogostejše statistične metode pri kvantitativnih analizah so bile uporabljene bivariatna (test hi-kvadrat, t-test) in multivariatna analiza.Diskusija in zaključek: Uporaba tobaka pri zdravstvenih delavcih je povezana s socialno-ekonomskimi dejavniki, starostjo, spolom, nižjo izobrazbo, nižjim dohodkom in delovnim okoljem. Krepiti je treba programe promocije nekadilskega vedenja in opogumljati zdravstvene delavce v vlogi vzornikov. 

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

BACKGROUND

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

RESULTS

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

CONCLUSION

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

Smoking behavior among third year dental students in Latin American countries: prevalence, perceptions, and risk factors

Objetivo. Analizar la asociación entre ciertos factores de riesgo relacionados con el tabaquismo en estudiantes de tercer año de odontología de países latinoamericanos. Material y métodos. Se analizaron los datos de la Encuesta Mundial de Estudiantes de Profesiones de la Salud (GHPSS, por sus siglas en inglés) mediante la aplicación de modelos de regresión logística. Resultados. De los 5 605 encuestados, 33% fumó y 45% estuvo expuesto al humo de segunda mano durante el mes pasado; 34% fumó en los edificios de las escuelas dentales durante el pasado año y 85% nunca recibió entrenamiento formal en cesación de tabaquismo. Ser boliviano, chileno o mexicano; estar expuestos al humo de segunda mano; no auto-percibirse como un “modelo a seguir” para los pacientes; y no creer que un profesional de salud que fuma es menos propenso a aconsejar a sus pacientes para dejar de fumar fueron factores asociados significativamente con el tabaquismo. Conclusiones. Todas las escuelas dentales deben fomentar las políticas contra el consumo de tabaco y ofrecer servicios de cesación de tabaquismo. La formación sobre cesación debe incorporarse a los planes de estudio con el fin de incluir a los profesionales dentales en la batalla contra la epidemia de tabaquismo.

Tobacco related knowledge and support for smoke-free policies among community pharmacists in Lagos state, Nigeria

Background:

There are no safe levels of exposure to second hand smoke and smoke-free policies are effective in reducing the burden of tobacco-related diseases and death. Pharmacists, as a unique group of health professionals, might be able to play a role in the promotion of smoke-free policies.

Objective:

To determine the tobacco-related knowledge of community pharmacists and assess their support for smoke-free policies in Lagos state, Nigeria.

Methods:

A cross-sectional descriptive study design using both quantitative and qualitative methods was employed. Two hundred and twelve randomly selected community pharmacists were surveyed using a pre-tested self-administered questionnaire. In addition, one focus group discussion was conducted with ten members of the Lagos state branch of the Association of Community Pharmacists of Nigeria.

Results:

The quantitative survey revealed that the majority (72.1%) of the respondents were aged between 20 and 40 years, predominantly male (60.8%), Yoruba (50.2%) or Igbo (40.3%) ethnicity and had been practicing pharmacy for ten years or less (72.2%). A majority (90.1%) of respondents were aware that tobacco is harmful to health. Slightly less (75.8%) were aware that second hand smoke is harmful to health. Among the listed diseases, pharmacists responded that lung (84.4%) and esophageal (68.9%) cancers were the most common diseases associated with tobacco use. Less than half of those surveyed associated tobacco use with heart disease (46.9%), chronic obstructive pulmonary disease (27.8%), bladder cancer (47.2%), peripheral vascular disease (35.8%) and sudden death (31.1%). Only 51.9% had heard of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). A little over half of the respondents (53.8%) were aware of any law in Nigeria controlling tobacco use. The majority of respondents supported a ban on smoking in homes (83.5%), in public places (79.2%), and in restaurants, nightclubs and bars (73.6%). For every additional client attended to daily, knowledge scores increased by 0.022 points. Current smokers were 1.3 times less likely to support smoke-free policies compared with non-smokers. The findings emanating from the focus group discussion reinforced the fact that the pharmacists were in support of smoke-free policies particularly in homes and public places. It also demonstrated that most of them were aware of the health risks associated with tobacco use and second hand smoke however some misconceptions seemed to exist.

Conclusion:

The pharmacists surveyed expressed support of smoke-free policies and most of them were aware of the health risks associated with tobacco use. However, awareness of WHO FCTC and country-level tobacco legislation was low. Current smokers were less likely to support smoke-free policies. Community pharmacists should therefore be considered worth engaging for the promotion of smoke-free policies. Efforts should also be made to educate pharmacists about country level smoke-free laws.

The association of affective temperaments with smoking initiation and maintenance in adult primary care patients

BACKGROUND

Smoking behaviour and its course is influenced by personality factors. Affective temperaments could allow a more specific framework of the role trait affectivity plays in this seriously harmful health-behaviour. The aim of our study was to investigate if such an association exists in an ageing population with a special emphasis on gender differences.

METHODS

459 primary care patients completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Rating Scale (HAM-A). Subjects were characterized according to their smoking behaviour as current, former or never smokers. Univariate analysis ANOVA and logistic regression were performed to analyse differences in the three smoking subgroups to predict smoking initiation and maintenance.

RESULTS

Current smokers were younger and less educated than former or never smokers. Males were more likely to try tobacco during their lifetime and were more successful in cessation. Depressive, cyclothymic and irritable temperament scores showed significant differences between the three smoking subgroups. Irritable temperament was a predictor of smoking initiation in females whereas depressive temperament predicted smoking maintenance in males with a small, opposite effect of HAM-A scores independent of age, education, lifetime depression and BDI scores. Whereas smoking initiation was exclusively predicted by a higher BDI score in males, smoking maintenance was predicted by younger age and lower education in females.

LIMITATIONS

The cross-sectional nature of the study design may lead to selective survival bias and hinder drawing causal relationships.

CONCLUSIONS

Affective temperaments contribute to smoking initiation and maintenance independently of age, education, and depression. The significant contribution of depressive temperament in males and irritable temperament in females may highlight the role of gender-discordant temperaments in vulnerable subgroups.

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys

BACKGROUND

Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws.

METHODS

Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law).

RESULTS

Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project.

CONCLUSIONS

A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

Are physicians aware of their role in tobacco control? A conference-based survey in Portugal

BACKGROUND

The crucial role of physicians in tobacco control (TC) is widely recognized. In 2008, Portugal implemented a non-comprehensive smoke-free policy (SFP). In 2009, a conference-survey was carried out to explore Portuguese physicians' engagement in tobacco control, by evaluating the following: 1) attendance at TC training and awareness of training needs; 2) participation in TC activities; 3) attitudes and beliefs regarding SFPs.

METHODS

Questionnaire-based cross-sectional study conducted during two major national medical conferences targeting GPs, hospitalists, and students/recent graduates. Descriptive analysis and logistic regression were performed.

RESULTS

Response rate was 63.7% (605/950). Of the 605 participants, 58.3% were GPs, 32.4% hospitalists, 9.3% others; 62.6% were female; mean age was 39.0 ± 12.9 years. Smoking prevalence was 29.2% (95% CI: 23.3-35.1) in males; 15.8% (95% CI: 12.1-19.5) in females, p < 0.001. While the overwhelming majority of physicians strongly agreed that second-hand smoke (SHS) endangers health, awareness of SFP benefits and TC law was limited, p < 0.001. A significant minority (35.5%) believed that SHS can be eliminated by ventilation systems. Most physicians lacked training; only a minority (9.0%) participated regularly in TC. Training was the most consistent predictor of participation in TC. General agreement with SFP was high; but significantly lower for indoor leisure settings, outdoors bans in healthcare/schools settings and smoking restrictions in the home/car, p < 0.001. Smoking behaviour strongly predicted support for smoking restrictions in restaurants and bars/discos, healthcare outdoors and private settings.

CONCLUSIONS

The findings suggest that Portuguese physicians are not aware of their role in tobacco control. Poor engagement of physicians in TC may contribute to the current lack of comprehensive policies in Portugal and Europe and undermine social norm change. Medical and professional continuing education on tobacco control should be made top priorities.

Patterns of adherence to and compliance with the Portuguese smoke-free law in the leisure-hospitality sector

Background

In 2008, the Portuguese smoke-free law came into effect including partial bans in the leisure-hospitality (LH) sector. The objective of the study is to assess the prevalence of smoking control policies (total ban, smoking permission and designated smoking areas) adopted by the LH sector in Portugal. The levels of noncompliance with each policy are investigated as well as the main factors associated with smoking permission and noncompliance with the law.

Methods

Cross-sectional study conducted between January 2010 and May 2011. A random sample of venues was selected from the Portuguese LH sector database, proportionally stratified according to type, size and geographical area. All venues were assessed in loco by an observer. The independent effects of venues' characteristics on smoking permission and the level of noncompliance with the law were explored using logistic regression.

Results

Overall, 1.412 venues were included. Total ban policy was adopted by 75.9% of venues, while 8.4% had designated smoking areas. Smoking ban was more prevalent in restaurants (85.9%). Only 29.7% of discos/bars/pubs opted for complete ban. Full or partial smoking permission was higher in discos/bar/pubs (OR = 7.37; 95%CI 4.87 to 11.17). Noncompliance with the law was higher in venues allowing smoking and lower in places with complete ban (33.6% and 7.6% respectively, p<0.001). Discos/bars/pubs with full smoking permission had the highest level of noncompliance (OR = 3.31; 95%CI 1.40 to 7.83).

Conclusions

Our findings show a high adherence to smoking ban policy by the Portuguese LH sector. Nonetheless, one quarter of the venues is fully or partially permissive towards smoking, with the discos/bars/pubs considerably contributing to this situation. Venues with smoking permission policies were less compliant with the legislation. The implementation of a comprehensive smoke-free law, without any exceptions, is essential to effectively protect people from the second hand smoke.

Medical students' tobacco use and attitudes towards tobacco control

CONTEXT

Despite their important roles as future doctors in tobacco cessation counselling, the high prevalence of tobacco use among medical students may hinder them from advocating tobacco control policies and providing cessation counselling. Promoting this role among medical students is especially important in low- and middle-income countries with high burdens of tobacco use but limited resources for cessation programmes. This study examined the associations between medical students' tobacco use and their attitudes towards tobacco control policies and the roles of health professionals in the provision of tobacco cessation advice.

METHODS

This cross-sectional study included data from the large multi-country dataset generated by the Global Health Professions Student Survey, 2005-2008 (n = 36,533 medical students). Thirteen binary dependent variables related to medical students' attitudes towards tobacco control policies and the health professional's role in cessation counselling were examined using random-effects logistic regression, with tobacco use status as the key explanatory variable. Covariates included gender, receipt of cessation training, country-level and gender-specific smoking prevalence, region, and country income group.

RESULTS

Current tobacco use was consistently associated with less favourable attitudes towards tobacco control policy and cessation advice. Compared with never users, daily users were less likely to agree that the sale of tobacco products to adolescents should be banned (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.39-0.58) and that health professionals should routinely advise patients to quit smoking (OR = 0.48, 95% CI 0.41-0.52) or other forms of tobacco use (OR = 0.84, 95% CI 0.72-0.97). Daily users were less likely to agree that health professionals who smoke are less likely to advise patients to stop smoking (OR = 0.44, 95% CI 0.39-0.41).

CONCLUSIONS

Medical schools may benefit from a thorough re-evaluation of the scope of tobacco cessation training in their curricula in order to support students in smoking cessation and to shape their attitudes towards tobacco control. Targeting medical students who are current tobacco users in tobacco control efforts may be beneficial, given the cost-effectiveness of providing cessation advice.

Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings

INTRODUCTION

Environmental tobacco smoke (ETS) is currently the main indoor pollutant and causes a high morbility and mortality. A partial restriction came into force in Portugal, in 2008, law 37/2007, trying to control, define and regulate smoke-free environments.

OBJECTIVE

To assess exposure and perceived impact of the law 37/2007 on exposure to ETS among adults attending to the two health care facilities of Chaves (Portugal).

METHOD

A cross-sectional survey on tobacco consumption and exposure to ETS was undertaken in Chaves (Northern Portugal) between November 2009 and February 2010. All the patients, over 17, attending to any of the Chaves Primary Care Facilities were interviewed. Patient enrolment was done on a rolling basis covering all days of the week. A face to face interview was carried out and a carbon monoxide was measured. Prevalence and means are shown with 95% confidence intervals.

RESULTS

287 patients participated in the survey, 56% were males and the mean age was 54 years. Smoking prevalence was 23,6%, significantly higher in males (31% vs 17%). 46,2% reported exposure tobacco smoke elsewhere (53% in males vs. 40% in females). Smokers declared to be more exposed to ETS than non-smokers. 16.2% of the population declared to be exposed at home, 14% at work and 33% at leisure places. The highest decrease in perception of passive exposure was found for restaurants (95%). In nightclubs 68% of the participants stated that exposure has remained unchanged.

CONCLUSION

The tobacco control law offered protection against tobacco smoke in several closed public spaces. However, a significant proportion of the population remains exposed. This study highlights the ineffectiveness of a partial ban. A comprehensive law is, therefore, required in Portugal.

Implementation of a smoke-free policy in a high secure mental health inpatient facility: staff survey to describe experience and attitudes

BACKGROUND

In 2008, a new forensic hospital was opened as a totally smoke-free facility. This study describes the attitudes and experience of mental health professionals working in the high secure mental health facility three years after it was opened. It is part of a larger evaluation describing the experience of current and discharged hospital patients.

METHODS

Quantitative data was collected using a survey of hospital staff (N = 111) with a 50% response rate. The survey collected demographic and smoking data to describe staff responses to statements relating to hospital smoking policy, patient care and staff support.

RESULTS

Among staff surveyed, 13% were current smokers and 41% were ex-smokers (10% quit after commencing employment in the smoke-free hospital). Most (88%) preferred to work in a smoke-free environment, although this was significantly lower in smokers compared to non-smokers (39% vs. 95%). While most staff felt that the smoke-free environment had a positive impact on the health of patients (86%) and on themselves (79%), smokers were significantly less likely to agree. Just over half (57%) of staff surveyed agreed that patient care was easier in a totally smoke-free environment, although less smokers agreed compared to non-smokers. Staff who smoked were also significantly less likely to indicate they had sufficient support working in a smoke-free environment, compared to non-smokers (15% vs. 38%).

CONCLUSIONS

The staff surveyed supported the smoke-free workplace policy; most agreed that patient care was easier and that the policy did not lead to an increase in patient aggression. Implementation of a total smoking ban can result in positive health outcomes for patients and staff, and may influence some staff to quit. Staff who smoke have a less positive experience of the policy and require additional support.

Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study

Background

Research evaluating enforcement and compliance with smoking partial bans is rather scarce, especially in countries with relative weak tobacco control policies, such as Portugal. There is also scarce evidence on specific high risk groups such as vehicle workers. In January 2008, Portugal implemented a partial ban, followed by poor enforcement. The purpose of this study was to explore the effectiveness of a partial smoking ban in a pro-smoking environment, specifically transportation by taxi in the city of Lisbon. Ban effectiveness was generally defined by ban awareness and support, compliance and enforcement.

Methods

Exploratory cross-sectional study; purposive sampling in selected Lisbon streets. Structured interviews were conducted by trained researchers while using taxi services (January 2009-December 2010). Participants: 250 taxi drivers (98.8% participation rate). Chi-square, McNemar, Man Whitney tests and multiple logistic regression were performed.

Results

Of the participants, 249 were male; median age was 53.0 years; 43.6% were current smokers. Most participants (82.8%) approved comprehensive bans; 84.8% reported that clients still asked to smoke in their taxis; 16.8% allowed clients to smoke. Prior to the ban this value was 76.9% (p < 0.001). The major reason for not allowing smoking was the legal ban and associated fines (71.2%). Of the smokers, 66.1% admitted smoking in their taxi. Stale smoke smells were detected in 37.6% of the cars. None of the taxi drivers did ever receive a fine for non-compliance. Heavy smoking, night-shift and allowing smoking prior the ban predicted non-compliance.

Conclusions

Despite the strong ban support observed, high smoking prevalence and poor enforcement contribute to low compliance. The findings also suggest low compliance among night-shift and vehicle workers. This study clearly demonstrates that a partial and poorly-enforced ban is vulnerable to breaches, and highlights the need for clear and strong policies.

Smoking behavior, attitudes, and cessation counseling among healthcare professionals in Armenia

BACKGROUND

Smoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions.

METHODS

This study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed.

RESULTS

The survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p < 0.001). Non-smokers and ex-smokers had more positive attitudes toward the hospital's smoke-free policy compared to smokers (90.1% and 88.2% vs. 73.0%). About 42.6% of nurses and 26.9% of physicians reported having had formal training on smoking cessation methods. While both groups showed high support for routinely assisting patients to quit smoking, nurses more often than physicians considered health professionals as role models for patients.

CONCLUSIONS

This study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia's medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.