1
|
Gonzalez-Parreño S, Miralles-Muñoz FA, Martinez-Mendez D, Perez-Aznar A, Gonzalez-Navarro B, Lizaur-Utrilla A, Vizcaya-Moreno MF. Smoking is not closely related to revision for periprosthetic joint infection after primary total knee and hip arthroplasty. Orthop Traumatol Surg Res 2024:103876. [PMID: 38582225 DOI: 10.1016/j.otsr.2024.103876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/21/2023] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The influence of smoking on the risk of periprosthetic joint infection (PJI) remains unclear. The objective was to explore the impact of smoking on PJI after primary total knee (TKA) and hip (THA) arthroplasty. HYPOTHESIS Current smoking patients should have an increased risk of PIJ compared with nonsmoking patients. PATIENTS AND METHODS A prospective registry-based observational cohort study was performed. A total of 4591 patients who underwent primary TKA (3076 patients) or THA (1515) were included. According to the smoking status at the time of arthroplasty, patients were classified as nonsmokers (3031 patients), ex-smokers (688), and smokers (872). Multivariate analysis included smoking status, age, gender, education level, body mass index, American Society of Anesthesiologists class, diagnosis (osteoarthritis, rheumatism), diabetes, chronic obstructive pulmonary disease, perioperative blood transfusion, site of arthroplasty (knee, hip), length of operation, and length of stay. RESULTS There were PJI after 59 (1.9%) TKA and 27 (1.8%) THA (p=0.840). There were PJI in 47 (1.6%) nonsmokers, 12 (1.7%) ex-smokers, and 17 (1.9%) smokers (p=0.413). There were wound complications (delayed wound healing and superficial wound infection) in 34 (0.7%) nonsmokers, 9 (1.3%) in ex-smokers, and 17 (1.9%) in smokers (p=0.045). In multivariate analysis, only the female gender was a significant predictor of PJI (OR 1.3, 95% CI 1.1-2.4 [p=0.039]). Specifically, the categories of ex-smokers (OR 0.8, 95% CI 0.2-1.7 [p=0.241]) and smokers (OR 1.1, 95% CI 0.6-1.5 [p=0.052]) were not significant predictors. The 4-year arthroplasty survival with PJI as the endpoint was 99.1% (95% CI: 99.0-99.7) for nonsmokers, 99.0% (95% CI: 98.8-99.2) for ex-smokers, and 98.7% (95% CI: 98.2-99.0) for smokers was not significantly different between smoking status groups (p=0.318). DISCUSSION Smoking was not identified as a significant predictor for PJI following primary TKA or THA. LEVEL OF EVIDENCE III, prospective cohort study.
Collapse
Affiliation(s)
- Santiago Gonzalez-Parreño
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | | | - Daniel Martinez-Mendez
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Adolfo Perez-Aznar
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Blanca Gonzalez-Navarro
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain; Dpt. of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, 03202 San Juan de Alicante, Alicante, Spain.
| | - Maria Flores Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Ctra San Vicente del Raspeig, s/n, 03690 San Vicente del Raspeig, Alicante, Spain
| |
Collapse
|
2
|
Bafunno D, Catino A, Lamorgese V, Longo V, Montrone M, Pesola F, Pizzutilo P, Petrillo P, Varesano N, Zacheo A, Del Bene G, Lapadula V, Mastrandrea A, Ricci D, Di Lauro A, Cassiano S, Galetta D. Smoking Prevalence, Knowledge and Perceptions on Tobacco Control Among Healthcare Professionals: A Survey in an Italian Cancer Center. J Community Health 2021; 46:597-602. [PMID: 32789714 DOI: 10.1007/s10900-020-00907-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in "IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion.
Collapse
Affiliation(s)
- Daniela Bafunno
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Annamaria Catino
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy.
| | - Vito Lamorgese
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vito Longo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Michele Montrone
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Francesco Pesola
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Pamela Pizzutilo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Patrizia Petrillo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Niccolò Varesano
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Antonella Zacheo
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Gabriella Del Bene
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vittoria Lapadula
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Angelica Mastrandrea
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Donata Ricci
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Alessandra Di Lauro
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Sandro Cassiano
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Domenico Galetta
- IRCCS Istituto Tumori "Giovanni Paolo II" 65, Viale Orazio Flacco, 70124, Bari, Italy
| |
Collapse
|
3
|
Nilan K, McKeever TM, McNeill A, Raw M, Murray RL. Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis. PLoS One 2019; 14:e0220168. [PMID: 31344083 PMCID: PMC6657871 DOI: 10.1371/journal.pone.0220168] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population. METHODS We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231. RESULTS 229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population. CONCLUSIONS HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.
Collapse
Affiliation(s)
- Kapka Nilan
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Tricia M. McKeever
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
| | - Martin Raw
- NYU College of Global Public Health, New York University, New York, New York, United States of America
- NYU Medical School, New York University, New York, New York, United States of America
| | - Rachael L. Murray
- UK Centre for Tobacco and Alcohol Studies, School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
4
|
Martínez C, Castellano Y, Andrés A, Fu M, Feliu A, Antón L, Ballbè M, Fernández P, Cabrera S, Riccobene A, Gavilan E, Baena A, Margalef M, Tigova O, Quirós N, Guillen O, Company A, Fernández E. Impact of an Online Training Program in Smoking Cessation Interventions in Hospitals. J Nurs Scholarsh 2019; 51:449-458. [PMID: 30874373 DOI: 10.1111/jnu.12469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess changes in the self-reported performance of smoking cessation interventions according to the 5A's model (Ask; Advise; Assess; Assist; and Arrange follow-up) among clinicians; and to identify the main barriers and facilitators in smoking cessation implementation before and after an online smoking cessation training program. DESIGN Pre-post evaluation. METHODS We assessed self-reported smoking cessation interventions in the implementation of the 5A's model among clinicians working in Catalan hospitals (Spain). In addition, we assessed individual-, behavioral-, and organizational-level factors that act as barriers and facilitators in the implementation of the 5A's model. We used a questionnaire of 63 items reflecting each of the 5A's performance (scored from 0 = none to 10 = most possible). The questionnaire was completed both immediately before and 6 months after the training. We analyzed the data of those participants who had a clinical role and answered pre- and post-questionnaires. We used the nonparametric test for paired data (Wilcoxon) to examine changes in scores. FINDINGS A total of 127 clinicians completed the pre-post questionnaire; 63.0% were registered nurses, 17.3% were nursing assistants, 7.9% were physicians, and 11.8% were other professionals (p < .001). Overall, there were significant increases in the implementation of the assist component (from a score of 4.5 to 5.2; p < .003) and arrange a follow-up component (from 3.6 to 4.5; p < .001) of the intervention. Scores in the perception of the level of overall preparation, preparedness in using smoking cessation drugs, level of competence, and organizational recognition improved (p < .001) at the follow-up; however, the score in the perception that implementing smoking cessation is part of their job decreased (from 6.3 to 4.4; p < .001). CONCLUSIONS The online training had a positive impact on the implementation of assist and arrange follow-up components. Although self-preparedness in the management of smokers increased, the motivation and involvement of key professionals decreased. Organizational factors related to the incorporation of resources (such as protocols, records, etc.) should be improved for the correct progression of smoking cessation interventions within the institutions. CLINICAL RELEVANCE Smoking cessation training programs should incorporate some motivational content to increase the engagement of health professionals in smoking cessation interventions in their clinical practice.
Collapse
Affiliation(s)
- Cristina Martínez
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Public Health, Mental Health and Perinatal Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Statistician, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Granvia de L'Hospitalet; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ana Andrés
- Lecturer and Researcher, Faculty of Psychology, Education and Sport Sciences, Ramon Llull Universityl, Barcelona, Spain
| | - Marcela Fu
- Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Ariadna Feliu
- Predoctoral student, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Laura Antón
- Program coordinator, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Montse Ballbè
- Program Coordinator and Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, and Cancer Control; and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paz Fernández
- Coordinator of Nursing Research, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Sandra Cabrera
- Coordinator of Nursing Researcher, Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Ana Riccobene
- Nurse, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Eva Gavilan
- Nurse and Predoctoral student, Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Baena
- Associate Researcher, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Mercè Margalef
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olena Tigova
- Project Manager, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO. Av; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Núria Quirós
- Administrative support, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; and Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Olga Guillen
- Program Coordinator, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Assumpta Company
- Director E-oncologia, E_oncologia Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Esteve Fernández
- Director of the Tobacco Control Unit, Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL; and Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Martínez C, Fu M, Castellano Y, Riccobene A, Fernández P, Cabrera S, Gavilan E, Feliu A, Puig-Llobet M, Fuster P, Martínez-Sánchez JM, Montes J, Estrada JM, Moreno C, Falcó-Pegueroles A, Galimany J, Brando C, Suñer-Soler R, Capsada A, Fernández E. Smoking among hospitalized patients: A multi-hospital cross-sectional study of a widely neglected problem. Tob Induc Dis 2018; 16:34. [PMID: 31516433 PMCID: PMC6659490 DOI: 10.18332/tid/92927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A comprehensive smoking ban was recently enacted for acute-care hospital campuses in Spain. The aim of this study was to assess the prevalence and patterns of smoking among inpatients before and during hospitalization. METHODS Multi-center cross-sectional study was conducted in 13 hospitals in the province of Barcelona, Spain from May 2014 to May 2015. Participants were adults who provided informed consent. The sample size was calculated to be representative of each hospital (prevalence 29.4%, precision ± 5%, error 5%). We approached 1228 subjects, 888 accepted to participate and 170 were replaced (were not available or declined to participate). Final sample comprised 1047 subjects. We used a computer-assisted personal interview system to collect data, including sociodemographic variables and use of tobacco before and during hospitalization. Smoking status was validated with exhaled carbon monoxide. We calculated overall tobacco prevalence and investigated associations with participant and center characteristics. We performed multiple polytomous and multilevel logistic regression analyses to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustments for potential confounders. RESULTS In all, 20.5% (95% CI: 18.1–23.0) of hospitalized patients were smokers. Smoking was most common among men (aOR=7.47; 95% CI: 4.88–11.43), young age groups (18–64 years), and individuals with primary or less than primary education (aOR=2.76; 95% CI: 1.44–5.28). Of the smokers, 97.2% were daily consumers of whom 44.9% had medium nicotine dependence. Of all smokers, three-quarters expressed a wish to quit, and one-quarter admitted to consuming tobacco during hospitalization. CONCLUSIONS Our findings indicate the need to offer smoking cessation interventions among hospitalized patients in all units and service areas, to avoid infringements and increase patient safety, hospital efficiency, and improve clinical outcomes. Hospitalization represents a promising window for initiating smoking interventions addressed to all patients admitted to smoke-free hospitals, specially after applying a smoke-free campus ban.
Collapse
Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Nursing Science, Gimbernat School, Barcelona, Spain.,Department of Nursing Science, University of Girona, Girona, Spain.,Fundació Althaia, Barcelona, Spain
| | - Anna Riccobene
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain
| | - Paz Fernández
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Sandra Cabrera
- Nursing Research Unit, Institut Català d'Oncologia-ICO, Barcelona, Spain
| | - Eva Gavilan
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Montse Puig-Llobet
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pilar Fuster
- Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Javier Montes
- Department of Nursing Science, Gimbernat School, Barcelona, Spain
| | - Joan Maria Estrada
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Carmen Moreno
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jordi Galimany
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Cecilia Brando
- Department of Nursing Science, Gimbernat School, Barcelona, Spain
| | - Rosa Suñer-Soler
- Department of Nursing Science, University of Girona, Girona, Spain
| | | | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO-IDIBELL, Barcelona, Spain.,School of Medicine, Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | | |
Collapse
|
6
|
Pianori D, Gili A, Masanotti G. Changing the smoking habit: prevalence, knowledge and attitudes among Umbrian hospital healthcare professionals. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2017; 58:E72-E78. [PMID: 28515635 PMCID: PMC5432782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Health care professionals should work against smoking habit to promote a correct life style. This study aimed to evaluate smoking prevalence and attitudes towards tobacco among Umbrian hospital professionals in a period between 2006 and 2015, since the approbation of the law that ban smoking in hospitals and all public areas in 2003. METHODS A cross-sectional study was carried out using a questionnaire administered in 2006, 2011 and 2015 to healthcare professionals. It consists of 53 multiple-choice questions. Potential predictors of current smoking habits were evaluated using univariate and multivariate logistic regression. RESULTS The sample included 475 healthcare professionals. Current smokers constituted 34.53% of the sample and no significant difference (p = 0.257) emerged in prevalence over time (33.74% in 2006; 36.02% in 2011 and 33.77% in 2015). The risk of being a smoker increased by not considering the smoking habit as the main cause of preventable deaths (OR = 2.25; 95% CI: 1.47- 3.45). The strongest risk factor, which was significant in both models (p < 0.01), was being against the "No Smoking" law (OR = 18.90; 95% CI: 2.43-147.71; adjusted OR = 22.10; 95% CI: 1.85-264.78). CONCLUSIONS The hospital staff has higher prevalence of smoking than the general population. The No Smoking law alone has been shown to be inadequate. Effective results can be achieved only by a common strategy and shared intervention programmes that are based on a workplace health promotion strategy. That for the moment has demonstrated to give interesting outcomes in modifying deep-rooted behaviour patterns.
Collapse
Affiliation(s)
- D. Pianori
- Department of Public Health, University of Bologna, Italy
| | - A. Gili
- Department of Experimental Medicine, section of Public Health, University of Perugia, Italy
| | - G. Masanotti
- Department of Experimental Medicine, section of Public Health, University of Perugia, Italy,Correspondence: Giuseppe Masanotti, Department of Experimental Medicine, section of Public Health, University of Perugia, piazza Lucio Severi 1, 06132 Perugia, Italy. Tel. +39 0755857315 - Fax +39 0755857317 - E-mail:
| |
Collapse
|
7
|
Martínez C, Ballbè M, Vilardell M, Fu M, Fernández E. The role of middle managers in tobacco control after a national smoke-free hospital campus ban. BMC Health Serv Res 2016; 16:517. [PMID: 27663779 PMCID: PMC5035500 DOI: 10.1186/s12913-016-1764-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Much of the recent health services research on tobacco control implementation has explored general views and perceptions of health professionals and has rarely taken into account middle management's perspectives. We state that middle managers may facilitate the implementation of smoke-free campus bans and thereby improve their effectiveness. The aim of this study was to assess middle managers' behaviors to enforce a new national smoke-free hospital campus ban, to evaluate their perceptions of the level of compliance of the new regulation, and to explore their attitudes towards how smoking affects the work environment. METHODS We used a cross-sectional survey, conducted online to evaluate middle managers of a general hospital in Catalonia, Spain. Close-ended and open-ended questions were included. Results were analyzed by using quantitative and qualitative methods. The managers' open opinions to the proposed topics were assessed using UCINET, and a graph was generated in NetDraw. RESULTS Sixty-three of the invited managers (78.7 %) participated in the survey. 87.2 % of them agreed that the hospital complied with the smoke-free campus ban and 79.0 % agreed that managers have an important role in enforcing the ban. They also perceived that smoking disturbs the dynamics of work, is a cause of conflict between smokers and non-smokers, and harms both the professional and the organization images. However, 96.8 % of respondents have never given out fines or similar measures and their active role in reminding others of the policy was limited; in addition, 68.2 % considered that hospitals should provide tobacco cessation treatments. Smoker middle managers were more likely than non-smokers to perceive that smoking has little impact on work. CONCLUSIONS Middle managers play a limited role in controlling tobacco consumption; smokers are less prone to think that smoking disturbs work dynamics than non-smokers. Tailored training and clear proceedings for middle managers could encourage more active roles.
Collapse
Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain. .,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain. .,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915, Sant Cugat del Valles, Barcelona, Spain. .,Tobacco Control Unit, Institut Català d'Oncologia, Av. Gran Via de L'Hospitalet, 199-203, E-08908, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Montse Ballbè
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Addictions Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Miquel Vilardell
- Department of Prevention, Hospital de Vic, Vic, Barcelona, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine and Health Sciences School, Universitat Internacional de Catalunya, C. Josep Trueta s/n, 08915, Sant Cugat del Valles, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, C. Feixa llarga s/n, 08907, L'Hospitalet del Llobregat, Barcelona, Spain
| |
Collapse
|
8
|
Frazer K, McHugh J, Callinan JE, Kelleher C. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure. Cochrane Database Syst Rev 2016:CD011856. [PMID: 27230795 PMCID: PMC10164285 DOI: 10.1002/14651858.cd011856.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Smoking bans or restrictions can assist in eliminating nonsmokers' exposure to the dangers of secondhand smoke and can reduce tobacco consumption amongst smokers themselves. Evidence exists identifying the impact of tobacco control regulations and interventions implemented in general workplaces and at an individual level. However, it is important that we also review the evidence for smoking bans at a meso- or organisational level, to identify their impact on reducing the burden of exposure to tobacco smoke. Our review assesses evidence for meso- or organisational-level tobacco control bans or policies in a number of specialist settings, including public healthcare facilities, higher education and correctional facilities. OBJECTIVES To assess the extent to which institutional smoking bans may reduce passive smoke exposure and active smoking, and affect other health-related outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE, EMBASE, and the reference lists of identified studies. We contacted authors to identify completed or ongoing studies eligible for inclusion in this review. We also checked websites of state agencies and organisations, such as trial registries. Date of latest searches was 22nd June 2015. SELECTION CRITERIA We considered studies that reported the effects of tobacco bans or policies, whether complete or partial, on reducing secondhand smoke exposure, tobacco consumption, smoking prevalence and other health outcomes, in public healthcare, higher educational and correctional facilities, from 2005 onwards.The minimum standard for inclusion was having a settings-level policy or ban implemented in the study, and a minimum of six months follow-up for measures of smoking behaviour. We included quasi-experimental studies (i.e. controlled before-and-after studies), interrupted time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS Two or more review authors independently assessed studies for inclusion in the review. Due to variation in the measurement of outcomes we did not conduct a meta-analysis for all of the studies included in this review, but carried out a Mantel-Haenszel fixed-effect meta-analysis, pooling 11 of the included studies. We evaluated all studies using a qualitative narrative synthesis. MAIN RESULTS We included 17 observational studies in this review. We found no randomized controlled trials. Twelve studies are based in hospitals, three in prisons and two in universities. Three studies used a controlled before-and-after design, with another site used for comparison. The remaining 14 studies used an uncontrolled before-and-after study design. Five studies reported evidence from two participant groups, including staff and either patients or prisoners (depending on specialist setting), with the 12 remaining studies investigating only one participant group.The four studies (two in prisons, two in hospitals) providing health outcomes data reported an effect of reduced secondhand smoke exposure and reduced mortality associated with smoking-related illnesses. No studies included in the review measured cotinine levels to validate secondhand smoke exposure. Eleven studies reporting active smoking rates with 12,485 participants available for pooling, but with substantial evidence of statistical heterogeneity (I² = 72%). Heterogeneity was lower in subgroups defined by setting, and provided evidence for an effect of tobacco bans on reducing active smoking rates. An analysis exploring heterogeneity within hospital settings showed evidence of an effect on reducing active smoking rates in both staff (risk ratio (RR) 0.71, 95% confidence interval ( CI) 0.64 to 0.78) and patients (RR 0.86, 95% CI 0.76 to 0.98), but heterogeneity remained in the staff subgroup (I² = 76%). In prisons, despite evidence of reduced mortality associated with smoking-related illnesses in two studies, there was no evidence of effect on active smoking rates (1 study, RR 0.99, 95% CI 0.84 to 1.16).We judged the quality of the evidence to be low, using the GRADE approach, as the included studies are all observational. AUTHORS' CONCLUSIONS We found evidence of an effect of settings-based smoking policies on reducing smoking rates in hospitals and universities. In prisons, reduced mortality rates and reduced exposure to secondhand smoke were reported. However, we rated the evidence base as low quality. We therefore need more robust studies assessing the evidence for smoking bans and policies in these important specialist settings.
Collapse
Affiliation(s)
- Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland
| | | | | | | |
Collapse
|
9
|
Burns S, Hart E, Jancey J, Hallett J, Crawford G, Portsmouth L. A cross sectional evaluation of a total smoking ban at a large Australian university. BMC Res Notes 2016; 9:288. [PMID: 27230617 PMCID: PMC4882868 DOI: 10.1186/s13104-016-2090-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total smoking bans have been found to contribute positively to the health of non-smokers by reducing exposure to second-hand smoke, and to enhance the likelihood of cessation among smokers. METHODS Two cross-sectional electronic surveys of staff and students at a large Australian university were conducted prior (n = 969) and 1 year post (n = 670) the implementation of a smoke free campus policy. Demographics, tobacco use, intention to quit, attitudes towards smoking and smoking restrictions and awareness of and attitudes towards the campus smoking policy were measured. RESULTS Exposure to second-hand smoke (SHS) reduced significantly (p < 0.001) one year after policy implementation. Smoking prevalence was similar at both time periods (T1 9.3 %; T2 8.4 %) and over half of smokers indicated they were planning to quit smoking in the future (T1 65.5 vs T2 62.3 %). There was a significant increase in positive responses to the statement the campus should be totally smoke free including all outdoor areas at T2 compared to T1 (T1 60.8 vs T2 71.4 %; p < 0.001), however respondents felt there should be places on campus for smokers to smoke (T1 53.6 vs T2 47 %; p < 0.05). CONCLUSIONS This study found a significant positive difference in exposure SHS after implementation of the total ban. Although prevalence of smoking in this study was low, the proportion of respondents who were contemplating smoking cessation suggests support for smokers would be beneficial. Continued awareness raising, education and enforcement is likely to enhance the long term outcomes of the total ban.
Collapse
Affiliation(s)
- Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Ellen Hart
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Jonine Jancey
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Jonathan Hallett
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| | - Linda Portsmouth
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Perth, WA 6845 Australia
| |
Collapse
|
10
|
Hospital doctors' smoking behavior and attitude towards smoking cessation interventions for patients: a survey in an Italian Comprehensive Cancer Centre. TUMORI JOURNAL 2016; 2016:244-51. [PMID: 27079902 DOI: 10.5301/tj.5000501] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians' smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field. METHODS A Web-based survey was sent to 285 physicians. RESULTS The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients' smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients' stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward. CONCLUSIONS This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians' smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.
Collapse
|
11
|
[Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals]. GACETA SANITARIA 2015; 30:55-8. [PMID: 26422688 DOI: 10.1016/j.gaceta.2015.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. METHOD A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. RESULTS The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). CONCLUSION The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups.
Collapse
|
12
|
Han JO, Im JS, Yim J, Choi YH, Ko KP, Kim J, Kim HG, Noh Y, Lim YK, Oh DK. Association of Cigarette Prices with the Prevalence of Smoking in Korean University Students: Analysis of Effects of the Tobacco Control Policy. Asian Pac J Cancer Prev 2015. [PMID: 26225706 DOI: 10.7314/apjcp.2015.16.13.5531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased pricing of cigarettes might be one of the most effective approaches for reducing the prevalence of smoking. This study aimed to investigate the effects of increasing cigarette prices through taxation by a tobacco intervention policy on the changes in smoking prevalence in Korean university students. MATERIALS AND METHODS The participants in this study were 23,047 healthy university students aged 18-29 years from a health examination in 2011-2015. We investigated the adjusted prevalence of daily and occasional smoking before and after increasing cigarette prices through taxation. RESULTS The prevalence of occasional smoking was significantly decreased in 2015 from 2014 in both male (from 10.7% in 2014 to 5.4%) and female (from 3.6% to 1.1%) students, but the prevalence of daily smoking did not decrease significantly. The frequency of individuals who had attempted smoking cessation during the past year was significantly higher among occasional smokers in male students (90.2%) compared with daily smokers (64.9%). For female students, there were no differences in experience of smoking cessation, willingness for smoking cessation, or E-cigarette experience between daily and occasional smokers. CONCLUSIONS We found that a policy of increasing cigarette prices through taxation is associated with decreases in the prevalence of occasional smokers, who have relatively lower nicotine dependence compared with individuals who smoke daily. The results of our study suggest that social support and direct intervention for smoking cessation at the community level are needed for university students alongside the pricing policy.
Collapse
Affiliation(s)
- Jin-Ok Han
- Department of Preventive Medicine, Gachon University College of Medicine, Sungnam, Republic of Korea E-mail : and
| | | | | | | | | | | | | | | | | | | |
Collapse
|