Patients' self-reported receipt of brief smoking cessation interventions based on a decision support tool embedded in the healthcare information system of a large general hospital in China

Usage, acceptability, and preliminary effectiveness of an mHealth-based integrated modality for smoking cessation interventions in Western China

INTRODUCTION

Many smokers have not accessed professional smoking cessation assistance due to limited smoking cessation services. We developed a novel mHealth-based integrated modality for smoking cessation (WeChat + Quitline modality, WQ modality) and applied it to a large public welfare project (China Western-QUIT Program) in western China. This study evaluated the usage, acceptability, and preliminary effectiveness of the WQ modality in the population of western China.

METHODS

A prospective cohort study was conducted between April and August 2021. Smokers or their relatives were recruited through online advertisements and medical staff referrals. After using the services of the WQ modality for one month, the self-reported awareness, use, and satisfaction with each service among the participants were collected by a telephone interview. We also evaluated the self-reported 7-day point prevalence of abstinence (PPA) and quit attempt rate among baseline current smokers. The usage data of each service were downloaded from quitline and WeChat platforms.

RESULTS

Of the 17326 people from western China using the WQ modality, the largest number of users was WeChat official account (11173), followed by WeChat mini program (3734), WeChat group (669), and quitline (541 inbound calls, 605 outbound calls). At one month follow-up, over 70% of participants who completed the baseline survey (n=2221) were aware of WeChat-based services, and over 50% used them. However, the awareness rate (11.1%) and utilization rate (0.5%) of quitline were relatively low. The median satisfaction scores across all services were 9 out of 10 points (IQR: 8-9). Among the baseline current smokers (n=1257), self-reported 7-day PPA was 41.8% (526/1257), and another 225 smokers (17.9%) reported making a quit attempt.

CONCLUSIONS

The WQ modality could be well used and accepted, and it has great potential to motivate and aid short-term smoking cessation in smokers from western China.

The estimated influence of assumed physicians' advice for tobacco smoking cessation among current smokers in Shanghai, China: A cross-sectional study

INTRODUCTION

Evidence indicates that physicians' smoking cessation advice is significant for tobacco control, which is an impetus to encourage smoking cessation among smokers, but the estimated influence of physicians' smoking cessation advice on smokers' intention to quit is limited in Shanghai, China.

METHODS

We enrolled 1104 participants who were current smokers in the SJ (Songjiang) and FX (Fengxian) districts in Shanghai in 2021. An electronic questionnaire was used to collect data and SAS 9.4 was used for data analysis. Univariate and multivariate logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to estimate the influence of the assumed physicians' advice for smoking cessation on current smokers' smoking cessation plan.

RESULTS

A total of 1104 participants provided information of which 914 were male smokers (82.8%) and 190 (17.2%) were female smokers. Multivariate logistic regression demonstrated that female smokers (OR=2.47; 95% CI: 1.66-3.68), smokers with at least 1 type of non-communicable disease (OR=2.09; 95% CI: 1.42-3.07), smoking intensity <20 cigarettes/day (OR=1.64; 95% CI: 1.22-2.17), with personal tobacco burden less than 20% (OR=1.52; 95% CI: 1.10-2.13), exposed to secondhand smoke (OR=1.99; 95% CI:1.44-2.76), and previous smoking cessation attempt (OR=4.43; 95% CI: 3.23-6.08), were more likely to report an intent to quit smoking. Moreover, approximately 50% of participants without a plan to quit in a year had also reported their intention to quit smoking with the presumption that the physicians would advise them to quit, irrespective of their sex, age, NCD status and secondhand tobacco smoke exposure.

CONCLUSIONS

Physicians' cessation advice could promote smokers to consider stopping smoking. The reported cessation intention was higher among female smokers, and smokers with NCD, lower smoking intensity and burden, with smoking cessation attempts, all of which could be incorporated into the implementation of tobacco control measures in the future in Shanghai.

Smoking behaviour among adult patients presenting to health facilities in four provinces of Vietnam

Background

Attendance at healthcare facilities provides an opportunity for smoking cessation interventions. However, the smoking behaviours of patients seeking healthcare in Vietnam are not well-understood. We aimed to evaluate behaviours related to smoking among patients presenting to health facilities in Vietnam.

Methods

We conducted a cross-sectional study in 4 provinces of Vietnam. Consecutive patients aged ≥15 years presenting to 46 health facilities were assessed. Current smokers were randomly selected to complete a full survey about smoking behaviour, quit attempts, and preparedness to quit.

Results

Among 11,245 patients who sought healthcare, the prevalence of current smoking was 18.6% (95% CI: 17.8–19.4%) overall, 34.6% (95% CI: 33.2–36.0%) among men and 1.1% (95% CI: 0.8–1.3%) among women. Current smokers who were asked about smoking by healthcare providers in the last 12 months were more likely to make quit attempts than those not asked (40.6% vs 31.8%, p = 0.017). Current smokers who attempted to quit in the past 12 months made limited use of cessation aids: counselling (1.9%) and nicotine replacement therapy (10%). A higher proportion of patients wanted to quit in the next month at national/provincial hospitals (30.3%) than those visiting district hospitals (11.3%, p < 0.001) and commune health centres (11.1%, p = 0.004).

Conclusions

Smoking is common among male patients presenting to healthcare facilities in Vietnam. Formal smoking cessation supports are generally not used or offered. This population is likely to benefit from routine smoking cessation interventions that are integrated within the routine healthcare delivery system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10880-z.

Relationships among smoking abstinence self-efficacy, trait coping style and nicotine dependence of smokers in Beijing

INTRODUCTION

Psychological, physiological and social factors play an important role in the initiation, persistence, dependence and relapse of smoking behaviors, and coping style and smoking abstinence self-efficacy can all affect nicotine dependence.

METHODS

A cross-sectional sample of 568 quitters from 19 communities in Beijing in 2019 was surveyed. Demographic information and psychological characteristics of smokers were collected by an interview questionnaire, and psychological traits scales including the Smoking Abstinence Self-Efficacy (SASE) and the Trait Coping Style Questionnaire (TCSQ). We compared differences in psychological traits across demographic information and explored the relationship between nicotine dependence and coping styles and self-efficacy in refusing to smoke.

RESULTS

Significant differences were identified in self-efficacy in refusing to smoke and across dimensions among quitters by gender, job type, education level, and monthly income level (all p<0.05). Males had lower self-efficacy in the habitual/addictive context than females; retirees had better overall self-efficacy and self-efficacy in the negative/emotional context than business service workers and professionals; and high-educated, high-income quitters had lower self-efficacy in the negative/emotional context. There are significant differences in positive coping styles among quitters of different ages, levels of education, and types of work (all p<0.05). The results further showed that the underage population, highly educated population, and practitioners other than those in retirement, are less likely to use positive coping styles. Interventional effects analysis showed that a higher sense of self-efficacy in addictive contexts can counteract some of the negative coping styles that induce smoking.

CONCLUSIONS

Self-efficacy played an indirect mediating role between negative coping style and nicotine dependence; individuals who used more negative coping styles were more likely to engage in smoking and therefore were more nicotine dependent. Hence, it is necessary to reduce the use of negative coping strategies and improve the self-efficacy of smoking abstinence in the face of addiction.

Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students

INTRODUCTION

The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China.

METHODS

A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model.

RESULTS

In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05).

CONCLUSIONS

Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.

Smoking cessation advice from healthcare professionals helps those in the contemplation and preparation stage: An application with transtheoretical model underpinning in a community-based program

INTRODUCTION

The efficacy of smoking cessation intervention has been proven with randomized controlled trials. Our study aims to elucidate the effects of the delivery method of smoking cessation advice on the process of stage of changes with transtheorectical model underpinning in a community setting.

METHODS

A total of 436 subjects were recruited in a quasi-experimental untreated control design study, with 46 receiving advice from healthcare professionals (HCP group) and 390 in the control group, in 2003, Nantou, Taiwan. A discrete time Markov model was used to quantify the multi-state process of smoking cessation in light of the transtheorectical model. Multiple polytomous logistic regression models were simultaneously applied to different transitions.

RESULTS

The estimated forward transition probabilities were higher in the HCP group compared to their counterparts in the control group. On the other hand, the backward transition probabilities were smaller in the HCP group. After adjusting for confounding factors, HCP had a 4.3-fold (95% CI: 2.21–8.46) odds ratio of moving forward from the contemplation stage, and 2.4-fold odds ratio (95% CI: 1.03–4.42) from the preparation stage. Elderly people were more reluctant to change from precontemplation (AOR=0.50; 95% CI: 0.34–0.74) and contemplation (AOR=0.58; 95% CI: 0.44–0.84), but once in the preparation stage, they were more likely to take action (AOR=1.28; 95% CI: 1.01–1.83). For those in the preparation stage, longer smoking years had a negative effect on taking action (AOR=0.74; 95% CI: 0.52–0.99), but cessation advice from others enhanced the likelihood to take action (AOR=1.36; 95% CI: 1.01–1.99).

CONCLUSIONS

The direct advice on smoking cessation from healthcare professionals enforced the net forward transition towards smoking cessation, especially the transition from contemplation and preparation. The proposed Markov regression model assessed the net effect of different intervention approaches allowing for the simultaneous consideration of multiple transitions and the effects of other confounders.

Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries

INTRODUCTION

In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines.

METHODS

We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019.

RESULTS

Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001).

CONCLUSIONS

An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.