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Nursing interventions for smoking cessation
Abstract
Background:
Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives:
To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking.
Search methods:
We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017.
Selection criteria:
Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months.
Data collection and analysis:
Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI).
Main results:
Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings.
Authors' conclusions:
There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.
... In nursing research related to tobacco control, the most common nursing interventions are those aimed at smoking cessation. These include lifestyle assessment, identification of barriers to stopping smoking, assessment of smoking dependence, beliefs and values, rehabilitation of smokers, groups and training (7) . ...
... The literature contains various instruments aimed at assessing predisposition to tobacco use and identifying the barriers that hinder the smoking cessation process, or even assessing satisfaction with counseling services (7)(8) . ...
... However, the studies did not identify any instruments aimed at assessing nurses' smoking cessation practices (7)(8) . ...
Objective:
to evaluate the evidence of validity of the internal structure and reliability of the Brazilian version of the Smoking Cessation Counseling instrument.
Method:
psychometric study of confirmatory factor analysis and reliability carried out on 250 nurses in clinical practice. For the analysis of the convergent validity of the factor model, Average Variance Extracted values were calculated, and discriminant analysis was carried out using the Fornell-Larcker criterion. Reliability was examined using Cronbach's alpha coefficient and composite reliability.
Results:
it was necessary to exclude seven items from the Advanced Counseling domain and one item from the Basic Counseling domain in order to properly obtain the Average Variance Extracted values and the Fornell-Larcker criterion. The composite reliability ranged from 0.76 to 0.86 and the overall Cronbach`s alpha coefficient was 0.86, ranging from 0.53 to 0.84 depending on the domain assessed. The final version of the instrument was made up of 16 items divided into 4 domains.
Conclusion:
the Brazilian version of Smoking Cessation Counseling obtained adequate psychometric evidence of validity and reliability. Further studies are needed to refine the instrument.
Background:
(1) Instrument shows adequate internal consistency and validity.
Background:
(2) Evaluate counseling practices and their impact on patient care.
Background:
(3) Instrument for evaluating smoking cessation counseling.
Background:
(4) Provides important information for planning nursing care.
... Approximately 27 million men and women comprise the global nursing and midwifery workforce, accounting for nearly 50% of the global health workforce [6]. In addition, there is evidence that behavioral support to motivate and sustain smoking cessation delivered by nurses can increase the number of people who achieve prolonged abstinence [7]. ...
... They concluded that intensive interventions that begin in the hospital with nicotine replacement therapy increase the rate of smoking cessation [11]. Additionally, multiple studies demonstrated that interventions provided by nurses could lead to an increase in the number of people who stop smoking or prolong abstinence [7,12]. ...
... Nurses have an important window of opportunity to intervene with patients during their hospital stay or introduce the notion of not resuming smoking upon hospital discharge [7]. In addition, previous research shows that training nurses to implement smoking cessation interventions is extremely important and increases their willingness to participate in such programs [14,15]. ...
Background:
Smoking is a major public health problem in Croatia. It is unknown to what extent nurses in Croatia use interventions for smoking cessation to help their patients. This study aimed to analyze the knowledge, attitudes and behaviors of hospital nurses on smoking cessation interventions.
Methods:
We conducted a cross-sectional study in Zagreb, Croatia, in 2022 on a convenient sample of hospital nurses. We collected data with a questionnaire that included sociodemographic questions and questions about the frequency of implementation of 5 A's (Ask, Advise, Assess, Assist, Arrange) interventions for smoking cessation during their work using the Helping Smokers Quit (HSQ) survey, participants' attitudes and knowledge about smoking cessation skills and the smoking status of the nurses.
Results:
There were 824 nurses employed in the targeted departments; 258 nurses participated in the study (response rate: 31%). Among them, 43% responded that they always ask patients about their use of tobacco products. Only 2.7% indicated that they always help the patient to stop smoking. Very few (2%) attended any training in the past two years about helping patients to quit smoking, and 82% never had such training. 44% of the included nurses were smokers. Nurses who smoked stated more frequently than nonsmokers they should not be role models for their patients by avoiding smoking (P 0.001). Additionally, patients were less frequently questioned about their inability to stop smoking by nurses who smoked than nurses who did not smoke (P = 0.010).
Conclusion:
Even though smoking cessation interventions delivered by nurses were proven effective, such interventions are used by a small number of surveyed nurses. A small number of nurses have received training to help them support smokers in quitting. The high smoking prevalence among nurses may impact their attitudes and the implementation of workplace smoking cessation efforts.
... 7,8 BI was effective in directing patients to SC treatments and increasing tobacco abstinence. [9][10][11][12][13] The 5As (Ask, Advise, Assess, Assist, Arrange follow-up) and 5Rs (Relevance, Risk, Rewards, Roadblocks, Repetition) model are the most known BI models recommended by the World Health Organization (WHO), 14 the US Centers for Disease Control and Prevention, 15 and the 2020 Surgeon General Report. 1 However, many healthcare providers cannot adhere to or implement the full BI. 16 More simplified SC intervention models, namely very brief advice (VBA), such as AAR (Ask, Advise, Refer), 17 AWARD (Ask, Warn, Advice, Refer, Do-it-again), 8 and the ABC (Ask about smoking, give Brief advice to quit, and offer Cessation assistance) 18 were developed for healthcare practitioners to implement easily in routine medical consultation, with very short duration. ...
... 21,24 BI was commonly defined as taking 10 to 30 min in systematic reviews. [10][11][12] Some systematic reviews even included trials testing "BI" which exceeded 30 min, 9,13 which far exceeded the usual time (about 10 min) for medical consultation. However, no previous systematic reviews that specifically synthesized the RCTs result in the effectiveness of opportunistic SC advice that was 3 min or less. ...
Background
Very brief advice (VBA; ≤ 3 min) on quitting is practical and scalable during brief medical interactions with patients who smoke. This study aims to synthesize the effectiveness of VBA for smoking cessation and summarize the implementation strategies.
Methods
We searched randomized controlled trials aiming at tobacco abstinence and comparing VBA versus no smoking advice or no contact from Medline, Embase, CINAHL, Cochrane Library, PsycInfo databases, six Chinese databases, two trial registries ClinicalTrials.gov and WHO-ICTRP from inception to September 30, 2023. Grading of Recommendations, Assessment, Development, and Evaluations framework was used to assess the certainty of the evidence of the meta-analytic findings. The outcomes were self-reported long-term tobacco abstinence at least 6 months after treatment initiation, earlier than 6 months after treatment initiation, and quit attempts. Effect sizes were computed as risk ratio (RR) with 95% CI using frequentist random-effect models.
Data Synthesis
Thirteen randomized controlled trials from 15 articles ( n = 26,437) were included. There was moderate-certainty evidence that VBA significantly increased self-reported tobacco abstinence at ≥ 6 months in the adjusted model (adjusted risk ratio ARR 1.17, 95% CI: 1.07–1.27) compared with controls. The sensitivity analysis showed similar results when abstinence was verified by biochemical validation ( n = 6 studies, RR 1.53, 95% CI 0.98–2.40). There was high-certainty evidence that VBA significantly increased abstinence at < 6 months (ARR 1.22, 95% CI: 1.01–1.47). Evidence of effect on quit attempts (ARR 1.03, 95% CI 0.97–1.08) was of very low certainty.
Discussion
VBA delivered in a clinical setting is effective in increasing self-reported tobacco abstinence, which provides support for wider adoption in clinical practice.
... Several pairwise and network meta-analyses have been done to estimate the effectiveness of various non-pharmacological interventions for tobacco cessation around the world. [40][41][42][43][44][45][46][47][48] Most of these reviews support the current review findings that e-Health interventions in the form of telephone counseling, text messaging, etc., individual and group counseling interventions as the best methods of intervention for tobacco cessation amongst non-pharmacological interventions. Our study findings have strengthened and reiterated the existing evidences that these non-pharmacological interventions are indeed very much helpful in achieving tobacco cessation in the country. ...
... Most of these reviews have included large number of trials as it was not context or setting-specific. [41][42][43][44][45][46] Given the limited number of studies involving e-Health intervention in India, it is better to conduct more large-scale RCTs utilizing some form of e-Health intervention and find out whether On reviewing the existing guidelines around the world, we can see that most of them have recommended the use of behavioral support therapy for tobacco cessation. Clinical Practice Guidelines in US have recommended the provision of face-to-face counseling involving practical problemsolving along with skills training components. ...
Introduction:
Non-pharmacological management of tobacco cessation has been reported to yield a high level of abstinence from tobacco usage. However, it is unclear which type of non-pharmacological intervention to be adopted in national tobacco control program. Hence, we undertook this review to identify the best non-pharmacological tobacco cessation therapies for tobacco cessation.
Methods:
Systematic literature search was performed in EMBASE, SCOPUS, PubMed Central, CENTRAL, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov from 1964 until September 2022. Randomized controlled trials assessing the effectiveness of non-pharmacological intervention for tobacco cessation in India were eligible for inclusion. Comparative intervention effect estimates obtained from network meta-analyses were represented as pooled odds ratio (OR) with 95% confidence interval (CI).
Results:
21 studies were eligible for the analysis. More than half of the studies had high risk of bias. E-Health intervention had the highest odds ratio (pooled OR=9.90; 95%CI: 2.01-48.86) in terms of tobacco cessation rate followed by group counselling (pooled OR=3.61; 95%CI: 1.48-8.78) and individual counselling (pooled OR=3.43; 95%CI: 1.43 to 8.25). Brief advice or self-help intervention or comparison between each of these interventions against each other (both direct and indirect network) did not yield any significant results.
Conclusion:
E-Health intervention was the best intervention followed by group intervention and individual face-to-face counselling intervention for tobacco cessation in India. Nonetheless, more high-quality large scale RCTs either individual or by combining the e-Health, individual or group counselling interventions are required to provide conclusive evidence and subsequent adoption into the national health programs in India.
Implications of the study:
This study would aid the policymakers, clinicians and public health researchers in choosing the right tobacco cessation therapy to be offered across various levels of the healthcare delivery system, including major health facilities providing drug therapy (i.e., concurrently with pharmacological treatment for tobacco cessation) in India. The study findings can be adopted by the national tobacco control program to decide the appropriate intervention package and identify the areas of focus to perform tobacco-related research in the country.
... Nursing professionals may have an important "window of opportunity" for delivering smoking cessation intervention to smoking patients. A Cochrane review showed that nurse-led smoking cessation intervention increases smokers' success in quitting smoking, especially in hospitals (Rice et al., 2017). However, most nurses asked about patients' smoking status, but few assisted them in quitting (Mak et al., 2018;Sarna et al., 2009Sarna et al., , 2016. ...
Aim: To systematically evaluate the effect of smoking cessation training on nursing students’ learning outcomes.
Design: This systematic review followed the PRISMA guidelines and was registered with PROSPERO (CRD42022373280).
Methods: Ten electronic English and Chinese databases were searched to identify articles on nursing students’ smoking cessation training from inception to October 2022. Medical Education Research Study Quality Instru�ment was used to assess the methodological quality of eligible studies.
Results: Twelve moderate methodological quality studies (three randomized controlled trials and nine quasi�experimental studies) with 2114 undergraduate nursing students were included. Teaching strategies included didactic lectures, collaborative learning, blended learning and the service-learning approach. Eight studies
showed that the training significantly increased nursing students’ knowledge of smoking cessation (p < 0.05) and three of them showed a large effect size (Cohen’s d: 0.83–1.31). Seven studies showed that training enhanced students’ attitudes/motivation towards smoking cessation interventions significantly (p < 0.05) and two of them showed a large effect size (Cohen’s d: 1.11–1.84). Nine studies reported that students’ self-efficacy improved significantly after training (p < 0.05) and six of them showed a large effect size (Cohen’s d: 0.98–2.18). Two one�group pre-post studies showed training significantly improved students’ practice of 5 A’s behavior (p < 0.05), with a small effect size (Cohen’s d < 0.50).
Conclusions: This review showed that smoking cessation training had a positive and large effect on undergraduate nursing students’ knowledge, attitudes/motivation and self-efficacy towards smoking cessation intervention, but the effect of changing the practice of 5 A’s was modest. We noted that very few RCTs were done and most studies only used subjective measures. More robust experimental studies with long-term follow-up are warranted in evaluating nursing students’ practice/behavior of smoking cessation intervention and patients’ quitting out�comes. Blended and collaborative learning are recommended in smoking cessation education.
... 43 Caregivers who implement smoking cessation interventions can effectively improve patients' lung function and promote pulmonary rehabilitation. 44 The ability to perform daily living activities is an important indicator for assessing pulmonary rehabilitation in patients with COPD. The key to pulmonary rehabilitation care is to strive for maximum activity in daily living and to improve endurance for exercise and activity, thereby increasing their ability to care for themselves. ...
Background and Aim
COPD nursing plays a crucial role in alleviating disease symptoms, prolonging patient survival, and is therefore of paramount importance. However, authoritative research findings, research hotspots, and development trends in the field of COPD are still unclear. This study aimed to examine authoritative research findings, research hotspots, and trends in the field of COPD nursing. Descriptive statistics and bibliometric and visual analyses of the literature were conducted.
Methods
Bibliometric data were obtained from the Web of Science database. Citespace was used to explore publication trends, countries, institutions, journals, authors, keywords, and co-citation characteristics of the included literature in order to summarize the key research in the field of COPD nursing.
Results
In total, 693 articles on COPD nursing were published. 1998–2014 showed a rapid growth period in this research field, which stabilized in 2015–2022. The research content could mostly be summarized into five categories: acute exacerbation, quality of life, risk, evidence-based nursing, and pulmonary rehabilitation. The research hotspots in 1998–2014 included randomized controlled trials, education, elderly patients, nursing home residents, nursing homes, rehabilitation, and prevalence. Research in 2015–2022 focused on impact, palliative care, needs, and predictors. In recent years, research mainly concentrated on symptom management models, cost-effectiveness, and cumulative meta-analysis.
Conclusion
Bibliometric analysis of COPD nursing articles indicates that the focus of COPD nursing research is shifting from tertiary prevention to primary and secondary prevention. Helping patients achieve self-management of symptoms, reducing the financial burden of COPD on healthcare, and summarizing research evidence by meta-analyses will likely remain the focus of future research.
... As health specialists and promoters who stay with patients the most time, nurses are best suited for health education and smoking cessation interventions 6 . Studies reveled that the smoking cessation rate increased significantly after nurses provided brief smoking control counseling 7,8 . Currently, the number of nursing staff in China exceeds 5 million, making it the largest healthcare professional personnel 9 . ...
INTRODUCTION
Nursing staff’s assistance for smokers to quit smoking can increase the rate of quitting. The smoking cessation help can be affected by many factors. This study surveyed the use of the 5As (Asking, Advising, Assessing, Assisting, Arranging) approach to support smoking cessation by the nursing staff in Chongqing, China, and analyzed the corresponding influencing factors.
METHODS
A stratified random cluster sampling method was used to select nursing staff from 8 tertiary hospitals, 5 secondary hospitals, 12 community health centers, and 35 township health centers in different geographical regions of Chongqing. A questionnaire survey was conducted among the nursing staff to investigate their participation in smoking cessation. Binary logistic regression analysis was employed to analyze the influencing factors of smoking cessation 5As behavior of the nursing staff.
RESULTS
The 1669 participants were 44 males (2.6%) and 1625 females (97.4%), with an average age of 37.00 ± 10.89 years. Among the participants, 55.2% were from tertiary hospitals, 23.2% from secondary hospitals, 14.2% from township health centers, and 7.4 from community health centers. The often or always used behaviors were: Asking, 69.2%; Advising, 53.0%; Assessing, 39.5%; Assisting, 33.7%; and Arranging, 25.1%. The factors that affected all the 5As were: smoking cessation training (AOR=1.60; 95% CI: 1.22–2.11), knowledge of smoking cessation guidelines (AOR=1.75; 95% CI: 1.32–2.32) and the use of smoking cessation Apps (AOR=1.50; 95% CI: 1.09–2.06), and smokers’ willingness to quit (AOR=2.20; 95% CI: 1.60–3.02).
CONCLUSIONS
Smoker’s motivation to quit smoking and nurses’ knowledge of tobacco cessation resources affected nurses’ participation in smoking control behavior. While encouraging smokers to quit smoking, clinical nursing staff should be provided with related resources to advocate smoking cessation. Guided by the Chinese Clinical Tobacco Cessation Guidelines, smoking control knowledge and skills training should be provided for nursing staff to increase their positive attitude towards smoking control, so as to promote their active participation.
... A number of Cochrane Database Systematic Reviews have shown that behavioural interventions [155][156][157][158][159] are all associated with an increase in relative smoking cessation for six months or more. One Cochrane review [156] examined 312 randomised and controlled trials involving 250,563 participants and 845 distinct study arms, and found that behavioural support can increase six-month or longer quitting rates without increasing possible harms. ...
Electronic nicotine delivery systems (ENDS), which are becoming increasingly popular in many parts of the world, have recently become more sophisticated in terms of their more active content and better controlled vaporisation. This review begins by describing how cigarette smoking led to the development of ENDS as a means of combatting nicotine addiction. ENDS are usually categorised as belonging to one of only three main generations, but a fourth has been added in order to differentiate the latest, most powerful, most advanced and innovative that have improved heating efficiency. Descriptions of the principal substances contained in ENDS are followed by considerations concerning the risk of toxicity due to the presence of albeit low concentrations of such a variety of compounds inhaled over a long time, and the increasingly widespread use of ENDS as a means of smoking illicit drugs. We also review the most widely used pharmacotherapeutic approaches to smoking cessation, and recent epidemiological data showing that ENDS can help some people to stop smoking. However, in order to ensure their appropriate regulation, there is a need for higher-quality evidence concerning the health effects and safety of ENDS, and their effectiveness in discouraging tobacco smoking.
... Brief advice from either a physician or a nurse has a small effect on cessation rate, while more intensive interventions are more effective. 16,17 The available evidence on the effectiveness of physical exercise for smoking cessation is of low certainty, and higher quality studies are required. 18 Likewise, the existing evidence does not support mindfulness-based interventions. ...
Smoking is a global health challenge that causes a myriad of diseases. Smoking cessation services are part of the armamentarium to combat smoking epidemic. In addition to the approved treatments, alternative therapies, including electrical stimulation, have been proposed. The aim of this study is to review and summarize the evidence for the efficacy of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. A historical background and descriptive summary of various acupuncture and related therapies is provided. Systematic reviews and original studies were reviewed, and their results were summarized. In conclusion, the current best available evidence does not support the use of electrical stimulation, including Silver Spike Point therapy, in smoking cessation. Policy makers and healthcare providers should aim to utilize the available resources to provide evidence-based treatment options for patients seeking to quit tobacco use.
... Reducing the number of current tobacco users by way of cessation support is a key policy focus of the World Health Organization [3][4][5]. Health professionals occupy a crucial role in cessation interventions [5][6][7], given their involvement is both efficacious and cost effective [8][9][10]. However, a small but non-trivial proportion of health professionals continue to use tobacco [11,12], posing a threat to the optimal implementation of cessation support [7], because doctors and nurses who smoke conventional tobacco are 17% and 13% less likely, respectively, to deliver cessation advice to patients [13,14]. ...
Background:
Offering cessation support to health professionals who smoke to ensure optimal implementation of cessation support for patients is a key recommendation of the WHO Framework Convention on Tobacco Control Article 14 guidelines. However, direct efforts to support this population to quit are limited. Although numerous articles on the topic of tobacco use among health professionals have been published, the factors associated with their own cessation have not been systematically synthesised.
Objective:
We sought to synthesise existing literature on the predictors and processes informing attitudes and beliefs of smoking health professionals' own cessation.
Methods:
A five-step methodological framework for scoping reviews was followed. We conducted a systematic search of EMBASE, PubMed, Web of Science, and PsycINFO databases, as well as Google Scholar for relevant articles. Titles, abstracts, and full texts were screened against predefined criteria: research published between 1990 and 2021, in English-language peer-reviewed journals; participants included doctors, nurses, medical, and student nurses who smoke.
Results:
The initial search yielded 120, 883 articles, with 27 selected for synthesis. Prevalence estimates and predictors of smoking behaviour have remained the primary focus of smoking health professional research. Few studies explicitly examined the relevant predictors of quit attempts and quit attempt success. There is evidence that age and work environment factors predict quit attempt success in some health professional groups. There is also some evidence of tobacco smoking stigma experiences among nurses and nursing students who smoke.
Conclusion:
Although cessation support is desperately needed for health professionals who smoke, the evidence for factors predicting quit success remains limited. To better guide future research, first, more theoretical work is required to identify the relevant predictors. Second, these should be tested using prospective research designs that take a multi-focal perspective to clarify the targets for change.
... Among the healthcare providers, nurses are ideally positioned to advise patients to quit smoking in a wide range of nursing care circumstances. Nurse-led smoking cessation interventions have been effective in quitting smoking in various settings 3 . However, the lack of smoking cessation education hinders nurses from providing adequate tobacco cessation counseling 4 . ...
Introduction:
Lack of smoking cessation education hinders nurses in providing adequate tobacco cessation counseling. Video training on smoking cessation counseling for nurses was developed and assessed for its short-term outcomes on knowledge and self-efficacy.
Methods:
A quasi-experimental study using pretest-posttest design was conducted with nurses in Thailand in 2020. A total of 126 nurses received online video training. Patient-nurse role-playing was used to demonstrate cessation counseling for smokers who are in the contemplation and preparation stage. Motivational interviewing techniques were emphasized throughout the video. Knowledge and self-efficacy in smoking cessation counseling were assessed pre and post training by a questionnaire.
Results:
Comparisons of the pre and post training, mean score of knowledge (10.75 ± 2.39 vs 13.01 ± 2.86, t=7.716, p<0.001) and self-efficacy in smoking cessation counseling (3.70 ± 0.83 vs 4.36 ± 0.58, t=11.187, p<0.001) were significantly increased. These positive learning outcomes were found in nurses with experience and no experience in cessation counseling (p<0.001).
Conclusions:
This study shows that video training can improve nurses' knowledge and confidence in smoking cessation counseling. It could therefore be included in nursing continuing education to improve nurses' knowledge and confidence in smoking cessation services.
... This is a much-underestimated answer, compared to the smoking-attributable fractions for COPD and lung cancer being reported as approximately 80-90% and 81-95%, respectively, from previous studies 17 , and that half to two-thirds of smokers who smoke ≥1 pack a day will die from a smoking-related disease 19 . Their knowledge of the effectiveness of smoking cessation methods was also insufficient compared to reported literature; given that an unassisted quit rate was reported at only 2-3% in the literature 21 , the majority of OHNs regarded 'will power alone' as very effective and more effective than the scientifically proven and recommended methods, such as physicians' advice and pharmacotherapy with behavioral support [21][22][23] . Acupuncture, which appears to have no scientific evidence in previous work 24 , was overestimated as effective as pharmacotherapy, and even previous training experience on smoking cessation did not improve acknowledgement of the importance of smoking cessation methods. ...
Introduction:
Occupational health nurses (OHNs) in South Korea who visit the workplace periodically could play a key role in smoking cessation. It would be helpful to assess their understanding of smoking hazards and smoking cessation methods to encourage them to provide smoking intervention services at the workplace. This study aimed to investigate the knowledge of smoking hazards and perceptions of smoking cessation methods among OHNs.
Methods:
We conducted an anonymous self-administered cross-sectional questionnaire survey of 108 OHN nurses employed in an occupational health service outsourcing specialized agency with 19 regional branches in Korea from July to August 2019. We assessed the perceptions of the OHNs about smoking interventions, hazards of smoking, and perceived competence to counsel smokers according to training experience, using chi-squared tests and Fisher's exact tests.
Results:
The majority of the nurses underestimated the smoking-attributable fraction for lung cancer (78.7%), chronic obstructive pulmonary disease (64.8%), and mortality (49.0%), regardless of training experience on smoking cessation, while more than half perceived their skill and knowledge to counsel patients concerning smoking as inadequate (56.5%). However, those trained in smoking cessation interventions felt more competent in smoking cessation counselling, with 52.2% and 29.3% in the trained and non-trained groups, respectively (p=0.019).
Conclusions:
The OHNs in this study underestimated smoking hazards and perceived themselves as lacking counselling skills regarding smoking cessation interventions. It is necessary to encourage OHNs to promote smoking cessation by increasing their knowledge, skills and competence in smoking cessation interventions.
... Thus, it is reasonable to believe that repeated information and extended follow-up with behavioral support and cessation drugs could enhance the probability of successful cessation. An acute hospitalization is also a teachable moment to introduce help for smoking cessation (Rice et al., 2017). However, consistent results from a Cochrane review exploring interventions for smoking cessation found that cessation counseling interventions initiated at Frontiers in Psychology frontiersin.org . ...
Objectives
Smoking is common in patients with cardiovascular disease. Despite strong recommendations for cessation and the existence of efficacious pharmacological and behavioral interventions, cessation rates remain low. Therefore, in this study, we explore perceived facilitators and barriers to smoking cessation in patients with atherosclerotic cardiovascular disease who have participated in a cessation intervention study.
Methods
Participants (N = 10) from the intervention arm of a randomized controlled study with access to free cessation support and pharmacological aids completed a semi-structured, in-depth telephone interview after a 6-monthfollow-up between October 2021 and July 2022. The interviews were audio recorded, transcribed, and analyzed according to principles of thematic analysis.
Results
The mean age was 65.7 (range: 55–79) years, and three of the 10 participants were women. Among the participants, five had quit smoking, three had relapsed, and two were persistent smokers. The themes identified encompassed barriers and facilitators to cessation, both including individual and contextual factors. Barriers included the upsides of smoking, difficult life situations, addiction to smoking, smoking in social circles, perceived lack of support and understanding from health professionals. Facilitators included intrinsic motivation, concerns about the health condition, financial implications, specific behavioral strategies, positive influence from the social environment, and helpful components of the cessation intervention.
Conclusion
Smokers with cardiovascular disease who have attended a cessation intervention study report several facilitators weighted against barriers, interacting with the intention to cease smoking. The most important potentially modifiable factors of significance for cessation identified may be addressed through motivational interviews and focus groups with other smokers.
... There is a global call from policy makers, health care organisations and health professionals to utilise the nurse workforce to achieve universal health coverage, mental health and noncommunicable diseases care, emergency preparedness, patient safety and the delivery of integrated people-centred care [2]. When enabled and supported to work to the full scope of their professional training, nurses can provide effective primary and preventive health care [3][4][5][6]. As the largest group of clinical workers, nurses' personal and work environment characteristics are critical predictors of patient care quality and safety [7]. ...
Objectives
Knowledge of the predictors of nursing quality and safety remains a gap in global primary care research. This study examines organisational‐level and nurse‐level predictors of nurse‐reported quality of care from a management perspective.
Methods
We recruited 175 primary care nurses in 38 community health centres (CHCs) varying by size and ownership in Jinan, Tianjin, Shenzhen and Shanghai. Guided by the Systems Engineering Initiative for Patient Safety model, the organisation‐level predictors comprised organisational structure, organisational culture, psychological safety and organisational support, while the nurse‐level predictors included organisational commitment and organisational citizenship behaviour. Nurse‐reported quality of care was measured by two questions: “How do you rate the quality of care that you provide?” and “Do you often receive complaints from patients or their family members at work?” Multilevel linear regression models were used to examine the predictors of nurse‐reported quality of care.
Results
Among the four organisation‐level predictors, organisational structure, psychological safety and organisational support were positive predictors of nurse‐reported quality of care. Nurses working in CHCs with highly hierarchical organisational structures (Coef. = 0.196, p = 0.000), a high level of organisational support (Coef. = 0.158, p = 0.017) and a high level of psychological safety (Coef. = 0.159, p = 0.035) were more likely to report high quality of care or less likely to receive medical complaints. In terms of nurse‐level predictors, nurses willing to increase their knowledge through continuous education were more likely to report good quality of care (Coef. = 0.107, p = 0.049) and less likely to receive medical complaints from patients (Coef. = 0.165, p = 0.041).
Conclusions
Potential management levers to improve quality of nursing care include formalised organisational structures, strong organisational support and a psychologically safe environment as well as the provision of training to facilitate continuous education. Implementing these recommendations is likely to enhance the nursing quality in primary care.
... (15) Brief intervention is goal-directed but nondirective communication designed to improve motivation for change in quit behavior by eliciting feedback to plan for change. (12,(16)(17)(18)(19)(20) The terms brief intervention (BI) and motivational interview (MI) are used with a common principle of active engagement of the client in the process of reduced use and teaching alternative coping skills. (21) These interventions are based on the philosophy that the client holds a key role in showing commitment and successful recovery. ...
Objectives:
To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults.
Methods:
For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trialson the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies.
Results:
A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups.
Conclusions:
The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.
... In their classification of nursing interventions, Butcher et al. (2018) supported that "even if standardized interventions are available and found to be effective, a tailored or targeted intervention may promote better adherence, achieve better outcomes, and be more cost-efficient" (p.17). A systematic review conducted by Rice et al. (2017) indicated that nurse-led smoking cessation interventions could enhance a person's success in the cessation of smoking in community settings or in health care centers. Such success can be attributed to the high-sensitivity level of these interventions to subjects' unique characteristics when compared with standardized interventions (Butcher et al., 2018). ...
Background: Nursing interventions tailored to the smoking triggers in patients with non-communicable chronic diseases are essential. However, these interventions are scant due to the nature of factors associated with smoking cessation and the poor understanding of the effect of nurse-led intervention in Iraq.
Purpose: This study aimed to determine the dominant smoking triggers and examine the effects of a tailored nursing intervention on smoking behavior in patients with non-communicable chronic diseases.
Methods: Convenience samples of 128 patients with non-communicable chronic diseases, male and female patients, who were 18-70 years old, were recruited in this quasi-experimental, randomized comparative trial in the outpatient clinic in one major teaching hospital in Baghdad City, Iraq. The intervention included simple yet specific instructions that were given both orally and in written form to the study samples to enable them to manage their craving to smoke for 6 weeks. The smoking triggers were assessed using Why Do You Smoke questionnaire. Participants were randomly allocated to receive either the nurse-led intervention or standard care. Data were analyzed using descriptive statistics, independent sample t-tests, logistic regression, and two-sided tests.
Results: Stress reduction was the dominant smoking trigger among subjects. The percentage of participants who were either able to completely quit smoking or reduce the number of smoked cigarettes per day (n=19, 29.7%; n=28, 43.8%, respectively) was greater in the study group than those in the control group (n=5, 5.8%; n=5, 5.8%, respectively). Study findings demonstrated significant differences in the inability to improve readiness to quit smoking between the intervention group and control group (p=0.000) at the sixth-week follow-up.
Conclusion: The tailored nursing intervention was effective for a successful achievement of smoking reduction and cessation among patients with non-communicable chronic diseases, and a potential to equip nurses in clinical settings to support patients to achieve this is recommended.
... (15) Brief intervention is goal-directed but nondirective communication designed to improve motivation for change in quit behavior by eliciting feedback to plan for change. (12,(16)(17)(18)(19)(20) The terms brief intervention (BI) and motivational interview (MI) are used with a common principle of active engagement of the client in the process of reduced use and teaching alternative coping skills. (21) These interventions are based on the philosophy that the client holds a key role in showing commitment and successful recovery. ...
Objective. To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults Methods. For this systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trials on the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. Results. A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. Conclusion. The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.
... On the other hand, the guidance and monitoring of patients by nurses with specific training can be useful, although the evidence on the effectiveness of behavioural support, provided by nurses, to motivate and maintain abstinence from smoking is moderate. (29) R8. The rheumatology nurse must educate the patient on infection prevention and identification. ...
Objectives:
To develop practical recommendations, based on the best available evidence and experience, on the nursing management of patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD).
Methods:
The usual consensus methodology was used, with a nominal group, systematic reviews (SRs), and Delphi survey. The expert panel, consisting of rheumatology nurses, rheumatologists, a psychologist, a physiotherapist, and a patient, defined the scope, the users, the topics on which to explore the evidence and on which to issue recommendations.
Results:
Three PICO questions evaluated the efficacy and safety of pulmonary rehabilitation and non-pharmacological measures for the treatment of chronic cough and gastroesophageal reflux by means of SR of the literature. With the results of the reviews, 15 recommendations were established for which the degree of agreement was obtained with a Delphi survey. Three recommendations were rejected in the second round. The 12 recommendations were in patient assessment (n=4); patient education (n=4); and risk management (n=4). Only one recommendation was based on available evidence, while the remaining were based on expert opinion. The degree of agreement ranged from 77% to 100%.
Conclusions:
This document presents a series of recommendations with the aim of improving the prognosis and quality of life of patients with RA-ILD. Nursing knowledge and implementation of these recommendations can improve the follow-up and prognosis of patients with RA who present with ILD.
... Behavioral therapy with nursing also increases smoking cessation with an RR of 1.29 (95% CI 1.21-1.38) [15]. ...
This study aims to evaluate the effect of regularly reporting spirometry results during smoking cessation counseling from a primary care physician on the quit rate in adult smokers.
Methods:
A randomized, two-arm intervention study was conducted at six primary care centers. A total of 350 smokers, ≥18 years of age, who consulted their primary care physician, participated in the study. At the selection visit, smokers who gave their consent to participate underwent spirometry. Subsequently, an appointment (visit 0) was scheduled to complete a nicotine dependence test, a smoking cessation motivation questionnaire, and a sociodemographic questionnaire. Participants were also offered brief, structured advice on how to quit smoking, as well as detailed information on spirometry results. Patients were then randomized and scheduled for follow-up visits at 3, 6, 12, and 24 months. Both arms received brief, structured advice and detailed information on spirometry results at visit 0. At consecutive follow-up visits, the control group only received brief, structured smoking cessation advice, while the intervention group also received information on initial spirometry results at visits 3 and 6, and a spirometry retest at visit 12. Exhaled carbon monoxide testing was used to check smoking cessation.
Results:
The study included 350 smokers; 179 were assigned to the control group and 171 to the intervention group. Smoking cessation at one year was 24.0% in the intervention group compared to 16.2% in the control group. At two years, it was 25.2% in the intervention group and 18.4% in the control group. Overall, the adjusted odds of quitting smoking in the intervention group were 42% higher than in the control group (p = 0.018).
Conclusions:
Regular and detailed feedback of spirometry results with smokers increases smoking cessation. Specifically, the likelihood of quitting smoking in the intervention group is 1.42 times higher than in the control group (p = 0.018).
... in the present study, telling the lung age and motivational interviewing proved to be effective in increasing the rate of smoking cessation among the undergraduate smokers. These results came in accordance with previous reports which concluded that advice and behavioural support from health professionals could help smokers to stop smoking [46] and that even brief advice from healthcare providers could significantly increase the smoking quit rate in the general population [47]. The raised quit rate, the participants' motivation and decision to quit smoking in response to knowing their lung age may be based on the behavioural belief that the smoking-related health hazards were still within 'the modest zone' and on the fact that the pulmonary function indicators were not seriously deteriorated; these concepts might have positively supported their decision of smoking cessation since it was not too late to stop smoking [22]. ...
Introduction
To evaluate the effect of telling undergraduate smokers their lung ages on the rate of smoking cessation.
Methods
This randomized controlled study involved 142 eligible volunteer current undergraduate smokers. They were randomly allocated to the study group (group 1; n = 72) and the control group (group 2; n = 70). Participants in group 1 were told their lung age, received a 5-minute motivational interview, and were given raw figures of their pulmonary function, while participants in group 2 received the same intervention except the lung age. Initially (evaluation 1), the subjects’ lung ages were estimated through spirometric assessment of forced expiratory volume in 1 second. The number of smoked cigarettes per day was reported and the smoking status was ensured through the assessment of exhaled carbon monoxide at evaluation 1, after 6 months (evaluation 2), and after 12 months (evaluation 3).
Results
At evaluation 2, the overall follow-up rate was 95.07%. There was a significant difference in the smoking quit rate between group 1 (23.61%) and group 2 (10%) ( p = 0.03). At evaluation 3, no change existed in the follow-up rate. The smoking quit rate was 19.4% and 4.3% for groups 1 and 2, respectively ( p = 0.01).
Conclusions
Telling undergraduate smokers their lung ages can significantly improve the smoking quit rate in a short- and long-term perspective. The long-term partial relapse status arouses the question about other contributing factors out of the scope of this study.
... Community nurses must organize regular activities and inform citizens about smoking through brochures or presentations. Moreover, the contribution of school nurses should be emphasized more because through educational programs are informed not only children and parents but also the school teachers [22]. Last but not least, media has also an important role to play [23], by providing the appropriate time to health professionals so that they will inform about smoking and the harmful effects on human health. ...
Introduction: It is true that the comparison of conventional and electronic cigarettes is a topic that has been discussed a lot and concerns both citizens and health professionals worldwide. The rates of smokers in Greece are high in combination with the fact that smokers are more likely to get seriously ill from covid-19, it was the reason to investigate this topic. Aims: To investigate the citizens knowledge and attitude about the electronic and conventional cigarette. Study Design: It was a comparative descriptive research. Place and Duration of Study: The questionnaires were given to citizens who lived in the prefecture of Achaia (one of the largest prefectures in Greece). The present survey was conducted between March and May 2020. Methodology: A questionnaire was developed with 28 questions. The Chronbach alpha reliability was .75. The sample consisted of 681 citizens. The statistical analysis was performed with SPSS 25 program. Results: The majority of citizens had very good knowledge (57.6%) while 20.3% had good knowledge. Most citizens were non-smoker (64.3%), they did not use electronic cigarette (91%) but they did try in the past (52.3%). Regarding electronic cigarette, they believe that it was not replaced the conventional, was not helpful for quit smoking and it was harmful as much as the conventional one. Finally, the cheaper price of e-cigarette contributes to its choice. Age, permanent residence and educational level significantly correlated with knowledge score (p<0.05). Conclusion: The majority of citizens were non-smokers while the conventional cigarette is still the first preference of the citizens. Although citizens' knowledge of conventional cigarettes and e-cigarettes was very good, it is necessary for health professionals to enrich their knowledge and inform citizens efficiently about smoking.
... Brief interventions are one form of preventive care that has been shown to be practical in situations where staff are unable to provide more intensive support [18]. Evidence-based models of a brief intervention to address chronic disease risk behaviours include the 5As model (Ask, Assess, Advise, Assist, Arrange) [19][20][21][22] and the briefer AAC model (Ask, Advise, and Connect) [23]. Existing clinical guidelines also acknowledge that preventive care is a vital component of holistic care for people with mental health conditions [14][15][16][17]. ...
People living with mental health conditions experience a reduced life expectancy largely due to a higher prevalence of chronic diseases. Addressing health risk behaviours, including tobacco smoking, inadequate nutrition, harmful alcohol consumption, and physical inactivity (SNAP), through the provision of preventive care, is recommended to reduce this burden. Community Managed Organisations (CMOs) may play an important role in providing preventive care to consumers with mental health conditions, however, few studies have examined preventive care provision in CMO settings; and no studies have comprehensively assessed barriers to the provision of this care using a tool such as the Theoretical Domains Framework (TDF). To fill this research gap, we conducted an online survey among staff (N = 190) from one CMO in Australia to (1) identify barriers to preventive care provision (ask, advise, assist, connect) to address SNAP behaviours among consumers; and (2) explore associations between barriers and preventive care provision. Results demonstrate that while staff reported knowing how to provide preventive care and believed it would positively impact consumers; barriers including confidence in providing this care and consumer uptake of referrals, were identified. Further research among multiple CMOs is needed to identify care provision and associated barriers in the sector more widely.
Background: Empathy and self-efficacy for smoking cessation counseling can be enhanced through smoking
cessation training. Narrative videos and virtual reality (VR) games have been applied in medical education, but
their application in smoking cessation training is limited and understudied.
Objectives: To evaluate the effect of smokers' narrative videos and mini-VR games on nursing students' empathy
towards smokers (State Empathy Scale), confidence in practicing empathy, self-efficacy in smoking cessation
counseling, and learning satisfaction.
Design: An open-labeled randomized controlled trial, registration number: NCT05440877 (ClinicalTrials.gov).
Setting and participants: Master of nursing students from the University in Hong Kong who enrolled in a smoking
cessation course.
Methods: All students attended a tutorial including case-based discussions and role-play. The intervention group
could additionally access the narrative videos and mini-VR games of smokers' cases. Linear mixed models and
Cohen's d were used to evaluate the intervention effect on the self-reported learning outcomes after the
intervention.
Results: 26 students enrolled in this trial, with 13 in each trial arm. All completed the trial. Post-test state
empathy scores were significantly higher in the control group than in the intervention group (Cohen's d = 0.814,
p = 0.049). No significant group differences were observed in the change of confidence in practicing empathy (β
= − 11.154, p = 0.073), self-efficacy (β = 4.846, p = 0.096), and students' learning satisfaction (Cohen's d =
0.041, p = 0.917). Both groups showed a significant increase in self-efficacy post-test (p < 0.001).
Conclusions: Narrative videos showing smoking scenes and reluctance to quit, and our mini-VR games may
weaken nursing students' empathy towards smokers. Smoking cessation training involving narrative videos
should be modified. Debriefing and guidance to understand smokers' difficulties and express empathy are
needed. VR games for smoking cessation training can involve more frame stories and challenging tasks to in�crease engagement.
Objetivo: avaliar as evidências de validade da estrutura interna e da confibialidade da versão brasileira do instrumento Smoking Cessation Counseling Método: estudo psicométrico de análise fatorial confirmatória e de confiabilidade realizado em 250 enfermeiras da prática clínica. Para a análise da validade convergente do modelo fatorial foram calculados valores de Average Variance Extracted , a análise discriminante foi realizada pelo critério de Fornell-Larcker. A confiabilidade foi examinada pelo coeficiente de alfa de Cronbach e pela confiabilidade composta Resultados: foi necessária a exclusão de sete itens do domínio de Aconselhamento avançado e um item do domínio Aconselhamento básico para obtenção adequada dos valores de Average Variance Extracted e do critério de Fornell-Larcker. A confiabilidade composta variou de 0,76 a 0,86 e o coeficiente de alfa de Cronbach global alcançado foi de 0,86, variando de 0,53 a 0,84 a depender do domínio avaliado. Obteve-se a versão final do instrumento composto de 16 itens distribuídos em quatro domínios Conclusão: a versão brasileira da Smoking Cessation Counseling obteve adequadas evidências psicométricas de validade e de confiabilidade. Estudos posteriores serão necessários para o refinamento do instrumento.
Objetivo: evaluar las evidencias de validez de la estructura interna y de la confiabilidad de la versión brasileña del instrumento Smoking Cessation Counseling. Método: estudio psicométrico de análisis factorial confirmatorio y de confiabilidad realizado en 250 enfermeras de la práctica clínica. Para el análisis de la validez convergente del modelo factorial se calcularon valores de Average Variance Extracted, el análisis discriminante se realizó mediante el criterio de Fornell-Larcker. La confiabilidad se examinó por el coeficiente de alfa de Cronbach y por la confiabilidad compuesta. Resultados: fue necesaria la exclusión de siete ítems del dominio de Asesoramiento avanzado y un ítem del dominio Asesoramiento básico para obtener adecuadamente los valores de Average Variance Extracted y del criterio de Fornell-Larcker. La confiabilidad compuesta varió de 0,76 a 0,86 y el coeficiente de alfa de Cronbach global alcanzado fue de 0,86, variando de 0,53 a 0,84 dependiendo del dominio evaluado. Se obtuvo la versión final del instrumento compuesto de 16 ítems distribuidos en 4 dominios. Conclusión: la versión brasileña de Smoking Cessation Counseling obtuvo adecuadas evidencias psicométricas de validez y confiabilidad. Estudios posteriores serán necesarios para el refinamiento del instrumento.
Among smoker women with breast cancer quitting smoking has been shown to increase survival and surgical outcomes. Where surgery is indicated, the preoperative seems to be a crucial moment for smoking cessation interventions as it enhances recovery after surgery and motivates prolonged tobacco abstinence. Timing and frequency of preoperative quitting conversations were variables associated with quitting. An early, multidisciplinary, and personalized approach is recommended. A solid integration between primary care services and specialized care is challenging but feasible, implementing prehabilitation pathways that include tobacco treatment routinely as an integral part of breast cancer care. Smoking cessation programs before surgical procedures impact recidivism prevention, survivorship improvement, public health, and cost savings. The contribution of healthcare professionals can make a difference in tobacco control, collaborating with organizations, public health, and nursing research. Integrated solutions in oncological clinical care pathways might help patients build and maintain tobacco abstinence after breast cancer. Future research shall study when patients should abstain from smoking before oncological breast surgery.
Combustible cigarette consumption is at an all-time low in the United States. Still, it remains at epidemic levels, with cigarette smoking a leading cause of disability and premature death in the United States, disproportionately affecting vulnerable populations and minority groups. Sustained abstinence from smoking poses a significant opportunity for positively impacting all-cause mortality, including that from smoking-related cardiac and pulmonary disease and the deadliest cancer known, lung cancer. Nicotine addiction is a complex chronic disease with physical and behavioral afflictions that often lead to relapse. Tobacco treatment guidelines informed by solid evidence promise to enhance the opportunity for successful abstinence from tobacco use. Healthcare providers and others must integrate this science into the effective implementation of pharmacotherapy and behavioral counseling to optimize the effects of such interventions to save lives from tobacco-related diseases. Proactively seeking to understand each patient’s tobacco use and cessation journey through patient-centered care and empathic communication without judgment is vital to building a trusting partnership with patients that accentuates and accelerates successful smoking cessation.
Background:
Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students.
Objectives:
The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes.
Design:
A pre-post evaluation study with a satisfaction assessment tool was used.
Setting:
Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated.
Participants:
One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program.
Methods:
All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test.
Results:
Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10).
Conclusions:
The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.
Consenso de Prevención Cardiovascular
Background:
While cigarette smoking has declined globally, waterpipe smoking is rising, especially among youth. The impact of this rise is amplified by mounting evidence of its addictive and harmful nature. Waterpipe smoking is influenced by multiple factors, including appealing flavors, marketing, use in social settings, and misperceptions that waterpipe is less harmful or addictive than cigarettes. People who use waterpipes are interested in quitting, but are often unsuccessful at doing so on their own. Therefore, developing and testing waterpipe cessation interventions to help people quit was identified as a priority for global tobacco control efforts. OBJECTIVES: To evaluate the effectiveness of tobacco cessation interventions for people who smoke waterpipes.
Search methods:
We searched the Cochrane Tobacco Addiction Review Group Specialized Register from database inception to 29 July 2022, using variant terms and spellings ('waterpipe' or 'narghile' or 'arghile' or 'shisha' or 'goza' or 'narkeela' or 'hookah' or 'hubble bubble'). We searched for trials, published or unpublished, in any language.
Selection criteria:
We sought randomized controlled trials (RCTs), quasi-RCTs, or cluster-RCTs of any smoking cessation interventions for people who use waterpipes, of any age or gender. In order to be included, studies had to measure waterpipe abstinence at a three-month follow-up or longer.
Data collection and analysis:
We used standard Cochrane methods. Our primary outcome was abstinence from waterpipe use at least three months after baseline. We also collected data on adverse events. Individual study effects and pooled effects were summarized as risk ratios (RR) and 95% confidence intervals (95% CI), using Mantel-Haenszel random-effects models to combine studies, where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarized secondary outcomes narratively. We used the five GRADE considerations (risk of bias, inconsistency of effect, imprecision, indirectness, and publication bias) to assess the certainty of the body of evidence for our primary outcome in four categories high, moderate, low, or very low.
Main results:
This review included nine studies, involving 2841 participants. All studies were conducted in adults, and were carried out in Iran, Vietnam, Syria, Lebanon, Egypt, Pakistan, and the USA. Studies were conducted in several settings, including colleges/universities, community healthcare centers, tuberculosis hospitals, and cancer treatment centers, while two studies tested e-health interventions (online web-based educational intervention, text message intervention). Overall, we judged three studies to be at low risk of bias, and six studies at high risk of bias. We pooled data from five studies (1030 participants) that tested intensive face-to-face behavioral interventions compared with brief behavioral intervention (e.g. one behavioral counseling session), usual care (e.g. self-help materials), or no intervention. In our meta-analysis, we included people who used waterpipe exclusively, or with another form of tobacco. Overall, we found low-certainty evidence of a benefit of behavioral support for waterpipe abstinence (RR 3.19 95% CI 2.17 to 4.69; I2 = 41%; 5 studies, N = 1030). We downgraded the evidence because of imprecision and risk of bias. We pooled data from two studies (N = 662 participants) that tested varenicline combined with behavioral intervention compared with placebo combined with behavioral intervention. Although the point estimate favored varenicline, 95% CIs were imprecise, and incorporated the potential for no difference and lower quit rates in the varenicline groups, as well as a benefit as large as that found in cigarette smoking cessation (RR 1.24, 95% CI 0.69 to 2.24; I2 = 0%; 2 studies, N = 662; low-certainty evidence). We downgraded the evidence because of imprecision. We found no clear evidence of a difference in the number of participants experiencing adverse events (RR 0.98, 95% CI 0.67 to 1.44; I2 = 31%; 2 studies, N = 662). The studies did not report serious adverse events. One study tested the efficacy of seven weeks of bupropion therapy combined with behavioral intervention. There was no clear evidence of benefit for waterpipe cessation when compared with behavioral support alone (RR 0.77, 95% CI 0.42 to 1.41; 1 study, N = 121; very low-certainty evidence), or with self-help (RR 1.94, 95% CI 0.94 to 4.00; 1 study, N = 86; very low-certainty evidence). Two studies tested e-health interventions. One study reported higher waterpipe quit rates among participants randomized to either a tailored mobile phone or untailored mobile phone intervention compared with those randomized to no intervention (RR 1.48, 95% CI 1.07 to 2.05; 2 studies, N = 319; very low-certainty evidence). Another study reported higher waterpipe abstinence rates following an intensive online educational intervention compared with a brief online educational intervention (RR 1.86, 95% CI 1.08 to 3.21; 1 study, N = 70; very low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence that behavioral waterpipe cessation interventions can increase waterpipe quit rates among waterpipe smokers. We found insufficient evidence to assess whether varenicline or bupropion increased waterpipe abstinence; available evidence is compatible with effect sizes similar to those seen for cigarette smoking cessation. Given e-health interventions' potential reach and effectiveness for waterpipe cessation, trials with large samples and long follow-up periods are needed. Future studies should use biochemical validation of abstinence to prevent the risk of detection bias. Finally, there has been limited attention given to high-risk groups for waterpipe smoking, such as youth, young adults, pregnant women, and dual or poly tobacco users. These groups would benefit from targeted studies.
Destaques
● Este mapa tem como objetivo apresentar estratégias que podem auxiliar na
promoção da saúde da população.
● Foram incluídas 156 revisões sistemáticas (RS), cujos estudos primários foram
realizados em sua maioria na América do Norte (48,6%).
● As intervenções foram classificadas em 4 categorias e 41 subcategorias. Observou-se maior frequência da categoria "promoção de alimentação saudável" e das subcategorias "multicomponentes" e "educação/educação nutricional".
● Os desfechos foram classificados em clínicos e não clínicos. Desfechos clínicos
foram relatados em 128 RS, com destaque para “alimentação
saudável/consumo/ingestão”. Desfechos não clínicos foram relatados em 63 RS,
com destaque para “cessação e comportamentos alimentares / hábitos
saudáveis”. Apenas duas RS analisaram eventos adversos.
● As intervenções relacionadas à Promoção de alimentação saudável, Promoção de
atividade física, Promoção de aleitamento materno, apresentaram efeito positivo
ou potencialmente positivo acima de 50% para os desfechos avaliados.
Introduction:
Socioeconomically deprived populations are at greater risk for smoking-induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse-led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse-led smoking reduction intervention performed at out-patient clinics in Karachi, Pakistan.
Methods:
A single group pre-and post-test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021.
Intervention:
The multi-modal nurse-led intervention consisted of two face-to-face motivational counseling (30-min) and free nicotine replacement therapy with telephonic counseling and follow-ups offered to all eligible patients for 2 months.
Results:
The nurse-led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1-week follow-up (p < .001), verified by a CO breath test.
Conclusion:
A nurse-managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients.
Zusammenfassung
Tabakrauchen ist das größte vermeidbare Gesundheitsrisiko. Die Auswirkungen sind individuell und gesellschaftlich gravierend. Dennoch ist die Prävalenz aktuell Tabakrauchender in Deutschland mit ca. 35 % weiterhin hoch. Sorge bereitet zudem ein zuletzt starker Anstieg aktiv rauchender Jugendlicher (14- bis 17-Jährige, aktuelle Prävalenz ca. 16 %) und junger Erwachsener (18- bis 24-Jährige, aktuelle Prävalenz ca. 41 %). Etwa ein Drittel der stationär behandelten Patienten:innen rauchen. Die Hospitalisierung von aktiven Rauchern:innen in Akut- und Rehakliniken ist als „teachable moment“ ein günstiger Zeitpunkt, eine Tabakentwöhnung einzuleiten. Eine Intervention, die im Krankenhaus beginnt und nach der Entlassung mindestens einen Monat lang fortgesetzt wird, führt zu etwa 40 % zusätzlich entwöhnter Patienten:innen. Sie ist wissenschaftlich gut untersucht, effektiv und kosteneffizient. Die poststationäre Anbindung kann an ein Tabakentwöhnungsprogramm, eine Rehabilitationseinrichtung, ein Internet- oder Telefonangebot erfolgen. Es bestehen in Deutschland strukturierte und qualitätsgesicherte Angebote zur Umsetzung sowohl für den stationären als auch für den ambulanten Bereich. Größtes Hindernis für eine breite Etablierung solcher Angebote ist die fehlende Kostenerstattung. Zwei umsetzbare Wege, dies zu ändern, wären die Einführung eines Zusatzentgelts für den bestehenden OPS 9-501 „Multimodale stationäre Behandlung zur Tabakentwöhnung“ sowie die Etablierung von Qualitätsverträgen nach § 110a SGB V. Ein Ausbau der Tabakentwöhnung in Gesundheitseinrichtungen würde die Rauchprävalenz und die damit einhergehenden Erkrankungen sowie die konsekutiven Kosten nachhaltig reduzieren.
Non-pharmacologic interventions have been shown to be effective for tobacco cessation, both alone and paired with cessation medications. Behavioral approaches which confer skills for managing urges and triggers are key to many interventions. Approaches based on cognitive therapy models (e.g., cognitive behavioral and acceptance and commitment therapies) are best-studied and generally effective. Brief interventions incorporated into healthcare visits are effective but challenging to implement; these are most effective when they include referral to a tobacco treatment specialist who proactively reaches out to engage the patient in treatment. Similarly, tobacco quitline counseling is effective but not widely utilized to date. Interventions based on modern technology (text messaging, mobile apps, web-based, video telehealth) and innovations (transcranial magnetic stimulation) are promising and in some cases may substantially expand intervention reach to rural areas. However, more work is needed to identify effective components and long-term outcomes. Finally, members of racial, ethnic, and sexual minority groups, pregnant individuals, and those with fewer resources have historically been less likely to quit because standard interventions may fail to address important barriers. Behavioral interventions have demonstrated efficacy, increasing the likelihood of cessation by up to 57%, but barriers remain that limit broad implementation. Recent research demonstrates that adapting interventions to address relevant barriers leads to increased likelihood of cessation.
Introduction:
Tobacco dependence treatment is usually offered in primary care settings. Yet, if many patients who smoke do no not access primary care, cessation interventions may be missing those who most need them. This study describes Wisconsin adults' health care utilization by smoking status.
Methods:
Data were analyzed from 1726 individuals participating in a population-based, cross-sectional, in-person health survey of Wisconsin residents (2014-2016). Demographic characteristics were compared across smoking status using Wald chi-square tests weighted for the complex survey design. Odds ratios were calculated using multivariate logistic regression models.
Results:
Of 1726 respondents, 15.3% reported current smoking, 25.4% former smoking, and 59.4% never smoking. Those currently smoking were more likely than former- or never-smoking respondents to report emergency departments as their "usual place to go when sick" (12% vs 3%) or report they had "no place to go when sick" (16% vs 7%). People who currently smoke also reported more emergency department visits during the past year (mean = 1.4 visits) than did others (mean = 0.4, P< 0.01). Among those currently smoking, 18% reported that they "needed health care but didn't get it" over the past year, compared to 6% of others (P< 0.01). Those currently smoking also were more likely to report a "delay in getting care" (16% vs 9%, P = 0.02) and were less likely to have had a "general health checkup" within the past year (58% vs 70%, P< 0.02). These relationships persisted in logistic regression models controlling for variables related to smoking status and health care utilization, including health insurance.
Conclusions:
These findings suggest that more than a quarter of Wisconsin adults who smoke do not receive primary care every year and that they delay care or seek care in emergency departments more frequently than do those who never smoked or who quit smoking. As a result, such individuals may be missing out on evidence-based tobacco cessation treatment.
Background
Despite evidence showing that continued smoking in patients with non-communicable diseases can reduce treatment efficacy and increase the risk of disease progression and multimorbidity, many smoker patients either have no intention to quit or have had failed attempts at quitting.
Objective
To examine the feasibility of a general health promotion approach that uses instant messaging to deliver brief motivational interviewing to help smokers with non-communicable diseases quit smoking.
Methods
In total, 60 participants who had medical follow-up in a special out-patient clinic were randomized into two groups, 30 in the intervention group received brief motivational interviewing to assist them with their chosen behavioral changes, and 30 in the control group received only a smoking cessation booklet. The outcome measures included self-reported 7-day point prevalence of smoking abstinence and any behavioral change reported by the participants at 6 and 12 months. Biochemical validation was performed for those who verbally reported a 7-day point prevalence of smoking abstinence at 12 months.
Results
The majority (95%) of smokers who attended the out-patient clinic owned a smartphone. The response rate was 73.2%. Retention rates at 6-month and 12-month follow-up were 83.3 and 71.7%, respectively. The process evaluation indicated that participants were satisfied with the content of the brief MI messages and appreciated the use of instant messaging as a way to provide them with professional advice and support for managing their health-related lifestyles. The intervention group had a higher biochemically validated abstinence rate than the control group at 12 months (16.7 vs. 6.7 P = 0.23) although the difference was not statistically significant (Adjusted odd ratio 2.4, 95% confidence interval, 0.43–13.75; P = 0.32.), In addition, the proportion of participants reporting a behavioral change was higher in the intervention group at 6 and 12 months.
Conclusion
This study suggested the potential efficacy and feasibility of a general health promotion approach that uses instant messaging to deliver brief motivational interviewing to help smokers with non-communicable diseases quit smoking. The findings can be used to create a new smoking cessation service model that implements a flexible, proactive and personalized approach to help smokers quit smoking.
Clinical trial registration
ClinicalTrials.gov, identifier: NCT03983330.
Background
Health care professionals have an important role in increasing awareness about smoking harms and serving as role models. This study aims to assess knowledge, attitude and perception toward electronic cigarettes (ECs) as well as prevalence of ECs use among male health colleges students.
Method
This is a cross-sectional survey-based study conducted among students in the male campus of five different health colleges over a 4-month period from February 2020 to May 2020. Descriptive analysis was used to assess the knowledge, perception and attitude, and inferential testing was used to evaluate the association of different participant's variables and knowledge toward ECs usage using SPSS.
Results
A total of 333 students were included in the analysis. Most of students (n = 205; 61.6%) had never used ECs, while 22.8 and 15.6% used them for recreational and smoking cessation purposes, respectively. Focusing on ECs users from each college individually, medical students had the highest prevalence followed by dental, pharmacy and nursing students (47.4, 40.7, 34.5, and 32%, respectively). Many students had misconceptions and a low level of knowledge about ECs, such as recognizing them as smoking-cessation tools and not knowing whether toxic and carcinogenic components levels in ECs are similar to conventional cigarettes, respectively. Medical students had significantly higher knowledge compared to dental students [3 (2) vs. 2 (1); p = 0.033]. Moreover, smokers were less knowledgeable than non-smokers [2.5 (1) vs. 2.1 (1), p = 0.027]. At least 62.8% of students perceived using ECs as a fashionable alternative smoking method and 59.2% believed that they may become a gateway for smoking addiction. Only 120 (36.0%) health colleges students were confidently able to advise smokers regarding ECs.
Conclusion
Our study highlights an increased trend of ECs use accompanied with insufficient knowledge and several misconceptions about ECs among health colleges students. This was associated with a negative influence on their attitude toward ECs use, which would potentially lead to negative consequences on public health.
Objective:
The purpose of this systematic review was to determine the effectiveness of non-pharmacological community-based nursing interventions for smoking cessation in adults.
Method:
Studies published between January 1, 2008 and December 31, 2017 were comprehensively searched to 14 databases. Quality Assessment Tool for Quantitative Studies was used to examine the methodological quality of the included studies. The obtained studies were listed on a code table by title, summary, and author/s' name. A narrative synthesis was used interpreting the data. This study was registered to PROSPERO (ID: CRD42018088007).
Results:
Strong-quality rated three randomized controlled studies were included. Nurses were found to perform intensive behavioral support, brief-advice and mTobacco cessation interventions. These were effective on changing knowledge, belief and attitudes. No sufficient evidence on the cessation rate and the non-relapse rate was found.
Discussion:
This review puts forward that non-pharmacological community-based smoking cessation interventions by nurses has an impact on changing knowledge, belief and attitudes in adult smokers. Findings can encourage public health nurses to use their counsellor role more actively. Improving the health literacy of the adult smokers via these findings can facilitate their intention to behavior change. Findings can be a useful resource for policy makers and governments in controlling the smoking epidemic.
Aim
To evaluate the practice and attitude of doctors towards substance use disorders (SUD) and their management.
Methods
Following stratified proportionate random sampling, selected doctors in the south zone of Bengaluru, India, were interviewed face-to-face using a structured questionnaire.
Results
150 doctors were interviewed. In their practice, a quarter of patients (median of 27.5 (IQR: 11.45-45) use one or other form of Alcohol, Tobacco or Other Drugs of abuse (ATOD). Doctors, in general, enquire about substance use but do not actively intervene. They have mixed attitudes (both positive and negative) towards persons with SUD. A significant positive correlation was noted between the number of years of experience (post-MBBS) with practices related to “brief-intervention” (p=0.014) and “concerned and sympathetic” attitudes (p<0.001). However, a significant negative correlation was observed between the number of years of experience and “substance-specific management” practices (p<0.001). Further, there was a positive correlation between “brief-interventions” practices with the attitude of being “concerned and sympathetic” (p <0.001). A mediation analysis revealed that nearly a third of the overall effect of the number of years of experience on brief-interventions practices was mediated by a concerned and sympathetic attitude.
Conclusions
Serious efforts must be made to train doctors in the effective management of SUD. Attitudes of the doctors influence practices such as brief interventions. Programs directed towards changing the attitudes of doctors can bring changes in their practices.
O problema: O uso contínuo do tabaco, por exposição direta ou indireta, é considerado um problema global de saúde pública, responsável por oito milhões de mortes ao ano. Cerca de 80% dos usuários da substância residem em países de baixa e média renda, como o Brasil. O principal problema de saúde decorrente do uso dos derivados de tabaco é o câncer de pulmão, terceiro tipo de câncer mais comum na população e o mais letal. Neste cenário é importante que equipes e serviços de Atenção Primária à Saúde (APS) estejam preparados para fornecer ações de prevenção e controle do fumo.
Opções para enfrentar o problema: De 234 registros recuperados das bases de dados, após processo de seleção e elegibilidade, treze Revisões Sistemáticas (RS) foram incluídas nesta síntese narrativa. Os resultados foram organizados em quatro opções para políticas em contextos de APS. Efeitos positivos foram relatados nas RS para uma variedade de intervenções, no entanto, algumas incertezas também foram apontadas. Com relação à qualidade metodológica, uma RS foi classificada como de confiança moderada, duas de confiança baixa e dez de confiança criticamente baixa.
Aims
To analyse the degree of susceptibility to smoking according to gender in students between 12 and 16 years of age and study the role of factors associated with gender and the extended index of susceptibility to smoking.
Design
Cross‐sectional study.
Methods
Between November 2019 and March 2020, 12‐ to 16‐year‐old students were recruited from three educational centres in western Spain. Sociodemographic, environmental, social and personal variables were analysed. The value of the extended index of susceptibility to smoking was calculated, and the associations between the students' genders and smoking susceptibility were studied. Multinomial logistic regression was used to study associations between the independent variables and Expanded Susceptibility Index (ESSI) results. The roles of factors in this association were explored through mediation analysis.
Results
A total of 364 students participated in the study (53% females). A total of 79.3% of females and 61.4% of males presented a medium‐high level of the extended index of susceptibility. Females reported greater cigarette use (28% vs. 12.3%), hookah (19.9% vs 9.9%) and alcohol consumption (20.7% risk alcohol consumption). They obtained higher scores on the impulsivity scale in the urgency domain and the negative affect scale. Regardless of other factors, females showed more than double the smoking susceptibility (aOR: 2.05, 95% CI: 1.03–4.07, p = .041). Mediation analysis showed that gender had a total effect on the extended susceptibility index β = .023 (95% CI: 0.07–0.38, p = .01). The effect appeared to be mediated only by having smoking friends (0.08; 95% CI: 0.03–0.15, p = .001).
Conclusions
The greater susceptibility to smoking found in females may be related to a greater influence of smoking among friends.
Impact
These results show that smoking friends have a strong influence among adolescent females; therefore, developing preventive programmes with gender approaches aimed at reducing the influence of these environmental factors would be of interest.
Das vorliegende Kapitel bietet die Behandlungsempfehlungen der Tabakleitlinie mit ihren Hintergrundtexten. Es ist untergliedert in die Abschnitte Motivationsbehandlung und Kurzinterventionen, Harm Reduction, Psychotherapeutische Interventionen, Arzneimittel zur Entzugsbehandlung und Rückfallprophylaxe, Somatische Therapieverfahren, Gender- und Altersaspekte, Somatische Komorbidität, Psychische Komorbidität sowie Setting, Versorgungsorganisation und Aspekte der Finanzierung.
Introduction: Perioperative smoking is the main risk factor for the development of postoperative cutaneous wound healing complications. We require that all patients undergoing elective foot and ankle surgery stop smoking (6 weeks before and 3 months after) and this abstinence is monitored with a preoperative cotinine test. We therefore wanted to understand how this impacted wound healing in elective foot and ankle surgery: do wounds heal differently in patients who quit smoking for surgery, former smokers and nonsmokers?.
Hypothesis: Our hypothesis was that patients who stopped smoking for an upcoming surgery had the same wound healing complications as nonsmokers and former smokers.
Materials and methods: This was a historical, single-center, single-surgeon cohort study of adult patients who underwent an elective ankle or foot surgery between June 2016 and July 2017. Patients were divided into 3 groups: Group 1 smokers who stopped for surgery, Group 2 former smokers, and Group 3 nonsmokers. The primary endpoint was the occurrence of wound healing complications during the wound care consult scheduled 3 weeks after surgery.
Results: A total of 256 patients with a mean age of 58 ± 14.2 years (range, 18–88) were included. Group 3 had more women and a lower BMI than the other groups, but all the other demographic characteristics were similar. Smoking cessation was achieved in Group 1 on average 2.5 ± 1.3 months (range, 1–6) before surgery. There were a total of 20 wound healing complications or 7.5% of the cohort: 13% in Group 1, 11.1% in Group 2 and 6.4% in Group 3. The univariate analysis found that the odds ratio was 2.3 when comparing Group 1 to Group 3 and 1.85 when comparing Group 2 to Group 3 (p =.413). No significant risk factors for wound healing complications were found.
Discussion/Conclusion: Smoking cessation for foot and ankle surgery seems to limit the risk of wound healing complications, with results close to those of former smokers and nonsmokers. Mandatory smoking cessation before surgery could be one of the solutions to prevent this frequent complication.
Level of evidence: III.
Background:
Tobacco cessation after a cancer diagnosis can extend patient survival by improving outcomes for primary cancer and preventing secondary cancers. However, smoking is often unaddressed in cancer care, highlighting the need for strategies to increase treatment reach and cessation. This study examined a low-burden, point-of-care tobacco treatment program (ELEVATE) featuring an electronic health record-enabled smoking module and decision support tools to increase the reach and effectiveness of evidence-based smoking cessation treatment.
Methods:
This study included adult outpatient tobacco smokers (n=13,651) in medical oncology, internal medicine, and surgical oncology clinics from a large midwestern healthcare system. We examined reach and effectiveness of ELEVATE with 2 comparisons: (1) preimplementation versus postimplementation of ELEVATE and (2) ELEVATE versus usual care. Data were evaluated during 2 time periods: preimplementation (January through May 2018) and postimplementation (June through December 2018), with smoking cessation assessed at the last follow-up outpatient encounter during the 6 months after these periods.
Results:
The proportion of current tobacco smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (1.6%-27.9%; difference, 26.3%; relative risk, 16.9 [95% CI, 9.8-29.2]; P<.001). Compared with 27.9% treatment reach with ELEVATE in the postimplementation time period, reach within usual care clinics ranged from 11.8% to 12.0% during this same period. The proportion of tobacco smokers who subsequently achieved cessation increased significantly from pre-ELEVATE to post-ELEVATE (12.0% vs 17.2%; difference, 5.2%; relative risk, 1.3 [95% CI, 1.1-1.5]; P=.002). Compared with 17.2% smoking cessation with ELEVATE in the postimplementation time period, achievement of cessation within usual care clinics ranged from 8.2% to 9.9% during this same period.
Conclusions:
A low-burden, point-of-care tobacco treatment strategy increased tobacco treatment and cessation, thereby improving access to and the impact of evidence-based cessation treatment. Using implementation strategies to embed tobacco treatment in every healthcare encounter promises to engage more smokers in evidence-based treatment and facilitate smoking cessation, thereby improving care cancer for patients who smoke.
Introduction
Cervical cancer screening in general practice could be a routine moment to provide female smokers with stop smoking advice and support. The aim of this study is to assess the effect of a stop smoking strategy delivered by trained practice assistants after the cervical smear, and to evaluate the implementation process.
Methods and analysis
The study is a two-arm, pragmatic cluster randomised trial, in Dutch general practice. Randomisation takes place 1:1 at the level of the general practice. Practices either deliver the SUCCESS stop smoking strategy or the usual care condition. The strategy consists of brief stop smoking advice based on the Ask-Advise-Connect method and is conducted by trained practice assistants after routine cervical cancer screening. The primary outcome is the performance of a serious quit attempt in the 6 months after screening. Secondary outcomes are 7-day point prevalence abstinence, reduction in the number of cigarettes per day and transition in motivation to quit smoking. Follow-up for these measurements takes place after 6 months. Analysis on the primary outcome aims to detect a 10% difference between treatment arms (0.80 power, p=0.05, using a one-sided test), and will be performed according to the intention to treat principle. The process evaluation will assess feasibility, acceptability and barriers or enablers to the strategy’s implementation. For this purpose, both qualitative and quantitative data will be collected via questionnaires and in-depth interviews, respectively, in both individual study participants and involved staff.
Ethics and dissemination
The Dutch Ministry of Health, Welfare and Sport approved of the trial after an advisory report from the Health Council (Nr. 2018/17). A licence was provided to conduct the study under the Population Screening Act. Study results will be disseminated through publications in peer-reviewed journals and conference presentations.
Trial registration number
NL5052 (NTR7451).
This study investigated the effects of Web-based multiple computer tailoring and counseling by a practice nurse (MTC) compared with computer tailoring without counseling (MT) and usual care (UC) on smoking cessation rates, via a randomized controlled trial with 414 Dutch adult smokers, recruited by 91 practice nurses from May 2009 to June 2010. Logistic multilevel regression analyses were conducted with 24-hour point prevalence, 7-day point prevalence, and prolonged abstinence after 6 and 12 months as dependent variables and experimental condition as the independent variable. After 6 and 12 months, 38% and 56% of respondents were followed up, respectively. At both follow-ups, no main effects of the interventions could be identified when comparing them with care as usual and with each other—neither in analyses using available data nor in analyses using a negative scenario in which respondents lost to follow-up were considered to still be smoking. A Web-based multiple computer-tailored smoking cessation program combined with a single face-to-face counseling session by a practice nurse may not be more effective than this computer-tailored program alone or than usual smoking cessation care in the general practice setting. Yet before concluding that the addition of counseling to Web-based computer tailoring cannot be successful, more research needs to be conducted to identify the optimal number of counseling sessions to be combined with the Web-based program and to how to best attune the two modalities.
Quitting cigarette smoking benefits smokers at any age (1). Individual, group, and telephone counseling and seven Food and Drug Administration-approved medications increase quit rates (1-3). To assess progress toward the Healthy People 2020 objectives of increasing the proportion of U.S. adults who attempt to quit smoking cigarettes to ≥80.0% (TU-4.1), and increasing recent smoking cessation success to ≥8.0% (TU-5.1),* CDC assessed national estimates of cessation behaviors among adults aged ≥18 years using data from the 2000, 2005, 2010, and 2015 National Health Interview Surveys (NHIS). During 2015, 68.0% of adult smokers wanted to stop smoking, 55.4% made a past-year quit attempt, 7.4% recently quit smoking, 57.2% had been advised by a health professional to quit, and 31.2% used cessation counseling and/or medication when trying to quit. During 2000-2015, increases occurred in the proportion of smokers who reported a past-year quit attempt, recently quit smoking, were advised to quit by a health professional, and used cessation counseling and/or medication (p<0.05). Throughout this period, fewer than one third of persons used evidence-based cessation methods when trying to quit smoking. As of 2015, 59.1% of adults who had ever smoked had quit. To further increase cessation, health care providers can consistently identify smokers, advise them to quit, and offer them cessation treatments (2-4). In addition, health insurers can increase cessation by covering and promoting evidence-based cessation treatments and removing barriers to treatment access (2,4-6).
To evaluate the effectiveness of a 6-month, partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease.
Self-management is a widely valued concept used to address contemporary issues of chronic health problems. Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive.
Pragmatic randomized control trial.
Patients, 45-65 years old, with mild and moderate chronic obstructive pulmonary disease were invited with a family member. Experimental group (n = 48) participated in a 6-month, partnership-based self-management programme consisting of: (a) three to four conversations between nurse and patient-family member; (b) 6 months of smoking cessation; and (c) interdisciplinary team-patient-family member group meeting. Control group (n = 52) received usual care. Data were collected at months zero, six and 12. The trial lasted from June 2009-March 2013.
Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group. Patients in the experimental group did not have better health-related quality of life, less anxiety or depression, increased physical activity, fewer exacerbations or better smoking status than patients in the control group. Patients in both groups found participation in the research useful and important.
The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles, activities and interests for young patients with the disease in its early stages. High satisfaction in control group, low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme.
© 2015 John Wiley & Sons Ltd.
Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care.
Design 24 month, multicentre, pragmatic cluster randomised controlled trial
Setting 40 general practices in the western part of the Netherlands
Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team.
Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice. The control group continued usual care (based on international guidelines).
Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self management, physical activity, and level of integrated care (PACIC) were also assessed as secondary outcomes.
Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain “follow-up/coordination” (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain.
Conclusion In this pragmatic study, an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system.
Trial registration Netherlands Trial Register NTR2268.
The purpose was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs hospitals.
In this effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in Ann Arbor and Detroit, while Indianapolis was the control site (N = 1,070). Smokers were surveyed and given cotinine tests. The components of the intervention included nurse counseling, brochure, DVD, manual, pharmaceuticals, 1-800-QUIT-NOW card, and post-discharge telephone calls.
There were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p = 0.004) and Detroit (p < 0.001) compared to Indianapolis. Pre- versus post-intervention quit rates were 4 % compared to 13 % in Detroit, were similar (6 %) pre- and post-intervention in Ann Arbor, and dropped from 26 % to 12 % in Indianapolis.
The Tobacco Tactics program, which meets the Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among Veterans.
Background:
Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions.
Objectives:
To determine the effectiveness of nursing-delivered smoking cessation interventions.
Search methods:
We searched the Cochrane Tobacco Addiction Group specialized Register and CINAHL in June 2013.
Selection criteria:
Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months.
Data collection and analysis:
Two authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI).
Main results:
Forty-nine studies met the inclusion criteria. Pooling 35 studies (over 17,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention to increase the likelihood of quitting (RR 1.29; 95% CI 1.20 to 1.39). In a subgroup analysis the estimated effect size was similar for the group of seven studies using a particularly low intensity intervention but the confidence interval was wider. There was limited indirect evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in non-hospitalized adults also showed evidence of benefit. Eleven studies comparing different nurse-delivered interventions failed to detect significant benefit from using additional components. Six studies of nurse counselling on smoking cessation during a screening health check or as part of multifactorial secondary prevention in general practice (not included in the main meta-analysis) found nursing intervention to have less effect under these conditions.
Authors' conclusions:
The results indicate the potential benefits of smoking cessation advice and/or counselling given by nurses, with reasonable evidence that intervention is effective. The evidence for an effect is weaker when interventions are brief and are provided by nurses whose main role is not health promotion or smoking cessation. The challenge will be to incorporate smoking behaviour monitoring and smoking cessation interventions as part of standard practice so that all patients are given an opportunity to be asked about their tobacco use and to be given advice and/or counselling to quit along with reinforcement and follow-up.
Question. What is the effect of a nurse-led intervention on smoking cessation in people admitted to hospital for coronary heart disease? Study design. Randomised controlled trial. Main results. The nurse-led smoking cessation intervention increased smoking cessation rates at 12 months (AR for quitting: 50% (57/114) with intervention v 37% (4/119) with control; absolute risk reduction 13%, 95% CI 0% to 26%; NNT 8, 95% CI 4 to 250; conservative intention to treat analysis). Authors' conclusions. A nurse-led smoking cessation program was effective in people who had been admitted to hospital for coronary heart disease. The extended duration of the intervention may have been an important factor.
To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.
RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.
Multicentre trial in secondary and tertiary healthcare settings.
754 patients admitted for acute coronary syndrome.
A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care.
The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target.
The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023).
The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions.
TC1290.
Cigarette smoking is the major risk factor for chronic obstructive pulmonary disease (COPD).But a fewer smoking cessation measures were conducted in communities for smokers with COPD in China. The aim of our study was to assess the preventive effects of behavioral interventions for smoking cessation and potential impact factors in smokers with COPD in China.
In a randomised controlled smoking cessation trial 3562 patients with COPD who were current smoker were allocated to intervention group received behavioral intervention and control group received the usual care for two years. The primary efficacy endpoint was the complete and continuous abstinence from smoking from the beginning of month 24 to the end of month 30. Participants were followed up at month 48.
Continuous smoking abstinence rates from month 24 to 30 were significantly higher in participants receiving behavioral intervention than in those receiving usual care (46.4% vs 3.4%, p<0.001). Continuous abstinence rates from months 24 to 36 (45.8% vs 4.0%) and months 24 to 48 (44.3% vs 5.1%) were also higher in participants receiving behavioral intervention than in those control group. Family members or family physicians/nurses smoking were first identified to influence smoking cessation.
Behavioral intervention doubled the smoking cessation rate in patients with COPD and was complied well by the general practitioners. The family members and family physicians/nurses smoking were the main risk factors for smoking cessation.Trial registration: Chinese Clinical Trials Registration (ChiCTR-TRC-12001958) URL: http://www.chictr.org/usercenter/project/listbycreater.aspx.
Objective: To evaluate the effectiveness of inpatient brief counselling by a smoking cessation nurse compared to usual care (no advice). Methods: The subjects (n = 381, 245 men and 136 women) studied were in-patients, in four Flemish University Hospitals, who were daily smokers. Patients were randomised between 2005 and June 2006. Patients were allocated to an experimental group (EG) or to a control group (CG). Allocation and smoking cessation interventions of patients were stagematched according to their stage of change as defined by Prochaska and Diclemente. Smoking cessation advice was administered by a qualified smoking cessation nurse.
Results: The six-month self-reported continuous abstinence in the EG in 28/178 patients (15.7%) compared to the CG where 14/180 patients were abstinent (7.7%) was significantly better. The effect was most pronounced in the subgroup over 40 years old in the preparation and action stage. In this cohort in the EG, 44% of patients were abstinent at six months compared to 18%in the CG. All patients tended to smoke less after a hospitalisation. Conclusion: The intervention by a smoking cessation nurse during hospitalisation seems effective and is most rewarding in the smokers > 40 years old, and who were well motivated to stop.
Smoking cessation interventions for cardiac patients need improvement given their weak effects on long-term abstinence rates and low compliance by nurses to implementation. This study tested the effectiveness of two smoking cessation interventions against usual care in cardiac patients, and conditional effects for patients' motivation to quit and socio-economic status (SES). An experimental study was conducted from 2009 to 2012 for which Dutch cardiac patient smokers were assigned to: usual care (UC; n = 245), telephone counseling (TC; n = 223) or face-to-face counseling (FC; n = 157). The three groups were comparable at baseline and had smoked on average 21 cigarettes a day before hospitalization. After six months, interviews occurred to assess self-reported smoking status. Patients in the TC and FC group had significantly higher smoking abstinence rates than patients in the UC group (p ≤ 0.05 at all times). Regression analysis further revealed significant conditional effects of the interventions on smoking abstinence in patients with lower SES, with a larger effect for TC than FC when compared to UC. These findings suggest that intensive counseling is effective in increasing short-term abstinence rates, particularly in patients with lower SES. Future studies need to investigate how patients with higher SES can profit equally from these type of interventions.
Objective:
To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices.
Intervention:
Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting.
Subjects:
Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m². Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires).
Results:
Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8-0.35) and diet (fat (difference between groups = 0.19; CI 20.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = 20.02; CI 20.26-0.22)), and physical activity (difference between groups = 21.15; CI 212.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life.
Conclusion:
A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
Intensive lifestyle interventions in well-controlled settings are effective in lowering the risk of chronic diseases such as type 2 diabetes (T2DM) and cardiovascular diseases (CVD), but there are still no effective lifestyle interventions for everyday practice. In the Hoorn Prevention Study we aimed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality, and to motivate changes in lifestyle behaviors.
The Hoorn Prevention Study is a parallel group randomized controlled trial, implemented in the region of West-Friesland, the Netherlands. 622 adults with ≥10% estimated risk of T2DM and/or CVD mortality were randomly assigned and monitored over a period of 12 months. The intervention group (n=314) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment, provided by trained practice nurses in 12 general practices. The control group (n=308) received existing health brochures. Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities (ARIC) Study, and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation (SCORE) formula. Secondary outcomes included lifestyle behavior (diet, physical activity and smoking). The research assistants, the principal investigator and the general practitioners were blinded to group assignment. Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure, adjusted for baseline values.
536 (86.2%) of the 622 participants (age 43.5 years) completed the 6-month follow-up, and 502 (81.2%) completed the 12-month follow-up. The mean baseline T2DM risk was 18.9% (SD 8.2) and the mean CVD mortality risk was 3.8% (SD 3.0). The intervention group participated in a median of 2 sessions. Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up.
The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population.
Trial registration
Current Controlled Trials: ISRCTN59358434
Second-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking.
This was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a “no smoking” sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women”s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups.
A higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands’ willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands’ history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups.
A brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: ‘Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking’.
Trial registration
Current Controlled Trials ISRCTN72290421.
Objective:
To measure the change in cardiovascular risk factors achievable in families over one year by a cardiovascular screening and lifestyle intervention in general practice.
Design:
Randomised controlled trial in 26 general practices in 13 towns in Britain.
Subjects:
12,472 men aged 40-59 and their partners (7460 men and 5012 women) identified by household.
Intervention:
Nurse led programme using a family centred approach with follow up according to degree of risk.
Main outcome measures:
After one year the pairs of practices were compared for differences in (a) total coronary (Dundee) risk score and (b) cigarette smoking, weight, blood pressure, and random blood cholesterol and glucose concentrations.
Results:
In men the overall reduction in coronary risk score was 16% (95% confidence interval 11% to 21%) in the intervention practices at one year. This was partitioned between systolic pressure (7%), smoking (5%), and cholesterol concentration (4%). The reduction for women was similar. For both sexes reported cigarette smoking at one year was lower by about 4%, systolic pressure by 7 mm Hg, diastolic pressure by 3 mm Hg, weight by 1 kg, and cholesterol concentration by 0.1 mmol/l, but there was no shift in glucose concentration. Weight, blood pressure, and cholesterol concentration showed the greatest difference at the top of the distribution. If maintained long term the differences in risk factors achieved would mean only a 12% reduction in risk of coronary events.
Conclusions:
As most general practices are not using such an intensive programme the changes in coronary risk factors achieved by the voluntary health promotion package for primary care are likely to be even smaller. The government's screening policy cannot be justified by these results.
Strict implementation of guidelines directed at multiple targets reduces vascular risk in diabetic patients. Whether this also applies to patients with chronic kidney disease (CKD) is uncertain. To evaluate this, the MASTERPLAN Study randomized 788 patients with CKD (estimated GFR 20-70 ml/min) to receive additional intensive nurse practitioner support (the intervention group) or nephrologist care (the control group). The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death. During a mean follow-up of 4.62 years, modest but significant decreases were found for blood pressure, LDL cholesterol, anemia, proteinuria along with the increased use of active vitamin D or analogs, aspirin and statins in the intervention group compared to the controls. No differences were found in the rate of smoking cessation, weight reduction, sodium excretion, physical activity, or glycemic control. Intensive control did not reduce the rate of the composite end point (21.3/1000 person-years in the intervention group compared to 23.8/1000 person-years in the controls (hazard ratio 0.90)). No differences were found in the secondary outcomes of vascular interventions, all-cause mortality or end-stage renal disease. Thus, the addition of intensive support by nurse practitioner care in patients with CKD improved some risk factor levels, but did not significantly reduce the rate of the primary or secondary end points.Kidney International advance online publication, 27 June 2012; doi:10.1038/ki.2012.137.
Nursing faculty practice groups can play a vital role in tobacco cessation in academic medical centers. Outcomes from the Georgia Health Sciences University Nursing Faculty Practice Group Tobacco Cessation Program revealed 64% abstinence outcomes at the end of treatment (N = 160) over a 2-year period from the campus-wide tobacco-free policy initiation. A nurse-led, evidence-based, interdisciplinary approach can be an effective strategy to make a difference in the lives of tobacco-dependent individuals, while at the same time integrating practice with education and research.
Background:
Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries.
Objectives:
To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes.
Search methods:
In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors.
Selection criteria:
Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy.
Data collection and analysis:
Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14.
Main results:
The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I(2) = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions.
Authors' conclusions:
Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
Background:
Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist).
Objectives:
To review the efficacy of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation.
Search methods:
We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('cytisine' or 'Tabex' or 'dianicline' or 'varenicline' or 'nicotine receptor partial agonist') in the title or abstract, or as keywords. The register is compiled from searches of MEDLINE, EMBASE, and PsycINFO using MeSH terms and free text to identify controlled trials of interventions for smoking cessation and prevention. We contacted authors of trial reports for additional information where necessary. The latest update of the specialised register was in May 2015, although we have included a few key trials published after this date. We also searched online clinical trials registers.
Selection criteria:
We included randomised controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment.
Data collection and analysis:
We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomisation procedure, concealment of allocation, and completeness of follow-up.The main outcome measured was abstinence from smoking at longest follow-up. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model.
Main results:
Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow-up, with a pooled risk ratio (RR) of 3.98 (95% confidence interval (CI) 2.01 to 7.87; low-quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).One trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development.We identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with nicotine replacement therapy (NRT). Nine studies tested variations in varenicline dosage, and 13 tested usage in disease-specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline.The pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high-quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high-quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate-quality evidence). Four trials which tested the use of varenicline beyond the 12-week standard regimen found the drug to be well-tolerated during long-term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). The most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of SAEs among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high-quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow-up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of SAEs among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta-analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but we await the findings of the CATS trial, which should establish whether or not this is a valid concern.
Authors' conclusions:
Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials. Varenicline at standard dose increased the chances of successful long-term smoking cessation between two- and three-fold compared with pharmacologically unassisted quit attempts. Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events. More participants quit successfully with varenicline than with bupropion or with NRT. Limited evidence suggests that varenicline may have a role to play in relapse prevention. The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time. Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research.Future trials of cytisine may test extended regimens and more intensive behavioural support.
Aim:
The aim of this paper is to describe the prevalence of cardiovascular risk factors in families screened systematically by nurses in British general practice, and in subgroups with reported hypertension, hypercholesterolaemia, diabetes and coronary heart disease.
Method:
Twenty six general practices (13 intervention and 13 control practices) in 13 towns in England, Wales and Scotland were involved in a randomized control trial. Randomly ordered invitations were sent for a family health check to 4158 households (men aged 40-59 years and their partners) registered with the 13 intervention practices.
Results:
One or more adult members from 2373 households (57%) were screened; in 1477 visits the selected man and his female partner attended of whom 98% were married. In all, 3850 individuals were screened (2246 men and 1604 women); 15% of men and women were in the predefined top quintile of the British family heart study risk score. Twenty four per cent of men and 22% of women smoked cigarettes and 62% of men and 44% of women were overweight (body mass index 25+). One third of men and one sixth of women with no known history of high blood pressure had a diastolic blood pressure of 90+ mmHg. Among the 491 individuals with previously reported high blood pressure 64% were not adequately controlled, having a diastolic blood pressure of 90+ mmHg, while 26% had diastolic blood pressure of 100+ mmHg. Eighteen per cent of men and women with no known history of a high cholesterol level had a random cholesterol level of 6.5+ mmol l-1. In the 173 people with a previously reported high cholesterol level and who had their level measured over half had a cholesterol level of 6.5+ mmol l-1 and in 7% this level was 8.0+ mmol l-1. One per cent of men and 0.3% of women were newly identified as diabetic (random glucose level of 10.0+ mmol l-1). In the 52 with previously diagnosed diabetes unsatisfactory control was found in 52% (random level of 10.0+ mmol l-1). A total of 3034 men and women overall (79%) qualified for follow up for one or more risk factor; 1909 men (85%) and 1125 women (70%). Among the 139 with pre-existing coronary heart disease 119 (86%) had modifiable risk factors: 27% were cigarette smokers, 68% had a body mass index of 25+, 40% had diastolic hypertension, 29% had hypercholesterolaemia and 19% had hyperglycaemia. Five per cent of men and women were taking antihypertensive drugs, 0.3% cholesterol lowering drugs and 0.7% drugs for diabetes.
Conclusion:
There is considerable scope for primary and secondary prevention among families registered with general practices, but whether nursing and medical intervention can reduce the risk factors related to cardiovascular disease in this setting remains unknown.
Patients with coronary artery disease (CAD) are at high risk of recurrent events. A healthy lifestyle can significantly reduce this risk. A previous trial, Randomized Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists (RESPONSE), demonstrated that nurse-coordinated outpatient clinics improve drug treatment of cardiovascular risk factors. However, lifestyle-related risk factors, including smoking, overweight, and physical inactivity, were common and remained largely unchanged at follow-up in most patients (66%). The aim of the current study is to evaluate the impact of 3 community-based lifestyle programs in patients after hospitalization for CAD. We are conducting a multicenter (n = 15), randomized trial that will recruit 800 patients to test the efficacy of up to 3 widely available commercial lifestyle programs, aimed at patients and their partners, on top of usual care. These programs are aimed at smoking cessation (Luchtsignaal(®)), weight loss (Weight Watchers(®)), and improving physical activity (Philips DirectLife(®)).
The primary outcome at 12months is the proportion of patients in whom at least 1 lifestyle risk factor is improved without deterioration in any of the other 2, and a relative increase of at least 30% in this proportion is considered clinically relevant.
Copyright © 2015 Elsevier Inc. All rights reserved.
To evaluate the effectiveness of a nurse intervention aimed at helping college student smokers quit smoking.
Single-blind, pragmatic randomized controlled trial which compares a multicomponent intervention, specifically tailored to college students, with a brief advice session with a 6-month follow-up.
This study was conducted at the University of Navarra, Spain.
A total of 255 college student smokers (age range 18-24 years old) were randomized to an intervention group (n = 133) or to a control group (n = 122).
A multicomponent intervention based on the Theory of Triadic Influence of Fly was developed. The intervention consisted of a 50-min motivational interview conducted by nurse, and online self-help material. The follow-up included reinforcing email and group therapy.
The primary outcome was self-reported abstinence, with biochemical verification at 6 months. The secondary outcomes consisted of the mean number of cigarettes smoked per day, self-reported attempts to quit smoking, and stage of change at 6 months.
At the 6-month follow-up, the smoking cessation incidence was 21.1% in the intervention group compared with 6.6% in the control group (Difference = 14.5 confidence interval = 6.1-22.8; Relative Risk = 3.41, 95% confidence interval = 1.62-7.2). The difference in the mean number of cigarettes at 6 months was significantly different (difference = -2.2, confidence interval = -3.6 - -0.9).
A multicomponent intervention tailored to college students and managed by a nurse is effective in increasing smoking cessation among college students.
This article is protected by copyright. All rights reserved.
Background:
People with severe mental ill health are three times more likely to smoke but typically do not access conventional smoking cessation services, contributing to widening health inequalities and reduced life expectancy. We aimed to pilot an intervention targeted at smokers with severe mental ill health and to test methods of recruitment, randomisation, and follow up before implementing a full trial.
Methods:
The Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR) is a pilot randomised controlled trial of a smoking cessation strategy designed specifically for people with severe mental ill health, to be delivered by mental health nurses and consisting of behavioural support and drugs, compared with a conventional smoking cessation service (ie, usual care). Adults (aged 18 years or older) with bipolar disorder or schizophrenia, who were current smokers, were recruited from NHS primary care and mental health settings in the UK (York, Scarborough, Hull, and Manchester). Eligible participants were randomly allocated to either usual care (control group) or usual care plus the bespoke smoking cessation strategy (intervention group). Randomisation was done via a central telephone system, with computer-generated random numbers. We could not mask participants, family doctors, and researchers to the treatment allocation. Our primary outcome was smoking status at 12 months, verified by carbon monoxide measurements or self-report. Only participants who provided an exhaled CO measurement or self-reported their smoking status at 12 months were included in the primary analysis. The trial is registered at ISRCTN.com, number ISRCTN79497236.
Findings:
Of 97 people recruited to the pilot study, 51 were randomly allocated to the control group and 46 were assigned to the intervention group. Participants engaged well with the bespoke smoking cessation strategy, but no individuals assigned to usual care accessed NHS smoking cessation services. At 12 months, 35 (69%) controls and 33 (72%) people assigned to the intervention group provided a CO measurement or self-reported their smoking status. Smoking cessation was highest among individuals who received the bespoke intervention (12/33 [36%] vs 8/35 [23%]; adjusted odds ratio 2·9, 95% CI 0·8-10·5).
Interpretation:
We have shown the feasibility of recruiting and randomising people with severe mental ill health in a trial of this nature. The level of engagement with a bespoke smoking cessation strategy was higher than with a conventional approach. The effectiveness and safety of a smoking cessation programme designed particularly for people with severe mental ill health should be tested in a fully powered randomised controlled trial.
Funding:
National Institute of Health Research Health Technology Assessment Programme.
OBJECTIVE—To evaluate the effectiveness of a nurse led shared care programme to improve coronary heart disease risk factor levels and general health status and to reduce anxiety and depression in patients awaiting coronary artery bypass grafting (CABG).
DESIGN—Randomised controlled trial.
SETTING—Community, January 1997 to March 1998.
STUDY GROUPS—98 (75 male) consecutive patients were recruited to the study within one month of joining the waiting list for elective CABG at Glasgow Royal Infirmary University NHS Trust. Patients were randomly assigned to usual care (control; n = 49) or a nurse led intervention programme (n = 49).
INTERVENTION—A shared care programme consisting of health education and motivational interviews, according to individual need, was carried out monthly. Care was provided in the patients' own homes by the community based cardiac liaison nurse alternating with the general practice nurse at the practice clinic.
OUTCOME MEASURES—Smoking status, obesity, physical activity, anxiety and depression, general health status, and proportion of patients exceeding target values for blood pressure, plasma cholesterol, and alcohol intake.
RESULTS—Compared with patients who received usual care, those participating in the nurse led programme were more likely to stop smoking (25% v 2%, p = 0.001) and to reduce obesity (body mass index > 30 kg/m2) (16.3% v 8.1%, p = 0.01). Target systolic blood pressure improved by 19.8% compared with a 10.7% decrease in the control group (p = 0.001) and target diastolic blood pressure improved by 21.5% compared with 10.2% in the control group (p = 0.000). However, there was no significant difference between groups in the proportion of patients with cholesterol concentrations exceeding target values. There was a significant improvement in general health status scores across all eight domains of the 36 item short form health survey with changes in difference in mean scores between the groups ranging from 8.1 (p = 0.005) to 36.1 (p < 0.000). Levels of anxiety and depression improved (p < 0.000) and there was improvement in time spent being physically active (p < 0.000).
CONCLUSIONS—This nurse led shared care intervention was shown to be effective for improving care for patients on the waiting list for CABG.
Keywords: coronary artery bypass grafting; coronary heart disease risk; nurse led shared care; risk reduction
Objectives. To evaluate the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse (PN), and compare this to other forms of cessation support.Methods. Three arm cluster randomized controlled trial conducted in 101 general practices in Sydney and Melbourne involving 2390 smokers. The Quit with PN intervention was compared to Quitline referral and a usual care control group. Smoking cessation pharmacotherapy was recommended to all groups. Outcomes were assessed by self-report at 3- and 12-month follow-up. Uptake of the interventions is also reported.Results. The three groups were similar at baseline. Follow-up at 12 months was 82%. The sustained and point prevalence abstinence rates, respectively, at 3 months by group were: PN intervention 13.1% and 16.3%; Quitline referral 10.8% and 14.2%; Usual GP care 11.4% and 15.0%. At 12 months, the rates were: PN intervention 5.4% and 17.1%; Quitline referral 4.4% and 18.8%; Usual GP care 2.9% and 16.4%. Only 43% of patients in the PN intervention group attended to see the nurse. Multilevel regression analysis showed no effect of the intervention overall, but patients who received partial or complete PN support were more likely to report sustained abstinence [partial support odds ratio (OR) 2.27; complete support OR 5.34].Conclusion. The results show no difference by group on intention to treat analysis. Those patients who received more intensive PN intervention were more likely to quit. This may have been related to patient motivation or an effect of PN led cessation support.
Background:
Hospitalization may be an opportune time to change smoking behavior because it requires smokers to abstain from tobacco at the same time that illness can motivate them to quit. A hospital-based intervention may promote smoking cessation after discharge.
Methods:
We tested the efficacy of a brief bedside smoking counseling program in a randomized controlled trial at Massachusetts General Hospital, Boston. The 650 adult smokers admitted to the medical and surgical services were randomly assigned to receive usual care or a hospital-based smoking intervention consisting of (1) a 15-minute bedside counseling session, (2) written self-help material, (3) a chart prompt reminding physicians to advise smoking cessation, and (4) up to 3 weekly counseling telephone calls after discharge. Smoking status was assessed 1 and 6 months after hospital discharge by self-report and validated at 6 months by measurement of saliva cotinine levels.
Results:
One month after discharge, more intervention than control patients were not smoking (28.9% vs 18.9%; P=.003). The effect persisted after multiple logistic regression analyses adjusted for baseline group differences, length of stay, postdischarge smoking treatment, and hospital readmission (adjusted odds ratio, 2.19; 95% confidence interval, 1.34-3.57). At 6 months, the intervention and control groups did not differ in smoking cessation rate by self-report (17.3% vs 14.0%; P=.26) or biochemical validation (8.1% vs 8.7%; P=.72), although the program appeared to be effective among the 167 patients who had not previously tried to quit smoking (15.3% vs 3.7%;P=.01).
Conclusions:
A low-intensity, hospital-based smoking cessation program increased smoking cessation rates for 1 month after discharge but did not lead to long-term tobacco abstinence. A longer period of telephone contact after discharge might build on this initial success to produce permanent smoking cessation among hospitalized smokers.Arch Intern Med. 1997;157:2653-2660
Study Objective: To determine the effect of a nurse-managed intervention for smoking cessation in patients who have had a myocardial infarction.
Design: Randomized, with a 6-month treatment period and a 6-month follow-up.
Setting: Kaiser Foundation hospitals in Redwood City, Santa Clara, Hayward, and San Jose, California.
Patients: Sequential sample of 173 patients, 70 years of age or younger, who were smoking before hospitalization for acute myocardial infarction. Eighty-six patients were randomly assigned to the intervention and 87 to usual care; 130 patients (75%) completed the study and were available for follow-up.
Intervention: Nurse-managed and focused on preventing relapse to smoking, the intervention was initiated in the hospital and maintained thereafter primarily through telephone contact. Patients were given an 18-page manual that emphasized how to identify and cope with high-risk situations for smoking relapse.
Measurements and Main Results: One year after myocardial infarction, the smoking cessation rate, verified biochemically, was 71% in the intervention group compared with 45% in the usual care group, a 26% difference (95% CI, 9.5% to 42.6%). Assuming that all surviving patients lost to follow-up were smoking, the 12-month smoking cessation rate was 61% in the intervention group compared with 32% in the usual care group, a 29% difference (95% CI, 14.5% to 43.5%). Patients who either resumed smoking within 3 weeks after infarction or expressed little intention of stopping in the hospital were unlikely to have stopped by 12 months.
Conclusions: A nurse-managed smoking cessation intervention largely conducted by telephone, initiated in the hospital, and focused on relapse prevention can significantly reduce smoking rates at 12 months in patients who have had a myocardial infarction.
Aims and objectivesTo evaluate the one-year prognosis of a lifestyle counselling intervention (diet, smoking cessation and exercise) among patients who had open heart surgery.Background
Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries. Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease.DesignRandomised, nonblind and lifestyle counselling intervention study with a one-year follow-up.MethodsA randomised, nonblind intervention study was performed on 500 patients who had open heart surgery. After hospital discharge, 250 patients (intervention group) were randomly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology (European Journal Preventive Cardiology, 19, 2012, 585). The remaining 250 patients (control group) received the regular instructions. Primary end-point was the development of a cardiovascular disease (nonfatal event) during the first year; secondary end-points included fatal events, smoking abstinence, dietary habits and a physical activity evaluation.ResultsAccording to the primary end-point, the odds of having a nonfatal cardiovascular disease event are 0·56-times (95%CI 0·28, 0·96, p = 0·03) lower for the intervention group compared to the control group. One-year after surgery, it was found that participants in the intervention group were 1·96-times (95%CI 1·31, 2·93, p < 0·001) more likely to achieve dietary recommendations, 3·32-times (95%CI 2·24, 4·91, p < 0·001) more likely to achieve physical activity recommendations and 1·34-times (95%CI 1·15, 1·56, p < 0·001) more likely to return to work.Conclusion
Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event. Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient's needs.Relevance to clinical practiceA well-structured cardiac rehabilitation programme adjusted to the patient's profile is a safe and cost-effective way to improve patients' outcome.
Objective: Physician-delivered advice to stop smoking is effective, but time demands often reduce the number of smokers who receive assistance. We evaluated three nurse-assisted interventions designed to minimize physician burden and increase counseling in primary care settings. Design: Randomized controlled trial with a 12-month follow-up. Setting: Internal medicine and family practice offices in a health maintenance organization. Participants: Smokers (n=3161) who were patients of participating physicians or other medical care providers (n=60). Intervention: Medical care providers delivered a 30-second stop-smoking prompt to 2707 smokers and referred them to an on-site nurse smoking counselor
Objective: To test the efficacy of a smoking cessation program for inpatients recovering from coronary artery bypass graft surgery and to identify predictors of cessation. Design: Randomized, controlled clinical trial. Setting: Postoperative cardiac surgery unit of a large teaching hospital. Patients: Patients scheduled for coronary artery bypass surgery by participating surgeons between 1 July 1986 and 1 July 1987 who had smoked 1 or more packs of cigarettes in the 6 months before admission. Of 120 eligible patients, 93 enrolled and 87 were discharged alive. All survivors were followed for at least 1 year; 94% were followed for a median of 5.5 years
To combat the increasingly poor physical health of people with serious mental illness, the position of a cardiometabolic health nurse has been proposed. We recently conducted a 26-week trial in a regional mental health service. This paper describes the background and rationale for the position, presents the outcomes on health behaviours and health behaviour knowledge and attitudes, and offers recommendations for the future direction of the role. We show that a cardiometabolic health nurse can improve the physical health behaviours in people with mental illness, however much needs to be done to further develop and implement the role.
Many stroke survivors would benefit from modification of their lifestyle in order to reduce their risk of recurrent stroke. We investigated if tailored smoking cessation advice would yield a higher smoking cessation rate and a higher rate with sustained abstinence in ex-smokers in the intervention group than among controls.
Patients admitted with an acute stroke or a transient ischaemic attack were included in a randomised controlled trial focusing on control of lifestyle risk factors and hypertension. Here, we report the intervention focused on smoking cessation. We used multiple logistic regression analysis to identify patient characteristics associated with smoking cessation. Analyses were by intention to treat excluding those who died or suffered severe disease.
We included 254 patients with a history of smoking. Two years after inclusion, 15 of 57 (26%) baseline smokers in the intervention group had stopped smoking versus eight of 56 (14%) among controls (p = 0.112). Living with a partner (p = 0.012), having at least ten years of education (p = 0.012), and not being exposed to smoking at home (p = 0.036) were independent predictors of smoking cessation.
We did not achieve our aim of higher smoking cessation rates in the intervention group. Future smoking cessation interventions should be more intensive, focus on patients' social circumstances and, if possible, involve patients' relatives.
This study was supported by the Ludvig and Sara Elsass Foundation, the Lundbeck Foundation and The Danish Heart Foundation (Grant 07-4-B703-A1378-22384F).
This protocol is registered with Clinical Trials.gov (NCT 00253097).
Objectives
To evaluate the effects of nurse led clinics in primary care on secondary prevention, total mortality, and coronary event rates after four years.
Design
Follow up of a randomised controlled trial by postal questionnaires and review of case notes and national datasets.
Setting
Stratified, random sample of 19 general practices in north east Scotland.
Participants
1343 patients (673 intervention and 670 control) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound.
Intervention
Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year.
Main outcome measures
Components of secondary prevention (aspirin, blood pressure management, lipid management, healthy diet, exercise, non-smoking), total mortality, and coronary events (non-fatal myocardial infarctions and coronary deaths).
Results
Mean follow up was at 4.7 years. Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year, and these were sustained after four years except for exercise. The control group, most of whom attended clinics after the initial year, caught up before final follow up, and differences between groups were no longer significant. At 4.7 years, 100 patients in the intervention group and 128 in the control group had died: cumulative death rates were 14.5% and 18.9%, respectively (P=0.038). 100 coronary events occurred in the intervention group and 125 in the control group: cumulative event rates were 14.2% and 18.2%, respectively (P=0.052). Adjusting for age, sex, general practice, and baseline secondary prevention, proportional hazard ratios were 0.75 for all deaths (95% confidence intervals 0.58 to 0.98; P=0.036) and 0.76 for coronary events (0.58 to 1.00; P=0.049)
Conclusions
Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events. Secondary prevention clinics should be started sooner rather than later.
What is already known on this topic
What is already known on this topic
Several effective interventions exist for the secondary prevention of coronary heart disease, but implementing them in practice has proved difficult Secondary prevention programmes for coronary heart disease have improved short term outcomes such as processes of care and quality of life
What this study adds
What this study adds
Short term improvements in uptake of secondary prevention produced by nurse led clinics are maintained in the longer term Improved medical and lifestyle components of secondary prevention produced by nurse led clinics seem to lead to fewer total deaths and coronary events
Young women are smoking at higher rates than ever, generating the potential for much smoking related disease. Many of these women, especially those at lower income levels, could be provided with smoking cessation counseling during their regular family planning clinic visits. The purpose of this study was to implement a smoking cessation intervention in public health family planning clinics, and thereby increase the number of these women who quit smoking. A quasi-experimental pilot study of 176 smokers was conducted, using a brief, multimodal smoking cessation intervention in two suburban public family planning clinics. The intervention included a protocol-based smoking cessation message, pamphlets and posters, measurement of exhaled carbon monoxide, and a follow-up letter. Exit questionnaire data showed significant increases in use of all tested cessation techniques. At four-and-a-half month follow-up, self-reported quit rates were 2% in the reference group and 15% in the subjects (95% confidence interval for difference 4-21%). A simple, inexpensive smoking cessation intervention was integrated into a routine family planning clinic visit, increasing short-term quit rates by more than seven-fold. Such an intervention could have substantial impact on the future health of young women and their children.
To determine the effect of a nurse-delivered smoking cessation intervention for hospitalized smokers on smoking cessation rates and smoking cessation self-efficacy at 6 months after enrollment.
A quasi-experimental design was used; specifically, a nonequivalent control group design was implemented.
A 450-bed major teaching and research tertiary care hospital, serving patients from across the province of British Columbia, Canada.
Smokers with a cardiac diagnosis (n = 102) who were admitted to 1 of 2 inpatient cardiac units for medical or surgical treatment. Outcome Measures: Self-reported smoking status and self-reported smoking cessation self-efficacy.
Two structured, in-hospital contacts, followed by 3 months of telephone support. The interventions focused on problem-solving and reinforcing the patient's self-efficacy.
Of the patients enrolled, 86 completed 6-month follow-up questionnaires. When subjects who were lost to follow-up were assumed to be smokers, 46% of the intervention group, compared with 31% of the control group, were nonsmokers. When key variables were controlled, we found that those subjects in the control group were 3 times more likely to relapse and begin smoking than those who received the intervention. There were no significant differences in follow-up smoking cessation self-efficacy scores in the treatment and control groups. When background variables were controlled, self-efficacy related to positive/social situations and habit/addictive situations were noted to be significantly higher in the intervention group.
The findings of this research are encouraging; they suggest that a nurse-delivered smoking cessation intervention improved the smoking cessation rate in patients with cardiac disease.
Background:
Few research studies have evaluated the effectiveness of smoking interventions in hospitalized patients. This randomized controlled trial compared the efficacy of 2 smoking cessation programs in patients hospitalized in 4 community hospitals in a large health maintenance organization within the San Francisco Bay Area in California.Methods:
Patients were randomly assigned to usual care (n=990), nurse-mediated, behaviorally oriented in-patient counseling focused on relapse prevention with 1 postdischarge telephone contact (minimal intervention, n=473), or the same inpatient counseling with 4 postdischarge telephone contacts (intensive intervention, n=561). The main outcome measure, smoking cessation rate, was corroborated by plasma cotinine determination or family confirmation, 1 year after enrollment.Results:
At 1 year smoking cessation rates were 27%, 22%, and 20% for intensive intervention, minimal intervention, and usual care groups, respectively (P=.009 for intensive vs usual care). Subgroup analyses by diagnosis revealed that the odds of cessation among patients with cardiovascular disease or other internal medical conditions were greater among those receiving the intensive intervention than among their counterparts receiving usual care (odds ratios, 1.6 and 2.0, respectively).Conclusions:
A multicomponent smoking cessation program consisting of physician advice; in-hospital, nurse-mediated counseling; and multiple postdischarge telephone contacts was effective in increasing smoking cessation rates among hospitalized smokers. Hospital-wide smoking cessation programs could substantially increase the effectiveness of hospital smoking bans.Arch Intern Med. 1997;157:409-415
One fifth of Canadians are smokers despite the availability of community-based smoking cessation programs. It was hypothesized that offering a post-discharge smoking cessation program to cardiac patients would decrease smoking rates at six months.
This pilot randomized study explored the feasibility, acceptability and preliminary efficacy of a smoking cessation intervention delivered by a smoking cessation nurse specialist (SCNS) to cardiac patients after hospital discharge.
Participants (N=40) were randomized to either a postdischarge telephone intervention delivered weekly for the first month and then monthly until the third month (experimental group [EG]), or referral to usual community care (control group [CG]).
The researchers confirmed the feasibility of recruitment and acceptability of the intervention, but dfficulty with follow-up. The intention-to-treat analysis showed similar smoking cessation rates in both groups at six months (25% EG versus 30% CG; p = 0.72).
An intensifed follow-up protocol, or a more intensive, comprehensive and multidisciplinary intervention might be required, given the characteristics of the smokers.
To determine the effectiveness of a systematic and intensive programme of tobacco counselling, as against brief anti-tobacco counselling.
Controlled and randomised clinical trial.
Primary care medical and nursing clinics at an urban Health Centre in Getafe.
Smokers who request health care at the medical clinics for any reason during the recruitment period, who satisfy the inclusion criteria and who want to take part in the study. The inclusion criteria are: 18 years old or more, people who have smoked daily during the previous month any amount of cigarettes, and high motivation (score over 7 on the Richmond test).
The 110 patients recruited by each doctor will be included, depending on the clinic they come from, in the control group (brief counselling) or the intervention group (intensive counselling). For the patients in the intervention group, monitoring visits will be programmed for 6 months after giving up. Both groups will be called by phone after a year to see if they are still smoking.
Abstinence at 12 months. SECONDARY MEASUREMENTS: a) Recorded at the start: personal details, medical history and smoking history; b) recorded at the consultations: abstinence, date of first giving up and symptoms of withdrawal syndrome.
The study will define the role of nursing professionals in taking patients off tobacco and will help define the effectiveness of non-medical methods to achieve this.
This paper describes the planning and implementation of an individualized teaching programme for patients and their families following primary uncomplicated myocardial infarction. This preliminary study was designed and implemented by a senior nurse while working in the clinical area. Patients were randomly allocated to a control or study group. Both groups of patients were interviewed on the fourth day following admission to hospital and again at 2 and 6 months after discharge. Nurse intervention in the form of individually planned consecutive teaching sessions achieved a reduction in anxiety and modification of identifiable risk factors (smoking, obesity, diet, exercise) in the patients included in the teaching programme.
Background:
Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting.
Objectives:
To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.
Search methods:
We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted.
Selection criteria:
Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted to facilities that primarily treat psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow-up of less than six months. Both acute care hospitals and rehabilitation hospitals were included in this update, with separate analyses done for each type of hospital.
Data collection and analysis:
Two authors extracted data independently for each paper, with disagreements resolved by consensus.
Main results:
Fifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48; 25 trials). A specific benefit for post-discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post-discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non-significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. These trials were all conducted in acute care hospitals. A comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials).
Authors' conclusions:
High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals. There was no evidence of effect for interventions of lower intensity or shorter duration. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone.
The focus on acute care, time pressure, and lack of resources hamper the delivery of smoking cessation interventions in the emergency department (ED). The aim of this study was to 1) determine the effect of an emergency nurse-initiated intervention on delivery of smoking cessation counseling based on the 5As framework (ask-advise-assess-assist-arrange) and 2) assess ED nurses' and physicians' perceptions of smoking cessation counseling.
The authors conducted a pre-post trial in 789 adult smokers (five or more cigarettes/day) who presented to two EDs. The intervention focused on improving delivery of the 5As by ED nurses and physicians and included face-to-face training and an online tutorial, use of a charting/reminder tool, fax referral of motivated smokers to the state tobacco quitline for proactive telephone counseling, and group feedback to ED staff. To assess ED performance of cessation counseling, a telephone interview of subjects was conducted shortly after the ED visit. Nurses' and physicians' self-efficacy, role satisfaction, and attitudes toward smoking cessation counseling were assessed by survey. Multivariable logistic regression was used to assess the effect of the intervention on performance of the 5As, while adjusting for key covariates.
Of 650 smokers who completed the post-ED interview, a greater proportion had been asked about smoking by an ED nurse (68% vs. 53%, adjusted odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.3 to 2.9), assessed for willingness to quit (31% vs. 9%, adjusted OR= 4.9, 95% CI = 2.9 to 7.9), and assisted in quitting (23% vs. 6%, adjusted OR = 5.1, 95% CI = 2.7 to 9.5) and had arrangements for follow-up cessation counseling (7% vs. 1%, adjusted OR = 7.1, 95% CI = 2.3 to 21) during the intervention compared to the baseline period. A similar increase was observed for emergency physicians (EPs). ED nurses' self-efficacy and role satisfaction in cessation counseling significantly improved following the intervention; however, there was no change in "pros" and "cons" attitudes toward smoking cessation in either ED nurses or physicians.
Emergency department nurses and physicians can effectively deliver smoking cessation counseling to smokers in a time-efficient manner. This trial also provides empirical support for expert recommendations that call for nursing staff to play a larger role in delivering public health interventions in the ED.