Patient-reported recall of smoking cessation interventions from a health professional

Objective

To determine the prevalence and characteristics of current cigarette smokers who report receiving health care provider interventions (‘5A's’: ask, advise, assess, assist, arrange) for smoking cessation.

Methods

Data came from the 2009–2010 National Adult Tobacco Survey, a telephone survey of United States adults aged ≥ 18 years. Among current cigarette smokers who reported visiting a health professional in the past year (n = 16,542), estimates were calculated overall and by sex, age, race/ethnicity, education, income, health insurance coverage, and sexual orientation.

Results

Among smokers who visited a health professional (75.2%), 87.9% were asked if they used tobacco, 65.8% were advised to quit, and 42.6% were asked if they wanted to quit. Among those wanting to quit, 78.2% were offered assistance and 17.5% had follow-up arranged. Receipt of the ‘ask’ component was lower among males and uninsured individuals. Receipt of the ‘advise’ and ‘assess’ components was lower among those aged 18–24 and uninsured individuals. Receipt of the ‘assist’ component was lower among non-Hispanic blacks. No differences were observed for the ‘arrange’ component.

Conclusions

Many current smokers report receiving health care provider interventions for smoking cessation. Continued efforts to educate, encourage, and support all health professionals to provide effective, comprehensive tobacco cessation interventions to their patients may be beneficial.     

Smoking,stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine's Stigma,Prejudice, Discrimination and Health Special Issue (67: 3)

In recent years, addictions policy has stressed the need to counteract stigmatization in order to promote public health. However, as recent observers have noted, through the widespread implementation of tobacco ‘denormalization’ strategies, tobacco control advocates appear to have embraced the use of stigma as an explicit policy tool. In a recent article, Ronald Bayer (2008) argues that the mobilization of stigma may effectively reduce the prevalence of smoking behaviors linked to tobacco-related morbidity and mortality and is therefore not necessarily antithetical to public health goals. This commentary takes up this question of whether stigmatizing smoking may ultimately serve the interests of public health. Through an examination of the unique contours of tobacco control policy, we suggest that stigmatizing smoking will not ultimately help to reduce smoking prevalence amongst disadvantaged smokers – who now represent the majority of tobacco users. Rather, it is likely to exacerbate health-related inequalities by limiting smokers’ access to healthcare and inhibiting smoking cessation efforts in primary care settings.     

Individual responsibility and health-risk behaviour: a contingent valuation study from the ex ante societal perspective

This study analyzes peoples’ social preferences for individual responsibility to health-risk behaviour in health care using the contingent valuation method adopting a societal perspective. We measure peoples’ willingness to pay for inclusion of a treatment in basic health insurance of a hypothetical lifestyle dependent (smoking) and lifestyle independent (chronic) health problem. Our hypothesis is that peoples’ willingness to pay for the independent and the dependent health problems are similar. As a methodological challenge, this study also analyzes the extent to which people consider their personal situation when answering contingent valuation questions adopting a societal perspective.513 Dutch inhabitants responded to the questionnaire. They were asked to state their maximum willingness to pay for inclusion of treatments in basic health insurance package for two health problems. We asked them to assume that one hypothetical health problem was totally independent of behaviour (for simplicity called chronic disease). Alternatively, we asked them to assume that the other hypothetical health problem was totally caused by health-risk behaviour (for simplicity called smoking disease). We applied the payment card method to guide respondents to answer the contingent valuation method questions.Mean willingness to pay was 42.39 Euros (CI = 37.24-47.55) for inclusion of treatment for health problem that was unrelated to behaviour, with ‘5-10’ and ‘10-20 Euros’ as most frequently stated answers. In contrast, mean willingness to pay for inclusion treatment for health-risk related problem was 11.29 Euros (CI = 8.83-14.55), with ‘0’ and ‘0-5 Euros’ as most frequently provided answers. Difference in mean willingness to pay was substantial (over 30 Euros) and statistically significant (p-value = 0.000).Smokers were statistically significantly more (p-value < 0.01) willing to pay for the health-risk related (smoking) problem compared with non-smokers, while people with chronic condition were not willing to pay more for the health-risk unrelated (chronic) problem than people without chronic condition. This suggests that sub groups of people might differ in terms of abstracting from their personal situation when answering valuation questions from a societal perspective.     

Influenza cost and cost-effectiveness studies globally – A review

Every year, approximately 10–20% of the world's population is infected with influenza viruses, resulting in a significant number of outpatient and hospital visits and substantial economic burden both on health care systems and society. With recently updated WHO recommendations on influenza vaccination and broadening vaccine production, policy makers in middle- and low-income countries will need data on the cost of influenza disease and the cost effectiveness of vaccination. We reviewed the published literature to summarize estimates of cost and cost-effectiveness of influenza vaccination. We searched PUBMED (MEDLINE), EMBASE, WEB of KNOWLEDGE, and IGOOGLE using the key words ‘influenza’, ‘economic cost’, ‘cost effectiveness’, and ‘economic burden’. We identified 140 studies which estimated either cost associated with seasonal influenza or cost effectiveness/cost–benefit of influenza vaccination. 118 of these studies were conducted in World Bank-defined high income, 22 in upper-middle income, and no studies in low and lower-middle income countries.     

Configuring users of cholesterol lowering foods: A review of biomedical discourse

This paper explores how users of foods containing phytosterols are ‘configured’ within biomedical research and writing on these substances. A growing range of such foods have been launched and marketed on the basis that they actively lower cholesterol. They are among the most prominent examples of a set of foods designated as ‘functional foods’. The paper is based on an analysis of biomedical journal articles which address the use of phytosterols as a cholesterol lowering agent in humans. These include both original research papers and commentaries such as review articles, letters, editorials, news items and professional guidelines. My analysis suggests that users are constituted variously as autonomous, self-motivated consumers, patients and publics needing advice, people resistant to pill use, and practitioners looking for something to offer their patients. I characterise the imagined uses of the products as healthy/holistic, lazy/busy/contemporary, and incompetent use. These varying portrayals of users and their use of these food products entail different ways of understanding health identities and different allocations of responsibilities between the technology, user and health care professionals. I conclude that, while experts and regulators may attempt to configure ‘correct’ uses of these products, relatively little is known about the rationales and practices of actual users.     

‘It cuts both ways’: A relational approach to access and accommodation for autism

Drawing on a qualitative study of 45 autobiographical texts by authors with autism spectrum disorders (ASDs), this paper examines and attempts to aggregate recommendations for challenging barriers to socio-spatial inclusion. The autobiographies were selected by means of purposive sampling and subjected to a sequential process of detailed annotation, manual coding for emergent themes, and ongoing critical discourse analysis until data-saturation occurred. Resulting findings reveal that the extraordinarily heightened senses typically associated with ASDs mean that those on the spectrum often struggle to process environmental stimuli in a way that makes sense. Negotiating the sensory geographies of daily life requires considerable work, and while the access afforded by such cognitive and emotional labour may be rewarding, ASD authors reveal that their efforts are rarely understood – or assisted – by non-autistic others. Many proposed accommodations could, however, be made with relative ease, and ASD texts provide good reasons and recommendations for toning down ‘toxic’ stimuli – such as fluorescent lights – and for redesigning or reorganizing the shared sensory ‘furniture’ of social space. The paper thus suggests that by attending closely to voices from the spectrum, the non-autistic majority might ensure responsibilities to open access are taken seriously, and do indeed ‘cut both ways’.     

Conceptualising the prevention of adverse obstetric outcomes among immigrants using the ‘three delays’ framework in a high-income context

Women from high-mortality settings in sub-Saharan Africa can remain at risk for adverse maternal outcomes even after migrating to low-mortality settings. To conceptualise underlying socio-cultural factors, we assume a ‘maternal migration effect’ as pre-migration influences on pregnant women’s post-migration care-seeking and consistent utilisation of available care. We apply the ‘three delays’ framework, developed for low-income African contexts, to a high-income western scenario, and aim to identify delay-causing influences on the pathway to optimal facility treatment. We also compare factors influencing the expectations of women and maternal health providers during care encounters. In 2005–2006, we interviewed 54 immigrant African women and 62 maternal providers in greater London, United Kingdom. Participants were recruited by snowball and purposive sampling. We used a hermeneutic, naturalistic study design to create a qualitative proxy for medical anthropology. Data were triangulated to the framework and to the national health system maternity care guidelines. This maintained the original three phases of (1) care-seeking, (2) facility accessibility, and (3) receipt of optimal care, but modified the framework for a migration context. Delays to reciprocal care encounters in Phase 3 result from Phase 1 factors of ‘broken trust, which can be mutually held between women and providers. An additional factor is women’s ‘negative responses to future care’, which include rationalisations made during non-emergency situations about future late-booking, low-adherence or refusal of treatment. The greatest potential for delay was found during the care encounter, suggesting that perceived Phase 1 factors have stronger influence on Phase 3 than in the original framework. Phase 2 ‘language discordance’ can lead to a ‘reliance on interpreter service’, which can cause delays in Phase 3, when ‘reciprocal incongruent language ability’ is worsened by suboptimal interpreter systems. ‘Non-reciprocating care conceptualisations’, ‘limited system-level care guidelines’, and ‘low staff levels’ can additionally delay timely care in Phase 3.     

‘Workers’, ‘clients’ and the struggle over needs: Understanding encounters between service providers and injecting drug users in an Australian city

A feature of contemporary Western, neo-liberal democracies is the frequent interaction between representatives of health and social services and the members of stigmatised and ‘unruly’ populations, such as injecting drug users. Previous research on drugs has tended to ignore the power relations and cultural dynamics at work in these encounters, and the ways in which they are framed by the wider neo-liberal context. Drawing on an ethnography of street-based heroin use in Melbourne, Australia's second largest city, I show how the discourses of both service providers and injecting drug users draw on wider neo-liberal values of independence, autonomy, rationality and responsibility. Service providers negotiate a framework of needs interpretation that creates and reproduces professional identities, and maintains boundaries between ‘workers’ and ‘clients’. It also includes tensions around the definition of injecting drug users as ‘chaotic’ (i.e., failed neo-liberal) subjects, and slippage between service philosophies that emphasise a social model of health and forms of service delivery that emphasise the production of responsibilised subjects. For their part, street-based injectors construct an alternative framework of needs interpretation that emphasises their self-reliance, autonomy and independence, attributes and capacities largely denied them in service-provider discourse. In encounters with service providers, street-based injectors respond in various ways that include elements of resistance, strategic accommodation and the incorporation of therapeutic discourse. I conclude by considering the implications of my analysis for the future development of drug policy and practice.     

Swimming pools and health-related behaviours: results of an Italian multicentre study on showering habits among pool users

Objectives

Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of indoor swimming pool users; analysed the variables associated with lack of showering; and assessed awareness of the importance of showering.

Study design

Cross-sectional study.

Methods

A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance.

Results

In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was ‘to wash oneself’ (50.5%); or ‘to get used to the temperature of the water’ (44.3%); and 5.2% answered ‘for both reasons’. Risk factors significantly associated with lack of showering were: female sex (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2–1.59), age 14–17 years (OR 5.09, 95% CI 3.40–7.64); not reading the swimming pool rules (OR 1.24, 95% CI 1.10–1.41); living in Central Italy (OR 3.3, 95% CI 2.65–4.1) or Southern Italy (OR 1.35, 95% CI 1.18–1.55); and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48–1.97).

Conclusions

The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool.