Smoking prevalence and attitudes toward tobacco among student and staff nurses in Niigata, Japan

The present study investigated smoking prevalence and attitudes toward smoking in student and staff nurses, and activities to promote tobacco intervention by staff nurses. A total of 743 student nurses in 2 colleges and one university and 490 staff nurses in the university hospital in Niigata, Japan participated in the study and filled in self-administered anonymous questionnaires focused on smoking habits, attitudes toward smoking, and activities to promote tobacco intervention. The smoking prevalence among student nurses was 6% and increased with the year of study, whereas that of among staff nurses was 16% and increased by employment up to 3-5 years. Almost half of the student nurse smokers started the habit before admission to higher education facilities, and more than half of staff smokers also started smoking in their school years, in high school or college. Nicotine dependence, as defined by over 11 cigarettes per day and the first cigarette within 30 min after getting up, was high in smokers who started smoking before admission to college or university, but not in those who took up the habit thereafter. Thirty-six percent of student nurses and 25% of staff nurses agreed with the statement that "nurses should not smoke." Only 12% of staff nurses were involved in anti-tobacco interventions routinely, partly due to lack of broad knowledge and the necessary skills. Greater efforts are needed as a high priority to educate student and staff nurses systematically and comprehensively about the range of tobacco interventions available in Japan.     

Smoking behavior and desire to quit among low-income female caregivers.

The purpose of this study was to examine smoking behavior and the desire to quit among low-income women. Two hundred and eight women caregivers were surveyed about their smoking status, exposure to environmental tobacco smoke in the home, and desire to quit smoking. Most of the smokers (74%) wanted to quit smoking. With a logistic regression model, the number of years smoked was the only significant predictor variable for the dependent variable of thoughts about quitting when age, years of smoking, number of children, marital status, number of smokers in the home, cigarettes smoked per day, and money spent per week on cigarettes were entered as independent variables. The fewer years smoked the more likely the women wanted to quit.     

Cognitive dissonance and undergraduate nursing students' knowledge of, and attitudes about, smoking

BACKGROUND: Smoking is a major cause of morbidity and mortality. Although nurses have an important role in health promotion, and are well placed to see the harmful effects of tobacco smoking, studies suggest that they smoke at much the same rate as the general population. AIM: The aim of this paper is to report a study examining undergraduate nursing students' knowledge about the impact of smoking on health, and their attitudes towards smokers and smoking. METHODS: The study took place in 2001, using a non-probability sample of 366 undergraduate nursing students from an Australian university. Participants completed the Smoking and Health Promotion instrument. Festinger's theory of cognitive dissonance provided an explanatory framework for the findings. RESULTS: Most respondents who were still smoking began the habit while in high school. Students had greater generic than specialized knowledge about the effects of smoking on health, and there was no significant difference between second and third year students' knowledge. Those who still smoked had less favourable attitudes towards smoking-related health promotion than those who had never smoked or stopped smoking. Non-smokers were more supportive of non-smokers' rights than those who continued to smoke, while those who had stopped smoking were undecided. There was minimal association between levels of knowledge and attitudes about being sensitive to smoking-related health risks. CONCLUSION: The findings have implications for both high school education and undergraduate nursing education, and for the recruitment of students to undergraduate nursing programmes. More attention needs to be given in undergraduate nursing programmes to smoking and smoking-related illnesses, and to nurses' role in smoking health promotion.     

Admission to a psychiatric unit and changes in tobacco smoking

Smoking and withdrawal from smoking complicates the assessment and treatment of mental illness. We aimed to establish whether psychiatric inpatients smoke different amounts after admission than beforehand and, if so, to find out why. Forty-three inpatients on a working age adult psychiatry ward completed self-report questionnaires about smoking habits. Those who smoked a different amount after admission had a follow-up interview to find out why they thought this had occurred. The interview incorporated qualitative and quantitative aspects which were analysed accordingly.Fifty-six percent of participants were smokers before admission, rising to 70% afterwards. Of the smokers, 17% smoked less after admission, and 63% smoked more. The average number of cigarettes smoked per person per day increased from five to thirteen. The main reasons for smoking more were boredom, stress and the wish to socialise.     

Serum thiocyanate, smoking habits and smoking cessation trial in patients with peripheral atherosclerosis

The smoking habits in patients with atherosclerosis in the lower limbs and the effect of advising them to stop smoking was studied by means of self-declaration of the number of cigarettes smoked per day and determination of serum thiocyanate. Ninety-six per cent of males and 70 per cent of the females were smokers or ex-smokers. The number of years of smoking was about 40 for the smokers of both sexes and the male ex-smokers and 23 for the female ex-smokers. The number of cigarettes smoked per day reported by the patients was less than that reported by the smokers in a reference population. The serum thiocyanate levels confirmed the smoking status of the non-smokers and showed that about one-sixth of the ex-smokers had smoked in the last month prior to the study, and that the smokers on the average were heavy smokers smoking much more than the self-reported number of cigarettes. The effect of advising the patients to quit smoking was very disappointing. A maximum of 15 per cent of the smokers stopped smoking while some of the ex-smokers resumed smoking.     

Smoking behaviour in young families: Do parents take practical measures to prevent passive smoking by the children?

Objective - To investigate smoking behaviour in young families.

Design - Cross-sectional study.

Setting - Mother and child health centres in Oslo, Norway.

Subjects - the families of 1046 children attending the health centres for 6-weeks-, 2- or 4- year well child visits.

Main outcome measures - Daily smoking, smoking quantity and practical measures taken by the parents to prevent passive smoking among the children as assessed by parental reports.

Results - in 48% of the families at least one adult was smoking. 33% of the smoking parents smoked more than ten cigarettes per day. 47% of the smoking families reported that they did not smoke indoors.

Conclusions - the parents were less likely to smoke if they were more than 35 years of age, had a child aged less than one year, had' a spouse/co-habitee or had a long education. Smoking parents smoked less if they had a spouse/co-habitee, had a child aged less than one year or had few children. Smoking parents were more often careful and did not smoke indoors if they had a child aged less than one year, had a spouse/co-habitee, did not have a smoking spouse/co-habitee or smoked a low number of cigarettes per day.     

Screening for lung cancer. Is it worthwhile?

Prevention of lung cancer remains the best method of decreasing lung cancer mortality. Patients who smoke should be urged to quit, and children, teenagers, and young adults must not begin smoking. At high risk are smokers, especially those under 40 years of age who may have smoked two to four packs of cigarettes per day for 20 years; persons who have had a previous lung cancer; patients with bullous emphysema; patients with asbestosis; and patients with evidence of chronic airflow obstruction. Although radiographic screening may detect lung cancer earlier and lead to increased 5-year survival rates, it does not reduce lung cancer mortality rates.     

Chronic smoking and the BOLD response to a visual activation task and a breath hold task in patients with schizophrenia and healthy controls

Many psychiatric patient groups smoke heavily, but little is known regarding the effects of this habit on functional brain imaging results. The present report assesses the effect of chronic smoking on the blood oxygen level-dependent (BOLD) response to a simple visual activation (VA) task and a breath hold (BH) task in patients with schizophrenia. Eight healthy controls and twelve patients with schizophrenia were studied. Half of each group had never smoked and the other half of each group had smoked for more than 10 pack years. Responses to the VA task were assessed in the visual cortex and responses to the BH task were assessed in gray matter generally. There were four fMRI-dependent measures: (1) median percent signal change; (2) activation volume (in voxels); (3) time-to-peak of the impulse response function (IRF); and (4) time-to-trough of the IRF. All measures were tested as dependent variables in an ANCOVA with diagnosis and smoking status as crossed factors and age as a covariate. Heavy smokers had 22% larger percent signal change for the VA task and 50% larger percent signal change for the BH task. Patients had a 40% larger percent signal change for the breath hold task. Other statistically significant effects of smoking history on activation volume and the timing of the brain responses were noted. If replicated, the results may have important implications for fMRI studies comparing groups with markedly different smoking habits, such as studies comparing patients with schizophrenia, 60-90% of whom smoke, and healthy controls, who smoke with a much lower frequency.     

Prevalence of patients continuing to smoke after vascular interventions

INTRODUCTION: Smoking is one of the most important risk factors for the development and progression of atherosclerosis. Smoking cessation is an obligatory element in the management of vascular problems and in patients scheduled for vascular interventions. The aim of this study was to assess the prevalence of patients smoking before and after vascular surgical procedures and to evaluate the requirements for inpatient programs for smoking cessation and nicotine replacement therapy. METHODS: 500 patients admitted for vascular interventions were included in this prospective study. Smoking status was evaluated both objectively and subjectively. All patients underwent measurements of exhaled breath carbon monoxide to quantify nicotine dependency and all answered a standardized Fagerstr?m questionnaire both on admission and after surgery to identify current smokers. RESULTS: Of 500 vascular patients included in the study, only 70 (14 %) never had smoked, 243 (49 %) had given up smoking before admission and 161 (32 %) were current smokers. Of the current smokers, 64 (40 %) did not smoke during hospitalization but 97 (60 %) continued to smoke in hospital. Of these 97 patients, 78 (80 %) were men and 19 women; their mean age was 61 +/- 4 years (range 40-84). Four patients had surgery for infrarenal aortic aneurysm, 40 underwent carotid endarterectomy and 53 had peripheral arterial occlusive disease (PAD). There was no difference between abstinent patients and continuing smokers in previous cigarette consumption or Fagerstr?m score, a predictor for long-term smoking behavior. Patients with carotid artery stenosis were significantly more abstinent while hospitalized (P = 0.006); patients with PAD, however, were more likely to continue smoking as inpatients (P = 0.004). Sixty-five percent of continuing smokers stated that they would stop smoking in hospital if counseling and nicotine replacement therapy were provided. With regard to their predominant location of atherosclerosis, patients with PAD were less willing than those with carotid stenosis to abstain from smoking while hospitalized (53 % vs 88 %, respectively; P < 0.001). CONCLUSION: A substantial proportion of patients admitted for vascular surgery are smokers. More than half of these continue to smoke in the hospital, an environment where smoking is prohibited by law. Counseling, nicotine replacement therapy and smoking-cessation programs are urgently needed for vascular surgical inpatients.     

Knowledge of the damages of wrong nutrition and of the effect of stimulants. (Results of questioning 100 employees of a large industry]

In an unselected collective of 100 employees of a big concern the knowledge with regard to body weight, nutrition and nicotine abuse was studied and the eating habits as well as the principles of education connected with them were ascertained. Nearly all questioned persons knew their body weight. Half of them were able to indicate their ideal weight with a precision of +/- 10%. The rate of the considerably overweight persons in the collective showed a dependence on higher age and female sex. Among the questionees with secondary education more normalweight persons were found. The test persons were well informed about the disadvantages of overweight and controlled their body weight in two thirds of the cases at least once a week. They stated to have met the term "diet" above all in the mass media. About half of them were able to define the term "calorie" approximately precisely. The questionees, however, often underestimated the required caloric quantity, apparently without drawing conclusions. The caloric content of alcoholic drinks was underestimated. Beer ranked first among the consumed alcoholic drinks. Only one fifth of the test persons "reward" their children with sweets and wish that they eat up their dinner. About half of the questionees were smokers. One fourth had never smoked, while another fourth had given up smoking. Mostly cigarettes were consumed, although nearly all test persons regarded inhaling smoking as harmful. The sole knowledge of factors that have a detrimental effect on the state of health (e.g. overweight, smoking) seems to be not sufficient to lead a healthy life. Since the test persons are, however, willing to do something for their health it would be useful to concentrate adipose persons and smokers into groups that should be treated by behaviour therapy and be positively motivated.     

Nursing undergraduate students and their relationship with smoking

This study was designed to investigate: the prevalence of smokers among the UNIFESP nursing undergraduate students; some initial usage features; the smokers' dependence degree on nicotine. In order to compare the ratio of some variables, Pearson's Square Chi test was applied. The number of smokers among the nursing undergraduate students in the sample was 23 (8.2%) and 167 (59.9%) said they had never smoked a cigarette. Smokers' average age was 19.5 years old, and there is a significant difference between genders and only 2 (9.1%) smoking students may show a more severe discomfort while attempting to stop smoking, as showed the Fagerstr?m's Test.     

Effect of nicotine lozenges on affective smoking withdrawal symptoms: secondary analysis of a randomized, double-blind, placebo-controlled clinical trial

BACKGROUND: The suggested mechanism for the effects of nicotine replacement medications such as nicotine lozenges on smoking abstinence is reduction in the withdrawal symptoms of emotional distress and craving (the subjective desire to smoke). OBJECTIVES: This study assessed the effect of nicotine lozenges on affective withdrawal symptoms (collectively termed emotional distress) and craving over 6 weeks of treatment and the role of emotional distress and craving in mediating the effect of the lozenges on smoking abstinence. METHODS: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled clinical trial of nicotine lozenges. High-dependence smokers (those who smoked their first cigarette of the day within 30 minutes of waking) were assigned to receive the 4-mg lozenge; low-dependence smokers (those who smoked their first cigarette of the day >30 minutes after waking) were assigned to receive the 2-mg lozenge. Participants were randomized to receive active or placebo lozenges within these dose and dependence strata. Smokers were to rate their withdrawal symptoms daily during the baseline week (while still smoking) and for 6 weeks after starting treatment. Study analyses included the effect of the active lozenge on affective symptoms (ie, anxiety; anger, irritability, or frustration; difficulty concentrating; restlessness; and depressed mood) during weeks 1 through 6 in high- and low-dependence smokers; the prospective associations between these symptoms and craving and subsequent abstinence; and the mediating influence of these symptoms on the lozenge's effect on abstinence. The analyses included smokers who provided symptom data for the baseline period and for at least week after the initiation of treatment. RESULTS: Of 1,818 smokers enrolled in the original study, this analysis included data from 1,144. The population was predominantly white, had a mean age ranging ranging from 40.65 to 46.01 years, and included slightly more women than men. The 2-mg lozenge did not have consistently significant effects on the withdrawal symptoms of emotional distress among low-dependence smokers; however, in high-dependence smokers, the 4-mg dose was associated with significant reductions versus placebo in overall emotional distress symptoms through week 4 (P < 0.001-P = 0.025), all individual symptoms through week 3 (P < 0.001-P = 0.035), and irritability and anxiety through week 4 (P = 0.002-P = 0.049). In the low-dependence group, the 2-mg lozenge was associated with significant reductions versus placebo in craving through week 3 (P = 0.012-P = 0.033), whereas in the high-dependence group, the 4-mg lozenge was associated with significant reductions in craving in each of the first 6 weeks (P < 0.001-P = 0.028). Among high-dependence smokers, both week-1 and week-2 emotional distress scores were associated with a return to smoking by week 6 (P < 0.001); among low dependence smokers, the association applied only to week-2 symptoms (P = 0.017). Week-1 and week-2 craving was associated with a return to smoking at week 6 in both groups (P < 0.001-P = 0.001). Emotional distress modestly and inconsistently mediated the effects of the lozenges, accounting for 3% to 13% of the treatment effects, whereas craving more strongly (though incompletely) mediated the treatment effects, particularly among high-dependence smokers, in whom it accounted for 29% to 39% of the treatment effects. CONCLUSIONS: In high-dependence smokers, the 4-mg nicotine lozenge significantly reduced all affective withdrawal symptoms through the first 4 weeks of treatment. Lozenge-related decreases in craving partially mediated the effect of treatment on abstinence, particularly in high-dependence smokers.     

An analysis of smoking patterns among older adults.

BACKGROUND, SUBJECTS, AND METHODS: The 1990 Health Promotion and Disease Prevention Supplement to The National Health Interview Survey was used to develop point-prevalence data about smoking for four age groups, 55 to 64, 65 to 74, 75 to 84, and over 84 and to assess the association of sociodemographics, health status, and health beliefs with a respondent's smoking profile. RESEARCH DESIGN: Chi-square and Cohran-Mantel-Haenszel tests were used to investigate prevalence patterns. Odds ratios generated from logistic regressions were used to indicate degree of association. RESULTS: Fifty-three percent of individuals above the age of 54 smoked in the past and 17% smoked in 1990. Among these smokers, 61% tried to quit and 36% noted that their physicians never advised them to quit. Significant age group differences were noted on the various measures of smoking prevalence. Beliefs about the adverse health effects of smoking were associated with a greater likelihood of never smoking, and among smokers, a greater likelihood of being a former smoker. CONCLUSIONS: Analyses of health behaviors among older adults must recognize the diversity within this age group, and measures of health beliefs should be included in subsequent studies of health behaviors among older adults. Physicians must also play a greater role in discussing smoking with their patients and advocating smoking cessation.     

The effect of cigarette smoking on salivation and esophageal acid clearance

To further define the influence of cigarette smoking on the pathophysiology of gastroesophageal reflux disease, studies were done to evaluate acid clearance in the esophagus and the salivary titratable base secretion of chronic smokers as compared to those of nonsmokers, and to ascertain the acute effects of smoking on these variables. Eight nonsmoking volunteers and 16 cigarette smokers without symptoms of gastroesophageal reflux disease were studied. All studies were initiated after a 6-hour fast, with the smokers also having refrained from smoking. Of the 16 smokers half smoked three cigarettes in the course of the experiments and half did not smoke. The immediate effects of cigarette smoking were a prolongation of the acid clearance time and a diminution of the secretion of salivary titratable base. However, both of these effects were overshadowed by greater baseline differences between the populations of smokers and nonsmokers. As a population the smokers had only 60% of the titratable base secretion of nonsmokers and acid clearance times that were 50% longer than those of nonsmokers. These effects were presumably long-lasting effects of cigarette smoking, although the duration of the effect was not defined. The observed differences in acid clearance are most likely the result of diminished salivary base secretion, since good correlation existed between these parameters.     

Smoking rates and smoking cessation among individuals with multiple sclerosis

Purpose. Adults with physical disabilities tend to smoke at higher rates than smokers in the general population. No study to date, however, has assessed smoking prevalence and cessation among individuals with multiple sclerosis (MS). Such information is critically needed because smoking is more deleterious for individuals with MS than for smokers without MS and increases MS risk.

Method. Questionnaires were sent to 700 National Multiple Sclerosis Society Rhode Island Chapter members.

Results. Based on a 50% response rate, results demonstrated a 15.2% current smoker prevalence rate, which is lower than USA and Rhode Island general adult population averages. Individuals who smoked, however, tended to be heavy smokers, consuming 20 - 30 cigarettes daily, and had been smoking 10 years or longer. Smokers varied in their interest in quitting but seemed confident in their ability to do so. Respondents reported that it was difficult to quit because smoking was pleasurable; smoking was helpful in coping with boredom and with having MS; withdrawal symptoms were unpleasant; and treatment for tobacco dependence was expensive.

Conclusions. Efficacious smoking cessation interventions for smokers with MS should be developed to address a critical health need for a population of highly nicotine-dependent smokers who face numerous obstacles to quitting.     

Smoking Habits of Emergency Department Patients: An Opportunity for Disease Prevention

Objective: To determine smoking habits, levels of addiction, readiness to quit, and access to primary care among ED patients.
Methods: A questionnaire was administered prospectively to all non-critical adult patients who presented to one university hospital ED during 23 randomly selected four-hour time blocks; 336 (89%) of 376 eligible patients responded. Self-reported smoking was validated by carbon monoxide breath testing in a pilot sample of 49 patients.
Results: The study patients were mostly young (mean age = 35 ± 15 years), female (59%), white (62%), and high school-educated (73%). Of the 336 ED patients, 41% were current smokers (95% CI = 0.36–0.46); 42% of these were "moderately" to "very highly" dependent on nicotine (Fagerstrom Test for Nicotine Dependence > 4). Of those who smoked, 68% stated they wanted to quit, and 49% wanted to quit within the month. Fifty-six percent of all those who smoked stated that they had never been told to quit smoking by any physician. Thirty-five percent of the ED sample (118 patients) relied upon EDs for most or all of their routine, primary health care; 55% (95% CI = 0.46–0.64) of these patients were current smokers.
Conclusions: The prevalence rates of smoking and nicotine addiction among ED patients are high. Almost half of ED smokers are ready to quit, but most state they have never been told by a physician to do so. Finally, a large proportion of ED smokers receive their primary care in EDs. Therefore, the ED may be an underused setting for smoking cessation intervention.     

Implementation of a smoke‐free policy in an inpatient psychiatric facility: Patient‐reported adherence,support, and receipt of nicotine‐dependence treatment

The implementation of smoke‐free policies in inpatient psychiatric facilities, including patient adherence, mental health nursing staff support, and provision of nicotine‐dependence treatment to patients, has been reported to be poor. The extent to which the quality of smoke‐free policy implementation is associated with patient views of a policy is unknown. We conducted a cross‐sectional survey of 181 patients (53.6%, n = 97 smokers; and 46.4%, n = 84 non‐smokers) in an Australian inpatient psychiatric facility with a total smoke‐free policy. Smokers' adherence to the policy was poor (83.5% smoked). Only half (53.6%) perceived staff to be supportive of the policy. Most smokers used nicotine‐replacement therapy (75.3%); although few received optimal nicotine‐dependence treatment (19.6%). Overall, 45.9% of patients viewed the smoke‐free policy in the unit as positive (29.9% smokers; 64.3% non‐smokers). For smokers, adhering to the ban, perceiving staff to be supportive, and reporting that the nicotine‐replacement therapy reduced cravings to smoke were associated with a more positive view towards the smoke‐free policy. These findings support the importance of patient adherence, mental health nursing staff support, and adequate provision of nicotine‐dependence treatment in strengthening smoke‐free policy implementation in inpatient psychiatric settings.     

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.     

Contemporary smoking habits among nurses in Mainland China

Although China is the world's largest consumer of tobacco and tobacco-related products, the epidemiology of smoking has not been well studied among nurses. Given this serious gap in the literature, we considered it necessary to investigate tobacco smoking habits among a large cross-section of contemporary Chinese nurses, by means of a questionnaire survey. A total of 509 replies were obtained from 520 nurses (response rate: 97.9%). The overall prevalence of smoking was 2.6% (95%CI 1.5 - 4.3). When stratified by gender, the prevalence rate among male nurses was 52.2% (33.0 - 70.8). Of those who smoked, the median number was 11 smokes per day for a period of 25.0 years. When categorized by severity, 15.4% were light smokers, 69.2% moderate smokers and 15.4% heavy smokers. When stratified by age there were no smokers under 25 years, with the prevalence between 25 and 34 years similarly low, at 1.1%. The highest smoking rate was seen among nurses aged 45 to 50 years (10.1%), even though they only comprised 9.8% of the total workforce. Although our study suggests that tobacco usage is relatively uncommon among Chinese nurses overall, the rate among male nurses was alarmingly high. The distribution of smoking by age was not uniform however, with a high proportion being concentrated in the older age ranges. As such, future preventive measures will need to consider the individual situation of Chinese nurses who smoke, particularly those who occupy the older age groups.     

Smoking Status Among Women in Households With Young Children

purpose . To identify sociodemographic and health-related correlates of smoking status among women in households with young children.
design . A secondary analysis of the 1992 California Behavioral Risk Factor Surveillance System public-use data tape
participants . Women (N = 520) in households with very young children (≤ 5 years of age)
main outcome measures . Current smoking status
results . Approximately 18% were current smokers; more than 40% smoked more than 10 cigarettes each day. A majority of smokers indicated a high level of nicotine addiction, but had plans to quit. Smoking prevalence varied by sociodemographic variables with higher rates for unmarried, less than college educated, and unemployed participants. Health status also was related to smoking, with higher rates among those with poor health and those limited in activities.
conclusions . Smoking is one way of coping with the stressors of daily life, including those associated with caring for young children. Special cessation efforts may be needed for the unemployed, the unmarried woman, and for those in poor health.