Review of perinatal partner-focused smoking cessation interventions

One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors.     

Smoking cessation intervention with pregnant women and new parents (part 2): A focus group study of health visitors and midwives working in the UK

A qualitative, focus group study was undertaken in the United Kingdom with NHS-employed health visitors and midwives to examine their attitudes towards smoking in pregnancy and their perception of their professional role in smoking cessation/relapse prevention work with women in their care. The health visitors and midwives felt there were several social and personal reasons why women smoke in pregnancy. Most felt a professional responsibility to intervene with smokers, even though they also felt their intervention was ineffective unless patients were ‘ready’ to quit and a multidisciplinary team was in place to support their patients according to their individual needs. Midwives and health visitors are willing to promote smoking cessation with their patients, but feel there are personal and organisational barriers to providing an effective service. Respondents held mixed views on the effectiveness of interventions for smoking cessation highlighting the need for evidence-based training.     

Predictors of Progress in Smoking Cessation

Abstract This study examined the ability of two specific measures of stressors associated with smoking cessation to act as predictors of progress through the stages of smoking cessation as described by Prochaska and DiClemente (1983). Specifically, a 19-item scale measuring barriers to smoking cessation and a 14-item scale measuring smoking cessation self-efficacy were completed by 127 smokers and self-quitters at three time points over a six-month period. Subjects who made progress through the stages of smoking cessation had lower barriers scores initially and had significant changes in their self-efficacy and barriers scores over the six-month period. In contrast, non-progressors had no significant change in either their self-efficacy or barriers scores over the time period. These results suggest that the two scales may provide clinically useful data to public health nurses working with smokers.     

Participation of Icelandic nurses in smoking cessation counselling

Aims and objectives. The purpose of this study was to investigate the participation and knowledge of Icelandic nurses in smoking cessation counselling and to find barriers to smoking interventions by nurses. Background. Research has shown that clinical intervention as brief as three minutes can substantially increase smoking cessation success. Several studies have revealed that majority of nurses agree that smoking cessation counselling is within their duties. However, the percentage of nurses who report advising and/or counselling patients remains low. Design and methods. An anonymous mail survey of all practicing nurses in Iceland was conducted in September 2004. A self‐administered questionnaire was used, consisting of 74 questions in six sections: asking about smoking behaviour, to advise, to assess/assist/arrange, children and passive smoking, other questions and demographic questions. Results. Of 2453 questionnaires, 868 complete questionnaires were returned, giving a 36% response rate. While the majority of nurses ‘asked’ about smoking behaviour, a minority ‘advised’ or ‘assisted’ their clients with smoking cessation. However, if the clients had no smoking‐related symptoms, less than half of the nurses asked about smoking behaviour. Failure to ask and advise clients about the importance of smoking cessation and assisting with smoking cessation correlated (p < 0·001) with several factors, including: lack of time, insufficient knowledge or training and not considered as a part of daily duty. Nurses who smoked were less likely to advise against smoking (p < 0·05). Conclusions. Nurses frequently neglect to counsel clients about smoking cessation. Common barriers to the delivery of smoking cessation interventions by nurses include insufficient education and training in smoking cessation therapy. Relevance to clinical practice. The number of patients with tobacco‐related illnesses is increasing worldwide. Effective smoking cessation interventions by nurses have the enormous potential of reducing smoking prevalence and improve health.     

Pregnancy and the struggle to quit smoking

The negative effects of smoking during pregnancy are well documented. Health care providers typically advise pregnant women who smoke usually to quit for their health as well as for the health of their fetus. Most women are familiar with the need to stop smoking while pregnant. Hospitals offer various smoking cessation services. However, the literatures reveals a low uptake of smoking cessation services among pregnant women. The purpose of this paper is to explore the smoking cessation experience and feelings amongst women during pregnancy and assess smoking cessation intervention in antenatal care. Findings may provide health care providers a better understanding of this issue and help women overcome related challenges.     

The health benefits of smoking cessation.

Extensive evidence has now accumulated on the health benefits of smoking cessation. With few exceptions, disease risks are reduced following smoking cessation and continue to drop as abstinence is maintained. The review of the evidence in the 1990 Report of the Surgeon General led to major conclusions that establish smoking cessation as a clear priority for health care providers.     

In-hospital smoking cessation programs: what do VA patients and staff want and need?

In preparation for delivering an inpatient smoking cessation intervention, surveys and interviews of general inpatients and staff were conducted in two Veterans Affairs (VA) hospitals to determine the motivation of veterans to quit smoking and to identify facilitators and barriers to inpatient staff delivery of inpatient cessation services. Seventy percent of inpatients were “motivated smokers” (thinking of quitting in the next 30 days), yet only 17% stated that they received cessation services during their hospitalization. Most staff said that VA should do more to assist patients to quit, yet less than half said that they personally provided cessation services due to lack of confidence/training and hesitancy to upset patients. Given the high motivation to quit among hospitalized veterans and the lack of knowledge about providing cessation services among nurses, training health professionals may facilitate and overcome barriers to the provision of these services. As frontline providers, nurses are ideally positioned to deliver inpatient smoking cessation services to hospitalized veterans.     

Smoking cessation strategy use among pregnant ex-smokers

There is strong evidence for the beneficial health effects associated with smoking cessation during pregnancy. Although many pregnant women spontaneously quit smoking during pregnancy, postpartum relapse is high. Evidence suggests that pregnant women do not use smoking cessation strategies as identified by the 40-item Processes of Change Scale as frequently as others who quit smoking. The purpose of this study is to identify factors associated with pregnant exsmokers' use of experiential and behavioral smoking cessation strategies. A cross-sectional survey design is used for the study. From a sample of 201 primarily low-income pregnant women recruited to participate in a larger study, 58 were biologically confirmed ex-smokers. Multiple regression analysis reveals that motivation to quit smoking is the only significant factor explaining the use of experiential and behavioral smoking cessation strategies, accounting for 44% of the variance in experiential processes and 31% of the variance in behavioral processes.     

An exploration of the smoking-related health beliefs of older people with chronic obstructive pulmonary disease

Aim. To explore the smoking‐related health beliefs of older people with chronic obstructive pulmonary disease (COPD). Background. Globally, smoking is a major cause of COPD and symptoms present typically mid to later life. Substantial numbers of people with COPD continue to smoke even though smoking cessation is known to slow the rate of disease progression and prevent further deterioration in lung function. There is evidence to suggest that, although older long‐term smokers can successfully quit smoking with the help of specialist structured programmes, those with COPD find it more difficult to achieve sustained cessation. An understanding of the health beliefs of people with COPD will assist professionals to provide the most appropriate support with cessation attempts. Design. A secondary analysis of qualitative interview data. Methods. Twenty‐two current and former smokers with COPD who used the outreach service of an inner city hospital in Scotland were interviewed in their own homes using semi‐structured interviews which were transcribed verbatim. The main concepts of the Health Belief Model were used as an analysis framework. Findings. Interviews were carried out with 15 women and seven men with a median age of 68 years. Almost 90% lived in areas of the highest socio‐economic deprivation according to DEPCAT scores. Almost two‐thirds of the individuals in this study continued to smoke even though they largely perceived smoking as a threat to health. Individuals who continued to smoke cited various barriers to quitting smoking and all had, at some time, attempted smoking cessation. Over half were still attempting to quit. Cues to action came from external sources rather than increasing disease severity. Conclusions. Cessation is challenging and knowledge of a person's health beliefs is a prerequisite to supporting behaviour change. Relevance to clinical practice. Findings emphasize the need for frontline health professionals to reflect on their current practice with a view to providing sustained encouragement and support towards smoking cessation and relapse prevention for people with COPD.     

Advice as a smoking cessation strategy: A systematic review and implications for physical therapists

Although identified as a clinical priority, smoking cessation has been addressed minimally in the literature in the context of physical therapy practice. Smoking cessation advice delivered by a health professional can help smokers quit. The salient components of such advice however warranted elucidation to enable physical therapists to integrate this clinical competence into their practices. Therefore, we conducted a systematic review to elucidate the effectiveness of advice by a health professional and its components to optimize smoking cessation instituted in the context of physical therapy practice. Thirty source articles were identified. A random-effects model meta-analysis was used to assess the effectiveness of the advice parameters. Risk ratios (RRs) were used to estimate pooled treatment effects. RRs for brief, intermediate, and intensive advice were 1.74 (95% CI=1.37, 2.22), 1.71 (95% CI=1.39, 2.09), and 1.60 (95% CI=1.13, 2.27), respectively. Self-help materials, follow-up, and interventions based on psychological or motivational frameworks were particularly effective components of intermediate and intensive advice interventions. Advice can be readily integrated into physical therapy practice and used to initiate or support ongoing smoking cessation in clients irrespective of reason for referral. Incorporating smoking cessation as a physical therapy goal is consistent with the contemporary definition of the profession and the mandates of physical therapy professional associations to promote health and wellness, including smoking cessation for both primary health benefit and to minimize secondary effects (e.g., delayed healing and recovery, and medical and surgical complications). Thus, advice is an evidence-based strategy to effect smoking cessation that can be exploited in physical therapy practice. Further research to refine how best to assess smokers and, in turn, individualize brief smoking cessation advice could augment positive smoking cessation outcomes.     

Australian mental health care practitioners’ practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness

Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking‐related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross‐sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1–39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e‐cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5–5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1–0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1–0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.     

北京市临床护士实施5A’S戒烟干预的现状调查

目的了解护士在临床工作中实施5A’S戒烟干预的现状,为促进其实施戒烟干预行为提供依据。方法采用方便取样,在北京市城区6家三级医院对230名护士进行问卷调查。问卷主要内容包括：护士实施5A’s戒烟干预的频度及影响因素,护士对自身戒烟干预能力的评价,护士在校期间学习烟草相关知识的情况。结果护士实施5A’s戒烟干预方案中的“建议”和“评估患者的吸烟史及现状”比较频繁,实施其余干预内容的现状均不理想（如评估对尼古丁的依赖程度、提供尼古丁替代疗法的帮助、协助制定戒烟计划等）。“戒烟能改善患者的健康”的信念能促进护士实施戒烟干预,“患者没有戒烟的动机”、“繁重的工作量”、不认为“帮助患者戒烟是护理工作中优先考虑的”,会阻碍护士实施戒烟干预。临床护士对自身进行吸烟危害的健康教育、沟通能力等评价较为理想,但对给予尼古丁替代疗法（NRT）建议和使用一氧化碳检测仪等方面的能力认同较差。护士在校期间学习过的相关内容主要是烟草的危害,且学时有限（1～2h）,很少涉及戒烟技巧、药物疗法等内容,毕业工作后参加过戒烟培训的护士比例也极低（12．8％）。结论临床护士对5A’s戒烟干预的实施、所接受的戒烟相关教育以及实际戒烟干预能力和临床戒烟干预需要之间存在差距。     

Reliability and Validity of the Smoking and Women Questionnaire among Three Ethnic Groups

Abstract Cigarette smoking among women continues to be a major health risk to the smoker and to those around her. Programs aimed at stopping and maintaining smoking cessation have had very limited success due in part to the failure to individualize smoking cessation programs based on specific characteristics of the smoker. This study presents reliability and validity of a 14-item questionnaire developed to determine the readiness of women from three ethnic groups (non-Hispanic white, black American, and Hispanic American) to stop smoking. The Smoking and Women Questionnaire (SWQ) consists of items representative of core elements conceptualized in the Smoking/Ex-smoking Model for Women. The core factors are: beliefs/attitudes toward smoking, sociability, stress, coping, self-efficacy, motivation, nicotine dependence, and support. The SWQ was completed by both smoking and nonsmoking non-Hispanic white ( N = 233), smoking and nonsmoking black American ( N = 70), and smoking and nonsmoking Hispanic American ( N = 73) women. The test-retest correlation coefficient over a one- to three-week period ( N = 53) was .84. Cronbach alphas for whites, blacks, Hispanics, and combined groups were .81, .85, .84, and .83, respectively. Content validity was shown by experts who agreed that the core elements were represented in the SWQ. Construct validity was shown for ethnic groups separately and combined in that smokers had significantly lower SWQ scores than non-smokers. Items representative of the core elements were rated by smokers in a similar manner irrespective of ethnicity, suggesting similar attitudes and behaviors toward smoking. Further research is needed to determine if the SWQ can predict readiness of women to stop smoking and serve as a basis for developing individualized smoking cessation programs. Implications for smoking cessation programs are reviewed.     

WIC providers' perspectives on offering smoking cessation interventions

PURPOSE: To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. STUDY DESIGN AND METHODS: Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. RESULTS: Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. CLINICAL IMPLICATIONS: WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.     

The influence of friends on smoking commencement and cessation in undergraduate nursing students: a survey

BACKGROUND: Smoking is one of the leading causes of morbidity and mortality in most countries. Despite the fact that nurses have an important role in health promotion, and are in a good position to see and reflect on the detrimental effects of tobacco smoking, research has shown that the rate of smoking among nurses is similar to the rest of the population. OBJECTIVE: The objective of this study was to examine the attitudes and experiences of undergraduate nursing students in relation to smoking commencement and cessation. It was part of a larger study that explored students smoking behaviours, knowledge and attitudes. METHOD: A non-probability sample of 366 undergraduate nursing students from a large Australian school of nursing and midwifery took part in the study. The participants completed the Smoking and Health Promotion instrument. Ethics approval was obtained prior to the commencement of the study. RESULTS: Peers and friends were an important influence on the decision to commence smoking. The wish to comply with peer norms was especially prominent in mid-adolescence. Most smokers wanted to cease smoking, and many had tried unsuccessfully to stop on one or more occasions. They conceded that the pleasure they obtained from smoking and the effects of stress acted as barriers to stopping. The participants acknowledged the adverse health effects of smoking and some had already experienced these effects, but neither of these was enough to prompt them to cease. CONCLUSIONS: Undergraduate nursing curricula need to place greater emphasis on examining smoking related illnesses, as well as health promotion and role modelling in particular. Health promotion strategies that target peers are needed as an alternative to programmes that use fear or appeals to moral authority to prevent individuals from commencing smoking or encouraging cessation.     

Meeting national tobacco challenges: recommendations for smoking cessation groups

PURPOSE: To review the literature on model smoking cessation programs and provide an overview of the practice guidelines for intensive smoking cessation groups. DATA SOURCES: Selected evidence-based literature and AHCPR/AHRQ clinical practice guidelines. CONCLUSIONS: Smoking is the leading cause of preventable death in our global society and is expected to kill more people than any other disease within 20 years. Data support that most smokers want to quit and are more likely to succeed with a combination of behavioral and pharmacological support. IMPLICATIONS FOR PRACTICE: Smoking cessation must be a priority in the delivery of patient care. Intensive interventions are more effective than brief interventions and should be available for all smokers.