Feasibility of implementation of a Dutch smoking cessation and relapse prevention protocol for pregnant women

A cross-sectional design was used to asses whether Dutch midwives trained to use a smoking cessation counseling protocol appreciated it and could implement it in routine care. Midwives received a questionnaire after the implementation period of the effectiveness study was finished. In total, 118 midwives from 42 practices participated in the study, 69 midwives (58.5%) returned the questionnaire. To validate the results collected among midwives, clients who participated in the study were also questioned about the information they received about smoking cessation from their midwife.Experimental midwives more often reported giving the advice to quit (B=0.50, S.E.=0.24, P<0.05), setting a quit date with clients who indicated to be motivated to quit (B=1.69, S.E.=0.28, P<0.001) and discussing aftercare (B=1.10, S.E.=0.25, P<0.001). These results were confirmed by data collected among clients.This easy-to-implement program is recommended for broad dissemination. Further investigation is needed to improve the partner and postpartum component.     

African-American physicians and smoking cessation counseling.

While African American physicians can play a key role in encouraging black patients who smoke to quit, little is known about the views and activities of these physicians with respect to antitobacco programming. In the process of developing a protocol for encouraging physicians'' smoking cessation intervention, 96 African-American physicians completed a survey indicating their knowledge, attitudes, and practices relating to stop smoking counseling. Few physicians reported patient help-seeking behavior and 47.9% cited lack of patient motivation as a key barrier to intervention. Only 46.8% believed that it is possible to accomplish a lot of cessation help in a few minutes time, and 34.4% believed that setting up and maintaining an office protocol would require a great deal of effort. Explaining health risks (71.9%) and enrolling patients in programs (66.6%) were perceived as keys to patient cessation; fewer than half of the physicians surveyed discuss specific strategies for quitting with their patients. Physicians indicated a willingness to offer more counseling in the future and were open to a range of strategies for learning more about effective approaches. Our findings support the need for dissemination of such information, particularly among specialists, to support antitobacco efforts among African-American physicians.     

An automated telephone-based smoking cessation education and counseling system

Automated patient education and counseling over the telephone is a convenient and inexpensive method for modifying health-related behaviors. A computer-controlled, telecommunications technology called Telephone-Linked Care (TLC) was used to develop a behavioral intervention to assist smokers to quit and to prevent relapse. The education and counseling is offered through a series of interactive telephone conversations which can take place in the smoker's home. The system's automated dialogues are driven by an expert system that controls the logic. The content is derived from the Transtheoretical Model of behavioral change, principles of Social Cognitive Theory, strategies of patient-centered counseling and recommendations of clinical experts in smoking cessation. The system asks questions, provides information, gives positive reinforcement and feedback, and makes suggestions for behavioral change. Information that the patient communicates is stored and is used to influence the content of subsequent conversations.     

Provision of smoking cessation counseling by general practitioners assisted by training and screening procedure

OBJECTIVE: To examine which counseling behavior among GPs can be achieved after counseling training when organizational support is provided. METHODS: A random sample of 39 general practices was drawn, 34 took part. GPs received a pre-study assessment followed by a training session for smoking counseling. All patients showing up during a period of 1 week were asked about smoking status. Current smokers, aged 18-70 years were eligible (N=551), 81.8% participated. A documentation sheet, filled in by a study nurse transferred smoking-related information about patient to the GP. GPs were advised to fill in a post-counseling assessment for every patient. A post-study assessment with the GPs was conducted. RESULTS: Frequent barriers for smoking counseling were lack of time and the assumption that patients were not motivated to quit. The GP's documented smoking counseling in 96.0%. The patients (87.8%) could be thoroughly counseled. Younger age of the GP, a high number of patients and the contemplation stage quitting smoking were predictors for realizing counseling. 79.3% of the GPs assessed the procedure to be practicable. CONCLUSIONS: Smoking counseling in the general practice is feasible. PRACTICE IMPLICATION: Involving staff in the screening procedure may support counseling activity of the GP.     

The effects of depressed mood on smoking cessation: mediation by postcessation self-efficacy

This study evaluated the relationship between precessation depressed mood and smoking abstinence and assessed the mediation of this effect by postcessation self-efficacy, urges to smoke, nicotine withdrawal, and coping behavior. The sample included 121 smokers previously treated in a randomized controlled trial involving behavior therapy and the nicotine patch. The results showed that precessation depressed mood was inversely related to 6-month abstinence. This effect remained significant after controlling for treatment, possible depression history, baseline smoking rates, and several other demographic factors. Postcessation self-efficacy, at the 2-, 4-, and 8-week postquit assessments, was the strongest mediator of the effects of precessation depressed mood on abstinence, accounting for 32%, 38%, and 48% of the effect of mood on abstinence, respectively.     

Biomarker feedback intervention for smoking cessation among Alaska Native pregnant women: Randomized pilot study

Objective

There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers.

Attitudes toward smoking cessation among men and women

Recent reports indicate that women are less successful than men in their attempts to quit smoking. Sex differences in attitudes toward smoking cessation were examined cross-sectionally in a sample of 447 smokers randomly selected from employees of 10 diverse Minnesota worksites and interviewed in early 1984. No sex differences were found in the percentage of smokers who had tried to quit at least once in the past; indeed, over four of five respondents reported prior attempts to quit. Yet compared to women, men were more interested in quitting. Women were less likely than men to perceive the health benefits of quitting and expressed more concern about weight gain and job pressures related to quitting. No significant sex differences were found in prior use of formal cessation services, which had been used by about one-fourth of these respondents. Yet compared to men, women appeared to rely on informal sources of support, such as encouragement from co-workers. These findings underline the importance of intervention programs targeting women and suggest strategies that might enhance the effectiveness of such programs oriented toward women.     

Smoking in Dutch pregnant women and birth weight

In this study 796 ambulatory singular pregnant women were questioned about their smoking habits both before and during pregnancy (ambispective). Important covariates such as parity, blood pressure, maternal weight gain, salt- and alcohol consumption and length of gestation were taken into account. At the beginning of pregnancy 52% of the questioned women smoked; 36% smoked in the seventh/eighth month of pregnancy. A dose-response relationship was found between the number of cigarettes smoked per day and birth weight. For those pregnant women who still smoked after 7 months of pregnancy an average birth weight loss of 24 g was found per cigarette per day. Even after controlling for covariates, there still remains an independent influence of smoking on birth weight loss on the average of 19 g for each cigarette smoked per day.     

Effectiveness of physicians-in-training counseling for smoking cessation in African Americans.

This study examined the effectiveness of smoking cessation counseling by physicians-in-training (residents) with African-American patients. One hundred fifty-eight family and internal medicine residents at a large urban public general hospital participated in the study; two thirds of the residents underwent a 2-hour smoking cessation training program. Ninety-two of the trained physicians counseled from 1 to 18 patients. The majority of physicians were male, with 8% being current smokers. Over a 26-month period, 1086 patients were randomly assigned to intervention and control (usual care) groups. Mean patient age was 44 years, mean years smoking was 25, and mean number of cigarettes smoked per day was 14. There were no differences in biochemically validated smoking cessation rates between the intervention and control groups at 3 or 12 months postenrollment (2% versus 1.8% and 2.2% versus 2.8%, respectively). Losses to follow-up were high at both 3 and 12 months (38% and 40% respectively). Implications for future trials in minority populations are discussed. A brief physician-based smoking cessation message does not appear to be an effective strategy for use with African-American smokers in a large urban public general hospital.     

Nicotine dependence and secondary effects of smoking cessation

The secondary effects of smoking cessation among subjects included in a randomized trial, performed to test the efficacy of acupuncture and nicotine chewing gum vs. the control group, are reported according to nicotine dependence. After 1 month of cessation, ex-smokers had modified their nutritional intake, had gained weight, and felt more irritable compared to subjects still smoking. After 1 year, secondary effects concerned greater weight gain and irritability. The percentage of subjects who presented these secondary effects was more frequent among high-dependent than among low-dependent ex-smokers.We thank the Haut Comité d'Aide à la Lutte Contre le Cancer, France, for financial support and A. B. Leo and Co., Sweden, for financial support and for supplying the nicotine gum.     

Changes in energy balance following smoking cessation and resumption of smoking in women

Caloric intake, resting metabolic rate (RMR), leisure-time physical activity, and sensitivity and preference for sweet taste were prospectively examined in 7 female smokers across 3 weeks during periods of normal smoking (Week 1), complete cessation (Week 2), and resumption of smoking (Week 3). Energy balance changed significantly across weeks, as caloric intake increased (largely as a result of alcohol consumption) and RMR decreased during cessation, followed by decreased caloric intake and increased RMR with resumption of smoking. Activity and taste sensitivity and preference remained unchanged. Smoking cessation may thus cause rapid change in energy balance, which is quickly reversed on resumption of smoking.     

A comparison of homeless women and their intimate partners

In this study, we examine differences among 448 homeless women and their male partners in terms of sociodemographic and psychological characteristics, risky sexual and drug-use behaviors, and childhood abuse and adult victimization. Findings reveal women scored significantly lower on mental health and self-esteem, and significantly higher on depression, anxiety, and hostility measures, than their intimate partners. Scores for the dyad were nevertheless indicative of poor mental health functioning. Homeless women and their intimate partners both reported low levels of injection drug-use (5% and 6%); higher percentages of both groups reported practicing unprotected sex (70% vs. 72%) and sex with multiple partners (26% vs. 23%). Homeless women were less likely to report non-injection drug use, but more likely to report childhood and adult sexual abuse, than their intimate partners. Implications for Acquired Immune Deficiency Syndrome (AIDS) risk reduction and safety enhancement programs for the dyad are discussed. © 1999 John Wiley & Sons, Inc.     

University hospital physicians' attitudes and practices for smoking cessation counseling in Malatya, Turkey

The aim of the study is to determine attitudes and self-reported practices performance for smoking cessation counseling of the physicians working at a university hospital in Malatya, Turkey. All physicians who were providing health care to adult patients in 19 outpatient clinics at the hospital were administered a self-reported questionnaire. Of the physicians, 26.5% reported that they were always asking about their patients' smoking history and 22.6% were always advising their smoker patients to quit. Men non-smoker physicians more often practiced counseling than men smoker physicians. Negative attitudes of physicians about smoking cessation counseling negatively effected their practices. Negative attitudes were significantly higher among men smoker physicians than non-smokers but attitudes did not differ among female smoker and non-smoker physicians. The findings showed that smoking cessation counseling was rarely practiced by physicians and physicians' practices differed by their smoking behavior, departments and attitudes towards smoking cessation.     

The cost effectiveness of an education outreach representative to OB practitioners to promote smoking cessation counseling.

Growing concern about mothers, smoking during pregnancy calls for effective patient education by health care professionals. Because most women receive prenatal care and people with high perceived self-risk do have high cessation rates when advised by physicians, prenatal care in private practice offers a unique opportunity to decrease the number of pregnant women who smoke. The pilot test described here is a one-group pretest and posttest community trial which tested the feasibility of using an education outreach representative to market smoking- and pregnancy-education materials to private practice physicians. The costs of the pilot test are compared to the costs of three other strategies for disseminating education materials. The pilot test proved more cost-effective than two direct-mail strategies and one commercial enterprise. These results suggest that this strategy is feasible and merits further study for distributing education materials and teaching effective education strategies to physicians.