Australian nurses' smoking behaviour, knowledge and attitude towards providing smoking cessation care to their patients

This study examined smoking-related knowledge, attitudes andpractices of hospital-based nurses. The specific aims were:to determine the prevalence of self-reported smoking and thecharacteristics of hospital nurses who smoke; to describe nurses'knowledge of the health risks of smoking and strategies whichaid quitting; and to describe their attitudes to smoking andquitting and providing smoking cessation care. The sample wasformed from all direct-care nurses from six large hospitalsin the Hunter region of New South Wales, Australia rosteredon the randomly selected data collection days over 4 monthsin 1991 (n = 388, 98%). Participating nurses completed an interviewmeasuring demographic and smoking history characteristics, andknowledge of smoking-related diseases, quitting strategies andreferral options (open-ended questions). A self-completed questionnairemeasured attitudes about smoking, quitting and nurse provisionof smoking cessation care. Twenty-two percent of nurses reportedbeing current smokers and 21.5% reported being ex-smokers, withhigher smoking rates reported by enrolled nurses compared withregistered nurses. Knowledge about the health effects of smokingwas high, but knowledge of more effective strategies to aidquitting and referral options was poor. Nurses had positiveattitudes towards assisting patients to stop smoking (60%),but restricted this to patients who wanted to quit. Only 21%felt competent to discuss cessation with patients and identifiedskills training as necessary. The findings suggest that smokingrates among nurses may be lower than those reported in pastdecades and lower than rates among women of the same age inthe general population. The findings also suggest that nurses,while perceiving a role in smoking care, require training inthe provision of smoking cessation care to hospital patients,and that hospital policies and nurse education providers needto strongly support the provision of smoking cessation by providingnurses with time, access and incentive to undertake such activities.     

Determinants of smoking and cessation during and after pregnancy.

Smoking during pregnancy is harmful to both the foetus and the woman herself. However, in spite of educational efforts, a substantial proportion of pregnant women continue to smoke and many women who do stop smoking during pregnancy resume smoking following childbirth. To foster successful maternal smoking cessation, public health professionals need to focus on the major determinants of smoking and cessation during and after pregnancy, and then to address these with their intervention efforts. It is important to review contemporary epidemiological evidence on this significant public health issue. We have identified nine cohort studies, published in international peer-reviewed journals, that have examined determinants of smoking and cessation in pregnant women. The results indicate that the determinants of pregnant smoking and cessation include maternal age, dose and duration of smoking, partner's smoking habit, socioeconomic status, level of education, age to start smoking, level of addiction, parity and passive smoking. However, many other psychosocial factors, which may affect smoking status among pregnant women, remain to be identified. Evidence reviewed here suggests that a more focused, integrated approach and a more comprehensive assessment of major determinants of smoking and cessation during pregnancy will be required as part of any future intervention effort.     

Smoking cessation in New Zealand: education and resources for use by midwives for women who smoke during pregnancy

This study describes the development and evaluation of educationprogrammes and associated resource materials to support smokingcessation and reduction, and breastfeeding promotion strategiesfor pregnant women who smoke, during usual primary maternitycare by midwives. Education programmes and resource materialswere developed by midwives and researchers as part of a clusterrandomized trial of Midwifery Education for Women who Smoke(the MEWS study). Development included a cohort study, advicefrom lactation consultants and smoking cessation counsellors(including Ma-ori professionals), and early consultation withmidwives who would be delivering the programmes. Resources developedincluded videotapes, charts and laminated information cards.Resources were pre-tested with pregnant women and opinion leaders.Consultation with the midwives allocated to each of the interventiongroups in the trial raised a number of issues. These were addressed,and solutions incorporated into each of the programmes, to enableeffective delivery within usual care. Following delivery ofthe programmes, women and their midwives were surveyed and asample interviewed to ascertain attitudes to the programmesand resources. Women and their midwives responded positivelyto the smoking cessation education programme, the breastfeedingpromotion programme and the resources used. Those women whodid not stop smoking completely often succeeded in significantlyreducing their tobacco consumption. Women identified their midwifeas a valuable resource and appreciated her ongoing encouragement.Involvement of health professionals who are to deliver healthpromotion interventions is essential for successful integrationof programmes into usual care. Midwives were able to effectivelydeliver programmes that were developed and targeted to theirneeds as health educators. The pregnancy-specific resourcesdeveloped for women who smoke played an important part in helpingmidwives deliver their health promotion messages more effectively.     

How place matters for smoking cessation: Barriers to smoking cessation among low-income Black women

African Americans start smoking later in life, yet they are less likely to quit smoking than other racial/ethnic groups. Drawing upon 40 in-depth interviews with former and current Black women smokers in the South Side of Chicago, this study examines external barriers to successful smoking cessation among socioeconomically disadvantaged Black women smokers. Beyond individual factors (e.g., stressors), this study finds interpersonal and structural factors that influence Black women's cessation efforts, including the high prevalence and normality of smoking and access to cheaper, loose cigarettes in their communities. Findings highlight the importance of considering local contexts for future tobacco research and policies.     

Smoking, smoking cessation, and use of smoking cessation aids and support services in South Derbyshire, England

OBJECTIVES: To describe smoking behaviour, motivation to quit and quit rates, and the effect of advice and support for smoking cessation among smokers from more and less disadvantaged socio-economic groups in South Derbyshire, a mixed urban and rural area of central England. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional study with a random, stratified sample of people aged 25-44 years and people aged 65-74 years with over-sampling of populations living in disadvantaged areas. Main outcome measures included the proportion of smokers wishing to quit and quitting in the last year; reported advice to quit from family and friends and health professionals; and awareness and use of NHS smoking-cessation services. RESULTS: Over half of smokers aged 25-44 years, about one-third of women smokers and 40% of male smokers aged 65-74 years wished to quit. This varied little by socio-economic status. Quit rates were generally lower among smokers of lower socio-economic status (SES), especially among people aged 25-44 years. Smokers of lower SES reported slightly less advice to quit from family and friends, and more so from health professionals. Awareness and use of cessation services was about 30% and 5%, respectively, among smokers and recent quitters. Awareness varied little but accessing services was generally higher among smokers of lower SES. CONCLUSIONS: Despite evidence that health professionals and cessation services were targeting smokers with lower SES and of similar motivation to quit, quit rates were lower. Broader tobacco control interventions targeting the social and environmental contexts that create and maintain socio-economic differentials in smoking are required.     

Smoking behavior,initiating and cessation factors among Japanese nurses: a cohort study

The prevalence of smoking among Japanese nurses, specially in their twenties, is higher than that among the general female population. To examine smoking behavior, smoking initiating and cessation factors, we conducted a cohort study through questionnaire survey, targeting nurses (n=1572) working at 11 hospitals located in Tokyo metropolitan area. The first survey was conducted using a confidential questionnaire on smoking, followed by a second survey conducted in the same manner on the same subjects two years later. As to smoking status after two years, 8% (95%CI=1.5%) started smoking and 6% (95%CI=1.4%) quitted resulting in a 2% increase in the prevalence of current smoking. The average nicotine dependence for nurses who were smokers in the two surveys rose from 3.9 to 4.3 (P<0.05). Smoking behavior of mother, friends, or superiors at work had a significant influence on smoking behavior of nurses. As to smoking cessation factors, the idea that women and medical workers should not smoke, and living with family each had a significant influence. Considering the fact that 6% of nurses in this study succeeded in quitting smoking within two years, it is required that anti-smoking education be conducted at medical institutions to decrease the prevalence of current smoking among the nurses in Japan.     

Quitting smoking and experience of smoking cessation interventions among UK Bangladeshi and Pakistani adults: the views of community members and health professionals

OBJECTIVE: To explore attitudes to quitting smoking and experience of smoking cessation among Bangladeshi and Pakistani ethnic minority communities. DESIGN: Qualitative study using community participatory methods, purposeful sampling, interviews and focus groups, and a grounded approach to data generation and analysis. SETTING: Newcastle upon Tyne, UK, 2000-2002. PARTICIPANTS: 53 men and 20 women aged 18-80 years, including smokers, former smokers, and smokers' relatives, from the Bangladeshi and Pakistani communities; and eight health professionals working with these communities. RESULTS: Motivation to quit was high but most attempts had failed. "Willpower" was the most common approach to quitting. For some, the holy month of Ramadan was used as an incentive, however few had been successful in quitting. Perceived barriers to success included being tempted by others, everyday stresses, and withdrawal symptoms. Few participants had sought advice from health services, or received cessation aids, such as nicotine replacement therapy (NRT) or buproprion. Family doctors were not viewed as accessible sources of advice on quitting. Health professionals and community members identified common barriers to accessing effective smoking cessation, including: language, religion and culture; negative attitudes to services; and lack of time and resources for professionals to develop necessary skills. CONCLUSIONS: High levels of motivation do not seem to be matched by effective interventions or successful attempts to quit smoking among Bangladeshi and Pakistani adults in the UK. There is a need to adapt and test effective smoking cessation interventions to make them culturally acceptable to ethnic minority communities. UK tobacco control policies need to give special attention to the needs of ethnic minority groups.     

Work stress, smoking habits and competence in supporting clients to cease smoking--a survey among Finnish nurses

This paper describes results of a survey of Finnish nurses (n=882), their views of themselves as employees, their experiences of work stress and their competence to guide clients in smoking cessation. Nurses' skills to guide clients were fairly good but they had a lack of knowledge of smoking cessation centers and nicotine substitutions. The more positive the nurses' views were of themselves as employees, and the less they had experienced work stress related to their clients, the better they evaluated their skills and knowledge to guide clients to cease smoking. The results can be used to develop nurse education by providing a stronger knowledge base of smoking cessation. Nurses' view of themselves as employees could be strengthened by providing them with positive feedback from colleagues and managers.     

Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study

Objective : This study aimed to explore factors influencing community service organisation (CSO) staff members’ willingness to provide tobacco cessation support to clients experiencing disadvantage. Methods : Face‐to‐face semi‐structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. Results : The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. Conclusions : The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health : The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.     

妊娠早期被动吸烟与不良妊娠结局的队列研究

目的分析城市孕早期妇女被动吸烟状况,探讨被动吸烟对不良妊娠结局的影响,减少不良妊娠结局的发生。方法调查孕早期妇女被动吸烟状况,将其分成被动吸烟组与无被动吸烟组,追踪其妊娠结局,采用χ2检验和Logistic回归分析方法,分析被动吸烟与不良妊娠结局的关系。结果城市孕早期妇女被动吸烟率为38·2%,被动吸烟与不良妊娠结局呈一定的剂量-反应关系,每日被动吸烟的时间越长发生不良妊娠结局的可能性就越大,每日被动吸烟的时间超过3h对不良妊娠有显著影响。结论被动吸烟可使不良妊娠发生的危险增加,每日被动吸烟的时间超过3h是不良妊娠的强危险因素。加强孕前对孕妇的宣教和指导,尽量避免暴露于吸烟环境,可减少不良妊娠结局的发生。     

Existential multiplicity and the late‐modern smoker: negotiating multiple identities in a support group for smoking cessation

To examine identity work of smokers attempting to quit, we undertook participant observation at an Israeli cessation support group. Grounded theory and thematic analysis of group dialogue permitted identification of recurring themes and the presentation of illustrative vignettes. We found that, rather than the linear, goal‐oriented constitution of a univocal non‐smoking identity, identity work entailed re‐appraisals of the experience of liminality between smoking and non‐smoking selves. Although the group participants reduced their tobacco consumption and some even quit, specific technologies of self sustained the smoking self alongside the non‐smoking self. We propose that the social contextualisation of the smoker in the context of late modernity may explain the tolerance of chronic ambivalence and the constitution of a ‘resistant’ smoking– non‐smoking self. Phenomenological accounts of the experience of this hybrid self may more fully explain protracted or failed cessation and further deconstruct binary readings of indulgence or control, addiction or abstinence and illness or wellness. Our findings call for the re‐conceptualisation of the experience and outcome of protracted cessation and a tolerant policy‐driven intervention.     

Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan

Cigarette smoking during pregnancy affects the unborn fetus. This study aimed to investigate: (1) the smoking status of pregnant women before, during and after pregnancy in the Yamato and Ayase municipalities, Kanagawa, Japan; (2) the characteristics that differentiate successful spontaneous smoking quitters from continuous smokers during pregnancy; and (3) the awareness of risks of smoking that may influence smoking cessation during pregnancy. A community-based, cross-sectional survey of 420 postpartum women, who delivered their babies from July 2002 to October 2002, was performed. Out of 420 respondents, 275 (65.4%) did not smoke before and during pregnancy. Of the 145 women who smoked before pregnancy, 101 (69.3%) quit successfully while pregnant. Smoking prevalence during pregnancy was 10.4%. Out of 101 successful quitters during pregnancy, 22 (21.8%) women resumed smoking after childbirth. A multiple regression analysis showed that the independent predictors of smoking cessation during pregnancy were primiparous women and women living with non-smokers in the household. Although maternal age predicted smoking cessation in a simple regression analysis, this predictive value was lost in the multiple analysis. A simple analysis showed no significant association between the awareness of smoking risks and smoking cessation during pregnancy. It is suggested that Japanese smokers are more likely to quit while pregnant than women in other countries. In the future, smoking cessation programmes should be designed to help multiparous women and women living with smokers to give up smoking.     

Indigenous women and smoking during pregnancy: knowledge, cultural contexts and barriers to cessation

Despite active tobacco control efforts in Australia, smoking prevalence remains disproportionately high in pregnant Indigenous women. This study investigated the place of smoking in pregnancy and attitudes towards smoking within the broader context of Indigenous lives. Focus groups and in-depth interviews were used to collect data from 40 women, and ten Aboriginal Health Workers (AHWs) in Perth, Western Australia. The research process and interpretation was assisted by working with an Indigenous community reference group. Results demonstrated the impact of contextual factors in smoking maintenance, and showed that smoking cessation even in pregnancy was not a priority for most women, given the considerable social and economic pressures that they face in their lives. Overwhelmingly, smoking was believed to reduce stress and to provide opportunities for relaxation. Pregnancy did not necessarily influence attitudes to cessation, though women's understanding of the consequences of smoking during pregnancy was low. Reduction of cigarette intake during pregnancy was seen as an acceptable and positive behaviour change. The AHWs saw their role to be primarily one of support and were conscious of the importance of maintaining positive relationships. As a result, they were often uncomfortable with raising the issue of smoking cessation with pregnant women. The stories of Indigenous women and AHWs provided important insight into smoking during pregnancy and the context in which it occurs.     

Lifecourse influences on women's smoking before,during and after pregnancy

The concept of the socioeconomic lifecourse is increasingly informing understanding of the social patterning of cigarette smoking. We investigated lifecourse influences on (i) women's smoking status (smoker/non-smoker) before pregnancy and (ii) quitting in pregnancy in the UK Millennium Cohort study. Our analyses included conventional measures of the socioeconomic lifecourse (woman's childhood circumstances, education, current socioeconomic circumstances) and measures of her domestic lifecourse (age of becoming a mother, current cohabitation status), as well as parity (first/subsequent child). In analyses of quitting, we also included pre-pregnancy cigarette consumption.     

Healthy foods prepared at home: Diet and support as protective strategies during pregnancy for Hispanic women

Birth outcomes tend to be better among Hispanics than among other ethnic groups, even when matched for poverty and education, and foreign-born Latinas compared to their US-born counterparts. These patterns suggest that sociocultural factors exhibited by recent immigrants have the potential to protect birth outcomes against the instability of minority and low socioeconomic status. To discover potential sociocultural factors, a pilot qualitative study was carried out in Tucson, Arizona, with 18 Hispanic mothers. The two most prevalent factors reported were (1) a healthy diet prepared at home from minimally processed ingredients, and (2) constant and comprehensive social support. When comparing responses related to diet by interview language preference, a proxy for acculturation, there was very little difference between participants who interviewed in Spanish and those who interviewed in English. This result may be explained by greater maternal social support and higher education levels among those who interviewed in English.