中国戒烟门诊现状调查

目的 了解我国戒烟门诊运行现状和面临的挑战,为今后的控烟工作提供证据支持。方法 2013年采用电话调查的方式对我国201家戒烟门诊进行问卷调查,采用半结构式访谈的方法对6家戒烟门诊负责人进行访谈,并采用面对面调查方式对北京地区398名吸烟者进行问卷调查。使用SPSS 19.0软件进行统计学分析。结果 全国仍在正常运行的戒烟门诊有94家,51%的戒烟门诊设置在呼吸内科,平均配备出诊医生或护士3.24人,近一个月平均每周接诊量为6.92人。针对北京戒烟门诊和吸烟者调查显示,戒烟门诊病例的一个月戒烟成功率在50%以上;公众对戒烟门诊知晓率为48%;如果要戒烟,会选择去戒烟门诊的比例为21.9%;不选择的主要原因是认为吸烟不是“疾病”。结论 戒烟门诊就诊量少,导致戒烟门诊数量大幅下降,政府和医院应共同努力加大戒烟门诊的宣传力度,提高公众对戒烟门诊的认识和接受程度,建立良好的戒烟门诊转诊机制,提高医务人员戒烟咨询能力。     

Identifying perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital results from focus group interviews

OBJECTIVE: To identify perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital. SUBJECTS: Thirty-three female nurses who were interested in providing their patients with smoking cessation support in the hospital setting participated in focus group interviews. They conducted six focus group interviews segmented by age, working conditions (e.g., outpatient or inpatient sections) and occupational class (e.g., administrative post or not). DESIGN: An experienced researcher moderated two focus groups and another researcher who received training moderated four focus groups. At least two observers hand-recorded participants' conversations in each group and all groups were also tape-recorded. Moderators and observers analyzed the focus group data together. RESULTS: We found that smoking cessation counseling or health education on effects of smoking to be rarely conducted in the hospital. The study participants ordinarily just told patients to stop smoking. They mentioned several barriers to conducting smoking cessation support and suggested a number of ideas to promote this aim in the hospital. CONCLUSIONS: The focus group interview is an effective means to determine the needs and interests of Japanese health professionals. Nurses have many opinions and insights for supporting smoking patients. To introduce a smoking cessation program into hospitals, there are various problems that should be solved. First, nurses and other health professionals should have accurate knowledge, positive attitudes and appropriate skills for smoking cessation support. Second, smoking cessation support should be programmed as part of treatment or nursing. Third, healthcare professionals, especially doctors, should collaborate in supporting patients to stop smoking. Fourth, the hospital environment should be modified to promote smoking cessation. Finally, hospitals should develop a consensus among all staff about the importance of smoking cessation support and smoking control activities. As the result, multidimensional strategies are needed to effectively promote smoking cessation support in the hospital setting.     

Is provider training effective? Changes in attitudes towards smoking cessation counseling and counseling behaviors of home health care nurses

OBJECTIVE: We prospectively examined whether training home health care nurses is associated with changes in attitudes towards smoking cessation counseling and counseling behaviors. METHODS: We trained 98 home health care nurses to deliver cessation counseling to their patients. Measures were administered at pre-training, post-training, and 6 months later. This was part of a larger study conducted in Providence, RI, USA (1998-2002). RESULTS: Compared with pre-training, at post-training, nurses reported significantly higher levels of self-efficacy to counsel, positive outcome expectations, optimism that patients would follow their advice, perceived worth of smoking counseling, perceived importance of quitting smoking, and perceived organizational support. These training effects were maintained 6 months later. Between the end of training and the 6-month follow-up, nurses reported significant increases in their perceived effectiveness to counsel smokers and confidence to encourage behavior change. Compared with pre-training, at 6 months of follow-up, nurses were significantly more likely to ask about smoking status, assess readiness to quit, advise to quit, assist with quitting, and arrange follow-up. Nurses spent significantly more time counseling smokers at 6 months than at pre-training, and were less likely to selectively counsel. CONCLUSIONS: Brief training facilitates both short- and long-term changes in nurse attitudes and behaviors regarding smoking cessation counseling.     

Smoking-cessation counseling in the home: Attitudes, beliefs, and behaviors of home healthcare nurses

BACKGROUND: Despite advances in smoking treatment, cessation rates remain stagnant, possibly a function of the lack of new channels to reach heavily addicted smokers. This cross-sectional study examined home care nurses' attitudes, beliefs, and counseling behaviors regarding counseling their home care patients who smoke. METHODS: Home healthcare nurses (N=98) from the Visiting Nurse Association of Rhode Island were randomly selected to participate in a study helping home-bound medically ill smokers to quit. At baseline, nurses completed a questionnaire that assessed a constellation of cognitive factors (self-efficacy, outcome expectations, perceived effectiveness, risk perception, motivation, and perceived patient adherence) as correlates of self-reported nurse counseling behaviors. RESULTS: Nurses with higher outcome expectations spent more time counseling their patients about quitting (p<0.04). Nurses' self-efficacy was the only variable associated with consistent counseling (p<0.05). While the majority of nurses "asked and advised" their patients, a minority of nurses "assisted or arranged" follow-up. Perceived importance of counseling was associated with a greater likelihood of asking, advising and assisting (p<0.05). None of the nurses who currently smoked (n=13) provided follow-up to their patients. Nurses who reported higher levels of both risk perception (regarding the harmful effects of smoking) and perceived effectiveness were more likely to recommend the nicotine patch. CONCLUSIONS: Attitudes and beliefs about smoking are significantly associated with nurse counseling behaviors. Helping nurses to overcome their barriers to smoking counseling may open up new channels for smoking intervention.     

Nurse and physician patient counseling about tobacco smoking in Jordan

The objective of this study was to identify whether nurses are as likely as physicians to feel prepared to assist patients to quit smoking, to have smoked in front of patients, or to have received training on counseling patients about smoking cessation. The sample consisted of 262 nurses and 251 physicians, ages 18 years and older, from public and private hospitals in Jordan. It was found that nurses were more likely than physicians to receive training on counseling patients about smoking cessation (41% vs. 18%); more likely to currently smoke (30% vs. 19%); and less likely to feel prepared to assist patients to quit smoking (78% vs. 95%). Smoking status and training were associated with counseling patients about smoking. Approximately 19% of nurses and 81% of physicians who currently or formerly smoked had previously smoked in front of patients. Nurses compared with physicians have lower agreement with statements involving smoking-related responsibilities and views on smoking policy, but higher agreement that second-hand smoke is related to selected diseases. Physicians felt more strongly than nurses that they should serve as role models for the public, routinely advise their smoking patients to quit, and speak to lay groups about smoking. In conclusion, a greater level of smoking cessation training among physicians and nurses in Jordan is warranted.     

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.     

Barriers experienced by nurses providing smoking cessation support to disadvantaged,young women during and after pregnancy

In Europe, smoking during and after pregnancy is still highly prevalent among socioeconomically disadvantaged women. Nurses caring for these women can play a key role in smoking cessation, but encounter many problems when providing support. This research aims to identify barriers in providing smoking cessation support, experienced by nurses working within a Dutch preventive care programme for disadvantaged young women (VoorZorg), and to understand the underlying reasons of these barriers. Sixteen semi‐structured interviews with nurses were performed. All interviews were recorded, transcribed and analysed deductively and inductively. We found that the VoorZorg programme provided nurses with training, resources and time to deliver smoking cessation support. Yet, nurses experienced important barriers, such as unmotivated clients and support methods that do not fit clients’ needs. Underlying reasons are competing care demands, unsatisfactory training for cessation support, lack of self‐efficacy in attending their clients, and conflicts with own professional attitudes. The results emphasise that nurses’ ability to provide smoking cessation support could be improved by proper training in interventions that fit their clients’ needs, and by time schedules and task definitions that help them to prioritise smoking cessation support over other matters.     

2015-2018年央补项目戒烟门诊患者首诊后1个月随访时戒烟率影响因素分析

目的 评估中央补助地方戒烟门诊项目实施效果,探索影响吸烟者戒烟成功的因素,以指导戒烟服务的提供和戒烟门诊工作的开展。方法 采用人群现场干预研究,由经过项目培训的医务人员,对吸烟者进行面对面访谈,完成调查问卷,并进行心理行为干预。已配备戒烟药物的医院,为患者开具相应药物。首诊1个月后开展随访干预,获得1个月随访7 d时点戒烟率。结果 1个月随访7 d时点戒烟率为34.1%。多元logistic回归结果显示, ≥60岁患病人群戒烟可能性最大;自身患病、首诊非每天吸烟、准备在30 d内戒烟、使用酒石酸伐尼克兰和盐酸安非他酮的患者,戒烟成功的可能性更大;未就业者相对于就业者更不利于戒烟;每日吸烟量越大、吸烟年限越长、晨起后第一支烟越急迫的患者,戒烟的可能性越小;是否有戒烟史对戒烟可能性没有影响。结论 从1个月随访时7 d时点戒烟率看,央补戒烟门诊项目戒烟干预有效。应加大对吸烟者的宣传,戒烟越早越有效。使用酒石酸伐尼克兰和盐酸安非他酮等药物能增加戒烟的可能性,应加强戒烟门诊有效药物的配备率。戒烟门诊医务人员帮助患者在戒烟过程中克服戒断症状很重要。     

Helping Smokers Quit: Understanding the Barriers to Utilization of Smoking Cessation Services

Context: Counseling smokers to quit smoking and providing them with pharmaceutical cessation aides are among the most beneficial and cost‐effective interventions that clinicians can offer patients. Yet assistance with quitting is not universally covered by health plans or offered by all clinicians. Analysis of stakeholders' perspectives and interests can identify the barriers to more widespread provision of cessation services and suggest strategies for the public policy agenda to advance smoking cessation. Methods: Review of literature and discussions with representatives of stakeholders. Findings: All stakeholders—health plans, employers, clinicians, smokers, and the government—face barriers to broader smoking cessation activities. These range from health plans' perceiving that covering counseling and pharmacotherapy will increase costs without producing commensurate health care savings, to clinicians' feeling unprepared and uncompensated for counseling. Like other preventive measures aimed at behavior, efforts directed at smoking cessation have marginal status among health care interventions. State governments can help correct this status by increasing Medicaid coverage of treatment and expanding coverage for state employees. The federal government can promote the adoption of six initiatives recommended by a government subcommittee on cessation: set up a national quit line, develop a media campaign to encourage cessation, include cessation benefits in all federally funded insurance plans, create a research infrastructure to improve cessation rates, develop a clinician training agenda, and create a fund to increase cessation activities through a new $2 per pack cigarette excise tax. Both the federal and state governments can increase cessation by adopting policies such as the higher cigarette tax and laws prohibiting smoking in workplaces and public places. Conclusions: Public policy efforts should assume greater social responsibility for smoking cessation, including more aggressive leadership at the state and federal levels, as well as through advocacy, public health, and clinician organizations.     

Smoking Cessation Counseling Practices of Texas Pharmacists

A cross-sectional study was conducted to determine pharmacists’ awareness and education about smoking cessation and their communication with patients about smoking cessation. A survey was mailed to East Texas pharmacists practicing in the areas of hospital or clinical, retail or community, managed care, consultant, or academic pharmacy. Outcome measurements included: measures of the awareness of the 5 A’s and 5 R’s of smoking cessation, training received in smoking cessation, and communication practices regarding smoking cessation. There were 320 respondents. Approximately 10% of the respondents indicated they had received tobacco cessation counseling education during their formal educational training, 36% during continuing education programs, and 9% during both formal training and continuing education. About 44% reported they had received no tobacco cessation counseling training. Among pharmacists surveyed, 5% responded that they usually or always ask their patients if they smoke cigarettes, pipe, or cigars, 43% reported they sometimes or half of the time ask, and 45% said they never ask. There is a clear relationship between pharmacists awareness and education of smoking cessation techniques and their communication with patients about them. Pharmacy education leaders must continue their movement to include public health in the pharmacy curricula to produce pharmacists who are prepared to better serve the community. This project was funded by a grant from the Texas Department of State Health Services.     

Nurses' Attitudes Concerning the Delivery of Brief Cessation Advice to Hospitalized Smokers

BACKGROUND: Nurses have a unique opportunity to assist hospitalized smokers with cessation. However, relatively little is known about nurses' attitudes and beliefs toward their role in assisting patients with cessation. METHODS: A cross-sectional survey of staff nurses at four hospitals was conducted. Four scales based on constructs from the Theory of Planned Behavior were developed for this survey: attitudes toward offering cessation advice, beliefs about the outcome of offering advice, perceived normative beliefs, and perceived ability to offer advice. Other survey items included sociodemographics, employment characteristics (shift, unit worked), and personal smoking status. RESULTS: Of the nurses surveyed, 397 (68%) returned completed questionnaires. Nurses had a relatively positive attitude toward helping patients to quit smoking, 63% believed that hospitalization was an ideal time for patients to try to quit smoking, and 59% believed a nurse had an obligation to advise patients to quit smoking. In the final multiple linear regression model, self-reported delivery of cessation advice was related to attitudes toward offering cessation advice, perceived ability to offer advice, and unit worked. CONCLUSIONS: Efforts should be made to educate staff nurses about the efficacy of brief cessation advice and current smoking cessation methods and practices.     

北京市丰台区1182名医务人员吸烟及控烟情况调查

目的了解丰台区医务人员吸烟及控烟情况，为下一步开展医院控烟工作提供基础资料。方法采用分层抽样的方法抽取北京市丰台区一、二、三级医院各2家，再在被抽中的医院中以系统抽样的方式抽取1182名医务人员进行问卷调查。调查内容包括一般情况、吸烟和戒烟情况、医院控烟情况。结果男性吸烟率为41．8％，女性吸烟率为0．8％，男性高于女性（P〈0．01）。男性中，医生的吸烟率为31．5％，后勤人员吸烟率为75．6％。不同文化程度者吸烟率不同，中专及以下者吸烟率最高，平均为13．6％，其中男性为69．2％，女性为1．7％。在吸烟者中，有54．0％的人曾经戒过烟，戒烟失败的主要原因为缺乏意志力，占50．0％。36．0％的医务人员不知道该如何戒烟，只有23．7％知道“五日戒烟法”，3．8％知道“安非他酮是尼古丁替代品”。结论男性医务人员吸烟率高，控烟知识和技能较差，临床医务人员的控烟工作还面临着巨大挑战。     

Opportunities for improving inpatient smoking cessation programs: a community hospital experience

BACKGROUND: This cohort study examined the role of smoking during hospitalization, duration of cessation counseling, patient awareness of the hospital's smoke-free policy, belief that smoking is associated with a current symptom or disease, and the presence of withdrawal symptoms with 12-month smoking cessation among inpatients enrolled in a smoking cessation program. METHODS: Inpatients in four community hospitals (N = 1,317) participated in a smoking cessation intervention consisting of face-to-face counseling at baseline and four follow-up counseling phone calls. Patients were classified as nonsmokers only if they reported not smoking at both the 6- and the 12-month interviews. All patients lost to follow-up were considered smokers. RESULTS: At 1 year the smoking cessation rate was 22.5%. Cessation was independently associated with reporting no smoking during hospitalization, noting no withdrawal symptoms at baseline, and believing that a current illness or symptom is related to smoking. Length of counseling interview and awareness of the hospital's smoke-free policy were not independently associated with cessation. CONCLUSIONS. Smoking cessation programs and hospital policies that decrease smoking during hospitalization, address withdrawal symptoms during hospitalization, and make clear the connection between a patient's health and cigarette smoking may increase the effectiveness of their smoking cessation efforts.     

Enhancing smoking cessation rates in primary care.

BACKGROUND: The Agency for Health Care Policy and Research (AHCPR) guidelines on smoking cessation recommend that primary care physicians provide both brief advice against smoking and follow-up care for all smokers. Surveys show that although physicians understand the importance of smoking cessation, the actual implementation of these guidelines is limited. The main objective of our study was to evaluate the comparative effectiveness of 2 different approaches to smoking cessation counseling: practice-based and community-based. METHODS: Both smoking cessation approaches consisted of 1 recruitment session and 6 computer-assisted counseling sessions. In the practice-based approach, counseling was provided by office nurses and telephone counselors; in the community-based approach, the counseling was given by telephone counselors only. Four practices in 3 mid-Michigan communities participated, including 120 physicians and 487 patients who were smokers. The physicians were trained to provide brief advice for smoking cessation consistent with the AHCPR guidelines; the nurses and telephone counselors were trained in relapse prevention, computer skills, and individual case management. Sixty-two percent of the participants obtained free nicotine replacement therapy. RESULTS: At 6 months, quit rates (7-day smoke-free status) were 35% in the practice-based group and 36% in the community-based group. Participants who completed at least 4 sessions showed higher quit rates than those who did not. CONCLUSIONS: Nurses in primary care practices and counselors can be trained to deliver effective relapse-prevention counseling during office visits and by telephone. Our study showed an increase in the reported rates of smoking cessation by using these counseling methods.     

Nationwide Smoking Cessation Treatment Support Program – Turkey project

BackgroundIn 2011, Turkish Ministry of Health (MoH) initiated a nation-wide “Smoking Cessation Treatment Support Program” (SCTSP), to provide smoking cessation drugs free of charge.MethodsSCTSP was conducted in all 81 cities of Turkey, at 228 smoking cessation clinics, and by over 400 physicians. In total, 164,733 participants took advantage of the program between January and November 2011. Varenicline (Champix^®, Pfizer) and Bupropion (Zyban^®, GlaxoSmithKline) were used in the program at a ratio of 0.7 and 0.3 respectively. Post-program data were obtained by phone interviews from randomly selected participants, who had completed a 1-year follow-up after enrollment in the program.FindingsQuit rates were 29.6% for those given Varenicline and 25.1% for those given Bupropion. The quit rates for participants with hypertension (35.0%), diabetes mellitus (36.9%), coronary artery disease (32.1%) and cerebrovascular events (34.0%) were higher than those without. Increased age, female gender, longer duration of cessation drug use, low Fagerstrom score, the presence of hypertension, the absence of chronic obstructive pulmonary disease, and the absence of cancer were found to be associated with higher success rates.InterpretationSCTSP is the first successful report of a nation-wide community-based smoking cessation intervention. The real-life quit rates obtained herein are comparable to those of clinical evidence to date. The centralization of smoking cessation clinics, standardization of treatment guidelines, application of a specific drug assignment algoritm, and provision of primary care support and follow-ups by trained physicians, appeared to be key elements for success.     

上海市闵行区社区医院职工吸烟行为干预效果研究

目的探索医院吸烟行为干预模式并评价干预效果。方法在闵行区选择3家人口构成、吸烟率相似的社区卫生服务中心，随机分为3组，以其所有职工为研究对象。对照组按照无烟医院标准进行管理；干预组1实施为期一年的控烟行政措施干预方法；干预组2实施为期一年的控烟技能培训干预方法。在干预前后进行问卷调查评价干预效果。结果干预后，2个干预组在吸烟有害因素知晓率、控烟知识和技能掌握情况以及吸烟行为方面均有较大改善，其中干预组l的吸烟率下降了4．2％，干预组2的吸烟率下降了6．0％，对照组的吸烟率上升了7．0％，干预组1和2的吸烟率均明显低于对照组；两个干预组对病人进行戒烟指导的情况无明显变化，仍以简单指导为主。结论在医院中开展控烟干预，可以降低医务人员的吸烟率，弥补了无烟医院建设在长效管理中出现的薄弱环节。     

Hospital nurse counseling of patients who smoke.

Smoking-related diseases comprise a large portion of hospital admissions. This paper reports the attitudes and behaviors of a group of hospital-based nurses toward counseling patients on smoking cessation. The majority of nurses do not counsel patients who smoke. Counseling practices vary with the smoking status of the nurse. Barriers to increased nursing participation in counseling efforts include the lack of counseling training and physician failure to utilize nurses in this role.     

综合性医院开展戒烟干预方法研究的设计和初步结果

为探索综合性医院开展戒烟干预的方法并评价其效果,采用戒烟门诊专科干预、简单干预、义诊干预和集体干预等模式对不同吸烟人群进行包括健康咨询、心理干预和药物治疗等不同形式及内容的戒烟干预,以统一规范的指标和方法评价干预效果.在项目实施的20个月中,共对690名吸烟者进行干预,对其中402名完成6个月随访的干预对象进行的初步统计分析发现:目前已完成的戒烟门诊专科干预、集体干预和戒烟义诊时的简单干预3种模式均有一定干预效果,吸娴者的吸烟量有不同程度下降,吸烟者戒烟的动机、医生采用的干预模式及强度是影响干预效果的主要影响因素;戒烟门诊专科干预和集体干预的效果优于戒烟义诊的简单干预,其6个月随访时的时点戒烟率分别为31.6%、30.9%和15.1%.戒烟者的戒烟动机和医生的态度、戒烟方法的选择及干预技能水平对戒烟成功率影响较大,因此探索适合国情的戒烟服务模式及个体化干预方法十分必要.

Abstract：

To study the intervention programs on smoking cessation in a general hospital and to evaluate its effects of the programs. Four methods including: a) the intervention through specialists in the smoking cessation clinic, b) short-time intervention in the out-patient department,c) free medical intervention, d) group intervention, were adopted for different smokers, with health counseling, psychological intervention and drug treatment. Intervention effect was evaluated by standard methods. During the 20-month period of the project, we treated 690 cases and 402 completed 6-month follow-up. Preliminary results in 402 cases showed that the three methods of smoking cessation interventions could reduce the amount of cigarette smoking and increase the quitting rate. Motivation to quit smoking, intervention methods and intensity of intervention seemed cessation clinic (31.6%) and in the group intervention (30.9%) was higher than short-time intervention in free medical events (15.1%). The successful rate of smoking cessation depended on the motivation of quitters, and the attitude, methods and intervention skills of the physicians.Therefore, it is necessary to explore and develop smoking cessation service models suitable to national context and individual intervention methods in China.     

Smoking behavior of nurses in Mie Prefecture, Japan

Nurses who work in hospitals and clinics belonging to a regional medical association in Mie prefecture were surveyed regarding their smoking behavior and several related factors. The results are summarized as follows: 1) Smoking prevalence in male and female nurses was 75.5% and 14.6% respectively. In the present study the rate of female nurses was almost equal to results reported in a national survey. 2) Smoking prevalence was higher among licensed practical nurses than registered nurses, and it was highest among psychiatric nurses. 3) Smoking prevalence among hospital and clinical nurses was 15.7% and 9.1% respectively. Smoking prevalence was lower among clinical nurses, even though, they have a higher number of licensed practical nurses. Also smoking prevalence was higher in hospitals with a smaller nursing staff than in hospitals with a larger nursing staff. 4) Among smokers, 44.5% seriously had attempted to quit smoking, and 34.1% had considered quitting but never tried. Therefore, the results suggest the importance of providing smoking cessation programs for nurses.     

Barriers among nurses to providing smoking cessation advice to hospitalized smokers.

Nine focus groups were conducted with 75 staff nurses in three hospitals to determine the low participation rate of nurses in a smoking cessation programs directed at patients. Nurses felt that hospitalization was an appropriate time to offer quit-smoking advice to patients, particularly those with smoking related diseases. However, many felt advice should be given only to those receptive to it. The most common barriers to providing smoking cessation advice were lack of concrete techniques, or referral to provide and fear of alienating patients who were not receptive to hearing advice.