Predictors of physician's smoking cessation advice

OBJECTIVES--To determine the percentage of smokers reporting that a physician had ever advised them to smoke less or to stop smoking, and the effect of time, demographics, medical history, and cigarette dependence on the likelihood that respondents would state that a physician had ever advised them to stop smoking. DESIGN AND SETTING--Data were collected from the Stanford Five-City Project, a communitywide health education intervention program. The two treatment and three control cities were located in northern and central California. As there was no significant difference between treatment and control cities regarding cessation advice, data were pooled for these analyses. PARTICIPANTS--There were five cross-sectional, population-based Five-City Project surveys (conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990); these surveys randomly sampled households and included all residents aged 12 to 74 years. MAIN OUTCOME MEASURES--Improved smoking advice rates over time in all towns was an a priori hypothesis. RESULTS--Of the 2710 current smokers, 48.8% stated that their physicians had ever advised them to smoke less or stop smoking. Respondents were more likely to have been so advised if they smoked more cigarettes per day, were surveyed later in the decade, had more office visits in the last year, or were older. In 1979-1980, 44.1% of smokers stated that they had ever been advised to smoke less or to quit by a physician, vs 49.8% of smokers in 1989-1990 (P less than .07). Only 3.6% of 1672 ex-smokers stated that their physicians had helped them to quit. CONCLUSION--These findings suggest that physicians still need to increase smoking cessation counseling to all patients, particularly adolescents and other young smokers, minorities, and those without cigarette-related disease.     

Cigarette smoking in pregnancy

It is likely that the most important example of passive smoking is that which is imposed on the fetus. An article in the April 18, 1988, issue of the "Medical Journal of Australia" makes it clear (Condon and Hilton) that great difficulties will be faced in dealing with the effects of smoking during pregnancy. Gritz (1980) examined the evidence for fetal toxicity from tobacco smoke and the risk ratios for the various hazards. The risk of spontaneous abortion is increased by a factor of 1.8, low birth weight by a factor of 2.0, and perinatal mortality by a factor of 1.35. These increases come as no surprise given what is known regarding the pathophysiology of tobacco's effect on the fetus and the placenta. Condon and Hilton report on the observation that pregnant women find it much easier to stop drinking alcohol than to quit smoking cigarettes. Women who reported positive feelings about their pregnancy also indicated that their concern about, and attachment to, their unborn child provided insufficient motivation to stop using nicotine. It is assumed that the women described in this article were aware of the risks to the fetus from smoking in that such information is available almost as a routine part of antenatal care, and all but 1 of the smokers did try to reduce or to stop their use of nicotine. Yet, 14 of the 35 smokers failed in their efforts to reduce their smoking; another 7 smokers could manage only a small reduction. The 23,000 tobacco-associated deaths/year support the importance of developing a strategy to deal with nicotine dependence, particularly in situations of high risk such as pregnancy. The most reasonable and potentially effective approach would be to expend energy on preventing or dissuading young women from smoking in the 1st place. Over the past decade there have been numerous efforts at mass-media and educational campaigns to dissuade women from smoking, but these efforts have been overwhelmed totally by the determined drive on the part of tobacco companies to recruit female smokers.     

Quitting smoking in pregnancy

Smoking doubles the risk of having a low-birthweight baby and significantly increases the rate of perinatal mortality and several other adverse pregnancy outcomes. The mean reduction in birthweight for babies of smoking mothers is 200 g. High quality interventions to help pregnant women quit smoking produce an absolute difference of 8.1% in validated late-pregnancy quit rates. If abstinence is not achievable, it is likely that a 50% reduction in smoking would be the minimum necessary to benefit the health of mother and baby. Healthcare providers perform poorly in antenatal interventions to stop women smoking. Midwives deliver interventions at a higher rate than doctors. The efficacy of nicotine replacement therapy has not been established in pregnancy. Currently, its use should only be considered in women smoking more than 10 cigarettes per day who have made a recent, unsuccessful attempt to quit and who are motivated to quit. Relapse prevention programs have shown little success in the postpartum period.     

The impact of routine advice on smoking cessation from family physicians.

Cigarette smoking continues to be a major health problem. Therefore, physicians have been asked to advise all their patients on the hazards of smoking. A controlled trial was undertaken to measure the impact of family physicians' advice to cigarette smokers during a routine office visit. No significant differences were found in the three measures used to determine outcome--desire to stop smoking, an attempt to stop and success in stopping--between the control and intervention groups. These results are discussed in relation to the health belief model, and suggestions are made on how to increase the impact family physicians could have on smoking cessation to their practices.     

A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland

Background

The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit.

Aims

To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital.

Methods

Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital.

Results

Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe.

Conclusions

Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.     

Effects of smoking and fetal hypokinesia in early pregnancy

BACKGROUND: The aim of this study was to perform qualitative and quantitative ultrasound (US) monitoring of fetal movement in early pregnancy (gestational weeks 10-20) as a component of fetal behavior in women smokers. METHODS: The study included three groups of 20 pregnant women each: non-smokers (group 1), smokers of an average of 10 cigarettes daily (group 2), and smokers of an average of >20 cigarettes daily (chronic smokers; group 3). Two-dimensional US study was performed once during gestational weeks 10-20 by the then standard method of fetal movement monitoring: 1) quantitative measurement of global fetal movements qualitatively verified as brisk or sluggish; 2) quantitative measurement of isolated spontaneous head movements; 3) quantitative measurement of isolated spontaneous arm movements; 4) quantitative measurement of isolated spontaneous leg movements; and 5) M-mode measurement of fetal heart rate. RESULTS: The ratio of brisk to sluggish fetal movements was 82.8% to 17.2%, 79.01% to 20.98%, and 44.25% to 55.75% in groups 1, 2, and 3, respectively (p <0.001). The rate of isolated spontaneous head and arm movements and of the upper cerebral pattern (head and arm movements) was statistically significantly lower in group 3 as compared with groups 1 and 2 (p <0.001), whereas no statistical significance was recorded in isolated spontaneous leg movements (p >0.01). The rate of fetal tachycardia was also significant in group 3, whereas tachyarrhythmia was recorded in seven children born to group 3 mothers (p <0.001). CONCLUSIONS: The present study of the effect of chronic tobacco hypoxia on the components of fetal behavior revealed a positive correlation between global and isolated fetal hypokinesia of the upper cerebral pattern (p <0.001), fetal tachycardia, and tachyarrhythmia in the group of mothers who were chronic smokers (p <0.001).     

Cost-effectiveness of nicotine gum as an adjunct to physician's advice against cigarette smoking

A nicotine chewing gum has recently become available for use as an aid in giving up cigarette smoking. Although its efficacy has been demonstrated in clinic-based smoking cessation programs, its value in a primary care setting is uncertain. We examined the cost-effectiveness of nicotine gum as an adjunct to physician's advice and counseling against smoking during routine office visits. Our findings indicate that the cost per year of life saved with this intervention ranges from $4113 to $6465 for men and from $6880 to $9473 for women, depending on age. This compares favorably with other widely accepted medical practices, eg, treatment of hypertension or hyperlipidemia. Our study, therefore, suggests that nicotine gum is a cost-effective adjunct to physician's advice against cigarette smoking in a primary care setting.     

Teenage smoking in pregnancy and birthweight: a population study, 2001-2004

OBJECTIVE: To determine the association between smoking in pregnant teenagers and baby birthweight. DESIGN, SETTING AND PARTICIPANTS: A retrospective population-based study of women aged < 20 years who gave birth to liveborn singletons in Australia between January 2001 and December 2004. Data were drawn from the National Perinatal Data Collection. MAIN OUTCOME MEASURES: Maternal smoking, birthweight, low birthweight (LBW). RESULTS: The prevalence of LBW in babies born to teenage smokers was 9.9%, compared with 6.0% in babies born to teenage non-smokers (odds ratio [OR], 1.72 [95% CI, 1.57-1.90]). On average, babies born to teenage smokers were 179.8 g lower in birthweight than babies born to teenage non-smokers (95% CI, 165.5 -194.1 g; t = 24.6, P < 0.001). Smoking, Indigenous status, Socio-Economic Indexes for Areas category and parity were independently associated with LBW (all ORs > 1.3; P < 0.001) after adjusting for maternal age group. Teenagers smoking > 10 cigarettes a day had babies with lower birthweight that those who smoked < or = 10 cigarettes a day, demonstrating a dose-response relationship. The babies of teenage smokers who stopped smoking before 20 weeks' gestation had birthweights similar to those of babies born to teenage non-smokers. One in 15 teenage smokers stopped smoking during pregnancy. CONCLUSION: Babies whose mothers smoked during pregnancy were more likely to have LBW than babies whose mothers did not smoke. Mothers who continue to smoke in the second half of pregnancy increase their baby's risk of LBW. There is significant scope to improve the quitting rate, and health professionals need to target smoking cessation at all contacts with pregnant women who continue to smoke.     

Nutrition and aging--practical advice for healthy eating

This article provides practical advice about foods and dietary supplements that are beneficial for the health of older people. Overweight and obesity are among the most common nutrition-related disorders in older people. A plant-based diet is associated with reduced risk of chronic diseases such as obesity, cardiovascular disease, cancer, and diabetes. Vitamin B12 deficiency is prevalent in older adults, but there are misconceptions about the causes, consequences, and treatments. Diminished synthesis of vitamin D in the skin that occurs with aging and poor dietary intake contribute to the high prevalence of poor vitamin D status in older adults. Vitamin D deficiency is associated with chronic disorders beyond poor bone health. Supplements containing vitamin B12 and vitamin D will help older adults meet their needs for these key nutrients.