Telephone counseling for population-based smoking cessation

OBJECTIVES: To examine the options for use, efficiency, and effectiveness for structuring a population-based telephone smoking-cessation service. METHODS: Callers (n=632) to a 1-800 number were randomized in a 2 (50-minute counseling with 2/6 calls) x 2 (pamphlet/booklet) design with print only control. RESULTS: Six-month use of the service was 0.6% of adult smokers. Service promotion cost 31.02 dollars/person. Telephone counseling resulted in higher continued abstinence (5%) than did print only (1%), P<.05. Amount of print and calls did not increase cessation. Six calls resulted in lower completion rates than 2 (22% vs 56%, P<.05). CONCLUSIONS: For planning, consider 1% use, low-cost promotion, pamphlet, 50-minute initial counseling plus 2 follow-ups, and minimize call-attempts.     

The impact of physicians' brief smoking cessation counseling: a MIRNET study

Although many family physicians may discuss smoking cessation with their patients, few do so consistently. A common belief among many physicians is that such efforts will not deter their patients from smoking. Others believe the time commitment required for a successful intervention is excessive. The present study addressed the above issues by examining the effect of a 3- to 5-minute unstructured physician discussion encouraging smoking cessation with family practice patients. Cigarette-smoking patients of two busy family practices in southeast Michigan were randomly assigned to either a control group receiving routine care or an intervention group receiving, in addition to routine care, smoking cessation counseling from their physician. A third comparison group was drawn from smokers in practices not involved in delivering the intervention. Two hundred thirty-eight patients from the intervention group, 178 from the control group, and 47 from the comparison group were followed up with a telephone interview at 6 months. Intervention group patients made significantly more quit attempts than did those in the control group (P less than .001), which was similar to the comparison group. At the 6-month follow-up, 8% of intervention group members, and 4% of both the comparison and control groups reportedly were abstinent from smoking. Among those contacted at the 1-year follow-up, the respective percentages abstinent were 8%, 3%, and 4%. Although these differences in quit rates were not statistically significant, the findings suggest that physicians can positively affect patient smoking cessation. This intervention was feasible in busy family practices, highlighting its generalizability and applicability to other family practice settings in the United States.     

国际戒烟热线综述

戒烟热线是国际上广为采用的一种有效咨询服务方式。本文就国际戒烟热线的建立、宣传和运作等进行综述,以期为建立符合我国国情的热线咨询模式提供借鉴。1戒烟热线的服务种类戒烟热线通过各种方式为吸烟者提供多种戒烟服务[1],包括人工和语音咨询服务,在回答电话时当场给予一次     

Improving smoking cessation counseling by family practice residents.

BACKGROUND. While programs to train residents in smoking cessation counseling skills have been devised, few have assessed trainee behavioral changes in practice settings where residents were blind to the evaluation of their behavior. This study assessed the effectiveness of a training program in smoking cessation counseling and chart-prompting system in increasing the frequency and quality of counseling by residents at three clinic sites. METHODS. Twenty-eight residents participated in a training program that included epidemiology, discussion of attitudes, counseling techniques, videotaped examples, and small group role play. The chart-prompting system was implemented at two clinics 1 month after training. Patient exit interviews, during which information on resident counseling on smoking cessation was obtained, were conducted before training, after training, at 3-month follow-up, and at 6-month follow-up. Questionnaires assessing knowledge, attitudes, and self-perceived counseling behaviors were completed by residents at pretraining, posttraining, and 6-month follow-up periods. RESULTS. Interviews with 517 smokers were analyzed. Results showed an increase in counseling at 3-month follow-up but a regression toward baseline at 6 months. Counseling improved at clinics where chart prompting was initiated. The number of counseling behaviors decreased when the number of patients seen increased. Whether a patient received counseling was positively associated with prior contact with the physician. There was no correlation between resident self-perception and patient report. CONCLUSIONS. A training program in smoking cessation counseling and a chart-prompting system did not result in a lasting change in resident behavior. System factors may play an important role in long-term behavior change.     

Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling

Background  

Diseases associated with smoking are a foremost cause of premature death in the world, both in developed and developing countries. Eliminating smoking can do more to improve health and prolong life than any other measure in the field of preventive medicine. Today's medical students will play a prominent role in future efforts to prevent and control tobacco use.     

Gender differences among general practitioners in smoking cessation counseling practices

OBJECTIVES: To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender. METHODS: Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000. RESULTS: Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p<0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs. CONCLUSIONS: Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.     

Implementation rate of periodic health checkup at manufacturing factories in Kawasaki]

A questionnaire survey on periodic health checkup was conducted on 4,432 manufacturing factories in Kawasaki and the following results were obtained. 1) Implementation rate of periodic health checkup was 100% in factories with 100 workers or more. In smaller factories employing less than 100 workers, the implementation rate decreased with decrease in their total work force. The rate was 47.5% and 37.7% in factories with 9-4 and 3-1 workers, respectively. 2) The proportion of workers less than 30 years of age decreased and that of 60 or more years of age increased with decreasing size of the total work force. Distribution of both age groups was 12.6% and 12.9%, respectively in factories with less than 10 workers. The proportion of female workers increased from about 10% in factories with 300 workers or more to 26.8% in factories with less than 10 workers. 3) In large factories with 500 workers or more periodic health checkups were implemented mostly at their own or related medical facilities and in factories with 499-10 workers, almost 50% were implemented in independent health service facilities. In factories with less than 10 workers periodic health checkup were implemented mainly at health centers (33.1%) and at hospitals or clinics (26.9%). 4) The main reasons why small factories could not implement periodic health checkup were: (1) they could not afford the time for the implementation (50.0%) and (2) ignorance of the law of mandatory periodic health checkup for workers (23.6%).     

A randomized controlled trial of smoking cessation counseling after myocardial infarction

BACKGROUND: Smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality but in-hospital smoking cessation interventions are rarely part of routine clinical practice. METHODS: One hundred cigarette smokers consecutively admitted during 1996 with MI were assigned to minimal care or to a hospital-based smoking cessation program. Intervention consisted of bedside cessation counseling followed by seven telephone calls over the 6 months following discharge. Primary outcomes were abstinence rates measured at 6 months and 1 year post-discharge. RESULTS: At follow-up, 43 and 34% of participants in minimal care and 67 and 55% of participants in intervention were abstinent at 6 and 12 months. respectively (P<0.05). Abstinence rates were calculated assuming that participants lost to attrition were smokers at follow-up. Intervention and self-efficacy were independent predictors of smoking status at follow-up. Low self-efficacy combined with no intervention resulted in a 93% relapse rate by 1 year (P<0.01). CONCLUSIONS: A hospital-based smoking cessation program consisting of inpatient counseling and telephone follow-up substantially increases smoking abstinence 1 year after discharge in patients post-MI. Patients with low self-efficacy are almost certain to relapse without intervention. Such smoking cessation programs should be part of the management of patients with MI.     

Effects of skill level on individual behavioral counseling for smoking cessation

OBJECTIVE: The relationship between smokers' characteristics and success of smoking cessation has been examined in smoking intervention studies, but counselors' characteristics have generally not been considered. The purpose of the present study was to examine the relationship between counselor's skill level and intervention outcome. METHODS: The subjects were 858 smokers identified at annual health checkup at 6 worksites from January 1998 to September 1999. Smokers received stage-matched individual counseling by 23 trained counselors with feedback of results for carbon monoxide testing and nicotine metabolites in urine. If smokers set a quit date at the initial counseling session they received 4 follow-up telephone calls over 3 months. We further conducted 6 month and 1 year follow-up surveys using self-administered questionnaires. Smoking cessation status was validated by carbon monoxide test or family or colleague witnesses. We evaluated counselors' intervention skills using a structured evaluation form (total score: 0-24) based on videotaped interactions between each counselor and a simulated smoker. The intervention skills were classified into 3 levels, Low (0-14), Middle (15-17) and High (18-24). We performed multiple logistic regression analysis to adjust for smokers' characteristics and multi level analysis to adjust for counselors' characteristics other than counseling skills. RESULTS: Among the 23 counselors, 4, 11 and 8 counselors were assigned to the Low, Middle and High groups, respectively, which counseled 190, 344 and 324 smokers. The 7 day point prevalence abstinence rates at 6 months were 2.1%, 4.7% and 7.4%, respectively (cumulative chi-square test: P < 0.01). The 6 month sustained abstinence rates at one year were 1.1%, 3.2% and 4.6%, respectively (P < 0.05). The odds ratios of abstinence rates at 6 months and one year in Middle group were 2.33 (95% CI: 0.75-7.28) and 3.07 (0.65-14.54) respectively, compared to the Low group by multiple logistic regression analysis. In the High group they were 3.66 (1.21-11.04) and 4.86 (1.06-22.28). The results of the multi level analysis were approximately equal to those in the multiple logistic regression analysis. CONCLUSION: This result suggests that a higher counseling skill level can lead to higher abstinence rates.     

An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project

BACKGROUND: Little is known about the effectiveness of interventions to disseminate smoking cessation interventions among a population of primary care physicians. This study's objective was to determine the effect of a community-based academic detailing intervention on the quit rates of a population-based sample of smokers. METHODS: This community-based, quasi-experimental study involved representative samples of 259 primary care physicians and 4295 adult smokers. An academic detailing intervention was delivered to physicians in intervention areas over a period of 15 months. Analyses were performed on the data from the 2346 subjects who reported at least one physician visit over 24 months. Multivariate regression analyses were conducted to determine the impact of the intervention on self-reported smoking quit rates, reported by adjusted odds ratios. RESULTS: Among smokers reporting a physician visit during the study period, there was a borderline significant effect for those residing in intervention areas versus control areas (OR = 1.35; 95% CI.99-1.83; P = 0.057). Among a subgroup of 819 smokers who reported a visit with an enrolled physician, we observed a significant effect for those residing in intervention areas (OR = 1.80; 95% CI 1.16-2.75; P = 0.008). CONCLUSION: An academic detailing intervention to enhance physician delivered smoking cessation counseling is an effective strategy for disseminating smoking cessation interventions among community-based practices.     

Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence

We review the various ways in which telephone counseling has been used in smoking cessation programs. Reactive approaches--help lines or crisis lines--attract only a small percentage of eligible smokers but are sensitive to promotional campaigns. While difficult to evaluate, they appear to be efficacious and useful as a public intervention for large populations. Proactive phone counseling has been used in a variety of ways. In 13 randomized trials, most showed significant short-term (3-6 month) effects, and four found substantial long-term differences between intervention and control conditions. A meta-analysis of proactive studies using a best-evidence synthesis confirmed a significant increase in cessation rates compared with control conditions [pooled odds ratios of 1.34 (1.19-1.51) and 1.20 (1.06-1.37) at short- and long-term follow-up, respectively]. Proactive phone counseling appeared most effective when used as the sole intervention modality or when augmenting programs initiated in hospital settings. Suggestions for further research and utilization are offered.     

The costs of benefits: smoking cessation and health care expenditures

Guest commenator Dr. Kenneth E. Warner reflects on the unique contribution of the articles by Martinson et al and Musich et al in this issue in helping to explain why former smokers having higher medical costs than current smokers.     

The total lifetime health cost savings of smoking cessation to society

BACKGROUND: Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined. METHODS: The economic effects of smoking cessation in a lifetime perspective have been examined by comparing the health costs of continuing smokers and ex-smokers by quantity of daily tobacco consumption, age, gender and disease group, while taking differences in life expectancy and the reductions in relative risks after cessation into account. RESULTS: The total lifetime health cost savings of smoking cessation are highest at the younger ages. Although the economic savings vary with age at quitting, gender and quantity of daily tobacco consumption, all ex-smoking men and women who quit smoking at the age of 35 to 55 years generate sizeable total lifetime cost savings. At older ages, the total lifetime health cost savings of smoking cessation are of little economic consequence to the society. The total, direct and productivity lifetime cost savings of smoking cessation in moderate smokers who quit smoking at the age of 35 years are 24,800 euros, 7600 euros, and 17,200 euros in men, and 34,100 euros, 12,200 euros, and 21,800 euros in women, respectively. CONCLUSIONS: Lifetime health cost savings of smoking cessation to society are substantial at younger ages, in terms of both direct and productivity costs.     

The effect of Transtheoretical Model based interventions on smoking cessation

The Transtheoretical Model (TTM) proposes that stage matching improves the effectiveness of behaviour change interventions, such as for smoking cessation. It also proposes that standard smoking cessation interventions are matched to the relatively few smokers in the preparation stage and will not assist the majority of smokers, who are in the precontemplation or contemplation stages. This study tested the hypothesis that stage-matched interventions increase movement through the stages relative to interventions not stage-matched. It also tested the hypothesis that the relative effectiveness of stage-matched interventions is greater for people in precontemplation or contemplation (stage-matched for TTM but not for control) than for people in preparation (where both intervention and control were stage-matched). A total of 2471 UK adult smokers were randomised to either control or TTM-based self-help intervention and followed up 12 months after beginning the programme. Content analysis of the intervention and control self-help interventions examined whether control interventions were action-oriented, meaning they emphasised the processes of change relevant for preparation and action. Participants in the TTM arm were slightly more likely to make a positive move in stage, but this was not significant. There was no evidence that the TTM-based intervention was more effective for participants in precontemplation or contemplation than for participants in preparation. There was no evidence that TTM-based interventions were effective in this trial. The control intervention advocated process use appropriate for all stages and was not action-orientated. Stage matching does not explain the modest effects of TTM-based interventions over control interventions observed in some trials. These effects may instead have occurred because TTM-based interventions were more intensive than control interventions.     

Effect of training program regarding smoking cessation counseling for primary health care physicians in Port Said City,Egypt

Background

Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.

Objective

To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.

Methods

This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.

Results

There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%–80%), attitude (65% -100%), and practice (20%–70%) (p?<?0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%–87.3%) (p?<?0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%–100%) (p?<?0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%–100%) (p?<?0.001) pre-post intervention.

Conclusion

Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program.