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.     

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.     

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.     

Dissecting the genetic overlap of smoking behaviors,lung cancer,and chronic obstructive pulmonary disease: A focus on nicotinic receptors and nicotine metabolizing enzyme

Smoking is a major contributor to lung cancer and chronic obstructive pulmonary disease (COPD). Two of the strongest genetic associations of smoking-related phenotypes are the chromosomal regions 15q25.1, encompassing the nicotinic acetylcholine receptor subunit genes CHRNA5-CHRNA3-CHRNB4, and 19q13.2, encompassing the nicotine metabolizing gene CYP2A6. In this study, we examined genetic relations between cigarettes smoked per day, smoking cessation, lung cancer, and COPD. Data consisted of genome-wide association study summary results. Genetic correlations were estimated using linkage disequilibrium score regression software. For each pair of outcomes, z-score-z-score (ZZ) plots were generated. Overall, heavier smoking and decreased smoking cessation showed positive genetic associations with increased lung cancer and COPD risk. The chromosomal region 19q13.2, however, showed a different correlational pattern. For example, the effect allele-C of the sentinel SNP (rs56113850) within CYP2A6 was associated with an increased risk of heavier smoking (z-score = 19.2; p = 1.10 × 10⁻⁸¹), lung cancer (z-score = 8.91; p = 5.02 × 10⁻¹⁹), and COPD (z-score = 4.04; p = 5.40 × 10⁻⁵). Surprisingly, this allele-C (rs56113850) was associated with increased smoking cessation (z-score = −8.17; p = 2.52 × 10⁻²⁶). This inverse relationship highlights the need for additional investigation to determine how CYP2A6 variation could increase smoking cessation while also increasing the risk of lung cancer and COPD likely through increased cigarettes smoked per day.     

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.     

Use of medical counseling for the prevention and control of smoking in the municipality of old Havana

Physicians have an important responsibility for addressing smoking cessation and prevention with their patients. The objective of this study was to describe the use of physician counseling for the prevention and control of smoking and to predict its use according to physician characteristics. A cross-sectional survey of a random sample of 121 family physicians in one municipality of the city of Havana was used to address sociodemographic factors, years of practice in the community, smoking status, use of physician counseling in daily practice (ask, advise, and assist), and the role of physician counseling as an intervention. Summary statistics were used as well as canonical and discriminant analyses. The prevalence of smoking among the physicians was 18%. The smoking status of patients was determined “almost always” by 32% of doctors. Twenty-five percent asked their patients whether they intended to stop smoking; 35% recommended smoking cessation; and 38% gave advice on how to achieve this. More than half (58%) explored factors that might influence cessation in their patients, and 12% reported doing this “frequently.” Physician characteristics were associated significantly with preventive behavior, with community involvement, and with the perceived value of physician counseling and smoking status. Physician responses were associated with actual practice in 82% of the cases. Predisposing, facilitating, and reinforcing factors for preventive behavior were strong determinants of active involvement by physicians in daily practice. Training of health professionals must include smoking cessation.     

Effects of stage-matched repeated individual counseling on smoking cessation: A randomized controlled trial for the high-risk strategy by lifestyle modification (HISLIM) study

Objective  The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking. Methods  We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20–30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia. Results  The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia. Conclusions  We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit. Investigators of the research group are listed in the final report of the Research on Long-Term Chronic Disease “Seikatsu Syukanbyo han” 1998, granted from the Ministry of Health and Welfare, Japan     

江西省2013年成年人吸烟与戒烟行为现状调查

目的 调查2013年江西省≥18岁常住居民吸烟与戒烟行为的流行状况。方法 2013年7-10月采用多阶段分层整群随机抽样方法,在江西省10个全国慢性病及其危险因素监测点抽取≥18岁常住居民6 000人,通过面对面问卷调查收集慢性病相关危险因素信息,用于吸烟与戒烟行为分析的有效样本量为5 997人。对样本进行复杂加权后,分析江西省不同人群特征成年居民吸烟和戒烟流行现状。结果 2013年江西省≥18岁常住居民现在吸烟率为21.53%（1 291/5 997,标化率为20.60%）,复杂加权计算后,现在吸烟率为26.07%（95%CI：23.48%~28.66%）,男性现在吸烟率（50.62%,95%CI：46.31%~54.94%）高于女性（1.46%,95%CI：0.57%~2.35%）,差异有统计学意义（P<0.05）,各年龄组人群现在吸烟率差异有统计学意义（P=0.029）,并随文化程度提高而上升（P<0.05）、随自报健康状况下降而下降（P<0.05）。87.16%（95%CI：83.29%~91.03%）的现在吸烟者每日吸烟;日均吸烟量（机制卷烟）为19.27（95%CI：17.69~20.85）支;平均每天吸烟量≥20支的吸烟者比例为64.74%（95%CI：55.79%~73.70%）;每日吸烟者开始吸烟平均年龄为20.28（95%CI：19.74~20.82）岁,男性开始每日吸烟年龄[20.11（95%CI：19.61~20.61）岁]小于女性[26.88（95%CI：24.73~29.03）岁],差异有统计学意义（P<0.05）,27.04%（95%CI：18.91%~35.16%）的成年男性开始每日吸烟年龄不足18岁。吸烟者戒烟率为14.80%（95%CI：10.88%~18.72%）,随年龄增大而上升（P<0.05）、随收入水平增加而上升（P=0.04）,随自报健康状况下降而上升（P<0.05）;吸烟者成功戒烟率为10.89%（95%CI：8.36%~13.42%）;32.10%（95%CI：21.95%~42.25%）的现在吸烟者有戒烟打算。被动吸烟率为54.71%（95%CI：44.20%~65.21%）。结论 江西省≥18岁常住居民吸烟率处于较高水平,重度吸烟者比例大,戒烟者比例低,戒烟意识不强,男性和青少年为控烟工作主要目标人群,应根据江西省流行特点采取针对性的控烟措施。     

Involvement of family nurses in home visits during an 8-year period encompassing primary healthcare reforms in Poland

Home visits by doctors and nurses are considered an important indicator of the quality of healthcare. Published data are scarce regarding the role of family nurses in providing professional home care in Central and Eastern European countries that have recently introduced reforms to their primary care systems. The objective of the present study was to describe the involvement of family nurses in home visits in the context of organizational and legal changes in service provision, that is, to analyse the role of the family nurses employed by family doctors (1998) versus family nurses working in autonomous positions (2002 and 2006). The proportion of patients in the community receiving a home visit from a family nurse, the purpose of the family nurse's home visit and patient expectations towards the family nurse were studied. A series of cross-sectional studies were conducted in a small town in northeastern Poland, based on three consecutive surveys taken at 4-year intervals (1998, 2002, 2006, surveys I, II and III, respectively). During each survey, 1000 patients were interviewed (face to face) with structured questionnaires. In 1998, family nurses were employed by family doctors, but by 2002, nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II (12.8% and 30.0%); however, the number of respondents reporting a home visit in survey III decreased to 23.9%. Patients over 75 years of age were the major demographic group receiving family nursing at home. This study suggests that reform of the primary healthcare system in Poland has produced changes in the family nursing system. Independence, contractual obligations and self-employment of Polish family nurses have resulted in their greater participation in home visits.     

Smoking Cessation Counseling Practices of General Practitioners in Montreal

BACKGROUND: Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. METHODS: A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities. RESULTS: Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided "thorough" counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1-3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0-6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5-3.5)), high self-efficacy (OR = 3.5 (2.0-5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6-4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1-3.2)), awareness of stages of change (OR = 2.4 (1.3-4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3-3.9)). CONCLUSION: Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners.     

Health care costs among smokers,former smokers,and never smokers in an HMO

OBJECTIVE: We estimate long-term health care costs of former smokers compared with continuing and never smokers using a retrospective cohort study of HMO enrollees. Previous research on health care costs associated with former smokers has suggested that quitters may incur greater health care costs than continuing smokers, therefore, getting people to quit creates more expensive health care consumers. We studied the trend in cost for former smokers over seven years after they quit to assess how the cessation experience impacts total health care cost. DATA SOURCES/STUDY SETTING: Group Health Cooperative (GHC), a nonprofit mixed model health maintenance organization in western Washington state. STUDY DESIGN: Retrospective cohort study using automated and primary data collected through telephone interviews. PRINCIPAL FINDINGS: We find that former smokers' costs are significantly greater (p<.05) in the year immediately following cessation relative to continuing smokers, but former smokers' costs fall in year two. This decrease maintains throughout the six-year follow-up period. Although former smokers cost more than continuing smokers in the year after cessation, this increase appears to be transient. Long-term costs for former smokers are not statistically different from those of continuing smokers and cumulative health care expenses are lower by the seventh year postquit. Our evidence suggests that smoking cessation does not increase long-term heath care costs. CONCLUSIONS: Health care costs among former smokers increase relative to continuing smokers in the year after cessation but fall to a level that is statistically indistinguishable in the second year postquit. Any net increase in costs among former smokers relative to continuing smokers appears compensated for within two years post-quit and is maintained for at least six years after cessation.     

A 2-Year Efficacy Study of Not On Tobacco in Florida: An Overview of Program Successes in Changing Teen Smoking Behavior

BACKGROUND: Adolescent smoking has been an issue of major concern in the United States. This has led to a need for the development, evaluation, and dissemination of effective youth cessation programs. The purpose of this paper is to report the results of a 2-year demonstration study (1999-2000) of the American Lung Association's teen smoking cessation program, the Not On Tobacco (NOT) program. METHODS: The study used a "matched" design wherein each NOT school was matched to a brief intervention (BI) school. The study consisted of 20 NOT and 20 BI Florida high schools encompassing 627 students. The primary outcome measures were carbon monoxide-validated quit and reduction rates for NOT and BI schools at 5.2 months postprogram. RESULTS: NOT smoking cessation and reduction outcomes were significantly better than those of the brief intervention. Further, data indicate that NOT was more effective than the brief intervention for females compared with males; males showed successful quit attempts in both intervention groups. Overall, more NOT youth either quit or reduced smoking than did BI youth. CONCLUSIONS: These positive smoking behavior changes suggest that NOT is an effective teen smoking cessation option.     

The Association Between Adolescent Smokers' Desire and Intentions to Quit Smoking and Their Views of Parents' Attitudes and Opinions about Smoking

Objective: To explore whether an association exists between adolescent smokers’ attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents’ expressed disapproval of smoking, and the importance they place on their parents’ opinions. Methods: This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. “Have you ever seriously thought about quitting smoking?” was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit. Results: Regardless of whether their parents smoked, adolescents who placed value on their parents’ opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents’ expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, “When I’m older, my parents won't mind that I smoke” was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit. Conclusions: Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers’ desire to quit smoking.     

心理干预联合药物对吸烟者的戒烟效果评价

目的 评价伐尼克兰在临床实践中对戒烟门诊患者戒烟的有效性.方法 采用前瞻性观察性研究设计,选择符合纳入标准的吸烟者799人,每名患者首诊时进行标准的基线问卷评估,并在第1、第3和第6个月进行随访.由经过培训的医师对每名患者完成面对面的咨询和个体化戒烟干预.接受药物辅助戒烟者定为心理干预联合药物组(n=272),未用药者为单纯心理干预组(n=527).采用意向性分析的统计学方法分析比较两组的7天时点戒烟率、3个月随访时的1个月持续戒烟率和6个月随访时的3个月持续戒烟率.结果 6个月随访时,心理干预联合药物组的7天时点戒烟率显著高于单纯心理干预组(34.6% vs. 23.1%;OR=1.75,95% CI:1.27～2.42;P<0.001),心理干预联合药物组的3个月持续戒烟率也显著高于单纯心理干预组(31.3% vs. 18.2%;OR=2.04,95%CI:1.46～2.86;P<0.001).1和3个月随访时,心理干预联合药物组无论是7天时点戒烟率还是1个月持续戒烟率均高于单纯心理干预组.结论 在真实临床实践的戒烟门诊中,给予戒烟者药物辅助戒烟可有效提高戒烟率.     

家长参与家庭控烟程度对初中生吸烟行为影响

目的探讨家长参与家庭控烟程度对初中生吸烟行为的影响。方法采用随机抽样方法从广州市黄埔区20所中学中抽取3所学校,对在校初中生的家长以自填式结构问卷进行调查,内容包括家长的一般情况、家长参与家庭控烟程度以及其子女吸烟行为等。采用多元协方差分析法分析家长参与家庭控烟的程度对子女吸烟行为的影响。结果2 019份有效问卷中,初中生尝试吸烟率为5.60%（男生10.05%,女生2.25%）;偶尔吸烟率为4.41%（男生8.47%,女生1.32%）;规律吸烟率为1.19%（男生1.58%,女生0.93%）。母亲参与家庭控烟程度高于父亲,男生家长参与程度高于女生家长。家长参与控烟的程度越高,其子女吸烟越少。结论家长在家庭内进行烟草控制可减少和（或）延缓青少年吸烟。     

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.     

A comparison of smoking habits, beliefs and attitudes among Tuscan student nurses in 1992 and 1999

Two-hundred-and-fifty students (aged 24 ± 4 years, mean ± SD, females were 75%) attending the first year of training in Florence Nursing School in 1991–1992 and 205 ones (aged 22 ± 4 years; females 83% of the total) in the first year course of Nursing Schools of the Universities of Siena and Florence in 1998–1999 answered the same anonymous, self-administered questionnaire about their smoking habits, beliefs and attitudes. The overall response rate was 92% in 1992 and 88% in 1999. In 1992 and 1999, respectively, ex-smokers were 13 and 11%, current smokers 51 and 43%. Ten percent of nurses who smoked in 1992 and 16% in 1999 were occasional smokers. The average daily number of cigarettes among respondents who smoked was lower in 1999. For both the surveys the beliefs about tobacco smoking remained generic and more often drawn from unspecific sources of information. Compared to 1992, in 1999 student nurses improved some attitudes towards smoking, such as the increased awareness that smoking cessation methods may be useful to quit and that hospital should be smoke-free. These positive attitudes did not change their smoking habits and the opinion on their ongoing smoking habits. Student nurses also did not obtain a consistently increased awareness about their role for advising subjects who smoked against smoking. We conclude that from 1992 to 1999 in Tuscany the smoking habits of first year student nurses changed little and remained high. There is a need for targeting antismoking education and for including specific training about tobacco smoking in the curricula of Italian nurse schools.     

Knowing the diagnosis and counselling the relatives of a person with dementia: the perspective of home nurses and home care workers in Belgium

Home nurses and home care workers share the care for a person with dementia with family caregivers, and are confronted with their needs for medical and service-related information, for advice on how to cope with the behaviour changes, and for emotional support. The first objective of the present study was to describe some of the conditions for effective counselling, such as the perception that knowing the diagnosis has positive consequences for the formal caregivers. A second objective was to describe the formal caregivers' counselling practice, and ascertain its relationship with the psychological variables of attitudes, self-efficacy and subjective norm. A postal questionnaire was sent to 287 home nurses and 1259 home care workers in a defined region of Belgium; the questionnaire was returned by 169 home nurses (58.9% response) and 665 home care workers (52.8% response). The Theory of Planned Behaviour was the organising framework which underpinned the development of the instruments. Only the 168 home nurses and 601 home care workers reporting experience with caregiving to people with dementia were included in the analysis. Formal caregivers indicated that knowing the diagnosis was important, but it could facilitate or hinder caregiving. They were able to describe behavioural characteristics which are indicative of dementia, but only in a limited way, and their strategies to uncover the diagnosis were also limited. Formal caregivers reported that they supported family members emotionally, advised about communication with the person with dementia and informed family caregivers about services. However, providing family caregivers with information about dementia lagged behind these forms of support. In general, nurses scored higher than home care workers. Multiple linear regression analysis was used to investigate the relationships between self-reported practice and the concepts of the model. In both professions, attitudes and self-efficacy were found to be strong independent predictors, and the implications for practice are discussed.     

Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study

PURPOSE Guidelines encourage primary care clinicians to document smoking status when obtaining patients’ blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling.METHODS This study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identification system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion.RESULTS A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P=.04). There was no significant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P=.18).CONCLUSIONS The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.