Physician-delivered advice to quit smoking among Italian smokers

OBJECTIVE: A clinical practice guideline for smoking cessation was released in Italy in 2002, but to date little is known about the implementation of these recommendations among primary care physicians. The objectives of this study were to estimate the prevalence of receiving physician-delivered advice to quit smoking and to determine what factors were related to the receipt of advice among adult Italian smokers. METHODS: The data were collected as part of the Italian 2004-2006 adult tobacco surveys (analyzed in 2007), conducted by DOXA, the Italian branch of the Gallup International Association, and representative of the population aged>or=18 years. Each year smokers were asked whether they had received advice to quit smoking from their family physician during the previous year. Demographic, socioeconomic, tobacco-related, and physician-related variables were examined for their association with the receipt of advice. A logistic regression model was then fit to the data to determine which variables were related to receiving advice to quit smoking. RESULTS: Overall, 22% of smokers reported receiving advice to quit smoking from their physician in the previous year. Less likely to receive advice to quit were smokers who: were single (compared to divorced, widowed, or separated); lived in the South; had a higher level of education; were lighter smokers; had no previous quit attempts; and had physicians who likely smoked. CONCLUSIONS: The data suggest that Italian physicians are not advising smokers to quit at a high rate. Future research should focus on methods that encourage physicians to counsel smokers to quit during a patient-provider encounter.     

Chinese physicians' cigarette smoking habits and their anti-smoking counselling practices

A survey of Chinese physicians' cigarette smoking habits andtheir counselling of patients to quit smoking was carried outin two provincial hospitals in Wuhan, capital city of Hubeiprovince, People's Republic of China. All 559 physicians inthe two hospitals were given the questionnaire, of which 86%(480) returned their completed questionnaires. Of the 480 physicians,50.9% of the males, and 4.8% of the females were current cigarettesmokers. The majority of physicians (85.6%) had counselled theirpatients about cigarette smoking in the past year, althoughfew physicians (2.9%) felt that they were very successful inhelping patients to quit smoking. The frequency of physicians'anti-smoking counselling was significantly correlated with anumber of variables: physicians' own smoking status; whetherthey perceived themselves as the most influential people inhelping patients to quit smoking; whether physicians thoughtthat they were successful in their past counselling practices;and physicians' age.     

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.     

Peer Reviewed: Smoking Status and Cessation Counseling Practices Among Physicians,Guangxi, China, 2007

Introduction

We examined Chinese physicians'' smoking behavior, knowledge of smoking''s health effects, and compliance with accepted cessation counseling practices.

Methods

We used a structured questionnaire adapted from the Global Health Professionals Survey of the World Health Organization to survey Chinese physicians based at 5 hospitals in Nanning, Guangxi Province, China.

Results

The response rate was 85% for a total of 673 completed questionnaires. Of the 673 respondents, 73% were men, 42% were aged 30 years or younger, and 26% were smokers (men, 35%; women, 3%). Only 28% of the smokers were ready to quit immediately. A substantial proportion of physicians did not have adequate knowledge of smoking-related health hazards or favorable attitudes toward smoking cessation counseling. Asking patients whether they smoked and recording smoking status in the medical record were significantly associated with being female and being very well or somewhat prepared to counsel patients about smoking cessation. Advising patients to quit smoking was significantly associated with being female, being a nonsmoker, being very well or somewhat prepared to counsel patients about smoking cessation, and having read any smoking cessation guidelines.

Conclusions

Our findings suggest that smoking is common among male Chinese physicians and that Chinese physicians have inadequate knowledge of smoking''s health hazards and of how to help smokers quit. Physicians in China and their patients who smoke would benefit from widely accessible Chinese clinical practice guidelines on smoking cessation, better medical school education about the health risks of smoking, and government funding of cessation medications.     

Smoking among Aboriginal health workers: findings of a 1995 survey in western New South Wales

Abstract: As part of the Western NSW Aboriginal Smoking Project (1995) a self–administered questionnaire surveyed regional Aboriginal health workers (AHWs) about their tobacco use and their awareness of smoking related health issues. The aim was to provide baselineinformation to guide the development of project interventions. The majority of respondents smoked. Among the smokers most said that they would like to quit smoking, and all said that they had tried to quit. All the smokers were interested in assistance to help them quit, and were interested in assistance to help them help others in their communities to quit. AHWs are a professional group whose smoking rates might typify that of their communities, and in the future they might provide indications of smoking trends in their communities.     

A community view of smoking cessation counseling in the practices of physicians and dentists.

The practice norms of community physicians and dentists in the Lehigh Valley of Pennsylvania for counseling about smoking cessation were surveyed. In addition, 1,373 residents in the valley were interviewed by telephone about the smoking counseling behaviors of their dentists and physicians. These activities were conducted as part of the planning for an intervention by the Coalition for a Smoke-Free Valley, a coalition of 100 persons and organizations in the area. The survey response rate for 172 physicians was 77 percent, and for 103 dentists, it was 76 percent. More physicians than dentists advised patients to quit, counseled patients, provided materials, and helped the patient to set a quit date. However, there was a clear discrepancy between what physicians say they do and what smokers say they hear.     

A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III.

BACKGROUND. Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a physician. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients. METHODS. This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics. RESULTS. Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05). CONCLUSIONS. The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.     

Smoking prevalence, attitudes, and perceived smoking prevention and control responsibilities and behaviors among physicians in Jordan

This study identifies smoking prevalence among physicians in Jordan. It also assesses their attitudes, perceived smoking prevention, and control responsibilities and behaviors. A cross-sectional survey was administered to 251 physicians from public and private hospitals in Jordan. The response rate was 67%. The prevalence of smoking is 22.4% for male and 9.1% for female physicians. Among current or former smokers, 81.1% (n = 73), 29.1% overall, had smoked in front of a patient. The physicians believed that physician counseling could more effectively prevent patients from smoking than influencing patients to quit smoking. Approximately 56.2% of physicians had ever counseled patients about smoking and 34.3% regularly counseled patients about smoking. Only 18.3% (n = 46) had received training, either in medical school or thereafter, on counseling patients about smoking. Physicians with training on counseling patients about smoking cessation were significantly more likely to have counseled or to routinely counsel patients to help them quit or not start smoking. Training also lowered the percentage of smokers who smoked in front of patients.     

Knowledge of health effects and intentions to quit among smokers in India: findings from the Tobacco Control Policy (TCP) India pilot survey

Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.     

Peer Reviewed: Smoking, Barriers to Quitting, and Smoking-Related Knowledge, Attitudes, and Patient Practices Among Male Physicians in China

Introduction

Successful interventions to reduce the high rate of smoking among male physicians in China might contribute to reduction in tobacco use in the country overall. Better characterization of smoking, barriers to quitting, and smoking-related knowledge, attitudes, and patient practices in this physician population will help plan such interventions and provide baseline data to evaluate their effectiveness.

Methods

A self-administered survey of smoking-related knowledge, attitudes, behaviors, and patient practices was conducted among health care professionals in 2 large teaching hospitals in China.

Results

Of 103 male physicians, those who smoked (n = 51) had a more limited knowledge of smoking-related disease and were less likely to advise patients to quit smoking compared with nonsmoking physicians (n = 52). More than one-fourth (29%) of nonsmoking physicians accepted gift cigarettes, and these physicians were less likely to ask their patients about their smoking status than those who did not accept gift cigarettes. Seventy-five percent of smokers reported that their hospitals did not help them quit, and only 19% reported receiving training in how to help their patients quit.

Conclusion

High rates of smoking, gifting of cigarettes, limited support for physician quitting, and limited training on cessation approaches may compromise the ability of male physicians in China to effectively treat their patients who smoke.     

Favourable changes in economic well-being and self-rated health among the elderly

Adverse economic shocks exert an influence on health perceptions, but little is known about the effect of sudden positive changes in a person's financial situation on self-rated health, particularly among low income people. This paper explores the association between an increase in the amount of non-contribution pensions, public cash transfers given to Costa Rican elderly of low socio-economic status (SES) and changes in self-rated health over time. The analysis is based on data from CRELES, the "Costa Rican Study on Longevity and Healthy Aging", which is based on a probabilistic sample of people born in 1945 or earlier, and living in Costa Rica by 2002. The fieldwork for the first and second waves of CRELES was conducted from 2004 to 2006, and from 2006 to 2008, respectively. The Costa Rican Government raised the amount of the non-contribution pension for the poor 100% before July 2007, and an additional 100% after that date. Due to the CRELES fieldwork schedule, the data have a natural quasi-experimental design, given that approximately half of CRELES respondents were interviewed before July 2007, independently of their status in receiving the public cash transfers. Using random effects ordered probit regression models, we find that people who experienced such increase report a greater improvement in self-rated health between waves than those who experienced a smaller increase and than the rest of the interviewees. Results suggest that increases in income may lead to a greater improvement in self-rated health.     

Smoking behaviour change among fathers of new infants

Protecting infants from exposure to parental tobacco smoke is key to positive health outcomes in childhood and later life. While mothers' smoking has been well researched, fathers' smoking has received little attention. This paper reports data from a cross-sectional survey of 286 smoking fathers in the English Midlands, interviewed when their infants were 8-14 weeks old. It examines whether fathers attempt and successfully achieve two smoking behaviours positively associated with infant health: quitting and not smoking in the home. The birth of a new baby was not associated with attempting or successfully quitting smoking for the majority of fathers. Less than 20% had tried to quit and only 4% had successfully quit smoking since the birth of their baby. Half of the participants reported that they had not changed their cigarette consumption since their baby's birth. Not smoking in the home appeared to be a more achievable behaviour for many fathers; 78.0% had attempted and 60% had successfully achieved not smoking in home. Independent predictors of attempting to quit were fathers' own cigarette consumption and level of knowledge about infant exposure to tobacco smoke. Attempting to abstain from smoking in the home and being successful in the attempt were both independently associated with partner's smoking status, number of financially dependent children and father's social class. Findings suggest that promoting reductions in cigarette consumption and improving knowledge levels among fathers about passive smoking in infants may encourage more quit attempts. Not smoking in the home is a more achievable behaviour and is linked to fathers' caring and economic circumstances and their partner's smoking status. Influences on fathers' smoking behaviour appear to be multi-factorial. Understanding father's smoking and developing health promotion strategies to protect infants from passive smoking is likely to depend on research which can bridge the caring and economic spheres of their lives.     

Smoking by French general practitioners: behaviour, attitudes and practice

INTRODUCTION: This paper examines smoking prevalence, sociodemographic factors and the medical practice of French general practitioners. METHOD: Data from the 1998 cross-sectional national survey of 2,073 GPs. The questionnaire was administered by telephone. A response rate of 67% was attained. Instrumentation included questions about medical practice, sociodemographic characteristics, and health behaviour. Bivariate and multiple logistic regression (MLR) analyses were conducted. RESULTS: Almost one-third (32.1%) of physicians were current smokers. A significantly higher proportion of male (33.9%) were smokers compared to women (25.4%, p<0.001) and men were more likely to be former smokers (49.1% versus 31.7%). Two-thirds of physicians reported recommending nicotine replacement therapy to their patients. MLR shown that former smokers were more likely (OR = 1.51, 95% CI, 1.24-1.83) to indicate that their help in getting patients to quit was not effective compared to smokers. Also, physicians who were 'dissatisfied' with the profession were more likely (OR = 0.75, 95% CI, 0.60-0.92) to report their help as not effective than those who were 'satisfied'. CONCLUSION: These data support the need for greater professional participation in reducing smoking among general practitioners in France and greater education concerning the vital role of physicians in promoting cessation among the general population. KEY POINTS: This study examines smoking habits among French GP's, intervention practices, and opinions about their ability to help patients quit smoking. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women. This study found a smoking prevalence rate of 32.1%, 33.9% of male physicians were smokers and 25.4% of women.     

Smoking Cessation Intervention for Pregnant Women: A Call for Extension to the Postpartum Period

The association between smoking during pregnancy and adverse maternal/neonatal health outcomes is widely acknowledged, and recent health care reform has filled a much-needed gap by extending prenatal smoking cessation intervention coverage to all pregnant women on Medicaid. While more extensive coverage will improve quit rates during pregnancy, there continues to be a need to address high relapse rates in the postpartum period for both the insured and the uninsured. Smoking during the postpartum period exposes infants directly and indirectly to negative health effects, and has additional costs to mothers and society. Approximately 80% of women who quit smoking during pregnancy relapse in the first year postpartum, highlighting a need for effective continuing care that supports them through the challenging postpartum period when stress is high and motivations to stay quit may change. Existing relapse prevention interventions, typically delivered during pregnancy, have been found to be of little benefit during the postpartum period, suggesting the need for a more formal continuing care approach. Phone-based protocols are promising because they address the need for flexible access, and are known to be effective at increasing quit rates and sustained cessation.     

Prevalence of coronary heart disease risk factors in Costa Rican adolescents.

PURPOSE: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. METHODS: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12-18 years (167 males, 161 females), randomly selected from San José's urban and rural high schools. RESULTS: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. CONCLUSIONS: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.     

Smoking habits and smoking cessation among North Carolina nurses

A 1987 questionnaire survey of a 1% random sample (n = 356) of registered nurses in North Carolina provided data on the smoking habits and smoking cessation. Fifty-six percent were never smokers; 19% were current smokers. Among the ever smokers, 31% had quit smoking for at least one year. Twenty-two percent of the former smokers had smoked less than 5 years and 39% less than 10 years before quitting. Anecdotal notes from never smokers suggested that their major deterrent to smoking was their own parents smoking. Concerns about the addictive smoking behavior and health effects of smoking observed in their parents as well as concerns about potential health risks to themselves deterred them from smoking. Concerns about the adverse consequences of smoking was the most influential factor influencing smoking cessation and reduction of cigarette smoking. Friends' and family's encouragement to stop smoking was the most influential external factor motivating nurses to quit or reduce cigarette consumption. Fifty-seven percent of the former smokers quit smoking after one or two attempts while 53 of the current smokers had tried to quit 3 or more times - 90% had tried at least once to quit smoking; however, only 18% of the current smokers had abstained for more than one year during any of their attempts to quit. Implications of the results include: (1) smoking cessation programs for nurses in the workplace may have considerable impact since the majority of nurses who smoke are tying to quit; (2) relapse prevention strategies need to be an integral part of such smoking cessation programs including involvement of family and friends to support the smokers in their cessation efforts.     

Plasma lipids and other cardiovascular risk factors in Costa Rican adolescents.

This study assessed plasma lipids and other cardiovascular risk factors in adolescents in a developing Latin American country and compared those risk factors to those of adolescents in the United States of America, where the risk of heart disease is high. In a cross-sectional study, data were collected from September 1998 to April 1999 on 161 Costa Rican adolescents between the ages of 12 and 20. A general questionnaire was used to collect demographic, smoking, socioeconomic, and women's health data. Anthropometric measurements, blood pressure, and a fasting blood sample were taken. The Costa Rican males had lower levels of total cholesterol than did the Costa Rican females (mean +/- standard error of the mean (SEM), 149 +/- 6.5 mg/dL vs. 158 +/- 6.3 mg/dL). This was mainly due to lower high-density lipoprotein (HDL) cholesterol in males than in females (mean +/- SEM, 38 +/- 2.0 mg/dL vs. 44 +/- 2.4 mg/dL). As compared to the United States, adolescents in this study had lower levels of total cholesterol, largely due to lower HDL cholesterol. Both genders of Costa Ricans had levels of low-density lipoprotein (LDL) cholesterol that were similar to those of counterpart groups in the United States. Costa Rican male and female adolescents had higher LDL/HDL ratios than did their United States counterparts. Therefore, as compared to the United States, Costa Rican adolescents have an adverse lipid profile as demonstrated by a higher LDL/HDL ratio. Overweight prevalence in Costa Rica was 13%, approaching the 15% overall level of the United States.     

Pictorial health warnings on cigarette packs and the impact on women

OBJECTIVE

To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women.

METHODS

Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette.

RESULTS

Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03).

CONCLUSIONS

Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment.