Prevalence of patients continuing to smoke after vascular interventions

INTRODUCTION: Smoking is one of the most important risk factors for the development and progression of atherosclerosis. Smoking cessation is an obligatory element in the management of vascular problems and in patients scheduled for vascular interventions. The aim of this study was to assess the prevalence of patients smoking before and after vascular surgical procedures and to evaluate the requirements for inpatient programs for smoking cessation and nicotine replacement therapy. METHODS: 500 patients admitted for vascular interventions were included in this prospective study. Smoking status was evaluated both objectively and subjectively. All patients underwent measurements of exhaled breath carbon monoxide to quantify nicotine dependency and all answered a standardized Fagerstr?m questionnaire both on admission and after surgery to identify current smokers. RESULTS: Of 500 vascular patients included in the study, only 70 (14 %) never had smoked, 243 (49 %) had given up smoking before admission and 161 (32 %) were current smokers. Of the current smokers, 64 (40 %) did not smoke during hospitalization but 97 (60 %) continued to smoke in hospital. Of these 97 patients, 78 (80 %) were men and 19 women; their mean age was 61 +/- 4 years (range 40-84). Four patients had surgery for infrarenal aortic aneurysm, 40 underwent carotid endarterectomy and 53 had peripheral arterial occlusive disease (PAD). There was no difference between abstinent patients and continuing smokers in previous cigarette consumption or Fagerstr?m score, a predictor for long-term smoking behavior. Patients with carotid artery stenosis were significantly more abstinent while hospitalized (P = 0.006); patients with PAD, however, were more likely to continue smoking as inpatients (P = 0.004). Sixty-five percent of continuing smokers stated that they would stop smoking in hospital if counseling and nicotine replacement therapy were provided. With regard to their predominant location of atherosclerosis, patients with PAD were less willing than those with carotid stenosis to abstain from smoking while hospitalized (53 % vs 88 %, respectively; P < 0.001). CONCLUSION: A substantial proportion of patients admitted for vascular surgery are smokers. More than half of these continue to smoke in the hospital, an environment where smoking is prohibited by law. Counseling, nicotine replacement therapy and smoking-cessation programs are urgently needed for vascular surgical inpatients.     

The smoking behaviour of military nurses: the relationship to job stress, job satisfaction and social support

Three hundred and seven nurses at a large military medical centre were sent and completed an anonymous questionnaire which measured their smoking status along with job stress, job satisfaction and social support, as well as a variety of demographic factors. Three groups of nurses were defined on the basis of their response to the smoking status questions: those who have never smoked (54%), former smokers (23%) and current smokers (22%). The results revealed that the current smokers reported significantly (P less than 0.05) more job stress, job dissatisfaction and less social support than either former smokers or those who had never smoked. Further, the former smokers reported significantly less social support, defined from a variety of perspectives, than those who had never smoked. These were not as important in predicting amount smoked (number of cigarettes per day) among the current smoker group as they were in predicting differences between the different smoking status groups. The results suggest the need to incorporate the issues of social support and to a lesser extent job stress/satisfaction issues into smoking cessation programmes aimed at this population.     

Smoking cessation after stroke: education and its effect on behavior.

Smoking is an independent risk factor for stroke. The purpose of this prospective study was to determine whether significant changes in smoking behavior occurred in a cohort of stroke patients who were educated about risk reduction during their initial recovery period. Participants or their proxies were then contacted at 3 months for a follow-up interview, during which their current location, smoking status, and functional outcome were recorded. Of 405 participants interviewed, 112 were current smokers at the time of stroke. Participants younger than 65 years and Blacks were more likely to be smokers. At 3 months, 48 (43%) of the baseline smokers had quit smoking compared with an estimated rate of 28% previously reported in the literature. The number of participants who smoked > 20 cigarettes per day was 31 at baseline versus 7 at 3 months. This change of behavior was independent of baseline characteristics and the level of poststroke disability. Risk-reduction education provides stroke survivors with the information needed to change their lifestyles. Further research is needed to determine whether this behavior continues beyond 3 months and to determine why some stroke survivors continue to smoke.     

Serum thiocyanate, smoking habits and smoking cessation trial in patients with peripheral atherosclerosis

The smoking habits in patients with atherosclerosis in the lower limbs and the effect of advising them to stop smoking was studied by means of self-declaration of the number of cigarettes smoked per day and determination of serum thiocyanate. Ninety-six per cent of males and 70 per cent of the females were smokers or ex-smokers. The number of years of smoking was about 40 for the smokers of both sexes and the male ex-smokers and 23 for the female ex-smokers. The number of cigarettes smoked per day reported by the patients was less than that reported by the smokers in a reference population. The serum thiocyanate levels confirmed the smoking status of the non-smokers and showed that about one-sixth of the ex-smokers had smoked in the last month prior to the study, and that the smokers on the average were heavy smokers smoking much more than the self-reported number of cigarettes. The effect of advising the patients to quit smoking was very disappointing. A maximum of 15 per cent of the smokers stopped smoking while some of the ex-smokers resumed smoking.     

Smoking: knowledge, attitudes, habits and degree of dependence of young adults in Salvador

This study was aimed at evaluating the degree of smoking dependence and to characterize social demographic data, habits and attitudes of young smokers. Answered the questionnairel02 students from Salvador, State of Bahia, of which 11 were smokers. Their mean age and the age in which they first smoked were 18.2 and 13.4 years respectively. Most of them were male, in the first year of senior high school, of brown skin color and had close relatives who smoke. The majority of those young smokers had been advised about the risks of smoking at home and in school, but few had knowledge about the benefits of quitting. Almost half of them had been smoking for more than three years and had started to smoke out of curiosity. More than half of them smoked one cigarette per day, with low levels of nicotine, bought the cigarettes in shops, and wanted and tried to quit smoking, but never succeeded. The degree of dependence was low for most of them. This study offers hints for nurses to act against smoking with young adults.     

Smoking behavior and desire to quit among low-income female caregivers.

The purpose of this study was to examine smoking behavior and the desire to quit among low-income women. Two hundred and eight women caregivers were surveyed about their smoking status, exposure to environmental tobacco smoke in the home, and desire to quit smoking. Most of the smokers (74%) wanted to quit smoking. With a logistic regression model, the number of years smoked was the only significant predictor variable for the dependent variable of thoughts about quitting when age, years of smoking, number of children, marital status, number of smokers in the home, cigarettes smoked per day, and money spent per week on cigarettes were entered as independent variables. The fewer years smoked the more likely the women wanted to quit.     

Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers,former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.     

Smoking during pregnancy in Blekinge 1984-88

During the past 5-year period, midwives and doctors working in antenatal care in Blekinge county, Sweden, have increased their efforts to help pregnant smokers to stop or reduce smoking. To evaluate the effects of these efforts, all women giving birth during each September from 1984 to 1988 inclusive were asked to fill in an anonymous questionnaire on smoking habits before and during pregnancy. The answering frequency was 81-86%. The frequency of never-smokers was constant at 44-49%, while the proportion of women who had stopped smoking before pregnancy increased significantly, from six to 31%. Six to 13% of the responders had stopped smoking during pregnancy, and the persistent smokers smoked significantly less at the end of the period. Thus, during the study there was a gradual reduction in the proportion of pregnant women who smoked, and the smokers smoked less.     

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic

Background: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. Aim: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. Results: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non‐menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non‐menthol smokers. At 4‐week follow up, AA, Latino and White non‐menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non‐menthol counterparts. At 6‐month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non‐menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). Conclusions: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non‐menthol smokers within the same ethnic/racial groups.     

Smoking in a forensic psychiatric service: a survey of inpatients' views

Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.     

Cigarettes smoking habit may reduce benefit from cetuximab-based treatment in advanced colorectal cancer patients

Background: NF-κB is one of the nuclear effectors of EGFR activation. There are reports showing that NF-κB expression and activity is enhanced after nicotine treatment. Some data demonstrated that NF-κB activation plays a role in the induction of resistance to cetuximab and irinotecan in advanced colorectal tumors. The aim of this study was to evaluate the effect of cigarette smoking on cetuximab efficacy in advanced colorectal cancer patients. Methods: We retrospectively analysed the smoking habits of 200 patients treated with a variety of anticancer regimens containing cetuximab for advanced colorectal cancer. All patients were irinotecan-resistant and received an oxaliplatin-based first line treatment. We divided our patient population as follows: no previous smoking habit, previous smokers (any number of cigarettes), current smokers of less of 10 cigarettes/day, current smokers of more than 10 cigarettes/day. Results: Out of 200 patients 58 declared a history of cigarette smoking, 108 patients never smoked and the remaining 44 patients were cigarette smokers during cetuximab-based anticancer therapy. Of the 44 smokers, 18 smoked more than 10 cigarettes per day. No statistically significant differences in terms of response rate (RR) and time to progression (TTP) were identified between previous smokers and never smokers. RR in actual smokers was 13.6% and was lower than RR reported for non-smokers (27.1%; p = 0.023). In addition, the median TTP was 5.5 months in the non-smokers versus 2.8 months in the current smokers (p < 0.0001). A difference in terms of overall survival (OS) was detected between the two groups (p = 0.03). Comparing smokers of more than 10 cigarettes per day and smokers of less than 10 cigarettes per day no differences were detected in RR, TTP or OS. Conclusions: Our results suggest that cigarette smoking during anticancer treatment with a cetuximab-based regimen may be responsible for a decrease in RR and lead to a lower TTP.     

General Medicine; Breaking Down Frontiers

Lendahls L, Liljestrand J. Smoking during Pregnancy in Blekinge 1984–88. Scand J Prim Health Care 1989 7: 189–92

During the past 5-year period, midwives and doetors working in antenatal care in Blekinge county, Sweden, have increased their efforts to help pregnant smokers to stop or reduce smoking. To evaluate the effects of these efforts, all women giving birth during each September from 1984 to 1988 inclusive were asked to fill in an anonymous questionnaire on smoking habits before and during pregnancy.

The answering frequency was 81–86%. The frequency of never-smokers was constant at 44–49%, while the proportion of women who had stopped smoking before pregnancy increased significantly, from six to 31%. Six to 13% of the responders had stopped smoking during pregnancy, and the persistent smokers smoked significantly less at the end of the period. Thus, during the study there was a gradual reduction in the proportion of pregnant women who smoked, and the smokers smoked less.     

Inpatient views and experiences before and after implementing a totally smoke‐free policy in the acute psychiatry hospital setting

In the present study, we examined the views and experiences of patients admitted to an acute psychiatry unit before and after the implementation of a totally smoke‐free policy. Forty‐six inpatients completed a questionnaire assessing their views before the smoking ban. Another 52 inpatients completed a questionnaire assessing their views and experiences after the smoking ban. Before the totally smoke‐free policy, 69.6% smoked, with 67.7% smoking more when admitted to the psychiatry ward. Before the smoking ban, 54.4% reported that the totally smoke‐free policy would be ‘negative’ or ‘very negative,’ and 30.5% said it would be ‘positive’ or ‘very positive.’ After the totally smoke‐free policy, 57.7% smoked heavily before hospital (mean cigarettes/day = 24.9), with consumption dramatically reducing following admission to a totally smoke‐free psychiatric unit (mean cigarettes/day = 8.3). After the totally smoke‐free policy, 36.5% reported that it was ‘negative’ or ‘very negative,’ and 50% reported that it was ‘positive’ or ‘very positive.’ Overall, inpatients reported improved acceptance of the policy following implementation. Inpatients stated that the most difficult thing about the smoking ban was experiencing increased negative emotions, while the most positive aspect was the improved physical environment of the ward. Inpatients who smoke must be appropriately supported using a range of strategies, and in the present study, we suggest relevant clinical implications.     

微型肺功能仪检测男性吸烟者第一秒用力呼气容积的结果分析

目的应用微型肺功能仪测定男性吸烟者肺功能第一秒用力呼气容积(FEV1),分析吸烟对肺功能的影响,筛查早期慢性阻塞性肺疾病(COPD)患者以便早期干预。方法选择体检中心体检的符合标准的吸烟男性1050例,对其行肺功能检测。筛查标准为:①男性,年龄大于40岁。②吸烟指数大于200(吸烟指数=每天吸烟支数×吸烟年数)。③排除诊断为支气管扩张、支气管哮喘及有过肺部手术史。结果吸烟者中FEV1%<80%占48.6%,FEV1%平均值为89.8%(变化在22%～120%)。其中第一秒用力呼气容积(FEV1)/用力肺活量(FVC)<70%者为16.5%,其中85%伴有咳嗽和活动后气短症状。年龄与肺功能FEV1%呈负相关。结论微型肺功能仪可以发现吸烟人群早期肺功能异常者及无症状COPD患者,有利于其早期干预。     

Smoking status ascertainment and interventions in acute medical patients

Hospital admission provides an opportunity to promote smoking cessation. Clinical guidelines recommend ascertainment of smoking status and delivery of cessation interventions in all consultations. In this article, smoking ascertainment and intervention among all patients admitted to medical wards in a UK hospital over a four-week period in 2010 were audited. Medical records of 767 patients were screened; 96 (13%) were current smokers, 243 (32%) ex-smokers and 233 (30%) non-smokers. There was no record of smoking status in 243 (25%) individuals and this proportion varied between specialties. Of the 96 current smokers, only 23 received documented cessation advice or pharmacological support. Four weeks after discharge, 31% reported that they were abstinent from smoking, representing 50% of those who received support and 20% of those who did not. Ascertainment of smoking status and delivery of cessation support to patients admitted to medical wards was low, suggesting that there is room for improvement in the management of smoking among inpatients.     

Successful implementation of a no-smoking policy

Literature suggests that positive behavioural changes occur among employees after the introduction of a no-smoking policy (NSP). This paper reports successful results following the introduction of a revised NSP at Hawker de Havilland Victoria (HDHV) Limited, an aerospace component manufacturing company.In February, 1994 a poll survey indicated that 86 of the 480 employees smoked. In April, 1994 all 480 employees were surveyed, to assess smoking behaviour and attitudes. Education programs and company-sponsored Fresh Start Quit courses were conducted on-site.In August, 1994 a second survey was distributed, to the smokers only, to assess smoking habits, behaviour, satisfaction with the NSP and whether education programs influenced them to change their smoking habits.Findings in this study suggest that the introduction of the NSP and education programs induced positive behavioural and attitudinal changes to smoking.In August, 1994 the key results of the second smoking survey indicated that 5 per cent of employees quit smoking, 43 per cent reduced the number of cigarettes smoked per day, 1.6 per cent smoked more and 30 per cent reported no change. These results show that a short-term multifaceted smoking cessation program implemented over 5 months can produce a decrease in cigarette smoking.     

Psychosocial factors and heavy smoking during pregnancy among parous Scandinavian women

Objective - To analyse how psychosocial and social factors are associated with heavy smoking in the third trimester of pregnancy.

Design - Data were collected from a prospective study primarily initiated to study fetal growth retardation. (NICHD Study of successive small for gestational age births).

Setting - Uppsala in Sweden, Bergen and Trondheim in Norway.

Subjects - Study subjects were 775 para I and II, referred from GPs or maternity wards to the University Hospitals in Uppsala, Bergen and Trondheim. AH women smoked at the time of conception. “Heavy smokers” were defined as women who smoked 15 or more cigarettes per day during the third trimester.

Main outcome measure - Psychosocial factors and potentially associated heavy smoking in the third trimester.

Results - Young women and women without a partner smoked heavily more often than older women and married/cohabitant women. Growing up with just one parent and the experience of a difficult childhood were also significantly associated with heavy smoking before delivery. If the woman's family (except partner) did not approve of the pregnancy, the woman was more often a heavy smoker. the women who smoked heavily in the third trimester had started smoking at an earlier age than the rest of the smokers.

Conclusion - the pregnant woman's previous and present psychosocial conditions are related to her heavy smoking in the third trimester of pregnancy.     

A nurse-led 'stop smoking' initiative.

A one-week smoking awareness initiative and subsequent audit in a general practice are described. All patients attending morning surgery during the study period were offered the opportunity to discuss smoking habits at a smoking awareness clinic: 84 smokers attended. They were interviewed by the practice preventive care nurse who took a smoking history, monitored carbon monoxide (CO Hb) levels and offered a follow-up appointment. CO Hb provided immediate feedback on the effect of smoking and patients who smoked 20 or more cigarettes per day had an average CO Hb of 16.1 per cent. Fifteen per cent of smokers made a commitment to stop smoking and agreed to attend follow-up clinics. A random sample (50) of attenders at the initial Smoking Awareness Clinic (84) were followed up by questionnaire six months later. There were 29 replies (58 per cent); 19 patients (65 per cent) found the visit to the clinic helpful, 14 (48 per cent) reduced the number of cigarettes they smoked, and 11 (38 per cent) altered some other aspect of their lifestyle, of whom four modified their diet and four increased exercise. Five patients claimed they had given up smoking.     

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.     

Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies

OBJECTIVE: Cigarette smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM) or pregestational diabetes mellitus (PDM). Smoking has been associated positively with hyperinsulinemia and insulin resistance in experimental studies, although the association with diabetes remains unclear. To further explore this issue, we examined the association with smoking in the largest prospective cohort study of GDM and PDM to date. RESEARCH DESIGN AND METHODS: The study population comprised 212190 women in the population-based Swedish Birth Registry who had their first and second deliveries between January 1987 and December 1995. Maternal characteristics were recorded in a standardized manner at the first prenatal visit, followed by a clinical examination and a standardized in-person interview to assess lifestyle habits. Women were categorized as nonsmokers, light smokers (one to nine cigarettes per day), or moderate-to-heavy smokers (at least 10 cigarettes per day). RESULTS: Women with GDM in their first pregnancy experienced an eight- to ninefold increased risk of GDM or PDM in their second pregnancy. Cigarette smoking was not associated with increased risk of these conditions. Neither women who smoked during their first and second pregnancies nor those who commenced smoking between pregnancies had a higher risk of GDM or PDM than nonsmokers. CONCLUSIONS: Our findings do not support an association between cigarette smoking and risk of GDM or PDM in young women of childbearing age.