Smoking initiation prevention among youths: implications for community health nursing practice

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.     

Tobacco control curricula content in baccalaureate nursing programs in four Asian nations

In Asia there is widespread smoking among men; smoking among women and youth is increasing, and quitting tobacco use is rare. The involvement of nurses, as the largest group of healthcare professionals, in tobacco control efforts is essential. The findings of this survey of 282 (69% response rate) baccalaureate nursing programs in 4 countries in Asia (China, Japan, Korea, and the Philippines) revealed that the majority included content on health risks of smoking (92%), but almost half (49%) did not provide smoking cessation content, and 94% did not cover it in-depth. Only 11% of programs included supervised cessation practice with patients. Fewer than 10% reported in-depth coverage of cessation interventions and few reported opportunities for clinical practice of cessation skills. Most schools surveyed delivered < 1 hour of instruction each year on tobacco control. Further educational efforts are needed to prepare future nurses to assist smokers with smoking cessation. Tobacco use is one of the leading causes of death worldwide, and tobacco-induced deaths in Asia continue to rise. The Western Pacific accounts for one-third of the cigarettes smoked in the world (25% in China alone) and 20% of the 5 million annual deaths from tobacco. China is expected to lead the world in tobacco-related deaths by 2025. Countries in Asia have widespread smoking, especially among men. There is a disturbing increase in smoking among women and youth, quitting tobacco use is rare, and exposure to second-hand smoke is common. Considering the immensity of the problem, all health care professionals throughout the world need to be actively engaged in tobacco control measures, including prevention, cessation, and reduction of exposure to second-hand smoke. Training health care professional students about these issues can have a profound impact on public health. In recognition of the importance of involvement of health care professionals, the World Health Organization (WHO) highlighted their role in tobacco control during "World No Tobacco Day" on May 31, 2005. The involvement of nurses, as the largest group of health care professionals, could boost these efforts. Thus, education of nurses regarding the multiple aspects of tobacco control has strategic implications in controlling global tobacco use and promoting health.     

Smoking among Japanese nursing students: nationwide survey

AIM: This paper reports a study estimating the nationwide prevalence of and attitudes towards smoking among Japanese nursing students. BACKGROUND: The World Health Organization established "World No Tobacco Day" in 1987, and has been promoting antismoking measures worldwide since then, with annual themes. It has emphasized that health care professionals, including nurses, as role models for healthy living, should not smoke, and that as promoters of health education they should not seem to justify or condone their patients' smoking. To promote antismoking measures among nurses, it will be necessary to scrutinize the smoking habits and behavior of nursing students and associated factors, and to conduct effective antismoking education and health education before they acquire the smoking habit. METHODS: A cross-sectional survey was carried out through self-administered, closed-ended, structured questionnaires. Questionnaires were mailed to 4169 nursing students at 27 randomly selected vocational nursing schools nationwide. Smoking status, history, and attitudes towards smoking were examined. RESULTS: Smoking prevalence among female nursing students was 23.5%, which was higher than that among the Japanese general female population aged 20-29 (21.9%). Smoker-students were significantly more positive toward smoking than non-smokers in all opinions about health care professionals' smoking. Multiple logistic regression analysis showed that smoking statuses of the people around the participants, dissatisfaction with being a nursing student, and living alone were associated with participants' smoking behaviour. CONCLUSIONS: The results of the present study suggest an urgent necessity to provide effective antismoking measures for nursing students.     

Smokeless Tobacco Use Among Rural Women in NE Alabama

Smokeless tobacco use among women living in rural areas is poorly understood and largely ignored. This qualitative study explored the use of smokeless tobacco with 10 participants living in rural areas in Alabama, with the women telling their own stories of use. Themes emerging from interviews included the initiation of use, secrecy, health-risk beliefs, daily-use patterns, and thoughts about quitting. The study results could assist community health nurses in awareness of risks, case finding, and development of community-based prevention strategies. Additional research would help better understanding of the epidemiology of the problem, cultural implications, and practice interventions.     

Tobacco smoking as a chronic disease: notes on prevention and treatment

Tobacco use represents a rare confluence of interesting circumstances. Elements of inheritable risk combine with powerful neuropharmacology and a ubiquitous environmental exposure and result in an epidemic that claims over 430,000 lives and costs us over $100 billion annually. It is the single most important remediable public health problem in the United States. Most smokers want to quit smoking and a simple advice from a physician can increase the likelihood of doing so. Moreover, there are a number of pharmacologic and behavioral therapies that are proven to be effective in smoking cessation. Yet, there is an apparent reluctance among physicians to address smoking cessation, perhaps due to a sense of frustration or low self-efficacy. Physicians play an important role in smoking cessation, and intensive interventions are necessary to improve their participation and efficacy. Teaching practical smoking cessation techniques within medical school curricula, with an opportunity for standardized practice and self-evaluation, may be an effective strategy to improve physician practice in this area. Since most smokers try their first cigarette before the age of 18, and youth smoking is on the rise, targeted interventions aimed at preventing initiation and encouraging cessation of smoking among youth are needed. For all tobacco users, a better understanding of the pharmacology and physiology of nicotine addiction may translate into targeted and individualized treatment and prevention strategies, which may improve success rates dramatically. To better control this epidemic, and to meet the nation's public health goals for the year 2010 [145], local tobacco control interventions need to be multifaceted and well integrated into regional and national efforts [146]. Because of the physician's unique societal role with respect to tobacco, doctors may indeed find it possible to impact public opinion and significantly reduce the toll of tobacco by acting at the public health and public policy levels [147]. Those interested in engaging in the public health debate can do more than relay facts about tobacco and health. Involvement in tobacco-control issues provides the opportunity to impact the environmental influences promoting smoking among patients, and is likely to be synergistic with efforts to help smokers quit within the office. Physicians who take steps to engage in local public health initiatives are likely to magnify the effects of their efforts at the bedside [148, 149].     

Childhood smoking: the research, clinical and theoretical imperative for nursing action

BACKGROUND: Tobacco smoking is a major international health issue which nurses are ideally positioned to address. Childhood represents a critical period for intervention to prevent/reduce smoking. During childhood, the majority of smokers first experiment with smoking, are initiated into the smoking subculture and become addicted to tobacco. Children are highly susceptible to smoking as a result of developmental factors, which promote or facilitate high-risk behaviours, limited coping skills, limited defences and inadequate legal protection against youth-focused marketing of tobacco. AIM: This paper is intended to sensitize nurses to the magnitude of childhood smoking as an international health problem and to familiarize them with current intervention approaches and care issues pertinent to child and adolescent populations. METHOD: An extensive literature review was conducted to determine the impact of childhood smoking at the personal and community level, characteristics of child smokers, the processes associated with smoking cessation, intervention approaches and intervention models for use by nurses across the spectrum of clinical settings. FINDINGS: Evidence exists that behaviourally based interventions by nurses for smoking prevention/cessation are effective with children. Key components of effective behaviourally based antismoking approaches for smokers include addressing self-efficacy to quit, providing social support, resisting temptation to smoke and discussing issues related to relapse and relapse prevention. For all children, the reinforcement of non-smoking behaviour is essential. Intervention models, which can be incorporated into routine clinical care of individual children or with groups, emphasize the importance of parental involvement, routine screening for tobacco use and provision of a clear message that smoking and tobacco use is unhealthy.     

Cigarettes: a growing problem for Taiwanese adolescents

An alarming number of Taiwanese teenagers continue to smoke despite the adverse health consequences of cigarette smoking. This research review describes the prevalence and onset of smoking behavior among Taiwanese adolescents and analyzes the risk factors contributing to smoking initiation. The findings of this review suggest that health educators need to target high-risk groups before they initiate smoking. High-risk groups are those who have poor school achievement, have an external locus of control, have a prosmoking attitude, know others who smoke, and are from low socioeconomic status families. These risk factors support the need for nurses to implement an effective smoking prevention program for adolescents.     

Occupational health surveillance, screening, and prevention activities in occupational health nursing practice.

Occupational health nursing practice is broad and encompasses surveillance, screening, and prevention activities as part of the scope of practice. While there has been some controversy about who is responsible for these activities, it is clear occupational health nurses play a pivotal role in overseeing, managing, implementing, and evaluating these programs. In fact, recent OSHA standards have included broad language that permits licensed health care professionals acting within their legal scope of practice to conduct medical and health surveillance activities. While the contributions of occupational health nurses are well documented, little is known about the degree and emphasis in practice related to surveillance, screening, and prevention programs. This study examined the scope of independent and interdependent practice by occupational health nurses related to these activities and found 71% of occupational health nurses had overall responsibility for program management, and the majority performed surveillance, screening, and prevention functions as independent practice. Physician supervision for any of these activities ranged from only 0% to 8% in reporting. The results of this study validate the independent functioning in scope of occupational health nursing practice related to surveillance, screening, and prevention activities while recognizing the contributions all providers make to a healthy work force.     

Preventing youth use of tobacco products: the role of nursing

In the 1997 Youth Risk Behavior Survey (Centers for Disease Control and Prevention [CDC], 1998a), 70.2% of high school students reported cigarette use, 36.4% were current cigarette smokers, and 16.7% reported frequent cigarette use (as measured by more than 20 in the last 30 days). Current tobacco use by all racial and ethnic groups is 42.7% (48.2% male, 36.0% female). Preventing youth tobacco use requires nurses to be active in many different domains. Public health experts agree that tobacco control efforts must target youth, with the goal of preventing tobacco product use and dependence. Nurses need to be actively involved in directing resources and talents toward public awareness and tobacco prevention programs, formulating public policy initiatives to control youth access to tobacco, and initiating cessation programs for youth. Efforts can be targeted at the schools, community, and health care system, as well as the public policy arena and media campaigns.     

Focusing on local health needs and promoting new partnerships

Government reports have stressed the importance of community-based interventions in addressing health inequalities. This article discusses the pivotal role played by a health visitor and school nurse team in identifying the health needs of a local community and working in partnership with local people, key community groups, health and youth workers to address these specific needs. A health needs assessment highlighted the need for a parenting programme to support parents in managing young children's behaviour, a forum for teenagers to socialize and access pertinent health information and health days to raise public awareness of key community health issues. To date the parenting programme and the youth club have been implemented. Evaluation has considered how accessible, appropriate, efficient and effective they have been and the knowledge and skills gained by participants. This community development demonstrates how health promotion works through effective community action.     

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. OBJECTIVES: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. METHODS: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. RESULTS: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. CONCLUSIONS: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.     

Adaptation to chronic illness. Analysis of nursing research

The review of reported nursing research on chronic illness has many implications for nursing practice. Results of these studies may be implemented in many of the interventions provided for chronically ill patients. There needs to be collaboration between the researcher and practitioner to share knowledge of interventions that promote adaptation to chronic illness, and to investigate new and innovative therapies. Another contribution to nursing practice is the psychosocial variables that affect adaptation of chronically ill patients. Depending on the health problem and practice setting, nurses need to identify which variable may increase the effectiveness of their interventions and how they can best promote adaptation. Particularly noticeable was the absence of studies on the prevention of chronic illness. Although there is documented evidence of the relationship between stress and illness, and predictions that future environments will be even more stressful, a needed area for nursing research is prevention of chronic health problems. Areas such as stress management, health promotion, relaxation training, and behavior modification are timely subjects for nurses to research for prevention of these problems. There are merits to studying a particular chronic health problem in depth and in studying the commonalities among several chronic illnesses. With knowledge of both the physical and psychosocial, nurses are in an ideal position to contribute to the knowledge base of human responses to chronic illnesses.     

Prevention of chronic obstructive pulmonary disease (primary prevention and secondary prevention)

Cigarette smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). The prevention of smoking initiation among teenagers and the encouragement of smoking cessation among smokers lead to preventing the onset and progression of COPD. Smoking cessation is the single most effective- and cost-effective-way to reduce the risk of developing COPD and stop its progression. Comprehensive tobacco control policies and programs, which involve some mix of public education, mass media campaigns, prevention of youth access to tobacco, school-based smoking prevention curricula, creation of smoke-free environment, and health professional training on cessation techniques should be delivered.     

How Much Public Health in Public Health Nursing Practice?

Public health nursing (PHN) practice is defined by an emphasis on population health issues rather than individually focused clinical interventions, but the actual scope and focus of PHN practice have not been well documented. The purpose of this survey was to investigate the practice activities, priorities, and education of public health nurses in California. Public health nurses in five counties were surveyed about interventions targeted at individual-family, community, and system levels. Summary scales (range: 1-4) were created to measure self-rated PHN activity, importance, and education at each level. Staff were most likely to perform individual-family level interventions (mean score, m=2.55), followed by community (m=1.86) and system-level interventions (m=1.46). Managers rated individual-family level interventions as most important (m=2.91) and community-level interventions (m=2.42) as more important than those at the system level (m=1.99). Individually focused case management was the most frequently performed and highly valued intervention. Staff and manager-directors deemed individual-family interventions as the area in which public health nurses were best educated, followed by community and then system interventions. Results indicate that the population health focus of public health nursing is not reflected in the practice activities, management priorities, or educational preparation of public health nurses.     

Alternative models in the delivery of primary and secondary prevention programs

Despite the strong scientific evidence supporting the effectiveness of cardiovascular risk reduction interventions, their application is inconsistent across medical care settings and patient groups. Traditional approaches have been largely ineffective. Thus, there is an urgent need to develop and implement innovative approaches that provide persons with or at risk for coronary heart disease effective risk reduction interventions that are accessible and affordable. Advanced practice nurses and community health workers providing care as members of multidisciplinary teams have been successful strategies for improving outcomes. This paper describes the evidence supporting these alternative models and suggests strategies for the delivery of such programs for the primary and secondary prevention of coronary heart disease.     

Older people's perspectives on fall risk and fall prevention programs: a literature review

Despite evidence supporting fall prevention methods, fall-related injury and death rates continue to rise. Understanding older people's views on fall risk and prevention will help nurses and other health professionals in the design of fall prevention strategies that will broaden their scope, reach and adoption. This literature review synthesised 19 qualitative and quantitative studies examining older people's perspectives about fall risk and prevention using a social-ecological framework. Three themes emerged about fall risk; fearing vulnerability, maintaining autonomy and independence and interpreting risk. Four themes emerged about fall prevention programs: influence of participant and program characteristics, need for personal relevance and preference, maintaining autonomy and independence and increased support for and access to programs. Implications for practice include individual, interpersonal, organizational and community level considerations for improving fall prevention efforts.     

Smoking cessation programs in the workplace. Review and recommendations for occupational health nurses

The worksite offers occupational health nurses unique opportunities to assist workers in their smoking cessation efforts. For nurses to be effective in this endeavor, they must be knowledgeable about the various quit smoking strategies that have met with some success. Based on the review of the research, there is no "magic bullet" to offer smokers who want to quit. Occupational health nurses have an opportunity, therefore, to use multiple approaches and design programs to fit the specific needs of the smokers in their practice. Published reports of nurses' involvement in workplace smoking cessation programs are sparse. It is crucial that occupational health nurses spearhead smoking cessation efforts at the workplace and communicate the results of these enterprises.     

Identifying older people in need using action research

An ageing population has implications for community-based health promotion and disease prevention. There is concern about older people who do not fit into existing programmes and services yet need minimal support to maintain independence. A study was designed to develop approaches to gain access to this hard to reach population, assess needs and design and test interventions to integrate them into the community. The study, informed by theories of health promotion and social support, used action research methods. Participant observation documented in field notes, together with case notes and clinical assessments, provided a rich source of qualitative and quantitative data. This article discusses the needs assessment. Over a 3-year period, public health nurses linked with community groups in a predominantly francophone, urban community to identify the target group. Key characteristics of the target group included limitations with instrumental activities of daily living and low levels of social support combined with stressful life situations that challenged adaptation. Three patterns of inadequate support were identified.