Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey

Objective

The smoking status of physicians can impact interactions with patients about smoking. The ‘Smoking: The Opinions of Physicians’ (STOP) survey examined whether an association existed between physician smoking status and beliefs about smoking and cessation and a physician's clinical interactions with patients relevant to smoking cessation, and perceptions of barriers to assisting with quitting.

Methods

General and family practitioners across 16 countries were surveyed via telephone or face-to-face interviews using a convenience-sample methodology. Physician smoking status was self-reported.

Results

Of 4473 physicians invited, 2836 (63%) participated in the survey, 1200 (42%) of whom were smokers. Significantly fewer smoking than non-smoking physicians volunteered that smoking was a harmful activity (64% vs 77%; P < 0.001). More non-smokers agreed that smoking cessation was the single biggest step to improving health (88% vs 82%; P < 0.001) and discussed smoking at every visit (45% vs 34%; P < 0.001). Although more non-smoking physicians identified willpower (37% vs 32%; P < 0.001) and lack of interest (28% vs 22%; P < 0.001) as barriers to quitting, more smoking physicians saw stress as a barrier (16% vs 10%; P < 0.001).

Conclusion

Smoking physicians are less likely to initiate cessation interventions.

Practice implications

There is a need for specific strategies to encourage smoking physicians to quit, and to motivate all practitioners to adopt systematic approaches to assisting with smoking cessation.     

Evaluation of a minimal-contact smoking cessation program in a health care setting.

A controlled evaluation of a minimal-contact smoking cessation intervention was conducted with 213 inpatients and outpatients at a Veterans Administration Medical Center (VAMC). The intervention had three components: Brief consultation from a health practitioner; administration of a self-help smoking cessation manual; and provision of an incentive to adhere to recommendations in the manual. Enrollment procedures differed from those of many other smoking-intervention trials in that, instead of enrolling only smokers who were motivated to quit, all patients who smoked and who would normally be considered eligible for a smoking-cessation intervention were included. The evaluation examined acceptability of the program to patients who smoked, overall effectiveness of the intervention, and efficacy of the intervention for specific patient demographic, social status, and health status groups. The program had a high degree of acceptance by patients who smoked, with over 60% agreeing to participate and take home the self-help smoking-cessation manual. The program was effective in getting patients to reduce their daily smoking, and marginally effective in influencing smoking cessation, with some patient groups exhibiting higher cessation rates than others. Special problems to be considered when attempting to influence groups of smokers at high levels of psychological stress and with low levels of education and income--factors normally associated with high rates of smoking and failure in traditional smoking-cessation programs--are discussed in light of the results obtained.     

Detection of ophthalmic artery stenosis by least-mean squares backpropagation neural network

Doppler ultrasound is a noninvasive technique that allows the examination of the direction, velocity, and volume of blood flow. In this study, ophthalmic artery Doppler signals were obtained from 105 subjects, 48 of whom had suffered from ophthalmic artery stenosis. A least-mean squares backpropagation neural network was used to detect the presence or absence of ophthalmic artery stenosis. Spectral analysis of ophthalmic artery Doppler signals was done by the Welch method for determining the neural network inputs. The network was trained, cross validated and tested with subject records from the database. Performance indicators and statistical measures were used for evaluating the neural network. Ophthalmic artery Doppler signals were classified with the accuracy varying from 88.9% to 90.6%.     

Online social networks and smoking cessation: a scientific research agenda

Background

Smoking remains one of the most pressing public health problems in the United States and internationally. The concurrent evolution of the Internet, social network science, and online communities offers a potential target for high-yield interventions capable of shifting population-level smoking rates and substantially improving public health.

Objective

Our objective was to convene leading practitioners in relevant disciplines to develop the core of a strategic research agenda on online social networks and their use for smoking cessation, with implications for other health behaviors.

Methods

We conducted a 100-person, 2-day, multidisciplinary workshop in Washington, DC, USA. Participants worked in small groups to formulate research questions that could move the field forward. Discussions and resulting questions were synthesized by the workshop planning committee.

Results

We considered 34 questions in four categories (advancing theory, understanding fundamental mechanisms, intervention approaches, and evaluation) to be the most pressing.

Conclusions

Online social networks might facilitate smoking cessation in several ways. Identifying new theories, translating these into functional interventions, and evaluating the results will require a concerted transdisciplinary effort. This report presents a series of research questions to assist researchers, developers, and funders in the process of efficiently moving this field forward.     

Predictors of adolescent smoking cessation and smoking reduction

Objective

To investigate the processes of change, demographic, health- and smoking-related predictors of both smoking cessation and smoking reduction in adolescents.

Methods

Data were drawn from a sample of 755 adolescent smokers who participated in a study testing the efficacy of a text messaging-based intervention for smoking cessation. Demographic, health- and smoking-related variables were assessed at baseline. Five processes of smoking cessation, derived from the Transtheoretical Model and the Social Cognitive Theory, as well as outcome measures were assessed at 6-month follow up. Univariate and multivariate regression analyses were conducted to identify baseline and process variables to predict smoking abstinence and smoking reduction.

Results

Male gender (OR = 0.43, p < .01), lower alcohol consumption (OR = 0.90, p = .05) and a lower number of cigarettes smoked per day at baseline (OR = 0.87, p < .01) predicted smoking abstinence. Baseline physical activity predicted smoking reduction (OR = 1.04, p = .03). None of the examined process variables significantly predicted smoking abstinence. The process variable “counter-conditioning” predicted smoking reduction (OR = 1.46, p = .03).

Conclusions

Baseline predictors of smoking cessation differ from predictors of smoking reduction. Dynamic or modifiable variables play an important role in predicting adolescent smoking cessation.

Practice implications

Counter-conditioning might be an important element in adolescent smoking cessation interventions.     

Design considerations in developing a text messaging program aimed at smoking cessation

BackgroundCell phone text messaging is gaining increasing recognition as an important tool that can be harnessed for prevention and intervention programs across a wide variety of health research applications. Despite the growing body of literature reporting positive outcomes, very little is available about the design decisions that scaffold the development of text messaging-based health interventions. What seems to be missing is documentation of the thought process of investigators in the initial stages of protocol and content development. This omission is of particular concern because many researchers seem to view text messaging as the intervention itself instead of simply a delivery mechanism. Certainly, aspects of this technology may increase participant engagement. Like other interventions, however, the content is a central driver of the behavior change.ObjectiveTo address this noted gap in the literature, we discuss the protocol decisions and content development for SMS Turkey (or Cebiniz birakin diyor in Turkish), a smoking cessation text messaging program for adult smokers in Turkey.MethodsContent was developed in English and translated into Turkish. Efforts were made to ensure that the protocol and content were grounded in evidence-based smoking cessation theory, while also reflective of the cultural aspects of smoking and quitting in Turkey.ResultsMethodological considerations included whether to provide cell phones and whether to reimburse participants for texting costs; whether to include supplementary intervention resources (eg, personal contact); and whether to utilize unidirectional versus bidirectional messaging. Program design considerations included how messages were tailored to the quitting curve and one’s smoking status after one’s quit date, the number of messages participants received per day, and over what period of time the intervention lasted.ConclusionThe content and methods of effective smoking cessation quitline programs were a useful guide in developing SMS Turkey. Proposed guidelines in developing text messaging-based behavior change programs are offered.     

Implementation and effectiveness of a hospital smoking cessation service in Germany

Objective

Hospitalized smokers are often highly motivated to quit and receptive to assistance. There are few published accounts of hospital-based smoking cessation programmes implemented outside of a trial setting, particularly outside North America. We describe the implementation and effectiveness of a dedicated smoking cessation service in Freiburg, Germany.

Methods

Measures of implementation (e.g. number of patients referred and consenting to participate, receipt of post-discharge support) and effectiveness are presented.

Results

In the first 2 years of the service, 1432 patients were referred. Over half (55.3%) of counselled smokers agreed to participate. Sustained abstinence for 6 months was achieved by 28.0% (missing cases coded as smokers), whereas 7-day point prevalence rates were between 30 and 35% at 3, 6 and 12 months. Those who received 4+ post-discharge calls were more likely to achieve sustained abstinence, as were older smokers, those with higher self-efficacy, and cardiovascular patients.

Conclusion

Hospitalized patients in Germany are receptive to the offer of bedside counselling and to phone support post-discharge, and success rates are comparable to those achieved in other countries.

Practice implications

The findings argue strongly for the routine identification of smokers upon hospital admission, and the availability of cessation support both during hospitalization and following discharge.     

Implementing a hospital-based smoking cessation programme: evidence for a learning effect

OBJECTIVE: This study assessed a newly set-up, hospital-based smoking cessation clinic with regard to continuous abstinence rates and the effectiveness of concomittant nicotine replacement therapy. METHODS: Smoking status of 369 participants of this 8-week cognitive-behavioural smoking cessation group programme was obtained using exhaled carbon monoxide at the end of the course as well as self-report 6 months after the course. In addition to demographic data, FTND score, SDS score, and usage of nicotine replacement products were recorded. RESULTS: Overall, 29.8% of all participants reported to have been continuously abstinent for 6 months after the course. Success rates increased significantly during the first year after initiation of the programme (from 15 to 35%, p<0.001), indicating a learning process of the staff running the course. Nicotine replacement therapy was used by 51.3% of participants, but 58% of these discontinued its use within 5 weeks. Nicotine substitution for more than 5 weeks was associated with a 50% success rate after 6 months. CONCLUSIONS: Our data indicate a learning effect of smoking cessation course staff and a possible minimum duration required for nicotine replacement to be effective. PRACTICE IMPLICATIONS: The observed learning effect in smoking cessation programmes should be considered when evaluating newly established interventions of this kind. Patients tend to stop nicotine replacement therapy too early, thereby decreasing their chances of middle-term abstinence.     

Examining why smokers do not want behavioral support with stopping smoking

Objective

This article delineates theory-based determinants of the low use of behavioral stop-smoking support with a view to inform interventions to address the low use.

Methods

Study 1 comprised interviews with 27 smokers recruited from a primary care centre in England. Study 2 used a nationwide sample of 212 smokers who completed a questionnaire informed by Study 1. Multiple regression and mediation analyses were used in Study 2 to discern the determinants of smokers’ motivation to use behavioral stop-smoking support.

Results

The best predictors of low motivation to use (a) group support, and (b) one-to-one support were expectations that stop-smoking support is ineffective at increasing chances of stopping smoking. In turn, expectations of ineffectiveness were predicted by expectations that both services provide insufficient support, as well as smokers’ low self-efficacy to use them. A negative image of those attending groups was another predictor of group support.

Conclusion

A substantial proportion of smokers hold expectations about stop-smoking support that are unlikely to facilitate motivation to use such support.

Practice implications

Intervention studies are now needed targeting such expectations.     

The effects of the acupuncture treatment for smoking cessation in high school student smokers

The use of alternative medicine for smoking cessation have been increasing steadily in recent years. A series of clinical group studies was performed to clarify the effect, outcome and success rate of an acupuncture treatment for smoking cessation. This study was conducted for four weeks using 238 smoking students at 2 high schools. The subjects were separated into two groups: 159 students were treated with acupuncture on the anti-smoking acupoints of the ear, which is known to be effective for cessation of smoking (case group), and 79 students were treated at other sites of the ear (control group). The acupuncture treatment was alternately administered at each side of the ears on a weekly basis for 4 weeks. The smoking cessation success was only 1 case (0.6%) in the case group and none in the control group after 4 weeks. The change in the taste of tobacco and the intensity of the desire to smoke were not significantly different between the case and control groups, but the case group showed a tendency of reduction in the taste of tobacco and the intensity of the desire to smoke. In addition, the reduction in cigarette consumption was not significant, but the tendency of reduction in the study group was significant. It is believed that the site of auricular acupuncture for smoking cessation is not important. However, there was a significant tendency in terms of the reduction in cigarette consumption, the taste of tobacco and the intensity of the desire to smoke in the case group, indicating that auricular acupuncture in smoking cessation has some effect.     

Effect of tailoring in an internet-based intervention for smoking cessation: randomized controlled trial

Background

Studies suggest that tailored materials are superior to nontailored materials in supporting health behavioral change. Several trials on tailored Internet-based interventions for smoking cessation have shown good effects. There have, however, been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components.

Objective

The study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention, with and without tailored content.

Methods

We conducted a two-arm, randomized controlled trial of the open and free Norwegian 12-month follow-up, fully automated Internet-based intervention for smoking cessation, slutta.no. We collected information online on demographics, smoking, self-efficacy, use of the website, and participant evaluation at enrollment and subsequently at 1, 3, and 12 months. Altogether, 2298 self-selected participants aged 16 years or older registered at the website between August 15, 2006 and December 7, 2007 and were randomly assigned to either a multicomponent, nontailored Internet-based intervention for smoking cessation (control) or a version of the same Internet-based intervention with tailored content delivered on the website and via email.

Results

Of the randomly assigned participants, 116 (of 419, response rate = 27.7%) in the intervention group and 128 (of 428, response rate = 29.9%) in the control group had participated over the 12 months and responded at the end of follow-up. The 7-day intention-to-treat abstinence rate at 1 month was 15.2% (149/982) among those receiving the tailored intervention, compared with 9.4% (94/999) among those who received the nontailored intervention (P < .001). The corresponding figures at 3 months were 13.5% (122/902) and 9.4% (84/896, P =.006) and at 12 months were 11.2% (47/419) and 11.7% (50/428, P = .91). Likewise, the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months. Self-efficacy was found to partially mediate the effect of the intervention.

Conclusion

Tailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term, but not in the long term.     

Adenosine receptors in COPD and asymptomatic smokers: effects of smoking cessation

Our group has shown that 1-year smoking cessation persisted or increased airway inflammation in chronic obstructive pulmonary disease (COPD). We compared adenosine and adenosine receptor (AR) expression in COPD and asymptomatic smokers (AS) before and after 1-year smoking cessation. Sputum cytospins and bronchial biopsies of (ex)smoking COPD patients and AS were studied for A₁R, A_2AR, A_2BR, and A₃R expression. Adenosine and inflammatory mediators were measured in sputum supernatants. At baseline, COPD patients had lower levels of adenosine and higher levels of vascular endothelial growth factor in sputum than AS. Smoking cessation induced significantly different effects in COPD than in AS, i.e. an increase in percentages of A₃R expressing neutrophils and A₁R expressing macrophages in COPD as increase in adenosine and monocyte chemoattractant protein-1 levels in sputum. Adenosine-related effector mechanisms may contribute to the persistence and progression of airway inflammation in COPD following 1-year smoking cessation.     

Prospective determinants of smoking cessation in COPD patients within a high intensity or a brief counseling intervention

OBJECTIVES: The aims of this study were to identify prospective determinants of smoking cessation in COPD patients, and to assess whether prospective determinants vary between two different cessation interventions. METHODS: Two hundred and twenty-five moderate to severe COPD patients were randomly allocated to two smoking cessation interventions. One-year cotinine-validated continuous abstinence rates were 9% for the minimal intervention strategy for lung patients (LMIS) and 19% for the SmokeStopTherapy (SST). The baseline characteristics that showed a significant univariate relationship with 1-year continuous abstinence (p<.20) were included in the logistic regression model. This procedure was performed for each intervention separately. Variables that did not remain independent predictors were removed. RESULTS: For the SST separately, no independent significant predictor remained. For the LMIS, attitude towards smoking cessation (OR: 11.8; 95% CI: 1.7-81.5; p=.013) and cotinine level (OR: 2.1; 95% CI: 1.08-3.93; p=.028) remained significant predictors. Within the LMIS, 31% of the variance in continuous abstinence was explained by these variables (p=.003). CONCLUSION: This study suggests that a moderately intensive intervention (LMIS) is primarily suitable for COPD patients with a positive attitude regarding smoking cessation. The more intensive SST can be an alternative for patients without such baseline characteristic. PRACTICE IMPLICATIONS: This stepped-care approach in smoking cessation counseling may be useful in clinical practice and will enable health care providers to match interventions to individual needs and increase efficiency.     

The importance of practitioner smoking status: A survey of NHS Stop Smoking Service practitioners

Objective

To investigate the smoking status of stop smoking practitioners, the impact of this on their practice, and clients’ quit rates.

Methods

Smoking cessation practitioners in the UK NHS Stop Smoking Service were asked about their smoking status, client quit rates and practitioner–client interaction, using an online survey. Associations between responses were investigated using logistic regression.

Results

51% of the sample (N = 484) were ex-smokers. Most practitioners had been questioned about their smoking status by clients, with more never than ex-smokers claiming that this reduced their confidence when advising. Never smokers more frequently reported that clients questioned their ability as a practitioner, but no significant difference in quit rates was reported between never and ex-smokers.

Conclusion

Although evidence suggests smokers believe many practitioners are never smokers, this survey found that this is not true. Research investigating how many smokers might not be seeking support to quit because of this could be beneficial.

Practice implications

Raising awareness of the similarity of quit rates achieved by never and former smoker practitioners, and the experience practitioners draw upon when offering advice, might encourage greater use of the NHS SSS. It could also be beneficial to improve training in never smokers to address confidence issues.     

Oncology healthcare providers’ implementation of the 5A's model of brief intervention for smoking cessation: Patients’ perceptions

Objective

Health care providers (HCPs) can play an important role in promoting smoking cessation and preventing relapse. Public Health Service guidelines recommend the “5A's” model of brief intervention. The goal of the current study was to examine cancer patients’ perceptions of 5A's model implementation by their oncology HCPs.

Methods

This study included 81 thoracic and 87 head and neck cancer patients at a large NCI-designated comprehensive cancer center. Patients completed questionnaires assessing perceptions of their oncology HCPs’ implementation of the 5A's model of brief intervention.

Results

Results indicate partial implementation of the 5A's model. The majority of patients reported that their providers had asked about smoking and advised them to quit, however; only half reported that their interest in quitting had been assessed, and few reported assistance in quitting or follow-up. Delivery of the 5A's was greater among patients who requested cessation advice from their HCPs.

Conclusion

The current findings suggest a need to increase adherence to the 5A's in the oncology setting.

Practical implications

Efforts to increase smoking cessation treatment provision by HCPs may improve the rate of cessation among cancer patients, and ultimately translate into better long-term cancer treatment outcomes.     

Interactive voice response telephony to promote smoking cessation in patients with heart disease: a pilot study

OBJECTIVE: A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response (IVR) follow-up system for smokers recently hospitalized with coronary heart disease (CHD). METHODS: Ninety-nine smokers hospitalized with CHD completed a baseline questionnaire, were provided with bedside counseling, and offered nicotine replacement therapy. They were randomly assigned to a usual care (UC) or an IVR group. The IVR group received automated telephone follow-up calls 3, 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free. When deemed necessary, they were offered additional counseling. Smoking status was determined 52 weeks after hospital discharge. RESULTS: The 52-week point prevalence abstinence rate in the IVR group was 46.0% compared to 34.7% in the UC group (OR=1.60, 95% CI: 0.71-3.60; P=.25). After adjustment for education, age, reason for hospitalization, length of hospitalization, and quit attempts in the past year, the odds of quitting in the IVR group compared to the UC group were 2.34 (95% CI: 0.92-5.92; P=.07). CONCLUSIONS: IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital, however, a larger trial is required to confirm its efficacy. PRACTICE IMPLICATIONS: IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD.     

107例戒烟就诊者的疗效相关因素分析

对107例戒烟者资料的分析结果表明,与戒烟成功有关的因素包括:男性、戒前自我预测能戒掉、健康状况较差、良好的家庭支持监督系统、原戒烟时间较长、服用可乐宁药物;而戒断症状较严重,艾森克个性问卷 N 分较高者戒烟较困难。本文还对这些因素对结果的影响途径进行了简单的讨论。