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.     

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 in a public health agency: its relationship to sick leave and other life-style behavior

A survey questionnaire was administered to employees of a public health agency regarding their involvement with smoking and other life-style behavior. Responses were analyzed and combined with sick leave data to determine the use of sick leave among employees who currently smoke, those who never smoked, and those who formerly smoked. Current smokers took significantly more sick leave than those who have never smoked ("nonsmokers") or former smokers. Using an analysis of variance model, only smoking status, education level, and sex, among selected demographic variables, were significantly related to the amount of sick leave taken. Current smokers took excess sick leave (amounting to nearly $40,000) as compared with nonsmokers and ex-smokers combined over a 21-month period. This study also characterizes the relationship between smoking status and selected life-style behavior. Smokers were less active, less likely to use seat belts, less likely to believe that smoking is related to health, and more likely to be heavier and to eat a poor diet than their nonsmoking or former smoking counterparts. We make suggestions regarding the reduction of smoking and other deleterious behavior as a means of controlling costs and reducing employee morbidity.     

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.     

Smoking habits among Finnish middle-aged men: experiences and attitudes

The purpose of this study was to explain smoking habits amongst middle-aged men in Finland by describing their experiences of smoking and their attitudes towards smoking. As a pilot survey for a major health campaign targeted at 40-year-old men, the data for this study were collected using two questionnaires in connection with voluntary medical examinations. The first questionnaire was based on Prochaska's theory of stages of change in health behaviour. The second instrument was an attitude scale developed specifically for this study on the basis of Green and Kreuter's theory of factors influencing health behaviour. According to the results 31% of males aged 40 were regular smokers. Men with a lower level of education and out of work smoked more often than others. Non-smokers reported a better self-perceived health than smokers. Smoking cessation is a process in which men gradually proceed from one step to the next. In this study 12% of the men were in the contemplation stage and 11% in the preparation stage. One-quarter of the men had recently given up the habit and were in the action stage, while 2% had quit smoking over 6 months ago and were in the maintenance stage. One-quarter of the men regarded smoking as an integral part of their way of life and felt that public opinion towards smoking is hostile.     

GPs have key role in helping patients to stop smoking

Eighteen per cent of all deaths in adults aged 35 or over in England are still attributable to smoking. Almost all these premature deaths could be avoided if smokers stopped before their mid-thirties but only a quarter of people who have ever smoked regularly manage to quit by this age. Advice from the patient's GP is one of the most important triggers to a smoker making an attempt to quit. All patients attending a surgery for any reason who have smoked within the past three years should be offered advice on stopping smoking. Smokers without smoking-related diseases are just as likely to respond to advice as those with them. It is also important to re-assess the status of former smokers who were recorded as having stopped within the past three years. Half of those who stopped six months ago will relapse at some point as will 40% of those who stopped a year ago. Offer help with stopping to all smokers. The National Centre for Smoking Cessation and Training has launched a new online training module on how GPs can best deliver smoking cessation support to their patients. Optimum treatment involves behavioural support plus one of the smoking cessation medications. Behavioural support includes a number of specific behaviour change techniques that enhance the smoker's chances of remaining abstinent. These include: measurement of carbon monoxide in expired air; advice on best use of medication and helping smokers to put in place a clear 'not a puff' rule.     

Nurses' competence in advising and supporting clients to cease smoking: a survey among Finnish nurses

The article describes the results of a survey of Finnish nurses (n = 882). The purpose of the study was to describe how nurses' education, working experience and their own smoking habits relate to their self-reported competence in advising and supporting clients to cease smoking. Nurses evaluated their skills fairly highly, but did not believe that advice alone was helpful to clients who wished to cease smoking. Nurses had minimal knowledge of smoking substitutes. Lower general education, a fairly short time from graduation and a history of smoking were positively related to nurses' competence to guide clients. Nurses who smoked daily were found to have better skills in giving advice and support than their non-smoking colleagues. The results have implications for the design of smoking cessation programmes. More education and guidance is required for nurses, so that they can develop their understanding and a positive view as to the effectiveness of smoking cessation programmes.     

Smoking habits of nurses and midwives

A study was designed to examine the hypothesis that increased awareness of the health hazards of smoking aids smoking cessation in female health care workers. One hundred and thirteen nurses and midwives completed a questionnaire about their smoking habits. When the group was tested as a whole against the national average for the same socio-economic group, it was found that there was a strong similarity between the subject's smoking habits and the national average. However, when the nurses and midwives were separated into two groups, the nurses smoked significantly more than the national average, whereas the midwives smoked significantly less. In addition, there was an intriguing finding that a highly significant number of the midwives had never smoked compared to the national average.     

Admission to a psychiatric unit and changes in tobacco smoking

Smoking and withdrawal from smoking complicates the assessment and treatment of mental illness. We aimed to establish whether psychiatric inpatients smoke different amounts after admission than beforehand and, if so, to find out why. Forty-three inpatients on a working age adult psychiatry ward completed self-report questionnaires about smoking habits. Those who smoked a different amount after admission had a follow-up interview to find out why they thought this had occurred. The interview incorporated qualitative and quantitative aspects which were analysed accordingly.Fifty-six percent of participants were smokers before admission, rising to 70% afterwards. Of the smokers, 17% smoked less after admission, and 63% smoked more. The average number of cigarettes smoked per person per day increased from five to thirteen. The main reasons for smoking more were boredom, stress and the wish to socialise.     

Smoking behaviour in young families: Do parents take practical measures to prevent passive smoking by the children?

Objective - To investigate smoking behaviour in young families.

Design - Cross-sectional study.

Setting - Mother and child health centres in Oslo, Norway.

Subjects - the families of 1046 children attending the health centres for 6-weeks-, 2- or 4- year well child visits.

Main outcome measures - Daily smoking, smoking quantity and practical measures taken by the parents to prevent passive smoking among the children as assessed by parental reports.

Results - in 48% of the families at least one adult was smoking. 33% of the smoking parents smoked more than ten cigarettes per day. 47% of the smoking families reported that they did not smoke indoors.

Conclusions - the parents were less likely to smoke if they were more than 35 years of age, had a child aged less than one year, had' a spouse/co-habitee or had a long education. Smoking parents smoked less if they had a spouse/co-habitee, had a child aged less than one year or had few children. Smoking parents were more often careful and did not smoke indoors if they had a child aged less than one year, had a spouse/co-habitee, did not have a smoking spouse/co-habitee or smoked a low number of cigarettes per day.     

Knowledge of the damages of wrong nutrition and of the effect of stimulants. (Results of questioning 100 employees of a large industry]

In an unselected collective of 100 employees of a big concern the knowledge with regard to body weight, nutrition and nicotine abuse was studied and the eating habits as well as the principles of education connected with them were ascertained. Nearly all questioned persons knew their body weight. Half of them were able to indicate their ideal weight with a precision of +/- 10%. The rate of the considerably overweight persons in the collective showed a dependence on higher age and female sex. Among the questionees with secondary education more normalweight persons were found. The test persons were well informed about the disadvantages of overweight and controlled their body weight in two thirds of the cases at least once a week. They stated to have met the term "diet" above all in the mass media. About half of them were able to define the term "calorie" approximately precisely. The questionees, however, often underestimated the required caloric quantity, apparently without drawing conclusions. The caloric content of alcoholic drinks was underestimated. Beer ranked first among the consumed alcoholic drinks. Only one fifth of the test persons "reward" their children with sweets and wish that they eat up their dinner. About half of the questionees were smokers. One fourth had never smoked, while another fourth had given up smoking. Mostly cigarettes were consumed, although nearly all test persons regarded inhaling smoking as harmful. The sole knowledge of factors that have a detrimental effect on the state of health (e.g. overweight, smoking) seems to be not sufficient to lead a healthy life. Since the test persons are, however, willing to do something for their health it would be useful to concentrate adipose persons and smokers into groups that should be treated by behaviour therapy and be positively motivated.     

Survey of students from an eating disorders programme

AIM: To survey former students of the English National Board N46 eating disorders programme at Anglia Polytechnic University, since its introduction in 1994. METHOD: This was a collaborative exercise involving lecturers and a former ENB N46 student, and provides a good example of evidence-based education. A postal questionnaire, consisting of questions relating to current employment, qualifications, evaluation of the ENB N46 and further training needs, was delivered to 45 former students, 27 of whom returned questionnaires. RESULTS: The analysis suggests that the ENB N46 programme had a significant effect on students' practice and continuing professional development, with 96 per cent of respondents saying they would recommend the course to others and 92 per cent indicating a clear commitment to continue working in this area. CONCLUSION: Specialist training courses in eating disorders represent a valuable contribution to the quality of client care and treatment, despite their scarcity and uneven distribution across the UK.     

Relationship between smoking status and serum lipids in a hyperlipidemic population and analysis of possible confounding factors.

The aim of our study was to estimate the potential relationship between smoking behavior and other coronary heart disease risk factors in 250 hyperlipidemic patients. We present data obtained through self-reporting of the number of cigarettes smoked per day, measurements of three tobacco markers, and data on dietary habits and lipid variables. We measured cotinine (by HPLC) and thiocyanate and used a recent colorimetric assay for the indirect evaluation of the nicotine metabolites in a single urine specimen. Mean values of nicotine metabolites, expressed as cotinine equivalents, were 6.7, 39.9, and 79.4 mumol/L, respectively, for nonsmokers, light smokers (7.7 cigarettes per day), and heavy smokers (25.8 cigarettes per day). We found that light smokers have higher concentrations of cotinine and nicotine metabolites in proportion to the number of cigarettes smoked per day than do heavy smokers. Thus, the simple colorimetric assay can accurately evaluate smoking status. Hyperlipidemia and smoking are linked by an intricate network of multiple relations. The concentration of high-density lipoprotein (HDL) cholesterol is lower in heavy smokers, and the concentrations of triglycerides and cholesterol are higher. The 0.11 mmol/L difference in HDL cholesterol between light and heavy smokers is close to the results of previous papers; however, when gender, dietary habits (including alcohol intake), and data on body mass index are included in a multiple regression analysis, there is no longer an association between HDL cholesterol concentrations and smoking status. Therefore, these different dietary habits may be confounding factors that partly explain the pattern of lipid variables.     

Waking at night to smoke as a marker for tobacco dependence: patient characteristics and relationship to treatment outcome

AIM: This study aimed to describe the characteristics of treatment-seeking patients who wake at night to smoke (night-smoking), identify factors that may be associated with night-smoking, and assess the association between night-smoking and treatment outcome. METHODS: A total of 2312 consecutive eligible cigarette smokers who sought treatment at a specialist tobacco-dependence clinic declared a Target Quit Date, provided baseline information at assessment, and were then followed-up 4 and 26 weeks after their target quit date. RESULTS: Of the total sample, 51.1% were identified as night-smokers and 25.1% reported smoking abstinence at 26-week follow-up. Night-smoking was associated with a number of other patient characteristics, including African-American race or Hispanic ethnicity, having smoking-related medical symptoms, having been treated for a behavioural health problem, smoking mentholated cigarettes, smoking within 30 min of waking in the morning, increased cigarettes smoked per day, and not having private health insurance. In multivariate analyses, night-smoking at assessment remained a significant predictor of smoking at 26-week follow-up when controlling for other factors associated with treatment outcome (adjusted odds ratio: 0.77, 95% confidence interval: 0.62-0.96). Night-smokers also experienced a shorter average time to relapse (38.5 vs. 56 days, p<0.0001). CONCLUSIONS: Several socioeconomic and tobacco use characteristics are shared among patients who wake at night to smoke. This behaviour can be assessed by a simple question and used as a marker for tobacco dependence and as an indicator that more intensive and sustained treatment may be required.     

Jordanian nurses' perceptions of their preparedness for disaster management

AimTo assess Jordanian RNs’ perceptions regarding their knowledge, skills, and preparedness for disaster management.BackgroundCurrent disaster knowledge, skills, and preparedness levels need to be evaluated to guide plans for effective educational programs. There is also a need to know where RNs received their knowledge, skills, and preparation, to enhance or improve future educational opportunities.MethodsCross-sectional survey where the Disaster Preparedness Evaluation Tool (DPET®) was distributed to Jordanian RNs who work in three randomly selected Ministry of Health hospitals and two university hospitals.ResultsFour hundred and seventy-four participants completed the survey. Sixty-five per cent of respondents described their current disaster preparedness as weak: 18% medium: 12% good; and 5% felt their preparation was very good. Thirty-one per cent received disaster education in undergraduate programs; 8% in graduate nursing programs; 31% in facility drills, and 22% in continuing education courses. Eleven per cent had participated in a real disaster. Four hundred and thirty RNs wanted to learn more about RNs role in disasters, including knowledge and skills.ConclusionKnowledge, skills, and disaster preparedness need continual reinforcement to improve self efficacy for disaster management.RecommendationsThere is a need for a consistent national nursing curriculum for disaster preparedness and nationwide drills to increase disaster knowledge, skills, preparedness, and confidence.     

Ethnicity predicts perceptions of smoking and smoking cessation among veterans

The objective of this study was to determine if race/ethnicity predicts motivation to quit smoking and preferences for cessation services among smokers serviced by a primarily psychiatric Veterans Affairs hospital. A self-administered survey was given to a convenience sample of smokers (n=146) at the Battle Creek Veterans Affairs Medical Center. Univariate, bivariate and multivariate regression analyses were calculated to determine the association between race/ethnicity and motivation to quit smoking. Forty-two per cent of the sample was non-white. Non-white patients smoked significantly less cigarettes per day as compared with white patients (P=0.002). In the multivariate analyses, compared with whites, non-whites had 3.5 times greater odds of thinking that quitting smoking was extremely/very important to health (P= 0.01), 4.0 times greater odds of thinking of quitting using tobacco products in the next 30 days (P=0.004) and 3.4 times greater odds of being interested in receiving smoking cessation services (P=0.007). Yet, non-white patients were less likely to be interested in intensive nurse counselling and cessation medications. As the number of non-whites continues to increase in the military, novel strategies may be needed to capitalize on the high motivation to quit smoking and preference for non-traditional interventions among non-white smokers treated in Veterans Affairs hospitals.     

The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings.     

Determination of smoking habits and personality traits among nursing students

The purpose of this research was to determine the smoking habits of students who receive nursing education in universities and their personality traits. We found that 29.2% of the students were habitual smokers, and the average score on the Fagerstr?m Nicotine Dependence Test was 3.4 +/- 2.3. A significant difference in statistical terms was marked between the participants' smoking habits and the self-control factor. Because we found that the level of smoking among individuals with high self-control is rather low, providing information to students on quitting smoking and periodically assessing smoking status are recommended. In addition, individual improvement programs focused on the development of self-control can be added to nursing curricula.     

Participation of Icelandic nurses in smoking cessation counselling

Aims and objectives. The purpose of this study was to investigate the participation and knowledge of Icelandic nurses in smoking cessation counselling and to find barriers to smoking interventions by nurses. Background. Research has shown that clinical intervention as brief as three minutes can substantially increase smoking cessation success. Several studies have revealed that majority of nurses agree that smoking cessation counselling is within their duties. However, the percentage of nurses who report advising and/or counselling patients remains low. Design and methods. An anonymous mail survey of all practicing nurses in Iceland was conducted in September 2004. A self‐administered questionnaire was used, consisting of 74 questions in six sections: asking about smoking behaviour, to advise, to assess/assist/arrange, children and passive smoking, other questions and demographic questions. Results. Of 2453 questionnaires, 868 complete questionnaires were returned, giving a 36% response rate. While the majority of nurses ‘asked’ about smoking behaviour, a minority ‘advised’ or ‘assisted’ their clients with smoking cessation. However, if the clients had no smoking‐related symptoms, less than half of the nurses asked about smoking behaviour. Failure to ask and advise clients about the importance of smoking cessation and assisting with smoking cessation correlated (p < 0·001) with several factors, including: lack of time, insufficient knowledge or training and not considered as a part of daily duty. Nurses who smoked were less likely to advise against smoking (p < 0·05). Conclusions. Nurses frequently neglect to counsel clients about smoking cessation. Common barriers to the delivery of smoking cessation interventions by nurses include insufficient education and training in smoking cessation therapy. Relevance to clinical practice. The number of patients with tobacco‐related illnesses is increasing worldwide. Effective smoking cessation interventions by nurses have the enormous potential of reducing smoking prevalence and improve health.