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.     

Effect of an inpatient nurse-directed smoking cessation program

The purpose of this study was to evaluate the effect of a nurse-directed smoking cessation intervention for adults hospitalized in a small community hospital using a quasiexperimental, prospective, longitudinal design with biochemical validation of self-reported tobacco abstinence. Sixty-eight inpatients were assigned to either a control (n = 30) or an intervention group (n = 38). The control group received smoking cessation literature. The intervention group received smoking cessation literature and a nursing intervention. Each member of the intervention group was randomly assigned to a one or four telephone call subgroup for post discharge nurse follow-up at 3 months. Fifty-five participants completed the study. Smokers receiving the nurse-directed intervention were significantly more likely to be tobacco abstinent at 3 months (n = 17, 55%) than smokers in the control group (n = 5, 21%). Within the intervention group, tobacco abstinence at 3 months was not significantly different between the one and four telephone call groups. For the total sample, smoking relapse was significantly higher for participants who lived with another smoker.     

Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility

Aims and objectives. To test the transportability and implementation of the Tobacco Tactics intervention using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, for inpatient units at the Jesse Brown Veterans Affairs Medical Center. Background. Smoking rates are high among veterans. While the Department of Veterans Affairs has standardised outpatient cessation clinics, inpatient cessation services, known to be efficacious, are only sporadically provided. Design. This was a phase 4, pre and postimplementation study of the Tobacco Tactics intervention. Methods. A unique convenience sample of inpatient veteran smokers was recruited both before (n = 54) and after (n = 50) implementation of the Tobacco Tactics programme. Participants completed baseline and 30‐day follow‐up surveys along with urine cotinine test kits. In addition, staff completed anonymous surveys during the preintervention period (n = 158) and two months after (n = 81) the Tobacco Tactics training. Bivariate analyses compared preintervention vs. postintervention patient and staff characteristics using Chi‐square, Fisher’s Exact or Student’s t‐test. p‐values <0·05 were considered significant. Results. Patient‐reported receipt of services and satisfaction was 10% higher in the postintervention compared to the preintervention group. Quit rates were 3% higher in the postintervention than in the preintervention group. The mean number of cigarettes smoked per day increased from 13 to 15 in the preintervention group, while the mean number of cigarettes smoked per day decreased from 14 to 9 in the postintervention group. Staff’s confidence in their ability to provide cessation services improved greatly posttraining (p = 0·0017) as did self‐reported delivery of cessation services (p = 0·0154). Conclusions. With as little as one‐hour training for nurses, the Tobacco Tactics intervention has the potential to be widely disseminated in the Department of Veterans Affairs. Relevance to clinical practice. The implementation of inpatient smoking interventions has the potential to improve quit rates and decrease morbidity and mortality in the Department of Veterans Affairs.     

Multicomponent individualized smoking cessation intervention for patients with lung disease

AIMS: This paper reports a study examining the process and outcomes of a long-term, multicomponent smoking cessation intervention for patients with lung disease initiated while hospitalized and provided over 1-year postdischarge. BACKGROUND: Successful smoking cessation interventions are of primary importance for people with lung disease. Initiation of such an intervention in hospital settings is particularly important as patients may be especially motivated to quit as a result of strong perceptions of vulnerability while hospitalized for a smoking-related disease. Tailoring the intervention to each person's needs is a promising approach to practice. METHODS: All patients who smoked and were admitted to a pulmonary unit over 2 years were invited to participate in this quasi-experimental study (n = 85), and 69 continued beyond the first month. The intervention was shaped by the TransTheoretical Model and used nicotine replacement therapy, along with individual and group counselling and support grounded in the nurse-patient relationship. The intervention was provided during hospitalization and by telephone after discharge at 1 week, and 1, 3, 6 and 12 months. RESULTS: At 12-months postdischarge, 39% of the patients reported continuous abstinence from smoking from the time they joined the programme and 52% were not smoking at that time. No relationship was found between abstinence and the number of quit attempts, readiness to quit, nicotine dependency and length of hospital stay. Readiness to quit had increased and nicotine dependency decreased significantly by the end of the programme. No gender differences were found for the main variables. CONCLUSIONS: Comprehensive, individualized smoking cessation interventions for hospitalized patients having lung disease, with a 1-year follow-up, was successful. Abstinence was high in comparison with other studies. This may in part be explained by significantly enhanced motivation to quit during the smoking cessation programme.     

5步式叙事护理干预在经皮冠状动脉介入术后病人戒烟护理中的应用

[目的]观察5步式叙事护理干预在经皮冠状动脉介入(PCI)术后病人戒烟护理中的应用效果。[方法]将接受PCI治疗的120例病人随机分为对照组与观察组各60例,对照组接受常规护理,观察组在常规护理的基础上接受5步式叙事护理法干预,对两组干预后各相关观察指标进行比较。[结果]观察组病人干预后吸烟有利决策评分和尼古丁依赖程度评分均显著低于对照组,而吸烟有弊评分和戒烟成功率(近期与中期)均显著高于对照组(P0.05)。[结论]采用5步式叙事护理干预对PCI术后病人实施戒烟护理,能促使其做出戒烟决策,降低尼古丁依赖程度,提高戒烟成功率。     

Abuse and smoking cessation in clinical practice

Aims and objectives. This discursive paper explores issues of abuse during smoking cessation counselling. Background. During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. Methods. A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. Results. There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress‐management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patient’s decision whether to continue with cessation counselling. Conclusion. Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. Relevance to clinical practice. This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention.     

The effects of a nursing smoking cessation intervention on military students in Turkey

Aim: This study aimed to evaluate the effect of a nursing smoking cessation intervention based on the Transtheoretical Model of change on a sample of military students. Methods: The quasi‐experimental and longitudinal designs were used with a sample of 36 smokers from a Turkish air force school of higher education system. Data were collected through face‐to‐face interviews conducted in 1 December 2004–30 June 2005 at pre‐intervention and at each follow‐up. Results: At the end of the programme, the mean scores related to the perceived ‘cons’ of smoking increased significantly (P < 0.05). The students' self‐efficacy mean scores increased significantly (P < 0.01). The students' stages of change before and after the programme were significant (P < 0.01). The mean number of cigarettes smoked per day before the programme was 14.8 (SD = 5.9) and after the programme was 9.6 (SD = 6.4) at the 6‐month follow‐up (P < 0.05). The quit rate was 8.3% at the 6‐month follow‐up. Conclusions: The interventions by the nurses in the smoking cessation programme were effective, resulting in a positive change in attitude and behaviour that would support the students' smoking cessation and the process of cessation.     

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study Tobacco use is considered the single most preventable cause of premature morbidity and mortality. Smoking cessation programs aim at two interrelated purposes, to help people to give up smoking and to prevent relapse. A multicomponent intervention consisting of nicotine replacement therapy, health education, behaviour modification therapy and counselling is widely recommended in the health care literature. Smoking cessation studies from a nursing perspective are few. The purpose of this quasi‐experimental study was to compare outcomes of two nurse‐managed 1‐year group smoking cessation interventions. Intervention 1 (n=34) was provided at a health care centre and consisted of nicotine replacement therapy, health education, behavioural modification and individual and group counselling. In intervention 2 (n=33), provided in a health club, physical exercise was added to the intervention provided in 1. Participants were self‐referred with equal numbers in both interventions. A nonsignificant difference in lapse free abstinence time (LFAT) at 1 year was demonstrated between intervention 1 (20.6%, n=7) and intervention 2 (39.4%, n=13) (p=0.16, odds ratio=2.5). The difference in weight gain between intervention groups was also nonsignificant. Within intervention comparison between abstinent participants and smokers showed that abstinent participants had gained significantly more weight than smokers in intervention 2 (p=0.001), but in intervention 1 the difference was nonsignificant (p=0.2). The small sample size in the study detracts from the significance of the findings. However, a trend is observed showing that physical exercise increases the abstinence rate of participants. The conclusion is drawn that a multicomponent smoking cessation program that includes physical exercise might be an effective intervention, but further studies with a larger sample size are needed.     

Promoting smoking cessation

Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.     

Smoking cessation and characteristics of success and failure among female high‐school smokers

Aim: The purpose of this study was to investigate the effects of a smoking cessation program on female high‐school students and to analyze the characteristics of students who quit smoking compared to those of students who failed to quit. Methods: This study used a mixed research design, including a pre‐ and post‐experimental design for measuring the effects of the smoking cessation intervention and a qualitative design using a focus group interview to analyze the characteristics of individuals who successfully quit in comparison to those who failed to stop smoking. Data were collected before and after the intervention through a self‐report questionnaire, a biochemical index, and a focus group interview. Results: After the intervention, positive changes in stage in the transtheoretical model for smoking‐cessation behavior increased significantly (P < 0.001), and the number of cigarettes smoked daily (P = 0.001), dependency on nicotine, expiratory CO levels, and positive frequency of urine nicotine levels decreased significantly (P < 0.001). Based on data from the focus group interview, students who stopped smoking showed different intrapersonal, interpersonal, and environmental characteristics compared to students who failed to stop smoking. Conclusion: The results suggest that the smoking‐cessation program could be more effective if it were to involve teachers and family members. In addition, a smoking‐prohibited community environment could assist in the control of adolescents' smoking behavior.     

Assessing the feasibility of a clinical practice guideline for inpatient smoking cessation intervention

Although a great deal of effort has been devoted to the development of evidence-based practice guidelines at both the national and local levels, relatively few studies have explored translating these guidelines into clinical practice. The purpose of this study was to assess the feasibility of implementing an inpatient smoking cessation intervention, based on an externally developed clinical practice guideline, at a tertiary care medical center. All smokers who were referred to cardiac rehabilitation services for a 5-week period were eligible for referral to the smoking cessation program. Twenty patients participated in the bedside counseling program. The mean amount of time to deliver the intervention was 43.5 minutes. At 1 month, 14 (70%) of the participants reported continuous abstinence from tobacco. Estimated cost per patient for smoking cessation intervention was $51.14.     

护理干预对腰椎手术患者戒烟效果的影响

目的:探讨护理干预对腰椎手术患者吸烟强度和戒烟成功率的影响。方法:选择2007年11月～2011年6月行腰椎手术的住院患者、有吸烟史且住院前正在吸烟者共238例,随机分为两组。对照组116例行健康教育,从而劝其戒烟。干预组122例在健康教育基础上,采用"5A"方法和"5 R"方法进行个体化戒烟护理干预。随访并比较两组患者术后3,6,9个月时的吸烟强度和戒烟成功率。结果:术后3,6,9个月随访时,干预组患者吸烟强度下降,按每日吸烟量计分别为(14.25±4.62)支/d,(17.36±4.81)支/d,(20.34±5.86)支/d,较对照组均下降(P<0.05);戒烟率分别为51.64%,47.54%及42.62%,与对照组比较戒烟率增高,差异有统计学意义(P<0.05)。结论:护理干预能显著改善腰椎手术患者戒烟效果,降低吸烟强度,提高戒烟率。     

The effect of three-part breathing exercise on smoking cessation: A 6-month cluster-randomized clinical trial

IntroductionNegative affect was identified as an important barrier to smoking cessation. Three-part breathing exercise showed a significant effect on decreasing negative affect immediately after being practiced. Thus, this study evaluated the effect of three-part breathing exercise on smoking cessation.MethodsA 6-month cluster-randomized clinical trial was conducted. Forty-three participants recruited from 8 companies in Bangkok Metropolitan areas were randomly assigned at the cluster level into either the intervention or control groups. Control group (n = 23) received counseling for smoking cessation once a week for 12 weeks. Intervention group (n = 20) received counseling for smoking cessation plus a three-part breathing exercise program once a week for 12 weeks. The primary outcomes were 7-day point prevalence and continuous abstinence rate as validated by saliva cotinine. The secondary outcomes were cigarette cravings, nicotine withdrawal symptoms, affect and quality of life.ResultsThe results revealed no significant difference in smoking abstinence rate between the three-part breathing exercise and control group. Participants demonstrated significant pre-post improvement in cigarette cravings, nicotine withdrawal symptoms, affect, and quality of life within each group.ConclusionThere were no statistically significant differences between the two groups. However, the improvement in abstinence rate from the three-part breathing exercise was deemed clinically relevant. Thus, it may be recommended to smokers interested in smoking cessation and more research is needed on this topic.     

Activating patients for smoking cessation through physician autonomy support

OBJECTIVE: Test whether physicians' counseling patients for smoking cessation with an autonomy supportive rather than controlling style would increase patients' active involvement in the counseling session and increase maintained abstinence. DESIGN: Randomized trial of 27 community-based physicians using two interview styles, with observer ratings of patient active involvement and assessments of patient smoking status at 6 months, 12 months, and 30 months. PATIENTS: Adult smokers: 336 recruited; 249 for final analyses. INTERVENTION: Physicians used an autonomy- supportive or controlling interpersonal style, randomly assigned within physician, to briefly counsel patients about smoking cessation, using the National Cancer Institute's 4-A's model. MEASUREMENT: Patient active involvement was rated from audio tapes of the interviews. Continuous abstinence came from self-reports at 6 months, 12 months, and 30 months, CO validated at 6 months or 12 months and at 30 months. RESULTS: Physician style did not have a significant direct effect on smoking cessation but did significantly increase patient active involvement in the interview. Active involvement, in turn, increased smoking cessation. Structural equation modeling confirmed a theoretical model in which the intervention positively predicted patient active involvement after controlling for patient reports of wanting to stop smoking, and active involvement significantly predicted continuous abstinence after controlling for previous quit attempts. CONCLUSIONS: Although physicians' autonomy- supportive style while counseling smokers to quit did not have a direct effect on smoking cessation, it increased patients' active involvement in the counseling session which in turn increased continuous abstinence over 30 months. Further research should clarify the direct effects of physician interpersonal style on health outcomes.     

The effect of a multi-component smoking cessation intervention in African American women residing in public housing

The purpose of this study was to test the effectiveness of a multi-component smoking cessation intervention in African American women residing in public housing. The intervention consisted of: (a) nurse led behavioral/empowerment counseling; (b) nicotine replacement therapy; and, (c) community health workers to enhance smoking self-efficacy, social support, and spiritual well-being. The results showed a 6-month continuous smoking abstinence of 27.5% and 5.7% in the intervention and comparison groups. Changes in social support and smoking self-efficacy over time predicted smoking abstinence, and self-efficacy mediated 6-month smoking abstinence outcomes. Spiritual well-being did not predict or mediate smoking abstinence outcomes. These findings support the use of a nurse/community health worker model to deliver culturally tailored behavioral interventions with marginalized communities.     

Evaluating the effectiveness of the coronary care nurses' role in smoking cessation

Summary

• ? The aim of this small-scale study was to assess the feasibility and impact of an individualized smoking cessation intervention among clients admitted to a coronary care unit with severe angina or a first time myocardial infarction.
• ? The intervention involved in-depth nursing assessment interviews related to client beliefs, motivation and experiences of smoking, culminating in an individualized cessation plan. Participants were offered follow up support during the first year post-intervention.
• ? The findings are highly encouraging with a 77% smoking cessation rate for surviving clients within the intervention group at the end of the first year, and with 75% continued successful smoking cessation amongst surviving clients 2 years post-intervention.

     

The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD

BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates. OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function. METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years. RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups. CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.     

Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic,cluster-randomized controlled trial

BackgroundNovel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers.MethodsThis is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat.CommentsThis is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.     

Predictors of response to brief smoking cessation interventions for adolescents who have contravened school smoking policy

Objective: To determine factors impeding favourable response to brief interventions for smoking by Australian middle high school students.

Method: Predictors of smoking at one month follow‐up were examined in 56 Queensland state high school students (34% female) who had received a brief smoking cessation intervention. The potential predictors included smoking days/week at Time 1, academic performance, nicotine dependence, parental care, problem drinking, and peer smoking.

Results: After accounting for academic performance, small variations in outcomes across two intervention types, and Time 1 smoking, problem drinking emerged as a modest predictor of smoking outcome. Peer smoking and parental care did not predict changes in smoking.

Conclusions: Brief tobacco cessation programmes may benefit from routine screening and an additional focus on heavy drinking.