BACKGROUND: Since the initial report on the negative effects of smoking by the Surgeon General's Advisory Committee, the components of cigarettes and tobacco smoke and the mechanisms by which these cause disease have been studied extensively. Despite the well-documented health consequences associated with tobacco use, nearly 70 million Americans over the age of 12 actively use tobacco products, with 57.5 million of these (22.1% of the U.S. population in this age range) actively smoking cigarettes. Understanding how nicotine addiction develops and reinforces itself is important context for understanding the high prevalence of quit interest among smokers and the high relapse rates associated with quit attempts. While the increased availability of different, clinically proven tobacco cessation aids should lower the barrier associated with tobacco abstinence, the prevalence of quit aid use still remains low among those attempting to quit smoking. This study examines quit interest in active smokers, the quit attempts attempted by current and former smokers, the prevalence of tobacco cessation aid use in these quit attempts, and the perceived efficacy of certain quit aids. METHODS: This study was conducted in the Emergency Departments of ten hospitals nationwide by the National Association of Research Associates Programs in 2012. This study utilized trained research staff to enroll non-emergent patients and visitors over the age of 18 years old, obtaining demographical information and a detailed history of tobacco use from the participant. This included such information as current tobacco use status, how many cigarettes were consumed during a typical day, how many times they had attempted to abstain from tobacco use in the past, if they had used any tobacco cessation aids during those quit attempts, and, if so, how effective they believed these aids were. Participants were also asked to rate their readiness to quit smoking and intent to quit smoking, markers this study used to analyze quit interest. RESULTS: Of those approached, 10,303 study participants were selected for inclusion in this study, reporting tobacco use for longer than one month at any point in their life. 50.5% reported current tobacco use, while 46.8% reported current abstention from smoking. A majority of active smokers expressed interest in initiating tobacco cessation, with 55.2% reporting they were ready to quit smoking, though a smaller majority (51.9%) of active smokers reported that they intended to quit smoking. Most smokers reported at least 1 quit attempt in the past, with 76.5% of former smokers reporting that they quit within 1 to 5 attempts. Only 30.7% of study participants reported ever using some form of tobacco cessation aid in previous quit attempts, with nicotine replacement therapy use being the most commonly reported, and with pharmacological interventions more commonly reported than counseling-based cessation interventions. A majority of participants who reported using nicotine replacement gum and lozenges (57.8% and 49.5%, respectfully) reported that they were not helpful in aiding their cessation attempts, with only 30.1% of gum and 38.7% of lozenge users reporting a positive effect. CONCLUSIONS: The results indicated that among active smokers, smokers that reported smoking less (only some days or fewer cigarettes per day) were more likely to express interest (readiness and intent) in initiating tobacco cessation than those that reported smoking more (every day or more cigarettes per day). Quit interest also appeared to be lowest in 18-25 year olds, with this age group also reporting the lowest proportion of quit attempts, a finding that differed from another national tobacco survey. The prevalence of quit aid use in our study was comparable to another national tobacco survey, but our findings for the prevalence of unassisted quit attempts did not coincide with results found in other studies. These results also indicated that cessation aid use increased with increased number of quit attempts. Though we found that former smokers were more likely to indicate that NRT products were helpful than active smokers were, we were unable to fully analyze the perceived effects of cessation aid use due to the loss of some of this data. In light of the limitations of this study, further study needs to be conducted to better understand the perceived effect of tobacco cessation aids and how this might differ from the efficacy values found in clinical trials. In order to make findings more comparable to other tobacco surveys, future studies should also be designed around clear and common definitions for active tobacco use and quit interest, and a focus on quit attempts should be modulated by some degree of recency (e.g., quit attempts made within the previous year or two years).

Tobakskonsumtion är ett folkhälsoproblem och tobaksförebyggande arbete är en viktig del i arbetet för att främja en hållbar utveckling. Distriktssjuksköterskor inom primärvården har en betydande roll i det hälsofrämjande och förebyggande arbetet inom tobaksavvänjning. Syftet var att belysa distriktssjuksköterskans hälsobefrämjande arbete vid tobaksavvänjning med inriktning på rökning. Studien har en kvalitativ ansats. Intervjuer genomfördes med nio distriktssjuksköterskor verksamma inom primärvården i tre olika kommuner i Västra Sverige. Intervjuerna spelades in på band och transkriberades sedan. Intervjuerna analyserades genom kvalitativ innehållsanalys. Intervjutexter strukturerades utifrån meningsbärande enheter, kondenserade meningsenheter, koder, underkategorier och kategorier. Resultatet har delats in i fyra huvudkategorier: Distriktssjuksköterskans roll, Förhållningssätt, Arbetssätt och Resurser. I resultatet framkommer att distriktssjuksköterskan utformar en behandlingsplan tillsammans med patienten, stöttar under processen och följer sedan upp patienten. Resultatet påvisar att distriktssjuksköterskorna har olika arbetssätt och olika förhållningssätt. Det är viktigt att anpassa hela behandlingen efter patientens förutsättningar för att uppnå bäst resultat. Nyckeln till en framgångsrik tobaksavvänjning är patientens motivationsnivå. För ett lyckosamt arbete inom tobaksavvänjning behövs resurser som exempelvis tid ses över och anpassas efter behov. Studien visar att utbildning i motiverande samtal är en angelägenhet för distriktssjuksköterskor som jobbar med livsstilsförändringar. All vårdpersonal inom vården bör motivera patienten till rökstopp. / Tobacco consumption is a public health problem and its prevention is an important part of the work to promote sustainable development. District nurses in primary health care have an important role in health-promotion and prevention work in tobacco cessation. The aim of the study is to highlight the role of the district nurse in tobacco cessation in primary care. The study has a qualitative approach. The interviews were conducted with nine district nurses who work in primary care in three municipalities in western Sweden. They were recorded on tape and then transcribed and analysed through qualitative content analysis. The interview texts were structured based on meaning units, condensed meaning units, codes, subcategories and categories. The results have been classified into four main categories: Role of the district nurse, Attitude, Method of working and Resources. The results show that the district nurse draws up a treatment plan together with the patient, provides support during the process and then follows up the patient. They also indicate that district nurses have different ways of working and different attitudes. To achieve the best results, it is important to adapt all the treatment to the conditions of the patient. The key to successful tobacco cessation is the motivational level of the patient. For successful work on tobacco cessation, resources such as, for example, time, need to be reviewed and adapted to the needs. The study shows that training in motivational interviewing is important for district nurses who work with lifestyle changes. All nursing staff in the care sector should motivate the patient to stop smoking.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-07T12:18:26Z No. of bitstreams: 1 barbaraanybianchibottarodeandrade.pdf: 4066498 bytes, checksum: 2b4e2f2307812fa1228fb8223692091e (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-13T12:23:22Z (GMT) No. of bitstreams: 1 barbaraanybianchibottarodeandrade.pdf: 4066498 bytes, checksum: 2b4e2f2307812fa1228fb8223692091e (MD5) / Made available in DSpace on 2016-07-13T12:23:22Z (GMT). No. of bitstreams: 1 barbaraanybianchibottarodeandrade.pdf: 4066498 bytes, checksum: 2b4e2f2307812fa1228fb8223692091e (MD5) Previous issue date: 2016-02-23 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A importância de cessar o tabagismo é amplamente divulgada, mas alcançar e manter a abstinência tabágica é um processo difícil. Para pacientes portadores de condições crônicas, o tabagismo acarreta danos ainda maiores, enquanto a cessação do consumo pode prevenir a morte prematura e auxiliar o processo de tratamento das doenças. A presente pesquisa teve como objetivos propor um modelo de registro eletrônico, descrever e explorar o tratamento do tabagismo em pacientes com doenças crônicas que participaram das reuniões na Unidade de Atenção Integral ao Tabagista (UAI-T) e analisar os potenciais preditores relacionados à cessação tabágica. Foi criado um registro eletrônico para armazenamento e gerenciamento dos dados da UAI-T e um questionário telefônico que será realizado em 6 e 12 meses após a 12ª semana do tratamento. Foram usados dados registrados nos prontuários de pacientes fumantes encaminhados para tratamento na Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia (IMEPEN) e que participaram dos encontros do Grupo de Tabagismo realizados entre maio de 2012 e dezembro de 2013. Nesse período, participaram dos encontros 98 pacientes com múltiplas condições crônicas. A média de idade foi de 54,9 anos (DP=10,3), 41 eram homens e 57 eram mulheres. A partir dos dados presentes nas fichas, observou-se que foi alcançada uma taxa de cessação de 76,9% na 12ª semana do tratamento, sendo que os aderentes cessaram mais que os não aderentes. O questionário telefônico foi respondido por 62 participantes. Constatou-se que 27,4% são ex-fumantes, 44,4% permaneceram cerca de 6 meses sem fumar, e os que fumam atualmente diminuíram seu consumo diário de cigarros. / Tobacco cessation importance is widely reported, but achieving and maintaining abstinence is a difficult process. For patients suffering from chronic conditions, smoke can cause even more harm, while cessation may help treatment and prevent premature death. This study aims to create an electronic record model, describe and explore the smoking cessation in patients with chronic diseases who participated in treatment meetings of a smoking cessation unit, and to analyse the potential predictors related to smoking cessation. An electronic database was created to store and manage treatment data and a telephone questionnaire to be held 6 and 12 months after the 12 weeks of treatment was designed. Data from the records of smokers referred for treatment at IMEPEN and participated in the treatment meetings held between May 2012 and December 2013 were used in this study. During this period, 98 patients with multiple chronic conditions received treatment. The mean age we 54.9 years (SD=10.3), 41 were male and 57 were female. From the data analysed, it was observed that a 76.9% cessation rate was achieved at 12 weeks of treatment, and the adherents ceased more than non-adherents. The telephone questionnaire was completed by 62 of the participants. It was found that 27.4% are former smokers, 44.4% remained around 6 months without smoking, and those who currently smoke decreased their daily cigarette consumption.

Research indicates that tobacco cessation rates are at least doubled when smokers receive assistance from a clinician; receiving tobacco cessation advice from multiple types of clinicians increases quit rates even further.¹ To address a decades-long deficiency in the tobacco cessation training of health professionals in general, a shared curriculum, Rx for Change: Clinician-Assisted Tobacco Cessation, was developed in 1999 as a collaboration of the schools of pharmacy in California.^2,3 Between 2003 and 2005, pharmacy faculty members (n=191) participated in national train-the-trainer workshops designed to equip faculty with the necessary knowledge and skills to implement the Rx for Change curriculum at their academic institutions.⁴ <div><br></div><div> The studies that comprise this dissertation are a logical extension of this national initiative, applying a mixed-methods approach to: (a) evaluate the long-term impact of training pharmacy faculty using the Rx for Change program, (b) delineate recommendations for developing and disseminating shared curricula for health-care programs, and (c) evaluate utilization of the Rx for Change website, which hosts faculty resources and curricular files for download. In combination, these (along with a previously-conducted qualitative study) provide a comprehensive “view” of the long-term impact of this unique shared curriculum. </div><div><br></div><div>Results from the three studies provided evidence for: (1) reach to the majority of pharmacy institutions, (2) a high level of adoption of the Rx for Change in health professional schools, (3) a positive impact on faculty trainees’ careers and their level of confidence for teaching, precepting clinical students, and assisting tobacco users, (4) implementation of the Rx for Change curriculum with a variety of teaching methodologies, and (5) continuity of use within the core curriculum of pharmacy institutions. Seven key factors were found to have contributed to the success of the Rx for Change program, and thus the following are recommended for future shared curriculum developers: (1) appeal to attendees, (2) relate content to clinical practice, (3) deliver live training (in-person), (4) develop high quality materials delivered by experts, (5) meet accreditation standards, (6) provide support for teaching, and (7) demonstrate effectiveness. Data from the website analysis provided evidence for interprofessional reach of the Rx for Change website to educators, learners, and professionals.<br></div>

Tobacco use is the leading cause of premature and preventable death in the United States, yet millions of Americans continue to use tobacco. Nursing professionals comprise the largest health care provider group and can help improve tobacco cessation among their patients. The purpose of this doctoral project was to increase nursing staff and advanced practice providers knowledge, skills, and confidence related to tobacco cessation interventions. The project took place in a family medicine clinic in Central Texas. The nursing staff (which included 1 registered nurse and 3 licensed vocational nurses) and advanced practice providers (which included 3 nurse practitioners and one physician assistant) were asked to participate in the project. Knowles' theory of adult learning and Prochaska's transtheoretical model served as the conceptual frameworks for the project. The United States Public Health Service Rx for Change program was used to create 2 posters on tobacco cessation interventions that were presented to staff as an educational intervention. A 10-question knowledge survey and a 15-question skills and confidence survey were administered before and after the education program; 8 nurses completed the survey before the education and 7 nurses completed the survey after the education. For the presurvey, 29% of responses were correct; while for the postsurvey 83% of responses were correct. Results also showed an increase on the 4-point Likert-scale survey measuring the participants' skills and confidence regarding tobacco cessation interventions. The finds of this project will help nurses and advanced practice providers use evidence-based practices to promote smoking cessation, leading to positive social change for patients, families, and communities.

The stage at diagnosis is the single most important predictor of lung cancer outcome. Therefore, detecting lung cancer early is of utmost importance. Low-dose computed tomography (LDCT) has proven beneficial in the early detection and mortality reduction of lung cancer. Despite this, very few of the high-risk population get annual LDCT done. Patients' attitudes towards tobacco usage and preventive care can be a factor in getting LDCT. We analyzed the relationship between the willingness to undergo LDCT and a person's readiness to try tobacco cessation medication or get the pneumococcal vaccine. We also analyzed the relationship between patients who had tobacco cessation counseling and their willingness to get LDCT and pneumococcal vaccine. Medical records of high-risk patients seen in the East Tennessee State University (ETSU) clinics between January 1, 2016, and November 30, 2020, were analyzed retrospectively. In the data obtained, a total of 2,834 patients were current smokers and were included in the research. The study subjects were assessed in two ways, which from here on will be referred to as method one and method two. In the first method, patients who underwent LDCT were assessed, and the outcome investigated was tobacco cessation counseling, tobacco cessation medication prescription, and pneumococcal vaccination. In the second method, patients who had tobacco cessation counseling were assessed, and the outcome evaluated was LDCT, tobacco cessation medication prescription, and pneumococcal vaccination. In the first method, out of 2,834 total population, 570 had undergone at least one LDCT screening during the study period. Of the 570 patients who underwent LDCT, 22.8% tried one of the tobacco cessation medications at least once during the study period (vs. 9.8% in patients who did not get the LDCT). Also, 71.5% of patients who had LDCT received at least one dose of pneumonia vaccine (vs. 35.5% in patients who did not get the LDCT). In the second method, 1,673 out of 2,834 patients received at least one tobacco cessation counseling, and out of those, 27.5% had LDCT screening (vs. 9.5% among those who never received counseling). Also, 54.9% received a pneumococcal vaccine (vs. 45.1% among those who did not receive counseling). The study demonstrates a relationship between getting LDCT and getting a pneumococcal vaccine or tobacco cessation medications. It also reveals that tobacco cessation counseling increases the odds of getting LDCT, tobacco cessation medications, and pneumococcal vaccine.

Bakgrund: Tobaksanvändande är kraftigt associerat med ohälsa i munnen. Socioekonomiskt svaga grupper har högre tobaksanvändning, vilket resulterar i att de drabbas av mer tobaksrelaterad ohälsa. Denna ojämlikhet i hälsa minskar möjligheten till en hållbar utveckling. I synnerhet är rökare överrepresenterade bland patienter med tandlossningssjukdom. Tidigare forskning har fokuserat på tandvårdens upplevelser av att tillhandahålla tobaksrådgivning och tobaksavvänjning, mycket få studier har fokuserat på patienternas perspektiv. Sveriges åtta folkhälsopolitiska mål strävar åt en mer jämlik hälsa och betonar vikten av att agera mot tobaksanvändning. För att nå framgång i detta arbete måste organisationer samarbeta och samverka tvärsektoriellt. Detta har givit tandvården incitament att ge rökande patienter tobaksrådgivning och stöd i tobaksavvänjning. Syfte: Syftet är att utforska patienters upplevelse av råd och stöd för tobaksavvänjning inom tandvård genom en systematisk litteraturöversikt. Metod: Systematisk litteraturstudie har genomförts på 15 artiklar publicerade mellan 1999–2021. Samtliga artiklar hämtades från PubMed och behandlade patienters upplevelser kring tobaksrådgivning och stöd för tobaksavvänjning. Resultat: Majoriteten av patienterna upplever tandvården som en god arena för tobaksrådgivning och tobaksavvänjning. Tandläkare har möjlighet att påverka patienterna, då resultatet visar att yrkesrollen erhåller ett högt förtroendekapital. Tobakens påverkan på munhälsan betonas vara en viktig faktor för att inse att en beteendeförändring måste ske. Slutsats: Efter analys av granskade artiklar visar resultatet att en majoritet av patienterna förväntar sig råd om tobaksanvändning och även stöd i tobaksavvänjning av sin tandläkare. Genom att använda samtalsmetoder för att stärka empowerment kan tandläkare och tandvårdspersonal bidra till folkhälsofrämjande interventioner.

Although tobacco cessation is an uphill battle for almost everyone who attempts to quit, it is important that dental hygienists do not assume that patients are not interested. Dental hygienists are in an ideal position to offer cessation help to their tobacco using patients. The purpose of this study was to gain a better understanding of the tobacco cessation practices among central Texas dental hygienists. Specifically, dental hygienists were asked about beliefs, motivation, and confidence with regard to their tobacco cessation practice. A positive significant, moderate, relationship was found between beliefs and confidence (r=0.647), beliefs and practices (r=0.704), knowledge and capability (r=0.579), motivation and capability (r=0.529), motivation and practice (r=0.605), and years of practice and capability (r=0.699). The mean confidence scores for hygienists with more than 20 years of experience differed from those with 1-5 years of experience (p=.003) and 6-10 years of experience (p=.025).

BACKGROUND: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. METHODS: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. RESULTS: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. CONCLUSIONS: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.

Syftet med denna studie var att skapa förståelse för hur man kan motivera individer med utländsk bakgrund till att sluta använda tobak. Studien undersökte vilka uppfattningar dessa individer kan ha om tobaksrelaterade hälsorisker och vilka anledningarna kan vara till att dessa individer röker. Metoden som användes är av kvalitativ ansats, som är induktiv och tolkande. Datainsamling skedde med hjälp av systematiska litteraturöversikter som analyserades med hjälp av en metaetnografi. Resultatet visar att individer med utländsk bakgrund underskattar tobaksrelaterade hälsorisker och har en positiv inställning till tobak. Familjeutmaningar, stress, ångest, nöje och lycka är de ledande motiven för tobaksbruk bland dessa individer. Brist på kunskap om tobaksrelaterade hälsorisker leder till mindre motivation till att sluta röka. Slutsatsen av denna studie påvisar att för att kunna motivera individer med utländsk bakgrund till att sluta röka är det viktigt att utveckla insatser för att öka deras kunskaper om tobakens hälsorisker.