Using the ‘very brief advice’-method for referral to smoking cessation programs

IntroductionFamily medicine doctors play a crucial role in smoking cessation efforts but often lack adequate training and skills in this area. This study aimed to assess attitudes, knowledge, and behaviors regarding smoking cessation among family medicine residents using a newly developed instrument.MethodsA novel 29-item questionnaire called “Attitudes and Knowledge Assessing Tool on Smoking Cessation Methods” (SMOKE AKAT) was developed and administered online to 161 family medicine residents at the University of Zagreb. This cross-sectional survey assessed knowledge about smoking-related health risks, cessation methods, and harm reduction approaches, as well as attitudes and behaviors related to smoking cessation counseling. Descriptive statistics were used to analyze the responses.Results93 residents completed the survey (57.76% response rate). Key findings include: 91.4% had never received formal education on smoking cessation methods; 62.4% incorrectly believed nicotine causes cancer; 84.9% incorrectly classified e-cigarettes as nicotine replacement therapy; only 57% correctly identified the definition of harm reduction; 51.6% reported spending 2–5 min on cessation counseling per patient visit; and 84.9% believed family doctors should be responsible for implementing smoking cessation interventions.ConclusionIn light of the European Commission’s agenda to make the EU smoke-free by 2040, where healthcare professionals play an increasingly crucial role this study revealed significant knowledge gaps and misconceptions about smoking cessation among family medicine residents. Many lack formal training but express interest in further education. There is a need to enhance smoking cessation curricula in family medicine training programs, focusing on evidence-based cessation methods, pharmacotherapy options, and harm reduction approaches. Improving residents’ knowledge and skills in this area could lead to more effective smoking cessation interventions in primary care settings. The SMOKE AKAT questionnaire addresses a critical gap in the current healthcare research landscape by providing an assessment tool to identify knowledge deficiencies, attitudinal barriers, and practice gaps among family medicine physicians in smoking cessation counseling and enables targeted educational interventions to correct specific deficiencies that might otherwise remain undetected in standard medical education assessments.

The study estimated the prevalence of unassisted quitting (ie, quitting without pharmacological aids or other interventions) among former smokers and identified the most common smoking cessation methods used by U.S. adult smokers who quit smoking between 2007 and 2011. Among long-term quitters, smoking-related behaviors and factors associated with using pharmacological methods and quitting unassisted were examined. The analytic sample consisted solely of former smokers, including 3,583 "long-term quitters" (those who quit 1 to 3 years prior to the survey) and 2,205 "recent quitters" (those who quit within a year prior to the survey), who responded to the 2010-2011 Tobacco Use Supplement to the Current Population Survey. About 72% of former smokers quit unassisted, 26% used at least one pharmacological method, and 7% used at least one nonpharmacological method. The most common pharmacological methods were the nicotine patch (12%), Chantix/Varenicline (11%), and a nicotine gum/lozenge (8%). For long-term quitters, cutting back on cigarettes gradually and relying on social support were more commonly associated with pharmacological methods. Among long-term quitters, younger adults (18 to 44 years old), Non-Hispanic Blacks, Hispanics, those who were less nicotine dependent prior to quitting and those who did not visit a doctor in the past 12 months before quitting had higher odds of reporting unassisted quitting than quitting with pharmacological methods. Unassisted quitting remains the predominant means of recent and long-term smoking cessation in the United States. Attempters may try different ways of quitting during the same quit attempt. Unassisted quitting remains a much more common method for recent and long-term smoking cessation than use of pharmacological or nonpharmacological methods. Smokers may try different ways of quitting during the same quit attempt. Thus, population-based studies that investigate the use of particular methods while ignoring other ways of quitting may overestimate the benefits of certain methods for smoking cessation.

Background: Professional and consistent smoking prevention and cessation may avoid many smoking-associated deaths worldwide. Dentists can exert a decisive influence on smoking behavior, as most people regularly visit a dentist. However, only if dentists have been trained sufficiently about the consequences of smoking and of smoking cessation methods might they fulfill this task appropriately. Objectives: The aim of our study was therefore to examine the prevalence of smokers among dental students in Germany, their attitude toward smoking in general, and their knowledge about tobacco-related diseases and smoking cessation programs. Methods: A cross-sectional survey among dental students in Germany was conducted in 2016. Students of the first and tenth semesters were asked to participate in this anonymous survey. The questionnaire included items concerning their own smoking habits, their knowledge about effects of smoking on health, and their attitude toward prevention and cessation in a dental setting. Results: Seven hundred and thirty dental students participated in this survey; 21% of the participating students were smokers. Their knowledge about smoking-related diseases was widespread. Some diseases were rarely known (only in 34% of students) and others were well known (in 99% of the students). Knowledge about health risks of e-cigarettes was low. About 30% of the participating students felt competent to encourage and support patients in cessation strategies; 2 out of 3 students were willing to improve their knowledge in that area. More than 85% confirmed that advice for smoking cessation should be one of the tasks of a dentist. Conclusions: Smoking is common among dental students, their knowledge about smoking-related health risks is moderate, and self-perceived smoking cessation skills are poor. More emphasis should be placed on education regarding smoking prevention and cessation methods.

ObjectivesThis study reports lumbar MRI referral patterns in the Region of Southern Denmark (RSD) and investigates the hypothesis that we will see an increase in imaging rates (MRI rates) following new referral options to lumbar MRI in the RSD in comparison with the other regions in Denmark from 2010 to 2013.DesignA difference-in-difference (DD) analysis, using general practitioners (GPs) in other regions as control, was used to test if the new referral options had an effect on the MRI rates.SettingIn 2010, RSD introduced organisational changes affecting the referral options for lumbar MRI. First, the possibility for direct referral to lumbar MRI was introduced GPs, and second, the region gathered all local spine departments into one specialist hospital called the Spine Centre.ParticipantsWe retrieved all lumbar MRIs performed on patients aged 18+ performed on Danish hospitals from 2008 to 2013 using the registries from Statistics Denmark. We use sociodemographic information from all Danish citizens aged 18+ aggregated to GP level. Primary and secondary outcome measures: lumbar MRI scans per 1000 capita enlisted with a GP (MRI rates) were calculated based on GPs patient list. Four referral types were made to describe changes in referral patterns.ResultsIn total 183 389 patients received 240 760 lumbar MRIs in the period. The use of the direct referral option by GPs in the RSD increased by 115% in the period from 2010 to 2013 and accounted for 34% of all referrals (n=6545) in 2013. MRI rates were significantly higher in RSD following the organisational changes (DD 1.389(0.925–1.852) lumbar MRI per 1.000 enlisted with a GP).ConclusionsIntroduction of organisational changes in RSD as direct referral to lumbar MRI from GPs and chiropractors as well as establishing a Spine Centre increase the lumbar MRI rate in comparison with other regions in Denmark.

This work describes and analyses the prevalence of smoking amongst medical students, their awareness of the methods of smoking cessation and the effectiveness they attribute to these methods and to medical advice. A questionnaire was distributed to students of medicine at the University of Navarra with open questions on the methods of smoking cessation of which they were aware, the effectiveness attributed to each of these and the effectiveness attributed to medical advice. Information was also gathered on: sex, year of study, smoking habit, average number of cigarettes smoked per day and the length of exposure to tobacco. Of 480 valid interviews, the prevalence of active smokers was 27.5% (CI 95%: 23.5-31.9); 4.2% ex-smokers and 68.3% who had never smoked. 42.7% named nicotine patches as a method of cessation and 25.2% nicotine chewing gum. With respect to the effectiveness attributed to each method, a median and interquartile range (IQR) of 20% (0-50) for the nicotine patches, 10% (0-40) for nicotine chewing gum and 20% (1-50) for medical advice. The more senior students and those that had been smoking for longer mentioned nicotine patches more frequently; more women than men knew about nicotine chewing gum. The senior students attributed greater effectiveness to nicotine patches. A future reduction is predicted in the number of active smokers in the medical sector. Amongst medical students the effectiveness of medical advice is overestimated. It is necessary to increase awareness of the methods for smoking cessation amongst medical students.

ObjectiveThe impact of pharmaceutical services on public health especially in regards to smoking cessation counseling can influence the rate of smoking cessation. The present study aims to evaluate prevalence, beliefs, and attitude of pharmacy students toward smoking habit and SC methods.MethodsAn online cross-sectional survey was conducted among pharmacy students at King Saud University, Riyadh, Saudi Arabia over 4-month period from May to August 2021. The survey consisted of 22-items focused on evaluating the prevalence, belief, and attitude toward smoking habits and smoking cessation methods. Data was descriptively analyzed using a statistical package for social science version 26 (SPSS).ResultsA total of 675 students completed the survey, among which 78.7 % were non-smokers and only 31.7% received education on the dangers of smoking. The most common methods of smoking cessation they heard of were consultation (58.6%), followed by use of electronic cigarettes (41.92 %) and Nicotine patch (40.7%). One-third of the surveyed students (36.8 %) agreed that specialized smoking cessation clinics enhance the efficacy of smoking cessation methods. The majority of students (80.6%) agreed to ban smoking in public places and 92.2% believed that tobacco sales to adolescents should be forbidden. Health professionals should actively participate and advise their patients to quit smoking as 89.8 % students agreed on that. Age and gender of students had significantly influenced the prevalence of smoking, history of smoking, frequency of smoking, efforts to quit smoking among smokers (p = 0.0001).ConclusionThe prevalence of non-smokers among pharmacy students is encouraging, yet level of awareness about and usefulness of smoking cessation methods is unsatisfactory. Therefore, the study clearly highlights a great need for integrating smoking cessation programs in their academic curricula to prepare them for real-world practice.

Nicotine replacement for smokers

Objective: To evaluate the effect of "Smoking cessation: Doctor first" program on smoking medical staff. Methods: From December 2016 to September 2019, 1 747 smoking medical staff from 54 units of China Tobacco Cessation Alliance were enrolled into"Smoking cessation: Doctor first"program. Demographic characteristics, smoking characteristics, degree of tobacco dependence, willingness to quit smoking and other related factors were collected during the baseline survey. Multivariate logistic regression model was used to analyze the related factors of willingness to quit. The subjects were given intensive smoking cessation intervention from October 2017 to September 2019, including education on the hazards of smoking, methods of smoking cessation and giving smoking cessation drugs. After intervention, the subjects were investigated about their smoking cessation progress and the effect of the project was evaluated. Results: The subjects were (41±11) years old, 91.9% (1 609/1 747) were male and 62.2% (1 086/1 747) were daily smokers. The main reasons for smoking included the influence of friends [697 (39.9%)], the need for social entertainment [629 (36.0%)], the relief of mental stress [589 (33.7%)] and the refreshment [459 (26.3%)]. At baseline, 52.9% (885/1 672) and 43.2% (755/1 747) smokers had intention to quit smoking and had planned to quit within one year, respectively. Multivariate logistic regression model analysis showed that: low education level [OR (95%CI) of high school and junior high school and below were 2.42 (1.61, 3.63) and 1.57 (1.18, 2.11)], daily smoking [OR (95%CI): 1.38 (1.06, 1.78)], thinking quitting smoking is not important [OR (95%CI): 4.15 (3.33, 5.18)] and having no quitting experience [OR (95%CI): 3.21 (2.53, 4.05)] were associated with no intention to quit smoking. After intensive smoking cessation intervention, 81.0% (1 415/1 747) smokers started to quit and 36.6% (518/1 415) quit smoking with drugs, both higher than the baseline level (all P values<0.001). By the end of the program, 60.2% (852/1 415) of the medical staff had quit smoking successfully. Conclusion: "Smoking cessation: Doctor first"program can improve the willingness to quit and the proportion of using smoking cessation drugs of medical staff.

In the United States and around the world, nicotine dependence is a leading cause of preventable death. Smoking cessation results in immediate and enduring health benefits. A wide range of clinical interventions have been shown to facilitate smoking cessation and to have a favorable cost-benefit profile. Practice guidelines and national reports have issued calls to action and have made smoking cessation resources readily available. Yet utilization of smoking cessation interventions and resources is lagging. Health care systems and providers have a shared responsibility to ensure that all smokers are offered appropriate interventions. This article summarizes the epidemiology and pathophysiology of nicotine dependence as a background for reviewing the central components of clinical evidence-based smoking cessation interventions: screening, assessment, advice, assistance, and follow-up. Specific patient populations are discussed, as well as emerging strategies to address nicotine dependence.

Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians’ behaviors toward smoking and vaping cessation interventions; and to assess differences in the tobacco cessation interventions recommended for cigarette smokers and users of electronic cigarettes (e-cigarettes). A questionnaire-based survey was conducted in 2018 among physicians attending mandatory public health training courses delivered at the School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland. The questionnaire included 25 questions related to tobacco product use and smoking cessation interventions. Data were obtained from 423 physicians (64.3% female; mean age 32.0 ± 5.8 years) with response rate of 84.6%. Current cigarette smoking was declared by 7.8% of participants; 1.9% of participants were e-cigarette users and 1.9% used heated tobacco. Smoking cessation interventions were offered more often to patients who smoked cigarettes than those who used e-cigarettes (p < 0.001). Physicians’ behaviors toward smoking cessation and vaping cessation interventions were associated with (p < 0.05) physicians’ smoking status and self-declared knowledge about smoking cessation methods. Among physicians in Poland, discussion of smoking cessation was not common behavior and limited mainly to identification of smoking status.

BackgroundSmoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions.MethodsThis study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed.ResultsThe survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p < 0.001). Non-smokers and ex-smokers had more positive attitudes toward the hospital’s smoke-free policy compared to smokers (90.1% and 88.2% vs. 73.0%). About 42.6% of nurses and 26.9% of physicians reported having had formal training on smoking cessation methods. While both groups showed high support for routinely assisting patients to quit smoking, nurses more often than physicians considered health professionals as role models for patients.ConclusionsThis study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia’s medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.

BackgroundIn Korea, nicotine replacement therapy (NRT) has been widely used in government-led, public health center-based smoking cessation services since 2004 and varenicline has become available from 2007 but without reimbursement. In this study which used a series of nationwide cross-sectional surveys in Korea performed from 2005 to 2011, we examined the prevalence of smoking cessation medication use and factors associated with it.MethodsWe analyzed data from the third to fifth waves of Korean National Health and Nutrition Examination Survey (2005–2011). Prevalence of each smoking cessation method use was calculated for each year, and its secular trend was tested by multivariate logistic regression.ResultsAmong smokers who made quit attempt during the previous year, 15.7% had used smoking cessation medications,15.3% had used NRT, and 0.7% had used prescription medication. There was a significant increasing trend for NRT use (P<0.001) during the study period, but use of prescription medication did not show any increase over time (P = 0.654) Education on smoking prevention and cessation was associated with smoking cessation medications use (OR 2.08, 95% CI 1.58–2.75).ConclusionsWhile the use of NRT has increased over years through government-sponsored smoking cessation programs, use of prescription drugs remained very low and flat probably due to lack of reimbursement. Education of smokers about effective smoking cessation methods and change in reimbursement policy are suggested to stimulate evidence-based smoking cessation practice.

The present article is intended to review the recent literature on three topics that are very important in pediatric office practice: hyperlipidemia, eating disorders, and smoking cessation. Review of the current literature will help pediatricians understand current data on the pathophysiology, diagnosis, and treatment of hyperlipidemia in childhood and adolescence. This article also provides practitioners with a summary of the most current literature on identifying the characteristics and risk factors of pediatric patients with eating disorders. The article concludes with a summary of recent literature on smoking prevention and cessation methods. The current literature shows that practitioners must be more aggressive in screening patients for hyperlipidemia. Education regarding the prevention of hyperlipidemia is also essential. Recent work has further identified the characteristics and risk factors of patients with eating disorders. Further, recent literature has studied innovative tools that can be employed by patients interested in smoking cessation. Hyperlipidemia, eating disorders, and smoking are three extremely important problems that negatively impact the lives of children and adolescents. Pediatricians should regularly screen their patients for hyperlipidemia and eating disorders. Practitioners should assist their pediatric patients with the process of smoking cessation.

Interactive conversational agents, also known as chatbots, have the potential to increase the success rate of digital technology interventions to promote healthy behaviors. However, due to their newness and limited use, little is known about their integration, usefulness, and effectiveness in promoting smoking and vaping cessation. The aim of this mixed-methods systematic review was to assess the effectiveness and characteristics of current interactive conversational agents in promoting and supporting smoking and vaping cessation. A mixed-methods systematic review was conducted to identify studies published in the last 20 years in five relevant databases. Eight studies, including seven on smoking cessation and one on smoking and vaping cessation, were included. The results showed that, compared to other smoking cessation methods, chatbots can lead to better engagement in treatment, resulting in higher rates of sustained abstinence and improved quality of life. In addition, chatbots can be perceived as empathetic and establish a decent therapeutic alliance thanks to their communication skills. This knowledge could be useful for the development of interactive conversational agents to support smoking and/or vaping cessation. Alternative intervention tools targeting younger generations, such as chatbots, may offer an additional way for public health professionals to reach them.

Aim: To investigate the attitudes of different sections of society about smoking and the level of knowledge about quitting smoking. Method: The 32-question evaluation questionnaire was administered to volunteers under supervision. Demographic characteristics, starting time, reasons and duration of smoking, smoking together with family members, hazards of smoking, protection from harmful effects, cigarette quitting methods, reasons for not quitting were analyzed. Results: A total of 273 people participated in this study. 34.4% of participants were college and 19.4% were health personnel. The reason for starting smoking was priority due to the encouraging of friends and secondly due to curiosity. There were 41 people who started smoking after marriage. While 21,1% people were smoking less than 5 years, A 32.3% of participants were smoking over 20 years old. The survey results were as follows: Cigarette smoking in the family 67.5% Compliance with the smoking ban at work 78.7% Knowing harms of smoking 97.4% Explanation of the harms of cigarette smoking to child 86.6% Request to quit smoking 66.2% Suggestion by doctor for quit smoking 57.7% Knowing smoking cessation methods 13.5% Receiving expert help for smoking cessation %2 Knowing smoking cessation outpatient clinics 45% 86.5% of participants knew at least one smoking cessation method. The education level correlated with the number of known smoking cessation methods (r=0.391, p Conclusion: Our study shows that the society9s awareness about smoking was increase. Because of the low rate of awareness about smoking cessation methods and support centers it is necessary to increase the number of these centers and social awareness.