Smoking Cessation Help Research Articles

Smoking Cessation in Participants of Lung Cancer Screening Program in a Community Hospital Setting

SESSION TITLE: Lung Cancer II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The National Lung Screening Trial (NLST) provided evidence that screening with low-dose CT (LDCT) in a select population, for three consecutive years, reduces lung cancer mortality by 20 % compared to a screening chest x-ray, with an overall decrease in mortality of 7%. Lung cancer screening was started at our hospital in September 2012. The program also involved providing the patients with a brochure for smoking cessation and referring motivated and interested patients to “Freedom from Smoking” sessions. Reports of the effect on the smoking cessation rate in participants of lung cancer screening are lacking in the literature. METHODS: We surveyed participants (n=77) enrolled in the Lung Cancer Screening program at AMH. Participants were contacted via phone, informed consent was obtained, and a predetermined questionnaire was completed. The participants were called up to three times at different times of the day. RESULTS: 35(47%) out of 77 patients who participated in the screening program could be reached by phone. Four patients refused to participate in the study. Among the 31 survey respondents, 45.2% (14/31) were female and 54.8% (17/31) were male. In terms of smoking patterns, 48.3% (15/31) are still smoking, 51.6% (16/31) reportedly had quit smoking at the time of the survey. 41.9% (13/31) participants had quit smoking before the screening CT was done. 9.7% (3/31) participants quit smoking after the CT scan. LDCT was positive (nodule to mass) among 58% (18/31) participants. Among the participants with abnormal LDCT, 55.5% (10/18) are still smoking, 33.3% (6/18) quit before the LDCT and 11.1% (2/18) quit after the LDCT. Among the participants with abnormal LDCT, 55.5% (10/18) felt that the results of LDCT influenced their decision to quit, of which 20% (2/10) successfully quit smoking. LDCT was negative among 42% (13/31) participants. 39% of these patients (5/13) are still smoking, 54% (7/13) quit smoking before the LDCT and 8% (1/13) quit after the LDCT. Among all the participants, 45.1% (14/31) felt that screening results influenced their decision to quit. 64.2% (9/14) among these are still smoking, 21.4% (3/14) quit smoking, 14.2% (2/14) quit smoking before the screening CT and felt that screening results reinforced their decision to quit. 15% (5/31) participants attended smoking cessation classes; 80% (4/5) of these felt that classes were helpful. 100% (5/5) participants who attended the classes are still smoking. The majority of participants - 67.7% (21/31), felt that enhancing education to children in school would promote smoking abstinence. CONCLUSIONS: Though a significant number of participants had positive screening CT results, most patients continued to smoke. Significant numbers of patients stated they were influenced by the results, however only a minority quit. CLINICAL IMPLICATIONS: Patients participating in the screening program need better smoking cessation help to achieve the objective of the program. This could be accomplished by either support groups among interested participants or counseling sessions on a more frequent basis or mandating “freedom from smoking” cessations. Enhancing education among school children may promote smoking abstinence in general population. DISCLOSURE: The following authors have nothing to disclose: Akshay Avula, Sudhamshi Toom, Navin Victor, Rajesh Patel, Apurva Gandhi No Product/Research Disclosure Information

Evaluating the effectiveness of smoking cessation in the management of COPD.

The aim of this literature review is to assess the effectiveness of smoking cessation in managing patients with chronic obstructive pulmonary disease (COPD). COPD is the fifth leading cause of death in the world and smoking leads to COPD in more than 80% of cases. Smoking cessation aids are considered the most effective intervention to improve quality of life and prevent further deterioration in COPD. Evidence based on the use of pharmacotherapies, patient support and motivation as part of smoking cessation strategies were evaluated and discussed. The findings demonstrate that pharmacotherapies, support and counselling in smoking cessation help reduce hospital stay and hospitalisation and improve symptoms and quality of life. In addition, nurses need more education on how to use open-ended questions and motivation when giving advice on smoking cessation to patients with COPD.

Outcomes of a One-Time Telephone Intervention for Smoking Cessation in Adults.

Tobacco use is the single greatest cause of disease and premature death in America today. To address this major public health concern, states are required to provide smoking cessation services. The purpose of this article is to examine the effectiveness of a one-time telephone adult smoking cessation program designed by a certified addictions registered nurse-advanced practice and conducted over an 11-month period by the State of Nevada. Specifically, the program included a telephone-based counseling session and distribution of a 2-week supply of nicotine replacement therapy patches. The sample population consisted of 1471 Nevada residents, men and women, aged 18 years and over who called the Quitline for smoking cessation help. All participants in the program provided consent for a follow-up call to report on their quit rates and satisfaction with the intervention at 7 months postintervention. Although everyone who participated in the interventions was called, only 373 (25.4%) were actually reached via telephone contact. Of this group, quit rates showed that 34.6% reported continuous abstinence at 7 months, whereas 35.1% were abstinent at the 7-day point prevalence and 31.9% were abstinent at the 30-day point prevalence. Patient satisfaction with the program revealed that 87.6% (n = 373) of the participants reported being very or mostly satisfied. This program evaluation study shows that short-duration telephone counseling plus nicotine replacement therapy was associated with helping at least one third of the participants to quit using tobacco for all of the prevalence points-7 and 30 days and at 7 months postintervention.

303 Smoking cessation help should be available at CF reference centres – a Belgian national survey of smoking in patients with cystic fibrosis

Background In Belgium in 2011, 35% of the 15–29 years age group were regular smokers. No information is available about epidemiology of smoking by CF patients in Belgium. Aims To identify active and passive smokers in the Belgian CF patients, to investigate the characteristics of addiction of active CF smokers. Methods Active and passive smokers were identified by means of urinary cotinine (UC) >100 ng/ml, measured by HPLC. Patients with positive UC were asked to meet with a tabacologist, to evaluate their expired CO, their physical, psychological and behavioural addiction to nicotine, and their HAD score. Results Preliminary analysis of 351 patients with complete data sets did not disclose any patient with positive UC before age 19.5. Overall, 30 out of 706 patients (4.5%, 78.8% of target) had a positive UC; 17 met the tabacologist (12 active smokers, 5 passive smokers). Most active smokers (28±10 y) were males (10/12). Mean UC of active smokers was 863±464 ng/ml, mean expired CO was 13.3±7.6 ppm, Fagestrom score was 4.5±3. Almost all active smokers (11/12) had attempted at least once to quit smoking and 5/12 (41%) smoked also cannabis. UC of active smokers was higher in patients with low SE status (1270 vs 747 ng/ml, p=0.04) and correlated with anxiety (R = 0.82, p=0.009). All smoking patients wished to receive specific help for smoking cessation at their CF centre. Conclusion Active or passive exposure to cigarette smoke was present in at least 4–5% of CF patients. Smoking cessation expertise should be available at CF reference centres.

Türk Toraks Derneği üyesi olan göğüs hastalıkları hekimleri arasında sigara bırakma polikliniği yapılma sıklığı ve ilişkili faktörler

Although helping patients to stop smoking is a good clinical practice that has to be carried out by physicians everywhere and in every area, it is known that carrying out this help systematically in accordance to a programme in smoking cessation outpatient clinics significantly improves the chance of success. The study is a cross-sectional survey performed among chest disease specialists who are members of Turkish Thoracic Society (TTS), between June 2010 and February 2011. As independent variables relevant to status of performing/not performing Smoking Cessation Outpatient Clinic (SCOC); sex, age (younger or older than 40), being graduated before or after 1996, being or not being in a consultant position, work place (Hospital of Ministry of Health/private hospital/university hospital), having or not having an education for smoking cessation help and being or not being member of a City Tobacco Control Committee (CTCC) were investigated. Data was collected via a web-questionnaire prepared by using WHO Global Health Professionals Questionnaire which was sent to members through TTS secreteriat. 41% (699/1701) of members of TTS responded. 39.5% of responders reported that they perform SCOC. When the factors possibly affecting the performance of SCOC are evaluated with logistic regression analysis; being graduated after 1996, having an education for smoking cessation help, being a member of CTCC and not being an active smoker are found to improve this performance. Our study showed that having an education for smoking cessation help (and tobacco control) makes chest disease specialists get more responsibility on this topic. Accordingly, continuous efforts for improving awareness of personal and social responsibilities of all physicians, especially chest disease specialists, have to be made to provide their taking active roles in tobacco control.

144 Smoking cessation advice and help for lung cancer patients – an audit of current practice

144 Smoking cessation advice and help for lung cancer patients – an audit of current practice

Population‐level effects of automated smoking cessation help programs: a randomized controlled trial

To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) onQ, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and onQ; and (v) a choice of either alone or the combined program. Australia, via a mix of internet and telephone contacts. A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources (n = 1335) or cold-contacted from internet panels (n = 2195). The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio (OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence (OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website.

Smoking cessation interventions in the pre-admission clinic: assessing two approaches

Brief intervention (BI) to encourage patients who smoke to quit is effective and should occur at every patient interaction. If smokers receive a motivational interview in addition to BI and are offered pharmacotherapy to treat nicotine withdrawal, cessation rates may be improved. We compared the uptake, implementation, and effectiveness of these two approaches in the delivery of a smoking cessation intervention during assessments in a pre-admission clinic (PAC). The study was performed in the PAC at two tertiary care hospitals. At both hospitals, PAC patients were screened for smoking status, and current smokers were offered the opportunity to participate in a cessation program. Those who agreed were asked to consent to participate in an evaluation of program effectiveness that included a telephone interview about smoking status six months after hospital discharge. A cohort design was used to compare cessation outcomes across PACs during a one-year period of patient recruitment. The primary outcome measure was a self-reported continuous quit rate six months following hospitalization. Secondary outcomes included the number of patients willing to participate and the completeness of the delivery of program components. A BI delivered at one PAC consisted of brief advice and self-help materials, including handing the patient a business card with an available 1-800 Quit line (a telephone smoking cessation help line). The other PAC offered an intensive intervention (II) that included augmenting the BI with an in-hospital and post-discharge motivational interview and access to nicotine replacement therapy (NRT) during admission. At follow-up, we were able to contact 147 of the 288 smokers who agreed to participate in the evaluation of the program, and the self-reported quit rates for the BI and II interventions were 11.4% and 19.5%, respectively. More than 1,200 current smokers were identified and approached at both PACs during the 12-month patient recruitment period, and 60% of those were willing to accept the offered smoking cessation intervention (either BI or II). Implementation of II was uneven, particularly the delivery of the in-hospital motivational interview and prescription of NRT. Uptake of the 1-800 Quit service after discharge was inadequate. The PAC is a feasible location to identify smokers and offer a cessation intervention. There are considerable logistical barriers to the development of an II intervention program as described. A program that incorporates elements of BI and II could offer a practical approach to the implementation of a hospital-wide smoking cessation intervention.

Le développement du repérage des pratiques addictives en médecine générale en France

Background Make an inventory of screening of addictive behaviours among general practice since the end of the 1990s. Methods A representative sample of 2,083 general practitioners was surveyed in 2008/2009. They were asked about their prevention practices. Results Two thirds of the general practitioners (GPs) reported discussing tobacco consumption at least once with each patient. This assessment was less systematic for alcohol (23% of GPs) and cannabis (8% of GPs). Approximatively 70% reported addressing cannabis or alcohol use issues only with patients at risk. One third reported using tobacco smoking screening questionnaires, while there were only 6% in 2003. Only 13% of GPs used alcohol standardized questionnaires, a clear rise since 1998 (1.4% in 1998, 2.0% in 2003). Using alcohol standardized screening tests was more frequent among GPs belonging to a drug addiction network, but no significant link was found with gender, age or area. Only 2% of GPs used cannabis use screening tests. The care for cannabis users seemed particularly linked to the practitioners’ inclination to discuss this issue without waiting for a demand arising from the patient. The proportion of practitioners reporting helping patients kick their nicotine addiction in the last seven days proved stable since 2003, after a very significant increase between 1998 and 2003. The proportion of GPs reporting seeing a patient for an alcoholic weaning (52%) was stable since 1998. Conclusion This study illustrates the development of addiction care practices integrating smoking cessation help and, to a more limited extent, screening of alcohol and cannabis abuse, evidenced by the expanded application of standardized questionnaires in general practice. Consideration given to cannabis and alcohol use assessment appeared correlated to GPs feeling at ease with addressing drug use issues, this feeling being linked to their ability to rely on institutional directives or validated screening tools. It seems thus important to encourage the implementation of a health educational approach including early screening and brief intervention during consultation.

The use of cessation assistance among smokers from China: Findings from the ITC China Survey.

BackgroundStop smoking medications significantly increase the likelihood of smoking cessation. However, there are no population-based studies of stop-smoking medication use in China, the largest tobacco market in the world. This study examined stop-smoking medication use and its association with quitting behavior among a population-based sample of Chinese smokers.MethodsFace-to-face interviews were conducted with 4,627 smokers from six cities in the ITC China cohort survey. Longitudinal analyses were conducted using Wave 1 (April to August, 2006) and Wave 2 (November 2007 to January 2008).ResultsApproximately 26% of smokers had attempted to quit between Waves 1 and 2, and 6% were abstinent at 18-month follow-up. Only 5.8% of those attempting to quit reported NRT use and NRT was associated with lower odds of abstinence at Wave 2 (OR = 0.11; 95%CI = 0.03-0.46). Visiting a doctor/health professional was associated with greater attempts to quit smoking (OR = 1.60 and 2.78; 95%CI = 1.22-2.10 and 2.21-3.49 respectively) and being abstinent (OR = 1.77 and 1.85; 95%CI = 1.18-2.66 and 1.13-3.04 respectively) at 18-month follow-up relative to the smokers who did not visit doctor/health professional.ConclusionsThe use of formal help for smoking cessation is low in China. There is an urgent need to explore the use and effectiveness of stop-smoking medications in China and in other non-Western markets.

Smoking and Metabolic Control in Adolescents with Type 1 Diabetes

To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes. In the multicenter Diabetes Patienten Verlaufsdokumentationssystem database from Germany and Austria, anonymized records on 27 561 patients < 20 years of age with documented smoking status were available for analysis. Self-reported smoking was negligible in patients younger than 11 years (0.1%), increasing to 5% in 11- to 15-year-old patients, and 28.4% in the 15- to 20-year-old age group. Multivariate analysis with adjustment for age, diabetes duration, sex, insulin therapy, and center differences, revealed that smokers had higher HbA1c-levels compared with non-smokers (9.1% vs 8.0%, P < .0001). Diastolic blood pressure was higher (68.2 vs 67.6 mm Hg, P < .0001), and the lipid profile was unfavorable in patients who smoke: Triglycerides and total cholesterol were higher and high-density lipoprotein-cholesterol was lower (all P < .0001). Smokers display significantly worse metabolic control and a higher cardiovascular risk profile. Although not attested in trials, we state that education about smoking, smoking prevention, and psychological help for smoking cessation should be an integral part of comprehensive pediatric care for adolescent patients with type 1 diabetes.

Hospital doctors' attitudes toward giving their patients smoking cessation help

While guidelines recommend all doctors to ask their patients about their smoking habits and, in case they smoke, offer cessation advice, limited data are available about hospital doctors' attitudes toward these recommendations. We aimed to examine hospital doctors' attitudes toward asking their patients about their smoking habits, informing about the health benefits of stopping, and offering help to quit smoking. A random sample (n = 1025) of Norwegian hospital doctors was mailed a questionnaire on this topic. After two reminders, 76% responded. Among the respondents 23% of the doctors found it too time consuming to ask if the patient smoked, and approximately 35% found it too time consuming to inform or offer help on smoking cessation. About 25% of the doctors felt that they did not possess enough knowledge to help the patient to stop smoking, and 65% of the doctors preferred to refer to a specialist for this. Twenty-eight per cent of the doctors did not see it as their task to help the patient to stop smoking, while 32% did not think it is worth the effort to offer the patient help to stop smoking. Twice as many non-internists as internists regarded it as not their task to ask about smoking and advised on smoking cessation. In conclusion, about one-quarter to one-third of Norwegian hospital doctors seem to disagree with current guidelines that all doctors should address their patients' smoking habits.

Reaching and treating Spanish-speaking smokers through the National Cancer Institute's cancer information service

Although the prevalence of smoking is lower among Hispanics than among the general population, smoking still levies a heavy public health burden on this underserved group. The current study, Adiós al Fumar (Goodbye to Smoking), was designed to increase the reach of the Spanish-language smoking cessation counseling service provided by the National Cancer Institute's Cancer Information Service (CIS) and to evaluate the efficacy of a culturally sensitive, proactive, behavioral treatment program among Spanish-speaking smokers. Adiós was a 2-group randomized clinical trial evaluating a telephone-based smoking cessation intervention. Spanish-speaking smokers (N = 297) were randomized to receive either standard counseling or enhanced counseling (EC). Paid media was used to increase the reach of the Spanish-language smoking cessation services offered by the CIS. The Adiós sample was of very low socioeconomic status (SES), and more than 90% were immigrants. Calls to the CIS requesting smoking cessation help in Spanish increased from 0.39 calls to 17.8 calls per month. The unadjusted effect of EC only approached significance (OR = 2.4, P = .077), but became significant after controlling for demographic and tobacco-related variables (OR = 3.8, P = .048). Adiós al Fumar demonstrated that it is possible to reach, retain, and deliver an adequate dose of treatment to a very low SES population that has traditionally been viewed as difficult to reach and hard to follow. Moreover, the findings suggest that a proactive, telephone-counseling program, based on the Treating Tobacco Use and Dependence Clinical Practice Guideline and adapted to be culturally appropriate for Hispanics, is effective. Cancer 2007. (c) 2006 American Cancer Society.

Randomized Trial of an Intervention to Facilitate Recycling for Relapsed Smokers

Tobacco dependence is a chronic condition requiring repeat treatment and long-term follow-up. However, current evidence regarding best approaches to providing these services is fairly limited. This study assessed the effectiveness of an intervention for increasing repeat tobacco-dependence treatment in a population of relapsed smokers. The study was a multicenter randomized controlled trial. Patients aged 19 and older receiving a prescription for nicotine replacement therapy or bupropion for smoking cessation in 2002 at one of five participating Veterans Affairs (VA) facilities were eligible. A total of 1900 eligible veterans were randomized to (1) patient phone call to assess smoking status, quit challenges, and treatment preferences, and computerized progress note to providers communicating this information (intervention); or (2) usual care (control). Outcomes, assessed in 2003, included the proportion of patients receiving repeat pharmacologic or behavioral smoking-cessation treatment in the 6-month follow-up period (assessed from VA pharmacy and outpatient data), 7-day point prevalence abstinence, and satisfaction (assessed by patient survey). Thirty-four percent of intervention participants versus 22% of controls received treatment for tobacco dependence in the follow-up period (p = 0.0001). Thirty-two percent of intervention participants versus 21% of controls received pharmacologic treatment (p = 0.0001), and 12% of intervention subjects versus 8% of controls received behavioral treatment (p = 0.005). Abstinence rates at follow-up were 25% for intervention subjects and 22% for controls (p = 0.15). Intervention subjects were more likely than controls to report being satisfied with the general smoking-cessation help (87% vs 82%, p = 0.01), as well as the pharmacologic help that they received from the VA (89 vs 84%, p = 0.01). The intervention significantly increased repeat treatment rates and satisfaction with services but did not have a significant effect on abstinence rates.

Sevrage tabagique chez la femme enceinte : étude descriptive en Limousin

Among obstetricians and midwives, estimate the percentage of smokers, appraise the proportion of medical professionals who mention the subject of nicotine addiction to their pregnant patients, and assess the quality of the information delivered to patients as well as their own experience in the field of tobacology. Between February and March 2002, 188 postal questionnaires were sent to obstetricians and gynecologists, midwives and midwife students of public hospitals in Limousin and private clinics in Limoges. The response rate was 75,5% (142 answers) and the median age was 37 years old (20-59). 43,6% of the respondents were current smokers. Patients' smoking habits would be asked for and the risks of tobacco smoking would be explained by the majority of praticians and midwives. Minimal counsel to be given was known and given by 34,4% of gynecologists an 26,5% of midwives. Smoking cessation counselling was never proposed by 62% of gynecologists and 79% of midwives. Seventy per cent of them did not have any specific training in the field of tobacology during their studies. There seems to be a deficiency in smoking cessation help for pregnant women in Limousin. Specifics programs and trainings for obstetricians, gynecologists, as well as midwives should be organized.

Accessing adult smokers in the pediatric setting: What do parents think?

The anticipation of negative parental reaction is cited by pediatricians as a common barrier to intervening with parents who smoke. In an effort to clarify perceived versus actual parent reaction, the present study investigated the reactions of a diverse parent sample toward pediatricians addressing parental smoking in the outpatient setting. This study represents a descriptive cross-sectional in-person survey of 906 parents interviewed exiting four geographically diverse pediatric practices. Only 3% of the sample felt their smoking status was not the pediatrician's business, 89% stated they believe it is an important part of a pediatrician's job to ask about their smoking status, and 8% stated it wouldn't matter if the pediatrician asked. Demographic characteristics were associated with a positive attitude about being asked. Compared with nonsmokers, fewer smokers had positive attitudes (81% vs. 91%, p = .0002); and more highly educated parents were more strongly positive about being asked (91% vs. 83%, p = .006). Among 187 smokers, 177 (95%) would appreciate or feel okay about the physician's concern if advised to quit and 57% reported wanting some kind of smoking cessation help from the pediatrician's office. In a heterogeneous sample of parents, strong support exists for pediatricians addressing parental smoking at pediatric office visits. This finding is encouraging for pediatricians who are concerned about negative parental reaction.

Evidence for clinical smoking cessation for adolescents.

This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. Qualitative literature review. Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track.

Teen smoking cessation help via the Internet: a survey of search engines.

The objective of this study was to assess Web sites related to teen smoking cessation on the Internet. Seven Internet search engines were searched using the keywords teen quit smoking. The top 20 hits from each search engine were reviewed and categorized. The keywords teen quit smoking produced between 35 and 400,000 hits depending on the search engine. Of 140 potential hits, 62% were active, unique sites; 85% were listed by only one search engine; and 40% focused on cessation. Findings suggest that legitimate on-line smoking cessation help for teens is constrained by search engine choice and the amount of time teens spend looking through potential sites. Resource listings should be updated regularly. Smoking cessation Web sites need to be picked up on multiple search engine searches. Further evaluation of smoking cessation Web sites need to be conducted to identify the most effective help for teens.

Smoking Habit among the Relatives of Patients with Serious Smoking-Related Disorders

Objective: To assess smoking habit and awareness of smoking as a potential cause of disease among relatives of patients with serious smoking-related disorders. Design and Setting: A survey using a face-to-face interview-assisted questionnaire at the Ege University Hospital between October 1998 and March 1999. Subjects: We interviewed 242 relatives of patients with serious smoking-related disorders, of whom 56.6% were female and 43.4% male. The mean age was 41.2 ± 13.2 years (15–75). One relative per patient completed the questionnaire and the chosen relative took care of the patient during his illness and accompanied him during hospital visits. Main Outcome Measures: We assessed the relationship between smoking habit and the perception of smoking as a potential cause of illness by the relatives. Statistical analysis was performed by χ² test. Results: The prevalence of smoking among relatives was 37.6% [49.5% males (n = 105) and 28.5% females (n = 137), p = 0.0003] and an additional 20.2% were ex-smokers. Of the relatives, 86.4% knew that the diseases were directly related to smoking, and 37.8% of these people were smokers and 21.5% ex-smokers. Only 7.2% reported that they had quit smoking after being influenced by the diseases of the patients. The decision to quit was statistically unrelated to the awareness of smoking as the cause of disease. Of all the relatives, 69.2% had tried to quit at least once, 86.8% considered quitting, and 89.0% considered using professional help for smoking cessation. Conclusion: The findings show that even though this group of smokers is aware of the harmful effects of smoking they cannot successfully quit smoking; however, the majority reconsider quitting and receiving professional help.

Patient satisfaction and discussion of smoking cessation during clinical visits.

To learn whether patients who smoke and who receive smoking cessation information during medical office visits were less likely to be satisfied with the smoking cessation help they received than patients who smoke but who did not receive such information. A total of 3703 current cigarette smokers were identified by a mailing in November 1998 to 163,596 members of 2 Minnesota health plans, and 2714 (77.3%) responses to a 44-item questionnaire were available for analysis. Using hierarchical analysis to control confounding variables, we assessed the relationship between patient-reported smoking cessation support actions at the last physician visit and satisfaction "with the help received from your doctor about quitting smoking." Smokers were very satisfied (12.0%), satisfied (25.3%), neutral (48.6%), and dissatisfied or very dissatisfied (13.5%) with physician help. After controlling for other characteristics, the 1898 patients who reported that they had been asked about tobacco use or advised to quit during the latest visit had 10 percentage point greater satisfaction ratings and 5 percentage point less dissatisfaction than those not reporting such discussions (P<.001). Smokers reporting no interest in quitting at the time of the latest visit also demonstrated greater satisfaction in association with these actions. Smoking cessation interventions during physician visits were associated with increased patient satisfaction with their care among those who smoke. This information should reduce concerns of physicians or nurses about providing tobacco cessation assistance to patients during office visits.