Provide Smoking Cessation Counseling Research Articles

Smoking cessation counselling patterns in cancer patients - survey of Lebanese physicians.

Tobacco smoking is a known risk factor for cancer development and smoking cessation can lower this risk and improve outcomes in some cancer patients. Despite that, many cancer patients do not quit smoking after a cancer diagnosis, and smoking cessation counselling is still not routinely provided in cancer care. The aim of this study is to examine patterns in smoking cessation counselling to cancer patients by their treating physicians. A self-administered, web-based (mobile-friendly), anonymous questionnaire was developed on LimeSurvey and sent by e-mail to Lebanese physicians of different specialties between June 2020 and January 2022. Data were analysed using SPSS and associations between the different items were determined using the χ2 test. A total of 146 physicians filled out the questionnaire. Almost all physicians ask cancer patients about their smoking status, but only 45.9% provide smoking cessation counselling, and only 24% refer patients to smoking cessation counselling programs. Only 27.4% of all respondents have received formal smoking cessation training, and only 27.4% feel capable of providing smoking cessation counselling in their clinic. Specifically, family medicine physicians were more likely to provide smoking cessation counselling in the clinic (69%), more likely to refer patients to a smoking cessation counselling program (44%), and more likely to have received formal smoking cessation counselling training (67%) and more likely to feel capable of providing smoking cessation counselling (93%). Lack of training, lack of knowledge of available programs and the lack of availability of enough programs are leading obstacles contributing to low rates of smoking cessation counselling in cancer patients as reported by the physicians. Our data reveals a deficiency in smoking cessation counselling and referral of cancer patients to smoking cessation counselling programs in our region. This highlights the need for dedicated smoking cessation counselling training for practicing physicians and physicians in training.

Smoking cessation support in social and community service organizations: potential activities, barriers and facilitators.

Social and Community Service Organizations (SCSOs) are a potential setting to reach and support people with a low socioeconomic position who smoke, yet smoking cessation is not widely supported by SCSO professionals. This study aims to identify SCSO professionals' 1) potential activities to support smoking cessation and 2) barriers and facilitators in undertaking these activities. Between July and November 2022, semi-structured interviews were conducted with 21 professionals recruited through SCSOs in Amsterdam North, including participation workers, welfare workers, parent and child counselors, budget coach, debt counselor, welfare work, community sports and community center coordinators. Data were analyzed using a thematic approach. Eight activities were identified that could support the client either directly (i.e., recognizing smoking clients, discussing smoking and smoking cessation, referring clients, providing smoking cessation counseling, offering help around services) or indirectly (i.e., collaboration with relevant network partners, implementing smoke-free environments, enhancing professional skills). Various barriers and facilitators were identified related to the 1) client and their environment (i.e., clients' readiness and social environment), 2) interaction between professional and client (i.e., topic sensitivity), 3) professional (i.e., professionals is non-smoker, knowledge and self-efficacy), 4) professionals' work environment (i.e., necessity, responsibility, priority and time), and 5) smoking cessation services (i.e., availability of appropriate services and referral process). There is potential for SCSO professionals to support smoking cessation, but several barriers hinder their efforts. To address these barriers, it is essential to take into account the factors that SCSO professionals believe facilitate the provision of smoking cessation support. This study provides insight into how the potential of SCSOs in Amsterdam North to support smoking cessation efforts among people with a low socioeconomic position can be harnessed. Barriers were found at multiple levels (client, professional, client-professional interaction, and organizational) and these findings imply that stakeholders across these levels will need to prioritize smoking cessation to facilitate and stimulate SCSO professionals in supporting smoking cessation. A concrete action would be to offer SCSO professionals additional training conversational skills to discuss smoking. As a prerequisite, easily accessible and suitable smoking cessation services should be available in the neighborhood.

Bladder cancer patient and provider perspectives on smoking cessation

BackgroundSmoking is the most common risk factor for bladder cancer and is associated with adverse clinical and cancer-related outcomes. Increasing understanding of the patient and provider perspectives on smoking cessation may provide insight into improving smoking cessation rates among bladder cancer survivors. We sought to inform strategies for providers promoting cessation efforts and help patients quit smoking. MethodsUsing a modified Delphi process with multidisciplinary input from bladder cancer providers, researchers, and a patient advocate, 2 surveys were created for bladder cancer patients and providers. Surveys included multiple-choice questions and free answers. The survey was administered electronically and queried participants’ perspectives on barriers and facilitators associated with smoking cessation. Survey responses were anonymous, and participants were provided with a $20 Amazon gift card for participating. Patients were approached through the previously established Bladder Cancer Advocacy Network (BCAN) Patient Survey Network, an online bladder cancer patient and caregiver community. Providers were recruited from the Society of Urologic Oncology (SUO) and the Large Urology Group Practice Association (LUGPA). ResultsFrom May to June 2021, 308 patients and 103 providers completed their respective surveys. Among patients who quit smoking, most (64%) preferred no pharmacologic intervention (“cold turkey”) followed by nicotine replacement therapy (28%). Repeated efforts at cessation commonly occurred, and 67% reported making more than one attempt at quitting prior to eventual smoking cessation. Approximately 1 in 10 patients were unaware of the association between bladder cancer and smoking. Among providers, 75% felt that barriers to provide cessation include a lack of clinical time, adequate training, and reimbursement concerns. However, 79% of providers endorsed a willingness to receive continuing education on smoking cessation. ConclusionsBladder cancer patients utilize a variety of cessation strategies with “cold turkey” being the most used method, and many patients make multiple attempts at smoking cessation. Providers confront multiple barriers to conducting smoking cessation, including inadequate time and training in cessation methods; however, most would be willing to receive additional education. These results inform future interventions tailored to bladder cancer clinicians to better support provider efforts to provide smoking cessation counseling.

Telephone versus face-to-face consultation on smoking cessation at primary health care centers in Qatar during COVID-19 pandemic

Smoking cessation leads to a reduction in risks of smoking-related morbidity and mortality. During the coronavirus 2019 (COVID-19) pandemic, smoking cessation services were interrupted. Providing smoking cessation counseling by telephone could be a convenient and safe alternative to traditional face-to-face service. However, the effectiveness of telephone smoking cessation counseling has not yet been thoroughly investigated. This study evaluated telephone smoking cessation counseling compared to face-to-face consultations during the COVID-19 era. In addition, it investigated the association between sociodemographic and health-related factors and cessation rates. A retrospective cohort design was used. Participants were randomly selected from two lists: (1) telephone counseling and (2) face-to-face counseling in smoking cessation clinics in five primary health care centers in Qatar between March 2020 and March 2021. Cessation rates were compared between the two groups at 1, 2, 4, 8, and 12 weeks. A multivariable logistic regression analysis was used to identify the significant associations with smoking cessation.Smokers who underwent telephone consultations had significantly lower quit rates at all follow-ups compared to those who attended face-to-face visits. At the 12-week follow-up, the adjusted odd ratio for quitting through face-to-face consultations was 1.96 (95% CI [1.15–3.35]) times higher than that achieved through telephone consultations. In addition to receiving face-to-face counseling, higher self-efficacy to cease smoking was an independent predictor of successful cessation. Providing smoking cessation counseling by telephone could be a safer but less effective mode of delivery versus traditional face-to-face encounters during the pandemic.

Perceptions and preparedness toward tobacco cessation counseling amongst clinical medical students in Chongqing, Southwest China: A cross-sectional study.

BackgroundMedical students play an indispensable role in providing smoking cessation counseling. Despite the rapid increase in tobacco use, there is little data on what Chinese medical students know or are taught about it. This study aims to investigate the relationship between medical students' tobacco education level, clinical experience, and tobacco cessation counseling (TCC) provided by medical students.MethodsThis cross-sectional study was carried out among clinical medical students of Chongqing medical university. An anonymous, self-administered questionnaire included items on demographic information, perceptions, and perceived preparedness, clinical medical students' self-reported level of education about alternative tobacco products, and traditional cigarettes. We assessed their perspectives toward TCC using a 5-point Likert scale. Descriptive and binary logistic regression analyses were carried out.ResultsA total of 1,263 medical students completed the questionnaire. The majority of students (85%) expressed a willingness to provide TCC to patients in need. However, only half of the students stated unequivocally that they knew some ways and methods of tobacco cessation, while 18% stated that they did not know methods of tobacco cessation. Tobacco education and clinical experience were significantly associated with the ability to provide TCC. Our findings revealed that students with more clinical experience (undergraduates: B = 0.326, P < 0.001; postgraduates: B = 0.518, P < 0.001) were significantly more likely to have a greater self-reported comprehensive ability to provide TCC.ConclusionTobacco education and clinical experience can enhance the ability of medical students to provide smoking cessation counseling. There is a need to focus on alternative tobacco products with changing times, and curriculum planners should collaborate to incorporate comprehensive tobacco prevention and cessation training into the medical school curriculum.

Atatürk Üniversitesi Eğitim Aile Sağlığı Merkezlerine Kayıtlı Hastalarda Diyabetik Retinopati Sıklığı, İlişkili Faktörler ve Diyabetik Retinopati Farkındalığı: Kesitsel Bir Çalışma

Amaç: Çalışmamızda Tip 2 diyabet hastalarımızda diyabetik retinopati (DRP) sıklığını, ilişkili faktörleri ve DRP farkındalık düzeyini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışma Şubat 2019-Nisan 2020 tarihleri arasında Atatürk Üniversitesi Tıp Fakültesine bağlı Eğitim Aile Sağlığı merkezlerinde (EASM) yürütülmüştür. Kayıtlı 350 diyabet hastasına telefonla ulaşılıp çalışma hakkında bilgi verilerek çalışmaya davet edildi. Yapılan örneklem hesabına göre 18 yaş üstü Tip 2 diyabet tanısı almış 200 hasta çalışmaya dahil edildi. Tip 1 DM olanlar, oftalmolojik cerrahi geçirenler çalışmaya dahil edilmedi. Yüz yüze görüşme ile hastaların sosyodemografik ve klinik özellikleri kaydedilip; DRP farkındalık anketi uygulandı. Hastalar ikinci basamak sağlık kuruluşuna yönlendirildi ve bir göz hekimi tarafından detaylı oftalmalojik muayeneleri yapıldı. Veriler SPSS 20.0.0 ile analiz edildi. Anlamlılık düzeyi p&amp;lt;0,05 kabul edildi. Bulgular: Katılımcıların yaş ortalamaları 56,8±9,9 yıldı, %45,5’i (n=91) kadındı. Hastaların %36’sında (n=48) DRP tespit edildi. DRP’si olanların %60,4’ünde (n=29) mikrohemoraji mevcuttu. Sigara kullananlarda, ileri yaşta, DM tanı süresi fazla, HbA1c ortalaması ve sistolik kan basıncı ortalaması yüksek olanlarda DRP sıklığı daha fazlaydı (p&amp;lt;0,05). Bu değişkenler içinde DM tanı süresi, HbA1c düzeyi ve sigara kullanımı DRP olasılığını tahmin ettiren en önemli değişkenler olarak tespit edildi. 'Şeker hastaları ne sıklıkla göz muayenesi olmalıdır?' sorusuna %33,5 (n=37) oranında yılda bir kez cevabı verilmişti. Katılımcıların %58,5’i (n=117) en son göz muayenesine bir yıldan daha uzun zaman önce giderken; %6,5’i (n=13) hiç göz muayenesi olmamıştı. Bir hekim tarafından göz muayenesi önerilenlerin %20'sine (n=14) aile hekimi tarafından öneri yapılmıştı. Sonuç: Araştırma popülasyonunda DRP oranı yüksek olup; sigara kullananlarda, ileri yaşta, uzun süredir DM olanlarda, HbA1c ve sistolik kan basıncı yüksek olanlarda bu oran daha fazlaydı. Hastalarımızın DRP hakkında bilgi ve farkındalığı yetersizdi. Birinci basamak sağlık hizmeti sunan ve koruyucu hekimlik için kilit noktada bulunan aile hekimlerinin bu konudaki rolü önemlidir. Diyabetik hastalarda DRP gelişimini önlemek için aile hekimleri tarafından verilecek sigara bırakma danışmanlığı ve yakın takiplerle kan şekeri ve kan basıncı regülasyonunun sağlanması oldukça önemlidir.

Attitudes and Behaviors Regarding Smoking in Friends and Relatives of Patients in Emergency Room: A New Frontier in the Fight against Tobacco

BackgroundEmergency rooms (ERs) are usually crowded with friends and relatives (F&Rs) of the patients. This experience may result in changes in smoking behaviors and create opportunities for smoking cessation interventions. The study aims to investigate these changes and offers a new frontier in the fight against smoking.MethodsThis cross-sectional study was conducted in the ERs of two universities in different cities. A questionnaire consisting of 18 questions was applied to F&Rs of the emergency patients. Statistical analysis was performed using Jamovi program.FindingsA total of 603 respondents were included in the study. Of them, 71.3% were first-degree relatives, 51.7% waited 5 or more times in ER before, and 68.6% spent 0-2 hours in a day around the ER. Upon witnessing patients in the ERs, 53.4% of the F&Rs had the idea of quitting smoking and 42.9% wanted to have smoking cessation therapy during their wait in the hospital. While 76.1% of the participants were not using different brands of cigarettes when offered in normal life, this rate was lower around the ERs (64.6%) (P < 0.001). Participants smoked 0.82 ± 0.34 cigarette per hour in normal life excluding sleeping time; this number raised almost 6 folds during the wait (4.85 ± 2.11) (P < 0.001).ConclusionF&Rs smoked more during waiting around ERs. However, they also expressed desire to quit smoking and receive smoking cessation intervention during the wait. Providing smoking cessation counseling to F&Rs in the ER may be a valuable intervention.

Awareness, Attitude, Practice And Perceived Barriers Of Tobacco Cessation Counseling Among Dental Practitioners In Ghaziabad – A Cross-Sectional Study

Introduction: Tobacco using habit is one of the leading causes of preventable death and disease globally. Dental practitioners play a vital role in preventing tobacco related diseases. The present study attempted to carry out a survey on the Awareness, Attitude, Practice and Perceived barriers of tobacco cessation counseling among dental practitioners in Ghaziabad. Materials and Methods: The present descriptive cross-sectional study encompasses 401 dental practitioners in Ghaziabad. A self-administered survey questionnaire was designed to collect the required data. The data were entered in Microsoft Excel spreadsheet and were exposed to frequency distribution and Chi square analysis using the Statistical Package for the Social Sciences software (SPSS) 21.0v. Results: 75% graduate dentists and 93% post graduate dentists counseled their patients about the effects of smoking on oral health. According to the dentists, lack of financial incentives reflected to be another barrier in providing tobacco cessation counseling. The fear of damaging dentist–patient relationship was considered to an extent as a barrier in providing smoking cessation counseling by 85.07% graduate dentists while 84.9% post graduate dentists considered only to some extent about the same and this difference was found to be statistically significant (p≤0.01). Conclusion: According to the present study, dental professionals were aware about their role in motivating people to quit the habit of tobacco usage. But Dentists are facing many perceived barriers for tobacco cessation counseling so effective approaches should be made to overcome all these hurdles. Keywords: Attitude, Awareness, Counseling, Dentist, Practice, Tobacco Cessation

Effects of education methods on self-efficacy of smoking cessation counseling among medical students

BackgroundMedical students need to receive training in providing smoking cessation counseling to provide effective smoking cessation interventions to smokers when they become doctors. This study examined the smoking cessation education curricula and factors affecting counseling self-efficacy (CSE) in smoking cessation treatment among medical students.MethodsIn a multicenter cross-sectional study, we obtained demographic information, personal history of tobacco use and intention to quit smoking, exposure to secondhand smoke in the school premises during the past week, the experience of learning about tobacco in each medical school, tobacco-related medical knowledge, and self-efficacy in smoking cessation counseling on medical students of four Korean medical schools.ResultsAmong 1,416 medical students eligible, 313 (22.1%) students completed a self-administered questionnaire. Only 20.3% of the students reported positive CSE on smoking cessation. The factors affecting positive CSE were scores of ≥ 60 on tobacco-related medical knowledge, smoking experience, and blended learning (p = 0.014, 0.005, and 0.015, respectively).ConclusionThis study shows that high scores in tobacco-related medical knowledge and blended learning are correlated with positive CSE for smoking cessation counseling.

Smoking cessation and counseling: A mixed methods study of pediatricians and parents.

Pediatric providers play an important role in parental and youth smoking cessation. The goal of this study was to understand smoking cessation attitudes of parents and the behaviors, confidence and self-efficacy of pediatricians related to providing smoking cessation counseling to parents and youth. A mixed methods study was conducted in a convenience sample of families (n = 1,549) and pediatric primary care clinicians (n = 95) in Connecticut using surveys and focus groups from April, 2016 to January, 2017. The smoking rate (cigarettes or electronic cigarettes) among all households surveyed was 21%. Interest in quitting smoking was high (71%) and did not differ based on smoking amount, duration, type of community of residence (urban, rural, etc), or race/ethnicity. For example, compared to participants who smoked for <10 years, those who smoked ≥20 years had a similar interest in quitting (OR = 1.12; 95% CI: 0.85-1.48). Ninety percent of clinicians surveyed asked parents about their smoking behavior at least annually but 36% offered no smoking cessation counseling services or referral. Clinicians almost always reported counseling youth about the dangers of nicotine and tobacco use (99%), were more confident about counseling youth than parents (p<0.01) and reported low self-efficacy about smoking cessation and prevention counseling of parents and youth. Ninety-three percent of clinicians opined that electronic cigarettes were equally or more dangerous than cigarettes but 34% never counseled youth about the dangers of electronic cigarettes. Clinicians frequently screen parents about their smoking behaviors, but rarely provide smoking cessation counseling and express low confidence in this activity. Clinicians are more confident counseling youth than parents. Clinicians also recognize the dangers of electronic cigarettes, yet they infrequently counsel youth about these dangers.

Variation in Patient Smoking Cessation Rates Among Health-Care Providers: An Observational Study

Physicians play a crucial role in providing smoking cessation counseling and medications. However, it is unknown whether individual physicians' approaches affect whether patients quit. This study assessed patient quit rates within a national quality-improvement learning collaborative to document variation in quit rates at the physician, practice, and health system levels. A retrospective cohort study was conducted of primary care patients identified from the Optum analytics database containing longitudinal ambulatory data for patients from 22 health-care organizations between January 2012 and December 2018. The study included smokers aged≥ 18 years who attended at least three ambulatory visits, with two visits at least 1 year apart. The primary study outcome was abstinence for≥ 1 year. A mixed effects logistic regression model was used to predict the probability of quitting as a function of patient variables. Quit rates were then adjusted by patient factors and calculated at the level of clinician, clinic/practice, and health system. Across all systems, 56%of patients had a documented smoking status in 2017. Among nearly 1 million smokers, 24%quit smoking. In the regression model, patient characteristics associated with quitting included older age, Hispanic ethnicity, being married, urban residence, commercial insurance, pregnancy, and a diagnosis of pneumonia, myocardial infarction, ischemic heart disease, cataract, or asthma. Medicaid insurance, low income, high BMI, peripheral vascular disease, alcohol-related diagnosis, and COPD were negatively associated with smoking cessation. Adjusted quit rates ranged from 14.3%to 34.5%across 20 health systems, 5%to 66%among 1,399 practice sites, and 4%to 87%among 3,803 health-care providers. Of smokers, 10.2%were prescribed smoking deterrents, and 3.9%were referred for counseling. Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation influence patients' likelihood of quitting.

P2.10-13 Effects of the Advanced Tobacco Control Training (ATCT) on Healthcare Professionals’ Smoking Cessation Knowledge and Counseling

Smoking is the major threat to health and it may cause cancer and many chronic illnesses. Due to nature of nicotine dependence, it is not easy to quit smoking. Trained health care personnel play important roles in helping people in smoking cessation (SC). This study is part of a national project. The purpose of the study is to (1) explore the influencing factors related to providing SC counseling interventions among healthcare professionals; and (2) examine the effects of an “advanced tobacco control (ATC) in healthcare professionals of its effects on their SC knowledge, attitudes and providing SC counseling. It is a health outcome research with pretest-post-test design. Eligible subjects were health care professionals with basic knowledge of tobacco control. In Taiwan, a national advanced tobacco control training (ATCT) was applied for them and examine of its further effects. A total of 383 subjects participated the study (combining from four groups of trainings). The self-report questionnaire was used before the ATCT as baseline data (T0). The 3 and 6 months post-training examination were again delivered (T1 & T2). A generalized estimating equation (GEE) was used for data analyses. Several important findings were found. (1) Subjects with more knowledge, more positive attitude, less barriers, and higher self-efficacy reported to provide more smoking cessation counseling to smokers. (2) Subjects had significantly higher scores in knowledge, more positive attitudes and increasing providing smoking cessation counseling in 3 and 6 month post-training compared to before training the basic point. The advanced tobacco control training (ATCT) has short-term (3 month) and lasting effects (6 months) on providing smoking cessation counseling to smokers. It suggests that the ATCT is effective and worthwhile to implement nationally and internationally to enhance the effect the tobacco control.

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States.

Background:OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States.Methods:The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%.Results:The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents’ competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation.Conclusion:Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.

Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia.

Despite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia. A sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015-May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients' motivation to quit, poor compliance with the treatment, patients' withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings. Targeted interventions are needed to address barriers that limited PHPs' involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs' knowledge and skills in delivering smoking cessation counseling, to increase patients' demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.

Validation of the Smoking Cessation Counseling Scale Chinese Version in Taiwan.

Providing tobacco control (TC) and smoking cessation (SC) counseling is an important part of healthcare. An assessment tool to understand healthcare providers' experiences in providing SC counseling may enhance TC. The aims of this study were to (1) translate and develop the Smoking Cessation Counseling Scale-Chinese version (SCCS-C) and (2) evaluate its psychometric properties in Taiwan. This is a 2-phase instrument testing study. In the first phase, the SCCS-C was developed and translated. In the second phase, 2 groups of participants were recruited. First, 292 SC educator trainees completed the psychometric assessment measures (internal consistency reliability and construct validity). The 2-week test-retest reliability was assessed in certified TC instructors. The results showed that (1) the SCCS-C has satisfactory content validity and internal consistency reliability with a Cronbach's α of .96; (2) the overall 2-week test-retest reliability was 0.70; (3) instead of the 4-factor structure of the original scale, a 3-factor structure of the SCCS-C was identified by exploratory factor analysis to explain 65.37%; (4) construct validity was supported by significant negative correlations between SCCS-C and barriers regarding TC and positive correlations with counseling, responsibility, and self-efficacy; and (5) discriminant validity was supported by significant differences between SC educator trainees and the certified TC instructors, as well as between those living with or without smokers. The SCCS-C has satisfactory reliability, test-retest reliability, and construct validity. The SCCS-C is a valid, reliable instrument for assessing healthcare counseling activities for SC in Taiwan.

Ambulatory bladder cancer care in the United States

PurposeContemporary data on bladder cancer care in the United States (US) is lacking. Here, we use nationally representative data to characterize outpatient bladder cancer care in the US and identify potential areas for quality improvement. Materials and MethodsThe National Ambulatory Medical Care Survey (NAMCS), conducted annually by the Centers for Disease Control and Prevention, is designed to generate weighted estimates of national ambulatory care practice patterns. We evaluated NAMCS data from 2001 to 2014 to characterize patient, physician, and visit characteristics associated with a diagnosis of bladder cancer. ResultsOver the 14-year study period there were 7,410,240 weighted visits to a urologist for a diagnosis of bladder cancer. The total number of urology visits for bladder cancer significantly increased over the study period (p=0.03). Thirty-five percent of bladder cancer patients saw their urologist 6 or more times annually. The mean visit duration was 21.8 minutes. The mean age of patients with a bladder cancer diagnosis was 71.3. Men and women accounted for 8,106,756 and 3,052,690 visits, respectively (p< 0.01). Medicare coverage represented the largest payer system (60.7%). Urologists provided smoking cessation counseling to only 21.2% of current smokers, and nutrition counseling was provided for just 14.7% of all obese patients with bladder cancer. ConclusionsBladder cancer visits account for over half a million ambulatory urology visits annually. Routine lifestyle interventions, such as smoking cessation and nutrition counseling, should be implemented during urology visits to further improve the care of bladder cancer patients.

Practices, attitudes, and knowledge about Crohn’s disease and smoking cessation among gastroenterologists

Cigarette smoking is one of the most important, modifiable environmental factors in Crohn's disease (CD) and screening for tobacco use is an official recommendation and quality measure in the care of CD patients. The objective of this study was to learn more about gastroenterologists' practices, opinions, and knowledge in this area. A 15 question survey was sent through email to two national gastroenterology distribution lists. Questions were written in multiple choice formats and were designed to collect information about gastroenterologists' practices, attitudes, and knowledge regarding smoking cessation in CD patients. Responses were stratified by practice setting, experience, and inflammatory bowel disease-focus. Responses were anonymous and were collected in a secure, online database. A total of 141 respondents completed the survey. Overall, 89% of participants screened their CD patients for smoking more than 75% of the time. In all, 62% provided smoking cessation counseling more than 75% of the time. Overall, 94% of respondents felt comfortable discussing the benefits of smoking cessation with their patients. In all, 56% felt comfortable discussing smoking cessation strategies with their patients. Overall, 88% of respondents agreed that gastroenterologists should provide smoking cessation counseling; however, 43 and 11% agreed that the gastroenterologist should be the primary counselor and primary prescriber of cessation-related pharmacotherapy, respectively. Surveyed gastroenterologists agree that smoking cessation is an important part of the care of CD patients and this is reflected in their screening practices. Counseling occurs irregularly and many gastroenterologists do not feel comfortable discussing cessation strategies. Future guidelines should provide further guidance on the gastroenterologist's role in smoking cessation counseling for CD patients.

Malaysian pharmacy students' intention to provide smoking cessation counseling

Background and purposeMalaysian National Quit Smoking Program had proposed to integrate smoking cessation counseling skills into all relevant healthcare curricula as one of its strategies to increase the number of Malaysians giving up smoking. More effective implementation of the curricula can be facilitated by further understanding the factors influencing students' intention in terms of providing smoking cessation counseling. This study, guided by Integrated Behavior Model (IBM), aimed to explore the factors which influenced pharmacy undergraduates in providing smoking cessation counseling. Educational activity and settingFollowing the elicitation study, the IBM-guided questionnaire was developed and distributed to students from two pharmacy schools which agreed to participate, each representing public and private institutions. FindingsA total of 387 pharmacy students participated yielding a 83% response rate. Multiple regression analysis revealed that all three, namely, attitude (23%), perceived norm (16%), and personal agency (16%) were significant predictors of students' intention. Further analysis revealed ‘experiential attitude’, a component of attitude as the strongest predictor. In other words, students who felt more comfortable had higher intention to provide smoking cessation counseling. SummaryAn implication of this study is that tobacco-related curricula with an emphasis to enhance students' comfort level in providing counseling would be of value for these future pharmacists in terms of their intention as well as actual provision of smoking cessation counseling through the mediation of “experiential attitude” and personal agency.

Perceived Role and Self-efficacy to Provide Smoking Cessation Counseling: Results from a One-day Training Seminar on Health Care Providers

Perceived Role and Self-efficacy to Provide Smoking Cessation Counseling: Results from a One-day Training Seminar on Health Care Providers

Smoking Cessation Counseling Improves Quality of Care and Surgical Outcomes with Financial Gain for a Vascular Practice

Cigarette smoking is strongly associated with atherosclerotic disease. It is incumbent on vascular surgeons to provide smoking cessation counseling (SCC) to their patients. The objective of this study was to determine the association of SCC and improvement in quality of care. As a quality project using retrospective data, the study received institutional review board exemption status. A retrospective review of prospectively maintained database from April 2014 through March 2015 of outpatient encounters in a vascular surgery clinic was performed of current smokers. Through the quality support team, providers were encouraged to counsel smokers to quit, document the discussion, and bill specific Evaluate and Management codes (99406 and 99407). The number of outpatients by smoking status, documentation and billing of SCC, demographics of current smokers, and monetary collections were collected. Data were compared using a correlation coefficient calculated and tested for statistical significant using two-tailed t-test. A sample of 1,077 visits by 612 currently smoking patients accounted for 24% of all outpatient vascular surgery visits. The average age was 61years, and 64% were male. Comorbidities included 77% with hypertension, 32% with diabetes mellitus, and 14% with chronic kidney disease. Medically, 72% were on aspirin, 71% on statin, and 48% on beta blocker. A total of 208 (34%) never underwent a vascular intervention, and 183 (30%) had an intervention during the study period (44% for peripheral artery disease, 10% for carotid stenosis, 14% amputations, and 10% abdominal aortic aneurysm). Documentation improved from 65% of encounters during the first month to 89% in the peak month and 79% of total encounters. All-cause mortality rate was 2%, and this cohort demonstrated 75% SCC for 28 encounters. Fifty-five patients (9%) quit smoking for more than 30days at the end of the study period, and this cohort had 69% of their 97 encounters with documented SCC. Increased SCC was correlated with decreased 30-day readmissions during the concurrent month (r=-0.711, P=0.009) and the following month (r=-0.719, P=0.008). There was a weak correlation with decreased amputations the following month (r=-0.5, P=0.08). From a financial perspective, $1,373 was collected for 33 patients with a potential for collection of $7,460 predicted for minimum Medicare payment of 1 visit per patient. Advising vascular patients in the arduous process of smoking cessation benefits both the patient and the health system. Proper documentation and billing decreases costs of early readmissions and increases departmental revenue.