Provision Of Smoking Cessation Advice Research Articles

Effect of food insecurity on smoking and quitting behaviours: a survey of food bank clients

BackgroundRates of tobacco smoking among recipients of food aid are reported to be high (28–55%), yet whether food insecurity affects the smoking and quitting behaviour of this group remains unclear. We aimed to describe the effect of food insecurity on tobacco use among users of food banks. MethodsBetween Sept 4 and Nov 4, 2014, individuals attending two food banks in a large English city were invited to complete a survey assessing tobacco use and food security. Descriptive statistics were used to summarise the characteristics of food bank users and to provide data on the effect of food insecurity on smoking behaviours, including quitting. Since socioeconomic disadvantage can affect an individual's ability to access health services, we compared the provision of smoking cessation advice and ability to access smoking cessation services by respondents’ food security status using χ2 tests. Ethics approval was granted by the University of Nottingham Research Ethics Committee and participant consent was informed and implied through the return of a completed survey. Findings94 (93%) of 101 individuals completed the survey, of whom 62 (66%) were rated as food insecure and 32 (34%) food secure. Overall smoking prevalence was high (n=57, 61%), with little difference between food insecure respondents (39, 63%) and food secure respondents (18, 56%). Smokers experiencing food insecurity were more likely than food secure smokers to report purchasing illicit tobacco products (7 [19%] of 37 who answered this question vs none of 18) and decreases in their tobacco consumption (17 [65%] of 26 who provided a response vs 3 [43%] of 7). 36 (63%) of the 57 smokers reported receiving smoking cessation advice from a health professional; overall, quit motivation and confidence in making a successful quit attempt (rated out of 10 points) was moderate, with no significant differences between food insecure or food secure respondents (mean 4·7 [SD 2·8] vs 4·3 [3·1]). Of the 27 smokers (49%) who reported that they would experience difficulty in attending smoking cessation services as a result of their financial circumstances, 19 (70%) were food insecure compared with eight (20%) food secure. InterpretationHigh smoking rates and self-imposed reduction of tobacco consumption by respondents as a result of adverse financial circumstances suggest a potential unmet need to intervene to promote smoking cessation among this disadvantaged population. FundingUK Centre for Tobacco and Alcohol Studies.

The midwife's role in providing smoking cessation interventions for pregnant women: The views of midwives working with high risk, disadvantaged women in public sector antenatal services in South Africa

ObjectiveThe purpose of this study was to assess the knowledge, attitudes, beliefs and current practices of South Africa midwives in relation to providing smoking cessation education or counselling to pregnant women. This was with a view to involving them in a potential smoking cessation intervention, targeting a sub-group of South African women who are at particularly high risk of the adverse pregnancy outcomes associated with smoking. DesignA cross-sectional survey of midwives, supplemented by individual, in depth, qualitative interviews. SettingPublic sector antenatal clinics serving this particular community of women in five of the major urban centres of South Africa. ParticipantsA total of 102 midwives were surveyed across 29 antenatal clinics and 24 were interviewed. MeasurementsSelf-administered survey and semi-structured, individual interviews describing constructs from the Theory of Planned Behaviour with respect to the provision of smoking cessation education/counselling, including: knowledge, attitudes, subjective norms and perceived behavioural control. FindingsThe majority of midwives accepted that providing smoking cessation advice was a part of their remit, perceived prevailing social norms to be supportive and were, overall, positively predisposed to participating in a smoking cessation intervention in antenatal clinics. However, the study identified a number of constraints to midwives fulfilling this role, which affected their perceived behavioural control. These included stressful working conditions, too little time, a dearth of educational resources and a lack of knowledge of best practice intervention methods and counselling skills. Perceived patient resistance to quitting was a further obstacle. Key conclusions and implications for practiceFor the intervention to be accepted and adopted by midwives, it would need to offer them an opportunity to enhance their professional knowledge and expertise, provide them with attractive educational aids and take into account the very limited time they have for smoking education. Patient-centred, best practice methods for cessation counselling may help midwives overcome the problem of patient resistance and to engage smokers in constructive discussions about smoking with a greater prospect of success.

What are the factors that influence the delivery of smoking cessation advice in critical care?

The world's leading cause of preventable deaths, diseases and disabilities is smoking. Hospitalization can provide an opportunity for smokers to quit. Previous research found that smokers make up a high percentage of patients admitted to intensive care. Health care professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice. To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings. Quantitative design using an online survey. This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14-bed general intensive care and a 16-bed cardiovascular intensive care unit. The target population for this research was the nursing and medical staff working in adult critical care environments. The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments. The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and extubated patients. Further research might be required to confirm this. The provision of smoking cessation advice is an on-going World Health Organization and New Zealand Government priority and all parts of the health sector need to provide responses. However, responses need to be adapted to the specific context such as the unique challenges of critical care.

Missed opportunities: general practitioner identification of their patients’ smoking status

BackgroundIn order to provide smoking cessation support to their patients in line with clinical practice guidelines, general practitioners must first ascertain whether their patients’ use tobacco. This study examined (i) the sensitivity, specificity, positive predictive value and negative predictive value of general practitioner detection of smoking, and (ii) the general practitioner and patient characteristics associated with detection of tobacco use.MethodsEligible patients completed a touchscreen computer survey while waiting for an appointment with their general practitioner. Patients self-reported demographic characteristics, medical history, and current smoking status. Following the patient’s consultation, their general practitioner was asked to indicate whether the patient was a current smoker (yes/no/unsure/not applicable). Smoking prevalence, sensitivity, specificity, positive predictive value and negative predictive values (with 95% confidence intervals) were calculated using patient self-report of smoking status as the gold standard. Generalised estimating equations were used to examine the general practitioner and patient characteristics associated with detection of tobacco use.ResultsFifty-one general practitioners and 1,573 patients in twelve general practices participated. Patient self-report of smoking was 11.3% compared to general practitioner estimated prevalence of 9.5%. Sensitivity of general practitioner assessment was 66% [95% CI 59–73] while specificity was 98% [95% CI 97–98]. Positive predictive value was 78% [95% CI 71–85] and negative predictive value was 96% [95% CI 95–97]. No general practitioner factors were associated with detection of smoking. Patients with a higher level of education or who responded ‘Other’ were less likely to be detected as smokers than patients who had completed a high school or below level of education.ConclusionDespite the important role general practitioners play in providing smoking cessation advice and support, a substantial proportion of general practitioners do not know their patient’s smoking status. This represents a significant missed opportunity in the provision of preventive healthcare. Electronic waiting room assessments may assist general practitioners in improving the identification of smokers.

Combining intensive practice nurse counselling or brief general practitioner advice with varenicline for smoking cessation in primary care: Study protocol of a pragmatic randomized controlled trial

IntroductionCombining behavioural support and pharmacotherapy is most effective for smoking cessation and recommended in clinical guidelines. Despite that smoking cessation assistance from the general practitioner can be effective, dissemination of clinical practice guidelines and efforts on upskilling has not lead to the routine provision of smoking cessation advice among general practitioners. Intensive counselling from the practice nurse could contribute to better smoking cessation rates in primary care. However, the effectiveness of intensive counselling from a practice nurse versus usual care from a general practitioner in combination with varenicline is still unknown. Materials and methodsA pragmatic randomized controlled trial was conducted comparing: (a) intensive individual counselling delivered by a practice nurse and (b) brief advice delivered by a general practitioner; both groups received 12-weeks of open-label varenicline. A minimum of 272 adult daily smoking participants were recruited and treated in their routine primary care setting. The primary outcome was defined as prolonged abstinence from weeks 9 to 26, biochemically validated by exhaled carbon monoxide. Data was analysed blinded according to the intention-to-treat principle and participants with missing data on their smoking status at follow-up were counted as smokers. Secondary outcomes included: one-year prolonged abstinence, short-term incremental cost-effectiveness, medication adherence, and baseline predictors of successful smoking cessation. DiscussionThis trial is the first to provide scientific evidence on the effectiveness, cost-effectiveness, and potential mechanisms of action of intensive practice nurse counselling combined with varenicline under real-life conditions. This paper explains the methodology of the trial and discusses the pragmatic and/or explanatory design aspects. Trial RegistrationDutch Trial Register NTR3067.

Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter?

Brief cessation advice from health-care professionals in the hospital setting significantly increases the likelihood of patients quitting smoking, yet patients are not routinely provided with this advice. Smoke-free hospital policies aim to protect individuals from the adverse effects of smoking; however, it is unclear if such policies encourage systematic delivery of cessation advice by health-care professionals. The study's aim was to determine the prevalence of smoking and cessation advice received by in-patients in two teaching hospitals in Ireland which have implemented smoke-free hospital policies, and to examine patient attitudes towards smoking cessation. Change in smoking prevalence and delivery of smoking cessation advice prior to and post-policy implementation was also examined in one hospital. This study surveyed 466 in-patients across 2 hospital sites, over a 3-week and 5-week period, respectively. Data were also compared to a survey completed prior to the implementation of the smoke-free policy in one of the hospital sites. Smoking prevalence was 17% in Beaumont Hospital and 28% in Connolly Hospital. Overall, nicotine dependence was low (Mean Fagerström Test for Nicotine Dependence = 4.21, ±2.9). Overall, 62% of smokers did not receive smoking cessation advice from a health professional, although 55% indicated a willingness to engage with this type of service. The before-and-after analysis of Beaumont Hospital showed a reduction in smoking prevalence (17% vs 21%) amongst hospital in-patients, and a 6% increase in reported cessation advice provided following the introduction of the hospital smoke-free policy. Smoke-free hospital policies play a role in decreasing the prevalence of in-patient smokers, but further intervention is needed to increase rates of cessation advice provided. Positive attitudes to smoking cessation, coupled with low average nicotine dependence, suggest that low-intensity interventions would be beneficial for most smokers. A systematic focus on provision of brief smoking cessation advice is needed in hospitals.

The Role of Health Care Professionals in Providing Smoking Cessation Advice in Najran Armed Forces Hospital, KSA

Background: Smoking is an established risk factor for many diseases and is one of the most important public health problems worldwide. According to the WHO, medical and paramedical staff can influence positively or negatively the smoking habits of a community. Objective: To explore the predictors of providing smoking cessation advice by medical and paramedical staff. Methods: We have conducted a cross-sectional study from April, 2014 through May, 2014 in Najran Armed Forces Hospital. Data collection was done using an anonymous, self-administered questionnaire. Results: The study included 128 health care professionals. The mean age and standard deviation of the study group was 33.8 ± 8.10 years. The overall prevalence of tobacco use among medical and para-medical staff amounted to 21.1%. The prevalence among male health care providers amounted to 37.5% compared to 9.4% among females. The highest prevalence of tobacco use was among physicians (33.3%) followed by technicians (24.2%) and nurses (11.3%). More than 16% of the medical and paramedical staff didn't at all ask patients about their smoking status and only 40 % of them do that from time to time. Nurses were found to be significant predictors in providing smoking cessation advice to patients compared to physicians (aOR = 5.21, 95% CI: 1.1–25.1). Conclusion: The prevalence rate of smoking habit is still higher among persons who understand the related problems of smoking. Nurses are more active than doctors in providing tobacco cessation advice to their patients.

Lebanese medical students’ intention to deliver smoking cessation advice

ObjectivesObjectives of this study were to examine the constructs of the Theory of Planned Behavior and determine how they predict Lebanese medical students’ behavioral intention to advise patients to quit smoking. Study designThis was a cross-sectional study conducted among 191 medical students from six medical schools in Lebanon. MethodsThe instrument contained scales that measured attitudes toward the behavior, behavioral beliefs, subjective norms, and perceived behavioral control. Psychometric properties of the scale were examined. Item to total scale score correlations were determined and linear regression was conducted to predict the intention to advise smokers to quit. ResultsRespondents had a positive, but not very high, intention to deliver smoking cessation advice. Students reported a positive attitude toward advising patients to quit cigarette smoking and a strong belief in the physician’s obligations in smoking cessation advising. The majority reported lack of time to provide smoking cessation advice, insufficient knowledge of pharmacological aids, and the lack of openness of the patient to receive the advice. The attitude scale was the only variable that yielded a significant prediction of the intended behavior. ConclusionsThe construct of attitude toward the behavior appeared to be the most predictive of the intention to deliver advice to quit smoking among Lebanese medical students. Focusing training efforts on this construct could improve the rate of delivery of brief cessation counseling.

Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians.

Background:Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs).Aim:To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients.Methods:A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced.Results:Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care.Conclusions:Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.

Effect of Magnet Recognition on Provision of Smoking Cessation Advice to Inpatients With Pneumonia

The study examined the effect of Magnet recognition on hospital-reported rates of smoking cessation advice (SCA) provided to inpatients with community-acquired pneumonia. Logistic and propensity score regression models estimated the magnet effect on the SCA rate. Predictors were hospital characteristics, socioeconomic factors affecting smoking, and baseline and mid-study SCA rates as variations in hospital-improvement systems. Magnet recognized hospitals reporting higher mid-study SCA rates had higher outcome SCA rates.

Helping people with serious mental illness to cut down or stop smoking

The prevalence of smoking in people with serious mental illness is up to 5.3 times higher than in the general population and many die prematurely from smoking-related diseases. There is a need to develop effective, accessible, acceptable smoking cessation services that are tailored to this client group. Scimitar is a flexible, bespoke intervention based on a traditional NHS smoking cessation model with a ‘cut down to quit’ option. Cultural factors in mental health services may still create barriers to service users giving up smoking, and all mental health nurses should be trained to provide smoking cessation advice as part of their routine preparation for practice.

Association between awareness of smoking-related evidence and smoking cessation treatments provided by hospital chest physicians in Guangzhou, China: a multi-institutional cross-sectional survey

Factors associated with smoking cessation interventions initiated by hospital chest physicians in China had not been studied. We examined if the physicians' awareness of emerging evidence regarding negative effects of smoking was associated with the initiation of smoking cessation. A cluster randomized cross-sectional survey was conducted from July 2011 to August 2011 in hospital-based chest physicians (n = 354) in Guangzhou, China. Of those who responded (n = 354, 92.2%), 63.8% were aware of emerging evidence regarding negative effects of smoking and 64.5% initiated smoking cessation programs with their patients who smoked. Regarding the related awareness on smoking differed across physicians depending on their affiliation to evidence hospitals(χ(2) = 54.7, P > 0.001), i.e., primary (44.9%), secondary (55.1%)and tertiary hospitals (87.0%)was further supported by the related odds ratio (OR = 1.732, 95%CI:1.072-2.797, P < 0.05). Smoking status of physicians was related to their practice on smoking cessation, supported by the odds ratio (OR = 4.251, 95% CI:1.460-12.380, P = 0.008). Smoking cessation practice by physicians also depended on their affiliated hospitals. Physicians working at primary and secondary hospitals were less aware of the fact that smoking could reduce patients' responsiveness to inhaled corticosteroids than those working at the tertiary hospitals(χ(2) = 37.9, P > 0.001). Furthermore, these physicians would less frequently prescribed medication related to smoking cessation(χ(2) = 137.71, P < 0.001). Physicians who were better aware of the health hazards of smoking might more actively provide smoking cessation advice in their clinics. The awareness might correlate with the hospital levels they worked and the smoking status while the the advice they provided might correlate with their educational background, job title, department affiliation and smoking status, but not with the level of hospitals.

Exploring the views of healthcare professionals on increasing smoking cessation advice for patients

Background Smoking cessation advice provided by healthcare professionals can be effective in increasing smoking cessation among patients. Any successful intervention will require staff knowledge of local barriers to implementation. However, the views of Irish healthcare professionals in increasing provision of smoking cessation advice and these barriers are unknown. The aim of this qualitative study is to explore the views of Irish healthcare professionals on barriers in increasing smoking cessation advice for patients in a large Irish teaching university hospital.

P205 Smoking Prevalence and Smoking Cessation Amongst Acute Medical Admissions

Introduction and ObjectivesIn 2009/10 there were 1.5 million hospital admissions in adults aged >35yrs with a smoking related illness. Smoking cessation is a cost effective clinical intervention, producing better health...

P100 Designing and implementing a COPD discharge care bundle

ProblemAcute exacerbations of COPD are a major cause of hospital admission and readmission. National surveys have revealed significant differences in patient outcomes which are likely to be due to variations...

Are pharmacists reducing COPD’S impact through smoking cessation and assessing inhaled steroid use?

The National Institute for Health and Clinical Excellence (NICE) COPD 2004 guidelines recommend: ∗ COPD patients who smoke should be encouraged to stop at every opportunity; ∗ Inhaled corticosteroid should be used only among patients with moderate to severe COPD; ∗ Pharmacists should identify smokers and provide smoking cessation advice. The community pharmacy contract requires pharmacists to review patients' medications, creating an opportunity for reviewing the prescribing of inhaled corticosteroids in COPD. The survey explored the degree to which community pharmacists in North West England identify and provide advice to smokers and assess prescribed inhaled corticosteroids among COPD patients. A self-completion questionnaire was sent to 2080 community pharmacists from the 2005 pharmacist census database. Of the 1051 (50.5%) respondants, 37.1% mentioned COPD as a risk from smoking most or every time and 54.5% sometimes or rarely, and 19.6% routinely asked about smoking status when dispensing COPD medication. Pharmacists with more than 20 years experience were more likely to have read the Guideline compared to pharmacists with 10 years or less (OR: 1.54; 95% CI: 1.13 to 2.10). Pharmacists who had read the NICE Guideline (46.8%) were around twice as likely to mention COPD as a risk of smoking, ask about COPD if inhaled corticosteroids were dispensed and ask about smoking routinely if COPD medication was dispensed. (p<0.005). The NICE guidelines on COPD encourage community pharmacists to carry out smoking cessation and educational interventions, but further support is needed.

A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia

BackgroundDespite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision.MethodOne-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice.ResultsA significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision.ConclusionsThe existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome.

Experienced barriers and facilitators for integrating smoking cessation advice and support into daily dental practice. A short report

In a controlled study, primary care dental professionals in the intervention group were encouraged to provide smoking cessation advice and support for all smoking patients with the help of a stage-based motivational protocol. The barriers and facilitators reported by the dental professionals on two occasions for their efforts to incorporate smoking cessation advice and counselling into daily patient care are summarised here. Lack of practice time and anticipated resistance on the part of the patient were cited as barriers by over 50% of the dental professionals in the first interviews. Periodontal treatment and the presence of smoking-related diseases were mentioned as the most important stimuli. The experience-based interviews revealed key points for the implementation of smoking cessation advice and support in daily dental care. Education on the associations between smoking and oral health, vocational training on motivational interviewing and the offering of structured advice protocols were identified as promising components for an implementation strategy to promote the involvement of dental professionals in the primary and secondary prevention of tobacco addiction.

Health professional's perceptions of and potential barriers to smoking cessation care: a survey study at a dental school hospital in Japan

BackgroundSmoking is currently accepted as a well-established risk factor for many oral diseases such as oral cancer and periodontal disease. Provision of smoking cessation care to patients with oral problems is a responsibility of health care professionals, particularly dentists and dental hygienists. This study examined the smoking-related perceptions and practices of dental school hospital-based health professionals in Japan.FindingsA cross-sectional study design was used. The sample was formed from dentists, dental hygienists, physicians and nurses of a dental school hospital in Tokyo, Japan (n = 93, 72%). Participants were asked to complete an 11-item questionnaire assessing demographic variables and smoking history, provision of smoking cessation advice or care, attitudes about smoking cessation, and perceived barrier(s) to smoking cessation care. Eighteen percent of participants reported being current smokers and 15% reported being ex-smokers, with higher smoking rates reported by dentists compared with other health professionals (p = 0.0199). While recognizing the importance of asking patients about their smoking status, actual provision of smoking cessation advice or care by participants was relatively insufficient. Interventions such as 'assess willingness to make a quit attempt' and 'assist in quit attempt' were implemented for less than one-quarter of their patients who smoke. Non-smokers were more likely to acknowledge the need for increased provision in smoking cessation care by oral health professionals. 'Lack of knowledge and training' was identified as a central barrier to smoking cessation care, followed by 'few patients willing to quit'.ConclusionsA need for further promotion of smoking cessation activities by the health professionals was identified. The findings also suggest that dentists and dental hygienists, while perceiving a role in smoking care, do require training in the provision of smoking cessation care to hospital patients. In order to overcome the potential barriers, it is necessary to provide staff with appropriate training and create an atmosphere supportive of smoking cessation activities.

Quit in general practice: a cluster randomised trial of enhanced in-practice support for smoking cessation.

BackgroundThis study will test the uptake and effectiveness of a flexible package of smoking cessation support provided primarily by the practice nurse (PN) and tailored to meet the needs of a diversity of patients.Methods/DesignThis study is a cluster randomised trial, with practices allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline referral 3) GP usual care. PNs from practices randomised to the intervention group will receive a training course in smoking cessation followed by access to mentoring. GPs from practices randomised to the Quitline referral group will receive information about the study and the process of written referral and GPs in the usual care group will receive information about the study. Eligible patients are those aged 18 and over presenting to their GP who are daily or weekly smokers and who are able to give informed consent. Patients on low incomes in all three groups will be able to access free nicotine patches.Primary outcomes are sustained abstinence and point prevalence abstinence at the three month and 12 month follow-up points; and incremental cost effectiveness ratios at 12 months. Process evaluation on the reach and acceptability of the intervention approached will be collected through Computer Assisted Telephone Interviews (CATI) with patients and semi-structured interviews with PNs and GPs.The primary analysis will be by intention to treat. Cessation outcomes will be compared between the three arms at three months and 12 month follow-up using multiple logistic regression. The incremental cost effectiveness ratios will be estimated for the 12 month quit rate for the intervention groups compared to usual care and to each other. Analysis of qualitative data on process outcomes will be based on thematic analysis.DiscussionHigh quality evidence on effectiveness of practice nurse interventions is needed to inform health policy on development of practice nurse roles. If effective, flexible support from the PN in partnership with the GP and the Quitline could become the preferred model for providing smoking cessation advice in Australian general practice.Trial RegistrationACTRN12609001040257