Provision Of Smoking Cessation Support Research Articles

A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses.

Background and aimsPeople with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in‐depth through qualitative synthesis.MethodsThe online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: ‘attitudes’, ‘mental health professionals’ and ‘smoking cessation’. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta‐analysis. Qualitative findings were evaluated using thematic synthesis.ResultsThirty‐eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7–48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4–51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9–58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4–69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4–62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as ‘the norm’ and a perception of cigarettes as a useful tool for patients and staff.ConclusionsA significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.

Clinicians worry smoking cessation advice can be perceived as criticism

This systematic review of qualitative research investigated professionals’ experience of providing smoking cessation support in pregnancy to inform new interventions and improve routine care. Eight studies were included, reporting the views of 190 health professionals/key informants, including 85 midwives and health visitors.

Health professionals' perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and during the post-partum period: a systematic review of qualitative research.

BackgroundReducing smoking in pregnancy is a policy priority in many countries and as a result there has been a rise in the development of services to help pregnant women to quit. A wide range of professionals are involved in providing these services, with midwives playing a particularly pivotal role. Understanding professionals’ experiences of providing smoking cessation support in pregnancy can help to inform the design of interventions as well as to improve routine care.MethodsA synthesis of qualitative research of health professionals’ perceptions of the barriers and facilitators to providing smoking cessation advice to women in pregnancy and the post-partum period was conducted using meta-ethnography. Searches were undertaken from 1990 to January 2015 using terms for maternity health professionals and smoking cessation advisors, pregnancy, post-partum, smoking, and qualitative in seven electronic databases. The review was reported in accordance with the ‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) statement.ResultsEight studies reported in nine papers were included, reporting on the views of 190 health professionals/key informants, including 85 midwives and health visitors. The synthesis identified that both the professional role of participants and the organisational context in which they worked could act as either barriers or facilitators to an individual’s ability to provide smoking cessation support to pregnant or post-partum women. Underpinning these factors was an acknowledgment that the association between maternal smoking and social disadvantage was a considerable barrier to addressing and supporting smoking cessationConclusionsThe review identifies a role for professional education, both pre-qualification and in continuing professional development that will enable individuals to provide smoking cessation support to pregnant women. Key to the success of this education is recognising the centrality of the professional-client/patient relationship in any interaction. The review also highlights a widespread professional perception of the barriers associated with helping women give up smoking in pregnancy, particularly for those in disadvantaged circumstances. Improving the quality and accessibility of evidence on effective healthcare interventions, including evidence on ‘what works’ to support smoking cessation in disadvantaged groups, should therefore be a priority.PROSPERO 2013CRD42013004170.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2961-9) contains supplementary material, which is available to authorized users.

The Clinical Effort against Secondhand Smoke Exposure (CEASE) California: Implementing a Pediatric Clinical Intervention to Reduce Secondhand Smoke Exposure

Introduction: The Clinical Effort against Secondhand Smoke Exposure (CEASE) is an evidence based intervention to reduce secondhand smoke exposure (SHSE) in children. The goals of this study were: 1. To improve pediatric providers’ perceived knowledge of the consequences of and need for SHSE screening. 2. Increase screening rates of SHSE and the provision of smoking cessation support services for identified smokers including nicotine replacement therapy (NRT) and referrals to the California Smoker’s Helpline (Helpline). Methods: Pediatric clinics in Northern California were trained to implement CEASE. The evaluation had three components: (1) An evaluation of the training and its impact on participants’ knowledge and ability to implement CEASE (via anonymous post-training survey). (2) Referrals received by the California Smokers’ Helpline (Helpline); and (3) pre-post changes in perceived knowledge, screening practices, and provision of smoking cessation support (nicotine replacement therapy prescriptions and referrals to the Helpline) to family members who were identified as smokers (using a retrospective pre-post design). In addition, clinician champions were interviewed to gather information on barriers and facilitators to the implementation of CEASE 6 months after the training. Result: A total of 24 practice sites with 315 staff were trained to implement CEASE. Training participants rated the quality of the training high and most either strongly agreed or agreed that the training improved their knowledge and ability to implement CEASE. Referrals to the Helpline increased significantly and there were significant pre-post improvements in the provision of smoking cessation support services but not in rates of screening for SHSE. Barriers and facilitators to implementing CEASE are discussed. Conclusion: The CEASE California training is a practical and replicable model for pediatric providers to screen patients for SHSE and provide smoking cessation support services. Practice support tools, on-site champions, and coverage for NRT facilitated implementation of CEASE. However, not all patients referred to the Helpline followed up and there was no system for providers to track referrals. In addition, in-person trainings are costly and require significant travel time. Future interventions should leverage electronic health records to facilitate screening for SHSE and to improve referral and follow-up care for smokers. Future studies should examine other training modalities to more cost-effectively disseminate the CEASE training.

Provision of smoking cessation support in UK primary care: impact of the 2012 QOF revision.

Before 2012, UK GPs were paid only to offer cessation advice to smokers and only to those with smoking-related disease, a minority of all smokers. From 2012, GPs are now paid to offer all smokers referral for behavioural support and medication to assist cessation at least once every 2 years. To quantify the impact of this new recommendation and payment on indicators of smoking cessation activity. Interrupted time series analysis of data from general practices in England contributing data to The Health Improvement Network (THIN). Data were extracted on monthly rates of recorded delivery of smoking cessation advice, referral to NHS Stop Smoking Services, and prescription of smoking cessation medications, among an average of 3.3 million patients aged >16 years registered each month in THIN. ARIMA models were used to quantify changes in rates of cessation activity after the 2012 Quality and Outcomes Framework (QOF) revision compared with beforehand. The proportion of patients each month with a record of advice to quit smoking increased by 19.6% (95% CI = 7.9 to 31.4) in the year after the introduction of payments compared with the 8 years beforehand; the recording of referral to Stop Smoking Services increased by 38.8% (95% CI = 15.2 to 62.4). There was no significant change in prescription of smoking cessation medication, -7.7% (95% CI = -21.6 to 6.2). Paying GPs to intervene with all smokers and offer support rather than just advice to quit is associated with an increase in recording of advice and referring patients for behavioural support to stop smoking, but no change in prescribing pharmacotherapy for cessation.

Tobacco Cessation Practices and Attitudes Among Nurses in the Czech Republic.

Tobacco is the leading cause of cancer in the Czech Republic. More than one-third of the population older than 15 years smokes, including many nurses. Most smokers want to quit, but the extent of nurses' involvement in tobacco cessation is unknown. The purposes of this study are to describe the frequency of nurses' interventions in helping smokers quit, examine their attitudes and skills, and explore the relationship of nurses' smoking status to level of intervention. A convenience sample of nurses in the Czech Republic completed a survey about their frequency of interventions according to the 5As for tobacco dependence treatment (i.e., ask, advise, assess, assist, arrange), their attitudes and perceived skills, and their smoking status (never, former, current). A total of 157 nurses completed the survey; 26% "always" or "usually" assisted patients with smoking cessation. Few (22%) reported that nurses could play an important role in helping patients quit, and 65% rated their ability to help smokers quit as "fair/poor." Nurse who smoked (30%) were less likely to consistently assess smoking status or arrange for follow-up support. Few nurses in the Czech Republic consistently provide smoking cessation support to patients, have the skills to do so, or view this role as an important part of their role. To reduce tobacco-related cancers in the Czech Republic, capacity-building efforts are needed to enhance nurses' skills and confidence in providing smoking cessation interventions. Support is also need to help nurses who smoke quit.

Identifying Targeted Strategies to Improve Smoking Cessation Support for Cancer Patients

Although smoking causes adverse outcomes in cancer patients, most oncology providers do not regularly provide smoking cessation support. The purpose of this study was to identify key areas that can be targeted to improve delivery of evidence-based cessation support for cancer patients. In 2012, the International Association for the Study of Lung Cancer surveyed members asking about tobacco assessment and cessation practices for cancer patients. Responses from 1153 physician level oncology providers were analyzed to evaluate the effects of respondent demographics, tobacco use perceptions, and perceived barriers to providing cessation support on practice patterns. Respondents from the United States generally reported higher rates of asking about tobacco use, advising patients to quit, and assisting patients in quitting smoking. Work setting, time since completing a terminal degree, percent of time devoted to clinical care, and history of tobacco use were generally associated with asking about tobacco use and advising patients to quit, but not associated with discussing medications or actively treating patients. The dominant multivariate barriers to providing cessation support were a lack of clinician education or experience and lack of available resources to refer patients for smoking cessation support. Patient resistance to treatment, inability for patients to quit smoking, or feeling that smoking was not an important part of cancer outcome or cancer care had less meaningful associations with providing support. Improving clinician education and developing dedicated resources to provide cessation support were identified as ideal targets to address for improving cessation support for cancer patients.

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.

Smoking-related cancer in Scottish military veterans

Background: Serving military personnel have been shown to be more likely to smoke, and to smoke more heavily, than civilians. Our aim was to examine whether veterans have an increased risk of smoking-related cancer compared with non-veterans. Methods: Retrospective cohort study of 57,000 veterans born 1945-1985, resident in Scotland, and 173,000 age, sex and area of residence matched non-veterans, using Cox proportional hazard models to compare risk of lung cancer and other smoking-related cancers overall, by sex and by birth cohort, adjusting for socioeconomic status. Results: Over mean 29 years follow-up, 445 (0.79%) veterans developed lung cancer compared with 1,106 (0.64%) non-veterans (adjusted hazard ratio 1.16, 95% confidence intervals 1.04-1.30, p = 0.008). Other smoking-related cancers occurred in 737 (1.31%) veterans compared with 1,883 (1.09%) non-veterans (adjusted hazard ratio 1.18, 95% confidence intervals 1.08-1.29, p < 0.001). Risk was significantly increased among veterans born 1950-1954 for lung cancer and 1945–1954 for other smoking-related cancers. Risk of lung cancer was decreased among veterans born 1960 onwards. Conclusion: Veterans living in Scotland born before 1955 were at increased risk of smoking-related cancer compared with non-veterans, but younger veterans were not. This may reflect changing patterns of smoking in military personnel as a consequence of health promotion policy, and a changing operational environment. Primary healthcare providers should be aware of the importance of providing smoking cessation support to veterans.

Knowledge and practices of tobacco dependence treatment among junior doctors in a Malaysian teaching hospital

Introduction: Junior doctors are ideally placed to assist smokers quit yet little is known about their knowledge and practices.Aims: To determine knowledge and practices in providing smoking cessation support, among junior doctors in a Malaysian teaching hospital.Methods: In 2012, all junior doctors at University Malaya Medical Centre were invited to complete a self-administered questionnaire. The data were collated and analysed using standard descriptive methods.Results/Findings: Seventy per cent (n = 122/173) of those eligible completed the questionnaire, 71% reporting cessation training at medical school. Most (90%) asked patients their smoking status but only 52% asked about quitting. Sixty-one per cent lacked confidence in providing assistance to quit, especially female doctors (70.8%, p&lt;0.01). Most (80%) were unaware of local cessation clinics, and over half (59%) were unaware of the existence of guidelines for smoking cessation (p&lt;0.001).Conclusions: Asking about smoking was undertaken at satisfactory levels, but low knowledge, confidence and skills among this group of junior doctors indicates that cessation education should be included in undergraduate and in postgraduate curriculum training programmes. Awareness of specialist services and guidelines should be raised. Our findings are unlikely to be unique to this hospital, suggesting the need for a nationally consistent approach.

Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS stop smoking services for pregnant women

BackgroundSmoking during pregnancy is a major public health concern and an NHS priority. In 2010, 26% of UK women smoked immediately before or during their pregnancy and 12% smoked continuously. Smoking cessation support is provided through free at the point of use Stop Smoking Services for Pregnant women (SSSP). However, to date, little is known of how these services provide support across England. The aim of this study was to describe the key elements of support provided through English SSSP.MethodsSSSP managers were invited to participate in this survey by email. Data were then collected via an online questionnaire; one survey was completed for each SSSP. Up to four reminder emails were sent over a two month period.Results86% (121 of 141) of services completed the survey. Responding services were, on average, larger than non-responding services in terms of the number of pregnant women setting quit dates and successfully quitting (p < 0.01). In line with the 2010 NICE guidelines, Stop Smoking in Pregnancy and following Childbirth, one in five SSSP identified pregnant smokers using carbon monoxide (CO) testing and refer via an opt-out pathway. All services offered nicotine replacement therapy (NRT) to pregnant women and 87% of services also offered dual therapy NRT, i.e. combination of a patch and short acting NRT product.. The 2010 NICE guidelines note that services should be flexible and client-centred. Consistent with this, SSSP offer pregnant women a range of support types (median 4) including couple/family, group (open or closed) or one-to-one. These are available in a number of locations (median 5), including in community venues, clinics and women’s homes.ConclusionsEnglish Stop Smoking Services offer behavioural support and pharmacotherapy to pregnant women motivated to quit smoking. Interventions provided are generally evidence-based and delivered in a variety of both social and health care settings.

Systematic identification and treatment of smokers by hospital based cessation practitioners in a secondary care setting: cluster randomised controlled trial

Objectives To investigate the effectiveness of the systematic default provision of smoking cessation support to all adult smokers admitted to hospital, relative to usual care.Design Open, cluster randomised controlled trial.Setting...

Smoking cessation counselling in general practice for COPD smokers: determinants for general practitioners' compliance with a treatment protocol

For chronic obstructive pulmonary disease (COPD), smoking cessation is the main treatment goal. We examined compliance with a smoking cessation treatment protocol for COPD smokers by 47 general practitioners (GPs). Baseline and evaluation questionnaires were completed, and 34 of the GPs then took part in a semi-structured telephone interview. The main outcome measure was restarting of the protocol when a patient had relapsed during a quit attempt. Attitudes, social influences and perceived self-efficacy were assessed to understand compliance or non-compliance with the treatment protocol. The rates of self-reported compliance with seven out of nine aspects of the protocol were high (76% on average). Fifty-three per cent of the GPs restarted the treatment protocol following patient's relapse. A substantial percentage of the GPs reported being seriously disappointed by the effectiveness of the treatment protocol. A change of practice personnel or having unmotivated personnel hindered compliance with the treatment protocol. The majority of the GPs planned to continue using the protocol. Given that negative attitudes, a perceived lack of social support and lack of counselling self-confidence were associated with lower protocol compliance, less confident GPs and GPs who have negative attitudes towards the provision of smoking cessation support should delegate the counselling or refer their patients. It is also concluded that GPs should be given more realistic expectations about smoking cessation and, rather than drop support efforts when they experience a lack of time or lack of confidence for counselling smoking cessation, delegate these tasks to practice assistants or other personnel.

Novel setting for addressing tobacco-related disparities: a survey of community welfare organization smoking policies, practices and attitudes.

Research in the United States and Australia acknowledges the potential of non-government social and community service organizations (SCSOs) for reaching socially disadvantaged smokers. This study aimed to describe SCSO smoking policies and practices, and attitudes of senior staff towards smoking and cessation. It also investigated factors associated with positive tobacco control attitudes. In 2009, a cross-sectional telephone survey was undertaken of senior staff in Australian SCSOs, 149 respondents representing 93 organizations completed the survey (response rate = 65%; 93/142). Most service clients (60%) remained in programs for 6 months plus, and 77% attended at least weekly. Although 93% of respondents indicated they had an organizational smoking policy, it often did not include the provision of smoking cessation support. Most respondents indicated that client smoking status was not recorded on case notes (78%). Attitudes were mostly positive towards tobacco control in SCSOs, with a mean (standard deviation) score of 8.3 (2.9) of a possible 13. The practice of assessing clients’ interest in quitting was the only statistically significant factor associated with high tobacco control attitude scores. The results suggest that SCSOs are appropriate settings for reaching socially disadvantaged smokers with cessation support. Although generally receptive to tobacco control, organizations require further support to integrate smoking cessation support into usual care. In particular, education, training and support for staff to enable them to help their clients quit smoking is important.

A survey of smoking prevalence and interest in quitting among social and community service organisation clients in Australia: a unique opportunity for reaching the disadvantaged

BackgroundSocial and community service organisations (SCSOs) are non-government, not-for-profit organisations that provide welfare services to disadvantaged individuals. SCSOs hold considerable potential for providing smoking cessation support to disadvantaged smokers. This study aimed to establish the prevalence of smoking, interest in quitting and interest in receiving cessation support amongst clients accessing SCSOs.MethodsClients seeking financial or material assistance from three SCSOs in NSW, Australia, between February and October 2010 were invited to complete a 60-item general health touch screen computer survey. This included questions about smoking status, past quit attempts and interest in receiving support to quit smoking from SCSO staff.ResultsA total of 552 clients were approached to participate during the study period, of which 383 provided consent and completed the survey (69% consent rate). Daily smoking was reported by 53.5% of participants. Occasional smoking (non-daily smoking) was reported by a further 7.9% of participants. Most participants had tried to quit smoking in the past (77%) and had made an average of two quit attempts (SD = 3.2) lasting longer than 24 hours in the previous 12 months. More than half of all participants (52.8%) reported that they would like help from SCSO staff to quit smoking. For those interested in receiving help, the preferred types of help were access to free NRT (77%), cash rewards (52%) and non-cash rewards (47%) for quitting, and to receive support and encouragement from SCSO staff to quit (45%).ConclusionsSmoking rates among clients accessing SCSO are substantially higher than the general population rate of 15.1%. A substantial proportion of clients are interested in quitting and want support from the SCSO to do so.

Developing cessation interventions for the social and community service setting: A qualitative study of barriers to quitting among disadvantaged Australian smokers

BackgroundSmoking rates remain unacceptably high among individuals who are socially disadvantaged. Social and community service organisations (SCSO) are increasingly interested in providing smoking cessation support to clients, however little is known about the best way to assist disadvantaged smokers to quit in this setting. This study aimed to explore barriers and facilitators to quitting within the conceptual framework of the PRECEDE model to identify possible interventions appropriate to the social and community service setting.MethodsSemi-structured focus groups were conducted with clients attending five community welfare organisations located in New South Wales, Australia. Thirty-two clients participated in six focus groups. A discussion guide was used to explore the barriers and facilitators to smoking and smoking cessation including: current smoking behaviour, motivation to quit, past quit attempts, barriers to quitting and preferences for cessation support. Focus groups were audio-taped, transcribed and analysed using thematic analysis techniques.ResultsParticipants were current smokers and most expressed a desire to quit. Factors predisposing continued smoking included perceived benefits of smoking for stress relief, doubting of ability to quit, fear of gaining weight, and poor knowledge and scepticism about available quit support. The high cost of nicotine replacement therapy was a barrier to its use. Continual exposure to smoking in personal relationships and in the community reinforced smoking. Participants expressed a strong preference for personalised quit support.ConclusionsDisadvantaged smokers in Australia express a desire to quit smoking, but find quitting difficult for a number of reasons. SCSOs may have a role in providing information about the availability of quit support, engaging disadvantaged smokers with available quit support, and providing personalised, ongoing support.

Brief Report – A qualitative study about smoking cessation with clients of community service organisations that work with disadvantaged families

To determine whether clients of community service organisations (CSOs) that work with disadvantaged families consider the organisation to be a suitable avenue for the delivery of smoking cessation assistance, and to explore clients' knowledge and attitudes on smoking, and barriers to quitting. Seven focus groups were undertaken with clients from CSOs that work with disadvantaged families. Participants were asked questions on effects of smoking on health, barriers to quitting smoking and whether CSOs could provide smoking cessation support. Note-based analysis was undertaken to identify issues. Participants view CSOs as an acceptable avenue to provide support to quit smoking. Participants had misconceptions about the effects of smoking on health and the desire to quit smoking was not a priority among many participants. There is a need for smoking cessation support to be integrated into CSOs for disadvantaged families as clients are unlikely to seek support elsewhere.

Evaluation of the conceptual framework of undergraduate nursing students' intention to provide smoking cessation support

Objective : For the purpose of improving the education curriculum of the Department of Nursing, the present study structurally examine factors affecting undergraduate nursing students' intention to provide smoking cessation support.Methods : We conducted an anonymous questionnaire survey of 322 undergraduate nursing students, and obtained 298 valid responses. Structural equation modeling was performed in order to identify factors related to intention to provide smoking cessation support.Results : The percentages of male and female students were 4.4% and 95.6%, respectively. The average age was 20.3 years old, and 5.4% were smokers. The results of structural equation modeling demonstrated that their intention to provide smoking cessation support was elevated by : (1) more positive attitudes toward smoking cessation support based on higher awareness of smoking as a health professional, which was related to their own smoking choice and their increasing grade level, and (2) elevation of self-efficacy in supporting smoking cessation, which related to their increasing grade level and increased opportunities to learn about smoking cessation support.Discussion : The present findings support the suggestion to encourage undergraduate nursing students to quit smoking, and to provide early education regarding smoking cessation support for the intention to support patients' smoking cessation efforts.

A study of the effects of the tobacco educational program for smoking cessation support in baccalaureate nursing students over 18 months

Objective : We developed a tobacco educational program for baccalaureate nursing students, which aimed to encourage the students to be non-smokers, improve their attitudes toward smoking as healthcare professionals, enhance their attitudes toward smoking cessation support, increase their opportunities to learn about smoking cessation support, and elevate their smoking cessation support efficacy. We assessed the long-term effects of the program on the baccalaureate nursing students.Methods : We surveyed 188 students at 6 months before, immediately before, immediately after, 6 months after, and 18 months after the intervention. Responses were collected at all five points from 163 students. The questionnaires included information about the students' smoking behavior and attitudes, learning experience, and ability to provide smoking cessation support. To verify the effects of the intervention, we performed the Friedman test, repeated measures analysis of variance, and multiple comparisons tests.Results : Most students continued to be non-smokers or quit smoking after the intervention. The scores for their attitudes towards smoking as healthcare professionals, experience of smoking cessation support learning methods, and smoking cessation efficacy rose significantly after the intervention.Conclusion : Our program was simpler than those used in previous studies, and thus, it is considered to be highly implementable, even in the already overcrowded nursing education curriculum.

Smoking cessation support in community pharmacies: is the association of smoking and eye disease an additional tool to increase uptake?

Abstract Objective Community pharmacists have a central role in provision of smoking-cessation support. Evidence is growing that tobacco smoking is associated with development and progression of several potentially blinding eye diseases. As part of an ongoing programme of raising awareness of this link, we investigated whether community pharmacists are aware of this association and incorporate relevant advice into their smoking-cessation guidance. Setting Two-thousand and eighty community pharmacists in north west England, UK. Method A postal self-completion questionnaire asked pharmacists about their current practice with regard to smoking habits of their clients. Data were extracted and entered onto a database for statistical analyses. Key findings The response rate was 50.5%; 685 (65.2%) pharmacists asked clients about smoking habits; the most common situation was when clients complained of respiratory symptoms. Of these pharmacists, 52.7% always/usually recommended that smokers should stop and 37.2% always/usually assessed motivation to succeed. Help provided by pharmacists included brief advice on smoking cessation, leaflets, more structured support, referral to smoking-cessation services, and nicotine replacement therapies. The most common reason why pharmacists did not ask about smoking was lack of time (83.1%); 52.0% were aware of the causal association of smoking with eye disease, and 19.8% of those who asked about smoking habits mentioned this association when discussing smoking cessation. Conclusion Our study shows that community pharmacists are actively involved in smoking cessation. Many pharmacists are aware of the causal association between smoking and eye disease, but few are actively counselling patients about the eye heath risks of smoking. Community pharmacists could include this information in their advice to clients who smoke, as an additional means to promote smoking cessation.