Smoking Cessation Counseling Research Articles

A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study.

BackgroundThe prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV.ObjectiveWe conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV.MethodsA total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch.ResultsOf the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02).ConclusionsResults suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV.Trial RegistrationClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609

Immediate, Remote Smoking Cessation Intervention in Participants Undergoing a Targeted Lung Health Check: Quit Smoking Lung Health Intervention Trial, a Randomized Controlled Trial

Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3months. Differences between groups were assessed using logistic regression. Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48%of whom were women, were randomized to TSI (n= 152) or UC (n= 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1%vs8.9%(OR, 2.83; 95%CI, 1.44-5.61; P= .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. Immediate provision of an intensive telephone-based smoking cessation intervention including pharmacotherapy, delivered within a targeted lung screening context, is associated with increased smoking abstinence at 3months. ISRCTN registry; No.: ISRCTN12455871; URL: www.IRSCN.com.

The effectiveness of smoking cessation interventions in rural and remote populations: Systematic review and meta-analyses.

Rural and remote residents are more likely to smoke tobacco than those in major cities. However, they may experience unique systemic, provider, and individual barriers to accessing smoking cessation treatments, including distance and limited resources. Understanding the effectiveness of smoking cessation interventions in this population is important due to higher smoking-related disease burden and death compared to those in major cities. Medline, EMBASE, Scopus, PsychINFO, and Cochrane Library were searched until 19-02/2021. Inclusion criteria were randomised controlled trials (RCTs), cluster RCTs, randomised trials, or cluster randomised trials investigating behavioural interventions and pharmacotherapies for smoking cessation in rural and remote populations compared with a control or another smoking cessation treatment; and published in English. Given there is no internationally-standardised rurality index, definitions of 'rural' and 'remote' used by authors of studies were applied to reflect their country. Exclusion criteria were studies of non-combustible smoking cessation; and studies with urban participants in the sample. Two reviewers independently screened records for eligibility, extracted data from studies utilising a modified Cochrane Effective Practice and Organisation of Care Group form, and rated methodological quality using the Quality Assessment Tool for Quantitative Studies. Sixteen studies were included. Meta-analysis revealed a statistically significant treatment effect of individual face-to-face counselling on smoking cessation (RR 2.35, 95% CI 1.16-4.76, I2=0%) in rural and remote populations. There was no statistically significant treatment effect for nicotine replacement therapy (RR 2.97, 95% CI 0.84-10.53, I2=47%), telephone-counselling (RR 1.69, 95% CI 0.56-5.06, I2=62%), and community-based multiple-interventions (RR:1.57, 95% CI 0.89-2.78, I2=85%). Certainty of evidence was rated very low for each meta-analysis. Despite limited resources in rural and remote settings, individual face-to-face counselling for smoking cessation appears promising. Given the limited number of studies, further research about the effectiveness of smoking cessation interventions in rural and remote populations is warranted.

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.

The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon.

IntroductionThe management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.MethodsWe conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.ResultsSignificantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).ConclusionThe study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.

Long-term effects of systematic smoking cessation counselling during acute coronary syndrome, a multicentre before-after study.

In the Special Program University Medicine-Acute Coronary Syndromes (SPUM-ACS) observational study (clinical trial registration: NCT01000701), a multicentre before-after clinical trial, we assessed 5-year outcome after acute coronary syndrome, comparing a systematic with an opportunistic smoking cessation counselling phase. We studied smokers who were hospitalised for acute coronary syndromes (ACS), and we assessed self-reported smoking cessation, incidence of cardiovascular events and mortality 5 years after hospital discharge. In the observational phase, from August 2009 to October 2010, only smokers who requested smoking cessation counselling received it during hospitalisation. In the interventional phase, from November 2010 to February 2012, hospitalised smokers with ACS were systematically offered intensive smoking cessation counselling including four telephone calls within 2 months of discharge. Because of the before-after design, the care givers were aware of study phase. The objective was to assess whether systematic counselling to every smoker with ACS has an impact on the long-term smoking cessation rate, incidence of cardiovascular events and mortality. Missing data on smoking cessation were analysed with multiple imputation. The study was not powered to assess differences in 5-year smoking cessation rates or cardiovascular outcomes. Overall, 458 smokers with ACS were included at baseline (225 during the intervention phase and 233 during the observation phase). At 5 years, 286 (62.4%) reported their smoking status (140 for the intervention phase and 146 for the observation phase) and 51 (11.1%) had died. There was no statistically significant difference in the abstinence rate between the interventional phase (75/140, 54%), and the observational phase (68/146, 47%), with a risk ratio with multiple imputation adjusted for age, sex, education and ACS type of 1.13 (95% confidence interval [CI] 0.84-1.51, p = 0.4). The 5-year risk of major acute cardiovascular event was similar in the intervention phase as compared with the observational phase. The multivariate adjusted hazard ratio for all-cause mortality was 0.84 (95% CI 0.45-1.60, p = 0.6). In this controlled long-term interventional study, systematic intensive smoking cessation counselling in all hospitalised smokers with ACS did not increase 5-year smoking cessation rates, nor decrease cardiovascular event recurrence, as compared with opportunistic smoking cessation counselling during hospitalization.

Optimizing Smoking Cessation Counseling in a University Hospital: Results and Pitfalls.

Healthcare professionals (HPs) can play a substantial role in smoking cessation counseling (SCC) but in practice often skip this task due to time constraints. This study evaluates the implementation of the rapid Ask-Advise-Connect (AAC) method in a University hospital setting. This mixed methods pre-post interventional study was performed at the Cardiology department of a University hospital and consisted of (1) a quantitative assessment of patient smoking registration and HP connection rates to external SCC from the Electronic Medical Record, (2) semi-structured interviews with 10 HPs to assess their attitudes toward AAC, and (3) a blended intervention aimed to implement AAC. The blended intervention consisted of face-to-face and online AAC psychoeducation for HPs followed-up with motivational messages on their smart pagers over a period of 6 weeks. In total, 48,321 patient registrations and 67 HPs were included. Before AAC implementation, HPs assessed smoking status in 74.0% of patients and connected 9.3% of identified smokers with SCC. Post intervention, these percentages did not increase (73.2%, p = 0.20; and 10.9%, p = 0.18, respectively). Nonetheless, the vast majority (90%) of HPs feel it is important to discuss patient smoking, and view it as their duty to do so. Main barriers to AAC reported by HPs were forgetfulness and time pressure. This study shows that this AAC intervention does not increase Asking after smoking status or Connection of patients to SCC in a University Hospital. However, HPs hold positive attitudes toward AAC. A better understanding of the mechanisms required for optimizing HPs practice behavior is needed.

Smartphone Application for Smoking Cessation (Quit with US): A Randomized Controlled Trial among Young Adult Light Smokers in Thailand.

This study aimed to determine the efficacy of a smartphone application named Quit with US among young adult smokers. An open-label, parallel, 2-group, randomized controlled trial with a 12-week follow-up was conducted between March and November 2020 among undergraduate students (18 to 24 years) in Chiang Mai Province, Thailand. A total of 273 participants were assigned by simple randomization procedure to the Quit with US intervention group (n = 137) or the control group (n = 136). All participants received pharmacists’ smoking cessation counseling at baseline and follow-ups. In addition, the intervention group’s participants were advised to use Quit with US. The baseline and 12-week follow-up assessments were conducted at a study unit, whereas other follow-ups were completed over the telephone. The primary abstinence outcome was the exhaled CO concentration level (≤6 ppm) verified 7-day point prevalence abstinence. At baseline, the participants’ mean (standard deviation) age was 21.06 (1.62) years. Most identified as daily smokers (57.9%, n = 158), consumed ≤10 cigarettes daily (89.4%, n = 244), and expressed low level of nicotine dependence as measured by Heaviness of Smoking Index score (86.1%, n = 235). Regarding intention-to-treat analyses, participants in the Quit with US intervention group achieved significantly greater smoking abstinence rate than those in the control group (58.4% (80/137) vs. 30.9% (42/136), risk ratio = 1.89, 95% confidence intervals = 1.42 to 2.52, p < 0.001). In conclusion, Quit with US integrated with pharmacists’ smoking cessation counseling significantly enhanced smoking abstinence rates among young adult light smokers consuming ≤ 10 cigarettes daily.

Smoking cessation programme in hospitalised patients due to acute respiratory disease.

Hospital environment is generally propitious to smoking cessation for several reasons, such as a legal ban on smoking in hospital facilities, greater vulnerability facing acute illness and the continuous contact with healthcare professionals. To evaluate the effectiveness of intensive smoking cessation intervention during hospital admission due to acute respiratory disease and a 6-month follow up after hospital discharge. This prospective study included patients admitted at our Pulmonology Department due to acute respiratory disease - active smokers who consented to participate in smoking cessation counselling programme - between January and December 2019. After hospital discharge, the patients completed a 6-month follow up. Statistical analysis was performed with spss system version 24.0, using univariate analysis with Chi-squared and t-test. We included 30 patients, 86.7% male, with a mean age of 58.6 ± 13.6 years. The mean length of stay was 10 ± 11 days. The mean smoking time was 40.3 ± 14.4 years and the mean smoking load 40 ± 26 pack-year units. The mean level of nicotine dependence, measured by the Fagerström test, was 4.3 ± 2.8. None of the patients accepted smoking cessation pharmacological therapy. After hospital discharge, 19 patients were seen in consultation, 11 of whom maintained smoking cessation at 6 months, determining an overall smoking cessation rate of 36.7%. There was a statistically significant difference in the smoking cessation successful group regarding the motivation to quit smoking and the Richmond test compared to the unsuccessful group. Smoking cessation counselling behaviour programmes during hospitalisation, with regular follow up after hospital discharge, contribute to an increase in smoking cessation rate.

Comparison of Motivational Short Interventions to Improve Smokers' Health Behavior (The COSMOS Study): A Pragmatic Cluster-Randomized Two-Arm Trial in General Practice.

Helping smokers to quit is an important task of general practitioners (GPs). However, achieving tobacco abstinence is difficult, and smokers who fail may still want to improve their health in other ways. Therefore, Swiss GPs developed a multithematic coaching concept that encourages health behavior changes beyond smoking cessation alone. To compare the effectiveness of such coaching with state-of-the-art smoking cessation counseling, we conducted a pragmatic cluster-randomized two-arm trial with 56 GPs in German-speaking Switzerland and 149 of their cigarette smoking patients. GPs were instructed in either multithematic health coaching or smoking cessation counseling. After 12 months, we compared their patients' improvements in cigarette consumption, body weight, physical inactivity, alcohol consumption, stress, unhealthy diet, and a health behavior of their own choice, using hierarchical logistic regression models and Fisher's exact and t tests. Over 95% of all participants achieved clinically relevant improvements in at least one health behavior, with no difference between study arms (health coaching vs. smoking cessation counseling: aOR = 1.21, 95% CI = [0.03-50.76]; and aOR = 1.78, 95% CI = [0.51-6.25] after non-responder imputation). Rates of clinically relevant improvements in the individual health behaviors did not differ between study arms either (they were most frequent in physical activity, achieved by 3 out of 4 patients), nor did the extent of the improvements. Multithematic health coaching and state-of-the art smoking cessation counseling were found to be comparable interventions, both in terms of smoking cessation success and, quite unexpectedly, their effects on other health behaviors. The findings of our study suggest that in general practice, multithematic health coaching is an effective smoking cessation intervention, and conversely, monothematic smoking cessation counseling also achieves the beneficial effects of a multithematic health behavior intervention. This opens up the possibility for GPs to support their smoking patients in improving their health behavior in additional and more flexible ways.

Comparative Effectiveness of Postdischarge Smoking Cessation Interventions for Hospital Patients

Smoking cessation interventions for hospitalized patients must continue after discharge to improve long-term tobacco abstinence. How health systems can best deliver postdischarge tobacco treatment is uncertain. To determine if health system-based tobacco cessation treatment after hospital discharge produces more long-term tobacco abstinence than referral to a community-based quitline. This randomized clinical trial was conducted September 2018 to November 2020 in 3 hospitals in Massachusetts, Pennsylvania, and Tennessee. Cigarette smokers admitted to a study hospital who received brief in-hospital tobacco treatment and wanted to quit smoking were recruited for participation and randomized for postdischarge treatment to health system-based Transitional Tobacco Care Management (TTCM) or electronic referral to a community-based quitline (QL). Both multicomponent interventions offered smoking cessation counseling and nicotine replacement therapy (NRT) for up to 3 months. Data were analyzed from February 1, 2021, to April 25, 2022. TTCM provided 8 weeks of NRT at discharge and 7 automated calls with a hospital-based counselor call-back option. The QL intervention sent referrals from the hospital electronic health record to the state quitline, which offered 5 counseling calls and an NRT sample. The main outcome was biochemically verified past 7-day tobacco abstinence at 6 months. Self-reported point-prevalence and continuous tobacco abstinence and tobacco treatment utilization were assessed 1, 3, and 6 months after discharge. A total of 1409 participants (mean [SD] age, 51.7 [12.6] years; 784 [55.6%] women; mean [SD] 16.4 [10.6] cigarettes/day) were recruited, including 706 randomized to TTCM and 703 randomized to QL. Participants were comparable at baseline, including 216 Black participants (15.3%), 82 Hispanic participants (5.8%), and 1089 White participants (77.3%). At 1 and 3 months after discharge, more TTCM participants than QL participants used cessation counseling (1 month: 245 participants [34.7%] vs 154 participants [21.9%]; 3 months: 248 participants [35.1%] vs 123 participants [17.5%]; P < .001) and pharmacotherapy (1 month: 455 participants [64.4%] vs 324 participants [46.1%]; 3 months: 367 participants [52.0%] vs 264 participants [37.6%]; P < .001). More TTCM than QL participants reported continuous abstinence for 3 months (RR, 1.30; 95% CI, 1.06-1.58) and point-prevalence abstinence at 1 month (RR, 1.22; 95% CI, 1.08-1.35) and 3 months (RR, 1.23; 95% CI, 1.09-1.37) but not at 6 months (RR, 1.14; 95% CI, 0.99-1.29). The primary outcome, biochemically verified point-prevalence abstinence at 6 months, was not statistically significantly different between groups (19.9% vs 16.9%; RR, 1.18; 95% CI, 0.92-1.50). In this randomized clinical trial, biochemically verified tobacco abstinence rates were not significantly different between groups at the 6-month follow-up. However, the health system-based model was superior to the community-based quitline model throughout the 3 months of active treatment. A longer duration of postdischarge treatment may sustain the superiority of the health system-based model. ClinicalTrials.gov Identifier: NCT03603496.

Contingency management and cognitive behavior therapy for smoking cessation among veterans with posttraumatic stress disorder: Design and methodology of a randomized clinical trial

BackgroundSmoking is a prevalent concern among Veterans, especially those with posttraumatic stress disorder (PTSD). Despite the availability of interventions for smoking cessation, these treatments have not been as effective among Veteran populations, particularly Veterans with PTSD. The present study seeks to describe the methods of a randomized clinical trial examining the efficacy of CPT-SMART, a multidimensional treatment combining cognitive processing therapy (CPT) for PTSD, smoking cessation counseling, pharmacotherapy, and contingency management (CM) compared to a yoked comparison group. MethodsOne hundred twenty Veterans with PTSD who smoke cigarettes will be enrolled. All participants will receive CPT in addition to counseling and pharmacotherapy for smoking cessation. Participants will be randomized to the CPT-SMART condition, which includes monetary reinforcement that is contingent on bioverification of smoking abstinence (i.e., contingency management), or a yoked comparison with monetary reinforcement matched to the participant to whom they are yoked. The primary outcome is bioverified smoking abstinence at the 6-month follow-up appointment. ConclusionIf shown efficacious, a combined PTSD and smoking treatment plus incentive-based approach for smoking could be implemented into specialty PTSD programs. The positive public health impact of reducing smoking among Veterans with PTSD could be enormous as it would prevent significant smoking-related morbidity and mortality.

Tobacco Use Among Dental Students in Morocco: Opportunities for Professional Cancer Education.

The study aimed to evaluate tobacco use, attitudes, knowledge, and perceptions about tobacco control policies and smoking cessation counseling among dental students in Morocco. This cross-sectional study was conducted at the Dentistry Faculty of the Mohammed VI University of Health Sciences of Casablanca, using the Global Health Professions Student Survey (GHPSS) tool. Participants completed a self-administered survey questionnaire, including information on socio-demographic characteristics, tobacco use, exposure to secondhand smoke, attitudes, behavior and cessation, curriculum, and training. A total of 426 dental students were included in the study. Over 15% of the participants were current smokers, and 31.2% had tried smoking at least once. About 29.3% reported having been exposed to secondhand smoke in family settings and 49.5% in other environments. The majority of the students had felt that health professionals were role models for their patients. However, only 20% had felt they had received formal training in smoking cessation approaches. More than 70% of smokers had tried to quit smoking in the past year; however, only 41.7% reported having received help or advice. It is crucial that education and public health officials join efforts to plan and carry out programs aimed at training dental students in evidence-based cessation counseling methods, in order to change their own smoking behavior and assist their future patients. Improving dental school curriculums with regard to tobacco use prevention and cessation is also a powerful means of alleviating the national burden of cancer.

In vivo Experience With NRT to Increase Adherence and Smoking Abstinence Among Individuals in the Criminal Legal System: Study Protocol for a Randomized Clinical Trial.

BackgroundWhile tobacco use among individuals involved in the criminal legal system remains 3–4 times higher than the general population, few interventions have been targeted for this population to aid in smoking cessation. Nicotine replacement therapy (NRT) is a relatively effective and accessible smoking cessation aid; however, individuals frequently stop use of NRT early due to side effects and misperceptions about the products. The present study aims to address low medication adherence by examining the efficacy of an “in vivo” NRT sampling experience in individuals under community criminal legal supervision.MethodsFollowing recruitment through community legal outlets, participants (N = 517) are randomized to either an “in vivo NRT sampling” group or a standard smoking cessation behavioral counseling group. The in vivo group uses NRT in session and discusses perceptions and experiences of using NRT in real time while the standard smoking cessation counseling group receives four sessions of standard behavioral smoking cessation counseling. Both groups receive four intervention sessions and 12 weeks of NRT following the intervention. The 6-month post-intervention primary outcome measures are smoking point-prevalence abstinence and medication adherence.ConclusionThis is a novel smoking cessation intervention specifically aimed at increasing NRT adherence and smoking cessation among those involved in the criminal legal system, a group of individuals with high smoking rates and low rates of pharmacotherapy use. If proven effective, the present treatment could be a novel intervention to implement in criminal legal settings given the minimal requirement of resources and training.This trial is registered with www.clinicaltrials.gov-NCT02938403

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.

Smoking Cessation Advice“The Best Time to Quit Smoking was the Day you Started, the SecondBest Time to Quit is Today”

Objective: To decide the mindfulness and competency of dental and clinical experts in offering smoking discontinuance guidance.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Tertiary Care Teaching Institute, Rawalpindi Pakistan, from Oct 2019 to Feb 2020.&#x0D; Methodology: A pilot study carried out at 15-20 participants for questionnaire validation and reviewed by independent experts for face validity. A final questionnaire comprised of ten multiple-choice questions in addition to demographic profile. The minimum sample size required for the study was 261, where the national prevalence of smoking was 21.6%.&#x0D; Results: A total of 550 participants participated in the study and data were extracted from their responses. There were 335 (61.0%) males and 215 (39.0%) females in the study group, with a mean age of 32.4 ± 4.3 and the age range 25 – 44 years. Among total respondents, 380 (69%) were qualified dental and medical practitioners whereas 170(31%) were medical and dental students. Only (40%) respondents were confident in rendering cessation advice whereas (60%) were not. Only (15.5%) participants declared that they received formal training to counsel for quitting smoking. Among the total 234 (100%) males were confident in giving in advice whereas none of the females were sure enough p value &lt;0.001.&#x0D; Conclusion: Despite smoking is of immense concern regarding Public Health, Medical and dental professionals are not proficient enough in smoking cessation counselling. A major fraction of mortality and morbidity is attributable to it; therefore, importance is to be enlightened as a preventable cause of death

Smoking cessation counseling in patients with active malignancy.

e18655 Background: Tobacco smoking increases risk of multiple malignancies, most notably lung cancer, and is a leading cause of premature morbidity and mortality. Tobacco cessation counseling is effective in assisting patients to quit smoking and improving health outcomes, but over one third of smokers report receiving no counseling by healthcare providers. In this study, we investigated rates of tobacco cessation education at ambulatory visits among patients with active malignancy. Methods: We identified ambulatory visits among current smokers with a diagnosis of malignancy using the National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of ambulatory visits in the US, from 2008 to 2018. We first determined weighted rates of documented smoking cessation counseling. We next evaluated sociodemographic characteristics, provider and visit type, and chronic conditions as determinants of counseling in this population using logistic regression. Results: We identified 2,437 total visits during the study period, representing an estimated 48.9 million such visits in the US. In this cohort, smoking cessation counseling was provided at 14.2% (95% confidence interval [CI] 12.1-16.7%) of visits. Patients were significantly less likely to receive counseling with older age (adjusted OR 0.97 per year of age; 95% CI 0.96-0.98) and less likely in surgical (OR 0.49; 95% CI 0.32-0.75) or medical subspecialties (OR 0.60; 95% CI 0.36-0.99) compared to primary care visits. Sex, race, year of visit, insurance type, and previous visit to the same provider were not significantly related to receipt of counseling. Patients with concomitant COPD were substantially more likely to receive counseling (OR 3.50; 95% CI 2.21-5.53), with 28.4% (95% CI 21.5-36.4%) of such visits including tobacco cessation education. Conclusions: Tobacco smoking is a modifiable risk factor associated with multiple malignancies and substantial non-neoplastic morbidity and mortality. Nonetheless, smokers with current malignancy receive smoking cessation counseling at only about one in seven outpatient visits, with lower frequency with advanced age and at subspecialty visits. As more effective treatments improve survival for cancer patients, further work is needed to improve tobacco cessation efforts that could improve survival and quality of life.[Table: see text]

Impact of smoking cessation counseling among acute myocardial infarction patients on post-hospitalization mortality rates: a systematic review

Abstract Objective The current systematic review aimed to assess the impact of smoking cessation counseling (SCC) on patients’ short- and long-term mortality after acute myocardial infarction (AMI). Methods The Cochrane guidelines were used to conduct a systematic review of Medline (PubMed), ScienceDirect, CINAHL Cochrane database, and Google Scholar for studies on the impact of SCC on AMI patients’ mortality. Results Five studies were found to meet the predefined inclusion criteria. Smoker patients were not routinely counseled to quit smoking during their post-AMI hospital stay. Studies showed a reduction in mortality among AMI patients’ who received SCC compared with patients who did not receive it. Conclusions SCC during hospitalization and after discharge is a simple and cost-effective intervention that improves AMI patients’ survival.

A novel approach to assessing the effects of smoking on treatment response rate in muscle-invasive bladder cancer.

e16554 Background: Cigarette smoking is the strongest modifiable risk factor for bladder cancer and has been implicated in mechanisms of chemotherapy resistance. Prior studies examining tobacco exposure on chemotherapy response were limited by use of retrospective design and self-report assessment of smoking status, potentially under-estimating the association and risking bias towards the null. Cotinine is the central metabolite of nicotine and can be detected in saliva for up to 4 days after tobacco use. In this prospective cohort study, we tested the association between salivary cotinine level and pathologic response to neoadjuvant chemotherapy, assessed post-chemotherapy at the time of cystectomy, among patients with muscle-invasive bladder cancer (MIBC). Methods: Thirty-one patients with MIBC were prospectively recruited and surveyed on their smoking habits. Salivary cotinine was measured during chemotherapy using NicAlert test strips with cotinine concentration &gt; 10ng/mL indicating active smoking (cotinine = 1) and cotinine concentration &lt; 10ng/mL indicating no evidence of active tobacco use (cotinine = 0). Primary outcome was pathologic response at cystectomy, defined as complete response (pT0) or residual disease (pT1-4 or node+). For patients with prior history of tobacco use, the association between pre-chemotherapy cotinine level and post-chemotherapy response at cystectomy was assessed using a chi-squared test and an odds ratio with a 95% confidence interval (CI) using the Baptista-Pike method. Results: Thirty-one patients had cotinine levels measured during chemotherapy and 25 reported prior history of smoking. Of these 25 patients, 17 patients denied active smoking, 2 of whom had cotinine levels = 1 during chemotherapy. Response to chemotherapy by cotinine level among patients with prior history of tobacco use are shown in table 1. One patient declined cystectomy and was excluded from the analysis. The odds ratio of a complete response at cystectomy for patients with cotinine = 0 vs. cotinine = 1 was 3.86 (95% CI: 0.54-22.05) (p = 0.148). The odds ratio of residual disease with cotinine = 0 vs. cotinine = 1 was 0.26 (95% CI: 0.045-1.86) (p = 0.148). Conclusions: Prior smokers with no evidence of active tobacco use during curative chemotherapy were more than three-times as likely to demonstrate a complete response at the time of cystectomy compared to those with evidence of current tobacco use based on salivary cotinine levels. While this study was limited by a small sample size, it highlights a novel approach to tobacco use monitoring and the importance of continued smoking cessation counseling in patients with bladder cancer even after the diagnosis of cancer is made.[Table: see text]

Exploring the quality of smoking cessation in community pharmacies: A simulated patient study.

The prevalence of cigarette smoking continues to be a major public health problem In the United Arab Emirates (UAE); the government has recently implemented policies to reduce smoking prevalence. Innovative strategies to support cessation are needed. Community pharmacies are vital venues to extend the reach and effectiveness of smoking cessation support. To evaluate the quality of community pharmacist smoking cessation counseling in the UAE. A cross-sectional, simulated patient (SP) study was conducted among N=111 urban community pharmacies selected at random in Sharjah city. Two scenarios were developed to cover different types of cessation needs of treatment-seeking smokers and where pharmacists could have a major role in assisting with smoking cessation pharmacotherapy. The quality of pharmacist counseling was defined in terms of comprehensiveness and communication skills. Two formal assessment tools were used; an analytical checklist to assess the comprehensiveness of pharmacists smoking cessation counseling, and a global assessment form to evaluate communication skills. A descriptive analysis of the data was undertaken. A total of 101 pharmacists participated in the study. Pharmacist assessment of smoking cessation-specific information and provision of counseling were minimal. Pharmacists most frequently assessed nicotine dependence and provided generic guidance on the use of nicotine replacement products (NRTs) to manage withdrawal, but they largely did not obtain relevant histories (e.g., medical/medication histories, previous quit attempts, smoking triggers), explain individualized management strategies (e.g., setting quit date, changing environment, reassurance and encouragement), or provide advice about ongoing support. Pharmacists attained low scores in verbal and nonverbal communication and were frequently unempathetic and judgmental towards female SPs. Pharmacist-led smoking cessation programs can expand primary care-based cessation opportunities in the UAE and address the demand for cessation services. Pharmacists will benefit from additional training on the provision of smoking cessation interventions, with an emphasis on patient-centered communication skills.