Smoking-related Symptoms Research Articles

Young physician smoking status

Tobacco smoking is a global health problem and physicians should know how harmful is. However in many countries smoking is commonly prevalent among physicians. The aim of our study was to give an overview of smoking behavior among young Tunisian Physician. This was a descriptive study including 302 resident practising in Tunisia and who agreed to participate to our study by taking an online questionnaire submitted on February 2020. Residents mean age was 28 ± 2 years and sex ratio was 0.65. Twenty nine per cent were active smokers, 7% were former smokers and 64% were non-smokers. They were aware of the main role of the physician in smoking cessation counselling in 92% of cases and 57% used systematically minimal smoking cessation advice. The former smokers used to smoke cigarette in 86% of cases. They started at the mean age of 19 ± 3, 71% during medical studies (MS), 65% stopped smoking because of smoking-related symptoms and 9% used nicotine substitute to do it. The occasional smoker started smoking at the age of 21 ± 4 years, 77% during MS and 17% during internship. Smoking consumption increased during nightshifts (46%), parties (57%) and in association with alcohol (40%). Permanent smokers started smoking at the mean age of 19 ± 3, 70% during their MS. They all used cigarettes and six associated cigarettes with waterpipe. Smoking consumption increased during nightshifts (87%), parties and in association with alcohol (77%) and when preparing an exam (74%). Sixty-eight per cent felt smoking-related symptoms and 72% have tried to stop smoking. The Fagertsrom test showed that the nicotine dependence was high in 20%. The smoking cessation motivation was insufficient in 56% of cases. Smoking is common among young Tunisian physician despite their knowledge about its side effects on health and practising smoking cessation counselling remains insufficient. Training on smoking cessation should be ameliorated.

Perceptions, symptoms, and practices of electronic cigarette users: Descriptive analysis and validation of Arabic short form vaping consequences questionnaire.

BackgroundE-cigarette (EC) use is increasing worldwide. Understanding the practices and perceptions of e-cigarette users and profiling the symptoms they experience is essential for regulating the use of such products. This study aims to investigate the practices and perceptions of e-cigarette users in Jordan and examine the symptoms (e.g. respiratory) they associate with e-cigarette use.MethodsA cross-sectional online survey was conducted to assess EC use and tobacco smoking behaviors and the corresponding health symptoms among EC users in Jordan. EC use expectancies were also assessed using the Short Form Vaping Consequences Questionnaire, which was first translated into Arabic and tested for validity and reliability.ResultsOut of the 400 EC users surveyed, 95.5% were male, 76.2% used nicotine-containing juice, and 56.8% were concurrent tobacco smokers. Further, the participants had a mean age of 28.9 years (±10.2). Among dual EC/cigarette users, 88.6% reported that they tried to quit cigarette smoking, with e-cigarette use being the most commonly tried method of smoking cessation. The smoking-related symptoms reported by regular cigarette smokers mainly included sputum production (77.5%). The participants reported that using e-cigarettes instead of tobacco cigarettes had led to improvements in their sputum production (60.8%), breathing (59%), and general wellbeing (52%). Pleasant taste, enjoyable taste sensation, and flavor were significantly stronger (P-value < 0.05) among e-cigarette users compared to dual users. Dual EC/cigarette users reported stronger perceptions in the negative consequences scale, particularly with regards to the hazardous effects of smoking on health (P-value < 0.05).ConclusionDual daily use of e-cigarettes and regular cigarettes is a common practice among EC users. We recommend that further research is conducted on dual EC/cigarette use and the potential health risks this may have (e.g. higher nicotine intake as compared to the single use of either products).

Smokefree policy and medication dispensing for people in prison: interrupted time series analysis

Abstract Background Previous evaluations of smokefree prison policies have suggested improvements in self-rated health and some smoking-related symptoms. No studies to date have investigated impacts on medication use as proxy measures of objective ill-health or as indicators of potential negative unintended consequences. These is limited evidence to date on these important outcomes. Methods We obtained from NHS National Services Scotland aggregate data on medication items dispensed in prisons, based on individual named patient medication records, and from the Scottish Prison Service data on the prison population, for the period Jan 2013-Nov 2019. Items of interest comprised those for smoking cessation (varenicline and buproprion); nicotine replacement; specific smoking-related health conditions (glyceryl trinitrate; inhaled bronchodilators and steroids; antibiotics; chloramphenicol eye drops; and proton pump inhibitors and H2 receptor antagonists), and potential unintended mental health consequences (anti-depressants). We also included a set of negative controls for which dispensing was not expected to be affected by the new smokefree policy (anticonvulsants, excluding pregabalin and gabapentin). Analyses were undertaken using AutoRegressive Integrated Moving Average (ARIMA) time series methods, with the dates of the policy's announcement and of implementation included as pre-specified breakpoints. Results The results of ARIMA modelling of medication dispensing are confidential until May 2020 due to their sensitivity and will be available to present at WCPH 2020. Conclusions The use of routinely available dispensing data as an indicator of objective health impacts and potential negative unintended consequences provides novel insights into the effectiveness of smokefree prison policies. Results will be of interest to international jurisdictions considering such policies and to those seeking to harness the potential of administrative data for natural experiments.

Prevalence of tobacco use among young adults in Palestine.

Smoking tobacco is a worldwide public health issue. Over the last few decades, smoking patterns have been changing, reflected by increasing rates among young people and females in particular. This study aimed to determine the prevalence and modalities of smoking and to assess the factors, habits and beliefs that might encourage or discourage smoking among young adults in Palestine. A cross-sectional study was conducted in the West Bank in 2014 among Palestinians aged 18-25 years old. Subjects were recruited from six Palestinian universities (n=1997). Participants were asked to complete a questionnaire focusing on sociodemographics, knowledge and beliefs towards tobacco smoking, and the reasons that motivate or hinder smokers to quit. The prevalence of tobacco smoking was found to be 47.7%. Males had higher smoking rates, consumption levels, and initiated smoking at younger ages (74.4% started at ≤18 years old). Smoking cigarettes and waterpipe were the most common forms among both sexes. Smokers were also found to consume higher amounts of caffeinated drinks and fast food, showed lower scores towards anti-smoking beliefs, and reported significantly higher prevalence of smoking-related symptoms and diseases, primarily shortness of breath (20.5%) and cough (16.6%). The majority of smokers reported attempting and willingness to quit smoking. Health and financial costs were the strongest factors encouraging quitting while mood changes and lack of self-control were the most reported discouraging factors. Moreover, smoking among family members and peers increased the odds of smoking. Increasing rates of smoking among young Palestinians and a growing popularity of waterpipe use should alert stakeholders to the necessity for the implementation of smoking prevention and awareness policies and programmes.

Oral Contraceptives and Cigarette Smoking: A Review of the Literature and Future Directions.

Evidence continues to mount indicating that endogenous sex hormones (eg, progesterone and estradiol) play a significant role in smoking-related outcomes. Although approximately one out of four premenopausal smokers use oral contraceptives (OCs), which significantly alter progesterone and estradiol levels, relatively little is known about how OCs may influence smoking-related outcomes. Thus, the goal of this review article is to describe the state of the literature and offer recommendations for future directions. In March 2017, we searched seven databases, with a restriction to articles written in English, using the following keywords: nicotine, smoker(s), smoking, tobacco, cigarettes, abstinence, withdrawal, and craving(s). We did not restrict on the publication date, type, or study design. A total of 13 studies were identified. Three studies indicated faster nicotine metabolism in OC users compared to nonusers. Five of six laboratory studies that examined physiological stress response noted heightened response in OC users compared to nonusers. Three studies examined cessation-related symptomatology (eg, craving) with mixed results. One cross-sectional study observed greater odds of current smoking among OC users, and no studies have explored the relationship between OC use and cessation outcomes. Relatively few studies were identified on the role of OCs in smoking-related outcomes. Future work could explore the relationship between OC use and mood, stress, weight gain, and brain function/connectivity, as well as cessation outcomes. Understanding the role of OC use in these areas may lead to the development of novel smoking cessation interventions for premenopausal women. This is the first review of the relationship between oral contraceptives (OCs) and smoking-related outcomes. The existing literature suggests that the use of OCs is related to increased nicotine metabolism and physiological stress response. However, the relationship between OC use and smoking-related symptoms (eg, craving) is mixed. Further, no published data were available on OC use and smoking cessation outcomes. Therefore, we recommend additional research be conducted to characterize the relationship between OC use and smoking cessation outcomes, perhaps as a function of the effect of OC use on mood, stress, weight gain, and brain function/connectivity.

Rūkymo ypatumai tarp psichiatrijos ir nepsichiatrijos stacionaruose gydomų pacientų Lietuvoje

Tyrimo tikslas. Išsiaiškinti rūkymo paplitimo ypatumus įvairiuose Lietuvos gydymo įstaigų stacionaruose. Tyrimo metodas. Buvo atliktas vienmomentis, kiekybinis, anoniminis, anketinis tyrimas psichiatrijos ir nepsichiatrijos stacionaruose Vilniuje, Klaipėdoje ir Šiauliuose. Apklausti 228 asmenys: 113 psichiatrijos (49,6%) ir 115 nepsichiatrijos (50,4%) stacionaruose besigydančių asmenų, tarp jų moterų buvo 116 (50,9%) ir vyrų 112 (49,1%). Respondentų amžius buvo nuo 18 iki 92 (54,5 ± 18,5) metų. Tyrimo rezultatai. Psichiatrijos stacionaruose rūkančių asmenų gydosi 3,5 karto daugiau – 48,7%, nei nepsichiatrijos stacionaruose 13,9% (p = 0,001). Iš visų rūkančių pacientų psichiatrijos ir nepsichiatrijos stacionaruose beveik dvigubai dažniau rūko vyrai, atitinkamai 65,5% ir 62,5%. Net 96,3% rūkančių psichiatrijos ir 75% nepsichiatrijos stacionarų respondentų tęsia rūkymą besigydydami stacionare (p=0,008). Psichikos sutrikimus gydantys pacientai surūkydavo vidutiniškai 5,6 cigaretėmis daugiau, t. y. vidutiniškai po 16,3 cigaretes per dieną lyginant su gydančiais somatinius sutrikimus – 10,7. Net 55,8% psichiatrijos stacionarų respondentų pažymėjo rūkantys vidutinio stiprumo cigaretes, o nepsichiatrijos stacionarų pacientai dažniau rūkė lengvas – 43,8% (p = 0,013). Dažniausiai rūkantys pacientai rūko lauke: psichiatrijos – 46,9%, nepsichiatrijos – 75,0%. Be to psichiatrijos skyrių pacientai rūkė tualetuose ir net palatose. Pagrindiniai du rūkymą palaikantys faktoriai abejose grupėse buvo tie patys: tai raminantis ir gerinantis nuotaiką poveikis, o psichiatrijos stacionaruose gydomi rūkaliai išskyrė dar ir vaistų šalutinius reiškinius mažinantį poveikį. Taip pat atkreipiamas dėmesys į tai, kad 85,5% rūkančių ir 23,8% nerūkančių asmenų psichiatrijos stacionaruose pažymėjo reikalingumą specialių rūkyti skirtų vietų, kai nepsichiatrijos stacionaruose dauguma rūkančių 68,7% bei 100% nerūkančių pasisakė priešingai (p = 0,001). Svarbu atkreipti dėmesį į tai, kad nei vienam pacientui nebuvo nustatyta su rūkymo problemomis susijusi diagnozė ir nebuvo skirtas gydymas. Metant rūkyti psichiatrijos skyrių respondentai daugiausia vilčių teikė rūkymo metimo konsultacijoms, gydymui, elektroninėms cigaretėms, o nepsichiatrijos skyrių: elektroninėms cigaretėms, griežtiems draudimams ir gydymui. Įdomu pažymėti, kad literatūrai apie rūkymo žalą abiejų grupių rūkoriai teikė mažiausiai reikšmės. Išvados. Lietuvoje stacionaruose gydomiems pacientams rūkymo problema yra aktuali, ypač tarp psichiatrijos stacionarų ligonių. Psichiatrijos stacionarų pacientai turi sunkesnius rūkymo požymius ir patiria daugiau diskomforto sprendžiant rūkymo problemą. Rūkymo sukeltai psichikos ir elgesio sutrikimų diagnostikai, profilaktikai ir gydymui nėra skiriama adekvataus dėmesio, priemonių ir resursų. Sąlygų rūkyti nebuvimas veda į rūkančių ir nerūkančių pacientų žeminimą, diskriminaciją ir psichiatrijos stigmatizavimą.

Changes in smoking-related symptoms during enforced abstinence of incarceration.

Tobacco use among prisoners is much higher than among the general population. Little is known about changes in smoking-related symptoms during periods of incarceration. The objective of this study is to evaluate changes in smoking-related symptoms during incarceration. We recruited 262 inmates from a tobacco-free prison. At baseline, participants were asked about smoking-related symptoms prior to incarceration and then asked about recent symptoms. All symptom scores on the American Thoracic Society Questionnaire (ATSQ) improved during incarceration. Higher ATSQ scores were associated with asthma, depressive symptoms, stress, higher addiction and more pack years of smoking. Greater improvement in symptoms was not associated with smoking status after release. Forced tobacco abstinence leads to significant improvements in smoking-related symptoms. However, improvements in symptoms are not associated with smoking behavior changes. Addressing changes in symptoms during incarceration will require further evaluation in smoking cessation interventions for incarcerated populations.

Integrative Smoking Cessation Stage Model for Chinese Students Studying in Korea

The present study aimed at developing an integrative stage model of smoking cessation behavior by combining highly predictable constructs extracted from previously verified health behavior models. The fitness of the hypothetical model was also tested. The study participants were 214 Chinese students studying in Korea, presenting high smoking rates. Perceived severity, benefit, barrier, self-efficacy, and social support were measured using the modified Attitudes-Social Influences-Self Efficacy Questionnaire. Demographic and smoking-related characteristics were also evaluated. Results showed that the hypothetical model provides a good fit. Significant psychosocial predictors of smoking cessation stage were perceived benefit (p=.050), barrier (p=.003), and social support (p=.003). Among demographic and smoking-related characteristics, gender (p=.030), duration of smoking (p=.010), and previous smoking cessation experience (p=.020) were found to influence smoking cessation stage. In addition, gender, age, number of cigarettes smoked, previous smoking cessation experience, smoking-related symptoms, and smoking cessation education needs were found to influence psychosocial constructs significantly. The significant psychosocial predictors and demographic and smoking-related characteristics defined in the present study appear to be potent and promising predictors of smoking cessation behavior stages for a cohort of Chinese students studying in Korea.

Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers.

BackgroundThe emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling.MethodsED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling.ResultsThree hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r = 0.09), gender (average Likert score = 2.75 for men, 2.42 for women), education (average Likert score = 2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r = 0.10) were significant at the p < 0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling.ConclusionsIn this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.

Manipulation of Cigarette Craving with Transcranial Magnetic Stimulation

Manipulation of Cigarette Craving with Transcranial Magnetic Stimulation

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be. This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs' engagement in smoking cessation and the factors that influence their engagement. Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills. The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs' engagement in smoking cessation include GPs' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs' engagement in smoking cessation. Strategies to improve the frequency and quality of GPs' engagement in smoking cessation need to address the multifaceted influences on GPs' practice and to reflect the widely differing contexts across Europe.

The early health consequences of smoking: Relationship with psychosocial factors among treatment-seeking Black smokers

Blacks suffer disproportionately from the long-term health effects of smoking. Little is known about the prevalence of the early health consequences of smoking in this population or whether psychosocial factors influence the frequency of symptoms. This study investigated the prevalence and psychosocial correlates of smoking-related physical symptoms in Black smokers. Adult smokers (N = 117, 58% female, M(age) = 43.0 years) who smoked at least 5 cigarettes/day completed self-administered assessments of cigarettes smoked per day, smoking duration, alcohol use, perceived stress, depressive symptoms, and smoking-related symptoms. The most frequently occurring physical symptoms were shortness of breath (66%), coughing (50%), and headaches (49%). Multivariate analyses showed that smoking history, alcohol use, perceived stress, and depressive symptoms were independently related to smoking-related symptoms, even after controlling for sociodemographic variables and medical diagnoses. The early health consequences of smoking appear to be common among Black smokers and can serve as a cue to action for cessation efforts. Alcohol use, stress, and depression appear to negatively influence the early health consequences of smoking and should be assessed routinely in treatment-seeking Black smokers.

Participation of Icelandic nurses in smoking cessation counselling

The purpose of this study was to investigate the participation and knowledge of Icelandic nurses in smoking cessation counselling and to find barriers to smoking interventions by nurses. Research has shown that clinical intervention as brief as three minutes can substantially increase smoking cessation success. Several studies have revealed that majority of nurses agree that smoking cessation counselling is within their duties. However, the percentage of nurses who report advising and/or counselling patients remains low. An anonymous mail survey of all practicing nurses in Iceland was conducted in September 2004. A self-administered questionnaire was used, consisting of 74 questions in six sections: asking about smoking behaviour, to advise, to assess/assist/arrange, children and passive smoking, other questions and demographic questions. Of 2453 questionnaires, 868 complete questionnaires were returned, giving a 36% response rate. While the majority of nurses 'asked' about smoking behaviour, a minority 'advised' or 'assisted' their clients with smoking cessation. However, if the clients had no smoking-related symptoms, less than half of the nurses asked about smoking behaviour. Failure to ask and advise clients about the importance of smoking cessation and assisting with smoking cessation correlated (p < 0.001) with several factors, including: lack of time, insufficient knowledge or training and not considered as a part of daily duty. Nurses who smoked were less likely to advise against smoking (p < 0.05). Nurses frequently neglect to counsel clients about smoking cessation. Common barriers to the delivery of smoking cessation interventions by nurses include insufficient education and training in smoking cessation therapy. The number of patients with tobacco-related illnesses is increasing worldwide. Effective smoking cessation interventions by nurses have the enormous potential of reducing smoking prevalence and improve health.

Doctors and Patients Using an Electronic Health and Medical Record: Research Studies Offer Multiple Views of 21st Century Health Care

“I already know you better (after several e-mails) than the internist I was seeing since 1990,” wrote a new patient of Chuck Kilo, MD, MPH, at Portland's Greenfield Health, who believes that the relationship between doctors and patients is built on continuous communication, requiring multiple modes and encounters.a With the developing electronic capability that doctors and patients now have, to complement their traditional forms of interaction—the office visit, the hospital visit, the telephone—they can form quicker and deeper relationships than previously possible; and both can access data in a common electronic medical record. All of the Original Articles in this issue represent a research and applications view of various components of this developing integrated electronic capability. Patients can now contact their physician by secure e-mail online—a new physician-patient e-communication—which resulted in Kaiser Permanente patients sending more than one million electronic messages to their physicians in 2006. E-communication will develop along the same continuum as have personal visits: from simple e-data to e-mail exchange to e-encounter to e-correspondence to e-conversation. The question becomes: How easily can doctors translate their patient-satisfying, personal office visit behaviors into a satisfying e-visit? Can doctors write a subjective, personal piece of e-correspondence? (MyChart—A New Mode of Care Delivery: 2005 Personal Health Link Research Report, page 14; see Figure 1 #1.) Figure 1 Research Studies: Realms of Health and Medical Care. With the electronic medical record available in the exam room, “it” could disrupt the personal visit. The effect that “it” has on patients depends on the doctor, though its intrusion can be positive, and, through involvement and by improved understanding, can enhance communication and relationship between patient and doctor. (Implementing the Electronic Medical Record in the Exam Room: The Effect on Physician-Patient Communication and Patient Satisfaction, page 21; see Figure 1 #2.) Online features accessible to patients at home include interactive, health e-programs, such as weight management, with positive outcomes of healthy behavior change. With a health e-program as part of the treatment plan, connection between patient and doctor builds without additional office visits. (Obesity in the Kaiser Permanente Patient Population and Positive Outcomes of Online Weight-Management Programs, page 25; see Figure 1 #3.) As patients transition from home to the medical delivery system and back home, doctors and patients will be able to rely on an electronic reconciliation system to ensure that current outpatient medications continue when s/he becomes an inpatient, and inpatient medication changes continue when s/he becomes an out-patient again. (Decreasing Medication Discrepancies Between Outpatient and Inpatient Care Through the Use of Computerized Pharmacy Data, page 31; see Figure 1 #4.) Surgical Intensive Care Unit glycemic control after Bariatric Surgery, reported from the Henry Ford Health System, exemplifies use of multiple hospital database and analytical systems that aid cycles of quality improvement work to advance clinical outcomes in the inpatient setting. (Perioperative Tight Glycemic Control: The Challenge of Bariatric Surgery Patients and the Fear of Hypoglycemic Events, page 36; see Figure 1 #5.) Patients can benefit from doctors matching their health assessments with their documented medical histories through using a data warehouse to access information essential for understanding how adverse childhood events can result in unhealthy adult behaviors. (Adverse Childhood Experiences and Smoking Persistence in Adults with Smoking-Related Symptoms and Illness, page 5; see Figure 1 #6.) This connection of electronic components becomes a web of electronic capability—a whole system of integrated data, information, programs, and communication—to enhance traditional in-person care, offering people a more complete health care experience. By developing an eHealth Service, physician leaders define a new realm of health and medical care that is interactive, convenient, low cost, and personal. With its addition, medical and nursing care is now practiced in a whole-system context, without singular dependence on the office visit and the doctor as the only way to assess and treat a condition, or to improve health. Use of this electronic capability will transform medical care.

Adverse Childhood Experiences and Smoking Persistence in Adults with Smoking-Related Symptoms and Illness

Little is known about why people continue to smoke after learning that they have diseases and conditions that contraindicate smoking. Using data from the Adverse Childhood Experiences (ACE) Study, we examined the relation between ACEs and smoking behavior when smoking-related illnesses or conditions are present, both with and without depression as a mediator. Participants were more than 17,000 adult HMO members who retrospectively reported on eight categories of ACEs (emotional, physical, and sexual abuse; witnessing interparental violence; parental divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member). The number of maltreatment categories was summed to form an ordinal variable called the ACE Score. We measured current smoking, conditions that contraindicate smoking (heart disease, chronic lung disease, and diabetes), and symptoms of these illnesses (chronic bronchitis, chronic cough, and shortness of breath). Logistic regression models compared the ACE Score of smokers with smoking-related illnesses to participants who reported these illnesses but were not current smokers (n = 7483). Significant dose-response relations between the ACE Score and smoking persistence were found (odds ratio = 1.69; confidence interval = 1.34-2.13 for participants with ≥4 ACEs). Depression was a significant independent predictor of smoking persistence as well as a mediator. Depression only slightly attenuated the relation between the ACE Score and persistent smoking, however. Medical practitioners should consider the maltreatment history and depression status of their patients when a smoking-related diagnosis fails to elicit smoking cessation. Programs should be developed that better address the underlying motivations for continuing to smoke in the face of health problems that contraindicate smoking.

Smoking cessation patterns in methadone-maintained smokers

To determine predictors of smoking cessation duration in a randomized clinical trial, we assigned participants to nicotine patch (8-12 weeks) plus either (a) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session, or (b) brief advice using the National Cancer Institute's 4A's model. A total of 383 smokers from five methadone maintenance treatment centers in Rhode Island were enrolled, of whom 312 (82%) completed 6-month follow-up assessments. The primary outcome was longest period of self-reported abstinence during follow-up. Participants were on average 40.5 years of age; 51.9% were male, and 77.6% were White. In multivariate analysis controlling for demographics, nicotine dependence, depressive symptoms, and smoking-related symptoms, we found longer periods of abstinence in persons reporting at least one 24-hr quit attempt in the year prior to baseline (OR = 1.97, p = .003), in those anticipating success in cessation (OR = 1.33, p = .024), and in those with a greater percentage of nicotine patch use days (OR = 2.78, p<.001). Past quit attempts, self-efficacy, and constant nicotine replacement were associated with duration of abstinence among methadone-maintained smokers. Attention to these domains in future intervention studies may improve treatment success.

Relationship Between Stages of Change and Advice from Family and Medical Physicians to Quit in Japanese Smokers

produces significant health benefits because smoking is a major preventable cause of morbidity and mortality. However, smoking cessation is the most difficult item in lifestyle modification. The concept of stage of change is a core element of the transtheoretical model of behavior change and is widely used in smoking cessation interventions1,2. According to this model, current smokers are classified in three stages of change or readiness to quit smoking ; precontemplation, contemplation, and preparation3. Smokers who are planning to quit within the next 30 days are classified in the preparation stage. Previous research based on nine samples by five countries (Finland, Netherlands, Spain, Switzerland, and the United States) showed that a higher prevalence of smoking was associated with a higher proportion of smokers in the precontemplation stage4. Increasing the proportion of smokers in the preparation stage is important to promote smoking cessation. The experience of smoking-related symptoms or diseases, and advice from a private medical physician to quit smoking are frequently given as reasons for successful smoking cessation5. Although similar reasons are given for the transition to preparation stage from contemplation or preparation stage, it is not clear whether this supposition is correct or not. The current study aims to elucidate the relationship between stages of change and advice to quit smoking from a family member and a medical physician.

Should general practitioners screen smokers for COPD?

Objective– To discuss whether screening for early chronic obstructive lung disease (COPD) is justifiable.Background– The COPD diagnosis can usually be made by means of spirometry before symptoms appear. General practitioners are these days encouraged, from several quarters, to screen their smoking patients for early COPD. Smoking cessation is still the only available treatment that indisputably improves the long-term prognosis of this disease. The argument for screening is that people will be more easily motivated to stop smoking if they know their lung function results. There is, however, no documentation that this is the case.Data sources– Pub Med using the search terms “mass screening”, “COPD” and “spirometry”.Results– There is no evidence today that spirometry screening aids smoking cessation.Conclusions– A large randomized study is needed, in which the independent effect of spirometry as part of a smoking cessation programme is studied. Until such a study has shown convincing results, and has been followed by a cost–benefit analysis in favour of screening, screening for pre-clinical COPD in general practice should not be recommended. However, it is important to diagnose people who may benefit from symptom-relieving treatment, and therefore patients with smoking-related symptoms should be offered spirometry. Finally, the general practitioner should strive to offer smoking cessation counselling to all smokers, regardless of their lung function.

Smoking prevalence, behaviour and nicotine addiction among coal workers in Zonguldak, Turkey.

To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X-rays and pulmonary function tests were performed to evaluate patients' related diseases and complications. Smoking status of the workers was as follows; Sixty-nine never smokers (17.7%), 62 ex-smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 +/- 4.2 versus 15.0 +/- 4.0). The most common reason for starting smoking was smoking interest (50%) and friends' influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking-related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0-3 points), moderate (4-6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7% respectively. Ex-smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Smoking behavior and interest in quitting among homeless smokers

Objectives: To examine smoking behavior in homeless persons, including the impact of self-reported tobacco-related health problems and drug and alcohol abuse on readiness to quit and interest in smoking cessation counseling. Methods: Cross-sectional survey of outpatients and inpatients on the homeless service at Massachusetts General Hospital. Results: Among 98 homeless smokers with a mean age of 44 years, tobacco-related medical diagnoses and symptoms and psychiatric illnesses were common, as were drug and alcohol abuse. One third of the smokers in this sample intended to quit smoking within the next 6 months, including 19% who planned to quit in the next 1 month. Forty-four percent of the participants were somewhat or very interested in smoking cessation counseling. In multivariate analyses, significant ( P<.05) predictors of readiness to quit smoking were greater confidence in one's ability to quit (self-efficacy) and more social support for quitting. Multivariate predictors of interest in smoking cessation counseling were smoking-related symptoms and higher self-efficacy for quitting. Conclusions: Homeless smokers recruited from the inpatient and outpatient services of a large, urban teaching hospital reported interest in both stopping tobacco use and receiving assistance to quit smoking. Having an illness that a smoker believes is tobacco-related, having greater confidence in the ability to quit, and having more social support for quitting were associated with greater readiness to quit and more interest in smoking cessation counseling. Alcohol and drug abuse were not associated with reduced interest in quitting smoking. These findings suggest that homeless smokers may benefit from smoking cessation programs that are colocated in medical or drug treatment settings.