Tobacco-using Patients Research Articles

Dental Students' Awareness, Preparedness and Barriers towards Managing Tobacco-Using Patients-A Cross-Sectional Study.

Aims: To evaluate Hong Kong dental students’ perceived awareness, preparedness and barriers towards managing tobacco-using patients. Methods: A validated questionnaire was administered to dental students who were in their clinical years (the third, fourth, fifth and sixth year of study) in 2017 at the University of Hong Kong. The questionnaire consisted of three sections: (1) awareness towards practicing tobacco cessation counselling (TCC), (2) preparedness in terms of confidence, knowledge and clinical practices when managing tobacco-using patients, and (3) perceived barriers to counselling. Results: All 206 invited students had participated this study. Most (93%) agreed that dentists should deliver TCC. However, only around a quarter (26%) of students were well-prepared to help patients in tobacco cessation. While 60% of students agreed nicotine replacement therapy (NRT) was helpful for patients to quit tobacco use, only 28% understood its mechanism of action, and merely 16% were knowledgeable enough to introduce NRT to their patients. Two-thirds (62%) of students felt they did not have sufficient skills at this stage of their training. Conclusions: Most Hong Kong dental students had good awareness that dental professionals had an important role to promote tobacco cessation in their patient pools. However, not many of them were well-prepared to manage tobacco-using patients. Common barriers were found to be patients’ apathy and students’ inadequate familiarity with NRT.

Quitline program utilization and cessation outcomes: A comparison of provider-referred clients by healthcare settings.

US Public Health Service guidelines recommend that healthcare providers assess patients for tobacco use and refer tobacco users to cessation services (e.g., quitlines). However, once referred, little is known on how program outcomes for referred tobacco users vary across healthcare settings. To examine differences in program enrollment, dropout at follow-up, utilization (number of coaching sessions and nicotine replacement therapy use), and quit outcomes among tobacco users referred across settings to a state quitline. In a retrospective analysis of clients referred to the quitline (January 2011–June 2016), referrals were categorized into six settings: general medical practice (reference group), acute care hospitals, behavioral health, federally qualified health centers (FQHCs), county health departments, and specialty clinics. Outcome variables included enrollment, dropout, program utilization, and 30-day tobacco abstinence at 7-month follow-up. Compared to medical practices, clients referred from behavioral health were less likely to enroll in services (OR = 0.81, 95%CI: 0.76, 0.87), less likely to report using NRT in-program (OR = 0.51, 95%CI: 0.42, 0.62), and along with clients referred from FQHCs (OR = 0.78, 95%CI: 0.64, 0.94) were less likely to be quit at follow-up (OR = 0.73, 95%CI: 0.59, 0.92). Clients referred from acute care hospitals were less likely to enroll in services (OR = 0.60, 95%CI: 0.56, 0.64) and were more likely to drop-out of cessation services (OR = 1.12; 95%CI: 1.00–1.26). Findings reflect the need for better tailoring of messages for tobacco assessment within specific healthcare settings while bolstering behavioral counseling that quitlines provide to increase enrollment, engagement, and retention in tobacco cessation services.

Systems Approach in Tobacco Dependence Treatment through Hospitals

This study on systems approach in tobacco dependence treatment was done to (a) Assess the feasibility of tobacco treatment protocol (TTP), (b) Assess quit rate among those treated with TTP vs. no treatment and (c) Compare treatment outcome in Brief Intervention (BI) and Intensive Intervention (II) with or without pharmacotherapy. This one year study (2013), undertaken at a hospital at Jaipur, India identified currently tobacco-using patients. Those willing were assisted to quit through brief intervention (BI) or intensive treatment (II). All were followed-up telephonically for one year. The responders were categorized as successful quit, failed to quit and relapsed. This study enrolled 1264 patients out of 19657 (6.43%). In 43.4 per cent patients (549/1264) who consented for the treatment, the overall quit rate was 26.1 per cent (CI: 23.8 -28.6) whereas in those treated with BI and II were 54.2 per cent (CI: 49.7 -59.0) and 84.9 per cent (CI: 78.4 -92.0) respectively vs. zero quit rate in untreated. The use of pharmacotherapy improved overall quit rate by 14.6 per cent. The quit rates did not differ for the type of tobacco used. Since, this study could achieve its objective of implementing the systems approach in tobacco treatment protocol in a hospital-setting, it merits a replication.

Approaches and Strategies for Habit Intervention in Smokeless Tobacco/Arecanut/ Betel Quid and Non-Starting

Background: Although adequate research has been conducted regarding smoking and smokeless tobacco, there is a dearth of research exploring reasons for chewing areca nut and betel-quid. Global epidemiology of areca nut and betel-quid shows distinct ethnic and cultural preferences. Areca nut is chewed for its psychological stimulating effects and perhaps, a medicinal value. To develop empirically supported treatments and to promote nonstarting, healthcare workers and researchers must first understand the reasons people engage in the behavior. Aim: To discuss evidence based approaches and strategies for habit intervention in smokeless tobacco/arecanut/betel-quid and nonstarting. Methods: Data were collected from published national and international research, conference reports, WHO reports, tobacco control guides, Clinical Best Practice Guidelines and Cochrane database systematic reviews. Results: Individual behaviors are largely determined by complex range of factors beyond the control of the most individuals. Behavior change is complex and most people are well-informed about the basic health messages. Most people will have extensive experience of attempting to change their health career including quitting tobacco products. It is therefore essential to know a detailed history of a person's previous experiences of change and learn from this. Interventions need to match individuals' desire and ability to change. Encouragement, understanding, support, and empathy are all essential to enable clients achieve their goals. The most effective preventive intervention that a clinician can provide for tobacco-using patients against is an empathic, personalized smoking cessation intervention program with extended assistance and follow-up. The goal of the intervention must be complete cessation. Reduction provides no direct health benefits to the individual. Oral examination by a dental professional who points out tissue damage from smokeless tobacco use in a user´s own mouth, advice to quit, and brief problem solving and supportive counseling are effective in promoting smokeless tobacco cessation. There is also a need to develop culturally tailored areca nut and betel-quid cessation and risk reduction programs, the first step in reducing the public health burden associated with betel-quid chewing worldwide. Interventions are available, but underutilized, in part due to lack of clinician training and organizational support. Conclusion: Although the deleterious effects of smokeless tobacco/areca nut/betel-quid are well known by both users and healthcare workers, the knowledge has not translated effectively into cessation. Proven, brief, repetitive, directed interventions tailored to the needs of the patients can increase successful cessation. Controlling sociodemographic, environmental and personal factors may promote nonstarting.

Evaluation of a Dedicated Tobacco Cessation Support Service for Thoracic Cancer Center Patients.

Cancer patients' continued tobacco use results in poorer therapeutic outcomes including decreased quality of life and survival. To assess reach and impact of a free, opt-out, telephone-based tobacco cessation program for thoracic cancer center patients. Observational study. Comprehensive Cancer Center in Western New York. Current or recent (within past 30 days) tobacco-using thoracic cancer center patients referred to a tobacco cessation support service between October 2010 and October 2012 at a Comprehensive Cancer Center (n = 942/1313 referrals were eligible for cessation support). A free, opt-out, telephone-based cessation service that was implemented as standard of care. Cessation specialists had patient-guided conversations that assessed readiness to quit; methods used in the past provided cessation strategies and worked to set up a quit date. There was an average of 35.9 days between referral and first contact. Program reach (referral and participation rates) and impact (as self-reported cessation outcomes measured twice after referral). Of 942 patients, 730 (77.5%) referred to and called by a tobacco cessation service participated in at least 1 cessation support call, of which 440 of 730 (60.3%) were called for follow-up and 89.5% (394/440) participated. In total, 20.2% (69/342) of current smokers at referral reported at least 7-day abstinence at follow-up. Among current smokers at referral and first contact, being married (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.01-4.18) and having a lower Eastern Cooperative Oncology Group (ECOG) performance score (OR = 4.05; 95% CI, 1.58-10.39) were associated with quitting at follow-up, after controlling for demographic, clinical, and health behavior characteristics. Our results demonstrate that 78% of thoracic cancer center patients, if contacted, participated at least once in this cessation support service; for current smokers at referral and first contact, being married and having a lower ECOG performance score were associated with self-reported quitting at follow-up. Other organizations may find our results useful while implementing a systematic way to identify tobacco-using patients as part of routine care and to improve available cessation support services.

Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities - United States, 2016.

Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).

Cluster-Randomized Trial of Clinical Pharmacist Tobacco Cessation Counseling Among Patients with Cardiovascular Disease.

Optimal management of patients with cardiovascular disease (CVD) includes evaluation of risk factors using a team-based approach. Tobacco use often receives less attention than other CVD risk factors; therefore, utilization of nonphysician health care providers may be valuable in addressing tobacco use. The purpose of this trial was to assess the impact of brief, structured, telephone tobacco cessation counseling (BST) delivered by clinical pharmacists on tobacco cessation attempts compared to usual care. The BST consisted of 1 to 5 minutes discussing 3 key counseling points, including a recommendation to quit and education about cessation aids. This was a cluster-randomized trial of tobacco-using patients with CVD who were enrolled in a clinical pharmacist-managed, physician-directed, CVD disease state management service. Clinical pharmacists were randomized to provide usual care (control) or BST (intervention) to their tobacco-using patients during a 4-month period. Patients were surveyed 3 months later to assess their tobacco cessation attempts, use of tobacco cessation aids, and self-reported cessation. One hundred twenty patients were enrolled. Subjects were predominately white males, aged ≥65 years, with a history of myocardial infarction. One hundred and four subjects completed the follow-up survey. No differences were detected between the 36.2% and 38.6% of control and intervention subjects, respectively, reporting a tobacco cessation attempt (P=0.804) or in the other outcomes (all P>0.05). A BST delivered by clinical pharmacists may not adequately affect patient motivation enough to increase tobacco cessation attempts in tobacco-dependent patients with CVD. Future research is needed to evaluate other team-based strategies that can decrease tobacco use in patients with CVD.

Readiness of primary care clinicians to implement lung cancer screening programs.

We examined the readiness of primary care clinicians to implement lung cancer screening programs in their practice settings in light of recent policy changes in the U.S.Attendees of two large continuing medical education events in Texas held in October and November of 2014 completed surveys about their current lung cancer screening practices and implementation needs.Surveys were completed by 350 participants (57.2% of registered attendees). Although 89.5% of participants routinely screened their patients for tobacco use, only 10.1% had a formal lung cancer screening program in their practice. More than half (56.0%) planned to refer eligible patients for lung cancer screening, 35.6% were not sure, and 8.3% did not plan to refer. Priority areas for implementing lung cancer screening programs in their settings included 1) greater clarity about coverage by private insurance and Medicare, 2) information about available screening centers offering low-dose computed tomography, 3) patient education and shared decision-making tools, 4) implementation toolkits and training for clinic staff, 5) integrating screening programs in electronic health records, and 6) more clarity about clinical guidelines.Practical needs related to identifying eligible patients, referral to screening centers, and tools for shared decision-making must be addressed before lung cancer screening can be implemented on a national scale.

Increased evidence-based tobacco treatment through Oklahoma hospital system changes.

Oklahoma hospitals admit approximately 120,000 tobacco users each year, many for diseases resulting from tobacco use. To describe a unique partnership between the Oklahoma Hospital Association and Oklahoma Tobacco Settlement Endowment Trust to reach more tobacco users through the implementation of sustainable health system changes within hospitals and clinics to integrate an evidence-based tobacco treatment protocol for all tobacco-using patients. The Oklahoma Hospital Association tobacco-cessation model included (1) identifying all tobacco-using patients; (2) assessing addiction level and readiness to quit; (3) prescribing medications to manage withdrawal while in hospital; and (4) proactively faxing a referral to the Oklahoma Tobacco Helpline for all patients ready to quit. Helpline registration patterns and characteristics of fax-referred hospitalized patients were tracked for the 4 years of the initiative (2009-2013); data were analyzed in 2013. Twenty-one hospitals and 12 clinics participated in the initiative. Fax referrals to the Helpline increased by >150% in the first year, from about 600 during the year prior to the implementation of the program (July 2009 to June 2010) to 1,581 from Oklahoma Hospital Association facilities alone in the first year following the launch of the initiative. Nearly 5,600 Oklahoma Hospital Association fax referrals were made during the 4-year study period. About 41% of these referrals resulted in Helpline enrollment (n=2,289). Sustainable, evidence-based tobacco treatment interventions embedded in hospital systems can successfully identify tobacco users and provide effective treatment, including increased proactive Helpline referrals for quit coaching.

Tobacco use and cessation for cancer survivors: an overview for clinicians.

Approximately 30% of all cancer deaths in the United States are caused by tobacco use and smoking. Cancers of eighteen sites have been causally linked to smoking, the most common of which are the lung, head and neck, bladder, and esophagus. While quit rates and quit attempt rates are relatively high shortly after a cancer diagnosis, the recidivism rates are also high. Therefore, screening, treating, and preventing relapse to tobacco use is imperative among patients with and survivors of cancer. To date, research has consistently shown that a combination of pharmacologic and behavioral interventions is needed to achieve the highest smoking cessation rates, with a recent emphasis on individualized treatment as a most promising approach. Challenges in health care systems, including the lack of appropriate resources and provider training, have slowed the progress in addition to important clinical considerations relevant to the treatment of tobacco dependence (eg, a high degree of comorbidity with psychiatric disorders and other substance use disorders). However, continued tobacco use has been shown to limit the effectiveness of major cancer treatments and to increase the risk of complications and of developing secondary cancers. The authors recommend that oncology providers screen all patients for tobacco use and refer users to specialized treatment when available. Alternatively, oncology clinicians can provide basic advice on tobacco use cessation and pharmacotherapy and/or referral to outside resources (eg, quitlines). Herein, the authors summarize the current knowledge on tobacco use and its treatment, with a focus on the related available evidence for patients with and survivors of cancer.

Factors influencing tobacco use treatment patterns among Vietnamese health care providers working in community health centers

BackgroundAlmost half of adult men in Viet Nam are current smokers, a smoking prevalence that is the second highest among South East Asian countries (SEAC). Although Viet Nam has a strong public health delivery system, according to the 2010 Global Adult Tobacco Survey, services to treat tobacco dependence are not readily available to smokers. The purpose of this study was to characterize current tobacco use treatment patterns among Vietnamese health care providers and factors influencing adherence to guideline recommended tobacco use screening and cessation interventions.MethodsA cross sectional survey of 134 health care providers including physicians, nurses, midwives, physician assistants and pharmacists working in 23 community health centers in Viet Nam.Results23% of providers reported screening patients for tobacco use, 33% offered advice to quit and less than 10% offered assistance to half or more of their patients in the past three months. Older age, attitudes, self-efficacy and normative beliefs were associated with screening for tobacco use. Normative beliefs were associated with offering advice to quit. However in the logistic regression analysis only normative beliefs remained significant for both screening and offering advice to quit. Over 90% of providers reported having never received training related to tobacco use treatment. Major barriers to treating tobacco use included lack of training, lack of referral resources and staff to support counseling, and lack of patient interest.ConclusionsDespite ratifying the FCTC, Viet Nam has not made progress in implementing policies and systems to ensure that smokers are receiving evidence-based treatment. This study suggests a need to change organizational norms through changes in national policies, training and local system-level changes that facilitate treatment.

Practical Counseling and Communication Strategies: Tobacco Cessation

OPEN ACCESSJanuary 28, 2013Practical Counseling and Communication Strategies: Tobacco Cessation Laura Romito, DDS, MS, Lorinda Coan, Arden Christen Laura Romito, DDS, MS Indiana University School of Dentistry Google Scholar More articles by this author , Lorinda Coan Indiana University School of Dentistry Google Scholar More articles by this author , Arden Christen Indiana University School of Dentistry Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9324 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractTobacco use is a primary cause of preventable morbidity and mortality worldwide. Therefore, it is critical that health care providers address the issue of tobacco use and dependence with their patients. The purpose of this module is to explain and demonstrate the application of communication techniques for patient tobacco cessation counseling. This presentation contains three formative learning activities and several video clips demonstrating communication techniques involved in tobacco cessation counseling interventions. It also includes a slide script, reference list, and instructor's guide, as well as a sample 10-item assessment based on the content of the module. The content of this module is significant for learners about to enter the clinical setting, or already involved in patient care because they can readily apply the material to a clinical encounter. Health professions students and practitioners are often reticent to discuss tobacco use because they lack the time and skills to do so or are afraid of offending patients. After completion of the module, the student should be better prepared to communicate with patients in a more effective manner when discussing tobacco use and dependence and attempting to encourage a behavior change (tobacco cessation). The module presents evidence-based behavioral and communication strategies and techniques which have been shown to be effective in tobacco counseling. As such, it is anticipated that they may be more likely to engage their tobacco-using patients in education and cessation counseling. Educational Objectives By the end of the module, the learner will be able to: Explain the principles of practical counseling and motivational interviewing as applied in tobacco cessation counseling.Explain the stages of Health Behavior Change and identify a patient's current stage of change.Explain the 5As tobacco dependence intervention and provide examples of patient-practitioner communication for each step of the process.Demonstrate the communication strategies involved in motivational interviewing, and practical counseling for tobacco cessation. ReferencesChamberlain P., Patterson G. R., Reid J. B., Forgatch M. S., & Kavanagh K.Observation of client resistance. Behavior Therapy. 1984;15: 144–155. http://dx.doi.org/10.1016/S0005-7894(84)80016-7Google ScholarFiore MC, Baker TB. Clinical practice. Treating smokers in the health care setting. N Engl J Med.2011. Sep 29;365(13):1222–31. http://dx.doi.org/10.1056/nejmcp1101512Medline, Google ScholarFiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service, 2008.Google ScholarMiller WR, & Rollnick S. Ten Things That Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy. 2009; 37(2): 129–140. doi: 10.1017/S1352465809005128. http://dx.doi.org/10.1017/S1352465809005128Medline, Google ScholarMiller WR., Rollnick S., Butler C.Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing), 2007. Guilford Press. New York, New York.Google ScholarMiller WR, Rollnick S. Motivational Interviewing: Preparing people to change addictive behaviors. 1991. Guilford Press. New York, New York.Google ScholarProchaska J.O., DiClemente C.C.Toward a Comprehensive Model of Change. In Miller W.R. & Heather N. (Eds.), Treating Addictive Behaviors: Processes of Change 1986. pp. 3–27. New York: Plenum Press. http://dx.doi.org/10.1007/978-1-4613-2191-0_1Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: INSTRUCTOR GUIDE.doc BOHC Toolkit.pdf ASSESSMENT.docx Slide Script.docx Practical Counseling and Communication Strategies — Tobacco Cessation.pptx REFERENCES.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2013 Romito et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsCounselingCommunicationMotivational InterviewingBuilding Oral Health Capacity (BOHC) CollectionEducationTobacco Use Cessation Disclosures None to report. Funding/Support None to report. Loading ...

Feasibility of a Computerized Clinical Decision Support System for Treating Tobacco Use in Dental Clinics

This study tested the feasibility of using information technology to improve dentists' adherence to the Treating Tobacco Use and Dependence Clinical Practice Guidelines by offering a web-based computer-mediated clinical decision support system (CDSS) for tobacco use treatment in dental clinics. The authors developed a CDSS tool, deployed the software in one of New York University College of Dentistry's general practice clinics, interviewed associate student dentists, and reviewed a random selection of patients' charts to determine if, after implementation, there were changes in tobacco use screening and referral to treatment. Students reported that the CDSS was easy to use, increased their efficiency, and provided better quality of evidence than was available prior to the intervention. Chart reviews demonstrated that, after CDSS implementation, patients in the target clinic were significantly more likely to be screened for tobacco use (<0.001), and tobacco-using patients were more likely to be advised (<0.001), referred to the state's Quit Line (<0.001), and prescribed nicotine replacement therapy (0.035). This study concludes that it is feasible to implement a CDSS for tobacco use treatment in dental clinics. The CDSS is a promising method for improving adherence to tobacco use treatment guidelines and warrants further study.

A qualitative examination of the positive and negative consequences associated with going tobacco-free in substance abuse treatment: the NY State experience.

In 2008, the New York State (NYS) Office of Alcoholism and Substance Abuse Services (OASAS) required all state-funded or state-certified addiction treatment programs to be 100% tobacco-free. The regulation prohibits the use or possession of all tobacco products by patients, employees, volunteers, and visitors. This includes exterior grounds and vehicles owned, leased, or operated by the facility. Addiction treatment centers are also required to screen patients for tobacco use and incorporate tobacco cessation into treatment programming. This study examined the perceived effectiveness of this regulation from the perspective of counselors and clinical supervisors. Qualitative data were collected from 261 counselors and 80 clinical supervisors working in 50 free-standing substance abuse treatment programs throughout NYS. Questions asked about the perceived positive and negative consequences of the OASAS regulation approximately 1 year after its implementation. The findings indicate mixed reactions to the regulation. A wide range of positive and negative consequences were identified, which were generally consistent across counselor and clinical supervisor reports. The most commonly reported positive outcomes were positive behavior change (e.g., less smoking, increased intentions to quit) and increased awareness about smoking (e.g., dangers, available assistance to quit). The most commonly reported negative consequences were reinforcing addict behaviors among patients (e.g., lying, "dealing" cigarettes) and enforcement problems (e.g., difficulty enforcing, policing for compliance). Findings have implications for the implementation of tobacco-free regulations in substance abuse treatment programs.

Effectiveness of pictorial warnings on tobacco packs: Hospital-based study findings from Vikarabad

Background:Recently, the Indian government introduced pictorial warnings that occupy an important position among different tobacco control initiatives. A study was done to evaluate the opinion of tobacco consumers on the implementation of pictorial warnings on tobacco packs and to compare the effectiveness of these warnings among individuals of varying socioeconomic status.Materials and Methods:This was a hospital-based study carried out among the tobacco-using patients attending the Outpatient Department of Sri Sai College of Dental Surgery, Vikarabad, Andhra Pradesh. The number of participants in the survey was 111. Questionnaire method was used for collecting the data.Results:Among the 111 participants, maximum number of study participants using any form of tobacco products were in the age group of 15–24 years, and higher consumption was seen among the lower socioeconomic strata. 88.3% of the participants strongly agreed on strengthening the warnings while 73.2% of them felt that pictures on tobacco packs should occupy 100% of the display area to make them more effective.Conclusion:These results suggest that policy makers should not be reluctant to introduce stronger and vivid pictures.

Abstract B36: Respiratory symptoms after smoking cessation among college students

Abstract Introduction: Data about respiratory symptoms and lung function are available for middle-aged adults post-cessation. Similar evidence is lacking for those aged 18 to 24 years. This study addresses that gap. Procedures: This report is a secondary analysis of data derived from two randomized controlled smoking cessation trials among a subset of 18- to 24-year-old college students. Data from both studies were combined regardless of treatment condition. Some participants received an active intervention while controls were provided with self-help smoking materials. Self-reported respiratory symptoms were longitudinally analyzed in 273 quitters. The change in respiratory symptoms was calculated by subtracting the final scores from those at baseline. Summary of Data: The respiratory symptoms of continued smokers were compared to the quitters at the final visit using t-tests. Significant improvements in respiratory symptoms were found among quitters for morning cough, (p =.002) daytime cough, (p =.007), and chest pain (p =.007). Statement of Conclusions: Young individuals rarely respond to quit-smoking motivation based on long-term health consequences, such as risk of tobacco-attributable cancers. A more appropriate motivational strategy for young adults appears to be emphasizing the existing respiratory symptoms caused by smoking. Clinicians are encouraged to detect and discuss respiratory symptoms with their young tobacco-using patients as a part of smoking cessation counseling and treatment. Highlighting post-cessation reduction in these symptoms is likely to reinforce continued abstinence. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B36.

Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond Education

Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers' documentation of cessation advice to tobacco users. The intervention was conducted at three emergency departments (EDs) and four clinics at a community-based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco-using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post-wrap-around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post-wrap-around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson's chi-square cell frequency were used to analyze and compare sites. Fisher's exact test was used to compare those tests with a chi-square cell frequency of five or less. The statistical tests used for pre-/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance. Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post-wrap-around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted. This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions.

Providers' experiences caring for adolescents who smoke cigarettes.

To describe providers' experiences screening for and counseling adolescent patients who smoke cigarettes. Eight qualitative focus groups were conducted with 51 health care providers in primary care settings. Focus groups were video- and audiotaped; tapes were transcribed for coding by an interdisciplinary team using the constant comparative method. Providers reported experiences screening for and managing adolescent patients who reported smoking cigarettes. Providers expressed confidence in their ability to screen adolescent patients for tobacco use, particularly as part of regularly scheduled preventive and medical visits. Providers reported difficulty balancing screening for smoking with their concern for maintaining rapport with their adolescent patients. In addition, providers reported that adolescent smoking patterns differed from those of adults, and consequently, providers were not certain at what level of smoking an adolescent required intervention. Furthermore, providers were unclear regarding what interventions were recommended for and effective with adolescents. Providers are interested in adolescent evidence-based screening methods and cessation interventions that are supportive of a nonjudgmental and empathic approach to caring for adolescent smokers, particularly those with irregular and situational smoking patterns.

A survey of oral and maxillofacial surgeons' tobacco-use–related knowledge, attitudes and intervention behaviors

Oral and maxillofacial surgeons (OMS) treat oral disease attributable to and/or complicated by tobacco use and have unique opportunities to treat patients with tobacco dependence. This study assessed the tobacco-use-related knowledge, attitudes and intervention behaviors of OMS in the United States. The authors mailed a 38-item survey to members of the American Association of Oral and Maxillofacial Surgeons (N = 5,234). More than one-half (52.4 percent) of recipients responded; 21.9 percent reported that they assisted tobacco-using patients most of the time; 14.5 percent reported having an awareness of the U.S. Public Health Service Clinical Practice Guideline; and 8.7 percent had received training in treating tobacco dependence. Most respondents (90.1 percent) identified tobacco users and 63.3 percent advised tobacco users to quit; less than 15 percent assisted most patients with various interventions. Most respondents did not view providing tobacco treatment as their professional responsibility. Self-efficacy ratings were low, as was perceived treatment effectiveness. Providers with training performed more interventions, perceived interventions to be more effective, reported greater self-efficacy and perceived fewer barriers than did those without training. Most respondents (71.4 percent) were interested in improving their skills in this area. Being female and having received training in treating patients with tobacco dependence predicted a higher frequency of providing interventions. Current tobacco use by providers predicted a lower frequency of providing interventions. OMS provide interventions for tobacco use at an unacceptably low rate but report that they desire to improve their skills in this area. Training is associated with a higher frequency of intervention behaviors. Training is likely to be well-received and to increase the frequency with which dentists provide treatment for tobacco dependence.

Resolution of Oral Lesions After Tobacco Cessation

Dentists and other health care professionals are familiar with the impact of tobacco on oral and general health. However, oral health care professionals do not often provide tobacco-cessation counseling to their patients, thus reflecting a significant disconnect between research and clinical practice. This report demonstrates the benefits of tobacco cessation in resolving oral lesions and improving overall periodontal and oral health. A 51-year-old white male presented to the University at Buffalo, School of Dental Medicine clinic requesting an oral and periodontal examination as part of a presurgical protocol prior to cardiac surgery. A review of the patient's history from a health questionnaire revealed that he was using smokeless tobacco every day. An oral examination revealed several white lesions (5 x 10 mm) on the maxillary right and left labial mucosa. The patient was provided with tobacco-cessation counseling as well as oral hygiene instructions and professional dental prophylaxis. An oral examination 2 weeks after tobacco cessation revealed complete resolution of the oral lesions and overall improvement of periodontal and oral health. Although the findings presented in this article are based only on a single case report, the improvement in the patient's oral health after cessation of tobacco use was dramatic and reinforces the belief that tobacco-cessation counseling should be a routine component of the standard of care for tobacco-using patients.