Changes in smoking prevalences among health care professionals from 2003 to 2010-2011

Arab male physicians' perceptions about their own smoking behaviors: a qualitative study

BACKGROUND

Smoking remains the leading preventable cause of disease, disability, and death worldwide. Although physicians have high levels of health literacy with awareness of the consequences of smoking and their essential role in smoking cessation of patients, some physicians continue to smoke. Rates of smoking among Arab male physicians are high. This study aimed to gain insights into Arab male physician's perceptions of their own smoking behaviors and their professional role in health promotion.

METHODS

Using purposive sampling, we recruited 25 Arab male physicians working in hospital and community clinic settings who currently smoke. Semi-structured, hour-long, interviews were held during January-June 2022. We then performed a thematic analysis of the interview data.

RESULTS

The analysis revealed three categories, two sub-categories, and 15 emerging themes. The category 'Antecedents: prior to becoming a physician' revealed the themes: smoking experience during adolescence; social and ethnic culture; stress during medical studies; and on & off periods of quitting smoking. The category 'Physicians' perception of smoking' was sorted into two sub-categories: (1) Personal aspects, including the themes 'relaxation from stress', 'self-compensation', 'addiction', and 'enjoyable experience', and (2) Professional aspects, including the themes 'lack of knowledge about cessation', 'inadequate workplace support', 'motivation to consult patients', and 'awareness of their role as primary care physicians'. The category'Impacts' revealed the themes 'personal health and well-being', 'professional competence', and 'professional image in public'.

CONCLUSIONS

This study provides an in-depth understanding of the personal, socio-cultural, and professional aspects of the phenomenon of Arab male smoking physicians from their perspective. Based on this information, we recommend developing programs that support and empower all physicians to cope better with their personal and professional stress as well as instituting programs that will provide all physicians with specific knowledge and skills related to smoking cessation. These programs should improve the ability of physicians to serve as positive role models for their patients for preventing and ceasing smoking, thus enhancing the image of the medical profession and, most importantly, improving the health of the public.

Predictors of Substance Use Risk in Nurse Anesthetists

BACKGROUND

Certified registered nurse anesthetists (CRNAs) are exposed daily to highly addictive substances and stressful work environments, placing them at risk for substance use disorders (SUDs). Previous research, which is scarce, indicated that drugs of choice were opioids and propofol. Therefore, the purpose of this study was to investigate predictors of SUD risk using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test.

METHOD

From June to July 2020, an online survey was sent via the American Association of Nurse Anesthesiology Research Survey Service to 3,000 CRNAs with a response of approximately 225 members.

RESULTS

CRNAs were found to be at a moderate risk for SUDs in the following categories: 10.27% for tobacco, 23.56% for alcohol, and 6.28% for cannabis. Regression analysis by substance category includes robust, differing models in this homogeneous sample. Predictors for all three models include a collection of demographic variables, religiosity, anxiety, difficulties due to anxiety, depression, substance use history, contact with the American Association of Nurse Anesthesiology Peer Assistance Program, and organizational support.

CONCLUSION

Over 10% of CRNAs are at risk for developing tobacco use disorder, and almost one quarter of those surveyed are at a moderate risk for developing alcohol use disorder. These data are of concern and may indicate a shift of preferred substances used by CRNAs from controlled substances to alcohol.

Tobacco use and related behaviors among staff and students in a university hospital: A large cross-sectional survey

INTRODUCTION

Smoking prevalence in the overall population in France was 27% in 2017. There are few data about smoking prevalence in hospital workers. The aim of this study was to assess prevalence of current smoking in student and staff populations at Lyon University Hospital. Secondary objectives were to identify main variables associated with current smoking and willingness to quit.

METHODS

We designed a single center, cross-sectional survey, using printed questionnaires. During one day, all registered staff and students were surveyed. We used optical reading to extract information from questionnaires. We performed univariate and multivariate analysis adjusted on most relevant factors.

RESULTS

We analyzed 9712 questionnaires. The participating rates were high: 40.6% in the student cohort and 51.5% in the staff cohort. The proportion of current cigarette users was 26% in students and 25% in staff. In multivariate analysis, current smoking was significantly associated with: younger age, male sex, occupation type (e.g. logistical staff, and paramedical students), overnight work, and e-cigarette use. Among smokers, 53% reported a willingness to quit. In multivariate analysis, number of quit attempts, and feeling symptoms from tobacco were associated with willingness to quit.

CONCLUSIONS

Current smoking is less frequent in our cohorts of hospital staff and students than in the general French population. However, there are deep disparities in current smoking prevalence underlining a heterogeneous population. Among smokers, the majority reported a willingness to quit and some predictive factors may help to target this audience.

The Health of Health Care Professionals

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis

AIMS

To gain new insights into the experiences of nurses who smoke and to understand the impact of those experiences on their delivery of smoking cessation interventions.

DESIGN

A meta-ethnographic synthesis.

DATA SOURCES

CINAHL, Embase, MEDLINE, PsychINFO, Web of Science and grey literature databases were searched from their inception to April 2019.

REVIEW METHODS

Meta-ethnography was employed to synthesize findings from included studies. The CASP qualitative checklist was used to appraise the quality of each study, and the GRADE-CERQual approach to appraise review findings. The synthesis is reported in accordance with the eMERGe reporting guidance.

RESULTS

From an initial search outcome of 6,019 citations, 13 studies were included detailing the experiences of 195 nurses who were smokers or ex-smokers. Four main themes were identified beliefs, dissonance, coping mechanisms and workplace policies. An integrated conceptual map was proposed on the basis of findings. Nurses who smoke were aware of tobacco harms and their role in addressing tobacco use, which resulted in experiences of guilt and stigma. Workplace policies played a crucial role in the creation of cognitive dissonance. Nurses used different strategies to cope with dissonance such as rationalizing smoking benefits, hiding their smoking behaviour, denial of smoking risks, and failing to engage with smoking cessation interventions. Some nurses expressed more positive aspirations to cope with their dissonance, including a willingness to quit and to embrace smoking cessation interventions with their patients.

CONCLUSION

Implementing smoke-free policies and supportive interventions targeting nurses' cognitive dissonance may assist them to quit smoking and improve their engagement in smoking cessation practices.

Prevalence of rheumatoid arthritis among hospital workers in the north of Jordan: Preliminary report of a hospital-based cohort study

Background

Rheumatoid arthritis (RA) is the most common autoimmune inflammatory arthritis in adults. Prevalence estimates of rheumatoid arthritis vary in the world. Occupational factors and geographical location might contribute to a higher risk of developing the disease, however the exact etiology remains unknown.

The aim of our study was to estimate the prevalence of RA among hospital workers in the North of Jordan and to compare this prevalence with that in the general population. In addition to describing the characteristics of RA patients.

Methods

The study was performed in two stages; during the first stage a specially designed questionnaire was conducted by trained residents with 2569 hospital workers from 6 government hospitals to identify individuals with RA. Suspected individuals of having RA identified in stage one were invited and examined further by two rheumatologists for confirmation of the diagnosis.

Results

A total of 2569 employees were interviewed; among them 1240 (48.5%) were males and 1318 (51.5%) were females. The mean (SD) age was 34±(8.4) years. In the second stage the diagnosis of RA according to ACR criteria 1987 was confirmed in 8 individuals (2 males and 6 females). Male: Female (M: F) ratio was 1:3 with mean (SD) age 43.38 (7.52) years. The estimated prevalence of RA among hospital workers in the North of Jordan was 8/2569 = 0.00311, 31.1:10.000, 0.31%, (95% confidence interval, 9.6–52.7:10.000).

Conclusion

The prevalence of RA among hospital workers in the North of Jordan is 0.31%, similar to that of other parts of Jordan and neighboring regions.

•

Rheumatoid arthritis is a chronic disabling disease.

•

Data regarding RA in Jordan is very limited. We conducted this study to shed light on how widespread RA.

•

Our study showed similar prevalence of RA in surrounding regions, suggesting influence of environmental and occupational factors.

•

We hope this may help advance patient care and management.

Smoking in nursing students: A prevalence multicenter study

The role of nursing students as future health promoters of healthy behaviors is influenced by their attitude towards smoking. A cross-sectional study using a self-administered survey was performed to analyze smoking prevalence among undergraduate the nursing students who attend nursing faculties in 2 European countries (Spain and Portugal) during academic period 2015 to 2016. A total of 1469 subjects were surveyed (response rate of 79.8%). An 80% of the students were female with a mean age of 21.9 (4.8) years. The overall prevalence of tobacco use was 18.9%, with an average percentage of 16.2% in Portugal and 18.3% in Spain. Statistical significance was observed in relation to smoke and previous studies (16.4% vs 27.1%; P < .001). Only 1.1% of the students reported using electronic cigarette. 15.8% of smokers started smoking while at university with statistical gender and previous studies differences (P < .001). Fagerström and Richmond test showed low nicotine dependence (2.8 ± 2) and moderate motivation to stop smoking (4.9 ± 3), respectively. Smoking prevalence among nursing students was slightly higher than the general European population. For that reason, measures to reduce tobacco use have to be focused on students and university policies on tobacco control should be a challenge in the future.

Tobacco use and attitudes on tobacco control among faculty members of a medical school in Northern Cyprus (tobacco use among medical teachers)

The smoking prevalence of medical faculty members has not been a subject of research as frequently as physicians and medical students. The objective of this study was to determine the status of tobacco use and some attitudes among medical faculty members of a Northern Cyprus university. The data were collected by a questionnaire of 22 questions, developed in compliance with WHO guidelines. The data were analyzed using IBM-SPSS 23.0 with p < .05 evaluated as significant. For this cross-sectional study, 128 members of the 146 academics responded (response rate of 87.7%). Lifetime smoking frequency was 46.9%. Current smokers comprised 21.9% while 7.0% consumed non-cigarette products with overall tobacco use of 26.6%. Of the smokers, 52.9% had started smoking at medical school. Regarding doctors being nonsmoking role models, positive attitudes were expressed significantly more by non-smokers than smokers. Only 33.8% were covering tobacco control in their teaching programs while 86.5% had positive attitudes for comprehensive tobacco control in the curriculum. The medical faculty members had a relatively high frequency of tobacco use and the tobacco issue did not have sufficient content in the education programs. Promisingly, the majority of the medical faculty members were in a supportive attitude for comprehensive tobacco control education.

Smoking behaviour among nurses in Ontario: cross-sectional results from the Champlain Nurses' Study

OBJECTIVE

Nurses comprise the largest professional group within the Canadian health care workforce. We aimed to assess the prevalence and correlates of smoking among nurses.

METHODS

The Champlain Nurses' Study was a multi-centre, observational study that evaluated the physical activity levels and health of hospital-based nurses. Participants completed a series of self-report questionnaires addressing a variety of health indicators including smoking status and smoking history. Multi-level modelling was used to examine variability in smoking status across hospital sites and to identify correlates of current smoking.

RESULTS

A total of 406 nurses, from 14 urban and rural hospitals, were included in this analysis. On average, the nurses were 42.9 (standard deviation (SD), 11.9) years old, had a waist circumference of 78.7 (95% confidence interval (CI): 77.5, 80.2) cm and body mass index of 25.9 (95% CI: 25.3, 26.5) kg/m2, worked in urban hospitals (81.3%), and had either a university bachelor's (46.9%) or college (39.6%) education. Most participants (92.0%) reported that they are not current smokers, 4.0% reported that they currently smoke occasionally, and 4.0% reported that they are current daily smokers. Smokers were more likely to be working in rural hospitals than urban hospitals (34.4% versus 17.4% respectively, p = 0.018), associated with having a higher waist circumference (mean difference = 4.5 (SD, 2.1), p = 0.035), a college but not university education (71.9% versus 36.9%, respectively, p < 0.001), lower scores for the Barriers Specific Self-Efficacy Scale (mean difference = - 9.7 (SD, 4.6), p = 0.038), and higher scores for the Profile of Mood States scale (mean difference = 2.0 (SD, 3.3), p = 0.007). The only correlate that remained statistically significant in the final, multivariate model was marital status; however, this analysis may be underpowered.

CONCLUSIONS

The prevalence of nurse smokers in our population is lower than previous estimates, and consistent with global declines in cigarette smoking. However, smoking was still prominent and associated with several other risk factors. Given the important relationship between smoking and health, and the critical role that nurses play in health care delivery, they should be an important focus for smoking cessation initiatives and other health education initiatives.

Practical nursing students' discursive practices on smoking in Finland

Purpose: Based on focus groups, we analyse how practical nursing students deal with being as smokers and future healthcare workers. The way they justify their smoking is discussed within a group of peers.

Methods: The study has a qualitative design with an inductive approach using focus group interviews (FGIs) for data collection. A total of 29 students were interviewed in five groups of five and one group of four participants.

Results: In the analysis, we found four different discursive practices the students utilized for rationalizing their own smoking and coping with the moral dilemma of smoking in a context of health care where smoking is forbidden: (1) students normalized smoking with references to its prevalence within their social circles, (2) the students asserted that their smoking was under control, (3) students considered themselves responsible smokers, and (4) students identified smoking as a part of their identity.

Conclusion: Training should support the growth of professional identity and address the smoker’s identity right from the start of education. Smokers need special attention in the formulation of professional identity, however, without being stigmatized any further.

Self-rated health and smoking among physicians and general population with higher education in Estonia: results from cross-sectional studies in 2002 and 2014

Background

Poor self-rated health (SRH) and smoking have consistently been shown to be related to mortality. The aim of this study was to explore SRH and smoking among physicians and general population with higher education in Estonia in 2002 and 2014 and to analyse the association of SRH with smoking and sociodemographic factors.

Methods

This study was based on cross-sectional postal surveys among physicians and general population with higher education in Estonia n in 2002 and 2014. Calculation of age-standardized prevalence of SRH and current smoking with 95% confidence intervals (CI) was performed. Multivariate logistic regression analysis was used to measure association between SRH (at-least-good vs less-than good) and smoking status, study year, age group, ethnicity, and marital status. Fully adjusted odds ratios (OR) with 95% CI were computed.

Results

Age-standardized prevalence of at-least-good SRH was 71.3 and 80.6% among male physicians, 68.4 and 83.1% among female physicians, 45.4 and 67.4% among men with higher education, and 44.7 and 63.1% among women with higher education in 2002 and 2014, respectively. Age-standardized prevalence of current smoking was 26.0 and 15.6% among male physicians, 10.2 and 5.9% among female physicians, 38.7 and 22.2% among men with higher education, and 20.9 and 16.4% among women with higher education in 2002 and 2014, respectively. There was no significant gender difference in at-least-good SRH, but prevalence of current smoking was significantly higher among men in both study groups in 2002 and 2014. Compared to year 2002, odds to have at-least-good SRH was higher in 2014 (OR = 1.64; 95% CI 1.16-2.31 among male and OR = 2.36; 95% CI 2.02-2.75 among female physicians, OR = 1.49; 95% CI 1.07-2.07 among men and OR = 2.40; 95% CI 1.84-3.13). Odds to have at-least-good SRH was significantly higher among non-smokers (except female physicians), in the youngest age group, and among Estonians.

Conclusions

This study gave an overview of differences in SRH and smoking between two target groups with higher education in two timepoints highlighting the importance of addressing smoking cessation counselling and health promotion campaigns in the population by different subgroups in Estonia.

Prevalence of tobacco use in healthcare workers: A systematic review and meta-analysis

OBJECTIVES

To estimate tobacco use prevalence in healthcare workers (HCW) by country income level, occupation and sex, and compare the estimates with the prevalence in the general population.

METHODS

We systematically searched five databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 2000 and March 2016 without language restriction. All primary studies that reported tobacco use in any category of HCW were included. Study extraction and quality assessment were conducted independently by three reviewers, using a standardised data extraction and quality appraisal form. We performed random effect meta-analyses to obtain prevalence estimates by World Bank (WB) country income level, sex, and occupation. Data on prevalence of tobacco use in the general population were obtained from the World Health Organisation (WHO) Global Health Observatory website. The review protocol registration number on PROSPERO is CRD42016041231.

RESULTS

229 studies met our inclusion criteria, representing 457,415 HCW and 63 countries: 29 high-income countries (HIC), 21 upper-middle-income countries (UMIC), and 13 lower-middle-and-low-income countries (LMLIC). The overall pooled prevalence of tobacco use in HCW was 21%, 31% in males and 17% in females. Highest estimates were in male doctors in UMIC and LMLIC, 35% and 45%, and female nurses in HIC and UMIC, 21% and 25%. Heterogeneity was high (I2 > 90%). Country level comparison suggest that in HIC male HCW tend to have lower prevalence compared with males in the general population while in females the estimates were similar. Male and female HCW in UMIC and LMLIC tend to have similar or higher prevalence rates relative to their counterparts in the general population.

CONCLUSIONS

HCW continue to use tobacco at high rates. Tackling HCW tobacco use requires urgent action as they are at the front line for tackling tobacco use in their patients.

Medical staff contributions to thirdhand smoke contamination in a neonatal intensive care unit

INTRODUCTION

Non-smoking policies are strictly enforced in neonatal intensive care units (NICUs), which may still become contaminated by thirdhand smoke (THS), posing potential health risks to medically fragile infants. Study aims were to explore contamination routes by characterizing nicotine levels (THS proxy) found on the fingers of NICU medical staff and to assess finger-nicotine correlates.

METHODS

NICU medical staff were surveyed regarding smoking and electronic nicotine devices (ENDS) use/exposure, and household characteristics. Approximately 35% of staff were randomly selected for a finger-nicotine wipe. Three separate quantile regressions modeled percentiles associated with: presence of any finger nicotine, finger-nicotine levels above the median field blank level (i.e. 0.377 ng/wipe), and finger-nicotine levels two times the median blank.

RESULTS

The final sample size was 246 (n=260 approached; n=14 refusals). Over three-quarters (78.5%) reported some exposure to tobacco smoke or ENDS vapor/aerosols. After field-blank adjustments, the median nicotine level (ng/finger wipe) was 0.232 (IQR: 0.021–0.681) and 78.3% of medical staff had measurable finger-nicotine levels. Both being near smoking in friends’/family members’ homes and finger-surface area were related to elevated finger-nicotine levels (p<0.05) in the median blank model.

CONCLUSIONS

Almost four in five NICU staff had measurable finger nicotine, with finger surface area and frequency of reported exposure to tobacco smoke in friends’/family members’ homes emerging as important correlates. Future research will determine the impact of THS on NICU infants. Medical personnel working in a NICU should be cognizant of secondhand smoke and THS, particularly inside friends’/family members’ homes, to reduce potential NICU contamination and infant exposures.

Attitudes, barriers and facilitators to smoking cessation among Central and Eastern European nurses: A focus group study

PURPOSE

Smoking among nurses is a barrier to providing smoking cessation interventions to patients. In Central and Eastern Europe-where tobacco use is the leading cause of preventable death and disease-there is limited knowledge about nurses' attitudes toward cessation interventions. Our aim was to describe the attitudes of nurses who are former and current smokers toward providing cessation interventions to patients as well as explore barriers and facilitators to their own quit efforts.

METHODS

Nine focus groups with 81 nurses (94% females) in five Central and Eastern European countries. Content analysis was used to identify major themes.

RESULTS

Nurses agreed that they should set a good example by not smoking; should be involved in helping patients stop smoking; and needed additional training in tobacco control. Five common themes were identified as barriers to quitting: smoking cues in the environment; presence of smokers in the environment; relapse postpartum; stress and nicotine addiction; and misperceptions about the dangers of smoking. Former smokers reported facilitators to quitting including: seeing the health consequences of smoking among their patients; personal and family health concerns; receiving support from family; and pregnancy.

CONCLUSION

There is a need to build upon nurses' positive attitudes about engaging in smoking cessation interventions with patients to ensure that cessation interventions are standard nursing practice. Future studies should focus on programs that support nurses' quit efforts by addressing barriers to smoking cessation, which will improve their health and patient care.

Nurses' Attitudes toward Intervening with Smokers: Their Knowledge, Opinion and E-Learning Impact

BACKGROUND

Numbering about 90,000, nurses represent the largest group of health care providers in the Czech Republic. Therefore, nurses can make a significant impact in the treatment of tobacco dependence, particularly in applying brief interventions to smokers.

METHODS

During 2014, 279 nurses from the Czech Republic participated in an e-learning education programme consisting of two Webcasts with additional web-based resources about smoking cessation in relation to health and treatment options in daily clinical practice, particularly regarding brief intervention methods. Before viewing the e-learning programme, and three months after viewing it, the nurses completed a questionnaire documenting their interventions with smokers and their knowledge, attitudes and opinions regarding nurses' roles in smoking cessation.

RESULTS

The responses in all of the following categories significantly improved: usually/always asking patients about smoking from 58% to 69% (OR 1.62, CI=1.14-2.29, p=0.007); recommendations to stop smoking from 56% to 66% (OR 1.46, CI=1.03-2.06, p=0.03); assessing willingness to quit from 49% to 63% (OR 1.72, CI=1.23-2.42, p=0.002); assisting with cessation from 21% to 33% (OR 1.85, CI=1.26-2.71, p=0.002); and recommending a smoke-free home from 39% to 58% (OR 2.16, CI=1.54-3.04, p<0.001). The increase in arranging follow-up from 7% to 10% did not constitute a statistically significant improvement, however, this finding is understandable in relation to the status of nurses in the Czech Republic. However, nurses' confidence in helping smokers to quit smoking, their senses of responsibility and determining the appropriateness of these interventions remains inadequate.

CONCLUSION

The nurses' brief intervention skills improved significantly after the completion of the e-learning programme, even though reservations remain among this group. The systematic education of nurses aimed at smoking cessation intervention and analyzing their motivation for treatment may contribute to improved nursing care, and thus lead to a reduction of smoking prevalence in the general population.

Nurses' Perceptions of Self as Role Models of Health

This study purposed to determine the relationship between nurses' personal health practices and their perceptions of themselves as role models for health promotion, and assess the relationship of personal and professional characteristics both on perception of self as role model and on the practice of healthy behaviors. In this study of 804 Tennessee registered nurses, 4% report smoking, 24.9% drink alcohol, 34% are overweight, and 30% are obese. Approximately 70% do not meet the weekly physical activity recommendations of 150 min, and 36.2% follow guidelines for a healthy diet only 50% of the time or less. There were significant correlations between following a healthy diet or physical activity and the Self as a Role Model of Health Promotion (SARMHEP) scores. Based on the regression analysis, working in an acute care or ambulatory setting negatively affected the SARMHEP, as opposed to age and sex having a positive effect on the SARMHEP score.

Cigarette Smoking Prevalence Among Adults Working in the Health Care and Social Assistance Sector, 2008 to 2012

OBJECTIVE

The primary objective of this study was to estimate current smoking among workers in the health care and social assistance sector.

METHODS

We analyzed the 2008 to 2012 National Health Interview Survey data for adults (age 18 years or more) working in health care and social assistance sector who reported current cigarette smoking.

RESULTS

Of the approximately 18.9 million health care and social assistance workers, 16.0% were current cigarette smokers. Smoking prevalence was highest in women (16.9%) and among workers: age 25 to 44 years (17.7%); with a high school education or less (24.4%); with income less than $35,000 (19.5%); with no health insurance (28.5%); in the nursing and residential care facilities (26.9%) industry; and in the material recording, scheduling, dispatching, and distributing (34.7%) occupations.

CONCLUSIONS

These findings suggest that specific group of workers in the health care and social assistance sector might particularly benefit from cessation programs and incentives to quit smoking.

General Practitioners and Dentists: A Call for Action Against Tobacco

INTRODUCTION

To investigate the frequency of advice to quit smoking received by the Italian population from general practitioners (GP) and dentists, we analyzed a cross-sectional study.

METHODS

A face-to-face survey was conducted in 2014 on 3052 individuals, representative of the general Italian population aged 15 years or more.

RESULTS

During the previous year, 89% of individuals (82% of smokers) reported that they had visited a GP while 71% (67% of smokers) had visited a dentist. Among smokers, 25% reported that they had received advice to quit smoking from their GP, and 26% from their dentist. Advice by GPs was less frequently received by smokers with higher education (multivariate odds ratios (OR) were 0.48 for intermediate and 0.38 for high as compared to low education), and more frequently by heavy smokers (≥15 cigarettes/day; OR = 1.78), those with intention to quit (OR = 2.59), with previous quit attempts (OR = 2.09), and those aware of the existence of smoking cessation services (OR = 1.59). Advice by dentists was more frequently received by smokers aged 25-44 years (OR = 3.55 compared to those aged 15-24) and those with an intention to quit (OR = 2.46). Among Italian current smokers, 32% reported that their GP and 17% that their dentist was a current smoker. The corresponding figures among young smokers were 40% and 26%, respectively.

CONCLUSION

Healthcare providers have the potential to become a key reference point in the fight against smoking. However, before acting, GPs and dentists should set a good example: those who smoke should urgently quit or at least refrain from smoking during working hours.

IMPLICATIONS

GPs and dentists, reaching the large majority of Italian smokers, can make a major contribution in the fight against tobacco. Future studies are needed to investigate possible reasons of the apparently high smoking prevalence among GPs, in order to develop tailored smoking cessation interventions for healthcare providers.

Commentary on a smoke-free medical campus in Jerusalem: data for action

Over the past 30 years, Israel has made great progress in attitudes and practices about smoking; probably nothing else has contributed more to the health of its population. Yet, a recent survey about a non-smoking ban at an Israeli health sciences campus found incomplete enforcement. In addition, smoking rates among health sciences students, though lower than the general population, were higher than might be expected based on rates in other developed countries. Whether the ban is—as the authors speculate—“an intrusive life style intervention” or a justifiable public health intervention, cuts to the heart of the history of tobacco control efforts and their opposition by the tobacco industry. Despite concerns that the Israeli population is not ready to accept smoke-free bans, experience in other countries suggests otherwise.

Lifestyles of nursing students from a Colombian public university

OBJECTIVE

To assess the lifestyles of nursing students from a Colombian public university.

METHODS

A cross-sectional study was conducted in 2014. 380 students answered by self-reporting the adapted version in Spanish of FANTASTIC Lifestyles Assessment Questionnaire of Wilson and Ciliska.

RESULTS

Lifestyles were poor in 9.2%, fair in 31.3%, good in 53.7%, and excellent in only 5.8% of the participants. Statistically-significant differences of the total mean score were not found when comparing with gender, age group, and course year, but were detected in two domains by gender: a) physical activity (higher score in men) and b) cigarette smoking (higher score in women).

CONCLUSION

An important proportion of our nursing students has inadequate lifestyles, which means deferred risks for the development of chronic diseases. Universities should promote the training of the future professionals in nursing with knowledge and skills aimed at healthy lifestyles.

Tobacco Use Among Healthcare Workers: Impact of a Worksite Policy Change at a US Military Community Hospital

Introductions:Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.

Aims/Methods:Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.

Results:Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.

Conclusions:Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

Historical Perspectives of the Causation of Lung Cancer: Nursing as a Bystander

Lung cancer is the leading cause of cancer deaths worldwide. Less-known forces are involved in the etiology of lung cancer and have relevant implications for providers in ameliorating care. The purpose of this article is to discuss theories of causation of lung cancer using historical analyses of the evolution of the disease and incorporating related explanations integrating the relationships of science, nursing, medicine, and society. Literature from 160 years was searched and Thagard's model of causation networks was used to exhibit how nursing and medicine were significant influences in lung cancer causation theory. Disease causation interfaces with sociological norms of behavior to form habits and rates of health behavior. Historically, nursing was detrimentally manipulated by the tobacco industry, engaging in harmful smoking behaviors, thus negatively affecting patient care. Understanding the underlying history behind lung cancer causation may empower nurses to play an active role in a patient's health.

Feasibility of using an epigenetic marker of risk for lung cancer, methylation of p16, to promote smoking cessation among US veterans

Introduction

Providing smokers feedback using epigenetic markers of lung cancer risk has yet to be tested as a strategy to motivate smoking cessation. Epigenetic modification of Rb-p16 (p16) due to tobacco exposure is associated with increased risk of developing lung cancer. This study examined the acceptance of testing for methylated p16 and the understanding of test results in smokers at risk for development of lung cancer.

Methods

Thirty-five current smokers with airways obstruction viewed an educational presentation regarding p16 function followed by testing for the presence of methylated p16 in sputum. Participants were offered smoking cessation assistance and asked to complete surveys at the time of enrolment regarding their understanding of the educational material, perception of risk associated with smoking and desire to quit. Participants were notified of their test result and follow-up surveys were administered 2 and 10 weeks after notification of their test result.

Results

Twenty per cent of participants had methylated p16. Participants showed high degree of understanding of educational materials regarding the function and risk associated with p16 methylation. Sixty-seven per cent and 57% of participants with low-risk and high-risk test results, respectively, reported that the information was more likely to motivate them to quit smoking. Smoking cessation rates were similar between methylated and non-methylated participants.

Conclusions

Testing for an epigenetic marker of lung cancer risk is accepted and understood by active smokers. A low-risk test result does not decrease motivation to stop smoking.

Trial registration number

NCT01038492.

Risk factors of smoking among health care professionals

BACKGROUND

Health care professionals (HCPs) play a vital role at various levels of smoking cessation programs to reduce tobacco use in general populations. However, their smoking habits may limit their ability to intervene with their patients who smoke.

AIMS

To determine prevalence rates of current smoking and examine sociodemographic and work-related factors associated with current smoking among HCPs.

METHODS

A statewide survey was conducted in a representative sample of 4 groups of HCPs, physicians, nurses, respiratory therapists, and occupational therapists, with active licenses in Texas in 2003. Weighted prevalence estimates of current smoking rates were computed. Survey logistic regression analysis was used to investigate associations between individual characteristics and current smoking.

RESULTS

There were 3600 HCPs included in the analysis. The overall prevalence of current smoking was 9% with the highest prevalence (16%) recorded among respiratory therapists and the lowest prevalence (3%) recorded among physicians. In the multivariable logistic regression analysis non-Hispanic white HCPs were almost 4 times as likely to be current smokers (adjusted odds ratio= 3.95, 95% confidence interval = 1.24-12.59) and those working for 50 hours or more per week were twice as likely to be current smokers (adjusted odds ratio = 2.07, 95% CI = 1.20-3.57). Compared with physicians, all other HCP groups had significantly greater odds of currently smoking. HCPs who were female and resided or worked in rural settings had higher smoking rates in univariable analysis only (P < .05).

CONCLUSIONS

Smoking is prevalent among certain HCP groups. Working long hours was identified as an important occupational factor associated with current smoking.