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Lyons A, Bhardwaj N, Masalkhi M, Fox P, Frazer K, McCann A, Syed S, Niranjan V, Kelleher CC, Kavanagh P, Fitzpatrick P. Specialist cancer hospital-based smoking cessation service provision in Ireland. Ir J Med Sci 2024; 193:629-638. [PMID: 37740109 PMCID: PMC10961275 DOI: 10.1007/s11845-023-03525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND While much progress has been made in reducing tobacco use in many countries, both active and passive smoking remain challenges. The benefits of smoking cessation are universally recognized, and the hospital setting is an ideal setting where smokers can access smoking cessation services as hospital admission can be a cue to action. Consistent delivery of good quality smoking cessation care across health services is an important focus for reducing the harm of tobacco use, especially among continued smokers. AIMS Our objective was to document the smoking cessation medication and support services provided by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. METHODS A cross-sectional survey based on recent national clinical guidelines was used to determine smoking cessation care delivery across eight specialist adult cancer tertiary referral university hospitals and one specialist radiotherapy center. Survey responses were collected using Qualtrics, a secure online survey software tool. The data was grouped, anonymized, and analyzed in Microsoft Excel. RESULTS All responding hospitals demonstrated either some level of smoking cessation information or a service available to patients. However, there is substantial variation in the type and level of smoking cessation information offered, making access to smoking cessation services inconsistent and inequitable. CONCLUSION The recently launched National Clinical Guideline for smoking cessation provides the template for all hospitals to ensure health services are in a position to contribute to Ireland's tobacco endgame goal.
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Affiliation(s)
- Ailsa Lyons
- Department of Preventive Medicine and Health Promotion, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland.
| | - Nancy Bhardwaj
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Mouayad Masalkhi
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Patricia Fox
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Amanda McCann
- UCD Conway Institute of Biomolecular and Biomedical Research and UCD School of Medicine, College of Health and Agricultural Science (CHAS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Shiraz Syed
- Department of Preventive Medicine and Health Promotion, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Vikram Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Cecily C Kelleher
- Department of Preventive Medicine and Health Promotion, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Paul Kavanagh
- Health Service Executive Tobacco Free Ireland Programme, Strategy and Research, 4th Floor, Jervis House, Jervis Street, Dublin 1, D01 W596, Ireland
| | - Patricia Fitzpatrick
- Department of Preventive Medicine and Health Promotion, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
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Rogova A, Leal IM, Britton M, Chen TA, Lowenstein LM, Kyburz B, Casey K, Skeene K, Williams T, Reitzel LR. Implementing a tobacco-free workplace program at a substance use treatment center: a case study. BMC Health Serv Res 2024; 24:201. [PMID: 38355470 PMCID: PMC10865640 DOI: 10.1186/s12913-024-10629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND People with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center. METHODS This study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice. RESULTS Staff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center. CONCLUSIONS Substance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.
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Affiliation(s)
- Anastasia Rogova
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America.
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America.
| | - Isabel Martinez Leal
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Maggie Britton
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Tzuan A Chen
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
| | - Lisa M Lowenstein
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
| | - Bryce Kyburz
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kathleen Casey
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Kim Skeene
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Teresa Williams
- Integral Care, 1430 Collier St, 78704, Austin, TX, United States of America
| | - Lorraine R Reitzel
- The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 77230-1402, Houston, TX, Unit 1444, P.O. Box 301402, United States of America
- University of Houston, 3657 Cullen Blvd, Stephen Power Farish Hall, 77204, Houston, TX, United States of America
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Hashim MAB, Bin Sebri KF, Bin Mohd Hanim MF, Binti Anwar DS, Binti Mohd Radzi NA, Bin Ahmad Fuad AF, Md Sabri BAB. The Impact of Military Tobacco Control Policy: A Systematic Review. Mil Med 2024:usad507. [PMID: 38330180 DOI: 10.1093/milmed/usad507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings. MATERIALS AND METHODS We searched for published English articles in Medline, Web of Science, Scopus, and Google Scholar databases using relevant subject headings without year restriction. We included randomized controlled trials, nonrandomized controlled trials, case-control, cohort, controlled before and after, and uncontrolled before and after studies evaluating the impact of tobacco control policy in the military population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three independent reviewers independently screened initially identified articles, reviewed the full text, and extracted the data and any disagreements resolved by consensus after data recheck. Five reviewers used a validated tool to assess the quality of the included studies. The primary outcome was the reduction of any tobacco or nicotine-contained products (TNCPs) use among the troops. The impacts of the tobacco control policy were synthesized and analyzed qualitatively. This study is registered with the International Prospective Register of Systematic Review (CRD42022314117). RESULTS Fourteen studies were included in the analysis from 5372 studies screened. Most of the studies were from the USA, and fractions were from Thailand, France, and Taiwan. These studies were methodologically heterogeneous. Most studies employed a total ban policy on TNCP use during basic military training or operational deployment as the primary strategy. Other methods utilized were the brief tobacco intervention, targeted treatment, support, and counseling provided through telephone or mailing systems, the adjunctive behavioral intervention, providing free nicotine gum, the "Pharsai clinic", active and regular smoking restriction, and interventions aimed at intrapersonal, interpersonal, and organizational levels. There is a moderate quality of evidence that the tobacco control policies effectively reduced the prevalence of TNCP use, increased the cessation rate, reduced the intake, and lowered the dependency. The adjunctive interventions provided after the total ban on TNCP use may increase its effectiveness. However, findings from this review need to be carefully considered as the definition of TNCP use status was not universal between studies and lacked a biochemical validation procedure. CONCLUSIONS There is reasonable evidence to support that the tobacco control policy employed in the military population has multiple positive impacts in reducing the prevalence of TNCP use, increasing the cessation rates, reducing the intake, and lowering dependency. Other evidence-based strategies need to be fully utilized to materialize the tobacco endgame.
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Affiliation(s)
- Muhamad Arham Bin Hashim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
- The Malaysian Armed Forces, Wilayah Persekutuan, Kuala Lumpur 50634, Malaysia
| | - Khairul Fikri Bin Sebri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Muhammad Faiz Bin Mohd Hanim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Diyana Shereen Binti Anwar
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Nawwal Alwani Binti Mohd Radzi
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | | | - Budi Aslinie Binti Md Sabri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
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Mattson A, Doherty K, Lyons A, Douglass A, Kerley M, Stynes S, Fitzpatrick P, Kelleher C. Evidence from a Smoking Management Service in a University Teaching Hospital in Dublin, Ireland monitored by repeat surveys, 1997-2022. Prev Med Rep 2023; 36:102415. [PMID: 37744740 PMCID: PMC10511793 DOI: 10.1016/j.pmedr.2023.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/11/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
St Vincent's University Hospital (SVUH) has a comprehensive smoking management programme and since 1997 has conducted periodic surveys of inpatients, outpatients, staff and visitors to establish prevalence of smoking and associated attitudes towards the hospital's smoke-free campus policy pioneered in 2009. We report trends and describe also the online community stop smoking course (SSC) developed more recently in response to COVID-19. A questionnaire examining attitudes and smoking status was administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors in the time period of 1997-2018. Chi square test for trend was used. Smoking rates declined in all groups but significantly so in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs. 9.5%; p < 0.0001) and staff (30.0% vs. 10.8%; p < 0.0001). Use of E-Cigarettes was low in all cohorts. Rates of smoking were borderline higher in inpatients eligible by income for state-funded General Medical Services (33.2% vs 26.8%, p = 0.099). Support for and awareness of the ban increased over time. Demographic and quit data was compared between participants of in-person or online SSC. The online courses were successful with a maintenance of quit rates (End of Course: 54.7% vs. 55.0%, 1 Month: 50.4% vs. 54.0%, 3 Month: 19.8% vs. 22.5%). While the hospital community's smoking prevalence has decreased over time and attitudes to the smoking ban have been increasingly positive, the campus is not without difficulties in keeping it smoke-free. We continue to advocate for hospital staff support in enacting this flagship initiative.
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Affiliation(s)
- Ana Mattson
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kirsten Doherty
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Ailsa Lyons
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Alexander Douglass
- UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin, Ireland
| | - Mary Kerley
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Sinead Stynes
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Patricia Fitzpatrick
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin, Ireland
| | - Cecily Kelleher
- Department of Preventive Medicine & Health Promotion, Saint Vincent’s University Hospital, Elm Park, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin, Ireland
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Druckrey-Fiskaaen KT, Furulund E, Madebo T, Carlsen SEL, Fadnes LT, Lid TG. A qualitative study on people with opioid use disorders' perspectives on smoking and smoking cessation interventions. Front Psychiatry 2023; 14:1185338. [PMID: 37636821 PMCID: PMC10447904 DOI: 10.3389/fpsyt.2023.1185338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Smoking-related diseases are major contributors to disability and shorter life expectancy among opioid-dependent patients. Smoking prevalence is considerably higher for opioid-dependent persons than among the general population, and only a minority quit smoking in treatment settings. Studies show that pharmacological smoking cessation interventions have modest success rates. This study aimed to investigate patients' receiving opioid agonist therapy perspectives on factors affecting behavior and decisions related to smoking cessation, and their experiences with smoking cessation. Methods This is a qualitative study using semi-structured individual interviews. The participants were asked, among others, to elaborate on the participants' thoughts about smoking, previous attempts to quit tobacco use, and what could prompt a smoking cessation attempt. We analyzed the transcripts with systematic text condensation. The Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Opioid-dependent patients receiving opioid agonist therapy in outpatient clinics were invited to participate using a purposive sampling method. In total, fourteen individuals participated in this study. Results We identified six themes which were: (1) reflections on how smoking affected decisions, (2) smoking and its impact on physical and mental health, (3) the economy as a motivator to stop smoking, (4) emotions, desires, and habits related to smoking, (5) knowledge of smoking, smoking cessation, and quit attempts, and (6) social factors influencing the participants' choices and activities. The participants were well informed about the consequences of smoking and had some knowledge and experience in quitting. The participants' pulmonary health was an important motivational factor for change. Withdrawal symptoms, anxiety, and fear of using other substances discouraged several from attempting to quit smoking. In contrast, social support from partners and access to meaningful activities were considered important factors for success. Few reported being offered help from health professionals to make a smoking cessation attempt. Discussion Experiencing social support, being encouraged to quit smoking, and patients' concerns for their physical health were important reasons for wanting to quit smoking. Smoking cessation interventions based on patient preferences and on the behavior change wheel may enable a higher success rate among patients receiving opioid agonist therapy.
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Affiliation(s)
- Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Einar Furulund
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Tesfaye Madebo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Siv-Elin Leirvåg Carlsen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lars T. Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Torgeir Gilje Lid
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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Mullin M, Allwright S, McGrath D, Hayes CB. Use of a Living Lab Approach to Implement a Smoke-Free Campus Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5354. [PMID: 37047968 PMCID: PMC10094473 DOI: 10.3390/ijerph20075354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
While universities have increasingly become tobacco-/smoke-free, to our knowledge, no campus has reported 100% policy compliance. Innovative approaches to encourage compliance and ongoing data collection are needed. This paper describes actions undertaken, framed within a Living Lab (LL) approach, to implement smoke-free campus policies in an Irish university. The action research comprised student-collected data on observed smoking on campus to evaluate adherence and compliance, first to a smoke-free zones policy (June 2016-March 2018), and then to a smoke-free campus policy (March 2019-February 2020). From June 2016-February 2020, 2909 smokers were observed. Adherence, defined as the average reduction in number of observed smokers from baseline in May 2016, reduced by 79% from 5.7 to 4.9 . Compliance, defined as the proportion of smokers who complied when reminded of the policy, was 90% (2610/2909). Additional activities included development of a broader health promotion programme; identification of a pattern of 'social smoking'; and promoting increased awareness of the environmental harms of tobacco. Ongoing policy implementation is essential for smoke-free policies and should include data collection and evaluation. Actions framed within the characteristics of a LL achieved fewer observed smokers. A LL approach is recommended to encourage policy adherence and compliance.
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Affiliation(s)
- Martina Mullin
- College Health, Trinity College Dublin, College Green, D02 PN40 Dublin, Ireland
| | - Shane Allwright
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH74 Dublin, Ireland
| | - David McGrath
- College Health, Trinity College Dublin, College Green, D02 PN40 Dublin, Ireland
| | - Catherine B. Hayes
- Public Health & Primary Care, Institute of Population Health, Trinity College Dublin, Russell Centre, Tallaght Cross, D24 DH74 Dublin, Ireland
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Badanapurkar A, Nelson D, Varghese S, Singh R, Haddad PM. Support and attitudes of Qatar mental health professionals to a proposed mental health inpatient smoking ban: Results of a cross-sectional survey. J Psychiatr Ment Health Nurs 2022; 29:327-345. [PMID: 34143910 DOI: 10.1111/jpm.12777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Smoking is more common among people with serious mental illness, and it contributes to a reduced life expectancy. Several Western countries have successfully introduced smoke-free policies in inpatient mental health units. There is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We surveyed mental health professionals working in Qatar's main mental health service to determine support for and attitudes towards a proposed total smoking ban in psychiatric wards. Most staff who completed the survey supported an inpatient smoking ban. However, further analysis, both quantitative and qualitative, showed markedly ambivalent attitudes, that is staff simultaneously held attitudes that supported and opposed a smoking ban. Professionals who did not support a ban were more likely to have not received smoking cessation training in the last 5 years, to be a psychiatrist rather than a nurse or allied mental health professional, to be current smokers and to be a Middle Eastern and North African national. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further staff training is necessary to achieve more consistent attitudes that support a total smoking ban and increase the likelihood of successful implementation. The attitudes in this study showed similarities and differences to those reported for mental health professionals in Western countries. This highlights that local research is necessary to help shape training and successfully implement smoke-free policies. ABSTRACT: Introduction Despite the fact that patients with serious mental illness (SMI) have high rates of smoking and an increased standardized mortality, there is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. Aim To assess support for, and attitudes towards, a proposed total smoking ban in psychiatric wards among mental health clinicians in Qatar. Method Cross-sectional survey of mental health professionals working in Qatar's primary mental health service. Results The response rate was 68% (353/520). Support for a ban was assessed with a single-item question; 73% of respondents supported a ban with opposition significantly (p < .05) associated with being a current smoker, a Middle Eastern and North African (MENA) national, a psychiatrist versus a mental health nurse or allied health professional and not receiving smoking cessation training in the last 5 years. A 21-item questionnaire assessed attitudes to a total smoking ban. It showed marked ambivalence with multiple linear regression identifying MENA nationality, male gender and current smoking status as independent variables influencing attitudes. The most strongly held attitude supporting a ban was concern about passive smoking and against a ban was concern it may increase patient agitation. Qualitative data confirmed ambivalent views. Discussion The results show similarities and differences to research from other countries suggesting that cultural factors influence some attitudes to smoke-free policies. Implications for Practice Staff support and smoking cessation education are necessary to achieve more consistent staff attitudes to support smoke-free policies.
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Affiliation(s)
| | - Deborah Nelson
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,Curtin University, Perth, WA, Australia
| | - Sejo Varghese
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Peter M Haddad
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,University of Manchester, Manchester, UK
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Support of the Implementation of a Whistleblowing System for Smoke-Free Environments: A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312401. [PMID: 34886128 PMCID: PMC8656714 DOI: 10.3390/ijerph182312401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Enforcement of a smoke-free policy is of vital concern in support of the health of smokers and bystanders. Indonesia has issued a smoke-free law, but implementation and enforcement lie with the regional and municipal governments. In a survey of 225 respondents recruited via schools, knowledge about the health effects of smoking and the smoke-free regulation, as well as attitudes towards and commitment and support of the enforcement of the smoke-free regulation in the Kendari City through an electronic whistleblowing system was examined. Furthermore, the participants were asked about the smoking status and smoking behavior. About half of the respondents were students (teenagers), the other half—their parents. Male respondents were strongly overrepresented (85%). Only 18% of the respondents declared to be smokers, mostly adults and males. Both the smokers and the non-smokers supported the smoke-free law and its enforcement through a whistleblowing system. Representatives of the local government were interviewed and participated in focus group discussions. In general, they also exhibited strong support of an electronic enforcement tool. However, issues of efficiency, costs, and responsibility must still be resolved. Nevertheless, an electronic whistleblowing system has the potential to further the health and livelihoods in a community like the Kendari City.
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El Sharkawy M, Heinze S, Hendrowarsito L, Weinberger A, Huß J, Nennstiel U, Herr C, Kutzora S. Change in exposure of children to second-hand smoke with impact on children's health and change in parental smoking habits after smoking ban in Bavaria - a multiple cross-sectional study. BMC Public Health 2021; 21:2134. [PMID: 34801027 PMCID: PMC8605541 DOI: 10.1186/s12889-021-12130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children's exposure to second-hand smoke (SHS) before and after the ban, its effect on children's health and prevalence of active smoking in adults. METHODS Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children's intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking. RESULTS The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95% 1.01-1.35), 1.65 (CI95% 1.39-1.95), 2.85 (CI95% 2.32-3.51), 2.24 (CI95% 1.84-2.72) and 3.66 (CI95% 2.89-4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95% 1.03-1.24)) and S8 (OR = 1.24 (CI95% 1.13-1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95% 1.06-1.40) for S2 and 1.57 (CI95% 1.33-1.86) for S8 compared to S1. Adverse health effects related to children's exposure to SHS are significantly less in S8 compared to S1. CONCLUSION After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.
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Affiliation(s)
- Mohammed El Sharkawy
- Institute for Medical Information Processing, Biometry and Epidemiology - IBE, LMU Munich, Munich, Germany. .,Pettenkofer School of Public Health, Munich, Germany. .,Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany.
| | - Stefanie Heinze
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Lana Hendrowarsito
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany
| | - Alisa Weinberger
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany
| | - Jonas Huß
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany
| | - Uta Nennstiel
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - Caroline Herr
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Susanne Kutzora
- Department for Occupational and Environmental medicine, Bavarian Health and Food Safety Authority, Pfarrstraße 3, Munich, Germany
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10
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Bowe A, Marron L, Devlin J, Kavanagh P. An Evaluation of the Impact of a Multicomponent Stop Smoking Intervention in an Irish Prison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211981. [PMID: 34831737 PMCID: PMC8624287 DOI: 10.3390/ijerph182211981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
The disproportionately high prevalence of tobacco use among prisoners remains an important public health issue. While Ireland has well-established legislative bans on smoking in public places, these do not apply in prisons. This study evaluates a multi-component tobacco control intervention in a medium security prison for adult males in Ireland. A stop-smoking intervention, targeting staff and prisoners, was designed, implemented, and evaluated with a before-and-after study. Analysis was conducted using McNemar’s test for paired binary data, Wilcoxon signed rank test for ordinal data, and paired T-tests for continuous normal data. Pre-intervention, 44.3% (n = 58) of the study population were current smokers, consisting of 60.7% of prisoners (n = 51) and 15.9% of staff (n = 7). Post-intervention, 45.1% of prisoners (n = 23/51) and 100% of staff (n = 7/7) who identified as current smokers pre-intervention reported abstinence from smoking. Among non-smokers, the proportion reporting being exposed to someone else’s cigarette smoke while being a resident or working in the unit decreased from 69.4% (n = 50/72) pre-intervention to 27.8% (n = 20/72) post-intervention (p < 0.001). This multicomponent intervention resulted in high abstinence rates, had high acceptability among both staff and prisoners, and was associated with wider health benefits across the prison setting.
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Affiliation(s)
- Andrea Bowe
- Health Intelligence Unit, Strategic Planning and Transformation, Health Service Executive, Dublin, Ireland;
- Correspondence:
| | - Louise Marron
- Department of Public Health, Health Service Executive, Dr. Steevens’ Hospital, Dublin, Ireland;
| | - John Devlin
- Irish Prison Service Irish, IDA Business Park, Ballinalee Road, Longford, Ireland;
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Health Service Executive, Dublin, Ireland;
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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11
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van Trier TJ, Mohammadnia N, Snaterse M, Peters RJG, Jørstad HT, Bax WA, Mackenbach JD. An appeal to our government for nationwide policies in the prevention of cardiovascular disease. Neth Heart J 2021; 30:58-62. [PMID: 34606024 PMCID: PMC8489361 DOI: 10.1007/s12471-021-01628-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
The high prevalence and burden of cardiovascular diseases (CVD) is largely attributable to unhealthy lifestyle factors such as smoking, alcohol consumption, physical inactivity and unhealthy food habits. Prevention of CVD, through the promotion of healthy lifestyles, appears to be a Sisyphean task for healthcare professionals, as the root causes of an unhealthy lifestyle lie largely outside their scope. Since most lifestyle choices are habitual and a response to environmental cues, rather than rational and deliberate choices, nationwide policies targeting the context in which lifestyle behaviours occur may be highly effective in the prevention of CVD. In this point-of-view article, we emphasise the need for government policies beyond those mentioned in the National Prevention Agreement in the Netherlands to effectively reduce the CVD risk, and we address the commonly raised concerns regarding ‘paternalism’.
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Affiliation(s)
- T J van Trier
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - N Mohammadnia
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.,Vascular Research Alkmaar, Alkmaar, The Netherlands.,Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - M Snaterse
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R J G Peters
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bax
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.,Vascular Research Alkmaar, Alkmaar, The Netherlands
| | - J D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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12
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Galiatsatos P, Soybel A, Jassal M, Cruz SAP, Spartin C, Shaw K, Cunningham J, Kanarek NF. Tobacco treatment clinics in urban public housing: feasibility and outcomes of a hands-on tobacco dependence service in the community. BMC Public Health 2021; 21:1514. [PMID: 34353308 PMCID: PMC8344144 DOI: 10.1186/s12889-021-11561-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As a further extension of smoke-free laws in indoor public places and workplaces, the Department of Housing and Urban Development's declaration to propose a regulation that would make housing units smoke-free was inevitable. Of note is the challenge this regulation poses to current tenants of housing units who are active smokers. We aimed to assess the efficacy of a tobacco treatment clinic in public housing. The utilization of the clinic by tenants and tenants' respective outcomes regarding smoking status were used to determine the intervention's effectiveness. METHODS Tobacco treatment clinics were held in two urban-based housing units for 1-year. The clinics provided on-site motivational interviewing and prescriptions for pharmacological agents if warranted. Outcomes collected include the tenants' clinic attendance and 3- and 6-month self-reported smoking status. RESULTS Twenty-nine tobacco treatment clinic sessions were implemented, recruiting 47 tenants to participate in smoking cessation. The mean age of the cohort was 53 ± 12.3 years old. Of the 47 tenants who participated, 21 (44.7%) attended three or more clinic sessions. At the 3-month mark, five (10.6%) tenants were identified to have quit smoking; at 6-months, 13 (27.7%) tenants had quit smoking. All 13 of the tenants who quit smoking at the end of 6-months attended three or more sessions. CONCLUSION An on-site tobacco treatment clinic to provide strategies on smoking cessation was feasible. Efforts are warranted to ensure more frequent follow-ups for tenants aiming to quit smoking. While further resources should be allocated to help tenants comply with smoke-free housing units' regulations, we believe an on-site tobacco treatment clinic is impactful.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Medicine for the Greater Good, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
| | - Alexandria Soybel
- Medicine for the Greater Good, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Mandeep Jassal
- Division of Pediatric Pulmonary, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Caroline Spartin
- Medicine for the Greater Good, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Katie Shaw
- Department of Urban Residency, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Norma Fox Kanarek
- Environmental Health and Engineering, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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13
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Kulhánek A, Lukavská K, Švancarová I, Fidesová H, Gabrhelík R. Changes in tobacco use patterns and motivation to quit related to the new smoke-free legislation in the Czech Republic. J Public Health (Oxf) 2021; 43:348-354. [PMID: 31832643 DOI: 10.1093/pubmed/fdz156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoke-free policy belongs to key public health instruments to promote health in populations. In 2017, new comprehensive smoke-free law prohibiting smoking in indoor public places was implemented. We aimed to measure changes in tobacco smoking patterns and changes in motivation to quit in adult smokers prior to and after the new smoke-free legislation came into force. METHODS We conducted a prospective cohort study prior to and post the implementation of Act No. 65/2017 Coll. Self-reported questionnaires were administered to 131 adult smokers by trained nurses in general practitioner offices in Prague. We analysed changes in cigarette consumption per day; ratio of cigarettes smoked in pub, street, work and home; and motivation to quit using regression modelling. RESULTS We found a statistically significant decrease in the daily consumption of cigarettes (an average of 1.7 cigarettes per day, P < 0.001, d = 0.34). Smoking in indoor public spaces decreased to almost zero, while tobacco consumption in outdoor public spaces (such as streets and squares) increased by nearly 20%. We observed statistically significant increase of motivation to quit smoking (P = 0.021, d = 0.21). CONCLUSION The study brings valuable indication of the desired public health impact related to key legislative change in the Czech Republic.
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Affiliation(s)
- Adam Kulhánek
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kateřina Lukavská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.,Department of Psychology, Faculty of Education, Charles University, Czech Republic
| | - Iveta Švancarová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Hana Fidesová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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14
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Ghamri RA, Baamir NJ, Bamakhrama BS. Cardiovascular health and lifestyle habits of hospital staff in Jeddah: A cross-sectional survey. SAGE Open Med 2020; 8:2050312120973493. [PMID: 33282297 PMCID: PMC7682204 DOI: 10.1177/2050312120973493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Cardiovascular disease is a major cause of morbidity and mortality worldwide. Cardiovascular disease was responsible for over 17.9 million deaths in 2016, accounting for 31% of deaths globally and 37% of deaths in Saudi Arabia. With a lifetime risk exceeding 60% for the general population, healthcare professionals are continuously monitoring the health of others but often do not find time to care for themselves. This study aimed to assess the prevalence of cardiovascular risk factors; medical conditions, such as, hypertension and diabetes mellitus; stress; and attitudes and barriers against healthy lifestyle choices among healthcare professionals at King Abdulaziz University Hospital. Methods A cross-sectional study based on a self-administered questionnaire was conducted among the staff at King Abdulaziz University Hospital over a period of 12 weeks. A validated questionnaire was adopted from a study that had previously been conducted in the United Kingdom. Results The study included 400 healthcare workers, of whom, 78% were clinical staff and 22% were non-clinical staff. Approximately, two-thirds of the clinical staff were aged ⩽25 years, whereas 43.2% of the non-clinical staff were aged 26-35 years. Most of the clinical staff (70.5%) were female, compared to 56.8% of the non-clinical staff. Significantly higher rates of hypertension and smoking were observed among the non-clinical staff than among the clinical staff. However, no other significant differences were observed in the prevalence of diseases between the groups. Overall, poor lifestyle, in terms of low compliance with the recommended dietary and physical activity guidelines, was observed in both groups. Conclusion The prevalence of cardiovascular risk factors among the clinical staff at King Abdulaziz University Hospital was not markedly different from that among the non-clinical staff, except the prevalence of hypertension and smoking, which was significantly higher among the non-clinical staff. Further studies that include staff from other institutions are recommended.
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Affiliation(s)
- Ranya Alawy Ghamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Noor Jamal Baamir
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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15
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Li S, Keogan S, Clancy L. Does smoke-free legislation work for teens too? A logistic regression analysis of smoking prevalence and gender among 16 years old in Ireland, using the 1995-2015 ESPAD school surveys. BMJ Open 2020; 10:e032630. [PMID: 32801188 PMCID: PMC7430408 DOI: 10.1136/bmjopen-2019-032630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the gender equalisation in prevalence in 16 years old seen between 2003 and 2015. SETTING Data are from the 4 yearly European School Survey Project on Alcohol and Other Drugs from 1995 to 2015. Total sample size was 12.394. A logistic regression model on grouped data was used. Dependent variable is whether a student was a smoker in last 30 days. Independent variables are time, gender and the policy indicators, workplace ban on smoking, point-of-sale (POS) display ban, the introduction of graphical images on packs and the average real price of cigarettes. RESULTS Smoking prevalence dropped from 41% in 1995 to 13% in 2015. The effects of policies differed between boys and girls. For girls, estimates for workplace bans, graphical images on packs and a unit real (Consumer Price Index adjusted) price increase reduced prevalence by 7.31% (95% CI 2.94% to 11.68%), 8.80% (95% CI 2.60% to 15.01%) and 5.87 (95% CI 2.96 to 8.79), respectively. The POS ban did not have a significant effect in girls. For boys, estimates for workplace bans and a unit real price increase, reduced prevalence by 8.41% (95% CI 5.16% to 11.66%) and 4.93% (95% CI 0.77% to 9.08%), respectively, POS gave an increase of 7.02% (95% CI 1.96% to 12.40%). The introduction of graphical images had an insignificant effect. CONCLUSIONS TC legislation helps to explain the out-of-trend reduction in youth smoking prevalence. The estimated differential effects of the workplace ban, POS displays, real price changes and graphical images on packs help to explain the sharper decline in girls than boys. These findings should remind policy-makers to give increased consideration to the possible effects on young people of any legislative changes aimed at adults in TCL.
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Affiliation(s)
- Shasha Li
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Sheila Keogan
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
| | - Luke Clancy
- TU Dublin, TobaccoFree Research Institute Ireland, Kevin Street, Dublin 8, Dublin, Ireland
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16
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Giles L, Bauer LA. Supporting visitor compliance with a smoke-free policy at hospital using a nicotine replacement therapy vending machine. Health Promot J Austr 2020; 32:378-382. [PMID: 32506756 PMCID: PMC8359432 DOI: 10.1002/hpja.371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022] Open
Abstract
ISSUE ADDRESSED To support visitors to comply with Central Coast Local Health District's (CCLHD) smoke-free hospital grounds policy, a need was identified for round-the-clock availability of nicotine replacement therapy (NRT). Providing NRT through a vending machine was identified as a possible solution. This initiative complemented other strategies that provide staff and patients who smoke with NRT. METHODS NRT was originally provided through a snack vending machine; however, there were commercial and regulatory concerns with this method. In 2015, dedicated NRT vending machines were installed at Gosford and Wyong Hospitals, and were operated by the Health Promotion Service. The appropriate regulatory permission was gained to supply a specific brand of NRT. Sales and incident data were recorded, and ongoing smoking counts were performed both before and after installation. RESULTS In all, 247 sales of NRT gum were made through the vending machines from early 2017 to late 2019. Smoking counts show that there are very low rates of visitor smoking (<1%) in the approximately 4.5 years pre- and post-installation of dedicated vending machines. There was no statistically significant change in the smoking rate of visitors since the vending machine was installed at Wyong Hospital. CONCLUSIONS While NRT is generally provided to patients and staff within health settings to support compliance with smoke-free policies, alternatives to smoking for visitors are typically overlooked. A NRT vending machine achieves this. However, because there are few purchases made, the vending machines as currently operating are unlikely to make any significant impact on smoke-free policy compliance at these hospitals. SO WHAT?: While vending machines have limited effectiveness on overall smoke-free policy compliance, this strategy may have applicability to all sectors with smoke-free policies, especially those operating 24 hours a day, as a means of providing an alternative to smoking for visitors.
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Affiliation(s)
- Luke Giles
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
| | - Lyndon A Bauer
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
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17
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Conrad L, Perzanowski MS. The Role of Environmental Controls in Managing Asthma in Lower-Income Urban Communities. Clin Rev Allergy Immunol 2020; 57:391-402. [PMID: 30903438 DOI: 10.1007/s12016-019-08727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Children living in lower-income urban communities are at much greater risk of developing asthma, going to the emergency department for an asthma attack and being hospitalized for asthma than children living in upper- and middle-income communities. For many asthmatic children living in urban communities, especially those with greater morbidity, the allergic pathway is important in the etiology of the disease. The stages of developing allergic disease can be divided into the onset of allergic sensitization, development of allergic disease and subsequent exacerbations, and it is useful to consider the relevance of interventions at each of these stages. Indoor allergens and environmental exposures are a major contributor to allergic disease, particularly among lower socioeconomic status, urban, minority communities. These exposures include allergens, environmental tobacco smoke, combustion by-products, and mold, all of which can play an important role in asthma progression as well as morbidity. These exposures are often not found in isolation and thus these concomitant exposures need to be considered when conducting environmental interventions. There have been numerous studies looking at both primary and tertiary prevention strategies and the impact on allergic sensitization and asthma with varied results. While the outcomes of these studies have been mixed, what has emerged is the need for tertiary interventions to be targeted to the individual and to reduce all relevant exposures to which an asthmatic child is exposed and sensitized. In addition, effective intervention strategies must also consider other social determinants of asthma morbidity impacting low socioeconomic, urban communities.
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Affiliation(s)
- Laura Conrad
- Division of Pulmonology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, 11th floor, New York, NY, 10032, USA.
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18
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Christian WJ, Vanderford NL, McDowell J, Huang B, Durbin EB, Absher KJ, Walker CJ, Arnold SM. Spatiotemporal Analysis of Lung Cancer Histological Types in Kentucky, 1995-2014. Cancer Control 2019; 26:1073274819845873. [PMID: 31014079 PMCID: PMC6482657 DOI: 10.1177/1073274819845873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent metabolic and genetic research has demonstrated that risk for specific histological types of lung cancer varies in relation to cigarette smoking and obesity. This study investigated the spatial and temporal distribution of lung cancer histological types in Kentucky, a largely rural state with high rates of smoking and obesity, to discern population-level trends that might reflect variation in these and other risk factors. The Kentucky Cancer Registry provided residential geographic coordinates for lung cancer cases diagnosed from 1995 through 2014. We used multinomial and discrete Poisson spatiotemporal scan statistics, adjusted for age, gender, and race, to characterize risk for specific histological types—small cell, adenocarcinoma, squamous cell, and other types—throughout Kentucky and compared to maps of risk factors. Toward the end of the study period, adenocarcinoma was more common among all population subgroups in north-central Kentucky, where smoking and obesity are less prevalent. During the same time frame, squamous cell, small cell, and other types were more common in rural Appalachia, where smoking and obesity are more prevalent, and in some high poverty urban areas. Spatial and temporal patterns in the distribution of histological types of lung cancer are likely related to regional variation in multiple risk factors. High smoking and obesity rates in the Appalachian region, and likely in high poverty urban areas, appeared to coincide with high rates of squamous cell and small cell lung cancer. In north-central Kentucky, environmental exposures might have resulted in higher risk for adenocarcinoma specifically.
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Affiliation(s)
- W Jay Christian
- 1 Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Nathan L Vanderford
- 2 Department of Toxicology and Cancer Biology, Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jaclyn McDowell
- 3 Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA
| | - Bin Huang
- 4 Department of Biostatistics, Markey Cancer Control Program, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Eric B Durbin
- 5 Division of Biomedical Informatics, Department of Internal Medicine, Kentucky Cancer Registry, Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Kimberly J Absher
- 6 Department of Pathology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Courtney J Walker
- 7 Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Susanne M Arnold
- 8 Department of Internal Medicine, Markey Cancer Center, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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19
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Linnansaari A, Schreuders M, Kunst AE, Rimpelä A, Lindfors P. Understanding school staff members' enforcement of school tobacco policies to achieve tobacco-free school: a realist review. Syst Rev 2019; 8:177. [PMID: 31324212 PMCID: PMC6642528 DOI: 10.1186/s13643-019-1086-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND School tobacco policies (STPs) that aim to achieve a tobacco-free environment require consistent enforcement by school staff. However, little is known about why staff choose whether or not to enforce STPs. Therefore, we investigated staff members' responses to STPs that determine enforcement. Furthermore, we examined how these responses depend on contextual factors at the individual, interpersonal, school, implementation, and national levels. METHODS We performed a realist review (RR), which synthesizes existing primary evidence into a programme theory demonstrating key causal pathways through Context-Mechanism-Outcome configurations (CMOs). These CMOs link contextual factors to outcomes (i.e. staff enforcement) by explaining the underlying generative mechanisms (i.e. staff members' cognitive, psychosocial, and behavioural responses). A systematic literature search for the period 2000-2016 was performed using Academic Search Premier, PsycInfo, and MEDLINE. Forty English-language articles were identified for the synthesis. RESULTS Our programme theory demonstrated three CMOs: when contextual factors make staff members experience STP enforcement as part of their professional role and duties, it may lead to staff members showing responsibility for STP enforcement (CMO1); when contextual factors make staff members feel their contribution is leading to positive outcomes, it may lead to staff members showing motivation to enforce STPs (CMO2), and when contextual factors make staff members feel that they are able to deal with students' responses, it may lead to staff members showing confidence in STP enforcement (CMO3). Moreover, the programme theory provided more precise insights into what contextual factors contribute to triggering the individual mechanisms and the consequent outcomes. CONCLUSIONS By applying a realist approach, we have been able to detect three CMOs explaining staff members' STP enforcement. The findings provide useful insights explaining how stakeholders can support staff members' STP enforcement and consequently improve the impact of STPs on adolescent smoking.
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Affiliation(s)
- Anu Linnansaari
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Arja Rimpelä
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland.,PERLA-Tampere Centre for Childhood, Youth and Family Research, Tampere University, 33014, Tampere, Finland.,Department of Adolescent Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, 33380, Nokia, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Health Sciences, Tampere University, P.O. Box 100, 33014, Tampere, Finland.
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20
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Sue K, Applewhite D. Smoking and hospitalisation: harnessing medical ethics and harm reduction. JOURNAL OF MEDICAL ETHICS 2019; 45:483-486. [PMID: 30846491 DOI: 10.1136/medethics-2018-105065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
As resident physicians practicing Internal Medicine in hospitals within the USA, we are confronted on a daily basis with patients who wish to leave the hospital floor to smoke a cigarette. While many physicians argue that hospitals should do everything in their power to prevent patients from smoking, we argue that a more comprehensive and nuanced approach is needed. In part 1 of this perspective piece, we outline the various forms of smoking bans in hospital settings, applauding the development of indoor smoking bans while questioning the move towards stricter, campus-wide smoking bans. In part 2, we turn to traditional biomedical ethics to guide our approach to the hospitalised patient who smokes. This approach, which is informed by our backgrounds in harm reduction and medical anthropology, takes into account the lived realities of patients and acknowledges the complicated sociohistorical contexts of tobacco use.
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Affiliation(s)
- Kimberly Sue
- Harm Reduction Coalition, New York, New York, USA
| | - Dinah Applewhite
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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21
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Christian WJ, Walker CJ, Huang B, Hahn EJ. Effect of Local Smoke-Free Ordinances on Smoking Prevalence in Kentucky, 2002-2009. South Med J 2019; 112:369-375. [PMID: 31282965 PMCID: PMC6687407 DOI: 10.14423/smj.0000000000001000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Many local communities in Kentucky, a state with one of the highest smoking prevalence rates in the United States, have enacted smoke-free ordinances that prohibit smoking in workplaces and enclosed buildings open to the public. Research has shown that such ordinances are clearly beneficial for public health, but their influence on smoking prevalence in the populations they cover remains unclear. This study explores the effect of local smoke-free ordinances on smoking prevalence in Kentucky. METHODS We used a database of smoke-free ordinances maintained by the Kentucky Center for Smoke-Free Policy, Kentucky Behavioral Risk Factor Surveillance System survey data, and US Census data. We estimated the proportion of Kentucky adults living in counties with smoke-free ordinances of varying strength; examined bivariate associations between smoke-free ordinances and smoking prevalence; and fit regression models that adjusted for various county-level demographic, socioeconomic, and geographic factors. RESULTS Smoking prevalence was approximately 5% lower in counties with smoke-free ordinances, even after adjusting for other relevant factors, including a trend in decreasing prevalence throughout the study region. There was a slight dose-response effect related to the strength of smoke-free ordinances after adjustment for these covariates. Smoke-free ordinances appear to have a modest effect on smoking prevalence across the span of several years. CONCLUSIONS Findings demonstrate that although smoking prevalence fell throughout the state during the study period, counties with smoke-free ordinances experienced a greater decline. Future research should examine the strength of smoke-free ordinances in greater detail to better understand their influence on smoking prevalence.
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Affiliation(s)
- W Jay Christian
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Courtney J Walker
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Bin Huang
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Ellen J Hahn
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
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22
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Zeng J, Zhang D, Liu Y, Zhao D, Ou Y, Fang J, Zheng S, Yin J, Chen S, Qiu Y, Qiu Z, Luo S, Zhou H, Lin Y, Ba-Thein W. Compromised Air Quality and Healthcare Safety from Smoking inside Hospitals in Shantou, China. Sci Rep 2019; 9:7955. [PMID: 31138869 PMCID: PMC6538634 DOI: 10.1038/s41598-019-44295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
Achieving smoke-free healthcare facilities remains a great challenge in countries with a high smoking prevalence and weak regulation. Assessment of the impact of environmental tobacco smoke (ETS) and its constituent PM2.5 on the air quality in Chinese hospitals has not been reported. In this study, we conducted air quality surveys by measuring real-time PM2.5 concentrations with Dylos Air Quality Monitors in five tertiary hospitals in Shantou, China during summer (July-August 2016) and winter (November-February 2017). Twenty-eight-day surveys inside the hospitals showed median PM2.5 concentrations above the China Air Quality Standard in elevator lobbies (51.0 μg/m3, IQR 34.5-91.7), restrooms (40.2, 27.1-70.3), and corridors (36.5, 23.0-77.4). Evidence of tobacco smoking was significantly associated with PM2.5 spikes observed in all the survey locations, contributing to the air quality undesirable for health in 49.1% of total survey hours or 29.3% of summer and 75.4% of winter survey hours inside the buildings, and 33.5%, 25.7%, and 6.8% of survey hours in doctor offices, nurse stations, and patient rooms, respectively. In conclusion, smoking inside hospitals induces PM2.5 spikes that significantly compromise the air quality and impose significant health risk to the hospital inhabitants. Reinforcing comprehensive smoking ban with the vested interest of all stakeholders followed by creative disciplinary actions are suggested to ensure healthcare safety.
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Affiliation(s)
- Jun Zeng
- Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, P.R. China
- Division of Endocrinology, The People's Hospital of China Three Gorges University, The First People's Hospital of Yichang, Yichang, Hubei, P.R. China
| | - Dangui Zhang
- Research Center of Translational Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Yindu Liu
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Duanlong Zhao
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Yunxuan Ou
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Jiezhuang Fang
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Shimin Zheng
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Jianbin Yin
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Sicheng Chen
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Yiling Qiu
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Zhenbin Qiu
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Siping Luo
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Hui Zhou
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - Ying Lin
- Undergraduate Research Training Program (UGRTP), Shantou University Medical College, Shantou, Guangdong, P.R. China
| | - William Ba-Thein
- Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, P.R. China.
- Department of Microbiology and Immunology, Shantou University Medical College, Shantou, Guangdong, P.R. China.
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23
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Fu M, Castellano Y, Tigova O, Mons U, Agar T, Kyriakos CN, Trofor AC, Quah ACK, Fong GT, Przewoźniak K, Zatoński WA, Demjén T, Tountas Y, Vardavas CI, Fernández E. Smoking in public places in six European countries: Findings from the EUREST-PLUS ITC Europe Survey. Tob Induc Dis 2019; 16:A18. [PMID: 34671233 PMCID: PMC8525624 DOI: 10.18332/tid/104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Surveillance of tobacco consumption in public places is an important measure to evaluate the impact of tobacco control interventions over time. The objective of this study was to estimate the prevalence of smoking as seen by smokers and their smoking behaviour in public places, in six European countries. METHODS We used baseline data of the International Tobacco Control Six European countries (ITC 6E) Survey, part of the EUREST-PLUS Project, conducted in 2016 in national representative samples of about 1000 adult smokers aged 18 years and older in Germany, Greece, Hungary, Poland, Romania and Spain. For each setting (workplaces, restaurants, bars/pubs and discos) participants were asked whether they had seen someone smoking during their last visit there and whether they too had smoked there. We report the overall and by-country weighted prevalence of seeing someone smoking and the smokers' own smoking behaviour at each setting. We also assess the relationship between seeing someone smoking and smoking themselves at these settings. RESULTS The prevalence of smoking as seen by smokers was 18.8% at workplaces, with high variability among countries (from 4.7% in Hungary to 40.8% in Greece). Among smokers visiting leisure facilities in the last year, during their last visit 22.7% had seen someone smoking inside restaurants and 12.2% had smoked themselves there, while for bars/pubs the corresponding prevalences were 33.9% and 20.4%, and inside discos 44.8% and 34.8%. CONCLUSIONS Smoking is still prevalent at leisure facilities, particularly at discos in Europe, with high variability among countries. More extensive awareness campaigns and stricter enforcement are needed to increase the compliance of smoke-free regulations, especially in leisure facilities.
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Affiliation(s)
- Marcela Fu
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,University of Barcelona (UB), Barcelona, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Olena Tigova
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Agar
- University of Waterloo (UW), Waterloo, Canada
| | - Christina N Kyriakos
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi (UMF Iasi), Iasi, Romania.,Aer Pur Romania (APR), Bucharest, Romania
| | | | - Geoffrey T Fong
- University of Waterloo (UW), Waterloo, Canada.,Ontario Institute for Cancer Research (OICR), Toronto, Canada
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland.,Maria Skłodowska-Curie Institute - Oncology Center (MSCI), Warsaw, Poland
| | - Witold A Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences (PSWZ), Kalisz, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Constantine I Vardavas
- European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium.,University of Crete (UoC), Heraklion, Greece
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,University of Barcelona (UB), Barcelona, Spain
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24
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Woodward ER, Richmond R. Smoking Bans in Psychiatric Units: An Issue of Medical Ethics. Front Psychiatry 2019; 10:134. [PMID: 30949076 PMCID: PMC6435855 DOI: 10.3389/fpsyt.2019.00134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/25/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Eleanor R Woodward
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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25
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Meijer E, Kampman M, Geisler MS, Chavannes NH. "It's on everyone's plate": a qualitative study into physicians' perceptions of responsibility for smoking cessation. Subst Abuse Treat Prev Policy 2018; 13:48. [PMID: 30541580 PMCID: PMC6290505 DOI: 10.1186/s13011-018-0186-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians' perceptions of responsibility for smoking cessation. METHODS Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N = 55). Data analysis followed the framework approach. RESULTS The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care. CONCLUSIONS The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and -as suggested by comments by several participants- the government.
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Affiliation(s)
- E. Meijer
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. Kampman
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - M. S. Geisler
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - N. H. Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
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26
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Hewko SJ, Cummings GG, Pietrosanu M, Edwards N. The Impact of Quality Assurance Initiatives and Workplace Policies and Procedures on HIV/AIDS-Related Stigma Experienced by Patients and Nurses in Regions with High Prevalence of HIV/AIDS. AIDS Behav 2018; 22:3836-3846. [PMID: 29476436 PMCID: PMC6208913 DOI: 10.1007/s10461-018-2066-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the incidence, prevalence and morbidity of HIV/AIDS.
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27
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Luck KE, Doucet S. What Are the Perceptions, Experiences, and Behaviors of Health Care Providers After Implementation of a Comprehensive Smoke-Free Hospital Policy? Glob Qual Nurs Res 2018; 5:2333393618756770. [PMID: 29568792 PMCID: PMC5858618 DOI: 10.1177/2333393618756770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to explore the perceptions, experiences, and behaviors of health care providers (HCPs) after the implementation of a comprehensive smoke-free policy. This qualitative descriptive study, using semi-structured interviews, was conducted with 28 HCPs working in a Canadian hospital. Four overarching themes emerged from the analysis including (a) greater support for tobacco reduction, (b) enhanced patient care and interactions, (c) improved staff morale, and (d) some barriers still exist. The main findings suggest a comprehensive smoke-free hospital environment can strengthen the tobacco-free workplace culture within a hospital setting among HCPs where support for tobacco reduction is amplified, patient care and interactions regarding tobacco dependence are improved, and staff morale is enhanced. While there are still some challenging barriers as well as opportunities for improvements, the implementation of a comprehensive smoke-free policy heightened the call-to-action among HCPs to take a more active role in tobacco reduction.
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Affiliation(s)
- Kerrie E Luck
- University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- University of New Brunswick, Saint John, New Brunswick, Canada.,Jarislowsky Chair in Interprofessional Patient-Centred Care, University of New Brunswick, Saint John, New Brunswick, Canada.,Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
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28
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Lim KH, Teh CH, Nik Mohamed MH, Pan S, Ling MY, Mohd Yusoff MF, Hassan N, Baharom N, Dawam ND, Ismail N, Ghazali SM, Cheong KC, Chong KH, Lim HL. Exposure to tobacco secondhand smoke and its associated factors among non-smoking adults in smoking-restricted and non-restricted areas: findings from a nationwide study in Malaysia. BMJ Open 2018; 8:e017203. [PMID: 29317411 PMCID: PMC5780697 DOI: 10.1136/bmjopen-2017-017203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Secondhand smoke (SHS) has been associated with increased morbidity and mortality. Therefore, the aims of the paper are to assess SHS exposure among non-smoking adults in Malaysia attending various smoking-restricted and non-restricted public areas according to the Control of Tobacco Product Regulations (CTPR) as well as its relationship with various sociodemographic variables. DESIGN Data were extracted from a cross-sectional study, the Global Adults Tobacco Survey (GATS) 2011 which involved 3269 non-smokers in Malaysia. Data was obtained through face-to-face interviews using a validated pre-tested questionnaire. Factors associated with exposure to SHS were identified via multivariable analysis. RESULTS The study revealed that almost two-thirds of respondents were exposed to SHS in at least one public area in the past 1 month, with a significantly higher exposure among males (70.6%), those with higher educational attainment (81.4%) and higher income (quintile 1%-73.9%). Besides, the exposure to SHS was almost four times higher in non-restricted areas compared with restricted areas under the CTPR (81.9% vs 22.9). Multivariable analysis revealed that males and younger adults at non-restricted areas were more likely to be exposed to SHS while no significant associated factors of SHS exposure was observed in restricted areas. CONCLUSIONS The study revealed the prevalence of SHS exposure was higher among Malaysian adults. Although smoke-free laws offer protection to non-smokers from exposure to SHS, enforcement activities in restricted areas should be enhanced to ensure strict public abidance. In addition, legislation of restricted areas should also be extended to greatly reduce the SHS exposure among non-smokers in Malaysia.
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Affiliation(s)
| | | | | | - Sayan Pan
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Miaw Yn Ling
- Institute of Public Health, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Noraryana Hassan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Nizam Baharom
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Norliana Ismail
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | | | - Kar Hon Chong
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
| | - Hui Li Lim
- Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia
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29
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Weitzman M. American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco. Pediatr Res 2018; 83:23-30. [PMID: 28945701 DOI: 10.1038/pr.2017.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022]
Abstract
This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.
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Affiliation(s)
- Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York City, New York
- Department of Environmental Medicine, New York University School of Medicine, New York City, New York
- College of Global Public Health, New York University, New York City, New York
- NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
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30
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Mittal TK, Cleghorn CL, Cade JE, Barr S, Grove T, Bassett P, Wood DA, Kotseva K. A cross-sectional survey of cardiovascular health and lifestyle habits of hospital staff in the UK: Do we look after ourselves? Eur J Prev Cardiol 2017; 25:543-550. [PMID: 29198137 PMCID: PMC5833024 DOI: 10.1177/2047487317746320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background A high prevalence of stress-related disorders is well known among healthcare professionals. We set out to assess the prevalence of cardiovascular risk factors and compliance with national dietary and physical activity recommendations in NHS staff in the UK with comparison between clinical and non-clinical staff, and national surveys. Design A multi-centre cross-sectional study. Methods A web-based questionnaire was developed to include anonymised data on demographics, job role, cardiovascular risk factors and diseases, dietary habits, physical activity and barriers towards healthy lifestyle. This was distributed to staff in four NHS hospitals via emails. Results A total of 1158 staff completed the survey (response rate 13%) with equal distribution between the clinical and non-clinical groups. Most staff were aged 26–60 years and 79% were women. Half of the staff were either overweight or obese (51%) with no difference between the groups (P = 0.176), but there was a lower prevalence of cardiovascular risk factors compared to the general population. The survey revealed a low compliance (17%) with the recommended intake of five-a-day portions of fruit and vegetables, and that of moderate or vigorous physical activity (56%), with no difference between the clinical and non-clinical staff (P = 0.6). However, more clinical staff were exceeding the alcohol recommendations (P = 0.02). Lack of fitness facilities and managerial support, coupled with long working hours, were the main reported barriers to a healthy lifestyle. Conclusions In this survey of UK NHS staff, half were found to be overweight or obese with a lower prevalence of cardiovascular risk factors compared to the general population. There was a low compliance with the five-a-day fruit and vegetables recommendation and physical activity guidelines, with no difference between the clinical and non-clinical staff.
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Affiliation(s)
- Tarun K Mittal
- 1 Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, UK
| | | | - Janet E Cade
- 3 Nutritional Epidemiology Group, University of Leeds, UK
| | - Suzanne Barr
- 4 Faculty of Medicine, Imperial College London, UK
| | - Tim Grove
- 4 Faculty of Medicine, Imperial College London, UK
| | | | - David A Wood
- 4 Faculty of Medicine, Imperial College London, UK
| | - Kornelia Kotseva
- 4 Faculty of Medicine, Imperial College London, UK.,6 Department of Public Health, University of Ghent, Belgium
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31
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Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, McKenzie JE. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2017; 2:CD001055. [PMID: 28196405 PMCID: PMC6472671 DOI: 10.1002/14651858.cd001055.pub5] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tobacco smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. Smoking in pregnancy is decreasing in high-income countries, but is strongly associated with poverty and is increasing in low- to middle-income countries. OBJECTIVES To assess the effects of smoking cessation interventions during pregnancy on smoking behaviour and perinatal health outcomes. SEARCH METHODS In this sixth update, we searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2015), checked reference lists of retrieved studies and contacted trial authors. SELECTION CRITERIA Randomised controlled trials, cluster-randomised trials, and quasi-randomised controlled trials of psychosocial smoking cessation interventions during pregnancy. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and trial quality, and extracted data. Direct comparisons were conducted in RevMan, with meta-regression conducted in STATA 14. MAIN RESULTS The overall quality of evidence was moderate to high, with reductions in confidence due to imprecision and heterogeneity for some outcomes. One hundred and two trials with 120 intervention arms (studies) were included, with 88 trials (involving over 28,000 women) providing data on smoking abstinence in late pregnancy. Interventions were categorised as counselling, health education, feedback, incentives, social support, exercise and dissemination.In separate comparisons, there is high-quality evidence that counselling increased smoking cessation in late pregnancy compared with usual care (30 studies; average risk ratio (RR) 1.44, 95% confidence interval (CI) 1.19 to 1.73) and less intensive interventions (18 studies; average RR 1.25, 95% CI 1.07 to 1.47). There was uncertainty whether counselling increased the chance of smoking cessation when provided as one component of a broader maternal health intervention or comparing one type of counselling with another. In studies comparing counselling and usual care (largest comparison), it was unclear whether interventions prevented smoking relapse among women who had stopped smoking spontaneously in early pregnancy. However, a clear effect was seen in smoking abstinence at zero to five months postpartum (11 studies; average RR 1.59, 95% CI 1.26 to 2.01) and 12 to 17 months (two studies, average RR 2.20, 95% CI 1.23 to 3.96), with a borderline effect at six to 11 months (six studies; average RR 1.33, 95% CI 1.00 to 1.77). In other comparisons, the effect was unclear for most secondary outcomes, but sample sizes were small.Evidence suggests a borderline effect of health education compared with usual care (five studies; average RR 1.59, 95% CI 0.99 to 2.55), but the quality was downgraded to moderate as the effect was unclear when compared with less intensive interventions (four studies; average RR 1.20, 95% CI 0.85 to 1.70), alternative interventions (one study; RR 1.88, 95% CI 0.19 to 18.60), or when smoking cessation health education was provided as one component of a broader maternal health intervention.There was evidence feedback increased smoking cessation when compared with usual care and provided in conjunction with other strategies, such as counselling (average RR 4.39, 95% CI 1.89 to 10.21), but the confidence in the quality of evidence was downgraded to moderate as this was based on only two studies and the effect was uncertain when feedback was compared to less intensive interventions (three studies; average RR 1.29, 95% CI 0.75 to 2.20).High-quality evidence suggests incentive-based interventions are effective when compared with an alternative (non-contingent incentive) intervention (four studies; RR 2.36, 95% CI 1.36 to 4.09). However pooled effects were not calculable for comparisons with usual care or less intensive interventions (substantial heterogeneity, I2 = 93%).High-quality evidence suggests the effect is unclear in social support interventions provided by peers (six studies; average RR 1.42, 95% CI 0.98 to 2.07), in a single trial of support provided by partners, or when social support for smoking cessation was provided as part of a broader intervention to improve maternal health.The effect was unclear in single interventions of exercise compared to usual care (RR 1.20, 95% CI 0.72 to 2.01) and dissemination of counselling (RR 1.63, 95% CI 0.62 to 4.32).Importantly, high-quality evidence from pooled results demonstrated that women who received psychosocial interventions had a 17% reduction in infants born with low birthweight, a significantly higher mean birthweight (mean difference (MD) 55.60 g, 95% CI 29.82 to 81.38 g higher) and a 22% reduction in neonatal intensive care admissions. However the difference in preterm births and stillbirths was unclear. There did not appear to be adverse psychological effects from the interventions.The intensity of support women received in both the intervention and comparison groups has increased over time, with higher-intensity interventions more likely to have higher-intensity comparisons, potentially explaining why no clear differences were seen with increasing intervention intensity in meta-regression analyses. Among meta-regression analyses: studies classified as having 'unclear' implementation and unequal baseline characteristics were less effective than other studies. There was no clear difference between trials implemented by researchers (efficacy studies), and those implemented by routine pregnancy staff (effectiveness studies), however there was uncertainty in the effectiveness of counselling in four dissemination trials where the focus on the intervention was at an organisational level. The pooled effects were similar in interventions provided for women classified as having predominantly low socio-economic status, compared to other women. The effect was significant in interventions among women from ethnic minority groups; however not among indigenous women. There were similar effect sizes in trials with biochemically validated smoking abstinence and those with self-reported abstinence. It was unclear whether incorporating use of self-help manuals or telephone support increased the effectiveness of interventions. AUTHORS' CONCLUSIONS Psychosocial interventions to support women to stop smoking in pregnancy can increase the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight. Counselling, feedback and incentives appear to be effective, however the characteristics and context of the interventions should be carefully considered. The effect of health education and social support is less clear. New trials have been published during the preparation of this review and will be included in the next update.
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Affiliation(s)
- Catherine Chamberlain
- La Trobe UniversityJudith Lumley Centre251 Faraday StreetMelbourneVicAustralia3000
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - Alison O'Mara‐Eves
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Jessie Porter
- University of MelbourneMelbourne School of Population and Global HealthMelbourneAustralia
| | - Tim Coleman
- University of NottinghamDivision of Primary CareD1411, Medical SchoolQueen's Medical CentreNottinghamUKNG7 2UH
| | - Susan M Perlen
- Murdoch Childrens Research InstituteHealthy Mothers Healthy Families Research GroupMelbourneVictoriaAustralia3052
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education18 Woburn SquareLondonUKWC1H 0NR
| | - Joanne E McKenzie
- Monash UniversitySchool of Public Health & Preventive MedicineMelbourneAustralia
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Zhou L, Niu L, Jiang H, Jiang C, Xiao S. Facilitators and Barriers of Smokers' Compliance with Smoking Bans in Public Places: A Systematic Review of Quantitative and Qualitative Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121228. [PMID: 27973436 PMCID: PMC5201369 DOI: 10.3390/ijerph13121228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 12/02/2022]
Abstract
Background: Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Many countries have ratified a national smoking ban in public places, but studies on factors related to smoking issues in public places post-ban are lacking. Aim: To identify facilitators and barriers that influenced smokers’ compliance with smoking bans in public places. Methods: Using PubMed, MEDLINE, and the Web of Science database, we conducted a systematic search of English articles published before June 2015 on factors of smokers’ compliance with the smoking bans in public places. Results: A total of 390 references were identified, among which seventeen articles (twelve quantitative studies, two qualitative studies, three mixed-method studies) were included in this review. These studies focused on four types of public places including recreational venues (n = 7), hospital (n = 5), school (n = 4), and workplace (n = 1). Factors at the individual-, interpersonal-, and organizational-level were identified: at the individual level, nicotine dependence, insufficiency of tobacco-related knowledge, and the negative attitudes towards smoking bans were the most commonly identified barriers; at the interpersonal level, the smoking behaviors of people around, close relatives, and friends’ approval were the main barriers; and at the organizational level, the main barriers were inefficient implementation of the bans and the inconvenience of the designative smoking areas. Conclusions: This synthesis of the literature provided evidence of the identified barriers and facilitators of smokers’ compliance with the smoking bans. It will be beneficial for the policy-maker to consider interventions on multiple levels of factors to overcome the barriers and enhance smokers’ compliance with the smoking bans in public places.
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Affiliation(s)
- Li Zhou
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078, China.
| | - Lu Niu
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078, China.
- Centre for Health Behaviors Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Hui Jiang
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078, China.
| | - Caixiao Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha 410078, China.
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha 410078, China.
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