Why nurses smoke: a review of the literature

Burden of Risk Factors for Cervical Cancer Among Women Living in East Africa: An Analysis of the Latest Demographic Health Surveys Conducted Between 2014 and 2017

In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries.

The Health of Health Care Professionals

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

Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study

BACKGROUND

Nurses are important agents in public health, which includes being active in tobacco control. Studies show that nurses who smoke are less inclined to offer smoking cessation aid. Nursing students, as the future labor force of nursing, are one of the key groups to monitor.

OBJECTIVES

To identify the prevalence and determinants of use of several tobacco products, e-cigarettes, and cannabis among nursing students in Catalonia.

DESIGN

Cross-sectional multicenter study.

SETTINGS

15 university nursing schools in Catalonia (Spain) in 2015-2016.

PARTICIPANTS

Nursing students attending class at the day of the survey.

METHODS

An anonymous, self-administered questionnaire based on the Global Health Professional Survey was designed. The questions included information on consumption of several tobacco products (manufactured cigarettes, roll your own cigarettes, etc.), e-cigarettes, and cannabis. We estimated the prevalence of use (%) and computed multilevel logistic regressions models, at two levels, to calculate the odds ratios (OR) and their corresponding 95% confidence intervals (CI), adjusting for several individual sociodemographic variables and the nursing school as a grouping variable.

RESULTS

4381 students participated in the study (57.2% of Nursing students in Catalonia at the time of the survey). 29.7% (95%CI: 27.2-32.2) were smokers (18.4% daily and 11.3% occasionally). 66.4% smoked manufactured cigarettes, 47.0% roll your own cigarettes, 10.0% waterpipe, and 0.4% e-cigarettes. The main predictors of smoking were: being ≥25 years (OR = 2.57, 95%CI: 2.03-3.26) and belonging to other Spanish regions (OR = 1.82, 95%CI: 1.30-2.54). 71.5% had low nicotine dependence as defined by the Heavy Smoking Index. Among 11.5% (95%CI: 10.6-12.4) of students used cannabis (daily or occasionally), and men presented higher odds of use (OR = 2.81, 95%CI: 2.11-3.73) than women.

CONCLUSIONS

Tobacco and cannabis use is high among nursing students. It is necessary to carry out early tobacco and cannabis cessation programs among young nursing students.

Tobacco product use among workers in the construction industry, United States, 2014-2016

BACKGROUND

Although cigarette smoking has declined among U.S. workers, smoking remains high among construction workers. This study assessed tobacco product use among U.S. construction workers.

METHODS

The 2014-2016 National Health Interview Survey data for U.S. working adults were analyzed.

RESULTS

Of the 10.2 (6.3% of working adults) million construction workers, 35.1% used any tobacco product; 24.4% were cigarette smokers, 8.3% were cigar, cigarillo, pipe or hookah smokers, 7.8% were smokeless tobacco users, 4.4% were e-cigarette users, and 7.6% used ≥2 tobacco product users. Tobacco use varied by worker characteristics, with highest tobacco use (>35%) among those reporting ≤5 years on the job, temporary work status, job insecurity, or an unsafe workplace. Construction workers had higher odds of tobacco product use than non-construction workers.

CONCLUSIONS

Over one-third of U.S. construction workers use tobacco products and disparities exist across sub-groups. Workplace tobacco control strategies could reduce tobacco use among this population.

Should nurses be role models for healthy lifestyles? Results from a modified Delphi study

AIM

To explore the expectation that nurses should be role models for healthy behaviours.

BACKGROUND

Nurses are expected to be role models for healthy behaviours. Whether this is a realistic and acceptable expectation has not been explored.

DESIGN

Modified Policy Delphi study with two rounds of data collection.

METHOD

Purposive sampling was used to explore areas of agreement and disagreement among six stakeholder groups who influence nursing roles: practising nurses, nursing students, service users, policy makers, workforce development leads and stakeholders working in nurse education. Two rounds of a modified Policy Delphi study were conducted between February - June 2015. The first round used telephone interviews for an open exploration of opinions. The second round used attitude statements to explore convergence and divergence of opinions across stakeholder groups. Responses were analysed thematically.

RESULTS

Policy and professional discourse that asserts that nurses should be healthy role models was seen as unrealistic and unhelpful. Contrary to the view that nurses should epitomize and demonstrate healthy behaviours to encourage patients and to be credible in advice, stakeholders agreed that it was more important to be seen as 'human' and understand the challenges of health behaviour change. Student and practising nurses did not see role modelling healthy behaviours as a reasonable professional expectation.

CONCLUSIONS

The findings challenge the assumptions underpinning the argument that nurses be healthy role models. Further research is needed to understand the views of frontline nurses and to further explore avenues by which health services staff health can be improved.

An international review of tobacco smoking research in the nursing profession, 1976-2006

Tobacco smoking represents a contentious issue in the nursing profession, and one that has now become an important topic in nursing research. Despite this fact, the epidemiological quality of research varies widely, and it has been difficult to accurately determine the true incidence of smoking among nurses. Given these inconsistencies, we conducted a state-of-the-art review to identify international trends in tobacco usage among nurses, to ascertain how the epidemiological quality of research has improved over the past 30 years, and also to elucidate the directions in which nursing research has evolved. A total of 73 English-language studies that met the inclusion criteria were located and analysed. Overall, our review suggests that, while tobacco smoking among nurses appears to be decreasing in many countries during recent years, the international trend is far from uniform, and some developed nations still report high smoking rates among their nursing staff. From a methodological perspective, the relative epidemiological quality of smoking research has also fluctuated over time, making it difficult to compare the results of one study to the next. Despite these caveats, tobacco smoking remains a key topic in nursing research, as well as a critically important occupational-health issue for the entire nursing profession. In order to make the next generation of tobacco research data as comparable as possible, future scholars should consider devising and implementing a standardised format for conducting international tobacco smoking research within the nursing profession.

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

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

Contemporary smoking habits among nurses in Mainland China

Although China is the world's largest consumer of tobacco and tobacco-related products, the epidemiology of smoking has not been well studied among nurses. Given this serious gap in the literature, we considered it necessary to investigate tobacco smoking habits among a large cross-section of contemporary Chinese nurses, by means of a questionnaire survey. A total of 509 replies were obtained from 520 nurses (response rate: 97.9%). The overall prevalence of smoking was 2.6% (95%CI 1.5 - 4.3). When stratified by gender, the prevalence rate among male nurses was 52.2% (33.0 - 70.8). Of those who smoked, the median number was 11 smokes per day for a period of 25.0 years. When categorized by severity, 15.4% were light smokers, 69.2% moderate smokers and 15.4% heavy smokers. When stratified by age there were no smokers under 25 years, with the prevalence between 25 and 34 years similarly low, at 1.1%. The highest smoking rate was seen among nurses aged 45 to 50 years (10.1%), even though they only comprised 9.8% of the total workforce. Although our study suggests that tobacco usage is relatively uncommon among Chinese nurses overall, the rate among male nurses was alarmingly high. The distribution of smoking by age was not uniform however, with a high proportion being concentrated in the older age ranges. As such, future preventive measures will need to consider the individual situation of Chinese nurses who smoke, particularly those who occupy the older age groups.

Prevalence of nurses' smoking habits in psychiatric and general hospitals in China

This study determined the prevalence of lifetime and current smoking and the correlates of current smoking in nurses working in psychiatric and general hospitals in China. Of 807 distributed questionnaires, 799 nurses who were working in two psychiatric hospitals (n=387, 48.4%), and one general hospital (n=412, 51.6%) had analyzable data. Socio-demographic, alcohol use and smoking data were collected with a self-reported questionnaire. Work-related stress was evaluated with the Nurse Stress Inventory. In the whole sample, the lifetime smoking prevalence was 7.6% (females=2.1% vs. males=48.9%, p<0.0001; psychiatric nurses=14.5% vs. non-psychiatric nurses=1.2%, p<0.0001). The prevalence of current smoking was 7.1% (females=2.1% vs. males=44.7%, p<0.0001; psychiatric nurses=13.4% vs. non-psychiatric nurses=1.2%, p<0.0001). In a multiple logistic regression analysis, age 30 years or older, male gender, having children, being a psychiatric nurse and alcohol consumption were positively associated with smoking, while being a nursing officer was negatively associated with smoking (r(2) = 0.513, p<0.0001). Considering the harmful effects of smoking as well as second-hand smoking in the presence of children, effective measures to promote smoking cessation for male, older and psychiatric nurses and those with children are warranted.

Smoking prevalence, attitudes, and confidence about tobacco roles among Australian nursing students

This study identified major challenges to be addressed before student nurses can achieve their full potential in providing effective and comprehensive smoking cessation interventions. Smoking behaviors were assessed among undergraduate nursing students. In addition, students' attitudes, confidence levels, and support for extra training in tobacco control were examined. A nonprobability sample of 381 students at an Australian university was surveyed. The consent rate was 81%. Prevalence of current smoking was 21%. In the regression analysis, age group was the only statistically significant predictor of smoking status. Over one third (36%) did not endorse the nonsmoking exemplar role of their future profession. Most (60%) did not support the concept of routine smoking cessation intervention. Students who were smokers had significantly higher tobacco control confidence levels than nonsmokers. Smoking-related variables did not differ between students in different years of the course. Improved tobacco control training is needed at undergraduate level.

Smoking health professional student: an attitudinal challenge for health promotion?

Tobacco is a major preventable cause of premature morbidity and mortality. Health professionals are uniquely positioned to provide targeted interventions and should be empowered to provide cessation counselling that influence patient smoking. A cross-sectional national survey was administered to all third year students in four disciplines at the University of Malta. The Global Health Professional Student Survey (GHPSS) questionnaire was distributed to collect standardised demographic, smoking prevalence, behavioural, and attitudinal data. 81.9% completed the questionnaire (n = 173/211). A positive significant association between tobacco smoke exposure at home and current smoking status was identified. Non-smokers regarded anti-tobacco policies more favourably than smokers, being more likely to agree with banning of tobacco sales to adolescents (OR 3.6; 95% CI: 2.5–5.3; p ≤ 0.001); and with a smoking ban in all public places (OR 8.9; 95% CI: 6.1–13.1; p ≤ 0.001). Non-smokers favoured a role for health professionals in promoting smoking cessation (OR 5.1; 95% CI: 3.1–8.5; p ≤ 0.001). Knowledge of antidepressants as tools for smoking cessation was also associated with a perceived role for skilled health professionals in cessation counselling (OR 4.9; 95% CI: 1.8–13.3; p = 0.002). Smoking negatively influences beliefs and attitudes of students toward tobacco control. There is a need to adopt a standard undergraduate curriculum containing comprehensive tobacco prevention and cessation training to improve their effectiveness as role models.

Substantiating the concept of work strain: its implication for the assessment of work stressors

OBJECTIVE

To assess which work stressors are substantially contributing to work strain and examine their relative contribution.

METHODS

We prospectively examined the association between work stressors and work strain, which was defined as employees reporting ill due to work stress. Relevant work stressors were combined into a stressor score with each stressor having its own relevance. Standardized odds ratios (SORs) were calculated using logistic regression analysis and used to compare the associations obtained between already existing scales and the stressor score with work strain.

RESULTS

The stressor score yielded an SOR of 1.89 (95% confidence interval: 1.49 to 2.41) for work strain, while psychological demands (JCQ) yielded an SOR of 1.46 (95% confidence interval: 1.09 to 1.88) for work strain.

CONCLUSIONS

We were able to extend and substantiate the range of relevant work stressors into a more comprehensive measure, which should be used to optimize prevention strategies.

Nursing education and beliefs towards tobacco cessation and control: a cross- sectional national survey (GHPSS) among nursing students in Greece

BACKGROUND

Within the healthcare system, nurses have the ability to influence their patients' smoking habits through counselling. Therefore, it is of great importance to appropriately train health professionals on smoking cessation strategies with the aim to help them provide advice to their patients. In light of the above, the objective of this study was to assess the association between Greek nursing students' beliefs towards tobacco control/smoking cessation and the professional training received.

METHODS

During February 2009, we conducted a cross sectional national survey among all 3rd year nursing students of the two university based nursing departments in Greece (University of Athens, University of the Peloponnese). The Global Health Professional Student Survey (GHPSS) questionnaire was applied and following written informed consent 73% provided a completed questionnaire (n = 192/263 enrolled students).

RESULTS

Overall, 33% were current active smokers, while 74% reported ever to experiment smoking. In regards to their beliefs towards tobacco control policies, non smokers were more positive in regards to banning smoking in restaurants (94% vs. 61%, p < 0.001), in bars and cafes (82% vs. 34%, p < 0.001), and all public places (93% vs. 51%, p < 0.001) when compared to current smokers. In comparison with students who had not received training on the importance of asking patients about their smoking habits, those that did were more likely to believe that nurses should have a role in smoking cessation and should act as role models for their patients.

CONCLUSIONS

Resources should be invested in improving the quality of undergraduate education in nursing departments in Greece with respect to tobacco control and smoking cessation.

Differences of smoking knowledge, attitudes, and behaviors between medical and non-medical students

BACKGROUND

Previous studies in the world reported inconsistent results about the relationship of medical professional education with medical students' smoking behaviors, and no similar research had been published in China.

PURPOSE

This paper aims to explore whether the differences of smoking-related knowledge, attitudes, and behaviors existed between medical and non-medical undergraduate students.

METHODS

Eight thousand one hundred thirty-eight undergraduate students sampled from a university in Guangzhou were investigated with a self-administered structured questionnaire about their smoking-related knowledge, attitude and behaviors, and other relevant factors. General linear model and multinomial logistic regression were conducted to test the differences in smoking-related knowledge, attitude, and behaviors between medical and non-medical students while controlling for potential confounding variables.

RESULTS

There was no difference in smoking-related knowledge scores between medical and non-medical freshmen, but medical sophomores and juniors had higher scores of smoking-related knowledge than their non-medical counterparts. The medical sophomores had higher mean score of attitudes towards smoking than non-medical ones. Before entering university, the difference in the prevalence of experimental and regular smoking between medical and non-medical college students was not significant. After entering university, in contrast, the overall prevalence of regular smoking was significantly higher among male non-medical college students than among male medical students. Stratified by current academic year, this difference was significant only among male sophomores.

CONCLUSIONS

Medical students have higher smoking-related knowledge, stronger anti-smoking attitude, and lower prevalence of regular smoking than non-medical college students of similar age, which may be associated with medical professional education.

Nurses, smoking, and immunity: a review

Nurses regularly are exposed to a variety of occupational hazards. In addition to documented occupational hazards, exposure to smoking remains a major concern. This article reviews the prevalence of smoking among nurses working in the United States and discusses their reasons for smoking. Researchers conducted a state-of-the-art review on the effects of cigarette smoking and exposure to secondhand smoke (SHS) on the immune system. Smoking prevalence among nurses working in the United States ranged from 796-12%, and high work stress, poor work environment, shift work, and peer influence were suspected major risk factors influencing smoking behavior. A review of the effects of smoking on immunity revealed that both active smoking and exposure to SHS negatively affects immune function. When rehabilitation nurses stop smoking their health improves and nonsmokers are exposed to less SHS. Rehabilitation nurses are encouraged to share knowledge of the immunological benefits of smoking cessation with patients to facilitate nurse-led rehabilitation programs.

The relationship between workplace, job stress and nurses' tobacco use: a review of the literature

The aim of this study was to provide a summary of the existing published knowledge on the possible relationship between the workplace as a stressor factor and nurses’ tobacco use. A systematic review of the literature from 1995 to 2009, using the MEDLINE database took place. Studies, that referred to nurses’ smoking habit exclusively or as a part of the study, were included in the review. 491 studies were retrieved and their titles/abstracts were examined systematically. Twenty one studies were retrieved for further consideration by a comprehensive literature review. Ten studies fulfilled the eligibility criteria and they were examined further. There is a conflict on the possible relationship between workplace as a stressor factor and nurses’ smoking habits, because there is no evidence on if the nurses’ work environment causes smoking initiation.

Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship

AIM

To identify the perception of Primary Health Care (PHC) female nurses in the Balearic Islands in Spain who are smokers, regarding the suitability of their anti-smoking therapeutic relationships with their clients. Also, to identify what factors they consider may determine why nurses smoke less in PHC than in specialized care (SC).

BACKGROUND

Backed by the signing of the WHO Framework Convention on Tobacco Control (WHO FCTC), a new Anti-Smoking law has been in force in Spain since 2006. This legislation limits the places where tobacco may be consumed. PHC nurses, because of their professional abilities, their number and their direct contact with society on all accounts - both health- and illness-wise - and also because of the proven efficacy of their interventions in the fight against the smoking habit, are called upon to play an important role against the smoking habit in the 21st century.

METHOD

A qualitative study using a semi-structured interview with 15 PHC female nurses who are smokers.

FINDINGS

Regarding the therapeutic relationship, basically two attitudes are adopted: first, blaming themselves and feeling uncomfortable and inadequate to be able to help someone to give up smoking or, second, considering themselves to be in an optimum situation in which to be able to help by sharing their addiction and thereby understanding and empathizing much more with clients. PHC nurses believe they smoke less than SC nurses as a result of a greater degree of awareness.

CONCLUSION

We would suggest that SC nurses should acquire a more relevant role in the fight against the smoking habit. In light of their capacity, commitment and efficacy, we believe there is a case for total autonomy as far as their role as therapists in breaking smoking habits is concerned.

Determinants of smoking initiation among women in five European countries: a cross-sectional survey

BACKGROUND

The rate of smoking and lung cancer among women is rising in Europe. The primary aim of this study was to determine why women begin smoking in five different European countries at different stages of the tobacco epidemic and to determine if smoking is associated with certain characteristics and/or beliefs about smoking.

METHODS

A cross-sectional telephone survey on knowledge and beliefs about tobacco was conducted as part of the Women in Europe Against Lung Cancer and Smoking (WELAS) Project. A total of 5,000 adult women from France, Ireland, Italy, Czech Republic, and Sweden were interviewed, with 1,000 from each participating country. All participants were asked questions about demographics, knowledge and beliefs about smoking, and their tobacco use background. Current and former smokers also were asked questions about smoking initiation. Basic statistics on the cross-sectional data was reported with chi-squared and ANOVA p-values. Logistic regression was used to analyze ever versus never smokers. Linear regression analyses were used to analyze age of smoking initiation.

RESULTS

Being older, being divorced, having friends/family who smoke, and having parents who smoke were all significantly associated with ever smoking, though the strength of the associations varied by country. The most frequently reported reason for initiation smoking was friend smoking, with 62.3% of ever smokers reporting friends as one of the reasons why they began smoking. Mean age of smoking initiation was 18.2 years and over 80% of participants started smoking by the age of 20. The highest levels of young initiators were in Sweden with 29.3% of women initiating smoking at age 14-15 and 12.0% initiating smoking younger than age 14. The lowest level of young initiators was in the Czech Republic with 13.7% of women initiating smoking at age 14-15 and 1.4% of women initiating smoking younger than age 14. Women who started smoking because their friends smoked or to look 'cool' were more likely to start smoking at a younger age. Women who started smoking to manage stress or to feel less depressed were more likely to start smoking at an older age.

CONCLUSIONS

In all five participating countries, friends were the primary factor influencing ever smoking, especially among younger women. The majority of participants began smoking in adolescence and the average reported age of smoking initiation was youngest in Sweden and oldest in the Czech Republic.

Smoking trends in the Nurses' Health Study (1976-2003)

BACKGROUND

Smoking trends among nurses are important to monitor as smoking negatively affects their health and decreases their likelihood of providing cessation interventions to patients.

OBJECTIVES

The objective of the study was to describe the changes in smoking trends in the participants in the Nurses' Health Study (NHS) cohorts over 27 years.

METHODS

An analysis of biennial changes in smoking status and cigarette consumption within nine 5-year birth cohorts (1920-1924 to 1960-1964) and age-specific mortality rates by smoking status were examined in 237,648 female registered nurses (RNs): NHS (ages of 30-55 years in 1976, followed through 2002) and NHS II (ages of 25-42 years in 1989, followed through 2003).

RESULTS

Current smokers constituted 33.2% of NHS in 1976 and 13.5% of NHS II in 1989. Smoking rates declined in all birth cohorts; 8.4% were smoking in 2002/2003. Seventy-nine percent of nurses who ever smoked had quit. The mean cigarettes per day declined over time but still exceeded half a pack per day (15.1 cigarettes) at the end of follow-up. The mortality rate among current smokers was higher than that of former smokers and was approximately twice that of never smokers in all age categories; those who smoked were more likely to have comorbid conditions.

DISCUSSION

This study provides the first report of smoking trends among RNs in the NHS. The decline in smoking rate among female nurses mirrors the decline in smoking rate among women in the United States over the past 25 years. Increased mortality and morbidity rates indicate the devastating cost of smoking to the profession and can provide support for the urgent need for further research to encourage continued smoking cessation efforts for nursing professionals.

Tobacco use amongst nursing and physiotherapy students: a cross sectional questionnaire survey

AIM

The aim of this research was to evaluate the prevalence, knowledge and attitudes of tobacco use in the students of the School of Health Sciences in the Campus of Ponferrada (University of León, Spain). Two-hundred and sixty-six (88.3% of respondents) students were assessed by a confidential questionnaire, which was distributed, completed by the students and collected in the same session.

METHODS

This was a descriptive quantitative survey research design to examine the tobacco use among nursing and physiotherapy students.

RESULTS

The global prevalence was 29.3%. In relation to academic courses we have observed statistical significance (p=0.006). Therefore students increased tobacco use while their training at the school. Seventy (89.7%) of students were smokers prior to commencing degree. Nursing students declared were unfamiliar with strategies and methods to help people to quit. The first academic course students (78.6%) significantly differed (p=0.009) from second and third course. We have found scores statistically significant (p=0.04) about the students opinion about health professionals social role function.

CONCLUSION

Tobacco consumption in university health students in the third year was higher than people aged 16-24 years old reported from the National Health Survey. The findings showed a great need to improve the curricular content in the area of tobacco including information, prevention, and treatment.

Impact of reproductive experience on women's smoking behaviour in Japanese nurses

OBJECTIVES

The objectives of this study were to describe current and past smoking behaviour of female Japanese nurses, to examine factors associated with developing and stopping a smoking habit, and to examine how their reproductive experiences affect their smoking behaviour.

STUDY DESIGN

A cross-sectional study. This study was a baseline survey of a prospective occupational cohort study.

METHODS

A self-administered survey of 1748 female Japanese nurses aged over 20 years was conducted in Gunma prefecture, Japan, in 1999.

RESULTS

Overall, 27.2% developed a smoking habit (current smokers, 19.8%; ex-smokers, 7.4%) and 72.2% were never smokers. Logistic regression analysis showed that the type of nursing certificate was statistically associated with developing a smoking habit. It also showed that the type of nursing certificate, work place, marital status and current pregnancy were statistically associated with smoking cessation. Currently pregnant women were more likely to stop smoking than non-pregnant women (adjusted odds ratio, 3.18; 95% confidence intervals, 1.25-8.06). For women aged 20-29 years, the proportions of current smokers, ex-smokers and never smokers among pregnant women were 11.5, 23.1 and 65.4%, respectively; among non-pregnant women of this age, the values were 22.3, 4.3 and 73.4%, respectively. There was a statistically significant difference in such proportions between the two groups (chi2=19.27; P<0.0001). More than half of the ex-smokers who were currently pregnant had stopped smoking in the last 12 months. Smoking behaviour showed no statistically significant difference between women who had had at least one delivery and women who had not.

CONCLUSIONS

The results suggest that pregnancy provides a good opportunity for smoking cessation, but a large proportion of women who successfully quit smoking during pregnancy relapse after delivery.

Tobacco cessation in acute and critical care nursing practice: challenges and approaches

Recently, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented new national core measures, including tobacco-cessation interventions for patients hospitalized because of pneumonia or other pulmonary-related illnesses, acute myocardial infarction, or heart failure. All interventions performed for such patients must be documented in the patient's chart. Because the JCAHO standards for tobacco cessation are implemented hospital-wide, acute and critical care nurses must take an active role in their execution. This article discusses the challenges to integrating tobacco cessation in daily acute and critical care nursing practice and makes recommendations regarding cessation approaches designed to improve health outcomes for tobacco-dependent patients.

Influence of lifestyle, health, and work environment on smoking cessation among Danish nurses followed over 6 years

BACKGROUND

The purpose of this study was to examine the influence of lifestyle, health, and work environment on smoking cessation among Danish nurses age 45-66 years over a 6-year period from 1993-1999.

METHODS

Data derive from the Danish Nurse Cohort Study; a prospective cohort established in 1993 when all Danish female nurses 45+ years old and members of the Danish Nurses Association were mailed a questionnaire. The cohort was followed up 6 years later in 1999. In total, 12,980 responded to questions concerning smoking status in both the 1993 and 1999 surveys. This study deals with the 4713 women (36%) who reported smoking at baseline. Smoking cessation was based on self-report.

RESULTS

At follow-up in 1999, 24% reported that they no longer smoked. Low prior tobacco consumption at baseline, high fresh fruit consumption, high blood pressure, working day shifts, having low physical job strain, perceiving influence on one's own work, and partner's socio-economic status (as measured by most recent occupation) were associated with successful smoking cessation.

CONCLUSION

The findings from this study highlight the importance of various factors, including lifestyle, health status, and aspects of one's work environment, on successful efforts at smoking cessation.

Nurses, smoking, and the workplace

The purpose of this study was to examine attitudes and experiences of nurses regarding smoking and smoking cessation in the workplace. Eight focus groups were conducted with current or former smokers (n = 60). A questionnaire provided information about smoking history. Content analysis revealed six themes: taking breaks, stress and smoking, social support from colleagues, hiding smoking from patients and their families, impact of workplace smoking restrictions, and challenges to smoking cessation in the workplace. Nurses who smoke were perceived as taking more breaks and spending less time with patients than those who do not smoke. These findings document the impact of smoking among nurses in the workplace. Strategies are needed to support smoking cessation efforts of nurses as an important occupational health issue.

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND

It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement.

OBJECTIVES

To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions.

METHODS

Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes.

RESULTS

Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups.

CONCLUSIONS

Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.

Associations of sleep problems and recent life events with smoking behaviors among female staff nurses in Japanese hospitals

For the purpose of examining the relation of sleep problems and other possible correlates with smoking among staff nurses in hospitals, the cross-sectional data of a self-administered questionnaire survey for 522 Japanese female staff nurses were reanalyzed. Registered nurses or licensed practical nurses were 82%, while nursing assistants were 18%. The prevalence of current smoking (PCS) was 29%, being higher than that in the general population of Japanese women. The current smokers exhibited a high tendency toward tobacco dependence. Multivariate analyses revealed that PCS was associated with recent frequent night shifts and a large amount of support from coworkers, while the association of a large amount of job control and a feeling of light overnight sleep with PCS was also suggested. The tobacco-dependent tendency was associated with recent life events and the presence of insomnia. It is possible that smoking is a countermeasure against sleepiness caused by the disadaptation to shift-work, or that tobacco-intake pharmacologically disturbs sleep. For decreasing PCS in staff nurses, further research should focus on the relation of smoking with their sleepiness and shift-working system, and also on the process in which major life events develop smoking behaviors.

Smoking as a symbol of friendship: Qualitative study of smoking behavior and initiation of a group of male nurse students in Iran

The study of smoking initiation and behavior of nurses and nurse students is important when considering their professional health promotion roles. In the present qualitative study, 26 nursing students of all grades from two nursing schools in the capital city of Iran were surveyed to explore their reasons for smoking. Through in-depth and semistructured interviews, participants were encouraged to talk about their smoking behavior and explain initiating reasons freely. Majority of the participants began smoking before commencing nursing, while only a few initiated smoking after entering into nursing school. Reasons for smoking included belonging to a group and as a symbol of friendship and mutual trust. Indeed, peer group behaviors influenced most participates to commence smoking and social influences also emerged as a theme in this study.

Biochemical hypoglycemia in female nurses during clinical shift work

Female nurses in Japan commonly experience symptoms similar to those of hypoglycemia while working. Biochemical hypoglycemia can lead to impaired cognition; thus, it is important to know the prevalence of biochemical hypoglycemia among nurses. Five hundred and sixty-eight female nurses (53% of the target population) in four hospitals completed questionnaires. They determined their blood glucose levels 12 times, at four points during three shifts. Fifty-seven nurses (10%) recorded biochemical hypoglycemia (<or=3.0 mM) at least once. Multivariate analysis revealed three independent risk factors for hypoglycemia: higher coefficient of variation of blood glucose level, lower body mass index, and not smoking. Subjective symptoms were not associated with hypoglycemia. More research on hypoglycemia is needed in order to improve working environment for nurses.

International efforts in tobacco control

OBJECTIVES

To review international nursing involvement in tobacco control and discuss opportunities and challenges to enhance nurses' participation in decreasing tobacco-related morbidity and mortality.

DATA SOURCES

Published literature and published and unpublished material developed by nurses in their tobacco control initiatives.

CONCLUSION

Worldwide, nurses have been involved in tobacco control. However, many opportunities remain for involvement in the areas of education, research, and practice.

IMPLICATIONS FOR NURSING PRACTICE

There are numerous opportunities for nurses throughout the world to enhance their involvement in tobacco control.

Nursing and tobacco reduction: a review of the literature

Nurses have an instrumental role to play in tobacco reduction, which is one strategy used to address tobacco use; a primary source of preventable morbidity and mortality globally. The following review addresses activities by two groups of nurses: nursing governance bodies and nurse scientists, whom together provide vision and knowledge to support and shape nursing practice. While nursing governance bodies and scientists have contributed a great deal to tobacco reduction, there are also gaps. Areas that require strengthening are: support for tobacco dependent nurses, basic nursing education concerning tobacco dependency treatment, and integration of tobacco dependence treatment into nursing practice.

The role of stress, peer influence and education levels on the smoking behaviour of nurses

Smoking kills yet a substantial number of qualified nurses continue to smoke. Stress, peer influence and education levels have been cited as influencing prevalence levels among nurses. A self-completed questionnaire was used to survey qualified nurses' perceptions of smoking prevalence, attitudes, and reasons for smoking. The respondents were composed of a random sample (n=1074) of qualified nurses employed in Northern Ireland. Results show that 25.8% of the sample smoked. Factors influencing smoking behaviour and reasons for continuing smoking are explored. This paper discusses the implications of these findings for nursing and nurses' health promotion activities.

Qualified nurses' smoking prevalence: their reasons for smoking and desire to quit

AIM AND RATIONALE: The preventable nature of smoking related diseases places a major responsibility for health promotion on all health professionals. This study used a questionnaire to survey qualified nurses in Northern Ireland as to smoking prevalence and their desire to quit the habit. It also explores their knowledge base relating to smoking related diseases and their motivation to act as health promoters with patients who smoke.

METHODS

A random sample (n=1074) of qualified nurses employed by the Health and Social Services Trusts, private, and voluntary organizations in the province were surveyed.

RESULTS

Results show that 25.8% were smokers, 19% were ex-smokers and 55.2% were nonsmokers. Three quarters expressed a wish to stop within 6-months. Almost all smokers and half of ex-smokers had taken up the habit prior to commencing nursing. 'Addiction' and 'enjoyment' were given as the principle reasons for continued smoking. Health reasons were paramount in smokers' desire to stop smoking.

CONCLUSIONS

These findings suggest that smoking prevalence among qualified nurses in no greater than that reported by females in the general Northern Ireland population. Results also indicate that those nurses who smoke were less willing to take on the role of a health promoter with patients who smoke. Implications and recommendations for practice, education and research are explored.

Predictors of tobacco control among nursing students

As the most numerous health care providers, nurses could reduce tobacco-related morbidity and mortality. A cross-sectional survey of 476 junior and senior students at 12 schools of nursing in the New York metropolitan area was conducted, to determine nurse knowledge of tobacco control, their attitudes, beliefs, and practices. Overall, 76% of all nursing students reported that they practiced tobacco control. Current smokers were less likely to participate in tobacco control with targets ranging from the nurse herself to the community than either never or ex-smokers. Nurses were more likely to engage in tobacco control among individual, family, or group clients than to advocate for changes in the community. Student nurses who were African American or Hispanic, had never smoked or were ex-smokers, those who had better knowledge of cessation approaches, and those who tended to have more confidence in their cessation counseling skills were more likely to engage in multi-target tobacco control than other similar nurses. Tailored interventions that emphasize discrete counseling skills are suggested.

Barriers to tobacco cessation in clinical practice: report from a National Survey of Oncology Nurses

This study describes the survey results of a national random sample of members of the Oncology Nursing Society who reported the greatest number of barriers to delivering a tobacco cessation intervention with their patients. Nurses who perceived the greatest number of barriers were more likely to be current smokers and to be young and were less likely to have an advanced degree, to be a nurse practitioner, or to have administrative responsibilities. Those with greater barriers were less likely to deliver tobacco cessation interventions.