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Daly JB, Doherty E, Tully B, Wiggers J, Hollis J, Licata M, Foster M, Tzelepis F, Lecathelinais C, Kingsland M. Effect of implementation strategies on the routine provision of antenatal care addressing smoking in pregnancy: study protocol for a non-randomised stepped-wedge cluster controlled trial. BMJ Open 2024; 14:e076725. [PMID: 38580367 PMCID: PMC11002428 DOI: 10.1136/bmjopen-2023-076725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/21/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Globally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety of clinical services but there is an absence of evidence in applying such strategies to support improvements to antenatal care for smoking cessation in pregnancy. This study aims to determine the effectiveness and cost effectiveness of implementation strategies in increasing the routine provision of recommended antenatal care for smoking cessation in public maternity services. METHODS AND ANALYSIS A non-randomised stepped-wedge cluster-controlled trial will be conducted in maternity services across three health sectors in New South Wales, Australia. Implementation strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training and monitoring and feedback will be delivered sequentially to each sector over 4 months. Primary outcome measures will be the proportion of: (1) pregnant women who report receiving a carbon monoxide breath test; (2) smokers or recent quitters who report receiving quit/relapse advice; and (3) smokers who report offer of help to quit smoking (Quitline referral or nicotine replacement therapy). Outcomes will be measured via cross-sectional telephone surveys with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost effectiveness of the implementation intervention. Process measures including acceptability, adoption, fidelity and reach will be reported. ETHICS AND DISSEMINATION Ethics approval was obtained through the Hunter New England Human Research Ethics Committee (16/11/16/4.07; 16/10/19/5.15) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health policy-makers and health services to inform best practice processes for effective guideline implementation. Findings will also be disseminated at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry-ACTRN12622001010785.
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Affiliation(s)
- Justine B Daly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
- Gomeroi Nation, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jenna Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Milly Licata
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Michelle Foster
- Nursing and Midwifery Services, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Guri-Scherman ALY, Neumark Y, Rodnay M, Bar-Zeev Y. Barriers and Enablers to Implementing a Smoke-free Home and Car During Pregnancy: A Qualitative Study Among Expectant Israeli Fathers. Nicotine Tob Res 2024; 26:94-101. [PMID: 37565607 DOI: 10.1093/ntr/ntad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers. AIMS AND METHODS Twenty-four qualitative semistructured telephone interviews were audio-recorded, transcribed, and analyzed according to a reflexive and collaborative thematic approach. Inclusion criteria were being male, Hebrew speaker, age ≥18 years, smoking at least one cigarette a day, and living with their nonsmoking pregnant spouse. The Capability, Opportunity and Motivation for Behavior (COM-B) model was used as a theoretical model for analysis. RESULTS Participants reported feeling a strong responsibility for their pregnant spouse's comfort and health, stating that they are doing the best they can to reduce their spouse's secondhand smoke exposure (Motivation). Participants had a low level of knowledge about specific secondhand smoke health consequences, effective strategies to reduce secondhand smoke exposure, with incorrect perceptions about what constitutes exposure (Capability). Couple relationships were not affected by the husband's smoking habits, and participants expressed mutual consideration and understanding (Opportunity). Participants also expressed positive attitudes regarding smoke-free home and car implementation but emphasized that any changes have to be their own decision (Motivation). CONCLUSIONS The present study identified principal Capability, Opportunity and Motivation barriers and facilitators that influence Israeli expectant fathers' decision to implement a smoke-free home and car. Those findings will inform the development of a digital behavioral intervention targeting expectant fathers to reduce prenatal secondhand smoke exposure. IMPLICATIONS Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. Interventions among expectant fathers that focus on creating a smoke-free home and car may be effective because pregnancy has been identified as a "window of opportunity" that generates a strong motivation and creates a sense of urgency to change smoking behavior, while being considered more achievable than smoking cessation. Interventions might be effective if they focus on strengthening the parental responsibility among expectant fathers and emphasize the benefits of a smoke-free home and car, while maintaining male autonomy and increasing skills to effectively implement a smoke-free home and car.
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Affiliation(s)
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Burtin A, Clet E, Stevens N, Kervran C, Frevol M, Ratel R, Moysan P, Alla F. Factors associated with the implementation of the 5As model of smoking cessation support during pregnancy: A scoping review. Tob Induc Dis 2023; 21:110. [PMID: 37654503 PMCID: PMC10467347 DOI: 10.18332/tid/169623] [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: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION The prevalence of smoking among pregnant women is the highest in the European region, making smoking cessation a public health priority. In order to address this, pregnant smokers need to be better supported by their healthcare professionals in their attempts to quit smoking. The 5As model, which is a psychosocial intervention, seems to be effective in this specific population. The objective of this review is to identify the factors that act as barriers or facilitators to the implementation of the 5As model within prenatal practices. METHODS We conducted a scoping review of the literature on PubMed and Scopus databases, using the terms: 'smoking cessation', 'pregnan*', and ('5A' or '5As'). The identified factors were categorized using a theoretical framework of The European Observatory on Health Systems and Policies. RESULTS Among the 43 articles identified in the databases, 13 articles were included in this review. In total, we identified 48 factors. When necessary, we grouped them together, resulting in 12 sub-categories, which in turn were grouped into 9 categories. Those 9 categories were then classified into the 3 levels of the theoretical framework: the clinical level (motivation), the organizational level (healthcare pathway), and the health system level (political environment). CONCLUSIONS The factors identified are varied and numerous and are involved in each level of the theoretical framework.
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Affiliation(s)
- Adrianna Burtin
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Estelle Clet
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Nolwenn Stevens
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Charlotte Kervran
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Manon Frevol
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
| | - Rébecca Ratel
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - Perrine Moysan
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
| | - François Alla
- Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, Bordeaux, France
- Inserm UMR 1219-Bordeaux Population Health, University of Bordeaux, Bordeaux, France
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Small SP, Maddigan J, Swab M, Jarvis K. Pregnant and postnatal women's experiences of interacting with health care providers about their tobacco smoking: a qualitative systematic review. JBI Evid Synth 2022:02174543-990000000-00111. [PMID: 36477572 DOI: 10.11124/jbies-22-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this review was twofold: (i) to comprehensively identify the best available evidence about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) concerning health care providers' interactions with them about their smoking, when such interactions occurred during contact for prenatal or postnatal health care in any health care setting; and (ii) to synthesize the research findings for recommendations to strengthen health care providers' interventions regarding smoking during pregnancy and smoking during the postnatal period. INTRODUCTION Maternal tobacco smoking during pregnancy and maternal tobacco smoking postnatally pose serious health risks for the woman, fetus, and offspring, whereas maternal smoking cessation has beneficial health effects. Given the importance of health care providers' interactions with pregnant and postnatal women for smoking cessation care, it is essential to understand women's experiences of such interactions. INCLUSION CRITERIA Studies considered for this review had qualitative research findings about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) in relation to health care providers' interactions with them about their smoking. METHODS The review was conducted using the JBI approach to qualitative systematic reviews. Published studies were sought through 6 academic databases (eg, CINAHL, MEDLINE). Unpublished studies were searched in 6 gray literature sources (eg, ProQuest Dissertations and Theses, Google Scholar). Reference lists of retrieved records were also searched. The searches occurred in October and November 2020; no country, language, or date limits were applied. Study selection involved title and abstract screening, full-text examination, and critical appraisal of all studies that met the inclusion criteria for the review. Study characteristics and research findings were extracted from the included studies. Study selection and extraction of findings were conducted by two reviewers independently; differences between reviewers were resolved through consensus. The research findings were categorized, and the categories were aggregated into a set of synthesized findings. The synthesized finding were assigned confidence scores. The categories and finalized synthesized findings were agreed upon by all reviewers. RESULTS The 57 included studies varied in qualitative research designs and in methodological quality (from mostly low to high). There were approximately 1092 eligible participants, and 250 credible and unequivocal research findings. The research findings yielded 14 categories and 6 synthesized findings with low to very low confidence scores. Some women who smoked tobacco during pregnancy and some women who smoked tobacco postnatally lacked supportive interactions by health care providers regarding their smoking; other women experienced supportive interactions by health care providers. Women were adversely impacted when health care providers' interactions lacked supportiveness, and were beneficially impacted when interactions were supportive. Women varied in openness to health care providers' interactions regarding their smoking, from not being receptive to being accepting, and some women wanted meaningful health care provider interactions. CONCLUSIONS Although confidence in the synthesized findings is low to very low, the evidence indicates that supportive health care provider interactions may facilitate positive smoking behavior change in pregnancy and postnatally. It is recommended that health care providers implement accepted clinical practice guidelines with women who smoke prenatally or postnatally, using an approach that is person-centered, emotionally supportive, engaging (eg, understanding), and non-authoritarian. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020178866.
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Affiliation(s)
- Sandra P Small
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Joy Maddigan
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada.,Health Sciences Library, Memorial University, St. John's, NL, Canada
| | - Kimberly Jarvis
- Faculty of Nursing, Memorial University, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
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Cruvinel E, Richter KP, Pollak KI, Ellerbeck E, Nollen NL, Gajewski B, Sullivan-Blum Z, Zhang C, Shergina E, Scheuermann TS. Quitting Smoking before and after Pregnancy: Study Methods and Baseline Data from a Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10170. [PMID: 36011811 PMCID: PMC9408087 DOI: 10.3390/ijerph191610170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Smoking during pregnancy and postpartum remains an important public health problem. No known prior study has prospectively examined mutual changes in risk factors and women's smoking trajectory across pregnancy and postpartum. The objective of this study was to report methods used to implement a prospective cohort (Msgs4Moms), present participant baseline characteristics, and compare our sample characteristics to pregnant women from national birth record data. The cohort study was designed to investigate smoking patterns, variables related to tobacco use and abstinence, and tobacco treatment quality across pregnancy through 1-year postpartum. Current smokers or recent quitters were recruited from obstetrics clinics. Analyses included Chi-square and independent sample t-tests using Cohen's d. A total of 62 participants (41 smokers and 21 quitters) were enrolled. Participants were Black (45.2%), White (35.5%), and multiracial (19.3%); 46.8% had post-secondary education; and most were Medicaid-insured (64.5%). Compared with quitters, fewer smokers were employed (65.9 vs 90.5%, Cohen's d = 0.88) and more reported financial strain (61.1% vs 28.6%; Cohen's d = 0.75). Women who continue to smoke during pregnancy cope with multiple social determinants of health. Longitudinal data from this cohort provide intensive data to identify treatment gaps, critical time points, and potential psychosocial variables warranting intervention.
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Affiliation(s)
- Erica Cruvinel
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kimber P. Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, and Cancer Prevention and Control Program, Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27705, USA
| | - Edward Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Nicole L. Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Zoe Sullivan-Blum
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Chuanwu Zhang
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Taneisha S. Scheuermann
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Gould GS, Ryan NM, Kumar R, Stevenson LC, Carson‐Chahhoud KV, Oldmeadow C, Foster J, Deeming S, Boydell K, Doran CM, Searles A, Mattes J, Atkins L, Clarke M. SISTAQUIT: training health care providers to help pregnant Aboriginal and Torres Strait Islander women quit smoking. A cluster randomised controlled trial. Med J Aust 2022; 217:36-42. [PMID: 35780458 PMCID: PMC9540312 DOI: 10.5694/mja2.51604] [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: 09/02/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND About 44% of Indigenous Australian women smoke during pregnancy, compared with 12% of pregnant non-Indigenous women. Health care providers can assist smoking cessation, but they are not typically trained in culturally appropriate methods. OBJECTIVES To determine whether a health care worker training intervention increases smoking cessation rates among Indigenous pregnant smokers compared with usual care. METHODS AND ANALYSIS Supporting Indigenous Smokers to Assist Quitting (SISTAQUIT) study is a multicentre, hybrid type 1, pragmatic, cluster randomised controlled trial that compares the effects of an intervention for improving smoking cessation by pregnant Indigenous women (16 years or older, 32 weeks' gestation or less) with usual care. Twenty-one health services caring for Indigenous people in five Australian jurisdictions were randomised to the intervention (ten sites) or control groups (eleven sites). Health care providers at intervention sites received smoking cessation care training based on the ABCD (ask/assess; brief advice; cessation; discuss psychosocial context) approach to smoking cessation for Indigenous women, an educational resource package, free oral nicotine replacement therapy for participating women, implementation support, and trial implementation training. Health care providers in control group services provided usual care. PRIMARY OUTCOME abstinence from smoking (self-reported abstinence via survey, validated by carbon monoxide breath testing when possible) four weeks after enrolment in the study. SECONDARY OUTCOMES health service process evaluations; knowledge, attitudes, and practices of health care providers; and longer term abstinence, perinatal outcomes, and respiratory outcomes for babies (to six months). Ethics approval: The human research ethics committees of the University of Newcastle (H-2015-0438) and the Aboriginal Health and Medical Research Council of NSW (1140/15) provided the primary ethics approval. Dissemination of results: Findings will be disseminated in peer-reviewed publications, at local and overseas conferences, and via public and social media, and to participating health services in art-based formats and reports. Policy briefs will be communicated to relevant government organisations. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry, ACTRN12618000972224 (prospective).
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Affiliation(s)
| | - Nicole M Ryan
- Southern Cross UniversityCoffs HarbourNSW
- The University of NewcastleNewcastleNSW
| | | | | | | | | | | | | | | | | | - Andrew Searles
- The University of NewcastleNewcastleNSW
- Hunter Medical Research InstituteNewcastleNSW
| | | | - Louise Atkins
- UCL Psychology and Language Sciences University College LondonLondonUnited Kingdom
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Smoking status: A tacit screen for postpartum depression in primary care settings. J Affect Disord 2021; 295:1243-1250. [PMID: 34706438 DOI: 10.1016/j.jad.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/22/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Universal screening for postpartum depression (PPD) remains an unachieved national priority. A tacit screen that requires no additional resources for administration can help to achieve this priority. We examine the predictive utility of using smoking as a tacit screen for PDD. We first establish smoking is a valid proxy for more prominent psychosocial determinants of PPD and is a predictor for PPD. METHODS We analyzed PRAMS data (2012-2015; N=134,435). Time of smoking was categorized as nonsmoker, during the prenatal period, the postpartum, or continuously; PPD was assessed using two PHQ-2 style questions. RESULTS Compared to nonsmokers, women who smoked only during the prenatal period (OR: 1.41; 95% CI: 1.06 - 1.86), only during the postpartum (OR: 1.33; 95% CI: 1.18 - 1.49), and continuously throughout both periods (OR: 1.54; 95% CI: 1.41 - 1.69) were more likely to experience PPD. Smoking assessed at a prenatal visit (SN: 0.90, SP: 0.21), postpartum visit (SN: 0.86, SP: 0.25), or assessed at both visits (SN: 0.90, SP: 0.19) performed relatively well as a tacit screen for PPD, performing better among unmarried women (SN: 0.75 - 0.81; SP: 0.29 - 0.36). LIMITATIONS In this study, the criterion of positivity used was PRAMS' adapted version of the PHQ-2. This tacit screen may perform differently relative to a clinical diagnosis. CONCLUSIONS Time of smoking predicts risk of PPD and can be used to tacitly screen for PPD with reasonable accuracy without requiring any additional time in settings with limited resources for routine screening of PPD.
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Mersha AG, Kennedy M, Eftekhari P, Gould GS. Predictors of Adherence to Smoking Cessation Medications among Current and Ex-Smokers in Australia: Findings from a National Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212225. [PMID: 34831981 PMCID: PMC8619677 DOI: 10.3390/ijerph182212225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022]
Abstract
Background: Adherence to smoking cessation medications (SCMs) improve the rate of successful quitting. This study aimed to evaluate the level of adherence to SCMs and associated factors among smokers and ex-smokers in Australia. Method: A cross-sectional study using an online survey was conducted in Australia. Descriptive statistics were used to present the overall characteristics of participants. Cross-tabulation with Pearson’s chi-square test was performed to evaluate the possible associations between factors. To explore barriers and facilitators of adherence to SCMs, logistic regressions were conducted. Results: Among 201 participants, 57 (28.4%) were found to be adherent to SCMs. The odds of being adherent were found to be higher among participants with good social support (AOR = 3.28, 95% CI of 2.30–6.27). Participants who did not experience anxiety symptoms had higher odds of being adherent to SCMs as compared to smokers who had anxiety symptoms (AOR = 4.41, 95% CI of 3.64–14.68). Having previous experience of using SCMs improved adherence four-fold (AOR = 3.87, 95% CI of 1.11–13.44). Level of nicotine dependence showed a direct association with adherence (AOR = 3.53, 95% CI of 1.40–8.95). Not relapsing while on the medications improved adherence (AOR = 2.88, 95% CI of 1.21–6.88). Conclusion: In a study of smokers and ex-smokers in Australia, the self-reported level of adherence to SCMs was found to be low. Adherence was associated with social, psychological, and medication-related factors. Smoking cessation interventions are recommended to include strategies that can address medication adherence.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Correspondence:
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; (M.K.); (P.E.)
- Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Gillian Sandra Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
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Kumar R, Stevenson L, Jobling J, Bar-Zeev Y, Eftekhari P, Gould GS. Health providers' and pregnant women's perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies. BMC Pregnancy Childbirth 2021; 21:550. [PMID: 34384387 PMCID: PMC8359058 DOI: 10.1186/s12884-021-03773-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Methods A systematic search of online databases (MEDLINE, EMBASE, PsycINFO and CINAHL) using PRISMA guidelines. PW’s and HPs’ quotes, as well as the authors’ analysis, were extracted and double-coded (30%) using the COM-B framework. Results Thirty-two studies included research from 5 continents: twelve on HPs’ perspectives, 16 on PW’s perspectives, four papers included both. HPs’ capability and motivation were affected by role confusion and a lack of training, time, and resources to provide interventions. HPs acknowledged that advice should be delivered while taking women’s psychological state (capability) and stressors into consideration. Pregnant women’s physical capabilities to quit (e.g., increased metabolism of nicotine and dependence) was seldom addressed due to uncertainty about nicotine replacement therapy (NRT) use in pregnancy. Improving women’s motivation to quit depended on explaining the risks of smoking versus the safety of quit methods. Women considered advice from HPs during antenatal visits as effective, if accompanied by resources, peer support, feedback, and encouragement. Conclusions HPs found it challenging to provide effective SCC due to lack of training, time, and role confusion. The inability to address psychological stress in women and inadequate use of pharmacotherapy were additional barriers. These findings could aid in designing training programs that address HPs’ and PW’s attitudes and supportive campaigns for pregnant smokers. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03773-x.
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Affiliation(s)
- Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Leah Stevenson
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Judith Jobling
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine Hebrew University - Hadassah Medical Center, PO Box 12272, Jerusalem, 91120, Israel
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia.
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Mersha AG, Eftekhari P, Bovill M, Tollosa DN, Gould GS. Evaluating level of adherence to nicotine replacement therapy and its impact on smoking cessation: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2021; 79:26. [PMID: 33663575 PMCID: PMC7934490 DOI: 10.1186/s13690-021-00550-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
Background Nicotine replacement therapy (NRT) has proven effect in assisting smoking cessation. However, its effectiveness varies across studies and population groups. This may be due to differences in the rate of adherence. Hence, this review aims to examine the level of adherence to NRT and to assess if the level of adherence to NRT affects success of smoking cessation. Methods A systematic review and meta-analysis was conducted using studies retrieved from five electronic databases (MEDLINE, Scopus, EMBASE, Web of science, and PsycINFO) and grey literature. Pooled analysis was conducted using Stata version 16 software. Methodological quality and risk of bias were assessed using the NIH Quality Assessment Tool. Analyses were done among those studies that used similar measurements to assess level of adherence and successful smoking cessation. Heterogeneity of studies was assessed using the Higgins’ I2 statistical test. Funnel plots and Egger’s regression asymmetry test were used to affirm presence of significant publication bias. Results A total of 7521 adult participants of 18 years old and above from 16 studies were included in the analysis. Level of adherence to NRT among participants of randomised controlled trials were found to be 61% (95% CI, 54–68%), p-value of < 0.001 and I2 = 85.5%. Whereas 26% of participants were adherent among participants of population-based studies with 95% CI, 20–32%, p-value of < 0.001 and I2 = 94.5%. Level of adherence was the lowest among pregnant women (22%) with 95% CI, 18–25%, p-value of 0.31 and I2 = 15.8%. Being adherent to NRT doubles the rate of successful quitting (OR = 2.17, 95% CI, 1.34–3.51), p-value of < 0.001 and I2 = 77.6%. Conclusions This review highlights a low level of adherence to NRT among participants of population-based studies and pregnant women as compared to clinical trials. Moreover, the review illustrated a strong association between adherence and successful smoking cessation. Hence, it is recommended to implement and assess large scale interventions to improve adherence. Health programs and policies are recommended to integrate the issue of adherence to NRT as a core component of smoking cessation interventions. Trial registration PROSPERO registration number: CRD42020176749. Registered on 28 April 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00550-2.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Chechela street, kebele 16, Gondar, Amhara region, Ethiopia. .,School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia.
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
| | - Daniel Nigusse Tollosa
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia
| | - Gillian Sandra Gould
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, Newcastle, New South Wales, 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, Newcastle, NSW, 2305, Australia
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Gould GS, Holder C, Oldmeadow C, Gruppetta M. Supports Used by Aboriginal and Torres Strait Islander Women for Their Health, including Smoking Cessation, and a Baby's Health: A Cross-Sectional Survey in New South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217766. [PMID: 33114142 PMCID: PMC7660307 DOI: 10.3390/ijerph17217766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/16/2022]
Abstract
This study explored Aboriginal and Torres Strait Islander women’s use of supports for their general health, for smoking cessation, and the health of babies or children, and analyzed the women’s predictors for seeking types of support. Aboriginal and Torres Strait Islander women were recruited for a cross-sectional survey in two regions of NSW N = 132. The 19-item survey questioned the likelihood that the participant would use the various supports for their health, to quit smoking, and for a baby or child’s health. Logistic regression analyses were performed on N = 98 with complete data. Older participants were less likely to use Facebook or the internet for their health, or the health of a child, but were more likely to consult with health professionals. Women who had quit smoking were less likely to use an app for their health compared to smokers. Women who had a child living in their household were less likely to use the internet for a child’s health. This community-based study revealed age-related differences for access to health services and differences according to smoking status. Patterns of internet and app use warrant further consideration when planning strategies to improve Aboriginal and Torres Strait Islander women and children’s health.
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Affiliation(s)
- Gillian S. Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
- Correspondence: ; Tel.: +61-40-361-5563
| | - Carl Holder
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights 2305, Australia; (C.H.); (C.O.)
| | - Maree Gruppetta
- School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, Australia;
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General practitioner and obstetrician views on system changes to improve smoking cessation care in pregnancy in Australia: a cross-sectional survey. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AbstractIntroductionSystemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training.AimAssess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses.MethodsNational cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians).ResultsN = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%).ConclusionGPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates.
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Hyndman K, Thomas RE, Schira HR, Bradley J, Chachula K, Patterson SK, Compton SM. The Effectiveness of Tobacco Dependence Education in Health Professional Students' Practice: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214158. [PMID: 31661922 PMCID: PMC6862178 DOI: 10.3390/ijerph16214158] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 01/18/2023]
Abstract
The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers’ websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students’ counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I2 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I2 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I2 = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.
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Affiliation(s)
- Kathryn Hyndman
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Roger E Thomas
- School of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
| | - H Rainer Schira
- John E. Robbins Library, Brandon University, Manitoba R7A 6A9, Canada.
| | - Jenifer Bradley
- Department of National Defence, Petawawa, Ontario K8H 2X3, Canada.
| | - Kathryn Chachula
- Faculty of Health Studies, Brandon University, Brandon, Manitoba R7A 6A9, Canada.
| | - Steven K Patterson
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
| | - Sharon M Compton
- Dental Hygiene Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
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