The pharmacist "toolbox" for smoking cessation: a review of methods, medicines, and novel means to help patients along the path of smoking reduction to smoking cessation

Using the pharmacy retail model to examine perceptions and biases of a UK population sample towards regulation of specific psychoactive drugs

Background:

Contemporary research indicates that the legal classifications of cannabis (Schedule 2, Class B), 3,4-methylenedioxymethamphetamine (MDMA) (Schedule 1, Class A) and psilocybin (Schedule 1, Class A) in the United Kingdom are not entirely based on considerations of harm and therapeutic utility. The legal classifications of the substances discussed are typically determined by legislators such as Parliament and, therefore, may be a reflection of the views or perceived views of the general public.

Objective:

The aim of the study was to provide an indication of the underlying psychology regarding the legislated sale of alcohol, tobacco, cannabis, MDMA and psilocybin in pharmacies according to a UK general population sample.

Methods:

A sample of 105 UK nationals was selected for the survey. Participants were asked questions on perceived relative harm of the five substances. After viewing contemporary information on reported relative harm and therapeutic applications, the participants were asked questions related to using the pharmacy retail model for the sale of the substances discussed. Participants who opposed the substances being sold primarily in pharmacies were asked to explain their rationale according to a predetermined list of options for each of the five drugs. Participants were also asked whether they consider it a human right to be legally permitted to consume the substances.

Results:

The participants' perceptions of relative harm (tobacco > MDMA > psilocybin > alcohol > cannabis) were not in agreement with the relative harm reported in the literature (alcohol > tobacco > cannabis > MDMA > psilocybin). Principal objections to the currently illicit substances being legally available in pharmacies include it sending the wrong message; it feels wrong; it is too dangerous; disliking the smell of cannabis; disapproval of the people; and not liking the idea of people using psychoactive drugs for entertainment or to have mystical/religious experiences. Overall, the participants determined that being legally permitted to consume the substances discussed is an issue of relevance to human rights. A majority of the male participants concluded that being legally permitted to consume alcohol, tobacco, cannabis and Psilocybe mushrooms is a human right in contrast to the majority of female participants who solely considered alcohol consumption to be a human right.

Conclusions:

The data suggest that the legal classifications may not simply be based on considerations of harm. Misperceptions of the dangers, biases and non-health-related aversions likely contribute to the continuation of policies that do not reflect the state of scientific research.

Survey of dental clinic patients: smoking and preferences for cessation support

BACKGROUND

Smoking cessation interventions delivered by dental practitioners can be as effective as those delivered by general medical practitioners. However, concern that addressing smoking may cause offence to their patients is a reason cited by dental practitioners for not regularly addressing patient smoking behaviours, despite believing they should play a role in smoking cessation. This study aimed to elicit the smoking behaviour and smoking cessation preferences of dental patients to determine if these concerns accurately reflect patient attitudes.

METHODS

We surveyed 726 adult dental patients attending The University of Queensland's School of Dentistry dental clinics, Brisbane Dental Hospital and four private dental practices in South-East Queensland.

RESULTS

Most (80%) current daily smokers had tried to quit smoking. Smokers and non-smokers both agreed that dentists should screen for smoking behaviour and are qualified to offer smoking cessation advice (99% and 96% respectively). Almost all participants (96%) said they would be comfortable with their dentist asking about their smoking and that if their smoking was affecting their oral health their dentist should advise them to quit.

CONCLUSIONS

Patients are receptive to dental practitioners inquiring about smoking behaviour and offering advice on quitting. Smoking patients showed considerable motivation and interest in quitting smoking, particularly in the context of health problems related to smoking being identified. These results should encourage dentists to raise the issue with their patients.

Survey of community pharmacists' perception of electronic cigarettes in London

OBJECTIVES

To seek community pharmacists' perception on use, safety and possible effectiveness of e-cigarettes as quit smoking tools, and their future regulation.

SETTING

A survey of a sample of 154 community pharmacies across London, UK.

CONTEXT

E-cigarettes have exclusively established themselves in the market through consumers-led demand. To date, e-cigarettes still remain unregulated and can be easily purchased in shops, over the internet, but more controversially also in pharmacies in the UK. Pharmacists find themselves with a shortage of information on their safety and efficacy, and may experience an ethical dilemma when consulted by patients/customers.

KEY FINDINGS

Response rate: 60% (n=92). Independent pharmacies accounted for 90% of the sample. The majority of participants (73%) sell e-cigarettes. A minority of participants (20%) have been presented with adverse effects such as cough and dry mouth. As possible reasons for their use, pharmacists ranked 'aid in stop smoking' as the most important (56%), with 'cheaper alternative' (43%) and 'social/recreational use' (31%) being the least important ones. Safety issues were raised as statements such as 'e-liquid in cartridges may be toxic' were agreed by 52% of respondents. The majority of pharmacists (97%) were supportive of e-cigarettes being regulated, expressing current concerns regarding excipients (42%) and nicotine content (34%). Participants indicated that they would require training in the form of information packs (88%), online tutorials (67%), continuous professional development (CPD) workshops (43%) to cover safety, counselling, dosage instructions, adverse effects and role in the smoking cessation care pathway in the future.

CONCLUSIONS

Pharmacists expressed concerns about the safety of e-cigarettes, especially regarding the amounts of excipients and nicotine as these still remain unregulated. Currently, there are no guidelines for pharmacists regarding e-cigarettes. Community pharmacists look forward to regulations so to conduct their duties in a more confident and legislated fashion.

Opinions of Romanian Dental Students Toward Tobacco Use Interventions in the Dental Setting

The aim of the present study was to assess smoking habits as well as attitudes toward smoking cessation counseling among Romanian dental students in order to build an evidence base for further undergraduate curriculum development. A 38-item self-administered questionnaire was delivered to first to sixth dental students enrolled at the University "Lucian Blaga" Sibiu. The questionnaire covered sociodemographics, smoking habits, knowledge concerning health effects, attitudes, and confidence toward smoking cessation counseling. Smoking was reported by 37 % of participants and was more prevalent among clinical (48.98 %) than preclinical (29.58 %) and basic science students (35.93 %). Students' knowledge that tobacco affects general and oral/dental health and knowledge of dental students regarding the smoking and alcohol behavior taken during medical history varied according to academic year and smoking status, but not according to gender. Only 51.1 % of all students agreed or strongly agreed that they were adequately trained to provide tobacco cessation education. 58.6 %, respectively 52.9 %, strongly agreed that is part of their role as a dentist to assist their patients to stop smoking and to prevent patients from starting to use tobacco products, while only 35.8 % believed that smoking cessation counseling provided by a dentist can be effective in helping patients stop smoking. The main determinants of student's attitudes toward smoking cessation counseling were academic year, clinical experience in the dental settings, and knowledge of smoking adverse effects. Dental school should offer adequate training in tobacco dependence and available continuing education in tobacco intervention in aim to encourage oral health care practitioners to have up-to-date information in aim to play their role effectively in the overall smoking cessation and prevention activities.

A qualitative study of smoking within a Western Sydney Arabic-speaking community: a focus on men in the context of their families

ISSUE ADDRESSED

Smoking rates are high among Arabic-speaking populations, particularly men, and there is limited evidence to formulate effective tobacco-control strategies in this group. This study explored smoking within an Arabic-speaking community in Sydney, focusing on men's smoking in the context of their families.

METHODS

We conducted six focus groups with a total of 60 Arabic-speaking participants recruited through health workers, counsellors and community leaders in Western Sydney, Australia. The focus groups, conducted in Arabic or English, discussed smoking experiences, family issues and quit attempts. Focus group data were recorded, transcribed and analysed for emerging themes.

RESULTS

Male smoking was normalised in home, social and religious settings. There was concern about children's exposure to environmental tobacco smoke (ETS), but less concern for adults, particularly wives. Smoking created conflict within families and quit attempts were often made without assistance. There was a lack of enthusiasm for telephone support services with participants suggesting free Nicotine Replacement Therapy (NRT) and programs in religious settings as potential strategies.

CONCLUSIONS

Smoking is normalised in Arabic-speaking society and is socially acceptable. Strategies to de-normalise smoking, particularly among men, are critical. Ongoing ETS exposure of wives is concerning and suggests the need to empower women to control their exposure. There is an opportunity to create locally tailored interventions by engaging leaders in religious settings and to improve perceptions of telephone support services. SO WHAT?: Culturally appropriate strategies to de-normalise smoking for Arabic-speaking male smokers are needed together with novel approaches that incorporate families and involve community leaders.