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Objectives: To examine the association between health behavior indicators, school contentment, and academic achievement. Methods: Structural equation modeling with 5810 adolescents. Results: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school contentment and academic achievement, but physical activity was positively related to school contentment and academic achievement (P< .01). School contentment was strongly related to academic achievement but only a weak mediator of the health behavior indicators. Conclusion: Findings may inform the efforts to improve academic achievement and the general health status of youth. [ABSTRACT FROM AUTHOR]

Relevant information for clinical decision-making in a wide spectrum of diseases includes the extent to which sexual function is intact, how important it is to preserve sexual capacity and whether waning sexual function causes distress. Little information is available on elderly men. We aimed to obtain this basic information. Radiumhemmet's Scale of Sexual Function was posted to 435 randomly selected men aged 50-80 years. Assessments included sexual desire, erectile capacity, orgasm and ejaculation and to what extent waning sexual function distressed the men. The questions were answered anonymously. Information was obtained from 319 men (73%). Of these, 83% stated that sex was 'very important', 'important' or a 'spice to life'. Physiological potency for men aged 50-59, 60-69 and 70-80 amounted to 97%, 76% and 51% respectively. Among the oldest men (70-80 years), 46% reported orgasm at least once a month. Over 80% of all men who reported some level of erection stated that it was of importance to them to maintain the present level of erection stiffness. Most men who reported waning sexual function (compared with their youth) stated that this distressed them. Sex is important to elderly men. Even among the 70-80-year-olds, an intact sexual desire, erection and orgasm are common and it is considered important to preserve them. Sexual function should be considered in the clinical assessment of elderly men. [ABSTRACT FROM AUTHOR]

Background: Motivational interviewing (MI) is a collaborative, client-centred counselling style aimed at eliciting and strengthening clients' intrinsic motivation to change. There is strong research evidence supporting the efficacy of MI, notably in its application among alcohol and drug abuse populations. MI interventions in smoking cessation may yield modest but significant increases in quitting. The present study sought to assess the acquisition and retention of MI skills in counsellors at the Swedish National Tobacco Quitline.Methods: Three audio-recorded sessions from each of three counsellors were assessed using the Motivational Interviewing Treatment Integrity (MITI) Code Version 3.0 over 11 assessment periods at fixed intervals in a two-and-a-half year period during which counsellors received ongoing supervision.Results: The mean skill for all counsellors improved throughout the study period in most MITI variables. However, great variations in MI skill between counsellors were observed, as well as fluctuations in performance in counsellors over time.Conclusion: The present exploratory study covers a longer time period than most evaluations of MI training, and has several advantages with regard to study design. It may provide a basis for (larger sample) replication to test MI skill (as measured by the MITI) in relation to behaviour change in clients, to evaluate MI training, and to assess the acquisition and retention of MI skill over time. Difficulties in acquiring and retaining MI skill may raise the issue of a selection policy for MI training. Moreover, fluctuations in MI skill over time emphasise the greater importance of continuous feedback and supervision over initial MI training, and the need for the use of validated treatment integrity assessment instruments in ordinary clinical implementations of MI. [ABSTRACT FROM AUTHOR]

Background: Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.Methods: 300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (> or = 183 days) at the 12-month follow-up.Results: Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.Conclusion: Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.Trial Registration: Trial Registration Number: NCT00670514. [ABSTRACT FROM AUTHOR]

Aims: Adverse childhood experiences are known to relate positively to various health risks and adverse health behaviour in adult life, although the precise mechanisms are still debated. The aim of this study was to investigate whether a single-item measure of the quality of childhood relationships with family and household members might show a similar association., Methods: We measured the overall quality of relationships with family and household members during the first 18 years of life. A one-dimensional question scored 0-10 ( N =4983) was included in the ongoing SIBS Iceland Patient Association's national 'Life and Health' public health prevention project among adults. Relationship quality was then assessed against measures of health and health behaviour using 21 validated scales., Results: A lower childhood relationships score was associated with a higher risk of all 21 suboptimal health and health behaviour outcomes in adulthood, with adjusted effect sizes measured by standardised betas (magnitude 0.111-0.284), variance explained (1.3-8.5%) and per-point adjusted odds ratios (1.10-1.30). The strongest associations were found with measures of social and mental health, followed by physical health, alcohol and tobacco use, sleeping problems, financial sustenance, physical pain and aerobic fitness., Conclusions: Odds were found to match well with pooled odds ratios presented in a systematic review of 37 adverse childhood experiences studies. This may indicate that a one-dimensional relationships question is a useful substitute in surveys in which a traditional multi-question adverse childhood experiences scale cannot be accommodated. Further investigations are recommended to investigate the applicability of a single adverse childhood experiences question.

Introduction: In the coming years, an increase in the number of cancer cases can be expected in Iceland. It is important to gain more insight into the experiences of the diagnostic- and treatment phase among those diagnosed with cancer to improve quality of life and life expectancy., Methods: The study included 4575 individuals diagnosed with cancer between 2015 and 2019 in Iceland, 18 years or older at the time. Participants answered an on-line questionnaire once between 2020 and 2021., Results: A total of 1672 (37%) individuals responded to the questionnaire. The mean age at diagnosis was 59 years (±12). The majority of participants were informed on their cancer diagnosis during a doctor's appointment (67%), but a quarter (25%) received the information by telephone. A total of 77% of participants were satisfied with the diagnostic process, thereof relatively fewer women than men (73% vs. 83%) (p<0,001). Fewer of those who received the cancer diagnosis by telephone were pleased with the diagnostic process (62%) compared with those receiving information during a doctor's appointment (85%) (p<0,001). More women (58%) than men (33%) expressed the need for support regarding mental well-being from healthcare professionals during the diagnostic process (p<0.001). In 2015, 36% of participants started treatment more than month after diagnosis, compared with 51% in 2019. The need for various specific resources during treatment, e.g. physiotherapy, psychological services or nutritional counseling were regularly assessed among 20-30% of participants., Conclusion: A quarter of respondents diagnosed with cancer received information about the diagnosis over the phone instead of an interview. There is a suggestion that the time from diagnosis to the start of cancer treatment is increasing. It is necessary to assess whether it is possible to support individuals with cancer better during the diagnostic- and treatment phase based on their individual needs.

Introduction: Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users., Methods and Analysis: This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders., Ethics and Dissemination: The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders., Trial Registration Number: NCT04819152., Competing Interests: Competing interests: HG: Doctors Against Tobacco (unpaid NGO chair). AP: Nurses against Tobacco (unpaid NGO vice chair); NGO Tobaksfakta-independent think tank (paid general secretary). SW: Received in total £4650 from Pfizer AB, and £490 from Sanofi, for lectures and education about smoking cessation. ML: Received in total £3500 from Phizer AB, £3500 from ASTRA Zenega AB, £1500 from MSD, and £1000 from Boehringer Ingelheim AB, all for lectures, speech, or education about smoking cessation and/or smoking and COVID-19., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up., Design and Outcome Measures: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio., Setting: The study was conducted in dental clinics in Sweden., Participants: 294 smokers aged 19-71 years were included in the study., Interventions: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT)., Results: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden., Conclusion: CEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Objective: Screen-based media use by children and adolescents has increased in recent years but the consequences of their use are not well understood. The objective of this study was to provide a comprehensive examination of the relationship between screen-based activities and a selection of single and multiple self-reported somatic symptoms in a large sample of 10-12 year old children., Method: We use data from the population-based 2011 Youth in Iceland school survey (N=10,829, response rate: 84.5%, boys: 49.9%) that is conducted triennially in 5th-7th grades in all secondary schools in Iceland. Self-reported measures of common screen-based activities were hypothesized to predict the odds of dizziness, tremors, headaches, stomach aches, and multiple symptoms., Results: In general the reported prevalence of symptoms increased with greater number of hours reported on screen based activity for boys and girls. This held for all individual screen activities as well as the cumulative measure of daily minutes spent on screen-based media and prevalence of one or more somatic symptoms., Conclusions: This study confirms previous findings and puts forth additional information concerning the relationship between the prevalence of electronic screen use and somatic symptoms in 10-12 year old children., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users., Methods: Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05)., Results: Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships., Conclusions: Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: The Swedish National Tobacco Quitline (SNTQ), which has both a proactive and a reactive service, has successfully provided tobacco cessation support since 1998. As there is a demand for an increase in national cessation support, and because the quitline works under funding constraints, it is crucial to identify the most clinically effective and cost-effective service. A randomized controlled trial was performed to compare the effectiveness of the high-intensity proactive service with the low-intensity reactive service at the SNTQ., Methods: Those who called the SNTQ for smoking or tobacco cessation from February 2009 to September 2010 were randomized to proactive service (even dates) and reactive service (odd dates). Data were collected through postal questionnaires at baseline and after 12 months. Those who replied to the baseline questionnaire constituted the study base. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Intention-to-treat (ITT) and responder-only analyses were performed., Results: The study base consisted of 586 persons, and 59% completed the 12-month follow-up. Neither ITT- nor responder-only analyses showed any differences in outcome between proactive and reactive service. Point prevalence was 27% and continuous abstinence was 21% in analyses treating non-responders as smokers, and 47% and 35%, respectively, in responder-only analyses., Conclusion: Reactive service may be used as the standard procedure to optimize resource utilization at the SNTQ. However, further research is needed to assess effectiveness in different subgroups of clients., Trial Registration: ClinicalTrials.gov: NCT02085616.

Background: According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient's family without that patient's consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient's impending death, patient's significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients., Methods: This is a retrospective analysis of detailed prospective "field notes" from chaplain interviews of all patients aged 30-75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication., Results: During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001)., Conclusions: Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.

Objective: To assess the relative cost-effectiveness of a high-intensity treatment (HIT) and a low-intensity treatment (LIT) for smoking cessation., Methods: The societal and health care perspective economic evaluation was based on the reported number of quitters at 12-month follow-up (point prevalence) from a randomized controlled trial of 2 smoking cessation programs in Sweden. Future disease-related costs (in Swedish kronor [SEK] 2004; SEK7.35 = USD1) and health effects (in quality-adjusted life-years [QALYs]) were estimated via a Markov model comprising lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease including stroke with costs and QALYs discounted 3% annually., Results: HIT was more effective than LIT (23% vs. 16% quitters), but at a considerably higher intervention cost: SEK26,100 versus 9,100 per quitter. The model-estimated societal costs avoided did not balance the higher intervention costs, so the incremental cost-effectiveness ratio (ICER) amounted to SEK100,000 per QALY for HIT versus LIT. All sensitivity analyses indicated an ICER below SEK300,000 and that HIT is the preferred option if the decision maker willingness-to-pay exceeds SEK50,000 per QALY. Compared with no intervention, LIT was cost saving, whereas HIT was estimated at SEK8,400 per QALY., Conclusions: Compared with no smoking cessation program, it is a societal waste not to implement the LIT as it is estimated to result in lower societal costs. The incremental cost per QALY gained of SEK100,000 for HIT is considered very cost-effective in Sweden. Thus, if smoking cessation programs are judged in the same manner as other Swedish health care measures, the high-intensity program should be chosen before the low-cost program.

Introduction: The present study aimed to assess the effect of adding motivational interviewing (MI) to the first session of an effective smoking cessation treatment protocol in an ordinary clinical setting: the Swedish National Tobacco Quitline (SNTQ)., Method: The study was designed as a controlled clinical trial. Between September 2005 and October 2006, 772 clients accepted the invitation to participate in the study and were semi-randomised to either standard treatment (ST) or MI. The primary outcome measures were self-reported 7-day point prevalence abstinence and 6-month continuous abstinence., Results: At 12-month follow-up, the 772 clients were included in an intention to treat analysis. Of the clients allocated to MI, 57/296 (19%) reported 6-month continuous abstinence compared to 66/476 (14%) of the clients allocated to ST (OR 1.48, 95% CI 1.00-2.19; P=.047)., Conclusions: Integrating MI into a cognitive behavioural therapy-based smoking cessation counselling in an ordinary clinical setting at a tobacco quitline increased client 6-month continuous abstinence rates by 5%., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Today's children spend a great deal of time viewing electronic screen material, but the consequences of such behaviors, if any, are unknown. This study sought to identify (i) the magnitude of total daily electronic screen time and (ii) the relations between electronic screen use and mental well-being indicators, in a sample of 10-12-year-old children., Methods: We analysed cross-sectional, population-based data of 10-12-year-old children from the 2007 Youth in Iceland school survey (n = 10,829, response rate: 81.7%, boys: 50.5%). Logistic regression models with odds ratios and 95% confidence intervals were conducted to assess the odds of each selected mental well-being indicator, depending on the number of daily hours spent on each electronic screen-based activity. All analyses were conducted separately for boys and girls and adjusted for family structure., Results: The prevalence of self-reported screen use of 4 hours per day or more ranges from 2.8% to 6.6% among boys and from 1.0% to 3.8% among girls. All five screen-based activities were significantly associated with all seven well-being indicators (P < 0.001) with symptoms being more common with increased time spent on screen use., Conclusions: This study is the first of its kind to demonstrate a dose-response relationship between electronic screen use and mental well-being in 10-12-year-old children. Further research is needed to assess the validity and potential implications of these findings.

Background: This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence., Methods: Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect., Results: Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i.e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized., Conclusions: Few people receive alcohol-related hospital care and it remains unclear whether this group's underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems--i.e. a history of alcohol-related hospitalizations--are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

Background: The aim of this study was to assess if widowers had an increased mortality rate during the first 6 to 9 years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland., Methods: The study base was comprised of all 371 men born in 1924-1969 who were widowed in Iceland in 1999-2001 and 357 controls, married men, who were matched by age and residence.The widowers and controls were followed through the years 2002-2007 using information from Statistics Iceland. Mortality rates were compared between the groups and also with the general population. The mortality rate comparisons were: study group vs. control group, on the one hand, and study group vs. general population on the other. Causes of death were also compared between widowers and their wives., Results: A statistically significant increase in mortality in the widowers' group, compared to controls, was observed.Lifestyle-related factors could not be excluded as contributing to cause of death in these cases., Conclusions: Being a widower was related to an increased risk of death for at least 9 years after the death of their wife.

Objective: To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities among Icelandic adolescents., Methods: This study used a quasi-experimental, non-randomized control group design to compare outcomes in 4 Icelandic communities (n=3117) that participated in community-based substance use prevention activities designed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities (n=1,907). Annual, nationwide, population-based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icelandic adolescents, aged 14-15 years (N=5,024), in all communities from 1997 to 2009., Results: Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not, whereas unmonitored idle hours and attendance at unsupervised parties decreased. Over time, alcohol use (OR=0.89, 95% CI 0.82, 0.98, p=0.012) and being intoxicated during the last 30 days (OR=0.86, 95% CI 0.78, 0.96, p=0.004) decreased more in the intervention than control communities., Conclusion: Community-based prevention designed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to determine if Icelandic widowers might foresee obstacles to responding to a questionnaire on bereavement. Also, we sought to compare the proportion of men reporting obstacles in a telephone interview to the actual response rate in the questionnaire survey., Methods: The study was part of a nation-wide survey of widowers who lost their wives in 1999, 2000, and 2001. This included all widowers born in Iceland 1924-1969 (aged 30-75 years) who were alive, and residing in Iceland at the time of the study. A telephone poll was conducted prior to sending out a questionnaire to determine if the widowers would be interested in responding, or if they could see obstacles, which could affect their willingness to respond to a subsequent questionnaire survey. The telephone poll was repeated five years later with a random sample of the original study base to determine if views initially expressed towards the questionnaire survey, had changed over time., Results: Of the 357 eligible widowers, 11 had died prior to the first telephone interview, yielding a study population of 346 widowers. Of those, 296 (86%) were reachable and all of these (100%) were willing to participate in the telephone survey. Of them, 55% identified obstacles to participation in the questionnaire survey. Men under 60 years were less likely to identify obstacles. Years from loss (second through fourth years) were not associated with reporting obstacles to participation. The response rate in the epidemiological questionnaire survey following the telephone interview was 62% (216/346).Of those who did identify obstacles 23%, did not did not identify any particular obstacle, but 33% stated that "they felt bad" or that it would be "a painful experience" or that they felt "uncomfortable" talking about their grief. About 18% stated their grief was "a private matter"; 6% stated that they did not want to be "stuck with their grief"; 9% said that it was "too late" to talk about their grief or that they "wanted to look towards their future". Additionally, 11% stated "other reasons", including responses like: "it's too early to talk about it", and "I have started another relationship - don't want complications.", Conclusions: The willingness to participate in the telephone interview was high and indicates a strong interest in the subject. Also, exposure to the study appeared to increase willingness to participate, since many men who initially could see obstacles to participation, actually participated in the epidemiological questionnaire survey. However, approximately one third of the men who initially identified obstacles to participation remained negative toward participation throughout the study period.

Cigarette smoking and alcohol use contribute substantially to the global burden of morbidity and premature mortality. Most use begins during adolescence, often with experimentation taking place between 11 and 15 years of age. This study examined the importance of perceived parental reactions to, and peer respect for, cigarette smoking and alcohol use. Particular attention was given to the relative importance of these variables compared with the more widely examined influences of perceived parental and peer support. Our final models explained 44% of the variance in cigarette smoking and 46% in alcohol use. Most of the explained variance in both cigarette smoking and alcohol use was accounted for by only three variables: peer use, perceived parental reaction to use, and perceived respect from peers if using. Our findings indicate that perceived parental reaction to use and peer respect for use may be important contributors to adolescent cigarette smoking and alcohol use., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Aim: To investigate how family conflict contributes to the relationship between parental divorce and adolescent cigarette smoking and alcohol use., Design: Population-based cross-sectional survey., Setting: School classrooms in Iceland in which an anonymous questionnaire was administered to respondents by supervising teachers. Participants were 7430 (81.4%) of 9124 14- to 16-year-old adolescents., Main Outcome Measure: Cigarette smoking and alcohol use during the last 30 days were assessed by self-report., Results: Parental divorce was related to adolescent cigarette smoking during the last 30 days (OR = 2.12, 95% CI 1.84-2.44) when controlling for gender only, but was insignificant (OR = 1.18 95%, CI 0.99-1.44) when controlling for relationship with parents, disruptive social changes and family conflict. There was a significant relationship between parental divorce and adolescent alcohol use during last 30 days (OR = 1.66, 95% CI 1.48-1.87), controlling only for gender; however, the relationship disappeared (OR = 1.04, 95% CI 0.91-1.20) when controlling for other variables., Conclusion: Family conflicts are important contributors to the relationship between parental divorce and adolescent cigarette smoking and alcohol use. Conflict between parents and adolescents, but not inter-parental conflict, appears to be the most important factor in the relationship between family conflict and adolescent substance use.

Background: Previous research has shown that between 80 and 90 percent of adult smokers report having started smoking before 18 years of age. Several studies have revealed that multiple social factors influence the likelihood of smoking during adolescence, the period during which the onset of smoking usually occurs. To better understand the social mechanisms that influence adolescent smoking, we analyzed the relationship and relative importance of a broad spectrum of social variables in adolescent smoking in Iceland, a Nordic country with high per-capita income., Methods: We used cross-sectional data from 7,430 14- to 16 year-old students (approximately 81% of all Icelanders in these age cohorts) in the 2006 Youth in Iceland study. The Youth in Iceland studies are designed to investigate the role of several cognitive, behavioral, and social factors in the lives of adolescents, and the data collected are used to inform the design, implementation, and evaluation of substance use prevention programs that are being developed by Icelandic social scientists, policy makers, and practitioners., Results: Our analysis revealed that friends' smoking behavior and attitude toward smoking were strongly associated with adolescent smoking and other tobacco use, as well as alcohol consumption during the previous 30 days. Main protective factors were parent's perceived attitude toward smoking, the quantity of time spent with parents, absence of serious verbal conflict between parents and adolescents, and participation in physical activity. Family structure was related to adolescent smoking to a small extent, but other background factors were not., Conclusion: We conclude that multiple social factors are related to adolescent smoking. Parents and other primary preventive agents need to be informed about the complicated nature of the adolescent social world in order to maximize their impact.

To evaluate the Swedish version of the Motivational Interviewing Treatment Code (MITI), MITI coding was applied to tape-recorded counseling sessions. Construct validity was assessed using factor analysis on 120 MITI-coded sessions. Discriminant validity was assessed by comparing MITI coding of motivational interviewing (MI) sessions with information- and advice-giving sessions as well as by comparing MI-trained practitioners with untrained practitioners. A principal-axis factoring analysis yielded some evidence for MITI construct validity. MITI differentiated between practitioners with different levels of MI training as well as between MI practitioners and advice-giving counselors, thus supporting discriminant validity. MITI may be used as a training tool together with supervision to confirm and enhance MI practice in clinical settings. MITI can also serve as a tool for evaluating MI integrity in clinical research.

The aim of this study was to evaluate inter-rater reliability when using the Swedish version of the Motivational Interviewing Treatment Code (MITI) as an adjunct to MI training, clinical practice and research. Coders were trained to use the MITI for scoring taped sessions. The 4-month basic training had a duration of 39 hours. Following training, 60 audio-taped live interviews were randomly assigned for MITI coding. Mean intra-class correlation (ICC) coefficients were calculated for 7 coders across all pairs of coders. Cronbach's alpha was calculated to estimate the covariance between each pair across their common interviews. Six months later, a second inter-rater reliability test was performed, when 5 coders coded the same 15 randomly selected tapes. At the second reliability testing the mean ICC was 0.81 and the mean Cronbach's alpha was 0.96. However, the ICC varied for different sub-variables of the MITI, ranging from 0.42 empathy to 0.79 for number of Closed questions. In conclusion, MITI shows promising potential to be a reliable tool to confirm and enhance MI training as well as practice in clinical settings and in evaluating MI integrity in clinical MI research. However, coder assessment of empathy and MI-spirit, "global" variables, requires further refinement.

This cross-sectional study assessed changes between 1999 and 2003 in attitudes among Swedish general practitioners (GPs) toward smoking cessation activities and also assessed the effect of a nationwide quitline on GPs' smoking cessation activities. A random sample of 621 Swedish GPs answered a questionnaire mailed to their home addresses in spring 2003. When possible, the results of the present study were compared with results from a similar study conducted in 1999. Main outcome measures were GPs' self-reported activities, perceived barriers to engaging in smoking cessation, and referrals to the quitline. Between 1999 and 2003, GPs increased their overall smoking cessation activities and were more aware of the complexity of smoking cessation support. Significantly more GPs experienced smoking cessation support as "too time consuming" and preferred to refer smokers to counselors specializing in smoking cessation. GPs referring patients to the quitline were more likely to be active in other smoking cessation activities. One out of five GPs had advised their patients to use oral smokeless tobacco as a means to stop smoking. A paradigm shift regarding awareness of the complexity of smoking cessation support may be ongoing amongst Swedish GPs. The nationwide smoking cessation quitline appears to have had a positive effect on GPs' engagement in smoking cessation.

Objectives: The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice., Methods: A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compared with a previous investigation., Results: Among the respondents, awareness of a popular science version of a systematic review on smoking and its effect on oral health was reported by 90 percent of the hygienists and 66 percent of the dentists. The information was used in clinical work by 34 percent of the dentists and 54 percent of the hygienists. Reported changes in patterns of practice were more frequent recommendations to use nicotine replacement therapy and a more widespread use of setting quit dates. Approximately one quarter of the dental professionals reported that they had increased tobacco cessation consultation because of the results from the reports., Conclusions: Changes in patterns of practice were observed after dissemination of evidence-based information on tobacco cessation. Methods that were proven to be effective in the evidence-based report such as discussing quit dates and recommending nicotine replacement therapy were more commonly used after the publication of the report. Short, popular versions of extensive systematic reviews seem to be useful for implementing evidence-based knowledge and changing clinical practice.

Aims: To describe the prevalence and intensity of different symptoms in relation to tobacco abstinence. To explore latent dimensions between symptoms in smokers trying to quit., Design: A cross sectional study using a questionnaire to retrospectively assess symptoms over a period of 12 months., Setting: Swedish telephone quitline, a nationwide free of charge service., Participants: All 741 individuals who had called the quitline and signed up for smoking cessation treatment between February 2000 to November 2001 and reported to have been smoke free for at least 24 hours during the previous 12 month period from first contact., Measurements: Assessments were made by self-report, and abstinence was defined as "not a single puff of smoke during the last week". A factor analysis approach where individual items aggregate into factors was used to explore the relationship between the different symptoms., Findings: High intensity of symptoms related to unsuccessful quitting attempts and included craving, irritability, apprehension/anxiety, difficulties concentrating, restlessness, depression/depressed mood, and insomnia. The factor loadings of all 17 symptoms resulted in three factors with factor 1, psychological being the most important. High scores on this factor relates to unsuccessful quitting attempts. Using Nicotine Replacement Therapy (NRT) for 5 weeks or longer, reduced symptoms included in factor 1. The other two factors were factor 2 physiological and factor 3 neurological., Conclusion: Symptoms that are psychological and/or neurological in nature are interrelated and appear to be the most significant obstacles for successful quitting attempts in a population-based setting. These symptoms may be successfully treated with NRT.

Objective: The Radiumhemmets Scale of Disease-Specific Symptom Assessment-Prostate Cancer has been used in several studies. However, no test-retest reliability study of it has been conducted concerning the assessment of urinary, anal sphincter or large bowel function. The aim of this study was to evaluate the reliability of items assessing these functions., Material and Methods: We investigated 89 prostate cancer patients randomly selected from a group of patients diagnosed in Stockholm. The patients answered 24 questions assessing anal sphincter, large bowel and urinary function twice, with a 3-week interval in-between, to assess reliability., Results: Most of the questions assessing bowel and urinary symptoms showed substantial or near-perfect agreement. The kappa value for bowel symptom items was > or = 0.60 for all items, except for defecation urgency (0.40-0.55). The kappa value for urinary symptom items varied between 0.43 and 1.0, except for urinary urgency (0.30-0.39)., Conclusions: When comparing the impact of different symptoms of anal sphincter, large bowel or urinary tract dysfunction, it may be important to consider that defecation urgency and urinary urgency have the highest measuring error (low reliability). This error dilutes assessed associations with, for example, decreased quality of life. Nevertheless, the test-retest reliability for anal sphincter, large bowel and urinary symptoms indicates that surveys yield meaningful information.

Background: The estimation of the parameters that describe the dose-response relations of anal sphincter regarding the clinical endpoints of fecal leakage and blood or phlegm in stools is important in the optimization of prostate cancer radiotherapy. Also, the validity of the relative seriality model for this clinical case needs to be examined by associating the clinical follow-up results with the predicted complication rates., Patients and Methods: In this study, 65 patients who received radiation therapy for clinically localized prostate adenocarcinoma are analyzed. The clinical treatment outcome and the three-dimensional dose distribution delivered to anal sphincter were available for each patient. A questionnaire was used for assessing the clinical bowel and urinary symptoms. A maximum likelihood fitting was performed to calculate the best estimates of the parameters used by the relative seriality model. The clinical utilization of the calculated parameters in predicting anal sphincter complication probabilities was illustrated by applying the best estimate of the parameters to a subset of the patient population., Results: The estimated values of the parameters for the two clinical endpoints are D (50) = 70.2 Gy, gamma = 1.22, s = 0.35 for fecal leakage and D (50) = 74.0 Gy, gamma = 0.75, s approximately 0 for blood or phlegm in stools. The standard deviations of the parameters were also calculated together with the confidence intervals of the dose-response curves. The analysis proved that the treatment outcome pattern of the patient material can suitably be reproduced by the relative seriality model (probability of finding a worse fit = 60.2%, the area under the receiver operating characteristic curve = 0.72 and 0.69 and chi(2)-test = 0.97 and 0.86, respectively)., Conclusion: Fecal leakage is characterized by a medium relative seriality whereas blood or phlegm in stools was found to have strong volume dependence (low relative seriality). Diminishing the biologically effective uniform dose to anal sphincter < 40-45 Gy may significantly reduce the risk of fecal leakage or blood or phlegm in stools for patients irradiated for prostate cancer.

Background: The aims of the present study were to assess changes between 1995 and 2001 in the prevalence of child exposure to environmental tobacco smoke (ETS), attitudes towards ETS among parents of small children and awareness among parents regarding the potential hazards of passive smoking to children., Method: A questionnaire, along with a stamped, addressed envelope, was sent to a stratified random sample of 1000 households in Norway containing children aged 3 years old at the time of the investigation (May 1995 and August 2001)., Results: The prevalence of households containing smokers was similar in the two study periods. However, households reporting exposure of children to ETS fell from 32% in 1995 to 18% in 2001. Health-risk awareness had significantly increased in households containing smokers. In both surveys, the probability of children being exposed to ETS was positively correlated with the number of parents smoking, and inversely correlated to strength of health-risk awareness, negative attitudes towards ETS and length of household education., Conclusions: Increasing parents' awareness of the health risk of ETS exposure to children may significantly reduce children's ETS exposure.

Purpose: To investigate dysfunction caused by unwanted radiation to the anal-sphincter region and the rectum., Methods and Materials: A questionnaire assessing bowel symptoms, sexual function, and urinary symptoms was sent to 72 patients with clinically localized prostatic adenocarcinoma treated by external beam radiation therapy at the Radiumhemmet, Karolinska Hospital, in Stockholm, Sweden, 2-4 years after treatment. The mean percentage dose-volume histograms for patients with and without the specific symptom were calculated., Results: Of the 65 patients providing information, 9 reported fecal leakage, 10 blood and mucus in stools, 10 defecation urgency, and 7 diarrhea or loose stools. None of the 19 and 13 patients who received, respectively, a dose of > or =35 Gy to < or =60% or > or =40 Gy to < or =40% of the anal-sphincter region volume reported fecal leakage (p < 0.05). In dose-volume histograms, a statistically significant correlation was found between radiation to the anal-sphincter region and the risk of fecal leakage in the interval 45-55 Gy. There was also a statistically significant correlation between radiation to the rectum and the risk of defecation urgency and diarrhea or loose stools in the interval 25-42 Gy. No relationship was found between anatomic rectal wall volume and the investigated late effects., Conclusions: Although the limited data in this study prevent the definition of a conclusive threshold regarding volume and dose to the anal-sphincter region and untoward morbidity, it seems that careful monitoring of unnecessary irradiation to this area should be done because it can potentially help reduce the risk of adverse effects, such as fecal leakage. Future studies should pay more attention to the anal-sphincter region and help to more rigorously define its radiotherapeutic tolerance.

Objective: Widowhood imposes difficult psychological, social and practical challenges. We investigated the prevalence and predictors of access to bereavement interventions during the first 6 months after the loss of a husband/male partner to prostate or urinary bladder cancer., Material and Methods: All women (n = 506) aged < 80 years living in Sweden who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were asked to answer an anonymous postal questionnaire 2-4 years after their loss., Results: Thirty percent of the widows stated that they would not have needed psychological support by caregivers during the first 6 months of bereavement. Two-thirds of the others (162/242) (those who did not state that they had no need of support) did not have any access to psychological support, 10% (25/242) had little access, 11% (27/242) had moderate access and 12% (28/242) had a large amount of access to psychological support. Similar figures were observed for other bereavement interventions, such as information, economic counselling and support groups. Emotional relations during the last months prior to bereavement, intensity of faith, education, prior mental health problems and a diagnosis of prostate cancer were all positively correlated with access to psychological support by caregivers, whereas previously identified risk factors for excess morbidity in widowhood were not., Conclusions: A large majority of Swedish widows who lost their husband to urologic cancers in 1995 or 1996 indicated a need for psychological support, information and economic counselling. This need was not met by caregivers and help was not aimed at important groups at risk of morbidity.

The purpose of this study was to collect information that may be valuable in developing successful skin cancer prevention programmes. A random sample of 6000 adolescents and 4000 adults answered a questionnaire about sun-related issues. The response rate was 68%. Using sunscreen was the main sun-protection behaviour measured. Approximately 40% of adolescents and 30% of adults did not use any sun-protection strategy other than sunscreen. Readiness to change sun-protection behaviour was measured by assessing the stages of change modified from the Transtheoretical Model (TTM). Half of the participants were in the precontemplation stage of giving up sunbathing and avoiding the sun between 11 a.m. and 3 p.m. Attitude had the strongest association with being in the action/maintenance stages for all sun protection behaviours. A large proportion of participants were not ready to change their sun-protection behaviours, which highlights the importance of including motivational strategies when attempting to change sun-protection behaviours.

Objectives: The cost-effectiveness of the Swedish quitline, a nation-wide, free of charge service, is assessed., Methods: The study was based on data of a sample of 1131 callers enrolled from February 1, 2000 to November 30, 2001. Outcome was measured as cost per quitter and cost per year of life saved. Cost per quitter was based on a calculation of the total cost of the quitline divided by the number of individuals who reported abstinence after 12 months. The cost per life year saved (LYS) was calculated by the use of data from the literature on average life expectancy for smokers versus quitters, the total cost of the quitline, and the cost of pharmacological treatment., Results: The number of smokers who used the quitline and reported abstinence after 1 year was 354 (31 percent). The accumulated number of life years saved in the study population was 2400. The cost per quitter was 1052-1360 USD, and the cost per life year saved was 311-401 USD. A sensitivity analysis showed that, for outcomes down to an abstinence rate of 20 percent, the cost per LYS rose modestly, from 311 to 482 USD. Discounting the cost per LYS showed the cost to be 135 USD for 3 percent and 283 USD for 5 percent., Conclusions: The Swedish quitline is a cost-effective public health intervention compared with other smoking cessation interventions.

Background: Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed., Method: Subjects included 694 smokers calling a reactive (no contact initiated by the counsellors) and 900 smokers calling a proactive (four or five contacts initiated by the counsellors after the first call) quitline for smoking cessation. The subjects were followed up 12 months after the first call using a mailed questionnaire assessing current abstinence, stages of change and factors potentially related to abstinence rates., Results: The questionnaire was returned by 70% of the subjects. Women receiving the proactive treatment reported 34% abstinence rates compared with 27% for those receiving the reactive treatment (p=0.03). For men the abstinence rates were 27% and 28%, respectively (p=0.80). Factors significantly related to abstinence in the adjusted analysis included no nicotine use at base-line, the adjusted odds ratio with 95% confidence interval being 6.4 (2.1-19.4), additional support from a health care professional 3.5 (1.0-12.3), additional social support 3.1 (1.6-6.1), stress or depressive mood 2.7 (1.6-4.7), nicotine replacement therapy for five weeks or more 2.1 (1.1-4.0), and exposure to second-hand smoke 1.9 (1.1-3.3). The use of oral tobacco did not significantly increase current abstinence., Conclusion: Quitlines are effective as an adjunct to the health care system. For women a proactive treatment may be more effective than a reactive treatment.

Background: We investigated the predictors and long-term consequences of awareness time - the length of time a woman is aware of her husband's impending death from cancer., Methods: All women (n = 506) living in Sweden under 80 years of age who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were followed with an anonymous postal questionnaire, 2-4 years after their loss., Results: We received completed questionnaires from 379 of the widows. Of these, 55 (15%) reported an awareness time of 24 hours or less, 56 (15%) of 3-6 months and 95 (26%) of one year or more. The associations between the awareness time and morbidity were of a reverted 'J-shape,' with awareness time of 24 hours or less carrying the highest risk and 3-6/6-12 months the lowest. On comparing the awareness time of 24 hours or less with 3-6 months (preformed response category), the relative risks for anxiety were found to be 1.9. (1.0-3.6) (visual digital scale) and 4.5 (1.0-20.0) for intake of tranquillising drugs. Those not informed of their husband's fatal condition or not provided with psychological support by caregivers during their husband's last months of life had an increased risk of a short awareness time., Conclusions: During a man's terminal cancer illness, the wife's awareness time varies considerably and is influenced by information and psychological support from caregivers. A short awareness time may result in an additional and avoidable psychological trauma.

Background: The Norwegian Cancer Society has led a comprehensive information campaign since 1995 with the aim of reducing young children's ETS (environmental tobacco smoke) exposure in their homes. The aims of the present study were to assess changes in parents' reporting of child exposure to ETS, attitudes towards ETS, and awareness regarding the potential hazards of passive smoking to children., Material and Methods: A questionnaire along with a stamped, addressed envelope was sent to a stratified random sample of 1000 households in Norway with three-year-old children at the time of the investigation (May 1995 and August 2001)., Results: According to parents, the prevalence of households in which children were exposed to ETS fell from 32% in 1995 to 18% in 2001. In both surveys, the probability of children being exposed was positively correlated with the number of parents smoking and inversely correlated with length of education, negative attitudes towards ETS and strength of health-risk awareness., Interpretation: The observed changes must be viewed in the light of the media focus on passive smoking during this period, a nationwide information campaign and as an artifact caused by more underreporting of a behaviour that is being internalised as in breach of a norm.

The incidence of malignant melanoma and non-melanoma skin cancers has increased rapidly in Sweden as well as in other western countries during the last 20 years. Adolescents are an important group in skin cancer prevention. Interventions targeting this group have been reported to affect knowledge and attitudes, but the effect on sun protection behaviour has been slight. The aim of this study was to investigate the applicability of the Transtheoretical Model (TTM) for skin cancer prevention for adolescents. A random sample of 1200 18-year-olds living in Stockholm County was selected from the national census registry. A questionnaire that included three of the major constructs of the TTM (i.e. stages of change, processes of change and decisional balance) was sent by mail. The majority of the teenagers were in the precontemplation stage for giving up intentional tanning. The relations between the stages of change and two other major constructs of the TTM, processes of change and decisional balance, were consistent with data on other health behaviours. The results may aid in developing successful skin cancer prevention programmes. The results give support for the stages of change measurement used in this study and that utilizing the TTM in skin cancer prevention may be appropriate.

Objective: To assess tobacco prevention in Swedish dental care and to identify barriers. Also, to investigate whether dentists and dental hygienists were familiar with recently published review of smoking cessation methods., Methods: A questionnaire was mailed to all 353 dental hygienists and 528 dentists in Stockholm County., Results: The overall response rate was 61% for the dentists and 67% for the dental hygienists. Nearly all considered smoking to be a major health issue, but one out of two was not convinced that smokeless tobacco use was a major health problem. A small minority was routinely engaged in cessation support. However, on the aggregate level, the active dentists and hygienists advised annually approximately 70 000 and 40 000 smokers, respectively. The main barrier to cessation counseling was lack of smoking cessation experts to refer to and was followed by a lack of reimbursement, a lack of knowledge, time constraints, and a feeling of inadequacy. Also, one out of two dentists and 3 out of 10 hygienists did not see it as a part of their job to help patients stop smoking. Approximately 10% in both groups made use of the review of smoking cessation methods. Fifty per cent of these had increased their cessation consultations by an average of 30% because of the guidelines. On the average, dentists and hygienists had spent approximately 1.4 and 2.9 h, respectively, during the previous month on all smoking cessation activities., Conclusions: Despite several barriers, there is an excellent potential for a more active role in tobacco cessation counseling in Swedish dental care.

The aim of this study was to describe the knowledge, attitudes and smoking behavior among doctors at Mahosot University Hospital in Lao PDR. A cross-sectional, descriptive study used a self-administered anonymous questionnaire. The study population comprised 164 doctors. Answers were retrieved from 151 (92%) of the doctors. The prevalence of smoking among male doctors was 35%, 16% smoked daily and 19% occasionally. None of the female doctors reported to have ever smoked. Out of the five diseases related to smoking, 5% of the doctors recognized all and 10% recognized only one. Doctors were significantly more likely to advise patients with symptoms related to smoking. However, approximately one in two doctors reported that they did not always counsel smokers with severe smoking related symptoms to stop smoking. Almost all doctors, independent of smoking behavior, perceived tobacco prevention to be important. The findings indicate a lack of comprehensive knowledge on tobacco related issues. Most doctors expressed a positive attitude towards tobacco prevention. An effort is needed to get doctors in Lao PDR to stop smoking engage in smoking assation support.