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Background Child exposure to cigarette smoke is harmful. It should be reduced through parental smoking cessation interventions. The aim of our study was to determine the impact of simple advice provided by the pediatrician on the smoking habits of parents of children with cystic fibrosis (CF), diabetes mellitus (DM) and infants hospitalized for bronchiolitis. Methods Parents were interviewed on their smoking habits. Smoking cessation advice was provided by the pediatrician. A new smoking habits assessment was done at three months by phone interviews. Results Two hundred and sixty parents were interviewed (91 in the CF group, 136 in the DM group and 33 in the bronchiolitis group). Seventy parents were active smokers: 33% of parents of children with CF, 23.5% of parents of children with DM and 24.2 % for those with infants hospitalized for bronchiolitis (p = 0.42). In the CF group, smoking cessation had been significantly more frequently discussed with the medical team previously. Sixty-seven smoking parents (95.7%) answered the 3-month assessment: 29.8% reported having started a smoking cessation process; 10.4% had quit smoking. The quitting rate was significantly higher in the groups of patients followed for a respiratory disorder (37.5% for bronchiolitis, 15% for CF versus 0% for DM, p= 0.005). Conclusion This study shows the important role that information and simple advice from pediatricians can have in initiating smoking cessation in parents of patients followed in specialized clinics or who are hospitalized, with a greater efficiency in parents of patients suffering from lung disorders. This article is protected by copyright. All rights reserved.

Introduction The aim of this study was to determine trends in receiving quit advice from healthcare professionals among current smokers in South Africa, pre- and post-adoption of Article 14 guidelines of the WHO FCTC in 2010, and to determine the association between quit advice, e-cigarette use and quit attempt. Methods This study was a secondary data analysis involving 2206 ever-smokers aged ≥16 years who participated in the South African Social Attitude Surveys conducted in 2007, 2010 and 2017. Data included participants' sociodemographics, tobacco, and/or e-cigarette use (for years 2010 and 2017 only), exposure to others' smoking at home and/or work or public places, quit advice, and quit attempts. Analyses included chi-squared test and logistic regression. Results The mean cigarettes smoked per day, the proportions of smokers offered quit advice, planning to quit and who made a quit attempt did not change significantly between 2007 and 2017 (p=0.67, p=0.70, p=0.09 and p=0.40, respectively). However, there was a marginally significant increase in e-cigarette uptake between 2010 and 2017 (p=0.05). In a bivariate analysis, quit advice was significantly associated with making a quit attempt across all survey years. In the final multivariable-adjusted regression model, having received a quit advice (OR=1.967; 95% CI: 1.255-3.083) compared to not, and being Colored/mixed race (OR=0.467; 95% CI: 0.298-0.732) compared to self-identifying as Black African, remained independently associated with making a quit attempt. Conclusions Except for marginally increased e-cigarette use, there was no significant change in smoking or quitting behavior in South Africa post-adoption of Article 14 guidelines. The study findings highlight the importance of quit advice in promoting quitting behavior and suggest the need to scale it up in South Africa.

OBJECTIVE: To identify how best to provide smoking cessation advice and support during the Covid-19 pandemic. Preferences were assessed in relation to: (i) specific forms of tobacco cessation support (eg, nicotine replacement therapy (NRT) and various counseling formats); (ii) information sources (eg, government officials, doctors); and (iii) channels via which to receive relevant information (eg, television, social media). METHODS: An online survey was administered to adults who smoke tobacco in Australia (n = 604) and the UK (n = 600). Descriptive analyses were conducted to identify levels of interest in cessation support and information provision. Differences in responses according to demographic characteristics and smoking history were assessed. RESULTS: Around half of the respondents were interested in receiving personal counseling and/or participating in a text support program over the next month. By far the most popular delivery mechanism for personal counseling was email. Three-quarters of the sample expressed an interest in receiving free, home-delivered NRT. The most popular information sources nominated by respondents seeking more information about smokers' Covid-related risks were government departments and their doctor/general practitioner. Television and online news sources were the most preferred information dissemination channels. CONCLUSIONS: The substantial levels of interest expressed in accessing various forms of cessation assistance within the next month suggest that Covid-19 may be increasing receptiveness to quitting. The strong interest in free, home-delivered NRT indicates that this may be a useful mechanism for facilitating quit attempts during the pandemic.

Objective: Several studies have offered evidence of the importance of nursing-led interventions in smoking cessation. However, other studies have found that negative perceptions and smoking among nurses were barriers to them providing such interventions. The purpose of this study is to investigate smoking prevalence among nursing students and the demographic predictors of smoking, as well as perceptions about their roles with regard to smoking behaviour. Methods: A cross-sectional, self-administered, anonymous survey was conducted with all nursing students of the Maranatha School of Health Science in Indonesia. Smoking status, individual and familial characteristics including socio-economic status, and smoking cessation-related knowledge and attitudes were examined. Result: From the population of 313 students, 197 (62.9%) completed questionnaires were included in the analysis. The prevalence of current smoking for participants overall (25.9%) and males (52.4%) were similar to general population smoking rates in East Nusa Tenggara Province (25.9% overall and 52% for males) but lower than national rates (39% and 75.2%). However, the smoking rate among female participants (7%) was higher than national (2.9%) and regional (0.8%) female smoking rates. The majority of participants were aware of smoking health-related risk (87.3%) and supportive of giving smoking cessation advice (96.4%). In terms of seeing themselves as role models by not smoking at all, approximately 97% non-smokers agreed whereas only 60.8% of smokers agreed. Gender and being supportive of being role models by not smoking at all were significant predictors of the smoking status. Conclusion: This study suggests that smoking prevalence among nursing students is high. Despite most of the students having good smoking-related knowledge and having supportive attitudes towards providing smoking cessation services, high smoking prevalence is known to be an impediment to being effective in delivering cessation services. Personal smoking behaviour among nurses needs to be addressed to encourage critical nursing-led smoking cessation interventions.

Tobacco smoking is a major risk factor for a wide range of diseases, and smoking cessation significantly reduces these risks. Clinical guidelines for diseases associated with smoking should therefore include guidance on smoking cessation. This review updated evidence on the proportion of clinical guidelines that do so. We conducted a systematic review investigating clinical guidelines and recommendations developed by UK national or European transnational medical specialty associations and societies between January 2014 and October 2019 on 16 diseases to be at least twice as common among smokers than non-smokers. Outcomes of interest were the reporting of smoking as a risk factor, and the inclusion either of smoking cessation advice or referral to other cessation guidance. We compared our findings with an earlier review of guidelines published between 2000 and 2013. We identified 159 clinical guidelines/recommendations. Over half (51%) made no mention of smoking, while 43% reported smoking as a risk factor for the development of the disease, 31% recommended smoking cessation and 19% provided detailed information on how to deliver smoking cessation support. These proportions were similar to those in our earlier review. Smoking cessation continues to be neglected in clinical management guidance for diseases caused by smoking.

AimsAudit carried out to assess whether or not patients had been asked about their smoking status during admission onto an acute adult mental health ward, as well as if they had received any smoking cessation advice or offered nicotine replacement therapy.Background•Physical health outcomes in patients with serious mental illness (SMI) are consisitently worse than the general public This is due to multiple factors; adverse effects of medication (including metabolic syndromes with psychotropics) as well as poor lifestyle factors such as smoking status•Patients with an SMI are 3–6 times more likely to die due to coronary artery disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease.•Smoking cessation is a potent modifiable risk factor that can prevent mortality and reduce morbidity.MethodA cross-sectional review of all 34 inpatients across four general adult acute psychiatric wards.Patient records were explored using the Aneuran Bevan Health Board admission proformas to identify evidence of smoking status and whether advice was offered.ResultSmoker but not given cessation advice n = 13 (38%)Not asked about smoking n = 11 (32%)Smoker and given cessation advice n = 4 (12%)Non-smoker n = 6 (18%)ConclusionPatients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers (identified smokers and patients not asked about smoking status).A consideration to be taken into account is that on admission, a patient's physical health status may be unknown, with the additional difficulty of a patient's acute distress complicating the physical examination, smoking status and modification of patient's smoking status may not be the highest priory in that context.Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status.There is a lack of smoking cessation literature available on the wards and patients are often unaware of what options are available to quit smoking.The audit simply determined whether or not assessors were documenting smoking status, it does not measure the quantity or quality of smoking cessation advice provided.Further quality improvement projects should be launched, with focus groups as the intial step at further investigating inpatient smoking rates, as well as attempting to reduce them in a more systemic way.

Statement of problem Data on the oral cancer screening skills and beliefs of prosthodontists practicing in Saudi Arabia are lacking. Purpose The purpose of this survey was to assess the beliefs, experiences, and practices of prosthodontists practicing in Saudi Arabia regarding the early detection of oral cancer and potentially malignant disorders. Material and methods A cross-sectional, questionnaire-based survey was conducted on prosthodontists practicing in Saudi Arabia. A 26-item questionnaire was sent to all eligible prosthodontists (N=250). The collected data were analyzed with a statistical software program. Results The response rate was 57.2% (N=143). The majority of participants (79%) reported that they routinely examined all new patients for mucosal pathologies. However, only 58% reported that they examine their patients at recall visits, and only 61.5% stated that they provide tobacco use or smoking cessation advice. With regard to the respondents’ experiences with suspicious mucosal lesions, the majority said that they had detected a suspicious lesion (79.7%) and had referred affected patients (83.2%) during their career. Most prosthodontists (65%) believed that they were able to detect oral cancer on their own, and 40% believed that they could influence their patients to stop smoking. A lack of training, confidence, time, and financial incentives were reported as barriers to oral cancer screening. Conclusions Most of the prosthodontists surveyed in this study appeared motivated to perform routine oral mucosal screening. However, more efforts are needed to help improve the attitudes, confidence, and skills of prosthodontists when it comes to identifying and referring suspicious oral mucosal lesions.

INTRODUCTION Tobacco smoking may increase susceptibility to and severity of coronavirus disease 2019 (COVID-19). This information may influence smoking cessation related beliefs in smokers.METHODS Online questionnaires were answered from 26 March to 3 April 2020 in the Netherlands by 340 smokers willing to quit smoking. Beliefs regarding (quitting) smoking and (consequences of) the coronavirus are described and associations with motivation to quit due to the coronavirus are reported.RESULTS While 67.7% of the smokers indicated that the coronavirus did not influence the number of cigarettes smoked per day, 18.5% smoked less cigarettes and 13.8% smoked more cigarettes per day due to the coronavirus. One-third of the smokers were more motivated to quit smoking due to the coronavirus. Motivation to quit due to the coronavirus was positively associated with beliefs about the coronavirus as a serious threat, being at high risk of catching the coronavirus and developing severe illness, smokers being at higher risk than non-smokers, quitting smoking to reduce complaints, the social environment endorsing quitting, and perceived stress.CONCLUSIONS Subgroups of smokers may be receptive to smoking cessation advice due to COVID-19. Because of the measures taken to reduce the spread of the virus (e.g. stay at home as much as possible), personalized digital health interventions may be particularly suitable to reach smokers at home.

Introduction This study examined smoking cessation advice offered by vape shop employees, as well as their perceived awareness of vaping research. Aims and Methods This cross-sectional study was conducted in 121 vape shops in the Greater Los Angeles area of Southern California in four multiethnic communities (Hispanic/Latino, African American, Korean/Asian, and non-Hispanic White). A 35-minute interview assessed the employee’s tobacco product use, perceptions of vaping research, and experience advising customers to quit cigarette smoking. Results Among 121 vape shop employees surveyed, 106 (88%) reported that they provided smoking cessation advice or counseling to customers. Nearly half (45%) reported having no vaping-related research knowledge, while 30% were aware of provaping studies only. Approximately 85% of employees had quit cigarettes by switching to e-cigarettes instead, whereas 15% were dual users. Only 49% believed that vaping products contribute to nicotine addiction among youth. Those who provided advice on quitting cigarette smoking reported significantly lower knowledge of e-cigarette research than those who did not provide advice (p < .01). Conclusions Most vape shop employees provide advice to customers who desire to quit cigarette smoking and initiate electronic cigarette use. However, they report a low level of awareness about e-cigarette research. Future research is warranted to examine the specifics of advice provided by vape shop employees. Training programs for vape shop employees and educational campaigns about evidence-based scientific findings on vaping may be beneficial. Implications Almost nine out of 10 surveyed vape shop employees offered cigarette smoking cessation advice to their customers, while almost half of the retailers report not being aware of any vaping-related research studies. Providing employees with training on evidence-based cessation advice could help protect customers. Also, training programs for vape shop employees and educational campaigns about the risk of nicotine addiction could potentially increase their motivation to avoid sales to minors and to warn adults about nicotine addiction.

Background: Early diagnosis and management can mitigate the long-term morbidity and mortality of chronic obstructive pulmonary disease (COPD). Aims: To gain insights into the initial diagnostic process and early management of COPD by Australian general practitioners (GPs). Methods: A random sample of Australian GPs was invited to complete a postal survey, which assessed familiarity with and use of contemporary practice guidelines, diagnostic criteria, and management preferences for COPD. Results: Two hundred and thirty-three GPs completed the survey. While most GPs based a COPD diagnosis on smoking history (94.4%), symptoms (91.0%) and spirometry (88.8%), only 39.9% of respondents recorded a formal diagnosis of COPD after the patient's first symptomatic presentation. Tiotropium was the preferred treatment in 77.3% of GPs for the initial management of COPD, while only 27.5% routinely recommended pulmonary rehabilitation. GPs routinely recorded patients' smoking status and offered smoking cessation advice, but the timing of this advice varied. Less than half of the respondents routinely used COPD management guidelines, or tools and resources provided by the Australian Lung Foundation. Conclusion: There is scope for major improvement in GPs' familiarity with and use of COPD management guidelines, and readily available tools and resources. Some systematic issues were highlighted in the Australian primary care setting, such as a reactive and relatively passive and delayed approach to diagnosis, potentially delayed smoking cessation advice and under-utilisation of pulmonary rehabilitation. There is an urgent need to devise strategies for improving patient outcomes in COPD using resources that are readily available.

Introduction: Social media advertising could be effective in promoting smoking cessation. However, it's salience to Pacific youth in New Zealand who smoke is unknown.Aim: To explore the views that 18–25 year old Pacific smokers have towards online smoking cessation advertising.Methods: Twenty young Pacific smokers, aged 18–25 years, were recruited through indirect snowballing methods interviewed in focus groups by a female Pacific researcher. Questions centred on smoking cessation advice via social media and devices, preferences for advertisements, effective features and implications for internet banner and ad designs, positive versus negative framing, cultural cues and motivations. The general inductive approach was used to analyse the data for common themes.Results: Smartphones were the most common device and Facebook the social media site most often used by participants. The informants recommended that the advertisements should have the following features: central position, eye-catching, bold imagery using simple language; endorsed by Pacific Island personalities; and positively framed messages to secure and maintain interest. The collective nature of Pacific cultures should be leveraged and testimonies from previous smokers used to strengthen motivation and dispel common myths around smoking.Conclusion: There are potential opportunities for social media to be used as a platform to promote smoking cessation among Pacific young people.

In the antenatal period, smoking cessation is a key health promotion topic for midwives due to the recognised adverse outcomes. Carbon monoxide screening and locally available referral pathways demonstrate the wide availability of support for women who smoke when pregnant. However, there is arguably less health promotion provided to women in the postnatal period, due to minimal research. Reflecting on a case study throughout, this article analyses the health promotion provided by midwives to women about postpartum smoking and its effects, exploring the risks to the newborn, particularly highlighting the relationship between smoking and breastfeeding. There will be reference made to what is implemented in the local area of Hertfordshire to assist in smoking cessation, comparing both national and local policies. There is a great emphasis on the fundamental role of the midwife in providing health promotion, assessing the suitable environment and communication skills to ensure effectiveness.

Jens Dollerup,1 Jørgen Vestbo,2 Tarita Murray-Thomas,3 Alan Kaplan,4 Richard J Martin,5 Emilio Pizzichini,6 Marcia M M Pizzichini,6 Anne Burden,7 Jessica Martin,7 David B Price7,8 1Dollerup Medical Consultancy, Kongens Lyngby, Denmark; 2Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK; 3Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK; 4Family Physician Airways Group of Canada, Richmond Hill, ON, Canada; 5National Jewish Health, Denver, CO, USA; 6Federal University of Santa Catarina, Santa Catarina, Brazil; 7Observational and Pragmatic Research Institute Pte Ltd, Singapore; 8Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK Background: Previous research suggests exposure to nicotine replacement therapy (NRT) may be associated with an increased risk of cardiovascular disease (CVD).Methods: Using data from the United Kingdom’s Clinical Practice Research Datalink, this study aimed to evaluate CVD events and survival among individuals who attempted smoking cessation with the support of NRT compared with those aided by smoking cessation advice only. We studied CVD outcomes over 4 and 52 weeks in 50,214 smokers attempting to quit – 33,476 supported by smoking cessation advice and 16,738 with the support of NRT prescribed by their primary care physician. Patients were matched (2 smoking cessation advice patients:1 NRT patient) on demographic and clinical characteristics during a baseline year preceding their quit attempt. Cox proportional hazard regression, conditional negative binomial regression model, and conditional logistic regression were used to analyze data.Results: Mean (standard deviation) population age was 47 (11.2) years; 51% were females. Time to first diagnosis of ischemic heart disease (IHD) among NRT and smoking cessation advice patients was similar within the first 4 weeks, but shorter for NRT patients over 52 weeks (hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.03–1.77). A similar trend was observed for cerebrovascular disease (HR: 1.54, 95% CI: 1.08–2.19). NRT patients with a prior diagnosis of IHD or cerebrovascular disease had a higher rate of primary or secondary care consultations for IHD or cerebrovascular disease by 52 weeks (rate ratio: 1.50, 95% CI: 1.14–1.99). Patients prescribed NRT had a shorter survival time over 52 weeks, compared with those receiving advice only (HR: 1.39, 95% CI: 1.09–1.76).Conclusion: Our findings suggest that treatment with NRT over 4 weeks does not appear to have an impact on cardiovascular risks. However, a longer follow-up period of 52 weeks resulted in an increase in cardiovascular events for patients prescribed NRT, compared with those receiving smoking cessation advice only.ENCePP registration ENCePP/SDPP/4238 Keywords: smokers, cardiovascular, risk, nicotine replacement therapy, smoking cessation advice

The adverse health effects of smoking are well known, including its effects on the musculoskeletal system. Limb reconstruction using external fixators is a high intensity process with high levels of patient contact time, complications and cost. The aim of this study was to examine smoking patterns in this group and in particular to assess trends in smoking cession. Data was collected from 41 patients all undergoing treatment using circular frame external fixation, for a variety of pathologies, most commonly acute tibial trauma. A patient reported questionnaire was used. Data was collected over a six-month period. In our population 56.1% of patients were smokers. During the study 47.8% patients stopped smoking and a further 39.1% decreased their smoking behaviour. 78.3% of patients could recall being given smoking cessation advice. In our group, 87% of patients were unaware of the effects of smoking on bone healing. Once made aware during discussion of proposed treatment, 73.9% stated that it was, in part, this knowledge that prompted them to positively change their smoking habits. The results of this study show that advice regarding smoking cessation during limb reconstruction treatment can potentially have a positive impact on patients smoking habits. The effect of smoking should be linked to the patient pathology and discussed during the consent process. Taking the time with the patient for this simple free intervention can have a positive impact on patient health, and potentially on the outcome of their current treatment, and is an opportunity not to be missed.

Background Smoking is the single most important public health challenge facing the National Health Service. The detrimental effects on the general health of tobacco smoking are well documented. Smoking is a primary risk factor for oral cancer and many oral diseases. Dental professional scan plays an important role in preventing adverse health effects by promoting smoking cessation. Objective To assess the knowledge, attitude, and practice among clinical dental students in giving smoking cessation advice and to explore the barriers to this activity. Materials and methods A total of 262 clinical dental trainee of two dental colleges (College of Dental Sciences and Bapuji Dental College) of Davangere city were included in the survey. A self-administered questionnaire was administered to assess the knowledge, attitude, and practice toward Tobacco Cessation Advise. Results Among the 262 participants in the study, around 51% said they know about Nicotine Replacement Therapy, and among them, only 4.6% were aware of the options available in the market. When asked about 5A's of tobacco cessation, only 35.5% were aware of it. Similarly, when asked about 5R's of tobacco cessation, 48.5% were unaware of it. Conclusions The respondents did not have sufficient knowledge regarding tobacco cessation advice. With patient's disinterest and lack of time being quoted as the important barriers in providing tobacco cessation advice, it is highly recommended that there is need to incorporate few chapters on tobacco, its effect and cessation of habit in the undergraduate dental curriculum with simultaneous application of the same in clinical practice.

Introduction: The 8FG Rocket® Pleural Vent™ is a device that allows ambulatory pneumothorax (ptx) management. It is a valve and a drain, and does not require insertion of a chest drain, which other devices such as Heimlich or Pneumostat valves require. We established guidelines and review our practice. Method: Analysis of all patients managed with a vent Mar 2018-Jan 2019 Results: Procedures since guidelines: 21 - 11 primary ptx, 8 secondary ptx, 2 post CT guided biopsy Device enabled complete resolution of pneumothorax in 16 patients Complications: 1 vent kinked on insertion and was removed, 1 patient got in a fight and damaged vent (same patient had an allergic reaction to the dressing) and 1 was removed due to pain post insertion 2 were taken out as surgical emphysema developed, both were secondary pneumothoraces. We observe all patients post insertion and repeat their x-ray. Surgical empysema can be expected due to the smaller bore size of the vent. Patient selection is crucial. Our patients have to be ambulant with normal observations. Many training events have been held with ED and Respiratory staff, facilitated by company rep Cost Improvement: 16 patients would have accrued 50 bed days. All patients were reviewed on ambulatory care Only 3 of the primary ptx patients were never smokers, and all other 8 smoked cigarettes and cannabis. All were provided with smoking cessation advice. 2 patients have had recurrence, one from the primary group and one from the secondary group, requiring cardiothoracic referral. Conclusions: Ambulatory pneumothorax management is safe and can be established with clear local protocols in place. Large UK based trials in primary and secondary pneumothoraces are ongoing.

Introduction Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone. Methods In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo. Results The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years. Conclusions Few studies have been undertaken to examine the efficacy of spirometry in increasing patient quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

Brief smoking cessation advice from physicians is an effective smoking cessation intervention and is therefore an important skill medical students should master. We sought to assess the ability of medical students at the University of Auckland, New Zealand at different stages of their clinical education to provide accurate smoking cessation advice.Seventy-five medical students participated in a five-minute videotaped objective structured clinical examination (VOSCE) with a standardized patient. We marked them using a 10-point scale based on the "5As" of smoking cessation, with a score of 7/10 or more considered a pass. We used the general inductive method to analyze student feedback for key themes.The mean score was 5.81/10, with only 15 (20%) students reaching the pass mark. Qualitative analysis revealed three themes: students had breadth of knowledge but lacked depth; their preference was to prescribe medications; and students were unable to identify where further smoking cessation support could be sourced.University of Auckland medical students performed poorly when giving smoking cessation advice. Inclusion of smoking cessation education in the undergraduate curriculum is required to ensure all graduates are capable of providing evidence-based and accurate cessation advice.

Increased outdoor smoking is a common phenomenon after indoor smoking bans were in place. A series of observational studies were conducted to evaluate a novel, proactive, and brief smoking cessation intervention at outdoor smoking "hotspots," i.e., outdoor public areas where ashtrays were available and smokers clustered to smoke. The number of smokers at 26 selected hotspots were observed and counted for two consecutive days. Further observations of the smokers' characteristics and brief smoking cessation intervention were conducted at ten of the hotspots with the greatest number of smokers. Responses of the smokers to the brief intervention, including a leaflet and brief smoking cessation advice using AWAR protocol delivered by trained smoking cessation ambassadors, were assessed. A total of 24,034 smokers were observed within 464 h, which equals 51.8 smokers per hour. Of the 5070 pedestrians observed at the ten hotspots during the intervention sessions, 1228 (24.2 %) were smokers. In the 1228 smokers who were approached during our intervention sessions, about two thirds were willing to receive the self-help leaflet on smoking cessation whereas about half received the brief smoking cessation advice. Recruiting smokers and delivering brief smoking cessation interventions at smoking hotspots are feasible and likely effective to reach large numbers of smokers. Studies to evaluate the effectiveness of using this approach for smoking cessation are warranted.

Mohammed AlAteeq,1 Abdulaziz M Alrashoud,2 Mohammed Khair,2 Mahmoud Salam3 1Department of Family Medicine, 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 3King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Background: Brief advice on smoking cessation from primary health care (PHC) physicians reduces smoking prevalence. However, few studies have investigated the provision of such advice by PHC physicians providing services to military communities. The aim of this study was to evaluate PHC physicians’ attitudes toward and practice of delivering smoking cessation advice to smokers in a military community in central Saudi Arabia.Methods: A self-reported survey of PHC physicians was conducted in 2015 using a previously validated tool. The age, sex, educational level, job title, experience and previous smoking cessation training of each physician was recorded. Attitude (ten statements) and practice (six statements) were evaluated on a five-point Likert scale. Scoring system was applied and percentage mean scores (PMS) were calculated. Descriptive/statistical analyses were applied to identify factors that were significantly associated with a positive attitude and favorable practice (PMS >65 each). P-values

The aim of the current study was to use interviews to explore midwives' experiences of talking to pregnant women about smoking cessation. Eight midwives based in one UK hospital took part in face-to-face semi-structured interviews. Thematic analysis revealed that midwives were aware of health risks associated with smoking, saw providing smoking cessation advice as part of their role, would value more support from GPs, and were clear that support and a woman-centred approach were key. Failure to refer women for support was related to cumbersome or misunderstood referral procedures rather than reluctance to refer.

Background: Hospitalisation is an ideal time to implement smoking cessation interventions. However, little is known about the extent to which inpatients receive such advice, or the impact it has on motivation to quit and quitting behaviours post-hospitalisation. Aims: This study aimed to determine the prevalence of smoking and cessation advice received by inpatients in two teaching hospitals in Ireland, and the impact of cessation advice on smoking at 3 months post discharge. Methods: We surveyed 1001 inpatients across two hospital sites, over a six-month period. Demographic details, clinical history, smoking history, motivation to quit, cigarette dependence, and recent quitting history were assessed. Results: Prevalence of smoking within the sample was 23.4% (235/1001). Only 32% (75/235) of smokers reported that smoking cessation was discussed during admission. Smokers’ mean Fagerström nicotine-dependence score was 3.7 (SD = 2.7), indicating low dependence levels. At 3 months, 17% (25/146) of smokers reported smoking cessation. Provision of smoking cessation advice during hospitalisation was associated with higher motivation to quit (OR = 2.79, 95% CI 2.12–3.68), and successful quit behaviour for confirmed (OR = 1.98, 95% CI 1.55–2.53) and self-reported quitters (OR = 1.47, 95% CI 1.3–1.66) Conclusions: This observational study finds that provision of brief cessation advice and smoking status documentation was suboptimal. Where advice was given, it was associated with enhanced motivation to quit and increased quit rates. These findings, along with low dependence scores, suggest that systematic provision of low-intensity cessation interventions could significantly enhance quit rates in hospitalised smokers.

Introduction: Tobacco smoking is a well-known risk factor for postoperative complications. Quitting smoking prior to surgery helps overcome those complications. Problem: Surgeons' attention for educating their patients about the importance of smoking cessation prior to surgery is one of the most effective ways to reduce smoking-related surgical complications. The extent of advised patients by their surgeons has not been identified. Methods: A descriptive, comparative cross-sectional study using a survey was conducted in 2013 including eligible patients in King Khalid University Hospital. Simultaneously, 69 surgeons were included. All participant data were randomly collected and analyzed using Chi-square analysis. Results: The frequency of smokers is more in surgical patients (37.5%) when compared to ex-smokers (12.5%) and passive smokers (8.3%), which were ex- and passive smokers, and it demonstrated an increased risk (P = 0.001) for surgery group compared to the nonsurgery group (P = 0.001). When comparing with nonsurgery group, most surgical patients agreed to quit smoking before surgery (95.3%)S. More than half (58.8%) of the patients said that they have been advised by their treating surgeons to quit smoking before surgery. Concerning the surgeons, 66 nonvascular and nonpediatric surgeons responded to the questionnaire (response rate: 22.83%). The majority of the surgeons (60.9%) were interacting with smoker patients. With regard to smoking cessation, 69.6% surgeons have advised smoker patients to stop smoking for more than 2 weeks before surgery. More than half of the surgeons (53.6%) believed that patients quit smoking after preoperative smoking cessation advice. Conclusion: The surgeons and patients who participated in this study were aware that smoking cessation improves outcomes, but most of the surgeons did not provide brief advice about time duration to stop smoking.

Background: Electronic nicotine delivery systems (ENDS) is commercially available since 2004.the health hazards posed by ENDS is not yet known. Documentation of ENDS commonly known as e cigarettes is important from surveillance and research point of view.the use of e cigarettes is reported to be 10% in Ireland. Methods: we performed retrospective analysis of 50 medical admission notes in admitted patients in Connolly hospital, Dublin.patients were selected randomly and approval from the ethics committee was obtained. Patients were 60% female, age [mean±SD] 75±13years,34% patients had known diagnosis of COPD. Results: shortness of breath was the commonest presenting complaint seen in 40% of patients,18% presented with cerebrovascular accident,12% presented with fall at home, 30% had other complaints. Smoking status was documented in 66% of the patients.38% of the patients had their smoking pack years documented in medical notes.36% of the patients had never smoked in their life.e cigarettes status was documented in 1 patient(0.03%). Alcohol consumption history was documented in 44% of patients. Conclusion: we hypothesize that patients don’t consider e cigarettes use as smoking. It’s important to have standardized documentation of e cigarettes to facilitate smoking cessation advice and discussions regarding potential health hazards and nicotine dependence. Good documentation in medical notes may help in surveillance and research into potential health hazards caused by electronic nicotine delivery systems (ENDS)

Performing spirometry on patients who smoke, yet are asymptomatic, to show adverse effects has been suggested to be useful for motivation to quit smoking. However, the effect of such intervention is unclear. The purpose of this review is to determine whether or not feedback of spirometry results to adult smokers in connection with counselling to stop smoking can increase the rates of smoking cessation compared to smoking cessation advice alone. In this systematic review, we included RCTs evaluating smoking cessation interventions for smokers. A systematic search was performed in seven databases. This resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometric results in combination with smoking cessation counselling, as compared to patients who only received smoking cessation counselling. In both studies, the spirometry results were expressed as so-called lung age. In the other five studies no difference was found. Five further study protocols for ongoing RCTs have been found, which can be expected to necessitate the updating of this systematic overview within a few years. In summary, there is today limited support in the literature that feedback from spirometry including demonstration of lung age, in addition to smoking cessation counselling, is favorable for motivating patients to stop smoking. Regarding long-term effects, scientific support is today insufficient.

Objective: To investigate the effectiveness and cultural relevance of Quitskills training tailored for health professionals working with Aboriginal and Torres Strait Islander people who smoke. Methods: A retrospective analysis was conducted with data collected from 860 participants(54% Aboriginal and Torres Strait Islander participants) in tailored Quitskills training from 2012to 2016. Course participants took part in a survey at pre-training, post-training and four-six weeks post-training to assess confidence in skills to address tobacco, and perceptions of the strengths, areas for improvement and cultural relevance of the training. Results: Confidence in skills and knowledge to address tobacco increased significantly from pre- to post-training (all indicators of confidence in skills increased p

Aims To determine the current level of knowledge and opinions of UK dental professionals with regards to smoking cessation and e-cigarettes. Method A self-administered online survey was distributed by postal invitation to all dental practices in the north of England registered on the National Health Service (NHS) Choices website. Findings One hundred and ninety completed questionnaires were received. Seventy-nine percent of respondents reported always enquiring about the smoking status of their patients with 17% completing referrals to a specialist stop smoking service. Just under half of respondents reported not receiving any smoking cessation advice training. Lack of time during appointments, lack of training and lack of perceived interest by patients were reported as the most important barriers. The importance of a lack of remuneration, as a barrier, varied considerably with professional role. Approximately a third (31%) of respondents were of the opinion that e-cigarettes are more or equally harmful than cigarettes with the majority not aware of any guidance documents or recommendations regarding e-cigarettes. Conclusion The majority of dental professionals in the north of England reported providing smoking cessation advice, although only half had training on this. Opinions on electronic cigarettes were mixed, with a third having negative views.

Background Children and pregnant women are vulnerable to the harms of tobacco smoke. All healthcare professionals (HCPs) have a responsibility to protect them from tobacco smoke. This study aims to identify the gaps between this knowledge and real world practice in a clinical setting. Methods Self administered questionnaires were distributed to 2436 HCPs at a women´s and children´s hospital. The HCPs were asked about their practice of smoking/tobacco smoke exposure (TSE) assessment and provision of smoking cessation advice/assistance in their clinical work, and the barriers they face in carrying out these activities. Results The response rate was 74.6% (1817 respondents), from 276 (15.2%) doctors, 1498 (82.4%) nurses and 43 pharmacists (2.4%). Only 20% of HCPs would always ask about smoking/TSE, while 19.5% do not at all. Only 15.1% of HCPs would always provide smoking cessation advice/assistance to patient smokers or smoker parents/caregivers, while 28.4% do not at all. Only 7.9% of Paediatrics HCPs would always ask about smoking/TSE, while 38.7% of O&G HCPs would always do so ( p = 0.000 ). The reasons/barriers for not always assessing smoking/TSE or providing smoking cessation advice/assistance are listed in Table 1. Not always assessing for smoking/TSE Not always providing smoking cessation advice/assistance Smoking/TSE is not a common/significant issue (35.6%) Smoking/TSE is not a common/significant issue (23.4%) Not my direct responsibility (21.7%) Not my direct responsibility (20.9%), Smoking/TSE is not related to the patient´s disease (19.4%) Smoking/TSE is not related to the patient´s disease (17.0%) Fear of negative reaction from smoker (14.5%) Lack of counseling skills (16.5%) Lack of time (7.5%) Fear of negative reaction from smoker (15.7%) Inadequate resource personnel to assist (3.2%) Lack of time (14.6%) [Table 1 - Reasons and Barriers] The most common interventions for patient smokers and smoker parents/caregivers are provision of general advice for the smoker to quit smoking (36.5%), assessment of smoker willingness to quit (15.7%), and provision of reading materials (9.9%). The suggestions from HCPs on how to overcome the barriers identified are relevant training courses for all HCPs (62.2%), setting up of smoking cessation clinics (42.4%), and training more smoking cessation counselors (30.6%). Conclusions There is room for improvement in the real world practice of HCPs in protecting children and women from tobacco smoke. Awareness and mindset issues are barriers to be addressed. Fear of negative reaction and lack of counseling skills limit HCPs´ confidence but the majority are receptive to receiving training.

Objective To compare voice-activated internet searches by smartphone (two digital assistants) with laptop ones for information and advice related to smoking cessation. Design Responses to 80 questions on a range of topics related to smoking cessation (including the FAQ from a NHS website), compared for quality. Setting Smartphone and internet searches as performed in New Zealand. Main outcome measures Ranked responses to the questions. Results Google laptop internet searches came first (or first equal) for best quality smoking cessation advice for 83% (66/80) of the responses. Voiced questions to Google Assistant (“OK Google”) came first/first equal 76% of the time vs Siri (Apple) at 28%. Google and Google Assistant were statistically significantly better than Siri searches (odds ratio 12.4 and 8.5 respectively, p

Background The world's leading cause of preventable deaths, diseases and disabilities is smoking. Hospitalization can provide an opportunity for smokers to quit. Previous research found that smokers make up a high percentage of patients admitted to intensive care. Health care professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice. Aim To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings. Design Quantitative design using an online survey. Methods This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14-bed general intensive care and a 16-bed cardiovascular intensive care unit. The target population for this research was the nursing and medical staff working in adult critical care environments. Results The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments. Conclusions The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and extubated patients. Further research might be required to confirm this. Relevance to clinical practice The provision of smoking cessation advice is an on-going World Health Organization and New Zealand Government priority and all parts of the health sector need to provide responses. However, responses need to be adapted to the specific context such as the unique challenges of critical care.

Objective Little smoking research in the past 20 years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics. Method In 2012–4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 ( n = 346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation. Results 12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65–69, 3% of 85 +) and education (12–15% with no high school degree, 5–6% with BA +). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African–American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice “always” or “usually” at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p Conclusions Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians.

Brief cessation advice from health-care professionals in the hospital setting significantly increases the likelihood of patients quitting smoking, yet patients are not routinely provided with this advice. Smoke-free hospital policies aim to protect individuals from the adverse effects of smoking; however, it is unclear if such policies encourage systematic delivery of cessation advice by health-care professionals. The study's aim was to determine the prevalence of smoking and cessation advice received by in-patients in two teaching hospitals in Ireland which have implemented smoke-free hospital policies, and to examine patient attitudes towards smoking cessation. Change in smoking prevalence and delivery of smoking cessation advice prior to and post-policy implementation was also examined in one hospital. This study surveyed 466 in-patients across 2 hospital sites, over a 3-week and 5-week period, respectively. Data were also compared to a survey completed prior to the implementation of the smoke-free pol...

Background: Smoking is an established risk factor for many diseases and is one of the most important public health problems worldwide. According to the WHO, medical and paramedical staff can influence positively or negatively the smoking habits of a community. Objective: To explore the predictors of providing smoking cessation advice by medical and paramedical staff. Methods: We have conducted a cross-sectional study from April, 2014 through May, 2014 in Najran Armed Forces Hospital. Data collection was done using an anonymous, self-administered questionnaire. Results: The study included 128 health care professionals. The mean age and standard deviation of the study group was 33.8 ± 8.10 years. The overall prevalence of tobacco use among medical and para-medical staff amounted to 21.1%. The prevalence among male health care providers amounted to 37.5% compared to 9.4% among females. The highest prevalence of tobacco use was among physicians (33.3%) followed by technicians (24.2%) and nurses (11.3%). More than 16% of the medical and paramedical staff didn't at all ask patients about their smoking status and only 40 % of them do that from time to time. Nurses were found to be significant predictors in providing smoking cessation advice to patients compared to physicians (aOR = 5.21, 95% CI: 1.1–25.1). Conclusion: The prevalence rate of smoking habit is still higher among persons who understand the related problems of smoking. Nurses are more active than doctors in providing tobacco cessation advice to their patients.

Objectives. We compared patient-reported receipt of smoking cessation counseling from US dentists and physicians. Methods. We analyzed the 2010 to 2011 Tobacco Use Supplement of the Current Population Survey to assess receipt of smoking cessation advice and assistance by a current smoker from a dentist or physician in the past 12 months. Results. Current adult smokers were significantly less likely to be advised to quit smoking during a visit to a dentist (31.2%) than to a physician (64.8%). Among physician patients who were advised to quit, 52.7% received at least 1 form of assistance beyond the simple advice to quit; 24.5% of dental patients received such assistance (P Conclusions. Our results indicate a need for intensified efforts to increase dentist involvement in cessation counseling. System-level changes, coupled with regular training, may enhance self-efficacy of dentists in engaging patients in tobacco cessation counseling.

The study examined the effect of Magnet recognition on hospital-reported rates of smoking cessation advice (SCA) provided to inpatients with community-acquired pneumonia. Logistic and propensity score regression models estimated the magnet effect on the SCA rate. Predictors were hospital characteristics, socioeconomic factors affecting smoking, and baseline and mid-study SCA rates as variations in hospital-improvement systems. Magnet recognized hospitals reporting higher mid-study SCA rates had higher outcome SCA rates.

Objective The aim of this study was to understand practices regarding smoking cessation among rheumatologists for patients with inflammatory rheumatic diseases. Methods A survey was sent to the rheumatologists participating in the multinational Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) group. The survey inquired about the clinical practice characteristics and practices regarding smoking cessation (proportion of smokers with inflammatory rheumatic diseases given smoking cessation advice, specific protocols and written advice material, availability of dedicated smoking cessation clinic). Results Rheumatologists from 44 departments in 25 countries (16 European) completed the survey. The survey involved 395 rheumatologists, of whom 25 (6.3%) were smokers, and 199 nurses for patient education, of whom 44 (22.1%) were smokers. Eight departments (18.1 %) had a specific protocol for smoking cessation; 255 (64.5%) rheumatologists reported giving smoking cessation advice to all or almost all smokers with inflammatory diseases. In a regression model, early arthritis clinics (P = 0.01) and high gross domestic product countries (P = 0.001) were both independently associated with advice by the rheumatologist. Nurse gives advice to most patients in 11 of the 36 (30.5%) departments with nurses for patient education. Conclusion Advice for smoking cessation within rheumatology departments is not homogeneous. In half of the departments, most doctors give advice to quit smoking to all or almost all patients with inflammatory diseases. However, only one in five departments have a specific protocol for smoking cessation. Our data highlight the need to improve awareness of the importance of and better practice implementation of smoking cessation advice for inflammatory rheumatic disease patients.

Objectives: The objective of the following study is to assess the knowledge of patients about the consequences of smoking on the general and oral health, to analyze the patient's perceptions about the role of dentists in smoking prevention, counseling and cessation and to analyze the willingness of smokers to quit smoking following dentist's advice. Materials and Methods: A descriptive study was conducted in a sample of 486 dental patients visiting Vokkaligara Sangha Dental College and Hospital, Bengaluruin the month of August 2011 using a self-administered questionnaire. Descriptive statistics and Chi-square test was performed to analyze data. Results: The patients had good knowledge about the effects of smoking on general and oral health. Statistically significant difference was observed in the knowledge of smokers and non-smokers about the effects of smoking on ageing (P = 0.008) and oral cancer (P = 0.0012). Patients had a positive perception about the role of dentists in smoking cessation activities. Smokers exhibited a willingness to quit if suggested by the dentist. Conclusion: Patients perceive that dentists can play an important part in smoking cessation activities. Hence, dentists should not hesitate to give smoking cessation advice to their patients and grasp this opportunity to improve the general and oral health of the community.