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1.  What Do Mothers Think about Concurrent Breastfeeding and Smoking? 
Background
According to newer AAP policies, smoking is not contraindicated with breastfeeding, yet smokers initiate and maintain breastfeeding less than non-smokers.
Objectives
1) Describe maternal knowledge and 2) attitudes regarding concurrent breastfeeding and smoking or nicotine replacement therapy (NRT) and 3) evaluate the association between maternal smoking and infant feeding practices.
Methods
Mothers bringing children <13 months old for an appointment completed a 24-item, anonymous survey which addressed knowledge, attitudes and practices about concurrent breastfeeding and smoking/NRT.
Results
Among 204 survey completers, 63% were African American, 52% had never breastfed and 54% had never smoked. Knowledge: Regardless of smoking status, 19% were aware of the recommendation to smoke after breastfeeding; most did not know that nicotine gum (42%) or patch (40%) transfers less or about the same amount of nicotine into breast milk than smoking a pack per day. Attitudes: Most mothers (80%) believe that women should not smoke any cigarettes if breastfeeding; current smokers (25%) were more likely than former (10%) or never smokers (11%) to find it acceptable to smoke one or more cigarettes per day (p=.03). Only 2% found it acceptable to use NRT while breastfeeding. Practice: Among ever breastfeeders, 10% stopped breastfeeding because of smoking. Over half of recent or current smokers reported that smoking impacted their infant feeding decision.
Conclusions
Mothers in this sample believe that women who smoke or take NRT should not breastfeed. Smoking status impacted women’s infant feeding practices. Correction of misinformation could increase breastfeeding rates.
doi:10.1016/j.ambp.2008.01.008
PMCID: PMC2587350  PMID: 18501868
Breastfeeding; Smoking; Tobacco
2.  Pediatricians' attitudes, experience and referral patterns regarding complementary/alternative medicine: a national survey 
Background
To assess pediatricians' attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies.
Methods
An anonymous, self-report, 27-item questionnaire was mailed nationally to fellows of the American Academy of Pediatrics in July 2004.
648 of 3500 pediatricians' surveyed responded (18%).
Results
The median age ranged from 46–59 yrs; 52% female, 81% Caucasian, 71% generalists, & 85% trained in the US. Over 96% of pediatricians' responding believed their patients were using CAM. Discussions of CAM use were initiated by the family (70%) & only 37% of pediatricians asked about CAM use as part of routine medical history. Majority (84%) said more CME courses should be offered on CAM and 71% said they would consider referring patients to CAM practitioners. Medical conditions referred for CAM included; chronic problems (headaches, pain management, asthma, backaches) (86%), diseases with no known cure (55.5%) or failure of conventional therapies (56%), behavioral problems (49%), & psychiatric disorders (47%). American born, US medical school graduates, general pediatricians, & pediatricians who ask/talk about CAM were most likely to believe their patients used CAM (P < 0.01).
Conclusion
Pediatricians' have a positive attitude towards CAM. Majority believe that their patients are using CAM, that asking about CAM should be part of routine medical history, would consider referring to a CAM practitioner and want more education on CAM.
doi:10.1186/1472-6882-7-18
PMCID: PMC1894987  PMID: 17547752
3.  GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey 
BMC Research Notes  2010;3:82.
Background
Many breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited.
Methods
GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640). Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes.
Results
335 (52%) GPs responded to the survey, and 253 (76%) provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%), other infections (24%) and depressive disorders (21%). The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression.
Conclusion
GPs feel that prescribing medicines for breastfeeding women is a contentious issue. They manage the risk of prescribing by gathering information and assessing the possible effects on the breastfed infant. Without evidence-based information, they sometimes recommend cessation of breastfeeding unnecessarily.
doi:10.1186/1756-0500-3-82
PMCID: PMC2860488  PMID: 20331898
4.  A survey of pediatricians' attitudes and practices about maternal employment. 
Public Health Reports  1987;102(3):302-307.
A survey of 281 members (31 percent) of the Texas Pediatric Society was performed in 1981 to assess members' knowledge of, attitudes toward, and practices regarding mothers who work outside the home. Only 15 percent correctly answered two of three knowledge questions about maternal employment. Thirty-five percent of the pediatricians failed to inquire about maternal employment. Although only 1 percent advised all mothers not to work, 22 percent said that mothers with children at home should not work. Most pediatricians had traditional conservative attitudes and opinions (exemplified by the statement "a woman's place is in the home") in regard to two factors, "acceptability of maternal employment" and "effects of maternal employment on children." More liberal views were associated with more recent graduation from medical school, being a woman, having a working wife, being in favor of wife's working status, and knowledge of statistics concerning maternal employment. These results suggest that if the practices of those Texas pediatricians who responded correspond with other pediatricians' practices in the United States, a large proportion of pediatricians may not be providing adequate support for the 17 million working mothers and their children.
PMCID: PMC1477842  PMID: 3108947
5.  Knowledge, attitudes, and beliefs of health care workers regarding alternatives to prolonged breast-feeding (ANRS 1201/1202, Ditrame Plus, Abidjan, Cote d'Ivoire) 
The Ditrame Plus project conducted in Abidjan, Côte d’Ivoire is aimed at the prevention of mother-to-child transmission of HIV in combining perinatal antiretroviral interventions with a systematic proposal of alternatives to prolonged breastfeeding: formula-feeding from birth, or exclusive breastfeeding during three months then early cessation of breastfeeding. We surveyed all health care workers involved in this project in November 2003 using a self-administered anonymous questionnaire to investigate their knowledge, attitudes and beliefs regarding the infant feeding interventions proposed since March 2001. Their knowledge regarding infant practices proposed within the study was consistent and their attitude was in accordance with the study protocol. However, proposing alternatives to prolonged breastfeeding induces difficulties to health-care workers that should be taken into account when tailoring such complex interventions.
PMCID: PMC2475525  PMID: 16123690
Anonymous Testing; Bottle Feeding; Cote d'Ivoire; Cross-Sectional Studies; Disease Transmission; Vertical; prevention & control; Female; HIV Infections; prevention & control; Health Care Surveys; Health Knowledge; Attitudes; Practice; Humans; Infant; Infant; Newborn; Milk; Human; Pregnancy; Pregnancy Complications; Infectious; prevention & control; Questionnaires; HIV; mother-to-child transmission; infant feeding; health care worker; Africa
6.  Physician Counseling of Pregnant Women About Active and Second-hand Smoking in Argentina 
Objective
Describe physicians' practices of smoking cessation and secondhand smoke (SHS) exposure counseling during prenatal visits.
Design
Cross-sectional survey
Setting
13 public and private hospitals from three cities in Argentina
Population
300 obstetrician/gynecologists
Methods
Self-administered survey included knowledge and attitudes about tobacco use during pregnancy, frequency, type and duration of smoking cessation counseling, barriers to counseling, communication skills, level of understanding, and personal smoking history.
Main Outcome Measures
Composite outcomes of 4 items, each representative of counseling on smoking cessation and SHS exposure.
Results
235 (78.3%) questionnaires were completed; 54.5% men, mean age 45, 35% current smokers. Only 22% had received training in smoking cessation counseling and 48.5% reported insufficient knowledge to provide smoking cessation advice. Although 88.9% always or almost always advised women to stop smoking, 75% believed it was acceptable for pregnant women to smoke up to 6 cigarettes per day. The risk of SHS exposure was “always or almost always discussed” by only 34.5% of physicians. Multivariate logistic regression showed that lack of training was associated with less counseling about smoking cessation (OR 0.18; 95%CI 0.04-0.82) and SHS exposure (OR 0.27; 95%CI 0.12-0.59). Current compared to never smokers had lower odds of smoking cessation counseling (OR 0.39; 95%CI 0.05-0.82). Current smokers were less likely than former smokers to counsel about SHS (OR 0.25, 95%CI 0.11-0.62).
Conclusions
Smoking cessation counseling during pregnancy in Argentina occurs infrequently, interventions are needed to assist physicians motivate and counsel women to quit smoking and avoid SHS exposure. Physicians taking care of pregnant women also need to quit smoking.
doi:10.3109/00016341003739567
PMCID: PMC3158573  PMID: 20367427
Tobacco use; adolescents; Latin America; ethnicity; pregnancy; smoking; second hand smoke; counselling
7.  Pediatricians are More Supportive of the Human Papillomavirus Vaccine than the General Public 
Southern medical journal  2008;101(12):1216-1221.
Objective
The purpose of this study was to determine pediatricians’ attitudes about the human papillomavirus (HPV) vaccine and to compare their attitudes with those expressed by the general public.
Methods
Eight-hundred and fifty pediatricians from the American Academy of Pediatrics were surveyed, including general pediatricians (n = 450), and members of the sections of adolescent medicine (n = 200) and infectious diseases (n = 200). Pediatricians were asked to answer four items that had been included on a Wall Street Journal (WSJ) poll of the general public shortly after the HPV vaccine was approved by the Food and Drug Administration.
Results
Of 752 eligible pediatricians, 373 (50%) responded. Compared to the general public, pediatricians were less likely to agree that routine Papanicolaou smears are a better strategy for preventing cervical cancer than HPV vaccination (12% vs 45%, P < 0.001), that abstinence programs are a better strategy for preventing the spread of HPV (17% vs 44%, P < 0.001), and that HPV vaccination may encourage sexual activity (4% vs 27%, P < 0.001). Pediatricians were more likely to support HPV vaccination without parental permission (77% vs 47%, P < 0.001). There were no differences between pediatricians based on gender. General pediatricians were more likely than pediatricians affiliated with the sections of infectious diseases and adolescent medicine to endorse abstinence programs over HPV vaccination (22% vs 16% and 8%, respectively, P = 0.01).
Conclusion
Pediatricians are much more supportive of HPV vaccination than the general public. Pediatricians should be aware of these differences when counseling patients and their families.
doi:10.1097/SMJ.0b013e3181836b03
PMCID: PMC2867466  PMID: 19005458
abstinence; attitudes; cervical cancer; human papillomavirus vaccine; Pap smears
8.  Knowledge, attitude and techniques of breastfeeding among Nigerian mothers from a semi-urban community 
BMC Research Notes  2013;6:552.
Background
Mothers’ poor knowledge and negative attitude towards breastfeeding may influence practices and constitute barriers to optimizing the benefits of the baby-friendly initiative. This study assessed breastfeeding knowledge, attitude and techniques of postures, positioning, hold practice and latch-on among Nigerian mothers from a Semi-Urban community.
Methods
Three hundred and eighty three consenting lactating mothers who have breastfed for 6 months and up to two years volunteered for this cross-sectional survey, yielding a response rate of 95.7%. A self-administered questionnaire that sought information on maternal socio-demographic variables, knowledge, attitudes and breastfeeding techniques of mothers was employed.
Results
Based on cumulative breastfeeding knowledge and attitude scores, 71.3% of the respondents had good knowledge while 54.0% had positive attitude. Seventy one point three percent practiced advisable breastfeeding posture. Sitting on a chair to breastfeed was common (62.4%); and comfort of mother/baby (60.8%) and convenience (29.5%) were the main reasons for adopting breastfeeding positions. Cross-cradle hold (80.4%), football hold technique (13.3%), breast-to-baby (18.0%) and baby-to-breast latch-on (41.3%) were the common breastfeeding techniques. A majority of the respondents (75.7%) agreed that neck flexion, slight back flexion, arm support with pillow and foot rest was essential during breastfeeding. There was no significant association between breastfeeding posture practice and each of cumulative breastfeeding knowledge score levels (X2 = 0.044; p = 0.834) and attitude score levels (X2 = 0.700; p = 0.403).
Conclusion
Nigerian mothers demonstrated good knowledge and positive attitude towards breastfeeding. Most of the mothers practiced advisable breastfeeding postures, preferred sitting on a chair to breastfeed and utilized cross-cradle hold and baby-to-breast latch-on.
doi:10.1186/1756-0500-6-552
PMCID: PMC3878086  PMID: 24359943
9.  Patterns and correlates of tobacco control behavior among american association of pediatric dentistry members: a cross-sectional national study 
BMC Oral Health  2007;7:13.
Background
To determine the tobacco-related knowledge, attitudes, and practice behaviors among US pediatric dentists.
Methods
A survey was conducted in 1998 among a national, random sample of 1500 American Academy of Pediatric Dentistry members. Chi-square tests and logistic regression with odds ratios (ORs) and 95% confidence intervals assessed factors related to pediatric dentists' tobacco control behaviors.
Results
Response was 65% for the survey. Only 12% of respondents had prior tobacco prevention/cessation training. Of those untrained, 70% were willing to be trained. Less than two-thirds correctly answered any of four tobacco-related knowledge items. Over one-half agreed pediatric dentists should engage in tobacco control behaviors, but identified patient resistance as a barrier. About 24% of respondents reported always/often asking their adolescent patients about tobacco use; 73% reported always/often advising known tobacco users to quit; and 37% of respondents always/often assisting with stopping tobacco use. Feeling prepared to perform tobacco control behaviors (ORs = 1.9–2.8), a more positive attitude score (4 points) from 11 tobacco-related items (ORs = 1.5–1.8), and a higher statewide tobacco use prevalence significantly predicted performance of tobacco control behaviors.
Conclusion
Findings suggest thatraining programs on tobacco use and dependence treatment in the pediatric dental setting may be needed to promote tobacco control behaviors for adolescent patients.
doi:10.1186/1472-6831-7-13
PMCID: PMC2174452  PMID: 17931425
10.  Knowledge, Attitude and Practice of Family Physicians Regarding Smoking Cessation Counseling in Family Practice Centers, Suez Canal University, Egypt 
Introduction:
Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments.
Aims:
The present study was conducted to assess family physicians’ knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians.
Materials and Methods:
The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice.
Statistical Analysis:
SPSS version 18 was used for data entry and statistical analysis.
Results:
The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling.
Conclusions:
Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.
doi:10.4103/2249-4863.117411
PMCID: PMC3894034  PMID: 24479071
Counseling; family physicians; primary care; smoking cessation
11.  Correlates of tobacco cessation counseling among Hispanic physicians in the US: A cross-sectional survey study 
BMC Public Health  2008;8:5.
Background
Physician advice is an important motivator for attempting to stop smoking. However, physicians' lack of intervention with smokers has only modestly improved in the last decade. Although the literature includes extensive research in the area of the smoking intervention practices of clinicians, few studies have focused on Hispanic physicians. The purpose of this study was to explore the correlates of tobacco cessation counseling practices among Hispanic physicians in the US.
Methods
Data were collected through a validated survey instrument among a cross-sectional sample of self-reported Hispanic physicians practicing in New Mexico, and who were members of the New Mexico Hispanic Medical Society in the year 2001. Domains of interest included counseling practices, self-efficacy, attitudes/responsibility, and knowledge/skills. Returned surveys were analyzed to obtain frequencies and descriptive statistics for each survey item. Other analyses included: bivariate Pearson's correlation, factorial ANOVAs, and multiple linear regressions.
Results
Respondents (n = 45) reported a low level of compliance with tobacco control guidelines and recommendations. Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices (r = .35, variance shared = 12%). Self-efficacy and gender were both significantly correlated to tobacco related practices (r = .42, variance shared = 17%). A significant correlation was also found between self-efficacy and knowledge/skills (r = .60, variance shared = 36%). Attitudes/responsibility was not significantly correlated with any of the other measures.
Conclusion
More resources should be dedicated to training Hispanic physicians in tobacco intervention. Training may facilitate practice by increasing knowledge, developing skills and, ultimately, enhancing feelings of self-efficacy.
doi:10.1186/1471-2458-8-5
PMCID: PMC2267183  PMID: 18179722
12.  Breastfeeding attitudes of Finnish parents during pregnancy 
Background
Breastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents' prenatal breastfeeding attitudes and their relationships with demographic characteristics.
Methods
The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.
Results
Breastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18-26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.
Conclusions
Both mothers and fathers found breastfeeding important. A father's eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.
doi:10.1186/1471-2393-10-79
PMCID: PMC3003624  PMID: 21126368
13.  Knowledge, attitude and practice of breastfeeding in the north of Jordan: a cross-sectional study 
Background
In Jordan, as in neighboring countries in the Middle East, higher education and higher employment rates in recent years among women have had an impact on traditionally based infant feeding. The objective of this study was to evaluate practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in the north of Jordan.
Methods
A cross sectional study was carried out between 15 July 2003 and 15 August 2003. A total of 344 women with children aged between 6 months and 3 years from five different villages in the north of Jordan were randomly selected and interviewed. Information regarding participants' demographics, infant feeding in first six months of life, knowledge and attitude towards breastfeeding was collected.
Results
Full breastfeeding was reported by 58.3%, mixed feeding was reported by 30.3% and infant formula feeding was reported by 11.4%. Almost one third of the full breastfeeding group did so for 6–12 months, and almost two thirds did continue breastfeeding for more than one year. Employed women were more likely not to practice full breastfeeding compared to unemployed women (odds ratio 3.34, 95% CI 1.60, 6.98), and women who had caesarian delivery were more likely not to practice full breastfeeding compared to those who had vaginal delivery (odds ratio 2.36, 95% CI 1.17, 4.78). Jordanian women had a positive attitude but work place and short maternity leaves had a negative impact on breastfeeding.
Conclusion
This study showed that a high proportion of Jordanian women did breastfeed for more than one year. However, working women and those who deliver by caesarean section were less likely to breastfeed. It is speculated that adopting facilitatory measures at hospitals and work place could increase the rate of full breastfeeding.
doi:10.1186/1746-4358-1-17
PMCID: PMC1590005  PMID: 16995953
14.  What are the beliefs of pediatricians and dietitians regarding complementary food introduction to prevent allergy? 
Background
The timing of complementary food introduction is controversial. Providing information on the timing of dietary introduction is crucial to the primary prevention of food allergy. The American Academy of Pediatrics offers dietary recommendations that were updated in 2008.
Objective
Identify the recommendations that general pediatricians and registered dietitians provide to parents and delineate any differences in counselling.
Methods
A 9-item survey was distributed to pediatricians and dietitians online and by mail. Information on practitioner type, gender, length of practice and specific recommendations regarding complementary food introduction and exposure was collected.
Results
181 surveys were returned with a 54% response rate from pediatricians. It was not possible to calculate a meaningful dietitian response rate due to overlapping email databases. 52.5% of all respondents were pediatricians and 45.9% were dietitians. The majority of pediatricians and dietitians advise mothers that peanut abstinence during pregnancy and lactation is unnecessary. Dietitians were more likely to counsel mothers to breastfeed their infants to prevent development of atopic dermatitis than pediatricians. Hydrolyzed formulas for infants at risk of developing allergy were the top choice of formula amongst both practitioners. For food allergy prevention, pediatricians were more likely to recommend delayed introduction of peanut and egg, while most dietitians recommended no delay in allergenic food introduction.
Conclusions
In the prophylaxis of food allergy, pediatricians are less aware than dietitians of the current recommendation that there is no benefit in delaying allergenic food introduction beyond 4 to 6 months. More dietitians than pediatricians believe that breastfeeding decreases the risk of atopic dermatitis. Practitioners may benefit from increased awareness of current guidelines.
doi:10.1186/1710-1492-8-3
PMCID: PMC3337797  PMID: 22436326
Food allergy; Children; Survey; Prevention; Dietary advice
15.  Reliability and validity of a Malay-version questionnaire assessing knowledge of breastfeeding 
Background:
There is a need to identify the knowledge that mothers have about breastfeeding to help promote it. Therefore, it is important to develop a valid and reliable questionnaire to provide useful and comparable data about breastfeeding knowledge. The objectives of this study were to determine the reliability and validity of a Malay version of a questionnaire assessing breastfeeding knowledge and describe the breastfeeding knowledge level among respondents.
Methods:
A cross-sectional study was conducted from 1 January to 31 May 2008 among female staff working at the Universiti Sains Malaysia Health Campus. A self-administered questionnaire containing 53 items assessing breastfeeding knowledge was given to respondents. The questions were adapted and modified from a breastfeeding questionnaire developed by a team of Hospital Universiti Sains Malaysia paediatric nurses. Exploratory factor analysis, internal consistency reliability, and descriptive analysis of respondents’ knowledge were conducted.
Results:
A total of 252 female staff participated in the study. Factor analysis constructed 10 domains of knowledge and excluded 6 items, leaving 47 items in the final questionnaire. Cronbach’s alpha of the final questionnaire was 0.77. Respondents’ lowest knowledge was on the practical aspects of breastfeeding.
Conclusion:
The questionnaire is reliable and valid to assess the breastfeeding knowledge of Malaysian women.
PMCID: PMC3216168  PMID: 22135547
breastfeeding; knowledge; reliability and validity; questionnaires; medical sciences
16.  Smoking behavior, attitudes, and cessation counseling among healthcare professionals in Armenia 
BMC Public Health  2012;12:1028.
Background
Smoking cessation counseling by health professionals has been effective in increasing cessation rates. However, little is known about smoking cessation training and practices in transition countries with high smoking prevalence such as Armenia. This study identified smoking-related attitudes and behavior of physicians and nurses in a 500-bed hospital in Yerevan, Armenia, the largest cancer hospital in the country, and explored barriers to their effective participation in smoking cessation interventions.
Methods
This study used mixed quantitative and qualitative methods. Trained interviewers conducted a survey with physicians and nurses using a 42-item self-administered questionnaire that assessed their smoking-related attitudes and behavior and smoking cessation counseling training. Four focus group discussions with hospital physicians and nurses explored barriers to effective smoking cessation interventions. The focus group sessions were audio-taped, transcribed, and analyzed.
Results
The survey response rate was 58.5% (93/159) for physicians and 72.2% (122/169) for nurses. Smoking prevalence was almost five times higher in physicians compared to nurses (31.2% vs. 6.6%, p < 0.001). Non-smokers and ex-smokers had more positive attitudes toward the hospital’s smoke-free policy compared to smokers (90.1% and 88.2% vs. 73.0%). About 42.6% of nurses and 26.9% of physicians reported having had formal training on smoking cessation methods. While both groups showed high support for routinely assisting patients to quit smoking, nurses more often than physicians considered health professionals as role models for patients.
Conclusions
This study was the first to explore differences in smoking-related attitudes and behavior among hospital physicians and nurses in Yerevan, Armenia. The study found substantial behavioral and attitudinal differences in these two groups. The study revealed a critical need for integrating cessation counseling training into Armenia’s medical education. As nurses had more positive attitudes toward cessation counseling compared to physicians, and more often reported having cessation training, they are an untapped resource that could be more actively engaged in smoking cessation interventions in healthcare settings.
doi:10.1186/1471-2458-12-1028
PMCID: PMC3533858  PMID: 23176746
Smoking cessation; Smoke-free hospital policy; Survey research; Qualitative research; Healthcare professionals; Physician smoking; Armenia; Transition economies
17.  Knowledge, attitudes and practices regarding infant feeding among HIV-infected pregnant women in Gaborone, Botswana: a cross-sectional survey 
BMJ Open  2013;3(11):e003749.
Objectives
To assess knowledge, attitudes and practices regarding infant feeding among HIV-positive pregnant women in Gaborone, Botswana, and factors that influence their infant feeding choices.
Design
A cross-sectional study.
Methods and study setting
A questionnaire survey of 96 HIV-positive pregnant women attending four public infectious disease control clinics in Gaborone, Botswana.
Results
Only about half of the study participants had knowledge about prevention of mother-to-child transmission (PMTCT) services related to breastfeeding, and very few (19.8%) chose to breastfeed their infants exclusively. Results of multiple logistic regression analysis showed that receiving infant feeding counselling as part of the PMTCT programme was significantly associated with a decision to exclusively breastfeed (OR (95% CI) 5.38 (1.83 to 15.81)). Similarly, HIV-positive pregnant women who received breastfeeding counselling through the PMTCT programme had higher knowledge of PMTCT practices related to appropriate infant feeding (OR (95% CI) 5.91 (1.06 to 34.31)). Women who did not express concern about HIV stigma had significantly higher knowledge of PMTCT practices related to infant feeding (OR (95% CI) 5.91 (1.69 to 15.56)). Knowledge of PMTCT practices related to breastfeeding was negatively associated with the belief that breastfeeding could transmit HIV to the baby (OR (95% CI) 9.73 (3.37 to 28.08)).
Conclusions
Knowledge, attitudes and practices related to breastfeeding among HIV-positive pregnant women need further improvement, and the PMTCT programme should strengthen infant feeding counselling services to assist HIV-positive mothers in making informed and appropriate decisions regarding infant feeding.
doi:10.1136/bmjopen-2013-003749
PMCID: PMC3845062  PMID: 24293206
18.  The attitudes of surgeons concerning preoperative smoking cessation: a questionnaire study* 
Hippokratia  2012;16(2):124-129.
Background: The purpose of this study was to evaluate the attitudes and behavior of surgeons regarding preoperative smoking cessation.
Methods: A total of 109 anonymous questionnaires were distributed to non-vascular surgeons in our hospital, inquiring about their smoking attitudes, their smoking cessation advice practices, whether they appreciated the benefits of preoperative smoking cessation, and their knowledge of smoking cessation methods.
Results: Eighty questionnaires (from 51 resident doctors and 29 academic staff) were returned (response rate: 73.40%). Of the surgeons, 17.50% were current smokers. Although 40% of the surgeons surveyed believed that preoperative smoking cessation reduces postoperative complications, 31.2% of the surgeons (25/63) had given smoking cessation advice at least to 1 patient in the last month. Most of the resident doctors (39.2%) advised smoking cessation within a month; prior to surgery however, the academic staff (27.6%) advised cessation immediately before the operation (p=0.038). There was a significant difference between academic sfaff and resident doctors concerning the method to increase a patient’s chance of quitting (p=0.045), even among current smokers (p=0.049).
Conclusion: The surgeons who participated in the questionnaire were aware that smoking cessation improves outcome, but most of them did not appreciate that providing brief advice, referring to cessation services, or prescribing nicotine replacement therapy (NRT) may be of benefit in helping patients to quit. It is necessary to educate surgeons about the scale of the benefit and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke.
PMCID: PMC3738413  PMID: 23935267
preoperative smoking cessation; postoperative complications; surgeons; smoking cessation methods
19.  Awareness of retinopathy of prematurity among pediatricians in a tier two city of South India 
Oman Journal of Ophthalmology  2011;4(2):77-80.
Purpose:
To analyze the level of awareness and knowledge about retinopathy of prematurity (ROP) among pediatricians in Coimbatore, which is a tier two city in South India.
Materials and Methods:
A questionnaire was framed on the knowledge attitude and practice (KAP) pattern. The questionnaire was given to 83 practicing pediatricians in government and private practice in Coimbatore and collected in person between November and December 2009. Answers were obtained on criteria like knowledge, prevention, screening, treatment and awareness of ROP.
Results:
Only 54 (65.1%) pediatricians were aware of ROP, while 29 (34.9%) were not aware of the disease. Thirty-three (39.8%) answered that ROP is preventable, while 24 (28.9%) responded that ROP is not preventable. Thirty-four (41%) pediatricians had no idea as to which part of the eye is affected in ROP, while 38 (45.8%) did not know when ROP screening should be started. Only 43 (51.8%) pediatricians were sure that ROP is treatable. Pediatricians in private hospitals were more aware of ROP compared to their counterparts in government hospitals (P = 0.006).
Conclusion:
Awareness among pediatricians in Coimbatore about ROP is poor. Our study emphasizes the need to increase awareness of this avoidable cause of blindness.
doi:10.4103/0974-620X.83658
PMCID: PMC3160074  PMID: 21897623
Awareness; India; retinopathy of prematurity
20.  Knowledge, attitude and practices of pediatricians regarding the prevention of oral diseases in Italy 
BMC Public Health  2006;6:176.
Background
Pediatricians are in an ideal position to advise families about the prevention and management of oral diseases in children. The objective of the study was to determine knowledge, attitude, and practices regarding the prevention of oral diseases among pediatricians in Italy.
Methods
A systematic random sample of 1000 pediatricians received a questionnaire on socio-demographic and practice characteristics; knowledge on risk factors; attitude and practices towards the prevention of oral diseases.
Results
A total of 507 pediatricians participated. More than half knew the main risk factors for oral diseases and this knowledge was higher in primary care pediatricians (p = 0.007), in those with a higher number of hours worked per week (p = 0.012), and who believed that oral diseases may be prevented (p = 0.017). Pediatricians with higher knowledge about the main risk factors (p = 0.006) believe that they have an important role in preventing oral diseases and that they can perform an oral examination. Almost all (89%) prescribed fluoride supplements and those younger (p = 0.016), with a higher number of patients seen in workday (p = 0.001), with longer practice activity (p = 0.004), those who believe that fluoride is effective in preventing caries (p < 0.0001), and who learned about prevention from scientific sources (p = 0.002) were more likely to prescribe fluoride. One-fourth and 40.6% provides and recommends a dental visit once a year and primary care pediatricians (p = 0.014) and those who believed that routine visit is important in preventing oral diseases (p < 0.0001) were more likely to recommend a dental visit once a year.
Conclusion
The results showed a lack of knowledge among pediatricians although almost all believed that they had an important responsibility in preventing oral diseases and provided an oral examination.
doi:10.1186/1471-2458-6-176
PMCID: PMC1543635  PMID: 16822318
21.  Smoking cessation counseling by pediatricians in an inner-city setting. 
OBJECTIVE: To assess mothers' perceptions of pediatrician-provided smoking cessation counseling. DESIGN: Cross-sectional, descriptive study. SETTING: Waiting rooms of five ambulatory pediatric clinics in the Bronx, NY. PARTICIPANTS: Convenience sample of 115 mothers. MAIN OUTCOME MEASURES: A structured questionnaire assessed the smoking history of the subject, presence or absence of environmental tobacco smoke(ETS)-related conditions in the subject's youngest child, and extent of smoking cessation counseling by the pediatrician. Subjects were asked whether they had been 1) asked about smoking; 2) advised about the risks of ETS exposure; 3) assisted in smoking cessation; and 4) arranged for a follow-up appointment to discuss smoking cessation. RESULTS: Overall, 73% of mothers reported being asked about smoking by their child's pediatrician, and 50% reported being advised about the effects of ETS exposure. Of the 26 smokers in the sample, only two reported being assisted in smoking cessation. None reported being arranged for a follow-up appointment. Mothers of children with ETS-related conditions reported a higher rate of assessment for smoking status (ask: 85% vs. 63%, p =.01; advise: 57% vs. 43%, p =.19). CONCLUSIONS: Mothers in our setting report a high level of inquiry into their tobacco use, especially when they have children with ETS-related conditions. While they also report receiving advice about the risks of ETS exposure, smokers are very infrequently assisted in smoking cessation.
PMCID: PMC2594142  PMID: 12392048
22.  The environmental history in pediatric practice: a study of pediatricians' attitudes, beliefs, and practices. 
Environmental Health Perspectives  2002;110(8):823-827.
We conducted a mail survey of practicing pediatricians in Georgia to assess their knowledge, attitudes, and behaviors regarding recording patients' environmental histories. Of 477 eligible pediatricians, 266 (55.8%) responded. Fewer than one in five reported having received training in environmental history-taking. Pediatricians reported that they strongly believe in the importance of environmental exposures in children's health, and 53.5% of respondents reported experience with a patient who was seriously affected by an environmental exposure. Pediatricians agreed moderately strongly that environmental history-taking is useful in identifying potentially hazardous exposures and in helping prevent these exposures. Respondents reported low self-efficacy regarding environmental history-taking, discussing environmental exposures with parents, and finding diagnosis and treatment resources related to environmental exposures. The probability of self-reported history-taking varied with the specific exposure, with environmental tobacco smoke and pets most frequently queried and asbestos, mercury, formaldehyde, and radon rarely queried. The pediatricians' preferred information resources include the American Academy of Pediatrics, newsletters, and patient education materials. Pediatricians are highly interested in pediatric environmental health but report low self-efficacy in taking and following up on environmental histories. There is considerable opportunity for training in environmental history-taking and for increasing the frequency with which such histories are taken.
PMCID: PMC1240956  PMID: 12153766
23.  Smoking Status and Cessation Counseling Practices Among Physicians, Guangxi, China, 2007 
Preventing Chronic Disease  2009;7(1):A15.
Introduction
We examined Chinese physicians' smoking behavior, knowledge of smoking's health effects, and compliance with accepted cessation counseling practices.
Methods
We used a structured questionnaire adapted from the Global Health Professionals Survey of the World Health Organization to survey Chinese physicians based at 5 hospitals in Nanning, Guangxi Province, China.
Results
The response rate was 85% for a total of 673 completed questionnaires. Of the 673 respondents, 73% were men, 42% were aged 30 years or younger, and 26% were smokers (men, 35%; women, 3%). Only 28% of the smokers were ready to quit immediately. A substantial proportion of physicians did not have adequate knowledge of smoking-related health hazards or favorable attitudes toward smoking cessation counseling. Asking patients whether they smoked and recording smoking status in the medical record were significantly associated with being female and being very well or somewhat prepared to counsel patients about smoking cessation. Advising patients to quit smoking was significantly associated with being female, being a nonsmoker, being very well or somewhat prepared to counsel patients about smoking cessation, and having read any smoking cessation guidelines.
Conclusions
Our findings suggest that smoking is common among male Chinese physicians and that Chinese physicians have inadequate knowledge of smoking's health hazards and of how to help smokers quit. Physicians in China and their patients who smoke would benefit from widely accessible Chinese clinical practice guidelines on smoking cessation, better medical school education about the health risks of smoking, and government funding of cessation medications.
PMCID: PMC2811510  PMID: 20040230
24.  Survey assessment on pediatricians’ attitudes on head lice management 
Background
Pediculosis capitis is a worldwide health problem. One of the most important factor in effective head lice eradication is to ensure that infestation is adequately recognized and treated. Our survey investigated the knowledge and practice among primary care Italian pediatricians regarding to the prevention and treatment of head lice.
Methods
The questionnaire was distributed to all the pediatricians registered at the Annual Congress of Practice in Pediatrics held in Florence, Italy, November 11–12, 2011. It includes 10 questions in a multiple choice format, and one answer for each question was provided. The questionnaire was conceived by pediatricians at the Infectious Disease Unit of the Department of Science for the Health of Woman and Child, University of Florence. Questions were designed according to the guidelines by the Italian Pediatric Society (SIP), and international guidelines, such as the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics (AAP).
Results
Overall, 364/600 pediatricians (60.7% of physicians registered to the Congress) returned the questionnaire. The majority of them (232/364; 63,7%) believe that parents consult their primary care pediatrician only after the failure of other “remedies”. Mostly, they prescribe Malathion (116/364, 31,8%) as first line treatment. Two-hundred-fourty-three (66.7%) of participants consider creams, foams and gels the most effective formulations. Two-hundred-sixty-two of pediatricians interviewed (72.0%) suggest to repeat the treatment after one week, 37/364 (10.2%) after two weeks. The majority of the pediatricians interviewed reported that recurrences occur in less than 30% of cases (279/364; 76,6%). In their own opinion, most of recurrences are the consequence of a reinfestation in the community (259/264; 77%). Three-hundred-thirty-four (91.7%) of them have never prescribed oral therapy for the treatment of head lice. Finally, 289/364 (79.4%) pediatricians believe that no product is effective for prevention.
Conclusions
This is the first study that investigates the clinical practice of family pediatricians about the management and treatment of head lice globally, the Italian pediatricians surveyed proved to be quite informed on the head lice management. However, even in a country where pediatric assistance is free for everybody, a considerable proportion of parents do not seek advice to their own family pediatrician. Therefore, educations of parents, other than continuous updating of pediatricians, may contribute to a better management of head lice in the community.
doi:10.1186/1824-7288-39-62
PMCID: PMC3853107  PMID: 24090319
Head lice; Infestation; Children; Pediatrics
25.  Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians 
Pediatrics  2012;129(2):222-230.
OBJECTIVES:
To determine pediatricians’ attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder.
METHODS:
A survey of 1600 randomly selected, practicing US pediatricians with American Academy of Pediatrics membership was conducted. Multivariate models were created for 3 screening practices: (1) performing an in-depth cardiac history and physical (H & P) examination, (2) discussing potential stimulant-related cardiac risks, and (3) ordering an electrocardiogram (ECG).
RESULTS:
Of 817 respondents (51%), 525 (64%) met eligibility criteria. Regarding attitudes, pediatricians agreed that both the risk for sudden cardiac death (SCD) (24%) and legal liability (30%) were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk. When identifying cardiac disorders, few (18%) recognized performing an in-depth cardiac H & P as a barrier; in contrast, 71% recognized interpreting a pediatric ECG as a barrier. When asked about cardiac screening practices before initiating stimulant treatment for a recent patient, 93% completed a routine H & P, 48% completed an in-depth cardiac H & P, and 15% ordered an ECG. Almost half (46%) reported discussing stimulant-related cardiac risks. Multivariate modeling indicated that ≥1 of these screening practices were associated with physicians’ attitudes about SCD risk, legal liability, their responsibility to inform about risk, their ability to perform an in-depth cardiac H & P, and family concerns about risk.
CONCLUSIONS:
Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening. Barriers to identifying cardiac disorders influence practice.
doi:10.1542/peds.2011-1574
PMCID: PMC3269113  PMID: 22250023
attention-deficit/hyperactivity disorder; stimulants; sudden cardiac death; pediatrics; electrocardiogram

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