The purpose of this study was to use qualitative interviews to examine antismoking discussions African American parents and adult family members have with adolescent children. This study is one of the first studies to examine the content of family discussions about not smoking among rural African American families from the perspective of parents and extended family members.
Interview topics included discussions with their children, how their children reacted to those discussions, expected and actual consequences for their children trying a cigarette, and perspectives on how best to keep their children from becoming cigarette smokers. A total of 72 African American households participated in the overall study, and 112 people were interviewed.
Major themes that emerged included discussing the negative health and economic aspects of smoking and the influence of peer pressure. Likely consequences for trying a cigarette included talking to the child about the dangers of smoking and taking away privileges. Making cigarettes less accessible, continued discussions, leading by example, and not smoking around children were suggested as strategies to keep children from smoking.
This study provides insight into antismoking socialization efforts in rural African American families and confirms that African American families are actively engaged in keeping their children from smoking.
Of 6052 adult patients who consulted their doctors in six Oxfordshire general practices between October 1980 and February 1981, 2110 (35%) were smokers. The smokers were allocated to one of four study groups--a control (non-intervention) group; a group that received verbal and written antismoking advice from the general practitioner; a group that received this advice and also a demonstration of exhaled carbon monoxide; and a group that received the advice plus the offer of further help from a health visitor. After one year 72% of smokers replied to a postal follow up questionnaire: 11% of the control group claimed to have stopped smoking compared with 15% in the group that received advice alone, 17% in the exhaled carbon monoxide group, and 13% in the health visitor group. Validation of these findings by assays of urinary concentrations of cotinine showed that between 24% and 40% of subjects may have misreported their smoking habits, but there was no indication that the rate of misreporting was higher in the intervention groups than in the control group. Giving advice routinely against smoking has a useful effect, and showing an immediate, personal, and potentially harmful consequence of smoking using a CO-oximeter may improve this, particularly in lower socioeconomic groups.
A questionnaire on antismoking activities and education was sent to 369 nurses in general practice. The response rate was 80%. Although most of the nurses sometimes advised patients about smoking, routine antismoking education occurred less frequently. Only a few regularly referred smokers to other agencies for help, recommended aids to stop smoking, or used antismoking literature. Although the nurses thought that they had an important role in helping smokers to give up, they expressed little confidence in their effectiveness, believing that advice from the general practitioner and the smoker's personal determination to give up have more impact. The nurses expressed a need for training in antismoking education. Seventy seven per cent were interested in attending seminars and listed information about smoking, techniques for stopping, and counselling skills as priorities. If practice nurses are to use opportunities in primary care to help smokers there is clearly a need to provide further training and to establish the effectiveness of nurses in their role as smoking educators.
To elicit general practitioners' and practice nurses' accounts of changes in their clinical practice or practice organisation made to claim a pilot health promotion payment. To describe attitudes towards the piloted and previous health promotion payments.
Qualitative, semistructured interview study.
13 general practices in Leicester.
18 general practitioners and 13 practice nurses.
Health professionals did not report substantially changing their clinical practice to claim the new payments and made only minimal changes in practice organisation. The new health promotion payment did not overcome general practitioners' resistance towards raising the issue of smoking when they felt that doing so could cause confrontation with patients. General practitioners who made the largest number of claims altered the way in which they recorded patients' smoking status rather than raising the topic of smoking more frequently with patients. Participants had strong negative views on the new payment, feeling it would also be viewed negatively by patients. They were, however, more positive about health promotion payments that rewarded “extra” effort—for example, setting up practice based smoking cessation clinics.
General practitioners and practice nurses were negative about a new health promotion payment, despite agreeing to pilot it. Health promotion payments do not automatically generate effective health promotion activity, and policymakers should consider careful piloting and evaluation of future changes in health promotion payments.
What is already known on this topicHealth promotion payments have been made to UK general practitioners since 1990, but their effectiveness is unknownWhat this study addsPrimary care staff held strong negative views about the pilot payments to promote smoking cessation and previous health promotion paymentsThe highest claiming practitioners altered their methods of recording smoking status rather than increasing the frequency with which they advised patients against smokingFuture changes in health promotion payments should be carefully piloted
This study examined the effects of sequencing different types of antismoking threat and efficacy appeals on smoking cessation intentions for smokers with low and high levels of readiness to quit. An experiment was done to test predictions based on Witte's (1992) Extended Parallel Process Model and research by Cho and Salmon (2006). A national probability sample of 555 adult smokers was recruited to take part in this study. Results found a positive two-way interaction effect between message threat and perceived level of message efficacy on intentions to seek help for quitting. A three-way interaction effect was found between message threat, perceived level of message efficacy, and readiness to quit on quitting intentions. Both threat and efficacy were important for smokers with low readiness to quit, whereas efficacy was most important among smokers with high readiness to quit. Implications of the results for antismoking campaigns are discussed along with limitations and future directions.
The study examines the effectiveness of antismoking public service announcements (PSAs) among adult smokers as a function of smoking cues and the argument strength of the PSAs. Consistent with the previous cue-reactivity studies, smoking cues are defined as one of the following visual scenes: (a) objects associated with smoking, (b) holding or handling cigarettes, and (c) actual smoking behaviors. Argument strength indicates smoker's judgments of perceived strength and persuasiveness of the arguments extracted from the PSAs.
Data were collected through a web-based experiment of a random sample of general population of smokers (n = 566 adults aged 19 years or older). Each participant was shown 4 PSAs randomly selected from a set of 60. Data were analyzed using multilevel modeling to assess the effects of smoking cues and argument strength. Effectiveness measures include perceived persuasiveness, transportation, valenced thought, negative emotion, and smoking-related thoughts.
Argument strength is a significant predictor of outcome variables. Although there were no significant main effects of smoking cues on any outcome variables, smoking cues were found to interact with argument strength such that the association between argument strength and outcome variables became weaker for PSAs in the smoking cue condition compared with those in the no-cue condition.
The interaction between smoking cues and argument strength suggests that smoking cues in antismoking PSAs undermine a significant part of what makes PSAs effective—their arguments against smoking. In designing antismoking messages, the inclusion of smoking cues should be weighed carefully.
This study examines how addicted smokers attend visually to smoking-related public service announcements (PSAs) in adults smokers. Smokers’ onscreen visual fixation is an indicator of cognitive resources allocated to visual attention. Characteristic of individuals with addictive tendencies, smokers are expected to be appetitively activated by images of their addiction—specifically smoking cues. At the same time, these cues are embedded in messages that associate avoidance responses with these appetitive cues, potentially inducing avoidance of PSA processing. Findings suggest that segments of PSAs that contain smoking cues are processed similarly to segments that contain complex stimuli (operationalized in this case as high in information introduced) and that visual attention is aligned with smoking cues on the screen.
OBJECTIVE: To evaluate the effectiveness of an antismoking campaign conducted by the Health Education Board for Scotland. DESIGN: Descriptive survey of adult callers to a telephone helpline (Smokeline) for stopping smoking; panel study of a random sample of adult callers; assessment of changes in prevalence of smoking in Scotland before and after introduction of the helpline. SETTING: Telephone helpline. SUBJECTS: Callers to Smokeline over the initial one year period. Detailed information was collected on a 10% sample (n = 8547). A cohort of adult smokers who called Smokeline (total n = 848) was followed up by telephone interview three weeks, six months, and one year after the initial call. MAIN OUTCOME MEASURES: Numbers of adult smokers calling helpline; changes in smoking behaviour, especially stopping smoking among cohort members; and changes in prevalence of smoking in the general population. RESULTS: An estimated 82782 regular adult smokers made genuine contact with Smokeline over the year, representing about 5.9% of all adult smokers in Scotland. At one year 143 of the cohort of 848 callers (23.6%; 95% confidence interval 20.2% to 27.0%) reported that they had stopped smoking and 534 (88.0%; 85.4% to 90.6%) reported having made some change. About 19500 (16700 to 22350) adult smokers, equivalent to 1.4% (1.2% to 1.6%) of the mean adult smoking population, stopped smoking with direct help from Smokeling. During the second year of the campaign (1994) smoking prevalence among 25-65 year olds in Scotland was 6% (2.0% to 10.0%) lower than it had been before the start of the campaign. CONCLUSION: The Health Education Board for Scotland's antismoking campaign reached a high number of adult smokers, was associated with a highly acceptable quit rate among adults given direct help through Smokeline, and contributed considerably to an accelerated decline in smoking prevalence in Scotland.
Every year, more than 650,000 Europeans die because they smoke. Smoking is considered to be the single most preventable factor influencing health. General practitioners (GP) are encouraged to advise on smoking cessation at all suitable consultations. Unsolicited advice from GPs results in one of 40-60 smokers stopping smoking. Smoking cessation advice has traditionally been given on an individual basis. Our aim was to gain insights that may help general practitioners understand why people smoke, and why smokers stop and then remain quitting and, from this, to find fruitful approaches to the dialogue about stopping smoking.
Interviews with 18 elderly smokers and ex-smokers about their smoking and decisions to smoke or quit were analysed with qualitative content analysis across narratives. A narrative perspective was applied.
Six stages in the smoking story emerged, from the start of smoking, where friends had a huge influence, until maintenance of the possible cessation. The informants were influenced by "all the others" at all stages. Spouses had vital influence in stopping, relapses and continued smoking. The majority of quitters had stopped by themselves without medication, and had kept the tobacco handy for 3-6 months. Often smoking cessation seemed to happen unplanned, though sometimes it was planned. With an increasingly negative social attitude towards smoking, the informants became more aware of the risks of smoking.
"All the others" is a clue in the smoking story. For smoking cessation, it is essential to be aware of the influence of friends and family members, especially a spouse. People may stop smoking unplanned, even when motivation is not obvious. Information from the community and from doctors on the negative aspects of smoking should continue. Eliciting life-long smoking narratives may open up for a fruitful dialogue, as well as prompting reflection about smoking and adding to the motivation to stop.
Decisions; general medical practice; qualitative; smoking cessation; spouse
The New York Tobacco Control Program (NY TCP) is one of the largest state tobacco control programs in the United States. Little research has been published on the effectiveness of its antismoking media campaign. The objective of this study was to examine whether exposure to NY TCP's statewide antismoking media campaign corresponded to smoking outcomes.
We used data from the 2003 through 2009 New York Adult Tobacco Survey to evaluate exposure to NY TCP advertising, cessation intentions, quit attempts, and cigarette consumption among New York adult smokers. We also used data from the 2003 through 2009 New York Behavioral Risk Factor Surveillance System (BRFSS) and the 2003 through 2009 National Health Interview Survey (NHIS) to examine smoking prevalence among New York adults compared with US adults.
From 2003 through 2009, smokers' exposure to NY TCP advertising increased from 6% to 45%, the prevalence of 30-day intentions to quit increased from 26% to 35%, and the prevalence of quit attempts increased from 46% to 62%. Average cigarettes smoked per day decreased from 15 in 2003 to 11 in 2009. The New York BRFSS and NHIS both showed significant downward trends in adult smoking prevalence. The decline during this period was greater in New York (18%) than in the United States as a whole (5%).
NY TCP's campaign generated significant increases in exposure to advertising over time that corresponded with changes in key cessation- and smoking-related outcomes. Findings suggest that NY TCP's sustained implementation of evidence-based cessation advertisements contributed to these changes.
A three community study was carried out in northern New South Wales, Australia, to determine the effectiveness of interventions via media and media plus community programmes in altering behaviours of life style, including smoking, dietary fat intake, and exercise. Results were analysed of one aspect of the "North Coast Healthy Lifestyle Programme" entitled "Quit for Life," which aimed at reducing cigarette smoking over a two year period. There was a significant decline in the prevalence of smoking in both test towns, ranging from 16% in younger men to 6% in older women. These were significantly greater than the declines in the control town. The declines were more sustained over the two year period in the town subjected to media plus community programmes.
OBJECTIVE--To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling. DESIGN--Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check. SETTING--Three general practices in the MRC general practice research framework. MAIN OUTCOME MEASURES--Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems. RESULTS--73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p <0.001) [corrected]. Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking. CONCLUSION--General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.
This study examined whether the appeal of actors (i.e., their likeability and attractiveness) used in antismoking public service announcements (PSAs) interacts with adolescents’ risk of future smoking to predict adolescents’ smoking resistance self-efficacy and whether the antismoking messages in the PSAs further moderate this relationship.
We used a 2 (future smoking risk: low, high) × 2 (actor appeal: low, high) × 3 (PSA antismoking message: tobacco industry manipulation, short-term smoking effects, long-term smoking effects) study design. A diverse sample of 110 adolescents (aged 11–17 years), with varying levels of experience with smoking, rated their smoking resistance self-efficacy after viewing each of the PSAs in each design cell.
Overall, PSAs that used long-term smoking effects messages were associated with the strongest smoking resistance self-efficacy, followed in turn by PSAs that used short-term smoking effects messages and by tobacco industry manipulation messages. We found a significant interaction of actor appeal and PSA antismoking message. The use of more appealing actors was associated with stronger smoking resistance self-efficacy only in long-term smoking effects PSAs. The use of less appealing actors was associated with stronger smoking resistance self-efficacy for tobacco industry manipulation PSAs and short-term smoking effects PSAs. Future smoking risk did not moderate any of these findings.
Antismoking PSAs that emphasize long-term smoking effects are most strongly associated with increased smoking resistance self-efficacy. The effect of these PSAs can be strengthened by using actors whom adolescents perceive to be appealing.
We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups.
We followed 1491 adult smokers over 24 months and related quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment.
On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio [OR]=1.11; 95% confidence interval [CI]=1.00, 1.23; P<.05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR=1.14; 95% CI 1.02, 1.29; P<.05), which was greater among respondents with low and mid-socioeconomic status than among high–socioeconomic status groups.
Emotionally evocative ads and ads that contain personalized stories about the effects of smoking and quitting hold promise for efforts to promote smoking cessation and reduce socioeconomic disparities in smoking.
One hundred and sixty-seven individuals with chronic conditions were interviewed about their smoking history and current habits as part of two larger studies on health care. The interviews were lengthy and permitted individuals to comment freely on reasons for stopping or continuing smoking and the role of doctors' advice in these decisions. Only 22 per cent had never smoked. The youngest and males were most likely to have smoked. At time of interview, 51 per cent of those who had ever smoked were still smoking. Those with circulatory disorders, in contrast to respiratory or musculoskeletal disorders, were most likely to have stopped. Perceptions of doctors' advice varied by both age and diagnosis, with the elderly claiming to have received little medical advice. Those with histories of circulatory disorders reported receiving advice more frequently. Doctors may have advised these individuals more frequently because there was threat to life, but it is also possible that individuals with life-threatening disorders are more likely to recall such advice.
Although government-funded specialist smoking cessation services in England offer advice and support to smokers motivated to quit, only a small proportion of smokers make use of this service. Evidence suggests that if smokers are proactively and personally invited to use services, use will be higher than with a standard referral made by health professionals. Computer-based systems generating personalised tailored communications also have the potential to engage with a larger proportion of the smoking population. In this study smokers are proactively invited to use the NHS Stop Smoking Service (SSS), with a personal computer-tailored letter and the offer of a no-commitment introductory session designed to give more information about the service. The primary objective is to assess the relative effectiveness on attendance at the NHS SSS, of proactive recruitment by a brief personal letter, tailored to individual characteristics, and invitation to a taster session, over a standard generic letter advertising the service.
This randomised controlled trial will recruit smokers from general practice who are motivated to quit and have not recently attended the NHS SSS. Smokers aged 16 years and over, identified from medical records in participating practices, are sent a brief screening questionnaire and cover letter from their GP. Smokers giving consent are randomised to the Control group to receive a standard generic letter advertising the local service, or to the Intervention group to receive a brief personal, tailored letter with risk information and an invitation to attend a ‘Come and Try it’ taster session. The primary outcome, assessed 6 months after the date of randomisation, is the proportion of people attending the NHS SSS for at least one session. Planned recruitment is to secure 4,500 participants, from 18 regions in England served by an NHS SSS.
Personal risk information generated by computer, with the addition of taster sessions, could be widely replicated and delivered cost effectively to a large proportion of the smoking population. The results of this trial will inform the potential of this method to increase referrals to specialised smoking cessation services and prompt more quit attempts.
Current Controlled Trials ISRCTN76561916
Smoking cessation; Stop smoking clinics; Computer-tailoring; Personalisation; Risk information
School tobacco use policies are often considered to be part of a comprehensive approach to preventing or reducing adolescent cigarette smoking. However, little is known about the relationships between such policies and adolescents’ smoking behaviors or the mechanisms by which any such influence may occur. The present study tested a conceptual model that specifies possible direct and indirect relationships among community norms, school antismoking policies, adolescents’ personal smoking beliefs, and cigarette smoking behaviors.
This study used data from 17,256 middle and high school students who participated in the 2006 Oregon Health Teens Survey.
Structural equation modeling indicated that perceived enforcement of school policy was directly and positively related to perceived community norms. In addition, adolescents’ personal beliefs appeared to mediate the relationship between perceived enforcement of school antismoking policies and past-30-day cigarette smoking. School policies, in turn, partially mediated the relationship between community norms and smoking beliefs.
The results of this study provide a better understanding of how community norms and school antismoking policies may affect adolescents’ cigarette smoking.
Construction-related occupations have very high smoking prevalence rates and are an identified priority population for efforts to promote cessation. This study sought to identify the smoking cessation supports and services which best suited this workforce group, and to identify gaps in reach of preventive health services. We performed qualitative text analysis on pre-existing conversations about smoking cessation among workers in this sector. The material appeared on a discussion forum about residential construction from 1998 and 2011. Roughly 250 unique user names appeared in these discussions. The qualitative analysis addressed knowledge, motivation, environmental influences, and positive and negative experiences with supports for cessation. Self-identified smokers tended to want to quit and described little social value in smoking. Actual quit attempts were attributed to aging and tangible changes in health and fitness. Peer-to-peer social support for cessation was evident. Advice given was to avoid cigarettes and smokers, to focus on personal skills, personal commitment, and the benefits of cessation (beyond the harms from smoking). Many discussants had received medical support for cessation, but behavioural counselling services appeared underutilized. Our findings support efforts toward more complete bans on workplace smoking and increased promotion of available behavioural support services among dispersed blue-collar workers.
smoking cessation; workplace; qualitative research; blue-collar smokers
This study examined the use of a Video Doctor plus provider cueing to promote provider advice and smoking cessation outcomes in pregnancy.
A randomized clinical trial was conducted from 2006 to 2008.
Five, community, prenatal clinics in the San Francisco Bay Area of the United States.
410 pregnant patients completed screening for behavioral risks including tobacco use in the past 30 days. Pregnant smokers (N = 42) were randomized regardless of their intention to quit smoking.
Participants were assigned to either usual care or intervention. Intervention participants received 15-minute Video Doctor sessions plus provider cueing, at baseline and 1 month, prior to their routine prenatal visit. The Video Doctor delivered interactive tailored messages, an educational worksheet for participants and a cueing sheet for providers.
Main outcome measures
Receipt of advice from the provider and 30-day smoking abstinence, both by self report.
Intervention participants were more likely to receive provider advice on tobacco use at both prenatal visits during the intervention period (61% vs 16%, p = 0.003). The intervention yielded a significantly greater decrease in the number of days smoked and in cigarettes smoked per day. The 30-day abstinence rate at 2 months post baseline was 2.5 times greater in the intervention group; the difference was not statistically significant (26.1% vs 10.5%, p = 0.12).
The Video Doctor plus provider cueing is an efficacious adjunct to routine prenatal care by promoting provider advice and smoking reduction among pregnant smokers.
smoking cessation; pregnancy; prenatal care; patient education; randomized controlled trial
The enormous health benefits of stopping smoking are now well established. Doctors have a vital role in motivating smokers and initiating quit attempts. The mainstay of National Health Service smoking cessation strategy should be the routine provision of brief opportunistic intervention in primary care, backed up by referral to a specialist smoking cessation service. There is an urgent need to increase substantially the numbers of smokers referred by general practitioners, other members of the primary care team, and those working in acute hospital trusts, to specialist smoking cessation services and for better channels of communication between the various agencies. Use of pharmacotherapy (nicotine replacement therapy or bupropion) in combination with behavioural support achieves higher cessation rates than either component alone and is the most effective way of helping smokers to stop. Smokers who quit often relapse and hence will need repeated help.
In the winters of 1977-8 and 1978-9 about 400 children in seven junior schools in northern England were taught the "My Body" health education programme. In the springs of 1980 and of 1982 these children, and an age matched control group, answered a questionnaire about their smoking behaviour, knowledge, and attitudes. Comparison of the two groups suggested that the programme had had a positive effect on the boys but a negligible, or even negative, effect on the girls. Various suggestions as to the reasons for this differential impact are discussed.
There is a sizeable and growing body of empirical literature on the effects of physician advice to quit smoking. Because of the association between tobacco use and the health problems that may provoke referral to chiropractic care, doctors of chiropractic (DCs) may be able to give patients personalized proximal health feedback that may motivate them to quit. However, DCs have not been utilized in this role. The primary aim of this study was to design and refine a brief office-based tobacco intervention for use within chiropractic settings.
This study was conducted in 20 private chiropractic practices in 2 phases: (a) intervention development, in which we created and focus tested practitioner and patient materials, and (b) feasibility, in which we evaluated the impact of the intervention on 210 tobacco-using chiropractic patients.
Analyses were conducted on 156 patients who exclusively smoked cigarettes. Using an intent-to-treat approach, assuming all nonresponders to be smokers, 13 (8.3%) reported 7-day abstinence at 6 weeks, 22 (14.1%) at the 6-month follow-up, and 35 (22.4%) at the 12-month assessment. Eleven participants (7.1%) reported prolonged abstinence at the 6-month follow-up, and 15 (9.6%) reported prolonged abstinence at 12 months.
To our knowledge, this is the first study to refine a brief office-based treatment for tobacco dependence for use in chiropractic settings. The results of this study were promising and will lead to a randomized clinical trial. If found to be effective, this model could be disseminated to chiropractic practitioners throughout the United States.
Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients.
We conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives.
AHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding).
An extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated.
Little is known about the demand for smoking cessation services in settings with high smoking prevalence rates. Furthermore, acceptability of text messaging and Internet as delivery mechanisms for smoking cessation programs in non-developed countries is under-reported. Given the cost effectiveness of technology-based programs, these may be more feasible to roll out in settings with limited public health resources relative to in-person programs.
148 adult smokers took part in a community-based survey in Ankara, Turkey. Two in five (43%) respondents reported typically smoking their first cigarette within 30 minutes of waking. Many participants expressed a desire to quit smoking: 27% reported seriously thinking about quitting in the next 30 days; 53% reported at least one quit attempt in the past year. Two in five smokers wanting to quit reported they were somewhat or extremely like to try a smoking cessation program if it were accessible via text messaging (45%) or online (43%).
Opportunities for low-cost, high-reach, technology-based smoking cessation programs are under-utilized. Findings support the development and testing of these types of interventions for adult smokers in Turkey.
smoking cessation; Turkey; middle income country; technology-based interventions
Native Hawaiians have high smoking prevalence and high lung cancer mortality rates.
To describe a comprehensive tobacco cessation protocol and share lessons learned in institutionalizing it across the five Native Hawaiian Health Care Systems (NHHCS).
NHHCS representatives worked together to culturally tailor the Agency for Healthcare Research and Quality protocol for smoking cessation. Process objectives included number of staff trained in tobacco cessation, inclusion of the Tobacco User Guide Sheet (TUGS) in the intake process and medical record, and expansion of programs for smokers who want to quit. Outcome objectives included percent of individuals asked about smoking status and percent of identified smokers that received brief intervention, set a quit date, were linked to services, and remained smoke-free for 90 days.
After 18 months, the NHHCS were at different stages of protocol adoption. More successful NHHCS were more likely to have several champions for the program and administrative support for staff training, new programs, and integrating the TUGS into client charts. They also showed greater success in getting smokers to set a quit date and remain smoke-free for 90 days.
Although the five NHHCS helped design the protocol, each operates independently. More effort and time are needed to help each system overcome internal barriers to institutionalizing a new protocol and to facilitate support for tobacco-cessation champions among medical records and data management supervisors. These lessons may be useful to other organizations that want to institutionalize a comprehensive tobacco-cessation protocol.
Community health centers; guideline adherence; minority; nicotine; organizational change; organizational innovation; Native Hawaiian; Pacific Islander; smoking