Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting

OBJECTIVES: To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital. DESIGN: Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts. SETTING: Four hospitals in the Minneapolis/St Paul metropolitan area. SUBJECTS: 682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months. RESULTS: 71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, kappa = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation. CONCLUSIONS: Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.     

Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy

Background

Tobacco users receiving behavioural and pharmacological assistance are more likely to quit. Although telephone quitlines provide population access to counselling, few offer pharmacotherapy.

Objective

To assess change in cessation rates and programme impact after the addition of free nicotine replacement therapy (NRT) to statewide quitline services.

Design, setting, participants

An observational study of cohorts of callers to the Minnesota QUITPLAN^SM Helpline before (n  =  380) and after (n  =  373) the addition of access to free NRT.

Intervention

Mailing of NRT (patch or gum) to callers enrolling in multi‐session counselling.

Main outcome measure

Thirty‐day abstinence six months after programme registration.

Results

The number of callers increased from 155 (SD 75) to 679 (180) per month pre‐NRT to post‐NRT (difference 524, 95% confidence interval (CI) 323 to 725). Post‐NRT, the proportion of callers enrolling in multi‐session counselling (23.4% v 90.1%, difference 66.6%, 95% CI 60.8% to 71.6%) and using pharmacotherapy (46.8% v 86.8%, difference 40.0%, 95% CI 31.3% to 47.9%) increased. Thirty‐day abstinence at six months increased from 10.0% pre‐NRT to 18.2% post‐NRT (difference 8.2%, 95% CI 3.1% to 13.4%). Post‐NRT the average number of new ex‐smokers per month among registrants increased from 15.5 to 123.6 (difference 108.1, 95% CI 61.1 to 155.0). The cost per quit pre‐NRT was $1362 (SD $207). The cost per quit post‐NRT was $1934 ($215) suggesting a possible increase in cost per quit (difference $572, 95% CI −$12 to $1157).

Conclusion

The addition of free NRT to a state quitline is followed by increases in participation and abstinence rates resulting in an eightfold increase in programme impact. These findings support the addition of access to pharmacological therapy as part of state quitline services.     

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States)

OBJECTIVES—To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States).
METHODS—Data were obtained via a telephone interview of 774 Vietnamese men in 1994.
DESIGN—Cross-sectional survey administered via telephone in 1994.
SETTING—Massachusetts, United States.
SUBJECTS—Randomly selected Vietnamese men (n = 774).
MAIN OUTCOME MEASURES—Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population.
RESULTS—Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking.
CONCLUSIONS—Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.


Keywords: smoking cessation; tobacco use; Vietnamese     

Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden

Objectives

The strategies used to support smoking cessation among quitters were investigated according to year of smoking cessation and sociodemographic characteristics.

Methods

The 2004 public health survey in Skåne, Sweden, is a cross‐sectional study. A total of 27 757 people aged 18–80 answered a postal questionnaire. The participation rate was 59%. Different strategies to support smoking cessation—that is, no therapy, nicotine replacement (NRT), professional therapy and snus (snuff) use, were investigated among quitters according to year of smoking cessation, and demographic and socioeconomic characteristics.

Results

14.9% of the men and 18.1% of the women were daily smokers. The prevalence of daily snus use was 19.5% among men but only 2.3% among women. Stratifying the data according to year of smoking cessation (1938–2004) revealed a significant increase in active smoking cessation strategies such as NRT, professional therapy and snus use. NRT was more common among women (23.6%) than men (14.8%) among smokers who quit in 2000–4, but snus use was more common among men (30.4% versus 8.7%). No replacement or other therapy at all was significantly more common among women (63.6%) than men (52.1%). People aged 35–80 years used more nicotine replacement than people aged 18–34, while men aged 18–34 used snus to quit smoking significantly more than men aged 55–80.

Conclusions

Snus is used commonly among men as a support for smoking cessation in Sweden. Women use pharmacological NRT to a greater extent, but this can probably not compensate for the much higher extent of snuff use as a cessation strategy among men.     

Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults

OBJECTIVE—To examine the factors that determine whether or not smokers become long-term quitters, and to study whether determinants of successful cessation differ with levels of motivation to stop.
DESIGN—In a cohort of men and women, aged 30-60 years at first examination in 1982/1984, smoking behaviour was evaluated from questionnaires at baseline and at follow up 10 years later.
SETTING—County of Copenhagen, Denmark
PARTICIPANTS—2554 subjects from the original sample of 4581 were successfully followed. This study deals with the 1365 subjects who were smokers at the first examination.
MAIN OUTCOME MEASURE—Smoking status (abstinent for one year or more) at follow up.
RESULTS—At follow up 15% of the baseline smokers had been abstinent for one year or more. In multivariate analysis, successful smoking cessation was associated with older age, high social status, low prior tobacco consumption, baseline motivation to stop smoking, and having a non-smoking spouse/cohabitant. The same result was obtained when the analyses were repeated separately for smokers with and without motivation to stop.
CONCLUSIONS—Smokers motivated to stop are more likely to quit and remain abstinent than smokers with no such motivation. Age, social status, spouse/cohabitant's smoking behaviour, and the daily consumption of tobacco predict success in smoking cessation, irrespective of smokers' former motivation to stop.


Keywords: smoking cessation predictors; Denmark     

Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review

Objectives

To establish the effect of preoperative smoking cessation on the risk of postoperative complications, and to identify the effect of the timing of preoperative cessation.

Data sources

The Cochrane Library Database, PsycINFO, EMBASE, Medline, and CINAHL databases were searched, using the terms: “smoking”, “smoking‐cessation”, “tobacco‐use”, “tobacco‐abstinence”, “cigarett$”, “complication$”, “postoperative‐complication$”, “preoperative”, “perioperative” and “surg$”. Further articles were obtained from reference lists. The search was limited to articles on adults, written in English and published up to November 2005.

Study selection

Prospective cohort designs exploring the effects of preoperative smoking cessation on postoperative complications were included. Two reviewers independently scanned abstracts of relevant articles to determine eligibility. Lack of agreement was resolved through discussion and consensus. Twelve studies met the inclusion criteria.

Data extraction

Methodological quality was assessed by both reviewers, exploring validation of smoking status, clear definition of the period of smoking cessation, control for confounding variables and length of follow‐up.

Data synthesis

Only four of the studies specified the exact period of smoking cessation, with six studies specifying the length of the follow‐up period. Five studies revealed a lower risk or incidence of postoperative complications in past smokers than current smokers or reported that there was no significant difference between past smokers and non‐smokers.

Conclusions

Longer periods of smoking cessation appear to be more effective in reducing the incidence/risk of postoperative complications; there was no increased risk in postoperative complications from short term cessation. An optimal period of preoperative smoking cessation could not be identified from the available evidence.     

A group randomised trial of two methods for disseminating a smoking cessation programme to public antenatal clinics: effects on patient outcomes

Objective

To assess the differential effectiveness of two methods of disseminating a smoking cessation programme to public hospital antenatal clinics.

Design

Group randomised trial.

Setting

22 antenatal clinics in New South Wales, Australia.

Intervention

Clinics were allocated to a simple dissemination (SD) condition (11 clinics) which received a mail‐out of programme resources or to an intensive dissemination (ID) condition (11 clinics) which included the mail‐out plus feedback, training, and ongoing support with midwife facilitator.

Main outcome measures

Independent cross sectional surveys of women on a second or subsequent visit undertaken pre‐dissemination and 18 months after dissemination. Outcomes were: (1) levels of smoking status assessment by clinic staff; (2) proportion of women identifying as having been smokers at their first visit who reported receiving cessation advice; (3) proportion of these women who had quit (self report and expired air carbon monoxide (CO)); and (4) smoking prevalence among all women (self report and CO).

Subjects

5849 women pre‐dissemination (2374 SD, 3475 ID) and weighted sample of 5145 women post‐dissemination (2302 SD, 2843 ID).

Results

There were no significant differences between the groups on change on any outcome. Change in either group was minimal. In the post‐dissemination survey, the cessation proportions were 6.4% (SD) and 10.5% (ID).

Conclusions

Relatively modest strategies for encouraging incorporation of smoking cessation activities into antenatal care were not effective in the long term. Alternative strategies should be implemented and evaluated. The findings reinforce the importance of a whole population approach to tobacco control.     

Training pharmacists and pharmacy assistants in the stage-of-change model of smoking cessation: a randomised controlled trial in Scotland

OBJECTIVE—To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model.
DESIGN—A randomised controlled trial of community pharmacies and pharmacy customers.
SETTING—All 76 non-city community pharmacies registered in Grampian, Scotland, were invited to participate. Sixty-two pharmacies (82%) were recruited.
SUBJECTS—All the intervention pharmacy personnel were invited to attend the training; 40 pharmacists and 54 assistants attended. A total of 492 customers who smoked (224 intervention, 268 controls) were recruited during the 12-month recruitment period (overall recruitment rate 63%).
MAIN OUTCOME MEASURES—The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one, four, and nine months.
RESULTS—The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel, 85% (113) compared with 62% (99) of the controls (p<0.001). The former also rated their discussion more highly; 34% (45) of the intervention customers compared with 16% (25) of the controls rated it as "very useful" (p = 0.048). Assuming non-responders had lapsed, one-month point prevalence of abstinence was claimed by 30% of intervention customers and 24% of controls (p = 0.12); four months' continuous abstinence was claimed by 16% of intervention customers and 11% of controls (p = 0.094); and nine months' continuous abstinence was claimed by 12% of intervention customers and 7% of controls (p = 0.089). These trends in outcome were not affected by potential confounders (sex, age, socioeconomic status, nicotine dependence, and type of nicotine replacement product used) or adjustment for clustering.
CONCLUSIONS—The intervention was associated with increased and more highly rated counselling, and a trend toward higher smoking cessation rates, indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets.


Keywords: community pharmacy; health education; smoking cessation     

Use of nicotine replacement therapy to reduce or delay smoking but not to quit: prevalence and association with subsequent cessation efforts

Objective

To assess the prevalence of nicotine replacement therapy (NRT) use for purposes other than quitting smoking and examine the relation of this non‐standard NRT use (NSNRT) with subsequent smoking cessation efforts.

Design

A population based cohort study of adult smokers who were interviewed by telephone at baseline (2001–2) and at two year follow‐up. The association between NSNRT use to cut down on smoking or to delay smoking before baseline and cessation attempts and smoking outcomes at two year follow‐up was assessed using logistic regression to adjust for multiple potential confounding factors.

Setting

Massachusetts, USA.

Subjects

1712 adult smokers in Massachusetts who were selected using a random digit dial telephone survey.

Main outcome measures

Quit attempt in 12 months before follow‐up, NRT use at quit attempt in 12 months before follow‐up, smoking cessation by follow‐up, or 50% reduction in cigarettes smoked per day between baseline and follow‐up.

Results

18.7% of respondents reported ever having used NSNRT. In a multiple logistic regression analysis, there was no statistically significant association between past NSNRT use and quit attempts (OR_{cut down}  = 0.89, 95% CI 0.59 to 1.33; OR_delay  = 1.29, 95% CI 0.73 to 2.29), smoking cessation (OR_{cut down}  = 0.74, 95% CI 0.43 to 1.24; OR_delay  = 1.22, 95% CI 0.60 to 2.50) or 50% reduction in cigarettes smoked per day (OR_{cut down}  = 0.93, 95% CI 0.62 to 1.38; OR_delay  = 0.80, 95% CI 0.43 to 1.49) at follow‐up. Past use of NRT to cut down on cigarettes was associated with use of NRT at a follow‐up quit attempt (OR_{cut down}  = 2.28, 95% CI 1.50 to 3.47) but past use of NRT to delay smoking was not (OR_delay  = 1.25, 95% CI 0.67 to 2.34).

Conclusions

Use of NRT for reasons other than quitting smoking may be more common than was previously estimated. This population based survey finds no strong evidence that NRT use for purposes other than quitting smoking is either harmful or helpful.     

Using state space models to monitor and estimate the effects of interventions on treatment risk and milk yield in dairy farms

Fast, flexible, and internally valid analytical tools are needed to evaluate the effects of management interventions made on dairy farms to support decisions about which interventions to continue or discontinue. The objective of this observational study was to demonstrate the use of state space models (SSM) to monitor and estimate the effect of interventions on 2 specific outcomes: a dynamic linear model (DLM) evaluating herd-level milk yield and a dynamic generalized linear model evaluating treatment risk in a pragmatic pretest/posttest design under field conditions. This demonstration study is part of a Danish common learning project that ran from March 2020 to May 2021 within the framework of veterinary herd health consultancy in relation to reducing antimicrobial use and improving herd health. Specific interventions for 2 commercial herds were suggested by 4 visiting farmers and were implemented during the project period. The intervention for herd 1 was the application of teat sealers, implemented in August 2020. For herd 2, the intervention was an adjustment of cubicles for cows of parity 2 and above, implemented from November 2020. A shift to an automatic milking system in October 2020 was also modeled as an intervention for herd 1 because the 2 interventions coincided. Data available from the Danish Cattle Database on obligatory registrations for individual cow movements and treatments, as well as test day information on milk yield, were used for model building and testing. Data from a 3-yr period before the project were used to calibrate the SSM to herd conditions, and data from the study period (March 2020 to May 2021) were used for monitoring and intervention testing based on application of the SSM. Herd bulk tank milk recordings were added to the data set during the study period to increase the precision of the estimates in the DLM. The developed SSM monitored herd-level milk yield and the overall probability of treatment throughout the study period in both herds. Furthermore, at the time of intervention, the SSM estimated the effect on herd-level milk yield and treatment risk associated with the implemented intervention in each herd. The SSM were used because they can be calibrated to herd conditions and they take into account herd dynamics and autocorrelation and provide standard deviations of estimates. For herd 1, the intervention effect of applying teat sealers was inconclusive with the current SSM application. For herd 2, no statistically significant changes in cow treatment risk or milk production were identified following the adjustment of cubicles. The use of SSM on observational data under field conditions shows that in this case, the interventions had a nonspecific onset of effect, were implemented during unstable times, and had varying coherence with the measured outcomes, making fully automated SSM analysis difficult. However, similar or expanded SSM with both monitoring and effect estimation functions could, if applied under the right conditions, serve as improved data-based decision support tools for farmers (and veterinarians) to minimize the risk of misinterpreting data due to confounding bias related to dynamics in dairy herds.     

Non-targeted multi-component analytical surveillance of plastic food contact materials: Identification of substances not included in EU positive lists and their risk assessment

A procedure used by the Norwegian Food Safety Authority for surveillance of contaminants from plastic food contact materials (polyolefin drinking bottles, water boilers, polyamide cooking utensils and plastic multi-layer materials) is described. It is based on gas chromatographic-mass spectrometric (GC/MS) analysis of food simulants exposed to plastic materials. Most migrants were substances not-intentionally added to the plastic (degradation products, impurities) or originated from non-plastic components, such as printing inks, adhesives, not-listed additives, solvents and coatings. Hence, the majority of the identified migrants were regulated by the general statements in the EU Framework Regulation, which neither specify limits nor requirements regarding risk assessment, rather than by specific migration controls. Risk assessment has been carried out for selected non-authorized substances. The analysis and the management of these substances and materials with respect to safety represents a challenge to the food authorities.     

Exposure to heterocyclic aromatic amines from the consumption of cooked red meat and its effect on human cancer risk: A review

This review covers the bibliographic data from the last 10 years on the possible carcinogenicity of heterocyclic aromatic amines (HAAs) in humans. Aspects such as red meat intake, cooking methods applied to red meat, and doneness of cooking are discussed from an epidemiological point of view. The role in the carcinogenicity of the HAAs has been assigned to two main factors: first, the very high frequency of consumption of red meat; and, second, very darkly browned meats from cooking. However, there are some uncertainties associated with epidemiological results such as the presence of other carcinogens, co-carcinogens and anti-carcinogens in the diet, analytical results on the content of HAAs in foods, food frequency questionnaires, and mainly genetic susceptibility to HAAs. It is concluded that there is not sufficient scientific evidence to support the hypothesis that human cancer risk is due specifically to the intake of HAAs in the diet.     

Exposure to heterocyclic aromatic amines from the consumption of cooked red meat and its effect on human cancer risk: A review

This review covers the bibliographic data from the last 10 years on the possible carcinogenicity of heterocyclic aromatic amines (HAAs) in humans. Aspects such as red meat intake, cooking methods applied to red meat, and doneness of cooking are discussed from an epidemiological point of view. The role in the carcinogenicity of the HAAs has been assigned to two main factors: first, the very high frequency of consumption of red meat; and, second, very darkly browned meats from cooking. However, there are some uncertainties associated with epidemiological results such as the presence of other carcinogens, co-carcinogens and anti-carcinogens in the diet, analytical results on the content of HAAs in foods, food frequency questionnaires, and mainly genetic susceptibility to HAAs. It is concluded that there is not sufficient scientific evidence to support the hypothesis that human cancer risk is due specifically to the intake of HAAs in the diet.     

Exposure of the Irish population to PBDEs in food: consideration of parameter uncertainty and variability for risk assessment

Polybrominated diphenyl ethers (PBDEs) are brominated flame retardants used to retard the ignition and/or spread of fire. PBDEs are used in various consumer products, such as textiles, mattresses and TV screens. This study presents a chemical risk assessment for the Irish population based on exposure to PBDEs from food. Special regard is given to the influence of parameter uncertainty and variability on the margins of safety. To quantitatively model uncertainty and variability in concentration data and variability in consumer behavior, a hierarchical probabilistic model was constructed. This model was evaluated using a two-dimensional Monte Carlo simulation (2D-MCS) approach. By considering uncertainty and variability in concentration data, margins of safety (MOS) were derived that are lower by a factor of ～2 compared to MOS based on dose estimates that only consider variability. The lowest MOS is 7.5?×?10⁴ for BDE-99, with impaired spermatogenesis as toxic endpoint. Assuming an MOS of 10⁴ as acceptable, we conclude that there is no significant risk for human health through intake of contaminated food. To investigate whether additional measurements could improve the quality of dose estimates, the statistic “uncertainty-to-variability (UVR)” was developed. By applying the UVR to our dose estimates, we show that, in our case, the datasets contain little uncertainty and additional measurements would not significantly improve the quality of dose estimates.     

Dietary exposure to trace elements and health risk assessment in the region of Valencia,Spain: a total diet study

ABSTRACT

Dietary exposure of the Valencian region population to lead, cadmium, inorganic arsenic (iAs), chromium, copper, tin and methylmercury (meHg) was assessed in a total diet study carried out in the region of Valencia in 2010–11. A total of 8100 food samples were collected and analysed. Occurrence data were combined with consumption data to estimate dietary exposure in adults (> 15 years of age) and young children (6–15 years of age). The estimated intake was calculated by a probabilistic approach. Average intake levels (optimistic scenario) for lead, iAs, chromium and tin were 0.21, 0.08, 1.79 and 1.87 µg kg^?1 bw day^?1 respectively; for Cd and meHg average intake levels were 0.77 and 0.54 µg kg^–1 bw week^?1, respectively, and for Cu, 1.60 mg day^?1. In terms of risk characterisation, the results showed that 2.84% of the adult population may exceed the BMDL₁₀ (benchmark dose lower confidence limit) established for Pb, which is linked to renal effects; whereas 28.01% of the young children population may exceed the BMDL₀₁ related to neurodevelopment effects. In addition, 8.47% of the adult population and 12.32% of young children exceeded the meHg tolerable weekly intake (TWI).     

Analytical chemistry,formation, mitigation,and risk assessment of polycyclic aromatic hydrocarbons: From food processing to in vivo metabolic transformation

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous in the air, oils, water, and food products we encounter every day. Among these exposures, food consumption is a major route of PAH exposure for nonsmokers. The PAH dietary exposure levels vary among different countries; however, many studies have shown PAH exposure to be highly concerning to human health. The levels of PAH contamination in food are mainly influenced by processing procedures and cooking methods, and they could be attenuated by modifying cooking procedures and adding antioxidant-rich marinades. Several PAHs have toxic, mutagenic, and carcinogenic properties. The PAH benzo[a]pyrene (BaP) is particularly regarded as carcinogenic. There are three major metabolism pathways for PAHs, and the final products can bind to DNA, thus exerting mutagenic effects. Biological monitoring through the use of biomarkers is necessary for comprehensive and accurate risk assessments of human PAH exposure. It is important to reduce dietary PAH exposure and to implement reasonable and effective risk management strategies to reduce PAH levels in food to improve public health.     

Use of global sensitivity analysis in quantitative microbial risk assessment: application to the evaluation of a biological time temperature integrator as a quality and safety indicator for cold smoked salmon

The aim of this study was to apply a global sensitivity analysis (SA) method in model simplification and to evaluate (eO)^®, a biological Time Temperature Integrator (TTI) as a quality and safety indicator for cold smoked salmon (CSS). Models were thus developed to predict the evolutions of Listeria monocytogenes and the indigenous food flora in CSS and to predict TTIs endpoint. A global SA was then applied on the three models to identify the less important factors and simplify the models accordingly. Results showed that the subset of the most important factors of the three models was mainly composed of the durations and temperatures of two chill chain links, out of the control of the manufacturers: the domestic refrigerator and the retail/cabinet links. Then, the simplified versions of the three models were run with 10⁴ time temperature profiles representing the variability associated to the microbial behavior, to the TTIs evolution and to the French chill chain characteristics. The results were used to assess the distributions of the microbial contaminations obtained at the TTI endpoint and at the end of the simulated profiles and proved that, in the case of poor storage conditions, the TTI use could reduce the number of unacceptable foods by 50%.