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At least 19 recordsLinked to original sources
PubMedDate not supplied

Tobacco use cessation within the context of tobacco control policy: opportunities for nursing research.

In this presentation, a brief review of tobacco control policies that are effective in decreasing tobacco use prevalence and consumption is provided, and the role of policies affecting tobacco cessation is discussed. An overview of existing coverage for cessation under different health insurance policies and a discussion of the implications that these policies have for nursing practice and research are also provided. Then, the need for nurses' knowledge of and involvement in tobacco control policy making is discussed. Finally, questions on how nursing research in the area of cessation policy development and evaluation can improve access to cessation services to a larger number of tobacco users in the population are considered.

Health Policy↗
PubMed2002

Impact of a dental/dental hygiene tobacco-use cessation curriculum on practice.

Tobacco use is the chief avoidable cause of morbidity and mortality in North America and is associated with increased risk for oral cancer and increased prevalence and severity of periodontitis and other oral conditions. By delivering two- to three-minute tobacco-use cessation counseling (TUCC), oral health professionals can achieve quit rates substantially higher than the spontaneous quit rate. However, many clinicians report lack of training and knowledge in TUCC as barriers to providing cessation counseling. The purpose of this study was to evaluate whether implementation of a comprehensive, dental school-based, tobacco-use cessation program would increase the extent to which tobacco-using patients received TUCC. The school's program was based on the critical administrative, cultural, structural, and policy components of effective TUCC interventions outlined by Fiore et al. A pre- and post-program telephone interview of tobacco-using patients assessed TUCC intervention by students. A significantly greater proportion of patients received TUCC post-program compared to pre-program in terms of consequences associated with tobacco use as well as advice to quit. A comprehensive TUCC program resulted in an improvement of 11.7 percent for consequences and 23 percent for advice to quit.

Adult↗
PubMed1999

Effects of thirty-four adolescent tobacco use cessation and prevention trials on regular users of tobacco products.

Since 1991, adolescent tobacco use rates have increased while adult use has steadily decreased. The failure of adolescent tobacco use cessation and prevention programs to reduce this overall smoking rate indicates that research must be advanced in this area. As a start, the current status of cessation and prevention research that targets adolescent regular tobacco users should be stated. This paper contributes to that goal by reviewing the last two and a half decades of research in this area. A total of 34 programs, equally divided between cessation and prevention (targeting regular tobacco users), are presented and relevant data are provided for each. Among the cessation studies, an emphasis of programming on immediate consequences of use, and instruction in coping strategies, may have led to relatively successful programs. Prevention studies arguably may have achieved lower success rates but were applied to a larger sample with a longer follow-up period. Despite showing some success, it is apparent that the scientific status of cessation research is less refined than prevention research. More research is needed to define the most successful approaches for cessation of adolescent tobacco use.

Adolescent↗
PubMed2005

An innovative tobacco use cessation program for military dental clinics.

Tobacco use is the chief avoidable cause of death and illness in our society. Military leaders are concerned with rising medical costs and the related negative effects on combat readiness associated with tobacco use. Tobacco use cessation (TUC) programs available in the military services have not reached their full potential. Dental officers have an opportunity to assume a more active role as first-line providers in TUC programs. This paper presents a model TUC program for use in military dental clinics. It emphasizes the dentist's role in directly prescribing pharmacologic agents in nicotine replacement therapy (NRT) combined with appropriate patient counseling. Other key elements of this TUC program include the non-threatening manner in which patients are offered access to TUC, its convenience when compared with other programs, and the minimal cost to implement this program.

Bupropion↗
PubMed2006

Tobacco use cessation for adolescents.

Adolescent tobacco users are unique. Thus far, effective interventions for adult tobacco users have been disappointing when applied to adolescents. This article reviews current evidence regarding adolescent tobacco use cessation interventions, explores under-researched areas in tobacco use cessation for adolescents, and offers assistance with treating adolescent tobacco users across the spectrum of use. A means of assessment and treatment of the adolescent smoker is proposed, and cases are included to assist the practitioner with treatment of the experimental tobacco user, the "adolescent-type" intermittent user, and the daily "adult-type" of adolescent tobacco user.

Adolescent↗
PubMed2004

Interventions for smokeless tobacco use cessation.

BACKGROUND: Use of smokeless tobacco (ST) can lead to nicotine addiction and health problems including periodontal disease and oral cancer OBJECTIVES: To assess the effects of behavioural and pharmacotherapeutic interventions to treat ST use. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966-February 2004), EMBASE (1988-January 2004), CINAHL (1982-February 2004), PsycINFO (1984-February 2004), Database of Abstract of Reviews of Effectiveness (DARE, The Cochrane Library, Issue 1, 2004). SELECTION CRITERIA: Randomized trials of behavioural or pharmacological interventions to help users of ST to quit, with follow-up of at least six months. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. MAIN RESULTS: One trial of bupropion did not detect a benefit of treatment after six months (Odds Ratio (OR) 1.00, 95% Confidence Interval (CI): 0.23 to 4.37). Three trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to 1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to 1.63). There was statistical heterogeneity among the results of eight trials of behavioural interventions included in the meta-analysis. Three trials showed significant benefits of intervention. In a post-hoc analysis the trials of interventions which included an oral examination and feedback about ST-induced mucosal changes had homogeneous results and when pooled showed a significant benefit (OR 2.41 95% CI: 1.79 to 3.24). REVIEWERS' CONCLUSIONS: Behavioural interventions should be used to help ST users to quit. Pharmacotherapies have not been shown to affect long-term abstinence but larger trials are needed.

Bupropion↗
PubMed1990

Tobacco use cessation curricula in the U.S. dental schools and dental hygiene programs.

Tobacco-related health problems are the most preventable forms of illness in the United States. By assuming proactive tobacco use cessation counseling roles, dentists and dental hygienists can help reduce the number of people who currently use tobacco. The literature reports that many oral health professionals feel unprepared to assume such roles. To help combat the problem of tobacco-related illness and to help prepare dentists and dental hygienists to assume tobacco use cessation counseling roles, dental schools and dental hygiene programs need to develop appropriate didactic and clinical tobacco use cessation curriculum content. To date, there are limited national data addressing the extent of tobacco use cessation education in dental schools and dental hygiene programs. Studies of medical schools have revealed a need for increased curriculum content on tobacco use prevention and cessation. Further, tobacco use cessation training programs for medical students, practicing dentists, and dental hygienists have resulted in increased student and provider confidence when tobacco use cessation counseling roles were assumed. This study surveyed all dental schools and dental hygiene programs in the U.S. to determine if tobacco-related curriculum content exists, and if so, to what extent. Variables addressed included allocated hours, subject content, scope, department responsible, workplace smoking policy, importance, and future curricular directions. Questionnaires were mailed to all dental hygiene program directors and dental school academic deans. Study findings suggest that dental and dental hygiene students receive limited tobacco use cessation education, and respondent schools have no immediate plans for curriculum change in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed2005

Dissemination of an effective inpatient tobacco use cessation program.

The present study aimed to determine whether tobacco use cessation rates observed in controlled trials of a hospital-based tobacco use cessation program could be replicated when the program was disseminated to a wide range of hospitals in a two-stage process including implementation and institutionalization phases. Using a nonrandomized, observational design, we recruited six hospitals to participate in the study. The research team helped implement the program during the first year of participation (implementation) and then withdrew from active involvement during the second year (institutionalization). The mean 6-month self-reported cessation rates were 26.3% (range = 17.6%-52.8%) for the implementation phase and 22.7% (range = 12.9%-48.2%) for the institutionalization phase. Hospitals with paid professionals providing the program had the best outcomes. Inpatient tobacco use cessation programs are feasible to implement and should target a 6-month self-reported cessation rate of at least 25%.

Adult↗
PubMed2006

Evaluation of tobacco use cessation (TUC) counselling in the dental office.

Tobacco use cessation (TUC) in dentistry is critical to reducing the effect of a major risk factor for both oral and systematic diseases. The effect of TUC interventions has been widely reported. The data show that the success of TUC without professional support is negligible but that behavioural and pharmacological interventions are effective. Furthermore, the greater the intensity of support, the greater the quit rate and success rates are similar comparing different health care professionals including dental professionals. Although few studies have been performed in dental practice, it is clear that TUC should be embedded in routine oral health care. In addition to evaluating the effect of TUC, several studies have investigated barriers to implementing TUC in dental settings. A large number of barriers have been reported. These studies highlight the importance of further training for dental professionals but also identify the need for major cultural and policy changes to facilitate the provision of TUC. Research on barriers to TUC in dental care could be facilitated by employing qualitative or mixed methods designs and studies that evaluate the impact of changing such barriers on TUC provision. Such an approach will help to close the gap between research findings and implementation. Regarding the measurement of outcomes from TUC, no gold standards exist currently. Therefore both self-reported and biochemical measures of tobacco use should be reported in evaluation studies. It is also clear that feedback from biochemical testing of tobacco use can increase success rates in tobacco use cessation.

Counseling↗
PubMed2001

Tobacco-use cessation programs and policies at the University of Manitoba's faculty of dentistry.

The deleterious effects of tobacco use on general health and oral health are well documented. While one-third of Manitobans are current smokers, up to 79% report they want to quit. Counselling by health care professionals can help achieve quit rates of 15-20%. Yet many health professionals do not provide tobacco-use cessation counselling because they feel they are not trained to do so. In 1998, the faculty of dentistry of the University of Manitoba implemented a number of tobacco-use cessation interventions in its undergraduate curricula and general teaching clinic. The faculty has also successfully obtained the inclusion of a dental fee code for tobacco-use cessation services in the provincial fee guide and has received approval to allow dentists who have completed an approved course in tobacco-use cessation training to prescribe bupropion HCl (Zyban), in consultation with a patient's physician, to aid smoking cessation.

Bupropion↗
PubMed2004

Implementation of evidence-based tobacco use cessation guidelines in managed care organizations.

BACKGROUND: Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings. PURPOSE: We examined issues related to the implementation of guidelines in MCOs, to provide examples of studies that have addressed issues related to guideline implementation and to suggest ways behavioral medicine researchers can play a role in examining issues of how guidelines can be better implemented. METHODS: Surveys of clinical guideline implementation, studies from the Robert Wood Johnson Foundation addressing tobacco use cessation in a managed care database, selected to illustrate issues related to system-wide implementation. RESULTS: Surveys show that effective tobacco use cessation interventions remain underutilized in MCOs. A few studies have evaluated and shown the benefit of insurance coverage for tobacco use and dependence treatments, clinician reimbursement and leadership incentives, practice feedback, and leveraging administrative data to create tobacco use tracking systems. The studies also point to the need for large-scale, multidisciplinary, methodologically rigorous studies that allow one to isolate the effects of promising strategies as well as to explore synergistic effects as different system changes are combined. CONCLUSIONS: Tobacco use cessation guidelines need to be better implemented in MCOs. Behavioral medicine research needs to move beyond treatment efficacy and effectiveness studies to focus on rigorous evaluations of these and other strategies to enhance guideline implementation and dissemination.

Databases, Factual↗
PubMedDate not supplied

Review of the pharmacology and clinical profile of bupropion, an antidepressant and tobacco use cessation agent.

Bupropion hydrochloride ((+/-)-2-tert-butylamino)-3'-chloropropiophenone x HCl) is a nonselective inhibitor of the dopamine transporter (DAT) and the norepinephrine transporter (NET) and is also an antagonist at neuronal nicotinic acetylcholine receptors (nAChRs). In animal models used commonly to screen for antidepressant activity, bupropion shows a positive response. Also using animal models, bupropion has been shown to attenuate nicotine-induced unconditioned behaviors, to share or enhance discriminative stimulus properties of nicotine and to have a complex effect on nicotine self-administration, i.e., low doses augmenting nicotine self-administration and high doses attenuating self-administration. Current studies show that bupropion facilitates the acquisition of nicotine conditioned place preference in rats, further suggesting that bupropion enhances the rewarding properties of nicotine. Bupropion has been shown to attenuate the expression of nicotine withdrawal symptoms in both animal models and human subjects. With respect to relapse, current studies show that bupropion attenuates nicotine-induced reinstatement in rats, but large individual differences are apparent. Clinically, bupropion is used as a treatment for two indications, as an antidepressant, the indication for which it was developed, and as a tobacco use cessation agent. In clinical trials, bupropion is being tested as a candidate treatment for psychostimulant drug abuse, attention-deficit hyperactivity disorder (ADHD) and obesity. Bupropion is available in three bioequivalent oral formulations, immediate release (IR), sustained release (SR), and extended release (XL). Extensive hepatic metabolism of bupropion produces three pharmacologically active metabolites, which may contribute to its clinical profile.

Animals↗
PubMed1990

Dental school-based continuing education in tobacco use cessation counseling for oral health care providers.

The role of health care providers in patient counseling for tobacco use cessation has gained increased attention in recent years. The present survey examined the activities of dental school continuing education departments in providing continuing education in tobacco use cessation counseling to oral health care personnel. A questionnaire was sent to the director of continuing education at all U.S. and Canadian dental schools. The results indicate that few continuing education programs have been or currently are being offered. Respondents to the survey perceived little interest in this topic among their target audiences. The reasons for the current situation and barriers to practitioner involvement are discussed.

Canada↗
PubMed2004

The use of 'academic detailing' to promote tobacco-use cessation counseling in dental offices.

BACKGROUND: The authors conducted this study to ascertain the feasibility of face-to-face educational outreach visits, also called "academic detailing," as a methodology to promote dentists' adoption and incorporation of tobacco-use cessation counseling activities into their practices. METHODS: The authors obtained a sampling frame of one dental health maintenance organization's, or DHMO's, enrolled dentists who practiced in one of four Northeastern states and who had more than 300 DHMO patients. Of 507 eligible dentists, 88 agreed to participate, and the authors randomly assigned them to either intervention (an academic detailing program) or control (practice as usual) conditions. Changes in practice behaviors over time were obtained by questionnaires. The authors used descriptive statistics to analyze data using a statistics software package. RESULTS: Only 9 percent of dentists who agreed to participate had received any training in decreasing patients' tobacco use. The authors associated the dentists' staff members' considerable resistance to the detailing program with issues such as having to deal with additional paperwork and uncooperative patients, the perception that only a few patients use tobacco and that counseling does not work. Many dentists also expressed concern about their lack of tobacco-use cessation knowledge. Overall, dentists' resistance to detailing decreased with follow-up detailing visits. CONCLUSIONS: It is feasible to increase and incorporate tobacco-use cessation counseling in dental offices. However, significant barriers must be surmounted first if this goal is to be achieved by use of academic detailing. CLINICAL IMPLICATIONS: Using academic detailing, dentists can be effective agents in increasing the longevity, decreasing the morbidity and improving the oral health status of their patients through the promotion of smoking cessation.

Attitude of Health Personnel↗
PubMed2006

Effects of the tobacco use cessation automated clinical practice guideline.

OBJECTIVE: To evaluate the effects of the Tobacco Use Cessation (TUC) Automated Clinical Practice Guideline (ACPG) (a variation of the US Department of Health and Human Services Clinical Practice Guideline on Treating Tobacco Use and Dependence) on guideline adherence in a multisite health system. STUDY DESIGN: The study used a pre-post cross-sectional design. Paneled patients were enrolled from 6 clinics, including 2 control clinics (arm 1), 2 control clinics that received a check-in screen only (the check-in screen provided a simplified method for entering patient vital signs into the electronic medical record) (arm 2), and 2 clinics that received the TUC intervention (arm 3). METHODS: Baseline data on physician compliance with the 5 As (ask, assess, advise, assist, and arrange) at the last office visit were collected via telephone surveys from patients in the 3 study arms. The TUC-ACPG was then introduced in the TUC intervention clinics as part of the existing electronic medical record. Approximately 2 weeks after the TUC intervention, postimplementation data were collected via telephone survey. RESULTS: In the TUC intervention arm, postimplementation adherence rates increased relative to baseline for all 5 points of the guideline, with the largest increases seen in the assess and arrange guideline points. Controlling for factors such as age, race, and relevant comorbidities, logistic regression analysis indicated that the time (preimplementation vs postimplementation)-x-TUC intervention arm interaction demonstrated a statistically significant increase in the assess guideline point. CONCLUSION: Although baseline adherence rates were already high, the introduction of the TUC-ACPG led to further increases in guideline adherence.

Adolescent↗
PubMed2006

Tobacco use, cessation advice to patients and attitudes to tobacco control among physicians in Ukraine.

To examine the relationship between physicians' smoking behaviors and their attitudes toward tobacco use by their patients and tobacco control in the Ukraine, a 70-item questionnaire was administered to 799 general practitioners (287 men and 512 women) working in both rural (278 physicians) and urban (521 physicians) areas of three regions of Ukraine. In all, 13.9% of physicians were current smokers and 21.6% reported being past smokers, with significantly (P<0.001) more men than women being current or past smokers. Odds ratios from logistic regression analysis reveal that physicians who are heavy smokers are 26% less likely to record tobacco use by patients than medium smokers. Heavy smokers devote significantly less effort to providing cessation information to patients and are 36% less likely to support the complete prohibition of smoking in the physician's workplace. Older physicians, female physicians and physicians working in urban areas are significantly more likely than younger, male and rural physicians to advise their patients on smoking. The provision of smoking cessation to patients by general practitioners in Ukraine is influenced by several factors, a major one being the smoking status of the physician. If smoking among physicians declines, this will encourage the patient to consider a serious quit attempt in several ways, most notably: (1) physicians act as societal role models and can promote non-smoking as a norm and (2) the likelihood that a patient will be provided smoking cessation counseling increases.

Adult↗
PubMedDate not supplied

Advancing the science of adolescent tobacco use cessation.

OBJECTIVE: To examine how science is advancing in order to address adolescent tobacco use cessation. METHODS: Review of the published scientific literature from 1995 to September 2000 and National Cancer Institute youth tobacco cessation research portfolio. RESULTS: Because of methodological limitations, results of behavioral interventions are inconclusive. Two studies have been published evaluating the nicotine patch for adolescent smoking cessation, though neither employed a randomized, placebo-control design. Both of these studies found the nicotine patch to be ineffective. CONCLUSIONS: Although much is known about youth tobacco use, additional research is needed to find answers to best help youth to quit smoking.

Adolescent↗