ABSTRACT
Aims To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to ...current standard care. It has been claimed that TTM‐based interventions will continue to create quitters after the end of the intervention period.
Design Cluster randomized trial.
Setting Antenatal clinics in general practices in the West Midlands, UK.
Participants A total of 918 pregnant smokers originally enrolled in the trial, of which 393 women were followed‐up at 18 months postpartum.
Interventions One hundred general practices were randomized into the three trial arms. Midwives in these practices delivered three interventions: A (standard care), B (TTM‐based self‐help manuals) and C (TTM‐based self‐help manuals plus sessions with an interactive computer program giving individualized smoking cessation advice).
Measurements Self‐reported continuous and point prevalence abstinence since pregnancy.
Findings When combined together, there was a slight and not significant benefit for both TTM arms compared to the control, with an odds ratio (OR) 95% confidence interval (CI) of 1.20 (0.29–4.88) for continuous abstinence. For point prevalence abstinence, the OR (95%CI) was 1.15 (0.66–2.03). Seven of the 54 (13%) women who had quit at the end of pregnancy were still quit 18 months later, and there was no evidence that the TTM‐based interventions were superior in preventing relapse.
Conclusions The TTM‐based interventions may have shown some evidence of a short‐term benefit for quitting in pregnancy but no benefit relative to standard care when followed‐up in the longer‐term.
Aim This paper examines the topic of sickness absence management in the context of the healthcare sector.
Background National Health Service (NHS) employee absenteeism is an expensive and difficult ...problem. Nurse managers need to assess the extent and characteristics of absenteeism, be aware of their organization's sickness policies, evaluate the effectiveness of these policies and contribute to the development of related initiatives to ensure prudent management of sickness absence.
Method A literature review has been undertaken, providing a broad conceptual context by which the problem of sickness absence in the NHS can be examined. The focus of this paper is to examine the accumulation of research based knowledge to provide a healthcare perspective on the problem of sickness absence management.
Conclusion Sickness absence management within the NHS is challenging but provides opportunities to improve the working lives of NHS employees. Sickness absence cannot be eradicated but it can be reduced by a selection of measures that reflect the uniqueness of the NHS. The many and diverse causes of sickness absence need acknowledgement, when devising strategies that can effectively provide solutions to the problems of sickness absence.
The English network of stop-smoking services (SSSs) is among the best-value life-preserving clinical intervention in the UK NHS and is internationally renowned. However, success varies considerably ...across services, making it important to examine the factors that influence their effectiveness.
Data from 126,890 treatment episodes in 24 SSSs in 2009-10 were used to assess the association between intervention characteristics and success rates, adjusting for key smoker characteristics. Treatment characteristics examined were setting (eg, primary care, specialist clinics, pharmacy), type of support (eg, group, one-to-one) and medication (eg, varenicline, single nicotine replacement therapy (NRT), combination of two or more forms of NRT). The main outcome measure was abstinence from smoking 4 weeks after the target quit date, verified by carbon monoxide concentration in expired air.
There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99).
Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options.
Objectives To analyse the performance of the English Stop Smoking Services from 2001/02 to 2010/11.Design Analysis of national service monitoring data.Setting England.Participants Smokers recorded as ...having been treated by English stop smoking services between April 2001 and March 2011.Main outcome measures Annual figures for the number of quit dates set (throughput), the percentage of these that led to biochemically verified abstinence after four weeks (four week quit rate), and the “impact” in terms of the number of four week quitters beyond those who it is estimated would have stopped with only a prescription for smoking cessation treatment; characteristics of smokers being treated, medication used, and mode of delivery (for example, one to one, group based); variability across local services in throughput, four week quit rates, and impact for 2010/11.Results Throughput rose from 227 335 in 2001/02 to 787 527 (8% of all smokers) in 2010/11. The percentage of four week quitters declined slightly from 35% to 34%. Impact rose from 22 933 four week quitters created in 2001/02 to 72 411 in 2010/11 (corresponding to an estimated 21 723 12 month quitters). The services were successful in reaching disadvantaged smokers; 54% (n=425 684) were in receipt of free prescriptions in 2010/11. Substantial variation existed across local services in throughput, success rates, and impact.Conclusions The English stop smoking services have had an increasing impact in helping smokers to stop in their first 10 years of operation and have successfully reached disadvantaged groups. However, performance across local services has varied considerably.
Aims
Smoking is an increasing cause of health inequalities in high‐income countries. This supplement describes pilot projects set up in England to develop and test pathways to ensure that ...disadvantaged groups, where smoking is frequently the norm, are reached, encouraged and supported to stop their tobacco use. Target groups were: smokers attending centres set up for highly deprived parents; smokers with serious and enduring mental illness; pregnant smokers; prisoners/other offenders who smoked; South Asian tobacco chewers; and recent quitters from ‘routine and manual’ occupational groups.
Methods
Commonalities observed across the six projects are summarized, alongside recommendations for implementation.
Results
A significant barrier to implementation was the lack of mandatory identification of tobacco users across primary, secondary and community health‐care settings and routine use of expired air carbon monoxide monitoring, particularly for high‐risk groups. Appropriate use of financial incentives and national guidance is probably necessary to achieve both this and the adoption of ‘joined‐up’ tobacco dependence treatment pathways for these target groups. Further research is needed on the impact of ‘opt out’ pathways: while resulting in increased referral rates, success rates were lower. In general, smoking cessation service targets were a barrier to implementation. Flexibility and tailoring of interventions were required and most projects trained those already working in relevant settings, given their greater understanding of target groups. Mandatory training of all frontline health‐care staff was deemed desirable.
Conclusions
Implementing the findings of these projects will require resources, for training, incentivizing health‐care workers and further research. However, continuing with the status quo may result in sustained tobacco use health inequalities for the foreseeable future.
ObjectiveTo assess the extent of uptake and impact of a nationally disseminated self-help intervention for smoking cessation (‘Quit Kit’).MethodsThe kit contained practical tools for supporting quit ...attempts. Of 480 000 individuals receiving the kit, telephone interviews were conducted with 2347 randomly selected individuals. Interviews assessed the impact of the kit on smoking behaviours and on attitudes to the intervention and to health service support.ResultsThe majority of interviewees reported the kit as being helpful for stopping smoking (61%) and agreed that, having received the kit, they would be more likely to consider the National Health Service for help with quitting (84%). Younger interviewees were significantly more likely to report the kit as helpful, to say they would recommend it to others and to agree that it increased their confidence in quitting (all p≤0.001). As a result of receiving the kit, 29%, 17% and 11% of interviewees, respectively, reported visiting their doctor, pharmacist or stop-smoking service for help with quitting. The kit was reported to have triggered a quit attempt among around half (57%) of those receiving it. When only including those who had received the kit at least 1 month prior to interview, 26.5% (126/475) of those attempting to quit reported remaining completely abstinent from smoking for at least a month.ConclusionsThe findings suggest that distributing a self-help intervention for smoking cessation at a national level may be successful in terms of uptake of the intervention, triggering quit attempts and aiding smoking cessation.
Abstract
Aims
Smoking is an increasing cause of health inequalities in high‐income countries. This supplement describes pilot projects set up in England to develop and test pathways to ensure that ...disadvantaged groups, where smoking is frequently the norm, are reached, encouraged and supported to stop their tobacco use. Target groups were: smokers attending centres set up for highly deprived parents; smokers with serious and enduring mental illness; pregnant smokers; prisoners/other offenders who smoked; South Asian tobacco chewers; and recent quitters from ‘routine and manual’ occupational groups.
Methods
Commonalities observed across the six projects are summarized, alongside recommendations for implementation.
Results
A significant barrier to implementation was the lack of mandatory identification of tobacco users across primary, secondary and community health‐care settings and routine use of expired air carbon monoxide monitoring, particularly for high‐risk groups. Appropriate use of financial incentives and national guidance is probably necessary to achieve both this and the adoption of ‘joined‐up’ tobacco dependence treatment pathways for these target groups. Further research is needed on the impact of ‘opt out’ pathways: while resulting in increased referral rates, success rates were lower. In general, smoking cessation service targets were a barrier to implementation. Flexibility and tailoring of interventions were required and most projects trained those already working in relevant settings, given their greater understanding of target groups. Mandatory training of all frontline health‐care staff was deemed desirable.
Conclusions
Implementing the findings of these projects will require resources, for training, incentivizing health‐care workers and further research. However, continuing with the
status quo
may result in sustained tobacco use health inequalities for the foreseeable future.
The public health role of the school nurse has been formalized recently in several documents. Within that role, they are charged with assessing and responding to health needs of the school-aged ...population. Children and young people are often accused of making unhealthy choices with regard to their fluid intake, however, there have been informal reports that it is difficult to access water in school. Also, with inclusion for all children high on the agenda, do schools have adequate toileting facilities for children with special needs? This survey used school nurses to assess the access to Midlands schools. It also assessed the cleanliness and facilities available for hand washing and other sanitary processes. It found that many schools are failing to provide the facilities they are expected to. Overcrowding and potentially insanitary conditions were found in a significant proportion of the schools surveyed. Drinking facilities and access was found to be poor. Recommendations are made to begin to address the problems seen here.
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