Effects of Trained Health Professionals' Behavioral Counseling Skills on Smoking Cessation Outcomes.

Background: There is evidence that training health professionals in behavioral counseling skills can lead to greater success in helping their smokers to quit. However, it is still unknown how counseling skills relate to counseling effects. Purpose: We established a method of skills evaluation of health professionals for smoking cessation counseling based on videotaped counseling sessions with a standardized smoker, and examined the relationship between skill levels and smoking cessation outcomes. Methods: Twenty-three health professionals at Japanese workplaces underwent a training program. Their counseling skills were evaluated before and after the program using a structured evaluation form-based analysis of videotaped interactions between participants and a standardized smoker. A total of 858 smokers then received individual smoking cessation counseling by the trained health professionals at an annual health checkup. These patients were followed-up through surveys after 1 year. Results: On a scale from 0 to 24, Total skill scores, which ranged from 0 to 24, were significantly higher after the training than before the training (p < .001). Multiple two-level logistic regression analysis adjusted for smokers' characteristics showed that the odds ratios of skill scores after the training for point prevalence and sustained abstinence rates among smokers who received counseling were 1.21 (95% confidence interval: 1.03-1.42) and 1.26 (1.05-1.50), respectively. Conclusions: This study demonstrates that higher behavioral counseling skills were associated with better smoking cessation outcomes. This research is of clinical importance in that it provides a tool for assessing counselling skills in a way that is demonstrably relevant to outcomes.

Adiponectin and smoking status: a systematic review.

AIM: Smoking and adiponectin are individually associated with cardiometabolic pathologies. The present systematic review was carried out in order to summarize the association between the smoking status and circulating adiponectin levels. METHODS: Original articles, restricted to epidemiological studies (by a cross-sectional, case-control and cohort study design) and intervention studies for adult humans, were screened for the years 1995-2010. All of the research group members then selected the eligible literature and assessed the articles in a structured systematic review manner. RESULTS: There were 11 key studies, which included 9 articles with a cross-sectional design and 2 articles with an intervention design. Most cross-sectional studies reported lower levels of adiponectin in current smokers than in non/never smokers and/or ex-smokers, while 2 studies reported a non-significant difference in adiponectin between male smokers and non-smokers. The two intervention studies, conducted in patients on 9-week bupropion treatment and 6-month non-pharmacological treatment, reported that smoking cessation increased the adiponectin levels. CONCLUSION: This review suggests that there is a decreased adiponectin level in current smokers and this reduction can be reversed by quitting smoking. More studies are required to confirm the findings and elucidate the biological mechanisms underlying the association between the smoking status and adiponectin levels.

Modeling the effect of disseminating brief intervention for smoking cessation at medical facilities in Japan: a simulation study.

PURPOSE: The Japanese male smoking prevalence is still high. Underlying causes are the low quit attempt rate (QAR) and lack of pharmacotherapy (PT) use. Though health checkups are widely and systematically performed in Japan, this setting has not been utilized for intervention to smokers. We aimed to estimate the population effect of disseminating brief intervention (BI) at health checkup facilities combined with encouraging PT utilization. METHODS: The annual population quit rate (PQR) was modeled as a product of three components: the QAR, utilization of PT, and effectiveness of PT. A policy to disseminate effective BI at health checkup facilities was then incorporated into the PQR model as means to increase the QAR and/or PT utilization. Japanese male smokers aged 40-74 years were the target population, and the baseline year was set at 2005. The PQR and the number of smokers who successfully quit were compared with the baseline to evaluate the BI policy. RESULTS: The BI policy was estimated to increase the PQR from 4.3 to 5.7 % (rate ratio: 1.34) in a scenario where 75 % of smokers having an annual health checkup received BI and 60 % of BI-induced quit attempts were supported by PT, resulting in 177,000 new successful quitters on an annual basis and 3,000 avoidable cancer deaths in 10 years. Comparisons of different scenarios revealed that increasing QAR and encouraging PT were both essential to maximize the effect of BI policy. CONCLUSION: The dissemination of BI at health checkup facilities encouraging PT utilization is an effective tobacco control policy in Japan.

Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study.

AIM: To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation. DESIGN AND SETTING: This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later. PARTICIPANTS: The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later. FINDINGS: Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting. CONCLUSIONS: Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.

[Effects of skill level on individual behavioral counseling for smoking cessation].

OBJECTIVE: The relationship between smokers' characteristics and success of smoking cessation has been examined in smoking intervention studies, but counselors' characteristics have generally not been considered. The purpose of the present study was to examine the relationship between counselor's skill level and intervention outcome. METHODS: The subjects were 858 smokers identified at annual health checkup at 6 worksites from January 1998 to September 1999. Smokers received stage-matched individual counseling by 23 trained counselors with feedback of results for carbon monoxide testing and nicotine metabolites in urine. If smokers set a quit date at the initial counseling session they received 4 follow-up telephone calls over 3 months. We further conducted 6 month and 1 year follow-up surveys using self-administered questionnaires. Smoking cessation status was validated by carbon monoxide test or family or colleague witnesses. We evaluated counselors' intervention skills using a structured evaluation form (total score: 0-24) based on videotaped interactions between each counselor and a simulated smoker. The intervention skills were classified into 3 levels, Low (0-14), Middle (15-17) and High (18-24). We performed multiple logistic regression analysis to adjust for smokers' characteristics and multi level analysis to adjust for counselors' characteristics other than counseling skills. RESULTS: Among the 23 counselors, 4, 11 and 8 counselors were assigned to the Low, Middle and High groups, respectively, which counseled 190, 344 and 324 smokers. The 7 day point prevalence abstinence rates at 6 months were 2.1%, 4.7% and 7.4%, respectively (cumulative chi-square test: P < 0.01). The 6 month sustained abstinence rates at one year were 1.1%, 3.2% and 4.6%, respectively (P < 0.05). The odds ratios of abstinence rates at 6 months and one year in Middle group were 2.33 (95% CI: 0.75-7.28) and 3.07 (0.65-14.54) respectively, compared to the Low group by multiple logistic regression analysis. In the High group they were 3.66 (1.21-11.04) and 4.86 (1.06-22.28). The results of the multi level analysis were approximately equal to those in the multiple logistic regression analysis. CONCLUSION: This result suggests that a higher counseling skill level can lead to higher abstinence rates.