Nursing leadership in tobacco dependence treatment to advance health equity: An American Academy of Nursing policy manuscript.

BACKGROUND: Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities. PURPOSE: The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing's Health Behavior Expert Panel Tobacco Control subcommittee. METHODS: Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research. FINDINGS: The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings. DISCUSSION: Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

Increased adoption of smoke-free policies on campuses with schools of nursing.

BACKGROUND: In 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies. PURPOSE: To determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources. METHODS: Smoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans. RESULTS: Smoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views. CONCLUSION: Smoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.

Parental Smoking Cessation: Impacting Children's Tobacco Smoke Exposure in the Home.

OBJECTIVES: There is no safe or risk-free level of tobacco use or tobacco smoke exposure. In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention. METHODS: Ps/Cs and children were recruited from 14 elementary schools across rural and urban settings. Approximately one-fourth (24.3%; n = 110) of the total Ps/Cs enrolled in the randomized controlled trial (n = 453) were smokers, predominantly women (80.9%), with a mean age of 37.7 years. (SD 12.2); 62.7% were African American, 44% had less than a high school education, and 58% earned <$20 000 annually. P/C smokers were offered a tailored cessation intervention in years 1 and 2. Self-report smoking status and saliva cotinine were obtained at baseline, the end of treatment (EOT) and/or year 2, and in the year 4 follow-up. RESULTS: Ps/Cs in the intervention group showed a larger increase in self-reported smoking abstinence over time (EOT: 6.5% [SE = 5.7%]; year 4: 40.6% [SE = 5.7%]) than the control group (EOT: 0.0% [SE = 6.5%]; year 4: 13.2% [SE = 6.4%]; F = 4.82; P = .0306). For cotinine, the intervention group showed a decrease from baseline (239.9 [SE = 1.3]) to EOT 99.3 [SE = 1.4]) and then maintenance through year 4 (109.6 [SE = 1.4]), whereas the control group showed increases from baseline (221.1 [SE = 1.4]) to EOT (239.0 [SE = 1.4]) to year 4 (325.8 [SE = 14]; F = 5.72; P = .0039). CONCLUSIONS: This study provides evidence that tailored cessation offered to Ps/Cs in their children's schools during their children's enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.

Tobacco-Cessation Interventions and Attributes of Individual and Organizational Excellence in Acute Care.

BACKGROUND: Despite years of reducing tobacco use, few studies describe to what extent evidence-based tobacco-cessation interventions are a standard of acute and critical care nursing practice using the US Public Health Service 5 A's framework: ask, advise, assess, assist, and arrange. OBJECTIVES: To identify relationships between the 5 A's framework, attributes of individual and organizational excellence, and intention to integrate tobacco-cessation interventions as a standard of daily practice among nurses. METHODS: Nurses attending the American Association of Critical-Care Nurses National Teaching Institute were invited to complete a 21-item survey. Data were gathered in Boston, Orlando, and Chicago in a 3-year period. Descriptive statistics and logistic regression were used for data analysis. RESULTS: Among 1773 completed surveys, nurses from organizations with standing orders for tobacco dependence were 5 times more likely to have high confidence in their 5 A's skills (odds ratio, 5.037; 95% CI, 3.429-7.400; P < .001) and 3.4 times more likely to have high intentions to integrate tobacco cessation into their daily practice (odds ratio, 3.421; 95% CI, 1.765-6.628; P < .001). Nurses with certifications were more likely to want to learn how to integrate tobacco-cessation interventions (odds ratio, 1.676; 95% CI, 0.990-2.836; P = .05). CONCLUSIONS: Opportunities abound to create strategies leveraging attributes of nursing and organizational excellence to promote evidence-based approaches to improve health outcomes in acutely and critically ill tobacco-dependent populations.

Few U.S. schools of nursing on campuses with smoke-free policies: A Call for Action.

INTRODUCTION: Tobacco remains the leading cause of preventable death in the United States. Recognizing that smoke-free policies can significantly reduce tobacco-related morbidity and mortality by preventing exposure to second-hand smoke and increasing quit rates, members of the Tobacco Control Subgroup of the American Academy of Nursing's (AAN) Health Behavior Expert Panel launched a health policy initiative entitled the Smoke-Free Campus Policy for Schools of Nursing Campaign. Designed as a two-phased initiative, the Campaign is a Call to Action to increase smoke-free policies on campuses with Schools of Nursing across the United States by 2020. METHODS: Phase I of the AAN Campaign included a cross-sectional study using secondary data analysis to describe the presence of smoke-free policies on campuses of Schools of Nursing across the United States. A list of colleges and universities with smoke-free policies maintained by the Americans for Nonsmokers Rights Foundation in January 2015 was accessed to conduct the analysis. Schools of Nursing granting baccalaureate and graduate nursing degrees were included. Descriptive statistics were obtained for Schools of Nursing by region of the country and by highest level of nursing degree program of study at each institution. RESULTS: Smoke-free policies of 689 Schools of Nursing were examined. Of these, 442 (64%) did not have 100% smoke-free policies on their campuses. A greater percentage of nursing schools without a smoke-free policy were located in the Northeast (114, 79%) and West (70, 73%). Nearly half (57, 46%) of the Schools of Nursing with a PhD/DNS program had a smoke-free policy in place compared with all other degree program levels (BS/BSN: 69, 35%; MS/MSN: 83, 35%; DNP: 38, 30%). CONCLUSIONS: With only 247 (36%) of Schools of Nursing on campuses with comprehensive smoke-free policies, more must be performed to promote healthy learning and working environments for nursing students, staff, and faculty. As public health advocates, nursing leaders in Schools of Nursing have a moral and ethical imperative to advance tobacco control on college campuses to meet the American College Health Association goals for smoke-free/tobacco-free environments.

Recruiting family dyads facing thoracic cancer surgery: Challenges and lessons learned from a smoking cessation intervention.

PURPOSE: Persistent smoking after a cancer diagnosis has adverse effects. Most smoking cessation interventions focus on individual behaviors; however, family members who smoke are major barriers to success. This article describes challenges and lessons learned related to recruitment and retention to a longitudinal, dyadic-centered smoking cessation intervention study for individuals confronting a new diagnosis of thoracic cancer and their family members who smoke. METHODS: A prospective, one-group repeated measures, mixed-method feasibility study measured recruitment, retention, adherence, and acceptability over a 6-month period in a thoracic surgery clinic at a university cancer center. A multidisciplinary, multi-component decision aid-"Tobacco Free Family"-was used to intervene with the dyads. Study recruitment occurred preoperatively with a thoracic surgery team member assessing smoking status. RESULTS: During the 6-month recruitment period, 50 patients who smoked were screened, and 18 eligible families were approached to participate. Sixteen participants (8 dyads) enrolled. Patients were all male, and participating family members were all female-either spouses or long-term girlfriends. Others types of family members declined participation. CONCLUSION: Recruitment was lower than anticipated (44%), retention was high (100%), and maximizing convenience was the most important retention strategy. Oncology nurses can assess the smoking status of patients and family members, facilitate understanding about the benefits of cessation, refer those willing to stop to expert resources, and help motivate those unwilling to quit. Research is needed to continue developing strategies to help patients with thoracic cancer and their families facing surgery as an impetus for stopping smoking. Novel intervention delivery and communication need further exploration.

A decision aid to improve smoking abstinence for families facing cancer.

PURPOSE/OBJECTIVES: To test the feasibility of a multidisciplinary, multicomponent, theory-based decision aid. DESIGN: Prospective, one-group repeated measures. SETTING: Thoracic surgery clinic in a university hospital cancer center in central Virginia. SAMPLE: 8 dyads, consisting of 16 total participants. METHODS: A multidisciplinary, multicomponent smoking cessation intervention incorporated a theory-based decision aid. Enrollment occurred preoperatively; four face-to-face visits and an exit interview were conducted during six months. MAIN RESEARCH VARIABLES: Feasibility was evaluated based on four criteria: recruitment, retention, adherence, and acceptability. FINDINGS: The recruitment rate was 44%, and the retention rate was 100%. Adherence to the intervention and the acceptability of the decision aid were greater for patients than family members. Patients had greater abstinence than family members before surgery and at six months. Exit interview themes included (a) preoperative timing was acceptable and (b) involving household members who smoke was important. CONCLUSIONS: Recruiting male patients and their female partners is feasible. Participants liked convenience, autonomy, and a family approach. Family members wanted more control over cessation timing and a more intensive approach to weight and mental health management. Successful dyads worked together to maintain abstinence. IMPLICATIONS FOR NURSING: Oncology nurses can assess patients' and family members' smoking status, facilitate understanding about specific benefits of smoking cessation and the obstacle posed by household smokers, and make referrals to expert resources. Encouraging smoke-free environments is an important step toward reducing secondhand smoke exposure and promoting cessation.

Emerging issues on the impact of smoking on health-related quality of life in patients with lung cancer and their families.

Compelling evidence exists that continued smoking after a diagnosis of lung cancer adversely affects treatment effectiveness, survival, risk of recurrence, second malignancy, and health-related quality of life (HRQOL). The importance of HRQOL to patients with cancer and their families has been well documented. Because of increasing evidence of the benefits of smoking cessation, more research has focused on the impact of smoking on HRQOL. Smoking is a behavior that clusters in families; patients who smoke are likely to have family members who smoke, and together they experience impaired HRQOL. This article describes the evidence regarding HRQOL measurement in individuals diagnosed with lung cancer and their family members who smoke and explores the implications for nursing practice. Oncology nurses are in a critical position to advocate for the integration of HRQOL assessment into clinical settings, monitor patient and family member smoking status and environmental tobacco smoke exposure, and support development of smoking cessation interventions to enhance HRQOL.

Comparison of enrollment rates of African-American families into a school-based tobacco prevention trial using two recruitment strategies in urban and rural settings.

PURPOSE: This study evaluated similarities and differences of enrollment rates using two different recruitment strategies for a tobacco control trial in rural and urban African-American (AA) elementary school families. DESIGN: A comparative study, nested within a larger randomized controlled trial, was used to test the effectiveness of two recruitment approaches on enrollment rates in rural and urban AA families. SETTING: The study was conducted in 14 Title 1 elementary schools in the southeastern United States: 7 rural and 7 urban. SUBJECTS: There were 736 eligible AA families, and 332 (45%) completed informed consent and were enrolled into the study. INTERVENTION: The Facilitate, Open and transparent communication, Shared benefits, Team and tailored, Educate bilaterally, and Relationships, realistic and rewards (FOSTER) approach guided the two recruitment strategies: (1) written informational packets provided to fourth graders to take home to parents; and (2) proactive, face-to-face family information sessions held at schools. MEASURES: Enrollment rates were based on responsiveness to the two recruitment strategies and completion of the informed consent process. ANALYSIS: Chi-square, Cochran-Mantel-Haenszel, and Breslow-Day tests were performed. RESULTS: Higher enrollment rates occurred during the family session for both rural and urban families (100% rural, 93.6% urban; p = .0475) than informational packets alone (28.7% rural, 22% urban; p < .0001). Rural family enrollment rates were overall higher than urban rates regardless of recruitment strategy (52.0% rural vs. 39.6% urban; p = .0008). CONCLUSION: The findings suggest the FOSTER approach, although effective in both rural and urban settings, was more successful in recruiting rural families.

The impact of the Georgia Health Sciences University nursing faculty practice on tobacco cessation rates.

Nursing faculty practice groups can play a vital role in tobacco cessation in academic medical centers. Outcomes from the Georgia Health Sciences University Nursing Faculty Practice Group Tobacco Cessation Program revealed 64% abstinence outcomes at the end of treatment (N = 160) over a 2-year period from the campus-wide tobacco-free policy initiation. A nurse-led, evidence-based, interdisciplinary approach can be an effective strategy to make a difference in the lives of tobacco-dependent individuals, while at the same time integrating practice with education and research.

Online tobacco cessation education to optimize standards of practice for psychiatric mental health nurses.

This article presents an overview of an online education offering to improve standards of practice for nurses intervening with tobacco-dependent mentally ill populations. Designed as a pilot study and guided by the theory of reasoned action framework, the pretest-posttest educational program was conducted to examine attitudes and beliefs, knowledge, and intentions to integrate tobacco cessation interventions into practice. Although positive attitudes and beliefs were demonstrated, knowledge gaps continued to exist after the online program. Strengths and challenges of the online education offering are presented with recommendations for future research.

Community-based participatory research and smoking cessation interventions: a review of the evidence.

This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.

An official American Thoracic Society workshop report: tobacco control initiatives within the American Thoracic Society.

Cigarette smoking represents the single most preventable cause of premature morbidity and mortality in the United States and the burden of tobacco use is apparent world-wide. Cigarette smoking is a major risk factor for chronic obstructive pulmonary disease, the third leading cause of death in the United States in 2004. The American Thoracic Society (ATS) and its members have contributed significantly to an understanding of the biological and pathophysiologic mechanisms responsible for the development and management of tobacco-attributable disease and disability. The society's active involvement in tobacco control advocacy and policy-related initiatives are central to its mission. Within the ATS, there is also increased interest in accelerating the society's efforts to understand the mechanisms responsible for the uptake, persistence, and cessation of tobacco use. Scientific, clinical, and educational activities that include an examination of these underlying mechanisms are warranted. This paper describes findings from an ATS initiative that developed a preliminary strategy for enhancing scientific, clinical, educational, and policy-related tobacco control efforts that are consistent with the vision of the ATS. The specific aims of this project included the identification of existing mechanisms, as well as the current governance in place within the ATS infrastructure, to address tobacco control issues related to scientific inquiry, policy initiatives, and advocacy for tobacco control. This assessment generated recommendations to inform the ATS leadership with regard to the future development of relevant tobacco control initiatives.

Evidence-based smoking cessation interventions for patients with acute respiratory disorders.

Worldwide, tobacco use continues to be the most significant preventable cause of death and hospital admissions, particularly related to respiratory diseases. Acute respiratory illnesses requiring hospitalization provide an opportunity for nurses to intervene and help smokers quit. Of the three top hospital admissions related to respiratory diseases, chronic obstructive pulmonary disease (COPD) is the one that continues to have increased mortality whereas community acquired pneumonia and asthma have decreased over the past 5 years. The course of all three can be caused or exacerbated by continued smoking. This review describes the state of the science of nursing research focused on tobacco cessation interventions for hospitalized patients with COPD, asthma, or community acquired pneumonia. Additionally, we describe two evidence-based, nurse-driven, hospital protocols to treat tobacco dependence that can serve as models of care. Recommendations are made as to how to effectively promote nursing interventions for tobacco cessation in the acute care setting.

Evidence-based approach to an inpatient tobacco cessation protocol.

Tobacco use contributes to USD53 to USD73 billion per year in healthcare expenditures and causes nearly 440,000 deaths per year. Given the strong cause-effect relationship between smoking and poor health outcomes, it is critical that smokers are identified early and advised about smoking cessation. Furthermore, the Joint Commission now mandates that tobacco cessation advice be given to patients admitted with heart failure, pneumonia, and acute myocardial infarction. As such, an interdisciplinary group at an urban academic medical center developed and implemented a tobacco cessation protocol with the goal of identifying and targeting inpatient smokers through evidence-based education and counseling. The protocol focused on admission assessment, education, and provision of standing orders for medication treatment for nicotine withdrawal and/or tobacco cessation therapy during the inpatient encounter and referral for outpatient counseling at discharge.

Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty.

We report on the findings of a national survey that examined factors that influence faculty's intentions to integrate tobacco education in their advanced practice nursing curricula. The addiction component of tobacco use is taking its toll on the health of 48 million smokers in the United States. Several national health authorities recommend and/or mandate that tobacco prevention and tobacco cessation be addressed at every point of entry in the health care delivery system. However, there is increasing evidence that health care providers may not be adequately prepared to meet national goals and/or standards. One hundred sixty-one advanced practice nursing faculty in the United States completed an 88-item survey regarding external factors (e.g., personal history of tobacco use, clinical practice, and current tobacco topics taught) and components of the Theory of Reasoned Action model (including perceived self-efficacy, behavioral beliefs, subjective norms, and control beliefs related to tobacco education). Descriptive statistics, chi(2) analysis, Pearson correlation, and linear regression were used to analyze the data. The findings revealed that sex (chi(2) = 7.949, P = .024), level of education (chi(2) = 26.853, P = .0005), years of academic teaching (chi(2) = 19.418, P = .013), and combined clinical and course responsibility (chi(2) = 10.430, P = .0236) were significant external (demographic) factors and that behavioral beliefs (attitude about tobacco education) demonstrated the strongest relationship with intention scores (r = 0.876, P < .0005). Overall, 62.7% of nurse practitioners reported high scores (>or=5, on a scale of 1-7) for intentions to integrate tobacco education, as compared with 37.5% of nurse midwives, 30.3% of clinical nurse specialists, and 8.7% of nurse anesthetists. This study adds to the growing body of evidence that nursing curricular gaps with tobacco education exist and that national efforts are needed to ensure that widespread changes occur to help reduce the morbidity and mortality related to tobacco use.

Evaluation of a tobacco cessation curricular intervention among acute care nurse practitioner faculty members.

BACKGROUND: In 2002, a report indicated that tobacco-related curricular content in educational programs for acute care nurse practitioners was insufficient. To provide healthcare professionals with the necessary knowledge and skills to intervene with patients who smoke tobacco, the Summer Institute for Tobacco Control Practices in Nursing Education was implemented at Georgetown University in Washington, DC. OBJECTIVE: To evaluate the impact of a train-the-trainer program in which the Rx for Change: Clinician-Assisted Tobacco Cessation curriculum was used among faculty members of acute care nurse practitioner programs. METHODS: Thirty faculty members participated in the 2-day train-the-trainer program. Surveys were administered at baseline and 12 months after training to examine perceived effectiveness for teaching tobacco content, the value of using an evidence-based national guideline, and the number of hours of tobacco content integrated in curricula. RESULTS: The percentage of faculty members who devoted at least 3 hours to tobacco education increased from 22.2% to 74.1% (P<.001). Perceived effectiveness in teaching tobacco cessation also increased (P < .001), as did mean scores for the perceived value of using an evidence-based national guideline (P<.001). CONCLUSIONS: Use of the Rx for Change train-the-trainer program can enhance the level of tobacco education provided in acute care nurse practitioner programs. Widespread adoption of an evidence-based tobacco education in nursing curricula is recommended to help decrease tobacco-related morbidity and mortality.

Using evidence-based educational strategies to increase knowledge and skills in tobacco cessation.

To meet the demand for improved patient outcomes and accountability for healthcare delivery, nurses must embrace a culture of evidence-based practice (EBP). Integrating EBP for tobacco cessation in nursing practice is particularly important for the 44.5 million smokers in the United States who contribute to 157 billion dollars of healthcare costs annually. Unfortunately, studies reveal that healthcare providers are not aware of what is considered the best evidence, the United States Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence, resulting in missed opportunities to promote optimal health outcomes for individuals wanting to quit smoking. Fortunately, leading healthcare authorities such as the Joint Commission of Accreditation for Healthcare Organizations and Centers for Medicare and Medicaid Services now require providers to offer tobacco cessation services. The challenges and opportunities to do this effectively are many and with limited resources it will be increasingly important to ensure that nurses have the necessary knowledge and skills to improve tobacco cessation outcomes. For tobacco cessation interventions to become a standard of nursing practice, strategic efforts must be directed at advancing nursing research that evaluates best educational strategies for promoting tobacco cessation interventions within nursing curricula. In this article, a framework to help address nursing strategies to bridge the gap between EBP and tobacco cessation will be described.