The Experiences of People Who Smoke With Type 2 Diabetes: A Qualitative Interview Study Using the Capability, Opportunity, Motivation, and Behavior Model.

ABSTRACT: Few interventions to support smoking cessation include content specifically about diabetes. This is problematic, as people with diabetes face unique challenges when they stop smoking. The purpose of this study was to understand patients' needs and challenges in relation to smoking with Type 2 diabetes and assess the acceptability of a text message intervention to support smoking cessation. People who smoke and have Type 2 diabetes in the United States and the United Kingdom were recruited to participate in semistructured interviews (n = 20), guided by the Capability, Opportunity, Motivation, and Behavior model. A combination of inductive and deductive approaches with framework analysis was used to analyze the data. Results indicated that the participants' experiences related to the constructs of the Capability, Opportunity, Motivation, and Behavior model and the categories of mental health and diabetes distress were also notable parts of their experiences. Results can be used to guide intervention development in this unique group.

Support Provided by Stop-Smoking Practitioners to Co-users of Tobacco and Cannabis: A Qualitative Study.

INTRODUCTION: Co-use of tobacco and cannabis is highly prevalent among cannabis users and is associated with poorer tobacco cessation outcomes. This study explored the barriers and enablers influencing stop-smoking practitioners' ability to provide optimal support to co-users. AIMS AND METHODS: Online semi-structured interviews were audio recorded. Interviewees (n = 20) were UK-based certified stop-smoking practitioners. An interview schedule informed by the "capability", "opportunity", "motivation" (COM-B) model was designed to explore participants' perceived barriers and enablers in better supporting co-users to achieve abstinence of both substances or tobacco harm reduction. The transcripts were analyzed using framework analysis. RESULTS: Capability: Practitioners' lack of knowledge and skills undermines their delivery of smoking cessation interventions to co-users. Interestingly, when cannabis is used for medicinal reasons, practitioners feel unable to provide adequate support. Opportunity: Service recording systems play an important role in screening for co-use and supporting co-users. When responding to clients' specific needs and practitioners' uncertainties, a positive therapeutic relationship and a support network of peers and other healthcare professionals are needed. Motivation: supporting co-users is generally perceived as part of practitioners' roles but there are concerns that co-users are less likely to successfully stop smoking. CONCLUSIONS: Practitioners are willing to support co-users, but their lack of knowledge and access to an appropriate recording system are barriers to doing so. Having a supportive team and a positive therapeutic relationship is perceived as important. Identified barriers can be mostly addressed with further training to improve tobacco cessation outcomes for co-users.

Differentiating people who use cannabis heavily through latent class analysis.

BACKGROUND: People who use cannabis daily or near-daily vary considerably in their daily dosage and use frequency, impacting both experienced effects and adverse consequences. This study identified heavy cannabis user groups according to consumption patterns and factors associated with class membership. METHODS: We conducted a cross-sectional study of 380 Spanish residents (61.8% male; average age = 30.3 years) who had used cannabis ≥ 3 days/week throughout the past year. Participants were recruited through chain referral and cannabis social clubs. We applied latent class analysis (LCA) to cluster participants according to use intensity. LCA indicators included frequency of weekly cannabis use, joints smoked each day, cannabis dosage, and if cannabis was consumed throughout the day or only at specific times. Associations between class membership and socio-demographics, use patterns, motives, supply sources, adverse outcomes, and use of other substances were measured using ANOVA and chi-squared tests. Multinomial regression identified the factors associated with latent class membership. RESULTS: Three latent classes (moderately heavy: 21.8%, heavy: 68.2%, very heavy: 10%) had average weekly cannabis intakes of 2.4, 5.5, and 18.3 g, respectively. Very heavy users were older ([Formula: see text]=17.77, p < 0.01), less educated [Formula: see text]=36.80, p < 0.001), and had used cannabis for longer (F = 4.62, p = 0.01). CAST scores (F = 26.51, p < 0.001) increased across the classes. The prevalence of past-month alcohol use was lower among the heaviest users ([Formula: see text]=5.95, p = 0.05). Cannabis was usually obtained from a club by very heavy users ([Formula: see text]=20.95, p < 0.001). CONCLUSIONS: People who use cannabis heavily present three groups according to frequency and quantity of cannabis consumption. Use intensity is associated with increased cannabis-related problems. Differences among heavy users must be considered in harm reduction interventions in cannabis clubs and indicated prevention.

Fathers' experiences of fetal attachment: A qualitative study.

Paternal-fetal attachment (PFA) is associated with the degree of emotional support offered by fathers during pregnancy and has implications for the safety and quality of a mother's labor and postnatal experiences. This study explored fathers' experiences of PFA including their understanding of the phenomenon and its manifestation. Data were collected through interviews with 10 fathers-to-be and analysis followed an interpretative phenomenological approach. Four themes emerged from the data: trigger moment; awareness of responsibility; transition to fatherhood; and emotional conflict. Most fathers experienced a trigger moment that made the reality of having a baby clear to them and which initiated or intensified feelings of attachment toward the fetus. Male family relatives, friends with children, and antenatal education groups provided support to expectant fathers. However, they felt quite lost in their role and some believed there was insufficient support for their mental health. Findings suggest that different situations can trigger the attachment process and that fathers longed to be included in perinatal care but experienced a lack of support. Raising awareness of the importance of PFA can help initiate the process in fathers and better equip them to contribute during the antenatal period and to future child development.

La afectividad paterno-fetal (PFA) se asocia con el nivel de apoyo emocional que los papás ofrecen durante el embarazo y que tiene implicaciones en cuanto a la seguridad y calidad del proceso de parto de la madre y las experiencias postnatales. Este estudio exploró las experiencias de PFA de los papás, incluyendo su comprensión del fenómeno y su manifestación. Se recogió la información a través de entrevistas con 10 futuros papás y los análisis siguieron un acercamiento fenomenológico interpretativo. Surgieron cuatro temas a partir de la información: el momento de activación del proceso; el estar consciente de la responsabilidad; la transición a la paternidad; y el conflicto emocional. La mayoría de los papás experimentaron el momento en que el proceso de parto se puso en acción como el punto que les aclaró la realidad de tener un bebé y el cual inició o intensificó los sentimientos de afectividad hacia el feto. Parientes varones de la familia y amigos con niños y grupos de educación antenatal ofrecieron apoyo a los futuros papás. Sin embargo, ellos se sintieron muy perdidos en su papel y algunos creyeron que no había apoyo suficiente para su salud mental. Los resultados indican que situaciones diferentes pueden activar el proceso de afectividad y que los papás anhelaban ser incluidos en el cuidado perinatal, pero experimentaron una falta de apoyo. Crear consciencia de la importancia de PFA puede ayudar a iniciar el proceso en los papás y equiparlos mejor para contribuir durante el período antenatal y al futuro desarrollo del niño.

L'attachement paternel-foetal (abrégé ici suivant l'anglais PFA) est lié au degré de soutien émotionnel offert par les pères durant la grossesse et a des implications pour la sécurité et la qualité du travail d'une mère et de ses expériences postnatales. Cette étude a exploré les expériences du PFA des pères y compris le compréhension du phénomène et de sa manifestation. Les données ont été recueillies durant les entretiens avec 10 futurs pères et l'analyse a suivi une approche phénoménologique interprétative. Quatre thèmes ont émergé des données: le moment de déclenchement; la prise de conscience de la responsabilité; la transition à la paternité; et le conflit émotionnel. La plupart des pères ont fait l'expérience d'un moment de déclenchement qui a clarifié la réalité d'avoir un bébé et qui a initié ou intensifié des sentiments d'attachement envers le fœtus. Des membres de la famille mâles, des amis avec des enfants et les groupes de préparation à la naissance ont offert du soutien aux futurs pères. Cependant ces derniers se sentaient très perdus dans leur rôle et certains pensaient recevoir un soutien insuffisant pour leur santé mentale. Les résultats suggèrent que des situations différentes peuvent déclencher le processus d'attachement et que les pères avaient vraiment envie d'être inclus dans le soin périnatal mais faisaient l'expérience d'un manque de soutien. La sensibilisation de l'importance du PFA peut aider à entamer le processus chez les pères et mieux les équiper à contribuer durant la période prénatale ainsi qu'au développement à venir de l'enfant.

Understanding how a smoking cessation intervention changes beliefs, self-efficacy, and intention to quit: a secondary analysis of a pragmatic randomized controlled trial.

Although beliefs, self-efficacy, and intention to quit have been identified as proximal predictors of initiation or quitting in young adults, few studies have studied how these variables change after a smoking cessation intervention. To evaluate the changes in the beliefs, self-efficacy, and intention to avoid smoking and determine if these are potential mediators in quitting, following a smoking cessation intervention, aimed at tobacco-dependent college students. Single-blind, pragmatic randomized controlled trial with a 6-month follow-up. A total of 255 smoker students were recruited from September 2013 to February 2014. Participants were randomly assigned to intervention group (n = 133) or to control group (n = 122). The students in the intervention group received a multicomponent intervention based on the Theory of Triadic Influence (TTI). The strategies of this program consisted of a 50 min motivational interview conducted by a nurse and online self-help material. The follow-up included a reinforcing e-mail and group therapy. The smoking-related self-efficacy, belief, and intention scale was used to assess outcomes. Intention to quit smoking is partial moderator explaining 36.2% of the total effects in smoking cessation incidence. At 6 month follow-up, the differences in the mean scores of self-efficacy and intention related to stopping smoking were significantly higher in the intervention than in the control group. A multicomponent intervention based on the TTI, tailored to college students, positively increased the self-efficacy to avoid smoking and the intention to quit, suggesting intention as potential mediator of quitting.

National Survey of Smoking and Smoking Cessation Education Within UK Midwifery School Curricula.

INTRODUCTION: Smoking in pregnancy in the United Kingdom remains prevalent (11%). To encourage and support pregnant smokers to quit, midwives must be adequately trained to do so. Substantial curricular gaps have been identified in the smoking cessation training of medical, nursing, and optometry schools. This study aimed to identify the extent of smoking cessation training and assessment in UK midwifery schools. METHODS: All UK undergraduate midwifery schools (n = 53) were invited to complete a web-based survey of their curricular coverage and assessment related to smoking cessation, and perceived barriers to delivering smoking cessation training. RESULTS: Twenty-nine (55%) midwifery schools responded. Most teaching was completed in the initial year of study. All reported teaching the harmful effects of tobacco use. The majority of respondents (83%) reported training students in brief intervention delivery and ways to assist quit attempts. Only 24% of schools in this study included relapse prevention in their curriculum. The most frequently reported barriers to teaching smoking cessation were "lack of knowledge amongst staff" (17%), "no space in a crowded curriculum" (17%), and "administrative problems" (13%). CONCLUSIONS: Midwifery schools are teaching the harmful effects of smoking and providing training on brief interventions. However, in some schools student midwives are not being sufficiently trained on relapse prevention or assessed in the practical skills necessary for delivering evidence-based interventions. IMPLICATIONS: Midwifery schools should revise the content and delivery of smoking cessation training to ensure midwives are equipped with the necessary knowledge and skills to contribute to the challenge of smoking cessation in pregnancy.

Nurses' smoking habits and their professional smoking cessation practices. A systematic review and meta-analysis.

BACKGROUND: A better understanding of whether nurses' own smoking behaviours influence their engagement with smoking cessation interventions is needed. AIM: To establish whether the smoking status of nurses is associated with their professional smoking cessation practices. METHODS: Twelve electronic databases covering English and Spanish language publications from 01 Jan, 1996 to 25 Mar, 2015 were systematically searched. Studies were included if they reported nurses' smoking cessation practices in relation to their personal smoking habits. Proportions of nurses' smoking status and smoking cessation practices were pooled across studies using random effects meta-analysis. RESULTS: Fifteen studies were included in this systematic review. Levels of reportedsmoking cessation interventions were generally low across the studies. The meta-analyses suggested that nurses' personal smoking status was not associated significantly with nurses always asking patients about their smoking, but nurses who smoked were 13% less likely to advise their patients to quit and 25% less likely to arrange smoking cessation follow-up. More intense interventions (assessing motivation and assisting) were not significantly associated with the smoking status of the nurse. CONCLUSIONS: The smoking status of nurses appears to have a negative impact in the delivery of smoking cessation practices. The overall level of nurses' engagement with the delivery of smoking cessation interventions requires attention if nurses are to be effective agents of smoking cessation.

Adherence to healthy diet and physical activity in clinical patients.

BACKGROUND: The aim of this study is to explore the psychometric properties of the Motiva.Diaf questionnaire, which assesses the adherence to healthy diet and physical activity in clinical patients. METHOD: Participants were 230 patients, who attended hospital services, with a mean age of 49.28 years (SD = 12.34). Women constituted 55.7% of the patients. Two weeks after initial administration, 40 participants, from those who had another hospital appointment scheduled, were selected at random to complete again the questionnaire in order to assess test–retest reliability.   Results:  the accuracy of the scores is adequate both in terms of internal consistency (α = .802; Ω = .776) and temporal stability ( r = .786).  The test’s structure is essentially one-dimensional, and the scores in this dimension converge with other necessary basic psychological measurements ( r Diet = .294; r Physical Activity = .359) and perceived health ( r = .266). In addition, a relatively moderate relationship was found with the Body Mass Index ( r = - .129). CONCLUSIONS: The test has shown adequate reliability and validity for evaluating adherence to healthy habits. The availability of an instrument with these characteristics has significant implications for evaluating behaviour, designing and implementing behavioural interventions.

Do doctors' smoking habits influence their smoking cessation practices? A systematic review and meta-analysis.

AIMS: To assess the association between doctors' smoking status and the use of the '5As' of smoking cessation. METHODS: A systematic search of 11 databases covering English and Spanish language publications since 1996 was undertaken. Studies were included if they reported doctors' smoking status (current, former or never smoker) and rates of practising any of the 5As of smoking cessation (Ask; Advise; Assess; Assist; and Arrange). Frequencies and proportions were extracted from individual papers and risk ratios (RR) were calculated. A random-effects meta-analysis model was used to assess the effect of the doctor's personal smoking history. Covariate effects were explored using meta-regression for three pre-specified study characteristics: doctors' role, smoking prevalence of the sample and study quality. RESULTS: Twenty studies were included in this systematic review. The RR of always asking patients about their smoking was not associated significantly with doctors' smoking status [RR = 0.98; 95% confidence interval (CI) = 0.94-1.02; P = 0.378; I(2) = 0.00%; 10 studies]. Meta-analysis suggested that doctors who were current smokers had a 17% increased risk of not advising their patients to quit compared with never-smokers (RR = 0.83; 95% CI = 0.77-0.90; P < 0.000; I(2) = 82.14%; 14 studies). However, high levels of heterogeneity were found that were not explained by the meta-regression. Regarding assisting patients to quit, never smokers were more likely to counsel than current smokers (RR = 0.92; 95% CI = 0.85-0.99; P = 0.036; I(2) = 0.00%; three studies) but less likely to make a referral (RR = 1.40; 95% CI = 1.09-1.79; P = 0.009; I(2) = 0.00%; five studies). No statistically significant differences were found in arranging future contact by smoking status (RR = 0.80; 95% CI = 0.52-1.23; P = 0.315; I(2) = 47.03%; four studies). CONCLUSIONS: Smoking status of doctors may affect their delivery of smoking cessation treatments to patients, with smokers being less likely than non-smokers or ex-smokers to advise and counsel their patients to quit but more likely to refer them to smoking cessation programmes.