Smoking cessation behavior in patients with a diagnosis of a non-communicable disease: The impact of perceived disease severity of and susceptibility to the disease.

INTRODUCTION: The Health Belief Model comprises two constructs influencing changed behaviors impacting on health, namely perceived severity and susceptibility. The aim of this study was to identify the impact of the combination of, or interactions between, these two constructs on quitting smoking in smokers with a diagnosis of a non-communicable disease (NCD). METHODS: From the large insurance claims database maintained by JMDC database (JMDC, Tokyo), we extracted data on 13284 participants who smoked. All participants were stratified according to their NCD diagnosis based on perceived severity and susceptibility as follows: Category I (high severity and high susceptibility) - acute myocardial infarction, and lung cancer; Category II (high severity and low susceptibility) - colorectal cancer, and stomach cancer; Category III (low severity and high susceptibility) - asthma, and transient ischemic attack; Category IV (low severity and low susceptibility) - appendicitis, and glaucoma. We performed multi-variable logistic regression analysis and calculated the proportion of those who were smoking at the first health check-up after the diagnosis and every three years thereafter. RESULTS: Using glaucoma as the reference, the adjusted odds ratios for smoking cessation were 14.2 (95% CI: 11.4-17.8) to 14.8 (95% CI: 12.5-17.4) in Category I; 4.5 (95% CI: 3.8-5.4) to 6.6 (95% CI: 5.4-8.0) in Category II; and 1.9 (95% CI: 1.7-2.1) to 2.8 (95% CI: 2.2-3.7) in Category III. In Categories I and II, the proportion of smokers rapidly decreased after diagnosis and mostly remained low thereafter. Smoking cessation rates for Categories I and II were not associated with readiness to improve lifestyles prior to NCD diagnosis. CONCLUSIONS: Our study confirms the significant impact of perceived severity of and susceptibility to the diagnosed disease on smoking cessation. The multiplicative effect of these two constructs at NCD diagnosis represents a 'teachable moment', a window of opportunity, for encouraging successful long-term smoking cessation.

Consensus statement on smoking cessation in patients with pain.

Smoking is closely associated with the development of various cancers and tobacco-related illnesses such as cardiovascular and respiratory disorders. However, data are scarce on the relationship between smoking and both acute and chronic pain. In addition to nicotine, tobacco smoke contains more than 4000 different compounds. Although nicotine is not the sole cause of smoking-induced diseases, it plays a critical role in pain-related pathophysiology. Despite the acute analgesic effects of nicotine, long-term exposure leads to tolerance and increased pain sensitivity due to nicotinic acetylcholine receptor desensitization and neuronal plastic changes. The purpose of smoking cessation interventions in smoking patients with pain is primarily not only to reduce their pain and associated limitations in activities of daily living, but also to improve the outcomes of underlying pain-causing conditions and reduce the risks of tobacco-related disorders. This statement aims to summarize the available evidence on the impact of smoking on pain and to inform medical professionals of the significance of smoking cessation in patients with pain.

Smoking cessation after cancer diagnosis reduces the risk of severe cancer pain: A longitudinal cohort study.

BACKGROUND: Whether abstinence from smoking among cancer patients reduces cancer pain is still unclear. Opioids can act as a surrogate index for evaluating the incidence of severe cancer pain in countries where opioid abuse is infrequent. This study aimed to investigate whether changed smoking behavior after cancer diagnosis influences the incidence of severe cancer pain as determined by strong opioid use. METHODS: Using a large Japanese insurance claims database (n = 4,797,329), we selected 794,702 insured employees whose annual health checkup data could be confirmed ≥6 times between January 2009 and December 2018. We selected 591 study subjects from 3,256 employees who were diagnosed with cancer pain and had health checkup data at the year of cancer pain diagnosis. RESULTS: A significantly greater proportion of patients who continued smoking after cancer diagnosis ("current smoker", n = 133) received strong opioids (36.8%) compared with patients who had never smoked or had stopped before cancer diagnosis ("non-smoker", n = 383, 20.6%; p<0.05) but also compared with patients who had quit smoking after cancer diagnosis ("abstainer:", n = 75, 24.0%; p<0.05). In multivariable Cox proportional hazards regression analysis, abstainers had a significantly lower risk of receiving strong opioids than current smokers (hazard ratio: 0.57, 95% CI: 0.328 to 0.997). These findings were consistent across multiple sensitivity analyses. CONCLUSION: Our study demonstrated that patients who quit smoking after cancer diagnosis have a lower risk of severe cancer pain. This information adds clinical incentives for improving quality of life among those who smoked at the time of cancer diagnosis.

Shorter Incubation Period among COVID-19 Cases with the BA.1 Omicron Variant.

We aimed to elucidate the range of the incubation period in patients infected with the SARS-CoV-2 Omicron variant in comparison with the Alpha variant. Contact tracing data from three Japanese public health centers (total residents, 1.06 million) collected following the guidelines of the Infectious Diseases Control Law were reviewed for 1589 PCR-confirmed COVID-19 cases diagnosed in January 2022. We identified 77 eligible symptomatic patients for whom the date and setting of transmission were known, in the absence of any other probable routes of transmission. The observed incubation period was 3.03 ± 1.35 days (mean ± SDM). In the log-normal distribution, 5th, 50th and 95th percentile values were 1.3 days (95% CI: 1.0−1.6), 2.8 days (2.5−3.1) and 5.8 days (4.8−7.5), significantly shorter than among the 51 patients with the Alpha variant diagnosed in April and May in 2021 (4.94 days ± 2.19, 2.1 days (1.5−2.7), 4.5 days (4.0−5.1) and 9.6 days (7.4−13.0), p < 0.001). As this incubation period, mainly of sublineage BA.1, is even shorter than that in the Delta variant, it is thought to partially explain the variant replacement occurring in late 2021 to early 2022 in many countries.

Effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of behavior in delivering smoking cessation counseling.

INTRODUCTION: Despite the effectiveness of smoking cessation counseling, participation of nurses in delivering smoking cessation advice has been far from satisfactory in practice. Training nurses is considered to be important for increasing self-efficacy and skills for routine delivery of smoking cessation counseling. The aim of the present study was to evaluate the effectiveness of a smoking cessation educational program for Japanese nurses on subsequent changes of their behavior in delivering smoking cessation counseling, three months later. METHODS: We ran a 6-hour smoking cessation educational program for nurses recruited from the Nursing Associations of 13 prefectures in Japan between May 2019 and February 2020. Surveys were conducted by questionnaire before the start of the program and 3 months thereafter. The successful implementation of smoking cessation counseling behavior was evaluated according to the 5As of the Clinical Practice Guidelines for Treating Tobacco Use and Dependence (Ask, Advise, Assess, Assist, Arrange). RESULTS: We received 289 responses 3 months after the program finished (response rate 46.0%). At that time, 43% of participants had increased the frequency of 'Ask' and 42.1%, 50%, 39.3%, and 28.6%, respectively, had also increased their frequency of 'Advise', 'Assess', 'Assist', and 'Arrange'. We found that smoking cessation counseling was significantly more frequently delivered after the educational program for those participants who had routinely delivered 'Advise' before the program as measured by increased delivery of 'Assess' and 'Assist' afterwards (OR=2.39; 95% CI: 1.00-5.69, OR=2.54; 95% CI: 1.16-5.60 and OR=3.68; 95% CI: 1.40-9.65, OR=2.77; 95% CI: 1.10-7.01, respectively). CONCLUSIONS: The program successfully increased the frequency of nurses providing smoking cessation advice to patients. Readiness to deliver smoking cessation counseling before the program and continuing self-efficacy after the program are important for changing the behavior of nurses in delivering smoking cessation counseling.

How Self-Efficacy toward, Perceived Importance of, and Beliefs about Smoking Cessation Support Impact-Related Behaviors in Japanese Nursing Professionals.

This study investigated the relationships among Japanese nursing professionals' percetions of the importance of smoking cessation support (SCS), attitude toward SCS, SCS self-efficacy, and SCS behaviors. An anonymous, self-administered questionnaire was administered to 613 nursing professionals (valid response rate: 89.9%) who participated in SCS workshops in Japan between May 2019 and February 2020. The survey measured factors such as SCS behaviors (the 5 As) and attitude toward SCS. Participants responded that they "always" or "usually" performed the 5 As at the following rates: Ask, 65.6%; Advise, 46.7%; Assess, 34.4%; Assist, 19.7%; and Arrange, 20.9%. Significant differences in implementation rates between "non-engagers" and "engagers" were found for all steps except Ask. Those who engaged daily in SCS had significantly higher scores for SCS behaviors and SCS perceived importance, attitude, and self-efficacy than those who did not. Structural equation modeling yielded a model with 61% explanatory power, which demonstrated that beliefs about and perceived importance of SCS had a greater impact on SCS behaviors than self-efficacy. Promotion of SCS behaviors among nursing professionals in Japan requires the beliefs about and recognition of the importance of SCS to be improved. The importance of engaging in SCS daily is also recommended.

Outcomes of a telemedicine smoking cessation programme for heated tobacco product users in Japan: a retrospective cohort study.

OBJECTIVES: Japan is one of the largest markets for heated tobacco products (HTPs), and the number of HTP users, including dual users, is growing. However, it is not yet clear whether a telemedicine smoking cessation programme is effective for nicotine-dependent HTP users to quit smoking. We assessed the outcomes of a telemedicine smoking cessation programme in terms of continuous smoking cessation among smokers who had used HTPs compared with those who used exclusively cigarettes. DESIGN: A retrospective cohort study to assess the outcomes of the telemedicine smoking cessation programme provided by Linkage, Japan, comparing the success rates of smoking cessation between exclusively cigarette group (as reference) and HTP user groups (exclusively HTPs or dual use of both cigarettes and HTPs). SETTING: Linkage telemedicine smoking cessation programme database, covering programme participants in Japan. PARTICIPANTS: Programme participants from between August 2018 and October 2020. OUTCOME MEASURES: Continuous abstinence rates (CARs) from 9 to 24 weeks (CAR9-24) and 9 to 52 weeks (CAR9-52). Adjusted ORs (aORs) with 95% CIs for CAR were calculated to compare the exclusively cigarette group with exclusively HTP and dual use groups. RESULTS: We analysed 733 telemedicine smoking cessation programme participants. Exclusively HTP users had higher CARs than the exclusively cigarette group for CAR9-24 (aOR 1.12, 95% CI 1.02 to 1.23; p=0.02) and CAR9-52 (1.09, 0.99 to 1.19; p=0.08). Conversely, dual users had lower CARs than the exclusively cigarette group for CAR9-24 (0.85, 0.76 to 0.95; p=0.004) and CAR9-52 (0.88, 0.79 to 0.97; p=0.01). CONCLUSIONS: Exclusive HTP users achieved higher CARs, whereas dual users had lower CARs than exclusively cigarette users over short-term and long-term periods. A telemedicine smoking cessation programme may be a reasonable option for exclusive HTP users.

Increased Transmissibility of the SARS-CoV-2 Alpha Variant in a Japanese Population.

To assess the relative transmissibility of the SARS-CoV-2 Alpha variant compared to the pre-existing SARS-CoV-2 in Japan, we performed a cross-sectional study to determine the secondary attack rate of COVID-19 in household contacts before and after the Alpha variant became dominant in Osaka. We accessed 290 household contacts whose index cases were diagnosed between 1 and 20 December 2020 (the third epidemic group), at a time when Osaka was free of the Alpha variant. We also accessed 398 household contacts whose index cases were diagnosed between 20 April and 3 May 2021 (the fourth epidemic group), by which time the Alpha variant had become dominant. We identified 124 household contacts whose index case was determined positive for the Alpha variant (Alpha group) in this fourth group. The secondary attack rates in the fourth group (34.7%) and the Alpha group (38.7%) were significantly higher than that in the third group (19.3%, p < 0.001). Multivariable Poisson regression analysis with a robust error variance showed a significant excess risk in the fourth group (1.90, 95% CI = 1.47-2.48) and the Alpha group (2.34, 95% CI = 1.71-3.21). This finding indicates that the SARS-CoV-2 Alpha variant has an approximately 1.9-2.3-fold higher transmissibility than the pre-existing virus in the Japanese population.

Association between swallowing function and oral bacterial flora in independent community-dwelling elderly.

BACKGROUND: Increasing incidences of swallowing dysfunction, or dysphagia, a risk factor for aspiration pneumonia, are being reported in aging populations. AIMS: To investigate the relationship between swallowing function and oral bacteria in independent, community-dwelling elderly. METHODS: This study recruited 139 community-dwelling individuals aged ≥ 70 years with poor swallowing function. The presence of anaerobic (Prevotella spp. and Fusobacterium spp.) and aerobic bacteria was examined in the participants' oral cavity flora. Swallowing function was evaluated using a 30 mL water swallowing test. Multivariate logistic regression analyses were performed to examine the association between oral bacteria and swallowing function. RESULTS: Swallowing function was assessed as abnormal in 2.9% and as abnormal in 47.5% of the subjects. The colony-forming units (CFUs/ml) of Prevotella spp. were associated with the swallowing dysfunction (odds ratio [OR] 3.45, 95% confidence interval [CI] 1.49-8.11). Further, CFUs/ml of Fusobacterium spp. and aerobes did not correlate with the swallowing dysfunction but were related with the number of teeth (OR 2.71; 95% CI 1.28-5.74, and OR 0.40; 95% CI, 0.18-0.91, respectively) CONCLUSIONS: Swallowing dysfunction in community-dwelling elderly is associated with increased abundance of Prevotella spp., which indirectly may be an increased risk factor for aspiration pneumonia.

Relationship between the strength of craving as assessed by the Tobacco Craving Index and success of quitting smoking in Japanese smoking cessation therapy.

BACKGROUND: We previously developed the Tobacco Craving Index (TCI) to assess craving of smokers. In the present study, we validated the relationship between the TCI grade over the 5 sessions of Japanese smoking cessation therapy (SCT) and success of quitting smoking among 889 Japanese patients. METHODS: The Japanese SCT consists of 5 sessions of SCT (first session and sessions 2, 4, 8 and 12 weeks later). In the TCI questionnaire, patients are asked to rate their strength of craving and frequency of craving, each on a four-point Likert scale. Patients are classified into one of four grades based on their responses (0, I, II, III, with III indicating severe craving). The TCI questionnaire was administered to each participant at each session of the SCT. This study included participants of Japanese SCT who answered the TCI at the first session of the SCT at five Japanese smoking cessation clinics. Patients who dropped out of the SCT from the second to the fifth sessions were considered to have failed smoking cessation. To elucidate how much the TCI grade predicts smoking status at the last session, we performed multivariate logistic regression analysis with adjustment for confounding factors. RESULTS: Participants who had higher TCI grade(III) in the 2nd through 5th sessions showed significantly lower probability for success of quitting smoking than those who had lower TCI grades(0 or I) (adjusted odds ratio: 2nd session: 0.30, 3rd session: 0.15, 4th session: 0.06, 5th session: 0.02). CONCLUSIONS: We validated the usefulness of the TCI grade for assessing probability of quitting smoking by using a large number of smoking cessation settings.

Characteristics, outcome and factors associated with success of quitting smoking in 77 people living with HIV/AIDS who received smoking cessation therapy in Japan.

AIM: Smokers with HIV/AIDS have lower success of quitting smoking than smokers with other chronic diseases. However, there have been no studies investigating characteristics and outcomes of success of quitting smoking among people living with HIV compared to HIV-negative people who received smoking cessation therapy. In addition, there have been no studies that investigated factors associated with success of quitting smoking among people living with HIV in Japan. The aim of this study was to elucidate characteristics, outcomes and factors associated with the success of quitting smoking in people living with HIV. METHODS: We previously conducted a prospective cohort study on patients who received Japanese smoking cessation therapy (SCT), which consists of smoking cessation intervention five times with nurses' counseling over a 12-week period. Among them, we compared 77 HIV-positive male individuals and 323 HIV-negative male individuals with complications. RESULTS: Smokers with HIV had a larger number of cigarettes smoked per day, and higher scores of nicotine dependence and depression compared with the HIV-negative group. The HIV-positive group had a significantly lower success rate of quitting smoking than the HIV-negative group (35.1 vs. 47.7%, p = .046). The subjects living with HIV who had higher self-efficacy showed a significantly higher quit rate compared with those who had lower self-efficacy (odds ratio 9.99, p < .01). CONCLUSION: Smokers with HIV had characteristics that made it difficult for them to quit smoking. Increasing their self-efficacy of quitting smoking through nurses' counseling will lead to success of quitting smoking in HIV-positive smokers receiving the SCT.

Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study.

BACKGROUND: In Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia. METHODS: A cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels. RESULTS: Data from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25-11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19-2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64-5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17-2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86-65.34). CONCLUSIONS: High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

[Effects of drug treatment on the surviral-time in patients with dementia].

AIM: The effect of polypharmacy on the surviral-time in patients with dementia has never been fully elucidated. METHODS: A retrospective study was conducted in a hospital in Aichi, Japan, by reviewing the medical charts and autopsy reports. Patients were hospitalized and neuropathologically diagnosed with dementia. The data on medication was collected from the prescribed drugs taking right before the admission. Patients were divided into two groups according to the number of prescribed drugs: ≥ 5 drugs (polypharmacy) vs. ≤ 4 drugs (non-polypharmacy). "Drugs to be prescribed with special caution" were defined in accordance with the guidelines for medical treatment and its safety in the elderly (2015). RESULTS: Seventy-six patients were eligible, and 39.5% of patients had polypharmacy. The Kaplan-Meier method showed that the polypharmacy group tended to have a shorter survival-time than the non-polypharmacy group (p=0.067). A Cox proportional hazard model showed that the polypharmacy group tended to have a higher risk for a reduced survival-time than the non-polypharmacy group, and this tendency was more prominent after adjusting for sex and age at admission (adjusted hazard ratio, 1.631; 95% confidence interval, 0.991-2.683; p=0.054). "Drugs to be prescribed with special caution", including hypnotic-sedative drugs, antianxiety drugs, antipsychotics, and benzodiazepines, were not found to be risk factors for a reduced survival-time. CONCLUSIONS: The present study showed that polypharmacy in terminal patients with dementia tended to carry a risk for reducing their remaining lifespan. The results warrant further additional study.

Factors influencing hospital admission among patients with autopsy-confirmed dementia.

BACKGROUND: The symptoms of geriatric syndromes and the behavioural and psychological symptoms of dementia (BPSD), in addition to clinical conditions, are associated with hospital admission among dementia patients. However, the principal factors that necessitate hospital admission among dementia patients have not been fully elucidated. METHODS: We retrospectively reviewed the data in the medical and autopsy reports of patients who had been treated at a hospital in Toyohashi, Japan. Each patient had been hospitalized sometime between 2012 and 2016 and underwent a brain autopsy. Dementia and the subtypes of dementia were diagnosed neuropathologically. Information about patients' general backgrounds, clinical conditions at the time of admission, and the geriatric syndrome symptoms and BPSD before admission was collected; comparisons were then made between patients with and without dementia and among those with the different major subtypes of dementia. Then, the factors relating to hospital admission of dementia patients were comprehensively evaluated by using principle component analysis. RESULTS: Of the 128 eligible patients, 100 (78.1%) had dementia. In the comparison of patients with and without dementia, patients without dementia were younger at both admission (P = 0.034) and death (P = 0.003). Among the patients with dementia with Lewy bodies, delusions had a significantly high prevalence (P = 0.014). Principal component analysis identified nine components (disinhibition, irritability/lability, agitation/aggression, anxiety, delusions, sleep/night-time behaviour disorders, hallucinations, aberrant motor behaviour, and speech impairment) as the principal factors related to hospital admission among dementia patients. Thus, BPSD were identified as principal factors. CONCLUSIONS: Compared to other factors, BPSD are more likely to cause dementia patients to be admitted to hospital. The present results indicate that measures should be taken to ameliorate the difficulties associated with caring for patients with BPSD at home.

Development of a new craving index for anticipating quitting smoking in patients who undergo the Japanese smoking cessation therapy.

INTRODUCTION: The 10-item version of the Questionnaire of Smoking Urges (QSU-brief) has demonstrated excellent reliability. However, the QSU-brief may be too long to use in clinical settings. We developed a new craving index called the Tobacco Craving Index (TCI) and investigated how closely the TCI grade is associated with success of quitting smoking in Japanese smoking cessation therapy (SCT) patients. METHODS: The TCI questionnaire consists of two items: the first question asks about the strength of tobacco craving on a 4-point scale, and the second question asks about the frequency of tobacco craving per day on a 4-point scale. We conducted a prospective cohort study of 85 participants who underwent the Japanese SCT at a Japanese smoking cessation clinic. We administered the QSU-brief and TCI at each of the 5 sessions during the 12-week SCT. RESULTS: Significant correlations were observed between the TCI grade and QSU-brief score (r=0.27, 0.55, 0.72, 0.58 and 0.68, at the five sessions). The change in mean TCI grade showed a similar trend as the change in mean QSU-brief score among the 43 patients who succeeded in quitting smoking and also among the 7 patients who failed to quit smoking by the last session. Both TCI and QSU-brief assessed after the second session were significantly associated with the smoking status at the last session. The area under the receiver operating characteristic curve for the success of quitting smoking in TCI grade was 0.615-0.881 at the 5 sessions, whereas it was 0.536-0.849 in QSU-brief score. CONCLUSIONS: The TCI can be used as a predictive tool for success of quitting smoking in the Japanese SCT. As the TCI consists of two questionnaire items, it can be easily administered in smoking cessation interventions.

Changes in self-efficacy associated with success in quitting smoking in participants in Japanese smoking cessation therapy.

AIMS: To identify the strength of self-efficacy during 12-week smoking cessation therapy (SCT) that consisted of 5 sessions and its association with the success of smoking cessation at the end of SCT. BACKGROUND: Few studies showed to what level self-efficacy should be reinforced to facilitate success in smoking cessation. DESIGN: Prospective cohort study. METHODS: We enrolled 488 smokers who received SCT from 6 Japanese smoking cessation clinics between October 2008 and October 2014. In each smoker, the self-efficacy of quitting smoking was assessed at each session of SCT. The association of the strength of self-efficacy with the success of smoking cessation was investigated by logistic regression analysis adjusting for age, gender, having a present illness, prescription, and nicotine dependence score. RESULTS: The self-efficacy of the 398 abstainers was significantly higher than that of the 90 nonabstainers at the first to fifth sessions of the SCT (P < .001 each). Participants with self-efficacy scores of greater than 60% were significantly more likely to attain abstinence than those with scores of 40% and less. CONCLUSION: During SCT, nurses' counselling to maintain patients' self-efficacy scores of smoking cessation in the range from 61% to 100% may be important for assisting patients in achieving smoking cessation.

Cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status among patients who received smoking cessation intervention with nurses' counselling.

AIM: To identify cognitive, behavioural and psychosocial factors associated with successful and maintained quit smoking status after patients received smoking cessation intervention with nurses' counselling. BACKGROUND: Although nurses' intervention for smoking cessation is effective for patients, few studies have been conducted to identify cognitive, behavioural and psychosocial factors associated with the success of quitting smoking. DESIGN: Prospective cohort study METHODS: In a multi-institutional study between October 2008 - October 2014, we administered the Japanese smoking cessation therapy, which consists of smoking cessation intervention five times with nurses' counselling over 12 weeks. Log-binomial regression analysis was performed in 1,320 participants using the following independent variables: age, gender, having a present illness, prescription, Fagerström test for nicotine dependence, strength of desire to quit, age at smoking initiation, previous abstinence, motivation of quit smoking, self-efficacy of quit smoking and Center for Epidemiologic Studies Depression Scale. Factors associated with maintained cessation for 12 months were identified in the 541 abstainers at the end of the intervention. RESULTS: Having higher self-efficacy to quit smoking as assessed before the intervention was significantly associated with the success of quitting smoking at the end of the intervention. Strong desire to smoke as assessed at the end of the intervention was associated with significantly increased risk of discontinuing cessation during the 12 months after the end of the intervention. CONCLUSION: It is important for nurses who provide smoking cessation intervention to reinforce patients' self-efficacy and to control the strength of the patients' desire to smoke by behavioural counselling.

Home-based walking during pregnancy affects mood and birth outcomes among sedentary women: A randomized controlled trial.

We examined the effects of home-based walking on sedentary Japanese women's pregnancy outcomes and mood. A randomized controlled trial was conducted, involving 118 women aged 22-36 years. Participants were randomly assigned to walking intervention (n = 60) or control (n = 58) groups. The walking group was instructed to walk briskly for 30 min, three times weekly from 30 weeks' gestation until delivery. Both groups counted their daily steps using pedometers. Pregnancy and delivery outcomes were assessed, participants completed the Profile of Mood States, and we used the intention-to-treat principle. Groups showed no differences regarding pregnancy or delivery outcomes. The walking group exhibited decreased scores on the depression-dejection and confusion subscales of the Profile of Mood States. Five of the 54 women in the intervention group who remained in the study (9.2%) completed 100% of the prescribed walking program; 32 (59.3%) women completed 80% or more. Unsupervised walking improves sedentary pregnant women's mood, indicating that regular walking during pregnancy should be promoted in this group.

Japanese Nurses' Perceptions Toward Tobacco Use Intervention for Hospitalized Cancer Patients Who Entered End of Life.

BACKGROUND: Smoking patients who are admitted to a smoke-free hospital often experience nicotine withdrawal. Control of withdrawal symptoms in hospitalized patients with terminal illness by nurses may be important to end-of-life care. OBJECTIVE: The aims of this study were to assess Japanese nurses' perceptions toward providing a tobacco use intervention to hospitalized cancer patients who are receiving palliative and end-of-life care and to investigate demographic factors associated with a positive perception. METHODS: We conducted a cross-sectional survey of 1955 nurses at 6 selected hospitals in Japan. Multivariate logistic regression analysis was performed using age, workplace, length of nursing education, primary position, academic certification, having received instruction on smoking cessation programs at their nursing school, having attended lectures on smoking cessation programs at his/her hospital, and smoking status as potential independent variables. RESULTS: The proportion of nurses who had a positive perception toward providing a tobacco use intervention to hospitalized cancer patients receiving end-of-life care was only 16% to 20% at each hospital. Experience of having received instruction on tobacco use interventions while in nursing school was significantly associated with having a positive perception toward providing a tobacco use intervention for such patients. CONCLUSIONS: Most of the Japanese nurses had a conservative perception toward providing a tobacco use intervention for cancer patients who are receiving end-of-life care. Having received instruction on interventions while in a nursing school was likely to yield a positive perception. IMPLICATIONS FOR PRACTICE: It is important to introduce instruction on tobacco use interventions for patients with terminal-stage cancer in the standard curriculum of nursing schools in Japan.