A qualitative study on a 30-year trend of tobacco use and tobacco control programmes in Islamic Republic of Iran.

We conducted in-depth interviews with key tobacco control policy-makers to explore their views and opinions of trends in tobacco use and the effectiveness of tobacco control programmes over the past 3 decades. A qualitative interview study was conducted in 2014 using a grounded theory approach. In-depth interviews were conducted with 86 key tobacco control policy-makers and data collection was based on principles of saturation. The core code "tobacco consumption and its control programme" was extracted and its related themes were listed. After review and classification by an expert panel, 9 categorized codes emerged. The final 31 codes were ordered according to their conceptual differentiations. Overall, tobacco consumption was constant over the past 3 decades; however it was increasing in females and young people and decreasing in older people; hookah consumption was increasing. A positive outcome is that tobacco use is now viewed negatively in the Islamic Republic of Iran, largely due to tobacco control programmes but the current situation is still not ideal and a comprehensive tobacco control law is needed.

A qualitative study on a 30-year trend of tobacco use and tobacco control programmes in Islamic Republic of Iran

We conducted in-depth interviews with key tobacco control policy-makers to explore their views and opinions of trends in tobacco use and the effectiveness of tobacco control programmes over the past 3 decades. A qualitative interview study was conducted in 2014 using a grounded theory approach. In-depth interviews were conducted with 86 key tobacco control policy-makers and data collection was based on principles of saturation. The core code "tobacco consumption and its control programme" was extracted and its related themes were listed. After review and classification by an expert panel, 9 categorized codes emerged. The final 31 codes were ordered according to their conceptual differentiations. Overall, tobacco consumption was constant over the past 3 decades; however it was increasing in females and young people and decreasing in older people; hookah consumption was increasing. A positive outcome is that tobacco use is now viewed negatively in the Islamic Republic of Iran, largely due to tobacco control programmes but the current situation is still not ideal and a comprehensive tobacco control law is needed

Nous avons mené des entretiens approfondis auprès de responsables politiques clés de la lutte antitabac afin d'examiner leurs vues et opinions sur les tendances du tabagisme et sur l'efficacité des programmes de lutte antitabac au cours des trois dernières décennies. Une étude qualitative par entretiens a été conduite en 2014 suivant la méthodologie dite de la théorie à base empirique. Des entretiens approfondis ont été menés auprès de 86 responsables politiques clés de la lutte antitabac, et la collecte des données a reposé sur le principe de saturation. Le code source " consommation de tabac et programmes de lutte antitabac " a été extrait et les thèmes apparentés ont ensuite été listés. Après examen et classification par un groupe d'experts, neuf codes catégorisés ont émergé ultérieurement. Les 31 codes finaux ont été ordonnés en fonction de leurs différenciations conceptuelles. Dans l'ensemble, le tabagisme est resté constant au cours des 30 dernières années ; mais il a augmenté chez les femmes et les jeunes, a baissé chez les personnes âgées, et la consommation de houka a connu une augmentation. L'un des résultats positifs est que le tabagisme est à présent perçu négativement en République islamique d'Iran, en grande partie grâce aux programmes de lutte antitabac. Mais la situation actuelle est loin d'être idéale et l'adoption d'une législation antitabac complète est nécessaire

Tracking intervention delivery in the 'Tobacco-Free Teachers/Tobacco-Free Society' program, Bihar, India.

In health education and behavior change interventions, process tracking monitors the delivery of an intervention and its receipt to the intended audience. A randomized controlled trial in the state of Bihar, India was conducted to help school teachers become tobacco free through appropriately designed intervention program and delivery system. We describe the results from process tracking of this intervention delivery. The intervention program was centred on six topics delivered in each school through 12 sessions over 6 successive months. The program deliverers recorded the process measures as total number of sessions and program-components implemented (fidelity); time spent conducting sessions (dose) and proportion of teachers attending at least one session (reach). The outcome measures (teachers' exposure to intervention messages and tobacco policy adoption) were assessed post-intervention. All 12 sessions were delivered in 33 out of 36 schools. Thirty-one schools implemented all six program components. In 18 schools, ≥95% of the teachers participated in one or more sessions. Thirty-three schools received 12 or more hours of dose. In 29 schools, 100% teachers reported exposure to all program messages. Tobacco policy was adopted by all schools. Thus, the intervention was generally delivered as planned and it had a positive impact on teachers and schools.

Improvement in prevalence of tobacco use among teachers in Bihar after COTPA.

CONTEXT: A high prevalence of tobacco use, even among educated professionals like teachers, has been reported from Bihar. After passing of the Cigarette and Other Tobacco Products Act (COTPA) in 2003, there have been major improvements in tobacco control nationwide. AIMS: To compare tobacco use prevalence among school teachers in Bihar reported in 2000 with a survey in 2008 and investigate correlates of current and past tobacco-use. METHODS: Data from the baseline survey of a cluster random sample of 72 government schools conducted during the beginning of two consecutive school years was analyzed. RESULTS: The prevalence of current tobacco use was 35.5% and past use, 11.3%. Likelihood of current use compared with no use increased with age (odds ratio [OR] =3.27 for > 50 years compared to < 30, 95% confidence interval [CI]: [1.50, 7.13]); whereas that of past use compared to current use decreased (OR = 0.25, 95% CI: [0.09-0.68] for age > 50 years compared to < 30 years). DISCUSSION: Compared to the tobacco use prevalence among Bihar school teachers reported from a survey in the year 2000 (77.4%), the prevalence in this survey in 2008 was much lower and past use, much higher. In the earlier survey, lal dantmajan was counted as a tobacco product. If we do the same in the current survey, and consider ever use, the prevalence even then was 53.9%, lower than the earlier figure. Although the tobacco use among teachers in Bihar is still high, it has decreased after the implementation of COTPA and the cessation has increased.

Senior dental student's attitudes toward older adults and knowledge of geriatric dental care in the Islamic Republic of Iran.

Dental students should have knowledge of geriatric dental care and positive attitudes toward elderly patients. This study assessed senior dental students' knowledge of geriatric dental care and their attitude towards elderly patients. A descriptive cross-sectional questionnaire survey was conducted on volunteer senior students in all dental schools (n = 512) in the Islamic Republic of Iran. The completed questionnaires (n = 464) were analysed. The mean scores of respondents' knowledge and attitudes were 12.7 (SD 2.9) and 48 (SD 6.1) respectively. Female and male students' knowledge did not differ significantly but their attitudes score was different. The majority of dental students had low to moderate levels of knowledge of geriatric dental care and attitudes toward elderly people; therefore, an intervention programme is indicated. We conducted the study to use the findings to incorporate geriatric dental care programmes into dental school curricula in the Islamic Republic of Iran.

Patients' attitudes towards the role of dentists in tobacco cessation counselling after a brief and simple intervention.

Dental professionals are in a unique position to promote smoking cessation among their patients. We evaluated the effects of a brief counselling intervention by a dentist on patients' attitude towards the role of dentists in tobacco cessation programmes. In a semi-experimental study in Tehran, Islamic Republic of Iran, 70 eligible smokers were selected and randomly assigned to intervention and control groups. The initial attitudes of the patients regarding tobacco cessation counselling services provided by the dentist were determined using a validated questionnaire. The intervention group received a brief chair-side counselling by a dentist based on the 5 A's approach, while no intervention was provided for the control group. At 8-weeks follow-up, smokers receiving the intervention showed significantly more positive attitudes towards the role of the dentist in advising patients to quit smoking compared with those in the control group. More responsibility could be transferred to dentists for tobacco prevention.

Utilization of a telephone interactive voice-response tobacco cessation support service in the Islamic Republic of Iran.

Telephone smoking cessation counselling is a very cost-effective means of reaching dependent smokers in a population. We investigated the frequency of contacts and the types of topics that people accessed after a national telephone helpline was set up in the Islamic Republic of Iran at the beginning of 2011. From a total of 23 979 calls received over a 24-month period, 26.5% of callers hung up without selecting any menus. The most frequently accessed menu was addresses of smoking cessation support services (23.9%), followed by methods of smoking cessation (14.0%), self-help materials for quitting smoking (11.8%) and nicotine dependence assessment (10.4%). The average number of contacts decreased dramatically after the first month of the service but there was a significant increase in the 2 months preceding the feast of Ramadan. Religious messages provide a good opportunity to engage individuals in smoking cessation and may be useful in the planning of media campaigns.

Utilization of a telephone interactive voice-response tobacco cessation support service in the Islamic Republic of Iran

يعتبر تقديم المشورة عبر الهاتف حول الإقلاع عن التدخين من الوسائل العالية المردود في الوصول إلى المعتمدين على التدخين بين السكان. وقد استقصى الباحثون في هذه الدراسة تكرار مرات التواصل وأنماط المواضيع التي يصل إليها الناس بعد إنشاء خط مساعدة هاتفي وطني في جمهورية إيران الإسلامية في مطلع عام 2011 . فمن بين العدد الإجمالي للمكالمات التي تلقاها خط، فمن العدد الإجمالي للمكالمات التى تلقاها خط المساعدة على مدى 24 شهرا، وهو 23979 مكالمة، أغلق 26.5 % من المتصلين الخط دون اختيار أي بند من قائمة الاختيارات. وكان أكثر بنود قوائم الاختيارات هي عناوين خدمات دعم الإقلاع عن التدخين [23.9 %]، ويتلوها طرق الإقلاع عن التدخين [14%]، ومواد المساعدة الذاتية للإقلاع عن التدخين [11.8 %]وتقييم الاعتماد على النيكوتين [10.4 %]. وقد انخفض العدد الوسطي للمكالمات انخفاضا ملحوظا بعد الشهر الأول من تقديم الخدمة، في حن حدث ازدياد ملحوظ خال الشهرين اللذين سبقا شهر رمضان المبارك. وتمثل الرسائل الدينية فرصا جيدة لإسهام الأفراد في الإقلاع عن التدخين، وقد تساعد في التخطيط للحملات الإعلامية

ABSTRACT Telephone smoking cessation counselling is a very cost-effective means of reaching dependent smokers in a population. We investigated the frequency of contacts and the types of topics that people accessed after a national telephone helpline was set up in the Islamic Republic of Iran at the beginning of 2011. From a total of 23 979 calls received over a 24-month period, 26.5% of callers hung up without selecting any menus. The most frequently accessed menu was addresses of smoking cessation support services (23.9%), followed by methods of smoking cessation (14.0%), self-help materials for quitting smoking (11.8%) and nicotine dependence assessment (10.4%). The average number of contacts decreased dramatically after the first month of the service but there was a significant increase in the 2 months preceding the feast of Ramadan. Religious messages provide a good opportunity to engage individuals in smoking cessation and may be useful in the planning of media campaigns.

RÉSUMÉ L'aide au sevrage tabagique par téléphone est un moyen d'un très bon rapport coût-efficacité de toucher les fumeurs dépendants dans une population. Nous avons étudié la fréquence des appels et les différents types de sujets que les appelants sélectionnaient depuis la mise en place début 2011 d'une ligne téléphonique nationale d'aide aux fumeurs en République islamique d'Iran. Sur un total de 23 979 appels reçus sur une période de 24 mois, 26,5 % des appelants raccrochaient sans sélectionner de choix dans les menus. Le menu le plus fréquemment sélectionné concernait les adresses des services d'aide au sevrage tabagique (23,9 %), suivi par les méthodes de sevrage tabagique (14,0 %), puis par les outils d'auto-assistance pour le sevrage tabagique (11,8 %) et enfin par l'évaluation de la dépendance à la nicotine (10,4 %). Le nombre moyen d'appels a diminué radicalement après le premier mois de mise en service mais a augmenté de manière importante dans les deux mois précédents la fête du Ramadan. Les messages religieux fournissent une bonne occasion pour encourager les consommateurs à renoncer au tabac et peuvent être utiles pour la planification des campagnes dans les médias.

Patients' attitudes towards the role of dentists in tobacco cessation counselling after a brief and simple intervention

Dental professionals are in a unique position to promote smoking cessation among their patients.We evaluated the effects of a brief counselling intervention by a dentist on patients' attitude towards the role of dentists in tobacco cessation programmes.In a semi-experimental study in Tehran, Islamic Republic of Iran, 70 eligible smokers were selected and randomly assigned to intervention and control groups.The initial attitudes of the patients regarding tobacco cessation counselling services provided by the dentist were determined using a validated questionnaire.The intervention group received a brief chair-side counselling by a dentist based on the 5 A's approach, while no intervention was provided for the control group.At 8-weeks follow-up, smokers receiving the intervention showed significantly more positive attitudes towards the role of the dentist in advising patients to quit smoking compared with those in the control group.More responsibility could be transferred to dentists for tobacco prevention

يتمتع أطباء الأسنان بموقع فريد يمكنهم من تعزيز الإقلاع عن التدخين بين مرضاهم. وقد أجرى الباحثون تقييما لأثر التدخلات الوجيزة للمشورة التي يقدمها أطباء الأسنان للمرضى، للتعرف على مواقف المرضى من دور أطباء الأسنان في برامج مكافحة التدخين؛ وهي دراسة شبه تجريبية في طهران، عاصمة جمهورية إيران الإسلامية، ساهم فيها 70 مدخنا مؤهلا تم اختيارهم عشوائيا وقسموا إلى فئتين، فئة للتدخل وفئة للشواهد. واستخدم الباحثون استبيانا تحققوا من سلامته للتعرف على المواقف المبدئية للمرضى تجاه خدمات المشورة حول الإقلاع عن التدخين التي يقدمها أطباء الأسنان. وقد تلقى أفراد فئة التدخل مشورة موجزة أثناء فترة جلوسهم على كرسي طبيب الأسنان، من قبل طبيب الأسنان، باستخدام أسلوب A5، ولم تتلق فئة الشواهد أي تدخل. وبعد متابعة دامت 8 أسابيع، أظهر المدخنون الذين تلقوا التدخل مواقف أكثر إيجابية تجاه دور طبيب الأسنان في تقديم المشورة للمريض حول الإقلاع عن التدخين، بالمقارنة مع فئة الشواهد. مما يدل على أنه يمكن نقل المزيد من المسؤوليات إلى أطباء الأسنان في مجال الوقاية من التدخين

Les professionnels en soins dentaires occupent une position idéale pour promouvoir le sevrage tabagique chez leurs patients.Nous avons évalué les effets d'une brève intervention de conseil par un dentiste sur l'attitude des patients vis-à-vis du rôle des dentistes dans les programmes de sevrage tabagique.Dans une étude semi-expérimentale menée à Téhéran [République islamique d'Iran], 70 fumeurs éligibles ont été sélectionnés puis répartis aléatoirement dans un groupe bénéficiant de l'intervention ou dans un groupe témoin.Les attitudes initiales des patients à l'égard des services de conseil sur le sevrage tabagique fournis par le dentiste ont été déterminées à l'aide d'un questionnaire validé.Les fumeurs du groupe bénéficiant de intervention ont reçu de brefs conseils reposant sur la méthode des 5 A pendant qu'ils étaient allongés sur le fauteuil et que le dentiste se tenait à côté, tandis que le groupe témoin n'a bénéficié d'aucune intervention.A la huitième semaine de suivi, les fumeurs ayant bénéficié de l'intervention avaient des attitudes nettement plus positives vis-à-vis du rôle de conseil du dentiste en matière de sevrage tabagique par rapport à ceux du groupe témoin.Des responsabilités supplémentaires pourraient être transférées aux dentistes en matière de prévention tabagique

WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report.

The aim of this cross-sectional study was to quantify the implementation of MPOWER tobacco control policies among Eastern Mediterranean Region countries. Information was obtained from the 2011 WHO MPOWER report. A checklist was designed and its scoring was agreed by Iranian and international tobacco control specialists. Seven questions were scored from 0-4 and 3 from 0-3. The 22 countries were ranked by their total score on a scale of 0 to 37. The highest scores were achieved by the Islamic Republic of Iran, Egypt and Jordan 29, 28 and 26 respectively. Twelve of the countries (55%) scored more than half of the possible score (19). The lowest and highest scores for all countries summed were on sections related to banning smoking in public places (18) and tobacco advertising bans (66) respectively. Compliance with smoke-free policies was especially low. MPOWER programmes are accepted in the Region but there is considerable room for improvement. Input from countries based on their successes and challenges is needed to strengthen the programmes.

WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report

The aim of this cross-sectional study was to quantify the implementation of MPOWER tobacco control policies among Eastern Mediterranean Region countries. Information was obtained from the 2011 WHO MPOWER report. A checklist was designed and its scoring was agreed by Iranian and International tobacco control specialists. Seven questions were scored from 0-4 and 3 from 0-3. The 22 countries were ranked by their total score on a scale of 0 to 37. The highest scores were achieved by the Islamic Republic of Iran, Egypt and Jordan 29, 28 and 26 respectively. Twelve of the countries [55%] scored more than half of the possible score [19]. The lowest and highest scores for all countries summed were on sections related to banning smoking in public places [18] and tobacco advertising bans [66] respectively. Compliance with smoke-free policies was especially low. MPOWER programmes are accepted in the Region but there is considerable room for improvement Input from countries based on their successes and challenges is needed to strengthen the programmes

Which form of nicotine replacement therapy is more effective for quitting smoking? A study in Tehran, Islamic Republic of Iran.

Nicotine replacement therapy can double the chance of success for smokers attempting to quit. This observational study aimed to compare quit rates of different formulations of nicotine replacement among clients referred to a smoking cessation clinic in Tehran, Islamic Republic of Iran. Clients entering the study (n = 308) participated in 4 sessions of behavioural therapy, chose a type of nicotine replacement to use (patches, chewing gum, tablets or both patches and gum) and were followed up for 12 months. After 4 weeks of quitting, 88.2% (246/279) reported abstaining from smoking. Self-reported maintenance rates for quitting were 54.9% after 6 months and 36.2% after 12 months follow-up. A significant correlation was found between type of nicotine replacement and quit rate. Use of nicotine patches and chewing gum together had the highest quit rate (95.2%) after 4 weeks and at 12 months follow-up (62.5%). Consuming 2 forms of nicotine replacement in therapy could result in enhanced rates of long-term quitting.

Status and costs of smoking cessation in countries of the Eastern Mediterranean Region.

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies (with a written prescription) in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible.

Which form of nicotine replacement therapy is more effective for quitting smoking? a study in Tehran, Islamic Republic of Iran

Nicotine replacement therapy can double the chance of success for smokers attempting to quit. This observational study aimed to compare quit rates of different formulations of nicotine replacement among clients referred to a smoking cessation clinic in Tehran, Islamic Republic of Iran. Clients entering the study [n= 308] participated in 4 sessions of behavioural therapy, chose a type of nicotine replacement to use [patches, chewing gum, tablets or both patches and gum) and were followed up for 12 months. After 4 weeks of quitting, 88.2% [246/279] reported abstaining from smoking. Self-reported maintenance rates for quitting were 54.9% after 6 months and 36.2% after 12 months follow-up. A significant correlation was found between type of nicotine replacement and quit rate. Use of nicotine patches and chewing gum together had the highest quit rate [95.2%] after 4 weeks and at 12 months follow-up [62.5%]. Consuming 2 forms of nicotine replacement in therapy could result in enhanced rates of long-term quitting

Status and costs of smoking cessation in countries of the Eastern Mediterranean Region

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies [with a written prescription] in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible

Barriers among nurses to providing smoking cessation advice to hospitalized smokers.

Nine focus groups were conducted with 75 staff nurses in three hospitals to determine the low participation rate of nurses in a smoking cessation programs directed at patients. Nurses felt that hospitalization was an appropriate time to offer quit-smoking advice to patients, particularly those with smoking related diseases. However, many felt advice should be given only to those receptive to it. The most common barriers to providing smoking cessation advice were lack of concrete techniques, or referral to provide and fear of alienating patients who were not receptive to hearing advice.

Nurses' attitudes concerning the delivery of brief cessation advice to hospitalized smokers.

BACKGROUND: Nurses have a unique opportunity to assist hospitalized smokers with cessation. However, relatively little is known about nurses' attitudes and beliefs toward their role in assisting patients with cessation. METHODS: A cross-sectional survey of staff nurses at four hospitals was conducted. Four scales based on constructs from the Theory of Planned Behavior were developed for this survey: attitudes toward offering cessation advice, beliefs about the outcome of offering advice, perceived normative beliefs, and perceived ability to offer advice. Other survey items included sociodemographics, employment characteristics (shift, unit worked), and personal smoking status. RESULTS: Of the nurses surveyed, 397 (68%) returned completed questionnaires. Nurses had a relatively positive attitude toward helping patients to quit smoking, 63% believed that hospitalization was an ideal time for patients to try to quit smoking, and 59% believed a nurse had an obligation to advise patients to quit smoking. In the final multiple linear regression model, self-reported delivery of cessation advice was related to attitudes toward offering cessation advice, perceived ability to offer advice, and unit worked. CONCLUSIONS: Efforts should be made to educate staff nurses about the efficacy of brief cessation advice and current smoking cessation methods and practices.

Promoting smoking abstinence in pregnant and postpartum patients: a comparison of 2 approaches.

OBJECTIVE: To compare the implementation, delivery, and implications for dissemination of 2 different maternal smoking-cessation/relapse-prevention interventions in managed care environments. STUDY DESIGN: Healthy Options for Pregnancy and Parenting (HOPP) was a randomized, controlled efficacy trial of an intervention that bypassed the clinical setting. Stop Tobacco for OuR Kids (STORK) was a quasi-experimental effectiveness study of a point-of-service intervention. Both incorporated prenatal and postnatal components. PATIENTS AND METHODS: Subjects in both studies were pregnant women who either smoked currently or had quit recently. The major intervention in HOPP was telephone counseling delivered by trained counselors, whereas the STORK intervention was delivered by providers and staff during prepartum, inpatient postpartum, and well-baby visits. RESULTS: In HOPP, 97% of telephone intervention participants reported receiving 1 or more counselor calls. The intervention delayed but did not prevent postpartum relapse to smoking. Problems with intervention delivery related primarily to identification of the target population and acceptance of repeated calls. STORK delivered 1 or more cessation contacts to 91% of prenatal smokers in year 1, but the rate of intervention delivery declined in years 2 and 3. Modest differences were obtained in sustained abstinence between 6 and 12 months postpartum, but not in point prevalence abstinence at 12 months. CONCLUSIONS: The projects were compared using 4 of the 5 dimensions of the RE-AIM model including reach, adoption, implementation, and maintenance. It was difficult to apply the fifth dimension, efficacy, because of the differences in study design and purpose of the interventions. The strengths and limitations of each project were identified, and it was concluded that a combined intervention that incorporates elements of both HOPP and STORK would be optimal if it could be implemented at reasonable cost.

The association of smoking and the cost of military training.

OBJECTIVE: To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING: A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES: Excess training costs as a result of premature discharge. RESULTS: In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS: Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with $18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over $130 million per year in excess training costs.

Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting.

OBJECTIVES: To determine rates of patient reported and physician documented counselling; to identify predictors of each report; and to identify the impact of each report on smoking cessation attempts after discharge from the hospital. DESIGN: Stickers on subjects' charts prompted physicians to give brief smoking cessation counselling to patients in the hospital. Patients reported counselling received and quit attempts in a phone interview conducted 7-18 days after discharge. Rates of counselling and correlations were calculated, and multivariate analysis identified predictors of patient report, physician documentation, and quit attempts. SETTING: Four hospitals in the Minneapolis/St Paul metropolitan area. SUBJECTS: 682 hospital patients who had smoked more than 100 cigarettes in their lifetime and had smoked in the last three months. RESULTS: 71.0% of patients reported counselling, and physicians documented counselling in the charts of 46.2% of patients (correlation = 0.15, kappa = 0.13). Patient report was predicted by specific hospital, belief that their hospitalisation was smoking related, diagnosis of a smoking related disease, and physician documentation of counselling. Physician documentation was predicted by female patient, specific hospital, longer hospital stay, and marginally predicted by smoking related disease. Quit attempts were predicted by patient report of counselling, but not physician documentation. CONCLUSIONS: Physicians document counselling in the hospital at a lower rate than patients report it, and the correlation between reports is very low, making an accurate assessment of true rates of counselling difficult. While it is important to increase physician documentation, it is even more important to increase patient recall, as this is the only report that predicts a quit attempt.