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1.
Rev. patol. respir ; 22(4): 157-167, oct.-dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-189006

RESUMEN

La telemedicina tiene múltiples aplicaciones en los programas de deshabituación tabáquica. Los estudios utilizan las nuevas tecnologías con la intención de cambiar los hábitos de vida, dar mensajes de refuerzo y monitorizar los avances de los usuarios. Los recursos más habitualmente utilizados fueron las aplicaciones móviles, páginas webs y el asesoramiento telefónico. Los resultados son prometedores, aunque son necesarios más estudios y analizar los motivos de la lenta implementación de estos programas. La aparición de nuevas tecnologías como el Big Data, la minería de datos, la gamificación, entre otros, van a darnos nuevas oportunidades para mejorar los programas de innovación en el tratamiento del tabaquismo


Telemedicine has several applications in the treatment of smoking cessation. The aim of new technologies was to promote changes in life habits, reinforcement messages and monitored patients’ achievements. Smartphone applications, web and telephone were the most used tools in telemedicine programs. The results are promising, although more studies are required and it is necessary to analyze other applications and the reasons of slow implementations. Big Data, data mining and gamification, among others, will give us new opportunities to improve these innovations programs


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adolescente , Adulto Joven , Adulto , Telemedicina/métodos , Cese del Uso de Tabaco/métodos , Prevención del Hábito de Fumar/métodos
2.
Artículo en Inglés | MEDLINE | ID: mdl-31661922

RESUMEN

The objective of this study was to perform a systematic review to examine the effectiveness of tobacco dependence education versus usual or no tobacco dependence education on entry-level health professional student practice and client smoking cessation. Sixteen published databases, seven grey literature databases/websites, publishers' websites, books, and pertinent reference lists were searched. Studies from 16 health professional programs yielded 28 RCTs with data on 4343 healthcare students and 3122 patients. Two researchers independently assessed articles and abstracted data about student knowledge, self-efficacy, performance of tobacco cessation interventions, and patient smoking cessation. All forms of tobacco were included. We did not find separate interventions for different kinds of tobacco such as pipes or flavoured tobacco. We computed effect sizes using a random-effects model and applied meta-analytic procedures to 13 RCTs that provided data for meta-analysis. Students' counseling skills increased significantly following the 5As model (SMD = 1.03; 95% CI 0.07, 1.98; p < 0.00001, I2 94%; p = 0.04) or motivational interviewing approach (SMD = 0.90, 95% CI 0.59, 1.21; p = 0.68, I2 0%; p < 0.00001). With tobacco dependence counseling, 78 more patients per 1000 (than control) reported quitting at 6 months (OR 2.02; 95% CI 1.49, 2.74, I² = 0%, p = 0.76; p < 0.00001), although the strength of evidence was moderate or low. Student tobacco cessation counseling improved guided by the above models, active learning strategies, and practice with standardized patients.


Asunto(s)
Consejo/educación , Empleos en Salud/educación , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/métodos , Tabaquismo/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevista Motivacional , Ensayos Clínicos Controlados Aleatorios como Asunto , Autoeficacia
3.
Health Educ Res ; 34(5): 505-520, 2019 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-31495883

RESUMEN

The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.


Asunto(s)
Terapia Conductista/métodos , Agentes Comunitarios de Salud/organización & administración , Pobreza , Apoyo Social , Cese del Uso de Tabaco/métodos , Brasil , Femenino , Recursos en Salud , Humanos , Desarrollo de Programa , Salud Pública
6.
Asian Pac J Cancer Prev ; 20(8): 2541-2550, 2019 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-31450930

RESUMEN

Background: Tobacco related mortality and morbidity is a growing public health problem world over. Counselling has emerged as an important arsenal in the battle against tobacco. Involving experts other than traditional medical health workers may be critical. Aim of the present study was to explore various aspects related to Tobacco cessation counselling among Indian dental students. Methods: Overall, 241 undergraduate students from Manipal College of Dental Sciences, Mangalore participated in the present investigation. A structured, pretested, self-administered questionnaire was used to ascertain knowledge, attitude, behavior, perceived effectiveness and barriers and socio-demographic details. Willingness to counsel patients and undergo further training counselling was also assessed. Results: Mean knowledge, attitude, behavior, perceived effectiveness and barrier scores were 2.94 (±2.08), 51.84 (±5.63), 19.25 (±8.79), 16.17 (±1.96) and 42.39 (±5.65) respectively. Age was significantly correlated with knowledge; while year of study revealed significant correlations with knowledge and behavior (p<0.05). Lack of motivation, poor attitude of patients; lack of knowledge and skills emerged as barriers. Multiple logistic regression analysis indicated that year of study, attitude, behavior and barrier scores were significant predictors for respondents ever counselled their patients (p<0.05). Conclusions: Knowledge and behavior scores of the respondents towards Tobacco cessation counselling were low, but a majority of the subjects were willing to counsel and undergo training. Year of study, attitude, behavior and barrier scores emerged as significant predictors of counselling for Tobacco use. The present study has important policy implications and highlights curriculum changes in making Tobacco cessation counselling more relevant and effective among Indian dental students.


Asunto(s)
Consejo/educación , Conocimientos, Actitudes y Práctica en Salud , Estudiantes de Odontología/psicología , Cese del Uso de Tabaco/métodos , Adulto , Estudios Transversales , Femenino , Humanos , India , Masculino , Encuestas y Cuestionarios , Cese del Uso de Tabaco/psicología , Cese del Uso de Tabaco/estadística & datos numéricos , Adulto Joven
7.
South Med J ; 112(7): 406-411, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31282972

RESUMEN

OBJECTIVES: Smoking is deadly and exacerbates comorbid health conditions, especially among those with co-occurring substance use disorders. Tennessee does not require substance abuse treatment facilities to concurrently provide tobacco-cessation treatment options or limit smoking on facility property as a standard for licensure. This study examines the relation between Tennessee facility region and availability of pharmacotherapeutic options for tobacco cessation, and the relation between the facilities' region and facility smoking policy. METHODS: This study is descriptive, cross-sectional, and exploratory in its design. Study findings are from a secondary analysis of data acquired from the 2016 edition of the National Directory of Drug and Alcohol Abuse Treatment Facilities published by the Substance Abuse and Mental Health Services Administration. RESULTS: The number of substance abuse treatment facilities providing pharmacotherapy options in west Tennessee (7.8%) are statistically significantly lower as compared with substance abuse treatment facilities in both middle (24.6%) and east (39.2%) Tennessee. A statistically significantly higher percentage of facilities in west Tennessee (23.5%) with policies that permit smoking without restriction as compared with the number of facilities in east Tennessee (6.8%) also was found, whereas the facilities in west Tennessee (60.8%) have a policy that permits smoking in designated areas that is significantly lower than the number of facilities in east Tennessee (81.1%). CONCLUSIONS: Tobacco-cessation options are a preventive intervention that can be easily incorporated into a treatment facility's standard of practice and should be made available within the context of all substance abuse treatment facilities. Failure to provide concurrent tobacco-cessation options during substance abuse treatment contradicts the purpose of medical treatment. Medically oriented substance abuse facilities are exemplary settings for offering pharmacotherapeutic options to concurrently treat tobacco use. It is suggested that interdisciplinary clinicians in the field of substance abuse advocate for the implementation of concurrent tobacco cessation treatment in their organization.


Asunto(s)
Accesibilidad a los Servicios de Salud , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Centros de Tratamiento de Abuso de Sustancias , Cese del Uso de Tabaco/métodos , Estudios Transversales , Humanos , Política Organizacional , Tennessee
9.
MedEdPORTAL ; 15: 10807, 2019 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-30931386

RESUMEN

Introduction: Motivational interviewing (MI) is a well-established evidence-based method of working with patients to promote health behavior change. Standardized patient (SP) simulation allows trainees to practice and receive feedback on clinical and communication skills and may be useful in applying MI techniques to address tobacco use and exposure. Methods: We developed two SP cases for pediatric residents to practice addressing tobacco use with parents of their patients. Results: Thirty-six residents participated, 26 of whom had prior MI training. Resident postencounter self-reflection identified MI-specific skills, including eliciting the SP's view on positive/negative aspects of smoking, identifying stressors/triggers associated with smoking, eliciting reasons for smoking, asking about motivation/willingness to quit, eliciting benefits of quitting smoking, letting the SP do the talking, and guiding the SP in making a quit plan. On paired-samples t tests, resident self-evaluation checklist scores averaged 6.79 out of 8.00 (SD = 1.018, SEM = 0.165), compared with SP checklist scores, which averaged 7.08 out of 8.00 (SD = 1.217, SEM = 0.197). Discussion: These two SP cases were useful in many ways, allowing residents with prior MI training the opportunity for practice/feedback on skills learned and introducing residents with no prior MI training to MI concepts through experience/feedback. Residents consistently identified using MI concepts on postencounter self-reflection; resident self-evaluation and SP evaluation of residents showed agreement. These sessions could be utilized within a communication/MI curriculum or as stand-alone sessions to introduce MI concepts/techniques for addressing tobacco cessation in the pediatric setting.


Asunto(s)
Curriculum/tendencias , Internado y Residencia/métodos , Entrevista Motivacional/métodos , Cese del Uso de Tabaco/métodos , Uso de Tabaco/psicología , Lista de Verificación/normas , Competencia Clínica/estadística & datos numéricos , Comunicación , Autoevaluación Diagnóstica , Conductas de Riesgo para la Salud/fisiología , Humanos , Exposición por Inhalación/efectos adversos , Motivación/fisiología , Pediatría/educación , Entrenamiento Simulado/métodos , Fumar/psicología , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/prevención & control , Uso de Tabaco/efectos adversos , Cese del Uso de Tabaco/psicología
10.
Enferm. glob ; 18(54): 63-70, abr. 2019.
Artículo en Español | IBECS | ID: ibc-183477

RESUMEN

Justificación: Existe una asociación entre tabaquismo y TUS, especialmente con alcohol y cannabis. Sin embargo, las intervenciones sanitarias parecen no ir encaminadas a su enfoque.Objetivo: Evaluar el grado de motivación para el abandono tabáquico tras realizar una intervención psicoeducativa breve sobre abordaje del tabaquismo.Metodología: Se trata de una investigación cuantitativa de tipo analítico cuasiexperimental que se lleva a cabo mediante dos cohortes experimentales, del tipo pre- y post-intervención. Se aplica una intervención breve educativa y se evalúan las diferencias en la motivación para el abandono tabáquico en un grupo antes de la intervención y en otro grupo después de la misma. Resultados: Existe una diferencia de 1,27 puntos en el grado de motivación encontrado en los individuos respecto a los grupos experimentales. Conclusiones: Las personas drogodependientes son fumadoras con altos grados de dependencia nicotínica por lo que es preciso diseñar estrategias de cesación adecuadas


Justification: There is a connection between smoking and substances use disorder, especially alcohol and cannabis. Nevertheless, health interventions seem not to be addressed to this approach. Objective: Evaluation of the motivation degree for the smoking quit after developing a brief psycho-educational intervention on smoking.Methodology: It is a quantitative research of analytical type, almost experimental, developed by means of two experimental series, of the types pre- and post- intervention. A brief educational intervention is applied and there is an evaluation of the differences in the motivation for the smoking quit in a group before the intervention and in another one after the intervention. Results: There is a difference of 1,27 points in the degree of motivation found in the individuals regarding the experimental groups. Conclusions: Drug addict people are smokers with a high degree of nicotinic dependence, so it is necessary to design suitable strategies of quitting


Asunto(s)
Humanos , Masculino , Femenino , Motivación/clasificación , Tabaquismo/enfermería , Cese del Uso de Tabaco/métodos , Trastornos Relacionados con Sustancias/complicaciones , Conducta Adictiva/terapia , Evaluación de Eficacia-Efectividad de Intervenciones , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos , Planificación de Atención al Paciente/organización & administración
12.
BMC Med ; 17(1): 26, 2019 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-30712513

RESUMEN

BACKGROUND: Tuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities. METHODS: Using a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years. RESULTS: The combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9-7.0%) and TB deaths by 10.4% (9.5-11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy. CONCLUSIONS: Currently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.


Asunto(s)
Fumar Tabaco/efectos adversos , Fumar Tabaco/prevención & control , Cese del Uso de Tabaco/economía , Cese del Uso de Tabaco/métodos , Tuberculosis/prevención & control , Adulto , Canadá/epidemiología , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Humanos , Inuits , Tuberculosis Latente/epidemiología , Tuberculosis Latente/prevención & control , Prevalencia , Salud Pública/métodos , Factores de Riesgo , Tuberculosis/epidemiología , Tuberculosis/etiología
13.
Saudi Med J ; 40(2): 119-125, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30723855

RESUMEN

OBJECTIVES: To examined published literature describing the predictors of  smoking cessation (SC)  and cessation interventions in Gulf Cooperation Council (GCC) countries. Methods: Systematic literature review using PubMed, Google Scholar, and grey literature. The study was conducted between October and December of 2017. Inclusion criteria were studies reporting factors associated with SC or studies of utilization or delivery of SC medications in GCC countries. Results: Twenty-one articles met the study criteria. Thematic analysis revealed factors associated with SC that were classified as individual or clinician level. Individual-level factors were access and cost of SC medications, knowledge about harms, concern about health, self-efficacy, perceived stress, level of tobacco consumption, belief about SC medications, clinician advice, social support, and enforcement of smoke-free ban. Clinician-level factors were time to provide counseling, training to assist patients, patient acceptance, best practice for treating patients, resources, perception related to responsibilities, and knowledge about effective medications. Conclusion: This review revealed perceived barriers to SC among smokers and clinicians in GCC countries. It highlighted cultural factors that need to be addressed by tobacco use policies in GCC countries to help smokers quit.


Asunto(s)
Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/métodos , Consejo Dirigido , Conocimientos, Actitudes y Práctica en Salud , Humanos , Medio Oriente , Aceptación de la Atención de Salud , Autoeficacia , Política para Fumadores , Agentes para el Cese del Hábito de Fumar/economía , Agentes para el Cese del Hábito de Fumar/provisión & distribución , Apoyo Social
14.
PLoS One ; 14(2): e0212641, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30789969

RESUMEN

BACKGROUND: A new intervention, Tobacco Cessation on Prescription (TCP), has been developed in the Swedish primary health care (PHC) setting to address inequalities in health caused by tobacco use. It consists of counseling for at least 10 minutes, an individualized prescription of tobacco cessation treatment and follow-up on at least one occasion. TCP is currently being tested in clinical practice for the first time but there is a lack of knowledge about how it is perceived by health care providers. AIM: To explore PHC provider's perceived barriers and facilitators of implementing TCP as an intervention targeting a context with socioeconomically disadvantaged groups in Sweden. METHODS: Directed content analysis of transcripts from eight semi-structured interviews and one focus group interview with PHC providers with personal experience of TCP as informants. Data collection and analysis was guided by The Consolidated Framework for Implementation Research. RESULTS: Perceived facilitators of implementing TCP were increased self-efficacy among the informants and involvement in the treatment among patients, which led to more intensive counseling and advice being taken more seriously by patients. Lack of resources, routines, and collaboration to work with tobacco cessation and lack of knowledge, motivation and self-efficacy among colleagues were perceived as barriers. Motivation and self-efficacy to quit was perceived as low among some patients, which was explained by low social support to quit, negative attitude and low adherence to treatment and tobacco being used as a coping strategy for life stress. Access to treatment for patients was limited by cost of treatment, long waiting times and focus on face-to-face counseling. CONCLUSION: TCP was perceived positively by the informants but access to treatment for patients was partly limited by how tobacco cessation services were organized. Lack of structural support, resources and differing attitudes among PHC providers need to be addressed to facilitate its implementation.


Asunto(s)
Cese del Uso de Tabaco , Adulto , Actitud del Personal de Salud , Femenino , Personal de Salud , Humanos , Persona de Mediana Edad , Motivación , Prescripciones , Atención Primaria de Salud , Investigación Cualitativa , Autoeficacia , Factores Socioeconómicos , Suecia , Cese del Uso de Tabaco/métodos , Poblaciones Vulnerables
15.
BMC Health Serv Res ; 19(1): 14, 2019 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-30621771

RESUMEN

BACKGROUND: Relatively little is known about which characteristics of smokers are related to choosing a specific type of smoking cessation service. The user characteristics of different smoking cessation services were compared to determine the service preferred by user characteristics. METHODS: The characteristics of adult smokers from Korea National Health and Nutrition Examination Survey (3762) and registered users of national smoking cessation services operated through the web (14,762), at Public Health Center-based Smoking Cessation Clinics (PHC-based SCCs) (335,532), and by telephone (Quitline) (2983) were compared. RESULTS: Females and younger aged were more in web and telephone-based cessation service users, while aged 50 years or older were more in PHC-based SCCs users. Although manufacturing and production workers were the most prevalent among smokers in the general population, office workers and others including housewives and unemployed were most prevalent among the users of Quitline and PHC-based SCCs, respectively. The number of cigarettes smoked per day was twice as high among cessation service users as in general population. Smokers with greater nicotine dependency were most prevalent in the web-based service. Overseas users were in the web-based cessation service. CONCLUSION: Identifying user-specific characteristics by the type of cessation services looks necessary to develop and offer appropriate cessation services.


Asunto(s)
Satisfacción del Paciente/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Cese del Uso de Tabaco/estadística & datos numéricos , Adulto , Conducta de Elección , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Evaluación de Programas y Proyectos de Salud , República de Corea/epidemiología , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/métodos
16.
J Dual Diagn ; 15(1): 67-73, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30646819

RESUMEN

Objective: Almost all individuals in methadone treatment for opioid dependence smoke cigarettes, and half of people in methadone treatment have an opioid relapse within six months. Dialectical behavior therapy (DBT) skills training has shown promise for addressing substance use and a variety of health behaviors and conditions; however, it has never been evaluated for smoking cessation in any population. The objective of this study was to field test a DBT skills training-based intervention for tobacco dependence and opioid relapse prevention (DBT-Quit) among people in methadone treatment. Methods: We recruited seven individuals in methadone treatment to participate in a field test of DBT-Quit. Participants attended 12 weekly 90-minute DBT skills training groups, focusing on mindfulness, emotion regulation, and distress tolerance skills. Participants received nicotine patches for eight weeks and completed assessments at baseline, 6 weeks (mid-treatment), and 12 weeks (post-treatment). Results: All but one participant (86%, n = 6) attended at least 50% of intervention sessions. Participants were "very" or "mostly" satisfied with the intervention. At 12 weeks, all but one (86%, n = 6) had made a quit attempt, and one (14%) had seven-day point prevalence abstinence. Participants were smoke-free for 24 hours (14%, n = 1), 7 to 14 days (43%, n = 3), and 30 to 59 days (29%, n = 2). Participants smoked significantly fewer cigarettes per day at 6 weeks and 12 weeks as compared to baseline. No participants used illicit drugs. As compared to baseline, at follow-up there were no significant differences in difficulties with emotion regulation, distress tolerance, or mindfulness. Conclusions: A DBT skills training-based intervention for individuals who smoke and have an opioid use disorder is feasible and acceptable in methadone treatment and may help this population prevent drug relapse, attempt to quit smoking, experience smoke-free days, and cut down on their smoking. More research is needed to determine the optimal structure and components of a DBT skills-based intervention for drug relapse prevention and smoking cessation. Further, a randomized controlled trial of DBT-Quit is needed to determine the efficacy of DBT skills training for smoking cessation and drug relapse prevention in this population.


Asunto(s)
Terapia Conductual Dialéctica , Metadona/uso terapéutico , Trastornos Relacionados con Opioides/terapia , Cese del Uso de Tabaco/métodos , Tabaquismo/terapia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Trastornos Relacionados con Opioides/complicaciones , Prevención Secundaria , Tabaquismo/complicaciones , Resultado del Tratamiento , Adulto Joven
17.
JMIR Mhealth Uhealth ; 7(1): e10071, 2019 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-30632971

RESUMEN

BACKGROUND: Although smoking cessation apps have become popular, few have been tested in randomized clinical trials or undergone formative evaluation with target users. OBJECTIVE: We developed a cessation app targeting tobacco-dependent cancer patients. Game design and behavioral rehearsal principles were incorporated to help smokers identify, model, and practice coping strategies to avoid relapse to smoking. In this randomized pilot trial, we examined feasibility (recruitment and retention rates), acceptability (patient satisfaction), quitting self-confidence, and other cessation-related indices to guide the development of a larger trial. METHODS: We randomized 42 English-speaking cancer patients scheduled for surgical treatment to either the Standard Care (SC; telecounseling and cessation pharmacotherapies) or the experimental QuitIT study arm (SC and QuitIT game). Gameplay parameters were captured in-game; satisfaction with the game was assessed at 1-month follow-up. We report study screening, exclusion, and refusal reasons; compare refusal and attrition by key demographic and clinical variables; and report tobacco-related outcomes. RESULTS: Follow-up data were collected from 65% (13/20) patients in the QuitIT and 61% (11/18) in SC arms. Study enrollees were 71% (27/38) females, 92% (35/38) white people, and 95% (36/38) non-Hispanic people. Most had either lung (12/38, 32%) or gastrointestinal (9/38, 24%) cancer. Those dropping out were less likely than completers to have used a tablet (P<.01) and have played the game at all (P=.02) and more likely to be older (P=.05). Of 20 patients in the QuitIT arm, 40% (8/20) played the game (system data). There were no differences between those who played and did not play by demographic, clinical, technology use, and tobacco-related variables. Users completed an average of 2.5 (SD 4.0) episodes out of 10. A nonsignificant trend was found for increased confidence to quit in the QuitIT arm (d=0.25, 95% CI -0.56 to 1.06), and more participants were abstinent in the QuitIT group than in the SC arm (4/13, 30%, vs 2/11, 18%). Satisfaction with gameplay was largely positive, with most respondents enjoying use, relating to the characters, and endorsing that gameplay helped them cope with actual smoking urges. CONCLUSIONS: Recruitment and retention difficulties suggest that the perihospitalization period may be a less than ideal time for delivering a smoking cessation app intervention. Framing of the app as a "game" may have decreased receptivity as participants may have been preoccupied with hospitalization demands and illness concerns. Less tablet experience and older age were associated with participant dropout. Although satisfaction with the gameplay was high, 60% (12/20) of QuitIT participants did not play the game. Paying more attention to patient engagement, changing the intervention delivery period, providing additional reward and support for use, and improving cessation app training may bolster feasibility for a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT01915836; https://clinicaltrials.gov/ct2/show/NCT01915836 (Archived by WebCite at http://www.webcitation.org/73vGsjG0Y).


Asunto(s)
Adaptación Psicológica , Juegos Recreacionales/psicología , Cese del Uso de Tabaco/psicología , Adulto , Anciano , Terapia Conductista/métodos , Consejo/métodos , Consejo/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/normas , Neoplasias/psicología , Neoplasias/terapia , Proyectos Piloto , Fumadores/psicología , Telemedicina/métodos , Cese del Uso de Tabaco/métodos
18.
BMC Health Serv Res ; 19(1): 71, 2019 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-30683087

RESUMEN

BACKGROUND: Low- and middle-income countries (LMICs) are disproportionately impacted by interacting epidemics of tuberculosis (TB) and tobacco consumption. Research indicates behavioural support delivered by health workers effectively promotes tobacco cessation. There is, however, a paucity of training to support LMIC health workers deliver effective tobacco cessation behavioural support. The TB and Tobacco Consortium undertook research in South Asia to understand factors affecting TB health workers' delivery of tobacco cessation behavioural support, and subsequently developed a training package for LMICs. METHODS: Using the "capability, opportunity, and motivation as determinants of behaviour" (COM-B) framework to understand any issues facing health worker delivery of behaviour support, we analysed 25 semi-structured interviews and one focus group discussion with TB health workers, facility in-charges, and national tuberculosis control programme (NTP) staff members in each country. Results were integrated with findings of an adapted COM-B questionnaire on health worker confidence in tobacco cessation support delivery, administered to 36 TB health workers. Based on findings, we designed a guide and training programme on tobacco cessation support for health workers. RESULTS: Qualitative results highlighted gaps in the majority of health workers' knowledge on tobacco cessation and TB and tobacco interaction, inadequate training on patient communication, insufficient resources and staff support, and NTPs' non-prioritization of tobacco cessation in all three countries. Questionnaire results reiterated the knowledge deficits and low confidence in patient communication. Participants suggested strengthening knowledge, skills, and competence through training and professional incentives. Based on findings, we developed an interactive two-day training and TB health worker guide adaptable for LMICs, focusing on evidence of best practice on TB and tobacco cessation support, communication, and rapport building with patients. CONCLUSIONS: TB health workers are essential in addressing the dual burden of TB and tobacco faced by many LMICs. Factors affecting their delivery of tobacco cessation support can be identified using the COM-B framework, and include issues such as individuals' knowledge and skills, as well as structural barriers like professional support through monitoring and supervision. While structural changes are needed to tackle the latter, we have developed an adaptable and engaging health worker training package to address the former that can be delivered in routine TB care. TRIAL REGISTRATION: ISRCTN43811467 .


Asunto(s)
Personal de Salud/educación , Cese del Uso de Tabaco/métodos , Tuberculosis/prevención & control , Adolescente , Adulto , Anciano , Bangladesh/epidemiología , Competencia Clínica/normas , Prestación de Atención de Salud , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Pakistán/epidemiología , Pobreza , Prevalencia , Apoyo Social , Uso de Tabaco/prevención & control , Tuberculosis/epidemiología , Adulto Joven
19.
J Interprof Care ; 33(2): 200-208, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30335530

RESUMEN

The high prevalence of smoking among persons with mental illness and co-occurring substance use disorders has not changed in the past decade despite a decline in smoking among the general population. Interprofessional collaborative care offers clinicians the opportunity to engage their patients in tobacco cessation treatment that is coordinated and comprehensive. Investigators applied a 1-group, pre/post-test design with qualitative and quantitative descriptive analyses to estimate the impact of an interprofessional tobacco education program on perceived self-efficacy and self-reported counseling abilities of graduate nursing, social work, and pharmacy (PharmD) students (N = 36; nursing, n = 13, n = 9 PharmD, n = 14 social work) to treat tobacco dependence among this subpopulation of smokers, and to assess their perceptions of interprofessional education. All participants completed a 2-h web-based module, a 3-h classroom training, a simulation with a standardized patient, and a group audio-recorded debriefing session with faculty. Emergent themes from qualitative analyses were valuing simulations, demystifying disciplines, reflecting on and critiquing practice, and lessons learned. Participants' perceived self-efficacy, self-rated counseling ability, intention to ask about tobacco use, and intention to provide counseling for tobacco cessation increased significantly. Teaching students an interprofessional team approach appears to be effective in enhancing counseling abilities and self-efficacy and may positively influence health professions students' perceptions of interprofessional education. Larger studies are recommended to validate the results of this pilot study.


Asunto(s)
Consejo/educación , Personal de Salud/educación , Relaciones Interprofesionales , Cese del Uso de Tabaco/métodos , Tabaquismo/terapia , Adulto , Curriculum , Femenino , Humanos , Masculino , Simulación de Paciente , Autoeficacia , Trabajadores Sociales/educación , Estudiantes de Enfermería , Estudiantes de Farmacia , Tabaquismo/diagnóstico , Adulto Joven
20.
Am J Health Promot ; 33(2): 285-288, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29969913

RESUMEN

PURPOSE: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. DESIGN: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. SETTING: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. PARTICIPANTS: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. MEASURES: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. ANALYSIS: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. RESULTS: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. CONCLUSIONS: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.


Asunto(s)
Líneas Directas/estadística & datos numéricos , Servicios de Salud del Trabajador/métodos , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/métodos , Análisis Costo-Beneficio , Líneas Directas/economía , Humanos , Kentucky , Servicios de Salud del Trabajador/economía , Estudios Retrospectivos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/economía
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