This randomized controlled trial assessed the efficacy of a smoking relapse prevention program featuring 3 postdischarge telephone contacts with subjects who had quit smoking on hospitalization.Patients were randomly assigned to public health nurse-mediated behaviorally oriented in-patient counseling focused on relapse prevention (control group, n = 49), or the same inpatient counseling with postdischarge telephone contacts at 7, 21 and 42 days after discharge (intervention group, n = 57). The main outcome measure, smoking cessation rate, was obtained from self-reports at 3, 6 and 12 months after discharge. Smoking cessation at 12 months after discharge was confirmed by urinary nicotine concentration.At 3, 6 and 12 months smoking cessation rates were 83%, 63% and 56% for the intervention group, and 76%, 65% and 51% for control group. After adjustment for sex, age, having any complication, number of family members, smoking status on admission, strength of nicotine dependence and self confidence to quit smoking, the odds ratio of cessation among the intervention group were 1.46 (95% confidence interval (CI): 0.48-4.47), 0.82 (95% CI: 0.31-2.17) and 0.99 (95% CI: 0.40-2.45) at 3, 6 and 12 months after discharge, respectively.This program had limited efficacy to maintain postdischarge smoking abstinence. We should re-consider the modality of smoking cessation program for relapse prevention among hospitalized patients.
In order to identify the risks, methods and locations of suicide among Japanese cancer patients, we followed up 23,979 cancer patients aged 15 years and older, who were newly diagnosed at one medical center between 1978–94. Suicide risk was evaluated by comparing the observed number (O) with the expected number (E), which was calculated from the suicide mortality rate among Osaka residents. By the end of 1994, there were 48 suicide death among 109,374 person‐years of follow‐up. Suicide risk was significantly increased within the first five years following cancer diagnosis (male: O/E=1.62, 95% confidence interval (CI)=1.03–2.43, female: O/E=2.13, 95%CI=1.22–3.47), and decreased to unity after five years had elapsed following the cancer diagnosis. Patients in their fifties (O/E=1.93, 95%CI=1.48–4.37), diagnosed between 1978–85 (O/E=1.93, 95%CI=1.19–2.95), having remote metastasis at their initial diagnosis (O/E=4.66, 95%CI=2.12–8.84), the site being in the female genital organs (O/E=3.58, 95%CI=1.54–7.06) or in the male genital organs (O/E= 5.86, 95%CI= 1.58–15.05), had a significantly higher suicide risk within five years following cancer diagnosis. The highest suicide mortality was observed between the third and fifth months after cancer diagnosis (O/E=4.35, 95%CI=1.87–8.58); most of these suicides (7/8) occurred soon after discharge from hospital. Among the 39 patients who committed suicide within five years after their diagnosis, the most common method among those who took their lives while in hospital was by jumping to their death (10/16), and that among those who committed suicide in other locations was by hanging (14/23). These findings indicate that Japanese patients with cancer run the highest risk of suicide soon after having been discharged from hospital. Clinicians should assess cancer patients' psychological distress and potential risk of suicide before approving discharge from hospital.
Little is known about the relationship between a patient's personality and smoking behavior. METHODS: We assessed the smoking status of 262 male smokers who had been diagnosed with cancer and admitted to a teaching hospital, using a self-administered questionnaire that was mailed to the patients 6 months after discharge. The personality of the patients was assessed with the Kyushu University Egogram at admission, and the patients were categorized into five groups according to the ego state with the highest value among the five ego states, namely "Critical Parent" dominant, "Nurturing Parent" dominant, "Adult" dominant, "Free Child" dominant and "Adapted Child" dominant. Multivariate logistic regression analyses were used to assess the influence of the type of personality on smoking behavior after hospital discharge with adjustment for considerable predictive variables. RESULTS: The smoking cessation rate at 6 months after hospital discharge was 63% (164/262). Multivariate analyses revealed that after adjustment for age, cancer site, length of hospital stay, time elapsed since last cigarette, self-confidence to quit smoking and strength of nicotine dependence, and being an Adult dominant personality were positively (p<0.01), and being a Free Child dominant person- ality was negatively (p<0.05) associated with post-discharge abstinence. These findings did not change when the non-responders (n=50) of the questionnaire were included in the analysis as post-discharge smokers. CONCLUSIONS: These findings indicate that a male cancer patient's personality as assessed by the egogram has predictive significance for whether the patient will have a smoking habit after discharge. J Epidemiol 2003;13:303-313.
OBJECTIVES The article describes the framework of an on-the-job training program for nurses that teaches them how to better advise hospitalized smokers to stop smoking. The purpose of the study was to evaluate the efficacy of the program. METHODS We corducted an on-the-job training program for 4 years aimed at nurses who worked in 2 of 11 wards in our hospital (training wards). The aim of the training program that we developed was to improve nurses' self-efficacy in advising and supporting patients to stop smoking. An average of 40 nurses worked in the two wards at any time during the study period. A self-administered questionnaire was given to nurses working at our hospital before (in 1997) and after (in 2002) the program was undertaken. Changes in cognition and behavior with regard to advice to hospitalized smokers were also compared between nurses working at the training wards and nurses working in the other wards in question, whose number averaged 200 nurses during the period. RESULTS There were no differences in age distribution, smoking habits and epidemiological knowledge of smoking between the two groups. Self-efficacy in advising and supporting patients to cease smoking was significantly increased among nurses working in the training wards (P=0.02), whereas no significant increase with time was found among nurses working in the other wards (P=0.14). After the program was undertaken, nurses working in the training wards had a significantly higher proportion who always advised hospital smokers to quit according to their predictable stage of change than their counter parts working in the other wards (adjusted odds ratio 2.93, 95% confidence interval 1.27-6.74). CONCLUSION The study indicates the job training program to have improved the nurses' self-efficacy, appearing to change their behavior in advising and supporting patients to cease smoking.
This study was conducted to address change in smoking behavior of cancer patients when admitted to a cancer center, and elucidate factors associated with long-term smoking abstinence after discharge.The subjects were 97 patients with stomach cancer and 93 with head and neck cancer (cancer in the oral cavity, pharynx and/or larynx that did not require total laryngectomy) who were current smokers at the time of first visit to a cancer center. In order to obtain detailed information on their smoking behavior, a self-administered questionnaire was mailed to each patient at least 18 months after the patient was discharged. Seventy-three percent (138/190) of the subjects returned the completed questionnaire by mail.The smoking cessation rates at five different time points, namely, 1) one day before admission, 2) the first day of admission, 3) the last day of admission, 4) one day after discharge, and 5) at the time the patient received the questionnaire, indicating long-term smoking abstinence after discharge, were 10.4%, 32.6%, 71.9%, 40.0% and 51.0%, respectively. Multivariate logistic regression analysis revealed that patients who had stopped smoking by the first day of admission had a significantly higher probability of long-term smoking abstinence than their counterparts who smoked up to the last day of admission. The patients who received doctors' and/or nurses' advice for smoking cessation at our medical center did not have significantly higher probability of long-term smoking abstinence than those who did not receive it.With patients suffering from stomach or head and neck cancer admitted to a cancer center, multivariate analysis indicated that smoking behavior in the pre-admission period influences long-term smoking abstinence after discharge.
This study aims at describing smoking behavior and cognition for smoking cessation among Japanese men after the diagnosis of cancer. Subjects were 144 patients with head and neck cancer (oral cavity, pharynx and larynx without requirement of total laryngectomy) and 104 patients with stomach cancer who were current or ex-smokers at time of diagnosis. A self-administered questionnaire was mailed at least 1.5 years alter diagnosis. Response was by mail and 72% (248/344) of completed questionnaires were returned. Among 164 patients who were smokers at the time of diagnosis, 59(36%) reported that they continued to smoke after the diagnosis of cancer. Stomach cancer patients (53%) had significantly higher (p < 0.01) continuance rate of smoking than head and neck cancer patients (24%), and patients in fifties (53%) had the highest continuance rate of smoking in the study participants. Among 105 patients who were abstinent, 83(79%) had stopped smoking within 6 months after the diagnosis of cancer. Interest in smoking cessation among the current smokers was high (83%), and they preferred a smoking cessation class with multiple participants to "person to person" counseling provided by health care practitioners.
"Neoceader smoking" is widely marketed in drug stores as an over the counter expectorant for cigarette smokers in Japan. Using high-pressure liquid chromatography, we determined that one piece of Neoceader (3 cm) contains 0.79 mg of nicotine, which is equivalent to one-sixth of the amount of nicotine in one Japanese cigarette (Mildseven extra-light, Mildseven super-light, or Sevenstar). Two patients who had switched from cigarette smoking to Neoceader smoking, subsequently became addicted to nicotine. The continine concentration in their urine were 937 ng/ml and 2,724 ng/ml, respectively. These findings demonstrate that Neoceader contains nicotine and that its use can lead to nicotine addiction.
To identify perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital.Thirty-three female nurses who were interested in providing their patients with smoking cessation support in the hospital setting participated in focus group interviews. They conducted six focus group interviews segmented by age, working conditions (e.g., outpatient or inpatient sections) and occupational class (e.g., administrative post or not).An experienced researcher moderated two focus groups and another researcher who received training moderated four focus groups. At least two observers hand-recorded participants' conversations in each group and all groups were also tape-recorded. Moderators and observers analyzed the focus group data together.We found that smoking cessation counseling or health education on effects of smoking to be rarely conducted in the hospital. The study participants ordinarily just told patients to stop smoking. They mentioned several barriers to conducting smoking cessation support and suggested a number of ideas to promote this aim in the hospital.The focus group interview is an effective means to determine the needs and interests of Japanese health professionals. Nurses have many opinions and insights for supporting smoking patients. To introduce a smoking cessation program into hospitals, there are various problems that should be solved. First, nurses and other health professionals should have accurate knowledge, positive attitudes and appropriate skills for smoking cessation support. Second, smoking cessation support should be programmed as part of treatment or nursing. Third, healthcare professionals, especially doctors, should collaborate in supporting patients to stop smoking. Fourth, the hospital environment should be modified to promote smoking cessation. Finally, hospitals should develop a consensus among all staff about the importance of smoking cessation support and smoking control activities. As the result, multidimensional strategies are needed to effectively promote smoking cessation support in the hospital setting.
Preoperative smoking cessation has been suggested to be effective in reducing various postoperative complications. However, the optimal duration of preoperative smoking cessation for reducing wound complications is unclear.One hundred eighty-eight consecutive patients who underwent reconstructive head and neck surgery at the authors' institution were included in this retrospective study. Information on preoperative smoking habits was obtained from the patients' medical records. Smokers were defined as having smoked within 7 days before surgery. Late, intermediate, and early quitters were defined as patients whose duration of abstinence from smoking was 8-21, 22-42, and 43 days or longer before the operation, respectively. Patients who required postoperative debridement, resuture, or reconstruction of their flap before hospital discharge were defined as having had impaired wound healing.The incidences (95% confidence intervals) of impaired wound healing among the late, intermediate, and early quitters and nonsmokers were 67.6% (52-83%), 55.0% (33-77%), 59.1% (47-71%), and 47.5% (32-63%), respectively, and the incidence of impaired wound healing was significantly lower among the intermediate quitters, early quitters, and nonsmokers than among the smokers (85.7% [73-97%]). After controlling for sex, age, American Society of Anesthesiologists physical status, operation time, history of diabetes mellitus, chemotherapy, radiation therapy, and the type of flap, the odds ratios (95% confidence intervals) for development of impaired wound healing in the late, intermediate, early quitters, and nonsmokers were 0.31 (0.08-1.24), 0.17 (0.04-0.75), 0.17 (0.05-0.60), and 0.11 (0.03-0.51), respectively, compared with the smokers.Preoperative smoking abstinence of longer than 3 weeks reduces the incidence of impaired wound healing among patients who have undergone reconstructive head and neck surgery.
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