The effects of perceived stress on biological parameters in healthcare professionals: A systematic review.

We synthesised evidence on biological correlates of psychological stress in hospital-based healthcare professionals, and examined whether there was evidence of consistent biological changes. Electronic databases were searched for empirical studies; 16 articles (0.6%) met the inclusion criteria. Evidence of a relationship between indices of psychological stress and biological parameters was limited and inconsistent. There was some evidence of a consistent relationship between natural killer cells and lymphocyte subpopulations. Considerable heterogeneity in the methods used was seen. Future prospective studies examining the relationship between indices of psychological stress and natural killer cells, including lymphocyte subsets, is required.

Evaluation of a programme to increase referrals to stop-smoking services using Children's Centres and smoke-free families schemes.

AIMS: To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS). DESIGN: This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. SETTINGS: Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. PARTICIPANTS: Parents and carers registered with, and staff working for, Children's Centres. MEASURES: Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. FINDINGS: In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. CONCLUSIONS: Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.

Implementation of routine biochemical validation and an 'opt out' referral pathway for smoking cessation in pregnancy.

AIMS: To introduce an 'opt out' referral pathway for smoking cessation in pregnancy and to compare different methods for identifying pregnant smokers in maternity care. DESIGN: Pilot study that analysed routine data from maternity and smoking cessation services with biochemical validation of smoking status. SETTING: Dudley and South Birmingham, England. PARTICIPANTS: A total of 3712 women who entered the referral pathway-1498 in Dudley and 2214 in South Birmingham. MEASUREMENTS: Routine monitoring data on smoking at maternity booking, referral to smoking cessation services, number of women who set quit dates set and short-term (4-week) self-report smoking status. Comparison of self-report, carbon monoxide (CO)-validated and urinary cotinine-validated smoking status for a subsample (n = 1492) of women at maternity booking. FINDINGS: In Dudley 27% of women who entered the opt out referral pathway were identified as smokers following CO testing. Of those referred to the smoking cessation services, 19% reported stopping smoking at 4-week follow-up. In South Birmingham 17% were smokers at booking, with 5% of those referred recorded as non-smokers at 4 weeks. The number of women quitting did not increase during the study when compared with the previous year, despite higher referral rates in both areas. An optimum cut-off CO measurement of 4 parts per million (p.p.m.) was identified for sensitivity and specificity. CONCLUSION: The introduction of an opt out referral pathway between maternity and stop smoking services resulted in more women being referred for support to quit but not higher numbers of quitters, suggesting that automatic referral may include women who are not motivated to stop and who may not engage with services. Routine carbon monoxide monitoring introduced as part of a referral pathway should involve a cut-off of 4 p.p.m. to identify smoking in pregnancy.

Quit attempts in response to smoke-free legislation in England.

OBJECTIVES: To determine whether England's smoke-free legislation, introduced on 1 July 2007, influenced intentions and attempts to stop smoking. DESIGN AND SETTING: National household surveys conducted in England between January 2007 and December 2008. The sample was weighted to match census data on demographics and included 10 560 adults aged 16 or over who reported having smoked within the past year. RESULTS: A greater percentage of smokers reported making a quit attempt in July and August 2007 (8.6%, n=82) compared with July and August 2008 (5.7%, n=48) (Fisher's exact=0.022); there was no significant difference in the number of quit attempts made at other times in 2007 compared with 2008. In the 5 months following the introduction of the legislation 19% (n=75) of smokers making a quit attempt reported that they had done so in response to the legislation. There were no significant differences in these quit attempts with regard to gender, social grade or cigarette consumption; there was however a significant linear trend with increasing age (chi(2)=7.755, df=1, p<0.005). The prevalence of respondents planning to quit before the ban came into force decreased over time, while those who planned to quit when the ban came into force increased as the ban drew closer. CONCLUSION: England's smoke-free legislation was associated with a significant temporary increase in the percentage of smokers attempting to stop, equivalent to over 300 000 additional smokers trying to quit. As a prompt to quitting the ban appears to have been equally effective across all social grades.

Improving access to smoking cessation services for disadvantaged groups: a systematic review.

BACKGROUND: Smoking is a main contributor to health inequalities. Identifying strategies to find and support smokers from disadvantaged groups is, therefore, of key importance. METHODS: A systematic review was carried out of studies identifying and supporting smokers from disadvantaged groups for smoking cessation, and providing and improving their access to smoking-cessation services. A wide range of electronic databases were searched and unpublished reports were identified from the national research register and key experts. RESULTS: Over 7500 studies were screened and 48 were included. Some papers were of poor quality, most were observational studies and many did not report findings for disadvantaged smokers. Nevertheless, several methods of recruiting smokers, including proactively targeting patients on General Physician's registers, routine screening or other hospital appointments, were identified. Barriers to service use for disadvantaged groups were identified and providing cessation services in different settings appeared to improve access. We found preliminary evidence of the effectiveness of some interventions in increasing quitting behaviour in disadvantaged groups. CONCLUSIONS: There is limited evidence on effective strategies to increase access to cessation services for disadvantaged smokers. While many studies collected socioeconomic data, very few analysed its contribution to the results. However, some potentially promising interventions were identified which merit further research.