Effects of Trained Health Professionals' Behavioral Counseling Skills on Smoking Cessation Outcomes.

Background: There is evidence that training health professionals in behavioral counseling skills can lead to greater success in helping their smokers to quit. However, it is still unknown how counseling skills relate to counseling effects. Purpose: We established a method of skills evaluation of health professionals for smoking cessation counseling based on videotaped counseling sessions with a standardized smoker, and examined the relationship between skill levels and smoking cessation outcomes. Methods: Twenty-three health professionals at Japanese workplaces underwent a training program. Their counseling skills were evaluated before and after the program using a structured evaluation form-based analysis of videotaped interactions between participants and a standardized smoker. A total of 858 smokers then received individual smoking cessation counseling by the trained health professionals at an annual health checkup. These patients were followed-up through surveys after 1 year. Results: On a scale from 0 to 24, Total skill scores, which ranged from 0 to 24, were significantly higher after the training than before the training (p < .001). Multiple two-level logistic regression analysis adjusted for smokers' characteristics showed that the odds ratios of skill scores after the training for point prevalence and sustained abstinence rates among smokers who received counseling were 1.21 (95% confidence interval: 1.03-1.42) and 1.26 (1.05-1.50), respectively. Conclusions: This study demonstrates that higher behavioral counseling skills were associated with better smoking cessation outcomes. This research is of clinical importance in that it provides a tool for assessing counselling skills in a way that is demonstrably relevant to outcomes.

Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study.

AIM: To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation. DESIGN AND SETTING: This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later. PARTICIPANTS: The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later. FINDINGS: Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting. CONCLUSIONS: Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.

[Effects of skill level on individual behavioral counseling for smoking cessation].

OBJECTIVE: The relationship between smokers' characteristics and success of smoking cessation has been examined in smoking intervention studies, but counselors' characteristics have generally not been considered. The purpose of the present study was to examine the relationship between counselor's skill level and intervention outcome. METHODS: The subjects were 858 smokers identified at annual health checkup at 6 worksites from January 1998 to September 1999. Smokers received stage-matched individual counseling by 23 trained counselors with feedback of results for carbon monoxide testing and nicotine metabolites in urine. If smokers set a quit date at the initial counseling session they received 4 follow-up telephone calls over 3 months. We further conducted 6 month and 1 year follow-up surveys using self-administered questionnaires. Smoking cessation status was validated by carbon monoxide test or family or colleague witnesses. We evaluated counselors' intervention skills using a structured evaluation form (total score: 0-24) based on videotaped interactions between each counselor and a simulated smoker. The intervention skills were classified into 3 levels, Low (0-14), Middle (15-17) and High (18-24). We performed multiple logistic regression analysis to adjust for smokers' characteristics and multi level analysis to adjust for counselors' characteristics other than counseling skills. RESULTS: Among the 23 counselors, 4, 11 and 8 counselors were assigned to the Low, Middle and High groups, respectively, which counseled 190, 344 and 324 smokers. The 7 day point prevalence abstinence rates at 6 months were 2.1%, 4.7% and 7.4%, respectively (cumulative chi-square test: P < 0.01). The 6 month sustained abstinence rates at one year were 1.1%, 3.2% and 4.6%, respectively (P < 0.05). The odds ratios of abstinence rates at 6 months and one year in Middle group were 2.33 (95% CI: 0.75-7.28) and 3.07 (0.65-14.54) respectively, compared to the Low group by multiple logistic regression analysis. In the High group they were 3.66 (1.21-11.04) and 4.86 (1.06-22.28). The results of the multi level analysis were approximately equal to those in the multiple logistic regression analysis. CONCLUSION: This result suggests that a higher counseling skill level can lead to higher abstinence rates.

Effects of stage-matched repeated individual counseling on smoking cessation: A randomized controlled trial for the high-risk strategy by lifestyle modification (HISLIM) study.

OBJECTIVE: The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking. METHODS: We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia. RESULTS: The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia. CONCLUSIONS: We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.

[Identifying perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital results from focus group interviews].

OBJECTIVE: To identify perceived needs among nurses in providing their patients with smoking cessation support in a Japanese hospital. SUBJECTS: 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). DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.