The effect of linking community health centers to a state-level smoker's quitline on rates of cessation assistance

<p>Abstract</p> <p>Background</p> <p>Smoking cessation quitlines are an effective yet largely untapped resource for clinician referrals. The aim of this study was to assess the effect of a fax referral system that links community health centers (CHCs) with the New York State Quitline on rates of provider cessation assistance.</p> <p>Methods</p> <p>This study was conducted in four CHCs using a quasi experimental study design. Two comparison sites offered usual care (expanded vital sign chart stamp that prompted providers to ask about tobacco use, advice smokers to quit, assess readiness, and offer assistance (4As)) and two intervention sites received the chart stamp plus an office-based fax referral link to the New York State Quitline. The fax referral system links patients to a free proactive telephone counseling service. Provider adherence to the 4 As was assessed with 263 pre and 165 post cross sectional patient exit interviews at all four sites.</p> <p>Results</p> <p>Adherence to the 4As increased significantly over time in the intervention sites with no change from baseline in the comparison sites. Intervention sites were 2.4 (p < .008) times more likely to provide referrals to the state Quitline over time than the comparison sites and 1.8 (p < .001) times more likely to offer medication counseling and/or a prescription.</p> <p>Conclusions</p> <p>Referral links between CHCs and state level telephone quitlines may facilitate the provision of cessation assistance by offering clinicians a practical method for referring smokers to this effective service. Further studies are needed to confirm the efficacy of fax referral systems and to identify implementation strategies that work to facilitate the utilization of these systems across a wide range of clinical settings.</p

The evaluation of a Taiwanese training program in smoking cessation and the trainees' adherence to a practice guideline

<p>Abstract</p> <p>Background</p> <p>The Taiwanese government began reimbursement for smoking cessation in 2002. Certification from a training program was required for physicians who wanted reimbursement. The program certified 6,009 physicians till 2007. The objective of this study is to evaluate the short- and long term efficacy of the training program.</p> <p>Methods</p> <p>For short term evaluation, all trainees in 2007 were recruited. For long term evaluation, computer randomly selected 2,000 trainees who received training from 2002 to 2006 were recruited. Course satisfaction, knowledge, confidence in providing smoking cessation services and the adherence to a practice guideline were evaluated by questionnaires.</p> <p>Results</p> <p>Trainees reported high satisfaction with the training program. There was significant difference between pre- and post-test scores in knowledge. Confidence in providing services was lower in the long term evaluation compared to short term evaluation. For adherence to a practice guideline, 86% asked the status of smoking, 88% advised the smokers to quit, 76% assessed the smoker's willingness to quit, 59% assisted the smokers to quit, and 60% arranged follow-up visits for smokers. The incentive of reimbursement was the most significant factor affecting confidence and adherence.</p> <p>Conclusions</p> <p>The training program was satisfactory and effective. Adherence to a practice guideline in our study was better than studies without physician training in other countries.</p

Preschool outdoor play environment may combine promotion of children´s physical activity and sun protection.:Further evidence from Southern Sweden and North Carolina

Objective. - To study the impact of preschool outdoor environments on children's physical activity and solar ultraviolet (UV) exposure at different latitudes and countries. Methods. Outdoor environments of 11 preschools (two in Raleigh NC, USA, Lat.36 degrees N, nine in Malmo, Sweden, Lat.55 degrees N) were scored (OPEC) regarding space, vegetation, hilly terrain and level of integration between open spaces, vegetation and play structures. Free sky (%) was determined by imaging. Physical activity was measured by pedometers and solar UV-exposure by polysulphone dosimeters during 5 days in spring 2009, and individual background data gathered by questionnaires and anthropometric measurements. Global UV radiation was measured and available individual UV radiation (%) computed. Results. - In Malmo, mean step count/minute was 21.2 in preschools with high-scored environment vs. 17.6 in low-scored environments, and UV-exposure lower, 26% vs. 43% of available UV during outdoor stay. In Raleigh, step count/minute was 12.3 and UV-exposure of available UV 27% during outdoor stay. Conclusions. - Step count/minute was lower in Raleigh than in Malmo, but in Malmo children at low-scored environments ran a higher risk of sunburn than in Raleigh. Trees and shrubbery integrated in children's playscape trigger both physical activity and sun-protective behaviour in Sweden, and previous measurements in Stockholm were confirmed. Such outdoor environment should be recommended, but the role of season and climate needs to be further explored. (C) 2011 Elsevier Masson SAS. All rights reserved