Current practices and perceived barriers to tobacco-treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project

Introduction: The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. Methods: In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http://elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals' current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. Results: At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). Conclusions: The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke

Current practices and perceived barriers to tobacco treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project

INTRODUCTION The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. METHODS In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http:// elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals’ current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. RESULTS At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). CONCLUSIONS The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke

Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence. An assessment across 15 European countries

INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals’ knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals’ self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals’ self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions

Availability, Affordability, and Prices of Smoking Cessation Products in 9 Countries: Preliminary Findings

Numerous effective medications are available for tobacco dependence treatment, and clinicians should encourage their use by all patients attempting to quit smoking. According to the FCTC Article 14 Guideline “Tobacco cessation medications should be made available to tobacco users wanting to quit and where possible be provided free or at an affordable cost”. Online survey was conducted among 9 countries (Armenia, Bangladesh, Brazil, India, Jordan, Nigeria, Spain, Turkey, Vietnam) to determine availability, affordability, and prices of smoking cessation drugs in countries that are Global Bridges grantees and to make comparisons across them. Preliminary findings of the online survey will be summarized during the presentation

Self-efficacy predicts the outcome of smoking cessation attempts

Background Despite well-established advantages of smoking cessation in the prevention and treatment of myocardial infarction (MI) many patients continue smoking after a diagnosis of MI. Recent evidence suggests that higher self-efficacy (SE), or confidence in one's ability to abstain from smoking, is positively associated with successful smoking cessation attempts. This study aimed to investigate the association between SE and smoking cessation outcome at 6 to 12 months after MI in Armenia. Methods Cross-sectional survey was conducted among smoker adult MI patients who were hospitalized at the largest cardiac hospital in Armenia (Nork-Marash Medical Center). Data collection was done at 6 to 12 months after MI through medical chart review and interviewer administered telephone survey. SE at the time of MI was measured through widely used and validated Self-Efficacy Questionnaire (SEQ-12). SEQ-12 consists of two six-item subscales which measure confidence in aptitude to abstain from smoking when facing internal stimuli (e.g. feeling nervous) and external stimuli (e.g. being with a smoker). Logistic regression analysis was performed to reveal the association between SE and quitting outcome. Results About half (54.37%) of 103 surveyed participants quitted smoking after MI. The mean SE score was 33.55 (SD: 16.49) (out of possible 60) which was significantly higher among quitters compared to non-quitters (45.55 vs. 19.26, p< 0.001). Likewise, the difference between was significant in terms of both internal and external subscale scores. Adjusted logistic regression elucidated that each unit increase in SE score was associated with 1.3 times higher odds of quitting (95% CI: 1.17-1.44; p< 0.001). Conclusions The results illustrated that SE is an independent predictor of smoking cessation after MI suggesting that increase in patients' confidence in ability to abstain from smoking will contribute to successful cessation outcomes. This emphasized the importance of behavioral interventions in encouraging and assisting smoking cessation attempts among MI patients

Interbirth interval and history of previous preeclampsia: a case¿control study among multiparous women

Abstract Background Preeclampsia is a disorder with a reported incidence of 2%-8% among all pregnancies, accounting for more than 50,000 deaths worldwide each year. In low- and middle- income countries maternal/perinatal morbidity and mortality associated with preeclampsia are high due to the lack of proper prenatal and hospital care and limited access to neonatal intensive care. The objectives of our study were to determine the association of long interbirth interval (IBI) and preeclampsia and to investigate the interactions between long IBI and other risk factors among multiparous women in Yerevan, Armenia. Methods We conducted a hospital-based case–control study among 36 multiparous women with preeclampsia (cases) and 148 without preeclampsia (controls) during their last pregnancy, selected from the two largest maternity hospitals in Armenia. The data were collected through telephone-based structured interviews and analyzed using STATA software. The study applied univariate and multivariate logistic regression analyses. Results The study found a significant interaction between IBI and previous history of preeclampsia. Among women without a history of previous preeclampsia, the odds of having preeclampsia among women with long IBI (greater than or equal to five years) was 6.88 time higher compared to those with short IBI (CI: 1.75-27.05; p = 0.006) after adjusting for confounders; among women with a history of previous preeclampsia the odds ratio was 0.60 (CI: 0.07-4.99; p = 0.638). The final fitted model for preeclampsia among multiparous women who had planned their pregnancies included IBI, time to pregnancy, Body Mass Index, method of contraception and household monthly income. Conclusions Long IBI appeared to be a strong risk factor for preeclampsia development only among women without a history of previous preeclampsia. This finding may contribute to a new approach in understanding the etiology of preeclampsia and may be useful for developing further recommendations for this particular subgroup of women that are at higher risk for preeclampsia development in subsequent pregnancies