David C. N. Wong

Helping Chinese Fathers Quit Smoking Through Educating Their Nonsmoking Spouses: A Randomized Controlled Trial

Purpose. Assess the effectiveness of a two-step health education program by nurses delivered through nonsmoking mothers to help fathers of sick children quit smoking. Design. Randomized, controlled trial. Setting. General pediatric wards of four major hospitals in Hong Kong. Subjects. Nonsmoking mothers who had a live-in smoking spouse were recruited when they brought sick children to the hospital. A total of 752 mothers were randomized into the intervention arm and 731 into the control arm. Intervention. The intervention group received standardized health advice, behavior modification booklets, and a 1–week telephone reminder. The control group received usual care. Measurements. The main outcome measure was the quit rate (7–day point prevalence) of smoking fathers as determined by telephone follow-up with mothers at 3 and 12 months. Quit attempts and smoking reduction were secondary outcome measures. Results. At 3 months, more fathers in the intervention group had quit smoking (7.4% vs. 4.8%; p = .03), reduced daily cigarette consumption by 50% or more (30.6% vs. 22.6%; p < .001), and reported quit attempts (6.5% vs. 3.6%; p = .01). The differences were not statistically significant by 12 months. Conclusion. A simple health education intervention provided by nurses to mothers of sick children has a short-term effect in helping smoking fathers quit, reduce consumption, and trigger quit attempts. Future studies should confirm the longer-term sustainability of the effect.

A randomized controlled trial of stage‐matched intervention for smoking cessation in cardiac out‐patients

AIM To examine the effectiveness of a stage-matched smoking cessation counselling intervention for smokers who had cardiac diseases. METHODS A total of 1860 Chinese cardiac patients who smoked at least one cigarette in the past 7 days and aged 18 years or above recruited from cardiac out-patient clinics in Hong Kong hospitals were allocated randomly to an intervention group or control group. The intervention group (n = 938) received counselling matched with their stage of readiness to quit by trained counsellors at baseline, 1 week and 1 month. The control group (n = 922) received brief counselling on healthy diet at baseline. The primary outcomes were self-reported 7-day and 30-day point prevalence (PP) of tobacco abstinence at 12 months after baseline. The secondary outcome measures included biochemically validated abstinence at 12-month follow-up, self-reported 7-day and 30-day PP abstinence and reduction of cigarette consumption by 50% at 3 and 6 months. RESULTS By intention-to-treat analysis, the intervention and control groups showed no significant difference in self-reported 7-day PP abstinence (intervention: 26.5% versus control: 25.5%; P = 0.60) and 30-day PP (intervention: 25.4% versus control: 24.2%; P = 0.55), biochemically validated abstinence (intervention: 6.6% versus control: 4.9%; P = 0.14) and overall quit attempts of least 24 hours (intervention: 40.3% versus control: 34.3%; P = 0.007) at the 12-month follow-up, adjusted for the baseline stage of readiness to quit smoking. CONCLUSIONS An intervention, based on the Stages of Change model, to promote smoking cessation in cardiac patients in China failed to find any long-term benefit.

The Establishment and Promotion of the First Youth Quitline in Hong Kong Challenges and Opportunities

This study describes the establishment, promotion, and preliminary findings of a peer-led smoking cessation quitline for Chinese youth smokers in Hong Kong. The Youth Quitline targeted Chinese smokers aged 12 to 25, who smoked at least one cigarette in the past 30 days and were willing to leave telephone numbers for follow up. The protocol was translated from the California Smokers Helpline and we provided toll-free telephone counseling based on motivational intervention with multiple follow-up sessions for smokers who called the service. By intention-to-treat analysis, 55% reported at least one quit attempt, and the quit rate was 22.1% (self-reported 7-day point prevalence) or 17.5% (self-reported 30-day point prevalence). The Hong Kong Youth Quitline, along with enforcement of the antismoking legislation for both youth and adults, advocacy to de-normalize smoking in the society, and appropriate publicity, could help to promote quitting among youth smokers in Hong Kong.

Building an integrated model of tobacco control education in the nursing curriculum: findings of a students' survey.

This study examined the outcome of a 2-hour introductory lecture on tobacco and health in improving the knowledge and attitudes of nursing students toward smoking and tobacco control. A group of 78 first-year undergraduate nursing students of a major university in Hong Kong were invited to complete a self-administered questionnaire before and after the lecture. The findings indicated a significant improvement in knowledge of and attitudes about tobacco control. The study suggests that education about smoking and tobacco control should be introduced into the nursing curriculum at an early stage so appropriate knowledge, attitudes, and skills can be subsequently strengthened to prepare students to lead an effective role in delivering tobacco control nursing interventions. Finally, a model of integrating tobacco control content in the undergraduate nursing curriculum was recommended.

Quitting trajectories of Chinese youth smokers following telephone smoking cessation counseling: a longitudinal study.

INTRODUCTION The smoking patterns of youth remain unknown after they have received smoking cessation counseling. This study aims to examine the quitting trajectories of Chinese youth smokers after they have received quitline services and to examine factors to predict their quitting trajectories. METHODS A total of 402 Chinese youth smokers (aged 12-25 years) called a quitline and participated in telephone follow-ups at 1 week, 1 month, and 3 and 6 months after initial telephone counseling. Finite mixture modeling was employed to examine the quitting trajectories by the SAS Proc Traj group-based modeling procedure. Hierarchical multinomial logistic regression was used to compare the baseline intention to quit smoking, prosmoking attitudes, social influences, self-efficacy to quit, smoking profile, quitting history, and demographic characteristics among the trajectory groups. RESULTS Three distinct quitting trajectory groups were identified: quitters, reducers, and persistent smokers. Both quitters and reducers dramatically reduced the level of their cigarette consumption immediately after initial counseling. Youth smokers who were intended to quit at baseline, perceived confidence to quit, and perceived importance of quitting were more likely to have successfully quit smoking at six-month follow-up. Those who had prosmoking attitudes were less likely to quit smoking. CONCLUSION The findings reveal the profiles of youth smokers who can quit successfully and can guide the development of better and relevant interventions based on the psychosocial characteristics of youth smokers. Short-term goals such as an abrupt quit attempt or immediately reducing cigarette consumption by half may be the key to help youth smokers quit successfully.

Improving older adults' knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong : A pilot study

Abstract Background The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong posed many challenges for health promotion activities among a group of older adults with low socio-economic status (SES). With concerns that this vulnerable group could be at higher risk of contracting the disease or spreading it to others, the implementation of health promotion activities appropriate to this group was considered to be essential during the epidemic. Objectives To assess the effectiveness of delivering a telephone health education programme dealing with anxiety levels, and knowledge and practice of measures to prevent transmission of SARS among a group of older adults with low SES. Design Pretest/posttest design. Settings Subjects were recruited from registered members of a government subsidized social service center in Hong Kong and living in low-cost housing estates. Participants The eligibility criteria were: (1) aged 55 or above; (2) able to speak Cantonese; (3) no hearing impairment, and (4) reachable by telephone. Of the 295 eligible subjects, 122 older adults completed the whole study. Methods The interviewers approached all eligible subjects by telephone during the period of 15–25 May 2003. After obtaining the participants’ verbal consent, the interviewer collected baseline data by use of a questionnaire and implemented a health education programme. A follow-up telephone call was made a week later using the same questionnaire. Results The level of anxiety was lowered (t=3.28, p<0.001), and knowledge regarding the transmission routes of droplets (p<0.001) and urine and feaces (p<0.01) were improved after the intervention. Although statistical significant difference was found in the practice of identified preventive measures before and after intervention, influence on behavioral changes needed further exploration. Conclusion The telephone health education seemed to be effective in relieving anxiety and improving knowledge of the main transmission routes of SARS in this group, but not the practice of preventing SARS. Telephone contact appears to be a practical way of providing health education to vulnerable groups when face-to-face measure is not feasible and may be useful in raising health awareness during future outbreaks of emerging infections.

Parental response to child's isolation during the SARS outbreak.

Objectives To examine the needs, uncertainties, and experiences of parents during their childs hospitalization with highly suspected severe acute respiratory syndrome (HSS), and to identify ways to improve their psychological preparedness and communication with health care professionals and their isolated children during future infectious disease outbreaks. Methods Qualitative, semistructured interviews were conducted in July 2003 with parents of HSS pediatric patients. Seventeen HSS patients were hospitalized in a pediatric outpatient clinic of a major academic medical center in Hong Kong, between March 20 and May 28, 2003, during severe acute respiratory syndrome (SARS). Seven parents (41%) consented to participate in the study. Results Four major themes were identified from the interviews: 1) fear of immediate isolation and infection control procedures, 2) sources of anxiety, 3) coping, and 4) communication with children and health care professionals. Conclusions Findings indicate a need to improve the psychological preparedness of the parents regarding the childs immediate isolation during hospitalization. Ample preparation and appropriate communication among parents, health care workers, and children might minimize fear and anxiety, sustain trust, and facilitate mutual understanding during an infectious disease outbreak.

Balancing infection control practices and family‐centred care in a cohort of paediatric suspected severe acute respiratory syndrome patients in Hong Kong

Objective: To identify key nursing issues for paediatric patients suspected of severe acute respiratory syndrome (SARS) in relation to the family‐centred model of nursing care and to develop a data‐based model of paediatric nursing care to be better applied in situations of suspected SARS or where outbreaks of other infectious diseases occur.

Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial

BackgroundSecond-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking.MethodsThis was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a “no smoking” sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women”s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups.ResultsA higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands’ willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands’ history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups.ConclusionsA brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: ‘Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking’.Trial registrationCurrent Controlled Trials ISRCTN72290421.

Misconceptions about smoking in patients with type 2 diabetes mellitus: a qualitative analysis.

AIMS AND OBJECTIVES To investigate the smoking behaviours, perceptions about quitting smoking and factors associated with intention to quit in patients with type 2 diabetes mellitus. BACKGROUND Smoking causes type 2 diabetes mellitus. There has been limited research on the needs and concerns of smokers with type 2 diabetes mellitus about quitting smoking. DESIGN The study used a qualitative design. METHODS Patients diagnosed with type 2 diabetes mellitus who had a history of smoking were recruited at the outpatient diabetic clinics of two major local hospitals in Hong Kong for a semi-structured interview (n = 42), guided by the theory of planned behaviour. RESULTS At data saturation, 22 current smokers and 20 ex-smokers with type 2 diabetes mellitus were recruited. The current smokers reported they had not quit smoking because of satisfaction with present health status, and misconceptions about the association between diabetes and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive opinion about quitting smoking, accepted advice about quitting from health professionals and received more family support than current smokers. Psychological addiction and weight gain after cessation made quitting challenging. CONCLUSIONS Satisfaction with health status, inadequate knowledge about the relationship between type 2 diabetes mellitus and smoking, and misconceptions about quitting smoking resulted in negative attitudes toward quitting by type 2 diabetes mellitus smokers. Smoking peers, psychological addiction and post-cessation weight gain hindered the quitting process. RELEVANCE TO CLINICAL PRACTICE Education on the causal link between smoking, type 2 diabetes mellitus and its complications is important to raise health awareness and counter misconceptions about quitting smoking. Behavioural counselling with weight control strategies should be part of a comprehensive smoking cessation intervention for type 2 diabetes mellitus smokers.