An article published in "Journal of Family & Community Medicine " by University Of Dammam on August 2011 ,
Author - Srabani Mittal, Samiran Das

   

Toward smoke-free homes: A community-based study on initiatives of rural Indian women
For Article click here ......
 
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Study: More can be done more to help smokers quit - PhysOrg
June 16, 2010


Many healthcare providers are quick to advise patients to quit smoking, but few follow up with programs, plans or prescriptions to help them break the habit, new research from UC Davis has found.

In the most comprehensive national study of its kind, Elisa K. Tong of the Division of General Medicine at UC Davis, reported that health professionals in the United States do not fully follow national guidelines for working with patients who use tobacco products.

Survey participants cited numerous barriers to compliance with the guidelines, including their own tobacco use, perceptions of patient attitudes about quitting, a lack of training in smoking-cessation interventions and a sense that it was not part of their professional responsibilities.

The study appeared online this month in Nicotine & Tobacco Research, and will be published in the July issue of the journal.

"This paper presents two important findings," said Steven A. Schroeder of the Division of General Internal Medicine and Smoking Cessation Leadership Center at the UC San Francisco, who contributed to the study. "First, although clinicians could play an important role in helping smokers quit, far too often they do not do so. Second, clinicians themselves have very low smoking rates. Even nurses, who were previously assumed to be heavy smokers, are substantially below the national average. If the entire country smoked at the rate of health professionals, the United States would be one of the healthiest nations in the world."

Tong and colleagues surveyed seven groups of health professionals whom smokers are most likely to encounter: primary-care physicians, emergency-medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists and pharmacists. They set out to determine the respondents' smoking status and also to examine whether they perform the "5 A's" with patients: asking, advising, assessing, assisting and arranging follow-up about tobacco use.

They found that 13 percent of registered nurses smoke, fewer than the national prevalence of 20 percent, but far more than other categories of health professionals.

They also found that up to 99 percent of health professionals report that they ask patients and almost as many advise them about smoking risks. But far fewer help them get the help they need to quit. For example, among registered nurses, 87 percent reported asking if a patient smokes, and 65 percent said they advise smokers to quit. But only 25 percent of respondents reported assisting smokers to set a quit date.

The low rate of assistance for patients was similar across the board, except among primary-care physicians, who reported assisting patients to set a quit date nearly 60 percent of the time.

Tong said primary-care physicians have been the main focus for smoking-cessation efforts, but are insufficient to help most smokers quit. She cited evidence that non-physician health professionals can be effective and that being asked about smoking by more than one type of health professional can increase the odds of a patient quitting.

"We know that provider advice is one of the simplest and most important things to help a smoker to try to quit and stay quit," said Tong. "Providers are not doing enough. It should be a priority for all health professionals, not just primary-care physicians."

Tong noted, for example, that smoking prevalence among mental health patients is high and that emergency room physicians are often on the front line of health care, but neither group sufficiently follows the guidelines. Referring to telephone "quitlines" such as the national 1-800-QUIT NOW is one way all health professionals can improve in assisting smokers to quit.

"Those are missed opportunities if they don't address tobacco use," she said. Source:

  • National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs
  • Nicotine & Tobacco Research Advance Access published online on May 27, 2010
  • Elisa K. Tong, M.D., Richard Strouse, B.A., John Hall, J.D., M.S., Martha Kovac, M.P.H. and Steven A. Schroeder, M.D.
 
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Link found between passive smoking and poorer mental health - EurekAlert!
June 9, 2010


Second hand smoke exposure is associated with psychological distress and risk of future psychiatric illness, according to new UCL research that suggests the harmful affects of passive smoking go beyond physical health.

The new research, published today in the Archives of General Psychiatry, examined the associations between mental health and second hand smoke (SHS) exposure – known as passive smoking - by measuring the circulating biochemical marker cotinine, which is found in saliva and can be used to measure levels of exposure to tobacco smoke. The study found that SHS exposure is associated with psychological distress and risk of future psychiatric illness in healthy adults.

A representative sample of 5,560 non-smoking adults and 2,689 smokers without history of mental illness were drawn from the 1998 and 2003 Scottish Health Surveys. A score greater than 3 on the 12-item General Health Questionnaire was employed as an indicator of psychological distress. Incident psychiatric hospital admissions over 6 years follow up were also recorded.

Psychological distress was apparent in 14.5% of the sample. In an analysis of the data, after adjustments for a range of potential confounding factors such as social status, high SHS exposure among non-smokers (cotinine levels between 0.70 and 15 micrograms per litre) was associated with 50% higher odds of reporting psychological distress in comparison with participants with cotinine levels below the limit of detection. Active smokers were also more likely to report psychological distress. The risk of future psychiatric illness was also related to high SHS exposure and active smoking.

Lead author Dr Mark Hamer, UCL Epidemiology & Public Health, said: "SHS exposure at home is growing in relative importance as restrictions on smoking in workplaces and public places spread. A growing body of literature has demonstrated the harmful physical effects of second hand smoke exposure, but there has been limited research about the affects on mental health.

"Animal data have suggested that tobacco may induce a negative mood, and some human studies have also identified a potential association between smoking and depression. Our data is therefore consistent with other emerging evidence to suggest a causal role of nicotine exposure in mental health. Importantly, this study advances previous research because we obtained an accurate assessment of SHS exposure using a valid biochemical indicator.

"Mental ill health accounts for almost 20% of the burden of disease in the European Region and can affect one in four people at some time in their life. Our findings emphasise the importance of reducing SHS exposure at a population level, not only for the benefit of our physical health but for our mental health as well."

Source:

  • Objectively Assessed Secondhand Smoke Exposure and Mental Health in Adults: Cross-sectional and Prospective Evidence From the Scottish Health Survey
  • Arch Gen Psychiatry. 2010;67(8):(doi:10.1001/archgenpsychiatry.2010.76).
  • Mark Hamer, PhD; Emmanuel Stamatakis, PhD; G. David Batty, PhD
 
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Source: Financial Times

In most restaurants today, the food and wine have never represented better value, nor been more skilfully prepared, nor been served so enthusiastically. If this statement sounds sweeping, it is based on hard facts. The recession has stopped restaurateurs raising their prices. The internet has fuelled creativity among chefs and raised customer awareness to a new level. Another factor that is still growing in importance, particularly in Britain and the US, is that so many young people feel the lure of a career in the fascinating world of food and wine, despite the long hours and unattractive pay.

The final factor (all but forgotten now that it has been in place in Britain for almost three years and longer in the US) is the smoking ban in public places, thanks to which food and wine can taste as they should. This significant improvement is best appreciated when visiting those countries without a ban.

However, restaurateurs, waiting staff and kitchens in countries where the smoking ban is now in place do have another big challenge: how to deal with the case of the disappearing diners.

These disappearances, which can arise several times during a meal, occur when smokers decide it’s time for a cigarette break and, stopping only to pick up their mobile phone and glass of wine, head for the door, usually without telling anyone and often passing the waiter bringing the next course on their way out. While the waiters struggle to keep the food hot, the customer is out on the doorstep.

Restaurateurs acknowledge that there is little they can do about this. But as well as “putting a massive spanner in the running of the service”, as one described it, doorstep smokers do affect the front-of-house: there are cigarette butts on the floor; new customers have to walk through a fug of smoke; and UK licensing laws, which allow the customer to take a glass of wine outside (something that is not possible in the US, for example), can make the exterior look more like a pub than a restaurant.

While many accept that this is a situation that they simply have to manage, a growing number of hoteliers across Britain, as well as a few restaurateurs, are tackling the ban by opening up specific areas to lure back the small group who used to be some of their best spending customers: cigar smokers.

Before the 2007 smoking ban, a third of all sales by Hunters & Frankau, Britain’s prime importer of Cuban cigars, were to the hospitality industry. That proportion plummeted again as the recession started to bite. But last year cigar sales to hotels, restaurants and bars increased by more than 10 per cent, in line with the construction of a growing number of comfortable outdoor smoking areas (where 50 per cent of the wall area has to be permanently open to the outside, allowing a circulation of fresh air to minimise the potential for damage to the staff’s health). Known in the trade as “cosas” (or “comfortable outdoor smoking areas”), these use under-floor and overhead heating to keep smokers warm.

There are now more than 220 such smoking areas in Britain, 73 of them in London, including two new restaurants that have them built in to their design – Galvin’s La Chapelle in the City and the second branch of Roka, a Japanese restaurant in Canary Wharf. In New York, at Eleven Madison Park, waiting staff will prepare the cigars for their customers, which they can then smoke in the park right outside the restaurant’s front door.

Many of the smoking areas in hotels have been introduced by their cigar-smoking owners, such as Tim Hart at Hart’s in Nottingham, Khalid Affara at his Ten Manchester Street Hotel near London’s Oxford Street and at the “cigar shacks”’ at Hotels du Vin across the country. These areas, with their sales of not just expensive cigars but the digestifs to accompany them, represent an opportunity to recoup the revenue that the smoking ban removed at a stroke.

They also present their owners with the commercial opportunity to rival the Garden Room of the Lanesborough Hotel, which I would guess has achieved the highest turnover and profit per square metre of any hotel or restaurant in the country since it opened in 2007. Judging by the hectic scene that greeted us at 7.30pm one weekday evening, these 44 seats may even have the highest turnover of any hotel bar anywhere in the world.

What helps achieve this turnover, as the waiter promptly explained, is that fact that there is a minimum charge of £25 for anyone other than hotel guests. With cigars ranging in price from £11.50 to £1,500, and the most popular at £57, this is easily reached – although the hotel’s practice of adding 12.5 per cent service but then incorporating this into the subtotal and leaving the service charge blank on the credit card slip must lead to many customers spending more than intended.

But what was once a small and rarely used garden has now become a magnet for cigar lovers from around the world thanks to the hotel’s far-sighted decision to invest in an extraordinary range of cigars and to the encyclopedic knowledge of Giuseppe Ruo, its director. Its position on the lower ground floor at the back of the hotel allows a breeze to blow through the room, just as it might in a bar in Havana. The sound of the buses circumnavigating Hyde Park Corner, along with the need for the heaters, will, however, remind you that this is definitely the heart of London, not Cuba.