Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively

BACKGROUND Tobacco use is a well-documented modifiable risk factor for perioperative complications.AIM To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty(TJA)procedure.METHODS A retrospective evaluation was performed on 88 self-reported tobacco users who underwent TJA between 2014-2022 and had tobacco cessation dates within 3 mo of surgery.Eligible patients were contacted via phone survey to understand their tobacco use pattern,and patient reported outcomes.A total of 37 TJA patients participated.RESULTS Our cohort was on average 61-years-old,60%(n=22)women,with an average body mass index of 30 kg/m^(2).The average follow-up time was 2.9±1.9 years.A total of 73.0%(n=27)of patients endorsed complete abstinence from tobacco use prior to surgery.Various cessation methods were used perioperatively including prescription therapy(13.5%),over the counter nicotine replacement(18.9%),cessation programs(5.4%).At final follow up,43.2%(n=16)of prior tobacco smokers reported complete abstinence.Patients who were able to maintain cessation postoperatively had improved Patient-Reported Outcomes Measurement Information System(PROMIS)-10 mental health scores(49 vs 58;P=0.01),and hip dysfunction and osteoarthritis outcome score for joint replacement(HOOS.JR)scores(63 vs 82;P=0.02).No patients in this cohort had a prosthetic joint infection or required revision surgery.CONCLUSION We report a tobacco cessation rate of 43.2%in patients undergoing elective TJA nearly 3 years postoperatively.Patients undergoing TJA who were able to remain abstinent had improved PROMIS-10 mental health scores and HOOS.JR scores.The perioperative period provides clinicians a unique opportunity to assist active tobacco smokers with cessation efforts and improve postoperative outcomes.

Persuasive Technology for the Future of Smoking Cessation*

This paper explores the integration of persuasive technology into smoking cessation efforts through the development and evaluation of a mobile app, “No-Smoke.” Leveraging compelling features like social support, tracking, planning, and motivation, the app aims to augment user engagement and support the process of quitting smoking. The efficacy of these features has been substantiated through both automated testing and user feedback, highlighting their potential to enhance awareness, motivation, and behavior modification. Despite notable successes, limitations, including a limited user base and uncertainties regarding long-term efficacy, have been acknowledged, stemming from the inherent complexities of smoking cessation. Nevertheless, based on user experiences and feedback, “No-Smoke” represents a promising advancement in the use of technology for public health interventions, particularly in the realm of smoking cessation. To address existing challenges, future research is recommended to encompass a comprehensive, long-term study involving a larger and more diverse user base. Additionally, further investigation should focus on personalization enhancements and the integration of machine learning algorithms to better understand and respond to user behavior.

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment

Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016.Patients were classified as the current smokers,the never smokers,and the ex-smokers based on their smoking history,and the ex-smokers were allocated into five subgroups according to their smoking cessation times(CeT):CeT W6 weeks,6weeks<CeT W lyear,lyear<CeT<5years,5years<CeT<lOyears,CeT>10years.The preoperative peripheral blood white blood cells(WBCs),albumin,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),intraoperative blood loss,30-day mortality,in-hospital days,hospitalization costs,intensive care un辻(ICU),admission days and placement time of closed thoracic drainage tube were compared among difTerent groups.Results There were significant differences in WBC(F=S.275,P<0.001)and albumin(F=2,470,P<0.05)among patients of current smokers,ex-smokers with different smoking cessation time,and never-smokers.The blood WBC count in current smokers(7.7 X 109/L)was significantly higher than that in ex・smokers(7.0 X 109/L)and never-smokers(5.9 X 109/L)(t=-2.145,P<0.05;t=-6.073,P<0.01,respectively).The level of peripheral blood albumin in current smokers(41.1 g/L)was lower than that in ex・smokers(42.1 g/L)and neve—smokers(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01,respectively).The level of peripheral blood NLR in current smokers(3.7)was higher than that in ex-smokers(3.1)and never smokers(2.8)(t—-1.836,P<0.05;t=-2.889,P<0.01,respectively).There was no significant difference in WBC,albumin and NLR among five subgroups of different smoking cessation time.No significant difference was observed in intraoperative blood loss,30-day mortality,hospitalization costs,hospital stay,ICU stay and placement time of closed thoracic drainage tube among groups either.Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients.Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes,which may be not impacted by the time length of smoking cessation.Therefore,lung cancer patients should be encouraged to quit smoking at any time.

Motivations, Challenges and Coping Strategies for Smoking Cessation: Based on Multi-ethnic Pregnant Couples in Far Western China

The present study aimed to clarify the smoking cessation motivations, challenges and coping strategies among pregnant couples. A qualitative design using a grounded theory approach was applied. Data were collected by individual semi-structured interviews with 39 married individuals(21 non-smoking pregnant women and 18 smoking or ever-smoking men with a pregnant wife) and 3 imams in an ethnically diverse region of far western China. The most common theme for smoking cessation motivation was 'embryo quality'(i.e., a healthier baby), followed by family's health. Most interviewees reported that husband's withdrawal symptoms were the greatest challenge to smoking cessation, followed by the Chinese tobacco culture. Coping strategies given by the pregnant women typically involved combining emotional, behavioral and social interventions. Social interventions showed advantages in helping to quit smoking. Pregnancy appears to be a positive stimulus for pregnant couples' smoking cessation. Our results suggest that pregnancy, a highly important life event, may help to reduce barriers to smoking cessation at the social level(e.g., limiting access to cigarettes, avoiding temptation to smoke), but does little to help with the withdrawal symptoms. Professional guidance for smoking cessation is still necessary.

Family History of Cancer and Smoking Cessation, Is There a Role for Physicians?

Aim: This study aims to investigate the relationships among family history of cancer, physician’s advice on quitting, and motivation to quit among smokers in the United State. Method: This study using data collected by the 2010 National Health Interview Survey. Five separate sets of multivariate logistic regression models were used to investigate the three-direction relationships among: 1) effect of family cancer history on medical doctors’ advice on quitting, 2) effect of family cancer history on motivation to quit smoking, 3) effect of doctor’s advice on smokers’ motivation to quit. Results: Smoking cessation advice given by physicians has a significant effect on both smoker’s motivation and action taken to quit smoking, but a large proportion of the smokers with family cancer history did not receive doctor’s advice on quitting. Conclusion: Family history of lung cancer or other cancer types was not found to be associated with increased motivation to quit smoking. This is at least partly due to poor collection of family cancer history by physicians. This may be ameliorated by promoting the use of a recently developed self-administered tool for the collection of patient data on family cancer history in primary care settings.

Effect of Cyantraniliprole on Feeding Cessation of Q Biotype Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae)

The whitefly, Bemisia tabaci (Hemiptera: Aleyrodidae) is one of the most devastating agricultural pests in many cropping systems worldwide. Growers rely on the use of insecticides to control this pest. However, some insecticides do not reduce the feeding of B. tabaci fast enough to prevent the direct and indirect damage produced by this insect. The effect of a new insecticide, cyantraniliprole 10OD (CyazypyrTM), on the feeding of B. tabaci adults, was studied under laboratory conditions. Cyantraniliprole 10OD is an insecticide that belongs to the IRAC Group 28 with a new mode of action for sucking insects, which provides rapid feeding cessation by impairing muscle function, resulting in reduced transmission of important insect vectored crop diseases. Laboratory experiments were conducted to determine the effect of cyantraniliprole along with some other commercially available insecticides on the feeding of B. tabaci adults by measuring the excretion of honeydew as an indirect assessment of insect feeding. In these experiments, cyantraniliprole resulted in significantly higher reduction of honeydew excretion (64.0%) by Q biotype B. tabaci adults during the first 30 minutes of exposure than diafenthiuron, triazophos, acetamiprid and spiromesifen, with all treatments having no adult mortality. Observations between 1 and 48 hours after exposure indicated that cyantraniliprole had numerically higher or similar reduction in honeydew production as the other insecticides, but by 48 hours (mid and high rate) and 96 hours (high rate) of exposure, cyantraniliprole had significantly higher reduction of honeydew excretion than all other insecticides tested. Low adult mortality was observed during first 24 hours of exposure in all treatments. Cyantraniliprole resulted in numerical or significantly higher adult mortality than all other treatments at the later observation intervals (72 - 96 hours). The higher reduction in honeydew excretion by cyantraniliprole appeared to be related to faster feeding cessation during the initial hours of exposure by a combination of feeding cessation and direct mortality as the exposure time increased. These findings document significant effects of cyantraniliprole on feeding cessation in Bemisia tabaci.

Exploration of nucleos(t)ide analogs cessation in chronic hepatitis B patients with hepatitis B e antigen loss

BACKGROUND Nucleos(t)ide analogs(NAs)cessation in chronic hepatitis B(CHB)patients remains a matter of debate in clinical practice.Current guidelines recommend that patients with hepatitis B e antigen(HBeAg)seroconversion discontinue NAs after relatively long-term consolidation therapy.However,many patients fail to achieve HBeAg seroconversion after the long-term loss of HBeAg,even if hepatitis B surface antigen(HBsAg)loss occurs.It remains unclear whether NAs can be discontinued in this subset of patients.AIM To investigate the outcomes and factors associated with HBeAg-positive CHB patients with HBeAg loss(without hepatitis B e antibody)after cessation of NAs.METHODS We studied patients who discontinued NAs after achieving HBeAg loss.The Cox proportional hazards model was used to identify predictors for virological relapse after cessation of NAs.The cut-off value of the consolidation period was confirmed using receiver operating characteristic curves;we confirmed the cut-off value of HBsAg according to a previous study.The log-rank test was used to compare cumulative relapse rates among groups.We also studied patients with CHB who achieved HBeAg seroconversion and compared their cumulative relapse rates.Propensity score matching analysis(PSM)was used to balance baseline characteristics between the groups.RESULTS We included 83 patients with HBeAg loss.The mean age of these patients was 32.1±9.5 years,and the majority was male(67.5%).Thirty-eight patients relapsed,and the cumulative relapse rate at months 3,6,12,24,36,60,120,and 180 were 22.9%,36.1%,41.0%,43.5%,45.0%,45.0%,45.0%,and 52.8%,respectively.Twentysix(68.4%)patients relapsed in the first 3 mo after NAs cessation,and 35 patients(92.1%)relapsed in the first year after NAs cessation.Consolidation period(≥24 mo vs<24 mo)(HR 0.506,P=0.043)and HBsAg at cessation(≥100 IU/mL vs<100 IU/mL)(HR 14.869,P=0.008)were significant predictors in multivariate Cox regression.In the PSM cohort,which included 144 patients,there were lower cumulative relapse rates in patients with HBeAg seroconversion(P=0.036).CONCLUSION HBeAg-positive CHB patients with HBeAg loss may be able to discontinue NAs therapy after long-term consolidation,especially in patients with HBsAg at cessation<100 IU/mL.Careful monitoring,especially in the early stages after cessation,may ensure a favorable outcome.

Characteristics of Callers Accessing the Tobacco Cessation Quitline in China's Mainland

To describe the characteristics of callers accessing the first national smoking quitline in China's Mainland. The national quitline provides residents in China's Mainland with free telephone smoking cessation services. Of 8260 callers from December 1, 2009 to May 31, 2012, the study included 1049 callers to the non-automated service who gave basic information during the call. Of the 1049 live-access callers.

Comparison of Rainy Season Onset, Cessation and Duration for Ghana from RegCM4 and GMet Datasets

The socio-economic sector of West African countries is rain-fed agriculture driven. Information regarding the onset, cessation and duration of the rainy season is thus, very essential. In this paper, a comparison of the onset, cessation and duration of the rainy season has been carried out using simulated rainfall data from the fourth generation Regional Climate Model (RegCM4) and rain gauge measurements from Ghana Meteorological Agency (GMet), covering a period of 1998 to 2012. Similar onset and cessation dates were seen in both the simulated and guage rainfall measurements for the various agro-ecological zones, resulting in similar duration of the rainy season. The average duration of the rainy season were less than 200 days for the savannah and coastal zones whereas the duration of the rainy season were beyond 200 days for the forest and transition zones. The bias of these comparisons was less than 30 days and the root mean square error (RMSE) values were less than 15 days for all stations, except Saltpond. The Pearson’s correlation (r) typically ranged between 0.4 and 0.8. However, negative correlations were observed for Tamale in the savannah zone, and the entire coastal zone. These findings are indications that RegCM4 has the potential to clearly simulate the movement of the rain belt, and thus, could fairly determine the onset, cessation and duration of the rainy season. The findings have significant contributions to effective water resource management and food security in Ghana, as the thriving of these sectors depend on the dynamics of the rainfall seasons.

Mining twitter to understand the smoking cessation barriers

Smoking cessation is challenging and lack of positive support is a known major barrier to quitting cigarettes.Previous studies have suggested that social influences might increase smokers' awareness of social norms for appropriate behavior,which might lead to smoking cessation.Although social media use is increasing among young adults in the United States,research on the relationship between social media use and smoking cessation is lacking.Twitter has provided a rich source of information for researchers,but no overview exists as to how the field uses Twitter in smoking cessation research.To the best of our knowledge,this study conducted a data mining analysis of Twitter to assess barriers to smoking cessation.In conclusion,Twitter is a cost-effective tool with the potential to disseminate information on the benefits of smoking cessation and updated research to the Twitter community on a global scale.

Use of systems change and health information technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare

Despite the availability of effective treatments and recommendations for systems change, full application of the USPublic Health Service clinical practice guideline for the treatment of tobacco use is seldom achieved. The present report describes a comprehensive, structured approach used to implement the guideline and to integrate evidence-based cessation services into a system for delivery of health care. The PRECEDE-PROCEDE model and systems strategies were employed to design and implement the Tobacco Control Initiative (TCI), which provides evidence-based cessation services for the patients of a statewide public hospital system. For the TCI, multi-level assessments, pilot programs, electronic data collection, and performance feedback were needed to produce system-wide changes in workflow and in the quality of care for tobacco users. Although there are advances in health information technology (HIT), systems approaches are required for responding effectively to the Health Information Technology for Economic and Clinical Health (HI-TECH) Act and to standards governing use of electronic data related to treatment of tobacco use and dependence.

Pattern of smoking cessation and its associated factors in Vietnam

Background: Even though the number of research on tobacco in Vietnam has recently increased rapidly, there remains a lack of reporting on the pattern of quit smoking and its correlates. It is necessary to have scientific evidence on this issue to help the policy makers and the Public Health sector to have appropriate intervention program to enhance the smoke cessation smoke program and improve the health status of the smokers. This study aims to: (1) Describe the pattern of smoking cessation in Vietnam 2010. (2) Examine the association between smoking cessation with some associated factors in Vietnam 2010. Methods: Data used in this paper were obtained from the Global Adult Tobacco Survey (GATS) conducted in Vietnam in 2010. A total of 11,142 households were selected for this survey using a two-phase sampling design analogous to a three-stage stratified cluster sampling. Both descriptive and analytical statistical analyses were carried out. Multivariate logistic regression modeling was performed to examine the association between the patterns of quit daily;quit smoke;attempt to quit and intend to quit among smokers with relevant factors. Results: The prevalence of the different type of cessation among male and female were 23.3% and 28.6% for quit daily;19.1% and 1.0% for quit;55.6% and 44.4% for attempt to quit and 29.6% and 19.3% for intend to quit respectively. The prevalence of quit daily and quit increased with age whereas attempt to quit decreased with age. Prevalence of cessation was highest among the group who were asked about smoking tobacco by health care providers. Some determinants of quit daily and quit include age, area, and knowledge of illnesses caused by smoking. There was no association between attempt and intend to quit with any socio-characteristic except for area. People in rural area were 2.1 and 1.7 times more likely attempt to quit and intend to quit than those in urban area, respectively. Conclusion: The GATS Vietnam 2010 showed that the prevalence of cessation in Vietnam was low. Quit daily and quit had association with age, area, knowledge about the top three consequences of smoke. People in rural area were 2.1 and 1.7 times more likely attempt to quit and intend to quit than those in urban area, respectively.

Comparison of characteristics among Korean American male smokers between survey and cessation studies

This study compared characteristics of Korean American men in two studies: a telephone survey with a random sample of Korean American men who reported daily smoking versus a smoking cessation clinical trial with a convenience sample of Korean American men who reported smoking at least 10 cigarettes a day. Guided by the Theory of Planned Behavior (TPB), both studies attempted to explain how much its theoretical variables (attitudes, perceived social norms, and self-efficacy) would explain quit intentions in Korean American men. Participants in the cessation study were less likely to have health insurance coverage (χ2 [2, 271] = 138.31, p = 0.001) than those in the survey study. The cessation group was more likely to smoke in indoor offices (χ2 [1, 231] = 18.09, p = 0.003) and had higher nicotine dependence than the survey group (t269 = 3.32, p = 0.001) but these differences became insignificant when only those who smoked 10 or more cigarettes were compared. Participants in the cessation study had more positive attitudes towards quitting (t267 = 4.99, p < 0.001), stronger perceived social norms favoring quitting (t269 = 5.63, p t268 = 9.86, p < 0.001) at baseline than those in the survey study. Korean American men are more likely to have a quit intention and make a quit attempt when they have more positive and fewer negative attitudes towards quitting and perceive stronger social norms favoring quitting. To motivate Korean American men to quit smoking, clinicians should underscore the immediate health benefits of quitting, promote quitting with cessation aids to reduce perceived risks of quitting in anticipation of withdrawal symptoms, and encourage family members to relate firm anti-smoking messages.

Plain cigarette packaging: A policy analysis of Australia’s integrated “whole-of-system” model for smoking cessation

Introduction: Plain cigarette packaging as a tobacco control measure is to be implemented in Australia on December 1st 2012. There is mounting evidence for its likely impact on smokers and potential smokers. Yet Australia’s integrated model of smoking cessation and the particular role and opportunities it has created for primary healthcare have not yet been subject to policy analysis in leading international journals. This policy analysis paper explores these new Australian policy developments and debates in ways that identify their international relevance to primary healthcare. Policy analysis: There are 57 studies about plain cigarette packaging published since 2002. Of these, 27 looked at the impact of health warnings. These studies support the introduction of plain packaging as a tobacco control measure, by increasing the efficacy of health warnings and reducing misconceptions about cigarettes. However, the Australian tobacco control reforms are not limited to plain cigarette packaging. They include other evidence-based tobacco control measures as part of its primary health care strategy: for example, increasing tobacco excises, a mass media campaign focusing on high-risk and hard-to-reach groups, and a national summit on smoking in prisons. The Australian government has acknowledged the key role of primary health care in health promotion activities, establishing a network of regional primary health care organisations (“medicare locals”) in 2011-2012, and expanding the role of nurses in general practice. These initiatives offer general practice a chance to seize “golden opportunities to intervene with smoking patients”. Conclusions: Whether the combined impact of the Australian government’s recent tobacco control reforms and its previous measures will be sufficient to reduce daily smoking prevalence to 10% or less by 2020, only time will tell. What is more certain is that the Australian experience of plain packaging offers international colleagues in general practice key lessons about the importance of “whole-of-system” approaches, integrating efforts at the local to national levels, to tackle smoking cessation. The achievement of Australia’s political leaders in plain cigarette packaging is an extraordinary testament to political will but there is no room for complacency. Primary healthcare sectors must continue to lobby political leaders around the world to tackle smoking at the system level where the motivations and beliefs about smoking are being shaped, especially among disadvantaged groups with lower health literacy.

Effects Assessment of Auricular Acupuncture and Group Counseling for Smoking Cessation in Senior High School Students

Smoking is a serious public health problem since it harms not only the smokers but also other people in touch with the smokers.Many obstinate illnesses such as cancer,chronic obstructive pulmonary disease,cardiovascular disease are now be proven to be related to smoking itself.To help young smokers,particularly adolescent,quitting smoking can prevent more tobacco use.Some studies showed auricular acupuncture(AA)is increasingly used to treat chemical dependency and withdrawal symptoms based as it’s safe and effective.Moreover,group counseling can motivate young adults to set a quit date and strengthen their belief in quitting smoking via peer effects.The present study evaluates the effects of a 8-week smoking cessation courses consisting of AA and group counseling once per week on senior high school students aged from 15 to 18.The AA treatment was administrated at both side of ears on a weekly basis for six weeks.Clinicians gave an intensive counseling session assessing the readiness to quit,exploring smoking habits,and identifying barriers to smoking cessation and relapsing factors.Before each intervention,the 23 participants completed questionnaires and offered levels of carbon monoxide exhalation.The participants showed significant differences in levels of carbon monoxide exhalation,daily tobacco consumptions,reduction in the taste of tobacco and intensity of the desire to smoke after 6-week consecutive sessions.However,the smoking cessation success was only three cases(13%).Given limited and uncertain efficacy of AA for smoking cessation,though it’s non-invasive and safe,it’s better to combine AA with other methods not only for synergistic effects but also better smoking cessation success rate.

Frequency of smoking cessation interventions from health care providers in Minnesota

Objective: There is strong evidence supporting the impact of health care provider advice on patients’ smoking behavior. This paper examines adult smoker reports of health care provider smoking cessation interventions. Design: The 2010 Minnesota Adult Tobacco Survey (MATS) is a random digit dial telephone survey with 7057 Minnesota adults. Both landline and mobile telephone samples were included. These samples were combined and weighted to represent the population of adults in Minnesota. Results: Among adult Minnesotans, 16.1% were current smokers, 80.9% reported seeing a health care provider in the past 12 months and 80.2% of those adults were asked if they smoke. Among smokers who saw any provider in the past 12 months, 94.4% reported they were asked about smoking and 71.8% were advised not to smoke. In contrast, 43.9% of smokers received referrals from a health care provider and among those, 37.5% were recommended medications and 24.8% were referred to a quit smoking program. Conclusion: Given the large body of evidence supporting cessation interventions by health care providers, the increase in use of electronic medical records and the availability and success of evidence-based cessation programs, efforts to improve rates of identifying and treating each tobacco user are needed. Further research is needed to explore how cessation intervention responsibilities can be shared among the clinical team and integrated into ongoing clinical care.

Geographical Analysis of Smoking in Leeds: A GIS-Based Location-Allocation Technique for the Optimal Location of Smoking Cessation Services

Smoking is associated with several illnesses in the UK. Smoking rate in Leeds is higher than the national average. Finding optimal locations for stop-smoking services will be a good place to start in reducing smoking rates. The study utilizes a GIS-Based location-allocation method for the optimal distribution of smoking cessation centres in relation to the spatial distribution of the smoking population in Leeds. The demand for the smoking cessation clinics was estimated based on the 2009 General Life Style (GLS) statistics on age and social class stratification of smoking rates for the UK. Leeds specific rates were then obtained from the 2001 census key statistics data on socioeconomic status and age structure for output areas via Census Area Statistics Website (CASWEB). The research findings show that spatial inequalities in smoking rate exist in output areas of Leeds. Poorer and non-skilled populations are demonstrated to have higher smoking rates compared with wealthier neighbourhoods. The study confirms the capability of GIS-Based location-allocation techniques to be useful modelling tools for determining the best locations for health facilities. The model allocates services in relation to the spatial patterns of demand in a fashion that minimises average travel distance.

Enhanced physician prompts in prenatal electronic medical records impact documentation on smoking cessation

Objective: Smoking cessation during pregnancy is a modifiable intervention that can improve maternal and neonatal outcomes. Encouraging smoking cessation is an assessed measure of the Meaningful Use incentives to ensure best practices with the increased use of the electronic medical record (EMR). Physician EMR prompts have been used shown to be successful with preventive care but there is a paucity of data evaluating prompts within obstetrics. The objective of this study is to determine the effectiveness of enhanced smoking cessation prompts in a prenatal EMR. Methods: A retrospective cohort study of an enhanced smoking cessation prompting system within our prenatal EMR was performed. Pregnant women who reported tobacco use at first prenatal visit were included. The number of times a smoking cessation method was offered and documented, the number of documented attempts at smoking cessation, and the final number of cigarettes smoked were compared pre and post the enhancement of the smoking cessation prompting system. Results: 95 patients were included (48 pre-enhancement;47 post-enhancement). Post-enhancement, the documentation of smoking cessation method offered increased (0 vs. 1, p = 0.03) and documentation of smoking cessation attempts increased (1 vs. 2, p = 0.006). There was no change in the final number of cigarettes smoked (p = 0.9). Conclusions: Enhanced prompting systems increase documentation related to smoking cessation with no change in number of cigarettes smoked. In the era of Meaningful Use guidelines which focus on documentation in the EMR, continued research must be done to assure that software enhancements and improved documentation truly result in improved patient care.

A Comparative Study for Successful Treatment per Gender in a Specialized Smoking Cessation Unit in the Albacete University Hospital during Two Years

Objective： Analysis of abstinence rates of smokers per gender at 3, 6, 9 and 12 months in a Smoking Cessation Unit from January 2008 to December 2009. Methods： Descriptive retrospective study. Analysis of socio-demographic variables, smoking patterns, associated comorbidities, continuous abstinence rates, success, relapses, failure and dropping out. Results： 278 smokers started treatment （33%）; 55.4% males and 44.6% females （mean age of 48.3 and 44.06 years, respectively）. The main associated comorbidities were： psychiatric （38.7%）, cardiovascular （dyslipemia 25%） and respiratory （COPD （chronic obstructive pulmonary disease） 9.7%） in females; cardiovascular （dyslipemia 34.4%）, psychiatric （34.4%） and respiratory （COPD 19.5%） in males. VRN （Varenicline） was prescribed in 40.2% males and 32.2% females; NRT （nicotine replacement therapy） was used in 46.6% and 38.7%, respectively; bupropion was employed in 6.5% and 21.8%, respectively. Psychological counseling was offered only to 7.8% males and 8.1% females. The continuous abstinence rates in males at 3, 6, 9 and 12 months were 51.3%, 37.7%, 32.5% and 30.5%, respectively, and were 45.2%, 29.8%, 25.0% and 24.2% for females. Failure was 9.7% for females and 18.8% for males. Success was more frequent for those on VRN （n = 41 males; n = 12 females）. No relapses were indicated for 42 females and 71 males. The percentage of relapses was higher at 3 months （29.0% females, 19.5% males）. Conclusions： The study observed differences in treating abstinence between genders （in the abstinence rates and failure index）. This implies having to consider incorporating the gender variable into the diagnosis, treatment and prevention of smoking.