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The Cochrane Database of Systematic... Nov 2017Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.
OBJECTIVES
To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.
SEARCH METHODS
We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.
SELECTION CRITERIA
We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.
MAIN RESULTS
Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.
AUTHORS' CONCLUSIONS
There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.
Topics: Adolescent; Antidepressive Agents, Second-Generation; Bupropion; Cognitive Behavioral Therapy; Controlled Clinical Trials as Topic; Counseling; Humans; Randomized Controlled Trials as Topic; Tobacco Use Cessation; Tobacco Use Cessation Devices; Young Adult
PubMed: 29148565
DOI: 10.1002/14651858.CD003289.pub6 -
The Cochrane Database of Systematic... Mar 2017Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Individual counselling from a smoking cessation specialist may help smokers to make a successful attempt to stop smoking.
OBJECTIVES
The review addresses the following hypotheses:1. Individual counselling is more effective than no treatment or brief advice in promoting smoking cessation.2. Individual counselling is more effective than self-help materials in promoting smoking cessation.3. A more intensive counselling intervention is more effective than a less intensive intervention.
SEARCH METHODS
We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with counsel* in any field in May 2016.
SELECTION CRITERIA
Randomized or quasi-randomized trials with at least one treatment arm consisting of face-to-face individual counselling from a healthcare worker not involved in routine clinical care. The outcome was smoking cessation at follow-up at least six months after the start of counselling.
DATA COLLECTION AND ANALYSIS
Both authors extracted data in duplicate. We recorded characteristics of the intervention and the target population, method of randomization and completeness of follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically-validated rates where available. In analysis, we assumed that participants lost to follow-up continued to smoke. We expressed effects as a risk ratio (RR) for cessation. Where possible, we performed meta-analysis using a fixed-effect (Mantel-Haenszel) model. We assessed the quality of evidence within each study using the Cochrane 'Risk of bias' tool and the GRADE approach.
MAIN RESULTS
We identified 49 trials with around 19,000 participants. Thirty-three trials compared individual counselling to a minimal behavioural intervention. There was high-quality evidence that individual counselling was more effective than a minimal contact control (brief advice, usual care, or provision of self-help materials) when pharmacotherapy was not offered to any participants (RR 1.57, 95% confidence interval (CI) 1.40 to 1.77; 27 studies, 11,100 participants; I = 50%). There was moderate-quality evidence (downgraded due to imprecision) of a benefit of counselling when all participants received pharmacotherapy (nicotine replacement therapy) (RR 1.24, 95% CI 1.01 to 1.51; 6 studies, 2662 participants; I = 0%). There was moderate-quality evidence (downgraded due to imprecision) for a small benefit of more intensive counselling compared to brief counselling (RR 1.29, 95% CI 1.09 to 1.53; 11 studies, 2920 participants; I = 48%). None of the five other trials that compared different counselling models of similar intensity detected significant differences.
AUTHORS' CONCLUSIONS
There is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit. There is moderate-quality evidence of a smaller relative benefit when counselling is used in addition to pharmacotherapy, and of more intensive counselling compared to a brief counselling intervention.
Topics: Behavior Therapy; Counseling; Humans; Psychotherapy, Group; Randomized Controlled Trials as Topic; Self-Help Groups; Smoking; Smoking Cessation; Smoking Prevention; Tobacco Use Cessation Devices
PubMed: 28361496
DOI: 10.1002/14651858.CD001292.pub3 -
Progress in Cardiovascular Diseases 2017Although healthy lifestyles (HL) offer a number of health benefits, nonadherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing... (Review)
Review
Although healthy lifestyles (HL) offer a number of health benefits, nonadherence to recommended lifestyle changes remains a frequent and difficult obstacle to realizing these benefits. Behavioral counseling can improve adherence to an HL. However, individuals' motivation for change and resistance to altering unhealthy habits must be considered when developing an effective approach to counseling. In the present article, we review psychological, behavioral, and environmental factors that may promote adherence and contribute to nonadherence. We discuss two established models for counseling, motivational interviewing and the transtheoretical model of behavior change, and provide an example of how these approaches can be used to counsel patients to exercise and increase their levels of physical activity.
Topics: Counseling; Exercise; Health Behavior; Health Promotion; Healthy Lifestyle; Humans; Life Style; Patient Compliance
PubMed: 27640186
DOI: 10.1016/j.pcad.2016.09.003 -
PloS One 2021Pediatric providers play an important role in parental and youth smoking cessation. The goal of this study was to understand smoking cessation attitudes of parents and...
OBJECTIVE
Pediatric providers play an important role in parental and youth smoking cessation. The goal of this study was to understand smoking cessation attitudes of parents and the behaviors, confidence and self-efficacy of pediatricians related to providing smoking cessation counseling to parents and youth.
METHODS
A mixed methods study was conducted in a convenience sample of families (n = 1,549) and pediatric primary care clinicians (n = 95) in Connecticut using surveys and focus groups from April, 2016 to January, 2017.
RESULTS
The smoking rate (cigarettes or electronic cigarettes) among all households surveyed was 21%. Interest in quitting smoking was high (71%) and did not differ based on smoking amount, duration, type of community of residence (urban, rural, etc), or race/ethnicity. For example, compared to participants who smoked for <10 years, those who smoked ≥20 years had a similar interest in quitting (OR = 1.12; 95% CI: 0.85-1.48). Ninety percent of clinicians surveyed asked parents about their smoking behavior at least annually but 36% offered no smoking cessation counseling services or referral. Clinicians almost always reported counseling youth about the dangers of nicotine and tobacco use (99%), were more confident about counseling youth than parents (p<0.01) and reported low self-efficacy about smoking cessation and prevention counseling of parents and youth. Ninety-three percent of clinicians opined that electronic cigarettes were equally or more dangerous than cigarettes but 34% never counseled youth about the dangers of electronic cigarettes.
CONCLUSIONS
Clinicians frequently screen parents about their smoking behaviors, but rarely provide smoking cessation counseling and express low confidence in this activity. Clinicians are more confident counseling youth than parents. Clinicians also recognize the dangers of electronic cigarettes, yet they infrequently counsel youth about these dangers.
Topics: Adult; Counseling; Electronic Nicotine Delivery Systems; Female; Humans; Male; Middle Aged; Parents; Pediatricians; Primary Health Care; Smoking Cessation; Surveys and Questionnaires
PubMed: 33561136
DOI: 10.1371/journal.pone.0246231 -
Fertility and Sterility Jan 2019The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address... (Review)
Review
The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals. Counseling can begin with the following question: "Would you like to become pregnant in the next year?" Prepregnancy counseling is appropriate whether the reproductive-aged patient is currently using contraception or planning pregnancy. Because health status and risk factors can change over time, prepregnancy counseling should occur several times during a woman's reproductive lifespan, increasing her opportunity for education and potentially maximizing her reproductive and pregnancy outcomes. Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before pregnancy. Counseling patients about optimal intervals between pregnancies may be helpful to reduce future complications. Assessment of the need for sexually transmitted infection screening should be performed at the time of prepregnancy counseling. Women who present for prepregnancy counseling should be offered screening for the same genetic conditions as recommended for pregnant women. All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons. Screening for intimate partner violence should occur during prepregnancy counseling. Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of neural tube defects.
Topics: Counseling; Diagnostic Techniques, Obstetrical and Gynecological; Female; Humans; Preconception Care; Pregnancy; Risk Factors
PubMed: 30611411
DOI: 10.1016/j.fertnstert.2018.12.003 -
Obstetrics and Gynecology Sep 2022To investigate women's preferences and experiences regarding health counseling of safe sexual enrichment aid use and hygiene and current counseling behaviors of medical...
OBJECTIVE
To investigate women's preferences and experiences regarding health counseling of safe sexual enrichment aid use and hygiene and current counseling behaviors of medical practitioners on this topic.
METHODS
This study used mixed methodology, leveraging quantitative data from a cross-sectional survey of 800 women and semi-structured qualitative interview data from 24 women across sexual practice groups. Additionally, we conducted a cross-sectional survey of 192 medical practitioners to understand current counseling behaviors and attitudes.
RESULTS
The majority of women (96.2%, 607/631) had never been counseled by a practitioner on safe sexual enrichment aid use and hygiene but would feel comfortable receiving counseling on the subject under certain circumstances. Overwhelmingly, women indicated the need for a nonjudgmental practitioner. Many cited the importance of having a female practitioner and preferred one within obstetrics and gynecology. Among medical practitioners, counseling on this topic was infrequent; 27.0% (52/192) stated that they counsel patients on safe sexual enrichment aid use and hygiene when discussing safe sex, and 21.4% (41/192) reported that this topic is included when counseling women after a sexually transmitted infection diagnosis. Only 7.4% (14/188) and 6.4% (12/188) had received training on this topic or were aware of any professional guidelines or recommendations, respectively.
CONCLUSION
Evidence-based guidelines should be developed that practitioners can use to counsel patients, ensuring that women are able to engage in sexual enrichment aid use safely.
Topics: Female; Humans; Pregnancy; Counseling; Cross-Sectional Studies; Gynecology; Obstetrics; Sexual Behavior
PubMed: 35926212
DOI: 10.1097/AOG.0000000000004892 -
American Family Physician Oct 2013Given that nearly one-half of pregnancies are unintended, preconception care should be considered an integral part of primary care for women of reproductive age. Common... (Review)
Review
Given that nearly one-half of pregnancies are unintended, preconception care should be considered an integral part of primary care for women of reproductive age. Common issues in preconception care include family planning, achieving a healthy body weight, screening and treatment for infectious diseases, updating appropriate immunizations, and reviewing medications for teratogenic effects. Women who want to become pregnant should take folic acid supplements to reduce the risk of neural tube defects. Control of chronic diseases is essential for optimizing pregnancy outcomes. Family physicians should work with patients to control conditions such as diabetes mellitus, hypertension, and seizure disorders while simultaneously offering family planning services to avoid unintended pregnancies. Bariatric surgery is increasingly common and may improve fertility in many women with previous insulin resistance. Family physicians should counsel women undergoing bariatric surgery to prevent pregnancy during rapid weight loss and provide assistance with contraception. In addition, patients have special nutritional requirements after bariatric surgery.
Topics: Chronic Disease; Counseling; Female; Humans; Maternal Nutritional Physiological Phenomena; Preconception Care; Primary Health Care; Women's Health
PubMed: 24364570
DOI: No ID Found -
Inquiry : a Journal of Medical Care... 2021The purpose of this study is to investigate the effects of an infertility counseling education program on education satisfaction and counseling competency of nurses. The...
The purpose of this study is to investigate the effects of an infertility counseling education program on education satisfaction and counseling competency of nurses. The study used a one-group pretest-posttest design. Participants were 135 nurses in Korea. Data on demographic characteristics on education satisfaction, and counseling competency were collected. After participating in the infertility counseling education program, the level of counseling competency increased significantly over that before participating in the infertility counseling education program. The infertility counseling education program improved the counseling competency of the participating nurses. Use of such an infertility counseling education program is recommended when nurses counsel patients facing infertility. It is necessary to repeat this study in the future to clarify the effects of these counseling education programs.
Topics: Counseling; Humans; Infertility; Personal Satisfaction; Republic of Korea
PubMed: 34866442
DOI: 10.1177/00469580211059997 -
Canadian Family Physician Medecin de... May 1995Many medical visits are generated by psychosocial problems or their symptoms. Every family physician, therefore, should have counseling skills despite constraints of... (Review)
Review
Many medical visits are generated by psychosocial problems or their symptoms. Every family physician, therefore, should have counseling skills despite constraints of time and training. This article discusses issues such as the characteristics of effective therapists, the limitations of the medical model, the core role of self-esteem in anxiety and depression, and the importance of purpose and meaning to physical and mental health.
Topics: Counseling; Family Practice; Humans; Life Change Events; Models, Psychological; Physician-Patient Relations; Psychotherapy
PubMed: 7756919
DOI: No ID Found -
Pediatrics Dec 2017The US Preventive Services Task Force recommends clinical counseling for individuals ages 10 to 24 years to decrease skin cancer risk.
BACKGROUND
The US Preventive Services Task Force recommends clinical counseling for individuals ages 10 to 24 years to decrease skin cancer risk.
METHODS
A national, random sample of US American Academy of Pediatrics members practicing primary care in 2002 (response rate 55%) and 2015 (response rate 43%). Surveys explored attitudes and experiences regarding sun protection counseling; indoor tanning questions were added in 2015. χ tests compared demographics and counseling responses across years, and multivariable logistic regression models examined counseling predictors.
RESULTS
More pediatricians in 2015 (34%) than in 2002 (23%) reported discussing sun protection during recent summer months with ≥75% of patients. This pattern held across all patient age groups (each <.001). Female and suburban pediatricians counseled more; those in the South and West counseled less. More pediatricians in 2015 than in 2002 named time as a barrier. Sun protection ranked lowest among preventive topics in both years. In 2015, approximately one-third of pediatricians reported discussing indoor tanning at least once with 10 to 13 year-old patients; approximately half discussed this with older adolescents. Most (70%) did not know if their states had laws on minors' indoor tanning access; those stating they knew whether a law existed counseled more.
CONCLUSIONS
Although improved, sun protection counseling rates remain low. Indoor tanning counseling can be improved. Because early-life exposure to UV radiation increases risk and clinician counseling can positively impact prevention behaviors, pediatricians have an important role in skin cancer prevention; counseling may save lives. Time constraints remain a barrier.
Topics: Adult; Aged; Counseling; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Skin; Skin Neoplasms; Sunbathing; Sunburn; Surveys and Questionnaires; United States
PubMed: 29127209
DOI: 10.1542/peds.2017-1680