Evidence-Based Practice to Assist Women in Hospital Settings to Quit Smoking and Reduce Cardiovascular Disease Risk

Abstract

Smoking and obesity are widely recognized cardiovascular risk factors for significant morbidity and mortality in women. Although women still smoke less than men do, smoking among women is on the increase, especially in younger women and teenagers. Reduction of cardiovascular risk through smoking cessation while maintaining weight is a major goal of intervention. The purpose of this article is to discuss best care practices for women with tobacco addiction using a 3-point integration of clinical expertise, the best available evidence gained from systematic research, and an analysis of satisfaction with care data. A model for a smoking cessation intervention with weight management content is presented using a conceptual framework of social learning theory, self-efficacy judgments, and the 4 principal sources of self-efficacy information. The specific aims of this pilot study are to (1) test the feasibility of the study methods and procedures, including subject accrual, attrition, and reliability of the instruments and protocol; (2) explore utilization of and satisfaction with the intervention; and (3) describe the impact of the intervention on primary (smoking biomarker) and secondary (weight/body mass index, depression, partner support, and smoking cessation self-efficacy temptations) outcomes. Results show that the study is feasible, but modifications are needed to improve utilization and satisfaction with care. The primary outcome showed a reduction in the smoking biomarker while maintaining weight at the 2-month follow-up. There was also improvement in skills to manage temptation situations that supported the conceptual framework. Hypotheses are presented for a future experimental study.

Profile of women who carried out smoking cessation treatment: a systematic review

“…Out of the total studies conducted in general health services, three were developed in cervical cancer prevention services, 10 , 11 , 23 two in specialized health services in women’s health, 18 , 21 and one in services that aim to decrease the risk of cardiovascular diseases. 8 In cervical cancer prevention services, most women were young average-aged, were highly level educated, were married, and were employed; two of the three studies were performed in Italy. 10 , 11 In the specialized health services in women’s health, women were young-aged and highly level educated; however, in the services aimed at decreasing the risk of cardiovascular diseases, most women were middle-aged, were highly level educated and were employed.…”

“…Dos estudos realizados em serviços de saúde geral, três foram desenvolvidos em serviços de prevenção de câncer cervical, 10 , 11 , 23 dois em serviços de saúde especializados em saúde da mulher, 18 , 21 e um em serviço que visa a diminuir o risco de doenças cardiovasculares. 8 Nos serviços de prevenção de câncer cervical a maioria das mulheres apresentavam faixa etária média jovem e alto nível educacional, exerciam atividade remunerada e eram casadas; dois dos três estudos foram realizados na Itália. 10 , 11 Nos serviços de saúde especializados em saúde da mulher, as mulheres situavam-se na faixa etária jovem e tinham um alto nível escolar; já nos serviços que visavam a diminuir o risco de doenças cardiovasculares, a maioria das mulheres estavam na meia idade, exerciam atividade remunerada e tinham alto nível educacional.…”

“…No que se refere à qualidade metodológica dos estudos, foram identificados, em sua maioria, ensaios clínicos randomizados (seis), 9 , 10 , 16 , 21 , 23 , 28 estudos de coorte (cinco) 7 , 11 , 18 , 33 , 35 e estudo descritivo exploratório 8 (um). Em alguns estudos, 7 , 18 , 33 o método não estava claro, o que gerou certa dificuldade de compreensão dos critérios de inclusão da amostra final da pesquisa.…”

A PDA Intervention to Sustain Smoking Cessation in Clients With Socioeconomic Vulnerability

“…Two studies of hospitalized clients that used content similar to the one in this study found that self-instructional diary or telephone delivery of content was not very interactive or interesting and required appointments that clients had difficulty keeping (Buchanan, El-Banna, Siedlik, White, & Wood, 2004;Buchanan & Likness, 2008). An alternative method of delivery for clients who have difficulty keeping structured appointments is the use of computer, cellular phone, or PDA technology (Fiore et al, 2008;Kwon & Chidambaram, 2000).…”

Promoting adherence to medical and lifestyle interventions for women with cardiovascular disease

“…One interesting approach is the FRIENDS-SIM (Follow-up Relationships Intended to End Smoking-Self-Instruction Manual) intervention, which uses a manual that supports patients during cravings, a key risk for smoking relapse [46]. The FRIENDS-SIM intervention found a need to further strengthen education and skills acquisition for partner support [47]. The use of technology such as a personal digital assistant could be an alternative to the manual that would allow easier use and portability [48].…”