Nurses Could Help Cut Smoking Rates In China

As non-smokers, nurses can play a bigger role in stopping the smoking epidemic in China, research suggests.

AsianScientist (Oct. 29, 2015) – To curb smoking in China, researchers have tapped into the role played by nurses to encourage smokers to quit. They have designed a web-based educational program to educate and empower nurses to help their patients quit smoking. Results of this study was published in two back to back papers in Journal of Advanced Nursing.

China has a big smoking problem. 350 million Chinese people smoke and one million deaths a year in China are attributed to smoking-related illnesses. By 2020, that is expected to double to two million Chinese people dying annually from consuming tobacco.

Smoking is such an accepted part of the Chinese culture that even 23 percent of physicians smoke. However, the smoking rate among the female population of nurses is very low, mirroring the general female population. Could nurses be the solution to getting Chinese smokers to quit?

An international team of investigators led by Linda Sarna, interim dean of the UCLA School of Nursing, and Stella Aguinaga Bialous, associate professor in the UC-San Francisco School of Nursing, have found that nurses can play a pivotal role in helping smokers to quit. But in order to do so, they need knowledge and skills.

“As non-smokers, nurses [are] in a stronger position to engage in smoking cessation interventions with patients [compared to] their physician colleagues who are more likely to smoke,” Sarna said. “But first we needed to understand how frequently nurses were trying to help patients quit.”

In the first study, researchers surveyed more than 2,000 nurses from eight hospitals in Beijing and Hefei. They found while 64 percent of nurses asked patients whether they smoked and 85 percent advised patients who smoked to quit, only 17 percent of nurses arranged for follow-up. Yet, when asked whether they should be involved in tobacco control, nearly 90 percent of nurses said that believed they could play a critical role in tobacco control.

“With these results, we developed a web-based educational smoking cessation program to give nurses across China the necessary tools to support a smoker’s efforts to quit,” Sarna said.

The results of the first study allowed investigators to create the first long-distance, web-based learning education program in China focused on smoking cessation. Using a model based on previous studies conducted in the United States, a native Mandarin speaker recorded the webcast using a script that was reviewed and validated by Chinese collaborators.

The content included the impact of health on smoking and exposure to second-hand smoke in China, data on prevalence of tobacco use, information on nicotine addiction and withdrawal, and evidence-based interventions that can be used by nurses to help patients quit.

All of the survey participants were sent an invitation with a link to the webcast, 1,400 of whom provided follow up data. Nurses were asked at three and six months whether there were changes in their practice. At three-months, 84 percent reported viewing the webcast.

Results from the second survey showed that six months after participating in the educational program, nurses reported they were more likely to assist with a quitting plan, and recommend a smoke-free home environment. There was also significant improvement in attitudes about tobacco control. The majority of nurses felt they should be non-smoking role models and that they should help patients quit smoking.

“This is the first time a web-based, distant-learning educational program on smoking cessation interventions targeting Chinese nurses was implemented and evaluated,” Sarna said. “Our study showed that it is feasible to use a long-distance, web-based learning education to increase nurses’ delivery of smoking interventions.”

“In the long-term, we know that all healthcare professionals need to be educated about evidence-based smoking cessation strategies,” Bialous added. “While most nursing schools include curriculum about the dangers of tobacco, few currently include smoking cessation interventions in their curriculum.”

Smoking is still considered a normal part of everyday life in China. According to studies published in The Lancet in 2012, the cultural acceptance of smoking is a strong barrier to success as is the power of the tobacco industry in China. Forty-two percent of the world’s cigarettes are produced in China and tobacco companies contribute almost 10 percent to central government revenues.

“More environments in China are becoming smoke-free, as recently announced in Beijing. We expect that there will be an increased demand for smoking cessation services,” Sarna said. “With the right intervention education, nurses will be positioned to play a significant role in reducing smoking rates in China.”

The educational program is available online at the International Society of Nurses in Cancer Care website and can be used to provide nurses in China with basic evidence-based knowledge and skills for smoking cessation interventions.

The articles can be found at:
Sarna et al. (2015) Helping Smokers Quit: Behaviours and Attitudes of Chinese Registered Nurses.
Sarna et al. (2015) Evaluation of a Web-Based Educational Programme on Changes in Frequency of Nurses’ Interventions to Help Smokers Quit and Reduce Second-Hand Smoke Exposure in China.


Source: University of California-Los Angeles; Photo: Morgan/Flickr/CC.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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