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Targeting Smoking Triggers: A Nurse-led Intervention for Tobacco Smoking Cessation

*Sadeq Al-Fayyadh  -  College of Nursing, University of Baghdad, Iraq
Ali Hussein Alek Al-Ganmi orcid scopus publons  -  Department of Adult Nursing, College of Nursing, University of Baghdad, Iraq
Musaab Majid Abdulwahhab  -  College of Nursing, University of Baghdad, Iraq
Shaymaa Mohammed Hussein  -  College of Nursing, University of Baghdad, Iraq
Linda Cook  -  Kramer School of Nursing, Oklahoma City University, United States
Abdulellah Al-Solais  -  College of Applied Medical Sciences, Shaqra University, Saudi Arabia
Mayada Sabri  -  College of Education for Pure Science- Ibn Al-Haitham, University of Baghdad, Iraq
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Background: Nursing interventions tailored to the smoking triggers in patients with non-communicable chronic diseases are essential. However, these interventions are scant due to the nature of factors associated with smoking cessation and the poor understanding of the effect of nurse-led intervention in Iraq.

Purpose: This study aimed to determine the dominant smoking triggers and examine the effects of a tailored nursing intervention on smoking behavior in patients with non-communicable chronic diseases.

Methods: Convenience samples of 128 patients with non-communicable chronic diseases, male and female patients, who were 18-70 years old, were recruited in this quasi-experimental, randomized comparative trial in the outpatient clinic in one major teaching hospital in Baghdad City, Iraq. The intervention included simple yet specific instructions that were given both orally and in written form to the study samples to enable them to manage their craving to smoke for 6 weeks. The smoking triggers were assessed using Why Do You Smoke questionnaire. Participants were randomly allocated to receive either the nurse-led intervention or standard care. Data were analyzed using descriptive statistics, independent sample t-tests, logistic regression, and two-sided tests.

Results: Stress reduction was the dominant smoking trigger among subjects. The percentage of participants who were either able to completely quit smoking or reduce the number of smoked cigarettes per day (n=19, 29.7%; n=28, 43.8%, respectively) was greater in the study group than those in the control group (n=5, 5.8%; n=5, 5.8%, respectively). Study findings demonstrated significant differences in the inability to improve readiness to quit smoking between the intervention group and control group (p=0.000) at the sixth-week follow-up.

Conclusion: The tailored nursing intervention was effective for a successful achievement of smoking reduction and cessation among patients with non-communicable chronic diseases, and a potential to equip nurses in clinical settings to support patients to achieve this is recommended.  

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Keywords: Nurse-led intervention; randomized control trial; smoking cessation; tobacco triggers
Funding: None

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  1. Agency for Healthcare Research and Quality. (2012). Five major steps to intervention (The "5 A's"). Agency for Healthcare Research and Quality.
  2. AL-Fayyadh, S., & Diener, E. (2017). Determinants of patient's decision-making in seeking care when experiencing stroke-associated warning signs. New Trends and Issues Proceedings on Humanities and Social Sciences, 4(2), 257-266. 10.18844/prosoc.v4i2.2756
  3. AL‐Fayyadh, S., & Mohammed, W. (2010). Patients' knowledge about chronic diseases towards risk factors and warning signs of stroke. Iraqi National Journal of Nursing Specialties, 2(23), 1-14
  4. Alexis-Garsee, C., Gilbert, H., Burton, M., & van den Akker, O. (2018). Difficulties quitting for smokers with and without a respiratory disease and use of a tailored intervention for smoking cessation–a qualitative study. Journal of Smoking Cessation, 13(2), 63-71. 10.1017/jsc.2017.5
  5. Almallah, N. A, Al Alwan, N. A. S., Al Attar, W. M., & Hassoun, T. K. (2018). Evaluation of college of nursing affiliates’ knowledge about lung cancer and its relationship with smoking. Iraqi National Journal of Nursing Specialties, 1(30), 108-116.
  6. Alnaqeeb, N., Abdul Raheem, Y., & Ali, B. M. (2022). Health-related quality of life in diabetic women with comparing obese & normal weight. AL-Kindy College Medical Journal, 18(2), 136-143.
  7. Alrefaee, J., E Albalawi, A., Alanazi, S., A Althobaiti, N., Daghash, H., Abu Hasb, T., & Abusuliman, M. (2022). The predicting factors of clinical outcomes in patients with COVID-19 in the Kingdom of Saudi Arabia [KSA]: A multi-center cohort study. Journal of the Faculty of Medicine Baghdad, 64(2), 65-73.
  8. American Lung Association. (1993). Why do you smoke? National Institutes of Health (NIH) Publication No. 94-1822. American Lung Association.
  9. Beech, B. M. (2013). Chronic disease: Significant public health threat of the 21st century. Family & Community Health, 36(2), 95-96.
  10. Bergh, A.-L., Friberg, F., Persson, E., & Dahlborg-Lyckhage, E. (2015). Registered nurses’ patient education in everyday primary care practice: Managers’ discourses. Global Qualitative Nursing Research, 2, 2333393615599168.
  11. Brooks, D. R., Burtner, J. L., Borrelli, B., Heeren, T. C., Evans, T., Davine, J. A., Greenbaum, J., Scarpaci, M., Kane, J., Rees, V. W., & Geller, A. C. (2017). Twelve-month outcomes of a group-randomized community health advocate-led smoking cessation intervention in public housing. Nicotine & Tobacco Research, 20(12), 1434-1441.
  12. Brouwer-Goossensen, D., Scheele, M., van Genugten, L., Lingsma, H. F., Dippel, D. W. J., Koudstaal, P. J., & den Hertog, H. M. (2021). Motivational interviewing in a nurse-led outpatient clinic to support lifestyle behaviour change after admission to a stroke unit: A randomized controlled trial. European Journal of Cardiovascular Nursing, 21(1), 36-45.
  13. Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. M. (2018). Nursing interventions classification (NIC)-e-book. Elsevier Health Sciences
  14. Cartujano-Barrera, F., Sanderson Cox, L., Arana-Chicas, E., Ramírez, M., Perales-Puchalt, J., Valera, P., Díaz, F. J., Catley, D., Ellerbeck, E. F., & Cupertino, A. P. (2020). Feasibility and acceptability of a culturally- and linguistically-adapted smoking cessation text messaging intervention for Latino smokers [brief research report]. Frontiers in Public Health, 8, 269.
  15. Crawford, T., Roger, P., & Candlin, S. (2018). Supporting patient education using schema theory: A discourse analysis. Collegian, 25(5), 501-507. 10.1016/j.colegn.2017.12.004
  16. Eisenberg, M. J., Hébert-Losier, A., Windle, S. B., Greenspoon, T., Brandys, T., Fülöp, T., Nguyen, T., Elkouri, S., Montigny, M., Wilderman, I., Bertrand, O. F., Bostwick, J. A., Abrahamson, J., Lacasse, Y., Pakhale, S., Cabaussel, J., & Filion, K. B. (2020). Effect of e-cigarettes plus counseling vs counseling alone on smoking cessation: A randomized clinical trial. Jama, 324(18), 1844-1854.
  17. Elshatarat, R. A., Yacoub, M. I., Khraim, F. M., Saleh, Z. T., & Afaneh, T. R. (2016). Self-efficacy in treating tobacco use: A review article. Proceedings of Singapore Healthcare, 25(4), 243-248.
  18. Fanshawe, T. R., Halliwell, W., Lindson, N., Aveyard, P., Livingstone‐Banks, J., & Hartmann‐Boyce, J. (2017). Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 11(11), CD003289.
  19. Fathi, A., Nasae, T., & Thiangchanya, P. (2012). Workplace stressors and coping strategies among public hospital nurses in Medan, Indonesia. Nurse Media Journal of Nursing, 2(1), 315-324.
  20. Goodchild, M., Nargis, N., & d'Espaignet, E. T. (2018). Global economic cost of smoking-attributable diseases. Tobacco Control, 27(1), 58-64.
  21. Grove, S. K., & Gray, J. R. (2018). Understanding nursing research e-book: Building an evidence-based practice. Elsevier Health Sciences
  22. Hayes, C., Ciblis, A., Darker, C., Dougall, N., Vance, J., O’Connell, N., Dobbie, F., Loudon, K., Burke, E., Devane, D., & Bauld, L. (2019). We can quit2 (WCQ2): A community-based intervention on smoking cessation for women living in disadvantaged areas of Ireland—study protocol for a pilot cluster randomised controlled trial. Pilot and Feasibility Studies, 5(1), 138.
  23. Huddlestone, L., Shoesmith, E., Pervin, J., Lorencatto, F., Watson, J., & Ratschen, E. (2022). A systematic review of mental health professionals, patients, and carers’ perceived barriers and enablers to supporting smoking cessation in mental health settings. Nicotine & Tobacco Research, 24(7), 945-954.
  24. Ibrahim, B. A., Al-Humaish, S., & Al-Obaide, M. A. (2018). Tobacco smoking, lung cancer, and therapy in Iraq: current perspective. Frontiers in Public Health, 6, 311.
  25. Iqbal, S., Barolia, R., Ladak, L., & Petrucka, P. (2021). Smoking cessation interventions in South Asian countries: Protocol for scoping review. BMJ Open, 11(2), e038818.
  26. Kassel, J. D., Stroud, L. R., & Paronis, C. A. (2003). Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychological Bulletin, 129(2), 270-304.
  27. Le Grande, M., Balmford, J., Borland, R., & McNeill, A. (2022). Perceived health and capacity to cope with stress in recent ex-smokers: Impact of vaping versus quitting all nicotine. Nicotine & Tobacco Research, ntac252.
  28. Lee, Y., Lee, K.-S., & Kim, H. (2019). Predictors of abstinence from smoking: A retrospective study of male college students enrolled in a smoking cessation service. International Journal of Environmental Research and Public Health, 16(18), 3363.
  29. Liao, Y., Wu, Q., Kelly, B. C., Zhang, F., Tang, Y.-Y., Wang, Q., Ren, H., Hao, Y., Yang, M., Cohen, J., & Tang, J. (2018). Effectiveness of a text-messaging-based smoking cessation intervention (“Happy Quit”) for smoking cessation in China: A randomized controlled trial. PLoS medicine, 15(12), e1002713.
  30. Lopez-Olivo, M. A., Sharma, G., Singh, G., James, J., Krause, K. J., Cinciripini, P., Volk, R. J., & Suarez-Almazor, M. E. (2022). A systematic review with meta-analysis of the effects of smoking cessation strategies in patients with rheumatoid arthritis. PLoS ONE, 17(12), e0279065.
  31. Maziak, W., Taleb, Z. B., Bahelah, R., Islam, F., Jaber, R., Auf, R., & Salloum, R. G. (2015). The global epidemiology of waterpipe smoking. Tobacco Control, 24(Suppl 1), i3-i12.
  32. Meleis, A. I., & Trangenstein, P. A. (1994). Facilitating transitions: redefinition of the nursing mission. Nursing Outlook, 42(6), 255-259.
  33. Mikkelsen, B., Williams, J., Rakovac, I., Wickramasinghe, K., Hennis, A., Shin, H.-R., Farmer, M., Weber, M., Berdzuli, N., & Borges, C. (2019). Life course approach to prevention and control of non-communicable diseases. BMJ, 364, I257.
  34. Miller, E. T., & Spilker, J. (2003). Readiness to change and brief educational interventions: successful strategies to reduce stroke risk. Journal of Neuroscience Nursing, 35(4), 215-222. 10.1097/01376517-200308000-00009
  35. Netemeyer, R. G., Burton, S., Andrews, J. C., & Kees, J. (2016). Graphic health warnings on cigarette packages: The role of emotions in affecting adolescent smoking consideration and secondhand smoke beliefs. Journal of Public Policy & Marketing, 35(1), 124-143.
  36. Pender, N. (1996). Health Promotion in nursing practice II (3rd ed.). Appleton and Lange
  37. Perski, O., West, R., & Brown, J. (2022). Estimated failure to report unsuccessful quit attempts by type of cessation aid: A population survey of smokers in England. Journal of Smoking Cessation, 2022, 5572480.
  38. Phang, K. F., Santosa, A., Low, B. P. L., Tan, P. S. H., Khong, Z. W., Lim, A. Y. N., Teng, G. G., & Tay, S. H. (2020). A nurse-led, rheumatologist-assisted telemedicine intervention for dose escalation of urate-lowering therapy in gout. International Journal of Rheumatic Diseases, 23(9), 1136-1144.
  39. Pleym, K., Sverre, E., Weedon-Fekjaer, H., Kahlon, M., Husebye, E., Tonstad, S., Dammen, T., Munkhaugen, J., & NORCOR Research Group. (2022). Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: A randomised pilot study. European Heart Journal, 43(Supplement_2).
  40. Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48.
  41. Puleo, G. E., Borger, T., Bowling, W. R., & Burris, J. L. (2022). The state of the science on cancer diagnosis as a “teachable moment” for smoking cessation: A scoping review. Nicotine & Tobacco Research: Official Journal of The Society for Research on Nicotine and Tobacco, 24(2), 160–168.
  42. Rabbani, F., Shipton, L., White, F., Nuwayhid, I., London, L., Ghaffar, A., Ha, B. T. T., Tomson, G., Rimal, R., Islam, A., Takian, A., Wong, S., Zaidi, S., Khan, K., Karmaliani, R., Abbasi, I. N., & Abbas, F. (2016). Schools of public health in low and middle-income countries: An imperative investment for improving the health of populations? BMC Public Health, 16(1), 941.
  43. Rice, V. H, Heath, L., Livingstone-Banks, J., & Hartmann-Boyce, J. (2017). Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews, 12(12), CD001188.
  44. Ruiter, R. A., Kessels, L. T., Peters, G. J. Y., & Kok, G. (2014). Sixty years of fear appeal research: Current state of the evidence. International Journal of Psychology, 49(2), 63-70.
  45. Shishani, K., Graves, J. M., McGowan, P., Lockwood, W., Nystrom, M., & Barbosa-Leiker, C. (2019). Quit happens: A community clinic-based, multitiered smoking cessation intervention. Public Health Nursing, 36(6), 813-818.
  46. Siewchaisakul, P., Luh, D. L., Chiu, S. Y. H., Yen, A. M. F., Chen, C. D., & Chen, H. H. (2020). Smoking cessation advice from healthcare professionals helps those in the contemplation and preparation stage: An application with transtheoretical model underpinning in a community-based program. Tobbaco Induced Disease, 18, 57.
  47. Slopen, N., Kontos, E. Z., Ryff, C. D., Ayanian, J. Z., Albert, M. A., & Williams, D. R. (2013). Psycho-social stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: a prospective study of middle-aged adults in the United States. Cancer Causes & Control, 24(10), 1849-1863.
  48. Smith, D. W., Lee, J. T., Colwell, B., & Stevens-Manser, S. (2008). Confirming the structure of the why do you smoke? questionnaire: A community resource for adolescent tobacco cessation. Journal of Drug Education, 38(1), 85-95.
  49. Stolt, M., & Suhonen, R. (2019). Supporting individualised nursing care by nursing interventions. In Individualized Care (pp. 187-194). Springer
  50. Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273-1296.
  51. Tadzimirwa, G. Y., Day, C., Esmail, A., Cooper, C., Kamkuemah, M., Dheda, K., & van Zyl-Smit, R. (2019). Challenges for dedicated smoking cessation services in developing countries. South African Medical Journal, 109(6), 431-436.
  52. Thurgood, S. L., McNeill, A., Clark-Carter, D., & Brose, L. S. (2016). A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 18(5), 993–1001.
  53. Van den Brand, F. A., Nagelhout, G. E., Winkens, B., Chavannes, N. H., & van Schayck, O. C. P. (2018). Effect of a workplace-based group training programme combined with financial incentives on smoking cessation: A cluster-randomised controlled trial. The Lancet Public Health, 3(11), e536-e544.
  54. West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology & Health, 32(8), 1018-1036.
  55. World Health Organization. (2017). Non-communicable diseases facts sheet. World Health Organization.
  56. World Health Organization. (2019). Tobacco-key fact. World Health Organization.

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