7.10 Role of health professionals and social services

Last updated: October 2016 

Suggested citation: Greenhalgh, EM., Stillman, S., & Ford, C. 7.10 Role of health professionals and social services. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-10-role-of-general-practice-and-other-health-pro

Smoking, poor nutrition, obesity, excess alcohol use, and sedentary behaviour are increasingly seen as essential targets for intervention in general practice, hospital, and community health services as part of efforts to reduce or manage preventable ‘lifestyle’ health problems. 1 Interventions delivered by healthcare and social service providers can increase smoking cessation among service users. Even brief, simple advice about quitting increases patients’ rates of successful cessation, 2-4 and given that smoking affects almost all parts of the body (see  Chapter 3), healthcare and social service providers should integrate brief cessation intervention into routine care. A 2015 review of healthcare interventions concluded that brief advice from a healthcare worker (and also telephone helplines, automated text messaging, printed self-help materials, and quitting medications) is a globally affordable health-care intervention to promote and assist smoking cessation. 4 Advice from physicians can also affect the attitudes, knowledge, intentions, and quitting behaviours of adolescents, thereby promoting both prevention and cessation. 5

Reviews show a small, additional benefit of intensive advice and follow-up visits. 2, 6 Interventions with more than one component, such as those that combine two or more of the elements of the 5As brief intervention framework (see below) increase quit rates in primary care settings. 6 The delivery of smoking cessation intervention by more than one type of health professional has the potential to increase quitting and readiness to quit. 7 Some doctors or other health professionals have the opportunity to provide intensive behavioural interventions for smokers or to refer them, if appropriate, to specialist services.(See  Section 7.10.8) Specialist services include telephone services, cessation specialists within practices or healthcare centres, group quit courses, and individual counsellors. Referral to specialist services can address some of the common barriers to intervention faced by other healthcare professionals, particularly time constraints. Quitline provides a readily accessible specialist service to which health professionals can refer their patients. (See  Section 7.14.1) Proactive referral (whereby the healthcare professional sends the person’s details to Quitline so that he or she is contacted by a Quitline staff person) leads to substantially higher rates of utilisation than the provision of simple advice to call. 8-10

Health professionals often underutilise opportunities to provide cessation advice to smokers. 6, 11-13 Factors positively associated with providing cessation intervention and counselling include believing that it is part of their role, confidence in providing counselling, knowledge of community cessation resources, and the patient-centeredness of the organisation. 12, 14 Barriers cited by healthcare providers include lack of reimbursement, lack of training, and lack of resources for follow-up. 6, 15, 16 Health professionals who are non-smokers are more likely to deliver cessation interventions than those who are smokers. 17, 18

This section includes information on the role of:

7.10.1 General practitioners (GPs)

In 2014–15, more than 4 in 5 people (83%) had consulted a GP at least once in the previous year, 19 which provides an excellent opportunity for promoting smoking cessation. GPs are perceived as credible and authoritative on health issues, and their advice as appropriate and acceptable. 20, 21 A 2013 Cochrane review concluded that even when doctors merely provide brief, simple advice about quitting, this increases the likelihood a smoker will successfully quit and remain a non-smoker 12 months later. 2

Time constraints mean that GPs spend only limited time with most smokers (i.e. a few minutes), therefore brief interventions are well-suited to form part of routine consultations. One widely researched framework for structuring brief intervention is called the ‘5As’, which is considered best practice in the US, 6, 22-24 UK, 25 New Zealand, 26 the Netherlands, 27 and by the World Health Organization. 28 The guidelines on cessation published by the Royal Australian College of General Practitioners also recommend using the 5As approach. 29 Receipt of the 5As is associated with a significant increase in patients' use of counselling and cessation medication. 30 The recommended procedure is: 31-22

  1. Ask. A system for recording the current and previous smoking status of every client can help promote quitting. Instituting such a system signals to smokers that their smoking is important and it almost doubles the rate of clinician intervention and results in higher rates of cessation. The system needs to be integrated into the usual record keeping of the practice.
  2. Assess. Assessing a smoker’s readiness to change is important in appropriately tailoring an intervention (see  Section 7.6.1.1). Asking, ‘How do you feel about your smoking at the moment?’ will often be enough to begin such an assessment. For those considering quitting, it is also important to assess level of nicotine dependence in order to predict whether they would benefit from using NRT or quitting medications to relieve withdrawal symptoms. The most widely used measure is the Fagerström Test for Nicotine Dependence.
  3. Advise. All smokers should be advised of the importance of quitting in a way that is clear, unambiguous, supportive, and non-confrontational, for example: ‘Stopping smoking is the most important thing you can do to protect your health now and in the future’. GPs can link this advice to the individual health concerns of the client.
  4. Assist. The assistance provided should be related to the smoker’s readiness to change. For example, providing concrete help to smokers interested in quitting might involve assistance by the GP or other trained practice staff if time and expertise permit, or alternatively by proactive referral to the Quitline.
  5. Arrange follow-up. Following up those who commit to making a quit attempt can help to promote sustained abstinence. A phone call or appointment after one week and one month can provide valuable ongoing encouragement and advice.

The Quitline provides such ongoing support. At future consultations, GPs should commend those who successfully quit and encourage those who have relapsed to try again, using the 5As process. For those not ready to quit, the issue of smoking needs to be raised regularly at future consultations.

Despite the inclusion of the 5As in a number of national guidelines, they are not always implemented in practice. 6, 34, 35 Failure to implement the 5As is associated with workload, perceived lack of remuneration, patients’ characteristics, and the smoking status of the GP. 18, 36, 37 Doctors who are smokers are less likely than non-smokers or ex-smokers to advise and counsel their patients to quit, 36 but can be more likely to refer them to smoking cessation programs. 38

Few patients visit their doctor with smoking addiction as their main complaint, and brief visits often focus on other problems. 39 Many clinics also do not have systems in place that can be used to efficiently apply the 5As in full, but there is some evidence that large healthcare settings can increase cessation interventions by building on an existing electronic health record platform. 39 An Australian study found that the combined use of self-auditing, feedback, and education can improve GP management of smoking cessation. 40 Suggested changes to clinical practice to improve tobacco treatment implementation in clinical settings include portraying proven treatments as best care, being prepared to deliver the appropriate treatment, including tobacco treatment in clinical team workflows, and taking advantage of every opportunity to deliver an intervention. 41 The use of computer-based interventions alone or in combination with practitioner-delivered advice can assist the participation of general medical practices in tobacco control. 42

Effective group and individual cessation programs designed for delivery by GPs include Fresh Start (see  Section 7.15.1.1) and Smokescreen. 20, 43 Clinical practice guidelines for smoking cessation intervention also emphasise the utility, efficacy and reach of telephone quitlines. 44 An Australian randomised controlled trial found that GPs referring smokers to an evidence-based quitline service increased smoking cessation compared with in-practice management, mainly because referred patients received more external help (both groups received equivalent assistance within clinics). 45 However, another Australian study found that acceptance of opportunistic cessation referral within a GP setting was low among patients, although increased along with the continuum of stages of change. 46 Proactive referral—whereby Quitline contacts the patient after receiving his or her details from the doctor—is more effective than simply advising patients to call. 8-10

Patient-centred approaches may also improve the implementation of cessation interventions. Although patients who are highly engaged during medical encounters are more likely to respond to cessation advice, even smokers with low engagement are more likely to try and quit if they receive cessation counselling. 47 Improving communication between patients and providers may promote greater engagement. One study that interviewed smokers about their cessation experiences found that many reported feeling shame, isolation, or disrespect, and frequently expressed wanting honest, consistent, and pro-active discussions and actions in their interactions with primary care providers. 48 A review of clinician messaging over time concluded that using gain-framed statements such as "Quitting smoking will benefit your health by preventing problems like lung and other cancers, heart disease, and stroke" is more effective than using loss-framed statements such as "Smoking will harm your health by causing problems like lung and other cancers, heart disease, and stroke." 49

7.10.1.2 GP practice nurses

Practice nurses provide additional patient care and support within general practice settings in Australia; however, there is relatively little research on their role in promoting smoking cessation. A randomised controlled trial that was conducted in Sydney and Melbourne evaluated the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse, and compared it to other forms of cessation support (quitline referral and usual GP care). Results showed that patients who received more intensive practice nurse intervention were more likely to quit. 50 An evaluation of the trial found that it was viewed positively by practice nurses, with most reporting being satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified. 51 A survey in the UK found positive attitudes among nurses toward providing cessation interventions and highlighted the importance of training in increasing nurses’ enthusiasm about giving cessation advice and perceiving such advice to be effective. 52

7.10.2 Hospital-based interventions

There are many opportunities to implement smoking cessation interventions with patients in hospitals, and also to implement interventions with smoking parents when their child is admitted to hospital. Despite a number of reviews, there is an absence of clear evidence regarding ideal methods within hospitals of screening, referral, intervention, and tailoring strategies for specific sub-groups. 53, 54 In the absence of standardised systems, the implementation of routine evidence-based cessation interventions by healthcare services is unlikely. 55 However, when such interventions are adopted by hospitals, they can lead to improved patient outcomes and decreased subsequent healthcare usage. 56

7.10.2.1 Emergency department

The role of emergency department (ED) staff in cessation intervention has received relatively little attention, but holds significant potential to encourage quit attempts in smoking patients. 57 ED doctors and nurses appear to frequently miss opportunities to offer smoking cessation interventions. 58 A multicentre survey of ED providers in the US found that while asking and advising were relatively common, assessing, assisting, and arranging support for patients were low overall. 59 A study involving ED staff in the US found that they expressed ambivalence toward the implementation of smoking cessation guidelines. Doctors and nurses agreed that implementing cessation interventions is important, but felt that it is not always practical due to time constraints, the competing demands of acute care, and resistance from patients. They also sought improved role clarity and teamwork when implementing the 5As in the ED. 60 New Zealand research found that doctors and nurses in critical care settings held positive attitudes toward and had received training in providing smoking cessation advice, and perceived advising patients to stop smoking as their responsibility. However, patient acuity and level of sickness affected their ability to deliver smoking cessation advice. 61

Despite the challenges, interventions in emergency healthcare settings are worthwhile. Tailored interventions in EDs can be effective in prompting initial quit attempts and ED patients are interested in quitting and in receiving support. 57, 62-64 A 2014 systematic review concluded that ED visits in combination with ED-initiated tobacco cessation interventions are associated with higher cessation rates. 65 Educations programs can be successful for patients with cardiovascular disease 66 and chronic obstructive pulmonary disease. 67 Intensive intervention can also improve tobacco abstinence rates in low-income ED smokers. 68 A study across two Melbourne hospitals found that although smoking was more prevalent than among the general population, more than one-third of ED patients reported wanting to quit, and almost two-thirds were willing to receive a brief intervention. Face-to-face individual or group counselling was preferred over telephone counselling or a session with a doctor. 69

7.10.2.2 In-patient care

High intensity behavioural interventions that start during a hospital stay and include follow-up support for at least a month are effective, regardless of the reason for being admitted to hospital. 70 Adding NRT to the counselling is likely to further increase cessation rates. 71 It may be possible to increase hospital smoking cessation delivery, particularly the provision of NRT, by using a multi-strategic intervention including education of health professionals. 72, 73 Making such interventions a routine part of hospital care could dramatically increase the number of smokers offered smoking cessation support. 74 In 2015, a framework for hospital-based intervention was proposed following the new NSW Health Smoke-free Health Care Policy, which stipulates that all clinical staff must provide routine brief interventions for all smoking patients. It suggests that: hospitalisation is a powerful teachable moment; all patients should be asked about smoking on admission, and smokers should be encouraged and assisted to quit permanently; the most effective interventions include a combination of counselling and NRT; and patients should be followed-up for at least 4 weeks after discharge. 75

Nurses are the largest healthcare workforce and are involved in nearly all levels of hospital care. Guidelines for clinical care in some countries recommend that every nurse should consult their patients about smoking. 76 Nurses can be effective in delivering tobacco cessation interventions, but some lack of appropriate knowledge and/or skill, which presents a major problem for implementation. 77 A 2013 Cochrane review found moderate quality evidence that advice and support from nurses could increase people's success in quitting smoking, especially in a hospital setting. 78

7.10.2.3 Surgical care

Smoking causes a range of adverse surgical outcomes. 79 (See  Chapter 3.15.1) Even short-term smoking cessation prior to surgery may help reduce the risk of postoperative complications. 80-83 Patients who smoke should be encouraged to stop smoking at least six to eight weeks before surgery. In the short term, smoking should not be permitted in the 12 hours before surgery. 84

Patients facing surgery are interested in quitting and believe their physicians have an important role in their cessation attempts. 85, 86 Smokers may benefit from an intensive cessation program one month before surgery, and it may help long-term cessation. 87-90 However, patients are not always well informed about the immediate benefits of quitting to their surgery outcomes. 85 One study of anaesthesiologists and their patients found significant discrepancies between reports of provision of smoking cessation counselling; three quarters of anaesthesiologists stated that they frequently or almost always advised patients about the health risks of smoking, but patient surveys showed that less than one third received advice about the health risks of smoking, and less than one quarter received advice to quit before surgery. 91 Research in the US found that, compared with non-surgical residents, surgical residents were less likely to perform cessation counselling and more likely to think that counselling was not part of their job. Both groups frequently missed opportunities to help patients quit. Surgical residents were also more likely to cite a lack of time and formal training as barriers to implementing interventions. 92

Barriers to cessation intervention in surgical care include perceived lack of time for training and intervention and lack of knowledge about referral options, such as quitline services. 85 Clinicians also report lack of organisational support, perceived patient objection, lack of systems to identify smokers, perceived inability to change care practices, perceived lack of efficacy of interventions, and the cost of providing care as barriers. 93 Patients may not have enough pre-operative contact with the hospital to maximise smoking cessation intervention. 94

A number of small trials have examined ways to increase the effectiveness of cessation intervention before and after surgery. Using computer-based assessment may increase the accuracy of assessing smoking status in pre-operative clinics and encourage cessation. 93 Implementing clinical guidelines that combine GP referral to surgery with referral to smoking cessation support can significantly increase the number of patients that receive such a referral. 94 Clinicians are able to effectively facilitate the use of a quitline by surgical patients, 95 and comprehensive interventions incorporating brief advice, counselling, self-help materials, NRT and referral support from a quitline are effective six months post-discharge. 93 Referral of surgical patients to a quitline for post-discharge help appears to be acceptable to patients and inexpensive. 8 A 2015 systematic review concluded that many studies looking at the effects of preoperative cessation have recruited smokers very close to their scheduled surgery, therefore the benefits of preoperative smoking cessation may have not been fully apparent. The authors highlight that further research is required to develop effective preoperative cessation programmes for smokers awaiting elective operations. 96

7.10.2.4 Outpatient care

Outpatient settings offer important opportunities to provide cessation intervention and relapse prevention to smokers, but are underutilised. Data from the US show that from 2005 through 2010, more than one-third of hospital outpatient visits had no screening for tobacco use, and among current tobacco users, only 1 in 4 received any cessation assistance. 97 This is despite the fact that referral to evidence-based tobacco treatment after hospital visits is effective. 98 Smoking cessation intervention by nurses are beneficial for non-hospitalised patients, 78 and cessation programs combined with routine rehabilitation for outpatients are also effective in promoting abstinence. 99 One study found that interventions offered by thoracic surgeons in outpatient clinics can be successful in increasing quit rates. 100 Limited evidence also supports the use of telephone support following an intensive group program in hospital, 101 use of automated interactive voice response systems to continue hospital-based smoking cessation intervention after discharge, 102 and the continued use of NRT following discharge from hospital. 103 One study found an internet program for smoking cessation during and after inpatient rehabilitation treatment to be effective in increasing abstinence. 104

7.10.3 Pharmacists

Community pharmacies may be an underused resource for helping to deliver public health services. 105 Pharmacies supply cessation products to a large number of people trying to quit smoking, which creates opportunities for providing sound advice and support. Pharmacies have potential as health promotion agencies as they are the most accessible healthcare services in the community and are visited by both healthy and sick people. 106

A number of studies suggest that trained community pharmacists can deliver smoking cessation interventions that are effective in helping smokers to quit. 107-111 A 2014 meta-analysis concluded that pharmacist-led interventions can increase abstinence rates in smokers. 112 A systematic review and meta-analysis published in 2016 also examined the effectiveness of community pharmacy-delivered interventions for smoking cessation. Active intervention, comprising behavioural support and/or NRT, was about 2.5 times more effective and cost-effective than usual care. 105 Another 2016 systematic review similarly concluded that pharmacists are able to offer advice, help, and support for smoking cessation with a higher success rate than unassisted quitting. 113 Smokers have also reported perceiving pharmacist-assisted cessation to be an appealing approach to quitting smoking. 114

Australian research that explored the knowledge and practices of community pharmacists found that while their cessation counselling was satisfactory, further education is needed to improve practice standards in terms of matching a patient's history and smoking status to an appropriate product. 115 Findings from a randomised controlled trial showed that pharmacist counselling involving more than one session, combined with NRT, can be effective, but that many participants do not complete the necessary follow-up sessions. 116 Similarly, longitudinal research in the US found that more intensive pharmacist-assisted intervention and those in group-formats led to higher quit rates. Difficulties with follow-up were associated with participants' relapse. 117

While specialist-led group services appear to have higher quit rates than one-to-one services provided by pharmacies, pharmacy services treat many more smokers and both are cost-effective. 118, 119 An economic analysis of providing cessation counselling training to physicians and pharmacists found that synergistic educational training for both groups could be a cost-effective method for smoking cessation in the community. 120

Pharmacists report a number of common barriers to providing cessation intervention, including fear of negative reaction from customers, their perception of a customer’s unwillingness to discuss smoking, the short length of the relationship with the customer, perceived lack of demand, and lack of confidence by the pharmacist. 121, 122 Education and routine training for all pharmacy personnel may increase the success rates of pharmacy-led smoking cessation services. 113

7.10.4 Dentists

Smoking is a significant contributor to oral disease and cancer, and cessation is an important part of the treatment of periodontal diseases. 123 A review of international evidence concluded that behavioural intervention for smoking cessation involving oral health professionals is effective in reducing tobacco use in smokers and users of smokeless tobacco and preventing uptake in non-smokers. 124 A randomised controlled trial in Sweden found that even very brief, structured counselling in dental practices led to significant reductions in tobacco consumption (but not abstinence), particularly among smokeless tobacco users. 125 Further, dental patients have reported being receptive to dental practitioners inquiring about smoking behaviour and offering advice on quitting. 126

Tobacco use prevention and cessation guidelines have been developed for dental settings. They involve a level-of-care model based on the 5As, with brief intervention, motivational interviewing, and more intensive plans involving pharmacotherapy. 127-129 A 2016 review concluded that brief behavioural interventions complemented by pharmacological treatment—with the participation of the entire dental team—are effective cessation interventions within dentistry. 130 However, implementation of such interventions is poor. 128, 131, 132 The most frequently delivered components of the 5As are ‘asking’, ‘advising’ and ‘assessing’, with ‘assisting’ and ‘arranging’ being less common. 129 A large survey of dentists in the US found that almost all reported that they routinely ask patients about tobacco use, about three quarters provide cessation counselling, and just under half routinely offer cessation assistance (such as referring on or writing a prescription). 133

Barriers to providing cessation interventions in dental settings include lack of time, financial considerations, concern about a patient’s interest and resistance, fear of losing patients, too little training, perceived lack of relevance and experience, lack of knowledge about where to refer the patient for further support, and forgetting. 123, 134-136 Willingness to intervene is related to periodontal treatment and the presence of smoking-related disease. 135 Some research does reveal a lack of adequate knowledge among dental school faculty, staff and students on the negative health effects associated with smoking and a lack of confidence in addressing smoking behaviour. 137, 138 Further research is needed to better understand and influence the factors that hinder guideline implementation. 128, 131, 139-141

Dental hygienists see their patients regularly, which provides opportunities for cessation assistance. 123 However, recommended smoking cessation interventions are not always implemented, with hygienists reporting lack of comfort and confidence in addressing smoking with their patients. 142, 143 A survey of Australian oral health practitioners found that while the majority of practitioners frequently screened for smoking behaviour, only about half assisted patients to quit smoking. They reported that lack of knowledge of pharmacological treatments and lack of access to smoking cessation resources are common barriers to providing cessation assistance. 144 Intervention within paediatric dental practices could help prevent initiation and increase cessation among young people, however several studies have highlighted low adherence by healthcare providers to recommended screening and prevention interventions for children and adolescents. 97, 145

Measures to promote the involvement of dental professionals in smoking prevention and cessation include increased education on the effects of smoking on oral health, brief intervention training, structured advice protocols, and encouraging greater involvement by dentists, dental nurses and hygienists with patients without acute oral complaints. 135, 146 Dentists are willing to receive training on smoking cessation interventions, and including training in academic dental programs increases the use of smoking cessation practices within the dental team. 134 Dental students generally agree that tobacco cessation counselling is within the responsibility of the dental profession, is within the scope of dental practice, and can be effective. 147

7.10.5 Specialists

Specialists have the potential to play an important role in promoting smoking cessation. For example, parents/carers generally visit their child’s paediatrician more often than their own, which provides opportunities for paediatricians to deliver cessation interventions and reduce children’s exposure to secondhand smoke. A systematic review found that physician-delivered training in a brief intervention using CEASE principles (Ask, Assist, Refer) may increase smoking cessation counselling, and training in a CEASE course delivered online or a short intervention using the 5As may increase screening. 3

There are enormous health benefits of smoking cessation for patients with cardiovascular disease. Australian guidelines recommend that advice on smoking, nutrition, alcohol, physical activity and body weight should be part of routine management of hypertension for all patients, regardless of drug therapy. Smoking cessation is recommended to reduce overall cardiovascular risk, 148 and US data suggest that smoking cessation is more cost-effective than other preventive cardiology measures. 149 However, cardiac health professionals, including lipidologists and cardiologists, could implement more effective smoking cessation interventions. 150, 151 Surveys assessing the knowledge, interest and attitudes of cardiologists regarding smoking cessation assistance to their patients highlight a lack of commitment to this preventive practice. 152 Cardiologists do not always consider themselves the most appropriate person for intervention, but many do not refer smoking patients to cessation specialists or teams for assistance, either. 152 Reasons for cessation being overlooked may include that the advent of effective high-tech interventions for cardiovascular diseases has drawn attention away from secondary prevention. Some professionals cite a lack of time or lack of training in smoking cessation counselling. 149 Cardiac rehabilitation health professionals report finding it difficult to work with smokers, partly because some patients deny the dangers of smoking or are reluctant to discuss their smoking because of the stigma attached to smoking after a cardiac event. Such professionals also report feelings of frustration, failure, and lack of confidence in managing this health issue. 153

Other relevant settings (i.e., specialties that see patients directly affected by or at risk for tobacco-related diseases) where there may be a need and potential for brief cessation interventions to be more fully integrated in routine practice include urological practice, 154 rheumatological practice, 155 gynaecological practice, 156 perioperative care (such as by anaesthetists), 157, 158 periodontal practice, 159 plastic and reconstructive surgery 160 and paediatric medical practices. 161, 162 Many of the findings stress the need for further research to highlight and address clinical barriers to providing cessation interventions and training to enhance specialists’ knowledge, skills, and confidence.

7.10.6 Allied health professionals

There is limited research exploring the effectiveness of smoking cessation interventions in other health professional practices, although some studies have highlighted interest in, and opportunities for increased and improved involvement by many healthcare providers. One small study within podiatrist consultations, for example, showed that providing routine advice to smokers could be significantly increased within existing budgets and without prolonging consultations. 163

Smoking cessation intervention by optometrists is important, given the relationship between smoking and eye diseases. Evidence suggests that optometrists provide limited cessation support for patients, with barriers to more active involvement being similar to other health professions. 164, 165 An Australian survey of optometrists found that fewer than half reported routinely asking their patients about smoking status, with younger practitioners least likely to enquire about patients' smoking behaviours. 166

Cessation as a goal in physiotherapy practices is consistent with the profession’s aims to promote health and wellness, 167 and smoking cessation advice can be readily integrated into physical therapy practice. 167 One study found that lack of resources and time are the main barriers to providing such advice, and suggested that physiotherapists’ preparedness and confidence in providing smoking cessation assistance need to be increased. 168

Psychologists may also play an important part in reducing the burden of tobacco-related disease through their roles as researchers and practitioners. Integrating evidence-treatment for tobacco use disorder into other ongoing treatments represents an important opportunity—albeit a complex one—for increasing cessation, particularly among underserved populations, including those with serious mental illness and/or substance use disorders (see  Section 7.12). 169 Similarly, social workers often work with disadvantaged and vulnerable groups that have much higher smoking prevalence, who may particularly benefit from the inclusion of cessation assistance into usual care. 170

7.10.7 Social and community service organisations

Social and community service organisations are non-government, not-for-profit organisations that provide welfare services, such as accommodation assistance, emergency relief, and financial and relationship counselling, to people who are socially disadvantaged. Given the much higher prevalence of smoking among people who are socially disadvantaged (see  Chapter 1.7), and the contribution of tobacco use to health disparities (see  Chapter 9), social and community service organisations are increasingly recognising their role as important settings for implementing cessation interventions. 171, 172

Although people who are disadvantaged can face complex barriers to quitting, social and community service organisations have the potential to increase service users’ knowledge and use of cessation aids, and to provide direct and tailored support to disadvantaged Australian smokers. 171 A study in NSW found that more than half of the service users reported wanting help from staff to quit, with access to free NRT, cash and non-cash rewards, and support and encouragement from staff cited as the most preferred types of help. 173 The implementation of evidence-based interventions, such as the 5As, brief motivational interviewing, and use of NRT, appears to be acceptable and feasible within social and community service organisations. 174 Staff education, training, and support may further promote the integration of smoking cessation support into usual care. 175

7.10.8 Practitioners of complementary and alternative medicine

While complementary and alternative medicine practitioners treat significant numbers of tobacco users, they are often not trained in evidence-based strategies. One study developed and evaluated a brief intervention adapted for such practitioners, and found that after three months, there were significant increases in practitioners' tobacco cessation activities, motivation, and confidence in helping patients quit, and comfort with providing information and referrals for guideline-based tobacco cessation aids. This may be an additional channel for reaching smokers. 176 (See  Section 7.18 for information on the use of alternative therapies for smoking cessation)

7.10.9 Training health professionals in smoking cessation interventions

Training clinicians in smoking cessation methods may increase patients’ cessation rates, 6, 177 as such training increases the number of people identified as smokers and advised to quit. 178-181 Training increases health professionals’ knowledge, skills, confidence, and likelihood of practicing smoking-related interventions. 108, 179, 180, 182-186 Brief cessation training and technical assistance also increases referral by health providers to specialist smoking cessation services. 187, 188 Medical students generally retain skills learned during their training and in turn become more active in cessation interventions. 189-192 However the inclusion of standardised tobacco curricula in medical schools varies. Part of the reason that some doctors may not be more actively involved in tobacco use treatment may be due to a lack of relevant training during medical school. 193-195 Despite some international evidence of an increase in cessation training in medical schools over time, increased emphasis on addressing tobacco use with patients is needed. 193, 196

Most postgraduate health professional training programs incorporate the 5As approach, stage of change, motivational interviewing, and pharmacotherapies, and commonly refer to clinical practice guidelines. 197 Although such training is generally delivered face-to-face, there are an increasing number of training programs available online. 197 However, a recent review and evaluation of online tobacco dependence treatment courses found that while many excelled in providing effective navigation, course rationale, and content, most failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. 198 Further, not all practising health professionals access cessation intervention training: they report lack of interest, time pressures, and competing priorities as major barriers. Overall, smoking cessation education programs for health professionals remain fairly ‘ad hoc’ and there is a lack of a systematic organised approach to ensure availability and consistency in most countries. 198 A randomised controlled trial was carried out between 2010 and 2014 in ten US medical schools that compared multi-modal tobacco treatment education (comprising a web-based course and instructor-facilitated training in addition to traditional education) with traditional tobacco treatment education alone. During a clinical examination, students with the additional training were significantly more likely to suggest behavioural strategies to patients and to provide information regarding Quitline. Of the 5As (see  Section 7.10.1 above), they also reported higher confidence for Assist, Arrange, and pharmacotherapy counselling. 199

The systematic, comprehensive and tailored program developed by Quit Victoria provides cessation training for a range of health professionals. The program includes face-to-face training and e-learning modules that are accessed by health professionals both in Australia and internationally.

7.10.10 Increasing intervention delivery and referrals

Along with training health professionals in smoking cessation intreventions, organisational systems for routinely recording client smoking behaviour increase the effectiveness of practice, 6, 39, 200, 201 as it increases intervention delivery resulting in increased cessation rates. 6, 202 The growing use of electronic medical records has the potential to remind doctors and other clinic staff to record tobacco use, to give brief advice to quit, to prescribe medications, and to refer to cessation counselling services. A 2014 Cochrane review concluded that electronic records appear to increase the documentation of tobacco status and referral to cessation counselling. 203

Providing financial incentives to providers is another strategy for shaping their behaviours, including incentives that are dependent upon specific patient outcomes. 204 Some potential risks of adopting a ‘payment by results’ 205 system in the context of smoking cessation may be:

  • that a certain proportion of smokers who try to stop would have managed to do so by themselves, so not every successful quitter from a service can be attributed to that service
  • providers may ‘cherry-pick’ easy cases to maximise income.

The use of other evidence-based smoking cessation interventions that are extremely cost-effective may be discouraged and over-claiming of successes may be encouraged. These risks may be minimised by only paying providers for levels of success above what might be expected if no intervention were delivered, and implementing an accreditation system for eligible providers. 205 A study in England examined the effects of paying accredited providers standard tariffs for each smoker who was supported to quit. Results showed that such payments significantly increased the number of people who remained abstinent for four weeks. 206

Few studies have examined how to increase health professionals’ referrals to Quitline. One trial using a direct mail campaign to a range of health professionals increased their awareness of the service and future intention to use the referral process. 207 Another project implemented a care co-ordination program that increased quitline referrals by providers. 208

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References

1. Harris M, Hobbs C, Powell Davies C, Simpson S, Bernard D, et al. Implementation of a snap intervention in two divisions of general practice: A feasibility study. Medical Journal of Australia, 2005; 183(10 suppl.):S54–8. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/16296953

2. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, et al. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews, 2013 DOI: 10.1002/14651858.CD000165.pub4. Available from:  http://dx.doi.org/10.1002/14651858.CD000165.pub3

3. Hall K, Kisely S, and Urrego F. The use of pediatrician interventions to increase smoking cessation counseling among smoking caregivers: A systematic review. Clinical Pediatrics, 2016. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26928569

4. West R, Raw M, McNeill A, Stead L, Aveyard P, et al. Healthcare interventions to promote and assist tobacco cessation: A review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 2015; 110(9):1388–403. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26031929

5. Hum A, Robinson L, Jackson A, and Ali K. Physician communication regarding smoking and adolescent tobacco use. Pediatrics, 2011; 127(6):e1368–74. Available from:  http://pediatrics.aappublications.org/content/127/6/e1368.long

6. Fiore MC and Jaén CR. A clinical blueprint to accelerate the elimination of tobacco use. Journal of the American Medical Association, 2008; 299(17):2083–5. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18460668

7. An LC, Foldes SS, Alesci NL, Bluhm JH, Bland PC, et al. The impact of smoking-cessation intervention by multiple health professionals. American Journal of Preventive Medicine, 2008; 34(1):54–60. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18083451

8. Wolfenden L, Wiggers J, Campbell E, Knight J, Kerridge R, et al. Feasibility, acceptability, and cost of referring surgical patients for postdischarge cessation support from a quitline. Nicotine & Tobacco Research, 2008; 10(6):1105–8. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18584474

9. Drehmer JE, Hipple B, Nabi-Burza E, Ossip DJ, Chang Y, et al. Proactive enrollment of parents to tobacco quitlines in pediatric practices is associated with greater quitline use: A cross-sectional study. BMC Public Health, 2016; 16:520. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919852/

10. Skov-Ettrup LS, Dalum P, Bech M, and Tolstrup JS. The effectiveness of telephone counselling and internet- and text-message-based support for smoking cessation: Results from a randomised controlled trial. Addiction, 2016. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26748541

11. Centers for Disease Control and Prevention (CDC). Smoking-cessation advice from health-care providers--Canada, 2005. Morbidity and Mortality Weekly Report, 2007; 56(28):708–12. Available from:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a3.htm

12. McMenamin S, Bellows N, Halpin H, Rittenhouse D, Casalino L, et al. Adoption of policies to treat tobacco dependence in US medical groups. American Journal of Preventive Medicine, 2010; 39(5):449–56. Available from:  http://www.ajpm-online.net/article/S0749-3797%2810%2900432-0/pdf

13. Pbert L, Zapka J, Jolicoeur D, White M, Valentine Goins K, et al. Implementing state tobacco treatment services: Lessons from the Massachusetts experience. Health Promotion Practice, 2011; 12(6):802–10. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21571986

14. Tremblay M, Cournoyer D, and O'Loughlin J. Do the correlates of smoking cessation counseling differ across health professional groups? Nicotine & Tobacco Research, 2009; 11(11):1330–8. Available from:  http://ntr.oxfordjournals.org/cgi/content/full/11/11/1330

15. Fagan K. Smoking-cessation counseling practices of college/university health-care providers—a theory-based approach. Journal of American College Health 2007; 55(6):351–60. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/17517547

16. Edwards R, Wilson N, and Thomson G. Tobacco control in New Zealand: Top marks for new smoking cessation guidelines, must try harder elsewhere. New Zealand Medical Journal, 2008; 121(1276):5–8. Available from:  http://www.nzma.org.nz/journal/121-1276/3112/content.pdf

17. Ulbricht S, Baumeister S, Meyer C, Schmidt C, Schumann A, et al. Does the smoking status of general practitioners affect the efficacy of smoking cessation counselling? Patient Education and Counseling, 2009; 74(1):23–8. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18818045

18. Azuri J, Peled S, Kitai E, and Vinker S. Smoking prevention and primary physician's and patient's characteristics. American Journal of Health Behavior, 2009; 33(6):710–7. Available from: h ttp://www.ajhb.org/issues/2009/6/06NovDec0809Azuri.pdf

19. Australian Institute of Health and Welfare, Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW; 2016. Available from:  http://www.aihw.gov.au/publication-detail/?id=60129555544

20. Richmond R, Makinson R, Kehoe L, Guigni A, and Webster W. One-year evaluation of three smoking cessation interventions administered by general practitioners. Addictive Behaviors, 1993; 18(2):187–99. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/8506790

21. Richmond R. Physicians can make a difference with smokers: Evidence-based clinical approaches. International Journal of Tuberculosis and Lung Disease, 1999; 3(2):100–12. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/10091874

22. Fiore M, Bailey W, and Cohen S, et al. Treating tobacco use and dependence. Clinical practice guideline. Rockville MD: US Department of Health and Human Services. Public Health Service., 2000. Available from:  http://www.treatobacco.net/fr/uploads/documents/Treatment%20Guidelines/USA%20treatment%20guidelines%20in%20English%202000.pdf

23. Fiore MC, Jaén M, Carlos Roberto, Baker TB, Bailey WC, Benowitz NL, et al. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: US Department of Health and Human Services, 2008. Available from:  http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html

24. US Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: US preventive services task force reaffirmation recommendation statement. Annals of Internal Medicine, 2009; 150(8):551–5. Available from:  http://www.annals.org/cgi/content/full/150/8/551

25. Raw M, McNeill A, and West R. Smoking cessation guidelines for health professionals. A guide to effective smoking cessation interventions for the health care system. Thorax, 1998; 53(Suppl 5 Pt 1):S1–19. Available from:  http://thorax.bmj.com/cgi/content/extract/53/suppl_5/S1

26. McRobbie H, Bullen C, Glover M, Whittaker R, Wallace-Bell M, et al. New Zealand smoking cessation guidelines. The New Zealand Medical Journal, 2008; 121(1276):57–70. Available from:  http://www.nzma.org.nz/journal/abstract.php?id=3117

27. Partnership on Smoking Cessation. Guideline. Treatment of tobacco dependence. 2006. Available from:  http://www.treatobacco.net/en/uploads/documents/Treatment%20Guidelines/Netherlands%20treatment%20guidelines%20in%20English%202006.pdf

28. Raw M, Anderson P, Batra A, Dubois G, Harrington P, et al. Who Europe evidence based recommendations on the treatment of tobacco dependence. Tobacco Control, 2002; 11(1):44–6. Available from:  http://tobaccocontrol.bmj.com/cgi/content/full/11/1/44

29. The Royal Australian College of General Practitioners, Supporting smoking cessation: A guide for health professionals. Melbourne: RACGP; 2014. Available from:  http://www.racgp.org.au/your-practice/guidelines/smoking-cessation/

30. Kruger J, O’Halloran A, Rosenthal AC, Babb SD, and Fiore MC. Receipt of evidence-based brief cessation interventions by health professionals and use of cessation assisted treatments among current adult cigarette-only smokers: National adult tobacco survey, 2009–2010. BMC Public Health, 2016; 16:141. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751655/

31. Zwar N RR, Borland R, Peters M, Litt J, Bell J, Caldwell B, and I. F. Supporting smoking cessation: A guide for health professionals. Melbourne: The royal Australian college of general practitioners. 2011. Available from:  http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/smoking/Smoking-cessation.pdf

32. Zwar N, Richmond R, Borland R, Stillman S, and Cunningham M. Smoking cessation guidelines for Australian general practice. Australian Family Physician, 2005; 34(6):461–4. Available from:  http://www.racgp.org.au/afp/200506/4897

33. Zwar N, Richmond R, Borland R, Stillman S, Cunninghan M, et al., Smoking cessation guidelines for Australian general practice: Practice handbook. Vol. 4 July 2004.Canberra: Department of Health and Ageing; 2004. Available from:  http://www.health.gov.au/pubhlth/publicat/document/smoking_cessation.pdf

34. Lawson P, Flocke S, and Casucci B. Development of an instrument to document the 5a's for smoking cessation. American Journal of Preventive Medicine, 2009; 37(3):248–54. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/19666161

35. Bryant J, Carey M, Sanson-Fisher R, Mansfield E, Regan T, et al. Missed opportunities: General practitioner identification of their patients inverted question mark smoking status. BMC Family Practice, 2015; 16(1):8. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25649312

36. Meshefedjian GA, Gervais A, Tremblay M, Villeneuve D, and O’Loughlin J. Physician smoking status may influence cessation counseling practices. Canadian Journal of Public Health, 2010; 101(4). Available from:  http://journal.cpha.ca/index.php/cjph/article/view/2532

37. Ulbricht S, Klein G, Haug S, Gross B, Rumpf H, et al. Smokers' expectations toward the engagement of their general practitioner in discussing lifestyle behaviors. Journal of Health Communication, 2010:1–13. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21128151

38. Duaso MJ, McDermott MS, Mujika A, Purssell E, and While A. Do doctors' smoking habits influence their smoking cessation practices? A systematic review and meta-analysis. Addiction, 2014; 109(11):1811–23. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25041084

39. Lindholm C, Adsit R, Bain P, Reber P, Brein T, et al. A demonstration project for using the electronic health record to identify and treat tobacco users. WMJ, 2010; 109(6):335–40. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21287886

40. McKay-Brown L, Bishop N, Balmford J, Borland R, Kirby C, et al. The impact of a GP clinical audit on the provision of smoking cessation advice. Asia Pacific Family Medicine, 2008; 7(1):4. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18973708

41. Woods S and Jaen C. Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems. American Journal of Preventive Medicine, 2010; 38(3 suppl.):S385–92. Available from:  http://www.ajpm-online.net/article/PIIS0749379709008794/fulltext

42. Meyer C, Ulbricht S, Gross B, Kastel L, Wittrien S, et al. Adoption, reach and effectiveness of computer-based, practitioner delivered and combined smoking interventions in general medical practices: A three-arm cluster randomized trial. Drug and Alcohol Dependence, 2011; [Epub ahead of print]. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21924563

43. Richmond R, Webster I, Elkins L, Mendelsohn C, and Rollnick S. Smokescreen for the 1990s: A stop smoking programme for general practitioners to use with smokers. Sydney: NSW Department of Health, 1991. Available from:  http://colinmendelsohn.com.au/files/3713/5574/3453/Mendelsohn_CP_Richmond_RL._Smokescreen_for_the_1990s._A_new_approach_to_smoking_cessation._Australian_Family_Physician_1994_23_5_841-848.pdf

44. Willett J, Hood N, Burns E, Swetlick J, Wilson S, et al. Clinical faxed referrals to a tobacco quitline reach, enrollment, and participant characteristics. American Journal of Preventive Medicine, 2009; 36(4):337–40. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/19201150

45. Borland R, Balmford J, Bishop N, Segan C, Piterman L, et al. In-practice management versus quitline referral for enhancing smoking cessation in general practice: A cluster randomized trial. Family Practice, 2008; 25(5):382–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18689856

46. Young J, Girgis S, Bruce T, Hobbs M, and Ward J. Acceptability and effectiveness of opportunistic referral of smokers to telephone cessation advice from a nurse: A randomised trial in Australian general practice. BMC Family Practice, 2008; 9 (1):16. Available from:  http://www.biomedcentral.com/content/pdf/1471-2296-9-16.pdf

47. Cunningham P. Patient engagement during medical visits and smoking cessation counseling. JAMA Internal Medicine, 2014; 174(8):1291–8. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24911033

48. Halladay JR, Vu M, Ripley-Moffitt C, Gupta SK, O'Meara C, et al. Patient perspectives on tobacco use treatment in primary care. Preventing Chronic Disease, 2015; 12:E14. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25654219

49. Toll BA, Rojewski AM, Duncan LR, Latimer-Cheung AE, Fucito LM, et al. "Quitting smoking will benefit your health": The evolution of clinician messaging to encourage tobacco cessation. Clinical Cancer Research, 2014; 20(2):301–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24436474

50. Zwar NA, Richmond RL, Halcomb EJ, Furler JS, Smith JP, et al. Quit in general practice: A cluster randomized trial of enhanced in-practice support for smoking cessation. Family Practice, 2015; 32(2):173–80. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25670206

51. Halcomb EJ, Furler JS, Hermiz OS, Blackberry ID, Smith JP, et al. Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: Views of general practitioners and practice nurses. Family Practice, 2015; 32(4):468–73. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26024924

52. Hall S, Vogt F, and Marteau TM. A short report: Survey of practice nurses' attitudes towards giving smoking cessation advice. Family Practice, 2005; 22(6):614–6. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/16055470

53. Wolfenden L, Campbell E, Wiggers J, Walsh R, and Bailey L. Helping hospital patients quit: What the evidence supports and what guidelines recommend. Preventive Medicine, 2008; 46(4):346–57. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18207229

54. Cunningham R, Bernstein S, Walton M, Broderick K, Vaca F, et al. Alcohol, tobacco, and other drugs: Future directions for screening and intervention in the emergency department. Academic Emergency Medicine, 2009; 16(11):1078–88. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/20053226

55. Freund M, Campbell E, Paul C, McElduff P, Walsh R, et al. Smoking care provision in hospitals: A review of prevalence. Nicotine & Tobacco Research, 2008; 10(5):757–74. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/18569750

56. Mullen KA, Manuel DG, Hawken SJ, Pipe AL, Coyle D, et al. Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes. Tobacco Control, 2016. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/27225016

57. Daube M and Jelinek G. Smoking out tobacco: A vital preventive role for emergency departments. Emergency Medicine Australasia : EMA, 2010; 22(4):260–2. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20796005

58. Buchbinder M, Wilbur R, Zuskov D, McLean S, and Sleath B. Teachable moments and missed opportunities for smoking cessation counseling in a hospital emergency department: A mixed-methods study of patient-provider communication. BMC Health Services Research, 2014; 14(1):651. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25526749

59. Walters EL, Reibling ET, Wilber ST, Sullivan AF, Gaeta TJ, et al. Emergency department provider preferences related to clinical practice guidelines for tobacco cessation: A multicenter survey. Academic Emergency Medicine, 2014; 21(7):785–93. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25112653

60. Katz DA, Paez MW, Reisinger HS, Gillette MT, Weg MW, et al. Implementation of smoking cessation guidelines in the emergency department: A qualitative study of staff perceptions. Addiction Science & Clinical Practice, 2014; 9:1. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24460974

61. Lang M, Waterworth S, and O'Brien A. What are the factors that influence the delivery of smoking cessation advice in critical care? Nursing in Critical Care, 2015. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26177914

62. Bock B, Becker B, Niaura R, Partridge R, Fava J, et al. Smoking cessation among patients in an emergency chest pain observation unit: Outcomes of the chest pain smoking study. Nicotine & Tobacco Research, 2008; 10(10):1523–31. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/18946771

63. Boudreaux E, Baumann B, Perry J, Marks D, Francies S, et al. Emergency department initiated treatments for tobacco: A pilot study. Annals of Behavioral Medicine, 2008; 36(3):314–25. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19050988

64. Lynch A and Quigley P. Exhaled study: Prevalence of smoking and harm levels in an emergency department cohort. Emergency Medicine Australasia, 2010; 22(4):287–95. Available from: h ttp://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2010.01299.x/full

65. Pelletier JH, Strout TD, and Baumann MR. A systematic review of smoking cessation interventions in the emergency setting. American Journal of Emergency Medicine, 2014; 32(7):713–24. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24768666

66. Bellman C, Hambraeus K, Lindback J, and Lindahl B. Achievement of secondary preventive goals after acute myocardial infarction: A comparison between participants and nonparticipants in a routine patient education program in Sweden. The Journal of Cardiovascular Nursing, 2009; 24(5):362–8. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19652617

67. Borglykke A, Pisinger C, Jørgensen T, and Ibsen H. The effectiveness of smoking cessation groups offered to hospitalised patients with symptoms of exacerbations of chronic obstructive pulmonary disease (COPD). The Clinical Respiratory Journal, 2008; 2(3):158–65. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20298324

68. Bernstein SL, D'Onofrio G, Rosner J, O'Malley S, Makuch R, et al. Successful tobacco dependence treatment in low-income emergency department patients: A randomized trial. Annals of Emergency Medicine, 2015; 66(2):140–7. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25920384

69. Weiland T, Jelinek GA, Taylor SE, and Taylor DM. Tobacco smoking by adult emergency department patients in Australia: A point-prevalence study. Public Health Research and Practice, 2016; 26(3). Available from:  http://www.ncbi.nlm.nih.gov/pubmed/27421346

70. Rigotti NA, Munafo MR, and Stead LF Interventions for smoking cessation in hospitalised patients. Cochrane Database of Systematic Reviews, 2007 DOI: 10.1002/14651858.CD001837.pub2. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/17636688

71. Rigotti NA, Munafo MR, and Stead LF. Smoking cessation interventions for hospitalized smokers: A systematic review. Archives of Internal Medicine, 2008; 168(18):1950–60. Available from:  http://archinte.ama-assn.org/cgi/content/full/168/18/1950

72. Freund M, Campbell E, Paul C, Sakrouge R, Lecathelinais C, et al. Increasing hospital-wide delivery of smoking cessation care for nicotine-dependent in-patients: A multi-strategic intervention trial. Addiction, 2009; 104(5):839–49. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19344446

73. Vega S and Stolare I. Smoking cessation education increases interventions in a New Zealand hospital: World no tobacco day revisited. The New Zealand Medical Journal, 2010; 123(1317):35–40. Available from:  http://www.nzma.org.nz/journal/123-1317/4187/

74. Routine smoking cessation support for hospital inpatients could reduce mortality. Nursing Standard, 2014; 29(13):16–7. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25424082

75. Mendelsohn C. Managing nicotine dependence in NSW hospitals under the smoke-free health care policy. Public Health Research and Practice, 2015; 25(3). Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26243492

76. Carlebach S and Hamilton S. Understanding the nurse's role in smoking cessation. British Journal of Nursing, 2009; 18(11):672–4, 6. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19525911

77. Sarna L, Bialous S, Rice V, and Wewers M. Promoting tobacco dependence treatment in nursing education. Drug and Alcohol Review, 2009; 28(5):507–16. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19737209

78. Rice VH, Hartmann-Boyce J, and Stead LF. Nursing interventions for smoking cessation. The Cochrane Library, 2013. Available from:  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001188.pub4/abstract

79. US Department of Health and Human Services. The health consequences of smoking: A report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available from:  http://www.cdc.gov/tobacco/data_statistics/sgr/index.htm

80. Theadom A and Cropley M. Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: A systematic review. Tobacco Control, 2006; 15(5):352–8. Available from:  http://tc.bmjjournals.com/cgi/content/abstract/15/5/352

81. Lindstrom D, Azodi O, Wladis A, Tonnesen H, Linder S, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: A randomized trial. Annals of Surgery, 2008; 248(5):739–45. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/18948800

82. Nasell H, Adami J, Samnegard E, Tonnesen H, and Ponzer S. Effect of smoking cessation intervention on results of acute fracture surgery: A randomized controlled trial. The Journal of Bone and Joint Surgery, 2010; 92(6):1335–42. Available from:  http://www.ejbjs.org/cgi/content/full/92/6/1335

83. Thomsen T, Villebro N, and Moller A. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews, 2010; 7:CD002294. Available from:  http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002294/frame.html

84. Australian and New Zealand College of Anaesthetists. Statement on smoking as related to the perioperative period. 2007. Available from:  http://www.anzca.edu.au/resources/professional-documents/documents/professional-standards/professional-standards-12.html

85. Warner DO, Klesges RC, Dale LC, Offord KP, Schroeder DR, et al. Telephone quitlines to help surgical patients quit smoking: Patient and provider attitudes American Journal of Preventive Medicine, 2008; 35(6):S486–93. Available from:  http://www.sciencedirect.com/science/journal/07493797

86. Shi Y and Warner D. Surgery as a teachable moment for smoking cessation. Anesthesiology, 2010; 112(1):102–7. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19996946

87. Moller A and Villebro N Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews, 2005 DOI: 10.1002/14651858.CD002294.pub2. Available from:  http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002294/frame.html

88. Sadr Azodi O, Lindström D, Adami J, Tønnesen H, Nåsell H, et al. The efficacy of a smoking cessation programme in patients undergoing elective surgery – a randomised clinical trial. Anaesthesia, 2009; 64(3):259–65. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19302637

89. Thomsen T, Tonnesen H, and Moller A. Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation. British Journal of Surgery, 2009; 96(5):451–61. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19358172

90. Zaki A, Abrishami A, Wong J, and Chung F. Interventions in the preoperative clinic for long term smoking cessation: A quantitative systematic review. Canadian Journal of Anaesthesia, 2008; 55(1):11–21. Available from:  http://www.cja-jca.org/cgi/content/abstract/55/1/11

91. Zaballos M, Canal MI, Martinez R, Membrillo MJ, Gonzalez FJ, et al. Preoperative smoking cessation counseling activities of anesthesiologists: A cross-sectional study. BMC Anesthesiology, 2015; 15:60. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25927569

92. Turner SR, Lai H, and Bedard EL. Smoking cessation counseling by surgical and nonsurgical residents: Opportunities for health promotion education. Journal of Surgical Education, 2014; 71(6):892–5. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24818539

93. Wolfenden L, Wiggers J, Campbell E, Knight J, Kerridge R, et al. Providing comprehensive smoking cessation care to surgical patients: The case for computers. Drug and Alcohol Review, 2009; 28(1):60–5. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19320677

94. Tonnesen H, Faurschou P, Ralov H, Molgaard-Nielsen D, Thomas G, et al. Risk reduction before surgery - the role of the primary care provider in preoperative smoking and alcohol cessation. BMC Health Services Research, 2010; 10(1):121. Available from:  http://www.biomedcentral.com/content/pdf/1472-6963-10-121.pdf

95. Warner D, Klesges R, Dale L, Offord K, Schroeder D, et al. Clinician-delivered intervention to facilitate tobacco quitline use by surgical patients. Anesthesiology, 2011; 114(4):847–55. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21317630

96. Song F, Brown TJ, Blyth A, Maskrey V, McNamara I, et al. Identifying and recruiting smokers for preoperative smoking cessation-a systematic review of methods reported in published studies. Systematic Reviews, 2015; 4(1):157. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26560883

97. Jamal A, Dube SR, and King BA. Tobacco use screening and counseling during hospital outpatient visits among US adults, 2005-2010. Preventing Chronic Disease, 2015; 12:E132. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26292063

98. Khara M, Okoli C, Nagarajan VD, Aziz F, and Hanley C. Smoking cessation outcomes of referral to a specialist hospital outpatient clinic. American Journal on Addictions, 2015; 24(6):561–70. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26303966

99. Paone G, Serpilli M, Girardi E, Conti V, Principe R, et al. The combination of a smoking cessation programme with rehabilitation increases stop-smoking rate. Journal of Rehabilitation Medicine, 2008; 40(8):672–7. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/19020702

100. Kozower B, Lau C, Phillips J, Burks S, Jones D, et al. A thoracic surgeon-directed tobacco cessation intervention. The Annals of Thoracic Surgery, 2010; 89(3):926–30; discussion 30. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/20172155

101. Metz K, Flöter S, Kröger C, Donath C, Piontek D, et al. Telephone booster sessions for optimizing smoking cessation for patients in rehabilitation centers. Nicotine & Tobacco Research, 2007; 9(8):853–63. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/17654298

102. Regan S, Reyen M, Lockhart AC, Richards AE, and Rigotti NA. An interactive voice response system to continue a hospital-based smoking cessation intervention after discharge. Nicotine & Tobacco Research, 2011; 13(4):255–60. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21330278

103. Williams J and Jones T. Smoking cessation post-discharge following nicotine replacement therapy use during an inpatient admission. Internal Medicine Journal, 2011; 42(2):154–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21299782

104. Haug S, Meyer C, and John U. Efficacy of an internet program for smoking cessation during and after inpatient rehabilitation treatment: A quasi-randomized controlled trial. Addictive Behaviors, 2011; 36(12):1369–72. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21907496

105. Brown TJ, Todd A, O'Malley C, Moore HJ, Husband AK, et al. Community pharmacy-delivered interventions for public health priorities: A systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation. BMJ Open, 2016; 6(2):e009828. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26928025

106. Joyce AW SV, Burrows S, McManus A, Howat P, Maycock B. Community pharmacy.S role in promoting healthy behaviours. Journal of Pharmacy Practice and Research, 2007; 37(1):42–4. Available from:  http://cbrcc.curtin.edu.au/reports_journal_articles/jppr%2037%2042-44.pdf

107. Dent L, Harris K, and Noonan C. Tobacco interventions delivered by pharmacists: A summary and systematic review. Pharmacotherapy, 2007; 27(7):1040–51. Available from:  http://www.atypon-link.com/doi/abs/10.1592/phco.27.7.1040

108. Sinclair HK, Bond CM, and Stead LF Community pharmacy personnel interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2004 DOI: 10.1002/14651858.CD003698.pub2. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/14974031

109. Ragucci K and Shrader S. A method for educating patients and documenting smoking status in an electronic medical record. The Annals of Pharmacotherapy, 2009; 43(10):1616–20. Available from:  http://www.theannals.com/cgi/content/full/43/10/1616

110. Thavorn K and Chaiyakunapruk N. A cost-effectiveness analysis of a community pharmacist-based smoking cessation programme in Thailand. Tobacco Control, 2008; 17(3):177–82. Available from:  http://tobaccocontrol.bmj.com/cgi/content/abstract/17/3/177

111. Shen X, Bachyrycz A, Anderson JR, Tinker D, and Raisch DW. Quitting patterns and predictors of success among participants in a tobacco cessation program provided by pharmacists in new Mexico. Journal of Managed Care Pharmacy, 2014; 20(6):579–87. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24856596

112. Saba M, Diep J, Saini B, and Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. Journal of Clinical Pharmacy and Therapeutics, 2014; 39(3):240–7. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24749899

113. Peletidi A, Nabhani-Gebara S, and Kayyali R. Smoking cessation support services at community pharmacies in the UK: A systematic review. Hellenic J Cardiol, 2016; 57(1):7–15. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26856195

114. Hudmon KS, Hemberger KK, Corelli RL, Kroon LA, and Prokhorov AV. The pharmacist's role in smoking cessation counseling: Perceptions of users of nonprescription nicotine replacement therapy. Journal of the American Pharmacists Association, 2002; 43(5):573–82. Available from:  http://europepmc.org/abstract/med/14626749

115. Saba M, Diep J, Bittoun R, and Saini B. Provision of smoking cessation services in Australian community pharmacies: A simulated patient study. International Journal of Clinical Pharmacy, 2014; 36(3):604–14. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24718946

116. Costello M, Sproule B, Victor J, Leatherdale S, Zawertailo L, et al. Effectiveness of pharmacist counseling combined with nicotine replacement therapy: A pragmatic randomized trial with 6,987 smokers. Cancer Causes & Control, 2011; 22(2):167–80. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21153694

117. Shen X, Bachyrycz A, Anderson JR, Tinker D, and Raisch DW. Improving the effectiveness of pharmacist-assisted tobacco cessation: A study of participant- and pharmacy-specific differences in quit rates. Annals of Pharmacotherapy, 2015; 49(3):303–10. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25527101

118. Bauld L, Chesterman J, Ferguson J, and Judge K. A comparison of the effectiveness of group-based and pharmacy-led smoking cessation treatment in Glasgow. Addiction, 2009; 104(2):308–16. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19149828

119. Boyd K and Briggs A. Cost-effectiveness of pharmacy and group behavioural support smoking cessation services in Glasgow. Addiction, 2009; 104(2):317–25. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19149829

120. Cantor SB, Deshmukh AA, Luca NS, Nogueras-Gonzalez GM, Rajan T, et al. Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacists. Addictive Behaviors, 2015; 45C:79–86. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25644592

121. Patwardhan P and Chewning B. Ask, advise and refer: Hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies. The International Journal of Pharmacy Practice, 2009; 17(4):221–9. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20161528

122. Williams D. Preparing pharmacy students and pharmacists to provide tobacco cessation counselling. Drug and Alcohol Review, 2009; 28(5):533–40. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19737211

123. Ramseier C and Fundak A. Tobacco use cessation provided by dental hygienists. International Journal of Dental Hygiene, 2009; 7(1):39–48. Available from:  http://www3.interscience.wiley.com/journal/121660568/abstract

124. Nasser M. Evidence summary: Is smoking cessation an effective and cost-effective service to be introduced in NHS dentistry? British Dental Journal, 2011; 210(4):169–77. Available from:  http://www.nature.com/bdj/journal/v210/n4/full/sj.bdj.2011.117.html

125. Virtanen SE, Zeebari Z, Rohyo I, and Galanti MR. Evaluation of a brief counseling for tobacco cessation in dental clinics among Swedish smokers and snus users. A cluster randomized controlled trial (the fritt study). Preventive Medicine, 2015; 70:26–32. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25445335

126. Ford P, Tran P, Cockburn N, Keen B, Kavanagh DJ, et al. Survey of dental clinic patients: Smoking and preferences for cessation support. Australian Dental Journal, 2015. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26086696

127. Ramseier C, Warnakulasuriya S, Needleman I, Gallagher J, Lahtinen A, et al. Consensus report: 2nd European workshop on tobacco use prevention and cessation for oral health professionals. International Dental Journal, 2010; 60(1):3–6. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20361571

128. Shelley D, Anno J, Tseng T, Calip G, Wedeles J, et al. Implementing tobacco use treatment guidelines in public health dental clinics in New York city. Journal of Dental Education, 2011; 75(4):527–33. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/21460273

129. Needleman I, Binnie V, Ainamo A, Carr A, Fundak A, et al. Improving the effectiveness of tobacco use cessation. International Dental Journal, 2010; 60(1):50–9. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20361574

130. Omana-Cepeda C, Jane-Salas E, Estrugo-Devesa A, Chimenos-Kustner E, and Lopez-Lopez J. Effectiveness of dentist's intervention in smoking cessation: A review. J Clin Exp Dent, 2016; 8(1):e78–83. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26855711

131. Amemori M, Michie S, Korhonen T, Murtomaa H, and Kinnunen T. Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implementation Science, 2011; 6(1):50. Available from:  http://www.implementationscience.com/content/pdf/1748-5908-6-50.pdf

132. Carter-Pokras O, Johnson T, Bethune L, Ye C, Fried J, et al. Lost opportunities for smoking cessation among adults with diabetes in Florida (2007) and Maryland (2006). Preventing Chronic Disease, 2011; 8(3):A51. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21477491

133. Jannat-Khah DP, McNeely J, Pereyra MR, Parish C, Pollack HA, et al. Dentists' self-perceived role in offering tobacco cessation services: Results from a nationally representative survey, United States, 2010-2011. Preventing Chronic Disease, 2014; 11:E196. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25376018

134. Lozier E and Gonzalez Y. Smoking cessation practices in the dental profession. The Journal of Contemporary Dental Practice, 2009; 10(4):97–103. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19575060

135. Rosseel J, Jacobs J, Hilberink S, Maassen I, Segaar D, et al. Experienced barriers and facilitators for integrating smoking cessation advice and support into daily dental practice. A short report. British Dental Journal, 2011; 210(7):E10. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21475254

136. Pendharkar B, Levy S, McQuistan M, Qian F, Squier C, et al. Fourth-year dental students' perceived barriers to providing tobacco intervention services. Journal of Dental Education, 2010; 74(10):1074–85. Available from:  http://www.jdentaled.org/cgi/content/full/74/10/1074

137. Muzyka B, Cropley L, Oertling K, Andrieu S, and Anderson P. Assessment of dental faculty, staff, and students on knowledge of health effects associated with tobacco use. Journal of Public Health Management and Practice, 2009; 15(2):135–8. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19202414

138. Clareboets S, Sivarajasingam V, and Chestnutt I. Smoking cessation advice: Knowledge, attitude and practice among clinical dental students. British Dental Journal, 2010; 208(4):173–7. Available from:  http://www.nature.com/bdj/journal/v208/n4/abs/sj.bdj.2010.158.html

139. Amemori M, Korhonen T, Kinnunen T, Michie S, and Murtomaa H. Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: A cluster randomised controlled trial. Implementation Science, 2011; 6(1):13. Available from:  http://www.implementationscience.com/content/pdf/1748-5908-6

140. Brocklehurst P, Baker S, and Speight P. Primary care clinicians and the detection and referral of potentially malignant disorders in the mouth: A summary of the current evidence. Primary Dental Care, 2010; 17(2):65–71. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20353654

141. Richards W and Higgs G. An audit of smoking behaviours among patients attending two general dental practices in south wales: An awareness-raising exercise for the dental team and patients. Primary Dental Care, 2010; 17(2):79–82. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20353656

142. Pau A, Olley R, Murray S, Chana B, and Gallagher J. Dental hygienists' self-reported performance of tobacco cessation activities. Oral Health & Preventive Dentistry, 2011; 9(1):29–36. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/21594204

143. Studts J, Burris J, Kearns D, Worth C, and Sorrell C. Evidence-based tobacco cessation treatment by dental hygienists. Journal of Dental Hygiene, 2011; 85(1):13–21. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/21396259

144. Ford P, Tran P, Keen B, and Gartner C. Survey of Australian oral health practitioners and their smoking cessation practices. Australian Dental Journal, 2015; 60(1):43–51. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25721277

145. Schauer GL, Agaku IT, King BA, and Malarcher AM. Health care provider advice for adolescent tobacco use: Results from the 2011 national youth tobacco survey. Pediatrics, 2014; 134(3):446–55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25136037

146. Vered Y, Livny A, Zini A, Shabaita S, and Sgan-Cohen H. Dental students' attitudes and behavior toward smoking cessation as part of their professional education. Teaching and Learning in Medicine, 2010; 22(4):268–73. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20936573

147. Anders PL, Davis EL, and McCall WD, Jr. Dental students' attitudes toward tobacco cessation counseling. Journal of Dental Education, 2014; 78(1):56–63. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24385525

148. Foundation NH. Guide to management of hypertension 2008. Assessing and managing raised blood pressure in adults. 2008 Available from:  http://www.heartfoundation.org.au/Professional_Information/Clinical_Practice/Hypertension.htm

149. Anon. Cardiologists should be less passive about smoking cessation. The Lancet, 2009; 373(9667):867. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19286063

150. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, et al. Cardiovascular prevention guidelines in daily practice: A comparison of euroaspire I, II, and III surveys in eight European countries. The Lancet, 2009; 373(9667):929–40. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/19286092

151. Erhardt L. Cigarette smoking: An undertreated risk factor for cardiovascular disease. Atherosclerosis, 2009; 205(1):23–32. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19217623

152. Aboyans V, Thomas D, and Lacroix P. The cardiologist and smoking cessation. Current Opinion in Cardiology, 2010; 22(5):469–77. Available from:  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20671551

153. Trotter L and Scanlan M. Smoking cessation training for health professionals working with cardiac patients, in Quit evaluation studies no.10. Melbourne: The Anti-Cancer Council of Victoria; 2000. p 97–108 Available from:  http://www.quit.org.au/downloads/QE/QE10/10Home.html

154. Sosnowski R and Przewozniak K. The role of the urologist in smoking cessation: Why is it important? Urologic Oncology, 2015; 33(1):30–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25154777

155. Naranjo A, Khan NA, Cutolo M, Lee SS, Lazovskis J, et al. Smoking cessation advice by rheumatologists: Results of an international survey. Rheumatology, 2014; 53(10):1825–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24840678

156. Demmert A, Grothues J, and Rumpf H. Attitudes towards brief interventions to reduce smoking and problem drinking behaviour in gynaecological practice. Public Health, 2011; 125(4):182–6. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/21439599

157. Schultz CR, Benson JJ, Cook DA, and Warner DO. Training for perioperative smoking cessation interventions: A national survey of anesthesiology program directors and residents. Journal of Clinical Anesthesia, 2014; 26(7):563–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25439420

158. Yousefzadeh A, Chung F, Wong DT, Warner DO, and Wong J. Smoking cessation: The role of the anesthesiologist. Anesth Analg, 2016; 122(5):1311–20. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/27101492

159. Martinelli E, Palmer R, Wilson R, and Newton J. Smoking behaviour and attitudes to periodontal health and quit smoking in patients with periodontal disease. Journal of Clinical Periodontology, 2008; 35(11):944–54. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/18976392

160. Rosenthal JS. The responsibility of plastic surgeons to help patients stop smoking. Plastic and Reconstructive Surgery, 2002; 109(3):1201–2. Available from:  http://journals.lww.com/plasreconsurg/Citation/2002/03000/THE_RESPONSIBILITY_OF_PLASTIC_SURGEONS_TO_HELP.72.aspx

161. Caponnetto P, Polosa R, and Best D. Tobacco use cessation counseling of parents. Current Opinion in Pediatrics, 2008; 20(6):729–33. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19023920

162. Winickoff J, Park E, Hipple B, Berkowitz A, Vieira C, et al. Clinical effort against secondhand smoke exposure: Development of framework and intervention. Pediatrics, 2008; 122(2):e363–75. Available from:  http://pediatrics.aappublications.org/cgi/reprint/122/2/e363

163. Gray J, Eden G, and Williams M. Developing the public health role of a front line clinical service: Integrating stop smoking advice into routine podiatry services. Journal of Public Health, 2007; 29(2):118–22. Available from:  http://jpubhealth.oxfordjournals.org/cgi/reprint/29/2/118

164. Kennedy R, Spafford M, Schultz A, Iley M, and Zawada V. Smoking cessation referrals in optometric practice: A Canadian pilot study. Optometry & Vision Science, 2011; 88(6):766–71. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21460753

165. Sheck L, Field A, McRobbie H, and Wilson G. Helping patients to quit smoking in the busy optometric practice. Clinical and Experimental Optometry, 2009; 92(2):75–7. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19278457

166. Downie LE and Keller PR. The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation. PLoS ONE, 2015; 10(4):e0124533. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25886641

167. Bodner M and Dean E. Advice as a smoking cessation strategy: A systematic review and implications for physical therapists. Physiotherapy Theory and Practice, 2009; 25(5–6):369–407. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19842864

168. Bodner M, Miller W, Rhodes R, and Dean E. Smoking cessation and counseling: Knowledge and views of Canadian physical therapists. Physical Therapy, 2011; 91(7):1051–62. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21546565

169. Bodie LP. To treat or not to treat: Should psychologists treat tobacco use disorder? Psychological Services, 2014; 11(3):317–23. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24867147

170. Kleinfelder J, Price JH, Dake JA, Jordan TR, and Price JA. Tobacco training in clinical social work graduate programs. Health & Social Work, 2013; 38(3):173–81. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/24437023

171. Bryant J, Bonevski B, Paul C, O'Brien J, and Oakes W. Developing cessation interventions for the social and community service setting: A qualitative study of barriers to quitting among disadvantaged Australian smokers. BMC Public Health, 2011; 11:493. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21699730

172. Bryant J, Bonevski B, Paul C, O'Brien J, and Oakes W. Delivering smoking cessation support to disadvantaged groups: A qualitative study of the potential of community welfare organizations. Health Education Research, 2010; 25(6):979–90. Available from:  http://her.oxfordjournals.org/content/25/6/979.abstract

173. Bryant J, Bonevski B, and Paul C. A survey of smoking prevalence and interest in quitting among social and community service organisation clients in Australia: A unique opportunity for reaching the disadvantaged. BMC Public Health, 2011; 11(1):1–6. Available from:  http://dx.doi.org/10.1186/1471-2458-11-827

174. Bryant J, Bonevski B, Paul C, Hull P, and O'Brien JON. Implementing a smoking cessation program in social and community service organisations: A feasibility and acceptability trial. Drug and Alcohol Review, 2012; 31(5):678–84. Available from:  http://dx.doi.org/10.1111/j.1465-3362.2011.00391.x

175. Bonevski B, O’Brien J, Frost S, Yiow L, Oakes W, et al. Novel setting for addressing tobacco-related disparities: A survey of community welfare organization smoking policies, practices and attitudes. Health Education Research, 2013; 28(1):46–57. Available from:  http://her.oxfordjournals.org/content/28/1/46.abstract

176. Muramoto ML, Gordon JS, Bell ML, Nichter M, Floden L, et al. Tobacco cessation training for complementary and alternative medicine practitioners: Results of a practice-based trial. American Journal of Preventive Medicine, 2016. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/27061892

177. Anderson P. Overview of interventions to enhance primary-care provider management of patients with substance-use disorders. Drug and Alcohol Review, 2009; 28(5):567–74. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19737215

178. Richmond R, Mendelsohn C, and Kehoe L. Family physicians' utilization of a brief smoking cessation program following reinforcement contact after training: A randomized trial. Preventive Medicine, 1997; 27(1):77–83. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/9465357

179. Gordon J and Mahabee-Gittens E. Development of a web-based tobacco cessation educational program for pediatric nurses and respiratory therapists. Journal of Continuing Education in Nursing, 2010; 42(3):136–44. Available from:  http://www.jcenonline.com/view.asp?rID=78487

180. Prokhorov A, Hudmon K, Marani S, Foxhall L, Ford K, et al. Engaging physicians and pharmacists in providing smoking cessation counseling. Archives of Internal Medicine, 2010; 170(18):1640–6. Available from:  http://archinte.ama-assn.org/cgi/content/full/170/18/1640

181. Carson KV, Verbiest MEA, Crone MR, Brinn MP, Esterman AJ, et al. Training health professionals in smoking cessation. Cochrane Database of Systematic Reviews, 2012; (5). Available from:  http://dx.doi.org/10.1002/14651858.CD000214.pub2

182. Victor J, Brewster J, Ferrence R, Ashley M, Cohen J, et al. Tobacco-related medical education and physician interventions with parents who smoke: Survey of Canadian family physicians and pediatricians. Canadian Family Physician, 2010; 56(2):157–63. Available from:  http://www.cfp.ca/cgi/content/full/56/2/157

183. Herie M, Connolly H, Voci S, Dragonetti R, and Selby P. Changing practitioner behavior and building capacity in tobacco cessation treatment: The teach project. Patient Education and Counseling, 2012; 86(1):49–56. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21612884

184. Martin B, Bruskiewitz R, and Chewning B. Effect of a tobacco cessation continuing professional education program on pharmacists' confidence, skills, and practice-change behaviors. Journal of the American Pharmacists Association, 2010; 50(1):9–16. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/20097634

185. Martin B and Chewning B. Evaluating pharmacists' ability to counsel on tobacco cessation using two standardized patient scenarios. Patient Education and Counseling, 2011; 83(3):319–24. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21237610

186. Sheffer CE, Barone CP, and Anders ME. Training health care providers in the treatment of tobacco use and dependence: Pre- and post-training results. Journal of Evaluation in Clinical Practice, 2009; 15(4):607–13. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19674215

187. McRobbie H, Hajek P, Feder G, and Eldridge S. A cluster-randomised controlled trial of a brief training session to facilitate general practitioner referral to smoking cessation treatment. Tobacco Control, 2008; 17(3):173–6. Available from:  http://tobaccocontrol.bmj.com/cgi/content/abstract/17/3/173

188. Bernstein S, Jearld S, Prasad D, Bax P, and Bauer U. Rapid implementation of a smokers' quitline fax referral service in an urban area. Journal of Health Care for the Poor and Underserved, 2009; 20(1):55–63. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19202246

189. Richmond R, Educating medical students about tobacco: Planning and implementation. Tobacco Prevention Section International Union Against Tuberculosis and Lung Disease Paris, France; 1996. Available from:  http://catalogue.nla.gov.au/Record/1470231

190. Leong S, Lewis P, Curry W, and Gingrich D. Tobacco world: Evaluation of a tobacco cessation training program for third-year medical students. Academic Medicine, 2008; 83(10 ):S25–8. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/18820494

191. Kosowicz L, Pfeiffer C, and Vargas M. Long-term retention of smoking cessation counseling skills learned in the first year of medical school. Journal of General Internal Medicine, 2007; 22(8):1161–5. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/17557189

192. Spollen J, Thrush C, Mui D, Woods M, Tariq S, et al. A randomized controlled trial of behavior change counseling education for medical students. Medical Teacher, 2010; 32(4):e170–7. Available from:  http://informahealthcare.com/doi/full/10.3109/01421590903514614

193. Chatkin J and Chatkin G. Learning about smoking during medical school: Are we still missing opportunities? International Journal of Tuberculosis and Lung Disease, 2009; 13(4):429–37. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19335946

194. Raupach T, Shahab L, Baetzing S, Hoffmann B, Hasenfuss G, et al. Medical students lack basic knowledge about smoking: Findings from two European medical schools. Nicotine & Tobacco Research, 2009; 11(1):92–8. Available from:  http://ntr.oxfordjournals.org/cgi/content/abstract/11/1/92

195. Kralikova E, Bonevski B, Stepankova L, Pohlova L, and Mladkova N. Postgraduate medical education on tobacco and smoking cessation in Europe. Drug and Alcohol Review, 2009; 28(5):474–83. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19737206

196. Richmond R. Education and training for health professionals and students in tobacco, alcohol and other drugs. Drug and Alcohol Review, 2009; 28(5):463–5. Available from:   http:// www.ncbi.nlm.nih.gov/pubmed/19737204

197. Zwar N, Richmond R, Davidson D, and Hasan I. Postgraduate education for doctors in smoking cessation. Drug and Alcohol Review, 2009; 28(5):466–73. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/19737205

198. Selby P, Goncharenko K, Barker M, Fahim M, Timothy V, et al. Review and evaluation of online tobacco dependence treatment training programs for health care practitioners. Journal of Medical Internet Research, 2015; 17(4):e97. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25887187

199. Ockene JK, Hayes RB, Churchill LC, Crawford SL, Jolicoeur DG, et al. Teaching medical students to help patients quit smoking: Outcomes of a 10-school randomized controlled trial. Journal of General Internal Medicine, 2015. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/26391030

200. McCullough A, Fisher M, Goldstein A, Kramer K, and Ripley-Moffitt C. Smoking as a vital sign: Prompts to ask and assess increase cessation counseling. The Journal of the American Board of Family Medicine, 2009; 22(6):625–32. Available from:  http://www.jabfm.org/cgi/content/full/22/6/625

201. Szatkowski L, McNeill A, Lewis S, and Coleman T. A comparison of patient recall of smoking cessation advice with advice recorded in electronic medical records. BMC Public Health, 2011; 11:291. Available from:  http://www.biomedcentral.com/1471-2458/11/291

202. Linder J, Rigotti N, Schneider L, Kelley J, Brawarsky P, et al. An electronic health record-based intervention to improve tobacco treatment in primary care: A cluster-randomized controlled trial. Archives of Internal Medicine, 2009; 169(8):781–7. Available from:  http://archinte.ama-assn.org/cgi/content/full/169/8/781

203. Boyle R, Solberg L, and Fiore M. Use of electronic health records to support smoking cessation. Cochrane Database of Systematic Reviews, 2014; 12:CD008743. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25547090

204. Maynard A, Street A, and Hunter R. Using ‘payment by results’ to fund the treatment of dependent drug users—proceed with care! Addiction, 2011; 106(10):1725–9. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21793968

205. West R. 'Payment by results' and smoking cessation support. Addiction, 2011; 106(10):1730–1. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21917036

206. McLeod H, Blissett D, Wyatt S, and Mohammed MA. Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: A cluster controlled study. PLoS ONE, 2015; 10(4):e0123349. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/25875959

207. Mathew M, Goldstein A, Kramer K, Ripley-Moffitt C, and Mage C. Evaluation of a direct mailing campaign to increase physician awareness and utilization of a quitline fax referral service. Journal of Health Communication, 2010; 15(8):840–5. Available from:  http://www.ncbi.nlm.nih.gov/pubmed/21170786

208. Sherman S, Takahashi N, Kalra P, Gifford E, Finney J, et al. Care coordination to increase referrals to smoking cessation telephone counseling: A demonstration project The American Journal of Managed Care, 2008; 14(3):141–8. Available from:  http:// www.ncbi.nlm.nih.gov/pubmed/18333706