Tobacco control among health professionals from the perspective of an educational institution - nurses' awareness of the importance of non-smoking behavior and the role of the Angela Boškin Faculty of Health Care (Slovenia) in endorsing a non-smoking policy
Sanela Pivač 1  
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Angela Boškin Faculty of Health Care, Slovenia
Publish date: 2019-03-26
Tob. Prev. Cessation 2019;5(Supplement):A22
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In Slovenia, smoking as a risk factor is the leading preventable cause of death. Each year, almost 3,600 inhabitants of Slovenia die of smoking-related illnesses, which is almost 10 a day; of these, one in four die before the age of 60. Almost a quarter of the adult population of Slovenia smokes, and smokers mostly took up the habit as early as their teenage years. Most of them smoke regularly, on a daily basis (National Institute of Public Health – NIPH, 2018). Restriction on the Use of Tobacco and Related Products Act (ZOUTPI, 2017) states that, in Slovenia, tobacco heating products may not be sold to persons younger than 18, it is prohibited to sell them from vending machines, online or through any other means of telecommunication or evolving technologies, also prohibited are cross-border distance sales of these products, their advertising, exhibiting, promotion and sponsorship, they may not be used in enclosed public spaces or at work premises, and must contain written health warnings. All venues selling such products must, from the end of 2018 onwards, possess a vending permit issued by a competent authority (NIPH, 2018). The prevalence of tobacco use is becoming a major issue also among health professionals (Smith & Leggat, 2007). Health professionals who smoke cannot provide appropriate health education and tobacco cessation counselling by setting an example as they are hindered in this by their own smoking (Tong, et al., 2010). By acting as role models and promoting non-smoking behavior, health professionals can significantly contribute to reducing tobacco use.
According to previous research findings on the prevalence of smoking among nurses and other health professionals, different work methods should be implemented to increase the knowledge, responsibility and awareness of health professionals on non-smoking behavior and on educating patients about tobacco cessation. A national cross-sectional study among nurses—the largest group of health professionals—, nursing assistants and midwives showed that smoking remains all too frequent among these professional groups, a fact which may impact their calling, promotion of non-smoking behavior, and assistance in smoking cessation (Koprivnikar, 2013).
As a faculty, we are well aware of the importance of promoting non-smoking behavior and endorsing non-smoking policy in our educational processes, as smoking is common also among nursing students—a fact which has drawn attention internationally. It is clear that health faculties must be aware of this issue and provide support in getting their students to quit smoking. Researchers have found that most students desire to quit smoking and faculties should support them in their endeavors, encourage them and raise awareness. One idea is to form work groups with members including both lecturers and nursing students (Durkin, 2008). Considering the prevalence of smoking and a high smoking rate among nursing students, there is an urgent need for implementing effective measures to increase quit rates among nursing students (Biraghi & Tortorano, 2010). Compared to other countries, Slovenia does not have as extensive research on nursing students’ psychological distress and their use of licit drugs. It is a known fact that self-image, positive opinions and role-model behavior contribute to the effectiveness of health education work. Health professionals should set an example by not consuming alcohol or using tobacco products because that is the only way to encourage patients to quit smoking and stop consuming alcohol. Medical faculties and other health faculties should ensure their students have all the knowledge available about the dangers of smoking to health.
The main aim of the study was to determine nurses’ opinions on the importance of their own non-smoking behavior and their self-assessed competency for implementing health education workshops in tobacco control.

A quantitative study design was employed and a structured questionnaire was used as a research instrument. The study was conducted among nurses who participated in the Tobacco Control project workshops in the period 2017-18. A convenience sample was used. The study included 79 nurses who participated in the workshops. The questionnaire was filled out by 66 nurses (a response rate of 83.5%). The obtained information was analyzed using statistical software SPSS 20.00.

Study results revealed that, of all the nurse respondents, 5 (7.6%) were active smokers. Of these, 3 (4.5%) smoked on a regular basis (daily). A total of 20 respondents (30.3%) reported having smoked 100 or more cigarettes in their lives. Of the active smokers, 4 (6.1%) expressed a desire to quit. The results showed a unified, stable and positive opinion on the impact of nurses’ own smoking status and role-model behavior (M=1.4; SD=0.7), on the role of nurses in actively assisting patients to quit smoking (M=1.4; SD=0.8), and the need for additional education in tobacco control (M=1.5; SD=0.8).

Our study revealed that nurse respondents are aware to a high degree that their own smoking status affects their calling, their work in health promotion, their promotion of non-smoking behavior, and assistance in smoking cessation, which can certainly represent an obstacle in effective implementation of tobacco control activities. It is crucial to increase nurses’ knowledge, responsibility, and awareness in terms of non-smoking behavior and patient education on smoking cessation by implementing various work methods such as the workshops conducted as part of the Tobacco Control project. It is important to remember that every health professional plays an important role in tobacco control activities and that their actions also influence their professional reputation. According to our findings on the importance of nurses’ smoking status, we suggest active participation and inclusion of professional health workers’ associations in the effort to lower smoking rates and provide support to health professionals in smoking cessation. Health workers’ associations are advised to promote the culture of non-smoking among their members at various meetings and events, thereby encouraging a non-smoking policy through all their activities.
Undoubtedly, educational institutions for future health professionals also have an important role on raising awareness about the dangers of smoking. Students must be made aware of all the dangers, risks and risk management strategies connected to smoking. Furthermore, we suggest the formation of work groups with lecturers and other professional staff members who can provide support in smoking cessation to both health professionals and students. As part of the Tobacco Control project, the Angela Boškin Faculty of Health Care has implemented e-learning with 97 nurses, conducted four workshops with a total of 79 nurse participants, and awarded seven Mini Grants. Nurses who participated in the workshops gave short seminars to raise awareness among nurses and patients. As a result of the project, a big emphasis was placed on raising awareness on the adverse effects of smoking among students. Five promotional activities were conducted which included 150 nursing and physiotherapy students. Under the guidance of mentors from the Angela Boškin Faculty of Health Care, students held a health education lecture on the detrimental effects of smoking for hospital patients. The lecture was attended by 10 patients and two employees. Moreover, students helped raise awareness among passers-by at a shopping center stand.
As an educational institution, we are aware of how important it is to promote non-smoking behavior. This is why we encourage students to prepare posters and stands for the World No Tobacco Day and the International No Smoking Day, raising awareness on the dangers of smoking.