Knowledge, attitude, practice and perceived barriers towards smoking cessation services among community pharmacists

Main Article Content


Pharmacist, Cessation, Jordan, Waterpipe use, Tobacco use, Counselling, Smoking, Smoking cessation programme


Introduction: With more than one billion current smokers, 80% of them living in low and middle-income countries, tobacco smoking is considered a global public health problem. Jordan has one of the highest estimate rates of tobacco use in the region and world. Still, tobacco use interventions, that could significantly reduce the number of smoking-related diseases and reduce health care costs, are scarce. While such interventions could be carried out by community pharmacists, given their unique position to counsel patients and provide effective cessation interventions, the role of community pharmacists in tobacco control services in Jordan has never been fully investigated. Objective: This study aimed at assessing the community pharmacists’ knowledge, attitudes, and practice towards smoking cessation and identifying their perceived barriers for smoking cessation counselling utilizing a sample of community pharmacists in Northern Jordan. Method: A cross-sectional study was conducted among community pharmacies in Irbid city, North of Jordan, between April and August 2018. A random sample of 95 pharmacies was selected using the multistage random sampling technique. A structured English questionnaire, consisting of 5 parts, was used. The Survey assessed pharmacists’ socio-demographics, knowledge, attitude, practice and perceived barriers related to tobacco use cessation services. Results: One hundred and fifty pharmacists completed the survey. Their mean age was 30.71±10.10 years. The mean of pharmacists’ knowledge score was 3.74±0.38, while their positive and negative attitude were 3.87±0.43 and 3.18±0.66 respectively. Pharmacists’ mean smoking cessation practice was 2.01+0.64. Barriers to providing cessation interventions included the lack of training on nicotine replacement therapy products (86%), the lack of smoking cessation programs (84%) and low demands from smokers (83.3%). Conclusion: While knowledge related to tobacco use cessation services among the community pharmacists was sub-optimal, a good positive attitude and a low practice levels were observed. The lack of educational materials, low patients’ demand, knowledge deficits, low training and the lack of cessation programs have been identified as barriers hindering the provision of smoking cessation services. Furthermore, the study identified factors that will increase community pharmacists’ participation in smoking cessation, help in raising pharmacists’ awareness of smoking as a public health problem and the importance of their role.


Download data is not yet available.
Abstract 269 | pdf Downloads 189


1. World Health O. WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies: World Health Organization. 2017.
2. Sotiropoulos A, Gikas A, Spanou E, et al. Smoking habits and associated factors among Greek physicians. Public health.2007;121(5):333-340.
3. World Health O. WHO report on the global tobacco epidemic, 2009: implementing smoke-free environments: Geneva: WorldHealth Organization. 2009.
4. Kheirallah KA, Veeranki SP, Alzyoud S, et al. Collision of waterpipe and cigarette smoking epidemics among youth in Arab countries. Journal of Substance Use. 2016;21(5):530-536.
5. Kheirallah KA, Alsulaiman JW, Al-Sakran Mohammad H, et al. Waterpipe tobacco smoking among Arab youth; a cross-country study. Ethnicity & disease. 2016;26(1):107.
6. Salloum RG, Nakkash R, Abu-Rmeileh NME, et al. Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries. Health promotion international. 2019;34(6):1157-1166.
7. High Health C. The National Strategy for Health Sector in Jordan 2015-2019. 2017.
8. Region EM. Framework for health information systems and core indicators for monitoring health situation and health system performance. Geneva (Switzerland): World Health Organization. 2016.
9. Riley RF. The development and implementation of secondary prevention measures for coronary artery disease. 2013. 10. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national
statistics with two case-control studies. Bmj. 2000;321(7257):323-329. 11. Fiore MC, Bailey WC, Cohen SJ, et al. Smoking cessation: clinical practice guideline no. 18. 1996.
12. Centers for Disease C, Prevention. Best practices for comprehensive tobacco control programs-2007. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Preventionand Health Promotion, Office on Smoking and Health. 2007:1-11.
13. Terres W, Becker P, Rosenberg A. Changes in cardiovascular risk profile during the cessation of smoking. The American journal of medicine. 1994;97(3):242-249.
14. Dhhs US. The health consequences of smoking: nicotine addiction. A report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services. Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health. DHHS Publication No.(PHS)(CDC) 88-8406. 1988. 
15. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long‐term abstinence among untreated smokers. Addiction.2004;99(1):29-38.
16. Fiore MC, Jaén CR. A clinical blueprint to accelerate the elimination of tobacco use. Jama. 2008;299(17):2083-2085.
17. Tobacco TCPGT. A clinical practice guideline for treating tobacco use and dependence: 2008 update: a US public health servicereport. American journal of preventive medicine. 2008;35(2):158-176.
18. Fiore MC. Treating tobacco use and dependence-Clinical practice guideline. http://www surgeongeneral gov/tobacco/. 2000.
19. Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. Bmj. 2000;321(Suppl S3).
20. Group TGC. Tobacco use and cessation counselling: Global health professionals survey pilot study, 10 countries, 2005. Tobacco control. 2006;15(Suppl 2):ii31.
21. Babb VJ, Babb J. Pharmacist involvement in healthy people 2010. Journal of the American Pharmaceutical Association (1996).2003;43(1):56-60.
22. Aquilino ML, Farris KB, Zillich AJ, et al. Smoking‐cessation services in Iowa community pharmacies. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2003;23(5):666-673.
23. Sinclair HK, Silcock J, Bond CM, et al. The cost-effectiveness of intensive pharmaceutical intervention in assisting people to stop smoking. International Journal of Pharmacy Practice. 1999;7(2):107-112.
24. Zillich AJ, Ryan M, Adams A, et al. Effectiveness of a pharmacist‐based smoking‐cessation program and its impact on quality of life. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2002;22(6):759-765. phco.22.9.759.34073
25. Hudmon KS, Hemberger KK, Corelli RL, et al. The pharmacist’s role in smoking cessation counseling: perceptions of users of nonprescription nicotine replacement therapy. Journal of the American Pharmacists Association. 2003;43(5):573-582.
26. Couchenour RL, Denham AZ, Simpson KN, et al. Smoking cessation activities in South Carolina community pharmacies. Journal of the American Pharmaceutical Association (1996). 2000;40(6):828-831.
27. Margolis JA, Meshack AF, McAlister AL, et al. Smoking cessation activities by pharmacists in East Texas. Journal of the American Pharmaceutical Association. 2002;42(3):508-509.
28. Chang J-C, Lee Y-Y, Kuo L-N, et al. Knowledge, attitudes, and behavior toward smoking cessation among hospital pharmacists in Taiwan. Journal of Experimental & Clinical Medicine. 2012;4(4):249-254.
29. Ashley MJ, Brewster JM, Victor JC. Pharmacists’ smoking cessation practices: relationship to their knowledge and skills, attitudes, and perceptions of roles. Journal of the American Pharmacists Association. 2006;46(6):729-737.
30. El Hajj MS, Al Nakeeb RR, Al-Qudah RaA. Smoking cessation counseling in Qatar: community pharmacists’ attitudes, role perceptions and practices. International journal of clinical pharmacy. 2012;34(4):667-676.
31. Ashley MJ, Victor JC, Brewster J. Pharmacists’ attitudes, role perceptions and interventions regarding smoking cessation: findings from four Canadian provinces. Chronic Dis Can. 2007;28(1-2):20-28.
32. Taha NA, Guat Tee O. Tobacco cessation through community pharmacies: Knowledge, attitudes, practices and perceived barriers among pharmacists in Penang. Health Education Journal. 2015;74(6):681-690.
33. Thananithisak C, Nimpitakpong P, Chaiyakunapruk N. Activities and perceptions of pharmacists providing tobacco control services in community pharmacy in Thailand. Nicotine & Tobacco Research. 2008;10(5):921-925.
34. Williams DM, Newsom JF, Brock TP. An evaluation of smoking cessation-related activities by pharmacists. Journal of the American Pharmaceutical Association (1996). 2000;40(3):366-370.
35. Bader RK, Shihab RA, Al-Rimawi DH, et al. Informing tobacco control policy in Jordan: assessing the effectiveness of pictorial warning labels on cigarette packs. BMC public health. 2018;18(1):1-7.
36. World Health O. Global Youth Tobacco Survey Country Fact Sheets-Jordan 2009. 2012.
37. Khabour OF, Alzoubi KH, Eissenberg T, et al. Waterpipe tobacco and cigarette smoking among university students in Jordan.The International Journal of Tuberculosis and Lung Disease. 2012;16(7):986-992. 
38. Saba M, Diep J, Saini B, et al. Meta‐analysis of the effectiveness of smoking cessation interventions in community pharmacy.Journal of clinical pharmacy and therapeutics. 2014;39(3):240-247.
39. Nazer LH, Tuffaha H. Health care and pharmacy practice in Jordan. The Canadian journal of hospital pharmacy. 2017;70(2):150.40. Goniewicz ML, Lingas EO, Czogala J, et al. The role of pharmacists in smoking cessation in Poland. Evaluation & the health
professions. 2010;33(1):81-95.
41. Beard E, McDermott M, McEwen A, et al. Beliefs of stop smoking practitioners in United Kingdom on the use of nicotine replacement therapy for smoking reduction. Nicotine & Tobacco Research. 2012;14(6):639-647.
42. Lee ML, Hassali MA, Shafie AA, et al. Challenges of pharmacist-managed smoking cessation services—a viewpoint. Nicotine & Tobacco Research. 2011;13(6):504-505.
43. Hudmon KS, Prokhorov AV, Corelli RL. Tobacco cessation counseling: pharmacists’ opinions and practices. Patient education and counseling. 2006;61(1):152-160.
44. Martin BA, Chewning BA. Evaluating pharmacists’ ability to counsel on tobacco cessation using two standardized patientscenarios. Patient education and counseling. 2011;83(3):319-324. 
45. Prokhorov AV, Hudmon KS, Marani S, et al. Engaging physicians and pharmacists in providing smoking cessation counseling. Archives of Internal Medicine. 2010;170(18):1640-1646.
46. Osler M, Prescott E. Psychosocial, behavioural, and health determinants of successful smoking cessation: a longitudinal study of Danish adults. Tobacco control. 1998;7(3):262-267.
47. Martin BA, Bruskiewitz RH, Chewning BA. 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):9-18a.
48. McBane SE, Corelli RL, Albano CB, et al. The role of academic pharmacy in tobacco cessation and control. American journal of pharmaceutical education. 2013;77(5).
49. Barrett R, Aldamkhi H. An Evaluation of the Knowledge and Perceptions of Pharmacy Staff and Pre-Registration Students of E-Cigarettes Use: A Systematic Review. Tobacco Use Insights. 2021;14:1179173X211016867. 
50. Al-Wazaify M, Matowe L, Albsoul-Younes A, et al. Pharmacy education in jordan, saudi arabia, and kuwait. American journal of pharmaceutical education. 2006;70(1).
51. Yan J, Xiao S, Ouyang D, et al. Smoking behavior, knowledge, attitudes and practice among health care providers in Changsha city, China. Nicotine & Tobacco Research. 2008;10(4):737-744.
52. Eades CE, Ferguson JS, O’Carroll RE. Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC public health. 2011;11(1):1-13. 
53. Shishani K, Nawafleh H, Jarrah S, et al. Smoking patterns among Jordanian health professionals: a study about the impediments to tobacco control in Jordan. European Journal of Cardiovascular Nursing. 2011;10(4):221-227.
54. Merrill RM, Madanat H, Kelley AT, et al. Nurse and physician patient counseling about tobacco smoking in Jordan. Promotion & education. 2008;15(3):9-14.
55. Smith DR, Leggat PA. An international review of tobacco smoking in the medical profession: 1974–2004. BMC public health.2007;7(1):1-12.
56. Ali AYM, Safwat T, Onyemelukwe G, et al. Smoking prevention and cessation in the Africa and Middle East region: a consensus draft guideline for healthcare providers–executive summary. Respiration. 2012;83(5):423-432.  
57. Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: US Department of Health and Human Services. 2008.
58. Vardavas CI, Symvoulakis EK, Lionis C. Dealing with tobacco use and dependence within primary health care: time for action.Vol 11: Springer; 2013:1-2.
59. Raw M, Anderson P, Batra A, et al. WHO Europe evidence based recommendations on the treatment of tobacco dependence. Tobacco control. 2002;11(1):44.
60. Odukoya OO, Poluyi EO, Aina B, et al. Pharmacist-led smoking cessation: The attitudes and practices of community pharmacists in Lagos state, Nigeria. A mixed methods survey. Tobacco Prevention & Cessation. 2016;2(January).
61. Dent LA, Harris KJ, Noonan CW. Tobacco treatment practices of pharmacists in Montana. Journal of the American Pharmacists Association. 2010;50(5):575-579.
62. Carson KV, Verbiest MEA, Crone MR, et al. Training health professionals in smoking cessation. Cochrane database of systematic reviews. 2012(5).
63. Tong EK, Strouse R, Hall J, Kovac M, et al. National survey of US health professionals’ smoking prevalence, cessation practices, and beliefs. Nicotine & Tobacco Research. 2010;12(7):724-733.
64. Hamadeh RR, Ahmed J, Al-Kawari M, et al. Quit tobacco clinics in Bahrain: smoking cessation rates and patient satisfaction. Tobacco induced diseases. 2017;15(1):1-7.
65. Inch J, Bond CM, Blenkinsopp A, et al. Progress in implementing the community pharmacy contractual framework: Provision of essential and enhanced services. International Journal of Pharmacy Practice. 2007;15:B50.