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Vila-Farinas A, Pérez-Rios M, Montes-Martinez A, Ruano-Ravina A, Forray A, Rey-Brandariz J, Candal-Pedreira C, Fernández E, Casal-Acción B, Varela-Lema L. Effectiveness of smoking cessation interventions among pregnant women: An updated systematic review and meta-analysis. Addict Behav 2024; 148:107854. [PMID: 37683574 DOI: 10.1016/j.addbeh.2023.107854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To carry out a systematic review of systematic reviews with an update of the existing evidence relating to a broad range of smoking cessation interventions, including psycho-social, digital and pharmacologic interventions, for pregnant women. DATA-SOURCES Search was conducted in March 2022 in PubMed, EMBASE, and Cochrane in two stages: 1) a search of systematic reviews and meta-analyses, published from January 2012 through January 2022; 2) an update of those that fulfilled eligibility criteria reproducing the primary search strategy. STUDY ELIGIBILITY CRITERIA We selected randomized clinical trials (RCTs) that evaluated the effectiveness of pharmacological, digital, and psychosocial interventions in aged 18 years and over who were daily smokers, and compared these with routine care, less intense interventions or placebo. STUDY APPRAISAL AND SYNTHESIS METHODS Data from eligible studies were manually extracted by two authors and reviewed by a third. The quality of the reviews was evaluated using the AMSTAR scale, and risk of bias was measured with the Rob-2 tool and GRADE level of evidence. RESULTS The meta-analysis included 63 RCTs (n = 19849 women). The interventions found to be effective were: financial incentives (RR:1.77; 95%CI:1.21-2.58), counseling (RR:1.27; 95%CI:1.13-1.43) and long-term nicotine replacement therapy (NRT) (RR:1.53; 95%CI:1.16-2.01). Short-term NRT, bupropion, digital interventions, feedback, social support, and exercise showed no effectiveness. The GRADE level of evidence was moderate-to-high for all interventions, with the exception of long-term NRT. CONCLUSIONS Non-pharmacological interventions for smoking cessation are the most effective for pregnant women. The moderator analysis suggests that pregnant women of low socioeconomic status might benefit less from smoking cessation interventions than women of a high socioeconomic status. These women are usually heavier smokers that live in pro-smoking environments and could require more intensive and targeted interventions.
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Affiliation(s)
- A Vila-Farinas
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - M Pérez-Rios
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Madrid, Spain.
| | - A Montes-Martinez
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Madrid, Spain
| | - A Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Madrid, Spain
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - J Rey-Brandariz
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - C Candal-Pedreira
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - E Fernández
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia (ICO), Barcelona, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain; School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - B Casal-Acción
- Galician Agency for Health Knowledge Management (avalia-t; ACIS), Santiago de Compsotela, Spain
| | - L Varela-Lema
- Department of Preventive Medicine and Public Health, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Madrid, Spain
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Wada A, Nakamura Y, Kawajiri M, Takeishi Y, Yoshida M, Yoshizawa T. Feasibility and Usability of the Job Adjustment Mobile App for Pregnant Women: Longitudinal Observational Study. JMIR Form Res 2023; 7:e48637. [PMID: 37962945 PMCID: PMC10685280 DOI: 10.2196/48637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Working pregnant women often need to adjust their physically demanding jobs for a healthy pregnancy. However, uncertainty about the extent of these adjustments can hinder their effectiveness. To address this, we developed the Job Adjustment mobile app, which allows users to input job and health details to generate a variety of personalized action plans. As this is the first version of the app, assessing its feasibility and usability is crucial. OBJECTIVE This study aims to verify the feasibility and usability of the Job Adjustment mobile app. METHODS A longitudinal observational study was conducted on pregnant Japanese women who were allowed to use the app anytime from 12 to 34 weeks of gestation; they received reminder emails every 2 weeks encouraging app use. A questionnaire was administered before app use and at 20 and 32 weeks of gestation. Feasibility was evaluated across 4 domains: implementation, demand, acceptability, and adverse events. Implementation was evaluated based on 3 parameters: dropout rate, initial reminder email receipt rate, and adherence rate (measured as pregnant women who used the app at intervals of 2.5 weeks or less). Demand was measured by intervals between use and intervals between log-in, and participants answered 15 questions to assess acceptability. Adverse events were assessed by analyzing the degree of anxiety related to work. Demographic data were analyzed to determine any statistically significant differences in intervals between uses. Usability was evaluated using the System Usability Scale. RESULTS The analysis included 66 pregnant women, and 61% (n=40) of them were multipara. The dropout rate, adherence rate, and initial reminder email receipt rate were 18% (13/71), 44% (29/66), and 79% (52/66) respectively. The median intervals between use and intervals between log-in were 2.94 (IQR 2.00-5.13) weeks and 2.28 (IQR 1.81-4.00) weeks, respectively. Overall, 60% (35/58) to 90% (52/58) of the participants responded positively to all 15 questions assessing acceptability, and no anxiety regarding work was recorded. The mean System Usability Scale score was 66.1 points. Multipara women had significantly longer intervals between app use compared to primipara women (P=.01). CONCLUSIONS The results demonstrated acceptable levels of feasibility and usability of the app. However, the low adherence rates, especially among multipara women, suggest the need for modifications to reduce the time burden of the app. Further research should explore more effective and acceptable intervals between use and timing, involving a larger sample and accounting for diverse characteristics of pregnant women. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000042943; https://tinyurl.com/ydrchfas.
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Affiliation(s)
- Aya Wada
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Hachioji, Tokyo, Japan
| | - Yasuka Nakamura
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maiko Kawajiri
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoko Takeishi
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toyoko Yoshizawa
- Health Sciences Department of Nursing, Kansai University of International Studies, Miki, Hyogo, Japan
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Eghdami S, Ahmadkhaniha HR, Baradaran HR, Hirbod-Mobarakeh A. Ecological momentary interventions for smoking cessation: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1431-1445. [PMID: 37269310 DOI: 10.1007/s00127-023-02503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Tobacco use is an important cause of preventable mortality and morbidity worldwide. Only 7% of smokers successfully quit annually, despite numerous evidence-based smoking cessation treatments. An important reason for failure is barriers to accessing appropriate smoking cessation interventions, which can be minimized by technology-delivered interventions, such as ecological momentary interventions. Ecological momentary interventions provide the right type and intensity of treatment in real time, based on ecological momentary assessments of relevant variables. The aim of this review was to assess the effectiveness of ecological momentary interventions in smoking cessation. METHODS We searched MEDLINE, Scopus, CENTRAL, psychINFO, and ProQuest without applying any filters on 19 September, 2022. One author screened search results for obvious irrelevant and duplicate studies. The remaining studies were independently reviewed by two authors to exclude irrelevant studies, and then they extracted data from the included studies. We collated study findings, transformed data into a common rubric, and calculated a weighted treatment effect across studies using Review Manager 5. FINDINGS We analyzed 10 studies with a total of 2391 participants. Assessment methods included exhaled CO analyzers, bidirectional SMS, data input in apps, and hand movement detection. Interventions were based on acceptance and commitment therapy and cognitive behavioral therapy. Smoking abstinence was significantly higher in participants of intervention groups compared to control groups (RR = 1.24; 95% CI 1.07-1.44, P = 0.004; I2 = 0%). CONCLUSION Ecological momentary intervention is a novel area of research in behavioral science. The results of this systematic review based on the available literature suggest that these interventions could be beneficial for smoking cessation.
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Affiliation(s)
- Shayan Eghdami
- Research Committee, School of Medicine, Iran University of Medical Sciences, Hemat Highway, Next to Milad Tower, Tehran, 14535, Iran.
| | - Hamid R Ahmadkhaniha
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid R Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Armin Hirbod-Mobarakeh
- Research Center for Addiction and Risky Behaviors, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Hirbod Psychiatric and Psychologic Club (BAVAR), Tehran, Iran
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Monárrez R, Mohamadi A, Drew JM, Abdeen A. Mobile Application's Effect on Patient Satisfaction and Compliance in Total Joint Arthroplasty: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00005. [PMID: 37678829 PMCID: PMC10484373 DOI: 10.5435/jaaosglobal-d-22-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 09/09/2023]
Abstract
Use of mobile applications to improve patient engagement is particularly promising in total joint arthroplasty (TJA) whereby successful outcomes are predicated by patient engagement. In accordance with published guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, studies were searched, screened, and appraised for quality on various search engines. Hedges' g or odds ratios of patient adherence were reported. Twelve studies met the inclusion criteria, and the average age of 9,521 patients included was 60 years. Six studies concluded that mobile applications improved patients' satisfaction, with Hedges' g revealing an effect size of 1.64 (95% confidence interval [CI] 0.90 to 2.37), P < 0.001, in favor of mobile applications increasing patient satisfaction. Six studies reported improvements in compliance demonstrating an odds ratio for improved adherence of 4.57 (95% CI, 1.66 to 12.62), P < 0.001. Two studies reported a reduction in unscheduled office or emergency department visits. With evolving reimbursement policies linked to outcomes paired with the exponentially increasing volume of TJA performed, innovative ways to efficiently deliver high-quality care are in demand. Our systematic review is limited by a dearth of research on the nascent technology, but the available data suggest that mobile applications may enhance patient satisfaction, improve compliance, and reduce unscheduled visits after TJA.
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Affiliation(s)
- Rubén Monárrez
- From the Department of Orthopaedic Surgery (Dr. Mohamadi, Dr. Drew), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Monárrez, Dr. Mohamadi, Dr. Drew, and Dr. Abdeen); the Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD (Monárrez); and the Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA (Abdeen)
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Fang YE, Zhang Z, Wang R, Yang B, Chen C, Nisa C, Tong X, Yan LL. Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e45111. [PMID: 37505802 PMCID: PMC10422176 DOI: 10.2196/45111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. OBJECTIVE This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. METHODS We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. RESULTS A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI -0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). CONCLUSIONS Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. TRIAL REGISTRATION PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104.
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Affiliation(s)
- Yichen E Fang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Zhixian Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Ray Wang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Bolu Yang
- Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Chen Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China
| | - Claudia Nisa
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Division of Social Sciences, Duke Kunshan University, Kunshan, China
| | - Xin Tong
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Data Science Research Center, Duke Kunshan University, Kunshan, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, China
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Institute for Global Health and Development, Peking University, Beijing, China
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Thrul J, Howe CL, Devkota J, Alexander A, Allen AM, Businelle MS, Hébert ET, Heffner JL, Kendzor DE, Ra CK, Gordon JS. A Scoping Review and Meta-analysis of the Use of Remote Biochemical Verification Methods of Smoking Status in Tobacco Research. Nicotine Tob Res 2023; 25:1413-1423. [PMID: 36449414 PMCID: PMC10347976 DOI: 10.1093/ntr/ntac271] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Increasing digital delivery of smoking cessation interventions has resulted in the need to employ novel strategies for remote biochemical verification. AIMS AND METHODS This scoping review and meta-analysis aimed to investigate best practices for remote biochemical verification of smoking status. The scientific literature was searched for studies that reported remotely obtained (not in-person) biochemical confirmation of smoking status (ie, combustible tobacco). A meta-analysis of proportions was conducted to investigate key outcomes, which included rates of returned biological samples and the ratio of biochemically verified to self-reported abstinence rates. RESULTS A total of 82 studies were included. The most common samples were expired air (46%) and saliva (40% of studies), the most common biomarkers were carbon monoxide (48%) and cotinine (44%), and the most common verification methods were video confirmation (37%) and mail-in samples for lab analysis (26%). Mean sample return rates determined by random-effects meta-analysis were 70% for smoking cessation intervention studies without contingency management (CM), 77% for CM studies, and 65% for other studies (eg, feasibility and secondary analyses). Among smoking cessation intervention studies without CM, self-reported abstinence rates were 21%, biochemically verified abstinence rates were 10%, and 47% of individuals who self-reported abstinence were also biochemically confirmed as abstinent. CONCLUSIONS This scoping review suggests that improvements in sample return rates in remote biochemical verification studies of smoking status are needed. Recommendations for reporting standards are provided that may enhance confidence in the validity of reported abstinence rates in remote studies. IMPLICATIONS This scoping review and meta-analysis included studies using remote biochemical verification to determine smoking status. Challenges exist regarding implementation and ensuring high sample return rates. Higher self-reported compared to biochemically verified abstinence rates suggest the possibility that participants in remote studies may be misreporting abstinence or not returning samples for other reasons (eg, participant burden, inconvenience). Remote biochemical confirmation of self-reported smoking abstinence should be included in smoking cessation studies whenever feasible. However, findings should be considered in the context of challenges to sample return rates. Better reporting guidelines for future studies in this area are needed.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Carol L Howe
- University of Arizona Health Sciences Library, Tucson, AZ, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam Alexander
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alicia M Allen
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Michael S Businelle
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Darla E Kendzor
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chaelin K Ra
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, NJ, USA
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Tahan C, Dobbins T, Hyslop F, Lingam R, Richmond R. Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis. BMJ Open 2023; 13:e060549. [PMID: 36963792 PMCID: PMC10040078 DOI: 10.1136/bmjopen-2021-060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum. SETTINGS Any healthcare setting servicing pregnant women, including any country globally. PARTICIPANTS Pregnant women of any social, ethnic or geographical background who smoke. METHODS We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence. RESULTS We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision. CONCLUSION NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
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Affiliation(s)
- Chadi Tahan
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Paediatric Population Health, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
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Raynor P, Corbett C, West D, Johnston D, Eichelberger K, Litwin A, Guille C, Prinz R. Leveraging Digital Technology to Support Pregnant and Early Parenting Women in Recovery from Addictive Substances: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4457. [PMID: 36901467 PMCID: PMC10002058 DOI: 10.3390/ijerph20054457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Little is known about digital health interventions used to support treatment for pregnant and early parenting women (PEPW) with substance use disorders (SUD). METHODS Guided by the Arksey and O'Malley's Scoping Review Framework, empirical studies were identified within the CINAHL, PsycInfo, PubMed, and ProQuest databases using subject headings and free-text keywords. Studies were selected based on a priori inclusion/exclusion criteria, and data extraction and descriptive analysis were performed. RESULTS A total of 27 original studies and 30 articles were included. Varying study designs were used, including several feasibility and acceptability studies. However, efficacious findings on abstinence and other clinically important outcomes were reported in several studies. Most studies focused on digital interventions for pregnant women (89.7%), suggesting a dearth of research on how digital technologies may support early parenting women with SUD. No studies included PEPW family members or involved PEPW women in the intervention design. CONCLUSIONS The science of digital interventions to support treatment for PEPW is in an early stage, but feasibility and efficacy results are promising. Future research should explore community-based participatory partnerships with PEPW to develop or tailor digital interventions and include family or external support systems to engage in the intervention alongside PEPW.
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Affiliation(s)
- Phyllis Raynor
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Cynthia Corbett
- College of Nursing, Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, University of South Carolina, Columbia, SC 29208, USA
| | - Delia West
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - D’Arion Johnston
- College of Education, University of South Carolina, Columbia, SC 29208, USA
| | - Kacey Eichelberger
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
| | - Alain Litwin
- Prisma Health Upstate, University of South Carolina School of Medicine, Greenville, SC 29605, USA
- School of Health Research, Clemson University, Greenville, SC 29601, USA
| | - Constance Guille
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ron Prinz
- Psychology Department, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA
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Amiri S, Khan MAB. Digital interventions for smoking abstinence: a systematic review and meta-analysis of randomized control trials. J Addict Dis 2023; 41:4-29. [PMID: 35426355 DOI: 10.1080/10550887.2022.2058300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Technological advancements have improved patients' health and clinical care through digital interventions. This study investigated the effects of digital interventions on smoking abstinence. METHODS PubMed, the Cochrane Library, and Scopus were systematically searched from inception until December 2021. Meta-analysis was carried out using a random-effects model. The degree of heterogeneity, quality, and publication bias of the selected studies was further evaluated. RESULTS A total of 43 randomized control trial studies were eligible for this study. 38,814 participants from 18 countries were included in the analysis. Digital interventions on seven-day point prevalence abstinence (1 month) showed increased smoking abstinence. The odds ratio was 2.02 and confidence interval (CI) was 1.67-2.43; p < 0.001; I2 = 55.1%) . The result for a 30-day point prevalence abstinence (1 month) was 1.63 (CI 1.09-2.46; p = 0.018; I2 = 0%). Digital intervention also had a significant effect on continuous abstinence (odds ratio = 1.68; CI 1.29-2.18; p < 0.001; I2 = 70.1%) and prolonged abstinence (odds ratio = 1.60; CI 1.19-2.15; p = 0.002; I2 = 53.6%). There was evidence of heterogeneity and publication bias. CONCLUSIONS Digital interventions led to increased smoking abstinence and can be a valuable tool in smoking cessation. Further research is required to evaluate the long-term impact of digital interventions on outcomes related to smoking cessation.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Moien A B Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.,Primary Care, NHS North West London, London, UK
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Coleman T, Clark M, Welch C, Whitemore R, Leonardi-Bee J, Cooper S, Hewitt C, Jones M, Sutton S, Watson J, Daykin K, Ussher M, Parrott S, Naughton F. Effectiveness of offering tailored text message, self-help smoking cessation support to pregnant women who want information on stopping smoking: MiQuit3 randomised controlled trial and meta-analysis. Addiction 2022; 117:1079-1094. [PMID: 34636086 DOI: 10.1111/add.15715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
AIMS To test the efficacy of 'MiQuit', a tailored, self-help, text message stop smoking programme for pregnancy, as an adjunct to usual care (UC) for smoking cessation in pregnancy. DESIGN Multicentre, open, two-arm, parallel-group, superiority randomised controlled trial (RCT) and a trial sequential analysis (TSA) meta-analysis combining trial findings with two previous ones. SETTING Twenty-four English hospital antenatal clinics. PARTICIPANTS A total of 1002 pregnant women who were ≥16 years old, were ≤25 weeks gestation and smoked ≥1 daily cigarette and accepted information on cessation with no requirement to set quit dates. INTERVENTIONS UC or UC plus 'MiQuit': 12 weeks of tailored, smoking cessation text messages focussed on inducing and aiding cessation. MEASUREMENTS Primary outcome: biochemically validated cessation between 4 weeks after randomisation and late pregnancy. SECONDARY OUTCOMES shorter and non-validated abstinence periods, pregnancy outcomes and incremental cost-effectiveness ratios. FINDINGS RCT: cessation was 5.19% (26/501) and 4.59% (23/501) in MiQuit and UC groups (adjusted odds ratio [adj OR] for quitting with MiQuit versus UC, 95% CI = 1.15 [0.65-2.04]); other abstinence findings were similar, with higher point estimates. Primary outcome ascertainment was 61.7% (309) and 67.3% (337) in MiQuit and UC groups with 71.1% (54/76) and 69.5% (41/59) abstinence validation rates, respectively. Pregnancy outcomes were similar and the incremental cost per quality-adjusted life year was -£1118 (95% CI = -£4806-£1911). More MiQuit group women reported making at least one quit attempt (adj OR [95% CI]) for making an attempt, 1.50 (1.07-2.09). TSA meta-analysis: this found no significant difference in prolonged abstinence between MiQuit and UC (pooled OR = 1.49, adjusted 95% CI = 0.62-3.60). CONCLUSIONS Irrespective of whether they want to try quitting, when offered a tailored, self-help, text message stop smoking programme for pregnancy (MiQuit) as an adjunct to usual care, pregnant women are not more likely to stop smoking until childbirth but they report more attempts at stopping smoking.
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Affiliation(s)
- Tim Coleman
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Miranda Clark
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Charlie Welch
- York Trials Unit, University of York, York, Yorkshire, England
| | - Rachel Whitemore
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, Clinical Sciences Building, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Sue Cooper
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | | | - Matthew Jones
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, England
| | - Judith Watson
- York Trials Unit, University of York, York, Yorkshire, England
| | - Karen Daykin
- Centre for Academic Primary Care, Medical School, University of Nottingham, Nottingham, Nottinghamshire, England
| | - Michael Ussher
- Population Health Research Institute, St. George's, University of London, London, England.,Institute for Social Marketing and Health, University of Stirling, Stirling, Stirlingshire, Scotland
| | - Steve Parrott
- York Trials Unit, University of York, York, Yorkshire, England
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, England
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11
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Fradkin N, Zbikowski SM, Christensen T. Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study. JMIR Public Health Surveill 2022; 8:e32499. [PMID: 35262491 PMCID: PMC8943539 DOI: 10.2196/32499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/25/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Background Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups.
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Affiliation(s)
- Nick Fradkin
- Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, Olympia, WA, United States
| | | | - Trevor Christensen
- Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, Olympia, WA, United States
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Schnitman G, Wang T, Kundu S, Turkdogan S, Gotlieb R, How J, Gotlieb W. The role of digital patient education in maternal health: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:586-593. [PMID: 34183217 DOI: 10.1016/j.pec.2021.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the recent trends, acceptability, and effectiveness of digital maternal patient education through summarizing the literature. METHODS Articles published in 2010-2020 on patient education, digital tools, and maternal health were searched on PubMed. Abstract and full texts were reviewed to identify eligible studies and extract key information. RESULTS Digital patient education studies covered various topics throughout pregnancy, with the greatest number of studies targeting the prenatal period. Among the 55 studies, 38 (69%) reported significant patient outcomes, with the main benefits of increased knowledge (83.3%), emotional benefits (73.7%), and behavioral changes (60.6%). The number of studies per year increased steadily over the past decade, with frequently utilized formats of texts with images (40%), SMS (30.9%), and videos (25.5%). Video produced the highest rate of positive patient outcomes; however, no statistical significance was found. CONCLUSION Our study presented evidence supporting the high effectiveness and prevalence of digital tools in maternal patient education, and analyzed the content, platforms, and formats utilized by digital tools of the past decade. PRACTICE IMPLICATIONS Digital tools are effective and feasible in conducting maternal patient education. No specific patient education format is found to be superior in improving patient's health outcomes.
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Affiliation(s)
- Gabriel Schnitman
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Tianci Wang
- Department of Physiology, McGill University, Montreal, Quebec, Canada.
| | - Shreenik Kundu
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Sena Turkdogan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Jeffrey How
- Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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13
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Xuto P, Toyohiko K, Prasitwattanaseree P, Sriarporn P. Effect of Receiving Text Messages on Health Care Behavior and State Anxiety of Thai Pregnant Women: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2022; 10:18-29. [PMID: 35005038 PMCID: PMC8724727 DOI: 10.30476/ijcbnm.2021.89364.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/12/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The health care behavior of Thai pregnant women should enhance. Pregnant women are facing anxiety from a variety of issues. Current evidence suggests that a text message can support health care services and reduce anxiety. This study aimed to examine receiving text messages on health care behavior and state anxiety among Thai pregnant women. METHODS This study was a single-blind randomized controlled trial. A sample of 66 primigravidas was randomly assigned using a random number table, 33 per group. All participants received a recommendation for healthy behavior during pregnancy. The intervention group added 56 text messages between 13 and 40 gestational weeks, from two government hospitals in Thailand, from March 2018 to May 2019. The data collection tool comprised of demographic characteristics questionnaire, Pregnancy Outcomes Record, The Health Care Behavior during Pregnancy Questionnaire (HCBPQ) (Thai version) which developed by the researcher, and State-Trait Anxiety Inventory (STAI-S). Data were analyzed via SPSS version 18 using descriptive statistics, independent t-test, Fisher's exact test, and chi-square. The significance level was considered P<0.05. RESULTS The results showed that the intervention group adopted appropriate mean health care behaviors significantly only in physical activity domain (15.40±3.19) compared to the control group (13.58±1.89), (P=0.01) and revealed a significantly lower total mean score of state-anxiety than the control group (35.23±8.50 vs. 40.79±9.28, P=0.02). Other health care behavior domains between the two groups were not statistically significant (P>0.05). CONCLUSION Text messages could increase physical activity in Thai pregnant women and reduce the total score of anxiety during pregnancy. Thus, the text message strategy is appropriate to use during the antenatal period. TRIAL REGISTRATION NUMBER TCTR20180814005.
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Affiliation(s)
- Piyanut Xuto
- Department of Obstetrics and Gynaecology, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Kodama Toyohiko
- Department of Nursing, School of Health Science, University of Occupational and Environmental Health, Fukuoka, Japan
| | | | - Punpilai Sriarporn
- Department of Obstetrics and Gynaecology, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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14
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Murphy CM, Micalizzi L, Sokolovsky AW, Borrelli B, Jennings EG, Lee CS, Parker DR, Risica PM. Motivational interviewing telephone counseling to increase postpartum maintenance of abstinence from tobacco. J Subst Abuse Treat 2022; 132:108419. [PMID: 34098201 PMCID: PMC8531179 DOI: 10.1016/j.jsat.2021.108419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 01/03/2023]
Abstract
Although many women quit smoking while pregnant, rates of relapse after delivery are high. We examined the effectiveness of motivational interviewing (MI) in maintaining postpartum abstinence from smoking among pregnant women who recently quit smoking (N = 382), randomized to receive five brief MI phone counseling calls or to a prenatal and postpartum care as usual control condition. Relapse to smoking was assessed at 3, 6, and 12 months postpartum based on self-report and urine cotinine. Cox regressions compared conditions on relapse outcomes and hazard ratio of total number of MI calls was examined to probe dose-response effects. Results revealed no difference in the hazard ratio of relapse between treatment condition and no dose-response effect of total number of MI calls. Phone counseling in the prenatal and postpartum period did not facilitate maintenance of abstinence among new mothers. Considerations for future intervention development studies on relapse prevention during the postpartum period are discussed.
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Affiliation(s)
- Cara M Murphy
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Lauren Micalizzi
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Alexander W Sokolovsky
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Alcohol and Addiction Studies, Brown School of Public Health, Providence, RI, USA
| | - Belinda Borrelli
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Center for Behavioral Science Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
| | - Christina S Lee
- Department of Clinical Practice, Boston University School of Social Work, Boston, MA, USA
| | - Donna R Parker
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Patricia Markham Risica
- Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown School of Public Health, Providence, RI, USA.
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Abstract
OBJECTIVE This study aimed to develop a Transtheoretical-Model-based and WhatsApp-text-message-supported smoking cessation program for pregnant women and to evaluate its effectiveness. METHODS This study is a pretest-posttest designed, randomized controlled and quasi-experimental intervention research. The study was conducted on 50 pregnant women, 25 of them in the intervention group and 25 of them in the control group. A theory-based motivational individual counseling initiative has been applied to the intervention group, and WhatsApp text messages have been sent 3 days a week, in accordance with the stages of change to support the interviews. RESULTS In the final follow-up, 60% of pregnant women in the intervention group and 36% of pregnant women in the control group quit smoking. All participants indicated they would recommend the WhatsApp-text-message-supported smoking cessation program. Transtheoretical-Model-based and WhatsApp-text-message-supported smoking cessation programs were found to be effective in reducing nicotine dependency scores and carbon monoxide levels of pregnant women and quitting smoking. PRACTICE IMPLICATIONS The smoking cessation program used in the research may be applied by midwives or nurses trained on the subject to help pregnant women quit smoking.
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Melwani S, Cleland V, Patterson K, Nash R. A scoping review: global health literacy interventions for pregnant women and mothers with young children. Health Promot Int 2021; 37:6322401. [PMID: 34269394 DOI: 10.1093/heapro/daab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization is focused on enhancing health literacy (HL) throughout the life-course to address the growing burden of non-communicable diseases (NCDs) globally. Pregnancy and early motherhood offer a window of opportunity to address NCDs risk earlier in the life-course. Empowering women through HL may help to reduce the intergenerational impact of NCDs. A scoping review of the international literature was conducted to identify HL interventions that focused on improving NCD-related health outcomes or health behaviors of pregnant women and/or mothers with young children. The search was conducted on 4 databases and identified 5019 articles. After full text screening, 25 studies met the inclusion criteria. No study acknowledged their intervention as an HL intervention, even though they were assessed as targeting various HL dimensions. Only one study measured the HL of mothers. The review suggests that HL interventions are being underutilized and highlight the need to create awareness about the importance of addressing HL of pregnant women and mothers using appropriate tools to understand HL strengths and challenges in achieving healthy lifestyle practices. This can help to co-design locally responsive solutions that may enable women to make informed healthier lifestyle choices for themselves and for their children and thus may accelerate prevention of NCDs globally.
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Affiliation(s)
- Satish Melwani
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Kira Patterson
- School of Education, College of Arts, Law and Education, University of Tasmania, Launceston, TAS 7250, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
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Vogel EA, Pechmann CC. Application of Automated Text Analysis to Examine Emotions Expressed in Online Support Groups for Quitting Smoking. JOURNAL OF THE ASSOCIATION FOR CONSUMER RESEARCH 2021; 6:315-323. [PMID: 36275173 PMCID: PMC9585921 DOI: 10.1086/714517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Online support groups offer social support and an outlet for expressing emotions when dealing with health-related challenges. This study examines whether automated text analysis of emotional expressions using Linguistic Inquiry and Word Count (LIWC) can identify emotions related to abstinence expressed in online support groups for quitting smoking, suggesting promise for offering targeted mood management to members. The emotional expressions in 1 month of posts by members of 36 online support groups were related to abstinence at month end. Using the available LIWC dictionary, posts were scored for overall positive emotions, overall negative emotions, anxiety, anger, sadness, and an upbeat emotional tone. Greater expressions of negative emotions, and specifically anxiety, related to nonabstinence, while a more upbeat emotional tone related to abstinence. The results indicate that automated text analysis can identify emotions expressed in online support groups for quitting smoking and enable targeted delivery of mood management to group members.
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Affiliation(s)
- Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, X3C16, Stanford, CA 94305
| | - Cornelia Connie Pechmann
- Paul Merage School of Business, University of California, Irvine, 4293 Pereira Drive, SB Bldg. 1, Suite 4317, Irvine, CA 92697-3125
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18
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Mersha AG, Bovill M, Eftekhari P, Erku DA, Gould GS. The effectiveness of technology-based interventions for smoking cessation: An umbrella review and quality assessment of systematic reviews. Drug Alcohol Rev 2021; 40:1294-1307. [PMID: 33825232 DOI: 10.1111/dar.13290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/01/2023]
Abstract
ISSUES With the advancement and rapid increase in the public's interest in utilisation of Internet and mobile phones, technology-based interventions are being implemented across a range of health conditions to improve patient outcomes. The aim of this review was to summarise findings from systematic reviews that evaluated the effectiveness of technology-based smoking cessation interventions and to critically appraise their methodological qualities. APPROACH An umbrella review was conducted using studies identified from a comprehensive literature search of six databases and grey literature. All included systematic reviews were checked for eligibility criteria and quality using the Assessment of Multiple Systematic Reviews tool. The level of evidence for each intervention category was assessed, citation matrices were generated and corrected covered area was calculated. KEY FINDINGS Five systematic reviews with a total of 212 randomised controlled trials and 237 760 participants were included. Fourteen intervention approaches were identified and classified into three categories: stand-alone web-based; stand-alone mobile phone-based and multicomponent interventions. Incorporating web and/or mobile-based interventions with face-to-face approach improved the rate of smoking cessation. However, there was no consistent evidence regarding the effectiveness of stand-alone Internet or mobile-based interventions. IMPLICATIONS Policymakers are recommended to develop strategies that enable health professionals to integrate these approaches with face-to-face smoking cessation support. Health professionals are recommended to be trained and equipped for online and mobile-based interventions. CONCLUSION Adding technology-based intervention to face-to-face smoking cessation support improves smoking cessation. Further research is needed to evaluate stand-alone web-based and mobile phone-based interventions.
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Affiliation(s)
- Amanual Getnet Mersha
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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Quit4hlth: a preliminary investigation of tobacco treatment with gain-framed and loss-framed text messages for quitline callers. J Smok Cessat 2020; 15:143-148. [DOI: 10.1017/jsc.2020.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractIntroductionRecent evidence suggests that quitline text messaging is an effective treatment for smoking cessation, but little is known about the relative effectiveness of the message content.AimsA pilot study of the effects of gain-framed (GF; focused on the benefits of quitting) versus loss-framed (LF; focused on the costs of continued smoking) text messages among smokers contacting a quitline.MethodsParticipants were randomized to receive LF (N = 300) or GF (N = 300) text messages for 30 weeks. Self-reported 7-day point prevalence abstinence and number of 24 h quit attempts were assessed at week 30. Intent-to-treat (ITT) and responder analyses for smoking cessation were conducted using logistic regression.ResultsThe ITT analysis showed 17% of the GF group quit smoking compared to 15% in the LF group (P = 0.508). The responder analysis showed 44% of the GF group quit smoking compared to 35% in the LF group (P = 0.154). More participants in the GF group reported making a 24 h quit attempt compared to the LF group (98% vs. 93%, P = 0.046).ConclusionsAlthough there were no differences in abstinence rates between groups at the week 30 follow-up, participants in the GF group made more quit attempts than those in the LF group.
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20
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Palmer MJ, Henschke N, Bergman H, Villanueva G, Maayan N, Tamrat T, Mehl GL, Glenton C, Lewin S, Fønhus MS, Free C. Targeted client communication via mobile devices for improving maternal, neonatal, and child health. Cochrane Database Syst Rev 2020; 8:CD013679. [PMID: 32813276 PMCID: PMC8477611 DOI: 10.1002/14651858.cd013679] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.
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Affiliation(s)
- Melissa J Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. OBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
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Pollak KI, Lyna P, Gao X, Noonan D, Bejarano Hernandez S, Subudhi S, Swamy GK, Fish LJ. Efficacy of a Texting Program to Promote Cessation Among Pregnant Smokers: A Randomized Control Trial. Nicotine Tob Res 2020; 22:1187-1194. [PMID: 31647564 PMCID: PMC7291805 DOI: 10.1093/ntr/ntz174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/10/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Smoking during pregnancy poses serious risks to baby and mother. Few disseminable programs exist to help pregnant women quit or reduce their smoking. We hypothesized that an SMS text-delivered scheduled gradual reduction (SGR) program plus support texts would outperform SMS support messages alone. METHODS We recruited 314 pregnant women from 14 prenatal clinics. Half of the women received theory-based support messages throughout their pregnancy to promote cessation and prevent relapse. The other half received the support messages plus alert texts that gradually reduced their smoking more than 3-5 weeks. We conducted surveys at baseline, end of pregnancy, and 3 months postpartum. Our primary outcome was biochemically validated 7-day point prevalence abstinence at late pregnancy. Our secondary outcome was reduction in cigarettes per day. RESULTS Adherence to the SGR was adequate with 70% responding to alert texts to smoke within 60 minutes. Women in both arms quit smoking at the same rate (9%-12%). Women also significantly reduced their smoking from baseline to the end of pregnancy from nine cigarettes to four; we found no arm differences in reduction. CONCLUSIONS Support text messages alone produced significant quit rates above naturally occurring quitting. SGR did not add significantly to helping women quit or reduce. Sending support messages can reach many women and is low-cost. More obstetric providers might consider having patients who smoke sign up for free texting programs to help them quit. IMPLICATIONS A disseminable texting program helped some pregnant women quit smoking.Clinical Trial Registration number: NCT01995097.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Devon Noonan
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,School of Nursing, Duke University, Durham, NC
| | | | - Sonia Subudhi
- Doctor of Medicine Program, Eastern Virginia Medical School, Norfolk, VA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, DUMC 3083, Duke University School of Medicine, Durham, NC
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
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Hussain T, Smith P, Yee LM. Mobile Phone-Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e15111. [PMID: 32463373 PMCID: PMC7290451 DOI: 10.2196/15111] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/22/2019] [Accepted: 01/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain.
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Affiliation(s)
- Tasmeen Hussain
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Patricia Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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24
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Vinci C. Cognitive Behavioral and Mindfulness-Based Interventions for Smoking Cessation: a Review of the Recent Literature. Curr Oncol Rep 2020; 22:58. [PMID: 32415381 PMCID: PMC7874528 DOI: 10.1007/s11912-020-00915-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cigarette smoking is the primary cause of cancer and is the leading preventable cause of morbidity and mortality. Cognitive behavioral therapy (CBT) is one of the most well-established and efficacious interventions for smoking cessation. The study of mindfulness-based interventions (MBIs) has increased exponentially in recent years, showing efficacy for smoking cessation as well. This review highlights research from the past 5 years examining CBT and MBIs for smoking cessation. RECENT FINDINGS Both CBT and MBIs are efficacious for special populations (e.g., low SES; pregnant smokers) and have shown initial efficacy when delivered via mhealth/ehealth. CBT has shown efficacy when combined with another behavioral treatment (e.g., ACT). Continued research is needed on CBT and MBIs that have high potential for scalability. Understanding whether they are beneficial for certain populations (e.g., cancer survivors), along with determining for whom CBT vs MBIs are most effective, is also needed.
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Affiliation(s)
- Christine Vinci
- Moffitt Cancer Center, Health Outcomes and Behavior, 4115 E Fowler Ave, Tampa, FL, 33617, USA.
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25
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Iribarren SJ, Wallingford J, Schnall R, Demiris G. Converting and expanding mobile support tools for tuberculosis treatment support: Design recommendations from domain and design experts. J Biomed Inform 2020; 112S:100066. [PMID: 34327316 DOI: 10.1016/j.yjbinx.2019.100066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 12/23/2022]
Abstract
Background Tuberculosis (TB) remains one of the top ten causes of death globally despite it being largely treatable. Poor adherence to treatment directly contributes to poor outcomes, such as, prolonged infectivity and the development of drug resistance. Mobile phone-based interventions have the potential to improve treatment outcomes. Objective The purpose of this study was to solicit design and domain expert feedback of a previously developed TB support intervention converted to a mobile application. Methods We used prototyping in iterative cycles that included integrating findings from prior formative research with endusers and soliciting feedback from design and content experts. In this project, we used low-fidelity prototype evaluation to inform the design of high-fidelity prototypes for further testing and iterative refinement. Results We received 12 survey results. Overall, the participants agreed that the functions would be easy to learn/use. Recommendations for improvement included: simplify the reporting by offering broad categories; split complex screens to be more intuitive and user friendly; modify feedback graphics to display data more clearly; incorporate instructions for each task/function to guide users and collapse the information once users had viewed it; display navigation icons on each screen and add a main menu button; have medication tracker be homepage and limit redundancies. Several potential functionalities were suggested, such as adding a notes/journal and a social feature. We were able to easily incorporate recommendations and feedback into the high-fidelity prototypes and continue testing and refinement. After we came to a stable prototype through testing, we gave the interactive prototype to our developers to program a base functioning model. Conclusion The proposed design recommendations provide valuable insight to inform initial conversion of an interactive intervention to customize patient support, which include a smartphone app and a direct drug metabolite test reengineered for home use. We argue that iteratively developing low- and high-fidelity prototypes with content and design experts to guide initial programming of a functional beta app paves the way to better explore further refinement needs and recommendations with endusers rather than using hypothetical scenarios.
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Affiliation(s)
- Sarah J Iribarren
- Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195
| | - Jessica Wallingford
- Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195
| | - Rebecca Schnall
- Columbia University, School of Nursing, Columbia University, New York, NY, USA
| | - George Demiris
- University of Pennsylvania, Claire Fagin Hall, Rm 324, 418 Curie Blvd, Philadelphia PA 19104
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26
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Pollak KI, Lyna P, Gao X, Noonan D, Hernandez SB, Subudhi S, Kennedy D, Farrell D, Swamy GK, Fish LJ. Pilot Test of Connecting Pregnant Women who Smoke to Short Message Service (SMS) Support Texts for Cessation. Matern Child Health J 2020; 24:419-422. [PMID: 32026323 DOI: 10.1007/s10995-020-02893-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most pregnant women know that smoking poses serious risks to baby and mother, yet many still smoke. We conducted a large randomized controlled trial and found that an SMS text-delivered program helped about 10% of these women quit smoking. In this paper, we describe the feasibility of disseminating a text-based intervention to pregnant women who smoke. METHODS We tested dissemination in two ways from prenatal clinics and compared recruitment rates to those found in our large randomized controlled trial. The first method involved "direct texting" where study staff identified women who smoked and sent them a text asking them to text back if they wanted to receive texts to help them quit. The second involved "nurse screening" where clinic staff from county health departments screened women for smoking and asked them to send a text to the system if they wanted to learn more about the program. Our primary outcome was feasibility assessed by the number of women who texted back their baby's due date, which served as "enrolling" in the texting program, which we compared to the recruitment rate we found in our large trial. RESULTS Over 4 months, we texted 91 women from the academic health system. Of those, 17 texted back and were counted as "enrolled." In the health departments, across the 4 months, 12 women texted the system initially. Of those, 10 were enrolled. This rate was similar to the rate enrolled in the randomized controlled trial. DISCUSSION Two different methods connected pregnant women who smoke to a texting program. One of these methods can be automated further and have the potential of helping many women quit smoking with minimal effort. Clinical Trial # NCT01995097.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA.
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA.
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Devon Noonan
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- School of Nursing, Duke University, Durham, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Santiago Bejarano Hernandez
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Sonia Subudhi
- Doctor of Medicine Program, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Danielle Kennedy
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - David Farrell
- People Designs, Inc, Durham, NC, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, DUMC 3083, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
| | - Laura J Fish
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, 27710, USA
- Department of Community and Family Medicine, Duke University School of Medicine, 2424 Erwin Road, Suite 602, Durham, NC, 27710, 27705, USA
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Willcox JC, Dobson R, Whittaker R. Old-Fashioned Technology in the Era of "Bling": Is There a Future for Text Messaging in Health Care? J Med Internet Res 2019; 21:e16630. [PMID: 31859678 PMCID: PMC6942182 DOI: 10.2196/16630] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/20/2023] Open
Abstract
In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more "technologically advanced" systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model.
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Affiliation(s)
- Jane C Willcox
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev 2019; 10:CD006611. [PMID: 31638271 PMCID: PMC6804292 DOI: 10.1002/14651858.cd006611.pub5] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012. OBJECTIVES To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018. SELECTION CRITERIA Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up. DATA COLLECTION AND ANALYSIS We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only. MAIN RESULTS This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. AUTHORS' CONCLUSIONS There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.
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Affiliation(s)
- Robyn Whittaker
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
| | - Hayden McRobbie
- University of New South WalesNational Drug and Alcohol Research Centre22‐32 King Street,RandwickSydneyAustralia
| | - Chris Bullen
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
| | - Anthony Rodgers
- The George Institute for Public Health321 Kent StreetSydneyAustraliaNSW 2000
| | - Yulong Gu
- Stockton UniversitySchool of Health SciencesGallowayNew JerseyUSA
| | - Rosie Dobson
- University of AucklandNational Institute for Health InnovationTamaki CampusPrivate Bag 92019AucklandNew Zealand1142
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Schlam TR, Baker TB. Playing Around with Quitting Smoking: A Randomized Pilot Trial of Mobile Games as a Craving Response Strategy. Games Health J 2019; 9:64-70. [PMID: 31536384 DOI: 10.1089/g4h.2019.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: Strong cravings to smoke are an obstacle to cessation success. Unfortunately, cessation medication and counseling only modestly quell craving. This pilot study was designed to examine the feasibility of mobile games as a response strategy to craving and whether a fully powered trial is warranted. Materials and Methods: Smokers interested in quitting (N = 30) were offered 4 weeks of nicotine patch plus counseling and randomized to quit with (games-on) versus without (games-off) access to 11 commercial mobile games. Outcomes included post-target quit day (TQD) game play, craving, smoking, and quitting. Almost all P's were >0.05; outcomes should be interpreted with caution due to the small N. Results: Of games-on participants (n = 16), one played games ≥80% of days post-TQD (22/28 days); 38% played >1/3 of days; 25% did not play. Games-on participants reported games moderately helped them cope with cravings; M = 3.22 on a scale from 1 (not at all) to 5 (very much). Also, games-on participants showed a slight decrease in craving from baseline to 1-week post-TQD (2.35-2.25 on a 0-5 point-scale), whereas games-off participants showed an increase (2.01-2.53). Games-on participants showed greater decreases in craving after playing a game than after the passage of time (when an app imposed a 2-minute wait period following their game request), but there was little evidence games-on versus games-off participants differed in mean post-TQD cigarettes/day. Games-on participants reported modestly but not significantly higher continuous abstinence through day 28 (31.3% vs. 21.4%). Conclusion: Feasibility results encourage a fully powered trial of this easily disseminable intervention. Clinical Trial Registration: ClinicalTrials.gov NCT02164383.
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Affiliation(s)
- Tanya R Schlam
- Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy B Baker
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Chiang SC, Abroms LC, Cleary SD, Pant I, Doherty L, Krishnan N. E-cigarettes and smoking cessation: a prospective study of a national sample of pregnant smokers. BMC Public Health 2019; 19:964. [PMID: 31319846 PMCID: PMC6637539 DOI: 10.1186/s12889-019-7299-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Smoking during pregnancy has adverse health consequences for the mother and fetus. E-cigarettes could aid with smoking cessation but there is limited research on the prevalence and patterns of e-cigarette use, and their association with smoking cessation among pregnant smokers. Methods We conducted a secondary analysis of a randomized controlled trial of a text-messaging program for smoking cessation among a U.S. national cohort of pregnant smokers (n = 428). Outcomes assessed were trajectories of e-cigarettes use from baseline to one-month follow-up, and longitudinal association between e-cigarette use at baseline and smoking cessation at one-month follow-up. Results At baseline, 74 (17.29%) pregnant smokers used e-cigarettes in the past 30 days and 36 (8.41%) used e-cigarettes in the past 7 days. The primary reason stated for using e-cigarettes during pregnancy was for quitting. E-cigarette use between baseline and 1-month was inconsistent. Of 36 dual-users at baseline, 20 (55.56%) stopped using e-cigarettes by the 1-month follow-up and 14 initiated e-cigarette use. There was no evidence of an association between e-cigarette use at baseline and the primary smoking cessation outcome, 7-day point prevalence abstinence [adjusted odds ratio = 0.79, 95% confidence intervals = 0.33–1.92]. Conclusions A secondary analysis of a national sample of pregnant smokers indicates that use of e-cigarettes is inconsistent and is not associated with improved smoking cessation outcomes. There is an urgent need to further examine the risk and benefits of e-cigarette use, especially during pregnancy. Electronic supplementary material The online version of this article (10.1186/s12889-019-7299-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shawn C Chiang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW, Washington, DC, 20052, USA.
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW, Washington, DC, 20052, USA
| | - Sean D Cleary
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Ichhya Pant
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW, Washington, DC, 20052, USA
| | - Lindsay Doherty
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Nandita Krishnan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW, Washington, DC, 20052, USA
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Tombor I, Beard E, Brown J, Shahab L, Michie S, West R. Randomized factorial experiment of components of the SmokeFree Baby smartphone application to aid smoking cessation in pregnancy. Transl Behav Med 2019; 9:583-593. [PMID: 30011020 PMCID: PMC6629841 DOI: 10.1093/tbm/iby073] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Smartphone applications (apps) might be able to reach pregnant smokers who do not engage with face-to-face support. However, we do not know how far pregnant smokers will engage with smoking cessation apps or what components are likely to be effective. This study aimed to assess pregnant smokers' engagement with the SmokeFree Baby app (v1) and to assess the short-term efficacy of selected components ("modules") for smoking abstinence. Positive outcomes would provide a basis for further development and evaluation. SmokeFree Baby was developed drawing on behavior change theories and relevant evidence. Pregnant smokers (18+) who were interested in quitting and set a quit date were recruited. Following multiphase optimization development principles, participants (N = 565) were randomly allocated to one of 32 (2 × 2 × 2 × 2 × 2) experimental groups in a full factorial design to evaluate five modules (each in minimal and full version: identity, health information, stress management, face-to-face support, and behavioral substitution). Measures of engagement included duration and frequency of engagement with the app. Smoking abstinence was measured by self-reported number of smoke-free days up to 4 weeks from the quit date. Participants engaged with the app for a mean of 4.5 days (SD = 8.5) and logged in a mean of 2.9 times (SD = 3.1). Main effects of the modules on the number of smoke-free days were not statistically significant (identity: p = .782, health information: p = .905, stress management: p = .103, face-to-face support: p = .397, behavioral substitution: p = .945). Despite systematic development and usability testing, engagement with SmokeFree Baby (v1) was low and the app did not appear to increase smoking abstinence during pregnancy.
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Affiliation(s)
- Ildiko Tombor
- Department of Behavioural Science and Health, University College London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, UK
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Bary-Weisberg D, Meltser M, Oberman M, Pato Benari A, Bar-Zeev Y, Shalev S, Berg CJ, Abroms LC, Levine H. Feasibility of a text-messaging smoking cessation program for soldiers in Israel. BMC Public Health 2019; 19:715. [PMID: 31238914 PMCID: PMC6593531 DOI: 10.1186/s12889-019-6958-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cigarette smoking is a main cause of preventable morbidity and mortality. Many young adults begin smoking in the military, with smoking rates higher among soldiers than in the general population. Among other health effects, smoking impairs performance among soldiers. Smoking cessation programs in the military are challenging due to the unique settings and low access to smoking cessation resources. Studies have shown that text-messaging smoking cessation programs are feasible and effective, but there is a lack of studies on soldiers. OBJECTIVE To evaluate the feasibility of a text-messaging smoking cessation program tailored for soldiers. METHODS We recruited 81 soldiers who smoked, 76.5% of whom were male. Following enrollment, participants filled out a baseline survey and were given a text messaging program for 6 months. Participants could send predetermined keywords and immediately receive a response from a list of messages that were constructed as a response to the specific keyword. Participants filled out a follow-up survey at 1 month. Additionally, we retrieved and analyzed program usage data, including keywords sent and received, for the entire program period. Based on the follow-up survey and the program usage data, we assessed feasibility of the recruitment methods, participants' engagement and satisfaction and technical usability of the program. RESULTS At 1 month, 20.6% reported that they had not smoked in the past week. A high percentage of the participants were engaged in the program, with 82.5% sending at least one valid keyword. The lowest self-efficacy group had higher chances of leaving the program (50.0%) while for the highest group there were much lower chances (4.8%). Most of the soldiers (96.8%) found the program easy to use and would recommend it to a friend (84.1%). CONCLUSIONS The study demonstrates that a text-messaging smoking cessation program is feasible in a military setting. Further development and evaluation of digital smoking cessation tools tailored for soldiers are warranted.
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Affiliation(s)
- Dov Bary-Weisberg
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hadassah-Hebrew University, P.O Box 12272, Kiryat Hadassah, Ein Kerem, 9112002, Jerusalem, Israel
| | - Marina Meltser
- Army Health Branch, Medical Corps, Israel Defense Forces, Tel Hashomer, Ramat Gan, Israel
| | - Maya Oberman
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hadassah-Hebrew University, P.O Box 12272, Kiryat Hadassah, Ein Kerem, 9112002, Jerusalem, Israel
| | | | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hadassah-Hebrew University, P.O Box 12272, Kiryat Hadassah, Ein Kerem, 9112002, Jerusalem, Israel
| | - Sarit Shalev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hadassah-Hebrew University, P.O Box 12272, Kiryat Hadassah, Ein Kerem, 9112002, Jerusalem, Israel
| | - Carla J Berg
- Department of Behavioral Sciences and Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hadassah-Hebrew University, P.O Box 12272, Kiryat Hadassah, Ein Kerem, 9112002, Jerusalem, Israel.
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Deutsch C, Bock BC, Lantini R, Walaska K, Rosen RK, Fava JL, Jennings EG, Foster R, Flanagan W. A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study. Contemp Clin Trials 2019; 81:19-27. [PMID: 30999058 PMCID: PMC6550345 DOI: 10.1016/j.cct.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/05/2019] [Accepted: 04/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. METHODS/DESIGN This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. CONCLUSIONS This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion.
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Affiliation(s)
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Behavioral and Social Sciences, School of Public Health of Brown University, Providence, RI, United States
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Whitemore R, Leonardi-Bee J, Naughton F, Sutton S, Cooper S, Parrott S, Hewitt C, Clark M, Ussher M, Jones M, Torgerson D, Coleman T. Effectiveness and cost-effectiveness of a tailored text-message programme (MiQuit) for smoking cessation in pregnancy: study protocol for a randomised controlled trial (RCT) and meta-analysis. Trials 2019; 20:280. [PMID: 31118090 PMCID: PMC6530023 DOI: 10.1186/s13063-019-3341-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/02/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Smoking in pregnancy is a major international public health problem. Self-help support (SHS) increases the likelihood of women stopping smoking in pregnancy and delivering this kind of support by text message could be a cost-effective way to deliver SHS to pregnant women who smoke. SHS delivered by text message helps non-pregnant smokers to stop but the currently available message programmes are not appropriate for use in pregnancy. A randomised controlled trial (RCT) has demonstrated the feasibility and acceptability of using a programme called 'MiQuit' to text SHS support to pregnant women who smoke. Another pilot RCT has shown that it would be feasible to run a larger, multi-centre trial within the UK National Health Service (NHS). The aim of this third RCT is to complete MiQuit's evaluation, demonstrating whether or not this is efficacious for smoking cessation in pregnancy. METHODS/DESIGN This is a multi-centre, parallel-group RCT. Pregnant women aged over 16 years, of less than 25 weeks' gestation who smoke one or more daily cigarettes but smoked at least five daily cigarettes before pregnancy and who understand written English and are being identified in 24 English antenatal care hospitals. Participants are randomised to control or intervention groups in a 1:1 ratio stratified by gestation (< 16 weeks versus ≥ 16 weeks). All participants receive a leaflet on stopping smoking during pregnancy; they are also able to access standard NHS smoking cessation support. Intervention group women also receive the 12-week MiQuit programme of tailored, interactive text message, and self-help cessation support. Women are followed up by telephone at 4 weeks after randomisation and 36 weeks' gestation. The RCT will recruit 692 women (346 per group), enabling a 95% confidence interval for the difference in quit rates to be estimated within ± 3%. To determine whether or not MiQuit helps pregnant smokers to stop, intervention group quit rates from this trial will be combined with those from the two earlier trials in a Trial Sequential Analysis (TSA) meta-analysis to derive a pooled efficacy estimate. DISCUSSION If effective, MiQuit will be a cheap, cost-effective method to help pregnant women to stop smoking. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03231553 . Registered on 20 July 2017.
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Affiliation(s)
- Rachel Whitemore
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, Nottingham, NG5 1PB UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Stephen Sutton
- Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Steve Parrott
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Catherine Hewitt
- Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD UK
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. George’s, University of London, London, SW17 0RE UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LJ UK
| | - Matthew Jones
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
| | - David Torgerson
- Population Health Research Institute, St. George’s, University of London, London, SW17 0RE UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD UK
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
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Danan ER, Fu SS, Clothier BA, Noorbaloochi S, Hammett PJ, Widome R, Burgess DJ. The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial. Am J Prev Med 2018; 55:506-516. [PMID: 30139707 DOI: 10.1016/j.amepre.2018.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/14/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers' response to a population-based proactive smoking-cessation intervention. METHODS This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up. RESULTS Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range (<$10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0). CONCLUSIONS In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00608426.
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Affiliation(s)
- Elisheva R Danan
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Steven S Fu
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Barbara A Clothier
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Siamak Noorbaloochi
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Patrick J Hammett
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Rachel Widome
- Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Diana J Burgess
- Veterans Affairs Health Services Research & Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Preston KL, Kowalczyk WJ, Phillips KA, Jobes ML, Vahabzadeh M, Lin JL, Mezghanni M, Epstein DH. Before and after: craving, mood, and background stress in the hours surrounding drug use and stressful events in patients with opioid-use disorder. Psychopharmacology (Berl) 2018; 235:2713-2723. [PMID: 29980821 PMCID: PMC6119104 DOI: 10.1007/s00213-018-4966-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/02/2018] [Indexed: 12/22/2022]
Abstract
RATIONALE Ecological momentary assessment (EMA) of specific events usually focuses more on antecedents and concomitants than on aftermaths. OBJECTIVES To examine mental state both before and after discrete episodes of stress and drug use. METHODS For up to 16 weeks, outpatients on opioid-agonist treatment carried smartphones on which they initiated entries for stressful events (SEs) or lapses to drug use (DUs), and thrice daily when randomly prompted (RPs). Participants rated their stress, opioid craving, cocaine craving, and moods. RP entries within 5 h of an event were analyzed and compared to other RPs. RESULTS Stress, negative mood, and craving were generally higher before and after DUs and SEs compared to background levels in participants with at least one DU (n = 149) or SE (n = 158). Before DUs, there were increases in negative mood, opioid craving, and cocaine craving, but not background stress. Before SEs, there were increases in background stress, opioid craving, and cocaine craving, but not negative mood. These changes were more variable after events than before. Neither DUs nor SEs were significantly related to positive mood. CONCLUSIONS Stress increased before stressful-event entries, but was less evident before drug use. Craving increased in the hours before drug use and stressful events-and remained elevated in the hours after either event. These results suggest a stronger link between drug use and craving than between drug use and stress. Lapses to drug use did not improve mood or reduce stress, at least not at our 1-h-bin time resolution, suggesting that if such benefits exist, they are brief.
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Affiliation(s)
- Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
| | - William J Kowalczyk
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Michelle L Jobes
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Massoud Vahabzadeh
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Jia-Ling Lin
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Mustapha Mezghanni
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
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Griffiths SE, Parsons J, Naughton F, Fulton EA, Tombor I, Brown KE. Are digital interventions for smoking cessation in pregnancy effective? A systematic review and meta-analysis. Health Psychol Rev 2018; 12:333-356. [PMID: 29912621 DOI: 10.1080/17437199.2018.1488602] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of 9 databases resulted in the inclusion of 12 published articles (n = 2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04-2.00, p = .03) in favour of digital interventions compared with comparison groups. Computer-based (OR = 3.06, 95% CI 1.28-7.33) and text-message interventions (OR = 1.59, 95% CI 1.07-2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy.
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Affiliation(s)
- Sarah Ellen Griffiths
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Joanne Parsons
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Felix Naughton
- b School of Health Sciences , University of East Anglia , Norwich , UK
| | - Emily Anne Fulton
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
| | - Ildiko Tombor
- d Department of Behavioural Science and Health , University College London , London , UK
| | - Katherine E Brown
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
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Raise the Bar to Help Pregnant Smokers, Rather Than Lower It. Am J Prev Med 2018; 54:722. [PMID: 29680120 DOI: 10.1016/j.amepre.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/30/2017] [Accepted: 01/02/2018] [Indexed: 11/21/2022]
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Abroms LC, Johnson PR, Brandon TH. Author Response to Letter to the Editor "Raise the Bar to Help Pregnant Smokers, Rather Than Lower It". Am J Prev Med 2018; 54:723-724. [PMID: 29680121 DOI: 10.1016/j.amepre.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 11/30/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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Salgado García FI, Derefinko KJ, Bursac Z, Hand S, Klesges RC. Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit. Contemp Clin Trials 2018; 68:14-22. [PMID: 29549007 PMCID: PMC5899672 DOI: 10.1016/j.cct.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/20/2022]
Abstract
Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.
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Affiliation(s)
- Francisco I Salgado García
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA.
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Sarah Hand
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Charlottesville, VA 22911, USA
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