IMPLEMENTATION, RECRUITMENT AND BASELINE CHARACTERISTICS: A RANDOMIZED TRIAL OF COMBINED TREATMENTS FOR SMOKING CESSATION AND WEIGHT CONTROL

Effect of BMI on Prolonged Abstinence after Smoking Cessation Treatment: A Retrospective Cohort Study

BACKGROUND

 Despite the well-documented relationship between weight gain and poorer cessation outcomes among smokers, the role of the former (baseline) weight in smoking cessation is insufficiently investigated. We hypothesized that patients with higher baseline body mass index(BMI) have a worse prognosis in tobacco cessation.

OBJECTIVES

 This retrospective clinical cohort study aimed to investigate the role of the baseline BMI on abstinence over 12 months after participation in smoking cessation treatment conducted in a middle-income country (n = 664).

METHODS

 Data from a 6-week smoking cessation protocol performed in a Psychosocial Care Unit(CAPS) were used. The protocol included four medical consultations and six Cognitive-Behavioral Therapy(CBT) group sessions. Initially, 1,213 participants were evaluated for the study, but only the participants whose telephone contact was successful were included in the outcome analyses. The attrition rate was 45.3%. Continuous and categorical (normal, overweight, and obesity) BMI values were computed. Survival regression models were used to test the associations between BMI and the 12-month abstinence outcome. Self-report 4-week abstinence at the end of treatment was also investigated using logistic regression models.

RESULTS

 Baseline BMI had no significant effect on both short (4-week-point abstinence) and long (12-month prolonged abstinence) treatment outcomes.

CONCLUSION

 The possible influence of the baseline BMI on smoking cessation outcomes, especially considering prolonged abstinence, was not corroborated by our results. Regardless of our results, the detrimental health outcomes due to the combination of obesity/overweight and smoking justify that these subgroups of individuals be continuously targeted for adequate smoking prevention and treatment.

Six Month Abstinence Heterogeneity in the Best Quit Study

BACKGROUND

Understanding the characteristics of smokers who are successful in quitting may help to increase smoking cessation rates.

PURPOSE

To examine heterogeneity in cessation outcome at 6 months following smoking cessation behavioral counseling with or without weight management counseling.

METHODS

2,540 smokers were recruited from a large quitline provider and then randomized to receive proactive smoking cessation behavioral counseling without or with two versions of weight management counseling. A Classification and Regression Tree (CART) analysis was conducted to identify the individual pretreatment and treatment characteristics of groups of smokers with different quitting success (as measured by point prevalence of self-reported smoking of any amount at 6 months).

RESULTS

CART analysis identified 10 subgroups ranging from 25.5% to 70.2% abstinent. The splits in the CART tree involved: the total number of counseling and control calls received, whether a smoking cessation pharmacotherapy was used, and baseline measures of cigarettes per day, confidence in quitting, expectation that the study would help the participant quit smoking, the motivation to quit, exercise minutes per week, anxiety, and lack of interest or pleasure in doing things. Costs per quitter ranged from a low of $US270 to a high of $US630. Specific treatment recommendations are made for each group.

CONCLUSIONS

These results indicate the presence of a substantial variation in abstinence following treatment, and that the total extent of contact via counseling calls of any type and baseline characteristics, rather than assigned treatment, were most important to subgroup membership and abstinence. Tailored treatments to subgroups who are at high risk for smoking following a quit attempt could increase successful smoking cessation.

Smoking Consequences Questionnaire: Factor Structure and Invariance among Smokers and Non-Smokers

BACKGROUND

The Smoking Consequences Questionnaire was developed to assess smoking expectancies, which have been found to be linked to the initiation and maintenance of smoking.

OBJECTIVES

The purpose of the current study was to examine the factor structure of a modified brief version of the instrument in Greek and to test its invariance between groups of smokers and nonsmokers.

METHODS

Participants were 813 Greek-Cypriot university students (524 females; Mean age =20.94, SD = 2.70) who completed this brief version of the instrument translated into Greek using the forward-backward method.

RESULTS

Confirmatory factor analysis supported a four-factor structure: Negative Consequences, Positive Reinforcement, Negative Reinforcement and Appetite/Weight Control. Multigroup confirmatory factor analysis indicated configural, metric and partial scalar invariance of the instrument in groups of smokers and nonsmokers. Comparison of the mean difference in the invariant factors showed significant difference in appetite/weight control mean scores, whereas mean difference in negative consequences was not significant. Conclusions/Importance. Findings support the four-factor structure of the brief Greek version of the SCQ in a sample of young adults, and factorial invariance between smokers and nonsmokers. More expectancies about appetite/weight control among smokers compared to nonsmokers suggest focusing on this category of smoking expectancies in smoking prevention and cessation programs.

A survey of women who continue to smoke during pregnancy in Slovenia

INTRODUCTION

Smoking in pregnancy is unhealthy and can also have negative effects on the foetus. However, there are still some women who do not quit smoking during pregnancy. The aim of the study was to identify Slovenian women at risk who smoke during pregnancy.

METHODS

A quantative approach using an online survey was adopted. The study was conducted in May and June 2017, in Slovenia. A snowball sample was used. Participation in the survey was anonymous and voluntary, and 118 women who identified themselves as smokers participated in the study. Descriptive statistics was used to analyse the data.

RESULTS

More than half (66%) did not quit smoking during pregnancy. Women who continued to smoke during pregnancy were usually younger, less educated with a partner who smoked. Women who smoked more cigarettes per day before conception were less likely to refrain from smoking during pregnancy. The most common reason for not quitting smoking during pregnancy was failure in attempts to quit (37%).

CONCLUSIONS

Women who smoke need support to stop smoking before pregnancy or, at least, in the first trimester. Special groups for smoking cessation need to be created. Further and more extensive research is warranted in Slovenia to assess this issue.

Simultaneous vs. sequential treatment for smoking and weight management in tobacco quitlines: 6 and 12 month outcomes from a randomized trial

BACKGROUND

Smoking cessation often results in weight gain which discourages many smokers from quitting and can increase health risks. Treatments to reduce cessation-related weight gain have been tested in highly controlled trials of in-person treatment, but have never been tested in a real-world setting, which has inhibited dissemination.

METHODS

The Best Quit Study (BQS) is a replication and "real world" translation using telephone delivery of a prior in-person efficacy trial.

DESIGN

randomized control trial in a quitline setting. Eligible smokers (n = 2540) were randomized to the standard 5-call quitline intervention or quitline plus simultaneous or sequential weight management. Regression analyses tested effectiveness of treatments on self-reported smoking abstinence and weight change at 6 and 12 months.

RESULTS

Study enrollees were from 10 commercial employer groups and three state quitlines. Participants were between ages 18-72, 65.8% female, 68.2% white; 23.0% Medicaid-insured, and 76.3% overweight/obese. The follow-up response rate was lower in the simultaneous group than the control group at 6 months (p = 0.01). While a completers analysis of 30-day point prevalence abstinence detected no differences among groups at 6 or 12 months, multiply imputed abstinence showed quit rate differences at 6 months for:simultaneous (40.3%) vs. sequential (48.3%), p = 0.034 and simultaneous vs. control (44.9%), p = 0.043. At 12 months, multiply imputed abstinence, was significantly lower for the simultaneous group (40.7%) vs. control (46.0%), p < 0.05 and vs. sequential (46.3%), p < 0.05. Weight gain at 6 and 12 months was minimal and not different among treatment groups. The sequential group completed fewer total calls (3.75) vs. control (4.16) and vs. simultaneous group (3.83), p = 0.01, and fewer weight calls (0.94) than simultaneous (2.33), p < 0.0001. The number of calls completed predicted 30-day abstinence, p < 0.001, but not weight outcomes.

DISCUSSION

This study offers a model for evaluating population-level public health interventions conducted in partnership with tobacco quitlines.

CONCLUSIONS

Simultaneous (vs. sequential) delivery of phone/web weight management with cessation treatment in the quitline setting may adversely affect quit rate. Neither a simultaneous nor sequential approach to addressing weight produced any benefit on suppressing weight gain. This study highlights the need and the challenges of testing intensive interventions in real-world settings.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01867983 . Registered: May 30, 2013.