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Hall W, Gartner C, Morphett K. How has the brain disease model of addiction contributed to tobacco control? Drug Alcohol Depend 2023; 253:111033. [PMID: 38006672 DOI: 10.1016/j.drugalcdep.2023.111033] [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: 07/12/2023] [Revised: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 11/27/2023]
Abstract
Our paper evaluates the extent to which the brain disease model of addiction (BDMA) has contributed to reducing the prevalence of tobacco smoking and tobacco-related harm over the past 20 years. We discuss the ways in which genetic and neuroscience research on nicotine addiction have contributed to our understanding of tobacco smoking. We then examine the extent to which the BDMA has produced more effective treatments to assist smoking cessation. We also assess the degree to which the BDMA has contributed to the tobacco control policies that have produced substantial reductions in tobacco-related morbidity and mortality in the two decades since the model was first proposed by Alan Leshner. We also assess whether the BDMA has reduced the stigmatisation of people who smoke tobacco.
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Affiliation(s)
- Wayne Hall
- The National Centre for Youth Substance Use Research, the University of Queensland, Australia.
| | - Coral Gartner
- The School of Public Health, The University of Queensland, Australia
| | - Kylie Morphett
- The School of Public Health, The University of Queensland, Australia
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Bendotti H, Lawler S, Chan GCK, Gartner C, Ireland D, Marshall HM. Conversational artificial intelligence interventions to support smoking cessation: A systematic review and meta-analysis. Digit Health 2023; 9:20552076231211634. [PMID: 37928336 PMCID: PMC10623979 DOI: 10.1177/20552076231211634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Background Conversational artificial intelligence (chatbots and dialogue systems) is an emerging tool for tobacco cessation that has the potential to emulate personalised human support and increase engagement. We aimed to determine the effect of conversational artificial intelligence interventions with or without standard tobacco cessation interventions on tobacco cessation outcomes among adults who smoke, compared to no intervention, placebo intervention or an active comparator. Methods A comprehensive search of six databases was completed in June 2022. Eligible studies included randomised controlled trials published since 2005. The primary outcome was sustained tobacco abstinence, self-reported and/or biochemically validated, for at least 6 months. Secondary outcomes included point-prevalence abstinence and sustained abstinence of less than 6 months. Two authors independently extracted data on cessation outcomes and completed the risk of bias assessment. Random effects meta-analysis was conducted. Results From 819 studies, five randomised controlled trials met inclusion criteria (combined sample size n = 58,796). All studies differed in setting, methodology, intervention, participants and end-points. Interventions included chatbots embedded in multi- and single-component smartphone apps (n = 3), a social media-based (n = 1) chatbot, and an internet-based avatar (n = 1). Random effects meta-analysis of three studies found participants in the conversational artificial intelligence enhanced intervention were significantly more likely to quit smoking at 6-month follow-up compared to control group participants (RR = 1.29, 95% CI (1.13, 1.46), p < 0.001). Loss to follow up was generally high. Risk of bias was high overall. Conclusion We found limited but promising evidence on the effectiveness of conversational artificial intelligence interventions for tobacco cessation. Although all studies found benefits from conversational artificial intelligence interventions, results should be interpreted with caution due to high heterogeneity. Given the rapid evolution and potential of artificial intelligence interventions, further well-designed randomised controlled trials following standardised reporting guidelines are warranted in this emerging area.
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Affiliation(s)
- Hollie Bendotti
- Faculty of Medicine, Thoracic Research Centre, The University of Queensland, Chermside, Queensland, Australia
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Sheleigh Lawler
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gary C K Chan
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - David Ireland
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Queensland, Australia
| | - Henry M Marshall
- Faculty of Medicine, Thoracic Research Centre, The University of Queensland, Chermside, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, Queensland, Australia
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Barbalich I, Gartner C, Edwards R, Hoek J. New Zealand Smokers' Perceptions of Tobacco Endgame Measures: A Qualitative Analysis. Nicotine Tob Res 2022; 24:93-99. [PMID: 34498088 DOI: 10.1093/ntr/ntab161] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap. AIMS AND METHODS In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data. RESULTS Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction. CONCLUSIONS Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought. IMPLICATIONS Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.
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Affiliation(s)
- Ivana Barbalich
- Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Morphett K, Puljević C, Borland R, Carter A, Hall W, Gartner C. Attitudes towards a hypothetical 'clean nicotine' product and harm reduction among smokers. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:103020. [PMID: 33161296 DOI: 10.1016/j.drugpo.2020.103020] [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: 05/06/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cleaner nicotine delivery devices, such as nicotine vaping products (NVPs), could expose smokers to less harm than combustible cigarettes. While use of NVPs is increasing, it is unknown how harm reduction attitudes are related to intention to use these or other "clean nicotine" products and how smokers would prefer to use them. METHODS A sample of 1,538 Australian smokers participated in an online survey. Questions covered use NVPs and nicotine replacement therapy (NRT), and attitudes towards a hypothetical "clean nicotine" product and tobacco harm reduction. RESULTS Lifetime use of NVPs was reported by 21% of participants, while 42% reported that they would probably or definitely use NVPs as a cessation aid in the future. Around three-quarters expressed interest in using a hypothetical clean nicotine product as a short-term cessation aid (75.7%), a long-term substitute for cigarettes (72.4%), or as a partial replacement for cigarettes (74.9%). However, despite this interest, 52% endorsed the statement that using nicotine products long-term was undesirable because it maintained nicotine addiction. A binary logistic regression showed that interest in using the hypothetical "clean nicotine" product was associated with higher education, moderate nicotine dependence, support of tobacco harm reduction, and previous use of NRT and NVPs. CONCLUSION Most smokers were interested in the use of a hypothetical clean nicotine product that is as addictive as combustible cigarettes but much less harmful. However, many of the participants who were interested in the use of a hypothetical clean nicotine product also endorsed statements that long-term addiction to nicotine is undesirable. These seemingly contradictory findings have implications for communication with smokers about tobacco harm reduction approaches with non-smoked nicotine products.
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Affiliation(s)
- Kylie Morphett
- School of Public Health, The University of Queensland, Herston, Queensland, Australia.
| | - Cheneal Puljević
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Ron Borland
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Melbourne, Australia
| | - Wayne Hall
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Alliance for Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
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