Evaluation of smoking cessation intervention in patients with chronic diseases in smoking cessation clinics

The trajectory of smoking cessation after treatment and its related factors in Taiwan

Smoking has multiple negative effects on health; therefore, the Taiwanese government provides smoking cessation clinics to smokers. This study aimed to explore the trajectory of smoking cessation after smokers received treatment and the variables related to different trajectories. A retrospective longitudinal study was conducted, in which 735 adult smokers who received smoking cessation medications were recruited. The participants' demographic characteristics, chronic diseases, smoking characteristics, and cigarette dependence were collected from chart review. The amount of smoking was collected at baseline, and at 1 week, 1 month, 3 months, and 6 months after treatment. The Proc Traj procedure for group-based modeling and multinomial logistic regression were used for statistical analysis. Three trajectories were identified: early quitters (28.03%), late quitters (11.43%) and reducers (60.54%). Compared with early quitters, reducers were younger and had a higher probability of severe cigarette dependence. Compared with early quitters, late quitters had a higher number of taking smoking cessation medications. The findings revealed that approximately 60% of participants who received smoking cessation treatment could not completely quit smoking, and that age, number of medications taken, and cigarette dependence were significant predictors of different trajectories.

Effectiveness of smoking cessation interventions for smokers with chronic diseases: A systematic review

AIMS

To systematically summarize seminal studies on the design and effectiveness of smoking cessation interventions targeted at patients with chronic diseases through a critical appraisal of the literature.

DESIGN

A systematic review.

DATA SOURCES

This review included literature identified through a search of six databases up to June 2020.

REVIEW METHODS

This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The literature search was limited to English-language articles on the effectiveness of smoking cessation interventions for smokers who were aged ≥18 years and diagnosed with chronic diseases. Data were extracted using the Cochrane Data collection form for intervention reviews of randomized controlled trials and non-randomized controlled trials. The articles were subjected to a quality assessment.

RESULTS

Ten relevant articles were identified. The designs of the interventions were highly heterogeneous, and only six articles reported a significant increase in smoking abstinence among patients with chronic diseases. In the target population, an intervention delivered by healthcare professionals on an intensive schedule was shown to more effectively induce smoking cessation, compared with minimal counselling. However, methodological flaws were identified in most of the included studies.

CONCLUSION

The findings of this review suggest that additional efforts are needed to design smoking cessation interventions for patients with chronic diseases and that further examination of the effectiveness and feasibility of these interventions is warranted.

IMPACT

What problem did the study address? This review evaluated the effectiveness of smoking cessation interventions targeted at patients with chronic diseases. What were the main findings? An intervention with an intensive schedule that was delivered by healthcare professionals was shown to more effectively induce smoking cessation in patients with chronic diseases, compared with minimal counselling. More attention and resources should be directed towards smokers with no intention to quit, especially those with chronic diseases. There is an urgent need for generic smoking cessation interventions that use novel approaches to address the unique needs of this population and to integrate such evidence-based interventions into routine care. Where and on whom will the research have impact? The findings of this review may guide nurses, who play a prominent role in raising the issue of smoking cessation with patients, to design appropriate smoking cessation interventions for patients with chronic diseases. The resulting improvements in patients' health would not only benefit patients themselves but also reduce the burden of chronic diseases on healthcare systems.

Characteristics and Predictors of Abstinence Among Smokers of a Smoking Cessation Clinic in Hunan China

Background: More than 300 million smokers make China the largest cigarette consumer globally, which is a huge economic burden. Smoking cessation (SC) clinics can offer counseling and follow-up services. The operational experience of SC clinics in China needs to be summarized and improved based on research evidence.

Purpose: The objectives of this study were to describe quit rates among attendees of SC clinics in Hunan and assess predictors of successful SC.

Methods: The participants in this study were smokers who visited the SC clinic of Hunan Cancer Hospital from February 1, 2015 to September 30, 2018. Individuals who received individual counseling and assessment from the SC clinic staff and were willing to quit smoking were eligible for inclusion. Those with critical illness or cancer were excluded. Application of smoking cessation clinic registration form (unified by Chinese Center for Disease Control and Prevention) was used to assess participants at the consultation. Follow-ups and counseling were performed over telephone at 1 week, 1 month, and 3 months after the initial cessation consultation or in times of need. Successful SC was checked for at 3 months after the start of SC.

Results: A total of 328 smokers (mean age 45.67 ± 12.38 years) had participated. The abstinence rate at 3 months was 28.4%. Binary regression analysis revealed significant independent predictors to be the total numbers of SC follow up sessions, previous SC attempts, and participants' decision on when to quit smoking (The relative to quit immediately group, quit within 30 days, quit after 30 days, and undecided quit were less likely to succeed in quitting. while quit within seven days had no statistical significance.

Conclusion: SC clinics can achieve a desirably high quit rate. Participant's previous attempts at quitting, three or more follow-ups, and the decision to quit immediately or within seven days were factors helpful in predicting the success of SC.

Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS)

As part of the China National Health Survey, the objective of this study was to explore the prevalence, patterns, and influencing factors of smoking, and understand reasons for smoking cessation among adults in Hebei Province, central China. Using a multi-stage stratified cluster sampling method, 6,552 adults (2,594 males) aged 20–80 were selected in 2017. Demographic, socioeconomic, and tobacco use information were collected by questionnaire interview. The prevalence of ever-smoking, current smoking, and ex-smoking was 28.94, 21.08, and 7.86%, respectively. Male participants had a much higher prevalence of ever-smoking and current smoking (67.39 and 48.77%) than females (3.74 and 2.93%). In male participants, the daily cigarette consumption was 16.61, and the mean age of smoking initiation was 20.95, decreasing with birth year (27.50 in people born before 1946 vs. 17.9 for those born after 1985, p for trend < 0.001). Over 40% of male ever-smokers initiated regular smoking before 20. Compared with never drinking, the ORs (95% CI) of ever-smoking for low, moderate, and high alcohol consumption in male participants were 1.44 (1.11–1.86), 2.80 (1.91–4.11), and 2.40 (1.72–3.33), respectively. Among 479 male ex-smokers, 50.94% stopped smoking because of illness and 49.06% by choice. Among male ex-smokers, hypertensive men were more likely to quit smoking than the normotensive individuals (OR: 1.48, 95% CI: 1.13–1.96). For CVD patients, this effect was estimated as 2.27 (95% CI: 1.56–3.30). This study revealed a high prevalence of ever-smoking, especially in men, in a representative population in central China. Health education focus on tobacco control could be integrated with alcohol consumption reduction to achieve additional benefit.

Predictors of long-term abstinence rate by income level in the Korean smoking cessation programme

BACKGROUND AND AIMS

To assess whether predictors of success in stopping smoking vary as a function of income level in Korean smoking cessation services.

DESIGN

Prospective study of predictors of smoking cessation up to 6 months' follow up.

PARTICIPANTS

A sample of 954 people (mean age 49.13 ± 10.69 years; 863 [90.5%] men) enrolled in the Korean National Health Insurance Service smoking cessation programme in 2015.

MEASURES

The outcome measure was self-reported continuous abstinence up to 6-month follow up. Predictors were income and other sociodemographic variables as well as smoking-related variables measured at baseline.

RESULTS

The continuous 6-month abstinence rate was 30.5%. The adjusted odds of 6-month continuous abstinence were lower among low-income versus the middle- or high-income smokers (OR, 0.54; 95% CI, 0.35-0.84), those with severe versus light/moderate cigarette dependence (OR, 0.72; 95% CI, 0.52-0.98), and use of bupropion versus varenicline (OR, 0.60; 95% CI, 0.39-0.91). The association between cigarette dependence and outcome was only present among low-income smokers.

CONCLUSIONS

Lower income, higher cigarette dependence, and choice of bupropion versus varenicline are associated with lower chances of stopping smoking in Korean smoking cessation services, but the association with cigarette dependence is only found in low-income smokers.

A retrospective study of smoking cessation intervention among university students

This retrospective study investigated the effect of smoking cessation intervention (SCI) among university students in China.Around 192 eligible smokers among university students were included, and were assigned to an intervention group (n = 100), and a control group (n = 92). All included subjects in both groups were recommended to increase fruits and vegetables consumptions. Additionally, participants in the intervention group also underwent SCI therapy for a total of 4 weeks. The outcome measurements consisted of a number of students quit smoking, daily cigarettes, quit attempts, mean days of smoking in the past 30 days, and also stage of change.After 4-week treatment, SCI neither can decrease the number of students quit smoking (P = .21), daily cigarettes (P = .21), quit attempts (P = .07), and mean days of smoking in past 30 days (P = .77), nor can enhance the stage of change (precontemplation, P = .18; contemplation, P = .59; preparation, P = .46).The results of this study showed that after 4-week therapy, SCI may be ineffective for smokers among university students in Chinese.