1
|
Kaplan A, Nelson D. Simple Bayesian models for missing binary outcomes in randomized controlled trials. Stat Med 2023; 42:4377-4391. [PMID: 37573785 DOI: 10.1002/sim.9866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Missing outcomes are commonly encountered in randomized controlled trials (RCT) involving human subjects and present a risk for substantial bias in the results of a complete case analysis. While response rates for RCTs are typically high there is no agreed upon universal threshold under which the amount of missing data is deemed to not be a threat to inference. We focus here on binary outcomes that are possibly missing not at random, that is, the value of the outcome influences its possibility of being observed. Salient information that can assist in addressing these missing outcomes in such situations is the anticipated response rate in each study arm; these can often be anticipated based on prior research in similar populations using similar designs and outcomes. Further, in some areas of human subjects research, we are often confident or we suspect that response rates among RCT participants with successful treatment outcomes will be at least as great as those among participants without successful treatment outcomes. In other settings we may suspect the opposite relationship. This direction of the differential response between those with successful and unsuccessful outcomes can further aid in addressing the missing outcomes. We present simple Bayesian pattern-mixture models that incorporate this information on response rates to analyze the relationship between a binary outcome and an intervention while addressing the missing outcomes. We assess the performance of this method in simulation studies and apply this method to the results of an RCT of a smoking abstinence intervention.
Collapse
Affiliation(s)
- Adam Kaplan
- Center for Care Delivery and Outcomes Research, Minneapolis VA HCS, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA HCS, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Little MA, Porter KJ, Pebley K, Wiseman KP, Cohn W, Anderson RT, Krukowski RA. Evaluating the feasibility of pharmacist-facilitated tobacco cessation interventions in independent community pharmacies in rural Appalachia. J Am Pharm Assoc (2003) 2022; 62:1807-1815. [PMID: 35953377 PMCID: PMC9732831 DOI: 10.1016/j.japh.2022.06.015] [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: 04/28/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Smoking rates in the United States are the highest in underserved rural regions. Thus, more points of contact are needed to link smokers to evidence-based cessation programs. OBJECTIVES The purpose of this study was to conduct an evaluation to determine the feasibility, acceptability, and interest among rural pharmacists in implementing a pharmacist-facilitated smoking cessation program in independent community pharmacies in rural Appalachian communities in Virginia, North Carolina, Tennessee, and West Virginia. METHODS This study utilized a complementary sequential mixed-methods approach to explore independent community pharmacists and technicians' experiences and beliefs about implementing a tobacco cessation program in their pharmacy. RESULTS There were 49 pharmacists or technicians who completed the survey and 7 pharmacists who participated in the interviews. Four main findings emerged from the data: 1) pharmacies can help fill the gap in tobacco cessation services in rural communities, 2) under current practice, tobacco cessation resources when offered by independent community pharmacies are not always formalized, 3) there are known barriers, such as reimbursing for services, that need to be addressed to provide tobacco cessation in an independent pharmacy setting, and 4) the Ask-Advise-Connect model is a feasible tobacco cessation approach in a pharmacy. CONCLUSION Although pharmacists may be ideally situated to build capacity for smoking cessation in rural areas, smoking cessation interventions need to use existing approaches that compensate pharmacists for their time spent counseling patients. Furthermore, simple documentation and billing systems are needed to maximize utilization of tobacco cessation products and services provided in the pharmacy.
Collapse
Affiliation(s)
- Melissa A. Little
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| | - Kathleen J. Porter
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| | - Kinsey Pebley
- University of Memphis, The University of Memphis, Department of Psychology, Memphis, TN
| | - Kara P. Wiseman
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| | - Wendy Cohn
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| | - Roger T. Anderson
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| | - Rebecca A. Krukowski
- University of Virginia School of Medicine, School of Medicine Department of Public Health Sciences, Charlottesville, VA,University of Virginia Cancer Center, Charlottesville, VA
| |
Collapse
|
3
|
Baliunas D, Zawertailo L, Voci S, Gatov E, Bondy SJ, Fu L, Selby PL. Variability in patient sociodemographics, clinical characteristics, and healthcare service utilization among 107,302 treatment seeking smokers in Ontario: A cross-sectional comparison. PLoS One 2020; 15:e0235709. [PMID: 32650339 PMCID: PMC7351500 DOI: 10.1371/journal.pone.0235709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Since 2005, the Smoking Treatment for Ontario Patients (STOP) program has provided smoking cessation treatment of varying form and intensity to smokers through 11 distinct treatment models, either in-person at partnering healthcare organizations or remotely via web or telephone. We aimed to characterize the patient populations reached by different treatment models. Methods We linked self-report data to health administrative databases to describe sociodemographics, physical and mental health comorbidity, healthcare utilization and costs. Our sample consisted of 107,302 patients who enrolled between 18Oct2005 and 31Mar2016, across 11 models operational during different time periods. Results Patient populations varied on sociodemographics, comorbidity burden, and healthcare usage. Enrollees in the Web-based model were youngest (median age: 39; IQR: 29–49), and enrollees in primary care-based Family Health Teams were oldest (median: 51; IQR: 40–60). Chronic Obstructive Pulmonary Disease and hypertension were the most common physical health comorbidities, twice as prevalent in Family Health Teams (32.3% and 30.8%) than in the direct-to-smoker (Web and Telephone) and Pharmacy models (13.5%-16.7% and 14.7%-17.7%). Depression, the most prevalent mental health diagnosis, was twice as prevalent in the Addiction Agency (52.1%) versus the Telephone model (25.3%). Median healthcare costs in the two years up to enrollment ranged from $1,787 in the Telephone model to $9,393 in the Addiction Agency model. Discussion While practitioner-mediated models in specialized and primary care settings reached smokers with more complex healthcare needs, alternative settings appear better suited to reach younger smokers before such comorbidities develop. Although Web and Telephone models were expected to have fewer barriers to access, they reached a lower proportion of patients in rural areas and of lower socioeconomic status. Findings suggest that in addition to population-based strategies, embedding smoking cessation treatment into existing healthcare settings that reach patient populations with varying disparities may enhance equitable access to treatment.
Collapse
Affiliation(s)
- Dolly Baliunas
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Laurie Zawertailo
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Voci
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Susan J. Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter L. Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Kotz D, Batra A, Kastaun S. Smoking Cessation Attempts and Common Strategies Employed. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:7-13. [PMID: 32008606 DOI: 10.3238/arztebl.2020.0007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical guidelines on smoking cessation contain recommendations for various evidence-based methods. The goal of this study was to provide a represen- tative analysis for Germany of the percentage of smokers who try to quit smoking at least once per year, the use of evidence-based methods and other methods of smoking cessation, and potential associations of the use of such methods with the degree of tobacco dependence and with socioeconomic features. METHODS Data from 19 waves of the German Smoking Behavior Questionnaire (Deutsche Befragung zum Rauchverhalten, DEBRA), from the time period June/July 2016 to June/July 2019, were analyzed. Current smokers and recent ex-smokers (<12 months without smoking) were asked about their smoking cessation attempts in the past year and the methods they used during the last attempt (naming more than one method was permitted). The degree of tobacco dependence in current smokers was assessed with the Heaviness of Smoking Index. RESULTS Out of 11 109 current smokers and 407 recent ex-smokers, 19.9% (95% confidence interval: [19.1; 20.6]) had tried to quit smoking at least once in the preceding year. 13.0% of them [11.6; 14.5] had used at least one evidence-based method during their last attempt. The stronger the tobacco dependence, the more likely the use of an evidence-based method (odds ratio [OR] = 1.27 [1.16; 1.40]). Pharmacotherapy (nicotine replacement therapy, medication) was used more com- monly by persons with higher incomes (OR = 1.44 per 1000 euro/month [1.28; 1.62]). Electronic cigarettes were the most commonly used single type of smoking cessation support (10.2 % [9.0; 11.6]). CONCLUSION In Germany, only one in five smokers tries to quit smoking at least once per year. Such attempts are only rarely supported by evidence-based methods and are thus likely to fail. The high cost of treatment must be borne by the individual and thus fall disproportionately on poorer smokers. It follows that there is an urgent need for vered by health insurance pro- viders, in order to give all smokers fair and equal access to the medical care they need.
Collapse
Affiliation(s)
- Daniel Kotz
- Institute of General Medicine, Addiction Research and Clinical Epidemiology Unit, Medical Faculty ofthe Heinrich-Heine University Düsseldorf; Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care,University College London, London, UK; Section for Addiction Medicine and Addiction Research, Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen
| | | | | |
Collapse
|
5
|
Minué-Lorenzo C, Olano-Espinosa E, Del Cura-González I, Vizcaíno-Sánchez JM, Camarelles-Guillem F, Granados-Garrido JA, Ruiz-Pacheco M, Gámez-Cabero MI, Martínez-Suberviola FJ, Serrano-Serrano E. Subsidized pharmacological treatment for smoking cessation by the Spanish public health system: A randomized, pragmatic, clinical trial by clusters. Tob Induc Dis 2019; 17:64. [PMID: 31582953 PMCID: PMC6770612 DOI: 10.18332/tid/111368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Research has shown that financing drug therapy increases smoking abstinence rates, although most of these studies have been carried out in the private healthcare setting. The aim of this work is to assess the effect of subsidized pharmacological treatment on smoking cessation rates by the Spanish public healthcare system. METHODS A pragmatic, randomized, clinical trial was performed by clusters. Randomization unit was the primary healthcare center and the analysis unit was the patient. Smokers consuming ≥10 cigarettes/day were randomly assigned to an intervention group that received financed pharmacological treatment or to a control group that followed usual care. The main outcome was self-reported or CO-confirmed continuous abstinence at 12 months. The main outcome, continuous abstinence rates (%), were compared between groups at 12 months post-intervention. A model was adjusted using mixed-effect logistic regression. RESULTS A total of 1154 patients were included from 23 healthcare centers. In the intention-to-treat analysis, self-reported abstinence after 12 months in the control and intervention groups, respectively, was 9.6% (37/387) and 15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1–2.8); for CO-confirmed abstinence the corresponding values were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted OR=1.72; 95% CI: 0.7–4.0). Pharmacological treatment use was 35.1% (136/387) in the control group, and 58.3% (447/767) in the intervention group (adjusted OR=4.25; 95% CI: 1.8–9.9) CONCLUSIONS Subsidizing pharmacological treatment for smoking cessation increases self-reported or CO-confirmed abstinence rates under realistic conditions in the primary care setting of the Spanish public health system.
Collapse
Affiliation(s)
- César Minué-Lorenzo
- Perales del Río Health Center, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, Spain
| | - Eduardo Olano-Espinosa
- Los Castillos Health Center, Dirección Asistencial Oeste, Servicio Madrileño de Salud, Madrid, Spain.,Area Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Del Cura-González
- Area Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain.,Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,Red de Investigación Servicios de Salud en enfermedades crónicas, REDISSEC, Madrid, Spain
| | - Jose M Vizcaíno-Sánchez
- Fuentelarreina Health Center, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, Spain
| | | | - José A Granados-Garrido
- Guayaba Health Center, Dirección Asistencial Centro, Servicio Madrileño de Salud, Madrid, Spain
| | - Margarita Ruiz-Pacheco
- Doctor Castroviejo Health Center, Dirección Asistencial Norte, Servicio Madrileño de Salud, Madrid, Spain
| | - M Isabel Gámez-Cabero
- Majadahonda Valle de la Oliva Health Center, Dirección Asistencial Noroeste, Servicio Madrileño de Salud, Madrid, Spain
| | | | | |
Collapse
|
6
|
Abstract
OBJECTIVES We examined the impact of the Affordable Care Act-mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income. METHODS Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination, N=16,199) or 2015 (after elimination, N=16,469). Multivariable models estimated 1-year changes in rates of any TCP fill, and of combination TCP fill, and tested for differences by income (<$50k, $50≥75k, ≥$75k). Through telephone surveys in 2016 with a subset of smokers newly enrolled in 2014 (n=306), we assessed barriers to TCP use, with results stratified by income. RESULTS Smokers enrolled in KPNC in 2015 versus 2014 were more likely to have a TCP fill (9.1% vs. 8.2%; relative risk, 1.19; 95% confidence interval, 1.11-1.27), and combination TCP fill, among those with any fill (42.3% vs. 37.9%; relative risk, 1.12; 95% confidence interval, 1.02-1.23); findings were stronger for low-income smokers. Low-income patients (<$50k) were less likely to report that clinicians discussed smoking treatments with them (58%) compared with higher income smokers ($50≥75k, 67%; ≥$75k, 83%), and were less aware that TCP was free (40% vs. 53% and 69%, respectively, P-values<0.05). CONCLUSIONS The Affordable Care Act's copayment elimination was associated with a modest increase in TCP use and a greater effect among low-income smokers. Uptake may have been enhanced if promoted to patients directly and via providers.
Collapse
|
7
|
Factors Correlated with Success Rate of Outpatient Smoking Cessation Services in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061218. [PMID: 29890766 PMCID: PMC6025172 DOI: 10.3390/ijerph15061218] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 11/17/2022]
Abstract
Smoking is the leading cause of preventable death. The purpose of this study was to explore the patient’s and physician’s factors that are correlated with smoking cessation success rate. A total of 877 smokers who visited the outpatient smoking cessation services at a medical center in Northern Taiwan were recruited for the study. Phone interviews were carried out six months after the initial visit to evaluate the success rate of smoking cessation. The result showed that the abstinence rate at six-month was 37.7%. By the multivariate logistic regression model, the predictive factors of abstinence were smokers who had a lower Fagerström test for cigarette dependence (FTCD), lower exhaled carbon monoxide (CO) concentration, or who smoked less than 20 cigarettes per day at the first visit. Smokers who had more than one smoking cessation outpatient visit or seen by physicians who, on average, delivered more than one smoking cessation consultations per week also led to a higher success rate. Therefore, we suggest that physicians should put more efforts and encourage follow-up visits for some smokers by knowing their characteristics at the first visit. Furthermore, physicians with more experience in smoking cessation consultation seemed to be more likely to help patients to quit smoking successfully.
Collapse
|
8
|
van den Brand FA, Nagelhout GE, Hummel K, Willemsen MC, McNeill A, van Schayck OCP. Does free or lower cost smoking cessation medication stimulate quitting? Findings from the International Tobacco Control (ITC) Netherlands and UK Surveys. Tob Control 2018; 28:s61-s67. [PMID: 29618494 DOI: 10.1136/tobaccocontrol-2017-054023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/25/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate whether mentioning free or lower cost smoking cessation medication as a trigger for thinking about quitting is related to higher medication use, more quit attempts and quit success, and whether these associations are modified by education and income. METHODS Data were derived from the 2013 and 2014 surveys of the International Tobacco Control Netherlands (n=1164) and UK (n=768) cohort. Logistic regression analyses were used to assess associations between mentioning in 2013 that free/lower cost smoking cessation medication was a trigger for thinking about quitting smoking and the use of medication, quit attempts and smoking cessation in 2014. RESULTS 37.0% of smokers in the UK and 24.9% of smokers in the Netherlands mentioned free/lower cost medication as a trigger for thinking about quitting. Smokers who mentioned this trigger were more likely to have used cessation medication during a quit attempt both in the UK (OR=4.19, p<0.001) and in the Netherlands (OR=2.14, p=0.033). The association between mentioning free/lower cost medication as a trigger for thinking about quitting and actual quit attempts was significant in the UK (OR=1.45, p=0.030), but not in the Netherlands (OR=1.10, p=0.587). There was no significant association with quit success. Associations did not differ across income and education groups. CONCLUSION Free/lower cost smoking cessation medication may increase the use of cessation medication and stimulate quit attempts among smokers with low, moderate and high education and income.
Collapse
Affiliation(s)
- Floor A van den Brand
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Gera E Nagelhout
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands.,Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.,IVO Addiction Research Institute, The Hague, The Netherlands
| | - Karin Hummel
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.,Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Onno C P van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, The Netherlands
| |
Collapse
|
9
|
Fraser DL, Fiore MC, Kobinsky K, Adsit R, Smith SS, Johnson ML, Baker TB. A Randomized Trial of Incentives for Smoking Treatment in Medicaid Members. Am J Prev Med 2017; 53:754-763. [PMID: 29079405 PMCID: PMC5978743 DOI: 10.1016/j.amepre.2017.08.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low-income populations are especially likely to smoke and have difficulty quitting. This study evaluated a monetary incentive intended to increase smoking treatment engagement and abstinence among Medicaid recipients who smoke. STUDY DESIGN Two-group randomized clinical trial of Incentive (n=948) and Control interventions (n=952) for smoking. SETTING/PARTICIPANTS Medicaid recipients recruited from primary care patients (n=920) and callers to the Wisconsin Tobacco Quit Line (n=980). INTERVENTION Participants were offered five quitline cessation calls and were encouraged to obtain cessation medication (covered by Medicaid). All participants received payment for completing a baseline assessment and a 6-month smoking test. Only Incentive condition participants received compensation for taking counseling calls ($30 per call) and for biochemically verified abstinence at the 6-month visit ($40). MAIN OUTCOME MEASURES Seven-day point-prevalence smoking abstinence 6-months post study entry and cost/quit. RESULTS Incentive condition participants had significantly higher biochemically determined 7-day point-prevalence smoking abstinence rates 6 months after study induction than did Controls (21.6% vs 13.8%, respectively, p<0.0001). A positive treatment effect of incentives was present across other abstinence indices, but the size of effects and levels of abstinence varied considerably across indices. Incentive condition participants were also significantly more likely than non-incentivized Control participants to accept Wisconsin Tobacco Quit Line treatment calls and their acceptance of calls mediated their attainment of higher abstinence rates at 6-month follow-up. The cost/quit/participant averaged $4,268.26 for the Control participants and $3,601.37 for the Incentive participants. CONCLUSIONS This study shows that fairly moderate levels of incentive payments for treatment engagement and abstinence (a total possible payment of $190) increased very low-income smokers' engagement and success in smoking cessation treatment. CLINICAL REGISTRATION This study is registered at www.clinicaltrials.gov: NCT02713594.
Collapse
Affiliation(s)
- David L Fraser
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | - Kate Kobinsky
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Robert Adsit
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mimi L Johnson
- Wisconsin Department of Health Services, Madison, Wisconsin
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Division of General Internal Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| |
Collapse
|
10
|
van den Brand FA, Nagelhout GE, Reda AA, Winkens B, Evers SMAA, Kotz D, van Schayck OCP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev 2017; 9:CD004305. [PMID: 28898403 PMCID: PMC6483741 DOI: 10.1002/14651858.cd004305.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. This is an update of the original 2005 review. OBJECTIVES The primary objective of this review was to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). We also assessed the cost effectiveness of different financial interventions, and analysed the costs per additional quitter, or per quality-adjusted life year (QALY) gained. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register in September 2016. SELECTION CRITERIA We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or their healthcare providers, or both. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the quality of the included studies. We calculated risk ratios (RR) for individual studies on an intention-to-treat basis and performed meta-analysis using a random-effects model. MAIN RESULTS In the current update, we have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both.Full financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared to no intervention (RR 1.77, 95% CI 1.37 to 2.28, I² = 33%, 9333 participants). There was no evidence that full coverage interventions increased smoking abstinence compared to partial coverage interventions (RR 1.02, 95% CI 0.71 to 1.48, I² = 64%, 5914 participants), but partial coverage interventions were more effective in increasing abstinence than no intervention (RR 1.27 95% CI 1.02 to 1.59, I² = 21%, 7108 participants). The economic evaluation showed costs per additional quitter ranging from USD 97 to USD 7646 for the comparison of full coverage with partial or no coverage.There was no clear evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%, 2311 participants).Full financial interventions increased the number of participants making a quit attempt when compared to no interventions (RR 1.11, 95% CI 1.04 to 1.17, I² = 15%, 9065 participants). There was insufficient evidence to show whether partial financial interventions increased quit attempts compared to no interventions (RR 1.13, 95% CI 0.98 to 1.31, I² = 88%, 6944 participants).Full financial interventions increased the use of smoking cessation treatment compared to no interventions with regard to various pharmacological and behavioural treatments: nicotine replacement therapy (NRT): RR 1.79, 95% CI 1.54 to 2.09, I² = 35%, 9455 participants; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%, 6321 participants; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65, I² = 75%, 9215 participants.There was evidence that partial coverage compared to no coverage reported a small positive effect on the use of bupropion (RR 1.15, 95% CI 1.03 to 1.29, I² = 0%, 6765 participants). Interventions directed at healthcare providers increased the use of behavioural therapy (RR 1.69, 95% CI 1.01 to 2.86, I² = 85%, 25820 participants), but not the use of NRT and/or bupropion (RR 0.94, 95% CI 0.76 to 1.18, I² = 6%, 2311 participants).We assessed the quality of the evidence for the main outcome, abstinence from smoking, as moderate. In most studies participants were not blinded to the different study arms and researchers were not blinded to the allocated interventions. Furthermore, there was not always sufficient information on attrition rates. We detected some imprecision but we judged this to be of minor consequence on the outcomes of this study. AUTHORS' CONCLUSIONS Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting. There was no clear and consistent evidence of an effect on smoking cessation from financial incentives directed at healthcare providers. We are only moderately confident in the effect estimate because there was some risk of bias due to a lack of blinding in participants and researchers, and insufficient information on attrition rates.
Collapse
Affiliation(s)
- Floor A van den Brand
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
| | - Gera E Nagelhout
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
- IVO Addiction Research InstituteRotterdamNetherlands
- Maastricht University (CAPHRI)Department of Health PromotionMaastrichtNetherlands
| | - Ayalu A Reda
- Brown UniversityDepartment of Biostatistics, School of Public HealthProvidenceRIUSA
- Brown UniversityDepartment of SociologyProvidenceUSA
- Brown UniversityPopulation Studies and Training CentreProvidenceUSA
| | - Bjorn Winkens
- Maastricht UniversityDepartment of Methodology and Statistics, Faculty of Health Medicine and Life Sciences (FHML)Debyeplein 1MaastrichtNetherlands6200 MD
| | - Silvia M A A Evers
- Maastricht University (CAPHRI)Department of Health Services ResearchPO Box 6166200 MDMaastrichtNetherlands6229 ER
| | - Daniel Kotz
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
- Heinrich‐Heine‐UniversityInstitute of General Practice, Addiction Research and Clinical Epidemiology, Medical FacultyDüsseldorfGermany
| | - Onno CP van Schayck
- Maastricht University (CAPHRI)Department of Family MedicineP.debyeplein 1MaastrichtZuid‐LimburgNetherlands6229 HA
| | | |
Collapse
|
11
|
Bukreeva EB, Bulanova AA, Kistenev YV, Nikiforova OY. [Photoacoustic spectroscopy evaluation of the impact of smoking on the composition of exhaled air in patients with bronchopulmonary diseases]. TERAPEVT ARKH 2017; 89:34-37. [PMID: 28378727 DOI: 10.17116/terarkh201789334-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the impact of smoking on the air exhaled by patients with chronic obstructive pulmonary disease (COPD) and asthmatics, by applying photoacoustic spectroscopy. SUBJECTS AND METHODS The exhaled air absorption spectra (EAAS) were analyzed in healthy volunteers and patients with COPD and asthmatics, by applying an ILPA-1 CO2 laser photoacoustic gas analyzer. The procedure based on the calculation of an integrated estimate (IE) of the state of the object was used to assess the findings. RESULTS Comparison of the IE of EAAS in COPD patients and non-smoking healthy individuals showed that spectra of the compounds, the formation of which was associated with smoking, were recorded in the range of wavelengths corresponding to the 10R branch of CO2 laser generation. This also provided evidence indicating that the exhaled air of asthmatics differed from that of both smoking and non-smoking healthy individuals. The calculations yielded the threshold values of EAAS IE in the range of wavelengths corresponding to the 10P branche of CO2 laser generation, which made it possible to distinguish non-smoking healthy individuals from asthmatics and COPD patients in 94 and 89% of cases, respectively. CONCLUSION The investigation has confirmed that smoking substantially impacts the composition of the air exhaled by healthy individuals. It has been shown that the use of reference groups formed from non-smoking healthy individuals can improve the accuracy of photoacoustic spectroscopy in detecting COPD and asthma. A further development in this direction will open up new prospects for a new method to diagnose COPD and asthma.
Collapse
Affiliation(s)
- E B Bukreeva
- Siberian State Medical University, Ministry of Health of Russia, Tomsk, Russia
| | | | - Yu V Kistenev
- Siberian State Medical University, Ministry of Health of Russia, Tomsk, Russia; Tomsk State University, Tomsk, Russia
| | - O Yu Nikiforova
- V.E. Zuev Institute of Atmospheric Optics, Siberian Branch, Russian Academy of Sciences, Tomsk, Russia
| |
Collapse
|
12
|
Trofor AC, Man MA, Marginean C, Dumitru F, Trofor L. Smoking cessation for free: outcomes of a study of three Romanian clinics. Open Med (Wars) 2016; 11:605-610. [PMID: 28352853 PMCID: PMC5329885 DOI: 10.1515/med-2016-0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
In 2007, Romania implemented a national program for smoking cessation, providing medication and counseling, entirely for free. The present study focuses on the results of the program among participating smokers treated in three smoking cessation centers from three main cities of Romania: Iasi, Targu Mures and Cluj. Telephone interviews of 832 subjects from three databases of the Romanian cessation clinics of Iasi, Cluj and Targu Mures cities were conducted. These interviews were based on a standard Romanian guideline follow-up questionnaire. At 3 months follow up, abstinence was quite high (53.4%); at 12 months post quit date the study found 18.6% still abstinent subjects. More severely addicted smokers have quit with varenicline and the most difficult category of patients was represented by heavy smokers with respiratory co-morbidities. 61.5% of smokers and 97.2% of non-smokers were willing to receive relapse prevention counseling. Many subjects achieved a long duration partial abstinence (154 days ± 180 SD abstinence days). This is the first study in Romanian smoking cessation centers to analyze the long term impact of fully reimbursed smoking cessation, covering three months pharmacotherapy and counseling. Providing smoking cessation for free had a positive long term impact on program participants.
Collapse
Affiliation(s)
| | - Milena Adina Man
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj, Romania, Tel. +40-264-597453; , Romania
| | - Corina Marginean
- County Clinical Hospital Mures, Clinic of Pulmonary Diseases Tg. Mures, Romania
| | - Filipeanu Dumitru
- Technical University "Gh.Asachi" Iasi, Romania University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - Letitia Trofor
- University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| |
Collapse
|
13
|
Thompson TP, Greaves CJ, Ayres R, Aveyard P, Warren FC, Byng R, Taylor RS, Campbell JL, Ussher M, Michie S, West R, Taylor AH. Factors associated with study attrition in a pilot randomised controlled trial to explore the role of exercise-assisted reduction to stop (EARS) smoking in disadvantaged groups. Trials 2016; 17:524. [PMID: 27788686 PMCID: PMC5084338 DOI: 10.1186/s13063-016-1641-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/06/2016] [Indexed: 12/23/2022] Open
Abstract
Background Study attrition has the potential to compromise a trial’s internal and external validity. The aim of the present study was to identify factors associated with participant attrition in a pilot trial of the effectiveness of a novel behavioural support intervention focused on increasing physical activity to reduce smoking, to inform the methods to reduce attrition in a definitive trial. Methods Disadvantaged smokers who wanted to reduce but not quit were randomised (N = 99), of whom 61 (62 %) completed follow-up assessments at 16 weeks. Univariable logistic regression was conducted to determine the effects of intervention arm, method of recruitment, and participant characteristics (sociodemographic factors, and lifestyle, behavioural and attitudinal characteristics) on attrition, followed by multivariable logistic regression on those factors found to be related to attrition. Results Participants with low confidence to quit, and who were undertaking less than 150 mins of moderate and vigorous physical activity per week at baseline were less likely to complete the 16-week follow-up assessment. Exploratory analysis revealed that those who were lost to follow-up early in the trial (i.e., by 4 weeks), compared with those completing the study, were younger, had smoked for fewer years and had lower confidence to quit in the next 6 months. Participants who recorded a higher expired air carbon monoxide reading at baseline were more likely to drop out late in the study, as were those recruited via follow-up telephone calls. Multivariable analyses showed that only completing less than 150 mins of physical activity retained any confidence in predicting attrition in the presence of other variables. Conclusions The findings indicate that those who take more effort to be recruited, are younger, are heavier smokers, have less confidence to quit, and are less physically active are more likely to withdraw or be lost to follow-up.
Collapse
Affiliation(s)
- T P Thompson
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK.
| | - C J Greaves
- University of Exeter Medical School, Exeter, UK
| | - R Ayres
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F C Warren
- University of Exeter Medical School, Exeter, UK
| | - R Byng
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| | - R S Taylor
- University of Exeter Medical School, Exeter, UK
| | | | - M Ussher
- Institute of Population Health Research, St George's University of London, Cranmer Terrace, London, UK
| | - S Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK
| | - R West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, UK
| | - A H Taylor
- Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK
| |
Collapse
|
14
|
van den Brand FA, Nagelhout GE, Winkens B, Evers SMAA, Kotz D, Chavannes NH, van Schayck CP. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial. BMC Public Health 2016; 16:1056. [PMID: 27716132 PMCID: PMC5053183 DOI: 10.1186/s12889-016-3729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive) is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training. METHODS/DESIGN In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50), after three months (€50), after six months (€50), and after one year (€200). The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel's standard). Additionally, an economic evaluation is performed from a societal and an employer perspective. DISCUSSION The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation. TRIAL REGISTRATION Dutch Trial Register: NTR5657 . First received 27-01-2016.
Collapse
Affiliation(s)
- F. A. van den Brand
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - G. E. Nagelhout
- Department of Health Promotion/Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - S. M. A. A. Evers
- Department of Health Services Research, Maastricht University (CAPHRI), Duboisdomein 30, 6229 GT Maastricht, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluations, Utrecht, Netherlands
| | - D. Kotz
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Institute of General Practice, Heinrich-Heine University, P.O. Box 101007, 40001 Düsseldorf, Germany
| | - N. H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD Leiden, Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| |
Collapse
|
15
|
Beard E, Shahab L, Cummings DM, Michie S, West R. New Pharmacological Agents to Aid Smoking Cessation and Tobacco Harm Reduction: What Has Been Investigated, and What Is in the Pipeline? CNS Drugs 2016; 30:951-83. [PMID: 27421270 DOI: 10.1007/s40263-016-0362-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A wide range of support is available to help smokers to quit and to aid attempts at harm reduction, including three first-line smoking cessation medications: nicotine replacement therapy, varenicline and bupropion. Despite the efficacy of these, there is a continual need to diversify the range of medications so that the needs of tobacco users are met. This paper compares the first-line smoking cessation medications with (1) two variants of these existing products: new galenic formulations of varenicline and novel nicotine delivery devices; and (2) 24 alternative products: cytisine (novel outside Central and Eastern Europe), nortriptyline, other tricyclic antidepressants, electronic cigarettes, clonidine (an anxiolytic), other anxiolytics (e.g. buspirone), selective serotonin reuptake inhibitors, supplements (e.g. St John's wort), silver acetate, Nicobrevin, modafinil, venlafaxine, monoamine oxidase inhibitors (MAOIs), opioid antagonists, nicotinic acetylcholine receptor (nAChR) antagonists, glucose tablets, selective cannabinoid type 1 receptor antagonists, nicotine vaccines, drugs that affect gamma-aminobutyric acid (GABA) transmission, drugs that affect N-methyl-D-aspartate (NMDA) receptors, dopamine agonists (e.g. levodopa), pioglitazone (Actos; OMS405), noradrenaline reuptake inhibitors and the weight management drug lorcaserin. Six 'ESCUSE' criteria-relative efficacy, relative safety, relative cost, relative use (overall impact of effective medication use), relative scope (ability to serve new groups of patients) and relative ease of use-are used. Many of these products are in the early stages of clinical trials; however, cytisine looks most promising in having established efficacy and safety with low cost. Electronic cigarettes have become very popular, appear to be efficacious and are safer than smoking, but issues of continued dependence and possible harms need to be considered.
Collapse
Affiliation(s)
- Emma Beard
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK.
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK.
| | - Lion Shahab
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
| | - Damian M Cummings
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 6BP, UK
| | - Robert West
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BP, UK
| |
Collapse
|
16
|
Sigmon SC, Miller ME, Meyer AC, Saulsgiver K, Badger GJ, Heil SH, Higgins ST. Financial incentives to promote extended smoking abstinence in opioid-maintained patients: a randomized trial. Addiction 2016; 111:903-12. [PMID: 26638126 PMCID: PMC4826799 DOI: 10.1111/add.13264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Prior studies by our group demonstrated the efficacy of a brief but intensive behavioral intervention for producing initial smoking abstinence among opioid-dependent patients. In the present study, our aim was to promote longer-duration abstinence in this population. Following an initial 2-week incentive intervention for smoking abstinence, we examined whether a 10-week maintenance arm involving continuation of contingent reinforcement will produce greater smoking abstinence than a similar duration of noncontingent reinforcement. DESIGN Randomized, 12-week, parallel-group study. SETTING Out-patient research clinic in Burlington, Vermont, USA. PARTICIPANTS Opioid-maintained smokers (n = 88) who provided breath carbon monoxide and urinary cotinine specimens and received contingent reinforcement for smoking abstinence during weeks 1-2 (phase 1), with 63 randomized on day 14 to an extended contingent (EC; n = 31) or extended noncontingent (EN; n = 32) experimental condition for weeks 3-12 (phase 2). INTERVENTION AND CONTROL The EC condition consisted of voucher values that escalated across consecutive negative samples until they reached $30, after which they remained at $30 per negative sample. A positive or a missing sample resulted in no vouchers for that day and reset the value of the next negative same to $9. Two consecutive negatives returned the schedule to the pre-reset value. The EN control condition consisted of vouchers delivered for providing scheduled samples, but independent of smoking status. MEASUREMENTS The primary outcome was percentage of biochemically abstinent samples during phase 2. Secondary measures included abstinence status at final study visit, complete abstinence, participants' longest duration of continuous abstinence, cotinine and carbon monoxide (CO) levels and self-reported cigarettes per day. FINDINGS EC participants achieved greater smoking abstinence during phase 2 than EN participants [46.7 versus 23.5% negative samples, respectively; odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.16-7.65, χ(2) 1 (=) 5.0, P = 0.02]. When longest duration of continuous abstinence was compared between experimental groups, EC participants achieved twice the mean duration of continuous abstinence compared with EN participants (3.31 versus 1.68 weeks; t61 = 1.83, P = 0.07). An effect of experimental condition was also seen on mean cotinine levels (42.5 versus 210.6 ng/ml, respectively; F1,61 =5.9, P = 0.02). CONCLUSIONS Among opioid-maintained smokers receiving an initial period of daily contingent incentives, a contingent reinforcement intervention appears to be more effective at extending smoking abstinence than noncontingent reinforcement over 10 weeks.
Collapse
Affiliation(s)
- Stacey C. Sigmon
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| | - Mollie E. Miller
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychology, University of Vermont
| | - Andrew C. Meyer
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont
| | | | - Gary J. Badger
- Department of Medical Biostatistics, University of Vermont
| | - Sarah H. Heil
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont,Department of Psychiatry, University of Vermont,Department of Psychology, University of Vermont
| |
Collapse
|
17
|
Metz VE, Brandt L, Unger A, Fischer G. Substance abuse/dependence treatment: a European perspective. Subst Abus 2015; 35:309-20. [PMID: 24766667 DOI: 10.1080/08897077.2014.909377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However, not all interventions are evidence based. Patients with cannabis and cocaine/amphetamine use disorders and special patient populations especially lack evidence-based treatment recommendations. Many patients undergo treatment that has not been scientifically evaluated for quality and efficacy. Moreover, there are large disparities regarding availability and treatment access across Europe, with the new member states of the European Union (EU) reporting long waiting lists and low treatment coverage. Even in Austria, which ranks among the countries with relatively high treatment coverage and good diversification of treatment in opioid maintenance therapy due to the availability of methadone, buprenorphine, and slow-release oral morphine (SROM), a considerable population of untreated or inadequately treated patients exists. Treatment for substance use disorders in Europe still has scope for improvement in terms of treatment availability and access, which is ideally provided by further development and implementation of evidence-based interventions.
Collapse
Affiliation(s)
- Verena E Metz
- a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | | | | | | |
Collapse
|
18
|
Brandt L, Fischer G. Tobacco Cessation: A Guide for Clinicians. Eur Urol Focus 2015; 1:47-49. [DOI: 10.1016/j.euf.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 01/25/2023]
|
19
|
Thompson TP, Greaves CJ, Ayres R, Aveyard P, Warren FC, Byng R, Taylor RS, Campbell JL, Ussher M, Green C, Michie S, West R, Taylor A. An Exploratory Analysis of the Smoking and Physical Activity Outcomes From a Pilot Randomized Controlled Trial of an Exercise Assisted Reduction to Stop Smoking Intervention in Disadvantaged Groups. Nicotine Tob Res 2015; 18:289-97. [PMID: 25969453 DOI: 10.1093/ntr/ntv099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 05/04/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Economically disadvantaged smokers not intending to stop may benefit from interventions aimed at reducing their smoking. This study assessed the effects of a behavioral intervention promoting an increase in physical activity versus usual care in a pilot randomized controlled trial. METHODS Disadvantaged smokers who wanted to reduce but not quit were randomized to either a counseling intervention of up to 12 weeks to support smoking reduction and increased physical activity (n = 49) or usual care (n = 50). Data at 16 weeks were collected for various smoking and physical activity outcomes. Primary analyses consisted of an intention to treat analysis based on complete case data. Secondary analyses explored the impact of handling missing data. RESULTS Compared with controls, intervention smokers were more likely to initiate a quit attempt (36 vs. 10%; odds ratio 5.05, [95% CI: 1.10; 23.15]), and a greater proportion achieved at least 50% reduction in cigarettes smoked (63 vs. 32%; 4.21 [1.32; 13.39]). Postquit abstinence measured by exhaled carbon monoxide at 4-week follow-up showed promising differences between groups (23% vs. 6%; 4.91 [0.80; 30.24]). No benefit of intervention on physical activity was found. Secondary analyses suggested that the standard missing data assumption of "missing" being equivalent to "smoking" may be conservative resulting in a reduced intervention effect. CONCLUSIONS A smoking reduction intervention for economically disadvantaged smokers which involved personal support to increase physical activity appears to be more effective than usual care in achieving reduction and may promote cessation. The effect does not appear to be influenced by an increase in physical activity.
Collapse
Affiliation(s)
- Tom Paul Thompson
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, United Kingdom;
| | | | - Richard Ayres
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona C Warren
- University of Exeter Medical School, Exeter, United Kingdom
| | - Richard Byng
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, United Kingdom
| | - Rod S Taylor
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, United Kingdom
| | - Colin Green
- University of Exeter Medical School, Exeter, United Kingdom
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Adrian Taylor
- Centre for Clinical Trials and Population Studies, Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, United Kingdom
| |
Collapse
|
20
|
Kotz D. Implementation of a new 'opt-out' default for tobacco treatment is urgently needed, but requires free access to evidence-based treatments. Addiction 2015; 110:387-8. [PMID: 25678284 DOI: 10.1111/add.12793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Kotz
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, PO Box 616, 6200 MD, Maastricht, the Netherlands; Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK.
| |
Collapse
|
21
|
Oostveen R, van der Galiën OP, Smeets HM, Hollinga APD, Bosmans JE. Effectiveness of pharmacotherapy in behavioural therapeutic smoking cessation programmes. Eur J Public Health 2014; 25:204-9. [PMID: 25477132 DOI: 10.1093/eurpub/cku200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2011, pharmacotherapy as a part of smoking cessation treatment was reimbursed through the basic health insurance in the Netherlands. We examine the (cost)-effectiveness of pharmacotherapy added to behavioural therapy. METHODS An observational study was conducted using data from the suppliers of the smoking cessation programmes together with information on costs from health insurance company Achmea. National suppliers, general practitioners and healthcare centres offered four different programmes. (i) Behavioural support (=therapy); (ii) Behavioural support combined with nicotine replacement therapy (NRT); (iii) Behavioural support combined with smoking cessation aids (=medication) (SCA); (iv) Behavioural support combined with NRT and SCA. The primary independent variable was the programme type, and the primary outcome was whether someone quitted smoking. To examine the effectiveness of the different programmes logistic regression and logistic multilevel analyses were performed. Bootstrapping was used to evaluate cost-effectiveness. RESULTS The results indicate that behavioural support combined with SCA has more quitters than the reference programme of behavioural support alone, and it also seems the most cost-effective programme for general practitioners and healthcare centres. Behavioural therapy combined with NRT had also more quitters, although the difference with the reference programme was smaller. CONCLUSION Behavioural support combined with SCA seems the most successful programme. However, as we performed an observational study, firm conclusions about the differences in effectiveness between the programme types cannot be made. Future research should consider the type of smoker (smoking history, amount of cigarettes per day).
Collapse
Affiliation(s)
- Rosan Oostveen
- 1 Achmea, Care and Health division, knowledge and expertise centre, Zeist, The Netherlands
| | - Onno P van der Galiën
- 1 Achmea, Care and Health division, knowledge and expertise centre, Zeist, The Netherlands
| | - Hugo M Smeets
- 1 Achmea, Care and Health division, knowledge and expertise centre, Zeist, The Netherlands 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne P D Hollinga
- 1 Achmea, Care and Health division, knowledge and expertise centre, Zeist, The Netherlands
| | - Judith E Bosmans
- 3 Faculty of Earth and Life Science, VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
22
|
Kurko T, Linden K, Kolstela M, Pietilä K, Airaksinen M. Is nicotine replacement therapy overvalued in smoking cessation? Analysis of smokers' and quitters' communication in social media. Health Expect 2014; 18:2962-77. [PMID: 25292017 DOI: 10.1111/hex.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Internet discussion forums provide new, albeit less used data sources for exploring personal experiences of illness and treatment strategies. OBJECTIVE To gain an understanding of how discussion forum participants value nicotine replacement therapy (NRT) in smoking cessation (SC). SETTING Finnish national Internet-based discussion forum, STUMPPI, supporting SC and consisting of ten free discussion areas, each with a different focus. The analysis was based on STUMPPI forum participants' postings (n = 24 481) in five discussion areas during January 2007-January 2012. DESIGN Inductive content analysis of the postings concerning NRT use or comparing NRT to other SC methods. RESULTS Three major themes related to NRT in SC emerged from the discussions. These were as follows: (I) distrust and negative attitude towards NRT; (II) neutral acceptance of NRT as a useful SC method; and (III) trust on the crucial role of NRT and other SC medicines. The negative attitude was related to following perceptions: NRT use maintains tobacco dependence, fear of NRT dependence or experience of not gaining help from NRT use. NRT was perceived to be useful particularly in the initiation of SC attempts and in dealing with physiological dependence. The most highlighted factors of successful quitting were quitters' own psychological empowerment and peer support from the discussion community. CONCLUSIONS The majority of STUMPPI forum participants had low or balanced expectations towards the role of NRT in SC. More research from the smokers' and quitters' perspective is needed to assess the real value of NRT compared to other methods in SC.
Collapse
Affiliation(s)
- Terhi Kurko
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Kari Linden
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,Global Innovative Pharma, Pfizer Oy, Helsinki, Finland
| | - Maija Kolstela
- Organisation for Respiratory Health in Finland, Helsinki, Finland
| | | | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| |
Collapse
|
23
|
Panaitescu C, Moffat MA, Williams S, Pinnock H, Boros M, Oana CS, Alexiu S, Tsiligianni I. Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians. NPJ Prim Care Respir Med 2014; 24:14022. [PMID: 25010432 PMCID: PMC4373378 DOI: 10.1038/npjpcrm.2014.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). AIM To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. METHODS A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. RESULTS Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients' inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. CONCLUSIONS Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption.
Collapse
Affiliation(s)
| | - Mandy A Moffat
- Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Ioanna Tsiligianni
- Agia Barbara Health Care Centre, Crete, Greece
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
24
|
Hsueh KC, Hsueh SC, Chou MY, Pan LF, Tu MS, McEwen A, West R. Varenicline versus transdermal nicotine patch: a 3-year follow-up in a smoking cessation clinic in Taiwan. Psychopharmacology (Berl) 2014; 231:2819-23. [PMID: 24522334 DOI: 10.1007/s00213-014-3482-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE A network meta-analysis of randomized trials and real-world comparative studies strongly suggest that varenicline is more effective in aiding smoking cessation than single form nicotine replacement therapy (NRT). Modeling the health benefits attributable to this difference relies on extrapolation to lifetime cessation, but to date, follow-up has only extended to 12 months. Longer term follow-up data are helpful in checking these assumptions. OBJECTIVES This study aimed to compare the sustained abstinence rates of smokers using varenicline versus nicotine patch in their quit attempt up to 36 months. METHOD Five hundred eighty-seven smokers were recruited at Kaohsiung Veteran General Hospital between Feb 2006 and Aug 2009. Participants received counseling from a physician and received either varenicline (N=296) or the nicotine patch (N=291) for smoking cessation. Both varenicline and nicotine patch users could receive their medications for a maximum of 8 weeks. Participants were followed up by telephone at 3, 6, 12, and 36 months from the first visit. The primary outcome measure was self-reported sustained abstinence up to 36 months. Measures were also taken of smoking characteristics, cigarette dependence, and sociodemographic characteristics. RESULTS Multiple logistic regression of 36-month sustained abstinence on to medication adjusting for other baseline variables showed a significant advantage for varenicline, OR=7.94 (95 % CI 1.87-33.74). CONCLUSION An 8-week course of varenicline appears to yield higher abstinence rate up to 3 years than a similar length course of nicotine transdermal patch in routine clinical practice where behavioral support is available.
Collapse
Affiliation(s)
- Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung, 813, Taiwan,
| | | | | | | | | | | | | |
Collapse
|
25
|
Selby P, Brosky G, Oh P, Raymond V, Arteaga C, Ranger S. A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (ACCESSATION). BMC Public Health 2014; 14:433. [PMID: 24885542 PMCID: PMC4022549 DOI: 10.1186/1471-2458-14-433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/29/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many smokers find the cost of smoking cessation medications a barrier. Financial coverage for these medications increases utilization of pharmacotherapies. This study assesses whether financial coverage increases the proportion of successful quitters. METHODS A pragmatic, open-label, randomized, controlled trial was conducted in 58 Canadian sites between March 2009 and September 2010. Smokers (≥10 cigarettes/day) without insurance coverage who were motivated to quit within 14 days were randomized (1:1) in a blinded manner to receive either full coverage eligibility for 26 weeks or no coverage. Pharmacotherapies covered were varenicline, bupropion, or nicotine patches/gum. Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method(s). All subjects received brief smoking cessation counseling. The primary outcome measure was self-reported 7-day point prevalence of abstinence (PPA) at week 26. RESULTS Of the 1380 randomized subjects (coverage, 696; no coverage, 684), 682 (98.0%) and 435 (63.6%), respectively, were dispensed at least one smoking cessation medication dose. The 7-day PPA at week 26 was higher in the full coverage versus no coverage group: 20.8% (n = 145) and 13.9% (n = 95), respectively; odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.23-2.18; p = 0.001. Urine cotinine-confirmed 7-day PPA at week 26 was 15.7% (n = 109) and 10.1% (n = 69), respectively; OR = 1.68, 95% CI 1.21-2.33; p = 0.002. After pharmacotherapy, coverage eligibility was withdrawn from the full coverage group, continuous abstinence between weeks 26 and 52 was 6.6% (n = 46) and 5.6% (n = 38), in the full coverage and no coverage groups, respectively; OR = 1.19, 95% CI 0.76-1.87; p = 0.439. CONCLUSIONS In this study, the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve 26-week quit rates in Canada. The advantages were lost once coverage was discontinued. Further study is required on the duration of coverage to prevent relapse to smoking. (clinicaltrials.gov identifier: NCT00818207; the study was sponsored by Pfizer Inc.).
Collapse
Affiliation(s)
- Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Departments of Family and Community Medicine and Psychiatry and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | - Gerald Brosky
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Oh
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Canada
| | - Vincent Raymond
- Health Economics and Outcomes Research, Pfizer Canada Inc, Kirkland, Québec,Canada
| | - Carmen Arteaga
- Chantix/Champix Project Statistical Lead, Pfizer Inc, New York, NY, USA
| | | |
Collapse
|
26
|
Verbiest MEA, Chavannes NH, Crone MR, Nielen MMJ, Segaar D, Korevaar JC, Assendelft WJJ. An increase in primary care prescriptions of stop-smoking medication as a result of health insurance coverage in the Netherlands: population based study. Addiction 2013; 108:2183-92. [PMID: 23819654 DOI: 10.1111/add.12289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/07/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
AIMS To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. DESIGN Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases. SETTING The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners (GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011. PARTICIPANTS GPs, pharmacists and people in the general population aged 15 years and older. MEASUREMENTS Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions. FINDINGS No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval (CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000). CONCLUSIONS Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence.
Collapse
Affiliation(s)
- Marjolein E A Verbiest
- Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
27
|
Near AM, Blackman K, Currie LM, Levy DT. Sweden SimSmoke: the effect of tobacco control policies on smoking and snus prevalence and attributable deaths. Eur J Public Health 2013; 24:451-8. [PMID: 24287030 DOI: 10.1093/eurpub/ckt178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study examines the effect of past tobacco control policies and projects the effect of future policies on smoking and snus use prevalence and associated premature mortality in Sweden. METHODS The established SimSmoke model was adapted with population, smoking rates and tobacco control policy data from Sweden. SimSmoke evaluates the effect of taxes, smoke-free air, mass media, marketing bans, warning labels, cessation treatment and youth access policies on smoking and snus prevalence and the number of deaths attributable to smoking and snus use by gender from 2010 to 2040. RESULTS Sweden SimSmoke estimates that significant inroads to reducing smoking and snus prevalence and premature mortality can be achieved through tax increases, especially when combined with other policies. Smoking prevalence can be decreased by as much as 26% in the first few years, reaching a 37% reduction within 30 years. Without effective tobacco control policies, almost 54 500 lives will be lost in Sweden due to tobacco use by the year 2040. CONCLUSION Besides presenting the benefits of a comprehensive tobacco control strategy, the model identifies gaps in surveillance and evaluation that can help better focus tobacco control policy in Sweden.
Collapse
Affiliation(s)
- Aimee M Near
- 1 Department of Oncology, Georgetown University, Lombardi Cancer Center, Washington, DC, USA
| | | | - Laura M Currie
- 3 Division of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David T Levy
- 1 Department of Oncology, Georgetown University, Lombardi Cancer Center, Washington, DC, USA
| |
Collapse
|
28
|
Targeting cessation: understanding barriers and motivations to quitting among urban adult daily tobacco smokers. Addict Behav 2013; 38:1639-42. [PMID: 23254211 DOI: 10.1016/j.addbeh.2012.09.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/17/2012] [Accepted: 09/24/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Many people continue to smoke tobacco products despite known negative health consequences, including increased risk of chronic disease and death. Disparities exist in rates of smoking and chronic disease, underscoring the importance of understanding the barriers and motivations to smoking cessation among vulnerable populations, such as socioeconomically disadvantaged people of color. METHODS This study uses data from a cross-sectional randomized household survey conducted in six low-income neighborhoods in New Haven, Connecticut, USA (N=1205). The objectives were to examine barriers and motivations to quitting smoking among daily tobacco smokers (31.6% of respondents) and sociodemographic differences in endorsement of barriers and motivations. RESULTS The two most common barriers to quitting were perceiving it to be too difficult and not wanting to quit. Financial costs, social support, and social influence were themes endorsed highly across both barriers and motivations to quitting. Sociodemographic differences were found, such as women and Black participants being more likely to be interested in a free quitline or quit website; women and Latinos being more likely to be afraid of gaining weight; and women, participants with less education, and older participants being more likely to be concerned about the cost of cessation products. CONCLUSIONS Understanding barriers and motivations to quitting among disadvantaged populations is crucial. Financial issues, social support, and social norms should be targeted in promoting cessation among disadvantaged, urban populations. Programs, interventions, and policies can also use research about specific barriers and motivations for sociodemographic sub-groups to be tailored, targeted, and more effective.
Collapse
|
29
|
Productivity cost calculations in health economic evaluations: Correcting for compensation mechanisms and multiplier effects. Soc Sci Med 2012; 75:1981-8. [DOI: 10.1016/j.socscimed.2012.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 07/03/2012] [Accepted: 07/05/2012] [Indexed: 11/23/2022]
|
30
|
Sigmon SC, Patrick ME. The use of financial incentives in promoting smoking cessation. Prev Med 2012; 55 Suppl:S24-32. [PMID: 22525802 PMCID: PMC3411852 DOI: 10.1016/j.ypmed.2012.04.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cigarette smoking is the leading cause of preventable death in the United States and world. Despite the availability of numerous therapies for smoking cessation, additional efficacious interventions are greatly needed. We provide a narrative review of published studies evaluating financial incentives for smoking cessation and discuss the parameters important for ensuring the efficacy of incentive interventions for smoking cessation. METHODS Published studies that evaluated the impact of incentives to promote smoking cessation and included an appropriate control or comparison condition were identified and reviewed. RESULTS Incentives are efficacious for promoting smoking abstinence across the general population of smokers as well as substance abusers, adolescents, patients with pulmonary disease, patients with serious mental illness and other challenging subgroups. To develop and implement an effective incentive treatment for smoking, special attention should be paid to biochemical verification of smoking status, incentive magnitude and the schedule of incentive delivery. CONCLUSION Consistent with the extensive literature showing that incentives are effective in reducing illicit drug use, a large body of evidence supports their effectiveness in reducing smoking. Continued efforts are warranted to further develop and disseminate incentive-based treatments for smoking cessation across clinical settings and populations.
Collapse
Affiliation(s)
- Stacey C Sigmon
- Department of Psychiatry, University of Vermont, University Health Center Campus, 1 S. Prospect St, Burlington, VT 05401, USA.
| | | |
Collapse
|
31
|
Reda AA, Kotz D, Evers SMAA, van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev 2012:CD004305. [PMID: 22696341 DOI: 10.1002/14651858.cd004305.pub4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We hypothesized that provision of financial assistance for smokers trying to quit, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. OBJECTIVES The primary objective of this review was to assess the impact of reducing the costs of providing or using smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use and/or prescription of smoking cessation treatment and on the number of smokers making a quit attempt. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2012. SELECTION CRITERIA We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or their healthcare providers or both. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed the quality of the included studies. Risk ratios (RR) were calculated for individual studies on an intention-to-treat basis and meta-analysis was performed using a random-effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives. MAIN RESULTS We found eleven trials involving financial interventions directed at smokers and healthcare providers.Full financial interventions directed at smokers had a statistically significant favourable effect on abstinence at six months or greater when compared to no intervention (RR 2.45, 95% CI 1.17 to 5.12, I² = 59%, 4 studies). There was also a significant effect of full financial interventions when compared to no interventions on the number of participants making a quit attempt (RR 1.11, 95% CI 1.04 to 1.32, I² = 15%) and use of smoking cessation treatment (NRT: RR 1.83, 95% CI 1.55 to 2.15, I² = 43%; bupropion: RR 3.22, 95% CI 1.41 to 7.34, I² = 71%; behavioural therapy: RR 1.77, 95% CI 1.19 to 2.65). There was no evidence of an effect on smoking cessation when we pooled two trials of financial incentives directed at healthcare providers (RR 1.16, CI 0.98 to 1.37, I² = 0%). Comparisons of full coverage with partial coverage, partial coverage with no coverage, and partial coverage with another partial coverage intervention did not detect significant effects. Comparison of full coverage with partial or no coverage resulted in costs per additional quitter ranging from $119 to $6450. AUTHORS' CONCLUSIONS Full financial interventions directed at smokers when compared to no financial interventions increase the proportion of smokers who attempt to quit, use smoking cessation treatments, and succeed in quitting. The absolute differences are small but the costs per additional quitter are low to moderate. We did not detect an effect on smoking cessation from financial incentives directed at healthcare providers. The methodological qualities of the included studies need to be taken into consideration when interpreting the results.
Collapse
Affiliation(s)
- Ayalu A Reda
- Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center,Maastricht, Netherlands
| | | | | | | |
Collapse
|
32
|
Willems RA, Willemsen MC, Nagelhout GE, de Vries H. Understanding smokers' motivations to use evidence-based smoking cessation aids. Nicotine Tob Res 2012; 15:167-76. [PMID: 22573725 DOI: 10.1093/ntr/nts104] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Use of evidence-based smoking cessation aids (SCA) is an efficacious way to improve smoking cessation relapse rates. However, use of SCA in the Netherlands is particularly low. This study examined determinants of intention to use SCA in smokers willing to quit. METHODS The Dutch Continuous Survey of Smoking Habits, a cross-sectional population survey, was used. Respondents were smokers (n = 594) wanting to quit sometime in the future and who made at least one quit attempt in the past, categorized as past users of evidence-based SCA, past users of nonevidence-based SCA, and smokers who had never used SCA before (nonusers). Respondents were asked about past SCA use, motivational determinants regarding smoking cessation and SCA use, and intention to use SCA during a future quit attempt. RESULTS Older and more addicted smokers were more likely to have used evidence-based SCA. Evidence-based and nonevidence-based users reported stronger attitudes and perceived social norm as well as lower self-efficacy expectations regarding smoking cessation and SCA use than nonusers. Having positive outcome expectations and perceived social norm regarding SCA use were strong predictors of intention to use SCA. Self-efficacy regarding smoking cessation was negatively related with intention to use SCA. CONCLUSIONS Nonusers, nonevidence-based users, and evidence-based users have different motivations for using evidence-based SCA and should not be treated as a homogenous group in smoking cessation programs. Additionally, it is unclear whether nonusers should be encouraged to use SCA, given that this group is less addicted and more confident about quitting.
Collapse
Affiliation(s)
- Roy A Willems
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
33
|
Xenakis JG, Kinter ET, Ishak KJ, Ward AJ, Marton JP, Willke RJ, Davies S, Caro JJ. A discrete-event simulation of smoking-cessation strategies based on varenicline pivotal trial data. PHARMACOECONOMICS 2011; 29:497-510. [PMID: 21452908 DOI: 10.2165/11589230-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Smoking is the leading cause of preventable death in the US. While one in five individuals smoke, and 70% of these indicate a desire to quit, <5% of unaided quit attempts succeed. Cessation aids can double or triple the odds of successfully quitting. Models of smoking-cessation behaviour can elucidate the implications of individual abstinence patterns to allow better tailoring of quit attempts to an individual's characteristics. OBJECTIVE The objectives of this study were to develop and validate a discrete-event simulation (DES) to evaluate the benefits of smoking abstinence using data from the pooled pivotal clinical trials of varenicline versus bupropion or placebo for smoking cessation and to provide a foundation for the development of a lifetime smoking-cessation model. METHODS The DES model simulated the outcome of a single smoking-cessation attempt over 1 year, in accordance with the clinical trial timeframes. Pharmaceutical costs were assessed from the perspective of a healthcare payer. The model randomly sampled patient profiles from the pooled varenicline clinical trials. All patients were physically and mentally healthy adult smokers who were motivated to quit abruptly. The model allowed for comparisons of up to five distinct treatment approaches for smoking cessation. In the current analyses, three interventions corresponding to the clinical trials were evaluated, which included brief counselling plus varenicline 1.0 mg twice daily (bid) or bupropion SR 150 mg bid versus placebo (i.e. brief counselling only). The treatment periods in the clinical trials were 12 weeks (target quit date: day 8), with a 40-week non-treatment follow-up, and counselling continuing over the entire 52-week period in all treatment groups. The main outcome modelled was the continuous abstinence rate (CAR; defined as complete abstinence from smoking and confirmed by exhaled carbon monoxide ≤ 10 ppm) at end of treatment (weeks 9-12) and long-term follow-up (weeks 9-52), and total time abstinent from smoking over the course of 52 weeks. The model also evaluated costs and cost-effectiveness outcomes. RESULTS For the varenicline, bupropion and placebo cohorts, respectively, the model predicted CARs for weeks 9-12 of 44.3%, 30.4% and 18.6% compared with observed rates of 44.0%, 29.7% and 17.7%; over weeks 9-52, predicted CARs in the model compared with observed rates in the pooled clinical studies were 22.9%, 16.4% and 9.4% versus 22.4%, 15.4% and 9.3%, respectively. Total mean abstinence times accrued in the model varenicline, bupropion and placebo groups, respectively, were 3.6, 2.6 and 1.5 months and total pharmaceutical treatment costs were $US261, $US442 and $US0 (year 2008 values) over the 1-year model period. Using cost per abstinent-month achieved as a measure of cost effectiveness, varenicline dominated bupropion and yielded an incremental cost-effectiveness ratio of $US124 compared with placebo. CONCLUSION The model accurately replicated abstinence patterns observed in the clinical trial data using individualized predictions and indicated that varenicline was more effective and may be less costly than bupropion. This simulation incorporated individual predictions of abstinence and relapse, and provides a framework for lifetime modelling that considers multiple quit attempts over time in diverse patient populations using a variety of quit attempt strategies.
Collapse
|
34
|
DeSantis SM, Bandyopadhyay D. Hidden Markov models for zero-inflated Poisson counts with an application to substance use. Stat Med 2011; 30:1678-94. [PMID: 21538455 DOI: 10.1002/sim.4207] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 01/03/2011] [Indexed: 11/10/2022]
Abstract
Paradigms for substance abuse cue-reactivity research involve pharmacological or stressful stimulation designed to elicit stress and craving responses in cocaine-dependent subjects. It is unclear as to whether stress induced from participation in such studies increases drug-seeking behavior. We propose a 2-state Hidden Markov model to model the number of cocaine abuses per week before and after participation in a stress-and cue-reactivity study. The hypothesized latent state corresponds to 'high' or 'low' use. To account for a preponderance of zeros, we assume a zero-inflated Poisson model for the count data. Transition probabilities depend on the prior week's state, fixed demographic variables, and time-varying covariates. We adopt a Bayesian approach to model fitting, and use the conditional predictive ordinate statistic to demonstrate that the zero-inflated Poisson hidden Markov model outperforms other models for longitudinal count data.
Collapse
Affiliation(s)
- Stacia M DeSantis
- Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA.
| | | |
Collapse
|
35
|
Abstract
Promoting smoking cessation is among the key medical interventions aimed at reducing worldwide morbidity and mortality in this century. Both behavioural counselling and pharmacotherapy have been shown to significantly increase long-term abstinence rates, and combining the two treatment modalities is recommended. This article provides an update on pharmacotherapy for smoking cessation in the general population. Current first-line agents used to support quit attempts are nicotine replacement therapy (NRT), bupropion and varenicline. Research suggests that abstinence rates can be increased by combining different forms of NRT or simultaneously administering NRT and non-nicotine medications. New treatments targeting the nicotinic acetylcholine receptor as well as other pathophysiological pathways involved in nicotine addiction are being developed, with nicotine vaccines now being tested in phase III clinical trials. Among the numerous research topics currently addressed, pharmacogenetics and tailoring therapy to specific groups of smokers look most promising. However, substantial progress is unlikely to be made unless social gradients impeding effective treatment of all smokers are overcome. In addition, public smoking bans and reimbursement of medication costs are crucial in reducing the future burden of disease caused by smoking on a global level.
Collapse
Affiliation(s)
- Tobias Raupach
- Department of Cardiology and Pneumology, University Hospital Gttingen, Gttingen, Germany.
| | | |
Collapse
|
36
|
Wasserfallen JB, Digon P, Cornuz J. Medical and pharmacological direct costs of a 9-week smoking cessation programme. Eur J Prev Cardiol 2011; 19:565-70. [DOI: 10.1177/1741826711406059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Medical and pharmacological direct costs of cigarette smoking cessation programmes are not covered by health insurance in several countries despite documented cost-effectiveness. Design: prospective cost identification study of a 9-week programme in Switzerland. Methods: A total of 481 smokers were followed-up for 9 weeks. Socio-demographic characteristics, number of outpatient visits, dosage and frequency of use of nicotine replacement therapy (NRT) as well as date of relapse were prospectively collected. Individual cost of care until relapse or programme end as well as cost per week of follow-up were computed. Comparisons were carried out between the groups with or without relapse at the end of the programme. Results: Of the 209 men and 272 women included, 347 patients (72%) finished the programme. Among them, 240 patients (70%) succeeded in quitting and 107 patients (30%) relapsed. As compared with the group relapsing by the end of the programme, the group succeeding in quitting was more often living in a couple (68% vs. 55%, p = 0.029). Their mean weekly costs of visits were higher (CHF 81.2 ± 6.1 vs. 78.4 ± 7.6, p = 0.001), while their mean weekly costs for NRT were similar (CHF 24.2 ± 12.6 vs. 25.4 ± 15.9, p = 0.711). Mean total costs per week were similar (CHF 105.4 ± 15.4 vs. 103.8 ± 19.4, p = 0.252). More intensive NRT at week 4 increased the probability not to relapse at the end of the programme. Conclusions: Over 9 weeks, medical and pharmacological costs of stopping smoking are low. Good medical and social support as well as adequate NRT seem to play a role in successful quitting.
Collapse
Affiliation(s)
- Jean-Blaise Wasserfallen
- Health Technology Assessment Unit, Medical Direction, University Hospital of Lausanne, Switzerland
- Institute of Health Economics and Management, University of Lausanne, Switzerland
| | - Patricia Digon
- Institute of Health Economics and Management, University of Lausanne, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| |
Collapse
|
37
|
Papadakis S, Aitken D, Gocan S, Riley D, Laplante MA, Bhatnagar-Bost A, Cousineau D, Simpson D, Edjoc R, Pipe AL, Sharma M, Reid RD. A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients. BMJ Open 2011; 1:e000366. [PMID: 22123923 PMCID: PMC3225588 DOI: 10.1136/bmjopen-2011-000366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population. Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic. Trial design Cluster randomised controlled trial. Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation. Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20). Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial. Trial registration number http://ClinicalTrials.gov # UOHI2010-1.
Collapse
Affiliation(s)
- Sophia Papadakis
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Debbie Aitken
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sophia Gocan
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dana Riley
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mary Ann Laplante
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Abha Bhatnagar-Bost
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Donna Cousineau
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Danielle Simpson
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Rojiemiahd Edjoc
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mukul Sharma
- Champlain Regional Stroke Network, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert D Reid
- Minto Prevention and Rehabilitation Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
38
|
Liu F. Quit attempts and intention to quit cigarette smoking among Medicaid recipients in the USA. Public Health 2010; 124:553-8. [DOI: 10.1016/j.puhe.2010.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 04/30/2010] [Accepted: 05/26/2010] [Indexed: 11/25/2022]
|
39
|
Vemer P, Rutten-van Mölken MPMH, Kaper J, Hoogenveen RT, van Schayck CP, Feenstra TL. If you try to stop smoking, should we pay for it? The cost-utility of reimbursing smoking cessation support in the Netherlands. Addiction 2010; 105:1088-97. [PMID: 20659063 DOI: 10.1111/j.1360-0443.2010.02901.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost-utility is lacking. OBJECTIVES To evaluate long-term effects of reimbursement of SCS. METHODS Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial's confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses. RESULTS Intervention costs per QALY gained compared to the reference scenario were approximately euro1200 extrapolating the trial effects directly, and euro4200 when combining the trial's use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost-utility of euro4500 and euro7400, respectively. In both scenarios costs per QALY remained below euro16 000 in sensitivity analyses using a life-time horizon. CONCLUSIONS Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective.
Collapse
Affiliation(s)
- Pepijn Vemer
- Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
40
|
Louhelainen N, Stark H, Mazur W, Rytilä P, Djukanovic R, Kinnula VL. Elevation of sputum matrix metalloproteinase-9 persists up to 6 months after smoking cessation: a research study. BMC Pulm Med 2010; 10:13. [PMID: 20226090 PMCID: PMC2841651 DOI: 10.1186/1471-2466-10-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 03/14/2010] [Indexed: 12/21/2022] Open
Abstract
Background Smoking cessation is the best possible way to prevent the progression of smoking related airway diseases. However, the effect and time scale of smoking cessation on airway inflammation/remodelling are largely unknown. This prospective study evaluated the effects of smoking cessation on induced sputum (IS) neutrophils, matrix metalloproteinases (MMP-7, -8, -9) and tissue inhibitor of metalloproteinase-1 (TIMP-1). Methods A total of 61 subjects participated in the study; 17 stopped smoking for 3 months and 9 for 6 months. The proportion of IS neutrophils and the levels of MMPs and TIMP-1 by ELISA were determined at baseline and at 3 and 6 months after cessation. Results In the smokers, baseline IS neutrophils, MMPs and TIMP-1 were significantly higher compared to non-smokers. Levels of MMP-7, -8 and TIMP-1 decreased nearly to those of non-smokers but the levels of MMP-9 increased significantly from the baseline of the same subjects at 3 months after cessation (p = 0.009) with no significant decline at 6 months after cessation. Conclusions Sputum MMP-9 remained elevated after 6 months of smoking cessation, which may contribute to ongoing lung damage typical of COPD.
Collapse
Affiliation(s)
- Noora Louhelainen
- Department of Medicine, Division of Pulmonary Medicine, University of Helsinki, Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
41
|
Abrams DB, Graham AL, Levy DT, Mabry PL, Orleans CT. Boosting population quits through evidence-based cessation treatment and policy. Am J Prev Med 2010; 38:S351-63. [PMID: 20176308 PMCID: PMC4515751 DOI: 10.1016/j.amepre.2009.12.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/28/2009] [Accepted: 12/03/2009] [Indexed: 11/19/2022]
Abstract
Only large increases in adult cessation will rapidly reduce population smoking prevalence. Evidence-based smoking-cessation treatments and treatment policies exist but are underutilized. More needs to be done to coordinate the widespread, efficient dissemination and implementation of effective treatments and policies. This paper is the first in a series of three to demonstrate the impact of an integrated, comprehensive systems approach to cessation treatment and policy. This paper provides an analytic framework and selected literature review that guide the two subsequent computer simulation modeling papers to show how critical leverage points may have an impact on reductions in smoking prevalence. Evidence is reviewed from the U.S. Public Health Service 2008 clinical practice guideline and other sources regarding the impact of five cessation treatment policies on quit attempts, use of evidence-based treatment, and quit rates. Cessation treatment policies would: (1) expand cessation treatment coverage and provider reimbursement; (2) mandate adequate funding for the use and promotion of evidence-based state-sponsored telephone quitlines; (3) support healthcare systems changes to prompt, guide, and incentivize tobacco treatment; (4) support and promote evidence-based treatment via the Internet; and (5) improve individually tailored, stepped-care approaches and the long-term effectiveness of evidence-based treatments. This series of papers provides an analytic framework to inform heuristic simulation models in order to take a new look at ways to markedly increase population smoking cessation by implementing a defined set of treatments and treatment-related policies with the potential to improve motivation to quit, evidence-based treatment use, and long-term effectiveness.
Collapse
Affiliation(s)
- David B Abrams
- Steven A. Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington DC, USA.
| | | | | | | | | |
Collapse
|
42
|
Seidman DF, Westmaas JL, Goldband S, Rabius V, Katkin ES, Pike KJ, Wiatrek D, Sloan RP. Randomized controlled trial of an interactive internet smoking cessation program with long-term follow-up. Ann Behav Med 2010; 39:48-60. [PMID: 20177844 DOI: 10.1007/s12160-010-9167-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Internet programs for smoking cessation are widely available but few controlled studies demonstrate long-term efficacy. PURPOSE To determine the 13-month effectiveness of an Internet program presenting a set sequence of interactive steps, and the role of depressed affect. METHODS In a randomized controlled trial sponsored by the American Cancer Society, a treatment condition (n = 1,106) was compared to a control site (n = 1,047). RESULTS More treatment condition participants were abstinent (30-day point prevalence) than control site participants (12.9% vs. 10.1%, p < .05) at 13 months. This effect was greater among participants not reporting depressed affect (15.0% vs. 10.1%, p < .01). Among smokers who reported depressed affect, there was no difference in abstinence between the treatment and control conditions. CONCLUSIONS Data support the long-term efficacy of an Internet intervention for cessation modeled on a structured, in-person treatment approach, especially for participants not experiencing daily depressed affect.
Collapse
|
43
|
Hagimoto A, Nakamura M, Morita T, Masui S, Oshima A. Smoking cessation patterns and predictors of quitting smoking among the Japanese general population: a 1-year follow-up study. Addiction 2010; 105:164-73. [PMID: 19919598 DOI: 10.1111/j.1360-0443.2009.02735.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation. DESIGN AND SETTING This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later. PARTICIPANTS The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later. FINDINGS Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting. CONCLUSIONS Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.
Collapse
Affiliation(s)
- Akiko Hagimoto
- Senri Kinran University School of Nursing, Suita, Osaka, Japan.
| | | | | | | | | |
Collapse
|
44
|
Effect of Medicaid coverage of tobacco-dependence treatments on smoking cessation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:3143-55. [PMID: 20049252 PMCID: PMC2800340 DOI: 10.3390/ijerph6123143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 12/04/2009] [Indexed: 11/16/2022]
Abstract
Smoking cessation aids (nicotine replacement products and anti-depressant medication) have been proven to double quitting rates compared to placebo in several randomized controlled trials. But the high initial cost of cessation aids might create a financial barrier to cessation for low-income smokers. In the U.S., Medicaid provides health insurance coverage to low-income people, and in some states covers smoking cessation products. This paper uses nationally representative data of the U.S. to examine how the Medicaid coverage of cessation aids affect smoking behavior. The results indicate the Medicaid coverage of cessation products is positively associated with successful quitting among women aged 18-44.
Collapse
|
45
|
Hanioka T, Ojima M, Tanaka H, Naito M, Hamajima N, Matsuse R. Intensive Smoking-cessation Intervention in the Dental Setting. J Dent Res 2009; 89:66-70. [DOI: 10.1177/0022034509350867] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Smoking exerts detrimental effects on dental treatment and oral health. Our goal was to evaluate effectiveness in terms of the abstinence rate in smoking-cessation intervention delivered by dental professionals. Individuals who were willing to quit smoking were randomly assigned to either an intervention or a non-intervention group. Intensive intervention was provided, consisting of 5 counseling sessions, including an additional nicotine replacement regimen. Reported abstinence was verified by the salivary cotinine level. Thirty-three persons in the intervention and 23 in the non-intervention group started the trial. On an intent-to-treat basis, 3-, 6- and 12-month continuous abstinence rates in the intervention group were 51.5%, 39.4%, and 36.4%, respectively, while the rates in the non-intervention group were consistent at 13.0%. Adjusted odds ratios (95% confidence interval) by logistic stepwise regression analyses were 7.1 (1.8, 28.5), 8.9 (1.7, 47.2), and 6.4 (1.3, 30.7), respectively. Intensive smoking-cessation intervention in the dental setting was therefore effective.
Collapse
Affiliation(s)
- T. Hanioka
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| | - M. Ojima
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| | - H. Tanaka
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| | - M. Naito
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| | - N. Hamajima
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| | - R. Matsuse
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2–15–1 Tamura, Sawara-ku, Fukuoka 814–0193, Japan
- Department of Preventive Dentistry, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
- Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and
- Department of Research and Development, Kyoto Medical Science Laboratory, Inc., Kyoto, Japan
| |
Collapse
|
46
|
Chang FC, Hu TW, Lo SY, Yu PT, Chao KY, Hsiao ML. Quit smoking advice from health professionals in Taiwan: the role of funding policy and smoker socioeconomic status. Tob Control 2009; 19:44-9. [PMID: 19965797 PMCID: PMC2921261 DOI: 10.1136/tc.2009.031435] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counselling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007). Methods We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined. Results The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice. Conclusions During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups.
Collapse
|
47
|
DeSantis SM, Bandyopadhyay D, Back SE, Brady KT. Non-treatment laboratory stress- and cue-reactivity studies are associated with decreased substance use among drug-dependent individuals. Drug Alcohol Depend 2009; 105:227-33. [PMID: 19717245 PMCID: PMC2875261 DOI: 10.1016/j.drugalcdep.2009.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 07/13/2009] [Accepted: 07/14/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Human laboratory paradigms for examining stress- or cue-reactivity in substance-dependent individuals often involve exposure to pharmacological, psychosocial or physical laboratory procedures or drug paraphernalia. This study examines whether participation in such studies alters drug-seeking behavior and which patient attributes contribute to increased use. METHODS In two separate studies, the relationship between participation and drug use post-study were examined. Cocaine-dependent participants received 1 microg/kg of corticotropin releasing hormone intravenously, underwent the Trier Social Stress Task, and were exposed to drug cues and various measures obtained. Cocaine use for 90 days prior and 28 days following the study was assessed. Methamphetamine-dependent participants were exposed to drug cues and various measures obtained. Methamphetamine use for 90 days prior and 14 days following the study was assessed. Weekly drug use was modeled using a 2-state hidden Markov model assuming two possible underlying states at each week. Bayesian estimation was used. Results are presented as posterior mean odds ratios (OR) and 95% credible intervals (CI). RESULTS Participation decreased the odds of remaining in or transitioning to the high use state (cocaine study OR=0.04 [CI=0.01, 0.11]; methamphetamine study OR=0.39 [CI=0.07, 1.70]). In the cocaine study, older age increased the odds of remaining in or transitioning into the high use state (1.66 [CI=0.99, 2.96]). In the methamphetamine study, male gender increased the odds (2.70 [CI=1.10, 6.17]). CONCLUSION Stress and cue exposure paradigms were associated with a decreased odds of drug use following participation.
Collapse
Affiliation(s)
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, Bioinformatics, and Epidemiology, 135 Cannon Street Suite 303, Charleston, SC 29425 USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, 67 President Street, Charleston, SC 29425 USA
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Clinical Neuroscience Division, 67 President Street, Charleston, SC 29425 USA
| |
Collapse
|
48
|
Reda AA, Kaper J, Fikrelter H, Severens JL, van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database Syst Rev 2009:CD004305. [PMID: 19370599 DOI: 10.1002/14651858.cd004305.pub3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND We hypothesized that provision of financial assistance for smokers trying to quit, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. OBJECTIVES The primary objective of this review was to assess the impact of reducing the costs of providing or using smoking cessation treatment by health care financing interventions on abstinence from smoking and utilization of smoking cessation treatment. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction group specialized register; the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2008; MEDLINE (from January 1966 to August 2008) and EMBASE (from January 1980 to August 2008) to identify trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) and controlled trials involving financial benefit interventions to smokers or their health care providers or both. DATA COLLECTION AND ANALYSIS Three reviewers independently extracted data and assessed the quality of the included studies. Rate ratios (RR) were calculated for individual studies on an intention-to-treat basis and meta-analysis was performed using a random effects model. We included economic evaluations when a study presented the costs and effects of two or more alternatives. MAIN RESULTS We found nine trials involving financial interventions directed at smokers and two studies directed at health care providers.There was a statistically significant favourable effect of full financial interventions directed at smokers on continuous abstinence compared to no interventions with a risk ratio (RR) of 4.38 (95% CI 1.94 to 9.87). There was also a significant effect of full financial interventions when compared to no interventions on the number of participants making a quit attempt (RR 1.19; 95% CI 1.07 to 1.32; N = 3). There was a significant effect of financial interventions directed at health care providers in increasing the utilization of behavioural interventions for smoking cessation (RR 1.33; 95% CI 1.01 to 1.77). Comparison of full benefit with partial or no benefit resulted in costs per additional quitter ranging from $260 to $1453. AUTHORS' CONCLUSIONS Full financial interventions directed at smokers when compared to no financial interventions could increase the proportion quitting, quit attempts and utilization of pharmacotherapy by smokers. Although the absolute differences were small the costs per additional quitter were low. The methodological qualities of the included studies need to be taken into consideration in interpreting the conclusions.
Collapse
Affiliation(s)
- Ayalu A Reda
- Care and Public Health Research Institute (CAPHRI), Maastricht University, P. Debyeplein 1, P.O. Box 616, Maastricht, Netherlands, 6200 MD
| | | | | | | | | |
Collapse
|
49
|
Dempsey JP, Back SE, Waldrop AE, Jenkins L, Brady KT. The influence of monetary compensation on relapse among addicted participants: empirical vs. anecdotal evidence. Am J Addict 2008; 17:488-90. [PMID: 19034740 PMCID: PMC2677021 DOI: 10.1080/10550490802408423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Although common, the use of cash incentives to compensate drug-addicted participants is controversial. This is particularly true given concerns that cash incentives might precipitate relapse, as is commonly believed. The following investigation examined whether cash versus money order compensation differentially influenced drug use among 34 non-treatment-seeking, cocaine-dependent individuals. Consistent with past evidence, results did not suggest that form of compensation was associated with likelihood of continued cocaine use or dollar amount of cocaine consumed after participation. Findings do not support commonly held concerns that cash incentives increase the risk of relapse following research participation.
Collapse
Affiliation(s)
- Jared P Dempsey
- Department of Psychiatry and Behavioral Sciences, Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | | | | |
Collapse
|
50
|
Jackson M, Gaspic-Piskovic M, Cimino S. Description of a Canadian employer-sponsored smoking cessation program utilizing community pharmacy–based cognitive services. Can Pharm J (Ott) 2008. [DOI: 10.3821/1913-701x(2008)141[234:doaces]2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|