Foucault, surveillance, and carbon monoxide testing within stop-smoking services

Systematic review and meta-analysis of short-term and long-term smoking abstinence rates of intensive perioperative smoking cessation programs vs brief interventions for smoking cessation

BACKGROUND

The perioperative period is an important "teachable moment" where smoking interventions may be particularly effective. We aim to explore the effectiveness of intensive perioperative smoking cessation programs not just on short term, but long term smoking abstinence as well.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials published between 1 Jan 2007 and 15 May 2022. The studies include perioperative smoking cessation programs that were conducted either in the preoperative surgical clinic or anaesthesia clinic settings. Some programs included follow-up sessions in the postoperative phase. The primary outcomes were short-term and long-term smoking abstinence rates for patients who participated in intensive perioperative smoking cessation programs. Subgroup analyses were also conducted to compare the effects between patients undergoing surgery for smoking-induced and non-smoking induced illnesses.

RESULTS

In total, thirteen trials with a total of 2597 smokers undergoing elective surgery were included in the analysis. The pooled results show that patients who participated in intensive perioperative smoking cessation programs had a higher chance of abstinence in both short term (OR: 2.41, 95% CI [1.95 to 2.98], p < 0.001) and long term (OR: 1.64, CI [1.23 to 2.2], p < 0.001) periods postoperatively. This effect was seen regardless of whether patients underwent surgery for smoking-induced or non-smoking induced illnesses.

CONCLUSIONS

Intensive peri-operative smoking interventions are more effective than brief interventions in achieving both short and long term abstinence. Hospitals should consider integrating structured intensive smoking interventions into perioperative care. Further studies examining the optimal timing and duration of such programs will be useful.

Novel Application of Exhaled Carbon Monoxide Monitors: Smoking Cessation in Orthopaedic Trauma Patients

OBJECTIVES

To determine whether an in-office exhaled carbon monoxide (CO) monitor can increase interest in smoking cessation among the orthopaedic trauma population.

DESIGN

Prospective.

SETTING

Level I trauma center.

PATIENTS

One hundred twenty-four orthopaedic trauma patients.

INTERVENTION

In-office measurement of exhaled CO.

MAIN OUTCOME MEASURES

Stage of change, Likert scale score on willingness to quit today, patient's request for referral to a quitline, and increase in readiness to quit.

RESULTS

The use of an exhaled CO monitor increased willingness to quit in 71% of participants still smoking and increased willingness to quit on average by 0.8 points on a 10-point Likert scale (P < 0.001). Fifteen percent of patients modified their stage of change toward quitting. Forty percent of patients after exhaled CO monitor requested referral to a quitline, compared with 4% presurvey (P < 0.001). Anecdotally, most participants were very interested in the monitoring device and its reading, expressing concern with the result. The value of exhaled CO was not associated with any measured outcomes.

CONCLUSIONS

The use of an exhaled CO monitor increased willingness to quit smoking in 71% of patients, but the effect size was relatively small (0.8 points on a 10-point Likert scale). However, use of the CO monitor resulted in a large increase (40% vs. 4%) in referral to the national Quitline. Use of the Quitline typically increases the chance of smoking cessation by 10 times the baseline rate, suggesting that this finding might be clinically important.

LEVEL OF EVIDENCE

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Boosting efficacy of nurse-led stop smoking interventions with a quit and win contest: pilot study results

BACKGROUND

Grave disparities in smoking prevalence exist between indigenous Māori, Pacific Island peoples, and other New Zealanders. Primary care nurses routinely provide brief stop smoking interventions to achieve national targets but they are constrained by time. Innovations using new technologies offer opportunities to enhance brief interventions and improve uptake and outcomes. Objectives/Aims/Hypotheses: This study explored the feasibility of adding a novel scratch card and internet-based, quit and win contest with mobile phone support messages, to practice nurses' brief smoking cessation interventions.

DESIGN

Pragmatic exploratory mixed methods pilot study comprising a quantitative two-group comparison and qualitative interviews.

METHODS

In two intervention clinics, practice nurses added supportive mobile phone messages, novelty scratch cards to win online prizes and $1000 prize draw entry following 1 month smokefree, to routine brief stop smoking interventions. In three control clinics, patients who smoked received brief stop smoking interventions only. Practice nurses collected baseline and 1-month data describing patients' smoking status, quit attempts, and cessation support. Researchers conducted qualitative interviews with two nurses and ten patients and collected 3-month data.

RESULTS

Five primary care clinics recruited 67 smokers (37 intervention; 30 control). The contest was readily incorporated into nurses' practice. It appealed to nurses and Māori and Pacific Island patients, increased time to first cigarette, and attracted first time quitters. However, it had no extra effect on smoking cessation compared with usual care. Pacific Island patients' participation in the online elements was limited by low access to the internet.

CONCLUSIONS

While the exploratory study did not indicate the potential for triggering mass quitting, reduced dependency was suggested. The intervention attracted Māori and Pacific Island smokers and engaged first time quitters. Low cost, novelty activities could be used to refresh routine brief stop smoking interventions, and to motivate practice nurses to engage more smokers in quitting.

Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review

Introduction

Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities.

Aims

To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking.

Methods

We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations.

Results

We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences.

Conclusions

Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men.

Implications

This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.

Smokers' Views on Personal Carbon Monoxide Monitors, Associated Apps, and Their Use: An Interview and Think-Aloud Study

Smartphone-based personal carbon monoxide (CO) monitors and associated apps, or "CO Smartphone Systems" (CSSs) for short, could enable smokers to independently monitor their smoking and quitting. This study explored views and preferences regarding CSSs and their use among 16 adult, UK-based smokers. First, semi-structured interviews explored participants' expectations of CSSs. Secondly, a think-aloud study identified participants' reactions to a personal CO monitor and to existing or prototype apps. Framework Analysis identified five themes: (1) General views, needs, and motivation to use CSSs; (2) Views on the personal CO monitor; (3) Practicalities of CSS use; (4) Desired features in associated apps; and (5) Factors affecting preferences for CSSs and their use. Participants had high expectations of CSSs and their potential to increase motivation. Priority app features included: easy CO testing journeys, relevant and motivating feedback, and recording of contextual data. Appearance and usability of the personal CO monitor, and accuracy and relevance of CO testing were considered important for engagement. Participants differed in their motivation to use and preferences for CSSs features and use, which might have non-trivial impact on evaluation efforts. Personal CO monitors and associated apps may be attractive tools for smokers, but making CSSs easy to use and evaluating these among different groups of smokers may be challenging.

Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings

Carbon monoxide (CO) testing is considered an easy, noninvasive, and objective contribution to the assessment of smoking behavior, as CO is rapidly absorbed into the bloodstream when lit cigarettes or cigars are inhaled. CO testing is a medically important billable outpatient service that can contribute to sustainability of face to face tobacco use treatment services by clinicians. This article reviews research on the clinical use of CO testing to provide biomedical feedback in assessing smoking behavior, educating smokers on tobacco health effects, assisting with treatment planning, and as a motivational tool to encourage people to become tobacco free. Further research can focus on how to best incorporate CO testing into clinical practice, including more research on outcomes and methods to ensure that insurers reimburse for testing and improved ways to use CO testing to initiate attempts to quit tobacco use, to maintain cessation, and to prevent relapse.