Weight gain and smoking: perceptions and experiences of obese quitline participants

Health and Wellness Coaching Can Improve Tobacco Quit Rates and Weight Management Efforts in an Employee Population

PurposeThis study aims to investigate gender differences in tobacco quit rates and weight gain among employees undergoing a cessation program with a health and wellness coach.DesignThis project was a retrospective observational study of an employee population.SettingAll data were collected during health coaching sessions by nationally certified health coaches.Subjects211 men and women (116 males, 95 females, age 51.3 ± 9.9 years) enrolled in a Tobacco cessation health coaching program (TCHC) between January 2020 and December 2021.MeasuresData were compared between genders for quit rate, weight, body mass index (BMI), and nicotine replacement therapy (NRT) usage across 12-month follow-ups.AnalysisDescriptive statistics, repeated measures ANOVA, and independent samples t-test.ResultsSignificantly more men than women successfully quit by the goal date set with their coach (P < 0.05). There was a significant reduction in tobacco use across 12 months, leading to the participant's quit date (P < 0.001). Women (Weight lost ± SD= 1.49 lbs. ±16.06 lbs.) lost significantly more weight than men (0.7 lbs. ± 8.5 lbs.; P < 0.001). NRT users lost significantly more weight than non-users (P = .007).ConclusionHealth and wellness coaching was effective for participants to successfully stop tobacco use while in this program by their quit date. The coaching program also elicited weight loss while achieving smoking cessation for both men and women.

Multicomponent Workplace Tobacco Cessation Interventions: A Scoping Review

INTRODUCTION

Tobacco is the leading modifiable risk factor for cancer and other chronic diseases. The workplace provides an opportunity to advance tobacco cessation efforts. Combining tobacco cessation with complementary components addressing mental health, physical activity, and healthy eating has demonstrated effectiveness in non-workplace settings. This scoping review examines the literature on multicomponent workplace tobacco cessation interventions to identify core components and implementation facilitators and barriers to support uptake in the workplace setting.

METHODS

A scoping review was conducted following PRISMA guidelines for Scoping Reviews and Arksey and O'Malley's five-step process. Peer-reviewed literature published in the past 20 years was searched across 9 databases. A search for relevant gray literature (i.e., conference papers/proceedings) was also completed. Articles were screened by two independent researchers for inclusion. Included studies evaluated workplace interventions recruiting individuals to participate in a tobacco cessation program alongside a complementary component (i.e., physical activity, mental health, healthy eating).

RESULTS

Most of the 12 included studies paired tobacco cessation with mental health or stress reduction interventions. Most complementary components targeted the individual versus organizational or policy levels. The synthesized facilitators indicated that multicomponent interventions should be incentivized and tailored to adequately meet the needs of different workplaces and employees.

DISCUSSION

This scoping review synthesizes studies integrating multiple complementary program components into workplace tobacco cessation efforts. Future interventions should implement tobacco cessation interventions at multiple levels, combining complementary components to maximize effectiveness and overcome barriers (e.g., weight gain and stress) to successful outcomes.

e-Cigarettes, Smoking Cessation, and Weight Change: Retrospective Secondary Analysis of the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation Trial

BACKGROUND

While smoking cessation has been linked to substantial weight gain, the potential influence of e-cigarettes on weight changes among individuals who use these devices to quit smoking is not fully understood.

OBJECTIVE

This study aims to reanalyze data from the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation (E3) trial to assess the causal effects of e-cigarette use on change in body weight.

METHODS

This is a secondary analysis of the E3 trial in which participants were randomized into 3 groups: nicotine e-cigarettes plus counseling, nonnicotine e-cigarettes plus counseling, and counseling alone. With adjustment for baseline variables and the follow-up smoking abstinence status, weight changes were compared between the groups from baseline to 12 weeks' follow-up. Intention-to-treat and as-treated analyses were conducted using doubly robust estimation. Further causal analysis used 2 different propensity scoring methods to estimate causal regression curves for 4 smoking-related continuous variables. We evaluated 5 different subsets of data for each method. Selection bias was addressed, and missing data were imputed by the machine learning method extreme gradient boosting (XGBoost).

RESULTS

A total of 257 individuals with measured weight at week 12 (mean age: 52, SD 12 y; women: n=122, 47.5%) were included. Across the 3 treatment groups, of the 257 participants, 204 (79.4%) who continued to smoke had, on average, largely unchanged weight at 12 weeks, with comparable mean weight gain ranging from -0.24 kg to 0.33 kg, while 53 (20.6%) smoking-abstinent participants gained weight, with a mean weight gain ranging from 2.05 kg to 2.70 kg. After adjustment, our analyses showed that the 2 e-cigarette arms exhibited a mean gain of 0.56 kg versus the counseling alone arm. The causal regression curves analysis also showed no strong evidence supporting a causal relationship between weight gain and the 3 e-cigarette-related variables. e-Cigarettes have small and variable causal effects on weight gain associated with smoking cessation.

CONCLUSIONS

In the E3 trial, e-cigarettes seemed to have minimal effects on mitigating the weight gain observed in individuals who smoke and subsequently quit at 3 months. However, given the modest sample size and the potential underuse of e-cigarettes among those randomized to the e-cigarette treatment arms, these results need to be replicated in large, adequately powered trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02417467; https://www.clinicaltrials.gov/study/NCT02417467.

"Healthier health in more ways than one": Perspectives on a program for changing both smoking and obesity-related health behaviors

INTRODUCTION

Individuals with obesity who smoke cigarettes have increased risk of morbidity and mortality. The goal of the current study was to inform the development of a multiple health behavior change intervention designed to facilitate smoking cessation while also targeting weight gain.

METHODS

Four qualitative focus groups were conducted with individuals who smoked cigarettes and had overweight or obesity (n = 16) to explore the combined effects of smoking and obesity, past attempts to quit smoking or lose weight, and preferences for a combined health intervention.

RESULTS

Focus groups converged on five themes including: the interactive effects of weight and smoking; lack of experience with evidence-based weight loss approaches; a desire and expectation to lose weight quickly; rapid weight gain during past attempts at smoking cessation; and interest in a multiple health behavior change intervention with weight management preceding smoking cessation and an emphasis on planning for the future and receiving encouragement and support.

CONCLUSIONS

Groups provided insight into key topics to highlight in a combined intervention and key issues that have interfered with success in both domains.

The Effect of Smoking Cessation on Body Weight and Other Metabolic Parameters with Focus on People with Type 2 Diabetes Mellitus

Smokers with diabetes mellitus substantially lower their risks of microvascular and macrovascular diabetic complications, in particular cardiovascular disease, by quitting smoking. However, subsequent post-smoking-cessation weight gain may attenuate some of the beneficial effects of smoking cessation and discourage attempts to quit. Weight gain can temporarily exacerbate diabetes and deteriorate glycemic control and metabolic profile. The molecular mechanisms by which quitting smoking leads to weight gain are largely associated with the removal of nicotine's effects on the central nervous system. This review addresses mechanisms of post-smoking-cessation weight gain, by reviewing the effects of nicotine on appetite, food intake, eating behaviour, energy expenditure, fat oxidation and appetite-regulating peptides. We also highlight correlations between post-cessation weight gain and risk of type 2 diabetes, consequences of weight gain in people with type 2 diabetes and the role of pharmacotherapies, which combine treatment of nicotine addiction and promotion of weight control.

Psychometric investigation of the Chinese version of the Habit, Reward and Fear Scale (HRFS)

BACKGROUND

Tobacco use is one of the most important risk factors for health, and China is the largest producer and consumer of tobacco in the world. Monitoring and controlling the tobacco epidemic is an important issue. However, the motivation underlying smoking behavior is complex and specific to the individual. The Habit, Reward and Fear Scale (HRFS) is a feasible tool to evaluate this complex motivation.

OBJECTIVES

To validate the psychometric properties of the HRFS Chinese version (HRFS-C) and to assess the relationship between motivation and smoking behavior.

METHOD

We recruited 967 participants through social media and assessed their smoking behavior with three instruments: the Fagerstrom Test for Nicotine Dependence-Chinese version (FTND-C), the Questionnaire on Smoking Urges-Brief Scale-Chinese version (QSU-brief-C), and the HRFS-C. Ultimately, we retained 700 valid data points. Cronbach's α and split-half tests were used to evaluate the reliability. Confirmatory factor analysis, Pearson's r and an analysis of variance (ANOVA) were used to evaluate the validity. In addition, linear regression was used to explore the relationship among the three instruments. The HRFS-C showed good homogeneity (α = 0.965), concurrent validity, and discriminant validity. A significant linear relationship was observed among the FTND-C, QSU-brief-C, and HRFS-C (p < .001).

CONCLUSION

The motivation measured by the HRFS-C can significantly predict nicotine dependence and craving in the smoking population. The HRFS-C can be used to carry out targeted interventions for addicted patients (e.g., motivational enhancement therapy).

Impact of tobacco and/or nicotine products on health and functioning: a scoping review and findings from the preparatory phase of the development of a new self-report measure

BACKGROUND

Measuring self-reported experience of health and functioning is important for understanding the changes in the health status of individuals switching from cigarettes to less harmful tobacco and/or nicotine products (TNP) or reduced-risk products (RRP) and for supporting tobacco harm reduction strategies.

METHODS

This paper presents insights from three research activities from the preparatory phase of the development of a new self-report health and functioning measure. A scoping literature review was conducted to identify the positive and negative impact of TNP use on health and functioning. Focus groups (n = 29) on risk perception and individual interviews (n = 40) on perceived dependence in people who use TNPs were reanalyzed in the context of health and functioning, and expert opinion was gathered from five key opinion leaders and five technical consultants.

RESULTS

Triangulating the findings of the review of 97 articles, qualitative input from people who use TNPs, and expert feedback helped generate a preliminary conceptual framework including health and functioning and conceptually-related domains impacted by TNP use. Domains related to the future health and functioning measurement model include physical health signs and symptoms, general physical appearance, functioning (physical, sexual, cognitive, emotional, and social), and general health perceptions.

CONCLUSIONS

This preliminary conceptual framework can inform future research on development and validation of new measures for assessment of overall health and functioning impact of TNPs from the consumers' perspective.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectiveness of the WeChat-based smoking cessation intervention ('WeChat WeQuit' program) in China: study protocol for a randomized controlled trial

BACKGROUND AND AIMS

Since its first release in 2011, WeChat (Chinese pinyin: Wei Xin) has been widely used to promote health. As the most popular all-in-one social media application providing free instant messaging, voice, text, pictures, videos and location information exchange via smartphone, WeChat holds promise for delivering smoking cessation services to a large number of people at low unit cost in China, a country with more than 300 million smokers. This protocol is for a study that aims to assess the efficacy of a WeChat-based smoking cessation intervention ('WeChat WeQuit') for treatment-seeking smokers in China.

DESIGN

In this two-arm randomized controlled trial (RCT), the control group will receive only a digital version of a booklet of 'Happy Quit'. The intervention group will also receive the 2 weeks pre- and 12 weeks post-quit 'WeChat WeQuit' intervention. Both groups will be followed-up to 26 weeks (6 months) after quit day.

SETTING

This on-line trial has no restrictions on setting or location.

PARTICIPANTS

Chinese-speaking current smokers (have smoked ≥100 cigarettes in their life-time and currently smoke cigarettes) aged 18+ years willing to make a quit attempt within 1 month (n = 2000) will be recruited by on- and off-line advertising. Potential participants will register their interest by sending WeChat messages or text messages, or making a voice call.

MEASUREMENTS

The primary outcome measure is self-reported 26-week continuous smoking abstinence with biological verification [test by clinic visit: expired carbon monoxide concentration <10 parts per million (p.p.m.) or by mailing cotinine urine dipsticks: urine cotinine <200 ng/ml]. Secondary outcome measures include: 7-day point prevalence abstinence at weeks 1, 4, 8, 12, 16, 20 and 26 after-quit day; self-reported 12-week continuous smoking abstinence and 26-week continuous smoking abstinence; reductions in number of cigarettes smoked per day; and rates of participation in and completion of the smoking-cessation program.

CONCLUSIONS

If the 'WeChat WeQuit' program is found to be effective, it will be an accessible, affordable and widely implementable intervention to help cigarette smokers to quit. The potential public health impact of its expansion into underserved regions or communities is considerable.

Dissemination and Effectiveness of the Peer Marketing and Messaging of a Web-Assisted Tobacco Intervention: Protocol for a Hybrid Effectiveness Trial

BACKGROUND

Smoking continues to be the leading preventable cause of death. Digital Interventions for Smoking Cessation (DISCs) are health communication programs accessible via the internet and smartphones and allow for greater reach and effectiveness of tobacco cessation programs. DISCs have led to increased 6-month cessation rates while also reaching vulnerable populations. Despite this, the impact of DISCs has been limited and new ways to increase access and effectiveness are needed.

OBJECTIVE

We are conducting a hybrid effectiveness-dissemination study. We aim to evaluate the effectiveness of a machine learning-based approach (recommender system) for computer-tailored health communication (CTHC) over a standard CTHC system based on quit rates and risk reduction. In addition, this study will assess the dissemination of providing access to a peer recruitment toolset on recruitment rate and variability of the sample.

METHODS

The Smoker-to-Smoker (S2S) study is a 6-month hybrid effectiveness dissemination trial conducted nationally among English-speaking, current smokers aged ≥18 years. All eligible participants will register for the DISC (Decide2quit) and be randomized to the recommender system CTHC or the standard CTHC, followed by allocation to a peer recruitment toolset group or control group. Primary outcomes will be 7-day point prevalence and risk reduction at the 6-month follow-up. Secondary outcomes include recruitment rate, website engagement, and patient-reported outcomes collected via the 6-month follow-up questionnaire. All primary analyses will be conducted on an intent-to-treat basis.

RESULTS

The project is funded from 2017 to 2020 by the Patient Centered Outcomes Research Institute. Enrollment was completed in early 2019, and 6-month follow-ups will be completed by late 2019. Preliminary data analysis is currently underway.

CONCLUSIONS

Conducting a hybrid study with both effectiveness and dissemination hypotheses raises some unique challenges in the study design and analysis. Our study addresses these challenges to test new innovations and increase the effectiveness and reach of DISCs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14814.

A clinical prescription for heart health in midlife women

Cardiovascular disease is the leading cause of death in women throughout the United States and Europe. Despite efforts to raise awareness, the sex-specific risk factors are still poorly recognized in both regions, and many women do not identify cardiovascular disease as a primary threat. During midlife, the incidence of cardiovascular disease increases dramatically, and this unique time gives an opportunity to identify both traditional cardiovascular risk factors as well as emerging risk factors unique to women. This review will focus on the current guidelines for cardiovascular risk assessment in Europe and the United States, traditional and emerging cardiovascular risk factors, and preventive lifestyle recommendations for midlife women.

Effects of isolated tobacco alkaloids and tobacco products on deprivation-induced food intake and meal patterns in rats

The ability of smoking to reduce body weight serves as motivation for continued smoking. It is unclear to what extent non-nicotine constituents in cigarettes are contributing to the weight-reducing effect of smoking. The purpose of the current study was to examine the effects of nicotine and four minor tobacco alkaloids (nornicotine, cotinine, anatabine, and anabasine) on food intake, one of the key regulators of body weight. In addition, a smokeless tobacco extract (STE) and e-cigarette (EC) refill liquid were used to model the effects of actual tobacco product exposure on food intake. Male Holztman rats were trained to lever press for food pellets during daily 2h sessions in operant chambers. In Experiment 1, the effects of subcutaneous injections of saline, nicotine (0.25-1.00mg/kg), nornicotine (0.50-6.00mg/kg), cotinine (1.00-100.00mg/kg), anatabine (0.25-3.00mg/kg), and anabasine (0.50-4.00mg/kg) were assessed. In Experiment 2, rats from Experiment 1 were used to examine the effects of nicotine, STE, and EC liquid. All alkaloids, except cotinine, produced a dose-dependent reduction in overall food intake. The highest doses of all drugs significantly reduced latency and response rate to obtain the first pellet. At some doses, nicotine, anatabine, and nornicotine reduced food intake within the first 45min without compensatory increases in intake later in the session. STE and EC liquid produced dose dependent decreases in food intake similar to nicotine alone. These data suggest that minor tobacco alkaloids have appetite suppressant effects and warrant further investigation into their effects on body weight, energy intake, and energy expenditure under free-feeding conditions. However, findings with STE and EC liquid suggest that nicotine is the primary constituent in these products to affect food intake, whereas levels of minor alkaloids in these products may be too low to influence food intake.

Postcessation weight gain concern as a barrier to smoking cessation: Assessment considerations and future directions

PURPOSE

Concern about postcessation weight gain may be one potential barrier to quitting smoking. In this 'mini-review' of recent literature, we summarize findings on the relationship between postcessation weight gain concern and smoking cessation, and evaluate varied use of postcessation weight gain concern assessments and potential moderators of the postcessation weight gain concern-cessation association.

METHODS

We conducted a search using the terms "smoking" OR "smoking cessation" AND "weight concern" for articles published between January 1, 2011 and December 31, 2016. We identified 17 studies assessing postcessation weight gain concern, seven of which evaluated the postcessation weight gain concern-cessation association.

RESULTS

The relationship between postcessation weight gain concern and smoking cessation was mixed. Recent studies varied in their assessments of postcessation weight gain concern, many of which were not validated and assessed correlates of this construct. Studies varied in their adjustment of demographic (e.g., sex), smoking-specific (e.g., smoking level), and weight-specific (e.g., body mass index) variables.

CONCLUSIONS

The use of non-validated assessments and variability in testing covariates/moderators may contribute to conflicting results regarding the postcessation weight gain concern-cessation relationship. We recommend validating an assessment of postcessation weight gain concern, maintaining vigilance in testing and reporting covariates/moderators, and investigating trajectories of this construct over time and by smoking status to inform future assessment and intervention efforts.

The relationships among physical activity, sedentary behaviour, obesity and quitting behaviours within a cohort of smokers in California

BACKGROUND

Smoking, insufficient physical activity (PA), sedentary behaviour (SB) and obesity are leading risk factors for morbidity and premature mortality. Few studies examining the relationship between these behavioural risk factors and quitting behaviours among cohorts of smokers have been published.

PURPOSE

The goals of this study are to examine the cross-sectional relationships among behavioural health risk factors (insufficient PA, SB and obesity) and past year quitting behaviours within a sample of smokers.

METHODS

The California Smokers Cohort, conducted from 2011 through 2013, is a population-based survey of adult smokers in California. Using follow-up data (n = 1050), participants' self-reported health behaviours and past year quitting behaviours were examined in univariate analyses and multivariate logistic regression analyses controlling for demographic covariates.

RESULTS

In univariate analyses examining health behaviours among smokers, all three health behaviours examined (PA, SB and obesity) were related, and significantly more obese smokers with high PA and low SB reported a ≥20% smoking rate reduction than smokers with other combinations of health behaviours (48.8%, Chi-squared = 4.765, P = 0.045). In multivariate models adjusted for sociodemographic characteristics, obese smokers (odds ratio [OR] = 1.450, 95% confidence interval [CI]: 1.088-1.932, P = 0.011) and smokers with higher levels of PA (OR = 1.448, 95% CI: 1.111-1.887, P = 0.006) were more likely to report a past year ≥24-hour quit attempt regardless of SB, and obese smokers (OR = 1.760, 95% CI: 1.095-2.828, P = 0.019) were more likely to report being quit for ≥30 days regardless of PA and SB.

CONCLUSIONS

Overall, the results demonstrated that more physically active and obese smokers were more likely to report positive strides towards quitting. These findings support the potential positive effect of addressing multiple health behaviours along with smoking.

Collective-Intelligence Recommender Systems: Advancing Computer Tailoring for Health Behavior Change Into the 21st Century

BACKGROUND

What is the next frontier for computer-tailored health communication (CTHC) research? In current CTHC systems, study designers who have expertise in behavioral theory and mapping theory into CTHC systems select the variables and develop the rules that specify how the content should be tailored, based on their knowledge of the targeted population, the literature, and health behavior theories. In collective-intelligence recommender systems (hereafter recommender systems) used by Web 2.0 companies (eg, Netflix and Amazon), machine learning algorithms combine user profiles and continuous feedback ratings of content (from themselves and other users) to empirically tailor content. Augmenting current theory-based CTHC with empirical recommender systems could be evaluated as the next frontier for CTHC.

OBJECTIVE

The objective of our study was to uncover barriers and challenges to using recommender systems in health promotion.

METHODS

We conducted a focused literature review, interviewed subject experts (n=8), and synthesized the results.

RESULTS

We describe (1) limitations of current CTHC systems, (2) advantages of incorporating recommender systems to move CTHC forward, and (3) challenges to incorporating recommender systems into CTHC. Based on the evidence presented, we propose a future research agenda for CTHC systems.

CONCLUSIONS

We promote discussion of ways to move CTHC into the 21st century by incorporation of recommender systems.