1
|
Lawson S, Bryant J, Freund M, Dizon J, Haber PS, Shakeshaft A, Jefferies M, Farrell M. Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse. Drug Alcohol Rev 2024. [PMID: 38462541 DOI: 10.1111/dar.13833] [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: 09/10/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. METHODS Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. RESULTS In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk. DISCUSSION AND CONCLUSIONS Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.
Collapse
Affiliation(s)
- Samuel Lawson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Joshua Dizon
- Clinical Research Design and Statistics, Hunter Medical Research Institute, Newcastle, Australia
| | - Paul S Haber
- Edith Collins Centre, Royal Prince Alfred Hospital, and Specialty of Addiction Medicine, The University of Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Meryem Jefferies
- Western Sydney Local Health District Drug Health, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| |
Collapse
|
2
|
Guillaumier A, Skelton E, Tzelepis F, D'Este C, Paul C, Walsberger S, Kelly PJ, Palazzi K, Bonevski B. Patterns and predictors of nicotine replacement therapy use among alcohol and other drug clients enrolled in a smoking cessation randomised controlled trial. Addict Behav 2021; 119:106935. [PMID: 33848758 DOI: 10.1016/j.addbeh.2021.106935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Nicotine replacement therapy (NRT) use to support client smoking quit attempts is low and inconsistent at alcohol and other drug (AOD) treatment services. This study examined predictors of any NRT use and combination NRT use among AOD clients who were smokers. METHODS The study was part of a cluster-RCT of an organisational change intervention to introduce smoking cessation support as part of routine treatment in 32 AOD services. The intervention provided AOD services with free NRT and training. Service clients completed baseline (n = 896), 8-week (n = 471) and 6.5-month (n = 427) follow-up surveys. Mixed-model logistic regression examined whether baseline socio-demographic and smoking variables were associated with single and combination NRT use. RESULTS At 8-weeks follow-up 57% (n = 269/471), and at 6.5-months 33% (n = 143/427) of participants reported using at least one form of NRT. Odds of NRT use at 8-weeks follow-up were greater among participants from treatment vs control group (OR = 3.69, 95%CI 1.8-7.4; p < 0.001), higher vs lower nicotine dependence (OR = 1.74 95%CI 1.1-2.8; p = 0.024), or those motivated to quit (OR = 1.18 95%CI 1.0-1.4; p = 0.017). At 6.5-months, only the treatment arm remained significant. Combination NRT use at the 8-week follow-up was higher among those in treatment vs control group (OR = 2.75 95%CI 1.4-5.6; p = 0.005), or with higher vs lower nicotine dependence (OR = 2.12 95%CI 1.2-3.8; p = 0.014). No factors were associated with combination NRT use at 6.5-months. CONCLUSIONS An organisational change intervention that supplied AOD services with NRT training and products to provide to clients during treatment significantly increases client single form and combination NRT use in the short term.
Collapse
Affiliation(s)
| | | | - Flora Tzelepis
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Hunter New England Population Health, Wallsend, Australia
| | - Catherine D'Este
- The University of Newcastle, Callaghan, Australia; Australian National University, Canberra, Australia
| | - Christine Paul
- The University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter J Kelly
- The University of Wollongong, Illawarra Health and Medical Research Institute, School of Psychology, Northfields Avenue, Wollongong, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | | |
Collapse
|
3
|
Skelton E, Guillaumier A, Tzelepis F, Walsberger S, Paul CL, Dunlop AJ, Palazzi K, Bonevski B. Alcohol and other drug health-care providers and their client's perceptions of e-cigarette use, safety and harm reduction. Drug Alcohol Rev 2021; 40:998-1002. [PMID: 33774886 DOI: 10.1111/dar.13276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION E-cigarettes containing nicotine may potentially assist cessation in a heavily nicotine-dependent population with high relapse and tobacco-related burden. This study aims to determine alcohol and other drug (AOD) health-care provider and client awareness, use and attitudes regarding harm reduction and safety of e-cigarettes. METHODS The study was part of a larger cluster randomised controlled trial with 32 Australian AOD services. At a post-intervention survey conducted October 2016, health-care providers were asked whether they believed e-cigarettes could help smokers quit tobacco, whether they believe e-cigarettes are safer than tobacco smoking and whether they would recommend e-cigarettes to clients who are interested in quitting smoking. At the 6-month follow-up survey conducted January 2015-March 2016, AOD clients were asked about their e-cigarette knowledge, ever use, current use, reasons for use and place of purchase. RESULTS One hundred and eighty health-care providers and 427 AOD clients responded. A minority of health-care providers agreed with the statements that e-cigarettes could help smokers quit tobacco (30%), while just under one-third (25%) agreed that e-cigarettes were safer than tobacco smoking. However, only 19% would recommend e-cigarettes. Most AOD clients (93%) reported awareness of e-cigarettes, 39% reported ever use; however, only 7% reported current use. Of those reporting ever use, 52% used a nicotine e-cigarette. The most common reasons for e-cigarette use were 'wanted to try' (72%) and 'help cut down smoking' (70%). DISCUSSION AND CONCLUSIONS Both AOD health-care providers and clients are aware of e-cigarettes but are cautious in using and recommending their use.
Collapse
Affiliation(s)
- Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Ashleigh Guillaumier
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Flora Tzelepis
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | | | - Christine L Paul
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian J Dunlop
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle, Australia
| | | | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| |
Collapse
|
4
|
Guillaumier A, Skelton E, Shakeshaft A, Farrell M, Tzelepis F, Walsberger S, D'Este C, Paul C, Dunlop A, Stirling R, Fowlie C, Kelly P, Oldmeadow C, Palazzi K, Bonevski B. Effect of increasing the delivery of smoking cessation care in alcohol and other drug treatment centres: a cluster-randomized controlled trial. Addiction 2020; 115:1345-1355. [PMID: 31762105 DOI: 10.1111/add.14911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/25/2019] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
AIM Aims were to test the effectiveness of an organizational change intervention integrating smoking cessation treatment into usual alcohol and other drug (AOD) treatment, compared with usual care, on (1) 7-day point prevalence abstinence (PPA) at 8 weeks follow-up; (2) prolonged abstinence; (3) cigarettes smoked per day; (4) number of quit attempts; and (5) offer and use of nicotine replacement therapy (NRT). All outcomes were assessed at 8 weeks and 6.5 months follow-up. DESIGN Cluster-randomized controlled trial, with AOD service as unit of randomization, conducted January 2015-March 2016. SETTING Thirty-two eligible services (provided face-to-face client sessions to ≥ 50 clients/year) in Australia were randomized to control (usual care; n = 15) or intervention (n = 17) groups by an independent blinded biostatistician. PARTICIPANTS Eligible participants (≥ 16 years, current smoker) completed surveys at the service at baseline (n = 896) and telephone follow-up surveys (conducted by blinded assessors) at 8 weeks (n = 471; 53%) and 6.5 months (n = 427; 48%). INTERVENTION Intervention services received an intervention to establish routine screening, assessment and delivery of smoking cessation care. MEASUREMENTS Primary outcome was biochemically verified 7-day PPA at 8-week follow-up. Secondary outcomes included verified and self-reported prolonged abstinence, self-reported 7-day PPA, cigarettes/day, quit attempts and offer and use of NRT. Intention-to-treat analyses were performed, assuming missing participants were not abstinent. FINDINGS At 8 weeks, the findings in verified 7-day PPA between groups [2.6 versus 1.8%, odds ratio (OR) = 1.72, 95% confidence interval (CI) = 0.5-5.7, P = 0.373] were inconclusive as to whether a difference was present. Significantly lower mean cigarettes/day were reported in the intervention group compared to the usual care group at 8 weeks [incidence rate ratio (IRR) = 0.88, 95% CI = 0.8-0.95, P = 0.001] but were similar at 6.5 months (IRR = 0.96, 95% CI = 0.9-1.02, P = 0.240) follow-up. At both follow-ups the intervention group reported higher rates of NRT use. CONCLUSIONS Integrating smoking cessation treatment into addiction services did not significantly improve short-term abstinence from smoking.
Collapse
Affiliation(s)
- Ashleigh Guillaumier
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Eliza Skelton
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Flora Tzelepis
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, NSW, Australia
| | - Scott Walsberger
- Tobacco Control Unit, Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Catherine D'Este
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christine Paul
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adrian Dunlop
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Newcastle Community Health Centre, Hunter New England Local Health District, Newcastle West, NSW, Australia
| | - Robert Stirling
- Network of Alcohol and other Drugs Agencies, Woolloomooloo, NSW, Australia
| | - Carrie Fowlie
- Alcohol, Tobacco and Other Drug Association ACT, Ainslie, ACT, Australia
| | - Peter Kelly
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | | | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
5
|
Skelton E, Guillaumier A, Lambert S, Palazzi K, Bonevski B. Same same but different: A comparison of LGB and non-LGB client preferences and reported receipt of smoking care in alcohol and other drug treatment services. J Subst Abuse Treat 2020; 113:107968. [PMID: 32359665 DOI: 10.1016/j.jsat.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Lesbian, gay, and bisexual (LGB) people are more likely to use tobacco and other substances than non-LGB people. A limited body of research has examined LGB people in the alcohol and other drug (AOD) treatment setting. This study aims to examine the tobacco smoking behaviours of LGB people receiving AOD treatment, their receipt and preferences for quit support compared to non-LGB, as well as the factors associated with receipt of quit smoking support strategies for LGB people. DESIGN AND METHODS We examined baseline survey responses (February to August 2014) from a longitudinal RCT, with clients who were current smokers from 32 AOD treatment services in four states and territories of Australia. RESULTS Among 896 respondents, 100 respondents identified as LGB. Nearly all LGB (94%) respondents identifies as daily tobacco smokers. On average, LGB respondents had made more quit attempts in the last 12 months (3 vs 2, p = 0.012). Both LGB and non-LGB respondents reported receiving similar rates of quit smoking support however more LGB respondents reported receiving a prescription of varenicline (31.5% vs 36.4%, p = 0.04). Higher motivation to quit (OR 1.39 95% CI 1.07, 1.78) and older age of LGB respondents were associated with greater receipt of quit smoking support. Both LGB and non-LGB respondents reported similar preferences for quit support. DISCUSSION AND CONCLUSIONS LGB smokers in AOD treatment are attempting to quit smoking yet both LGB and non-LGB smokers are not receiving adequate treatment despite openness to receive multiple types of quit support.
Collapse
Affiliation(s)
- Eliza Skelton
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308, Australia.
| | - Ashleigh Guillaumier
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308, Australia
| | - Sarah Lambert
- ACON, Wellbeing Programs, 414 Elizabeth St, Surry Hills, NSW 2010, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute (HMRI), Clinical Research Design, Information Technology and Statistical Support, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Billie Bonevski
- The University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, 1 University Drive, Callaghan, NSW 2308, Australia
| |
Collapse
|
6
|
Baker AL, Robson D, Lawn S, Steinberg ML, Bucci S, McNeill A, Castle DJ, Bonevski B. Reducing Smoking Among People With Schizophrenia: Perspectives on Priorities for Advancing Research. Front Psychiatry 2018; 9:711. [PMID: 30618881 PMCID: PMC6305594 DOI: 10.3389/fpsyt.2018.00711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023] Open
Abstract
Although tobacco smoking is very common among people with schizophrenia and has devastating effects on health, strategies to ameliorate the risk are lacking. Some studies have reported promising results yet quit rates are much lower than in the general population. There is a need to advance research into smoking cessation efforts among people with schizophrenia. We posed the following question to five leading international experts in the field: "What are the top three research ideas we need to prioritize in order to advance the field of reducing smoking amongst people with schizophrenia?" They identified three broad priorities: (i) deeper understanding about the relationship between smoking, smoking cessation and symptomatology; (ii) targeted, adaptive and responsive behavioral interventions evaluated with smarter methodologies; and (iii) improvements in delivery of interventions. Efforts should be made to establish a collaborative international research agenda.
Collapse
Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, University of Newcastle Newcastle, NSW, Australia
| | - Debbie Robson
- Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Margaret Tobin Centre, College of Medicine & Public Health, Flinders University Adelaide, SA, Australia
| | - Marc L Steinberg
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School New Brunswick, NJ, United States
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust Manchester, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience King's College London, London, United Kingdom
| | - David J Castle
- Department of Psychiatry, University of Melbourne Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital Melbourne Fitzroy, VIC, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle Newcastle, NSW, Australia
| |
Collapse
|
7
|
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
|
8
|
Bonevski B, Borland R, Paul CL, Richmond RL, Farrell M, Baker A, Gartner CE, Lawn S, Thomas DP, Walker N. No smoker left behind: it's time to tackle tobacco in Australian priority populations. Med J Aust 2017; 207:141-142. [PMID: 28814207 DOI: 10.5694/mja16.01425] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW
| | | | | | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA
| | | | - Natalie Walker
- National Institute for Health Innovation, University of Auckland, Auckland, NZ
| |
Collapse
|
9
|
Abstract
BACKGROUND System change interventions for smoking cessation are policies and practices designed by organizations to integrate the identification of smokers and the subsequent offering of evidence-based nicotine dependence treatments into usual care. Such strategies have the potential to improve the provision of smoking cessation support in healthcare settings, and cessation outcomes among those who use them. OBJECTIVES To assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both. SEARCH METHODS We searched databases including the Cochrane Tobacco Addiction Group Specialized Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO in February 2016. We also searched clinical trial registries: WHO clinical trial registry, US National Institute of Health (NIH) clinical trial registry. We checked 'grey' literature, and handsearched bibliographies of relevant papers and publications. SELECTION CRITERIA Randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs and interrupted time series studies that evaluated a system change intervention, which included identification of all smokers and subsequent offering of evidence-based nicotine dependence treatment. DATA COLLECTION AND ANALYSIS Using a standardized form, we extracted data from eligible studies on study settings, participants, interventions and outcomes of interest (both cessation and system-level outcomes). For cessation outcomes, we used the strictest available criteria to define abstinence. System-level outcomes included assessment and documentation of smoking status, provision of advice to quit or cessation counselling, referral and enrolment in quitline services, and prescribing of cessation medications. We assessed risks of bias according to the Cochrane Handbook and categorized each study as being at high, low or unclear risk of bias. We used a narrative synthesis to describe the effectiveness of the interventions on various outcomes, because of significant heterogeneity among studies. MAIN RESULTS We included seven cluster-randomized controlled studies in this review. We rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow-up (four studies), and for the secondary outcome 'prescribing of smoking cessation medications' (two studies). Four studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. AUTHORS' CONCLUSIONS The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services. However, as the available research is limited we are not able to draw strong conclusions. There is a need for additional high-quality research to explore the impact of system change interventions on both cessation and system-level outcomes.
Collapse
Affiliation(s)
- Dennis Thomas
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash UniversityCentre for Medicine Use and SafetyParkville Campus381 Royal ParadeParkvilleVictoriaAustralia3052
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash UniversityEpidemiology & Preventive MedicineMelbourneVictoriaAustralia3004
| | - Billie Bonevski
- University of NewcastleSchool of Medicine & Public HealthDavid Maddison BuildingCnr of King and Watt StreetsNewcastleNSWAustralia2300
| | - Johnson George
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
| | | |
Collapse
|
10
|
Ingram I, Kelly PJ, Deane FP, Baker AL, Lyons G, Blackman R. An Exploration of Smoking Among People Attending Residential Substance Abuse Treatment: Prevalence and Outcomes at Three Months Post-Discharge. J Dual Diagn 2017; 13:67-72. [PMID: 28129092 DOI: 10.1080/15504263.2017.1287456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Smoking continues to be a major health concern for people with a history of alcohol or other substance use problems. The current research is aimed to (1) describe the prevalence of smoking in residential addictions treatment services and (2) compare characteristics of people who had or had not quit smoking. METHODS Participants were attending residential substance abuse treatment provided by the Australian Salvation Army. These programs are up to 10 months in length and offer a range of low-intensity smoking cessation supports. Measures of smoking, substance use, and clinical characteristics were collected from 2008 to 2015 at baseline and three months post-discharge from treatment (N = 702). RESULTS At baseline, 86% of people were smokers (n = 606). At follow-up, only 48 participants who were smokers at baseline (7%) had quit smoking. Participants who had quit smoking at follow-up also reported higher rates of abstinence from alcohol or other substances at follow-up (72%) than people who had not quit smoking (46%; OR = 2.95, 95% CI [1.52, 5.74]). CONCLUSIONS There is potential for smoking cessation to be better addressed as part of routine care in substance abuse treatment settings. Future research should evaluate the provision of more systematic smoking cessation interventions within these settings.
Collapse
Affiliation(s)
- Isabella Ingram
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , New South Wales , Australia
| | - Peter J Kelly
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , New South Wales , Australia
| | - Frank P Deane
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , New South Wales , Australia
| | - Amanda L Baker
- b School of Medicine and Public Health, University of Newcastle , New South Wales , Australia
| | - Geoff Lyons
- c Australian College of Applied Psychology , Sydney , New South Wales , Australia
| | - Russell Blackman
- a Illawarra Institute for Mental Health, School of Psychology, University of Wollongong , New South Wales , Australia
| |
Collapse
|