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Courtney R, Gupta D, Gould GS. The Australasian Professional Society on Alcohol and other Drugs' submission to the consultation draft National Tobacco Strategy 2022-2030. Drug Alcohol Rev 2023; 42:507-512. [PMID: 36698287 DOI: 10.1111/dar.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/27/2023]
Abstract
Tobacco use continues to be a leading cause of death and morbidity globally. At the core of Australia's response to tobacco-related harms is the National Tobacco Strategy which highlights a national collaborative framework to reduce prevalence, and associated health, social and economic impacts of tobacco use. A draft National Tobacco Strategy (2022-2030) has recently been released for consultation and as members of the Australasian Professional Society on Alcohol and other Drugs' Special Interest Group for Smoking Cessation Professionals we provide a commentary on key successes of the previous National Tobacco Strategy, and suggestions for improvement areas to strengthen Australia's policy response to tobacco and e-cigarette-related issues.
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Affiliation(s)
- Ryan Courtney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Special Interest Group for Smoking Cessation, Australasian Professional Society on Alcohol and other Drugs, Sydney, Australia
| | - Deepali Gupta
- Special Interest Group for Smoking Cessation, Australasian Professional Society on Alcohol and other Drugs, Sydney, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Gillian Sandra Gould
- Special Interest Group for Smoking Cessation, Australasian Professional Society on Alcohol and other Drugs, Sydney, Australia
- Faculty of Health, Southern Cross University, Coffs Harbour, Australia
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2
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Daglish M. The multiple facets of addiction in psychiatry. Australas Psychiatry 2018; 26:5-6. [PMID: 29384002 DOI: 10.1177/1039856217752831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark Daglish
- Director of Addiction Psychiatry, Royal Brisbane & Women's Hospital, Metro North Mental Health Service, Queensland Health and; Honorary Senior Lecturer in Addiction Psychiatry, The University of Queensland, St Lucia, QLD, Australia
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Garey L, Taha SA, Kauffman BY, Manning KF, Neighbors C, Schmidt NB, Zvolensky MJ. Treatment non-response: Associations with smoking expectancies among treatment-seeking smokers. Addict Behav 2017; 73:172-177. [PMID: 28528227 DOI: 10.1016/j.addbeh.2017.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
Despite the high rate of smoking cessation treatment non-response, relatively little empirical work has examined predictors of treatment non-response. The present study sought to explore the effect of smoking outcome expectancies on treatment response in a sample of treatment-seeking adult daily smokers (N=182; 53.3% female; Mage=40.67; SD=13.63). Results indicated that expectancies for smoking to reduce negative affect were related to an increased likelihood of treatment non-response (OR=0.73, CI: 0.54, 0.98). These findings remained significant after controlling for sex, presence of Axis I disorder, tobacco-related health problems, tobacco dependence, anxiety sensitivity, and condition assignment as well as other smoking expectancy dimensions. Post hoc analyses revealed that this relation was stronger for smokers in the integrated care condition vs. the standard care condition (Interaction: OR=1.69, CI: 1.05, 2.73). Additionally, expectancies for smoking to enhance positive affect and provide sensory satisfaction were associated with an increased likelihood of treatment response in the standard care condition. The current findings suggest expectancies that smoking will alleviate negative affect may be a risk factor of smoking cessation treatment non-response. Additionally, findings provide evidence that the relation between smoking expectancies and treatment non-response may differ by smoking cessation treatment.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Samar A Taha
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Kara F Manning
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA. Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial. Aust N Z J Psychiatry 2017; 51:366-381. [PMID: 28195010 DOI: 10.1177/0004867417692424] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours. METHOD A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence. RESULTS Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls. CONCLUSIONS Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.
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Affiliation(s)
- Alexandra P Metse
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Paula Wye
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Megan Freund
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard Clancy
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,4 Centre for Translational Neuroscience and Mental Health, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Emily Stockings
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Margarett Terry
- 6 Mental Health and Substance Use Service, Calvary Mater Hospital, Waratah, NSW, Australia
| | - John Allan
- 7 Mental Health Alcohol and Other Drugs Branch, Queensland Health, Fortitude Valley, QLD, Australia
| | - Kim Colyvas
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Judith J Prochaska
- 8 Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jenny A Bowman
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Gupta D, Winckel K, Burrows J, Ross J, Upham JW. Utilisation of Nicotine Replacement Therapy within a Hospital Pharmacist Initiated Smoking-Cessation Intervention – A Pragmatic Randomised Controlled Trial. J Smok Cessat 2017; 12:45-54. [DOI: 10.1017/jsc.2015.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction:Hospital pharmacists currently play a limited role in the management of nicotine withdrawal and smoking-cessation. They have multiple tasks and limited time; a strong evidence base is required to determine importance of including smoking-cessation interventions into their routine practice.Aims:The aims of this study were to evaluate the effectiveness of a hospital pharmacist initiated smoking-cessation intervention (SCI) in increasing the utilisation of Nicotine Replacement Therapy (NRT) in hospitalised smokers, and in increasing quit rates post-discharge.Methods:This study was conducted in a tertiary referral hospital using a pragmatic randomised control design. After screening, 100 inpatient smokers were enrolled and randomised by the research pharmacist (RP) to either the intervention or usual care arm (n= 50 for both arms). Smoking-cessation advice was available to all smokers during their hospital stay under the smoking management policy, which represented usual care. However, this approach is often unstructured and provided on an ad-hoc basis. Those in the intervention arm received brief SCI from the RP, who also facilitated NRT prescribing if required. Prescribing rates of NRT in the hospital and on discharge in both the groups were compared. Participants were contacted by phone three-months after enrolment to assess their seven-day point prevalence of abstinence (PPA) from smoking and use of NRT post-discharge.Results:A significantly higher proportion of participants in the intervention arm used NRT in the hospital (82% vs. 24%,Χ2= 33.8,p< 0.001) and at discharge (68% vs. 12%,Χ2= 32.7,p< 0.0001) and significantly more participants who received SCI from the RP continued to use NRT after discharge (OR 3.1, CI 1.2 to 8.2). A similar number of participants in both the groups claimed seven-day PPA after three-months (18% usual-care vs. 15% intervention-arm, OR 0.8, CI 0.24 to 2.67).Conclusions:Hospital pharmacist led brief SCI can enhance the utilisation of NRT in hospital and after discharge; there was no clear effect on cessation rates at three months. There is a need to explore feasible options for a coordinated, multidisciplinary approach to smoking-cessation in hospital and across the continuum, which may have a greater impact on long term smoking-cessation rates.
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Shields P, Bradley R, Graco M, Hutchinson A. Descriptive Evaluation of a Smoking Cessation Support Service for Chronic Disease Clients Within a Hospital Admissions Risk Program. J Smok Cessat 2017; 12:22-31. [DOI: 10.1017/jsc.2015.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: The Northern Alliance HARP smoking cessation program provides support to chronic disease participants who desired to quit smoking. This is an individualised program with pharmacotherapy and behavioural support, delivered by specialist clinicians.Aims: The aims of this descriptive evaluation were to explore factors that affect abstinence rates, record those rates, and describe the impact of anxiety, depression, self-efficacy, quality of life and motivation on quit rates at three months.Methods: Data was collected prospectively from clients enrolled in the service. Participants were assessed for abstinence at three months, six months and one year by carbon monoxide (CO) monitoring and self-reporting. Factors predictive of quitting were analysed using logistic regression; factors with a p value < 0.05 and 95% CI not containing one were considered statistically significant.Results: 103 clients were assessed and 86 were enrolled in the program. The odds of successful quitting at three months CO verified was higher amongst completers of the program compared to non-completers (OR = 6.6, 95% CI = 2.03–21.57, p = 0.002). The probability of sustained quitting at one year was over 18 times higher in the group who completed the program (n = 16/21 completers and n = 1/4 non-completers) (OR 18.5, 95% CI, 2.32–147.34, p = 0.006). No other factors predicted quitting.The rate of quitting was 28.7% at three months, 19.5% at six months and 10.3% at one year, CO verified. Measures of anxiety and depression, self-efficacy, quality of life and motivation did not influence either the quit rate or the likelihood of completing the course of treatment at three months.
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Abstract
OBJECTIVE We aimed to review research on smoking and mental illness and provide evidence-based guidelines for psychiatrists to help smoking patients quit. METHOD We undertook a narrative review of the literature with a special focus on the Australian context. RESULTS Although one in three people with mental illness smoke tobacco, smoking is often neglected in psychiatric practice. Smoking is a significant contributor to the health gap between people with mental illness and the general population. Smokers with mental illness are motivated to quit and are able to do so, albeit with lower quit rates. Quitting can lead to substantial improvements in mental wellbeing and physical health and does not exacerbate pre-existing mental illness. Psychiatrists should advise all smokers to quit and provide counselling, medication and support, based on the 5As framework. Approved pharmacotherapy - nicotine replacement therapy, varenicline and bupropion - is recommended for nicotine-dependent smokers. Smoking induces the metabolism of certain psychotropic drugs such as clozapine and olanzapine and dose reductions may be necessary after cessation. CONCLUSIONS Psychiatrists have a duty of care to identify the smoking status of their patients and to provide evidence-based support to quit.
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Affiliation(s)
| | - Dianne P Kirby
- Consultant Psychiatrist, Melbourne Health and Bendigo Health Services, Melbourne, NSW, Australia
| | - David J Castle
- Chair of Psychiatry, St. Vincent's Hospital MelbourneThe University of Melbourne; Adjunct Professor, Faculty of Health Sciences, Australian Catholic University, Melbourne, NSW, Australia
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Mcavoy BR, Yallop JJ. Implementing a Smoke-free Policy in an Inpatient Withdrawal Unit. J Smok Cessat 2014; 9:119-121. [DOI: 10.1017/jsc.2013.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Stockings EAL, Bowman JA, Baker AL, Terry M, Clancy R, Wye PM, Knight J, Moore LH, Adams MF, Colyvas K, Wiggers JH. Impact of a Postdischarge Smoking Cessation Intervention for Smokers Admitted to an Inpatient Psychiatric Facility: A Randomized Controlled Trial. Nicotine Tob Res 2014; 16:1417-28. [DOI: 10.1093/ntr/ntu097] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
OBJECTIVE Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. METHODS Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. RESULTS Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. CONCLUSIONS Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.
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Bonevski B. System-centred tobacco management: from 'whole-person' to 'whole-system' change. Drug Alcohol Rev 2013; 33:99-101. [PMID: 24256303 DOI: 10.1111/dar.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 11/29/2022]
Abstract
Patient-centred tobacco management is a pragmatic approach for helping smokers achieve their goals in terms of either cessation or harm reduction. However, the success of the approach is dependent on clinicians embracing and delivering it as intended. There are a number of structural and systemic organisational barriers which are limiting clinician-delivered patient-centred tobacco dependence. In response, 'whole system' approaches which help support clinicians in the delivery of patient-centred tobacco management are required. Health system changes to support clinicians and facilitate the delivery of patient-centred tobacco management are worth further investigation, particularly in settings where tobacco smoking rates are high.
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Affiliation(s)
- Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
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Abstract
Patient-centred tobacco management approaches tobacco smoking as a chronic disease and can be offered to all smokers irrespective of their attitude to quitting. Maintaining a long-term relationship with smokers enables the adoption of flexible solutions and shared goals. It is argued that patient-centred tobacco management potentially heightens the chances of eventual abstinence for smokers who are unable, or not yet ready to quit.
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Affiliation(s)
- Gillian S Gould
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, Australia; School of Health and Human Sciences, Southern Cross University, Coffs Harbour, Australia
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Devine E, Khan RJ, Bedford K, Jiang WZ, Lim H. A group based smoking cessation pilot programme for community mental health clients in Sydney. J Smok Cessat 2014; 9:26-30. [DOI: 10.1017/jsc.2013.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: This article describes the process and evaluation of a smoking cessation support programme for mental health clients in Sydney.Aim: The objective of the study was to assess a group-based smoking cessation support model for community mental health clients.Methods: Two community mental health services participated; 29 clients received free NRT products and weekly education for 12 weeks on: effects of smoking, nicotine dependence, NRT use, withdrawal process and the benefits of quitting. Evaluation included face-to-face interviews, telephone or postal survey using a semi-structured questionnaire.Results: The baseline (n = 29) and follow-up (n = 14) surveys showed reduction in the number of cigarettes (30 to 21) smoked a day (55% vs. 36%). At one month 47% (n = 19) were confident about stopping smoking permanently whereas 19% (n = 14) reported the same after six months. Participants reported concerns of health effects, illness, physical symptoms (77% n = 27) and financial cost (93% n = 27) were the motivating factors in quitting. None of the findings was statistically significant.Conclusions: Community based interventions to address the rate of smoking in this group is needed. Financial and health benefits can be used as motivating factors, and integration of smoking cessation assistance in treatment and rehabilitation of mental health consumers would be useful.
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Abstract
It is not uncommon for staff of mental health facilities to have diverging opinions regarding the tobacco use of their patients. Surveys have shown that a significant proportion of staff believe that the smoke free policies are harsh and difficult to implement in health facilities where patient compliance is a matter of serious concern (Lawn, 2004, Wye et al., 2010). Intra-staff disputes and arguments with patients as to how to implement these policies, if at all, occur frequently. This protocol was developed at the request of staff at a mental health facility for HIV AIDS patients afflicted with dementia. Staff were concerned about imminent smoke-free regulations that would impact on their unit.
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Abstract
Around 19% of US adults smoke cigarettes, and smoking remains the leading avoidable cause of death in this country. Without treatment only ~5% of smokers who try to quit achieve long-term abstinence, but evidence-based cessation treatment increases this figure to 10% to 30%. The process of smoking cessation comprises different pragmatically defined phases, and these can help guide smoking treatment development and evaluation. This review evaluates the effectiveness of smoking interventions for smokers who are unwilling to make a quit attempt (motivation phase), who are willing to make a quit attempt (cessation phase), who have recently quit (maintenance phase), and who have recently relapsed (relapse recovery phase). Multiple effective treatments exist for some phases (cessation), but not others (relapse recovery). A chronic care approach to treating smoking requires effective interventions for every phase, especially interventions that exert complementary effects both within and across phases and that can be disseminated broadly and cost-effectively.
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Affiliation(s)
- Tanya R Schlam
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53711, USA.
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Conigrave KM, Lee KSK. Smoking or alcohol dependence among Indigenous Australians: treatment may be needed, not just education. Heart Lung Circ 2012; 21:626-31. [PMID: 22819096 DOI: 10.1016/j.hlc.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/23/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND In trying to help Aboriginal and Torres Strait Islander (Indigenous) individuals or communities to stop smoking or reduce the harms from alcohol, it is important to be aware of the strong biological basis of the drive to return to nicotine or alcohol. METHODS In this paper we briefly describe the social and neurobiological factors that drive a dependent smoker or drinker to keep using. We set out the current range of pharmacological treatments for dependence, their role in assisting a person to either stop using or avoid relapse, and we discuss issues relating to their use in Aboriginal Australians. CONCLUDING COMMENTS There is a firm evidence base for the use of pharmacological treatments for nicotine or alcohol dependence, particularly in severe dependence or when counselling or non-pharmacological approaches have failed. Indigenous Australians should be able to access the full range of approaches to managing these conditions. Working in partnership with Indigenous health staff and agencies can help ensure that appropriate access to treatment and quality treatment delivery occurs.
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Loh WY, Piper ME, Schlam TR, Fiore MC, Smith SS, Jorenby DE, Cook JW, Bolt DM, Baker TB. Should all smokers use combination smoking cessation pharmacotherapy? Using novel analytic methods to detect differential treatment effects over 8 weeks of pharmacotherapy. Nicotine Tob Res 2012; 14:131-41. [PMID: 22180577 PMCID: PMC3265742 DOI: 10.1093/ntr/ntr147] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 06/09/2011] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Combination pharmacotherapy for smoking cessation has been shown to be more effective than monotherapy in meta-analyses. We address the question of whether combination pharmacotherapy should be used routinely with smokers or if some types of smokers show little or no benefit from combination pharmacotherapy versus monotherapy. METHODS Two smoking cessation trials were conducted using the same assessments and medications (bupropion, nicotine lozenge, nicotine patch, bupropion + lozenge, and patch + lozenge). Participants were smokers presenting either to primary care clinics in southeastern Wisconsin for medical treatment (Effectiveness trial, N = 1,346) or volunteering for smoking cessation treatment at smoking cessation clinics in Madison and Milwaukee, WI (Efficacy trial, N = 1,504). For each trial, decision tree analyses identified variables predicting outcome from combination pharmacotherapy versus monotherapy at the end of treatment (smoking 8 weeks after the target quit day). RESULTS All smokers tended to benefit from combination pharmacotherapy except those low in nicotine dependence (longer latency to smoke in the morning as per item 1 of the Fagerström Test of Nicotine Dependence) who also lived with a spouse or partner who smoked. CONCLUSIONS Combination pharmacotherapy was generally more effective than monotherapy among smokers, but one group of smokers, those who were low in nicotine dependence and who lived with a smoking spouse, did not show greater benefit from using combination pharmacotherapy. Use of monotherapy with these smokers might be justified considering the expense and side effects of combination pharmacotherapy.
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Affiliation(s)
- Wei-Yin Loh
- Department of Statistics, University of Wisconsin, Madison, WI
| | - Megan E. Piper
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tanya R. Schlam
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael C. Fiore
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stevens S. Smith
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Douglas E. Jorenby
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica W. Cook
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Daniel M. Bolt
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Educational Psychology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Timothy B. Baker
- Center for Tobacco Research and Intervention, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Bittoun R. Drinking and Smoking. J Smok Cessat 2011. [DOI: 10.1375/jsc.6.2.iii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Stockings EAL, Bowman JA, Wiggers J, Baker AL, Terry M, Clancy R, Wye PM, Knight J, Moore LH. A randomised controlled trial linking mental health inpatients to community smoking cessation supports: a study protocol. BMC Public Health 2011; 11:570. [PMID: 21762532 PMCID: PMC3155917 DOI: 10.1186/1471-2458-11-570] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/17/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mental health inpatients smoke at higher rates than the general population and are disproportionately affected by tobacco dependence. Despite the advent of smoke free policies within mental health hospitals, limited systems are in place to support a cessation attempt post hospitalisation, and international evidence suggests that most smokers return to pre-admission smoking levels following discharge. This protocol describes a randomised controlled trial that will test the feasibility, acceptability and efficacy of linking inpatient smoking care with ongoing community cessation support for smokers with a mental illness. METHODS/DESIGN This study will be conducted as a randomised controlled trial. 200 smokers with an acute mental illness will be recruited from a large inpatient mental health facility. Participants will complete a baseline survey and will be randomised to either a multimodal smoking cessation intervention or provided with hospital smoking care only. Randomisation will be stratified by diagnosis (psychotic, non-psychotic). Intervention participants will be provided with a brief motivational interview in the inpatient setting and options of ongoing smoking cessation support post discharge: nicotine replacement therapy (NRT); referral to Quitline; smoking cessation groups; and fortnightly telephone support. Outcome data, including cigarettes smoked per day, quit attempts, and self-reported 7-day point prevalence abstinence (validated by exhaled carbon monoxide), will be collected via blind interview at one week, two months, four months and six months post discharge. Process information will also be collected, including the use of cessation supports and cost of the intervention. DISCUSSION This study will provide comprehensive data on the potential of an integrated, multimodal smoking cessation intervention for persons with an acute mental illness, linking inpatient with community cessation support.
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Affiliation(s)
- Emily AL Stockings
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jennifer A Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Hunter New England Population Health (HNEPH), Wallsend Health Services, Longworth Avenue Wallsend, NSW, 2287, Australia
| | - Amanda L Baker
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Centre for Brain and Mental Health Research (CBMHR), Level 5 McAuley Centre, The Mater Hospital, Edith Street Waratah, NSW, 2998, Australia
| | - Margarett Terry
- Mental Health and Substance Use Service (MHSUS), Level 4 McAuley Centre, The Mater Hospital, Edith Street Waratah, NSW, 2298, Australia
| | - Richard Clancy
- Mental Health and Substance Use Service (MHSUS), Level 4 McAuley Centre, The Mater Hospital, Edith Street Waratah, NSW, 2298, Australia
| | - Paula M Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Mental Health and Substance Use Service (MHSUS), Level 4 McAuley Centre, The Mater Hospital, Edith Street Waratah, NSW, 2298, Australia
| | - Jenny Knight
- Hunter New England Population Health (HNEPH), Wallsend Health Services, Longworth Avenue Wallsend, NSW, 2287, Australia
| | - Lyndell H Moore
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Mental Health and Substance Use Service (MHSUS), Level 4 McAuley Centre, The Mater Hospital, Edith Street Waratah, NSW, 2298, Australia
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20
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Bonevski B, Paul C, D'Este C, Sanson-Fisher R, West R, Girgis A, Siahpush M, Carter R. RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population. BMC Public Health 2011; 11:70. [PMID: 21281519 PMCID: PMC3038158 DOI: 10.1186/1471-2458-11-70] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 01/31/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population. METHODS/DESIGN A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up. DISCUSSION This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited. TRIAL REGISTRATION NUMBER ISRCTN: ISRCTN85202510.
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Affiliation(s)
- Billie Bonevski
- Centre for Health Research & Psycho-oncology (CHeRP), Cancer Council NSW & University of Newcastle, Newcastle, Australia.
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21
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Abstract
Currently, there are nine validated medications, four validated psychosocial strategies, and three validated ways to deliver psychosocial treatments for smoking cessation. This article presents an algorithm based on a literature review and the author's clinical experience. The algorithm integrates the recommendations of the major guidelines and meta-analyses and provides rationales for its treatment decisions. The algorithm suggests a brief assessment followed by use of one to two medications and counseling in most smokers. Because all treatments appear equally effective and have few adverse events, the algorithm suggests clinicians inform smokers of the pros and cons of the different treatments, and recommend use of one or more of each. If a smoker fails to quit, the algorithm suggests an assessment of why relapse occurred and then a more intense treatment, a new treatment, or both.
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Affiliation(s)
- John Hughes
- University of Vermont, Burlington, VT 05401-1419, USA.
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