The effectiveness of an integrated multicomponent program for adolescent smoking cessation in Taiwan

Effectiveness of digital tools for smoking cessation in Asian countries: a systematic review

AIM

The use of tobacco is responsible for many preventable diseases and deaths worldwide. Digital interventions have greatly improved patient health and clinical care and have proven to be effective for quitting smoking in the general population due to their flexibility and potential for personalization. However, there is limited evidence on the effectiveness of digital interventions for smoking cessation in Asian countries.

METHODS

Three major databases - Web of Science (WOS), Scopus, and PubMed - for relevant studies published between 1 January 2010 and 12 February 2023 were searched for studies evaluating the effectiveness of digital intervention for smoking cessation in Asian countries.

RESULTS

A total of 25 studies of varying designs were eligible for this study collectively involving a total of n = 22,005 participants from 9 countries. Among different digital tools for smoking cessation, the highest abstinence rate (70%) was reported with cognitive behavioural theory (CBT)-based smoking cessation intervention via Facebook followed by smartphone app (60%), WhatsApp (59.9%), and Pharmacist counselling with Quit US smartphone app (58.4%). However, WhatsApp was preferred over Facebook intervention due to lower rates of relapse. WeChat was responsible for 15.6% and 41.8% 7-day point prevalence abstinence. For telephone/text messaging abstinence rate ranged from 8-44.3% and quit rates from 6.3% to 16.8%. Whereas, no significant impact of media/multimedia messages and web-based learning on smoking cessation was observed in this study.

CONCLUSION

Based on the study findings the use of digital tools can be considered an alternative and cost-effective smoking cessation intervention as compared to traditional smoking cessation interventions.

Effectiveness of Health Coaching in Smoking Cessation and Promoting the Use of Oral Smoking Cessation Drugs in Patients with Type 2 Diabetes: A Randomized Controlled Trial

INTRODUCTION

This study looked into the effectiveness of a 6 month health coaching intervention in smoking cessation and smoking reduction for patients with type 2 diabetes.

METHODS

The study was carried out via a two-armed, double-blind, randomized-controlled trial with 68 participants at a medical center in Taiwan. The intervention group received health coaching for 6 months, while the control group only received usual smoking cessation services; some patients in both groups participated in a pharmacotherapy plan. The health coaching intervention is a patient-centered approach to disease management which focuses on changing their actual behaviors. By targeting on achieving effective adult learning cycles, health coaching aims to help patients to establish new behavior patterns and habits.

RESULTS

In this study, the intervention group had significantly more participants who reduced their level of cigarette smoking by at least 50% than the control group (p = 0.030). Moreover, patients participating in the pharmacotherapy plan in the coaching intervention group had a significant effect on smoking cessation (p = 0.011), but it was insignificant in the control group.

CONCLUSIONS

Health coaching can be an effective approach to assisting patients with type 2 diabetes participating in a pharmacotherapy plan to reduce smoking and may help those who participate in pharmacotherapy plan to quit smoking more effectively. Further studies with higher-quality evidence on the effectiveness of health coaching in smoking cessation and the use of oral smoking cessation drugs in patients with type 2 diabetes are needed.

Perspectives Emerged from Students and Supervisory Staff Interaction in Drug Use Prevention: A Q Methodology Investigation

This study aims to identify and describe the patterns of shared perspectives of students and supervisory staff associated with their interaction in drug use prevention. We applied the Q methodology to cluster participants into groups according to the similarities of their Q sorts. A total of 31 pairs of students and their supervisory staff participated in the study to rank the designed Q statements. The Q factor analysis for supervisory staff revealed a five-factor solution that accounted for 58% of the total variance. Another five-factor solution for the students explained 49% of the total variance. One similarity between the groups was the need to enhance the involvement of significant others to help the students quit drugs. A major identified difference between the groups was that whereas the students highlighted the importance of health consequences of drug use in helping them stop use, the supervisory staff did not. The elucidation of similarities and differences between supervisory staff and students could offer more insightful strategies of preventing the drug use.

Lung cancer survival and mortality in Taiwan following the initial launch of targeted therapies: an interrupted time series study

OBJECTIVES

Two oral targeted therapies, gefitinib and erlotinib, were first approved and then launched into the market for treatment of late-stage non-small cell lung cancer (NSCLC) in Taiwan in 2003 and 2006, respectively. The aim of this study were to determine the trends in lung cancer burden and examine changes in lung cancer-related survival rates and mortality following the launch of these new drugs.

SETTING

Yearly lung cancer-related data (1994-2013), including incidence, number of newly diagnosed patients, survival rate and mortality, were retrieved from the Taiwan Cancer Registry Database.

DESIGN AND OUTCOME MEASURES

Using a time series design with autoregressive integrated moving average model, we investigated and projected trends in the incidence and early diagnosis of lung cancer in Taiwan. We also estimated the changes in survival rates and mortality following the launch of targeted therapies using interrupted time series and segmented regression models.

RESULTS

The age-standardised incidence of lung cancer increased from 22.53 per 100 000 people in 1994 to 34.09 in 2013, and it was projected to reach 38.98 by 2020. The rate of early-stage NSCLC at diagnosis increased from 12.63% in 2004 to 23.99% in 2013, and it was projected to reach 32.95% by 2020. The 2-year lung cancer survival increased by 19.81% (95% CI 14.90% to 24.71%) 3 years following the launch of gefitinib. Lung cancer mortality declined by 5.97% (95% CI -8.20% to -3.73%) 3 years following the launch of gefitinib.

CONCLUSIONS

Lung cancer survival rate increased and mortality decreased significantly following the launch of gefitinib and erlotinib in Taiwan.

Testing the Usability of Digital Educational Games for Encouraging Smoking Cessation

This study, using an observational design, assessed the effect of digital educational games on students' intention to quit smoking. Specifically, a series of digital games were developed to encourage smoking cessation and enhance students' engagement with the material. Three determinants of engagement were tested: perceived ease of use, perceived usefulness, and perceived satisfaction. Usability assessments were performed using a structured questionnaire and usability-testing software (Morae). Most students reported that the games were easy to use (73.3-93.3%), useful (60.0-83.3%) and satisfactory (66.7-70.0%). After using the games, approximately half (46.7-53.3%) reported that they intended to quit smoking. After controlling for gender and age, multiple regression analysis revealed that only perceived usefulness statistically significantly contributed to intention to quit (β = 2.38, p < 0.05). 'Taiko Drumming' showed the highest number of mouse clicks (67.23), and the lowest time between inputs (7.88 s). It also received the most positive feedback (17 marks). These findings show that integrating learners' experiences into the development of learning material can improve learning effectiveness.

Effectiveness of a smoking cessation program on self-esteem, attitude, perception, and practice regarding control over smoking among male high school

Purpose

The smoking rate of male high school students continues to increase. Therefore, the purpose of this paper is to examine the effectiveness of a smoking cessation program on self-esteem, attitude, perception and practice regarding smoking behavioral control among male high school students in Ubon Ratchathani Province, Thailand.

Design/methodology/approach

The effectiveness of the smoking cessation program was tested by a quasi-experimental pre-posttest and follow-up with a 24-week design. Multistage sampling was used to recruit 70 male high school students, including 35 male students in the intervention group and 35 male students in the control group. The intervention group received a 12-week smoking cessation program based on information-motivation-behavioral skills and stages of change models and follow-up at 12 weeks, whereas the control group did not. A self-administered questionnaire was used to assess the improvement of subjects’ self-esteem, attitude toward smoking, perceived control over smoking, number of cigarettes per day and urine cotinine test. The descriptive statistics, generalized estimating equation and proportion test were used for data analysis.

Findings

After the program, there were statistically significant differences in mean scores between the group and control groups; the difference of self-esteem was 4.15 (95% CI: 1.95, 6.36), attitude toward smoking was 3.30 (95% CI: 1.89, 5.52) and perceived control over smoking was 6.99 (95% CI: 4.04, 9.94). Thus, all differences in the intervention group were significantly higher than in the control group. The proportion of non-smokers, measured by the urine cotinine test at follow-up, was 25 percent (95% CI: 0.03, 0.48) significantly higher (p-value = 0.015), in the intervention group. Therefore, the smoking cessation program in this study was effective at changing the behavior of male high school student smokers.

Originality/value

This smoking cessation program increased self-esteem, attitude toward smoking, perceived control over smoking and decreased smoking per day among male high school students. Therefore, schools and parents should focus on developing these factors to encourage students to quit smoking.

The Methodological Quality and Effectiveness of Technology-Based Smoking Cessation Interventions for Disadvantaged Groups: A Systematic Review and Meta-analysis

Aims

To assess the methodological quality and effectiveness of technology-based smoking cessation interventions in disadvantaged groups.

Method

Four databases (EMBASE, Cochrane, Medline, and PsycInfo) were searched for studies conducted from 1980 to May 2016. Randomized controlled trials that compared a behavioral smoking cessation intervention delivered primarily through a technology-based platform (eg, mobile phone) with a no-intervention comparison group among disadvantaged smokers were included. Three reviewers assessed all relevant studies for inclusion, and one reviewer extracted study, participant and intervention-level data, with a subset crosschecked by a second reviewer.

Results

Thirteen studies targeting disadvantaged smokers (n =4820) were included. Only one study scored highly in terms of methodological rigor on EPOC criteria for judging risk of bias. Of the 13 studies using a technology-based platform, most utilized websites (n = 5) or computer programs (n = 5), and seven additionally offered nicotine replacement therapy. Technology-based interventions increased the odds of smoking cessation for disadvantaged groups at 1 month (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.10, 2.63), 3 months (OR 1.30, 95% CI 1.07, 1.59), 6 months (OR 1.29, 95% CI 1.03, 1.62), and 18 months post-intervention (OR 1.83, 95% CI 1.11, 3.01).

Conclusion

Few methodologically rigorous studies were identified. Mobile phone text-messaging, computer- and website-delivered quit support showed promise at increasing quit rates among Indigenous, psychiatric and inpatient substance use disorder patients. Further research is needed to address the role technology-based interventions have on overcoming health inequalities to meet the needs of disadvantaged groups.

Implications

This review provides the first quantitative evidence of the effectiveness of a range of technology-based smoking cessation interventions among disadvantaged smokers, with separate estimates on the basis of intervention type, and cessation outcome measure. Providing cost-effective, easily accessible and real-time smoking cessation treatment is needed, and innovative technology-based platforms will help reach this endpoint. These interventions need to be tested in larger scale randomized controlled trial designs and target broader disadvantaged groups. Data collection beyond 6 months is also needed in order to establish the efficacy of these intervention approaches on long-term cessation rates among disadvantaged population groups.

Evaluation of the effects of a designated program on illegal drug cessation among adolescents who experiment with drugs

BACKGROUND

Studies indicate that adolescent-onset drug users experience a greater likelihood of dependence that continues into adulthood. The importance of early intervention was evident in treating adolescents before their substance use progressed. We examined the effectiveness of an intervention program that prevents students who experiment with drugs from reusing them.

METHODS

The study was based on 10 out of 18 invited schools that were randomly assigned to either the intervention group (5 schools, n = 43) or the comparison group (5 schools, n = 41). The intervention group received an E-course program that comprised a main intervention course (12 sessions) and a booster course (2 sessions). By reducing the burden of teaching content during the 14 sessions, the in-class counselor had opportunities for face-to-face discussions with students on their ambivalence toward quitting illegal drugs. The comparison group received the conventional didactic drug prevention course (2 sessions). Outcomes in terms of stress management, refusal skills, pros of drug use, cons of drug use, and drug use resistance self-efficacy were measured via structured questionnaires conducted thrice: at baseline, after the main intervention sessions, and after the booster sessions. A linear mixed model (LMM) was employed to investigate the effects of time and groups on the outcome variables with group, time, and group × time as fixed effects. Subjects and schools were selected as random effects in order to consider both within-subject and within-school correlations.

RESULTS

There was a significant group × time interaction with regard to stress management, refusal skills, pros of drug use, and drug use resistance self-efficacy, excluding cons of drug use. The intervention group displayed better stress management compared to the comparison group after the booster intervention. Similar between-group differences were identified in that the intervention group displayed better refusal skills and drug use resistance self-efficacy compared to that of the comparison group. The intervention group favored using drugs less (a decrease in the pros of drug use score) compared to the comparison group after the booster intervention.

CONCLUSIONS

Our program provided an example of the results of early intervention among students who experiment with illegal drugs.

Tobacco cessation interventions for young people

BACKGROUND

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effectiveness of strategies that help young people to stop smoking tobacco.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO.

SELECTION CRITERIA

We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up.

MAIN RESULTS

Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias.

AUTHORS' CONCLUSIONS

There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

The Experiences of Tobacco Use among South-Western Taiwanese Adolescent Males

Most smokers start young. Initiation of cigarette smoking at an earlier age leads to more life-years for tobacco use, makes quitting harder, and increases the risk of serious health consequences. Despite these challenges, research focusing on smoking behavior among adolescent boys in Taiwan is rare. Although the Taiwanese government enacted the Tobacco Hazards Prevention Act in 2009, aimed at prevention and reducing the rate of smoking, the percentage of high school students who smoke has continued to increase. In 2006, 7.5% of adolescent boys engaged in smoking. By 2012 the rate had increased to 24.6%. This paper explores the experiences that contribute to adolescent Taiwanese boys making the decision to smoke. A phenomenological approach to inquiry was used as the philosophical foundations for this study with twelve adolescent boys who engaged in smoking behaviors. Data was gathered through two face-to-face semi-structured interviews and a focus group. Data analysis was performed using Colaizzi's analysis method. Findings indicated that decisions to begin smoking were motivated by curiosity and as a means of establishing friendships while decisions to continue smoking were linked to the addictive nature of smoking and as a means of coping with stress and passing the time. The findings can be used to inform the prevention of tobacco use and to reduce the high smoking rates among adolescent boys.

Update of Adolescent Smoking Cessation Interventions: 2009-2014

The treatment of adolescent tobacco dependence is an imperative public health goal. Adolescent-focused smoking cessation interventions have shown modest results at most, indicating the need for the development of innovative and effective interventions for this vulnerable population. This review aims to provide an update of smoking cessation interventions for youth by reviewing the literature published between 2009 and November 2014 evaluating psychosocial and pharmacological interventions. Based on this examination, future directions for research in advancing the development of adolescent-focused tobacco treatments are provided.