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Rashidi Mohamed PM, Mohd Hairi F, Bullen C, Nordin ASA. The feasibility and efficacy of the group-based therapy for smoking cessation in Klang Valley, Malaysia. Tob Induc Dis 2024; 22:TID-22-50. [PMID: 38476513 PMCID: PMC10928854 DOI: 10.18332/tid/175617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Tobacco epidemic is a global public health concern, killing more than 8 million people annually. Individual therapy is the standard of care of behavioral intervention for smoking cessation in Malaysia and group-based therapy for smoking cessation is an alternative to behavioral intervention commonly used in the western population effectively. The study explored the feasibility and efficacy of group-based therapy for smoking cessation for smokers who want to quit smoking at a quit smoking clinic and community centers in an urban setting in Malaysia. METHODS A total of 40 participants who were active smokers and fulfilled the criteria were recruited for the study at the quit smoking clinic. Participants were given behavioral support based on the GBT-M module and individually for 7 weeks with both groups receiving behavioral intervention plus pharmacotherapy. RESULTS The median age of participants was 48 years for individual therapy and 45 years for group therapy. Group-based therapy was comparable to individual therapy in smoking abstinence outcome at 4 weeks post quit date (35% vs 30%). CONCLUSIONS Group-based therapy was equally effective compared to individual therapy, similar to the western population. Using a group format should allow more people to be treated by a therapist, and therefore could be more cost-effective. Group-based therapy is an option to be included as part of the smoking cessation program in Malaysia.
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Affiliation(s)
- Pakri Mohamed Rashidi Mohamed
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Family Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher Bullen
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amer Siddiq Amer Nordin
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Walker N, von Blaramberg T, Mackay J, McNaughton W, Strickland J, Van Mil J, Moorcroft J, Funnell C, Smith L, Bettle E, Power K, Parore M, Parag V, Bullen C, Springford Metcalfe S. Effectiveness of a preschool asthma education programme, compared to usual care, on the frequency of acute asthma events: a community-based cluster randomised trial. N Z Med J 2022; 135:80-92. [PMID: 35728220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM To determine whether an asthma intervention delivered within preschools can improve asthma outcomes in children aged 2-5 years with asthma or a high probability of asthma. METHODS Between 2011 and 2013, we undertook a pragmatic, single-blind, cluster randomised trial in Auckland, New Zealand. We randomly assigned (1:1 ratio) preschools, and their children aged 2-5 years with asthma or a high probability of asthma, to receive an asthma intervention (a 12-month respiratory nurse-led asthma assessment using an evidence-based, web-based tool and a class-based asthma education programme for four months), or a control intervention (a class-based science education programme for four months). Both groups received standard asthma management by their primary care physician. The primary outcome was the proportion of children that had at least one unscheduled ("urgent") medical or ED attendance for asthma over 12 months. RESULTS We randomised 171 preschools, 85 to the intervention (341 children) and 86 to the control (334 children). We found no difference in the primary outcome (intervention: 216/341, 63% vs control: 181/334, 54%: adjusted Odds Ratio=1.36, 95% Confidence Interval=0.95-1.94, p=0.095). However, compared with the control group, the intervention group had improved and sustained asthma control and fewer asthma symptoms over 12 months. CONCLUSIONS Combining asthma education with a nurse-led, evidence-based asthma assessment and education intervention led to sustained improvements in asthma control in this preschool population, but its effect on acute events remains unclear.
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Affiliation(s)
- Natalie Walker
- Associate Professor in Population Health, National Institute for Health Innovation, School of Population Health, The University of Auckland New Zealand
| | - Taina von Blaramberg
- Project Manager, formerly at the National Institute for Health Innovation, School of Population Health, The University of Auckland New Zealand
| | - Janet Mackay
- Manager Implementation, Pharmaceutical Management Agency of New Zealand
| | - Wendy McNaughton
- Respiratory Programme Manager, formerly at Comprehensive Care Ltd., Albany, Auckland, New Zealand
| | - Janine Strickland
- Team Leader, formerly at Comprehensive Care Ltd. Albany, Auckland, New Zealand
| | - Janice Van Mil
- Formerly at Comprehensive Care Ltd. Albany, Auckland, New Zealand
| | - Joanne Moorcroft
- Formerly at Comprehensive Care Ltd. Albany, Auckland, New Zealand
| | - Caroline Funnell
- Formerly at Comprehensive Care Ltd. Albany, Auckland, New Zealand
| | - Lynne Smith
- Formerly at Comprehensive Care Ltd. Albany, Auckland, New Zealand
| | - Emma Bettle
- Co-Director, Ministry of Done, Hamilton, New Zealand
| | - Kylie Power
- Co-Director, Ministry of Done, Hamilton, New Zealand
| | | | - Varsha Parag
- Senior Biostatistician, National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- Professor in Population Health, National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Scott Springford Metcalfe
- Chief Advisor Population Medicine/Deputy Medical Director, Pharmaceutical Management Agency of New Zealand, Wellington, New Zealand
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Chu JTW, Wadham A, Jiang Y, Stasiak K, Shepherd M, Bullen C. Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e17723. [PMID: 34932007 PMCID: PMC8726057 DOI: 10.2196/17723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/05/2020] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. OBJECTIVE This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. METHODS A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. RESULTS Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). CONCLUSIONS The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307.
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Affiliation(s)
- Joanna Ting Wai Chu
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Christopher Bullen
- The National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Foulds J, Cobb CO, Yen MS, Veldheer S, Brosnan P, Yingst J, Hrabovsky S, Lopez AA, Allen SI, Bullen C, Wang X, Sciamanna C, Hammett E, Hummer BL, Lester C, Richie JP, Chowdhury N, Graham JT, Kang L, Sun S, Eissenberg T. Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers with no Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial. Nicotine Tob Res 2021; 24:955-961. [PMID: 34850164 DOI: 10.1093/ntr/ntab247] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 06/25/2021] [Revised: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking is unclear. This exploratory analysis examined the effects of ENDS delivering different amounts of nicotine on cigarette abstinence up to 24-week follow-up, in comparison to placebo or a behavioral substitute. METHODS This four-arm parallel-group, randomized, placebo-controlled trial took place at two academic medical centers in USA (Penn State Hershey and Virginia Commonwealth University). Participants were current adult smokers (N=520) interested in reducing but not planning to quit. They received brief advice and were randomized to one of four 24-week conditions, receiving either an eGo-style ENDS paired with 0, 8 or 36 mg/ml nicotine liquid (double-blind) or a cigarette-shaped tube, as a cigarette substitute (CS). Self-reported daily cigarette consumption and exhaled carbon monoxide (CO) were measured at all study visits. Outcomes included intent-to-treat, self-reported 7-day cigarette abstinence, biochemically confirmed by exhaled CO at 24 weeks after randomization. RESULTS At 24 weeks, significantly more participants in the 36 mg/ml condition (14/130, 10.8%) than in the 0 mg/ml condition (1/130, 0.8%) and the CS condition (4/130, 3.1%) were abstinent (relative risk = 14 [95% CI=1.9-104.9] and 3.5 [95% CI=1.2-10.4], respectively). The abstinence rate in the 8 mg/ml condition was 4.6% (6/130). CONCLUSIONS When smokers seeking to reduce smoking tried ENDS, few quit smoking in the short term. However, if smokers continued to use an ENDS with cigarette-like nicotine delivery, a greater proportion completely switched to ENDS, as compared with placebo or a cigarette substitute. IMPLICATIONS The extent to which use of electronic nicotine delivery systems (ENDS) for smoking reduction leads to cigarette abstinence in smokers with no plans to quit smoking was unclear. This randomized trial found that ENDS with nicotine delivery approaching that of a cigarette are more effective in helping ambivalent smokers to quit cigarette smoking.
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Affiliation(s)
- Jonathan Foulds
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Caroline O Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Susan Veldheer
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Phoebe Brosnan
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Jessica Yingst
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Shari Hrabovsky
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Alexa A Lopez
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Sophia I Allen
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Christopher Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Xi Wang
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Chris Sciamanna
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Erin Hammett
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Breianna L Hummer
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Courtney Lester
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - John P Richie
- Center for Research on Tobacco & Health, Penn State College of Medicine, Hershey, PA
| | - Nadia Chowdhury
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Jacob T Graham
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Le Kang
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Shumei Sun
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
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Walker N, Smith B, Barnes J, Verbiest M, Parag V, Pokhrel S, Wharakura M, Lees T, Cubillos Gutierrez H, Jones B, Bullen C. Cytisine versus varenicline for smoking cessation in New Zealand indigenous Māori: a randomized controlled trial. Addiction 2021; 116:2847-2858. [PMID: 33761149 PMCID: PMC8519028 DOI: 10.1111/add.15489] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/13/2020] [Accepted: 03/10/2021] [Indexed: 01/06/2023]
Abstract
AIM To determine whether cytisine was at least as effective as varenicline in supporting smoking abstinence for ≥ 6 months in New Zealand indigenous Māori or whānau (extended-family) of Māori, given the high smoking prevalence in this population. DESIGN Pragmatic, open-label, randomized, community-based non-inferiority trial. SETTING Bay of Plenty, Tokoroa and Lakes District Health Board regions of New Zealand. PARTICIPANTS Adult daily smokers who identified as Māori or whānau of Māori, were motivated to quit in the next 2 weeks, were aged ≥ 18 years and were eligible for subsidized varenicline. Recruitment used multi-media advertising. INTERVENTIONS A total of 679 people were randomly assigned (1 : 1) to receive a prescription for 12 weeks of cytisine or varenicline, plus low-intensity cessation behavioural support from the prescribing doctor and community stop-smoking services or a research assistant. Day 5 of treatment was the designated quit date. MEASUREMENTS The primary outcome was carbon monoxide-verified continuous abstinence at 6 months, analysed as intention-to-treat (with multiple imputation for missing data). Secondary outcomes measured at 1, 3, 6 and 12 months post-quit date included: self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance and acceptability, nicotine withdrawal/urge to smoke and health-care utilization/health-related quality of life. FINDINGS Verified continuous abstinence rates at 6 months post-quit date were 12.1% (41 of 337) for cytisine versus 7.9% (27 of 342) for varenicline [risk difference 4.29%, 95% confidence interval (CI) = -0.22 to 8.79; relative risk 1.55; 95% CI = 0.97-2.46]. Sensitivity analyses confirmed that the findings were robust. Self-reported adverse events over 6 months occurred significantly more frequently in the varenicline group (cytisine: 313 events in 111 participants; varenicline: 509 events in 138 participants, incidence rate ratio 0.56, 95% CI = 0.49-0.65, P < 0.001) compared with the cytisine group. Common adverse events were headache, nausea and difficulty sleeping. CONCLUSION A randomized controlled trial found that cytisine was at least as effective as varenicline at supporting smoking abstinence in New Zealand indigenous Māori or whānau (extended-family) of Māori, with significantly fewer adverse events.
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Affiliation(s)
- Natalie Walker
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Barry Smith
- Lakes District Health BoardRotoruaNew Zealand
| | - Joanne Barnes
- School of Pharmacy, The University of AucklandAucklandNew Zealand
| | - Marjolein Verbiest
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
| | - Varsha Parag
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Mary‐Kaye Wharakura
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Tina Lees
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Huber Cubillos Gutierrez
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Brian Jones
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
| | - Christopher Bullen
- National Institute for Health InnovationSchool of Population Health, The University of AucklandAucklandNew Zealand
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Mohamed R, Bullen C, Hairi FM, Nordin ASA. A systematic review of group therapy programs for smoking cessation in Asian countries. Tob Induc Dis 2021; 19:63. [PMID: 34413718 PMCID: PMC8336625 DOI: 10.18332/tid/140089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/26/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco causes more than 8 million deaths each year. Behavioral interventions such as group therapy, which provides counselling for smoking cessation, can be delivered in group form and smokers who receive cessation counselling are more likely to quit smoking compared to no assistance. We review the evidence of group-based counselling for smoking cessation for smokers in Asian countries. METHODS The review aims to determine the availability of group-based therapy for smoking cessation in Asian countries. The outcome measured was abstinence from smoking following group therapy. Electronic database searches in PubMed, OVID Medline, SCOPUS, Google Scholar, and PsycINFO, using keywords such as: ‘smoking’, ‘cigarette’, ‘tobacco’, ‘nicotine’, ‘group therapy’ and ‘cessation’ (smok*, *cigarette*, tobacco, nicotine, group therap*, cessation) were used. The results were reported following PRISMA and PROSPERO guidelines. Review Manager was used for data analysis. RESULTS A total of 21251 records were retrieved for screening the abstracts. In all, 300 articles for review were identified and assessed for eligibility. Nine articles, including Cochrane reviews, randomized control trials, cohort, observational and cross-sectional studies, were included in the final review. There were three observational qualitative studies, two prospective cohort studies, two crosssectional studies, one non-randomized quasi-experimental study and a single cluster-randomized, controlled trial. Group therapy was found to significantly increase the abstinence rate. Group therapy provided at the workplace, smoking cessation services, availability of pharmacotherapy, and socioeconomic status, appear to be key factors determining success. CONCLUSIONS Evidence of the use of group therapy for smoking cessation in Asian countries is still lacking despite publications in the Western population showed that group therapy was effective. Further research on group-based interventions for smoking cessation in Asian countries is required and direct one-to-one comparisons between group therapy and individual therapy for smokers who want to quit smoking, are needed.
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Affiliation(s)
- Rashidi Mohamed
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Bangi, Malaysia
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Farizah Mohd Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,University of Malaya Centre for Addiction Science Studies, Universiti Malaya, Kuala Lumpur, Malaysia
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Cobb CO, Foulds J, Yen MS, Veldheer S, Lopez AA, Yingst JM, Bullen C, Kang L, Eissenberg T. Effect of an electronic nicotine delivery system with 0, 8, or 36 mg/mL liquid nicotine versus a cigarette substitute on tobacco-related toxicant exposure: a four-arm, parallel-group, randomised, controlled trial. Lancet Respir Med 2021; 9:840-850. [PMID: 33857436 DOI: 10.1016/s2213-2600(21)00022-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDSs) are used by some smokers to reduce cigarette consumption, but their effectiveness is uncertain. We aimed to examine the extent to which ENDSs or a non-nicotine cigarette substitute influence tobacco-related toxicant exposure and cigarette consumption in smokers interested in smoking reduction. METHODS We did a four-arm, parallel-group, randomised controlled trial at two sites in the USA (Penn State University, Hershey, PA, and Virginia Commonwealth University, Richmond, VA). We enrolled adults aged 21-65 years who smoked more than nine cigarettes per day (for at least the past year), with exhaled CO of more than 9 parts per million at screening, who were not currently using an ENDS, and who were interested in reducing smoking but not quitting. Participants were randomised (site-specific with allocation concealment; 1:1:1:1) to receive either a cartomiser-based, pen-style ENDS (eGo-style) paired with 0, 8, or 36 mg/mL liquid nicotine (participants and researchers masked to concentration) or a non-ENDS cigarette-shaped plastic tube that delivered no nicotine or aerosol (cigarette substitute; unmasked) for 24 weeks. Conditions were chosen to reflect a range of nicotine delivery including none (cigarette substitute and 0 mg/mL ENDS), low (8 mg/mL), and cigarette-like (36 mg/mL), and all conditions were paired with smoking reduction instructions. The primary outcome was concentration of the tobacco-specific carcinogen metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL; urinary total) collected at randomisation and at 4, 12, and 24 weeks. Multiple imputation with and without covariate adjustment was used in addition to sensitivity analyses. This trial is registered with ClinicalTrials.gov, NCT02342795. FINDINGS Between July 22, 2015, and Nov 16, 2017, 684 individuals were screened and 520 (76%) were enrolled and randomised. 188 (36%) of 520 participants were lost to follow-up by week 24; attrition did not differ by study group (39 [30%] of 130 in the cigarette substitute group, 56 [43%] of 130 in the ENDS with 0 mg/mL nicotine group, 49 [38%] of 130 in the ENDS 8 mg/mL group, and 44 [34%] of 130 in the ENDS 36 mg/mL group). Urinary total NNAL at 24 weeks in the ENDS with 36 mg/mL nicotine group was 210·80 pg/mg creatinine (95% CI 163·03-274·42) compared with 346·09 pg/mg creatinine (265·00-455·32) in the cigarette substitute group (p=0·0061). No other significant differences between groups were observed for any time point for urinary total NNAL. Serious adverse event frequency was similar across groups (12 events in 12 participants [9%] in the ENDS with 36 mg/mL nicotine group, seven events in six participants [5%] in the 8 mg/mL group, 11 events in ten participants [8%] in the 0 mg/mL group, and 13 events in 13 participants [10%] in the cigarette substitute group), and all of these were deemed unrelated or unlikely to be related to study product use. There was one death between randomisation and 24 weeks (suicide; in the ENDS with 0 mg/mL nicotine group). INTERPRETATION Use of an ENDS with cigarette-like nicotine delivery can reduce exposure to a major pulmonary carcinogen, NNAL, even with concurrent smoking. Future ENDS trials should involve products with well characterised nicotine delivery, including those with nicotine delivery approaching that of a cigarette. FUNDING National Institutes of Health, US Food and Drug Administration.
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Affiliation(s)
- Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jonathan Foulds
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Miao-Shan Yen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Veldheer
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA; Department of Family and Community Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Alexa A Lopez
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jessica M Yingst
- Center for Research on Tobacco and Health, Penn State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
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Piper ME, Bullen C, Krishnan-Sarin S, Rigotti NA, Steinberg ML, Streck JM, Joseph AM. Defining and Measuring Abstinence in Clinical Trials of Smoking Cessation Interventions: An Updated Review. Nicotine Tob Res 2020; 22:1098-1106. [PMID: 31271211 DOI: 10.1093/ntr/ntz110] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/02/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Changes in tobacco products, use patterns, and assessment technology in the last 15 years led the Society for Research on Nicotine and Tobacco (SRNT) Treatment Research Network to call for an update to the 2003 SRNT recommendations for assessing abstinence in clinical trials of smoking cessation interventions. METHODS The SRNT Treatment Research Network convened a group of investigators with decades of experience in conducting tobacco treatment clinical trials. To arrive at the updated recommendations, the authors reviewed the recommendations of the prior SRNT Workgroup as well as current literature. Ten additional experts in the field provided feedback on this paper and these recommendations. RESULTS With respect to defining abstinence, the authors recommend: (1) continuing to use the definition of no use of combustible tobacco products (regardless of use of noncombustible tobacco products [e.g., snus] and alternative products [e.g., e-cigarettes]) and collecting additional data to permit alternate abstinence definitions; (2) no use of combustible or smokeless tobacco products; and (3) no use of combustible or smokeless tobacco products or alternative products, as appropriate for the research question being addressed. The authors also recommend reporting point prevalence and prolonged abstinence at multiple timepoints (end of treatment, ≥3 months after the end of treatment, and ≥6 months postquit or posttreatment initiation). CONCLUSIONS Defining abstinence requires specification of which products a user must abstain from using, the type of abstinence (i.e., point prevalence or continuous), and the duration of abstinence. These recommendations are intended to serve as guidelines for investigators as they collect the necessary data to accurately describe participants' abstinence during smoking cessation clinical trials. IMPLICATIONS This paper provides updated recommendations for defining abstinence in the context of smoking cessation treatment clinical trials.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention of Wisconsin, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Nancy A Rigotti
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marc L Steinberg
- Division of Addiction Psychiatry, Rutgers University, New Brunswick, NJ
| | - Joanna M Streck
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota, Minneapolis, MN
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Chen J, Ho E, Jiang Y, Whittaker R, Yang T, Bullen C. Mobile Social Network-Based Smoking Cessation Intervention for Chinese Male Smokers: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17522. [PMID: 33095184 PMCID: PMC7647814 DOI: 10.2196/17522] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/04/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Abstract
Background Around 2 million Chinese people, mostly men, die annually from tobacco-related diseases; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation support. Objective This study aimed to test the preliminary effectiveness and feasibility for a mobile social network (WeChat)–based smoking cessation intervention (SCAMPI program) among Chinese male smokers. Methods Chinese male smokers aged 25-44 years were recruited online from WeChat, the most widely used social media platform in China. Individuals using other smoking cessation interventions or who lacked capacity to provide online informed consent were excluded. Participants were randomly assigned (1:1) to intervention or control groups. Neither participants nor researchers were masked to assignment. The trial was fully online. All data were collected via WeChat. The intervention group received access to the full-version SCAMPI program, a Chinese-language smoking cessation program based on the Behaviour Change Wheel framework and relevant cessation guidelines. Specific intervention functions used in the program include: planning to help users make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, information about smoking harms, motivational messages to help users overcome urges, standardized tests for users to assess their levels of nicotine dependence and lung health, as well as a social platform to encourage social support between users. The control group had access to a static WeChat page of contacts for standard smoking cessation care. Both groups received incentive credit payments for participating. The primary outcome was 30-day biochemically verified smoking abstinence at 6 weeks after randomization, with missing data treated as not quitting. Secondary outcomes were other smoking status measures, reduction of cigarette consumption, study feasibility (recruitment and retention rate), and acceptability of and satisfaction with the program. Results The program recorded 5736 visitors over a 13-day recruitment period. We recruited 80 participants who were randomly allocated to two arms (n=40 per arm). At 6 weeks, 36 of 40 (90%) intervention participants and 35 of 40 (88%) control participants provided complete self-reported data on their daily smoking status via WeChat. Biochemically verified smoking abstinence at 6 weeks was determined for 10 of 40 (25%) intervention participants and 2 of 40 (5%) control participants (RR=5, 95% CI 1.2-21.4, P=.03). In the intervention group, the calculator function, motivational messages, and health tests were underused (less than once per week per users). Participants rated their satisfaction with the intervention program as 4.56 out of 5.00. Conclusions Our program is a novel, accessible, and acceptable smoking cessation intervention for Chinese male smokers. A future trial with a greater sample size and longer follow-up will identify if it is as effective as these preliminary data suggest. Trial Registration ANZCTR registry, ACTRN12618001089224; https://tinyurl.com/y536n7sx International Registered Report Identifier (IRRID) RR2-18071
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Affiliation(s)
- Jinsong Chen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Elsie Ho
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tingzhong Yang
- Centre for Tobacco Control Research, Zhejiang University, Hangzhou, China
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Lim SH, Daghar L, Bullen C, Faiz HM, Akbar M, Amer Nordin AS, Yee A. Tobacco Use and Cessation Among a National Online Sample of Men Who Have Sex With Men in Malaysia. Asia Pac J Public Health 2020; 32:414-417. [PMID: 33084374 DOI: 10.1177/1010539520965370] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/17/2022]
Abstract
Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P = .001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized.
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Affiliation(s)
- Sin How Lim
- University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Mohd Akbar
- University of Malaya, Kuala Lumpur, Malaysia
| | | | - Anne Yee
- University of Malaya, Kuala Lumpur, Malaysia
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11
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Chen J, Ho E, Jiang Y, Whittaker R, Yang T, Bullen C. A Mobile Social Network-Based Smoking Cessation Intervention for Chinese Male Smokers: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18071. [PMID: 32945261 PMCID: PMC7532454 DOI: 10.2196/18071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/29/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Approximately 2 million Chinese people die annually from tobacco-related diseases, mostly men; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation advice or support. A social network–based gamified smoking cessation intervention (SCAMPI: Smoking Cessation App for Chinese Male: Pilot Intervention) is designed to help Chinese male smokers to quit smoking. Objective This paper aims to present the protocol of a study examining the preliminary effectiveness of SCAMPI by comparing the prolonged abstinence rate of a group of users with a comparator group during a 6-week follow-up period. Methods A two-arm pilot randomized controlled trial was conducted to assess the preliminary effectiveness and acceptability of the SCAMPI program as a smoking cessation intervention. After initial web-based screening, the first 80 eligible individuals who had gone through the required registration process were registered as participants of the trial. Participants were randomly allocated to the intervention group (n=40) and the control group (n=40). Participants in the intervention group used the full version of the SCAMPI program, which is a Chinese smoking cessation program developed based on the Behavior Change Wheel framework and relevant smoking cessation and design guidelines with involvement of target users. The program delivers a range of smoking cessation approaches, including helping users to make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, providing information about smoking harms, motivational messages to help users overcome urges, providing standardized tests to users for assessing their levels of nicotine dependence and lung health, and providing a platform to encourage social support between users. Participants in the control group used the restricted version of the SCAMPI program (placebo app). Results Recruitment for this project commenced in January 2019 and proceeded until March 2019. Follow-up data collection was commenced and completed by June 2019. The primary outcome measure of the study was the 30-day bio-verified smoking abstinence at the 6-week follow-up (self-reported data verified by the Nicotine Cotinine Saliva Test). The secondary outcome measures of the study included participants’ cigarette consumption reduction (compared baseline daily cigarette consumption with end-of-trial daily cigarette consumption), participants’ 7-day smoking abstinence at 4-week and 6-week follow-up (self-reported), participants’ 30-day smoking abstinence at 6-week follow-up (self-reported data only), and participants’ acceptability and satisfaction levels of using the SCAMPI program (measured by the Mobile App Rating Scale questionnaire). Conclusions If the SCAMPI program is shown to be preliminary effective, the study will be rolled out to be a future trial with a larger sample size and longer follow-up (6 months) to identify if it is an effective social network–based tool to support Chinese male smokers to quit smoking. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001089224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375381 International Registered Report Identifier (IRRID) RR1-10.2196/18071
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Affiliation(s)
- Jinsong Chen
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Elsie Ho
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Tingzhong Yang
- Centre for Tobacco Control Research, School of Medicine, The Zhejiang University, Hangzhou, China
| | - Christopher Bullen
- The National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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12
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Jiang S, Yang T, Bullen C, Chen J, Yu L, Peng S, Rockett IRH. Real-world unassisted quit success and related contextual factors: a population-based study of Chinese male smokers. Tob Control 2020; 30:498-504. [PMID: 32675250 DOI: 10.1136/tobaccocontrol-2019-055594] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/26/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the association of exposure to secondhand smoke (SHS) and tobacco advertising with unassisted smoking cessation among Chinese male smokers. METHODS A questionnaire was administered to 6500 male adult smokers from six cities in China selected in a cross-sectional multistage sampling design. The survey collected self-reported demographic characteristics, smoking and cessation status, SHS exposure and tobacco advertising exposure, with 5782 valid questionnaires included in this study. Multiple logistic regression analysis was used to assess the association of unassisted smoking cessation with exposure to SHS and tobacco advertising. RESULTS 42.1% of smokers who made unassisted quit attempts achieved abstinence (95% CI 32.5% to 51.7%). SHS (adjusted OR (aOR) 0.36; 95% CI 0.18 to 0.71; p=0.033) and tobacco advertising exposure (aOR 0.63; 95% CI 0.37 to 0.95; p=0.039) were negatively associated with unassisted smoking cessation. CONCLUSION The vast majority of Chinese male smokers rely on unassisted methods to quit smoking. Success prevalence is high, which is very beneficial to health. This study suggests that exposure to secondhand smoking and tobacco advertising hinders the success of unassisted cessation. These findings speak to the need for environmental tobacco control measures to promote unassisted smoking cessation among Chinese adult male smokers.
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Affiliation(s)
- Shuhan Jiang
- School of Humanities and Management, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tingzhong Yang
- Children's Hospital/Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Christopher Bullen
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Jinsong Chen
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Lingwei Yu
- Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sihui Peng
- Center for Tobacco Control Research, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ian R H Rockett
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, USA.,Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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13
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Wang TKM, Grey C, Jiang Y, Bullen C, Jackson R, Kerr A. Increases in early discharge following acute coronary syndrome hospitalisations and associated clinical outcomes in New Zealand between 2006 and 2015: ANZACS-QI-43 study. Intern Med J 2020; 51:1312-1320. [PMID: 32447807 DOI: 10.1111/imj.14927] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/18/2020] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND International guidelines recommend early discharge for uncomplicated acute coronary syndrome (ACS) patients within 3 days; however, there is a paucity of contemporary literature regarding the safety of this strategy. AIMS To report the trends in the proportion of ACS hospitalisations discharged within 3 days and their outcomes in New Zealand. METHODS ACS hospitalisations 2006-2015 using national routinely collected data were categorised by length of stay (LOS) into ≤3, 4-5 and >5 days, excluding deaths during the index admission. Trend analysis of death, cardiovascular and bleeding events and their composites (net adverse clinical events) at 30-day and 1-year post-discharge were performed using generalised linear mixed regression models adjusting for covariates by LOS subgroups. RESULTS Among 130 037 ACS hospitalisations, LOS ≤ 3 days increased from 32% in 2006 to 44% in 2016. This trend was observed for all demographics, ACS subtypes and management strategies. Event rates at 30 days and 1 year were the lowest for the LOS ≤3 days subgroup (all-cause mortality 1.6% and 9.1% respectively). Thirty-day and 1-year all-cause mortality rates were unchanged over time for this subgroup (adjusted odds ratio (95% confidence interval) of 1.011 (0.985-1.038) and 0.991 (0.979-1.003)), while net adverse clinical event rates significantly decreased (0.962 (0.950-0.973) and 0.972 (0.964-0.980) respectively). CONCLUSION There was a substantial increase in early discharge post-ACS over 10 years. These patients were associated with reduction in adverse clinical events up to 1 year and no increase in all-cause mortality. These findings from a comprehensive national register suggest that guideline recommendations on early discharge after uncomplicated ACS are safe and appropriate.
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Affiliation(s)
- Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand
| | - Corina Grey
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Andrew Kerr
- Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.,Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.,Department of Medicine, University of Auckland, Auckland, New Zealand
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14
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Yingst J, Foulds J, Veldheer S, Cobb CO, Yen MS, Hrabovsky S, Allen SI, Bullen C, Eissenberg T. Measurement of Electronic Cigarette Frequency of Use Among Smokers Participating in a Randomized Controlled Trial. Nicotine Tob Res 2020; 22:699-704. [PMID: 30365024 PMCID: PMC7171268 DOI: 10.1093/ntr/nty233] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 01/30/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The United States Food and Drug Administration has prioritized understanding the dependence potential of electronic cigarettes (e-cigs). Dependence is often estimated in part by examining frequency of use; however measures of e-cig use are not well developed because of varying product types. This study used an e-cig automatic puff counter to evaluate the value of self-reported e-cig use measures in predicting actual use (puffs). METHODS Data were collected from a two-site randomized placebo-controlled trial evaluating the effects of e-cigs on toxicant exposure in smokers attempting to reduce their cigarette consumption. Participants randomized to an e-cig condition self-reported their e-cig frequency of use (times per day-one "time" consists of around 15 puffs or lasts around 10 minutes) on the Penn State Electronic Cigarette Dependence Index (PSECDI) and kept daily diary records of the number of puffs per day from the e-cig automatic puff counter. A linear mixed-effects model was used to determine the predictive value of the times per day measure. Correlations were used to further investigate the relationship. RESULTS A total of 259 participants with 1165 observations of e-cig use were analyzed. Self-reported e-cig use in times per day was a significant predictor of e-cig puffs per day (p < .01). The Spearman correlation between measures was r equal to .58. Examination of individual participant responses revealed some potential difficulties reporting and interpreting times per day because of the difference in use patterns between cigarettes and e-cigs. CONCLUSION This study provides evidence that the self-reported PSECDI measure of times per day is a significant predictor of actual frequency of e-cig puffs taken. IMPLICATIONS Self-reported measures of e-cig frequency of use are predictive of actual use, but quantifying e-cig use in patterns similar to cigarettes is problematic.
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Affiliation(s)
- Jessica Yingst
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Susan Veldheer
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Miao-Shan Yen
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA
| | - Shari Hrabovsky
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | - Sophia I Allen
- Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, Hershey, PA
| | | | - Thomas Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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15
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Walker N, Parag V, Verbiest M, Laking G, Laugesen M, Bullen C. Nicotine patches with e-cigarettes for smoking cessation: Twitter discussion from a respirology journal club - Authors' reply. Lancet Respir Med 2020; 8:e9. [PMID: 32135097 DOI: 10.1016/s2213-2600(20)30073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Natalie Walker
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Marjolein Verbiest
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - George Laking
- Department of Oncology, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Murray Laugesen
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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16
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Walker N, Parag V, Verbiest M, Laking G, Laugesen M, Bullen C. Nicotine patches used in combination with e-cigarettes (with and without nicotine) for smoking cessation: a pragmatic, randomised trial. The Lancet Respiratory Medicine 2020; 8:54-64. [DOI: 10.1016/s2213-2600(19)30269-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
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17
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Chu JTW, Wadham A, Jiang Y, Whittaker R, Stasiak K, Shepherd M, Bullen C. Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e15664. [PMID: 31746767 PMCID: PMC6893562 DOI: 10.2196/15664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/26/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/02/2022] Open
Abstract
Background Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen—an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective The aim of this qualitative study was to explore parents and/or primary caregivers’ perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents.
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Affiliation(s)
- Joanna Ting Wai Chu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Christopher Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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18
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Biondi‐Zoccai G, Sciarretta S, Bullen C, Nocella C, Violi F, Loffredo L, Pignatelli P, Perri L, Peruzzi M, Marullo AG, De Falco E, Chimenti I, Cammisotto V, Valenti V, Coluzzi F, Cavarretta E, Carrizzo A, Prati F, Carnevale R, Frati G. Acute Effects of Heat-Not-Burn, Electronic Vaping, and Traditional Tobacco Combustion Cigarettes: The Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking ( SUR - VAPES ) 2 Randomized Trial. J Am Heart Assoc 2019; 8:e010455. [PMID: 30879375 PMCID: PMC6475061 DOI: 10.1161/jaha.118.010455] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/18/2018] [Indexed: 02/05/2023]
Abstract
Background Little clinical research on new-generation heat-not-burn cigarettes ( HNBC ) in comparison with electronic vaping cigarettes ( EVC ) and traditional tobacco combustion cigarettes ( TC ) has been reported. We aimed to appraise the acute effects of single use of HNBC , EVC, and TC in healthy smokers. Methods and Results This was an independent, cross-over, randomized trial in 20 TC smokers, with allocation to different cycles of HNBC , EVC , and TC . All participants used all types of products, with an intercycle washout of 1 week. End points were oxidative stress, antioxidant reserve, platelet activation, flow-mediated dilation, blood pressure, and satisfaction scores. Single use of any product led to an adverse impact on oxidative stress, antioxidant reserve, platelet function, flow-mediated dilation, and blood pressure. HNBC had less impact than EVC and TC on soluble Nox2-derived peptide (respectively, P=0.004 and 0.001), 8-iso-prostaglandin F2α- III ( P=0.004 and <0.001), and vitamin E ( P=0.018 and 0.044). HNBC and EVC were equally less impactful than TCs on flow-mediated dilation ( P=0.872 for HNBC versus EVC ), H2O2 ( P=0.522), H2O2 breakdown activity ( P=0.091), soluble CD 40 ligand ( P=0.849), and soluble P-selectin ( P=0.821). The effect of HNBC and, to a lesser extent EVC , on blood pressure was less evident than that of TC , whereas HNBC appeared more satisfying than EVC (all P<0.05). Conclusions Acute effects of HNBC , EVC, and TC are different on several oxidative stress, antioxidant reserve, platelet function, cardiovascular, and satisfaction dimensions, with TCs showing the most detrimental changes in clinically relevant features. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 03301129.
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Affiliation(s)
- Giuseppe Biondi‐Zoccai
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
- IRCCS NEUROMEDPozzilliItaly
| | - Sebastiano Sciarretta
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
- IRCCS NEUROMEDPozzilliItaly
| | - Christopher Bullen
- National Institute for Health InnovationSchool of Population HealthFaculty of Medical and Health SciencesThe University of AucklandNew Zealand
| | | | - Francesco Violi
- Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeItaly
| | - Lorenzo Loffredo
- Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeItaly
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeItaly
| | - Ludovica Perri
- Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeItaly
| | - Mariangela Peruzzi
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Antonino G.M. Marullo
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Elena De Falco
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Isotta Chimenti
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Vittoria Cammisotto
- Department of Internal Medicine and Medical SpecialtiesSapienza University of RomeItaly
| | - Valentina Valenti
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Flaminia Coluzzi
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Elena Cavarretta
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | | | - Francesco Prati
- Division of CardiologySan Giovanni Addolorata HospitalRomeItaly
- Centro Per La Lotta Contro L'InfartoRomeItaly
| | - Roberto Carnevale
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Giacomo Frati
- IRCCS NEUROMEDPozzilliItaly
- National Institute for Health InnovationSchool of Population HealthFaculty of Medical and Health SciencesThe University of AucklandNew Zealand
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Mastrangeli S, Carnevale R, Cavarretta E, Sciarretta S, Peruzzi M, Marullo AGM, De Falco E, Chimenti I, Valenti V, Bullen C, Roever L, Frati G, Biondi-Zoccai G. Predictors of oxidative stress and vascular function in an experimental study of tobacco versus electronic cigarettes: A post hoc analysis of the SUR-VAPES 1 Study. Tob Induc Dis 2018; 16:18. [PMID: 31516418 PMCID: PMC6659516 DOI: 10.18332/tid/89975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/16/2018] [Accepted: 04/16/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Use of a conventional cigarette (CC) or electronic cigarette (EC) leads to oxidative stress and endothelial dysfunction, but the impact of other features and their interplay with CCs and ECs have been incompletely appraised. We explored moderators of CC and EC effects on oxidative stress and endothelial dysfunction. METHODS We have conducted an experimental study on CCs and ECs in which repeated indicators of oxidative stress (serum levels of soluble NOX2-derived peptide, nitric oxide bioavailability, 8-iso-prostaglandin F2α-III, and vitamin E) and endothelial dysfunction (flow-mediated dilation) were collected in 40 subjects (20 smokers, 20 non-smokers). Several moderating features were appraised, adjusting for smoking status and cigarette type. RESULTS Absolute changes in oxidative stress and vascular features after smoking a CC or vaping an EC were significantly correlated (all p<0.05), with the notable exception of 8-iso-prostaglandin F2α-III levels (p=0.030). Inferential analysis based on generalized estimating equations highlighted that the only variable significantly associated with oxidative stress and vascular features was smoking status (all p<0.05). Specifically, we found that smokers had a less pronounced untoward oxidative and vascular response after vaping an EC in comparison to non-smokers, who had oxidative and vascular reactions to an EC that resembled more those seen after smoking a CC. Intriguingly, women taking oral contraceptives appeared to have more unfavorable changes in vitamin E (p=0.002) and FMD (p=0.008). CONCLUSIONS This study suggests that the comparative oxidative and vascular effects of an EC versus a CC may be influenced by smoking status, with a potential interaction in women taking oral contraceptives. These findings need further confirmation but could have important clinical and policy implications. ABBREVIATIONS SUR-VAPES: Sapienza University of Rome-Vascular Assessment of Proatherosclerotic Effects of Smoking
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Affiliation(s)
- Simona Mastrangeli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Roberto Carnevale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino G M Marullo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Elena De Falco
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Isotta Chimenti
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy
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Affiliation(s)
- Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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Leung W, Roberts V, Gordon LG, Bullen C, McRobbie H, Prapavessis H, Jiang Y, Maddison R. Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial. Tob Induc Dis 2017; 15:21. [PMID: 28360828 PMCID: PMC5371274 DOI: 10.1186/s12971-017-0126-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background In the Fit2Quit randomised controlled trial, insufficiently-active adult cigarette smokers who contacted Quitline for support to quit smoking were randomised to usual Quitline support or to also receive ≤10 face-to-face and telephone exercise-support sessions delivered by trained exercise facilitators over the 24-week trial. This paper aims to determine the cost-effectiveness of an exercise-counselling intervention added to Quitline compared to Quitline alone in the Fit2Quit trial. Methods Within-trial and lifetime cost-effectiveness were assessed. A published Markov model was adapted, with smokers facing increased risks of lung cancer and cardiovascular disease. Results Over 24 weeks, the incremental programme cost per participant in the intervention was NZ$428 (US$289 or €226; purchasing power parity-adjusted [PPP]). The incremental cost-effectiveness ratio (ICER) for seven-day point prevalence measured at 24-week follow-up was NZ$31,733 (US$21,432 or €16,737 PPP-adjusted) per smoker abstaining. However, for the 52% who adhered to the intervention (≥7 contacts), the ICER for point prevalence was NZ$3,991 (US$2,695 or €2,105 PPP-adjusted). In this adherent subgroup, the Markov model estimated 0.057 and 0.068 discounted quality-adjusted life-year gains over the lifetime of 40-year-old males (ICER: NZ$4,431; US$2,993 or €2,337 PPP-adjusted) and females (ICER: NZ$2,909; US$1,965 or €1,534 PPP-adjusted). Conclusions The exercise-counselling intervention will only be cost-effective if adherence is a minimum of ≥7 intervention calls, which in turn leads to a sufficient number of quitters for health gains. Trial registration Australasian Clinical Trials Registry Number ACTRN12609000637246
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Affiliation(s)
- William Leung
- University of Otago, Wellington, PO Box 7343, New Zealand.,University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Vaughan Roberts
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | | | - Hayden McRobbie
- UK Centre for Tobacco Control Studies, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Harry Prapavessis
- School of Kinesiology, Faculty of Medical and Health Sciences, University of Western Ontario, 1151 Richmond St, London, ON Canada
| | - Yannan Jiang
- University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Ralph Maddison
- University of Auckland, Private Bag 92019, Auckland, New Zealand.,Centre for Physical Activity and Nutrition, Deakin University, Melbourne, VIC Australia
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Bourke L, Bauld L, Bullen C, Cumberbatch M, Giovannucci E, Islami F, McRobbie H, Silverman DT, Catto JWF. E-cigarettes and Urologic Health: A Collaborative Review of Toxicology, Epidemiology, and Potential Risks. Eur Urol 2017; 71:915-923. [PMID: 28073600 DOI: 10.1016/j.eururo.2016.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
Abstract
CONTEXT Use of electronic cigarettes (ECs) is on the rise in most high-income countries. Smoking conventional cigarettes is a known risk factor for urologic malignancy incidence, progression, and mortality, as well as for other urologic health indicators. The potential impact of EC use on urologic health is therefore of clinical interest to the urology community. OBJECTIVE To review the available data on current EC use, including potential benefits in urologic patients, potential issues linked to toxicology of EC constituents, and how this might translate into urologic health risks. EVIDENCE ACQUISITION A Medline search was carried out in August 2016 for studies reporting urologic health outcomes and EC use. Snowballing techniques were also used to identify relevant studies from recent systematic reviews. A narrative synthesis of data around EC health outcomes, toxicology, and potential use in smoking cessation and health policy was carried out. EVIDENCE SYNTHESIS We found no studies to date that have been specifically designed to prospectively assess urologic health risks, even in an observational setting. Generating such data would be an important contribution to the debate on the role of ECs in public health and clinical practice. There is evidence from a recent Cochrane review of RCTs that ECs can support smoking cessation. There are emerging data indicating that potentially harmful components of ECs such as tobacco-specific nitrosamines, polyaromatic hydrocarbons, and heavy metals could be linked to possible urologic health risks. CONCLUSIONS ECs might be a useful tool to encourage cessation of conventional cigarette smoking. However, data collection around the specific impact of ECs on urologic health is needed to clarify the possible patient benefits, outcomes, and adverse events. PATIENT SUMMARY While electronic cigarettes might help some people to stop smoking, their overall impact on urologic health is not clear.
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Affiliation(s)
- Liam Bourke
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
| | - Linda Bauld
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Christopher Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Marcus Cumberbatch
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Hayden McRobbie
- Wolfson Institute of Preventative Medicine and UK Centre for Tobacco and Alcohol Studies, Queen Mary University of London, London, UK
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - James W F Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Abstract
In this review, we discuss current evidence on electronic cigarettes (ECs), a rapidly evolving class of nicotine delivery system, and their role in managing nicotine addiction, specifically in helping smokers to quit smoking and/or reduce the amount of tobacco they smoke. The current evidence base is limited to three randomized trials (only one compares ECs with nicotine replacement therapy) and a growing number of EC user surveys (n=6), case reports (n=4), and cohort studies (n=8). Collectively, these studies suggest modest cessation efficacy and a few adverse effects, at least with the short-term use. On this basis, we provide advice for health care providers on providing balanced information for patients who enquire about ECs. More research, specifically well-conducted large efficacy trials comparing ECs with standard smoking cessation management (eg, nicotine replacement therapy plus behavioral support) and long-term prospective studies for adverse events, are urgently needed to fill critical knowledge gaps on these products.
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Affiliation(s)
- Oliver Knight-West
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- The National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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Bullen C, Beaglehole R, Daube M, Devlin G, Hughes S, Swinburn B. Targets and actions for noncommunicable disease prevention and control in New Zealand. N Z Med J 2015; 128:55-60. [PMID: 26914005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To propose non-communicable diseases (NCD) prevention and control targets for New Zealand, where NCDs are the leading causes of death and health inequalities in men and women. METHOD We adapted NCD global targets for New Zealand in the light of local progress, priorities and feasibility. RESULTS National NCD targets relevant to New Zealand, yet congruent with global targets, together with inclusive, collaborative and feasible actions to achieve them are outlined. CONCLUSION A national commitment to collaborative and pragmatic action is needed to capitalise on opportunities for further progress in the prevention and control of NCDs in New Zealand.
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Affiliation(s)
- Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Tamaki Campus, Private Bag 92019, Victoria Street West, Auckland 1142.
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Abstract
SETTING Cancer patients recorded in Fiji's National Patient Information System (PATIS) from 2000 to 2010. OBJECTIVE To identify trends in cervical cancer using case numbers, incidence rates and case fatality in Fiji over the decade 2000-2010. DESIGN Retrospective descriptive and analytical study. RESULTS Between 2000 and 2010, 1234 patients were registered with cervical cancer, of whom 845 (68%) were indigenous Fijians and 357 (29%) were Indians; only 32 (3%) were of other ethnic groups. Mortality rates were much higher among Fijian women, and were far higher in women aged ≥45 years. CONCLUSION The high incidence rates of cervical cancer in Fijian women between the ages of 35 and 45 years reflect ethnic differences in social norms. The higher case fatality and mortality rates in these groups indicate that more work is needed to improve access to and quality of screening and treatment services.
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Affiliation(s)
- L Vodonaivalu
- Ministry of Health, Public Health Division, Suva, Fiji
| | - C Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Abstract
Electronic cigarettes (e-cigarettes) are novel vaporising devices that, similar to nicotine replacement treatments, deliver nicotine but in lower amounts and less swiftly than tobacco smoking. However, they enjoy far greater popularity than these medications due in part to their behaviour replacement characteristics. Evidence for their efficacy as cessation aids, based on several randomised trials of now obsolete e-cigarettes, suggests a modest effect equivalent to nicotine patch. E-cigarettes are almost certainly far less harmful than tobacco smoking, but the health effects of long-term use are as yet unknown. Dual use is common and almost as harmful as usual smoking unless it leads to quitting. Population effects, such as re-normalising smoking behaviour, are a concern. Clinicians should be knowledgeable about these products. If patients who smoke are unwilling to quit or cannot succeed using evidence-based approaches, e-cigarettes may be an option to be considered after discussing the limitations of current knowledge.
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Affiliation(s)
- Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand,
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O'Brien B, Knight-West O, Walker N, Parag V, Bullen C. E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness: secondary analysis of data from the ASCEND trial. Tob Induc Dis 2015; 13:5. [PMID: 25814920 PMCID: PMC4374189 DOI: 10.1186/s12971-015-0030-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background People with mental illness have higher rates of smoking than the general population and are at greater risk of smoking-related death and disability. In smokers from the general population, electronic cigarettes (e-cigarettes) have been shown to have a similar effect on quit rates as nicotine replacement therapy, but little is known about their effect in smokers with mental illness. Methods Secondary analysis of data from the ASCEND trial involving 657 dependent adult smokers motivated to quit, randomised to 16 mg nicotine e-cigarette, 21 mg nicotine patch, or 0 mg nicotine e-cigarette, with minimal behavioural support. Using self-reported medication use and the Anatomical Therapeutic Chemical Classification System, we identified 86 participants with mental illness and analysed their cessation and smoking reduction outcomes. Results For e-cigarettes alone, and all interventions pooled, there was no statistically significant difference in biochemically verified quit rates at six months between participants with and without mental illness, nor in smoking reduction, adverse events, treatment compliance, or acceptability. Rates of relapse to smoking were higher in participants with mental illness. Among this group, differences between treatments were not statistically significant for cessation (patch 14% [5/35], 16 mg e-cigarette 5% [2/39], 0 mg e-cigarette 0% [0/12], p = 0.245), adverse events or relapse rates. However, e-cigarette users had higher levels of smoking reduction, treatment compliance, and acceptability. Conclusions The use of e-cigarettes for quitting appears to be equally effective, safe, and acceptable for people with and without mental illness. For people with mental illness, e-cigarettes may be as effective and safe as patches, yet more acceptable, and associated with greater smoking reduction. Trial registration Australian New Zealand Clinical trials Registry, number: ACTRN12610000866000.
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Affiliation(s)
- Brigid O'Brien
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Oliver Knight-West
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
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Abstract
BACKGROUND Placebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months. We investigated whether cytisine was at least as effective as nicotine-replacement therapy in helping smokers to quit. METHODS We conducted a pragmatic, open-label, noninferiority trial in New Zealand in which 1310 adult daily smokers who were motivated to quit and called the national quitline were randomly assigned in a 1:1 ratio to receive cytisine for 25 days or nicotine-replacement therapy for 8 weeks. Cytisine was provided by mail, free of charge, and nicotine-replacement therapy was provided through vouchers for low-cost patches along with gum or lozenges. Low-intensity, telephone-delivered behavioral support was provided to both groups through the quitline. The primary outcome was self-reported continuous abstinence at 1 month. RESULTS At 1 month, continuous abstinence from smoking was reported for 40% of participants receiving cytisine (264 of 655) and 31% of participants receiving nicotine-replacement therapy (203 of 655), for a difference of 9.3 percentage points (95% confidence interval, 4.2 to 14.5). The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. In a prespecified subgroup analysis of the primary outcome, cytisine was superior to nicotine-replacement therapy among women and noninferior among men. Self-reported adverse events over 6 months occurred more frequently in the cytisine group (288 events among 204 participants) than in the group receiving nicotine-replacement therapy (174 events among 134 participants); adverse events were primarily nausea and vomiting and sleep disorders. CONCLUSIONS When combined with brief behavioral support, cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events. (Funded by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12610000590066.).
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Affiliation(s)
- Natalie Walker
- From the National Institute for Health Innovation (N.W., C.H., V.P., C.B.), the Centre for Tobacco Control Research, Department of Social and Community Health (M.G.), the Department of Pacific Health (V.N.) and the School of Population Health and the School of Pharmacy (J.B.), University of Auckland, Auckland, and the Quit Group, Wellington (B.B.) - all in New Zealand; and Queen Mary University of London, Wolfson Institute of Preventive Medicine, and UK Centre for Tobacco and Alcohol Studies, Barts and the London School of Medicine and Dentistry - all in London (H.M.)
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Walker N, Johnston V, Glover M, Bullen C, Trenholme A, Chang A, Morris P, Segan C, Brown N, Fenton D, Hawthorne E, Borland R, Parag V, Von Blaramberg T, Westphal D, Thomas D. Effect of a family-centered, secondhand smoke intervention to reduce respiratory illness in indigenous infants in Australia and New Zealand: a randomized controlled trial. Nicotine Tob Res 2014; 17:48-57. [PMID: 25156527 PMCID: PMC4282121 DOI: 10.1093/ntr/ntu128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a significant cause of acute respiratory illness (ARI) and 5 times more common in indigenous children. A single-blind randomized trial was undertaken to determine the efficacy of a family centered SHS intervention to reduce ARI in indigenous infants in Australia and New Zealand. METHODS Indigenous mothers/infants from homes with ≥ 1 smoker were randomized to a SHS intervention involving 3 home visits in the first 3 months of the infants' lives (plus usual care) or usual care. The primary outcome was number of ARI-related visits to a health provider in the first year of life. Secondary outcomes, assessed at 4 and 12 months of age, included ARI hospitalization rates and mothers' report of infants' SHS exposure (validated by urinary cotinine/creatinine ratios [CCRs]), smoking restrictions, and smoking cessation. RESULTS Two hundred and ninety-three mother/infant dyads were randomized and followed up. Three quarters of mothers smoked during pregnancy and two thirds were smoking at baseline (as were their partners), with no change for more than 12 months. Reported infant exposure to SHS was low (≥ 95% had smoke-free homes/cars). Infant CCRs were higher if one or both parents were smokers and if mothers breast fed their infants. There was no effect of the intervention on ARI events [471 intervention vs. 438 usual care (reference); incidence rate ratio = 1.10, 95% confidence intervals (CI) = 0.88-1.37, p = .40]. CONCLUSIONS Despite reporting smoke-free homes/cars, mothers and their partners continue to smoke in the first year of infants' lives, exposing them to SHS. Emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal.
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Affiliation(s)
- Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;
| | - Vanessa Johnston
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - Marewa Glover
- Centre for Tobacco Control Research, Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adrian Trenholme
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand
| | - Anne Chang
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Peter Morris
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - Catherine Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, Victoria, Australia
| | - Ngiare Brown
- Department of Medicine, University of Wollongong, Wollongong, Australia
| | - Debra Fenton
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Ron Borland
- VicHealth Center for Tobacco Control, Cancer Council Victoria, Victoria, Australia
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Taina Von Blaramberg
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Darren Westphal
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - David Thomas
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Lowitja Institute, Charles Darwin University, Darwin, Australia
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Marck K, Glover M, Kira A, McCool J, Scragg R, Nosa V, Bullen C. Protecting children from taking up smoking: parents' views on what would help. Health Promot J Austr 2014; 25:59-64. [PMID: 24625526 DOI: 10.1071/he13029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED The present study investigated what factors the parents of children in low-income areas of Auckland, New Zealand, thought could help protect their children from smoking initiation. METHODS Participants in a large quasi-experimental trial that tested a community-, school- and family-based smoking-initiation intervention were asked in a questionnaire 'What could we do to help you protect your children from smoke and taking up smoking?' Free-text responses were divided into distinct meaning units and categorised independently by two of the researchers. RESULTS 1806 participants (70% of parents who returned the questionnaire) completed the question. The majority of respondents (80%) were either Pacific Island or Māori mothers and 25% were current smokers. Five main categories of suggested strategies for preventing smoking initiation were identified: building children's knowledge of the ill-effects of smoking; denormalising smoking; reducing access to tobacco; building children's resilience; and health promotion activities. The most common suggestion was to educate children about smoking. CONCLUSION Building children's knowledge of smoking risks was the main strategy parents proposed. There was some support for banning smoking in most public areas and for tougher moves to stop tobacco sales to minors. Few parents suggested innovative or radical strategies, such as banning the sale of tobacco, fining children for smoking or use of competitions. So what? To ensure reductions in smoking initiation for lower socioeconomic and Māori and Pacific Island people, further research should engage Māori, Pacific Island and lower socioeconomic parents in a process that elicits innovative thinking about culturally acceptable strategies.
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Affiliation(s)
- K Marck
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - M Glover
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - A Kira
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - J McCool
- Social and Community Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - R Scragg
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - V Nosa
- Pacific Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - C Bullen
- NIHI, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Affiliation(s)
- Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1142, New Zealand.
| | - Colin Howe
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1142, New Zealand
| | | | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, UK Centre for Tobacco Control Studies, Queen Mary University of London, London, UK
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1142, New Zealand
| | - Jonathan Williman
- Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1142, New Zealand
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Selak V, Elley C, Crengle S, Wadham A, Rafter N, Bullen C. Polypills for high risk patients: Results of a New Zealand randomised controlled trial. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nordin ASA, Bullen C. Malaysia: Standing firm on trade and tobacco. Tob Control 2014; 23:4-5. [PMID: 24479154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) can deliver nicotine and mitigate tobacco withdrawal and are used by many smokers to assist quit attempts. We investigated whether e-cigarettes are more effective than nicotine patches at helping smokers to quit. METHODS We did this pragmatic randomised-controlled superiority trial in Auckland, New Zealand, between Sept 6, 2011, and July 5, 2013. Adult (≥18 years) smokers wanting to quit were randomised (with computerised block randomisation, block size nine, stratified by ethnicity [Māori; Pacific; or non-Māori, non-Pacific], sex [men or women], and level of nicotine dependence [>5 or ≤5 Fagerström test for nicotine dependence]) in a 4:4:1 ratio to 16 mg nicotine e-cigarettes, nicotine patches (21 mg patch, one daily), or placebo e-cigarettes (no nicotine), from 1 week before until 12 weeks after quit day, with low intensity behavioural support via voluntary telephone counselling. The primary outcome was biochemically verified continuous abstinence at 6 months (exhaled breath carbon monoxide measurement <10 ppm). Primary analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000866000. FINDINGS 657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis. At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes (risk difference for nicotine e-cigarette vs patches 1·51 [95% CI -2·49 to 5·51]; for nicotine e-cigarettes vs placebo e-cigarettes 3·16 [95% CI -2·29 to 8·61]). Achievement of abstinence was substantially lower than we anticipated for the power calculation, thus we had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches or to placebo e-cigarettes. We identified no significant differences in adverse events, with 137 events in the nicotine e-cigarettes group, 119 events in the patches group, and 36 events in the placebo e-cigarettes group. We noted no evidence of an association between adverse events and study product. INTERPRETATION E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- Christopher Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.
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Varman S, Bullen C, Tayler-Smith K, Van Den Bergh R, Khogali M. Primary school compliance with school canteen guidelines in Fiji and its association with student obesity. Public Health Action 2013; 3:81-4. [PMID: 26393002 DOI: 10.5588/pha.12.0063] [Citation(s) in RCA: 6] [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: 09/27/2012] [Accepted: 11/30/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING Childhood obesity is of growing public health concern in Fiji. The study setting was primary schools in Fiji's Western Division. OBJECTIVE 1) To assess primary schools' compliance with national school canteen guidelines, 2) to understand reasons for non-compliance, and 3) to assess the relationship between compliance with the guidelines and students' body mass index (BMI). DESIGN Cross-sectional analysis of data collected in 2010 by public health dieticians of the Ministry of Health on annual visits to primary schools. RESULTS Among 230 schools, 33 (14%) had no canteen data. Of the 197 schools with data, only 31 (16%) were fully compliant with national school canteen guidelines, while the remaining 166 (84%) did not fully comply with the guidelines. This was irrespective of school location or whether the canteen was school or commercially operated. In a random sample (n = 44 schools), overweight and obesity were more common among children in non-compliant schools than in fully compliant schools (40% vs. 32%, P < 0.001). CONCLUSION Most primary schools in Fiji's Western Division did not comply with school canteen guidelines, which is worrying given the increasing rates of overweight children. Given the association between non-compliance and student overweight/obesity, further action is needed to ensure that these guidelines are implemented.
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Affiliation(s)
- S Varman
- College of Engineering Science and Technology, Fiji National University, Lautoka, Fiji
| | - C Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - R Van Den Bergh
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - M Khogali
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
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Bullen C, McRobbie H, Thornley S, Glover M, Lin R, Laugesen M. Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: randomised cross-over trial. Tob Control 2010; 19:98-103. [DOI: 10.1136/tc.2009.031567] [Citation(s) in RCA: 389] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fraser T, McRobbie H, Bullen C, Whittaker R, Barlow D. Acceptability and outcome of an Internet-based smoking cessation programme. Int J Tuberc Lung Dis 2010; 14:113-118. [PMID: 20003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Three district health boards (DHBs), organisations that govern public hospitals and services in Auckland, New Zealand. OBJECTIVE To evaluate a commercial web-based smoking cessation programme (Smokestop). DESIGN Smokestop was offered free of charge to 126 staff members of three Auckland DHBs who wanted to stop smoking. Following a 30 minute face-to-face enrolment meeting, participants were able to log on and use the programme. Nicotine replacement therapy (NRT) was available at no cost. All participants who used the programme at least once were followed up at 1, 3 and 6 months after first logging on for assessment of smoking status by self-report verified by carbon monoxide (CO) in expired breath. RESULTS Of 104 participants who logged onto the programme, 12 (12%) achieved 6-month continuous CO-validated abstinence. Participant feedback was largely positive: 46% agreed that the programme had assisted them and 74% stated they would recommend it to other smokers. The concomitant use of NRT was seen as an important component. CONCLUSIONS The results suggest that this internet-based smoking cessation programme is an acceptable method to deliver behavioural support to people who want help in stopping smoking, and that it shows promise as a smoking cessation intervention.
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Affiliation(s)
- T Fraser
- Global Public Health, P O Box 82, Glenorchy 9350, New Zealand.
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Edwards R, Thomson G, Wilson N, Waa A, Bullen C, O'Dea D, Gifford H, Glover M, Laugesen M, Woodward A. After the smoke has cleared: evaluation of the impact of a new national smoke-free law in New Zealand. Tob Control 2008; 17:e2. [DOI: 10.1136/tc.2007.020347] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence. OBJECTIVES The aims of this review were:To determine the effect of NRT compared to placebo in aiding smoking cessation, and to consider whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets/lozenges) in achieving abstinence from cigarettes. To determine whether the effect is influenced by the dosage, form and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated. To determine whether combinations of NRT are more likely to lead to successful quitting than one type alone. To determine whether NRT is more or less likely to lead to successful quitting compared to other pharmacotherapies. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register for papers with 'nicotine' or 'NRT' in the title, abstract or keywords. Date of most recent search July 2007. SELECTION CRITERIA Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow up of less than six months. DATA COLLECTION AND ANALYSIS We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS We identified 132 trials; 111 with over 40,000 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The RR of abstinence for any form of NRT relative to control was 1.58 (95% confidence interval [CI]: 1.50 to 1.66). The pooled RR for each type were 1.43 (95% CI: 1.33 to 1.53, 53 trials) for nicotine gum; 1.66 (95% CI: 1.53 to 1.81, 41 trials) for nicotine patch; 1.90 (95% CI: 1.36 to 2.67, 4 trials) for nicotine inhaler; 2.00 (95% CI: 1.63 to 2.45, 6 trials) for oral tablets/lozenges; and 2.02 (95% CI: 1.49 to 3.73, 4 trials) for nicotine nasal spray. The effects were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. The effect was similar in a small group of studies that aimed to assess use of NRT obtained without a prescription. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum, but weaker evidence of a benefit from higher doses of patch. There was evidence that combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with nicotine patch were lower than with the antidepressant bupropion. AUTHORS' CONCLUSIONS All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
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Affiliation(s)
- L F Stead
- University of Oxford, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF.
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Abstract
We report on the effects of Lewis bases and other ligands on radiative recombination in CdSe quantum dots (QDs) in several solvents. Long-chain primary amines are found to be the most efficacious capping agents for CdSe QDs in nonpolar solvents. Primary alkylamines are superior to secondary and tertiary alkylamines. The kinetics of chemisorption and desorption in less polar solvents, such as hexane or chloroform, are temperature controlled and obey a Langmuir isotherm. Mercaptan adsorption also obeys a Langmuir isotherm, and alkylmercaptans rapidly displace amines, leading to luminescence quenching. In more polar solvents, such as toluene, ligands desorb, leading to luminescence quenching. It is proposed that surface Cd vacancies function as nonradiative recombination centers. The adsorption of a Lewis base to the QD raises the surface vacancy energy close to, or above, the conduction band edge and eliminates electron capture by the surface vacancies. Solvent polarity has a strong effect on luminescence since the solvent determines the extent of ligand adsorption to the QD surface.
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Affiliation(s)
- C Bullen
- Chemistry School, University of Melbourne, Parkville, Victoria 3010, Australia
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McRobbie H, Whittaker R, Bullen C. Using Nicotine Replacement Therapy to Assist in Reducing Cigarette Consumption before Quitting. ACTA ACUST UNITED AC 2006. [DOI: 10.2165/00115677-200614060-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Aponso D, Bullen C. Presenting features of meningococcal disease, public health messages and media publicity: are they consistent? N Z Med J 2001; 114:83-5. [PMID: 11297142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
AIMS To investigate whether the presenting features of meningococcal disease as promoted in public health awareness material and in the print media accurately reflect the clinical features in patients admitted to Auckland hospitals with meningococcal disease January 1998 to June 1999. METHODS Hospital record, public health message and newspaper article review, with analysis by presenting feature, age group and disease complex. RESULTS The most common presenting features were fever (95%), rash (65%), vomiting and nausea (64%), lethargy (62%), headache (44%), refusing food and drink (35%), irritability (33%), muscle ache and joint pains (27%) and stiff neck (26%). Public health messages gave appropriate emphasis to the key features, whereas newspaper articles under-emphasised these. The term 'meningitis' was used more frequently in newspapers (65%) than in public health messages (30%), despite meningitis alone presenting less frequently (38% of cases) than meningococcal septicaemia, and having a less serious prognosis. CONCLUSIONS Presenting features currently noted in the Ministry of Health's health education resource material are appropriate. Public health specialists dealing with the media should ensure that appropriate messages are incorporated into media reports. A greater use of the term 'meningococcal disease' by both public health agencies and media would convey to the public the message that this disease has a spectrum of presenting features, with those of septicaemia more common, but also indicating an even greater need for urgency of action than with 'classical' meningitic features.
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Abstract
Since 1991, New Zealand has experienced a dramatic increase in cases of serogroup B meningococcal disease. Early in 1998, a program was initiated in Auckland to raise awareness among high-risk communities about the early clinical features of meningococcal disease and appropriate action to take. The campaign was conducted largely through door-to-door visiting by Maori and Pacific Islands lay educators, who visited more than 11,000 households and engaged more than 9,000 people in discussion. Significantly greater awareness was found in people visited by lay educators than those not visited. For the first time in 5 years, there were no meningococcal deaths among the target population for the 6 months from the start of the campaign. Home visiting by lay educators is an effective and highly acceptable means of communicating important health information to populations at high risk of meningococcal disease in New Zealand and should be considered for other public health campaigns.
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Affiliation(s)
- C Bullen
- Auckland Healthcare Public Health Protection Service, New Zealand.
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Bullen C, Simmons G, Trye P, Lay-Yee R, Bonita R, Jackson R. Cardiovascular disease risk factors in 65-84 year old men and women: results from the Auckland University Heart and Health Study 1993-4. N Z Med J 1998; 111:4-7. [PMID: 9484425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To describe the distribution of the major cardiovascular risk factors among older men and women in the Auckland region, New Zealand. METHODS Means and prevalences of the major cardiovascular risk factors were estimated for non-Maori, non-Pacific Islands men and women in the age groups 65-74 and 75-84 years using data from the 1993-4 survey of the University of Auckland Heart and Health Study, a cross-sectional, population-based study of cardiovascular risk factors. RESULTS 996 people aged 65-84 years participated, with men and women and the two ten-year age groups almost equally represented. Fewer than half engaged in regular leisure time physical activity; around 35% were overweight (BMI 25-30) and 10% were obese (BMI > 30). Total mean cholesterol levels were higher in women and 46% of women had a cholesterol level > or = 6.5 mmol/L compared with only 17% of men. However, total cholesterol:HDL ratios were higher among men. Age and sex differences in blood pressure were small. Around 50% had raised blood pressure (BP > 150/90) or were currently on antihypertensive medication; only 8% smoked; around 6% were diabetic. Almost 8% had three or all of four major modifiable cardiovascular risk factors (elevated blood pressure, total cholesterol:HDL ratio > or = 6.5, current smoking and physical inactivity). CONCLUSIONS These results are broadly comparable to those from other Western populations. Differences between 65-74 and 75-84 year age groups are few but important differences in cholesterol, smoking and physical activity between older men and women are noted. These findings indicate that there is considerable potential for prevention of cardiovascular disease among older people.
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Affiliation(s)
- C Bullen
- Auckland Healthcare Ltd., Auckland
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