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McCuistian C, Lisha NE, Campbell B, Cheng C, Le J, Guydish J. Reducing tobacco use in substance use treatment: The California tobacco free initiative. Addict Behav 2024; 155:108025. [PMID: 38593596 DOI: 10.1016/j.addbeh.2024.108025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND People in substance use disorder (SUD) treatment have a smoking prevalence that is five times higher than the national average. California funded the Tobacco Free for Recovery Initiative, designed to support programs in implementing tobacco-free grounds and increasing smoking cessation services. In the first cohort of the initiative (2018-2020) client smoking prevalence decreased from 54.2% to 26.6%. The current study examined whether similar findings would be replicated with a later cohort of programs (2020-2022). METHOD Cross-sectional survey data were collected from clients in 11 residential SUD treatment programs at baseline (n = 185) and at post intervention (n = 227). Multivariate logistic regression assessed change over time in smoking prevalence, tobacco use behaviors, and receipt of cessation services across the two timepoints. RESULTS Client smoking prevalence decreased from 60.3 % to 40.5 % (Adjusted Odds Ratio [AOR] = 0.46, 95 % CI = 0.27, 0.78; p = 0.004). Current smokers and those who quit while in treatment reported an increase in nicotine replacement therapy (NRT)/pharmacotherapy from baseline to post intervention (31.9 % vs 45.6 %; AOR = 2.22, 95 % CI = 1.08, 4.58; p = 0.031). CONCLUSIONS Like the first cohort, the Tobacco Free for Recovery initiative was associated with decreased client smoking prevalence and an increase in NRT/pharmacotherapy. These findings strengthen the evidence that similar initiatives may be effective in reducing smoking prevalence among people in SUD treatment.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States.
| | - Nadra E Lisha
- Division of General Internal Medicine, School of Medicine University of California, San Francisco 530 Parnassus Ave, San Francisco, CA 94143, United States
| | - Barbara Campbell
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States
| | - Christine Cheng
- Smoking Cessation Leadership Center, University of California, San Francisco 490 Illinois Street, 9216, San Francisco, CA 94158, United States
| | - Jennifer Le
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco 1001 Potrero Ave, San Francisco, CA 94110, United States
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., Floor 7, San Francisco, CA 94158, United States
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Polick CS, Dennis P, Calhoun PS, Braley TJ, Lee E, Wilson S. Investigating disparities in smoking cessation treatment for veterans with multiple sclerosis: A national analysis. Brain Behav 2024; 14:e3513. [PMID: 38698620 PMCID: PMC11066415 DOI: 10.1002/brb3.3513] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND AIMS Smoking is a risk factor for multiple sclerosis (MS) development, symptom burden, decreased medication efficacy, and increased disease-related mortality. Veterans with MS (VwMS) smoke at critically high rates; however, treatment rates and possible disparities are unknown. To promote equitable treatment, we aim to investigate smoking cessation prescription practices for VwMS across social determinant factors. METHODS We extracted data from the national Veterans Health Administration electronic health records between October 1, 2017, and September 30, 2018. To derive marginal estimates of the association of MS with receipt of smoking-cessation pharmacotherapy, we used propensity score matching through the extreme gradient boosting machine learning model. VwMS who smoke were matched with veterans without MS who smoke on factors including age, race, depression, and healthcare visits. To assess the marginal association of MS with different cessation treatments, we used logistic regression and conducted stratified analyses by sex, race, and ethnicity. RESULTS The matched sample achieved a good balance across most covariates, compared to the pre-match sample. VwMS (n = 3320) had decreased odds of receiving prescriptions for nicotine patches ([Odds Ratio]OR = 0.86, p < .01), non-patch nicotine replacement therapy (NRT; OR = 0.81, p < .001), and standard practice dual NRT (OR = 0.77, p < .01), compared to matches without MS (n = 13,280). Men with MS had lower odds of receiving prescriptions for nicotine patches (OR = 0.88, p = .05), non-patch NRT (OR = 0.77, p < .001), and dual NRT (OR = 0.72, p < .001). Similarly, Black VwMS had lower odds of receiving prescriptions for patches (OR = 0.62, p < .001), non-patch NRT (OR = 0.75, p < .05), and dual NRT (OR = 0.52, p < .01). The odds of receiving prescriptions for bupropion or varenicline did not differ between VwMS and matches without MS. CONCLUSION VwMS received significantly less smoking cessation treatment, compared to matched controls without MS, showing a critical gap in health services as VwMS are not receiving dual NRT as the standard of care. Prescription rates were especially lower for male and Black VwMS, suggesting that under-represented demographic groups outside of the white female category, most often considered as the "traditional MS" group, could be under-treated regarding smoking cessation support. This foundational work will help inform future work to promote equitable treatment and implementation of cessation interventions for people living with MS.
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Affiliation(s)
- Carri S. Polick
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
- School of Nursing, Duke UniversityDurhamNorth CarolinaUSA
| | - Paul Dennis
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Patrick S. Calhoun
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | | | - Sarah Wilson
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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Tweed EJ, Mackay DF, Boyd KA, Brown A, Byrne T, Conaglen P, Craig P, Demou E, Graham L, Leyland AH, McMeekin N, Pell JP, Sweeting H, Hunt K. Evaluation of a national smoke-free prisons policy using medication dispensing: an interrupted time-series analysis. Lancet Public Health 2021; 6:e795-e804. [PMID: 34537108 PMCID: PMC8554387 DOI: 10.1016/s2468-2667(21)00163-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Internationally, smoking prevalence among people in prison custody (ie, people on remand awaiting trial, awaiting sentencing, or serving a custodial sentence) is high. In Scotland, all prisons implemented a comprehensive smoke-free policy in 2018 after a 16-month anticipatory period. In this study, we aimed to use data on medication dispensing to assess the impact of this policy on cessation support, health outcomes, and potential unintended consequences among people in prison custody. METHODS We did an interrupted time-series analysis using dispensing data for 44 660 individuals incarcerated in 14 closed prisons in Scotland between March 30, 2014, and Nov 30, 2019. We estimated changes in dispensing rates associated with the policy announcement (July 17, 2017) and full implementation (Nov 30, 2018) using seasonal autoregressive integrated moving average models. Medication categories of primary interest were treatments for nicotine dependence (as an indicator of smoking cessation or abstinence attempts), acute smoking-associated illnesses, and mental health (antidepressants). We included antiepileptic medications as a negative control. FINDINGS A 44% step increase in dispensing of treatments for nicotine dependence was observed at implementation (2250 items per 1000 people in custody per fortnight, 95% CI 1875 to 2624) due primarily to a 42% increase in dispensing of nicotine replacement therapy (2109 items per 1000 people in custody per fortnight, 1701 to 2516). A 9% step decrease in dispensing for smoking-related illnesses was observed at implementation, largely accounted for by respiratory medications (-646 items per 1000 people in custody per fortnight, -1111 to -181). No changes associated with announcement or implementation were observed for mental health dispensing or antiepileptic medications (control). INTERPRETATION Smoke-free prison policies might improve respiratory health among people in custody and encourage smoking abstinence or cessation without apparent short-term adverse effects on mental health dispensing. FUNDING National Institute of Health Research Public Health Research programme, Scottish Government Chief Scientist Office, and UK Medical Research Council.
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Affiliation(s)
- Emily J Tweed
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Daniel F Mackay
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ashley Brown
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Thomas Byrne
- NHS Healthcare Improvement Scotland, Glasgow, UK
| | - Philip Conaglen
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evangelia Demou
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Alastair H Leyland
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola McMeekin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Sweeting
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Pierce JP, Chen R, Kealey S, Leas EC, White MM, Stone MD, McMenamin SB, Trinidad DR, Strong DR, Benmarhnia T, Messer K. Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products. JAMA Netw Open 2021; 4:e2128810. [PMID: 34665239 PMCID: PMC8527352 DOI: 10.1001/jamanetworkopen.2021.28810] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Although e-cigarettes are not approved as a cessation device, many who smoke believe that e-cigarettes will help them quit cigarette smoking successfully. OBJECTIVE To assess whether people who recently quit smoking and who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared with those who remained tobacco free. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed a nationally representative sample of US households that participated in 4 waves of the Population Assessment of Tobacco and Health Study (conducted 2013 through 2017), combining 2 independent cohorts each with 3 annual surveys. Eligible participants were individuals who smoked at baseline, had recently quit at the first follow-up, and completed the second follow-up survey. EXPOSURES Use of e-cigarettes or alternate tobacco products at follow-up 1 after recently quitting smoking. MAIN OUTCOMES AND MEASURES Weighted percentage of participants with over 12 months abstinence by follow-up 2. RESULTS Of a total of 13 604 participants who smoked cigarettes at baseline, 9.4% (95% CI, 8.7%-10.0%) recently had quit smoking (mean age, 41.9; 95% CI, 39.7-46.6 years; 641 [43.2%] women) Of these, 22.8% (95% CI, 19.7%-26.0%) had switched to e-cigarettes, with 17.6% (95% CI, 14.8%-20.5%) using them daily. A total of 37.1% (95% CI, 33.7%-40.4%) used a noncigarette tobacco product and 62.9% (95% CI, 59.6%-66.3%) were tobacco free. Rates of switching to e-cigarettes were highest for those who were in the top tertile of tobacco dependence (31.3%; 95% CI, 25.0%-37.7%), were non-Hispanic White (26.4%; 95% CI, 22.3%-30.4%), and had higher incomes (annual income ≥$35 000, 27.5%; 95% CI, 22.5%-32.4% vs <$35 000, 19.3%; 95% CI, 16.3%-22.3%). At follow-up 2, unadjusted relapse rates were similar among those who switched to different tobacco products (for any tobacco product: successfully quit, 41.5%; 95% CI, 36.2%-46.9%; relapsed with significant requit, 17.0%; 95% CI, 12.4%-21.6%; currently smoking, 36.2%; 95% CI, 30.9%-41.4%). Controlled for potential confounders, switching to any tobacco product was associated with higher relapse rate than being tobacco free (adjusted risk difference, 8.5%; 95% CI, 0.3%-16.6%). Estimates for those who switched to e-cigarettes, whether daily or not, were not significant. While individuals who switched from cigarettes to e-cigarettes were more likely to relapse, they appeared more likely to requit and be abstinent for 3 months at follow-up 2 (17.0%; 95% CI, 12.4%-21.6% vs 10.4%; 95% CI, 8.0%-12.9%). CONCLUSIONS AND RELEVANCE This large US nationally representative study does not support the hypothesis that switching to e-cigarettes will prevent relapse to cigarette smoking.
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Affiliation(s)
- John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Sheila Kealey
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Martha M. White
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Dennis R. Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
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Jackson SE, Garnett C, Shahab L, Oldham M, Brown J. Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data. Addiction 2021; 116:1233-1244. [PMID: 33089562 PMCID: PMC8436745 DOI: 10.1111/add.15295] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine changes in smoking, drinking and quitting/reduction behaviour following the COVID-19 lockdown in England. DESIGN/SETTING Monthly cross-sectional surveys representative of the adult population in England, aggregated before (April 2019-February 2020) versus after (April 2020) lockdown. PARTICIPANTS A total of 20 558 adults (≥ 16 years). MEASUREMENTS The independent variable was the timing of the COVID-19 lockdown (before versus after March 2020). Dependent variables were: prevalence of smoking and high-risk drinking, past-year cessation and quit attempts (among past-year smokers), past-year attempts to reduce alcohol consumption (among high-risk drinkers) and use of evidence-based (e.g. prescription medication/face-to-face behavioural support) and remote support [telephone support/websites/applications (apps)] for smoking cessation and alcohol reduction (among smokers/high-risk drinkers who made a quit/reduction attempt). Covariates included age, sex, social grade, region and level of nicotine and alcohol dependence (as relevant). FINDINGS The COVID-19 lockdown was not associated with a significant change in smoking prevalence [17.0% (after) versus 15.9% (before), odds ratio (OR) = 1.09, 95% CI = 0.95-1.24], but was associated with increases in quit attempts [39.6 versus 29.1%, adjusted odds ratio (ORadj ) = 1.56, 95% CI = 1.23-1.98], quit success (21.3 versus 13.9%, ORadj = 2.01, 95% CI = 1.22-3.33) and cessation (8.8 versus 4.1%, ORadj = 2.63, 95% CI = 1.69-4.09) among past-year smokers. Among smokers who tried to quit, there was no significant change in use of evidence-based support (50.0 versus 51.5%, ORadj = 1.10, 95% CI = 0.72-1.68) but use of remote support increased (10.9 versus 2.7%, ORadj = 3.59, 95% CI = 1.56-8.23). Lockdown was associated with increases in high-risk drinking (38.3 versus 25.1%, OR = 1.85, CI = 1.67-2.06), but also alcohol reduction attempts by high-risk drinkers (28.5 versus 15.3%, ORadj = 2.16, 95% CI = 1.77-2.64). Among high-risk drinkers who made a reduction attempt, use of evidence-based support decreased (1.2 versus 4.0%, ORadj = 0.23, 95% CI = 0.05-0.97) and there was no significant change in use of remote support (6.9 versus 6.1%, ORadj = 1.32, 95% CI = 0.64-2.75). CONCLUSIONS Following the March 2020 COVID-19 lockdown, smokers and high-risk drinkers in England were more likely than before lockdown to report trying to quit smoking or reduce alcohol consumption and rates of smoking cessation and use of remote cessation support were higher. However, high-risk drinking prevalence increased post-lockdown and use of evidence-based support for alcohol reduction by high-risk drinkers decreased with no compensatory increase in use of remote support.
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Affiliation(s)
- Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Claire Garnett
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Melissa Oldham
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonUK
- SPECTRUM Consortium, LondonUK
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Pacek LR, Holloway AD, Cropsey KL, Meade CS, Sweitzer MM, Davis JM, Joseph McClernon F. Experiences With Smoking Cessation Attempts and Prior Use of Cessation Aids in Smokers With HIV: Findings From a Focus Group Study Conducted in Durham, North Carolina. AIDS Educ Prev 2021; 33:158-168. [PMID: 33821680 PMCID: PMC8158019 DOI: 10.1521/aeap.2021.33.2.158] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cigarette smoking remains disproportionately prevalent and is increasingly a cause of death and disability among people with HIV (PWH). Many PWH are interested in quitting, but interest in and uptake of first-line smoking cessation pharmacotherapies are varied in this population. To provide current data regarding experiences with and perceptions of smoking cessation and cessation aids among PWH living in Durham, North Carolina, the authors conducted five focus group interviews (total n = 24; 96% African American) using semistructured interviews. Interviews were recorded, transcribed, coded, and thematically analyzed. Major themes included ambivalence and/or lack of interest in cessation; presence of cessation barriers; perceived perceptions of ineffectiveness of cessation aids; perceived medication side effects; and conflation of the harms resulting from use of tobacco products and nicotine replacement therapy. Innovative and effective interventions must account for the aforementioned multiple barriers to cessation as well as prior experiences with and misperceptions regarding cessation aids.
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Affiliation(s)
- Lauren R Pacek
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Alicia D Holloway
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Karen L Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, Alabama
| | - Christina S Meade
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - Maggie M Sweitzer
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
| | - James M Davis
- Duke University School of Medicine, General Internal Medicine, and the Duke Cancer Institute, Durham, North Carolina
| | - F Joseph McClernon
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, North Carolina
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Lienemann BA, Cummins SE, Tedeschi GJ, Wong S, Zhu SH. American Indian/Alaska Native Smokers' Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behaviors From 2008 to 2018. Nicotine Tob Res 2021; 23:219-226. [PMID: 31711234 DOI: 10.1093/ntr/ntz205] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/30/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The objective of this study was to examine access, engagement, and quitting behaviors of American Indian/Alaska Native (AIAN) callers to the California Smokers' Helpline. Telephone counseling is the primary function of the quitline. The overarching theoretical framework for California's quitline is social cognitive theory, although it also utilizes motivational interviewing and cognitive-behavioral strategies. AIMS AND METHODS AIAN (n = 16 089) and White (n = 173 425) California quitline callers from 2009 to 2018 were compared on their characteristics, engagement, and quitting behaviors. Quitline callers responded to a telephone survey at intake. A random selection was called for evaluation 7 months later (White n = 8194, AIAN n = 764). Data from the 2009 to 2017 California Health Interview Survey (CHIS) were used as a reference point for AIANs (AIAN n = 1373). RESULTS The quitline and CHIS had similar proportions of AIANs (4.6% vs. 4.3%, respectively). AIAN smokers were more likely than White smokers to report physical (53.6% vs. 44.9%) and mental (65.7% vs. 57.8%) health conditions at intake. AIANs were more likely to participate in counseling than White callers (67.1% vs. 65.7%). Among those who received counseling, AIANs had greater odds than White smokers of making a quit attempt (adjusted odds ratio = 1.39 [1.06, 1.81]) and similar odds of quitting for 180 days (adjusted odds ratio = 0.95 [0.69, 1.31]). CONCLUSIONS Rates of access, engagement, and quitting suggest that individualized quitline counseling was as effective with AIANs as it was with White smokers. Increasing efforts to refer AIANs to existing state quitlines can help more smokers quit. IMPLICATIONS This study showed that AIAN smokers were well represented among California quitline callers, even without a targeted campaign. It also found that AIAN smokers engaged in quitline services and were as able to quit as their White counterparts were, even after adjusting for other baseline characteristics. One implication is that public health programs can promote quitlines using broad-based campaigns knowing that they will still motivate AIAN smokers to seek help. Another implication is that a standard, individualized counseling protocol delivered by culturally competent quitline staff can effectively help AIAN smokers to quit.
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Affiliation(s)
| | - Sharon E Cummins
- Moores Cancer Center, University of California-San Diego, La Jolla, CA
| | - Gary J Tedeschi
- Moores Cancer Center, University of California-San Diego, La Jolla, CA
| | - Shiushing Wong
- Moores Cancer Center, University of California-San Diego, La Jolla, CA
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California-San Diego, La Jolla, CA
- Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, CA
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McRobbie HJ, Phillips-Waller A, El Zerbi C, McNeill A, Hajek P, Pesola F, Balmford J, Ferguson SG, Li L, Lewis S, Courtney RJ, Gartner C, Bauld L, Borland R. Nicotine replacement treatment, e-cigarettes and an online behavioural intervention to reduce relapse in recent ex-smokers: a multinational four-arm RCT. Health Technol Assess 2020; 24:1-82. [PMID: 33270009 PMCID: PMC7750867 DOI: 10.3310/hta24680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Relapse remains an unresolved issue in smoking cessation. Extended stop smoking medication use can help, but uptake is low and several behavioural relapse prevention interventions have been found to be ineffective. However, opportunistic 'emergency' use of fast-acting nicotine replacement treatment or electronic cigarettes may be more attractive and effective, and an online behavioural Structured Planning and Prompting Protocol has shown promise. The present trial aimed to evaluate the clinical effectiveness and cost-effectiveness of these two interventions. DESIGN A randomised controlled trial. SETTING English stop smoking services and Australian quitlines, Australian social media and St Vincent's Hospital Melbourne, Fitzroy, VIC. PARTICIPANTS Ex-smokers abstinent for at least 4 weeks, with some participants in Australia also recruited from 1 week post quit date. The planned sample size was 1400, but the trial was curtailed when 235 participants were recruited. INTERVENTIONS Participants were randomised in permuted blocks of random sizes to (1) oral nicotine replacement treatment/electronic cigarettes to use if at risk of relapse, plus static text messages (n = 60), (2) the Structured Planning and Prompting Protocol and interactive text messages (n = 57), (3) oral nicotine replacement treatment/electronic cigarettes plus the Structured Planning and Prompting Protocol with interactive text messages (n = 58) or (4) usual care plus static text messages (n = 59). OUTCOME MEASURES Owing to delays in study set-up and recruitment issues, the study was curtailed and the primary outcome was revised. The original objective was to determine whether or not the two interventions, together or separately, reduced relapse rates at 12 months compared with usual care. The revised primary objective was to determine whether or not number of interventions received (i.e. none, one or two) affects relapse rate at 6 months (not biochemically validated because of study curtailment). Relapse was defined as smoking on at least 7 consecutive days, or any smoking in the last month at final follow-up for both the original and curtailed outcomes. Participants with missing outcome data were included as smokers. Secondary outcomes included sustained abstinence (i.e. no more than five cigarettes smoked over the 6 months), nicotine product preferences (e.g. electronic cigarettes or nicotine replacement treatment) and Structured Planning and Prompting Protocol coping strategies used. Two substudies assessed reactions to interventions quantitatively and qualitatively. The trial statistician remained blinded until analysis was complete. RESULTS The 6-month relapse rates were 60.0%, 43.5% and 49.2% in the usual-care arm, one-intervention arm and the two-intervention arm, respectively (p = 0.11). Sustained abstinence rates were 41.7%, 54.8% and 50.9%, respectively (p = 0.17). Electronic cigarettes were chosen more frequently than nicotine replacement treatment in Australia (71.1% vs. 29.0%; p = 0.001), but not in England (54.0% vs. 46.0%; p = 0.57). Of participants allocated to nicotine products, 23.1% were using them daily at 6 months. The online intervention received positive ratings from 63% of participants at 6 months, but the majority of participants (72%) completed one assessment only. Coping strategies taught in the Structured Planning and Prompting Protocol were used with similar frequency in all study arms, suggesting that these are strategies people had already acquired. Only one participant used the interactive texting, and interactive and static messages received virtually identical ratings. LIMITATIONS The inability to recruit sufficient participants resulted in a lack of power to detect clinically relevant differences. Self-reported abstinence was not biochemically validated in the curtailed trial, and the ecological momentary assessment substudy was perceived by some as an intervention. CONCLUSIONS Recruiting recent ex-smokers into an interventional study proved problematic. Both interventions were well received and safe. Combining the interventions did not surpass the effects of each intervention alone. There was a trend in favour of single interventions reducing relapse, but it did not reach significance and there are reasons to interpret the trend with caution. FUTURE WORK Further studies of both interventions are warranted, using simpler study designs. TRIAL REGISTRATION Current Controlled Trials ISRCTN11111428. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 68. See the NIHR Journals Library website for further project information. Funding was also provided by the National Health and Medical Research Council, Canberra, ACT, Australia (NHMRC APP1095880). Public Health England provided the funds to purchase the nicotine products in England.
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Affiliation(s)
- Hayden J McRobbie
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | | | - Catherine El Zerbi
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Ann McNeill
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Peter Hajek
- Health and Lifestyle Research Unit, Queen Mary University of London, London, UK
| | - Francesca Pesola
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stuart G Ferguson
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Lin Li
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Lewis
- Clinical Sciences Building, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ron Borland
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Kruse GR, Park ER, Chang Y, Haberer JE, Abroms LC, Shahid NN, Howard S, Haas JS, Rigotti NA. Proactively Offered Text Messages and Mailed Nicotine Replacement Therapy for Smokers in Primary Care Practices: A Pilot Randomized Trial. Nicotine Tob Res 2020; 22:1509-1514. [PMID: 32198520 PMCID: PMC7443591 DOI: 10.1093/ntr/ntaa050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/05/2019] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. AIMS AND METHODS This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages (TM) and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics. From 2017 to 2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), TM, 2 weeks of mailed NRT, or both interventions (TM + NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA. RESULTS Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages, and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% vs. TM 86% [p = .07], NRT 81% [p = .18], TM + NRT 79% [p = .21]) and NRT use (BA 51% vs. NRT 83% [p = .007], TM 65% [p = .25], TM + NRT 76% [p = .03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p = .09), NRT 28% (p = .06), and TM + NRT 23% (p = .14). CONCLUSIONS Proactively offering TM or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence. IMPLICATIONS Proactive intervention programs to promote quit attempts outside of office visits among smokers enrolled in primary care practices are needed. TM have potential to engage smokers not planning to quit or to support smokers to make a planned quit attempt. This pilot study demonstrates the feasibility of testing a proactive treatment model including TM and/or mailed NRT to promote quit attempts, treatment use, and cessation among nontreatment-seeking smokers in primary care. CLINICALTRIALS.GOV IDENTIFIER NCT03174158.
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Affiliation(s)
- Gina R Kruse
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jessica E Haberer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Center for Global Health, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Naysha N Shahid
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sydney Howard
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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10
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Rose JE, Davis JM. Combination Lorcaserin and Nicotine Patch for Smoking Cessation Without Weight Gain. Nicotine Tob Res 2020; 22:1627-1631. [PMID: 31589323 PMCID: PMC7443600 DOI: 10.1093/ntr/ntz149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/06/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explored the efficacy of combination lorcaserin and nicotine patch for smoking cessation treatment and prevention of postsmoking cessation weight gain. METHODS We conducted a trial in which 61 adult daily smokers were asked to quit smoking using a combination of lorcaserin and nicotine patch. During the first 2 weeks of treatment prior to the quit day, participants were randomized to receive either lorcaserin (10 mg twice daily) plus nicotine patch (21 mg) or placebo plus nicotine patch (21 mg). Following this 2-week period, participants received both medications for 12 weeks. Outcomes included 4-week continuous smoking abstinence at the end of treatment (weeks 7-10 postquit attempt), weight change, ad libitum smoking, withdrawal symptoms, and ratings of cigarette reward. RESULTS Biochemically confirmed continuous smoking abstinence from 7 to 10 weeks postquit attempt was 31.1% (90% confidence interval, 21.4%-40.8%). Participants who quit smoking showed no weight gain; in fact, mean weight change was minus 0.16 kg (SD = 3.27) over the study period. There was an unexpected but strong association (p = .006) between a decrease in sensory enjoyment of smoking and successful quit outcome on this regimen. During the prequit randomization period, lorcaserin versus placebo reduced the impact of smoking to relieve craving for cigarettes as well as the sensory enjoyment of smoking (p = .005). Adherence and tolerability to lorcaserin and nicotine patch was good. CONCLUSIONS The combination of lorcaserin and nicotine patch was well tolerated, associated with a relatively high smoking abstinence rate, and effectively prevented weight gain associated with quitting smoking. IMPLICATIONS This report provides an important contribution to the literature because it details evidence of a medication combination-lorcaserin and nicotine-that is effective for smoking cessation and for ameliorating weight gain associated with smoking cessation. For many smokers, postcessation weight gain is a major obstacle to quitting, and this medication combination provides a suitable treatment option for these smokers. CLINICAL TRIAL REGISTRATION NCT02906644.
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Affiliation(s)
- Jed E Rose
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - James M Davis
- Division of Internal Medicine, Department of Medicine, Duke University, Durham, NC
- Duke Cancer Institute, Durham, NC
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Hatsukami DK, Meier E, Lindgren BR, Anderson A, Reisinger SA, Norton KJ, Strayer L, Jensen JA, Dick L, Murphy SE, Carmella SG, Tang MK, Chen M, Hecht SS, O’connor RJ, Shields PG. A Randomized Clinical Trial Examining the Effects of Instructions for Electronic Cigarette Use on Smoking-Related Behaviors and Biomarkers of Exposure. Nicotine Tob Res 2020; 22:1524-1532. [PMID: 31828315 PMCID: PMC7443587 DOI: 10.1093/ntr/ntz233] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 01/21/2019] [Accepted: 12/10/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) have the potential to significantly reduce exposure to harmful constituents associated with cigarette smoking when smokers completely substitute cigarettes with e-cigarettes. This study examined patterns of e-cigarette and cigarette use, and extent of toxicant exposure, if smokers were instructed and incentivized to completely switch to e-cigarettes compared to instructions to use the product ad libitum. AIMS AND METHODS US adult daily smokers (n = 264; 49.2% female; Mage = 47.0), uninterested in quitting smoking immediately, were recruited from Minneapolis, MN, Columbus, OH, and Buffalo, NY. Participants were randomized to 8 weeks of instructions for (1) ad libitum use of e-cigarettes (AD-E), (2) complete substitution of cigarettes with e-cigarettes (CS-E), (3) complete substitution of cigarettes with nicotine gum or lozenge (CS-NRT), or (4) continue smoking of usual brand cigarettes (UB). Participants were incentivized for protocol compliance, including complete switching in the CS-E and CS-NRT groups. Outcome variables were cigarette smoking rate and tobacco-related biomarkers of exposure. RESULTS Smokers in the CS-E and CS-NRT groups showed lower rates of smoking and lower exposure to carbon monoxide, tobacco carcinogens, and other toxicants than smokers in the AD-E group. In general, no significant differences were observed between CS-E versus CS-NRT or between AD-E versus UB for most biomarkers. Significantly higher 7-day point prevalence smoke-free rates were observed for CS-E versus CS-NRT. CONCLUSIONS Smokers instructed and incentivized to completely switch to e-cigarettes resulted in lower smoking rates and greater reductions in exposures to harmful chemicals than smokers instructed to use the product ad libitum. IMPLICATIONS Smokers instructed to completely substitute e-cigarettes for cigarettes displayed significantly lower levels of smoking and biomarkers of exposure to carcinogens and toxicants, compared to smokers instructed to use e-cigarettes ad libitum and similar levels as smokers instructed to completely substitute with nicotine replacement therapies. Furthermore, a higher rate of complete switching was achieved with e-cigarettes versus nicotine replacement therapies. Approaches to maximize complete substitution with e-cigarettes are an important area for future research.
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Affiliation(s)
- Dorothy K Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Ellen Meier
- Department of Psychology, University of Wisconsin – Stevens Point, Stevens Point, WI
| | | | - Amanda Anderson
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Kaila J Norton
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lori Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Joni A Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Laura Dick
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Mei-Kuen Tang
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Richard J O’connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Peter G Shields
- James Cancer Center, The Ohio State University, Columbus, OH
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Kuipers MAG, West R, Beard EV, Brown J. Impact of the "Stoptober" Smoking Cessation Campaign in England From 2012 to 2017: A Quasiexperimental Repeat Cross-Sectional Study. Nicotine Tob Res 2020; 22:1453-1459. [PMID: 31246257 PMCID: PMC7443602 DOI: 10.1093/ntr/ntz108] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/26/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Since 2012, England has an annual "Stoptober" campaign for collective smoking cessation. Our aim was to assess (1) overall impact of the Stoptober campaign on quit attempts over its first 6 years, (2) consistency of impact over the campaign years, and (3) the role of the campaign budget. METHODS We used data of 51 399 adult smokers and ex-smokers in 132 repeat cross-sectional monthly surveys in England, 2007-2017. In a quasiexperimental design, adjusted logistic regression analyses compared past-month quit attempt rate between (1) October and other months in the year, between 2007-2011 and 2012-2017; (2) October and other months, across years 2012-2017; and (3) October and other months, between high-budget (2012-2015) and low-budget Stoptober campaigns (2016-2017). Bayes factors (BF) differentiated insensitive data and absence of an effect. RESULTS (1) In 2012-2017, quit attempts were more prevalent in October versus other months (odds ratio [OR]: 1.24, 95% confidence interval [CI]: 1.00 to 1.53), whereas similar in 2007-2011 (OR: 0.95, 95% CI: 0.76 to 1.18; BF = 0.2); data were somewhat insensitive but supported this difference (OR: 1.30, 95% CI: 0.97 to 1.75; BF = 2.1). (2) In 2012-2017, quit attempt prevalence ranged from 3.1% to 8.5% in October and 5.0% to 7.3% in other months. The difference between October and other months was large in 2012 (absolute unadjusted difference of 3.3%; OR: 1.92, 95% CI: 1.23 to 2.98) and 2015 (3.1%; OR: 1.84, 95% CI: 1.14 to 2.95), but small in 2013-2014 and 2016-2017 (0.36 < BF < 1.02). (3) Data were somewhat insensitive but supported interaction with campaign budget (OR: 1.50, 95% CI: 0.92 to 2.44; BF = 2.2). DISCUSSION In 2012-2017, there appears to have been an increase in past-month quit attempts during October in England. The increase was inconsistent across Stoptober campaigns and appears to have been greater when the campaign budget was higher. IMPLICATIONS Over the first 6 years of Stoptober campaigns, there appears to have been an overall increase in past-month quit attempts during October in England, and the data imply that a sufficiently high budget contributes to greater impact of the Stoptober campaign. These findings encourage the further spread of the Stoptober campaign to other countries. Future research should clarify how increased quit attempts as a consequence of Stoptober translate into quit success and which of Stoptober's ingredients were most important in increasing quit attempts, especially among vulnerable groups.
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Affiliation(s)
- Mirte A G Kuipers
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma V Beard
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences. Nicotine Tob Res 2020; 22:1476-1483. [PMID: 31418449 PMCID: PMC7443610 DOI: 10.1093/ntr/ntz141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 02/02/2023]
Abstract
AIM To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England. METHODS Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies. RESULTS There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant. CONCLUSION Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact. IMPLICATIONS This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mirte A G Kuipers
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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Garnett C, Shahab L, Raupach T, West R, Brown J. Understanding the Association Between Spontaneous Quit Attempts and Improved Smoking Cessation Success Rates: A Population Survey in England With 6-Month Follow-up. Nicotine Tob Res 2020; 22:1460-1467. [PMID: 31300827 PMCID: PMC7443601 DOI: 10.1093/ntr/ntz115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/06/2019] [Accepted: 07/11/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Almost half of smoking quit attempts are "spontaneous" (initiated as soon as the decision to quit has been made) and are associated with increased success rates. This study aimed to assess to what extent other factors may account for this association. METHODS Data were used from respondents to a survey representative of the adult population in England from 2006 to 2016. We included 2018 respondents who were current smokers at baseline and had attempted to quit between baseline and 6-month follow-up. Logistic regression models assessed the association between quit success and spontaneous quit attempts while adjusting for smoking, sociodemographic, and quit attempt characteristics. RESULTS Spontaneous quit attempts were associated with greater odds of quit success (OR = 1.31, 95% CI = 1.07 to 1.60) but the association was not significant in the fully adjusted model (ORadj = 1.19, 95% CI = 0.95 to 1.49). In this adjusted model, those who attempted to quit without cutting down first (ORadj = 3.08, 95% CI = 2.46 to 3.88) and were male (ORadj = 1.44, 95% CI = 1.16 to 1.80) had greater odds of success; although a greater number of attempts in the past 6 months, stronger urges to smoke (strong vs. none), higher daily cigarette consumption, and lower social grade (E vs. AB) were associated with lower odds of success (ORadj range = 0.32-0.98, p < .030). Quit attempts made without cutting down first were correlated with spontaneous quit attempts (r = .150, p < .001) and appeared to account for the diminished association between spontaneous quitting and success (ORadj = 1.18, 95% CI = 0.96 to 1.46). CONCLUSIONS The increased success rate of spontaneous quit attempts appears to be because spontaneous quit attempts are more likely to be made without cutting down first. IMPLICATIONS The apparent benefit of spontaneous over planned quit attempts may be attributable to the former being more likely to involve quitting without cutting down first (ie, abrupt cessation) than cutting down first (ie, gradual cessation) and so this may be a more useful target for advice to improve the chances of successful quitting.
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Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Tobias Raupach
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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Oncken C, Allen S, Litt M, Kenny A, Lando H, Allen A, Dornelas E. Exercise for Smoking Cessation in Postmenopausal Women: A Randomized, Controlled Trial. Nicotine Tob Res 2020; 22:1587-1595. [PMID: 31536112 PMCID: PMC8135660 DOI: 10.1093/ntr/ntz176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/26/2019] [Accepted: 09/10/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postmenopausal smokers have difficulty quitting smoking and experience considerable weight gain with smoking cessation. We examined whether adjunctive smoking treatment with exercise, compared to a relaxation control condition, could improve cigarette abstinence, decrease cigarettes smoked per day (CPD), and ameliorate changes in body mass index (BMI) in postmenopausal smokers. METHODS Women (N = 301) signed informed consent and were randomized to treatment at two sites (Universities of Connecticut and Minnesota). We randomized groups of participants to a comprehensive group treatment program that included 12 weeks of varenicline and either a moderate exercise or relaxation component for 6 months. Participants were followed for a year after medication treatment. RESULTS Overall, 17.3% of patients reported carbon monoxide-verified continuous abstinence for the 9- to 12-week period, and 11.6% reported prolonged abstinence at 1 year, with no significant differences between treatment conditions. CPD reported at study visits showed significant main effects for time in weeks, for site, and for treatment. The Exercise condition reported smoking fewer CPD over time, and that advantage widened over time. In terms of BMI, significant effects for time in weeks, and for the interaction of Week × Treatment condition, reflected gradually increasing BMI in these women over time, but with the increase in BMI slower in the Exercise condition. CONCLUSIONS Exercise, compared to relaxation, was associated with a reduced BMI and CPD in postmenopausal women, but did not increase end of treatment or prolonged abstinence. Further research is needed to devise exercise programs that increase smoking cessation rates in postmenopausal women. IMPLICATIONS This study adds to the literature on the effectiveness of a moderate exercise intervention compared to a relaxation control condition as an adjunctive treatment for smoking cessation in postmenopausal women. Our exercise program did not increase end of treatment or prolonged abstinence rates in postmenopausal women; however, there was a beneficial effect on smoking reduction and reduced body mass index. Additional research is needed to devise exercise programs that increase smoking cessation rates in postmenopausal women.
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Affiliation(s)
- Cheryl Oncken
- Department of Medicine, UConn School of Medicine, Farmington, CT
| | - Sharon Allen
- Department of Family Medicine, University of Minnesota, Minneapolis, MN
| | - Mark Litt
- Department of Behavioral Sciences, UConn School of Dental Medicine, Farmington, CT
| | - Anne Kenny
- Department of Medicine, UConn School of Medicine, Farmington, CT
| | - Harry Lando
- Department of Epidemiology, University of Minnesota, Minneapolis, MN (Lando)
| | - Alicia Allen
- Department of Family Medicine, University of Arizona, Tuscon, AZ
| | - Ellen Dornelas
- Department of Medicine, UConn School of Medicine, Farmington, CT
- Cancer Center, Hartford Hospital, Hartford, CT
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Valera P, Acuna N, Vento I. The Preliminary Efficacy and Feasibility of Group-Based Smoking Cessation Treatment Program for Incarcerated Smokers. Am J Mens Health 2020; 14:1557988320943357. [PMID: 32705965 PMCID: PMC7383630 DOI: 10.1177/1557988320943357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Group-based tobacco dependence treatment has been known to help smokers to quit in general adult populations, but the feasibility and efficacy of this type of smoking cessation treatment in correctional settings remain uncertain. A 6-week group-based smoking cessation treatment with nicotine replacement therapy (NRT) in the form of nicotine patches was implemented in seven male prison facilities, in the Northeast, among smokers who were born biologically as male. Exhaled breath carbon monoxide (CO) levels were collected from participants at each session to confirm smoking status. Participants were evaluated at the 1-month post-group treatment follow-up to determine abstinence. Those who were lost to follow-up were recorded as continued smoking and not using NRT nicotine patches. The goal of the study was to explore the feasibility and preliminary efficacy of conducting a smoking cessation treatment program for incarcerated smokers. A total of 350 inmates were screened, 177 inmates were enrolled across the prison sites for the 6-week program, and 102 inmates completed the program. A majority of those enrolled reported that they began smoking when they were between 15 and 19 years of age (44.9%) and were smoking on average for 26 years. Less than half (21.3%) reported ever using electronic cigarettes at baseline and in Session 1,116 individuals who attended reported a median CO level of 18.0 parts per million (ppm). At a 1-month follow-up, 43 individuals reported a median CO level of 5.00 ppm. The study demonstrated preliminary efficacy and feasibility of group-based smoking cessation treatment with NRT nicotine patches in incarcerated smokers.
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Affiliation(s)
- Pamela Valera
- School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, USA
| | - Nicholas Acuna
- School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, USA
| | - Ismary Vento
- School of Public Health, Rutgers, The State University of New Jersey, Newark, NJ, USA
- Cancer Health Justice Lab, Rutgers University School of Public Health, Newark, NJ, USA
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Lucherini M, Hill S, Smith K. Inequalities, harm reduction and non-combustible nicotine products: a meta-ethnography of qualitative evidence. BMC Public Health 2020; 20:943. [PMID: 32539788 PMCID: PMC7296947 DOI: 10.1186/s12889-020-09083-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 06/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We sought to review qualitative evidence on how smokers in different socioeconomic groups engage with non-combustible nicotine products (NCNP), including electronic cigarettes and nicotine replacement therapies, in order to provide insight into how these products might impact on smoking inequalities. METHODS We searched ten electronic databases in February 2017 using terms relating to NCNP and socioeconomic status. We included qualitative studies that were published since 1980 and were available in English. We used guidelines adapted from the Critical Appraisal Skills Programme for appraising qualitative research. RESULTS The review only identified studies exploring the attitudes of socioeconomically disadvantaged smokers towards NCNP for harm reduction or cessation purposes (i.e. we did not identify any relevant studies of more advantaged socioeconomic groups). Using a lines-of-argument meta-ethnographic approach, we identified a predominantly pessimistic attitude to NCNP for harm reduction or cessation of smoking due to: wider circumstances of socioeconomic disadvantage; lack of a perceived advantage of alternative products over smoking; and a perceived lack of information about relative harms of NCNP compared to smoking. Optimistic findings, although fewer, suggested the potential of NCNP being taken up among smokers experiencing socioeconomic disadvantage. CONCLUSIONS Overall, our review highlights the importance of considering the social, cultural and economic circumstances that influence experiences of smoking and of alternative product use.
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Affiliation(s)
- Mark Lucherini
- School of Geography, Geology and the Environment, Keele University, Keele, UK.
| | - Sarah Hill
- Global Health Policy Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, UK
| | - Katherine Smith
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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Kotsen C, Santorelli ML, Bloom EL, Goldstein AO, Ripley-Moffitt C, Steinberg MB, Burke MV, Foulds J. A Narrative Review of Intensive Group Tobacco Treatment: Clinical, Research, and US Policy Recommendations. Nicotine Tob Res 2020; 21:1580-1589. [PMID: 30124924 DOI: 10.1093/ntr/nty162] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/14/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Clinical practice guidelines recommend comprehensive treatment for tobacco dependence including pharmacotherapies and behavioral interventions. Group counseling may deliver unique treatment aspects not available with other modalities. This manuscript provides a narrative review of group treatment outcomes from real-world practice settings and complements recent meta-analyses of randomized controlled trials (RCTs). Our primary goals were to determine whether group treatments delivered in these settings have yielded similar quit rates compared to individual treatment and to provide recommendations for best practices and policy. METHODS Group treatment was defined as occurring in a clinical or workplace setting (ie, not provided as part of a research study), led by a professionally trained clinician, and offered weekly over several weeks. English language PubMed articles from January 2000 to July 2017 were searched to identify studies that included outcomes from both group and individual treatment offered in real-world settings. Additional data sources meeting our criteria were also included. Reports not using pharmacotherapy and research studies (eg, RCTs) were excluded. The primary outcome was short-term, carbon monoxide (CO)-validated point prevalence abstinence (4-week postquit date). RESULTS The review included data from 11 observational studies. In all cases, group treatment(s) had higher 4-week CO-validated quit rates (range: 35.5%-67.3%) than individual treatment(s) (range: 18.6%-53.3%). CONCLUSIONS Best practice group treatments for tobacco dependence are generalizable from research to clinical settings and likely to be at least as effective as intensive individual treatment. The added advantages of efficiency and cost-effectiveness can be significant. Group treatment is feasible in various settings with good results. IMPLICATIONS A major barrier to achieving high rates of tobacco abstinence is under-utilization of evidence-based treatment interventions. This review demonstrates the effectiveness and utility of group treatment for tobacco dependence. Based on the available data described in this narrative review in conjunction with existing RCT data, group treatment for tobacco dependence should be established and available in all behavioral health and medical settings. Group tobacco treatment is now one of the mandated reimbursable tobacco treatment formats within the US health care system, creating enormous opportunities for widespread clinical reach. Finally, comprehensive worksite group programs can further extend impact.
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Affiliation(s)
- Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, RWJ Barnabas Health, Robert Wood Johnson Barnabas Health University Hospital Somerset, Somerville, NJ
| | - Melissa L Santorelli
- Community Health and Wellness Unit, New Jersey Department of Health, State of New Jersey, Trenton, NJ
| | - Erika Litvin Bloom
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam O Goldstein
- Tobacco Intervention Programs, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Carol Ripley-Moffitt
- Nicotine Dependence Program, Department of Family Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael B Steinberg
- Rutgers Tobacco Dependence Program, Division of General Internal Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Jonathan Foulds
- Population Health and Cancer Control Program, Cancer Institute, College of Medicine, Penn State University, Hershey, PA
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Perkins KA, Karelitz JL. A Procedure to Standardize Puff Topography During Evaluations of Acute Tobacco or Electronic Cigarette Exposure. Nicotine Tob Res 2020; 22:689-698. [PMID: 30590778 PMCID: PMC7171283 DOI: 10.1093/ntr/nty261] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/04/2018] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Documenting factors that influence differential sensitivity to acutely inhaled nicotine products requires carefully controlling the amount of exposure (dose), and thus a procedure by which to control such exposure. METHODS We evaluated consistency of puff volume from intermittent acute exposures to smoked tobacco cigarettes (study 1, n = 45, plus a comparison study of uninstructed use with n = 59) and to vaped electronic cigarettes (e-cigarettes; study 2, n = 27 naive to e-cigarettes) in adult-dependent smokers. All in primary studies 1 and 2 participated in research administering different nicotine levels in each product under blind conditions, one per session using within-subject designs. In both studies, participants followed an automated instructional procedure on a computer monitor standardizing the timing and amount of exposure to each product during a given trial, with four trials per session, each separated by 20 minutes. Puff volume per trial via Clinical Research Support System (CReSS) was the primary dependent measure to determine consistency across trials via intraclass correlation coefficients (ICCs). RESULTS Control over topography with both inhaled products was demonstrated by highly significant ICCs for puff volume across trials. Instructed control with own brand was generally better in study 1 than with uninstructed smoking in the comparison sample, as expected. As intended, reliability of puff volume generally did not differ by menthol preference or sex in either study, but ICCs in study 2 tended to be lower for some men using the placebo e-cigarette. CONCLUSIONS This instructional procedure may substantially improve control over amounts of acute exposure to tobacco or e-cigarette use. IMPLICATIONS Control over topography in studies of acute exposure to these inhaled products can potentially aid validity of research into differential sensitivity to use, so findings can be attributed to factors of interest and not to variable exposure. Our procedure minimized variability in exposure to the same product and between moderate nicotine products, but remaining differences suggest that compensation for very low or no nicotine commercial products may be difficult to totally eliminate with these instructions alone. Further study is needed to determine this procedure's utility with other inhaled products among experienced users and when comparing different products in between-groups analyses.
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Affiliation(s)
- Kenneth A Perkins
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joshua L Karelitz
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Beard E, Jackson SE, West R, Kuipers MAG, Brown J. Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis. Addiction 2020; 115:315-325. [PMID: 31626370 PMCID: PMC7004132 DOI: 10.1111/add.14837] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/25/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023]
Abstract
AIMS To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level. DESIGN time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling. SETTING AND PARTICIPANTS Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England. MEASUREMENTS The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate. FINDINGS The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant. CONCLUSION In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Mirte A. G. Kuipers
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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Jackson SE, Beard E, Michie S, West R, Brown J. Is the use of e-cigarettes for smoking cessation associated with alcohol consumption? A population-level survey of successful quitters in England. Addict Behav 2020; 101:106138. [PMID: 31645002 DOI: 10.1016/j.addbeh.2019.106138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine associations between the use of e-cigarettes for smoking cessation and levels of alcohol consumption, high-risk drinking, and attempts to cut down alcohol consumption compared with use of nicotine replacement therapy (NRT) or no aid. METHODS Cross-sectional survey of adults (≥16 years) in England. The sample included a total of 961 people who had quit smoking with the use of either e-cigarettes (n = 425), NRT (n = 116), or no aid (n = 421) within the past year and were still abstinent at the survey. Drinking behaviour was assessed with the AUDIT. RESULTS Mean (SD) alcohol consumption among those who quit smoking with e-cigarettes, NRT, and no aid was 7.78 (13.41), 7.12 (13.85), and 5.55 (8.70) units/week, respectively. The prevalence of high-risk drinking was 43.3% (n = 184), 32.2% (n = 37), and 36.8% (n = 155), respectively. Among high-risk drinkers, the prevalence of attempts to cut down alcohol consumption was 22.3% (n = 41), 18.9% (n = 7), and 27.7% (n = 43), respectively. After adjustment for covariates, those who quit with e-cigarettes had significantly higher alcohol consumption than those who quit unaided (B = 1.69, 95%CI 0.21-3.17), but there was no significant difference relative to those who quit with NRT. Differences in high-risk drinking and attempts to cut down were not significant, but Bayes factors indicated the data were insensitive (range: 0.47-0.95). CONCLUSIONS Recent ex-smokers who used e-cigarettes to help them quit consumed around two more units of alcohol each week than those who quit unaided, but their alcohol consumption was similar to those who quit with NRT. Data on differences in high-risk drinking and attempts to cut down alcohol consumption among high-risk drinkers were inconclusive.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK; Department of Clinical, Educational and Health Psychology, University College London, UK
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Kim N, McCarthy DE, Loh WY, Cook JW, Piper ME, Schlam TR, Baker TB. Predictors of adherence to nicotine replacement therapy: Machine learning evidence that perceived need predicts medication use. Drug Alcohol Depend 2019; 205:107668. [PMID: 31707266 PMCID: PMC6931262 DOI: 10.1016/j.drugalcdep.2019.107668] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nonadherence to smoking cessation medication is a frequent problem. Identifying pre-quit predictors of nonadherence may help explain nonadherence and suggest tailored interventions to address it. AIMS Identify and characterize subgroups of smokers based on adherence to nicotine replacement therapy (NRT). METHOD Secondary classification tree analyses of data from a 2-arm randomized controlled trial of Recommended Usual Care (R-UC, n = 315) versus Abstinence-Optimized Treatment (A-OT, n = 308) were conducted. R-UC comprised 8 weeks of nicotine patch plus brief counseling whereas A-OT comprised 3 weeks of pre-quit mini-lozenges, 26 weeks of nicotine patch plus mini-lozenges, 11 counseling contacts, and 7-11 automated reminders to use medication. Analyses identified subgroups of smokers highly adherent to nicotine patch use in both treatment conditions, and identified subgroups of A-OT participants highly adherent to mini-lozenges. RESULTS Varied facets of nicotine dependence predicted adherence across treatment conditions 4 weeks post-quit and between 4- and 16-weeks post-quit in A-OT, with greater baseline dependence and greater smoking trigger exposure and reactivity predicting greater medication use. Greater quitting motivation and confidence, and believing that stop smoking medication was safe and easy to use were associated with greater adherence. CONCLUSION Adherence was especially high in those who were more dependent and more exposed to smoking triggers. Quitting motivation and confidence predicted greater adherence, while negative beliefs about medication safety and acceptability predicted worse adherence. Results suggest that adherent use of medication may reflect a rational appraisal of the likelihood that one will need medication and will benefit from it.
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Affiliation(s)
- Nayoung Kim
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA.
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA
| | - Wei-Yin Loh
- Department of Statistics, University of Wisconsin, Madison, WI 53706, USA
| | - Jessica W Cook
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA
| | - Tanya R Schlam
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA
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Lucherini M, Hill S, Smith K. Potential for non-combustible nicotine products to reduce socioeconomic inequalities in smoking: a systematic review and synthesis of best available evidence. BMC Public Health 2019; 19:1469. [PMID: 31694602 PMCID: PMC6836524 DOI: 10.1186/s12889-019-7836-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND While some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic. METHODS Ten electronic databases were searched in February 2017 using terms relating to e-cigarettes, smokeless tobacco and nicotine replacement therapy (NRT); and SES. We included studies published since 1980 that were available in English and examined product use by SES indicators such as income and education. Data synthesis was based on those studies judged to be of medium- to high-quality using guidelines adapted from the Critical Appraisal Skills Programme. RESULTS We identified 54 studies describing NCNP use by SES across 12 countries, of which 27 were judged of sufficient quality to include in data synthesis. We found mixed patterns of e-cigarette current use by SES, with evidence of higher use among low-income adults but unclear or mixed findings by education and occupation. In contrast, smokeless tobacco current use was consistently higher among low SES adults. There was very limited evidence on the SES distribution of NRT in adults and of all NCNPs in young people. CONCLUSIONS The only NCNP for which there are clear patterns of use by SES is smokeless tobacco, where prevalence is higher among low SES groups. While this suggests a potentially positive impact on inequalities in smoking (if NCNP use displaces smoked tobacco use), this has not been seen in practice. These findings do not support the suggestion that e-cigarettes have the potential to reduce social inequalities in smoking, since i) current evidence does not show a clear trend of higher e-cigarette use in population groups with higher tobacco consumption, and ii) the experience of smokeless tobacco suggests that - even where NCNP use is higher among low SES groups - this does not necessarily replace smoked tobacco use in these groups.
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Affiliation(s)
- Mark Lucherini
- Global Health Policy Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, UK.
- School of Geography, Geology and the Environment, Keele University, Newcastle, UK.
| | - Sarah Hill
- Global Health Policy Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, UK
| | - Katherine Smith
- School of Social Work & Social Policy, University of Strathclyde, Glasgow, UK
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Itani T, Martin R, Rai D, Jones T, Taylor G, Thomas K, Munafo M, Davies N, Taylor A. Use of varenicline and nicotine replacement therapy in people with and without general practitioner-recorded dementia: retrospective cohort study of routine electronic medical records. BMJ Open 2019; 9:e027569. [PMID: 31473613 PMCID: PMC6720236 DOI: 10.1136/bmjopen-2018-027569] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/24/2019] [Accepted: 06/26/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Our primary objective was to estimate smoking prevalence and prescribing rates of varenicline and nicotine replacement therapy (NRT) in people with and without general practitioner (GP)-recorded dementia. Our secondary objective was to assess and compare quit rates of smokers with versus without GP-recorded dementia who were prescribed varenicline or NRT for smoking cessation. DESIGN A retrospective cohort study based on the analysis of electronic medical records within the Clinical Practice Research Datalink (2007-2015). SETTING 683 general practices in England. PARTICIPANTS People with and without GP-recorded dementia, aged 18 years and have a code indicating that they are a current smoker. INTERVENTION Index prescription of varenicline or NRT (from 1 September 2006). OUTCOME MEASURES The primary outcomes were smoking prevalence and prescribing rates of varenicline and NRT (2007-2015). The secondary outcome was smoking cessation at 2 years. RESULTS Age and sex-standardised prevalence of smoking was slightly higher in people with GP-recorded dementia than in those without. There were 235 314 people aged 18 years and above prescribed NRT or varenicline. Among smokers with GP-recorded dementia (N=447), 409 were prescribed NRT and 38 varenicline. Smokers with GP-recorded dementia were 74% less likely (95% CI 64% to 82%) to be prescribed varenicline than NRT, compared with smokers without GP-recorded dementia. Compared with people without GP-recorded dementia, people with GP-recorded dementia had consistently lower prescribing rates of varenicline from 2007 to 2015. Two years after prescription, there was no clear evidence for a difference in the likelihood of smoking cessation after prescription of these medications between individuals with and without dementia (OR 1.0, 95% CI 0.8 to 1.2). CONCLUSIONS Between 2007 and 2015, people with GP-recorded dementia were less likely to be prescribed varenicline than those without dementia. Quit rates following prescription of either NRT or varenicline were similar in those with and without dementia.
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Affiliation(s)
- Taha Itani
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Richard Martin
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dheeraj Rai
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Avon & Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
| | - Tim Jones
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gemma Taylor
- Addiction and Mental Health Group (AIM) Department of Psychology, University of Bath, Bath, UK
| | - Kyla Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus Munafo
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Neil Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amy Taylor
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Hajek P, Phillips-Waller A, Przulj D, Pesola F, Smith KM, Bisal N, Li J, Parrott S, Sasieni P, Dawkins L, Ross L, Goniewicz M, Wu Q, McRobbie HJ. E-cigarettes compared with nicotine replacement therapy within the UK Stop Smoking Services: the TEC RCT. Health Technol Assess 2019; 23:1-82. [PMID: 31434605 PMCID: PMC6732716 DOI: 10.3310/hta23430] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Over the past few years, a large number of smokers in the UK have stopped smoking with the help of e-cigarettes. So far, UK Stop Smoking Services (SSSs) have been reluctant to include e-cigarettes among their treatment options because data on their efficacy compared with the licensed medications are lacking. OBJECTIVE The objective was to compare the efficacy of refillable e-cigarettes and nicotine replacement therapy (NRT) products, when accompanied by weekly behavioural support. DESIGN A randomised controlled trial comparing e-cigarettes and NRT. SETTING Three sites that provide local SSSs. PARTICIPANTS The participants were 886 smokers seeking help to quit smoking, aged ≥ 18 years, not pregnant or breastfeeding, with no strong preference to use or not to use NRT or e-cigarettes in their quit attempt, and currently not using NRT or e-cigarettes. A total of 886 participants were randomised but two died during the study (one in each study arm) and were not included in the analysis. INTERVENTIONS The NRT arm (n = 446) received NRT of their choice (single or combination), provided for up to 12 weeks. The e-cigarette arm (n = 438) received an e-cigarette starter pack and were encouraged to buy addtional e-liquids and e-cigarette products of their choice. Both arms received the same standard behavioural support. Participants attended weekly sessions at their SSS and provided outcome data at 4 weeks. They were then followed up by telephone at 6 and 12 months. Participants reporting abstinence or at least 50% reduction in cigarette consumption at 12 months were invited to attend for carbon monoxide (CO) validation. Participants/researchers could not be blinded to the intervention. MAIN OUTCOME MEASURES The primary outcome was CO-validated sustained abstinence rates at 52 weeks. Participants lost to follow-up or not providing biochemical validation were included as non-abstainers. Secondary outcomes included abstinence at other time points, reduction in smoke intake, treatment adherence and ratings, elicited adverse reactions, and changes in self-reported respiratory health. A cost-efficacy analysis of the intervention was also conducted. RESULTS The 1-year quit rate was 9.9% in the NRT arm and 18.0% in the e-cigarette arm (risk ratio 1.83, 95% confidence interval 1.30 to 2.58; p < 0.001). The e-cigarette arm had significantly higher validated quit rates at all time points. Participants in the e-cigarette arm showed significantly better adherence and experienced fewer urges to smoke throughout the initial 4 weeks of their quit attempt than those in the NRT arm, and gave their allocated product more favourable ratings. They were also more likely to be still using their allocated product at 1 year (39.5% vs. 4.3%, χ2 = 161.4; p < 0.001). Participants assigned to e-cigarettes reported significantly less coughing and phlegm at 1 year than those assigned to NRT (controlling for smoking status). A detailed economic analysis confirmed that, because e-cigarettes incur lower NHS costs than NRT and generate a higher quit rate, e-cigarette use is more cost-effective. LIMITATIONS The results may not be generalisable to other types of smokers or settings, or to cartridge-based e-cigarettes. CONCLUSIONS Within the context of multisession treatment for smokers seeking help, e-cigarettes were significantly more effective than NRT. If SSSs provide e-cigarette starter packs, it is likely to boost their success rates and improve their cost-efficacy. FUTURE WORK The efficacy of e-cigarettes provided with different levels of support will show whether smokers should be encouraged to switch to vaping within support services or whether e-cigarettes can be recommended with less intensive or no support. TRIAL REGISTRATION Current Controlled Trials ISRCTN60477608. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 43. See the NIHR Journals Library website for further project information. The trial was supported by the Cancer Research UK Prevention Trials Unit (grant A16893).
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Affiliation(s)
- Peter Hajek
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Phillips-Waller
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Francesca Pesola
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Katie Myers Smith
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natalie Bisal
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Peter Sasieni
- King's Clinical Trials Unit, Institute of Psychiatry, King's College London, London, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | | | - Maciej Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Hayden J McRobbie
- Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Kalkhoran S, Inman EM, Kelley JHK, Ashburner JM, Rigotti NA. Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network. J Gen Intern Med 2019; 34:1571-1577. [PMID: 31197730 PMCID: PMC6667589 DOI: 10.1007/s11606-019-05079-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/07/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Population-based strategies can expand the reach of tobacco cessation treatment beyond clinical encounters. OBJECTIVE To determine the effect of two population-based tobacco cessation strategies, compared with usual care, on providing tobacco treatment outside of clinical encounters. DESIGN 3-arm pragmatic randomized controlled trial. PARTICIPANTS Current smokers ≥ 18 years old with a primary care provider at one of five community health centers in Massachusetts were identified via the electronic health record (n = 5225) and recruited using automated phone calls. INTERVENTIONS One intervention group involved engagement with a health system-based tobacco coach (internal care coordination), and the other connected patients to a national quitline (external community referral). MEASUREMENTS Proportion of smokers with documentation of any evidence-based cessation treatment in the 6 months after enrollment. KEY RESULTS Of 639 individuals who responded to the proactive treatment offer, 233 consented and were randomized 1:1:1 to study arm. At 6-month follow-up, the pooled intervention group, compared with usual care, had higher documentation of any smoking cessation treatment (63% vs. 34%, p < 0.001), cessation medication prescription (52% vs. 30%, p = 0.002), and counseling (47% vs. 9%, p < 0.001). Internal care coordination was more effective than external community referral at connecting smokers to any cessation treatment (76% vs. 50%, p = 0.001) and at providing cessation medication (66% vs. 39%, p < 0.001), but comparable at linking smokers to cessation counseling resources. CONCLUSIONS Smokers responding to a population-based, proactive outreach strategy had better provision of tobacco cessation treatment when referred to either a health system-based or community-based program compared with usual care. The health system-based strategy outperformed the quitline-based one in several measures. Future work should aim to improve population reach and test the effect on smoking cessation rates. TRIAL REGISTRATION ClinicalTrials.gov NCT03612895.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA.
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Elizabeth M Inman
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey M Ashburner
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
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Bar-Zeev Y, Bovill M, Bonevski B, Gruppetta M, Oldmeadow C, Palazzi K, Atkins L, Reath J, Gould GS. Improving smoking cessation care in pregnancy at Aboriginal Medical Services: 'ICAN QUIT in Pregnancy' step-wedge cluster randomised study. BMJ Open 2019; 9:e025293. [PMID: 31167863 PMCID: PMC6561434 DOI: 10.1136/bmjopen-2018-025293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to examine the impact of the 'ICAN QUIT in Pregnancy' intervention on individual health providers (HPs) smoking cessation care (SCC) knowledge, attitudes and practices in general, and specifically regarding nicotine replacement therapy (NRT) prescription. DESIGN Step-wedge clustered randomised controlled study. HPs answered a preintervention and 1-6 months postintervention survey. SETTING Six Aboriginal Medical Services (AMSs) in three states of Australia. PARTICIPANTS All HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%). INTERVENTION Included three 1-hour webinar sessions, educational resource package and free oral NRT. OUTCOMES HPs knowledge was measured using two composite scores-one from all 24 true/false statements, and one from 12 NRT-specific statements. Self-assessment of 22 attitudes to providing SCC were measured using a five-point Likert scale (Strongly disagree to Strongly agree). Two composite mean scores were calculated-one for 15 general SCC attitudes, and one for 7 NRT-specific attitudes. Self-reported provision of SCC components was measured on a five-point Likert scale (Never to Always). Feasibility outcomes, and data collected on the service and patient level are reported elsewhere. RESULTS Mean knowledge composite scores improved from pre to post (78% vs 84% correct, difference 5.95, 95% CI 1.57 to 10.32). Mean NRT-specific knowledge composite score also improved (68% vs 79% correct, difference 9.9, 95% CI 3.66 to 16.14). Mean attitude composite score improved (3.65 (SD 0.4) to 3.87 (SD 0.4), difference 0.23, 95% CI 0.05 to 0.41). Mean NRT-specific attitudes composite score also improved (3.37 (SD 0.6) to 3.64 (SD 0.7), difference 0.36, 95% CI 0.13 to 0.6). Self-reported practices were unchanged, including prescribing NRT. CONCLUSIONS A multicomponent culturally sensitive intervention in AMSs was feasible, and might improve HPs provision of SCC to pregnant Aboriginal women. Changes in NRT prescription rates may require additional intensive measures. TRIAL REGISTRATION NUMBER ACTRN 12616001603404; Results.
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Affiliation(s)
- Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Maree Gruppetta
- Wollotuka Institute, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kerrin Palazzi
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Louise Atkins
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Gillian Sandra Gould
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Abstract
The studyHajek P, Phillips-Waller A, Przulj D, et al. A randomised trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med 2019;380:629-37.This trial was funded by the NIHR Health Technology Assessment Programme (12/167/135) and by Cancer Research UK.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000757/e-cigarettes-helped-more-smokers-quit-than-nicotine-replacement-therapy.
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Affiliation(s)
- Rob Cook
- Bazian, Economist Intelligence Unit healthcare, London, UK
| | - Peter Davidson
- Wessex Institute, University of Southampton, Southampton, UK
| | - Rosie Martin
- Bazian, Economist Intelligence Unit healthcare, London, UK
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Shahab L, Bauld L, McNeill A, Tyndale RF. Does the nicotine metabolite ratio moderate smoking cessation treatment outcomes in real-world settings? A prospective study. Addiction 2019; 114:304-314. [PMID: 30276911 PMCID: PMC6492100 DOI: 10.1111/add.14450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/18/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In smoking treatment trials comparing varenicline with transdermal nicotine replacement therapy (NRT), stratified by nicotine metabolite (3-hydroxycotinine/cotinine) ratio (NMR), the relative benefit of varenicline is greater among normal rather than slow metabolizers. This study tested if the relative effectiveness of varenicline and NRT is associated with NMR status in a natural treatment setting. A secondary aim was to test if this relationship is moderated by behavioural support. DESIGN Prospective observational multi-centre study with 4-week and 52-week follow-up. SETTING Nine English Stop Smoking Services (SSS). PARTICIPANTS Data came from 1556 smokers (aged ≥ 16 years) attending SSS between March 2012 and March 2013. INTERVENTIONS Participants received pharmacotherapy together with behavioural support. MEASUREMENTS The primary outcome was carbon monoxide-verified continuous abstinence at both follow-up times. Main explanatory variables were (1) NMR status [slow (NMR < 0.31, n = 451) versus normal (NMR ≥ 0.31, n = 1105) metabolizers]; (2) pharmacotherapy (varenicline versus NRT) and (3) behavioural support (individual versus group-based treatment). Analyses adjusted for baseline socio-demographic, SSS, mental/physical health and smoking characteristics. FINDINGS Of participants, 44.2% [95% confidence interval (CI) = 41.7-46.6%] and 8.0% (95% CI = 6.8-9.5%) were continuously abstinent at 4 and 52 weeks. Varenicline was more effective than NRT at 4 weeks (P < 0.001) but only marginally so at 52 weeks (P = 0.061). There was no or inclusive evidence that NMR status moderated relative efficacy of varenicline and NRT at 4- [P = 0.60, Bayes factor (BF) = 0.25] or 52-week follow-ups (P = 0.74, BF = 0.73). However, this relationship was moderated by behavioural support (p = 0.012): the relative benefit of varenicline over NRT at 52-week follow-up was greater in slow, not normal, metabolizers receiving group rather than individual support (P = 0.012). CONCLUSIONS In a real-world setting, the nicotine metabolite ratio status of treatment-seeking smokers does not appear to contribute substantially to the differential effectiveness of varenicline and nicotine replacement therapy in Stop Smoking Services, when both pharmacotherapy and behavioural support are self-selected.
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Affiliation(s)
- Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
| | - Linda Bauld
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Ann McNeill
- UK Centre for Tobacco and Alcohol StudiesNottinghamUK
- Addictions DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Rachel F. Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH) and Departments of Psychiatry and Pharmacology and ToxicologyUniversity of TorontoTorontoOntarioCanada
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Benmarhnia T, Pierce JP, Leas E, White MM, Strong DR, Noble ML, Trinidad DR. Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers. Am J Epidemiol 2018; 187:2397-2404. [PMID: 29955810 PMCID: PMC6211241 DOI: 10.1093/aje/kwy129] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
Many smokers believe that electronic nicotine delivery systems (ENDS) and pharmaceutical cessation aids can help them quit smoking or reduce cigarette consumption, but the evidence for e-cigarettes to aid quitting is limited. Examining 3,093 quit attempters in the nationally representative US Population Assessment of Tobacco and Health (PATH) Study, using data from 2013-2015, we evaluated the influence of ENDS and pharmaceutical cessation aids on persistent abstinence (≥30 days) from cigarettes and reduced cigarette consumption, using propensity score matching to balance comparison groups on potential confounders and multiple imputation to handle missing data. At PATH Wave 2, 25.2% of quit attempters reported using ENDS to quit during the previous year, making it the most popular cessation aid in 2014-2015. More quit attempters were persistently cigarette abstinent than were persistently tobacco abstinent (15.5% (standard error, 0.8) vs. 9.6% (standard error, 0.6)). Using ENDS to quit cigarettes increased the probability of persistent cigarette abstinence at Wave 2 (risk difference (RD) = 6%, 95% confidence interval (CI): 2, 10), but using approved pharmaceutical aids did not (for varenicline, RD = 2%, 95% CI: -6, 13; for bupropion, RD = 4%, 95% CI: -6, 17; for nicotine replacement therapy, RD = -3%, 95% CI: -8, 2). Among quit attempters who relapsed, ENDS did not reduce the average daily cigarette consumption (cigarettes per day, -0.18, 95% CI: -1.87, 1.51).
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Affiliation(s)
- Tarik Benmarhnia
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - John P Pierce
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Eric Leas
- Stanford Prevention Research Center, Stanford University, Palo Alto, California
| | - Martha M White
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - David R Strong
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Madison L Noble
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Dennis R Trinidad
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
- Division of Health Policy, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
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Abstract
INTRODUCTION Tobacco use is related to augmented morbidity and mortality. People who smoke heavily before orthopedic surgery may have more nonmedical complications than nonsmokers. Therefore, all orthopedic surgery patients should be screened for tobacco use. AIM To investigate the musculoskeletal effects of perioperative smoking. METHODS A narrative review of the literature on the topic was performed. RESULTS Orthopedic perioperative complications of smoking include impaired wound healing, augmented infection, delayed and/or impaired fracture union and arthrodesis, and worst total knee and hip arthroplasty results. Orthopedic surgeons seldom postponed surgery or utilized smoking cessation methods. CONCLUSIONS The adoption of smoking cessation methods such as transdermal patches, chewing gum, lozenges, inhalers, sprays, bupropion, and varenicline in the perioperative period should be recommended. Perioperative smoking cessation appears to be an efficacious method to decrease postoperative complications even if it is implemented as late as 4 weeks before surgery.
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Ellerbeck EF, Nollen N, Hutcheson TD, Phadnis M, Fitzgerald SA, Vacek J, Sharpe MR, Salzman GA, Richter KP. Effect of Long-term Nicotine Replacement Therapy vs Standard Smoking Cessation for Smokers With Chronic Lung Disease: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e181843. [PMID: 30646142 PMCID: PMC6324503 DOI: 10.1001/jamanetworkopen.2018.1843] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Smokers with chronic obstructive pulmonary disease (COPD) have particular difficulty quitting. Long-term nicotine replacement therapy (LT-NRT) might offer a strategy for reducing harm from cigarettes and provide a pathway for later cessation. OBJECTIVE To compare the effect of LT-NRT vs standard smoking cessation (SSC) on exposure to cigarette smoke, harm related to smoking, and cessation among smokers with COPD. DESIGN, SETTING, AND PARTICIPANTS This unblinded, randomized clinical trial recruited smokers who self-reported a diagnosis of COPD at any level of readiness to quit from May 23, 2014, through November 30, 2015. The 12-month follow-up was completed December 6, 2016. Patients were recruited at a clinical research unit of an academic medical center. Analysis was based on intention to treat and performed from March 8 through November 30, 2017. INTERVENTIONS Standard smoking cessation treatment included 10 weeks of NRT and 4 follow-up counseling sessions for those willing to make a quit attempt. Long-term NRT included 12 months of NRT and 6 follow-up counseling sessions regardless of initial willingness to quit. Overall, 198 patients were randomized to SSC, and 197 were included in the primary analysis; 200 patients were randomized to LT-NRT, and 197 were included in the primary analysis. MAIN OUTCOMES AND MEASURES The primary outcome was 7-day abstinence verified by carbon monoxide (CO) levels at 12 months. Secondary outcomes included cigarettes smoked per day (CPD), exposure to CO, urinary excretion of 4-methylnitrosamino-1-3-pyridyl-1-butanol (NNAL) (a smoking-related carcinogen), and adverse events. RESULTS Among 398 patients who were randomized (59.8% female; mean [SD] age, 56.0 [9.3] years), the mean (SD) CPD was 23.1 (12.3). Twelve-month follow-up was completed by 373 participants (93.7%), and 394 (99.0%) were included in the primary analysis. At 12 months, CO-verified abstinence occurred in 23 of 197 participants (11.7%) in the SSC arm and 24 of 197 (12.2%) in the LT-NRT arm (risk difference, 0.5%; 95% CI, -5.9% to 6.9%). Continuing smokers in the SSC and LT-NRT arms had similar, significantly reduced harms caused by smoking, including cigarette consumption by 12.4 and 14.5 CPD, respectively, exhaled CO level by 5.5 and 7.8 ppm, respectively, and mean urinary NNAL excretion by 21.7% and 23.0%, respectively. In multivariate analyses, continuing smokers with greater adherence to NRT experienced less reduction in NNAL exposure. The frequency of major adverse cardiac events was similar in both groups. CONCLUSIONS AND RELEVANCE Similar rates of cessation and similar reductions in exposure to tobacco smoke resulted with LT-NRT and SSC. Among continuing smokers, ongoing use of NRT was not associated with reductions in smoke exposure. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02148445.
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Affiliation(s)
- Edward F. Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Nicole Nollen
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Tresza D. Hutcheson
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - Milind Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Missouri
| | - Sharon A. Fitzgerald
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
| | - James Vacek
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Missouri
| | - Matthew R. Sharpe
- Department of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | - Gary A. Salzman
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kimber P. Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Missouri
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Beard E, Brown J, Michie S, West R. Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis. BMJ Open 2018; 8:e016046. [PMID: 29921676 PMCID: PMC6020958 DOI: 10.1136/bmjopen-2017-016046] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/21/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Many smokers use e-cigarettes and licensed nicotine replacement therapy (NRT), often in an attempt to reduce their cigarette consumption. We estimated how far changes in prevalence of e-cigarette and NRT use while smoking were accompanied by changes in cigarette consumption at the population level. DESIGN Repeated representative cross-sectional population surveys of adults aged 16+ years in England. METHODS We used Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling of monthly data between 2006 and 2016 from the Smoking Toolkit Study. Prevalence of e-cigarette use and NRT use in current smokers, and specifically for smoking reduction and temporary abstinence, were input variables. Mean daily cigarette consumption was the dependent variable. Analyses involved adjustment for mass media expenditure and tobacco-control policies. RESULTS No statistically significant associations were found between changes in use of e-cigarettes (β -0.012, 95% CI -0.026 to 0.002) or NRT (β 0.015, 95% CI -0.026 to 0.055) while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use (β -0.010, 95% CI -0.025 to 0.005 and β 0.011, 95%-0.027 to 0.004) or NRT use (β 0.006, 95%-0.030 to 0.043 and β 0.022, 95%-0.020 to 0.063) specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption. CONCLUSION If use of e-cigarettes and licensed NRT while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level.
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Affiliation(s)
- Emma Beard
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Susan Michie
- Research Department of Educational, Clinical and Health Psychology, University College London, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
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Abstract
OBJECTIVE To examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt. DESIGN Randomised controlled open label trial. SETTING Primary care and smoking cessation clinics in England, 2012-15. PARTICIPANTS 1792 adults who were daily smokers with tobacco dependence. 899 were allocated to the preloading arm and 893 to the control arm. INTERVENTIONS Participants were randomised 1:1, using concealed randomly permuted blocks stratified by centre, to either standard smoking cessation pharmacotherapy and behavioural support or the same treatment supplemented by four weeks of 21 mg nicotine patch use before quitting: "preloading." MAIN OUTCOME MEASURES The primary outcome was biochemically confirmed prolonged abstinence at six months. Secondary outcomes were prolonged abstinence at four weeks and 12 months. RESULTS Biochemically validated abstinence at six months was achieved by 157/899 (17.5%) participants in the preloading arm and 129/893 (14.4%) in the control arm: difference 3.0% (95% confidence interval -0.4% to 6.4%), odds ratio 1.25 (95% confidence interval 0.97 to 1.62), P=0.08 in the primary analysis. There was an imbalance between arms in the frequency of varenicline use as post-cessation treatment, and planned adjustment for this gave an odds ratio for the effect of preloading of 1.34 (95% confidence interval 1.03 to 1.73), P=0.03: difference 3.8% (0.4% to 7.2%). At four weeks, the difference in prolonged abstinence unadjusted for varenicline use was odds ratio 1.21 (1.00 to 1.48), difference 4.3% (0.0% to 8.7%), P=0.05, and adjusted for varenicline use was 1.32 (1.08 to 1.62) P=0.007. At 12 months the odds ratio was 1.28 (0.97 to 1.69), difference 2.7% (-0.4% to 5.8%), P=0.09 unadjusted for varenicline use and after adjustment was 1.36 (1.02 to 1.80) P=0.04. 5.9% of participants discontinued preloading owing to intolerance. Gastrointestinal symptoms-chiefly nausea-occurred in 4.0% (2.2% to 5.9%) more people in the preloading arm than control arm. Eight serious adverse events occurred in the preloading arm and eight in the control arm (odds ratio 0.99, 0.36 to 2.75). CONCLUSIONS Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect seems to have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect. TRIAL REGISTRATION Current Controlled Trials ISRCTN33031001.
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Affiliation(s)
- B Dautzenberg
- CHU Pitié-Salpêtrière (AP-HP), Sorbonne université, 75651 Paris cedex 13, France.
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Leas EC, Pierce JP, Benmarhnia T, White MM, Noble ML, Trinidad DR, Strong DR. Effectiveness of Pharmaceutical Smoking Cessation Aids in a Nationally Representative Cohort of American Smokers. J Natl Cancer Inst 2018; 110:581-587. [PMID: 29281040 PMCID: PMC6005055 DOI: 10.1093/jnci/djx240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/28/2017] [Accepted: 10/31/2017] [Indexed: 01/29/2023] Open
Abstract
Background Despite strong efficacy in randomized trials, the population effectiveness of pharmaceutical aids in long-term smoking cessation is lacking, possibly because of confounding (factors that are associated with both pharmaceutical aid use and difficulty quitting). Matching techniques in longitudinal studies can remove this confounding bias. Methods Using the nationally representative Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we assessed the effectiveness of medications to aid quitting among baseline adult smokers who attempted to quit prior to one year of follow-up in two longitudinal studies: 2002-2003 and 2010-2011. Pharmaceutical aid users and nonusers with complete data (n = 2129) were matched using propensity score models with 12 potential confounders (age, sex, race-ethnicity, education, smoking intensity, nicotine dependence, previous quit history, self-efficacy to quit, smoke-free homes, survey year, and cessation aid use). Using matched data sets, logistic regression models were fit to assess whether use of any individual pharmaceutical aid increased the proportion of patients who were abstinent for 30 days or more at follow-up. Results Propensity score matching markedly improved balance on the potential confounders between the pharmaceutical aid use groups. Using matched samples to provide a balanced comparison, there was no evidence that use of varenicline (adjusted risk difference [aRD] = 0.01, 95% confidence interval [CI] = -0.07 to 0.11), bupropion (aRD = 0.02, 95% CI = -0.04 to 0.09), or nicotine replacement (aRD = 0.01, 95% CI = -0.03 to 0.06) increased the probability of 30 days or more smoking abstinence at one-year follow-up. Conclusions The lack of effectiveness of pharmaceutical aids in increasing long-term cessation in population samples is not an artifact caused by confounded analyses. A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population.
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Affiliation(s)
- Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Climate, Atmospheric Science and Physical Oceanography, Scripps Institution of Oceanography, La Jolla, CA
| | - Martha M White
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Madison L Noble
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
- Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Soulakova JN, Crockett LJ. Level of Cigarette Consumption and Duration of Smoking Abstinence During Failed Quit Attempts Among Long-Term Daily Smokers: the Role of Race/Ethnicity and Cessation Aids. J Racial Ethn Health Disparities 2018; 5:293-303. [PMID: 28444627 PMCID: PMC5656561 DOI: 10.1007/s40615-017-0370-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 11/25/2022]
Abstract
The goal of this study was to determine whether race/ethnicity and use of smoking cessation aids are associated with the duration of the last serious quit attempt and reductions in cigarette consumption among long-term daily smokers who tried, and failed, to quit smoking during the preceding year. Data came from the 2010-2011 Tobacco Use Supplement survey conducted in the USA, and analyses included 6672 reports of long-term daily smokers (i.e., smokers who smoked daily for 1 year or longer) who made at least one serious quit attempt in the past 12 months. About 39% of these smokers used at least one smoking cessation aid during their last quit attempt. Use of aids was significantly lower for non-Hispanic Black (NHB, 29%) and Hispanic (HISP, 29%) smokers than for non-Hispanic White (NHW, 42%) smokers, possibly due to differences in socioeconomic status and access to healthcare for smoking cessation. The effect of using any aids on mean cigarette reduction and duration of the last long quit attempt (i.e., one that lasted a day or more) was similar across race/ethnicity. Using any aids did not substantially influence mean cigarette reduction but was positively associated with duration of the quit attempt: the duration was 6 days longer (CI = 3:10), on average, when aids were used than when smokers attempted to quit unassisted. Race/ethnicity was significantly associated with mean cigarette reduction (p = 0.023); non-Hispanic American Indian and Alaska Native smokers had the highest mean reduction (of 3 cigarettes, CI = 1:5) among the racial/ethnic groups considered. Use of aids may help increase duration of quit attempts and thus, may increase likelihood of quitting successfully in the near future.
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Affiliation(s)
- Julia N Soulakova
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA.
| | - Lisa J Crockett
- Department of Psychology, University of Nebraska-Lincoln, 315 Burnett Hall, Lincoln, NE, 68588-0308, USA
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Truman P, Gilmour M, Robinson G. Acceptability of electronic cigarettes as an option to replace tobacco smoking for alcoholics admitted to hospital for detoxification. N Z Med J 2018; 131:22-28. [PMID: 29470469] [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: 06/08/2023]
Abstract
AIM A feasibility/acceptability trial was undertaken at Ward 5, Kenepuru Hospital, Porirua, to ascertain whether electronic cigarettes (e-cigarettes) were a useful option to replace or reduce smoking in the detoxification ward. METHODS Two groups of patients were studied. Tobacco use and dependency data were collected for each. The first group was surveyed on the usefulness of standard nicotine replacement therapy (NRT). The second group were offered e-cigarettes with the option of standard NRT as well. All were asked to record their use of cigarettes, e-cigarettes and NRT during their stay on the ward, and to comment on their experiences. Outcomes monitored were self-reported use of NRT and of tobacco. Informal impressions of the nursing staff were also collected, where offered. For the e-cigarette group, a blood sample was taken on day 3 or 4 of their stay in hospital for nicotine/cotinine analysis, to confirm nicotine intake status. RESULTS E-cigarettes were well tolerated as a form of nicotine replacement, eliciting positive comments, though they were not effective for all. The average reduction in median cigarettes per day was very similar between the group given standard NRT and the e-cigarette group, at 80% and 86% respectively. There were no adverse effects reported. CONCLUSION The study showed that e-cigarettes were an acceptable form of nicotine replacement for these alcohol-dependent patients during their time in the ward. For heavily tobacco-dependent smokers, e-cigarettes may provide a useful aid to patient management within a hospital setting.
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Affiliation(s)
- Penelope Truman
- Senior Scientist, Environmental Health, Institute of Environmental Science and Research Ltd, Porirua; Senior Lecturer, School of Public Health, Massey University, Wellington
| | - Moira Gilmour
- Clinical Nurse Specialist, Capital and Coast District Health Board, Wellington
| | - Geoffrey Robinson
- Physician, Capital and Coast District Health Board, Wellington; Medical Research Institute of New Zealand, Wellington
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Walker N, Gainforth H, Kiparoglou V, Robinson H, van Woerden H, West R. Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services. Addiction 2018; 113:313-324. [PMID: 28804929 DOI: 10.1111/add.14004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/31/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
Abstract
AIMS To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice. DESIGN We used observational data from 22 472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence and treatment context. From the above, 15 640 episodes were analysed in relation to 4-week quit and 14 273 episodes at 12 weeks. All two-way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure. SETTING England PARTICIPANTS: Clients of smoking cessation service (number of individuals in 4-week quit analysis = 15 640). MEASUREMENTS Four-week carbon monoxide-validated (primary outcome) and 12-week self-reported (secondary outcome) quit success/failure. FINDINGS At both follow-up points, varenicline was associated with higher success rates overall [P < 0.001 at both 4 and 12 weeks; adjusted odds ratio (OR) varenicline versus NRT = 1.82 (95% confidence interval (CI) = 1.61, 2.06) and 2.58 (95% CI = 2.26, 2.94) at 4 and 12 weeks, respectively]. At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided [P < 0.001 for interaction pharmacotherapy × setting; adjusted odds ratio for varenicline × pharmacy setting = 0.53 (95% CI = 0.42, 0.69) and for varenicline × general practice (GP) setting = 0.79 (95% CI = 0.64, 0.98) against a baseline of 1 for varenicline × community setting]. The same trends were evident at 4 weeks, but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables. CONCLUSIONS Varenicline use was associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference was less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting.
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Affiliation(s)
- Neil Walker
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
| | - Heather Gainforth
- School of Health and Exercise Sciences, University of British Columbia, BC, Canada
| | - Vasiliki Kiparoglou
- NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, UK
| | | | - Hugo van Woerden
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
- Centre for Health Science, University of the Highlands and Islands, Inverness, UK
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Zyoud SH. Estimates of global research productivity in using nicotine replacement therapy for tobacco cessation: a bibliometric study. Global Health 2018; 14:14. [PMID: 29382348 PMCID: PMC5791372 DOI: 10.1186/s12992-018-0335-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tobacco use is a major healthcare problem worldwide. Tobacco smoking remains the most important risk factor for both cancer and heart diseases. This study was initiated due to the lack of published data concerning the real progress in research output in the use of nicotine replacement therapy (NRT) for tobacco cessation. This study was aimed to use bibliometric analysis to estimate the NRT literature indexed in Scopus database at global level. METHODS Core of the search strategy was the documents that contained specific words or phrases regarding NRT as keywords in the title. Publication output of most prolific countries was adjusted to the gross domestic product and population size. All citations analysis were accomplished on December 22, 2017. RESULTS A total of 2138 references were retrieved and published from 56 countries, which were published between 1970 and 2016. The USA has the most number of published articles accounted to 986, followed by the UK (312 publications) and then Australia (102 publications), and Sweden (102 publications). No data related to NRT were published from 156 countries. No significant correlation was found between the country population size or 2016 gross domestic product values and the number of publications of the top-10 most prolific countries in the field of NRT (r = - 0.156, P = 0.664; and r = - 0.173, P = 0.632, respectively). Furthermore, there is no correlation between prevalence of tobacco smoking and number of publications of the top-10 most prolific countries in the field of NRT (r = - 0.235, P = 0.514). CONCLUSIONS The present data reveal a solid mass of research activity on NRT. The USA was by far the predominant country in the amount of NRT-based research activity. NRT-based research activities were low or not available in most countries. The results of this study delineate a framework for better understanding the situations of current NRT research and prospective directions of the research in this field which could be applied for managing and prioritizing future research efforts in NRT research.
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Affiliation(s)
- Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
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Hughes JR, Solomon LJ, Peasley-Miklus CE, Callas PW, Fingar JR. Effectiveness of continuing nicotine replacement after a lapse: A randomized trial. Addict Behav 2018; 76:68-81. [PMID: 28756042 DOI: 10.1016/j.addbeh.2017.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Four post-hoc analyses of prior trials found smokers using nicotine patch following a lapse were less likely to progress to relapse compared to those using a placebo patch following a lapse. We attempted a conceptual replication test of these results via a randomized trial of instructions to continue vs. stop nicotine patch after a lapse. METHODS Smokers trying to quit (n=701) received nicotine patch (21/14/7mg) and brief phone counseling (six 15-min sessions). We randomized smokers to receive instructions for and rationale for stopping vs. continuing patch after a lapse. The messages were repeated before and after cessation and following lapses via counseling, phone and written instructions. RESULTS Among those who lapsed, those told to Continue Patch did not have a greater incidence of 7-day abstinence at 4months (primary outcome) than those told to Discontinue Patch (51% vs. 46%). Most (81%) participants in the Discontinue condition stopped patch for only 1-2days and then resumed abstinence and patch use. Analyses based on all participants randomized were similar. Adverse events were as expected and did not differ between conditions. CONCLUSION Instructions to continue nicotine patch after a lapse did not increase return to abstinence. These negative results may have occurred because actual use of patch after a lapse was similar in the two conditions. Also, allowing patch use while smoking may have reduced motivation to stay abstinent.
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Affiliation(s)
- John R Hughes
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States.
| | - Laura J Solomon
- Office of Health Promotion Research, University of Vermont, United States
| | - Catherine E Peasley-Miklus
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States
| | - Peter W Callas
- Department of Medical Biostatistics, University of Vermont, United States
| | - James R Fingar
- Vermont Center for Behavior and Health, Department of Psychiatry, and Department of Psychological Sciences, University of Vermont, United States
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Shahab L, Dobbie F, Hiscock R, McNeill A, Bauld L. Prevalence and Impact of Long-term Use of Nicotine Replacement Therapy in UK Stop-Smoking Services: Findings From the ELONS Study. Nicotine Tob Res 2017; 20:81-88. [PMID: 27664995 PMCID: PMC5896546 DOI: 10.1093/ntr/ntw258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/23/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) was licensed for harm reduction in the United Kingdom in 2005, and guidance to UK Stop-Smoking Services (SSS) to include long-term partial or complete substitution of cigarettes with NRT was issued in 2013. Yet, NRT prevalence data and data on changes in biomarkers associated with long-term NRT use among SSS clients are scarce. METHODS SSS clients abstinent 4 weeks postquit date were followed up at 12 months. At baseline standard sociodemographic, smoking and SSS use characteristics were collected and of those eligible, 60.6% (1047/1728) provided data on smoking status and NRT use at follow-up. A subsample also provided saliva samples at baseline and of those eligible, 36.2% (258/712) provided follow-up samples. Saliva was analyzed for cotinine (a metabolite of nicotine) and alpha-amylase (a stress biomarker). RESULTS Among those who had used NRT during their initial quit attempt (61.5%, 95% CI 58.4%-64.6%), 6.0% (95% CI 4.3%-8.3%) were still using NRT at 1 year, significantly more ex-smokers than relapsed smokers (9.5% vs. 3.7%; p = .005). In adjusted analysis, NRT use interacted with smoking status to determine change in cotinine, but not alpha-amylase, levels (Wald χ2 (1) = 13.0, p < .001): cotinine levels remained unchanged in relapsed smokers and ex-smokers with long-term NRT use but decreased in ex-smokers without long-term NRT use. CONCLUSIONS Long-term NRT use is uncommon in SSS clients, particularly among relapsed smokers. Its use is associated with continued high intake of nicotine among ex-smokers but does not increase nicotine intake in smokers. It does not appear to affect stress response. IMPLICATIONS Little is known about the long-term effects of NRT. Given an increasing shift towards harm reduction in tobacco control, reducing the harm from combustible products by partial or complete substitution with noncombustible products, more data on long-term use are needed. This study shows that in the context of SSS, clients rarely use products for up to a year and that NRT use does not affect users' stress response. Ex-smokers using NRT long-term can completely replace nicotine from cigarettes with nicotine from NRT; long-term NRT use by continuing smokers does not increase nicotine intake. Long-term NRT appears to be a safe and effective way to reduce exposure to combustible nicotine.
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Affiliation(s)
- Lion Shahab
- Department of Epidemiology and Public Health, University College London and UK Centre for Tobacco and Alcohol Studies, London, UK
| | - Fiona Dobbie
- School of Health Sciences, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Rosemary Hiscock
- School for Health, University of Bath and UK Centre for Tobacco and Alcohol Studies, Bath, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London and UK Centre for Tobacco and Alcohol Studies, London, UK
| | - Linda Bauld
- School of Health Sciences, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
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Rodu B, Plurphanswat N. Quit Methods Used by American Smokers, 2013-2014. Int J Environ Res Public Health 2017; 14:E1403. [PMID: 29149048 PMCID: PMC5708042 DOI: 10.3390/ijerph14111403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/02/2017] [Accepted: 11/15/2017] [Indexed: 01/16/2023]
Abstract
This report describes the quit methods used in the past 12 months by current and former smokers in the baseline Population Assessment of Tobacco and Health (PATH) Study during 2013-2014. Descriptive statistics were used to report the use of single and two or more quit methods; survey weights were used to compute population estimates. Logistic regression was used to estimate the association between past year former smokers and single quit method, including individual characteristics. RESULTS Of 11,402 current smokers and 4919 former smokers, 4541 had tried and 839 had quit in the past 12 months. Unaided quit attempts were the most common; the number was almost as high as all single methods combined (n = 1797 and n = 1831 respectively). The most frequently used single method was help from friends and family (n = 676) followed by e-cigarettes (n = 587). Use of e-cigarettes was the only method with higher odds of users being a former smoker than unaided attempts (OR = 1.42, 95% CI 1.12-1.81). Current use of e-cigarettes among current (34%) and former (54%) smokers was significantly higher than current use of nicotine replacement therapy (NRT). CONCLUSIONS In 2013-2014 e-cigarettes were used by American adult smokers as quit-smoking aids more frequently than NRT products or prescription drugs.
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Affiliation(s)
- Brad Rodu
- James Graham Brown Cancer Center, University of Louisville, 505 South Hancock Street, Louisville, KY 40202, USA.
- Department of Medicine, School of Medicine, University of Louisville, Louisville, KY 40202, USA.
| | - Nantaporn Plurphanswat
- James Graham Brown Cancer Center, University of Louisville, 505 South Hancock Street, Louisville, KY 40202, USA.
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Jordan H, Hidajat M, Payne N, Adams J, White M, Ben-Shlomo Y. What are older smokers' attitudes to quitting and how are they managed in primary care? An analysis of the cross-sectional English Smoking Toolkit Study. BMJ Open 2017; 7:e018150. [PMID: 29146649 PMCID: PMC5695521 DOI: 10.1136/bmjopen-2017-018150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/07/2017] [Accepted: 10/11/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To investigate whether age is associated with access to smoking cessation services. DESIGN Data from the Smoking Toolkit Study 2006-2015, a repeated multiwave cross-sectional household survey (n=181 157). SETTING England. PARTICIPANTS Past-year smokers who participated in any of the 102 waves stratified into age groups. OUTCOME MEASURES Amount smoked and nicotine dependency, self-reported quit attempts and use of smoking cessation interventions. Self-report of whether the general practitioner (GP) raised the topic of smoking and made referrals for pharmacological support (prescription of nicotine replacement therapies (NRTs)) or other support (counselling or support groups). RESULTS Older smokers (75+ years) were less likely to report that they were attempting to quit smoking or seek help from a GP, despite being less nicotine-dependent. GPs raised smoking as a topic equally across all age groups, but smokers aged 70+ were more likely not to be referred for NRT or other support (ORs relative to 16-54 years; 70-74 years 1.27, 95% CI 1.03 to 1.55; 75-79 years 1.87, 95% CI 1.43 to 2.44; 80+ years 3.16, 95% CI 2.20 to 4.55; p value for trend <0.001). CONCLUSIONS Our findings suggest that there are potential missed opportunities in facilitating smoking cessation in older smokers. In this large population-based study, older smokers appeared less interested in quitting and were less likely to be offered support, despite being less addicted to nicotine than younger smokers. It is unclear whether this constitutes inequitable access to services or reflects informed choices by older smokers and their GPs. Future research is needed to understand why older smokers and GPs do not pursue smoking cessation. Service provision should consider how best to reduce these variations, and a stronger effectiveness evidence base is required to support commissioning for this older population so that, where appropriate, older smokers are not missing out on smoking cessation therapies and the health benefits of cessation at older ages.
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Affiliation(s)
- Hannah Jordan
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nick Payne
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jean Adams
- MRC Epidemiology Unit & CEDAR, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Martin White
- MRC Epidemiology Unit & CEDAR, School of Clinical Medicine, University of Cambridge, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Rigotti NA, Chang Y, Rosenfeld LC, Japuntich SJ, Park ER, Tindle HA, Levy DE, Reid ZZ, Streck J, Gomperts T, Kelley JHK, Singer DE. Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials. J Gen Intern Med 2017; 32:1005-1013. [PMID: 28616847 PMCID: PMC5570745 DOI: 10.1007/s11606-017-4085-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/31/2017] [Accepted: 05/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge. OBJECTIVE To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation. DESIGN Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up. PARTICIPANTS A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge. INTERVENTION After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling. MAIN MEASURES Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge. KEY RESULTS Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting. CONCLUSIONS Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT01177176, NCT01714323.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa C Rosenfeld
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Sandra J Japuntich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zachary Z Reid
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Joanna Streck
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Timothy Gomperts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Jang S, Park S, Jang BH, Park YL, Lee JA, Cho CS, Go HY, Shin YC, Ko SG. Study protocol of a pragmatic, randomised controlled pilot trial: clinical effectiveness on smoking cessation of traditional and complementary medicine interventions, including acupuncture and aromatherapy, in combination with nicotine replacement therapy. BMJ Open 2017; 7:e014574. [PMID: 28576892 PMCID: PMC5623405 DOI: 10.1136/bmjopen-2016-014574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Nicotine dependence is a disease, and tobacco use is related to 6 million deaths annually worldwide. Recently, in many countries, there has been growing interest in the use of traditional and complementary medicine (T&CM) methods, especially acupuncture, as therapeutic interventions for smoking cessation. The aim of this pilot study is to investigate the effectiveness of T&CM interventions on smoking cessation. METHODS AND ANALYSIS The STOP (Stop Tobacco Programme using traditional Korean medicine) study is designed to be a pragmatic, open-label, randomised pilot trial. This trial will evaluate whether adding T&CM methods (ie, ear and body acupuncture, aromatherapy) to conventional cessation methods (ie, nicotine replacement therapy (NRT), counselling) increases smoking cessation rates. Forty participants over 19 years old who are capable of communicating in Korean will be recruited. They will be current smokers who meet one of the following criteria: (1) smoke more than 10 cigarettes a day, (2) smoke less than 10 cigarettes a day and previously failed to cease smoking, or (3) smoke fewer than 10 cigarettes a day and have a nicotine dependence score (Fagerstrom Test for Nicotine Dependence) of 4 points or more. The trial will consist of 4 weeks of treatment and a 20 week follow-up period. A statistician will perform the statistical analyses for both the intention-to-treat (all randomly assigned participants) and per-protocol (participants who completed the trial without any protocol deviations) data using SAS 9.1.3. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board (IRB) of the Dunsan Korean Medicine Hospital of Daejeon University (IRB reference no: DJDSKH-15-BM-11-1, Protocol No. version 4.1.).The protocol will be reapproved by IRB if it requires amendment. The trial will be conducted according to the Declaration of Helsinki, 7th version (2013). This study is designed to minimise the risk to participants, and the investigators will explain the study to the participants in detail. As an ethical clinical trial, the control group will also be given conventional cessation treatments, including NRT and counselling. Participants will be screened and provided with a registration number to protect their personal information. Informed consent will be obtained from the participants prior to enrolling them in the trial. Participants will be allowed to withdraw at anytime without penalty. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT02768025); pre-results.
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Affiliation(s)
- Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sunju Park
- Department of Preventive Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yu Lee Park
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ju Ah Lee
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Chung-Sik Cho
- Department of Korean Internal Medicine, Daejeon University Korean Medicine Hospital, Daejeon, Republic of Korea
| | - Ho-Yeon Go
- Internal Medicine College of Korean Medicine, Semyung University, Jecheon, Republic of Korea
| | - Yong Cheol Shin
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Hsia SL, Myers MG, Chen TC. Combination nicotine replacement therapy: strategies for initiation and tapering. Prev Med 2017; 97:45-49. [PMID: 28257667 DOI: 10.1016/j.ypmed.2016.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022]
Abstract
Several studies and meta-analyses have demonstrated the efficacy of combination nicotine replacement therapy (NRT) for patients who wish to quit smoking. However, there is limited guidance with respect to initiation and tapering of combination NRT. We attempt to review the evidence and rationale behind combination NRT, present the dosing used in combination NRT studies, and propose a step-down approach for tapering of combination NRT with integration of behavioral strategies.
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Affiliation(s)
- Stephanie L Hsia
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive (119), San Diego, CA 92161, USA.
| | - Mark G Myers
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive (119), San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, 9500 Gillman Drive, MC 0603, La Jolla, CA 92093, USA.
| | - Timothy C Chen
- VA San Diego Healthcare System (VASDHS), 3350 La Jolla Village Drive (119), San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, 9500 Gillman Drive, MC 0603, La Jolla, CA 92093, USA.
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48
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Cheung YTD, Wang MP, Li HCW, Kwong A, Lai V, Chan SSC, Lam TH. Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial. Addict Behav 2017; 66:17-25. [PMID: 27863323 DOI: 10.1016/j.addbeh.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Large amount of financial incentive was effective to increase tobacco abstinence, but the effect of small amount is unknown. PURPOSE We evaluated if a small amount of cash incentive (HK$500/US$64) increased abstinence, quit attempt, and use of cessation aids. METHODS A three-armed, block randomized controlled trial recruited 1143 adult daily smokers who participated in the Hong Kong "Quit to Win" Contest. Biochemically validated quitters of the early-informed (n=379, notified about the incentive at 1-week and 1-month follow-up) and the late-informed incentive group (n=385, notified at 3-month follow-up) received the incentive at 3months. The validated quitters of the control group (n=379) received the incentive at 6months without prior notification. All subjects received brief advice, a self-help education card and a 12-page booklet. The outcomes were self-reported 7-day point prevalence of abstinence, quit attempt (intentional abstinence for at least 24h) and use of cessation aids at 3-month follow-up. RESULTS By intention-to-treat, the early-informed group at 3-month follow-up reported a higher rate of quit attempt (no smoking for at least 24h) than the other 2 groups (44.1% vs. 37.4%, Odds ratio (OR)=1.32, 95% CI 1.03-1.69, p=0.03), but they had similar abstinence (9.2% vs. 9.7%, OR=0.95, 95% CI 0.62, 1.45). The early- and late-informed group showed similar quitting outcomes. The early-informed group reported more quit attempts by reading self-help materials than the other 2 groups (31.4% vs. 25.3%, OR=1.56, 95% CI 1.12-2.18, p<0.01). CONCLUSIONS The small cash incentive with early notification increased quit attempt by "self-directed help" but not abstinence. Future financial incentive-based programmes with a larger incentive, accessible quitting resources and encouragement of using existing smoking cessation services are needed.
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Affiliation(s)
- Yee Tak Derek Cheung
- School of Public Health, The University of Hong Kong, Hong Kong; School of Nursing, The University of Hong Kong, Hong Kong.
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Vienna Lai
- Hong Kong Council on Smoking and Health, Hong Kong
| | | | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Ma P, Kendzor DE, Poonawalla IB, Balis DS, Businelle MS. Daily nicotine patch wear time predicts smoking abstinence in socioeconomically disadvantaged adults: An analysis of ecological momentary assessment data. Drug Alcohol Depend 2016; 169:64-67. [PMID: 27776246 DOI: 10.1016/j.drugalcdep.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Individuals who use the nicotine patch are more likely to quit smoking than those who receive placebo or no medication. However, studies have not yet examined the association between actual daily nicotine patch wear time during the early phase of a smoking cessation attempt and later smoking abstinence. The purpose of this study was to address this gap in the literature. METHODS Participants who enrolled in a safety-net hospital smoking cessation program were followed for 13 weeks (i.e., 1 week pre-quit through 12 weeks post-quit). Participants completed in-person assessments and daily ecological momentary assessments on study provided smartphones. Multivariate logistic regressions were used to determine if daily patch wear time during the first week post-quit predicted 7-day biochemically verified point prevalence smoking abstinence 4 and 12 weeks following the scheduled quit date. Demographic characteristics and smoking behaviors were adjusted as covariates. RESULTS Participants (N=74) were primarily non-White (78.7%) and most (86%) had an annual household income of <$20,000. Greater average hours of daily nicotine patch wear time during the first week post-quit was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=2.22, 95% CI:1.17-4.23; aOR=2.24, 95% CI:1.00-5.03). Furthermore, more days of wearing the patch for ≥19h was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=1.81, 95% CI:1.01-3.22; aOR=2.18, 95% CI:1.03-4.63). CONCLUSIONS Greater adherence to the nicotine patch early in a quit attempt may increase the likelihood of smoking cessation among socioeconomically disadvantaged adults.
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Affiliation(s)
- Ping Ma
- Children's Health/Children's Medical Center at Dallas, Dallas, TX, United States.
| | - Darla E Kendzor
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma, OK, United States
| | - Insiya B Poonawalla
- Department of Health Promotion and Behavioral Sciences, Dallas, TX, United States
| | - David S Balis
- University of Texas Southwestern Medical Center, Department of General Internal Medicine, Dallas, TX, United States
| | - Michael S Businelle
- University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma, OK, United States
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50
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Chang PY, Lo PC, Chang HC, Hsueh KC, Tsai YW. Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan. PLoS One 2016; 11:e0166992. [PMID: 27893843 PMCID: PMC5125644 DOI: 10.1371/journal.pone.0166992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022] Open
Abstract
Background and objective Relative effectiveness of smoking cessation medications—varenicline, bupropion and nicotine replacement therapy (NRT)—remains unclear among smokers in real-world settings. Evidence in females and smokers with light/moderate nicotine dependence is particularly insufficient. This study compared the effectiveness of varenicline, bupropion or NRT gum relative to NRT patch, in achieving abstinence among recent quitters. Methods In a national smoking cessation program in Taiwan (2012–2015), a cohort of 11,968 participants received varenicline (n = 5,052), bupropion (n = 823), NRT gum (n = 1944) or NRT patch (n = 4,149). The 7-day, 1-month or 6-month point-prevalence was calculated based on self-reported last smoking event via telephone interview after 6 months. Logistic regression modellings estimated odds ratios (OR) and 95% confidence intervals (CI) for achieving abstinence using different modalities (NRT patch as referent). Models included age, sex, education, marital status, geographic region, smoke-years, nicotine-dependence level, medical institution, number of clinic visits and medication use duration. Analyses were further stratified by sex and dependence severity. Results Participants were predominantly male (83%) with a mean age of 43.7±12.6 years. Varenicline users were more likely than NRT patch users to achieve abstinence, based on 7-day point-prevalence (OR = 1.30, CI: 1.19–1.44), 1-month point-prevalence (OR = 1.36, CI: 1.24–1.50) or 6-month point-prevalence (OR = 1.30, CI: 1.14–1.47). Compared with NRT patch, varenicline was associated with greater odds of being abstinent in women (OR = 1.29, CI: 1.01–1.65), men (OR = 1.31, CI: 1.18–1.46), those with light/moderate dependence (OR = 1.42, CI: 1.24–1.63) or smokers with severe dependence (OR = 1.19, CI: 1.04–1.37), based on 7-day point-prevalence. Differences in effectiveness were not observed between users of bupropion, NRT gum and NRT patch. Conclusions In smoking cessation clinics in Taiwan, varenicline users reported higher abstinence rates than NRT patch users after 6 months. Women and smokers with light/moderate nicotine dependence may also benefit from varenicline in actual clinical practice.
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Affiliation(s)
- Po-Yin Chang
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Po-Ching Lo
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chin Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | | | - Yi-Wen Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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