7-day Point Prevalence Abstinence Rates Research Articles

Contingency management for smoking cessation for individuals with overweight or obesity: A randomized controlled trial

BackgroundInterventions for quitting smoking and weight control among individuals with excess weight are scarce. Our study evaluated the effectiveness of cognitive behavioral therapy (CBT) plus contingency management (CM) in this population, and examined whether CM for smoking cessation improved CBT treatment outcomes at end of treatment (EOT) and at 1-, 3-, 6-, and 12-month follow-ups (FU). MethodsIn an 8-week randomized clinical trial, 120 adults who smoke with overweight or obesity (54.16% females; MBMI = 31.75 ± 4.31) were randomly assigned to CBT for both quitting smoking and weight control (n = 60) or the same treatment plus CM for smoking cessation (n = 60). Outcome variables were compared (i.e., treatment completion, smoking abstinence, weight change and secondary outcomes). ResultsAt EOT, the CBT + CM group achieved 78.33% 7-day point-prevalence abstinence rates compared to 61.67% in the CBT group (p = .073), and rates declined over time (12-month FU: 18% vs 12%). Participants who attained abstinence weighed more compared to baseline at EOT (Mkg = 1.07; SD = 1.88) and over time (12-month FU: Mkg = 4.19; SD = 4.31). No differences were found between the two groups in outcome variables. ConclusionsBoth interventions were effective in promoting abstinence and reducing tobacco use over time. Combining CBT with CM for smoking cessation did not improve treatment outcomes in individuals with overweight or obesity compared to CBT only. Future studies should evaluate whether implementing CM for weight maintenance helps control post-cessation weight gain in this population.

Preliminary Efficacy of a Cognitive Behavioral Therapy-Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial.

The overall prevalence of cigarette smokers in China is very high, and China's total cigarette consumption makes up more than 40% of the world's consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app-based smoking cessation trial in China. This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)-based smoking cessation smartphone app among smokers seeking treatment in China. We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a "thank you" message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170. RR2-10.1136/bmjopen-2020-041985.

Interactive assistance via eHealth for small- and medium-sized enterprises’ employer and health care manager teams on tobacco control (eSMART-TC): protocol for a cluster randomized hybrid type II trial (N-EQUITY2101/J-SUPPORT2102)

BackgroundTobacco control should be a higher public health priority in Japan. Some workplaces provide smoking cessation support and connect employees to effective smoking cessation treatments such as outpatient clinics. However, tobacco control measures have not been sufficiently implemented in Japan, especially in small- and medium-sized enterprises (SMEs), where resources are limited. Organizational commitment and consistent leadership are crucial to facilitate implementation, but research on whether supporting organizational leaders leads to health behavior changes among employees is limited.MethodsThis hybrid type II cluster randomized effectiveness implementation trial (eSMART-TC) aims to examine the effects of interactive assistance for SME management on health and implementation outcomes. We will provide interactive assistance to employers and health managers for 6 months, aiming to promote the utilization of reimbursed smoking cessation treatments by public health insurance and to implement smoke-free workplaces. The intervention will consist of three strategies: supporting employees through campaigns, tailored ongoing facilitation, and ensuring executive engagement and support. The primary health and implementation outcomes will be salivary cotinine-validated 7-day point-prevalence abstinence rate, and the adoption of two recommended measures (promoting utilization of smoking cessation treatment and implementing smoke-free workplaces) 6 months after the initial session, respectively. Other outcomes for implementation (e.g., penetration of smoking cessation clinic visits), health (e.g., salivary cotinine-validated 7-day point-prevalence abstinence rate at 12 months), and process (e.g., adherence and potential moderating factors) will be collected via questionnaires, interviews, logbooks, and interventionists’ notes at 6 and 12 months. An economic analysis will be undertaken to assess the cost-effectiveness of the implementation interventions at 12 months.DiscussionThis will be the first cluster randomized controlled trial to evaluate the effectiveness of an implementation intervention with interactive assistance for employers and health managers in SMEs on smoking cessation and implementation of evidence-based tobacco control measures in SMEs. The findings of this trial targeting management in SMEs have the potential to accelerate the implementation of evidence-based smoking cessation methods as well as abstinence rates among employees in SMEs across Japan.Trial registrationThe study protocol has been registered in the UMIN Clinical Trials Registry (UMIN-CTR; ID: UMIN000044526). Registered on 06/14/2021.

Utilization and Effectiveness of a Message-Based Tobacco Cessation Program (mCessation) in the Chinese General Population: Longitudinal, Real-world Study.

Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates.

The Effectiveness of Smartphone App-Based Interventions for Assisting Smoking Cessation: Systematic Review and Meta-analysis.

Smoking is a leading cause of premature death globally. Quitting smoking reduces the risk of all-cause mortality by 11%-34%. Smartphone app-based smoking cessation (SASC) interventions have been developed and are widely used. However, the evidence for the effectiveness of smartphone-based interventions for smoking cessation is currently equivocal. The purpose of this study was to synthesize the evidence for the effectiveness of smartphone app-based interventions for smoking cessation. We conducted a systematic review and meta-analysis of the effectiveness of smartphone interventions for smoking cessation based on the Cochrane methodology. An electronic literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, PsycINFO, China National Knowledge Infrastructure, and Wanfang databases to identify published papers in English or Chinese (there was no time limit regarding the publication date). The outcome was the smoking abstinence rate, which was either a 7-day point prevalence abstinence rate or a continuous abstinence rate. A total of 9 randomized controlled trials involving 12,967 adults were selected for the final analysis. The selected studies from 6 countries (the United States, Spain, France, Switzerland, Canada, and Japan) were included in the meta-analysis between 2018 and 2022. Pooled effect sizes (across all follow-up time points) revealed no difference between the smartphone app group and the comparators (standard care, SMS text messaging intervention, web-based intervention, smoking cessation counseling, or apps as placebos without real function; odds ratio [OR] 1.25, 95% CI 0.99-1.56, P=.06, I2=73.6%). Based on the subanalyses, 6 trials comparing smartphone app interventions to comparator interventions reported no significant differences in effectiveness (OR 1.03, 95% CI 0.85-1.26, P=.74, I2=57.1%). However, the 3 trials that evaluated the combination of smartphone interventions combined with pharmacotherapy compared to pharmacotherapy alone found higher smoking abstinence rates in the combined intervention (OR 1.79, 95% CI 1.38-2.33, P=.74, I2=7.4%). All SASC interventions with higher levels of adherence were significantly more effective (OR 1.48, 95% CI 1.20-1.84, P<.001, I2=24.5%). This systematic review and meta-analysis did not support the effectiveness of delivering smartphone-based interventions alone to achieve higher smoking abstinence rates. However, the efficacy of smartphone-based interventions increased when combined with pharmacotherapy-based smoking cessation approaches. PROSPERO CRD42021267615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=267615.

Efficacy of Combined Relaxed Deep-Breathing with Chest Mobilization Exercise and Vernonia cinerea-Hard Candy on Smoking Cessation and Oxidative Stress in Active Teenage Smokers

Background: Smoking cessation is very important worldwide. Chronic smoking can induce oxidative stress and inflammatory status and induce dangerous diseases such as hypertension and lung cancer. Standardized counseling is an important process in a routine program for smoking cessation. Withdrawal symptoms from smoking cessation are a significant barrier to a successful result, and they can be relieved by relaxed deep-breathing exercise. At present, the Thai herb, Vernonia cinerea (VC), has been claimed to reduce cigarette smoking because of its antioxidant compounds and nicotine that are modified and used as lozenges, gum, and hard candy. However, its efficacy in smoking cessation has not been confirmed. Furthermore, the efficacy of relaxed deep-breathing (rDB) during the chest mobilization exercise (CME) with VC hard candy on smoking cessation and oxidative stress is unclear. Objective: This study aimed to evaluate the combined effects of rDB/CME and VC-hard candy on smoking cessation and oxidative stress status in active teenage smokers. Methods: Hard candy with honey and VC powder from whole mixed parts of the stem, flowers and leaves was developed industrially under the spray dry technique. Thirty active smokers were randomized into three groups; product group (rDB/CME+ product) (aged 25.0 ± 3.0 years, n = 10), placebo group (rDB/CME + placebo) (aged 26.9 ± 3.7 years, n = 10), and a control group with no product or placebo administered (aged 25.6 ± 2.7 years, n=10). All of the groups received consultation on specific smoking cessation and two weeks of strict observation, which was followed up for 8 weeks. The 7-day point prevalence abstinence rates (7-day PAR) and continuous abstinence rate (CAR) were reported at week 2, 4, 6 and 8. In addition, the oxidative stress status with lipid peroxide and glutathione (GSH) in blood was evaluated before the program and after 2 weeks. Results: The results of 7-day PARs in the control group showed no statistical changes at week 2 (0%), 4 (10%), 6 (20%) and 8 (20%), which was the same in the rDB/CME + placebo group (10%, 20%, 30% and 40%, respectively). Whereas, a significant difference was presented in the rDB/CME+ product group (20%, 60%, 80% and 90% respectively). When comparing between the groups, 7-day PARs at week 2 was not statistically different, but it was in the follow-up period at week 4, 6 and 8. There was no statistical difference at week 4 between the three groups, but there was between the rDB/CME+ product, control and rDB/CME+ placebo groups at week 6 and 8. The results of CAR showed no statistical difference between the control and rDB/CWE+ placebo group in any of the periods. Whereas the rDB/CWE+ product group showed a significant difference after week 4. The CAR was statistically different between the groups after week 6 and 8. At week 6, the CAR of the rDB/CWE+ product group was different to the control group. There was no difference between the control and rDB/CWE+ placebo groups, or between the rDB/CWE+ product and placebo groups. At week 8, the CAR of the rDB/CWE+ product group was different from that of the control, but not from the rDB/CWE+ placebo group. Finally, the GSH level increased significantly in the rDB/CWE + product group when compared to the rDB/CWE+placebo group. Moreover, malondialdehyde (MDA) levels decreased significantly in both the placebo and product groups. In addition, MDA levels showed a significant difference between baseline and after 2 weeks in the rDB/CWE + placebo and product groups. Conclusion: Integrating relaxed-deep breathing with chest mobilization exercise and VC hard candy for 2 weeks can help smoking cessation during consultation, and possibly reduce oxidative stress status among active teenage smokers.

Optimizing tobacco treatment delivery for people with HIV: trial protocol for a randomized controlled trial

BackgroundWith advances in antiretroviral therapy, people with HIV (PWH) are living longer and are less likely to die from AIDS-related complications. Yet, prior research has shown that smoking is often not addressed in the context of HIV care, and few individuals are offered cessation treatment. Optimizing tobacco treatment delivery for PWH may increase engagement with evidence-based treatments and successful quit attempts.MethodsThe current study is a type 1 hybrid effectiveness-implementation trial to evaluate the impact of a proactive, opt-out tobacco treatment intervention on cessation outcomes and advance understanding of key barriers and facilitators of implementation processes. A total of 230 PWH who smoke will be recruited from an infectious diseases clinic at an academic medical center and will be randomized to receive (1) treatment as usual (TAU) or (2) Proactive Outreach with Medication Opt-out for Tobacco Treatment Engagement (PrOMOTE). Primary outcomes include: biochemically verified 7-day point prevalence abstinence (PPA) rates, continuous abstinence (Weeks 9–12), and the number of 24-hour quit attempts at the end of study treatment (Week 12). Secondary outcomes include: participant reach (proportion reached out of contact attempts), implementation fidelity (including number of prescriptions written), participant adherence to prescribed pharmacotherapy, acceptability (participant and provider satisfaction with intervention delivery and content), and perceived barriers.DiscussionThis study will examine a novel approach to optimizing tobacco treatment delivery for PWH. Integrating effectiveness and implementation results will help define best practices for engaging PWH with evidence-based tobacco treatment interventions. The intervention is low-cost, has the potential to be highly scalable, and could be translatable to other ambulatory HIV clinic settings.Trial Registration ClinicalTrials.gov: NCT05019495 (August 24, 2021).

A pilot randomized controlled trial of smartphone-assisted mindfulness-based intervention with contingency management for smokers with mood disorders.

Adult smokers receiving outpatient psychiatric treatment for mood disorders were randomized to receive a smartphone-assisted mindfulness-based smoking cessation intervention with contingency management (SMI-CM, n = 25) or enhanced standard treatment (EST, n = 24) with noncontingent rewards. Participants in SMI-CM were prompted to practice audio-guided mindfulness five times per day for 38 days (vs. no comparison intervention in EST), and received monetary incentives for carbon monoxide (CO) ≤ 6 ppm. The primary outcome was biochemically verified 7-day point prevalence abstinence rates 2, 4, and 13 weeks after a target quit day. Of the 49 participants, 63.3% were Latinx and 30.6% Black; 75.5% reported household incomes < $25,000. Abstinence rates for SMI-CM were 40.0%, 36.0%, and 16.0% versus 4.2%, 8.3%, and 4.2% in EST at weeks 2, 4, and 13. A generalized estimating equations (GEE) model showed significant overall differences in abstinence rates in SMI-CM versus EST (adjusted odds ratio [AOR] = 8.12, 95% CI = 1.42-46.6, p = .019). Those who received SMI-CM reported significantly greater reduction in smoking-specific experiential avoidance from baseline to 3 days prior to quit date (β = -7.21, 95% CI = -12.1-2.33, p = .006). SMI-CM may increase cessation rates among smokers with mood disorders, potentially through reduced smoking-specific experiential avoidance. SMI-CM is a promising intervention, and warrants investigation in a fully powered randomized controlled trial (RCT). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of three-part breathing exercise on smoking cessation: A 6-month cluster-randomized clinical trial

IntroductionNegative affect was identified as an important barrier to smoking cessation. Three-part breathing exercise showed a significant effect on decreasing negative affect immediately after being practiced. Thus, this study evaluated the effect of three-part breathing exercise on smoking cessation. MethodsA 6-month cluster-randomized clinical trial was conducted. Forty-three participants recruited from 8 companies in Bangkok Metropolitan areas were randomly assigned at the cluster level into either the intervention or control groups. Control group (n = 23) received counseling for smoking cessation once a week for 12 weeks. Intervention group (n = 20) received counseling for smoking cessation plus a three-part breathing exercise program once a week for 12 weeks. The primary outcomes were 7-day point prevalence and continuous abstinence rate as validated by saliva cotinine. The secondary outcomes were cigarette cravings, nicotine withdrawal symptoms, affect and quality of life. ResultsThe results revealed no significant difference in smoking abstinence rate between the three-part breathing exercise and control group. Participants demonstrated significant pre-post improvement in cigarette cravings, nicotine withdrawal symptoms, affect, and quality of life within each group. ConclusionThere were no statistically significant differences between the two groups. However, the improvement in abstinence rate from the three-part breathing exercise was deemed clinically relevant. Thus, it may be recommended to smokers interested in smoking cessation and more research is needed on this topic.

Abrupt versus gradual smoking cessation with pre-cessation varenicline therapy for Chinese treatment-seeking smokers: A retrospective, observational, cohort study

INTRODUCTIONThis study aimed to explore the efficacy of abrupt and gradual smoking cessation with pre-cessation varenicline therapy.METHODSA total of 278 smokers who experienced moderate-to-severe nicotine dependence and visited a Chinese smoking cessation outpatient clinic from March 2017 to February 2021 were enrolled. This was a retrospective, observational, cohort study. Participants were divided into two groups by the cessation strategy they received: the abrupt cessation group (n=139, tobacco was not controlled during the first 3 weeks before the target cessation date and smoking was entirely discontinued on the 22nd day) and the gradual cessation group (n=139, tobacco was gradually reduced in the first 3 weeks before the target cessation date and smoking was discontinued on the 22nd day). The abstinence rates were compared between groups (7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment; and 1-month and 3-month continuous abstinence rates of 6-month follow-up). Possible factors that influence efficacy, reasons for smoking cessation failure, and associated adverse events were also analyzed.RESULTSNo significant difference in the 7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment was observed between the groups (p>0.05). The 1-month continuous abstinence rate of the gradual cessation group was higher than that of the abrupt cessation group (51.1% vs 31.7%; χ2=10.812, p=0.001). The 3-month continuous abstinence rate of the gradual cessation group was also higher than that of the abrupt cessation group (42.4% vs 27.3%; χ2=6.983, p=0.008). Abrupt cessation was a risk factor for successful smoking cessation than gradual cessation (AOR=2.39; 95% CI: 1.15–3.85, p=0.013),the motivation of ‘prevention and treatment of own diseases’ reduced the risk of incomplete abstinence (AOR=0.87; 95% CI: 0.38–0.99, p=0.049). The incidence of adverse events was higher in the abrupt cessation group than in the gradual cessation group. The incidence rates of nausea and insomnia were statistically significant differences.CONCLUSIONSCompared with abrupt cessation, gradual smoking cessation with pre-cessation varenicline therapy produced higher abstinence rates and relatively milder withdrawal symptoms.

Feasibility and Acceptability of a Cognitive Behavioral Therapy-Based Smartphone App for Smoking Cessation in China: A Single-Group Cohort Study

BackgroundPrevious research has suggested that mobile phone applications (apps) may potentially increase quit rates. The purpose of this single-group cohort study sought to examine the feasibility and acceptability of a novel smartphone-based smoking cessation app designed for smoking cessation in China: smoking quit rate.MethodsA total of 180 smokers from two cities of mainland China with willingness to make a quit attempt were invited to this smoking cessation app program, a cognitive behavioral theory (CBT)-based smoking cessation intervention via a smartphone app. Participants received 37- to 44-day intervention (including 7- to 14-day pre-quit preparation and 33-day intervention from quit date). Feasibility and acceptability of the program, and smoking status were assessed at baseline stage (initial installation), pre-quit stage, and post-quit stage (days 7, 15, and 33 after quit date).ResultsA total of 163 (90.6%) participants completed the study. Among them, 76–89% of the participants logged into the app ≥1 time per day across stages (at baseline, during pre-quit stage, and on days 7, 15, and 33 of post-quit stage); approximately 90% of the participants were satisfied with the app across stages. A significant rise in self-reported overall satisfaction with the app is observed from baseline (93% at Time 1) to the end of the program (98% at Time 2, 33 days after quit date) (p = 0.021). Participants who believed/agreed this app can help them to quit smoking significantly increased from 69% at baseline to 97% at day 33 after quit date (p < 0.001). Participants were satisfied with most (80–90%) of the features, especially the information feature. Intention-to-treat analysis showed that the percentage of 33-day self-reported continuous prevalence abstinence was 63.9%, and 7-day point prevalence abstinence rate was 81.7, 87.2, and 77.8% on days 7, 15, and 33 after quit date, respectively.ConclusionsThis study demonstrated the feasibility and acceptability of the smartphone app intervention for smoking cessation and introduced a new digital treatment model, which is expected to overcome barriers facing accessing traditional in-person smoking cessation services and extend nationwide smoking cessation services in China.

Efficacy of Electronic Cigarettes for Smoking Cessation: A Systematic Review and Meta-Analysis.

to synthesize evidence about the efficacy of electronic cigarettes versus Nicotine Replacement Therapy and placebo to quit smoking. We searched for clinical trials with no publication date restriction until December 2019. The search included CENTRAL, MEDLINE, PsycINFO, Science Direct, Center for reviews and dissemination and HTA database and Trip database, clinical trials registries, gray literature and examined the references of relevant articles. Two review authors independently checked the titles and abstracts then the full text of initial hits. Main outcomes were sustained continuous abstinence rate, 7-day point prevalence abstinence rate, sustained reduction of 50% or greater in baseline cigarette consumption and adverse effects. Two review authors independently extracted data and assessed risk of bias using the Cochrane RoB 2 tool. We conducted a random-effects model through the Mantel-Haenszel method. We retrieved 12 trials involving 9863 participants. CO- validated 1-month continuous abstinence rate improved by 33% in the e-cigarettes group (range 6-66%, moderate evidence). We are uncertain if e-cigarettess influence continuous abstinence rate at 3-, 6- and 12 months as well as sustained reduction of 50% or greater in baseline cigarette consumption at different follow-up periods. One study of 884 participants displayed improved 12-month 7-day point abstinence by 46% (range 17%-82%). E-cigarettes may increase or do not affect the proportion of serious adverse effect at 6 and 12 months follow up. Very low certainty evidence supported e-cigarettess to help quit smoking in the short term. There is not enough evidence to determine if e-cigarettess are a safe and efficacious means of smoking cessation in the long term (12+ months).

Influencing factors on smoking cessation among outpatients from the National Central Subsidy Smoking Cessation Clinic Project, in 2015-2018

Objective: To evaluate the effect of smoking cessation project run by the Central Subsidy Smoking Cessation Clinic and to explore the related influencing factors on smoking cessation, in order to improve related services and provide better guidance to these smoking cessation clinics. Methods: Practitioners who had been trained to run smoking cessation projects were recruited to conduct face-to-face interview with the smokers. Questionnaires were completed to provide information on related psychological, social and behavioral issues. In these clinics, medications were provided to the patients by the health care takers in the clinic. One month after the first visit, smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) was counted. Results: The overall smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) appeared as 34.1%. Results from the multivariate logistic regression showed that patients over the age of 60 were the ones most likely to quit smoking. Smokers who showed higher possibility of quitting would include those: not on the daily base, intend to quit within 30 days, with other diseases, or taking varenicline and bupropion. Factors as unemployment, longer history of smoking, bigger quantity of cigarettes consumption per day, dependence on nicotine and urgency on taking up the first cigarette in the early morning etc., were related to the less likelihood of giving up smoking. However, histories of cessation did not seem to affect the possibility of quitting. Conclusions: Data from self-reported 7-day point prevalence abstinence at 30-day follow-up study showed that the smoking cessation intervention programs run by the central subsidy smoking cessation clinic project had been effectively implemented. Advocacy on quit smoking at early stage seemed to have better outcomes, thus should be called for. Since medications as varenicline tartrate and bupropion hydrochloride can increase the possibility of stop smoking, we would suggest that all the hospitals which are with smoking cessation clinics be equipped with these medicines. Professional assistance provided by practitioners is of key importance to help overcome the withdrawal symptoms during the periods of cessation, on these smokers.

Automated Mobile Delivery of Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: Feasibility Study.

BackgroundSocioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults.ObjectiveThis study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation.MethodsSocioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US $250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt.ResultsParticipants (N=16) were predominantly female (12/16, 75%) and non-Hispanic white (11/16, 69%), black (4/16, 25%), or Hispanic of any race (1/16, 6%). Most participants (9/16, 56%) reported an annual household income of <US $11,000. During the first 4 weeks after the scheduled quit date, participants completed a median of 16 (out of 21; range 1-21) mobile smoking status assessments, and they earned a median of US $28 in abstinence-contingent incentives (out of a possible US $150; range US $0-US $135). Median earnings did not change during the 8- and 12-week incentivized follow-up periods (total median earnings over 12 weeks=US $28; range US $0-US $167). During the first 4 weeks after the scheduled quit date, participants abstained from smoking on a median of 5 (out of 21) assessment days (range 0-20). At the in-person follow-up visits, the expired CO-confirmed 7-day point prevalence abstinence rates were 19% (3/16) and 13% (2/16) at 12 and 26 weeks postquit, respectively. Overall, most participants reported that the system was easy to use and that they would recommend this treatment to their friends and family.ConclusionsPreliminary data suggest that this smartphone-based approach to verifying identity and smoking status and automating the delivery of abstinence-contingent incentives to a credit card is feasible for use among socioeconomically disadvantaged adults. However, continued refinement is warranted.

Using social media for smoking cessation interventions: a systematic review.

Previous studies have shown that smoking tobacco significantly increases both incidence and mortality rates for many diseases. Social media has become one of the most influential platforms for various smoking cessation interventions. However, results from smoking cessation interventions have differed from study to study. Limited studies have summarised cessation outcomes from social media-based interventions. Therefore, the objective of this review is to explore the effectiveness of using social media for smoking cessation. We searched PubMed, MEDLINE, PsycINFO, and CINAHL for articles between June 2008 and June 2018, and also assessed the references of selected articles. We included studies that used social media as intervention platforms, provided a baseline assessment before the intervention, and provided smoking cessation outcomes after the intervention. We identified 13 original studies that enrolled between 16 and 1698 participants; 7-day Point Prevalence Abstinence (PPA) rate was the most frequently used measure of abstinence, with a range of 7%-75%, regardless of the measurement time, study design, and analysis methods. Social media-based smoking cessation interventions were effective, because (1) smokers reported higher 7-day PPA rates after intervention compared to baseline and (2) smokers reported higher 7-day PPA rates in intervention groups than in control groups. Moreover, at each time point, approximately half of all smokers in studies reporting abstinence were found to be biochemically abstinent. There were no significant differences in the effectiveness of smoking cessation outcomes between those that used existing popular social networking platforms (e.g. Pechmann et al's studies) and those that used individually designed interactive platforms (e.g. MyLastDip, iQuit system, Quitxt system). This review highlights the effectiveness of social media-based smoking cessation intervention studies. Due to the widespread use of social media, as well as its low cost, we suggest embedding smoking cessation interventions within existing popular social media platforms.

Characteristics of Chinese smokers with psychotic disorders and their predictors on smoking cessation in Hong Kong

INTRODUCTIONPeople with psychotic disorders are associated with high prevalence of cigarette smoking and prevalence rates. Studies show that many smokers with psychotic disorders would like to stop smoking, yet the abstinence rate among them is low. Despite this significant public health problem, few studies have examined the characteristics of this group of smokers and the predictors of smoking cessation.METHODSThis is a retrospective chart review study. Case records of smokers who attended our smoking cessation clinic with and without psychotic disorders were reviewed. The outcome measure was self-reported 7-day point prevalence abstinence rate at week 26. The basic demographic and biosocial characteristics of these smokers were analyzed.RESULTSA total of 3671 case records were reviewed and 155 smokers with psychosis were identified. The independent predictors of smoking abstinence at week 26 were to improve performance in exercise and sports, greater confidence of quitting, and greater number of counselling sessions. The 7-day point prevalence abstinence rate was 22.6% at 26 weeks.CONCLUSIONSThis study has demonstrated that many smokers with psychosis are able to quit smoking even with NRT and counselling and without use of oral medications. Health professionals need to pay greater attention to tobacco use by individuals with mental disorders. Every effort should be given to enhance their motivation, build up their confidence and to provide adequate counselling sessions.

A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial.

BackgroundThe integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach.ObjectiveThe aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation.MethodsFollowing a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention).ResultsRegarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16).ConclusionsResults demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment).

Pilot study of a 3-day residential treatment for smoking cessation in Hong Kong.

INTRODUCTIONThe Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation has been providing free smoking cessation services since 2009. The average quit rate from 2009 to 2014 was 37%. In order to boost the quite rate, we have implemented a residential treatment program for smokers who volunteered to participate. Having run the program for two years, we conducted a retrospective cohort study to evaluate its effectiveness.METHODSWe recruited the participants who had failed previous quit attempts and who came to seek our smoking cessation services. A 3-day residential program of activities were arranged for our participants. Intensive individual and group counseling was provided. Pharmacotherapy was also provided to alleviate withdrawal symptoms. This was followed by our usual treatment and follow-up program. Self-reported 7-day point prevalence abstinence rate at 26 weeks based on intention-to-treat (ITT) analysis was assessed.RESULTSA total of 40 clients volunteered to join the program, age 26 to 65 years old with a mean of 44.1 years. There were 25 (62.5%) males and 15 (37.5%) females. The quit rate at 26 weeks was 57.5%. Smokers older than 43 years, having cohabiting smokers, and smoking for more than 28 years, were more likely to quit and this was statistically significant.CONCLUSIONSThis pilot study demonstrated that a 3-day residential program is effective in helping addicted smokers who volunteer to quit smoking and is cost effective compared to longer residential programs.

Efficacy and safety of Vernonia cinerea (L.) Less. for smoking cessation: A systematic review and meta-analysis of randomized controlled trials

Background & objectiveSeveral randomized controlled trials have investigated Vernonia cinerea (L.) Less. for smoking cessation but there remains no critical summary of overall findings. This study uses systematic review and meta-analysis to summarize the efficacy and safety of V. cinerea. MethodsNine databases were searched through November 2017. Randomized controlled trials that reported the smoking cessation effect of V. cinerea were included. Data were extracted by two independent researchers. Study quality was assessed using the Cochrane risk of bias and JADAD score. The estimates of pooled effects were calculated as relative risk (RR) with 95% CI using a random-effects model. ResultsFive trials with 347 smokers were included. V. cinerea treatment group was significantly associated with cessation rate higher than that in the control group with no evidence of heterogeneity for both continuous abstinence rate (CAR) at week 8 with risk ratio (RR): 1.69, 95% CI [1.00, 2.86]; week 12 RR: 2.18, 95% CI [1.17, 4.04]) and 7-day point prevalence abstinence rate (PAR) (week 8 RR: 1.51, 95% CI [1.01, 2.27]; week 12 RR: 1.93, 95% CI [1.24, 2.99]) at week 8 and 12, respectively. There was no significant difference of all adverse events between the treatment and the control groups. ConclusionOur study demonstrates that V. cinerea has potential efficacy for smoking cessation. Further well-design RCTs of standardized V. cinerea compared with standard treatment should be conducted to strengthen this evidence.

A Randomised Controlled Trial Evaluating the Effectiveness and Tolerability of Step-up and Step-down Varenicline Therapy for Smoking Cessation: A Study Protocol

Background: Varenicline remains the most effective medication for smoking cessation; however, discontinuation as a result of adverse events negatively impacts medication adherence, and the likelihood of a quit attempt being successful. Post-treatment cravings and withdrawal symptoms may also occur, increasing the likelihood of treatment failure, due to lapse and relapse after achieving initial abstinence. This protocol details a trial investigating changes in the effectiveness and tolerability of varenicline, when an extended step-up and step-down regimen are used.Methods: A phase four, randomised, double-blinded, placebo-controlled single-centre study with a treatment period of 16 weeks, and follow-up period of 12 weeks will be conducted. Up to 201 participants will be enrolled and allocated in a 1:1:1 ratio to a placebo-matching control group, step-up, or step-down intervention group, all receiving behavioural counselling and quitting advice. Participants will be contacted weekly during treatment and fortnightly during follow-up. Eligible participants are smokers over 18 years old, willing to quit smoking, are able to attend clinic visits, and have no uncontrolled or serious medical issues. Primary outcome measures are comparisons of biochemically confirmed continuous abstinence rates, 7-day point prevalence abstinence rates, and the frequency, severity and duration of adverse events, cravings and withdrawal symptoms. Secondary outcome measures are participant adherence to the study medication throughout treatment, and comparisons of changes in smoking satisfaction and reward. Effects of each regimen on smoking cessation will be assessed by logistic regression, with survival analyses used for a more precise estimate of when cessation occurs. Primary endpoints will then be compared using a general linear model. Australian New Zealand Clinical Trials Registry: ACTRN12616000802404p