Smoking Abstinence Research Articles

The Mismatch between Adult Smokers’ Abstinence Expectancies and Experiences at Outpatient Facilities: An Exploratory Study

Background:: Smokers’ expectancies about abstinence, that is the effects that smokers anticipate when they attempt to quit smoking, remain understudied. The aim of the present study was to examine the relation between smoking abstinence expectations and subjective experience over time among individuals in smoking cessation treatment. Methods:: A total of 215 adult smokers seeking treatment at two Italian third-level outpatient facilities were assessed at baseline and three-time points after the quit day (QD): 7 days, and 1 and 3 months. The following self-report instruments were administered: the Smoking Abstinence Expectancies Questionnaire (SAEQ), as a baseline measure of expectancies before quitting; the SAEQ-past, for assessing the actual occurrence of symptoms that were expected; the Minnesota Nicotine Withdrawal Scale, as a measure of withdrawal symptoms post-quitting. Results:: One and 3 months after the QD, participants reported fewer negative abstinence symptoms than expected, except for somatic symptoms, and fewer positive consequences than expected. A mismatch between smoking abstinence expectations and actual postquitting experiences was found, thus expectancies were violated. Conclusion:: The present findings confirm the need to assess both abstinence expectancies and actual post-quitting experiences. Future studies should examine tailored interventions aimed at educating smokers about expectancies and post-quitting experiences.

Sustainability of an Opt-Out Electronic-Health Record-Based Tobacco Treatment Consult Service at a Large Safety-Net Hospital: A 6-Year Analysis.

Our safety-net hospital implemented a hospital-based tobacco treatment intervention in 2016. We previously showed the intervention, an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+ order-set that triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all patients who smoke, improves smoking abstinence. We now report on sustainability, 6 years after inception. We analyzed data collected between July 2016-June 2022 of patients documented as "currently smoking" in the EHR. Across the 6 years, we used Pearson's correlation analysis to compare Adoption (clinician acceptance of the BPA+ order-set, thus generating consultation to the TTC service); Reach (number of consultations completed by the TTC service); and Effectiveness (receipt of pharmacotherapy orders between patients receiving and not receiving consultations). Among 39 558 adult admissions (July 2016-June 2022) with "currently smoking" status in the EHR for whom the BPA triggered, clinicians accepted the TTC order set on 50.4% (19 932/39 558), though acceptance varied across services (eg, Cardiology [71%] and Obstetrics-Gynecology 12%]). The TTC service consulted on 17% (6779/39 558) of patients due to staffing constraints. Consultations ordered (r = -0.28, p = .59) and completed (r = 0.45, p = .37) remained stable over 6-years. Compared to patients not receiving consultations, patients receiving consultations were more likely to receive pharmacotherapy orders overall (inpatient: 50.8% vs. 35.1%, p < .0001; at discharge: 27.1% vs. 10%, p < .0001) and in each year. The "opt-out" EHR-based TTC service is sustainable, though many did not receive consultations due to resource constraints. Health care systems should elevate the priority of hospital-based tobacco treatment programs to increase reach to underserved populations. Our study shows that opt-out approaches that utilize the EHR are a sustainable approach to providing evidence-based tobacco treatment to all hospitalized individuals who smoke, regardless of readiness to stop smoking and clinical condition.

Changes in biomarkers of exposure and withdrawal symptom among Chinese adult smokers after completely or partially switching from combustible cigarettes to an electronic nicotine delivery system.

This study assessed changes in biomarkers of exposure (BoE) after 5 days of completely or partially switching to an electronic nicotine delivery system (ENDS) use, compared with continued use of combustible cigarettes and smoking abstinence among Chinese adult smokers. A randomized, open-label, parallel-arm study was conducted among Chinese adult smokers who were naive ENDS users. Forty-six subjects were randomized to 4 study groups (n = 11-12 per group): exclusive ENDS use, dual use of ENDS and cigarettes, exclusive cigarettes use, and smoking abstinence. Subjects were confined in clinic for 5 consecutive days and product use was ad libitum. Nicotine and its metabolites (cotinine and 3-hydroxycotinine), and BoEs (AAMA, CEMA, HEMA, HMPMA, 3-HPMA, SPMA, exhaled CO, and exhaled NO) were measured. Withdrawal symptom was measured using MNWS throughout the 5-day period. Six urine BoEs of volatile organic compounds decreased by 55.1-84.1% in the exclusive ENDS use group, which is similar to the smoking abstinence group (67.2-87.4%). The level of decrease was 56.8-70.4% in the dual use group and 10.7-39.0% in the cigarettes group. Urine total nicotine exposure had a non-significant increase in the exclusive ENDS use group, and plasma nicotine and cotinine showed a trend of increasing day by day. After completely or partially switching to ENDS use among Chinese smokers, exposure to selected toxicants were significantly decreased. The results of this study add to the body of evidence that exposure to toxic substance decreased among smokers after complete or partial switch from combustible cigarettes to ENDS use. As part of transition to experienced ENDS use, this study found that smokers of the initial stage who have no prior ENDS experience may increase nicotine intake after switching to ENDS use.

Effectiveness of Instant Messaging-Based Online Group Support for Preventing Smoking Relapse: a Pragmatic Randomized Controlled Trial

AbstractOnline group support potentially help prevent smoking relapse. This two-arm, pragmatic, open-label randomized controlled trial assessed the effectiveness of instant messaging (IM) (i.e., WhatsApp) online group support versus text messages for smoking relapse prevention. The intervention group (n = 469) participated in 8-week counsellor-moderated IM-based online discussion groups and receive messages on preventing relapse via WhatsApp. The control group (n = 459) received similar messages via text messaging for 8 weeks. Primary outcome was biochemically validated tobacco abstinence (exhaled carbon monoxide &lt; 4 parts per million; or saliva cotinine &lt; 10 ng/ml) at 12-month follow-up. By intention-to-treat, intervention and control groups showed similar prevalence of biochemically validated abstinence (11.9% versus 11.7%, risk ratio [RR] = 1.01; 95%CI 0.71–1.44; P = 0.93). The interactive IM-based online group support was costly but did not increase smoking abstinence compared to simple text messaging. More interactive digital health interventions are more costly but may not be more effective than simple text messaging. ClinicalTrials.gov Identifier: # NCT03717051.

Process and effect evaluation of a referral aid for smoking cessation counselling in primary care: Findings of a randomized controlled trial.

This study explored the use and effects of a smoking cessation referral in: 1) practice nurses (PNs), and 2) smokers. The use of evidence-based smoking cessation interventions (EBSCIs) can double the likelihood of a successful smoking cessation attempt. A referral aid was developed to aid Dutch PNs in primary care in deciding which smokers are the most suitable for EBSCI. Two different studies were conducted: 1) a randomized controlled trial with a process evaluation (n=82) and effect evaluation (n=285) among smoking patients recruited by PNs (n=73), and 2) a process evaluation among a subgroup of PNs (n=40) from January 2019 to September 2020. Overall, the response in both groups was low. PNs found the referral aid materials clear and understandable. Smokers had similar but (slightly) less-positive opinions. The smokers in both groups did not differ in the amount of discussion and use of EBSCIs, nor on smoking abstinence. Further research should assess how to better involve PNs and smokers when recruiting for an RCT and how to foster effective counselling. Additional research should also look deeper into barriers to referral of both PNs and smokers, and how to stimulate referral to EBSCIs best and help smokers to make a decision; for example by implementing a simplified strategy both within the primary care setting and outside, by involving other healthcare professionals or options outside healthcare such as the workplace and social domain. The study was registered at the Netherlands Trial Register (NL7020, https://www.trialregister.nl/trial/7020).

Electronic cigarettes for smoking cessation.

Electronic cigarettes for smoking cessation.

Emotional dysregulation among English-speaking Hispanic persons who smoke living in the United states

Hispanic/Latinx (hereafter Hispanic) individuals in the United States (US) experience serious tobacco-related disparities and factors contributing to such disparities need to be adequately identified and clinically addressed. Emotion dysregulation is a key transdiagnostic relevant to smoking. The present cross-sectional investigation sought to test if emotion dysregulation was related to more severe problems during smoking quit attempts (e.g., irritability, weight gain), perceptions of difficulty about quitting, as well as negative and positive beliefs about smoking abstinence in a sample of English-speaking Hispanic adults residing in the US who smoke. Participants included 332 Hispanic adults who engaged in daily cigarette smoking (35.46 years old, 37 % identified as female). Emotion dysregulation was significantly related to more severe problems when quitting and perceived barriers for quitting, as well as negative beliefs about smoking abstinence. Additionally, emotion dysregulation was significantly and negatively related to positive outcomes about smoking abstinence. The amount of change in the various smoking criterion variables accounted for by emotion dysregulation was small (sr2 range: 0.028-0.085), but evident in adjusted models that accounted for a wide range of factors (e.g., depression, drug use severity). Overall, this investigation found consistent empirical evidence that individual differences in emotion dysregulation in Hispanic individuals were associated with several clinically significant smoking processes, suggesting this construct may represent an important factor involved in the maintenance and relapse of smoking among this ethnic population.

A longitudinal analysis of the impact of the local tobacco retail availability and neighbourhood deprivation on male smoking behaviours in Shanghai, China

Some evidence from Western high-income countries suggests local tobacco retail availability and neighbourhood deprivation may influence smoking behaviours. However, this assertion has not been considered in China, where 44% of males continue to smoke. Data were analysed from Chinese males (n = 2054) who participated in Waves 3–5 (2009–2015) of the International Tobacco Control (ITC) China Survey by linking information on tobacco retail availability (estimated through population weighted Kernel Density of tobacco retailers in 2019) and neighbourhood deprivation (calculated as a composite score derived from the 2010 Chinese census) across Shanghai. Generalised Estimating Equation models were fitted to examine the impacts of local tobacco availability and neighbourhood deprivation on smoking behaviours (current smoking versus current non-smoking, quitting versus current smoking, longer durations of smoking abstinence versus current smoking) using the longitudinal data. Examining the impacts separately, participants living in neighbourhoods with greater availability and higher levels of deprivation were less likely to maintain longer durations of smoking abstinence in both unadjusted and adjusted models. Neighbourhood deprivation, but not availability, was found to be associated with higher odds of being a current smoker. Examining the impacts jointly, neighbourhood deprivation was still positively associated with current smoking and negatively associated with longer durations of smoking abstinence, but the negative association between availability and longer durations of smoking abstinence disappeared. The findings offer some evidence that greater tobacco retail availability and deprivation are obstacles on prolonged smoking cessation among males in Shanghai, China. Policymakers should consider small-area level place-based restrictions in China, such as reducing the availability of tobacco, as part of a comprehensive tobacco control strategy aimed at addressing the high prevalence of smoking.

Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021.

Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).

Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses.

Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.

Does alcohol consumption elevate smoking relapse risk of people who used to smoke? Differences by duration of smoking abstinence

BackgroundPast research indicates dual users of tobacco and alcohol find it harder to quit smoking and may be more likely to relapse. This study investigated whether post-quit alcohol use predicted smoking relapse among ex-smokers, and whether this relationship varied by length of smoking abstinence. MethodThe study included 1064 ex-smokers (18+ years) from Canada (n = 340), US (n = 314), England (n = 261), and Australia (n = 149) who participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Survey, and we conducted analyses using multivariable logistic regression. We assessed alcohol consumption in 2018 using AUDIT-C and coded as never/low, moderate or heavy level and used alcohol consumption to predict smoking status in 2020. ResultsOverall 26 % and 21 % of ex-smokers consumed alcohol at a moderate and heavy level, respectively. Compared to never/low alcohol consumption, risk of smoking relapse among those who consumed alcohol at a moderate level was significantly lower within the first year of abstinence (OR = 0.34, 95 % CI = 0.14–0.81, p = 0.015) but higher thereafter (OR = 2.44, 95 % CI = 1.13–5.23, p = 0.023). The pattern of results was similar for those who consumed alcohol at a heavy level. ConclusionsOverall, baseline alcohol consumption of ex-smokers did not predict their smoking relapse risk. As expected, risk differed by smoking abstinence duration. However, the pattern was unexpected among the short-term quitters as the subgroup who drank moderately/heavily had lower relapse risk than their counterparts who never drink or at low level, underscoring the need to replicate this unexpected finding.

AI Conversational Agent to Improve Varenicline Adherence: Protocol for a Mixed Methods Feasibility Study.

Varenicline is a pharmacological intervention for tobacco dependence that is safe and effective in facilitating smoking cessation. Enhanced adherence to varenicline augments the probability of prolonged smoking abstinence. However, research has shown that one-third of people who use varenicline are nonadherent by the second week. There is evidence showing that behavioral support helps with medication adherence. We have designed an artificial intelligence (AI) conversational agent or health bot, called "ChatV," based on evidence of what works as well as what varenicline is, that can provide these supports. ChatV is an evidence-based, patient- and health care provider-informed health bot to improve adherence to varenicline. ChatV has been programmed to provide medication reminders, answer questions about varenicline and smoking cessation, and track medication intake and the number of cigarettes. This study aims to explore the feasibility of the ChatV health bot, to examine if it is used as intended, and to determine the appropriateness of proceeding with a randomized controlled trial. We will conduct a mixed methods feasibility study where we will pilot-test ChatV with 40 participants. Participants will be provided with a standard 12-week varenicline regimen and access to ChatV. Passive data collection will include adoption measures (how often participants use the chatbot, what features they used, when did they use it, etc). In addition, participants will complete questionnaires (at 1, 4, 8, and 12 weeks) assessing self-reported smoking status and varenicline adherence, as well as questions regarding the acceptability, appropriateness, and usability of the chatbot, and participate in an interview assessing acceptability, appropriateness, fidelity, and adoption. We will use "stop, amend, and go" progression criteria for pilot studies to decide if a randomized controlled trial is a reasonable next step and what modifications are required. A health equity lens will be adopted during participant recruitment and data analysis to understand and address the differences in uptake and use of this digital health solution among diverse sociodemographic groups. The taxonomy of implementation outcomes will be used to assess feasibility, that is, acceptability, appropriateness, fidelity, adoption, and usability. In addition, medication adherence and smoking cessation will be measured to assess the preliminary treatment effect. Interview data will be analyzed using the framework analysis method. Participant enrollment for the study will begin in January 2024. By using predetermined progression criteria, the results of this preliminary study will inform the determination of whether to advance toward a larger randomized controlled trial to test the effectiveness of the health bot. Additionally, this study will explore the acceptability, appropriateness, fidelity, adoption, and usability of the health bot. These insights will be instrumental in refining the intervention and the health bot. ClinicalTrials.gov NCT05997901; https://classic.clinicaltrials.gov/ct2/show/NCT05997901. PRR1-10.2196/53556.

Differences in smoking behavior and beliefs about abstinence among Latinx individuals with and without depression who smoke cigarettes

There is a well-established relation between depression and smoking in the general population. However, past work focused on Latinx persons who smoke in relation to depressed affect has yielded inconsistent findings. The present investigation aimed to build on past research and evaluate differences among English-speaking Latinx adults who smoke combustible cigarettes with and without probable depression in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The current sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18–61; 37.3% female) that were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with probable depression (compared to those without) demonstrated higher levels of cigarette dependence, more severe problems when trying to quit, greater perceived barriers for quitting, and increased negative abstinence expectancies after adjusting for sociodemographic and concurrent substance use variables. Future work could build from this research to elucidate the role of depression in the maintenance and relapse of smoking among the Latinx population.

Relative Efficacy of an Acceptance and Commitment Therapy-Based Smartphone App with a Standard US Clinical Practice Guidelines-Based App for Smoking Cessation in Dual Users of Combustible and Electronic Cigarettes: Secondary Findings from a Randomized Trial

Background While smartphone apps for smoking cessation have shown promise for combustible cigarette smoking cessation, their efficacy in helping dual users of combustible and electronic cigarettes (e-cigarettes) to quit cigarettes remains unknown. This study utilized data from a randomized trial to determine if an Acceptance and Commitment Therapy (ACT)-based app (iCanQuit) was more efficacious than a US Clinical Practice Guidelines-based app (QuitGuide) for combustible cigarette smoking cessation among 575 dual users. Methods The primary cessation outcome was self-reported, complete-case 30-day abstinence from combustible cigarettes at 12 months. Logistic regression assessed the interaction between dual use and treatment arm on the primary outcome in the full trial sample (N = 2,415). We then compared the primary outcome between arms among dual users (iCanQuit: n = 297; QuitGuide: n = 178). Mediation analyses were conducted to explore mechanisms of action of the intervention: acceptance of cues to smoke and app engagement. Results: There was an interaction between dual use of combustible and e-cigarettes and treatment arm on the primary outcome (p = 0.001). Among dual users, 12-month abstinence from cigarettes did not differ between arms (23% for iCanQuit vs. 27% for QuitGuide, p = 0.40). Mediation analysis revealed a significant positive indirect effect of the iCanQuit app on 12-month abstinence from cigarettes through acceptance of emotions that cue smoking (p = 0.004). Conclusions Findings from this study of dual users of combustible and e-cigarettes showed no evidence of a difference in quit rates between arms. Acceptance of emotions that cue smoking is a potential mechanism contributing to cigarette smoking abstinence among dual users.

Acute effects of outdoor and indoor walking on cigarette cravings, withdrawal symptoms and affective response during temporary smoking abstinence

RationaleCigarette smoking is one of the leading preventable causes of premature death worldwide. There is evidence in the literature that brief exercise units indoors can improve well-being in temporarily abstinent smokers and reduce cigarette cravings and withdrawal symptoms.ObjectiveBecause exercise in natural environments showed enhanced psychological effects, the aim of our study was to examine the acute effects of outdoor exercise compared with indoor exercise on craving, withdrawal symptoms and affective response in temporarily abstinent smokers.MethodsIn a randomized controlled within-subject-design, temporarily abstinent smokers (N = 16) participated in three interventions lasting 10 min: outdoor walking (OUT-EX), indoor walking (IN-EX) and a sedentary control condition (CC). Self-reported cigarette craving, withdrawal symptoms and affective response were assessed pre-, mid-, post-interventions and at follow-up.ResultsIn contrast to CC, OUT-EX and IN-EX significantly reduced cigarette cravings during and at the end of the intervention compared to pre-intervention, but not at 20 min follow-up. Cigarette withdrawal symptoms decreased significantly over time in all three groups, but no significant group differences were found. OUT-EX and IN-EX, but not CC, showed significantly improved affective valence at the end of the intervention and at follow-ups. Outdoor walking resulted in significantly lower cigarette cravings than indoor walking at the end of the intervention.ConclusionThe study adds to existing evidence that short bouts of indoor or outdoor exercise can help reduce cigarette cravings and increase well-being in abstinent smokers. Further studies are needed to address the potential additional effect of outdoor exercise on craving, affective states and smoking cessation.

Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial

The efficacy and safety of varenicline for smoking cessation among individuals who smoke tobacco cigarettes and also use electronic cigarettes (known e-cigarettes or vapes) have not been studied. We aimed to address this knowledge gap and examine predictors for smoking abstinence. In this double-blind, placebo-controlled, single-centre randomised trial in Italy, we enrolled adults who had used an e-cigarette daily for at least 12 months and who also smoked at least one tobacco cigarette per day and had a willingness to quit smoking. 155 participants were randomly assigned to receive either varenicline (n=78) or matched placebo (n=77). Varenicline (1mg, administered twice daily for 12 weeks) was given in combination with smoking cessation counseling in dual users with an intention to quit smoking. Participants in both treatment groups received the same smoking cessation counselling throughout the whole duration of the study. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up. The primary efficacy endpoint was continuous abstinence rate (CAR) in weeks 4-12. Secondary efficacy endpoints were the CAR in weeks 4-24 and 7-day point prevalence of smoking abstinence at weeks 12 and 24. This study is registered in EUDRACT, 2016-000339-42. Between November 2018, and February 2020, 114 participants (61 in the varenicline group and 53 in the placebo group) completed the intervention phase at week 12 and 88 participants (52 in the varenicline group and 36 in the placebo group) completed the follow-up phase at week 24. CARs were significantly higher for the varenicline vs placebo at each time-point: 50.0% vs 16.9% (OR=4.9; 95% CI, 2.3-10.4; P<0.0001) between weeks 4 and 12; and 48.7% vs 14.3% (OR=5.7; 95% CI, 2.6-12.3; P<0.0001) between weeks 4 and 24. The 7-day point prevalence of smoking abstinence was also higher for the varenicline than placebo at each time point. Adverse events were rated as mild or moderate and rarely led to treatment discontinuation. Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking. Further research in larger and more generalisable populations is required to strengthen such a suggestion. Global Research Award for Nicotine Dependence, an independently reviewed competitive grants programmeme funded by Pfizer.

Effect of a Personalized Tobacco Treatment Intervention on Smoking Abstinence in Individuals Eligible for Lung Cancer Screening

IntroductionTo determine whether personalized gain-framed messaging and biomarker feedback related to tobacco cessation or reduction decrease smoking behavior in patients undergoing or eligible for lung cancer screening. MethodsBetween 2016 and 2020, 188 patients were enrolled in a two-phase, sequential, randomized controlled trial. Phase 1 evaluated whether standard of care (SC) (five in-person counseling sessions and 8 weeks of nicotine patch) plus gain-framed messaging (GFM) versus SC would increase 8-week biochemically verified smoking cessation rates. In 143 participants randomized in phase 2, we tested whether feedback on smoking-related biomarkers would reduce 6-month self-reported number of cigarettes smoked per day compared with a no feedback control. Chi-square test and mixed effects repeated measures analyses were used to evaluate group differences. ResultsParticipants were 62.5 ± 5.6 (mean ± SD) years of age, had a 50.3 ± 21 pack-year smoking history, and were smoking 16.9 ± 9.9 cigarettes per day. At 8 weeks, there was no difference in quit rates between those randomized to SC plus GFM (n = 15 of 93, 16.1%) and those randomized to SC (n = 16 of 95, 16.8%), with p equals to 0.90. At the 6-month post-randomization follow-up, number of cigarettes smoked per day was similar in the feedback (least-squares mean = 7.5, 95% confidence interval: 6.0–9.1) and no feedback arms (7.7, 95% confidence interval: 6.2–9.3), with p equals to 0.87. ConclusionsGain-framed messaging and health feedback did not significantly improve quit rates relative to comprehensive standard of care. Nevertheless, the overall program achieved clinically meaningful smoking quit rates in this older high pack-year cohort, highlighting the importance of intensive tobacco treatment for patients undergoing lung cancer screening. Clinical trial registered with ClinicalTrials.govNCT02658032.

Effects of a Workplace mHealth Intervention for Smoking Behaviour: A Quasi Experimental Study Protocol

Introduction: Tobacco smoking causes various chronic diseases and adds costs to healthcare systems. The current smoking cessation interventions mostly target smokers who are ready to quit and are reactive in recruitment. Recently, mobile phones have become a new tool for promoting smoking cessation. The aim of this paper is to present a study protocol on a quasi-experimental study investigating the effects of a workplace mHealth intervention for smoking behaviour. Methods: A quasi-experimental study will be conducted among employees in an academic institution in Malaysia. The intervention group will receive a theory based WhaSTOP module via WhatsApp and will be compared with the control group (receive usual care). The primary outcomes are stage movement and the number of cigarettes per day. The secondary outcomes include knowledge of smoking, quit attempt, nicotine dependence, 7-day point prevalence of smoking abstinence, and the Transtheoretical Model constructs. A generalised estimating equation analysis will be performed to determine the effects of the intervention. Discussion: This protocol will provide a novel method to proactively approach smokers regardless of readiness to quit and to guide them through the stages of change so that they will be ready to take action to quit. This research will also provide insight into whether the intervention can be utilised as an additional tool for smokers at the workplace to quit smoking. Trial Registration: The trial was registered with the Iranian Registry of Clinical Trials (Registry Number IRCT20220415054539N1).

Health outcomes of an ambulatory exercise-based cardiac rehabilitation program across patient risk categories

Abstract Background Exercise-based cardiac rehabilitation is recommended after an ST-segment elevation myocardial infarction (STEMI) to improve prognosis, quality of life and control of cardiovascular risk factors. Ambulatory training has been proposed as an alternative if in-hospital training is unavailable. Purpose To study the health outcomes of an ambulatory exercise-based Cardiac Rehabilitation Program (aCRP) in STEMI patients across different patient risk profiles. Methods A Phase 2 aCRP aimed to STEMI patients was implemented in our hospital in 2022. Conventional or cardiopulmonary exercise testing (C/CPET) was performed, patient risk was stratified as low risk or intermediate/high risk, and a 3-month, individualized aerobic and strength ambulatory training program was provided. C/CPET was repeated at the end of Phase 2 and peak oxygen consumption (peak VO2) was measured. Questionnaires were used to analyse quality of life (SF-36), depression (PHQ-2), anxiety (GAD-2), adherence to Mediterranean diet (PREDIMED) and weekly physical activity (IPAQ). Comparisons were performed between patients at low risk and patients at intermediate/high risk. A p&amp;lt;0.05 was considered statistically significant. Results The cohort comprised 41 patients who completed Phase 2 of aCRP (mean age 60.1±10.2 years, 82.9% male and 53.7% smokers) and were stratified as low risk (n=15, 36.6%) or intermediate/high risk (n=26, 63.4%). Reductions in systolic blood pressure (-7.9±15.7mmHg), LDL cholesterol (-59.5±35mg/dL), weight (-3±6.5kg) and body mass index (BMI, -1±2.2) were attained (all p&amp;lt;0.05). Smoking abstinence was accomplished in 90.9% of smokers and most patients achieved an LDL&amp;lt;55mg/dL target (75.6%). Quality of life improved (+8.4±23.7 points in SF-36, p=0.03) and anxiety symptoms diminished (-0.6±1.8 points in GAD2, p=0.04). A median 4.1±4.7ml/kg/min peak VO2 increase was achieved (+17.9% from baseline, p&amp;lt;0.001) and patients increased their reported weekly physical activity in 2681.1±3385.3 METS/week (+156.2% from baseline, p&amp;lt;0.001). No significant differences were noted between low risk and intermediate/high risk patients, except lower LDL&amp;lt;55mg/dL (65.4% vs. 93.3%, p=0.045) and higher weight loss and BMI reduction (-4.2±7.7 vs. -0.8±3kg, p=0.05 and -0.16±1.1 vs. -1.54±2.5, p=0.02, respectively) in intermediate/high risk patients. No readmissions for cardiovascular causes or complications of ambulatory training were registered. Conclusions In STEMI patients, a Phase 2 ambulatory Cardiac Rehabilitation Program can provide excellent control of cardiovascular risk factors, improve quality of life, and significantly increase functional capacity and reported weekly physical activity. Results are comparable in patients at low risk and intermediate/high risk of cardiac rehabilitation, which could support the inclusion of intermediate/high risk patients in ambulatory exercise-based cardiac rehabilitation programs if in-hospital supervised training is unavailable.Health outcomes of aCRP.

Effectiveness of the spirometry-based motivational intervention to quit smoking: RESET randomised trial

BackgroundThe effectiveness of providing feedback on spirometry results for smoking cessation remains inconclusive according to the current evidence.ObjectivesTo assess the effectiveness of a motivational intervention based on spirometry results in achieving prolonged smoking abstinence (12 months post-intervention).Design and SettingA randomised, controlled, observer-blinded, multicentre clinical trial was conducted (from January 2012 to December 2015) in 20 primary healthcare centres in the Tarragona province, Spain.MethodsParticipants, active smokers aged 35–70 without known respiratory disease, were recruited from primary healthcare centres by family doctors and nurses. They were randomly assigned to either the intervention group (IG = 308) or the control group (CG = 306). Both groups received brief smoking cessation counselling. Additionally, the IG underwent spirometry and received detailed information about the results, including lung age. The primary outcome was prolonged abstinence, defined as lasting at least 12 months and validated through cotinine measurement in urine.ResultsThe prolonged abstinence rate was 7.8% in the IG, compared to 2.6% in the CG (p = 0.004). At 12 months, in the multivariate analysis, the intervention was identified as an independent factor for smoking cessation (OR 2.8; 95%CI 1.2 to 7.7), a trend maintained throughout the follow-up (HR 2.74; 95%CI 1.13 to 6.62). Moreover, according to the Prochaska and DiClemente model, the preparation or action phase to quit was also associated with smoking cessation (HR 2.55, 95%CI 1.07 to 6.09).ConclusionA primary care-delivered intervention involving brief counselling and detailed spirometry information proves effective in increasing abstinence rates among active smokers without known respiratory disease. Additionally, smoking cessation is also influenced by the individual’s stage of change.Trial RegistrationClinicatTrials.gov NCT02153047