Smoking Cessation Aid Research Articles

The Efficacy of Body Acupuncture Combined with Ear Acupressure versus Frequent Counseling as Adjuvant Therapy for Quitting Smoking – An Intervention Pilot Study

Background and Objectives: Quitting smoking is a primary preventive measure for many chronic and fatal diseases including various types of cancers, cardiovascular and respiratory diseases. Unfortunately, the available pharmacological therapies may have potential side effects and may be unsuitable for all smokers. The present study aimed to evaluate the efficacy of using Chinese acupuncture as a nonconventional aid for smoking cessation. Subjects and Methods: The smokers have been randomized into one of two groups, the acupuncture group (n = 20) or the interpersonal canceling group (n = 26) as control. All smokers were interviewed to fill pretested, well-structured questionnaire form to assess their smoking and nicotine-dependent status. In the acupuncture group, the body acupuncture needles were retained for 30 min and then removed while the ear press needles were inserted to be maintained in place for a few days. The treatment in the two groups continued once weekly for successive 12 weeks. Results: The smokers in the acupuncture group showed significantly higher continuous abstinence rate, incomplete abstinence rate, and lower failure rates, at 4 weeks, 8 weeks, and 12 weeks (P = 0.04, 0.003, and 0.02 respectively) than the counseling group. In the 24th week, no significant differences were detected in the treatment outcome between the two treatment groups (P > 0.05). In addition, fewer occurrences of nicotine withdrawal symptoms have been detected including craving for smoking. Conclusion: According to the results of this pilot study, the use of acupuncture therapy in the form of body acupuncture combined with ear acupressure was a successful aid for smoking cessation superior to counseling alone. Based on the literature review, this is the first Egyptian study addressing this research point. A large-scale multicenter study is intended to work in the future.

Effectiveness and Acceptability of a Comprehensive Mobile Health-Based Modality for Smoking Cessation - Beijing Municipality, China, 2022.

Mobile health interventions have been demonstrated to be effective in aiding smoking cessation among smokers. Nevertheless, research on this topic remains limited in China. Following two months of utilizing the services of a comprehensive mobile health (mHealth)-based modality ("Way to Quit" modality) which integrated three online interventions through the WeChat application, 29.1% of participating smokers successfully quit smoking. Participants who used a greater number of online services were more likely to cease smoking. All services were scored highly for satisfaction among smokers. This study presents a practical and feasible method to assist Chinese smokers in quitting smoking. The results of this research suggest a promising direction for enhancing the accessibility and utilization of smoking cessation services. Additionally, these findings serve as a critical reference for addressing the obstacles faced by smoking cessation services in China.

Knowledge and Awareness Regarding Nicotine Replacement Therapy among Dental Students: A Questionnaire Study

Abstract Context: Nicotine replacement therapy (NRT) is one of the most effective smoking cessation aids. The ability of dental students to recognize and implement NRT is important for guiding patients toward tobacco cessation. Aims: The aim of this study was to assess the knowledge and awareness among interns and postgraduate students (PGS) from Dental Colleges in Dakshina Kannada toward NRT. Materials and Methods: A questionnaire-based survey was conducted, which included 249 interns and PGS from Dental Colleges in Dakshina Kannada. The survey was conducted using an online form (Google Form). A self-administered questionnaire with 19 questions was distributed regarding demographics, general information, and knowledge and awareness about NRT. Statistical Analysis Used: Inter-group comparison (two groups) was done using t-test. Comparison of the frequency of categories of variables with groups was done using Chi-square test. P <0.05 was considered to be statistically significant. Results: A total of 249 responses were received and analyzed. Most of the study population was familiar with the term NRT (89.2%). For most of the questions regarding knowledge and awareness about NRT, there was no statistically significant difference in responses between the interns and postgraduates (P > 0.05). There was no statistically significant difference in mean knowledge and awareness score between interns (9.15 ± 5.74) and postgraduates (9.98 ± 5.068) (P > 0.05). Conclusions: Although there is an awareness of NRT, there lacks an in-depth knowledge and awareness regarding it.

The Efficacy of Individualized, Community-Based Physical Activity to Aid Smoking Cessation: A Randomized Controlled Trial.

The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP). The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use "lifestyle" activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months. Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups. Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

General practitioners’ knowledge, attitudes, beliefs and practices surrounding the prescription of e-cigarettes for smoking cessation: a mixed-methods systematic review

BackgroundGeneral practitioners (GPs) play an important role in providing patients who smoke with health information, support and treatment to encourage them to quit smoking. Despite conflicting evidence on the effectiveness of electronic cigarettes (e-cigarettes) as a smoking cessation aid, there is growing interest in the role e-cigarettes might play as an alternative to smoking tobacco. This systematic review aims to synthesise evidence from qualitative, quantitative and mixed-methods studies of the knowledge, attitudes, beliefs and social norms of GPs with respect to the use of e-cigarettes as smoking cessation aids.MethodsThis study adhered to the PRISMA guidelines. Studies from MEDLINE, CINAHL, SCOPUS, PsycINFO, EMBASE and grey literature were searched. Two independent reviewers screened abstracts and full-text articles to identify studies that met the inclusion criteria. A data extraction form was used to extract relevant data from included papers and were quality appraised using the MMAT checklist. A PRISMA flow diagram was used to record the flow of papers and reasons for exclusion. Studies were included if they collected quantitative, qualitative or mixed methods data to determine knowledge, attitudes, beliefs and social norms of GPs for use of e-cigarettes as smoking cessation aids.ResultsA total of 4056 abstracts were screened and 25 articles were included. Our findings showed that GPs had mixed views on recommending e-cigarettes as a smoking cessation aid. Some GPs were optimistic and had recommended e-cigarettes to their patients. Others were reluctant and disagreed that e-cigarettes are an effective method to quit smoking. Most GPs lacked knowledge and confidence in having discussions with patients around e-cigarette safety and efficacy as smoking cessation alternatives.ConclusionThis systematic review shows there are mixed views on e-cigarettes as smoking cessation aids. Clear guidance on the role of e-cigarettes is needed to inform and upskill GPs about e-cigarettes for smoking cessation.PROSPERO registrationCRD42021227612.

E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study.

E-cigarette use is increasing globally. Recent evidence suggests that e-cigarettes contain harmful substances that could cause adverse health outcomes. This study investigated the prevalence and associated factors of e-cigarette use among male current smokers in Saudi Arabia. We conducted a cross-sectional survey of adult male current smokers in the Al-Ahsa province of Saudi Arabia. Data were collected using a structured questionnaire. We performed logistic regression analyses to investigate the factors associated with e-cigarette use among adult male current smokers. 325 current smokers participated in the study. A third of them (33.5%) were e-cigarette users. Almost all the study participants (97.0%) had heard about e-cigarettes. Participants who were occasional smokers (Odds Ratio (OR): 2.28; 95% Confidence Interval (CI): 1.17-4.41) and had good knowledge perception of e-cigarettes (OR 3.49; 95% CI: 2.07-5.90) had higher odds of using e-cigarettes when compared to regular smokers of conventional cigarettes and current smokers with poor knowledge perception of e-cigarettes, respectively. In contrast, private employees (OR: 0.25, 95% CI: 0.07-0.85), and business owners (OR: 0.09, 95% CI: 0.01-0.63) had lower odds of using e-cigarettes compared to unemployed individuals. Compared with non-e-cigarette users, the rate of conventional cigarette smoking per day was significantly lower among e-cigarette users. Use of e-cigarette (OR: 3.57, 95% CI: 2.14-5.98), believing that e-cigarette quitting is hard (OR: 2.02, 95% CI: 1.17-3.49) and trying to quit e-cigarettes (OR: 2.17, 95% CI: 1.1-4.25) were found to be significant predictors of good knowledge perception of e-cigarettes among the current smokers. The use and knowledge perception of e-cigarettes were higher among occasional conventional male cigarette smokers than regular male smokers in Al-Ahsa province. The use of e-cigarettes as smoking cessation aids should be examined further in the Saudi Arabian setting.

Smoking cessation economic benefits in a human capital approach: emerging evidence in Jordan

Background: Smoking is a major cause globally of morbidity and mortality hence life years lost, this issue manifested in 399 Million Jordanian dinars (JD)($562.3 million USD) lost yearly due to productivity lost as a consequence of smoking in Jordan1. It is no surprise that quitting smoking will reduce the loss in life years and hence productivity. In this study, using cohort simulation, we want to quantify the gains in productivity from smoking cessation aids usage for one course of smoking cessation aid varenicline or nicotine replacement therapy in comparison to physician counseling only without pharmacological therapy, in the population that intends to quit at a point of time, through campaigns nationwide, among the working-age population followed up until retirement. Methodology: We present a transparent, generic model based on accepted analytic methods that allow users to assess the present value of lifetime earnings gained (PVLE) in smokers who intend to quit. It is shown in previous studies that smoking cessation aids are cost-effective in Jordan (Madae’en et al. 2020), yet the benefit of using smoking cessation aids goes further to reduce productivity loss by reducing life years lost. Our model incorporates life-years gained from the Markov Model in Madae’en et al. (2020), simulation of Jordanian male smokers’ cohort in three scenarios of either using varenicline or nicotine replacement therapy or only physician consultation, to estimate life-years gained and hence reduction in lost productivity costs. Results: We found productivity loss was reduced in males who attempted to quit in their productive years. Using Varenicline, the researchers calculated the expected future payments (wages) count for years gained due to varenicline use for a wage average of 507 JDs ($714.5 USD) per month discounted by 8% for the rest of their productive life. As well as for the other two scenarios, the gained productivity from one course of varenicline to the male adults over 30 who intend to quit will reduce loss by more than 72 billion JDs ($101.42 billion USD) among the working-age population followed up until retirement. Conclusion: policy change must be approached to reimbursement of smoking cessation aid in the Jordanian formulary.

Effectiveness of an mHealth App as an add-on for Smoking Cessation in One year: A multicenter and randomized Trial (The MASCOT study)

Introduction: Smoking accounts for 480,000 deaths per year in the United States. Traditional pharmacotherapeutic interventions for smoking cessation continue to fail, urging the implementation of new therapies to prevent further harm. Mobile Health apps have appeared to support smoking cessation; their low cost, wide availability, absence of side effects, and drug-to-drug interaction make them useful adjuncts in some populations. Despite promising results, only a small number of smoking cessation apps have been formally researched as an add-on therapy. Therefore, we hypothesize that using a mobile health app (PIVOT) as an add-on to the current standard therapy (varenicline plus cognitive-behavioral therapy) could increase the smoking cessation rate. Methods: We propose a Phase III, multicenter, randomized, parallel-group, open-label, superiority trial. The control group will receive varenicline 1mg/daily for 3 months plus 10 sessions of cognitive-behavioral therapies. The intervention group will receive the same treatment plus the addition of the PIVOT® app for one year. Participants will be 21 to 60 years old who meet the Tobacco Use Disorder criteria. The primary outcome will be smoking abstinence at 1 year of follow-up. Secondary outcomes will be lapses and relapses, cotinine hair drug testing at the end of follow-up, and the impact on Quality of Life measured through the WHO Quality of Life Scale-Brief questionnaire.  Discussion: mobile Health Apps are widely available and extensively used by smokers to aid smoking cessation; however, their effectiveness as an add-on is unproven. This study will provide evidence on this matter to advise future clinical practice guidelines and decrease the morbidity and mortality attributable to tobacco use.

Online platforms' framing around vaping.

In this paper, we provide a descriptive overview of how vaping is framed differently between various online platforms (Wikipedia, Quora, Medium, Reddit, Stack Exchange, wikiHow, Facebook, and online news media). We provide an overview of >1 million posts and news articles about vaping to study the differences in framing between online platforms. Findings indicate an inconsistent framing around vaping across platforms. Stakeholders may utilize our findings to intervene around the framing of vaping and may design communications campaigns that improve the way society sees vaping, possibly aiding smoking cessation and reducing youth vaping.

Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation

ObjectivesFinancial incentives are recommended by the UK’s National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact...

Effects of bupropion on sign- and goal-tracking in male Sprague Dawley rats

Relapse into addiction is often triggered by cues that have a Pavlovian association with drugs and drug-taking. Sign-tracking involves approach of and interaction with Pavlovian conditioned signals for appetitive events (as opposed to goal-tracking, which involves approach of the site of the appetitive events themselves) and may be important in understanding cue-driven relapse. Bupropion is an atypical antidepressant and smoking cessation aid with effects on dopamine and norepinephrine that may have some utility in reducing sign-tracking. Male Sprague-Dawley rats were trained in a task where sign- and goal-tracking were possible and then administered doses of bupropion during a test phase. Bupropion decreased measures of sign-tracking and increased goal-tracking. This suggests that bupropion might be a useful adjunct medication for many kinds of behavioral disorders in which cue-driven behavior is problematic.

Method Development and Validation of a Novel Anti-Depressant Bupropion by RP-HPLC

Bupropion is an atypical antidepressant and smoking cessation aid. The drug is a non-tricyclic antidepressant and differs from most commonly prescribed antidepressants such as SSRIs, as its primary pharmacological action is thought to benorepinephrine-dopamine reuptake inhibition. A new sensitive and rapid HPLC method was developed for the determination of buproprion in bulk and pharmaceutical dosage forms; it was validated according to ICH and FDA guidelines. The HPLC analysis was performed on the Alliance Waters e2695 Separations Module system equipped with a Waters X – Bridge C-18 5µm, 4.6 X 150 mm column 5, with a mixture of Acetonitrile: Ammonium bicarbonate (5mM) pH-9 adjusted with 1% Ammonium hydroxide (50:50, %v/v). Flow rate was 1 ml/min quantification was done by PDA detector at 254nm. The proposed method showed linearity in the concentration range of 50 to 250 ppm for Bupropion. The linear regression equation of Bupropion was found to be y = 6E+06x + 91344 and correlation coefficient value was found to be 0.997 indicating a high degree of linearity for the drug. The proposed method was stable except the basic condition during analysis. The stability of the analyte solution was determined at interval of 1st, 2nd, 3nd, 4th and 5th day.
 The low values of %recovery and %C.V. showed that the method is precise within the acceptance limit of 5% (according to ICH guidelines).The limit of detection (LOD) of Bupropion was 0.5 ppm and limit of quantification (LOQ) was 2.0 ppm respectively. The proposed method showed excellent linearity, accuracy, precision, specificity, robustness, LOD, LOQ, and system suitability results within the acceptance criteria.

Varenicline serves as the training stimulus in the drug-discriminated goal-tracking task with rats: initial evaluation of potential neuropharmacological processes.

Varenicline (Chantix) is an FDA-approved smoking cessation aid that is pharmacologically similar to nicotine, the primary addictive component found within tobacco. In support of this similarity, previous drug discrimination research in rats has reported that the internal or interoceptive stimulus effects of nicotine and varenicline share stimulus elements. Those shared elements appear to be mediated, in part, by overlapping action at alpha4beta2-containing nicotinic acetylcholine receptors (nAChRs). The research supporting this conclusion, however, has only used nicotine, and not varenicline, as the training drug. Accordingly, we used the discriminated goal tracking (DGT) task in which 1 mg/kg varenicline signaled intermittent access to sucrose. On separate intermixed saline days, sucrose was not available. Rats acquired the discrimination as measured by a differential increase in dipper entries (goal tracking) evoked by varenicline. These rats then received a series of tests with several doses of varenicline, nicotine, nornicotine (a metabolite of nicotine and tobacco alkaloid), sazetidine-A (a partial alpha4beta2 agonist), PHA-543613 (an alpha7 agonist), and bupropion (a norepinephrine and dopamine reuptake inhibitor). Control of goal tracking by varenicline was dose-dependent. Nicotine and nornicotine evoked responding comparable to the varenicline training dose indicating full substitution. Sazetidine-A partially substituted for the varenicline stimulus, whereas bupropion and PHA-543613 evoked little to no varenicline-like responding. These findings indicate that varenicline can serve as the training stimulus in the DGT task. Further, stimulus control of varenicline in the DGT task is driven by its partial agonist activity at alpha4beta2-containing nAChRs. The use of this approach could lead to a better understanding of the pharmacological action of varenicline and help guide treatment geared towards tobacco cessation through a more targeted development of novel synthetically designed, subunit-specific pharmacological interventions.

Understanding addiction in e-cigarette users – the EVAPE project

Abstract Background Electronic cigarettes (e-cigarettes) are often advertised as a healthier option to combustible cigarettes and as smoking cessation aid. However, e-cigarettes are a growing health concern and their addictive potential remains to be fully understood. Within the EValuation of the Addictive Potential of E-cigarettes (EVAPE) project, we studied subjective and objective measures of addiction in relation to e-cigarette use. Methods This cross-sectional analysis was based on 832 participants of the first wave (2016) of England from the ITC Four Country Smoking and Vaping (4CV) Survey, who were using e-cigarettes daily or weekly for at least four months. Perceived addiction to e-cigarettes was categorised as very vs. not/somewhat addicted, and perceived addictiveness of e-cigarettes relative to combustible cigarettes as equally/more addictive vs. less addictive. Objective measures of addiction included urge to vape, time to first vape after waking, frequency of use, and used nicotine strength. We examined associations between these objective and subjective measures of addiction using multivariate logistic regression, adjusted for age, gender, education, and cigarette smoking. Results 17.8% of participants reported feeling very addicted to e-cigarettes and 42.3% considered e-cigarettes equally/more addictive than combustible cigarettes. Those who felt very addicted had higher odds of regarding e-cigarettes as more addictive (OR 3.43 (95%-CI 2.29-5.19)). All objective measures of addiction were associated with higher perceived addiction, whereas only a shorter time to first vape was associated with perceived product addictiveness. Conclusions Subjective measures of addiction to e-cigarettes, in particular perceived addiction, correspond with objective measures. Understanding the addictive potential of e-cigarettes is the cornerstone for developing new strategies for prevention and treatment, and ultimately understanding their role from a public health perspective. Key messages

An Analysis of Arguments Advanced via Twitter in an Advocacy Campaign to Promote Electronic Nicotine Delivery Systems.

Advocates of electronic nicotine delivery systems (ENDS) increasingly use Twitter to promote liberal ENDS policies. "World Vape Day" (WVD) is an annual campaign organized by pro-ENDS advocacy groups, some of which have links to the nicotine industry (eg, via funding from the "Foundation for a Smoke-Free World"). In 2020, the campaign used dedicated social media accounts to disseminate WVD-branded images and campaign messages. We examined tweets posted as part of WVD 2020 to identify and analyze pro-ENDS policy arguments. We extracted tweets posted between 26 May and 3 June 2020 that included the hashtag #WorldVapeDay. We used qualitative thematic analysis to code a random sample (n = 2200) of approximately half the original English language tweets (n = 4387) and used descriptive analysis to identify the most frequently used co-hashtags. Arguments related to four themes: harm reduction, smoking cessation, rights and justice, and opposition to ENDS restrictions. Tweets criticized individuals and groups perceived as opposing liberal ENDS regulation, and used personal testimonials to frame ENDS as a harm reduction tool and life-saving smoking cessation aid. Tweets also advanced rights-based arguments, such as privileging adults' rights over children's rights, and calling for greater recognition of consumers' voices. Tweets frequently used hashtags associated with the WHO and World No Tobacco Day (WNTD). The WVD campaign presented a series of linked pro-ENDS arguments seemingly aimed at policy-makers, and strategically integrated with the WHO's WNTD campaign. Critically assessing pro-ENDS arguments and the campaigns used to promote these is vital to helping policy actors develop proportionate ENDS policy. Social media platforms have considerable potential to influence policy actors. Tweets are easily generated and duplicated, creating an impression of sizeable and influential stakeholders. Evidence that the "World Vape Day" campaign was supported by groups with industry links, and targeted-at least in part-at WHO officials and those who follow the WHO World No Tobacco Day campaign, highlights the importance of critically reviewing such campaigns. Further research could examine how health advocates could engage in pro-ENDS campaigns to support balanced messaging and informed policy-making.

Barriers Against and Motivations for Quitting Smoking during the COVID-19 Health Crisis: Results of a Qualitative Study in France.

The COVID-19 epidemic and its psychological, economic and social consequences could have an impact on the evolution of tobacco-smoking prevalence and attitudes towards quitting. The aim of this study is to analyse the specific characteristics of the motivations for and barriers against smoking cessation in this period. The study is based on qualitative data collected from late 2020 to early 2021 in France from 89 smokers with a low or intermediate socio-economic level. Among the motivations for quitting smoking, health concerns and the financial cost of cigarettes carried increased importance among the smokers in this period. Inversely, perceived stress, isolation, and a lack of social or healthcare support prevented some smokers from attempting to quit. These results are useful for explaining the evolution of smoking prevalence and preparing future interventions in the context of the health crisis and its aftermath. They highlight the relevance of educational messages, of the promotion of validated smoking-cessation aids and, in particular, remote support, as well as the implementation of community-based actions.

Electronic Cigarettes: A Narrative Review and Cohort Study of Electronic Cigarette Users in the Otolaryngology Clinic.

Electronic nicotine delivery systems (ENDSs) are growing in popularity, particularly in young adults. While in vitro and murine models have demonstrated potentially harmful health effects of ENDSs, long-term health effects and clinical outcomes are generally unknown. Use as a smoking cessation aid is propagated by studies of potential harm reduction compared to conventional cigarette smoking. We present a review of the current controversies of ENDS use and present a novel cohort of patients visiting the otolaryngology clinic with known ENDS use to understand their clinical and demographic characteristics and the prevalence of otolaryngologic inflammatory diagnoses. Eighty-eight patients had 105 diagnoses. Forty-three (48.9%) ENDS users had at least 1 inflammatory diagnosis. ENDS use was more common in White, male patients between the ages of 18 and 35 years. The most common inflammatory diagnoses were chronic otitis media (17.4%) and allergic rhinitis (13.0%). While the rate of inflammatory disease was significantly higher in male than in female patients (60.7% vs 28.1% p = 0.003), no significant association was seen between inflammatory disease and age, race/ethnicity, or length of ENDS use. The identification and description of patients with ENDS use will help clinicians' better risk-stratify otolaryngologic diagnoses associated with this novel health behavior. Additionally, further clinical research is necessary to elucidate long-term health outcomes of ENDS use.

Indigenous Smoking Behaviors in Olmsted County, Minnesota: A Longitudinal Population-Based Study

To describe smoking behaviors and pharmaceutical cessation aid uptake in a population-based Indigenous cohort compared with an age- and sex-matched non-Indigenous cohort. Using the health record-linkage system of the Rochester Epidemiology Project (January 1, 2006, to December 31, 2019), smoking data of Indigenous residents of Olmsted County in Minnesota were abstracted to define the smoking prevalence, incidence, cessation, relapse after cessation, and pharmaceutical smoking cessation aid uptake compared with a matched non-Indigenous cohort. Prevalence was analyzed with a modified Poisson regression; cessation and relapse were evaluated with generalized estimating equations. Incidence was evaluated with a Cox proportional hazards model. Smoking prevalence was higher in the Indigenous cohort (39.0% to 47.0%; n=898) than the matched cohort (25.6% to 30.3%; n=1780). Pharmaceutical uptake was higher among the Indigenous cohort (35.8% of n=584 ever smokers vs 16.3% of n=778 ever smokers; P<.001). Smoking cessation events occurred more frequently in the Indigenouscohort (relative risk, 1.10; 95% CI, 1.06 to 1.13; P<.001). Indigenous former smokers were more likely to resume smoking (relative risk, 3.03; 95% CI, 2.93 to 3.14; P<.001) compared with the matched cohort. These findings were independent of socioeconomic status, age, and sex. Smoking in this Indigenous cohort was more prevalent compared with a sex- and age-matched non-Indigenous cohort despite more smoking cessation events and higher use of smoking cessation aids in the Indigenous cohort. The relapse rate after achieving cessation in the Indigenous cohort was more than three times higher than the non-Indigenous cohort. This finding has not been previously described and represents a potential target for relapse prevention efforts in US Indigenous populations.

A novel stress-based intervention reduces cigarette use in non-treatment seeking smokers

Tobacco use is the leading cause of preventable mortality worldwide. Since current smoking cessation aids show only modest efficacy, new interventions are needed. Given the evidence that stress is a potent trigger for smoking, the present randomized clinical trial tested whether stress could augment the effects of a memory updating (retrieval-extinction) intervention. Non-treatment seeking smokers (n = 76) were assigned to one of four conditions composed of either a stressful or non-stressful psychosocial challenge followed by either smoking or neutral cues. Ten minutes after this manipulation, all underwent a 60-minute extinction procedure during which they viewed smoking-related videos and images and manipulated smoking paraphernalia. Compared to participants who were not exposed to the laboratory stressor, the stressor-exposed groups exhibited greater psychophysiological responses during their intervention and greater decreases in cigarette use at two- and six-weeks follow-up independent of smoking cue exposure. Together, these findings suggest that the ability of stress to activate cigarette seeking processes can be exploited to decrease cigarette use. With replication, the stress-based intervention could become a novel strategy for decreasing cigarette use in non-treatment seeking smokers.Clinicaltrials.gov identifier: NCT04843969.

Combining default choices and an encounter decision aid to improve tobacco cessation in primary care patients: protocol for a cluster-randomized trial

BackgroundWhile quitting smoking dramatically decreases overall mortality, general practitioners (GPs) are less likely to prescribe medications for smoking cessation than other cardiovascular risk factors. Guidelines recommend providers first assess patients’ “readiness” to quit, an “opt-in” strategy, but only a minority of tobacco users are ready to quit on a given day. An “opt-out” strategy offering treatment as the default choice increased quit attempts in hospital and with pregnant women, but has not been tested in primary care. We will assess the efficacy of training GPs to offer treatment as the default choice using an encounter decision aid with current smokers seen in primary care.MethodsThis is a pragmatic cluster-randomized controlled superiority trial with block randomization at the GP level in private practice in French-speaking Switzerland. GPs will be blinded to the arm allocation. The intervention is a half-day training course teaching an ‘opt-out’ approach to smoking cessation using an encounter decision aid (paper or electronic). GPs in the enhanced usual care group receives a brief refresher training about smoking cessation without changing their behaviour. GPs in both arms will recruit 23 patients each prior to routine primary care visits. The primary outcome is the effect of consulting a GP who received the intervention on the 7-day, point prevalence, smoking abstinence 6 months after the baseline appointment. Secondary outcomes include continuous abstinence; number of quit attempts; use of smoking cessation aids; patient-perceived involvement in discussions; and changes in GP behaviour. Patient outcomes will be collected using paper and telephone questionnaires. Assuming 15% drop-out, recruiting 46 GPs with 23 patients each will give us 80% power to detect an increase in smoking cessation from 4% (control) to 10.5% (intervention), with an alpha < 0.05.DiscussionGP visits are an opportunity to administer proven smoking cessation treatments. We hypothesize GPs offering smoking cessation treatment as the default choice using an encounter decision aid will increase the number of patients who quit. This study could significantly change our approach to smoking cessation in primary care. Default choices and the electronic decision aid are low-cost, easily diffusible interventions.Trial registrationClinicalTrials.gov Identifier: NCT04868474, First Posted May 3, 2021, Last Update Posted October 6, 2021.