Assess Tobacco Use Research Articles

Intérêt d’une offre systématique d’aide au sevrage chez des fumeurs hospitalisés en service de soins intensifs en cardiologie

Aim of the study To offer routine information on smoking cessation and bedside counseling to smokers admitted in cardiac intensive care unit. The objective is to encourage cessation and/or use of smoking cessation services after discharge. Population and methods Thirty-three smokers were admitted in cardiac intensive care unit at the Georges Pompidou European hospital (HEGP) in Paris (France) from 1st March to June 30th 2010. Assessment of tobacco use and offer of counseling and follow-up visits during and after hospital stay. Evaluation of tobacco use by telephone at least six months after discharge. Results It was found that 30.3% of the patients stopped smoking, mostly without specialized help despite heavy smoking prior to hospitalization. They declared being impressed by their hospital stay. Motives for smoking among continuing smokers were mostly automatic smoking and stress relief. They had declined any smoking aid, despite subsequent hospital stays in cardiac intensive care. Three smokers with a severe profile had died at follow-up. Smokers followed-up at HEGP were in need of nicotine replacement therapy. More than six months after hospital discharge, nearly all smokers remembered being offered bedside counseling to stop smoking. Conclusion This experience reveals the importance of routine bedside counseling for smoking cessation in cardiac intensive care unit. Smokers in this unit often continue smoking even though smoking hinders cardiac rehabilitation.

Toward the identification of communities with increased tobacco-associated cancer burden: Application of spatial modeling techniques

Introduction:Smoking-attributable risks for lung, esophageal, and head and neck (H/N) cancers range from 54% to 90%. Identifying areas with higher than average cancer risk and smoking rates, then targeting those areas for intervention, is one approach to more rapidly lower the overall tobacco disease burden in a given state. Our research team used spatial modeling techniques to identify areas in Florida with higher than expected tobacco-associated cancer incidence clusters.Materials and Methods:Geocoded tobacco-associated incident cancer data from 1998 to 2002 from the Florida Cancer Data System were used. Tobacco-associated cancers included lung, esophageal, and H/N cancers. SaTScan was used to identify geographic areas that had statistically significant (P<0.10) excess age-adjusted rates of tobacco-associated cancers. The Poisson-based spatial scan statistic was used. Phi correlation coefficients were computed to examine associations among block groups with/without overlapping cancer clusters. The logistic regression was used to assess associations between county-level smoking prevalence rates and being diagnosed within versus outside a cancer cluster. Community-level smoking rates were obtained from the 2002 Florida Behavioral Risk Factor Surveillance System (BRFSS). Analyses were repeated using 2007 BRFSS to examine the consistency of associations.Results:Lung cancer clusters were geographically larger for both squamous cell and adenocarcinoma cases in Florida from 1998 to 2002, than esophageal or H/N clusters. There were very few squamous cell and adenocarcinoma esophageal cancer clusters. H/N cancer mapping showed some squamous cell and a very small amount of adenocarcinoma cancer clusters. Phi correlations were generally weak to moderate in strength. The odds of having an invasive lung cancer cluster increased by 12% per increase in the county-level smoking rate. Results were inconsistent for esophageal and H/N cancers, with some inverse associations. 2007 BRFSS data also showed a similar results pattern.Conclusions:Spatial analysis identified many nonoverlapping areas of high risk across both cancer and histological subtypes. Attempts to correlate county-level smoking rates with cancer cluster membership yielded consistent results only for lung cancer. However, spatial analyses may be most useful when examining incident clusters where several tobacco-associated cancer clusters overlap. Focusing on overlapping cancer clusters may help investigators identify priority areas for further screening, detailed assessments of tobacco use, and/or prevention and cessation interventions to decrease risk.

Awareness and Implementation of the 2000 United States Public Health Service Tobacco Dependence Treatment Guideline in a Public Hospital System

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.

Tobacco use among the elderly: a systematic review and meta-analysis.

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

Autoeficacia e intención conductual del consumo de tabaco en adolescentes: validez factorial y relación estructural

The objective of this research was to obtain, in a structural equation model, the factorial validity of smoking-related self-efficacy, as well as its structural association with behavior and smoking intention. The sample was made up of 1012 young people aged 14 to 22 (mean 16.76) from public high schools in Mexico City. These young people filled out a questionnaire that assessed tobacco use (current smokers' age at first cigarette, smoking frequency and quantity of cigarettes smoked). They were also asked about intention to smoke in the future. Self-efficacy was assessed using items that measured one's capacity to avoid smoking. The results indicated the factorial validity of the smoking-related self-efficacy measure in this sample. Structural equation modeling analyses suggested (X²= 113.319, p<.001; CFI= .99; NFI= .99; GFI= .95; RMSEA= .05) that those young people with lower confidence in their ability to avoid smoking would have higher levels of smoking intention and smoking behavior; moreover, intention to smoke in the future predicts level of smoking. The discussion analyzes the utility of the results for the assessment of self-efficacy, as well as the clinical implications for the people in treatment.

Assessing the utility of targeted outreach to intervene with 18 to 24 year old non-treatment seeking tobacco users

Objective: This pilot study assessed the utility of a targeted outreach approach to intervene with non-treatment seeking 18 to 24 year old tobacco users to quit smoking.Methods: A total of 184 tobacco users were recruited from community settings and completed a structured interview assessing tobacco use patterns. Interest in quitting tobacco was measured with an analog scale (1 = none to 10 = highest). Participants (N = 145) who reported any interest (2 or greater) in quitting were provided a brief tobacco intervention.Results: Overall 78/145 (54%) completed a 6 month follow-up of which 14 (17.9%) reported no tobacco use in the past 30 days. Also, a service utilization assessment found that 19.2% used a Nicotine Replacement Therapy (NRT) and 19.2% enrolled in a tobacco cessation program during the past 6 months.Conclusions: The pilot targeted outreach program is an acceptable public health technique to recruit non-treatment seeking tobacco users and help them to quit smoking and engage in cessation services.

PC-FACS

PC-FACS

Longitudinal self-reported and serum-based assessment of tobacco or nicotine use in head and neck cancer patients during definitive radiotherapy or chemoradiotherapy.

1594 Background: Tobacco use during cancer treatment is associated with a poor prognosis, but tobacco or nicotine use (TNU) assessment in cancer treatment patients is poorly characterized. Methods: Patients with measurable squamous cell carcinoma of the head and neck (HNSCC) treated with definitive radiotherapy (RT) or chemoradiotherapy (CRT) were eligible for enrollment. Entry and weekly self-reported TNU was measured in combination with objective serum cotinine (SC, an established quantitative measure of TNU). Results: At interim analysis, 50 patients are enrolled and SC assessments are complete for 37 patients. Of 37 patients, 81% are male (median age at diagnosis 53, range 39-75), 68% have oropharyngeal tumors, 84% are node positive, 81% presented at stage III-IVB, and 89% were treated with CRT. Any tobacco use was reported in 78% (median pack-year history of 32.5, range 3-138). Successful tobacco cessation was reported in 54% with 1-3 years median duration (range 2 wks to 40 yrs). At diagnosis, 30% of patients reported TNU; however, 41% of patients were SC positive at some time throughout RT or CRT. Of 30% of patients reporting second-hand smoke (SHS) exposure, 45% denied TNU at study entry. Of 19% of patients reporting social help with cessation, 71% reported that a friend or family helped and only 29% reported that doctors helped. SC values varied widely in individual patients over the course of RT or CRT. Of 41% of SC positive patients, 93% were SC positive at study entry, 73% at mid-treatment (week 4), and 53% during the final week of treatment. Conclusions: Data demonstrate that most HNSCC patients presenting with TNU at the beginning of RT or CRT continue TNU throughout treatment. Multiple TNU and SHS assessments are necessary to accurately characterize TNU during cancer treatment and the effects on clinical outcome. No significant financial relationships to disclose.

Biological models for studying and assessing tobacco use.

The purpose of this chapter on biological models for studying and assessing tobacco use is to provide an introduction to some of the common concepts and biomarkers in this arena to ultimately inform intervention research by nurse scientists. An overview of selected biomarkers of tobacco exposure in individuals includes exhaled carbon monoxide, cotinine (the proximate metabolite of nicotine), and measurement of an individual's puffing pattern termed smoking topography. Common tobacco contents discussed include tobacco specific nitrosamines (TSNA) and polycyclic aromatic hydrocarbons (PAH) some of which increase disease risk including cancer. Exemplars of additives to cigarettes by the tobacco industry will be described including menthol, one additive marketed by the industry. Genetics and tobacco addiction has emerged as a rapidly expanding field. Illustrative of this area are twin studies, nicotinic receptors, CYP2A6 polymorphisms, and genes that impact dopamine receptors. The cadre of nurse scientists conducting research in this much needed area is small. The opportunity for nurse scientists educated in biological inquiry in tobacco-related research is great. Nurse scientists actively involved in multidisciplinary translational teams to address nicotine addition are needed.

A review of the US Public Health Service–sponsored Clinical Guideline: Treating Tobacco Use and Dependence: 2008 Update

Tobacco dependence is a chronic disease that deserves treatment. Effective strategies have now been identified and should be used with every current and former smoker. The Quick Reference Guide for Clinicians provides point of care access and the tools necessary to effectively identify and assess tobacco use, and to treat tobacco users willing to quit; those who are currently unwilling to quit; and those who are former tobacco users. The experience of the past four decades has culminated in a transformed culture that maintains as its social norm a plethora of public, private and nonprofit venues of anti-tobacco infrastructure. Moreover, there is likely no clinical treatment available today that has the potential to reduce illness, prevent death, and increase quality of life more profoundly than the tobacco treatment interventions outlined in the US Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence.

Who's assessing tobacco use in cancer clinical trials?

Clinical trials that do not collect data on tobacco use/exposure may not adequately assess the efficacy and effectiveness of experimental treatments. A cross-sectional study of interventional trials cited on ClinicalTrials.gov was undertaken that inquired of Local Project Directors from Connecticut guiding studies of breast, prostate, or colorectal cancer chemotherapy (N = 68) whether their protocols measured tobacco use by trial participants. Information pertaining to 46 trials (68%) is reported here. All but 1 were multicentered trials enrolling patients around the country. Only 3 trials (7%) reported routine collection of tobacco use information at baseline and no trial reported monitoring tobacco use during treatment follow-up. None of the 3 trials collecting tobacco data reported using exposure information in analysis of treatment effects. Survey respondents suggested that uncertainty about the relevance of tobacco exposure to therapeutic efficacy, ambivalence about how to incorporate such data into analyses, insufficient resources for collecting such information, and uncertainty about the validity of assessment methods might be reasons why tobacco use is not routinely assessed. Additional studies that address a fuller range of cancers, therapies, disease states, and clinical environments are needed to fully define the extent of this data lapse. Providing clinicians and trialists with appropriate tools for tobacco use assessment and encouraging them to collect such information about patients during treatment and follow-up may offer a simple cost-effective way to improve the quality and consequences of cancer care for every patient.

Is the Fagerström Test for Nicotine Dependence a good instrument to assess tobacco use in patients with schizophrenia?

Although the FTQ is considered to be adequate to assess nicotine dependence due to its extensive use, it suffers from significant psychometric shortcomings, such as low internal consistency and poor criterion validity. To address these problems, the Fagerstrom Test for Nicotine Dependence (FTND) was developed.

Implementing a Tobacco Assisted Referral Program in Dental Practices

The objectives of this study are to design and implement a system-level tobacco-control intervention in a large prepaid dental group practice and assess effects on staff performance measures and patient satisfaction. We matched 14 dental facilities on size, socioeconomic status, smoking rate, and periodontal status, and then randomly assigned them to intervention or usual-care control. We trained intervention staff in an "Assisted Referral" team approach for assessing tobacco use, providing tailored advice and brief counseling, and encouraging smokers to talk by telephone with a specially trained tobacco counselor. Patients could call from the office or ask that the counselor call them later. Telephone counselors helped patients explore motivations and barriers for quitting; review available cessation-support strategies, programs, and medications; and identify next steps. During the 14-month study period, 66,516 members had annual- or new-patient examinations. Both intervention and control sites had high rates of tobacco assessment (97 percent) and advice (93 percent). Intervention patients were more likely than controls (69 percent versus 3 percent, P < 0.01) to receive additional chair-side tobacco counseling and assistance, and 11 percent agreed to receive additional telephone counseling. Intervention patients were more satisfied than controls with the dental team's tobacco-control efforts (P < 0.03). Referral rates varied substantially for different staff. The Assisted Referral approach was successfully integrated into routine dental care, was well received by patients, and resulted in increased patient satisfaction. Because free telephone-based tobacco counseling is now available nationwide, the approach may be a practical strategy for most dental-care settings.

Association of tobacco dependence and quit attempt duration with Rasch‐modeled withdrawal sensitivity using retrospective measures

To examine whether Rasch modeling would yield a unidimensional withdrawal sensitivity measure correlating with factors associated with successful smoking cessation. The psychometric Rasch modeling approach was applied to estimate an underlying latent construct (withdrawal sensitivity) in retrospective responses from 1644 smokers who reported quitting for 3 or more months at least once. Web-based, passcode-controlled self-administered computerized questionnaire. Randomly selected convenience sample of 1644 adult members of an e-mail invitation-only web panel drawn from consumer databases. Lifetime Tobacco Use Questionnaire, assessing tobacco use across the life-span, including demographics and respondent ratings of the severity of withdrawal symptoms experienced in respondents' first and most recent quit attempts lasting 3 or more months. Rasch-modeled withdrawal sensitivity was generally unidimensional and was associated with longer periods of smoking cessation. One latent variable accounted for 74% of the variability in symptom scores. Rasch modeling with a single latent factor fitted withdrawal symptoms well, except for increased appetite, for which the fit was marginal. Demographic variables of education, gender and ethnicity were not related to changes in sensitivity. Correlates of greater withdrawal sensitivity in cessation attempts of at least 3 months included younger age at first quit attempt and indicators of tobacco dependence. The relationship between tobacco dependence symptoms and Rasch-model withdrawal sensitivity defines further the relationship between sensitivity and dependence. The findings demonstrate the utility of modeling to create an individual-specific sensitivity measure as a tool for exploring the relationships among sensitivity, dependence and cessation.

Smoking Among HIV Positive New Yorkers: Prevalence, Frequency, and Opportunities for Cessation

Tobacco use presents unique health risks for persons living with HIV/AIDS (PLWHA). There is an urgent need to characterize tobacco use among PLWHA, and to assess the capacity of HIV/AIDS service providers to deliver smoking cessation interventions. Questionnaires were administered to PLWHA in care in New York State (n = 1,094) and to State-funded HIV/AIDS service providers (n = 173) from 2005 to 2007. Current PLWHA smoking prevalence was 59%, three times the general population rate. Over 50% of current smokers were moderately or highly dependent on nicotine. Three-quarters of smokers indicated an interest in quitting, and 64% reported a least one quit attempt during the past year. Less than half of HIV/AIDS service providers reported always assessing tobacco use status, history, dependence, or interest in quitting at intake. Medical care providers were more likely to conduct assessments and provide services. Although 94% of providers indicated a willingness to incorporate tobacco cessation services, 65% perceived client resistance as a barrier to services. HIV/AIDS service providers are inadequately addressing the high smoking rate among PLWHA, despite being uniquely suited to do so. Efforts are needed to educate providers about the need for, and interest in, tobacco cessation.

The Influence of Tobacco on Early Dental Implant Failure

The purpose of this study was to assess tobacco use as a risk factor for early implant failure. To address the research aim, a retrospective study design was used, and a study sample was derived from among patients who had 1 or more implants inserted between July 1996 and July 2004. The main predictor variable was the frequency of tobacco use. The major outcome variable was early implant failure. Appropriate descriptive, bivariate, and multivariate statistics were computed. The study sample was composed of 650 patients who had 1,628 implants inserted and were selected for analysis. The early implant loss rates found in the nonsmoking group and the smoking group were 3.32% and 2.81%, respectively. Univariate and bivariate analyses showed no statistical significance for early implant losses associated with the frequency of tobacco use. The results of this study suggest that tobacco use alone cannot be considered as a factor for risk related to early implant failures. Prospective studies are needed to assess the risk of early implant failure in conjunction with smoking.

Variability of Healthcare Practitioner Intervention Among 18- to 24-Year-Old Tobacco Users

A survey of 184 young, rural, tobacco users found that healthcare professionals often assessed tobacco use, although there was significant variability by professional type (physician vs. dentist) and tobacco service (advise vs. referral). Females reported significantly higher levels of receiving tobacco services (advice to quit) than males.

Reliability of adult retrospective recall of lifetime tobacco use

Retrospective assessment of tobacco use underlies much of the data collected in epidemiological and genetic epidemiological research. Although individuals are asked to report lifetime tobacco use for periods spanning months to decades, the test-retest reliability intervals of the instruments often span only a few weeks to several months. The present analyses examined the test-retest reliability of retrospective tobacco use measures, including details of first use, circumstances of first use, and initial subjective reactions. The questions were part of the Lifetime Tobacco Use Questionnaire (LTUQ), a Web-based questionnaire designed to assess use of most forms of tobacco or nicotine retrospectively across the lifespan. A convenience sample of 236 men and women with history of tobacco use (Time 1 mean age, 44.9 years; 74.2% females; 75.1% regular monthly tobacco use) responded verifiably to invitations to self-administer the LTUQ two times, 2 years apart. Test-retest reliability analyses reflected high reliability for salient tobacco-use questions. Acceptable levels of reliability were observed for initial subjective reactions to smoking, if the scaled response options were dichotomized. Few differences in the reliability of recall were apparent between sexes and between age groups. These results indicate that recall of important tobacco use information can form a reliable basis for research.

The development of tobacco use in adolescence among "snus starters" and "cigarette starters": An analysis of the Swedish "BROMS" cohort

Whether the use of smokeless tobacco can facilitate the transition to cigarette smoking and/or to prolonged tobacco use in adolescence is unclear. We analyzed data from a cohort of 2,938 Swedish adolescents, with six follow-up assessments of tobacco use between the ages of 11 and 18 years. The majority of tobacco users (70%) started by smoking cigarettes, 11% took up snus before smoking, and 19% used both tobacco types close in time. Ever users of tobacco at baseline had a higher risk of being current smokers and/or smokeless tobacco users at the end of follow-up compared with never users, with the highest excess relative risk for "mixed users." Adolescents who initiated tobacco use with cigarettes had a non-significantly increased probability to end up as current smokers compared with snus starters (adjusted OR=1.42; 95% CI 0.98-2.10) The OR of smoking for "mixed starters" was 2.54 (95% CI 1.68-3.91). The risk of becoming current user of any tobacco was also significantly enhanced for "mixed starters." Marked sex differences were observed in these associations, as initiation with cigarettes rather than with snus predicted current smoking or tobacco use only among females. Progression of tobacco use in adolescence is not predicted by onset with snus or cigarettes, but rather by initiation with both tobacco types close in time and/or at young age. The proportion of adolescent smoking prevalence attributable to a potential induction effect of snus is likely small.

The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline

Objectives:State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with...