Behavioral Smoking Cessation Treatment Research Articles

Safety and pharmacokinetics of oxycodone DETERx administered intranasally in recreational opioid users

s / Drug and Alcohol Dependence 146 (2015) e118–e201 e163 middle school students described parental disapproval as a deterrent, high school students also cited friend disapproval as deterring use. Across all groups, thosewhohad not tried e-cigs described lack of “coolness” as an additional deterrent. Conclusions: This qualitative study indicated several reasons why youth initiated, abstained from and discontinued e-cigarettes. While there were some common themes across groups, different themes also emerged across the age groups. Understanding these factors may inform e-cig prevention messages. Financial Support: This work was supported by the National Institute on Drug Abuse grant P50DA009241. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.359 Safety and pharmacokinetics of oxycodone DETERx administered intranasally in recreational opioid users A. Kopecky1, Alison B. Fleming1, Patrick K. Noonan2 1 Collegium Pharmaceutical, Inc., Canton, MA, United States 2 PK Noonan Pharmaceutical Consulting, LLC, Williamsburg, VA, United States Aims: Oxycodone DETERx is a multi-particulate, abusedeterrent formulation designed to retain ER properties following common methods of tampering. The purpose of this study was to assess the safety and the pharmacokinetics (PK) of crushed DETERx capsule contents administered IN (DETERx IN) compared with 2 control treatments: immediate-release (IR) oxycodone powder administered IN (Oxy IN) and intact DETERx capsules administered orally (DETERx PO). Methods: Open-label, randomized, naltrexone-blocked, 3treatment, 3-period, crossover comparison study. Safety and PK of 40mg doses of DETERx IN, Oxy IN, and DETERx PO were compared innondependent, recreational opioid users experiencedwith IN administration (n=13). DETERx capsule contents were crushed using themost aggressive crushingmethod identified in previously conducted studies. Plasma samples were collected at pre-specified time points and analyzed using a LC–MS/MS method. PK parameters Cmax, AUCINF, TmaxandAbuseQuotient (AQ)were calculated. Safety assessments included treatment-emergent adverse events, vital signs, oxygen saturation and nasal cavity assessments. Results: Cmax LSMean ratio for DETERx IN relative to Oxy IN was 59.0%. Cmax LSMean ratio for DETERx IN relative to DETERx PO was 79.6%. DETERx IN and DETERx PO both had a median Tmax of 5.0h, longer than Oxy IN (3.0h). Oxy IN had the highest AQ value (42.5ng/ml/h); AQ values for DETERx IN and DETERx POwere similar (8.5 and 8.4ng/ml/h, respectively). AUCINF values were similar for all treatments. There weremore spontaneously reported nasalrelated AEs and a greater number of episodes of need to blow nose post insulation of crushed DETERx compared with Oxy. Conclusions: Crushing and snorting DETERx capsule contents produces relatively lower plasma concentrations of oxycodone compared with intact DETERx PO and Oxy IN, indicating that a concentration driven euphoric effect sought by drug abusers may not be achieved. Due to the higher number of nasal-related AEs, abusers may find DETERx less desirable. Financial Support: Collegium Pharmaceutical. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.360 A novel behavioral activation intervention for smoking cessation; mechanisms of change Catalina Kopetz1, Laura MacPherson2, Avery Mitchell 2, Alexandra HoustonLudlam2, Reinout W. Wiers3, Helle Larsen3 1 Psychology, Wayne State University, Detroit, MI, United States 2 Psychology, University of Maryland, College Park, MD, United States 3 Psychology, University of Amsterdam, Amsterdam,

Nursing interventions to promote smoking cessation during pregnancy: An integrative review

Background: Smoking during their pregnancy or even through a portion of the pregnancy put the unborn child at risk for many complications during pregnancy and after delivery. Teaching smoking cessation is vital to women of childbearing age. Smoking cessation provides immediate and long-term benefits for pregnant women and their children. Purpose: The purpose of this study is to describe the degree of variability in the methodological approaches and theoretical frameworks of behavioral intervention for smoking cessation during pregnancy. Methods: The design selected for this research is integrative review. Twenty-four articles were reviewed. The inclusion criteria were: (a) studies published between 2000 and 2013, (b) studies published in the English language, (c) a smoking cessation intervention program that targeted pregnant women, and (d) measurement of smoking status after a smoking cessation intervention was implemented. A data extraction tool developed for the purpose of this study utilizing the frameworks of Cooper (1984), and Stetler and colleagues (1998). Results: Seventy percent of the reviewed studies reported either smoking cessation or a reduction in smoking as a result of participating in a smoking cessation program. The reviewed studies confirmed that smoking cessation interventions should begin at the beginning of pregnancy, as early pregnancy is a peak opportunity for education. It is highly beneficial if the interventions last throughout the woman’s pregnancy to ensure smoking cessation through the duration of the post-partum period. Conclusion: The majority of the reviewed interventions proved to be highly beneficial with the reduction in smoking or smoking cessation. Additional research is needed to evaluate individual treatment modalities using a side-by-side comparison. Normal 0 false false false EN-US X-NONE X-NONE

Hair cortisol as a biomarker of stress in mindfulness training for smokers.

Stress is a well-known predictor of smoking relapse, and cortisol is a primary biomarker of stress. The current pilot study examined changes in levels of cortisol in hair within the context of two time-intensity matched behavioral smoking cessation treatments: mindfulness training for smokers and a cognitive-behavioral comparison group. Eighteen participants were recruited from a larger randomized controlled trial of smoking cessation. Hair samples (3 cm) were obtained 1 month after quit attempt, allowing for a retrospective analysis of hair cortisol at preintervention and post-quit attempt time periods. Self-reported negative affect was also assessed before and after treatment. Both groups received a 7-week intensive intervention using mindfulness or cognitive-behavioral strategies. Cortisol significantly decreased from baseline to 1 month after quit attempt in the entire sample (d=-0.35; p=.005). In subsequent repeated-measures analysis of variance models, time by group and time by quit status interaction effects were not significant. However, post hoc paired t tests yielded significant pre-post effects among those randomly assigned to the mindfulness condition (d=-0.48; p=.018) and in those abstinent at post-test (d=-0.41; p=.004). Decreased hair cortisol correlated with reduced negative affect (r=.60; p=.011). These preliminary findings suggest that smoking cessation intervention is associated with decreased hair cortisol levels and that reduced hair cortisol may be specifically associated with mindfulness training and smoking abstinence. RESULTS support the use of hair cortisol as a novel objective biomarker in future research.

The role of participants’ self-selected future smoking goals in adolescent smoking cessation interventions

BackgroundThere is an implicit assumption that abstinence is the treatment goal of young smokers that deliberately participate in cessation interventions, but this may not always be the case. To gain information on subgroups of adolescent intervention participants, we compare participants who want to achieve smoking abstinence (Abst) with those stating a non-abstinence future smoking goal (NAbst), with regard to baseline characteristics, reasons for participation, quit motivation, retention, goal attainment, and smoking abstinence. MethodsThe sample consisted of 202 adolescent smokers (49.5% female). At baseline, 118 (58.4%) indicated abstinence as future smoking goal and 84 (41.6%) indicated non-abstinence. All participants received a behavioral smoking cessation intervention. Assessments took place before, during, and after treatment, and at 6-month follow-up. Regression analyses were conducted. ResultsAbst and NAbst participants reported similar baseline characteristics. Abst participants, however, were more likely to report a previous quit attempt and indicated a higher quit motivation before and during treatment. Abst participants were more likely to participate based on own initiative and NAbst participants because of participating friends. Both groups attended a similar number of intervention sessions and were equally likely to attain their self-selected smoking goal. However, more Abst participants reported a successful quit attempt during treatment and abstinence at post-treatment and follow-up. ConclusionsNAbst participants may represent a substantial subgroup in smoking cessation interventions for adolescents. Results indicate that future smoking goals can influence treatment outcomes. NAbst participants in treatment may benefit from additional information on the negative health consequences of light smoking.

A preliminary randomized controlled trial of a behavioral exercise intervention for smoking cessation.

Previous exercise intervention studies for smoking cessation have been challenged by a number of methodological limitations that confound the potential efficacy of aerobic exercise for smoking cessation. The preliminary efficacy of a behavioral exercise intervention that incorporated features designed to address prior limitations was tested in a randomized controlled trial (RCT). Sixty-one smokers (65.6% female, mean age = 47.3 years, smoked a mean of 19.7 cigarettes/day) were randomized to receive either a 12-week exercise intervention or a 12-week health education contact control. Participants in both conditions received an 8-week telephone-delivered, standard smoking cessation protocol (with the transdermal nicotine patch). Follow-ups were conducted at the end of treatment (EOT), 6- and 12-month timepoints. There were no differences between conditions with respect to the number of weekly exercise or health education sessions attended (9.3±2.8 vs. 9.3±3.0, respectively). While not statistically significant, participants in the exercise condition demonstrated higher verified abstinence rates (EOT: 40% vs. 22.6%, odds ratio [OR] = 2.28; 6- and 12-month follow-ups: 26.7% vs. 12.9%, OR = 2.46). Irrespective of treatment condition, higher levels of moderate-to-vigorous exercise were associated with lower levels of depressive symptoms during the intervention. The results of this small RCT point toward the benefit of a behavioral exercise intervention designed to address previous methodological limitations for smoking cessation. Given the potential public health impact of the demonstrated efficacy of exercise for smoking cessation, the continued development and optimization of exercise interventions for smokers through larger RCTs merits pursuit.

The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use.

Evidence suggests that smoking may have negative associations with HIV health outcomes. The smoking rate in our sample of people living with HIV (N = 333) was triple that of the general population (57 v. 19 %). Regression analyses revealed that (smokers v. non-smokers) reported lower medication adherence (unstandardized beta = 9.01) and were more likely to have a detectable viral load (OR = 2.85, 95 % CI [1.53-5.30]). Smokers attended fewer routine medical visits (β = -0.16) and were more likely to report recent hospitalization (OR = 1.89, 95 % CI [0.99, 3.57]). Smokers ranked "health" as less important to their quality of life (β = -0.13) and were more likely to report problematic alcohol (OR = 2.40, 95 % CI [1.35, 4.30]), cocaine (OR = 2.87, 95 % CI [1.48-5.58]), heroin (OR = 4.75, 95 % CI [1.01, 22.30]), or marijuana use (OR = 3.08, 95 % CI [1.76-5.38]). Findings underscore the need for integrated behavioral smoking cessation interventions and routine tobacco screenings in HIV primary care.

Prize contingency management for smoking cessation: A randomized trial

BackgroundAdjunctive behavioral smoking cessation treatments have the potential to improve outcomes beyond standard care. The present study had two aims: (1) compare standard care (SC) for smoking (four weeks of brief counseling and monitoring) to SC plus prize-based contingency management (CM), involving the chance to earn prizes on days with demonstrated smoking abstinence (carbon monoxide (CO) ≤6ppm); and (2) compare the relative efficacy of two prize reinforcement schedules—one a traditional CM schedule, and the second an early enhanced CM schedule providing greater reinforcement magnitude in the initial week of treatment but equal overall reinforcement. MethodsParticipants (N=81 nicotine-dependent cigarette smokers) were randomly assigned to one of the three conditions. ResultsPrize CM resulted in significant reductions in cigarette smoking relative to SC. These reductions were not apparent at follow-up. We found no meaningful differences between the traditional and enhanced CM conditions. ConclusionsOur findings reveal that prize CM leads to significant reductions in smoking during treatment relative to a control intervention, but the benefits did not extend long-term.

The Accuracy of a Lower-Cost Breath Carbon Monoxide Meter in Distinguishing Smokers from Non-smokers

Breath carbon monoxide (CO) is a biochemical marker of recent cigarette smoking (see Bittoun, 2008; Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification, 2002). Breath CO correlates well with other established assays of cigarette smoking, such as COHb concentration in blood samples (Hald, Overgaard, & Grau, 2003; Jarvis, Belcher, Vesey, & Hutchison, 1986), and urinary cotinine levels (Marrone, Paulpillai, Evans, Singleton, & Heishman, 2010; Marrone et al., 2011), and has high levels of sensitivity and specificity in distinguishing between cigarette smokers and non-smokers (Javors, Hatch, & Lamb, 2005; MacLaren et al., 2010; Perkins, Karelitz, & Jao, 2013; Raiff, Faix, Turturici, & Dallery, 2010). Further, as the collection of blood or urine samples is relatively invasive, breath CO provides a useful assay for researchers, clinicians, and physicians as a non-invasive, efficient method for assessing recent cigarette smoking. The clinical utility of breath CO has been established in a variety of contexts and across several populations of smokers. For example, adolescent (National Survey on Drug Use and Health, 2011) and pregnant (Cnattingius, 2004) smokers represent vital target populations for smoking prevention and cessation efforts. Given the often surreptitious nature of cigarette smoking in these populations, breath CO provides an accurate and reliable method for verifying self-report assessments, which may be unreliable under some conditions (Dolcini, Adler, Lee, & Bauman, 2003; Shipton et al., 2009). Breath CO has also been used as a sensitive measure for the verification of smoking abstinence in the context of behavioural interventions for smoking cessation (i.e., contingency man-

PRS35 - Beliefs In Effectiveness Of Various Smoking Cessation Interventions Among Jordanian Adult Smokers

Background: Formal smoking cessation interventions including pharmacologic and behavioral interventions have been well known among Chinese smokers, however, the utilization of such interventions is not widely adopted. Lack of belief in the effectiveness of these interventions may be a probable reason. The objective of this study was to identify potential predictors affecting smokers’ beliefs in the effectiveness of smoking cessation interventions among Chinese adult smokers. Methods: A self-reported survey was distributed using convenience sampling among adult smokers over 18 years at two sites in China. Potential predictors, including socio-demographic characteristics, health conditions, and addiction level that affect smokers’ beliefs in the effectiveness of either pharmacologic or behavioral smoking cessation interventions were explored using multivariate logistic regression. Results: A total of 365 smokers were identified and considered as cohort in this analysis. Higher income ($450/ month or more vs. less than $450) (odds ratio (OR): 3.05, 95% confidence interval (CI): 1.38-6.72), studying in private schools (OR: 4.87, 95% CI: 1.06-22.39) and preferring to inhale when smoking (OR: 1.95, 95% CI: 1.07-3.57) were associated with having beliefs in the effectiveness of pharmacological products. Heavy smokers (smoke 20 cigarettes/ day or more vs. less than 20) (OR: 0.36, 95% CI: 0.18-0.71) and age group (≥40 years old vs. 18-40 years old) (OR: 0.36, 95% CI: 0.18-0.72) were negatively associated with having beliefs in the effectiveness of behavioral methods. Conclusions: The rates of believing in the effectiveness of various smoking cessation interventions among Chinese adult smokers ranged from approximately 30% to 60%. The utilization of formal cessation interventions including both pharmacologic and behavior methods can be limited by smokers’ beliefs which should be considered when choosing a smoking cessation intervention.

Combined pharmacotherapy and behavioural interventions for smoking cessation

Our earlier Cochrane Reviews already show that all types of nicotine replacement therapy help people to stop smoking,[1] as do several non-nicotine pharmacotherapies, including bupropion and varenicline, sold as Champix and Chantix.[2] We also know that providing behavioural support, such as individual[3] or group counselling,[4] helps people quit too, and trials of pharmacotherapy typically also provide behavioural support to all participants. Whilst encouraging the use of both is considered to be better, we haven't really been sure how much better and, so, this new review looks at the effects of the combination of an effective smoking cessation pharmacotherapy and behavioural support on helping people to stop smoking.[5] We aimed to identify all the randomised trials that provided people in the intervention group with a pharmacotherapy and behavioural support, and gave neither to people in the control group. Instead, the control group typically got some advice about quitting, which we know is likely to be of some help. We found 41 trials. When we pooled all their results, the findings from one study stood out as being much better, and so we limited the rest of the analyses to the 40 other studies. Overall, we found that the combined approach increased the chance of quitting by between 70 and 100%. And, even though the trials were done in many different settings, some with volunteers, and some in healthcare settings with patients who were not necessarily motivated to quit, we found that the size of effect was quite stable. There was slight evidence, when we compared different trials, that offering more sessions of support gave better results, but the difference was not clear. This may be because people don't make use of all the available support. We found the effect of more support was a little clearer when we just looked at trials which delivered more of the planned treatment. These results are important because they show that the effects of combined treatment with pharmacotherapy and behavioural support are quite robust, even in people who might be finding it hard to quit smoking.

S-adenosyl-L-methionine (SAMe) for smoking abstinence: a randomized clinical trial.

S-Adenosyl-L-methionine (SAMe) is a dietary supplement commonly used to treat depression. SAMe facilitates dopamine and norepinephrine synthesis in the central nervous system. This study investigated the efficacy of SAMe for increasing tobacco abstinence among cigarette smokers. A randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial was conducted. Subjects were randomly allocated to receive SAMe 1600 mg or 800 mg by mouth every day or a matching placebo for 8 weeks. All subjects received a behavioral smoking cessation intervention. Self-reported smoking abstinence was biochemically confirmed with exhaled-air carbon monoxide. Subjects in the study comprised 120 adults. One hundred and twenty (120) subjects with a mean age of 40.0±14.0 (SD) years were enrolled. Participants smoked an average of 19.6±8.6 cigarettes per day for 21±13.2 years. The study dropout rate was high (42.5%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 8 and 24 weeks between SAMe dose groups and placebo. SAMe did not attenuate withdrawal symptoms among abstinent subjects. Rates of gastrointestinal side-effects were higher with SAMe 1600 mg/d compared to placebo. SAMe did not increase smoking abstinence rates. Abstinence and tobacco withdrawal data from this clinical trial suggest that SAMe holds little promise for the treatment of tobacco dependence.

Cognitive behavioral smoking cessation during alcohol detoxification treatment: A randomized, controlled trial

BackgroundAmong alcohol-dependent subjects tobacco smoking is very common and causes a variety of health risks. Therefore, it is necessary to reach this high-risk population early with appropriate smoking interventions. MethodsSmokers in alcohol detoxification treatment were offered to participate in a smoking cessation study. A total of 103 patients was enrolled and randomly assigned to either the experimental group (EG) receiving a cognitive behavioral smoking cessation treatment (CBT) or the control group (CG) receiving autogenic training. Smoking outcomes were measured by self-report and carbon monoxide levels, directly after intervention and 6 months later, where additionally alcohol outcomes were recorded. ResultsThere were no differences in smoking quit rates directly after intervention. However, patients in the EG were significantly more likely to reduce their daily cigarette use compared to CG (p=.046). Sub-group analyses revealed that heavy smokers (FTND score≥7) seemed to profit most in the EG regarding cigarette reduction. After 6 months, these positive effects had leveled out. No evidence was found that smoking cessation might jeopardize alcohol outcomes. ConclusionsResults suggest that alcohol-dependent smokers are interested in smoking interventions even during alcohol detoxification. CBT is promising in short-term smoking outcomes and in the approach of harm reduction, however, long-term effects are desirable. These findings underline the feasibility and the importance to provide smoking cessation interventions to patients in alcohol detoxification treatments.

Effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups

Effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups

The Effects of a Multilingual Telephone Quitline for Asian Smokers: A Randomized Controlled Trial

Although telephone counseling services (quitlines) have become a popular behavioral intervention for smoking cessation in the United States, such services are scarce for Asian immigrants with limited English proficiency. In this study, we tested the effects of telephone counseling for smoking cessation in Chinese-, Korean-, and Vietnamese-speaking smokers. A culturally tailored counseling protocol was developed in English and translated into Chinese, Korean, and Vietnamese. We conducted a single randomized trial embedded in the California quitline service. Smokers who called the quitline's Chinese, Korean, and Vietnamese telephone lines between August 2, 2004, and April 4, 2008, were recruited to the trial. Subjects (N = 2277) were stratified by language and randomly assigned to telephone counseling (self-help materials and up to six counseling sessions; n = 1124 subjects) or self-help (self-help materials only; n = 1153 subjects) groups: 729 Chinese subjects (counseling = 359, self-help = 370), 848 Korean subjects (counseling = 422, self-help = 426), and 700 Vietnamese subjects (counseling = 343, self-help = 357). The primary outcome was 6-month prolonged abstinence. Intention-to-treat analysis was used to estimate prolonged abstinence rates for all subjects and for each language group. All statistical tests were two-sided. In the intention-to-treat analysis, counseling increased the 6-month prolonged abstinence rate among all smokers compared with self-help (counseling vs self-help, 16.4% vs 8.0%, difference = 8.4%, 95% confidence interval [CI] = 5.7% to 11.1%, P < .001). Counseling also increased the 6-month prolonged abstinence rate for each language group compared with self-help (counseling vs self-help, Chinese, 14.8% vs 6.0%, difference = 8.8%, 95% CI = 4.4% to 13.2%, P < .001; Korean, 14.9% vs 5.2%, difference = 9.7%, 95% CI = 5.8% to 13.8%, P < .001; Vietnamese, 19.8% vs 13.5%, difference = 6.3%, 95% CI = 0.9% to 11.9%, P = .023). Telephone counseling was effective for Chinese-, Korean-, and Vietnamese-speaking smokers. This protocol should be incorporated into existing quitlines, with possible extension to other Asian languages.

Telehealth-delivered group smoking cessation for rural and urban participants: Feasibility and cessation rates

Background Large-group behavioral smoking cessation interventions are effective for helping people quit smoking, but have not been evaluated using videoconferencing technology for rural and remote participants who have no access to in-person cessation programs. The objectives of this study were to provide and evaluate an evidence-based group smoking cessation program for rural/remote smokers wishing to quit through a Telehealth videoconferencing link at their local Health Centre. Methods From September 2005 through April 2008, eight separate eight-session, 4 month long smoking cessation group programs were offered both in person to urban participants in Calgary and at up to six rural sites simultaneously via Telehealth videoconferencing. Quit rates were assessed at program completion, 6 and 12 month follow-up. Participants also provided evaluations of the program and technology. Results 554 smokers participated in the program: 370 in Calgary and 184 at various remote sites. Sixteen Telehealth sites participated from across Alberta and one site from the Northwest Territories. After program completion, continuous abstinence rates using the most conservative intent-to-treat method were 27.5% in Calgary and 25.5% for the rural Telehealth sites. Quit numbers were much higher using only Available Data at 39.2% for Calgary and 37.2% for the rural sites. Similar rates were maintained over the 12-month follow-up. Program evaluations were positive. Conclusions It is possible to offer effective smoking cessation to small groups of patients in rural or remote locations through Telehealth videoconferencing technology, which produces quit rates similar to in-person groups.

Selegiline Transdermal System (STS) as an Aid for Smoking Cessation

This study examined the efficacy and safety of selegiline transdermal system (STS) and brief repeated behavioral intervention (BRBI) for smoking cessation in heavy smokers. We hypothesized that the quit rate of subjects who received STS and BRBI would be significantly greater than that of those who received placebo patch and BRBI. This was a double-blind, placebo-controlled parallel-group study in which 246 men and women were randomized to receive either STS (n = 121) or placebo patch (n =125) for 9 weeks. Recruitment targeted heavy smokers, defined as individuals with self-reported use of ≥15 cigarettes/day in the 30 days prior to enrollment, who had smoked cigarettes for the past 5 years, and had an expired CO level ≥9 ppm during screening. Although STS was well tolerated, the overall results indicated that STS with BRBI was not more effective than placebo plus BRBI for smoking cessation (p = .58). The results are discussed in relation to interventions for heavy smokers. Although 2 trials using oral selegiline both showed trends toward improved abstinence, these results indicate that STS with BRBI was not an effective aid for smoking cessation at the end of treatment (10 weeks), 14, or 26 weeks.

A systematic review and meta‐analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups

A systematic review and meta-analysis was conducted to assess the methodological quality and effectiveness of behavioural smoking cessation interventions targeted at six disadvantaged groups; the homeless, prisoners, indigenous populations, at-risk youth, individuals with low socio-economic status and individuals with a mental illness. Medline, EMBASE, the Cochrane Library and PsycInfo databases were searched using MeSH and keywords for studies conducted in developed countries prior to October 2010. Included studies were assessed for methodological quality. A DerSimonian and Laird random effects meta-analysis was conducted where possible to explore the effectiveness of interventions for the different subgroups. A narrative review was conducted for studies unable to be included in the meta-analysis. Outcomes examined were abstinence rates at short-term (up to 3 months) and long-term (6 months or the longest) follow-up. Thirty-two relevant studies were identified. The majority (n = 20) were rated low in methodological quality. Results of the meta-analysis showed a significant increase in cessation for behavioural support interventions targeted at low-income female smokers at short-term follow-up [relative risk (RR) 1.68, confidence interval (CI) 1.21-2.33], and behavioural support interventions targeted at individuals with a mental illness at long-term follow-up (RR 1.35, CI 1.01-1.81). Results of the narrative review showed several promising interventions that increased cessation rates at 6-month or longer follow-up. Few well-controlled trials have examined the most effective smoking cessation strategies for highly disadvantaged groups, especially among the homeless, indigenous smokers and prisoners. The use of behavioural smoking cessation interventions for some socially disadvantaged groups appears promising; however, overall findings are inconsistent. Further research is needed to establish the most effective interventions for vulnerable high-risk groups. Special attention should be given to increasing sample size and power, and to sound evaluation methodology to overcome methodological limitations of conducting research with these high-risk groups.

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in an Adolescent Smoking Cessation Trial

To determine which factors predict smoking cessation treatment completion and retention among adolescents. In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14-18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention. In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention. High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.

Utilization of Services in a Randomized Trial Testing Phone- and Web-Based Interventions for Smoking Cessation

Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone-Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. One thousand two hundred and two participants were randomized to phone, Web, or combined phone-Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone-Web, 41% Web), and those in the phone-Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities.

Beliefs in Effectiveness of Various Smoking Cessation Interventions among Chinese Adult Smokers

Background: Formal smoking cessation interventions including pharmacologic and behavioral interventions have been well known among Chinese smokers, however, the utilization of such interventions is not widely adopted. Lack of belief in the effectiveness of these interventions may be a probable reason. The objective of this study was to identify potential predictors affecting smokers’ beliefs in the effectiveness of smoking cessation interventions among Chinese adult smokers. Methods: A self-reported survey was distributed using convenience sampling among adult smokers over 18 years at two sites in China. Potential predictors, including socio-demographic characteristics, health conditions, and addiction level that affect smokers’ beliefs in the effectiveness of either pharmacologic or behavioral smoking cessation interventions were explored using multivariate logistic regression. Results: A total of 365 smokers were identified and considered as cohort in this analysis. Higher income ($450/ month or more vs. less than $450) (odds ratio (OR): 3.05, 95% confidence interval (CI): 1.38-6.72), studying in private schools (OR: 4.87, 95% CI: 1.06-22.39) and preferring to inhale when smoking (OR: 1.95, 95% CI: 1.07-3.57) were associated with having beliefs in the effectiveness of pharmacological products. Heavy smokers (smoke 20 cigarettes/ day or more vs. less than 20) (OR: 0.36, 95% CI: 0.18-0.71) and age group (≥40 years old vs. 18-40 years old) (OR: 0.36, 95% CI: 0.18-0.72) were negatively associated with having beliefs in the effectiveness of behavioral methods. Conclusions: The rates of believing in the effectiveness of various smoking cessation interventions among Chinese adult smokers ranged from approximately 30% to 60%. The utilization of formal cessation interventions including both pharmacologic and behavior methods can be limited by smokers’ beliefs which should be considered when choosing a smoking cessation intervention.