Cessation Counseling Research Articles

Efficacy of e-cigarettes for smoking cessation in populations with psychiatric and/or substance use problems: A secondary analysis of a randomized controlled trial.

People with psychiatric and substance use disorders are more likely to smoke and less likely to quit than smokers in the general population. We evaluated the efficacy of e-cigarettes for abstinence from tobacco smoking in people with psychiatric and substance use problems. We analyzed data collected in the larger 'Efficacy, Safety, and Toxicology of ENDS as an Aid for Smoking Cessation' (ESTxENDS) trial (n=1246): the intervention group received e-cigarettes and e-liquids, plus standard-of-care smoking cessation counseling (SOC) for 6 months; the control group received SOC and a voucher. The primary outcome was biochemically validated continuous self-reported abstinence at 6 months; secondary outcomes included 6-month and 7-day self-reported abstinence. We calculated adjusted relative risks (ARR) for two subsamples meeting these conditions at the baseline visit: 1) psychotropic medication use; and 2) problematic substance or polysubstance use. Among the participants using psychotropic medications (n=239), the ARR for validated abstinence was 2.62 (95% CI: 1.40-4.90) in the intervention group versus the control group, 2.95 (95% CI: 1.72-5.07) for 6-month and 2.96 (95% CI: 1.92-4.55) for 7-day self-reported abstinence, while among participants with problematic substance or polysubstance use (n=818), the ARR was 1.57 (95% CI: 1.20-2.04), 1.42 (95% CI: 1.15-1.74), and 1.53 (95% CI: 1.31-1.79), respectively. Adding e-cigarettes to standard-of-care counseling increased the likelihood that participants with psychiatric and substance use problems would abstain from smoking, but larger studies should test the efficacy and safety of smoking cessation interventions in this often-marginalized population.

The impact of drinking on smoking cessation outcomes among Hong Kong Chinese youth smokers

Drinking is a common unhealthy behaviour among youth smokers aged 25 or below. However, the effects of drinking on smoking cessation outcomes are not well understood. This study aimed to explore the impact of drinking on smoking cessation outcomes among Hong Kong Chinese youth smokers who received smoking cessation counselling. This study adopted a cross-sectional design at the Youth Quitline, which is the only government-funded hotline providing telephone smoking cessation counselling to Hong Kong smokers aged 25 or younger. Of the 142 participants at the six-month follow-up, 75 were in the drinking group and 67 in the non-drinking group. Multiple logistic regression analyses were performed to identify any significant differences in self-reported quit rates, smoking reduction by at least 50%, quit attempts, and biochemically validated quit rates between the drinking and non-drinking groups. The results showed a significant difference in self-reported quit rate between the two groups at 6-month, but no significant difference in smoking reduction by at least 50%, quit attempts, and biochemically validated quit rate. Alcohol drinking and male were identified as significant factors decreasing self-reported quit rate at 6 months. The study revealed that drinking could decrease quit rates among young smokers who received counselling, but not their smoking reduction or quit attempts. Given the negative impact of drinking on smoking abstinence and the increased popularity of drinking among the youth, assessment of alcohol use and brief advice on smoking are recommended to be an integral part of smoking cessation counselling for youth smokers.

Use of adjuvant treatment options in tobacco and nicotine counseling: results of an anonymous survey

Counseling and treatment of tobacco and nicotine users include classical behavioral therapy and cognitive-behavioral therapy methods. More than half of the quitters after an intervention relapsed into old behavior after 12 months. Discussions with experts have shown that evidence-based interventions are individually supplemented with treatment options without scientific evidence or with inconsistent efficacy. This study examined the use of adjuvant treatment options in the area of smoking cessation such as aromatherapy.The sample for our anonymous online survey (Sosci survey) consisted of 351 experts. All of them had registered with their contact data in a freely accessible database (https://www.anbieter-raucherberatung.de/anbieter.php). A total of 88 experts took part in the survey. Respondents were on average 53 years old, and 71% were female. They reported on average 14 years of experience in smoking cessation counseling. More than half of the participants (66.3%; n=57) had employed at least one adjuvant treatment option. Exercise (49.1%), hypnosis (34.5%) and acupuncture (27.3%) were mentioned most often.Adjuvant treatment options appear to be important in the counseling of tobacco and nicotine users and there should be more discussion on these options among experts. These should also considered in the development of curricula for counsellors on tobacco and nicotine cessation.

E-liquid flavors and nicotine concentration choices over 6 months after a smoking cessation attempt with ENDS: Secondary analyses of a randomized controlled trial.

Many tobacco smokers try to quit with electronic nicotine delivery systems (ENDS or e-cigarettes). We aimed to describe e-liquid flavors and nicotine concentration use over 6 months in a prospective cohort of smokers willing to quit with ENDS. We included 622 participants from the intervention group of the Efficacy, Safety and Toxicology of ENDS randomized controlled trial. Participants were adult smokers smoking at least five cigarettes a day. They received free ENDS and a choice of 6 e-liquid flavors in 4 nicotine concentrations and smoking cessation counseling. We tracked flavor choice and nicotine concentration at 1, 2, 4, and 8 weeks, and at 6 months, after the target quit date, comparing participants who reported only vaping (exclusive e-cigarette users) to those who vaped and smoked (dual users) over the last 7 days. We applied multivariable regression models to compute adjusted risk ratios (ARR). At Week 1, 66% (n=409) were exclusive e-cigarette users, and 21% (n=129) were dual users. At Month 6, 43% (n=266) were exclusive e-cigarette users, and 16% (n=102) were dual users. While flavor choices were similar at Week 1, at 6 months, exclusive e-cigarette users reported using more fruity flavors than dual users (31% vs 22%, ARR=2.10; 95% CI: 1.21-3.66). The nicotine concentration used initially was similar in both groups and diminished over time. At 6 months, exclusive e-cigarette users used a lower mean nicotine concentration than dual users (6.3 vs 8.2 mg/mL, difference= -1.55; 95% CI: -2.84 - -0.25 mg/mL). After 6 months, exclusive e-cigarette users used more fruity-flavored e-liquids and chose a lower mean nicotine concentration than dual users.

Exploring Predictors of Treatment Response to GLP-1 Receptor Agonists for Smoking Cessation.

Understanding predictors of smoking cessation medication efficacy facilitates the ability to enhance treatment effectiveness. In our pilot trial, exenatide, a glucagon-like peptide-1 receptor agonist, adjunct to nicotine patch improved smoking abstinence compared to nicotine patch alone. This secondary analysis explores potential baseline characteristics associated with differential treatment response to exenatide. The parent trial randomized (1:1) 84 smokers with prediabetes and/or overweight to once-weekly placebo or exenatide, 2mg, subcutaneously. All participants received nicotine patch (21mg) and brief smoking cessation counseling, with biologically confirmed 7-day point prevalence abstinence at week 6 (end-of-treatment) deemed the primary outcome. Bayesian generalized linear modeling explored differential response to treatment as a function of baseline patient characteristics, including demographic, psychosocial, clinical, smoking related, and genetic factors. Posterior probability (PP)≥75% that an effect exists was taken as a minimum threshold of evidence in favor of model effects. Exenatide showed stronger benefit versus placebo in participants that smoked >20 cigarettes per day (PP=81.7%) and in those without prediabetes (PP=76.0%) or obesity (PP=94.4%). Exenatide's efficacy was observed only in individuals with no/minimal depression symptoms but not in those with symptoms (PP=91.2%). Finally, exenatide was more efficacious than placebo only in those with the CHRNA rs16969968 GG genotype (PP=88.6%). The effect of exenatide on abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger prospective investigations are needed to confirm and extend these findings. Understanding predictors of smoking cessation medication efficacy enhances the ability to improve treatment effectiveness. In our pilot trial, extended-release exenatide, a GLP-1 receptor agonist, adjunct to nicotine patch, improved smoking abstinence in smokers with prediabetes and/or overweight. The current post-hoc analysis found that the effect of exenatide on smoking abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger investigations are needed to confirm and extend these findings.

Engaging and supporting young adults in smoking cessation: Insights from a mobile-based cessation program in China.

Evidence-based smoking cessation treatments are underutilized by young adult smokers. This study explored young smokers' experiences with a mobile-based smoking cessation program that included a Quit & Win contest at a university in Zhuhai, China, aiming to identify key engagement and cessation mechanisms. Twenty participants (aged 18-25 years) were selected through purposive sampling. Semistructured interviews explored participants' experiences, motivations, and perceptions of the intervention. Thematic analysis was used to identify major themes from interview transcripts. Two main themes emerged: (1) strategies for enhancing program engagement, including the influence of campus-wide smoke-free environments, the appeal of the Quit & Win contest, and the use of peer counselors for recruitment; and (2) strategies for supporting smoking cessation, emphasizing the importance of a multifaceted approach. This approach included financial incentives as a motivator for quitting, sustaining cessation efforts with online group support, and building a therapeutic alliance with cessation counselors. Mobile-based interventions, combined with peer support, financial incentives, and campus-wide smoke-free activities, can effectively engage young adults in smoking cessation. Future interventions should implement comprehensive programs that incorporate these elements to address the unique challenges faced by this population.

Tailored text-messaging versus standard Quitline telephone counselling for smoking cessation among people who smoke from a low-socio-economic status background in Australia: A study protocol for a non-inferiority randomized controlled trial (The Quit By Phone Study).

Signficant inequalities in tobacco smoking exist, with higher smoking rates among people from low-socio-economic status (low-SES) populations. Tailored technology-based programs for low-SES smoking populations have the potential for high reach, but require effectiveness data from large-scale trials. This trial among Australians who smoke from a low-SES background will determine the effectiveness and cost-effectiveness of tailored text-message (TTM) support compared with standard Quitline (SQL) telephone support service. This is a two-arm, parallel group, randomized, non-inferiority trial with allocation concealment and blinded outcome assessment in an Australian population within the greater Sydney region in New South Wales. Participants are adults who smoke daily (n = 1246), are interested in quitting and currently receiving a government pension or allowance, and will be recruited via advertisements. Participants will be randomized (1:1 ratio) to receive either 12 months of TTM quit support or enrolment in SQL telephone support. Assessments will be completed at baseline (telephone interview), within 1 month (check-in call), at 3months (on-line questionnaire) and 12 months (telephone interview) post-randomization. The primary outcome will be 6-month continuous abstinence verified by carbon monoxide breath test at 12-month follow-up. The study will test whether TTM is non-inferior to SQL by a non-inferiority margin of 2%, i.e. the quit rate in the TTM group will be no worse than 2% less than the quit rate in the SQL group. Secondary outcomes will include self-reported continuous and point prevalence abstinence and acceptability and cost-effectiveness of TTM versus SQL. Should the tailored text-message support prove non-inferior and more cost-effective than Quitline for this population, this will provide an opportunity for the upscaling of an effective, inexpensive and tailored quit support service. The trial findings will inform cessation treatment policy for priority populations in Australia and globally.

Attitude, Practice and Perceived Barrier for Tobacco Cessation Counseling and Nicotine Replacement Therapy among Private Dental Practitioners of North India: A Web based Survey.

To assess the attitude and practices towards the Tobacco Cessation Counselling and Nicotine Replacement Therapy and identify the possible barriers towards the implementation of these practices amongst Private dental practitioners of North, India. Methodology: A cross sectional web based survey using 33 item pre-tested self administered questionnaire was conducted. A total of 250 valid responses were received and were available for analysis. Using the statistical package SPSS Version 23 the statistical analysis was done. The survey results was disseminated in accordance with the CHERRIES criteria for sharing E-survey results. There was a response rate of 78.12 %. 69% of the subjects were offering tobacco cessation counseling while only 20.4% were actually practicing NRT. 52% believed that NRT along with counseling increases the rate of successful quitting the habit. 98% believed that they lacked formal training to introduce NRT for patients. Though study subjects had a positive attitude towards tobacco cessation and Nicotine Replacement Therapy, it does not reflect their current practice. Dental practitioners must get ongoing education in order to enhance their skills in prescription NRT, as a major obstacle to providing NRT is a lack of formal training.

Prevalence and predictive risk factor analysis of potentially malignant oral mucosal lesions among gond tribes of Bhopal

Introduction: India ranks second in the total incidence of oral cancer. The purpose of the present study is to identify the predictive risk factors for potentially premalignant oral mucosal lesions among a vulnerable Indigenous community in Bhopal. Materials and Methods: A cross-sectional study design with a prevalidated questionnaire including the demographic characteristics, tobacco usage, and other predictive risk factors was used to survey subjects aged between 15 and 75 years, both males and females of the Gond community in the Bhopal division. Type III Oral examination was conducted to determine oral mucosal changes. Statistical Analysis: Descriptive statistics were done to estimate the prevalence of oral premalignant mucosal lesions (OPMLs) and the demographic characteristics of participants. Chi-square statistics was employed to analyze the association between predictive risk factors and with the prevalence of oral premalignant lesions. Linear logistic regression was done to correlate the significance of predictive risk factors of OPMLs. P ≤ 0.05 was considered statistically significant. Results: A statistically significant association for OPMLs was observed with tobacco use, alcohol, and tobacco with alcohol usage and gender (P = 0.00). OPMLs do not show any significant association with trauma, oral ulcers, or dentures (P ≥ 0.05). The most common lesion identified was leukoplakia (39.1%), followed by Oral sub mucous fibrosis (33.33%) and both (16.66%). Lesions were most commonly seen on the buccal mucosa (60.3%), followed by the tongue (21.8%) and alveolar ridge/gingiva (9.6%). Logistic regression of predictive risk factors showed a significant correlation of OPMLs with smokeless, smoking, alcohol, and tobacco with alcohol usage. Conclusion: There is a higher burden of OPMLs and increased tobacco consumption observed in the Gond community residing in the rural areas of Bhopal. The increased burden of tobacco usage and oral mucosal lesions needs to be addressed, and interventions, including tobacco cessation counseling and awareness of oral hygiene practices, should be made feasible for the problem.

Factors associated with retention in Quitline counseling for smoking cessation among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam.

Quitline counseling is an effective method for supporting smoking cessation, offering personalized and accessible assistance. Tobacco use is a significant public health issue among people living with HIV. In Vietnam, over 50% of men living with HIV use tobacco. However, there is limited research on Quitline use and retention rates in this population and a lack of research on factors associated with retention in Quitline counseling. The study aims to evaluate the factors associated with retention in Quitline counseling for smoking cessation among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam. The study analyzed data from a randomized controlled trial (RCT) that compared the effectiveness of three smoking cessation interventions for smokers living with HIV at 13 Outpatient Clinics in Ha Noi. A total of 221 smokers aged 18 and above living with HIV participated in Arm 1 of the RCT, which included screening for tobacco use (Ask), health worker-delivered brief counseling (Assist), and proactive referral to Vietnam's national Quitline (AAR), in which the Quitline reached out to the patient to engage them in up to 10 sessions of smoking cessation counseling. Retention in Quitline counseling was defined as participating in more than five counseling calls. The study used bivariate and logistic regression analyses to explore the associations between retention and other factors. Fifty-one percent of HIV-positive smokers completed more than five counseling sessions. Smokers living with HIV aged 35 or older (OR = 5.53, 95% CI 1.42-21.52), who had a very low/low tobacco dependence level (OR = 2.26, 95% CI 1.14-4.51), had a lower score of perceived importance of quitting cigarettes (OR = 0.87, 95% CI 0.76-0.99), had a household ban or partial ban on cigarettes smoking (OR = 2.58, 95% CI 1.39-4.80), and had chosen a quit date during the Quitline counseling (OR = 3.0, 95% CI 1.63-5.53) were more likely to retain in the Quitline counseling than those smokers living with HIV whose ages were less than 35, who had a high/very high tobacco dependence level, had a higher score of perception of the importance of quitting cigarettes, did not have a household ban on cigarettes smoking, and did not choose a quit date during counseling. There is a high retention rate in Quitline counseling services among PLWHs receiving care at HIV outpatient clinics. Tailoring interventions to the associated factors such as age, tobacco dependence, perceived importance of quitting, household smoking bans, and setting a quit date during counseling may improve engagement and outcomes, aiding in the reduction of smoking prevalence among HIV-positive individuals.

What Do Dental Students Know About E-Cigarettes? A Cross-Sectional Survey from One Palestinian Dental School.

Owing to the vital role played by dentists in patient education and due to the growing popularity of e-cigarette use among the younger population, this cross-sectional study aimed to assess the use, knowledge, beliefs, and attitudes toward e-cigarettes among dental students. A cross-sectional questionnaire was given between March and June of 2024 to undergraduate dental students in the Faculty of Dentistry at the Arab American University in Palestine. A 32-item questionnaire with five sections, namely demographics, smoking habits, knowledge, beliefs and attitude, and education about e-cigarettes was sent to all appropriate participants (N = 1050). The response rate was 31% (N = 325). About 11.7% of the respondents were current e-cigarette smokers. The two most commonly cited reasons for initial use of e-cigarettes were curiosity (52.8%) and a desire to quit conventional smoking (27.8%). The average knowledge score was 6.63 (3.08) out of 12, demonstrating a generally inadequate level of knowledge about e-cigarettes. Conventional cigarette smokers were more knowledgeable about e-cigarettes than non-smokers (OR = 1.928; 95% CI: 1.061-3.505; p-value = 0.031). The majority of students (92%) considered the level of education they received in the dental school about e-cigarettes as inadequate, and more than half (53.2%) received information from social media. In conclusion, the prevalence of e-cigarette use among Palestinian dental students is relatively high compared with that reported for other dental students worldwide. Since the students showed a generally inadequate level of knowledge about e-cigarettes, this study casts doubt on the competency of Palestinian dental students to offer cessation counseling, highlighting the necessity to revise the dental curricula to foster positive knowledge and belief conducive to ideal behaviors.

Exploring Gender Differences in Receipt of the 5As for Smoking Cessation for Recently-Diagnosed Cancer Patients (ECOG-ACRIN EAQ171CD).

Smoking cessation is important for men and women diagnosed with cancer. Oncology clinicians should encourage all patients to quit and offer resources to help them do so, following the 5As framework (Ask, Advise, Assess, Assist, and Arrange follow-up). This study tests gender differences in self-reported receipt of the 5As by an oncology provider among 306 recently-diagnosed male and female cancer patients. Receipt of praise for quitting efforts was also assessed as an indicator of empathic communication. Participants completed baseline surveys as part of a larger clinical trial focused on smoking cessation (NCT03808818), reflecting on pre-trial interactions with their oncology clinicians. Most male and female patients received "Ask," "Advise," and "Assess" (i.e., asking patients if they smoke, advising them to quit, and assessing their interest in doing so), though significant gender differences emerged in receiving "Assist" and "Arrange follow-up." Women were less likely to receive assistance (e.g., medication or counseling referral; 85.25% versus 93.18%, respectively) or a follow-up appointment to discuss their progress (28.11% versus 40.91%, respectively). Approximately half of men and women were praised for their quitting efforts. In exploratory sensitivity analyses, gender differences in arrange-follow-up were attenuated when adjusting for cancer location (smoking-related or not), self-reported distress, and self-reported coping ability. Women may be at risk for suboptimal smoking-related support during cancer care, as assistance and follow-up are essential to sustained abstinence. Clinicians should consistently deliver each of the 5As to all cancer patients who smoke, regardless of cancer type or expressed distress/coping difficulty. The current study findings add to the growing literature describing gender disparities in tobacco treatment access. Findings highlight an addressable gap in access to tobacco treatment for a group of women who have cancer. Advancements in the equitable delivery of smoking cessation counseling have the potential to improve cessation outcomes for women with cancer who smoke.

Effects of the 5A Model toward perceiving self-efficacy of nursing students’ counseling for tobacco cessation

Effects of the 5A Model toward perceiving self-efficacy of nursing students’ counseling for tobacco cessation

A stop-smoking strategy after cervical cancer screening: Results of a cluster-randomised controlled trial in Dutch general practice.

This study aimed to assess whether brief stop-smoking advice given to women who smoke and visit their general practice for cervical cancer screening improves smoking cessation outcomes. This two-arm cluster-randomised controlled trial was conducted in 75 Dutch general practices. Participants in the intervention group received brief stop-smoking advice based on the Ask-Advise-Connect method, delivered by a practice assistant. Patient-reported outcomes were measured at 6 months: undertaking a serious quit attempt of at least 24 hours during follow-up (primary outcome), 7-day point prevalence abstinence (PPA) at 6 months, reduction in number of cigarettes smoked, increase in motivation to quit smoking, exposure to advice or support, and other psychological and behavioural measurements. There was no significant difference in undertaking a serious quit attempt between the intervention (39.8% of n=266) and control group (36.0% of n = 214), OR 1.18 (95% CI: 0.80-1.72, P=0.41). Neither did the PPA significantly differ between groups: 21.1% vs. 16.3%, OR 1.38 (95% CI: 0.83-2.29, P=0.21). Although nonsignificant, the direction of effects for the aforementioned outcomes was in favour of the intervention group. The reduction in number of cigarettes smoked and increase in motivation to quit did not differ between groups. The uptake of cessation counselling was higher in the intervention (14.7%) than in the control group (2.8%). A brief stop-smoking strategy after the smear test for cervical screening might encourage women who smoke to attempt quitting and seek cessation counselling, but a significant effect could not be demonstrated in this trial. The results of this cluster randomised trial suggest that brief advice to stop-smoking delivered by a practice assistant after routine cervical screening in general practice might encourage women who smoke to attempt quitting, but a significant effect could not be proven. Also, women who receive advice show a higher uptake of professional cessation counselling compared to their controls. Providing brief advice after the cervical smear might therefore be an useful opportunistic approach to stimulate cessation in women who smoke.

Gaps in smoking cessation counseling administered by healthcare providers to BIPOC gay men who smoke daily in the U.S.

BackgroundBlack, Indigenous, and People of Color (BIPOC) racial/ethnic groups, sexual minorities (SM), and men have higher odds of smoking, less access to smoking cessation education and services, and lower smoking cessation rates than their white, heterosexual, and women counterparts. The purpose of this study is to examine the experiences of BIPOC gay men in accessing smoking cessation counseling from their healthcare providers and understand the facilitators and barriers to smoking cessation. MethodsThis study analyzed data from BIPOC gay men who smoke daily via social media and organizational listservs throughout the United States and conducted semi-structured individual qualitative interviews. Two trained coders used thematic analysis to analyze the data. ResultsFindings identified three overarching themes: 1) Sources of Information, 2) Facilitators and Barriers, and 3) Areas of Improvement for Smoking Cessation Counseling. Participants reported trusting advice from community members over healthcare providers regarding smoking cessation counseling. They also felt that the smoking cessation advice received from healthcare providers was, at times, confusing and inadequate. Identity concordance between patient and healthcare provider helped participants feel seen by their provider, which motivated them to engage in smoking cessation counseling. Finally, participants suggested improvements for smoking cessation counseling for BIPOC gay men such as integrating mental health support in smoking cessation services, accountability for patients, and providing harm reduction alternatives instead of smoking cessation only. ConclusionBIPOC gay men who smoke daily value the importance of receiving culturally adaptive and gender-affirming care from healthcare providers who share their identities when receiving smoking cessation and harm reduction counseling.

Prevalence of pulmonary hypertension and its associated factors among chronic obstructive pulmonary diseases patients at public hospitals of Addis Ababa, Ethiopia, 2024: a facility-based cross-sectional study.

Pulmonary hypertension (PH) is a serious medical condition characterized by elevated pressure in the lung blood vessels, with chronic heart and lung diseases being the most common causes worldwide. However, there is a dearth of studies on the prevalence of pulmonary hypertension and its associated factors among chronic obstructive pulmonary disease (COPD) patients in Ethiopia and the study area. This study aimed to assess the prevalence of pulmonary hypertension and its associated factors among patients with chronic obstructive pulmonary disease at public hospitals in Addis Ababa, Ethiopia, 2024. A facility-based cross-sectional study involving 422 COPD patients charted in Addis Ababa town, Ethiopia from May - June 2024 was conducted. Respondents' records were chosen using simple random numbers. Structured, and pretested questionnaires, were used to collect data. The data were coded and entered into EpiData 3.1 before being exported to SPSS version 25 for analysis. Logistic regression was employed to identify factors influencing the prevalence of pulmonary hypertension. Statistical significance was set at p < 0.05 with a 95% confidence interval. The study found the prevalence of pulmonary hypertension was 52% (95% CI: 49, 54.4%). Aged above 55 years [Adjusted Odds Ratio (AOR): 2.45 (1.55-3.9), Being male (AOR): 2.5 (1.5-4.1)]. Furthermore, having a history of alcohol [(AOR): 5.5 (2.4-13)], a history of smoking [(AOR): 4.6 (2.7-7.8), and congestive heart failure (AOR): 2.65 (1.5-4.6)], all increase the likelihood of pulmonary hypertension. The study revealed a higher prevalence of pulmonary hypertension among COPD patients. Significant associations were found with being male, belonging to an older age group, and having a history of alcohol use, smoking, and congestive heart disease. Implementing screening programs, smoking cessation programs, educational initiatives, and counseling patients on lifestyle modifications were recommended.

Self-Reported Comfort and Use of Tobacco Cessation Interventions by Healthcare Providers.

Background The effects of tobacco use create a significant burden on the American healthcare system.The U.S. Preventive Services Task Force (USPSTF) recommends a tobacco cessation framework consisting of asking all patients about any tobacco use, advising they quit, assessing their willingness to start a quit attempt, assisting in any attempts, and arranging follow-up. This is known as the "5A's" and is considered a standard of care for tobacco cessation. Physician-provided cessation interventions have been shown to be effective in helping patients stop their tobacco use; however, studies have shown that physicians and other healthcare providers do not consistently offer tobacco cessation interventions. This study aimed to evaluate healthcare providers' comfort with and self-reported use of tobacco cessation interventions. Methods An online survey was made available to all Penn State HealthMilton S. Hershey Medical Center physicians, physician assistants (PAs), nurse practitioners (NPs), registered nurses (RNs), and respiratory therapists (RTs). The survey assessed respondents' use of the USPSTF"5A's" cessation framework, comfort in counseling patients, use of cessation interventions, and desire for further education. Descriptive statistics were generated, and chi-square tests were used to compare differences in responses across provider groups. Results A total of 430 healthcare professionals (mean age of 40.1 years,76.1% female) responded to the survey, including 55 (12.1%) physicians, 76 (17.7%) resident/fellows, 44 (10.2%) PAs, 57 (13.5%) NPs, 146 (33.9%)RNs, and 54 (12.5%)RTs. The majority (n = 407, 95.5%) of respondents reported a belief that it is "extremely" or "very" important for their patients to stop smoking cigarettes. Although more than 160 (70%) providers reported feeling "very comfortable" or "somewhat comfortable" counseling patients who were "ready to quit" smoking, only half reported the same for patients who were "not ready to quit." There was significant variation in the use of the recommended "5A's," with NPs and attending physicians reporting the most regular use. Self-reported use of the "Ask" and "Advise" components of the "5A's" was higher than the "Assess", "Assist", and "Arrange" components, with low rates of use of pharmacologic cessation methods. Only 13 (3.2%)providers reported regularly billing for cessation counseling. Conclusions While healthcare professionals recognize the importance of tobacco cessation for their patients, gaps persist in the consistent application of the "5A's" modeland provider comfort in counseling patients to quit, particularly those perceived as "not ready to quit." This discomfort with counseling, along with hesitancy to offer cessation interventions, results in missed opportunities to help patients with tobacco use disorder. Differences in cessation practices across healthcare roles suggest opportunities for targeted improvement. Enhancing both provider training and health system interventions is essential for expanding patient access to effective cessation interventions.

Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program.

Hospitalization provides a key opportunity to address tobacco use. Few studies have examined cessation treatment in hospitals in low- and middle-income countries (LMIC). We aimed to measure tobacco abstinence among individuals discharged from a Mumbai hospital after the implementation of cessation counseling compared to abstinence among those discharged pre-implementation. Pre-post intervention study in the Prince Aly Khan Hospital, Mumbai pre- (11/2015-10/2016) and post-implementation (02/2018-02/2020) of LifeFirst counseling. LifeFirst is multi-session (up to six sessions) counseling extending from hospitalization up to six months post-discharge. Primary analyses compare self-reported 6-month continuous abstinence among hospitalized individuals post-implementation (intervention) with pre-implementation (comparator) using an intent-to-treat approach that includes all participants offered LifeFirst post-implementation in the intervention group. Secondary analyses compare those who received ≥ 1 LifeFirst session with the pre-implementation group. We enrolled n = 437 individuals pre-implementation (8.7% dual use, 57.7% smokeless tobacco, 33.6% smoking) and n = 561 post-implementation (8.6% dual use, 64.3% smokeless tobacco, 27.1% smoking). Post-implementation, 490 patients (87.3%) accepted ≥ 1 counseling session. Continuous abstinence 6-months post-discharge was higher post-implementation (post: 41.6% vs. pre: 20.0%; adjusted odds ratio [aOR]: 2.86, 95% confidence interval [CI] 1.94-4.21). Those who received LifeFirst had higher odds of continuous abstinence compared to pre-implementation (aOR: 2.95, 95% CI 1.98-4.40). Post-discharge abstinence was more common after implementation of a multi-session tobacco counseling program for hospitalized patients compared to abstinence among patients hospitalized before implementation. These findings represent observational evidence of a promising association between post-discharge abstinence and a hospital-based tobacco cessation program implemented within routine practice in an LMIC setting.

Performance Measures in the Management of ST-Segment Elevation Myocardial Infarction Patients at Manila Doctors Hospital

INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is a common and potentially fatal presentation of cardiovascular disease. Once a diagnosis is made, prompt intervention is crucial, with substantial effect on morbidity and even mortality. OBJECTIVE: The aim of this study was to assess the adherence of physicians of a tertiary care hospital to American College of Cardiology/American Heart Association and European Society of Cardiology performance measures for the management of acute STEMI patients. METHODOLOGY: This was a descriptive retrospective chart review of acute STEMI patients seen in a tertiary care hospital over a 2-year period. RESULTS: A total of 118 STEMI patients were included in the study. Mean age was 57.8 years with male predominance. High adherence rates (100% achievement score) to recommended discharge medications and counseling for smoking cessation were observed. However, performance measures for time to reperfusion therapy via percutaneous coronary intervention (average, 16.7% over 2 years) and referral to cardiac rehabilitation (average, 38.0%) were consistently low, although time to percutaneous coronary intervention improved from an average of 170 minutes to 142 minutes in the second year of this study. CONCLUSION: For 2 consecutive years, all STEMI patients seen in our institution were adequately managed with regard to recommended medications. All patients have been advised lifestyle change, particularly smoking cessation for current smokers. There is room for improvement with regards to time to reperfusion therapy and referral to cardiac rehabilitation. Some measures have been suggested, including shortening the time to secure patient consent. KEYWORDS: myocardial infarction, performance measures, STEMI

Identifying pragmatic solutions to reduce cigarette smoking prevalence in Indigenous North Americans: A sequential exploratory mixed-methods study protocol.

American Indians and Alaska Natives (AI/AN) have the highest prevalence of cigarette smoking of any race or ethnicity in the United States. Efforts to address smoking prevalence in this population have not historically targeted maintenance of smoking cessation, or behaviors associated with pregnancy. Recent longitudinal cohort studies have identified maintenance of cessation and pregnancy as potential opportunities to address smoking in AI/AN people. To promote success in achieving sustained smoking cessation in AI/AN people, we propose a community engaged sequential exploratory mixed-methods study focused on identifying pragmatic elements of cessation interventions. A discovery sample of 45 AI/AN people will be included in the qualitative study in one of two arms consisting of small groups or one-on-one interviews to develop elements of cessation interventions for evaluation in a discrete choice experiment survey. These one-on-one interviews will characterize the key drivers of smoking relapse and unique experiences of smoking during pregnancy. An additional, independent small group will consist of counselors who engage in smoking cessation counseling. A larger-scale survey will be administered to an AI/AN cohort from Olmsted County, Minnesota (n = 898). Elements of successful interventions will be used to inform a smoking cessation intervention pilot study. Community stakeholders have informed the methods outlined in this protocol, and there is a longitudinal engagement plan for the duration of study. We outline the methods to understand optimal strategies to promote sustained cigarette smoking cessation and cessation during pregnancy in AI/AN people. This study is critical to inform a pilot intervention aimed at reducing smoking prevalence in AI/AN people.