Confirmed Smoking Cessation Research Articles

Monitoring expiratory carbon monoxide to study the effect of complete smoking cessation on definitive radiation therapy for early stage glottic carcinoma

Background Previous studies reported that cigarette smoking during radiation therapy was associated with unfavorable outcomes in various cancers using medical interviewing or monitoring of cotinine. Here, we evaluated the effect of smoking cessation on definitive radiation therapy for early stage glottic carcinoma by monitoring expiratory carbon monoxide (CO). Material and methods We enrolled 103 patients with early glottic carcinoma (T1N0/T2N0 = 79/24) who underwent conventional radiotherapy between 2005 and 2016. The median age was 70 years. Pathologically, all patients had squamous cell carcinoma. Since 2009, we confirmed smoking cessation before radiation therapy by medical interviews. Since 2014, we measured expiratory CO to strictly monitor smoking cessation. The patients were divided according to diagnosis years: ‘no cessation’ (2005–2008), ‘incomplete cessation’ (2009–2013), and ‘complete cessation’ (2014–2016). We retrospectively analyzed the local recurrence rate and disease-free survival (DFS). Results The median follow-up period was 60.1 months (range, 1.9–110.0 months). The 2-year local recurrence rate in the ‘complete cessation’ group was 5.3% and tended to be lower than that in the ‘incomplete cessation’ group (13.7%) and ‘no cessation’ group (21.2%). Multivariate analysis revealed that ‘no cessation’ was a risk factor for DFS (hazard ratio [HR] = 4.25) and local recurrence rate (HR = 16.5, p < .05) compared to ‘complete cessation.’ Discussion We confirmed that the ‘complete cessation’ group had better prognosis than the ‘no cessation’ group by monitoring expiratory CO during radiation therapy for early stage glottic carcinoma. Moreover, monitoring expiratory CO was easier and more suitable than conventional methods for evaluating smoking cessation because it provided real-time measurements.

Financial Incentives for Smoking Cessation in Hospitalized Patients: A Randomized Clinical Trial

BackgroundFinancial incentives for smoking cessation and use of evidence-based therapy may increase quitting rates and reduce health and economic disparities. MethodsWe randomized a low-income population of 182 hospitalized patients (mean age 58 years, 45% with high school education or less) to enhanced usual care, which included hospital-directed cessation care and Quitline referral or enhanced usual care plus financial incentives. All patients received enhanced usual care, while participants randomized to the financial incentives group were also eligible to receive up to $550 for participation in Quitline counseling ($50), participation in a community-based cessation program ($50), use of pharmacotherapy ($50), and biochemically confirmed smoking cessation at 2 months ($150) and 6 months ($250). Primary outcome was biochemically confirmed smoking cessation at 6 months after hospital discharge. ResultsTotal mean payment was $84 (standard deviation [SD] = $133) in the incentive group. The 6-month rate of biochemically confirmed smoking cessation was 19.6% in the incentive group and 8.9% in the enhanced usual care group (odds ratio [OR] 2.56; 95% confidence interval [CI] 0.84 to 7.83, P = 0.10). Participants in the incentive group had higher rates of nicotine replacement therapy use (57.3% vs 31.3%, P = 0.002). Financial incentives did not improve subjective social status but did increase financial stress. ConclusionsRates of bioconfirmed smoking cessation were higher among hospitalized patients randomized to financial incentives compared to usual care alone, but the difference was not significant. Considering the frequency of low payouts and the importance of assistance for successful quitting, future studies should explore the effectiveness of financial incentives sufficiently large to overcome barriers to evidence-based therapy.

Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial.

BackgroundMindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources.ObjectiveThis pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation.MethodsA total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person).ResultsStrong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully.ConclusionsText messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting.Trial RegistrationClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819

Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant Women

Maternal smoking places the child at risk during pregnancy and postpartum. Most women who quit smoking do so early when they first learn of pregnancy. Few low-income women quit once they enter prenatal care. The purpose of this study is to test in a clinical prenatal care setting the effectiveness of the Smoke-Free Moms intervention, which provides pregnant women a series of financial incentives for smoking cessation. A prospective nonrandomized controlled trial that collected control population data of smoking-cessation rates at each clincal visit during pregnancy and postpartum with usual smoking counseling in 2013-2014. In 2015-2016, the same data were collected during the implementation of the Smoke-Free Moms intervention of financial incentives. Data analysis occurred in 2017. Women who were smoking at the first prenatal visit at four federally qualified health centers in rural New Hampshire. All women received 5A's smoking counseling from clinic staff. At each clinic visit, with point-of-care confirmed negative urinary cotinine, intervention women received gift cards. Cotinine confirmed smoking cessation without relapse: (1) during pregnancy and (2) smoking cessation in both pregnancy and postpartum. Of 175 eligible pregnant women enrolled, 134 women were followed to the postpartum visit (Intervention n=66, Control n=68). The quit rates during pregnancy did not differ between groups (Intervention 36.4%, Control 29.4%, p=0.46). However, significantly more intervention mothers quit and continued as nonsmokers postpartum (Intervention 31.8%, Control 16.2%, p=0.04). In a logistic regression model including baseline sociodemographic, depressed mood, stress, and readiness to quit items, confidence in being able to quit predicted both cessation outcomes. The financial incentive intervention was an independent predictor of cessation in pregnancy through postpartum. Financial incentives with existing smoking-cessation counseling by staff in low-income clinical prenatal programs led to cessation that continued during the postpartum period. Further study in larger populations is indicated.

Biochemically confirmed smoking cessation and gestational weight gain.

Prenatal smoking cessation has substantial health benefits for mothers and offspring, but concerns about weight gain may be a barrier to quitting. We quantified gestational weight gain associated with biochemically confirmed smoking cessation. Data originated from a randomized controlled cessation trial: Smoking Cessation in Pregnancy project (1987-1991). We calculated gestational weight gain using self-reported prepregnancy weight and measured weight at 30-34weeks of gestation. We used linear regression to estimate adjusted mean differences in gain for quitters versus continuing smokers by the last trimester. The effects of quitting earlier (by 2nd trimester) versus later (by 3rd trimester) were calculated. We assessed the percentages who gained weight according to Institute of Medicine (IOM) recommendations within 2weeks of a full-term delivery. At 30-34weeks, nulliparous and multiparous quitters gained an average of 3.0 pounds (95% CI 0.9-5.1 pounds) (1.4 kg [0.4-2.3 kg]) and 6.6 pounds (95% CI 4.3-8.9 pounds) (3.0 kg [1.9-4.0 kg]) more, respectively, than continuing smokers. Weight gain in early quitters did not differ significantly from that in late quitters. Quitters were more likely than continuing smokers to gain above current guidelines (60.3% vs 46.3%) and were less likely to gain below guidelines (11.5% vs 21.6%) (P=0.002). Although quitters had modest additional weight gain by 30-34weeks compared to continuing smokers, a high proportion in both groups gained in excess of IOM recommendations. Both quitters and continuing smokers may need support to achieve optimal gestational weight gain.

Financial IncEntives for Smoking TreAtment: protocol of the FIESTA trial and FIESTA Oral Microbiome Substudy

BackgroundSmoking is the leading preventable cause of death in the United States, but evidence-based smoking cessation therapy is underutilized. Financial incentive strategies represent an innovative approach for increasing the use of counseling and pharmacotherapy. If effective, they could supplement or supplant resource-intensive policy options, particularly in populations for whom smoking has substantial societal costs. FIESTA (Financial IncEntives for Smoking TreAtment) will randomize hospitalized smokers to receive usual smoking cessation care alone or usual smoking care augmented with financial incentives. We aim to compare the impact of these two strategies on 1) smoking abstinence, 2) use of counseling and nicotine replacement therapy, and 3) quality of life of participants. We also will evaluate the short-term and long-term return on the investment of incentives. The FIESTA Oral Microbiome Substudy will compare the oral microbiome of smokers and nonsmokers to longitudinally assess whether smoking cessation changes oral microbiome composition.MethodsWe will enroll 182 inpatient participants from the Manhattan campus of the Veterans Affairs New York Harbor Healthcare System. All participants receive enhanced usual care, including screening for tobacco use, counseling while hospitalized, access to nicotine replacement therapy, and referral to a state Quitline. Patients in the financial incentive arm receive enhanced usual care and up to $550 for participating in the New York Smoker’s Quitline, using nicotine replacement therapy (NRT), and achieving biochemically confirmed smoking cessation at 2 months and 6 months. In the microbiome substudy, we enroll nonsmoking control participants matched to each recruited smoker’s hospital ward, sex, age, diabetes status, and antibiotic use. After discharge, participants are asked to complete periodic phone interviews at 2 weeks, 2 months, 6 months, and 12 months and provide expired carbon monoxide and saliva samples at 2 months, 6 months, and 12 months for cotinine testing and oral microbiome analysis.DiscussionThe incentive interventions of FIESTA may benefit hospitalized smokers, an objective made all the more critical because smoking rates among hospitalized patients are higher than those in the general population. Moreover, the focus of FIESTA on evidence-based therapy and bioconfirmed smoking cessation can help guide policy efforts to reduce smoking-related healthcare costs in populations with high rates of tobacco use and costly illnesses.Trial registrationClinicalTrials.gov, NCT02506829. Registered on 1 July 2014.

Effect of Patient Navigation and Financial Incentives on Smoking Cessation Among Primary Care Patients at an Urban Safety-Net Hospital

ImportanceWhile the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings.ObjectiveTo evaluate a multicomponent intervention to promote smoking cessation among low-SES and minority smokers.Design, Setting, and ParticipantsFor this prospective, unblinded, randomized clinical trial conducted between May 1, 2015, and September 4, 2017, adults 18 years and older who spoke English, smoked 10 or more cigarettes per day in the past week, were contemplating or preparing to quit smoking, and had a primary care clinician were recruited from general internal medicine and family medicine practices at 1 large safety-net hospital in Boston, Massachusetts.InterventionsPatients were randomized to a control group that received an enhancement of usual care (n = 175 participants) or to an intervention group that received up to 4 hours of patient navigation delivered over 6 months in addition to usual care, as well as financial incentives for biochemically confirmed smoking cessation at 6 and 12 months following enrollment (n = 177 participants).Main Outcomes and MeasuresThe primary outcome determined a priori was biochemically confirmed smoking cessation at 12 months.ResultsAmong 352 patients who were randomized (mean [SD] age, 50.0 [11.0] years; 191 women [54.3%]; 197 participants who identified as non–Hispanic black [56.0%]; 40 participants who identified as Hispanic of any race [11.4%]), all were included in the intention-to-treat analysis. At 12 months following enrollment, 21 participants [11.9%] in the navigation and incentives group, compared with 4 participants [2.3%] in the control group, had quit smoking (odds ratio, 5.8; 95% CI, 1.9-17.1; number needed to treat, 10.4; P < .001). In prespecified subgroup analyses, the intervention was particularly beneficial for older participants (19 [19.8%] vs 1 [1.0%]; P < .001), women (17 [16.8%] vs 2 [2.2%]; P < .001), participants with household yearly income of $20 000 or less (15 [15.5%] vs 3 [3.1%]; P = .003), and nonwhite participants (21 [15.2%] vs 4 [3.0%]; P < .001).Conclusions and RelevanceIn this study of adult daily smokers at 1 large urban safety-net hospital, patient navigation and financial incentives for smoking cessation significantly increased the rates of smoking cessation.Trial Registrationclinicaltrials.gov Identifier: NCT02351609

Financial incentives for smoking cessation during pregnancy: a randomised controlled trial

BackgroundIn the UK, smoking during pregnancy kills 4000 babies annually and costs an extra £20–90 million for pregnancy and infant care. Only 5–10% of pregnant smokers quit when offered current interventions. We aimed to assess efficacy, cost-effectiveness, and acceptability of adding £400 of shopping vouchers to routine pregnancy smoking cessation services. MethodsThis study was a phase 2, single-centre, single-blinded, parallel-group individually randomised controlled superiority trial with qualitative and health economic components. Participants were self-reported pregnant smokers referred to Stop Smoking Services between Dec 15, 2011, and Feb 28, 2013, in Greater Glasgow and Clyde, Scotland. Randomisation, with allocation concealed from staff and participants, was by computer generated permuted blocks of four. 306 participants were randomised to routine care and 306 to the intervention (routine care plus incentives), giving 90% power to detect an increase in smoking cessation from 4·0% in women in the control group to 11·4% in women given incentives. Assessors of the primary outcome were masked to allocation. Women in both groups were offered routine care—namely, the offer of face-to-face contact to set a quit date, 10 weeks' free nicotine replacement therapy, and support calls weekly for 4 weeks. In addition, women in the intervention group were offered £50 in vouchers for setting a quit date, £50 if carbon monoxide confirmed smoking cessation after 4 weeks, £100 after 12 weeks, and £200 in late pregnancy (34–38 weeks' gestation). The primary outcome, analysed by intention to treat, was self-report of quitting in late pregnancy corroborated by cotinine in saliva (<14·2 ng/mL) or urine (<44·7 ng/mL). Cost-benefit analysis used routine and trial derived data. Ethics approval supported telephone consent. This trial is registered with Current Controlled Trials, ISRCTN87508788. FindingsSignificantly more smokers who were offered incentives quit than did controls (69/306 [23%] vs 26/303 [9%], 95% CI 8·3–19·5). Three control participants opted out. The relative risk of smoking in late pregnancy was 0·85 (95% CI 0·79–0·91). No harms were reported, and incentives were acceptable to clients and health workers. Short-term incremental cost per quitter was £1127 and longer-term cost per quality-adjusted life year gained was £482. InterpretationThis trial provides evidence for the efficacy and cost-effectiveness of financial incentives, which must now be tested in other centres and with varied cessation services. FundingChief Scientist Office of the Scottish Government, Glasgow Centre for Population Health, NHS Greater Glasgow and Clyde Endowments, and Yorkhill Children's Charity.

Systematic review of Swedish snus for smoking cessation based on primary subject data from randomised clinical trials

Introduction: The ability of Swedish snus to serve as a smoking cessation aid has been documented in several observational, population surveys from Scandinavia, but randomised clinical trials provide more reliable information on efficacy. Aims: To perform a systematic review and meta-analysis of randomised clinical trials of Swedish snus as an aid to smoking cessation. Methods: Literature searches were conducted in MedLine, Cochrane Library, and Embase to identify relevant clinical trials. The primary outcome was defined as biologically confirmed smoking cessation during around six months. Meta-analyses based on primary subject data tested for effect of allocated treatment as well as selected baseline characteristics. Results: There were two relevant clinical trials, one conducted at five sites in the US (n = 250), the other at two sites in Serbia (n = 319). Based on the primary outcome, success was higher in the treated group in both Serbia (5.7% vs 1.9%) and the US (4.0% vs 1.6%). Meta-analysis estimated the relative success rate at 2.83 (95% CI 1.03–7.75), which was of borderline significance (exact p = 0.06, chi-squared p = 0.03). For smoking cessation in the last 4 weeks of each study, rates were 12.4% for snus and 6.6% for placebo (RR 1.86, 95% CI 1.09-3.18). Efficacy of snus was not clearly related to any baseline characteristic. Conclusions: Swedish snus increased quit rates similarly in US and Serbia. These results confirm and extend previous information based on observational population surveys.

Presence of the carcinogen N'-nitrosonornicotine in the urine of some users of oral nicotine replacement therapy products.

N'-nitrosonornicotine (NNN) is a strong carcinogen present in unburned tobacco and cigarette smoke. We here analyze data obtained in two studies, in which a biomarker of exposure to NNN--the sum of NNN and its pyridine-N-glucuronide, called total NNN--was quantified in the urine of people who had stopped smoking and used various nicotine replacement therapy (NRT) products. In 13 of 34 nicotine gum or lozenge users from both studies, total NNN at one or more time points after biochemically confirmed smoking cessation was comparable with, or considerably higher than, the baseline levels. For most of the subjects who used the nicotine patch as a smoking cessation aid, urinary total NNN at all post-quit time points was <37% of their mean baseline levels. These results indicate that endogenous formation of significant amounts of NNN may occur sporadically in some users of oral NRT. Given the carcinogenicity of NNN and the frequent use of nicotine gum as a smoking cessation aid, further studies are needed so that preventive measures can be developed.

Impact of a cell phone intervention on mediating mechanisms of smoking cessation in individuals living with HIV/AIDS

Mounting evidence suggests that smokers living with HIV/AIDS have a significantly increased risk of numerous adverse health outcomes (both AIDS- and non-AIDS-related) compared with HIV-positive nonsmokers. Therefore, efforts to design and implement effective cessation programs for this ever-growing special population are warranted. The present study assessed the effects of a cell phone intervention (CPI) on hypothesized mediators (i.e., changes in depression, anxiety, social support, and self-efficacy) demonstrated to influence cessation outcomes in other populations. Ninety-five participants from an inner-city AIDS clinic were randomized to receive either the CPI or recommended standard of care (RSOC) smoking cessation treatment. Participants randomized to the RSOC group (n=47) received brief advice to quit, a 10-week supply of nicotine patches, and self-help materials. Participants randomized to the CPI group (n=48) received RSOC components plus a series of eight proactive counseling sessions delivered via cell phones. A series of regression analyses (linear and logistic) was used to assess the relationships between treatment group, the hypothesized mediators, and biochemically confirmed smoking cessation outcomes. Results indicated that the CPI group experienced greater reductions in anxiety and depression, and increases in self-efficacy compared with the RSOC group. Further, changes in depression, anxiety, and self-efficacy weakened the association between treatment group and cessation outcome. The mediator hypothesis, however, for social support was rejected, as the difference score was not significantly associated with treatment group. These results suggest that the efficacy of the CPI is at least partially mediated by its ability to decrease symptoms of distress while increasing self-efficacy.

Effects of Biochemically Confirmed Smoking Cessation on White Blood Cell Count

To determine the relationship between white blood cell (WBC) Indices and several baseline variables In a large cohort of healthy smokers and to assess whether these changed after biochemically confirmed smoking cessation. The study consisted of 784 healthy smokers enrolled in a trial of sustained-release bupropion, 300 mg/d, for relapse prevention after smoking cessation from 1995 to 1998. Both WBC counts and absolute neutrophil counts (ANCs) were measured at baseline, week 7, and week 52. Smoking status was assessed at weeks 7 and 52 by self-report and biochemically confirmed with expired air carbon monoxide levels. Multivariate analyses compared changes in WBC count and ANC between smokers who did and did not stop smoking, adjusting for treatment group, age, sex, and body mass index. Of 784 smokers enrolled, 461 had biochemically confirmed tobacco abstinence after 7 weeks of bupropion; 429 were randomly assigned to receive continued bupropion therapy or placebo until week 52. Between baseline and week 7, there was a significantly larger decrease in WBC count in continuously abstinent subjects compared with continuing smokers (adjusted P = .03). At 52 weeks, continuously abstinent subjects, compared with continuing smokers, had a greater decline from baseline in WBC count (1.2 +/- 1.9 x 10(9)/L vs 0.1 +/- 1.9 x 10(9)/L; P < .001) and ANC (1.0 +/- 1.6 x 10(9)/L vs 0.2 +/- 1.5 x 10(9)/L; P < .001). Biochemically confirmed tobacco abstinence leads to a rapid and sustained decrease in WBC and ANC, possibly reflecting a decrease In an underlying state of tobacco-induced inflammation.

A cluster randomised controlled trial of smoking cessation in pregnant women comparing interventions based on the transtheoretical (stages of change) model to standard care

Objectives: To evaluate the effectiveness in helping pregnant women stop smoking of two interventions (Pro-Change for a healthy pregnancy) based on the transtheoretical model of behaviour change (TTM) compared to...

Nicotine Intervention During Detoxification and Treatment for Other Substance Use

This preliminary study evaluated the efficacy of a brief smoking cessation intervention (30 controls, 34 intervention groups) on a smoke-free inpatient unit for substance use detoxification. Controls received usual care, including the transdermal nicotine patch and referral to an outpatient smoking program. The intervention group additionally received a structured motivational enhancement program. Biochemically confirmed smoking cessation rate and abstinence/reduction of alcohol or other drug use were the main outcome measures taken 6 months after treatment initiation. The smoking cessation intervention did not result in greater participation in formal outpatient smoking cessation treatment and was not associated with either enhanced smoking cessation (6 vs. 0%) or greater smoking reduction at follow-up. Both groups significantly reduced the number of cigarettes smoked per day (cpd) from about 24 at baseline to 10 cpd. The groups did not differ on abstinence from nonnicotine addictive substances. Smoking cessation treatment in substance users undergoing detoxification resulted in little or no smoking cessation advantage.

Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP)

Objective: To assess the effectiveness of a programme to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina.Design: Randomised controlled trial;...

Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year

Objective : To assess the effectiveness of health checks by nurses in reducing risk factors for cardiovascular disease in patients from general practice. Design : Randomised controlled trial. Setting : Five urban general practices in Bedfordshire. Subjects : 2136 patients receiving an initial health check in 1989-91 and scheduled to be re-examined one year later in 1990-2 (intervention group); 3988 patients receiving an initial health check in 1990-2 (control group). All patients were aged 35-64 years at recruitment in 1989. Main outcome measures : Serum total cholesterol concentration, blood pressure, body mass index, confirmed smoking cessation. Results : Mean serum total cholesterol was 2.3% lower in the intervention group than in the controls (difference 0.14 mmol/l (95% confidence interval 0.08 to 0.20)); the difference was greater in women (3.2%, P =100 mm Hg was 2.6% (55/2131) in the intervention group and 3.4% (137/3987) in the controls (difference 0.9% (0.0 to 1.7); the proportion with total cholesterol concentration >=8 mmol/l 4.8% (100/2068) and 7.6% (295/3905) (difference 2.7% (1.5 to 4.0)); and that with body mass index >=30 12.4% (264/2125) and 14.0% (559/3984) (difference 1.6% (-0.2 to 3.4)). Conclusion : General health checks by nurses are ineffective in helping smokers to stop smoking, but they help patients to modify their diet and total cholesterol concentration. The public health importance of this dietary change depends on whether it is sustained. © 1994, BMJ Publishing Group Ltd. All rights reserved.