Effective Smoking Cessation Interventions Research Articles

Efficacy of approach bias modification as an add-on to smoking cessation treatment: study protocol for a randomized-controlled double-blind trial

BackgroundAlthough effective treatments for smoking cessation are available, long-term abstinence is the exception rather than the norm. Accordingly, there is a need for novel interventions that potentially improve clinical outcome. Although implicit information processing biases, for example approach biases for smoking-related stimuli, are ascribed a dominant role in the maintenance of tobacco dependence, these biases are hardly targeted in current treatment. Past research has shown that so-called Approach Bias Modification (AppBM) trainings, aiming to modify this bias, lead to improved long-term abstinence in abstinent alcoholic inpatients when delivered as an add-on to treatment-as-usual. Findings on the efficacy of AppBM in smoking have been inconsistent. The present large-scale clinical trial pursues two goals. First, it aims to investigate the efficacy of AppBM as an add-on to treatment-as-usual in a representative sample of adult smokers. Second, possible mechanisms of change are investigated.MethodsThe study is a randomized-controlled, double-blind, parallel-group superiority trial. We aim at a final sample of at least 336 adult smokers. Participants are allocated with a 1:1:1 allocation ratio to one of the following conditions: (1) treatment-as-usual + AppBM, (2) treatment-as-usual + Sham, (3) treatment-as-usual only. During the add-on training, participants are presented smoking-related and positive pictures and are instructed to respond by either pushing or pulling a joystick, depending on the tilt of the pictures (5○ to the left/right). During AppBM, all smoking-related pictures are tilted in the direction that is associated with pushing, thereby aiming to train an avoidance bias for smoking. All positive pictures are tilted in the direction associated with pulling. During Sham, the contingency is 50/50. Participants are assessed before and after the intervention and at a 6-month follow-up. The primary outcome is prolonged abstinence, and secondary outcomes include smoking-related variables and psychological distress. Additionally, the motivational significance of smoking-related stimuli (i.e., approach bias, valence) is assessed with different experimental tasks (Approach-Avoidance Task; Single Target Implicit Association Test) and psychophysiological measures.DiscussionThis is the first large-scale clinical trial investigating the efficacy of AppBM as an add-on in smokers including a TAU only condition. Additionally, it is the first study to systematically investigate potential mechanisms mediating the effects of treatment on clinical outcome.Trial registrationGerman Clinical Trials Register, DRKS00019221, 11/11/2019

Ayahuasca and tobacco smoking cessation: results from an online survey in Brazil.

Smoking-related disease is a major problem globally. Effective smoking cessation treatments are however limited. Increasing evidence suggests that psychedelics have potential as treatments for substance use disorders and may therefore prove an option in aiding smoking cessation. To establish which factors predict smoking cessation in people who reported quitting or reducing smoking following ayahuasca consumption. A retrospective cross-sectional mixed-method study (quantitative and qualitative design) was undertaken using data from an online survey evaluating peoples' experiences before and after drinking ayahuasca. Multivariate logistic regression was performed with smoking condition (cessation or reduction/relapse) as a dependent variable and demographics, smoking, ayahuasca-related variables and the mystical experience (MEQ30) as predicting factors. A total of 441 responses were grouped according to self-reported smoking status: cessation (n = 305) or reduction/relapse (n = 136) smoking. Logistic regression showed that mystical experience (OR: 1.03; 95% CI [1.00-1.05]) and frequency of ayahuasca intake (OR: 2.16[1.00-4.70]) were protective factors, while positive mood (measured by the MEQ30) during the ayahuasca experience was a risk factor (OR: 0.91[0.85-0.97]). Qualitative thematic analysis identified eight themes (e.g. acquired awareness, spiritual experience, increased motivation) related to the ayahuasca experience and the process of smoking cessation/reduction. Our results suggest that ayahuasca could be used as a potential tool for smoking cessation, and that effects may be mediated by mystical experience. Given the current burden of smoking-related disease and the limited treatment options, studies are needed to investigate the efficacy of psychedelics in smoking cessation.

Abstract TP72: Cost Effectiveness Of Smoking-Cessation Interventions Following Ischemic Stroke And Transient Ischemic Attack

Introduction: The cost effectiveness of smoking-cessation interventions after ischemic stroke and TIA has not been evaluated. We performed a cost-effectiveness analysis of smoking-cessation interventions in this population. Methods: We constructed a decision tree model to compare brief counseling alone to 3 interventions: varenicline, any pharmacotherapy with intensive counseling, and monetary incentives. Direct health care costs of interventions and outcomes were modeled. The outcomes were recurrent stroke, myocardial infarction, and death using a 5-year horizon. Estimates and variance for the base case (42% cessation), costs and effectiveness of interventions, and outcome rates were imputed from the stroke literature. Using standard techniques, we calculated incremental cost-effectiveness ratios (ICER) and net-monetary benefits (NMB). An intervention was considered cost effective if the ICER was less than the standard willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) or when the NMB was maximized. Sensitivity analyses and a probabilistic Monte Carlo simulation modeled the impact of parameter uncertainty, including for the base case cessation rate and costs and effectiveness of interventions (TreeAge Pro). Results: All three interventions were cost effective based on the ICER: varenicline - $7,422/QALY, pharmacotherapy with counseling - $14,550/QALY, and monetary incentives - $23,280/QALY. In one-way sensitivity analyses, interventions costing up to $1,729 remained cost-effective. In a two-way sensitivity analysis varying the cost and effectiveness of smoking-cessation interventions, all three interventions were cost effective based on NMB (Figure). In 10,000 Monte Carlo simulations, smoking-cessation interventions were cost effective 90% of the time, as compared to brief counseling alone. Conclusion: Smoking-cessation strategies are cost effective in secondary prevention after stroke and TIA.

Electronic cigarettes as a harm reduction strategy among patients with COPD: protocol for an open-label two arm randomized controlled pilot trial

BackgroundSmoking cessation is the most effective means of slowing the decline of lung function associated with chronic obstructive pulmonary disease (COPD). While effective smoking cessation treatments are available, they are underutilized and nearly half of people with COPD continue to smoke. By addressing both nicotine and behavioral dependence, electronic cigarettes (EC) could help people with COPD reduce the harm of combustible cigarettes (CC) through reductions in number of Cigarettes per Day (CPD) or quitting CC completely. The purpose of this pilot study is to identify barriers and facilitators to the use of and assess the preliminary effectiveness of EC as a harm reduction strategy among people with COPD.MethodsIn an open-label two-arm randomized controlled trial pilot study, 60 patients identified as smokers with a COPD diagnosis via electronic health records from a large urban health center are randomized in a 1:1 ratio to either standard care [counseling + nicotine replacement therapy (NRT)] or counseling + EC. The NRT arm will receive nicotine patches and nicotine lozenges for 12 weeks. The EC arm will receive EC for 12 weeks. Both cohorts will receive counseling from a licensed mental health counselor. Using ecological momentary assessment, participants will report their use of CC in both arms and EC use in the EC arm daily via text message. Primary outcomes will be feasibility and acceptability of intervention, and secondary outcomes will be reduction in CPD and change in COPD symptoms as measured by COPD Assessment Tool (CAT) score at 12-weeks. EC displacement of CC. To explore attitudes towards the use of EC as a harm-reduction strategy for patients with COPD, interviews will be performed with a sample of participants from both study arms.DiscussionDespite decades of availability of smoking cessation medications, nearly half of people with COPD still smoke. This study aims to address the unmet need for feasible and effective strategies for reducing CC use among those with COPD, which has the potential to significantly improve the health of people with COPD who smoke.Trial Registration ClinicalTrials.gov Identifier: NCT04465318.

Effectiveness of smoking cessation interventions in dental settings: A randomized controlled trial

Background: Smoking is associated with increased overall morbidity and mortality. Globally, more than 6 million deaths per year are related to smoking. The aim of the study was to assess the effectiveness of motivational interviewing (MI), MI in combination with bupropion 150 mg (milligrams), and MI in combination with bupropion and nicotine chewing gums (2 mg) (nicotine replacement therapy [NRT]) in smoking cessation. Materials and Methods: A double-blind, 6-month, parallel, randomized controlled trial was conducted among healthy smokers who were motivated to quit smoking. Based on the sample size estimation, 132 heavy smokers with moderate-to-high dependence were randomized to one of the three intervention groups: A: MI + Placebo, B: MI + bupropion, and C: MI + NRT + bupropion. Interventions were delivered for 3 months. The main outcome was self-reported continuous abstinence rates at 6 months. The data were analyzed using the Mann–Whitney U test, Kruskal–Wallis test, Wilcoxon signed-rank test, and Pearson's Chi-square test with P value fixed at 0.05. Results: The study participants included predominantly males (98.5%) with a mean age of 35.1 ± 9.32 years. The overall continuous abstinence rate at 6 months was 18.9%. The continuous abstinence rates were 12.2%, 22.2%, and 23.4% in Group A, B, and C, respectively (P = 0.318). There was no significant difference in 7-day point prevalence abstinence from smoking at the end of 3 months in between the three groups (P = 0.06). Conclusion: MI plays a significant role in smoking cessation and offers benefits comparable to pharmacotherapies and hence can be used as an integral part of smoking cessation interventions.

The Effectiveness and Harms of Screening for Chronic Obstructive Pulmonary Disease: An Updated Systematic Review and Meta-Analysis.

BackgroundThis study aimed to perform meta-analyses to update a previous systematic review (SR) conducted by the US Preventive Services Task Force (USPSTF) to evaluate the benefits and harms of screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults.MethodsMEDLINE, EMBASE, Cochrane Library, and regional databases were searched from their inception to January 2020. Studies for diagnostic accuracy, preventive services effect, treatment efficacy, and treatment harms were included.ResultsEighteen studies were included, and twelve of these were newly added in this update. In meta-analyses, the pooled sensitivity and specificity for COPD diagnosis using spirometry were 73.4% and 89.0%, respectively. The relative effect of smoking cessation intervention with screening spirometry, presented as abstinence rate, was not statistically significant (risk ratio [RR], 1.21; 95% confidence interval [CI], 0.87–1.67) when all selected studies were pooled, but screening on smoking cessation was effective (RR, 1.58; 95% CI, 1.14–2.19) when limited to studies with smoking cessation programs that provided smoking cessation medicines or intensive counseling at public health centers or medical institutions.ConclusionIn this study, no direct evidence for the impact on health outcomes of screening asymptomatic adults for COPD was identified similar to the previous SR. Further research is necessary to confirm the benefits of COPD screening.

Effectiveness of smoking cessation intervention in opioid-dependent male subjects on buprenorphine maintenance treatment: An open-label trial.

High prevalence (more than 80%) rates of tobacco smoking have been found both in, opioid-dependent subjects and among opioid-dependent subjects on opioid substitution treatment (OST) with buprenorphine or methadone. We aimed to explore the efficacy of combined nicotine replacement therapy (NRT) and individual counseling (IC) when compared to NRT alone in subjects on OST with buprenorphine. This study was carried out in a tertiary medical care center. It was an open-label randomized clinical trial. A total of 57 buprenorphine maintained smokers were recruited and randomized into two groups. They were assigned nicotine gum for 4 weeks plus either (1) a baseline IC session, and a second IC session after 1 week, or (2) simple advice to quit. In the first group, 31 subjects received NRT with IC and in the second group, 26 subjects received NRT plus simple advice to quit. The primary outcomes of this study were seven days point prevalence abstinence, biochemically confirmed by carbon monoxide (CO) breath analyzer, and reduction in smoking (mean no. of cigarettes or bidis/day). The smoking behavior during the 4 weeks follow-up period was assessed by the timeline follow-back (TLFB) method and confirmed by the CO breath analyzer. The group of subjects who received NRT with IC showed higher rates of smoking cessation at the end of treatment (51%) as compared to the NRT and simple advice group where smoking cessation rates were around 8% (P < 0.001). A multi-component approach (pharmacotherapy and counseling) enhances treatment outcomes and enhances rates of abstinence from smoking.

Varenicline for Gradual Versus Abrupt Smoking Cessation in Poorly Motivated Smokers With COPD: A Prematurely Terminated Randomized Controlled Trial.

Although smoking is the leading cause of chronic obstructive pulmonary disease (COPD), many patients with COPD smoke, highlighting the need for effective smoking cessation interventions in this population. This study examined the efficacy and safety of varenicline in increasing smoking cessation rates through "gradual" versus "abrupt" cessation in COPD patients with low motivation to quit smoking. A randomized, open label, 30-week, controlled trial (ClinicalTrials.gov identifier: NCT02894957) was conducted between January 2019 and October 2020 at a center in Israel. Smokers with COPD, poorly motivated to quit, were randomized to 6 weeks of varenicline for smoking reduction and a target quit day (TQD) at the end of week 6 (gradual cessation group) or ad libitum smoking for 5 weeks, 1 week of varenicline, and a TQD at the end of week 6 (abrupt cessation group). After the pre-quit phase, both groups received 12-week regular varenicline treatment and 12-week follow-up. Primary outcome was biochemically-validated continuous abstinence for weeks 6-30. Secondary outcomes were: (1) biochemically-confirmed7-day point prevalence abstinence for weeks 4-30, (2) efficient smoking reduction (≥50% in number of cigarettes/day) in the pre-quit phase; and (3) number of cigarettes/day, motivation to quit, and changes in respiratory symptoms and spirometry from baseline through week 30. A drug recall issued by the study sponsor stopped the study after 70/242 (28.9%) patients had been enrolled. The gradual cessation group (n=29) had significantly higher continuous abstinence rates from TQD through week 30 versus the abrupt cessation group (n=41): 20.7% versus 4.9% (odds ratio [OR]=5.09; 95% confidence interval [CI] 0.89-29.17; p=0.048) and higher 7-day point prevalence abstinence levels at all time points but week 18 (p=0.027 at week 6, 0.056 at week 7, and 0.096 at week 9). Motivation to quit increased (p=0.002) and the number of cigarettes/day decreased (p=0.002) over time in both groups. Respiratory symptoms, but not spirometry, improved in both groups at week 30. Treatment was safe and well tolerated. In poorly motivated smokers with COPD, using varenicline for a 6-week gradual smoking cessation before TQD, compared with abrupt cessation, significantly increased quit rates up to 6 months. Results were not affected by the smaller-than-expected sample size. Further studies are needed to confirm these data.

Identifying Active Ingredients, Working Mechanisms, and Fidelity Characteristics Reported in Smoking Cessation Interventions in Dutch Primary Care: A Systematic Review.

Background Evidence-based smoking cessation interventions provided by healthcare professionals can be successful in helping citizens to quit smoking. Yet, evidence is needed about the active ingredients of these interventions, how these ingredients work and how they are implemented in practice. Such knowledge is required to effectively support healthcare professionals to optimally put evidence-based smoking cessation interventions to (inter)national practice.ObjectiveTo identify active ingredients (including behavior change techniques), mechanisms of action and implementation fidelity reported in smoking cessation interventions in Dutch primary care settings and to relate these to intervention effectiveness.MethodsA systematic review was conducted by searching nine national intervention or funding databases, five international scientific databases and consulting 17 national smoking cessation experts. Out of 1066 identified manuscripts, 40 interventions were eligible for this review. Based on published protocols, information regarding behavior change techniques and mechanisms of action was systematically abstracted. Additionally, information regarding study characteristics and other active ingredients, effects on smoking behavior and implementation fidelity was abstracted. Comparative effectiveness concerning abstracted intervention characteristics was qualitatively explored.ResultsActive ingredients, mechanisms of action and implementation fidelity were moderately to poorly reported. Interventions applying behavior change techniques and interventions with a single behavioral target (i.e. smoking-only versus multiple behaviors) seemed to provide stronger evidence for successfully changing smoking behavior.ConclusionAttention to and reporting on interventions’ active ingredients (e.g. behavior change techniques), mechanisms of action and implementation fidelity are prerequisites for developing more effective evidence-based smoking cessation interventions to be successfully implemented in primary healthcare.ImplicationsThis systematic review provides an overview of smoking cessation interventions in Dutch primary care settings, identified since the year 2000. Smoking cessation support is offered in various forms, but our qualitative findings show that interventions including more behavior change techniques and interventions targeting only smoking cessation (compared to multiple behaviors) might be more effective. Results also show that—based on available intervention reports—it is difficult to distinguish patterns of active ingredients (such as behavior change techniques), mechanisms of action and fidelity of implementation in relation to interventions’ effectiveness. This means (quality of) reporting on these intervention characteristics should improve.

Perceived Barriers to and Recommendations for Cessation among Poly-tobacco-using Young Adults

Objective: Young adult tobacco users are at an increased risk for using non-cigarette tobacco products and have high poly-use rates. We interviewed poly-tobacco-using young adults from an urban community to explore characteristics associated with their poly-tobacco use, perceived barriers to tobacco cessation, and recommendations for and interest in cessation programs. Methods: We conducted 17 focus group discussions with 97 poly-tobacco-using young adults. Interviews were analyzed using framework analysis and quantitative surveys were analyzed using descriptive statistics. Results: All participants reported a history of tobacco product poly-use, and 85% reported poly-use in the past 30 days. Study results indicate that this population faces multiple barriers to cessation (eg, influence of social network, easy access, anxiety management, belief in self-control, boredom), but that there is interest in utilizing mobile-based interventions and social media for cessation attempts, ultimately allowing them to manage cessation in their own time, and in a way that is more fitting with their lifestyle. Conclusions: To work toward eliminating tobacco-related cancer disparities, we must understand social and environmental factors that influence tobacco use among underserved populations so that primary prevention strategies to prevent smoking initiation may be implemented. Equally important are secondary prevention strategies that develop more targeted, effective smoking cessation interventions.

Effectiveness of Personalized Cardiovascular Risk Score on Employee Smoking Behavior: An RCT

Abstract Background Based on the Nudge Theory, an individual could make better decisions by offering small changes to the choices offered that could lead to dramatic changes in their behaviors. A cardiovascular risk score could be added to the employee health checkup report and become a good nudge for smoking employees. This study aimed to compare the effect of various personalized cardiovascular risk score reports on employee smoking cessation. Methods This three-arm randomized controlled trial recruited smoking employees of a 600-bed hospital in Bangkok, Thailand, and was conducted during January-April, 2020. The cardiovascular risk score of each participant was calculated by using the 2013 American College of Cardiology and American Heart Association guidelines. While a conventional annual checkup report was provided to all participants, intervention group A also received both smoking-positive and smoking-negative risk scores whereas intervention group B also received a smoking-positive risk score. The number of cigarettes was collected at weeks 0, 4, 8, and 12. The changes in the number of cigarettes were analyzed by using repeated measure ANOVA. Results Thirty-six smoking employees were recruited (mean age 35.67±10.54 years; male 97.2%). Two-third (66.7%) had a low cardiovascular risk. The participants smoked 53.03±47.88 cigarettes per week and 66.7% did not have the intention to quit smoking. For Group A, the number of cigarettes significantly reduced by 19.58 (p = 0.04), 28.92 (p = 0.00), and 35.50 (p = 0.00) at weeks 4, 8, and 12, respectively. For Group B, the number of cigarettes reduced by 14.25 (p = 0.13), 21.35 (p = 0.03), and 18.08 (p = 0.06) at weeks 4, 8, and 12, respectively. For Group C, the number of cigarettes increased by 0.42 (p = 0.96), 5.89 (p = 0.54), and 12.44 (p = 0.20) at weeks 4, 8, and 12, respectively. Conclusions Cardiovascular risk score in an employee checkup report could be a simple yet effective intervention for smoking cessation. Key messages Based on the Nudge Theory, an individual could make healthier decisions by offering small changes to the choices offered that could lead to a reduction in cigarette consumption. Cardiovascular risk score in an employee checkup report could be a simple yet effective intervention for smoking cessation.

Association between self-reported motivation to quit smoking with effectiveness of smoking cessation intervention among patients hospitalized for acute coronary syndromes in Switzerland

Guidelines recommend brief smoking cessation interventions for hospitalized smokers reporting low motivation-to-quit. However, an intensive smoking cessation intervention may improve smoking cessation for these smokers. We conducted a secondary analysis of a pre-post interventional study that tested the efficacy of a proactive approach systematically offering intensive smoking cessation intervention to all hospitalized smokers with acute coronary syndrome (ACS) compared to a reactive approach offering it only to smokers willing to quit.We analyzed data from one study site in Switzerland, which recorded motivation-to-quit smoking at study inclusion between 08.2009 and 02.2012. The primary outcome was smoking cessation at 1- and 5-year. We tested for interaction by participant’s motivation-to-quit score (low vs. high motivation), and calculated multivariable adjusted risk ratios (RR), stratified by motivation score.We obtained motivation scores for 230 smokers. Follow-up was 94% (217/230) at 1-year and 68% (156/230) at 5-year. Among participants with low motivation to quit, 19% of smokers in the reactive phase had quit at 1 year compared to 50% of smokers in the proactive phase (multivariable adjusted RR = 2.85, 95%CI:0.91–8.91). Among highly motivated smokers, rates did not differ between phases: 48% vs. 49% (multivariable adjusted RR = 1.02, 95%CI:0.75–1.39, p-value for interaction between motivation-to-quit categories = 0.10). At 5-year follow-up, the point estimates were similar.While our study has limitations inherent to the study design and sample size, we found that a proactive approach to offer systematic smoking cessation counseling for smokers with ACS reporting low motivation to quit was associated with higher smoking cessation rates at 1 year.

Smoking cessation interventions for pregnant women attending treatment for substance use disorders: A systematic review.

Background and aimsUp to 95% of pregnant women seeking treatment for alcohol and other drug (AOD) use smoke tobacco. Previous reviews indicate few effective smoking cessation treatments for this group. This updated review aimed to identify and measure the efficacy of smoking cessation interventions trialled among pregnant women in AOD treatment settings who smoke tobacco.MethodsA narrative synthesis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Studies involving psychological, behavioural or pharmacological interventions used to treat tobacco use, including electronic nicotine delivery systems, for pregnant women of any age, who smoked tobacco and were seeking/receiving treatment, or in post‐treatment recovery for AOD concerns, were reviewed. MEDLINE, PsycINFO, CINAHL, EMBASE and ProQuest databases, grey literature and reference lists were searched, and field experts were contacted for unpublished study data. The Effective Public Health Practice Project tool assessed study quality. The review was pre‐registered with PROSPERO no. CRD42018108777.ResultsSeven interventions (two randomised controlled trials, two single‐arm pilot studies, two program evaluations and one causal comparative study) treating 875 women were identified. All were United States (US)‐based and targeted women with drug dependence, but not alcohol dependence. Three interventions used contingency management, five provided behavioural counselling, and one offered nicotine replacement therapy. All reported reductions in cigarette consumption; one contingency management‐based study demonstrated higher abstinence rates compared with controls at treatment‐end that were not maintained at follow‐up. Four of six studies were rated as methodologically weak and one unpublished study was not rated.ConclusionsConclusions about the efficacy of smoking interventions for pregnant women with alcohol and other drug concerns who also smoke tobacco are hindered by the paucity of available data and poor methodological quality of included studies.

Risk of neuropsychiatric adverse events associated with varenicline treatment for smoking cessation among Dutch population: A sequence symmetry analysis.

PurposeVarenicline is an effective treatment for smoking cessation. While clinical trials did not confirm a causal role, case reports suggested a possible link of varenicline with neuropsychiatric adverse drug events (NPAEs). This study aims to investigate the risk of NPAEs associated with varenicline initiation among the general population in a real‐world setting.MethodsWe conducted a sequence symmetry analysis (SSA) based on the University of Groningen IADB.nl prescription database. We selected incident users of both varenicline and marker drugs for NPAEs, including depression, anxiety and sleep disorder within different time‐intervals. Adjusted sequence ratios (aSR) were calculated for each time‐interval.ResultsWithin 365‐days' time‐interval 1066 patients were incident users of both varenicline and NPAE marker drugs. In total, 505 patients were prescribed varenicline before NPAE marker drugs and 561 vice versa (crude sequence ratio [cSR] 0.90, 95% CI: 0.80–1.02). After adjustments for trends in prescriptions, overall a null association was found (aSR 1.00, 95% CI: 0.89–1.13). Regarding specific NPAEs, no increased risks were found for depression nor anxiety within any time‐interval. A small transient increased risk was found for sleep disorders, particularly in earlier time‐intervals 3 and 6 months (aSRs 1.52, 95% CI: 1.10–2.11 and 1.45, 95% CI: 1.15–1.83, respectively). Subgroup and sensitivity analyses showed similar findings.ConclusionsVarenicline initiation was unlikely to be associated with an increased risk of taking anti‐depressants nor anti‐anxiety drugs. Yet a small, but statistically significant, transient association with drugs for sleep disorders was noticed, possibly associated with withdrawal symptoms caused by smoking cessation.

The effectiveness of smoking cessation interventions in promoting long-term quitting habits: A systematic review

The effectiveness of smoking cessation interventions in promoting long-term quitting habits: A systematic review

Modelling long-term cost effectiveness of smoking-cessation interventions in people with mental disorders

Modelling long-term cost effectiveness of smoking-cessation interventions in people with mental disorders

The use of the theory of planned behavior variables in predicting the intention of waterpipe tobacco smoking cessation among Iranian consumers

ABSTRACT Background Waterpipe tobacco smoking is an emerging threat to public health in Iran. The research objective was to examine the ability of the Theory of Planned Behavior (TPB) variables to predict the intention to stop waterpipe tobacco smoking among a group of Iranian waterpipe smokers. Methods This cross-sectional study was carried out among the residents of two villages in Shiraz, Southern Iran, from November 2016 to April 2017. The demographic and TPB variables were assessed using a questionnaire. Multiple linear regression (enter method) was applied to specify the predictors of participants’ intention to stop waterpipe smoking based on TPB variables. Results The mean age of participants was 38.36 years (SD = 11.84). All TPB variables were significantly related to the intention of waterpipe tobacco smoking cessation. The findings showed that TPB variables only explained 19.1% of the variance in the intention to quit waterpipe tobacco smoking (R2 = 0.191, F = 21.72, p < .001). Result also revealed the highest weights related to the subjective norms (β = 0.264). Conclusions The predictive power of TPB in terms of the intention to quit waterpipe tobacco smoking was very low. Other behavioral change theories and models need to be studied to select the best theoretical framework for developing effective waterpipe tobacco smoking cessation interventions. Abbreviation: TPB: Theory of Planned Behavior; PBC: Perceived Behavior Control; SN: Subjective Norms

Occupational Health Nurses' Self-Efficacy in Implementing Smoking Cessation Interventions for Workers: A Manufacturing Company Quality Improvement Project.

Effective smoking cessation interventions (SCIs) are urgently needed for the working population where smoking continues at high rates. Occupational health nurses (OHNs) could be effective in providing SCI, but self-efficacy was found to be a major barrier. The purpose of this study was to improve the delivery of SCI to those who smoke in the workplace and to explore nurse self-efficacy. Pretest and posttest were conducted on two groups, OHNs (n = 5) and smokers (n = 11) working at U.S. manufacturing facilities. OHNs were trained on motivational interviewing (MI) techniques who then recruited smokers to help them practice their newly acquired skills. The two groups were measured by Likert-type scale for OHN self-efficacy and smoker level of change toward quitting. Paired t-tests detected statistically significant differences in OHN's preintervention and postintervention self-efficacy scores, t(4) = -4.46, p < .001,; d = 2.92) and smokers' preintervention and postintervention stage of change toward quitting scores, t(10) = -9.07, p < .001,; d = 2.09), suggesting that the training and MI intervention were effective in increasing OHN self-efficacy and smokers' motivation to change. This quality improvement (QI) project indicated smokers can be successfully recruited and counseled using MI techniques, while simultaneously improving OHN self-efficacy toward helping patients. Theory-based applications brought OHNs and smokers together in a new paradigm resulting in positive changes for both. Secondary findings in the reverse nurse-patient role revealed success in an innovative recruitment method for smoking cessation.

Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration.

Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.

History and Correlates of Smoking Cessation Behaviors Among Individuals With Current or Past Major Depressive Disorder Enrolled in a Smoking Cessation Trial.

Smoking among adults with major depressive disorder (MDD) is at least double that of the general US population. More effective smoking cessation interventions for depressed smokers may be facilitated through a better understanding of the smoking and depression-related characteristics of this population. We used baseline data from 300 participants enrolled in randomized clinical trial for smokers with current or past MDD. We described history of smoking cessation behaviors (ie, quit attempts, quit motivation, and cessation treatment utilization) and used multivariate regression to identify demographic and depression-related correlates of these behaviors. Sixty-eight percent of participants reported at least one quit attempt in the past year, nearly 51% reported motivation to quit in the subsequent 30 days, and 83% reported prior use of a nicotine replacement therapy. A greater readiness to quit smoking was associated with increased age (p = .04) and lower cigarettes per day (p = .01). Greater use of smoking cessation medication was associated with greater education and nicotine dependence, minority race, and greater use of complementary reinforcers (eg, activities associated with increased reinforcing value of smoking; p's < .05). These data indicate that smokers with current or past MDD are highly motivated to quit smoking and have a history of engaging in efforts to quit. Interventions to promote smoking cessation behaviors should address younger and lighter smokers, who may perceive less risk from tobacco use, and efforts to promote smoking cessation medications and counseling should address minority smokers who are engaging in complementary reinforcers. These data are inconsistent with the assumption that smokers with serious mental illness are not willing to quit smoking and suggest the need for studies that test behavioral interventions that address complementary reinforcers to treat tobacco use in this community.