Higher Smoking Cessation Rates Research Articles

Impact of the Ottawa model on opiate screening and smoking cessation in methadone-treated patients with opioid use disorder: A retrospective cohort analysis.

Approximately 60 million individuals worldwide used opioids in 2021, constituting 1.2% of the global adult population. This study aimed to evaluate the effectiveness of integrated treatment strategies for opioid use disorder and nicotine use disorder by assessing the impact of smoking cessation within a methadone treatment framework. In a retrospective cohort study, 53 methadone maintenance patients were divided into 16 treatment-seeking smokers (TSS) and 37 treatment-rejecting smokers (TRS) based on their participation in the Ottawa model for smoking cessation plus 16 weeks of varenicline treatment. Both groups received standard methadone treatment for 68 weeks. TSS were followed up for 44 weeks to assess smoking cessation outcomes, while TRS had none due to their lack of participation in smoking cessation treatment. The median age of the TSS group was 48 years, while that of the TRS group was 45.5 years. Males comprised 75% of TSS and 94.6% of the TRS. TSS exhibited an 83% decrease in positive opioid screen results compared to TRS (p=0.023). In TSS, peak smoking cessation success was observed at week 20, with 57% of participants maintaining carbon monoxide levels <5 ppm. The significant reduction in positive opioid screens and the high smoking cessation rate in the TSS group highlight the efficacy of combined treatment methods. This study underscores the advantages of integrating smoking cessation with methadone maintenance treatment, indicating that comprehensive approaches can substantially improve treatment outcomes.

Koori Quit Pack: A feasibility study of a multi-component mailout smoking cessation support for Aboriginal and Torres Strait Islander people: "I would recommend it to anybody. It's just so much easier".

Smoking is the leading cause of preventable death among Aboriginal and Torres Strait Islander people. The Koori1 Quit Pack study aimed to assess the feasibility of a multi-component mailout smoking cessation intervention to reduce smoking among Aboriginal and Torres Strait Islander people. A non-randomised, single-group feasibility study conducted among Aboriginal and Torres Strait Islander people who reported current smoking. The intervention package included information pamphlets and resources on quitting, referral offer to Aboriginal Quitline and optional free Nicotine Replacement Therapies (NRT). Follow-up was conducted at 2-weeks, 6-weeks, 10-weeks and 6-months post recruitment. Feasibility outcomes were recruitment and retention rates, uptake of intervention components and smoking abstinence at 6-week follow-up (primary end point). Cessation outcomes were analysed using both a complete case analysis and intention-to-treat approach. 165 participants were recruited, 111 (67.3%), 79 (47.9%), 59 (35.8%), and 94 (57%) participants completed the 2-week, 6-week, 10-week, and 6-month follow-up. At 10-week follow-up, 40.7% of participants used pamphlets and booklets, 13.6% used Quitline and > 90% used NRT. At 6-week follow-up, 87.3% reported a quit attempt and 46.8% sustained quitting. 46.8% were continuously smoke-free at the 6-week timepoint. The complete case analysis and the intention-to-treat analysis at 6-month shows a 7-day self-reported point prevalence abstinence of 34% and 19.4% respectively. The Koori Quit Pack mailout smoking cessation program was feasible to support Aboriginal and Torres Strait Islander people. The intervention resulted in a high smoking cessation rate and should be upscaled, implemented and evaluated nationally. Aboriginal and Torres Strait Islander people are disproportionately impacted by tobacco related harms, however the majority want to quit or wish they never took up smoking. Mailout cessation support is feasible, overcomes access barriers to evidence-based support and increases quitting success. We recommend a national mailout smoking cessation program is implemented for, and by Aboriginal and Torres Strait Islander people to accelerate declines in smoking prevalence to eliminate tobacco related death and disease.

Systematic review and meta-analysis of text messaging interventions to support tobacco cessation

ObjectiveTo review randomised controlled trials (RCTs) investigating the effectiveness of text message-based interventions for smoking cessation, including the effects of dose (number of text messages) and concomitant use of behavioural...

Assessing the Impact of Smoking Cessation Interventions on Periodontal Health and Gingival Inflammation in Smokers with Periodontitis

ABSTRACT Background: Smoking is a well-established risk factor for periodontitis, a chronic inflammatory disease of the oral cavity. While smoking cessation has been linked to improved overall health, its specific impact on periodontal health and gingival inflammation in individuals with periodontitis remains less explored Materials and Methods: We conducted a prospective cohort study involving 200 smokers diagnosed with periodontitis. Participants were divided into two groups: Group A received comprehensive smoking cessation interventions, including counseling and pharmacotherapy, while group B continued smoking without intervention. Periodontal health was assessed through clinical parameters, including probing depth (PD) and clinical attachment level (CAL), at baseline and 6 months post intervention. Gingival inflammation was evaluated using the Gingival Index (GI). Results: After 6 months, group A exhibited a significant reduction in mean PD (from 4.5 mm to 3.2 mm) and CAL (from 5.0 mm to 3.5 mm) compared to group B. Conversely, group B showed no significant change in these parameters. The GI score significantly decreased in group A (from 2.8 to 1.2) but remained unchanged in group B. Furthermore, group A demonstrated a higher rate of smoking cessation (72%) compared to group B (14%) Conclusion: Smoking cessation interventions play a crucial role in improving periodontal health and reducing gingival inflammation in smokers with periodontitis. The observed reductions in PD, CAL, and gingival inflammation highlight the potential benefits of smoking cessation on oral health outcomes in this high-risk population.

Evaluation of a pharmacist‐led smoking cessation service in a pulmonary clinic

AbstractIntroductionStudies have demonstrated the positive effect that pharmacist‐led smoking cessation services have on smoking cessation rates, but data regarding pharmacists' impact on smoking cessation in a pulmonary clinic are lacking.ObjectivesTo evaluate the effect of pharmacist‐led smoking cessation visits compared with routine smoking cessation counseling performed by other pulmonary practitioners on smoking cessation rates and outcomes in a population with significant pulmonary disease.MethodsThis was a single center, retrospective, observational cohort study comparing patients who were solely counseled on smoking cessation by a practitioner during their pulmonary clinic appointment to patients who received smoking cessation services from a pharmacist. The primary outcome was a comparison of the percentage of patients who self‐reported cessation at 1, 6, and at 12 months from their initial visit between both cohorts. Other outcomes included the rate of relapse, rate of asthma and chronic obstructive pulmonary disease exacerbations, and time spent counseling patients. Continuous variables were analyzed with an independent samples t‐test or Mann–Whitney U‐test as appropriate. Pearson's chi‐square or Fisher's exact test was used to analyze categorical data.ResultsIn total, 149 patients counseled by a pharmacist met the inclusion criteria for the study. A matched cohort of 88 practitioner‐managed patients was used for comparison. Patients managed by the pharmacist achieved higher cessation rates at 1 and 6 months compared with those managed by practitioners, though results were not statistically significant. Patients managed by the pharmacist had significantly higher quit rates at 12 months compared with those managed by practitioners, with 21 patients (14.1%) quitting in the pharmacist‐managed group versus 5 patients (5.7%) in the practitioner‐managed group (p = 0.045).ConclusionPatients with significant pulmonary disease had higher rates of smoking cessation at 12 months when managed by a pharmacist compared with routine counseling provided during practitioner‐led visits.

Effect of a Best-Practice Alert on the Rate of Smoking Cessation among Pregnant Women.

This study aimed to determine if a best-practice alert (BPA) implementation increases the rate of smoking cessation during pregnancy and affects pregnancy outcomes associated with smoking. This was a pretest-posttest study design where a BPA was added to electronic medical records (EMR) of pregnant persons who reported active smoking. The BPA provided the 5A's method to conduct counseling on smoking cessation. The rates of smoking cessation during pregnancy were compared 1.5 years before and after implementation of the BPA. Secondary outcomes examined whether counseling on smoking cessation was done, the number of the counseling sessions during pregnancy, and obstetric outcomes associated with maternal smoking. After implementation of the BPA, the rate of smoking cessation in pregnancy increased from 17.5% prior to BPA implementation to 54.9% after BPA implementation (p < 0.001). The rate of counseling on smoking cessation increased from 66.6% prior to BPA implementation to 95.6% after BPA implementation, with an increase noted also in the number of smoking cessation counseling sessions. In multivariate analyses, after controlling for maternal demographic and clinical factors, BPA implementation was significantly associated with higher rates of smoking cessation (adjusted odds ratio [aOR]: 3.44, 95% confidence interval [CI]: 2.17-5.51), higher rates of documented smoking cessation counseling in the EMR (aOR: 12.44, 95% CI: 6.06-25.64), and higher odds of conducting the counseling more than once (aOR: 6.90 95% CI: 4.45-10.88). The rate of smoking cessation and number of times pregnant persons were counseled increased after implementation of a BPA. The BPA could be a useful EMR tool to increase smoking cessation rates during pregnancy. · Smoking during pregnancy is a maternal and fetal concern.. · Prenatal care offers the chance to address smoking.. · BPA increases rates of smoking counseling and cessation..

High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders

Background:Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation.Methods:We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation.Results:High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit.Conclusion:As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

Effect of Smoking Type, Smoking Cessation-related Psychological Factors and Nicotine Dependence on Smoking Cessation in Working Female Smokers

Objectives: Recently, female smokers are increasing in Korea. This study aims to report the dependence of nicotine and the type of smoking as a factor influencing the success of smoking cessation among female smokers.Methods: Data were collected from the Comprehensive information system for smoking cessation service, and data from 862 women who used the smoking cessation service by Gyeongnam Tobacco Control Center between June 2015, and December, 2018, were used. After controlling demographic and smoking-related variables, a multiple logistic regression analysis was performed on the relationship between nicotine dependence, smoking type, smoking cessation related psychological factors and smoking cessation.Results: The smoking cessation rate of female smokers was 7.8%. Smoking type and nicotine dependence were low in stimulus-seeking type, and high in addiction, habit type, and complex type. After controlling demographic, health behavior and disease variables, the factors affecting female smokers’ smoking cessation were nicotine dependence (odds ratio, OR = 0.49, p= 0.020), preparation (OR = 7.14, p= 0.015), confidence (OR = 7.14, p= 0.015) of smoking cessation. In other words, smoking cessation among women who smoked was higher in the high group than in the group with low anti-smoking preparation and confidence and smoking cessation was higher in the low group than in the high group of nicotine dependence.Conclusions: The actual smoking cessation strategy for women considering related factors of smoking cessation is to reconsider the content of counseling interventions according to the type of smoking and to reduce the dependence of nicotine through a treatment approach for each type, resulting in a higher smoking cessation rate.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Commentary: Electronic Nicotine Delivery Systems: Seeing Through the Clouds.

Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial.

BackgroundCardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.ObjectiveThis study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).MethodsAll 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables.ResultsThere was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic −27.7 vs −16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic −25.3 vs −16.4 mm Hg; P=.02, and diastolic −13.4 vs −9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25.ConclusionsComplementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.Trial RegistrationClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-3118-1

Embedding comprehensive smoking cessation programs into community clinics: study protocol for a cluster-randomized controlled trial

BackgroundCigarette smoking among adults in the USA is a leading cause of preventable death worldwide, even though there has been a decline in prevalence since 2005. The addictive nature of nicotine is the chief reason smokers continue to use tobacco. Although the majority of smokers report a desire to quit smoking, a small minority who attempt to quit achieve long-term cessation. Combined, smoking cessation best practices include coordinated medication and behavioral treatments. However, these treatments are not currently adequately delivered to Medi-Cal beneficiaries in the publicly funded patient-centered medical homes (PCMHs) and community mental health clinics operated by Los Angeles County (LAC)-Department of Health Services (LACDHS) and LAC-Department of Mental Health (LACDMH).MethodsThis is a 5-year implementation, cluster-randomized comparative effectiveness trial that will support the implementation of smoking cessation services delivered in LAC-LACDHS-operated outpatient primary care clinics and in LAC-LACDMH-operated community mental health clinics. We will enroll 1000 participants from clinics that will offer smoking cessation services and 200 from clinics that will offer treatment as usual. Participants will be asked to complete assessments at baseline, 3 months, 6 months, and 12 months. The assessments will include self-reports on smoking history, anxiety, stress, quality of life, and participant satisfaction. Participants who are assigned to clinics that provide smoking cessation services will also be asked about the frequency of their participation in the smoking cessation services during the 12-month period.DiscussionThis study will evaluate the effectiveness and feasibility of implementing smoking cessation services in outpatient primary care and community mental health clinics. It will also determine if there will be higher rates of smoking cessation in the implementation sites as compared to the sites with treatment as usual. If the implementation proves to be effective, the plan is to sustain these services using a workflow we will develop in the LAC-operated sites. This would lead to ameliorating the significant smoking cessation treatment gaps among those served within the LAC Health Agency departments.Trial registrationClinicalTrials.gov NCT04717544 “Embedding comprehensive smoking cessation programs into community clinics.” Registered on January 22, 2021

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.

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.

SCREENING QUESTIONS AS AN EFFECTIVE PREDICTOR OF SMOKING CESSATION SUCCESS IN A SMOKING CESSATION PILOT PROGRAM

TOPIC: Tobacco Cessation and Prevention TYPE: Original Investigations PURPOSE: Smoking cessation reduces mortality, confers morbidity benefits for the smoker and can bring about significant economic benefits for the society. Considering that smokers have varying motivational levels to quit smoking and that smoking cessation programmes can be resource and manpower intensive, the careful identification and enrollment of committed smokers into such programmes would allow the judicious use of resources to be put to the greatest effect in smoking cessation efforts. We embarked on a quality improvement project (QIP) to improve smoking cessation rates in our tertiary healthcare institution. We describe and examine the use of screening questions as an effective predictor of smoking cessation success as a pilot initiative for our QIP. METHODS: A pharmacist-driven QIP was implemented in our hospital from September 2020 to March 2021. Centred on the transtheoretical model of behaviour change, 3 screening questions were devised to screen newly admitted patients who smoked and who would potentially benefit from the hospital’s smoking cessation programme: (1) Are you currently smoking? (2) Have you thought of quitting or cutting down on smoking? (3) Would you like to speak with someone to help you with this? As a pilot initiative, all newly admitted patients who smoke and who were admitted to the 2 pilot wards over this time period would be screened by the ward nurses. Smokers who answered “yes” to all 3 questions were assessed to be at the “preparation” phase of the transtheoretical model and would be approached by the ward pharmacist for enrollment into the hospital’s smoking cessation programme, through which appropriate interventions to quit smoking would be recommended to the smokers. Interventions offered can include counselling and nicotine replacement therapy. Each enrolled smoker would be followed up by pharmacists via telephonic and/or clinic consults and smoking cessation rates were then assessed at 3 and 6 months. RESULTS: Out of a total of 1868 patients admitted to the 2 pilot wards, of which 207 were smokers, 37 smokers, comprising male and female patients with age ranging from 26-87 years old, were enrolled into the smoking cessation programme. 6 smokers were lost to follow-up and 1 patient was deceased. Smoking cessation rate at 3 months was 36% and 41% at 6 months. These smoking cessation rates were higher compared to smoking cessation rates at other centres in Singapore, which range from 24% to 27%. The proportion of smokers who had reduced cigarette smoking was 95% at 3 months and 91% at 6 months. Estimated economic benefits per year taking into account direct and indirect costs amount to at least US$52,210. CONCLUSIONS: The higher smoking cessation rates seen at the 3rd and 6th month of enrollment in the smoking cessation programme compared to other local institutions may be due to the identification of smokers who are prepared to take action to quit smoking. Significant economic benefits can also be derived from the successful smoking cessation endeavours. However, further studies are required to assess the sustained outcomes and impact of screening questions in smoking cessation programmes. CLINICAL IMPLICATIONS: Application of screening questions can help identify smokers who are prepared to take action to quit smoking. In resource conscious environments, the identification of committed smokers would enable the judicious use of resources that may yield the best chance of smoking cessation success. DISCLOSURES: No relevant relationships by JOO WEI CHUA, source=Web Response No relevant relationships by Nicholas Shaowen Goh, source=Web Response No relevant relationships by Golda Wang, source=Web Response

Associations between cancer diagnosis and patients' responses to an inpatient tobacco treatment intervention.

BackgroundDiagnosis of a chronic illness, such as cancer may influence health behavior changes, such as smoking cessation. The present analyses examine associations between a cancer diagnosis (i.e., yes or no) and response to an opt‐out smoking cessation bedside intervention provided to hospitalized patients. It was hypothesized that patients with a past or present cancer diagnosis would report higher motivation and engagement with quitting smoking, and higher rates of smoking abstinence after hospital discharge, compared to those without a cancer diagnosis.MethodsChart review was conducted on 5287 inpatients who accepted bedside treatment from a counselor and opted‐in to automated follow‐up calls from July 2014 to December 2019.ResultsAt the time of inpatient assessment, those with a past or present cancer diagnosis (n = 419, 7.9%) endorsed significantly higher levels of importance of quitting than those without a cancer diagnosis (3.92/5 vs. 3.77/5), and were more likely to receive smoking cessation medication upon discharge (17.9% vs. 13.3%). Follow‐up data from 30‐days post‐discharge showed those with a cancer diagnosis endorsed higher rates of self‐reported abstinence (20.5%) than those without a cancer diagnosis (10.3%; p < 0.001).ConclusionBeing hospitalized for any reason provides an opportunity for smokers to consider quitting. Having a previous diagnosis of cancer appears to increase intention to quit and lead to higher rates of smoking cessation in patients who are hospitalized compared to patients without cancer. Future research needs to work toward optimizing motivation for smoking cessation while admitted to a hospital and on improving quit rates for all admitted patients, regardless of diagnosis.

Electronic cigarettes in standard smoking cessation treatment by tobacco counselors in Flanders: E-cigarette users show similar if not higher quit rates as those using commonly recommended smoking cessation aids

BackgroundThis interventional-cohort study tried to answer if people who smoke and choose an e-cigarette in the context of smoking cessation treatment by tobacco counselors in Flanders are achieving smoking abstinence and how they compare to clients who opt for commonly recommended (or no) aids (nicotine replacement therapy, smoking cessation medication).MethodsParticipants were recruited by tobacco counselors. They followed smoking cessation treatment (in group) for 2 months. At several times during treatment and 7 months after quit date, participants were asked to fill out questionnaires and to perform eCO measurements.ResultsOne third of all participants (n = 244) achieved smoking abstinence 7 months after the quit date, with e-cigarette users having higher chances to be smoking abstinent at the final session compared to NRT users. Point prevalence abstinence rates across all follow-up measurements, however, as well as continuous and prolonged smoking abstinence, were similar in e-cigarette users and in clients having chosen a commonly recommended (or no) smoking cessation aid. No differences were obtained between smoking cessation aids with respect to product use and experiences.ConclusionsPeople who smoke and choose e-cigarettes in the context of smoking cessation treatment by tobacco counselors show similar if not higher smoking cessation rates compared to those choosing other evidence-based (or no) smoking cessation aids.

Effectiveness of community health workers involvement in smoking cessation programme: A systematic review.

Sustainable Development Goals (SDG) has set the target to reduce premature mortalities from non-communicable diseases (NCDs) by one-third. One of the ways to achieve this is through strengthening the countries' implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Community health workers (CHWs) involvement has shown promising results in the prevention of NCDs. This systematic review is aimed at critically evaluating the available evidence on the effectiveness of involving CHWs in smoking cessation. We systemically searched PubMed and CENTRAL up to September 2019. We searched for published interventional studies on smoking cessation interventions using the usual care that complemented with CHWs as compared to the usual or standard care alone. Our primary outcome was abstinence of smoking. Two reviewers independently extracted data and assessed study risks of bias. We identified 2794 articles, of which only five studies were included. A total of 3513 smokers with 41 CHWs were included in the studies. The intervention duration range from 6 weeks to 30 months. The studies used behavioral intervention or a combination of behavioral intervention and pharmacological treatment. Overall, the smoking cessation intervention that incorporated involvement of CHWs had higher smoking cessation rates [OR 1.95, 95% CI (1.35, 2.83)]. Significant smoking cessation rates were seen in two studies. Higher smoking cessation rates were seen in the interventions that combined the usual care with interventions by CHWs as compared to the usual care alone. However, there were insufficient studies to prove the effectiveness. In addition, there was high heterogeneity in terms of interventions and participants in the current studies.

Effect of a lifestyle-focused electronic patient support application on risk factor management in post-myocardial infarction patients – a randomized controlled trial

Abstract Background Cardiac rehabilitation (CR) is central in reducing morbidity and mortality after myocardial infarction (MI). However, the fulfillment of guideline recommended CR targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Purpose The aim of this study was to assess the efficacy of a mobile device application to support adherence to lifestyle advice and self-control of risk factors as a complement to traditional CR after MI. Method This unblinded multi-centre randomized controlled trial included 150 patients with MI (81% men, 60.4±8.8 years). All patients in the intervention (INT) and control (CON) groups participated in a 1-year CR program. Additionally, INT patients (n=101) received access to the mobile device application for 25 weeks post-MI where information about lifestyle (i.e., diet, physical activity, smoking), modifiable risk factors (i.e., weight, blood pressure (BP)), and symptoms could be registered. The software provided direct positive feedback and lifestyle advice. Data was reviewed twice weekly by the CR nurse. The primary outcome was change in sub-maximal exercise capacity (W) between an exercise test 2-weeks post MI and at follow-up 4 month later. Secondary outcomes included changes in lifestyle and modifiable risk factors including body mass index, waist circumference, blood-lipids, fasting glucose and HbA1c, between baseline and 2-week, 2-month and 1-year follow-up visits. Regression analysis was used, adjusting for relevant baseline variables. Results Participation in CR was high, with 96% of INT patients and 98% of the CON patients attending the 1-year follow-up visit. Forty-six percent of the INT patients and 57% of the CON patients attended centre-based exercise training (p=0.1). In the INT group 86% logged data in the application at least once. Adherence, defined as logging data at least twice per week, was 92% in week 1 and 57% in week 25. There was a numerical trend toward better exercise capacity improvement in the INT group (INT +14.4±19.0 vs. CON +10.3±16.1 W, p=0.2) although differences were non-significant. INT patients achieved larger BP reduction at 2-weeks (systolic) and 2-months (systolic and diastolic) (Figure). At 2-months 70% vs. 46% of smokers in the INT vs CON groups had quit smoking, and at 1-year the respective percentages were 57% vs. 36%. The number of smokers in the study was however low (n=33) and the differences non-significant. For other secondary endpoints no differences were observed. Conclusion Complementing CR with a mobile device application improved BP during the first months after MI, and non-significant trends towards better exercise capacity and higher smoking cessation rates were observed. Even though the differences were non-significant in our small study sample, they indicate that using eHealth in the form of a mobile device application could clinically benefit post-MI patients participating in CR. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Governmental funding of clinical research within the National Health Services in Sweden.

Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England.

The current study investigated whether people are less likely to be smokers when they live in greener neighbourhoods, and whether such an association is attributable to lower rates of ever-smoking and/or higher rates of smoking cessation. Using a representative sample of the adult population of England (N = 8,059), we investigated the relationships between neighbourhood greenspace and three inter-related smoking outcomes (current smoking, ever-smoking and smoking cessation). After controlling for a range of individual and area-level covariates, including socioeconomic status, income and education, living in the highest greenspace quartile was associated with a 20% lower prevalence of current smoking, compared to living in the lowest greenspace quartile (PR = 0.80, CI = 0.67, 0.96, p < .017). Neighbourhood greenspace was not significantly associated with ever-smoking. However, amongst ever-smokers, residing in the two highest quartiles of neighbourhood greenspace quartiles (vs. 1st quartile) was associated with a 10% and 12% higher prevalence of smoking cessation (PR = 1.10, CI = 1.02, 1.18, p = .012; PR = 1.12, CI = 1.02, 1.22, p = .016, respectively). This suggests that the association between greenspace and current smoking is due to a higher likelihood of smoking cessation, rather than lower rates of ever- smoking. The associations between greenspace, current smoking and smoking cessation were similar in magnitude to those of having high (vs. low) household income and were largely unmoderated by socioeconomic measures. Our findings advocate the need to protect and invest in local greenspaces, to maximise the public health benefits they may afford. Improving access to greenspace may constitute an overlooked public health strategy for reducing smoking prevalence.

Effectiveness of the e-Tabac Info Service application for smoking cessation: a pragmatic randomised controlled trial

ObjectiveTo compare the effectiveness of the mobile e-Tabac Info Service (e-TIS) application (app) for helping adult smokers quit smoking with current practices.DesignPragmatic randomised controlled trial with a 1-year follow-up (2017–2018).SettingFrance,...