Increase Cessation Rates Research Articles

Salivary nicotine test increases cessation rates

Salivary nicotine test increases cessation rates

Evaluating the Program of a Smoking Cessation Support Group for Adult Smokers: A Longitudinal Pilot Study

Tobacco use is the leading cause of preventable death in Taiwan. In order to increase cessation rates among adult smokers, the Department of Health in Taiwan has begun providing financial support for nicotine replacement therapy (NRT). However, therapies based on multiple interventions can lead to significantly higher cessation rates than NRT alone. This study develops and evaluates the outcomes of a smoking cessation program that provides a combination of physiological and psychological treatment in the context of a short-term support group. In this study, ten adult smokers were recruited by means of advertisements broadcast on local television over a seven-day period and one thousand flyers that advertised free assistance with quitting smoking. The smoking cessation support group was carried in Tainan County, in southern Taiwan. The three-month program consisted of three, monthly group sessions, free nicotine patches, telephone counseling by public health nurses, and telephone interviews by community health volunteers. Those participating in the group were encouraged to keep a record of all smoking behavior and its "triggers" in a diary, list the personal benefits of quitting, draw up a quitting contract, and enlist significant family members to monitor their quitting behavior. Participants were also trained in behavioral strategies to avoid smoking, including imagery rehearsal, relaxation techniques, exercise, and distraction. The outcome of the project was assessed by the following two criteria: (1) carbon monoxide (CO) level in the breath before and after the three-month program, as measured by percentage of carboxyhemoglobin (%COHB), and (2) the self-reported number of cigarettes smoked per month, taken at the outset of the three-month program, at the conclusion of the program, and six months after the termination of the program. The Wilcoxon signed-rank and Friedman tests respectively revealed that there were significant decreases both in the subjects' %COHB level at the 3-month data-point, and in the number of cigarettes smoked at one month from the pretest, at the 3-month test and at the 9-month follow-up test. At the 9-month follow-up, five of the ten participants (50%) were abstinent, and three (30%) had decreased cigarette consumption by at least 49% of their pretest levels. Eighty percent of participants had, therefore, changed their smoking behavior. These results demonstrate the promise of integrated smoking cessation therapy in a group support context and indicate the need to pursue implementation and evaluation of this type of therapy on a larger scale.

Cost-Effectiveness of Face-to-Face Smoking Cessation Interventions: A Dynamic Modeling Study

Objectives To estimate the cost-effectiveness of five face-to-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. Methods Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. Results Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100‰ for telephone counseling to 4900‰ for intensive counseling with nicotine patches or gum for implementation periods of 75 years. Conclusions All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.

Nicotine delivery systems

Over the past 20 years, medicinal nicotine has been used to aid smoking cessation, and has led to a significant increase in the number of smokers who successfully quit. This review describes currently available medicinal nicotine products, which include nicotine patch, gum, lozenge, nasal spray, inhaler and sublingual tablet, including their pharmacokinetics and recommended dosing. New developments in nicotine delivery that could further increase cessation rates include high-dose patches, rapid release gum, combined patch and acute forms, and several novel channels for nicotine delivery, such as nicotine drink, straw, lollipop and a pulmonary inhaler. New applications of existing and novel medicinal nicotine products may include relapse prevention, nicotine maintenance, temporary withdrawal management, reduced smoking and gradual quitting.

Psychologists and tobacco: attitudes to cessation counseling and patterns of use

Background Psychologists can play an important role in helping their clients stop using tobacco. The extent to which they do so, or quit themselves, has not been reported previously. The utility of snus in reducing smoking prevalence is also questioned and merits study. Method A 36-item self-completion questionnaire was mailed to a random sample of 1000 Swedish psychologists. Results The response rate was 85%. Very few psychologists (1%) ‘often’ helped clients to stop using tobacco. While a majority (72%) believed that quitting tobacco use would improve their client's quality of life, most (75%) thought that it was not their responsibility to help clients stop and 74% felt they lacked the necessary skills. About 8% of psychologists smoked cigarettes daily. Use of snus as an aid to cigarette cessation was common in men, but not women, although overall, the percentage of smokers who had quit smoking (72%) did not differ by gender. Conclusions Most Swedish psychologists have stopped smoking, but very few help their clients to quit. Targeted campaigns aimed at encouraging and supporting psychologists to treat nicotine dependence are needed. This could increase cessation rates in the population. Snus helped reduce smoking prevalence among men and is a potentially useful harm reduction tool.

A nurse led smoking cessation intervention increased cessation rates after hospital admission for coronary heart disease

A nurse led smoking cessation intervention increased cessation rates after hospital admission for coronary heart disease

Giving infants a great start: launching a national smoking cessation program for pregnant women.

Data suggest that 12%-22% of women smoke during pregnancy. The link between smoking during pregnancy and adverse health and reproductive outcomes has been well documented. Great Start is a public education and smoking cessation program developed especially for pregnant women. Launched in December 2001, Great Start was the first national program focused on providing free and confidential smoking cessation counseling to pregnant women through a toll-free quitline. Great Start consisted of a media campaign to raise awareness and direct women to telephone counseling tailored for the pregnant smoker, and educational materials designed to support pregnant women through cessation counseling. The program was evaluated to assess the ability of the television ads to reach pregnant smokers and the effectiveness of a quitline for increasing cessation rates among pregnant women. Great Start demonstrates that it is possible to reach pregnant smokers through television ads that provide information about the consequences of smoking while pregnant, are affirming in tone, and provide direction for women to take action. Initial response to the program indicates that pregnant women want to quit and confirms the need for programs designed specifically to address the needs of this population.

An evidence-based approach to planning tobacco interventions for Aboriginal people.

Systematic reviews have shown that interventions such as the delivery of cessation advice by heath professionals and the use of nicotine replacement therapy are effective at increasing cessation rates, however little is known about whether such interventions are appropriate and effective for and thus transferable to Aboriginal Australians. The aim of this paper was to assess whether evidence of effectiveness for brief interventions for cessation and nicotine patches from studies conducted in other populations was likely to be transferable to Aboriginal people in the NT. This paper involved assessment of systematic reviews of evidence for the use of brief interventions for smoking cessation and the use of nicotine replacement therapy, when planning two such interventions for delivery to Aboriginal people. Emerging themes are discussed. There were many factors which were likely to mean that these brief advice on cessation and the use of nicotine patches were likely to be less effective when implemented in Aboriginal communities. The planned interventions were delivered in primary care, and were of low intensity. Few studies included in systematic reviews were set in the developing world or in minority populations. Many features of the context for delivery, such as the normality of the use of tobacco among Aboriginal people, the low socio-economic status of this population and cultural issues, may have meant that these interventions were likely to be less effective when delivered in this setting. Further research is required to assess effectiveness of tobacco interventions in this population, as evidence from systematic reviews in other populations may not be directly transferable to Aboriginal people.

Cigarette smoking and the periodontal patient.

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask--identify tobacco users; advise--advise them to quit; assess--evaluate the patient's readiness to quit; assist--offer assistance in cessation; and arrange--follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far-reaching positive effects on our patients' oral and general health.

Supplemental Material for Telephone Counseling Increases Cessation Rates Among Young Adult Smokers

Supplemental Material for Telephone Counseling Increases Cessation Rates Among Young Adult Smokers

Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings.

To review the evidence of the effectiveness of various smoking cessation methods and appropriateness for use in Australian health care settings. Cochrane and other existing reviews and meta-analyses of evidence were the basis for the review. Systematic literature searches were also conducted to identify relevant controlled trials published internationally between January 1999 and May 2002. The main inclusion criteria for studies were use of a controlled evaluation design and an outcome measure of continuous abstinence from smoking for at least five months. A three-tiered grading system for strength of evidence was used. Clinic and hospital systems to assess and document tobacco use and routine provision of cessation advice can double long-term quit rates. While brief intervention can achieve a significant effect at population level, at individual level there is a strong dose response between the number and length of sessions of tobacco cessation counselling and its effectiveness. Effective behavioural interventions can increase cessation rates by 50-100% compared with no intervention. Some pharmacotherapies are safe and also help to substantially increase cessation rates. Effective behavioural and pharmacological methods of tobacco cessation are available. Every smoker should be offered evidence-based advice and treatment to quit smoking. This includes pharmacotherapy, unless contra-indicated. Health professionals and health care settings can play a significant role in motivating and assisting smokers to quit.

Women and tobacco.

Smoking prevalence is lower among women than men in most countries, yet there are about 200 million women in the world who smoke, and in addition, there are millions more who chew tobacco. Approximately 22% of women in developed countries and 9% of women in developing countries smoke, but because most women live in developing countries, there are numerically more women smokers in developing countries. Unless effective, comprehensive and sustained initiatives are implemented to reduce smoking uptake among young women and increase cessation rates among women, the prevalence of female smoking in developed and developing countries is likely to rise to 20% by 2025. This would mean that by 2025 there could be 532 million women smokers. Even if prevalence levels do not rise, the number of women who smoke will increase because the population of women in the world is predicted to rise from the current 3.1 billion to 4.2 billion by 2025. Thus, while the epidemic of tobacco use among men is in slow decline, the epidemic among women will not reach its peak until well into the 21st century. This will have enormous consequences not only for women's health and economic wellbeing but also for that of their families. The health effects of smoking for women are more serious than for men. In addition to the general health problems common to both genders, women face additional hazards in pregnancy, female-specific cancers such as cancer of the cervix, and exposure to passive smoking. In Asia, although there are currently lower levels of tobacco use among women, smoking among girls is already on the rise in some areas. The spending power of girls and women is increasing so that cigarettes are becoming more affordable. The social and cultural constraints that previously prevented many women from smoking are weakening; and women-specific health education and quitting programmes are rare. Furthermore, evidence suggests that women find it harder to quit smoking. The tobacco companies are targeting women by marketing light, mild, and menthol cigarettes, and introducing advertising directed at women. The greatest challenge and opportunity in primary preventive health in Asia and in other developing areas is to avert the predicted rise in smoking among women.

Workplace interventions for smoking cessation.

The workplace has potential as a setting through which large groups of people can be reached to encourage smoking cessation. To categorise workplace interventions for smoking cessation tested in controlled studies and to determine the extent to which they help workers to stop smoking or to reduce tobacco consumption. We searched the Tobacco Addiction Review Group trials register in November 2002, Medline (1966 - November 2002), EMBASE (1985 - November 2002) and PsycINFO (to November 2002). We searched abstracts from international conferences on tobacco and we checked the bibliographies of identified studies and reviews for additional references. We categorised interventions into two groups: a) Interventions aimed at the individual to promote smoking cessation and b) interventions aimed at the workplace as a whole. We applied different inclusion criteria for the different types of study. For interventions aimed at helping individuals to stop smoking, we included only randomised controlled trials allocating individuals, workplaces or companies to intervention or control conditions. For studies of smoking restrictions and bans in the workplace, we also included controlled trials with baseline and post-intervention outcomes and interrupted times series studies. Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by two others. Because of heterogeneity in the design and content of the included studies, we did not attempt formal meta-analysis, and evaluated the studies using qualitative narrative synthesis. Workplace interventions aimed at helping individuals to stop smoking included nine studies of group therapy, three studies of individual counselling, eight studies of self-help materials and four studies of nicotine replacement therapy. The results were consistent with those found in other settings. Group programmes, individual counselling and nicotine replacement therapy increased cessation rates in comparison to no treatment or minimal intervention controls. Self-help materials were less effective. Workplace interventions aimed at the workforce as a whole included 13 studies of tobacco bans, two studies of social support, four studies of environmental support, four studies of incentives, six studies of comprehensive (multi-component) programmes and two studies of competitions and recruitment. Tobacco bans decreased cigarette consumption during the working day but their effect on total consumption was less certain. We failed to detect an increase in quit rates from adding social and environmental support to these programmes. There was a lack of evidence that comprehensive programmes reduced the prevalence of smoking. Competitions and incentives increased attempts to stop smoking, though there was less evidence that they increased the rate of actual quitting. We found 1. Strong evidence that interventions directed towards individual smokers increase the likelihood of quitting smoking. These include advice from a health professional, individual and group counselling and pharmacological treatment to overcome nicotine addiction. Self-help interventions are less effective. All these interventions are effective whether offered in the workplace or elsewhere. Although people taking up these interventions are more likely to stop, the absolute numbers who quit are low. 2. Limited evidence that participation in programmes can be increased by competitions and incentives organised by the employer. 3. Consistent evidence that workplace tobacco policies and bans can decrease cigarette consumption during the working day by smokers and exposure of non-smoking employees to environmental tobacco smoke at work, but conflicting evidence about whether they decrease prevalence of smoking or overall consumption of tobacco by smokers. 4. A lack of evidence that comprehensive approaches reduce the prevalence of smoking, despite the strong theoretical rationale for their use. 5. A lack of evidence about the cost-effectiveness of workplace programmes.

Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation.

Successful smoking cessation is a major public health goal. In controlled clinical trials, nicotine replacement therapy (NRT) and the antidepressant bupropion have been shown to significantly increase cessation rates only for moderate to heavy smokers (> or = 15 cigarettes/d). Nicotine replacement therapy is heavily promoted to the general population by both the pharmaceutical industry and tobacco control advocates. To examine trends in smoking cessation, pharmaceutical cessation aid use, and success in cessation in the general California population. The large population-based California Tobacco Surveys of 1992, 1996, and 1999, including 5247 (71.3% response rate), 9725 (72.9% response rate), and 6412 (68.4% response rate) respondents, respectively. Rates of cessation attempts (> or = 1 day) among smokers in the last year, use of pharmaceutical aids (mostly over-the-counter products since 1996), and cessation success. Between 1992 and 1999, cessation attempts among California smokers increased 61.4% (from 38.1% to 61.5%), and NRT use among quitters increased 50.5% (from 9.3% to 14.0%). A total of 17.2% of quitters used NRT, an antidepressant, or both as an aid to cessation in 1999. In 1996 and 1999, the median duration of aid use (14 days) was much less than recommended, and only about 20% of users had adjuvant one-on-one or group behavioral counseling. Use of NRT increased short-term cessation success in moderate to heavy smokers in each survey year. However, a long-term cessation advantage was only observed before NRT became widely available over-the-counter (August 1996). In 1999, no advantage for pharmaceutical aid users was observed in either the short or long term for the nearly 60% of California smokers classified as light smokers (<15 cigarettes/d). Since becoming available over the counter, NRT appears no longer effective in increasing long-term successful cessation in California smokers.

Controlled trial of three weeks nicotine replacement treatment in hospital patients also given advice and support

Background: Smoking is a major public health issue, estimated as causing 120 000 deaths in the UK per year. Smoking cessation is an important aspect of the treatment of many...

Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled trial

Objectives: To develop and evaluate, in a primary care setting, a computerised system for generating tailored letters about smoking cessation.Design: Randomised controlled trial.Setting: Six general practices in Aberdeen, Scotland.Participants: 2553...

Smoking Cessation

Smoking accounts for significant morbidity and mortality and has major economic consequences for healthcare delivery throughout the world. Government policy such as increasing taxes and restricting advertising go some way toreduce smoking, but the social and economic factors that affect target populations will impact on the success of any strategy. Public health interventions can also contribute to increasing cessation rates. The most successful interventions appear to be those characterised by personalised advice and assistance, repeated in different forms over the longest feasible period of time. Pharmacological aids, which are important components of acessationprogramme,includenicotinereplacementtherapyintheformofchewing gum, patches, nasal spray, oral inhaler or sublingual tablets; bupropion (amfebutamone) has been approved for use in some countries.Asthe community pharmacy is the major point of supply of such products, the pharmacist is in a key position to encourage and support clients who wish to stop smoking. A number of studies have examined the role of the community pharmacist in assisting smokers through the so-called ‘cycle of change’. These studies have utilised a model that offers individualised advice through a motivational technique to encourage a change in behaviour; nicotine replacement therapy is optional. Follow-up is an essential part of these programmes to monitor progress and to provide additional support. Evaluations of these pharmacy-based initiatives have confirmed the importance of a multifaceted approach in achieving

A simulation of the effects of youth initiation policies on overall cigarette use.

We developed a simulation model to predict the effects of policies aimed at reducing smoking initiation by youths younger than 18 years. The model projected the number of smokers, never smokers, and ex-smokers by age, sex, and racial/ethnic group and the effects of reductions in youth initiation. The model predicted that even if tobacco policies eliminated youth initiation, the number of smokers would not be halved for more than 30 years. If initiation were halved and some of the initiation were delayed rather than eliminated, substantially smaller reductions would result. Policies that increase cessation rates are needed to reduce the number of current smokers and the more near-term health problems.

A comparative study of endoscopic trigonoplasty for vesicoureteral reflux in children and in adults

Endoscopic trigonoplasty is an experimental therapy for vesicoureteral reflux. We investigated differences in surgical results between children and adults. Endoscopic trigonoplasty was performed on 51 patients and 15 pediatric and 21 adult patients were included in this study. The children accounted for 27 cases of refluxing ureter (grade II, 8; III, 14; IV, 4; V, 1) and the adults for 28 cases (I, 4; II, 18; III, 4; IV, 2). There was a greater proportion of bilateral disease and a higher average degree of reflux in the children's group. We found no significant differences in operative time, complications, analgesics usage, the duration of the indwelling catheter and hospital stay. Our follow up at 3 months showed that the reflux had ceased in 19 of 27 cases (70%) in the children's group and in 27 of 28 cases (96%) in the adults' group. The next follow up at 12 months showed that there was no reflux in 16 of 27 cases (59%) in 15 children and in 17 of 23 adult cases (74%). Trigonal splitting caused recurrence of reflux greater than grade II, in two children (13%) affecting four ureters and in three adults (14%) affecting four ureters. Endoscopic trigonoplasty has proved to be equally less invasive in children and in adults, but vesicoureteral reflux was less often resolved in children. This suggests that the greater original distance between the ureteral orifices and the greater thickness of the detrusor muscle favor the adult patient. For children, a new surgical concept is needed to increase cessation rate of vesicoureteral reflux.

Telephone counseling for smoking cessation: rationales and meta-analytic review of evidence.

We review the various ways in which telephone counseling has been used in smoking cessation programs. Reactive approaches--help lines or crisis lines--attract only a small percentage of eligible smokers but are sensitive to promotional campaigns. While difficult to evaluate, they appear to be efficacious and useful as a public intervention for large populations. Proactive phone counseling has been used in a variety of ways. In 13 randomized trials, most showed significant short-term (3-6 month) effects, and four found substantial long-term differences between intervention and control conditions. A meta-analysis of proactive studies using a best-evidence synthesis confirmed a significant increase in cessation rates compared with control conditions [pooled odds ratios of 1.34 (1.19-1.51) and 1.20 (1.06-1.37) at short- and long-term follow-up, respectively]. Proactive phone counseling appeared most effective when used as the sole intervention modality or when augmenting programs initiated in hospital settings. Suggestions for further research and utilization are offered.