Increase Cessation Rates Research Articles

A Pilot Randomized Controlled Trial of a Web-Based Growth Mindset Intervention to Enhance the Effectiveness of a Smartphone App for Smoking Cessation.

BackgroundAlthough smartphone apps have shown promise for smoking cessation, there is a need to enhance their low engagement rates. This study evaluated the application of the growth mindset theory, which has demonstrated the potential to improve persistence in behavior change in other domains, as a means to improve engagement and cessation.ObjectiveThis study aimed to explore the feasibility, utility, and efficacy of a Web-based growth mindset intervention for addiction when used alongside a smoking cessation app.MethodsDaily smokers (N=398) were all recruited on the Web and randomly assigned to receive either a cessation app alone or the app plus a Web-delivered growth mindset intervention. The primary outcome was engagement, that is, the number of log-ins to the smoking cessation app. The secondary outcome was 30-day point prevalence abstinence at 2-month follow-up collected through a Web-based survey.ResultsThe 2-month outcome data retention rate was 91.5% (364/398). In addition, 77.9% (310/398) of the participants in the experimental arm viewed at least 1 page of their growth mindset intervention, and 21.1% (84/398) of the group viewed all the growth mindset intervention. The intention-to-treat analysis did not show statistically significant differences between the experimental and comparison arms on log-ins to the app (19.46 vs 21.61; P=.38). The experimental arm had cessation rates, which trended higher than the comparison arm (17% vs 13%; P=.10). The modified intent-to-treat analysis, including only participants who used their assigned intervention at least once (n=115 in experimental group and n=151 in the control group), showed that the experimental arm had a similar number of log-ins (32.31 vs 28.48; P=.55) but significantly higher cessation rates (21% vs 13%; P=.03) than the comparison arm.ConclusionsA growth mindset intervention for addiction did not increase engagement rates, although it may increase cessation rates when used alongside a smartphone app for smoking cessation. Future research is required to refine the intervention and assess efficacy with long-term follow-up to evaluate the efficacy of the mindset intervention.Trial RegistrationClinicalTrials.gov NCT03174730; https://clinicaltrials.gov/ct2/show/NCT03174730

Extending Varenicline Preloading to 6 Weeks Facilitates Smoking Reduction and Cessation: A Randomised Controlled Trial

Background: In smokers receiving varenicline cessation treatment, increasing the pre-quit period by 3 weeks reduces smoking intake prior to quit attempts and increases cessation rates; however, the lack of an intake plateau suggests longer preload periods are required. We assessed whether varenicline preloading for 6 weeks reduces pre-quit smoke intake and enhances 6-month abstinence outcomes compared with the standard 1-week preloading. Methods: This randomised controlled trial was conducted between February 2016 and July 2018 in Israel. Everyday smokers (n = 242) aged ≥ 18 years were randomly assigned (1:1) to receive extended varenicline preloading for 6 weeks (n = 121) or a placebo for 5 weeks followed by varenicline for 1 week (n = 121) before the target quit date (TQD). Both groups received standard 12-week post-TQD varenicline treatment. Participants and researchers were masked to treatment allocation. Primary outcomes were the 24-week biochemically-verified continuous abstinence rate (CAR) (weeks 6-30) and the 12-week CAR (weeks 6-18). Other measures included pre- and post-quit rewards, smoking urges, nausea, aversion, and markers of cigarette consumption. Analysis involved intention-to-treat. Findings: The 12-week CAR was 24·8% for extended preloading vs. 7·4% for standard preloading (odds ratio [OR], 4·10 [95% confidence interval [CI]: 1·85-9·08]; p < 0·001). The 24-week CAR was 23·1% for extended preloading vs. 4.1% for standard preloading (OR, 6·98 [95% CI: 2·60-18·80]; p < 0·001). Extended preloading significantly decreased pre-quit rewards and urges; nausea increased along with decreased smoke intake, including unsolicited smoking abstinence. In the post-quit period, after beginning the standard varenicline treatment, between-group differences in rewards and nausea subsided; smoking urges remained remarkably lower in the extended preloading group. Extended preloading was safe and well accepted. Interpretation: Extended preloading generated a marked reduction in ad lib smoking, enhanced cessation rates at 3 and 6 months, and increased abstinence rates by promoting a reinforcement-reduction mechanism unnoticed with the standard dosing regimen. Our data substantiate extending the standard pre-treatment period and suggest that targeting pre-quit smoking sensations should be a priority in smoking cessation treatments. Trial Registration: ClinicalTrials.gov (Identifier: NCT02634281). Funding Statement: This study was funded by a 2013 Global Research Award for Nicotine Dependence (GRAND) supported by Pfizer, Inc (#WI182915). Editorial support in the form of editing, proofing and formatting the text and preparing the manuscript for submission was provided by Elsevier Editing Services and funded by the Pulmonary Institute of Shaare Zedek Medical Center. Declaration of Interests: The authors state: None to declare. Ethics Approval Statement: The study was conducted in compliance with the recommendations guiding physicians in biomedical research involving humans adopted by the 18th World Medical Assembly, Helsinki, Finland, 1964 and later revisions. The “Helsinki Committee” of the SZMC approved all study procedures and all participants provided written informed consent prior to any procedures.

Biomedical risk assessment as an aid for smoking cessation.

A possible strategy for increasing smoking cessation rates could be to provide smokers with feedback on the current or potential future biomedical effects of smoking using, for example, measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer or other diseases. The main objective was to determine the efficacy of providing smokers with feedback on their exhaled CO measurement, spirometry results, atherosclerotic plaque imaging, and genetic susceptibility to smoking-related diseases in helping them to quit smoking. For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialized Register in March 2018 and ClinicalTrials.gov and the WHO ICTRP in September 2018 for studies added since the last update in 2012. Inclusion criteria for the review were: a randomised controlled trial design; participants being current smokers; interventions based on a biomedical test to increase smoking cessation rates; control groups receiving all other components of intervention; and an outcome of smoking cessation rate at least six months after the start of the intervention. We used standard methodological procedures expected by Cochrane. We expressed results as a risk ratio (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate, we pooled studies using a Mantel-Haenszel random-effects method. We included 20 trials using a variety of biomedical tests interventions; one trial included two interventions, for a total of 21 interventions. We included a total of 9262 participants, all of whom were adult smokers. All studies included both men and women adult smokers at different stages of change and motivation for smoking cessation. We judged all but three studies to be at high or unclear risk of bias in at least one domain. We pooled trials in three categories according to the type of biofeedback provided: feedback on risk exposure (five studies); feedback on smoking-related disease risk (five studies); and feedback on smoking-related harm (11 studies). There was no evidence of increased cessation rates from feedback on risk exposure, consisting mainly of feedback on CO measurement, in five pooled trials (RR 1.00, 95% CI 0.83 to 1.21; I2 = 0%; n = 2368). Feedback on smoking-related disease risk, including four studies testing feedback on genetic markers for cancer risk and one study with feedback on genetic markers for risk of Crohn's disease, did not show a benefit in smoking cessation (RR 0.80, 95% CI 0.63 to 1.01; I2 = 0%; n = 2064). Feedback on smoking-related harm, including nine studies testing spirometry with or without feedback on lung age and two studies on feedback on carotid ultrasound, also did not show a benefit (RR 1.26, 95% CI 0.99 to 1.61; I2 = 34%; n = 3314). Only one study directly compared multiple forms of measurement with a single form of measurement, and did not detect a significant difference in effect between measurement of CO plus genetic susceptibility to lung cancer and measurement of CO only (RR 0.82, 95% CI 0.43 to 1.56; n = 189). There is little evidence about the effects of biomedical risk assessment as an aid for smoking cessation. The most promising results relate to spirometry and carotid ultrasound, where moderate-certainty evidence, limited by imprecision and risk of bias, did not detect a statistically significant benefit, but confidence intervals very narrowly missed one, and the point estimate favoured the intervention. A sensitivity analysis removing those studies at high risk of bias did detect a benefit. Moderate-certainty evidence limited by risk of bias did not detect an effect of feedback on smoking exposure by CO monitoring. Low-certainty evidence, limited by risk of bias and imprecision, did not detect a benefit from feedback on smoking-related risk by genetic marker testing. There is insufficient evidence with which to evaluate the hypothesis that multiple types of assessment are more effective than single forms of assessment.

Hepatitis C transmission in young people who inject drugs: Insights using a dynamic model informed by state public health surveillance

Increasing injection of heroin and prescription opioids have led to increases in the incidence of hepatitis C virus (HCV) infections in US young adults since the early 2000s. How best to interrupt transmission and decrease HCV prevalence in young people who inject drugs (PWID) is uncertain.We developed an age-stratified ordinary differential equation HCV transmission model of PWID aged 15–64, which we fit to Michigan HCV surveillance data among young PWID aged 15–29. We used Latin hypercube sampling to fit to data under 10,000 plausible model parameterizations. We used the best-fitting 10% of simulations to predict the potential impact of primary (reducing injection initiation), secondary (increasing cessation, reducing injection partners, or reducing injection drug use relapse), and tertiary (HCV treatment) interventions (over the period 2017–2030) on acute and chronic HCV cases by the year 2030.Treating 3 per 100 current and former PWID per year could reduce chronic HCV by 27.3% (range: 18.7–30.3%) and acute HCV by 23.6% (range: 6.7–29.5%) by 2030 among PWID aged 15–29 if 90% are cured (i.e. achieved sustained virologic response [SVR] to treatment). Reducing the number of syringe sharing partners per year by 10% was predicted to reduce chronic HCV by 15.7% (range: 9.4–23.8%) and acute cases by 21.4% (range: 14.2–32.3%) among PWID aged 15–29 by 2030. In simulations of combinations of interventions, reducing injection initiation, syringe sharing, and relapse rates each by 10% while increasing cessation rates by 10% predicted a 27.7% (range: 18.0–39.7%) reduction in chronic HCV and a 38.4% (range: 28.3–53.3%) reduction in acute HCV.Our results highlight the need for HCV treatment among both current and former PWID and the scale up of both primary and secondary interventions to concurrently reduce HCV prevalence and incidence in Michigan.

Tobacco Use and Subsequent Cessation Among Hospitalized Patients in Mumbai, India: A Longitudinal Study.

Hospitalization is an important setting to address tobacco use. Little is known about post-discharge cessation and treatment use in low- and middle-income countries. Our objective was to assess tobacco use after hospital discharge among patients in Mumbai, India. Longitudinal observational study of inpatients (≥15 years) admitted at one hospital from November 2015 to October 2016. Patients reporting current tobacco use were surveyed by telephone after discharge. Of 2894 inpatients approached, 2776 participated and 15.7% (N = 437) reported current tobacco use, including 5.3% (N = 147) smokers, 9.1% (N = 252) smokeless tobacco (SLT) users, and 1.4% (N = 38) dual users. Excluding dual users, SLT users, compared to smokers, were less likely to report a plan to quit after discharge (42.6% vs. 54.2%, p = .04), a past-year quit attempt (38.1% vs. 52.7%, p = .004), to agree that tobacco has harmed them (57.9% vs. 70.3%, p = .02) or caused their hospitalization (43.4% vs. 61.4%, p < .001). After discharge, 77.6% of smokers and 78.6% of SLT users reported trying to quit (p = .81). Six-month continuous abstinence after discharge was reported by 27.2% of smokers and 24.6% of SLT users (p = .56). Nearly all relapses to tobacco use after discharge occurred within 30 days and did not differ by tobacco type (log-rank p = .08). Use of evidence-based cessation treatment was reported by 6.5% (N = 26). Three-quarters of tobacco users in a Mumbai hospital attempted to quit after discharge. One-quarter reported continuous tobacco abstinence for 6 months despite little use of cessation treatment. Increasing post-discharge cessation support could further increase cessation rates and improve patient outcomes. No prior study has measured the patterns of tobacco use and cessation among hospitalized tobacco users in India. Three-quarters of tobacco users admitted to a hospital in Mumbai attempted to quit after discharge, and one-quarter remained tobacco-free for 6 months, indicating that hospitalization may be an opportune time to offer a cessation intervention. Although smokers and SLT users differed in socioeconomic status, perceived risks and interest in quitting, they did not differ in their ability to stay abstinent after hospital discharge.

Knowledge Gaps Around Smoking and Nicotine Among U.S. Military Veterans Who Smoke and Implications for Practice

The present study describes knowledge about smoking and nicotine among a sample of Iraq-/Afghanistan-era veterans who smoke (N = 117). A majority of participants had knowledge regarding general risks of smoking and benefits of nicotine replacement therapy. However, many participants underestimated their personal cardiovascular (50%) and cancer risk (41%) as a smoker. Many participants also inaccurately believed that nicotine causes cancer (44%) and that nicotine medications work by making one physically sick if used while smoking (56%). These beliefs could lead to reluctance to use nicotine replacement therapy. Discussion of findings offers potential solutions in the form of patient education as well as emphasis on training healthcare providers training on best practices for patient education (beyond simple advice to quit). More nuance and detail in patient education may facilitate increased knowledge about smoking and nicotine among U.S. military veterans with the ultimate goal of increasing cessation rates.

Efficacy of Mobile Phone–Delivered Smoking Cessation Interventions for Socioeconomically Disadvantaged Individuals

Limited evidence supports mobile phone-delivered cessation interventions for socioeconomically disadvantaged individuals. To assess the efficacy of mobile phone-delivered cessation interventions targeted to smokers at neighborhood sites serving racial/ethnic minority and socioeconomically disadvantaged individuals. This group-randomized clinical trial with neighborhood site serving as the sampling unit compared smoking cessation interventions that included (1) nicotine replacement therapy (NRT), (2) NRT plus text messaging, and (3) NRT plus text messaging plus proactive counseling via mobile phone. Recruitment took place at churches, public housing complexes, and community centers located throughout the Houston, Texas, area. A total of 624 current cigarette smokers 18 years or older were enrolled at neighborhood sites from August 13, 2011, through December 12, 2014. Final follow-up was completed on June 12, 2015, and data were analyzed from August 17, 2017, through May 10, 2018, based on intention to treat. Nicotine replacement therapy consisted of transdermal nicotine patches; NRT plus text messages, transdermal nicotine patches and individually tailored mobile phone text messages; and NRT plus text plus call, transdermal patches, individually tailored mobile phone text messages, and proactive counseling via mobile phone. The primary outcome was smoking abstinence at 6 months, defined as (1) biochemically verified smoking abstinence (calculated among a subgroup of 377 participants) as determined by saliva cotinine level; and (2) self-reported 30-day abstinence (calculated among all 624 participants). The study sample included 624 current cigarette smokers (50.6% female; mean [SD] age, 45.8 [12.8] years). Among the 377 participants eligible for biochemical verification, 127 self-reported 30-day abstinence and were asked to provide saliva samples. Of these, 98 samples were returned (participants who did not return samples were coded as smoking). Biochemically verified abstinence rates were 12.0% for NRT, 12.0% for NRT plus text, and 25.5% for NRT plus text plus call. Participants in the NRT plus text plus call group were 2.11 (95% CI, 1.00-4.48) times more likely to be biochemically verified as abstinent compared with the NRT group. No differences in biochemically verified abstinence between the NRT plus text group and the NRT group were observed. Similar associations were observed with the self-report cessation outcomes. Findings indicate that assignment to an intervention consisting of text messaging alone may not increase cessation rates for socioeconomically disadvantaged smokers. However, text messaging plus proactive counseling may be an efficacious option. ClinicalTrials.gov identifier: NCT00948129.

Large multi-centre pilot randomized controlled trial testing a low-cost, tailored, self-help smoking cessation text message intervention for pregnant smokers (MiQuit).

AimsTo estimate the effectiveness of pregnancy smoking cessation support delivered by short message service (SMS) text message and key parameters needed to plan a definitive trial.DesignMulti‐centre, parallel‐group, single‐blinded, individual randomized controlled trial.SettingSixteen antenatal clinics in England.ParticipantsFour hundred and seven participants were randomized to the intervention (n = 203) or usual care (n = 204). Eligible women were < 25 weeks gestation, smoked at least one daily cigarette (> 5 pre‐pregnancy), were able to receive and understand English SMS texts and were not already using text‐based cessation support.InterventionAll participants received a smoking cessation leaflet; intervention participants also received a 12‐week programme of individually tailored, automated, interactive, self‐help smoking cessation text messages (MiQuit).Outcome measurementsSeven smoking outcomes, including validated continuous abstinence from 4 weeks post‐randomization until 36 weeks gestation, design parameters for a future trial and cost‐per‐quitter.FindingsUsing the validated, continuous abstinence outcome, 5.4% (11 of 203) of MiQuit participants were abstinent versus 2.0% (four of 204) of usual care participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 0.93–9.35]. The Bayes factor for this outcome was 2.23. Completeness of follow‐up at 36 weeks gestation was similar in both groups; provision of self‐report smoking data was 64% (MiQuit) and 65% (usual care) and abstinence validation rates were 56% (MiQuit) and 61% (usual care). The incremental cost‐per‐quitter was £133.53 (95% CI = –£395.78 to 843.62).ConclusionsThere was some evidence, although not conclusive, that a text‐messaging programme may increase cessation rates in pregnant smokers when provided alongside routine NHS cessation care.

System change interventions for smoking cessation.

System change interventions for smoking cessation are policies and practices designed by organizations to integrate the identification of smokers and the subsequent offering of evidence-based nicotine dependence treatments into usual care. Such strategies have the potential to improve the provision of smoking cessation support in healthcare settings, and cessation outcomes among those who use them. To assess the effectiveness of system change interventions within healthcare settings, for increasing smoking cessation or the provision of smoking cessation care, or both. We searched databases including the Cochrane Tobacco Addiction Group Specialized Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO in February 2016. We also searched clinical trial registries: WHO clinical trial registry, US National Institute of Health (NIH) clinical trial registry. We checked 'grey' literature, and handsearched bibliographies of relevant papers and publications. Randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs and interrupted time series studies that evaluated a system change intervention, which included identification of all smokers and subsequent offering of evidence-based nicotine dependence treatment. Using a standardized form, we extracted data from eligible studies on study settings, participants, interventions and outcomes of interest (both cessation and system-level outcomes). For cessation outcomes, we used the strictest available criteria to define abstinence. System-level outcomes included assessment and documentation of smoking status, provision of advice to quit or cessation counselling, referral and enrolment in quitline services, and prescribing of cessation medications. We assessed risks of bias according to the Cochrane Handbook and categorized each study as being at high, low or unclear risk of bias. We used a narrative synthesis to describe the effectiveness of the interventions on various outcomes, because of significant heterogeneity among studies. We included seven cluster-randomized controlled studies in this review. We rated the quality of evidence as very low or low, depending on the outcome, according to the GRADE standard. Evidence of efficacy was equivocal for abstinence from smoking at the longest follow-up (four studies), and for the secondary outcome 'prescribing of smoking cessation medications' (two studies). Four studies evaluated changes in provision of smoking cessation counselling and three favoured the intervention. There were significant improvements in documentation of smoking status (one study), quitline referral (two studies) and quitline enrolment (two studies). Other secondary endpoints, such as asking about tobacco use (three studies) and advising to quit (three studies), also indicated some positive effects. The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates, but have been shown to improve process outcomes, such as documentation of smoking status, provision of cessation counselling and referral to smoking cessation services. However, as the available research is limited we are not able to draw strong conclusions. There is a need for additional high-quality research to explore the impact of system change interventions on both cessation and system-level outcomes.

SmokefreeTXT Behaviour Change Technique Analysis

Mobile text-messaging smoking cessation interventions have demonstrated their efficacy in increasing cessation rates. These interventions tend to be multifaceted and there is a need to specify their building blocks. The purpose of this study was to use the Behavioural Change Techniques Taxonomy V1 (BCTTv1) to systematically analyse the behaviour change techniques present in the SmokefreeTXT (SFTXT) adult programme. The entire SFTXT library was coded using the BCTTv1. Frequencies were calculated to assess the presence of BCT groups and unique BCTs in the entire programme. The mix of BCTs was also examined by programme week and during periods of high user dropout. Of the 16 groups of behavioural techniques, 14 were present in SFTXT. Of the 93 distinct BCTs, 41 were present in the full SFTXT message library. The most prevalent BCT groups were Feedback and Monitoring, Natural Consequences, Social Support, and Shaping Knowledge. There were differences in the mix of BCTs across the duration of the intervention. The results will enable us to test how changes in the use of specific BCTs and their frequency of use over time, impact (1) engagement with the programme (particularly during the days with high dropout rates), and (2) smoking cessation outcomes over time.

Predictors of medication adherence and smoking cessation among smokers under community corrections supervision

IntroductionIndividuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. MethodsFive hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. ResultsThe strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. ConclusionsThese results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population.

Prevalence of potential smoking-related conditions among tobacco users in the emergency department and their perception that their visit may be smoking-related.

Patients who are tobacco users present to the emergency department (ED) with many medical conditions that are causally or potentially causally related to smoking. Previous studies have shown increased cessation rates for patients who accurately perceive that their ED visit is smoking-related. Our study goals were 1) to determine the prevalence of potential smoking-related conditions among tobacco users at a tertiary care academic ED, and 2) to determine which medical conditions are more or less likely to be perceived by patients as smoking-related. We included adults≥19 years of age who reported smoking within 30 days of their ED visit, and were enrolled in a randomized controlled trial (ClinicalTrials.gov, NCT01454375) from December 1, 2011 to August 31, 2012. Patients were asked whether they perceived their ED visit to be related to smoking. ED discharge diagnoses were coded as smoking-related or not smoking-related based on the 2004 U.S. Surgeon General's Report. We included 893 patients (62% male; mean age=40±15), of which 120 (13%) had a visit for a potential smoking-related condition: 6 (5%) of neoplasm, 18 (15%) of cardiovascular disease, 67 (56%) of respiratory disease, 3 (3%) of reproductive complication, 7 (6%) of postoperative complication, 9 (8%) of dental disease, 9 (8%) of peptic ulcer disease, 0 (0%) of eye condition, and 1 (1%) of bony condition. Of the potential smoking-related conditions, 46 (38%) were perceived by patients to be possibly smoking-related: 61% of cardiovascular disease, 33% of neoplasm, 43% of respiratory disease, 22% of dental disease, 14% of postoperative complication, 11% of peptic ulcer disease, and 0% of the remaining conditions. In this study, 13% of all ED visits among smokers were for a potential smoking-related condition, of which 38% were perceived by patients to be smoking-related. Education to increase awareness of smoking-related conditions may increase cessation rates.

Has Smoking Cessation Increased? An Examination of the US Adult Smoking Cessation Rate 1990-2014.

We examine the trajectory of adult smoking prevalence in the United States over the period 1990-2014 to investigate whether the smoking cessation rate has changed during this period. We employ a dynamic model of smoking prevalence, and data from the National Health Interview Survey (NHIS) and the National Survey on Drug Use and Health (NSDUH), to estimate the adult cessation rate in 6-year intervals. We use weighted nonlinear least squares to perform the estimation. We then employ a meta-regression model to test whether the cessation rate has increased. The annual cessation rate has increased from 2.4% in 1990 to 4.5% in 2014 according to the NHIS data, and from 3.2% in 2002 to 4.2% in 2014 according to the NSDUH data. The increasing trend is statistically significant (p value = 1.57×10-6) and the two independent surveys produced nearly identical results, which makes it unlikely that our findings are a product of chance. Our analysis finds that the smoking cessation rate in the United States has almost doubled since 1990. This increase is responsible for at least 2 million fewer smokers in 2014. If current conditions persist, by the year 2020 the increase in cessation rates will be responsible for 3.5 million fewer smokers. Our findings can assist in predicting the future path of the smoking epidemic and determining the correct allocation of resources to eradicate it. We show that the adult smoking cessation rate has greatly increased since 1990. We demonstrate this by studying prevalence trajectories from two independent population surveys, which yielded nearly identical results. Different from other studies, we focus on permanent quit rates (net of relapses) which we estimate from a dynamic model of prevalence. Our results do not stem from self-reported quitting behavior, but from the analysis of observed prevalence and its inherent variability. Our findings can contribute to predicting the future path of the smoking epidemic and to determining the optimal allocation of resources to eradicate it.

An Argument for Change in Tobacco Treatment Options Guided by the ASAM Criteria for Patient Placement.

Tobacco use is a major threat to public health in the United States, and the number one cause of preventable death. Although most smokers try to quit unaided, robust data indicate that pairing behavioral support to US Food Drug Administration-approved cessation medications significantly increase cessation rates. Those who do receive assistance in quitting usually receive very low intensity treatment, regardless of the severity of their dependence or their medical and environmental circumstances. This is in stark contrast to how other substance use disorders are treated, where there are varying levels of care depending on addiction severity and biopsychosocial circumstances. The American Society of Addiction Medicine (ASAM) developed a formal algorithm for assessing substance use disorders and determining the optimal level of care. The ASAM Patient Placement Criteria are regularly used to determine the appropriate level of care for all substance use disorders except tobacco. This paper will review key aspects of the ASAM dimensions of care and placement levels, with emphasis on how they apply to tobacco use and present case examples of typical smokers who would benefit from a higher intensity of tobacco dependence treatment. We also present current barriers to reimbursing healthcare providers for these services. We conclude with a commentary and discussion regarding recommendations for improvements in tobacco dependence treatment care.

Current and past smoking patterns in a Central European urban population: a cross-sectional study in a high-burden country.

BackgroundMany studies have examined the socioeconomic variations in smoking and quitting rates across the European region; however, data from Central and East European countries, where the tobacco burden is especially high, are sparse. This study aimed to assess the patterns in current and past smoking prevalence based on cross-sectional data from a Central European urban population sample.MethodsData from 2160 respondents aged 25–64 years in Brno, Czech Republic were collected in 2013–2014 using the Czech post-MONICA survey questionnaire to assess the prevalence of cardiovascular risk factors, including smoking status. The age- and sex-stratified randomized sample was drawn using health insurance registries. Descriptive statistics and quit ratios were calculated, and chi-square and multivariate logistic analyses conducted to examine relationships between current and past smoking and demographic (age, gender, marital status) and socioeconomic variables (education, income, occupation).ResultsThe prevalence of current and past smoking was 23.6 and 31.3 % among men and 20.5 and 23.2 % among women, respectively. Education reliably predicted smoking and quitting rates in both genders. Among men, being unemployed was associated with greater odds of smoking (OR 3.6; 1.6–8.1) and lower likelihood of quitting (OR 0.2: 0.1–0.6); the likelihood of quitting also increased with age (OR 1.8; 1.2–2.8). Among women, marital status (being married) decreased the odds of current smoking (OR 0.6; 0.4–0.9) and increased the odds of quitting (OR 2.2; 1.2–3.9). Quit ratios were the lowest in the youngest age group (25–34 years) where quitting was more strongly associated with middle income (OR 2.7; 95 % CI 1.2–5.9) than with higher education (OR 2.9; 95 % CI 0.9–8.2).ConclusionsInterventions to increase cessation rates and reduce smoking prevalence need to be gender-specific and carefully tailored to the needs of the disadvantaged groups of the population, especially the less well-off young adults. Future studies should examine the equity impact of the tobacco control policies and be inclusive of the Central and East European countries.

Smoking-related changes or brand switching? Smokers' anticipated responses to a large increase in Taiwan's Tobacco Health and Welfare Surcharge

ObjectivesThis study examines the impact on smokers' behaviour of a planned increase in the Health and Welfare Surcharge of Tobacco Products in Taiwan. Study designThis study used a structured questionnaire to perform telephone interviews. Stratified random sampling was applied to interview current smokers aged 18–65 years in Taiwan. MethodsBased on nationwide survey data of smokers' responses to future increases in cigarette prices, this study used multinomial logistic regression to perform its analyses. ResultsAfter the proposed increase in the Health and Welfare Surcharge of Tobacco Products, subsequent cigarette price increases would motivate nearly 30% of the smokers to adopt smoking-related changes and 10% to change to lower-priced brands. ConclusionsThe study suggests that a large increase in the Health and Welfare Surcharge of Tobacco Products would lead to considerable changes in smoking behaviour, which in turn would increase cessation rate at the population level.

Smoking Cessation: A Case Study of a Pilot Integrated Programme in Qingdao, China

Background: China is the largest producer and consumer of tobacco. A cost-of-illness study suggested that the healthcare cost and productivity loss incurred to the society due to smoking was US$28.9 billion in 2008. The government is increasingly aware of the long-term social and economic impact of smoking in recent years. Hence, various tobacco control measures have been implemented nationwide since 2009. Tobacco dependence management is an evidence-based intervention, recommended by the WHO as a way to increase cessation rates. However, the high cost of treatment might deter smokers from enrolling into the program. Objectives: The aim of this paper is to share our pilot experience in designing and implementing an integrated tobacco dependence management program in 2014 in Qingdao, and to provide preliminary results of the program. Method: In order to effectively improve uptake of the intervention and overall treatment outcomes, a pilot integrated tobacco dependence management program was conducted in Qingdao with 6 key initiatives namely: 1) new collaborative model across different government agencies, 2) partnership strategy between government and the private sector, 3) funding mechanism of the program, 4) introduction of new payment method, 5) development of electronic medical records, and 6) management of associated medical risk and fraud. To evaluate the outcomes of this integrated program, 1000 participants were interviewed and follow-up visited for 6 times. Various indicators had been collected for assessment on tobacco dependence management, including spending on smoking, nicotine dependence grade and carbon monoxide concentration after dependence treatment. Results: The primary results of the pilot study found that of the completed follow-up cases (828), more than 60% of the study participants quit smoking successfully. From the societal perspective, there are long-term cost-savings from an integrated tobacco dependence management program in China.

Eficacia y seguridad del uso de medicamentos para la cesación de la adicción al tabaco: revisión de guías de práctica clínica

To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.

Minimal-Intervention on smoking cessation: a Meta-analysis

To systematically evaluate the effectiveness of Minimal Smoking Cessation Intervention Program (MSCIP) and to provide theoretical basis for the feasibility of implementation in China. Systematically, we searched data from studies published between January, 2000 and September, 2014 on the database that including Cochrane Library, Medline, EMbase, CNKI, Wanfang, Vip, etc. Studies related to MSCIP were designed by random controlled trials. Meta analysis was performed by Revman 5.1. Nine studies were included, with the Random-Effect Model Relative Risk as 1.57 (1.01-2.44), which indicated that the probability of being tobacco abstinent had increased by 57% in the treating group than in the control group. Participants who developed other diseases, being pregnant or the time of receiving intervention messages ≤ 10 minutes, were more likely to quit the program. There were no significant statistically differences noticed between the different subgroups. Minimal smoking cessation intervention increased cessation rates, RCTs with a larger sample size are needed to draw the related conclusions.

Physical activity for smoking cessation in pregnancy: randomised controlled trial

Objective To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy.Design Parallel group, randomised controlled, multicentre trial.Setting 13 hospitals in England, April 2009 to January 2014.Participants...