Smoking Cessation Interventions Research Articles

Feasibility of remote delivery of a smoking cessation intervention for people with severe mental illness: a telephone consultation

Background The COVID-19 pandemic meant that face-to-face delivery of a smoking cessation intervention in India and Pakistan for people with severe mental illness within a feasibility trial was not possible. Rather than halt the feasibility trial, the decision was taken to adapt the intervention for remote delivery. This paper presents a telephone consultation conducted with key stakeholders to inform this adaptation. Objective To consult with key stakeholders on the feasibility, challenges and solutions for remote delivery of a smoking cessation intervention for people with severe mental illness in India and Pakistan. Design Rapid mixed-methods telephone consultation. Setting Two mental health facilities, one in Bengaluru, India, and the other in Rawalpindi, Pakistan. Participants Thirty-two members (16 India, 16 Pakistan) of Community Advisory Panels at the mental health facilities. Members were people with severe mental illness (2 India, 8 Pakistan), caregivers (3 India, 2 Pakistan) and professionals (11 India, 6 Pakistan). Data collection and analysis Questions explored general views on remote intervention delivery and specific feedback on nine intervention components (providing information, advising, asking questions, discussion, assessing motivation, using a flipbook, recording activities in a booklet, measuring exhaled carbon monoxide and administering medication). Telephone consultations were audio-recorded. Descriptive statistics were used for quantitative data, content analysis for qualitative data and then triangulated. Results All three participant groups identified challenges and solutions. Overall remote delivery was considered feasible with a preference for telephone sessions, supplemented with video, delivered for 30 minutes in the morning. Except for measuring carbon monoxide, all components were seen to be feasible, with more positive opinions evident in India. The key challenge related to achieving effective communication over the phone, especially for people with severe mental illness or low literacy. Access (connectivity and phone ownership) and monitoring medication use were other challenges. Popular solutions were to involve caregivers in all intervention components and to ensure these components and associated resources were appropriate for this patient group including those with low literacy. Based on this valuable feedback, the smoking cessation intervention was adapted for hybrid (remote and face-to-face) delivery instead of exclusive remote delivery with significant changes made to its delivery and content. Limitations This was a rapid consultation with a small sample of stakeholders. There were missing quantitative data in Pakistan. Conclusions Key stakeholders viewed remote delivery of the smoking cessation intervention among people with severe mental illness as feasible and particularly important when face-to-face delivery is not possible. The intervention was subsequently adapted for hybrid (remote and face-to-face) delivery. Future work Evaluating the feasibility and acceptability of hybrid delivery of this smoking cessation intervention was completed. A full trial commences in July 2024. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130.

Fine-mapping the CYP2A6 regional association with nicotine metabolism among African American smokers.

The nicotine metabolite ratio (NMR; 3'hydroxycotinine/cotinine) is a stable biomarker for CYP2A6 enzyme activity and nicotine clearance, with demonstrated clinical utility in personalizing smoking cessation treatment. Common genetic variation in the CYP2A6 region is strongly associated with NMR in smokers. Here, we investigated this regional association in more detail. We evaluated the association of CYP2A6 single-nucleotide polymorphisms (SNPs) and * alleles with NMR among African American smokers (N = 953) from two clinical trials of smoking cessation. Stepwise conditional analysis and Bayesian fine-mapping were undertaken. Putative causal variants were incorporated into an existing African ancestry-specific genetic risk score (GRS) for NMR, and the performance of the updated GRS was evaluated in both African American (n = 953) and European ancestry smokers (n = 933) from these clinical trials. Five independent associations with NMR in the CYP2A6 region were identified using stepwise conditional analysis, including the deletion variant CYP2A6*4 (beta = -0.90, p = 1.55 × 10-11). Six putative causal variants were identified using Bayesian fine-mapping (posterior probability, PP = 0.67), with the top causal configuration including CYP2A6*4, rs116670633, CYP2A6*9, rs28399451, rs8192720, and rs10853742 (PP = 0.09). Incorporating these putative causal variants into an existing ancestry-specific GRS resulted in comparable prediction of NMR within African American smokers, and improved trans-ancestry portability of the GRS to European smokers. Our findings suggest that both * alleles and SNPs underlie the association of the CYP2A6 region with NMR among African American smokers, identify a shortlist of variants that may causally influence nicotine clearance, and suggest that portability of GRSs across populations can be improved through inclusion of putative causal variants.

A systematic review of suicide among Iranians physicians, etiology and solutions

Suicide is a multifaceted public health problem that, unfortunately, remains the leading cause of death worldwide. Studies show that the rate of mental illness, particularly suicide, is higher among doctors than among the public, and the risk of depression and suicide among doctors has also increased. Interventions such as resilience and mindfulness programs can reduce suicidal thoughts among medical students. Suicide prevention programs should target high-risk groups, such as physicians. Studies have shown that medical students and physicians are at higher risk of suicide than the general population. The prevalence of mental health issues and suicidal thoughts increases during medical school. Psychological factors, such as burnout, depression, anxiety, and hopelessness, can lead to suicidal thoughts. Considering the worldwide significance of this issue and the recent increase in mortality among youthful Iranian physicians, we conducted and investigated the prevalence and possible causes of suicidal ideation among Iranian medical students and graduates in this study. The problem of suicides among Iranian doctors and the sudden increase in the deaths of doctors, especially young people, is dangerous. Suicides among Iranian medical, dental, and pharmacy students have increased in recent years. It may be beneficial to support populations at high risk for suicidal ideation and provide screening for early intervention, as well as raise awareness of the prevalence and impact of suicidal thoughts among male students, school officials, and teachers. Screening should include individuals with a family history of mental health issues and those who are separated from their parents, as these individuals are at increased risk for suicidal thoughts. Reducing the prevalence of suicidal ideation may benefit from smoking cessation interventions and stress-reducing curricula. In addition, studies show that work stress among Iranian doctors and dentists can affect their work and treatment. Controlling and managing occupational stress is vital to prevent future problems, as it can have physical and psychological consequences. High levels of occupational stress among these doctors can also pose a danger to their patients. Identifying the causes of physician suicide can help to control and manage it.

Perspectives of Hospital Staff on Barriers to Smoking Cessation Interventions among Drug-Resistant Tuberculosis Patients in a South African Management Hospital.

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients' barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking's effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes.

A multicomponent smoking cessation program for adults with Type 2 Diabetes Mellitus (DiMe-SALUD2 project): A study protocol of a randomized controlled trial

BackgroundTobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project). MethodsThis RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life. DiscussionThe DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs. Trial registrationClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

A National Dental Practice-Based Research Network phase II, cluster-randomized clinical trial assessing nicotine replacement therapy sampling in dental settings: study protocol for the Free Samples for Health (FreSH) study

BackgroundCigarette smoking has major detrimental effects on oral health. Tobacco interventions in dental settings are effective, but rarely delivered. The American Dental Hygienists Association recommends that oral health providers: Ask patients about tobacco use, Advise quitting tobacco use, and Refer to state quitlines (Ask-Advise-Refer; AAR). While AAR connects patients to counseling, it does not directly connect patients to medication. Nicotine replacement therapy sampling (NRTS) is an empirically supported intervention to provide starter packs of nicotine replacement therapy (NRT) to people who smoke. NRTS combined with AAR could be an effective tobacco treatment intervention for dental settings.MethodsThis manuscript describes the study protocol for the Free Samples for Health (FreSH) study, a group randomized clinical trial testing the effectiveness of NRTS + AAR vs. AAR alone on long-term smoking abstinence. Fifty dental practices in the Midwest and Northeast nodes of the National Dental Practice-Based Research Network are randomly assigned to provide AAR and either a 2-week supply of 14-mg nicotine patches and 4-mg nicotine lozenges (NRTS condition) or an electric toothbrush (ET condition). Approximately 1,200 patients who currently smoke—regardless of interest in quitting— are recruited during dental visits. Participants complete a baseline survey in-person, then after visit, 1-, 3-, and 6-month follow-up surveys remotely. The primary outcome is carbon monoxide-confirmed 7-day point prevalence abstinence from combustible tobacco measured at 6 months post-enrollment. Secondary outcomes include: 24-h intentional quit attempts, change in cigarettes smoked per day, NRT utilization, attitudes toward NRT, intention to use NRT, and intention to quit smoking. A key informant process evaluation and cost effectiveness analysis will provide information for future implementation of NRTS.DiscussionThis is the first clinical trial to assess the effectiveness of NRTS on promoting smoking cessation in dental settings. If effective, this treatment could be implemented to increase the provision of smoking cessation interventions in dental settings to provide an additional treatment access point for people who smoke.Trial Registration.Registered at ClincalTrials.gov (NCT05627596) on 11/25/2022.

Implementing a Metabolism-informed approach for smoking cessation in an Alaska Tribal health system: study protocol for a single-arm implementation pilot trial

BackgroundIndividualized treatment for commercial tobacco smoking cessation, such as through the utilization of the nicotine metabolite ratio (NMR), offers potential clinical benefit. NMR is a metabolism-informed biomarker that can be used to guide medication selection. NMR testing is particularly promising for tobacco cessation efforts in populations with high rates of smoking, such as some Alaska Native and American Indian (AN/AI) communities. To date, no prior study has evaluated the implementation of NMR-guided tobacco cessation with AN/AI populations.MethodsThe present “QUIT” protocol is a two-phase study that will occur at Southcentral Foundation (SCF), an Alaska Native-owned health system, serving 70,000 AN/AI people, based in Anchorage, Alaska. In Phase one, qualitative interviews with customer-owners (patients), providers and administrators (n = 36) and a 10-participant beta-test will be used to refine a strategy to implement NMR testing in the health system. Phase two will involve a single-arm pilot trial (n = 50) and qualitative interviews throughout data collection (n = 48) to evaluate the implementation strategy and explore the real-world acceptability and feasibility of NMR testing to guide tobacco cessation with AN/AI populations.DiscussionThis study utilizes a community-based participatory approach to refine and implement a nicotine metabolism-informed smoking cessation program in a Tribal healthcare setting. The process and findings from this study will reflect the importance of customer-owner choice and honor the lived experience involved in quitting commercial tobacco. Pilot study data will inform the effect and sample sizes required for a future pragmatic trial of NMR-guided smoking cessation.Trial registrationThis study will be registered with clinicaltrials.gov after the beta test is complete and the final IRB protocol is approved.

Pregnant women's receipt of comprehensive guideline recommended antenatal care for smoking.

Antenatal clinical guidelines recommend antenatal care providers routinely assess smoking status for all pregnant women at the first antenatal visit and, for women who are current smokers, provide cessation support at the first and all subsequent visits. This study aimed to assess women's receipt of comprehensive guideline recommended care for smoking during pregnancy and the maternal and service characteristics associated with such care. A telephone survey was conducted with women who were recently pregnant and received antenatal care from public maternity services in one Australian local health district. Of the 514 participants, 9% were smokers when they found out they were pregnant. Of these, 47% continued smoking until giving birth. Almost all participants (96%) were asked about their smoking status at their first antenatal visit. Among pregnant smokers, 76% were asked about their smoking at subsequent visits, 73% were advised to quit, 62% were provided with information or advice to assist quitting, 24% were offered Nicotine Replacement Therapy (NRT) and 38% were offered a referral to Quitline. A third of maternal smokers reported receiving all elements of guideline recommended care. No associations were found between maternal and service characteristics and receipt of care for smoking. Guideline recommended routine assessment and care for smoking in pregnancy may be less than optimal, particularly for smoking cessation interventions with strong evidence of effectiveness - NRT and quit lines. Identification of barriers and implementation of strategies to increase the offer and uptake of these services by women is required. This study is the first to examine pregnant women's reported receipt of comprehensive guideline recommended care for maternal smoking. The findings indicate that a significant proportion of pregnant women attending public maternity services are not receiving comprehensive care and that many are not being offered evidence based interventions to assist them to quit. Barriers to comprehensive care delivery need to be identified and addressed if the potential for smoking interventions delivered in this setting to impact smoking rates in pregnancy is to be realised.

A pilot pragmatic randomized controlled trial of a nicotine metabolite ratio-guided smoking cessation intervention in a lung health and screening program

IntroductionPatients with pulmonary nodules detected through lung cancer screening or as incidental findings are often followed in lung health and screening programs. The use of personalized pharmacotherapy for smoking cessation informed by the nicotine metabolite ratio (NMR), a measure of nicotine metabolism, has not yet been evaluated in this setting. This pilot randomized controlled trial (RCT) evaluated the feasibility of conducting a larger trial. MethodsThrough a pragmatic RCT design, participants were recruited from a Mid-Atlantic lung health and screening program. Eligible participants smoked >5 cigarettes per day and completed a blood draw to determine NMR before being randomized to standard or NMR-guided care treatment arms. Standard care participants were offered nicotine replacement therapy (NRT) or varenicline and a referral to phone-based smoking cessation counseling. NMR-guided participants received standard care except they were provided a personalized medication recommendation based on their NMR. Study outcomes included measures of feasibility, medication uptake, and treatment matching (i.e., uptake of the optimal medication). ResultsMore than 80 % of 205 screened patients were eligible. However, only 37 (22 %) of these patients enrolled in the study, with a mean age of 65 years, 43 % female, and 25 % Black. Nearly all patients who declined cited a disinterest in smoking cessation. Participants in both treatment arms had high rates of medication uptake (68 %), with NMR-guided participants showing a trend towards greater treatment matching (55 % vs. 29 %). ConclusionsThe results of this pilot study provide support for conducting a larger RCT of an NMR-guided smoking cessation intervention in a lung health and screening setting. Consideration should be given to augmenting the intervention to address barriers to study entry.

Receipt of the 5As intervention for smoking cessation among people with and without mental health disorders

Brief interventions for smoking cessation, such as the 5As (ask, assess, advise, assist, arrange) are effective, but limited data are available regarding their delivery to smokers with mental health disorders (MHDs), and whether a disparity in care exists. This study explored the difference in the self-reported receipt of 5As between smokers with and without MHDs in a community setting. Baseline data from 1452 (1206 without and 246 with self-reported MHDs) Australian smokers who participated in a smoking cessation trial were analysed. Participants reported interactions with healthcare providers and receipt of the 5As over the past 12 months. Multivariate logistic regression analysis was employed to investigate the association between receipt of the 5As and MHD status. Smokers with MHDs were significantly more likely to be asked, assessed, advised, and assisted compared to those without MHDs, but arranging follow-up was very low in both groups (7.7% with MHDs and 4.1% without MHDs). This is particularly concerning for vulnerable population like smokers with MHDs, who may struggle more in their quit attempt. The findings highlight the need to enhance the implementation of the 'arrange follow-up' component to improve cessation outcomes and reduce health disparities.

Cost-effectiveness of point of care smoking cessation interventions in oncology clinics

BackgroundWe examined the cost-effectiveness of providing systematic smoking cessation interventions to oncology patients at point-of-care.MethodsA decision analytic model was completed from the healthcare payer’s perspective and included all incident cancer cases involving patients who smoke in New Brunswick, Canada (n = 1040), cancer site stratifications, and risks of mortality, continued smoking, and cancer treatment failure over one year. Usual care (no cessation support) was compared to the standard Ottawa Model for Smoking Cessation (OMSC) intervention, and to OMSC plus unlimited cost-free stop smoking medication (OMSC + SSM), including nicotine replacement therapy, varenicline, or bupropion. Primary outcomes were incremental cost per quit (ICQ) and incremental cost per cancer treatment failure avoided (ICTFA).ResultsThe ICQ was $C143 and ICTFA $C1193 for standard OMSC. The ICQ was $C503 and ICTFA was $C5952 for OMSC + SSM. The number needed to treat (NNT) to produce one quit was 9 for standard OMSC and 4 for OMSC + SSM, and the NNT to avoid one first-line treatment failure was 78 for OMSC and 45 for OMSC + SSM. Both were cost-effective in 100% of 1000 simulations.ConclusionsGiven the high clinical benefits and low incremental costs, systematic smoking cessation interventions should be a standard component of first-line cancer treatment.

Factors associated with participation in a walking intervention for veterans who smoke and have chronic pain.

This analysis was part of the Pain and Smoking Study (PASS), a randomized trial of a cognitive behavioral intervention (CBI) for Veterans with chronic pain who smoke. The objective of this study was to examine factors associated with participation in the walking component of the intervention. Demographics and clinical characteristics were obtained at baseline. Completion of two or more CBI counseling sessions was required to be included in analyses. Average daily step counts obtained via pedometer in the prior week were recorded in up to three telephone counseling sessions. Participants were then categorized as "sedentary" (≤ 4999 daily steps) or "not sedentary" (≥ 5000 daily steps). Multivariable logistic regression was used to model variance in activity categorization. Overall, 91.0% of participants were men, 70.5% were white, mean age was 58.4 years, mean BMI was 28.6, median pack years was 20.5, and 43.8% were depressed. Veterans reported moderate pain intensity (4.9/10) and pain interference (5.4/10). Pain locations included: lower extremity (67.4%), back (53.4%) and upper extremity (28.1%). Median daily steps were 2491 [IQR: 1720-3550] (sedentary) (n = 65), 7307 [IQR: 5952-8533] (not sedentary) (n = 24), and 3196 [IQR: 2237-5067] (overall) (n = 89). Veterans with older age (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.04, 1.17) and presence of LE pain (OR: 5.98, 95% CI: 1.82, 19.65) had increased odds of being "sedentary." Integrated smoking cessation and chronic pain self-management interventions that include a walking component may need to consider the impact of age and pain location on participation.Trial registration: The trial is registered at www.ClinicalTrials.gov (NCT02971137). First posted on November 22, 2016.

Effects of smoking cessation on endothelial function as assessed by flow-mediated total dilation

BackgroundIn assessing the effects of smoking cessation on endothelial function, low-flow-mediated constriction (L-FMC) may provide complementary information to flow-mediated dilation (FMD). However, the value of flow-mediated total dilation (FMTD), an index that incorporates L-FMC into FMD, remains underreported. We aimed to evaluate the effect of smoking cessation on endothelial function, as assessed by FMD and FMTD, and clarify its associated clinical factors.MethodsWe enrolled 118 consecutive current smokers without previous coronary artery disease (72.9% were men; age: 59 ± 11 years) who underwent smoking cessation treatment. The clinical variables %FMD, %L-FMC, and %FMTD were examined before and 20 weeks after treatment initiation. A multivariate linear regression model was used to investigate the effects of smoking cessation on %FMD and %FMTD and the interaction between smoking cessation and baseline clinical variables.ResultsAfter 20 weeks, 85 smokers (69.4% were men; age: 59 ± 12 years) ceased smoking (abstainers), whereas 33 smokers (81.8% were men; age: 58 ± 11 years) did not (continued smokers). The estimated group differences (abstainers - continued smokers) in changes in the %FMD and %FMTD were 0.77% (95% confidence interval [CI], -0.22–1.77%; p = 0.129) and 1.17% (95% CI, 0.16–2.18%; p = 0.024), respectively. Smoking cessation-associated improvement in %FMTD was greater in women than in men (5.41% [95% CI, 3.15–7.67%] versus 0.24% [95% CI, -0.81–1.28%]; p-value for interaction, < 0.001). Additionally, a greater %FMTD improvement was observed in patients who smoked fewer cigarettes per day (p-value for interaction, 0.042) and those who had a smaller resting baseline lumen diameter (Dbase) (p-value for interaction, 0.023).ConclusionsSmoking cessation was associated with an improvement in %FMTD. Sex, cigarettes smoked per day, and Dbase significantly affected this improvement. The FMTD may help in risk stratification after smoking cessation.

Effectiveness of using risk communication to help smokers with cancer quit smoking: A randomized controlled trial.

158 Background: Despite evidence that patients living with cancer who continue to smoke after diagnosis are at a higher risk for all-cause mortality and reduced treatment efficacy, many cancer patients continue to smoke. This study aimed to examine the effectiveness of using a brief risk communication approach to help smokers with cancer quit smoking. Methods: A randomized controlled trial was conducted on 528 patients who continued to smoke and were follow-up at five out-patient clinics in Hong Kong. A total of 268 subjects were randomly assigned to the intervention group that received health warnings on smoking, and 260 subjects were randomly assigned to the control group that received usual care. All subjects had follow-up telephone calls at 1week, 1 month, 3 months, 6 months and 12 months to assess smoking status. Results: The biochemically validated quit rate at the 6-month follow-up was higher in the intervention group than in the control group (5.2% vs 3.8%; OR 1.38, 95% CI 0.60–3.16). The rate of at least 50% self-reported reduction of smoking at 6 months, was higher in the intervention group than in the control group (16.8% vs 12.3%; OR 1.43, 95% CI 0.88–2.35).The results showed that many smokers diagnosed with cancer believed that it was too late to quit smoking. Many participants claimed that overcoming cigarette cravings was extremely difficult, and therefore felt that the barriers to quitting outweighed the perceived benefits. Conclusions: It is crucial to proactively implement novel and effective smoking cessation interventions for smokers with cancer. Importantly, it will help to improve the physical well-being and health-related quality of life of smokers with cancer and protect the public, especially vulnerable groups such as women and children, from exposure to second-hand smoke. This will ultimately save more lives, protect the environment, and boost sustainable development. Clinical trial information: NCT01685723 .

Trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019, a repeated cross-sectional study

BackgroundSmoking continues to be the single largest cause of preventable disease and death and a major contributor to health inequalities. Dental professionals are well placed to offer behavioural support in combination with pharmacotherapy to increase smoking cessation rates across the population. We aimed to assess the trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019 and examine the potential population reach of dental settings for smoking cessation interventions.MethodsA secondary analysis was conducted of combined Scottish Health Surveys (SHeS) from 2009/11, 2013/15 and 2017/19. ‘Recent’ dental attendance (within the past two years) was the focus and descriptive analysis examined attendance of self-reported smokers compared to non-smokers and stratified by the area-based Scottish Index of Multiple Deprivation (SIMD) and individual socioeconomic measures (income, education, and occupation). Generalised linear models were used to model recent attendance in non-smokers relative to smokers adjusted by the socioeconomic measures, for each of the survey cohorts separately. Absolute differences and risk ratios were calculated with 95% Confidence Intervals (CI).ResultsRecent dental attendance was generally high and increased in both smokers (70–76%) and non-smokers (84–87%) from 2009/11 to 2017/19 and increased across all SIMD groups. After adjustment for sociodemographic variables, the adjusted Risk Difference (aRD) for recent attendance between non-smokers and smokers was 8.9% (95% CI 4.6%, 13.2%) by 2017/19. Within smokers, recent attendance was 7–9% lower in those living in the most deprived areas compared to those living in the least deprived areas over the three surveys.ConclusionsSHeS data from 2009 to 2019 demonstrated that a high and increasing proportion of smokers in the population attend the dentist, albeit slightly less frequently than non-smokers. There were large inequalities in the dental attendance of smokers, to a lesser extent in non-smokers, and these persisted over time. Dental settings provide a good potential opportunity to deliver population-level smoking cessation interventions, but smokers in the most deprived groups and older age groups may be harder to reach. Consideration should be given to ensure that these groups are given appropriate proportionate support to take up preventive interventions.

Attitudes toward smoking cessation according to smoking status among dentists in the Aichi Dental Association in Japan.

The prevalence of smoking, including heated tobacco products (HTPs), among Japanese dentists was reported to be 16.5%, significantly higher than that among Japanese physicians and United States dentists. However, large-scale studies on smoking cessation implementation based on dentists' smoking status and perceptions since the introduction of HTPs are lacking. Therefore, we aimed to investigate and assess dentists' attitudes toward smoking, including HTP use and smoking cessation, according to smoking status. A self-administered questionnaire comprising six major items was mailed to 3883 dentists who were members of the Aichi Dental Association in August 2019. The primary outcome was smoking cessation status. The secondary outcome was the impact of smoking on intervention for smoking cessation. This study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Among the 1317 (42%) dentists analyzed, men were more positive toward smoking than women. Current and former smokers were more positive about smoking than never smokers/users, regardless of the tobacco product type. Additionally, the current smoker group using conventional cigarettes was less likely to ask for their patients' smoking status than the never smoker group. Furthermore, the current smoker (OR=2.0; 95% CI: 1.3-3.1 vs never smoker) and HTP user (OR=1.9; 95% CI: 1.2-3.1 vs never user) groups were less likely to engage in smoking cessation than the never smoker/user groups, regardless of the tobacco product type. Since the smoking status of dentists affects the implementation of smoking cessation interventions, it is crucial to encourage them to quit using all tobacco products to promote smoking cessation interventions in dental practice. Additionally, providing proper smoking prevention education to dentists is an important task.

Optimizing Cardiovascular Health: A Comprehensive Review of Risk Assessment Strategies for Primary Prevention.

Cardiovascular disease (CVD) is a leading global health concern, and effective primary prevention strategies are essential to mitigate its impact. This comprehensive review examines current risk assessment strategies for primary prevention of CVD, emphasizing the importance of early identification and intervention to reduce disease incidence. Traditional risk factors such as hypertension, hyperlipidemia, smoking, and lifestyle choices are discussed alongside emerging factors, including genetic predispositions and biomarkers. The review evaluates various risk assessment tools and models, such as the Framingham risk score, atherosclerotic CVD risk calculator, QRISK, and Reynolds risk score, highlighting their methodologies, strengths, and limitations. Additionally, the review explores lifestyle modifications, including dietary changes, physical activity, weight management, smoking cessation, and pharmacological interventions like statins and antihypertensives. Special considerations for different populations, including the elderly, women, and those with a family history of CVD, are addressed. Future directions in cardiovascular risk assessment are also discussed, focusing on technological advancements and personalized medicine. This review aims to enhance the implementation of effective primary prevention measures and improve cardiovascular health outcomes by providing a thorough analysis of risk assessment strategies.

Discordances in patients' and physicians' perspectives on which contextual factors should be accounted for during smoking cessation.

Smoking cessation interventions requires attending to the circumstances and needs of individual patients. We aimed at highlighting the discordances between patients' and physicians' perspectives on contextual factors that should be considered during smoking cessation. We identified 36 contextual factors identified that should be considered during smoking cessation using PubMed and interviewing general practitioners. Physicians recruited through social networks campaigns and smoker or former smoker patients from the ComPaRe cohort selected the factors they considered most relevant in two online paired comparison experiment. Bradley Terry Luce models estimated the ability of each factor (i.e. the probability to be preferred). We calculated the Pearson's correlation and the intraclass correlation coefficients for the contextual factor from each perspective and compared the ranking of the 10 contextual factors with the highest abilities. Seven hundred and ninety-three patients' and 795 physicians' perspectives estimated the ability (i.e., importance) of the contextual factors in 11 963 paired comparisons. We found a high correlation between physicians' and patients' perspectives of the contextual factors to be considered for smoking cessation (r = 0.76, P < 0.0001). However, the agreement between the abilities of contextual factors was poor (ICC = 0.42 [-0.10; 0.75]; P = 0.09). Fine-grain analysis of participants' answers revealed many discrepancies. For example, 40% factors ranked in the top 10 most important for physicians were not in patients' top 10 ranking. Our results highlight the importance of patient-centered care, the need to engage discussions about patients' values, beyond what is thought to be important, to avoid overlooking their real context.

Smartphone-Based Smoking Cessation Intervention (OKquit) for Oklahoma Tobacco Helpline Users: Protocol for a Randomized Controlled Trial.

Tobacco quitlines provide effective resources (eg, nicotine replacement therapy, smoking cessation counseling, and text and web-based support) for those who want to quit smoking in the United States. However, quitlines reach approximately only 1%-3% of people who smoke each year. Novel, smartphone-based, and low-burden interventions that offer 24/7 access to smoking cessation resources that are tailored to current readiness to quit may increase appeal, reach, and effectiveness of smoking cessation interventions. This study will examine the efficacy of OKquit, a low-burden smartphone-based app for smoking cessation. Approximately 500 people who smoke cigarettes and access the Oklahoma Tobacco Helpline (OTH) will be randomized to receive standard OTH care (SC) or SC plus the novel OKquit smartphone app for smoking cessation (OKquit). All participants will use a smartphone app to complete study surveys (ie, baseline, 27 weekly surveys, brief daily check-ins, and 27-week follow-up). Upon completion of daily check-ins and weekly surveys, participants will receive either trivia type messages (SC) or messages that are tailored to current readiness to quit smoking and currently experienced lapse triggers (OKquit). In addition, those assigned to receive the OKquit app will have access to on-demand smoking cessation content (eg, quit tips, smoking cessation medication tips). It is hypothesized that participants assigned to OKquit will be more likely to achieve biochemically verified 7-day point prevalence abstinence than those assigned to SC at 27 weeks post enrollment. In addition, participants who use more OTH resources (eg, more cessation coaching sessions completed) or more OKquit resources (eg, access more quit tips) will have greater biochemically verified smoking cessation rates. Data collection began in September 2022 and final follow-ups are expected to be completed by May 2025. Data from this randomized controlled trial will determine whether the OKquit smartphone app combined with OTH care will increase smoking cessation rates over standard OTH care alone. If successful, OKquit could provide tailored intervention content at a fraction of the cost of traditional interventions. Furthermore, this type of low-burden intervention may offer a way to reach underserved populations of adults who smoke and want to quit. ClinicalTrials.gov NCT05539209; https://clinicaltrials.gov/study/NCT05539209. DERR1-10.2196/56827.

Decídetexto: Mobile cessation support for Latino adults who smoke. A randomized clinical trial.

Latino adults experience multiple barriers to health care access and treatment that result in tobacco-related disparities. Mobile interventions have the potential to deliver smoking cessation treatment among Latino adults, the highest users of mobile technologies. Is Decídetexto, a culturally accommodated mobile health intervention, more effective for smoking cessation compared with standard care among Latinx adults who smoke? A two-arm parallel group randomized clinical trial (RCT) was conducted in Kansas, New Jersey, and New York between October 2018 and September 2021. Eligible Latino adults who smoke (n= 457) were randomly assigned to Decídetexto or a standard care group. The primary outcome was biochemically verified 7-day smoking abstinence at week 24. Secondary outcomes included self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake and adherence of nicotine replacement therapy (NRT). Participants' mean age was 48.7 (SD, 11.1) years, 45.2%were female, and 50.3%smoked≥10 cigarettes per day. Two hundred twenty-nine participants were assigned to Decídetexto and 228 to standard care. Treating those lost to follow-up as participants who continued smoking, 14.4%of participants in the Decídetexto group were biochemically verified abstinent at week 24 compared with 9.2%in the standard care group (OR, 1.66; 95%CI, 0.93-2.97; P= .09). Treating those lost to follow-up as participants who continued smoking, 34.1%of the participants in the Decídetexto group self-reported smoking abstinence at week 24 compared with 20.6%of participants in the standard care group (OR, 1.99; 95%CI, 1.31-3.03; P< .001). Analyzing only participants who completed the assessment at week 24, 90.6%(174/192) of participants in the Decídetexto group self-reported using NRT for at least 1day compared with 70.2%(139/198) of participants in standard care (OR, 4.10; 95%CI, 2.31-7.28; P< .01). Among Latino adults who smoke, the Decídetexto intervention was not associated with a statistically significant increase in biochemically verified abstinence at week 24. However, the Decídetexto intervention was associated with a statistically significant increase in self-reported 7-day smoking abstinence at weeks 12 and 24 and uptake of NRT. This RCT provides encouragement for the use of Decídetexto for smoking cessation among Latino adults. ClinicalTrials.gov identifier: NCT03586596.