Treating Tobacco Use Research Articles

Barriers to and Facilitators of Delivering Brief Tobacco and Alcohol Interventions in Integrated Primary Care Settings.

Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief interventions for alcohol and tobacco use are effective and can be delivered by behavioral health providers (BHPs) embedded in the primary care setting. However, BHPs do not report frequent use of these interventions. The aim of the current study was to conduct the first examination of barriers to and facilitators of implementing brief interventions for at-risk drinking and tobacco use among integrated BHPs. BHPs (N = 285) working in a primary care setting for at least 6 months with at least 10% effort allocated to clinical activities were recruited through professional listservs (August-September 2016) and completed an online survey that assessed barriers to and facilitators of delivering brief tobacco and alcohol interventions in routine clinical practice. BHPs were primarily psychologists (48%) and social workers (33%) with cognitive-behavioral orientation (51%). The primary barriers to addressing tobacco use and at-risk drinking reported by BHPs was the perception that patients did not want to discuss or did not want to change these behaviors. The primary facilitators of addressing tobacco use and at-risk drinking were patients identifying cessation or reduction as a treatment goal, positive provider-patient relationship, and receiving referrals specifically for tobacco or alcohol use. Clinicians, researchers, and administrators should focus on strategies to increase the regularity with which BHPs assess and provide intervention for smoking and alcohol use in the context of other primary presenting concerns.

A pilot study to implement and sustain the US PHS clinical practice guidelines for treating tobacco use and dependence in free clinics, a safety net care setting for the uninsured

AbstractIntroductionUninsured patients are more likely than the general population to use tobacco and less likely to quit.AimsTo determine if the mode of delivering the PHS Guidelines influenced the effectiveness of smoking cessation among patients in a safety net setting.MethodsSix free clinics were randomly assigned to a training program delivered by an academic physician or community partner plus video support. A repeated cross-sectional survey of patients was conducted at three waves to assess effectiveness to promote quitting.ResultsTobacco use was triple the rate of the US population: 57.7% (Wave 1), 44.7% (Wave 2), and 48.9% (Wave 3). Patients were more likely to report receipt of at least one evidence-based strategy to promote quitting at Wave 2 (AOR = 2.33, 95% CI (1.18–4.58)). Patients treated in clinics trained by the community partner were significantly more likely to report receiving cessation assistance at Wave 2 (AOR 2.54, 95%CI 1.29–5.00) and the trend was similar, but not significant at Wave 3. Patients in the community partner-led arm were significantly less likely to report tobacco use at Wave 3 (AOR 0.59, 95% CI 0.35–0.99).ConclusionsImplementation of the PHS Guidelines in free clinics demonstrates preliminary efficacy, with delivery by community partners offering greater scalability.

Implementation of the Smoking Treatment and Recovery (STAR) program: healthy cancer survivorship through integrated tobacco control.

It is well-established that persistent tobacco use among patients with cancer results in numerous adverse outcomes. However, the assessment and treatment of tobacco use with evidence-based methods have been lacking in cancer care. Our cancer center has established its first tobacco treatment program, a multidisciplinary, evidence-based, clinical program for hematology/oncology patients. We describe the development and implementation of the program, emphasizing lessons learned in treating nicotine addiction among patients who are at very high risk for continuing to use tobacco throughout the survivorship phase. We developed a system to assess tobacco use at each outpatient visit, from those recently diagnosed to long-term survivors. For patients who have smoked in the past month, the protocol offers standard behavioral and pharmacological treatments, delivered by tobacco treatment specialists and nurse practitioners over four in-person and/or telephone-based sessions. Partnerships with the Psychosocial Oncology and Cancer Survivorship Programs have provided integrated and comprehensive care for patients during and after their cancer treatment. The systematic efforts to reach and engage current smokers have laid the groundwork for maximizing the program's future effectiveness and impact. Our initial results demonstrate not only the complexities but also the feasibility of developing a new tobacco treatment program in the oncology setting. The implications for cancer survivors are the significant improvements in treatment outcomes that occur with tobacco abstinence.

Interventions for pregnant women who use tobacco and other substances: a systematic review protocol

IntroductionThe prevalence of tobacco smoking in pregnancy remains elevated in some disadvantaged populations of women. One group is those who use alcohol and/or other psychoactive substances during pregnancy, with tobacco...

TOBACCO CESSATION: DO SMOKERS NEED PROFESSIONAL HELP TO QUIT?


 Tobacco use is considered a risk factor for 6 ofthe 8 leading causesof death worldwide and isknownto cause diseasesaffectingthe heart and lungs1. Tobacco hasa definite rolein the etiologyofa number of dental morbidities, and is an established riskfactor for Oral Cancer and periodontitis. World health organization reported more than a billionsmokersworldwide. Thenumber ofsmokersis increasingand a shift ofincreasednumber of smokersin developing world is noticed. Tobacco isa bigkilleras more than 10% ofadultdeathsannually, fromallcauses are attributedtoit. Moreover,tobacco kills almost five and a half million annuallyand on the average 10 persons per minute2. Considering gravityof thesituation, a global and localtobacco controlstrategybecomes veryimportant. The Government ofPakistan hasincreased taxesontobacco products, bannedits use inpublicplacesto discourageits use. Thisstrategywould helpreducethe number of tobacco productsused byindividuals. But what’smissing isto focus on regular smokers, and assesswhethertheyneed professional help to quit tobacco. Most ofthesmokersfind it difficult to quit on their own, while some successfulquittersconsider motivation, willpower and commitment important factors. Howcan aregularsmoker be motivated isstillnot clear andneedsmore research3.Theself-quitproportion for regular smokersis 3-5%4,which isquite lowand most ofthe tobacco usersfind it difficult to quit, evenafter feelingthe effectsafteryearsofsmoking. The reason could be addictionto dailydose ofnicotineto the brain. Agood number ofsmokerswant to quit at some time, but it is alsonotedthat onlya limitednumber ofthesessmokers have ever tried5. Theclinical practice guidelinesfor treatment ofTobacco use and dependence, recommendstheuse “Five A’s”for tobacco cessation6. Thefirst stepofthissmokingcessation protocol is to “ASK” anindividual about current smoking statusand anypreviousattempt to quit smoking. The next step is to “ADVISE”,througha clearand strong personalizedmessage andhelp identifyaquitting date. This isfollowed by“ASSESS”, whether the smoker isreadyto quit. This isfollowedbythestep “ASSIST”, in which literature isprovidedto help thesmoker understand the benefits ofquitting. Thelast stepiscalled “ARRANGE”, whichmeans arranging a follow upvisit,usuallyafter 1 to2 weeksofquitting date. Health professionalsare consideredas acredible source ofinformation.Familyphysicians canplaya veryimportant part in helping their patients who are regular smokers. Bybringing “Five A’s” modelinto practice,a physiciancangivea better opportunityto asmoker to understand the health hazardsoftobacco use, andknowthe benefits ofquittingperiodically. Thiscan lead to a higherpercentageof successfultobacco quitters. Otherhealthcare professionals, who can playanimportant role in helpingsmokersquit, are the dentalprofessionals. Apatient would spend more time in a dental office and routine dentaladvice should alsoinclude quit tobacco, alongwith oralhygieneinstructions and dietaryadvice. Dentalassociations should encourage their membersto advisepatients about oral and systemic hazards of tobaccoproducts.

Treating Parents for Tobacco Use in the Pediatric Setting

Despite the availability of free and effective treatment, few pediatric practices identify and treat parental tobacco use. To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years. This cluster randomized clinical trial was conducted from April 2015 to October 2017. Ten pediatric practices in 5 states were randomized to either implement the CEASE protocol or maintain usual care (as a control group). All parents who screened positive for tobacco use by exit survey after their child's clinical visit 2 weeks (from April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate. Data analysis occurred from January 2018 to March 2019. The CEASE intervention is a practice-change intervention designed to facilitate both routine screening in pediatric settings of families for tobacco use and delivery of tobacco cessation treatment to individuals in screened households who use tobacco. The primary outcome was delivery of meaningful tobacco treatment, defined as the prescription of nicotine replacement therapy or quit line enrollment. Furthermore, changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of intervention implementation were assessed. Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]). In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care. ClinicalTrials.gov identifier: NCT01882348.

Smoking cessation in pregnancy: An update for maternity care practitioners.

INTRODUCTIONThis paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings.METHODSWe conducted a qualitative review of published peer reviewed and grey literature.RESULTSThere is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high.CONCLUSIONSThere have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.

Associations of Multiple Acculturation Domains with Smoking Status among Latino Adults.

Few efficacious interventions for tobacco use exist for Latinos. Identification of cultural factors relevant to smoking among Latinos can inform the development of efficacious interventions for Latino smokers. Acculturation is associated with smoking, especially among Latinas, but extant research is limited by operationalization of acculturation with unidirectional, single-domain proxies. We examined associations of multiple domains of acculturation with gender and smoking status among Latino adults. Cross-sectional data from 140 bilingual Latino adults was utilized. Acculturation was measured with the 4 subscales of the Multidimensional Acculturation Scale II (MAS-II). Logistic regression analyses tested interaction effects between MAS-II American and Latino Cultural Identification subscales, English and Spanish Proficiency subscales, and their interactions with gender, on smoking status. Higher English Proficiency was associated with greater odds of being a smoker at Spanish Proficiency scores of 4.5 or higher. Higher Latino Cultural Identification was associated with lower odds of being a smoker among women, but not men. Acculturation toward American culture, per se, may not be a risk factor for smoking; rather, its influence depends on Latino culture maintenance. Unlike in other areas of mental/behavioral health among Latinos, biculturalism may not be protective against smoking. The association between acculturation and smoking among Latinas may be a function of loss of Latino culture identification. Intervention programs should consider targeting these at-risk individuals. Longitudinal work that corroborates current findings and identifies mechanisms underlying these associations is needed.

Impact of a tobacco cessation intervention on adherence to tobacco use treatment guidelines among village health workers in Vietnam.

Community health workers (in Vietnam referred to as village health workers) have the potential to play a key role in expanding access to evidence-based tobacco use treatment. We conducted a cluster randomized controlled trial in community health centers in Vietnam that compared the effect of provider advice and cessation assistance (i.e. brief counseling and patient education materials) (BC) vs. BC + three sessions of in-person counseling delivered by a village health worker (BC+R) on providers' and village health workers' adherence to tobacco use treatment guidelines. All village health workers and health care providers received training. This paper presents data on the effect of the intervention on village health workers' adherence to tobacco use treatment guidelines, including asking about tobacco use, advising smokers to quit, offering assistance and their attitude, norms, and self-efficacy related to tobacco use treatment. We examined changes in adherence to tobacco use treatment guidelines before and 12 months after the intervention among 89 village health workers working in the 13 community health centers enrolled in the BC+R study condition. Village health workers' adherence to tobacco use treatment guidelines increased significantly. Village health workers were more likely to ask about tobacco use (3.4% at baseline, 32.6% at 12 months), offer advice to quit (4.5% to 48.3%) and offer assistance (1.1% to 38.2%). Perceived barriers to treating tobacco use decreased significantly. Self-efficacy and attitudes towards treating tobacco use improved significantly. Increased adherence to tobacco use treatment guidelines was associated with positive attitudes towards their role in delivering tobacco use treatment and increasing awareness of the community health center smoke-free policy. The findings suggest that, with training and support systems, village health workers can extend their role to include smoking cessation services. This workforce could represent a sustainable resource for supporting smokers who wish to quit.

Incentivizing university students to quit smoking: a randomized controlled trial of a contingency management intervention in a developing country

ABSTRACT Background: Contingency management (CM) is an empirically supported behavioral treatment for tobacco use, but its efficacy with university student smokers in a developing country is unknown. Objectives: We evaluate a randomized controlled trial of a CM smoking cessation program conducted on a sample of treatment-seeking student smokers at the University of Cape Town. Methods: The study included a recruitment period, a 6-week intervention period, and a 6-month follow-up period. Subjects in the control group (information and monitoring; n = 47, 76% male) were given information to help them quit smoking and had their quit attempt monitored, receiving R50 ($8) at each assessment. Subjects in the treatment group (information and monitoring, plus CM; n = 40, 80% male) could additionally earn R150 ($24) in abstinence-contingent incentives at each assessment. Outcome variables: 7-day point-prevalence abstinence at 6 months and at the end of the intervention period, and a repeated measure of smoking intensity of non-abstinent subjects. Results: CM had no long-term effect on abstinence at 6 months but had a marked and statistically significant effect on the likelihood of abstinence by the end of the intervention period (p < .001). In addition, while CM did not affect smoking intensity, participation in the program decreased the average number of cigarettes smoked per day by non-abstainers (p < .001). Conclusions: The CM program was efficacious in promoting abstinence amongst treatment-seeking university students in a developing country but only while incentives were in place. Future research should focus on promoting continuous abstinence with this target sample.

Assessing the Availability of Pharmacotherapy Options for Tobacco Cessation in Tennessee's Substance Use Facilities.

Smoking is deadly and exacerbates comorbid health conditions, especially among those with co-occurring substance use disorders. Tennessee does not require substance abuse treatment facilities to concurrently provide tobacco-cessation treatment options or limit smoking on facility property as a standard for licensure. This study examines the relation between Tennessee facility region and availability of pharmacotherapeutic options for tobacco cessation, and the relation between the facilities' region and facility smoking policy. This study is descriptive, cross-sectional, and exploratory in its design. Study findings are from a secondary analysis of data acquired from the 2016 edition of the National Directory of Drug and Alcohol Abuse Treatment Facilities published by the Substance Abuse and Mental Health Services Administration. The number of substance abuse treatment facilities providing pharmacotherapy options in west Tennessee (7.8%) are statistically significantly lower as compared with substance abuse treatment facilities in both middle (24.6%) and east (39.2%) Tennessee. A statistically significantly higher percentage of facilities in west Tennessee (23.5%) with policies that permit smoking without restriction as compared with the number of facilities in east Tennessee (6.8%) also was found, whereas the facilities in west Tennessee (60.8%) have a policy that permits smoking in designated areas that is significantly lower than the number of facilities in east Tennessee (81.1%). Tobacco-cessation options are a preventive intervention that can be easily incorporated into a treatment facility's standard of practice and should be made available within the context of all substance abuse treatment facilities. Failure to provide concurrent tobacco-cessation options during substance abuse treatment contradicts the purpose of medical treatment. Medically oriented substance abuse facilities are exemplary settings for offering pharmacotherapeutic options to concurrently treat tobacco use. It is suggested that interdisciplinary clinicians in the field of substance abuse advocate for the implementation of concurrent tobacco cessation treatment in their organization.

Provider-Patient Discussions About Smoking and the Impact of Lung Cancer Screening Guidelines: NHIS 2011-2015.

Clinical practice guidelines for treating tobacco use and lung cancer screening guidelines recommend smoking cessation counseling to current smokers by health care professionals. Our objective was to determine the contemporary patterns of current smokers' discussions about smoking with their health care professionals in the USA. We conducted an observational study of 30,132 current smokers (weighted sample 40,126,006) for the years 2011 to 2015 using data from the National Health Interview Survey. Our main outcome was the proportion of current smokers who had discussions about smoking with their health care professionals. We used the Cochran-Armitage trend test to evaluate the temporal trends in current smokers' discussions about smoking, and used a multivariable logistic model to determine the predictors of discussions about smoking, controlling for smokers' demographics, health status, and receipts of lung cancer screening. Our study found the proportion of current smokers who had discussions about smoking with their health care professionals increased from 51.3% in 2011 to 55.4% in 2015 (P-trend < 0.0001). However, about 15% of current smokers who underwent lung cancer screening did not have or could not recall discussions about smoking with their health care professionals. In multivariable analyses and sensitivity analysis, the predictors of discussions about smoking were being a heavy smoker, receipt of lung cancer screening, being non-Hispanic white, having a physician office visit in the past year, being diagnosed with respiratory conditions, having fair or poor health, and having insurance coverage. The results demonstrated a steady but slow increase in current smokers' discussions about smoking with their health care professionals in recent years, especially among heavy smokers. More than 40% of current smokers did not have or could not recall any discussions about smoking with their health care professionals.

Innovations in parental smoking cessation assistance delivered in the child healthcare setting.

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice. CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348.

An electronic health record-based interoperable eReferral system to enhance smoking Quitline treatment in primary care.

The study sought to determine whether interoperable, electronic health record-based referral (eReferral) produces higher rates of referral and connection to a state tobacco quitline than does fax-based referral, thus addressing low rates of smoking treatment delivery in health care. Twenty-three primary care clinics from 2 healthcare systems (A and B) in Wisconsin were randomized, unblinded, over 2016-2017, to 2 smoking treatment referral methods: paper-based fax-to-quit (system A =6, system B = 6) or electronic (eReferral; system A = 5, system B = 6). Both methods referred adult patients who smoked to the Wisconsin Tobacco Quitline. A total of 14 636 smokers were seen in the 2 systems (system A: 54.5% women, mean age 48.2 years; system B: 53.8% women, mean age 50.2 years). Clinics with eReferral, vs fax-to-quit, referred a higher percentage of adult smokers to the quitline: system A clinic referral rate = 17.9% (95% confidence interval [CI], 17.2%-18.5%) vs 3.8% (95% CI, 3.5%-4.2%) (P < .001); system B clinic referral rate = 18.9% (95% CI, 18.3%-19.6%) vs 5.2% (95% CI, 4.9%-5.6%) (P < .001). Average rates of quitline connection were higher in eReferral than F2Q clinics: system A = 5.4% (95% CI, 5.0%-5.8%) vs 1.3% (95% CI, 1.1%-1.5%) (P < .001); system B = 5.3% (95% CI, 5.0%-5.7%) vs 2.0% (95% CI, 1.8%-2.2%) (P < .001). Electronic health record-based eReferral provided an effective, closed-loop, interoperable means of referring patients who smoke to telephone quitline services, producing referral rates 3-4 times higher than the current standard of care (fax referral), including especially high rates of referral of underserved individuals. eReferral may help address the challenge of providing smokers with treatment for tobacco use during busy primary care visits.ClinicalTrials.gov; No. NCT02735382.

Mobile Applications for the Treatment of Tobacco Use and Dependence.

Smoking remains a leading preventable cause of premature death in the world; thus, developing effective and scalable smoking cessation interventions is crucial. This review uses the Obesity-Related Behavioral Intervention Trials (ORBIT) model for early phase development of behavioral interventions to conceptually organize the state of research of mobile applications (apps) for smoking cessation, briefly highlight their technical and theory-based components, and describe available data on efficacy and effectiveness. Our review suggests that there is a need for more programmatic efforts in the development of mobile applications for smoking cessation, though it is promising that more studies are reporting early phase research such as user-centered design. We identified and described the app features used to implement smoking cessation interventions, and found that the majority of the apps studied used a limited number of mechanisms of intervention delivery, though more effort is needed to link specific app features with clinical outcomes. Similar to earlier reviews, we found that few apps have yet been tested in large well-controlled clinical trials, although progress is being made in reporting transparency with protocol papers and clinical trial registration. ORBIT is an effective model to summarize and guide research on smartphone apps for smoking cessation. Continued improvements in early phase research and app design should accelerate the progress of research in mobile apps for smoking cessation.

A content analysis of free smoking cessation mobile applications in the USA

AbstractAimsTo evaluate the quality and content of free smoking cessation apps and assess their adherence to the US Public Health Service guideline for treating tobacco use and dependence.MethodsIn total 180 apps were downloaded from the App Store and Google Play Store in January 2018; the top-ranking 30 apps were retrieved for the search terms: ‘smoking cessation’, ‘quit smoking’, ‘stop smoking’. Technical quality was rated using the Mobile Application Rating Scale (MARS) and by assessing other characteristics, behavioral change strategies and adherence to the 5As.Results/findingsA total 67 free-to-download apps were identified for full review (n = 40 from the Apple App Store and n = 27 from the Google Play Store). The average MARS score was 16.2/19.0: Engagement (3.3/5.0), Functionality (4.4/5.0), Aesthetics (4.0/5.0), and Information (2.6/5.0). Overall, 43 apps allowed sharing, 12 allowed for an app community, and five required a password. The following features were observed: assessment (n = 51), feedback (n = 38), information/education (n = 45), monitoring (n = 52), and goal setting (n = 23). Significant differences were found among apps adhering to the 5As: Ask (n = 44), Advise (n = 54), Assess (n = 30), Assist (n = 62), and Arrange (n = 0).ConclusionsGiven the growth in smoking cessation apps, future efforts should focus on improving their technical quality and adherence to the 5As.

To smoke or not to smoke: Does delay discounting affect the proximal choice to smoke?

Background: Delay discounting rate shows robust predictive validity for tobacco use behaviors and is a new therapeutic target in the treatment of tobacco use. Identifying factors that influence relations between delay discounting and the choice to smoke cigarettes is key to the development of effective interventions that target delay discounting to reduce cigarette consumption. Objective: To examine relations between delay discounting, motivational factors, self-efficacy, nicotine dependence level, and the proximal choice to smoke in the context of other commonly rewarding activity choices. Methods: In this cross-sectional design, daily smokers (n = 480) from Amazon Mechanical Turk completed a questionnaire that assessed delay discounting rate; motivation, intention, and self-efficacy to quit smoking; nicotine dependence level, and the preference for immediately engaging in multiple commonly rewarding activities. We hypothesized that 1) greater motivation to quit would be associated with lower priority given to smoking; 2) the relation between delay discounting and the priority given to smoking would be mediated by motivation, self-efficacy, and nicotine dependence level. Results: Greater motivation to quit was significantly associated with a lower priority given to smoking. The relation between delay discounting and the priority given to smoking was marginally mediated by nicotine dependence level (p > .057). Conclusions: Motivation to quit influences decision-making by impacting the prioritization of choices. Nicotine dependence is likely to mediate the relation between delay discounting and the choice to smoke. Interventions that target delay discounting to reduce cigarette consumption or prevent relapse need to account for motivation to quit and nicotine dependence level.

The relationship between health-related variables and increases in smoking among recently diagnosed HIV+ people who inject drugs in Vietnam

BackgroundIn Vietnam tobacco smoking is prevalent among people living with HIV (PLHIV) and causes excess mortality in this population. Injection drug use is a driver of HIV infections in Vietnam. Changes in HIV disease state may correlate to changes in smoking among PLHIV. This study investigates the relationship between increases in smoking and health-related variables among recently diagnosed HIV+ people who inject drugs (PWID) in Vietnam. MethodsWe analyzed longitudinal data from 323 recently diagnosed HIV+ PWID in a randomized controlled trial from 2009 to 2013 in Thai Nguyen province, Vietnam. The outcome was an increase of >one cigarette/day from baseline visit cigarette smoking. A generalized estimating equation for repeated measures was used to estimate bivariable and multivariable associations between participant characteristics and smoking increases. We collected qualitative data to enhance our understanding of quantitative results, from 16 HIV+ PWID who smoke. ResultsNinety three point 5% of participants reported some smoking at baseline. Smoking fewer cigarettes, higher health related quality of life (QOL), and higher CD4 counts were predictive of increases in smoking at future visits in a multivariable model. Qualitative data showed smoking increases were tied to improved perceived health, and counseling during respiratory illnesses may increase intention to quit. ConclusionHIV+ PWID in Vietnam smoke at a very high rate. Increases in their smoking are correlated to increases in heath-related QOL, and increases in perceptions of health. Any tobacco-use intervention should account for internal tobacco use triggers faced by HIV+ PWID.

Tobacco Use as a Health Disparity: What Can Pediatric Clinicians Do?

Tobacco use is a global health crisis, and has a tremendous and negative impact on health and wellbeing. Tobacco use disproportionately affects members of vulnerable populations, and by acting on multiple socioecological levels, serves to perpetuate and reinforce cycles of poverty. Members of the pediatric medical community can play a key role in interrupting cycles of tobacco use. Providers can serve as powerful allies to vulnerable communities by treating tobacco use in caregivers, counseling youth against using tobacco products, protecting children from the impact of secondhand smoke exposure, and advocating for economic, social, and health policies to disrupt intergenerational smoking.

Overcoming Challenges to Treating Tobacco use During Pregnancy - A Qualitative study of Australian General Practitioners Barriers

BackgroundGeneral practitioners can play an important role in addressing smoking among pregnant women but studies suggest they rarely do so. The aim of this study was to explore general practitioners perceptions about the management of smoking in pregnancy, and what would enable them to provide better care.MethodsQualitative semi-structured interviews were conducted (Feb-July 2017), with 19 Australian general practitioners recruited from a sample that participated in a national survey on managing smoking during pregnancy; and through a national conference. The interview guide was structured using the theoretical domains framework, exploring previously reported barriers and two specific components of smoking cessation care - nicotine replacement therapy prescription and Quitline referral.ResultsParticipants reported high confidence and knowledge to provide pregnant patients adequate support for quitting. Nonetheless, participants reported lacking communication skills, focusing on providing information on smoking harm, accepting cutting down cigarettes as adequate, while following the ‘Stages of Change’ model and only providing treatment options to motivated patients. Lack of time, nicotine replacement therapy cost and safety concerns, and being unfamiliar with the Quitline (particularly for Aboriginal and Torres Strait Islander pregnant smokers) were perceived as challenges. Participants reported needing better communication skills, clear detailed nicotine replacement therapy guidelines for special populations, and visual resources they could use to discuss treatment options with patients.ConclusionsDifficulty communicating with pregnant patients about smoking, using the ‘Stages of Change’ model to guide support provision and concerns regarding nicotine replacement therapy safety are barriers to providing cessation support to pregnant patients for general practitioners. Training on specific effective behaviour change techniques, clear guidance for nicotine replacement therapy use, and practical visual patient education tools may facilitate smoking cessation care provision to pregnant women.