Nicotine Replacement Therapy Prescription Research Articles

Is hospitalization a missed opportunity to intervene on tobacco cessation?

BackgroundAlthough tobacco use is associated with elevated morbidity and mortality, its use remains widespread among adults within the United States. Nicotine Replacement Therapy (NRT) products are effective aids that improve rates of tobacco cessation. Many smokers interact with the medical system, such as during hospitalization, without their tobacco use addressed. Hospitalization is a teachable moment for patients to make health-related changes, including tobacco cessation. MethodsRetrospective cohort study of adult patients in a university-based patient-centered medical home from 2012 to 2021 evaluating the proportion of adults who smoke who received at least one prescription for NRT. Logistic regression models were used to analyze the association of being hospitalized and receipt of a NRT prescription. ResultsOf the 4,072 current smokers identified, 1,182 (29%) received at least one prescription for NRT during the study period. Hospitalization was associated with increased odds of receiving a NRT prescription (OR 1.68). Of 1,844 current smokers with a hospitalization during the study period, 1,078 (58%) never received a prescription for NRT at any point. Only 87 (5%) of the smokers received a prescription for NRT during hospitalization or at the time of hospital discharge. ConclusionsDespite hospitalization being associated with NRT prescribing, most patients who use tobacco and are hospitalized are not prescribed NRT. Hospitalization is an underutilized opportunity for both hospitalists and primary care physicians to intervene on smoking cessation through education and prescription of tobacco cessation aids.

Clinical impacts of an integrated electronic health record-based smoking cessation intervention during hospitalisation

ObjectiveTo assess the effects of an electronic health record (EHR) intervention that prompts the clinician to prescribe nicotine replacement therapy (NRT) at hospital admission and discharge in a large integrated...

Pregnancy and tobacco: Practice and knowledge of French midwives

ObjectivesEvaluate the midwives’ practices and knowledges with regard to the management of the smoking cessation in pregnant women and analyse the profile of midwives prescribing nicotine replacement therapy (NRT). MethodsA national practice survey amongst 23,541 French midwives was conducted from 1 September 2020 to 15 September 2021 using an online self-administered questionnaire. ResultsThe analysis of the 1,216 usable questionnaires (97, 7% women, mostly aged 30 to 49 years and non-smokers) showed that 93.4% of midwives frequently questioned pregnant women about their smoking consumption during pregnancy. The minimal counselling was known and practiced by 91% of midwives, the Fagerström test by 26.9% and the measurement of exhaled CO by 27.1%. Concerning NRT, 60% of the midwives prescribed them in a usual way and 36.8% were aware of the possibility of prescribing them to the pregnant woman's entourage. The profile of midwives prescribing NRT was significantly more concerned with smoking cessation in pregnant women; worked more frequently in a hospital; carried out 25% or more of antenatal monitoring consultations; and had significantly better knowledge of the evaluation tools, without influence of sex or smoking status. ConclusionsImproving the training of midwives in the screening and management of smoking cessation during pregnancy seems necessary.

Impact of Nicotine Replacement Therapy on Breast Surgery Outcomes.

Smoking cessation therapy, including nicotine replacement therapy (NRT), is used perioperatively to assist patients to reduce their tobacco smoke intake and consequently decrease their risk of smoking-associated complications. There are, however, theoretical concerns that nicotine-induced peripheral vasoconstriction could impair wound healing. This study investigated the effect of NRT on postoperative outcomes in patients undergoing breast surgery. A retrospective chart review of patients undergoing breast surgery within the Yale New Haven Health System from the years 2014 to 2020 was performed. Documented smoking status within 6 months before surgery, use or prescription of NRT, type of surgery, and surgical complications of infection, wound dehiscence, tissue necrosis, hematoma, seroma, fat necrosis, and return to operating room within 30 days were recorded. Demographic and complication data were compared between patients with NRT usage and those without using t-tests and chi-square analyses. Multivariable logistic regression models were created to predict the effect of NRT usage on the occurrence of any complication. A total of 613 breast procedures met inclusion criteria, of which 105 (17.2%) had documented NRT use. The NRT cohort and the non-NRT cohort were well balanced with respect to demographics and procedural variables. Upon multivariable modeling for risk of any surgical complication, NRT was not a significant predictor (odds ratio [OR]: 1.199, p = 0.607 and OR: 0.974, p = 0.912, respectively), whereas procedure type, increased body mass index, and increased age were. NRT use was not associated with an increased risk of postoperative complications compared with not using NRT as part of smoking cessation therapy prior to operation.

690 Quality Improvement Project: Improving Engagement with Smoking Cessation Services Among Emergency Surgical Admissions

Abstract Aim Smoking status has a significant impact on surgical patient outcomes, with significantly increased rates of intra- and post-operative complications. Within Liverpool University Hospitals NHS Foundation Trust (LUHFT), the CURE team is a dedicated smoking cessation service that uses an electronic proforma to identify smokers and offer support. We assessed smoking cessation efforts among emergency surgical admissions pre- and post-teaching intervention. Method Two rounds of audit were completed: a baseline audit of emergency surgical admissions from 01/01/21 to 31/01/21(n = 202); and a reaudit of emergency surgical admissions from 01/11/22 to 30/11/22 (n = 163), following a structured teaching session on smoking cessation, delivered to incoming doctors in August 2022. We assessed documentation of smoking status within patient notes, completion of the smoking status proforma, prescription of nicotine replacement therapy (NRT), and assessment/follow up from CURE. Results Following intervention, smoking status documentation improved from 83% (n = 166) to 96% (n = 157), and proforma completion from 55% (n = 112) to 91% (n = 148). Among documented smokers (cycle 1 n = 49; cycle 2 n = 47), NRT prescription improved from 29% to 40%, and CURE involvement increased from 31% to 64%. Overall, following intervention, 21% of smokers accepted ongoing support from CURE during and post-admission, compared to 10% at baseline. Conclusions Use of electronic smoking status proforma and a dedicated inpatient smoking cessation team has high rates of engagement among emergency surgical inpatients. The use of structured teaching sessions to highlight the importance of smoking cessation among these patients has led to improved rates of smoking cessation support, benefiting surgical outcomes.

54 Is Nicotine Replacement Therapy (NRT) Offered and Prescribed to Current Smokers Admitted to Thoracic Surgery?

Abstract Background Cigarette smoking is a well-known habitual risk factor for lung cancer. Lung cancer resections make up the majority of BRI Thoracic Surgery admissions. Smoking has a negative impact on long term survival and disease progression of lung cancer patients increasing risk of recurrence and secondary tumours following surgery with curative intent. Method Retrospective analysis of all patients discharged from thoracic surgery during December 2021, February 2022 and March 2022. Interventions were implemented following thoracic surgery team meetings in January and February. Data was obtained from pre-operative assessments, inpatient clinical notes, discharge summaries and discharge medications. Interventions included team discussions and education, implementation of NRT prompts in EPR pathway and NRT prescribing stickers in drug charts. Results The majority of admissions were for lung cancer resections reaching 49% of admissions in February and March. In December, February and March: 70%, 55% and 50% of patients respectively had no documented discussion of smoking cessation/ NRT during admission and were not discharged with NRT. Conclusions 78% of patients who were offered NRT as an inpatient accepted and were discharged with appropriate NRT. The number of patients who had no documented discussion about smoking cessation, and subsequently no NRT prescribed on discharge improved over the months (70%, 55% and 50% respectively). 16% of patients had no smoking status documented at pre-op or during admission. There is room for improvement in NRT discussions on the ward, allowing prescription of NRT to promote smoking cessation on discharge.

180. A Missing Patch in Training: Pediatric Residents’ Attitudes, Practices, Training and Confidence Around Prescribing Nicotine Replacement Therapy

180. A Missing Patch in Training: Pediatric Residents’ Attitudes, Practices, Training and Confidence Around Prescribing Nicotine Replacement Therapy

Study of exit survey and awareness program analysis on tobacco cessation counselling amongst the health care professionals of the tertiary care.

Tobacco addiction in the rural community is very high, where we require efforts to break this addiction. Our aim was to find out the impact of awareness program on the current status of counselling on cessation of use of tobacco by the healthcare workers in various OPDs of PRH, Loni. All patients visiting any of the OPD of Pravara satisfying the stated inclusion and exclusion criteria were included in the study. We conducted awareness survey amongst the health care professionals on tobacco cessation counselling. In our study, 423 patients (79.2%) were not enquired regarding tobacco use by doctor to the patients, while 111 patients (20.8%) were asked for the same. Of the 111 patients who were enquired about tobacco use, 35 patients (31.5%) were given support for tobacco cessation. Thus overall (out of 534 patients), only 6.17% received support for tobacco cessation. Of these patients, most were given verbal counselling (13, 2.43%), followed by prescription of Nicotine replacement therapy in the form of nicotine gum (8, 1.5%) and one patient (0.19%) referred to the Tobacco Cessation center. Eleven patients (2.1%) did not recall the support provided. There is an urgent need for awareness among health care professionals in order to investigate, consult and stop smoking cessation. Our research strongly identifies an opportunity to significantly increase access to tobacco control services in rural India.

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study.

IntroductionAvailable evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown.MethodsElectronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission.ResultsCurrent (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06–1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04–1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50–0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16–0.66) and former smokers (aOR, 0.47; 95% CI, 0.39–0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66–0.83) than never smokers (aOR, 0.87; 95% CI, 0.79–0.97).ConclusionsFormer but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers.ImplicationsPrior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects.

An evaluation of junior doctors' experience in smoking cessation training in a rural mental health setting.

IntroductionSmoking prevalence remains high amongst people with mental illness, however, they are less likely to be screened for tobacco dependence and offered treatment to quit. Smoking cessation and education training are insufficient in medical schools, despite a positive relationship between training and practice once qualified. However, the question as to whether there is adequate skill and expertise to address smoking in people with mental illness within Australian mental health settings is unclear. Furthermore, people living in rural and remote areas smoke at higher rates, quit at lower rates than those in urban areas, and experience limitations in their ability to access smoking cessation supports. The Smokers’ Clinic is an initiative established in a rural Australian mental health service offering a smoking cessation service to patients and staff employed by the service.AimThis study aims to assess the change in the knowledge and confidence of resident medical officers in their understanding of nicotine dependence, smoking cessation strategies and prescribing nicotine replacement therapy in a community mental health setting. It was hypothesized that providing education and supervised clinical experience would improve knowledge, increasing confidence and motivation in managing smoking cessation in mental health patients. The research was undertaken using data collected through a questionnaire obtained from surveying resident medical officers administering the Smokers’ Clinic following a 10-week rural community mental health rotation.Materials and methodsTwenty resident medical officers completed the 10-week rotation, with 14 completing the questionnaire. Knowledge of tobacco smoking, nicotine dependence and smoking cessation interventions improved with the experience of the Smokers’ Clinic during the clinical rotation. Resident medical officers were motivated to spend additional time engaged in self-directed learning and all reported continued use of acquired experience and information in their clinical work after the rotation.ConclusionThis study indicates the utility of a novel approach in delivering education, training, building clinical expertise, and facilitating sustained clinical capacity amongst junior medical staff for smoking cessation in a rural community mental health setting. It offers an efficient approach for mental health services to deliver smoking cessation services to reduce the morbidity and mortality burden associated with tobacco smoking.

Knowledge, Attitude, Practices, and Preparedness of Dental Professionals in Prescribing Nicotine Replacement Therapy.

Objective To assess the knowledge, practice, attitude, and preparedness of dental professionals in prescribing nicotine replacement therapy (NRT). Methodology. A prevalidated voluntary web-based questionnaire was generated as a link through Google Drive and was sent to 117 dental professionals in North India using Whatsapp, Messenger, and Instagram social media platforms. A total of 94 responses were received and out of which 76 responses were analyzed (18 forms were excluded due to incomplete or duplicate responses). Frequency analysis was done using SPSS software version 21. Result The participation rate was found to be 80.3%. More than half of the study population were familiar with the term NRT (77.6%) and its uses (67.1%), but approximately less than half of the total study subjects knew the duration (32.9%), cost (27.6%), dosage (25%), and contraindications (36.8%) of the NRT. Approximately 56.6% of the study participants showed a positive attitude towards helping patients to quit smoking through tobacco cessation counseling. Nearly one-fourth of the study population, i.e., 27.6%, were confident in explaining the negative impacts of tobacco, while 22.4% knew about the tobacco cessation protocol. Among the participants, only 27.6% reported that they practice NRT and out of which approximately less than 20% of the study participants were prescribing correct dose of NRT. Conclusion Though study subjects had an ample knowledge regarding NRT use in tobacco cessation, it does not reflect their current attitude and preparedness. Thus, there is a need for continuing education to further train dental professionals for prescribing NRT.

Trends in Incident Varenicline Prescribing Among Veterans Following the US Food and Drug Administration Drug Safety Warnings.

Objective: To evaluate national trends in incident varenicline and nicotine replacement therapy (NRT) prescribing among Department of Veterans Affairs (VA) beneficiaries before and after US Food and Drug Administration (FDA) warnings regarding neuropsychiatric side effects with varenicline use. Methods: All adult VA patients identified as smokers from 2007 to 2019 (N = 3,600,947) were determined and monthly counts of new varenicline and NRT users were calculated. An interrupted time-series analysis estimated the effect of the FDA warnings on varenicline and NRT prescribing overall and among Veterans with and without mental health disorders. Results: The incident use rate of varenicline decreased from a peak of 6.2 per 1,000 veteran smokers in October 2007 to 1.0 by July 2009 following the first FDA warning (pre-warning monthly slope = −0.27; P = .03). New NRT use increased from 10.7 per 1,000 veteran smokers in October 2007 to a peak of 12.6 per 1,000 in July 2009 (slope change = 0.71; P = .01), suggesting potential substitution. Following removal of the FDA boxed warning in December 2016, varenicline prescribing increased but did not return to pre-warning levels by December 2019. Among veterans with and without mental health disorders, varenicline use decreased 90% and 88%, respectively, following the first FDA warning, and both groups had comparable rates of new NRT use. Conclusions: Following the first FDA warning, incident use of varenicline declined significantly among veterans both with and without mental health disorders. Despite removal of the FDA boxed warning in December 2016, new use of varenicline had not returned to pre-warning levels 3 years following the removal.

Time trends in access to smoking cessation support for people with depression or severe mental illness: a cohort study in English primary care

ObjectivesTo investigate delivery of smoking cessation interventions, recorded quit attempts and successful quitting rates within primary care in smokers with depression or severe mental illness (SMI) compared with those without.DesignLongitudinal...

Knowledge, Attitude and Practice Regarding Tobacco Cessation Methods among the Dental Professionals of Bareilly International University: A Cross-sectional Study

INTRODUCTION: In India, the percentage of deaths caused by tobacco smoking is anticipated to rise from 1.4 percent in 1990 to 13.3 percent by 2020.Health care experts have done their best to persuade and counsel users to quit the habit through their collaborative efforts. AIM AND OBJECTIVES: Assessment of dentistry students' attitudes and practices concerning tobacco cessation strategies, as well as the role of information in their promotion. MATERIALS AND METHODS: This cross-sectional survey was carried out at the Institute of Dental Sciences, Bareilly among the dental professionals, i.e. final year, interns, postgraduates students. The questionnaire was designed to test the knowledge, attitude, and practice of dental students regarding tobacco use. The self-administered survey included a set of questions. Descriptive statistics and Chi-square test had been used to test associations between their responses among age, qualification, and academic year using statistical package for social sciences (SPSS) version 22. RESULTS: A total of 300 surveys were sent out, with a 96.39 percent response rate. There were 54 percent females and 46 percent males among the 250 participants. Approximately 68 percent of people were between the ages of 20 and 23. In the current study, 32.4 percent were seeking MDS and 67.6 percent were pursuing BDS. Nearly half of those prefer to prescribe nicotine replacement therapy (NRT) as a cigarette cessation recommendation to patients, followed by self-quitting at 48% and pharmaceutical approaches at 1.2 percent. DISCUSSION: More than half of the respondents had an average level of awareness of smoking cessation therapies, and the majority of them had a favorable attitude toward their provision. As a result, it is important to persuade students to develop an interest in learning about tobacco quitting strategies.

A quality improvement project on nicotine replacement therapy in Shannon Clinic (Northern Ireland)

AimsThe aims of this quality improvement project were to determine if Nicotine Replacement Therapy was being prescribed correctly in Shannon Clinic in Northern Ireland and also to improve the rates of correct prescribing of Nicotine Replacement Therapy in the aforementioned unit.BackgroundThere are several different types of Nicotine Replacement Therapy currently available. Shannon Clinic is a smoke-free clinical environment therefore patients who smoke are offered Nicotine Replacement Therapy on admission. When I was working at Shannon Clinic I became aware that there was no clear guidance available to medical staff on the wards regarding prescribing Nicotine Replacement Therapy and therefore I decided to carry out this quality improvement project.MethodAn audit of drug charts was done on the patients who were under the care of the consultant that I worked with. In total nine drug charts were included in the audit. After the audit was complete, I produced a poster to show how to correctly prescribe Nicotine Replacement Therapy. A copy of this poster was placed on each ward in Shannon Clinic. After a period of time the drug charts were re-audited to see if there had been an improvement in the rates of correct prescribing of Nicotine Replacement Therapy.ResultIn total, 22% of the drug charts which were included in the audit had Nicotine Replacement Therapy prescribed incorrectly on them. After the inclusion of a poster outlining how to prescribe Nicotine correctly on each ward in Shannon Clinic, 0% of drug charts had Nicotine Replacement Therapy prescribed incorrectly on them. This was an improvement of 22%.ConclusionThis quality improvement project was successful at reducing the rates of incorrect Nicotine Replacement Therapy in Shannon Clinic. In the future it is my hope that this quality improvement project should lead to the correct prescribing of Nicotine Replacement Therapy for all patients in Shannon Clinic. It should also lead to an increased awareness regarding the different types of Nicotine Replacement Therapy for medical staff working in this clinical unit.

Evaluation of tobacco use and willingness to accept nicotine replacement therapy during stay in an acute inpatient psychiatric ward

AimsTo evaluate tobacco smoking and willingness to try and to accept prescription of nicotine replacement therapy during psychiatric acute inpatient stay. When free to choose and use as desired (without imposing smoking cessation) patients may be open to nicotine replacement therapy.BackgroundTobacco smoking interventions are increasingly in demand especially for difficult to treat patient populations, as are those with severe mental illness. Implementing totally smoke-free psychiatric inpatient units is challenging. Imposing smoking cessation and use of nicotine substitutes may or not be the best of strategies for smoking reduction and cessation in the mid and long term. Allowing the patient free choice as to trying and learning to use nicotine replacement therapy with supervision may constitute a more acceptable approach.MethodFrom 1/1/2020 to 28/1/2020 (four weeks), 40 of the 44 patients in a general adult psychiatric inpatient unit (4 patients were too sedated or too agitated to be evaluated), with smoking restricted to a designated area and only during the day, were briefly evaluated as to their tobacco smoking habits (cigarettes/day) and willingness to accept nicotine lozenges and patches and were invited to participate in a smoking cessation programme during or after discharge.ResultOf the 40 patients evaluated, 26 were male and 14 were female, average age was 34 years (age range from 19 to 79 years). Diagnostic hypotheses for patients at admission were: schizophrenic disorder/schizoaffective disorder 9, bipolar disorder 7, psychosis not otherwise specified 19, depressive disorder 1 and other 4. 20(50%) were current smokers and 20 (50%) were non or ex-smokers. The smokers reported smoking an average of 14 cigarettes/day. Only one patient refused to try nicotine lozenges and all other smokers accepted regular prescription of nicotine lozenges during inpatient stay. 5 patients (25% of smokers) asked for or accepted suggestion to try nicotine patches in combination therapy with nicotine lozenges with the goal of smoking cessation.ConclusionPatients were open to a brief informal intervention targeting smoking behaviours and readily accepted trying nicotine lozenges and prescription during their inpatient stay. The regular use of nicotine replacement therapy by some patients encouraged other patients to try and accept therapy. In addition to the habitual tobacco sharing among patients, nicotine lozenges were also shared especially with newly admitted patients. The evaluation of the impact of this intervention will require a much longer period of time of implementation.

A systematic review of tobacco smoking cessation services in Africa: Practices and challenges faced by healthcare workers

Background: Tobacco smoking is a global public health challenge, resulting in an estimated loss of 1.4 trillion United States Dollars (USD), a preventable risk that can be achieved through tobacco cessation services. The study, therefore, aimed to review the most frequently used methods employed by healthcare workers (HCWs) in providing tobacco cessation services and reported challenges in Africa.
 Methods: A systematic review was conducted using five electronic databases (PubMed, Base, PsychInfo, Google Scholar, and African Journal Online) for published studies on HCW’s practices and challenges on tobacco cessation in Africa. We adopted a three-stage methodology to conduct the study, which identified articles using pre-defined key terms, screened articles to remove duplicates, and excluded irrelevant articles after reading the manuscripts’ titles and abstracts.
 Results: We reviewed articles and found that 35.0% to 83.0% of HCWs frequently asked their patients to quit smoking. Also, 14.9% of HCWs assisted smoking cessation among their patients, among whom 3.9% prescribed oral depressants and 2.8% prescribed Nicotine Replacement Therapy (NRT). Further, 17.0% of HCWs had guidelines to help patients to cease smoking. Challenges were lack of efficacy and training, lack of system support, low sense of responsibility by some physicians to incorporate the smoking cessation therapy to their patients, lack of attractive educational resources on smoking cessation, limited knowledge on effective intervention strategies, lack of guidelines, lack of specialists for smoking cessation, and unavailability of NRT.
 Conclusion: Follow-up should be commenced and intensified by HCWs for smoking cessation among tobacco smokers.

Nicotine Replacement Therapy during Pregnancy and Child Health Outcomes: A Systematic Review.

Tobacco smoking in pregnancy is a worldwide public health problem. A majority of pregnant smokers need assistance to stop smoking. Most scientific societies recommend nicotine replacement therapy (NRT) during pregnancy but this recommendation remains controversial because of the known fetal toxicity of nicotine. The objective of this systematic review was to provide an overview of human studies about child health outcomes associated with NRT use during pregnancy. The electronic databases MEDLINE, the Cochrane Database, Web of Science, and ClinicalTrials.gov were searched from the inception of each database until 26 December 2020. A total of 103 articles were identified through database searching using combination of keywords. Out of 75 screened articles and after removal of duplicates, ten full-text articles were assessed for eligibility and five were included in the qualitative synthesis. NRT prescription seems to be associated with higher risk of infantile colic at 6 months as in case of smoking during pregnancy, and with risk of attention-deficit/hyperactivity disorder. No association between NRT during pregnancy and other infant health disorders or major congenital anomalies has been reported. Well-designed controlled clinical trials with sufficient follows-up are needed to provide more information on the use of NRT or other pharmacotherapies for smoking cessation during pregnancy on post-natal child health outcomes.

Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England.

IntroductionSmoking during pregnancy remains common, and the English National Health Service (NHS) has recently been directed to prioritize providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other nonhealth services (local authorities).MethodsWe used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005–2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, (1) any NRT and (2) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared with pre-2013.ResultsWe identified 84 539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n = 6704) and dual NRT in 1.7% (n = 1466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of −0.25% per year, but the rate of decline significantly increased from 2013 onwards to −1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013.ConclusionsThese findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments.ImplicationsWomen who smoke during pregnancy may be being denied potentially effective means to help them quit, contrary to NICE guidance, at what can be a teachable moment with substantial immediate and longer-term health benefits for woman and their unborn child, and economic benefits for the NHS. When the organizations responsible for offering smoking cessation support are changed, health systems should consider potential adverse effects on the delivery of support and deploy strategies for mitigating these.

Smoking Cessation Treatment for Parents Who Dual Use E-Cigarettes and Traditional Cigarettes.

Introduction An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers. Methods A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child's clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices. Results Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child's insurance status, parents' sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.