Self-help Brochure Research Articles

Long-Term Effectiveness of a Quitline for Smoking Cessation: Results of a Randomized Controlled Trial

Plain Language SummarySmoking is a major global health problem, causing many preventable deaths and disabilities each year. Telephone counselling is a recommended method to help people quit smoking because it provides accessible support. This study examined the long-term effectiveness of the national German Smokers Quitline. Daily smokers who wanted to quit smoking were divided into two groups. One group received up to six phone calls from the national German Smokers Quitline, the other group received a self-help brochure. We measured how many participants stopped smoking for at least 7 days 12 months after the start of the intervention (7-day point prevalence of abstinence). We assessed long-term cigarette and tobacco abstinence, i.e., how many participants abstained from cigarettes/tobacco for a period of 9 months after the start of the intervention. We also examined the use of other cessation aids. A total of 905 participants took part in the study. The telephone counselling group had higher rates of long-term cigarette (31.7% vs. 17.8%) and tobacco abstinence (30.8% vs. 15.2%) compared to the other group. The odds of quitting were significantly higher in the telephone counselling group. However, the 7-day point prevalence of abstinence did not differ between the groups. Many participants used additional cessation aids, with e-cigarettes being the most common. In conclusion, telephone counselling provided by the national German Smokers Quitline is effective in helping people quit smoking long term. Increasing its awareness could improve smoking cessation rates in Germany. Counselling should include information about the risks and benefits of new nicotine consumer products.

Behavioral interventions for tobacco use in HIV-infected smokers: systematic review and pairwise, network meta-analysis of randomized trials.

Smoking among persons living with HIV infection (PLWH) is estimated to be 2-3 times greater than that in the general population. Data suggest that cigarette smoking is more common among PLWH because of several factors, including lower socioeconomic status, previous, or concurrent illicit drug and alcohol use, younger age, lower education level, and concomitant depressive symptoms. Cigarette smoking among PLWH has been associated with a higher risk of certain cancers and infections as well as lowered response to antiretroviral therapy. Randomized controlled trials on behavioral interventions for tobacco use among smokers with HIV were searched in the PubMed, Cochrane Library, EMBASE, and Web of Science databases. The retrieval period was from the inception of databases to November 2023. Network meta-analysis (NMA) was performed using the Stata 18.0 software with 19 studies (3190 subjects), of which 15 reported 7-day point prevalence abstinence and seven of which reported continuous abstinence. The NMA results showed that compared with general advice plus self-help brochure, text messaging (relative risk [RR] = 4.60, 95% confidence interval [CI], 1.12-18.81) and cell phone counseling (RR = 3.29, 95% CI, 1.71-6.32) were the most effective for 7-day point prevalence abstinence among smokers with HIV infection. Moreover, the meta-analysis showed that compared with smoking counseling and self-help brochures, continuous abstinence was statistically significantly enhanced after behavioral interventions (RR = 2.52, 95% CI, 1.51-4.20). The study revealed very low-to-high-quality evidence that text messaging, telephone counseling, and smoking cessation websites were effective for smokers with HIV infection.

Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial

BackgroundThe objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation.MethodsA parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention.ResultsA total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention.ConclusionThe present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking.Trial registrationThis study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.

Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial

BackgroundDespite the decline in cigarette smoking prevalence during nearly the past two decades, tobacco use is still widespread in the German adult population, accounting for 125,000 deaths each year and causing tremendous social costs. To accelerate the reduction in tobacco smoking prevalence, evidence-based smoking cessation methods are pivotal to a national tobacco control strategy. The present study aims to evaluate the effectiveness of the national German Smokers Quitline offering cessation support to smokers.MethodsA total sample of 910 daily smokers, who are motivated to quit, will be recruited via an online access panel and randomly assigned to either the intervention (telephone counselling) or control condition. In the intervention group, participants will receive up to six proactive phone calls during an intervention period of approximately six weeks. The provided treatment will combine the principles of motivational interviewing and those of the cognitive behavioural approach to treating substance use. Participants in the control condition will receive a self-help brochure to support smoking cessation. Data collection will take place at baseline as well as three (post assessment) and twelve months (follow-up assessment) after baseline assessment. Primary outcome measures will include the seven-day point prevalence abstinence at 3-month and 12-month assessments as well as prolonged abstinence (abstinence over the 12 month period). Secondary outcome measures will include a change in smoking-related cognitions and coping strategies among all participants. Among non-abstainers, treatment success indicators such as a reduction in number of cigarettes smoked per day and changes in the number and duration of quit attempts after intervention start will be assessed. It is expected that after both three and twelve months, smoking cessation rates will be higher in the telephone counselling condition compared to the control condition.DiscussionThe results will provide insights into the effectiveness of proactive telephone counselling by the national German Smokers Quitline.Trial registrationThe protocol for this study is registered with the German Clinical Trials Register: DRKS00025343, Date of registration: 2021/06/07, https://www.drks.de/drks_web/setLocale_EN.do

Tobacco Cessation – as We Want It: An Interview Study with Young People

Background: Smoking is still common among teenagers and young adults, and about every third young smoker states that he/she wants to quit smoking. There are no obvious evidence-based methods for tobacco cessation for young adults, and therefore, the same methods are used for adolescents and adults. The aim was to study adolescents’ and young adult’s experiences and views about what support they would like for smoking cessation. Methods: A qualitative study using a descriptive and exploratory design was conducted. Young smokers 16 - 29 years old (n=25) were interviewed in five focus groups in southern Sweden. Data were analyzed by qualitative content analysis. Results: The results illuminate young people’s suggestions to develop a model for tobacco cessation. Four themes emerged; <i>Finding your own motivation – a prerequisite for taking the first step towards giving up smoking. Existing support rejected</i> - existing apps, support by SMS, and self-help brochures did not appeal to the adolescents. <i>Agreement between friends</i> – To sign an agreement between two friends, which included a fee for relapses. <i>Supportive environment</i> - To organize the model with duo groups and give adapted support, and create the opportunity to win simple prizes to celebrate achieved interim goals. Conclusions: The participants suggested that the model for tobacco cessation should contain an agreement between friends, contain professional support, as well as have elements of celebration and competition. The challenge will be to implement this model into environments where they live.

Proactive Telephone Smoking Cessation Counseling Tailored to Parents: Results of a Randomized Controlled Effectiveness Trial.

A recent Dutch efficacy trial showed the efficacy of a telephone smoking cessation counseling tailored to smoking parents. Currently, it is unknown whether such telephone counseling would be effective under more real-world conditions. This study aimed to examine the effectiveness of parent-tailored telephone smoking cessation counseling in a two-arm randomized controlled effectiveness trial and whether the effectiveness depended on the recruitment approaches that were used to recruit parents (mass media vs. health care). In total, 87 parents received either telephone counseling (intervention) or a self-help brochure (control). Parents were asked to complete questionnaires at baseline and three months post-intervention. Results showed that the odds of reporting 7-day point-prevalence abstinence at three months post-intervention was 7.54 higher for parents who received telephone counseling than for parents in the control condition (53.3% vs. 13.2%, 95% CI = 2.49–22.84). Because inclusion was lower than anticipated, interaction-effects of condition and recruitment approach could not be interpreted. The present study demonstrates that the parent-tailored smoking cessation telephone counseling is effective in helping parents to quit smoking. Yet, before large-scale implementation, future research should focus on how recruitment of parents via the recruitment approaches could be improved.

Predictors of cessation treatment outcome and treatment moderators among smoking parents receiving quitline counselling or self-help material

ObjectiveSeveral cessation treatments effectively enhance cessation, but it is not always clear which treatment may be most suitable for a particular client. We examined predictors of treatment outcome and treatment moderators among smoking parents in the Netherlands. MethodWe conducted secondary analyses of a randomized controlled trial in which smoking parents received either quitline counselling (n=256) or a self-help brochure (n=256). Data collection was completed in October 2012. Endpoints were 7-day point prevalence abstinence and 6-month prolonged abstinence at 12-month follow-up. Potential predictors and moderators included socio-demographic characteristics, smoking-related variables, and child-related variables. ResultsMale gender, higher employment status, lower daily cigarette consumption, higher levels of confidence in quitting, presence of a child with a chronic respiratory illness, and wanting to quit for the health of one's child predicted abstinence at 12months. Significant treatment moderators were intention to quit and educational level. Quitline counselling was effective regardless of intention to quit and educational level, but self-help material was less effective among less motivated and lower educated parents. ConclusionCertain subgroups of smokers, such as parents who are concerned about the health of their child, are particularly receptive to cessation support. Individual characteristics should be considered in treatment selections.

Promoting smoking cessation among parents: Effects on smoking-related cognitions and smoking initiation in children

BackgroundParental smoking is associated with an increased risk of smoking among youth. Epidemiological research has shown that parental smoking cessation can attenuate this risk. This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents. MethodsData of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their children's primary schools. After the baseline assessment, smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure. Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up. Children's smoking-related cognitions and smoking initiation were examined at 3-month, 12-month, and 30-month follow-up. ResultsNo statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions (i.e., smoking outcome expectancies, perceived safety of smoking, self-efficacy to refrain from smoking, susceptibility to smoking) or smoking initiation rate on any follow-up assessment. ConclusionsThis study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children. Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence, there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth.

Feasibility and preliminary efficacy of a web-based smoking cessation intervention for HIV-infected smokers: a randomized controlled trial.

To evaluate the feasibility and preliminary efficacy of a Web-based tobacco treatment for persons living with HIV (PLWH). Prospective, randomized controlled trial. HIV-care center in the Bronx, New York. Eligibility criteria included HIV infection, current tobacco usage, interest in quitting, and access to a computer with internet. One hundred thirty-eight subjects enrolled, and 134 completed the study. Positively Smoke Free on the Web (PSFW), an 8-session, 7-week targeted tobacco treatment program for PLWH, was compared with standard care (brief advice to quit and self-help brochure). All subjects were offered nicotine patches. The main feasibility outcomes were number of sessions logged into, number of Web pages visited, number of interactive clicks, and total time logged in. The main efficacy outcome was biochemically verified, 7-day point prevalence abstinence 3 months after intervention. PSFW subjects logged into a mean of 5.5 of 8 sessions and 26.2 of 41 pages. They executed a mean of 10 interactive clicks during a mean total of 59.8 minutes logged in. Most required reminder phone calls to complete the sessions. Educational level, anxiety score, and home access of the Web site were associated with Web site usage. Ten percent of the PSFW group vs. 4.3% of controls achieved the abstinence end point. Among those who completed all 8 sessions, 17.9% were abstinent, and among women completers, 30.8% were abstinent. Web-based treatment is a feasible strategy for PLWH smokers, and preliminary findings suggest therapeutic efficacy.

Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation

BackgroundFew studies have examined why smoking cessation interventions are effective. The aim of this study was to examine the mediating processes underlying the effectiveness of cessation counseling administered by the Dutch national quitline. MethodsData were used of a two-arm randomized controlled trial in which smoking parents, who were recruited through primary schools in The Netherlands, received either quitline cessation counseling (n=256) or a self-help brochure (n=256). The endpoint was 6-months prolonged abstinence at 12-months follow-up, with 86.7% outcome data retention. Putative psychological mediators of treatment effectiveness included smoking-related cognitions (positive smoking outcome expectancies, self-efficacy), emotions (negative affect, perceived stress, depressive symptoms), and smoking cue coping methods (avoidance coping, acceptance coping) assessed at 3-months post-measurement. ResultsQuitline cessation counseling significantly decreased positive smoking outcome expectancies and negative affect and increased self-efficacy to refrain from smoking, avoidance of external cues to smoking, and acceptance of internal cues to smoking compared to self-help material. Increased self-efficacy to refrain from smoking in stressful and tempting situations (p<.001) and increased acceptance of cravings to smoke (p<.001) significantly mediated the effect of quitline cessation counseling on prolonged abstinence at 12-months follow-up (explained variance: 25.1%). ConclusionsSelf-efficacy to refrain from smoking and acceptance of cravings represent an important source of therapeutic change in smoking cessation counseling.

Effectiveness of proactive quitline counselling for smoking parents recruited through primary schools: results of a randomized controlled trial

To test the effectiveness of tailored quitline (telephone) counselling among smoking parents recruited into cessation support through their children's primary schools. Two-arm randomized controlled trial with 3- and 12-month follow-up. Proactive telephone counselling was administered by the Dutch national quitline. Smoking parents were recruited through their children's primary schools and received either intensive quitline support in combination with tailored supplementary materials (n = 256) or a standard self-help brochure (n = 256). The primary outcome was 7-day point-prevalence abstinence at 12-month follow-up. Also measured were baseline characteristics, use of and adherence to nicotine replacement therapy and pharmacotherapy, smoking characteristics and implementation of a home smoking ban. Parents who received quitline counselling were more likely to report 7-day point-prevalence abstinence at 12-month assessment [34.0 versus 18.0%, odds ratio (OR) = 2.35, confidence interval (CI) = 1.56-3.54] than those who received a standard self-help brochure. Parents who received quitline counselling were more likely to use nicotine replacement therapy (P < 0.001) than those who received a standard self-help brochure. Among parents who did not achieve abstinence, those who received quitline counselling smoked fewer cigarettes at 3-month (P < 0.001) and 12-month assessment (P < 0.001), were more likely to make a quit attempt (P < 0.001), to achieve 24 hours' abstinence (P < 0.001) and to implement a complete home smoking ban (P < 0.01). Intensive quitline support tailored to smoking parents is an effective method for helping parents quit smoking and promoting parenting practices that protect their children from adverse effects of smoking.

School-based promotion of cessation support: reach of proactive mailings and acceptability of treatment in smoking parents recruited into cessation support through primary schools

BackgroundSeveral forms of cessation support have been shown effective in increasing the chance of successful smoking cessation, but cessation support is still underutilized among smokers. Proactive outreach to target audiences may increase use of cessation support.MethodsThe present study evaluated the efficiency of using study invitation letters distributed through primary schools in recruiting smoking parents into cessation support (quitline support or a self-help brochure). Use and evaluation of cessation support among smoking parents were examined.ResultsFindings indicate that recruitment of smokers into cessation support remains challenging. Once recruited, cessation support was well received by smoking parents. Of smokers allocated to quitline support, 88% accepted at least one counselling call. The average number of calls taken was high (5.7 out of 7 calls). Of smokers allocated to receive self-help material, 84% read at least some parts of the brochure. Of the intention-to-treat population, 81% and 69% were satisfied with quitline support or self-help material, respectively. Smoking parents were significantly more positive about quitline support compared to self-help material (p<.001).ConclusionsCessation support is well-received and well-used among smoking parents recruited through primary schools. Future studies need to examine factors that influence the response to offers of cessation support in samples of nonvolunteer smokers.Trial registrationThe protocol for this study is registered with the Netherlands Trial Register NTR2707

Diätetische Kopfschmerzbehandlung bei Kindern

During the past 30 years, the prevalence of headache in children in the western world has significantly increased. Although food intolerance is a well known factor influencing headache in children, the dimensions of this have not been clearly evaluated yet. Severe migraine in children can be mitigated by strict dietary treatment in about 90 % of the cases. But in the long-term, such strict dietary regimes – especially according to Chinese medicine – are hardly practicable. Thus, a simplified nutritional change seems to be more appropriate in order to achieve a long-lasting influence on school children's headache. Methods Therefore, a randomized study was started to investigate the efficacy of a longer lasting nutritional intervention in children with headache, comparing the effects of a self-help brochure to those of individual nutritional advice. Children (7–18 years) with migraine, tension-type headache or a combination of both were randomized into two groups: “self-help program with a brochure” or “individual nutritional advice”. Nutritional change according to Traditional Chinese Medicine as well as state of the art in modern nutritional chemistry included avoidance of milk, curd cheese, wheat flour, white sugar, chocolate, preservatives, coloring and other food additives. After 12 weeks of nutritional change, mitigation of headache was checked in a control appointment. A reduction of headache frequency and intensity in the range of 50 % or more as revealed in headache calendars was defined as success. Results Out of 117 randomized participants, 32 (27 %) suffered from lactose malabsorption. 25 patients failed to fulfil the introduction criteria or broke off, showing a slightly higher but not significant dropout rate in the self-help group. 76 of the remaining participants changed their nutritional habits. 59 (83 %) reported subjective improvement, 56 of which fulfilled the success criteria with no statistically significant difference between the two groups. No significant difference was found between tension type headache and migraine. Conclusion Not only migraine but also tension-type headache responded in a relevant dimension to nutritional treatment. In case of higher migraine frequency combined with allergic comorbidity the efficacy of the nutritional regime seems to be even more pronounced. Personal counseling shows only a trend towards better clinical results. The lacking statistical difference between the two treatment groups excludes a significant importance of personal influence as explanation of headache improvement. In daily counselling, a combination of written information and a short personal explanation seems to be a practicable procedure.

A new health education instrument for occupational health promotion—Transtheoretical Model approach

The objective of this study was based on the Transtheoretical Model (TTM) to explore the mechanisms of health behavioral change, and design an effective health educational instrument. This study has been carried out since 2003 at an electric company in southern Taiwan area among 200 subjects. There were seven health behaviors being studied, including: healthy diet, weight control, physical activity, reducing alcohol, smoking and betel nut consumption and health exam. The purpose is to apply pretest results and the TTM to design seven self-help brochures with a Q&A and desk calendar functions. After 6 months of intervention, the posttest survey revealed that 30% of subjects needed very strong help, 48% with partial help and 13% with minor help from the brochures. Each brochure provided different significant effect for health behavioral change on life style. The study results may provide a new useful health educational tool and references for developing more effective health promotion program at worksites.

New Developments in Smoking Cessation

Research on smoking has increased in the past several years, and many new therapeutic modalities have been developed. Primary intervention for smoking cessation begins with systematic identification of smokers and a formal diagnosis of nicotine dependence. Providing self-help brochures without clinical advice has marginal efficacy, but these can be useful as an adjunct to clinician intervention. Several large studies have shown that physician advice alone can lead to quit rates of up to 10%, and follow-up for patients trying to quit can double cessation rates. Behavioral therapy alone has demonstrated cessation rates of approximately 20% for those willing to participate. Drug therapy remains the most attractive method of smoking cessation for many patients. The standard approach has been nicotine substitution using one of the four forms of nicotine replacement (gum, patches, nasal spray, inhaler) currently available. The efficacy of nicotine replacement products is similar, with each agent providing a doubling of the cessation rate. Thus, the choice of agent depends on patient factors and preference. Bupropion is the first nonnicotine-containing agent approved for smoking cessation, with cessation rates ranging from 10.5 to 24.4%, depending on dose. One-year follow-up suggests a continued benefit with this agent. The combination of bupropion and transdermal nicotine has also been shown to be effective for smoking cessation in clinical trials. Effective approaches to smoking cessation should combine identification of smokers, provision of advice at each visit, and widespread availability of treatment.