Self-reported Abstinence Research Articles

Brief mindfulness training for smoking cessation in Chinese women in workplaces: A pilot randomized controlled trial

IntroductionMindfulness training (MT) has shown preliminary efficacy as a behavioral treatment for smoking cessation. We examined the effect of a brief-MT intervention on smoking cessation for Chinese women in workplaces in Hong Kong, China. MethodsIn this pilot randomized controlled trial, 213 daily smokers were recruited from workplaces and computer-randomized into the intervention (n = 114) or control (n = 99) groups. Participants in both groups received a self-help booklet. Participants in the intervention group additionally attended 2 sessions of a brief-MT workshop. The primary outcome was self-reported 7-day point-prevalence abstinence (PPA) at 6 months. Secondary outcomes were biochemically validated abstinence (exhaled CO < 4 ppm and salivary cotinine < 10 ng/mL) and smoking reduction at 6 months. Analyses were done by intention to treat. We conducted a post-trial qualitative evaluation on participants in the intervention group (n = 14). Data were analyzed thematically. ResultsAt 6-month follow-up, self-reported 7-day PPA were similar between the intervention and control groups (18.4% vs. 21.2%; P = 0.61). Very few participated in biochemical validation (n = 17), and validated abstinence and smoking reduction rates showed no significant difference (5.3% vs. 11.1%, P = 0.12 and 20.2% vs. 20.2%, P = 1.00, respectively). A posteriori analysis showed that brief-MT participants who were psychologically engaged with the intervention had greater 6-month PPA. Qualitative evaluation showed brief-MT reduced stress but its effectiveness was restrained by the insufficient home practice. ConclusionsThis pilot trial on a brief-MT intervention for smoking cessation on Chinese women in workplaces showed feasibility, but improving compliance is needed to maximize the efficacy in future fully powered trials.

Results of a Feasibility Study of Helpers Stay Quit Training for Smoking Relapse Prevention.

Most smoking quit attempts end in relapse, and interventions focused on relapse prevention are lacking. Helpers Stay Quit (HSQ) is a novel behavioral relapse prevention intervention that teaches newly abstinent smokers to offer a "helping conversation" (HC) to help others quit tobacco. Pre-post intervention feasibility study with state quitline participants ≥14 days abstinent. Measures at baseline, 3 months, and 6 months included smoking status, offering HCs, and cessation self-efficacy. Primary outcomes: self-reported 7-day point prevalence abstinence; offering HCs. Cox models explored association of HCs with relapse. Preliminary effects analysis using propensity score matching compared 30-day abstinence of quitline clients with study sample at 7 months. Participants (N = 104) were as follows: mean age of 53 years (SD 13.9 years), 48.1% male, mean of cigarettes smoked/day of 16.2 (SD 9.7). Compared with participants who remained abstinent (n = 82), relapsers (n = 22) had fewer HCs over 6 months (2.6 vs 7.2; 95% confidence interval [CI]: 1.4, 7.8, p = .006). Using adjusted Cox regression, the hazard ratio of relapse for each HC was 0.85 (95% CI: 0.74, 0.99, p = .03). Compared with a matched sample of quitline clients not exposed to HSQ, study participants were 49% more likely to report 30-day abstinence at 7-month quitline follow-up (95% CI: 40%, 59%, p < .0001). HSQ, delivered to newly abstinent smokers who received standard quitline treatment, was associated with less self-reported relapse. These promising preliminary study results warrant further research to evaluate HSQ as a novel behavioral intervention to prevent smoking relapse. To date, behavioral interventions for smoking relapse prevention that teach abstainers cessation skills to apply to themselves have not shown effectiveness. This feasibility study examines the preliminary efficacy of a conceptually novel, "help others" behavioral intervention approach for relapse prevention in newly abstinent smokers recruited from a state quitline. HSQ teaches the newly abstinent smoker communication and listening skills to encourage other smokers in their personal social network to quit. Exploratory analysis using propensity score matching suggests that participants exposed to HSQ were significantly more likely to self-report 30-day abstinence at quitline 7-month follow-up than other quitline clients.

Walk or Run to Quit: a 3-year evaluation of a physical activity-based smoking cessation intervention

AbstractIntroductionWalk or Run to Quit was a national program targeting smoking cessation through group-based running clinics. Increasing physical activity may facilitate smoking cessation as well as lead to additional health benefits beyond cessation.AimTo evaluate the impact of Walk or Run to Quit over 3 years.MethodsAdult male and female participants (N = 745) looking to quit smoking took part in 156 running-based cessation clinics in 79 locations across Canada. Using a pre-post design, participants completed questionnaires assessing physical activity, running frequency and smoking at the beginning and end of the 10-week program and at 6-months follow-up. Carbon monoxide testing pre- and post- provided an objective indicator of smoking status and coach logs assessed implementation.Results55.0% of program completers achieved 7-day point prevalence (intent-to-treat = 22.1%) and carbon monoxide significantly decreased from weeks 1 to 10 (P &lt; 0.001). There was an increase in physical activity and running from baseline to end-of-program (P's&lt;0.001). At 6-month follow-up, 28.9% of participants contacted self-reported prolonged 6-month abstinence (intent-to-treat = 11.4%) and 35.6% were still running regularly.ConclusionsAlthough attrition was a concern, Walk or Run to Quit demonstrated potential as a scalable behaviour change intervention that targets both cessation and physical activity.

Efficacy of Smartphone Applications for Smoking Cessation

Smoking is a leading cause of premature death globally. Smartphone applications for smoking cessation are ubiquitous and address barriers to accessing traditional treatments, yet there is limited evidence for their efficacy. To determine the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy (ACT) vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines (USCPG). A 2-group, stratified, double-blind, individually randomized clinical trial was conducted from May 27, 2017, to September 28, 2018, among 2415 adult cigarette smokers (n = 1214 for the ACT-based smoking cessation application group and n = 1201 for the USCPG-based smoking cessation application group) with 3-, 6-, and 12-month postrandomization follow-up. The study was prespecified in the trial protocol. Follow-up data collection started on August 26, 2017, and ended at the last randomized participant's 12-month follow-up survey on December 23, 2019. Data were analyzed from February 25 to April 3, 2020. The primary analysis was performed on a complete-case basis, with intent-to-treat missing as smoking and multiple imputation sensitivity analyses. iCanQuit, an ACT-based smoking cessation application, which taught acceptance of smoking triggers, and the National Cancer Institute QuitGuide, a USCPG-based smoking cessation application, which taught avoidance of smoking triggers. The primary outcome was self-reported 30-day point prevalence abstinence (PPA) at 12 months after randomization. Secondary outcomes were 7-day PPA at 12 months after randomization, prolonged abstinence, 30-day and 7-day PPA at 3 and 6 months after randomization, missing data imputed with multiple imputation or coded as smoking, and cessation of all tobacco products (including e-cigarettes) at 12 months after randomization. Participants were 2415 adult cigarette smokers (1700 women [70.4%]; 1666 White individuals [69.0%] and 868 racial/ethnic minorities [35.9%]; mean [SD] age at enrollment, 38.2 [10.9] years) from all 50 US states. The 3-month follow-up data retention rate was 86.7% (2093), the 6-month retention rate was 88.4% (2136), and the 12-month retention rate was 87.2% (2107). For the primary outcome of 30-day PPA at the 12-month follow-up, iCanQuit participants had 1.49 times higher odds of quitting smoking compared with QuitGuide participants (28.2% [293 of 1040] vs 21.1% [225 of 1067]; odds ratio [OR], 1.49; 95% CI, 1.22-1.83; P < .001). Effect sizes were very similar and statistically significant for 7-day PPA at the 12-month follow-up (OR, 1.35; 95% CI, 1.12-1.63; P = .002), prolonged abstinence at the 12-month follow-up (OR, 2.00; 95% CI, 1.45-2.76; P < .001), abstinence from all tobacco products (including e-cigarettes) at the 12-month follow-up (OR, 1.60; 95% CI, 1.28-1.99; P < .001), 30-day PPA at 3-month follow-up (OR, 2.20; 95% CI, 1.68-2.89; P < .001), 30-day PPA at 6-month follow-up (OR, 2.03; 95% CI, 1.63-2.54; P < .001), 7-day PPA at 3-month follow-up (OR, 2.04; 95% CI, 1.64-2.54; P < .001), and 7-day PPA at 6-month follow-up (OR, 1.73; 95% CI, 1.42-2.10; P < .001). This trial provides evidence that, compared with a USCPG-based smartphone application, an ACT-based smartphone application was more efficacious for quitting cigarette smoking and thus can be an impactful treatment option. ClinicalTrials.gov Identifier: NCT02724462.

Real-World Utilization and Outcomes of the Veterans Health Administration's Smoking Cessation Text Message Program.

Smoking cessation mobile health (mHealth) programs are effective and have been recommended for integration into health care services but have not been evaluated in real-world health care settings. The Veterans Health Administration, a safety net health care provider, provides health care for 9 million US military veterans. Veterans Health Administration implemented the SmokefreeVET text message program in 2013. A retrospective evaluation of 6153 SmokefreeVET subscribers was conducted. The primary outcome was 30-day self-reported abstinence at 6 months. Secondary outcomes included percentage of opt outs, program completers, and 30-day self-reported abstinence at 3 months. SmokefreeVET subscribers were on average 47.5 years old and 71.4% male. Smoking cessation medication use was reported by 11.5% of subscribers at the start of their quit attempt and subscribers enrolled in the program for an average of 29 days. Subscribers who were younger, female, and heavier smokers were more likely to opt out of the six-week program early. The abstinence rate for the primary outcome, self-reported 30-day abstinence at 6 months among all subscribers was 3.7%. SmokefreeVET enrolled a younger and more female population of subscribers than other studies of veterans interested in tobacco treatment. The mHealth program was generally acceptable to veterans, yet strategies to increase retention may improve completion rates and outcomes. In this real-world setting, nearly half of the mHealth program subscribers combined use of the text program with smoking cessation medication. Further study of the optimal combination of mHealth with smoking cessation treatments is needed. mHealth smoking cessation programs can be effectively implemented within real-world health care settings, even in those serving disadvantaged populations. Further research to improve mHealth program efficacy and integration into clinical settings will increase the population-level impact of these effective smoking cessation programs.

Psychosocial interventions for reducing alcohol consumption in sub-Saharan African settings: a systematic review and meta-analysis.

Harmful alcohol use is a leading cause of morbidity and mortality in sub-Saharan Africa (sSA); however, the effects of non-pharmacological alcohol interventions in this region are unknown. A systematic review and meta-analysis of the available literature through 14March 2019 was undertaken. Two authors extracted and reconciled relevant data and assessed risk of bias. Meta-analyses were conducted. The review protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019094509). Studies conducted in sSA were eligible for inclusion. Individuals participating in interventions aimed at reducing alcohol use. Randomized and non-randomized controlled trials testing non-pharmacological interventions (psychosocial and structural) on alcohol consumption in sSA. Eligible outcomes included the Alcohol Use Disorders Identification Test (AUDIT) scores; alcohol abstinence; measures of drinking quantity and frequency; and biomarkers of alcohol consumption. Nineteen intervention trials (18 reports) testing psychosocial interventions (no structural interventions included), judged of moderate quality, were included in meta-analyses. A beneficial effect was identified for psychosocial interventions on alcohol abstinence at 3-6months [odds ratio (OR)=2.05, 95% confidence interval (CI)=1.20-3.48, k=5, n=2312, I2 =79%] and 12-60months (OR=1.91, 95% CI=1.40-2.61, k=6, n=2737, I2 =63%) follow-up. There were no statistically significant effects found for AUDIT score [2-3months: mean differences (MD)=-1.13, 95% CI=-2.60 to 0.34, k=6, n=992, I2 =85%; 6months: MD=-0.83, 95% CI=-1.92 to 0.26, k=6, n=1081, I2 =69%; 12months: MD=-0.15, 95% CI=-1.66 to 1.36, k=4; n=677; I2 =75%], drinks per drinking day (3months: MD=-0.22, 95% CI=-2.51 to 2.07, k=2, n=359, I2 =82%; 6-36months: MD=-0.09, 95% CI=-0.49 to 0.30, k=3, n=1450, I2 =60%) or percentage of drinking days (3months: MD=-4.60, 95%=-21.14 to 11.94; k=2; n=361; I2 =90%; 6-9months: MD=1.96, 95% CI=-6.54 to 10.46; k=2; n=818; I2 =88%). Psychosocial interventions show promise at increasing self-reported alcohol abstinence in sSA, but clinical, methodological and statistical heterogeneity across meta-analytical outcomes suggests that results should be interpreted with caution.

Medication adherence and rate of nicotine metabolism are associated with response to treatment with varenicline among smokers with HIV

IntroductionPLWHA who smoke have shown lower cessation rates within placebo-controlled randomized trials of varenicline. Adherence and rate of nicotine metabolism may be associated with quit rates in such clinical trials. MethodsThis secondary analysis of a randomized placebo-controlled trial of varenicline for smoking among PLWHA (N = 179) examined the relationship between varenicline adherence (pill count, ≥80% of pills), nicotine metabolism (based on the nicotine metabolite ratio; NMR) and end-of-treatment smoking cessation (self-reported 7-day point prevalence abstinence, confirmed with carbon monoxide of ≤ 8 ppm, at the end of treatment; EOT). ResultsCombining varenicline and placebo arms, greater adherence (OR = 1.011, 95% CI:1.00–1.02, p = 0.051) and faster nicotine metabolism (OR = 3.08, 95% CI:1.01–9.37, p = 0.047) were related to higher quit rates. In separate models, adherence (OR = 1.009, 95% CI:1.004–1.01, p < 0.001) and nicotine metabolism rate (OR = 2.04, 95% CI:1.19–3.49, p = 0.009) interacted with treatment arm to effect quit rates. The quit rate for varenicline vs. placebo was higher for both non-adherent (19% vs. 5%; χ2[1] = 2.80, p = 0.09) and adherent (35% vs. 15%; χ2[1] = 6.51, p = 0.01) participants, but the difference between treatment arms was statistically significant only for adherent participants. Likewise, among slow metabolizers (NMR < 0.31), the varenicline quit rate was not significantly higher vs. placebo (14% vs. 5%; χ2[1] = 1.17, p = 0.28) but, among fast metabolizers (NMR ≥ 0.31), the quit rate for varenicline was significantly higher vs. placebo (33% vs. 14%; χ2[1] = 4.43, p = 0.04). ConclusionsIncreasing varenicline adherence and ensuring that fast nicotine metabolizers receive varenicline may increase quit rates for PLWHA.

Virtual Reality Smartphone-Based Intervention for Smoking Cessation: Pilot Randomized Controlled Trial on Initial Clinical Efficacy and Adherence.

BackgroundObstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness of digital interventions for tobacco cessation.ObjectiveThis study aimed to evaluate participant adherence and smoking cessation outcomes in a pilot randomized controlled trial of the digital intervention Mindcotine (MindCotine Inc) using a self-administered treatment of virtual reality combined with mindfulness.MethodsA sample of 120 participants was recruited in the city of Buenos Aires, Argentina (mean age 43.20 years, SD 9.50; 57/120, 47.5% female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on virtual reality mindful exposure therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists, or a control group (CG), which received the online version of the smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at postintervention and 90-day follow-up. The primary outcome was self-reported abstinence at postintervention, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit.ResultsFollow-up rates at day 1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At postintervention, the TG reported 23% (14/60) abstinence on that day compared with 5% (3/60) in the CG. This difference was statistically significant (χ21=8.3; P=.004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Since only 20% (12/60) of participants in the CG completed the 90-day follow-up, we did not conduct a statistical comparison between groups at this follow-up time point. Among participants still smoking at postintervention, the TG was significantly more ready to quit compared to the CG (TG: mean 7.71, SD 0.13; CG: mean 7.16, SD 0.13; P=.005). A total of 41% (23/56) of participants completed the treatment in the time frame recommended by the program.ConclusionsResults provide initial support for participant adherence to and efficacy of Mindcotine and warrant testing the intervention in a fully powered randomized trial. However, feasibility of trial follow-up assessment procedures for control group participants needs to be improved. Further research is needed on the impact of VR-MET on long-term outcomes.Trial RegistrationISRCTN Registry ISRCTN50586181; http://www.isrctn.com/ISRCTN50586181

Comparison between success rates for smokers re-treated by a smokers' clinic and success rates for smokers treated for the first time.

To compare success rates and characteristics of smokers treated a second time by a smokers' clinic with success rates of their first treatment. Retrospective cohort study. Tobacco Dependence Treatment clinic in Prague, Czech Republic, between 2005 and 2017. A total of 5225 smokers treated either once (n=5006, single treatment sample, SS) or also second time (n=219, re-treated sample, RS), on average 4.47years after the first visit. Smokers received intensive treatment of tobacco dependence with pharmacotherapy options. Outcomes were evaluated after 1year. In case of failure or relapse, participants could undergo re-treatment in the same setting at least 1year after the start of the first treatment. Twelve-month self-reported continuous abstinence; CO-validated (≤6parts per million); number of visits; type of pharmacotherapy; mental health history; Fagerström Test for Cigarette Dependence; time between first and second treatment. The abstinence rate in the SS was 34.8% [95% confidence interval (CI)=33.4%, 36.1%] and in the RS was 37% (95% CI=30.6%, 43.8%) and 39.7% (95% CI=33.2%, 45.5%) for their first and second treatments, respectively. The samples were comparable on smoking and socio-demographic characteristics and pharmacotherapy used, but the RS in the second treatment had a higher prevalence of diagnosed mental health disorder at 39.3% (95% CI=32.8%; 46.1%) compared with 23.7% (95% CI=22.5%; 24.9%) in the SS. Participants who initiated their second quit attempt 1 to 2years after the first one were less successful than those who initiated their second quit attempt later (25 versus 43%; P<0.05). The results of the first treatment cycle were not found to be a reliable predictor for outcomes of the second cycle of treatment in univariate or multivariate logistic regression (odds ratio=1.35, 95% CI=0.70-2.63, P=0.373). In Prague, Czech Republic, smokers re-attending stop-smoking treatment more than 2years after their previous quit attempt appear to achieve similar success rates to those being treated for the first time.

Impact of a smoking cessation program on smoking prevalence and food security among food pantry users \u2013 a study protocol for a pragmatic cluster randomised controlled trial

BackgroundAmong food pantry users there is a high prevalence of both smoking and food insecurity, which may be related to one another. This study aims to evaluate the impact of a smoking cessation program carried out in food pantries on the smoking status and the food security status of food pantry users.Methods / designBefore starting the cluster randomised controlled trial, stakeholders will be engaged to adapt a behavioural group counselling program for smoking cessation to the needs of the food pantry users in a pre study. Food pantry users and workers as well as other experts, such as smoking cessation trainers, social workers, and psychologists, will be involved, using the world café technique and telephone interviews and a qualitative thematic analysis for data analysis to design the concept of the intervention program will be applied. In the second phase, the impact of the intervention on the smoking status and on food insecurity will be investigated by a cluster randomised controlled trial. A total of 416 food pantry users across 32 clusters (food pantries) in Berlin, Germany, should be recruited and randomly assigned to either the intervention group or the waiting list control group. The intervention will consist of a behavioural group counselling program for smoking cessation, specially tailored for food pantry users, as well as optional nicotine replacement therapy and the implementation of environmental smoking reduction measures in the food pantries. The primary outcomes 6 months after the treatment will be self-reported continuous smoking abstinence, validated by exhaled carbon monoxide (< 10 ppm of carbon monoxide), and increased food security level (the percentage of participants with an improved food security level).DiscussionThis study will be the first long-term investigation into the effect of a smoking cessation program on smoking status and food insecurity. The results of this study will inform the implementation of smoking cessation programs in food pantries throughout Germany.Trial registrationProspectively registered DRKS00020037. Registered 29 April 2020

Association between income and education with quit attempts, use of cessation aids, and short-term success in tobacco smokers: A social gradient analysis from a population-based cross-sectional household survey in Germany (DEBRA study)

IntroductionSmoking is more prevalent in smokers from lower compared with higher socioeconomic (SES) groups, but studies are inconsistent regarding underlying mechanisms. We aimed to assess associations between SES indicators and three distinct aspects of the smoking cessation process: attempting to quit; use of evidence-based cessation treatments; and success. MethodsWe analysed data of 12,161 last-year smokers (i.e., current smokers and recent ex-smokers who quit ≤ 12 months) from 20 waves (June/July 2016 to August/September 2019) of the German Study on Tobacco Use (DEBRA) – a representative household survey. Associations between indicators of SES (income and education) and (1) last-year quit attempts; (2) use of evidence-based cessation treatment or electronic cigarettes during the last attempt; and (3) short-term self-reported abstinence were analysed using multivariable logistic regression, adjusted for potential confounders. ResultsOf all last-years smokers, 18.6% had attempted to quit, of whom 15.2% had successfully stopped. Higher income (OR 0.82, 95%CI = 0.77–0.88 per 1000€) but low vs. high education (OR 0.83, 95%CI = 0.73–0.95) were associated with lower odds of quit attempts. In smokers with quit attempts, higher income but not education was associated with higher odds of using cessation medication (OR 1.31, 95%CI = 1.08–1.59 per 1000 €). Neither income nor education were associated with using behavioural support or success. ConclusionsIn the German healthcare system without free access to evidence-based cessation therapy, low-income smokers are more likely to make a quit attempt but less likely to use cessation medication than high-income smokers. Equitable access to such medication is crucial to reduce SES-related health disparities.

Assessment of the Effectiveness and Cost-Effectiveness of Tailored Web- and Text-Based Smoking Cessation Support in Primary Care (iQuit in Practice II): Protocol for a Randomized Controlled Trial.

BackgroundThe prevalence of smoking is declining; however, it continues to be a major public health burden. In England, primary care is the health setting that provides smoking cessation support to most smokers. However, this setting has one of the lowest success rates. The iQuit in practice intervention (iQuit) is a tailored web-based and text message intervention developed for use in primary care consultations as an adjunct to routine smoking cessation support with the aim of increasing success rates. iQuit has demonstrated feasibility, acceptability, and potential effectiveness.ObjectiveThis definitive trial aims to determine the effectiveness and cost-effectiveness of iQuit when used as an adjunct to the usual support provided to patients who wish to quit smoking, compared with usual care alone.MethodsThe iQuit in Practice II trial is a two-arm, parallel-group, randomized controlled trial (RCT) with a 1:1 individual allocation comparing usual care (ie, pharmacotherapy combined with multisession behavioral support)—the control—with usual care plus iQuit—the intervention. Participants were recruited through primary care clinics and talked to a smoking cessation advisor. Participants were randomized during the initial consultation, and those allocated to the intervention group received a tailored advice report and 90 days of text messaging in addition to the standard support provided to all patients.ResultsThe primary outcome is self-reported prolonged abstinence biochemically verified using saliva cotinine at 6 months after the quit date. A sample size of 1700 participants, with 850 per arm, would yield 90% power to detect a 4.3% difference in validated quit rates between the groups at the two-sided 5% level of significance. The Cambridge East Research Ethics Committee approved the study in February 2016, and funding for the study was granted from May 2016. In total, 1671 participants were recruited between August 2016 and July 2019. Follow-up for all participants was completed in January 2020. Data analysis will begin in the summer of 2020.ConclusionsiQuit in Practice II is a definitive, pragmatic RCT assessing whether a digital intervention can augment the impact of routine smoking cessation support in primary care. Previous research has found good acceptability and feasibility for delivering iQuit among smoking cessation advisors working in primary care. If demonstrated to be cost-effective, iQuit could be delivered across primary care and other settings, such as community pharmacies. The potential benefit would likely be highest where less behavioral support is delivered.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 44559004; http://www.isrctn.com /ISRCTN44559004.International Registered Report Identifier (IRRID)DERR1-10.2196/17160

Engagement and Effectiveness of a Smoking Cessation Quitline Intervention in a Thoracic Surgery Clinic

Smoking quitline programs effectively promote smoking cessation in outpatient primary care settings. To examine the factors associated with smoking quitline engagement and smoking cessation among patients undergoing thoracic surgery who consented to a quitline electronic referral. A retrospective cohort study was conducted from January 1, 2014, to December 31, 2018, among 111 active smoking patients referred to the quitline from a thoracic surgery outpatient clinic visit. Patients were divided into operative and nonoperative cohorts. Primary outcomes were engagement rates in the quitline program and successful smoking cessation. Secondary outcomes were self-reported point prevalence abstinence at 1 month and 6 months after the smoking quit date. Of 111 patients (62 men; mean [SD] age, 61.8 [11.2] years) who had a quitline referral, 58 (52%) underwent surgery, and 32 of these 58 patients (55%) participated in the program. Of the 53 nonoperative patients (48%), 24 (45%) participated in the program. In the operative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (21 of 32 [66%] vs 16 of 6 [62%]; P = .79) or in point prevalence abstinence at 1 month (23 of 32 [72%] vs 14 of 25 [56%]; P = .27) or 6 months (14 of 28 [50%] vs 6 of 18 [33%]; P = .36). Similarly, in the nonoperative cohort, there was no difference in the smoking cessation rate between quitline participants and nonparticipants (8 of 24 [33%] vs 11 of 29 [38%]; P = .78) or in point prevalence abstinence at 1 month (7 of 24 [29%] vs 8 of 27 [30%]; P = .99) or 6 months (6 of 23 [26%] vs 6 of 25 [24%]; P = .99). Regardless of quitline participation, operative patients had a 1.8-fold higher proportion of successful smoking cessation compared with nonoperative patients (37 of 58 [64%] vs 19 of 53 [36%]; P = .004) as well as a 2.2-fold higher proportion of 1-month point prevalence abstinence (37 of 57 [65%] vs 15 of 51 [29%]; P < .001) and a 1.8-fold higher proportion of 6-month point prevalence abstinence (20 of 45 [44%] vs 12 of 48 [25%]; P = .05). Having surgery doubled the odds of smoking cessation (odds ratio, 2.44; 95% CI, 1.06-5.64; P = .04) and quitline engagement tripled the odds of remaining smoke free at 6 months (odds ratio, 3.57; 95% CI, 1.03-12.38; P = .04). Patients undergoing thoracic surgery were nearly twice as likely to quit smoking as those who did not have an operation, and smoking quitline participation further augmented point prevalence abstinence. Improved smoking cessation rates, even among nonoperative patients, were associated with appropriate outpatient counseling and intervention.

Influencing factors on smoking cessation among outpatients from the National Central Subsidy Smoking Cessation Clinic Project, in 2015-2018

Objective: To evaluate the effect of smoking cessation project run by the Central Subsidy Smoking Cessation Clinic and to explore the related influencing factors on smoking cessation, in order to improve related services and provide better guidance to these smoking cessation clinics. Methods: Practitioners who had been trained to run smoking cessation projects were recruited to conduct face-to-face interview with the smokers. Questionnaires were completed to provide information on related psychological, social and behavioral issues. In these clinics, medications were provided to the patients by the health care takers in the clinic. One month after the first visit, smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) was counted. Results: The overall smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) appeared as 34.1%. Results from the multivariate logistic regression showed that patients over the age of 60 were the ones most likely to quit smoking. Smokers who showed higher possibility of quitting would include those: not on the daily base, intend to quit within 30 days, with other diseases, or taking varenicline and bupropion. Factors as unemployment, longer history of smoking, bigger quantity of cigarettes consumption per day, dependence on nicotine and urgency on taking up the first cigarette in the early morning etc., were related to the less likelihood of giving up smoking. However, histories of cessation did not seem to affect the possibility of quitting. Conclusions: Data from self-reported 7-day point prevalence abstinence at 30-day follow-up study showed that the smoking cessation intervention programs run by the central subsidy smoking cessation clinic project had been effectively implemented. Advocacy on quit smoking at early stage seemed to have better outcomes, thus should be called for. Since medications as varenicline tartrate and bupropion hydrochloride can increase the possibility of stop smoking, we would suggest that all the hospitals which are with smoking cessation clinics be equipped with these medicines. Professional assistance provided by practitioners is of key importance to help overcome the withdrawal symptoms during the periods of cessation, on these smokers.

Which Method of Assessing Depression and Anxiety Best Predicts Smoking Cessation: Screening Instruments or Self-Reported Conditions?

Affective disorders and symptoms (ADS) are predictive of lower odds of quitting smoking. However, it is unknown which approach to assessing ADS best predicts cessation. This study compared a battery of ADS screening instruments with a single, self-report question on predicting cessation. Among those who self-reported ADS, we also examined if an additional question regarding whether participants believed the condition(s) might interfere with their ability to quit added predictive utility to the single-item question. Participants (N = 2637) enrolled in a randomized controlled trial of web-based smoking treatments completed a battery of five ADS screening instruments and answered a single-item question about having ADS. Those with a positive self-report on the single-item question were also asked about their interference beliefs. The primary outcome was complete-case, self-reported 30-day point prevalence abstinence at 12 months. Both assessment approaches significantly predicted cessation. Screening positive for ≥ one ADS in the battery was associated with 23% lower odds of quitting than not screening positive for any (p = .023); those with a positive self-report on the single-item had 39% lower odds of quitting than self-reporting no mental health conditions (p < .001). Area under the receiver operating characteristic curve values for the two assessment approaches were similar (p = .136). Adding the interference belief question to the single-item assessment significantly increased the area under the receiver operating characteristic curve value (p = .042). The single-item question assessing ADS had as much predictive validity, and possibly more, than the battery of screening instruments for identifying participants at risk for failing to quit smoking. Adding a question about interference beliefs significantly increased the predictive utility of the single-item question. This is the first study to demonstrate that a single-item question assessing ADS has at least as much predictive validity, and possibly more, than a battery of validated screening instruments for identifying smokers at highest risk for cessation failure. This study also demonstrates adding a question about interference beliefs significantly adds to the predictive utility of a single, self-report question about mental health conditions. Findings from this study can be used to inform decisions regarding how to assess ADS in the context of tobacco treatment settings.

Abstract A032: Quitline treatment enrollment, dose, and cessation outcomes among safety net patients linked with treatment via Ask-Advise-Connect: Differential efficacy among Spanish- vs. English-speaking smokers

Abstract Most quitlines offer treatment in Spanish. However, little is known about the long-term efficacy of quitline-delivered treatment among Spanish-speaking smokers. This study is a secondary analysis of a 34-month implementation trial evaluating Ask-Advise-Connect (AAC)—an electronic health record (EHR)-based approach designed to facilitate enrollment in quitline-delivered treatment—in 13 community clinics serving low-income, racially/ethnically diverse patients in Houston, TX. Our goal was to compare treatment engagement, counseling dose received, and smoking abstinence among individuals who received treatment in Spanish versus English. Clinic staff were trained to Ask all patients about their smoking status, Advise all smokers to quit, and offer to immediately Connect smokers with treatment through a link within the EHR. Quitline treatment consisted of up to 5 proactive counseling calls. Outcomes included treatment engagement (i.e., enrollment in treatment), treatment dose (i.e., number of counseling calls completed), and biochemically confirmed, self-reported abstinence six months after enrollment. The smoking status of 218,915 unique patients was assessed and recorded in the EHR. The preferred language for 95.2% of patients assessed was Spanish (n=102,146) or English (n=106,312). Among Spanish speakers, smoking prevalence was 8.4% (8,602/102,146). Among English speakers, smoking prevalence was 29.4% (31,264/106,312). The proportion of Spanish-speaking smokers who enrolled in treatment was 10.7% (924/8,602), and 78.5% of these individuals (725/924) agreed to be contacted for the 6-month follow-up. The proportion of English-speaking smokers who enrolled in treatment was 12.1% (3,785/31,264), and 78.1% of these individuals (2,957/3,785) agreed to be contacted for follow-up. Outcomes were examined among the subset of individuals who agreed to be contacted for follow-up. Among those who received treatment in Spanish, the median number of counseling calls completed was 2.26. Among those who received treatment in English, the median number of counseling calls completed was 1.20. Among those who received treatment in Spanish, self-reported 7-day point prevalence abstinence was 25.1% (182/725), and biochemically confirmed abstinence was 7.6% (55/725). Among those who received treatment in English, self-reported abstinence was 14.5% (429/2,957) and biochemically confirmed abstinence was 3.7% (110/2,957). Those who received treatment in Spanish were twice as likely to be abstinent at 6 months (self-report: OR: 1.98; 95% CI: 1.62, 2.40; biochemically confirmed: OR: 2.13; 95% CI: 1.52, 2.97). Findings indicate that streamlined, automated approaches such as AAC have great potential to engage Spanish-speaking smokers in treatment. Once engaged, Spanish speakers completed more counseling calls and were twice as likely to be abstinent at 6 months. It is also notable that large discrepancies were observed between self-reported and biochemically confirmed abstinence. Citation Format: Bárbara Piñeiro, Damon J. Vidrine, David W. Wetter, Diana S. Hoover, Summer Frank-Pearce, Nga Nguyen, Susan M. Zbikowski, Jennifer I. Vidrine. Quitline treatment enrollment, dose, and cessation outcomes among safety net patients linked with treatment via Ask-Advise-Connect: Differential efficacy among Spanish- vs. English-speaking smokers [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A032.

Quit4hlth: a preliminary investigation of tobacco treatment with gain-framed and loss-framed text messages for quitline callers.

Recent evidence suggests that quitline text messaging is an effective treatment for smoking cessation, but little is known about the relative effectiveness of the message content. A pilot study of the effects of gain-framed (GF; focused on the benefits of quitting) versus loss-framed (LF; focused on the costs of continued smoking) text messages among smokers contacting a quitline. Participants were randomized to receive LF (N = 300) or GF (N = 300) text messages for 30 weeks. Self-reported 7-day point prevalence abstinence and number of 24 h quit attempts were assessed at week 30. Intent-to-treat (ITT) and responder analyses for smoking cessation were conducted using logistic regression. The ITT analysis showed 17% of the GF group quit smoking compared to 15% in the LF group (P = 0.508). The responder analysis showed 44% of the GF group quit smoking compared to 35% in the LF group (P = 0.154). More participants in the GF group reported making a 24 h quit attempt compared to the LF group (98% vs. 93%, P = 0.046). Although there were no differences in abstinence rates between groups at the week 30 follow-up, participants in the GF group made more quit attempts than those in the LF group.

Brief cessation advice, nicotine replacement therapy sampling and active referral (BANSAR) for smoking expectant fathers: Study protocol for a multicentre, pragmatic randomised controlled trial

BackgroundPregnancy presents a teachable moment to engage male smokers whose partners are pregnant in smoking cessation. Evidence on how to approach and help these smokers quit smoking in antenatal settings has remained scarce. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a brief intervention model for promoting smoking cessation in expectant fathers. MethodsBANSAR is a pragmatic randomised controlled trial conducted in antenatal clinic in seven public hospitals in Hong Kong, China. An estimated 1148 fathers who smoke at least one cigarette daily and whose partners are pregnant and non-smoking will be randomised (1:1) to receive brief advice combined with 1-week sample of nicotine replacement therapy (NRT) and active referral to smoking cessation services, or brief advice only (usual care). Outcome will be assessed at 3 and 6 months after treatment initiation. The primary outcome is carbon monoxide-verified (<4 part per million) abstinence at 6 months post-treatment initiation. Secondary outcomes include self-reported 7-day point-prevalence abstinence and 24-week continuous abstinence, use of smoking cessation service and NRT and quit attempt, and smoking reduction, change in nicotine dependence and intention to quit in continuing smokers. CommentThis trial will provide real-world evidence on the effectiveness of a combined brief intervention model for smoking cessation in expectant fathers, an understudied population. The findings may be particularly relevant to low and middle-income countries, where male-to-female smoking ratios and birth rates tend to be higher than higher-income countries. Trial registrationClinicalTrials.gov, number NCT03671707.

Is It Feasible to Impact on Smoking Habits in HIV-Infected Patients? Mission Impossible From the STOPSHIV Project Cohort.

Assessment of the feasibility and effectiveness of a brief intervention for smoking cessation in people living with HIV (PLWH). Multicenter cohort prospective study involving PLWH from 10 Italian infectious disease centers. During routine HIV care, clinicians delivered the 5As brief intervention (Ask, Advise, Assess, Assist, Arrange) to each patient who enrolled in the study, following the European AIDS Clinical Society guidelines. At study end, participating clinicians evaluated their own adherence to intervention: "standard" if counseling was delivered in at least half of the follow-up visits, "soft" if less. The main outcome measure was smoking abstinence ≥6 months. Abstinence predictors were evaluated using a Cox-proportional hazard regression model. One thousand eighty-seven PLWH-patients (age 47.9 ± 10.8, male 73.5%) were followed for a median of 23 months (interquartile range 21-25). At baseline, current smokers were 561 (51.6%). Standard intervention was performed in 4 of 10 centers and included 343 smokers; soft intervention was performed in 6 centers (218 smokers). At last visit, 35 patients in standard (10.8%) and 6 in soft intervention (2.8%) achieved self-reported tobacco abstinence ≥6 months (P = 0.0009). Overall, the 5As intervention led to 7.3% 6-month interruptions. In the multivariable analysis, significant predictors for 6-month smoking cessation were: lower Fagerström score, stage of change (preparation/contemplation vs. precontemplation), and standard intervention. Adherence to the 5As brief intervention emerged as a critical factor for success. In fact, compared with soft intervention, the standard intervention significantly increased abstinence, highlighting that clinicians need more time and supporting tools to encourage PLWH to quit smoking.

Effectiveness of nicotine replacement therapy sample at outdoor smoking hotspots for initiating quit attempts and use of smoking cessation services: a protocol for a cluster randomised controlled trial

IntroductionMore than half of the smoking population in Hong Kong are unmotivated to quit. Only about 2% of tobacco users in the territory have ever used cessation aids such as...