Seven-day Point Prevalence Abstinence Research Articles

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.

Combining varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with serious mental illness who smoke: The randomized ACTSLow pilot feasibility trial

BackgroundPeople with serious mental illness (SMI; bipolar [BD] or schizophrenia spectrum disorders [SSD]) who smoke have 30–60% lower odds of quitting and are more prone to experience neuropsychiatric adverse events (NPSAEs) when quitting than smokers without SMI. We pilot-tested the feasibility of combining two different dosing strategies of varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with SMI in an attempt to bolster quit rates without increasing NPSAEs. MethodsTwelve-week, single center, randomized, double-blind, pilot feasibility trial of low (0.5mg twice daily, slower titration) versus standard dose (1.0mg twice daily, standard titration) varenicline in persons with BD or SSD with a 12-week follow-up. All participants received up to 10 sessions of ACT for smoking cessation. Participants were asked to preload with varenicline while still smoking and set a flexible target quit day (TQD) by day 35. ResultsRecruitment was hampered by shutdowns related to COVID-19 and the worldwide varenicline recall, respectively. Retention goals were met. Treatment satisfaction was high across both dosing and diagnostic groups. Most participants (92.9%) adhered to preloading instructions and the flexible TQD. Seven-day point prevalence abstinence at week 12 was highest in BD participants (37.5%) but lowest in SSD participants (16.7%) who received the standard dose. Medication was well tolerated. ConclusionsAlthough recruitment was hindered by unanticipated world events, feasibility was demonstrated. Participants adhered to and were highly satisfied with the combination of pre-cessation varenicline plus ACT. Findings support testing this combined treatment approach in a fully powered trial of persons with BD who smoke.

A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial

IntroductionRates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. MethodsThe study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. ResultsSelf-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07–2.58) but not six (OR = 1.35; 95 % CI: 0.85–2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20–3.42). Biochemical verification suggested low rates of misreporting. ConclusionsA tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.

A pilot adaptive trial of text messages, mailed nicotine replacement therapy, and telephone coaching among primary care patients who smoke

IntroductionSequential multiple assignment randomized trials (SMART) inform the design of adaptive treatment interventions. We tested the feasibility of a SMART to deliver a stepped-care intervention among primary care patients who smoked daily. MethodsIn a 12-week pilot SMART (NCT04020718), we tested the feasibility of recruiting and retaining (>80 %) participants to an adaptive intervention starting with cessation text messages (SMS). The study randomly assigned participants (R1) to assessment of quit status, the tailoring variable, after either 4 or 8 weeks of SMS. The study offered continued SMS alone to those reporting abstinence. Those reporting smoking were randomized (R2) to SMS + mailed NRT or SMS + NRT + brief telephone coaching. ResultsDuring Jan–March and July–Aug 2020, we enrolled 35 patients (>18 years) from a primary care network in Massachusetts. Two (6 %) of 31 participants reported seven-day point prevalence abstinence at their tailoring variable assessment. The 29 participants who continued to smoke at 4 or 8 weeks were randomized (R2) to SMS + NRT (n = 16) or SMS + NRT + coaching (n = 13). Thirty of 35 participants (86 %) completed 12-weeks; 13 % (2/15) of those in 4-week group and 27 % (4/15) of those in 8-week group had CO < 6 ppm at 12-weeks (p = 0.65). Among 29 participants in R2, one was lost to follow-up, 19 % (3/16) of the SMS + NRT group had CO < 6 ppm vs. 17 % (2/12) of SMS + NRT + coaching (p = 1.00). Treatment satisfaction was high (93 %, 28 of 30 who completed 12-weeks). ConclusionsA SMART exploring a stepped-care adaptive intervention combining SMS, NRT, and coaching for primary care patients was feasible. Retention and satisfaction were high and quit rates were promising.

Cost-free pharmacotherapy in smokers with TIA or stroke: QUIT-MED randomised controlled trial

ObjectiveTo examine whether cost-free (CF) smoking cessation medication was more effective than a prescription for cessation medication in patients after transient ischaemic attack (TIA) or stroke.DesignTwo-site randomised trial.SettingStroke prevention clinics...

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

Smoking Cessation in People With and Without Diabetes After Acute Coronary Syndrome.

People with diabetes smoke at similar rates as those without diabetes, with cardiovascular consequences. Smoking cessation rates were compared between people with and without diabetes 1 year after an acute coronary syndrome (ACS). People with ACS who smoked and were part of an observational prospective multicenter study in Switzerland were included from 2007 to 2017 and followed for 12 months. Seven-day point prevalence abstinence was assessed at 12 months follow-up. Association between diabetes and smoking cessation was assessed using multivariable-adjusted logistical regression model. 2457 people with ACS who smoked were included, the mean age of 57 years old, 81.9% were men and 13.3% had diabetes. At 1 year, smoking cessation was 35.1% for people with diabetes and 42.6% for people without diabetes (P-value .01). After adjustment for age, sex, and educational level, people with diabetes who smoked were less likely to quit smoking compared with people without diabetes who smoked (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98, P-value = .037). The multivariable-adjusted model, with further adjustments for personal history of previous cardiovascular disease and cardiac rehabilitation attendance, attenuated this association (OR 0.85, 95% CI 0.65-1.12, P-value = .255). Among people with diabetes, cardiac rehabilitation attendance was a positive predictor of smoking cessation, and personal history of cardiovascular disease was a negative predictor of smoking cessation. People with diabetes who smoke are less likely to quit smoking after an ACS and need tailored secondary prevention programs. In this population, cardiac rehabilitation is associated with increased smoking cessation. This study provides new information on smoking cessation following ACSs comparing people with and without diabetes. After an ACS, people with diabetes who smoked were less likely to quit smoking than people without diabetes. Our findings highlight the importance of tailoring secondary prevention to people with diabetes.

Assessment of the real-world impact of the Thai smoking cessation programme on clinical outcomes: protocol for a multicentre prospective observational study.

Tobacco smoking is the most common preventable cause of morbidity and mortality in the world. In an effort to counteract the harmful consequences of smoking, various tobacco control measures have been implemented, including the use of smoking cessation programmes to reduce the number of new smokers as well as helping current smokers to quit smoking. In Thailand, the SMART Quit Clinic Program (FAH-SAI Clinics) was launched in 2010 to provide smoking cessation services by a multidisciplinary team. There are currently 552 FAH-SAI Clinics established across all 77 provinces of Thailand. This protocol describes a study aiming to evaluate the SMART Quit Clinic Program (FAH-SAI Clinics) in terms of programme performance and clinical outcomes. We hope that the results of the study could be used to improve the current service model and the programme's success. A multicentre prospective observational study will be conducted. The study will focus on 24 FAH-SAI Clinics across 21 provinces of Thailand. The primary outcomes are seven-day point prevalence abstinence rate and continuous abstinence rate at three and six months. The outcomes will be measured using a self-reported questionnaire and biochemical validated by exhaled carbon monoxide. This study will be the first real-world study that reports the effectiveness of the well-established smoking cessation programme in Thailand. Findings from this study can help improve the quality of smoking cessation services provided by multidisciplinary teams and other smoking cessation services, especially those implemented in low- and middle-income countries.

Feasibility and acceptability of testing a menstrual-cycle timed smoking cessation intervention for women of reproductive age (Project Phase): Results of a pilot randomized control trial

IntroductionMenstrual phase influences cigarette smoking-related outcomes. Telephone-based cessation programs (e.g., quitlines) may incorporate the role of the menstrual cycle in an effort to tailor interventions for women. Purpose: The goal of this preliminary randomized clinical trial was to examine the feasibility and acceptability of timing quit date to menstrual phase in women in a quitline setting. MethodsWe recruited treatment-seeking women with regular menstrual cycles between the ages of 18–40 years. Participants were randomized to the follicular phase (FP; quit date set 6–8 days post onset of menses) or standard of care (SC; no menstrual timing of quit date). All participants received four weeks of nicotine replacement therapy transdermal patch concurrent with six weeks of telephone-based counseling. We explored self-reported and biochemically-verified seven-day point prevalence abstinence at end-of-treatment and three-month follow-up. ResultsParticipants (n = 119; FP: n = 58, SC: n = 61) were, on average, 33.4 years old and smoked 13.6 cigarettes/day. The median number of counseling sessions completed was 6 out of 6 available, and 66% of participants completed the intervention. Over 90% of participants reported they would recommend this study to friends/family. Cessation rates did not significantly vary by randomization. ConclusionsResults of this preliminary trial indicate that timing quit date to FP is an acceptable and feasible approach to address smoking cessation in women of reproductive age. While we observed similar smoking cessation rates between groups, this preliminary study was not fully powered to determine efficacy. Therefore, the feasibility and acceptability results indicate that a fully-powered efficacy trial is warranted.

Time to put it out - nurse-facilitated tobacco treatment in a comprehensive cancer center.

Few cancer patients receive guideline-concordant care for treatment of tobacco dependence. The purpose of this pilot trial was to obtain preliminary estimates of effectiveness of an evidence-based practice intervention on the delivery of tobacco treatment and cessation outcomes in cancer patients. We conducted a pragmatic implementation trial with a before-after design in 119 current or recently quit adult smokers with cancer who met with a clinician at a single National Cancer Institute designated comprehensive cancer center (CCC) (n = 61 pre-implementation, n = 58 post-implementation). We used a multi-component strategy based on the Chronic Care Model to implement National Comprehensive Cancer Network (NCCN) guidelines for smoking cessation. Smoking cessation counseling during the index visit was assessed by exit interview and patients were interviewed by phone to assess cessation outcomes at 3-month follow-up. Performance of cessation counseling and 7-day point prevalence abstinence (PPA) were compared across the pre- and post-implementation periods using log-logistic regression, accounting for clustering by nursing staff. More patients had received assistance in quitting at the index visit during the post-implementation period compared to the pre-implementation period (30 vs. 10%, p < .01). At 3-month follow-up, 38 and 14% of participants had discussed smoking cessation medication with a CCC healthcare professional and 57 and 27% of participants had used pharmacotherapy, respectively (p < .01 for both comparisons). Seven-day PPA at 3-month follow-up was similar in both periods, however (14 vs. 12%, respectively). A multi-component tobacco treatment intervention increased the proportion of smokers who received assistance in quitting smoking during usual cancer care but did not improve cessation outcomes.

The Effectiveness of Nicotine Replacement Therapy in Light Versus Heavier Smokers.

The prevalence of light smoking has increased in North America; however, research on the effectiveness of current treatments in this subpopulation of smokers is limited. We compared quit outcomes between light (1-10 cigarettes per day [CPD]) versus heavier smokers (>10 CPD) enrolled in a treatment program at their primary care clinic. This secondary analysis analyzed 45 087 participants (light smokers [n = 9861]; heavier smokers [n = 35 226]) enrolled in a smoking cessation program between April 2016 and March 2020. The program offered cost-free nicotine replacement therapy (NRT) plus in-person counseling. Type, dose, and duration of NRT treatment were personalized. Data were collected at baseline, and at 6 months following enrollment to assess 7-day point prevalence abstinence (PPA), the primary outcome variable of interest. Logistic regression models were used for analyses. Seven-day PPA at 6 months was significantly higher among light smokers (30.6%) than heavier smokers (26.0%; odds ratio = 1.25, 95% confidence interval = 1.18-1.33, p < .001). Heavier smokers were prescribed more weeks of NRT than light smokers (B = 0.82, 95% confidence interval = 0.64-1.0, p < .001). The association between smoking cessation and daily NRT dose did not differ between groups (p = .98). However, a stronger positive relationship between the number of clinic visits attended and 7-day PPA was found among heavier smokers in comparison to light smokers (p < .001). All findings remained significant after adjusting for baseline variables. There is a paucity of scientific literature on the effectiveness of NRT for light smokers. Our findings suggest that individualized doses of NRT may be helpful in these subpopulations, and highlight the different treatment needs of light smokers. Current clinical guidelines do not provide formal recommendations for light smokers who want to quit smoking. Similar to heavy smokers, light smokers are at substantial risk for many adverse health problems. As such, it is important to understand what treatment options are effective in assisting light smokers to quit smoking. Findings from this study support the use of personalized treatment for all smokers who are interested in quitting smoking, including light smokers.

The short-term effectiveness of real-time video counselling on smoking cessation among residents in rural and remote areas: An interim analysis of a randomised trial

BackgroundReal-time video counselling for smoking cessation uses readily accessible software (e.g. Skype). This study aimed to assess the short-term effectiveness of real-time video counselling compared to telephone counselling or written materials (minimal intervention control) on smoking cessation and quit attempts among rural and remote residents. MethodsAn interim analysis of a three-arm, parallel group randomised trial with participants (n = 655) randomly allocated to; 1) real-time video counselling; 2) telephone counselling; or 3) written materials only (minimal intervention control). Participants were daily tobacco users aged 18 years or older residing in rural or remote areas of New South Wales, Australia. Video and telephone counselling conditions offered up to six counselling sessions while those in the minimal intervention control condition were mailed written materials. The study measured seven-day point prevalence abstinence, prolonged abstinence and quit attempts at 4-months post-baseline. ResultsVideo counselling participants were significantly more likely than the minimal intervention control group to achieve 7-day point prevalence abstinence at 4-months (18.9% vs 8.9%, OR = 2.39 (1.34–4.26), p = 0.003), but the video (18.9%) and telephone (12.7%) counselling conditions did not differ significantly for 7-day point prevalence abstinence. The video counselling and minimal intervention control groups or video counselling and telephone counselling groups did not differ significantly for three-month prolonged abstinence or quit attempts. ConclusionGiven video counselling may increase cessation rates at 4 months post-baseline, quitlines and other smoking cessation services may consider integrating video counselling into their routine practices as a further mode of cessation care delivery. Trial registrationwww.anzctr.org.au ACTRN12617000514303.

Exenatide Adjunct to Nicotine Patch Facilitates Smoking Cessation and May Reduce Post-Cessation Weight Gain: A Pilot Randomized Controlled Trial.

Approved pharmacological treatments for smoking cessation are modestly effective, underscoring the need for improved pharmacotherapies. Glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate the rewarding effects of nicotine in preclinical studies. We examined the efficacy of extended-release exenatide, a GLP-1R agonist, combined with nicotine replacement therapy (NRT, patch) for smoking cessation, craving, and withdrawal symptoms, with post-cessation body weight as a secondary outcome. Eighty-four prediabetic and/or overweight smokers were randomized (1 : 1) to once-weekly placebo or exenatide, 2 mg, subcutaneously. All participants received NRT (21 mg) and brief smoking cessation counseling. Seven-day point prevalence abstinence (expired CO level ≤5 ppm), craving, withdrawal, and post-cessation body weight were assessed following 6 weeks of treatment. A Bayesian approach for analyzing generalized linear models yielded posterior probabilities (PP) to quantify the evidence favoring hypothesized effects of treatment on the study outcomes. Exenatide increased the risk for smoking abstinence compared to placebo (46.3% and 26.8%, respectively), (risk ratio [RR] = 1.70; 95% credible interval = [0.96, 3.27]; PP = 96.5%). Exenatide reduced end-of-treatment craving in the overall sample and withdrawal among abstainers. Post-cessation body weight was 5.6 pounds lower in the exenatide group compared to placebo (PP = 97.4%). Adverse events were reported in 9.5% and 2.3% of participants in the exenatide and placebo groups, respectively. Exenatide, in combination with the NRT improved smoking abstinence, reduced craving and withdrawal symptoms, and decreased weight gain among abstainers. Findings suggest that the GLP-1R agonist strategy is worthy of further research in larger, longer duration studies. Despite considerable progress in tobacco control, cigarette smoking remains the leading cause of preventable disease, disability, and death. In this pilot study, we showed that extended-release exenatide, a glucagon-like peptide-1 receptor agonist, added to the nicotine patch, improved abstinence and mitigated post-cessation body weight gain compared to patch alone. Further research is needed to confirm these initial positive results.

The impact of menthol cigarette use on quit attempts and abstinence among smokers with opioid use disorder

An exceedingly high proportion of persons with opioid use disorder (OUD) smoke cigarettes. Smokers with OUD face multiple barriers to smoking cessation. While menthol cigarette use has been associated with low cessation rates, research has not explored the impact of menthol cigarette use on tobacco use outcomes among smokers with OUD. Participants were current smokers, in methadone treatment for OUD, participating in randomized controlled trials of smoking cessation therapies. We examined the use of menthol cigarettes, and the association between menthol cigarette use and achieving 24-hour quit attempts and seven-day point prevalence abstinence. Of 268 participants, 237 (88.4%) reported menthol use. A similar proportion of menthol and non-menthol smokers achieved a 24-hour quit attempt (83.1% vs. 83.8%, p = 0.92). Though fewer menthol smokers (vs. non-menthol smokers) achieved abstinence (12.7% vs. 22.6%), this did not reach statistical significance (p = 0.14). In this sample of smokers with OUD, menthol smoking was nearly ubiquitous. Menthol smoking was not associated with differences in quit attempts, but was associated with differences in cessation that were not statistically significant. Menthol smoking may contribute to the challenges in achieving abstinence among smokers with OUD.

A Preoperative Contingency Management Intervention for Smoking Abstinence in Cancer Patients: A Preliminary Randomized Controlled Trial.

The purpose of this study was to evaluate a pilot preoperative contingency management (CM) intervention for smoking abstinence. This multisite pilot study was conducted at two cancer center-based tobacco treatment programs. Participants who were smoking, diagnosed with or suspected to have any type of operable cancer, and had a surgical procedure scheduled in the next 10 days to 5 weeks (N = 40) were randomized to receive standard care plus monitoring only (MO) or CM prior to surgery. All patients received breath carbon monoxide (CO) tests 3 times per week, nicotine patches, and counseling. The CM group also earned payments for self-reported smoking abstinence confirmed by CO breath test ≤6 ppm on an escalating schedule of reinforcement (with a reset if they smoked). Seven-day point prevalence abstinence rates on the day of surgery and at 3-month follow-up were compared between groups using repeated measures log-linear regression models utilizing generalized estimating equations. Participants lost to follow-up are assumed to have returned to smoking. The sample was 50% female and 75% White. In covariate adjusted models, patients in the CM group had a greater probability of reported abstinence. On the day of surgery (end of treatment), 52% of CM patients were abstinent compared with 16% of patients in MO (risk ratio = 3.2 [1.1-9.3]; p = .03). At the 3-month follow-up, 43% of CM patients were abstinent compared with 5% in MO (risk ratio = 8.4 [1.5-48.3]; p = .02). Providing monetary incentives contingent on abstinence prior to cancer surgery may produce significant improvements in smoking abstinence rates relative to breath CO MO. In this pilot preoperative CM intervention for smoking abstinence, patients receiving a CM intervention prior to cancer surgery had a greater probability of smoking abstinence at the end of treatment compared with a breath MO group (52% vs. 16%, respectively). Thus, providing monetary incentives contingent on abstinence may produce significant improvements in smoking abstinence rates prior to cancer surgery relative to breath CO monitoring.

Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial.

Within the context of busy clinical settings, health-care providers need practical, evidence-based options to engage smokers in quitting. Sampling of nicotine replacement therapy [i.e. provision of nicotine replacement therapy (NRT starter kits)] is a brief, pragmatic strategy to address this need. We aimed to compare the effects of NRT sampling plus standard care (SC), relative to SC alone, provided by primary care providers during routine clinic visits. Cluster-randomized clinical trial. Twenty-two primary care clinics in South Carolina, USA. Adult smokers [n=1245; 61% female, mean age=50.7, standard deviation (SD)=13.5] both motivated and unmotivated to quit, seen during routine clinical visit. Interventions were provider-delivered SC (n=652, 12 clinics) cessation advice or SC+a 2-week supply of both nicotine patch and lozenge, with minimal instructions on use (n=593; 10 clinics). The primary outcome was 7-day point prevalence smoking abstinence at 6-month follow-up, using intent-to-treat. Additional outcomes included NRT use and quit attempts, assessed at 1, 3 and 6months following baseline. Seven-day point prevalence abstinence rates were significantly higher in the NRT sampling group throughout follow-up, including at 6months [12 versus 8%, odds ratio (OR)=1.5, 95% confidence interval (CI)=1.0-2.4]. NRT sampling increased prevalence of any use of NRT (65 versus 25%, OR=5.8, 95% CI=4.3-7.7), with higher prevalence of use at 6months (25 versus 14%, OR=2.0, 95% CI=1.5-2.7). NRT sampling increased the rate of quit attempts in the initial month (24 versus 18%, OR=1.5, 95% CI=1.0-2.3) but had no significant effect on overall rate of quit attempts (48 versus 45%, OR=1.2, 95% CI=0.8-1.7). Providing smokers with a free 2-week starter kit of nicotine replacement therapy increased quit attempts, use of stop smoking medications and smoking abstinence compared with standard care in a primary care setting.

Effect of the motivation program to quit smoking in Royal Thai Air Force officers with non-communicable disease risks

Purpose The purpose of this paper is to compare the outcome of a smoking cessation program based on the protection motivation theory and a brief intervention among Royal Thai Air Force (RTAF) officers, with non-communicable disease (NCD) risks. Design/methodology/approach This quasi-experimental study involved sixty RTAF officers, with NCD risks. The first 30 participants were assigned to a control group and the latter 30 to an experimental group. The control group received brief advice on quitting smoking while the experimental group took part in an eight-week motivational program. The primary outcome was biochemically verified seven-day point prevalence abstinence from smoking. A measurement of carbon monoxide (CO)&lt;8 ppm in exhaled breath was considered indicative of abstinence. Findings Most participants were non-commissioned officers, with an age range of 21–59 years and a mean age of 38.27 years (SD=10.59). No significant difference in the Fagerström test for nicotine dependence scores between control and experimental groups was observed. The proportion of the participants reporting the seven-day point prevalence abstinence verified by exhaled CO was significantly higher in the experiment group than in the control group (20.0 percent vs 3.3 percent; p&lt;0.05). Numbers of cigarettes per day decreased from 12.87±7.23 and 10.53 ± 7.45 at the baseline to 7.23 ± 5.90 and 8.83 ± 6.13 at the end of study in experimental and control group, respectively. Originality/value This motivation-based program to quit smoking had a promising outcome in terms of smoking abstinence and smoking reduction.

Changes in Use Patterns Over 1 Year Among Smokers and Dual Users of Combustible and Electronic Cigarettes.

Dual use of combustible and electronic cigarettes (e-cigarettes) is a growing use pattern; more than half of e-cigarette users are dual users. However, little is known regarding the course of dual use; for example, the likelihood of discontinuation of either combustible or e-cigarettes or both. Adult daily smokers and dual users (daily smokers who also vaped at least once per week) who did not intend to quit use of either product in the next 30 days participated in a longitudinal, observational study (N = 322, 51.2% women, 62.7% white, mean age = 42.27 [SD = 14.05]). At baseline, participants completed demographics and smoking and vaping history assessments. They also reported daily cigarette and e-cigarette use via timeline follow-back assessment and provided a breath sample for carbon monoxide assay at 4-month intervals for 1 year. Of those who completed the year 1 follow-up, 1.9% baseline smokers and 8.0% dual users achieved biochemically confirmed seven-day point-prevalence abstinence from combustible cigarettes (χ2 = 4.57, p = .03). Of initial dual users, by 1 year 43.9% were smoking only, 48.8% continued dual use, 5.9% were vaping only, and 1.4% abstained from both products. Among baseline smokers, 92.3% continued as exclusive smokers. Baseline dual users who continued e-cigarette use were more likely to be white and report higher baseline e-cigarette dependence. In this community sample, the majority of dual users transitioned to exclusive smoking. A higher percentage of dual users quit smoking than smokers, but attrition and baseline differences between the groups compromise strong conclusions. Sustained e-cigarette use was related to baseline e-cigarette dependence. This research suggests that dual use of combustible and e-cigarettes is not a sustained pattern for the majority of dual users, but it is more likely to be a continued pattern if the user is more dependent on e-cigarettes. There was evidence that dual users were more likely to quit smoking than exclusive smokers, but this may be due to factors other than their dual use.

Field Test of a Dialectical Behavior Therapy Skills Training–Based Intervention for Smoking Cessation and Opioid Relapse Prevention in Methadone Treatment

Objective: Almost all individuals in methadone treatment for opioid dependence smoke cigarettes, and half of people in methadone treatment have an opioid relapse within six months. Dialectical behavior therapy (DBT) skills training has shown promise for addressing substance use and a variety of health behaviors and conditions; however, it has never been evaluated for smoking cessation in any population. The objective of this study was to field test a DBT skills training–based intervention for tobacco dependence and opioid relapse prevention (DBT-Quit) among people in methadone treatment.Methods: We recruited seven individuals in methadone treatment to participate in a field test of DBT-Quit. Participants attended 12 weekly 90-minute DBT skills training groups, focusing on mindfulness, emotion regulation, and distress tolerance skills. Participants received nicotine patches for eight weeks and completed assessments at baseline, 6 weeks (mid-treatment), and 12 weeks (post-treatment).Results: All but one participant (86%, n = 6) attended at least 50% of intervention sessions. Participants were “very” or “mostly” satisfied with the intervention. At 12 weeks, all but one (86%, n = 6) had made a quit attempt, and one (14%) had seven-day point prevalence abstinence. Participants were smoke-free for 24 hours (14%, n = 1), 7 to 14 days (43%, n = 3), and 30 to 59 days (29%, n = 2). Participants smoked significantly fewer cigarettes per day at 6 weeks and 12 weeks as compared to baseline. No participants used illicit drugs. As compared to baseline, at follow-up there were no significant differences in difficulties with emotion regulation, distress tolerance, or mindfulness.Conclusions: A DBT skills training–based intervention for individuals who smoke and have an opioid use disorder is feasible and acceptable in methadone treatment and may help this population prevent drug relapse, attempt to quit smoking, experience smoke-free days, and cut down on their smoking. More research is needed to determine the optimal structure and components of a DBT skills–based intervention for drug relapse prevention and smoking cessation. Further, a randomized controlled trial of DBT-Quit is needed to determine the efficacy of DBT skills training for smoking cessation and drug relapse prevention in this population.

Contingency management and cognitive behavioral therapy for trauma-exposed smokers with and without posttraumatic stress disorder

IntroductionTrauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. MethodsFifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. ResultsOf the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). ConclusionsUse of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD.