Smoking Cessation Advice Research Articles

Cost-utility analysis of provision of e-cigarette starter kits for smoking cessation in emergency departments: An economic evaluation of a randomized controlled trial.

To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective. This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥8parts per million, attending the ED (n= 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS. Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups. The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%). The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.

What happens between first symptoms and first acute exacerbation of COPD - observational study of routine data and patient survey.

Chronic obstructive pulmonary disease affects nearly 400 million worldwide - over a million in the United Kingdom - and is the third leading cause of death. However, there is limited understanding of what prompts a diagnosis, how long this takes from symptom onset and the different approaches to clinical management by primary care professionals. Map out the clinical management and National Health Service contacts from symptom presentation to chronic obstructive pulmonary disease diagnosis and first acute exacerbation of chronic obstructive pulmonary disease in three time periods; construct risk prediction for first acute exacerbation of chronic obstructive pulmonary disease. Retrospective cohort study and cross-sectional survey. Primary care. Patients with incident chronic obstructive pulmonary disease aged > 35 years in England. None. First acute exacerbation of chronic obstructive pulmonary disease. Clinical Practice Research Datalink Aurum; new online survey. Forty thousand five hundred and seventy-seven patients were diagnosed between April 2006 and March 2007 (cohort 1), 48,249 between April 2016 and March 2017 (cohort 2) and 4752 between March and August 2020 (cohort 3). The mean (standard deviation) age was 68.3 years (12.0); 47.3% were female. Around three-quarters were diagnosed in primary care, with a slight fall in cohort 3. Compliance with National Institute for Health and Care Excellence diagnostic guidelines was slightly higher in cohorts 2 and 3 for all patients; 35.8% (10.0% in the year before diagnosis) had all four elements met for all cohorts combined. Multilevel modelling showed considerable between-practice variation in spirometry. The survey on the charity website had 156 responses by chronic obstructive pulmonary disease patients. Many respondents had not heard of the condition, hoped the symptoms would go away and identified various healthcare-related barriers to earlier diagnosis. Clinical Practice Research Datalink analysis showed notable changes in post-diagnosis prescribing from cohort 1 to 2, such as increases in long-acting muscarinic antagonist (21.7-46.3%). Triple therapy rose from 2.9% in cohort 2 to 11.1% in cohort 3. Documented pulmonary rehabilitation rose from just 0.8% in cohort 1 to 13.7% in cohort 2 and 20.9% in cohort 3. For all patients combined, the median time to first acute exacerbation of chronic obstructive pulmonary disease in patients who had one was 1.4 years in cohorts 1 and 2. Acute exacerbation of chronic obstructive pulmonary disease prediction models identified some consistent predictors, such as age, deprivation, severity, comorbidities, post-diagnosis spirometry and annual review. Models without post-diagnosis general practitioner actions had a c-statistic of around 0.70; the highest c-statistic was 0.81, for cohort 2 with post-diagnosis general practitioner actions and 6-month follow-up. All models had good calibration. The three most important predictors in terms of their population attributable risks were being a current smoker and offered smoking cessation advice (32.8%), disease severity (30.6%) and deprivation (15.4%). The highest population attributable risks for variables with adjusted hazard ratios < 1 were chronic obstructive pulmonary disease review (-27.3%) and flu vaccination (-26.6%). Symptom recording and chronic obstructive pulmonary disease diagnosis vary between practice; predicted forced expiratory volume in 1 second had many missing values. There has been some improvement over time in chronic obstructive pulmonary disease diagnosis and management, with large changes in prescribing, though patient and system barriers to further improvement exist. Data available to general practitioners cannot generate risk prediction models with sufficient accuracy. It will be important to expand the COVID-era cohort with longer follow-up and augment general practitioner data for better prediction. This study is registered as Researchregistry.com: researchregistry4762. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/72) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 43. See the NIHR Funding and Awards website for further award information.

Patient compliance with medications, nasal douching, smoking cessation and long-term outcomes of surgical septorhinoplasty - a prospective series of 56 cases.

Septorhinoplasty addresses both functional and cosmetic concerns with the nose and has been shown to have consistent, long-term benefits for patients. Nasal irrigation and medication such as antimicrobials are prescribed postoperatively to improve outcomes. Patient compliance with these interventions and outcomes of surgery have not been described. We aim to describe what the effects of compliance with these interventions may be in long-term follow-up. Patients undergoing septorhinoplasty were reviewed prospectively from 2015 to 2022. At time of operation, patients were prescribed medications, saline douching and given smoking cessation advice. Patients underwent rhinoplasty outcomes evaluation (ROE) preoperatively, at four weeks, and 3, 12, 24 and 36 months postoperatively. Compliance with postoperative interventions was measured at four weeks. Statistical tests were performed. A total of 56 patients underwent septorhinoplasty. Preoperative ROE scores were improved significantly at all stages of postprocedure follow-up (p<0.0001). Multiple linear regression found no significant differences in patients who were not compliant with medications (p>0.40), nasal douching (p>0.22), both medication and nasal douching (p>0.40), and a positive smoking status (p>0.11) at four weeks. At 3- and 24-months follow-up, there were no significant differences in ROE scores between compliant patients and those who were noncompliant with medications, nasal douching or both (p>0.13). Our data represent the only series of patient-reported outcomes from septorhinoplasty patients where compliance with nasal irrigation, smoking cessation and antimicrobials is considered. Compliance with nasal irrigation, topical antimicrobials or smoking cessation did not influence postoperative ROE scores.

Coronary artery calcification detected on low-dose computed tomography in high-risk participants of an Australian lung cancer screening program: A prospective observational study.

Coronary artery calcification (CAC) is a frequent additional finding on lung cancer screening (LCS) low-dose computed tomography (LDCT). Cardiovascular disease (CVD) is a major cause of death in LCS participants. We aimed to describe prevalence of incidental CAC detected on LDCT in LCS participants without prior history of coronary artery disease (CAD), evaluate their CVD risk and describe subsequent investigation and management. Prospective observational nested cohort study including all participants enrolled at a single Australian site of the International Lung Screen Trial. Baseline LDCTs were reviewed for CAC, and subsequent information collected regarding cardiovascular health. 5-year CVD risk was calculated using the AusCVD risk calculator. 55% (226/408) of participants had CAC on LDCT and no prior history of CAD, including 23% with moderate-severe CAC. Mean age of participants with CAC was 65 years, 68% were male. 53% were currently smoking. Majority were high risk (51%) or intermediate risk (32%) of a cardiovascular event in 5 years. 21% of participants were re-stratified to a higher CVD risk group when CAC detected on LCS was incorporated. Only 10% of participants with CAC received lifestyle advice (only 3% currently smoking received smoking cessation advice). 80% of participants at high-risk did not meet guideline recommendations, with 47% of this group remaining without cholesterol lowering therapy. LCS with LDCT offers the potential to identify and communicate CVD risk in this population. This may improve health outcomes for high-risk LCS participants and further personalize management once screening results are known.

How do people quit smoking using e-cigarettes? A mixed-methods exploration of participant smoking pathways following receiving an opportunistic e-cigarette-based smoking cessation intervention.

Pathways of transitioning from tobacco smoking to vaping after receiving an e-cigarette-based smoking cessation intervention have been minimally explored. 1) identify pathways between intervention delivery and final follow-up; 2) describe baseline and post-intervention statistical data in relation to smoking/vaping behaviour of the different pathway groups; 3) explore qualitative participant perspectives contextualising pathway groups. Embedded mixed-methods analysis of data collected for the Cessation of Smoking Trial in the Emergency Department (COSTED) randomised controlled trial. Recruitment from 6 Emergency Departments (5 in England and 1 in Scotland) between January and August 2022. 366 adult smokers who were randomised to receive the COSTED intervention and provided data at 6-month follow-up. Qualitative subsample of 24 participants interviewed after follow-up. Brief smoking cessation advice, provision of an e-cigarette starter kit and referral to the local Stop Smoking Service. Descriptive statistical reporting of identified pathways and smoking/vaping behaviour at baseline and 6-month follow-up. Semi-structured phone/video interviews analysed thematically. 13.4% (n = 49) of participants quit smoking within 1month of receiving the intervention, 19.1% (n = 70) quit between 1 and 6months, 24.9% (n = 91) reduced cigarettes per day (CPD) by at least 50%, and 42.6% did not experience a significant smoking reduction. Approximately a third of participants who quit reported not vaping at follow-up. Reporting dual use was associated with a reduction in CPD. Appoximately athird reported experimenting with a different device to the one provided as part of the intervention. Quitters reported themes of satisfaction with vaping, changes in environment facilitating quitting and motivation to quit. Dual use of cigarettes and e-cigarettes can result in a reduction of smoking and may preclude quitting smoking. Sustained e-cigarette use is not always necessary for quitting success. Success depends on personal context as well satisfaction with vaping.

WP1.8 - No, we can’t repair your hernia: An audit to assess pre-operative optimisation for umbilical hernia repair

Abstract Aims The European Hernia Association recently published guidelines which clearly outline the importance of pre-operative optimisation for those undergoing elective umbilical/epigastric hernias. The main factors of importance are: smoking cessation and BMI &amp;lt;35. This audit aimed to identify if we are adequately optimising our patients. Methods We retrospectively evaluated all elective umbilical hernia repairs from 1st January 2022- 31st December 2022 within a district general hospital setting. Clinic letters and pre-operative records were used to ascertain smoking status, BMI and diabetic control (HbA1c). Results 60 umbilical hernias were performed in our district general hospital setting from 1st January 2022- 31st December 2022. Of these patients, 12% (N=7) were known smokers and 13% (N=8) had a BMI of over 35 documented. Additionally, only in 15 cases, was there clear documentation of the patient smoking status. Out of these patients, 9 were subsequently found to be non-smokers and 6 remained smokers despite being given smoking cessation advice. Furthermore, in 10% (N=6) of these cases, there was poor diabetic control (HbA1c &amp;gt; 48), which was not addressed in clinic pre-operatively. Conclusion Patient factors such as smoking, obesity and diabetic control have been shown to significantly increase the rate of post-operative wound infections and complications. Patients are not being adequately optimised for elective procedures which puts them at increased risk of complications and increases the burden on limited NHS resources.

Mobile Phone–Based Personalized and Interactive Augmented Reality Pictorial Health Warnings for Enhancing a Brief Advice Model for Smoking Cessation: Pilot Randomized Controlled Trial

Background Augmented reality (AR) is a novel modality for promoting smoking cessation (SC). AR-visualized adverse consequences for education and smoking prevention have only been evaluated in nonsmokers in previous studies. Objective To assess the feasibility and preliminary effectiveness for SC of AR pictorial health warnings (PHWs) on cigarette packs. Methods We conducted a pilot randomized controlled trial in adult daily smokers in communities in Hong Kong. All participants received AWARD (ask, warn, advise, referral, do-it-again) model–guided SC advice, a warning leaflet, and referral to SC services at baseline. Interactive, chat-based SC support comprising regular messages and real-time support was provided to all participants via instant messaging apps (eg, WhatsApp) for 3 months after randomization. Participants in the intervention group additionally received 6 links to the AR PHWs showing the worsening health status of various organs caused by smoking. The level of the AR PHWs was adjustable to smoking behaviors (ie, smoking duration or daily cigarette consumption) to increase interaction. Participants could swipe, drag, or rotate the 3D PHWs to reinforce their impression of the health consequences of smoking. The primary outcome was self-reported past 7-day point-prevalence abstinence (PPA) at 3 months. The acceptability of the AR intervention was assessed by the proportion of participants who had viewed AR PHWs during the intervention. Participants who viewed AR PHWs further evaluated the perceived effect of the AR PHWs on a scale of 0 (not helpful at all) to 10 (very helpful). Intention to treat was used, and the risk ratio (RR) of the intervention effect was estimated by Poisson regression. Results From April to November 2021, 80 participants were recruited and randomly assigned to intervention (n=40) and control (n=40) groups. Most participants were male (66/80, 83%) and planned to quit beyond 30 days or were undecided (65/80, 81%). The intervention group had a higher but nonsignificant 7-day PPA (7/40, 18% vs 5/40, 13%; RR 1.40, 95% CI 0.48-4.07) and quit attempts (15/40, 38% vs 11/40, 28%; RR 1.36, 95% CI 0.71-2.60) at 3 months than the control group. In the intervention group, 17 of 40 (43%) participants viewed the AR PHWs. The AR PHWs had modest effects on knowledge of the adverse consequences of smoking on personal health (mean score 3.94, SD 3.52), reducing the frequency of buying cigarettes (mean score 3.29, SD 3.08), increasing the perceived importance of quitting (mean score 3.88, SD 3.50), and making the PHWs more disgusting (mean score 3.41, SD 3.08) and horrible (mean score 3.38, SD 3.05). The 3-month self-reported 7-day PPA was higher in those who ever (vs never) viewed the AR PHWs (5/17, 29% vs 2/23, 9%). Conclusions The mobile-based interactive AR PHWs were feasible, and the effectiveness on smoking abstinence warrants further testing. Trial Registration ClinicalTrials.gov NCT04830072; https://clinicaltrials.gov/study/NCT04830072

Engagement With Stop Smoking Services After Referral or Signposting: A Mixed Methods Study.

Screening for smoking when people interact with healthcare services and referral of those who smoke to stop smoking services (SSSs) is a key component of efforts to tackle tobacco use. However, little is known about what happens after someone is referred or signposted to SSSs. As part of the Cessation of Smoking Trial in the Emergency Department (NCT04854616), those randomised to intervention (n= 505) were referred to local SSSs (along with receiving brief advice and an e-cigarette starter kit) and those randomised to control (n= 502) were given contact details for the same services (signposted). SSS engagement data was collected: 1) directly from participants and 2) from SSS, additional qualitative data came from 33 participant interviews. Engagement with SSSs was very low. 3.2% (n=16) of those in the intervention group and 2.4% (n=12) in the control group reported attending a one-to-one support session. From SSS data, engagement was also low with 8.9% (n=43) of those referred engaging and 3.1% (n=15) going on to quit with SSS support. The majority of the 24 intervention participants interviewed did not recall being contacted by an SSS. Referral or signposting to stop smoking services within an Emergency Department based trial resulted in very low levels of engagement. Barriers to engagement identified included participants not being contacted by SSSs and the support offered not meeting their needs. Referral or signposting of those who smoke to Stop smoking services from the Emergency Department resulted in low rates of engagement in this large multi-centre randomised controlled trial. In order to better support those who smoke it may be more effective for smoking cessation advice to be offered 'in the moment' within clinical settings, and follow-up to be proactively offered rather than relying on people being motivated to contact the services themselves or engaging when contacted.

The Very Brief Advice method for smoking cessation

This review delves into the application and effectiveness of Very Brief Advice (VBA) for smoking cessation in Denmark's healthcare system. Despite some evidence, VBA's support remains limited, adopted by only a few hospitals and overlooked by many healthcare professionals. To enhance cessation efforts, we recommend elevating its status from optional to mandatory. Underlining VBA's significance as a referral catalyst is pivotal to ensuring its sustained influence within the broader cessation strategy.

Opportunistic smoking cessation interventions for people accessing financial support settings: A scoping review.

The aim of this work was to systematically scope the evidence on opportunistic tobacco smoking cessation interventions for people accessing financial support settings. We searched MEDLINE, Embase, PsycINFO and the Cochrane Tobacco Addiction Group specialized register to 21 March 2023. We duplicate screened 20% of titles/abstracts and all full texts. We included primary studies investigating smoking cessation interventions delivered opportunistically to people who smoked tobacco, within settings offering support for problems caused by financial hardship, for example homeless support services, social housingand food banks. Data were charted by one reviewer, checked by anotherand narratively synthesized. We included 25 studies conducted in a range of financial support settings using qualitative (e.g. interviews and focus groups) and quantitative (e.g. randomized controlled trials, surveys and single arm intervention studies) methodologies. Evidence on the acceptability and feasibility of opportunistic smoking cessation advice was investigated among both clients and providers. Approximately 90% of service providers supported such interventions; however, lack of resources, staff training and a belief that tobacco smoking reduced illicit substance use were perceived barriers. Clients welcomed being asked about smoking and offered assistance to quit and expressed interest in interventions including the provision of nicotine replacement therapy, e-cigarettes and incentives to quit smoking. Six studies investigated the comparative effectiveness of opportunistic smoking cessation interventions on quitting success, with five comparing more to less intensive interventions, with mixed results. Most studies investigating opportunistic smoking cessation interventions in financial support settings have not measured their effectiveness. Where they have,settings, populations, interventions and findings have varied. There is more evidence investigating acceptability, with promising results.

Evaluation and management of nonarteritic anterior ischemic optic neuropathy: a national survey

PurposeThe evaluation and management of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) lacks standardized guidelines. This study aimed to investigate the real-world practices of neuro-ophthalmologists in the evaluation and management of typical NAION cases.MethodsA national survey, conducted between 2019 and 2021, involved all practicing neuro-ophthalmologists. A structured questionnaire assessed their approach to risk factor evaluation and treatment of NAION, with 19 questions about risk factors and six questions concerning treatment and prevention of fellow-eye involvement.ResultsThirty-six out of 37 neuro-ophthalmologists participated. Most physicians referred patients for evaluation of the following risk factors: obstructive sleep apnea (83.3%), diabetes mellitus (83.3%), hypertension (77.7%), dyslipidemia (72.2%), and optic disc drusen (38.8%). However, there was considerable variation in the choice of diagnostic tests recommended. Furthermore, nearly 47% recommended an embolism workup. Regarding treatment, the majority (91%) did not recommend routine treatment for NAION, although in 16.7%, high-dose corticosteroids were occasionally prescribed. Secondary prevention with aspirin (80.6%), smoking cessation advice (86.1%), and advising against erectile dysfunction medications for men (80.6%) were common recommendations.ConclusionWhile the risk factors associated with NAION are well-reported, there is a lack of uniformity on which tests should be ordered to evaluate these risk factors. Most neuro-ophthalmologists concur that routine treatment for NAION is not warranted, but not unanimously. Future studies to develop a consensus guideline for post-NAION work-up and management recommendations may assist in the detection and management of preventable risk factors.

Protocol for the 'Supporting Young Cancer Survivors who Smoke' study (PRISM): Informing the development of a smoking cessation intervention for childhood, adolescent and young adult cancer survivors in England.

Childhood, adolescent and young adult (CAYA) cancer survivors are vulnerable to adverse late-effects. For CAYA cancer survivors, tobacco smoking is the most important preventable cause of ill-health and early death. Yet, effective strategies to support smoking cessation in this group are lacking. The PRISM study aims to undertake multi-method formative research to explore the need for, and if appropriate, inform the future development of an evidence-based and theory-informed tobacco smoking cessation intervention for CAYA cancer survivors. PRISM involves three phases of: 1) an environmental scan using multiple strategies to identify and examine a) smoking cessation interventions for CAYA cancer survivors that are published in the international literature and b) current smoking cessation services in England that may be available to, or tailorable to, CAYA cancer survivors; 2) a qualitative study involving semi-structured interviews with CAYA cancer survivors (aged 16-29 years and who are current or recent ex-smokers and/or current vapers) to explore their views and experiences of smoking, smoking cessation and vaping; and 3) stakeholder workshops with survivors, healthcare professionals and other stakeholders to consider the potential for a smoking cessation intervention for CAYA cancer survivors and what such an intervention would need to target and change. Findings will be disseminated to patient groups, healthcare professionals and researchers, through conference presentations, journal papers, plain English summaries and social media. PRISM will explore current delivery of, perceived need for, and barriers and facilitators to, smoking cessation advice and support to CAYA cancer survivors from the perspective of both survivors and healthcare professionals. A key strength of PRISM is the user involvement throughout the study and the additional exploration of survivors' views on vaping, a behaviour which often co-occurs with smoking. PRISM is the first step in the development of a person-centred, evidence- and theory-based smoking cessation intervention for CAYA cancer survivors who smoke, which if effective, will reduce morbidity and mortality in the CAYA cancer survivor population.

Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial.

While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719.

E015 Importance of smoking cessation in rheumatological outcomes

Abstract Background/Aims Smoking is a major preventable risk factor for many rheumatological diseases and can influence the severity of symptoms in conditions such as psoriatic arthritis (PsA), ankylosing spondylitis, giant cell arteritis (GCA) and systemic lupus erythematosus (SLE). The increased risk due to smoking is dose dependent. The objective was to identify the proportion of patients with rheumatological conditions who smoke and to ensure that smoking cessation advice is given in line with NICE guidelines. Methods A retrospective qualitative study with data collected from electronic patient records (EPR) between September and November 2022 across multiple rheumatology clinics. Data included age, gender, smoking status, diagnosis, disease duration, comorbidities, treatment, and smoking advice status. Results 459 patients were analysed (68% female), of which 11% were smokers, 6% were ex-smokers, 83% were non-smokers, and 1 vapes regularly. Among the smokers, 72% were female. The median age was 61 years, with a range of 18-91 years. The commonest age range for all patients is 71-80 years, while the commonest age range among smokers was 41-50 years at 28%. The commonest disease duration among smokers is 1-5 years. The most common disease diagnosis among smokers were RA (30%), PsA (19%) and SLE (6%). Regarding disease activity among smokers, 36% had mild, 56% had moderate, and 8% had severe disease activity. Among the 12 patients with respiratory comorbidities; 6 had asthma, and 4 had COPD. Among the 21 patients with cardiovascular comorbidities; 13 had hypertension, and 6 had hypercholesterolaemia. For patients on cDMARDS, 26% were on methotrexate, 11% were on sulfasalazine, 9.4% were on hydroxychloroquine and 2% were on leflunomide. 13% were on prednisolone, while 7.5% had required methylprednisolone injections. 11% were on bDMARDs, most commonly adalimumab. Smoking cessation advice was documented in 4%, whereas 96% had no evidence of any smoking cessation advice. Conclusion This study illustrates the most common age range of smokers in this cohort was 41-50 years (28%), which was almost twice the equivalent national level (14.3% in 45-54 years). Nationally, the most common age range is 25-34 years (15.8%). Patients with rheumatological disease who smoked were of younger age compared to non-smokers, and smoking rates were higher in females compared to males. Smoking cessation advice was only documented in 4% of this cohort. This indicates much scope for improvement, and enhanced disease control in a population with multiple challenges, primarily socioeconomically. VBA (Very Brief Advice) has been shown to be the single most effective and clinically proven preventive action a clinical can give to patients in relation to smoking cessation. The NCSCT (National Centre for Smoking Cessation Training) encourages the 3A’s (ASK, ADVICE, ACT). Disclosure M. Osikoya-Yekini: None. W. Walshe: None. A. Bharadwaj: None. A. Nandagudi: None.

Effectiveness of Auricular Acupressure Combined with Medication and Medical Advice for Smoking Cessation

Objective: Nicotine withdrawal symptoms (NWS) are the main impediments to the quitting attempt. The present study investigated the effectiveness of specific auricular acupressure combined with medication and medical advice to quit smoking. Materials and Methods: Two hundred eighty-two patients voluntarily participated in a smoking cessation program at the Smart Quit Clinic, Charoenkrung Pracharak Hospital. The patients were randomly divided into two groups, the treatment group (n=141) receiving specific auricular acupressure and the control group (n=141) receiving non-specific auricular acupressure. Five specific auricular acupressure points, including shenmen, lung, mouth, stomach, and sympathetic, were used to treat NWS. Each point was pressed with Wang Bu Liu Xing for one minute. The acupressure was applied three times a day for 12 weeks. The succession of cessation was assessed using carbon monoxide (CO) levels in exhaled breath and relief of NWS. Results: The success of smoking cessation in the treatment group was significantly higher than the control group after cessation at weeks 12 and 24. Specific auricular acupressure such as shenmen, lung, mouth, stomach, and sympathetic, could reduce anxiety, craving on smoking, insomnia, and nervous symptoms since the first week after cessation. Conclusion: Specific auricular acupressure using Wang Bu Liu Xing is an effective and safe treatment method for relieving NWS. Keywords: Auricular acupressure; Nicotine withdrawal symptoms (NWS); Smoking cessation; Wang Bu Liu Xing

A Cross Sectional Study on Self-Reported Tobacco Use and Tobacco Related Behaviour among Medical Students in Goa, India

Introduction: Tobacco is a major cause of preventable mortality and morbidity. Healthcare personnel are involved with smoking cessation advice and treatment of patients; their use of tobacco and related behaviour is an important public health problem. Objectives: To determine the proportion of tobacco use, exposure to second-hand tobacco smoke among medical students and to describe their tobacco-related behaviour and attitude regarding tobacco use. Method: A cross-sectional study was conducted at one of the Medical Colleges at Goa from July-August 2023.The sample size was calculated using a standard formula based on results of a systematic review, it included 255 medical students and interns selected by simple random sampling. The Global Health Professions Student Survey (GHPSS) was used as the study tool which is specifically designed for knowing the tobacco usage. Results: Among medical students surveyed, 23.5% (n = 60) reported ever smoking cigarettes, with 8.6% (n = 22) being current smokers. Additionally, 7.1% (n = 18) reported using smokeless tobacco. Exposure to passive smoking was prevalent, with 31.3% (n = 80) experiencing it at home and 43.9% (n = 112) in public places, surpassing active smoking. The majority of students expressed support for tobacco ban (78.8%, n= 201), and nearly all (98.4%, n= 251) agreed that healthcare professionals should advise patients to quit tobacco use. While over half of the current smokers attempted to quit in the past year, only 15% received professional assistance in their cessation efforts. Conclusion: The results of this study indicate that while a significant proportion of students were exposed to tobacco use, there is a prevailing support for tobacco control measures among them but actual implementation of such measures is lacking.

Experts' views on translating NHS support to stop smoking in pregnancy into a comprehensive digital intervention.

Many pregnant smokers need support to quit successfully. In the United Kingdom, trained smoking cessation advisors deliver structured behavioural counselling alongside access to free nicotine replacement therapy (NRT); known as the 'Standard Treatment Programme' (STP). Pregnant smokers who access STP support are more likely to quit, but uptake is low. A digital intervention could be offered as an adjunct or alternative to existing STP support to increase cessation rates. However, there are few pregnancy-specific digital options routinely available and, among those that are, there is limited evidence of their effectiveness. This study investigated experts' views on the feasibility of translating the STP into a comprehensive digital intervention. Virtual group and individual interviews were undertaken with 37 experts (11 focus groups, 3 interviews) with a real-time voting activity in the focus groups to prompt discussion. Framework Analysis was applied to the data to examine themes and patterns. Experts were supportive of a digital translation of the STP and considered most behavioural counselling content to be transferable. However, replicating human-to-human accountability, empathy and the ability to go 'off-script' was thought more challenging. Suggestions for how this might be achieved included tailoring and personalisation, use of artificial intelligence tools, peer support and the option to escalate contact to a human advisor. Experts had mixed views on the role that exhaled breath carbon monoxide monitoring might have in a digital cessation intervention for pregnancy. Electronic provision of free NRT, and potentially e-cigarettes, without interpersonal support was generally well received. However, experts had concerns about it exacerbating low NRT adherence, governance issues (e.g. being accountable for the suitability of recommended products), and people's ability to misrepresent their eligibility. The STP was considered largely transferable to a digital intervention and potentially helpful for cessation in pregnancy, so merits further development and evaluation.

Video consultation and treatment in the community smoking cessation therapy success rates in patients with mental illness: a randomized controlled trial

Purpose Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. Material and Method Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. Results Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. Conclusion The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients’ motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.

Factors influencing midwives' conversations about smoking and referral to specialist support: a qualitative study informed by the Theoretical Domains Framework.

The aim of this study was to identify factors influencing midwives' conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women's decisions, limited appointment times, and competing priorities were identified as barriers. Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.

Physician-brief advice for promoting smoking cessation among cancer patients on treatment in low and middle-income countries: a scoping review

IntroductionPhysician-brief advice has been utilized in high-income countries to promote smoking cessation among cancer patients. Empirical evidence on its effectiveness among cancer patients in low and middle-income countries (LMICs) is lacking. The gap could be due to inadequate training, and competing healthcare priorities, leading to insufficient implementation of targeted smoking cessation interventions in oncology settings. We undertook this scoping review to determine if physician-brief advice is effective in promoting smoking cessation among cancer patients in LMICs.MethodsWe conducted a literature search of all relevant articles across five databases: Cochrane Central Register of Controlled Trials, Cochrane Library (Tobacco Addiction Group trials), World Conference on Lung Cancer proceedings, PubMed, and Google Scholar up to November 2023, using pre-defined inclusion criteria and keywords. The study population was cancer survivors in LMICs, the intervention was smoking cessation advice by a physician in a clinic or oncology center during a consultation, and the outcome was the effect of smoking cessation programs in discontinuing smoking among cancer survivors in LMICs.ResultsOverall, out of every 10 cancer patients in LMICs, about seven were smokers, and one-half had received physician-brief advice for smoking cessation. Physician-brief advice was more likely to be delivered to patients with smoking-related cancer (Cohen’s d = 0.396). This means that there is a noticeable difference between patients with smoking-related cancer compared to those with cancer unrelated to smoking. Smoking cessation failure was due to the inability to cope with the symptoms of withdrawal, missed smoking cessation clinic visits, mental health disorders, limited time and resources, and minimal patient-physician contact.ConclusionThere is very little literature on the frequency of use or the efficacy of physician-brief advice on smoking cessation in LMICs. The literature suggests that cancer patients in LMICs have low self-efficacy to quit smoking, and smoking cessation is rarely part of cancer care in LMICs. Physicians in LMICs should be trained to use motivational messages and good counseling techniques to improve smoking cessation among cancer patients. Policymakers should allocate the resources to implement physician-brief advice and design training programs for physicians focusing on physician-brief advice tailored to cancer patients.