Smoking Cessation Care Research Articles

Israeli dentists' knowledge, attitudes, and practices regarding smoking cessation care.

The 5A's model for brief smoking cessation care (SCC) is recommended for dentists to reduce the negative impacts of smoking on oral health. This study investigates Israeli dentists' adherence to the 5A's guidelines and explores factors influencing their knowledge, attitudes, and practices. An online cross-sectional survey was conducted among Israeli dentists during June-August 2020. The questionnaire included sociodemographic, smoking, and professional characteristics; knowledge (10 true/false statements); attitudes regarding SCC [based on the Theoretical Domains Framework (TDF)] using 13 statements (1-5 Likert scale), for a composite mean attitude score; and 5A's performance (1-5 Likert scale, never to always). Two primary outcomes were analysed: (1) performing all of the 5A's 'often or always'; and (2) performing 'always' the first two steps ("Ask" and "Advise"). Multivariable logistic regression explored the association between the various characteristics and the primary outcomes. Overall, n = 410 responded. Mean knowledge score was 2.58 (SD = 1.51). Mean attitude score was 2.65 (SD = 0.60). Performance of all 5A's was low with 14.1% (n = 57) reporting completing all 5A's 'often or always', while 34.1% (n = 139) reported 'always' performing 'Ask' and 'Advise'. Specialists had better odds of 'often or always' performing the 5A's (adjusted OR = 2.01, p = .022) and 'always' performing 'Ask and Advise' (adjusted OR = 1.71, p = .022). This study highlights the insufficient performance of SCC among Israeli dentists, revealing gaps in knowledge and attitudes related to SCC. Various measures, such as training, automatic referral systems, and integrating SCC as quality measures, may improve SCC provision among Israeli dentists.

Evaluating chronic disease approaches to ameliorate tobacco-related health disparities: Study protocol of a hybrid type 1 implementation-effectiveness trial

BackgroundBlack, Indigenous, and People of Color (BIPOC) communities experience higher prevalence of cardiovascular disease and related chronic conditions compared to White communities due to disparities in tobacco exposure. Smoking can be effectively treated but evidence-based treatments are less likely to be offered to or used by BIPOC patients. We present the study protocol of the Smoking Cessation Outreach for Racial Equity (SCORE) trial that tests the effect of adding longitudinal care coordination to current standard of care for smoking cessation to promote health equity among BIPOC patients. MethodsLongitudinal Proactive Outreach (LPO; 4 culturally tailored outreach call cycles over one year by motivational interviewing trained counselors to connect patients to cessation counseling and medication) will be added to the current standard of care, Ask-Advise-Connect (AAC; primary care providers asking all patients if they smoke, and if smoking, advising to quit and connecting to treatment). We will conduct a hybrid type 1 implementation-effectiveness trial to examine the direct effect of AAC + LPO (a multilevel health system intervention) vs. AAC on population-level combustible tobacco abstinence at 18 months and treatment utilization among 2000 BIPOC adults who smoke across two healthcare systems in Minnesota. Participants will be surveyed at 6, 12, and, 18 months post-enrollment to assess outcomes. The primary outcome is biochemically confirmed combustible cigarette abstinence at 18 months. DiscussionLPO has potential to promote health equity by addressing barriers caused by structural racism, including access to care, care fragmentation, and provider racism, by systematically reaching out to all BIPOC patients who smoke. ClinicaltrialsgovNCT05671380.

Abstract B019: A machine learning approach to predicting smoking cessation outcomes among Spanish-speaking smokers who completed a culturally targeted intervention

Abstract Introduction: Among the Hispanic/Latinx population in the US, four of five leading causes of death are attributed to smoking. Few evidence-based interventions have been developed to improve smoking cessation for this population. Our team has demonstrated the efficacy of a culturally targeted, extended self-help intervention for Spanish-speaking smokers, estimating a smoking abstinence rate of 33% at 24 months, compared to 24% for usual care. Further efforts are needed to enhance this efficacious, low-cost, scalable intervention approach. Machine learning (ML) is one approach to increase understanding of the predictors of treatment outcomes and inform strategies to improve the intervention. Toward that goal, this secondary data analysis utilized the decision tree (DT) model to predict self-reported 7-day point prevalence abstinence at 18-month follow-up for participants receiving our intervention. Method: Data from participants who reported smoking status at an 18-month follow-up (N=332 of 714 enrolled, 36% abstinent) were randomly split (80:20) into training and test datasets based on smoking status. We entered demographics, psychosocial, and smoking variables collected at baseline as predictors in the model. In addition to handling missing values and normalizing numeric features, we employed the Synthetic Minority Over-sampling Technique (SMOTE) combined with Tomek links (SMOTE-Tomek) to improve inter-class separability. Recursive Feature Elimination (RFE) using DT was implemented to identify the most relevant predictors. The cross-validation (CV) pipeline incorporated preprocessing, feature selection, handling class-imbalance, over-sampling, and model training with a DT as the interpretable classifier. Hyperparameters were tuned using stratified K-fold (K=5) CV to optimize parameters using Grid search. F1 score was selected as the primary metric as it accounts for each class performance by combining the precision and recall metrics. Finally, the performance of the classifier was evaluated in 20% of the unseen dataset. Results: The DT classifier for the CV achieved the F1 score of 0.73 [95% CI 0.66, 0.77], revealing a reasonably good performance in identifying smokers at 18-months. RFE selected familism, age, affect, and confidence as the most relevant predictors of smoking status. Individuals who had lower familism scores (<138), combined with higher age (>50), were more likely to be smokers at 18 months. Individuals who had higher familism scores (>138) combined with higher negative affect (>42) were more likely to be smokers. Conclusion: This study provides the first step toward personalized care for smoking cessation among the Hispanic/Latinx population and demonstrates the potential of DT classifier to predict cessation outcomes among individuals who received and completed a culturally and linguistically targeted smoking cessation intervention. Our future analysis will compare this model with conventional statistical modeling approaches and other ML algorithms to identify the best-performing parsimonious model. Citation Format: Ranjita Poudel, K. Ruwani M. Fernando, Matthew B. Schabath, Steven K. Sutton, Thomas H. Brandon, Issam El Naqa, Vani N. Simmons. A machine learning approach to predicting smoking cessation outcomes among Spanish-speaking smokers who completed a culturally targeted intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B019.

Aboriginal and Torres Strait Islander people who smoke and want to quit - a cohort profile from the Koori Quit Pack study.

Reducing the prevalence of smoking is a national priority, however there is limited evidence on what smoking cessation supports are utilised, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions. Aboriginal and Torres Strait Islander people residing in New South Wales (NSW), Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarise participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services. 165 participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioural support. The majority believed NRT was safe (80.6%), effective (70.3%) and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR=3.12, 95%CI, 1.01-9.76). Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit. The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempt, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

“It's a big conversation”: Views of service personnel on systemic barriers to preventing smoking relapse among pregnant and postpartum Aboriginal and Torres Strait Islander women – A qualitative study

BackgroundProviding smoking cessation care has not successfully prevented women who quit smoking during pregnancy from relapsing due to multi-level barriers. AimThis paper explores systemic barriers to providing smoking cessation care, focusing on relapse prevention among pregnant and postpartum Aboriginal and Torres Strait Islander women (hereafter Aboriginal). MethodsTwenty-six interviews were conducted between October 2020 and July 2021 with health professionals, health promotion workers and managers working in Aboriginal smoking cessation across six Australian states and territories. Data were thematically analysed. FindingsThemes emerging from the data included: (a) limited time, competing priorities and shortage of health professionals; (b) a need for more knowledge and skills for health professionals; (c) influences of funding allocations and models of smoking cessation care; (d) lack of relevance of anti-tobacco messages to pregnancy and postpartum relapse; and (e) ways forward. Several barriers emerged from policies influencing access to resources and approaches to smoking cessation care for Aboriginal women. Individual-level maternal smoking cessation care provision was often under-resourced and time-constrained to adequately meet Aboriginal women's needs. Identified needs for health professionals included more time, knowledge and skills, better cultural awareness for non-Indigenous health professionals, and salient anti-tobacco messages for pregnant women related to long-term cessation. ConclusionTo drive smoking cessation in pregnant and postpartum Aboriginal women, we recommend adequately reimbursing midwives and Aboriginal Health Workers/Professionals to allow them to provide intensive support, build confidence in Quitline, continue health professionals’ capacity-building and allocate consistent funding to initiatives that have been efficacious with Aboriginal women.

Cost-effectiveness of point of care smoking cessation interventions in oncology clinics

BackgroundWe examined the cost-effectiveness of providing systematic smoking cessation interventions to oncology patients at point-of-care.MethodsA decision analytic model was completed from the healthcare payer’s perspective and included all incident cancer cases involving patients who smoke in New Brunswick, Canada (n = 1040), cancer site stratifications, and risks of mortality, continued smoking, and cancer treatment failure over one year. Usual care (no cessation support) was compared to the standard Ottawa Model for Smoking Cessation (OMSC) intervention, and to OMSC plus unlimited cost-free stop smoking medication (OMSC + SSM), including nicotine replacement therapy, varenicline, or bupropion. Primary outcomes were incremental cost per quit (ICQ) and incremental cost per cancer treatment failure avoided (ICTFA).ResultsThe ICQ was $C143 and ICTFA $C1193 for standard OMSC. The ICQ was $C503 and ICTFA was $C5952 for OMSC + SSM. The number needed to treat (NNT) to produce one quit was 9 for standard OMSC and 4 for OMSC + SSM, and the NNT to avoid one first-line treatment failure was 78 for OMSC and 45 for OMSC + SSM. Both were cost-effective in 100% of 1000 simulations.ConclusionsGiven the high clinical benefits and low incremental costs, systematic smoking cessation interventions should be a standard component of first-line cancer treatment.

Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults

Socioeconomically disadvantaged individuals (ie, those with low socioeconomic status [SES]) have difficulty quitting smoking and may benefit from incentive-based cessation interventions. To evaluate the impact of incentivizing smoking abstinence on smoking cessation among adults with low SES. This study used a 2-group randomized clinical trial design. Data collection occurred between January 30, 2017, and February 7, 2022. Participants included adults with low SES who were willing to undergo smoking cessation treatment. Data were analyzed from April 18, 2023, to April 19, 2024. Participants were randomized to usual care (UC) for smoking cessation (counseling plus pharmacotherapy) or UC plus abstinence-contingent financial incentives (UC plus FI). The primary outcome was biochemically verified 7-day point prevalence smoking abstinence (PPA) at 26 weeks after the quit date. Secondary outcomes included biochemically verified 7-day PPA at earlier follow-ups, 30-day PPA at 12 and 26 weeks, repeated 7-day PPA, and continuous abstinence. Multiple approaches were employed to handle missing outcomes at follow-up, including categorizing missing data as smoking (primary), complete case analysis, and multiple imputation. The 320 participants had a mean (SD) age of 48.9 (11.6) and were predominantly female (202 [63.1%]); 82 (25.6%) were Black, 15 (4.7%) were Hispanic, and 200 (62.5%) were White; and 146 (45.6%) participated during the COVID-19 pandemic. Overall, 161 were randomized to UC and 159 were randomized to UC plus FI. After covariate adjustment with missing data treated as smoking, assignment to UC plus FI was associated with a greater likelihood of 7-day PPA at the 4-week (adjusted odds ratio [AOR], 3.11 [95% CI, 1.81-5.34]), 8-week (AOR, 2.93 [95% CI, 1.62-5.31]), and 12-week (AOR, 3.18 [95% CI, 1.70-5.95]) follow-ups, but not at the 26-week follow-up (22 [13.8%] vs 14 [8.7%] abstinent; AOR, 1.79 [95% CI, 0.85-3.80]). However, the association of group assignment with smoking cessation reached statistical significance at all follow-ups, including 26 weeks, with multiple imputation (37.37 [23.5%] in the UC plus FI group vs 19.48 [12.1%] in the UC group were abstinent; AOR, 2.29 [95% CI, 1.14-4.63]). Repeated-measures analyses indicated that participants in the UC plus FI group were significantly more likely to achieve PPA across assessments through 26 weeks with all missing data estimation methods. Other secondary cessation outcomes also showed comparable patterns across estimation methods. Participants earned a mean (SD) of $72 ($90) (of $250 possible) in abstinence-contingent incentives. Participation during the COVID-19 pandemic reduced the likelihood of cessation across assessments. In this randomized clinical trial, incentivizing smoking cessation did not increase cessation at 26 weeks when missing data were treated as smoking; however, the UC plus FI group had greater odds of quitting at follow-ups through 12 weeks. Cessation rates were higher for the UC plus FI group at all follow-ups through 26 weeks when multiple imputation was used to estimate missing outcomes. ClinicalTrials.gov Identifier: NCT02737566.

"It's changed my life. I'm not smoking anymore. I don't want to smoke anymore": exploring the acceptability of mailout smoking cessation support for and by Aboriginal and Torres Strait Islander people.

Aboriginal and Torres Strait Islander people want to quit smoking. There is global evidence of combination Nicotine Replacement Therapy (c-NRT) alongside behavioural support as best practice approach to smoking cessation care. However, there is limited adherence and acceptability research regarding NRT and behavioural supports for Aboriginal and Torres Strait Islander people. Similarly, there is limited research on what is considered culturally appropriate and safe support for Aboriginal and Torres Strait Islander people to quit smoking. This Aboriginal-led qualitative study explored the acceptability of the Koori Quit Pack. Aboriginal and Torres Strait Islander participants shared experiences of quitting with the mailout c-NRT program and behavioural cessation support through Yarning. Reflexive thematic analysis was used to develop themes. Aboriginal and Torres Strait Islander people are motivated to quit smoking and have accessed cessation supports from health professionals. However, the support(s) received are not always appropriate or culturally safe. The Koori Quit Pack was deemed acceptable and useful for smoking cessation. Having access to smoking cessation care and knowledge of c-NRT helped people quit smoking, and support others to quit too. A combination of NRT products alongside culturally responsive behavioural support(s), delivered through a mailout package was a beneficial strategy to help Aboriginal and Torres Strait Islander people quit smoking. National implementation of such a package could assist to accelerate reductions in tobacco use, helping meet national smoking reduction targets and improve health outcomes. Cessation supports offered to Aboriginal and Torres Strait Islander people are not always culturally-safe or effectively delivered. The Koori Quit Pack provided Aboriginal and Torres Strait Islander people with culturally-safe smoking cessation support delivered for and by Aboriginal and Torres Strait Islander people, demonstrating mailout smoking cessation supports as acceptable and highly valued. Mailout support eliminates accessibility barriers to cessation care while providing tools and knowledge to quit can lead to smoke-free behaviours among individuals and communities. Country-wide availability of this program can accelerate reductions in tobacco use, helping meet national targets and improve health outcomes consistent with the National Tobacco Strategy and the WHO Framework Convention on Tobacco Control.

Effect of implementation strategies on the routine provision of antenatal care addressing smoking in pregnancy: study protocol for a non-randomised stepped-wedge cluster controlled trial

IntroductionGlobally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety...

Do Smartphone Apps Impact Long-Term Smoking Cessation for Sexual and Gender Minority Adults? Exploratory Results from a 2-Arm Randomized Trial Comparing Acceptance and Commitment Therapy with Standard US Clinical Practice Guidelines

ABSTRACT Sexual and gender minority (SGM) adults face unique challenges in accessing smoking cessation care due to stigma tied to their identities and smoking. While cessation apps show promise in the general population, their efficacy for SGM adults is unclear. This study utilized data from a randomized trial to compare two cessation apps, iCanQuit (Acceptance and Commitment Therapy-based) and QuitGuide (US Clinical Practice Guidelines-based) among 403 SGM adults. The primary outcome was self-reported complete-case 30-day abstinence from cigarette smoking at 12 months. Mediation analyses explored whether interventions operated through acceptance of cues to smoke and app engagement. At 12 months, quit rates did not differ between arms (26% iCanQuit vs. 22% QuitGuide, OR = 1.22; 95% CI: 0.74 to 2.00, p = .43). iCanQuit positively impacted cessation via acceptance of cues to smoke (indirect effect = 0.23; 95% CI: 0.06 to 0.50, p < .001) and demonstrated higher engagement (no. logins, 28.4 vs. 12.1; p < .001) and satisfaction (91% vs. 75%, OR = 4.18; 95% CI: 2.12 to 8.25, p < .001) than QuitGuide. Although quit rates did not differ between arms, acceptance of cues to smoke seemed to play a crucial role in helping SGM adults quit smoking. Future interventions should consider promoting acceptance of cues to smoke in this population.

Healthcare providers’ perspectives on implementing a brief physical activity and diet intervention within a primary care smoking cessation program: a qualitative study

BackgroundPost-smoking-cessation weight gain can be a major barrier to quitting smoking; however, adding behavior change interventions for physical activity (PA) and diet may adversely affect smoking cessation outcomes. The “Picking up the PACE (Promoting and Accelerating Change through Empowerment)” study assessed change in PA, fruit/vegetable consumption, and smoking cessation by providing a clinical decision support system for healthcare providers to utilize at the intake appointment, and found no significant change in PA, fruits/vegetable consumption, or smoking cessation. The objective of this qualitative study was to explore the factors affecting the implementation of the intervention and contextualize the quantitative results.MethodsTwenty-five semi-structured interviews were conducted with healthcare providers, using questions based on the National Implementation Research Network’s Hexagon Tool. The data were analyzed using the framework’s standard analysis approach.ResultsMost healthcare providers reported a need to address PA and fruit/vegetable consumption in patients trying to quit smoking, and several acknowledged that the intervention was a good fit since exercise and diet could improve smoking cessation outcomes. However, many healthcare providers mentioned the need to explain the fit to the patients. Social determinants of health (e.g., low income, food insecurity) were brought up as barriers to the implementation of the intervention by a majority of healthcare providers. Most healthcare providers recognized training as a facilitator to the implementation, but time was mentioned as a barrier by many of healthcare providers. Majority of healthcare providers mentioned allied health professionals (e.g., dieticians, physiotherapists) supported the implementation of the PACE intervention. However, most healthcare providers reported a need for individualized approach and adaptation of the intervention based on the patients’ needs when implementing the intervention. The COVID-19 pandemic was found to impact the implementation of the PACE intervention based on the Hexagon Tool indicators.ConclusionThere appears to be a need to utilize a flexible approach when addressing PA and fruit/vegetable consumption within a smoking cessation program, based on the context of clinic, the patients’ it is serving, and their life circumstances. Healthcare providers need support and external resources to implement this particular intervention.Name of the registryClinicaltrials.gov.Trial registration numberNCT04223336.Date of registration7 January 2020 Retrospectively registered.URL of trial registry recordhttps://classic.clinicaltrials.gov/ct2/show/NCT04223336.

The role of general practice nurses in supporting people to quit smoking: A qualitative study.

Encounters with General Practitioners (GPs) have previously been identified as opportune for the delivery of smoking cessation care however the role of nurses in general practice settings is unclear. This study aimed to understand how nurses are providing smoking cessation care in general practice. Participants were registered nurses currently working in a general practice setting in Australia, who participated in one-off interviews over Zoom. Interviews were recorded and a thematic analysis was conducted. Fourteen nurses participated of which 13 (93%) were female. Three themes were evident in the data: 1) Nurses' current practices in supporting people to quit smoking, 2) The influence of the general practice setting on smoking cessation discussions and 3) The challenges experienced by nurses in providing optimal smoking cessation care. Theme one describes the strategies currently employed by nurses to deliver smoking cessation care such as identifying appropriate clinical scenarios to have smoking cessation conversations with patients. Theme two explores the impact of diversity in the systems, processes, and structures across Australian general practice settings on the support offered by nurses, such as opportunities for ongoing relationships with patients Theme three focuses on ambiguity in nurses' roles within the practice setting including a lack of clarity for nurses in their roles in delivering smoking cessation care in the general practice setting. General practice nurses recognise the importance of their role in providing smoking cessation care and consider that general practice settings are ideally positioned to deliver that care. Smoking cessation care provided by nurses varies according to systems and processes within general practice clinics and relationships with general practitioners. Vaping is an emerging issue and nurses are seeking information on how to address this with patients. There is opportunity to support nurses to provide improved smoking cessation care.

Geographic Differences in Availability and Access to Care Services for Asthma and COPD: Case Study of Vancouver Coastal Health, British Columbia.

Background: With a diverse geographic and sociocultural landscape, Vancouver Coastal Health (VCH) Authority (British Columbia, Canada) encompasses both urban and rural regions, providing a case study to examine the delivery of care services for asthma and chronic obstructive pulmonary disease (COPD). To better understand the landscape of care services within VCH, we aimed to (1) identify asthma and COPD care services availability in urban and rural communities and (2) identify where asthma and COPD quality improvement (QI) initiatives were implemented and their implementation-related characteristics. Methods: An environmental scan was conducted to identify asthma and COPD care services provided in VCH communities. A literature review was conducted to determine where VCH asthma and COPD QI initiatives were implemented and identify their implementation-related characteristics. This case study was analysed descriptively and summarised in tables and figures. Results: The environmental scan analysis revealed that specialty outpatient care, pulmonary rehabilitation, respiratory education and clinical smoking cessation services were limited in urban and unavailable in rural VCH communities. Spirometry services were limited in urban and rural VCH communities. Cross-referencing recommendations from asthma and COPD clinical practice guidelines against prevalence data, we estimated that rural VCH communities could provide 0%-23% of required spirometry while urban could provide 40%-75%. Further, of the 16 asthma and COPD QI initiatives identified within 21 papers, none were conducted at rural VCH healthcare sites. Conclusion: Our findings suggest rural VCH communities have lower access to asthma and COPD care services and the limited urban care services were insufficient to make up for this difference. Past asthma and COPD QI initiatives have not apparently translated to care service improvements in rural regions. Future QI initiatives should focus on overcoming barriers to conducting and participating in QI to improve urban and rural regions' access to asthma and COPD care services.

Formulating tobacco control policies: How can local governments contribute?

Due to a continuing international trend of decentralization of public health policies, local governments are given an increasingly important role in tobacco control. The process of developing local-level tobacco control policies is an underexplored topic. This study uses grant applications as a data source to gain insight into the planning, development and proposed implementation of local tobacco control policies by regional public health departments in the Netherlands. Grant applications of 24 regional public health departments were analyzed using the second stage of the rational policy cycle, a four-stages policy model about the decisions made by local policy makers during the policy process. We coded the applications with open and axial coding. Public health departments formulated four main goals for tobacco control: adding tobacco control policies to existing local policy documents, creating smoke-free (child) environments, developing and improving access to smoking cessation care, and participating in media campaigns. Public health departments often specify tobacco control aims and involve partners in reaching these aims. However, the grant applications lacked information about implementing these tobacco control policies. The information on implementation strategies and process evaluation, as well as the (evidence-based) legitimation for the policy choices, needs improvement. Under the current conditions, which include the brief explanation the departments received, an unclear mandate, insufficient funding, and local restricting factors such as time and knowledge, significant contributions to tobacco control policy cannot be expected from local governments.

Effectiveness of culturally tailoring smoking cessation interventions for reducing or quitting combustible tobacco: A systematic review and meta-analyses.

Standard approaches to smoking cessation may not be as effective for certain populations, and tailoring on cultural factors could improve their effectiveness. This systematic review measured the effectiveness of culturally tailoring smoking cessation interventions on quitting or reducing smoking combustible tobacco. We searched MEDLINE, PsychInfo, Embase and Cochrane Central Register from inception to 21 June 2023 for randomized controlled trials (RCTs) of community-based, primary care or web-based interventions for smoking cessation in adults who smoked tobacco, with measurement of smoking abstinence or reduction at least 3months following baseline. We examined comparisons between either an intensity-matched culturally tailored intervention and a non-tailored intervention or a standard non-tailored intervention and the same intervention plus a culturally tailored adjunct. We sub-grouped studies according to the level of tailoring and performed subgroup analyses where appropriate. We assessed risk of bias and certainty of evidence. We identified 43 studies, 33 of which were meta-analyzed (n = 12 346 participants). We found moderate certainty evidence, limited by heterogeneity, that intensity-matched culturally tailored cessation interventions increased quit success when compared with non-tailored interventions at 3-month follow-up or longer (n = 5602, risk ratio [RR] = 1.29 95% confidence interval [CI] 1.10, 1.51, I2 = 47%, 14 studies). We found a positive effect of adding a culturally tailored component to a standard intervention compared with the standard intervention alone (n = 6674, RR = 1.47, 95% CI 1.10, 1.95, I2 = 74%, 18 studies), but our certainty in this effect was low due to imprecision and substantial statistical heterogeneity. Culturally tailored smoking cessation interventions may help more people to quit smoking than a non-tailored intervention. Adapting or adding cultural components to smoking cessation interventions originally developed for majority populations could improve cessation rates in populations who do not fully identify with majority cultural norms.

Effectiveness of using humor appeal in health promotion materials: evidence from an experimental study in Japan

BackgroundPublic health professionals have prepared and distributed many messages and materials to convince the public to adopt healthy behaviors or reduce risky behaviors. However, health promotion materials do not always have the desired effect due to a lack of ability to engage target audience. This study examined the effectiveness of humor appeal (i.e. using humor as an advertising technique to attract attention and increase acceptance of the message) in health promotion materials and how to use it effectively.MethodsTotal 17 printable posters with different frames (loss- vs. gain-framed) × tones (humorous vs. non-humorous) × topics (advance care planning, cancer screening, donor registry, smoking cessation, and physical activity) were created and evaluated for comprehensibility, persuasiveness, and resistance through two web-based surveys. Participants who were Japanese adults aged 25–64 years were randomly assigned one of the posters (200 people each) and asked to rate it. The overall score was calculated as the persuasiveness score (EHPM 2017;22:69) minus the resistance score (EHPM 2022;27:20).ResultsIn the advance care planning case, the highest overall score was found in the gain-framed humorous poster, followed by the loss-framed humorous poster, and the non-humorous poster (p = 0.007). In the other 4 cases, the posters using humorous illustrations received a significantly lower scores than the non-humorous poster(s).ConclusionThe use of humor appeal can help improve the acceptability and persuasiveness of the message when dealing with a little-known resistance-prone health topic. Humor appeal will provide an effective hook to direct public attention to what they do not know or care about in public health communication.

Gender differences in weight gain during attempted and successful smoking cessation on dulaglutide treatment: a predefined secondary analysis of a randomised trial

BackgroundWomen seem to have more difficulty quitting smoking than men. This is particularly concerning as smoking puts women at a higher risk of developing smoking-associated diseases. Greater concerns about postcessation...

The effect of a smoking cessation program for patients in cancer treatment: a quasi-experimental intervention study

Background Compared to non-smokers, smokers have reduced effects of cancer treatment, and increased risk of treatment-related toxicity. Quitting smoking can improve treatment effects and reduce side effects. This study reports on the potential impact of a smoking cessation program on smoking cessation rates among patients in cancer treatment. Material and methods Cancer patients 18 years and older who smoked, with survival prognosis ≥12 months, not suffering dementia or other mental illness, and who were referred to cancer treatment at six Norwegian hospitals were invited to participate. The study took place from 2017 to 2020 and used a pre-test-posttest non-equivalent control group design. The intervention group received structured smoking cessation guidance based on Motivational Interviewing combined with cost-free nicotine replacement products, while the control group received standard smoking cessation treatment. Self-reported smoking status were registered at baseline and at 6 months’ follow up. Results 76% of patients smoked at baseline and 44% at follow-up in the intervention group, correspondingly 72% and 49% in the control group. In an analysis of differences in within-person change, the reduction in the intervention group was 13 percentage points larger (95% CI = (0.25, −0.005), p = 0.041). Adjusting for gender, age, education, labour market participation and partnership status did not attenuate the estimated effect (18 percentage point difference, 95% CI = (−0.346, −0.016), p = 0.032). Demographic factors and dropout rate differed somewhat between the groups with a higher dropout rate in the intervention group, 54% vs. 51%, respectively). Conclusion Offering a structured smoking cessation program based on Motivational Interviewing and cost-free nicotine replacement products to cancer patients can increase cessation rates in comparison to standard smoking cessation care.

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation.

Cigarette smoking is a critical issue in caring for patients of chronic kidney disease (CKD). However, there is no routine care program designed for combining both smoking cessation and CKD care. The process of our quality improvement (QI) collaboration used data under our routine payment-for-performance for pre-end-stage renal disease (P4P Pre-ESRD) in Taichung Veterans General hospital from 2020 to 2022. We share our experience with a QI project that integrates the Ottawa model for smoking cessation (OMSC) with the Pre-ESRD care program as part of routine CKD care. The electronic health information systems were improved to reduce workload of medical staff. The number was more for both qualified CKD educators and nephrologists for smoking cessation. The access and availability for smoking cessation were immediate and convenient for patients. Specifically, all the actions were performed by CKD educators, with nephrologists overseeing the process in routine care. By combining OMSC with the Pre-ESRD program, we were able to provide smokers with satisfactory access and availability to smoking cessation services within our healthcare facility. The smoker cases found were more in number (206 in 2020, 344 in 2021, and 421 in 2022). Before the integrated OSTC-Pre-ESRD program (in 2020), the proportion of smokers was 3.88%. After implementing the integrated program, smokers increased significantly on a yearly basis (9.69% in 2021 and 9.82% in 2022). Finally, case numbers of on-site smoking cessations increased significantly after implementing the integrated system (0 in 2020, 17 in 2021, and 20 in 2022). All CKD patients for smoking cessation were also more (8 in 2020, 46 in 2021, and 38 in 2022). After implementing the QI program, focusing on the integrated OMSC-Pre-ESRD program, we found more smokers undergoing smoking cessation. This QI program highlighted the importance of better access and availability for smoking cessation.

FRI068 Gender Differences In Smoking Cessation? Results Of A Randomized Controlled Trial Of Dulaglutide-assisted Smoking Cessation

Abstract Disclosure: F. Baur: None. D. Coynel: None. C. Atila: None. S. Lengsfeld: None. T. Burkard: None. A. Meienberg: None. C. Bathelt: None. M. Christ-Crain: None. B.F. Winzeler: None. Introduction: Smoking harms women more than men and women seem to be less successful in quitting. Greater concerns about post-cessational weight in women and gender differences in craving and reward processing have been postulated as possible explanations. Our group recently showed that the GLP-1 analogue dulaglutide reduces post-cessational weight gain. We hypothesize that women compared to men might profit more from the weight-lowering effects of dulaglutide in terms of abstinence rates. Methods: This is a predefined secondary analysis of a placebo-controlled, double-blind, single-center randomized trial including 255 daily smokers (155 women, 100 men). Participants received weekly dulaglutide (1.5mg) or placebo (0.9% sodium chloride) subcutaneous injections for 12 weeks in addition to standardized smoking cessation care. Smoking status was self-reported and confirmed by end-expiratory carbon monoxide measurement. We analyzed gender differences after 12 weeks of dulaglutide / placebo treatment in weight change, abstinence rates and craving assessed by a visual analogue scale (VAS, minimum 1, maximum 10). Additionally, fMRI was performed in a subset of participants and craving and neuronal activity in response to smoking cue videos were examined for gender differences. Results: Median [IQR] age at inclusion was 42 [32,53] years in females and 44 [34,53] years in males. Mean (SD) BMI was 26.0 (5.0) kg/m² and 28.9 (4.9) kg/m², respectively. After 12 weeks, 61% of females in the dulaglutide and 65% in the placebo group were abstinent, compared to 66% and 64% of male participants. Among quitters, there were no gender differences in absolute or percentual weight change neither on dulaglutide (difference: 0.2 kg, 95%-CI [-1.2, 1.6]; p=0.762 / 0.7%, 95%-CI [-0.9, 2.3]; p= 0.382) nor on placebo treatment (difference: 0.0 kg, 95%-CI [-1.0, 1.0]; p=0.954 / -0.6 %, 95%-CI [-1.8, 0.6]; p=0.340).There is no evidence for either a direct association of gender with change in craving (mean difference females vs. males: 0.05 points, 95%-CI [-1.34, 1.43], p= 0.947) or that the effect of gender on change in craving might depend on dulaglutide treatment (interaction term: p=0.712). Smoking cessation was directly associated with a decline in craving (mean difference quitters vs. persistent smokers: -3.07 points, 95%-CI [-4.67, -1.47], p&amp;lt;0.001); however, this did not depend on gender (interaction term: p=0.380). Data of the fMRI substudy are currently being analyzed and will be presented at the congress. CONCLUSION: Our data showed similar abstinence rates, post-cessational weight changes and craving intensity in females and males. Presentation: Friday, June 16, 2023