Smoking Cessation Clinic Research Articles

Differential effects of heat-not-burn, electronic cigarettes and conventional cigarettes on endothelial glycocalyx

Abstract Background Heat-not-burn cigarette (HNBC) and electronic cigarette (Ecig) constitute non-combustible smoke products. Their effect on endothelial glycocalyx has not been investigated so far. Patients and Methods: Out of 100 subjects attending smoking cessation clinic: α) 50 smokers were randomized to usage of HNBC (n=25) or Ecig (n=25) and β) 50 smokers were used as control group. Participants randomized to the newer tobacco products had similar clinical and demographic characteristics to the control group. Smoking status was verified by measuring the concentration of exhaled carbon monoxide [(e CO) (ppm), Bedfont Scientific, Maidstone, Kent UK]. Perfused Boundary Region (PBR), which is inversely related to endothelial glycocalyx thickness in sublingual arterioles (range 5–25 μm) and blood levels of cotinine, a stable metabolite of nicotine, was assessed in all participants. Exhaled CO, endothelial glycocalyx, and blood cotinine were assessed at baseline and after 1 month. Results Conventional cigarette smokers were aged: 48 ± 5 years, 53% female and used 27 ± 9 cigarettes/day, 29 ± 9 pack-years. HNBC users were aged: 46 ± 14 years, 55% female and used 26 ± 8 cigarettes/day, 30 ± 8 pack-years. Ecig users were aged: 45 ± 8 years, 51% female and used 27 ± 10 cigarettes/day, 28 ± 10 pack-years. Compared to baseline, switching to HNBC for 1 month improved only PBR20-25 (2.55±0.49 vs 2.34±0.34 μm, p=0.002). Ecig use did not alter endothelial glycocalyx in any range of microvessels throughout the study (p>0.05). In contrast, Tcig smoking for one month further worsened endothelial glycocalyx in all microvessels ranges compared to baseline (p<0.05). Blood cotinine levels were similar at baseline and after 1 month using HNBC (p=0.432), Ecig (p=0.535) or conventional cigarette (p=0.489). Compared to baseline, exhaled CO decreased in HNBC or Ecig users (mean percent change: -55% and -58% respectively p<0.001), while remained unchanged in Tcig smokers (p=0.312) at 1 month. Thus, Tcig smokers had higher CO than those who switched to HNBC or E-cig after one month (p<0.01). Conclusion Conventional cigarette users further worsened endothelial glycocalyx after continuing to smoke for one month. In contrast, smokers who switched to Ecig maintained glycocalyx integrity, while those who switched to HNBC showed modest improvement in glycocalyx integrity in microvessels ranging from 20 to 25 μm. Cotinine levels, which reflect nicotine exposure, were similar between the Tcig, HNBC and Ecig groups. Thus, endothelial glycocalyx impairment in the conventional cigarette group was independent of nicotine consumption and possibly related to greater exposure to toxic emissions, such as CO, after Tcig use than after switching to HNBC or Ecig.

Preferences of Iranian smokers regarding smart smoking cessation technologies: a parallel convergent mixed methods study

BackgroundConsidering the values and preferences of individuals who attempt to quit smoking is a crucial step in the development of smoking cessation technologies. This study aimed to explore preferences regarding smart smoking cessation technologies.MethodsThis parallel convergent mixed-methods study was conducted in two phases: quantitative and qualitative. In the quantitative phase, a cross-sectional study was conducted with 360 participants selected through stratified random sampling from technology-based smoking cessation clinics in Tabriz, Tehran, and Karaj cities in Iran. Data on demographic characteristics and preferences for smart smoking cessation technologies were collected using questionnaires and analyzed using descriptive statistics. In the qualitative phase, 25 users of these technologies were selected through purposeful and snowball sampling. The data were gathered through in-depth semistructured interviews and analyzed using qualitative content analysis with a conventional approach. Quantitative and qualitative data were integrated using the merging strategy and convergence model.ResultsThe quantitative phase results indicated that the highest preference was related to wearing and using a smartwatch for smoking cessation and using mobile apps. In the qualitative phase, 17 subcategories were extracted and classified into 8 main categories: high effectiveness, better management of the smoking cessation process, personalized technology, safe and uncomplicated technologies, attractiveness and innovative design, scientific basis, mobile applications, and smart monitoring devices.ConclusionBy combining and integrating quantitative and qualitative results, it can be concluded that users are more interested in wearable technologies and interactive mobile applications. The findings of this study can assist smoking cessation technology developers in designing and improving their tools based on user needs and preferences to enhance their effectiveness and acceptability.

Associations between Nicotine Dependence, Smartphone Usage Patterns, and Expected Compliance with a Smoking Cessation Application among Smokers.

Smoking remains the leading cause of preventable disease. However, smokers have shown poor compliance with smoking cessation clinics. Smartphone applications present a promising opportunity to improve this compliance. This study aimed to explore the relationship between nicotine dependence, smartphone usage patterns, and anticipated compliance with a smoking cessation application among smokers, with the goal of informing future development of such applications. A total of 53 current smokers were surveyed using a questionnaire. Nicotine dependence was assessed using the Fagerstrom Test for Nicotine Dependence (FTND). Variables included the number of hours spent using a phone, willingness to quit smoking, number of previous quit attempts, desired number of text messages about smoking cessation, expected duration of application usage, and FTND scores. Kendall's partial correlation, adjusted for age, was employed for the analysis. The amount of time smokers spent on their mobile devices was negatively correlated with the number of smoking cessation text messages they wanted to receive (τ coefficient = -0.210, p = 0.026) and the duration they intended to use the cessation application (τ coefficient = -0.260, p = 0.006). Conversely, the number of desired text messages was positively correlated with the intended duration of application usage (τ coefficient = 0.366, p = 0.00012). Smokers who spent more time on their mobile devices tended to prefer using the cessation application for shorter periods, whereas those who desired more text messages about smoking cessation were more inclined to use the application for longer durations.

Mid-term outcomes of a smoking cessation program in hospitalized patients in Türkiye.

'Teachable moments', such as inpatient treatment periods, can be turned into opportunities for smokers to acquire healthy living behaviors. This study was conducted to evaluate the outcomes of smoking cessation interventions in an inpatient hospital setting. Data were collected for this single-arm prospective intervention cohort study between October 2021 and March 2022 from hospitalized patients at Recep Tayyip Erdoğan University Training and Research Hospital in Türkiye. Smoker patients received smoking cessation counseling and brief smoking cessation interventions during their hospitalization and were informed about how to apply to our hospital's smoking cessation outpatient clinic after discharge. They were followed via phone on the 3rd, 5th, and 7th day and the 1st, 3rd, 6th, and 12th month after their discharge, regarding their quit status as well as admissions to smoking cessation clinics. Quitters were confirmed by exhaled air carbon monoxide testing. Logistic regression analysis was performed to evaluate the presence of admission to the emergency department and family physicians at follow-up at 1st year. The model was adjusted in terms of age, sex, presence of malignancy, and education level. Of the 183 patients included in the study, 163 participants completed periodic follow-up during one year, with quit rate of 47.2%. The rate of anxiety was higher among non-quitters compared to quitters (9.4% vs 1.2%) (p=0.024). Non-quitters were 19 times more likely to have emergency department admissions (AOR=19.64; 95% CI: 8.08-47.68) and eight times more likely to have family doctor visits (AOR=8.43; 95% CI: 4.05-17.53) than quitters. This cessation program evaluated the quit rates of hospitalized patients in the first year and revealed that the rate of anxiety was higher in non-quitters compared to quitters. It would be an important approach to include psychiatric support in this practice.

성인 여성의 음주 및 흡연이 현존 치아 수 및 주관적 구강불편에 미치는 영향 요인 조사

Objectives: The purpose of this study was to determine the relationship between alcohol consumption and smoking on the existing dental index and subjective oral discomfort of Korean women. Methods: The subjects of this study were women aged 19 to 64. The collected data were analyzed using IBM SPSS Statistics ver. 21.0 (IBM Co. Armonk, NY, USA). The significance level of the statistical tests was set to 0.05. Results: Drinking (p < 0.001) and smoking (p = 0.011) had a statistically significant influence on the number of existing teeth, and drinking(p = 0.009) and smoking (p = 0.009) had a statistically significant influence on the discomfort of chewing. Conclusions: Programs that can provide women who are otherwise unable to obtain access smoking cessation clinics should be expanded.

Protective Measures for Counselors at Smoking-Cessation Clinic of Public Health Center

Protective Measures for Counselors at Smoking-Cessation Clinic of Public Health Center

The trajectory of smoking cessation after treatment and its related factors in Taiwan

Smoking has multiple negative effects on health; therefore, the Taiwanese government provides smoking cessation clinics to smokers. This study aimed to explore the trajectory of smoking cessation after smokers received treatment and the variables related to different trajectories. A retrospective longitudinal study was conducted, in which 735 adult smokers who received smoking cessation medications were recruited. The participants’ demographic characteristics, chronic diseases, smoking characteristics, and cigarette dependence were collected from chart review. The amount of smoking was collected at baseline, and at 1 week, 1 month, 3 months, and 6 months after treatment. The Proc Traj procedure for group-based modeling and multinomial logistic regression were used for statistical analysis. Three trajectories were identified: early quitters (28.03%), late quitters (11.43%) and reducers (60.54%). Compared with early quitters, reducers were younger and had a higher probability of severe cigarette dependence. Compared with early quitters, late quitters had a higher number of taking smoking cessation medications. The findings revealed that approximately 60% of participants who received smoking cessation treatment could not completely quit smoking, and that age, number of medications taken, and cigarette dependence were significant predictors of different trajectories.

Implementing a Staff-Led Smoking Cessation Intervention in a Diverse Safety-Net Rheumatology Clinic: A Pre-Post Scalability Study in a Low-Resource Setting.

Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26-fold in a predominantly White academic health care system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety-net rheumatology clinic with a predominantly Black population. In this pre-post study, adult rheumatology visits were analyzed 12 months before through 18 months after QC intervention (November 2019 through November 2021, omitting COVID-19 peak April through November 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre-post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost-effectiveness was also assessed. Visit-level patients who smoked were 89.8% Black and 69.5% women (n = 550). Before intervention, clinic staff rarely asked patients about readiness to cut back smoking (<10% assessment). After QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% before); 58.9% of these patients endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4 to $10. In a safety-net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness-to-quit assessment, and referrals and was also feasible and cost-effective.

Investigating the socio-demographic characteristics and smoking cessation incidence among smokers accessing smoking cessation services in primary care settings of Qatar, a Historical Cohort Study

BackgroundTobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. Cigarette smoking is the leading preventable cause of mortality. Globally, an estimated 1.3 billion people smoke.In Qatar, Smoking cessation services (SCSs) are provided free of charge to citizens and at a minimal cost to non-citizens. This study aimed to measure the effectiveness of the smoking cessation program adopted by the Primary Health Care Corporation (PHCC) of Qatar. This was achieved through calculating the percentage of smoking cessation service users (survival probabilities) who maintained the non-smoking status after selected follow up periods. Moreover, the study highlighted the possible association of selected explanatory variables with smoking cessation survival probabilities.MethodsIn this historical cohort study 490 participants were recruited by simple random sampling who attended the smoking cessation clinics (SCCs) in PHCC prior to 30/06/2021. The participants were contacted by phone and invited to participate in the study. The participants who agreed to participate in the study were interviewed utilizing a structured questionnaire.ResultsInitially 311 (63.5%) of the participants quitted smoking after receiving SCSs. There were statistically significant differences between quitting smoking and the nationality and the educational level of participants (p ≤ 0.001 and 0.02 respectively). About one fourth (23.3%) of individuals who initially quitted smoking relapsed and resumed smoking as early as 6 months after completing their SCC visits. This relapse rate increased to 38.7, 47.2 and 51.1% after 12, 24 and 36 months respectively. Less than a half (45.8%) maintained the non-smoking status after 42 months from their initially quitting.Conclusion and recommendationsThe findings of the study substantiate the effectiveness of SCSs designed within PHCC both in short- and long-term basis. Younger individuals, smokers with Arab ethnicity, smokers falling within high income and education groups were identified as high-risk groups and need highest focus. The accessibility to the service among the local population can be increased by upscaling the advertisement of the existing services.

Client's perception toward services of smoking cessation clinics in Riyadh, Saudi Arabia.

In Saudi Arabia, approximately 70,000 deaths yearly occur from diseases caused by smoking. Assessing patients' smoking behavior in primary care has apparent benefits. Assisting patients with smoking cessation is one of the essential roles of primary care. This study evaluated the quality of smoking cessation clinic counseling in Riyadh, Saudi Arabia, based on customer opinions of such services. This research employed a cross-sectional approach involving individuals attending smoking cessation clinics located within primary health care centers in Riyadh city. The participants were chosen through random selection. They were informed about the study's objectives, and those who consented to take part were contacted and provided with an online questionnaire to complete. A total of 340 subjects participated (95.6%) of them were males, and 41.2% were in the age group of 25 to 35 years old. The common modality of tobacco use was cigarettes (82.6%), and 87.9% reported consuming tobacco daily. The mean (±SD) total score of the Fagerstrom Test of Nicotine Dependence was 5.03 (±2.36), and the highest percentage (44.4%) of the participants had a moderate level of nicotine dependence. The vast majority (93.8%) of the participants had former quitting experiences. Half (50.9%) of the participants showed complete satisfaction with the cessation clinics, while 13.2% and 9.1% of them were not satisfied or slightly satisfied, respectively. The majority of smoking cessation clinic visitors were satisfied with the services provided, exceeding three-quarters of them, with half totally satisfied.

The effects of smoking cessation on the ratios of neutrophil/lymphocyte, platelet/lymphocyte, mean platelet volume/lymphocyte and monocyte/high-density lipoprotein cholesterol.

The amount of smoking, level of smoking addiction and smoking cessation have effects on blood cells, blood lipid levels, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV)/lymphocyte ratio (MPVLR) and monocyte/high- density lipoprotein (HDL) ratio (MHR). Methods In this self-controlled experimental study, we included individuals who applied to a smoking cessation clinic and quit smoking. Their sociodemographic and clinical characteristics, the amount of cigarettes consumed (pack/year), their Fagerstrom test for nicotine dependence (FTND) results, haemogram values before and 6 months after quitting smoking, NLR, PLR, MPVLR, MHR and blood lipid levels before and after the treatment were compared retrospectively. Results The mean (SD) age of the 239 individuals who participated in the study was 41.7 (10.9) years and 55.2% of them were women. Their mean FTND score was 7.06 (2.0), and most of them (47.7%) had a very high level of addiction. After the smoking cessation treatment, their neutrophil, platelet, MPV, red cell distribution width, platelet distribution width (PDW), cholesterol, triglyceride, low- density lipoprotein, NLR, PLR, MPVLR, MHR and HDL values increased (p<0.05). The amount of smoking and level of dependence were negatively correlated with HDL, and positively correlated with other parameters. Conclusion After smoking cessation, in addition to dyslipidaemia, the NLR, PLR, MPVLR and MHR values also decreased, and the difference was found to correlate with the level of addiction and the amount of smoking.

Determinants of Smoking Cessation Outcomes and Reasons for Relapse in Patients Admitted to a Smoking Cessation Outpatient Clinic in Turkey.

The aim of this study was to identify the determinants of smoking cessation outcomes and reasons for relapse following smoking cessation treatment. Using a mixed-method design, 179 patients were recruited from the Smoking Cessation outpatient clinic of Ankara Numune Training and Research Hospital between May 2016 and May 2017. Quantitative data were collected via questionnaires or from patient files and qualitative data were obtained via 5 focus group interviews with 28 patients who relapsed to smoking following treatment. The success rate of the smoking cessation clinic at the end of one year was 26%. The number of applications to the clinic was significantly higher in the group who quit smoking. Treatment success was found to be higher in the group that applied behavioral recommendations. In focus group interviews with patients who relapsed, the most common causes were stressful events, especially workplace problems and serious health problems experienced by relatives. The presence of smokers in the immediate vicinity increased the risk of relapse. It was concluded that not stopping treatment before the recommended period, continuity in follow-up appointments, support of the environment, support of pharmacotherapy with cognitive behavioral therapy and improving patients' coping skills were important.

The Role of Twice-Daily N-acetylcysteine (NAC) 2400 mg in Smoking Cessation: A Randomized, Placebo-Controlled Trial in Indonesia.

Tobacco smoking remains a health concern, especially in developing countries. Nicotine is significantly linked to many cancers and even second-hand exposure. Hence, smoking can increase the risk of lung and heart disease.This makes quitting smoking important and challenging. Success tends to rise by achieving abstinence with assisted pharmacology. These treatments aim to reduce symptoms of nicotine withdrawal. This is a preclinical trial on glutamate modulator in N-acetylcysteine (NAC) as a new potential treatment for smoking cessation.It is based on the administration of NAC related to elevated levels of dopamine in the central nervous system to accomplish successful smoking cessation. This study evaluated the efficacy and tolerability of NAC for smoking cessation. The primary outcome was abstinence rate and the secondary outcomes of the study were to assess carbon monoxide exhalation value (COexh), the withdrawal symptoms, craving score, safety, and tolerability associated with the administration of NAC. This is a randomized clinical trial. Eligible smokers were treated with NAC 2400 mg twice daily (BID) or placebo to obtain a potential effective abstinence rate.Subjects recruited from the smoking cessation clinic were screened for eligibility and wererandomized to either the NAC or placebo group. The trial consisted of a four-week treatment phase and participants were evaluated each week with a brief counseling. Intention to treat data analysis was performed from 2018 to 2019. Smoking cessation status was verified by measuring the amount of carbon monoxide exhaled and by documenting their smoking habits.Adverse events (AEs) have also been observed on each visit. A total of 90male smokers with a mean (SD) age of 38.7 (11) years were randomized into two groups to receive NAC (n=45) and placebo (n=45). The primary outcome revealed that the abstinence rate was significantly higher for the NACgroup than the placebo group (37.7% vs 6.6%; p=0.02). These findings were supported by data comparison between the NAC group and placebo group of COexh (ppm)(9.59±7.4 vs 13,4±6.1; p=0.04) and cigarette consumption/week (10 vs 46; p <0.001), which were statistically significant. Comparison of withdrawal with the Minnesota Nicotine Withdrawal Score between theNACgroup and the placebo group showed lower values (8 (1-31) vs 11 (0-43); p=0.178), respectively, even though not statistically significant. Compared to the placebo group, the craving score (6 (2-29) vs 12 (6-31); p=0.04) in the NAC group was significantly lower. The most common adverse event was mild gastrointestinal effects (28.9%) and arthralgia (2.2%). No serious adverse events were detected. Despite a small sample size, the data demonstrate the potential benefits of NAC that may help elevate abstinence rates and promote successful smoking cessation pharmacotherapy. Comprehensive treatment combining pharmacologic therapy and counseling increases smoking cessation success rates. It is essential to conduct a randomized multicenter study with a large population to support a sustained abstinence rate using NAC.

Evaluation of alexithymia, anger and anxiety depression levels in smokers

ABSTRACT Objective Smokingis a major mental health concern due to its addictive nature and its status asthe leading preventable cause of premature death worldwide. This study aimed toexamine the levels of alexithymia, anger, anxiety, and depression in smokerscompared to nonsmokers. Materials and Methods Thiscase-control study involved 176 smokers from a Smoking Cessation Clinic and 175age- and gender-matched nonsmokers. Participants completed assessments usingthe Toronto Alexithymia Scale (TAS-20), State-Trait Anger Expression Inventory(STAXI), and Hospital Anxiety and Depression Scale (HADS). Nicotine dependencein smokers was measured using the Fagerström Nicotine Dependency Test.Statistical analysis was performed using SPSS 22.0. Findings Significantdifferences were observed between smokers and nonsmokers in TAS, TAS-1, TAS-2,HADS-A, and HADS-D scores. Smokers exhibited higher levels of alexithymia, anger expression, and anxiety, while nonsmokers demonstrated better angercontrol. Additionally, addiction levels in smokers were associated withvariations in TAS, TAS-1, TAS-2, TAS-3, STAXI scores (SA, AC, AI, AO), andHADS-A, highlighting a complex interplay between addiction, psychologicalfactors, and smoking habits. Result This study establishes a link between smoking status, addictionlevels, and elevated alexithymia, anger, anxiety, and depression. The findingsunderscore the psychological impact of smoking, contributing valuable insightsfor mental health interventions in individuals with smoking habits.

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.

Neglecting the neglected: Tobacco cessation support is essential for the management of asthma and COPD.

Asthma and COPD management have a broad framework, and smoking cessation plays an essential role. We examine the management of asthma and COPD patients not only for inhaler treatment options but also for essential interventions, such as smoking cessation support. Data were collected cross-sectionally from pulmonology departments of three government hospitals in Türkiye between May and September 2022. Patients aged ≥18 years who had been diagnosed with asthma or COPD for at least a year, were included in the study. The demographic and clinical characteristics of the patients were investigated. Routine cessation interventions were implemented for current smokers, and they were followed via phone calls after one month regarding their quit status and access to cessation clinics. Data from 145 patients with asthma and 148 patients with COPD were analyzed. The rate of current smoking among patients with asthma and COPD was 18.8% and 34.5%, respectively. Current smoking was negatively associated with age (<65 years) and disease duration (years) for both diseases (p<0.05). In addition, for asthmatics, presence of pulmonary disease in the family (OR:0.28, 95% CI: 0.10-0.79) and for COPD patients presence of hospitalization (OR: 0.26, 95% CI: 0.07-0.93) were negatively associated with current smoking. After one month, 85.1% of current asthmatic smokers had not tried to call a quitline, while 14.8% had tried to contact a quitline. Among current smoker COPD patients, only 1.9% had visited a smoking cessation clinic. Tobacco cessation support seems to be neglected in asthma and COPD management. Instead, pulmonologists and patients focus on pharmaceutical treatments, which constitute the other component of care.

Effectiveness of immediate appointment scheduling in smoking cessation clinics for patients with chronic airway diseases: Preliminary results from a randomized trial.

Patients with airway diseases who bear the burden of smoking need access to smoking cessation support. We aimed to investigate the impact of immediately scheduled appointments on access to smoking cessation clinics compared with usual care in this patient group. This multicenter, prospective, randomized, open-label study was conducted between November 2022 and June 2023 at pulmonary outpatient clinics. The study included adult patients who were current smokers and had a diagnosis of asthma, COPD, or bronchiectasis for at least six months. Sequentially randomization was used for the allocation of patients in a 1:1 ratio to two study arms: the usual support arm (representing the current standard care procedure) and the immediate support arm (involving intensive brief cessation advice followed by the immediate arrangement of an appointment at the same clinic's smoking cessation service). After one week, both patient groups were contacted by phone to assess their quit attempts and whether they had sought assistance from smoking cessation outpatient clinics (SCCs). A total of 397 patients were enrolled in the study, with 199 allocated to the usual support arm and 198 allocated to the immediate support arm. Within the first week, 18.1% of patients in the usual support arm and 77.3% of patients in the immediate support arm sought assistance from the smoking cessation clinic (p<0.001). The rate of smokers without an intention to quit was 56.7% in the usual support arm and 27.7% in the immediate support arm in the first week of follow-up. Immediate appointment scheduling was significantly associated with a 13-fold (OR=13.38; 95% CI: 8.00-22.38) increase in referral rates in the multivariate logistic regression model. Arranging instant appointments has increased access to SCCs by 13 times compared to the usual care, this group of patients should be given an immediate appointment to SCCs.

Colposcopy and Smoking Cessation: Survey and Education Intervention Pilot Study

Objective: The objective of the study was to understand variations in smoking cessation practices across Canadian colposcopy clinics and to assess improvements in smoking cessation counseing after the provision of jurisdiction-specific resources. Methods: An electronic survey was sent to members of the Society of Canadian Colposcopists and the Gynaecologic Oncologists of Canada to characterize current smoking cessation counseling practices to inform the design of the educational initiative. Colposcopy clinics were invited to participate in the pilot involving the collection of smoking counseling data from patient charts pre- and postintervention. Region-specific smoking cessation resource toolkits were created for participating clinics. Descriptive statistics were used for the analysis. Results: 32/266 colposcopists responded to the survey. 25/32 respondents indicated that they asked all patients about their smoking status. Most respondents indicated that they tell patients smoking increases the risk of developing cervix cancer (88%) and that smoking negatively affects the immune system and human papillomavirus clearance (94%). Five clinics participated in the education initiative. While there is variation in practice, after providing smoking cessation resources to clinics, both assessing smoking status and smoking cessation counseling improved with most sites increasing their referral rates to family doctors or smoking cessation clinics (range: 10%–50%). Conclusions: Gaps exist in smoking cessation counseling in some Canadian colposcopy clinics. Standardizing assessment and documentation of smoking status, using effective models of counseling, and providing jurisdiction-specific resources to colposcopy clinics may improve smoking cessation counseling.

Prevalence of smoking among national military service recruits in UAE.

According to the various screening programs conducted, the prevalence of tobacco use among UAE Nationals is high. A considerable increase is also seen in various forms of smoking is seen among young military men during deployment which results in loss of physical health, less productivity, readiness and increased health care utilization. Also smokers are more likely to develop other addictions and chronic medical conditions. To estimate the prevalence of smoking among national military service recruits in the United Arab Emirates and to find its relation with various factors: socio-demographics, lifestyle, comorbidities, and military environment. A cross sectional study was conducted amongst national service recruits selected by random stratification through a self-administered anonymized questionnaire which was distributed to a final sample of 369 patients. Data was analyzed using SPSS version 16. Chi square, percentage and frequencies were used to present the data where applicable. A p < 0.05 was considered to be significant. The prevalence of smoking among national military service recruits was 41.6%. As the level of education increased the prevalence of smoking decreased. Smokers with insufficient income, divorced or widowed recruits tend to smoke more as against single and married recruits. Smoking rates were decreased in those who exercise regularly. There was a significant relationship between smoking status and chronic diseases. Smoker gatherings inside military campus encouraged initiation of smoking or its continuity. About half of the smokers were not satisfied with environment at military facilities. Smoking has high prevalence among national service military recruits. For this reason, a goal directed future plan toward screening of smokers among recruits and assigning them to smoking cessation clinics and educational seminars prior to joining the national service is the need of the hour.

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.