Smoking Cessation Counseling Research Articles

Association between self-reported motivation to quit smoking with effectiveness of smoking cessation intervention among patients hospitalized for acute coronary syndromes in Switzerland

Guidelines recommend brief smoking cessation interventions for hospitalized smokers reporting low motivation-to-quit. However, an intensive smoking cessation intervention may improve smoking cessation for these smokers. We conducted a secondary analysis of a pre-post interventional study that tested the efficacy of a proactive approach systematically offering intensive smoking cessation intervention to all hospitalized smokers with acute coronary syndrome (ACS) compared to a reactive approach offering it only to smokers willing to quit.We analyzed data from one study site in Switzerland, which recorded motivation-to-quit smoking at study inclusion between 08.2009 and 02.2012. The primary outcome was smoking cessation at 1- and 5-year. We tested for interaction by participant’s motivation-to-quit score (low vs. high motivation), and calculated multivariable adjusted risk ratios (RR), stratified by motivation score.We obtained motivation scores for 230 smokers. Follow-up was 94% (217/230) at 1-year and 68% (156/230) at 5-year. Among participants with low motivation to quit, 19% of smokers in the reactive phase had quit at 1 year compared to 50% of smokers in the proactive phase (multivariable adjusted RR = 2.85, 95%CI:0.91–8.91). Among highly motivated smokers, rates did not differ between phases: 48% vs. 49% (multivariable adjusted RR = 1.02, 95%CI:0.75–1.39, p-value for interaction between motivation-to-quit categories = 0.10). At 5-year follow-up, the point estimates were similar.While our study has limitations inherent to the study design and sample size, we found that a proactive approach to offer systematic smoking cessation counseling for smokers with ACS reporting low motivation to quit was associated with higher smoking cessation rates at 1 year.

CHARACTERIZING REGIONAL VARIABILITY IN HEALTH RESOURCE UTILIZATION DURING THE DIAGNOSTIC PHASE OF LUNG CANCER ACROSS ONTARIO: A POPULATION-BASED ANALYSIS

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer (LC) is the leading cause of cancer-related mortality among Canadians. Significant differences in LC relative survival exist within Ontario (ON), though the reasons for this require further elucidation. We aimed to characterize regional variability in LC care through assessment of health resource utilization (HRU) across ON health regions by Local Health Integration Networks (LHIN) to assess variability in access and equity of care and evaluate the impact of HRU on LC outcomes. METHODS: A retrospective population-based cohort study was conducted with ICES, an administrative database in ON, from January 2007 - December 2017. Patients with newly diagnosed LC were identified from the ON Cancer Registry, including if LC was the cause of death. Data were collected from 90 days prior to LC diagnosis until first LC treatment or up to 120 days after diagnosis if no treatment was received, and included: number of staging tests, biopsies, emergency department (ED) visits and admissions. Through OHIP billing codes, specialty appointments with internal medicine, pulmonology, thoracic surgery (TS), medical oncology, radiation oncology, and palliative care were identified. Descriptive data and unpaired t-tests are reported; a multivariate analysis is in progress. RESULTS: LC patients (n=70,749) in ON underwent a mean of 3.20 staging investigations, which varied by LHIN (range 2.52 to 3.61) and by stage (Stage I mean 2.97+/- 1.75 vs Stage IV mean 3.42+/- 1.88, p<0.001). Patients with stage I disease underwent more biopsies compared to stage IV disease (mean all patients = 1.47, stage I = 1.86+/-1.17, stage IV = 1.34+/-1.08, p<0.001), with variability across LHINs (range mean of all patients 1.25 to 1.61). ED visits were more common for patients with stage IV disease compared to stage I (Stage I = 0.92+/-1.56 visits vs Stage IV 1.68+/-1.67 visits, p<0.001), but hospital admissions occurred more frequently in stage I disease (stage I = 0.94+/-0.79 admissions vs stage IV = 0.91+/-0.87 admissions, p=0.001). The number of specialist visits prior to first LC treatment varied between LHIN from an average of 2.9 to 4.9 visits per patient, with patients in some remote areas seeing fewer specialists than in urban regions. There was significant variability in types of specialist visits between LHINs, with mean pulmonology visits ranging from 0.08 to 1.00 per patient and mean TS visits ranging from 0.21 to 1.62. Only 19.9% of LC patients received smoking cessation counselling ranging from 15.1% - 22.4% across LHINs. CONCLUSIONS: HRU varies by disease stage and by LHIN across ON. Further evaluation of regional differences between may explain the variation in LC survival outcomes. CLINICAL IMPLICATIONS: The knowledge gained from this project has the potential to identify disparities in care that may contribute to the variability in LC outcomes across ON and identify target areas for improvement in LC care. DISCLOSURES: no disclosure on file for Micheal Brundage; No relevant relationships by Genevieve Digby, source=Web Response No relevant relationships by Elizabeth Eisenhauer, source=Web Response Advisory Committee Member relationship with AstraZeneca Precision Program Please note: 2017 - present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Honoraria Research relationship with Astra Zeneca Inc Please note: 2018-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support Research relationship with GlaxoSmithKlein Please note: 2018-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Canadian Thoracic Society Please note: 2019 Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Honoraria Research relationship with Government of Ontario Please note: 2019-present Added 05/14/2021 by M. Diane Lougheed, source=Web Response, value=Grant/Research Support No relevant relationships by Monica Mullin, source=Web Response No relevant relationships by Chris Parker, source=Web Response No relevant relationships by Marlo Whitehead, source=Web Response

Smoking cessation counseling and treatment: An American Dental Association Clinical Evaluators Panel survey

BackgroundGiven the oral health implications of smoking, vaping, and using smokeless tobacco products (STPs), the dental office can be an effective setting for clinicians to offer smoking cessation counseling and treatment (SCCT). MethodsA survey tool was developed to assess dentists’ approach and experience with SCCT. This survey was deployed electronically on May 21, 2021, to the American Dental Association Clinical Evaluators (ACE) Panel (N = 982), and 1 week later, nonresponders were sent reminders. Results were summarized in SAS Version 9.4. ResultsOf the 283 survey responders, one-half offered SCCT to their patients. Of those who offered SCCT, 69% would be willing to prescribe pharmacologic agents to help with cessation. Nine of 10 times, SCCT conversations included the dentist. Of the 49% of respondents who did not offer SCCT, one-quarter were current or past smokers, vapers, or STP users. Out of all of the survey respondents, 40% were aware that SCCT is part of most medical benefits. Most respondents (82%) perform surgeries on patients who smoke, vape, or use STPs. ConclusionsImplementation of SCCT in the dental office was split among ACE panelists, but when it was offered, the dentist was almost always involved. Awareness about SCCT medical benefits and surgical protocols for current smokers, vapers, and STP users differed among this sample. Practical ImplicationsDentists can benefit from more formal training and resources around SCCT and access to reimbursement for having these crucial conversations with their patients.

Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study

BackgroundRecently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool.MethodsChild healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data.ResultsThe data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service.ConclusionsAlthough healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.

Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project

ABSTRACT Smoking causes an estimated 480,000 deaths every year. At our institute, tobacco treatment services (TTS) provide inpatient counseling and hospitalists have an essential role in providing education and replacement medications at discharge. Our project focused on increasing knowledge among hospitalists to improve the frequency of smoking cessation consultation and utilization of pharmacotherapy, accompanied by appropriate documentation and billing. We used baseline data from March 2018 to February 2019. Educational intervention was implemented from March 2019 to June 2019. Post-intervention results are reported from July 2019 to February 2020. Pre- and post-intervention periods’ results were compared. A significantly higher number of patients received TTS counseling during the post-intervention phase compared to pre-intervention (54 vs. 41%, p < 0.0001). A significantly higher number of patients were prescribed inpatient medications (42% to 48%, p = 0.004) and at the time of discharge (22% to 31%, p < 0.0001). However, there was a significant decrease in physician billing from pre-intervention to post-intervention, dropping from 19.5% to 16.2% (p = 0.012). Physicians’ gender, experience level, and loss of incentives impacted their consultation and billing behaviors. Future studies should continue to address the importance of TTS and physician behavior on increasing inpatient smoking cessation counseling and treatment.

Effects of brief smoking cessation counseling at one-stop nursing service center

Effects of brief smoking cessation counseling at one-stop nursing service center

Understanding health disparities affecting utilization of tobacco treatment in low-income patients in an urban health center in Southern California

Tobacco use disproportionately affects low-income communities. Prevalence among patients in Federally Qualified Health Centers (FQHCs) is higher (29.3%) than the general population (20%). Little is known about the rates of referrals to cessation services and cessation pharmacotherapy practices in FQHCs. This study will examine referral and prescribing patterns based on patient characteristics at a large FQHC in Southern California. We conducted a retrospective analysis of EHR data from 2019. Patients who were ≥ 18 years old and had “tobacco use” as an active problem were included in analyses. We characterized the proportion of 1) those who were referred to California Smokers’ Helpline (CSH), 2) referred to smoking cessation counseling (SCC) at the FQHC clinic, or 3) received pharmacotherapy. Associations of demographic characteristics and comorbidities with referral types and uptake of services were evaluated using mixed-effects multinomial and logistic regressions. Of the 20,119 tobacco users identified, 87% had some cessation intervention: 66% were advised to quit and given information to contact CSH, while 21% were referred to SCC. Patients were least likely to get referred to cessation services if they had more medical, psychiatric, or substance use comorbidities, were in the lowest income group, were uninsured or were Hispanic. Although EHR systems have enhanced the ease of screening, most patients do not receive more than brief advice to quit during a PCP visit. Most (70%) low-income smokers see their PCPs at least once a year, making FQHCs excellent settings to promote smoking cessation initiatives in low-income populations.

Decrease in Cardiovascular Disease Risk Due to a National Initiative to Improve Preventive Services in Small Primary Care Practices

Research ObjectiveCardiovascular disease (CVD) such as heart failure and stroke has been the top cause of death for over 90 years. The beneficial effects of four simple treatment options ‐‐ aspirin prescription, blood pressure control, cholesterol management and smoking screening and cessation counseling (ABCS) ‐‐ in reducing mortality are well established. Yet, delivering the ABCS at optimal levels continues to be challenging for primary care practices, where the majority of patients receive care. In 2015, the Agency for Healthcare Research and Quality (AHRQ) launched EvidenceNOW: Advancing Heart Health in Primary Care, a national, 110 million dollar initiative focused on providing external support interventions (e.g., practice facilitation or health information technology support) to 1500 small‐to‐medium sized primary care practices with over eight million patients. The research objective of this study was to estimate EvidenceNOW‐related reductions in the risk of experiencing an adverse CVD event.Study DesignStudy Design: We developed a new methodology to calculate CVD risk using (i) ABCS levels of EvidenceNOW practices; (ii) patient‐level information from the National Health and Nutrition Examination Survey (NHANES); and (iii) information about CVD risk over a 10‐year period developed by the American College of Cardiology and the American Heart Association. We estimated 10‐year CVD risk at baseline, just before EvidenceNOW started, and reductions to risk due to EvidenceNOW‐related improvements in the ABCS.Population StudiedPrimary care practices participating in EvidenceNOW and NHANES study participants.Principal FindingsThe average 10‐year CVD risk at baseline was estimated to be 10.3 percent among patients of practices participating in the initiative. Improvements in the ABCS due to EvidenceNow reduced this risk by about 0.1 percentage points, or approximately 1.0 percent relative to baseline. Two patient populations had the biggest CVD risk reduction: those with hypertension and those with multiple comorbidities who have a high CVD risk. According to these estimates, EvidenceNOW prevented about 4000 CVD events at a cost of approximately $29,000 per event.ConclusionsEvidenceNOW successfully reduced CVD events among patients of practices participating in the initiative, although overall reductions were small. Risk reductions were stronger for high‐risk patients, such as those with multiple comorbidities.Implications for Policy or PracticePreventive care efforts to reduce cardiovascular disease in primary care practices are cost effective even for a large patient population with moderate CVD risk and therefore should be implemented more widely. Targeting specific patient population can be a valuable policy to improve the health of high‐risk populations.Primary Funding SourceAgency for Healthcare Research and Quality.

Smoking as a method of coping for medical workers

Background: This article analyzes the professional stress at healthcare professionals (HCP), related to their job. Health care providers can serve as role models in promoting healthy lifestyles; however, HCP commitment to help individuals to quit smoking may be influenced by their own smoking behavior. Material and methods: In order to determine the level of perceptual stress, the Perceived Stress Questionnaire (PSQ) was applied, PSQ developed by Levenstein et al. In order to determine the level of addiction to smoking, the Fagerstorm nicotine addiction test was applied. The research was attended by 210 subjects from 5 medical institutions: doctors, nurses, and resident doctors. Confidentiality is maintained. Results: The doctors accumulated 32% on the scale of severe dependence, 8% moderate dependence and only 9% mild dependence, after calculating the score and interpreting the data. The resident doctors have accumulated the maximum score on the scale of mild dependence, 7% moderate dependence and only 3% severe dependence, which speaks of the fact that they are the youngest category of medical workers at the beginning of their careers and still do not have good defense mechanisms. The nurses, who represent 9% of the entire group of subjects, accumulated 0% on the scale of severe dependence, 8% moderate dependence and 1% mild dependence. Conclusions: Comparative data on smoking dependence levels in doctors of 32% according to the perceived stress level 71% confirm this. Stressed health workers are more likely to smoke, have different social problems and are males. The results of research have shown that the prevalence of smokers among health care professionals is high (51%), implying the ineffectiveness of the current government anti-tobacco strategy. Introducing new pillar – Harm Reduction in National Antismoking Action Plan, along with prevention, cessation and protection from second-hand smoking, can improve current smoking situation in general. It would be helpful to implement training programs about Tobacco Harm Reduction for healthcare workers to improve their ability in smoking cessation counselling techniques to provide active support to their patients.

I smoke to cope with pain: patients' perspectives on the link between cigarette smoking and pain.

For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized areciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association. Aretrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, atailored smoking cessation trial, was conducted. Avalidated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in aconsensus-forming exercise with salient themes validated among the wider research team. Participants averaged 60years of age (range 28-77years) and were 9% female. The median number of cigarettes smoked per day was15, with amean pain intensity score in the last week (from 0-10) of 5.1. While not all patients acknowledged aconnection between pain and smoking, we found that (1)pain motivates smoking and helps manage pain-related distress, as acoping strategy and through cognitive distraction, and (2)pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as anotable barrier to cessation. Many patients with chronic pain who smoke readily identified pain as amotivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain.

Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain

IntroductionSmoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. MethodsThe Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. ResultsThe 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). ConclusionsPASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.

The association between heated tobacco product use and cigarette cessation outcomes among youth smokers: A prospective cohort study

IntroductionThe U.S. Food and Drug Administration authorized the marketing of heated tobacco products (HTPs) with modified-risk information for adults on July 7, 2020. However, the effects of HTP use on cigarette cessation among youth smokers remain unclear. This study aimed to explore the association of HTP use with cigarette abstinence and cessation outcomes among youth smokers in Hong Kong who were willing to receive telephone counseling for smoking cessation. MethodsThis prospective cohort study included youth smokers aged ≤25 years who were enrolled in the Hong Kong Youth Quitline service. From December 1, 2016, to September 30, 2019, this study identified as HTP users 106 youth cigarette smokers who reported using HTPs on at least 1 of the past 30 days at enrollment, and identified as non-HTP users 473 smokers who reported smoking at least one conventional cigarette in the past 30 days and never using HTPs. The participants received follow-ups at 1 week and 1-, 3-, and 6-months postenrollment. The primary outcome was self-reported 7-day point prevalence of cigarette abstinence (PPA) at the 6-month follow-up. Secondary outcomes included reduction in cigarette smoking (excluding quitters), the number of cessation attempts, and the level of readiness to quit. ResultsThe self-reported 7-day PPA was statistically significantly lower among HTP users than among non-HTP users after 6 months (19.0% vs. 34.2%; p = 0.009), with an adjusted relative risk of 0.47 (95% confidence interval: 0.24–0.91; p = 0.03). The study identified no significant differences in secondary outcomes between the two groups. ConclusionsYouth HTP users were less likely to abstain from tobacco use than their non-HTP-using counterparts. These results suggest that HTPs should not be promoted as smoking cessation or reduction aids among the youth population.

Use of Geographic Information System Technology to Evaluate Health Disparities in Smoking Cessation Class Accessibility for Patients in Louisiana Public Hospitals.

Research has shown cigarette smoking is a major risk factors for many type of cancer or cancer prognosis. Tobacco related health disparities were addressed continually in cancer screening, diagnosis, treatment, prevention and control. The present study evaluated the health disparities in attendance of smoking cessation counseling classes for 4,826 patients scheduled to attend between 2005 and 2007. Of 3,781 (78.4%) patients with records to calculate the distance from their home domicile to counseling sites using Geographic Information System technology, 1,435 (38%) of smokers who attended counseling had shorter travel distances to counseling sites (11.6 miles, SD = 11.29) compared to non-attendees (13.4 miles, SD = 16.72). When the travel distance was >20 miles, the estimated odds of attending decreased with greater travel distance. Smokers who actually attended were more likely to be older, female, White, living in urban areas, and receiving free healthcare. After controlling for other socio-demographic factors, shorter distances were associated with greater class attendance, and individuals more likely to attend included those that lived closer to the counseling site and in urban settings, were female, White, commercially insured, and older than their counterparts. These findings have the potential to provide important insights for reducing health disparities for cancer prevention and control, and to improve shared decision making between providers and smokers.

Maintenance of smoking cessation in Korean single mothers

BackgroundSingle mothers in South Korea are vulnerable to developing smoking habits, due to many difficulties and limitations; however, they have often been overlooked by smoking cessation support services. Therefore, this study aimed to investigate the general and smoking-related characteristics of single mothers registered with the Visiting a Smoking Cessation Service in Seoul, South Korea, to identify factors associated with smoking cessation maintenance at 4 weeks and 24 weeks after they initially quit smoking.MethodsThe participants were 77 single mothers registered in the Smoking Cessation Service Program. Data were included from a three-year span (January 2017–December 2019). Smoking cessation counseling, motivational enhancement, and self-exploration counseling were provided for six months. The participants were evaluated on their smoking cessation status at 4 weeks and 24 weeks.ResultsMost participants were aged 22 years or younger. The rates of smoking cessation maintenance were 58.4 and 18% at 4 weeks and 24 weeks, respectively. The higher the number of counseling sessions, the higher the participants’ chances of maintaining smoking in all non-smoking periods, and whether pregnancy, CO level, and drinking were significant only in a short-term non-smoking period (4 weeks).ConclusionsOur results suggest that the number of smoking cessation counseling sessions is important for long-term smoking cessation beyond short-term cessation in single mothers. To increase the smoking cessation rate of single mothers, it is important to conduct customized smoking cessation counseling at the time of smoking cessation and continue such counseling in the long term.

A systematic review of group therapy programs for smoking cessation in Asian countries.

INTRODUCTIONTobacco causes more than 8 million deaths each year. Behavioral interventions such as group therapy, which provides counselling for smoking cessation, can be delivered in group form and smokers who receive cessation counselling are more likely to quit smoking compared to no assistance. We review the evidence of group-based counselling for smoking cessation for smokers in Asian countries.METHODSThe review aims to determine the availability of group-based therapy for smoking cessation in Asian countries. The outcome measured was abstinence from smoking following group therapy. Electronic database searches in PubMed, OVID Medline, SCOPUS, Google Scholar, and PsycINFO, using keywords such as: ‘smoking’, ‘cigarette’, ‘tobacco’, ‘nicotine’, ‘group therapy’ and ‘cessation’ (smok*, *cigarette*, tobacco, nicotine, group therap*, cessation) were used. The results were reported following PRISMA and PROSPERO guidelines. Review Manager was used for data analysis.RESULTSA total of 21251 records were retrieved for screening the abstracts. In all, 300 articles for review were identified and assessed for eligibility. Nine articles, including Cochrane reviews, randomized control trials, cohort, observational and cross-sectional studies, were included in the final review. There were three observational qualitative studies, two prospective cohort studies, two crosssectional studies, one non-randomized quasi-experimental study and a single cluster-randomized, controlled trial. Group therapy was found to significantly increase the abstinence rate. Group therapy provided at the workplace, smoking cessation services, availability of pharmacotherapy, and socioeconomic status, appear to be key factors determining success.CONCLUSIONSEvidence of the use of group therapy for smoking cessation in Asian countries is still lacking despite publications in the Western population showed that group therapy was effective. Further research on group-based interventions for smoking cessation in Asian countries is required and direct one-to-one comparisons between group therapy and individual therapy for smokers who want to quit smoking, are needed.

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

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

Development of a prenatal smoking cessation counseling scale for public health nurses in Japan.

INTRODUCTIONThis study aimed to develop a scale to measure prenatal smoking cessation counseling for Japanese public health nurses (PHNs).METHODSA cross-sectional study was conducted via an anonymous, self-administered questionnaire. The sample included 1933 PHNs working in 424 municipal health centers nationwide, which were randomly selected. We created the draft scale based on semi-structured interviews, previous studies, and preliminary survey. Additionally, we conducted back translation for English version of the draft scale to be applicable in English countries. The analytic strategy consisted of item analysis, exploratory factor analysis, and differentiation by ‘known groups’.RESULTSA total of 550 responses (28.5%) were included in the analysis. Most of the respondents were female (98.2%) and the mean age was 37.5±9.37 years. In the exploratory factor analysis, two factors were extracted and the factor loadings for all items were greater than 0.40. The first factor with eleven items was named as ‘basic counseling’ and the second factor with seven items was named as ‘advanced counseling’. The Cronbach’s alpha of the scale was 0.918, and the cumulative contribution was 44.908%. Multiple comparisons by experience years working as a PHN revealed significant differences in the scale and two factors.CONCLUSIONSIn this study, we initially developed the prenatal smoking cessation counseling scale for Japanese PHNs, and the reliability and validity of the scale were considered to be acceptable.

Transitioning a cardiovascular health and rehabilitation programme to a virtual platform during covid 19

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Our Hearts Our Minds Purpose Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme. Background The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme Methods Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided) Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs Bimonthly virtual coaching consultation for monitoring/goal resetting Bimonthly group video education sessions Results From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below. The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face. Conclusion Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service. Table 1 below exhibits the clinical and patient-reported outcomes.

\u201cAt least someone thinks I\u2019m doing well\u201d: a real-world evaluation of the quit-smoking app StopCoach for lower socio-economic status smokers

BackgroundSmoking is more prevalent and persistent among lower socio-economic status (SES) compared with higher-SES groups, and contributes greatly to SES-based health inequities. Few interventions exist that effectively help lower-SES smokers quit. This study evaluated “De StopCoach”, a mobile phone delivered eHealth intervention targeted at lower-SES smokers based on the evidence-based StopAdvisor, in a real-world setting (five municipalities) in The Netherlands in 2019–2020.MethodWe conducted individual semi-structured interviews with project leaders, healthcare professionals, and participating smokers (N = 22), and examined log data from the app (N = 235). For practical reasons, SES of app users was not measured. Qualitative data were analysed using the Framework Approach, with the Consolidated Framework for Implementation Research (CFIR) and Unified Theory of Acceptance and Use of Technology (UTAUT) as theoretical models.ResultsQualitative data showed that factors from the Intervention and Setting domains were most important for the implementation. StopCoach seemed suitable for lower-SES smokers in terms of performance and effort expectancy, especially when integrated with regular smoking cessation counseling (SCC). Key barriers to implementation of the app were limited integration of the app in SCC programs in practice, difficulty experienced by project leaders and healthcare professionals to engage the local community, and barriers to SCC more generally (e.g., perceived resistance to quitting in patients) that prevented healthcare professionals from offering the app to smokers. Quantitative data showed that 48% of app users continued using the app after the preparation phase and pre-quit day, and that 33% of app users had attempted to quit. Both app adherence and quit attempts were more likely if smokers also received SCC from a professional coach. Posthoc analyses suggest that adherence is related to higher likelihood of a quit attempt among participants with and without a professional coach.ConclusionsSmokers, healthcare professionals and project leaders indicated in the interviews that the StopCoach app would work best when combined with SCC. It also appears from app log that app adherence and quit attempts by app users can be facilitated by combining the app with face-to-face SCC. As such, blended care appears promising for helping individual smokers quit, as it combines the best of regular SCC and eHealth. Further research on blended care for lower-SES smokers is needed.

Quality Care in Survivorship: Lessons Learned From the ASCO Quality Oncology Practice Initiative.

The ASCO Quality Oncology Practice Initiative (QOPI) project was established to evaluate the influence of guideline recommendations on routine clinical practice. QOPI provided summary data from 839 unique practices in which data were collected every six months from the Fall of 2015 to the Spring of 2019. From these data, six items were chosen based on their relationship to domains of survivorship. A zero-inflated negative binomial regression model was used to test for trends in QOPI measures adherence rates over time. The models were adjusted for the time period, region, practice-ownership, multispecialty site, fellowship program, and hospital type. Smoking cessation counseling recommended and smoking cessation counseling administered or referred both increased over time, 50%-61% (adjusted incidence rate ratios (IRR), 1.028; 95% CI, 1.016 to 1.040; P < .001) and 34%-49% (adjusted IRR, 1.052; 95% CI, 1.035 to 1.070; P < .001), respectively. Infertility risks discussed before chemotherapy increased from 36% to 53% (adjusted IRR, 1.056; 95% CI, 1.035 to 1.078; P < .001) and fertility options discussed or referred to specialists increased from 23% to 38% (adjusted IRR, 1.074; 95% CI, 1.046 to 1.102; P < .001). Twenty-nine percent documented a positron emission tomography, computed tomography, or bone scan within the first 12 months for women diagnosed with early breast cancer treated for curative intent (adjusted IRR, 1.000; 95% CI, 0.977 to 1.024; P = .971). Tumor marker surveillance within 12 months increased from 78% to 87% (adjusted IRR, 1.018; 95% CI, 1.002 to 1.033; P = .023). As scientific evidence to guide cancer survivorship care grows, the role of guideline recommendations permeating clinical practice using quality metrics will become increasingly important.